Wire guided localisation for targeted axillary node dissection is accurate in axillary staging in node positive breast cancer following neoadjuvant chemotherapy.

AIM: This study investigated whether wire localisation of the histologically proven positive, clipped axillary lymph node (ALN) with subsequent targeted axillary dissection (TAD) following neoadjuvant chemotherapy (NACT) improves axillary staging in breast cancer. MATERIALS AND METHODS: We performed a retrospective review of patients with primary breast cancer and core biopsy proven metastatic ALNs, that had an excellent nodal radiological response following NACT, treated at our centre between January 2016 and December 2018. The initial cohort of patients (Group 1) underwent sentinel lymph node biopsy (SLNB), with a minimum of three nodes were sampled. The subsequent cohort (Group 2) had a marker clip inserted in the metastatic ALN prior to NACT. This cohort underwent wire guided excision of the clipped node in addition to SLNB, with a minimum of three nodes sampled. RESULTS: A total of 47 patients were identified. Group 1 comprised 22 patients with a sentinel lymph node (SLN) identification rate (IR) of 95%. 25 patients (Group 2) underwent wire guided clip location and the SLN IR was 100% with a 92% clipped node IR. Evidence of pathological complete response (pCR) in the clipped node was associated with pCR in other nodes. CONCLUSION: Targeted axillary dissection is a feasible technique following excellent response to NACT in selected patients with limited volume ALN metastasis, at diagnosis. The identification of the positive ALN during surgery is vital and the IR can be improved by clipping the node prior to NACT and wire guided localisation at the time of surgery.

Care After REsuscitation: Implementation of the United Kingdom's First Dedicated Multidisciplinary Follow-Up Program for Survivors of Out-of-Hospital Cardiac Arrest.

Survival rates after cardiac arrest (CA) are increasing, with more patients and their families living with the psychological consequences of surviving a sudden CA. The currently available neuropsychological assessment tools and therapies were not designed for CA, and may be inadequate. The Essex Cardiothoracic Centre set up the United Kingdom's first dedicated multidisciplinary "Care After REsuscitation" (CARE) service, offering CA survivors and their caregivers systematic psychological, cognitive, and specialized medical support for the first 6 months after CA. Twenty-one patients were recruited into the CARE pilot service evaluation. Patients' health at hospital discharge was poor; however, by 6 months all components (except general health) had improved significantly, and were close to that experienced by "healthy" individuals. Five (26%) required referral to a psychiatrist, with all 5 (26%) subsequently being diagnosed with moderate-to-severe depression, and 3 (16%) with comorbid post-traumatic stress disorder. Our study demonstrates a large unmet clinical need in general and neuropsychological assessment, and our results suggest that offering appropriate and prompt specialist diagnosis and therapies leads to an improvement in health at 6 months.

Genetics of breast cancer: management strategies and risk-reducing surgery.

The last two decades have witnessed major advances in genetic sequencing which have led to more accurate identification of women at risk of developing breast cancer and calculating the associated cancer risk. This review discusses the current genetic mutations conferring risk of developing breast cancer and the management pathway for these women with identifiable mutations as well as those with a strong family history for breast cancer. Management of these individuals is complex and should involve a multidisciplinary team with interest and expertise in breast cancer genetics. There are several treatment options ranging from surveillance to risk-reducing surgery. Risk reduction surgery has been popularised by celebrities who are carriers of breast cancer genes, and raised public awareness of breast cancer genetics and associated risk.

Office Based Endovenous Radiofrequency Ablation of Truncal Veins: A Case for Moving Varicose Vein Treatment out of Operating Theatres.

OBJECTIVES: This study aims to assess the efficacy and outcomes at one year after office based endovenous radiofrequency ablation (OBEVRFA) as a standalone procedure for varicose veins under local anaesthesia. METHODS: A retrospective study of prospectively collected data of all OBEVRFAs done in the vascular unit from April 2014 to June 2016 was performed. The demographics, clinical findings, initial venous duplex ultrasound (DUS) findings, the vein ablated, and immediate complications were recorded. Patients were reviewed at six weeks and again if necessary with or without a repeat DUS. The follow up period ranged from 12 to 38 months. Patients undergoing further procedures for symptomatic residual veins within the follow up period were recorded. Average cost and income were obtained from the hospital Patient Level Information and Costing Systems data. RESULTS: A total of 523 limbs were listed for OBEVRFA during the study period. Ninety-four (18%) were cancelled on the day of surgery for various reasons. A total of 429 procedures in 394 patients were performed. There were 35 bilateral cases; each limb performed on separate occasions. The female to male ratio was 1.2:1. The median age was 54 years (range 17-88 years). The CEAP (Clinical, Etiologic, Anatomic and Pathophysiologic) classification was C2 to C3, 291 (68%); C4 to C5, 11 (26%), and C6, 26 (6%). Forty-seven (11%) recurrent varicose veins were treated. There were three recorded cases of endovenous heat induced thrombosis (EHIT). Sixty (14%) patients were lost to follow up. One hundred and five (29%) patients underwent repeat DUS for persistent symptoms. In the follow up period, only 86 patients (23%) needed further multiple avulsions. CONCLUSIONS: OBEVRFAs of the truncal veins for the treatment of varicose veins is safe and effective and could be performed in all suitable patients to free up theatre capacity.

Jejunal diverticulum enterolith causing perforation and upper abdominal peritonitis.

A patient presented with a 4 h history of acute onset, progressive upper abdominal pain. There was localised peritonitis, with raised inflammatory markers and lactate. CT scan showed a large calcified mass, with evidence of mesenteric twist/volvulus causing some degree of small bowel obstruction. At laparotomy, there were multiple jejunal diverticula, one of which had perforated due to a large enterolith. Resection of the affected jejunum and washout was performed and the patient recovered well. Complications of jejunal diverticula and enteroliths are reported and should be considered in patients with an acute abdomen.

Application of mid-infrared chemical imaging and multivariate chemometrics analyses to characterise a population of microalgae cells.

A suite of multivariate chemometrics methods was applied to a mid-infrared imaging dataset of a eustigmatophyte, marine Nannochloropsis sp. microalgae strain. This includes the improved leader-follower cluster analysis (iLFCA) to interrogate spectra in an unsupervised fashion, a resonant Mie optical scatter correction algorithm (RMieS-EMSC) that improves data linearity, the band-target entropy minimization (BTEM) self-modeling curve resolution for recovering component spectra, and a multi-linear regression (MLR) for estimating relative concentrations and plotting chemical maps of component spectra. A novel Alpha-Stable probability calculation for microalgae cellular lipid-to-protein ratio Λi is introduced for estimating population characteristics.

Heterogeneous catalytic transesterification of phosphatidylcholine.

The transesterification of phosphatidylcholine (PC) via homogeneous and heterogeneous catalysis was investigated for the production of fatty acid methyl esters (FAME) i.e. biodiesel. Calcium methoxide and calcium oxide were used as heterogeneous catalysts, and KOH as a homogeneous catalyst for the transesterification of phosphatidylcholine (PC)--a polar phospholipid prevalent in eukaryotic organisms. The initial reaction rate was higher for KOH (24.23 g of FAME/g of catalyst.min) than for calcium methoxide (17.06 g of FAME/g of catalyst.min) and calcium oxide (1.06 g of FAME/g of catalyst.min). PC was then mixed with soybean oil at different proportions (i.e. 10%, 30% and 50%, PC10, PC30 and PC50, respectively) which was then used as the feedstock for transesterification using calcium methoxide. When the mass fraction of PC was increased in the feedstock reaction rate also increased. Phosphorus content of the FAME layer of PC100, PC50, PC30 and PC10 was 0.081, 0.041, 0.035 and 0.028% (w/w), respectively.

Perforated sigmoid diverticulum mimicking acute appendicitis in a young patient: a case report.

Acute colonic diverticula are uncommon in patients <40 years of age, with an incidence between 2% and 10%. In such patients, the condition may be misdiagnosed in the acute setting, because it is often not considered and may be mistaken for acute appendicitis, particularly if there are predominantly right-sided signs. As a result, it may result in diagnostic delay and complications. We report a case of a young patient who presented with a perforated sigmoid diverticulum mimicking acute appendicitis, which was not diagnosed initially, and the resulting course of events.

A rare and unusual case of bilateral, axillary, metachronous apocrine carcinoma.

Apocrine carcinoma is a rare sweat gland neoplasm with very few cases reported in the published literature. We report a case of primary axillary apocrine carcinoma with later recurrences in both axillae. A 55-year-old man was clinically diagnosed with hydradenitis suppurativa in the right axilla, and after excision of lesion, histology showed metastatic adenocarcinoma of probable breast origin. However, no primary focus was found after extensive work-up except for metastatic lymph nodes in the ipsilateral axilla treated with axillary clearance. After 4 years, the patient developed metastatic lymph nodes in the contralateral axilla and had surgery. He had a further recurrence in the right axilla and was treated with surgery and radiotherapy. He continues to do well at this time, with no evidence of local or distant metastases.