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Aim: Neoadjuvant chemotherapy (NAC) has recently been applied in treatment of operable breast cancers to enable breast conservation. We aimed to evaluate the accuracy of MRI in delineating residual tumor and pathological complete response (pCR). Patients & methods: 69 cases treated with NAC were monitored using breast MRI, findings were recorded and compared with histopathology. Results: MRI showed radiological complete response in 19 (27.5%), which correlated with pCR in 12 (63%) cases. However, five (7.3%) patients who achieved pCR were missed. Overall, the sensitivity was 70.6%, specificity 86.5%, positive predictive value 63.2% and negative predictive value of 90.0%. Conclusion: MRI showed promising results for evaluating response to NAC and predicting pCR, results need validation in larger trial.

A lymphocoele or cystic hygroma is a benign lymphatic malformation that usually presents as a congenital mass in infancy. These masses are most common in the cervicofacial region and more rarely occur elsewhere in the body. Spontaneous, atraumatic presentation in adulthood is extremely rare. We present a case of a 59-year-old woman who presented with a fluctuant mass in the axilla, which was diagnosed as a lymphocoele. Initial management by ultrasound-guided aspiration of the cyst proved unsuccessful due to recurrence. Surgical excision of the cyst was then successfully performed and histological analysis proved the diagnosis. The incidence of adult-onset lymphocoele without a history of prior trauma or operation is rare. This case report adds to the literature and reviews the various management strategies that have been successfully employed.

The object of the present study was to determine the effectiveness of a water-soluble contrast follow-through study for differentiating complete from incomplete small bowel obstruction (SBO) and for predicting the need for surgery. This prospective study was conducted at Riyadh Medical Complex, Saudi Arabia and spanned 2 years. All adult patients admitted with SBO were included, except those with obstructed hernias, peritonitis, or postabdominal irradiation. The initial resuscitation meglumine amidotrizoate (Gastrografin) follow-though was performed and was considered positive for complete obstruction if the contrast failed to reach the colon as shown on the 24-hour film. Patients were operated on only if they developed signs of strangulation or failed to improve within 48 hours. Our study group consisted of 73 patients, 48 (65.7%) of whom were male. The mean age was 35.70 ± 12.65 years. In 60 (82.2%) patients, contrast reached the ascending colon within 24 hours, giving a definitive diagnosis of incomplete obstruction; among these 60 cases, 49 (81.7%) resolved on conservative management. The other 13 (17.8%) patients were diagnosed as having a complete obstruction; 4 (30.8%) of them were treated conservatively, and 9 (69.2%) underwent surgery. Therefore the sensitivity, specificity, positive predictive value, and negative predictive value for meglumine amidotrizoate follow-through as an indicator for operative treatment of SBO were 45.0, 92.5, 81.7, and 69.2, respectively. The P value using Fisher’s exact test was 0.0006. We can confidently diagnose complete and incomplete SBO and differentiate one from the other. This accurate diagnosis indicates a high chance of success with conservative management for incomplete obstruction but does not always correlate with the need for surgical intervention.

This prospective study was carried out to compare the outcome of lung sparing damage control surgery versus major pulmonary resections for extensive thoracic trauma. The study analyses the results of 52 trauma victims who underwent thoracotomy for pulmonary injuries over a period of 5 years. Operative techniques, postoperative complications and mortality were assessed in both groups, results analysed with the help of Fisher’s exact test and Chi-square test and the analysis of variance for comparative analysis carried out with SPSS 10.0. Penetrating trauma was the main cause of thoracic injuries affecting 39/52 patients. Associated injuries were found in 9/13 blunt trauma victims, but only in 11/39 penetrating trauma sufferers. The morbidity and mortality were significantly higher after major resections, 6/11 and 2/11, as compared to lung sparing surgery, 10/41 and 2/41, respectively (p = 0.001). We recommend the use of lung sparing damage control techniques to manage major thoracic trauma requiring surgical intervention. Lung sparing surgery is an effective and much safer option as compared to major pulmonary resection when treating extensive lung trauma.

Background Adjuvant post-mastectomy radiotherapy (RT), which is often unpredicted, is known to increase complications following immediate breast reconstruction (IBR). Aim To investigate the role of sentinel lymph node biopsy (SLN) in predicting RT and improving the choice of IBR. Patients and methods All patients who had mastectomy and IBR between January 2004 and January 2007 were reviewed retrospectively. Axillary staging (clearance or SLN) was performed at the same time until October 2005 (Group 1), when the Unit's protocol was updated to perform SLN initially prior to mastectomy and IBR (Group 2). Patients in Group 2 with positive SLN were offered either a delayed reconstruction or a temporary subpectoral immediate tissue expander, while all options were offered if SLN was negative and in Group 1 patients. Results One hundred and thirty-nine patients were reviewed. 20 patients received unexpected RT in Group 1 (14 tissue expander, 4 Latissimus Dorsi flap with an implant and 2 DIEP flaps) compared to 11 patients in Group 2 who had a temporary tissue expander due to expected RT ( P =0.03). Unexpected RT caused delayed complications in 14 patients (70%) compared to no delayed complications in patients who received expected RT in Group 2. Conclusion SLN biopsy before IBR helps to predict RT and avoids its complications on breast reconstruction. Patients with positive SLN biopsy are best offered a temporary subpectoral tissue expander for IBR.

Wandering spleen is a rare clinical entity, characterized by splenic hypermobility that results from elongation or maldevelopment of its suspensary ligaments. The wandering spleen is in constant danger of torsion and infarction. This condition poses a great diagnostic challenge due to lack of awareness and paucity of symptoms. Among adults, it usually occurs in females of childbearing age, the children below ten years of age are other sufferers. The clinical presentation may be acute or chronic; such as asymptomatic abdominal mass, an acute abdomen, or, most commonly, a mass associated with vague abdominal symptoms. Computed tomography and duplex ultrasonography are best diagnostic modalities. The traditional conservative approach carries high risk of infarction leading to splenectomy and postsplenectomy sepsis. Splenopexy is the treatment of choice for all noninfarcted wandering spleens. Splenectomy should only be performed when there is no evidence of splenic blood flow after detorsion of the spleen. The present study, reviews the presentation, course, diagnostic modalities and management options of wandering spleen.