The ‘Vanishing Breast’: An Unusual Presentation of Infiltrating Ductal Carcinoma

Introduction: Breast cancer is a leading cause of cancer related morbidity and mortality world over. Most cases will present as palpable lump or bloody nipple discharge. However, there are cases of atypical presentation in the literature.Case summary: We report a case of a 50 year old female with infiltrating ductal carcinoma presenting as spontaneous reduction and complete loss of breast tissue.Conclusion: Breast cancer presentation can be atypical and non-specific. There is need for Kenyan females to take up radiological screening.Key words: Breast cancer, vanishing breast, breast self examination, pleurodesis

The Presentation Of Cryptorchidism At Consolata Hospital Nyeri

Introduction: Cryptorchidism is the commonest birth anomaly in boysbut data on the entity is scarce in Kenya. Neither population nor facilitybased study documenting the condition is available.Objective: To determine the age of presentation, presenting complaintsand findings among patients with cryptorchidism in Consolata hospital Nyeri, Kenya.Methods: We carried out an eight-year retrospective study by analysingall the cases of cryptorchidism operated on in our theatre usingthe available patients’ records.Results: A total of 54 patients with 71 undescended testes were analysed. The median age of presentation was 9.0 years (ranging from 0.58 to 80 years). Of the cases analysed, 31.48% were bilateral, 33.33% right sided and 29.63% left sided. The main presenting complaint was empty scrotum in 82.98% of the cases. Intra-operatively, 8.5% of the testes were at the deep inguinal ring, 8.5% at superficial inguinal ring and 5.6% at mid-inguinal regional. The location of the testes in 56.3% of the cases was not indicated. Orchidopexy was performed in 88.7% of the cases.Conclusion: Cryptorchidism is common a n d across all age groups with most of patients presenting to hospital late. Early diagnosis and orchidopexy is recommended

Epidemiology and Functional Outcome of Head Injury in Rural Kenya

Background: Head injury is a major cause of disability, morbidity, and mortality and is responsible for a significant proportion of all traumatic deaths. The aim of this study was to document the epidemiology and factors influencing functional recovery in patients treated for head injury in a rural institution in Kenya.  Methods: A retrospective analysis of 209 patients admitted to the surgical unit at Consolata Hospital and diagnosed with head injury between January 2009 and December 2012. Outcome was assessed according to the Glasgow Outcome Scale (GOS) score at the time of discharge from hospital. Results: There were 180 men (86.1%) and 29 women (13.9%). The median age was 30 years. Road traffic accidents (56.7%), assault (23.9%), and falls (15.4%) were the leading causes of head injury. The distribution of head injury severity was mild in 72.5%, moderate in 9%, and severe in 18.5%. Good functional recovery was achieved by 139(66.5%) of the patients in our series, whereas moderate and severe disability accounted for 18.2% and 5.3% while mortality accounted for 10%. Increasing age (p=0.006), a lower GCS score at admission, pupillary abnormalities, a history of loss of consciousness and admission into our Intensive Care Unit were all associated with poorer outcomes (p<0.000). Conclusion: Outcome depended on age, initial GCS score, pupillary abnormalities, history of loss of consciousness and admission into our Intensive Care Unit. These findings can be used to improve the  management criteria in rural hospitals but we recommend establishment of a standardized surveillance system for head injuries to aid in development of new, more effective, targeted prevention strategies.Key Words: Head injury, Outcome, Epidemiology, Incidenc

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020