Cancer screening for the primary care physician.

Cancer screening guidelines are developed by numerous agencies. These guidelines are often conflicting leaving the primary care physician in a difficult position. He (she) is requested to choose the best test for his or her patients taking into consideration the principles of screening, the test cost and most importantly the patient's emotional and physical well-being. Screening for some cancers, like lung cancer, has been considered of no benefit. Other cancers, like breast, colon, cervix and prostate, have been the subject of numerous recommendations: For breast cancer, clinical examination and mammography are recommended every 1-2 years for women between 50 to 70 years. For cervical cancer, PAP smear is suggested every 1-3 years and for colorectal cancer, a yearly fecal occult blood, sigmoidoscopy or colonoscopy every 5-10 years. Annual serum prostate specific antigen (PSA) and digital rectal examination screening for prostate cancer are still controversial.

Succinylcholine-induced rhabdomyolysis in a healthy child.

A case of Rhabdomyolysis occurred in a healthy boy 9 years of age after general anaesthesia. Succinylcholine, nitrous oxide and isoflurane were used for induction and maintenance of anaesthesia. Patient developed severe muscle pain, myoglobinuria, haemoglobinuria. Also creatinine phosphokinase was elevated up to 10,694 IU/L. Management was prompt and he was discharged home the third day in good condition. The injection of succinycholine may have precipitated rhabdomyolysis. This is a rare complication of succinylcholine without the disastrous outcome of renal failure, hyperkalaemia or cardiac arrest.

Unusual manifestation of an ampullary tumor presenting with severe upper gastrointestinal bleeding.

Ampullary tumors can occasionally ulcerate and present as frank gastrointestinal bleeding. The most common clinical presentation is jaundice like in other tumors of the biliary tree. We report on a 68-year-old man who presented with severe upper gastrointestinal hemorrhage secondary to an asymptomatic mass of the ampulla of Vater. An endoscopic biopsy specimen revealed a villous adenoma with moderate dysplasia. A curative resection was performed, and pathological work-up revealed the presence of an infiltrating, moderately differentiated ampullary adenocarcinoma.

Laparoscopic cholecystectomy and the umbilicus.

BACKGROUND: Pre-existing umbilical defects may present technical problems in patients having laparoscopic surgery. Fascial defects may also occur after operation. Understanding the causes and mechanisms of herniation at laparoscopic port sites may help avoid potentially serious postoperative complications. METHODS: The incidence, management and potential complications of pre-existing and postoperative umbilical defects were studied in 870 patients undergoing laparoscopic cholecystectomy. RESULTS: The incidence of umbilical or paraumbilical defects was 12 per cent. The hernias were symptomatic in only 16.3 per cent; the majority of patients were unaware of the defect. The umbilical port was established through, or directly adjacent to, the defect, allowing simple anatomical repair in 90 per cent, using absorbable sutures. The recurrence rate was 3.8 per cent; recurrence was usually caused by wound extension or infection. Incisional hernia occurred in 16 patients after cholecystectomy (1.8 per cent). Only one hernia developed at a port site other than the umbilicus. Risk factors associated with incisional hernia were wound extension in 12 patients, male sex in six, wound infection in five, diabetes in four, pre-existing umbilical hernia in four and acute cholecystitis in three. CONCLUSION: The significant incidence of umbilical defects in patients undergoing laparoscopic surgery calls for accurate diagnosis and good technique. The incidence of incisional hernia might be reduced by avoiding unnecessary wound extension and the use of non-absorbable sutures for defects larger than 2 cm and in men with umbilical hernia.

Mondor's disease. A forgotten cause of anterior chest pain.

A 50-year-old woman sought a rheumatological consultation for anterior chest pain of three weeks duration. The diagnosis of superficial phlebitis of the anterior chest wall (Mondor's disease) was made. This was confirmed thereafter by the pathological report. She was treated with a non-steroidal anti-inflammatory drug Oxyphenylbutazone (Tanderil) and made a prompt recovery.