The status of the axilla is the single most important prognostic indicator of overall survival in patients with breast cancer. Sentinel-node biopsy has false-negative rates of 5–10%. The aim of this study was to assess the importance of tumor and breast volume ratio as a predictive factor for axillary lymph node metastases in patients with T1c ductal invasive breast cancer. This study included 136 consecutive patients with T1c ductal invasive breast cancer. Three tumor diameters were measured. Tumor volume was calculated by the formula for ellipse. Breast volume was measured preoperatively. Tumor and breast volume ratio was calculated and shown per thousand. Tumor and breast volume ratio is a new independent predictive factor for axillary lymph node metastase in T1c ductal invasive breast cancer. This predictive factor could help to define a subgroup of patients who will be at a higher risk for axillary lymph node metastase and would benefit from additional close follow up or axillary lymph node dissection.

Breast cancers (BC) are usually classified into four molecular subtypes according to the expression of estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER2) receptors and proliferation marker Ki-67. Despite available anti-hormonal therapies and due to the inherent propensity of some subtypes to develop metastasis, there is a permanent need to discover new prognostic and predictive biomarkers, as well as therapeutic targets for BC. In this study, we used immunohistochemical staining to determine the expression of androgen receptor (AR) and sonic hedgehog protein (SHH), the main ligand of the Hedgehog-GLI (HH-GLI) signaling pathway, in 185 archival primary BC tissue samples and correlated it with clinicopathological characteristics, molecular subtypes, receptors statuses, and survival in a cohort of Croatian BC patients. Results showed that higher SHH and AR expressions were associated with positive receptor status, but increased SHH expression had a negative impact on survival in receptor-negative BCs. On the contrary, higher AR expression was mostly protective. However, multivariate analysis showed that only higher AR expression could be considered as an independent prognostic biomarker for poorer overall survival in triple-negative breast cancer patients (TNBC) (HR 10.9, 95% CI 1.43–83.67; p = 0.021), what could be Croatian population-related. SHH could be a potential target for treating TNBCs and HER2-enriched BCs, in cases where HH-GLI signaling is canonical (SHH-dependent).

Puerperal mastitis often occurs in younger primiparous women. Most cases occur between 3 and 8 weeks postpartum. If mastitis results in the formation of a breast abscess, surgical drainage or needle aspiration is most commonly performed. We report a case of an extremely large breast abscess in a primiparous 20-year-old woman, which presented 6 weeks postpartum. Surgical incision and evacuation of 2 liters of exudate were performed, and intravenous antibiotics therapy was administered. On the sixth day after incision, we secondarily closed the wound. Examination after 3 months showed symmetrical breasts with a small scar in the incision area of the right breast. A high degree of suspicion and adequate diagnostic procedures are essential to avoid delay in the treatment of mastitis and breast abscess and thereby prevent unnecessary surgical treatment.

Background: Frostbite is a severe injury characterized by tissue damage due to exposure to freezing temperatures. It often necessitates prompt medical intervention to prevent further complications such as necrosis and amputation. This case report explores the successful use of bilateral anterolateral thigh (ALT) free flaps for feet salvage in a 19-year-old male refugee from Gambia who suffered severe frostbite injuries. Case Report: The patient, found after six days in freezing conditions, exhibited necrosis on multiple toes. Initial management included stabilization, intravenous fluids, and rewarming. Subsequent necrectomy and amputation revealed exposed metatarsal bones, necessitating a meticulous reconstructive strategy. Bilateral ALT flaps were chosen to preserve walking function, with a staged reconstruction involving multiple operations. The patient’s progress, from inpatient care to outpatient follow-ups, is detailed, emphasizing the challenges and decisions in managing severe frostbite injuries. Results: The surgical intervention utilizing bilateral ALT flaps successfully salvaged the patient’s feet. Throughout the postoperative period, wound care, rehabilitation, and outpatient monitoring contributed to positive outcomes. Despite challenges associated with the patient’s ethnic background and nutritional status, the staged reconstruction facilitated effective healing and functional recovery. The use of ALT flaps provided a reliable solution with minimal donor site morbidity. Conclusion: This case highlights the efficacy of bilateral ALT flap reconstruction in salvaging feet following severe frostbite injury. The successful restoration of foot function underscores the importance of early intervention and tailored reconstructive approaches in frostbite management. Despite patient-specific challenges, including nutritional status and limited healthcare resources, the use of ALT flaps facilitated optimal recovery and functional outcomes. Importantly, this report is unique as it describes a novel case of feet salvage using bilateral ALT flaps in severe frostbite injury, with only one similar case previously reported in the literature. This emphasizes the rarity and significance of this specific surgical approach in frostbite management.

Background: The latissimus dorsi free flap is a workhorse for extensive lower-extremity soft tissue defects. Conventionally, the skin paddle is designed according to the anticipated defect and left in place on the muscle as a single composite unit. This report describes an alternative approach in which the skin paddle is secondarily mobilized through subcutaneous undermining and rotated as a separate propeller-type local extension flap on random-pattern vascularization, without a specifically identified perforator—a technique that has not been previously reported. Case Presentation: A 38-year-old male with a high-energy distal lower-extremity defect exposing bone, Achilles tendon, and hardware underwent free latissimus dorsi reconstruction with an empirically designed skin paddle over the constant perforator zone. The skin paddle was subsequently mobilized and rotated as a separate propeller-type extension flap to cover the Achilles region, with additional areas managed using split-thickness skin graft and a reverse soleus flap. Results: The latissimus dorsi flap and skin paddle remained viable, providing stable coverage of the defect. The additional reverse soleus flap achieved durable medial coverage, and the limb was ultimately preserved with satisfactory soft-tissue stability. Conclusion: A random-pattern latissimus dorsi skin paddle designed within the anatomically constant perforator zone can provide a feasible new option offering intraoperative flexibility in complex lower-extremity trauma when perforator mapping is impractical.

BACKGROUND The most recent studies suggest that parabens may negatively interfere with some endocrine and intracrine targets relevant to breast carcinogenesis. A concern arises on the long-term effect of parabens' deposition after dermal exposure and their potential to illicit not only localised toxicity, but also interfere potential cellular pathways via accumulation in human skin and subcutis, more specifically in the adipose tissue of the breast. MATERIALS AND METHODS A total of 20 women were enrolled in the study. The extraction of parabens from human plasma, urine and breast tumor tissue was mediated via the novel Fabric-Phase Sorptive Extraction (FPSE) based procedure which was followed by the High Precision Liquid Chromatography (HPLC) analytic method for determining concentration measurements. RESULTS The highest paraben leves have been determined in breast cancer tissue (1.49 ng/mL) followed by paraben levels in adipose tissue surrounding axillary lymph nodes (1.27 ng/mL). The lowest paraben concentration has been detected in breast quadrant tissue surrounding the breast cancer (0.68 ng/mL), i.e the tumour bed tissue. CONCLUSION This research further supports the possible cumulative effect of the higher paraben concentrations in adipose tissue surrounding axillary lymph nodes due to: axillar to medial direction of deodorant application, with the upper lateral quadrant (ULQ) being the most common location for breast tumors. More research is needed to unveil the mechanism and to carefully consider all possible interactions in a given risk assessment of Endocrine Disruptive Chemicals (EDCs) on breast cancer development.