WorldWideScience

Sample records for axilla

  1. MR and CT anatomy of the axilla

    Energy Technology Data Exchange (ETDEWEB)

    Hergan, K. [Central Inst. of Radiology, County Hospital, Feldkirch (Austria); Morrigl, B. [Innsbruck Univ. (Austria). Inst. of Anatomy; Kathrein, A. [Univ. Hospital, Innsbruck (Austria). Dept. of Trauma Surgery; Buchberger, W. [Univ. Hospital, Innsbruck (Austria). Dept. of Radiology; Judmaier, W. [Univ. Hospital, Innsbruck (Austria). Dept. of Radiology; Peer, S. [Univ. Hospital, Innsbruck (Austria). Dept. of Radiology; Oser, W. [Central Inst. of Radiology, County Hospital, Feldkirch (Austria)

    1997-03-01

    Purpose: To depict the complex anatomy of the axilla with CT and MR imaging. Material and Methods: The axillary regions of 2 cadavers (with arms hyperabducted) were examined by means of CT and MR. In this position the cadavers were frozen and cryosectioned. The anatomical sections documented by the MR and CT images were compared and anatomical structures were designated. To show the reproducibility of the anatomical structures and to find variations, 20 volunteers were also examined by MR, and 20 consecutive patients without axillary symptoms were examined by CT. Results: The complexity of the axilla was excellently shown by both CT and MR, but MR was able to demonstrate more detail in the small vessels and in the brachial plexus. The comparability of the examinations of the different individuals was best in the axial plane. Some differences appeared in the coronal and sagittal planes caused by different positions of the arm. Conclusion: Axillary anatomy was demonstrated in detail and was reproducible with CT and MR imaging. (orig.).

  2. Management of the axilla in patients with breast cancer

    OpenAIRE

    Goyal, Amit

    2009-01-01

    This article reviews the changes in management of the axilla in patients with breast cancer in the last decade. It discusses the recent advances, existing controversies and provides evidence-based guidelines for use in clinical practice.

  3. A rare presentation of an ectopic breast tissue in axilla

    Directory of Open Access Journals (Sweden)

    Radhika Vidyasagar

    2015-10-01

    Full Text Available Accessory breast tissue is rare accounting to less than 1% cases seen in females. It is usually bilateral. We report a case of 24-year-old woman with a lump in the left axilla in view of its rarity and made a differential diagnosis of fibroadenoma, which following the investigations and histopathological report was confirmed as revealed fibroadenoma in the axilla. It should also be considered as a differential diagnosis for all axillary swellings.

  4. A Rare Presentation Of An Ectopic Breast Tissue In Axilla

    Directory of Open Access Journals (Sweden)

    Vidyasagar Radhika

    2015-10-01

    Full Text Available Accessory breast tissue is rare accounting to less than 1% cases seen in females. It is usually bilateral. We report a case of 24-year-old woman with a lump in the left axilla in view of its rarity and made a differential diagnosis of fibroadenoma, which following the investigations and histopathological report was confirmed as revealed fibroadenoma in the axilla. It should also be considered as a differential diagnosis for all axillary swellings.

  5. A Rare Presentation Of An Ectopic Breast Tissue In Axilla.

    Science.gov (United States)

    Vidyasagar, Radhika; Singh, R N

    2015-10-01

    Accessory breast tissue is rare accounting to less than 1% cases seen in females. It is usually bilateral. We report a case of 24-year-old woman with a lump in the left axilla in view of its rarity and made a differential diagnosis of fibroadenoma, which following the investigations and histopathological report was confirmed as revealed fibroadenoma in the axilla. It should also be considered as a differential diagnosis for all axillary swellings. PMID:26812754

  6. Absence of musculocutaneous nerve in the left axilla

    Directory of Open Access Journals (Sweden)

    Virupaxi RD

    2009-11-01

    Full Text Available Variations of the arrangement and distribution of the lateral cord and its branches in the infraclavicular part of the brachial plexus are common in one or both axillae. These variations are important to the surgeons, neurologists, anesthetists and anatomists during surgery and dissection in the region of axilla. The present case report describes the absence of musculocutaneous nerve in the infraclavicular part of left brachial plexus, observed during routine dissection of a 40-year-old male Indian cadaver. On the right side usual origin and course of musculocutaneous nerve was seen. The clinical importances of these variations are discussed.

  7. Imaging Findings of Palpable Benign Masses in the Axilla

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Young; Kim, Eun Kyung; Kim, Min Jung; Youk, Ji Hyun; Oh, Ki Keun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2006-03-15

    The most common pathologic conditions in the axilla are the diseases related to lymph nodes, of which the most serious condition is a malignant lesion such as the metastatic lymphadenopathy or lymphoma. However, various benign conditions in the axilla have been reported and some of them show characteristic imaging findings which allow presumptive diagnosis to be made without invasive procedures. We review various conditions of benign axillary mass and illustrate typical findings in this essay. Sonography can evaluate the axillary area easily and immediately performed sonography-guided core needle biopsy is also useful when the axillary mass does not have typical benign features

  8. Fibroadenoma of ectopic breast of axilla: A rare case report

    Directory of Open Access Journals (Sweden)

    Umesh Jethwani

    2015-01-01

    Full Text Available Ectopic breast tissue (EBT is a rare anomaly. Common location of EBT is along the milk line extending from the nipple to the symphysis pubis. EBT is susceptible to same pathologic processes as normal breast. Fibroadenoma though very frequent entity, but is very rarely reported in EBT of axilla. It poses a diagnostic challenge to the treating physician, and high index of suspicion is required for early detection. Here we report a rare case of fibroadenoma of EBT of axilla in a 25-year-old girl, which was managed by excision.

  9. Mammographic appearance of accessory breast tissue in the axilla

    International Nuclear Information System (INIS)

    Objective: To observe the mammographic appearance of accessory breast tissue in the axilla. Methods: In the past 3 years, 7562 women were underwent bilateral screen-film mammography. All of the mediolateral oblique (MLO) films were reviewed retrospectively to look for whether there was accessory breast tissue and what the mammographic features were like. Radiographically the accessory tissue resembled the main normal breast glandular tissue but was separated from it. Results: Of the 7652 case, accessory breast tissue in the axilla was detected in 161 cases. The prevalence was 2%. The age ranged from 17 to 70 years (mean, 39 years). 38% of them were found in the bilateral axilla, 42% only in the right, and 20% only in the left. The dimensions on the right ranged from 0.7 to 8.0 cm (mean, 3.5 cm), and that on the left ranged from 1.0 to 7.0 cm (mean, 3.3 cm). There were four types among the accessory breast tissue: patchy type was the most (35%), then the branched type (26%), mixed type (20%), and mass-like type (19%). 3 cases were proved by pathology. Conclusion: It is important that the radiologist be familiar with the mammographic appearance of accessory breast tissue in the axilla in order that they could be distinguished from other pathological changes

  10. Fibroadenoma in axilla: another manifestation of ectopic breast.

    Science.gov (United States)

    Tiwary, Satyendra K; Kumar, Puneet; Khanna, Ajay Kumar

    2015-01-01

    Fibroadenoma of an accessory breast is a rare disease. The clinical significance lies in the fact that a number of cystic, inflammatory, neoplastic diseases similar to those of a normal breast have been reported in accessory breasts as well. Vigilant self-assessment and complete clinical examination are always encouraged to detect earliest malignancy in the axilla. We report two cases of ectopic breast fibroadenoma with the relevant literature. PMID:25917072

  11. Accessory breast tissue in axilla masquerading as breast cancer recurrence

    Directory of Open Access Journals (Sweden)

    Goyal Shikha

    2008-01-01

    Full Text Available Ectopic or accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line. Development is hormone dependent, similar to normal breast tissue. These lesions do not warrant any intervention unless they produce discomfort, thus their identification and distinction from other breast pathologies, both benign and malignant, is essential. We report a case with locally advanced breast cancer who presented with an ipsilateral axillary mass following surgery, radiotherapy, and chemotherapy. Subsequent evaluation with excision biopsy showed duct ectasia in axillary breast tissue and the patient was continued on hormone therapy with tamoxifen.

  12. Spindle cell lipoma of the posterior axilla: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jee Young; Suh, Kyung Jin; Kim, Sang Yoon [Dongguk University Hospital, Cheonan (Korea, Republic of)

    2008-07-15

    Spindle cell lipoma is characterized by different cell components, mature adipocytes, spindle cells and collagen bundles, and it presents as a well-defined benign fatty mass on the posterior neck or upper back of middle aged men. As a result of the various ratios of non-adipose tissue, it is difficult to differentiate spindle cell lipoma from liposarcoma. To the best of our knowledge, the imaging features of spindle cell lipoma have not been reported in Korea. We report here on the imaging findings of a histologically confirmed spindle cell lipoma in the subcutaneous layer of the posterior axilla.

  13. ACCESSORY FUNCTIONING BREAST TISSUE AS A LARGE MASS IN THE AXILLA

    Directory of Open Access Journals (Sweden)

    Tripathi

    2013-01-01

    Full Text Available ABSTRACT: Accessory breasts are an uncommon entity & more un common when it is functioning. They may present as asymptomatic mass al ong the mammary ridge or symptoms evident during menarche, menstruation, pregnancy & l actation. We report a case of unilateral accessory breast in right axilla which was secretin g milk on day 3rd postpartum

  14. The Safety and Efficiency of the Ultrasound-guided Large Needle Core Biopsy of Axilla Lymph Nodes

    OpenAIRE

    Kim, Ki Hong; Son, Eun Ju; Kim, Eun-Kyung; Ko, Kyung Hee; Kang, Haeyoun; Oh, Ki Keun

    2008-01-01

    Purpose To evaluate the safety and efficiency of the Ultrasound (US)-guided large needle core biopsy of axilla lymph nodes. Materials and Methods From March 2004 to September 2005, 31 patients underwent the US-guided core biopsy for axilla lymph nodes. Twenty five lesions out of 31 were detected during breast US, and 6 of 31 cases were palpable. Lymph nodes were classified based on their shape and cortical morphology. The core biopsy of axilla lymph nodes was performed on suspicious lymph nod...

  15. Male breast cancer originating in an accessory mammary gland in the axilla: a case report.

    Science.gov (United States)

    Yamamura, Jun; Masuda, Norikazu; Kodama, Yoshinori; Yasojima, Hiroyuki; Mizutani, Makiko; Kuriyama, Keiko; Mano, Masayuki; Nakamori, Shoji; Sekimoto, Mitsugu

    2012-01-01

    Carcinoma of an accessory mammary gland is an extremely rare tumor. A 61-year-old male patient presented with a hard mass measuring 85 mm × 51 mm in the left axilla. Incisional biopsy histopathologically showed an adenocarcinoma compatible with breast carcinoma originating in an accessory mammary gland. Systemic examinations revealed no evidence of malignant or occult primary lesion in the bilateral mammary glands or in other organs. Neoadjuvant chemotherapy was performed for the locally advanced axillary tumor and reduced the tumor to 55 mm in size, and, then, he could undergo complete resection with a negative surgical margin in combination with reconstructive surgery to fill the resulting skin defect with a local flap of the latissimus dorsi muscle. The patient has presented with no metastatic lesion in four years since the operation. This unusual case shows that neoadjuvant chemotherapy is an effective and tolerated therapy for advanced accessory breast cancer in the axilla. PMID:23251170

  16. BILATERAL ACCESSORY BREAST TISSUE PRESENTING AS MASS IN AXILLA WITH LEAKING MILK

    Directory of Open Access Journals (Sweden)

    Vineet

    2014-11-01

    Full Text Available Accessory breasts are an uncommon entity. They may present as asymptomatic masses or cause symptoms such as pain or restriction of arm movements even some time milk leaks from accessory breast. It may prove to be diagnostic challenge if found in locations along or outside the mammary line. We report a very rare case of an ectopic bilateral accessory breast presenting as mass in axilla with leaking milk in lactating young female. FNAC was diagnostic tool

  17. Do radiation oncologists practice evidence based medicine? Results of a survey of management of the axilla in operable breast cancer

    International Nuclear Information System (INIS)

    In 2002 the Radiation Oncology Expert Advisory Group (ROEAG) of the National Breast Cancer Centre (NBCC) and RANZCR Faculty of Radiation Oncology, posted a questionnaire to practicing radiation oncologists in Australia and New Zealand seeking information on a variety of practical issues in the radiation oncology treatment of women with operable breast cancer. The questionnaire aimed to evaluate the influence of the guidelines and discussion papers published in a resource for radiation oncologists and registrars by the NBCC in the preceding three years. This paper reports on the responses to the questions relating to management of the axilla . A discussion paper containing guidelines on management of the axilla was published in 2001. 102 responses were received (41% response rate) with 93% acknowledging receipt of the paper on management of the axilla. 74% of respondents stated that this paper was important or very important to their practice. Four questions investigating when radiation oncologists would irradiate the entire axilla following an axillary dissection were asked. While 100% of respondents would irradiate the axilla if the surgeon reported unresectable disease in the axilla, 56% of respondents would irradiate the axilla if the pathologist describes extra nodal spread in the report on the operative specimen. The paper 'Management of the Axilla' clearly states that there is no level I or II evidence to support axillary irradiation in patients with' breast cancer based solely on reported extra nodal spread. Factors influencing radiation oncologist's clinical practice will be briefly discussed, as well as the implications for changing practice in response to new clinical trial evidence

  18. Primary lymphoma of the breast involving both axillae with bilateral breast carcinoma

    Directory of Open Access Journals (Sweden)

    Rubin Gary

    2008-05-01

    Full Text Available Abstract Background Primary Non-Hodgkin's Lymphoma (PHNL of the breast is a rare entity, while secondary involvement of the breast with diffuse disease of Non-Hodgkin's lymphoma (NHL is more common. However, PNHL is the most frequent haematopoietic tumour of the breast. Diagnostic criteria for PNHL of the breast are presence of technically adequate pathologic specimens, close association of mammary tissue and lymphomatous infiltrate, no prior diagnosis of an extarammamary lymphoma, and no evidence of concurrent widespread disease, except for ipsilateral axillary lymph nodes if concomitant with the primary lesion. Case presentation A 57-year-old woman was recalled because her screening mammograms revealed three separate lesions in her right breast and one in the left. Histology of the lesions confirmed lymphoma in one breast with ductal carcinoma in the other. Conclusion Most of reported cases in literature have been involving the right breast, and almost all the patients were females. NHLs of the breast typically present as unilateral mass; the frequency of bilateral disease at first presentation ranges from 5–25%. Our objective is to report a case of primary lymphoma of the breast involving both axillae with concomitant bilateral primary breast cancer which has not been reported yet to our best of knowledge in literature.

  19. Massive nodular pseudoangiomatous stromal hyperplasia (PASH) of the breast arising simultaneously in the axilla and vulva.

    Science.gov (United States)

    Jordan, Adrienne C; Jaffer, Shabnam; Mercer, Stephen E

    2011-02-01

    The authors describe a 52-year-old woman with a history of bilateral mastectomies for macromastia caused by massive nodular pseudoangiomatous stromal hyperplasia (PASH), who presented with 2 large growths in her left axilla and groin. These masses had been increasing in size for nearly a year. When excised, the axillary mass had dimensions of 14.0 × 14.0 × 5.5 cm(3) and weighed 664 g. The groin mass was slightly smaller at 14.5 × 11.0 × 5.0 cm(3) and 518 g. Microscopic examination of both masses revealed breast tissue expanded by a hyalinized stroma with prominent slit-like pseudovascular spaces, consistent with PASH. Small incidental foci of PASH are common findings in breast excisions; however, large nodular foci are rare. Furthermore, nodular foci in accessory breast tissue are exceedingly rarer and can raise clinical concerns for malignancy. Histopathologically, PASH can be mistaken for low-grade angiosarcoma. To the authors' knowledge, the present case appears to be the first description of multiple simultaneous foci of massive nodular PASH arising in accessory breast tissue. PMID:21285079

  20. Stage III Melanoma in the Axilla: Patterns of Regional Recurrence After Surgery With and Without Adjuvant Radiation Therapy

    International Nuclear Information System (INIS)

    Purpose: To describe the anatomic distribution of regionally recurrent disease in patients with stage III melanoma in the axilla after curative-intent surgery with and without adjuvant radiation therapy. Methods and Materials: A single-institution, retrospective analysis of a prospective database of 277 patients undergoing curative-intent treatment for stage III melanoma in the axilla between 1992 and 2012 was completed. For patients who received radiation therapy and those who did not, patterns of regional recurrence were analyzed, and univariate analyses were performed to assess for potential factors associated with location of recurrence. Results: There were 121 patients who received adjuvant radiation therapy because their clinicopathologic features conferred a greater risk of regional recurrence. There were 156 patients who received no radiation therapy. The overall axillary control rate was 87%. There were 37 patients with regional recurrence; 17 patients had received adjuvant radiation therapy (14%), and 20 patients (13%) had not. The likelihood of in-field nodal recurrence was significantly less in the adjuvant radiation therapy group (P=.01) and significantly greater in sites adjacent to the axilla (P=.02). Patients with high-risk clinicopathologic features who did not receive adjuvant radiation therapy also tended to experience in-field failure rather than adjacent-field failure. Conclusions: Patients who received adjuvant radiation therapy were more likely to experience recurrence in the adjacent-field regions rather than in the in-field regions. This may not simply reflect higher-risk pathology. Using this data, it may be possible to improve outcomes by reducing the number of adjacent-field recurrences after adjuvant radiation therapy

  1. Stage III Melanoma in the Axilla: Patterns of Regional Recurrence After Surgery With and Without Adjuvant Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pinkham, Mark B., E-mail: mark.pinkham@health.qld.gov.au [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia); Foote, Matthew C. [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); Diamantina Institute, Brisbane (Australia); University of Queensland, Brisbane (Australia); Burmeister, Elizabeth [Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane (Australia); Research Centre for Clinical and Community Practice, Griffith University, Brisbane (Australia); Thomas, Janine [Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); Meakin, Janelle [Clinical Trials Research Unit, Princess Alexandra Hospital, Brisbane (Australia); Smithers, B. Mark [Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia); Burmeister, Bryan H. [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia)

    2013-07-15

    Purpose: To describe the anatomic distribution of regionally recurrent disease in patients with stage III melanoma in the axilla after curative-intent surgery with and without adjuvant radiation therapy. Methods and Materials: A single-institution, retrospective analysis of a prospective database of 277 patients undergoing curative-intent treatment for stage III melanoma in the axilla between 1992 and 2012 was completed. For patients who received radiation therapy and those who did not, patterns of regional recurrence were analyzed, and univariate analyses were performed to assess for potential factors associated with location of recurrence. Results: There were 121 patients who received adjuvant radiation therapy because their clinicopathologic features conferred a greater risk of regional recurrence. There were 156 patients who received no radiation therapy. The overall axillary control rate was 87%. There were 37 patients with regional recurrence; 17 patients had received adjuvant radiation therapy (14%), and 20 patients (13%) had not. The likelihood of in-field nodal recurrence was significantly less in the adjuvant radiation therapy group (P=.01) and significantly greater in sites adjacent to the axilla (P=.02). Patients with high-risk clinicopathologic features who did not receive adjuvant radiation therapy also tended to experience in-field failure rather than adjacent-field failure. Conclusions: Patients who received adjuvant radiation therapy were more likely to experience recurrence in the adjacent-field regions rather than in the in-field regions. This may not simply reflect higher-risk pathology. Using this data, it may be possible to improve outcomes by reducing the number of adjacent-field recurrences after adjuvant radiation therapy.

  2. Ultrasonography of the axilla in the follow-up of breast cancer patients who have a negative sentinel node biopsy and who avoid axillary clearance.

    Science.gov (United States)

    Leikola, Junnu; Saarto, Tiina; Joensuu, Heikki; Sarvas, Krista; Vironen, Jaana; Von Smitten, Karl; Virkkunen, Pekka; Vanharanta, Brita; Mäkelä, Pekka; Leidenius, Marjut

    2006-01-01

    The clinical value of ultrasonography of the axilla in detection of breast cancer recurrence is not known among patients who have a negative sentinel node biopsy and avoid axillary clearance. We studied a cohort of 205 such patients using ultrasonography one and three years after breast surgery. A recurrent tumour was found in the axilla in only two (0.5%) of the total of 383 ultrasound examinations performed during the study, and only one (0.3%) of the 369 examinations performed at the scheduled study visits revealed cancer. None of the ultrasound examinations was false positive, and no study participant was subjected to unnecessary surgery due to ultrasound monitoring. We conclude that the rate of breast cancer recurrence in the ipsilateral axilla is low following sparing of the axillary contents, and that monitoring of such patients with repeated ultrasound examinations is unlikely to be cost-effective. PMID:16864171

  3. Measurement of paraben concentrations in human breast tissue at serial locations across the breast from axilla to sternum.

    Science.gov (United States)

    Barr, L; Metaxas, G; Harbach, C A J; Savoy, L A; Darbre, P D

    2012-03-01

    The concentrations of five esters of p-hydroxybenzoic acid (parabens) were measured using HPLC-MS/MS at four serial locations across the human breast from axilla to sternum using human breast tissue collected from 40 mastectomies for primary breast cancer in England between 2005 and 2008. One or more paraben esters were quantifiable in 158/160 (99%) of the tissue samples and in 96/160 (60%) all five esters were measured. Variation was notable with respect to individual paraben esters, location within one breast and similar locations in different breasts. Overall median values in nanograms per gram tissue for the 160 tissue samples were highest for n-propylparaben [16.8 (range 0-2052.7)] and methylparaben [16.6 (range 0-5102.9)]; levels were lower for n-butylparaben [5.8 (range 0-95.4)], ethylparaben [3.4 (range 0-499.7)] and isobutylparaben 2.1 (range 0-802.9). The overall median value for total paraben was 85.5 ng g(-1) tissue (range 0-5134.5). The source of the paraben cannot be identified, but paraben was measured in the 7/40 patients who reported never having used underarm cosmetics in their lifetime. No correlations were found between paraben concentrations and age of patient (37-91 years), length of breast feeding (0-23 months), tumour location or tumour oestrogen receptor content. In view of the disproportionate incidence of breast cancer in the upper outer quadrant, paraben concentrations were compared across the four regions of the breast: n-propylparaben was found at significantly higher levels in the axilla than mid (P = 0.004 Wilcoxon matched pairs) or medial (P = 0.021 Wilcoxon matched pairs) regions (P = 0.010 Friedman ANOVA). PMID:22237600

  4. Dosimetric evaluation of incidental irradiation to the axilla during whole breast radiotherapy for patients with left-sided early breast cancer in the IMRT era.

    Science.gov (United States)

    Lee, Jayoung; Kim, Shin-Wook; Son, Seok Hyun

    2016-06-01

    The purpose of this study was to compare the dosimetric parameters for incidental irradiation to the axilla during whole breast radiotherapy (WBRT) with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). Twenty left breast cancer patients treated with WBRT after breast-conserving surgery (BCS) were enrolled in this study. Remnant breast tissue, 3 levels of the axilla, heart, and lung were delineated. We used 2 different radiotherapy methods: 3D-CRT with field-in-field technique and 7-field fixed-beam IMRT. The target coverage of IMRT was significantly better than that of 3D-CRT (Dmean: 49.72 ± 0.64 Gy vs 50.24 ± 0.66 Gy, P IMRT, respectively). In the IMRT plan, a lower dose was delivered to a wider region of the heart and lung. Significantly lower axillary irradiation was shown throughout each level of axilla by IMRT compared to 3D-CRT (Dmean for level I: 42.58 ± 5.31 Gy vs 14.49 ± 6.91 Gy, P IMRT, respectively). In conclusion, the incidental dose delivered to the axilla was significantly lower for IMRT compared to 3D-CRT. Therefore, IMRT, which only includes the breast parenchyma, should be cautiously used in patients with limited positive sentinel lymph nodes and who do not undergo complete axillary lymph node dissection. PMID:27368030

  5. Early application of percutaneous neuromuscular electric stimulation in interfering motor function of limbs and difference in temperature of axilla of patients with ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Zhenhui Jiang; Siyi Yin; Na Bi; Xiang He; Fang Qu

    2006-01-01

    BACKGROUND: Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke.OBJECTIVE: To observe the effect of percutaneous neuromuscular electric stimulation (PNES) on difference in temperature of axilla and analyze the relationship between function of limbs and difference in temperature of axilla.DESIGN: Randomized grouping and controlled observation.SETTING: Department of Neurology, General Hospital of Shenyang Military Area Command of Chinese PLA.PARTICIPANTS: Sixty patients with ischemic stroke were selected from Neurological Department of General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2003. All cases were diagnosed with clinical diagnosis criteria of ischemic stroke established by the Fourth Chinese Classification of Cerebrovasular Disease and CT examination and received neuromuscular electric stimulation (NES). Patients were randomly divided into control group and treatment group with 30 in each group.METHODS: Control group: Patients received routinely neurological therapy. Treatment group: Except routine therapy, patients suffered from NES at 48 hours after hospitalization. NMT-91 NES equipment was used to stimulated injured limbs with Iow frequency once 30 minutes a day in total of 10 times a course, especially extensor muscle of upper limb and flexor muscle of lower limb. Prescription of hemiplegia was internally decided by equipment with the output frequency of 200 Hz. Intensity of electric output could cause muscle contraction.The therapy needed two or three courses. Temperature of bilateral axilla was measured every day to calculate the difference with the formula of (temperature of axilla on the injured side - temperature of axilla on the healthy side). Motor function of limbs was measured with FugI-Meyer Motor Assessment (FMA) during hospitalization and at 2 and 4 hours after hospitalization. Among 90 points, upper and lower limb function was 54

  6. Assessment of the accuracy of ultrasound compared to magnetic resonance imaging in the ability to detect metastatic breast cancer to the axilla

    Directory of Open Access Journals (Sweden)

    Sarah Ines Ramirez

    2012-01-01

    Full Text Available Sentinel lymph node biopsy (SLNB is routinely used in the staging of invasive breast cancer. The aim of this study was to investigate the diagnostic accuracy of ultrasonography (US compared to magnetic resonance imaging (MRI in the pre-operative assessment of metastatic disease to the axilla in breast cancer patients at our community hospital. We retrospectively reviewed a prospectively collected database of 277 patients seen at our breast center from 2009 to 2010. Patients with invasive breast cancer were then evaluated for axillary metastasis. Lymph nodes were sampled using fine needle aspiration (FNAB or core biopsy. Histopathology of the sentinel lymph nodes (SLN or results of the axillary dissection were compared to US or MRI results. A total of 228 patients had invasive breast cancer. In these patients, 122 lymph nodes were sampled. Pathology proven metastases to axillary lymph nodes were found in 76 cases. Accuracy and sensitivity were higher in US than MRI in detecting metastatic disease to the axilla (70.2%, 84.6%, P<0.001 and 60.0%, 52.6%, P <0.1, respectively. US was more accurate than MRI at detecting metastatic breast cancer in the axilla in our community hospital. Axillary US should be a routine part of assessment of breast cancer patients.

  7. Staging the axilla in women with breast cancer:the utility of preoperative ultrasound-guided needle biopsy

    Institute of Scientific and Technical Information of China (English)

    Nehmat Houssami; Robin M.Turner

    2014-01-01

    Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy (UNB) identiifes approximately 50% of patients with axillary nodal metastases prior to surgical intervention. Although moderately sensitive, it is a highly speciifc staging strategy that is rarely falsely-positive, hence a positive UNB allows patients to be triaged to axillary lymph-node dissection (ALND) avoiding potentially unnecessary sentinel node biopsy (SNB). In this review, we extend our previous work through an updated literature search, focusing on studies that report data on UNB utility. Based on data for 10,934 breast cancer patients, sourced from 35 studies, a positive UNB allowed triage of 1,745 cases (simple proportion 16%) to axillary surgical treatment: the utility of UNB was a median 19.8% [interquartile range (IQR) 11.6%-26.7%] across these studies. We also modelled data from a subgroup of studies, and estimated that amongst patients with metastases to axillary nodes, the odds ratio (OR) for high nodal disease burden for a positive UNB versus a negative UNB was 4.38 [95% confidence interval (95% CI): 3.13, 6.13],P<0.001. From this model, the estimated proportion with high nodal disease burden was 58.9% (95% CI: 50.2%, 67.0%) for a positive UNB, whereas the estimated proportion with high nodal disease burden was 24.6% (95% CI: 17.7%, 33.2%) if UNB was negative. Overall, axillary UNB has good clinical utility and a positive UNB can effectively triage to ALND. However, the evolving landscape of axillary surgical treatment means that UNB will have relatively less utility where surgeons have modiifed their practice to omission of ALND for minimal nodal metastatic disease.

  8. Axillary basal cell carcinoma in patients with Goltz-Gorlin syndrome: report of basal cell carcinoma in both axilla of a woman with basal cell nevus syndrome and literature review

    OpenAIRE

    Cohen, Philip R.

    2014-01-01

    Background: Basal cell carcinoma of the axilla, an area that is not usually exposed to the sun, is rare. Individuals with basal cell nevus syndrome, a disorder associated with a mutation in the patch 1 (PTCH1) gene, develop numerous basal cell carcinomas.Purpose: To describe a woman with basal cell nevus syndrome who developed a pigmented basal cell carcinoma in each of her axilla and to review the features of axillary basal cell carcinoma patients with Goltz-Gorlin syndrome.Methods: Pubmed w...

  9. Successful Intra-Arterial Chemotherapy for Extramammary Paget’s Disease of the Axilla in a Patient with Parkinson’s Disease

    International Nuclear Information System (INIS)

    Extramammary Paget’s disease (EMPD) is a rare intraepithelial neoplasm occurring less frequently in men and even more rarely in the axilla. A 59-year-old man with severe Parkinson’s disease presented with axillary EMPD. The neurological comorbidity made treatment of the EMPD problematical and prompted us to propose locoregional intra-arterial chemotherapy in single short sessions. Two innovative chemotherapeutic macrocomplexes were used: doxorubicin incorporated in large liposomes and the taxane paclitaxel incorporated in albumin nanoparticles. A therapeutic response was seen right from the first treatment and was macroscopically close to complete after four cycles. Five months after the end of treatment the patient had minimal visible disease and had enjoyed a distinct improvement in quality of life, with no noteworthy complications related to the intra-arterial chemotherapy with percutaneous transfemoral catheterization.

  10. Dissection or irradiation of the axilla in postmenopausal patients with breast cancer? Long-term results and late effects in 655 patients

    International Nuclear Information System (INIS)

    Patients and methods: From 1986 to 1993 we irradiated 655 patients with breast cancer after breast conserving surgery (BET). In all 144 cN1- and all 209 premenopausal cNO-patients axillary dissection was recommended. Of 302 postmenopausal cNO-patients 129 had breast surgery in our institution. In a total of 129 patients axillary dissection was replaced by irradiation (AxRT-group). They were compared with all 173 patients referred from other hospitals for irradiation after both breast conserving surgery and axillary dissection (AxOP-group). Dissected patients with gross tumor involvement of the axilla or less than eight nodes removed had additional axillary irradiation. Patients age, tumor size, vessel-, muscle- or skin invasion and grading were similar in both groups. However, in the AxRT-group there were more patients with negative hormon receptors, multifocal and medial sited tumors. Late complications after dissection and/or irradiation of the axilla were evaluated in 502 patients free of locoregional relapse and with a minimal follow up of 3 years (media 9,5 years). Results: After 5, 10 and 15 years tumor free survival rated were 90%, 82% and 79% in the AxOP-group vs 91%, 82% and 80% in the AxRT-group, respectively (p = 0.95). Overall survival (p = 0.98) local (p = 0.47) and axillary control (p = 0.12) were equal in both groups. However, serious problems like lymphedema of the arm, pain, mobility impairment occured in 26% patients following axillary dissection but only in 1% after axillary irradiation. No difference in late sequelae after axillary dissection with or without irradiation could be detected (26 vs 27%). (orig.)

  11. Usefulness of imaging posture using modified oblique view of the axilla (MOVA) for sentinel lymph node scintigraphy in patients with breast cancer

    International Nuclear Information System (INIS)

    Identification of the sentinel lymph nodes in patients with breast cancer is often hampered by high radioactivity from the injection site, since the distance between the injection site and regional lymph nodes is quite short in these patients. We investigated the usefulness of the modified oblique view of the axilla (MOVA) method introduced by Haigh et al., aiming at better discrimination of the target and higher resolution. Compared with the standard anterior view (SAV) of the supine position and conventional oblique view (COV) imaging, MOVA was able to obtain a longer distance between the injection site and axillary lymph nodes in 20 of 21 lymph nodes. MOVA provided more effective information for visual evaluation of the geometry of axillary lymph nodes in half the cases, and one lymph node was detected only with MOVA. In contrast, SAV provided better imaging in one patient. Although our results support the usefulness of MOVA, the combined application of MOVA and SAV is desirable, since sentinel lymph node detection with the gamma-probe is performed in the supine position during surgery. (author)

  12. Staging the Axilla with selective sentinel node biopsy in patients with previous excision of non-palpable and palpable breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ruano, R.; Garcia-Talavera, J.R.; Arriba, A. de [University Hospital of Salamanca, Nuclear Medicine, Salamanca (Spain); Ramos, M.; Gonzalez-Orus, J.; Iglesias, M. [University Hospital of Salamanca, General Surgery, Salamanca (Spain); Serrano, E.; Macias, M.C. [University Hospital of Salamanca, Pathology, Salamanca (Spain)

    2008-07-15

    To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer. In the period 2001-2006, 138 patients with prior diagnostic excisional biopsy (96 non-palpable and 42 palpable breast cancer) and 328 without previous surgery (32 non-palpable; 296 palpable cancer) were treated. The combined technique ({sup 99m}Tc-colloidal rhenium and isosulfan blue dye) was the approach for sentinel lymph node (SLN) detection. Axillary lymph node dissection (ALND) was completed only when the SLN was positive for metastasis or not located. Detection rate, if there was prior surgery, was 95% for non-palpable and 98% for palpable cancer, and 99% for one-time treatment group. Metastasis rate in the SLN was 15% in non-palpable cancer (14/91), significantly smaller than in palpable breast cancer (39% if prior surgery and 37% in one-time surgery). According to tumoral size, ALND metastasis rate was similar for T1 and T2 tumors (43-44%). In the follow-up of the groups with prior diagnostic biopsy or surgery of the breast cancer we have not found any false negative in the axilla. The detection of the SLN is also feasible in patients with previous surgery of breast cancer. Because SLN metastasis rates are significantly smaller in non-palpable lesions, the effort in screening programs for early detection of breast cancer and also in improving histopathological confirmation of malignancy with ultrasound or stereotactic guided core biopsies must continue. (orig.)

  13. Dissection or irradiation of the axilla in postmenopausal patients with breast cancer? Long-term results and late effects in 655 patients; Axilladissektion oder Axillabestrahlung bei postmenopausalen Patientinnen mit Mammakarzinom?

    Energy Technology Data Exchange (ETDEWEB)

    Albrecht, M.R.; Zink, K.; Ruehl, U. [Abt. fuer Strahlentherapie, Klinikum im Friedrichshain, Standort Moabit, Berlin (Germany); Busch, W. [Abt. fuer Gynaekologie, Krankenhaus Moabit Berlin (Germany)

    2002-09-01

    Patients and methods: From 1986 to 1993 we irradiated 655 patients with breast cancer after breast conserving surgery (BET). In all 144 cN1- and all 209 premenopausal cNO-patients axillary dissection was recommended. Of 302 postmenopausal cNO-patients 129 had breast surgery in our institution. In a total of 129 patients axillary dissection was replaced by irradiation (AxRT-group). They were compared with all 173 patients referred from other hospitals for irradiation after both breast conserving surgery and axillary dissection (AxOP-group). Dissected patients with gross tumor involvement of the axilla or less than eight nodes removed had additional axillary irradiation. Patients age, tumor size, vessel-, muscle- or skin invasion and grading were similar in both groups. However, in the AxRT-group there were more patients with negative hormon receptors, multifocal and medial sited tumors. Late complications after dissection and/or irradiation of the axilla were evaluated in 502 patients free of locoregional relapse and with a minimal follow up of 3 years (media 9,5 years). Results: After 5, 10 and 15 years tumor free survival rated were 90%, 82% and 79% in the AxOP-group vs 91%, 82% and 80% in the AxRT-group, respectively (p = 0.95). Overall survival (p = 0.98) local (p = 0.47) and axillary control (p = 0.12) were equal in both groups. However, serious problems like lymphedema of the arm, pain, mobility impairment occured in 26% patients following axillary dissection but only in 1% after axillary irradiation. No difference in late sequelae after axillary dissection with or without irradiation could be detected (26 vs 27%). (orig.) [German] Patientinnen und Methoden: Von 1986 bis 1993 wurden 655 Patientinnen mit Mammakarzinom nach brusterhaltender Operation (BET) bestrahlt. Davon waren praeoperativ 144 cN1- und 511 cNO-Patientinnen. Bei allen 144 cN1- und allen 209 praemenopausalen cNO-Patientinnen war eine Axilladissektion vorgesehen. Von 302 postmenopausalen c

  14. Staging the axilla in breast cancer patients with {sup 18}F-FDG PET: how small are the metastases that we can detect with new generation clinical PET systems?

    Energy Technology Data Exchange (ETDEWEB)

    Bellevre, Dimitri [Francois Baclesse Cancer Centre, Nuclear Medicine Department, Cedex 5, Caen (France); Blanc Fournier, Cecile [Francois Baclesse Cancer Centre, Pathology Department, Caen (France); Switsers, Odile [Francois Baclesse Cancer Centre, Nuclear Medicine Department, Cedex 5, Caen (France); Francois Baclesse Cancer Centre, Breast Cancer Unit, Caen (France); Dugue, Audrey Emmanuelle; Grellard, Jean-Michel [Francois Baclesse Cancer Centre, Biostatistics and Clinical Research unit, Caen (France); Levy, Christelle [Francois Baclesse Cancer Centre, Breast Cancer Unit, Caen (France); Francois Baclesse Cancer Centre, Radiation Oncology Department, Caen (France); Allouache, Djelila [Francois Baclesse Cancer Centre, Breast Cancer Unit, Caen (France); Desmonts, Cedric [University Hospital, Medical Physics Department, Caen (France); Crouet, Hubert; Guilloit, Jean-Marc [Francois Baclesse Cancer Centre, Surgical Oncology, Caen (France); Aide, Nicolas [Francois Baclesse Cancer Centre, Nuclear Medicine Department, Cedex 5, Caen (France); Normandie Universite, Caen (France)

    2014-06-15

    Point spread function (PSF) reconstruction improves spatial resolution throughout the entire field of view of a PET system and can detect smaller metastatic deposits than conventional algorithms such as OSEM. We assessed the impact of PSF reconstruction on quantitative values and diagnostic accuracy for axillary staging of breast cancer patients, compared with an OSEM reconstruction, with emphasis on the size of nodal metastases. This was a prospective study in a single referral centre in which 50 patients underwent an {sup 18}F-FDG PET examination before axillary lymph node dissection. PET data were reconstructed with an OSEM algorithm and PSF reconstruction, analysed blindly and validated by a pathologist who measured the largest nodal metastasis per axilla. This size was used to evaluate PET diagnostic performance. On pathology, 34 patients (68 %) had nodal involvement. Overall, the median size of the largest nodal metastasis per axilla was 7 mm (range 0.5 - 40 mm). PSF reconstruction detected more involved nodes than OSEM reconstruction (p = 0.003). The mean PSF to OSEM SUV{sub max} ratio was 1.66 (95 % CI 1.01 - 2.32). The sensitivities of PSF and OSEM reconstructions were, respectively, 96 % and 92 % in patients with a largest nodal metastasis of >7 mm, 60 % and 40 % in patients with a largest nodal metastasis of ≤7 mm, and 92 % and 69 % in patients with a primary tumour ≤30 mm. Biggerstaff graphical comparison showed that globally PSF reconstruction was superior to OSEM reconstruction. The median sizes of the largest nodal metastasis in patients with nodal involvement not detected by either PSF or OSEM reconstruction, detected by PSF but not by OSEM reconstruction and detected by both reconstructions were 3, 6 and 16 mm (p = 0.0064) respectively. In patients with nodal involvement detected by PSF reconstruction but not by OSEM reconstruction, the smallest detectable metastasis was 1.8 mm. As a result of better activity recovery, PET with PSF

  15. Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora? Intramammary lymph node sentinel metastasis without metastasis in axilla: axillary lymph node dissection or conservative surgery?

    Directory of Open Access Journals (Sweden)

    René Aloisio da Costa Vieira

    2012-10-01

    Full Text Available A pesquisa do linfonodo sentinela constitui tratamento padrão para pacientes portadoras de câncer de mama e axila clinicamente negativa. A presença do linfonodo sentinela (LS extra-axilar e intramamário (IM ocorre em até 2,6% dos casos, e na presença do LS IM metastático, a positividade axilar pode alcançar até 81%. Na associação do LS IM metastático ao LS axilar não metastático, não há conduta padronizada, visto um limitado número de casos descritos. Adicionamos dois casos à literatura, observando, em um deles, a presença de doença metastática axilar na linfadenectomia complementar. A utilização de nomograma demonstrou que o risco de doença metastática axilar era inferior a 10%, e a adição destes casos à literatura mostrou que, nesta situação, a taxa de doença metastática axilar é de 6,25%. Discutimos os prós e contras da linfadenectomia axilar complementar nesta situação.The sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM sentinel lymph node (SLN occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.

  16. Linfonodo sentinela intramamário comprometido e axila livre: esvaziamento axilar ou conduta conservadora? Intramammary lymph node sentinel metastasis without metastasis in axilla: axillary lymph node dissection or conservative surgery?

    Directory of Open Access Journals (Sweden)

    René Aloisio da Costa Vieira

    2012-01-01

    Full Text Available A pesquisa do linfonodo sentinela constitui tratamento padrão para pacientes portadoras de câncer de mama e axila clinicamente negativa. A presença do linfonodo sentinela (LS extra-axilar e intramamário (IM ocorre em até 2,6% dos casos, e na presença do LS IM metastático, a positividade axilar pode alcançar até 81%. Na associação do LS IM metastático ao LS axilar não metastático, não há conduta padronizada, visto um limitado número de casos descritos. Adicionamos dois casos à literatura, observando, em um deles, a presença de doença metastática axilar na linfadenectomia complementar. A utilização de nomograma demonstrou que o risco de doença metastática axilar era inferior a 10%, e a adição destes casos à literatura mostrou que, nesta situação, a taxa de doença metastática axilar é de 6,25%. Discutimos os prós e contras da linfadenectomia axilar complementar nesta situação.The sentinel lymph node biopsy is a standard treatment for patients with breast cancer and clinically negative axilla lymph node. The presence of an extra-axillary and intra-axillary (IM sentinel lymph node (SLN occurs in up to 2.6% of cases. In the presence of a metastatic IM SLN, axillary positivity may occur in up to 81% of cases. Due to the limited number of cases reported, there is no standard treatment for the association of metastatic SLN IM and non-metastatic axillary SLN . We add here two cases to the literature, one of them with metastatic disease in the axilla. The use of a nomogram demonstrated that the risk of axillary metastasis was less than 10% and the addition of these cases to the literature showed that in this situation the rate of axillary metastasis is 6.25%. We discuss the pros and cons of further axillary dissection in this situation.

  17. Regional radiotherapy versus an axillary lymph node dissection after lumpectomy: a safe alternative for an axillary lymph node dissection in a clinically uninvolved axilla in breast cancer. A case control study with 10 years follow up

    Directory of Open Access Journals (Sweden)

    Elferink Marloes AG

    2007-10-01

    Full Text Available Abstract Background The standard treatment of the axilla in breast cancer used to be an axillary lymph node dissection. An axillary lymph node dissection is known to give substantial risks of morbidity. In recent years the sentinel node biopsy has become common practice. Future randomized study results will determine whether the expected decrease in morbidity can be proven. Methods Before the introduction of the sentinel node biopsy, we conducted a study in which 180 women of 50 years and older with T1/T2 cN0 breast cancer were treated with breast conserving therapy. Instead of an axillary lymph node dissection regional radiotherapy was given in combination with tamoxifen (RT-group. The study group was compared with 341 patients, with the same patient and tumour characteristics, treated with an axillary lymph node dissection (S-group. Results The treatment groups were comparable, except for age. The RT-group was significantly older than the S-group. The median follow up was 7.2 years. The regional relapse rates were low and equal in both treatment groups, 1.1% in RT-group versus 1.5% in S-group at 5 years. The overall survival was similar; the disease free survival was significant better in the RT-group. Conclusion Regional recurrence rates after regional radiotherapy are very low and equal to an axillary lymphnode dissection.

  18. Regional radiotherapy versus an axillary lymph node dissection after lumpectomy: a safe alternative for an axillary lymph node dissection in a clinically uninvolved axilla in breast cancer. A case control study with 10 years follow up

    International Nuclear Information System (INIS)

    The standard treatment of the axilla in breast cancer used to be an axillary lymph node dissection. An axillary lymph node dissection is known to give substantial risks of morbidity. In recent years the sentinel node biopsy has become common practice. Future randomized study results will determine whether the expected decrease in morbidity can be proven. Before the introduction of the sentinel node biopsy, we conducted a study in which 180 women of 50 years and older with T1/T2 cN0 breast cancer were treated with breast conserving therapy. Instead of an axillary lymph node dissection regional radiotherapy was given in combination with tamoxifen (RT-group). The study group was compared with 341 patients, with the same patient and tumour characteristics, treated with an axillary lymph node dissection (S-group). The treatment groups were comparable, except for age. The RT-group was significantly older than the S-group. The median follow up was 7.2 years. The regional relapse rates were low and equal in both treatment groups, 1.1% in RT-group versus 1.5% in S-group at 5 years. The overall survival was similar; the disease free survival was significant better in the RT-group. Regional recurrence rates after regional radiotherapy are very low and equal to an axillary lymphnode dissection

  19. Randomized Control Trial: Evaluating Aluminum-Based Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for Treatment of Stage 0, I, and II Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Watson, Linda C., E-mail: Linda.watson@albertahealthservices.ca [Department of Interdisciplinary Practice, Community Oncology, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Gies, Donna [Department of Radiation Oncology Nursing, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Thompson, Emmanuel [Department of Mathematics and Statistics, University of Calgary Faculty of Science, Calgary, AB (Canada); Thomas, Bejoy [Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Department of Psychosocial Oncology, University of Calgary Faculty of Medicine, Calgary, AB (Canada)

    2012-05-01

    Purpose: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. Methods: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy's questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. Results: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Conclusions: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from

  20. Randomized Control Trial: Evaluating Aluminum-Based Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for Treatment of Stage 0, I, and II Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. Methods: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy’s questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. Results: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Conclusions: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from using

  1. MORPHOLOGY OF ULNAR NERVE IN AXILLA & ARM & ITS VARIATIONS

    Directory of Open Access Journals (Sweden)

    Vijay Kumar S

    2014-11-01

    Full Text Available The ulnar nerve arises from the medial cord (C8, T1; medial cord also receives fibres from the ventral ramus of C7. Lesions of the ulnar nerve occur behind the medial epicondyle & in the cubital tunnel. When muscles are affected due to ulnar nerve dysfunction, there is ulnar neuropathy at the shoulder, arm & elbow. The study was done on 50 embalmed human cadavers (25 right & 25 left of both sexes of South Indian adult population obtained from the Department of Anatomy, Bangalore Medical College and Research Institute, Bangalore. Variations in the ulnar nerve in its presence, origin, relations, distribution & communications were observed. Ulnar nerve was present in all 50 upper limb specimens (100%. Ulnar nerve originated from the medial cord of the brachial plexus in 49 cases (98%. In 1 case (2%, the ulnar nerve received C7 fibers from lateral cord i.e. the lateral root of the median nerve and then later fused with the median root of the median nerve. In 49 specimens (98% ulnar nerve took origin from the tip of the acromion processes. In 1 case (2% it took origin from distal to the tip of the acromion process. 49 specimens (98% showed the normal course, i.e. medial to axillary & brachial artery. 1 case (2% showed ulnar nerve present anterior to the third part of the axillary artery and brachial artery. In the midarm it passed medially as a normal course, then runs distally through the cubital tunnel. The awareness of these variations along the normal pattern are helpful for the interventional radiologists, orthopaedicians and neurologists in preventing untoward iatrogenic injury to the ulnar nerve during radiological procedures or operating on fractured patients or diagnostic therapy.

  2. MORPHOLOGY OF ULNAR NERVE IN AXILLA & ARM & ITS VARIATIONS

    OpenAIRE

    Vijay Kumar S; Priya Ranganath

    2014-01-01

    The ulnar nerve arises from the medial cord (C8, T1); medial cord also receives fibres from the ventral ramus of C7. Lesions of the ulnar nerve occur behind the medial epicondyle & in the cubital tunnel. When muscles are affected due to ulnar nerve dysfunction, there is ulnar neuropathy at the shoulder, arm & elbow. The study was done on 50 embalmed human cadavers (25 right & 25 left) of both sexes of South Indian adult population obtained from the Department of Anatomy, Bangalore Medica...

  3. An Unusual Origin of Fetal Lymphangioma Filling Right Axilla.

    Science.gov (United States)

    Ersoy, Ali Ozgur; Oztas, Efser; Saridogan, Erdinc; Ozler, Sibel; Danisman, Nuri

    2016-03-01

    Fetal lymphangioma is a hamartomatous congenital anomaly of the lymphatic system, which is embracing the fetal skin (sometimes mucous membranes) and the subcutaneous tissue. The general consensus is that it occurs as a result of failure in lymphatic drainage. A 36-year-old pregnant woman was referred to our perinatology clinic at 22 weeks' gestation, because of a fetal right-sided axillary mass revealed by ultrasonography. The mass measuring 5x7x7cm in three dimensions had a multilocular structure without colour Doppler flow and well-circumscribed borders. Amniocentesis revealed a normal constitutional karyotyping. Lymphangioma was considered as prediagnosis. A healthy female baby weighing 3470 grams was delivered at term. Neonatal examination and the postnatal MRI confirmed the diagnosis. The baby is still on follow-up with the medical treatment of Sirolimus an anti-proliferative drug, and the mass got smaller significantly in 8 months after delivery. PMID:27134953

  4. Isolated Post-Transplantation Lymphoproliferative Disease Involving the Breast and Axilla as Peripheral T-cell Lymphoma

    International Nuclear Information System (INIS)

    Post-transplantation lymphoproliferative disorders (PTLDs) are a heterogeneous group of diseases that represent serious complications following immunosuppressive therapy for solid organ or hematopoietic-cell recipients. In contrast to B-cell PTLD, T-cell PTLD is less frequent and is not usually associated with Epstein Barr Virus infection. Moreover, to our knowledge, isolated T-cell PTLD involving the breast is extremely rare and this condition has never been reported previously in the literature. Herein, we report a rare case of isolated T-cell PTLD of the breast that occurred after a patient had been treated for allogeneic peripheral blood stem cell transplantation due to acute myeloblastic leukemia

  5. Isolated Post-Transplantation Lymphoproliferative Disease Involving the Breast and Axilla as Peripheral T-cell Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ji-Young [Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 150-950 (Korea, Republic of); Cha, Eun Suk; Lee, Jee Eun [Department of Radiology, Ewha Womans University School of Medicine, Seoul 158-710 (Korea, Republic of); Sung, Sun Hee [Department of Pathology, Ewha Womans University School of Medicine, Seoul 158-710 (Korea, Republic of)

    2013-07-01

    Post-transplantation lymphoproliferative disorders (PTLDs) are a heterogeneous group of diseases that represent serious complications following immunosuppressive therapy for solid organ or hematopoietic-cell recipients. In contrast to B-cell PTLD, T-cell PTLD is less frequent and is not usually associated with Epstein Barr Virus infection. Moreover, to our knowledge, isolated T-cell PTLD involving the breast is extremely rare and this condition has never been reported previously in the literature. Herein, we report a rare case of isolated T-cell PTLD of the breast that occurred after a patient had been treated for allogeneic peripheral blood stem cell transplantation due to acute myeloblastic leukemia.

  6. An unusual case of isolated, serial metastases of gallbladder carcinoma involving the chest wall, axilla, breast and lung parenchyma

    Directory of Open Access Journals (Sweden)

    Matthew J. Iott

    2013-02-01

    Full Text Available In the English literature, only 9 cases of adenocarcinoma of the gallbladder with cutaneous metastasis have been reported so far. One case of multiple cutaneous metastases along with deposits in the breast tissue has been reported. We present a case of incidental metastatic gallbladder carcinoma with no intra-abdominal disease presenting as a series of four isolated cutaneous right chest wall, axillary nodal, breast and pulmonary metastases following resection and adjuvant chemoradiation for her primary tumor. In spite of the metastatic disease coupled with the aggressive nature of the cancer, this patient reported that her energy level had returned to baseline with a good appetite and a stable weight indicating a good performance status and now is alive at 25 months since diagnosis. Her serially-presented, oligometastatic diseases were well-controlled by concurrent chemoradiation and stereotactic radiation therapy. We report this case study because of its rarity and for the purpose of complementing current literature with an additional example of cutaneous metastasis from adenocarcinoma of the gallbladder.

  7. Doença de Crohn metastática para axila Metastatic Crohn's disease to the axilla

    Directory of Open Access Journals (Sweden)

    Flávia Balsamo

    2007-03-01

    Full Text Available Relata-se um caso de doença de Crohn com manifestação cutânea axilar extremamente rara, bem como suas peculiaridades em relação ao diagnóstico e tratamento.The description of a case of metastatic Crohn's disease, a rare skin manifestation to the axillar region with diagnostic features and treatment schedules.

  8. Sequential {sup 18}F-FDG PET/CT for early prediction of complete pathological response in breast and axilla during neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Koolen, Bas B. [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Amsterdam (Netherlands); Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Amsterdam (Netherlands); Pengel, Kenneth E. [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Radiology, Amsterdam (Netherlands); Wesseling, Jelle [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Pathology, Amsterdam (Netherlands); Vogel, Wouter V.; Valdes Olmos, Renato A. [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Amsterdam (Netherlands); Vrancken Peeters, Marie-Jeanne T.F.D.; Rutgers, Emiel J.T. [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Amsterdam (Netherlands); Vincent, Andrew D. [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Biometrics, Amsterdam (Netherlands); Gilhuijs, Kenneth G.A. [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Radiology, Amsterdam (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Rodenhuis, Sjoerd [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam (Netherlands)

    2014-01-15

    To investigate the value of response monitoring in both the primary tumour and axillary nodes on sequential PET/CT scans during neoadjuvant chemotherapy (NAC) for predicting complete pathological response (pCR), taking the breast cancer subtype into account. In 107 consecutive patients 290 PET/CT scans were performed at baseline (PET/CT1, 107 patients), after 2 - 3 weeks of chemotherapy (PET/CT2, 85 patients), and after 6 - 8 weeks (PET/CT3, 98 patients). The relative changes in SUVmax (from baseline) of the tumour and the lymph nodes and in both combined (after logistic regression), and the changes in the highest SUVmax between scans (either tumour or lymph node) were determined and their associations with pCR of the tumour and lymph nodes after completion of NAC were assessed using receiver operating characteristic (ROC) analysis. A pCR was seen in 17 HER2-positive tumours (65 %), 1 ER-positive/HER2-negative tumour (2 %), and 16 triple-negative tumours (52 %). The areas under the ROC curves (ROC-AUC) for the prediction of pCR in HER2-positive tumours after 3 weeks were 0.61 for the relative change in tumours, 0.67 for the combined change in tumour and nodes, and 0.72 for the changes in the highest SUVmax between scans. After 8 weeks equivalent values were 0.59, 0.42 and 0.64, respectively. In triple-negative tumours the ROC-AUCs were 0.76, 0.84 and 0.76 after 2 weeks, and 0.87, 0.93 and 0.88 after 6 weeks, respectively. In triple-negative tumours a PET/CT scan after 6 weeks (three cycles) appears to be optimally predictive of pCR. In HER2-positive tumours neither a PET/CT scan after 3 weeks nor after 8 weeks seems to be useful. The changes in SUVmax of both the tumour and axillary nodes combined correlates best with pCR. (orig.)

  9. Application of artificial neural networks for the prediction of lymph node metastases to the ipsilateral axilla - initial experience in 194 patients using magnetic resonance mammography

    International Nuclear Information System (INIS)

    Background: In breast MRI (bMRI), prediction of lymph node metastases (N+) on the basis of dynamic and morphologic descriptors of breast cancers remains a complex task. Purpose: To predict N+ using an artificial neural network (ANN) on the basis of 17 previously published descriptors of breast lesions in bMRI. Material and Methods: Standardized protocol and study design were applied in this study (T1w-FLASH; 0.1 mmol/kg body weight Gd-DTPA; T2w-TSE; histological verification after bMRI). All lesions were evaluated by two experienced radiologists in consensus. In every lesion 17 previously published descriptors were assessed. Matched subgroups with (N+; n=97) and without N+ were created (N-; n=97), forming the dataset of this study (n=194). An ANN was constructed ('Multilayer Perceptron'; training: 'Batch'; activation function of hidden/output layer: 'Hyperbolic Tangent'/'Softmax') to predict N+ using all descriptors in combination on a randomly chosen training sample (n=123/194) and optimized on the corresponding test sample (n=71/194) using dedicated software. The discrimination power of this ANN was quantified by area under the curve (AUC) comparison (vs AUC=0.5). Training and testing cycles were repeated 20 times to quantify the robustness of the ANN (median-AUC; confidence intervals, CIs). Results: The ANN demonstrated highly significant discrimination power to classify N+ vs N- (P<0.001). Diagnostic accuracy reached 'moderate' AUC (median-AUC=0.74; CI 0.70-0.76). Conclusion: Application of ANNs for the prediction of lymph node metastases in breast MRI is feasible. Future studies should evaluate the clinical impact of the presented model

  10. Imaging methods for the local lymphatic system of the axilla in early breast cancer in patients qualified for sentinel lymph node biopsy.

    Science.gov (United States)

    Nowikiewicz, Tomasz; Kurylcio, Andrzej; Polkowski, Wojciech; Zegarski, Wojciech

    2016-03-01

    Breast cancer is the most common malignancy in women in well-developed countries. Despite a constant increase in its incidence, the percentage of patients diagnosed with the disease in the non-invasive stage is also rising. This allows more frequently for the use of breast-preserving surgical techniques, involving the breast and the regional lymphatic system. According to current guidelines of expert panels and research societies, the recommended method of identifying the sentinel lymph node is the use of an isotope marker with a dye (a combined isotope and dye method). Cooperation with a nuclear medicine unit is essential (performing a preoperative lymphoscintigraphic scan to identify the lymphatic drainage basin and sentinel lymph node). In the case of smaller centers treating breast cancer, it can be associated with a number of difficulties, including organizational ones, and also increasing general treatment costs. A possible solution to these problems is to use alternative techniques of visualizing the sentinel lymph node, which do not require a radiotracer. In this paper we discuss the currently available methods of mapping the lymphatic system of the axillary region in patients with early breast cancer. The review is limited to reporting on methods of proven (based on clinical research) high diagnostic value. PMID:27095960

  11. Traducción comentada de «Management of the Clinically Positive Axilla» y «Management of the Internal Mammary Lymph Nodes», Essentials of Breast Surgery

    OpenAIRE

    Gelmà Castillo, Carla

    2013-01-01

    La transmisión de conocimiento científico constituye una de las necesidades de traducción más importantes; es preciso realizar un estudio sobre la traducción del inglés médico. Este trabajo presenta una traducción inédita de fragmentos de Essentials of Breast Surgery y un análisis de esta jerga mediante un glosario y problemas de traducción.

  12. Deodorants

    DEFF Research Database (Denmark)

    Johansen, Jeanne Duus; Rastogi, S C; Bruze, M; Andersen, Klaus Ejner; Frosch, P J; Dreier, B; Lepoittevin, J P; White, I; Menné, T

    1998-01-01

    Deodorants are one of the most marketed types of cosmetics and are frequently reported as a cause of dermatitis, particularly among fragrance-sensitive persons. The aim of this study was to investigate the ability of deodorants, which had previously caused axillary dermatitis in fragrance....../20 (60%) deodorants elicited eczema on use testing in the axilla. 8/12 deodorants were positive in the axilla on day (D) 7 and 4 both in the axilla and on the upper arm. 2 of the 4 developed a reaction in the axilla before it developed on the upper arm. Chemical analysis revealed that 18/19 deodorants...

  13. LANGER’S AXILLARY ARCH AND ITS CLINICAL IMPLICATIONS

    Directory of Open Access Journals (Sweden)

    Jyothi K C

    2014-09-01

    Full Text Available Introduction: The axillary arch muscle of Langer is the most common anatomical variant of axillary musculature which is of clinical and surgical importance. It may lead to neurovascular compression syndrome in the cervicoaxillary region and can be misinterpreted while examining axilla and also impairs movements of shoulder joint. Observation: During routine dissection of axilla for undergraduate teaching, an unusual muscular slip in the left axilla was observed .The muscular slip was extending from lattisimus dorsi muscle to undersurface of pectoralis major muscle, arching over axillary vessels and cords of brachial plexus. Conclusion: The axillary arch may cause obstruction to axillary vessels and nerves and may be involved in thoracic outlet syndrome and shoulder instability. The knowledge of this muscular variant could help to minimize intraoperative complications related to surgeries in or nearby axilla such as mastectomy, breast reconstruction and axillary lymphadenectomy or lymph node biopsy.

  14. Kimura′s disease: An uncommon cause of lymphadenopathy

    Directory of Open Access Journals (Sweden)

    Kumar Veerendra

    2010-01-01

    Full Text Available Lymph node enlargement of neck and axilla is one of the common presenting complaints in pediatrics. We are presenting here a very rare cause of axillary lymphadenopathy detected in a toddler.

  15. The surgical importance of an axillary arch in sentinel node biopsy.

    LENUS (Irish Health Repository)

    Ridgway, P F

    2011-03-01

    When Carl Langer described the aberrant axillary arch in 1846 its relevance in sentinel node biopsy (SNB) surgery could not have been contemplated. The authors define an incidence and elucidate relevance of the arch in SNB of the axilla.

  16. Breast Reconstruction with Tissue Expansion

    Medline Plus

    Full Text Available ... Here's our superior drain, well-hidden in the shadows of the axilla. We just place this one ... for. The implant was in perfect condition. I don't know if you have anything else to ...

  17. Benign familial pemphigus ( Hailey-Hailey disease)

    OpenAIRE

    White, Forrest; Shvartsbeyn, Marianna; Meehan, Shane A; Urbanek, Richard W

    2015-01-01

    A 56-year-old man presented with a 15-year history of scaly red plaques on the trunk and axillae. Skin biopsy was consistent with Hailey-Hailey disease. His condition was refractory to multiple therapies, which included topical and oral antibiotics and topical, intralesional, and oral glucocorticoids. Treatment with subcutaneous botulinum toxin type A at the axillae and on the back led to a nearly complete resolution of plaques in those areas. Botulinum toxin type A should be considered in pa...

  18. Lymphoscintigraphy Can Select Breast Cancer Patients for Internal Mammary Chain Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hindie, Elif, E-mail: elif.hindie@sls.aphp.fr [Department of Nuclear Medicine, Saint-Louis Hospital, Paris 7 University, Paris (France); Department of Nuclear Medicine, CHU de Bordeaux, University of Bordeaux-Segalen, Bordeaux (France); Groheux, David [Department of Nuclear Medicine, Saint-Louis Hospital, Paris 7 University, Paris (France); Hennequin, Christophe [Department of Radiation Oncology, Saint-Louis Hospital, Paris (France); Zanotti-Fregonara, Paolo; Vercellino, Laetitia; Berenger, Nathalie; Toubert, Marie-Elisabeth [Department of Nuclear Medicine, Saint-Louis Hospital, Paris 7 University, Paris (France); Maylin, Claude [Department of Radiation Oncology, Saint-Louis Hospital, Paris (France); Vilcoq, Jacques-Robert [Department of Radiation Oncology, Hartmann Hospital, Neuilly sur Seine (France); Espie, Marc [Breast Diseases Unit, Saint-Louis Hospital, Paris (France)

    2012-07-15

    Purpose: Given the risk of undesired toxicity, prophylactic internal mammary (IM) chain irradiation should be offered only to patients at high risk of occult involvement. Lymphoscintigraphy for axillary sentinel node biopsy might help in selecting these patients. Methods and Materials: We reviewed published studies with the following selection criteria: {>=}300 breast cancer patients referred for axilla sentinel node biopsy; scintigraphy performed after peritumoral or intratumoral tracer injection; IM biopsy in the case of IM drainage; and axilla staged routinely independent of IM status. Results: Six prospective studies, for a total of 3,876 patients, fulfilled the inclusion criteria. Parasternal drainage was present in 792 patients (20.4%). IM biopsy was performed in 644 patients and was positive in 111 (17.2%). Of the positive IM biopsies, 40% were associated with tumors in the lateral breast quadrants. A major difference in the IM positivity rate was found according to the axilla sentinel node status. In patients with negative axilla, the IM biopsy was positive in 7.8% of cases. In patients with positive axilla, however, the IM biopsy was positive in 41% (p < .00001). Because biopsy of multiple IM hot nodes is difficult, the true risk could be even greater, probably close to 50%. Conclusions: Patients with IM drainage on lymphoscintigraphy and a positive axilla sentinel node have a high risk of occult IM involvement. These women should be considered for IM radiotherapy.

  19. Lymphoscintigraphy Can Select Breast Cancer Patients for Internal Mammary Chain Radiotherapy

    International Nuclear Information System (INIS)

    Purpose: Given the risk of undesired toxicity, prophylactic internal mammary (IM) chain irradiation should be offered only to patients at high risk of occult involvement. Lymphoscintigraphy for axillary sentinel node biopsy might help in selecting these patients. Methods and Materials: We reviewed published studies with the following selection criteria: ≥300 breast cancer patients referred for axilla sentinel node biopsy; scintigraphy performed after peritumoral or intratumoral tracer injection; IM biopsy in the case of IM drainage; and axilla staged routinely independent of IM status. Results: Six prospective studies, for a total of 3,876 patients, fulfilled the inclusion criteria. Parasternal drainage was present in 792 patients (20.4%). IM biopsy was performed in 644 patients and was positive in 111 (17.2%). Of the positive IM biopsies, 40% were associated with tumors in the lateral breast quadrants. A major difference in the IM positivity rate was found according to the axilla sentinel node status. In patients with negative axilla, the IM biopsy was positive in 7.8% of cases. In patients with positive axilla, however, the IM biopsy was positive in 41% (p < .00001). Because biopsy of multiple IM hot nodes is difficult, the true risk could be even greater, probably close to 50%. Conclusions: Patients with IM drainage on lymphoscintigraphy and a positive axilla sentinel node have a high risk of occult IM involvement. These women should be considered for IM radiotherapy.

  20. Radiation Therapy Field Extent for Adjuvant Treatment of Axillary Metastases From Malignant Melanoma

    International Nuclear Information System (INIS)

    Purpose: To compare treatment-related outcomes and toxicity for patients with axillary lymph node metastases from malignant melanoma treated with postoperative radiation therapy (RT) to either the axilla only or both the axilla and supraclavicular fossa (extended field [EF]). Methods and Materials: The medical records of 200 consecutive patients treated with postoperative RT for axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients received postoperative hypofractionated RT for high-risk features; 95 patients (48%) received RT to the axilla only and 105 patients (52%) to the EF. Results: At a median follow-up of 59 months, 111 patients (56%) had sustained relapse, and 99 patients (50%) had died. The 5-year overall survival, disease-free survival, and distant metastasis-free survival rates were 51%, 43%, and 46%, respectively. The 5-year axillary control rate was 88%. There was no difference in axillary control rates on the basis of the treated field (89% for axilla only vs. 86% for EF; p = 0.4). Forty-seven patients (24%) developed treatment-related complications. On both univariate and multivariate analyses, only treatment with EF irradiation was significantly associated with increased treatment-related complications. Conclusions: Adjuvant hypofractionated RT to the axilla only for metastatic malignant melanoma with high-risk features is an effective method to control axillary disease. Limiting the radiation field to the axilla only produced equivalent axillary control rates to EF and resulted in lower treatment-related complication rates.

  1. Supernumerary breast. A case Presentation

    Directory of Open Access Journals (Sweden)

    Juan Miguel Guerra Cabrera

    2010-07-01

    Full Text Available Congenital malformations of the breast appear in 10 % of the population. The existence of mammary tissue at any line of the breast is classified according to Kajava’s categories into eight classes which differ one from the other in the presence or absence of the areola of the breast, nipple and glandular tissue. This report presents a case of a puerpera who had delivered her child seven days before her attendance to hospital. She presented with discharge from her both axillae. On physical examination, a supernumerary nipple with milky secretion out from it was found in her right axilla and secretion throughout the contralateral axilla through the skin pores, with absence of nipple and areola in that axillary region. The echographic study revealed the presence of bilateral ectopic mammary tissue. This case belongs to Kajava’s class IV classification in the left axilla and a variery of Type I in the right axilla. In facing a mammary malformation, a conservative attitude seems to be the most appropriate although esthetics requires surgery. To keep into account the presence of supernumerary breasts will be a need for the prevention of breast cancer. This case has been presented due to all these reasons and the unusual features of this case.

  2. Reduced barrier efficiency in axillary stratum corneum.

    Science.gov (United States)

    Watkinson, A; Lee, R S; Moore, A E; Pudney, P D A; Paterson, S E; Rawlings, A V

    2002-06-01

    The skin of the axilla is cosmetically important with millions of consumers daily applying antiperspirant/deodorant products. Despite this, we know virtually nothing about axillary skin or how antiperspirant (AP) use impacts upon it. To characterize the axillary stratum corneum and determine whether this is a unique skin type, we have looked at stratum corneum composition and function, particularly its barrier properties, and compared it with other body sites. Transepidermal water loss (TEWL) and corneosurfametry (CSM) revealed a reduced barrier function in the axilla. HPTLC analysis of the stratum corneum lipids demonstrated statistically elevated levels of fatty acids, ceramides, and particularly cholesterol in the axilla. Both ceramide and cholesterol did not appear to change with depth, indicating that they were predominantly of stratum corneum origin. On the other hand, at least some of the fatty acid had a sebaceous origin. We hypothesized that the reduced barrier function might be owing to the changes in the crucial ceramide : cholesterol ratio. To address this, we used a combination of attenuated total reflectance-Fourier-transformed infrared spectroscopy (ATR-FTIR) with cyanoacrylate sampling. These results demonstrated more ordered lipid-lamellae phase behaviour in the axilla, suggesting that the elevated cholesterol might form crystal microdomains within the lipid lamellae, allowing an increase in water flux. Since an exaggerated application of antiperspirant had no effect upon the axilla barrier properties, it is concluded that this region of skin physiologically has a reduced barrier function. PMID:18498507

  3. Salvage surgery for a giant melanoma on the back

    Directory of Open Access Journals (Sweden)

    Schelto Kruijff

    2011-07-01

    Full Text Available We report a case of a giant melanoma on the back with a very extreme Breslow thickness. On physical examination a large odorous and ulcerating tumour was seen adjacent to two large crusted lesions, probably in transit metastases. In the right and left axilla enlarged lymph nodes were palpated. The patient underwent salvage surgery consisting of a complete wide excision of the tumors on the back as well as axillary lymph node dissection on both sides. Histopathology showed a malignant melanoma with a Breslow thickness of 48 mm. Four of fifteen nodes in the right axilla and one of nine nodes in the left axilla, were positive for metastatic disease. Also various in transit and subcutaneous metastases were found in the wide excision specimen. The interest of our observation relies in the rarity of a melanoma with such an extreme Breslow thickness and the difficulty in performing adequate palliative therapy that offers quality of life by means of tumor control.

  4. Salvage surgery for a giant melanoma on the back.

    Science.gov (United States)

    Kruijff, Schelto; Vink, Robert; Klaase, Joost

    2011-07-11

    We report a case of a giant melanoma on the back with a very extreme Breslow thickness. On physical examination a large odorous and ulcerating tumour was seen adjacent to two large crusted lesions, probably in transit metastases. In the right and left axilla enlarged lymph nodes were palpated. The patient underwent salvage surgery consisting of a complete wide excision of the tumors on the back as well as axillary lymph node dissection on both sides. Histopathology showed a malignant melanoma with a Breslow thickness of 48 mm. Four of fifteen nodes in the right axilla and one of nine nodes in the left axilla, were positive for metastatic disease. Also various in transit and subcutaneous metastases were found in the wide excision specimen. The interest of our observation relies in the rarity of a melanoma with such an extreme Breslow thickness and the difficulty in performing adequate palliative therapy that offers quality of life by means of tumor control. PMID:22066035

  5. UNILATERAL VARIATION IN THE BRANCHING PATTERN OF RIGHT AXILLARY ARTERY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    A.K.Manicka Vasuki

    2015-09-01

    Full Text Available Axillary artery and its branches are prone to have variations in their course. Knowledge about such variations are important for Radiologists in imaging techniques, Surgeons,Orthopedicians and Anesthetists in performing surgeries in the axilla and giving regional nerve blocks in the axilla.During dissection of a cadaver in the department of Anatomy, PSG IMS &R, Coimbatore, We observed a variation in the third part of right Axillary artery. From the common trunk, Subscapular artery, Anterior and Posterior circumflex humeral arteries and Profunda brachii artery arose. Third part of Axillary artery continued down as brachial artery. We are highlighting the variation in this study.

  6. Successful Treatment in a Child with Anaplastic Large Cell Lymphoma and Coexistence of Pulmonary Tuberculosis

    OpenAIRE

    Katerina Strantzia; Maria Varvoutsi; Despina Bouhoutsou; Maria Tsolia; Apostolos Pourtsidis; Dimitrios Doganis; Margarita Baka; Helen Kosmidis

    2013-01-01

    A 13-year-old girl was admitted to our department with a history of severe pain of her left axilla and fever. On physical examination, a block of lymph nodes in her left axilla, diffuse papular rash, and red-violet swelling of her supraclavicular and subclavian region were noted. Imaging investigations revealed left axillar and supraclavicular lymphadenopathy and a small nodular shade in the upper lobe of her left lung. A biopsy from an axillary lymph node established the diagnosis of anaplas...

  7. A case of collision tumor or transdifferentiation between malignant melanoma and leiomyosarcoma

    DEFF Research Database (Denmark)

    Ul-Mulk, Jamshaid; Rasmussen, Helle; Breiting, Line; Siim, Elsebeth

    2012-01-01

    presented a 10 cm rapidly growing mass in her right axilla. The mass in the axilla measured 12.5 ΄ 9 ΄ cm. It revealed a lymph node metastases with a tumor growth composed of two different contiguous morphological and immunohistochemical components, respectively, melanosomes and leiomyosarcoma. The...... seborrheic keratosis. There have also been occasional reports of rhabdomyosarcomatous differentiation. However, mesenchymal differentiation, and in this case leiomysarcoma, with formation of heterologous elements in melanocytic tumor is very rare. Another plausible explanation may be that malignant melanoma...

  8. The effect of aluminium chlorhydrate on sweat gland activity in cattle.

    Science.gov (United States)

    Rees-Jones, A M; Jenkinson, D M

    1978-03-01

    Topical application of aluminium chlorhydrate had no appreciable antiperspirant action on the epitrichial glands of cattle. There was no evidence of penetration of the salt into the dermis or of any change in the morphology of the glands. It is probable that the antiperspirant activity of aluminium chlorhydrate in the human axilla, is only on the atrichial glands. PMID:632617

  9. Is Acanthosis Nigricans a Reliable Indicator for Risk of Type 2 Diabetes?

    Science.gov (United States)

    Jones, Lisa H.; Ficca, Michelle

    2007-01-01

    Acanthosis nigricans (AN) is a thickening and hyperpigmentation of the skin commonly found on the neck, axilla, or groin and is generally caused by hyperinsulinemia, a consequence of insulin resistance associated with obesity. Insulin resistance is a primary risk factor for the development of type 2 diabetes, hypercholesterolemia, and…

  10. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity

    DEFF Research Database (Denmark)

    Sartorius, K; Emtestam, L; Jemec, G B E; Lapins, J

    2009-01-01

    BACKGROUND: Hidradenitis suppurativa (HS) is a long-standing disease with abscess and often fistula formation, predominantly in the axillae and groins. The disease is difficult to treat and has a severe impact on quality of life. A clinically relevant system for scoring disease severity is lackin...

  11. Fibroadenomatosis involving bilateral breasts and axillary accessory breast tissues in a renal transplant recipient given cyclosporin A.

    Science.gov (United States)

    Bulakci, Mesut; Gocmez, Ahmet; Demir, Ali Aslan; Salmaslioglu, Artur; Tukenmez, Mustafa; Yavuz, Ekrem; Acunas, Gulden

    2014-10-01

    We present the mammographic and sonographic findings in a case of fibroadenomatosis involving both breasts and axillae in a renal transplant patient after 16 years of treatment with cyclosporin A. Awareness of the fact that cyclosporin A may induce the formation of fibroadenomas, including in accessory breast tissue, is important for correct diagnosis and preventing unnecessary intervention. PMID:25131521

  12. Lupus vulgaris on keloid

    Directory of Open Access Journals (Sweden)

    Jena S

    2002-01-01

    Full Text Available A 28-year-old man presented with multicentric lupus vulgaris on keloids over chest, axilla, neck and back for last 6 months. He had pulmonary tuberculosis. All the laboratory investigations were in favour of clinical diagnosis. The patient responded to antituberculosis therapy.

  13. HAILEY - HAILEY DISEASE : 2 CASE REPORTS

    OpenAIRE

    Nilofar; Nidhi; Pragya

    2015-01-01

    Hailey - Hailey disease is an autosomal dominant acantholytic disorder relatively uncommon in India. It is characterized by painful, pruritic, foul smelling vesicles and bullous lesions with erosions in intertriginous areas such as the neck, axillae, inframammary areas and groin. The defect in ATPC2 gene leads to calcium channel dysfunction whic...

  14. Is it possible to treat the axillary nodes in the same radiation fields covering the breast? - A study to locate the limits of the axillary dissection relative to anatomic landmarks in the tangential fields

    International Nuclear Information System (INIS)

    Purpose/Objective: Following breast cancer surgery, radiation of the axillary contents may be considered in lieu of axillary dissection or to reduce potential failure in high risk patients. Tangential breast fields often include a portion of the axilla. This review was undertaken to locate the typical location of the axillary contents in a tangential plane. Surgical clips in the axilla were identified in patients treated with breast radiation and were related to bony landmarks in the vicinity of the tangential fields. The presumption was made that the clips, although often used for hemostasis, were contained in the surgical bed and therefore identified the general location of the axillary nodes. Materials and Methods: 111 patients with surgical clips in the axilla were identified. All patients had undergone 'lumpectomy' and axillary dissection for breast cancer. Simulation films of the breast were analyzed to determine the number and location of axillary clips relative to the tangential fields and bony landmarks. All patients were treated with an SSD technique using custom half-beam blocks designed along midline from the suprasternal notch to the xyphoid process. A 1 to 1.5 cm margin around the breast was targeted. The lateral border was placed at the midaxillary line unless accommodation was required to reduce lung volume or to cover the breast. The treatment table was angled in 22 patients along the divergence of the superior field edge if the lateral field angled into the neck or if a supraclavicular field was used (7 pts). There was no intent to include the axilla in any field. Extent of axillary dissection was not normally dictated in operative reports. Results: Two to 48 clips were identified in the axilla. The median number of clips was 10 (mean 12.4). The median number of dissected nodes was 16 (range 4 to 40). 81 patients had negative nodes. The average number of positive nodes was 3.7 (range 1 to 20). Field lengths ranged from 14 to 21.5 cm, with a median

  15. An unusual presentation and distribution of generalized eruptive syringomas.

    Science.gov (United States)

    Chow, Conroy; Gharavi, Nima M; Smart, Chandra N; Yashar, Sharona; Young, Lorraine C

    2013-01-01

    A 19-year-old Caucasian man presented with numerous erythematous to flesh-colored papules that appeared in crops on his neck, axillae, buttocks, and lower back. The lesions started on his anterior neck at age 12. At 18 years, new crops of papules appeared on his axillae, back, and buttocks over several months. He reported pruritus in the lesions following exercise and perspiration. He denied any family history of similar lesions. His primary care physician treated him with topical triamcinolone 0.1% cream, which made the lesions smaller, less erythematous, and less pruritic; however, the papules never fully resolved. After discontinuation of the steroids, these erythematous pruritic papules gradually recurred in the same areas of his body. The patient denied any other medical complaints. PMID:24340475

  16. Lesions in nerves and plexus after radiotherapy

    International Nuclear Information System (INIS)

    Apart from the typical, radiation-induced changes in the skin, common secondary findings were oedemas, radiation-induced ulceration, fibroses of the mediastinum and lungs, pleura adhesions, and osteoradionecroses. In one patient with radiogenic paresis of the plexus brachialis, irradiation of the spinal cord because of epidural metastases of a mammary carcinoma resulted in radiation myelopathy which was verified by laminectomy. Observations of radiogenic lesions of the plexus brachialis show that the usual site of the lesion in the vasomotoric nerve bundle is the axilla. The lesion is assumed to be caused mainly by an overlapping of the axillary, infraclavicular and supraclavicular fields of irradiation which results in a dose peak in the axilla. (orig./AJ) 891 AJ/orig.- 892 MKO

  17. Sodium-24 studies in postmastectomy lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Scanlon, E.F.; Milland, F.P.; Hellman, L. (Memorial Sloan-Kettering Cancer Center, New York, NY (USA))

    1990-05-01

    Seven patients were studied with {sup 24}Na to determine the relative disappearance time of the isotope from the postmastectomy lymphedematous arm as compared to the normal side. The results tend to confirm previously held convictions that the edema is usually confined to the subcutaneous fat and skin. The disappearance time (T1/2) of the radioactive sodium from the muscle of the edematous side was usually comparable to that of the control side. The data also indicate that the impairment of fluid drainage from other areas, such as the lateral chest wall, that normally drain into the axilla, is impaired similarly to that of the subcutaneous fat of the arm. Operative procedures designed to relieve the edema of the arm by providing an alternate route of drainage should provide a conduit for the fluid to an area that does not normally drain to the axilla of the affected side.

  18. Ultrasonographic findings of accessory breast

    International Nuclear Information System (INIS)

    Accessory breast is an ectopic breast tissue from developmental remnants. It sometimes begins to make symptom, pain and swelling, during premenstrual period or pregnancy. For it has been known as a rear condition, it has occasionally misdiagnosed as a abnormal mass, such as lymphadenitis or hidradentis. We have analyzed 52 accessory breast tissues prospectively, to document the characteristic findings of accessory breast. In summary, the characteristic sonographic findings of accessory breast were the presence of breast tissue superficial to the axillary fascia or underlying fascia if not in axilla, resembling the patient's own breast pattern, the presence of converging appearance of dilated ducts, presence of nipple and/or areola, the obliteration of inner wall of dermis, the obliteration of subcutaneous fat layer, and the downward displacement of axillary fascia or underlying fascia if not in axilla without interruption

  19. [Axillary web syndrome--a variant of Mondor's disease, following excision of an accessory breast].

    Science.gov (United States)

    Shoham, Yaron; Rosenberg, Nir; Krieger, Yuval; Silberstein, Eldad; Arnon, Ofer; Bogdanov-Berezovsky, Alex

    2011-12-01

    Cording, an unusual form of superficial thrombophlebitis, is a variant of the disease first described by Fage in 1870 and subsequently characterized by Henry Mondor in 1939 as sclerosing thrombophlebitis of the subcutaneous veins of the anterior chest wall. Similar lesions have also been found in the penis, groin, abdomen, arm, and axilla and have been reported under a variety of names. In the axilla the condition is termed axillary web syndrome (AWS) and is seen after axillary lymph node dissection and sentinel lymph node biopsy. A recent report suggests that pathophysiology of AWS is lymphatic in origin rather than venous. We report a unique case of unilateral AWS after excision of an axillary accessory breast and discuss the pathophysiology. PMID:22352279

  20. Fibroadenoma of axillary ectopic breast tissue: A rare clinical entity

    Directory of Open Access Journals (Sweden)

    Sunder Goyal

    2014-01-01

    Full Text Available Supernumerary breast or polymastia is a well-documented anomaly of the breast and commonly presents along the embryonic milk line extending between the axilla and groin. Reported incidence of accessory breast is 0.4-6% in females. During 2 years period, we encountered only two cases out of twenty cases of axillary lumps. We present one case of fibroadenoma in ectopic breast tissue (EBT in axilla. Ectopic breast denotes breast tissue at more than two pectoral regions, which is mostly benign but at times can be malignant. EBT is at a greater risk of malignancy. Fibroadenoma of ectopic axillary breast tissue (EBT is quiet rare, but should always be kept in mind for differential diagnosis of an axillary mass.

  1. Carcinoma in accessory axillary breast.

    Science.gov (United States)

    Khanna, Seema; Mishra, Shashi Prakash; Kumar, Satendra; Khanna, Ajay Kumar

    2015-01-01

    We present a rare case of carcinoma developing in an accessory breast. The patient presented with a progressive lump in her right axilla for 1 year. On examination, there was a well-developed nipple areola complex in the right axilla overlying a hard, fixed 5 × 3 cm lump. On investigation, core biopsy revealed poorly differentiated carcinoma of the breast. Mammography also revealed features of a malignant lesion with skin and muscle infiltration. Neoadjuvant chemotherapy was administered followed by modified radical mastectomy after three cycles. Immunohistochemistry study showed positive status of oestrogen and progesterone receptors, and negative HER-2 neu. Three more cycles of chemotherapy along with 50 Gy radiotherapy were given in an adjuvant setting followed by hormone therapy. PMID:26260957

  2. Nanoparticles in Sentinel Lymph Node Assessment in Breast Cancer

    Directory of Open Access Journals (Sweden)

    Michael Douek

    2010-11-01

    Full Text Available The modern management of the axilla in breast cancer relies on surgery for accurate staging of disease and identifying those patients at risk who would benefit from adjuvant chemotherapy. The introduction of sentinel lymph node biopsy has revolutionized axillary surgery, but still involves a surgical procedure with associated morbidity in many patients with no axillary involvement. Nanotechnology encompasses a broad spectrum of scientific specialities, of which nanomedicine is one. The potential use of dual-purpose nanoprobes could enable imaging the axilla simultaneous identification and treatment of metastatic disease. Whilst most applications of nanomedicine are still largely in the laboratory phase, some potential applications are currently undergoing clinical evaluation for translation from the bench to the bedside. This is an exciting new area of research where scientific research may become a reality.

  3. Confluent And Reticulate Papillomatosis

    Directory of Open Access Journals (Sweden)

    Thappa Devinder Mohan

    2002-01-01

    Full Text Available A 17 year old South Indian female born of consanguineous marriage presented with a widespread non-itchy eruption over scalp, face, below breasts and flexural aspects of limbs including axillae, inguinal regions and popliteal fossae since 3 months of age. The eruption consisted of individual small, flat, brownish black hyperkeratotic papules, which at some places, coalesced to from a reticulate pattern. Histopathological examination of biopsies from the axilla and forearm showed typical hyperkeratosis and papillomatosis without acanthosis. The dermis demonstrated a mild perivascular infiltrate. On the basis of the clinical and histopathological findings, a diagnosis of confluent and reticulate papillomatosis of Gourgerot and Carteaud was made. Partial response to doxycline in our case point towards this being a keratinization disorder where microflora may be playing an exacerbating rather than a primary role.

  4. Ofloxacin induced hypersensitivity reaction

    Directory of Open Access Journals (Sweden)

    Hari Babu Ramineni

    2015-01-01

    Full Text Available Ofloxacin is a commonly used antimicrobial agent to combat various infections. The adverse profile of quinolones includes gastrointestinal symptoms, which are the most frequent, neuropsychiatric symptoms, hematologic abnormalities are less common. We report a rare case of ofloxacin induced hypersensitivity reaction in a 57 year old female patient with complaints of rashes over the axilla, upper limb and back, abdomen, thorax associated with exfoliation of skin all over the axilla associated with severe itching. Based on history and clinical examination patient was diagnosed as ofloxacin induced hypersensitivity reaction and was successfully treated with antihistamines and corticosteroids. Pharmacovigilance should be a part of patient care in order to reduce occurrence of adverse drug reaction and also encourage practitioners in reporting so as to gather more and more data regarding adverse drug reactions. [Int J Res Med Sci 2015; 3(1.000: 349-351

  5. Sentinel node identification using microbubbles and contrast-enhanced ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Sever, A.R., E-mail: ali.sever@nhs.net [Department of Radiology, Maidstone Hospital, Maidstone, Kent (United Kingdom); Mills, P. [Department of Radiology, Maidstone Hospital, Maidstone, Kent (United Kingdom); Jones, S.E. [Department of Surgery, Maidstone Hospital, Maidstone, Kent (United Kingdom); Mali, W. [Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands); Jones, P.A. [Department of Surgery, Maidstone Hospital, Maidstone, Kent (United Kingdom)

    2012-07-15

    Sentinel lymph node (SLN) biopsy has become the recommended method for surgical staging of the axilla in patients with breast cancer. Grey-scale axillary ultrasonography (US) combined with US-guided biopsy is a widely used preoperative staging procedure but has limited sensitivity. US contrast agent 'microbubbles', when injected intradermally, have been shown to have the potential to enter the breast lymphatics, travel rapidly to the axilla, and visualize the putative SLNs. This review illustrates the SLN identification technique using intradermal injection of microbubbles and contrast-enhanced US. The injection method, lymphatic visualization techniques, grey-scale and contrast-enhanced US images of the putative SLNs are reviewed and exemplified.

  6. Ultrasonographic findings of accessory breast

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Ki Keun; Cho, Jae Hyun; Yoon, Choon Sik; Kim, Mi Hye [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1993-07-15

    Accessory breast is an ectopic breast tissue from developmental remnants. It sometimes begins to make symptom, pain and swelling, during premenstrual period or pregnancy. For it has been known as a rear condition, it has occasionally misdiagnosed as a abnormal mass, such as lymphadenitis or hidradentis. We have analyzed 52 accessory breast tissues prospectively, to document the characteristic findings of accessory breast. In summary, the characteristic sonographic findings of accessory breast were the presence of breast tissue superficial to the axillary fascia or underlying fascia if not in axilla, resembling the patient's own breast pattern, the presence of converging appearance of dilated ducts, presence of nipple and/or areola, the obliteration of inner wall of dermis, the obliteration of subcutaneous fat layer, and the downward displacement of axillary fascia or underlying fascia if not in axilla without interruption.

  7. Excretion of ciprofloxacin in sweat and multiresistant Staphylococcus epidermidis

    DEFF Research Database (Denmark)

    Høiby, N; Jarløv, J O; Kemp, M;

    1997-01-01

    BACKGROUND: Staphylococcus epidermidis develops resistance to ciprofloxacin rapidly. That this antibiotic is excreted in apocrine and eccrine sweat of healthy individuals might be the reason for the development of such resistance. We assessed whether S epidermidis isolated from the axilla and nasal...... flora of healthy people could develop resistance to ciprofloxacin after a 1-week course of this antibiotic. METHODS: The concentration of ciprofloxacin in sweat was measured in seven volunteers after oral administration of 750 mg ciprofloxacin twice daily for 7 days, and the development of resistance in...... S epidermidis from axilla and nostrils was monitored during and 2 months after the treatment. Genotyping of S epidermidis was done by restriction fragment length polymorphism. FINDINGS: The mean concentration of ciprofloxacin in sweat increased during the 7 days of treatment-from 2.2 micrograms/mL 2...

  8. Treatment related morbidity in breast cancer patients

    OpenAIRE

    Rietman, J.S.; Geertzen, J. H. B.; Dijkstra, P U; Hoekstra, H. J.

    2007-01-01

    Background: Sentinel lymph node biopsy (SLNB) was introduced for staging of the axilla to reduce the number of unnecessary axillary lymph node dissections (ALND’s) and proved to be an accurate and safe procedure to predict metastatic disease in clinically negative axillary lymph nodes. SLNB was expected to have less treatment related morbidity in comparison to ALND. In a multicenter prospective cohort study, long term upper-limb morbidity, perceived disabilities in activities of daily life (A...

  9. MRI and US findings of subcutaneous fat necrosis of the newborn

    International Nuclear Information System (INIS)

    Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon, benign disorder found in full-term or post-mature neonates. It usually presents in neonates who have experienced perinatal difficulty such as asphyxia, peripheral hypoxemia, hypothermia, meconium aspiration or trauma. We present a newborn with abnormal findings on MRI and US within the axilla, neck, and abdominal walls that were pathologically proved via biopsy to be subcutaneous fat necrosis. (orig.)

  10. Bullosis Diabeticorum involving an unusual site- a diagnostic dilemma; managed successfully with antidiabetic drugs: A case report

    Directory of Open Access Journals (Sweden)

    Rakesh Tilak Raj

    2014-07-01

    Full Text Available A case of Bullosis diabeticorum (BD affecting unusual sites involving anterior abdominal wall and axilla in a female with newly diagnosed type 2 diabetes mellitus (T2DM without antecedent trauma and drug intake is being reported for its rarity. Dermatologists must be made aware of this under diagnosed possibility in diabetes whose status is unknown after considering direct immunoflurescence studies to exclude other similar histological and immunological entities.

  11. Planar scintimammography 99mTc-MIBI in breast cancer. Part 1. Review of literature and studies in healthy women

    International Nuclear Information System (INIS)

    After reviewing of the literature concerning 99mTc-MIBI and scintimammography (SCM) using this tracer, the results of planar technique obtained in 40 ''healthy'' women chosen from the candidates for myocardial perfusion study are presented. The aim of the study was to assess the normalcy rate, e.g. the percentage of normal images in women with minimal risk of breast cancer and the analysis the sources of potential overdiagnosis changes caused by this disease. Two observers an oncologists and a nuclear medicine physician) reviewed scintigrams of both sides of the chest (80 images) focusing on the regions where changes caused by breast cancer may happen to occur. Positive approval as normal met 95% images of the breast and subclavicular region, 82.5% of the axilla, 97% of the supraclavicular region and 96% of the parasternal region. In 2 women prominent ductal pattern was noted. In 7 cases focal uptake in the axilla was observed (on 4 in the same side as injection) and in further 7 patients increased accumulation in the infero-external part of the axilla was shown (the muscles?). In 3 patients foci of increased uptake were noted in the parasternal region. Two cases of symmetrically increased activity in suclavicular region and 1 in supraclavicular region were recognized as due to overexpression. Planar SCM is specific enough to be used in the breast cancer patients, although avoiding of overexpression of the images and caution in interpretation of the results (especially for the axilla) is recommended. Nonspecific accumulation of the tracer in various conditions may lead to false positive diagnosis, therefore an interview about trauma and possible inflammatory or vasculary changes is mandatory with the analysis of other additional results. (author)

  12. Radiologic Features of Fibrous Hamartoma of Infancy Involving the Buttocks

    International Nuclear Information System (INIS)

    Fibrous hamartoma of infancy (FHI) is a rare benign subcutaneous tumor that presents in children younger than two years. The tumor mostly affects the trunk, axilla and upper extremities. Imaging findings of FHI that involve the buttocks have not been reported in the clinical literature. We reported the imaging features of a lesion in a 9-month-old infant who presented with a palpable mass on the buttocks. The imaging findings were evaluated after a review of previous studies

  13. Case for diagnosis.

    Science.gov (United States)

    Lencastre, André; Cabete, Joana; Apetato, Maria Margarida

    2013-01-01

    An 83 year-old man was observed for an 8 year-long pruritic, erythematous plaque of the left axilla. He had been continuously medicated with topical antifungals and steroids with occasional symptomatic relief, but with disease progression. After a clinical and histological diagnosis of Extramammary Paget's Disease, a total excision with wide margins was performed. He remains disease-free 12 months after surgery. We report this rare presentation of Extramammary Paget's Disease on a male patient. PMID:24173197

  14. Case for diagnosis *

    OpenAIRE

    Lencastre, André; Cabete, Joana; Apetato, Maria Margarida

    2013-01-01

    An 83 year-old man was observed for an 8 year-long pruritic, erythematous plaque of the left axilla. He had been continuously medicated with topical antifungals and steroids with occasional symptomatic relief, but with disease progression. After a clinical and histological diagnosis of Extramammary Paget's Disease, a total excision with wide margins was performed. He remains disease-free 12 months after surgery. We report this rare presentation of Extramammary Paget's Disease on a male patient.

  15. Case for diagnosis*

    Science.gov (United States)

    Lencastre, André; Cabete, Joana; Apetato, Maria Margarida

    2013-01-01

    An 83 year-old man was observed for an 8 year-long pruritic, erythematous plaque of the left axilla. He had been continuously medicated with topical antifungals and steroids with occasional symptomatic relief, but with disease progression. After a clinical and histological diagnosis of Extramammary Paget's Disease, a total excision with wide margins was performed. He remains disease-free 12 months after surgery. We report this rare presentation of Extramammary Paget's Disease on a male patient. PMID:24173197

  16. Technetium-99m methylene diphosphonate uptake in the brachialis muscle hematoma in a patient with prostate cancer and coagulation disorder mimicking bone metastasis evaluated by single-photon emission tomography-computed tomography/computed tomography

    International Nuclear Information System (INIS)

    We report a case of 79-year-old male with prostate cancer and coagulation disorder presented with left shoulder pain. He underwent bone scintigraphy to rule out metastasis, which showed intense foci of tracer activity in the left axilla. Hybrid single-photon emission tomography-computed tomography (SPECT/CT) of the shoulder region localized tracer uptake to the left brachialis muscle hematoma. (author)

  17. Dual-Modality Photoacoustic and Ultrasound Imaging System for Noninvasive Sentinel Lymph Node Detection in Patients with Breast Cancer

    OpenAIRE

    Alejandro Garcia-Uribe; Todd N. Erpelding; Arie Krumholz; Haixin Ke; Konstantin Maslov; Catherine Appleton; Margenthaler, Julie A.; Wang, Lihong V.

    2015-01-01

    The detection of regional lymph node metastases is important in cancer staging as it guides the prognosis of the patient and the strategy for treatment. Sentinel lymph node biopsy (SLNB) is an accurate, less invasive alternative to axillary lymph node dissection. The sentinel lymph node hypothesis states that the pathological status of the axilla can be accurately predicted by determining the status of the first lymph nodes that drain from the primary tumor. Physicians use radio-labeled sulfu...

  18. Ljubljana nomograms for predicting the likelihood of non-sentinel lymph node metastases in breast cancer patients with a positive sentinel lymph node

    OpenAIRE

    Perhavec, Andraž; Perme, Maja Pohar; Hočevar, Marko; Besić, Nikola; Žgajnar, Janez

    2009-01-01

    Abstract Several tools for predicting the likelihood of non-sentinel lymph node (non-SLN) involvement in SLN-positive breast cancer patients have been created so far. The aim of our study was to create and validate different nomograms for predicting the likelihood of non-SLN involvement that would be applicable in different institutions and that would also include the results of the preoperative US examination of the axilla. From January 2000 to January 2009, 534 breast cancer pati...

  19. Dowling-Degos Disease: A Case Report

    OpenAIRE

    Selma Emre; Gülşen Akoğlu; Ahmet Metin; Saliha Kırbaş; Sibel Orhun Yavuz

    2012-01-01

    Dowling-Degos Disease (DDD), is a rare, autosomal dominantly inherited pigmentation disorder. It is characterized by slowly progressive mottled or reticulated pigmented macules on the axillae, groins, perineum, inframammary regions and other flexural areas. The disease appears after puberty, most frequently during the fourth decade of life. Herein, we report a 42-year old female patient who presented with dark brown hyperpigmented macules on her groins, perineum and inframammary areas at our ...

  20. Calcifying fibrous tumour: an unusual omental lesion

    Energy Technology Data Exchange (ETDEWEB)

    Sudhakar, Sniya; Gibikote, Sridhar [Christian Medical College Hospital, Department of Radiology, Vellore, Tamil Nadu (India); Mistry, Yogesh [Christian Medical College Hospital, Department of Pathology, Vellore, Tamil Nadu (India); Dastidar, Arindam; Sen, Sudipta [Christian Medical College Hospital, Department of Pediatric Surgery, Vellore, Tamil Nadu (India)

    2008-11-15

    Calcifying fibrous tumour (CFT) is a recently described distinct clinicopathological entity characterized by calcifying lesions usually occurring in soft tissue of the extremities, trunk, axilla, pleura, mediastinum and peritoneum of children and adults. Most reported cases involving the peritoneum have been in adults. We present the imaging, surgical and pathology findings of CFT in a 7-year-old child who presented with an incidental finding of a large omental mass. (orig.)

  1. Calcifying fibrous tumour: an unusual omental lesion

    International Nuclear Information System (INIS)

    Calcifying fibrous tumour (CFT) is a recently described distinct clinicopathological entity characterized by calcifying lesions usually occurring in soft tissue of the extremities, trunk, axilla, pleura, mediastinum and peritoneum of children and adults. Most reported cases involving the peritoneum have been in adults. We present the imaging, surgical and pathology findings of CFT in a 7-year-old child who presented with an incidental finding of a large omental mass. (orig.)

  2. Elephantiasis of the external genitalia: a sequel to cutaneous tuberculosis.

    Science.gov (United States)

    Padmavathy, L; Rao, L Lakshmana; Chockalingam, K; Ethirajan, N; Dhanlakshmi, M

    2009-01-01

    Tuberculosis continues to be an important public health problem and cutaneous tuberculosis constitutes a minor proportion of extra pulmonary manifestations of tuberculosis. Elephantiasis of the external genitalia, as a sequel to cutaneous tuberculosis, in a 40-year-old diabetic lady is being reported for its rarity. The patient also had lesions of healed scrofuloderma of 27 years' duration, in both axillae, with residual pedunculated nodules. PMID:20049271

  3. ELEPHANTIASIS OF THE EXTERNAL GENITALIA: A SEQUEL TO CUTANEOUS TUBERCULOSIS

    OpenAIRE

    Padmavathy L; Rao L; Chockalingam K; Ethirajan N; Dhanlakshmi M

    2009-01-01

    Tuberculosis continues to be an important public health problem and cutaneous tuberculosis constitutes a minor proportion of extra pulmonary manifestations of tuberculosis. Elephantiasis of the external genitalia, as a sequel to cutaneous tuberculosis, in a 40-year-old diabetic lady is being reported for its rarity. The patient also had lesions of healed scrofuloderma of 27 years′ duration, in both axillae, with residual pedunculated nodules.

  4. Elephantiasis of the external genitalia: A sequel to cutaneous tuberculosis

    Directory of Open Access Journals (Sweden)

    Padmavathy L

    2009-01-01

    Full Text Available Tuberculosis continues to be an important public health problem and cutaneous tuberculosis constitutes a minor proportion of extra pulmonary manifestations of tuberculosis. Elephantiasis of the external genitalia, as a sequel to cutaneous tuberculosis, in a 40-year-old diabetic lady is being reported for its rarity. The patient also had lesions of healed scrofuloderma of 27 years′ duration, in both axillae, with residual pedunculated nodules.

  5. Pathological complete response in breast cancer patients following neoadjuvant chemotherapy at a Comprehensive Cancer Center: The natural history of an elusive prognosticator

    OpenAIRE

    Fayanju, Oluwadamilola M.; NWAOGU, IHEOMA; Jeffe, Donna B.; Margenthaler, Julie A

    2015-01-01

    Given the prognostic significance of pathological complete response (pCR) to neoadjuvant chemotherapy, we sought to chronicle the clinical course of breast cancer patients whose tumors exhibited pCR at our institution. We retrospectively reviewed 5,533 cancer center patients treated for a first primary breast cancer between March, 1999 and September, 2010 to identify those who received neoadjuvant chemotherapy that resulted in pCR (i.e., no residual invasive malignancy in the breast or axilla...

  6. Rare sweat gland tumors of vulva: Report of two cases

    OpenAIRE

    Rashmi Mahajan; Damodar Bang; Amit Nagar; Freny Bilimoria

    2012-01-01

    Syringomas and Fox-Fordyce disease are appendageal skin disorders. While syringomas represent an adenoma of the intraepidermal eccrine duct, Fox Fordyce disease occurs due to blockage of the apocrine sweat duct. In both conditions, extragenital sites are more frequently involved than the genitalia. We herein report two young females, one with syringomas on the face and vulva and the other with Fox Fordyce disease involving axilla, areola and vulva, thereby citing the importance of examination...

  7. A case of synchronous multiple bilateral breast cancer after breast augmentation

    OpenAIRE

    Yamamoto, Shinya; Chishima, Takashi; Harada, Fumi; Matsubara, Yuka

    2015-01-01

    Breast cancer after breast augmentation is not rare, but cases of bilateral breast cancer after augmentation are not often reported. A 43-year-old woman attended our hospital because of a mass in her left breast. She had undergone breast augmentation by implants 4 years before at a cosmetic surgery clinic. There were operative scars in her bilateral axilla. A detailed examination revealed bilateral breast cancer, and we performed nipple-sparing mastectomy in both breasts. Sentinel lymph node ...

  8. Plastic surgical procedures for the closure of radiation ulcers of the thoracic and pelvic regions

    International Nuclear Information System (INIS)

    Radiation ulcers of the thoracic and pelvic regions are usually very painful and also have an unpleasant odour. Two hundred and twelve patients with ulcerations on the neck, in the axilla, on the thoracic wall, in the inguinal region, over the sacrum and in the genital area were treated with local rotation flaps, following deep and extensive excisions. Myocutaneous flaps (latissimus dorsi, gracilis) were the method of choice in cases of very deep defects of the thoracic wall and the pelvic region. (author)

  9. Diagnostic value of mammography for occult breast cancer

    International Nuclear Information System (INIS)

    Objective: To evaluate the diagnostic value of mammography in occult breast cancer. Methods: 23 cases of non- palpable breast lesions were examined with stereotactic-guided or surgical biopsy. Results: Pathological diagnosis included ductal carcinoma in sim (7), infiltrating ductal carcinoma (5), lobular carcinoma in sim (2), carcinoma simplex (3), 4 intraductal papillary carcinoma (4), scirrhous carcinoma (1), metastatic adenocarcinoma (1) in the axilla. Conclusion: Mammography is a commonly used and effective method in diagnosis of occult breast cancer. (authors)

  10. Schwannoma of Brachial Plexus

    OpenAIRE

    Kumar, Ameet; Akhtar, Saeed

    2010-01-01

    Brachial plexus tumours are a rare entity. Schwannomas are benign nerve sheath tumours and only about 5% arise from the brachial plexus. Due to its rarity and complex anatomical location they can pose a formidable challenge to surgeons. We present a case of a young patient who presented with an axillary swelling three months after a lymph node biopsy from the same axilla, which turned out to be a Schwannoma arising for the medial cord of the brachial plexus.

  11. Frontal Fibrosing Alopecia in a Male Presenting with Sideburn Loss

    OpenAIRE

    AlGaadi, Salim; Miteva, Mariya; Tosti, Antonella

    2015-01-01

    Frontal fibrosing alopecia (FFA) is a cicatricial alopecia that affects mainly postmenopausal women. It is typically characterized by recession of frontotemporal hairline. Hair loss of eyebrows, eyelashes, axillae, limbs, and pubic area may be observed. Here, we describe a case of FFA in a male patient presenting with only localized loss of sideburns. Skin biopsy findings were consistent with lichen planopilaris. To our knowledge, this is the only reported case of FFA patient with only locali...

  12. Graham Little Piccardi Lasseur Syndrome: A Rare Case Report with Concomitant Hypertrophic Lichen Planus

    OpenAIRE

    Brar, BK; Khanna, Era; Bharat B Mahajan

    2013-01-01

    Graham Little Piccardi Lasseur Syndrome (GLPLS) is a rare variant of lichen planopilaris comprising of a triad of multifocal and patchy cicatricial alopecia of scalp, non-cicatricial alopecia of axillae and pubic region and keratotic follicular papules over a body. Its exact etiology is not known until date, but primarily involves an immune mediated inflammatory reaction against the bulge region of hair follicles resulting in cicatricial alopecia. We report an extensive and diffuse presentati...

  13. Frontal Fibrosing Alopecia in a Male Presenting with Sideburn Loss.

    Science.gov (United States)

    AlGaadi, Salim; Miteva, Mariya; Tosti, Antonella

    2015-01-01

    Frontal fibrosing alopecia (FFA) is a cicatricial alopecia that affects mainly postmenopausal women. It is typically characterized by recession of frontotemporal hairline. Hair loss of eyebrows, eyelashes, axillae, limbs, and pubic area may be observed. Here, we describe a case of FFA in a male patient presenting with only localized loss of sideburns. Skin biopsy findings were consistent with lichen planopilaris. To our knowledge, this is the only reported case of FFA patient with only localized loss of sideburns. PMID:26180452

  14. Coexistent axillary hydatid disease and tuberculosis: Case report of an extremely rare occurrence

    OpenAIRE

    Shalini Bahadur; Mukta Pujani; Sujata Jetley; Mohammad Jaseem Hassan; Shaan Khetrapal; Musharraf Husain

    2014-01-01

    Tuberculous infection is highly prevalent in India, however, hydatid disease is relatively uncommon. Frequent sites of predilection of hydatid disease are the liver and lungs. Other unusual sites of infliction are the peritoneum, thyroid, breast, pancreas, and mediastinum. Hydatid disease in the axilla is quite uncommon. We hereby report a case of coexistent axillary hydatid disease with tuberculous lymphadenitis. To the best of our knowledge, even after extensive search of the literature we ...

  15. Morphological Characteristics of Professional Ballet Dancers of the Bolshoi Theater Company

    OpenAIRE

    Pinheiro Ferrari, Elisa; Santos Silva, Diego Augusto; Rebolho Martins, Cilene; Fidelix, Yara Lucy; Petroski, Edio Luiz

    2013-01-01

    The objective of this study was to describe the morphological profile of professional dancers compared with university physical education students. Thirty-five subjects were evaluated as follows: 13 professional ballet dancers of the Bolshoi Theater Company, six males and seven females, and 22 university physical education students, 11 males and 11 females. Body mass, height, skinfold (triceps, biceps, subscapular, chest, axilla, supraspinale, Iliac crest, abdominal, Front thigh, medial calf)...

  16. Ulnar nerve palsy due to axillary crutch.

    OpenAIRE

    Veerendrakumar M; Taly A; Nagaraja D.

    2001-01-01

    A young lady with residual polio, using axillary crutch since early childhood, presented with tingling, numbness and weakness in ulnar nerve distribution of five months duration. Ulnar motor conduction study revealed proximal conduction block near the axilla, at the point of pressure by the crutch while walking. Distal ulnar sensory conduction studies were normal but proximal ulnar sensory conduction studies showed absence of Erb′s point potential. These findings suggested the presence...

  17. A Cadaveric Study of Ulnar Nerve Innervation of the Medial Head of Triceps Brachii

    OpenAIRE

    Bekler, Halil; Wolfe, Valerie M.; Rosenwasser, Melvin P.

    2008-01-01

    The presence of a separately innervated muscle unit of the triceps may have possible surgical importance and can be used for motor reconstructions. The ulnar nerve is closely situated to the triceps muscle and rarely examined above the elbow. The aim of this cadaveric study was to explore a possible contribution of the ulnar nerve to motor innervation of the medial head of the triceps. We dissected 18 limbs from axillae to midforearm. The path of the ulnar nerve was followed, and examination ...

  18. Unusual nerve supply of biceps from ulnar nerve and median nerve and a third head of biceps

    OpenAIRE

    Arora L; Dhingra R

    2006-01-01

    Variations in branching pattern of the brachial plexus are common and have been reported by several investigators. Of the four main nerves traversing the arm, namely median, ulnar, radial and musculocutaneous, the ulnar and median nerve do not give any branches to muscles of the arm. Ulnar nerve after taking origin from medial cord of brachial plexus runs distally through axilla on medial side of axillary artery till middle of arm, where it pierces the medial intermuscular septum and enters t...

  19. Sentinel lymph node biopsy in breast cancer: the node to recovery

    OpenAIRE

    Goyal, Amit

    2010-01-01

    The widespread adoption of sentinel lymph node biopsy to stage the axilla has led to decrease in arm and shoulder morbidity. Sentinel lymph node biopsy is suitable for patients with clinically/radiologically node negative invasive breast cancer and selected patients with DCIS (those with clinical/radiological mass or extensive lesions requiring mastectomy). The combined isotope-blue dye injection technique gives the best results. We inject the isotope intra-dermally preoperatively and blue dy...

  20. Sonographic Finding of Scrotal Cystic Lymphangioma with Hemorrhage Caused by Percutaneous Needle Aspiration: A Case Report

    International Nuclear Information System (INIS)

    Lymphangioma is a hamartoma, which is a benign tumor caused by congenital malformation of the lymphatic system. These tumors usually occur in the neck and axilla, and occasionally in the mediastinum, mesenterium, retroperitoneum and thigh, The scrotum and perineum are the least frequent sites. We report here on an uncommon case of cystic lymphangioma that presented as focal hemorrhage caused by percutaneous needle aspiration, and we briefly review the radiologic finding and the relevant literature

  1. Sonographic Finding of Scrotal Cystic Lymphangioma with Hemorrhage Caused by Percutaneous Needle Aspiration: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Woon; Cho, Jae Ho [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2011-03-15

    Lymphangioma is a hamartoma, which is a benign tumor caused by congenital malformation of the lymphatic system. These tumors usually occur in the neck and axilla, and occasionally in the mediastinum, mesenterium, retroperitoneum and thigh, The scrotum and perineum are the least frequent sites. We report here on an uncommon case of cystic lymphangioma that presented as focal hemorrhage caused by percutaneous needle aspiration, and we briefly review the radiologic finding and the relevant literature

  2. MRI and US findings of subcutaneous fat necrosis of the newborn

    Energy Technology Data Exchange (ETDEWEB)

    Vasireddy, Syam; Long, Scott D. [Southern Illinois University, Department of Radiology, Springfield, IL (United States); St. John' s Hospital, Department of Radiology, Springfield, IL (United States); Sacheti, Bhavna [Medical College of Wisconsin, Department of Pediatric Critical Care, Milwaukee, WI (United States); Children' s Hospital Wisconsin, Department of Critical Care, Milwaukee, WI (United States); Mayforth, Ruth D. [Southern Illinois University, Department of Surgery, Springfield, IL (United States); St. John' s Hospital, Department of Surgery, Springfield, IL (United States)

    2009-01-15

    Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon, benign disorder found in full-term or post-mature neonates. It usually presents in neonates who have experienced perinatal difficulty such as asphyxia, peripheral hypoxemia, hypothermia, meconium aspiration or trauma. We present a newborn with abnormal findings on MRI and US within the axilla, neck, and abdominal walls that were pathologically proved via biopsy to be subcutaneous fat necrosis. (orig.)

  3. Sparing sentinel node biopsy through axillary lymph node fine needle aspiration in primary breast cancers

    OpenAIRE

    Cheng, Yu-Shu; Kuo, Shou-Jen; Chen, Dar-Ren

    2013-01-01

    Background Axillary lymph node status is an important staging and prognostic factor in breast cancer. This study aimed to evaluate the efficacy of axilla fine needle aspiration cytology (FNAC) in primary breast cancer without a palpable node and even without image characteristics of a metastatic node. Methods From June 2008 to January 2012, 77 patients met the inclusion criteria of having received a FNAC procedure during the diagnostic protocol of primary breast cancer with the characteristic...

  4. Gila monster bite.

    Science.gov (United States)

    French, Robert N E; Ash, Jordan; Brooks, Daniel E

    2012-02-01

    A 29-year-old man was bitten on the forearm by a wild Gila monster. Radiographs demonstrated subcutaneous air. During a period of observation, erythema and edema progressed from the forearm to the axilla and he developed a significant leukocytosis. No purulence was found upon surgical evaluation. We hypothesize that air was introduced into the wound by the "pulsing," chewing-like action that the Gila monster made while it was attached to the man's forearm. PMID:22257299

  5. Mammography, US and MR findings of cystic lymphangioma of the breast : a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kook, Shin ho; Keum, Joo Seob [Kangbuk Samsung Hospital, Seoul(Korea, Republic of)

    1996-08-01

    Lymphangiomas are congenital malformations that occur most commonly in the head, neck or axilla and 80-90% of lesions are detected by the age of two years. Cystic lymphangioma of the breast in a 37-year-old woman ; it showed typical well-defined tubular and nodular opacity on mammogram, a multilocular septated anechoic mass on ultrasonogram, and low and high signal intensity on T1-and T2-weighted MR images, respectively. These findings before surgery indicated cystic lymphangioma.

  6. Axillary web syndrome after axillary dissection in breast cancer: a prospective study

    OpenAIRE

    Torres Lacomba, María; Mayoral del Moral, Orlando; Coperias Zazo, José Luís; Yuste Sánchez, María José; Ferrandez, Jean-Claude; Zapico Goñi, Álvaro

    2009-01-01

    Abstract The axillary web syndrome is a self-limiting and frequently overlooked cause of significant morbidity in the early post-operative period after breast cancer axillary surgery, which is characterized by axillary pain that runs down the medial arm, limited shoulder range of motion affecting mainly shoulder abduction, and cords of subcutaneous tissue extending from axilla into the medial arm, made visible or palpable and painful by shoulder abduction. We evaluated the incidenc...

  7. Clinical Effects of Topical Tacrolimus on Fox-Fordyce Disease

    OpenAIRE

    Hilal Kaya Erdoğan; Işıl Bulur; Zeliha Kaya

    2015-01-01

    Fox-Fordyce Disease (FFD) is a rare, chronic, pruritic, inflammatory disorder of apocrine glands. It is characterized by dome-shaped, firm, discrete, skin-colored, and monomorphic perifollicular papules. The most common sites of involvement are axillae and anogenital and periareolar regions which are rich in apocrine sweat glands. Treatment is difficult. Topical, intralesional steroids, topical tretinoin, adapalene, clindamycin, benzoyl peroxide, oral contraceptives, isotretinoin, phototherap...

  8. Aerobic Microbial Skin Flora in Jeddah City, Saudi Arabia

    OpenAIRE

    Rajaa M. Milyani

    2001-01-01

    The aerobic microbial skin flora of 40 healthy subjects living in Jeddah city (Saudi Arabia) was determined. Two age groups: children and adults; including males and females were investigated. Seven sites were studied: forehead, axilla, chest, groin, leg, toe web and anterior nares. The skin was sampled by rubbing the chosen site with a surfactant substance (Tween 80) moistened cotton swab which was dipped back in the surfactant container and the resulted suspension was agitated for one minut...

  9. A Rare Case of Mycetoma Due to Curvularia

    Science.gov (United States)

    Shinde, Rupali S; Hanumantha, Sreedevi; Mantur, Basappa G; Parande, Mahantesh V

    2015-01-01

    Mycetoma due to Curvularia is a rare clinical entity. Here, we report a case of 27-year-old female presented with multiple swellings and discharging wounds around left shoulder joint since 12 years. Local examination showed diffuse nodular swellings over left anterior chest wall, posterior chest wall, and axilla. Multiple nodules and discharging sinuses were seen. Fungal culture of the biopsy of the lesion revealed Curvularia species. Patient showed significant clinical improvement with itraconazole therapy. PMID:25949061

  10. An approach to acanthosis nigricans

    OpenAIRE

    Meghana Madhukar Phiske

    2014-01-01

    Acanthosis nigricans (AN) is characterized by dark, coarse and thickened skin with a velvety texture, being symmetrically distributed on the neck, the axillae, antecubital and popliteal fossae, and groin folds, histopathologically characterized by papillomatosis and hyperkeratosis of the skin. A high prevalence of AN has been observed recently. Different varieties of AN include benign, obesity associated, syndromic, malignant, acral, unilateral, medication-induced and mixed AN. Diagnosis is l...

  11. Extensive segmental acanthosis nigricans form of epidermal nevus.

    OpenAIRE

    Waal, A.C. de; van Rossum, M. M.; Bovenschen, H.J.

    2010-01-01

    Eight cases of the acanthosis nigricans form of epidermal nevus have been described in literature. The present case is impressive and has an extensive segmental distribution. Although etiological factors, such as mutations in the FGFR3 gene, are becoming recognized, treatment options remain limited. We present a case of a 14-year-old male with multiple hyperpigmented, hyperkeratotic plaques on the upper body, axillae, and groin with a segmental distribution following Blaschko lines. Histopath...

  12. Changes In Men’s Salivary Testosterone And Cortisol Levels, And In Sexual Desire After Smelling Female Axillary And Vulvar Scents

    Directory of Open Access Journals (Sweden)

    Ricardo eMondragón-Ceballos

    2013-10-01

    Full Text Available Several studies have shown that a woman’s vaginal or axillary odors convey information on her attractivity. Yet, whether such scents induce psychoneuroendocrinological changes in perceivers is still controversial. We studied if smelling axillary and vulvar odors collected in the periovulatory and late luteal phases of young women modify salivary testosterone and cortisol levels, as well as sexual desire in men. Forty-five women and 115 men, all of them college students and unacquainted with each other, participated in the study. Female odors were collected on pads affixed to the axilla and on panty protectors both worn the entire night before experiments. Men provided five saliva samples, a basal one before the smelling procedure, and four more 15, 30, 60 and 75 min after exposure to odors. Immediately after smelling the odor source, men answered a questionnaire rating hedonic qualities of scents, and after providing the last saliva sample they answered questionnaire on sexual desire. We found that periovulatory axillary and vulvar odors increased testosterone and cortisol levels, with vulvar scents producing a more prolonged effect. Luteal axilla odors decreased testosterone and cortisol levels, while luteal vulva odors increased cortisol. Periovulatory axilla and vulva scents accounted for a general increase of interest in sex. These odors were also rated as more pleasant and familiar, while luteal vulvar odors were perceived as intense and unpleasant.

  13. Accessory Breast Cancer Occurring Concurrently with Bilateral Primary Invasive Breast Carcinomas: A Report of Two Cases and Literature Review

    International Nuclear Information System (INIS)

    The development of accessory breast tissue, which is found anywhere along the milk line, is attributed to the failure of milk line remnants to regress during embryogenesis. Primary tumors may arise from any ectopic breast tissue. Accessory breast cancer occurring concurrently with primary invasive breast cancer is extremely rare. Two such cases were reported in this article. One was a 43-year-old Chinese female who exhibited bilateral breast cancer (invasive ductal carcinoma, not otherwise specified, IDC-NOS) and an accessory breast carcinoma (IDC-NOS) incidentally identified in her left axilla. The ectopic breast tissue in her right axilla presented with adenosis. The patient was surgically treated, followed by postoperative docetaxel epirubicin (TE) chemotherapy. The second case was a 53-year-old Chinese female with bilateral breast cancer (apocrine carcinoma) accompanied by an accessory breast carcinoma (IDC-NOS) in her right axilla that was also incidentally identified. The patient was surgically treated after three doses of cyclophosphamide epirubicin docetaxel (CET) neoadjuvant chemotherapy, followed by adjuvant chemotherapy of the same regimen

  14. Accessory breast cancer occurring concurrently with bilateral primary invasive breast carcinomas: a report of two cases and literature review.

    Science.gov (United States)

    Hao, Jin-Yan; Yang, Cui-Cui; Liu, Fang-Fang; Yang, Yi-Ling; Li, Shuai; Li, Wei-Dong; Li, Ya-Qing; Lang, Rong-Gang; Fan, Yu; Paulos, Estifanos; Zhang, Xin-Min; Fu, Li

    2012-09-01

    The development of accessory breast tissue, which is found anywhere along the milk line, is attributed to the failure of milk line remnants to regress during embryogenesis. Primary tumors may arise from any ectopic breast tissue. Accessory breast cancer occurring concurrently with primary invasive breast cancer is extremely rare. Two such cases were reported in this article. One was a 43-year-old Chinese female who exhibited bilateral breast cancer (invasive ductal carcinoma, not otherwise specified, IDC-NOS) and an accessory breast carcinoma (IDC-NOS) incidentally identified in her left axilla. The ectopic breast tissue in her right axilla presented with adenosis. The patient was surgically treated, followed by postoperative docetaxel epirubicin (TE) chemotherapy. The second case was a 53-year-old Chinese female with bilateral breast cancer (apocrine carcinoma) accompanied by an accessory breast carcinoma (IDC-NOS) in her right axilla that was also incidentally identified. The patient was surgically treated after three doses of cyclophosphamide epirubicin docetaxel (CET) neoadjuvant chemotherapy, followed by adjuvant chemotherapy of the same regimen. PMID:23691479

  15. Lymphatic drainage and sentinel node location in breast cancer

    International Nuclear Information System (INIS)

    Full text: Mammary lymphoscintigraphy using small volume (0.1-0.2 ml) peritumoral injections of 99Tcm-antimony sulphide colloid provided a map of the lymph drainage of a breast cancer to its draining sentinel lymph nodes in 92 of 102 patients (over 90%). Non-migration of tracer is reduced by post-injection massage for 5 min but may occur especially if the lymphatics are blocked by metastases. Drainage included the axilla in 92%, internal mammary nodes in 43%, supraclavicular nodes in 12% and intramammary interval nodes in 10% of patients. One patient drained to an interpectoral node. Drainage across the centre-line of the breast occurred in 46% of patients but direct drainage to the contralateral side of the patient was not seen. Lymphatic drainage occurred to 1 node field in 52 patients, 2 node fields in 34 patients and 3 node fields in 6 patients, so that 43% of patients had multiple draining node fields. Drainage to non-axillary sites occurred in 51% of patients. In conclusion, mammary lymphoscintigraphy accurately maps sentinel node location in breast cancer. Approximately half of the patients will have sentinel nodes outside the axilla. To achieve complete lymph node staging in patients with breast cancer, it is logical to biopsy these non-axillary sentinel nodes as well as the sentinel nodes in the axilla. Failure to do so will potentially understage the node status in 50% of patients

  16. Management of metastatic apocrine hidradenocarcinoma with chemotherapy and radiation

    Directory of Open Access Journals (Sweden)

    Daniel H. Miller

    2015-10-01

    Full Text Available Hidradenocarcinoma is a rare aggressive form of cutaneous adnexal skin carcinoma originating from the sweat gland. Due to its low incidence, prognostic and treatment strategies are still being explored both for primary and advanced disease. This tumor most often presents as either solid or cystic appearing subcutaneous nodules, which may be associated with pruritus or ulceration. To date the mainstay of treatment for local disease has been surgical excision; however, the paucity of historical data available has shown that these tumors often behave aggressively with high rates of local recurrence, metastasis, and poor overall outcomes. There are few case reports describing the utility of radiation therapy in the treatment of hidradenocarcinoma. Herein, we present a case of metastatic apocrine hidradenocarcinoma in a 32-year-old Caucasian male. The patient initially underwent excisional biopsy which confirmed the diagnosis of poorly differentiated, highly infiltrative, apocrine hidradenocarcinoma. He received systemic chemotherapy for metastatic disease, followed by radiation therapy to areas of grossly palpable adenopathy. Prior to radiation therapy the patient had an enlarged hypermetabolic conglomerate of lymph nodes in the right axilla, and borderline enlarged low activity nodes within the left axilla. He received 3 cycles of chemotherapy followed by tamoxifen and radiation therapy (50.4 Gy in 28 fractions to areas of progressive disease in the bilateral axilla, lower neck, and axillary skin. Following treatment, the patient had complete resolution of skin nodules and improvement of his pruritus. While the role of radiation therapy in the treatment of hidradenocarcinoma has not been well established, this case report demonstrated the potential benefit of external beam radiotherapy in the management of this rare disease

  17. Axillary lymph nodes siliconoma in a woman with intracapsular implant rupture

    International Nuclear Information System (INIS)

    Full text: Introduction: Siliconoma, or silicone granuloma is the migration of silicon particles in the axillary lymph nodes, muscle and other non- ruptured or intact silicone implant. The latter is a relatively rare finding, and usually occurs in patients with extracapsular rupture of silicone prosthesis and has a typical ultrasound image. We present a case of a young woman with bilateral silicone prostheses placed 5 years ago, where in the right axilla are enlarged, structurally altered lymph nodes in the clinical and ultrasonography studies. Subsequent magnetic resonance examination shows intracapsular rupture ipsilateral silicone prosthesis and migration of silicon particles in the axillary lymph nodes. What you will learn: In this case we present twenty-three year old woman who reported pain and ‘swelling’ in the right axilla. The patient is with bilateral silicone prosthesis, she is not febrile and not reported other illness. After physical examination enlarged and tender lymph nodes in the right axilla was found. Several structurally altered and enlarged lymph nodes were visualized by ultrasound. These lymph nodes are hypoechogenic with obliterated fatty hilus. Due to the suspicion of silicone ‘extravasation’ in axillary lymph nodes, a magnetic resonance study of both mammary glands was performed. The images show intracapsular rupture of the right prosthesis without reliable data on silicone gel outside the fibrous capsule. Discussion: Siliconoma is a complication after plastic surgery of the breast and can affect both the axillary lymph nodes, and other lymphatic chains and also muscle and lung. Most frequently it occurs at damage of the extracapsular silicone prostheses. More rarely siliconoma occurs in siliconoma intracapsular damage, as in the presented case or in a silicone gel microbleed. Conclusion: The presence of siliconoma in axillary lymph nodes is relatively rare complication in plastic surgery of the breast. Methods of imaging diagnostic

  18. Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Shin Hyung; Kim, Jae Chul; Lee, Jeong Eun; Park, In Kyu [Dept.of Radiation Oncology, Kyungpook National University Hospital, Daegu(Korea, Republic of)

    2015-03-15

    To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. The median level I and II axillary volume coverage percentages at the VD95% line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.

  19. Bi-tangential hybrid IMRT for sparing the shoulder in whole breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Farace, P.; Deidda, M.A.; Iamundo de Curtis, I.; Deiana, E.; Farigu, R.; Lay, G.; Porru, S. [Regional Oncological Hospital, Cagliari (Italy). Dept. of Radio-Oncology

    2013-11-15

    Background and purpose: A bi-tangential technique is proposed to reduce undesired doses to the shoulder produced by standard tangential irradiation. Patients and methods: A total of 6 patients affected by shoulder pain and reduced functional capacity after whole-breast irradiation were retrospectively analysed. The standard tangential plan used for treatment was compared with (1) a single bi-tangential plan where, to spare the shoulder, the lateral open tangent was split into two half-beams at isocentre, with the superior portion rotated by 10-20 medially with respect to the standard lateral beam; (2) a double bi-tangential plan, where both the tangential open beams were split. The planning target volume (PTV) coverage and the dose to the portion of muscles and axilla included in the standard tangential beams were compared. Results: PTV95 % of standard plan (91.9 {+-} 3.8) was not significantly different from single bi-tangential plan (91.8 {+-} 3.4); a small but significant (p < 0.01) decrease was observed with the double bi-tangential plan (90.1 {+-} 3.7). A marked dose reduction to the muscle was produced by the single bi-tangential plan around 30-40 Gy. The application of the double bi-tangential technique further reduced the volume receiving around 20 Gy, but did not markedly affect the higher doses. The dose to the axilla was reduced both in the single and the double bi-tangential plans. Conclusion: The single bi-tangential technique would have been able to reduce the dose to shoulder and axilla, without compromising target coverage. This simple technique is valuable for irradiation after axillary lymph node dissection or in patients without dissection due to negative or low-volume sentinel lymph node disease. (orig.)

  20. Bi-tangential hybrid IMRT for sparing the shoulder in whole breast irradiation

    International Nuclear Information System (INIS)

    Background and purpose: A bi-tangential technique is proposed to reduce undesired doses to the shoulder produced by standard tangential irradiation. Patients and methods: A total of 6 patients affected by shoulder pain and reduced functional capacity after whole-breast irradiation were retrospectively analysed. The standard tangential plan used for treatment was compared with (1) a single bi-tangential plan where, to spare the shoulder, the lateral open tangent was split into two half-beams at isocentre, with the superior portion rotated by 10-20 medially with respect to the standard lateral beam; (2) a double bi-tangential plan, where both the tangential open beams were split. The planning target volume (PTV) coverage and the dose to the portion of muscles and axilla included in the standard tangential beams were compared. Results: PTV95 % of standard plan (91.9 ± 3.8) was not significantly different from single bi-tangential plan (91.8 ± 3.4); a small but significant (p < 0.01) decrease was observed with the double bi-tangential plan (90.1 ± 3.7). A marked dose reduction to the muscle was produced by the single bi-tangential plan around 30-40 Gy. The application of the double bi-tangential technique further reduced the volume receiving around 20 Gy, but did not markedly affect the higher doses. The dose to the axilla was reduced both in the single and the double bi-tangential plans. Conclusion: The single bi-tangential technique would have been able to reduce the dose to shoulder and axilla, without compromising target coverage. This simple technique is valuable for irradiation after axillary lymph node dissection or in patients without dissection due to negative or low-volume sentinel lymph node disease. (orig.)

  1. Planar Tc99m – sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: Results of an international multicenter trial

    International Nuclear Information System (INIS)

    Lymph node status is the most important prognostic indicator in breast cancer in recently diagnosed primary lesion. As a part of an interregional protocol using scintimammography with Tc99m compounds, the value of planar Tc99m sestamibi scanning for axillary lymph node evaluation is presented. Since there is a wide range of reported values, a standardized protocol of planar imaging was performed. One hundred and forty-nine female patients were included prospectively from different regions. Their mean age was 55.1 ± 11.9 years. Histological report was obtained from 2.987 excised lymph nodes from 150 axillas. An early planar chest image was obtained at 10 min in all patients and a delayed one in 95 patients, all images performed with 740–925 MBq dose of Tc99m sestamibi. Blind lecture of all axillary regions was interpreted by 2 independent observers considering any well defined focal area of increased uptake as an involved axilla. Diagnostic values, 95% confidence intervals [CI] and also likelihood ratios (LR) were calculated. Node histology demonstrated tumor involvement in 546 out of 2987 lymph nodes. Sestamibi was positive in 30 axillas (25 true-positive) and negative in 120 (only 55 true-negative). The sensitivity corresponded to 27.8% [CI = 18.9–38.2] and specificity to 91.7% [81.6–97.2]. The positive and negative LR were 3.33 and 0.79, respectively. There was no difference between early and delayed images. Sensitivity was higher in patients with palpable lesions. This work confirmed that non tomographic Tc99m sestamibi scintimammography had a very low detection rate for axillary lymph node involvement and it should not be applied for clinical assessment of breast cancer

  2. Acute compartment syndrome of the forearm and hand in a patient of spine surgery -A case report-

    OpenAIRE

    Lee, Jung-ah; Jeon, Yeon Soo; Jung, Hong Soo; Kim, Hyung-Gun; Kim, Yong Shin

    2010-01-01

    A 38-year-old woman underwent a 4-hour operation in the prone position for a laminectomy at C4-7 and posterior cervical decompressive fusion at C7-T1 under general anesthesia. After undraping at the end of surgery, considerable swelling with many blisters of the left forearm and hand was observed. The chest roll at the left side had moved cephalad into the axilla and compressed the axillary structures. An emergency fasciotomy to decompress the compartments of the forearm and dorsal surface of...

  3. Breast Mass in a Rubens Painting.

    Science.gov (United States)

    Lazzeri, Davide; Lippi, Donatella; Castello, Manuel Francisco; Weisz, George M

    2016-01-01

    Deformity of the breast and axilla observed in famous paintings is a fascinating field for the medico-artists. The attempt of a retrospective diagnosis of breast tumors is highly challenging. This paper deals with a Rubens painting portraying the heroine Judith with a visible but previously unreported left breast mass. Though speculative, the present medico-artistic diagnosis is of a tumor likely to be of benign nature. It is of interest that the present case is the sixth breast disease discovered in Rubens's works. PMID:27101221

  4. Accumulation of FDG in axillary sweat glands in hyperhidrosis: a pitfall in whole-body PET examination

    International Nuclear Information System (INIS)

    A diabetic male with severe autonomic neuropathy and recently discovered Hodgkin's disease demonstrated bilateral uptake of [2-18F]-2-fluoro-2-deoxy-d-glucose (FDG) in the axillary sweat glands during profuse sweating caused by hypoglycaemia at positron emission tomography examination. It is not yet clear whether the sweating interfered with the distribution of the radiopharmaceutical. Regardless of the cause or mechanism for the uptake, the finding is clinically relevant. A bilateral symmetrical accumulation of FDG in the axillae of a tumour patient does not necessarily indicate malignant involvement of the lymph nodes. (orig.)

  5. Steatocystoma multiplex hos 39-årig kvinde

    DEFF Research Database (Denmark)

    Duffy, Jonas Raymond; Siersen, Hans Erik; Bonde, Christian T

    2011-01-01

    A clinical case of the rare disorder steatocystoma multiplex is described in a 39-year-old female. The patient was diagnosed with generalized intradermal lesions that started presenting in early adulthood. There was no family history of similar lesions.Skin examination showed multiple, skin-coloured...... cystic lesions on the chest, abdomen, axillae and back. The patient's clinical presentations and history were compatible with steatocystoma multiplex. Various treatment options for steatocystoma multiplex and steatocystoma multiplex suppurativum have been published and include oral antibiotics...

  6. Kimura's disease involving a long bone

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Yang-Guk; Kang, Yong-Koo; Bahk, Won-Jong; Cho, Hyun-Min [The Catholic University of Korea, Department of Orthopedic Surgery, Seoul (Korea); Jee, Won-Hee [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, Seoul (Korea); Jung, Chan-Kwon; Park, Gyeong-Sin; Lee, An-hi [The Catholic University of Korea, Department of Hospital Pathology, Seoul (Korea); Park, Jong-Won [The Catholic University of Korea, Department of Internal Medicine, College of Medicine, Seoul (Korea)

    2010-05-15

    Kimura's disease is a rare, benign lymphoproliferative disorder of unknown etiology. It occurs most often in Asian men, usually in the second or third decade of life. Most lesions occur in the head and neck followed by the axilla, groin, popliteal region, and arm. The lesions are commonly found in soft tissues. To the best of our knowledge, there has been only one case report of bone involvement in Kimura's disease presented on plain radiography. We report a case of Kimura's disease that involved the proximal meta-diaphysis of the humerus and adjacent soft tissue shown on radiography and MR imaging. (orig.)

  7. [3rd Hungarian Breast Cancer Consensus Conference - Surgery Guidelines].

    Science.gov (United States)

    Lázár, György; Bursics, Attila; Farsang, Zoltán; Harsányi, László; Kósa, Csaba; Maráz, Róbert; Mátrai, Zoltán; Paszt, Attila; Pavlovics, Gábor; Tamás, Róbert

    2016-09-01

    Therapy for breast cancer today is characterised by ever more precise diagnostic methods and ever more effective oncological treatments, a trend which will certainly continue in the future. Breast preservation and the application of oncoplastic principles are increasingly popular. A sentinel lymph node biopsy in the surgical treatment of the axilla is primary, with the indication for axillary block dissection (ABD) narrowing and radiation therapy becoming an alternative to ABD in certain cases. This publication summarises our recommendations on the surgical treatment of breast cancer based on the content of the 2nd Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations. PMID:27579720

  8. Acquired Lymphangioma Circumscriptum Caused Macroglossia: A Case Report

    Directory of Open Access Journals (Sweden)

    Mahmut Sami Metin

    2015-03-01

    Full Text Available Lymphangioma circumscriptum (LC is a hamartomatous vascular malformation of lymphatic channels. The etiology is not fully understood. It is usually congenital. Lesions are characterized as thin-walled and grouped vesicles. Lesions are usually seen on proximal extremities, shoulder, axilla, abdomen and neck. They are rarely seen on genital and oral mucosa. Our case was 20 years old male suffering from growing, pain and burning of tongue for 2 months durations. There was a plaque consisted of grouped vesicles on tongue in dermatological examination. Biopsy was obtained. LC was diagnosed. We decided to report this case since acquired LC on tongue and macroglossi is very rare in literature.

  9. Phenotypic heterogeneity in hidradenitis suppurativa (acne inversa): classification is an essential step toward personalized therapy.

    Science.gov (United States)

    Ingram, John R; Piguet, Vincent

    2013-06-01

    Awareness is increasing that there is phenotypic heterogeneity within the hidradenitis suppurativa (HS) disease spectrum. However, the few randomized HS trials that are available have not distinguished between the subtypes of the disease. In this issue, Canoui-Poitrine et al. used latent class (LC) analysis of the largest HS cohort described to date to generate three phenotypic subtypes. LC 1 correlates with "typical" European HS, mainly involving the axilla, groin, and, in women, the inframammary region. "Atypical" HS, which may be linked to γ-secretase gene mutations, was subdivided further into LC2 and LC3 subtypes. PMID:23673498

  10. Malignant acanthosis nigricans: an early diagnostic clue

    International Nuclear Information System (INIS)

    Acanthosis nigricans (AN) is characterized by velvety, hyper pigmented, verrucosus, symmetric and occasionally pruritic plaques along with papillomatous lesions which have a special predilection for neck, axillae, groin, umbilicu and mucosal regions. Rarely, it presents as a para neoplastic syndrome and prompts a thorough search for an internal malignancy. We present here a case of malignant acanthosis nigricans seen in an elderly patient who was found to have underlying adenocarcinoma of the lower end of esophagus. After diagnosing associated malignancy, he was referred for further evaluation and subsequent surgical resection of tumour. (author)

  11. Guide book mammary glands ultrasonography. A textbook according to the DEGUM and KBV guidelines. 3. upd. ed.

    International Nuclear Information System (INIS)

    The text book on the ultrasonography of mammary glands is based on the concept of a three-step course system. The large amount of pathological indications is supposed to communicate knowledge that is required to find an adequate diagnosis based on ultrasonsographic imaging. The book includes the following chapters: Basics of ultrasonic mammography; diagnostic techniques; sono-anatomy of breast and axilla; standardized diagnosis; mastopathy; cysts and intracystic tumors; prostheses; abscesses; benign solid tumors; scars; carcinomas; lymph nodes; interventional sonography; preoperative staging; preventive diagnostics; aftercare, relapses; 3D-sonography, panorama-scan, real-time compound-scan; CARI technique; Doppler sonography; elastography; examination questions on ultrasonic mammography.

  12. CYSTIC HYGROMA OF CHEST WALL- 2 Reported Cases

    Directory of Open Access Journals (Sweden)

    Tapan Shah

    2012-07-01

    Full Text Available Hygromas arise in the sites of primitive lymphatic lakes, on the floor of the mouth, under the jaw, in the neck and in the axillae, but they can occur virtually anywhere in the body. Their occurrence on the chest wall is very rare and they progressively grow with age infiltrating into the local tissues, insinuating lymphatic pseudopods and form cysts in and around muscle fibers and nerves, making them difficult and hazardous to remove. Here, we have reported 2 cases of cystic hygroma of chest wall in children

  13. CYSTIC HYGROMA OF CHEST WALL- 2 Reported Cases

    OpenAIRE

    Tapan Shah; Dipen Patel; Yash Vaidhya; Jigar Jadeja; Sharad Patel; Asit Patel

    2012-01-01

    Hygromas arise in the sites of primitive lymphatic lakes, on the floor of the mouth, under the jaw, in the neck and in the axillae, but they can occur virtually anywhere in the body. Their occurrence on the chest wall is very rare and they progressively grow with age infiltrating into the local tissues, insinuating lymphatic pseudopods and form cysts in and around muscle fibers and nerves, making them difficult and hazardous to remove. Here, we have reported 2 cases of cystic hygroma of chest...

  14. Mosaic neurofibromatosis type 1.

    Science.gov (United States)

    Liang, Christine; Schaffer, Julie V

    2008-01-01

    A 24-year-old man presented with numerous lentigines and multiple cafe-au-lait macules on both sides of the face, neck, and trunk as well as on the proximal area of the upper extremities and in the axillae. The pigmented lesions had a Blaschko-linear distribution on the upper trunk and were limited to the left side of the abdomen, with a sharp demarcation at the midline. Multiple, cutaneous neurofibromas were found on the trunk, and ophthalmologic examination showed a Lisch nodule in the left iris. The clinical findings and their widespread but segmental distribution were consistent with a diagnosis of mosaic neurofibromatosis type 1. PMID:18627742

  15. Lymphadenopathy by scrub typhus mimicking metastasis on FDG PET/CT in a patient with a history of breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Won [Dept. of Nuclear Medicine, Catholic Kwandong University International St. Mary' s Hospital, Incheon (Korea, Republic of); Lee, Sang Mi; Lee, Kyu Taek; Kim, Sung Young; Han, Sun Wook; Kim, Shin Young [Sooncheonhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

    2015-06-15

    We report the case of a 60-year-old woman with left-sided breast cancer who showed lymphadenopathy mimicking metastatic lesions. She underwent surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) after treatment. PET/CT demonstrated multiple lymphadenopathies with increased FDG uptake, most notably in the right axilla. She had an eschar on the right axillary area, and her serologic test was positive for anti-Orientia tsutsugamushi IgM antibody. Ten months after the treatment, follow-up FDG PET/CT and ultrasonography showed improvement in generalized lymphadenopathy.

  16. Epirubicin and docetaxel as neoadjuvant treatment of hormone receptor positive, HER-2 negative breast cancer: findings from two successive phase II studies

    International Nuclear Information System (INIS)

    We report on the activity of the combination of epirubicin and docetaxel given in neoadjuvant setting for 4 and 8 cycles respectively in 2 successive series of patients with large operable or locally advanced, hormone receptor positive, HER-2 negative breast cancer. Patients were treated from 2002 to 2006 with epirubicin 90 mg/m2 and docetaxel 75 mg/m2 intravenously, every 3 weeks for 4 cycles before and 4 cycles after surgery (Series I – 13 patients), and from 2006 to 2010 with the same regimen administered for 8 cycles preoperatively (Series II – 37 patients), plus hormonal therapy for 5 years and radiation therapy if indicated. All Series I and 32 Series II patients were able to complete the preoperative chemotherapy. A complete response was found in 1 patient from Series I and 13 patients from Series II and the partial remission in 10 patients from Series I and 21 patients from Series II. Two Series I and 3 Series II patients did not respond clinically. Response rate (Series I/Series II) was 84/92%. All 50 patients underwent surgery. In Series I patients, 3 pCR occurred in the breast and the axilla was histologically negative in 2 cases. No evidence of disease both in the breast and in the axilla was achieved in 7.6% (1/13) of patients. In Series II patients, 8 pCR occurred in the breast and axilla was histologically negative in 15 patients. No evidence of disease both in the breast and in the axilla occurred in 10.8% (4/37) of patients. G3–G4 toxicity included myelosuppression in 3 patients from Series I and all patients from Series II, and mucositis in 1 patient from Series I and 4 patients from series II. No other G3–4 toxicities or toxic deaths occurred. Five-year progression free survival was 38% and 90% in Series I and Series II patients respectively. The incidence of pathologic complete remissions was lower in our patient population, compared to reported data. A longer duration of the preoperative treatment might be associated with a longer

  17. Giant fibroepithelial polyp of the vulva

    Directory of Open Access Journals (Sweden)

    Selma Korkmaz

    2014-12-01

    Full Text Available Fibroepithelial polyps are among common benign skin lesions. They are usually small and skin-colored lesions and are located frequently in the axilla and neck. They are rarely seen in the vulva. There is a small number of cases that reach the giant sizes in this area in the literature. A 20-year-old female patient presented with a pedunculated mass measuring 25 cm in diameter, localized to the right labium majus. The lesion was excised and the histopathological diagnosis was fibroepithelial polyp. We present this case because of it is the largest reported fibroepithelial polyp of the vulva in the literature.

  18. Lymphangioma circumscriptum of the vulva: Report of a rare case

    OpenAIRE

    Sinha, Anuradha; Phukan, Jyoti Prakash; Jalan, Shilpa; Pal, Subrata

    2015-01-01

    Lymphangioma circumscriptum (LC) is a form of lymphangioma characterised by benign dilation of lymphatic channels, which affects the skin and subcutaneous tissues. The most common sites of LC are mucosa of mouth, tongue, groin, axilla, trunk and proximal region of extremities. Vulva is a rare site of LC. In this report, we are presenting a case of LC of vulva occurring in a 60-year-old female without any obvious reason. The patient presented with multiple genital wart-like papular lesions in ...

  19. Clear-PEM: A PET imaging system dedicated to breast cancer diagnostics

    CERN Document Server

    Abreu, M C; Albuquerque, E; Almeida, F G; Almeida, P; Amaral, P; Auffray, Etiennette; Bento, P; Bruyndonckx, P; Bugalho, R; Carriço, B; Cordeiro, H; Ferreira, M; Ferreira, N C; Gonçalves, F; Lecoq, Paul; Leong, C; Lopes, F; Lousã, P; Luyten, J; Martins, M V; Matela, N; Rato-Mendes, P; Moura, R; Nobre, J; Oliveira, N; Ortigão, C; Peralta, L; Rego, J; Ribeiro, R; Rodrigues, P; Santos, A I; Silva, J C; Silva, M M; Tavernier, Stefaan; Teixeira, I C; Texeira, J P; Trindade, A; Trummer, Julia; Varela, J

    2007-01-01

    The Clear-PEM scanner for positron emission mammography under development is described. The detector is based on pixelized LYSO crystals optically coupled to avalanche photodiodes and readout by a fast low-noise electronic system. A dedicated digital trigger (TGR) and data acquisition (DAQ) system is used for on-line selection of coincidence events with high efficiency, large bandwidth and small dead-time. A specialized gantry allows to perform exams of the breast and of the axilla. In this paper we present results of the measurement of detector modules that integrate the system under construction as well as the imaging performance estimated from Monte Carlo simulated data.

  20. Lymphadenopathy by scrub typhus mimicking metastasis on FDG PET/CT in a patient with a history of breast cancer

    International Nuclear Information System (INIS)

    We report the case of a 60-year-old woman with left-sided breast cancer who showed lymphadenopathy mimicking metastatic lesions. She underwent surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) after treatment. PET/CT demonstrated multiple lymphadenopathies with increased FDG uptake, most notably in the right axilla. She had an eschar on the right axillary area, and her serologic test was positive for anti-Orientia tsutsugamushi IgM antibody. Ten months after the treatment, follow-up FDG PET/CT and ultrasonography showed improvement in generalized lymphadenopathy

  1. Lymphadenopathy by Scrub Typhus Mimicking Metastasis on FDG PET/CT in a Patient with a History of Breast Cancer.

    Science.gov (United States)

    Lee, Jeong Won; Lee, Sang Mi; Lee, Kyu Taek; Kim, Sung Young; Han, Sun Wook; Kim, Shin Young

    2015-06-01

    We report the case of a 60-year-old woman with left-sided breast cancer who showed lymphadenopathy mimicking metastatic lesions. She underwent surveillance (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) after treatment. PET/CT demonstrated multiple lymphadenopathies with increased FDG uptake, most notably in the right axilla. She had an eschar on the right axillary area, and her serologic test was positive for anti-Orientia tsutsugamushi IgM antibody. Ten months after the treatment, follow-up FDG PET/CT and ultrasonography showed improvement in generalized lymphadenopathy. PMID:26082810

  2. CT scanning of the brachial plexus, normal anatomy, pathology, and radiation fibrosis

    International Nuclear Information System (INIS)

    The brachial plexus is a region difficult to examine clinically and by conventional radiology. CT is ideally suited to image this area, and detailed anatomy of the plexus can be visualized. Sixty patients with brachial plexus symptoms underwent CT of the root of the neck and axilla. Forty-two of these had previously been treated with radiation therapy for carcinoma of the breast. CT was a sensitive modality for demonstrating abnormalities in this region, and radiation fibrosis could be differentiated from recurrent axillary disease. A greater degree of fibrosis did not correlate with different treatment schedules but with a higher fraction size

  3. Five Roots Pattern of Median Nerve Formation

    Directory of Open Access Journals (Sweden)

    Konstantinos Natsis

    2016-04-01

    Full Text Available An unusual combination of median nerve’s variations has been encountered in a male cadaver during routine educational dissection. In particular, the median nerve was formed by five roots; three roots originated from the lateral cord of the brachial plexus joined individually the median nerve’s medial root. The latter (fourth root was united with the lateral (fifth root of the median nerve forming the median nerve distally in the upper arm and not the axilla as usually. In addition, the median nerve was situated medial to the brachial artery. We review comprehensively the relevant variants, their embryologic development and their potential clinical applications.

  4. Fibrous hamartoma of infancy in the hand: unusual location and MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Song, You Seon; Lee, In Sook [Pusan National University School of Medicine, Department of Radiology, Busan (Korea); Pusan National University School of Medicine, Medical Research Institute, Busan (Korea); Kim, Hui Taek [Pusan National University Hospital, Department of Orthopaedic Surgery, Busan (Korea); Choi, Kyung-Un [Pusan National University School of Medicine, Medical Research Institute, Busan (Korea); Pusan National University Hospital, Department of Pathology, Busan (Korea); Song, Jong Woon [Inje University Pusan Paik Hospital, Department of Radiology, Busan (Korea)

    2010-10-15

    Fibrous hamartomas of infancy (FHIs) are benign, poorly-circumscribed, soft tissue growths presenting during the first 2 years of life and characteristically affecting the axilla, upper arm, upper trunk, inguinal region, and external genital area. Involvement of the hands and feet is extremely rare. We report a case of FHI unusually occurring in a deep portion of the hand. MRI revealed atypical features similar to that of a vascular malformation, hemangioma, fibromatosis, or neurofibromatosis of the hand. Partial resection of the mass was performed to correct the contracture of the second finger and an additional operation was not performed because of the benign nature of FHIs. (orig.)

  5. False-Positive Axillary Lymph Nodes Due to Silicone Adenitis on (18)F-FDG PET/CT in an Oncological Setting.

    Science.gov (United States)

    D'hulst, Ludovic; Nicolaij, Daniël; Beels, Laurence; Gheysens, Olivier; Alaerts, Herwig; Van de Wiele, Christophe; Maes, Alex

    2016-06-01

    The case of a 49-year-old transgender individual with a history of bilateral silicone breast implants and a right lung mass proven by biopsy to be a non-small cell lung cancer is presented. In addition to the primary malignancy, a positron emission tomography/computed tomography scan showed contralateral hypermetabolic adenopathy in the left axilla that was suggestive of nodal metastatic disease. Additional imaging and histological examination of the lymph nodes indicated silicone breast implant leakage and silicone adenitis as the underlying cause of the hypermetabolic axillary lymph node. PMID:26776866

  6. Pseudofolliculitis Corporis: A New Entity Diagnosed by Dermoscopy

    OpenAIRE

    Puhan, Manas Ranjan; Sahu, Bharati

    2015-01-01

    Pseudofolliculitis mainly affects the beard area, but it can occur in any area of hair-bearing skin when traumatic methods like shaving or plucking are used to remove the hair. It can be a simple cosmetic problem or a disturbing medical condition for which the dermatologist must be prepared. It can develop in areas of shaving or depilation and has been seen in the pubic region or the axilla, where it is common to find curly hair that emerges at an acute angle. Here, we are reporting a case of...

  7. Ulnar nerve palsy due to axillary crutch.

    Directory of Open Access Journals (Sweden)

    Veerendrakumar M

    2001-01-01

    Full Text Available A young lady with residual polio, using axillary crutch since early childhood, presented with tingling, numbness and weakness in ulnar nerve distribution of five months duration. Ulnar motor conduction study revealed proximal conduction block near the axilla, at the point of pressure by the crutch while walking. Distal ulnar sensory conduction studies were normal but proximal ulnar sensory conduction studies showed absence of Erb′s point potential. These findings suggested the presence of conduction block in sensory fibers as well. Proper use and change of axillary crutch resulted in clinical recovery and resolution of motor and sensory conduction block.

  8. Unilateral appearance of a chondro-epitrochlearis muscle-a case report

    Directory of Open Access Journals (Sweden)

    Jaijesh P

    2005-01-01

    Full Text Available Variant muscle slips from pectoralis major muscle are rare. Among these, the muscle chondro-epitrochlearis is a very rare muscular anomaly. Here, in this report, we describe a similar muscle which had an origin from the lower ribs along with the lower fibres of the pectoralis major muscle, arched across the axilla, and then inserted to the medial epicondyle of humerus. In this report we present a review of literature on this muscle. We also discuss the clinical significance of this muscle since the knowledge of this muscle is important in the differential diagnosis of ulnar nerve entrapment.

  9. Predictor variables for half marathon race time in recreational female runners

    Directory of Open Access Journals (Sweden)

    Beat Knechtle

    2011-01-01

    Full Text Available INTRODUCTION: The relationship between skin-fold thickness and running performance has been investigated from 100 m to the marathon distance, except the half marathon distance. OBJECTIVE: To investigate whether anthropometry characteristics or training practices were related to race time in 42 recreational female half marathoners to determine the predictor variables of half-marathon race time and to inform future novice female half marathoners. METHODS: Observational field study at the 'Half Marathon Basel' in Switzerland. RESULTS: In the bivariate analysis, body mass (r = 0.60, body mass index (r = 0.48, body fat (r = 0.56, skin-fold at pectoral (r = 0.61, mid-axilla (r = 0.69, triceps (r = 0.49, subscapular (r = 0.61, abdominal (r = 0.59, suprailiac (r = 0.55 medial calf (r = 0.53 site, and speed of the training sessions (r = -0.68 correlated to race time. Mid-axilla skin-fold (p = 0.04 and speed of the training sessions (p = 0.0001 remained significant after multi-variate analysis. Race time in a half marathon might be predicted by the following equation (r² = 0.71: Race time (min = 166.7 + 1.7x (mid-axilla skin-fold, mm - 6.4x (speed in training, km/h. Running speed during training was related to skinfold thickness at mid-axilla (r = -0.31, subscapular (r = -0.38, abdominal (r = -0.44, suprailiacal (r = -0.41, the sum of eight skin-folds (r = -0.36 and percent body fat (r = -0.31. CONCLUSION: Anthropometric and training variables were related to half-marathon race time in recreational female runners. Skin-fold thicknesses at various upper body locations were related to training intensity. High running speed in training appears to be important for fast half-marathon race times and may reduce upper body skin-fold thicknesses in recreational female half marathoners.

  10. Guide book mammary glands ultrasonography. A textbook according to the DEGUM and KBV guidelines. 3. upd. ed.; Kursbuch Mammasonografie. Ein Lehratlas nach den Richtlinien der DEGUM und der KBV

    Energy Technology Data Exchange (ETDEWEB)

    Madjar, Helmut [Deutsche Klinik fuer Diagnostik, Wiesbaden (Germany). Fachbereich Gynaekologie DEGUM-Stufe III

    2012-07-01

    The text book on the ultrasonography of mammary glands is based on the concept of a three-step course system. The large amount of pathological indications is supposed to communicate knowledge that is required to find an adequate diagnosis based on ultrasonsographic imaging. The book includes the following chapters: Basics of ultrasonic mammography; diagnostic techniques; sono-anatomy of breast and axilla; standardized diagnosis; mastopathy; cysts and intracystic tumors; prostheses; abscesses; benign solid tumors; scars; carcinomas; lymph nodes; interventional sonography; preoperative staging; preventive diagnostics; aftercare, relapses; 3D-sonography, panorama-scan, real-time compound-scan; CARI technique; Doppler sonography; elastography; examination questions on ultrasonic mammography.

  11. Outcome following Nerve Repair of High Isolated Clean Sharp Injuries of the Ulnar Nerve

    OpenAIRE

    Post, René; de Boer, Kornelis S.; Malessy, Martijn J. A.

    2012-01-01

    Objective The detailed outcome of surgical repair of high isolated clean sharp (HICS) ulnar nerve lesions has become relevant in view of the recent development of distal nerve transfer. Our goal was to determine the outcome of HICS ulnar nerve repair in order to create a basis for the optimal management of these lesions. Methods High ulnar nerve lesions are defined as localized in the area ranging from the proximal forearm to the axilla just distal to the branching of the medial cord of the b...

  12. Four cases of pediculosis caused by Pthirus pubis Linnaeus, 1758 (Diptera: Anoplura) from peninsular Malaysia.

    Science.gov (United States)

    Pakeer, O; Jeffery, J; Mohamed, A M; Ahmad, F; Baharudin, O

    2007-12-01

    Four cases of pediculosis, two in adults and two in children, caused by the crab-louse, Pthirus pubis Linnaeus, 1758 (Diptera: Anoplura) is reported from peninsular Malaysia. This is the second report of the problem to be documented from the country. Although P. pubis is closely associated with genital hairs, it is, however, also found to occur on the eyelashes, eyebrows, hairs of the body, head and axilla. The few reported cases of pthiriasis probably do not reflect the true situation. PMID:18209717

  13. Rare sweat gland tumors of vulva: Report of two cases

    Directory of Open Access Journals (Sweden)

    Rashmi Mahajan

    2012-01-01

    Full Text Available Syringomas and Fox-Fordyce disease are appendageal skin disorders. While syringomas represent an adenoma of the intraepidermal eccrine duct, Fox Fordyce disease occurs due to blockage of the apocrine sweat duct. In both conditions, extragenital sites are more frequently involved than the genitalia. We herein report two young females, one with syringomas on the face and vulva and the other with Fox Fordyce disease involving axilla, areola and vulva, thereby citing the importance of examination of genitalia in these disorders.

  14. Sonographic findings of axillary masses: what can be imaged in this space?

    Science.gov (United States)

    Park, Ji Eun; Sohn, Yu-Mee; Kim, Eun-Kyung

    2013-07-01

    The diagnosis of axillary masses can be challenging because various tumors can develop in parts of the axilla other than lymph nodes, even though we frequently encounter axillary masses in daily practice. These lesions include soft tissue masses associated with nontumorous conditions (accessory breast tissue and chronic granulomatous inflammation) and benign and malignant tumorous conditions (lipomas, epidermal inclusion cysts, lymphangiomas, fibroadenomas, schwannomas, malignant neuroendocrine tumors, and lymph node-associated diseases). In this pictorial essay, we display commonly encountered sonographic findings of various axillary lesions to assist in the differential diagnosis of axillary masses. PMID:23804349

  15. Bilateral multiple axillary apocrine hidrocystomas accompanied by apocrine hyperplasia: a rare presentation.

    Science.gov (United States)

    Shukla, Shailaja; Patiri, Karsing; Pujani, Mukta; Komal, Singh Bhawana

    2014-01-01

    Apocrine hidrocystomas (AHC) are uncommon cystic lesions of apocrine glands and are most often solitary. They are usually found in the head and neck region. Multiple AHC have been rarely reported in the literature usually in the eyelids and face. On extensive search of literature, we came across only a single case report of multiple axillary AHC. We report a case of a 31-year-old female who presented with fullness and discomfort in bilateral axillae, so a clinical diagnosis of bilateral accessory breast was made. However on histopathological examination, it turned out to be bilateral multiple AHC associated with apocrine hyperplasia. PMID:24943766

  16. Anatomic and clinical rationale of the V-sign to detect accessory axillary breast tissue

    Directory of Open Access Journals (Sweden)

    Naraynsingh V

    2014-02-01

    Full Text Available Vijay Naraynsingh, Shamir O Cawich, Ravi Maharaj, Dilip Dan, Dale Hassranah Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies Abstract: The potential for breast cancer to present with lymphatic metastases, has instilled anxiety when women present with axillary masses. We discuss a simple and reliable clinical sign that can help clinicians to distinguish between axillary nodal metastases and accessory axillary breast tissue. Awareness and recognition of the “V-sign” can allay anxiety in women with accessary axillary breast tissue and prevent costly investigations in most cases. Keywords: axilla, cancer, axillary nodal metastases, lymphadenopathy, skin-folding

  17. Spectrum of axillary disorders (excluding metastasis from breast cancer): radiological and pathological correlation: a pictorial essay

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ho Jun; Kim, Keum Won; Park, Yong Sung; Chung, Dong Jin; Cho, Young Jun; Hwang, Cheol Mog; Yoo, Hyeun Mi; Kim, Yoon Mee [Konyang University Hospital, Seoul (Korea, Republic of); Lee, Mee Ran [Eulji University Hospital, Daejeon (Korea, Republic of)

    2007-12-15

    Axillary disorders originate from an axillary lymph node, subcutaneous fat layer, accessory breast, nerve, vessel and muscle. The most common causes of a palpable axillary mass are a lymph node pathology containing a benign axillary lymphadenopathy, and malignant lymph nodes such as a metastatic lymphadenopathy from breast cancer and a malignant lymphoma. For the detection of masses in the axilla, mammography and sonography are the imaging modalities of choice. We present a spectrum of various axillary masses with correlative radiological imaging and pathological findings in this pictorial essay. Knowledge of the radiological findings of various axillary disorders is useful for a differential diagnosis and for preventing unnecessary invasive procedures.

  18. Bilateral multiple axillary apocrine hidrocystomas accompanied by apocrine hyperplasia: A rare presentation

    Directory of Open Access Journals (Sweden)

    Shailaja Shukla

    2014-01-01

    Full Text Available Apocrine hidrocystomas (AHC are uncommon cystic lesions of apocrine glands and are most often solitary. They are usually found in the head and neck region. Multiple AHC have been rarely reported in the literature usually in the eyelids and face. On extensive search of literature, we came across only a single case report of multiple axillary AHC. We report a case of a 31-year-old female who presented with fullness and discomfort in bilateral axillae, so a clinical diagnosis of bilateral accessory breast was made. However on histopathological examination, it turned out to be bilateral multiple AHC associated with apocrine hyperplasia.

  19. Complicated axillary lymphadenectomy due to a pectoralis quartus muscle.

    Science.gov (United States)

    Totlis, T; Iosifidou, R; Pavlidou, F; Sofidis, G; Natsis, K; Bousoulegas, A

    2012-01-01

    During lymphadenectomy in the left axilla of a 38-year-old woman with a 1.4 cm invasive ductal breast carcinoma an accessory muscle was found. Due to the presence of the anomalous muscle the lymphadenectomy was carried out with difficulty through a limited field. Based on its anatomical characteristics, the supernumerary muscle was recognized as the pectoralis quartus. To our knowledge this is the first report of a pectoralis quartus muscle as a surgical finding. The surgeon should be aware of the possible presence of this anomaly as well as its anatomical characteristics in order to avoid any complications. PMID:22844841

  20. Spectrum of axillary disorders (excluding metastasis from breast cancer): radiological and pathological correlation: a pictorial essay

    International Nuclear Information System (INIS)

    Axillary disorders originate from an axillary lymph node, subcutaneous fat layer, accessory breast, nerve, vessel and muscle. The most common causes of a palpable axillary mass are a lymph node pathology containing a benign axillary lymphadenopathy, and malignant lymph nodes such as a metastatic lymphadenopathy from breast cancer and a malignant lymphoma. For the detection of masses in the axilla, mammography and sonography are the imaging modalities of choice. We present a spectrum of various axillary masses with correlative radiological imaging and pathological findings in this pictorial essay. Knowledge of the radiological findings of various axillary disorders is useful for a differential diagnosis and for preventing unnecessary invasive procedures

  1. Carcinoma of the Ectopic Breast

    Directory of Open Access Journals (Sweden)

    AMM Shariful Alam

    2013-01-01

    Full Text Available A 43-year-old woman presented with bilateral ectopic breasts in both the axillae in Chittagong Medical College Hospital in July 1996. She was diagnosed having carcinoma in the left ectopic breast. She was successfully treated with local surgical excision and regional lymph node dissection, adjuvant chemotherapy, loco-regional radiotherapy and hormone therapy. The patient continued tamoxifen for 5 years. Till last follow-up in December 2011, the patient was asymptomatic without any evidence of residual disease or local recurrence and evidence of metastases.

  2. Rupture of an expander prosthesis mimics axillary cancer recurrence.

    LENUS (Irish Health Repository)

    Ismael, T

    2005-10-01

    Regional silicone gel migration from a ruptured breast implant has been reported at different locations including the upper extremity, chest wall muscles, axilla and back. We report a patient who presented with an axillary mass that mimicked a regional recurrence 5 years after breast cancer reconstruction with a latissimus dorsi musculocutaneous flap and silicon gel expander-prosthesis. Surgical exploration revealed that the mass contained silicone gel around the port of the breast expander that had ruptured. The mass was confluent with an intracapsular silicone leak through a tract along the tube of the expander port.

  3. Cosmetic Effect of Botulinum Toxin In Focal Hyperhydrosis

    Directory of Open Access Journals (Sweden)

    Jain S

    2005-01-01

    Full Text Available Hyperhydrosis of axillae, palm and sole is not a very uncommon problem. It leads to great embarrassment and considerable emotional stress to the individuals. Botulinum toxins prevent the release of acetylcholine at nerve terminals, therefore, reduces sweat secretion. Six patients of axillary and 4 patients of palmer and planter hyperhydrosis were treated with botulinum toxin. All patients experienced relatively satisfactory reduction of hyperhydrosis for period ranging between 4-7 months. No adverse effects were observed. Botulinum toxin therefore can be considered as an effective treatment in focal hyperhydrosis.

  4. İntertriginöz alanlarda inatçı vezikülobülloz lezyonları olan bir hastada gecikmiş tanı: Hailey-Hailey hastalığı

    OpenAIRE

    Bakar, Dertlioğlu S; Pervin, K.; Yeşilova, Y; Çiçek, D

    2012-01-01

    Hailey-Hailey (H-H) disease is an autosomal dominant acantholytic dermatosis due to a mutation of ATP2C1. Hailey-Hailey is characterized by recurrent vesiculobullous lesions in the neck, axilla, inframammary, scrotum, and inguinal folds. The diagnosis of H-H was made by clinical and histopathological examination in a 54-year-old female patient who had lesions in the inframammary regions and on umbilicus. The lesions showed exacerbations during each premenstrual period. We judged that the pati...

  5. Extra-mammary findings detected on breast magnetic resonance imaging: A pictorial Essay

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) of the breast is used for various indications. Contrary to computed tomography as a staging tool, breast MRI focuses on the breast parenchyma and axilla. In spite of narrow field of view, many structures such as the anterior portion of the lungs, mediastinum, bony structures and the liver are included which should not be neglected because the abnormalities detected on the above structures may influence the staging and provide a clue to systemic metastasis, which results in the change of treatment strategy. The purpose of this pictorial essay was to review the unexpected extra-mammary findings seen on the preoperative breast MRI.

  6. Extra-mammary findings detected on breast magnetic resonance imaging: A pictorial Essay

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Hee Jung; Choi, Ji Soo; Ko, Kyung Ran [National Cancer Center, Goyang (Korea, Republic of)

    2014-08-15

    Magnetic resonance imaging (MRI) of the breast is used for various indications. Contrary to computed tomography as a staging tool, breast MRI focuses on the breast parenchyma and axilla. In spite of narrow field of view, many structures such as the anterior portion of the lungs, mediastinum, bony structures and the liver are included which should not be neglected because the abnormalities detected on the above structures may influence the staging and provide a clue to systemic metastasis, which results in the change of treatment strategy. The purpose of this pictorial essay was to review the unexpected extra-mammary findings seen on the preoperative breast MRI.

  7. A case of a patient with stage III familial hidradenitis suppurativa treated with 3 courses of infliximab and died of metastatic squamous cell carcinoma.

    OpenAIRE

    Scheinfeld, Noah

    2014-01-01

    Although rare, severe hidradenitis suppurativa (HS) of the anal, perianal, gluteal, thigh, and groin regions can evolve into squamous cell carcinoma (SCC). This usually does not occur until the HS has been present for more than 20 years. Malignant degeneration of HS in the axilla has not been reported. SCC has developed in dissecting cellulitis, acne conglobata, and pilonidal cysts (other members of the follicular tetrad). Whereas the male to female ratio of HS is 1:3, SCC in HS has a male to...

  8. Deodorants: an experimental provocation study with cinnamic aldehyde

    DEFF Research Database (Denmark)

    Bruze, Magnus; Johansen, Jeanne Duus; Andersen, Klaus Ejner; Frosch, P; Lepoittevin, J-P; Rastogi, S; Wakelin, S; White, I; Menné, T

    2003-01-01

    of axillary dermatitis when used by individuals with and without contact allergy to cinnamic aldehyde. METHODS: Patch tests with deodorants and ethanol solutions with cinnamic aldehyde, and repeated open application tests with roll-on deodorants without and with cinnamic aldehyde at different...... concentrations, were performed in 37 patients with dermatitis, 20 without and 17 with contact allergy to cinnamic aldehyde. RESULTS: A repeated open application test with positive findings was noted only in patients hypersensitive to cinnamic aldehyde (P <.001) and only in the axilla to which the deodorants...

  9. PROTEUS SYNDROME - SEGMENTAL OVERGROWTH WITH MULTIPLE NEVI

    Directory of Open Access Journals (Sweden)

    Ramasamy

    2015-01-01

    Full Text Available Proteus syndrome is a rare hamartomatous disorder characterized by various cutaneous and subcutaneous lesions , including vascular malformations , lipomas , hyperpigmentation , and several types of nevi. Partial gigantism with limb or digital overgrowth is pathognomonic of Proteus syndrome. We report a case of proteus syndrome in a 45 year old man , who presented with hypertrophy of index finger of both hands and middle , ring fing er of left hand , verrucous lesions over left axilla and two firm swellings over left palm for the past 15 years. Clinical findings , histopathology and imaging studies fulfilled the criteria of proteus syndrome which is rarely reported in literature.

  10. Erythema multiforme possibly triggered by food substances in a dog.

    Science.gov (United States)

    Itoh, Teruo; Nibe, Kazumi; Kojimoto, Atsuko; Mikawa, Mayumi; Mikawa, Kazuhiro; Uchida, Kazuyuki; Shii, Hiroki

    2006-08-01

    A 5-year-old female border collie presented with erythematous skin lesions at the axillae, groin, mucocutaneous junctions, and pinnae. Biopsy revealed lymphocytic interface dermatitis with hydropic degeneration of basal cells and keratinocyte apoptosis. Based on gross and histological features, diagnosis of erythema multiforme was made. The disease was resolved by treatment with azathioprine, prednisolone, and a hypoallergenic diet. Finally, the skin lesion was controlled without drug therapy but recurred easily every time commercial foods except the hypoallergenic diet were used, suggesting that food substances triggered this outbreak. PMID:16953090

  11. Rounded and velvety epidermal naevus, report of a verrucous form in axillary location.

    Science.gov (United States)

    Mestre, Tiago; Carvalho, Rodrigo; Amaro, Cristina

    2014-01-01

    Rounded and velvety epidermal naevus, naevoid acanthosis nigricans, also called the acanthosis nigricans form of epidermal naevus is an extremely rare entity, with fewer than 15 cases described in the literature. We report the case of a 23-year-old woman with asymptomatic velvety verrucous plaques on her left axilla starting at the age of 14. As far as we know this is the first case of such a verrucous form with only axillar involvement of naevoid acanthosis nigricans. We report this rare case, and we make a brief review of the clinical pathophysiology and treatment of this uncommon tumour. PMID:25406212

  12. Axillary radiotherapy: an alternative treatment option for adjuvant axillary management of breast cancer

    Science.gov (United States)

    Zhang, Jie; Wang, Chuan

    2016-01-01

    Axillary lymph node dissection is standard management of axilla in invasive breast cancer. Radiotherapy also is important in local treatment. It is controversial as to whether axillary radiotherapy can displace axillary lymph node dissection. We performed a meta-analysis comparing axillary radiotherapy with axillary dissection. No significant difference was observed for disease free survival and overall survival between the radiation group and the dissection group. There was also no significant difference in either the axillary recurrence or the local recurrence between the two groups. But the axillary relapse rate in the radiation group was higher than in the surgery group at five-year follow-up while the local recurrence rate in the surgery group was higher than in the radiation group. A subgroup analysis showed that the difference in the axillary recurrence rate (RR = 0.20, P = 0.01) and local recurrence rate (RR = 4.7, P = 0.01) mainly appeared in the clinical node-positive subgroup. The edema rate in the surgery group was higher than in the radiation group (RR = 2.08, 95%: 1.71–2.54, P < 0.0001). We concluded that radiotherapy may be an alternative treatment option for adjuvant management of the axilla in selected sub-groups of patients. PMID:27212421

  13. Successful treatment in a child with anaplastic large cell lymphoma and coexistence of pulmonary tuberculosis.

    Science.gov (United States)

    Baka, Margarita; Doganis, Dimitrios; Pourtsidis, Apostolos; Tsolia, Maria; Bouhoutsou, Despina; Varvoutsi, Maria; Strantzia, Katerina; Kosmidis, Helen

    2013-01-01

    A 13-year-old girl was admitted to our department with a history of severe pain of her left axilla and fever. On physical examination, a block of lymph nodes in her left axilla, diffuse papular rash, and red-violet swelling of her supraclavicular and subclavian region were noted. Imaging investigations revealed left axillar and supraclavicular lymphadenopathy and a small nodular shade in the upper lobe of her left lung. A biopsy from an axillary lymph node established the diagnosis of anaplastic large cell lymphoma (ALCL), whereas DNA of Mycobacterium tuberculosis was detected by polymerase chain reaction (PCR) in the same tissue biopsy. Patient was started on chemotherapy for ALCL and achieved remission of all initially involved fields. Nevertheless, two new nodular lesions were detected in the left lower lobe. Biopsy revealed granulomas, and PCR was positive for M. tuberculosis. Our patient received treatment with the combination of isoniazid and rifampin (12 months), pyrazinamide (the first 2 months), and maintenance chemotherapy for her ALCL for one year simultaneously. Four years later, she is disease free for both mycobacterial infection and lymphoma. We are reporting this successful management of mycobacterial infection in a patient with ALCL despite intensive chemotherapy that the patient received at the same time. PMID:23841007

  14. An overlap of angiolymphoid hyperplasia with eosinophilia and Kimura′s disease: Successful treatment of skin lesions with cryotherapy

    Directory of Open Access Journals (Sweden)

    Praveen Kumar S Reddy

    2015-01-01

    Full Text Available Kimura′s disease is characterized by a triad of painless subcutaneous masses, eosinophilia in the peripheral blood and in tissues with marked increase in Serum Ig E. Angiolymphoid hyperplasia with eosinophilia (ALHE manifests with the presence of dermal papules and nodules. Unique clinical, histopathological, and biochemical findings are noted in these individual entities. A 32-year-female presented with multiple nodules in the axillae for 2 years. Peripheral smear showed eosinophilia with AEC of 6080. Histopathological examination showed features of overlap. Antinuclear antibody immunoflorescence was was negative. CD31, CD34, and FVIII were positive in vascular component. A CT chest revealed left axillary lymphadenopathy. The patient was treated with Cryotherapy and there was complete regression of skin lesions, with no recurrence after 1 year of follow-up. ALHE and KD are common in the head and neck region, but no reports of an overlap, presenting with lesions in the axillae are available to date, to the best of our knowledge. Response of skin lesions to cryotherapy is highlighted.

  15. Successful Treatment in a Child with Anaplastic Large Cell Lymphoma and Coexistence of Pulmonary Tuberculosis

    Directory of Open Access Journals (Sweden)

    Margarita Baka

    2013-01-01

    Full Text Available A 13-year-old girl was admitted to our department with a history of severe pain of her left axilla and fever. On physical examination, a block of lymph nodes in her left axilla, diffuse papular rash, and red-violet swelling of her supraclavicular and subclavian region were noted. Imaging investigations revealed left axillar and supraclavicular lymphadenopathy and a small nodular shade in the upper lobe of her left lung. A biopsy from an axillary lymph node established the diagnosis of anaplastic large cell lymphoma (ALCL, whereas DNA of Mycobacterium tuberculosis was detected by polymerase chain reaction (PCR in the same tissue biopsy. Patient was started on chemotherapy for ALCL and achieved remission of all initially involved fields. Nevertheless, two new nodular lesions were detected in the left lower lobe. Biopsy revealed granulomas, and PCR was positive for M. tuberculosis. Our patient received treatment with the combination of isoniazid and rifampin (12 months, pyrazinamide (the first 2 months, and maintenance chemotherapy for her ALCL for one year simultaneously. Four years later, she is disease free for both mycobacterial infection and lymphoma. We are reporting this successful management of mycobacterial infection in a patient with ALCL despite intensive chemotherapy that the patient received at the same time.

  16. Eschar in scrub typhus: A valuable clue to the diagnosis

    Directory of Open Access Journals (Sweden)

    A P Kundavaram

    2013-01-01

    Full Text Available Background: Scrub typhus is an acute febrile illness widely prevalent in the ′tsutsugamushi triangle′ region of the world. Clinical features include fever, myalgia, headache, rash, and a pathognomonic eschar. An eschar is formed by the bite of chigger mite that inoculates the causative agent of Scrub typhus Orientia tsutsugamushi. The aim of this study is to determine the most common sites of eschars over the bodies of patients with Scrub typhus. Materials and Methods: In a retrospective analysis, we examined a total of 418 patients who presented to Christian Medical College, Vellore between 2009 and 2012 with an acute febrile illness and an eschar on clinical examination and confirmed to have scrub typhus with a positive Scrub typhus IgM ELISA test. We studied the distribution of eschars over the bodies of 418 patients with Scrub typhus. Results: There was a significant difference in the distribution of eschars between males and females with a preponderance of the chest and abdomen (42.3% among females and the axilla, groin and genitalia (55.8% in males. Some unusual sites of an eschar were the cheek, ear lobe and dorsum of the feet. Conclusion: The eschar is the most useful diagnostic clue in patients with acute febrile illness in areas endemic for Scrub typhus and therefore should be thoroughly examined for its presence especially over the covered areas such as the groin, genitalia, infra-mammary area and axilla.

  17. Filariasis of breast: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Prosanta Kumar Bhattacharjee

    2012-01-01

    Full Text Available Lymphatic filariasis involving the female breast is unusual but not rare, especially where filariasis is endemic. In this report, we present a 38-year-old married woman presenting with a painless mass in the left breast of 4 months duration and slightly painful masses in both axillae for similar duration. Examination revealed a small, discrete, firm, non-tender mass in lower inner quadrant of left breast with associated bilateral, tender axillary lymphadenopathy. Mammography suggested a well-defined mass lesion in the left breast without any architectural distortion or micro calcifications. Ultrasonography (USG of the breast suggested hypoechoic lesion in infero-medial quadrant of left breast and bilateral axillary lymphadenopathy. USG-guided fine needle aspiration cytology (FNAC from the breast lump showed non-specific findings like eosinophilic infiltrate and occasional granuloma, while that from the enlarged lymph nodes in the axilla revealed inflammatory cells, giant cells, and epithelioid cells. Histopathological examination of the lumpectomy specimen revealed adult microfilaria with characteristic morphology of Wuchereria bancrofti.

  18. Optimization of multiple muco-cutaneous site sampling method for screening MRSA colonization in ICU

    Directory of Open Access Journals (Sweden)

    Priya Datta

    2013-01-01

    Full Text Available Aims: Active screening for methicillin resistant Staphylococcus aureus (MRSA carriers remains a vital component of infection control policy in any health-care setting. The relative advantage of multiple anatomical site screening for detecting MRSA carriers is well recognized. However, this leads to increase in financial and logistical load in a developing world scenario. The objective of our study was to determine the sensitivity of MRSA screening of nose, throat, axilla, groin, perineum and the site of catheterization (central line catheter individually among intensive care unit patients and to compare it with the sensitivity of multiple site screening. Materials and Methods: Active surveillance of 400 patients was done to detect MRSA colonization; 6 sites-nose, throat, axilla, perineum, groin and site of catheter were swabbed. Result and Discussion: The throat swab alone was able to detect maximum number of MRSA (76/90 carriers, with sensitivity of 84.4%. Next in order of sensitivity was nasal swab, which tested 77.7% of MRSA colonized patients. When multiple sites are screened, the sensitivity for MRSA detection increased to 95%. Conclusions: We found that though throat represent the most common site of MRSA colonization, nose or groin must also be sampled simultaneously to attain a higher sensitivity.

  19. Body Site Is a More Determinant Factor than Human Population Diversity in the Healthy Skin Microbiome.

    Directory of Open Access Journals (Sweden)

    Guillermo I Perez Perez

    Full Text Available We studied skin microbiota present in three skin sites (forearm, axilla, scalp in men from six ethnic groups living in New York City.Samples were obtained at baseline and after four days following use of neutral soap and stopping regular hygiene products, including shampoos and deodorants. DNA was extracted using the MoBio Power Lyzer kit and 16S rRNA gene sequences determined on the IIlumina MiSeq platform, using QIIME for analysis.Our analysis confirmed skin swabbing as a useful method for sampling different areas of the skin because DNA concentrations and number of sequences obtained across subject libraries were similar. We confirmed that skin location was the main factor determining the composition of bacterial communities. Alpha diversity, expressed as number of species observed, was greater in arm than on scalp or axilla in all studied groups. We observed an unexpected increase in α-diversity on arm, with similar tendency on scalp, in the South Asian group after subjects stopped using their regular shampoos and deodorants. Significant differences at phylum and genus levels were observed between subjects of the different ethnic origins at all skin sites.We conclude that ethnicity and particular soap and shampoo practices are secondary factors compared to the ecological zone of the human body in determining cutaneous microbiota composition.

  20. Normalization of lymphocyte count after high ablative dose of I-131 in a patient with chronic lymphoid leukemia and secondary papillary carcinoma of the thyroid: case report; Normalizacao da contagem de linfocitos apos dose ablativa de I-131 em um paciente com leucemia linfoide cronica e carcinoma papilifero da tireoide: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Thom, Anneliese Rosmarie Gertrud Fischer; Hamerschlak, Nelson; Osawa, Akemi; Santos, Fabio Pires de Souza; Pasqualin, Denise da Cunha; Wagner, Jairo; Yamaga, Lilian Yuri Itaya; Cunha, Marcelo Livorsi da; Campos Neto, Guilherme de Carvalho; Funari, Marcelo Buarque de Gusmao, E-mail: afthom@einstein.br [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil); Teles, Veronica Goes [Sociedade Brasileira de Diabetes, Sao Paulo, SP (Brazil)

    2014-07-01

    The authors report the case of a 70-year-old male patient with chronic lymphoid leukemia who presented subsequently a papillary carcinoma of the thyroid with metastases to regional lymph nodes. The patient was treated with surgical thyroidectomy with regional and cervical lymph node excision and radioiodine therapy (I-131). The protocolar control scintigraphy 4 days after the radioactive dose showed I-131 uptake in both axillae and even in the inguinal regions. PET/CT showed faint FDG-F-18 uptake in one lymph node of the left axilla. An ultrasound guided fine needle biopsy of this lymph node identified by I-131 SPECT/CT and FDG-F-18 PET/CT revealed lymphoma cells and was negative for thyroid tissue and thyroglobulin content. The sequential blood counts done routinely after radiation treatment showed a marked fall until return to normal values of leucocytes and lymphocytes (absolute and relative), which were still normal in the last control 19 months after the radioiodine administration. Chest computed tomography showed a decrease in size of axillary and paraaortic lymph nodes. By immunohistochemistry, cells of the lymphoid B lineage decreased from 52% before radioiodine therapy to 5% after the procedure. The authors speculate about a possible sodium iodide symporter expression by the cells of this lymphoma, similar to some other non-thyroid tumors, such as breast cancer cells. (author)

  1. Complications after modified radical mastectomy in early breast cancer

    International Nuclear Information System (INIS)

    Objective: To study the frequency of complications, particularly the lymphedema of the arm, after modified radical mastectomy in early breast cancer patients who have not been given post-operative radiotherapy to axilla. Design: Hospital based descriptive study. Results: Median age of these patients was 47 years with a range of 25-58 years. Majority of these patients were stage II (84%) and infiltrating ductal carcinoma was the most frequent type of cancer (88%). Fifty-six percent of these patients had high grade tumors. None of the patients received radiotherapy to axilla after modified radical mastectomy. Early complications documented from history and medical record revealed that seroma formation was the most frequent early complication seen after modified radical mastectomy (20%). Frequent late complications included anterior chest tightness (56%), shoulder dysfunction (36%), lymphedema (26%) and sensory loss (22%). Shoulder dysfunction included limited range of movement in all 18 patients. Gross multiple restrictions were seen in 11 (61.11%) of these patients. Conclusion: It is concluded from this study that lymphedema and shoulder dysfunction are the two major complications in patients of early breast cancer who have undergone modified radical mastectomy without post-operative axillary radiation. (author)

  2. Tratamento da doença de Hailey-Hailey com toxina botulínica tipo A Hailey-Hailey disease treatment with Botulinum toxin type A

    Directory of Open Access Journals (Sweden)

    Giancarlo Rezende Bessa

    2010-10-01

    Full Text Available Duas irmãs com doença de Hailey-Hailey, com lesões recorrentes - uma em axilas e outra em região inguinal -, e resposta limitada aos tratamentos clássicos. Elas foram tratadas com aplicação de toxina botulínica tipo A. Observamos que houve importante melhora na paciente tratada na região inguinal e remissão completa na paciente em cujas axilas sofreram tratamento. Além disso, foi possível poupar uso de antibióticos sistêmicos e corticoides tópicos. O alto custo é um fator restritivo para uso rotineiro e estudos maiores são necessários para definir eficácia e relação custo-benefício dessa intervenção.Two sisters with recurrent lesions, one on axillae and other on the groin, and with limited response to classical treatments were treated with injections botulinum toxin type A. We observed marked improvement in the patient treated in the groin and complete remission in the patient treated in the axillae. It was possible to spare the use of systemic antibiotics and topical corticosteroids. The high cost is a restrictive factor to routine use and large studies are necessary to access efficacy and cost benefit profile.

  3. Acanthosis Nigricans associated with clear-cell renal cell carcinoma.

    Science.gov (United States)

    Ferraz de Campos, Fernando Peixoto; Narvaez, Margarita Rosa Aveiga; Reis, Paola Vasconcellos Soares; Gomes, Augusto Cesar Marins; Paraskevopoulos, Daniela Kallíope de Sá; Santana, Frederico; Fugita, Oscar Eduardo Hidetoshi

    2016-01-01

    Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. The latter, also known as malignant AN, is mostly related to abdominal neoplasms. Malignant AN occurs frequently among elderly patients. In these cases, the onset is subtle, and spreading involves the flexural regions of the body, particularly the axillae, palms, soles, and mucosa. Gastric adenocarcinoma is the most frequent associated neoplasia, but many others have been reported. Renal cell carcinoma (RCC), although already reported, is rarely associated with malignant AN. The authors report the case of a woman who was being treated for depression but presented a long-standing and marked weight loss, followed by darkening of the neck and the axillary regions. Physical examination disclosed a tumoral mass in the left flank and symmetrical, pigmented, velvety, verrucous plaques on both axillae, which is classical for AN. The diagnostic work-up disclosed a huge renal mass, which was resected and further diagnosed as a RCC. The post-operative period was uneventful and the skin alteration was evanescent at the first follow-up consultation. The authors call attention to the association of AN with RCC. PMID:27284539

  4. Normalization of lymphocyte count after high ablative dose of I-131 in a patient with chronic lymphoid leukemia and secondary papillary carcinoma of the thyroid: case report

    International Nuclear Information System (INIS)

    The authors report the case of a 70-year-old male patient with chronic lymphoid leukemia who presented subsequently a papillary carcinoma of the thyroid with metastases to regional lymph nodes. The patient was treated with surgical thyroidectomy with regional and cervical lymph node excision and radioiodine therapy (I-131). The protocolar control scintigraphy 4 days after the radioactive dose showed I-131 uptake in both axillae and even in the inguinal regions. PET/CT showed faint FDG-F-18 uptake in one lymph node of the left axilla. An ultrasound guided fine needle biopsy of this lymph node identified by I-131 SPECT/CT and FDG-F-18 PET/CT revealed lymphoma cells and was negative for thyroid tissue and thyroglobulin content. The sequential blood counts done routinely after radiation treatment showed a marked fall until return to normal values of leucocytes and lymphocytes (absolute and relative), which were still normal in the last control 19 months after the radioiodine administration. Chest computed tomography showed a decrease in size of axillary and paraaortic lymph nodes. By immunohistochemistry, cells of the lymphoid B lineage decreased from 52% before radioiodine therapy to 5% after the procedure. The authors speculate about a possible sodium iodide symporter expression by the cells of this lymphoma, similar to some other non-thyroid tumors, such as breast cancer cells. (author)

  5. Supernumerary breast. A case Presentation Mama supernumeraria. Presentación de un caso

    Directory of Open Access Journals (Sweden)

    Juan Miguel Guerra Cabrera

    2010-07-01

    Full Text Available Congenital malformations of the breast appear in 10 % of the population. The existence of mammary tissue at any line of the breast is classified according to Kajava’s categories into eight classes which differ one from the other in the presence or absence of the areola of the breast, nipple and glandular tissue. This report presents a case of a puerpera who had delivered her child seven days before her attendance to hospital. She presented with discharge from her both axillae. On physical examination, a supernumerary nipple with milky secretion out from it was found in her right axilla and secretion throughout the contralateral axilla through the skin pores, with absence of nipple and areola in that axillary region. The echographic study revealed the presence of bilateral ectopic mammary tissue. This case belongs to Kajava’s class IV classification in the left axilla and a variery of Type I in the right axilla. In facing a mammary malformation, a conservative attitude seems to be the most appropriate although esthetics requires surgery. To keep into account the presence of supernumerary breasts will be a need for the prevention of breast cancer. This case has been presented due to all these reasons and the unusual features of this case.Las malformaciones congénitas de la mama aparecen hasta en un 10 % de la población. La existencia de tejido mamario en algún punto de las líneas mamarias se clasifica, según Kajava, en 8 clases, que se diferencian por la presencia o no de areola mamaria, pezón y tejido glandular. Se presenta el caso de una paciente con secreción por ambas axilas en su séptimo día de puerperio. En la exploración se detectó un pezón supernumerario en axila derecha con secreción láctea a través de este y secreción a través de la axila contra lateral por los poros de la piel, con ausencia de pezón y de areola. El estudio ecográfico demostró la presencia de tejido mamario ectópico bilateral. Este caso pertenece

  6. High-resolution scintigraphy and 99mTc Bombesin are able to guide Mammotome biopsy and to detect lymph node invasion

    International Nuclear Information System (INIS)

    High-resolution (HR) γ-ray detector 99mTc Bombesin (99mTcBN) and 99mTc sestamibi (99mTcSM), have been used to drive Mammotome biopsy after fusion of scintigraphic with digital X-ray images. We studied eight patients with class V microcalcifications. An HR detector with spatial resolution of 3 mm was matched with Mammotome biopsy system provided with Fisher digital X-ray device: images were fused to use the pointer indifferently on X-ray, scintigraphic and fused images. Fusion between X-ray and HR image has previously been reported. The 12 Mammotome samples/patient were weighted and counted in a well counter. Tumour/bkg (T/B) ratio was measured on HR images as well as on biopsy samples. Axilla was also explored with the portable HR device in order to diagnose node invasion. Conventional histology assessment and immunohystochemical study with anti BN receptor antibody was blindly performed on samples. All the patients studied with 99mTcSM showed T1b cancer, 99mTcBN detected one T1a and two T1b cancers. HR scan of axilla detected node metastases in two patients, both studied with 99mTcBN. All the biopsies showed cancer on at least one of the 12 samples. Histology found node metastases in three patients: the two 99mTcBN positive and one studied with 99mTcSM whose axilla was negative at HR scan. Samples showed T/B ratio of 6.6±0.4 for 99mTcSM and 11.3±0.9 for 99mTcBN (p99mTcBN series. Not only 99mTcBN HR is able to show breast cancer and to guide biopsy, but also detects node metastases. Our is the first ex vivo measurement of T/B ratio of 99mTcBN on humans

  7. An enquiry into VR interface design for medical training: VR augmented anatomy tutorials for breast cancer

    Science.gov (United States)

    Charissis, V.; Ward, B. M.; Naef, M.; Rowley, D.; Brady, L.; Anderson, P.

    2008-02-01

    This paper presents an initial study exploring and evaluating a novel, accessible and user-centred interface developed for a VR Medical training environment. In particular, the proposed system facilitates a detailed 3D information exchange, with the aim of improving the user's internal 3D understanding and visualisation of complex anatomical inter-relationships. In order to evaluate the effectiveness of the proposed VR teaching method we developed a female 3D model under the guidance of Consultant Breast surgeons with particular emphasis given on the axilla section. In turn we commenced a comparative study between PBL tutorials augmented with VR and the contemporary teaching techniques involving twelve participants. Overall the paper outlines the development process of the proposed VR Medical Training environment, discusses the results from the comparative study, and offers suggestions for further research and a tentative plan for future work.

  8. Should a Sentinel Node Biopsy Be Performed in Patients with High-Risk Breast Cancer?

    International Nuclear Information System (INIS)

    A negative sentinel lymph node (SLN) biopsy spares many breast cancer patients the complications associated with lymph node irradiation or additional surgery. However, patients at high risk for nodal involvement based on clinical characteristics may remain at unacceptably high risk of axillary disease even after a negative SLN biopsy result. A Bayesian nomogram was designed to combine the probability of axillary disease prior to nodal biopsy with customized test characteristics for an SLN biopsy and provides the probability of axillary disease despite a negative SLN biopsy. Users may individualize the sensitivity of an SLN biopsy based on factors known to modify the sensitivity of the procedure. This tool may be useful in identifying patients who should have expanded up front exploration of the axilla or comprehensive axillary irradiation

  9. An unusual presentation of giant extrathoracic tumor in a child--managed successfully.

    Science.gov (United States)

    Singal, Rikki; Jora, Manjit Singh; Mittal, Amit; Gupta, Samita; Singh, Bir; Kohli, Sudha Khurana; Verma, Milan

    2012-01-01

    Lipoma is one of the most common mesenchymal tumors, usually seen over the trunk and proximal portions of the extremities. However, giant lipomas are very rarely seen over the chest wall and axilla in children. In rural areas, patients usually do not bother to be treated, which leads to complications, as seen in our case. Here, we report a rare case of a three-year-old child who presented with a large swelling on the right side of the anterior chest wall and in the axillary region. On histopathology, the diagnosis was lipoma. At the six-month follow-up, the child was normal without any complications. The clinical features, radiological and pathological findings and management of the lesion are discussed. If such a large tumor is not treated in a timely manner, it can cause respiratory discomfort or lead to malignancy. PMID:22734310

  10. Lymphoscintigraphy with 99mTc-dextran-comparison of different molecular weight and preliminary clinical studies

    International Nuclear Information System (INIS)

    Four 99mTc-labelled dextrans with average molecular weights of 40000, 70000, 90000, and 138000 have been evaluated. The study of biodistribution and tracer kinetics in rats demonstrated that, 99mTc-Dx(90) was much better than the others with high uptake of lymph nodes, low penetrating rate from injection site to blood, and excellent target/nontarget organ ratios. The preliminary clinical studies (in 20 normal and 10 patients) were also reported. Following interdigital injection of 0.5-1.0 ml Tc-99m-Dx(90) (about 57 MBq), it reached the knee, inguinal or axilla nodes in 5.0 ± 1.2, 10 ± 2.0, and 15 ± 3.0 min respectively. High quality imagings were obtained in all cases. It is concluded that 99mTc-Dx(90) is a very promising lymph system imaging agent

  11. Rediscovery of Microgecko helenae fasciatus (Schmidtler and Schmidtler, 1972) from Kermanshah Province, Western Iran with Notes on Taxonomy, Morphology, and Habitat

    Institute of Scientific and Technical Information of China (English)

    Ali GHOLAMIFARD; Nasrullah RASTEGAR-POUYANI; Eskandar RASTEGAR-POUYANI

    2015-01-01

    During extensive field work in the Zagros Mountains, western Iran, from October 2013 to November 2014, twenty five localities in different areas of the Kermanshah Province were investigated. Nineteen specimens of Schmidtler’s dwarf gecko, Microgecko helenae fasciatus, were collected from six localities in western and southeastern regions of the Kermanshah Province. This new collection verifies the presence of M. h. fasciatus in the area after the description of Schmidtler and Schmidtler of the holotype specimen in 1972. All of the collected specimens are consistent with the described specimens in diagnostic characters, as have a uniform dorsal pattern with five distinct dark crossbars and white posterior margins as well as the higher number of dorsal scales between axilla and groin. Detailed morphology of the new specimens is discussed and compared with those of rare previous records. Taxonomy, distribution, and habitat types of this tiny gecko in the western foothills of the Zagros Mountains are also discussed.

  12. Bilateral peri-renal lymphangioma - a case report and review of literature

    International Nuclear Information System (INIS)

    Lymphangioma are rare benign lesions and it is difficult to state whether they are true neoplasm, hamartomas or lymphangiectasias. They are most commonly seen in children and occur in regions of the neck and axilla. They increase in size both by proliferation and by the collection of fluid, thus forming cysts. The authors report a case of a 70-year-old man, who presented abdominal swelling, a palpable mass in both flanks and polycythemia. Abdominal sonography, kidney arteriograpy, CT scan and MRI have shown multiple cysts bilaterally surrounding the kidneys without either parenchymal or functional involvement. During surgery several intercommunicating cysts were found surrounding both kidneys. Biopsies were taken from the perirenal fat, the wall of the cysts and the kidney. The histologic diagnosis was cystic lymphangioma. (author)

  13. Bilateral peri-renal lymphangioma - a case report and review of literature; Linfangioma perirrenal bilateral - relato de um caso e revisao bibliografica

    Energy Technology Data Exchange (ETDEWEB)

    Teixeira, Sonia Marcelino; Borges, Aurea Valeria Rosa Mohana; Dinoa, Vanessa de Albuquerque [Hospital Universitario Antonio Pedro, Niteroi, RJ (Brazil). Dept. de Radiologia; Marchiori, Edson; Mello, Walter Assis de; Teixeira, Graca Helena Maia do Canto [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Inst. Biomedico. Dept. de Radiologia

    1996-11-01

    Lymphangioma are rare benign lesions and it is difficult to state whether they are true neoplasm, hamartomas or lymphangiectasias. They are most commonly seen in children and occur in regions of the neck and axilla. They increase in size both by proliferation and by the collection of fluid, thus forming cysts. The authors report a case of a 70-year-old man, who presented abdominal swelling, a palpable mass in both flanks and polycythemia. Abdominal sonography, kidney arteriograpy, CT scan and MRI have shown multiple cysts bilaterally surrounding the kidneys without either parenchymal or functional involvement. During surgery several intercommunicating cysts were found surrounding both kidneys. Biopsies were taken from the perirenal fat, the wall of the cysts and the kidney. The histologic diagnosis was cystic lymphangioma. (author) 11 refs., 4 figs.

  14. Variation of the latissimus dorsi

    Directory of Open Access Journals (Sweden)

    Ishani P Shah

    2014-01-01

    Full Text Available A typical muscle variation of latissimus dorsi - the axillary arch is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi passing over the axilla under the axillary fascia crossing the medial side of the brachial plexus to continue as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. The full extent of the muscle is rarely present. Slips of muscle extend from the latissimus dorsi at the inferior angle of scapula to insert into pectoralis major (Langer, coracobrachilis, biceps or coracoid process forming what is described as a common variant - the muscular axillary arch. We report three cases of variants of latissimus dorsi, one of which has not been reported in the literature before.

  15. Congenital fibrous hamartoma of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Arioni, Cesare; Bellini, Carlo; Risso, Francesco Maria; Scopesi, Fabio; Serra, Giovanni [University of Genoa, Neonatal Pathology Service, Department of Paediatrics, Institute G. Gaslini, Genoa (Italy); Oddone, Mauro; Toma, Paolo [Institute G. Gaslini, Radiology Service, Genoa (Italy); Nozza, Paolo [Institute G. Gaslini, U. O. di Anatomia Patologica, Genoa (Italy)

    2006-05-15

    A full-term male infant presented at birth with a hard swelling of the left knee. The lemon-sized lesion was fixed to the underlying knee muscles, while the overlying skin was stretched and shiny; there was no bruit. Radiography, sonography and MRI suggested a soft-tissue tumour. After surgical excision, histology showed the presence of fibrous and mesenchymal tissue, with mature adipose tissue. Fibrous hamartoma of infancy was diagnosed. Among soft-tissue tumours, fibrous hamartoma of infancy is a rare and benign lesion, occurring in the first 2 years of life. The tumour mainly affects the trunk, axilla, and upper extremities. This infant had unique involvement of the knee. The treatment of choice is local excision. (orig.)

  16. Congenital fibrous hamartoma of the knee

    International Nuclear Information System (INIS)

    A full-term male infant presented at birth with a hard swelling of the left knee. The lemon-sized lesion was fixed to the underlying knee muscles, while the overlying skin was stretched and shiny; there was no bruit. Radiography, sonography and MRI suggested a soft-tissue tumour. After surgical excision, histology showed the presence of fibrous and mesenchymal tissue, with mature adipose tissue. Fibrous hamartoma of infancy was diagnosed. Among soft-tissue tumours, fibrous hamartoma of infancy is a rare and benign lesion, occurring in the first 2 years of life. The tumour mainly affects the trunk, axilla, and upper extremities. This infant had unique involvement of the knee. The treatment of choice is local excision. (orig.)

  17. Whole body electron therapy using the Philips SL75/10 linear accelerator

    International Nuclear Information System (INIS)

    Whole-body electron irradiation for mycosis fungoides is described, using a short distance multiple field technique for an electron beam of normal energy 4 Mev from a Philips SL75/10 linear accelerator, which minimised x-ray contamination. No special equipment or modifications were required. The energy of the electron beam was adjusted so that the 80% depth dose occurred at a depth of 13 mm. Treatment was given in four fractions per week. One quarter of the body surface was irradiated to 400 rads at each session. The dose rate at the patient was 100 rad/min. and the time for each treatment session was about 30 minutes. The groin, axillae and soles of the feet were treated by small electron fields to compensate for under dosage during the whole body irradiation. The eyes, fingernails and tonsils were protected by lead shields during treatment. (U.K.)

  18. Development of a new method of whole body irradiation

    International Nuclear Information System (INIS)

    A new method of whole body irradiation was developed using a linear accelerator linked to microprocessor. By this modified arc technique, a total body photon irradiation and a total skin electron irradiation were practical for narrow room. Approximative calculations were deviced for dose distribution. Dosimetric results were consistent with those previosly calculated. Local doses in lungs, neck and other areas were easily adjustable with arrangements of pre-set dose rate. In total skin electron irradation, six predeterminated postures and 'make up' irradiation were necessary to dose homogeneity over 'shady area' such as axillae. Clinically, a large arteriovenous malformation in an arm decreased with normalization of plethysmogram after treatment, and remarkable reductions of mycosis fungoides tumor were observed. This new method of total skin electron irradiation and total body photon therapy will clinically expand with the progress of bone marrow transplantation. (author)

  19. A Life-Threatening Multilocalized Hidradenitis Suppurativa Case

    Science.gov (United States)

    Buyukasik, Oktay; Osmanoglu, C. Gokhan; Polat, Yilmaz; Kargici, Hulagu; Kaya, Gulay

    2005-01-01

    Abstract and Introduction Abstract The patient was a 38-year-old man. He had been suffering from hidradenitis suppurativa (HS) for approximately 20 years. He had active lesions at both axillas, hip, scrotum, and perineum, and inactive lesions located behind the ears, lower abdomen, and posterior neck. He was monitored and treated at different branches; he continuously used antibiotics and was given steroids at times. Antibiotic resistance developed subsequently. His general situation was bad; vital signs were poor; and he was in a state of sepsis and preshock, so this case was regarded as life-threatening. Total excision was performed first on the lesion at the right axilla, then on the lesion at the left axilla, and the parascapular fasciocutaneous flap was reversed. A skin graft was applied to the triangular defect on the scapula. No relapse occurred. Then the lesions at the hip were managed. Broad excision was used twice with the patient under general anesthesia; because the lesions spread to the retrococcygeal and gluteal muscles, coccyx resection and partial gluteal muscle resection were implemented. The defect was eliminated with a progressive flap. At the intergluteal sulcus, small lesions emerging at the median line were debrided with the patient under local anesthesia, and together with secondary recovery, the disease was completely managed. Lesions at the perineum and scrotum and at both inguinal areas were broadly excised and grafted. No lesion has relapsed so far. One year later, Hodgkin's lymphoma was diagnosed, and the patient was treated with chemoradiotherapy easily, because there was no infective focus. The disease is in remission now. The patient weighs 110 kg, is healthy, and is working again. Introduction HS is a disease that is characterized by intensive development of sclerosis due to abscess, sinus and fistula formation, and fibrosis as a result of a chronic infection of the apocrine sweat glands. The disease can be seen at the scrotum

  20. The role of radiotherapy in the treatment of non-Hodgkin's lymphoma of the thyroid

    International Nuclear Information System (INIS)

    Retrospective analysis was made of 30 cases of non-Hodgkin's lymphoma treated from 1967 through 1983 at the Department of Radiology, Osaka University Hospital, according to the Ann Arbor staging classification modified by us. Overall five-year survival and five-year relapse-free survival were 62 % and 60 %, respectively, with one out of 9 cases treated since 1979 being lost due to relapse. In cases with disease localized in the thyroid and neck nodes (Stage IIE-a, by modified classification), five-year survival of 74 % was obtained, whereas in those with the lesion extending to the mediastinum (IIE-b) or axillae (IIE-c), the survival pattern was similar to that with Stage III and IV. Complete local control was obtained in all cases by radiotherapy. (author)

  1. Fine-needle aspiration cytology of subcutaneous cysticercosis: A series of five cases

    Directory of Open Access Journals (Sweden)

    Kusum D Jashnani

    2016-01-01

    Full Text Available Taenia solium, a potentially dangerous parasite, causes human cysticercosis that can cause a gamut of manifestations affecting the various systems of the body. Sometimes, parasitic infestations present as only superficial palpable subcutaneous or intramuscular nodules that are usually mistaken for lymph nodes or benign tumors like lipoma, neurofibroma, or epidermal inclusion cysts. Fine-needle aspiration cytology (FNAC has emerged as a useful tool in the diagnosis of these superficial parasitic lesions. It also helps in avoiding unnecessary open biopsy to obtain a diagnosis. We, herein, report a series of five cases of subcutaneous cysticercosis at different sites (axilla, chest wall, abdominal wall, lateral neck, and cheek misdiagnosed as lipomas and lymph nodes and finally diagnosed on FNAC.

  2. Hidradenitis Suppurativa

    Directory of Open Access Journals (Sweden)

    Müzeyyen Gönül

    2009-03-01

    Full Text Available Hidradenitis suppurativa is a chronic inflammatory disorder of apocrine glands characterized by recurrent abscess, sinuses and scars. The disorder affects life quality significantly and usually involves axillae, groins, perineal and perianal regions. The etiology of the disease has been explained exactly. However follicular occlusion is thought to be the main cause. The treatment of the disorder is very difficult. The medical treatment is preferred for mild and modarate disease, whereas surgical treatment is suggested for severe disease. Among the medical treatment, there are systemic and topical antibiotics, intralesional steroid injection, systemic retinoids and hormonal therapy. The options of surgical treatment of disease change from drainage to radical excision, and the therapy should be choosen according to the severity of the disease. Whatever the therapeutic options are, recurrence is the most important causes of the morbidity of hidradenitis suppurativa.

  3. Dowling-Degos Disease: A Case Report

    Directory of Open Access Journals (Sweden)

    Selma Emre

    2012-06-01

    Full Text Available Dowling-Degos Disease (DDD, is a rare, autosomal dominantly inherited pigmentation disorder. It is characterized by slowly progressive mottled or reticulated pigmented macules on the axillae, groins, perineum, inframammary regions and other flexural areas. The disease appears after puberty, most frequently during the fourth decade of life. Herein, we report a 42-year old female patient who presented with dark brown hyperpigmented macules on her groins, perineum and inframammary areas at our outpatient clinic. The histopathological examination showed elongation of rete ridges from epidermis to dermis with a filiform or antler-like pattern. Increased melanin pigmentation on the peak of the rete ridges and melanophages in the papillary dermis were seen. Depending on these clinical and histopathological findings, DDD was diagnosed. DDD should be considered in the differential diagnosis of disorders with flexural pigmentation.

  4. Dowling-Degos Disease: A Case Report

    Directory of Open Access Journals (Sweden)

    Selma Emre

    2012-06-01

    Full Text Available Dowling-Degos Disease (DDD, is a rare, autosomal dominantly inherited pigmentation disorder. It is characterized by slowly progressive mottled or reticulated pigmented macules on the axillae, groins, perineum, inframammary regions and other flexural areas. The disease appears after puberty, most frequently during the fourth decade of life. Herein, we report a 42-year old female patient who presented with dark brown hyperpigmented macules on her groins, perineum and inframammary areas at our outpatient clinic. The histopathological examination showed elongation of rete ridges from epidermis to dermis with a filiform or antler-like pattern. Increased melanin pigmentation on the peak of the rete ridges and melanophages in the papillary dermis were seen. Depending on these clinical and histopathological findings, DDD was diagnosed. DDD should be considered in the differential diagnosis of disorders with flexural pigmentation. (Turk J Dermatol 2012; 6: 55-7

  5. Solitary axillary lymph node metastasis without breast involvement from ovarian Cancer: Case report and brief literature review

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ji In; Kim, Soo Jin; Park, Sung Hee; Kim, Hee Sung [Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul (Korea, Republic of)

    2014-11-15

    Axillary lymph node metastasis without breast involvement from ovarian cancer is rare. We report a case of a 68-year-old woman proven as ovarian serous papillary carcinoma and metastatic papillary carcinoma of the omentum on surgical diagnostic laparoscopy. In addition, a hypermetabolic lymph node was detected in left axilla and was considered a reactive benign lesion. Mammography and ultrasonography showed no focal lesion in both breasts, but ultrasonography-guided core needle biopsy for the lymph node revealed metastatic serous papillary carcinoma from ovarian origin. Even with a low incidence of axillary lymph node metastasis without breast involvement from ovarian cancer and only marginally elevated standardized uptake value in positron emission tomography, the possibility of metastasis at axillary lymph node in patients with known primary ovarian cancer must be considered.

  6. Axillary silicone lymphadenopathy secondary to augmentation mammaplasty

    Directory of Open Access Journals (Sweden)

    Dragoumis Dimitrios

    2010-01-01

    Full Text Available We report a case involving a 45-year-old woman, who presented with an axillary mass 10 years after bilateral cosmetic augmentation mammaplasty. A lump was detected in the left axilla, and subsequent mammography and magnetic resonance imaging demonstrated intracapsular rupture of the left breast prosthesis. An excisional biopsy of the left axillary lesion and replacement of the ruptured implant was performed. Histological analysis showed that the axillary lump was lymph nodes containing large amounts of silicone. Silicone lymphadenopathy is an obscure complication of procedures involving the use of silicone. It is thought to occur following the transit of silicone droplets from breast implants to lymph nodes by macrophages and should always be considered as a differential diagnosis in patients in whom silicone prostheses are present.

  7. Ecthyma gangrenosum in the periorbital region in a previously healthy immunocompetent woman without bacteremia.

    Science.gov (United States)

    Sarkar, Somenath; Patra, Arnab Kumar; Mondal, Madhumita

    2016-01-01

    Ecthyma gangrenosum (EG) is a cutaneous lesion classically associated with potentially fatal Pseudomonas septicemia in immunocompromised patients. Other bacterial and fungal pathogens have also been implicated. Although EG typically occurs in immunocompromised or neutropenic patients, it may occasionally affect a previously healthy person. The cutaneous findings are characteristic with small indurated papulovesicles progressing rapidly to necrotic ulcers with surrounding erythema and a central black Eschar. While lesions can occur at any site, most are commonly found over the buttocks, perineum, limbs, and axillae. We describe a case of EG in periorbital region in a previously healthy woman who responded to appropriate antibiotic treatment for Pseudomonas. It is very important to establish the diagnosis early so that appropriate systemic antibiotic therapy can be initiated to reduce morbidity and potential mortality. PMID:26955586

  8. Berardinelli–Seip syndrome type 2 – An Egyptian child

    Directory of Open Access Journals (Sweden)

    Rabah M. Shawky

    2015-04-01

    Full Text Available We report a 2.5 year old male, first in order of birth of first cousin consanguineous parents with the typical features of Berardinelli–Seip congenital lipodystrophy 2 (BSCL2 since birth with moderate mental retardation. He had generalized lipodystrophy with various dermatologic and systemic manifestations. The patient looked older than his age with the loss of buccal pad of fat, hypertrichosis mainly on the back and lower limbs, thick scalp hair, mild prognathism, large hands and feet with prominent joints and muscular hypertrophy. Acanthosis nigricans was evident over the neck and both axillae inspite of the normal level of sugar and insulin. The abdomen was markedly prominent with mild hepatosplenomegaly and enlarged external genitals. Echo-cardiography demonstrated cardiac hypertrophy. Triglyceride level was high with reduced high density lipoproteins (HDL.

  9. The chiggerflea Hectopsylla pulex (Siphonaptera: Tungidae as an ectoparasite of free-tailed bats (Chiroptera: Molossidae

    Directory of Open Access Journals (Sweden)

    Júlia Lins Luz

    2009-07-01

    Full Text Available In the present study, we investigated the prevalence and intensity of Hectopsylla pulex infection in Molossus rufus and Molossus molossus, the parasite's choice of attachment site, and whether this host-parasite system varies with host size. Twenty-four bats were captured by hand from the roof of a house in Southeastern Brazil. M. rufus exhibited a prevalence of 71.4% and the mean intensity averaged 5 ectoparasites per bat. M. molossus exhibited a prevalence of 90%, and the average mean intensity was 2.11 ectoparasites. The attachment sites were: ear, tragus, shoulder blade and tibia, anus, wing, axilla, mouth and dactylopatagium. A positive correlation was observed between the bats' weight and the number of fleas.

  10. Pseudofolliculitis corporis: a new entity diagnosed by dermoscopy.

    Science.gov (United States)

    Puhan, Manas Ranjan; Sahu, Bharati

    2015-01-01

    Pseudofolliculitis mainly affects the beard area, but it can occur in any area of hair-bearing skin when traumatic methods like shaving or plucking are used to remove the hair. It can be a simple cosmetic problem or a disturbing medical condition for which the dermatologist must be prepared. It can develop in areas of shaving or depilation and has been seen in the pubic region or the axilla, where it is common to find curly hair that emerges at an acute angle. Here, we are reporting a case of pseudofolliculitis over back, termed as pseudofolliculitis corporis. He used to put a pillow behind the back while driving and the pressure caused the pseudofolliculitis. The diagnosis was confirmed by dermoscopy, which is a simple office procedure. Patient was advised to stop using the pillow and improved with topical adapalene and clindamycin gel for 15 days. This entity has not been described in the literature. PMID:25878447

  11. Coexistent axillary hydatid disease and tuberculosis: Case report of an extremely rare occurrence

    Directory of Open Access Journals (Sweden)

    Shalini Bahadur

    2014-01-01

    Full Text Available Tuberculous infection is highly prevalent in India, however, hydatid disease is relatively uncommon. Frequent sites of predilection of hydatid disease are the liver and lungs. Other unusual sites of infliction are the peritoneum, thyroid, breast, pancreas, and mediastinum. Hydatid disease in the axilla is quite uncommon. We hereby report a case of coexistent axillary hydatid disease with tuberculous lymphadenitis. To the best of our knowledge, even after extensive search of the literature we did not come across any such case. Fine needle aspiration cytology (FNAC is a cost-effective procedure performed on an outpatient basis and helped clinch a prompt diagnosis, with minimum discomfort or complications. The role of FNAC in early diagnosis cannot be overemphasized.

  12. Coexistent axillary hydatid disease and tuberculosis: Case report of an extremely rare occurrence.

    Science.gov (United States)

    Bahadur, Shalini; Pujani, Mukta; Jetley, Sujata; Hassan, Mohammad Jaseem; Khetrapal, Shaan; Husain, Musharraf

    2014-01-01

    Tuberculous infection is highly prevalent in India, however, hydatid disease is relatively uncommon. Frequent sites of predilection of hydatid disease are the liver and lungs. Other unusual sites of infliction are the peritoneum, thyroid, breast, pancreas, and mediastinum. Hydatid disease in the axilla is quite uncommon. We hereby report a case of coexistent axillary hydatid disease with tuberculous lymphadenitis. To the best of our knowledge, even after extensive search of the literature we did not come across any such case. Fine needle aspiration cytology (FNAC) is a cost-effective procedure performed on an outpatient basis and helped clinch a prompt diagnosis, with minimum discomfort or complications. The role of FNAC in early diagnosis cannot be overemphasized. PMID:25190981

  13. Implementation of a forearm support to reduce the amount of irradiated lung and heart in radiation therapy of the breast

    International Nuclear Information System (INIS)

    We compared simulator images of medial tangential fields taken in two positions: (1) with the ipsilateral arm abducted, holding a 'L-bar' armrest and (2) with both arms extended above the head in a forearm support. The average maximum heart distance as well as the central lung distance decreased significantly by 3.4 (SE 0.9) and 4.7 (SE 1.1) mm, respectively, when the new forearm support was used. The estimated normal tissue complication probability for excess cardiac mortality decreased by on average 3.1% (SE 1.3%). For some patients, a greater amount of the axilla was included in the field. We recommend the use of the forearm support during breast cancer treatment with tangential fields to decrease the amount of heart and lung inside the fields

  14. Solitary axillary lymph node metastasis without breast involvement from ovarian Cancer: Case report and brief literature review

    International Nuclear Information System (INIS)

    Axillary lymph node metastasis without breast involvement from ovarian cancer is rare. We report a case of a 68-year-old woman proven as ovarian serous papillary carcinoma and metastatic papillary carcinoma of the omentum on surgical diagnostic laparoscopy. In addition, a hypermetabolic lymph node was detected in left axilla and was considered a reactive benign lesion. Mammography and ultrasonography showed no focal lesion in both breasts, but ultrasonography-guided core needle biopsy for the lymph node revealed metastatic serous papillary carcinoma from ovarian origin. Even with a low incidence of axillary lymph node metastasis without breast involvement from ovarian cancer and only marginally elevated standardized uptake value in positron emission tomography, the possibility of metastasis at axillary lymph node in patients with known primary ovarian cancer must be considered.

  15. An update in breast cancer screening and management.

    Science.gov (United States)

    Warrier, Sanjay; Tapia, Grace; Goltsman, David; Beith, Jane

    2016-03-01

    This article provides an overview of the main controversies in a number of key areas of breast cancer management. Relevant studies that have contributed to guide the treatment of this heterogeneous disease in the field of breast screening, surgery, chemotherapy and radiotherapy are highlighted. Mammography and ultrasound are the main methods of breast screening. MRI and tomosynthesis are emerging as new screening tools for a selected group of breast cancer patients. From a surgical perspective, oncoplastic techniques and neoadjuvant chemotherapy are improving cosmetic results in breast-conserving surgery. For high-risk patients, controversies still remain regarding prophylactic mastectomies. Finally, the appropriate management of the axilla continues evolving with the increasing role of radiotherapy as an alternative treatment to axillary dissection. PMID:26689336

  16. Ecthyma gangrenosum in the periorbital region in a previously healthy immunocompetent woman without bacteremia

    Directory of Open Access Journals (Sweden)

    Somenath Sarkar

    2016-01-01

    Full Text Available Ecthyma gangrenosum (EG is a cutaneous lesion classically associated with potentially fatal Pseudomonas septicemia in immunocompromised patients. Other bacterial and fungal pathogens have also been implicated. Although EG typically occurs in immunocompromised or neutropenic patients, it may occasionally affect a previously healthy person. The cutaneous findings are characteristic with small indurated papulovesicles progressing rapidly to necrotic ulcers with surrounding erythema and a central black Eschar. While lesions can occur at any site, most are commonly found over the buttocks, perineum, limbs, and axillae. We describe a case of EG in periorbital region in a previously healthy woman who responded to appropriate antibiotic treatment for Pseudomonas. It is very important to establish the diagnosis early so that appropriate systemic antibiotic therapy can be initiated to reduce morbidity and potential mortality.

  17. Cystic Lymphangioma of Pancreas.

    Science.gov (United States)

    Bihari, Chhagan; Rastogi, Archana; Rajesh, S; Arora, Ankur; Arora, Asit; Kumar, Nikhil

    2016-03-01

    Lymphangiomas are benign hamartomatous malformations which can arise either from congenitally sequestered lymphatic channels or due to acquired obstruction caused by fibrosis of lymph channels. They are common in the pediatric age group in the soft tissue of neck and the axilla. Abdominal lymphangiomas are rare; even rarer is the primary involvement of pancreas. It occurs more frequently in females and is often located in the distal pancreas. The authors report the case of cystic lymphangioma of pancreas in a 26-year old female presenting with recurrent episodes of upper abdominal pain that was treated with laparoscopic cyst excision. Although exceptionally rare, lymphangioma of the pancreas should be considered in the differential diagnosis of pancreatic cystic lesions, especially in young women. PMID:27065694

  18. Entrance, exit, and reentrance of one shot with a shotgun

    DEFF Research Database (Denmark)

    Gulmann, C; Hougen, H P

    1999-01-01

    The case being reported is one of a homicidal shotgun fatality with an unusual wound pattern. A 34-year-old man was shot at close range with a 12-gauge shotgun armed with No. 5 birdshot ammunition. The shot entered the left axillary region, exited through the left infraclavicular region, and...... thereafter penetrated the left side of the neck, causing tearing of the left common carotid artery and the right internal carotid artery. The entrance wound in the axilla was larger than the other wounds, and before autopsy it was believed that the shotgun had been fired twice, causing one wound in the neck...... and one wound perforating the infraclavicular region and exiting through the left axillary region. Thus, this case shows that unusual wound patterns in shotgun fatalities can easily lead to incorrect assumptions with regard to number and direction of shots fired unless thorough investigation is...

  19. Olanzepine-induced neuroleptic malignant syndrome in a case of multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Deepak Hanumanthaiah

    2014-01-01

    Full Text Available Suspicion of neuroleptic malignant syndrome (NMS is a frequent cause of emergent psychiatric consultation. Despite early recognition, NMS has remained a syndrome that causes high rates of morbidity and mortality. A 25-year-old male with multiple sclerosis presented to the accident and emergency department and E with ataxia. He was started on steroids. On the third day, he became tearful and anxious. A diagnosis of multiple sclerosis-induced psychosis was made and he was started on olanzepine 2.5 mg BD. On the sixth day the patient was tachypneic and had tachycardia. Temperature recorded in the axilla was 45°C. Patient was intubated and electively ventilated. A diagnosis of NMS was made and treated accordingly. This case report highlights the importance of recognizing and treating NMS in a patient on anti-psychotics.

  20. Sentinel node biopsy as an adjunct to limb salvage surgery for epithelioid sarcoma of the hand

    Directory of Open Access Journals (Sweden)

    Hammond Alex

    2005-06-01

    Full Text Available Abstract Background Epithelioid sarcomas of the hand are rare, high-grade tumors with a propensity for regional lymphatic spread approaching 40%. Case presentation A 54-year-old male with an epithelioid sarcoma of the palm was treated with neoadjuvant radiation, wide excision, and two-stage reconstruction. Sentinel lymph node biopsy was used to stage the patient's axilla. Sentinel node biopsy results were negative. The patient has remained free of local, regional and distant disease for the follow-up time of 16 months. Conclusion The rarity of this tumor makes definitive conclusions difficult but SLN biopsy appears to be a useful adjunct in the treatment of these sarcomas.

  1. A 3D ultrasound study of sinus tract formation in hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Wortsman, Ximena; Jemec, Gregor

    2013-01-01

    characterization of the morphological changes in hidradenitis, which include the variable degrees of involvement of the hair follicles and the appearance of fluid collections and sinus tracts. Knowledge of this anatomical information may allow the identification of lesions that can benefit from medical or surgical......Imaging of hidradenitis suppurativa allows the study of both the lesion morphology and evolution. Hidradenitis lesions of different stages were studied using 3D ultrasound in a cross sectional pilot study. A total of 25 HS patients (18 female/ 7 male, aged 18-46 year-old) and 10 healthy controls (5...... female/5 male, aged 21-49 year-old) were studied. All patients were referred by dermatologists. All examinations were performed on the right axilla and compared with both controls and the skin outside the lesional areas. 3D ultrasound images demonstrated enlargement of the deepest portion of the hair...

  2. A new and possibly critically endangered species of casque-headed tree frog Aparasphenodon Miranda-Ribeiro, 1920 (Anura, Hylidae) from southeastern Brazil.

    Science.gov (United States)

    De Assis, Clodoaldo Lopes; Santana, Diego José; Da Silva, Fabiano Aguiar; Quintela, Fernando Marques; Feio, Renato Neves

    2013-01-01

    A new species of casque-headed tree frog of the genus Aparasphenodon is described from the municipality of Cataguases (21°20'S, 42°45'W; 288 m a.s.l.) in the Atlantic Rain Forest of Minas Gerais State, southeastern Brazil. Aparasphenodon pomba sp. nov. is characterized by medium size (males, snout-vent length, SVL 51.6-60.5 mm; females, SVL 58.7-62.1 mm); snout almost round in dorsal view; dorsum and limbs with cream-colored reticulation on dark-brown background; spots on ventral surface cream-colored; lips white; cream-colored dorsolateral stripe originating on the snout, crossing the upper eyelid and extending posteriorly to the axilla level; and red iris. PMID:26106793

  3. A case of accessory mammary cancer in a male patient and a literature review.

    Science.gov (United States)

    Gao, Y G; Zhang, S H; Wang, Y

    2014-01-01

    A 68-year-old Chinese male patient was referred to the present hospital because of a right axillary lump in May 2011. Physical examination showed a rigid movable mass measuring 35 mm in diameter in the right axilla. No mass was palpable in either breast. Mammograms were normal. Physical and imaging examination of the head and neck region, lung, and upper and lower gastrointestinal tract also revealed no evidence of a primary tumor. Ultrasonography and resonance imaging (MRI) revealed no evidence of tumors in the bilateral mammary glands. Fine needle histological biopsy for suspected malignancy was performed, and the patient underwent tumor resection with axillary lymph node dissection on Jun 2011. Moderately differentiated adenocarcinoma in ectopic breast tissue was diagnosed based on the pathologic result, the tumor was immunohistochemically positive for ER, PR, and HER-2. PMID:25118491

  4. Hypermetabolic axillary mass on 18F FDG PET/CT: breast cancer arising from accessory breast tissue

    International Nuclear Information System (INIS)

    Differential diagnosis among several causes of axillary malignant mass is important. The most common cause of palpable malignant axillary mass is metastatic lymphadenopathy. Although carcinoma arising from ectopic breast tissue is rare, the diagnosis should be kept in mind when evaluation malignant axillary mass. In this report we present a case with carcinoma arising from ectopic breast tissue. 18F FDG PET/CT was performed for the purpose of localizing primary breast cancer lesion and systemic evaluation. PET/CT showed hypermetabolic lesions only in the right axilla. There is no evidence of malignancy in both breasts. When nuclear physicians encounter a hypermetabolic axillary mass indicating malignant lesion without evidence of primary breast malignant lesion, carcinoma arising from ectopic breast tissue should be included in the differential diagnosis

  5. Sclerotic fibroma (storiform collagenoma)-like stroma in a fibroadenoma of axillary accessory breast tissue.

    Science.gov (United States)

    Val-Bernal, José Fernando; González-Vela, María Carmen; De Grado, Mauricio; Garijo, María Francisca

    2012-08-01

    Accessory breast tissue is a subcutaneous remnant persisting after normal embryological development of the breast. It occurs most frequently in the axilla. Fibroadenomas in axillary breast tissue are rare. We report the case of a 29-year-old female patient who presented a fibroadenoma arising in the accessory breast tissue of the right axillary fossa. The neoplasm showed foci of sclerotic fibroma-like stroma. The patient had no signs of Cowden's syndrome. To the best of our knowledge, a lesion of this kind has not been previously reported. This stromal change suggests an uncommon involutional phase of the fibroadenoma with production of sclerotic and hypocellular collagen. The lesion should be differentiated from extraneural perineuroma, from the changes in fibroadenomas in Cowden's syndrome, from sclerosing lobular hyperplasia (fibroadenomatoid mastopathy) and from pseudoangiomatous stromal hyperplasia. PMID:22804110

  6. Hypermetabolic axillary mass on {sup 18}F FDG PET/CT: breast cancer arising from accessory breast tissue

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Sun; Lee, Ah Young; Bae, Sang Gyun; Lee, Seok Mo [Inje University, Pusan Paik Hospital, Busan (Korea, Republic of)

    2010-12-15

    Differential diagnosis among several causes of axillary malignant mass is important. The most common cause of palpable malignant axillary mass is metastatic lymphadenopathy. Although carcinoma arising from ectopic breast tissue is rare, the diagnosis should be kept in mind when evaluation malignant axillary mass. In this report we present a case with carcinoma arising from ectopic breast tissue. {sup 18}F FDG PET/CT was performed for the purpose of localizing primary breast cancer lesion and systemic evaluation. PET/CT showed hypermetabolic lesions only in the right axilla. There is no evidence of malignancy in both breasts. When nuclear physicians encounter a hypermetabolic axillary mass indicating malignant lesion without evidence of primary breast malignant lesion, carcinoma arising from ectopic breast tissue should be included in the differential diagnosis

  7. Accessory breast tissue mimicking pedunculated lipoma.

    Science.gov (United States)

    Husain, Musharraf; Khan, Sabina; Bhat, Ashraf; Hajini, Firdoos

    2014-01-01

    Accessory breast tissue is an uncommon condition which occurs in 0.4-6% of women. It is mostly located in the axilla where it can cause diagnostic difficulty, especially if it is unilateral and large. Usually it is bilateral and presents as an asymptomatic mass during pregnancy or lactation. The diagnosis of ectopic breast tissue is important as it can undergo the same pathological changes that occur in a normal breast, such as mastitis, fibrocystic disease and carcinoma. We present a case of a large right-sided accessory breast in a 32-year-old woman that was clinically diagnosed as pedunculated lipoma. However, subsequent histopathological examination proved it to be an accessory breast tissue with lactational changes. PMID:25006058

  8. Synchronous bilateral male breast cancer: a case report.

    Science.gov (United States)

    Sun, Woo-Young; Lee, Ki-Hyeong; Lee, Ho-Chang; Ryu, Dong-Hee; Park, Jin-Woo; Yun, Hyo-Young; Song, Young-Jin

    2012-06-01

    Synchronous bilateral breast cancer is extremely rare in men and has not, up to date, been reported in Korea. A 54-year-old man presented with a palpable mass in the right breast. The right nipple was retracted and bilateral axillary accessory breasts and nipples were present. On physical examination, a 2 cm-sized mass was palpated directly under the right nipple, and, with squeezing, bloody discharge developed in a single duct of the left nipple. There was no palpable mass in the left breast, and axillary lymph nodes were not palpable. Physical examination of external genitalia revealed a unilateral undescended testis on the left side. Synchronous bilateral breast cancer was diagnosed using mammography, ultrasonography, and core-needle biopsy. Histopathological examination revealed invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast. Bilateral total mastectomy, sentinel lymph node biopsy, and excision of accessory breasts in the axilla were performed. PMID:22807945

  9. A Rare Finding of Coexisting Fibroadenoma and Duct Ectasia in Axillary Ectopic Breast Tissue

    Directory of Open Access Journals (Sweden)

    Sunita Singh

    2015-09-01

    Full Text Available Ectopic breast tissue (EBT can present anywhere along the milk line from axilla to groin. It can harbor all the pathological conditions as that of the normal breast though incidence is very low. Fibroadenoma is rare in accessory breast and only a few cases have been reported in the literature. Here, we report a 30-year-old female presented with a firm and freely mobile right axillary lump measuring 6 cm and times; 4 cm. Fine-needle aspiration cytology revealed it as accessory breast tissue. However, the excision biopsy of the same showed fibroadenoma along with duct ectasia in EBT. This case has been reported due to its rarity and for consideration of fibroadenoma in differential diagnoses of axillary swellings. [J Interdiscipl Histopathol 2015; 3(3.000: 110-112

  10. Identification and distribution of a novel Malassezia species yeast on normal equine skin.

    Science.gov (United States)

    Nell, A; James, S A; Bond, C J; Hunt, B; Herrtage, M E

    2002-03-30

    This study aimed to investigate the distribution of Malassezia species yeasts on the skin of healthy horses. Acetate tape samples were obtained from the lip, axilla, interbulbar region, groin and anus of 12 healthy horses. The samples were stained and examined microscopically and sites harbouring yeast-like organisms were identified. Contact plates were applied to the skin at these sites and cultured at 26 degrees C and 32 degrees C. No growth was obtained on horse blood, Sabouraud's dextrose or modified Dixon's agar. A pure growth of a Malassezia-type organism was obtained on Sabouraud's dextrose agar enriched with oleic acid when it was incubated at 30 degrees C. It was identified by 26S ribosomal DNA D1/D2 sequence analysis as a member of the genus Malassezia, and most closely related to Malassezia sympodialis. However, the level of sequence divergence indicated that it was a novel species. PMID:11999275

  11. ONTOGENY RECAPITULATES PHYLOGENY: COMMUNICATION BETWEEN THE MEDIAN AND THE MUSCULOCUTANEOUS NERVE: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Subhra Mandal

    2016-01-01

    Full Text Available Neural variations of the brachium constitute important anatomical and clinical entity.Abnormal variations of median nerve, musculocutaneous nerve and their communicating branches have been reported very frequently by the anatomists in the past. The nerves of the extremities are particularly vulnerable to injury because of their long course and superficial distribution. Present report describes a case of a single abnormal communication between median and musculocutaneous nerve encountered in a 55 year old Indian male cadaver during routine undergraduate dissection. Knowledge of such anatomical variations is important while planning surgery in the region of axilla or arm as these nerves are more liable to be injured during surgical procedures as well as may result in unusual entrapment neuropathies. Clinical significance of such type of variation in the light of its developmental origin has been discussed.

  12. Management of the Regional Lymph Nodes Following Breast-Conservation Therapy for Early-Stage Breast Cancer: An Evolving Paradigm

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Laura E.G. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Punglia, Rinaa S.; Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: jbellon@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2014-11-15

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit.

  13. Hemosiderin: a new marker for sentinel lymph node identification Hemossiderina: um novo marcador para identificação do linfonodo sentinela

    Directory of Open Access Journals (Sweden)

    Luiz Gonzaga Porto Pinheiro

    2009-12-01

    Full Text Available PURPOSE: To evaluate and present our initial results of a new marker (hemosiderin for mammary sentinel lymph node identification in an experimental model. METHODS: Skins mapped like a lymphatic duct draining to the axilla in patients submitted to breast biopsy, in our mastology service, stimulated us to try it in an animal model (female dogs. Our theory was that some blood derivate (hemosiderin was captured by macrophages and accessed the lymphatic ducts in direction to the axilla. Six female dogs of no defined race were studied. We injected 0,2 ml of technetium on both superior mammary glands. After ten minutes, a 2,5 ml solution of hemolized blood (hemosiderin from the own animal was injected in the subareolar lymphatic plexus on the left superior mammary gland and 2,5 ml of patent blue concomitantly and equally on the contralateral gland. Ten minutes after, incisions on both axilas were made to search, through the lymphatic mapping and a gamma probe, the sentinel lymph nodes. RESULTS: Seven brown sentinel lymph nodes were indentified and also radiomarked on the left axilla. Six blue sentinel lymph nodes were identified and also radiomarked on the right axilla. CONCLUSION: Preliminary studies of a potential new dye for sentinel lymph node identification are presented. It may be the change of the current use of the blue dyes and their severe side-effects on patients submitted to sentinel lymph node biopsies.OBJETIVO: Avaliar e apresentar resultados preliminares de um novo marcador (hemossiderina para a identificação de linfonodos sentinela mamários em um modelo experimental. MÉTODOS: Durante acompanhamento de dois casos de biópsias excisionais de tumores da mama, no nosso serviço de mastologia, observou-se trajeto pigmentado no quadrante inferior externo daquelas mamas, sugerindo ser marcação cutânea do ducto de drenagem linfática a partir da papila mamária em direção a axila homolateral. Levantamos a hipótese que um derivado

  14. HAILEY - HAILEY DISEASE : 2 CASE REPORTS

    Directory of Open Access Journals (Sweden)

    Nilofar

    2015-08-01

    Full Text Available Hailey - Hailey disease is an autosomal dominant acantholytic disorder relatively uncommon in India. It is characterized by painful, pruritic, foul smelling vesicles and bullous lesions with erosions in intertriginous areas such as the neck, axillae, inframammary areas and groin. The defect in ATPC2 gene leads to calcium channel dysfunction which results in defect in epidermis. Fungal infection, intertrigo, psoriasis, extramammary Paget's disease, acanthosis nigricans, pemphigus vegetans and Darier's disease are some of the dermatosis from which it needs to be differentiated. Histopathology has a key role in diagnosis of Hailey - Hailey disease with characteristic ‘dilapidated brick wall' appearance . Hailey - Hailey disease can be easily misdiagnosed by general physicians due to lack of knowledge of this uncommon disease as it resembles dermatosis involving in tertriginous areas. Due to its relapsing and remitting course there is a need to have effective treatment options. Two cases of Hailey - Hailey disease are presented here.

  15. Clinical Effects of Topical Tacrolimus on Fox-Fordyce Disease

    Directory of Open Access Journals (Sweden)

    Hilal Kaya Erdoğan

    2015-01-01

    Full Text Available Fox-Fordyce Disease (FFD is a rare, chronic, pruritic, inflammatory disorder of apocrine glands. It is characterized by dome-shaped, firm, discrete, skin-colored, and monomorphic perifollicular papules. The most common sites of involvement are axillae and anogenital and periareolar regions which are rich in apocrine sweat glands. Treatment is difficult. Topical, intralesional steroids, topical tretinoin, adapalene, clindamycin, benzoyl peroxide, oral contraceptives, isotretinoin, phototherapy, electrocauterisation, excision-liposuction and curettage, and fractional carbon dioxide laser are among the treatment options. In the literature, there are articles reporting beneficial effects of pimecrolimus in FFD. Nevertheless, there have not been any reports about the use of tacrolimus in FFD. We report two patients diagnosed with FFD by clinical and histopathologic examination and discussed therapeutic effects of topical tacrolimus on FFD in the light of literature.

  16. Should a Sentinel Node Biopsy Be Performed in Patients with High-Risk Breast Cancer?

    Directory of Open Access Journals (Sweden)

    Kenneth D. Westover

    2011-01-01

    Full Text Available A negative sentinel lymph node (SLN biopsy spares many breast cancer patients the complications associated with lymph node irradiation or additional surgery. However, patients at high risk for nodal involvement based on clinical characteristics may remain at unacceptably high risk of axillary disease even after a negative SLN biopsy result. A Bayesian nomogram was designed to combine the probability of axillary disease prior to nodal biopsy with customized test characteristics for an SLN biopsy and provides the probability of axillary disease despite a negative SLN biopsy. Users may individualize the sensitivity of an SLN biopsy based on factors known to modify the sensitivity of the procedure. This tool may be useful in identifying patients who should have expanded upfront exploration of the axilla or comprehensive axillary irradiation.

  17. Staphylococcus aureus clonal dynamics and virulence factors in children with atopic dermatitis

    DEFF Research Database (Denmark)

    Lomholt, Hans Bredsted; Andersen, KE; Kilian, Mogens

    2005-01-01

    activity. Eleven children were examined every 6 wk with swaps taken from active eczema, anterior nose, axillae and perineum, and scoring of eczema activity by severity scoring of atopic dermatitis (SCORAD). Individual S. aureus clonal types were identified and examined for production of superantigens......, toxins, and were assigned to agr groups. S. aureus colonization patterns ranged from rare colonization over transient colonization to persistent colonization by a single clone or a dynamic exchange of up to five clones. Production of no single virulence factor including superantigens and toxins...... SCORAD value. In 11 of 12 cases with two different clones co-colonizing a child the clones belonged to the same agr group. In conclusion, this limited group of children with atopic dermatitis showed highly variable colonization patterns of S. aureus, and communication between strains by use of agr...

  18. Management of the Regional Lymph Nodes Following Breast-Conservation Therapy for Early-Stage Breast Cancer: An Evolving Paradigm

    International Nuclear Information System (INIS)

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit

  19. Nasopharyngeal carcinoma metastasis to the mammary gland: A case report.

    Science.gov (United States)

    Li, Shuang; Yang, Jiyuan

    2015-01-01

    Nasopharyngeal carcinoma is the second most common type of malignancy in Southern China. Metastatic sites are usually multifocal and involve the bones, lungs and distant lymph nodes. To date, there have been no studies with regard to nasopharyngeal carcinoma metastasis to the mammary gland. In the current study, the case of a 56-year-old female with nasal obstruction, epitaxis and a bilateral neck mass is presented. Following a series of examinations, the patient was diagnosed with nasopharyngeal carcinoma (cT3N3M0). Subsequently, the patient received radical radiation therapy. After three months, a mass was identified in the left breast, together with enlargement of multiple lymph nodes in the left axilla. The patient underwent a mastectomy and pathological examination revealed that the breast mass and axillary lymph node tissues were derived from the nasopharynx. To the best of our knowledge, this is the first report of a nasopharyngeal carcinoma that metastasized to the mammary gland. PMID:25435974

  20. [Circadian rhythms and temperature homeostasis in monkeys during a flight on the Kosmos 1514 biosatellite

    Science.gov (United States)

    Klimovitskui, V. Ia; Alpatov, A. M.; Salzman, F. M.; Fuller, C. A.; Moore-Ede, M. S.

    1987-01-01

    In the course of a 5-day space flight of two rhesus-monkeys the following parameters were recorded at an interval of 16 min: core body temperature (Tc), skin temperature (Ts), and motor activity (MA). The telemetric Tc sensor was implanted subcutaneously in the right axilla, Ts thermistor was attached to the right ankle, and the MA piezotape was fixed to the inner side of the vest. Circadian rhythms of Tc varied with a period of 24 hours in one monkey and 25 hours in the other. The daily Tc decreased on the average by 0.5 degrees C, Ts fell immediately after launch and remained close to the lower limit throughout the flight. The Ts amplitude decreased 5-fold. Phases of the circadian rhythms of Ts changed and circadian rhythms of MA remained unchanged and equal to 24 hours.

  1. A Case Report: Systemic Lymph Node Tuberculosis Mimicking Lymphoma on 18F-FDG PET/CT.

    Science.gov (United States)

    Wang, Qingxuan; Chen, Endong; Cai, Yefeng; Zhang, Xiangjian; Li, Quan; Zhang, Xiaohua

    2016-03-01

    F-fluorodeoxyglucose positron emission tomography--an established modality for evaluating malignancies--exhibits increased uptake under inflammatory conditions. A 21-year-old man came to our hospital with persistent pain in his right lower quadrant of abdomen for more than 1 month, but had no diarrhea, fever, chills, weight loss, or other constitutional symptoms. Colonoscopy analysis showed no organic diseases in his colorectum. Ultrasound results revealed multiple enlarged lymph nodes in the bilateral neck, axilla, and groin. Positron emission tomography analysis was performed and showed intense ¹⁸F-fluorodeoxyglucose accumulation in the bilateral neck, supraclavicular, pulmonary hilar, mediastinum, gastric paracardial, and mesenterium lymph node. These findings were considered typical for lymphoma. To confirm the diagnosis, we obtained a diagnostic biopsy in the left supraclavicular lymph node. The diagnosis of tuberculosis was confirmed in the final pathology. This uncommon case underscores the necessity of considering lymph node tuberculosis as a possible differential diagnosis in lymphoma. PMID:26945389

  2. Staphylococcus aureus clonal dynamics and virulence factors in children with atopic dermatitis

    DEFF Research Database (Denmark)

    Lomholt, Hans; Andersen, Klaus Ejner; Kilian, Mogens

    2005-01-01

    A prospective cohort study was undertaken to determine the clonal dynamics of Staphylococcus aureus colonization and infection during 1 y in children with atopic dermatitis, and to correlate specific clones, accessory gene regulator (agr) groups, and production of virulence factors with eczema...... activity. Eleven children were examined every 6 wk with swaps taken from active eczema, anterior nose, axillae and perineum, and scoring of eczema activity by severity scoring of atopic dermatitis (SCORAD). Individual S. aureus clonal types were identified and examined for production of superantigens...... SCORAD value. In 11 of 12 cases with two different clones co-colonizing a child the clones belonged to the same agr group. In conclusion, this limited group of children with atopic dermatitis showed highly variable colonization patterns of S. aureus, and communication between strains by use of agr...

  3. A comparison of technologies used for estimation of body temperature

    International Nuclear Information System (INIS)

    Body temperature measurement is an important clinical parameter. The performance of a number of non-invasive thermometers was measured by comparing intra- and inter-operator variability (n = 100) and clinical accuracy (n = 61). Variability was elevated in febrile compared to normothermic subjects for axillary and oral electronic contact thermometer measures and a temporal artery thermometer (p < 0.001 for both). Temporal artery thermometry and one mode of an infrared tympanic thermometer demonstrated significant clinical inaccuracy (p < 0.001 for both). Electronic contact thermometer repeatability and reproducibility are highly variable in febrile adults both in the axilla and oral cavity. Infrared thermometry of the skin over the superficial temporal artery is unreliable for measuring core body temperature, particularly in febrile subjects and patients in theatre. The infrared tympanic thermometers tested are acceptable for clinical practice; however, care should be exercised with the different modes of operation offered

  4. The validation and use of a radioimmunoassay for 5 α-androst-16-en-3-one in human axillary collections

    International Nuclear Information System (INIS)

    A radioimmunoassay for the boar pheromone, 5 α-androst-16-en-3-one, in human axillae has been validated by studies on pooled axillary collections. Oleic acid, diolein and triolein were shown to interfere in the assay but these effects were eliminated by the extensive extraction and separation stages employed. Levels of 5 α-androst-16-en-3-one were 12-1134 pmol/24 h, n = 14 in men and 13-39 pmol/24 h, n = 14 in women, with the exception of one normal female subject (551 pmol). The significance of these results, in relation to the possibility of 5 α-androst-16-en-3-one being a human pheromone, is discussed. (author)

  5. Steatocystoma multiplex suppurativum: oral isotretinoin treatment combined with cryotherapy.

    Science.gov (United States)

    Apaydin, R; Bilen, N; Bayramgürler, D; Başdaş, F; Harova, G; Dökmeci, S

    2000-05-01

    A 30-year-old man presented with numerous papules, nodules and inflamed cysts. The lesions were located all over the body, including the scalp, except the palms and soles. His mother and one sister had had similar but less extensive lesions. Histopathology of the biopsy specimens obtained from the anterior chest wall, axillae and the back region was consistent with steatocystoma multiplex (SM). A diagnosis of steatocystoma multiplex suppurativum was made. The inflamed lesions were treated with oral isotretinoin (1 mg/kg per daily) for 6 months. At the same time, cryotherapy was used for non-suppurating lesions smaller than 2 cm. When the patient was evaluated 6 months later, cosmetic results were good. No new lesions have appeared in the subsequent 12-month follow up. PMID:10812703

  6. Quality control in breast conservation

    International Nuclear Information System (INIS)

    Over the past 15 years, breast conservation has become an accepted option for treatment of Stages I and II carcinoma of the breast; in this practice in 1991, more than 80% of these patients were treated in this manner. A surgical procedure to excise the primary lesion and to dissect the axilla is generally required to prepare patients for breast conservation, concurrently maximizing esthetic appearance of the breast, minimizing the risk of local recurrence and providing appropriate information for recommendations concerning adjuvant therapy. The volume of breast tissue to be removed, significance of findings at surgical margins, and extent of the axillary dissection are all somewhat controversial subjects. Based upon a personal series of almost 800 patients undergoing breast conservation, observations that reflect the findings from this experience may be shared. (author)

  7. Unusual case of congenital/infantile fibrosarcoma in a new born

    Directory of Open Access Journals (Sweden)

    Eddiba Tarik

    2013-01-01

    Full Text Available Congenital infantile fibrosarcoma (CIFS is a rare mesenchymal tumor that is primarily developed in the soft tissue of distal extremities and occasionally in unusual locations such as the lung and retroperitoneum. It occurs mainly in children below the age of 5 years. About 200 cases have been reported in the literature so far, very few of them in new-borns. The prognosis of this tumor is relatively good compared to adult forms. We report an unusual case of CIFS occurring in new-born mimicking an hemangioma and causing hemorrhage in the neonatal period. The tumor is located in the left arm and axilla and associated with a hand malformation. A shoulder amputation is performed after chemotherapy failure. The infant is now two-years old with no recurrence.

  8. Colony-Stimulating Factors for Febrile Neutropenia during Cancer Therapy

    Science.gov (United States)

    Bennett, Charles L.; Djulbegovic, Benjamin; Norris, LeAnn B.; Armitage, James O.

    2014-01-01

    A 55-year-old, previously healthy woman received a diagnosis of diffuse large-B-cell lymphoma after the evaluation of an enlarged left axillary lymph node obtained on biopsy. She had been asymptomatic except for the presence of enlarged axillary lymph nodes, which she had found while bathing. She was referred to an oncologist, who performed a staging evaluation. A complete blood count and test results for liver and renal function and serum lactate dehydrogenase were normal. Positron-emission tomography and computed tomography (PET–CT) identified enlarged lymph nodes with abnormal uptake in the left axilla, mediastinum, and retroperitoneum. Results on bone marrow biopsy were normal. The patient’s oncologist recommends treatment with six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab (CHOP-R) at 21-day intervals. Is the administration of prophylactic granulocyte colony-stimulating factor (G-CSF) with the first cycle of chemotherapy indicated? PMID:23514290

  9. Postoperative infection of an abdominal mesh due to methicillin resistant Staphylococcus Aureus - A case report

    Directory of Open Access Journals (Sweden)

    Ashok R

    2004-01-01

    Full Text Available Methicillin resistant Stephylococcus aureus (MRSA infection has now become a major problem in hospitals. We present a case of postoperative infection MRSA where the primary source of the infection was found to be an abdominal mesh that was used to reinforce the abdominal wall. After one year of surgery, the patient developed wound dehiscence and discharge. MRSA was isolated from the wound, mesh, external nares, throat and axilla. Initially she was started on clindamycin and discharged from the hospital. After 5 months, patient came back to the hospital with infection at the same site. The patient was then treated with vancomycin and MRSA clearance. She responded to the treatment with complete healing of the wound and clearance of MRSA.

  10. An approach to acanthosis nigricans

    Directory of Open Access Journals (Sweden)

    Meghana Madhukar Phiske

    2014-01-01

    Full Text Available Acanthosis nigricans (AN is characterized by dark, coarse and thickened skin with a velvety texture, being symmetrically distributed on the neck, the axillae, antecubital and popliteal fossae, and groin folds, histopathologically characterized by papillomatosis and hyperkeratosis of the skin. A high prevalence of AN has been observed recently. Different varieties of AN include benign, obesity associated, syndromic, malignant, acral, unilateral, medication-induced and mixed AN. Diagnosis is largely clinical with histopathology needed only for confirmation. Other investigations needed are fasting lipoprotein profile, fasting glucose, fasting insulin, hemoglobin and alanine aminotransferase for obesity associated AN and radiological investigations (plain radiography, ultrasonography, magnetic resonance imaging/computerized tomography for malignancy associated AN. The most common treatment modalities include retinoids and metformin.

  11. An approach to acanthosis nigricans.

    Science.gov (United States)

    Phiske, Meghana Madhukar

    2014-07-01

    Acanthosis nigricans (AN) is characterized by dark, coarse and thickened skin with a velvety texture, being symmetrically distributed on the neck, the axillae, antecubital and popliteal fossae, and groin folds, histopathologically characterized by papillomatosis and hyperkeratosis of the skin. A high prevalence of AN has been observed recently. Different varieties of AN include benign, obesity associated, syndromic, malignant, acral, unilateral, medication-induced and mixed AN. Diagnosis is largely clinical with histopathology needed only for confirmation. Other investigations needed are fasting lipoprotein profile, fasting glucose, fasting insulin, hemoglobin and alanine aminotransferase for obesity associated AN and radiological investigations (plain radiography, ultrasonography, magnetic resonance imaging/computerized tomography) for malignancy associated AN. The most common treatment modalities include retinoids and metformin. PMID:25165638

  12. The use of thallium-201 in the preoperative detection of breast cancer: an adjunct to mammography and ultrasonography

    International Nuclear Information System (INIS)

    Thallium-201 breast scans were performed preoperatively in 72 female patients with breast abnormalities detected by mammography and/or ultrasonography (7.5-13 MHz), in order to differentiate benign from malignant breast disease. Informed consent was obtained from each patient. Scintigraphy consisted of anterior and oblique planar images of the affected breast and axilla at 10 min and 3 h following the injection of 201Tl chloride (110 MBq). Pathological features of breast malignancies, were analysed for their association with 201Tl uptake by tumour cells. A total of 76 breast lesions were assessed in the study. On final histological diagnosis, there were 56 malignant tumours, 14 benign nodules (9 fibroadenomas, two cases of adenosis, two cases of focal fibrosis and one case of epitheliosis) and six atypical lesions (atypical ductal or lobular hyperplasia). Thallium scintigraphy was shown to have high accuracy (92%) in detecting breast cancer, better than mammography (74%) and ultrasonography (84%). Almost all (51/56) breast cancers showed greater 201Tl activity than surrounding normal breast tissue while there was no significant increase in 201Tl activity above background in all but one (19/20) case of non-malignant disease. 201Tl activity within breast tumours, calculated as tumour/background (T/B) ratio, ranged between 1.2 and 2.5 with a mean value of 1.45. The concentration of thallium in the breast cancer seems to be primarily dependent on vascularity and tumour size. 201Tl scan sensitivity was 97% for malignant lesions larger than 1.5 cm (n = 35) and 80% for lesions of 1.5 cm or less (n = 21); however, five of the eight breast cancers smaller than 1.0 cm were also detectable by 201Tl scintigraphy, compared with five out of seven by mammography. Thallium scintigraphy would not be useful in evaluating the axilla for lymph node metastases (sensitivity 27%, specificity 77%). (orig./MG)

  13. Local tissue water assessed by tissue dielectric constant: anatomical site and depth dependence in women prior to breast cancer treatment-related surgery.

    Science.gov (United States)

    Mayrovitz, Harvey N; Davey, Suzanne; Shapiro, Elizabeth

    2008-09-01

    Assessing local tissue water using tissue dielectric constant (TDC) values is useful to evaluate oedema/lymphoedema features and their change. Knowledge of anatomical site and tissue depth dependence of TDC values could extend this method's utility. Our goal was to compare TDC values obtained at anatomically paired sites and to investigate their depth dependence. In 22 women (12 awaiting surgery for breast cancer and 10 cancer-free control subjects), four sites (mid-forearm, mid-biceps, axilla and lateral thorax) on both body sides were measured with a 2.5-mm sampling depth probe. Also, at forearm, four different probes with sampling depths of 0.5, 1.5, 2.5 and 5 mm were used. TDC values range between 1 for zero water to 78.5 for 100% water. Site comparisons showed TDC values (mean+/-SD) to be largest at axilla (36.4+/-8.9), least at biceps (21.6+/-3.5) and not different between forearm and thorax (24.3+/-4.0 versus 24.8+/-5.0). Group comparisons showed slightly greater values in patients at forearm and biceps (P<0.05) but no group difference at other sites. Dominant-non-dominant side comparisons showed no significant difference in paired-TDC values in either group at any site. Forearm TDC values decreased with increasing depth from 36.4+/-4.8 at 0.5 mm to a minimum of 21.4+/-3.9 at 5.0 mm, with a sharp decline between 1.5 and 2.5 mm. The composite findings suggest that TDC measurements have the necessary features for usefully assessing oedema/lymphoedema and its change on limbs and at body sites not routinely amenable to assessment by other techniques. The depth dependence feature provides additional flexibility to investigate oedematous or lymphoedematous conditions. PMID:18540873

  14. Can high frequency ultrasound predict metastatic lymph nodes in patients with invasive breast cancer?

    International Nuclear Information System (INIS)

    Purpose: Use high frequency ultrasound to predict the presence of metastatic axillary lymph nodes, with a high specificity and positive predictive value, in patients with invasive breast cancer. The clinical aim is to improve the surgical management and possible survival rate of groups of patients who would not normally have conventional axillary dissections. Materials and methods: The ipsilateral and contralateral axillas of 42 consecutive patients with invasive breast cancer were scanned prior to treatment using a B-mode frequency of 13 MHz and a Doppler frequency of 7 MHz. The presence or absence of an echogenic centre for each lymph node detected was recorded, measurements were also taken to determine the L/S (long axis/short axis) ratio of the node and the widest and narrowest part of the cortex. Power Doppler was also used to determine vascularity. The contralateral axilla was used as a control for each patient. Results: In this study of patients with invasive breast cancer, where ipsilateral lymph nodes had a cortical bulge of ≥3 mm and/or at least two lymph nodes had absent echogenic centres, all had disease spread to the axillary lymph nodes (10 patients). Sensitivity and specificity were 52.6% and 100%, respectively, positive and negative predictive values were 100% and 71.9%, respectively, the P-value was 0.001 and the Kappa score was 0.55. Conclusion: This would indicate that high frequency ultrasound could be used to accurately predict metastatic lymph nodes in a proportion of patients with invasive breast cancer, which may alter patient management

  15. Evaluation of immediate breast reconstruction and radiotherapy: Factors associated with complications

    International Nuclear Information System (INIS)

    Objectives: To determine prospectively the factors associated with reconstruction failure (i.e. requiring expander removal) and capsular contracture in patients undergoing mastectomy and immediate two-stage breast reconstruction with a tissue expander and implant, and radiotherapy for breast cancer. This is a multi-institutional prospective non-randomized trial. Patients and Methods: Between 2/1998 and 9/2006, we prospectively evaluated 141 consecutive patients who received 141 implants after mastectomy and underwent chest wall radiotherapy (46 to 50 Gy in 23 to 25 fractions). Patients were evaluated after 24 to 36 months by two senior physicians (radiation oncologist and surgeon). Results: Medical follow-up was 37 months. Baker 1 and 2 capsular contracture was observed in 67.5% of patients, Baker 3 and 4 in 32.5%. There were 32 reconstruction failures. In a univariate analysis, the following factors were associated with Baker 3 and 4 capsular contracture: surgeon, use of hormonotherapy and smoking, of which only one remained in the multivariate analysis: surgeon. In a univariate analysis, the following factors were associated with reconstruction failure: tumor size T3 or T4, smoking, pN+ axilla. Three factors remained associated with reconstruction failure in a multiple logistic regression: large tumors T3/T4, smoking and pN+ axilla. Conclusions: Mastectomy, radiotherapy and immediate breast reconstruction with a tissue expander and implant should be considered when breast conserving surgery has been denied. Adequate patients can be easily selected by using three factors of favourable outcome. (authors)

  16. Ultrasound elastography as an adjuvant to conventional ultrasound in the preoperative assessment of axillary lymph nodes in suspected breast cancer: A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, K., E-mail: kathryn.taylor@addenbrookes.nhs.uk [Department of Radiology, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge (United Kingdom); O' Keeffe, S.; Britton, P.D.; Wallis, M.G. [Department of Radiology, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge (United Kingdom); Treece, G.M.; Housden, J. [Department of Engineering, University of Cambridge, Cambridge (United Kingdom); Parashar, D.; Bond, S. [Cambridge Cancer Trials Centre, Department of Oncology, University of Cambridge, Addenbrookes Hospital, Cambridge (United Kingdom); Cambridge Hub in Trials Methodology Research, MRC Biostatics Unit, University Forvie Site, Cambridge (United Kingdom); Sinnatamby, R. [Department of Radiology, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge (United Kingdom)

    2011-11-15

    Aims: To compare the performance of ultrasound elastography with conventional ultrasound in the assessment of axillary lymph nodes in suspected breast cancer and whether ultrasound elastography as an adjunct to conventional ultrasound can increase the sensitivity of conventional ultrasound used alone. Materials and methods: Fifty symptomatic women with a sonographic suspicion for breast cancer underwent ultrasound elastography of the ipsilateral axilla concurrent with conventional ultrasound being performed as part of triple assessment. Elastograms were visually scored, strain measurements calculated and node area and perimeter measurements taken. Theoretical biopsy cut points were selected. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated and receiver operating characteristic (ROC) analysis was performed and compared for elastograms and conventional ultrasound images with surgical histology as the reference standard. Results: The mean age of the women was 57 years. Twenty-nine out of 50 of the nodes were histologically negative on surgical histology and 21 were positive. The sensitivity, specificity, PPV, and NPV for conventional ultrasound were 76, 78, 70, and 81%, respectively; 90, 86, 83, and 93%, respectively, for visual ultrasound elastography; and for strain scoring, 100, 48, 58 and 100%, respectively. There was no significant difference between any of the node measurements Conclusions: Initial experience with ultrasound elastography of axillary lymph nodes, showed that it is more sensitive than conventional ultrasound in detecting abnormal nodes in the axilla in cases of suspected breast cancer. The specificity remained acceptable and ultrasound elastography used as an adjunct to conventional ultrasound has the potential to improve the performance of conventional ultrasound alone.

  17. Accuracy of sentinel lymph node biopsy for the assessment of auxiliary status in patients with early (T1) breast carcinoma

    International Nuclear Information System (INIS)

    Objective: To determine the accuracy of SLN biopsy for the assessment of auxiliary status, and prognostic markers leading to lymphatic metastasis in patients with early (T1) breast cancer. Design: Cross-sectional study. Place and Duration of Study: Department of Surgery, Teaching and Research Hospital. Between January 2000 and August 2004. Patients and Methods: SLN mapping by blue dye method was performed on 39 patients with T1 breast carcinoma. SLNs, level 1 and 2 auxiliary nodes were dissected and excised. The size, pathologic features of the primary tumor, SLNs and other auxiliary nodes, and hormone receptors were evaluated by histopathologic examination. The rate of SLNs and non SLNs involvement, and demographic, clinical and pathologic risk factors leading to nodal metastasis were established. The diagnostic accuracy of SLN for auxiliary status was calculated. Results: SLNs were identified in 37 (95%) patients. The axilla had metastasis in 11 (28%) patients. Malignant cells involved SLNs in 8 patients. Non-SLNs had metastasis in 3 patients without SLN involvement. The sensitivity, specificity and accuracy of SLN biopsy for predicting auxiliary status was calculated as 73%, 100% and 92% respectively. Four of 5 patients T1c tumors (p=0.14) and lymphovascular invasion (p=0.0004). Conclusion: SLN biopsy with high diagnostic accuracy may prevent unnecessary disection of the axilla in the majority of patients with early (T1) breast carcinoma. Some risk factors as pre-menopausal status, absence of hormone receptors, and presence of lymphovascular invasion must be taken into account as important determinant of non-SLNs metastasis. (author)

  18. Contraindications of sentinel lymph node biopsy: Áre there any really?

    Directory of Open Access Journals (Sweden)

    Zografos George

    2007-01-01

    Full Text Available Abstract Background One of the most exciting and talked about new surgical techniques in breast cancer surgery is the sentinel lymph node biopsy. It is an alternative procedure to standard axillary lymph node dissection, which makes possible less invasive surgery and side effects for patients with early breast cancer that wouldn't benefit further from axillary lymph node clearance. Sentinel lymph node biopsy helps to accurately evaluate the status of the axilla and the extent of disease, but also determines appropriate adjuvant treatment and long-term follow-up. However, like all surgical procedures, the sentinel lymph node biopsy is not appropriate for each and every patient. Methods In this article we review the absolute and relative contraindications of the procedure in respect to clinically positive axilla, neoadjuvant therapy, tumor size, multicentric and multifocal disease, in situ carcinoma, pregnancy, age, body-mass index, allergies to dye and/or radio colloid and prior breast and/or axillary surgery. Results Certain conditions involving host factors and tumor biologic characteristics may have a negative impact on the success rate and accuracy of the procedure. The overall fraction of patients unsuitable or with multiple risk factors that may compromise the success of the sentinel lymph node biopsy, is very small. Nevertheless, these patients need to be successfully identified, appropriately advised and cautioned, and so do the surgeons that perform the procedure. Conclusion When performed by an experienced multi-disciplinary team, the SLNB is a highly effective and accurate alternative to standard level I and II axillary clearance in the vast majority of patients with early breast cancer.

  19. Evaluation of immediate breast reconstruction and radiotherapy: Factors associated with complications; Reconstruction mammaire immediate apres mastectomie suivie de radiotherapie: facteurs de risque de complications

    Energy Technology Data Exchange (ETDEWEB)

    Gross, E.; Cowen, D. [Departement de radiotherapie, hopital de la Timone, 13 - Marseille (France); Hannoun-Levi, J.M. [Departement de radiotherapie, centre Antoine-Lacassagne, 06 - Nice (France); Rouanet, P. [Departement de chirurgie, centre Val-d' Aurelle-Paul-Lamarque, 34 - Montpellier (France); Houvenaeghel, G. [Departement de chirurgie, institut Paoli-Calmettes, 13 - Marseille (France); Teissier, E. [Centre azureen de cancerologie, 06 - Mougins (France); Ellis, S. [Centre catalan d' oncologie, 66 - Perpignan (France); Resbeut, M. [Centre de radiotherapie Saint-Louis, 83 - Toulon (France); Tallet, A. [Departement de radiotherapie, institut Paoli-Calmettes, 13 - Marseille (France); Vaini Cowen, V. [Departement de chirurgie gynecologique, polyclinique du Parc-Rambot, 13 - Aix-en-Provence (France); Azria, D. [Departement de radiotherapie, centre Val-d' Aurelle-Paul-Lamarque, 34 - Montpellier (France)

    2010-12-15

    Objectives: To determine prospectively the factors associated with reconstruction failure (i.e. requiring expander removal) and capsular contracture in patients undergoing mastectomy and immediate two-stage breast reconstruction with a tissue expander and implant, and radiotherapy for breast cancer. This is a multi-institutional prospective non-randomized trial. Patients and Methods: Between 2/1998 and 9/2006, we prospectively evaluated 141 consecutive patients who received 141 implants after mastectomy and underwent chest wall radiotherapy (46 to 50 Gy in 23 to 25 fractions). Patients were evaluated after 24 to 36 months by two senior physicians (radiation oncologist and surgeon). Results: Medical follow-up was 37 months. Baker 1 and 2 capsular contracture was observed in 67.5% of patients, Baker 3 and 4 in 32.5%. There were 32 reconstruction failures. In a univariate analysis, the following factors were associated with Baker 3 and 4 capsular contracture: surgeon, use of hormonotherapy and smoking, of which only one remained in the multivariate analysis: surgeon. In a univariate analysis, the following factors were associated with reconstruction failure: tumor size T3 or T4, smoking, pN+ axilla. Three factors remained associated with reconstruction failure in a multiple logistic regression: large tumors T3/T4, smoking and pN+ axilla. Conclusions: Mastectomy, radiotherapy and immediate breast reconstruction with a tissue expander and implant should be considered when breast conserving surgery has been denied. Adequate patients can be easily selected by using three factors of favourable outcome. (authors)

  20. Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer - a prospective study

    Directory of Open Access Journals (Sweden)

    Mishra Ashwani

    2011-02-01

    Full Text Available Abstract Background Sentinel lymph node biopsy (SLNB is now considered a standard of care in early breast cancers with N0 axillae; however, its role in locally advanced breast cancer (LABC after neo-adjuvant chemotherapy (NACT is still being debated. The present study assessed the feasibility, efficacy and accuracy of sentinel lymph node biopsy (SLNB using "dye alone" (methylene blue method in patients with LABC following NACT. Materials and methods Thirty, biopsy proven cases of LABC that had received three cycles of neo-adjuvant chemotherapy (cyclophosphamide, adriamycin, 5-fluorouracil were subjected to SLNB (using methylene blue dye followed by complete axillary lymph node dissection (levels I-III. The sentinel node(s was/were and the axilla were individually assessed histologically. The SLN accuracy parameters were calculated employing standard definitions. The SLN identification rate in the present study was 100%. The sensitivity of SLNB was 86.6% while the accuracy was 93.3%, which were comparable with other studies done using dual lymphatic mapping method. The SLN was found at level I in all cases and no untoward reaction to methylene blue dye was observed. Conclusions This study confirms that SLNB using methylene blue dye as a sole mapping agent is reasonably safe and almost as accurate as dual agent mapping method. It is likely that in the near future, SLNB may become the standard of care and provide a less morbid alternative to routine axillary lymph node dissection even in patients with LABC that have received NACT.

  1. Concomitant chemotherapy and radiotherapy in the adjuvant treatment of breast cancer; Quimioterapia concomitante a radioterapia no tratamento adjuvante do cancer da mama localizado

    Energy Technology Data Exchange (ETDEWEB)

    Faria, Sergio L.; Oliveira Filho, Juvenal A.; Garcia, Alice R.; Amalfi, Christiane; Spirandeli, Julia M.B.; Campos, Eliane C. de [Hospital Mario Gatti, Campinas, SP (Brazil). Servico de Radioterapia; Pontificia Univ. Catolica de Campinas, SP (Brazil)]. E-mail: avo@correionet.com.br

    2001-06-01

    The conventional treatment of localized breast cancer involves the use of both systemic therapy and loco-regional radiation after surgery. The ideal sequence of these two treatments is still undefined. This paper focus on our experience of concomitant chemotherapy (CT) and radiotherapy (RT), and discusses information from the literature about this issue. Between Jan,1989 and Jan, 1999 a retrospective analysis of 103 patients with ductal carcinoma of the breast who received concomitant CT with cyclophosphamide, methotrexate and 5 flurouracil (CMF) and RT was made. Radiation did not included mammary chain or axilla and total dose was of 50 Gy. End points were tolerance and oxicity leading changes to doses. Mean age was 44y; median follow up time of 33 mo; 62 patients had breast conserving surgery and 41 had mastectomy. All patients received both treatments without a break or dose modification. There was no change or interruption of RT. Ten out of 103 patients had the prescribed dose of CT decreased of 10%-20%. There was no evident changes in cosmetic results. Most of the knowledge regarding the delay of CT or RT comes from retrospective studies, and results are conflicting. It is well accepted that high risk patients need both CT and RT. However, there are data suggesting that giving RT first and CT after may increase the rate of distant metastases. There are also studies showing worse impact in the local control with the delay of radiotherapy. The use of concomitant chemotherapy and radiotherapy has apparent advantages, but no randomized trial has addressed this issue yet. Our experience has shown that is possible to give concomitant CT with CMF and RT without irradiation of IMC and axilla without major changes in scheduling or dose of both therapies. (author)

  2. Dose to level I and II axillary lymph nodes and lung by tangential field radiation in patients undergoing postmastectomy radiation with tissue expander reconstruction

    International Nuclear Information System (INIS)

    To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose. The mean coverage of the level I/II axillary volume by the 95% isodose line (VD95%) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung VD50% was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary VD95% in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung VD50% correlated with angle of the expander from midline (p = 0.05). In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated

  3. Clinical and pathological response rates of docetaxel-based neoadjuvant chemotherapy in locally advanced breast cancer and comparison with anthracycline-based chemotherapies: Eight-year experience from single centre

    Directory of Open Access Journals (Sweden)

    D Gupta

    2011-01-01

    Full Text Available Introduction: The administration of neoadjuvant chemotherapy (NACT prior to local therapy is advantageous for women with locally advanced breast cancer (LABC, since it can render inoperable tumors resectable and can increase rates of breast conservative surgeries. Materials and Methods: We retrospectively analyzed LABC patients who received NACT from January 2000 to December 2007. Out of 3000 case records screened, 570 (19% were LABC and 110/570 (19% treatment-naïve patients started on NACT were analyzed. Ninety-one (37 docetaxel [D], 54 anthracycline [A] patients were eligible for response and survival analysis. Pathological complete remission (pCR was defined as no evidence of malignancy in both breast and axilla. Results: Median age of the whole cohort was 45 years (range 25-68 years. Premenopausal were 42% and estrogen receptor + 49.5%. Most (90% were T4 tumors and 70% were Stage IIIB. Median numbers of preoperative cycles were six and three in the D and A group respectively. Overall clinical response rates for breast primary were 74.3% and 53.7% (CR 28.6% vs. 16.7%, P=0.58 while for axilla ORR were 75.7% vs. 54.8% (51.4% vs. 40.4% CR, P=0.77 respectively for D and A. Corresponding pCR rates were 19% vs. 13% respectively. There was no significant difference in disease-free (three-year 56.84% vs. 61.16%, P=0.80 and overall survival (three-year 70% vs. 78.5%, P=0.86 between the two groups. Conclusions: Although pCR rates were higher with docetaxel-based NACT, it did not translate into superior disease-free survival / overall survival compared to anthracycline-based chemotherapies.

  4. Concomitant chemotherapy and radiotherapy in the adjuvant treatment of breast cancer

    International Nuclear Information System (INIS)

    The conventional treatment of localized breast cancer involves the use of both systemic therapy and loco-regional radiation after surgery. The ideal sequence of these two treatments is still undefined. This paper focus on our experience of concomitant chemotherapy (CT) and radiotherapy (RT), and discusses information from the literature about this issue. Between Jan,1989 and Jan, 1999 a retrospective analysis of 103 patients with ductal carcinoma of the breast who received concomitant CT with cyclophosphamide, methotrexate and 5 flurouracil (CMF) and RT was made. Radiation did not included mammary chain or axilla and total dose was of 50 Gy. End points were tolerance and oxicity leading changes to doses. Mean age was 44y; median follow up time of 33 mo; 62 patients had breast conserving surgery and 41 had mastectomy. All patients received both treatments without a break or dose modification. There was no change or interruption of RT. Ten out of 103 patients had the prescribed dose of CT decreased of 10%-20%. There was no evident changes in cosmetic results. Most of the knowledge regarding the delay of CT or RT comes from retrospective studies, and results are conflicting. It is well accepted that high risk patients need both CT and RT. However, there are data suggesting that giving RT first and CT after may increase the rate of distant metastases. There are also studies showing worse impact in the local control with the delay of radiotherapy. The use of concomitant chemotherapy and radiotherapy has apparent advantages, but no randomized trial has addressed this issue yet. Our experience has shown that is possible to give concomitant CT with CMF and RT without irradiation of IMC and axilla without major changes in scheduling or dose of both therapies. (author)

  5. Changes in postmastectomy radiotherapy targets among breast cancer patients in China from 1999 to 2008 : an epidemiological study%1999-2008年中国乳腺癌根治术后放疗部位变化的临床流行病学研究

    Institute of Scientific and Technical Information of China (English)

    王淑莲; 李晔雄; 宋清坤; 李静; 范金虎; 张斌; 杨红健; 谢小明; 唐中华

    2013-01-01

    Objective To investigate the changes in postmastectomy radiotherapy (PMRT) targets among breast cancer patients in China.Methods A multi-center retrospective epidemiological study was undertaken.Breast cancer patients who had received PMRT from 1999 to 2008 were randomly selected from seven hospitals in China,and the information on radiation targets,including the chest wall (CW),supraclavicular and infraclavicular regions (SCR/ICR),axilla,and internal mammary chain (IMC) was collected and analyzed.The Cochran-Armitage trend test and chi-square test were performed using SAS software to analyze the variation of PMRT targets over time,the differences in PMRT targets between hospitals,and the relationship between PMRT targets and clinicopathologic characteristics.Results Of 661included patients,596(90.2%),606(91.5%),196(29.6%),and 297(44.9%) had received PMRT to the CW,SCR/ICR,axilla,and IMC,respectively.From 1999 to 2008,there were an increase in use of PMRT to the CW (P =0.000) and decreases in use of PMRT to the axilla (P =0.027) and IMC (P =0.000).There were significant differences in use of PMRT to the CW (P =0.008),axilla (P =0.000),IMC (P =0.000),and SCR/ICR (P =0.000) between hospitals,but there were no significant differences in use of PMRT to the SCR/ICR from 1999 to 2008 (P =0.597).Use of PMRT to the axilla was associated with positive axillary nodes (P =0.007) and an axillary nodal ratio of 20% or more (P =0.007).Use of PMRT to the IMC was more frequent in patients with tumor located in the inner quadrant (P =0.015).Conclusions From 1999 to 2008,PMRT targets among breast cancer patients varied greatly over time and between different hospitals in China; most patients received PMRT to the CW and SCR/ICR,and use of PMRT to the axilla and IMC decreased significantly.%目的 了解中国乳腺癌根治术后放疗部位变化.方法 随机纳入国内7家医院1999-2008年间乳腺癌根治术后放疗并有详细放疗部位资料的乳腺癌患者

  6. Metastatic Brachial Plexopathy in a Case of Recurrent Breast Carcinoma Demonstrated on {sup 18}F-FDG PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Tripathi, Madhavi; Das, Chandan J.; Srivastava, Anurag; Bal, ChandraSekhar; Malhotra, Arun [All India Institute of Medical Sciences, New Delhi (India)

    2014-03-15

    This case highlights the importance of recognition of the pattern of metastatic brachialplexopathy in breast cancer patients undergoing {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) positron emission tomography/computed tomography (PET/CT) for evaluation of recurrent disease.This pattern can be appreciated on maximum intensity projection (MIP) and coronal {sup 18}F-FDG PET/CT images as a linear extension of tracer activity from superomedial aspect(supra/infraclavicular) to lateral aspect of the axilla closely related to the subclavian/axillary vessels). A 35-year-old woman diagnosed with infiltrating ductal carcinoma of the right breast had undergone six cycles of neoadjuvant chemotherapy, followed by wide local incision and radiotherapy. She had local recurrence, for which she was operated upon and given chemotherapy. She presented to her oncologist with pain and swelling in the right breast, nodules in the right axilla and restriction of movement of the right upper limb. The patient was referred for {sup 18}F-FDG PET/CT to evaluate the extent of recurrent/metastatic disease. Whole-body PET/CT was acquired 1 h following the intravenous injection of 296 MBq of {sup 18}F-FDG on a Biograph mCT scanner (Siemens). Evaluation of the MIP image revealed abnormal FDG accumulation at multiple sites in the thorax, along with a linear pattern of FDG uptake in the right lateral aspect of the upper chest (Fig. 1a, arrow). The coronal fused PET/CT image revealed a linear pattern of FDG uptake corresponding to an ill-defined mass extending from just behind the right clavicle into the right axilla (arrow). In addition, abnormal FDG accumulation was seen in a soft tissue density mass in the upper outer quadrant of the right breast, skin of the right breast laterally, both pectoral muscles (discrete foci) and in a few subpectoral nodes. Soft tissue nodular opacities in both lungs showed FDG accumulation suggestive of pulmonary metastasis (Fig. 1b, thick arrow). The patient was

  7. Sentinel lymph node mapping in breast cancer: a critical reappraisal of the internal mammary chain issue

    International Nuclear Information System (INIS)

    Although, like the axilla, the internal mammary nodes (IMNs) are a first-echelon nodal drainage site in breast cancer, the importance of their treatment has long been debated. Seminal randomized trials have failed to demonstrate a survival benefit from surgical IMN dissection, and several retrospective studies have shown that IMNs are rarely the first site of recurrence. However, the recent widespread adoption of sentinel lymph node (SLN) biopsy has stimulated a critical reappraisal of such early results. Furthermore, the higher proportion of screening-detected cancers, improved imaging and techniques (i.e., lymphoscintigraphy for radioguided SLN biopsy) make it possible to visualize lymphatic drainage to the IMNs. The virtually systematic application of adjuvant systemic and/or loco-regional radiotherapy encourages re-examination of the significance of IMN metastases. Moreover, randomized trials testing the value of post mastectomy irradiation and a meta-analysis of 78 randomized trials have provided high levels of evidence that local-regional tumor control is associated with long-term survival improvements. This benefit was limited to trials that used systemic chemotherapy, which was not routinely administered in the earlier studies. However, the contribution from IMN treatment is unclear. Lymphoscintigraphic studies have shown that a significant proportion of breast cancers have primary drainage to the IMNs, including approximately 30% of medial tumors and 15% of lateral tumors. In the few studies where IMN biopsy was performed, 20% of sentinel IMNs were metastatic. The risk of IMN involvement is higher in patients with medial tumors and positive axillary nodes. IMN metastasis has prognostic significance, as recognized by its inclusion in the American Joint Committee on Cancer staging criteria, and seems to have similar prognostic importance as axillary nodal involvement. Although routine IMN evaluation might be indicated, it has not been routinely performed

  8. Sentinel lymph node mapping in breast cancer: a critical reappraisal of the internal mammary chain issue.

    Science.gov (United States)

    Manca, G; Volterrani, D; Mazzarri, S; Duce, V; Svirydenka, A; Giuliano, A; Mariani, G

    2014-06-01

    Although, like the axilla, the internal mammary nodes (IMNs) are a first-echelon nodal drainage site in breast cancer, the importance of their treatment has long been debated. Seminal randomized trials have failed to demonstrate a survival benefit from surgical IMN dissection, and several retrospective studies have shown that IMNs are rarely the first site of recurrence. However, the recent widespread adoption of sentinel lymph node (SLN) biopsy has stimulated a critical reappraisal of such early results. Furthermore, the higher proportion of screening-detected cancers, improved imaging and techniques (i.e., lymphoscintigraphy for radioguided SLN biopsy) make it possible to visualize lymphatic drainage to the IMNs. The virtually systematic application of adjuvant systemic and/or loco-regional radiotherapy encourages re-examination of the significance of IMN metastases. Moreover, randomized trials testing the value of postmastectomy irradiation and a meta-analysis of 78 randomized trials have provided high levels of evidence that local-regional tumor control is associated with long-term survival improvements. This benefit was limited to trials that used systemic chemotherapy, which was not routinely administered in the earlier studies. However, the contribution from IMN treatment is unclear. Lymphoscintigraphic studies have shown that a significant proportion of breast cancers have primary drainage to the IMNs, including approximately 30% of medial tumors and 15% of lateral tumors. In the few studies where IMN biopsy was performed, 20% of sentinel IMNs were metastatic. The risk of IMN involvement is higher in patients with medial tumors and positive axillary nodes. IMN metastasis has prognostic significance, as recognized by its inclusion in the American Joint Committee on Cancer staging criteria, and seems to have similar prognostic importance as axillary nodal involvement. Although routine IMN evaluation might be indicated, it has not been routinely performed

  9. Morbidity related to axillary irradiation in the treatment of breast cancer

    International Nuclear Information System (INIS)

    Some of the most debilitating morbidity after surgery and radiotherapy for breast cancer is related to treatment of the axilla. This includes persistent arm lymphoedema, impaired shoulder mobility and brachial plexopathy. Considerable research efforts have been carried out on the radiation pathogenesis and the clinical radiobiology of these clinical endpoints, which has enabled their severity and incidence to be minimized. It is clear that the radiation dose-response relationships for these late endpoints are very steep. In other words, even small changes in the exact dose fractionation and physical dose distribution can cause major changes in toxicity. In particular, in many treatment schedules dose fractions larger than 2 Gy have been used without a sufficient reduction in total dose to avoid increased late effects. This is important, as much of the available literature reports side effects after suboptimal dose-fractionation schedules of side effects guaranteed and the locoregional lymphanot representative of what can be achieved using modern radiotherapy. An interesting parallelism to the problems encountered in reviewing historical experience is found in the British breast litigation, the current status of which is presented in this article. Furthermore, morbidity after radiotherapy is strongly influenced by concomitant surgery and/or chemotherapy, and this should be allowed for when designing the overall treatment. Apart from other therapeutic modalities, it has been suggested that other exogenous factors have an influence on the risk of radiotherapy-related morbidity. However, patients' age and, in the case of lymphoedema, also obesity are the only factors that have been established with some certainty. Routine adjustment of radiotherapy dose in these cases is not recommended. Two current developments may strengthen the role of radiotherapy in the treatment of breast cancer. Sentinel node biopsy may allow nodal staging without major surgical excision of

  10. Tangential vs. defined radiotherapy in early breast cancer treatment without axillary lymph node dissection. A comparative study

    International Nuclear Information System (INIS)

    Recent studies have demonstrated low regional recurrence rates in early-stage breast cancer omitting axillary lymph node dissection (ALND) in patients who have positive nodes in sentinel lymph node dissection (SLND). This finding has triggered an active discussion about the effect of radiotherapy within this approach. The purpose of this study was to analyze the dose distribution in the axilla in standard tangential radiotherapy (SRT) for breast cancer and the effects on normal tissue exposure when anatomic level I-III axillary lymph node areas are included in the tangential radiotherapy field configuration. We prospectively analyzed the dosimetric treatment plans from 51 consecutive women with early-stage breast cancer undergoing radiotherapy. We compared and analyzed the SRT and the defined radiotherapy (DRT) methods for each patient. The clinical target volume (CTV) of SRT included the breast tissue without specific contouring of lymph node areas, whereas the CTV of DRT included the level I-III lymph node areas. We evaluated the dose given in SRT covering the axillary lymph node areas of level I-III as contoured in DRT. The mean VD95% of the entire level I-III lymph node area in SRT was 50.28 % (range, 37.31-63.24 %), VD45Gy was 70.1 % (54.8-85.4 %), and VD40Gy was 83.5 % (72.3-94.8 %). A significant difference was observed between lung dose and heart toxicity in SRT vs. DRT. The V20Gy and V30Gy of the right and the left lung in DRT were significantly higher in DRT than in SRT (p < 0.001). The mean heart dose in SRT was significantly lower (3.93 vs. 4.72 Gy, p = 0.005). We demonstrated a relevant dose exposure of the axilla in SRT that should substantially reduce local recurrences. Furthermore, we demonstrated a significant increase in lung and heart exposure when including the axillary lymph nodes regions in the tangential radiotherapy field set-up. (orig.)

  11. EVOLUTION OF SYNCHRONOUS BILATERAL BREAST CARCINOMA IN A YOUNG PATIENT.

    Science.gov (United States)

    Manea, Elena; Munteanu, Anca

    2016-01-01

    Bilateral breast cancer incidence is appreciated to be between 0.3 to 12% and is determined either by a hereditary load associated with chromosomal instability under the effect of environmental factors, or by the evolution in a particular hormonal context which gives biological aggressiveness. We present the case of a patient, aged 38 years, clinically, imagistic and bioptic diagnosed with left axillary lymph node metastases of breast carcinoma NST invasive G3, IHC-RE = 60%, RP = 30%, HER2neu = 2 +, Ki67 = 20%, in August 2013. Patient followed neoadjuvant chemotherapy treatment during September-October 2013. In December 2013 she was clinically and imaging diagnosed with bilateral breast cancer, for which surgical intervention was done which consisted of bilateral radical Madden mastectomy with bilateral axillary lymphadenectomy. BAP-invasive carcinoma NST: left breast-pT2mN3a G2, right breast--pT3mN3a G2, IHC-RE = 90%, RP =70% HER2neu = 2 +, Ki67 = 50%. During the period of January-March 2014, the patient followed adjuvant chemotherapy and Herceptin. Bilateral breast ultrasound assessment in April 2014 revealed: left axilla--liquid blade 29 / 6mm; right axilla--oval ganglion 9/5 mm. Abdominal and pelvic ultrasound: empty uterine cavity, bosselated contour; at left ovary level multiple cystic formations. During the period of May-June 2014, adjuvant radiation therapy and ovarian irradiationwas administered to the patient. Subsequently hormone therapy was initiated. Following CHT / ovarian irradiation patient continues to experience intermittent uterine bleeding, which is why a total hysterectomy with bilateral ovariectomy was done, and BAP: cervical, endometrialand left ovary with tumor multifocal infiltration with histopathological aspect of invasive breast carcinoma NST. Periodic imaging evaluations do not reveal local or distant recurrence. The particularity of this case is synchronous bilateral breast cancer diagnosis in a young patient complicated in its

  12. Postmastectomy radiotherapy and chemotherapy in patients with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Sung Ja; Chung, Woong Ki; Nam, Taek Keun; Nah, Byung Sik; Song, Ju Young; Park, Seung Jin [Chonnam National University Medical School, Gwangju (Korea, Republic of)

    2004-03-15

    To evaluate the treatment outcomes after postmastectomy radiotherapy (PMRT) and chemotherapy in patients with breast cancer. The PMRT were retrospectively analyzed in 83 patients with stage II-III female breast cancer treated between 1989, and 1995. The median age was 46 years (range, 23-77); Seventy-seven patients had modified radical mastectomies. 5 radical mastectomies and 1 simple mastectomy. Three patients (4%) had pathologically negative axillae, and the remaining 80 (96%) had positive axillae. Eleven, 23, 44 and 5 patients had pathological stages IIA, IIB, IIIA, and IIIB, retrospectively. Eighty (96%) patients were treated with hockey-stick fields. The median dose of PMRT was 50.4 Gy, in 1.8 Gy fractions. Adjuvant systemic chemotherapy was given to 74 patients (89%). CMF-based or doxorubicin-containing regimens were given to 54 patients (65%). The median follow-up time was 82 months (range, 8-171) after the mastectomy. The 5 and 10-year overall survival rates for all patients were 65 and 49%, respectively. The univariate and multivariate analyses of the factors affecting the overall survival revealed the stage to be the most significant prognostic factor ({rho} = 0.002), followed by the combination of chemotherapy. Thirteen patients (16%) developed a LRF, at an interval of 4-48 months after radiotherapy, with a median of 20 months. The only significant prognostic factor affecting LRF was the combination of chemotherapy, in both the univariate and multivariate analyses. With respect to the sequence of chemoradiation, the sequence had no statistical significance ({rho} = 0.90). According to the time interval from mastectomy to the onset of radiotherapy, the LRFR of the patients group treated by RT within or after 6 month postmastectomy 6 months were 14 vs. 27%, respectively ({rho} = 0.24). One third of the patients (26/83) developed distant metastasis, in 2-29 months, after radiotherapy, with a median of 21 months. The most commonly involved site was bone in

  13. [Two cases of tick-borne tularemia in Yozgat province, Turkey].

    Science.gov (United States)

    Yeşilyurt, Murat; Kılıç, Selçuk; Cağaşar, Ozlem; Celebi, Bekir; Gül, Serdar

    2011-10-01

    Tularemia which has a worldwide distribution, is a zoonotic infection caused by Francisella tularensis. F.tularensis can infect a wide range of animals and can be transmitted to humans in a variety of ways, the most common being by the bite of an infected arthropod vector (usually tick) in the USA and Europe. The clinical presentations have been classically divided into ulceroglandular, glandular, oculoglandular, pharyngeal, respiratory, and typhoidal tularemia depending on the route of transmission. Arthropod-borne infection generally leads to the ulceroglandular form of tularemia. In Turkey, oropharyngeal form which is related to the consumption of contaminated water, is the most common presentation of tularemia. In this report, two cases of ulceroglandular tularemia which developed as a consequence of tick bite in Yozgat province have been presented. A 33-year-old female patient was admitted to the hospital with a tender lump on the right axilla. Empiric antibiotic treatment with amoxicillin clavulanate did not lead to an improvement in the painful axillary mass. She reported a tick bite on her right shoulder before development of fever, chills and regional tender lump. On physical examination, hyperemia was seen on the shoulder, with enlarged tender right axillary lymph node. The clinical diagnosis of suspected ulceroglandular tularemia was confirmed by the seroconversion (1/160 and 1/1280 titers in acute and convelescent sera, respectively) with microagglutination test (MAT) and F.tularensis DNA positivity in lymph node aspirate by polymerase chain reaction. The agent was identified as F.tularensis subsp. holarctica based on the results of amplification of target RD1 gene. Second case, a 18-year-old male, was admitted to our hospital with a-week history of sudden onset of fever, headache, generalized aches, vomiting, nause, and tender lump on the left axilla. On physical examination, an inflammatory eschar was seen on his scalp with enlarged cervical lymph

  14. Pretreatment Staging Positron Emission Tomography/Computed Tomography in Patients With Inflammatory Breast Cancer Influences Radiation Treatment Field Designs

    International Nuclear Information System (INIS)

    Purpose: Positron emission tomography/computed tomography (PET/CT) is increasingly being utilized for staging of inflammatory breast cancer (IBC). The purpose of this study was to define how pretreatment PET/CT studies affected postmastectomy radiation treatment (PMRT) planning decisions for IBC. Methods and Materials: We performed a retrospective analysis of 62 patients diagnosed with IBC between 2004 and 2009, who were treated with PMRT in our institution and who had a staging PET/CT within 3 months of diagnosis. Patients received a baseline physical examination, staging mammography, ultrasonographic examination of breast and draining lymphatics, and chest radiography; most patients also had a bone scan (55 patients), liver imaging (52 patients), breast MRI (46 patients), and chest CT (25 patients). We compared how PET/CT findings affected PMRT, assuming that standard PMRT would target the chest wall, level III axilla, supraclavicular fossa, and internal mammary chain (IMC). Any modification of target volumes, field borders, or dose prescriptions was considered a change. Results: PET/CT detected new areas of disease in 27 of the 62 patients (44%). The areas of additional disease included the breast (1 patient), ipsilateral axilla (1 patient), ipsilateral supraclavicular (4 patients), ipsilateral infraclavicular (1 patient), ipsilateral IMC (5 patients), ipsilateral subpectoral (3 patients), mediastinal (8 patients), other distant/contralateral lymph nodes (15 patients), or bone (6 patients). One patient was found to have a non-breast second primary tumor. The findings of the PET/CT led to changes in PMRT in 11 of 62 patients (17.7%). These changes included additional fields in 5 patients, adjustment of fields in 2 patients, and higher doses to the supraclavicular fossa (2 patients) and IMC (5 patients). Conclusions: For patients with newly diagnosed IBC, pretreatment PET/CT provides important information concerning involvement of locoregional lymph nodes

  15. Linfoma cutâneo primário de grandes células B de apresentação atípica: relato de caso Primary cutaneous large B-cell lymphoma of atypical presentation: case report

    Directory of Open Access Journals (Sweden)

    Antônio René Diógenes de Sousa

    2011-06-01

    Full Text Available Linfomas cutâneos primários são definidos como neoplasias linfocíticas que se apresentam clinicamente na pele sem doença extracutânea no momento do diagnóstico e até por 6 meses após. Os autores relatam o caso de um paciente masculino, idoso, com história de pápulas em axila, há 3 meses, que evoluíram para ulceração. Ao exame, úlcera profunda de bordos irregulares, infiltrados, em axila direita. Exames físico e complementares não evidenciaram doença à distância. O histopatológico mostra infiltrado dérmico denso e difuso de linfócitos atípicos. A imuno-histoquímica evidencia expressão de antígenos CD20 e bcl-2, com CD10 negativo, configurando diagnóstico de linfoma cutâneo difuso de grandes células B. Neste tipo de linfoma, é rara a manifestação cutânea primária, assim como a incidência é menor em homens e a localização, mais comum em membros inferioresPrimary cutaneous lymphomas are defined as lymphocytic neoplasias that present themselves clinically in the skin without extracutaneous disease at diagnosis and up to 6 months after it. The authors report the case of an elderly male patient, with a three- month-history of papules in the axilla which evolved into painful ulceration. Examination found deep ulcer with irregular borders ,infiltrates, in the right axilla. Physical and additional examinations did not evidence disease at distance. Histopathology revealed dense and diffuse dermic sample infiltrate of atypical lymphocytes. Imunohistochemistry shows expression of CD20 and bcl-2 antigens , with negative CD10, configuring diagnosis of cutaneous large B-cell lymphoma. In this type of cutaneous lymphoma, primary cutaneous manifestation is rare ,the incidence in men is lower and it is most commonly located in the lower limbs

  16. A case of a patient with stage III familial hidradenitis suppurativa treated with 3 courses of infliximab and died of metastatic squamous cell carcinoma.

    Science.gov (United States)

    Scheinfeld, Noah

    2014-03-01

    Although rare, severe hidradenitis suppurativa (HS) of the anal, perianal, gluteal, thigh, and groin regions can evolve into squamous cell carcinoma (SCC). This usually does not occur until the HS has been present for more than 20 years. Malignant degeneration of HS in the axilla has not been reported. SCC has developed in dissecting cellulitis, acne conglobata, and pilonidal cysts (other members of the follicular tetrad). Whereas the male to female ratio of HS is 1:3, SCC in HS has a male to female ration of 5:1. The reasons behind malignant degeneration in HS are complex and might differ from the malignant degeneration causing Marjolin ulcers. It likely involves the presence of human papilloma virus (HPV) in affected areas (a rarity in the axilla), and impaired defensins, which combat HPV, in the skin of Hurley Stage III HS. In familial HS, the odds of developing SCC are likely greater because of independent loss-of-function mutations in the γ-secretase multiprotein complex, which regulates the Notch signaling pathway. Compromise of the Notch signaling pathway can undermine immune function and increase the risk of neoplastic development. Coincident SCC with use of tumor necrosis factor α blockers has been reported. I report a patient with long standing Hurley Stage III, familial HS, wwho developed metastatic SCC after 3 courses of infliximab and expired 11 months after the infliximab was started. A 47-year-old male presented with progressive HS since early adulthood. His stage III hidradenitis suppurativa (HS) involved his groin, legs buttocks, and perineal areas. Interestingly, his HS was familial; one daughter also suffered from HS. A pilonidal cyst had been excised in the past. He suffered from hypertension for which he took ramipril, 2.5 mg per day. He did not admit to smoking. He had undergone numerous surgeries and courses of clindamycin with rifampin and clindamycin with minocycline. He used pregablin among other stronger medications for pain control. He

  17. Fat saturation in dynamic breast MRI at 3 Tesla: is the Dixon technique superior to spectral fat saturation? A visual grading characteristics study

    International Nuclear Information System (INIS)

    To intra-individually compare the diagnostic image quality of Dixon and spectral fat suppression at 3 T. Fifty consecutive patients (mean age 55.1 years) undergoing 3 T breast MRI were recruited for this prospective study. The image protocol included pre-contrast and delayed post-contrast spectral and Dixon fat-suppressed T1w series. Two independent blinded readers compared spectral and Dixon fat-suppressed series by evaluating six ordinal (1 worst to 5 best) image quality criteria (image quality, delineation of anatomical structures, fat suppression in the breast and axilla, lesion delineation and internal enhancement). Breast density and size were assessed. Data analysis included Spearman's rank correlation coefficient and visual grading characteristics (VGC) analysis. Four examinations were excluded; 48 examinations in 46 patients were evaluated. In VGC analysis, the Dixon technique was superior regarding image quality criteria analysed (P < 0.01). Smaller breast size and lower breast density were significantly (P < 0.01) correlated with impaired spectral fat suppression quality. No such correlation was identified for the Dixon technique, which showed reconstruction-based water-fat mixups leading to insufficient image quality in 20.8 %. The Dixon technique outperformed spectral fat suppression in all evaluated criteria (P < 0.01). Non-diagnostic examinations can be avoided by fat and water image reconstruction. The superior image quality of the Dixon technique can improve breast MRI interpretation. (orig.)

  18. Cases of Atypical Lymphangiomas in Children

    Directory of Open Access Journals (Sweden)

    Prashant K. Minocha

    2014-01-01

    Full Text Available Background. Lymphatic malformations or lymphangiomas are rare benign hamartomas that result from maldevelopment of primitive lymphatic sacs. They are most frequently found in the neck and axilla, while intra-abdominal and mediastinal lymphangiomas are uncommon. These are primarily tumours of infancy and childhood and are successfully treated with surgical excision. Summary of Cases. Five cases of lymphangioma comprising three intra-abdominal lymphangiomas and two unilateral axillary lymphangiomas presenting at one institution in Trinidad W.I. between 2005 and 2012 were examined. The presentations, location, workup, treatment, and outcome of these patients were studied. Conclusion. This paper discusses a range of extracervical lymphangioma cases seen at San Fernando General Hospital, Trinidad W.I. We report three intra-abdominal cases and the most common clinical presentations were abdominal pain and distension. Also two axillary cases were reported, which presented as painless axillary masses. The major concerns for excision of axillary lymphangioma by parents and surgeons were cosmesis and feasibility of complete resection without disruption of developing breast tissue and axillary vessels. We believe that ultrasound scan is very good at detection of the lesion, while CT is better at determining tumour content and planning for the operation. It is our opinion that complete surgical excision can be achieved.

  19. Endogenous ochronosis.

    Science.gov (United States)

    Turgay, E; Canat, D; Gurel, M S; Yuksel, T; Baran, M F; Demirkesen, C

    2009-12-01

    Endogenous ochronosis or alkaptonuria is a rare, autosomal recessive disease of tyrosine metabolism that is caused by a deficiency of the enzyme homogentisic acid oxidase. The disease results in the accumulation and deposition of homogentisic acid in the cartilage, eyelids, forehead, cheeks, axillae, genital region, buccal mucosa, larynx, tympanic membranes, and tendons. The disease generally presents in adults with arthritis and skin abnormalities; occasionally, involvement of other organs may be seen. A 49-year-old man was referred to our clinic with verrucous lesions on his hands. On physical examination, caviar-like ochronotic papules were found around his eyes and the helix cartilage of his ears, and on the dorsa of both hands. There were brown macules on the sclera (Osler's sign). The patient had arthritis and nephrolithiasis, and a sample of his urine darkened upon standing. Histopathological examination showed deposition of ochronotic pigment. High-dose ascorbic acid was given, and the patient showed improvement on follow-up examination 6 months later. PMID:20055850

  20. Lipoid proteinosis (Urbach-Wiethe disease: A case report

    Directory of Open Access Journals (Sweden)

    Munise Daye

    2014-12-01

    Full Text Available Lipoid proteinosis, which is known as “Urbach-Wiethe disease”, was first described in 1929 as “lipoidosis cutis et mucosae” by Urbach and Wiethe. It is a rare autosomal recessive inherited genodermatosis. There are PAS-positive hyaline material deposits in the skin, mucosa and visceral organs. A 23-year-old man, who was suffering from swelling of the lower lip and a fissure on the inner side of the lip, presented to our outpatient clinic. On dermatological examination, there were lower lip edema and infiltration, as well as macroglossia. There were bilateral yellowish papules along his eyelashes. For his ocular findings; it was learned that he had been treated for trichiasis at his childhood. There were multiple atrophic scars on his face, elbows, axilla, knees, and the skin overlying his spinous processes. He had no hoarseness. There was no consanguinity between his mother and father. Physical examination was normal. Three punch biopsies were carried out from his tongue, lips and elbow with the preliminary diagnoses of lipoid proteinosis, Melkersson-Rosenthal syndrome, focal epithelial hyperplasia, amyloidosis, granulomatous cheilitis, atrofoderma, and anetoderma. Deposition of hyaline PAS-positive materials was observed on his histopathological examination. According to the clinical and histopathological findings, the patient was diagnosed as having lipoid proteinosis. Otorhinolaryngologists, ophthalmologists, dermatologists, and neurologists should keep this rare condition in mind in the differential diagnosis.

  1. Using quantitative image analysis to classify axillary lymph nodes on breast MRI: A new application for the Z 0011 Era

    International Nuclear Information System (INIS)

    Highlights: •Quantitative image analysis showed promise in evaluating axillary lymph nodes. •13 of 28 features performed better than guessing at metastatic status. •When all features were used in together, a considerably higher AUC was obtained. -- Abstract: Purpose: To assess the performance of computer extracted feature analysis of dynamic contrast enhanced (DCE) magnetic resonance images (MRI) of axillary lymph nodes. To determine which quantitative features best predict nodal metastasis. Methods: This institutional board-approved HIPAA compliant study, in which informed patient consent was waived, collected enhanced T1 images of the axilla from patients with breast cancer. Lesion segmentation and feature analysis were performed on 192 nodes using a laboratory-developed quantitative image analysis (QIA) workstation. The importance of 28 features were assessed. Classification used the features as input to a neural net classifier in a leave-one-case-out cross-validation and evaluated with receiver operating characteristic (ROC) analysis. Results: The area under the ROC curve (AUC) values for features in the task of distinguishing between positive and negative nodes ranged from just over 0.50 to 0.70. Five features yielded AUCs greater than 0.65: two morphological and three textural features. In cross-validation, the neural net classifier obtained an AUC of 0.88 (SE 0.03) for the task of distinguishing between positive and negative nodes. Conclusion: QIA of DCE MRI demonstrated promising performance in discriminating between positive and negative axillary nodes

  2. Continuous shoulder analgesia via an indwelling axillary brachial plexus catheter.

    Science.gov (United States)

    Reuben, S S; Steinberg, R B

    2000-09-01

    Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene space and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the interscalene space to provide continuous cervicobrachial plexus analgesia. In the first case report, previous neck surgery made the anatomic landmarks for performing an interscalene block very difficult. An epidural catheter was advanced from the axillary brachial plexus sheath to the interscalene space under fluoroscopic guidance. This technique provided both intraoperative analgesia for shoulder surgery as well as 24-hour postoperative analgesia by an infusion of 0.125% bupivacaine. In the second case report, a catheter was inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex regional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach and thus prevents premature dislodgment. This approach may be a suitable alternative when either an interscalene or an infraclavicular catheter may not be inserted. PMID:11090734

  3. Respiratory responses to stimulation of abdominal and upper-thorax intercostal muscles using multiple Permaloc® electrodes

    Directory of Open Access Journals (Sweden)

    James S. Walter, PhD

    2015-04-01

    Full Text Available Stimulation of abdominal and upper-thoracic muscles was studied with the long-term goal of improved respiratory care for spinal cord injury (SCI patients. A 12-channel stimulator and multiple surface and implanted Permaloc electrodes were evaluated in five anesthetized canines. Abdominal stimulation with 100 mA using four bilateral sets of surface electrodes placed on the midaxillary line at the 7th through 13th intercostal spaces and with a closed airway at a large lung volume produced an expiratory tracheal pressure of 109 +/– 29 cm H2O (n = 2, mean +/– standard error of the mean. Similar high pressures were induced with implanted electrodes at the same locations. Upper-thoracic stimulation with 40 mA and four sets of implanted electrodes ventral to the axilla induced inspiratory pressures of −12 +/– 2 cm H2O (n = 5. Combined extradiaphragmatic pacing with an open airway produced a tidal volume of 440 +/– 45 mL (n = 4. The robust respiratory volumes and pressures suggest applications in SCI respiratory care.

  4. CUTANEOUS EPITHELIOTROPIC T-CELL LYMPHOMA WITH METASTASES IN A VIRGINIA OPOSSUM (DIDELPHIS VIRGINIANA).

    Science.gov (United States)

    Higbie, Christine T; Carpenter, James W; Choudhary, Shambhunath; DeBey, Brad; Bagladi-Swanson, Mary; Eshar, David

    2015-06-01

    A 2-yr-old, captive, intact female Virginia opossum ( Didelphis virginiana ) with a 7-mo history of ulcerative dermatitis and weight loss was euthanatized for progressive worsening of clinical signs. Initially the opossum was treated with several courses of antibiotics, both topically and systemically; systemic nonsteroidal anti-inflammatory medication; and, later, systemic glucocorticoids, with no improvement in clinical signs. Histopathologic samples of skin lesions taken 3 mo into the course of disease revealed no evidence of neoplasia; however, cytologic samples of a skin lesion taken 5 mo into the course of disease revealed mature lymphocytes, and were suggestive of cutaneous lymphoma. Postmortem histopathology revealed neoplastic cells consistent with lymphoma; these were found in the haired skin of the forearm, axilla, hind limb, face, and lateral body wall, as well as the liver, kidney, axillary lymph node, heart, and spleen. Multifocal neutrophilic and eosinophilic ulcerative and necrotizing dermatitis and folliculitis of the haired skin were also present. To the authors' knowledge, this is the first documented case of cutaneous lymphoma in a Virginia opossum and the first documented case with visceral metastases in a marsupial. PMID:26056906

  5. Classification of Systemic and Localized Sweating Disorders.

    Science.gov (United States)

    Ohshima, Yuichiro; Tamada, Yasuhiko

    2016-01-01

    Hyperhidrosis can be subdivided into generalized hyperhidrosis, with increased sweating over the entire body, and focal hyperhidrosis, in which the excessive sweating is restricted to specific parts of the body. Generalized hyperhidrosis may be either primary (idiopathic) or secondary. Secondary generalized hyperhidrosis may be caused by infections such as tuberculosis, hyperthyroidism, endocrine and metabolic disturbances such as pheochromocytoma, neurological disorders, or drugs. Focal hyperhidrosis may also be primary (idiopathic) or secondary. Frey's syndrome is one form of secondary focal hyperhidrosis that occurs during eating together with reddening of the area in front of the ear following parotid gland surgery or injury. Primary focal hyperhidrosis is particularly common on the palms and soles of the feet, in the axilla, and on the head. Anhidrosis may be either congenital/genetic or acquired. Some of the most typical forms of congenital/genetic anhidrosis include hypohidrotic ectodermal dysplasia, congenital insensitivity to pain and anhidrosis, and Fabry disease. Acquired anhidrosis is classified as secondary anhidrosis, which may be due to an underlying disorder such as a neurological disorder, an endocrine or metabolic disturbance, or the effect of drugs, or idiopathic anhidrosis for which the pathology, cause, and mechanism are unknown. Idiopathic anhidrosis is classified into acquired idiopathic generalized anhidrosis (AIGA), idiopathic segmental anhidrosis, and Ross syndrome. AIGA is divided into three categories according to differences in the site of disturbance: (1) sudomotor neuropathy, (2) idiopathic pure sudomotor failure, and (3) sweat gland failure. PMID:27584957

  6. Identification and description of the axillary web syndrome (AWS) by clinical signs, MRI and US imaging.

    Science.gov (United States)

    Leduc, O; Fumière, E; Banse, S; Vandervorst, C; Clément, A; Parijs, T; Wilputte, F; Maquerlot, F; Ezquer Echandia, M; Tinlot, A; Leduc, A

    2014-12-01

    The Axillary Web Syndrome (AWS) follows surgery for breast neoplasia and consists of one, or more frequently two or three, cords of subcutaneous tissue. Cords originate from the axilla, spread to the antero-medial surface of the arm down to the elbow and then move into the antero-medial aspect of the forearm and sometimes into the root of the thumb. The purpose of this study was to compare two techniques, ultrasound (US) and Magnetic Resonance Imaging (MRI) for their sensitivity and accuracy in identifying AWS cords and to provide insights to the origin of this pathology. US examinations were performed on fifteen patients using a high frequency probe (17 MHz). We first palpated and marked the cord with location aided by maximum abduction. To identify the cord with MRI (1.5 Tesla), a catheter filled with a gel detectable under MRI was placed on the skin at the site of the cord. We found that in some US cases, the dynamic abduction maneuver was essential to facilitate detection of the cord. This dynamic method on ultrasound confirmed the precise location of the cord even if it was located deeper in the hypodermis fascia junction. US and MRI images revealed features of the cords and surrounding tissues. Imaging the cords was difficult with either of the imaging modalities. However, US seemed to be more efficient than MRI and allowed dynamic evaluation. Overall analysis of our study results supports a lymphatic origin of the AWS cord. PMID:25915977

  7. COEXISTENCE OF CUTANEOUS MUCORMYCOSIS AND SCROFULODERMA IN AN IMMUNODEFICIENT CHILD

    Directory of Open Access Journals (Sweden)

    Mahalakshmi

    2016-01-01

    Full Text Available Severe Combined Immunodeficiency (SCID is a genetic disorder characterised by the disturbed development of functional T cells and B cells caused by numerous genetic mutations. (1 These patients are extremely vulnerable to infectious diseases and early death. (1 A 1-year-old child, known case of SCID since 8 months of age, presented with septic shock. He had a swelling on the left hand for 1 month and over left hand, which was a prior site of IV cannulation and swelling over axilla since 6 months. The child received multiple blood transfusions, though no bone marrow transplant was done. We entertained a differential diagnosis of cutaneous tuberculosis, atypical mycobacterial infection, deep fungal infection and foreign body granuloma for the left hand nodule. We thought of scrofuloderma with lymphadenopathy as a diagnosis for the axillary lesion. Biopsy of the hand lesion-multiple broad aseptate hyphae with granulomatous infiltrates suggesting mucormycosis. FNAC of axillary lymph node-necrotising lymphadenitis with AFB positive. Chest X-ray HRCT-PCP Pneumonia. He was started on IV Amphotericin-B

  8. Tangential vs. defined radiotherapy in early breast cancer treatment without axillary lymph node dissection. A comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Nitsche, Mirko [Zentrum fuer Strahlentherapie und Radioonkologie, Bremen (Germany); Universitaet Kiel, Klinik fuer Strahlentherapie, Karl-Lennert-Krebscentrum, Kiel (Germany); Temme, Nils; Foerster, Manuela; Reible, Michael [Zentrum fuer Strahlentherapie und Radioonkologie, Bremen (Germany); Hermann, Robert Michael [Zentrum fuer Strahlentherapie und Radioonkologie, Bremen (Germany); Medizinische Hochschule Hannover, Abteilung Strahlentherapie und Spezielle Onkologie, Hannover (Germany)

    2014-08-15

    Recent studies have demonstrated low regional recurrence rates in early-stage breast cancer omitting axillary lymph node dissection (ALND) in patients who have positive nodes in sentinel lymph node dissection (SLND). This finding has triggered an active discussion about the effect of radiotherapy within this approach. The purpose of this study was to analyze the dose distribution in the axilla in standard tangential radiotherapy (SRT) for breast cancer and the effects on normal tissue exposure when anatomic level I-III axillary lymph node areas are included in the tangential radiotherapy field configuration. We prospectively analyzed the dosimetric treatment plans from 51 consecutive women with early-stage breast cancer undergoing radiotherapy. We compared and analyzed the SRT and the defined radiotherapy (DRT) methods for each patient. The clinical target volume (CTV) of SRT included the breast tissue without specific contouring of lymph node areas, whereas the CTV of DRT included the level I-III lymph node areas. We evaluated the dose given in SRT covering the axillary lymph node areas of level I-III as contoured in DRT. The mean V{sub D95} {sub %} of the entire level I-III lymph node area in SRT was 50.28 % (range, 37.31-63.24 %), V{sub D45} {sub Gy} was 70.1 % (54.8-85.4 %), and V{sub D40} {sub Gy} was 83.5 % (72.3-94.8 %). A significant difference was observed between lung dose and heart toxicity in SRT vs. DRT. The V{sub 20} {sub Gy} and V{sub 30} {sub Gy} of the right and the left lung in DRT were significantly higher in DRT than in SRT (p < 0.001). The mean heart dose in SRT was significantly lower (3.93 vs. 4.72 Gy, p = 0.005). We demonstrated a relevant dose exposure of the axilla in SRT that should substantially reduce local recurrences. Furthermore, we demonstrated a significant increase in lung and heart exposure when including the axillary lymph nodes regions in the tangential radiotherapy field set-up. (orig.) [German] Aktuelle Studien zeigen

  9. Recurrent and second breast cancer detected on follow-up mammography and breast ultrasound after breast-conserving surgery: Findings and clinicopathologic factors

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Ga Young; Cha, Joo Hee; Kim, Hak Hee; Shin, Hee Jung; Chae, Eun Young; Choi, Woo Jung [Dept. of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul (Korea, Republic of)

    2016-01-15

    To assess the imaging and clinicopathologic outcomes of recurrent and second breast cancer after breast-conserving surgery for invasive ductal carcinomas detected on follow-up mammography and breast ultrasound (US). Seventy-six women with an ipsilateral breast tumor recurrence (IBTR) or regional lymph node recurrence and/or contralateral breast cancer (RLNR and CBC) after breast-conserving surgery were included in this study. The mammography and US images were analyzed and the clinicopathologic parameters were compared between the groups. Thirty had an IBTR, and 46 had a RLNR and CBC. The IBTR group's mammography and US images frequently revealed calcification and masses on the breast, respectively. The most frequent site of RLNR detected during follow-up mammography and breast US was the axilla. In univariate analysis, the tumors in the IBTR group were predominantly estrogen receptor (ER)-negative, HER-2 overexpression, and p53-positive. ER and HER-2 were shown by the multivariate analysis to be independent parameters associated for both types of recurrences. A mass or calcification is frequently present in IBTR and the axillary lymph node is the most frequent site of RLNR. ER and HER-2 status are major independent factors associated with recurrent and second breast cancer.

  10. Pathological axillary lymph nodes detected at mammographic screening

    International Nuclear Information System (INIS)

    AIM: To investigate the significance of abnormal axillary lymph nodes detected at mammographic screening in the absence of a concomitant breast lesion. METHODS: Twenty-three thousand, seven hundred and seven women were screened at the Merrion Unit as part of the Irish National Breast Screening Programme ('BreastCheck') in the period June 2000 to July 2002. Nine women (0.4 per 1000 women screened) were found to have an abnormal axillary lymph node(s) in the absence of a mammographic breast lesion and were recalled for assessment. The radiological criteria for recall included: size greater than or equal to 15 mm, round or irregular shape, increased node density and absence of hilar lucency. Each woman underwent further mammographic views, ultrasound examination of axilla and breast, clinical examination and lymph node biopsy either by 14 G needle core biopsy (NCB) or open excision. RESULTS: The final pathological diagnoses in the nine patients were oestrogen receptor (OR) positive metastatic breast carcinoma (two patients), metastatic malignant melanoma (one patient), malignant lymphoma (two patients), caseating granulomatous lymphadenitis suggestive of tuberculosis (one patient), and other benign conditions (three patients). CONCLUSION: Abnormal axillary lymph nodes, in the absence of an accompanying breast lesion, are rarely identified on screening mammogram, but may harbour significant pathology and their presence on screening mammogram merits further investigation including biopsy

  11. Thoracodorsal artery perforator flap for upper limb reconstruction

    International Nuclear Information System (INIS)

    Thoracodorsal artery perforator flap (TAP) is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required. Methods: This case series was carried out at department of Plastic and Reconstructive Surgery Combined Military Hospital Rawalpindi. A total of 5 patients with upper limb defects were reconstructed with thoracodorsal artery musculocutaneous perforator flaps. Among them, 3 were pedicled and two free TAP flaps. All flaps except one pedicled flap were raised on a single perforator pedicle. Recipient sites were one axilla, two shoulder regions and two hands. The soft tissue defects in the patients had resulted from burns, trauma, wide local excision of synovial sarcoma and surgery for hidradenitis suppurativa. Preoperative hand held Doppler ultrasound was used to locate and mark the perforator. Results: All flaps survived without significant complications. All flaps were hyperemic in the immediate postoperative period. We designed and raised all the five flaps on eccentrically placed perforators. All the raised perforators originated from the descending branch of the thoracodorsal artery. The donor sites were closed primarily with linear scars in all cases except one, in which partial closure was accomplished with split thickness skin grafting (STSG). Conclusion: The thoracodorsal artery perforator flap has great potential for reconstructing large, relatively shallow, defects of upper limb because of its suitable skin quality, texture and appropriate thickness, as well as hidden donor site, a reliable pedicle and sparing of muscle unit. (author)

  12. The evaluation of underarm deodorants.

    Science.gov (United States)

    Baxter, P M; Reed, J V

    1983-06-01

    Synopsis Double-blind cross-over trials in which trained assessors evaluated axillary malodour on a 0 to 10 scale showed that ethanol at 60% and 99% w/w significantly reduced odour for up to 24 h. Reduction in odour was increased by the addition of non-volatile antimicrobial ingredients such as chlorhexidine, Irgasan DP 300 (Triclosan, Ciba Geigy) or aluminium chlorhydrate. Volunteer panellists were able to identify statistically significant deodorant effects when they rated their own axillary odour on a 0 to 10 scale. An odour absorber, zinc ricinoleate (Grillocin, Grillo-Werke, A. G.) was used to treat existing malodour and gave reduced perception of that malodour for up to 24 h. A close correlation was found between panel odour scores and the bacterial status of the axilla as assessed by the replipad technique when biocidal systems were studied. Irgasan DP 300, a bacteriostat, did not perform so well in skin flora sampling procedures, but was nevertheless effective as a deodorant ingredient. Thus in vivo microbiological techniques, although often useful as predictors of deodorancy, do not replace the carefully controlled clinical trial with direct assessment of odour. PMID:19469981

  13. Epidermolysis bullosa in calves in the United Kingdom.

    Science.gov (United States)

    Foster, A P; Skuse, A M; Higgins, R J; Barrett, D C; Philbey, A W; Thomson, J R; Thompson, H; Fraser, M A; Bowden, P E; Day, M J

    2010-05-01

    Epidermolysis bullosa (EB) was diagnosed in eight calves from four farms in the United Kingdom on the basis of clinical, histological and ultrastructural findings. In three affected herds, pedigree Simmental bulls had been mated with Simmental-cross cows. In a fourth herd two Holstein-Friesian calves were affected. Lesions included multifocal erosion and ulceration of the hard and soft palates, tongue, nares and gingiva, with onychomadesis (dysungulation). There was alopecia, erosion and crusting of the coronets, pasterns, fetlocks, carpi, hocks, flanks and axillae. Histopathological findings included segmental separation of full thickness epidermis from the dermis, with formation of large clefts containing eosinophilic fluid, extravasated red blood cells and small numbers of neutrophils. Follicular and interfollicular areas of skin were affected, with clefts extending around hair follicles and sometimes involving whole follicles. Ultrastructurally, there was evidence of vacuolar change within basal keratinocytes, corresponding to areas of histological clefting. Preliminary genetic screening of the candidate keratin genes (bKRT5 and bKRT14) has excluded mutations of these as the cause of this condition. PMID:19909967

  14. Mammary and extramammary Paget's disease*

    Science.gov (United States)

    Lopes, Lauro Lourival; Lopes, Ione Maria Ribeiro Soares; Lopes, Lauro Rodolpho Soares; Enokihara, Milvia M. S. S.; Michalany, Alexandre Osores; Matsunaga, Nobuo

    2015-01-01

    Paget's disease, described by Sir James Paget in 1874, is classified as mammary and extramammary. The mammary type is rare and often associated with intraductal cancer (93-100% of cases). It is more prevalent in postmenopausal women and it appears as an eczematoid, erythematous, moist or crusted lesion, with or without fine scaling, infiltration and inversion of the nipple. It must be distinguished from erosive adenomatosis of the nipple, cutaneous extension of breast carcinoma, psoriasis, atopic dermatitis, contact dermatitis, chronic eczema, lactiferous ducts ectasia, Bowen's disease, basal cell carcinoma, melanoma and intraductal papilloma. Diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. Extramammary Paget's disease is considered an adenocarcinoma originating from the skin or skin appendages in areas with apocrine glands. The primary location is the vulvar area, followed by the perianal region, scrotum, penis and axillae. It starts as an erythematous plaque of indolent growth, with well-defined edges, fine scaling, excoriations, exulcerations and lichenification. In most cases it is not associated with cancer, although there are publications linking it to tumors of the vulva, vagina, cervix and corpus uteri, bladder, ovary, gallbladder, liver, breast, colon and rectum. Differential diagnoses are candidiasis, psoriasis and chronic lichen simplex. Histopathology confirms the diagnosis. Before treatment begins, associated malignancies should be investigated. Surgical excision and micrographic surgery are the best treatment options, although recurrences are frequent. PMID:25830993

  15. Unusual sites and presentations of pilonidal sinus disease

    Directory of Open Access Journals (Sweden)

    Pravin Gupta J.

    2014-01-01

    Full Text Available Pilonidal sinus usually develops in the sacrococcygeal area or other hair-bearing areas. However, it can present at some other sites with varied presentations and can mimic like other infective pathologies which are more common in that area. It has also been described as an occupational hazard in barbers, especially when presented interdigitally. Occupational pilonidal sinuses tend to occur even in non-hair-bearing areas where there is no presence of individual’s own hair. Pilonidal sinus occurs in many areas of the body such as web of fingers, penis shaft, axilla, intermammary area, groin, nose, neck following trauma during shaving, clitoris, sternum, suprapubic area, occiput, prepuce, chin, periungual region, breast, face or navel. Sporadic incidences of implantation of pilonidal sinus have been reported. The disease is mostly observed in hairdressers, but it has also been reported sporadically in other professions, as male sheep shearer, dog groomer, slaughter men or milker of cows. Short customers’ hairs that penetrate the supple interdigital skin of the hands produce barber’s disease. Though there are only a few reports about these peculiar sinuses in the available literature, they should be suspected in any chronically discharging, non-healing sinus or wound. A clinical suspicion of malignant transformation or affection with tuberculosis in the endemic area should also be kept in mind to avoid any delay in the treatment and the outcome of the disease.

  16. Ultrasonographic measurement of median nerve cross-sectional area reference values in a healthy Han population from Guiyang, China

    Institute of Scientific and Technical Information of China (English)

    Jun Chen; Shan Wu; Jun Ren

    2011-01-01

    High-resolution ultrasonography was used to analyze the nerve cross-sectional area (CSA) of the median nerve at 7 sites: the wrist crease, pisiform bone, hamate bone, 6 cm proximal to the tip of the wrist crease, proximal forearm (where the nerve enters the pronator teres muscle), 4 cm proximal to the tip of the medial epicondyle, and mid-humerus (mid-point between elbow crease and axilla) in 200 healthy volunteers from Guiyang, China. Results showed similar CSA values between the left and right sides, but the CSA 6 cm proximal to the tip of the wrist crease, proximal forearm, 4 cm proximal to tip of the medial epicondyle, and mid-humerus in males was greater than that of females. Moreover, CSA values at the wrist crease, pisiform bone, and hamate bone were greater in the middle-aged and old groups when compared to the young group, and correlated with body mass and height. Thus, reference values of median nerve CSA of the upper limbs can facilitate the analysis of abnormal nerve conditions.

  17. ALOPECIA AREATA - A CLINICAL ANALYSIS

    Directory of Open Access Journals (Sweden)

    Suma

    2013-12-01

    Full Text Available ABSTRACT : A lopecia areat a is one of the most emotionally devastating , dermatologic condition s . Alopecia areata is a unique , idiopathic disease in which there is patchy hair loss that is usually confined on the scalp but may occur on beard region , moustache , eyelashes , eyebrows , axilla , genitalia & general body surface . Alopecia total is a condition if all the hair on the scalp is lost and Alopecia universalis is a condition if in addition to scalp , there is complete loss of body hair . 1 It occurs equally in both males and females and onset can be at any age , but most often in children & y oung adults . 2 The etiology of alopecia areata is not known with certainty . Factors implicated are - autoimmune theory , genetic factors , atopic state & emotional stress . Alopecia areata progresses as a wave of follicles which enter telogen phase prematurely . It is characterized by non - scarring round and/or oval patches of hair loss . The diagnostic hallmark of alopecia areata is an exclamation mark hair at the active hair margin . The lesions are largely asymptomatic , which may manifest either as alopecia areat a classic , reticulate alopecia areata , alopecia totalis/universalis , or ophiasis&ophiasis inverse . 3 Associated clinical changes are - nail involvement , cataract , vitiligo etc

  18. A dual-modality photoacoustic and ultrasound imaging system for noninvasive sentinel lymph node detection: preliminary clinical results

    Science.gov (United States)

    Erpelding, Todd N.; Garcia-Uribe, Alejandro; Krumholz, Arie; Ke, Haixin; Maslov, Konstantin; Appleton, Catherine; Margenthaler, Julie; Wang, Lihong V.

    2014-03-01

    Sentinel lymph node biopsy (SLNB) has emerged as an accurate, less invasive alternative to axillary lymph node dissection, and it has rapidly become the standard of care for patients with clinically node-negative breast cancer. The sentinel lymph node (SLN) hypothesis states that the pathological status of the axilla can be accurately predicted by determining the status of the first (i.e., sentinel) lymph nodes that drain from the primary tumor. Physicians use radio-labeled sulfur colloid and/or methylene blue dye to identify the SLN, which is most likely to contain metastatic cancer cells. However, the surgical procedure causes morbidity and associated expenses. To overcome these limitations, we developed a dual-modality photoacoustic and ultrasound imaging system to noninvasively detect SLNs based on the accumulation of methylene blue dye. Ultimately, we aim to guide percutaneous needle biopsies and provide a minimally invasive method for axillary staging of breast cancer. The system consists of a tunable dye laser pumped by a Nd:YAG laser, a commercial ultrasound imaging system (Philips iU22), and a multichannel data acquisition system which displays co-registered photoacoustic and ultrasound images in real-time. Our clinical results demonstrate that real-time photoacoustic imaging can provide sensitive and specific detection of methylene blue dye in vivo. While preliminary studies have shown that in vivo detection of SLNs by using co-registered photoacoustic and ultrasound imaging is feasible, further investigation is needed to demonstrate robust SLN detection.

  19. Responses to concurrent radiotherapy and hormone-therapy and outcome for large breast cancers in post-menopausal women

    International Nuclear Information System (INIS)

    Introduction: This study aimed to evaluate responses and outcome of hormone-therapy (HT) and radiotherapy (RT) given concurrently for large breast cancers in post-menopausal women. Material and methods: Forty-two breast carcinomas in 41 women were treated with HT and concurrent RT to the breast ± lymph node bearing areas. For 30 tumours this was followed by breast surgery (with axillary lymph node dissection when the axilla had not been irradiated). RT delivered a median dose to the tumour of 50 Gy (48-66) and 75 Gy (65-84) for, respectively, preoperative and exclusive RT-HT. Median follow-up was 64 months. Results: Out of 42 clinically assessable tumours (after a mean dose of 50 Gy), 9 tumours (21%) had complete clinical responses, 24 (57%) partial responses, 9 (21%) stable disease. Breast-conserving surgery or exclusive RT-HT was possible in 74% of tumours. For 29 patients who underwent breast surgery, the rate of pathological complete responses was 17%. At 50 Gy no skin toxicity higher than grade 2 occurred. Five year OS, RFS and local control were, respectively, 85%, 84% and 97%. Lymphoedema occurred in one patient. Conclusion: Concurrent association of RT-HT demonstrated good efficacy, both in terms of clinical and pathological complete responses. It allowed breast conservation with acceptable tolerance and good 5-year local control

  20. Utility of second-look examinations in the management of a new hypermetabolic lesion detected by fluorodeoxyglucose positron emission tomography/CT for diagnosis of loco-regional recurrence in patients with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jin Young; Cho, Kyu Ran; Park, Eun Kyung; Seo, Bo Kyoung; Woo, Ok Hee; Song, Sung Eun; Oh, Yu Whan; Bae, Jeong Won [Korea University College of Medicine, Seoul (Korea, Republic of)

    2014-02-15

    To investigate the clinical significance of a new hypermetabolic lesion detected by fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) as well as the utility of second-look examinations to evaluate loco-regional recurrence of breast cancer. Our database revealed 922 breast cancer patients who underwent surgery from January 2008 to July 2011. We included 20 patients with negative findings on routine follow-up but with new hypermetabolic lesions on FDG-PET/CT. All underwent second-look examination [breast ultrasound (US) = 14, chest CT scan = 6]. A total of 17 cases were pathologically verified and 3 were diagnosed with follow-up imaging. The locations were in the axillae (n = 7), breast (n = 6), chest wall (n = 3), cervical/supraclavicular (n = 3), and internal mammary (n = 1). Of the 20 hypermetabolic lesions, 10 were pathologically confirmed malignancies. Of the 14 patients who had undergone US, 7 had suspicious findings and 5 were confirmed as malignancies. Of a total of 6 patients who had undergone CT scans, 5 had suspicious findings and all turned out to be malignancies. The positive predictive value of the second-look examination was 83.3% (10/12). Second-look examination and pathologic confirmation should be performed for newly appearing hypermetabolic lesions on FDG-PET/CT in order to exclude loco-regional recurrence in breast cancer patients.

  1. Cytological and Pathological Correlation of FNAC in Assessing Breast Lumps and Axillary Lymph Node Swellings in a Public Sector Hospital in India

    Directory of Open Access Journals (Sweden)

    Vasu Reddy Challa

    2013-01-01

    Full Text Available Background. Breast lumps have varied pathology, and there are different techniques to prove the diagnosis. The aim of the present study is to analyze the role of fine needle aspiration cytology (FNAC of the breast lesions at our center. Methods. We had retrospectively analysed 854 patients who underwent FNAC for primary breast lumps and 190 patients who underwent FNAC for an axillary lymph node in the year 2010. Results. Of 854 patients, histological correlation was available in 723 patients. The analysis was done for 812 patients as medical records were not available for 42 patients. FNAC was false negative in seven cases; 2 cases of phyllodes were reported as fibroadenoma, and 5 cases of carcinoma were diagnosed as atypical hyperplasia. The sensitivity, specificity, and false negative value of FNAC in diagnosing breast lumps were 99% (715/723, 100%, and 1%, respectively. Of 190 patients for whom FNAC was performed for axilla, 170 had proven to have axillary lymph node metastases, and the rest had reactive hyperplasia or inflammatory cells. Conclusions. FNAC is rapid, accurate, outpatient based, and less complicated procedure and helps in diagnosis of breast cancer, benign diseases, and axillary involvement in experienced hands with less chance of false results.

  2. Clinical effects of treating axillary osmidrosis by minimally invasive treatment%微创治疗腋臭临床效果探讨

    Institute of Scientific and Technical Information of China (English)

    李立仲; 魏斌; 石伟强; 彭旭; 魏超

    2015-01-01

    Objective To discuss the combination of liposuction and curette scratch method treating ex?perience. Methods From March 2012 to 2015 January the author treated 100 cases of patients with osmidrosis axillae and the anterior axillary fold 3mm incision approach and application of liposuction with curette scratch scratch,postoperative pressurized 7 days. Results The cure rate was 93%, with an efficiency of 100 percent.In 5 cases,the skin flap necrosis was found in the skin flap,which healed af?ter dressing change. Conclusion the combination of liposuction and curette scratch method of treat?ing axillary osmidrosis is minimally invasive treatment,effectively safe,and worthy of promotion.%目的:探讨吸脂结合刮匙搔刮方法治疗腋臭的心得体会.方法:2012年3月-2015年1月,笔者收治100例腋臭患者,采用腋前皱襞3mm切口为入路,应用吸脂术结合刮匙搔刮,术后加压包扎7d.结果:治愈率93%,有效率100%.术后5例出现皮瓣局灶性坏死,换药后愈合.结论:吸脂法结合搔刮法治疗腋臭具有微创、安全有效、值得推广.

  3. Ultrasound -a useful complementary tool to mammography in assessment of symptomatic breast diseases

    International Nuclear Information System (INIS)

    Breast cancer is the most common female malignancy worldwide. Pakistan has the highest incidence rate of breast cancer than any other Asian population. The purpose of the study was to evaluate the worth of sono-mammography in diagnosis of symptomatic breast diseases by comparing it with mammogram. Methods: In this cross-sectional validation study, 45 subjects with mean age of 45+-12.07 were included. Majority of the patients presented with complaint of breast lump. After complete history and clinical examination, all the patients had high resolution ultrasound of bilateral breasts and axilla followed by bilateral mammography. Histopathology was taken as gold standard in this study. The exclusion criteria were pregnancy and patients having direct clinical signs of breast malignancy. Results: Based on histopathology, out of 45 patients with breast symptoms, 12 patients had benign lesions, whereas 32 patients were diagnosed as the cases of breast cancers. Finally one patient did not have biopsy proven final diagnosis. Sensitivity and specificity of ultrasound were calculated to be 100% and 67% as compared to sensitivity and specificity of 90.6% and 91.7% for that of mammography. Conclusions: Ultrasound is a useful complementary tool to mammography in assessment of symptomatic breast diseases since it helps in characterization and localization of breast lesions seen on mammogram and it is not limited by dense breasts. Also it should be the considered as initial imaging technique for assessment of palpable breast lumps. (author)

  4. DISTRIBUTION OF ESCHAR IN CHILDREN WITH SCRUB TYPHUS

    Directory of Open Access Journals (Sweden)

    Bahubali D

    2015-08-01

    Full Text Available Scrub typhus is caused by an intracellular bacterium, Orientia tsutsugamushi. It causes a disseminated vasculitic and perivascular inflammatory lesions. These lead to significant vascular leakage and end ‑ organ injury. Eschar is the site of inoculation. It is painless and non - pruritic. It is a useful indicator of the disease. We studied the scrub typhus children with eschar to describe its distribution. MATERIAL AND METHODS: This is a retrospective study done in tertiary care hospital. Study was done with aim of studying the distribution of eschar. Patients included in study are: confirmed to have scrub typhus with a positive Scrub typhus IgM ELISA test and presence of eschar, Children less than 18 years. Data collected regarding clinical profile of cases and eschar distribution. RESULTS: Totally 52 cases with eschar were included in the study. Commonest site of eschar was axilla followed by groin. Other common sites of eschar included abdomen and chest. CONCLUSION: Detection of eschar helps clinically to distinguish scrub typhus from other febrile illness. Knowledge of common eschar sites would be useful for early clinical diagnosis of scrub typhus.

  5. Contralateral axillary disease in patients with previously treated breast cancer: manifestation of distant metastases or occult primary in contralateral breast?

    International Nuclear Information System (INIS)

    Contralateral axillary lymphadenopathy is occasionally seen in patients following disease in the ipsilateral breast. The aim of the study was to find out whether it might be a manifestation of an occult primary in the contralateral breast or manifestation of distant metastases from the previously treated carcinoma. A review of the records of 1331 breast cancer patients presented with recurrent disease and treated with surgery, radio-, chemo- or combined therapy showed that 36 patients presented with disease in the contralateral axilla during follow up. In 21 (1.6%) of them contralateral lymphadenopathy was the only symptom of the disease. 16 of them developed disease in the contralateral breast: in all cases the disease was locally advanced in nature indicative of diffuse involvement of the whole breast. In almost all 36 cases systemic disease developed soon after contralateral axillary disease was noted. These observations as well as pathological analysis suggested that contralateral axillary disease in our patients was an indication of metastases from the ipsilateral breast rather than manifestation of occult primary in the contralateral breast. (author)

  6. Breast Lymphatic Mapping and Sentinel Lymph Node Biopsy: State of the Art: 2015.

    Science.gov (United States)

    Reintgen, Michael; Kerivan, Lauren; Reintgen, Eric; Swaninathan, Santosh; Reintgen, Douglas

    2016-06-01

    Lymphatic mapping with sentinel lymph node biopsy (SLNB) was introduced in the 1990s as a method to stage the nodal axilla in women with breast cancer. Very quickly the technique became the standard of care because pathologic staging was more accurate and sensitive and the surgical procedure resulted in low morbidity. SLNB has continued to evolve, and the applications in breast cancer have been expanded. A review of the published data was performed to update the lymphatic mapping technique and identify key issues and trends in the application of SLNB in women with breast cancer in 2015. The importance of axillary staging continues to effect the surgical treatment of patients with breast cancer. Originally described for patients with invasive cancer, the technique now plays an important role in staging women with ductal carcinoma in situ or recurrent breast cancer and patients with advanced breast cancer who are receiving neoadjuvant chemotherapy. Histologic examinations have incorporated multiple sectioning and immunostains. The morbidity has been low, and techniques for limiting lymphedema are being introduced. Lymphatic mapping will continue to play an important role in the treatment of women with breast cancer. The SLNB will evolve by eliminating the need for radioactivity in the operating room, and the technique will become more accurate and used in expanded indications by incorporating preoperative imaging and intraoperative guidance procedures. PMID:26952594

  7. Radiation to the breast. Complications amenable to surgical treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bostwick, J.; Stevenson, T.R.; Nahai, F.; Hester, T.R.; Coleman, J.J.; Jurkiewicz, M.J.

    1984-10-01

    Major complications of radiation directed to the breast, axilla, and mediastinum were treated in 54 patients from 1974 to 1983. A classification of these complications facilitates both an understanding of the pattern of injury and the development of a treatment plan. Classification: I. Breast necrosis; II. Radionecrosis and Chest Wall Ulceration; III. Accelerated Coronary Atherosclerosis with Median Sternotomy Wound Failure After Coronary Revascularization; IV. Brachial Plexus Pain and Paresis; V. Lymphedema and Axillary Cicatrix; VI. Radiation-induced Neoplasia. The treatment has evolved during the 10-year study period to excision of the necrotic wound, including any tumor, and closure with a transposed muscle or musculocutaneous flap of latissimus dorsi (II, III, V) or rectus abdominis (I, II, VI). This strategy reflects a change from primary use of the omentum during the first years of the study. The vascularity, oxygen and antibiotic delivery of these muscle and musculocutaneous flaps promote wound healing, usually with one operation. The transfer of these muscles has not caused significant functional deficits.

  8. A triceps musculocutaneous flap for chest-wall defects

    Energy Technology Data Exchange (ETDEWEB)

    Hartrampf, C.R. Jr.; Elliott, L.F.; Feldman, S. (Emory Univ. School of Medicine, Atlanta, GA (USA))

    1990-09-01

    A posterior upper arm flap based on the profunda brachii vessels has been described to cover soft-tissue defects in the upper anterolateral chest. In our series, the posterior upper arm skin is elevated with the long head of the triceps muscle to cover seven chest-wall defects resulting from indolent postradiation open wounds following partial TRAM flap failure (n = 2), soft-tissue deficiencies following partial TRAM flap loss (n = 3), and primarily as an ancillary flap in TRAM flap breast reconstruction (n = 2). This flap also may be used to supply well-vascularized tissue in the regions of the shoulder, axilla, and posterolateral back. A prerequisite for this operation is redundant tissue of the upper arm often present in middle-aged women and in patients with lymphedema following mastectomy. In our series of seven patients, all donor sites were closed primarily, and there was no subjective functional deficit following transfer of the long head of the triceps muscle.

  9. Secondary pancreatic involvement by a diffuse large B-cell lymphoma presenting as acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    M Wasif Saif; Sapna Khubchandani; Marek Walczak

    2007-01-01

    Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma. More than 50% of patients have some site of extra-nodal involvement at diagnosis,including the gastrointestinal tract and bone marrow.However, a diffuse large B-cell lymphoma presenting as acute pancreatitis is rare. A 57-year-old female presented with abdominal pain and matted lymph nodes in her axilla. She was admitted with a diagnosis of acute pancreatitis. Abdominal computed tomography (CT) scan showed diffusely enlarged pancreas due to infiltrative neoplasm and peripancreatic lymphadenopathy. Biopsy of the axillary mass revealed a large B-cell lymphoma.The patient was classified as stage Ⅳ, based on the Ann Arbor Classification, and as having a high-risk lymphoma,based on the International Prognostic Index. She was started on chemotherapy with CHOP (cyclophosphamide,doxorubicin, vincristine and prednisone). Within a week after chemotherapy, the patient's abdominal pain resolved. Follow-up CT scan of the abdomen revealed a marked decrease in the size of the pancreas and peripancreatic lymphadenopathy. A literature search revealed only seven cases of primary involvement of the pancreas in B-cell lymphoma presenting as acute pancreatitis. However, only one case of secondary pancreatic involvement by B-cell lymphoma presenting as acute pancreatitis has been published. Our case appears to be the second report of such a manifestation.Both cases responded well to chemotherapy.

  10. The diagnosis by computed tomography of brachial plexus lesions following radiotherapy for carcinoma of the breast

    International Nuclear Information System (INIS)

    The region of the brachial plexus in the root of neck and axilla was examined by computed tomography (CT) in 62 patients attending the Royal Marsden Hospital. Forty-two of these patients had been treated by surgery and subsequent radiotherapy for carcinoma of the breast. Computed tomography was able to identify varying grades of abnormality that were ascribed to radiation fibrosis. Twenty-eight patients had neurological symptoms affecting the arm or hand on the treated side and CT changes were seen in 96%. The grading and significance of these CT abnormalities is discussed. The patients had been treated by two different radiotherapy techniques (three-field and four-field) which utilised either a large or small treatment fraction. The higher grades of abnormality on CT were seen in 57% of those treated with the large fraction size and 27% of those treated with the small fraction size. However, the changes on CT did not relate to the different radiotherapy techniques. (author)

  11. Radiation-induced brachial plexopathy: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wouter van Es, H. [Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Engelen, A.M. [Department of Radiation Therapy, University Hospital Utrecht, Utrecht (Netherlands); Witkamp, T.D. [Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Ramos, L.M.P. [Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Feldberg, M.A.M. [Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands)

    1997-05-01

    Objective. To describe the MR imaging appearance of radiation-induced brachial plexopathy. Design. MR imaging was performed in two patients with the clinical diagnosis of radiation-induced brachial plexopathy and in one with surgically proven radiation fibrosis of the brachial plexus. Patients. Three patients who had had radiation therapy to the axilla and supraclavicular region (two with breast carcinoma and one with Hodgkin`s lymphoma) presented with symptoms in the arm and hand. To exclude metastases or tumor recurrence MR imaging was performed. Results and conclusion. In one patient, fibrosis showing low signal intensity was found, while in two patients high signal intensity fibrosis surrounding the brachial plexus was found on the T2-weighted images. In one case gadolinium enhancement of the fibrosis was seen 21 years after radiation therapy. It is concluded that radiation-induced brachial plexopathy can have different MR imaging appearances. We found that radiation fibrosis can have both low or high signal intensities on T2-weighted images, and that fibrosis can enhance even 21 years after radiation therapy. (orig.). With 3 figs.

  12. Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer-a review

    Energy Technology Data Exchange (ETDEWEB)

    Galecki, Jacek; Hicer-Grzenkowicz, Joanna; Grudzien-Kowalska, Malgorzata; Zalucki, Wojciech [Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland). Dept. of Radiotherapy; Michalska, Teresa [Academy of Medicine, Warsaw (Poland). Neurological Clinic, Second Dept.

    2006-04-15

    In order to increase the availability of adjuvant radiotherapy of breast cancer patients and make it more convenient and cheaper, in numerous cancer centres, the dose per fraction has been increased from 2 Gy to 2.25-2.75 Gy and the total dose has been decreased from 50 Gy to 40-45 Gy. The risk of developing any late complications after conventionally fractionated megavoltage radiotherapy is estimated to be below 1%. The aim of this review is to determine whether hypofractionated regimens increase the risk of damage to the brachial plexus. A review of the published literature shows that the use of doses per fraction in the range from 2.2 Gy to 4.58 Gy with the total doses between 43.5 Gy and 60 Gy causes a significant risk of brachial plexus injury which ranged from 1.7% up to 73%. The risk of radiation induced brachial plexopathy was smaller than 1% using regimens with doses per fraction between 2.2 and 2.5 Gy with the total doses between 34 and 40 Gy. Surgical manipulations in the axilla and chemotherapy have to be taken into account as additional factors which may increase the risk of brachial plexopathy.

  13. A triceps musculocutaneous flap for chest-wall defects

    International Nuclear Information System (INIS)

    A posterior upper arm flap based on the profunda brachii vessels has been described to cover soft-tissue defects in the upper anterolateral chest. In our series, the posterior upper arm skin is elevated with the long head of the triceps muscle to cover seven chest-wall defects resulting from indolent postradiation open wounds following partial TRAM flap failure (n = 2), soft-tissue deficiencies following partial TRAM flap loss (n = 3), and primarily as an ancillary flap in TRAM flap breast reconstruction (n = 2). This flap also may be used to supply well-vascularized tissue in the regions of the shoulder, axilla, and posterolateral back. A prerequisite for this operation is redundant tissue of the upper arm often present in middle-aged women and in patients with lymphedema following mastectomy. In our series of seven patients, all donor sites were closed primarily, and there was no subjective functional deficit following transfer of the long head of the triceps muscle

  14. Radiotherapy alone in breast cancer

    International Nuclear Information System (INIS)

    This retrospective analysis was conducted on breast cancer patients treated by radiotherapy alone at The Princess Margaret Hospital and at the Institut Gustave-Roussy. These patients had either operable tumours, but were unfit for general anesthesia, or had inoperable tumors due to local contraindications to surgery. Previous results showed that a radiation dose increase of 15 Gy can decrease the relative risk of tumour or lymph node recurrence twofold. In this third report, the same data were analyzed to determine the treatment-related complication rates and to correlate these to the radiation dose levels. Overall results were analyzed on 453 patients, but detailed analyses on complications were conducted on 372 patients not developing local recurrence in the first 6 months of follow-up. Each complication was graded on a 3-level previously defined scale. Most frequent complications were skin changes of different degrees, which were usually asymptomatic. More disabling complications were arm edema, impaired shoulder mobility, rib fractures and brachial plexopathy. The incidence of disabling complications was low. The only factor significantly increasing the risk of complications was the radiation dose level to the tumour and axilla. Technical factors such as overlapping fields should also be taken into account. As the more effective control of tumour and lymph nodes obtained in patients treated with higher radiation doses is counterbalanced by an increase in the complication rate, the dose to be delivered for each patient should be carefully chosen according to individual risk factors. (author). figs

  15. Ultrasonographic features of fibrous hamartoma of infancy

    International Nuclear Information System (INIS)

    To review imaging features of fibrous hamartoma of infancy (FHI), focusing on ultrasonography (US) findings. We retrospectively reviewed pediatric patients who were diagnosed with pathologically confirmed FHI in two children's hospitals from 2004 to 2013. Imaging features of US, Doppler US, and magnetic resonance imaging (MRI) were evaluated. Thirteen pediatric patients (M:F = 7:6; age 5-22 months, mean 11.3 months) were included. Mean lesion size was 3.2 cm (range, 0.7-8.0 cm). The tumors were located in the back (n = 4), scrotum (n = 2), scalp, shoulder, axilla, forearm, intergluteal cleft, inguinal area, and thigh. US was performed in 11 patients. With the exception of two scrotal masses, all masses were located in the dermal and subcutaneous layer. All masses demonstrated heterogeneous hyperechogenicity with a ''serpentine pattern'' of intervening hypoechoic portions in the hyperechoic mass. The margins were ill-defined (n = 9) or lobulated (n = 2). Doppler US was performed in nine patients and showed no (n = 6) or minimal (n = 3) vascularity. MRI was performed in five patients and the masses showed heterogeneous signal intensity with the presence of fat on T1- and T2-weighted images. FHI is a tumor that is typically located in the dermal and subcutaneous layer in young children less than 2 years old and presents as a heterogeneously hyperechoic mass with a ''serpentine pattern'' and ill-defined or lobulated margin on US and no remarkable vascularity on Doppler US. (orig.)

  16. Survey of the Role of Combined Screening Method with Ultrasonography in the Diagnosis of Breast Cancer

    Directory of Open Access Journals (Sweden)

    F. Gharekhanloo

    2011-01-01

    Full Text Available Introduction & Objective: The breast cancer is the most common malignancy in women and in recent years it is seen in younger ages. Because of dense breast tissue in these ages, the mammography sensitivity for breast cancer detection is reduced, so high quality ultrasonography (US as a combined screening method is effective. The aim of this study is the evaluation of the mammographic finding with the positive finding of ultrasonogarphy.Materials & Methods: In this cross-sectional study 300 cases were referred to the Mehr Medical Imaging Center for breast US and sonography of breast and axilla was performed. Mammography before or after US was also performed by another radiologist. All suspicious patients were referred for biopsy or surgery.Results: Mean age of patients was 46 y/o with the range of 32-76 y/o. Pathologic specimens approved malignancy in 21 patients and abscess in 1 patient. The most frequent symptom was palpable breast mass with mean diameter of 29 mm. Mean diameter of lymph nodes was 17.3 mm. Positive mammographic findings were seen in 85.7%and negative findings or only an asymmetric density in 14.3%.Conclusion: According to dense breast tissue especially in young women sensitivity of single screening by mammography is reduced in breast cancer detection, so combined screening with sonography and mammography especially in younger women improves the detection rate of breast carcinoma. (Sci J Hamadan Univ Med Sci 2011;17(4:57-60

  17. Sudden onset of facial edema and serum LDH elevation after radiation therapy for malignant lymphoma of the left parotid gland. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Gen; Ogo, Etuyo; Toda, Yukihiro; Suefuji, Hiroaki; Hayabuchi, Naofumi [Kurume Univ., Fukuoka (Japan). School of Medicine

    2001-12-01

    A report of a 48 year-old male with non-Hodgkin's lymphoma of the left parotid gland (clinical stage I EA, follicular medium-sized B cell type) is presented. He was solely treated with 30 Gy of radiation to the whole neck region, bilateral paraclavicular region and the left axilla, and 10.6 Gy boost was given to the primary lesion. Five months later, facial edema and serum LDH elevation developed suddenly. Relapse of the malignant lymphoma was suspected, but a whole body CT scan failed to show this. On the contrary, the CT scan showed a diffuse hypoattenuated area of the thyroid gland. In addition to positive antibodies, i.e, antithyroglobulin and antimicrosomal antibodies, total cholesterol and other serum markers also suggested hypofunction of the thyroid due to acute exacerbation of chronic thyroiditis. Immediately after hormone-replacement therapy, his symptoms disappeared and the abnormal serum data improved. Although the relationship between chronic thyroiditis and radiation injury has not been clearly demonstrated, it seems necessary to evaluate thyroid function before radiotherapy for head and neck tumors. Patients with chronic thyroiditis should be followed carefully after radiotherapy. (author)

  18. Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI

    International Nuclear Information System (INIS)

    Metastatic involvement of axillary lymph nodes is one of the most important prognostic variables in breast cancer. The aim of our work was to study the value of dynamic contrast-enhanced MR imaging in revealing axillary lymph node metastases from breast cancer. A total of 65 patients with invasive breast cancer treated with axillary lymph node dissection were preoperatively evaluated by MRI. T1-weighted dynamic contrast-enhanced 3D images were acquired using a coil covering the breast and the axilla. The dynamic contrast enhancement, size, and morphology of the axillary lymph nodes were registered. Histopathological examination revealed axillary lymph node metastases in 24 patients. When using a signal intensity increase in the lymph nodes of > 100 % during the first postcontrast image as a threshold for malignancy, 57 of 65 patients were correctly classified (sensitivity 83 %, specificity 90 %, accuracy 88 %). These results were not improved when lymph node size and morphology were used as additional criteria. Axillary lymph nodes can be evaluated as a part of an MR-mammography study without substantial increase in examination time, and provide the surgeon with knowledge about the localization of possible metastatic lymph nodes. (orig.)

  19. Protecting the radiation-damaged skin from friction: a mini review

    Energy Technology Data Exchange (ETDEWEB)

    Herst, Patries M [Department of Radiation Therapy, University of Otago, Wellington (New Zealand)

    2014-06-15

    Radiation-induced skin reactions are an unavoidable side effect of external beam radiation therapy, particularly in areas prone to friction and excess moisture such as the axilla, head and neck region, perineum and skin folds. Clinical studies investigating interventions for preventing or managing these reactions have largely focussed on formulations with moisturising, anti-inflammatory, anti-microbial and wound healing properties. However, none of these interventions has emerged as a consistent candidate for best practice. Much less emphasis has been placed on evaluating ways to protect the radiation-damaged skin from friction and excess moisture. This mini review analyses the clinical evidence for barrier products that form a protective layer by adhering very closely to the skin folds and do not cause further trauma to the radiation-damaged skin upon removal. A database search identified only two types of barrier products that fitted these criteria and these were tested in two case series and six controlled clinical trials. Friction protection was most effective when the interventions were used from the start of treatment and continued for several weeks after completion of treatment. Soft silicone dressings (Mepilex Lite and Mepitel Film) and Cavilon No Sting Barrier Film, but not Cavilon Moisturizing Barrier Cream, decreased skin reaction severity, most likely due to differences in formulation and skin build-up properties. It seems that prophylactic use of friction protection of areas at risk could be a worthwhile addition to routine care of radiation-damaged skin.

  20. Unusual and Unique Variant Branches of Lateral Cord of Brachial Plexus and its Clinical Implications- A Cadaveric Study

    Science.gov (United States)

    Padur, Ashwini Aithal; Shanthakumar, Swamy Ravindra; Shetty, Surekha Devadas; Prabhu, Gayathri Sharath; Patil, Jyothsna

    2016-01-01

    Introduction Adequate knowledge on variant morphology of brachial plexus and its branches are important in clinical applications pertaining to trauma and surgical procedures of the upper extremity. Aim Current study was aimed to report variations of the branches of the lateral cord of brachial plexus in the axilla and their possible clinical complications. Materials and Methods Total number of 82 upper limbs from 41 formalin embalmed cadavers was dissected. Careful observation was made to note the formation and branching pattern of lateral cord. Meticulous inspection for absence of branches, presence of additional or variant branches and presence of abnormal communications between its branches or with branches of other cords was carried out. Results In the present study, we noted varied branching pattern of lateral cord in 6 out of 82 limbs (7%). In one of the limb, the median nerve was formed by three roots; two from lateral cord and one from medial cord. Two limbs had absence of lateral pectoral nerve supplemented by medial pectoral nerves. One of which had an atypical ansa pectoralis. In 2 upper limbs, musculocutaneous nerve was absent and in both cases it was supplemented by median nerve. In one of the limb, coracobrachialis had dual nerve supply by musculocutaneous nerve and by an additional branch from the lateral cord. Conclusion Variations of brachial plexus and its branches could pose both intraoperative and postoperative complications which eventually affect the normal sensory and motor functions of the upper limb. PMID:27190783

  1. The impact of the number of excised axillary nodes and of the percentage of involved nodes on regional nodal failure in patients treated by breast-conserving surgery with or without regional irradiation

    International Nuclear Information System (INIS)

    Purpose: After breast-conserving surgery, recommendations for regional nodal radiotherapy are usually based on the number of positive nodes. This number is dependent on the number of nodes removed during the axillary dissection. This study examines whether the percentage of positive nodes may help to select patients for regional radiotherapy. Methods and Materials: A retrospective study was conducted on 1,372 T1-T2 node-positive breast cancer patients treated at L'Hotel-Dieu de Quebec Hospital between 1972 and 1997. Results: Among the patients who did not receive regional radiotherapy, the percentage of involved nodes was significantly associated with axillary failure. Ten-year axillary control rates were 97% and 91% when the percentage of involved nodes was 3 nodes). Conclusions: The percentage of involved nodes should be taken into consideration in selecting patients for regional radiotherapy. Irradiation of the axilla should be reserved for patients with a specific ratio: >40% involved nodes if N1-3 and ≥50% involved nodes if N>3 nodes

  2. Hyalomma aegyptium on Spur-thighed Tortoise (Testudo graeca in Urmia Region West Azerbaijan, Iran

    Directory of Open Access Journals (Sweden)

    M Tavassoli

    2007-05-01

    Full Text Available Background: Ticks are obligate blood feeders that parasitize a wide variety of animals. Hyalomma aegyptium, parasitize tortoises and other small wild life and livestock. This study was carried out to determine spur-thighed tortoise (Testudo graeca infestation to H. ageyptium in Urmia region West Azerbaijan of Iran. Methods: The study was carried out over a 16 month period from the spring of 2004 to the fall of 2005. A total of 32 tor¬toises were sampled. Results: The results indicated that 14 tortoises infected with ticks. A total of 117 ticks were collected from infested animals, the minimum and maximum tick infestation was 1-60. Ticks were attached to the axilla of fore and hind legs of tortoises. All ticks were determined to be H. aegyptium. Conclusion: H. aegyptium was the most common tick species in the study area. Due to tendency of some people to keeping tortoise as pet animal, more attention must be done to tortoise’s tick infestation. Due to existence of H. aegyptium on tor¬toises in this region more study will need to evaluate presence of this tick on other animal species and its role on transmis¬sion of diseases.

  3. Ultrasound guidance improves the success rate of axillary plexus block: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Qin Qin

    2016-04-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the value of real-time ultrasound (US guidance for axillary brachial plexus block (AXB through the success rate and the onset time. METHODS: The meta-analysis was carried out in the Anesthesiology Department of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China. A literature search of Medline, EMBASE, Cochrane database from the years 2004 to 2014 was performed. The literature searches were carried out using medical subject headings and free-text word: "axilla", "axillary", "brachial plexus", "ultrasonography", "ultrasound", "ultrasonics". Two different reviewers carried out the search and evaluated studies independently. RESULTS: Seven randomized controlled trials, one cohort study and three retrospective studies were included. A total of 2042 patients were identified. 1157 patients underwent AXB using US guidance (US group and the controlled group included 885 patients (246 patients using traditional approach (TRAD and 639 patients using nerve stimulation (NS. Our analysis showed that the success rate was higher in the US group compared to the controlled group (90.64% vs. 82.21%, p < 0.00001. The average time to perform the block and the onset of sensory time were shorter in the US group than the controlled group. CONCLUSION: The present study demonstrated that the real-time ultrasound guidance for axillary brachial plexus block improves the success rate and reduce the mean time to onset of anesthesia and the time of block performance.

  4. Predicting invasion in mammographically detected microcalcification

    International Nuclear Information System (INIS)

    AIM: To identify pre-operative factors which predict presence of invasive disease within mammographically detected malignant microcalcification. MATERIALS AND METHODS: A retrospective analysis was undertaken of 116 serial stereotactic core needle biopsies (SCNBs) performed on malignant mammographic calcification. Final surgical pathology was correlated with pre-operative features (clinical, radiological and core histology) in an attempt to predict the presence of an invasive component. RESULTS: Thirty-eight clusters contained invasive carcinoma. The sensitivity of SCNB for invasion was 55%. Clinical features, calcium morphology and cluster size were not shown to be predictive of invasive disease. Ductal carcinoma in situ(DCIS) of high grade on core histology and increasing number of calcifications were predictive of increased risk of invasion (high grade core biopsy DCIS and >40 calcifications 48% invasive at surgical histology; high grade core biopsy DCIS and <40 calcifications 15% invasive; non-high grade core biopsy DCIS 0% invasive). CONCLUSIONS: Identification of those clusters diagnosed as DCIS by percutaneous biopsy which are likely to harbour an invasive component is possible. It would seem reasonable to consider staging the axilla at therapeutic surgery in these patients. Bagnall, M.J.C. et al. (2001)

  5. Infantile lipofibromatosis of the upper limb

    Energy Technology Data Exchange (ETDEWEB)

    Teo, Harvey E.L.; Peh, Wilfred C.G. [KK Women' s and Children' s Hospital, Department of Diagnostic Imaging, Singapore (Singapore); Chan, Mei-Yoke [KK Women' s and Children' s Hospital, Department of Paediatric Medicine, Singapore (Singapore); Walford, Norman [Tan Tock Seng Hospital, Department of Pathology, Singapore (Singapore)

    2005-12-01

    The imaging features of extensive lipofibromatosis presenting in a 1-day-old female infant are reported. This lesion involved her entire right upper limb, extending from the axilla to the palm of the hand. Radiographs showed marked deformity and thinning of all the right upper-limb bones due to pressure effect of soft-tissue enlargement, especially affecting the distal humerus and proximal forearm bones. Magnetic resonance imaging showed a huge soft-tissue mass infiltrating most of the muscles of the entire upper limb, with bony erosion. The mass was largely T1-isointense, moderately T2-hyperintense and showed marked enhancement. There were intra-lesional signal changes consistent with fatty elements. A lesion debulking procedure was performed and the histology was that of lipofibromatosis. The limb was found to be non-viable after the procedure and a subsequent above-elbow amputation was performed. Although the resection margins were not clear, she had no further recurrence over a subsequent 3-year follow-up period. (orig.)

  6. Scrotal and retroperitoneal lymphangioma of a 12-year-old boy: case report

    International Nuclear Information System (INIS)

    Lymphangiomas occurs in children quite frequently. They are most commonly localized in the head, neck, axilla, chest, abdomen, and retroperitoneum. Lymphangiomas of the scrotum are very rare and are usually clinically silent, so they are a challenge for radiologists performing US examination in children. They are obliged to differentiate the following lesions: torsion of the testicle, scrotal hernia, hydrocoele, and epididymal cyst, in addition to the masses of primary extra-testicular localization such as hemagioma, congenital vascular malformations, fibromas, and malignant tumors. Additional difficulties appear in boys who present acute scrotum syndrome. The paper reports the diagnostics and treatment of a huge multicystic lymphangioma situated in he scrotum and retroperitoneum of a 12-year-old boy who had fallen from a bicycle and presented acute scrotum. The lesion of the scrotum was surgically excised. Retroperitoneal lymphangioma was detected during this operation. Subsequent diagnostics was based on ultrasonography, computerized tomography, and magnetic resonance imaging of the abdominal cavity. The lymphangioma of the retroperitoneum was resected. The patient shows no evidence of recurrence after 7 years. Cystic lymphangiomas are rare but benign intra-scrotal, extra-testicular, painless masses in children. They are sonographically multicystic or multiloculated abnormalities and may show infiltrative extension to the perineum, retroperitoneum, or abdomen. Recognition of this entity and its extent is important for correct clinical management and may be for planning treatment. (author)

  7. Correlation of Various Biomarkers with Axillary Nodal Metastases: Can a Panel of Such Biomarkers Guide Selective Use of Axillary Surgery in T1 Breast Cancer?

    Science.gov (United States)

    Dass, Tufale A; Rakesh, Sharma; Prakash, K Patil; Singh, Chandraveer

    2015-12-01

    To evaluate the correlation of various clinic-pathological variables with axillary nodal involvement in T1 breast cancer & to identify a sub-group of T1 cancers, on the basis of observed variables, with a low risk of axillary nodal metastases. Clinico-pathological variables observed included tumor size, lymphovascular invasion (LVI), histological grade of tumor, tumor palpability, estrogen/progesterone (ER/PR) & her2/neu receptors, age, family history, histological type of tumor, axillary nodal metastases for 100 patients without clinically palpable nodes who underwent axillary lymph node dissection in Bombay Hospital & Medical Research Center from March, 2009. Data compiled was analyzed by univariate & multivariate analysis. All the variables viz. tumor size, LVI, histological grade, tumor palpability & ER/PR/Her2 receptor profile, which were found to be significantly associated with axillary lymph node involvement (ALNI) on univariate analysis were also found to be independent predictors of ALNI on multivariate analysis. Age of the patient, family history & histological type of tumor were not significantly correlated with ALNI. None of the 12 patients with tumor biomarker profile of T1a-b tumors without LVI & with histological grade I, had ALNI. The risk of ALNI can be predicted by using various tumor biomarker variables. Based on the predicted risk of ALNI, the management strategy for axilla can be individualized. The omission of operative axillary staging may be considered in patients with low predictive risk of ALNI. PMID:27065659

  8. Breast education in general surgery residency.

    Science.gov (United States)

    Wilson, Jason P; Miller, Austin; Edge, Stephen B

    2012-01-01

    Breast cancer treatment has changed substantially with increased specialization. Overall, the number of cases performed by residents upon completion of residency has decreased and the introduction of sentinel lymph node biopsy has reduced the number of axillary lymph node dissections being performed. Our objective was to evaluate the breast surgery education being provided by general surgery residency programs. A survey was administered to applicants to the Roswell Park Cancer Institute surgical oncology fellowship program in the fall of 2009. This survey examined the type of training program, the breast surgery exposure, and applicant comfort with the medical and surgical aspects of breast cancer. The survey was completed by 29 of 35 applicants. Of the respondents, 83 per cent were chief residents. Overall, participants had comfort levels above 8 (of 10) with breast related cases. For modified radical mastectomies and axillary lymph node dissections the comfort level dropped below 8. Participants were least comfortable discussing the medical management of breast cancer. General surgery residents completing training were less comfortable operating in the axilla compared with the breast. The study suggests careful attention should be paid to assuring adequate breast education in surgical residency. PMID:22273306

  9. CLINICAL AND HISTOPATHOLOGICAL STUDY OF CUTANEOUS TUBERCULOSIS

    Directory of Open Access Journals (Sweden)

    Ashok S

    2014-09-01

    Full Text Available Extrapulmonary tuberculosis constitutes about 10% of all cases of tuberculosis, and cutaneous tuberculosis makes up only a small proportion of these cases. Despite prevention programs, tuberculosis is still progressing endemically in developing countries. Commonest clinical variant of cutaneous tuberculosis in our study was tuberculous verrucosa cutis (TBVC seen in 46.66% patients followed by Lupus vulgaris seen in 33.33% patients followed by scrofuloderma (13.33%, papulonecrotic tuberculide (6.66%. The commonest site of involvement was upper limbs seen in 46.66% patients followed by lower limb seen in 20% patients, face, neck, inguinal region, axilla, chest in 6.66% and generalized pappilary eruptions in 6.66% patients. Maximum percentage of patients (53.3% had duration of cutaneous tuberculosis between 1-3 years followed by 33.33% between 1-6 months, 6.66% had duration of cutaneous tuberculosis between 7-12 months, and rest 6.66% had duration between 4-6 years. The commonest histopathological feature in our study was tuberculoid granuloma with epithelioid and Langhans giant cells seen in 70% patients, hyperkeratosis was seen in 13.33% patients and AFB bacilli were seen in 6.66% patients.

  10. Ecthyma gangrenosum in a patient with non-Hodgkin lymphoma

    Directory of Open Access Journals (Sweden)

    Čolović Nataša

    2007-01-01

    Full Text Available Introduction. Ecthyma gangrenosum is a rare disease of the skin that causes the localized necrosis of the skin and subcutaneous fat tissue, leading to the multiple ulcerations surrounded by local hyperaemia. The ulcerations are usually localized in groins, and perianal area. In the majority of cases ecthyma is caused by a Pseudomonas aeruginosa sepsis. The disease usually appears in immunocompromized, most frequently hematological patients. Case report. We presented a 78-year-old woman who had been treated for non-Hodgkin lymphoma for the last 18 years. She had recently been given cytotoxics which led to neutropenia. The patient suddenly developed high fever, chill and diarrhea, followed by ecthyma gangrenosum cutaneous lesions in groins, axillas, right side of the neck and umbilicus. Pseudomonas aeruginosa and Proteus mirabilis, that were sensitive to several antibiotics were isolated. The treatment included rehydratation, antibiotics, surgical debridement and regular dressing with antiseptics. The healing of all lesions was achieved after sixteen weeks of the treatment. Conclusion. If haemorrhagic- necrotic lesions of the skin are developed in immunocompromised, usually haematologic patients, an Ecthyma gangrenosum has to be considered immediately, material for identification of a cause has to be taken, followed by immediate administration of antibiotics effective against Pseudomonas aeruginosa. Surgical debridement and other therapeutic modalities are to be considered in some patients. .

  11. Inhibition of metastasis to lung of a human nasopharyngeal carcinoma cell line CNE-2L2 transfected with pRc/CMV-antisense 6A8 cDNA in nude mice

    Institute of Scientific and Technical Information of China (English)

    张立新; 刘玉琴; 马凤蓉; 顾蓓; 史耕先; 赵雪梅; 李波; 高进; 赵方萄; 张淑珍; 李国燕; 王讯; 朱立平

    1999-01-01

    The growth of CNE-2L2 cell, a cloned line of human nasopharyngeal carcinoma with a high potentiality of metastasis to lung was inhibited to a certain extent after transfection with a recombinant antisense expression vector of a cDNA encoding a human α-mannosidase (pRc/CMV-antisense 6A8 cDNA)( the Genbank accession number of 6A8 cDNA is U37248) in comparison with that of the cell transfected with the Mock and of the wild cell. Two months after a subcutaneous inoculation of CNE-2L2 cell into the axilla of nude mice metastatic lesions in the lung were observed in 9/10 mice (90%) with grade Ⅲ in 8 mice and grade Ⅱ in one mouse in the wild cell group, in 6/8 mice (75%) with grade Ⅲ in one mouse, grade Ⅱ in 2 mice and grade Ⅰ in 3 mice in the Mock-transfection group, in only 3/10 mice (30%) with all grade Ⅰ in pRc/CMV-antisense 6A8 cDNA-transfection group.

  12. HISTOPATHOLOGICAL CHARACTERISTICS OF LYMPH NODE SINUS CONTAINING BLOOD

    Institute of Scientific and Technical Information of China (English)

    YIN Tong; JI Xiao-long

    2001-01-01

    This study is to find out the histopathological characteristics of lymph node sinus containing blood. Routine autopsy was carried out in the randomly selected 102 patients(among them,100 patients died of various diseases, and 2 of non-diseased causes),their superficial lymph nodes locating in the bilateral neck, axilla, inguina, thorax and abdomen were sampled. Haematoxylin-eosin staining was performed on 10% formalin-fixed and paraffin-embedded lymph node tissue sections(5μm).The histological characteristics of the lymph node sinuses containing blood were observed under light microscope. Among the 1362 lymph nodes sampled from the 100 autopsies, lymph sinuses containing blood were found in 809 lymph nodes sampled from 91 cases, but couldn't be seen in the lymph nodes sampled from the non-diseased cases. According to histology, five kinds of lymph sinuses containing blood were found:vascular-opening sinus, blood-deficient sinus, erythrophago-sinus, blood-abundant sinus, and vascular-formative sinus. It is concluded that in the state of disease, the phenomenon of blood in the lymph sinus is not uncommon. Blood could possibly enter into lymph sinus through lymphatic-venous communications between the veins and sinuses in the node. Lymph circulation and blood circulation could communicate with each other in the lymph sinus.

  13. Treatment of Frontal Hyperhidrosis With Botulinum Toxin

    Directory of Open Access Journals (Sweden)

    Ayşe Esra Koku Aksu

    Full Text Available Focal hyperhidrosis is usually localized to the axillae, palms and soles. Less frequently, hyperhidrosis may be confined to the forehead and may have negative impact on patient’s quality of life. A 34-year-old man presented to our clinic with the complaint of frontal hyperhidrosis. He was treated with botulinum toxin A. Thirty points were marked over the forehead and at each injection point, 0.15 ml (3U botulinum toxin A were injected intracutaneously. Hyperhidrosis was significantly reduced and the effect lasted for 12 months. Skindex-29, a quality-of-life measure for skin disease, was administered to the patient at the beginning and at the end of second week of botulinum toxin A injection. There was a significant improvement on the Skindex-29 scale at the end of the treatment. There was no any side effect detected during and after the treatment. Botulinum toxin A treatment is considered to be effective and safe for frontal hyperhidrosis.

  14. Comparison between hemosiderin and Technetium-99 in sentinel lymph node biopsy in human breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Vasques, Paulo Henrique Diogenes; Aquino, Ranniere Gurgel Furtado de; Pinheiro, Luiz Gonzaga Porto, E-mail: luizgporto@uol.com.br [Universidade Federal do Ceara (UFC), Fortaleza, CE (Brazil). Departamento de Cirurgia; Alves, Mayara Maia [Rede Nordeste de Biotecnologia (RENORBIO/UFC), Fortaleza, CE (Brazil); Torres, Roberto Vitor Almeida; Bezerra, Jose Lucas Martins [Universidade Federal do Ceara (UFC), Fortaleza, CE (Brazil). Faculdade de Medicina; Brasileiro, Luis Porto [Faculdades INTA, Sobral, CE (Brazil). Faculdade de Medicina

    2015-11-15

    Purpose: To assess the safety and potential equivalence of the use of hemosiderin compared to the Technetium-99 in sentinel lymph node biopsy in human breast cancer. Methods: Non-random sample of 14 volunteer women diagnosed with breast cancer with primary tumors (T1/T2) and clinically tumor-free axilla were submitted to the identification of sentinel lymph node using hemosiderin obtained from autologous blood injected in the periareolar region 24h before surgery on an outpatient basis. Patients received preoperative subareolar intradermal injection of Technetium-99 in the immediate preoperative period. Patients were submitted to sentinel lymph node biopsy, with incision in the axillary fold guided by Gamma-Probe, dissection by planes until the identification of the point of maximum uptake of Technetium-99, identifying the marked nodes and their colors. All surgical specimens were sent for pathological and immunohistochemical study. Results: The results showed no evidence of side effects and/or allergic and non-allergic reactions in patients submitted to SLNB with hemosiderin. The SLN identification rate per patient was 100%. SLNB identification rate per patient with hemosiderin was the same as that of Technetium, with a concordance rate of 100% between the methods. Conclusion: Hemosiderin is a safe dye that is equivalent to Technetium in breast sentinel lymph node biopsy. (author)

  15. Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients

    International Nuclear Information System (INIS)

    The aims of this study were (1) to evaluate FDG PET/CT and CT for the detection of axillary lymph node metastases in breast cancer (BC) patients and (2) to evaluate FDG PET/CT as a pre-test for the triage to sentinel lymph node biopsy (SLNB) versus axillary lymph node dissection (ALND). The sensitivity, specificity, positive and negative predictive value (PPV, NPV), and accuracy of FDG PET/CT and CT for axillary lymph node metastases were determined in 61 patients (gold standard: histopathology). According to the equation NPV = specificity .(1-prevalence)/[specificity.(1-prevalence)+(1-sensitivity).prevalence] FDG PET/CT was evaluated as a triage tool for SLNB versus ALND. The sensitivity, specificity, PPV, NPV and accuracy of FDG PET/CT was 58,92,82,77 and 79% and of CT 46,89,72,71 and 72%, respectively. Patients with an up to ∝60% risk for axillary lymph node metastases appear to be candidates for SLNB provided that the axilla is unremarkable on FDG PET/CT. FDG PET/CT cannot replace invasive approaches for axillary staging but may extend the indication for SLNB. (orig.)

  16. [Prophylactic axillary radiotherapy for breast cancer].

    Science.gov (United States)

    Rivera, S; Louvel, G; Rivin Del Campo, E; Boros, A; Oueslati, H; Deutsch, É

    2015-06-01

    Adjuvant radiotherapy, after breast conserving surgery or mastectomy for breast cancer, improves overall survival while decreasing the risk of recurrence. However, prophylactic postoperative radiotherapy of locoregional lymph nodes for breast cancer, particularly of the axillary region, is still controversial since the benefits and the risks due to axillary irradiation have not been well defined. To begin with, when performing conformal radiotherapy, volume definition is crucial for the analysis of the risk-benefit balance of any radiation treatment. Definition and contouring of the axillary lymph node region is discussed in this work, as per the recommendations of the European Society for Radiotherapy and Oncology (ESTRO). Axillary recurrences are rare, and the recent trend leads toward less aggressive surgery with regard to the axilla. In this literature review we present the data that lead us to avoid adjuvant axillary radiotherapy in pN0, pN0i+ and pN1mi patients even without axillary clearance and to perform it in some other situations. Finally, we propose an update about the potential toxicity of adjuvant axillary irradiation, which is essential for therapeutic decision-making based on current evidence, and to guide us in the evolution of our techniques and indications of axillary radiotherapy. PMID:26044178

  17. Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema.

    Science.gov (United States)

    Buragadda, Syamala; Alhusaini, Adel A; Melam, Ganeswara Rao; Arora, Nisha

    2015-09-01

    [Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compression garment, received glenohumeral mobilization, and performed deep breathing exercises, and the complete decongestive therapy group received CDT from a trained physiotherapist and a daily home program along with the conventional treatment, 5 days a week for 6 weeks. [Results] Arm circumference measurements were taken at five levels: the wrist, mid forearm, elbow, mid-upper arm, and axilla. The upper extremity function was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and pain was assessed using the visual analogue scale. Measurements were taken at baseline, and at 4th and 6th weeks after the start of intervention. Within and between group comparisons showed significant improvements in the CDT group. [Conclusion] Complete decongestive therapy and a home program assists breast cancer related lymphedema survivors in regaining their lost functions. It also helps to improve their independence in daily activities, reduce their need for caregivers, and thereby improving their quality of life. Therefore, the results of this study showed that the CDT with a home program is an effective treatment for reducing post mastectomy lymphedema. PMID:26504284

  18. Clinical feasibility of Axillary Reverse Mapping and its influence on breast cancer related lymphedema: a systematic review.

    Science.gov (United States)

    Gebruers, Nick; Tjalma, Wiebren A A

    2016-05-01

    Breast cancer is the most common malignancy in women worldwide. Fortunately, the overall survival is good. Therefore it is important to focus on the morbidities related to breast cancer treatment. One of the most dreaded morbidities is lymphedema. In 2007 the Axillary Reverse Mapping (ARM) was introduced to limit the invasiveness in the axilla during breast cancer surgery. It is hypothesized that ARM is able to limit the incidence of breast cancer related lymphedema (BCRL) considerably. This systematic review aims to answer the following research questions: (1) which approaches for ARM are described? (2) Is ARM surgical feasible and oncological safe? (3) Does ARM decrease the incidence of lymphedema after sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND)? In total 27 papers were retrieved using four electronic databases (PubMed, Web of Science, Medline and Cochrane clinical trials; assessed until May 13, 2015. The level of evidence of these studies was low (mostly level 3). Therefore the conclusions are that the ARM procedure is feasible although ARM-node rates have a broad range. Additionally, from a theoretical point there is a clear benefit from ARM in terms of lymphedema prevention. From a practical point there is little scientific data to support this due to the lack of studies; and especially because of the different methods and definitions for lymphedema used in the different studies. PMID:27019287

  19. Varied presentations of ectopic breast - polymastia, fibroadenoma, and carcinoma arising from ectopic breast tissue

    Directory of Open Access Journals (Sweden)

    Yasmeen Khatib

    2015-01-01

    Full Text Available Ectopic breast is a congenital anomaly of the breast which can have varied presentations because of its different sites and pathologies arising from it. Lesions of ectopic breast tissue (EBT are commonly seen due to persistence of embryonic remnants along the milk line. They have also been reported from other sites like face, vulva, and perineum. They are prone to the same physiological and pathological alterations seen in the normal breast. Only 0.3% of breast carcinomas arise in the ectopic breast, whereas only a few cases of fibroadenoma have been reported at this site. We present a case of polymastia in a 21-year-old female in the inframammary region. We report two cases of fibroadenoma and carcinoma arising from EBT in the axilla of a 26 and 45-year females. Fibroadenoma was treated by simple excision while for carcinoma modified radical mastectomy was done followed by radiation and chemotherapy. Patient developed metastasis in the sternum. Carcinoma arising from EBT has a poorer prognosis and needs early diagnosis and treatment.

  20. Infiltrating ductal carcinoma of the breast presenting as breast abscess : A case report.

    Directory of Open Access Journals (Sweden)

    Vimal Bhandari

    2013-08-01

    Full Text Available Invasive ductal carcinoma, also known as Infiltrating Ductal Carcinoma (IDC is the most common form of breast cancer. IDC starts in the breast\\s milk ducts and invades the surrounding breast stroma. Breast cancer usually present as a: swelling of all or parts of breast, skin irritation or dimpling, breast pain, nipple pain or retraction, redness or scaliness or thickening of the nipple or breast skin, nipple discharge other than breast milk, or a lump in the axilla. We present a case of a 40 year old female, with no family history of malignancy, who underwent Incision and Drainage (I and D for Right Breast Abscess 2 months back followed by a non-healing wound at the I and D site, associated with fungating growth and Right axillary lymph node enlargement, diagnosed as IDC with Axillary lymph node metastasis. Immunohistochemical studies showed deficient basement membrane and myoepithelial layer confirming the infiltrative nature. [Natl J Med Res 2013; 3(4.000: 422-423

  1. Three-field technique for breast irradiation using tangential field corner blocks

    International Nuclear Information System (INIS)

    A further modification of the three-field technique for the radiotherapy of the breast has been developed. Two isocentric opposing tangential fields encompass the breast, chest wall, and may include the internal mammary lymph nodes. The third, an anterior field, incompasses the axilla and supraclavicular areas. As with our previously reported techniques, the objectives of the present modification is to make the posterior edges of the tangential fields coplanar and to match the cephalad geometric edges of the tangential fields to the caudad geometric edge of the supraclavicular field. A half-beam block is used to shield the caudad half of the anterior field, thus producing a veritcal transverse plane to which the tangential fields are matched. Small corner blocks are used on the cephalad edges of the tangential fields to produce the verical edge necessary for matching to the anterior field. It is essential that the match between the tangential fields and the anterior field be geometrically correct to ensure both local control of disease and good cosmetic results. Two advantages of the present technique are the ease with which it can be carried out and the precision of the match plane without the use of cumbersome mechanical accessories

  2. The use of microdebrider for the treatment of accessory axillary breast.

    Science.gov (United States)

    Jeremy, Sun Mingfa; Jack, Chong Si; Vincent, Yeow Kok Leng; Evan, Woo Kok Yen

    2012-11-01

    Accessory axillary breast tissue can be fairly common occurring in 2-6% of women. Treatment modalities thus far include direct excision as well as liposuction. While direct excision allows for accessible and adequate tissue resection, it results in long unsightly scars and the creation of significant amount of dead space. This may be complicated by seroma and haematoma formation. Liposuction is not without its drawbacks either. It is often very difficult to remove fibro-glandular breast tissue resulting in inadequate excision, thus leaving behind a visible core of breast tissue. This has led some surgeons to use a combination of direct excision and liposuction to manage accessory axillary breast tissue. Hence, we present the use of the microdebrider for sharp and precise excision of accessory axillary breast tissue. This day procedure can be performed through a single 5-mm incision which is well hidden in the axillary skin folds while allowing the operator the amount of control needed to accurately remove fibro-glandular breast tissue and restore an aesthetically pleasing contour to the axilla. PMID:22735506

  3. Nipple adenoma arising from axillary accessory breast: a case report

    Directory of Open Access Journals (Sweden)

    Shioi Yoshihiro

    2012-11-01

    Full Text Available Abstract Nipple adenoma is a relatively rare benign breast neoplasm, and cases of the disease arising from the axillary accessory breast have very seldom been reported in the English literature. We report a case of nipple adenoma arising from axillary accessory breast including clinical and pathological findings. An 82-year-old woman presented with the complaint of a small painful mass in the right axilla. Physical examination confirmed a well-defined eczematous crusted mass that was 8 mm in size. The diagnosis of nipple adenoma was made from an excisional specimen on the basis of characteristic histological findings. Microscopic structural features included a compact proliferation of small tubules lined by epithelial and myoepithelial cells, and the merging of glandular epithelial cells of the adenoma into squamous epithelial cells in the superficial epidermal layer. Because clinically nipple adenoma may resemble Paget’s disease and pathologically can be misinterpreted as tubular carcinoma, the correct identification of nipple adenoma is an important factor in the differential diagnosis for axillary tumor neoplasms. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1186821489769063

  4. Linfonodo-sentinela no câncer de mama acessória: relato de caso Sentinel lymph node in accessory breast cancer: a case report

    Directory of Open Access Journals (Sweden)

    Daniel Guimarães Tiezzi

    2006-01-01

    Full Text Available No último século, grandes avanços foram surgindo na forma de tratar o câncer de mama. A remoção radical da glândula e das estruturas adjacentes tem sido substituída por cirurgias conservadoras e a abordagem cirúrgica dos linfonodos axilares vem se tornando fundamental. Relatamos o caso de paciente com câncer de mama ectópica na axila esquerda e a identificação do linfonodo-sentinela pela técnica do azul patente. Discutimos os estudos relacionados à drenagem linfática do tecido mamário ectópico e a identificação do linfonodo-sentinela nesta rara situação.During the last century, remarkable progress has been made in the treatment of breast cancer. Radical surgical removal of the breast and surrounding structures has been replaced by conservative surgery and the surgical management of axillary lymphnodes has been fundamental. We report a case of a patient with an ectopic breast cancer in the left axilla and sentinel lymphnode identification by the patent blue dye technique. The studies about lymphatic drainage of the ectopic mammary tissue and sentinel lymph node identification in this rare situation were also reviewed.

  5. The "PIP problem": clinical and histologic characteristics.

    Science.gov (United States)

    Correia-Sá, Inês; Rodrigues-Pereira, Pedro; Marques, Marisa

    2013-10-01

    Implants from Poly Implant Prothése (PIP), the French manufacturer, showed increased risk of implant rupture and silicone leakage through the shell. Concerns also exist about the potential irritant behavior of silicone gel filler in these implants. This report presents the clinical, histologic, and microbiologic characteristics of a capsule and a siliconoma from a patient with a ruptured PIP implant. A 41-year-old woman submitted to breast augmentation in 2005 with PIP silicone gel implants presented with a recent history of progressive asymmetric breast enlargement and an enlarged lymph node on her right axilla. No capsular contracture was observed. A breast ultrasonography showed intra- and extracapsular ruptures of the right implant. The woman underwent explantation. Histologic analysis of the breast capsules showed a thin capsule with a chronic, mild inflammatory response. Microbiologic analysis showed no bacterial agent. The irritant behavior of the PIP silicone gel previously described was not able to produce capsular contracture or an exuberant inflammatory reaction. Studies to evaluate the potential risks of the silicone gel and to define the hazards for women implanted with those prostheses are urgently needed. PMID:23943050

  6. Breast conservation in BRCA1 or BRCA2 mutation carriers with early stage breast cancer

    International Nuclear Information System (INIS)

    The role of breast conservation therapy (limited surgery and irradiation of the breast with/without axilla) in the approximately 5% of breast cancer patients who harbour a germline mutation in BRCA1 or BRCA2, is a largely unexplored area and is seen by some as controversial. The relatively high cumulative risk of second primary cancers in such patients and concern about a possible decreased ability of mutation carriers to repair DNA damage caused by radiation has fuelled this controversy. Published studies of breast conservation therapy in carriers of a mutation in BRCA1 or BRCA2 are reviewed, with particular attention to their methodology. These studies have not demonstrated any increase in radiation sensitivity of normal tissues in mutation carriers, either in terms of increased early or late toxicity or tumourigenesis. Likewise, tumour sensitivity to radiotherapy, which might be expected based on the known functions of the BRCA1 and BRCA2 genes, has not been documented to date in mutation carriers. Further, methodologically rigorous studies of large numbers of breast cancer patients who carry a mutation in BRCA1 or BRCA2 are required to fully elucidate these issues. Copyright (2001) Blackwell Science Pty Ltd

  7. Carcinoma en cuirasse : A rare presentation of breast cancer

    Directory of Open Access Journals (Sweden)

    Mahore Sadhana

    2010-04-01

    Full Text Available Carcinoma en cuirasse is a form of cutaneous metastasis. Although this condition is rare, it is most commonly associated with breast carcinoma with local recurrence after mastectomy. Cutaneous metastasis presents most commonly a few months or years after the primary has been diagnosed. Less frequently a metastasis is diagnosed at the same time as the primary tumor or presents as the first manifestation of the disease. We report a case of carcinoma en cuirasse in a 50-year-old female who presented with elevated, finely nodular, indurated skin lesions on left anterior chest wall, axillary region and keloid - like patch on left upper arm. On further examination a breast mass was detected. Fine needle aspiration of all the lesions was performed. Cytodiagnosis was given as infiltrating duct carcinoma of breast with metastatic carcinoma involving left anterior chest wall, axilla and left upper arm. We should not disregard keloid-like or indurated patches on skin which should be investigated thoroughly.

  8. Description of familial keloids in five pedigrees: evidence for autosomal dominant inheritance and phenotypic heterogeneity

    Directory of Open Access Journals (Sweden)

    Kleta Robert

    2009-07-01

    Full Text Available Abstract Background Familial keloids have been reported, having either autosomal dominant or autosomal recessive inheritance. We wished to determine the inheritance pattern and phenotype of keloids among multigenerational families, as a prelude to a positional mapping strategy to identify candidate genes. Methods We studied three African American families, one Afro-Caribbean family and one Asian-American family. Phenotyping including assessing all patients for the presence, distribution, and appearance of keloids, together with the timing of keloid onset and provocative factors. The clinical trial was registered at clinicaltrials.gov (NCT 00005802. Results Age of keloid onset varied considerably within families, but commonly occurred by the second decade. The fraction of affected individuals was 38%, 45%, 62%, 67% and 73% among the five families respectively. Keloid severity and morphology differed within and between families. A novel finding is that certain families manifest keloids in distinct locations, with one family showing an excess of extremity keloids and two families showing an excess of axilla-groin keloids. Conclusion Familial keloids appear to most commonly manifest autosomal dominant or semidominant inheritance, and there may be familial patterns of keloid distribution.

  9. Breast cancer management: Past, present and evolving

    Directory of Open Access Journals (Sweden)

    M Akram

    2012-01-01

    Full Text Available Breast cancer is known from ancient time,and the treatment strategy evolved as our understanding of the disease changed with time. In 460 BC Hippocrates described breast cancer as a humoral disease and presently after a lot of studies breast cancer is considered as a local disease with systemic roots. For most of the twentieth century Halsted radical mastectomy was the "established and standardized operation for cancer of the breast in all stages, early or late". New information about tumor biology and its behavior suggested that less radical surgery might be just as effective as the more extensive one. Eventually, with the use of adjuvant therapy likeradiation and systemic therapy, the extent of surgical resection in the breast and axilla got reduced further and led to an era of breast conservation. The radiation treatment of breast cancer has evolved from 2D to 3D Conformal and to accelarated partial breast irradiation, aiming to reduce normal tissue toxicity and overall treatment time. Systemic therapy in the form of hormone therapy, chemotherapy and biological agents is now a well-established modality in treatment of breast cancer. The current perspective of breast cancer management is based on the rapidly evolving and increasingly integrated study on the genetic, molecular , biochemical and cellular basis of disease. The challenge for the future is to take advantage of this knowledge for the prediction of therapeutic outcome and develop therapies and rapidly apply more novel biologic therapeutics.

  10. A case of multiple basal cell carcinomas developed about 50 years after irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, Chu; Minamimoto, Toshiyuki; Hamada, Yoshimi; Sasaki, Harue; Furuya, Kazuhiko [Hakodate Central General Hospital, Hokkaido (Japan); Funayama, Emi

    1998-10-01

    Malignant skin tumors are known to develop in areas of chronic radiodermatitis. We experienced a patient with multiple basal cell carcinomas that developed about 50 years after irradiation. The patient was a 77-year-old man who underwent radiotherapy in his twenties for caries in the left shoulder joint. The dose given was unknown. Black skin tumor appeared initially about 10 years before the first consultation. The skin around the tumor began to erode about six months before presentation. Biopsy of the tumor was done at another institution and revealed basal cell carcinoma (BCC), so the patients was referred to our department. In addition to the BCC measuring 35 x 20 mm in the left shoulder, BCC measuring 17 x 20 mm and 15 x 15 mm were found on the chest and the left axilla, respectively. The lesions were excised with a margin of 5 mm from the radiodermatitis, and the resultant skin defects were covered with latissimus dorsi flaps. All three tumors were basal cell carcinomas. The patients died of an unrelated disease six years after surgery and there was no recurrence of his tumors. (author)

  11. Protecting the radiation-damaged skin from friction: a mini review

    International Nuclear Information System (INIS)

    Radiation-induced skin reactions are an unavoidable side effect of external beam radiation therapy, particularly in areas prone to friction and excess moisture such as the axilla, head and neck region, perineum and skin folds. Clinical studies investigating interventions for preventing or managing these reactions have largely focussed on formulations with moisturising, anti-inflammatory, anti-microbial and wound healing properties. However, none of these interventions has emerged as a consistent candidate for best practice. Much less emphasis has been placed on evaluating ways to protect the radiation-damaged skin from friction and excess moisture. This mini review analyses the clinical evidence for barrier products that form a protective layer by adhering very closely to the skin folds and do not cause further trauma to the radiation-damaged skin upon removal. A database search identified only two types of barrier products that fitted these criteria and these were tested in two case series and six controlled clinical trials. Friction protection was most effective when the interventions were used from the start of treatment and continued for several weeks after completion of treatment. Soft silicone dressings (Mepilex Lite and Mepitel Film) and Cavilon No Sting Barrier Film, but not Cavilon Moisturizing Barrier Cream, decreased skin reaction severity, most likely due to differences in formulation and skin build-up properties. It seems that prophylactic use of friction protection of areas at risk could be a worthwhile addition to routine care of radiation-damaged skin

  12. Morphological characteristics of professional ballet dancers of the Bolshoi theater company.

    Science.gov (United States)

    Ferrari, Elisa Pinheiro; Silva, Diego Augusto Santos; Martins, Cilene Rebolho; Fidelix, Yara Lucy; Petroski, Edio Luiz

    2013-05-01

    The objective of this study was to describe the morphological profile ofprofessional dancers compared with university physical education students. Thirty-five subjects were evaluated as follows: 13 professional ballet dancers of the Bolshoi Theater Company, six males and seven females, and 22 university physical education students, 11 males and 11 females. Body mass, height, skinfold (triceps, biceps, subscapular, chest, axilla, supraspinale, Iliac crest, abdominal, Front thigh, medial calf) girth (Arm flexed and tensed, forearm, waist, gluteal girth, Mid-thigh girth and calf) and breadth (wrist, ankle, Biepicondylar humerus and femur) were evaluated and somatotype, body fat percentage (BF%) body mass index (BMI), Sigma7 Skinfolds lean body mass, bone, residual and muscle mass were calculated. Dancers showed lower values for BMI, sum of seven skinfolds, BF%, body fat percentage, fat mass, residual mass (p<0.05). For females, lean body mass was also lower in the group of dancers. Body muscle values were lower for university physical education students of both sexes (p<0.05). When assessing differences between male and female dancers and male and female university physical education students, dancers appeared to be more homogeneous than students. As for somatotype, male dancers showed predominance of mesomorphy over the other components and female dancers showed predominance of ectomorphy. The intense training in classical ballet interfered in body composition components, changing them significantly. PMID:23914487

  13. Comparison between hemosiderin and Technetium-99 in sentinel lymph node biopsy in human breast cancer

    International Nuclear Information System (INIS)

    Purpose: To assess the safety and potential equivalence of the use of hemosiderin compared to the Technetium-99 in sentinel lymph node biopsy in human breast cancer. Methods: Non-random sample of 14 volunteer women diagnosed with breast cancer with primary tumors (T1/T2) and clinically tumor-free axilla were submitted to the identification of sentinel lymph node using hemosiderin obtained from autologous blood injected in the periareolar region 24h before surgery on an outpatient basis. Patients received preoperative subareolar intradermal injection of Technetium-99 in the immediate preoperative period. Patients were submitted to sentinel lymph node biopsy, with incision in the axillary fold guided by Gamma-Probe, dissection by planes until the identification of the point of maximum uptake of Technetium-99, identifying the marked nodes and their colors. All surgical specimens were sent for pathological and immunohistochemical study. Results: The results showed no evidence of side effects and/or allergic and non-allergic reactions in patients submitted to SLNB with hemosiderin. The SLN identification rate per patient was 100%. SLNB identification rate per patient with hemosiderin was the same as that of Technetium, with a concordance rate of 100% between the methods. Conclusion: Hemosiderin is a safe dye that is equivalent to Technetium in breast sentinel lymph node biopsy. (author)

  14. A case of pachyonychia congenita with unusual manifestations: an unusual type or a new syndrome?

    Science.gov (United States)

    Gönül, Müzeyyen; Gül, Ülker; Kılıç, Arzu; Soylu, Seçil; Koçak, Oğuzhan; Demiriz, Murat

    2015-03-01

    A 30-year-old man presented with lesions on his oral mucosa and soles. There were no similar complaints in his family members. The dermatological examination revealed follicular hyperkeratosis on his trunk and upper extremities and flesh-colored, firm cystic lesions on his axillae. He had focal, painful, hyperkeratotic areas sited particularly on both his soles and palms. In addition to these, leukokeratosis and ulcerative areas on buccal, labial mucosa, tongue, and at corners of the mouth, and complete loss of teeth was observed. The proximal layering was revealed on all of his nails. The laboratory investigations produced normal results except the deficiency of immunoglobulin A. The psychiatric examination revealed mild mental retardation. Keratin gene (KRT6a, KRT6b, KRT16, and KRT17) mutations for pachyonychia congenita were negative. He got removable dental prosthesis because of inadequate alimentation. Squamous cell cancer developed on lower lip mucosa during follow-up. We present an individual who had different nail dystrophy, epidermal cysts, mental retardation, blepharitis, complete loss of teeth, and negative keratin gene mutations for pachyonychia congenita and developed squamous cell cancer on the oral leukokeratosis lesions. We think that the present case may be an unusual new type of pachyonychia congenita. PMID:25713981

  15. Effect of shaving on axillary stratum corneum.

    Science.gov (United States)

    Marti, V P J; Lee, R S; Moore, A E; Paterson, S E; Watkinson, A; Rawlings, A V

    2003-08-01

    Removal of underarm hair is an intrinsic part of the care regimen for the majority of female consumers, with most using a wet shave with a disposable razor. However, little is known of the impact of shaving on axillary skin, and it is a particularly neglected area of research. To investigate this, we have studied the acute and chronic effects of shaving ultrastructurally, biochemically and functionally. A forearm patch test protocol was devised for antiperspirant (AP) product screening, which involved a pre-shave of the test site with a dry razor just prior to patching. Comparison of the irritation caused by a series of AP products confirmed that shaving leads to increased irritation consistent with enhanced sensitivity. The effect of regular shaving in the axilla was assessed in a 4-week in-use study with shaving either once a week or once a day, both combined with the application of an AP. Expert visual assessment of skin condition showed that more frequent shaving promoted a higher level of visible irritation. However, indirect measurement using corneosurfametry indicated no significant changes to the lipid barrier over the study period irrespective of shaving frequency. Nevertheless, digital images of the axillary skin after dry shaving show distinct opaque lines because of uplifting skin flakes with a corresponding increase in scaliness parameter. Moreover, histamine iontophoresis to assess skin sensitivity demonstrated a significant enhancement of histamine-induced itch and neurogenic flare. PMID:18494901

  16. "Toilet cake" encephalopathy.

    Science.gov (United States)

    Zhang, Zhentao; Moreno, Alejandro

    2014-01-01

    Paradichlorobenzene (PDB) is an aromatic compound found in several household insect repellents and deodorizers. Paradichlorobenzene may cause dependence and damage when inhaled or ingested. Prior cases of PDB neurotoxicity involved ingestion or inhalation of mothballs or occupational exposure. We report the first case of PDB neurotoxicity from chronic toilet bowl deodorizers ("toilet cake") sniffing. A 19-year-old woman, 4 weeks postpartum, presented with gradual mental status deterioration, lethargy, and general weakness for 2 weeks. On physical examination, the patient was found to have a strong odor of deodorizer and diffuse hyperpigmented skin lesions, with scratch marks in neck, axillae, trunk, and 4 limbs. She was alert but unable to communicate or follow commands. Ataxia, hyporeflexia, cogwheel rigidity, and decreased muscle tone were also noted. Laboratory tests revealed only normocytic anemia. A brain magnetic resonance imaging scan showed enhancement within the splenium of the corpus callosum. Postpartum depression, psychosis, and panhypopituitarism were excluded. Family members reported on further questioning that the patient was a habitual "toilet cake" sniffer for an unknown period. A urine test for 2,5-dichlorophenol (a PDB metabolite) level was 620 mg/L (3100 times higher than the average concentration with household exposure). Her clinical condition and body odor remained unchanged during the 30-day hospitalization and the skin findings improved. PMID:25187976

  17. RAPID MOLECULAR DETECTION OF METHICILLIN-RESISTANT S. AUREUS IN THE INTENSIVE CARE UNIT

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective Molecular detection of methicillin-resistant S. aureus(MRSA)in the Intensive Care Unit (ICU)will be helpful for the control of transmission among patients. Methods Both mecA and femB genes of 233 patients in ICU were examined ICU by polymerase chain reaction(PCR) for the presence of MRSA. Swabs were taken from various sites, such as axilla,nose , skin lesions and throat, and incubated over night in salt broth cultures. Results One hundred and five of patients(45.06%) were positive for mecA gene, twenty six(11. 16%)were femB positive and fifteen (6%) patients were positive for MRSA, and such screening data were available within 6~ 7 h fol- lowing admission. Conclusion Specific PCR approaches is helpful for routine conventional diagnosis of MRSA, mecA/femB PCR detection offers a rapid and specific alternative for screening MRSA from patients in high-risk ar- eas.

  18. The results of sentinel lymph node imaging and biopsy with a novel lymphoscintigraphy agent 99Tcm-Rituximab in 247 breast cancer patients

    International Nuclear Information System (INIS)

    Objective: The feasibility, reliability and influence factors of sentinel lymph node (SLN) imaging and biopsy with a new imaging agent 99Tcm-Rituximab were investigated in 467 breast cancer patients. Methods: The SLN imaging was taken after peritumoral and subdermal injection of 99Tcm-Rituximab guided by ultrasound. Based on the image, the SLN were identified by a gamma probe and removed, the resected SLN were examined pathologically with both HE and immunohistochemical staining. Results: The success rate of SLN imaging was 99.14% (463/467). A total 837 SLN (1.79 per case) were visualized, which located in axilla, internal mammary, subraclavicular and breast region. The success rate of SLN biopsy (SLNB) was 99.57% (465/467), a total 1182 SLN (2.53 per case) were identified. Pathological examination showed that there were 131 patients with 194 metastatic axillary SLN; one case of micrometastases was confirmed by immunohistochemical staining, whose result of HE staining was negative. The following factors, such as age, image time, biopsy history, pathologic type and clinical stage, had no effect on the results of SLN imaging and SLNB. But the SLN metastasis rates were different in patients with different pathologic type and clinical stage(χ2=14.134, 29.184, all P99Tcm-Rituximab showed potential in both SLN imaging and identification in breast cancer patients. (authors)

  19. Syringocystadenoma papilliferum in the right lower abdomen: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Xu D

    2013-03-01

    Full Text Available Dong Xu,1,2 Tienan Bi,3,2 Huanrong Lan,3,2 Wenjie Yu,1 Wenmin Wang,1 Feilin Cao,1,2 Ketao Jin1,2 1Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang, People’s Republic of China; 2Laboratory of Translational Oncology, Public Research Platform, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang, People’s Republic of China; 3Department of Gastrointestinal Surgery, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang, People’s Republic of China Abstract: Syringocystadenoma papilliferum (SCAP is an uncommon benign adnexal tumor of the skin. It is frequently seen in association with other benign adnexal lesions, such as nevus sebaceous, apocrine nevus, tubular apocrine adenoma, apocrine hidrocystoma, apocrine cystadenoma, and clear cell syringoma. The unusual reported locations of SCAP include the head and neck, the buttock, the vulva, the scrotum, the pinna, the eyelid, the outer ear canal, the forehead, the back, the scalp, the thigh, the nipple, the axilla, and the postoperative scar. The occurrence of SCAP in the right lower abdomen is distinctly uncommon. Herein, we report an unusual case of a 41-year-old man with SCAP occurring in the right lower abdomen that did not develop malignancy, despite a long disease course and an absence of medical treatment. The clinical and histopathologic features and the differential diagnosis of SCAP are also discussed. Keywords: adnexal, skin tumor, benign

  20. Aneurisma infectado de artéria braquial após endocardite infecciosa de valva mitral Infected aneurysm of brachial artery after mitral valve infective endocarditis

    Directory of Open Access Journals (Sweden)

    Heraldo Guedis Lobo Filho

    2011-03-01

    Full Text Available Apresentamos um caso de aneurisma infectado de artéria braquial em paciente com endocardite infecciosa por Streptococcus bovis. Homem de 49 anos de idade se apresentou com febre, dispnéia e sopro regurgitativo em foco mitral com irradiação para axila. O ecocardiograma demonstrou vegetação em valva mitral nativa. Após troca valvar mitral com implante de prótese biológica, observou-se massa pulsátil de cinco centímetros de diâmetro em fossa antecubital direita. Foi feito o diagnóstico de aneurisma infectado de artéria braquial, e o tratamento cirúrgico foi realizado com sucesso. O objetivo desse relato de caso é apresentar uma complicação pouco comum após endocardite infecciosa.We present a case of brachial artery infected aneurysm in a patient with infective endocarditis caused by Streptococcus bovis. A 49-year-old man presented with fever dyspnea and a pansystolic murmur with irradiation to axilla. The echocardiogram revealed vegetation in native mitral valve. After mitral valve replacement with bioprosthesis, it was observed pulsatile mass of five centimeters in diameter at antecubital fossa of right upper limb. It was made the diagnosis of infected aneurysm of the brachial artery, and the surgery was performed successfully. The aim of this case report is to show a rare complication after infective endocarditis.

  1. Mammary and extramammary Paget's disease.

    Science.gov (United States)

    Lopes Filho, Lauro Lourival; Lopes, Ione Maria Ribeiro Soares; Lopes, Lauro Rodolpho Soares; Enokihara, Milvia M S S; Michalany, Alexandre Osores; Matsunaga, Nobuo

    2015-01-01

    Paget's disease, described by Sir James Paget in 1874, is classified as mammary and extramammary. The mammary type is rare and often associated with intraductal cancer (93-100% of cases). It is more prevalent in postmenopausal women and it appears as an eczematoid, erythematous, moist or crusted lesion, with or without fine scaling, infiltration and inversion of the nipple. It must be distinguished from erosive adenomatosis of the nipple, cutaneous extension of breast carcinoma, psoriasis, atopic dermatitis, contact dermatitis, chronic eczema, lactiferous ducts ectasia, Bowen's disease, basal cell carcinoma, melanoma and intraductal papilloma. Diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. Extramammary Paget's disease is considered an adenocarcinoma originating from the skin or skin appendages in areas with apocrine glands. The primary location is the vulvar area, followed by the perianal region, scrotum, penis and axillae. It starts as an erythematous plaque of indolent growth, with well-defined edges, fine scaling, excoriations, exulcerations and lichenification. In most cases it is not associated with cancer, although there are publications linking it to tumors of the vulva, vagina, cervix and corpus uteri, bladder, ovary, gallbladder, liver, breast, colon and rectum. Differential diagnoses are candidiasis, psoriasis and chronic lichen simplex. Histopathology confirms the diagnosis. Before treatment begins, associated malignancies should be investigated. Surgical excision and micrographic surgery are the best treatment options, although recurrences are frequent. PMID:25830993

  2. Synchronous Bilateral Solid Papillary Carcinomas of the Breast

    Directory of Open Access Journals (Sweden)

    Noriko Yoshimura

    2013-01-01

    Full Text Available We herein report a case of synchronous bilateral solid papillary carcinoma of the breast. A 73-year-old female had a mass that was detected in the right breast on mammography. An ultrasound examination revealed one intracystic tumor in the right breast and two tumors in the left breast. A fine-needle aspiration biopsy of these three tumors was performed, which revealed a diagnosis of malignancy. A magnetic resonance imaging examination of the breasts showed diffuse small nodules surrounding these tumors bilaterally. Bilateral partial mastectomy and a sentinel lymph node biopsy were performed. Lymph node metastasis was detected in the right axilla, and additional lymph node dissection was performed. The pathological diagnosis was synchronous bilateral breast cancer, invasive ductal carcinoma NOS of the right breast, mucinous carcinomas of the left breast, and bilateral SPCs. A wide range of surgical margins were positive for SPCs, and additional bilateral total mastectomy was then performed. To the best of our knowledge, little is known about synchronous bilateral SPCs. Our case indicates that some SPCs can be widely scattered and make up a variety of invasive carcinomas. It is difficult to make a correct preoperative evaluation in such cases.

  3. Breast disease with skin thickening: differential diagnosis with mammography and ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Young Rok; Kim, Hak Hee; Cha, Eun Suk; Park, Hye Seong; Kim, Ki Tae; Shinn, Kyung Sub [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    Diffuse skin thickening of the breast is produced by lymphedema usually secondary to obstruction of the axillary lymphatics. On physical examination, the affected breast is, due to increased fluid content, larger, heavier, and of higher overall density. Mammography reveals an increased coarse reticular pattern. Thickening of the skin can have many causes. It may be a result of tumor invasion or a tumor in the dermal lymphatics ; or because of lymphatic congestion through obstruction of lymphatic drainage within the breast, in the axilla, or centrally in the mediastinum. Further causes may be congestive heart failure, benign inflammation, primary skin processes such as psoriasis, or systemic diseases which involve the skin. Mammographic appearance is known to be nonspecific. Ultrasound can demonstrate skin thickening directly, but despite some reports suggesting that the cause of skin thickening can be inferred from the results of ultrasound, this is not usually of practical importance. The purpose of this study is to review the causes of skin thickening of the breast and to use mammography and US to differentiate the causes.

  4. Prone decubitus dual incidence dynamic lymphoscintigraphy for sentinel lymph node localization in breast cancer; Lymphoscintigraphie dynamique en decubitus ventral et double incidence pour la localisation du ganglion sentinelle des cancers du sein

    Energy Technology Data Exchange (ETDEWEB)

    Gremillet, E.; Soler, C.; Champailler, A.; Griot, A.; Berger, E.; Griot, J.P.; Villard, P.; Bouteille, C. [Centre Hospitalier Prive de la Loire, 42 - Saint-Etienne (France)

    2000-09-01

    The sentinel lymph mode (SLN) technique in breast cancer is aimed to avoid useless axillary lymph node dissection (ALND). We present here our experience in a series of 42 patients. After some protocol evolutions imposed by the first results, 37 patients were similarly studied: 4 to 6 peritumoral injections (0,75 ml sulfur colloid labeled with {sup 99m}Tc) were immediately followed by local gentle massage for 5 min, and then by dynamic imaging (anterior and lateral simultaneously) in prone decubitus with pending breast. Then the SLN was skin-land-marked in surgical position (dorsal decubitus) in two incidences (typically anterior and lateral); SLN localisation on ventral decubitus images directed additional actions as necessary: pulling the breast, oblique incidence. Upon surgery, after primary lesion malignancy confirmation, the SLN was electively dissected and then the usual ALND was performed. If we exclude from analysis the 4 cases of previous lumpectomy (among which we had one total lack of tracer migration and one prediction error), the final diagnostic results were perfect: lympho-scintigraphic and per-operative SLN detection were 100%, predictive error was 0%. This result seems to be mainly due to prone decubitus imaging which moves away peritumoral activity from axilla and thus makes easier final land-marking in dorsal decubitus. (author)

  5. Efficacy of 3D-CT lymphography for sentinel lymph node byopsy in breast cancer

    International Nuclear Information System (INIS)

    In this study, three-dimensional computed tomography lymphography (3D-CTLG), a recently developed technique using a contrast medium in sentinel lymph node biopsy (SLNB), was evaluated in terms of efficacy. A mixture of 1-2.5 ml of iopamidol and 0.5 ml of 1% xylocaine was injected subareolarly in 51 patients with operable breast cancer. Within two minutes after the 15-30 sec gentle massage of the injection sites, 1.25 mm-thick cross-sectional CT images of the breast and axilla were taken. These images were reconstructed into 3D images to identify the location, size and number of the sentinel lymph nodes (SLN). All the subjects underwent dye-guided SLNB with a backup axillary dissection. The accuracy of the procedure was evaluated pathologically. In the first ten cases, we failed to obtain stabilized results due to lack of experience with the procedure. In the remaining 15 cases, with increased experience, the identification rate was 100% and the false-negative rate was 0%. The 3D-CTLG, allowing easy and accurate identification of SLN, is an appropriate procedure for visualizing SLN and lymphatic vessels. A concurrent use of the dye-guided method with the 3D-CTLG is useful for SLNB. (author)

  6. Prone decubitus dual incidence dynamic lymphoscintigraphy for sentinel lymph node localization in breast cancer

    International Nuclear Information System (INIS)

    The sentinel lymph mode (SLN) technique in breast cancer is aimed to avoid useless axillary lymph node dissection (ALND). We present here our experience in a series of 42 patients. After some protocol evolutions imposed by the first results, 37 patients were similarly studied: 4 to 6 peritumoral injections (0,75 ml sulfur colloid labeled with 99mTc) were immediately followed by local gentle massage for 5 min, and then by dynamic imaging (anterior and lateral simultaneously) in prone decubitus with pending breast. Then the SLN was skin-land-marked in surgical position (dorsal decubitus) in two incidences (typically anterior and lateral); SLN localisation on ventral decubitus images directed additional actions as necessary: pulling the breast, oblique incidence. Upon surgery, after primary lesion malignancy confirmation, the SLN was electively dissected and then the usual ALND was performed. If we exclude from analysis the 4 cases of previous lumpectomy (among which we had one total lack of tracer migration and one prediction error), the final diagnostic results were perfect: lympho-scintigraphic and per-operative SLN detection were 100%, predictive error was 0%. This result seems to be mainly due to prone decubitus imaging which moves away peritumoral activity from axilla and thus makes easier final land-marking in dorsal decubitus. (author)

  7. Sentinel node lymphoscintigraphy in breast cancer: problems, solutions and clinical utility

    International Nuclear Information System (INIS)

    Full text: Axillary lymph node status is an essential element in the staging of breast cancer. Recently, lymphatic mapping and sentinel node (SN) identification with lymphoscintigraphy has been promoted. The purposes of this study were to determine: (1) factors important in optimal identification of SNs preoperatively and (2) accuracy of SNs in predicting axillary lymph node status. Lymphoscintigraphy using 99Tcm-antimony trisulphide colloid was performed in 35 patients before axillary dissection surgery. Four injections (20 MBq in 0.5 ml) were administered either around the biopsy cavity/scar or peritumorally. Sequential images in the anterior, anterior oblique and lateral projections were obtained until a SN was identified and in some patients delayed images (up to 15 h) were required. SNs were marked on the patient's skin in two planes. During surgery, a hand-held gamma probe was used to localize the marked SNs, which were removed prior to complete axillary dissection. Dissected lymph nodes were evaluated histopathologically for tumour involvement. To optimize SN identification, we found that breast cleaning post-injection, breast massage, imaging with arms both raised and lowered, and using different symbols to mark multiple SNs were necessary. In 32/35 patients (91%), a SN was successfully identified. Drainage patterns varied and were primarily to the axilla, internal mammary chain and intra clavicular areas. The SN appears to be an accurate predictor of axillary node status. In conclusion, breast lymphoscintigraphy is a simple procedure which appears to accurately identify sentinel nodes

  8. Primary breast cancer: European radiotherapy trials

    International Nuclear Information System (INIS)

    For many years in Europe, surgically operable breast carcinomas have been treated by conservative treatments. There are two methods of conservative treatment: limited surgery with or without auxiliary dissection followed by irradiation and irradiation as the primary treatment. Depending on the size of the primary tumor and clinical findings in the axillae, patients were referred to either of the two treatment alternatives. Generally, limited surgery and irradiation was performed in patients with early breast carcinomas, while irradiation as the primary treatment was used for more locally advanced cancers. Since 1960, conservative treatments with megavoltage for patients with invasive breast carcinomas have been used more and more frequently. These conservation methods have been used hoping to achieve long-term survival comparable to that obtained by mastectomy and breast preservation with good cosmetic results. This chapter reviews results at 5 and 10 years obtained in Europe by several authors concerning early breast infiltration carcinomas treated by limited surgery or without axillary dissection followed by irradiation

  9. A new species of Hemidactylus from Lake Turkana, Northern Kenya (Squamata: Gekkonidae

    Directory of Open Access Journals (Sweden)

    Roberto Sindaco

    2007-01-01

    Full Text Available A new species of the genus Hemidactylus is described on the basis of two specimens (an adult male and an adult female collected in 2005 in rocky and sandy habitat of the semiarid climatic region on the eastern shore of Lake Turkana (Kenya. It is a medium-sized Hemidactylus (SVL from 40 to 50 mm distinguished from all other species by a unique combination of characters. The back is covered by large, trihedral, strongly keeled tubercles, intermixed with a few small, irregular shaped granules, forming 14 quite regular transverse rows from axilla to groin; nostrils contact the rostral, first supralabial, 1 enlarged internasal and 2-3 postnasals; the dorsal half of the rostral scale is divided longitudinally; there are 6 lamellae under the first toe and 10 under the 4th toe; male with 8 precloacal pores; female without pores. The dorsal colour pattern is very distinctive, consisting of four transverse bands, bordered with dark margins. The types are housed in the Herpetological Collections of the Museo di Storia Naturale of the University of Pavia and in the National Museums of Kenya (Nairobi.

  10. SEROMA FORMATION IN CANCER BREAST SURGERY

    Directory of Open Access Journals (Sweden)

    Sitaram

    2015-01-01

    , no individual study has shown a significant effect on seroma formation with or without the use of a laser scalpel , argon diathermy , or an ultrasonic scalpel . Ultrasonic scissors resulted in reduced seroma formation in a randomized controlled trial comparing level I and II axillary dissection using either ultrasound scissors or surgical scissors with ligation . MANAGEMENT OF DEAD SPACE: MECHANICAL DEVICES : Different techniques have been employed to obliterate the dead space (under flaps and the axilla to reduce seroma formation. CHEMICAL: Fibrin glue . light activated fibrin sealant , and transdermal photo - polymerized adhesive reduce seroma formation after mastectomy in animal models. Use of a fibrinolysis inhibitor was based on the hypothesis that fibrinolytic activity in serum and lymph might contribute to fluid accumulation . SHOULDER MOVEMENT: Shoulder dysfunction is a common complication of mastectomy , and it is necessary to mobilize the shoulder early to prevent this complication. It was thought that early shoulder mobilization led to increased seroma formation and this hypothesis was supported by a systematic review of 12 randomized controlled trials (RCTs of which six were included in a meta - analysis . CONCLUSIONS : Seroma formation is a side effect of M.R.M rather than a complication Physical closure of the dead space appears to reduce seroma rate, but studies have failed to address the issues of cosmesis, and shoulder movement restrictions and these add to the operating time. and mechanical pressure do not reduce seroma drainage. Drains should be used, but the number of drain tubes or a low pressure system does not decrease the formation of seroma. However, low vacuum drains in the axilla result in less seroma formation, earlier drain removal and earlier discharge. High pressure vacuum drains appear safe and acceptable to discharge many patients early with drains in situ , if adeq uate patient counseling and nursing support are provided. Seroma

  11. Linfadenectomia Axilar Conservadora no Câncer de Mama Estádio Clínico I Conservative Axillary Dissection in Stage I Breast Cancer

    Directory of Open Access Journals (Sweden)

    Luiz Antonio Guimarães Brondi

    2000-01-01

    histopathologically evaluated. Quadrantectomy was performed in 138 cases and modified mastectomy (Patey, in 4 cases. The predominance of the T1c (130 cases was observed. Results: a total of 3,282 lymph nodes were removed (2,456 at level I and 826 at level II, with an average of 23.1 nodes per axilla. Only 68 were histologically involved (2%. "Skip" metastasis was present only in one case (0.7%. Thirty-five false negative cases were observed (24.6%, with involvement of level I in 34 cases (97.1% and of level II in 2 cases (5.7%. We observed 107 cases with negative axillary lymph nodes (75.4%. Conclusion: the axillary dissection of levels I and II is sufficient to treat the axilla in clinical stage I breast cancer. In clinical stage II and III of the disease, the complete axillary dissection including levels I, II and III is indicated. The interpectoral Rotter group will be removed if surgically suspicious.

  12. Electrophysiologic study of chronic inflammatory demyelinating polyneuropathy by using segmental stimulation in the median nerve and ulnar nerve%正中神经和尺神经分段刺激在慢性炎性脱髓鞘性多发性神经病中的电生理研究

    Institute of Scientific and Technical Information of China (English)

    王晋荣; 王进华; 叶憬; 杨伟丽

    2013-01-01

    目的 探讨运动神经传导速度(MCV)、复合肌肉动作电位(CMAP)与肌力减退的关系和传导阻滞(CB)在慢性炎性脱髓鞘性多发性神经病(chronic inflammatory demyelinating polyradiculoneuritis,CIDP)中的表现特点.方法 30例CIDP患者在进行常规MCV、远端潜伏期(DML)、F波、感觉神经传导速度(SCV)、肌电图(EMG)测定的基础上,在正中神经采用由远到近的“腕-肘-腋-Erb's点”4点3段刺激,尺神经采用由远到近的“腕-肘下-肘上-腋-Erb's点”5点4段刺激,记录各段刺激后CMAP各参数及MCV的变化.结果 CMAP波幅衰减、面积衰减、时程增加以及MCV减慢与临床肌力减退无相关性,dCMAP波幅与上肢远端肌力呈正相关;患者中80.00%在正中神经、73.33%在尺神经发现了1个或多个节段的CB,且出现节段无明显选择性.结论 dCMAP波幅降低与CIDP患者肌力减退有相关性.在CIDP中CB出现率高,且较为弥散地在各节段中出现.%Objective To investigate the relationship between motor conduction velocity (MCV) and compound muscle action potential (CMAP) and muscle strength impairment; and to study the characteristics of conduction block (CB) in chronic inflammatory demyelinating polyneuropathy (CIDP). Methods 30 patients with CIDP formed the study population. All patients were examined by MCV, distal motor latency (DML), F wave, sensory nerve conduction velocity (SCV) and electromyography (EMG). Stimulations were perfomed at 4 sites of the median nerve from distal to proximal (wrist, elbow, axilla, Erb' s point) and 5 sites of the ulnar nerve (wrist, below elbow, above elbow, axilla, Erb' s point), while all the parameters of CMAP and MCV were recorded. Results There were no correlations between the CAMP amplitude attenuation, area, duration increase, MCV reduction and the clinical muscle strength. However, there was positive correlation between the amplitude of the dCMAP and the distal muscle strength in the upper

  13. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa.

    Science.gov (United States)

    Zouboulis, C C; Desai, N; Emtestam, L; Hunger, R E; Ioannides, D; Juhász, I; Lapins, J; Matusiak, L; Prens, E P; Revuz, J; Schneider-Burrus, S; Szepietowski, J C; van der Zee, H H; Jemec, G B E

    2015-04-01

    Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillae, inguinal and anogenital regions. A mean disease incidence of 6.0 per 100,000 person-years and an average prevalence of 1% has been reported in Europe. HS has the highest impact on patients' quality of life among all assessed dermatological diseases. HS is associated with a variety of concomitant and secondary diseases, such as obesity, metabolic syndrome, inflammatory bowel disease, e.g. Crohn's disease, spondyloarthropathy, follicular occlusion syndrome and other hyperergic diseases. The central pathogenic event in HS is believed to be the occlusion of the upper part of the hair follicle leading to a perifollicular lympho-histiocytic inflammation. A highly significant association between the prevalence of HS and current smoking (Odds ratio 12.55) and overweight (Odds ratio 1.1 for each body mass index unit) has been documented. The European S1 HS guideline suggests that the disease should be treated based on its individual subjective impact and objective severity. Locally recurring lesions can be treated by classical surgery or LASER techniques, whereas medical treatment either as monotherapy or in combination with radical surgery is more appropriate for widely spread lesions. Medical therapy may include antibiotics (clindamycin plus rifampicine, tetracyclines), acitretin and biologics (adalimumab, infliximab). A Hurley severity grade-relevant treatment of HS is recommended by the expert group following a treatment algorithm. Adjuvant measurements, such as pain management, treatment of superinfections, weight loss and tobacco abstinence have to be considered. PMID:25640693

  14. Bilateral Traumatic Anterior Dislocation of Shoulder – a rare entity

    Directory of Open Access Journals (Sweden)

    Yashavantha Kumar C

    2013-01-01

    Full Text Available Introduction: Bilateral shoulder dislocation are most commonly posterior type. These are most commonly due to seizure disorder and electrocution. Anterior shoulder dislocations occurring bilaterally without any predisposing factors are very rare. These types of injuries are due to trauma with a unique mechanism of injury. To best of our knowledge there are only few cases of similar kind are reported in literature. We hereby report a interesting case of posttraumatic, bilateral anterior dislocation of shoulder without associated fracture in a 45 old women without any predisposing pathoanatomy.Case Report: A 45-year-old women presented to casualty with sudden onset of pain and restriction of movement in both shoulders fallowing trauma. Immediately post trauma she had severe pain and restriction of both shoulders. On examination arms were abducted and externally rotated. Bilateral shoulder movements were painful and restricted . There was loss of round contour of shoulder with increased vertical diameter of axilla anteriorly. Radiological examination revealed bilateral anterior dislocation of the shoulders without any associated fractures. Closed reduction done by Milch technique after intraraticular lignocaine injection. MRI of bilateral shoulder showed no pathological lesion. Both shoulders were immobilized with a shoulder immobilizer for three weeks.Conclusion: Most of the bilateral shoulder dislocations are posterior type seen in seizure disorders. Bilateral traumatic anterior shoulder dislocations are rare and are seen as a result of unique mechanism of injury. In our case patient had a fall on her elbows causing forced extension. If diagnosed and treated promptly completely normal function of the shoulders can be restored.

  15. Radioimmunoimaging in malignant melanoma patients with the use of indium-111-labeled antimelanoma monoclonal antibody (ZME-018) to high-molecular-weight antigen

    International Nuclear Information System (INIS)

    Radioimmunolocalization of an 111In-labeled, mouse antimelanoma monoclonal antibody (MAb), ZME-018, was examined in 30 patients with metastatic malignant melanoma. Each patient received a single iv infusion of MAb at concentrations ranging from 0.6 to 40 mg, coupled to 5 mCi 111In by the chelating agent pentetic acid. No toxicity was observed in any patient. Total-body and region of interest scans performed at 4, 24, and 72 hours following MAb administration revealed uptake in 110 of 171 previously diagnosed metastases for a sensitivity of 64%. Nonspecific uptake of radioactivity was consistently observed in the liver and spleen, and less frequently in the bowel, testes, axillae, and bone. Sensitivity of detection increased significantly at doses of MAb above 2.5 mg, with 74% of the lesions imaging at 20 mg/5 mCi compared with 29% at 2.5 mg/5 mCi (P less than .005). Sensitivity actually decreased slightly at the 40-mg dose. There was a significant correlation between tumor uptake of MAb-111In-conjugate and increasing tumor size. Soft tissue lesions, such as skin and lymph node metastases, were imaged to a greater extent (77%) than were visceral metastases (40%). Mean plasma clearance of ZME-018 was prolonged with a half-life of 33.6 hours in patients receiving 40 mg, compared with 17.8 hours in patients given 2.5 mg (P less than .01). Urinary excretion of the isotope averaged 11.4% of the injected dose over 48 hours. Hence radioimmunolocalization of melanoma with 111In-ZME-018 appeared feasible. The sensitivity of the technique varies with MAb dose, specific activity of 111In-MAb conjugate, tumor size, and disease site

  16. Extra and Intramuscular Distribution of the Thoracodorsal Nerve with Regard to Nerve Reconstruction Surgeries.

    Science.gov (United States)

    Malalasekera, Ajith; Beneragama, Thushan; Kanesu, Sivasuganthan; Sahathevan, Vithoosan; Jayasekara, Rohan

    2016-06-01

    Background The lateral branch of the thoracodorsal nerve (LBTN) is used for nerve transfer in facial, musculocutaneous, axillary nerve injuries and for irreparable C5, C6 spinal nerve lesions and accessory nerve defects. For a successful surgical outcome, the nerve to be used in nerve transfer should be of adequate length and thickness for nerve coaptation. Aim Our objective was to evaluate the length of the LBTN that could be obtained as a donor nerve, externally and within the muscle. Method Eight (8) cadavers with intact upper limbs and thorax which could be positioned in the anatomical position were selected for the study. Cadavers with dissected axillae, brachial plexus or upper limbs were excluded. The thoracodorsal neurovascular bundle was dissected and the number of branches of the thoracodorsal nerve was identified along with its lateral branch. The lateral branch was dissected up to the latissimus dorsi muscle and further intramuscularly. All lengths were measured using a vernier caliper. Results The mean length of the LBTN, up to its first intramuscular branch, is 8.14 cm (range 5.99-12.29 cm). Beyond this, the intramuscular nerve branched further and was of very minute diameter. The mean unbranched intramuscular length of the nerve is 3.36 cm (range 1.3-7.71 cm) which is 41.28% of the total length of the LBTN. Conclusion A significant proportion of the LBTN is found within the latissimus dorsi muscle. This length could potentially be used for direct nerve coaptation by intrafascicular dissection. PMID:26890860

  17. Dosimetric prospective study comparing 2D and 3D planning for irradiation of supraclavicular and infraclavicular regions in breast cancer patients

    International Nuclear Information System (INIS)

    Purpose: The purpose of this study is to compare 2D plan and 3D plan regarding coverage of the target (supraclavicular and infraclavicular regions) and dose reaching the risk organs (using mean DVH). Depending on the results of this study, modifications can be made to the 2D conventional planning of supraclavicular and infraclavicular regions in order to achieve better coverage of the target tissues. Materials and methods: This is a dosimetric study carried out at the radiation oncology department in NCI-Cairo University in the period from January 2012 to October 2012, on 15 patients with breast cancer who are eligible for supraclavicular and infraclavicular irradiation. For All patients, a 2D and a 3D plan were done. Results: We found that the coverage of the supraclavicular and infraclavicular regions and the chest wall or breast together with levels I and II axilla (PTV) were significantly better with the 3D technique with less over dose than the 2D technique. That difference was highly significant and was most evident in MRM cases. Also we found that organs at risk received a dose in the 3D technique that was more than that received in the 2D technique, again that difference was highly significant and was also most evident in MRM cases but all doses were still within tolerance. Conclusions: From the present study we concluded that the coverage of the supraclavicular and infraclavicular PTV is significantly worse with the 2D technique using a single oblique field at a fixed depth of 3 cm for all patients despite their different builts.

  18. Effects of recombinant human growth hormone on growth of human gastric carcinoma xenograft model in nude mice

    Institute of Scientific and Technical Information of China (English)

    Dao-Ming Liang; Jia-Yong Chen; Yi Zhang; Ping Gan; Jie Lin; An-Bao Chen

    2006-01-01

    AIM: To study effects of recombinant human growth hormone (rhGH) on growth of a human gastric carcinoma cell in vivo.METHODS: Experimental mice were divided into control group, rhGH group, oxaliplatin (L-OHP) group and rhGH+L-OHP group. Cultured human gastric carcinoma cells BGC823 were inoculated into right axilla of nude mice and carcinoma xenograft model wasestablished successfully. Inhibitory rate of xenograft tumor growth was estimated by measuring tumor volume; expression of proliferating cell nuclear antigen (PCNA), Bax and Bcl-2 proteins of xenograft tumor was detected using immunohistochemical S-P method.RESULTS: Tumor growth inhibitory rate, the positive expression rate of PCNA, Bax and Bcl-2 were 49.3%,58.2%, 65.2% and 59.2% in rhGH+L-OHP group respectively; 46.6%, 62.5%, 59.7% and 64.7% in L-OHP group; 5.0%, 82.7%, 23.2% and 82.2% in rhGH group and 0, 77.8%, 23.5% and 80.3% in control group. There was significant difference between rhGH+L-OHP group (or L-OHP group ) and control group or rhGH group (P <0.05), whereas there were no significant differences (P >0.05) between L-OHP group and rhGH+L-OHP group and between rhGH group and control group.CONCLUSION: rhGH does not accelerate the proliferation of human gastric cancer cell in vivo.

  19. Versatile use of vacuum-assisted healing in fifty patients

    Directory of Open Access Journals (Sweden)

    Al Fadhli Ahmad

    2009-01-01

    Full Text Available Context: Wound management can often be a challenging experience, especially in the presence of diabetes mellitus, vascular or immunological compromise. While no single technique can be considered by itself to be ideal, vacuum-assisted healing, which is a recent innovation, is fast becoming a necessary addition as adjuvant therapy to hasten wound healing. Aims: To determine the efficacy of vacuum-assisted healing. Settings and Design: Plastic surgery centre. Ministry of Health Hospital, Kuwait. Materials and Methods: Patients from Kuwait in a wide variety of clinical situations were chosen for study: Patients (n=50 were classified by diagnosis: Group 1: pressure sore- sacral (n= 3, trochanteric (n=6, ischial (n= 2; Group 2: ulcers (n= 11; Group 3: traumatic soft tissue wounds (n =15; Group 4: extensive tissue loss from the abdominal wall perineum, thigh and axilla (n =5; Group 5: sternal dehiscence wounds (n =4 and Group 6: wounds from flap necrosis (n =4. All wounds were subjected to vacuum by wall unit or portable unit, using pressure of 100-125 mm - continuous or intermittent. Closure of wounds, significant reduction in size and refusal by patient for continuation of vacuum-assisted closure therapy were end points of vacuum application. Results: Sixteen per cent of patients showed complete healing of the wound. Seventy per cent of patients showed 20-78% reduction in wound size. In 14% of patients treatment had to be discontinued. All patients showed improvement in granulation tissue and reduction in bacterial isolates and tissue oedema. Conclusions: The application of subatmospheric pressure or negative pressure promotes healing in a wide range of clinical settings and is an advanced wound healing therapy that can optimize patient care, promote rapid wound healing and help manage costs. It may be used in most instances in both hospital and community settings.

  20. Use of gamma-irradiated amnion as a biological dressing in the management of radiation induced ulcers

    International Nuclear Information System (INIS)

    Full text: The treatment of moist skin desquamation (ulceration) following radiation therapy focuses on promoting healing, preventing microbial infections, protecting from mechanical trauma and providing pain relief. Various dressings like hydrocolloid, 1% gentian violet and other topical applications are routinely used. This study evaluated the use of freeze-dried, irradiated amnion from the Tata Memorial Hospital Tissue Bank in the management of radiation ulcers from 2001 to 2007. During this period, 2095 amnion dressings were used in 554 patients (238 male and 316 female). The ulcer was cleaned with normal saline and the amnion applied directly on the affected area. No topical antibiotics were used. The ulcer sites were in the regions of the groin and perianal area (40.79%), head and neck (30.50%), breast and axilla (18.59%), limbs (5.78%), chest (2.70%) and back (1.62%). Healing occurred within 4 days to 14 days using a single application of amnion in 291 patients (52.53%), 2 dressings in 129 patients (23.28%) and 3 dressings in 74 patients (13.36%). The remaining 60 patients (10.83%) required four or more dressings which were used over a period of a month. The amnion dressing was found to be convenient to apply and adhered well to the affected areas without the use of any adhesives unlike with routine hydro-colloid dressing. This was particularly advantageous in sites with irregular contours such as the groin and perianal areas and the head and neck regions (71.29%). Patients experienced almost immediate pain relief and the need for analgesics was reduced. In the majority of patients healing occurred earlier than was usually obtained with routine dressings. The amnion dressing proved to be advantageous over co ventional dressings because of its convenience of use and cost effectiveness due to shorter duration of healing, fewer dressing changes and diminished use of analgesics and antibiotics. (Author)

  1. Reservoirs of coagulase negative staphylococci in preterm infants.

    Science.gov (United States)

    Eastick, K; Leeming, J P; Bennett, D; Millar, M R

    1996-03-01

    This investigation was undertaken to determine the magnitude of, and interrelations between, reservoirs of coagulase negative staphylococci on infants' skin at various sites (including sites used for insertion of intravascular catheters) and in faeces during the first six months of life. Sites with large numbers of coagulase negative staphylococci were identified by sampling 16 skin sites and stools from 20 preterm neonates at 8-30 days of life. A more detailed survey of numbers and types of coagulase negative staphylococci in stool and at six skin sites of 10 preterm infants was then performed over the first six months of life. Isolates of coagulase negative staphylococci were collected and characterised by speciation, antibiotic susceptibility profiling, and plasmid restriction fragment length polymorphism analysis. Large, relatively stable reservoirs were identified in the faeces, around the ear, and in the axilla and nares. Skin on the forearm and leg, sites at which peripheral catheters are frequently sited, carried small unstable numbers of coagulase negative staphylococci, which were usually indistinguishable from coagulase negative staphylococci isolated from other body sites on the same baby. Contamination of catheter insertion sites with coagulase negative staphylococci from reservoir sites on the same baby could explain these observations. These data suggest that interventions reducing cross-contamination between sites on the same baby might be as important in preventing coagulase negative staphylococcal bacteraemias as measures taken to prevent cross infection between babies. Procedures which are likely to result in heavy coagulase negative staphylococcal contamination of the hands of healthcare staff, such as changing soiled nappies, should receive particular attention. PMID:8777675

  2. The clinical value of the qualitative and semi-quantitative 18F-FDG PET/CT in the detection of primary breast cancer and lymph node metastasis

    International Nuclear Information System (INIS)

    Objective: The purpose of this study was to assess the diagnostic efficiency of the qualitative and semi-quantitative analyses of 18F-fluorodeoxyglucose (FDG) PET/CT for staging primary breast cancer. Methods: This prospective study included 39 patients. Of the 39 cases, 24 were primary, breast cancer, 15 were benign breast lesions. Patients underwent regional FDG PET/CT scanning covering bilateral breasts and axilla. All primary breast cancer lesions were confirmed by pathologic results of surgery. Twenty-four cases with benign lesions were established according to the results of surgery or clinical follow-up for at least 12 months. The qualitative and semi-quantitative 18F-FDG uptake results were used for T staging and N staging of breast cancer. SPSS 11.5 was used for data analysis. Results: When using SUVmax>4.5 as the cutoff value or SUVmax>x-bar + 2s of contra-lateral normal breast SUVmax as the cutoff value combined CT malignant signs for initial diagnosis, the sensitivity, specificity of diagnosing breast malignant lesion were 96.0% (24/25), 63.2% (12/19), respectively. By using threshold of SUVmax>2.5, the sensitivity, specificity were 60% (6/10), 92.3 % (12/13) respectively for staging regional lymphadenopathy. Conclusion: For staging primary breast carcinoma with FDG PET/CT, higher sensitivity could be acquired when using SUVmax>4.5 or SUVmax>x-bar + 2s of contra-lateral normal breast SUVmax as the cutoff value combined with CT malignant signs. (authors)

  3. Study of the techniques for the sentinel lymph node in breast cancer

    International Nuclear Information System (INIS)

    Axillary lymphadenectomy for the treatment of breast carcinoma can benefit the patient only if there is lymph nodes metastasis. Methods used to evaluate lymph node status were inefficient in the majority of cases of invasive carcinoma. The search for the sentinel lymph node has presented a high negative predictive value. Acknowledge of its use and limitations is important. The objective is the analysis of various techniques to search for sentinel lymph node (SLN). The method: 81 cases of breast carcinoma were studied with clinically negative axilla. Of these, the dyeing technique was used in 36 cases, the probe technique was used in 6 cases and 39 both techniques were used simultaneously. A total axillary dissection was done in every case, except for two. The results were: the SLN was found in 74 cases and of these, 35 with axillary metastases. There were two false-negative results. Of the 36 cases where the dyeing technique was used, the SLN was found in 32 cases and of these, 21 presented axillary metastases and there were one false-negative result. The SLN was found in all 6 cases using the probe technique, two had axillary metastases and there were no false-negative results. The SLN was found in 36 of the 39 cases using the two different techniques. In 34 cases it was found by the two methods and there were one false-negative. In the other two cases there was a disagreement between the two methods and of these, two were false-negative (these two cases are contained in the first six using the probe. Conclusion: the predictive negative value of the SLN is very high in the different techniques and will be used as a method to avoid axillary dissection in certain cases. (author)

  4. Bullous Systemic Lupus Erythematosus: Case report

    Science.gov (United States)

    Miziara, Ivan Dieb; Mahmoud, Ali; Chagury, Azis Arruda; Alves, Ricardo Dourado

    2013-01-01

    Summary Introduction: Bullous systemic lupus erythematosus (BSLE) is an autoantibody-mediated disease with subepidermal blisters. It is a rare form of presentation of SLE that occurs in less than 5% of cases of lupus. Case Report: A 27-year-old, female, FRS patient reported the appearance of painful bullous lesions in the left nasal wing and left buccal mucosa that displayed sudden and rapid growth. She sought advice from emergency dermatology staff 15 days after onset and was hospitalized with suspected bullous disease. Intravenous antibiotics and steroids were administered initially, but the patient showed no improvement during hospitalization. She displayed further extensive injuries to the trunk, axillae, and vulva as well as disruption of the bullous lesions, which remained as hyperemic scars. Incisional biopsy of a lesion in the left buccal mucosa was performed, and pathological results indicated mucositis with extensive erosion and the presence of a predominantly neutrophilic infiltrate with degeneration of basal cells and apoptotic keratinocytes. Under direct immunofluorescence, the skin showed anti-IgA, anti-IgM, and anti-IgG linear fluorescence on the continuous dermal side of the cleavage. Indirect immunofluorescence of the skin showed conjugated anti-IgA, was anti-IgM negative, and displayed pemphigus in conjunction with anti-IgG fluorescence in the nucleus of keratinocytes, consistent with a diagnosis of bullous lupus erythematosus. Discussion: BSLE is an acquired autoimmune bullous disease caused by autoantibodies against type VII collagen or other components of the junctional zone, epidermis, and dermis. It must be differentiated from the secondary bubbles and vacuolar degeneration of the basement membrane that may occur in acute and subacute cutaneous lupus erythematosus. PMID:25992032

  5. Bullous Systemic Lupus Erythematosus: Case report

    Directory of Open Access Journals (Sweden)

    Miziara, Ivan Dieb

    2014-01-01

    Full Text Available Introduction: Bullous systemic lupus erythematosus (BSLE is an autoantibody-mediated disease with subepidermal blisters. It is a rare form of presentation of SLE that occurs in less than 5% of cases of lupus. Case Report: A 27-year-old, female, FRS patient reported the appearance of painful bullous lesions in the left nasal wing and left buccal mucosa that displayed sudden and rapid growth. She sought advice from emergency dermatology staff 15 days after onset and was hospitalized with suspected bullous disease. Intravenous antibiotics and steroids were administered initially, but the patient showed no improvement during hospitalization. She displayed further extensive injuries to the trunk, axillae, and vulva as well as disruption of the bullous lesions, which remained as hyperemic scars. Incisional biopsy of a lesion in the left buccal mucosa was performed, and pathological results indicated mucositis with extensive erosion and the presence of a predominantly neutrophilic infiltrate with degeneration of basal cells and apoptotic keratinocytes. Under direct immunofluorescence, the skin showed anti-IgA, anti-IgM, and anti-IgG linear fluorescence on the continuous dermal side of the cleavage. Indirect immunofluorescence of the skin showed conjugated anti-IgA, was anti-IgM negative, and displayed pemphigus in conjunction with anti-IgG fluorescence in the nucleus of keratinocytes, consistent with a diagnosis of bullous lupus erythematosus. Discussion: BSLE is an acquired autoimmune bullous disease caused by autoantibodies against type VII collagen or other components of the junctional zone, epidermis, and dermis. It must be differentiated from the secondary bubbles and vacuolar degeneration of the basement membrane that may occur in acute and subacute cutaneous lupus erythematosus.

  6. Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism.

    Science.gov (United States)

    Brunaud, Laurent; Li, Zhen; Van Den Heede, Klaas; Cuny, Thomas; Van Slycke, Sam

    2016-06-01

    Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders for which parathyroidectomy is the most effective therapy. Until late 1970s, the standard approach to parathyroidectomy was a four-gland exploration using a large skin incision. However, 80 to 85 percent of cases of PHPT are caused by a single adenoma. As such, the concept of performing a bilateral exploration in order to visualize all four glands has been argued to be excessive since in the majority of cases, there is only one abnormal gland. Focused exploration (one gland) is currently the standard technique for parathyroidectomy worldwide. Despite a rapid acceptance of minimally invasive approaches in most endocrine surgery centers, the use of an endoscope with or without the use of a robotic system to perform parathyroidectomy remains controversial. The goal of this study was to review current available data about surgical approaches using an endoscope with or without the use of a robotic system in the management of patients with PHPT. For conventional endoscopic and video assisted parathyroidectomy, several comparative studies have demonstrated some advantages in terms of reduced postoperative pain, better cosmetic results and higher patient satisfaction compared to open non-endoscopic minimally invasive parathyroidectomy. Robot-assisted transaxillary parathyroidectomy has the advantage of leaving no scar in the neck but its role has not yet been delineated clearly given the limited number of published series. Subjective postoperative cosmetic evaluation is good by concealing the scar in the axilla or infraclavicular area. However, this approach is associated with more extensive dissection than during conventional open or endoscopic neck access surgical procedures. Patients with true ectopic mediastinal parathyroid glands are good candidates for conventional or robot-assisted thoracoscopic approaches because these glands are in remote and narrow anatomical locations. PMID:27294044

  7. Is there a requirement for axillary lymph node dissection following identification of micro-metastasis or isolated tumour cells at sentinel node biopsy for breast cancer?

    LENUS (Irish Health Repository)

    Joyce, D P

    2012-02-29

    INTRODUCTION: Recent decades have seen a significant shift towards conservative management of the axilla. Increasingly, immunohistochemical analysis of sentinel nodes leads to the detection of small tumour deposits, the significance of which remains uncertain. The aims of this study are to examine patients whose sentinel lymph nodes are positive for macro-metastasis, micro-metastasis or isolated tumour cells (ITCs) and to determine the rate of further nodal disease after axillary lymph node dissection (ALND). METHODS: A retrospective analysis of all patients undergoing a sentinel lymph node biopsy (SLNB) between January 2007 and December 2010 in a tertiary referral breast unit was performed. Patients who underwent an axillary lymph node dissection for macro-metastasis, micro-metastasis or ITCs were identified. Demographics, histological data and the rate of further axillary disease were examined. RESULTS: In total, 664 breast cancer patients attended the symptomatic breast unit during the study period, 360 of whom underwent a SLNB. Seventy patients had a SLNB positive for macro-metastasis. All of these patients underwent ALND. A positive SLNB with either micro-metastasis or ITCs was identified in 58 patients. Only 41 of the 58 patients went on to have an ALND, due primarily to variations in surgeons\\' preferences. Nineteen patients with micro-metastasis underwent an ALND. Four patients had further axillary disease (21%). Twenty-two patients had ITCs identified, of whom only one had further disease (4.5%). No statistically significant difference was found between the two groups in terms of tumour size, grade, lymphovascular invasion or oestrogen receptor status. CONCLUSION: ALND should be considered in patients with micro-metastasis at SLNB. It should rarely be employed in the setting of SLNB positive for ITCs.

  8. Analysis of 18F-FDG PET images of patients with sarcoidosis

    International Nuclear Information System (INIS)

    Objective: To analyse 18F-fluorodeoxyglucose (FDG) PET images of patients with sarcoidosis, make an abstract of image characteristics. Methods: Twenty-four cases with sarcoidosis underwent both PET and CT. Among them, 5 were with pathologic evidence and had clinical symptoms, 19 were with positive Kveim test but asymptomatic. All 24 cases kept a fast of 6 h and the blood glucose was controlled below 6.7 mmol/L before injection of FDG. 40 min after administration, PET scan was performed with Siemens ECAT 47. After getting images through reconstruction by computer, the location and contour of the lesions were reviewed; the sizes and standardized uptake value (SUV) were measured. Results: For all 24 cases, strings of nodules were observed along the hili of lungs and the mediastinum, one of them had a nodule with high uptake of 18F-FDG in the left axilla in addition to the nodules along the hili of lungs and mediastinum. Sizes of nodules of 5 cases with symptoms and of 19 without symptoms were (2.16±0.67) and (1.55±0.21) cm, respectively; SUV were 2.68 ± 0.58 and 1.46±0.24, respectively. There was significant difference in the sizes and SUV of nodules between 5 with symptoms and 19 without symptoms (P 18F-FDG PET image characteristics of sarcoidosis i. e. strings of nodules distributing along the lung hili and mediastinum. Sizes of nodules were bigger and uptakes of 18F-FDG were higher for cases with symptoms than those for the asymptomatic cases

  9. Axillary lymph node dose with tangential whole breast radiation in the prone versus supine position: a dosimetric study

    Directory of Open Access Journals (Sweden)

    Leonard Kara

    2012-05-01

    Full Text Available Abstract Background Prone breast positioning reduces skin reaction and heart and lung dose, but may also reduce radiation dose to axillary lymph nodes (ALNs. Methods Women with early stage breast cancer treated with whole breast irradiation (WBI in the prone position were identified. Patients treated in the supine position were matched for treating physician, laterality, and fractionation. Ipsilateral breast, tumor bed, and Level I, II, and III ALNs were contoured according to the RTOG breast atlas. Clips marking surgically removed sentinel lymph nodes (SLNs were contoured. Treatment plans developed for each patient were retrospectively analyzed. V90% and V95% was calculated for each axillary level. When present, dose to axillary surgical clips was calculated. Results Treatment plans for 46 women (23 prone and 23 supine were reviewed. The mean V90% and V95% of ALN Level I was significantly lower for patients treated in the prone position (21% and 14%, respectively than in the supine position (50% and 37%, respectively (p p % of SLN clips was 47% for patients treated in the supine position and 0% for patients treated in the prone position (p % to SLN clips was 96% for women treated in the supine position but only 13% for women treated in the prone position. Conclusions Standard tangential breast irradiation in the prone position results in substantially reduced dose to the Level I axilla as compared with treatment in the supine position. For women in whom axillary coverage is indicated such as those with positive sentinel lymph node biopsy who do not undergo completion axillary dissection, treatment in the prone position may be inappropriate.

  10. Improving the radial nerve neurodynamic test: An observation of tension of the radial, median and ulnar nerves during upper limb positioning.

    Science.gov (United States)

    Manvell, Joshua J; Manvell, Nicole; Snodgrass, Suzanne J; Reid, Susan A

    2015-12-01

    The radial nerve neurodynamic test (ULNT2b), used to implicate symptoms arising from the radial nerve, is proposed to selectively increase strain of the nerve without increasing strain of adjacent tissue, though this has not been established. This study aimed to determine the upper limb position that results in: (1) the greatest tension of the radial nerve and (2) the greatest difference in tension between the radial nerve and the other two major nerves of the upper limb: median and ulnar. Tension (N) of the radial, median and ulnar nerves was measured simultaneously using three buckle force transducers during seven upper limb positions in the axilla of ten embalmed whole body human cadavers (n = 20 limbs). Repeated measures analysis of variance (ANOVA) with Bonferroni post-hoc tests determined differences in tension between nerves and between limb positions. A Composite position consisting of ULNT2b (scapular depression, shoulder internal rotation, elbow extension, forearm pronation, wrist flexion) with the addition of shoulder abduction 40° and extension 25°, wrist ulnar deviation and thumb flexion demonstrated significantly greater tension of the radial nerve than any other tested position (mean tension 11.32N; 95% CI 10.25, 12.29, p < 0.01), including ULNT2b (2.20N; 1.84, 2.57; p < 0.01). Additionally, the Composite position demonstrated the greatest difference in tension between the radial and median (mean difference 4.88N; 95% CI 3.16, 6.61; p < 0.01) and radial and ulnar nerves (9.26N, 7.54, 10.99; p < 0.01). This position constitutes a biomechanically plausible test to detect neuropathic pain related to the radial nerve. PMID:25892706

  11. Histiocitose de células de Langerhans com acometimento vulvar e com resposta terapêutica à talidomida: relato de caso Langerhans cells histiocytosis with vulvar involvement and responding to thalidomide therapy: case report

    Directory of Open Access Journals (Sweden)

    Lana Bezerra Fernandes

    2011-08-01

    Full Text Available A histiocitose de células de Langerhans é representante de um raro grupo de síndromes histiocitárias, sendo caracterizada pela proliferação das células de Langerhans. Suas manifestações variam de lesão solitária a envolvimento multissistêmico, sendo o acometimento vulvar incomum. Segue-se o relato de caso refratário da doença limitada à pele, em mulher de 57 anos. A paciente apresentava história de pápulas eritematosas ulceradas em couro cabeludo, face, vulva, tronco e axila há seis anos. O diagnóstico da doença é difícil, sendo confirmado neste caso através de estudo imuno-histoquímico e se obteve resposta terapêutica e eficaz, com a administração de talidomidaLangerhans cell histiocytosis is a member of a group of rare histiocytic syndromes and is characterized for the proliferation of histiocytes called Langerhans'cells. Its manifestations vary from a solitary injury to systemic involvement, and vulvar lesions are uncommon. We describe a refractory case of cutaneous limited disease in a 57-year-old woman. She presented with a 6-year history of an erythematous papular eruption of the scalp, face, vulva, trunk and axillae. The diagnosis is difficult and in this case it was confirmed through immunohistochemical study and clinical improvement was achieved with thalidomide

  12. Does Axillary Boost Increase Lymphedema Compared With Supraclavicular Radiation Alone After Breast Conservation?

    International Nuclear Information System (INIS)

    Purpose: To determine independent predictors of lymphedema (LE) after breast radiotherapy and to quantify added risks of LE from regional node irradiation (RNI). Materials and Methods: A total of 2,579 women with T1-2, N 0-3, M0 breast cancer treated with breast conservation between 1970 and 2005 were studied. A total of 2,169 patients (84%) received radiation to the breast (B), 226 (8.8%) to the breast and supraclavicular LNs (B+SC), and 184 (7.1%) to the breast, supraclavicular LNs, and a posterior axillary boost (B+SC+PAB). Median follow-up was 81 months (range, 3-271). Results: Eighteen percent of patients developed LE. LE risks were as follows: 16% (B), 23% (B+SC), and 31% (B+SC+PAB) (p < 0.0001). LE severity was greater in patients who had RNI (p = 0.0002). On multivariate analysis, RT field (p < 0.0001), obesity index (p = 0.0157), systemic therapy (p = 0.0013), and number of LNs dissected (p < 0.0001) independently predicted for LE. In N1 patients, the addition of a SC to tangents (p < 0.0001) and the addition of a PAB to tangents (p = 0.0017) conferred greater risks of LE, but adding a PAB to B+SC RT did not (p = 0.8002). In the N2 patients, adding a PAB increased the risk of LE 4.5-fold over B+SC RT (p = 0.0011). Conclusions: LE predictors included number of LNs dissected, RNI, obesity index, and systemic therapy. LE risk increased when a SC or PAB were added in the N1 subgroup. In the N2 patients, a PAB increased the risk over B+SC. The decision to boost the axilla must be weighed against the increased risk of LE that it imposes

  13. Evaluation of lymph node metastases of breast cancer using ultrasmall superparamagnetic iron oxide-enhanced magnetic resonance imaging

    International Nuclear Information System (INIS)

    Background: We assessed the utility of enhanced magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxide (USPIO) in the evaluation of axillary lymph node metastases in patients with breast cancer. Study design: MR examination of the axilla was performed before and 24-36 h after USPIO administration for patients with stage II or III breast cancer. Diagnostic performance was compared using size criteria (metastasis was defined when short axis diameter >5 or >10 mm) or morphologic criteria on conventional MRI, the combined study of USPIO precontrast and postcontrast images, and USPIO postcontrast study alone. Results: A total of 622 nodes (503 metastatic and 119 nonmetastatic nodes) were dissected from 33 patients. The results of conventional MRI for nodes >5 mm were 59.1% sensitivity, 86.7% specificity, and 80.4% overall accuracy. Results for nodes >10 mm were 15.7% sensitivity, 99.2% specificity, and 80.2% overall accuracy. Results based on morphology were 36.5% sensitivity, 94.1% specificity, and 81.0% overall accuracy. The results of the combined study of USPIO precontrast and postcontrast images were 86.4% sensitivity, 97.5% specificity, 91.1% positive predictive value, 96.1% negative predictive value, and 95.0% overall accuracy. The results of USPIO postcontrast images alone were 84.7% sensitivity, 96.8% specificity, and 94.0% overall accuracy. Patient-based results of postcontrast USPIO study alone were 100.0% sensitivity, 80.0% specificity, and 93.9% overall accuracy. Conclusions: USPIO postcontrast study alone was useful in the assessment of axillary lymph node metastases in patients with breast cancer

  14. Relationship between lymph node sinuses with blood and lymphatic metastasis of gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Tong Yin; Xiao-Long Ji; Min-Shi Shen

    2003-01-01

    AIM: To elucidate the relationship between lymph nodesinuses with blood and lymphatic metastasis of gastric cancer.METHODS: Routine autopsy was carried out in the randomlyselected 102 patients (among them 100 patients died ofvarious diseases, and 2 patients died of non-diseasedreasons), their superficial lymph nodes locating in bilateralnecks (include supraclavicle), axilla, inguina, thorax, andabdomen were sampled. Haematoxylin-Eosin staining wasperformed on 10 % formalin-fixed and paraffin-embeddedlymph node tissue sections (Sum). The histological pattemsof the lymph sinuses containing blood were observed underlight microscope. The expression of CD31, a marker forendothelial cell, was detected both in blood and non-bloodcontaining lymph node sinuses with the method ofimmunohistochemistry.RESULTS: Among the 1322 lymph nodes sampled fromthe autopsies of 100 diseased cases, lymph node sinusescontaining blood were found in 809 lymph nodes sampledfrom 91 cases, but couldn't be seen in the lymph nodessampled from the non-diseased cases. According to histology,we divided the blood containing lymph node sinuses intofive categories: vascular-opening sinus, blood-deficient sinus,erythrophago-sinus, blood-abundant sinus, vascular-formative sinus. Immunohistochemical findings showed thatthe expression of CD31 was strongly positive in vascular-formative sinuses and some vascular-opening sinuses whileit was faint in blood-deficient sinuses, erythrophago-sinusesand some vascular-opening sinuses. It was almost negativein blood-abundant sinus and non-blood containing sinus.CONCLUSION: In the state of disease, the phenomenonof blood present in the lymph sinus is not uncommon. Bloodcould possibly enter into the lymph sinuses through thelymphaticovenous communications between the veins andthe sinuses in the node. Lymph circulation and the bloodcirculation could communicate with each other in the lymphnode sinuses. The skipping and distal lymphatic metastasisof gastric cancer may

  15. Surgical treatment of early breast cancer in day surgery.

    Science.gov (United States)

    Marrazzo, Antonio; Taormina, Pietra; David, Massimo; Riili, Ignazio; Lo Gerfo, Domenico; Casà, Luigi; Noto, Antonio; Mercadante, Sebastiano

    2007-01-01

    Quadrantectomy and associated sentinel lymph node biopsy (SLNB) is currently employed in most breast surgery centres as the gold standard in the treatment of early breast cancer. This approach has a modest morbidity and can usually be performed in a day-surgery regimen, leading to best acceptance by the patients. This reports outlines the experience of our Breast Unit with quadrantectomy and SLNB in day surgery for early breast cancer. One hundred patients presenting to our institution with primary invasive breast cancer measuring less than 3 cm and clinically negative axillary nodes underwent quadrantectomy and SLNB in day surgery. For 60 women with breast cancer the sentinel node was negative, so the only definitive surgical treatment was performed in the day-surgery regimen; 40 patients with positive sentinel nodes were hospitalised a second time for axillary dissection. In these patients that needed clearance of the axilla, SLNB was performed on the only positive node in 22 cases (55%). None of the patients admitted for quadrantectomy and SLNB in day surgery required re-hospitalisation after discharge. All patients proved to be fully satisfied with early discharge from hospital when questioned on the occasion of subsequent monitoring. Short-stay surgical programs in early invasive breast cancer treatment are feasible today owing to the availability of less invasive approaches such as quadrantectomy and SLNB. There are two main pointers to a distinct advantage for this kind of approach, i.e. recovery and psychological adjustment. Recovery from surgery is faster and the patient tends to play down the seriousness of the operation and to have a better mental attitude to neoplastic disease. Moreover, when performing quadrantectomy with SLNB in day surgery fewer than 50% of breast cancer patients (40% in our experience) require another surgical treatment, concluding the surgery in a single session. PMID:18019641

  16. Prospective Analysis Methicillin-resistant Staphylococcus aureus and its Risk Factors

    Science.gov (United States)

    Abdallah, Soad A; Al-Asfoor, Khulood K; Salama, Mona F; Al-Awadi, Bashayer M

    2013-01-01

    Background: Since the early nineties, a new methicillin-resistant Staphylococcus aureus (MRSA) has existed in a form correlating with community health personnel. Community-acquired MRSA (CA-MRSA) could be differentiated from healthcare-associated MRSA (HA-MRSA) microbiologically, epidemiologically, and molecularly. Aims: To determine the prevalence, risk factors of MRSA infections in community and hospital. Settings: The incidence and risk factors for CA-MRSA and HA-MRSA among patients of medical, surgical, and pediatrics wards and ICU at a Kuwaiti teaching hospital between 1 March 2011 and 30 November 2011 were studied. Materials and Methods: Cultures for MRSA were taken from nasal (nostril), groin, axilla, wound, sputum, or throat, and the inguinal area in all enrolled patients upon admission. All preserved isolates were examined for their susceptibility to different types of antibiotics. Results and Conclusion: A total of 71 MRSA patients admitted to different hospital wards were examined. Among these patients, 52 (73.2%) were carriers of MRSA before they were admitted to the hospital. Nineteen patients (26.8%) were found to have acquired MRSA during their stay in the hospital. Twenty-nine patients (40.8%) were given mupirocin local skin antibiotic. Binomial and the t-test (paired) were used to compare the prevalence of CA-MRSA and HA-MRSA; significant correlation (P < 0.05) between the type of MRSA and different wards, sites, and lengths of hospital stay was found. The level of serum albumin that is routinely measured at hospital admission is a predictor to MRSA infection. This study suggests that S. aureus and MRSA should become a national priority for disease control to avoid outbreaks. PMID:23599613

  17. Evaluating the Effects of Aluminum-Containing and Non-Aluminum Containing Deodorants on Axillary Skin Toxicity During Radiation Therapy for Breast Cancer: A 3-Armed Randomized Controlled Trial

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Lucy, E-mail: Lucy.lewis@curtin.edu.au [Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia (Australia); School of Nursing and Midwifery Curtin University, Perth (Australia); Carson, Sharron [Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (Australia); Bydder, Sean [Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (Australia); School of Surgery, The University of Western Australia, Crawley, Western Australia (Australia); Athifa, Mariyam [School of Nursing and Midwifery Curtin University, Perth (Australia); Williams, Anne M. [School of Nursing and Midwifery Curtin University, Perth (Australia); School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia (Australia); Bremner, Alexandra [School of Population Health, The University of Western Australia, Crawley, Western Australia (Australia)

    2014-11-15

    Purpose: Deodorant use during radiation therapy for breast cancer has been controversial as there are concerns deodorant use may exacerbate axillary skin toxicity. The present study prospectively determined the use of both aluminum-containing and non aluminum containing deodorants on axillary skin toxicity during conventionally fractionated postoperative radiation therapy for breast cancer. Methods and Materials: This 3-arm randomized controlled study was conducted at a single center, tertiary cancer hospital between March 2011 and April 2013. Participants were randomized to 1 of 2 experimental groups (aluminum-containing deodorant and soap or non–aluminum containing deodorant and soap) or a control group (soap). A total of 333 participants were randomized. Generalized estimating equations were used to estimate and compare the odds of experiencing high levels of sweating and skin toxicity in each of the deodorant groups to the odds in the control group. The study evaluated a range of endpoints including objective measurements of axilla sweating, skin toxicity, pain, itch and burning. Quality of life was assessed with a validated questionnaire. Results: Radiation characteristics were similar across all groups. Patients in the deodorant groups did not report significantly different ratings for axillary pain, itch, or burning compared with the control group. Patients in the aluminum-containing deodorant group experienced significantly less sweating than the control; the odds of their sweating being barely tolerable and frequently or always interfering with their daily activities was decreased by 85% (odds ratio, 0.15; 95% confidence interval, 0.03-0.91). Conclusions: We found no evidence that the use of either aluminum-containing or non–aluminum containing deodorant adversely effects axillary skin reaction during conventionally fractionated radiation therapy for breast cancer. Our analysis also suggests patients in the aluminum-containing deodorant arm had

  18. Severe scrub typhus infection: Clinical features, diagnostic challenges and management.

    Science.gov (United States)

    Peter, John Victor; Sudarsan, Thomas I; Prakash, John Anthony J; Varghese, George M

    2015-08-01

    Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay (IFA) for the detection of IgM antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%. PMID:26261776

  19. Axillary treatment for patients with early breast cancer and lymph node metastasis: systematic review protocol

    Directory of Open Access Journals (Sweden)

    Goyal Amit

    2013-01-01

    Full Text Available Abstract Background For patients with early breast cancer and lymph node metastasis, axillary treatment is widely recommended. This is either surgical removal of the axillary lymph nodes, or axillary radiotherapy. The rationale for axillary treatment is that it will reduce the risk of recurrence in the axilla, and may improve survival. However, both treatments are associated with adverse effects, such as lymphedema, pain and sensory loss, and are costly to the health services and to patients. With improvements in adjuvant therapy, routine axillary treatment may no longer offer any overall advantage. Objectives To assess the short and long term benefits and adverse effects of routine axillary treatment (axillary lymph node clearance or axillary radiotherapy for patients with lymph node positive early-stage breast cancer. Methods/Design Criteria for potentially eligibility for the study will be that the participants are men and women with early breast cancer and lymph nodes with metastasis. The study compares either axillary treatment with no axillary treatment, or axillary node clearance with axillary radiotherapy, and the study is a randomized trial. Primary outcomes are axillary recurrence, disease-free and overall survival. Secondary outcomes include breast or chest wall recurrence, distant metastasis, time to axillary recurrence, axillary recurrence-free survival, arm morbidity, quality of life and health economic costs. The search strategy will include the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform (ICTRP search portal. Two independent reviewers will assess studies for inclusion in the review, assess study quality and extract data. Characteristics of included studies will be described. Meta-analysis will be conducted using ReVman software. Comment This review addresses an important clinical question, and results will inform clinical practice and health care policy.

  20. Five-year follow-up of treatment outcomes in patients with early-stage breast cancer and clinically negative axillary nodes treated with no lymph node dissection or axillary clearance

    Directory of Open Access Journals (Sweden)

    Yamamoto D

    2012-08-01

    Full Text Available Daigo Yamamoto,1 Kanji Tanaka,2 Yu T subota,1 Noriko Sueoka,1 Tetsuji Shoji,3 Kayoko Kuwana,1 A-Hon Kwon11Department of Surgery, Kansai Medical University, Hirakata, 2Ribon-Rose Tanaka Kanji Breast Clinic, 3Shoji Clinic, Osaka, JapanBackground: Sentinel lymph node biopsy has steadily replaced axillary lymph node dissection (ALND for staging clinically node-negative breast cancer. However, ALND remains standard management of the axilla when a tumor-positive sentinel lymph node is identified.Methods: We identified 460 patients with breast cancer (clinically T1/T2N0M0 from the database for 1999–2004. Patient age ranged from 26 to 81 (median 50 years. Patients who underwent mastectomy or breast-conserving surgery with or without ALND were compared for regional recurrence, disease-free survival, and overall survival.Results: Patients with ALND (n = 308 were compared with the no ALND group (n = 152. Five-year overall survival and disease-free survival were not significantly different between the two groups, while there was a significant difference between them for regional recurrence. Of the 152 patients who did not undergo axillary dissection, four developed ipsilateral axillary disease, most of whom were rescued by delayed axillary dissection. Further, the criterion for identifying lymphedema was used, ie, a 2 cm circumferential change at any measured location. As a result, the incidence of lymphedema in the ALND group was 12.7%, while it was not seen in the non ALND group.Conclusion: There is a possibility that ALND may be omitted for cT1/T2N0M0 breast cancer through a combination of hormone therapy and adjuvant chemotherapy.Keywords: breast cancer, axillary lymph node dissection

  1. Lymph Drainage Studied by Lymphoscintigraphy in the Arms after Sentinel Node Biopsy Compared with Axillary Lymph Node Dissection Following Conservative Breast Cancer Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Celebioglu, F.; Perbeck, L.; Frisell, J.; Groendal, E.; Svensson, L.; Danielsson, R. [Dept. of Molecular Medicine and Surgery, Karolinska Inst., Karolinska Univ Hospital Solna, Stockholm (Sweden)

    2007-07-15

    Purpose: To investigate lymphatic drainage as measured by lymphoscintigraphy in the arms of patients undergoing either sentinel lymph node biopsy (SNB) or axillary lymph node dissection (ALND). Material and Methods: From January 2001 to December 2002, 30 patients with unilateral invasive breast carcinoma underwent breast-conserving surgery with SNB and 30 patients with ALND. All patients received radiotherapy to the breast. Lymphoscintigraphy was performed, and skin circulation, skin temperature, and arm volume were measured 2-3 years after radiotherapy. Results: None of the 30 patients who underwent SNB showed any clinical manifestation of lymphedema. Of the 30 patients undergoing ALND, six (20%) had clinical lymphedema, with an arm volume that was >10% larger on the operated than on the non-operated side (P<0.01). Scintigraphically, visual analysis revealed lymphatic dysfunction in three patients, manifested as forearm dermal back flow. Two of these patients also had an increased arm volume. Quantitative analysis showed no differences between the groups, apart from a smaller amount of isotope in the axilla in the ALND group. There was no difference in skin circulation or skin temperature. Conclusion: Our study shows that lymph drainage in the operated arm compared with the non-operated arm was less affected by SNB than by ALND, and that morbidity associated with SNB was lower than with ALND. However, the results do not confirm our hypothesis that lymphoscintigraphy can reveal differences in lymph circulation that are not evident clinically in the form of manifest lymphedema. The most sensitive clinical method of assessing lymph drainage seems to be measurement of arm volume.

  2. Execution of mantle field with multileaf collimator: A simple approach

    Directory of Open Access Journals (Sweden)

    Prabhakar Ramachandran

    2008-01-01

    Full Text Available Background: Until very recently mantle field radiotherapy remained the gold standard for the treatment of favorable early-stage Hodgkin′s lymphoma. The classic mantle includes all the major lymph nodes above the diaphragm and extends from the inferior portion of the mandible to the level of the insertion of the diaphragm. Aims: To describe a simple technique that has been devised to treat the mantle field with the help of multileaf collimator and using computed tomography (CT-based treatment planning. Materials and Methods: CT scan was performed with the patient in the supine position and the datasets were transferred to the Eclipse™ treatment planning system. Elekta Precise™ linear accelerator equipped with 40 pairs of multileaf collimator (MLC was used for the execution of the mantle field. The MLC′s shapes were designed to take the shape of the conventional customized blocks used for treatment of mantle field. The anterior mantle field was divided into three separate MLC segments with the collimator kept at 0°. The first MLC segment was shaped to cover the neck, clavicular regions, and mediastinum. The second and the third MLC segments covered the right and left axilla, respectively. The posterior fields were opposed to the anterior subfields in a similar fashion. The dose was prescribed at the midplane, using reference points. Results and Conclusion: The technique described in this study is very simple, easy to implement, and avoids unnecessary delay in the execution of the mantle field. The mantle field can be easily shaped with the multileaf collimators, without any collimator rotation.

  3. Classical Hodgkin Lymphoma Arising Adjacent to a Breast Implant.

    Science.gov (United States)

    Ryan, Ciara; Ged, Yasser; Quinn, Fiona; Walker, Jan; Kennedy, John; Gillham, Charles; Pittaluga, Stefania; McDermott, Ronan; Vandenberghe, Elisabeth; Grant, Cliona; Flavin, Richard

    2016-08-01

    Breast implant-associated lymphoma has recently gained wide recognition. Anaplastic large cell lymphoma (ALCL) is the most frequently diagnosed subtype in this setting but the spectrum is broadening. A 66-year-old woman developed swelling and itch around her saline implant 6 years after its insertion. Imaging revealed a fluid collection surrounding the implant with an adjacent mass. Microscopy showed sclerotic tissue punctuated by discrete cellular nodules comprising small lymphocytes, eosinophils and interspersed large atypical Hodgkin Reed-Sternberg (HRS)-like cells. The HRS-like cells stained positively for CD30 and CD15 by immunohistochemistry. Small T-lymphocytes formed rosettes around HRS-like cells. Appearances were consistent with classical Hodgkin lymphoma (HL). Multiplex polymerase chain reaction demonstrated no clonal rearrangements of immunoglobulin or T-cell receptor genes, however, a t(14;18)(q32;q21)BCL2-JH translocation involving the major breakpoint region of the bcl2 gene was present. Staging positron emission tomography-computed tomography scan revealed FDG-avid masses in the right axilla and pelvis. Subsequent pathological examination identified low-grade follicular lymphoma (FL) with a t(14;18) translocation at these sites. To our knowledge, this is the first case of HL arising adjacent to a breast implant. An awareness of this diagnosis is important as classical HL, with its prominent mixed inflammatory background, may be overlooked as a reactive process when histologically assessing capsulectomy specimens. It is also important in the differential diagnosis for implant-associated ALCL as both contain large atypical CD30-positive cells highlighting the need for full immunohistochemical and molecular workup in such cases. This case also adds to the large body of literature regarding the association between HL and FL. PMID:26888955

  4. Skin tags: A link between lesional mast cell count/tryptase expression and obesity and dyslipidemia

    Directory of Open Access Journals (Sweden)

    Samar Abdallah M Salem

    2013-01-01

    Full Text Available Background:The etiology of skin tags (STs is not fully understood. A relation to diabetes mellitus and obesity was suggested. Few studies of possible mast cells (MCs involvement were reported. Tyrptase is a mast cell mediator and a potent fibroblast growth factor. It may provide a molecular link between mast cell activation and fibrosis. Aims: The aim was to assess clinical and laboratory findings in patients with STs, and the possible link between obesity, dyslipidemia, and lesional MC count/tryptase expression. Materials and Methods: A total of 20 patients with STs were subjected to clinical examination, estimation of body mass index (BMI, fasting blood glucose (FBG, postprandial blood glucose (PPBG, serum cholesterol and triglycerides, abdominal ultrasound for fatty liver assessment, in addition to study of MCs through staining for MC tryptase in two skin biopsies; lesional and nonlesional (control. Results:All patients showed abnormally high BMI and hypertriglyceridemia, with abnormal sonographic pattern in 15 patients (75%. STs number positively correlated with the age of patients. STs showed significantly higher MC counts and tryptase expression, compared with control skin ( P < 0.001, with no correlation of the STs number or MC count with BMI, FBG, PPBG or serum cholesterol. Obese patients showed a significantly higher MC count than overweight and there was a positive correlation between MC count and serum triglycerides. Axilla and under breast STs showed a higher MC count compared with other sites. Conclusions:STs seem to be related to obesity and hypertriglyceridemia. MCs with their tryptase are possibly involved in pathogenesis of STs. MC count is related to the associated factors; obesity and serum triglycerides. MC tryptase expression is a reliable method for accurate tissue MC counting.

  5. Evaluating the Effects of Aluminum-Containing and Non-Aluminum Containing Deodorants on Axillary Skin Toxicity During Radiation Therapy for Breast Cancer: A 3-Armed Randomized Controlled Trial

    International Nuclear Information System (INIS)

    Purpose: Deodorant use during radiation therapy for breast cancer has been controversial as there are concerns deodorant use may exacerbate axillary skin toxicity. The present study prospectively determined the use of both aluminum-containing and non aluminum containing deodorants on axillary skin toxicity during conventionally fractionated postoperative radiation therapy for breast cancer. Methods and Materials: This 3-arm randomized controlled study was conducted at a single center, tertiary cancer hospital between March 2011 and April 2013. Participants were randomized to 1 of 2 experimental groups (aluminum-containing deodorant and soap or non–aluminum containing deodorant and soap) or a control group (soap). A total of 333 participants were randomized. Generalized estimating equations were used to estimate and compare the odds of experiencing high levels of sweating and skin toxicity in each of the deodorant groups to the odds in the control group. The study evaluated a range of endpoints including objective measurements of axilla sweating, skin toxicity, pain, itch and burning. Quality of life was assessed with a validated questionnaire. Results: Radiation characteristics were similar across all groups. Patients in the deodorant groups did not report significantly different ratings for axillary pain, itch, or burning compared with the control group. Patients in the aluminum-containing deodorant group experienced significantly less sweating than the control; the odds of their sweating being barely tolerable and frequently or always interfering with their daily activities was decreased by 85% (odds ratio, 0.15; 95% confidence interval, 0.03-0.91). Conclusions: We found no evidence that the use of either aluminum-containing or non–aluminum containing deodorant adversely effects axillary skin reaction during conventionally fractionated radiation therapy for breast cancer. Our analysis also suggests patients in the aluminum-containing deodorant arm had

  6. Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism

    Science.gov (United States)

    Li, Zhen; Van Den Heede, Klaas; Cuny, Thomas; Van Slycke, Sam

    2016-01-01

    Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders for which parathyroidectomy is the most effective therapy. Until late 1970s, the standard approach to parathyroidectomy was a four-gland exploration using a large skin incision. However, 80 to 85 percent of cases of PHPT are caused by a single adenoma. As such, the concept of performing a bilateral exploration in order to visualize all four glands has been argued to be excessive since in the majority of cases, there is only one abnormal gland. Focused exploration (one gland) is currently the standard technique for parathyroidectomy worldwide. Despite a rapid acceptance of minimally invasive approaches in most endocrine surgery centers, the use of an endoscope with or without the use of a robotic system to perform parathyroidectomy remains controversial. The goal of this study was to review current available data about surgical approaches using an endoscope with or without the use of a robotic system in the management of patients with PHPT. For conventional endoscopic and video assisted parathyroidectomy, several comparative studies have demonstrated some advantages in terms of reduced postoperative pain, better cosmetic results and higher patient satisfaction compared to open non-endoscopic minimally invasive parathyroidectomy. Robot-assisted transaxillary parathyroidectomy has the advantage of leaving no scar in the neck but its role has not yet been delineated clearly given the limited number of published series. Subjective postoperative cosmetic evaluation is good by concealing the scar in the axilla or infraclavicular area. However, this approach is associated with more extensive dissection than during conventional open or endoscopic neck access surgical procedures. Patients with true ectopic mediastinal parathyroid glands are good candidates for conventional or robot-assisted thoracoscopic approaches because these glands are in remote and narrow anatomical locations. PMID:27294044

  7. Unusual Cause of Swelling in the Upper Limb: Kimura Disease

    Directory of Open Access Journals (Sweden)

    Kabilan Chokkappan

    2015-09-01

    Full Text Available Kimura disease is a rare chronic inflammatory disease of unknown etiology. The disease typically presents in young Asian males with single or multiple slowly progressing painless subcutaneous lumps in the head and neck region; regional lymphadenopathy is commonly accompanied. The disease is associated with peripheral blood eosinophilia and elevated serum immunoglobulin E levels. This gives an important clinical clue to the diagnosis and implies a possible immune-mediated pathophysiology. Although the disease commonly affects the head and neck region, it may also affect the extremities, axilla, groin, and abdomen. Upper limb involvement in Kimura’s disease is rare and few cases have been reported in the literature. We describe the case of a man who presented with a history of progressive upper limb swelling. He was diagnosed with Kimura’s disease based on concordant clinical, laboratory, radiological, and histopathological grounds. Although rare in the upper limb, the possibility of Kimura’s disease has to be considered in young males presenting with painless swelling in the medial epitrochlear region with compatible imaging appearance, particularly if associated with lymph node enlargement and increased blood eosinophils. Characteristic imaging findings of Kimura’s disease of the upper limb include specific location along the neuro-lymphovascular structures, the absence of necrosis or calcification, mutliple flow voids representing vascular structures, a varying amount of edema of subcutaneous fat plane overlying the lesion; displacement of adjacent muscles; and neurovascular structures without signs of direct invasion. Clinicians should be aware of this distinct entity in order to avoid misdiagnosis and to tailor appropriate management.

  8. Different types of androgen receptor mutations in patients with complete androgen insensitivity syndrome.

    Science.gov (United States)

    Shao, Jialiang; Hou, Jiangang; Li, Bingkun; Li, Dongyang; Zhang, Ning; Wang, Xiang

    2015-02-01

    Mutations of androgen receptor (AR) are the most frequent cause of 46, XY disorders of sex development and associated with a variety of phenotypes, ranging from phenotypic women (complete androgen insensitivity syndrome (CAIS)) to milder degrees of undervirilization (partial form or PAIS) or men with only infertility (mild form or MAIS). From 2009 to 2012, two young Chinese female individuals with CAIS from two families were referred to our hospital due to primary amenorrhea. Defects in testosterone (T) and dihydrotestosterone (DHT) synthesis were excluded. Physical examination revealed that the patients have normal female external genitalia, normal breast development, vellus hair in the axilla and on the arms and legs, but absence of pubic hair, and a blind-ending vagina. Two different types of AR mutations have been detected by sequencing of genomic DNA: Family A showed deletion of exon 2 in AR gene; Family B showed a single nucleotide C-to-T transition in exon 8 of AR gene resulting in a proline 893-to-leucine substitution (Pro893Leu). Testicular histology showed developmental immaturity of seminiferous tubules with the absence of spermatogenic cells or spermatozoa. No AR immunoreactivity was observed in either case. Three adult patients recovered well from bilateral orchiectomy. The juvenile patient of family B was followed up. Our present study on these two families revealed two different types of AR mutation. The definitive diagnosis of AIS was based on clinical examination and genetic investigations. Our findings verified the mechanism of CAIS and also enriched AR Gene Mutation Database. PMID:25674389

  9. Estudo de 15 casos de piedra branca observados na Grande Vitória (Espírito Santo - Brasil durante cinco anos Study on 15 cases of white piedra in Grande Vitória (Espírito Santo - Brazil over a five-year period

    Directory of Open Access Journals (Sweden)

    Lucia Martins Diniz

    2005-02-01

    Full Text Available A piedra branca é infecção fúngica do pêlo, rara, causada pelo Trichosporon beigelii, caracterizada por nódulos amarelados nos pêlos genitais, bigode, barba, axilas e raramente, no couro cabeludo. O estudo registra 15 casos, diagnosticados em serviço de dermatologia de Vitória, durante cinco anos, todos de pacientes do sexo feminino, com nódulos nos pêlos do couro cabeludo. Os autores supõem que o clima quente e úmido da região e o hábito de as pacientes utilizarem cremes recondicionadores nos fios dos cabelos tenham favorecido a infecção. O umedecimento dos fios com água facilita a visualização dos nódulos.White Piedra is a rare fungal infection of the hair shaft, caused by a yeast-like fungus (Trichosporon beigelii, characterized by yellow nodules on the pubic hair, moustache, beard and hair on the axillae and scalp. The objective was to register the presence of 15 cases of White Piedra in Espírito Santo diagnosed at the Dermatology Service in Vitória, over five years. All patients were female with nodules in the scalp hair, 13 were of mixed race and ten were between two and six years old. The hot and humid climate of the region together with the patients' habits regarding use of conditioning creams favored the infection. Moistening the hair with water can facilitate visualization of the nodules.

  10. Study of the synergistic effects of all-transretinoic acid and C-phycocyanin on the growth and apoptosis of A549 cells.

    Science.gov (United States)

    Li, Bing; Gao, Mei-Hua; Lv, Cong-Yi; Yang, Peng; Yin, Qi-Feng

    2016-03-01

    In the present study, we investigated the effects of the combination of all-transretinoic acid (ATRA) and natural nontoxic C-phycocyanin (C-PC) on the growth of A549 lung cancer cells in vitro and in vivo. Furthermore, the anticancer mechanism of the drug combination was revealed. Results showed both C-PC and ATRA could inhibit the growth of A549 cells in vivo. The combination of ATRA+C-PC could yield a higher inhibition rate. C-PC exerted a major effect on the proliferation of human embryo lung cells, but ATRA at a high concentration exerted an inhibitory effect. In addition, ATRA+C-PC could decrease the CDK4 mRNA level, but upregulated caspase-3 protein expression and induced cell apoptosis. A mouse model with tumor was constructed by a subcutaneous injection to the left axilla of nu nude (NU/NU) mice. Compared with the control group, the tumor weight was decreased in the single-drug treatment group and was the lowest in the combination group. C-PC+ATRA could upregulate tumor necrosis factor levels and downregulate Bcl-2 expression and the cyclin D1 gene in the tumor. C-PC could promote T cells' activities and spleen weight, but a single use of ATRA exerted an opposite effect. The dosage of ATRA could be reduced when combined with C-PC to reduce the toxic side-effects. In summary, the antitumor effects of the C-PC+ATRA combination were more significant than a single drug in vivo and in vitro. PMID:25812039

  11. iROLL: does 3-D radioguided occult lesion localization improve surgical management in early-stage breast cancer?

    International Nuclear Information System (INIS)

    To prospectively evaluate the feasibility of 3-D radioguided occult lesion localization (iROLL) and to compare iROLL with wire-guided localization (WGL) in patients with early-stage breast cancer undergoing breast-conserving surgery and sentinel lymph node biopsy (SLNB). WGL (standard procedure) and iROLL in combination with SLNB were performed in 31 women (mean age 65.1 ± 11.2 years) with early-stage breast cancer and clinically negative axillae. Patient comfort in respect of both methods was assessed using a ten point scale. SLNB and iROLL were guided by freehand SPECT (fhSPECT). The results of the novel 3-D image-based method were compared with those of WGL, ultrasound-based lesion localization, and histopathology. iROLL successfully detected the malignant primary and at least one sentinel lymph node in 97 % of patients. In a single patient (3 %), only iROLL, and not WGL, enabled lesion localization. The variability between fhSPECT and ultrasound-based depth localization of breast lesions was low (1.2 ± 1.4 mm). Clear margins were achieved in 81 % of the patients; however, precise prediction of clear histopathological surgical margins was not feasible using iROLL. Patients rated iROLL as less painful than WGL with a pain score 0.8 ± 1.2 points (p < 0.01) lower than the score for iROLL. iROLL is a well-tolerated and feasible technique for localizing early-stage breast cancer in the course of breast-conserving surgery, and is a suitable replacement for WGL. As a single image-based procedure for localization of breast lesions and sentinel nodes, iROLL may improve the entire surgical procedure. However, no advantages of the image-guided procedure were found with regard to prediction of complete tumour resection. (orig.)

  12. Fifteen year results of breast conservation therapy based on liberal patients selection criteria and less extensive surgery

    International Nuclear Information System (INIS)

    Between January 1, 1983 and December 31, 1997, 1,748 breasts of 1,687 patients visited our clinic, requesting breast conservation therapy (BCT). Of these, 1,543 breasts were preserved. The only criterion for patient selection was whether she could be satisfied with cosmetic result after BCT. Lumpectomy was done in such a way to obtain macroscopically clear margin. After 1987, axillary dissection was omitted for those with clinically negative axillae. Postoperatively, most patients received 50 Gy of external irradiation to the whole breast via tangential ports. Boost was not given. Separate axillary or supraclavicular ports were seldom used. Adjuvant postoperative chemo or hormone therapy were administered if indicated. One thousand five hundred and thirty patients, excluding patients with bilateral cancers or stage IV constituted this study. Median follow-up length was 50 months. Two hundred and fourteen patients experienced recurrences, including 95 in-breast recurrences, 31 regional nodal recurrences and 146 distant failures. Five year overall survival: All patients: 93.4%. Stage 0: 100%, I: 96.6%., II: 92.8%. III: 66%. Five year distant disease free survival: Stage 0: 100%, I: 94.1%, II: 86.2%, III: 59.2%. Five year freedom from in-breast recurrence: Stage 0: 84.1%, I: 94.0%, II: 93%, III: 90%. Positive margin, premenopausal state and multicentric tumors were judged to be independent risk factors for in-breast recurrence, but tumor size, location, nipple-tumor distance, EIC, receptor status and lymphatic permeation were not. Five year freedom from axillary recurrence: Axillary dissection 98.4%, axillary irradiation 97%. (K.H.)

  13. Intraoperative frozen section assessment of sentinel lymph nodes in the operative management of women with symptomatic breast cancer

    Directory of Open Access Journals (Sweden)

    Landers Rob

    2008-06-01

    Full Text Available Abstract Background Maximisation of the potential of sentinel lymph node biopsy as a minimally invasive method of axillary staging requires sensitive intraoperative pathological analysis so that rates of re-operation for lymphatic metastases are minimised. The aim of this study was to describe the test parameters of the frozen section evaluation of sentinel node biopsy for breast cancer compared to the gold standard of standard permanent pathological evaluation at our institution. Methods The accuracy of intraoperative frozen section (FS of sentinel nodes was determined in 94 consecutive women undergoing surgery for clinically node negative, invasive breast cancer (37:T1 disease; 43:T2; 14:T3. Definitive evidence of lymphatic spread on FS indicated immediate level II axillary clearance while sentinel node "negativity" on intraoperative testing led to the operation being curtailed to allow formal H&E analysis of the remaining sentinel nodal tissue. Results Intraoperative FS correctly predicted axillary involvement in 23/30 patients with lymphatic metastases (76% sensitivity rate permitting definitive surgery to be completed at the index operation in 87 women (93% overall. All SN found involved on FS were confirmed as harbouring tumour cells on subsequent formal specimen examination (100% specificity and positive predictive value with 16 patients having additional non-sentinel nodes found also to contain tumour. Negative Predictive Values were highest in women with T1 tumours (97% and lessened with more local advancement of disease (T2 rates: 86%; T3: 75%. Of those with falsely negative FS, three had only micrometastatic disease. Conclusion Intraoperative FS reliably evaluates the status of the sentinel node allowing most women complete their surgery in a single stage. Thus SN can be offered with increased confidence to those less likely to have negative axillae hence expanding the population of potential beneficiaries.

  14. Piodermatite-pioestomatite vegetante: relato de caso e revisão de literatura Pyodermatitis-pyostomatitis vegetans: case report and review of medical literature

    Directory of Open Access Journals (Sweden)

    Fernanda de Abreu Toledo Matias

    2011-08-01

    Full Text Available A piodermatite-pioestomatite vegetante é uma rara dermatose inflamatória de etiologia desconhecida, com típico comprometimento mucocutâneo. Relatamos caso de paciente feminina com lesões pustulosas e vesiculosas em axilas, evoluindo com placas vegetantes e pústulas com agrupamento anular. Houve progressão com comprometimento vulvar, inguinal e mucosas oral, nasal e ocular. Proposto o diagnóstico, optou-se por iniciar prednisona 40mg ao dia, com remissão das lesões após um mês de uso da medicação. A associação com doença inflamatória intestinal ocorre em 70% dos casos. A imunofluorescência é um fator que ajuda a caracterizar a doença, sendo tipicamente negativa. A rápida resposta à terapêutica com corticosteroides sistêmicos é esperadaPyodermatitis-pyostomatitis vegetans is a rare inflammatory dermatosis of unknown etiology, with a typical mucocutaneous involvement. We report the case of a woman with pustular and vesicular lesions in the axillae, evolving with vegetating plaques and pustules with annular grouping. The disease progressed with vulvar and inguinal involvement as well as involvement of the oral, nasal and ocular mucous membranes. She started the treatment with prednisone (40 mg/day, with remission of the lesions after one month of use of such medication. Association with inflammatory bowel disease occurs in 70% of the cases. Immunofluorescence, which is typically negative, helps to characterize the disease. A rapid response to systemic steroids is expected

  15. iROLL: does 3-D radioguided occult lesion localization improve surgical management in early-stage breast cancer?

    Energy Technology Data Exchange (ETDEWEB)

    Bluemel, Christina; Kajdi, Georg W.; Schmid, Jan; Buck, Andreas K.; Herrmann, Ken [University Hospital of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Cramer, Andreas; Grossmann, Christoph; Grimminger, Hanns-Joerg [Missionsaerztliches Klinikum Wuerzburg, Department of Obstetrics and Gynecology, Wuerzburg (Germany); Malzahn, Uwe [University of Wuerzburg, Institute of Clinical Epidemiology and Biometry, Wuerzburg (Germany); Lamp, Nora [University of Wuerzburg, Institute of Pathology, Wuerzburg (Germany); Langen, Heinz-Jakob [Missionsaerztliches Klinikum Wuerzburg, Department of Radiology, Wuerzburg (Germany)

    2015-10-15

    To prospectively evaluate the feasibility of 3-D radioguided occult lesion localization (iROLL) and to compare iROLL with wire-guided localization (WGL) in patients with early-stage breast cancer undergoing breast-conserving surgery and sentinel lymph node biopsy (SLNB). WGL (standard procedure) and iROLL in combination with SLNB were performed in 31 women (mean age 65.1 ± 11.2 years) with early-stage breast cancer and clinically negative axillae. Patient comfort in respect of both methods was assessed using a ten point scale. SLNB and iROLL were guided by freehand SPECT (fhSPECT). The results of the novel 3-D image-based method were compared with those of WGL, ultrasound-based lesion localization, and histopathology. iROLL successfully detected the malignant primary and at least one sentinel lymph node in 97 % of patients. In a single patient (3 %), only iROLL, and not WGL, enabled lesion localization. The variability between fhSPECT and ultrasound-based depth localization of breast lesions was low (1.2 ± 1.4 mm). Clear margins were achieved in 81 % of the patients; however, precise prediction of clear histopathological surgical margins was not feasible using iROLL. Patients rated iROLL as less painful than WGL with a pain score 0.8 ± 1.2 points (p < 0.01) lower than the score for iROLL. iROLL is a well-tolerated and feasible technique for localizing early-stage breast cancer in the course of breast-conserving surgery, and is a suitable replacement for WGL. As a single image-based procedure for localization of breast lesions and sentinel nodes, iROLL may improve the entire surgical procedure. However, no advantages of the image-guided procedure were found with regard to prediction of complete tumour resection. (orig.)

  16. Feasibility of radiotherapy after high-dose dense chemotherapy with epirubicin, preceded by dexrazoxane, and paclitaxel for patients with high-risk Stage II-III breast cancer

    International Nuclear Information System (INIS)

    Purpose: To verify the feasibility of, and quantify the risk of, pneumonitis from locoregional radiotherapy (RT) after high-dose dense chemotherapy with epirubicin and paclitaxel with peripheral blood progenitor cell support in patients with high-risk Stage II-III breast cancer. Methods and Materials: Treatment consisted of a mobilizing course of epirubicin 150 mg/m2, preceded by dexrazoxane (Day 1), paclitaxel 175 mg/m2 (Day 2), and filgrastim; followed by three courses of epirubicin 150 mg/m2, preceded by dexrazoxane (Day 1), paclitaxel 400 mg/m2 (Day 2), and peripheral blood progenitor cell support and filgrastim, every 16-19 days. After chemotherapy, patients were treated with locoregional RT, which included the whole breast or the chest wall, axilla, and supraclavicular area. Results: Overall, 64 of 69 patients were evaluable. The interval between the end of chemotherapy and the initiation of RT was at least 1.5-2 months (mean 2). No treatment-related death was reported. After a median follow-up of 27 months from RT (range 5-77 months), neither clinically relevant radiation pneumonitis nor congestive heart failure had been reported. Minor and transitory lung and cardiac toxicities were observed. Conclusion: Sequential high doses of epirubicin, preceded by dexrazoxane, and paclitaxel did not adversely affect the tolerability of locoregional RT in breast cancer patients. The risk of pneumonitis was not affected by the use of sequential paclitaxel with an interval of at least 1.5-2 months between the end of chemotherapy and the initiation of RT. Long-term follow-up is needed to define the risk of cardiotoxicity in these patients

  17. Radiologic Findings of Epidermal Cysts in the Trunk

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Myung Hyun; Chung, Jae Joon; Park, Kyoung Seuk; Park, Su Mi [NHIC Ilsan Hospital, Goyang (Korea, Republic of)

    2005-06-15

    To evaluate the ultrasonographic (US) or computer tomography (CT) findings of surgically proven epidermal cysts in the trunk, and to compare the echogenicity of cysts with internal contents. Forty-five patients were retrospectively evaluated. US and CT findings of epidermal cysts were assessed in regard to location, size, shape, number, echogenicity, posterior sound enhancement, internal density, septa, mural nodule and calcification, perilesional infiltration, contrast enhancement, and internal contents. All 45 patients (M:F=29:16; US in 26, CT in 19) had only one cyst, and they were located in the buttocks (n=19), back (n=13), inguinal (n=4), posterior neck (n=3), perineum (n=2), abdominal wall (n=2), presternal (n=1), and axilla (n=1). Of 26 patients who underwent US, there were 8 cases of homogeneously hypoechoic mass (30.8%), 8 of inhomogeneously hypoechoic mass (30.8%), 7 of homogeneously hypoechoic mass with internal hypoechoic lines and echogenic spots (26.9%) and 3 of homogeneously hypoechoic mass with internal echogenic spots (11.5%). Posterior sound enhancement was noted in 21 patients (80.8%). Of 19 patients who underwent CT, there were 14 cases of simple cyst (73.7%) and 5 of abscess-like lesion (26.3%). Overlying skin thickening (n=13), contrast enhancement of cystic wall (n=11), perilesional infiltration (n=7), and internal septa (n=6) were demonstrated. The internal contents of the cysts were keratinous (n=27, 60.0%) or greasy (n=15, 33.3%) material. There was no statistical significance between the echogenicity of the cysts and the internal contents (p > 0.2). Epidermal cysts showed homogeneous or inhomogeneous hypoechoic mass with posterior sound enhancement on US. There was no relationship between the echogenicity of the cysts and the internal contents. In the case of ruptured cyst, an abscess-like lesion with wall enhancement and perilesional infiltration was noted on CT scan

  18. Radiologic Findings of Epidermal Cysts in the Trunk

    International Nuclear Information System (INIS)

    To evaluate the ultrasonographic (US) or computer tomography (CT) findings of surgically proven epidermal cysts in the trunk, and to compare the echogenicity of cysts with internal contents. Forty-five patients were retrospectively evaluated. US and CT findings of epidermal cysts were assessed in regard to location, size, shape, number, echogenicity, posterior sound enhancement, internal density, septa, mural nodule and calcification, perilesional infiltration, contrast enhancement, and internal contents. All 45 patients (M:F=29:16; US in 26, CT in 19) had only one cyst, and they were located in the buttocks (n=19), back (n=13), inguinal (n=4), posterior neck (n=3), perineum (n=2), abdominal wall (n=2), presternal (n=1), and axilla (n=1). Of 26 patients who underwent US, there were 8 cases of homogeneously hypoechoic mass (30.8%), 8 of inhomogeneously hypoechoic mass (30.8%), 7 of homogeneously hypoechoic mass with internal hypoechoic lines and echogenic spots (26.9%) and 3 of homogeneously hypoechoic mass with internal echogenic spots (11.5%). Posterior sound enhancement was noted in 21 patients (80.8%). Of 19 patients who underwent CT, there were 14 cases of simple cyst (73.7%) and 5 of abscess-like lesion (26.3%). Overlying skin thickening (n=13), contrast enhancement of cystic wall (n=11), perilesional infiltration (n=7), and internal septa (n=6) were demonstrated. The internal contents of the cysts were keratinous (n=27, 60.0%) or greasy (n=15, 33.3%) material. There was no statistical significance between the echogenicity of the cysts and the internal contents (p > 0.2). Epidermal cysts showed homogeneous or inhomogeneous hypoechoic mass with posterior sound enhancement on US. There was no relationship between the echogenicity of the cysts and the internal contents. In the case of ruptured cyst, an abscess-like lesion with wall enhancement and perilesional infiltration was noted on CT scan

  19. PILONIDAL DISEASE MIMICKING AS FISTULA-IN ANO - A R ARE CASE REPORT

    Directory of Open Access Journals (Sweden)

    Pradeep Kumar

    2013-03-01

    Full Text Available ABSTRACT: INTRODUCTION: Pilonidal disease (cyst, abscess and sinus typical ly occur in the midline of the sacrococcygeal skin of young men. Pi lonidal disease has been described in other parts of the body, such as the hands, umbilicus, axi llae, and external genitalia. The following paper describes an unusual presentation of a pilonidal cyst with perianal drainage. Four cases were initially reported in 1948. A literature review found an additional 19 reported cases of pilonidal disease associated with a perianal fistula. PRESENTATION OF CASE: A 56- year- old male came with a chief complaint of peri-anal drainag e for 3 months. He had persistent irritation associated with intermittent discharge a nd pain from his peri-anal region. Physical examination revealed a tender external perianal openi ng with a small amount of purulent drainage. A transrectal ultrasound revealed a sinus tract without any internal anal communication DISCUSSION: Chronic pilonidal disease is associated with sinus tract formation which is almost exclusively limited to the sacrococ cygeal region but pilonidal disease has been described in other parts of the body, such as the ha nds, umbilicus, axillae, and external genitalia. The following paper describes an unusual presentation of a pilonidal cyst with perianal drainage. CONCLUSION: Although Pilonidal sinus usually occurs in sacroco ccygeal region, the other sites should also be kept in mind and whenever internal opening of fistula-in-ano is not easily evident, it is better to get MRI or TRUS to make a definitive diagnosis as the two conditions can mimic each other

  20. Medical documentation, bioanalytical evidence of an accidental human exposure to sulfur mustard and general therapy recommendations.

    Science.gov (United States)

    Steinritz, Dirk; Striepling, Enno; Rudolf, Klaus-Dieter; Schröder-Kraft, Claudia; Püschel, Klaus; Hullard-Pulstinger, Andreas; Koller, Marianne; Thiermann, Horst; Gandor, Felix; Gawlik, Michael; John, Harald

    2016-02-26

    Sulfur mustard (SM) is a chemical warfare agent (CWA) that was first used in World War I and in several military conflicts afterwards. The threat by SM is still present even today due to remaining stockpiles, old and abandoned remainders all over the world as well as to its ease of synthesis. CWA are banned by the Chemical Weapons Convention (CWC) interdicting their development, production, transport, stockpiling and use and are subjected to controlled destruction. The present case report describes an accidental exposure of three workers that occurred during the destruction of SM. All exposed workers presented a characteristic SM-related clinical picture that started about 4h after exposure with erythema and feeling of tension of the skin at the upper part of the body. Later on, superficial blister and a burning phenomenon of the affected skin areas developed. Similar symptoms occurred in all three patients differing severity. One patient presented sustained skin affections at the gluteal region while another patient came up with affections of the axilla and genital region. Fortunately, full recovery was observed on day 56 after exposure except some little pigmentation changes that were evident even on day 154 in two of the patients. SM-exposure was verified for all three patients using bioanalytical GC MS and LC MS/MS based methods applied to urine and plasma. Urinary biotransformation products of the β-lyase pathway were detected until 5 days after poisoning whereas albumin-SM adducts could be found until day 29 underlining the beneficial role of adduct detection for post-exposure verification. In addition, we provide general recommendations for management and therapy in case of SM poisoning. PMID:26321678

  1. Acute Shoulder Injuries in Adults.

    Science.gov (United States)

    Monica, James; Vredenburgh, Zachary; Korsh, Jeremy; Gatt, Charles

    2016-07-15

    Acute shoulder injuries in adults are often initially managed by family physicians. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral dislocations, proximal humerus fractures, and rotator cuff tears. Acromioclavicular joint injuries and clavicle fractures mostly occur in young adults as the result of a sports injury or direct trauma. Most nondisplaced or minimally displaced injuries can be treated conservatively. Treatment includes pain management, short-term use of a sling for comfort, and physical therapy as needed. Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and similar high-impact trauma. Patients will usually hold the affected arm in their contralateral hand and have pain with motion and decreased motion at the shoulder. Physical findings may include a palpable humeral head in the axilla or a dimple inferior to the acromion laterally. Reduction maneuvers usually require intra-articular lidocaine or intravenous analgesia. Proximal humerus fractures often occur in older patients after a low-energy fall. Radiography of the shoulder should include a true anteroposterior view of the glenoid, scapular Y view, and axillary view. Most of these fractures can be managed nonoperatively, using a sling, early range-of-motion exercises, and strength training. Rotator cuff tears can cause difficulty with overhead activities or pain that awakens the patient from sleep. On physical examination, patients may be unable to hold the affected arm in an elevated position. It is important to recognize the sometimes subtle signs and symptoms of acute shoulder injuries to ensure proper management and timely referral if necessary. PMID:27419328

  2. 99Tcm-dextran lymphoscintigraphy in evaluation of breast cancer-related lymphedema

    International Nuclear Information System (INIS)

    Objective: To investigate the imaging characteristics of lymphoscintigraphy in postoperative breast cancer patients and evaluate its diagnostic value in breast cancer-related lymphedema (BCRL). Methods: Seventy-nine breast cancer patients who underwent mastectomy and axillary lymph node dissection were studied. Patients (n = 158) were divided into the study (affected arms, n = 79 ) and control groups (contralateral arms, n = 79). After subcutaneous injection of 99Tcm-dextran via the first interphalangeal space, lymphoscintigraphy was performed at 10 min, 1, 3, 6 h respectively. Sensitivity and specificity of lymphoscintigraphy for detection of BCRL were calculated. Results: There were significant differences in the amount of visualized lymph nodes, lymphatic integrity and backflow pattern between the two groups. Lymphatic drainage was preserved in 96.2% (76/79) of the contralateral arms and only 5.1% (4/79) of affected arms. 87.3% (69/79) and 74.7% (59/79) of control arms had ≥2 lymph nodes in axilla and supraclavicular regions, respectively; while none (0/79) and 5.1% (4/79) of the affected arms had ≥2 lymph nodes in both regions, respectively. Four backflow patterns of radiotracer in subcutis were observed in the affected arms: normal (2.5%, 2/79), dilatated (55.7%, 44/79), diffused (36.7%, 29/79) and without backflow (5.1%, 4/79 ). The sensitivity and specificity of 'lymphatic integrity' and 'backflow pattern' on lymphoscintigraphy for detecting BCRL were 97.5% (77/79) and 96.2% (76/79), 94.8%(73/77) and 100.0% (81/81), respectively. Conclusion: Lymphoscintigraphy is a noninvasive, accurate and effective imaging modality for the evaluation of BCRL. (authors)

  3. Dynamic Angular Petrissage as Treatment for Axillary Web Syndrome Occurring after Surgery for Breast Cancer: a Case Report

    Science.gov (United States)

    Lewis, Paul A.; Cunningham, Joan E.

    2016-01-01

    Background In the context of breast cancer, axillary web syndrome (AWS), also called lymphatic cording, typically presents in the weeks after axillary surgery. This painful condition, likely lymphofibrotic in origin, restricts upper extremity range of motion (ROM). There is no established treatment, although physical therapy and other approaches have been used to variable effect. This report describes treatment of a female client with AWS, who had recently undergone a unilateral simple mastectomy with sentinel node biopsy plus axillary dissection. Methods The client presented with pain upon movement (self-reported as 5 on the 0–10 Oxford Pain Scale), visible cording and restricted use of the ipsilateral upper extremity. Clinical assessment included determining the extent of AWS cording (taut, from axilla to wrist) and measuring glenohumeral joint ROM (140° flexion by goniometer). A therapeutic massage with movement protocol, termed dynamic angular petrissage, was administered over two sessions: Swedish massage combined with dynamically taking the limb through all possible angles of movement (passive ROM), controlling stretch and tension while simultaneously and segmentally applying petrissage and non-petrissage techniques to the underlying soft tissue. Careful attention was taken to not break the cord. Home care consisted of prescribed exercises performed by the patient. Results After Session One, pain was reduced (to 0/10), ROM improved (to 170° flexion), and cording was visibly reduced. After Session Two the cord was residually apparent only on hyperextension, with no ROM restrictions in glenohumeral joint flexion. Follow-up at three months revealed absence of visual or palpable evidence of cording, unrestricted glenohumeral joint ROM, and absence of movement-associated pain. Conclusion The signs and symptoms of AWS were quickly and effectively eliminated, without causing any pain or discomfort to the client. We propose that dynamic angular petrissage may be

  4. Effect of One versus Two Drain Insertion on Postoperative Seroma Formation after Modified Radical Mastectomy

    Directory of Open Access Journals (Sweden)

    farzaneh ebrahimifard

    2016-04-01

    Full Text Available Background: Modified radical mastectomy (MRM is still one of globally accepted surgical techniques for breast cancer and in some selected patient is the gold standard type of surgery. The most frequent complication of this procedure is seroma under skin flaps or in the axilla as reported as much as 30% in some studies. The use of closed suction drainage system to reduce the incidence of this complication has been routinely accepted by surgeons; however, length of catheter stay and the number of catheters inserted in the wound are still controversial. The present study compares the results of single versus double drain insertion in patients undergoing MRM for breast cancer.Materials and Methods: The study was conducted on 100 women with breast cancer who were candidate for MRM surgery during 2007-2010 referred to Modarres hospital, Tehran, Iran as a randomized group matched controlled trial.Results: There was no significant difference between the two groups in terms of age, BMI, and tumor weight (P=0.406 (Table 1. Similarly, the difference between the two groups was insignificant in tumor size (T and number of lymph nodes involved (P=0.145. There was no significant difference between the two groups in timing of axillary drain removal (P=0.064. No significant differences were observed between the two groups in mean aspirated fluid (P=0.071 and mean aspirated sera (P=0.484 after removal of drains.Conclusion: This study revealed one drain insertion in MRM surgery is as effective as two drain and probably less morbidity and cost.

  5. Promoting Flowering, Lateral Shoot Outgrowth, Leaf Development, and Flower Abscission in Tobacco Plants Overexpressing Cotton FLOWERING LOCUS T (FT-Like Gene GhFT1

    Directory of Open Access Journals (Sweden)

    Chao eLi

    2015-06-01

    Full Text Available FLOWERING LOCUS T (FT encodes a mobile signal protein, recognized as major component of florigen, which has a central position in regulating flowering, and also plays important roles in various physiological aspects. A mode is recently emerging for the balance of indeterminate and determinate growth, which is controlled by the ratio of FT-like and TERMINAL FLOWER 1 (TFL1-like gene activities, and has a strong influence on the floral transition and plant architecture. Orthologs of GhFT1 was previously isolated and characterized from Gossypium hirsutum. We demonstrated that ectopic overexpression of GhFT1 in tobacco, other than promoting flowering, promoted lateral shoot outgrowth at the base, induced more axillary bud at the axillae of rosette leaves, altered leaf morphology, increased chlorophyll content, had higher photosynthesis and caused flowers abscission. Analysis of gene expression suggested that flower identity genes were significantly upregulated in transgenic plants. Further analysis of tobacco FT paralogs indicated that NtFT4, acting as flower inducer, was upregulated, whereas NtFT2 and NtFT3 as flower inhibitors were upregulated in transgenic plants under long-day conditions, but downregulated under short-day conditions. Our data suggested that sufficient level of foreign FT might disturb the balance of the endogenous FT paralogs of inducers and repressors and resulted in altered phenotype in transgenic tobacco, emphasizing the expanding roles of FT in regulating shoot architecture by advancing determine growth. Manipulating the ratio for indeterminate and determinate growth factors throughout FT-like and TFL1-like gene activity holds promise to improve plant architecture and enhance crop yield.

  6. Hidradenitis suppurativa: A practical review of possible medical treatments based on over 350 hidradenitis patients.

    Science.gov (United States)

    Scheinfeld, Noah

    2013-01-01

    Hidradenitis suppurativa (HS), a pathological follicular disease, impacts patients' lives profoundly. HS most commonly involves cutaneous intertriginous areas, such as the axilla, inner thighs, groin and buttocks, and pendulous breasts, but can appear on any follicular skin. Protean, HS manifests with variations of abscesses, folliculitis, pyogenic granulomas, scars (oval honeycombed), comedones, tracts, fistulas, and keloids. The pathophysiology might involve both defects of the innate follicular immunity and overreaction to coagulase negative Staphylococcus. Treatment depends on the morphology, extent, severity, and duration. Topical clindamycin and dapsone are often adequate for treating mild HS. For Stage 1 and 2 HS, first line treatment combines rifampin with either oral clindamycin or minocycline. Other HS treatments include: fluoroquinolones with metronidazole and rifampin, oral dapsone, zinc, acitretin, hormone blockers (oral contraceptive pills, spironolactone, finasteride, and dutasteride), and oral prednisone. For severe HS, cyclosporine, adalimumab, or infliximab (used at double psoriatic doses) and intravenous carbapenems or cephalosporins are often required. Isotretinoin, etanercept, isoniazid, lymecycline, sulfasalazine, methotrexate, metformin, colchicine, clarithromycin, IVIG, and thalidomide are less favored treatments. The role of botulinum toxin is uncertain. The most important life style modification is weight loss. De-roofing fluctuant nodules and injection of intralesional corticosteroids ameliorates the disease and perhaps, if done at regular intervals, improves HS more permanently. Surgical excision and CO2 laser ablation are more definitive treatments. The 1064 nm laser for hair removal aids in the treatment of HS. This article centers on medical therapies and will only passingly mention surgical and laser treatments. This article summarizes my treatment experience with over 350 HS patients. PMID:24021361

  7. Evaluation of antiinflammatory activity ofTephrosia purpurea in rats

    Institute of Scientific and Technical Information of China (English)

    Shenoy Smita; Shwetha K; Prabhu K; Maradi R; Bairy KL; Shanbhag T

    2010-01-01

    Objective:To evaluate the antiinflammatory activity of orally administered ethanolic extract of Tephrosia purpurea in acute and subacute inflammation in rats.Methods: An ethanolic extract of Tephrosia purpurea was prepared. Carrageenan induced paw edema and cotton pellet granuloma were the models for acute and subacute inflammation respectively. Four groups of rats in each model were treated orally with 2% gum acacia, 100 mg /kg of aspirin, 500 mg/kg and 1 000 mg/kg of ethanolic extract ofTephrosia purpurea respectively. In carrageenan induced paw edema model, subplantar injection of 1% carrageenan was made into the hind paw of the rats sixty minutes after the administration of the respective drugs. The paw volume was measured immediately after injection of carrageenan, at 3 hours and at 6 hours. Then percentage inhibition of edema was calculated. In the cotton pellet granuloma model, animals were administered drugs for six days after placing cotton pellets in the axilla on each side. On the 7th day, dry weight of granuloma was calculated.Results:The rats treated withTephrosia purpurea did not exhibit any significant decrease in paw volume and serum ceruloplasmin levels as compared to the control and aspirin treated groups in the acute inflammation model; while, there was a significant (P < 0.01) decrease in the weight of granuloma inTephrosia purpurea and aspirin treated groups as compared to control in subacute inflammation.Conclusions:The ethanolic extract of orally administered Tephrosia purpurea shows significant antiinflammatory effect in subacute inflammation but not in acute inflammation in rats.

  8. Plasma Catecholamines, Sweat Electrolytes and Physiological Responses of Exercised Normal, Partial Anhidrotic and Anhidrotic Horses

    Directory of Open Access Journals (Sweden)

    A. Bashir

    2009-01-01

    Full Text Available Problem statement: Malaysia imports horses from temperate countries to develop equine sports in the country. Several of these horses developed partial and complete anhidrosis. Approach: Normal, partial anhidrotic and anhidrotic horses were exercised to determine their sweating and physiological responses to exercise. The heart and respiratory rates, rectal temperature and blood samples were obtained before the horses were lunged at 10 km h-­1 for 1 h and at again at 15, 30, 45, 60 min and 24 h after exercise. The blood adrenaline and noradrenaline concentrations were determined. Sweat samples were obtained at 60 min after exercise and analyzed for Na+, K+, Cl-, urea and total protein concentrations. Results: The normal horses sweated profusely all over the body after 5 min into exercise, but the partial anhidrotic horses showed sweating in the neck, brisket, shoulder, rump, perineum and axilla only after 20-30 min of exercise. The sweat Na+, K+, Cl-, urea and total protein concentrations were lower in the partial anhidrotic horses than in normal horses while the Na+:K+ was higher. The heart and respiratory rates and rectal temperature of anhidrotic horses reached maximum values of 133.6±0.8 beats min-­1 and 186.8±0.5 breaths min-1 and 41.1±0.0°C respectively and took much longer to return to resting levels than other horses. The resting adrenaline concentrations in the anhidrotic horses were higher than in partial anhidrotic and normal horses, with the mean post-exercise adrenaline: Noradrenaline consistently above 1.15. Conclusion: The most important factor in equine anhidrosis was failure of sweat glands to respond to adrenaline. The anhidrotic horse regulated body electrolytes means other than sweating. Anhidrotic horses exhibited exercise intolerance, particularly in the hot and humid climate. There is a need to formulate a special regime for exercising anhidrotic horses in the tropical environment.

  9. Aerobic Microbial Skin Flora in Jeddah City, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Rajaa M. Milyani

    2001-12-01

    Full Text Available The aerobic microbial skin flora of 40 healthy subjects living in Jeddah city (Saudi Arabia was determined. Two age groups: children and adults; including males and females were investigated. Seven sites were studied: forehead, axilla, chest, groin, leg, toe web and anterior nares. The skin was sampled by rubbing the chosen site with a surfactant substance (Tween 80 moistened cotton swab which was dipped back in the surfactant container and the resulted suspension was agitated for one minute. Thirty three microbial species were isolated from the seven sites of the study group, in which Acinetobacter baumannii, Acinetobacter lwoffii, corynebacterium species and Staphylococcus (Staph. aureus dominated among children (30% each. The most other prevalent isolates recovered were Alkaligenes species, Bacillus species, Chryseomonas luteola, Staph. epidermidis, Enterococcus faecalis and Staph. hominis (27.5% each. Organisms including Candida albicans, Enterobacter agglomerans, Escherichia coli, Flavobacterium meningosepticum, Klebsiella oxytoca, Micrococcus luteus, Micrococcus roseus, Micrococcus varians, Micrococcus species, Burkholderia cepacia, Stenotrophomonas maltophilia, Pseudomonas paucimobilis, Pseudomonas fluorescence, Pseudomonas species, Staph. capitis, Staph. cohnii, Staph. saprophyticus, Staph. simulans, Staph. warneri, Staph. xylosus, viridans-type streptococcus and yeasts were also found in different percentage. Higher isolation rates of Acinetobacter lwoffii, Staph. aureus, Alkaligenes species, Corynebacterium species, Chryseomonas luteola, Enterobacter agglomerans, Staph. epidermidis and other coagulase negative Staphylococci were noted in children from the seven sites. However, Chryseomonas luteola, and Pseudomonas species, were found only in the groin area among males. Otherwise, no significant differences were recorded in the isolation rates from each site separately in relation to age and sex. The role of the isolated microorganisms

  10. COMPARISON OF ANTI - INFLAMMATORY ACTIVITY OF ALPINIA GALANGAL IN THREE EXPERIMENTAL ANIMAL MODELS

    Directory of Open Access Journals (Sweden)

    Venuturumilli Lakshmi

    2015-05-01

    Full Text Available Inflammation is not a disease but a non - specific response of the body defence 1 . Anti - inflammatory drugs have become popular because of their ability in controlling the inflammatory reaction and mitigating the suffering in such clinical situations. Edema represents the early phase of inflammation. 2 In the present study acute and subacute experimental methods were compared with standard drug Indomethacin. R at hind paw edema, formalin induced peritonitis in mice were used as acute methods, paper disc induced granuloma in rats was used as subacute method. Institutional animal ethics committee permission was taken for all the methods as per CPCSEA guide lines. Inflammation was induced by the following 3 methods: i Hind paw edema was produced by sub plantar injection of 0.1ml of1% carrageenin 3 and paw volume was measured by digital plethysmometer at 0, 3hours. ii Intraperitoneal injection of 1.5% formalin 3 was given to albino mice in peritonitis method and ascitic fluid was measured after 6hours by sacrificing the animals. iii Under ether anesthesia, sterilized &weighed paper discs were implanted subcutaneously in each axilla and groin of male wistar rats sutur ed under sterilized conditions in granuloma 4 method. The discs were cleared of extraneous tissue, dried and weighed on the 5 th day by sacrificing the animals. In all the methods 6 animals in each group (test, standard and control were taken. Results were tabulated in each method separately and statistical analysis was done by student t test. P value < 0.05 considered significant. Percentage inhibition in each method was calculated.

  11. Evaluation of paclitaxel and carboplatin versus combination chemotherapy with fluorouracil doxorubicin and cyclophosphamide as a neoadjuvant therapy in patients with inoperable breast cancer

    International Nuclear Information System (INIS)

    To compare the results of patients with locally advanced breast cancer receiving two different regimens Fluorouracil, Doxorubicin and Cyclophosphamide (FAC) and Paclitaxel and Carboplatin. Study Design: Comparative study. Place and Duration of Study: The Oncology Department, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, from March 2007 to September 2008. Methodology: Patients with inoperable locally advanced breast cancer of stage were included. Sixteen patients were given FAC regimen and 9 patients were given Paclitaxel and Carboplatin, each combination was cycled after 21 days for four times. Before enrollment, detailed medical histories, physical examinations and performance status assessments were done as well as post chemotherapy evaluation with regular follow-up visits was done. Complete Response (CR, 100%) is defined as the disappearance of all known disease parameter i.e. disappearance in detectable tumour size, node free disease and surgery is possible. Paratial Response (PR, > 50%) was defined by 50% or greater decrease in the sum of the areas of bidimensionally measured lesions i.e. change of N2 to N1 or no status and some surgical procedure is possible to down stage the disease. Minor Response (MR) was defined as a decrease in the tumour insufficient to quality for partial resp once. Static disease or no evaluable reflected no significant change in disease and no evidence of new disease. Progression of disease (> 25%) was defined as a 25% or greater increase in the area of any lesion > 2 cm or in the sum of the products of the individual lesions or the appearance of new malignant lesions, surgery not possible. Results: Twenty five patients completed neoadjuvant chemotherapy. Sixteen (66%) patients received FAC and 9 (37%) patients received PC chemotherapy. Overall CR (breast and axilla) was 54%, PR was 16% and minor response (MR) was 8%. FAC treatment induced more emesis, mucositis, alopecia and cardiotoxicity. No death occurred

  12. Pleomorphic lipoma lacking mature fat component in extensive myxoid stroma: a great diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Lin Xu-Yong

    2012-11-01

    Full Text Available Abstract Pleomorphic lipoma is a relatively uncommon entity, and is considered as a variant of spindle cell lipoma. Histologically, spindle cell lipoma/pleomorphic lipoma consists of varying quantity of mature fat, bland spindle cells and ropey collagen. In addition, pleomorphic lipoma is characterized by multinucleate giant cells, which possess the “floret-like” nuclei and marked pleomorphism. So, in contrast to spindle cell lipoma, pleomorphic lipoma is more easily misdiagnosed as a malignant tumor. Herein, we report a peculiar case of pleomorphic lipoma occurring in axilla with entirely devoid of mature fat in a 71-year-old male. The histopathological findings demonstrated the tumor was made up of bland spindle cells admixed with scattered “floret-like” cells and irregular ropey collagen in an extensive myxoid stroma. Immunostaining showed that the tumor was positive for the Vimentin, Bcl-2 and CD34, and was negative for S-100, desmin, CD68, and α–SMA. Although no fat component was found in the whole section, the tumor was still diagnosed as a pelomprphic lipoma. To our knowledge, this is the third reported case of pelomprphic lipoma which entirely lacked lipomatous component. Because of the existence of atypical multinucleate giant cells and lack of mature fat, this tumor may be easily misdiagnosed nonlipomatous lesions, such as myxoid fibrosarcoma, giant cell fibroblastoma. So, it is necessary to pay careful attention to the histological spectrum of pleomorphic lipoma, including the tumor with devoid of fat, and it should be kept in mind that pelomprphic lipoma still can be diagnosed even if lacking lipomatous component. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1967123180611361

  13. Lymphoscintigraphy and SPECT/CT in multicentric and multifocal breast cancer: does each tumour have a separate drainage pattern? Results of a Dutch multicentre study (MULTISENT)

    Energy Technology Data Exchange (ETDEWEB)

    Brouwer, O.R. [Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam (Netherlands); Antoni van Leeuwenhoekhospital, Amsterdam (Netherlands); Vermeeren, L.; Valdes Olmos, R.A. [Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam (Netherlands); Ploeg, I.M.C. van der; Rutgers, E.J.T.; Oldenburg, H.S.A. [Antoni van Leeuwenhoek Hospital, Department of Surgery, Netherlands Cancer Institute, Amsterdam (Netherlands); Loo, C.E. [Antoni van Leeuwenhoek Hospital, Department of Radiology, Netherlands Cancer Institute, Amsterdam (Netherlands); Pereira-Bouda, L.M.; Smit, F. [Rijnland Hospital, Department of Nuclear Medicine, Leiderdorp (Netherlands); Neijenhuis, P. [Rijnland Hospital, Department of Surgery, Leiderdorp (Netherlands); Vrouenraets, B.C. [Sint Lucas Andreas Hospital, Department of Surgery, Amsterdam (Netherlands); Sivro-Prndelj, F. [Sint Lucas Andreas Hospital, Department of Nuclear Medicine, Amsterdam (Netherlands); Jap-a-Joe, S.M.; Borgstein, P.J. [Onze Lieve Vrouwe Gasthuis, Department of Nuclear Medicine, Amsterdam (Netherlands)

    2012-07-15

    To investigate whether lymphoscintigraphy and SPECT/CT after intralesional injection of radiopharmaceutical into each tumour separately in patients with multiple malignancies in one breast yields additional sentinel nodes compared to intralesional injection of the largest tumour only. Patients were included prospectively at four centres in The Netherlands. Lymphatic flow was studied using planar lymphoscintigraphy and SPECT/CT until 4 h after administration of {sup 99m}Tc-nanocolloid in the largest tumour. Subsequently, the smaller tumour(s) was injected intratumorally followed by the same imaging sequence. Sentinel nodes were intraoperatively localized using a gamma ray detection probe and vital blue dye. Included in the study were 50 patients. Additional lymphatic drainage was depicted after the second and/or third injection in 32 patients (64 %). Comparison of planar images and SPECT/CT images after consecutive injections enabled visualization of the number and location of additional sentinel nodes (32 axillary, 11 internal mammary chain, 2 intramammary, and 1 interpectoral. A sentinel node contained metastases in 17 patients (34 %)). In five patients with a tumour-positive node in the axilla that was visualized after the first injection, an additional involved axillary node was found after the second injection. In two patients, isolated tumour cells were found in sentinel nodes that were only visualized after the second injection, whilst the sentinel nodes identified after the first injection were tumour-negative. Lymphoscintigraphy and SPECT/CT after consecutive intratumoral injections of tracer enable lymphatic mapping of each tumour separately in patients with multiple malignancies within one breast. The high incidence of additional sentinel nodes draining from tumours other than the largest one suggests that separate tumour-related tracer injections may be a more accurate approach to mapping and sampling of sentinel nodes in patients with multicentric or

  14. US imaging of the musculocutaneous nerve

    Energy Technology Data Exchange (ETDEWEB)

    Tagliafico, Alberto Stefano [National Institute for Cancer Research, Department of Radiology, Genoa (Italy); Michaud, Johan [University of Montreal, Department of Physiatry, Montreal, Quebec (Canada); Marchetti, Alessandra; Garello, Isabella; Martinoli, Carlo [Universita di Genova, Radiology Department, Genova (Italy); Padua, Luca [Universita Cattolica del Sacro Cuore-Rome, Institute of Neurology, Rome (Italy); Fondazione Don Carlo Gnocchi, Rome (Italy)

    2011-05-15

    To describe the potential value of high-resolution sonography for evaluation of the musculocutaneous nerve (MCN). The normal anatomy of the MCN was evaluated on three cadaveric limbs and correlated with the US images obtained in 15 healthy subjects. Seven consecutive patients with MCN neuropathy were then evaluated with sonography using 17.5 and 12.5-MHz broadband linear array transducers. All patients had abnormal nerve conduction studies and underwent correlative MR imaging on a 1.5-T system. One-to-one comparison between cadaveric specimens and sonographic images showed that the MCN can be reliably identified from the axilla through the elbow, including the lateral antebrachial cutaneous (LAbC) nerve. In the patients group with MCN neuropathy, sonography allowed detection of a wide spectrum of abnormalities. In 5/7 cases, a spindle neuroma was depicted in continuity with the nerve. In one case, US identified focal swelling of the nerve and in another case US was negative. The neuroma was hyperintense on T2-weighted sequences in 75% of cases. In one patient, the nerve showed Gd-enhancement on fat-suppressed T1-weighted sequences. The nerve was never detected on unenhanced T1-scans. Owing to its small-size and out-of-plane course, the MCN may be more reliably depicted with sonography rather than with MR imaging. US is promising for evaluating traumatic injuries of the MCN. By providing unique information on the entire course of the nerve, US can be used as a valuable complement of clinical and electrophysiologic findings. (orig.)

  15. Prevalence of and risk factors for MRSA colonization in HIV-positive outpatients in Singapore

    Directory of Open Access Journals (Sweden)

    Kyaw Win

    2012-11-01

    Full Text Available Abstract Background Whilst there have been studies on the risks and outcomes of MRSA colonization and infections in HIV-positive patients, local data is limited on the risk factors for MRSA colonization among these patients. We undertook this study in a tertiary HIV care centre to document the risk factors for colonization and to determine the prevalence of MRSA colonization among HIV-positive outpatients in Singapore. Methods This was a cross-sectional study in which factors associated with MRSA positivity among patients with HIV infection were evaluated. A set of standardized questionnaire and data collection forms were available to interview all recruited patients. Following the interview, trained nurses collected swabs from the anterior nares/axilla/groin (NAG, throat and peri-anal regions. Information on demographics, clinical history, laboratory results and hospitalization history were retrieved from medical records. Results MRSA was detected in swab cultures from at least 1 site in 15 patients (5.1%. Inclusion of throat and/or peri-anal swabs increased the sensitivity of NAG screening by 20%. Predictors for MRSA colonization among HIV-positive patients were age, history of pneumonia, lymphoma, presence of a percutaneous device within the past 12 months, history of household members hospitalized more than two times within the past 12 months, and a most recent CD4 count less than 200. Conclusions This study highlights that a proportion of MRSA carriers would have been undetected without multiple-site screening cultures. This study could shed insight into identifying patients at risk of MRSA colonization upon hospital visit and this may suggest that a risk factor-based approach for MRSA surveillance focusing on high risk populations could be considered.

  16. A Study of Using Massage Therapy Accompanied with Stretching Exercise for Rehabilitation of Mammary Gland Hyperplasia.

    Science.gov (United States)

    Lv, Pin; Chong, Yuping; Zou, Huagang; Chen, Xiangxian

    2016-01-01

    Purpose. To apply massage therapy accompanied with stretching exercises for treatment of mammary gland hyperplasia, evaluate the clinical outcome in patients, and estimate the therapy as a novel treatment method for mammary hyperplasia. Methods. 28 adult female patients were selected and treated with massage therapy and stretching exercises focusing on skeleton muscles of chest, abdomen, and axilla. The mammary gland oxyhemoglobin (OxyHb) and deoxyhemoglobin (DeoxyHb) levels were detected before and after treatment after 15, 30, and 45 days. Results. In this cohort, pretreatment OxyHb (mean ± SD) is 1.32 ± 0.14 (medium-high), and DeoxyHb is 0.87 ± 0.13 (normal). All patients were clinically diagnosed with benign mammary gland hyperplasia and mastitis. The posttreatment OxyHb levels are 1.23 ± 0.09 (normal-medium, 15-day), 1.16 ± 0.08 (normal, 30-day), and 1.05 ± 0.04 (normal, 45-day), and DeoxyHb levels are 0.90 ± 0.11 (normal, 15-day), 0.94 ± 0.18 (normal, 30-day), and 0.98 ± 0.12 (normal, 45-day). Patients were diagnosed with decreased hyperplasia 15 and 30 days after treatment and with no symptom of hyperplasia in mammary gland 45 days after treatment. Conclusion. Mammary gland hyperplasia is closely correlated with pathological changes of skeletal muscles and could be significantly improved by massage therapy and stretching exercises targeting neighboring skeletal muscles. PMID:27022615

  17. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer

    Institute of Scientific and Technical Information of China (English)

    FAN Lin-jun; JIANG Jun; YANG Xin-hua; ZHANG Yi; LI Xing-gang; CHEN Xian-chun; ZHONG Ling

    2009-01-01

    Background Breast conserving surgery (BCS) has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy (ESM) plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting.Methods From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. Results There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups (P>0.05).The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM (88.4%, 38/43) and BCS (92.6%, 50/54) patients (P>0.05). During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence-one of these patients died of multiple organ metastasis.Conclusions After considering the wide Indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants-the new surgery of choice for breast cancer-warrants serious consideration as the prospective next standard surgical procedure.

  18. Prevalence of Malignant Soft Tissue Tumors inExtremities: An Epidemiological Study in Syria

    Directory of Open Access Journals (Sweden)

    Habib Reshadi

    2014-06-01

    Full Text Available Background:   Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and site deep into the deep fascia.The purpose of this study was to determine the relative prevalence according to sex and age, site of tumor, skeletal distribution, and treatment (surgery, chemotherapy and radiotherapy before and after surgery, and ascertain the relative frequency of these tumors in specific anatomic sites and age groups based on pathological studies. Methods: A total of 308 patients, with a musculoskeletal tumor were evaluated retrospectively. All of the patients enrolled into this study were referred to the Beirouni Hospital of Damascus University with a proven diagnosis of alignant soft tissue tumors from the beginning of January 2008 until the end of 2010. The prevalence of the malignant soft tissue tumors in these patients was analyzed. For purposes of analysis, all lesions were placed in 1 of 9 categories: hand and wrist, forearm, humorous (arm, proximal limb girdle (axilla and shoulder, foot and ankle, thigh, hip and buttocks region, trunk, and other lesions. Age and sex also were recorded. Results: Malignant tumors consisted of seven diagnostic categories: malignant fibrous histiocytoma (23%, liposarcoma (22%, rhabdomyosarcoma (9%, leiomyosarcoma (8%, malignant schwannoma (5%, dermatofibrosarcoma protuberans (5%, synovial sarcoma (10%, fibrosarcoma (13%, extraskeletal chondrosarcoma (1%, and extraskeletal Ewing sarcoma (4%. Conclusions: Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the site of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in

  19. 背阔肌解剖变异在乳腺癌腋窝淋巴结清扫术中的临床意义%Clinical Significance of Latissimus Dorsi Mutation in Axillary Lymph Node Dissection for Breast Carcinoma

    Institute of Scientific and Technical Information of China (English)

    张钢龄; 张培礼; 朱敬军; 杨七玉; 祁燕云; 杜华

    2012-01-01

    目的:通过对腋窝处变异的背阔肌进行详尽解剖,为降低乳腺癌腋窝淋巴结清扫术中腋窝处重要神经血管损伤,减少手术并发症提供依据.方法:收集128例行腋窝淋巴结清扫术的乳腺癌患者中发生背阔肌解剖变异19例,对该19例患者的背阔肌变异肌束进行详尽的大体解剖,找到其起点与止点,并测量长、宽、厚度,观察与腋窝神经、血管、淋巴结的毗邻关系.结果:19例发生背阔肌解剖变异的肌束均从背阔肌外侧缘发出一束肌腱,向内上走行,横跨腋血管神经束,在其上方,呈“扇形”腱膜延续为喙锁胸筋膜的一部分止于喙突.其中14例为单肌束走行,5例变异肌束从背阔肌发出后与胸大肌外缘发出一肌束会合,再并行向上.该变异肌束与背阔肌止端健呈“丫”型夹持着腋血管神经束.肋间臂神经从其表面或深面通过.其内下侧毗邻胸背神经及肩胛下血管,后外毗邻肩胛下血管外淋巴组织.结论:背阔肌变异肌束可造成腋窝淋巴结清扫术的解剖混淆,给腋淋巴结清扫术时的定位带来困难.因此,了解此种变异在腋窝淋巴结清扫术中具有重要意义.%This study aimed to provide the basic surgical guidelines for important injured nerves and vessels in the axilla during axillary lymph node dissection and reduce surgery-related complications by dissecting the variant latissimus dorsi (LATS) in the axilla. Methods: Data of 19 cases with LATS mutation from 128 breast carcinoma cases who underwent axillary lymph node dissection were collected and studied. The start and end points of the variation of muscle bundle (VOMB) were found by analyzing a full gross anatomy of the variant muscle bundle of LATS in the 19 cases. Length, width, and depth of VOMB were measured. Adjacent relationship among the axillary nerve, blood vessels, and lymph nodes in the axilla was observed. Results: Among the 19 cases with LATS mutation, each VOMB

  20. Ductal Carcinoma In Situ With Microinvasion: Prognostic Implications, Long-Term Outcomes, and Role of Axillary Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Parikh, Rahul R.; Haffty, Bruce G. [Cancer Institute of New Jersey, University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Lannin, Donald [Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT (United States); Moran, Meena S., E-mail: meena.moran@yale.edu [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States)

    2012-01-01

    Purpose: To compare the clinical-pathologic features and long-term outcomes for women with ductal carcinoma in situ (DCIS) vs. DCIS with microinvasion (DCISM) treated with breast conservation therapy (BCT), to assess the impact of microinvasion. Patients and Methods: A total of 393 patients with DCIS/DCISM from our database were analyzed to assess differences in clinical-pathologic features and outcomes for the two cohorts. Results: The median follow-up was 8.94 years, and the mean age was 55.8 years for the entire group. The DCISM cohort was comprised of 72 of 393 patients (18.3%). Surgical evaluation of the axilla was performed in 58.3% (n = 42) of DCISM vs. 18.1% (n = 58) of DCIS, with only 1 of 42 DCISM (2.3%) vs. 0 of 58 DCIS with axillary metastasis. Surgical axillary evaluation was not an independent predictor of local-regional relapse (LRR), distant relapse-free survival (DRFS), or overall survival (OS) in Cox proportional hazards analysis (p > 0.05). For the DCIS vs. DCISM groups, respectively, the 10-year breast relapse-free survival was 89.0% vs. 90.7% (p = 0.36), DRFS was 98.5% vs. 97.9% (p = 0.78), and OS was 93.2% vs. 95.7% (p = 0.95). The presence of microinvasion did not correlate with LRR, age, presentation, race, family history, margin status, and use of adjuvant hormonal therapy (all p > 0.05). In univariate analysis, pathology (DCIS vs. DCISM) was not an independent predictor of LRR (hazard ratio [HR], 1.58; 95% confidence interval [CI], 0.58-4.30; p = 0.36), DRFS (HR, 0.72; 95% CI, 0.07-6.95; p = 0.77), or OS (HR, 1.03; 95% CI, 0.28-3.82; p = 0.95). Conclusions: Our data imply that the natural history of DCISM closely resembles that of DCIS, with a low incidence of local-regional and distant failures. On the basis of our large dataset, the incidence of axillary metastasis in DCISM appears to be small and not appear to correlate to outcomes, and thus, microinvasion alone should not be the sole criterion for more aggressive treatment.

  1. Ductal Carcinoma In Situ With Microinvasion: Prognostic Implications, Long-Term Outcomes, and Role of Axillary Evaluation

    International Nuclear Information System (INIS)

    Purpose: To compare the clinical-pathologic features and long-term outcomes for women with ductal carcinoma in situ (DCIS) vs. DCIS with microinvasion (DCISM) treated with breast conservation therapy (BCT), to assess the impact of microinvasion. Patients and Methods: A total of 393 patients with DCIS/DCISM from our database were analyzed to assess differences in clinical-pathologic features and outcomes for the two cohorts. Results: The median follow-up was 8.94 years, and the mean age was 55.8 years for the entire group. The DCISM cohort was comprised of 72 of 393 patients (18.3%). Surgical evaluation of the axilla was performed in 58.3% (n = 42) of DCISM vs. 18.1% (n = 58) of DCIS, with only 1 of 42 DCISM (2.3%) vs. 0 of 58 DCIS with axillary metastasis. Surgical axillary evaluation was not an independent predictor of local-regional relapse (LRR), distant relapse-free survival (DRFS), or overall survival (OS) in Cox proportional hazards analysis (p > 0.05). For the DCIS vs. DCISM groups, respectively, the 10-year breast relapse-free survival was 89.0% vs. 90.7% (p = 0.36), DRFS was 98.5% vs. 97.9% (p = 0.78), and OS was 93.2% vs. 95.7% (p = 0.95). The presence of microinvasion did not correlate with LRR, age, presentation, race, family history, margin status, and use of adjuvant hormonal therapy (all p > 0.05). In univariate analysis, pathology (DCIS vs. DCISM) was not an independent predictor of LRR (hazard ratio [HR], 1.58; 95% confidence interval [CI], 0.58–4.30; p = 0.36), DRFS (HR, 0.72; 95% CI, 0.07–6.95; p = 0.77), or OS (HR, 1.03; 95% CI, 0.28–3.82; p = 0.95). Conclusions: Our data imply that the natural history of DCISM closely resembles that of DCIS, with a low incidence of local-regional and distant failures. On the basis of our large dataset, the incidence of axillary metastasis in DCISM appears to be small and not appear to correlate to outcomes, and thus, microinvasion alone should not be the sole criterion for more aggressive treatment.

  2. Outcome and prognostic factors for local recurrence in mammographically detected ductal carcinoma in situ of the breast treated with conservative surgery and radiation therapy

    International Nuclear Information System (INIS)

    Purpose: We have retrospectively reviewed our institution's experience treating a predominantly mammographically detected population of ductal carcinoma in situ (DCIS) patients with conservative surgery and radiation therapy (CSRT) to determine outcome and prognostic factors for local recurrence. Methods and Materials: Between January 1, 1982 and December 31, 1988, 52 consecutive cases of DCIS of the breast were treated with CSRT at William Beaumont Hospital. Forty-six (88%) were mammographically detected nonpalpable lesions. All patients underwent at least an excisional biopsy and 28 (54%) were reexcised. The axilla was surgically staged in 41 (79%) and all were N0. The entire breast was irradiated to 45-50 Gy over 5-6 weeks. The tumor bed was boosted in 49 (94%) so that the minimum dose was 60 Gy. The three patients not boosted received a minimum dose of 50 Gy to the entire breast. Pathologic materials were reviewed by one of the authors. Results: The predominant DCIS pattern was comedo in 40%, cribriform in 28%, solid in 17%, and micropapillary in 15%. The predominant nuclear grade was Grade I in 51%, Grade II in 49%, and Grade III in 0%. The median follow-up is 68 months. There have been three recurrences in the treated breast at a median time to failure of 30 months. The 5- and 8-year actuarial local recurrence rate is 6%. One patient recurred with invasive ductal cancer at 28 months, and the other two recurrences were DCIS at 30 and 50 months. All three patients were treated with salvage mastectomy. The patient who recurred locally with an invasive cancer developed metastasis and died at 64 months. The 5- and 8-year actuarial cause-specific survival rates are 100% and 97%, respectively. The following pathologic factors were analyzed for an association with local recurrence: predominant DCIS histology, predominant nuclear grade, and highest nuclear grade. Of these, the predominant nuclear grade was the best predictor of local recurrence (p = 0.070). No

  3. Reexamining age, race, site, and thermometer type as variables affecting temperature measurement in adults – A comparison study

    Directory of Open Access Journals (Sweden)

    Smith Linda S

    2003-06-01

    Full Text Available Abstract Background As a result of the recent international vigilance regarding disease assessment, accurate measurement of body temperature has become increasingly important. Yet, trusted low-tech, portable mercury glass thermometers are no longer available. Thus, comparing accuracy of mercury-free thermometers with mercury devices is essential. Study purposes were 1 to examine age, race, site as variables affecting temperature measurement in adults, and 2 to compare clinical accuracy of low-tech Galinstan-in-glass device to mercury-in-glass at oral, axillary, groin, and rectal sites in adults. Methods Setting 176 bed accredited healthcare facility, rural northwest US Participants Convenience sample (N = 120 of hospitalized persons ≥ 18 years old. Instruments Temperatures (°F measured at oral, skin (simultaneous, immediately followed by rectal sites with four each mercury-glass (BD and Galinstan-glass (Geratherm thermometers; 10 minute dwell times. Results Participants averaged 61.6 years (SD 17.9, 188 pounds (SD 55.3; 61% female; race: 85% White, 8.3% Native Am., 4.2% Hispanic, 1.7 % Asian, 0.8% Black. For both mercury and Galinstan-glass thermometers, within-subject temperature readings were highest rectally; followed by oral, then skin sites. Galinstan assessments demonstrated rectal sites 0.91°F > oral and ≅ 1.3°F > skin sites. Devices strongly correlated between and across sites. Site difference scores between devices showed greatest variability at skin sites; least at rectal site. 95% confidence intervals of difference scores by site (°F: oral (0.142 – 0.265, axilla (0.167 – 0.339, groin (0.037 – 0.321, and rectal (-0.111 – 0.111. Race correlated with age, temperature readings each site and device. Conclusion Temperature readings varied by age, race. Mercury readings correlated with Galinstan thermometer readings at all sites. Site mean differences between devices were considered clinically insignificant. Still considered

  4. Adaptação à prótese híbrida de extremidade superior: estudo termográfico de um caso Adaptation to upper extremity hybrid prosthesis: a thermographic case study

    Directory of Open Access Journals (Sweden)

    Soraia Cristina Tonon da Luz

    2010-06-01

    Full Text Available O objetivo do estudo foi verificar, por meio de termografia, a adaptação à prótese híbrida de extremidade superior de um sujeito do sexo masculino, 42 anos, amputado proximal de braço esquerdo. Imagens termográficas foram captadas por uma câmara de infravermelho imediatamente após a retirada da prótese, que vinha sendo usada por 8 horas ininterruptas, e 20 minutos de repouso mais tarde, quando foi alcançado equilíbrio térmico em ambiente a 21°C. As imagens foram adquiridas nos planos frontal anterior, sagital direito e esquerdo, tendo sido definidas e analisadas regiões de interesse em cada uma. Os resultados mostram que as temperaturas das regiões avaliadas reduziram-se em média 0,79°C (pThe aim of this study was to assess, by means of thermography, the adaptation to upper-extremity hybrid prosthesis by a male subject, 42 years old, with proximal amputation of left arm. Thermographic images were captured by an infrared camera immediately after prosthesis withdrawal (which had been used for full 8 hours and 20 minutes later, when thermal balance was reached, in an environment of constant 21°C. Images were captured of frontal and sagittal planes (both right and left, on which seven regions of interest (ROI were defined and analysed. Results showed that mean ROI temperatures decreased 0.79°C (p<0,05 after thermal balance was reached. Along the chest strap path and at the sound side axilla - which coincides with subject's main discomfort complaint - high temperatures were found, indicating friction; high temperature in the ipsilateral to amputation anterior shoulder suggests overload; and low temperature on the residual limb suggests poor circulation, thus pointing to difficulty of adaptation. Results suggest that thermography may contribute to identifying amputees' discomfort and may be used for monitoring upper-limb prostheses users' rehabilitation; also, suggestion is made to foster developing new suspension systems in order

  5. Lymphoscintigraphy of melanoma. Lymphatic channel activity guides localization of sentinel lymph nodes, and gamma camera imaging/counting confirms presence of radiotracer in excised nodes

    International Nuclear Information System (INIS)

    Lymphoscintigraphy has become a standard preoperative procedure to map the cutaneous lymphatic channel for progression of nodal metastasis of melanoma of the skin. Lymphoscintigraphy was employed to visualize lymphatic channels as a guide to identify sentinel lymph nodes (SLNs). Excised tissue was imaged with a gamma camera to verify the findings of presurgical lymphoscintigraphy. Percent counts of SLN(s) among the total counts of the excised melanoma tumor or scar tissue and SLN(s) were calculated. Eleven patients with cutaneous melanoma received four to ten intradermal injections of Tc-99m sulfur colloid at elual distances around the melanoma site. Images were made immediately after injection: 1 minute per image for 15 min; and then 5 minutes or 1,000,000 counts per image for 30 min. After surgery, the excised melanoma tumor or scar and SLN(s) were imaged/counted with a gamma camera. Percent counts of SLNs among the total counts of the excised melanoma tumor or scar tissue and SLNs were calculated. To validate the specimen count accuracy, an experimental phantom study was done. Linear lymphatic channels were identified between the injected sites and the SLNs in each patient. Gamma camera images demonstrated radioactivity in the SLNs of all patients, verifying the lymphoscintigraphy findings. Uptake in the SLNs of ten of the eleven patients ranged from 0.4 to 7.2% (mean 2.2%) of the total counts in excised tissue. We noted that a node with lower uptake should not be ignored because a lower percent of SLN activity does not necessarily rule out existing metastasis. In two of eleven patients, histopathologic showed metastases. One patient's melanoma on the middle back had lymphatic channel activity directed to both axillae. The results of the phantom study validated accuracy of our specimen counts. Because liner lymphatic channels existed between lymph nodes and the injected sites in all eleven patients, these lymphatic channels could be used as a guide for

  6. An original approach in the diagnosis of early breast cancer: use of the same radiopharmaceutical for both non-palpable lesions and sentinel node localisation

    International Nuclear Information System (INIS)

    We propose the use of a single nanocolloid tracer which is labelled with technetium-99m for simultaneous performance of ROLL and sentinel node indentification. The aim of this study was to evaluate the feasibility of this approach, which should be easier and more practical than the dual-tracer injection method. We have employed this new technique in 73 patients with non-palpable, cytologically diagnosed breast cancer and non-palpable axillary lymph nodes. In all patients the radiocolloid, in a total volume of 0.3-0.4 cc, was injected under sonographic or stereotactic guidance. Half of the dose was injected intratumourally and half superficially, but very close to the tumour. Because of the slow lymphatic flow in the breast, Nanocoll must be injected some time before surgery in order to enable adequate migration to the axilla. We injected colloid in the afternoon before surgery (16-23 h before the start of the operation, with an average interval of 18 h). An average dose of 130 MBq (range 110-150) was injected in order to have about 10 MBq of radioactivity when surgery commenced. Lymphoscintigraphy was performed after 15-19 h, with an average interval of 17 h. The procedure was always successful in permitting the localisation of occult breast lesions. Lesions were always localised at the first attempt, and were always contained within the surgical margins. Histological examination revealed all 73 resected lesions to be malignant: there were 64 cases of infiltrating carcinoma and nine of intraductal carcinoma. All breast lesions were therefore confirmed to be early breast cancer. We achieved sentinel node localisation in 71 out of 73, either at scintigraphy or with the intraoperative probe; in two patients, radiopharmaceutical migration was absent. Lymphoscintigraphy showed only axillary drainage in 52 cases, only internal mammary chain (IMC) drainage in nine cases, and combined axillary and IMC drainage in eight cases. In two cases, lymphoscintigraphy suggested the

  7. Breast lymphoscintigraphy for sentinel node identification in clinically axillary node negative breast cancer: A preliminary report of 35 cases

    International Nuclear Information System (INIS)

    Full text: Lymphoscintigraphy is a sensitive, minimally invasive method for identifying sentinel lymph node (SLN). It has been extensively validated in malignant melanoma, penile cancer and recently in breast cancer. The aims of this study were to analyze and determine the clinical value of lymphoscintigraphy in SLN localization in woman undergoing surgery for breast cancer and to evaluate the predictive value of SLN versus axillary lymph node status in these patients. Pre-operative breast lymphoscintigraphy were preformed in 35 female patients with breast cancer and clinically negative axillary node. Mean age was 52.8 years (range 38 to 73 years). Prior to surgery, 74 MBq of Tc-99m nanocolloid in 0.2 to 0.5 ml was injected intra-dermally over the tumor mass. Immediately after injection, anterior dynamic images were acquired for 20 minutes, followed by anterior and lateral views static images at 30 minute, 1 hour and 2 hour using single-head gamma camera until SLN visualized. The SLN location was marked externally on skin. All patients underwent standard modified radical mastectomy with axillary node dissection. All lymph nodes were examined carefully by a skilled histopathologist. SLNs were assessed by visual inspection of both dynamic and static images. Comparison of SLN and axillary lymph node histopathologic results was done in order to define the means of SLN biopsy's ability to reflect the final status of axilla. The mean size of the primary breast tumor mass was 2.54 cm (1.0 to 4.0 cm). In 20/35 (57.1%), the SLNs were visualized in 20-minute dynamic imaging. In 12 patients, the SLNs were seen after delayed imaging and/or repositioning the patient. Overall estimated SLN identification rate was 91.43%. Of those 32 cases in whom the SLNs were localized on lymphoscintigraphy, 9 cases were positive for metastatic tumors and the rest were negative for tumor involvement. Four out of these 9 cases, SLN was the only node that contained metastatic tumor cells and in 5

  8. Imaging of non-central nervous system primitive neuroectodermal tumours: Diagnostic features and correlation with outcome

    International Nuclear Information System (INIS)

    AIM: To document the varied radiological features before, during, and after treatment of non-Central Nervous System Primitive Neuroectodermal Tumours (PNETs), which are rare tumours of childhood. MATERIALS AND METHODS: Thirty-three children with PNETs have been treated at our institution between 1990 and 1999. Full radiological and clinical follow-up was obtained in 29 (17 females, 12 males). Imaging was retrospectively reviewed, with particular attention to Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). RESULTS: Age range at diagnosis was 0-16 years old (mean 4.4 years). There were five main sites of tumour: head and neck (n = 7), scapula/axilla (n 2), chest (n = 11), abdomen (n = 3), and spinal/paraspinal (n = 6). Overall mortality was 62%. Tumours of the scapula or paraspinal region appear to show better survival than other sites. Of 23 patients who had Tc99m-methylene diphosphonate (MDP) bone scans at diagnosis, four patients showed widespread distant metastases, seven showed focal increased uptake in an adjacent bone only, and 12 had normal examinations. CT was performed in 25 patients and MRI in 20, both at diagnosis and follow-up. Average size of tumours at presentation was 4.5 cm in the paraspinal, head and neck and scapular regions and 7.5 cm in the chest and abdomen. Tumours were typically of soft tissue density on CT with the larger (>5 cm) masses tending to be more heterogeneous in character. The lesions were slightly higher signal than muscle on T1-weighted (T1W) MRI and all masses were heterogeneous on T2W sequences. Calcification was uncommon (n = 6) and generally sparse. Tumours tended to displace adjacent soft tissue structures such as vessels and bronchi rather than invade or encase them. Tumours rarely crossed the midline. Local or bony invasion was seen in 12 patients at diagnosis. Metastases were identified in the lung (n = 5), pleura (n = 2), brain (n = 4), bone (n = 4), lymph nodes (n = 2), liver (n = 2), subcutaneous tissues

  9. The feasibility of breast cancer sentinel lymph node mapping at CT lymphography

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility of sentinel lymph node (SLN) mapping with CT lymphography (CT-LG). Methods: Twenty-five patients with confirmed breast cancer and no palpably axillary lymph node underwent CT-LG examination. The first one or more lymph nodes along the lymph duct draining from the injection sites to axilla were defined as SLNs, and then the LG results were compared with sentinel lymph node biopsy (SLNB). The over- and underestimation of LG were evaluated. The quality of LG imaging was classified Grade I and II according to lymph duct appearance on volume rendering (VR). The body mass index (BMI) > 25 was considered obesity. Fisher exact test was used for the statistics. Results: (1) Of 25 patients, 5 had local mastectomy history. BMI < 25 was found in 20 cases, and ≥25 was in 5 cases. (2) All SLNs were showed by CT-LG, and Grade I and II imaging quality were achieved in 21 cases (84.0%) and 4 cases (16.0%), respectively. The obese patient tended to have a poor imaging quality (P<0.05). (3) Fifty-six SLNs and 45 lymph ducts in all 25 patients were identified on CT-LG. Compared with the results of SLNB, 7 cases (28.0%) and 9 cases (36.0%) were over- and underestimated respectively by CT-LG due to obesity and local mastectomy (P<0.05). (4) Fifty-two negative SLNs in 18 patients and 15 positive SLNs in 7 patients were confirmed by pathology through SLNB, while 56 SLNs were delineated on CT-LG with 43 negative and 13 positive. The shape in 32.6% of the negative SLNs (14/43) and 76.9% of the positive SLNs (10/13) was round, the difference was significant (P<0.05). The filling defect on the center in 9. 3% of negative SLNs (4/43) and 23.1% of positive SLNs (3/13) was demonstrated, and irregular filling defect on the margin was found only in 30. 8% of positive SLNs (4/13). 3 SLNs in 2 patients combined with small satellite lymph nodes on CT-LG were also confirmed to have tumor infiltration. Conclusion: CT-LG can clearly demonstrate the breast

  10. Does breast radiographic appearance influence success of sentinel lymph node biopsy?

    International Nuclear Information System (INIS)

    Full text: Controversy exists regarding the influence of sentinel lymph node (SLN) mapping technique or patient and disease variables on the success rate of SLN mapping. Faint uptake by lymph node on scintigraphy and gamma probe localization may hamper SLN identification. The aim of the study was to investigate whether radiological breast density affects the uptake of the colloid in SLN and subsequent rate of SLN identification in breast cancer patients. Sentinel node mapping, using radioisotope method, was performed in 102 patients with T1/T2 breast cancer having clinically negative axilla. In all cases a standard labelling of nano colloid and peritumoral administration was performed. Lymph node uptake was evaluated by a 4-step visual score (1- absent, 2- weak, 3- clear, 4- intense) using quantification of counts at 4 h in the SLN. Patients were divided in groups according to Wolfe's classification of mammographic parenchymal patterns: N1 (almost radiolucent breast because of a high proportion of fat; n=37), P1 (predominantly fat by radiography breast with 15% to 25% serpiginous parenchyma densities; n=21), P2 (linear nodular densities occupies more than 25% of the cone of the breast; n=30), DY (radiographically dense breast with homogeneous sheets of density; n=14). Lymphoscintigraphy showed axillary SLN in 93 (91%) and parasternal SLN in 21 (21%) patients. No SLN were visualized in 6 (6%) patients. All patients underwent SLN biopsy followed by complete axillary node dissection. There was a concordance between the SLN and axillary node status in 93 (97%) of 96 cases. The false negative rate of SLN biopsy was 3.1% (3/96). N1 mammographic pattern and patients' age (?60 years) significantly correlated with absent/weak SLN uptake and lower mean count ratio. The tumor size, histological node status, tumor location, histological type, lymphovascular invasion were not associated with SLN visualization and identification rate. The study suggests that SLN biopsy is highly

  11. The relationship between lymphatic vessel invasion, tumor size, and pathologic nodal status: can we predict who can avoid a third field in the absence of axillary dissection?

    International Nuclear Information System (INIS)

    Purpose: Tangential (2-field) radiation therapy to the breast and lower axilla is typically used in our institution for treating patients with early-stage breast cancer who have 0-3 positive axillary nodes, as determined by axillary dissection, whereas a third supraclavicular/axillary field is added for patients with 4 or more positive nodes. However, dissection may result in complications and added expense. We, therefore, assessed whether clinical or pathologic factors of the primary tumor could reliably predict, in the absence of an axillary dissection, which patients with clinically negative axillary nodes have such limited pathologic nodal involvement that they might be effectively treated with only tangential fields. This would eliminate both the complications of axillary dissection and the added complexity and potential morbidity of a supraclavicular/axillary field. Methods and Materials: In this study, 722 women with clinical Stage I or II unilateral invasive breast cancer of infiltrating ductal histology, with clinically negative axillary nodes, at least 6 lymph nodes recovered on axillary dissection, and central pathology review were treated with breast-conserving therapy from 1968 to 1987. Pathologic nodal status was assessed in relation to clinical T stage, the presence of lymphatic vessel invasion (LVI), age, histologic grade, and the location of the primary tumor. Results: LVI, T stage, and tumor location were each significantly correlated with nodal status on univariate analysis. Ninety-seven percent of LVI-negative patients had 0-3 positive axillary nodes compared to 87% of LVI-positive patients. There was no association between T stage and extent of axillary involvement within LVI-negative and LVI-positive subgroups. In a logistic regression model, only LVI remained a significant predictor of having 4 or more positive nodes, although tumor size was of borderline significance. The odds ratio for LVI (positive vs. negative) as a predictor of having 4

  12. Malignant cutaneous T-cell lymphoma among 1100 Iranian victims, two decades after exposure to sulfur mustard: a long term investigation

    International Nuclear Information System (INIS)

    Sulfur Mustard ((SM; 2, 2 -dichlorethyl sulfide)) is a potent chemical warfare agent that was widely used during First World War and Iran -Iraq conflict. Over 100,000 Iranians were injured by sulfur mustard. This vesicant agent has a lot of acute and chronic destructive influences on the skin, eye and respiratory system. SM via the alkylation of DNA and several cellular proteins (structural, cytoplasmic and enzymes) and cell nuclei; produce several toxic, mutagenic and carcinogenic effects on epidermis, dermis, dermal appendix and hypodermics. In acute phases flexural locations and thin epidermal area such as groin, scrotum, and axilla and eyelids showed the most severe complication. According to scientific studies on chemical victims depression of cell-mediated immunity and also lower percentage of NK cell has been observed in SM exposure furthermore cytokines and other growth factors produced and secreted during epidermal and dermal regeneration of healing skin blisters. In reference to the last study about long term effect of SM the cutaneous signs and disorders could be categorized into 3 different groups. Conclusion Human data on the carcinogenicity of SM are from (a) battlefield exposures, (b) accidents, and (c) workers in chemical factories. Both British and American studies and other researchers have investigated the increased incidences of leukemia, pulmonary and skin carcinoma arising from World War I battlefield exposure. Clinical documentation in our cases shows notable and common signs, symptoms and data such as 1- Middle ages 2- Location of CTCL (folds and exposed areas) 3- The similarity between CTCL and SM scar (pigmentory and vascular changes) 4- Chronic dermatitis especially xerosis and eczema with itching before the beginning of CTCL. All of this study and data leads us to the conclusion that SM can possibly cause CTCL in indirect and direct way. CTCL can be caused indirectly due to prolonged period of chronic dermatitis (xerosis, eczema

  13. Radioguided surgery: First experiences with surgical gamma probe

    International Nuclear Information System (INIS)

    Full text: Thanks to the International Atomic Energy Agency and co-operation of the Nuclear Regulatory Authority of the Slovak Republic - International and Public Relations Division, sentinel lymph node detection has been introduced in one of the regional hospitals in Slovakia. Surgical Gamma Probe, the equipment needed for this has been made available. IAEA first of all helped in organizing a workshop on Scintimammography, Sentinel Lymph Node Detection and Intra-Operative Surgical Probe in Breast Cancer, in April 2002. Education of specialists - surgeons, oncologists, and pathologists and of course radiologists helped them to better understand the subject visa-vis nuclear medicine techniques. We also started the sentinel node detection following the two-days protocol. A 57 years old female with newly detected breast carcinoma in right breast, with positive mammography was investigated. Axillary lymph nodes were not palpable. Tc-99m Nanocoll, with particles size ranging 4-100 nm, was administered, 75 MBq peritumorally + 75 MBq subdermally and a dynamic lymphoscintigraphy was acquired which showed migration of the radiotracer. Static views (after 120 min.) demonstrated 4 sentinel lymph nodes in the right axilla. No lymph node was seen in the internal mammary or left axillary region. Next day before operation about 2 ml of patten blue dye was injected around the tumor and breast was compressed for about 10 min. Identification of sentinel lymph node was done with the help of surgical gamma probe and blue tinting. We found 6 nodes, first two were not really sentinel, but they were blue. A breast conservation surgery with standard axillary lymphadenectomy was performed. Pathology revealed invasive ductal carcinoma. We understand the need to establish an algorithm of examination and treatment of patients with newly diagnosed breast carcinoma. This technology requires teamwork of surgeon, nuclear medicine physician and pathologist. Regarding radiation exposure which every

  14. Early and delayed prediction of axillary lymph node neoadjuvant response by {sup 18}F-FDG PET/CT in patients with locally advanced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Vicente, Ana Maria; Soriano Castrejon, Angel; Jimenez Londono, German Andres [University General Hospital, Nuclear Medicine Department, Ciudad Real (Spain); Leon Martin, Alberto [University General Hospital, Investigation Unit, Ciudad Real (Spain); Relea Calatayud, Fernanda [University General Hospital, Pathology Department, Ciudad Real (Spain); Munoz Sanchez, Maria del Mar [Virgen de la Luz Hospital, Oncology Department, Cuenca (Spain); Cruz Mora, Miguel Angel [Virgen de la Salud Hospital, Oncology Department, Toledo (Spain); Espinosa Aunion, Ruth [La Mancha Centro Hospital, Oncology Department, Ciudad Real (Spain)

    2014-07-15

    To determine the utility of {sup 18}F-FDG (FDG) PET/CT performed in an early and delayed phase during neoadjuvant chemotherapy in the prediction of lymph node histopathological response in patients with locally advanced breast cancer. FDG PET/CT studies performed in 76 patients (mean age 53 years) at baseline (PET-1), after the second course of chemotherapy (PET-2) and after the last course of chemotherapy (PET-3) were prospectively analysed. Inclusion criteria were lymph node involvement detected by PET/CT and non-sentinel node biopsy before or after the baseline PET/CT scan. Following the recommendations of the 12th International Breast Conference (St. Gallen), the patients were divided into five subgroups in relation to biological prognostic factors by immunohistochemistry. For diagnosis visual and semiquantitative analyses was performed. Absence of detectable lymph node uptake on the PET-2 or PET-3 scan with respect to the PET-1 scan was considered metabolic complete response (mCR). Lymph nodes were histopathologically classified according the lymph node regression grade and in response groups as pathological complete response (pCR) or not pCR (type A/D or B/C of the Smith grading system, respectively). ROC analysis was performed to determine a cut-off value of Δ% SUV1-2 and SUV1-3 for prediction of nodal status after chemotherapy. An association between mCR and pCR was found (Cohen's kappa analysis), and associations between phenotypes and metabolic behaviour and the final histopathological status were also found. Lymph node pCR was seen in 34 patients. The sensitivity, specificity, and positive and negative predictive values of PET-2 and PET-3 in establishing the final status of the axilla after chemotherapy were 52 %, 45 %, 50 % and 47 %, and 33 %, 84 %, 67 % and 56 %, respectively. No significant relationship was observed between mCR on PET-2 and PET-3 and pCR (p = 0.31 and 0.99, respectively). Lymph node metabolism on PET-1 was not able to predict

  15. Detection of hepatocyte growth factor/scatter factor receptor (c-Met) in axillary drainage after operations for breast cancer using reverse transcriptase–polymerase chain reaction

    International Nuclear Information System (INIS)

    The diverse biological effects of hepatocyte growth factor/scatter factor (HGF/SF) are mediated by c-Met, which is preferentially expressed on epithelial cells. Met signaling has a role in normal cellular activities, and may be associated with the development and progression of malignant processes. In this study we examined whether Met can be detected in the axillary drainage from patients who underwent conservative operations for breast cancer, and its prognostic significance. Thirty-one consecutive patients with invasive ductal carcinoma of the breast suitable for breast-conserving treatment were studied. The output of the drain that had been placed in the axilla during the operation was collected, and the presence of Met and β-actin were assessed by reverse transcriptase–polymerase chain reaction (RT–PCR) assays. The data were compared with the pathological features of the tumor and the axillary lymph nodes, and with the estrogen receptor and progesterone receptor status. RT–PCR of the axillary lymphatic drainage was positive for Met in 23 (74.2%) of the patients. Positive assays were correlated with increasing tumor size and grade, with capillary and lymphatic invasion, and with lymph node metastasis (P < 0.02, for all comparisons). All 12 patients with axillary lymph node metastases had positive assays for Met, compared with 57.9% of patients without lymph node metastases. All five patients with tumor involvement in the margins of the resection had positive assays for Met in their lymphatic fluid, compared with 18 of 26 positive assays (69.2%) for patients without involved margins (P < 0.04). Finally, Met showed negative correlations with positivity for estrogen receptor and progesterone receptor (P < 0.02). Met can be detected in the axillary fluids of patients with breast cancer and its expression in the axillary drainage may have potential as a prognostic factor. This finding might be relevant to therapeutic considerations, because a positive assay

  16. Is sentinel lymph node biopsy more accurate than axillary dissection for staging nodal involvement in breast cancer patients?

    Science.gov (United States)

    Marrazzo, Antonio; Taormina, Pietra; Gebbiab, Vittorio; David, Massimo; Riili, Ignazio; Lo Gerfo, Domenico; Casà, Luigi; Noto, Antonio

    2007-01-01

    Today evaluation of axillary involvement can be routinely performed with the technique of sentinel lymph node biopsy (SLNB). One of the greatest advantages of SLNB is the nearly total absence of local postoperative complications. It is important to understand whether SLNB is better than axillary lymph-node dissection (ALND) for staging axillary nodal involvement. The aim of the study was to evaluate the axillary staging accuracy comparing three different methods: axillary dissection, sentinel node biopsy with the traditional 4-6 sections and sentinel node biopsy with complete analysis of the lymph node. 527 consecutive patients (525 females and 2 males) with invasive breast cancer < or = 3 cm and clinically negative axillary nodes were divided into 3 different groups: group A treated with axillary dissection, group B treated with sentinel nodal biopsy analysed with 4-6 sections, and group C treated with sentinel node biopsy with analysis of the entire node. All patients underwent a quadrantectomy to treat the tumor. Group differences and statistical significance were assessed by ANOVA. The percentages of N+ in group A and group B were 25.80% and 28% respectively, while in the third group it rose to 45%, or almost half the patients. The differences among the three groups were statistically significant (p = 0.02). From our analysis of the data it emerges that axillary dissection and sentinel node biopsy with analysis of 4-6 sections have the same accuracy in staging the nodal status of the axilla; analysis of the entire sentinel lymph node revealed an increased number of patients with axillary nodal involvement, proving more powerful in predicting nodal stage. SLNB with complete examination of the SLN removed can be considered the best method for axillary staging in breast cancer patients with clinical negative nodes. In our study, the percentage of metastases encountered after complete examination of SLN was 45% compared to the accuracy of axillary dissection that

  17. Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation

    International Nuclear Information System (INIS)

    Purpose: To determine whether excision of an in-breast tumor recurrence (IBTR) plus 5000 cGy in 25 fractions to the new operative area is both tolerated and effective as treatment for an IBTR after previous lumpectomy and whole breast irradiation. Methods and Materials: Thirty-nine women with an IBTR after lumpectomy and breast irradiation for invasive carcinoma (n 31) or ductal carcinoma in situ (n = 8) were treated with excision of the IBTR and radiotherapy (RT), 5000 cGy in 25 fractions, to the operative area using electrons of appropriate energy. The interval from completion of the first course of RT to diagnosis of the IBTR ranged from 16 to 291 months (median 63). Results: The repeat course of RT to the new operative area was well tolerated in all patients, and no late sequelae occurred other than skin pigmentation changes. Eight patients, including 2 with suspicious bone scans at the time of IBTR, developed distant metastases, and 7 died 21-71 months (median 48) after retreatment. One patient was alive with distant metastases at 27 months after retreatment. Four of the 8 patients who developed distant metastases also had a second IBTR, and 3 died with persistent disease in the breast. An additional 4 patients, for a total of 8, had a second IBTR. Three were alive and free of disease after mastectomy, and 1 was alive and free of disease after mastectomy and additional RT for chest wall recurrence. An additional patient developed recurrence in the axilla 9 months after reirradiation and was treated with surgery; she died free of disease at 63 months. One patient underwent mastectomy for suspected persistent disease 2 months after completion of repeat RT; no evidence of recurrent tumor was found in the removed breast. Thus, 30 women (76.9%) had an intact breast free of tumor at death or at last follow-up 1-180 months (median 51.5) after reirradiation. Using the Kaplan-Meier life table analysis, the estimated overall and disease-free 5-year survival rate for the

  18. Low-dose-rate brachytherapy as the sole radiation modality in the management of patients with early-stage breast cancer treated with breast-conserving therapy: preliminary results of a pilot trial

    International Nuclear Information System (INIS)

    Purpose: We present the preliminary findings of our in-house protocol treating the tumor bed alone after lumpectomy with low-dose-rate (LDR) interstitial brachytherapy in selected patients with early-stage breast cancer treated with breast-conserving therapy (BCT). Methods and Materials: Since March 1, 1993, 60 women with early-stage breast cancer were entered into a protocol of tumor bed irradiation only using an interstitial LDR implant with iodine-125. Patients were eligible if the tumor was ≤3 cm, margins were ≥2 mm, there was no extensive intraductal component, the axilla was surgically staged, and a postoperative mammogram was performed. Implants were placed using a standardized template either at the time of reexcision or shortly after lumpectomy. A total of 50 Gy was delivered at 0.52 Gy/h over a period of 96 h to the lumpectomy bed plus a 2-cm margin. Perioperative complications, cosmetic outcome, and local control were assessed. Results: The median follow-up for all patients is 20 months. Three patients experienced minimal perioperative pain that required temporary nonnarcotic analgesics. There have been four postoperative infections which resolved with oral antibiotics. No significant skin reactions related to the implant were noted and no patient experienced impaired would healing. Early cosmetic results reveal minimal changes consisting of transient hyperpigmentation of the skin at the puncture sites and temporary induration in the tumor bed. Good to excellent cosmetic results were noted in all 19 patients followed up a minimum of 24 months posttherapy. To date, 51 women have obtained 6-12-month follow-up mammograms and no recurrences have been noted. All patients currently have no physical signs of recurrence, and no patient has failed regionally or distantly. Conclusion: Treatment of the tumor bed alone with LDR interstitial brachytherapy appears to be well tolerated, and early results are promising. Long-term follow-up of these patients is

  19. Irradiation of the tumor bed alone after lumpectomy in selected patients with early stage breast cancer treated with breast conserving therapy

    International Nuclear Information System (INIS)

    Purpose: We present the initial findings of our in-house protocol treating the tumor bed alone after lumpectomy with low dose rate (LDR) interstitial brachytherapy in selected patients with early stage breast cancer treated with breast conserving therapy (BCT). Materials and Methods: Since 1/1/93, 50 women with early stage breast cancer were entered into a protocol of tumor bed irradiation alone using an interstitial LDR implant. Patients were eligible if their tumor was an infiltrating ductal carcinoma ≤ 3 cm in maximum diameter, pathologic margins were clear by at least 2 mm, the tumor did not contain an extensive intraductal component, the axilla was surgically staged with ≤ 3 nodes involved with cancer, and a postoperative mammogram was performed. Implants were positioned using a template guide delivering 50 Gy over 96 hours to the lumpectomy bed plus a 1-2 cm margin. Local control, cosmetic outcome, and complications were assessed. Results: Patients ranged in age from 40 to 84 years (median 65). The median tumor size was 10 mm (range, 1-25). Seventeen patients (34%) had well differentiated tumors, 22 (4%) had moderately differentiated tumors, and in 11 (22%) the tumor was poorly differentiated. Forty-five patients (90%) were node negative while 5 (10%) had 1-3 positive nodes. A total of 23 (46%) patients were placed on tamoxifen and 3 (6%) received adjuvant systemic chemotherapy. No patient was lost to follow-up. The median follow-up is 40 months (range 29-50). No patient has experienced a local, regional, or distant failure. One patient died from colorectal carcinoma with no evidence of recurrent breast cancer. Good-to-excellent cosmetic results have been observed in all 50 patients (median cosmetic follow-up 36 months). No patient has experienced significant sequelae related to their implant. Conclusions: Early results with treatment of the tumor bed alone with a LDR interstitial implant appear promising. Long-term follow-up of these patients will be

  20. Accelerated partial breast irradiation with iridium-192 multicatheter PDR/HDR brachytherapy. Preliminary results of the German-Austrian multicenter trial

    International Nuclear Information System (INIS)

    Purpose: to evaluate perioperative morbidity, toxicity, and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole irradiation modality after breast-conserving surgery. Patients and methods: from November 1, 2000 to January 31, 2004, 176 women with early-stage breast cancer became partakers in a protocol of tumor bed irradiation alone using pulsed-dose-rate (PDR) or high-dose-rate (HDR) interstitial multicatheter implants. Patients became eligible, if their tumor was an infiltrating carcinoma ≤ 3 cm in diameter, the surgical margins were clear by at least 2 mm, the axilla was surgically staged node-negative, the tumor was estrogen and/or progesterone receptor-positive, well or moderately differentiated (G1/2), the tumor did not contain an extensive intraductal component (EIC) and the patient's age was > 35 years. Implants were positioned using a template guide, delivering either 49.8 Gy in 83 consecutive hours (PDR) or 32.0 Gy in two daily fractions over 4 days (HDR). Perioperative morbidity, toxicity, and cosmetic outcome were assessed. Interim findings of the first 69 patients, who were treated in this multicenter trial, after a median follow-up of 24 months (range, 15-39 months) are presented. Results: one of the 69 patients (1.4%) developed a bacterial infection of the implant. No other perioperative complications, for example bleeding or hematoma, were observed. Acute toxicity was low: 2.9% of the patients (2/69) experienced mild radiodermatitis. Late toxicity: hypersensation/mild pain 7.2% (5/69), intermittent but tolerable pain 1.4% (1/69), mild dyspigmentation 10.1% (7/69), mild fibrosis 11.6% (8/69), moderate fibrosis 1.4% (1/69), mild telangiectasia (2) 11.6% (8/69), and moderate teleangiectasia (1-4 cm2) 1.4% (1/69). Good to excellent cosmetic results were observed in 92.4% of the patients evaluated. All patients (n = 176) remained disease-free to the date of evaluation. Conclusion: this analysis indicates

  1. A multiple drug allergy syndrome, multiple drug intolerance syndrome and/or allergic drug reaction with multiple immune reactants

    Directory of Open Access Journals (Sweden)

    Ana Maria Abreu Velez

    2016-01-01

    Full Text Available Background: Adverse drug reactions (ADR, multiple drug allergy syndrome (MDAS and multiple drug intolerance syndrome (MDIS, are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E examination, direct immunofluorescence (DIF and immunohistochemistry (IHC analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not

  2. Mesothelin expression is associated with poor outcomes in breast cancer

    Science.gov (United States)

    Li, Yun R.; Xian, Rena R.; Ziober, Amy; Conejo-Garcia, Jose; Perales-Puchalt, Alfredo; June, Carl H.; Zhang, Paul J.; Tchou, Julia

    2014-01-01

    Background Mesothelin, previously shown to be expressed in triple negative breast cancer (TNBC), is a potential therapeutic target and prognostic marker in breast cancer. Methods We analyzed clinical data from two cohorts comprising of 141 patients treated between 2009 and 2011 at our institution (discovery cohort) and 844 patients from The Cancer Genome Atlas (TCGA) (validation cohort). Mesothelin expression was quantified by immunohistochemistry (IHC) or by RNA transcript levels as measured by whole-transcriptome sequencing in the discovery and validation cohorts respectively. Results In the discovery cohort, the median follow up was 3.55 years. Univariate analyses demonstrated that tumor size (hazard ratio (HR) =1.30, 95% confidence interval (CI) 1.11–1.51), positive (+) axillary lymph nodes (HR=3.34; 95% CI 1.51–7.39), and mesothelin expression (HR = 2.03; 95% CI 1.10–3.74) were associated with overall and disease-specific survival. We used a Cox-proportional hazard (Cox-PH) model to adjust for the two independent predictors of survival, namely (+) axilla lymph nodes and tumor size, and we found a significant association between mesothelin expression and overall and disease-specific survival in the discovery cohort (HR = 3.06, 95% CI 1.40–6.68). Using the TCGA dataset, we confirmed that, over a median follow-up of 16.0 months, patients with mesothelin-expressing tumors had poorer overall survival (HR=1.46; 95% CI 1.05–2.03). On Cox-PH multivariate analysis, mesothelin-positivity was an independent predictor of worse survival, after adjusting for (+) axillary lymph nodes and tumor size (HR = 1.69; 95%CI 1.17–2.42). Conclusions Our results suggest that mesothelin is a prognostic breast tumor marker whose expression is highly enriched in TNBC tumors, especially in African American women. As there is no existing targeted therapy for TNBC, mesothelin may be a promising drug target for TNBC. Future work is needed to evaluate the efficacy of mesothelin

  3. Breast conservation treatment of early stage breast cancer: patterns of failure

    International Nuclear Information System (INIS)

    Purpose: This study retrospectively assesses the patterns of failure in conservatively treated early stage breast cancer patients by correlating various clinical, pathologic, and treatment-related factors with local, axillary, and distant relapse. Methods and Materials: Between 1973 and 1990, 796 patients (817 breasts) received breast conservation surgery followed by radiotherapy. Local recurrences were counted as events even if they occurred simultaneously or after the appearance of axillary or distant metastases. Results: The 10-year actuarial relative disease-free survival (DFS) rate for T1N0, T2N0, and T1-2N1 was 82%, 71%, and 54%, respectively. Stage N0 patients had a significant DFS advantage over N1 patients (p = 0.02). The 15-year actuarial local recurrence-free rate for T1 and T2 tumors was 82% and 87%, respectively (p = nonsignificant). Univariate analysis identified three significant risk factors for local relapse: (a) 48 breasts with tumors showing an extensive intraductal component had a crude local recurrence rate of 23% compared to 8% for 769 breasts without intraductal component (p 0.0016); (b) the actuarial 10-year local recurrence-free rate for patients under age 40 years was 64% compared to 88% for patients over 40 years (p < 0.0001); (c) the 10-year actuarial local recurrence-free rate for 416 postmenopausal women without adjuvant tamoxifen was 83% compared to 97% for 107 postmenopausal women with tamoxifen (p = 0.0479). Salvage therapy for operable local recurrent patients resulted in a 8-year actuarial DFS rate of 47%, significantly lower than that obtained with primary treatment. The incidence of axillary relapse as the first sign of recurrence was 2%, and could be correlated with the lack of axillary dissection (p < 0.0000005) and primary tumor size (p = 0.03). Radiotherapy to the axilla did not influence axillary relapse. Actuarial 5-year DFS rate after treatment of isolated axillary recurrence was 27%. Axillary failure was a marker for

  4. Awareness and Knowledge of BreastCancer Among University Students in Al Madina Al Munawara Region

    Directory of Open Access Journals (Sweden)

    Sherien Shalaby

    2010-10-01

    Full Text Available Background: Breast cancer, a critical health problem, is considered to be a progressive disease with a poor prognosis if detected late. Public education about the disease plays a pivotal rolein early detection and subsequent improvements in prognosis. The present study assesses the knowledge and awareness about various aspects of breast cancer among female university students.Methods: The knowledge of various aspects of breast cancer including incidence, early warning signs, risk factors, screening, early detection measures and sources of information was evaluated among female students in different faculties of Taibah University, Al Madina AlMunawara, Saudi Arabia, from December 1 to 31, 2008. A self-structured validated questionnaire that contained 23 itemized questions about breast cancer was randomly distributed to the participants. Respondents’ levels of knowledge were determined and transferred to electronic spreadsheets for further analysis.Results: Of 301 students, 247 (82% were available for final analysis with a mean age of 27 years (SD 12.1; age range: 18 to 39 years. Two hundred eleven (85.4% respondents were single, 218 (88% nulliparous and 213 (86% had no family history of breast cancer. Their knowledge about the incidence of the disease was poor; only 34% replied correctly. A total of 148 (59.9% respondents mentioned swelling in the skin/axilla while 123 (49.7% suggested skin changes as early warning signs of breast cancer. None of the participants expressed knowledge about all established risk factors of the disease. One hundred fifty-nine (64.4% did not know the proper way to perform a breast self-examination and 104 (42.2% had never performed this test. Additionally, 128 (51.8% knew that mammography was a screening toolfor breast cancer. Sources of information about the disease were: television and radio (139,56.2%, printed material in journals and newspapers (86, 34.8% and family physicians (13,15.2%.Conclusion: This study

  5. Prognostic significance of local recurrence in breast cancer after postmastectomy radiotherapy

    International Nuclear Information System (INIS)

    Purpose: We have retrospectively analyzed the impact of local recurrence in patients with adjuvant radiation therapy after mastectomy for breast cancer. Patients and Methods: From January 1985 through December 1993, 959 patients were irradiated after mastectomy for breast cancer. The age ranged from 34 to 79 years, the median follow-up was 3.1 years (range; 0.3-12.2 years). 368 (38%) were pre- and 591 (62%) postmenopausal. 35% had T3-4 tumors, 62% had axillary lymph node involvement, and 66% received additional systemic hormonal and/or cytotoxic therapy. Postmastectomy radiotherapy was administered in case of positive axillary nodes and in high-risk pN0-patients. The chest wall and lymphatics (axilla, parasternal and supraclavicular nodes) were irradiated with an anterior photon field with 50 Gy and the chest wall with an electron field with 44 Gy in 2-Gy fractions. Results: The overall survival was 70.5% after 5 and 59.8% after 10 years. 53 patients (5.5%) developed a locoregional recurrence 2-96 months after treatment (median 26 months). The local control rate was 92.7% after 5 and 86.4% after 10 years. Axillary lymph node involvement was the most important and (in a multivariate analysis the only) risk factor for local recurrence (p=0.0001). Patients with local control had a significantly better 10-year distant-disease-free survival and overall survival as compared to patients with local recurrence (44.5% vs 15.4%, p=0.002 and 62.1% vs 34.8%, p=0.004). Local recurrence increased the risk of death by a factor of 1.7 and in a Cox regression model, axillary lymph node status, T-category and local recurrence were significant prognostic factors for overall survival. In patients with local recurrence, the initial axillary lymph node status was the most important prognostic factor for survival after local recurrence. The 3-year survival after local relapse was 86% for patients with pN0 status vs 27% in with positive axillary nodes (p=0.025). Conclusions: Local

  6. Accelerated partial breast irradiation with iridium-192 multicatheter PDR/HDR brachytherapy. Preliminary results of the German-Austrian multicenter trial

    Energy Technology Data Exchange (ETDEWEB)

    Ott, O.J.; Lotter, M.; Sauer, R.; Strnad, V. [Dept. of Radiation Oncology, Univ. Hospital Erlangen, Erlangen (Germany); Poetter, R.; Resch, A. [Dept. of Radiotherapy and Radiobiology, Univ. Hospital AKH Wien, Vienna (Austria); Hammer, J. [Dept. of Radiation Oncology, Barmherzige Schwestern Hospital Linz, Linz (Austria); Hildebrandt, G. [Dept. of Radiation Oncology, Univ. Hospital Leipzig, Leipzig (Germany); Poehls, U.; Beckmann, M.W. [Dept. of Gynecology, Univ. Hospital Erlangen, Erlangen (Germany)

    2004-10-01

    Purpose: to evaluate perioperative morbidity, toxicity, and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole irradiation modality after breast-conserving surgery. Patients and methods: from November 1, 2000 to January 31, 2004, 176 women with early-stage breast cancer became partakers in a protocol of tumor bed irradiation alone using pulsed-dose-rate (PDR) or high-dose-rate (HDR) interstitial multicatheter implants. Patients became eligible, if their tumor was an infiltrating carcinoma {<=} 3 cm in diameter, the surgical margins were clear by at least 2 mm, the axilla was surgically staged node-negative, the tumor was estrogen and/or progesterone receptor-positive, well or moderately differentiated (G1/2), the tumor did not contain an extensive intraductal component (EIC) and the patient's age was > 35 years. Implants were positioned using a template guide, delivering either 49.8 Gy in 83 consecutive hours (PDR) or 32.0 Gy in two daily fractions over 4 days (HDR). Perioperative morbidity, toxicity, and cosmetic outcome were assessed. Interim findings of the first 69 patients, who were treated in this multicenter trial, after a median follow-up of 24 months (range, 15-39 months) are presented. Results: one of the 69 patients (1.4%) developed a bacterial infection of the implant. No other perioperative complications, for example bleeding or hematoma, were observed. Acute toxicity was low: 2.9% of the patients (2/69) experienced mild radiodermatitis. Late toxicity: hypersensation/mild pain 7.2% (5/69), intermittent but tolerable pain 1.4% (1/69), mild dyspigmentation 10.1% (7/69), mild fibrosis 11.6% (8/69), moderate fibrosis 1.4% (1/69), mild telangiectasia (< 1 cm{sup 2}) 11.6% (8/69), and moderate teleangiectasia (1-4 cm{sup 2}) 1.4% (1/69). Good to excellent cosmetic results were observed in 92.4% of the patients evaluated. All patients (n = 176) remained disease-free to the date of evaluation. Conclusion

  7. Half versus full vacuum suction drainage after modified radical mastectomy for breast cancer- a prospective randomized clinical trial[ISRCTN24484328

    Directory of Open Access Journals (Sweden)

    Singh JP

    2005-01-01

    Full Text Available Abstract Background Suction drains are routinely used after modified radical mastectomy and are an important factor contributing to increased hospital stay as the patients are often discharged only after their removal. Amongst various factors that influence the amount of postoperative drainage, the negative suction pressure applied to the drain has been reported to be of great significance. While a high negative suction pressure is expected to drain the collection and reduce the dead space promptly, it may also prevent the leaking lymphatics from closing and lead to increased drainage from the wound. Against this background a prospective randomized clinical study was conducted to compare the amount and duration of drainage between a half negative suction and full vacuum suction drainage in patients following modified radical mastectomy. The associated postoperative morbidity was also compared between the two groups. Methods 85 FNAC (fine needle aspiration cytology proven cases of locally advanced breast cancer were randomized. (Using randomly ordered sealed envelops, which were opened immediately before the closure of the wound in to 50 patients with full vacuum suction (pressure = 700 g/m2 and 35 cases in to half vacuum suction drainage (pressure = 350 g/m2 groups. The two groups were comparable in respect of age, weight, and technique of operation and extent of axillary dissection. Surgery was performed by the same surgical team comprising of five surgeons (two senior and three resident surgeons using a standardized technique with electrocautery. External compression dressing was provided over the axilla for first 48 hrs and following that patients were encouraged to do active and passive shoulder exercises. The outcomes measured were postoperative morbidity and the length of hospital stay. Statistical methods used: Descriptive studies were performed with SPSS version 10 and group characteristics were compared using student t-test. Results

  8. Neurinoma del plexo braquial simulando metastasis de adenocarcinoma de mama Schwannoma of the brachial plexus resembling a breast adenocarcinoma metastasis

    Directory of Open Access Journals (Sweden)

    Gregorio Rodríguez Boto

    2011-10-01

    Full Text Available Los neurinomas del plexo braquial son tumores infrecuentes que pueden confundirse con otras lesiones de índole tumoral. Se presenta el caso de una mujer de 40 años, tratada previamente de un adenocarcinoma de mama derecha en el pasado, que en el estudio de extensión realizado 5 años después se detectó una lesión localizada en el plexo braquial derecho. La paciente se encontraba asintomática. El diagnóstico radiológico de presunción fue metástasis de adenocarcinoma mamario. Se realizó un abordaje axilar derecho descubriendo una lesión bien delimitada en el plexo braquial. Con ayuda de la monitorización neurofisiológica intraoperatoria, se observó que la lesión dependía de la rama cubital y se pudo realizar una resección completa preservando la función de dicho nervio. El estudio anatomopatológico confirmó que se trataba de un neurinoma, descartando así la existencia de metástasis. La evolución postoperatoria fue satisfactoria. Seis años después de la intervención no existe recidiva tumoral. En nuestro conocimiento este es el primer caso publicado en la literatura de un neurinoma del plexo braquial dependiente de la rama cubital. La monitorización neurofisiológica intraoperatoria resulta fundamental para abordar este tipo de lesiones con baja morbilidad.Schwa nomas originating from the brachial plexus, although rare, may be mistaken for another type of tumour. A 40 year-old woman, who had been treated years earlier for a breast adenocarcinoma, showed in the 5-year follow-up magnetic resonance examination a localized lesion in the right brachial plexus. The presumptive radiological diagnosis was a metastasis from the primary adenocarcinoma. Following surgical access via the right axilla, a well-circumscribed mass in the brachial plexus was detected. Under intraoperative electrophysiological guidance, the lesion was observed to depend on the ulnar nerve and its complete resection was possible without compromising nerve

  9. Levels of (1→3-β-D-glucan, Candida mannan and Candida DNA in serum samples of pediatric cancer patients colonized with Candida species

    Directory of Open Access Journals (Sweden)

    Khan Zia U

    2010-10-01

    Full Text Available Abstract Background Surveillance cultures may be helpful in identifying patients at increased risk of developing invasive candidiasis. However, only scant information exists on the effect of Candida colonization on serum levels of diagnostic biomarkers. This prospective surveillance study determined the extent of Candida colonization among pediatric cancer patients and its possible impact on serum levels of (1-3-β-D-glucan (BDG, Candida mannan and Candida DNA. Methods A total of 1075 swabs originating from oropharynx (n = 294, nostrils (n = 600, rectum (n = 28, groin (n = 50, ear (n = 54, and axilla (n = 49 of 63 pediatric cancer patients were cultured for the isolation of Candida spp. Patients yielding Candida spp. from any sites were considered as colonized. Serum samples were collected from patients at the time of first surveillance culture for detection of BDG by Fungitell kit and Candida mannan by Platelia Candida Ag. Candida DNA was detected by using panfungal primers and identification was carried out by using species-specific primers and DNA sequencing. Results Seventy-five (7.6% swab cultures from 35 (55.5% patients yielded Candida spp. These isolates included C. albicans (n = 62, C. dubliniensis (n = 8, C. glabrata and C. tropicalis (n = 2 each and C. krusei (n = 1. Eleven patients were colonized at three or more sites. Eight of 36 serum samples from 6 colonized patients yielded BDG values higher than the currently recommended cut-off value of ≥80 pg/ml. However, none of the serum samples yielded Candida mannan levels ≥0.5 ng/ml and PCR test for Candida DNA was also negative in all the serum samples of colonized patients. During the study period, only two colonized patients subsequently developed candidemia due to C. tropicalis. Besides positive blood cultures, C. tropicalis DNA, BDG and Candida mannan were also detected in serum samples of both the patients. Conclusions The present study demonstrates that while mucosal

  10. Dynamic lymphoscintigraphy in diagnosis and management of post mastectomy lymphoedema

    International Nuclear Information System (INIS)

    Introduction: Post mastectomy lymphoedema develops in 20-36% of women after breast cancer surgery with axillary clearance. In many cases lymphoedema delays full recovery and influence physical and psychosocial well-being. Objective: The aims of the study were: to evaluate dynamics of the lymph outflow in patients after axillary clearance for breast cancer with subsequent lymphoedema; to define the level of lymphatic insufficiency and its influence on effects of complex de-congestive therapy (CDT). Materials and Methods: The group of patient consisted of 16 women. The age of patients varied from 37 to 65 years. Dynamic lymphoscintigraphy was taken with Varicam gamma camera by Elscint. 0,5 ml of the radiotracer (Nanocoll labelled with 99m-Tc) was injected subcutaneously between II and III metacarpal bone at the back of the hand. Subsequent acquisitions were taken every 60 sec., radioactivity over axillary, sub- and supraclavicular lymph nodes area was evaluated. Registered parameters: arrival time - the time from radiotracer injection to revealing regional lymph nodes; lymph nodes uptake - storage capacity of the radiotracer in the regional lymph nodes in %. During examination patient was doing movements of flexion and extension in the wrist to activate muscle pump. The examination was ended by final scintigraphy after 2 hours or if necessary after 5 hours by scintigraphy evaluating dermal back flow. Lymphatic insufficiency was measured in 4 steps scale by Weissleder and compared with clinical grading and effects of CDT. Results: There were three types of images registered: no axillary lymph nodes revealed and flat radioactivity curve. This co-related with severe lymphoedema in clinical grading and poor results of CDT: a few lymph nodes revealed in the axilla with marked outflow to the sub-clavicular lymph nodes and delayed transport of the radioactive material. It correlated with moderate lymphoedema in clinical grading and slightly better effects of CDT. direct

  11. Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience

    International Nuclear Information System (INIS)

    To implement total body irradiation (TBI) using volumetric modulated arc therapy (VMAT). We applied the Varian RapidArc™ software to calculate and optimize the dose distribution. Emphasis was placed on applying a homogenous dose to the PTV and on reducing the dose to the lungs. From July 2013 to July 2014 seven patients with leukaemia were planned and treated with a VMAT-based TBI-technique with photon energy of 6 MV. The overall planning target volume (PTV), comprising the whole body, had to be split into 8 segments with a subsequent multi-isocentric planning. In a first step a dose optimization of each single segment was performed. In a second step all these elements were calculated in one overall dose-plan, considering particular constraints and weighting factors, to achieve the final total body dose distribution. The quality assurance comprised the verification of the irradiation plans via ArcCheck™ (Sun Nuclear), followed by in vivo dosimetry via dosimeters (MOSFETs) on the patient. The time requirements for treatment planning were high: contouring took 5–6 h, optimization and dose calculation 25–30 h and quality assurance 6–8 h. The couch-time per fraction was 2 h on day one, decreasing to around 1.5 h for the following fractions, including patient information, time for arc positioning, patient positioning verification, mounting of the MOSFETs and irradiation. The mean lung dose was decreased to at least 80 % of the planned total body dose and in the central parts to 50 %. In two cases we additionally pursued a dose reduction of 30 to 50 % in a pre-irradiated brain and in renal insufficiency. All high dose areas were outside the lungs and other OARs. The planned dose was in line with the measured dose via MOSFETs: in the axilla the mean difference between calculated and measured dose was 3.6 % (range 1.1–6.8 %), and for the wrist/hip-inguinal region it was 4.3 % (range 1.1–8.1 %). TBI with VMAT provides the benefit of satisfactory dose

  12. Postmastectomy Hypofractionated and Accelerated Radiation Therapy With (and Without) Subcutaneous Amifostine Cytoprotection

    Energy Technology Data Exchange (ETDEWEB)

    Koukourakis, Michael I., E-mail: targ@her.forthnet.gr [Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis (Greece); Panteliadou, Marianthi; Abatzoglou, Ioannis M.; Sismanidou, Kyriaki [Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis (Greece); Sivridis, Efthimios; Giatromanolaki, Alexandra [Department of Pathology, Democritus University of Thrace, Alexandroupolis (Greece)

    2013-01-01

    Purpose: Postmastectomy radiation therapy (PMRT) provides major local control and survival benefits. More aggressive radiation therapy schemes may, however, be necessary in specific subgroups, provided they are safely administered. We report the tolerance and efficacy of a highly accelerated and hypofractionated regimen (HypoARC). Methods and Materials: One hundred twelve high-risk patients who had undergone mastectomy received 10 consecutive fractions of 3.5 Gy in 12 days (thoracic wall and axillary/supraclavicular areas). Two consecutive additional fractions of 4 Gy were given to the surgical scar area (electrons 8-10 MeV) and 1 3.5-Gy fraction to the axilla (in cases with extensive nodal involvement). A minimum follow-up of 24 months (median, 44 months) was allowed before analysis. Of 112 patients, 21 (18.7%) refused to receive amifostine, the remaining receiving tolerance-based individualized doses (500-1000 mg/day subcutaneously). Results: By use of a dose individualization algorithm, 68.1%, 11%, and 18.7% of patients received 1000 mg, 750 mg, and 500 mg/day of amifostine. Patchy moist skin desquamation outside and inside the booster fields was noted in 14 of 112 (12.5%) and 26 of 112 (23.2%) patients, respectively. No case of acute pneumonitis was recorded. High amifostine dose offered a significant skin protection. Within a median follow-up time of 44 months, moderate subcutaneous edema outside and within the booster thoracic area was noted in 5 of 112 (4.4%) and 8 of 112 (7.1%) cases, respectively. Intense asymptomatic radiographic findings of in field lung fibrosis were noted in 4 of 112 (3.6%) patients. Amifostine showed a significant protection against lung and soft tissue fibrosis. A 97% projected 5-year local relapse free survival and 84% 5-year disease-specific survival were recorded. Lack of steroid receptor expression, simple human epidermal growth factor 2 positivity, or triple negative phenotype defined higher metastasis rates but had no effect on

  13. Early and delayed prediction of axillary lymph node neoadjuvant response by 18F-FDG PET/CT in patients with locally advanced breast cancer

    International Nuclear Information System (INIS)

    To determine the utility of 18F-FDG (FDG) PET/CT performed in an early and delayed phase during neoadjuvant chemotherapy in the prediction of lymph node histopathological response in patients with locally advanced breast cancer. FDG PET/CT studies performed in 76 patients (mean age 53 years) at baseline (PET-1), after the second course of chemotherapy (PET-2) and after the last course of chemotherapy (PET-3) were prospectively analysed. Inclusion criteria were lymph node involvement detected by PET/CT and non-sentinel node biopsy before or after the baseline PET/CT scan. Following the recommendations of the 12th International Breast Conference (St. Gallen), the patients were divided into five subgroups in relation to biological prognostic factors by immunohistochemistry. For diagnosis visual and semiquantitative analyses was performed. Absence of detectable lymph node uptake on the PET-2 or PET-3 scan with respect to the PET-1 scan was considered metabolic complete response (mCR). Lymph nodes were histopathologically classified according the lymph node regression grade and in response groups as pathological complete response (pCR) or not pCR (type A/D or B/C of the Smith grading system, respectively). ROC analysis was performed to determine a cut-off value of Δ% SUV1-2 and SUV1-3 for prediction of nodal status after chemotherapy. An association between mCR and pCR was found (Cohen's kappa analysis), and associations between phenotypes and metabolic behaviour and the final histopathological status were also found. Lymph node pCR was seen in 34 patients. The sensitivity, specificity, and positive and negative predictive values of PET-2 and PET-3 in establishing the final status of the axilla after chemotherapy were 52 %, 45 %, 50 % and 47 %, and 33 %, 84 %, 67 % and 56 %, respectively. No significant relationship was observed between mCR on PET-2 and PET-3 and pCR (p = 0.31 and 0.99, respectively). Lymph node metabolism on PET-1 was not able to predict the final

  14. Postmastectomy Hypofractionated and Accelerated Radiation Therapy With (and Without) Subcutaneous Amifostine Cytoprotection

    International Nuclear Information System (INIS)

    Purpose: Postmastectomy radiation therapy (PMRT) provides major local control and survival benefits. More aggressive radiation therapy schemes may, however, be necessary in specific subgroups, provided they are safely administered. We report the tolerance and efficacy of a highly accelerated and hypofractionated regimen (HypoARC). Methods and Materials: One hundred twelve high-risk patients who had undergone mastectomy received 10 consecutive fractions of 3.5 Gy in 12 days (thoracic wall and axillary/supraclavicular areas). Two consecutive additional fractions of 4 Gy were given to the surgical scar area (electrons 8-10 MeV) and 1 3.5-Gy fraction to the axilla (in cases with extensive nodal involvement). A minimum follow-up of 24 months (median, 44 months) was allowed before analysis. Of 112 patients, 21 (18.7%) refused to receive amifostine, the remaining receiving tolerance-based individualized doses (500-1000 mg/day subcutaneously). Results: By use of a dose individualization algorithm, 68.1%, 11%, and 18.7% of patients received 1000 mg, 750 mg, and 500 mg/day of amifostine. Patchy moist skin desquamation outside and inside the booster fields was noted in 14 of 112 (12.5%) and 26 of 112 (23.2%) patients, respectively. No case of acute pneumonitis was recorded. High amifostine dose offered a significant skin protection. Within a median follow-up time of 44 months, moderate subcutaneous edema outside and within the booster thoracic area was noted in 5 of 112 (4.4%) and 8 of 112 (7.1%) cases, respectively. Intense asymptomatic radiographic findings of in field lung fibrosis were noted in 4 of 112 (3.6%) patients. Amifostine showed a significant protection against lung and soft tissue fibrosis. A 97% projected 5-year local relapse free survival and 84% 5-year disease-specific survival were recorded. Lack of steroid receptor expression, simple human epidermal growth factor 2 positivity, or triple negative phenotype defined higher metastasis rates but had no effect on

  15. Clinical trends and outcomes of male breast cancer: Experience of a tertiary oncology centre in India

    Directory of Open Access Journals (Sweden)

    Anindya Mukherjee

    2014-08-01

    Full Text Available Purpose: Because of its rarity in any oncology centre, the clinical trends of male breast cancer specific to its geographical distribution have remained relatively unexplored. This study was done to analyze the clinico-pathological data, treatment given and survival patterns of male breast cancer patients visiting our tertiary medical centre and compare our results with available literature. Methods: All male breast cancer patients registered at our clinic from 2003 to 2009 were included. Frequency distribution analysis of the demographic and clinico-pathological data and treatment variables was done. Treatment outcome was examined from Kaplan-Meir survival estimates. Results: Thirty-three male breast cancer patients were encountered. The median age of presentation was sixty years. Mostly (87.9% they presented with lump in breast or axilla and were clinically staged to be ‘3’ (57.6%.Obesity and alcohol were the commonest risk factors identified. Modified radical mastectomy was the commonest (69.6% definitive therapy rendered with (only for clinically staged 3 patients or without neo-adjuvant chemotherapy. Infiltrating ductal carcinoma was identified in most cases. Twenty-two patients received adjuvant chemotherapy and twenty-four received adjuvant radiotherapy. Eighteen (54.5% patients were hormone-receptor positive and received tamoxifen. The median Overall survival (OS and Progression-free survival (PFS came out to be 14.3 months (standard error, SE of 1.185; 95% confidence interval, CI 12-16.6 and 15.7 (SE 5.35, 95% CI 5.2-26.19 months respectively.Conclusion: Male breast cancers usually carry a poor prognosis due to presentation at later stages. Most of our results correlate with previous literature. Multi-centric prospective studies are required to validate the etiological factors and prognostic determinants of survival.-----------------------------Cite this article as: Mukherjee A, Saha A, Chattopadhyay S, Sur P. Clinical trends and

  16. Comparison between palpable and nonpalpable breast cancers: mammographic and pathological findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Jung; Kim, Eun Kyung; Kim, Sung Jun; Oh, Ki Keun; Lee, Kyong Sik; Lee, Byung Chan [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-07-01

    To analyze the differences in mammographic and pathologic findings between palpable and non-palpable breast carcinoma. Among 362 patients with surgically proven breast carcinoma, 317, whose chief complaint during preoperative evaluation was a palpable mass, comprised group 1, and 45 with no masses comprised group 2. We compared mammographic and pathologic findings between the two groups. As regards the pattern of mammographic presentation, mass alone accounted for 51.4% of group 1 and 33.3% of group 2, while calcification alone was seen in 7.6% of group 1 and 24.4% of group 2 (p<0.05). In group 1, 48.6% of masses were of irregular shape, and in group 2, 46.2% were round. According to ACRBIRADS, 47.6% of group 1 was classified as category 5, and 51.1% of group 2 as category 4 (p<0.05). On the other hand, the margin of the mass showed no statistical difference. Among the 362 patients, the mean age of group 1 was 48.1 (range, 28-79) years, while that of group 2 was 51.7 (range 30-73) years (p<0.05). Histologically, infiltrative ductal carcinoma was seen in 84.9% of group 1, and DCIS in 8.5%, while for group 2 the respective figures were 62.2% and 28.9% (p<0.05). For group 1, mean lesional size was 3.01cm, with 47.9% lymph node metastasis in the axilla, while for group 2 the corresponding figures were 1.93cm (p<0.05) and 28.2% (p<0.05). Differences were statistically significant. Under the TMN system, 30% of group 1 were at stage 2, while 35.6% of group 2 were at stage 1(p<0.05). Palpable and non-palpable cancers showed statistically significant differences in mammographic findings such as mass shape and category, but not in the margin of the mass. The were also statistically significant differences with regard to age, histology, lesion size, axillary lymph node metastasis, and staging.

  17. Dacryocystorhinostomy ostium: parameters to evaluate and DCR ostium scoring

    Directory of Open Access Journals (Sweden)

    Ali MJ

    2014-12-01

    Full Text Available Mohammad Javed Ali,1 Alkis James Psaltis,2 Peter John Wormald2 1Dacryology Service, L V Prasad Eye Institute, Hyderabad, Telangana, India; 2Department of Surgery–Otorhinolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia Aim: This study aims to provide a systematic protocol for the evaluation of a dacryocystorhinostomy (DCR ostium and to propose a scoring system to standardize the assessment.Methods: Retrospective evaluation of 125 consecutive lacrimal ostia post-DCR was performed. Medical records were screened, and photographs and videos were assessed to note the details of various ostial parameters. The major time points in evaluation were 4 weeks, 6 weeks, 3 months, and 6 months post-DCR. The ostia were defined and parameters like shape, size, location, and evolution of ostium were noted. Evaluation parameters were defined for internal common opening (ICO, ostium stents, and ostium granulomas. Ostium cicatrix and synechiae were graded based on their significance. Surgical success rates were computed and ostium characteristics in failed cases were studied.Results: A total of 125 ostia were evaluated on the aforementioned ostium parameters. Because five ostia showed a complete cicatricial closure with no recognizable features, the remaining 120 ostia were studied. The ostium location was anterior to the axilla of middle turbinate in 85.8% (103/120 of the cases. Moreover, 76.6% (92/120 of the ostia were circular to oval in shape, with a shallow base. The ostium size was >8×5 mm in 78.3% (94/120 of the cases. The ICO was found to be located in the central or paracentral basal area in 75.8% (91/120. The anatomical and functional success rates achieved were 96% and 93.6%, respectively. All the five cases with anatomical failures showed a complete cicatrization and the ICO movements were poor in all the three cases of functional failure.Conclusion: The article attempts to standardize the postoperative

  18. Double-blind placebo-controlled randomised trial of vitamin E and pentoxifylline in patients with chronic arm lymphoedema and fibrosis after surgery and radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    (fibrosis) in the irradiated breast or chest wall, pectoral fold or supraclavicular fossa, change in photographic breast/chest wall appearance or patient self-assessment of function and Quality of Life at either 6 or 12 months. Conclusions: The study fails to demonstrate efficacy of dl-alpha tocopheryl acetate plus pentoxifylline in patients with arm lymphoedema following axillary surgery and lymphatic radiotherapy, nor does it suggest any benefits of these drugs in radiation-induced induration (fibrosis) in the breast, chest wall, pectoral fold, axilla or supraclavicular fossa

  19. 多时间节点荷人胰腺癌SW1990细胞裸鼠模型的建立及其MRI表现%Establishment of the nude mouse model bearing human pancreatic adenocarcinoma in multiple timepoints and its 3.0T MRI findings

    Institute of Scientific and Technical Information of China (English)

    潘璜; 邵成伟; 田建明

    2012-01-01

    Objective To establish nude mouse tumor models bearing human pancreatic adenocarcinoma SW1990 cells in multiple sites at different time-points and investigate the feasibiilty of multiple tumor-bearing in these models; then the findings and detection rate of 3.0T magnetic resonance image (MRI) in subcutaneous transplanted tumors was analyzed. Methods A total of 6 BALB/C nude mice were randomized into 3 groups (2 mice per group ).At the 1st,8th,15th day,the mice were injected subcutaneously with the suspension of SW1990 cells at left axilla and right axilla and right groin in sequence.Three weeks later,all the bearing-tumor mice were performed with MRI non-contrast enhanced scanning plus Gd-DTPA enhanced scan and the subcutaneous masses were subjected to pathological analysis.Results All the 6 nude mice were alive during the study and obvious mass was observed in every injected site.The tumor size was positively associated with the grwing time.There were 9 tumors which could be de.ted by noncontrast enhanced MRI scanning and one more tumor was detected by contrast enhanced scanning.2 tumors were not detected,the 2 tumors were located at subcutaneous of right groin,with the shortest growing time,and the major axis of the 2 un-detected tumors was less than 5mm.Despite the MRI findings of the transplanted masses similar to that of human pancreatic adenocarcinoma with bleeding,necrosis,they presented the characteristics of a clear rim,with "pseudocapeule" sign.All the 12 masses were similar with human pancreatic adenocarcinoma under light microscope.Conclusions It is feasible to transplant human pancreatic adenocarcinoma cell at three different subcutaneous sites (injected at three different points of time) in the nude mouse,with a minimal survival time of three weeks.However,routine 3.0T MRI cannot detect the early tumors (growing time within 1 week,major axis <5 mm).%目的 研究裸鼠荷载多时间节点人胰腺癌细胞的能力,分析其MRI表现及

  20. Subcutaneous pruning versus subcutaneous liposuction in treatments of axillary osmidrosis:a Meta-analysis%皮下修剪术与抽吸术治疗腋臭临床疗效的Meta分析

    Institute of Scientific and Technical Information of China (English)

    陆思锭; 殷国前; 潘新元; 彭鎏; 唐胜华; 陈子翔; 朱江英

    2015-01-01

    目的:对皮下修剪术与皮下抽吸术两种手术方法治疗腋臭的临床疗效进行系统评价。方法:应用计算机检索相关文献数据库,收集国内外报道有关皮下修剪、抽吸两种手术方法治疗腋臭的临床随机对照试验,评价纳入研究的方法学质量并进行资料提取后,采用RevMan 5.0软件进行Meta分析。结果:最终共纳入7个中文随机对照研究,共557个研究对象,修剪组292(47侧+245例),抽吸组265(50侧+215例),Meta分析结果显示皮下修剪术治愈率(OR=4.32,P=0.02)、总有效率(OR=3.76,<0.0001)较抽吸术高,复发率比抽吸术低(OR=0.23,=0.0009);而皮下抽吸术并发症较修剪术低(OR=6.65,<0.00001);手术时间及出血量抽吸术均较修剪术少(<0.05)。结论:现有数据Meta分析结果表明皮下修剪术较皮下抽吸术治疗腋臭具有治愈率、复发率低优势,而皮下抽吸术较皮下修剪术有其并发症低、手术时间短、术中出血少的优点。由于文献质量普遍不高,纳入样本量偏少,今后,尚需进一步开展设计良好、方法学质量更高的临床随机对照试验。%Objective To systemically analyze the different clinical efficacy of axillary osmidrosis between subcutaneous pruning and liposuction. Methods The relevant database were searched to collect all the randomized controlled trials (RCT) that compared the domestic different clinical efficacy of axillary osmidrosis between subcutaneous pruning and subcutaneous liposuction according to the principles of systematic review. The quality of the included studies was evaluated and Meta- analysis were performed using RevMan5.0 software. Results Seven RCT which included 557 patients were enrolled in our study. Two hundren and ninety two cases (47axillae and 245patients)were included in subcutaneous pruning group,while 265 cases (50axillae and 215patients) were included in subcutaneous