Background On-table Cholangiography (OTC) is an important diagnostic tool in biliary surgery, allowing for assessment of biliary duct patency. However, debate remains over its overall benefit and safety vs peri-operative imaging. Research into the radiation exposure to both patients and surgeons and its subsequent risks remains minimal. Aim The aim of this retrospective study was to assess the average radiological dosage exposure as well as total exposure time for on-table Cholangiograms performed during Laparoscopic Cholecystectomies. We also aimed to assess for any clear difference in dosage and time exposure between different levels of trainee surgeons and consultants. Results A total of 157 OTCs were identified over a 12-month period; 57% performed by consultants (n=91), 23% by senior trainees’ level ST6-ST8 (n=36) and 29% by trainees level ST3-ST5 (n=36). The median radiological exposure time for all cases was 27 seconds, while median dosage/area exposure was 54.84 (uGy*m2). There were no significant differences in mean and median results between the different training levels of the performing surgeon. Conclusions Average radiological exposure dosage/area and time was consistent throughout the different groups of surgeons. While the exposure appears to remain at relatively low levels, further research into the risk of exposure during OTCs is needed to provide guidance to surgeons performing such procedures.
PASH (Pseudoangiomatous stromal hyperplasia) is a rare pathological finding, defined as a benign mesenchymal proliferative lesion of the breast, presenting more frequently in premenopausal women. Although benign, differentiation from low grade Angiosarcoma due to their histological similarities. Management guidelines for PASH remain primitive due to the rarity in diagnosis and reporting of such cases. We present a very interesting case of an 11-year-old female assessed for her rapidly enlarging breasts. Initial management entailed right breast reduction Mammoplasty due to the presumed diagnosis of Macromastia. Histopathological assessment of the specimen initially reported the presence of Fibroadenoma. However, re-assessment by a senior Pathologist subsequently diagnosed the lesion as Pseudoangiomatous Stromal Hyperplasia (PASH). Further MRI imaging of both breasts revealed multiple, large, bilateral lesions. All identified bilateral breast lesions were excised, with a cumulative weight of 1.6 Kg, combined with WISE pattern reduction of the right breast overlying skin was carried out in due course. There has been no previous reporting of PASH in an 11-year-old female, which itself is a rare condition. Further studies on PASH are recommended to reduce the risk unnecessary surgical management of such cases due to misdiagnosis.
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