The treatment of carbuncles is early administration of antibiotics and surgery. The commonest surgical approaches are saucerization, and incision and drainage (I&D). Although these two techniques are vastly different, there is a lack of evidence to determine which one produces a better outcome. Three cases of carbuncles are presented to illustrate the contrasting surgical techniques and their results. Three consecutive patients who presented to this hospital with carbuncles were treated with either saucerization or I&D. They were followed up for 8 weeks to assess their outcome. One patient had saucerization while two other patients underwent I&D of their carbuncles. Saucerization produced the shortest length of hospital stay. I&D resulted in earlier wound healing. A randomized controlled is needed to determine the best surgical approach for the treatment of carbuncles.
Various techniques of sternal stabilization via either metal plates or wires have been described. We describe an alternative technique of simple median sternotomy followed by reduction and wire fixation of the sternal fracture. The 2 patients described in this report had traumatic comminuted and displaced sternal fractures. Even though wire repair was deemed to be tedious and achieved poor approximation of the bone, we performed median sternotomy and achieved simple wire fixation with an excellent result.
Haematuria is a common presentation of bladder cancer and requires a full urologic evaluation. This study aimed to develop a scoring system capable of stratifying patients with haematuria into high or low risk groups for having bladder cancer to help clinicians decide which patients need more urgent assessment. This cross- sectional study included all adult patients referred for haematuria and subsequently undergoing full urological evaluation in the years 2001 to 2011. Risk factors with strong association with bladder cancer in the study population were used to design the scoring system. Accuracy was determined by the area under the receiver operating characteristic (ROC) curve. A total of 325 patients with haematuria were included, out of which 70 (21.5%) were diagnosed to have bladder cancer. Significant risk factors associated with bladder cancer were male gender, a history of cigarette smoking and the presence of gross haematuria. A scoring system using 4 clinical parameters as variables was created. The scores ranged between 6 to 14, and a score of 10 and above indicated high risk for having bladder cancer. It was found to have good accuracy with an area under the ROC curve of 80.4%, while the sensitivity and specificity were 90.0% and 55.7%, respectively. The scoring system designed in this study has the potential to help clinicians stratify patients who present with haematuria into high or low risk for having bladder cancer. This will enable high-risk patients to undergo urologic assessment earlier.