We present the case of an unusual base of the first metacarpal fracture. The presentation and radiological images are provided to demonstrate a first metacarpal base fracture but with a concurrent appearance at first glance of a trapeziectomy mimic on plain radiographs. The CT scan however demonstrates the true nature of the injury - a comminuted fracture with carpometacarpal subluxation. The radiological and clinical findings presented a diagnostic and therapeutic dilemma. We elected to not intervene surgically with a good resulting clinical outcome, reminding us of the need to treat the patient and not their radiographic images.
ObjectivesThis study aims to review a case series of deep venous reconstruction procedures performed at one centre by a single consultant.MethodsA retrospective review of deep venous reconstruction procedures performed by a single consultant from 1994 to 2013 was carried out and all notes were reviewed for outcomes. A 58-month cumulative patency rate was calculated using Kaplan-Meier survival analysis.ResultsNineteen patients underwent deep venous reconstruction procedures including the Palma bypass, May-Husni bypass, femoral vein transposition and axillary vein transplant techniques from 1994 to 2013. Eleven patients were male and eight were female with a mean average age of 45.2 years (range 29-63). Clinical severity of disease ranged from C3 to C6, and 16 patients had a confirmed history of deep vein thrombosis. Cumulative primary patency rate for all reconstructions at 58 months was 89.5%, with two patients occluding and 17 remaining patent at last follow-up.ConclusionDeep venous reconstructions, particularly the Palma and May-Husni procedures, are feasible and can have good outcomes in patients failed by endovascular techniques and other more conservative therapies.
Background: The role of oncoplastic breast conserving surgery (OBCS) is that of a middle ground between standard breast conserving surgery (SBCS) and mastectomy - it allows adequate resection margins of tumours unsuitable for traditional breast conserving surgery whilst allowing for a better cosmetic outcome and a reduced morbidity rate when compared to a traditional mastectomy. However, due to this being a relatively new type of procedure, there is limited evidence on its oncological safety, which is the ultimate goal of any breast cancer surgery.
Methods: This study aims to compare oncological safety of OBCS with SBCS and mastectomy by examining the relative risk of cancer recurrence and re-operation rates through meta-analysis. Literature search of Pubmed and Web of Science databases was conducted looking for studies up until February 2019. Meta-Analysis was performed using R Statistical Software (www.r-project.org).
Results: Initial finding of 645 studies was narrowed down to a pool of 19 studies including 18,163 patients. For the primary outcome measure of recurrence there was found to be no significant difference between the OBCS and SBCS or mastectomy (RR 0.861; 95% CI 0.640-1.160; p<0.296). The secondary outcome measure of re-operation was initially found to be significant in favour of OBCS (RR 0.64; 95% CI 0.46-0.89; p<0.01), however after adjustment for publication bias this was attenuated to an insignificant difference between the two study groups (RR 0.86; 95% CI 0.56-1.31; p>0.05).
Conclusions: For both recurrence of cancer and re-operation rate, there was not found to be a significant difference between OBCS and more traditional techniques. This would suggest that OBCS is of comparable oncological safety to more established operations and a useful option in suitable patients.
Citation Format: Sebastian Kosasih, Salim Tayeh, Kefah Mokbel, Abdul Kasem. Oncoplastic breast conserving surgery (OBCS): A meta-analysis of real-world data [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-13-09.
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