Patients' views and experiences on the supported self-management/patient-initiated follow up pathway for breast cancer.

PURPOSE: To explore patients' expectations and experience of Supportive Self-Management (SSM)/ Patient Initiated Follow Up (PIFU) following breast cancer treatments over a 12-month period. METHODS: In total, 32/110 (29%) patient participants in the PRAGMATIC (Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer) study were interviewed at baseline, 3, 6, 9 and 12 months. Interviews in this sub-study used a mix-methods approach to explore understanding of the pathway, confidence in self-management, triggers to seek help and/or re-engage with the clinical breast team and impact of the COVID-19 pandemic. Responses to pre-assigned categories were summarised as counts/ percentages and collated in tabular or graphic format. Free responses were recorded verbatim and reviewed using framework analysis. RESULTS: Participants regarded the SSM/PIFU pathway as a way to save time and money for them and the National Health Service (NHS) (14/32; 44%) and as a means of assuming responsibility for their own follow-up (18/32; 56%). Most maintained (very/somewhat) confidence in managing their BC follow-up care (baseline 31/32, 97%; 12 months 29/31, 93%). During the year, 19% (5/26) stopped endocrine therapy altogether because of side effects. Qualitative analysis revealed general satisfaction with SSM/PIFU and described the breast care nurses as reassuring and empathic. However, there was a lingering anxiety about identifying signs and symptoms correctly, particularly for those with screen-detected cancers. There was also uncertainty about who to contact for psychological support. The COVID-19 pandemic discouraged some participants from contacting the helpline as they did not want to overburden the NHS. CONCLUSIONS: The results show that during the first year on the SSM/PIFU pathway, most patients felt confident managing their own care. Clinical teams should benefit from understanding patients' expectations and experiences and potentially modify the service for men with BC and/or those with screen-detected breast cancers.

Surgical dilemma of the management of breast cancer in a patient with neurofibromatosis: case report and a review of the literature.

Neurofibromatosis type 1 (NF-1)-also commonly known as Von Recklinghausen's disease-is an autosomal dominant disease that represents a constellation of clinical features. There are well-established links between NF-1 and many tumors; however, the link between NF-1 and breast cancer has more recently been elucidated. While the management of breast cancer is generally well established, there are unique challenges noted in patients with NF-1. There may be delayed presentations due to difficulty in differentiating underlying neurofibroma from a sinister breast mass. Additionally, multiple skin lesions seen in NF-1 create challenges in the interpretation of mammography. Furthermore, a surgical conundrum is created, as these patients appear to have a higher risk of angiosarcoma following radiotherapy. A mastectomy may be the best option as it obviates the need for radiation therapy and ongoing surveillance. A case exemplifying these dilemmas and a review of the literature are presented.

Oncoplastic breast surgery technique for retroareolar breast cancer: a technical modification of the Grisotti flap in patients with short nipple to inferior mammary crease distance.

The introduction of breast conservation surgery together with advances in oncoplastic techniques has revolutionized the management of retroareolar breast tumours. Traditionally, cancers in this location were often managed with central excision and primary closure or mastectomy. More recently, oncoplastic breast-conserving techniques such as the Grisotti mammoplasty have been increasingly encouraged as an alternative option as it allows oncological safe margin resections while restoring cosmesis. The use of a Grisotti flap enables safe resection of a retroareolar tumour with concurrent reconstruction of the defect using a local rotational advancement dermoglandular flap allowing a satisfactory cosmetic result in term of contour and projection. This technique is often limited to those patients with sufficient native nipple-inferior mammary fold (IMF) distance to accommodate for some inevitable post-operative reduction in this distance. We describe a modification of the original description, such that satisfactory cosmetic outcome can be achieved, even in patients with a short nipple areolar complex to inframammary fold distance.

Chronic breast abscess due to Mycobacterium fortuitum: a case report.

INTRODUCTION: Mycobacterium fortuitum is a rapidly growing group of nontuberculous mycobacteria more common in patients with genetic or acquired causes of immune deficiency. There have been few published reports of Mycobacterium fortuitum associated with breast infections mainly associated with breast implant and reconstructive surgery. CASE PRESENTATION: We report a case of a 51-year-old Caucasian woman who presented to our one-stop breast clinic with a two-week history of left breast swelling and tenderness. Following triple assessment and subsequent incision and drainage of a breast abscess, the patient was diagnosed with Mycobacterium fortuitum and treated with antibiotic therapy and surgical debridement. CONCLUSION: This is a rare case of a spontaneous breast abscess secondary to Mycobacterium fortuitum infection. Recommended treatment is long-term antibacterial therapy and surgical debridement for extensive infection or when implants are involved.

Pre-emptive angioaccess for haemodialysis in the elderly.

BACKGROUND: The fastest growing population group in the UK is the elderly, particularly those aged ≥ 80 years. The primary aim of this study was to assess if age was a determining factor for successful first dialysis through a pre-emptive angioaccess. The secondary aim was to investigate what risk factors are associated with angioaccess failure and to assess their patency and complications in three different age groups of patients who had pre-emptive angioaccess. METHODS: The study was carried out retrospectively on prospectively collected data for the period January 2006-December 2007. The study population included all patients who had pre-emptive angioaccess for haemodialysis during the time frame of the study. They were divided into three age groups including a control group (A) with age <70 years, a young old group (B) (70-79 years) and an old group (C) (≥80 years). Primary failure and primary, assisted primary and secondary patency rates were ascertained and compared using the Kaplan-Meier curves and log-rank testing. RESULTS: Of 243 patients who had a pre-emptive vascular access, 110 (45%), 82 (35%) and 51 (21%) patients were in Groups A, B and C, respectively. The rates of successful first dialysis through the angioaccess, excluding patients not in end-stage renal disease yet, or those who received pre-emptive kidney transplant were 88, 71 and 87% for Groups A, B and C, respectively (P > 0.05). There were six deaths before dialysis could be commenced. The primary, assisted primary and secondary patency rates after 12, 24 and 36 months did not show any significant difference between the groups (P > 0.05). CONCLUSIONS: Elderly patients should be considered for angioaccess as first line of venous access. Our study showed a successful first dialysis with angioaccess with failure and patency rates comparable to other age groups. However, we still recommend that patients >80 years old be assessed on a case-by-case basis.

Enormous brachio-cephalic arteriovenous fistula aneurysm after renal transplantation: case report and review of the literature.

Creation of arteriovenous fistulae provides readily available vascular access for haemodialysis in patients with end-stage renal disease. However, it is associated with various potentially serious complications if left unattended. We report a case of a 73-year-old male presenting with an enormous brachio-cephalic fistula aneurysm measuring 70-5.4 cm 20 years after successful renal transplantation. Despite attending regular renal outpatient clinic follow-up, this was only noticed as an incidental finding when the patient attended the emergency department after a fall that severely bruised his access. The patient subsequently underwent ligation with complete removal of the aneurismal fistula and discharged to a rehabilitation unit 3 days post-operatively. Systematic closure of an arteriovenous fistula should be considered in all patients after successful renal transplantation to avoid potentially catastrophic complications of an arteriovenous fistula. In patients in whom the closure of vascular access is contraindicated, it is crucial to regularly assess the status of any arteriovenous fistula when following up patients after renal transplantation.

Primitive Neuroectodermal Tumour (PNET) in subcutaneous abdominal wall: a case report.

Primitive neuroectodermal tumour (PNET) is a rare tumour mainly found in children under ten years old. It may be broadly categorised into those occurring from the central or peripheral nervous system of which the majority arise centrally. We report a 61 year-old lady who had previous lobular breast cancer presenting with a rapidly expanding lesion in her anterior right upper abdominal wall. Clinically it appeared to be benign, however, histopathology of the excised lesion revealed a localised PNET. This case is an unusual case of a PNET in an adult that is peripheral in nature arising from subcutaneous tissue in the abdominal wall.

Monophasic synovial sarcoma of the pharynx: a case report.

Synovial sarcomas are a rare form of soft tissue sarcomas. We present a case of a 62 year-old male presenting with a left thyroid lump initially though to be a thyroid adenoma but subsequently diagnosed as a monophasic synovial sarcoma of the pharynx. We discuss the diagnosis and treatment of this case.

Spontaneous ruptured splenic artery aneurysm: a case report.

Splenic artery aneurysms are rare. We discuss a case of a 58-year-old gentleman presenting with collapse and shock secondary to spontaneous splenic artery aneurysm rupture. Patient underwent laparotomy and splenectomy then discharged home within a week of presentation.