Breast Masses

Any breast mass needs careful evaluation which may include mammogram, ultrasound, MRI, percutaneous biopsy or surgical biopsy. If a breast biopsy comes back pre-malignant (ductal carcinoma in-situ or DCIS) or malignant (invasive ductal or lobular) there are many treatment options ranging from lumpectomy with sentinel node biopsy, mastectomy with possible reconstruction to radiation and chemotherapy. In the last decade or so, tremendous strides have been made in the diagnosis and treatment of breast cancer.

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Breast Masses

Any breast mass needs careful evaluation which may include mammogram, ultrasound, MRI, percutaneous biopsy or surgical biopsy. If a breast biopsy comes back pre-malignant (ductal carcinoma in-situ or DCIS) or malignant (invasive ductal or lobular) there are many treatment options ranging from lumpectomy with sentinel node biopsy, mastectomy with possible reconstruction to radiation and chemotherapy. In the last decade or so, tremendous strides have been made in the diagnosis and treatment of breast cancer.

Colon Cancer

Colon cancer is typically detected by colonoscopy. The current recommendation is to have a screening colonoscopy at age 50 if asymptomatic, and at age 40 or earlier if a first degree relative was diagnosed with colon cancer. Like all cancers, if detected early, the cure rates are high. Most colon cancers will need surgery as a primary treatment. This is often performed laparoscopically with shorter healing time than with traditional surgery.

Diverticulitis

Diverticuli are small out-pouchings in the colon. They are increasingly common with age and are due in part to a Western diet (relatively low fiber). Diverticulitis occurs when a diverticulum gets inflamed or ruptures. Mild forms of diverticulitis are treated with antibiotics and dietary modification (increasing fiber). Recurrent or more severe attacks may be treated surgically. Usually, the operation is performed laparoscopically (with smaller incisions than traditional surgery) and patients may be discharged after only a few days in the hospital.

Gallbladder Surgery

Gallstones are typically formed in the gallbladder and are classified as cholesterol or pigment stones. For the most part, asymptomatic gallstones do not require surgery. However, when patients have symptomatic gallstones surgery is often advised. A typical gallbladder attack involves upper abdominal pain, nausea, vomiting and perhaps some back pain. Ultrasound, CT scan, HIDA scan or MRI (MRCP) may be used to confirm the diagnosis. The surgery is normally performed laparoscopically, with most patients going home the day of surgery or the following day.

Hernia

A hernia is a hole in the abdominal wall where there shouldn’t be one. Common areas are in the groin (inguinal or femoral), at the belly button (umbilical), ventral and incisional (from prior surgeries). Although there may be circumstances when hernias are treated non-operatively most hernias are repaired surgically. The reason for this is that there is a risk of a loop of intestine becoming incarcerated in the hole and this might lead to strangulation. The majority of hernias are repaired with mesh (a screen like material) which minimizes the risk of recurrence. Some hernias may be best repaired in a conventional (open) technique whilst others may be better served with a laparoscopic technique. The majority of patients will go home the same day following a hernia repair.

Parathyroid

The parathyroid glands control calcium levels in the body. When one of these glands becomes enlarged there may be an overproduction of calcium causing deleterious effects. Blood work, ultrasound and a sestamibi scan may confirm the diagnosis. Surgery is often performed using minimally invasive techniques.

Thyroid

Most thyroid problems are treated medically. However, a thyroid nodule or goiter (enlarged thyroid) may require surgery. Surgery is indicated when there is a concern of cancer or when the thyroid is enlarged enough to cause symptoms such as difficulty swallowing or breathing. Most patients will go home within 24 hours and have excellent cosmetic results

Peritoneal Dialysis

Peritoneal Dialysis can be a good alternative to hemodialysis. Peritoneal dialysis works by instilling fluid into the abdomen and then draining the fluid, which contains toxins, out a later time. The procedure involves inserting a small tube into the abdomen. This is done as an outpatient procedure. Once functioning, patients can perform peritoneal dialysis at home thus avoiding going to a dialysis center, on their own schedule and avoiding needle sticks.

Minimally Invasive Surgery

Today a lot of procedures can performed in a minimally invasive fashion. This means smaller incisions are used with potentially less post-op pain, faster recovery and better cosmetic results. Examples of procedures that are now routinely performed using a minimally invasive surgery
techniques are gallbladder, hernia, incisional hernia, colon and parathyroid procedures. Dr. Agolini has expertise in all of these procedures

Copyright 2012 Dr. Stefano F. Agolini, M.D. - Alexandria, VA