Laparoscopic Cholecystectomy: Evaluation of Web-Based Information.

Introduction Laparoscopic cholecystectomy (LC), the gold standard treatment for symptomatic gallstone disease, is the most common procedure performed by general surgeons worldwide. The internet remains to be a popular source of medical information. Our aim was to evaluate the quality and readability of information available on the web for patients undergoing LC and to compare the information provided by the National Health Service (NHS) and non-NHS websites.  Methods We searched for the keywords 'laparoscopic cholecystectomy' using the three most popular search engines (Google, Yahoo and MSN) and looked at the first 50 websites only. The readability of each document was assessed using the Flesch Reading Ease (FRE) score. We checked Health on the Net Foundation Code of Conduct (HONcode) certification status, whether the sites had been checked by an expert and when the information was last updated. Results Fifty-five of the possible 150 sites were analysed thus excluding repetitions (n=65), irrelevant content (n=26) or inaccessible links (n=3). Only seven of those were HONcode-certified. The mean FRE score was 46 (range 0-68, SD=16.13). There were 13 NHS sites and 42 non-NHS sites. The mean FRE score for the NHS sites was significantly better compared to the non-NHS sites [58.31 (SD=5.01) vs 42.21 (SD=16.35); p=0.001]. Fifty-four per cent (54%) of the analysed websites had been checked by a medical expert and 22% were updated within the last year. Conclusions This study highlights the poor quality and readability of information on medical websites. The information provided by NHS sites have significantly better readability compared to non-NHS sites.

Synchronous Orbital and Gastrointestinal Metastases from Breast Cancer: A Case Report and Review of Literature.

Breast cancer is the most common malignancy among women and is a significant cause of morbidity and mortality worldwide. With the advent of improved imaging techniques and screening programmes, only a small proportion of women present with metastatic disease. Metastases involving the gastrointestinal (GI) tract and orbit are rare occurrences. We describe the case of a woman with simultaneous GI and orbital metastases from breast cancer who initially presented with abdominal pain and blurred vision and also summarise a review of the literature.

Conservative management of segmental infarction of the greater omentum: a case report and review of literature.

Segmental omental infarction (SOI) is a rare cause of acute abdominal pain. Depending on the site of infarction, it mimics conditions like appendicitis, cholecystitis, and diverticulitis. Before the widespread use of Computed Tomography (CT), the diagnosis was usually made intraoperatively. SOI produces characteristic radiological appearances on CT scan; hence, correct diagnosis using this form of imaging may prevent unnecessary surgery. We present the case of a young woman who was treated conservatively after accurate radiological diagnosis.

Popliteal artery entrapment syndrome presenting with acute limb ischaemia: a case report.

Popliteal artery entrapment syndrome (PAES) is a relatively rare condition that occurs in young patients as a result of anomalous anatomic relationships between the popliteal artery and the surrounding musculotendinous structures. Patients usually lack atherogenic risk factors and most commonly present with intermittent claudication in the early stages. In the later stages of undiagnosed PAES, acute ischaemia can occur as a result of complete arterial occlusion or embolism. Hence, early diagnosis and surgical release of the entrapment is crucial for good operative outcome and to prevent limb loss.

Familial adenomatous polyposis (FAP) and gender. Does gender influence the genetic transmission of FAP?

Familial adenomatous polyposis (FAP) is an autosomal dominant syndrome with a penetrance close to 100% at the age of 40 years. The incidence is thought to be equal among both sexes, but we noticed an excess of males undergoing primary surgery for FAP at our institution. The aim of the study is to investigate the hypothesis that FAP patients produce an excess of affected male offspring. We identified all families with known APC mutation in the polyposis registry at St Mark's from its foundation until October 2009. We analysed their pedigrees with respect to gender of the affected individuals with progeny and to the gender and mutation status of their offspring. Only individuals with complete data regarding their offspring (gender and mutation status) were included. We identified 666 (324 males and 342 females) affected individuals with progeny. We analysed the progeny of 368 (182 males, 186 females) affected individuals with complete data on all offspring: 235 (27.5%) affected males, 212 (24.8%) affected females, 207 (24.3%) unaffected males and 200 (23.4%) unaffected females. The overall ratio of affected/unaffected and male/female offspring did not differ from the expected 50%. Further sub-analysis by gender of parents did not show any statistically significant difference in gender and mutation status of offspring. In addition the mean number of children per affected parent did not depend on gender (males 2.34; females 2.30). This study shows that gender does not influence the genetic transmission of FAP. The excess of males undergoing primary surgery at our institution is probably a result of referral bias.