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Seven hundred and fifty-three new referrals with problems relating to the breast were seen as outpatients in a general surgical clinic during 1980 and 1981. The age distribution and final diagnoses are reported with a breakdown into the varying pathological groups. The relationship of diagnosis to previous benign breast disease, parity and breastfeeding is discussed. [ABSTRACT FROM AUTHOR]

The article illustrates the results of the clinical tests of a 79-year old woman with gastric outlet obstruction. The patient experienced repeated vomiting and upper abdominal pain. Blood tests were conducted including complete blood picture and liver and renal function tests. A nasogastric tube has drained out liters of gastric fluid.

Small-cell carcinomas of lung origin have been well characterised for their clinico-histopathological features. However, extrapulmonary small-cell carcinomas are rare, and in particular, they are extremely rare at the ampullary region. We report herein a case of small-cell carcinoma of ampulla of Vater and review its clinical, histological, and immunohistochemical features.

Objective: To review the site of involvement, clinical presentation, and treatment outcome of patients having immunoglobulin G4-related sclerosing disease in a local regional hospital., Design: Retrospective case series., Setting: Pamela Youde Nethersole Eastern Hospital, Hong Kong., Patients: All patients with a diagnosis of immunoglobulin G4-related sclerosing disease in the hospital diagnosed in the period from April 2008 to March 2010., Results: A total of 12 patients with involvement of various organs were identified. There was a male predominance (male-to-female ratio=5:1). The mean age at diagnosis was 65 years. The salivary glands, biliary tract, pancreas, and cervical lymph nodes were the commonest involved sites. The immunoglobulin G4 level was elevated in 83% of the patients. Patients usually appeared to respond well to steroid treatment., Conclusion: Immunoglobulin G4-related sclerosing disease is a systemic disease and can involve various systems.

Objective: To compare the use of endorectal plus phased-array coils with use of phased-array coil alone with respect to the accuracy of magnetic resonance imaging for detecting mesorectal involvement of rectal cancer., Design: Retrospective study., Setting: A tertiary referral centre in Hong Kong., Patients: Ethnic Chinese patients with rectal adenocarcinoma who underwent staging magnetic resonance imaging during the years 2003 to 2008 in our centre were selected; those who received preoperative neoadjuvant therapy were excluded. Unless otherwise contra-indicated, endorectal coils have been used since 2006., Main Outcome Measures: Magnetic resonance images were retrieved and reviewed by two radiologists blinded to the pathological results. The radiological findings were then correlated with the pathological reports to determine diagnostic accuracy., Results: A total of 50 patients were studied; 13 of the examinations were in patients having an endorectal coil. The overall accuracy of magnetic resonance imaging in detecting mesorectal tumour involvement was 80%. Subgroup analysis showed higher accuracy in the group with endorectal coils than in those with phased-array coils alone. Over-detection of mesorectal involvement was noted in 12% of the cases, with lower rate being observed in patients with endorectal coils. Underdetection of mesorectal tumour involvement was only noted in the group without endorectal coils. With the use of endorectal coils, the sensitivity reached 100% and the specificity increased to 86%., Conclusion: Use of endorectal coil in staging magnetic resonance imaging of the rectum improves diagnostic accuracy. Whenever feasible, endorectal coil use is therefore recommendable to enhance diagnostic accuracy. The study results substantiate the understanding of staging by magnetic resonance imaging of rectal cancer in the local Chinese population.

Immunoglobulin G4-related lymphoplasmacytic sclerosing disease is an emerging disease. Recently, it has been shown to be responsible for autoimmune pancreatitis-induced strictures of the bile duct mimicking cholangiocarcinoma. Making a diagnosis of immunoglobulin G4-associated sclerosing cholangitis requires a high index of suspicion. The differential diagnoses include primary sclerosing cholangitis, cholangiocarcinoma, and pancreatic cancer. The preoperative diagnosis is likely to be missed due to the lack of specific symptoms; a clinical presentation that may mimic other disorders, especially malignant biliary strictures; and the lack of specific imaging features. This article reports on a 51-year-old man with immunoglobulin G4-associated sclerosing cholangitis without autoimmune pancreatitis. He underwent resection of his extrahepatic bile duct with a hepaticojejunostomy. The diagnosis was confirmed after a histopathological examination. This case highlights the obstacles to making a preoperative diagnosis of immunoglobulin G4-associated sclerosing cholangitis.

Objective: To review results of laparoscopic liver resections, particularly in those patients with hepatic malignancy and recurrent pyogenic cholangitis., Design: Retrospective analysis., Setting: Minimal access surgery training centre, Hong Kong., Patients: Patients with pathologies located at anterio-inferio-lateral segments (Couinaud segments 2, 3, 4b, 5, 6) for laparoscopic resection were recruited during the period 1998 to 2005. Patients were excluded from review if they had: pathologies at central locations and the superior and posterior segments (4a, 7, 8), large tumours (>5 cm in diameter), and those close to major vasculature or the liver hilum., Results: During the study period, we attempted 40 such laparoscopic liver resections, excluding marsupialisations and resections for simple liver cysts. There were 20 female and 20 male patients, with a mean age of 57 (standard deviation, 13; range, 29-81) years. All but one underwent a successful laparoscopic operation. Pathology included hepatocellular carcinoma (n=17), recurrent pyogenic cholangitis (n=14), colorectal liver metastasis (n=4), benign liver tumour (n=4), and intrahepatic cholangiocarcinoma (n=1). All except four were hand-assisted laparoscopic liver resections. The mean operating time was 169 (range, 60-290) minutes and mean blood loss amounted to 270 mL (range, 0-1000 mL). Complications occurred in eight (20%) patients, which included six wound infections, one postoperative bile leak, and two incisional hernias. There was no operative or hospital mortality. For hepatocellular carcinoma, clear resection (>10 mm) was achieved in all except five patients, and the 1-year and 2-year survival rates were 86% and 59% respectively. Favourable results were also obtained for resections in patients with recurrent pyogenic cholangitis; after a mean (standard deviation) follow-up of 29 (23) months, only one was readmitted (for cholangitis)., Conclusion: In appropriately selected patients, laparoscopic liver resection is feasible and safe, and achieves acceptable survival among individuals with hepatic malignancy and very favourable long-term outcomes in those with recurrent pyogenic cholangitis undergoing hand-assisted laparoscopic segmentectomy.

Background: Acute torsion of the greater omentum is a rare cause of acute abdomen in adults. We report our experience on the clinical presentation, diagnosis, treatment, and outcome of this condition., Method: This is a retrospective review of 9 patients who had a clinicopathologic diagnosis of acute torsion of the greater omentum and were treated at the Department of Surgery, Pamela Youde Nethersole Eastern Hospital from January 1994 to March 2004. Eight patients were male and 1 was female with a median age of 43 years (range, 24 to 65). Median body mass index was 24 kg/m(2) (range, 22 to 24). All presented with acute abdominal pain with a median temperature of 36.8 degrees C (range, 36.5 to 37.2) and a median white cell count of 9.5 x 10(9)/L (range, 7.4 to 15.1 x 10(9)). Preoperative ultrasound was done in 5 patients., Results: All diagnoses were made during surgery. Resection of the infarcted omentum was performed for all patients (5 laparoscopic resections and 4 open resections). No postoperative complications occurred. The overall median time from admission to operation was 23 hours (range, 2 to 98). The overall median operating time and postoperative stay were 70 minutes (range, 38 to 105) and 3 days (range, 1 to 6), respectively. The median oral and parenteral analgesic requirement for postoperative pain control was less and the median hospital stay was shorter in patients who underwent laparoscopic resection., Conclusion: Acute torsion of the greater omentum is an uncommon cause of acute abdomen in adults, and preoperative diagnosis is usually difficult. Laparoscopy seems a safe and minimally invasive technique for both diagnosis and treatment of this rare disease entity.

Objectives: To evaluate the role of laparoscopic exploration of the common bile duct in the management of common bile duct stones., Design: Retrospective study., Setting: Regional minimal access surgery training centre in Hong Kong., Patients: Patients undergoing laparoscopic exploration of the common bile duct from 1995 to 2005., Main Outcome Measures: Demographic information, reasons for failed endoscopic retrograde cholangiopancreatography and open conversions, and operative morbidity and mortality., Results: A total of 174 laparoscopic explorations of the common bile duct were performed. Indications for surgery (some overlapping) included: concomitant gallstones and common bile duct stones (n=68, 39%) in young persons (<60 years), previously failed endoscopic extraction (n=59, 34%), large (>2 cm) or multiple common bile duct stones (n=40, 23%), and need for laparoscopic bypass to improve bile drainage (n=34, 20%). Mean patient age was 63 (standard deviation, 16) years and 103 were female. Altogether 156 choledochotomies and 18 transcystic duct explorations were performed, with 12 (7%) open conversions. The mean operating time was 129 (standard deviation, 57) minutes. Additional procedures included: 54 laparoscopic operative cholangiographies, 34 laparoscopic biliary bypasses, and 31 instances of adhesiolysis in patients with a history of open upper gastro-intestinal surgery. Complete stone clearance was achieved in 160 (92%) patients. Non-lethal complications occurred in 34 (20%) patients and one died of sepsis after a major bile leak. The mean postoperative stay was 9 (standard deviation, 9) days. Stone recurrence ensued in seven (4%) patients after a mean follow-up of 37 (standard deviation, 29) months., Conclusions: Laparoscopic exploration of the common bile duct is highly successful and can achieve satisfactory ductal clearance even after unsuccessful endoscopic extraction and previous upper gastro-intestinal surgery. In skilled hands, for selected patients laparoscopic bypass can also achieve improved bile drainage.

Amoebiasis is an uncommon disease in developed countries. Its clinical presentation can be variable and non-specific, and the diagnosis can be easily overlooked. We report a case of colonic amoebic abscess mimicking advanced colonic cancer with acute intestinal obstruction and liver metastasis. The presentation, diagnosis, and treatment of amoebiasis are also reviewed.

Objective: To study the safety and efficacy of laparoscopic cholecystectomy for acute cholecystitis in elderly patients by comparing the results with open cholecystectomy., Design: Retrospective study., Setting: Regional hospital, Hong Kong., Subjects and Methods: Patients aged 75 years or older undergoing laparoscopic cholecystectomy for acute cholecystitis between January 1994 and December 1999 were selected from the database. The comparison group comprised patients from the same age-group who underwent open cholecystectomy for acute cholecystitis during the same period., Main Outcome Measures: Operating time, hospital stay, morbidity, and mortality. RESULTS. Thirty-one patients underwent laparoscopic surgery and 42 had open surgery. The demographic data and co-morbidities were comparable between the two groups. The postoperative hospital stay was significantly shorter for patients undergoing laparoscopy (P=0.03). The overall morbidity rate was significantly lower for patients undergoing laparoscopy (P<0.05). There was, however, no statistical significant difference in the mortality rate. There was no major bile duct injury for patients in either group., Conclusion: Laparoscopic cholecystectomy is a safe procedure for acute cholecystitis in elderly patients, resulting in fewer complications and shorter hospital stay than open cholecystectomy.