World journal of surgery
-
World journal of surgery · Dec 2008
Breast cancer in Chinese women younger than age 40: are they different from their older counterparts?
Breast cancer in young women is uncommon, but when it does occur it has been reported to have aggressive biological characteristics. The incidence of breast cancer peaks at age 40 in Hong Kong Chinese women, earlier than in Caucasians. This study is the first to report the tumor characteristics and management of breast cancer in Chinese women younger than age 40 and a comparison with their older counterparts. ⋯ Chinese women present with breast cancer at an earlier age. Younger women present with more advanced disease and more aggressive tumor characteristics. More ethnic-specific screening protocols and treatment decisions may benefit this group of patients.
-
World journal of surgery · Dec 2008
Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis: low primary closure rate.
Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established. ⋯ Treatment of the open abdomen in patients with abdominal sepsis with the abdominal V.A.C. system is safe with good long-term quality of life. Primary closure rate in these patients is substantially lower than in trauma patients. Stepwise closure of the fascia during V.A.C. changes should be attempted to avoid additional lateral retraction of fascial edges. V.A.C.-related complications may be avoided with careful surgical technique.
-
World journal of surgery · Dec 2008
Skin-sparing mastectomy with immediate breast reconstruction by a new modification of extended latissimus dorsi myocutaneous flap.
The introduction of skin-sparing mastectomy has revolutionized both breast cancer surgery and breast reconstruction. Latissimus dorsi myocutaneous flap is a versatile flap that is gaining renewed popularity with the development of flap modifications and the continued recognition of its reliability and safety. We report our results with a new modification of the extended latissimus dorsi flap after skin-sparing mastectomy for breast cancer. ⋯ Skin-sparing mastectomy with immediate breast reconstruction using our new modification of extended latissimus dorsi flap allows single-stage, totally autologous reconstruction with satisfactory aesthetic results and low morbidity.
-
Since the introduction of breast-conserving surgery (BCS), it has been increasingly accepted as the standard surgical option for suitable breast cancer patients in Western countries. However, there have been reports suggesting striking ethnic variations in those undergoing BCS. This study aimed to review the rate of BCS in Hong Kong Chinese breast cancer patients and the possible clinicopathologic and psychosocial factors that may have affected the choice of surgery. ⋯ The rate of BCS in Hong Kong is relatively low compared to that of Western countries. Patients who opted for mastectomies tended to be older, married, and have a lower educational level. Prospective studies on how sociocultural, clinicopathologic, and other factors important in treatment decision-making processes and psychosocial impact of choice of surgery are important so that an ethnic-specific assessment can be made. Suitability and acceptance of BCS by Chinese women should increase with better understanding and education.
-
World journal of surgery · Nov 2008
Randomized Controlled TrialRoutine suction of intercostal drains is not necessary after lobectomy: a prospective randomized trial.
The decision to proceed to simple underwater seal drainage or apply active suction to the underwater seal after lung resection is mostly based on surgeon preference. The purpose of this study was to test whether routine application of active suction is necessary after lobectomy. ⋯ Routine application of active drain suction to the underwater seal is not necessary after lobectomy. However, it could be useful in persistent pneumothorax with sufficient air entry in the lung and clear airways. It is of no help in persistent air leaks when the lung is expanded.