Squamous Cell Carcinoma Arising within Verruca Vulgaris on the Nipple.

Cutaneous squamous cell carcinoma (SCC) is a common form of skin cancer and often appears as a hard, scaly lump that occasionally ulcerates. It is usually associated with cumulative exposure to ultraviolet light, although prior scarring, chronic wounds, exposure to radiation, HPV infection, and immunosuppression are also associated risk factors. Primary SCC of the nipple is very rare and only a few cases have been reported. We present a case of a 49-year-old female with concerns of a right nipple lesion with erythema and pain. She was initially evaluated for Paget's disease with an underlying malignancy and cellulitis, but, after biopsy and investigation, she was found to have a well-differentiated SCC arising from a verruca vulgaris. Current literature does not provide distinct guidelines on management of SCC or its variants on the nipple, and the case was managed based off of SCC at other cutaneous sites as well as other cases of SCC on the nipple.

A retrospective study of nosocomial pneumonia in postoperative patients shows a higher mortality rate in patients receiving nasogastric tube feeding.

Pneumonia remains a significant cause of morbidity and mortality in surgical patients. Though most studies have focused on pneumonia in trauma or special respiratory intensive care units (ICU), we examine postoperative ventilator-associated pneumonia in patients undergoing elective operations. We hypothesized that a study of multiple clinical variables would disclose factors influencing morbidity and mortality in these patients. We conducted a retrospective review of 1969 patients who underwent elective general, cardiac, and general thoracic procedures during a 6-month period in a private teaching hospital. A total of 77 patients (3.9%) developed postoperative ventilator-associated pneumonia. Thirty-eight (49%) patients had a history of smoking and 27 (35%) had chronic obstructive pulmonary disease (COPD). Among these 77 patients, 20 (26%) experienced recurrent pneumonia. The overall mortality rate for patients developing pneumonia was 34 per cent. At diagnosis of pneumonia, 33 patients were receiving enteral nutrition through nasogastric feeding tubes, whereas 41 received no enteral feeding. The method of nutritional intake was not known in 3 patients. The feeding/nonfeeding groups were similar in age and underlying disease, differing significantly only in the higher number of smokers in the patients not receiving enteral nutrition (P = 0.03). To our surprise, the mortality rate from all causes was higher (P = 0.018) in the patients who received tube feedings through soft, nasogastric feedings (33%) than in those not enterally fed (17%). Parenteral nutrition, COPD, number of ventilator days, and the location of the tip of the feeding tube did not correlate with mortality. The mortality rate from all causes was higher in patients with postoperative pneumonia who received tube feedings, despite similar underlying medical illnesses. Enteral feeding of postoperative surgical patients has many desirable effects, but prospective studies should address harmful effects, such as presumed aspiration and related pneumonia.

A U.S. Army Forward Surgical Team's experience in Operation Iraqi Freedom.

BACKGROUND: The Forward Army Surgical Team (FST) was designed to provide surgical capability far forward on the battlefield to stabilize and resuscitate those soldiers with life and limb threatening injuries. Operation Iraqi Freedom represents the largest military operation in which the FST concept of health care delivery has been employed. The purpose of our review is to describe the experience of the 555FST during the assault phase of Operation Iraqi Freedom. METHODS: During the 23 days beginning 21 March 2003, data on all patients seen by the 555 FST were recorded. These data included combatant status, injuries according to anatomic location, and operative procedures performed. RESULTS: During the twenty-three day period, the 555 FST evaluated 154 patients. There were 52 EPWs, 79 U.S. soldiers, and 23 Iraqi civilians treated. Injuries to the lower extremity and chest (48% and 25%) were the most common in the EPW group. Upper extremity and lower extremity injuries were the most common in the civilian (57% and 39%) and U.S. soldier groups (32% and 30%). The number of injured regions per patient were 1.14 for U.S. soldiers, 1.33 for EPWs, and 1.52 for Iraqi civilians (p < 0.003). EPWs had proportionately more thoracic and abdominal injuries than the other groups (p < 0.05). CONCLUSIONS: Majority of the life threatening injuries evaluated involved EPWs. A combination of body armor and armored vehicles used by U.S. soldiers limited the number of torso injuries presenting to the FST. Early resuscitation and stabilization of U.S. soldiers, EPWs, and civilians can be successfully accomplished at the front lines by FSTs. Further modification of the FST's equipment will be needed to improve its ability in providing far forward surgical care.