Neoadjuvant chemotherapy in non-metastatic breast cancer: The surgeon's perspective.

Breast cancer is the most common non-skin cancer in Australia, affecting 1 in 7 women by the age of 85 years. Current management of early breast cancer is becoming increasingly variable and complex. The typical range of treatments include some combination of surgery, chemotherapy and targeted therapy, immunotherapy, radiotherapy, and endocrine therapy. Neoadjuvant chemotherapy (NACT) in carefully selected patients can facilitate increased rates of breast conservation therapy, and when successful, offers improved cosmesis due to less extensive resection of tissue. A neoadjuvant approach also provides biological insight into a patient's tumour, prognostication based on a patient's response to therapy, as well as enabling their treating oncologist to personalise adjuvant strategies based on the presence or absence of residual cancer at surgery. Neoadjuvant chemotherapy has become an integral element in the provision of breast conserving surgery to selected early-stage breast cancer patients. Appreciating the indications and understanding the likely outcomes from NACT in select situations, can result in significant improvements in patient tailored care.

Horner's syndrome in traumatic first rib fracture without carotid injury; review of anatomy and pathophysiology.

Case report of a 51 year old man involved in a motor vehicle accident presenting with multiple thoracic wall injury, including bilateral first rib fractures. He slowly developed a right sided Horner's syndrome due to a right paravertebral haematoma. The initial imaging did not display any carotid injury, however the developing right paravertebral haematoma was not initially reported. We review the anatomy and pathophysiology of this well-known but rare condition to show how first rib fractures should raise suspicion of Horner's syndrome irrespective of the presence or absence of any underlying blunt carotid injury.