Justin James

• MBBS, MS(GEN SURG), Dip NB(GEN SURG), FRCSEd, FRACS; MS (Breast surgery)
• Consultant at Eastern Health Australia

Sentinel node biopsy (SNB) is routinely performed in people with node-negative early breast cancer to assess the axilla. SNB has no proven therapeutic benefit. Nodal status information obtained from SNB helps in prognostication and can influence adjuvant systemic and locoregional treatment choices. However, the redundancy of the nodal status inform...

Leiomyomas are benign smooth-muscle tumours and their cutaneous forms are rare clinical entities with subtypes including pilar leiomyoma, angioleiomyoma, and genital leiomyoma. Nipple leiomyomas, arising from the mammillary muscle cells of the nipple, are the least common type of genital leiomyoma. We present herein a case of male nipple leiomyoma...

Introduction: More than 80% of newly diagnosed breast cancers are managed with breast-conserving therapy (BCT). Preservation of cosmetically acceptable breasts is an inherent aim of all breast-conserving efforts-this can, however, be difficult to assess objectively. Compounding this is the difference in perception of breast cosmesis between patien...

Background: International guidelines do not recommend routine staging of EBCs. However, most clinicians still perform staging investigations (SI) selectively for several reasons. We examined our practice of selective use of SI to determine its performance, clinical utility, and cost-effectiveness. Methods: We performed this retrospective study o...

Background Measuring cosmetic outcome following breast-conserving therapy (BCT) is difficult. However, it is crucial to have an easy-to-use and reproducible method to record this outcome of BCT. We argue that breast cosmesis can be divided into a set of key cosmetic components that are easy to observe and score individually, and the total score syn...

Background Routine staging investigations are not recommended for early breast cancer (EBC). Staging scans and further confirmatory tests add to the cost of breast cancer treatment. Despite recommendations from international guidelines, whole body bone scan (BS) is commonly used for staging workup of EBCs. In this study, we examined our experience...

Background: Chest computed tomography (CTC) has now replaced chest X-ray (CXR) as the first choice of investigation to stage breast cancers in most centers in Australia. Routine staging is not recommended in early breast cancers (EBCs). This recommendation is based largely on the use of conventional tests like CXR as staging investigations (SIs)....

Background: In many centres in Australia, CT scan of abdomen and pelvis (CTAP) is a commonly used staging investigation to detect asymptomatic synchronous metastasis (ASM) in newly diagnosed breast cancer. However, its routine use is not supported by strong evidence either on its cost effectiveness or on specificity. Despite contrary recommendatio...

Background: The acellular dermal matrix (Flex HD) (FHD) became available for use in Western Australia in 2014 to aid prosthetic breast reconstruction and this descriptive study aims to review and discuss a single institution's experience since its introduction. Methods: By retrospective case note, review data were collected for all patients who...

Staging investigations on asymptomatic early breast cancer patients - Are we choosing wisely? Introduction Accurate staging information is desirable before commencement of multidisciplinary management of breast cancers. Even though current guidelines don’t recommend routine staging investigations (SI), practice is variable among different instituti...

Should staging CT abdomen be routinely performed for asymptomatic early breast cancer patients? JUSTIN JAMES, Melonie Teo, Vivek Ramachandran, Michael Law, David Stoney, Michael Cheng Breast & Endocrine Surgery Unit, Eastern Health, Melbourne Introduction As a result of early diagnosis, most breast cancer patients have a favourable prognosis. Howe...

Introduction: Idiopathic erythematous reaction of the breast (Red breast syndrome) is a known complication following breast reconstruction with acellular dermal matrix. However pustular dermatitis like presentation is not previously known. Presentation of case: We present a 42-year-old lady who developed bilateral pustular dermatitis like appear...

The manuscript deals with the case of a 53-year-old woman who developed large bowel obstruction. Per-rectal examination revealed a pedunculated lesion in the rectum; rigid sigmoidoscopy revealed a prolapsing pedunculated mass with a necrotic surface. The patient recovered well following anterior resection. Histology confirmed a pedunculated sub muc...

We report a case in which a thoracoabdominal aneurysm was present in association with previously unknown critical spinal canal stenosis. In spite of using left heart bypass, systemic hypothermia, and controlled cerebrospinal fluid drainage for spinal cord protection, the patient developed paraplegia following aortic aneurysm repair. Computed tomogr...

Intestinal ischaemia following cardiac surgery is a serious complication, which carries a high mortality rate. Several studies have examined pre-operative and intra-operative risk factors. We aimed to develop a multivariate risk model to identify those patients at highest risk of intestinal ischaemia. Data was prospectively collected for 10,976 con...