Colton H. Connor

Clostridium septicum is a rare, highly virulent Gram-positive, spore-forming anaerobic bacterium that preferentially colonizes hypoxic and necrotic tissue and is associated with underlying malignancy, particularly gastrointestinal cancers. C. septicum-associated mycotic aortic aneurysm is an uncommon but highly lethal complication. We report a case of a 64-year-old man with a history of squamous cell carcinoma of the head and neck who presented with central chest pain and was found to have a 9.2 × 7.5 × 6.2 cm necrotic mediastinal mass inseparable from the aortic arch, C. septicum bacteremia, and a 6 cm mycotic aneurysm of the distal aortic arch. Open repair was declined by cardiothoracic surgery due to the patient's prohibitive medical condition, and thoracic endovascular aortic repair (TEVAR) was performed as the only available surgical option. The patient initially recovered but returned two months later with hematemesis from progressive aortic degeneration and aortoenteric fistula despite endograft revision, and he died shortly thereafter. This case expands the literature on C. septicum aortitis by documenting direct contiguous extension from an adjacent necrotic mass as a viable mechanism of aortic infection and demonstrates the inadequacy of TEVAR as a standalone therapy when open surgical repair is not feasible. Early recognition, definitive open aortic repair when possible, and a multidisciplinary approach integrating vascular surgery, infectious disease, and oncology are essential to optimizing outcomes in this rare but lethal disease.

Radiation therapy complicates implant-based breast reconstruction by inducing fibrosis, vascular compromise, and capsular contracture, often resulting in significant breast asymmetry. Reoperation on irradiated implant pockets carries a high risk of wound-healing complications and implant loss, limiting reconstructive options. We present a case demonstrating a contralateral reconstructive strategy to address radiation-induced asymmetry without revising the irradiated breast. A woman with a history of bilateral mastectomy and implant-based reconstruction developed severe asymmetry following postmastectomy radiation to the left breast. Given the patient’s preference for the irradiated breast position and the risks of operating on irradiated tissue, revision was performed on the nonirradiated side using a narrow, ultra-high-profile implant wrapped in acellular dermal matrix that was positioned cephalad. This approach restored symmetry when surgical intervention of the irradiated breast was not advised, and nonsurgical treatment of the contracted breast was not preferred. This technique avoids the morbidity associated with operating on irradiated tissue and represents a safe, reproducible treatment option for select patients.

Breast cancer-related lymphedema (BCRL) is a chronic and debilitating complication of breast cancer treatment, commonly associated with mastectomy, axillary lymph node dissection, and adjuvant radiation therapy. Though demographic and treatment-related risk factors for BCRL are well documented, emerging evidence suggests that certain genetic polymorphisms may predispose some patients to developing the condition. This review aims to summarize the current research regarding the genetic variants implicated in the development and severity of BCRL. Several candidate genes related to lymphangiogenesis, inflammation, immune cell activation, and lymphatic contractility have been identified. Unfortunately, the existing literature remains limited by the small number of manuscripts, modest sample sizes, and heterogeneous methodologies of available studies. However, further research may shed light on screening options and lead to more personalized treatment strategies to mitigate the incidence and severity of secondary lymphedema.

Melanoma represents a significant public health challenge due to its increasing incidence and potential for metastasis. This review will explore the current clinical approaches to the management of melanoma, focusing on advancements in diagnosis, treatment, and prognosis. Methods for early detection and accurate staging have been enhanced by new diagnostic strategies. Treatment modalities have expanded beyond traditional surgical excision to include targeted therapy and immunotherapy. Prognostic assessment has benefited from the development of novel biomarkers and genetic profiling. This review will highlight the progress made in the multidisciplinary management of melanoma, underscoring the importance of continuous research to improve patient outcomes.