N-WASP is a key regulator of cell migration and actin polymerisation. We examined the correlation of N-WASP, with human breast cancer, in vitro, in vivo and in clinical breast cancer tissue. Immunohistochemical study of frozen sectioned human breast mammary tissues (n=124) revealed that mammary epithelial cells stained positively for N-WASP and that cancer cells in tumour tissues stained very weakly. Quantitative RT-PCR revealed that breast cancer tissues had significantly lower levels of N-WASP compared with normal background mammary tissues (0.83+/-0.3 vs 13.6+/-13, P=0.03). Although no significantly correlation was found with tumour grade and TNM staging, lower levels of transcript were seen to correlate with clinical outcome following a ten year follow up. Thus tumours from patients with predicted poor prognosis had significantly lower levels than from those with good prognosis (0.098+/-0.14 vs 1.14+/-0.56, P=0.05). Patients with metastatic disease/died of breast cancer had significantly lower levels of N-WASP compared to those remaining disease free (0.04+/-0.02 and 0.47+/-0.3, vs 0.79+/-0.44, P=0.01 and P<0.05 respectively). During in vitro experiments, MDA-MB-231 cells stably transfected with N-WASP (MDA-MB-231(WASP+)) exhibited a significantly reduced in vitro invasiveness and motility compared with control and wild type cells (P<0.0001), had increased adhesiveness (P=0.05) and moreover MDA-MB-231(WASP+ )exhibited reduced in vivo growth (P=0.002). The motogen HGF (50 ng/ml) caused a relocation of N-WASP to the cell periphery in a temporal and spatial response. It is concluded that N-WASP, a member of the N-WASP family may act as a tumour progression suppressor in human breast cancer and may therefore have significant clinical value in this condition.

Mammillary fistulas are uncommon, but when they occur they cause prolonged morbidity. The etiology and management strategies are less well established. The purpose of this study is to evaluate the etiologic factors and assess the results of surgical treatment. It is a retrospective study of all patients treated for mammillary fistula from 1990 to 2001. The clinical data, including complications of surgical treatment, were collected from medical records. Fistulas were segregated into simple and complex fistulas before analyzing the results of surgical treatment. Thirty-five patients were treated during this period. A history of either drainage of a subareolar abscess or spontaneous rupture of an inflammatory mass preceded the development of mammillary fistula in the majority of patients. Previous Hadfield's procedure for duct ectasia contributed to the development of fistula in seven patients. Seventeen patients presented with simple fistula. A large proportion of them were treated by total duct excision in recent years, with a higher rate of recurrence (4/6). Eighteen patients presented with complex fistulas; two of them had recurrences following surgical treatment. The overall recurrence rate was 23%. The majority of the patients showed features of periductal mastitis on histologic examination. Postoperative wound infection was positively associated with fistula recurrence. The best management of mammillary fistula remains a problem. Simple fistulas should be treated by fistulectomy and primary closure. Total duct excision should be reserved for complex fistulas. Postoperative wound infection is also a major factor in fistula recurrence. All patients should receive antibiotics. Surgery for duct ectasia has caused fistulas in 20% of cases in our study, raising the issue of restricting total duct excision to more severe forms of the disease. Mammillary fistulas should be treated more appropriately in a specialized breast unit with particular interest in benign breast disease.

Colonoscopies can be used for both interventional and dialogistic purposes. The use of colonoscopies is not without risk and an awareness of these risks, as well as the clinical presentation of these risks / adverse effects, is vital to ensure optimal patient care is achieved both throughout and after the procedure. We present a case of a 49-year-old patient who presented to a district general hospital within the National Health Service (NHS) with diffuse abdominal pain and haemodynamic instability following a colonoscopy. A splenic artery injury was identified following a computerized tomography (CT) scan with contrast, of the abdomen and pelvis of the patient. The patient was resuscitated and managed without the need of surgical intervention in the form of targeted splenic artery embolization. This case highlights that a high index of suspicion of splenic injury should be held by the clinical in any patient who presents with abdominal pain with or without haemodynamic instability as early intervention is key to good patient outcomes.