Intramural oesophageal dissection is an uncommon but important clinical condition. It often occurs in patients who are anticoagulated, and the clinical presentation may include chest pain, dysphagia and haematemesis. The aim of this review was to determine an appropriate treatment algorithm for patients with suspected intramural oesophageal dissection. We conducted a literature review using PubMed and MedLine up until December 2008. We also reported on our own case series of three patients with intramural oesophageal dissection presenting at two Adelaide hospitals over the past 5 years. Recognition of the risk factors and clinical symptoms associated with this condition is imperative to avoid unnecessary and potentially harmful investigations and therapy. Intramural oesophageal dissection usually follows a benign course requiring conservative therapy only.
Oncoplastic techniques used for partial mastectomies to provide greater oncological clearance resulted in a high level of patient satisfaction after surgery.
Microsurgical free tissue transfer is a valuable technique for the reconstruction of soft-tissue defects around the knee, and the medial sural artery (MSA) is an ideal recipient vessel for anastomosis. Previously, the vessel has been described as the dominant supply to the medial gastrocnemius, but no research has addressed the subsequent effect to the muscle after interruption of MSA. The volume of the postoperative medial gastrocnemius of 4 patients treated with free flap reconstruction using MSA as recipient, was assessed clinically and using magnetic resonance imaging, with muscle function assessed using a patient questionnaire, and measurement of ankle torque with concurrent electromyography. Magnetic resonance imaging volume assessment revealed the postoperative medial head of gastrocnemius proportional to its synergist of separate blood supply, the lateral gastrocnemius and functional assessment suggest little difference between limbs such that the MSA should be used with confidence as recipient vessel for free flap reconstruction of soft-tissue defects around the knee.
Sentinel node biopsy was an accurate tool for staging the axilla with a false negative rate comparable to that seen in small tumours. However, given the increased incidence of metastases with larger cancers, further prospective investigation is warranted.
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