The use of the trapdoor incision for access to thoracic inlet pathology in children.

Lesions at the thoracic inlet are difficult to access via a thoracic or cervical approach. The use of the anterior cervico-thoracic trapdoor incision has been reported to give good exposure to the anterior superior mediastinum in adults. We report our experience of four cases where a trapdoor incision was used to gain excellent access and exposure to thoracic inlet pathology in children.

Neonatal tumours in Malaysia: a call for heightened awareness.

PURPOSE: Neonatal neoplasms are rare tumours notorious for their atypical presentation and unpredictable behaviour. Their optimal treatment remains uncertain, a dilemma compounded by the deleterious effects of adjuvant chemo- or radiotherapy during this vulnerable period of growth. This paper examined the relatively high incidence of these tumours and its impact on paediatric surgery in Malaysia. METHODS: Neonatal tumours treated at the Department of Paediatric Surgery, Kuala Lumpur Hospital over an 8-year period were retrospectively analysed. Besides data pertaining to patient demographics, distribution of tumour types and survival rates, morbidity from disease as well as treatment was emphasised in particular. RESULTS: The 28 neonatal tumours, majority of which were sacrococcygeal teratoma, constituted 7% of all tumours treated by the unit. Surgical excision remained the mainstay of treatment. Mortality and morbidity from disease and treatment were not insignificant, at 7 and 29%, respectively. CONCLUSION: The outcome of neonatal tumours treated in Malaysia appeared to be influenced by indigenous factors unique to the local healthcare setting. Several solutions were expounded, chief among these are strategies of improved and earlier detection, in addition to the centralisation of expertise for this group of tumours.

Specimen shrinkage and its influence on margin assessment in breast cancer.

OBJECTIVE: The determination of tumour-free margin in breast cancer is crucial in deciding subsequent patient management. To exemplify the phenomenon of margin contraction during specimen preparation for histopathological analysis, we quantified the shrinkage of breast specimens as a result of formalin fixation. METHODS: Fifty consecutive mastectomy and wide excision specimens were prospectively appraised. The closest free margin and maximal tumour diameter of fresh, unprepared specimens were recorded. These measurements were compared with the corresponding parameters following tissue fixation. RESULTS: Following formalin fixation, the mean closest free margin of the specimens was found to have decreased from 10.28 mm to 6.78 mm (34%). The reduction of the mean diameter of the tumour itself was less significant, from 41.74 mm to 39.88 mm (4.5%). CONCLUSION: Breast specimens undergo shrinkage after histological fixation, losing more than a third of their original closest free margin, whilst the tumour itself does not shrink substantially. This phenomenon has vital implications in the accuracy of margin analysis and consequent decisions on further management, including re-operation and the institution of adjuvant radiotherapy.