OBJECTIVE: To determine whether administration of parenteral analgesic affects clinical monitoring, diagnostic accuracy and outcome of patients with suspected acute appendicitis.

METHODS: Prospective, double-blind, placebo-controlled administration of tramadol and normal saline (NS). Patients 11 to 65 years old with abdominal pain for less than seven days, with possibility of acute appendicitis and needing clinical monitoring for detinitive diagnosis, were included. Changes in abdominal physical examination findings and pain response were evaluated 30 minutes after administration of tramadol and placebo which were given right after initial assessment. Accuracy in diagnosis, appendiceal perforation rate, and morbidity and mortality rates were the outcome measures.

RESULTS: One hundred sixty-three patients were enrolled. Eighty-four patients received tramadol (Grp 1) and 79 received NS (Grp 2). Seven patients, 5 in Grp 1 and 2 in Grp 2, did not undergo an operation because of nonsurgical diagnoses which were verified to be accurate during follow-up. One hundred fifty-six patients, 79 in Grp 1 and 77 in Grp 2, were admitted with a diagnosis of acute appendicitis and underwent surgery. There was no significant difference between the groups when comparing the accuracy of preoperative diagnosis and outcome of appendectomy in terms of perforation, morbidity, and mortality rates. In those receiving parenteral analgesics, there was significant pain relief

CONCLUSION: When compared with saline placebo, the administration of a parenteral analgesic (tramadol) to patients being monitored for possible acute appendicitis effectively relieved pain and did not alter the ability of the surgeons to accurately evaluate such patients.

Human ; Male ; Female ; Tramadol ; Appendicitis ; Appendectomy ; Abdominal Pain ; Acute Pain ; Gastrin-releasing Peptide 2 ; Gastrointestinal Hormones

The exact local prevalence of angiosarcoma of the breast is unknown. The challenge in pinning down the incidence is due it its rarity and possible difficulty in diagnosis since it may mimic other benign breast disorders. We are reporting a case of a 21-year-old female Filipino patient who presented with a 2cm x 2cm palpable mass on the upper outer quadrant of her right breast initially diagnosed through cytology as hemangioma and was later found out to have angiosarcoma of the breast after mastectomy. This is to illustrate the clinical presentation, methods of diagnosis, surgical management, and consequently better understanding of this clinical entity.

Human ; Female ; Adult ; Angiosarcoma Of The Breast ; Hemangiosarcoma ; Mastectomy ; Breast ; Hemangioma

BACKGROUND: Breast abscess can be treated by needle aspiration and ultrasound can facilitate its complete drainage.

OBJECTIVE: To assess ultrasonographically guided needle aspiration of breast abscesses as an alternative approach after failed initial blind aspiration.

METHODS: Twenty consecutive lactating and non lactating women who were initially aspirated for breast abscess were examined with ultrasonography. Abscesses depicted at ultrasound were treated with ultrasonographic guidance, and the success of ultrasound-guided treatment was prospectively determined.

RESULTS: Twenty breast abscesses were identified at ultrasound; all were treated with ultrasound guidance: One patient who was treated subsequently underwent surgical intervention; all others were successfully treated with ultrasound intervention.

CONCLUSION: This case series demonstrates that sonographically guided percutaneous aspiration of breast abscesses appears to be a promising alternative to surgical incision and drainage. Its advantages include its cure rate, simplicity and apparently good cosmetic result.

Human ; Female ; Abscess ; Surgical Wound ; Lactation ; Drainage ; Suction ; Ultrasonography ; Mastitis