Health-related information gathering practices in breast and colorectal specialty clinics: the end of the electronic divide?

BACKGROUND: Health-related information can help patients understand their disease process and make informed decisions. We hypothesize that with the increased availability of Web-based resources, sociodemographic factors no longer impact Internet use among patients. METHODS: Study-specific surveys were administered to a convenience cohort of patients seen in the breast and colorectal specialty clinics at a single academic institution between August 2008 and February 2009. RESULTS: One hundred ninety-four surveys were returned (response rate 80%). Median age was 53 years (range 19-88) with 131 (75%) females. Twenty-six percent of patients were college graduates and 59% reported an annual income greater than $50,000. There was no association between Internet use and age, gender, income, or educational level. CONCLUSION: Web-based information is being increasingly used by patients irrespective of their demographic characteristics. These resources can therefore be used to educate patients about their disease, treatment options, and health maintenance.

Right lower quadrant pain and postpartum ovarian vein thrombosis. Uncommon but not forgotten.

INTRODUCTION: Ovarian vein thrombosis (OVT) is an uncommon, life-threatening complication of the postpartum period. Symptoms of OVT include lower abdominal and flank pain associated with fever, tachycardia, and nausea and vomiting. CASE HISTORY: We present a case of OVT in a 22-year-old woman 4 days postpartum presenting to the emergency department with right lower quadrant pain, tachycardia, and leukocytosis. The initial clinical diagnosis was of appendicitis; however, on CT scan, she had findings characteristic of right OVT. CONCLUSION: The clinical presentation of OVT can be very similar to that of acute appendicitis and should always be included in the differential diagnosis of right lower quadrant pain in the female patient. Modern imaging techniques enable confirmation of the diagnosis when OVT is suspected.

Utilization of bovine acellular dermal matrix for abdominal wall reconstruction: a retrospective case series.

Abdominal wall reconstruction using nonabsorbable synthetic material can be challenging due to the risk for bacterial colonization and subsequent complications. Bioprosthetic materials are a safe alternative that can facilitate soft tissue reconstruction, including abdominal wall repair. To assess the short-term outcomes of using a bovine acellular dermal matrix in contaminated postsurgical wounds, charts of all patients who were managed using the bovine acellular dermal matrix between November 2006 and July 2007 were reviewed. Six related procedures were performed in five patients: two men and three women, median age 61 years (range 50 to 66 years), median body mass index 35 kg/m2 (range 28 to 51 kg/m2). Patients underwent parastomal hernia repair and anterior abdominal wall reconstruction (one patient), reinforcement of colostomy site (one patient), and repair of large anterior abdominal wall defects following bowel resection (three patients). Clinical follow-up was complete on all patients until December 2008. Three of the five patients did not develop any wound-related complications during a median follow-up of 10 months (range 9 to 17 months). The two patients who developed complications (2 months and 10 days postoperatively, respectively) had a body mass index of 42 and 51, respectively, and multiple comorbidities. The authors' initial experience with bovine acellular dermal matrix for various soft tissue reconstruction suggests the product is safe when used in uninfected wounds. Further experience is required to determine the effectiveness, complication profile, and feasibility of using this bioprosthesis in clinical practice and to evaluate its use in infected wounds.

Long-term functional and quality of life outcomes of patients after repair of large perianal skin defects for Paget's and Bowen's disease.

INTRODUCTION: The assessment of long- term functional and quality of life outcomes of these patients following repair of large defects after surgical excision has not been reported. METHODS: Between 1992 and 2004, at two institutions, 18 patients underwent repair of a perianal defect for Paget's disease (n = 8) or Bowen's disease (n = 10) and were alive with intestinal continuity at last follow-up. Patients were mailed the fecal incontinence quality of life scale (FIQL) and the SF-36. RESULTS: Fourteen patients (78%) responded. Median follow-up for responders was 5 years. Mean age was 65 years with 12 females. Subcutaneous skin flaps (11) and split-thickness skin grafts (three) were used to repair the perianal defects, which were circumferential in 11 patients (79%). Nine patients reported incontinence and completed the FIQL. The FIQL scores of patients reporting incontinence were lower for lifestyle, coping/behavior, and embarrassment but not significantly different for depression compared to patients without incontinence. SF-36 scores of the patients were not significantly different from the normative population. CONCLUSION: Functional results after repair of large perianal defects are acceptable and overall quality of life (QOL) is similar to the normative population although a large proportion of patients have some form of incontinence that impacts certain aspects of their QOL.

Presacral tumors: diagnosis and management.

Presacral tumors are uncommon lesions that can be difficult to diagnose because of their nonspecific presenting signs and symptoms. Cross-sectional imaging is essential in evaluating these lesions to determine the optimal surgical approach and the extent of resection. Surgery is the mainstay of treatment as it establishes the diagnosis and prevents the adverse consequences associated with malignant degeneration and secondary bacterial infection. The outcomes for patients with benign presacral tumors are favorable. Although there have been substantial improvements in the prognosis of patients with malignant presacral tumors, the development of newer adjuvant therapies are likely to further improve the oncologic outcomes of malignant presacral tumors such as chordomas and sarcomas.

Malignancies of the anal margin and perianal skin.

Malignancies of the anal margin and perianal skin are relatively uncommon lesions, comprising 3 to 4% of all anorectal malignancies. Commonly included in this group of cancers are Bowen's disease (intraepithelial squamous cell cancer), perianal Paget's disease (intraepithelial adenocarcinoma), invasive squamous cell cancer, basal cell cancer, and malignant melanoma. Buschke-Lowenstein tumor, or giant condyloma acuminatum, is not always included because this lesion is technically benign, although it displays aggressive local invasive behavior that makes it difficult to manage. Complaints are usually nonspecific, such as itching or burning, bleeding, pain, drainage, or a mass. Proper diagnosis requires a high index of suspicion on the part of the surgeon. Innocent local irritations will resolve in a short time with appropriate therapy; those that persist must be biopsied for tissue diagnosis. Wide local excision is the mainstay of treatment for early stage tumors as it preserves continence and obtains adequate local control. Adjunct therapies have been utilized in more advanced or recurrent lesions, including radiotherapy, photodynamic therapy, and imiquimod. All have met with a fair amount of success in controlling local disease; however, the number of patients treated in each instance is small, making it difficult to design an evidence-based treatment strategy. Invasion and metastasis are relatively rare in this group of neoplasms; perianal Paget's disease has the highest risk of associated underlying neoplasm. The most important consideration in developing a treatment strategy is which strategy would achieve the best clinical result with the least morbidity to the patient.