Chronic granulomatous mastitis with axillary lymphadenopathy in a nulliparous woman.

Chronic Granulomatous Mastitis (CGM) is a rare disorder and this generally occurs in young women with a recent history of lactation. Development of this disease in nulliparous women are rare with an incidence of 10%. Axillary lymphadenopathy is seen in 15% of cases diagnosed with CGM. We present a case of CGM in a 23- year-old nulliparous woman presenting with a breast mass and multiple axillary lymphadenopathy. To the best of our knowledge there are no documented cases of both these rare clinical features occurring simultaneously. The use of oral steroids prevented surgery and effectively induced remission.

Breast cancer with dermatomyositis as initial presentation.

Patients with breast cancer normally present with breast lump or abnormal mammogram. Dermatomyositis is rarely the first presentation. We present a case of a 63-year-old woman who had generalised dermatitis, progressive fatigue and muscle weakness. She was first diagnosed as dermatomyositis and subsequently breast cancer. Her rash and muscle weakness progressed drastically over a month. Tumescent mastectomy and axillary surgery was performed, which led to gradual regression of her dermatomyositis over six months. This case report emphasized in the benefit of early diagnosis and treatment of dermatomyositis and breast cancer. Pros and cons of tumescent mastectomy is discussed as well.

Total parathyroidectomy under local anaesthesia for renal hyperparathyroidism.

INTRODUCTION: Renal hyperparathyroidism with attendant osteodystrophy is a frequent and severe morbidity affecting the quality of life of end stage renal failure patients surviving on long-term renal replacement therapy. A small subgroup of these patients with severe cardiorespiratory dysfunction was deemed at very high risk for general anaesthesia (GA). We report on a series of total parathyroidectomy under local anaesthesia (LA) for these patients. METHODOLOGY: A total of 32 consecutive patients with severe cardiorespiratory dysfunction who underwent total parathyroidectomy under LA over a period of 7 years were prospectively accrued in this study. The patient characteristics, the operative outcome and the feasibility to surgery under LA were analysed. RESULTS: Sixteen of the patients (50%) had severe restrictive lung disease as a result of renal osteodystrophy and the other 16 patients had poor cardiac status. Histopathological examination confirmed 23 (71.9%) patients had four glands removed and seven (21.9%) patients had three glands removed. Two patients had only two glands removed and had recurrent hypercalcaemia. However, all patients reported symptomatic improvement. The post-operative complications were minimal; one patient had acute coronary syndrome and wound haematoma and another patient had wound haematoma which necessitated exploration under LA. A further patient developed congestive heart failure requiring treatment in the coronary care unit. CONCLUSION: Total parathyroidectomy can be performed safely and successfully under LA. We believe surgery under LA would be the most appropriate option for selected, high-risk patients to minimise the risk of GA.

Thoracoplasty with acrylic plate-marlex mesh combination following near total resection of sternum: a case of chondrosarcoma of sternum.

Removal of the whole sternum for malignant tumours results in a large defect, causing severe deformity and possible paradoxical movements of the chest wall. The reconstruction of the resultant large defect of the chest wall is often complex and difficult. Commonly used materials include rib autograft, steel strus acrylic plate and various synthetic meshes such as Goretex or Marlex mesh, with a myocutaneous flap for coverage. A case of a 48-year-old man with sternal chondrosarcoma successfully treated with thoracoplasty using acrylic plate-marlex mesh combination following near total resection of sternum is reported.