Three-Port Laparoscopic Cholecystectomy in a Brazilian Amazon Woman with Situs Inversus Totalis: Surgical Approach

Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT

CA 15-3 is predictive of response and disease recurrence following treatment in locally advanced breast cancer

BACKGROUND: Primary chemotherapy (PC) is used for down-staging locally advanced breast cancer (LABC). CA 15-3 measures the protein product of the MUC1 gene and is the most widely used serum marker in breast cancer. METHODS: We retrospectively investigated the role of CA 15-3 in conjunction with other clinico-pathological variables as a predictor of response and time to disease recurrence following treatment in LABC. Pre and post primary chemotherapy serum concentrations of CA 15-3 together with other variables were reviewed and related to four outcomes following primary chemotherapy (clinical response, pathological response, time to recurrence and time to progression). Persistently elevated CA 15-3 after PC was considered as consecutively high levels above the cut off point during and after PC. RESULTS: 73 patients were included in this study. Patients received PC (AC or AC-T regimen) for locally advanced breast cancer. 54 patients underwent surgery. The median follow up was 790 days. Patients with high concentrations of CA 15-3 before PC treatment had a poor clinical (p = 0.013) and pathological (p = 0.044) response. Together with Her-2/neu expression (p = 0.009) and tumour lympho-vascular space invasion (LVI) (p = 0.001), a persistently elevated CA 15-3 post PC (p = 0.007) was an independent predictive factor of recurrence following treatment in LABC. CONCLUSION: Elevated CA 15-3 level is predictive of a poor response to chemotherapy. In addition, persistently elevated CA 15-3 levels post chemotherapy in conjunction with lympho-vascular invasion and HER2 status predict a reduced disease free survival following treatment in locally advanced breast cancer

Endocrine Surgeon-Performed US Guided Thyroid FNAC is Accurate and Efficient

BACKGROUND: Ultrasound guided fine needle aspiration cytology (US-FNAC) is a key diagnostic technique used to assess thyroid nodules. This procedure has been the domain of radiologists, but it is increasingly performed by endocrine surgeons. In the present study we aimed to assess the accuracy and clinical efficiency of US-FNAC performed by endocrine surgeons. PATIENTS AND METHODS: This study was a retrospective review of consecutive patients in a 3-year period who underwent US-FNAC performed by endocrine surgeons and radiologists. Medical records, cytology results, and surgical pathology results were collected and analyzed. RESULTS: A total of 576 US-FNAC were performed on 402 patients during the study period. The endocrine surgeons and radiologists performed 299 and 277 US-FNAC, respectively. The FNAC inadequacy rate was 5.3 % for the endocrine surgeons and 9.3 % for the radiologists (p = 0.05). For thyroid cancer, the sensitivity, specificity, and false negatives of the US-FNAC for the endocrine surgeons was 87 %, 98 %, and 3 %, respectively while that for the radiologists was 88 %, 95 %, and 3.5 %, respectively. Patients with thyroid cancer had a shorter time to surgery in the endocrine surgeons' group (mean 15.3 days) compared to the radiologists' group (mean: 53.3 days; p = 0.01). CONCLUSIONS: US-FNAC performed by an experienced endocrine surgeon is accurate and allows efficient surgical management for patients with thyroid cancer

Comparative efficacy of different CIDR protocols for the treatment of postpartum anestrous in Iraqi buffaloes

The aim of this study was to evaluate and compare the efficacy of different CIDR protocols including some hormonal preparations for the treatment of postpartum anestrous of Iraqi northern buffaloes. The present study was conducted on 70 anestrous buffaloes suffering from postpartum ovarian inactivity. Buffaloes were randomly assigned to three treatment groups. Buffaloes in Treatment 1 (n=20) injected on day 0 of the experiment, GnRH 250 μg and a CIDR was placed in the anterior vagina. On day 7, they were injected with 25 mg of PGF2α and on the following day (day 8) the CIDR were removed. On day 9 a second dose of GnRH (250 μg) was injected. Buffaloes in Treatment 2 (n=20) received on day 0 GnRH (250 μg) and a CIDR were placed in the anterior vagina. On day 7, CIDR were removed and injected with GnRH (250 μg). Treatment 3 (n=20) on day 0 a CIDR were placed in the anterior vagina. On day 6, they were injected with 1000 IU of eCG. CIDR were removed on day 7 and injected with GnRH (250 μg). A control group (n=10) received no treatments. Results showed that in treatment 1 (GnRH+CIDR—8days—7 PGF2α+9 GnRH), 15 out of 20 buffaloes received treatment exhibited estrus within 69.4 ± 8.4 h after CIDR removal. The estrus induction rate was 75%. Total number of buffaloes became pregnant was 4 (26.7%). In treatment 2 (GnRH+CIDR—7 days—GnRH), 65% of the buffaloes received treatment exhibited estrus within 77.8 ± 5.6 h after CIDR removal. Total number of buffaloes became pregnant was 4 (26.7%). In treatment 3 (CIDR—7 days— 6 eCG+7 GnRH), 100% of the buffaloes received treatment exhibited estrus within 78.3 ± 11.8 h after CIDR removal. In conclusion, our results indicate that the addition of GnRH and eCG to a progesterone-based CIDR protocol substantially improves the estrus induction and pregnancy rates in postpartum anestrous buffaloes. [Vet. World 2012; 5(4.000): 201-205