Breast conserving surgery for breast cancer involving the nipple.

We present two cases of invasive breast carcinoma with involvement of the dermis and epidermis of the nipple areolar complex (NAC), which were treated with an immediate breast reconstruction. Oncoplastic techniques were utilised in both cases: Latissimus Dorsi Mini Flap in the first and therapeutic reduction mammaplasty in the second. Both methods were used to fill the defect and also to recreate the NAC. We believe these techniques have an expanding role in the repertoire of surgical options for treating breast carcinoma.

Surgical resection of a liver metastasis from breast cancer.

We report a case of a solitary liver metastasis from breast cancer in a 65-year-old woman. The patient underwent a mastectomy and axillary lymph node clearance for right breast cancer in 1990. A solitary metastasis was found in the left lobe of the liver by ultrasonography, 20 years after the initial mastectomy. A left lateral segmentectomy was performed in January 2011 and adjuvant hormonal therapy was also initiated. At present, she remains disease free. This case demonstrates the implementation of liver resection to provide an effective treatment for metachronous metastatic breast cancer. We encourage surgeons to offer suitable patients this surgical treatment option, which is shown to provide a survival benefit.

Primary carcinoma of breast with small-cell differentiation.

We present a case of primary carcinoma of breast with neuro-endocrine small-cell features in a 58-year-old female. To the best of our knowledge this is the first reported case of this kind in the UK. The patient had regional nodal metastasis. She underwent breast conserving surgery and adjuvant chemotherapy. Immunocytochemistry was positive for neuro-endocrine origin of the tumour. We review the literature.

Chromic acid burns: early aggressive excision is the best method to prevent systemic toxicity.

Chromium poisoning can occur from the cutaneous absorption of chromium from burns that are as small as 1% of the total body surface area. In this case report, we describe a patient with 10% total body surface area burns caused by hot chromic acid. The amount of chromium removed by peritoneal dialysis and the amount of chromium in the urine were estimated, as well as the chromium content in the excised skin, serum, and red blood cells. The extent of chromium load from this type of injury and subsequent risk of systemic poisoning is not predictable, and we therefore believe that systemic toxicity is best prevented by early excision of the burned skin.

[Hemoperitoneum secondary to acute cholecystitis in kidney transplant]. / Hemoperitoneo secundario a colecistitis aguda en el trasplante renal.

We present two cases of acute cholecystitis occurring more than two years after renal transplantation. The course of the acute event was complicated by the presence of hemobilia in one of the patients and severe hemoperitoneum in both patients. We comment the possible etiologic factors, the high efficiency of the diagnostic procedures and the importance of prompt cholecystectomy as the best treatment method.

Skin reducing mastectomy and immediate reconstruction: the effect of radiotherapy on complications and patient reported outcomes.

AIM: Skin reducing mastectomy, dermal sling and immediate implant reconstruction (SRMIR) is an emerging technique where, de-epithelialised inferior skin flap sutured to pectoralis major provides vascularised, dermal sling for the implant. We aimed to assess patient satisfaction following SRMIR and determine if radiotherapy affected patient reported outcomes. METHOD: A prospective database of women undergoing SRMIR was analysed. SRMIR was performed in 92 women (116 breasts). Radiotherapy was received by 45 women and it was not required in 47 women. Forty eight women had contralateral surgery: 21 breast reduction/mastopexy, 1 augmentation, 26 mastectomy/reconstruction. A validated breast evaluation questionnaire provided patient reported outcomes. RESULTS: Median follow up was 20 months. Early complications were similar in both groups, but those in the radiotherapy group had a higher incidence of implant loss (6/45 = 13% vs 1/47 = 2%; p = 0.06) and grade III/IV capsular contracture (11/45 = 24% vs 6/47 = 13%; p = 0.20). The outcome questionnaire was sent to 83 women who were disease free and had retained their implants. Sixty three women responded (76%). Patient reported satisfaction was high, with or without radiotherapy. Women receiving radiotherapy gave lower scores, but it was statistically significant only for general appearance and symmetry. CONCLUSIONS: Although complications after radiotherapy are higher in patients who had SRMIR, the majority of women who retained their implant are highly satisfied with their reconstruction. Majority of these patients were happy to recommend SRMIR procedure to their friend.

Alternatives to thumb replantation in three cases of traumatic amputation of the thumb.

Three cases of complete amputation of the thumb are reported in which the amputated distal parts were not suitable for replantation. In all cases there were either complete or incomplete amputations of other digits. Two different techniques were used for thumb reconstruction: 1) pollicization of a partially amputated digit with transposition microsurgery in case 1; and 2) replantation of a less important amputated digit to the thumb stump for cases 2 and 3. These microsurgical efforts successfully restored thumb function in all three patients.