Rectal tumor height has been observed to increase after complete mobilization.
OBJECTIVES: 1.) to measure tumor height in resectable rectal cancers before and after complete mobilization, 2.) to describe changes in tumor height measurements at different levels of the rectum, and 3.) to determine the probability of a two centimeter increase in tumor height after mobilization in low rectal cancers.
METHODS: Prospective cross-sectional series including all resectable rectal cancer treated at our hospital from January to December, 2003. Proctoscopy measurements of rectal tumor height after induction of anesthesia were compared to measurements done after complete rectal mobilization. Logistic curve fitting was used to calculate the probability of a two centimeter increase in tumor height for low rectal cancers after complete mobilization.
RESULTS: In the 12-month period, 37 patients with adenocarcinoma of the rectum were seen. Ages of patients ranged from 26 to 86, with mean age of 57.8 years. Thirty-three patients had resectable rectal cancer. Tumor height ranged from zero to 11 cm, with mean height of 5.7 cm. After complete mobilization, tumor height increased in 50 percent of upper rectal cancers, 92 percent of mid-rectal cancers, and 32 percent of low rectal cancers. Logistic curve fitting showed probability of a two-centimeter increase in tumor height was 52 percent at seven centimeters, 40 percent at six centimeters, 28 percent at five centimeters, and 19 percent at four centimeters.
DISCUSSION: The decision to perform APR for low rectal cancers must not be based solely in pre-operative tumor height measurements since pre-operative measurements of rectal tumor height can increase when the rectum is completely mobilized.

Human ; Proctoscopy ; Rectumrectal Neoplasms ; Adenocarcinoma ; Anesthesiology ; Anesthesia ; Probability

The American Joint Committee on Cancer presently recommends obtaining at least seven to 14 lymph nodes in radical colon and rectum resections.
OBJECTIVES: 1.) To determine the number of lymph nodes recovered in our rectal cancer resection specimens, and 2.) to compare the number of our lymph node harvest with current international recommendations.
METHODS: Records of patients who underwent resection for adenocarcinoma of the rectum from 2001 to 2002 were reviewed. From the final pathology report, the number of lymph nodes recovered per specimen was described. This was correlated with the depth of tumor penetration (T) and the intra-operative staging of nodal status (N) by the surgeon.
RESULTS: Forty-seven patients underwent resection for adenocarcinoma of the rectum. Ages of patients ranged from 21 to 74 years, with a mean of 52 years. The lymph nodes recovered from the specimens ranged from zero to 15, with an average of 3.1 nodes per specimen. T4 tumors had the highest average rate of lymph node recovery at four nodes per specimen. In 16 patients, metastasis to regional lymph nodes were identified (16/47 or 34 percent node positive). The range of nodes recovered in node positive patients ranged from one to 15, with an average of six nodes. Thirty-one patients were node negative (31/47 or 66 percent). The average nodes recovered per specimen in this group was 1.8, ranging from zero to 12.
SUMMARY: From our review, almost 90 percent of our reports did not meet the minimum standard of recovering at least seven lymph nodes in rectal cancer resection specimens. In 94 percent of node negative patients, no sound therapeutic plans could be made due to inadequate lymph node harvest.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Rectum ; Lymph Nodes ; Rectal Neoplasms ; Adenocarcinoma ; Colon ; Lymph Node Excision ; Surgeons

BACKGROUND: In the Philippines, mammography is frequently requested in the evaluation of patients with breast cancer concern.
OBJECTIVES: The general objective was to take a look at the practice of requesting for a mammography in a health care institution and its outcome in terms of cancer detection in patients with non- palpable breast masses.
METHODS: A retrospective review of past records from 1994 to 2001 was accomplished.
RESULTS: A total of 7,323 mammog-raphies. 192 (3 percent) were done in the 20-29 age group; 966 (13 percent) in 30-39 age group; 2708 (37 percent) in 40-49 age group, 2410 (33 percent) in 50-59 age group and the remaining 1047 (14 percent) in those older than 60 years old. The top three physicians requesting for mammography were obstetrician-gynecologists, 2337 (32 percent); general surgeons, 1348 (18 percent) and internists and family medicine specialists, 806 (10 percent). Normal findings were reported in 4449 (61 percent); benign in 2721 (37 percent), suspicious for cancer without a clinically palpable mass in 99 (1.35 percent) and suspicious for cancer with a palpable breast mass in 52 patients (0.74 percent). A total of 50 patients underwent needle localization biopsy of which 35 had fibrocystic changes (70 percent), 10 had cancer (20 percent) and 5 with indefinite results.
CONCLUSION: The overall cancer detection yield for mammography in those without a palpable breast mass, 7271 (7323-52) persons, was extrapolated to be 0.28 percent (20/7271). The authors deemed the information obtained in this study would be useful to the public, health care administrators and health care providers in reviewing the indication and cost-effectiveness of mammography.

Human ; Male ; Female ; Middle Aged ; Adult ; Family Practice ; Public Health ; Specialization ; Mammography ; Breast ; Breast Neoplasms ; Surgeons ; Biopsy

INTRODUCTION: Palpable breast tissue is so prevalent in studies of men and boys that some authors suggest differentiating it from clinically important gynecomastia. Understanding male breast problems present a great challenge to many physicians especially when there is no specific guidelines developed for men.

OBJECTIVES: This study aims to determine the demographic and clinical profile of male patients with breast problems consulting at Vicente Sotto Memorial Medical Center.

METHODOLOGY: This study is a review of 77 male patients seen at the breast center of Vicente Sotto Memorial Medical Center from April 1, 2001 to March 31, 2004. The clinical profile included the age, geographic origin, chief complaint, family history of breast cancer, clinical breast examination findings, attributes of the clinically palpable breast mass like number, size, consistency, laterality, location, associated breast pain and pain score, clinical diagnosis and final histopathologic report.

RESULTS: Within this time period, there were 2,669 consultations seen at the breast clinic. A total of 77 male patients, comprising 2.9 percent were seen at the clinic. The mean age of occurrence was 36.2 years old. The frequency distribution of breast problem is highest between the ages of 20 to 29 years old at 40.3 percent. In all of the 69 patients (89.61 percent) with clinically palpable mass, 66 patients (95.65 percent) only had a solitary mass while 3 patients (4.35 percent) had two masses. Forty-three (59.7 percent) of the masses were less than 2 centimeters in diameter. Only 1 (1.4 percent) of the 72 masses was fixed to the chest wall which turned out to be a soft tissue sarcoma while the rest (98.6 percent) were freely movable. Based on the final histopathologic results, gynecomastia was the most common diagnosis among patients subjected to fine needle aspiration biopsy and excisional biopsy.

CONCLUSION: Male breast problems are common in the third decade of life and among patients living the urban area like Metro Cebu. Male patients sought consultation due to problems of unilateral firm breast mass less than 2 centimeters in diameter located in the nipple-areola complex. The most common clinical diagnosis is that of gynecomastia which is supported by the final histopathologic result of the same condition.

Human ; Male ; Mastodynia ; Nipples ; Gynecomastia ; Thoracic Wall ; Breast Diseases ; Breast Neoplasms ; Sarcoma

This is a case of a Filipino patient with necrotic soft tissue sarcoma (fibrosarcoma) on the thigh that developed tetanus. This case report intends to instill awareness that tetanus can occur in tumors and not just in traumatic wounds. Literature search was made obtaining no local reports and foreign literature showed that though uncommon, tetanus could occur in tumors, especially in those that developed necrosis. Recommended preventive measures include early treatment of the tumor before necrosis sets in and if necrosis has occurred,early treatment, usually by surgical extirpation and anti-tetanus prophylaxis.

Human ; Female ; Adult ; Tetanus ; Thigh ; Sarcoma ; Fibrosarcoma

Sentinel lymph node biopsy has not gained popularity in the Philippines, perhaps the reason being the unavailability of resources. The use of methylene blue may change this situation.
OBJECTIVE: The authors intend to demonstrate that methylene blue may be used as an alternative dye in sentinel lymph node biopsy for breast cancer with satisfactory results.
METHODS: Twenty patients diagnosed with breast cancer underwent sentinel lymph node biopsy after injection with methylene blue dye, followed by complete axillary dissection. Histologic evaluation of the nodes was done using H&E stain.
RESULTS: The identification rate was 95%, with no false negatives.
CONCLUSION: Sentinel lymph node biopsy using methylene blue can be done with satisfactory results.

Human ; Sentinel Lymph Node Biopsy ; Methylene Blue ; Philippines ; Lymph Node Excision ; Breast Neoplasms ; Coloring Agents

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

OBJECTIVE: This study seeks to describe the relative frequency of benign tumors in the mandible and maxilla, the operations done to manage these tumors at the Philippine General Hospital and compare it to previous reports.

METHODOLOGY: The histopathology records of patients with tumors affecting the mandible and maxilla who underwent biopsy or definitive surgery between January 1993 and December 2005 were included in this study and analyzed.

RESULTS: Out of 1049 cases of tumors of the mandible and maxilla, 566 were benign tumors. Patients had a mean age of 30.77 + 15.70 (Range of 4 mos to 83 years). There is a predilection for males (1.4:1), and the mandible (1.9:1). Ameloblastoma is the most common tumor encountered (266 out of 566 or 47.00 percent). Resection is the most common operation done (380 out of 575 or 66.09 percent). Nine operations were done for tumor recurrence (9 out of 575 or 1.57 percent). Ameloblastoma is the only histologic type of tumor that resulted in recurrence.

CONCLUSION: Benign tumors are more common in the mandible and maxilla. Odontogenic tumor, specifically ameloblastoma, is the most common histologic type. If has specific predilections as to site, age, and gender. In this study, resection is the most common procedure done for this tumor.

Human ; Ameloblastoma ; Maxilla ; Odontogenic Tumors ; Mandible

To determine the clinical profile of benign and malignant mastalgia in terms of age distribution, geographic location, laterality, pain severity and pattern.

METHOD: This is a 3-year (April 1,2001 until March 31, 2004) retrospective chart review of female patients presenting with mastalgia in a hospital-based government breast center at Vicente Sotto Memorial Medical Center, Cebu City. Malignant mastalgia was diagnosed based on histopathologic findings. Pain severity assessment was based on a numeric scale of 0 to 10. Exclusion criteria include patients without mastalgia as chief complaint, no histopathologic confirmation of malignancy and males. All statistical computations were done using Chi square test with a = 0.05.

RESULTS: A total of 1237 patients (89 percent) had benign mastalgia with an average age of 29.72 +/- 10.96 years and 156 (11 percent) had malignant mastalgia with an average of 48.92 +/- 11.96 years. Patients less than 60 years of age had a statistically significant probability that their mastalgia is due to benign pathology (p < 0.001 at a 0.05). However, for 60 years of age. there is a significant probability that the cause of mastalgia is malignant (p < 0.001). Right-sided mastalgia showed a significant probability for a benign cause (p value of 0.0132). Further, non-cyclical pain pattern significantly connotes malignant mastalgia with p < 0.001. No significant differences were found for geographic location and pain severity.

CONCLUSION: Age above 60 years, right-sidedness and non-cyclical pain pattern are the only significant factors for differentiating whether the mastalgia is due to a benign or malignant etiology.

Human ; Female ; Mastodynia ; Age Distribution ; Philippines ; Breast ; Probability ; Neoplasms

OBJECTIVE: To determine the impact of monitoring pain as the 5th vital sign and the utilization of a protocolized analgesic regimen on pain treatment outcome among patients admitted in the Department of General Surgery.

METHODS: Eight hundred fifty (850)admitted patients were included in the study. These were patients who underwent surgery (either trauma or non-trauma cases) and may or may not have had any complaint of pain magnitude. The Department's post operative analgesic regimen protocol (composed of tramadol and ketorolac combination)was followed. Pain scores were monitored every eight hours throughout the patient's hospitalization up to discharge and were documented on the new monitoring sheet of Vicente Sotto Memorial Medical Center.

RESULTS: Of the 850 patients, 629 patients (74 percent) were non-trauma cases and 221 patients (26 percent) were trauma cases. On admission, 313 (51 percent) non-trauma patients and 171 (81 percent) trauma patients experienced severe pain. upon discharge, only 1 (0.6 percent) non-trauma patient continued to be suffering from severe pain and non from trauma cases. Five hundred five (80 percent) non-trauma patients and 140 (63 percent) trauma patients had mild pain, 114 (18 percent) non-trauma patients and 81 (37 percent) trauma patients were totally pain free.

CONCLUSION: There was a significant reduction to pain from admission to discharge because patients were intervened appropriately of their respective symptoms by using proactive pain monitoring and providing analgesia using a protocolized analgesic regimen.

Human ; Male ; Female ; Tramadol ; Ketorolac ; Analgesics ; Pain ; Pain Management ; Analgesia ; Treatment Outcome ; Hospitalization