Technetium-99m sestamibi in the diagnosis of breast cancer. The Mayagüez Medical Center experience

The most successful screening procedures for breast cancer are breast physical examination and mammography. However, mammography has a positive predictive value of 15-30 for nonpalpable malignancy and of 22 for palpable carcinoma; this results in a large number of biopsies on patients with benign lesions. Furthermore, the benefit of mammography in woman with dense breast tissue (< 50 years old) has been questioned. Different studies have shown that Scintimammography with Tc-99m has a high sensitivity and specificity for detecting breast cancer (average of 85 and 89, respectively), with higher positive predictive value for palpable lesions (89). We reviewed retrospectively 35 records of patients that had Scintimammography in our institution, and the sensitivity, specificity, positive and negative predictive values were similar to other centers (100, 76, 62.5 and 100, respectively). So, Scintimammography may be a complement for current diagnostic techniques for breast malignancy in our setting

The abdominal compartment syndrome: a report of 3 cases including instance of endocrine induction

Three patients with the abdominal compartment syndrome are presented and discussed. In one of the patients the condition was induced in an endocrine fashion, since trauma was sustained exclusively by the middle third of the left leg. The development of the syndrome as a remote effect of local trauma has never been reported previously. In all three instances only insignificant amounts of intraperitoneal fluid was found and the increase in abdominal pressure was due to severe edema of the mesentery and retroperitoneum. Since the condition is highly lethal, early diagnosis is imperative, and this starts by carrying a high index of suspicion. Measurement of the intraperitoneal pressure easily confirms this diagnosis. It is emphasized that measurements at various sites, like bladder and stomach, in each patient is essential to confirm the diagnosis, since one of the sites may be rendered unreliable due to intraperitoneal processes impinging on the affected site and affecting its distensibility

A mini-invasive approach to transduodenal sphincteroplasty

A right lumbar approach to the duodenum was developed to perform transduodenal sphinctero-plasty for the treatment of retained common bile duct stones. With experience, the procedure was reduced to a mininvasive approach. Nine patients with symptomatic choledocal stones were subjected to translumbar transduodenal sphincteroplasty. Eventually it became obvious that limited dissection was equally effective in exposure of pertinent anatomical structures and ease of performance. Four patients were intervened using the mini-invasive approach. In one instance the procedure was combined with laparoscopic cholecystectomy and cholangiogram. There was no mortality or morbidity and there was universal clearance of the common bile duct

Transduodenal sphincteroplasty in the treatment of choledocholithiasis in pregnancy

Transduodenal sphincteroplasty is a safe, effective, reliable procedure in the treatment of choledocholithiasis. The fact that it can be practiced without radiographic surveillance makes it uniquely applicable during pregnancy. There are no reports applying this mode of treatment to the pregnant woman with choledocholithiasis

Proximal duodeno-jejunostomy for the safe management of the difficult duodenal stump

Seven patients with peptic ulcer disease had severe scarring of the duodenum, making its closure at the time of gastrectomy difficult. They were managed intraoperatively with proximal duodeno-jejunostomy as a means to avoid the catastrophic complication of disruption of the duodenal stump closure with its consequent peritonitis. The jejunum used for this anastomosis was an extension of the long limb of a Roux en Y which is brought up to perform the gastrojejunostomy. The end to end duodeno-jejunostomy is performed proximal to a side to side gastrojejunostomy, hence the name, proximal duodeno Jejunostomy. These seven patients had no unexpected immediate postoperative complications during the thirty days following surgery and were all discharged from the hospital well. During the same three and a half year period twenty five other patients were submitted to gastrectomy and had two duodenal stump leaks after conventional closures. One patient died and the other survived after prolonged intensive care stay. These differences were not statistically significant. These duodenojejunostomies are non-functional anastomoses and should consequently stricture, but in one patient it remained open and he developed bile reflux gastritis in spite of the Roux en Y gastrojejunostomy constructed to avoid this complication. These anastomoses should be constructed as stenotic as possible