Is The Breast Tumour Dangerous?

Every so often I am being asked the question whether its necessary to remove a small benign lump from breasts of young female patients.

This is compounded by a very common advice by many doctors that a small benign lumps in low risk patients may not  be removed.

Benign breasts lumps and cysts are very common among female patients young and old.

For patients above 35 years of age, any lump in the breast should be examined by Surgeons, then fully investigated with Ultrasound and Mammogram/Mammography.Then, the surgeon would decide whether to perform a Needle Biopsy or a Operative Biopsy depending in the Imagings findings.

Benign images suggest a benign tumour regardless of size( pics above), and the surgeon will decide on direct Surgical Excision of the whole tumour.

Pic 1 : A large breast tumour of 20 years duration in an old lady

Pic 2 : Mammogram  picture of large benign breast tumour

Pic 3 : a large benign breast tumour removed at surgery preserving the breast

When A Vogue Started By A Celebrity Confuse The Public......

Surgeons Say Many Women Opt For Unnecessary Double Mastectomies, Following Angelina Jolie’s Example

By Sarah Rae Fruchtnicht, Tue, September 17, 2013

Breast cancer doctors and surgeons are seeing an increase in the number of women requesting unnecessary double mastectomies after Angelina Jolie announced her surgery earlier this year.

Read more..

Complicated Soft Tissues Skin Infections In Diabetics

Infections of any kind is very common in diabetics especially those whose blood sugar level is poorly controlled.

Diabetics with varying severity and locations of infections commonly present to General Surgeons for treatment.

Carbuncle is a common but complex soft tissue infections that require emergency surgery.

The series of pictures above demonstrate a typical carbuncle management;

Pic1 ; preoperative appearance of carbuncle over patients back

Pic 2 ; carbuncle removed using cautery in operation theatre under general anaesthesia

Pic 3 ; Hydrogen Peroxide is a typical cleansing Agent frequently used at operation

Pic 4 ; The appearance of the wound after 2 weeks of daily dressing

Most patients will have to undergo daily dressings for weeks to even months until the wound heals by tissue growth and contraction.

Don't Be Scared If Your Surgeon Is Wearing Google Glass In The Operating Room

For most people, Google Glass still seems like little more than a gimmick. But in health care, doctors are already finding uses for the technology that could one day save your life.

Five years down the line, don't be surprised if surgeons are wearing Google Glass in the operating room. In fact, some surgeons--in San Francisco, naturally--are early adopters of the technology already. At Rock Health's recent Health Innovation Summit, Dr. Pierre Theodore, a cardiothoracic surgeon at UCSF Medical Center, described his experience wearing Google Glass while performing surgery, using the glasses to compare the patient's CAT scan images with what he was seeing in front of him.

http://www.fastcoexist.com/3015669/dont-be-scared-if-your-surgeon-is-wearing-google-glass-in-the-operating-room

Recurrent Sebaceous Skin Cyst Following Incomplete Surgery

Sebaceous cysts or sometimes described by pathologists as Epidermal Inclusion Cysts are common skin problems that general surgeons have to deal with everyday.

Most Sebaceous Cysts are small and asymptomatic.

When Sebaceous Cysts cause Pain due to the sheer size or infection,then the treatment is surgical removal/excision.

During Surgical removal,the surgeons have to completely remove the cyst including the capsule that contain the greasy content which is called Sebum.When sebum is infected than there will be pus/abscess admixed with the sebum.

The complete removal of the capsule is highly important,since leaving part or the whole capsule will give rise to recurrence in Sebaceous Cyst underneath the previous scars(as seen in the three pictures above).

Thyroidectomy To Treat Goitres

Thyroid diseases are common medical conditions that require surgical treatment.

Not all thyroid diseases need surgery.

In general, thyroid diseases are categorized into 2 forms;

1.Structural diseases-Nodular diseases-Goitre

2.Functional diseases-Hyper or hypothyroidism

3.Hybrid conditions-combinations of both diseases

In general,structural diseases are treated by surgery and functional diseases are treated medically.For some functional diseases that fail medical treatment,surgery may be necessary.

2 forms of surgery commonly done are;

1.Lobectomy or Hemithyroidectomy or Partial Thyroidectomy

2.Total Thyroidectomy

Benign partial goitre is treated by Lobectomy

Malignant goitre or total goiter are treated Total Thyroidectomy

A common generalized/total goiter is often called Multinodular Goitre large enough causing compressive symptoms mandating Total Thyroidectomy(pic. above)

Intestinal Obstruction due to Small Bowel Intussusception

One of the commonest operation that a busy practising General Surgeon does as emergency is a Laparotomy for Intestinal Obstruction.

The commonest causes of Intestinal Obstruction are Bowel Cancer,Adhesion from previous surger and Hernia.

There are rarer causes that are seldom seen by surgeons.One of them is the Intussusception of small bowel segment initiated by a polyp or a diverticulum.

A segment of bowel is "telescoped" into the adjacent segment of the more distal colon.

This process will cause blockage of the bowel lumen and hence Intestinal Obstruction.

Due to the sudden occurrence and complete obstruction of this condition,patient will present with the following symptoms;

1.very severe colicky(twisting) abdominal pain,often not relieved by the usual painkillers despite very high doses

2.persistent severe vomiting despite anti-vomiting medications

3.dehydration

Clinical examination may be unremarkable.

Abdominal X-ray confirms the diagnosis of Acute Intestinal obstruction.

The severe symptoms mandate Emergency Surgery.

At Exploratory Laparotomy,the Intussusception is discovered (see pic. above) and manually reduced.

If the bowels are still viable and there are no polyps or diverticulum,the bowels are left alone.But if the bowels are dead or there are polyps or diverticulum deemed to be the initiator of the Intusssusception,then the relevant segment of bowels will be resected.

Colonic Diverticulosis confused With Bowel Cancer Resolved byColonoscopy

Colonoscopy is frequently done in elderlies with complaints of abdominal pain, constipation, alteration in bowel habits and bleeding in stool essentially to rule out Colonic Cancer.

Quite often, there is no cancer but there is Colonic Diverticulosis.

Diverticulum is basically an outpouching of the weakened intestinal wall.Looking from the outside of the intestine such As during surgery, the Diverticulum will appear like an outpouching or lump on the surface.But looking from the inside surface of the bowel at colonoscopy,the Diverticulum(plural.=Diverticulae) appear like holes/discrete depressions on the inner surface of the bowel (see pics. below).

Diverticulosis can occur anywhere in the hollow intestinal tract,but frequently occur in the colon.

Colonic Diverticulosis are usually part of the ageing, chronic degenerating process.

Small bowel Diverticulosis tend to occur in younger people and they are related to congenital weakness of the bowel walls.

Uncomplicated Bowel Diverticulosis are usually asymptomatic, but complicated ones may present with symptoms much like bowel cancer.

Diverticulosis can be complicated by Infection(Diverticulitis) due to the impacted faecal matter in the Diverticulum(as seen by the yellow stuff sticking to the diverticulum in the picture above)

Neurofibroma.....an uncommon skin nodule

Lumps,bumps,nodules and polyps are interchangeable clinical terms that doctors and laity alike use to describe various protruding skin conditions that are of significance.

One such lump is a Neurofibroma(see pic.)

Neurofibroma(singular)/neurofibromata(plural) is a protruding skin nodule of varying sizes that occur on any skin surface.

They are usually painless but can be painful if large enough.

They can grow in size or remain small for a long time.

They arise from the nerve sheath cell that surrounds nerve cells.

They are genetically determined and as such familial in nature, i.e..it runs in family.

If they are small and few in numbers,there are no clinical significance.If they are large in size and numbers and located in clinically important areas like face,then it becomes a very important clinical problem that needs treatment.

The only treatment for a few clinically significant Neurofibromata is Surgical Excision.But for a large numbers,no surgery is possible,and patient is counseled to accept to live with the condition.Painkillers can be given.

How Acute Appendicitis starts

Acute Appendicitis is estimated to affect about 0.2%(2:1,000) of any modern population in the world except perhaps the very rural communities who subsist mainly on vegetables.

Upon making the diagnosis of Acute Appendicitis essentially based on clinical impressions without much sophisticated modern tools, the surgeon would then request a consent from patient for surgery.

Quite often, patients will ask why and how one can get Acute Appendicitis.

It seems like a "random fluke" that someone would have a piece of their faecal matter stuck at the mouth of the appendix (see pic.) and initiate a process of inflammation and infection within the lumen of the appendix.

Open Appendectomy for Acute Appendicitis

Acute Appendicitis is perhaps the most common emergency surgical conditions in the routine daily work of a general surgeon whether in a busy public hospital setup, academic university medical centre or a community private hospital setup.

The standard treatment is emergency Appendectomy/Appendicectomy.

Appendectomy can be performed either by Laparoscopic Method or by Open Method (see video).

For a lean patient and children,Open Appendectomy is the best choice.

For an obese adult especially female,the Laparoscopic Appendectomy is the best option.

Facial Wound = Facial Scar = "Scarred Personality"

As a General Surgeon in a community hospital private practice,i handle most of the common injuries resulting from domestic and road traffic accidents...

Children and elderlies are most susceptible to domestic accidents.

One common injury is Traumatic Wounds to the face.

This injury/wound may seem trivial to some people,but to the patients and parents concerned,this injury can be a major source of concern for the future health and wellbeing especially the female gender.

However small a wound is,the result of treatment will always leave a scar.

The face is the personality.

A scarred face is a "scarred personality".

In treating these patients,the surgeon will take that into consideration and all the Principles of Plastic Surgery will come into play to ensure a very favourable longterm outcome.One such technique is using a very small/fine stitches on the most superficial layers of the skin(lower pic.)

The other immediate concern for the surgeon is to ensure that the wound is thoroughly cleansed by thorough toiletting using the appropriate antiseptics and antibiotics to prevent any infection post-operatively.For children,to undertake this process satisfactorily will mandate a good general anaesthesia.

Endoscopic biliary stone extraction

Endoscopic biliary stone extraction is the standard way of removing a concomitant bile duct stones in patients suffering from gallstone disease prior to laparoscopic cholecystectomy.

The typical instrument used to catch,trap and remove the biliary stone is a Basket(pic.).

The usual size that ensure success is when the stone is less than 1cm...for a stone bigger than 1 cm,technically,its more difficult for the basket to negotiate the stone for trapping..

The usual stone type that is successfully removed is the soft,pigmented type with less cholesterol content....since the stone is softer and easily crushable

A modified basket called a Lithotriptor can crush a harder stone since it has a stronger force in the structure and design of the instrument

Giant Skin Cyst

Sometimes a large tumor can still be benign.What is required is merely excision of the tumor without wide excision of the adjacent normal tissues(as it is done in cancer surgery)

Benign tumor needs Simple Excision.Malignant tumor needs Radical Excision

A skin cyst(sebaceous cyst) is a common benign skin condition that is found on many people.

Sebaceous cyst starts with a small lump on the skin with a dimple in the centre.

Most small sebaceous cyst that is asymptomatic does not require any specific treatment.

Some sebaceous cysts will cause complications like pain and infection

Very rarely sebaceous cyst can grow to a very large size(see pic.) that require surgery under general anesthesia.

The profile of Gallbladder stones

This is a typical specimen of an inflamed gallbladder packed with pigmented cholesterol gallstones removed from a patient who has been suffering from typical Acute Cholecystitis.

The typical symptoms of Acute Cholecystitis are;

- acute upper abdominal pain after taking foods rich in fats

- nausea

- vomiting

- bloated abdomen after eating

- fever

- sharp pain with breathing

The inflamed gallbladder above was removed by Laparoscopic Cholecystectomy.

Laparoscopic Cholecystectomy is the Gold Standard for the treatment of any diseased gallbladder

Internal Biliary Stenting at ERCP before Laparoscopic Cholecystectomy

Many patients with gallstones neglect or ignore their symptoms by taking painkillers.

Many patients seek treatment from Primary Care Physicians who also prescribe painkillers to control the symptoms.

Patients with symptomatic gallstones should undergo a definitive surgical procedure called Laparoscopic Cholecystectomy.

One of the delayed complications of untreated symptomatic gallstones is a Secondary Bile Duct Stones...ie.Stones in the Biliary Tree which originate from the gallbladder

Patients with Bile duct stones should undergo Endoscopic Retrograde CholangioPancreatography (ERCP) to clear the bile duct from stones.During ERCP,quite often an Internal Biliary Stent(pic.) is inserted to prevent further secondary ductal stone before the definitive Laparoscopic Cholecystectomy is undertaken at a planned date in the near future.