Incidental breast carcinoma in reduction mammoplasty.

AIM: The objective of this study was to analyze the incidence and treatment options of occult cancer or atypical lesions found in the histopathological examination of reduction mammoplasty (RM) specimens. The role of preoperative mammography and systematic histopathological examination are discussed. METHODS: We performed a retrospective single-center database review of all patients who underwent a RM between January 2005 and December 2014. Preoperative examination, histopathological findings and follow-up were documented. RESULTS: A total of 1045 patients underwent RM, of which 97% were bilateral (1021). All patients received a mammography and routine clinical examination to exclude cancer preoperatively. The overall mean patient age was 40.2 years (14.2-73.4). A total of 19 patients (1.18%) had significant histopathological findings, all of whom were over 40 years of age. There were 4 incidental carcinomas (0.38%), of which 2 were DCIS (0.19%) and 2 invasive ductal carcinomas (0.19%). CONCLUSIONS: Incidence of postoperative diagnosis of occult breast cancer in RM specimens remains low, but poses significant therapeutic challenges. While emphasis should lay on preoperative diagnostics, routine histological analysis of RM specimens is recommended.

A Giant Phyllodes Tumor of the Breast.

Phyllodes tumors of the breast are rare, accounting for less than 1% of the breast tumors. They are mostly seen in women between 45 and 49 years old. These are fast growing tumors with a large spectrum of behavior (from benign to metastatic) and can resemble fibroadenomas. Correct diagnosis mostly through core needle biopsy is important to decide whether a surgical excision has to be done. Here we report a case of a 57-year-old woman with a fast growing, ulcerated tumor in the left breast. Core needle biopsy suggested a malignant phyllodes tumor with heterologous liposarcomatous differentiation. Treatment with total mastectomy and adjuvant radiotherapy followed. Primary treatment is always surgery, whether radiotherapy or chemotherapy has to follow remains uncertain. There is a high-recurrence rate, especially when the surgical margins are narrow.

Early complications after stapled hemorrhoidopexy: a retrospective study comparing three different circular staplers.

BACKGROUND: A retrospective analysis was performed to assess differences between three devices used for stapled hemorrhoidopexy (SH) in terms of early complications and complaints and the volume of excised tissue. MATERIALS AND METHODS: All patients who underwent an elective SH from January 2008 to December 2014 were included. Three different devices were used: the PPH03 stapler (Ethicon EndoSurgery, Diegem, Belgium) and the ChexTM CPH32 and CPH34 staplers (Frankenman International Ltd, Hong Kong, China). The demographic data were reviewed as well as indications for surgery. The volume of the excised tissue was determined by reviewing the anatomopathologic reports. We assessed early postoperative complications and complaints and compared the rate of complications between the three used devices. RESULTS: From 1 January 2008 to 30 December 2014, 253 patients underwent a SH using three different devices. One hundred and seventy-four patients were treated with the PPH03 stapler, 51 with the ChexTM CPH32 stapler and 28 with the ChexTM CPH34 stapler. Postoperatively, 28.5% of patients experienced minor early complications. There was no difference in complication rates between the three different devices, except for the occurrence of postoperative stenosis with more stricture formation when using the CPH32 stapler (p < 0.0001). The volume of tissue excised by the ChexTM CPH32 and CPH34 staplers was significantly larger than in the PPH03 group (18.19 ± 9.67 mL; 25.53 ± 13.99 mL; 11.63 ± 5.66 mL; p < 0.0001). CONCLUSIONS: Postoperative anal stenosis was more common after circular stapled hemorrhoidopexy with the ChexTM CPH32 stapler.

Appendiceal inflammatory myofibroblastic tumor: a rare postoperative finding.

Inflammatory myofibroblastic tumor (IMT) is a rare soft-tissue neoplasm of unknown etiology. It mimics, clinically and radiologically, malignant tumors. Histologically, this tumor is composed of differentiated myofibroblastic spindle cells accompanied by an inflammatory infiltrate, with numerous plasma cells and/or lymphocytes. Initially described in the lung, numerous extrapulmonary sites of this tumor have been found but appendiceal IMT is rare, especially in adult women. In this study, we aimed to examine the literature as well as to describe a case of a 42-year-old woman that we operated on that presented as an appendiceal mass that obstructed the lumen of the appendix and caused acute appendicitis. Upon histopathological examination, the lesion was identified as an IMT. Awareness of this type of tumor in the differential diagnosis of appendiceal masses, avoids overtreatment, and highlights the need of long-term follow-up regarding the tendency for local recurrence and small risk of distant metastasis.

What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care.

BACKGROUND: Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice. METHODS: We used a prospective before/after interventional study design. The intervention was the implementation of a GPC. RESULTS: One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836). CONCLUSIONS: One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.