Discrete Breast Masses in Female Children and Adolescents: Is there a Place for Non-operative Management by Pediatric Surgeons.

Background: The treatment of breast masses in female children and adolescents is controversial. While some advocate for early surgical removal others prefer the conservative non operative approach. The aim of this study is ascertain the evidence for the current protocol of early surgical removal in our centre. Materials and Methods: Retrospective observational study to highlight the epidemiology of discrete breast masses in female children and adolescents <18years seen at the Lagos University Teaching Hospital, Nigeria. Main outcome measure was to find out if there is a malignancy in excised tissue specimens. Results: Fifty three girls with 76 breast masses were evaluated. Median age at presentation was 16years (4 –17 years). Mean size of lumps was 3.6 cm (±2.1). All the breast masses had benign clinical characteristics and were confirmed histologically to be benign. There was no case of primary or secondary malignancy in any of the histological specimens. Family history, nipple discharge or ingestion of oral contraceptives did not affect presentation, diagnosis and outcome (p>0.05). Conclusion: This series show that breast masses in children and adolescents are almost always benign. It is advocated that conservative non-operative management (with close follow up with imaging such as breast ultrasound and/or MRI) should be adopted by paediatric surgeons in cases of breast masses in children except when surgery is specifically indicated. These indications which should be individualized include: cosmesis, bloody nipple discharge, persistent history of pain in the mass, rapid growth of the mass and malignancies with predilection for the breasts.

Gross and histologic evaluation of abdominal adhesions associated with chromic catgut and polypropylene sutured enteropexies in dog / Evaluación macroscópica e histológica de las adherencias abdominales asociadas a enteropexias suturadas con catgut crómico y polipropileno en perros

The gross and histologic patterns of abdominal adhesions formed by the use of chromic catgut and polypropylene suture materials were evaluated in dogs. Gross and histologic examinations did not reveal significant difference (p>0.05) in the degree of adhesions observed at enteropexy sites in both suture materials. The use of polypropylene with superior suture qualities should be considered instead of chromic catgut for procedures in which adhesion is desired in the dog.

Fueron evaluados los patrones macroscópicos e histológicos de las adherencias abdominales formadas por el uso de catgut crómico y materiales de sutura de polipropileno. Los exámenes macroscópicos e histológicos no revelaron diferencias significativas (p> 0,05) en el grado de adherencias observadas en los sitios de la enteropexia en ambos materiales de sutura. El uso de suturas de polipropileno con mejores cualidades debe ser considerado en lugar del catgut cromado para procedimientos en los que la adherencia en el perro es deseada.

Testicular Torsion : a Fifteen Year Review in a Nigerian Teaching Hospital

Aim and Objectives: To determine the prevalent age; presentation; duration of symptoms before intervention; and outcome of management of testicular torsion (TT) in our community. Design: A fifteen-year retrospective study. Setting: University Teaching Hospital. Materials and Method: Records of patients managed for TT; January 1992- Decem- ber 2006; were reviewed. Records of 91 out of 106 patients managed during the period were available for review. The age of patient; presentation; duration of symptoms; predisposing factors; interval between presentation and operation; and outcome of management were extracted and analyzed. Results: Ninety-one patients; mean age 20.1yrs (range 8-34) were reviewed. The average duration of symptoms at presentation was 26.7hrs (range 1.5- 168). The patients were mostly 74(81.3) students. All of them presented with scrotal pain; and 66(72.5) had scrotal swelling (Left: Right=1.8:1). Torsion was partial (180-270o) in 14(15.4); and complete (360o-1440o) in 77(84.6). Intra-scrotal anatomic abnormalities were observed in 77(84.6) patients. Testes were viable in 59(64.8) patients offered bilateral orchidopexy and gangrenous in 32(35.2) that had orchi- dectomy with contralateral orchidopexy. The average duration of hospital stay was 2.8days. Most of the patients 76(83.5) were lost to follow up within 3 weeks postoperative. Conclusion: TT occurs in patients aged 8-34yrs in our immediate community. Presentation is late and most patients 77(84.6) have predisposing congenital abnormalities. There is a need for increase awareness by the general public and the health personnel's of the danger posed by delay in treating TT. Where doubts exist; early scrotal exploration should be the investigation and intervention of choice to prevent irreversible damage to the germ cells