Woman feels breast lump--surgeon cannot: the role of ultrasound in arbitration.

The role of ultrasound scanning (USS) in patients complaining of a breast lump where the clinical examination (CE) is normal is not clearly defined. To determine this in greater detail, all patients complaining of a breast lump underwent CE. Where no lump could be found, but was still reported by the patient, an USS was performed. All lesions underwent biopsy and/or aspiration, as well as mammography in suspicious cases or those over 40 years of age. This cohort represented 5% of all referrals in the study period. Four hundred and twenty women were prospectively studied in this way. Median follow up is 3.4 years (range 2.5-4.2 years). Twenty two had solid lumps (of which 3 were cancers) and 48 had cysts. Nineteen patients re-presented with symptoms in the same breast (median time = 12 months (range 4.5-20 months), all of which were imaged on USS: 15 cysts and 4 further cancers (3 in the same quadrant as the original lump, one contralateral) were identified. Women with symptomatic breast lumps and a normal CE can be considered a reliable indication that cancer is very unlikely to be present (negative predictive value = 0.98). Ultrasound may be a suitable complimentary investigation, which will relieve symptoms in those with cysts and can detect small clinically--and sometimes mammographically--occult breast cancers.

Laparoscopic surgery in the elderly patient.

BACKGROUND: Elderly patients represent a unique surgical challenge because of the associated complex comorbidity and diminished cardiopulmonary reserve. Therefore, minimally invasive surgery in the elderly may have a larger impact compared to the younger population. The aim of this study was to prospectively evaluate the experience of laparoscopic surgery in patients >or=70 years of age in our unit. METHODS: Two hundred and thirty-two patients (34 females and 98 males) older than 70 years who underwent various elective and emergency laparoscopic procedures between 1992 and 1997 were assessed prospectively. Preoperative comorbidity, operative results, and postoperative outcomes were analyzed. RESULTS: The median age of the patients was 76 years. The majority of patients were ASA class II. The mean hospital stay was 3.4 days. The overall morbidity and mortality rates were 10.8% and 3.4% respectively, and the conversion rate was 4.3%. CONCLUSIONS: Our experience suggests that laparoscopic surgery in the elderly is safe, is associated with short hospital stay, and produces less morbidity and mortality. Therefore, it should be adopted widely if the expertise in the area of laparoscopic surgery is available for this group of patients.

Harina de Cassia aphylla. Estudio de la composicion quimica y calidad biologica de la proteina. / Cassia aphylla flour.Study of the chemical composition and biological quality of the protein

El presente estudio se realizo con el objeto de establecer las caracteristicas quimicas y biologicas de la harina de Cassia aphylla. El estudio quimico porcentual evidencio un buen contenido proteinico, asi como de calcio, fosforo, hierro, acido ascorbico, niacina y tiamina. La determinacion de aminoacidos demostro que la harina en estudio es una fuente muy buena de lisina y aminoacidos azufrados.La utilizacion proteinica neta (NPU) encontrada fue de 54.70 mas o menos 2.45, la digestibilidade, de 71.00 mas o menos 0.3 y el valor biologico, de 77.00. La razon de eficiencia proteinica (PER) fue de 1.74 corregida con respecto a la caseina. Para determinar su inocuidad se realizaron ensayos toxicologicos en ratas durante un periodo de 30 dias.Los analisis hematologicos, peso de organos, composicion del higado y rinon, no mostraron dano patologico en las condiciones en que se realizo el ensayo. A partir de estos resultados, es posible concluir que el producto estudiado es un buen recurso para la alimentacion animal