Documentation of abdominal exploration during laparoscopic cholecystectomy.

UNLABELLED: To assess the documentation of intraperitoneal exploration and events during laparoscopic cholecystectomy, we reviewed 200 dictated operative reports from eight different institutions. The 200 laparoscopic cholecystectomies were performed by 40 different surgeons on 158 female patients and 42 male patients. A description of the gallbladder was included in 134 (67%) reports and not mentioned in 66 (33%) reports. Fifty-four (27%) reports did not mention any intraperitoneal findings away from the gallbladder. Another 36 (18%) of the reports contained only a general comment indicating that no abnormalities were seen in the abdomen (excluding the gallbladder). The other 110 (55%) reports mentioned at least one specific site or finding in the abdomen other than the gallbladder. The most commonly mentioned sites were the liver, bowel, and stomach. Only 42 (21%) operative notes described what happened to the gallbladder contents: 30 described spillage of bile and/or gallstones and 12 stated that no spillage occurred. CONCLUSIONS: Laparoscopic cholecystectomy operative notes have often lacked a description of gallbladder appearance, documentation of abdominal exploration, and/or documentation of complete removal of the gallbladder and its contents.

Male breast carcinoma: clinical experience in a suburban community.

Male breast cancer is difficult to study because it occurs infrequently, accounting for 1% of all breast carcinoma. Breast cancer occurs 10 years later in men than in women, and its presentation parallels that in women. The authors retrospectively review 13 cases of male breast cancer occurring over a 20-year period in four community hospitals. Treatment methods paralleled those used for female cancer patients. Surgery, primarily radical mastectomy, was performed in all patients. In the eight patients in whom hormone receptor assays were obtained, all tests were positive for estrogen receptors, progesterone receptors, or both. Metastases were diagnosed in five patients during follow-up. The longest disease-free survival has been 10 years. Similarities and differences regarding male and female breast cancer are discussed as are the diagnosis and management of men with this disease.