Granular cell tumour of the male breast.

Granular cell tumour (GCT) is a rare neoplasm that can be found in multiple sites throughout the body. Occasionally GCT is located in the breast. In general, it appears as a singular benign lesion, although it can be multi-focal and rare cases with malignant behaviour have been reported. We report a rare case of granular cell tumour of the nipple in the male breast, treated by wide local excision.

Liposarcoma of the spermatic cord: report of 2 cases.

These case reports describe the rare condition of liposarcoma of the funiculus spermaticus. It is treated by radical surgical resection. The diagnosis is usually made postoperatively. The role of adjuvant radio- or chemotherapy is uncertain.

Cat and dog bites. What to do? Guidelines for the treatment of cat and dog bites in humans.

INTRODUCTION: Domestic animal bites are quite common, but mostly cause minor lesions, for which no medical help is sought. The objective of this study is to define the complications resulting from cat and dog bites that lead to hospital admission. This analysis led to updated guidelines for the treatment of dog and cat bites in humans. PATIENTS AND METHODS: The emergency department (ED) data of our hospital for the year 2004 were retrospectively analysed, seeking patients that presented with bite wounds from either cat or dog. The patient files were reviewed. RESULTS: 34 patients, bitten by cats or dogs, presented to our ED in 2004. 73.5% of them (n = 25) consulted within 24 hours after the bite. In 11 of these patients (44.0%), primary closure of the wound was performed after thorough rinsing and evaluation of the dead space. All these patients were given prophylactic antibiotics. In none of these did the wounds need to be reopened afterwards. Nine patients (26.5%) did not present to the ED until after the day they were bitten. In all these patients, the bite wounds were located on the hand (n = 6) or forearm (n = 3). They all consulted because of complications. The main symptoms were limited and there was painful mobilisation of fingers and wrist, and swelling and redness in the area of the bite wound. Their wounds were thoroughly explored and in 6 of these nine late-presenting patients, a tendon lesion or a purulent flexor tenosynovitis was diagnosed. These six patients needed admission for further management. The mean admission duration was 6 days (range 4 to 10 days). None of the admitted patients showed any signs of limited mobility or disability during follow-up after discharge. CONCLUSION: While cat and dog bites often cause minor lesions that can be treated by thorough wound care if presented early, the importance of possible late complications should not be overlooked. Patients that present with the symptoms of tissue infection due to a cat or dog bite should be examined adequately and may need admission. Due to aggressive treatment, we had no serious or disabling complications in our population after discharge.

Initial staging of malignant melanoma by positron emission tomography and sentinel node biopsy.

UNLABELLED: By a retrospective study and literature review we aimed to evaluate the accuracy of Sentinel Node Biopsy (SNB) and F-18-fluorodeoxyglucose positron emission tomography (PET) for early detection of lymph node metastases. MATERIAL AND METHODS: Every patient presenting with a malignant melanoma without clinical lymph node involvement and a Breslow index over 1 mm or a recurrence was subjected to a preoperative PET scan and a sentinel node biopsy. Over a period of 10 months, 5 patients were included. They were submitted to conventional staging techniques, PET and SNB. RESULTS: In none of the patients the PET scan showed signs of lymph node involvement or distant metastases. However, two patients, both with a Breslow index of 1.4, had micrometastases in the sentinel node. CONCLUSION: Already in this small group of patients, PET scanning missed two metastases (40%). This is confirmed by several recent publications, stating that the resolution of positron emission tomography is about 5 mm and thus insufficient to detect micrometastases. Several larger series showed a sensitivity of PET to detect lymph node involvement of 15-50%. Therefore we conclude that PET is of limited use in these patients without palpable lymph nodes. Sentinel node biopsy however proves to be a useful tool and should be considered in the initial staging of malignant melanoma without palpable lymph node or distant metastases.

Umbilical discharge: a review of 22 cases.

Umbilical discharge is a symptom of a varied pathology. We analysed the files of 22 patients with umbilical discharge operated on in our hospital over a period of 23 years. In 13 patients the umbilical discharge was accompanied by an acute umbilical inflammation. In 10 patients the symptoms were caused by embryonic anomalies and in 12 patients by an acquired pathology. We propose a surgical technique that can be applied regardless of the pathology, and that does not involve a pre-operative assessment of the causes.