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This study investigates whether methylene blue (MB), patent blue V (PBV), and indigo carmine (IDC) commonly used in sentinel node biopsy cause DNA damage to breast epithelial cells in vitro.MCF-7 and HB-2 cells were exposed for 5 minutes to the above dyes at the same concentrations used in clinical practice. Following exposure, the comet assay was performed to detect DNA damage. The enzyme, Fapy-DNA glycosylase (FpG) was incorporated to enable the detection of additional oxidative damage.Both PBV and MB stimulated DNA strand breaks in both MCF-7 and HB2 cell lines (P0.05). Levels were elevated over 3-fold (P0.05) in MCF-7 and HB2 cells treated with 2.5% PBV and 1% MB, compared with untreated control cells. In contrast, IDC did not stimulate DNA strand break damage at clinically relevant concentrations in either cell line. Addition of Fapy-DNA glycosylase enzyme also revealed significantly (P0.05) increased levels of oxidative DNA lesions (ODL) in MCF-7 cells treated with PBV (17.6% ODL) compared with control cells (5.9% ODL).This study shows, for the first time, that certain dyes (MB and PBV) commonly used in SLNB have genotoxic effects on breast cells at clinically relevant concentrations in vitro. In vivo studies are now warranted to assess and minimize DNA damage caused by these dyes during SLNB.

g-glutamyl transferase (GGT), which is found in both serum and cell plasma membrane, has an important antioxidant effect through the metabolism of glutathione [1]. Conversely, pro-oxidant species, including superoxide and hydrogen peroxide, are produced during glutathione catabolism as a result of interaction with trace levels of cellular iron ions [2]. Because of its protective role in oxidative stress, serum GGT has been found to be elevated in many pathological processes, including liver disease, cardiovascular disease, renal disease, diabetes, kidney disease and cancer [3]. There is also mounting evidence to suggest that elevated GGT may be associated with an increase in risk of breast cancer. In a population-based cohort of over 90,000 Austrian women, serial serum GGT levels were measured and the participants were followed for a median of 13.5 years [4]. During this time, 4884 cancers were diagnosed. When women with low normal GGT levels (

Primary leiomyosarcoma of the breast is a rare tumour with only around thirty cases reported in the literature. Most of the cases reported are in females, while only a few are reported in males. We present a case of primary breast leiomyosarcoma in a 59-year-old man that presented with a subareolar lump which felt to be benign clinically and radiologically but proven to be a leiomyosarcoma on excision.

Inflammatory breast cancer (IBC) is a rare entity that makes up 1-3% of breast cancers. As the diagnosis of IBC is mainly clinical, for the inexperienced the clinical appearance can mimic mastitis leading to diagnostic delay and it is often associated with a poor prognosis. Very few cases of bilateral IBC are reported in the literature, all of which have been synchronous. We report an unusual case of bilateral metachronous IBC each with complete clinico-pathological response after treatment with neoadjuvant chemotherapy and surgery on both occasions.

Leiomyosarcomas of the great vessels are rare, but the most common site for them is the inferior vena cava. Due to non-specific clinical signs, diagnosis is usually late. At present, surgery is the treatment of choice. This is a case report of a 44-year-old man who presented with left groin discomfort and a left varicocele which were secondary to leiomyosarcoma of the inferior vena cava.

Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign proliferating breast condition. It was first reported in 1986 when Vuitch, Rosen, and Erlandson described nine cases of benign well-circumscribed, breast masses that simulated vascular lesions consisting of mammary stromal proliferations (Vuitch et al. (1986)). Since then there have been few reported cases of PASH in the literature (Taira et al. (2005)). We describe a large PASH, mimicking inflammatory carcinoma in a young lady that was excised with excellent cosmetic results.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used worldwide, and their complications in the upper gastrointestinal tract are well described in the literature and well known to clinicians. However, complications in the large bowel are being increasingly recognized and reported. This review aims to address the different aspects of NSAIDs-associated colopathy. Methods: This is a review article addressing NSAIDs colopathy. A Medline-based search was performed for articles published between 1950 and 2008 on this condition. Keywords detailed were colonic disease, ulcers, strictures and/or diaphragm strictures. Only articles in the English language were considered. Results: The articles identified included letters to the editors, case reports, case series, review articles and few original research papers. The review was structured in a narrative style in different sections addressing pathophysiology, clinical presentation and management. Conclusions: NSAIDs colopathy is a rare benign condition. Current evidence only suggests an association with prolonged use of the NSAIDs, however, there are no studies to support the direct causation. The presentation is non-specific, and the commonest findings on endoscopy are ulceration and diaphragm-like strictures. The importance of identifying this condition is to prevent complications and also to be able to differentiate it from other conditions such as inflammatory bowel disease (IBD) and malignancy.

Objective: Nerve injury is one of the most common complications of varicose vein surgery and is a frequent cause for litigation but its incidence following lower limb arterial surgery has not been well documented. This study was undertaken to determine the incidence of nerve injury following lower limb arterial surgery. This was addressed in relation to long saphenous or femoral vein harvesting, or re-operative surgery. Materials and Methods: A total of one hundred patients who had undergone lower limb arterial reconstruction in the previous five years were invited to participate in this study. Seventy-eight patients responded, of which 44 patients (66 operated legs) agreed to participate. They underwent neurological assessment of the lower limbs. Results: 66.7% of limbs had objective evidence of sensory deficit following lower limb arterial surgery but none had motor deficit. Redo surgery or superficial femoral vein harvest had no influence on the incidence of nerve injury. Below knee incisions had a higher incidence of nerve injury than other approaches. Long saphenous vein harvest significantly increased the rate of nerve injury. Conclusions: There is a high incidence of sensory nerve damage following lower limb arterial surgery. In the present climate ofincreasing litigation it is important to know the likely incidence of post-operative nerve damage so that patients can be counselled appropriately during the process of obtaining informed consent.

Neoadjuvant chemotherapy (NACT) is a useful approach in the treatment of many breast cancers. One of the main advantages of NACT is the possibility of breast conservation surgery in patients who would otherwise require a mastectomy. Most literature on NACT focuses on the effectiveness of different chemotherapy regimen and subsequent mastectomy rates. There is little guidance in the literature on aspects of individual patient management and decision making during NACT. This paper considers practical management advice where NACT is considered and adopted.

Sentinel lymph node biopsy (SLNB) is currently used in the UK for axillary staging in breast cancer. Node localisation is achieved with the combination of injected dye and radioactive tracer.1 The commonly used dyes are the isomers isosulphan blue and Patent blue V (PBV).1–3 Methylene blue (MB) is also used in some centres as it is cheaper and easily available.4 In the Far East, other dyes such as Indigocarmine (IDC) are also being used.5 In the 1980s, when dyes were used to localise occult breast cancers before surgery, studies were carried out on the effect of the dyes on oestrogen receptor (ERα) assessment by ligand-binding assay. These showed a decrease in the binding capacity after treatment with MB but not with isosulphan blue.6,7 Given the importance of the determination of ERα expression in the treatment of breast cancer and the wider use of SLNB to stage the axilla, we investigated whether the dyes used change the immunocytochemical profile of these receptors. The ERα-positive and progesterone receptor (PR)-positive malignant breast cell line MCF-7 was cultured under standard conditions and exposed to the dyes diluted 1:10, 1:100 and 1:1000 in triplicate for 4 and 24 h. The dyes used were 2.5% PBV (Guerbert, France), 1% MB (Martindale Pharmaceuticals, UK) and 4% IDC (Amino), which are the concentrations used clinically for …

This article aims to review gallstone ileus in the literature addressing the pathophysiology, clinical presentation, radiological findings and treatment options of the condition. A literature search was done on gallstone ileus, for the period 1966-2005. Gallstone ileus is a disease of the elderly, causing up to one fourth of non-strangulation intestinal obstructions in patients older than 65 years of age. It is often missed or diagnosed late. The presentation is that of intestinal obstruction preceded by biliary complaints. Radiological features on plain X-rays include features of intestinal obstruction and pneumobilia, and an aberrant gallstone. Treatment depends on the site of the impacted stone, but surgery is needed in many cases. Gallstone ileus is a rare complication of a common condition. Because it primarily affects the elderly, mortality and morbidity are high, although they have improved over the years. Early diagnosis and treatment improve the outcome.

Abdominal aortic aneurysm (AAA) is one of the important differential diagnoses of back pain which is often missed. Chronic contained rupture is a rare event that can cause diagnostic difficulties, presenting in different ways such as back pain, neuropathy or groin mass. We are presenting a case of 46-year-old man who presented with history of recurrent low back pain radiating to his left leg, associated with sensory deficit in the left thigh. His complaint proved to be resulting from chronic contained AAA leak.

A review of the safety profile of dyes injected to assist in sentinel lymph node biopsy (SLNB) in breast cancer.A literature search was performed of the medline database 1966-2005 using the Ovid web Gateway detailing the words sentinel node, breast cancer, allergic reactions, blue dye, isosulfan blue, patent blue and methylene blue.There are reported side-effects from the parenteral administration of dyes, which range from minor to life threatening in severity. There are differences between the dyes as regards their effects. These aspects are discussed.Many dyes have been used for SLNB with acceptable identification rates. There are variable side-effects for each of those dyes. Further research is needed to clarify the safety profile of these dyes.

Vascular injuries following cholecystectomy are a known entity though the incidence is low. More frequently we are seeing cases of right hepatic artery pseudo aneurysm post cholecystectomy after the advent of the laparoscopic approach.We report a case of multiple right hepatic artery aneurysms as a complication of cholecystectomy in a 71-year-old patient.The diagnosis was confirmed by angiogram, and the patient was treated successfully with coil embolisation.Though it is a rare complication, early diagnosis and treatment of postoperative pseudo aneurysm is essential to prevent life threatening bleeding.

We read with great interest the article Conversion After Laparoscopic Cholecystectomy in England published in the Surgical Endoscopy [1]. We appreciate the efforts of the authors to explore the causes for conversion of laparoscopic cholecystectomy (LC) in England. We think the following points are complementary to the educational value of the study: 1. The two parameters for assessing difficult LC are conversion and the iatrogenic injuries. The article assessed some of the factors associated with conversion but did not indicate what types of injuries were encountered in the study group. We are very interested in knowing how many bile duct injuries and other visceral injuries were reported in this national study. In the United States, about 600,000 cases of LC are managed every year as well as approximately 1,800 to 3,600 bile duct injuries per year (incidence, 0.3‐0.6%) [2, 3]. 2. The article confirmed several predictive factors for conversion. However, other important factors were not mentioned including upper abdominal adhesions, obesity, liver cirrhosis, cholecysto-enteric fistula, large liver and gallbladder, abnormal anatomy due to Mirizzi syndrome, choledochal cyst, and cholangiocarcinoma. The significance of these parameters was confirmed in the literature [4]. Awareness of these by the surgical community that performs LC is therefore crucial to the reduction of the conversion rate to a minimum. We appreciate a kind response from the authors.

This is a case report of an 85-year old patient who presented with abdominal pain, nausea and vomiting associated with altered liver function test. The plain X-rays and CT scan showed pneumobilia with an ectopic gallstone. The patient was diagnosed with Bouveret syndrome and managed surgically. The report is followed by a discussion about Bouveret syndrome.