Breast ptosis is the result of reduced elasticity of the breast tissue over time causing the nipple areola complex to descend to a position that is level with or below the inframammary fold. As described by Regnault, breast ptosis results from a discrepancy between breast volume and the overlying skin envelope [1]. This can be resolved surgically by increasing the breast volume, reducing the skin envelope, or a combination of both by performing an augmentation/mastopexy. Breast augmentation is the most commonly performed surgical procedure in aesthetic plastic surgery. According to the American society of Plastic Surgeons Plastic Surgery Statistics Report, 300,378 such procedures were conducted last year, with mastopexy procedures at a count of 105,219 surgeries [2]. Breast augmentation alone may correct minimal ptosis or pseudoptosis, however, a significant number of patients who present for breast augmentation also need breast lifting. Increasing patient demand for the convenience of undergoing one procedure in place of two has led to the growing popularity of the combined augmentation-mastopexy operation. However this procedure is associated with a high degree of difficulty and has several limitations. Increasing the volume of the breast while simultaneously decreasing the skin envelope equates to surgery involving opposing forces. This results in a relatively long operation time with the associated additional costs, an increased risk of perioperative complications, and most importantly unpleasant scars and the high likelihood of a recurrence of the ptosis.

Background: Nocardia brain abscess is a rare entity. Commonly associated with immunocompromised conditions. Complete excision is the treatment of choice with intravenous antibiotics but the prognosis is limited. Case Description: This is a case of 42 years old male that presented with fever and disorientation. MRI brain with contrast showed multiple posterior fossa abscess which was surgically treated and found to be Nocardial brain abscess. The patient was treated accordingly and responded well to the treatment. Conclusion: Brain abscess caused by Nocardia species is uncommon, especially in immunocompetent people. It should be managed aggressively and dissemination through blood is associated with poor outcome.

Breast cancer is most frequently diagnosed cancer and leading cause of cancer related deaths in females. It has a varied behavior and biology responsible for its various clinical presentations and treatment outcome [1]. This necessitated the need for exhaustive study of tumor biology and Pathology which have significant reflection in the comprehensive evaluation and management. The different clinical presentations are early, locally advanced, recurrent and metastatic breast cancer. There had been lots of concern in comprehensive management of the disease and exponential growth in various diagnostic and therapeutic modalities. These concerns are early detection, lymph node mapping, detection of metastatic and recurrent lesions, tumor biology and pathology, various modalities of treatment including targeted therapy and disease free survival. One of the modalities which have been translated to overcome the concerns is imaging techniques.

Introductions: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder characterized by hamartomatous polyps in the gastrointestinal tract and hyperpigmentation on the lips and oral cavity. Bowel obstruction, intussusception and bleeding are common complications in PJS patients. PJS patients also have an increased risk of gastrointestinal and extra-intestinal malignancies. Case Description: A 32 years old male was brought to the emergency room due to suspected ileocolic intussusception. Ten years ago he had a history of laparotomy resection anastomosis of the bowel due to bowel polyps. Physical examination revealed multiple pigmented intraoral lesions. Abdominal examination showed mid-line laparotomy scar, distention with visible bowel movement. There was no palpable mass and no blood upon digital rectal examination. Computerized tomography of the abdomen demonstrated suspected ascending colon intussusception. Intra-operation; ileocolic intussusception was found with multiple polyps along the colon. Resection and stoma was done, with planned post-operative endoscopy via the stoma. Conclusion: The standard treatment for intussusception in PJS patients is laparotomy bowel resection to remove the polyps causing the recurrent invaginations. It has been recommended that endoscopic polyps removal should be performed to avoid multiple surgical resections, which lead to short bowel syndrome. Due to increased risk of malignancies, regular screening of PJ patients is needed.

Background: Doppler-guided Haemorrhoid Artery Ligation (HAL) of the terminal branches of the superior haemorrhoidal artery is an increasingly popular technique in haemorrhoid management. Objectives: The aim was to assess the role of Doppler HAL in haemorrhoid management, patient outcomes and satisfaction. Materials and Methods: The study was a prospective case series, analysed retrospectively. Seventy-eight consecutive patients undergoing Doppler HAL for Grade III and IV haemorrhoids at a single metropolitan private hospital in Sydney, Australia were included in the study. A modified proctoscope housing a Doppler transducer was used to sequentially suture ligate the haemorrhoidal arteries. The authors report our preliminary experience with regards to post-operative symptoms, re-intervention requirements and overall patient satisfaction with the procedure and symptom management. Results: The predominant pre-operative symptom was haemorridal bleeding. First follow-up was four weeks post-procedure. The minimum follow-up was at 1, 3 and 18 months. First follow-up showed 55 patients had no bleeding at all (71%), with most patients also having no pain (78%). Six patients underwent further intervention (8%). Short to medium term follow-up at 3 to 18 months showed 65 patients were satisfied with the procedure (84%). Of those surveyed beyond 18 months, 66 patients had no bleeding or bleeding less than once per month (89%), and satisfaction scores were high at 88%. Further intervention was reported in 24 patients (32%). Only a total of 4 patients (5%) progressed to requiring a haemorrhoidectomy. Conclusion: Doppler-guided HAL is safe and effective in treating symptomatic haemorrhoids. It has an acceptable progression to further intervention and importantly provides high patient satisfaction in the immediate, short and medium post-operative follow-up period.