HighlightsThe Finding of a giant phyllodes tumor is very rare.The diagnosis should be entertained in all patients presenting with progressive enlargement of breast lump.Emphasis should be given in early diagnosis and treatment to decrease morbidity and mortality.Core needle biopsy is key method of preoperative diagnosis of phyllodes tumour Emphasis should be given on proper health education on breast cancer and its management.Patient needs to be well educated about the negative consequences of alternative or delayed treatment.

Necrotizing soft tissue infection of the breast is an extremely rare event in routine surgical practice. It is the most aggressive form of soft tissue infection and a real surgical emergency. It is associated with a high risk of mortality if not diagnosed promptly. A Literature search has revealed only a few such cases. The exact etiology is variable and very often multifactorial. Early recognition and prompt surgical treatment along with broad-spectrum antibiotic therapy are of paramount importance to prevent mortality. In this report, we present the first case of necrotizing fasciitis of the breast following an insect bite in the literature, in a 57year-old diabetic patient with a delayed presentation that required a life-saving mastectomy.

Background. Breast cancer is the leading form of cancer in women in Trinidad and Tobago. Traditionally the practice of mastectomy or wide local excision with or without axillary clearance was applied to most of these patients. This is often associated with significant morbidity and a poor cosmetic outcome with both negatively impacting the patients quality of life. The aim of our study was to assess the mastectomy and axillary clearance rate before and after the introduction of a specialty breast clinic in September 2012. Design and Methods. This is a retrospective comparative study of all female patients who underwent breast cancer surgery at our tertiary hospital 3 years prior to and 3 years after starting of breast clinic (between January 2010 and December 2015). Patients were identified from the surgical log books of our hospital. There are 5 surgical units at our hospital and in one of those units the lead surgeon had a special interest in surgical oncoplastic breast surgery. That unit formed the breast clinic in August 2012. Results. There were 532 women (256 before breast clinic and 276 after breast clinic era) with histologically verified breast cancer operated on between January 2010 and December 2015. The overall mastectomy rate was reduced from 62% to 51% (0.7 to 0.4) and the axillary clearance rate from 66.79% versus 37.31% (0.6 to 0.4) after the introduction of the clinic with p values of 0.007 and 0.009, respectively. Conclusions. The introduction of breast clinic has significantly reduced the mastectomy and axillary clearance rate at our teaching hospital.

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Alternative methods to supravesical urinary diversion in myelodysplastic children, which protect the upper urinary tracts and provide urinary continence, are now available in the form of prosthetic devices and intermittent clean catheterization with or without ancillary pharmacologic agents. We believe that these alternatives deserve a trial before proceeding to supravesical urinary diversion. Short-term evaluation indicated improvements and stability in most urinary tracts treated by these methods but we recognized that, just as with the ileal conduit diversion, a longer period of followup is required before definite statements can be made about the long-term results. However, if the criteria of sterile urine and bladder emptying at physiological pressure ranges are strictly met we would suspect a favorable outcome.