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Inflammatory breast cancer (IBC) is a rare yet aggressive form of invasive ductal carcinoma, with a poor prognosis and decreased 5-year survival rates. Characteristic findings for IBC include rapid onset of breast edema, peau d'orange appearance, and involvement of the breast skin. Additionally, diagnosis is confirmed with a skin punch biopsy. With such nonspecific features, IBC can be mistaken for benign etiologies, causing delays in diagnosis and treatment. This patient is a 44-year-old woman presenting with left breast swelling while concurrently breastfeeding. Following antibiotic treatment but no symptom resolution, the patient was referred out for further follow-up. Despite multiple imaging studies, suggesting benign findings, clinical suspicion prompted continued evaluation and finally diagnosis of triple-negative inflammatory breast cancer with distant metastases. Further awareness of the presentation of IBC and its mimicking of other disease processes such as mastitis is paramount to earlier detection and improved outcomes in future patients. [ABSTRACT FROM AUTHOR]

The importance of resident wellbeing is increasingly recognized by the ACGME as essential. While prior studies have quantified wellbeing/burnout, few have defined wellbeing from the resident–physician perspective. A REDCap® survey was distributed to residents in various programs, responses were grouped by theme, and data analyzed via chi-square. From 19 institutions, 53/670 responded, from university (34.0%), community (30.2%), and community/university-affiliated (30.2%) programs, mostly surgical (84.9%), followed by medical (9.4%). Wellbeing was defined by mental and spiritual/religious health (33.8%), overall health (23.0%), free time/time management (23.0%), and job/salary satisfaction (18.9%). Proposed changes to traditional training included fewer hours and more schedule flexibility (38.2%), and increased/improved support/feedback (14.7%). Nearly half of the respondents perceived lacking education on career longevity. Wellbeing is paramount to the personal/professional development of residents. Data on resident-defined wellbeing are lacking. The improved understanding of wellbeing defined here can be used to improve residency training programs. [ABSTRACT FROM AUTHOR]

Background: The morbidity and mortality rates associated with cholecystectomy for acute cholecystitis are higher in the critically ill elderly population. As an alternative to cholecystectomy, we report the results of treatment of acute cholecystitis in the elderly after open cholecystolithotomy with cholecystostomy tube placement under local anesthesia.Methods: A case series was performed on 5 patients from August 2007 to April 2010 who presented with acute cholecystitis and underwent an open cholecystolithotomy and tube placement. Thirty-day mortality, intra- and immediate-postoperative complications, clinical improvement after drainage, additional biliary procedures needed, and outcome after cholecystostomy tube removal were recorded.Results: Open cholecystolithotomy and tube placement were performed successfully in all patients and permitted resolution of the acute attack in all after a mean period of 3.75 days. Thirty-day mortality was 0%. Patients did not experience any intraoperative complications. We observed 100% rate of successful short-term outcomes in our patients including resolution pain, and objectively, normalization of leukocytosis, and defervescence. None of the patients required emergency cholecystectomy. All patients had their cholecystostomy tubes removed at a mean postoperative day 27. There were no cases of biliary leakage or tube dislodgement. There were no recurrences of acute cholecystitis within the mean follow-up of 20.75 months.Discussion: Emergency open cholecystolithotomy and cholecystostomy tube placement represent an effective, safe, and definitive alternative treatment strategy for acute gallstone cholecystitis in selected elderly patients with a mortality rate of 0% in the authors' experience. [ABSTRACT FROM AUTHOR]

Background: Lactate levels in clinical practice are often used as a quantitative indicator for the severity of hypoperfusion and the responsiveness to therapeutic interventions. In the hospital acute care setting, lactic acidosis combined with the appropriate clinical exam signs warrants surgical evaluation. The purpose of our study was to evaluate all surgical consults for lactic acidosis in a single community hospital to identify what cofactors were most often predictive of the need for surgical management and operative intervention.Materials and Methods: A retrospective chart review within a 5-year period was conducted on all consultations to general surgery in which patients additionally had lactic acidosis defined as >2mEq. Within this population, various subjective and objective parameters were evaluated. Final analysis compared these parameters between patients with lactic acidosis who underwent surgical intervention and those who did not require operative intervention.Results: Within the 5-year period, 432 patients met our criteria of a surgical consult placed for lactic acidosis. Final results from the highest quality statistical model showed significant variables as diffuse tenderness on physical exam (P-value = .0010, Odds Ratio (OR) = 2.77) and focal tenderness on physical exam (P-value = .0440, OR = 1.76). The presence of peritoneal signs (P-value = .0521, OR = 2.02) resulted in operative intervention twice as often in patients with lactic acidosis.Discussion: To better appropriate health care costs, measures need to be taken to ensure resources are being utilized properly. In patients with lactic acidosis, one should go "back to the basics" with the physical examination to determine which patients truly need a surgical consultation. [ABSTRACT FROM AUTHOR]

While liposarcoma is one of the most common soft tissue sarcomas, it is rarely seen within the gastrointestinal tract, and even less frequently seen within the colon. Dedifferentiated liposarcoma is a subtype of liposarcoma, which along with the pleomorphic subtype is considered a high-grade, aggressive tumor; both possess the ability to metastasize and are associated with decreased survival. Despite complete resection, recurrence is common. While surgical excision is the cornerstone of treatment for liposarcoma of the colon, there is no consensus on adjuvant therapies. We present the case of a 66-year-old woman who presented with abdominal pain with rectal bleeding and was found on colonoscopy to have a high-grade dedifferentiated liposarcoma of the transverse colon. She underwent robotic segmental colectomy. Due to absence of nodal involvement or distal metastasis, adjuvant therapy was not administered. On 1-year follow-up, the patient remains disease free. [ABSTRACT FROM AUTHOR]