Miracles, Martyrdom and Violence: Historical Origins of the Patron Saints of Trauma and Orthopaedic Surgery.

Patron saints have been adopted to protect against disease and disability in the Christian world since the Middle Ages. A patron saint most often has a morbid connection to their affiliated ailment, although patronage may stem from physical attributes or a miracle performed. The purpose of this study is to identify and describe patron saints associated with injury, musculoskeletal disease and orthopaedic pathology.

Breast cancer metastasis burden in sentinel nodes analysed using one-step nucleic acid amplification predicts axillary nodal status.

Background: In breast cancer patients undergoing sentinel lymph node biopsy (SLNB) analysis using one-step nucleic acid amplification (OSNA), clarity is required as to the risk factors for non-sentinel lymph node (NSLN) involvement upon axillary lymph node dissection (ALND). This study aims to identify these factors, including categorising by extent of sentinel node positivity: solitary positive node (solitary), multiple nodes with some positive (multiple incomplete positive), or multiple nodes all of which are positive (multiple all positive).

Methods: We conducted a cohort study using prospectively collected data on 856 SLNBs analysed using OSNA, from patients with cT1-3 clinically node-negative invasive breast cancer.

Nonresective repair for abdominal aortic aneurysm.

Background: In this report, we present our experience with nonresective repair of abdominal aortic aneurysm in selected patients who were unsuited for other surgical approaches and would benefit from repair.

Methods: Seven patients with abdominal aortic aneurysm underwent nonresective repair comprising aneurysm embolization followed by the creation of an axillary-femoral, femoral-femoral bypass with a polytetrafluoroethylene (PTFE) graft.

Results: Between April 2006 and March 2009, seven patients (mean age: 85 years) underwent surgery.

Suprarenal stricture of the inferior vena cava with massive iliocaval and distal thromboses successfully treated with catheter-directed thrombectomy, thrombolysis and angioplasty.

Long-term complications from deep vein thrombosis, such as post-thrombotic syndrome and chronic venous insufficiency, can result in significant morbidity for the affected patient. Although anticoagulation has been the conventional method of treatment, the benefit of thrombus burden removal cannot be underestimated. The present case report describes the successful treatment of extensive iliocaval and distal thrombosis with suprarenal inferior vena cava stricture using catheter-directed thrombolysis, thrombectomy and angioplasty.

Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial.

Background: Sentinel lymph node biopsy in women with operable breast cancer is routinely used in some countries for staging the axilla despite limited data from randomized trials on morbidity and mortality outcomes. We conducted a multicenter randomized trial to compare quality-of-life outcomes between patients with clinically node-negative invasive breast cancer who received sentinel lymph node biopsy and patients who received standard axillary treatment.

Methods: The primary outcome measures were arm and shoulder morbidity and quality of life.

Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer.

This study is the first large prospective RCT of sentinel node biopsy (SNB) compared with standard axillary treatment (level I-III axillary lymph node dissection or four node sampling), which includes comprehensive and repeated quality of life (QOL) assessments over 18 months. Patients (n = 829) completed the Functional Assessment of Cancer Therapy - Breast (FACT-B+4) and the Spielberger State/Trait Anxiety Inventory (STAI) at baseline (pre-surgery) and at 1, 3, 6, 12, and 18 months post-surgery. There were significant differences between treatment groups favouring the SNB group throughout the 18 months assessment.