WorldWideScience

Sample records for axilla

  1. The design principles of axilla deodorant fragrances.

    Science.gov (United States)

    McGee, T; Rankin, K M; Baydar, A

    1998-11-30

    There are a number of ways that deodorant products control malodor: a) by suppressing sweat, b) by inhibiting bacterial activity, and c) by covering malodor. The paper focuses on the Givaudan Roure methodology used to develop fragrances that effectively cover malodor. Several steps are involved in the development of a successful deodorant fragrance. First, we test for substantivity of the deodorant fragrance material in the axilla, using odor value technology. Second, using an in vitro test with reconstituted axilla odor, we determine the effectiveness of the substantive fragrance material with carefully screened panelists. Third, using a multichannel olfactive blender, the perfumer creates a fragrance heart with effective deodorant fragrance materials that cover malodor in the vapor phase. Finally, the hedonically pleasing heart is used to create the final fragrance, which is then optimized using our in vitro test method.

  2. Postirradiation sarcoma (malignant fibrous histiocytoma) of axilla

    International Nuclear Information System (INIS)

    Hardy, T.J.; An, T.; Brown, P.W.; Terz, J.J.

    1978-01-01

    A case is reported of a patient who developed a histologically unusual sarcoma in the axilla and chest wall 8 years after receiving radiation therapy (6500 rad) for carcinoma of the breast. This sarcoma showed light- and electron-microscopic features of a malignant fibrous histiocytoma, a tumor not documented among 24 previously reported cases of postirradiation sarcoma following the diagnosis of breast carcinoma. In addition, the literature is reviewed and discussed regarding postirradiation sarcoma in general following breast carcinoma

  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. Fibroadenoma in axilla: another manifestation of ectopic breast.

    Science.gov (United States)

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

    2015-04-26

    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. 2015 BMJ Publishing Group Ltd.

  5. 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.

  6. Time trends in axilla management among early breast cancer patients

    DEFF Research Database (Denmark)

    Gondos, Adam; Jansen, Lina; Heil, Joerg

    2016-01-01

    for a comparative study of axillary management trends among patients with first non-metastatic breast cancer who were not selected for neoadjuvant therapy during the last decade. We used an additional short questionnaire to compare clinical care patterns in 2014. Results Patients treated in cancer centers were......Background We examined time trends in axilla management among patients with early breast cancer in European clinical settings. Material and methods EUROCANPlatform partners, including population-based and cancer center-specific registries, provided routinely available clinical cancer registry data...

  7. A rare cutaneous tumor of the axilla: Apocrine adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Karaca Semsettin

    2007-01-01

    Full Text Available Sweat gland neoplasms are rare with approximately 200 cases of eccrine sweat gland and less than 50 cases of apocrine gland carcinoma being reported in the worldwide literature. More than half of the reported cases with apocrine adenocarcinoma had lymph node metastases at the time of diagnosis. We report a case of a 56-year-old man, presented with a left axillary slow-growing seven year old painless nodule. Histopathological examination revealed an invasive apocrine adenocarcinoma with lymph node metastases. The patient successfully treated with total excision and radiotherapy. Apocrine adenocarcinoma is a rare malignancy with high metastatic potential that occurs mostly in the axilla. Physicians should be aware of this entity while differentiating cutaneous tumor located on the axillary region.

  8. Decreased Defibrillation Threshold and Minimized Myocardial Damage With Left Axilla Implantable Cardioverter Defibrillator Implantation.

    Science.gov (United States)

    Noro, Mahito; Zhu, Xin; Enomoto, Yoshinari; Oikawa, Yasuhiro; Tatsunami, Hiroyuki; Ishii, Rina; Toyoda, Yasutake; Asami, Masako; Sahara, Naohiko; Takagi, Takahito; Narabayashi, Yuriko; Hashimoto, Hikari; Ito, Naoshi; Kujime, Shingo; Sakai, Tsuyoshi; Nakamura, Keijirou; Sakata, Takao; Abe, Haruhiko; Sugi, Kaoru

    2016-01-01

    To reduce myocardial damage caused by implantable cardioverter defibrillator (ICD) shock, the left axilla was studied as an alternative pulse generator implantation site, and compared with the traditional implantation site, the left anterior chest. Computer simulation was used to study the defibrillation conduction pattern and estimate the simulated defibrillation threshold (DFT) and myocardial damage when pulse generators were placed in the left axilla and left anterior chest, respectively; pulse generators were also newly implanted in the left axilla (n=30) and anterior chest (n=40) to compare the corresponding DFT. On simulation, when ICD generators were implanted in the left axilla, compared with the left anterior chest, the whole heart may be defibrillated with a lower defibrillation energy (left axilla 6.4 J vs. left anterior chest 12.0 J) and thus the proportion of cardiac myocardial damage may be reduced (2.1 vs. 4.2%). Clinically, ventricular fibrillation was successfully terminated with a defibrillation output ≤5 J in 86.7% (26/30) of the left axillary group, and in 27.5% (11/40) of the left anterior group (P<0.001). Clinically and theoretically, the left axilla was shown to be an improved ICD implantation site that may reduce DFT and lessen myocardial damage due to shock. Lower DFT also facilitates less myocardial damage, as a result of the lower shock required.

  9. In vivo study of the surgical anatomy of the axilla.

    Science.gov (United States)

    Khan, A; Chakravorty, A; Gui, G P H

    2012-06-01

    Classical anatomical descriptions fail to describe variants often observed in the axilla as they are based on studies that looked at individual structures in isolation or textbooks of cadaveric dissections. The presence of variant anatomy heightens the risk of iatrogenic injury. The aim of this study was to document the nature and frequency of these anatomical variations based on in vivo peroperative surgical observations. Detailed anatomical relationships were documented prospectively during consecutive axillary dissections. Relationships between the thoracodorsal pedicle, course of the lateral thoracic vein, presence of latissimus dorsi muscle slips, variations in axillary and angular vein anatomy, and origins and branching of the intercostobrachial nerve were recorded. Among a total of 73 axillary dissections, 43 (59 per cent) revealed at least one anatomical variant. Most notable variants included aberrant courses of the thoracodorsal nerve in ten patients (14 per cent)--three variants; lateral thoracic vein in 12 patients (16 per cent)--four variants; bifid axillary veins in ten patients (14 per cent); latissimus dorsi muscle slips in four patients (5 per cent); and variants in intercostobrachial nerve origins and branching in 26 patients (36 per cent). The angular vein, a subscapular vein tributary, was found to be a constant axillary structure. Variations in axillary anatomical structures are common. Poor understanding of these variants can affect the adequacy of oncological clearance, lead to vascular injury, compromise planned microvascular procedures and result in chronic pain or numbness from nerve injury. Surgeons should be aware of the common anatomical variants to facilitate efficient and safe axillary surgery. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  10. Microbial pathways leading to steroidal malodour in the axilla.

    Science.gov (United States)

    Austin, C; Ellis, J

    2003-10-01

    Odorous steroids, specifically the 16-androstenes, 5alpha-androstenol and 5alpha-androstenone, are widely accepted as being contributors to underarm odour, but the precursors and pathways to these odorous steroids were unclear. This study demonstrated that the axillary microflora could only generate odorous 16-androstenes from precursors that already contain the C16 double bond, such as 5,16-androstadien-3-ol and 4,16-androstadien-3-one. In incubations containing 5,16-androstadien-3-ol, mixed populations of Corynebacterium spp., isolated from the axilla, could generate many different 16-androstene metabolites, several of which were odorous. Isolation of individual Corynebacterium strains, followed by pure culture incubations with 5,16-androstadien-3-ol, revealed organisms capable of efficient, rapid reactions. However, no single isolate could carry out a full complement of the observed biotransformations. 16-Androstene metabolites were identified by gas chromatography-mass spectrometry (GC-MS), either by comparison with known standards, or by prediction from molecular ion and fragmentation patterns. Based on detection of these metabolites, a metabolic map for axillary corynebacterial 16-androstene biotransformations was proposed, detailing potential enzyme activities. In summary, the formerly implicated 4,16-androstadien-3-one, 5alpha-androstenone and 5alpha-androstenol were detected, along with previously unreported hydroxy- and keto-substituted 16-androstenes, 16-androstatrienones and 16-androstatrienols. Additionally, many other metabolites with steroidal fragmentation patterns were present, but have remained unidentified.A key observation was that very low prevalences of microorganisms capable of biotransforming 16-androstenes were present on skin. For example, from a panel of 21 individuals, only 4 of 18 mixed populations of corynebacteria, and only 4 of 45 Corynebacterium isolates, could biotransform 5,16-androstadien-3-ol. This study has increased

  11. Fibroadenoma of ectopic breast tissue of the axilla in an adolescent ...

    African Journals Online (AJOL)

    Ectopic breast tissue (EBT) is a well-described entity in the English literature. However, fibroadenoma of the ectopic breast is a rare entity. We present a case of a 13-year-old adolescent girl with a subcutaneous mass in the right axilla that was pathologically identical to fibroadenoma seen in the EBT. To our knowledge, this ...

  12. Fibroadenoma of ectopic breast tissue of the axilla in an adolescent ...

    African Journals Online (AJOL)

    Ectopic breast tissue (EBT) is a well-described entity in the. English literature. However, fibroadenoma of the ectopic breast is a rare entity. We present a case of a 13-year-old adolescent girl with a subcutaneous mass in the right axilla that was pathologically identical to fibroadenoma seen in the EBT. To our knowledge, this ...

  13. [Anatomic-surgical study of intercostobrachial nerve (ICBN) course in axilla during I. and II. level of axilla clearance in breast cancer and malignant melanoma].

    Science.gov (United States)

    Kubala, O; Prokop, J; Jelínek, P; Ostruszka, P; Tošenovský, J; Ihnát, P; Zonča, P

    2013-06-01

    The aim of this paper is to offer results of anatomic study of axillary course of intercostobrachial nerve (ICBN) and the effort of its saving in primary axilla clearance (PE), secondary clearance (SE) after previous positive sentinel nodes detection (SLN) and in re-clearance (RE) after previous axilla clearance in breast cancer and malignant melanoma. The correlation between possibility of ICBN saving and anatomic variant of ICBN and type of previous surgery was observed. A total of 113 surgeries with the effort of description and preservation of ICBN were done between September 2007 and August 2011. Patients were divided into three groups according to type of surgery: primary clearance (PE), secondary clearance (SE) and re-clearance (RE). Results have been statistically tested using licensed statistical software Statgraphics. ICBN was found in 107 patients (94.7%), it wasnt found in six cases. There were eight different types of ICBN branching. Two most frequent variants formed majority of cases - 87 out of 107 (81.3%). The successful preservation of intact ICBN was in 86 patients (76.1%). ICBN was interrupted or not found in 10 patients (8.8%), partial injury of ICBN branches was detected in 17 cases (15.0%). If the most frequent variant of ICBN branching was present, the nerve was not injured in 42 out of 45 cases (93.3%). Statistical testing showed that non-standard anatomical branches are associated with higher risk of perioperative injury. The risk of injury was lowest in PE (21.6%) and the highest in RE (42.9%). The difference wasnt statistically significant because of low number of re-clearance cases in our study. The anatomy of ICBN in axilla is variable. The standard variant of ICBN course is the most frequent (the trunk coming out of second intercostal space; no branches in axillary course). If other variants are present, there is significantly higher risk of perioperative injury. ICBN preservation is possible also after previous axilla clearance

  14. Defining the minimum anatomical coverage required to protect the axilla and arm against penetrating ballistic projectiles.

    Science.gov (United States)

    Breeze, Johno; Fryer, R; Lewis, E A; Clasper, J

    2016-08-01

    Defining the minimum anatomical structural coverage required to protect from ballistic threats is necessary to enable objective comparisons between body armour designs. Current protection for the axilla and arm is in the form of brassards, but no evidence exists to justify the coverage that should be provided by them. A systematic review was undertaken to ascertain which anatomical components within the arm or axilla would be highly likely to lead to either death within 60 min or would cause significant long-term morbidity. Haemorrhage from vascular damage to the axillary or brachial vessels was demonstrated to be the principal cause of mortality from arm trauma on combat operations. Peripheral nerve injuries are the primary cause of long-term morbidity and functional disability following upper extremity arterial trauma. Haemorrhage is managed through direct pressure and the application of a tourniquet. It is therefore recommended that the minimum coverage should be the most proximal extent to which a tourniquet can be applied. Superimposition of OSPREY brassards over these identified anatomical structures demonstrates that current coverage provided by the brassards could potentially be reduced. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. 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.

  16. The strategy of therapy of the axilla in early cancer. Surgery or radiotherapy

    International Nuclear Information System (INIS)

    Izuo, Masaru

    1998-01-01

    The therapy of the axillary lymph node in early breast cancer was assessed perspectively. Recently, axillary irradiation was carried out and compared with surgery. Radiotherapy was not evaluated more successful. To carry out in accordance with the present guide line, so called ''modern technique'' or ''modern dosage schedule'', radiotherapy of the axilla is effective as well as surgery. We have many agreements that the rate of incidence of complication associated with irradiation was decreased in accordance with ''modern technique''. It is reasonable to radiate additionally after the selection by the ''node sampling'' in the sense of decreasing unnecessary irradiation. But it is not sufficient in their reliability, it is hard to expect this method getting more popular than now. We cannot find any difference in the effect of the treatment itself between present dissection and radiotherapy. However we have many agreements that axillary dissection may give the information about n-stage, and the contribution to the suitable selection to the prognosis factor and adjuvant chemotherapy was not so less even in early cancer. Some early cancers (non-invasive carcinoma or micro carcinoma) will not need the axillary therapy. It is one of the options ''to combine mastectomy under local anesthesia and radiotherapy'' in close cooperation with the skilled radiologist. (K.H.) 120 refs

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

    International Nuclear Information System (INIS)

    Pinkham, Mark B.; Foote, Matthew C.; Burmeister, Elizabeth; Thomas, Janine; Meakin, Janelle; Smithers, B. Mark; Burmeister, Bryan H.

    2013-01-01

    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

  18. 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.

  19. Curcuma aeruginosa Roxb. essential oil slows hair-growth and lightens skin in axillae; a randomised, double blinded trial.

    Science.gov (United States)

    Srivilai, Jukkarin; Phimnuan, Preeyawass; Jaisabai, Jiraporn; Luangtoomma, Nantakarn; Waranuch, Neti; Khorana, Nantaka; Wisuitiprot, Wudtichai; Scholfield, C Norman; Champachaisri, Katechan; Ingkaninan, Kornkanok

    2017-02-15

    Androgenic hair-growth contributes to secondary gender characteristics but can be troublesome in women. Inhibiting axillary hair-growth via 5-α-reductases using the Thai medicinal plant, Curcuma aeruginosa Roxb. is an attractive treatment strategy. C. aeruginosa essential oil (CA-oil) formulated as a lotion is an efficacious and safe inhibitor of axillary hair growth. This trial was a single center, randomized, double-blind, placebo controlled 10 weeks, intervention in 60 women (18-23 years) and 2 weeks washout with axillary hair length was the primary end-point. Bioactive-enriched essential oil of C. aeruginosa was formulated with a base lotion. All participants were pre-challenged with lotions by 4-h patch irritation tests to exclude skin reactions. Participants were randomly allocated to use either 1 or 5%w/w CA-oil lotion on one axilla and base-lotion (placebo) to the other for 10 weeks followed by placebo in both axillae for 2 weeks. Every week, the axillae were photographed to measure hair lengths, shaved, and roll-on applicators containing appropriate lotion replaced. Also, skin melanin by spectrophotometry and hair density were measured. From weeks 5-11 of trial, 1 and 5%w/w CA-oil retarded growth by 13 ± 1.5% and 16 ± 0.9% respectively, while placebo was ineffective. CA-oil had no influence on hair density. Both concentrations of CA-oil rapidly and equally effectively brightened skin within 3 weeks which persisted 2 weeks after treatment ceased while placebo darkened the skin. Adherence appeared good as judged by consistency of lotion consumption and between axillae. Participants were satisfied with the treatment and reported reduced hairiness, freedom from any discomforts, but product odour attracted some negative comment. No adverse reactions ascribed to CA-oil were detected or reported. This study points to a safe and efficacious dual action on retarding hair-growth and skin lightening by CA-oil. Copyright © 2016 Elsevier GmbH. All rights

  20. Towards optimal management of the axilla in the context of a positive sentinel node biopsy in early breast cancer.

    Science.gov (United States)

    Wazir, Umar; Manson, Aisling; Mokbel, Kefah

    2014-12-10

    The sentinel lymph node biopsy (SLNB) was initially pioneered for staging melanoma in 1994 and it has been subsequently validated by several trials, and has become the new standard of care for patients with clinically node negative invasive breast cancer. The focussed examination of fewer lymph nodes in addition to improvements in histopathological and molecular analysis has increased the rate at which micrometastases and isolated tumour cells are identified. In this article we review the literature regarding the optimal management of the axilla when the SLNB is positive for metastatic disease based on level 1 evidence derived from randomised clinical trials.

  1. Dosimetric comparison of axilla and groin radiotherapy techniques for high-risk and locally advanced skin cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mattes, Malcolm D.; Zhou, Ying; Berry, Sean L.; Barker, Christopher A. [Memorial Sloan Kettering Cancer Center, New York (United States)

    2016-06-15

    Radiation therapy targeting axilla and groin lymph nodes improves regional disease control in locally advanced and high-risk skin cancers. However, trials generally used conventional two-dimensional radiotherapy (2D-RT), contributing towards relatively high rates of side effects from treatment. The goal of this study is to determine if three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or volumetric-modulated arc therapy (VMAT) may improve radiation delivery to the target while avoiding organs at risk in the clinical context of skin cancer regional nodal irradiation. Twenty patients with locally advanced/high-risk skin cancers underwent computed tomography simulation. The relevant axilla or groin planning target volumes and organs at risk were delineated using standard definitions. Paired t-tests were used to compare the mean values of several dose-volumetric parameters for each of the 4 techniques. In the axilla, the largest improvement for 3D-CRT compared to 2D-RT was for homogeneity index (13.9 vs. 54.3), at the expense of higher lung V{sub 20} (28.0% vs. 12.6%). In the groin, the largest improvements for 3D-CRT compared to 2D-RT were for anorectum D{sub max} (13.6 vs. 38.9 Gy), bowel D{sub 200cc} (7.3 vs. 23.1 Gy), femur D{sub 50} (34.6 vs. 57.2 Gy), and genitalia D{sub max} (37.6 vs. 51.1 Gy). IMRT had further improvements compared to 3D-CRT for humerus D{sub mean} (16.9 vs. 22.4 Gy), brachial plexus D{sub 5} (57.4 vs. 61.3 Gy), bladder D{sub 5} (26.8 vs. 36.5 Gy), and femur D{sub 50} (18.7 vs. 34.6 Gy). Fewer differences were observed between IMRT and VMAT. Compared to 2D-RT and 3D-CRT, IMRT and VMAT had dosimetric advantages in the treatment of nodal regions of skin cancer patients.

  2. Posterior axilla sling traction for shoulder dystocia: case review and a new method of shoulder rotation with the sling.

    Science.gov (United States)

    Cluver, Catherine Anne; Hofmeyr, G Justus

    2015-06-01

    The purpose of this study was to report on all cases in which posterior axilla sling traction (PAST) has been used to deliver cases of intractable shoulder dystocia and to describe a new method of shoulder rotation with the sling. A record of all published and known cases was collected that included information on preliminary obstetric techniques that were used and how the PAST technique was performed. Maternal outcomes that included maternal injury and length of hospital stay and fetal outcomes, which included birthweight, Apgar scores, nerve injuries, fractures, hospital stay, and outcome, were documented. We have recorded 19 cases where PAST has been used. In 5 cases, the babies had died in utero. Ten were assisted deliveries. PAST was successful in 18 cases. In one case, it was partially successful because it enabled delivery of the posterior shoulder with digital axillary traction. The most commonly used material was suction tubing. Once the posterior shoulder was delivered, the shoulder dystocia was resolved in all cases. Time from insertion to delivery was shoulder was difficult because of very severe impaction, the sling could be used to rotate the shoulders easily through 180 degrees assisted by counter pressure on the back of the anterior shoulder. This new method was used in 5 cases and may reduce fetal trauma further during difficult shoulder delivery. This review confirms that PAST can be a lifesaving technique when all another techniques for shoulder dystocia fail. Advantages are that it is easy to use (even by someone who has not seen it used previously), that the sling material is readily available, and that it is inserted quickly with 2 fingers. This is the first report of its use to rotate the posterior shoulder to the anterior position for delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. A stab wound to the axilla illustrating the importance of brachial plexus anatomy in an emergency context: a case report.

    Science.gov (United States)

    Casal, Diogo; Cunha, Teresa; Pais, Diogo; Iria, Inês; Angélica-Almeida, Maria; Millan, Gerardo; Videira-Castro, José; Goyri-O'Neill, João

    2017-01-04

    Although open injuries involving the brachial plexus are relatively uncommon, they can lead to permanent disability and even be life threatening if accompanied by vascular damage. We present a case report of a brachial plexus injury in which the urgency of the situation precluded the use of any ancillary diagnostic examinations and forced a rapid clinical assessment. We report a case of a Portuguese man who had a stabbing injury at the base of his left axilla. On observation in our emergency room an acute venous type of bleeding was present at the wound site and, as a result of refractory hypotension after initial management with fluids administered intravenously, he was immediately carried to our operating room. During the course of transportation, we observed that he presented hypoesthesia of the medial aspect of his arm and forearm, as well as of the ulnar side of his hand and of the palmar aspect of the last three digits and of the dorsal aspect of the last two digits. Moreover, he was not able to actively flex the joints of his middle, ring, and small fingers or to adduct or abduct all fingers. Exclusively relying on our anatomical knowledge of the axillary region, the site of the stabbing wound, and the physical neurologic examination, we were able to unequivocally pinpoint the place of the injury between the anterior division of the lower trunk of his brachial plexus and the proximal portion of the following nerves: ulnar, medial cutaneous of his arm and forearm, and the medial aspect of his median nerve. Surgery revealed a longitudinal laceration of the posterior aspect of his axillary vein, and confirmed a complete section of his ulnar nerve, his medial brachial and antebrachial cutaneous nerves, and an incomplete section of the ulnar aspect of his median nerve. All structures were repaired microsurgically. Three years after the surgery he showed a good functional outcome. We believe that this case report illustrates the relevance of a sound anatomical

  4. Effect of deodorant and antiperspirant use and presence or absence of axillary hair on absorption of testosterone 2% solution applied to men's axillae.

    Science.gov (United States)

    Small, David S; Ni, Xiao; Polzer, Paula; Vart, Richard; Satonin, Darlene K; Mitchell, Malcolm I

    2014-11-01

    Testosterone 2% solution is applied to axillae and is indicated for testosterone replacement therapy in males deficient in endogenous testosterone. This open-label crossover study evaluated the effect of deodorant/antiperspirant use and presence or absence of axillary hair on absorption of testosterone solution. Healthy males (N = 30; ≥50 years of age with baseline testosterone deodorant/antiperspirant. Blood samples were taken over 72 hours after each dose for measuring serum testosterone concentrations. Profiles of mean testosterone concentrations were similar across treatments. For all treatments, area under the concentration-time curve through 24 hours (AUC[0-24] ) and 72 hours (AUC[0-72] ), and maximum total testosterone concentration (Cmax ) were similar except for 15% lower Cmax when treatment was applied after deodorant/antiperspirant to shaved vs. unshaved axillae (least squares mean, 531 ng/dL vs. 626 ng/dL, respectively; P = 0.011). This difference is not considered clinically significant. The 95% confidence intervals for AUC(0-24) , AUC(0-72) , and Cmax fell within the traditional bioequivalence limits of 0.8 to 1.25. Incidence of treatment-emergent adverse events (TEAEs) was low (deodorant/antiperspirant or by the presence or absence of axillary hair. Testosterone solution was generally well tolerated. © 2014 International Society for Sexual Medicine.

  5. 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...

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

    International Nuclear Information System (INIS)

    Damascelli, Bruno; Ticha, Vladimira

    2011-01-01

    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.

  7. High Ki67 predicts unfavourable outcomes in early breast cancer patients with a clinically clear axilla who do not receive axillary dissection or axillary radiotherapy.

    Science.gov (United States)

    Zurrida, S; Bagnardi, V; Curigliano, G; Mastropasqua, M G; Orecchia, R; Disalvatore, D; Greco, M; Cataliotti, L; D'Aiuto, G; Talakhadze, N; Goldhirsch, A; Viale, G

    2013-10-01

    Axillary dissection is increasingly forgone in early breast cancer patients with a clinically negative axilla. The GRISO 053 randomised trial recruited 435 patients of age over 45 years, tumour ≤1.4 cm and clinically negative axilla, to assess the importance of axillary radiotherapy versus no axillary radiotherapy in patients not given axillary dissection. In the present study on a subgroup GRISO cases our aim was to assess the prognostic importance of tumour biological factors after more than 10 years of follow-up. We retrospectively assessed biological factors in a subgroup of 285 GRISO cases (145 given axillary radiotherapy; 140 not given axillary radiotherapy) with complete biologic, therapeutic and follow-up information, using multivariable Cox proportional hazards regression modelling. Only 10-year cumulative incidence of distant metastasis was lower in the axillary radiotherapy (1%) than no axillary radiotherapy arm (7%) (p=0.037). Irrespective of study arm, hormone receptor positivity had significantly favourable effects on 10-year disease-free survival (DFS) and overall survival. human epidermal growth factor receptor 2 (HER2)-positive and triple-negative subtypes were associated with lower 10-year DFS (60% and 76%, respectively) than luminal A (96%) and B (91%) (p=0.001). Ten-year DFS for high (≥14%) Ki67 cancers was lower than for low Ki67 cancers (p=0.027); however, this effect was mainly confined to the no axillary radiotherapy arm. For patients with clinically node-negative small breast cancer not given axillary dissection, 10-year DFS is worsened by HER2 positivity, triple-negative phenotype and high Ki67. Axillary radiotherapy counteracts the negative prognostic effect of high Ki67 in patients not receiving axillary dissection. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Preoperative ultrasound staging of the axilla make's peroperative examination of the sentinel node redundant in breast cancer: saving tissue, time and money.

    Science.gov (United States)

    Van Berckelaer, Christophe; Huizing, Manon; Van Goethem, Mireille; Vervaecke, Andrew; Papadimitriou, Konstantinos; Verslegers, Inge; Trinh, Bich X; Van Dam, Peter; Altintas, Sevilay; Van den Wyngaert, Tim; Huyghe, Ivan; Siozopoulou, Vasiliki; Tjalma, Wiebren A A

    2016-11-01

    To evaluate the role of preoperative axillary staging with ultrasound (US) and fine needle aspiration cytology (FNAC). Can we avoid intraoperative sentinel lymph node (SLN) examination, with an acceptable revision rate by preoperative staging? This study is based on the retrospective data of 336 patients that underwent US evaluation of the axilla as part of their staging. A FNAC biopsy was performed when abnormal lymph nodes were visualized. Patients with normal appearing nodes on US or a benign diagnostic biopsy had removal of the SLNs without intraoperative pathological examination. We calculated the sensitivity, specificity and accuracy of US/FNAC in predicting the necessity of an axillary lymphadenectomy. Subsequently we looked at the total cost and the operating time of 3 models. Model A is our study protocol. Model B is a theoretical protocol based on the findings of the Z0011 trial with only clinical preoperative staging and in Model C preoperative staging and intraoperative pathological examination were both theoretically done. sentinel node, staging, ultrasound, preoperative axillary staging, FNAC, axilla RESULTS: The sensitivity, specificity and accuracy are respectively 0.75 (0.66-0.82), 1.00 (0.99-1.00) and 0.92 (0.88-0.94). Only 26 out of 317 (8.2%) patients that successfully underwent staging needed a revision. The total cost of Model A was 1.58% cheaper than Model C and resulted in a decrease in operation time by 9,46%. The benefits compared with Model B were much smaller. Preoperative US/FNAC staging of the axillary lymph nodes can avoid intraoperative examination of the sentinel node with an acceptable revision rate. It saves tissue, reduces operating time and decreases healthcare costs in general. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. 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.

    Science.gov (United States)

    Cohen, Philip R

    2014-08-17

    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. 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. Pubmed was used to search the following terms: axillary basal cell carcinoma and basal cell nevus syndrome. The papers and their citations were evaluated. Basal cell nevus syndrome patients with basal cell carcinoma of the axilla were observed in two women; this represents 2.5% (2 of 79) of the patients with axillary basal cell carcinoma. Both women had pigmented tumors that were histologically nonaggressive. The cancers did not recur after curettage or excision. Basal cell carcinoma of the axilla has only been described in 79 individuals; two of the patients were women with pigmented tumors who had basal cell nevus syndrome. Similar to other patients with axillary basal cell carcinoma, the tumors were histologically nonaggressive and did not recur following treatment. Whether PTCH1 gene mutation predisposes basal cell nevus patients to develop axillary basal cell carcinomas remains to be determined.

  10. Cytological features of malignant eccrine acrospiroma presenting as a soft tissue mass axilla: A rare sweat gland tumor with histologic correlation.

    Science.gov (United States)

    Pandey, Pinki; Dixit, Alok; Chandra, Subrat; Tanwar, Aparna

    2015-01-01

    Malignant eccrine acrospiroma is an infrequent, highly malignant primary skin tumor derived from eccrine sweat glands. Though fine-needle aspiration cytology (FNAC) is a well-established diagnostic tool, but if a skin adnexal tumor or primary skin lesion is suspected clinically, the usual approach is biopsy due to easy accessibility. Being itself rare, cytologic features of this lesion is hardly encountered in case reports. As a result, very little is known about the appearance of adnexal tumors like malignant eccrine acrospiroma on fine-needle aspiration samples. A 50-year-old man presented with swelling in the left axilla, clinically suspected to be a soft tissue sarcoma. Fine-needle aspiration was advised, and a cytological diagnosis of malignant eccrine acrospiroma was rendered which was later confirmed on histological examination. Rapid, accurate diagnosis of these tumors is imperative as they have very poor prognosis and an aggressive course with recurrence and/or metastasis. FNAC plays a decisive and easy diagnostic modality in these unusual, rare cases of highly malignant primary skin tumor, and awareness of the lesions is indispensable in their management.

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

    International Nuclear Information System (INIS)

    Ruano, R.; Garcia-Talavera, J.R.; Arriba, A. de; Ramos, M.; Gonzalez-Orus, J.; Iglesias, M.; Serrano, E.; Macias, M.C.

    2008-01-01

    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 ( 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.)

  12. 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

  13. 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

  14. 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.

  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

    2012-01-01

    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.

  16. 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.

  17. 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)

    Watson, Linda C.; Gies, Donna; Thompson, Emmanuel; Thomas, Bejoy

    2012-01-01

    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 using

  18. 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

  19. Management of axilla in breast cancer - The saga continues.

    Science.gov (United States)

    Layeequr Rahman, Rakhshanda; Crawford, Sybil L; Siwawa, Portia

    2015-08-01

    Prospective trials investigating the accuracy of SLNB for cN0 (primary surgical therapy) and cN1 patients (neoadjuvant chemotherapy) have not utilized likelihood ratios (LR) to assess the impact of false negative SLNB. This review evaluates the evidence on accuracy of SLNB using STARD and QUADAS-2 (revised) criteria for patients undergoing primary surgical therapy and primary chemotherapy. It utilizes the: (i) Reported rates for pre-test probabilities of node positive disease from Surveillance, Epidemiology, and End Results (SEER) database for the cN0 patients (primary surgical therapy) for each T stage; calculates the negative LR from cumulative evidence; and uses the Bayesian nomogram to compute the post-test probability of missing the metastatic axillary node based on negative SLNB. (ii) Reported rates of complete axillary response in ACOSOG-Z1071 trial for cN1 patients to calculate the pre-test probabilities of residual nodal disease for each biological tumor sub-type; calculates the negative LR from ACOSOG-Z1071, and SENTINA trial data; and uses the Bayesian nomogram to compute the post-test probability of missing the residual metastatic axillary node based on negative SLNB. For cN0 disease, the odds of missing axillary disease based on negative SLNB for each T stage are: T1a = 0.7%; T1b = 1.5%; T1c = 3%; T2 = 7%; T3 = 18%. For cN1 disease, the odds of missing residual axillary disease based on negative SLNB for each biological subtype are: HER2neu+ = 8%; Triple negative = 15%; ER+/PR+/HER2neu- = 45%. Negative LR is more accurate and superior to false negative rate for determining the clinical utility of SLNB by taking into account the changing pre-test probability of disease. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Eight-year follow up result of the OTOASOR trial: The Optimal Treatment Of the Axilla - Surgery Or Radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: A randomized, single centre, phase III, non-inferiority trial.

    Science.gov (United States)

    Sávolt, Á; Péley, G; Polgár, C; Udvarhelyi, N; Rubovszky, G; Kovács, E; Győrffy, B; Kásler, M; Mátrai, Z

    2017-04-01

    The National Institute of Oncology, Budapest conducted a single centre randomized clinical study. The OTOASOR (Optimal Treatment Of the Axilla - Surgery Or Radiotherapy) trial compares completion of axillary lymph node dissection (cALND) to regional nodal irradiation (RNI) in patients with sentinel lymph node metastasis (pN1sn) in stage I-II breast cancer. Patients with primary invasive breast cancer (cN0 and cT ≤ 3 cm) were randomized before surgery for cALND (standard treatment) or RNI (investigational treatment). Sentinel lymph nodes (SN) were investigated with serial sectioning at 0.5 mm levels by hematoxylin-eosin staining. Investigational treatment arm patients received 50 Gy RNI instead of cALND. Adjuvant treatment and follow up were performed according to the actual guidelines. Between August 2002 and June 2009, 1054 patients were randomized for cALND and 1052 patients for RNI. SN was evaluated in 2073 patients and was positive in 526 patients (25.4%). 474 cases were evaluable (244 in the cALND and 230 in the RNI arm), and in the cALND group 94 of 244 patients (38.5%) who underwent completion axillary surgery has additional positive nodes. The two arms were well balanced according to the majority of main prognostic factors. Primary endpoint was axillary recurrence and secondary endpoints were overall survival (OS) and disease-free survival (DFS). Mean follow-up was 97 months (Q1-Q3: 80-120). Axillary recurrence was 2.0% in cALND arm vs. 1.7% in RNI arm (p = 1.00). OS at 8 years was 77.9% vs. 84.8% (p = 0.060), and DFS was 72.1% in cALND arm and 77.4% after RNI (p = 0.51). The results show that RNI is statistically not inferior to cALND treatment. The long term follow-up results of this prospective-randomized trial suggest that RNI without cALND does not increase the risk of axillary failure in selected patients with early-stage invasive breast cancer (cT ≤ 3 cm, cN0) and pN1(sn). Axillary radiotherapy should be an alternative treatment for

  1. Histolopathologic approach to direct the management of the axilla in early breast cancer patients.

    Science.gov (United States)

    Farid, Rola M; Ahmed, Naglaa S

    2014-10-01

    Screening mammography improved early detection of breast cancer and since then, the percentage of patients with node involvement is declining. Sentinel lymph node biopsy (SLNB), although helpful in the diagnostic armamentarium of these patients, has consequential limitations. In these patients, moreover, lymphatic invasion (LI) is of utmost importance to determine the risk of local recurrence. To find an adjuvant histologic approach to assist in pre-operative analysis of the patient's risk for having LI and thus sentinel ± non-sentinel axillary lymph node metastasis, one hundred and twenty patients with early invasive duct carcinoma without axillary lymph node metastasis were evaluated. Logistic regression predictive models were built from 80 patients and validated in the remaining 40 patients. The final stepwise multi-regression analysis identified four sensitive models. In the validation group, model 1 [applicable to tumors grade 3 having micropapillary differentiation (MPD)] correctly identified 92.31% of patients with LI and confirmed LI [positive predictive value (PPV) = 83%], but with moderate sensitivity. Model 2 [applicable to tumors without MPD], model 3 [applicable to tumors grade 1/2], and model 4 [applicable to tumors grade 1/2 having no MPD] all had moderate PPV and a high negative predictive value (NPV) rendering these models reliable negative tests. However, as they had high sensitivity, positive results confirm the presence of LI. Patient with tumors grade 3 and MPD might need SLNB and/or axillary lymph node dissection (ALND). Patients having tumors grade 1/2, size model 2) and those without MPD (model 3), the proposed models are reliable negative tests rather than a definitive positive one. © 2014 APMIS. Published by John Wiley & Sons Ltd.

  2. A digital phantom of the axilla based on the Visible Human Project data set

    Science.gov (United States)

    McCallum, S. J.; Welch, A. E.; Baker, L.

    2001-08-01

    In this paper, we describe the development of a new digital phantom designed for Monte Carlo simulations of breast cancer and particularly positron emission tomography (PET) imaging of the axillary lymph nodes. The phantom was based on data from the Visible Human Project female data set. The phantom covers the head-to-diaphragm regions; 17 major tissue types were segmented and 66 individual lymph nodes were identified. The authors have used the phantom in Monte Carlo simulations to model a reduced field-of-view PET imager based on two flat plate arrays placed on either side of the shoulder. Images used a simple single angle set of projections. The authors have conducted two preliminary studies: one modeling a single-frame PET acquisition 60 min after FDG injection and the other modeling a dynamic PET acquisition simulating four time frames after FDG injection. The dynamic results were processed into parametric images using the Patlak method and show the advantage to be gained by including the temporal information for legion detection. The authors' preliminary results indicate that the performance of such an imager forming projection images is not sufficient for axillary node PET imaging.

  3. Three-dimensional Reconstruction of Scar Contracture-bearing Axilla and Digital Webs Using the Square Flap Method

    Directory of Open Access Journals (Sweden)

    Chenyu Huang, MD, PhD

    2014-05-01

    Conclusions: When used to treat joint scar contractures, the square flap method can fully span the web space in a stereometric manner, thus yielding a close-to-original shape and function. Compared with the classical Z-plasties, it also provides sufficient anatomical blood supply while imposing the least physiological tension on the adjacent skin.

  4. 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.

  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. 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.

  7. [Atypical course of an apocrine sweat gland carcinoma of the axilla : A very rare malignant tumor and its interdisciplinary treatment].

    Science.gov (United States)

    Wauer, U; Lorenz, D; Sellei, R; Zoga, E; Braun, S

    2017-10-01

    We report on an atypical clinical course of a patient with the very rare diagnosis of an apocrine sweat gland carcinoma with lymphatic metastasis, a single metachronous distant metastasis and a now reached survival time of more than 4 years and give a review about the current literature. Only a very small number of cases have been described. The recommendations for diagnostics and treatment of this tumor, therefore, are not based on prospective randomized studies but upon case reports and on new immunohistochemical and genetic markers.

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

    Directory of Open Access Journals (Sweden)

    Tomasz Nowikiewicz

    2016-03-01

    Full Text Available 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.

  9. Intraoperative examination of sentinel lymph nodes using scrape ...

    African Journals Online (AJOL)

    2014-08-03

    Aug 3, 2014 ... procedures were also performed. At operation 2 ml of reconstituted .... low volume of axillary disease undergoing mastectomy without radiation. The After the Mapping of the Axilla: ... or as a delayed procedure when SLNs were found to be N1mic only. Although it is unlikely that the axilla requires local ...

  10. A comparison of axillary with rectal thermometry in under 5 children ...

    African Journals Online (AJOL)

    Background: Body temperature measurement is a crucial clinical assessment in the care of an acutely ill child, especially the under fives. Most temperature measurements in our hospital are done from the axilla. Objective: To study the relationship between temperatures taken in the axilla with those taken in the rectum in ...

  11. Intraoperative examination of sentinel lymph nodes using scrape ...

    African Journals Online (AJOL)

    Background. In breast cancer, sentinel lymph node biopsy (SLNB) is widely used to assess the axilla when the nodes appear normal on palpation and ultrasonography. When the sentinel lymph nodes (SLNs) are negative, no further dissection is required. Surgical dissection or radiotherapy of the axilla is indicated for ...

  12. 21 CFR 900.4 - Standards for accreditation bodies.

    Science.gov (United States)

    2010-04-01

    ... and laterality. This information shall be placed on the image in a position near the axilla... paragraph (a)(8) of this section shall be used to identify view and laterality. (D) Facility name and...

  13. 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.

  14. Thyroid Surgery

    Science.gov (United States)

    ... can be performed with the assistance of a robot through a distant incision in either the axilla ... Contest Winners About the ATA Mission, Vision, Goals Work of the ATA Governance & Leadership Staff Contact the ...

  15. Basal cell carcinoma does metastasize.

    Science.gov (United States)

    Ozgediz, Doruk; Smith, E B; Zheng, Jie; Otero, Jose; Tabatabai, Z Laura; Corvera, Carlos U

    2008-08-15

    Basal cell carcinoma (BCC) rarely metastasizes. However, this unfortunate outcome can occur, usually in neglected tumors. We report a 52-year-old man with a BCC on the left chest that enlarged and then ulcerated over a 6-year period. Metastasis of the tumor to lymph nodes in the left axilla resulted, but the patient remains free of disease 24 months after wide excision, lymph node dissection, and local radiation therapy to the axilla.

  16. Hemosiderin: a new marker for sentinel lymph node identification.

    Science.gov (United States)

    Pinheiro, Luiz Gonzaga Porto; Oliveira Filho, Renato Santos de; Vasques, Paulo Henrique Diógenes; Filgueira, Pedro Henrique de Oliveira; Aragão, Douglas Henning Pinheiro; Barbosa, Pedro Macedo Esmeraldo; Beserra, Hugo Enrique Orsini; Cavalcante, Raissa Vasconcelos

    2009-01-01

    To evaluate and present our initial results of a new marker (hemosiderin) for mammary sentinel lymph node identification in an experimental model. 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 axillae were made to search, through the lymphatic mapping and a gamma probe, the sentinel lymph nodes. Seven brown sentinel lymph nodes were identified and also radiomarked on the left axilla. Six blue sentinel lymph nodes were identified and also radiomarked on the right axilla. 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.

  17. Comparative Study of Efficacy and Safety of Botulinum Toxin a Injections and Subcutaneous Curettage in the Treatment of Axillary Hyperhidrosis

    Science.gov (United States)

    Budamakuntla, Leelavathy; Loganathan, Eswari; George, Anju; Revanth, BN; Sankeerth, V; Sarvjnamurthy, Sacchidananda Aradhya

    2017-01-01

    Background: Primary focal axillary hyperhidrosis is a chronic distressing disorder affecting both the sexes. When the condition is refractory to conservative management, we should go for more promising therapies like intradermal botulinum toxin A (BtxA) injections in the axilla, and surgical therapies like subcutaneous curettage of sweat glands. Aims and Objectives: The aim of this study is to compare the efficacy, safety and duration of action of intradermal BtxA injections in one axilla and subcutaneous curettage of sweat glands in the other axilla of the same patient with axillary hyperhidrosis. Materials and Methods: Twenty patients (40 axillae) received intradermal BtxA injections on the right side (20 axillae) and underwent tumescent subcutaneous curettage of sweat glands on the left side (20 axillae). Sweat production rate was measured using gravimetry analyses at baseline and at 3 months after the procedure. Subjective analyses were done using hyperhidrosis disease severity scale (HDSS) score at baseline, at 3rd and 6th month after the procedure. Results: At 3 months post-treatment, the resting sweat rate in the toxin group improved by 80.32% versus 79.79% in the subcutaneous curettage method (P = 0.21). Exercise-induced sweat rate in the toxin group improved by 88.76% versus 88.8% in the subcutaneous curettage group (P = 0.9). There was a significant difference in the HDSS score after treatment with both the modalities. There were no adverse events with BtxA treatment compared to very minor adverse events with the surgical method. Conclusion: Both intradermal BtxA injections and tumescent subcutaneous curettage of sweat glands had a significant decrease in the sweat rates with no significant difference between the two modalities. Hence, in resource poor settings where affordability of BtxA injection is a constraint, subcutaneous curettage of sweat glands can be preferred which has been found equally effective with no or minimal adverse events. PMID

  18. [Acute axillary eczema caused by mercury compounds].

    Science.gov (United States)

    Ippen, H

    1979-01-01

    Not every axillary dermatitis is caused by an allergy against corresponding cosmetics (deodorants or anti-perspirants). This is shown in a 24-year-old man with an acute contact dermatitis in the left axilla. Sensitization probably developed against mercury salts due to the regular use of thermometers which were kept in a disinfecting solution containing phenylmercuric borate. The patient was in two hospitals for a check up before heart surgery and temperature was regularly measured in the left axilla. In both clincis phenylmercuric borate was used for desinfection of the thermometers. The sensitivity was proofed by positive patch tests.

  19. Cystic lymphangioma of the breast in an infant successfully ...

    African Journals Online (AJOL)

    Cystic hygromas, also known as lymphangiomas, are unusual congenital malformations of the lymphatic system and commonly involve the head and neck region or axilla. Involvement of other sites such as breasts is very rare. The preferred mode of treatment for lymphangioma of the breast in adults or children is surgery.

  20. Sustained Protection against Superficial Bacterial and Fungal Infection by Topical Treatment.

    Science.gov (United States)

    1974-12-31

    of penicillin had maigrated to the un- treated axilla inducing therein a resistant population. Mechanical transfer of resistant cells from the treated...secretions, adding rigor to the test. Deodorancy is a crude criterion of antibacterial efficacy. Quantitative bacteriologic study is much more

  1. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile ...

    African Journals Online (AJOL)

    have been described in the axilla, periolecranon, forearm, lower extremity,[1] hand,[6] and trunk.[7] In spite of the versatility of perforator‑based flaps, literature search reveals ... Anatomy of distal leg perforators. Perforators are small diameter vessels that originate from a main pedicle and perforate the fascia or muscle to ...

  2. A new Fagraea (Loganiaceae) from Celebes, Indonesia

    NARCIS (Netherlands)

    Leenhouts, P.W.

    1981-01-01

    Frutex scandens, 3 m altus. Folia petiolata; petiolus 1.5 — 2.25 cm longus, gracilis, exauriculatus; squama axillae pro majore parte libera, bilobata ad rotundata, usque ad 3.5 mm alta; lamina 13.5 — 22 cm longa, 4 — 6.5 cm lata, oblonga vel lanceolata, coriacea; basis anguste cuneata; margo

  3. A very accurate method for sentinel lymph node investigation: Gamma detecting probe associated with SPECT examination for depth

    International Nuclear Information System (INIS)

    Ascoli, G.; Cinti, P.; Nonni, M.; Rossi, B.

    2002-01-01

    Aim: aim of this study is to magnify the lymphoscintigraphy examination by gamma probe with SPECT acquisition for very accurate detection of depth of axilla node in patients affected by melanoma. Methods: according to physiological peculiarities the lymphatic system plays a very important role and represents the most important barrier to neoplastic cells spreading. The 'sentinel node' is the first lymph node draining the affected area. The tendency for surgery is a 'preventive' axillary dissection, even in presence of a clinically negative examination. In fact a high percentage of clinically negative lymph node shows a positive histology (presence of metastatic cells). The nuclear medicine method for researching 'sentinel node' is represented by a regional lymphoscintigraphy with normal gamma camera with a large field of view followed by examination with gamma detecting probe and, in following day, controlled in operating room to confirm the presence of the node early identified. We have completed this protocol with SPECT examination of affected axilla by use of injected laboratory capillary around axilla to perform an exact investigation of node depth. Discussion: Our experience in 150 cases in 18 months shows 100% of axilla 'sentinel node' detection, 25 cases with positive histologic examination and subsequently axillary dissection. Conclusions: In conclusion the scintigraphic examination with lymphoscintigraphy represents a good tool for management of patient with melanoma and the use of ''targeting' with collimated SPECT represent a very aid for the surgeon in reduction time for detection and dissection of lymph node, with high reduction of anesthesia duration

  4. Treatment of focal axillary hyperhidrosis using a long-pulsed Nd:YAG 1064 nm laser at hair reduction settings.

    Science.gov (United States)

    Letada, Philip R; Landers, John T; Uebelhoer, Nathan S; Shumaker, Peter R

    2012-01-01

    Axillary hyperhidrosis is a rather common idiopathic disorder of the eccrine sweat glands, which can interfere with daily activities and cause significant social distress. The effects of 1064 nm laser hair reduction on sweat production in a pilot study in patients with focal axillary hyperhidrosis are described. In a prospective, case-controlled, randomized pilot study, one axilla from six different subjects with axillary hyperhidrosis was treated with monthly laser hair reduction sessions using the 1064 nm Nd:YAG laser at typical settings. The contralateral axilla acted as a control. Subjects were asked to subjectively classify improvement of axillary sweating using a Global Assessment Questionnaire (GAQ) weekly after each treatment. Qualitative evaluation of sweating was also performed using a modified starch iodine test monthly after each treatment. In addition, prior to the first treatment and at one month following the final treatment, a punch biopsy was performed on the treatment axilla to assess for histologic changes to the eccrine gland and surrounding structures. Statistically significant improvements in subjective ratings of sweating using the GAQ compared to baseline were observed. Objective improvements in sweating with modified starch iodine testing comparing treated versus non-treated axillae were also seen for at least nine months in selected subjects. No significant differences in pre- and post-treatment biopsies were noted on routine histology. Laser hair reduction using the 1064 nm Nd:YAG at laser hair removal settings provides subjective and objective improvements in patients with focal axillary hyperhidrosis.

  5. Partial axillary dissection in early breast cancer | El-Fayoumi ...

    African Journals Online (AJOL)

    ... of later clinical involvement of the axilla and at establishing a sound basis for adjuvant treatment planning axillary dissection is an important operative procedure. ... Methods: Eighteen patients underwent modified radical mastectomy, while the other two patients who were fulfilling the criteria for conservative breast surgery ...

  6. The prevalence of chronic postmastectomy pain syndrome in female ...

    African Journals Online (AJOL)

    nerve (lateral cutaneous branch of T2), during operative procedures on the breast and/or axilla.6. Chronic pain can have wide-ranging effects on health, functioning and quality of life. Studies4,7,13 conducted previously show a significant number of postmastectomy breast cancer survivors (ranging from 20% to 40% in these ...

  7. Author Details

    African Journals Online (AJOL)

    Yilmaza, Engin. Vol 13, No 2 (2017) - Articles Fibroadenoma of ectopic breast tissue of the axilla in an adolescent girl: Report of a rare entity. Abstract PDF. ISSN: 1687-4137. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms ...

  8. Case report

    African Journals Online (AJOL)

    abp

    2017-12-13

    Dec 13, 2017 ... histological CAC and axillary metastasis of lobular carcinoma breast was recently highlighted [7] or supernumerary breast carcinoma, some malignant tumor of sweat glands, the whole interest of a thorough clinical and histological study. Axilla is undoubtedly the most frequent location of apocrine tumor due ...

  9. A new montane Scaevola from Borneo: S. Verticillata (Goodeniaceae)

    NARCIS (Netherlands)

    Leenhouts, P.W.

    1964-01-01

    Frutex. Rami subteretes, lanato-tomentosi. Folia 4-verticillata, apice ramulorum congesta, ad axillas pilis sericeis isabellinis c. 1½ cm longis fasciculatis instructa; periolus c. ¾ cm longus, supra canaliculatus, lanatus; lamina obovato-oblonga, 5½-7 cm longa, 2½—3 cm lata, chartacea, in vivo

  10. Long-term efficacy of a single course of infliximab in hidradenitis suppurativa

    NARCIS (Netherlands)

    Mekkes, J. R.; Bos, J. D.

    2008-01-01

    BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by abscess formation, predominantly in the axillae and groins. The disease is difficult to treat and has a severe impact on quality of life. Recently, several case reports have been published describing

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

    African Journals Online (AJOL)

    Rabah M. Shawky

    2014-08-30

    Aug 30, 2014 ... trophy of muscles in the calf and the thigh and loss of buttocks fat (Figs. 1–3). He also had thick hyperpigmented patchy areas. (acanthosis nigricans) in the neck and both axillae (Fig. 4). Abdominal examination revealed divarication of recti, pro- tuberant abdomen with the liver spanning 7 cm, non tender,.

  12. The prevalence and clinical significance of acanthosis nigricans in ...

    African Journals Online (AJOL)

    0.04). AN was more commonly seen in diabetics (p = 0.004). The presence and severity of AN in the neck correlated far better with. BMI and blood glucose than other sites, including the axilla. Conclusion: AN was found to be extremely common, with a prevalence of 30% in this group. An association with blood glucose.

  13. Anatomical variations of the brachial plexus terminal branches in ...

    African Journals Online (AJOL)

    Anatomical variations are clinically significant, but many are inadequately described or quantified. Variations in anatomy of the brachial plexus are important to surgeons and anesthesiologists performing surgical procedures in the neck, axilla and upper limb regions. It is also important for radiologists who interpret plain and ...

  14. Case report: Subcorneal pustular dermatosis in a Sudanese patient ...

    African Journals Online (AJOL)

    Herein we describe a 23-yearold Sudanese male diagnosed with SPD, based on clinical and histological findings. The presentation is unusual; pustules involving the whole body sparing palms, soles, axillae and groin. The patient recovered completely after 8 weeks treatment of 100mg/day oral dapsone. Sudanese Journal ...

  15. The baboon syndrome

    DEFF Research Database (Denmark)

    Andersen, Klaus Ejner; Hjorth, N; Menné, T

    1984-01-01

    The catchword "baboon syndrome" is used to denote a characteristic distribution pattern of systemic allergic contact dermatitis. Diffuse erythema of the buttocks, upper inner surface of the thighs, and axillae are characteristic features. We describe 3 cases provoked by ampicillin, nickel...

  16. Validation of Some Anthropometric Equations for Estimating Body ...

    African Journals Online (AJOL)

    Participants weight was measured under water using Hydrostatic weighing equipment. Skinfold was measured at chest, mid axilla, triceps, sub scapular, abdomen, supra iliac, mid thigh, and biceps. Body density (BD) was calculated using underwater weight and anthropometric equations from Behnke and Wilmore, Durning ...

  17. Evaluation of a standard breast tangent technique: a dose-volume analysis of tangential irradiation using three-dimensional tools

    International Nuclear Information System (INIS)

    Krasin, Matthew; McCall, Anne; King, Stephanie; Olson, Mary; Emami, Bahman

    2000-01-01

    Purpose: A thorough dose-volume analysis of a standard tangential radiation technique has not been published. We evaluated the adequacy of a tangential radiation technique in delivering dose to the breast and regional lymphatics, as well as dose delivered to underlying critical structures. Methods and Materials: Treatment plans of 25 consecutive women with breast cancer undergoing lumpectomy and adjuvant breast radiotherapy were studied. Patients underwent two-dimensional (2D) treatment planning followed by treatment with standard breast tangents. These 2D plans were reconstructed without modification on our three-dimensional treatment planning system and analyzed with regard to dose-volume parameters. Results: Adequate coverage of the breast (defined as 95% of the target receiving at least 95% of the prescribed dose) was achieved in 16 of 25 patients, with all patients having at least 85% of the breast volume treated to 95% of the prescribed dose. Only 1 patient (4%) had adequate coverage of the Level I axilla, and no patient had adequate coverage of the Level II axilla, Level III axilla, or the internal mammary lymph nodes. Conclusion: Three-dimensional treatment planning is superior in quantification of the dose received by the breast, regional lymphatics, and critical structures. The standard breast tangent technique delivers an adequate dose to the breast but does not therapeutically treat the regional lymph nodes in the majority of patients. If coverage of the axilla or internal mammary lymph nodes is desired, alternate beam arrangements or treatment fields will be necessary

  18. Breast Conserving Therapy: A surgical Technique where Little can ...

    African Journals Online (AJOL)

    shoulder pain, and nerve injury), phantom breast syndrome, delayed cellulitis and pain syndromes of the chest wall, axilla, and upper extremity are known complications after breast cancer treatment. Some of these complications especially arm morbidity is less common in BCT as compared to mastectomy, and less frequent ...

  19. 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

    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...

  20. Crystal deodorant dermatitis: irritant dermatitis to alum-containing deodorant.

    Science.gov (United States)

    Gallego, H; Lewis, E J; Crutchfield, C E

    1999-07-01

    Two patients developed an irritant dermatitis of the axillae shortly after using an over-the-counter "natural deodorant crystal" product containing alum. We discuss this previously unreported, untoward reaction to alum, an ancient agent with newfound popularity as an alternative health product.

  1. Diagnosis and treatment of HIV-related Kaposi's sarcoma

    NARCIS (Netherlands)

    Reyners, A.K.L.; Sprenger, H.G; Suurmeijer, A.J.H.; van der Graaf, W.T.A.

    2006-01-01

    A 42-year-old heterosexual man presented with bluish-purple spots on his skin and in his mouth cavity that had been present for a few months; a 48-year-old homosexual man had painful lymphadenopathy in the groins and left axilla. Both men appeared to have a Kaposi's sarcoma and to be HIV-positive.

  2. NJP VOLUME 39 No 4

    African Journals Online (AJOL)

    Prof Ezechukwu

    2012-05-06

    May 6, 2012 ... unremarkable except for 4 café au lait spots measuring about 3mm in diameter on the left axillae. As was the case with her younger sister, urinalysis and skull radio- graph were normal but neuro-imaging of the brain was not done. The parents were counseled. Discussion. Congenital glaucoma is a rare ...

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

    African Journals Online (AJOL)

    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 ...

  4. Leukemia cutis in an Indian female – a rare entity | Puri | Sudanese ...

    African Journals Online (AJOL)

    Leukemia cutis represents a skin infiltration by leukemic cells. Clinically it can mimic a wide variety of dermatoses. We describe a case of a 60 years old female who presented with multiple papulonodular and vesicular lesions over trunk, neck, axilla, abdomen and hands since 1 month. A skin biopsy revealed a leukemic ...

  5. Fournier's ganrene in the HIV era

    African Journals Online (AJOL)

    of the body such as the perineum, anterior abdominal and chest wall sometimes in the axilla11,12. Wilson de- scribed the underlying pathology as necrotizing fasciitis of deep fascia with subsequent loss of all the overlying skin and subcutaneous tissues.13. Fournier's gangrene has been reported from all parts of the world.

  6. 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.

  7. Shoulder Dislocation in the course of Revenue Collection: A Need to ...

    African Journals Online (AJOL)

    Alasia Datonye

    dislocation of the glenohumeral joint with the humeral head in the subcoracoid position (Figures 2a and 2b). Under sedation with diazepam and pentazocine, the dislocation was reduced by a modification of the. Hippocratic method utilizing folded bedsheet in the axilla for counter traction. Post reduction the shoulder contour.

  8. Malignant Giant Cell Tumour of Bone with Axillary Metastasis

    African Journals Online (AJOL)

    2002-06-06

    Jun 6, 2002 ... SUMMARY. Giant Cell Tumour of bone is a typically benign and solitary tumour. However, multiple lesions have been described and 5-10% of lesions may be malignant. We present a case of a malignant giant cell tumour of the distal radius with metastasis to the ipsilateral axilla (an uncommon location).

  9. Axillary fibroadenoma mimicking lymphadenopathy | Odike ...

    African Journals Online (AJOL)

    No Abstract. Keywords: breast; fibroadenoma; axilla. Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.73-74. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  10. Serum Anticytokine Autoantibody Levels Are Not Increased in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Theut Riis, Peter; Von Stemann, Jakob Hjorth; Kjærsgaard Andersen, Rune

    2017-01-01

    Background: Hidradenitis suppurativa is a skin disease of recurrent episodes of inflammatory nodules, abscesses, and scarring of the intertriginous regions, e.g. the axillae and groin. A dysregulated immune response to one or more unknown antigens in hidradenitis suppurativa has been suggested. O...

  11. Towards a body hair atlas of women of caucasian ethnicity.

    Science.gov (United States)

    Schweiger, D; Hoff, A; Scheede, S; Fischer, F; Tilsner, J; Lüttke, J; Neumann, Y; Hagens, R

    2016-08-01

    A preliminary study was conducted in 17 female volunteers (mean age 29.8 years) to gain deeper insights into the characteristics of terminal Caucasian female body hair of different body parts. The focus on Caucasian women was driven by the high number of different scalp hair phenotypes in this ethnicity and intended to identify relevant differences between body areas to improve body hair removal approaches. Multiple growth parameters and structural parameters were assessed for hair on the upper arm, forearm, upper leg, lower leg, axilla and intimate area and compared to scalp data. In particular, macroscopic and much less microscopic or hair surface properties differ strikingly in the investigated body areas. Hair density on the body is much lower than on scalp with the highest hair density in the axilla and intimate area. Multihair follicular units are described for scalp but were also found to a smaller proportion in the axilla and the intimate area. Substantial percentages of hair triplets are only found on the scalp and intimate area. Hair diameter is highest in the intimate area, followed by axillary and lower leg hair and correlates with a faster hair growth rate. The angle of emerging hair is smallest in the intimate area, axilla and on the lower leg. Hair shafts on the lower leg and in the axilla have most overlapping cuticle layers, but independent of body region, no significant differences in the mean thickness of cuticle layers were detectable. In addition, no differences were found in the mean distance between cuticle layer edges along the hair shaft and the hair surface roughness. Hair on the scalp, forearm, upper arm and upper leg had an almost round shape, whereas hair of the lower leg, intimate area and axilla had more elliptical shape. Hairs on the arm showed the highest luminance values and no visible medulla. The darkest hairs were in the axilla and intimate area containing the highest level of visible medulla in hair shafts. To our knowledge

  12. Gastric Metastasis of Ectopic Breast Cancer Mimicking Axillary Metastasis of Primary Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Selami Ilgaz Kayılıoğlu

    2014-01-01

    Full Text Available Ectopic breast tissue has the ability to undergo all the pathological changes of the normal breast, including breast cancer. Gastrointestinal metastasis of breast cancer is rarely observed and it is very difficult to differentiate gastric metastases from primary gastric cancer. We present a case of 52-year-old female, who suffered from abdominal pain. Physical examination showed a palpable mass in the left anterior axilla and computerized tomography revealed gastric wall thickening with linitis plastica. When gastroscopic biopsy showed no signs of malignancy, excisional biopsy was performed in the left axilla. Histological examination revealed invasive lobular carcinoma of the breast, consistent with ectopic breast cancer. Further gastroscopic submucosal biopsies and immunohistochemical studies revealed gastric metastases of invasive lobular carcinoma. Axillary ectopic breast tissue carcinomas can mimic axillary lymphadenopathies. Additionally, gastric metastasis of breast cancer is an uncommon but possible condition. To the best of our knowledge, this is the first report of ectopic breast cancer with gastric metastasis.

  13. Apocrine sweat gland carcinoma: initial evaluation, staging, and response monitoring using 18F-FDG PET/CT.

    Science.gov (United States)

    Singh, Harmandeep; Sharma, Punit; Suman Kc, Sudhir; Bal, Chandrasekhar; Malhotra, Arun; Julka, Pramod Kumar; Kumar, Rakesh

    2013-05-01

    Primary apocrine sweat gland carcinomas (PASGCs) are rare tumors, commonly located in the axilla. Metastases are common and confer poor prognosis. Given the rarity of these tumors, there is limited knowledge regarding its diagnosis and management. Here we show 18F-FDG PET/CT images of a 61-year-old man with PASGCs of the left axilla. PET/CT confirmed the diagnosis as primary axillary malignancy with nodal, pulmonary, and skeletal metastases. Another interesting finding in this case was the presence of FDG-avid calcified metastatic lymph nodes during the initial evaluation. Follow-up PET/CT showed progression of the disease. FDG PET/CT seems to be a promising tool in the management of PASGCs.

  14. 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...

  15. 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.

  16. Deodorants

    DEFF Research Database (Denmark)

    Johansen, Jeanne Duus; Rastogi, S C; Bruze, M

    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......-mix-sensitive eczema patients, to provoke reactions on repeated open application tests on the upper arm and in the axillae, and to relate the findings to the content of fragrance-mix constituents in those deodorants. 14 eczema patients performed a 7-day use test with 1 or 2 deodorants that had caused a rash within...... the last 12 months. 2 applications per day were made in the axilla and simultaneously on a 25 cm2 area on the upper arm. A total of 20 deodorants were tested among the 14 patients. Afterwards, the deodorants were subjected to quantitative chemical analysis identifying constituents of the fragrance mix. 12...

  17. Ultrasonographic findings of accessory breast

    International Nuclear Information System (INIS)

    Oh, Ki Keun; Cho, Jae Hyun; Yoon, Choon Sik; Kim, Mi Hye

    1993-01-01

    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

  18. Staging of women with breast cancer after introduction of sentinel node guided axillary dissection

    DEFF Research Database (Denmark)

    Tvedskov, Tove Filtenborg

    2012-01-01

    Today, sentinel lymph node dissection (SLND) has replaced axillary lymph node dissection (ALND) as standard procedure for staging of the axilla in the treatment of breast cancer. SLND can accurately stage the axilla by removing on average only two lymph nodes. Only in case of metastatic spread...... to sentinel nodes an ALND is offered. Removing fewer nodes has made more extensive histopathological examinations of the lymph nodes possible and as a consequence more metastases are found. This has resulted in stage migration. Based on data from the nationwide Danish Breast Cancer Cooperative Group (DBCG......) database we have estimated the magnitude and therapeutic consequences of this stage migration in Denmark by comparing the distribution of lymph node metastases in breast cancer patients operated in 1993-1996 and 2005-2008; before and after introducing SLND. The proportion of patients having macrometastases...

  19. Case Report and Dosimetric Analysis of an Axillary Recurrence After Partial Breast Irradiation with Mammosite Catheter

    International Nuclear Information System (INIS)

    Shah, Anand P.; Dickler, Adam; Kirk, Michael C.; Chen, Sea S.; Strauss, Jonathan B.; Coon, Alan B.; Turian, Julius V.; Siziopikou, Kalliopi; Dowlat, Kambiz; Griem, Katherine L.

    2008-01-01

    Partial breast irradiation (PBI) was designed in part to decrease overall treatment times associated with whole breast radiation therapy (WBRT). WBRT treats the entire breast and usually portions of the axilla. The goal of PBI is to treat a smaller volume of breast tissue in less time, focusing the dose around the lumpectomy cavity. The following is a case of a 64-year-old woman with early-stage breast cancer treated with PBI who failed regionally in the ipsilateral axilla. With our dosimetric analysis, we found that the entire area of this axillary failure would have likely received at least 45 Gy if WBRT had been used, enough to sterilize microscopic disease. With PBI, this area received a mean dose of only 2.8 Gy, which raises the possibility that this regional failure may have been prevented had WBRT been used instead of PBI

  20. Staging of women with breast cancer after introduction of sentinel node guided axillary dissection

    DEFF Research Database (Denmark)

    Tvedskov, Tove Filtenborg

    2012-01-01

    Today, sentinel lymph node dissection (SLND) has replaced axillary lymph node dissection (ALND) as standard procedure for staging of the axilla in the treatment of breast cancer. SLND can accurately stage the axilla by removing on average only two lymph nodes. Only in case of metastatic spread.......8%, when estimated using today´s criteria for risk-allocation, because nodal status is now less important in risk-allocation. In general, only 15-20% of patients with micrometastases and 10-15% of patients with isolated tumor cells (ITC) in sentinel node have further metastatic spread to non-sentinel nodes....../3 of patients with ITC in sentinel node for an ALND. In patients with micrometastases in sentinel node the risk of NSN metastases was significantly associated with increasing tumor size, lymphovascular invasion, negative hormone receptor status, location of tumor in the upper lateral quadrant of the breast...

  1. Sentinel lymph node biopsy in breast cancer--experience with the combined use of dye and radioactive tracer at Aarhus University Hospital

    DEFF Research Database (Denmark)

    Lauridsen, Mette Cathrine; Garne, Jens Peter; Sørensen, Flemming Brandt

    2004-01-01

    One hundred and twenty-four patients with palpable tumours underwent sentinel lymph node biopsy (SLNB) and subsequent axillary lymph node dissection. Ultrasound of the axilla was used as part of the diagnostic work-up on all patients and those with lymph node metastasis verified by fine-needle as......One hundred and twenty-four patients with palpable tumours underwent sentinel lymph node biopsy (SLNB) and subsequent axillary lymph node dissection. Ultrasound of the axilla was used as part of the diagnostic work-up on all patients and those with lymph node metastasis verified by fine......-needle aspiration biopsy (FNAB) were not included. For identifying the SLNs, a combination of Tc-99m-labelled human albumin (Solco-ALBU-RES) and blue dye (Patent Blue V) was used. No lymphoscintigraphy was performed. The SLN was successfully identified in 122 out of 124 (98%) patients and 66 (54%) patients were...

  2. Lesions in nerves and plexus after radiotherapy

    International Nuclear Information System (INIS)

    Vees, W.

    1978-01-01

    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 [de

  3. Suppression of Microbial Metabolic Pathways Inhibits the Generation of the Human Body Odor Component Diacetyl by Staphylococcus spp

    OpenAIRE

    Hara, Takeshi; Matsui, Hiroshi; Shimizu, Hironori

    2014-01-01

    Diacetyl (2,3-butanedione) is a key contributor to unpleasant odors emanating from the axillae, feet, and head regions. To investigate the mechanism of diacetyl generation on human skin, resident skin bacteria were tested for the ability to produce diacetyl via metabolism of the main organic acids contained in human sweat. L-lactate metabolism by Staphylococcus aureus and Staphylococcus epidermidis produced the highest amounts of diacetyl, as measured by high-performance liquid chromatography...

  4. Congenital cutis laxa with rectal and uterovaginal prolapse

    OpenAIRE

    Sanjiv V Choudhary; Shazia Bisati; Sankha Koley

    2011-01-01

    A two-month-old female infant born of a consanguineous marriage, presented with loose, wrinkled and inelastic skin over the neck, axillae, trunk, inguinal region and thighs with slow elastic recoil. Patient also had systemic manifestations in the form of bilateral apical lobe consolidation of lung, bilateral inguinal hernia, rectal and uterovaginal prolapse. Histopathological examination of skin biopsy with special stain for elastic tissue revealed absence of dermal elastic tissue. Genital ab...

  5. Primary mucinous eccrine carcinoma of axillary skin: Report of a rare case

    Directory of Open Access Journals (Sweden)

    Rajashree Pradhan

    2017-01-01

    Full Text Available Primary mucinous eccrine carcinoma is a rare low-grade malignancy of sweat gland. Axilla is an uncommon site of this tumor. Primary mucinous carcinoma mimics metastatic mucinous carcinoma from breast, gastrointestinal tract, lung, and ovary. Histopathology with immunohistochemistry and other ancillary investigations are necessary to confirm the diagnosis and to exclude metastatic mucinous carcinoma. We present a rare case of primary mucinous carcinoma of axillary skin in an elderly male patient, diagnosed by histopathology and immunohistochemistry.

  6. A Case of Primary Signet-Ring Cell/Histiocytoid Carcinoma of the Eyelid: Immunohistochemical Comparison With the Normal Sweat Gland and Review of the Literature

    OpenAIRE

    Iwaya, Mai; Uehara, Takeshi; Yoshizawa, Akihiko; Kobayashi, Yukihiro; Momose, Masanobu; Honda, Takayuki; Ota, Hiroyoshi

    2012-01-01

    Primary signet-ring cell/histiocytoid carcinomas of the eyelid are extremely rare tumors considered to originate from sweat glands. Here, we report the case of a 72-year-old man diagnosed with primary signet-ring cell/histiocytoid carcinoma of the eyelid and present immunohistochemical analyses of the eyelid apocrine gland (Moll gland) and apocrine and eccrine sweat glands of perineum and axilla. Widespread infiltration of tumor cells with signet-ring cell or histiocytoid appearance was obser...

  7. Olfactory exposure to males, including men, causes stress and related analgesia in rodents.

    Science.gov (United States)

    Sorge, Robert E; Martin, Loren J; Isbester, Kelsey A; Sotocinal, Susana G; Rosen, Sarah; Tuttle, Alexander H; Wieskopf, Jeffrey S; Acland, Erinn L; Dokova, Anastassia; Kadoura, Basil; Leger, Philip; Mapplebeck, Josiane C S; McPhail, Martina; Delaney, Ada; Wigerblad, Gustaf; Schumann, Alan P; Quinn, Tammie; Frasnelli, Johannes; Svensson, Camilla I; Sternberg, Wendy F; Mogil, Jeffrey S

    2014-06-01

    We found that exposure of mice and rats to male but not female experimenters produces pain inhibition. Male-related stimuli induced a robust physiological stress response that results in stress-induced analgesia. This effect could be replicated with T-shirts worn by men, bedding material from gonadally intact and unfamiliar male mammals, and presentation of compounds secreted from the human axilla. Experimenter sex can thus affect apparent baseline responses in behavioral testing.

  8. Tuberculosis axillary lymph node coexistent breast cancer in adjuvant treatment: case report

    OpenAIRE

    Bromberg, Silvio Eduardo; do Amaral, Paulo Gustavo Ten?rio

    2015-01-01

    Coexistence of breast cancer and tuberculosis is rare. In most cases, involvement by tuberculosis occurs in axillary lymph nodes. We report a case of a 43-years-old patient who had undergone adenomastectomy and left sentinel lymph node biopsy due to a triple negative ductal carcinoma. At the end of adjuvant treatment, the patient had an atypical lymph node in the left axilla. Lymph node was excised, and after laboratory analysis, the diagnosis was ganglion tuberculosis. The patient underwent ...

  9. Cystic hygroma: An overview

    Directory of Open Access Journals (Sweden)

    Bilal Mirza

    2010-01-01

    Full Text Available Cystic hygromas are the cystic variety of lymphangioma, common locations being cervico-facial regions and axilla. Respiratory distress, recurrent infections or cosmetic reasons are the main indications of the treatment. The ideal treatment is complete surgical excision; however, there is a gradual conversion towards sclerosant therapy. This article reviews the current literature and discusses the various problems encountered during the management of these lesions.

  10. 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

  11. 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.)

  12. [Unusual cutaneous emphysema in a newborn infant following bilateral pneumothorax].

    Science.gov (United States)

    Frisch, H; Luz, O; Pastner, E

    1985-01-01

    We report a patient with subcutaneous emphysema after a bilateral pneumothorax of gigantic extent: Subcutaneous emphysema extended over the chest, neck, axilla and both arms. The scalp was severed from the galea by an enormous air-cushion. Theories about the pathogenetic mechanisms are discussed. Therapy consisted of treatment of the underlying condition e. g. thoracocentesis with pleural drainage and artificial ventilation. The subcutaneous emphysema resolved without further therapeutic measures; only the subgaleal air was removed by aspiration.

  13. 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.

  14. Reliability of measurement of maximal isometric lateral trunk-flexion strength in athletes using handheld dynamometry.

    Science.gov (United States)

    Newman, Bram L; Pollock, Courtney L; Hunt, Michael A

    2012-08-16

    Lateral trunk-flexion strength is an important determinant of overall trunk stability and function, but the reliability in measuring this outcome clinically in athletic individuals is not known. To determine the interrater and intrarater reliability of lateral trunk-flexion strength measurement in athletic individuals using handheld dynamometry. Reliability study. Research laboratory. 12 healthy, athletic individuals. Lateral trunk-flexion strength was measured using handheld dynamometry across 2 different trunk placements (lateral aspect of the axilla and laterally at the level of the midtrunk) and 2 testing occasions by 2 therapists. Three maximum-effort trials during a "make test" at each placement were completed for each therapist on both occasions. Maximum force output was identified and converted to a torque. Intraclass correlation coefficients (ICC2,1) were calculated for each dynamometer placement, therapist, and test occasion to determine intrarater and interrater reliability. Intrarater reliability was moderate to good (ICC2,1= .53-.77), while interrater reliability was good to very good (ICC2,1 =.79-.81) at the axilla position. For the midtrunk position, intrarater reliability was good to very good (ICC2,1 = .80-.86), while interrater reliability was very good on both days (ICC2,1 = .87-.88). Finally, the standard errors of measurement were low for the axilla position (0.20 Nm/kg; 95% CI .15, .28) and midtrunk position (0.09 Nm/kg; 95% CI .07, .12). Maximum lateral trunk-flexion strength can be reliably measured in athletic individuals with greater overall strength. Based on the 2 positions used in this study, measurement with a dynamometer placement at the midtrunk may be more reliable than that obtained at the axilla.

  15. Hidradenitis suppurativa: Mammographic and sonographic manifestations in two cases

    OpenAIRE

    Newman, Tiffany M.; Sheth, Monica M.; Levy, Allison; Babagbemi, Kemi

    2015-01-01

    Hidradenitis suppurativa is a chronic debilitating disorder of the skin manifested by recurrent, painful, inflammatory, subcutaneous nodules. The lesions occur most commonly in the apocrine-gland-bearing skin sites such as the axillae and inguinal regions; they cause scarring and disfigurement from the formation of multiple abscesses and fistulous tracts within the skin. We report the radiologic manifestations of two cases of hidradenitis suppurativa in women who presented for breast imaging.

  16. [Breast cancer surgery].

    Science.gov (United States)

    Vlastos, Georges; Berclaz, Gilles; Langer, Igor; Pittet-Cuenod, Brigitte; Delaloye, Jean-François

    2007-10-24

    Breast conserving surgery followed by radiation therapy is the treatment of choice for early breast cancer. For patients who choice or need a mastectomy, breast reconstruction provides an acceptable alternative. Breast cancer surgery has been evolving through minimally invasive approaches. Sentinel node biopsy has already remplaced axillary lymph node dissection in the evaluation of the axilla. Local ablation of the tumor may be a valuable alternative to surgery in the future.

  17. An Update on the Acute Management of Shoulder Dystocia.

    Science.gov (United States)

    Gilstrop, Marisa; Hoffman, Matthew K

    2016-12-01

    Shoulder dystocia continues to challenge obstetrical providers and therefore the management must evolve. The available literature demonstrates clear value in both simulation training and having a clear algorithmic approach. Similarly, the available literature suggests that delivery of the posterior arm should be prioritized. Several new techniques such as the Menticoglou maneuver, Gaskin's maneuver, and the posterior axilla sling traction technique offer obstetrical choices after more traditional techniques have failed.

  18. CASE REPORT: Primary Cutaneous Nocardiosis of Axillary Region: A Case Report

    Directory of Open Access Journals (Sweden)

    Basavaraj V. Peerapur

    2012-07-01

    Full Text Available Background: Nocardiosis is an uncommon but world-wide infection caused by several species of soil-borne aerobic bacteria belonging to the genus Nocardia. Primary cutaneous nocardiosis (PCN is an uncommon entity. It usually occurs among immunocompetent but occupationally predisposed individuals. Clinically, it can present as acute infection (abscess or cellulitis, mycetoma, or sporotrichoid infection [1]. Here we are reporting a case of PCN presented as mycetoma in axilla which is a rare site. Case History: The patient had extensive lesions in and around the axilla, which could be attributed to the fact that the patient, being an agriculturist, had been exposed to recurrent trauma while carrying firewood and soiled sacks. Single lesion initiated four years ago, progressed to multiple lesions with few healed scars. Despite the treatment in several hospitals, lesions recurred. The present patient was diagnosed as PCN caused by Nocardia brasiliensis and appropriately treated. Conclusion: Nocardia infection should be considered in the differential diagnosis of a supportive and granulomatous dermatitis that presents clinically as multiple discharging sinuses with papules and nodules in and around axilla apart from tuberculosis.

  19. Pilot Study to Evaluate the Effect of Topical Dimethicone on Clinical Signs and Skin Barrier Function in Dogs with Naturally Occurring Atopic Dermatitis

    Directory of Open Access Journals (Sweden)

    C. Pellicoro

    2013-01-01

    Full Text Available This study investigated the effects of a skin protectant solution (dimethicone 2% on clinical signs and skin barrier function in canine atopic dermatitis (AD. Eighteen dogs with AD were randomly divided into two groups, one received dimethicone and the other received the vehicle (cyclomethicone on selected areas (pinnae, groin, and axillae daily for 4 weeks. Owners and investigators were blinded regarding group allocation. Clinical efficacy was evaluated using a scoring system and skin barrier by measuring the transepidermal water loss. Twelve dogs completed the study (50% drop rate in the vehicle and 20% in the dimethicone. For clinical signs, analysis of variance showed an effect of time (; day 0 day 28 and region (axillae groin pinnae but no effect of group or group × time interaction. For transepidermal water loss, analysis of variance showed only a main effect of region (axillae pinnae groin. Pearson found no correlation between transepidermal water loss and clinical scores. In this pilot study dimethicone had no significant effect on clinical signs and transepidermal water loss in canine atopic dermatitis.

  20. Epidemiological study and considerations of primary focal hyperhidrosis in Japan: from questionnaire analysis.

    Science.gov (United States)

    Fujimoto, Tomoko; Kawahara, Kazuo; Yokozeki, Hiroo

    2013-11-01

    Primary hyperhidrosis is a disorder of excessive, bilateral and relatively symmetrical sweating occurring in the palms, soles and axillae regions without obvious etiology. There have been some reports of the epidemiology of primary hyperhidrosis abroad so far, but there has never been any research performed in Japan. We performed a questionnaire survey for people aged 5-64 years who agreed with the purpose of this study at 20 companies or schools, and received 5807 valid responses. From this survey, each prevalence could broken down into 5.33% for primary palm hyperhidrosis, 2.79% for primary plantar hyperhidrosis, 5.75% for primary axillae hyperhidrosis and 4.7% for primary head hyperhidrosis. Patients with severe symptoms were estimated to be approximately 616,000 for primary palmar hyperhidrosis and 2,239,000 for primary axillae hyperhidrosis in Japan. These findings reveal that many patients feel a decreased quality of life because of symptoms of hyperhidrosis every day. However, only 6.2% of the patients had visited medical institutions. Moreover, few patients take appropriate treatment even after visiting the hospital. © 2013 Japanese Dermatological Association.

  1. 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.

  2. Clinical investigation: Regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy

    International Nuclear Information System (INIS)

    Strom, Eric A.; Woodward, Wendy A.; Katz, Angela; Buchholz, Thomas A.; Perkins, George H.; Jhingran, Anuja; Theriault, Richard; Singletary, Eva; Sahin, Aysegul; McNeese, Marsha D.

    2005-01-01

    Purpose: The purpose of this study was to describe regional nodal failure patterns in patients who had undergone mastectomy with axillary dissection to define subgroups of patients who might benefit from supplemental regional nodal radiation to the axilla or supraclavicular fossa/axillary apex. Methods and Materials: The cohort consisted of 1031 patients treated with mastectomy (including a level I-II axillary dissection) and doxorubicin-based systemic therapy without radiation on five clinical trials at M.D. Anderson Cancer Center. Patient records, including pathology reports, were retrospectively reviewed. All regional recurrences (with or without distant metastasis) were recorded. Median follow-up was 116 months (range, 6-262 months). Results: Twenty-one patients recurred within the low-mid axilla (10-year actuarial rate 3%). Of these, 16 were isolated regional failures (no chest wall failure). The risk of failure in the low-mid axilla was not significantly higher for patients with increasing numbers of involved nodes, increasing percentage of involved nodes, larger nodal size or gross extranodal extension. Only 3 of 100 patients with 20% involved axillary nodes, and the presence of gross extranodal extension (10-year actuarial rates 15%, 14%, and 19%, respectively, p 20% involved axillary nodes, or gross extranodal extension are at increased risk of failure in the supraclavicular fossa/axillary apex and should receive radiation to undissected regions in addition to the chest wall

  3. [Bilateral axillary nodes. 30-year-old patient, housewife].

    Science.gov (United States)

    Rodak, R; Ramseier, E

    2007-11-14

    A 20-year old patient who had been adequately treated for lymph node tuberculosis 14 years ago presented 1 week after giving birth to a healthy daughter. She complained about painful lumps in both axillae. During pregnancy the patient suffered from hyperemesis gravidarum, lost 6 kg of weight, and had night sweats. During the last three months of her pregnancy she had a deep vein thrombosis in her right lower leg. The clinical examination showed soft axillary lumps up to 3 cm. The lab showed the following pathological findings: blood sedimentation rate 51 mm/h, CRP 44.8 mg/l, LDH 221 U/l and INR 1.3 (indicating insufficient anticoagulation with phenprocoumon). The chest x-ray showed no infiltrate or indications of a past tuberculosis. A fine needle aspiration cytology was performed on an accessible node. Gram stain, Ziehl Neelsen stain, as well as the bacteriological cultures were all negative. An ultrasound examination of the axilla showed a thickened subcutis without a mass. Cytology showed lobular epithelium, consistent wih ductal mamma epithelium without atypical cells. The diagnosis of an accessory mamma tissue in both axillae was made. During the course of the following weeks the glands decreased in size and the patient was free of symptoms.

  4. Comparing axillary and mediastinal lymphadenopathy on CT in children with suspected pulmonary tuberculosis

    International Nuclear Information System (INIS)

    Theron, Salomine; Andronikou, Savvas

    2005-01-01

    Radiographic demonstration of mediastinal lymphadenopathy is important for the diagnosis of pulmonary tuberculosis (PTB). Plain radiographs are unreliable for this and CT, which is relatively more expensive and carries a high radiation burden, remains the gold standard. No studies correlating the presence of axillary with mediastinal lymphadenopathy have been reported. Such a correlation would allow for clinical or ultrasound diagnosis of PTB via the axilla. To correlate the presence of axillary lymphadenopathy with mediastinal lymphadenopathy in children with suspected PTB. CT scans were performed and reviewed in 100 children (prospectively recruited) with suspected PTB. The axilla and mediastinum were reviewed separately by covering the non-relevant sections on the CT scans prior to reading. Only nodes greater than 1 cm were regarded as pathological. Mediastinal lymphadenopathy was present in 46% of children; 70% had lymphadenopathy in either axilla. Bilateral axillary lymphadenopathy was identified in 47%. Axillary lymphadenopathy showed a sensitivity of 74% and a specificity of 33% for the presence of mediastinal adenopathy. Bilateral axillary adenopathy had a sensitivity of 50% and a specificity of 56%. Axillary lymphadenopathy has a moderate sensitivity and low specificity for the presence of mediastinal and hilar lymphadenopathy in children with suspected PTB. Further research should be aimed at correlating ultrasound-detected axillary lymphadenopathy with FNA results in children. (orig.)

  5. Lipoid proteinosis.

    Science.gov (United States)

    Bozdağ, K E; Gül, Y; Karaman, A

    2000-03-01

    A 21-year-old man presented with a complaint of hoarseness as well as lesions along the eyelids and on his knees, elbows, and fingers. Hoarseness had developed in childhood, followed by lesions along the eyelids and on the elbows and fingers. He had developed lesions on the knees, feet, scrotum, penis, and axilla over the last 2 years. His parents were relatives, but nobody in the family showed similar features. His physical examination was normal. On dermatologic examination, there were beaded papules along the eyelids and small, yellow-white infiltrations on the tongue, buccal mucosa, palate, scrotum, and penis (Fig. 1). His tongue was firm and its mobility was limited. He also had infiltration of the frenulum (Fig. 2) and warty and hyperkeratotic papular and nodular lesions on the hands, knees, elbows (Fig. 3), and axilla. The laboratory findings and laryngoscopic examination were normal. Ophthalmologic, neurologic, and psychiatric examinations were also normal. Electroencephalogram (EEG), electromyogram (EMG), craniography, and cranial computed tomography (CT) scanning revealed no abnormality. The histopathologic examination of the skin biopsy specimens obtained from the axilla, elbow, and dorsum of the hand showed hyperkeratosis and periodic acid-Schiff-positive (PAS(+)) staining hyaline material around the dermal capillaries and sweat glands, and confirmed the diagnosis of lipoid proteinosis.

  6. Endoscopic anatomy of the anterior ethmoidal artery: a cadaveric dissection study.

    Science.gov (United States)

    Araujo Filho, Bernardo Cunha; Weber, Raimar; Pinheiro Neto, Carlos Diógenes; Lessa, Marcus Miranda; Voegels, Richard Louis; Butugan, Ossamu

    2006-01-01

    The anterior ethmoidal artery (AEA) is an important point of anatomical reference in order to locate the frontal sinus and the skull base. Notwithstanding, despite numerous endoscopic studies in cadavers, we still lack an anatomical study on the AEA in the western population. to determine reference points used to locate the artery, study its relationship with the skull base and its degree of dehiscence, as well as to study intra and inter individual variations. we dissected the nasal fossae belonging to 25 cadavers. the average intranasal length of the anterior ethmoidal artery was 5.2 mm. The anterior ethmoidal canal presented some degree of dehiscence in 66.7%. The average distance between the artery middle point to the anterior nasal spine was of 61.72 mm (sd=4.18 mm); to the lateral nasal wall (nasal axilla) was of 64.04 mm (sd=4.69 mm); and from the anterior axilla to the middle turbinate was of 21.14 mm (sd=3.25 mm). For all the measures there was no statistically significant measures when both sides were compared (p>0.05). We concluded that the middle conchae axilla is the most reliable point of reference to locate the AEA.

  7. Results of conservative surgery and radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Osteen, R.T.; Smith, B.L. (Harvard Medical School, Boston, MA (USA))

    1990-10-01

    For stage I or II breast cancer, conservative surgery and radiation therapy are as effective as modified radical or radical mastectomy. In most cases, cosmetic considerations and the availability of therapy are the primary concerns. The extent of a surgical resection less than a mastectomy has not been a subject of a randomized trial and is controversial. It appears that removal of a quadrant of the breast for small lesions is safe but excessive. It may be possible to limit the breast resection to gross tumor removal for most patients while using wider resections for patients with an extensive intraductal component or for invasive lobular carcinoma. It also appears that excluding patients from breast conservation on the basis of positive margins on the first attempt at tumor excision may be unnecessarily restrictive. Although patients with an extensive intraductal component or invasive lobular carcinoma should have negative margins, it appears that a patient with predominantly invasive ductal carcinoma can be treated without re-excision if all gross tumor has been resected and there is no reason to suspect extensive microscopic disease. Patients with indeterminate margins should have a re-excision. Axillary dissection provides prognostic information and prevents progression of the disease within the axilla. Axillary dissections limited to level I will accurately identify a substantial number of patients who have pathologically positive but clinically negative nodes. When combined with radiation therapy to the axilla, a level I dissection results in a limited number of patients with progressive axillary disease. Patients with pathologically positive axillas and patients at particularly high risk for systemic disease because of the extent of axillary node involvement can be identified by dissections of levels I and II. 60 references.

  8. Conceptus dose from involved-field radiotherapy for Hodgkin's lymphoma on a linear accelerator equipped with MLCs

    Energy Technology Data Exchange (ETDEWEB)

    Mazonakis, Michalis; Samara, Elina; Zourari, Kyveli; Damilakis, John [Dept. of Medical Physics, Univ. Hospital of Iraklion, Crete (Greece); Lyraraki, Efrossini; Varveris, Charalambos [Dept. of Radiotherapy and Oncology, Univ. Hospital of Iraklion, Crete (Greece)

    2009-06-15

    Purpose: to estimate the scattered dose to conceptus from involved-field radiotherapy for Hodgkin's lymphoma on a linear accelerator equipped with multileaf collimators. Material and methods: anthropomorphic phantoms were used to simulate an average pregnant woman at the 1st, 2nd and 3rd trimesters of gestation. Conceptus dose was measured using thermoluminescent dosimeters. Phantom measurements were performed for the minimum, medium and maximum field dimensions that may be employed during radiation therapy to lymph nodes in the neck, axilla, mediastinum and neck-mediastinum. The components of the scattered dose to conceptus were determined. Phantom exposures were generated with a 6-MV photon beam. Results: neck irradiation with a tumor dose of 35 Gy resulted in a conceptus dose of 1.1-8.7 cGy depending upon the stage of pregnancy, the distance from treatment volume, and the field size applied. The corresponding conceptus dose ranges from radiotherapy in the regions of axilla, mediastinum and neck-mediastinum was 1.2-14.3 cGy, 3.7-57.7 cGy, and 5.1-91.8 cGy, respectively. The contribution of collimator scatter and head leakage to the total conceptus dose varied from 21% to 80% depending upon the irradiation site and gestational age. Conclusion: the conceptus dose associated with cervical node irradiation is below the threshold value of 10 cGy during the entire pregnancy. Radiation therapy to lymph nodes in the axilla, mediastinum and neck-mediastinum may possibly lead to a conceptus dose of > 10 cGy and, therefore, informed decisions about the pregnancy termination should be made. (orig.)

  9. Evaluation of bacterial colonization in patients with the diagnosis of mycosis fungoides

    Directory of Open Access Journals (Sweden)

    Bengü Nisa Akay

    2014-12-01

    Full Text Available Background and Design: Mycosis fungoides (MF is the most common form of cutaneous T-cell lymphoma (CTCL. Bacterial infections are a common complication of MF/Sezary syndrome (SS. Staphylococcus aureus is the most common causes of skin infections in patients with MF/SS. However, the role of infectious agents and their effects on the clinical course is controversial. In this study, we aimed to assess the prevalence of the colonization of bacterial pathogens among individuals with MF/SS in comparison with control subjects. Materials and Methods: Sixty-six patients with MF/SS and 66 healthy control subjects were included in this study. The subjects were swabbed in the nose, throat and axilla and the samples were evaluated according to the Clinical Laboratory Standards Institute (CLSI criteria. Results: The mean age of the patients was 55.9±14.8 years (range: 21-84 years. Forty-eight patients were with ≤stage 2A, 18 were ≥stage 2B SS and MF. No statistically significant difference was observed in the frequency of pathogenic bacteria colonization in the nose and axilla between the two groups. However, in the throat it was statistically higher in MF/SS (p=0.001. There was no statistically significant difference between the two groups in terms of S.aureus colonization. The frequency of pathogenic bacteria colonization in the throat cultures were significant (p=0.004 for patients with late stage disease compared to those with early stages, but this was not shown in axilla and nose cultures. Conclusion: In this study, bacterial colonization in the throat and nasal carriage of S.aureus were found to be higher in patients with MF/SS. Further studies on the benefits of controlling this problem, possibly with simple and inexpensive methods that might ameliorates the symptoms such as itching, scaling and erythema are needed.

  10. Anatomical information for intercostobrachial nerve preservation in axillary lymph node dissection for breast cancer.

    Science.gov (United States)

    Zhu, J J; Liu, X F; Zhang, P L; Yang, J Z; Wang, J; Qin, Y; Zhang, G L; Ren, D Q; Cui, C L; Guo, X G

    2014-01-24

    This study aimed to provide additional anatomical information for axillary lymph node dissection (ALND) through in vivo anatomy studies of intercostobrachial nerve (ICBN) preservation in order to provide theoretical and practical experience for clinicians. A total of 156 patients with breast cancer underwent ALND at the Department of Gynecology of Baotou Tumor Hospital between June 2009 and March 2010. The origin, destination, main source, length, branch type, and direction of ICBN in axilla were observed, as well as its relationship with adjacent major blood vessels and nerves within the axilla. There were 120 cases of single trunk, 23 cases of double trunks, 9 cases of multiple trunks, and 4 cases without trunks in 156 patients with ICBN preservation. The transverse diameter at the origin of the ICBN was 1.89 ± 0.44 mm with a length of 94.45 ± 12.08 mm; the distances were 77.19 ± 21.04 mm, 29.34 ± 6.73 mm, 90.04 ± 13.13 mm, and 28.63 ± 13.01 mm from origin to the inferior margin at the midpoint of the clavicle, inferior margin of the axillary vein, the bottom of axilla, and branch point, respectively. The identification, dissection, and preservation of ICBN was simple and easy in a modified radical mastectomy for breast cancer and breast-conserving surgery, which only took 10-20 min, but effectively reduced the incidence of post-mastectomy pain syndrome and significantly improved the quality of life for patients after surgery.

  11. Management of Metastatic Apocrine Hidradenocarcinoma with Chemotherapy and Radiation.

    Science.gov (United States)

    Miller, Daniel H; Peterson, Jennifer L; Buskirk, Steven J; Vallow, Laura A; Ta, Randy; Joseph, Richard; Krishna, Murli; Ko, Stephen J; Tzou, Katherine S

    2015-09-07

    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.

  12. Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer.

    Science.gov (United States)

    Henry, Brandon Michael; Graves, Matthew J; Pękala, Jakub R; Sanna, Beatrice; Hsieh, Wan Chin; Tubbs, R Shane; Walocha, Jerzy A; Tomaszewski, Krzysztof A

    2017-03-17

    The intercostobrachial nerve (ICBN), which usually originates from the lateral cutaneous branch of the second intercostal nerve, innervates areas of the axilla, lateral chest, and medial arm. It is at risk for injury during operative procedures that are often used in the management of breast cancer and such injury has been associated with postoperative sensory loss and neuropathic pain, decreasing the quality of life. PubMed, Excerpta Medica Database (EMBASE), ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), Scientific Electronic Library Online (SciELO), Biosciences Information Service (BIOSIS), and Web of Science were searched comprehensively. Data concerning the prevalence, branching, origin and communications of the ICBN were extracted and pooled into a meta-analysis. A total of 16 studies (1,567 axillas) reported data indicating that the ICBN was present in 98.4% of person. It most often (90.6%) originated from fibers at the T2 spinal level and commonly coursed in two branching patterns: as a single trunk in 47.0% of cases and as a bifurcating pattern in 42.2%. In the latter cases, the bifurcation was usually unequal (63.4%). Additionally, the ICBN presented with anastomosing communication to the brachial plexus in 41.3% of cases. The ICBN is a prevalent and variable structure at significant risk for injury during operative procedures of the axilla. In view of the postoperative pain and paresthesia experienced by patients following injury, surgeons need to exercise caution and aim to preserve the ICBN when possible. Ultimately, careful dissection and knowledge of ICBN anatomy could allow postoperative complications to be reduced and patient's quality of life increased.

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

    International Nuclear Information System (INIS)

    Plachkov, I.; Cvetankov, K.; Hadjidekov, G.

    2013-01-01

    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

  14. 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

  15. [Axillary pathologic response after neoadjuvant chemotherapy in locally advanced breast cancer with axillary involvement].

    Science.gov (United States)

    Jiménez-Ballvé, A; Serrano-Palacio, A; García-Sáenz, J A; Ortega Candil, A; Salsidua-Arroyo, O; Román-Santamaría, J M; Pelayo Alarcón, A; Fuentes Ferrer, M E; Carreras-Delgado, J L

    2015-01-01

    To compare axillary involvement (N+) at initial staging in locally advanced breast cancer (LABC) with axillary lymphadenectomy histologic results after neoadjuvant chemotherapy treatment (NeoChemo). Retrospective study between November 2011 and September 2013 of LABC cases treated with neoadjuvant chemotherapy based on docetaxel (associated with trastuzumab in HER2 positive cases and carboplatin/adriamycin in HER2 negative cases). Those clinically or radiologically suspected cases of axillary involvement were histologically confirmed. When there was no suspicion of axillary involvement, sentinel lymph node radioguided biopsy (SLNRB) was performed using intradermal injection of (99m)Tc-nanocolloid albumin prior to neoadjuvant treatment. Axillary lymphadenectomy after NeoChemo was undertaken in all cases with positive axilla. Final pathologic response was classified as complete (pCR) when there was no evidence of tumoral disease and as non-pathologic complete response (no pCR) in the opposite case. A total of 346 patients treated with docetaxel were reviewed, identifying 105 LABC. Axillary involvement at initial staging was detected in 70 (67%) before starting NeoChemo. From these 70, 73% (n=51) were N+ (fine needle biopsy and/or biopsy) and the remaining 19 (27%) were occult N+ detected by SLNRB. Axillary lymphadenectomy detected pCR in 56% (39/70), increasing up to 84% pCR when initial N+ status was reached using SNLB. On the other hand, when N+ was detected using fine needle biopsy/lymph biopsy, pCR was only 45%. More than 50% of women affected by locally advanced breast cancer with tumoral axillary involvement at initial diagnosis present free metastatic axilla after therapeutic neoadjuvant chemotherapy effect. This increases up to almost 90% in case of occult metastatic axilla detected with sentinel node biopsy prior starting neoadjuvant chemotherapy. Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  16. Malignant acanthosis nigricans: an early diagnostic clue

    International Nuclear Information System (INIS)

    Amjad, M.; Shah, A.A.; Bari, A.U.

    2010-01-01

    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)

  17. 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...

  18. Treatment of axillary hyperhidrosis: combination of the starch-iodine test with the tumescent liposuction technique.

    Science.gov (United States)

    Swinehart, J M

    2000-04-01

    To evaluate and permanently improve axillary hyperhidrosis. Excessive sweating of the axillae is a common problem for which patients frequently seek dermatologic advice and therapy. Many treatments, including aluminum chloride, topical and systemic anticholinergic agents, tranquilizers, iontophoresis, direct surgical excision, botulinum toxin injection, and thoracic sympathectomy, have been employed to control this problem. All have drawbacks of one sort or another. The starch-iodine technique for delineation of preoperative and postoperative axillary sweating is described in detail. A method of sweat gland removal utilizing tumescent liposuction is discussed. The combination of the starch-iodine technique and tumescent liposuction is safe and effective for therapy of axillary hyperhidrosis.

  19. 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.

  20. Fibroadenoma in an ectopic vulvar breast gland: a common neoplasm in an uncommon site.

    Science.gov (United States)

    Ayadi-Kaddour, A; Khadhar, A; Mlika, M; Braham, E; Ismail, O; Zegal, D; El Mezni, F

    2014-03-01

    Ectopic breast tissue is defined as glands located outside of the breast. It can be found anywhere along the milk line extending from the axilla to the groin, and can occur in the vulva. Ectopic breast tissue should be excised because it may develop benign or malignant pathologic processes. Less than 40 cases of fibroadenoma in the vulva have been reported in the literature. We report a case of a 37-year-old woman presenting a solitary vulvar mass. The mass was excised completely, and histology demonstrated an ectopic breast fibroadenoma. This is one of the few reports on the benign pathologies of vulvar mammary glands.

  1. Unicentric Castleman’s Disease Masquerading Pancreatic Neoplasm

    Directory of Open Access Journals (Sweden)

    Saurabh Jain

    2012-01-01

    Full Text Available Castleman’s disease is a rare nonclonal proliferative disorder of the lymph nodes with an unknown etiology. Common locations of Castleman’s disease are mediastinum, neck, axilla, and abdomen. Castleman’s disease of a peripancreatic location masquerading as pancreatic neoplasm is an even rarer entity. On search of published data, we came across about 17 cases published on peripancreatic Castleman’s disease until now. Here we are reporting a case of retropancreatic Castleman's disease masquerading as retroperitoneal neoplasm in a 46-year-old male patient.

  2. The effects of scoliosis and subsequent surgery on the shape of the torso

    Directory of Open Access Journals (Sweden)

    Adrian Gardner

    2017-11-01

    Full Text Available Abstract Background Adolescent idiopathic scoliosis (AIS causes asymmetry of the torso, and this is often the primary concern of patients. Surgery aims to minimise the visual asymmetry. It is not clear how scoliosis makes the torso asymmetric or how scoliosis surgery changes that asymmetry when compared to the distribution of asymmetries seen in a non-scoliotic group of normal controls. Methods Surface topography images were captured for a group with AIS both pre-operatively and post-operatively. Identifiable points were compared between the images to identify the effects of AIS on the shape of the torso by looking at the relative heights and distances from the midline of the shoulders, axillae and waist in a two-dimensional coronal view. This was then compared to a previously reported group of normal non-scoliotic children to analyse whether surgery recreated normality. Results There were 172 pairs of images with 164 females and 8 males, mean age at pre-operative scan of 13.7 years. The normal group was 642 images (237 females and 405 males from 116 males and 79 females, mean age of 12.5 years. The curve patterns seen in the scoliotic group matched the patterns of a main thoracic curve (n = 146 and main thoracolumbar curve (n = 26. The asymmetries seen in both shoulders, axillae and waist were different between the two different types of curve. Across both groups, the shoulder asymmetry was less than that of the corresponding axillae. There was a statistically significant reduction in all asymmetries following surgery in the main thoracic group (p < 0.001. This was not seen in the main thoracolumbar group, thought to be due to the small sample size. In the main thoracic group, there were statistically significant differences in the asymmetries between the post-operative and normal groups in the shoulders and axillae (p < 0.001 but not the waist. Conclusions This paper demonstrates quantitatively the range of asymmetries seen

  3. Anatomical patterns of dermatitis in adult filaggrin mutation carriers

    DEFF Research Database (Denmark)

    Heede, Nina G; Thyssen, Jacob Pontoppidan; Thuesen, Betina H

    2015-01-01

    in an adult general population stratified by FLG genotype. METHODS: Data from a population-based cohort study with a 5-year follow-up were used. This study included 2143 participants aged 18 to 72 years. Information about dermatitis on the hands; feet; face; axillae; and abdomen, chest, or back was obtained...... by use of questionnaires. Participants were genotyped for common FLG mutations. A history of AD was defined by the United Kingdom Working Party's diagnostic criteria. RESULTS: The frequency of foot dermatitis in the general population was associated with FLG genotype (P = .014). However, when...

  4. Cystic breast lymphangioma in adult female: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Chhanda Das

    2016-01-01

    Full Text Available Cystic lymphangiomas are rare benign tumor of the breast in adults. They are usually located in head and neck, axilla, and mediastinum. They are most commonly diagnosed in young children. Nearly 90% are apparent by the age of 2 years. Here, we reporting a case of 20-year-old female presented with gradually increasing painless swelling in the upper outer quadrant of her left breast for 1½ years. Mammography of the breast showed multiple irregular hypoechoic lesions associated with irregular duct dilatation. Lumpectomy was performed and diagnosed as cystic lymphangioma. Complete excision is the treatment of choice.

  5. 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.

  6. A lipomatous chest wall lesion: hibernoma

    International Nuclear Information System (INIS)

    Incedayi, M.; Sivrioglu, A.; Saglam, M.; Sonmez, G.; Tekin, L.

    2012-01-01

    Full text: A hibernoma is a rare benign soft tissue tumor derived from brown fat. The tumor is also known as 'fetal' lipoma, lipoma of embriogenic fat and lipoma of immature adipose tissue. Hibernomas are slow growing, painless soft tissue tumors which do not recur after surgical resection. Preferred locations are brown fat containing sites as thigh, inter scapular region, shoulder, axilla and mediastinum. The tumor occurs most commonly in adults, with a mean age of 38 years (age range, 2-75 years). We present a rare case of hibernoma with radiological and pathological findings

  7. 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.

  8. Attack of the scabies: what to do when an outbreak occurs.

    Science.gov (United States)

    Haag, M L; Brozena, S J; Fenske, N A

    1993-10-01

    Scabies remains a significant source of morbidity in nursing home residents because of its highly contagious nature. It is characterized by severe pruritus and papules, pustules, burrows, nodules, and occasionally urticarial lesions. Lesions are commonly found on the wrists, finger webs, antecubital fossae, axillae, areolae, periumbilical region, lower abdomen, genitals, and buttocks. Diagnosis is based on the history, physical examination, and demonstration of mites, eggs, or scybala on microscopic examination. Several topical scabicides are available, but permethrin cream appears to be less toxic and more effective in cases that are resistant to other agents. Successful management requires evaluation of individuals with close patient contact.

  9. Acanthosis nigricans – a common significant disorder usually unassociated with malignancy

    Directory of Open Access Journals (Sweden)

    Edmund J. Janniger

    2011-03-01

    Full Text Available Acanthosis nigricans (AN can be a highly significant cutaneous findingand is usually unrelated to cancer. It is most often evident as velvetythickening of axillae, posterior neck fold, flexor skin surfaces andumbilicus. It is common in obesity, which is seen increasing in childrenand adolescents, and can serve as a cutaneous marker of insulin resistance.It is most often associated with hyperinsulinemia, which mayresult from insulin receptor gene defects causing insulin resistance, andless frequently due to mutations in fibroblast growth factor receptors.In this work non malignancy-associated AN types will be emphasized,particularly the association of AN with insulin-resistance, itself a potentialthreat to life.

  10. Granulomatous slack skin syndrome: Report of a unique case.

    Science.gov (United States)

    Maheswari, S Uma; Sampath, V; Ramesh, A

    2018-01-01

    Granulomatous slack skin syndrome is a rare variant of cutaneous T-cell lymphoma (mycosis fungoides). It is characterized clinically by redundant skin folds, which show a predilection towards flexural areas such as the axilla and the groin. Histologically, it shows a granulomatous T-cell infiltrate and loss of elastic tissue. It has an indolent but progressive course; and is usually refractory to treatment. We report a unique case of slack skin syndrome, sparing the classical sites with rapid and unusual involvement of non-intertriginous areas.

  11. Primary mucosa-associated lymphoid tissue lymphoma of the breast: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jong Heon; Kim, Dae Bong; Shin, Mi Kyung; Jang, Suk Ki; Kang, Su Min; Ahn, In Oak [Bundang Jesaeng General Hospital, Seongnam (Korea, Republic of)

    2007-11-15

    A primary mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) of the breast is extremely rare. We report a case of a MALT lymphoma of the breast that presented as a palpable left breast mass in a 37-year-old woman. A physical examination revealed a large firm, and fixed mass in the left inner breast. Mammograms showed a large, isodense mass in the lower inner quadrant of the left breast and an enlarged lymph node in the axilla. A sonogram demonstrated a 5 cm sized, oval, circumscribed, and heterogeneously hypoechoic mass with posterior acoustic enhancement. A surgical biopsy was performed, and the pathology revealed a MALT lymphoma.

  12. Primary mucosa-associated lymphoid tissue lymphoma of the breast: a case report

    International Nuclear Information System (INIS)

    Park, Jong Heon; Kim, Dae Bong; Shin, Mi Kyung; Jang, Suk Ki; Kang, Su Min; Ahn, In Oak

    2007-01-01

    A primary mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) of the breast is extremely rare. We report a case of a MALT lymphoma of the breast that presented as a palpable left breast mass in a 37-year-old woman. A physical examination revealed a large firm, and fixed mass in the left inner breast. Mammograms showed a large, isodense mass in the lower inner quadrant of the left breast and an enlarged lymph node in the axilla. A sonogram demonstrated a 5 cm sized, oval, circumscribed, and heterogeneously hypoechoic mass with posterior acoustic enhancement. A surgical biopsy was performed, and the pathology revealed a MALT lymphoma

  13. Tuberculosis axillary lymph node coexistent breast cancer in adjuvant treatment: case report.

    Science.gov (United States)

    Bromberg, Silvio Eduardo; Amaral, Paulo Gustavo Tenório do

    2015-01-01

    Coexistence of breast cancer and tuberculosis is rare. In most cases, involvement by tuberculosis occurs in axillary lymph nodes. We report a case of a 43-years-old patient who had undergone adenomastectomy and left sentinel lymph node biopsy due to a triple negative ductal carcinoma. At the end of adjuvant treatment, the patient had an atypical lymph node in the left axilla. Lymph node was excised, and after laboratory analysis, the diagnosis was ganglion tuberculosis. The patient underwent treatment for primary tuberculosis. The development of these two pathologies can lead to problems in diagnosis and treatment. An accurate diagnosis is important to avoid unnecessary surgical procedures.

  14. Malignant chondroid syringoma in a West African cancer institute: A case report

    Directory of Open Access Journals (Sweden)

    Sidy Ka

    2016-01-01

    Results: We report a case of malignant chondroid syringoma of the deltoid and axilla in a 53 year old patient. Malignant chondroid syringoma is an extremely rare tumor of the sweat glands. It is included in myoepithelial tumors of the skin. It has an epithelial component with eccrin or apocrin differentiation, and myoepithelial component. It preferentially seat at the extremities. We report an unusual case with deltoid presentation and axillary mass masqueriding as metastatic lymph node. Surgery is the main treatment. It has a poor prognosis.

  15. Unilateral hyperhidrosis and hypothermia

    DEFF Research Database (Denmark)

    Dyring-Andersen, B; Kamp, S; Madelung, A

    2016-01-01

    A 34-year old man presented at the Department of Dermato-allergology, Herlev and Gentofte Hospital with unilateral hyperhidrosis localized to the right axilla through approximately 10 years without progression of symptoms. The patient often experienced that his right hand was colder than the left......, especially during bouts of hyperhidrosis. The symptoms usually arose in stressful situations. The patient had no sensory symptoms (pain and light touch of upper extremitieswere assessed) and no medical history of other diseases including lung disease or neurological disease. This article is protected...

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

    Energy Technology Data Exchange (ETDEWEB)

    Jacobsson, H. [Department of Radiology, Karolinska Hospital, Stockholm (Sweden); Celsing, F. [Department of Haematology and Infectious Diseases, Karolinska Hospital, Stockholm (Sweden); Ingvar, M. [Department of Cognitive Neurophysiology, Karolinska Hospital, Stockholm (Sweden); Stone-Elander, S. [Department of Cognitive Neurophysiology, Karolinska Hospital, Stockholm (Sweden)]|[Karolinska Pharmacy, Stockholm (Sweden); Larsson, S.A. [Department of Hospital Physics, Karolinska Hospital, Stockholm (Sweden)

    1998-03-27

    A diabetic male with severe autonomic neuropathy and recently discovered Hodgkin`s disease demonstrated bilateral uptake of [2-{sup 18}F]-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.) With 1 fig., 9 refs.

  17. Incidence and prevalence of hyperhidrosis.

    Science.gov (United States)

    Moraites, Eleni; Vaughn, Olushola Akinshemoyin; Hill, Samantha

    2014-10-01

    Hyperhidrosis is a skin disorder characterized by excessive sweating that often causes significant impairment in social, occupational, and emotional wellbeing. Hyperhidrosis is thought to affect 2.8% of the US population and can be of primary or secondary origin. Primary hyperhidrosis is usually bilateral, symmetric, and focal. The most common focal sites include, but are not limited to, the palms, soles, and axillae. Secondary hyperhidrosis is usually caused by an underlying medical condition or medication. Secondary hyperhidrosis must be ruled out before a diagnosis of primary hyperhidrosis is made. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Comparison of skin doses to large fields using tangential beams from cobalt-60 gamma rays and 4-MV x rays

    International Nuclear Information System (INIS)

    Gagnon, W.F.; Peterson, M.D.

    1978-01-01

    Excess radiation to the skin during external beam megavoltage radiation therapy has reportedly caused excessive erythema in patients treated with the Clinac 4 linear accelerator on sloping surfaces, but not for similar treatments with cobalt-60. Doses at the epidermal level were measured under geometries simulating sloping surfaces for a Clinac 4 and an Eldorado 8 cobalt-60 teletherapy machine. For equal doses to the axilla, doses to the epidermal layer were similar. When the tumor dose was calculated for the mediastinum, the dose to the skin in the axillary region was 12% higher for the Clinac 4

  19. Impact of receptor phenotype on nodal burden in patients with breast cancer who have undergone neoadjuvant chemotherapy

    LENUS (Irish Health Repository)

    Boland, M. R.

    2017-07-31

    Optimal evaluation and management of the axilla following neoadjuvant chemotherapy(NAC) in patients with node-positive breast cancer remains controversial. The aim of this study wasto examine the impact of receptor phenotype in patients with nodal metastases who undergo NAC to seewhether this approach can identify those who may be suitable for conservative axillary management.Methods: Between 2009 and 2014, all patients with breast cancer and biopsy-proven nodal diseasewho received NAC were identied from prospectively developed databases. Details of patients who hadaxillary lymph node dissection (ALND) following NAC were recorded and rates of pathological completeresponse (pCR) were evaluated for receptor phenotype.

  20. Axillary node status in breast cancer patients prior to surgery by imaging with Tc-99m humanised anti-PEM monoclonal antibody, hHMFG1.

    Science.gov (United States)

    Al-Yasi, A R; Carroll, M J; Ellison, D; Granowska, M; Mather, S J; Wells, C A; Carpenter, R; Britton, K E

    2002-03-18

    In early breast cancer axillary nodes are usually impalpable and over 50% of such patients may have an axillary clearance when no nodes are involved. This work identifies axillary node status by imaging with a Tc-99m radiolabelled anti-Polymorphic Epithelial Mucin, humanised monoclonal antibody (human milk fat globule 1), prior to surgery in 30 patients. Change detection analysis of image data with probability mapping is undertaken. A specificity of 93% and positive predictive value of 92% (both 100% if a second cancer in the axilla with negative nodes is considered) were found. A strategy for combining negative imaging with the sentinel node procedure is presented. Copyright 2002 Cancer Research UK

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

    Energy Technology Data Exchange (ETDEWEB)

    Abreu, M.C. [LIP, Lab. de Instrumentacao e Fisica Exp. Particulas (Portugal); Aguiar, D. [INESC-ID and INOV, Lisbon (Portugal); Albuquerque, E. [INEGI Inst. Eng. Mecanica Gestao Industrial, Porto (Portugal)] (and others)

    2007-02-01

    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.

  2. A variation of Musculocutaneous nerve without piercing the coracobrachialis muscle while communicating to the median nerve: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Hamid Tayefi Nasrabadi

    2017-01-01

    Discussion and Conclusion: Anatomically, in the axilla region, the Musculocutaneous nerve is originated of the lateral cord of brachial plexus, then, by piercing the coracobrachialis muscle arrives enters to anterior compartment of the arm. But, in the present report, we observed that the Musculocutaneous nerve without piercing the coracobrachialis muscle has arrived in the left arm, then communicated to the Median nerve. To exploratory interventions of the arms for peripheral nerve repair and surgical therapies, a good knowledge of nerve pathways helps to surgeons for preventing possible mistakes during surgery.

  3. Contribution of SPECT/CT for sentinel node localization in patients with ipsilateral breast cancer relapse

    Energy Technology Data Exchange (ETDEWEB)

    Borrelli, Pablo [Antoni Van Leeuwenhoek Hospital, Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam (Netherlands); Hospital La Fe, Nuclear Medicine, Medical Imaging Clinical Area, Valencia (Spain); Donswijk, Maarten L.; Stokkel, Marcel P.; Teixeira, Suzana C. [Antoni Van Leeuwenhoek Hospital, Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam (Netherlands); Tinteren, Harm van [Antoni Van Leeuwenhoek Hospital, Department of Biometrics, The Netherlands Cancer Institute, Amsterdam (Netherlands); Rutgers, Emiel J.T. [Antoni Van Leeuwenhoek Hospital, Department of Surgery, The Netherlands Cancer Institute, Amsterdam (Netherlands); Valdes Olmos, Renato A. [Antoni Van Leeuwenhoek Hospital, Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam (Netherlands); Leiden University Medical Centre, Nuclear Medicine Section and Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden (Netherlands)

    2017-04-15

    In recent years repeat sentinel node (SN) biopsy has been proven to be feasible in local breast cancer recurrence (LBCR). However, in these patients SNs outside the ipsilateral axilla are frequently observed. This study evaluates the contribution of SPECT/CT for SN localization and surgical adjustment in LBCR patients. SN biopsy was performed in 122 LBCR patients (median age 60.5 years, range 24-87), enrolled from August 2006 to July 2015. Median disease-free time lapse was 109.5 months (range 9-365). Axillary lymph node dissection (ALND) had previously been performed in 55 patients, SN biopsy in 44, both techniques in 13 and fine-needle aspiration in 10. Primary breast cancer treatment included radiotherapy in 104 patients (85.3 %) and chemotherapy in 40 (32.8 %). Preoperative lymphatic mapping, using planar scintigraphy (PS) and SPECT/CT included report of SN location according to lymph node territory. In case of a territorial PS-SPECT/CT mismatch, surgery was adjusted according to SPECT/CT findings. SPECT/CT SN visualization rate was higher than PS (53.3 % vs. 43.4 %, p n.s.) with, in total, 19 additional SN (118 vs. 99, p n.s.). PS-SPECT/CT territory mismatch, found in 60 % (39/65) of patients with SN visualization, led to surgical adjustment in 21.3 % (26/122) of patients. The SN procedure was finally performed in 104 patients resulting in a 65.7 % surgical retrieval rate with a total of 132 removed SNs (1.86/patient). SN metastases were found in 17/71 patients (23.9 %), in 16 of them (94 %) in ipsilateral basins outside the axilla or in the contralateral axilla. Using SPECT/CT there is a trend to visualize more SNs in LBCR, providing at the same time important anatomical information to adjust intraoperative SN procedures. The addition of SPECT/CT to the standard imaging protocol may lead to better staging mainly in patients presenting drainage outside the ipsilateral axilla. (orig.)

  4. [A case of Lyme neuroborreliosis without erythema migrans].

    Science.gov (United States)

    Eguchi, Katsuki; Tsuzaka, Kazuhumi; Yabe, Ichiro; Sasaki, Hidenao

    2018-02-28

    A 56-year-old man was sustained ticks at the left axilla and flank. He did not have a rash. About 3 months after the tick bites, he developed back pain, right leg weakness, right abducens nerve palsy, and left facial palsy. Western blot analysis for serum IgM and IgG antibodies against Borrelia were positive. We diagnosed Lyme borreliosis. The patient was treated with antibiotics and steroids, and the symptoms improved. Our findings demonstrate that, even if erythema migrans is not obvious, neuroborreliosis should be considered when neurological signs, such as multiple cranial nerve palsies, are present.

  5. 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.)

  6. Thoracic outlet syndrome: Case report

    International Nuclear Information System (INIS)

    Marquez, Juan Camilo; Acosta, Mauricio Fernando; Uribe Jorge Ricardo

    2009-01-01

    We report a case of vascular thoracic outlet syndrome in a young man, diagnosed with upper limb arteriography, leading to repeated arterio-arterial emboli originating from a post-stenotic subclavian artery aneurysm. It is of our interest due to its low incidence and the small number of cases reported that have been diagnosed by arteriography. The thoracic outlet is the path through which vascular and neural structures goes from the neck to the axilla, and it has three anatomical strictures, that when pronounced, can compress the brachial plexus or subclavian vessels, leading to different symptoms and signs.

  7. Breast Mass in a Rubens Painting.

    Science.gov (United States)

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

    2016-04-19

    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.

  8. 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.

  9. 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.

  10. State-of-the-art Magnetic Resonance Imaging in Vascular Thoracic Outlet Syndrome.

    Science.gov (United States)

    Aghayev, Ayaz; Rybicki, Frank J

    2015-05-01

    Vascular thoracic outlet syndrome is caused by compression of subclavian/axillary vessels during their passage from the thoracic cavity to the axilla. Early diagnosis and treatment is important to prevent debilitating outcomes of vascular thoracic outlet syndrome. Contrast-enhanced three-dimensional (3D) magnetic resonance angiography (MRA) with equilibrium phase using provocative arm positioning is the optimal examination to determine presence, degree of vascular compression, and complications of vascular thoracic outlet syndrome. This article reviews thoracic outlet anatomy, disorders of the vascular component, and typical imaging findings by contrast-enhanced 3D MRA. Published by Elsevier Inc.

  11. [Innovations in locoregional treatments of breast cancer].

    Science.gov (United States)

    Vlastos, G; Monnier, S; Vinh-Hung, V

    2010-10-27

    Breast conserving therapy including breast conserving surgery followed by radiation therapy is the treatment of choice for early breast cancer. Sentinel lymph node biopsy is a minimally approach that allows to evaluate the axilla with less morbidity and avoid an axillary lymph node biopsy. This surgical technique is now evaluated in more specific situations. Modern surgical techniques such as oncoplastic surgery allow to excise larger tumors and obtain better cosmetic results. In a near future it is expected that intraoperative radiation therapy will remplace classicals approaches of radiotherapy for selected patients.

  12. [Axillary local anesthetic spread after the thoracic interfacial ultrasound block - a cadaveric and radiological evaluation].

    Science.gov (United States)

    Torre, Patricia Alfaro de la; Jones, Jerry Wayne; Álvarez, Servando López; Garcia, Paula Diéguez; Miguel, Francisco Javier Garcia de; Rubio, Eva Maria Monzon; Boeris, Federico Carol; Sacramento, Monir Kabiri; Duany, Osmany; Pérez, Mario Fajardo; Gordon, Borja de la Quintana

    Oral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and does not have a specific regional anesthesia technique published that offers its adequate blockade. After institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane. Magnetic Resonance Imaging studies were then conducted in 15 of 34 patients scheduled for unilateral breast surgery that entailed any of the following: axillary clearance, sentinel node biopsy, axillary node biopsy, or supernumerary breasts, to ascertain the deposition and time course of spread of solution within the thoracic interfascial plane in vivo. Radiological and cadaveric studies showed that the injection of local anesthetic and methylene blue via the thoracic inter-fascial plane, using ultrasound guide technique, results in reliable deposition into the axilla. In patients, the injection of the local anesthetic produced a reliable axillary sensory block. This finding was supported by Magnetic Resonance Imaging studies that showed hyper-intense signals in the axillary region. These findings define the anatomic characteristics of the thoracic interfascial plane nerve block in the axillary region, and underline the clinical potential of this novel nerve block. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. Quantification of sweat secretion in focal axillary hyperhidrosis related to area and time: the hyperhidrosis area and secretion index.

    Science.gov (United States)

    Bahmer, Friedrich A

    2015-11-01

    Severity of focal axillary hyperhidrosis (FAH) hitherto is estimated semiquantitatively by weighting the secreted sweat with the sweating area visualized by iodine starch test. In this study, we quantified secretion (mg/cm(2) per min) simply by estimating the sweating area morphometrically via point counting. We have named the numeric value obtained the hyperhidrosis area and secretion index (HASI). In 183 patients (146 women, 37 men) with focal axillary hyperhidrosis, seen in a city hospital outpatient clinic, sweat secretion was assessed by gravimetry and the area of Minor's iodine-starch test determined by point counting. Values were analyzed with respect to gender, age, and body surface area. HASI values, combined for both axillae, ranged from 0.21 to 22.8 mg/cm(2) per minute with only minor gender differences. Men had larger sweating areas than women did. The comparison of left to right side axillae did not disclose substantial differences. No correlation was found between age and HASI values. A subgroup analysis of 91 patients showed a good correlation of HASI values with body surface area. HASI allows for a quantification of sweat secretion per time interval and area unit, thus facilitating pre- and post-test assessment of sweat intensity as well as a comparison between the results of different studies. © 2015 The International Society of Dermatology.

  14. A simple system for grading the response of breast cancer to neoadjuvant chemotherapy.

    Science.gov (United States)

    Rodenhuis, S; Mandjes, I A M; Wesseling, J; van de Vijver, M J; Peeters, M-J T D F Vrancken; Sonke, G S; Linn, S C

    2010-03-01

    The response of primary breast cancer to chemotherapy is usually expressed either as a pathological complete remission (pCR) or as 'no pCR'. A more quantitative measure is called for. The 'neoadjuvant response index' (NRI) was calculated by adding a breast response score (a number from a five-point scale) to an axillary response score (a number from a three-point scale) and dividing this by the score that would have been obtained in case of a pCR in both breast and axilla. Consequently, the NRI is a number between 0 (representing no response) and 1 (a pCR of both breast and axilla). The NRI was calculated in 267 patients who had received neoadjuvant chemotherapy. The average NRI was 0.48 (median 0.40). Forty-one patients (15%) had an NRI of 0; 55 patients (21%) had an NRI of 1 (pCR). 'Highly endocrine responsive' tumors responded substantially less than 'incompletely endocrine responsive' ones. In triple negatives, an NRI of >0.70 was associated with a better recurrence-free survival than a lower NRI. The NRI proposed here may be useful to better reflect the efficacy of neoadjuvant systemic regimens than the binary pCR-'no pCR' system.

  15. 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.

  16. Identification of axillary Staphylococcus sp. involved in the production of the malodorous thioalcohol 3-methyl-3-sufanylhexan-1-ol.

    Science.gov (United States)

    Bawdon, Daniel; Cox, Diana S; Ashford, David; James, A Gordon; Thomas, Gavin H

    2015-08-01

    The production of malodour by humans is mediated by bacterial transformation of naturally secreted, non-odorous molecules. Specifically in the underarm (axilla), malodour arises due to biotransformation by the microbiota of dipeptide-conjugated thioalcohols, particularly S-[1-(2-hydroxyethyl)-1-methylbutyl]-(L)-cysteinylglycine (Cys-Gly-3M3SH). This molecule, secreted by the axilla, has a well-established role in malodour when metabolized to free thioalcohol by bacteria. We present Cys-Gly-3M3SH biotransformation data from a library of skin-isolated corynebacteria and staphylococci and report a significant variation in thioalcohol generation across individual bacterial species. Staphylococcus hominis, Staphylococcus haemolyticus and Staphylococcus lugdunensis were particularly efficient Cys-Gly-3M3SH transformers. In contrast, Staphylococcus epidermidis and Corynebacterium tuberculostearicum, both highly prevalent axillary commensals, are low producers of 3M3SH. We also identify significant differences between the ability of several isolates to biotransform Cys-Gly-3M3SH compared to S-benzyl-L-Cys-Gly, a dipeptide-linked version of a commonly used malodour precursor substrate. Finally, using traditional biochemical assays we subsequently establish that Cys-Gly-3M3SH is actively transported into S. hominis, rather than passively diffusing across the membrane. This work significantly enhances our knowledge of Cys-Gly-3M3SH biotransformation by physiologically important bacteria in the axillary microbiota. © FEMS 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. The Omental Pedicle Flap in Dogs Revised and Refined: A Cadaver Study.

    Science.gov (United States)

    Doom, Marjan; Cornillie, Pieter; Simoens, Paul; Huyghe, Stephanie; de Rooster, Hilde

    2016-08-01

    To expand current knowledge on the canine omental vasculature and refine the existing lengthening technique of the canine omentum. Ex vivo study. Canine cadavers (n=20). In 10 canine cadavers the omental arteries were mapped using intravascular latex injection and these results were used to create an omental pedicle flap based on the splenic artery in 10 additional cadavers. The operating range of the flap was recorded with particular attention to the main regions of interest for omental transposition in dogs (axillary and inguinal regions). The superficial and deep omental leaves were each predominantly supplied by a left and a right marginal omental artery that anastomosed near the caudal omental border into a superficial and a deep omental arch, respectively. Anastomoses between arteries of the superficial and the deep omental leaves were weak and inconsistent, except for 1 anastomosis that was found in 8 of 10 dogs. By transposing the intact omentum, the right axilla could be reached in 3 dogs, both axillae in 1 dog, and both groins in all cadavers. In all cases, the omental pedicle reached to and beyond the axillary and inguinal regions. By unfolding the pedicle leaves, the width of the pedicle tip could be doubled. When lengthening the omentum is necessary to reach extra-abdominal structures, the omental pedicle flap based on the splenic artery appears to preserve the omental vascular supply. These observations warrant further clinical trials to evaluate this new omtental flap technique in vivo. © Copyright 2016 by The American College of Veterinary Surgeons.

  18. Endovascular treatment of a spontaneous aneurysm in the axillary artery.

    Science.gov (United States)

    Park, Sung Kyun; Hwang, Jeong Kye; Park, Sun Cheol; Kim, Sang Dong

    2015-01-01

    Spontaneous aneurysm in the axillary artery is extremely rare. The standard treatment for axillary artery aneurysm has been surgical repair, but endovascular management of select aneurysms using stent grafts has become more prevalent with the development of endoluminal technology. We report the case of a 36-year old man with a spontaneous aneurysm in the axillary artery. He experienced a tingling sensation and intermittent pain in the left upper extremity and had no history of trauma to the axilla. We performed endovascular treatment [placement of a Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA)] for a spontaneous aneurysm in the axillary artery. Following the procedure, his symptoms disappeared completely. After 6, 12 and 24 months, we carried out computed tomography angiography; all scans showed no complications. Now, the patient has no symptoms related to aneurysm in the axilla. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  19. Graham-Little-Piccardi-Lassueur Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Emine Nur Rifaioğlu

    2015-09-01

    Full Text Available A rare type of liken pilanopilaris, Graham-Little-Piccardi-Lassueur syndrome (GLPLS, is characterized by cicatricial alopecia of the scalp, follicular hyperkeratosis of trunk and extremities and non-cicatricial alopecia of axilla and pubis. A forty year-old woman admitted with hair loss and palpabl wheals on her body. On her dermatologic examination alopecic plaques with irregular border and atrophic appearance and milimetric papules around follicules on fronto-parietal part of scalp were detected. Also there were purple like-brown milimetric papules around follicules on both extensor part of distal arm, axilla, upper and lower back with alopecia on hairy areas. Additionally milimetric purplish papules on flexor area of wrists were accompanied to other signs. In histopathological investigation of the biopsy from scalp and back lesions were demonstrated orthokeratosis on superficial layer of epidermis, vacuolar degeneration and exocytosis on basal layer of epidermis and basal layer of follicular epithelium, perifollicular infiltration of mix type inflammatory cells, a few pigmentation deposited macrophages. The patient was diagnosed as GLPLS based on these symptoms and signs. Early diagnosis and treatment of this chronic, progressive characterized, rare type of lichen planopilaris is important. Treatments modalities could stop progression and provide partial remission, although they can’t success complete improvement.

  20. 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.

  1. Axillary silicone lymphadenopathy presenting with a lump and altered sensation in the breast: a case report

    Directory of Open Access Journals (Sweden)

    Adams Simon T

    2009-03-01

    Full Text Available Abstract Introduction Silicone lymphadenopathy is a rare but recognised complication of procedures involving the use of silicone. It has a poorly understood mechanism but is thought to occur following the transportation of silicone particles from silicone-containing prostheses to lymph nodes by macrophages. Case presentation We report of a case involving a 35-year-old woman who presented to the breast clinic with a breast lump and altered sensation below her left nipple 5 years after bilateral cosmetic breast augmentations. A small lump was detected inferior to the nipple but clinical examination and initial ultrasound investigation showed both implants to be intact. However, mammography and magnetic resonance imaging of both breasts revealed both intracapsular and extracapsular rupture of the left breast prosthesis. The patient went on to develop a flu-like illness and tender lumps in the left axilla and right mastoid regions. An excision biopsy of the left axillary lesion and replacement of the ruptured implant was performed. Subsequent histological analysis showed that the axillary lump was a lymph node containing large amounts of silicone. Conclusion The exclusion of malignancy remains the priority when dealing with lumps in the breast or axilla. Silicone lymphadenopathy should however be considered as a differential diagnosis in patients in whom silicone prostheses are present.

  2. A pilot study of the efficacy of wipes containing chlorhexidine 0.3%, climbazole 0.5% and Tris-EDTA to reduce Malassezia pachydermatis populations on canine skin.

    Science.gov (United States)

    Cavana, Paola; Peano, Andrea; Petit, Jean-Yanique; Tizzani, Paolo; Perrot, Sébastien; Bensignor, Emmanuel; Guillot, Jacques

    2015-08-01

    Wipes containing chlorhexidine and azole derivates have been recommended for veterinary use. No study has been published about their activity against Malassezia pachydermatis. To evaluate the in vivo and in vitro activity of wipes soaked in a chlorhexidine, climbazole and Tris-EDTA solution against Malassezia pachydermatis. Five research colony shar-pei dogs. Wipes were applied once daily onto the left axilla, left groin and perianal area (protocol A), and twice daily on the right axilla, right groin and umbilical region (protocol B) for 3 days. In vivo activity was evaluated by quantifying Malassezia colonies through contact plates on the selected body areas before and after wipe application. The activity of the solution in which the wipes were soaked was assessed in vitro by contact tests following the European Standard UNI EN 1275 guidelines. Samples collected after wipe application showed a significant and rapid reduction of Malassezia yeast CFU. No significant difference in the Malassezia reduction was found between protocols A and B. In vitro assay showed 100% activity against Malassezia yeasts after a 15 min contact time with the wipe solution. Wipes containing chlorhexidine, climbazole and Tris-EDTA substantially reduced the M. pachydermatis population on the skin of dogs. The results, although this was an uncontrolled study performed on a small number of dogs, suggest that these wipes may be useful for topical therapy of Malassezia dermatitis involving the lips, paws, perianal area and skin folds. © 2015 ESVD and ACVD.

  3. 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.

  4. Topical niacinamide 4% and desonide 0.05% for treatment of axillary hyperpigmentation: a randomized, double-blind, placebo-controlled study.

    Science.gov (United States)

    Castanedo-Cazares, Juan Pablo; Lárraga-Piñones, Gabryela; Ehnis-Pérez, Adriana; Fuentes-Ahumada, Cornelia; Oros-Ovalle, Cuauhtemoc; Smoller, Bruce R; Torres-Álvarez, Bertha

    2013-01-01

    Axillary hyperpigmentation is a frequent cause of cosmetic consultations in dark-skinned women from tropical areas, including Latin America. Currently, there is no widely accepted treatment for the disorder, but it is usually treated with bleaching agents because it is considered a variant of inflammatory hyperpigmentation. The purpose of this study was to assess the efficacy of niacinamide 4% and desonide 0.05% emulsions compared with placebo in the treatment of axillary hyperpigmentation. Twenty-four women aged 19-27 years with hyperpigmented axillae (phototype III-V) were randomly assigned to receive the study treatments in the axillary region. Improvement was assessed at baseline, then clinically and by colorimetry 9 weeks later. Quantitative evaluation including melanin, inflammatory infiltrates, NKI/Beteb, CD1a, CD68, and collagen type IV content was performed by histochemistry and immunohistochemistry, assisted by computerized morphometric analysis. Both niacinamide and desonide induced significant colorimetric improvement compared with placebo; however, desonide showed a better depigmenting effect than niacinamide. A good to excellent response was achieved in 24% of cases for niacinamide, 30% for desonide, and 6% for placebo. We observed a marked disruption of the basal membrane in axillary hyperpigmentation and an inflammatory infiltrate that improved after treatment. Decreased pigmentation in the desonide-treated axillae was associated with recovery of disruption at the basal membrane. Niacinamide and desonide showed depigmenting properties in women with axillary hyperpigmentation. These findings may be explained by their antimelanogenic and anti-inflammatory properties, respectively.

  5. 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.

  6. Axillary local anesthetic spread after the thoracic interfacial ultrasound block - a cadaveric and radiological evaluation

    Directory of Open Access Journals (Sweden)

    Patricia Alfaro de la Torre

    Full Text Available Abstract Background Oral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and does not have a specific regional anesthesia technique published that offers its adequate blockade. Methods After institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane. Magnetic Resonance Imaging studies were then conducted in 15 of 34 patients scheduled for unilateral breast surgery that entailed any of the following: axillary clearance, sentinel node biopsy, axillary node biopsy, or supernumerary breasts, to ascertain the deposition and time course of spread of solution within the thoracic interfascial plane in vivo. Results Radiological and cadaveric studies showed that the injection of local anesthetic and methylene blue via the thoracic inter-fascial plane, using ultrasound guide technique, results in reliable deposition into the axilla. In patients, the injection of the local anesthetic produced a reliable axillary sensory block. This finding was supported by Magnetic Resonance Imaging studies that showed hyper-intense signals in the axillary region. Conclusions These findings define the anatomic characteristics of the thoracic interfascial plane nerve block in the axillary region, and underline the clinical potential of this novel nerve block.

  7. Study of Variations in the Branching Pattern of Lower Subscapular Nerve

    Science.gov (United States)

    Havaldar, Pavan Prahlad

    2014-01-01

    Background: Variations in the origin of lower subscapular nerve of the posterior cord of brachial plexus are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of origin show population differences. Data from the South Indian population is scarce. Objective: To describe the variations in the origin of the lower subscapular nerve of the posterior cord of brachial plexus in the South Indian population. Materials and Methods: Forty brachial plexuses from 20 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of lower subscapular nerve was recorded. Representative photographs were then taken using a digital camera (Sony Cyber shot R, W200, 7.2 Megapixels). Results: Lower subscapular nerves had origin from axillary nerve in 57.5% of specimens, in 37.5% specimens, it was originating from the posterior cord and in 5% of specimens it arose from common trunk. Conclusion: Lower subscapular nerves in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid in advertent injury. PMID:25584202

  8. What Makes Us Smell: The Biochemistry of Body Odour and the Design of New Deodorant Ingredients.

    Science.gov (United States)

    Natsch, Andreas

    2015-01-01

    Today, axilla odours are socially stigmatized and are targeted with deodorants and antiperspirants representing a multi-billion market. Axilla odours aren't simple byproducts of our metabolism but specifically formed by an intricate interplay between i) specific glands, ii) secreted amino acid conjugates of highly specific odorants and iii) selective enzymes present in microorganisms colonizing our skin, providing a natural 'controlled-release' mechanism. Within a multidisciplinary research project, we were able to elucidate the structure of key body odorants, isolate and characterize secreted amino acid conjugates and identify the enzymes responsible for odour release. These enzymes then served as targets for the development of specific active compounds in an almost medicinal chemistry approach, an approach rarely used in the cosmetic field so far. Here we review the key new insights into the biochemistry of human body odour formation, with some remarks on the experimental steps undertaken and hurdles encountered. The development of deodorant actives and the difficult path to market for such specifically acting cosmetic actives is discussed. The basic insights into the biochemistry also opened the way to address some questions in population genetics: Why have large proportions of Asians lost the 'ability' to form body odours? Do twins smell the same? Are our typical body odours indeed influenced by the immune system as often claimed? After addressing these questions, I'll conclude with the key remaining challenges in this field on an ecological niche that is 'anatomically very close to our heart'.

  9. Debating the mathematical model to validate the sentinel lymph biopsy techniques in breast cancer patients. The danger of bias and its practical implications.

    Science.gov (United States)

    Martinez-Ramos, David; Escrig-Sos, Javier; Alcalde-Sanchez, Miguel; Hoashi, Jane S; Salvador-Sanchis, Jose Luis

    2009-12-01

    Sentinel node biopsy (SNB) is an effective alternative to axillary lymph node dissection (ALD) for axillary staging. SNB (test) needs a validation period in which ALD (the gold standard) is always performed. Sensitivity, specificity and predictive values (PV) are used to define the accuracy of the procedure. We hypothesise that, during the period of validation, a bias is produced if the result of SNB is included as a part of the ALD. A hypothetical population of 350 patients was analysed. First analyses were performed by including the sentinel lymph node as a part of 'the rest of the axilla'. Second analyses were re-done according to our theory, and sentinel lymph node was considered outside 'the rest of the axilla'. Sensitivity, specificity and PV were compared for both models. First group (classic) - sensitivity: 94%; specificity: 100%; positive PV: 100%; negative PV: 97%. Second group (new proposed model) - sensitivity: 87%; specificity: 81%; positive PV: 44%; negative PV: 97%. The classic concept of sentinel lymph node to calculate sensitivity, specificity and positive PV can result in a bias. The magnitude of this bias will vary in terms of the obtained values, but its direction is always optimistic.

  10. Colonization by methicillin resistant staphylococci of nares and skin in healthcare workers: a pilot study in spinal surgeries.

    Science.gov (United States)

    Drago, Lorenzo; Cappelletti, Laura; Lamartina, Claudio; Berjano, Pedro; Mattina, Roberto; De Vecchi, Elena

    2015-12-01

    Staphylococcus aureus and coagulase-negative staphylococci (CoNS) colonization among healthcare workers (HCWs) may have implications in development of infections and in spreading of resistance. This study aimed to determine the rate of methicillin-resistant staphylococci carriage in HCWs of spinal surgeries in an Italian Orthopaedic Institute. Samples from nares, axillae and hands were inoculated onto appropriate media in order to perform colony counts of methicillin-susceptible and resistant S. aureus and CoNS. Prevalence of S. aureus and CNS was 42.3% and 98%, respectively. Methicillin-resistance was rather infrequent in S. aureus (13.5%) while it was detected in most of CoNS (90.4%). Methicillin resistant S. aureus were prevalently isolated from nares while axillae showed the highest methicillin-resistant CoNS colonization rates. A relatively high rate of methicillin resistant staphylococci was found among HCWs in spinal surgeries wards, thus evidencing the need for careful prevention measures and for periodic evaluation of spread among HCWs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Quantitative Lymphoscintigraphy to Predict the Possibility of Lymphedema Development After Breast Cancer Surgery: Retrospective Clinical Study.

    Science.gov (United States)

    Kim, Paul; Lee, Ju Kang; Lim, Oh Kyung; Park, Heung Kyu; Park, Ki Deok

    2017-12-01

    To predict the probability of lymphedema development in breast cancer patients in the early post-operation stage, we investigated the ability of quantitative lymphoscintigraphic assessment. This retrospective study included 201 patients without lymphedema after unilateral breast cancer surgery. Lymphoscintigraphy was performed between 4 and 8 weeks after surgery to evaluate the lymphatic system in the early postoperative stage. Quantitative lymphoscintigraphy was performed using four methods: ratio of radiopharmaceutical clearance rate of the affected to normal hand; ratio of radioactivity of the affected to normal hand; ratio of radiopharmaceutical uptake rate of the affected to normal axilla (RUA); and ratio of radioactivity of the affected to normal axilla (RRA). During a 1-year follow-up, patients with a circumferential interlimb difference of 2 cm at any measurement location and a 200-mL interlimb volume difference were diagnosed with lymphedema. We investigated the difference in quantitative lymphoscintigraphic assessment between the non-lymphedema and lymphedema groups. Quantitative lymphoscintigraphic assessment revealed that the RUA and RRA were significantly lower in the lymphedema group than in the non-lymphedema group. After adjusting the model for all significant variables (body mass index, N-stage, T-stage, type of surgery, and type of lymph node surgery), RRA was associated with lymphedema (odds ratio=0.14; 95% confidence interval, 0.04-0.46; p=0.001). In patients in the early postoperative stage after unilateral breast cancer surgery, quantitative lymphoscintigraphic assessment can be used to predict the probability of developing lymphedema.

  12. Experimental study of hypoxia-imaging agent 99mTc-HL91 in mice bearing glioblastoma G422

    International Nuclear Information System (INIS)

    Zhou Ying; Qu Wanying; Yao Zhiming; Chen Fang; Zhu Ming; Zhu Lin

    1999-01-01

    Objective: To evaluate the ability of detecting cerebral tumor by 99m Tc-HL91 in mice bearing glioblastoma G422. Methods: Six model mice underwent static whole body planar imagings at once and at 1,2,3,4,6,7,8 h postinjection of 99m Tc-HL91. Three mice each were killed at 4 h and 8 h, respectively. the tumor, blood and organs were removed, weighted and the radioactivity was measured. ROIs were drawn around tumor, head, contralateral axilla and chest in whole body planar images, and the radioactivity ratios of tumor to head (T/H), contralateral axilla (T/A) and chest (T/C) were calculated. Results: Increased tumor activity was identified in static whole body planar images since 1 h postinjection. At 2h postinjection, T/H, T/A and T/C were 2.93 +- 0.51, 4.86 +- 0.79 and 2.00 +- 0.35 respectively, which were significantly higher than those at once and at 1h postinjection (P 99m Tc-HL91 in tumor tissue of mice bearing glioblastoma G422 is increased and clearance rate is decreased. 99m Tc-HL91 imaging is suitable for glioblastoma at 2 h postinjection. It is appropriate to image tumors in head, neck, thorax, bone and soft tissues, but not in abdominal area

  13. 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)

  14. EFFECTIVENESS OF EARLY STRETCHING EXERCISES FOR RANGE OF MOTION IN THE SHOULDER JOINT AND QUALITY OF FUNCTIONAL RECOVERY IN PATIENTS WITH BURNS - A RANDOMIZED CONTROL TRIAL

    Directory of Open Access Journals (Sweden)

    Amara D. Perer

    2017-10-01

    Full Text Available Background: This study evaluated the effects of an early stretching exercises programme on the range of motion of the shoulder joint and functional recovery in patients with burns. Methods: A randomized controlled study was conducted. Patients from 15 to 55 years of age with a total burn injury surface area (TBSA of 10% to 45% involving the shoulder joint including axilla were eligible. Participants were randomized into two groups; intervention and a usual care control group, with 110 patients in each group. A standardized protocol was used in the management of intervention group for 14 days. The control group was subjected to usual protocol currently used. The range of Motion (ROM was measured, and Functional recovery (FR was assessed with the Quick DASH questionnaire and the Abduction Ladder. Data were obtained before and after the intervention phase and at 3, 6 and 12 months of post-burn period. Results: The mean (SD age of intervention group and control group were 29.76 [9.81] and 30.31 [9.45] respectively. The mean (SD TBSA% of intervention group and control group was 26.15[9.45] and 24.60[9.56] respectively. There is a significant beneficial difference (p=<0.0001 in ROM and FR between the intervention group and the control group. Conclusion: This study demonstrated that an early sustained stretching exercise regime significantly improved the ROM and functional recovery of the shoulder joint after a severe burn involving the axilla.

  15. 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)

    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; Teles, Veronica Goes

    2014-01-01

    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)

  16. The detection of axillary lymph node metastases from breast cancer by radiolabelled monoclonal antibodies: a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Tjandra, J.J. (Melbourne Univ., Parkville (Australia) Royal Melbourne Hospital, Parkville (Australia)); Sacks, N.P.M.; Thompson, C.H. (Melbourne Univ., Parkville (Australia)) (and others)

    1989-02-01

    Two murine monoclonal antibodies that react with human breast cancer (3E1.2 and RCC-1) were labelled with {sup 131}iodine, and the radiolabelled antibody was injected into 40 patients, 36 of whom had breast cancer and the remaining four of whom had fibroadenoma (the normal, contralateral axilla was used as a control). Immunoscintigraphy had an overall sensitivity of 33% (23% with {sup 131}I-3E1.2 and 5% with {sup 131}I-RCC-1) for the detection of lymph node metastases and a specificity of 63% (67% with {sup 131}I-3E1.2 and 60% with {sup 131}I-RCC-1) with problems of non-specific uptake by presumably normal lymph nodes. The results of immunoscintigraphy obtained with {sup 131}I-RCC-1 (IgG) were superior to {sup 131}I-3E1.2 (IgM) although the accuracy of immunoscintigraphy using {sup 131}I-RCC-1 (56%) was not much better than preoperative clinical assessment (50%). However, there were cases when immunoscintigraphy using radiolabelled antibody (IgM or IgG) detected axillary lymph node metastases not suspected by clinical examination. Thus it appears that while immunoscintigraphy may be a useful adjunct to preoperative clinical assessment and is simple and safe, a major improvement in its accuracy is needed before it can replace axillary dissection and histological examination in the accurate staging of axilla in breast cancer. (author).

  17. Review of the role of the sentinel node biopsy in neoadjuvant chemotherapy in women with breast cancer and negative or positive axillary node at diagnosis.

    Science.gov (United States)

    Ruano Pérez, R; Rebollo Aguirre, A C; García-Talavera San Miguel, P; Díaz Expósito, R; Vidal-Sicart, S; Cordero García, J M; Carrera Salazar, D; Rioja Martín, M E

    The role of the selective sentinel node biopsy (SNB) is increasing in relevance in breast cancer women with indication of neoadjuvant chemotherapy (NAC). The Radiosurgery Working Group of the SEMNIM is aware of the necessity of establishing the need for SNB before or after NAC, and also how to manage patients with axillary node-negative or node-positive. There is sufficient data to assess that the SNB with radioisotope techniques are feasible and safe in all these scenarios. An adequate axilla evaluation prior to surgery and the possibility of marking prior to NAC the nodes infiltrated must be the two main pillars to guarantee the success of the SNB. It has been shown that to incorporate the SNB in breast cancer women with indication of NAC increases the rate of a conservative treatment of the axilla that will be a clear benefit for these patients. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  18. Long-term Comparison of a Large Spot Vacuum Assisted Handpiece vs the Small Spot Size Traditional Handpiece of the 800 nm Diode Laser.

    Science.gov (United States)

    Youssef, Nour J; Rizk, Alain G; Ibrahimi, Omar A; Tannous, Zeina S

    2017-09-01

    BACKGROUND The 800 nm long-pulsed diode laser machine is safe and effective for permanent hair reduction. Traditionally, most long-pulsed diode lasers used for hair removal had a relatively small spot size. Recently, a long-pulsed diode laser with a large spot size and vacuum assisted suction handpiece was introduced. The treatment parameters of each type of handpiece differ. Short and long-term clinical efficacy, treatment associated pain, and patient satisfaction are important factors to be considered. This study aims to conduct a direct head to head comparison of both handpieces of the 800nm long-pulsed diode laser by evaluating long term hair reduction, treatment associated pain and patient satisfaction. Thirteen subjects were enrolled in this prospective, self-controlled, single-center study of axillary laser hair removal. The study involved 4 treatments using a long pulsed diode laser with a large spot size HS handpiece (single pass), HS handpiece (double pass), and a small spot size ET handpiece according to a randomized choice. The treatment sessions were done at 4-8 week intervals with follow up visits taken at 6 and 12 months after the last treatment session. Hair clearance and thickness analysis were assessed using macro hair count photographs taken at baseline visit, at each treatment session visit and at follow up visits. Other factors including pain, treatment duration, and patients' preference were secondary study endpoints. At 6 months follow up visits after receiving four laser treatments, there was statistically significant hair clearance in the three treatment arms with 66.1 % mean percentage hair reduction with the ET handpiece, 43.6% with the HSS (single pass) and 64.1 % with the HSD (double). However, at one year follow up, the results significantly varied from the 6 months follow up. The mean percentage hair reduction was 57.8% with the ET handpiece treated axillas (n=9), 16.5% with the HSS (single pass) handpiece treated axillas (n=7), and

  19. Fibroadenoma in Axillary Supernumerary Breast in a 17-Year-Old Girl: Case Report.

    Science.gov (United States)

    Surd, Adrian; Mironescu, Aurel; Gocan, Horatiu

    2016-10-01

    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. However, cases of polymastia have been recorded in the face, vulva, and perineum. The clinical significance of these anomalies include their susceptibility to inflammatory and malignant changes, and their association with other congenital anomalies of the urinary and cardiovascular systems. In this article we report a case of fibroadenoma that developed in the supernumerary breast of the right axilla in a 17-year-old girl. It is uncommon to find such palpable masses in young patients. Clinical and sonographic examination of both breasts revealed no abnormalities and no lymph nodes were detected in the axillae or the neck. No associated urologic or cardiovascular abnormalities were found, and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated intracanalicular type of fibroadenoma similar to that of eutopic mammary tissue. In this report, we describe a rare case of fibroadenoma in an accessory breast in a young woman. There are a fewer than 40 reports in the world about this subject, of which differential diagnoses include: cancer in axillary supernumerary breast, hidradenitis, axillary lymphadenomegaly, lipomas, anexial cutaneous neoplasia, cysts, and phylloides tumor. The combination of clinical examination, ultrasound, and cytology leads to adequate treatment, especially surgical. The diagnosis could be confused because of findings from cytology. In this case, because of the clinical and sonographic findings and multiple differential diagnosis, only the histopathological study was used to confirm the diagnosis. Despite its high sensitivity, cytology has low specificity and could create false positive results. However, atypical lesions can be seen in fibroadenomas, especially in younger patients, pregnant patients, and in patients who use hormonal

  20. Is compensatory hyperhidrosis after thoracic sympathicotomy in palmar hyperhidrosis patients related to the excitability of thoracic sympathetic ganglions?

    Science.gov (United States)

    Chen, Jun-Peng; Peng, A-Jing; Xu, Chen-Hui; Li, Guo-Ying

    2017-01-01

    Background The mechanism of compensatory hyperhidrosis remains unclear. The aim of this study was to explore the relationship between compensatory hyperhidrosis and thoracic sympathetic ganglion excitability to assess the effectiveness of thoracoscopic T4 sympathicotomy for treating palmar hyperhidrosis. Methods Sixty-six cases of T4 sympathetic ganglions were prospectively collected from patients with palmar hyperhidrosis who underwent thoracoscopic T4 sympathicotomy from 2013 to 2016 in our department. The expression levels of choline acetyltransferase (ChAT), vasoactive intestinal peptide (VIP), and synaptophysin were detected using immunohistochemistry. Patients with palmar hyperhidrosis were followed-up for examination of postoperative sweating status. Results Thirty-eight cases (57.6%) of compensatory hyperhidrosis were identified. Mild compensatory hyperhidrosis occurred in 26 patients (39.4%), moderate in 11 (16.7%), and severe in 1 (1.5%). The rate of compensatory hyperhidrosis was higher in patients with axilla hyperhidrosis than those without (76.0% vs. 46.3%, P=0.018). However, the clinical data were similar between the compensatory hyperhidrosis group and the no compensatory hyperhidrosis group. In addition, the ChAT, VIP, and synaptophysin expression levels were not significantly different between the two groups (P values of 0.356, 0.071, and 0.141, respectively). Furthermore, the ChAT, VIP, and synaptophysin expression levels in the mild group were similar to those observed in the moderate/intense group (P values of 0.089, 0.124, and 0.149, respectively). The remission rate was 100% in palmar hyperhidrosis, 48.2% (27/56) in pedal hyperhidrosis, 56.0% (14/25) in axilla hyperhidrosis and 88.9% (16/18) in skin symptoms. No signs of chapped skin on the palms were found. Conclusions There was no significant correlation between compensatory hyperhidrosis and thoracic sympathetic ganglion excitability; however, compensatory hyperhidrosis is more likely to

  1. An Atypical Localized Form of Hidradenitis Suppurativa of the Jawline and Neck Mimicking Severe Cystic Acne on Presentation.

    Science.gov (United States)

    Castrillón Velásquez, María Adriana; Kim, Minhee; Tan, Mei-Heng; Tran, Kim; Murrell, Dedee F

    2017-10-01

    Hidradenitis suppurativa (HS) is a chronic and debilitating suppurative disease primarily affecting the axillae, perineum, and inframammary regions, where apocrine sweat glands are present. However, HS can occur in atypical locations. We present an interesting case of a 40-year-old man who developed chronic painful subcutaneous nodules, deep sinus tracts, and abscesses involving the jawline and the anterior aspect of the neck as the only parts of the body affected and who responded satisfactorily to adalimumab and laser hair removal treatment. This case is relevant because it helps clinicians to remember that HS may be isolated to atypical locations, such as the anterior aspect of the neck and chin. It also supports another possible HS pathogenesis which consists of the occlusion of terminal hair follicles rather than being essentially a disorder of the apocrine glands.

  2. HIGH ORIGIN OF SUPERFICIAL ULNAR ARTERY- A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Anjana Jayakumaran Nair

    2017-03-01

    Full Text Available BACKGROUND High origin and superficially placed ulnar artery is a rare anatomical variant that usually arises either in the axilla or arm and runs a superficial course in the forearm, enters the hand and participates in the formation of superficial palmar arch. During routine dissection of cadavers in our department, we observed a unilateral case of high origin and superficial ulnar artery in a human male cadaver. It originated from the brachial artery in the lower third of arm 4 cm above its bifurcation. From its origin, it passed downwards along the medial aspect of forearm, superficial to the flexors, entered hand superficial to the flexor retinaculum and formed superficial palmar arch. The knowledge of existence of a superficial ulnar artery is important during vascular and reconstructive surgery and also in evaluation of angiographic images. Superficial position makes it more vulnerable to trauma and more accessible to cannulation.

  3. A horn shaped air-cooled 300 MHz applicator for use in single field or parallel opposed phased system (POPAS)

    International Nuclear Information System (INIS)

    Bicher, H.I.; Moore, D.W.

    1985-01-01

    A 20cm x 23cm standard design 300 MHz horn waveguide may be used to heat tumors at moderate depth. The heating patterns have been observed using two such applicators excited in phase in parallel opposition about phantoms and living subjects. Both depth and homogeneity of heating profiles were greatly enhanced using the parallel opposed system by the convergence of the waveforms. Experiments performed in pigs and human volunteers show the feasibility of heating several anatomical regions. The pelvis, neck, axilla, limbs and single lung regions provide good candidates for this treatment method. The homogeneity of and treatment accessibility of in vivo fields and counterplay of high and low blood flow regions in normal and tumorous tissue are currently under study

  4. 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.

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

    Science.gov (United States)

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

    2010-07-01

    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 the hand was performed. In the post anesthesia care unit, the radial pulse of the left hand was palpable and the level of oxygen saturation was normal. Forearm and hand edema subsided gradually over several days and the patient was discharged with full function of her left arm. This compartment syndrome suggests careful attention should be paid to the position of the chest roll when the prone position is established for a long duration.

  6. 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. Copyright © 2012 John Wiley & Sons A/S.

  7. Fibroadenoma in axillary supernumerary breast: case report

    Directory of Open Access Journals (Sweden)

    Délio Marques Conde

    Full Text Available CONTEXT: Supernumerary breast tissue may be affected by the same diseases and alterations that compromise topical breast tissue. Nevertheless, reports of fibroadenoma in supernumerary breast tissue in the axillae are rare. OBJECTIVE: To describe a case of fibroadenoma in an axillary supernumerary breast. DESIGN: Case report. CASE REPORT: A 39-year-old woman was referred to the gynecology and obstetrics outpatient clinic at Hospital Estadual Sumaré, complaining of bilateral axillary masses. The patient reported cosmetic problems and local pain and discomfort. On physical examination, alterations compatible with bilateral axillary accessory breasts, without palpable nodules, were observed. Supplementary examinations (mammography and ultrasonography revealed a 1.1 cm mass in the right axillary breast. The patient underwent resection of the supernumerary breasts and histopathological examination revealed fibroadenoma of the right axillary breast tissue.

  8. Congenital cutis laxa with rectal and uterovaginal prolapse

    Directory of Open Access Journals (Sweden)

    Sanjiv V Choudhary

    2011-01-01

    Full Text Available A two-month-old female infant born of a consanguineous marriage, presented with loose, wrinkled and inelastic skin over the neck, axillae, trunk, inguinal region and thighs with slow elastic recoil. Patient also had systemic manifestations in the form of bilateral apical lobe consolidation of lung, bilateral inguinal hernia, rectal and uterovaginal prolapse. Histopathological examination of skin biopsy with special stain for elastic tissue revealed absence of dermal elastic tissue. Genital abnormalities in patients with congenital cutis laxa have been reported rarely. But rectal and uterovaginal prolapse have not been reported at an early age of two months. In the absence of mutational screening, with history and clinical findings our case is likely to be Type I autosomal recessive form of congenital cutis laxa.

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

    International Nuclear Information System (INIS)

    Choi, Ji In; Kim, Soo Jin; Park, Sung Hee; Kim, Hee Sung

    2014-01-01

    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.

  10. Neurothekeoma palpebrae in association with multiple superficial angiomyxomas: Tegumental Angiomyxoma- Neurothekeoma syndrome (TAN syndrome

    Directory of Open Access Journals (Sweden)

    Tan Aik Kah

    2011-09-01

    Full Text Available We report a case of 10-year-old Indian girl with history of multiple superficial angiomyxoma, presented with three months history of painless right upper lid swelling. There were no visual dysfunctions. Previously, the patient had multiple superficial angiomyxoma (left pinna, left upper cheek, left upper limb, chest, right axilla, hard palate and epidermal cyst (chin. The histopathological specimens were negative to S-100 protein antibody. Systemic review and family history was unremarkable. Excision biopsy and upper lid reconstruction were performed. Intraoperatively the tumor was multilobulated, firm, well encapsulated and did not invade the underlying tarsal plate. Histopathological features of the upperlid tumor were consistent with nerves sheath myxoma (neurothekeoma. To the best of the authors’ knowledge, this is the first reported case of neurothekeoma in association with multiple superficial angiomyxoma.

  11. A CASE OF SUBCUTANEOUS PHAEOHYPHOMYCOSIS CAUSED BY EXSEROHILUM SPECIES IN AN IMMUNOCOMPROMISED PATIENT

    Directory of Open Access Journals (Sweden)

    Koppada Rajasekhar

    2013-10-01

    Full Text Available Phaeohyphomycoses are rare fungal infections, caused by dematiaceous fungi, manifested as cutaneous and subcutaneous infections, meningitis, sinusitis, keratitis, osteomyelitis and disseminated infection. This is a case report of a 45year old immuno compromised female on ART (Anti Retroviral therapy presented with fever and generalized nodular lesions draining pus on face, hands, axilla, groin and labia majora since one month. Biopsy of the subcutaneous nodule on the lateral aspect of the thigh revealed septate fungal hyphae on 10% KOH (10% Potassium Hydroxide mount. Fungal culture of the biopsy material on SDA (Sabouraud’s Dextrose Agar at 250C showed cotton wooly, dark gray to olivaceous black growth with black reverse and identified as dematiaceous fungi belonging to Exserohilum species by microscopy. The patient was put on Itraconazole 200mg BD in combination with Terbinafine 250mg BD for which she responded with healing of pustular lesions in two weeks and complete remission in two months..

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

    Science.gov (United States)

    Luz, Júlia Lins; Costa, Luciana de Moraes; Gomes, Luiz Antonio Costa; Esbérard, Carlos Eduardo Lustosa

    2009-07-01

    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.

  13. Congenital fibrous hamartoma of the knee

    International Nuclear Information System (INIS)

    Arioni, Cesare; Bellini, Carlo; Risso, Francesco Maria; Scopesi, Fabio; Serra, Giovanni; Oddone, Mauro; Toma, Paolo; Nozza, Paolo

    2006-01-01

    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.)

  14. Alternatives to hexachlorophene bathing of newborn infants.

    Science.gov (United States)

    Hnatko, S. I.

    1977-01-01

    In controlled trials newborn infants were bathed with Lactacyd, pHisoHex, Hibitane, Lanohex or tap water. Bacteriologic samples were taken from three sites (groin, axilla and cord) immediately after birth, following an initial bath with one of the test agents, and on day 3 or 5 after a water bath. Initial bathing with all agents, including water, reduced the concentration of bacteria on the skin to a similar extent. However, comparisons of bacterial flora at birth versus those on days 3 and 5 indicated differences in the actions of the various agents on pathogenic and nonpathogenic organisms. Lactacyd and Hibitane appeared to be suitable alternatives to hexachlorophene in the control of pathogenic bacteria on the skin of newborns. However, their absorption and toxicity in the newborn are unknown and, unless use of a skin disinfectant is warranted, routine bathing of newborns with tap water appears to be satisfactory. PMID:328126

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

    International Nuclear Information System (INIS)

    Park, Ji Sun; Lee, Ah Young; Bae, Sang Gyun; Lee, Seok Mo

    2010-01-01

    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. 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

  16. In-situ and invasive carcinoma within a phyllodes tumor associated with lymph node metastases

    Directory of Open Access Journals (Sweden)

    Ross Joan

    2004-12-01

    Full Text Available Abstract Background Phyllodes tumors (cystosarcoma phyllodes are uncommon lesions in the female breast. Rarely, the occurrence of carcinoma within a phyllodes tumor has been reported in the literature, but has never been associated with lymph node metastases. Case presentation A 26-year-old woman presented with a firm, mobile, non-tender mass in the left breast and palpable lymph nodes in the left axilla. The excised lesion appeared well circumscribed and lobulated, with variable fleshy and firm areas. Microscopic examination showed a circumscribed fibroepithelial lesion with a well developed leaf-like architecture, in keeping with a benign phyllodes tumor. The epithelial component showed extensive high grade ductal carcinoma in-situ (DCIS and invasive carcinoma of no special type, located entirely within the phyllodes tumor. Subsequent axillary lymph node dissection revealed metastatic carcinoma in four lymph nodes. Conclusions Although rare, phyllodes tumors may harbor DCIS and invasive carcinoma, with potential for lymph node metastasis.

  17. A case of sarcoma of the chest wall after radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Izumi, Junko; Nishi, Tsunehiro; Fukuuchi, Atsushi; Takanashi, Riichiro

    1998-01-01

    A case of radiation-induced sarcoma of the chest wall after radiation therapy for breast cancer is reported. A 69-year-old woman underwent mastectomy with axillary lymph node dissection followed by linac therapy of 50 Gy delivered to the left axilla, left supraclavicular area, and parasternal area. During therapy for bone and liver metastases, a tumor was noted in the left chest wall 15 years after radiation therapy. Incisional biopsy was performed. Histological diagnosis was spindle cell sarcoma. Radiation-induced sarcoma was suspected because the tumor developed 15 years after radiation therapy within the same area. Radiation-induced sarcoma is a rare tumor, but radiation therapy following breast-conserving therapy is widely employed. It is important to be aware of the possibility of radiation-induced sarcoma. (author)

  18. Extrafacial Granuloma Faciale: A Case Report and Brief Review

    Directory of Open Access Journals (Sweden)

    Jacqueline Deen

    2017-07-01

    Full Text Available Granuloma faciale (GF is a rare, inflammatory, cutaneous disorder of unknown aetiology. It presents clinically as one or several well-circumscribed violaceous papules, plaques, and nodules almost exclusively confined to the facial region. Rarely, extrafacial lesions can occur, most often on sun-exposed sites. We report a case of extrafacial GF in a 63-year-old male with indolent lymphoma, who presented with plaques involving the right preauricular region and left posterior axilla. The clinical and histopathological findings were consistent with GF. Our case highlights the importance of performing skin biopsies in patients with persistent erythematous plaques and nodules, particularly to exclude important malignant and granulomatous differential diagnoses.

  19. Precision of the CAESAR Scan-Extracted Measurements

    Science.gov (United States)

    2006-05-01

    Biacromial breadth 8 5.0* 0.83 6.0* 0.78 Bi- cristale breadth 2.4 0.34 3.7 0.45 Bi-spinous breadth 3 2.1* 0.30 2.8 0.37 Bigonial breadth 2.4 0.38 3.0 0.66...1345.2 14.8 0.3 1341.8 24.4 0.4 Axilla height, right 1337.9 11.1 0.3 1325.5 24.2 0.4 Biacromial breadth 382.7 23.7 1.3 376.9 28.9 1.4 Bi- cristale breadth

  20. [Gastrocolic omental cyst in an adult: Case presentation and review of literature].

    Science.gov (United States)

    Serrano-Rodríguez, Pablo; Desai, Chirag Sureshchandra

    Mesenteric lymphangioma are rare tumours. They usually present early on in life, if congenital, or soon after trauma. The usual sites of presentation of lymphangiomas are in the neck, and axillae. In the abdomen they are more common in the mesentery, primarily of the ileum, or retroperitoneal. A rare case is presented of a mesenteric lymphangioma. It involves an elderly African-American male, many years after trauma, and characterised with early satiety, causing weight loss, but without gastric outlet obstruction or vomiting. Its diagnosis, management and review of literature are presented. Mesenteric cysts are rare tumours that should be included as differential diagnosis in elderly patients with a history of previous abdominal trauma. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  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.

  2. Noninvasive diagnosis of axillary node metastases with monoclonal antibody lymphoscintigraphy

    International Nuclear Information System (INIS)

    Fig, L.M.; Von Moll, L.; Brown, R.; Harness, J.; Appleman, H.; Stevens, R.; Johnson, J.W.; Mudgett, E.; Colcher, D.; Schlom, J.; Lichter, A.; Wicha, M.; Wahl, R.L.

    1989-01-01

    This study was undertaken to determine whether 131-I labeled B72.3 monoclonal antibody, when injected subcutaneously in patients with known breast cancer, successfully detects lymph node metastases. Eleven women with biopsy-proven B72.3 antibody-reactive breast cancer (determined by immunoperoxidase staining) received subcutaneous injections of 500 μ Ci 131-I B72.3 in ipsilateral finger web spaces (or, in three cases, intralesional injections into the site of the breast tumor). The antibody is a IgGlk reactive with a high molecular weight antigen found on most breast carcinomas. Images of the axilla were obtained immediately after injection and serially to 72 hours. Nodal uptake was scored on a 0-3+ scale in a blinded fashion and correlated with pathologic findings from lymph node dissection

  3. Adult Seborrheic Dermatitis

    Science.gov (United States)

    2011-01-01

    Seborrheic dermatitis is a common chronic-recurrent inflammatory disorder that most commonly affects adults; however, a more transient infantile form also occurs. The definitive cause of seborrheic dermatitis is unknown. However, proliferation of Malassezia species has been described as a contributing factor. The adult form of seborrheic dermatitis affects up to approximately five percent of the general population. The disorder commonly affects the scalp, face, and periauricular region, with the central chest, axillae, and genital region also involved in some cases. Pruritus is not always present and is relatively common, especially with scalp disease. A variety of treatments are available including topical corticosteroids, topical antifungal agents, topical calcineurin inhibitors, and more recently, a nonsteroidal “device ”cream. This article reviews the practical topical management of seborrheic dermatitis in the United States, focusing on the adult population. PMID:21607192

  4. 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.

  5. 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.

  6. [Interdisciplinary surgery of the thorax-from the general surgeon's point of view].

    Science.gov (United States)

    Izbicki, J R; Yekebas, E; Kastl, S

    2004-04-01

    Interdisciplinary professional management is the most important basic principle for successfully mastering thoracic operations including the thoracic wall and adjacent regions such as neck, axilla, mediastinal vessels, upper limb, and spine. Extended oncological resection in advanced malignant diseases, side-effects of radiotherapy and trauma explain the diversity of possible operative procedures. For technical success, the necessity of vascular grafting, reconstruction of the brachial plexus, spine surgery, cardiac surgery, plastic thoracic wall reconstruction, stabilization of the thoracic wall, modern equipment, and know-how are mandatory. We chose some show-cases which-in our opinion-might be appropriate for demonstrating interdisciplinary therapy management. Functional, oncological, and cosmetic/reconstructive aspects should be considered when approaching these cases.

  7. Pathophysiology and Treatment of Hyperhidrosis.

    Science.gov (United States)

    Fujimoto, Tomoko

    2016-01-01

    Primary focal hyperhidrosis is a disease of unknown cause with profuse perspiration of local sites (head, face, palms, soles of feet, and axillae) that adversely affects daily life. Guidelines have been proposed in the USA [1], Canada [2], and Japan [3]. The symptoms impair quality of life, with significant negative effects on daily existence and personal relationships. The current goal in medical practice for patients with hyperhidrosis is to provide guidance and encourage coping skills for a normal daily life, as well as give appropriate advice regarding treatment options. On occasion, in order to improve quality of life, it is necessary to recommend surgical therapy when conservative treatment fails; this requires an understanding of the mechanisms of available treatments and their effects. This paper reviews theories of primary focal hyperhidrosis with regard to pathology, epidemiology, and treatment. © 2016 S. Karger AG, Basel.

  8. Bilateral ultrasound-guided supraclavicular block in a patient with severe electrocution injuries of the upper extremities.

    Science.gov (United States)

    Gelpi, Brian; Telang, Pavan R; Samuelson, Christian G; Hamilton, Craig S; Billiodeaux, Seth

    2014-01-01

    The performance of bilateral supraclavicular brachial plexus nerve blocks is controversial. We present the challenging case of a 29-year-old male who suffered bilateral high-voltage electrocution injuries to the upper extremities, resulting in severe tissue damage, sensory and motor deficits, and wounds in both axillae. This injury necessitated bilateral below-elbow amputations. His postoperative course was complicated by pain refractory to intravenous narcotics. The decision was made to attempt bilateral supraclavicular brachial plexus blocks. Our concerns with this approach included the risks of pneumothorax and respiratory failure due to phrenic nerve block. Initial attempts at brachial plexus blockade using nerve stimulation were unsuccessful; therefore, ultrasound guidance was employed. With vigilant monitoring in an intensive care unit setting, we were able to safely perform bilateral continuous supraclavicular brachial plexus nerve blocks with an excellent analgesic response and no noted complications.

  9. 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.

  10. Petrus Camper: A history and overview of the clinical importance of Camper's fascia in surgical anatomy.

    Science.gov (United States)

    Mian, Asma; Bertino, Frederic; Shipley, Erik; Shoja, Mohammadali M; Tubbs, R Shane; Loukas, Marios

    2014-05-01

    Petrus Camper's contributions to modern anatomical science include descriptions of the foot, upper limb, axilla, and inguinal region. His explanation of the etiology of inguinal hernias revolutionized the surgical practice of their repair. Camper's description of abdominal anatomy was an invaluable contribution to the field of abdominal surgery. Current research reviewed in this article shows the importance of understanding the layers of the abdominal wall, notably Camper's fascia, the closure of which has been found to be vital to proper wound healing and patient recovery. This article begins with a biography of Petrus Camper and his research in the inguinal region. It continues with anatomical and histological descriptions of Camper's fascia and finishes with its clinical correlates in surgical practice. Copyright © 2013 Wiley Periodicals, Inc.

  11. 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.

  12. Encephalocraniocutaneous lipomatosis: A rare neurocutaneous syndrome

    Directory of Open Access Journals (Sweden)

    Gokhale N

    2007-01-01

    Full Text Available Encephalocraniocutaneous lipomatosis is a congenital hamartomatous disorder with unique ocular, cutaneous and neurological features. A 13-year-old boy presented with history of mental retardation and delayed developmental milestones. Bulbar conjunctiva of left eye showed hypertrophy with a soft reddish limbal nodule encroaching on the cornea. Dermatological examination showed multiple patches of alopecia, soft papules in the left perioral and periorbital areas, soft masses over the right axilla, trunk and in the lumbosacral region suggestive of lipomas. The CT scan of the brain revealed well-defined, hypodense lesions in both the cerebellar hemispheres suggestive of lipomas. The constellation of these findings led us to a diagnosis of encephalocraniocutaneous lipomatosis.

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

    International Nuclear Information System (INIS)

    Warren, Laura E.G.; Punglia, Rinaa S.; Wong, Julia S.; Bellon, Jennifer R.

    2014-01-01

    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

  14. 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.

  15. 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

  16. Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID)

    DEFF Research Database (Denmark)

    Zimakoff, J; Bangsgaard Pedersen, F; Bergen, L

    1996-01-01

    A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age......, diagnosis, number of months in dialysis, hospital and ward were registered on a precoded form. Standardized nose and four skin swabs (axillae, groins, perineum) were performed on the first day of the survey. After one and two months, nose swabs were collected. Infections were registered and cultures were.......4 and 4.7%). Approximately one third (36.6 and 40.7%) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5%) than non-diabetics (55.0%), the incidence of infection was much higher (26.3% vs. 10.3%, P = 0.004). In CAPD, peritonitis and tunnel...

  17. The Relationship Between Sensory Loss and Persistent Pain 1 Year After Breast Cancer Surgery

    DEFF Research Database (Denmark)

    Andersen, Kenneth Geving; Duriaud, Helle Molter; Kehlet, Henrik

    2017-01-01

    Moderate to severe persistent pain after breast cancer surgery (PPBCS) affects 10 to 20% of the patients. Sensory dysfunction is often concomitantly present suggesting a neuropathic pain state. The relationship between various postoperative pain states and sensory dysfunction has been examined......, mechanical pain threshold, and thermal thresholds. Two hundred ninety patients were enrolled and results showed that 38 (13%) had moderate to severe pain and 246 (85%) had hypoesthesia in the surgical area 1 year after surgery. Increased hypoesthesia areas were associated with pain at rest as well as during...... movement (P = .0001). Pain during movement was associated with a side-to-side difference of 140% (P = .001) for tactile detection threshold and 40% (P = .01) for mechanical pain threshold as well as increased thermal thresholds in the axilla (P > .001). Logistic regression models controlling...

  18. Unusual Sites of Cutaneous Tuberculosis: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Dimple Chopra

    2017-01-01

    Full Text Available Cutaneous tuberculosis (CTB is an uncommon small subset of extrapulmonary tuberculosis, comprising 1–1.5% of all extrapulmonary tuberculosis manifestations, which manifests only in 8.4–13.7% of all tuberculosis cases. Lupus vulgaris (LV and tuberculosis verrucosa cutis (TBVC are forms of reinfection tuberculosis and often occur in presensitized patients, by exogenous inoculation. We report two cases of cutaneous tuberculosis at unusual sites. A 35-year-old female having a forehead lesion for 2 years was diagnosed as having tuberculosis verrucosa cutis and another 16-year-old girl with lesion in left axilla for 10 years was proven to have lupus vulgaris. The delayed diagnosis was possibly due to lower clinical suspicion due to the presentation of CTB at unusual sites. This highlights the importance of keeping TB as an important differential as misdiagnosis or delayed diagnosis of this entity can lead to prolonged morbidity.

  19. Scrofuloderma associated with lupus vulgaris and tuberculosis verrucosa cutis in an immunocompetent boy

    Directory of Open Access Journals (Sweden)

    Angoori Gnaneshwar Rao

    2016-01-01

    Full Text Available Cutaneous tuberculosis is protean and diverse in its clinical manifestations, it usually manifests as a single clinical morphological form. However, three different morphological forms of cutaneous tuberculosis such as scrofuloderma (SFD, lupus vulgaris (LV, and tuberculosis verrucosa cutis (TVC may coexist in the same patient. Herein, we present coexistence of SFD, LV, and TVC in a 14-year-old boy, initially developed SFD in the left axilla and subsequently developed LV of the left elbow followed by TVC involving pubic region. Typical clinical morphology and epithelioid cell granuloma with Langhans giant cells on histopathological examination of the biopsy taken from the plaque of elbow and pubic region corroborated in establishing the diagnosis of SFD, LV, and TVC. The considerable clinical improvement was observed after 12 weeks of instituting four drugs antitubercular treatment.

  20. 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.

  1. Slow growing desmoid-type fibromatosis of the breast: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ah Reum; Kim, Ji Young; Kim, Hyun Jung; KIm, Jae Hyung; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Soo Hyun; Kang, Mi Jin; Lee, Ji Hae; Bae, Kyung Eun [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    Fibromatosis or desmoid tumor of the breast is a rare benign entity that has no metastatic potential but has significant risk of local recurrence. Its association with previous surgical or accidental trauma and Gardner's syndrome has been reported. Awareness of this lesion is important as the diagnosis is often confused with breast carcinoma. We report a case of a 44-year-old woman who presented with a palpable mass in her left breast, close to the axilla since a few months ago. She had undergone excisional biopsy for her left breast mass 15 months ago, and the diagnosis was confirmed as intraductal papilloma with atypical ductal hyperplasia. Subsequent ultrasound and core needle biopsy revealed stromal fibrosis. After 9 months, the mass showed an increase in its size and the anteroposterior to width ratio on ultrasonography compared to the previous examination, and final excisional biopsy confirmed the diagnosis of desmoid-type fibromatosis.

  2. Inoperable bulky melanoma responds to neoadjuvant therapy with vemurafenib

    Science.gov (United States)

    Fadaki, Niloofar; Cardona-Huerta, Servando; Martineau, Lea; Thummala, Suresh; Cheng, Shih-Tsung; Bunker, Steve R; Garcia-Kennedy, Richard; Wang, Wei; Minor, David; Kashani-Sabet, Mohammed; Leong, Stanley P L

    2012-01-01

    A patient with a bulky inoperable stage IIIC melanoma involving the left axilla and neck from a primary of the left medial elbow received vemurafenib as neo-adjuvant treatment. Based on the molecular analysis, BRAF V600E mutation was present. After 4 months of vemurafinib treatment, the tumours shrank to less than 50% of original clinical size and allowed the surgeons to perform a left modified radical neck dissection and left radical axillary dissection. Pathological analysis of specimen revealed viable metastatic cells only in 1 of 40 nodes resected in the neck and axillary dissection, accounting for over 98% pathological response. Other lymph nodes had a mixture of foamy histiocytic inflammatory reaction fibrosis and islands of necrotic tissues. After recovery from surgery, vemurafenib was resumed and continued for 6 months. He remained disease free 6 months after surgery. PMID:23093505

  3. Non-specific granulomatous or tuberculous mastitis

    Directory of Open Access Journals (Sweden)

    Gurjit Singh

    2012-01-01

    Full Text Available The significance of breast tuberculosis is due to rare occurrence and mistaken identity with breast cancer and pyogenic breast abscess. A 70-year-old woman presented with a gradually increasing swelling in the right breast involving the outer upper quadrant since 6 months. Examination of the axilla revealed no lymphadenopathy. FNAC from the lump was inconclusive. Straw-colored discharge from the FNAC site was negative for acid-fast bacilli on Z-N staining and on culture. Modified radical mastectomy was done since malignancy could not be ruled out. Histopathology showed features of granulomatous mastitis. Lymph nodes recovered from the specimen showed caseation necrosis. Anti-tubercular treatment was given to the patient, and she has remained asymptomatic over 1 year of follow-up so far. Extrapulmonary tuberculosis occurring in the breast is extremely rare and is uncommon even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high.

  4. An unusual case of chest pain: ultrasonographic diagnosis of Mondor’s disease

    Directory of Open Access Journals (Sweden)

    Bahjat Barakat

    2013-07-01

    Full Text Available Mondor’s disease is characterized by superficial thrombophlebitis affecting the subcutaneous veins, especially those of the anterolateral thoracoabdominal wall. Thrombophlebitis is usually a subcutaneous, tender, painful cord-like induration, usually found in the breast or the axilla. It typically affects middle-aged women. Thus, we believe the case of a 48-year-old male patient admitted to the emergency room for chest pain with a palpable, non-erythematous, and painful cord-like structure localized in the anterior chest wall and the abdomen to be of interest. He had had a mild thoracic trauma. Doppler analysis showed a thrombosis of the superficial vein of the thorax. The patient was treated by Fondaparinux Sodium 2.5 mg subcutaneously per day for 30 days. Evolution was favorable. Although uncommon, Mondor’s disease has to be recognized to avoid useless diagnosis testing and to deliver a specific treatment.

  5. Superficial thrombophlebitis of the breast (Mondor's disease)

    International Nuclear Information System (INIS)

    Becker, L.; McCurdy, L.I.; Taves, D.H.

    2001-01-01

    With breast imaging being increasingly the first investigation in the diagnosis of breast pathology, it is important for radiologists to be aware of the clinical and imaging characteristics of both malignant and benign breast lesions. Mondor's disease is a benign thrombophlebitis of the superficial veins of the breast, often extending to the chest wall, epigastrium or axilla, which has been demonstrated to have a rare association with underlying breast cancer. Mondor's disease was first described in 1869 but was named after the author of a series of 4 cases in 1939. Mondor's disease has only been reported once in the English-language imaging journals. We present a case of Mondor's disease with both the ultrasonographic and mammographic findings. (author)

  6. [Amino acid exchange in paeci lomycosis-complicated echinococcosis].

    Science.gov (United States)

    Streliaeva, A V; Akhmedov, Iu M; Gasparian, É R; Lazareva, N B; Samylina, I A; Chebyshev, N V; Polzikov, V V; Prokina, E S; Kurilov, D V; Zuev, S S; Shcheglova, T A; Gabchenko, A K; Sadykov, V M

    2011-01-01

    The authors have detected atypical paecilomycosis-associated myocarditis with impaired amino acid exchange and pain syndrome for the first time. At first, pain occurs in the chest and radiates into the axilla, to the left arm to the finger tips, by paralyzing the arm. In some patients, pain manifests itself in both arms with radiation to the belly, by accompanying by fainting. The skin is wet, cold; the pulse is frequent and of poor volume and difficult-to-count. Heart pain spreads into the armpit and down the arm, by making the fingers numb. Attempts to use current analgesics (movalis, sirdalud, nimesil, morphine) in combination with fungicides (diflucan, mycosist, orungal) have failed to yield positive results. The homeopathic drug Latrodectus mactans, prepared from caracurt venom, in combination with the authors' designed diet and other homeopathic agents have relieved pain syndrome and normalized amino acid exchange, which offered possibilities for successful surgical treatment for echinococcosis with later recovery.

  7. Long-term outcome in patients with four or more positive lymph nodes treated with conservative surgery and radiation therapy

    International Nuclear Information System (INIS)

    Mehta, Kiran; Haffty, Bruce G.

    1996-01-01

    Purpose: The purpose of this study was to review management strategies with respect to systemic therapy, radiation therapy treatment techniques, and patient outcome (local regional control, distant metastases, and overall survival) in patients undergoing conservative surgery and radiation therapy (CS + RT) who had four or more lymph nodes involved at the time of original diagnosis. Methods and Materials: Of 1040 patients undergoing CS + RT at our institution prior to December 1989, 579 patients underwent axillary lymph node dissection. Of those patients undergoing axillary lymph node dissection, 167 had positive nodes and 51 of these patients had four or more positive lymph nodes involved and serve as the patient population base for this study. All patients received radiation therapy to the intact breast using tangential fields with subsequent electron beam boost to the tumor bed to a total median dose of 64 Gy. The majority of patients received regional nodal irradiation as follows: 40 patients received RT to the supraclavicular region without axilla to a median dose of 46 Gy, 10 patients received radiation to the supraclavicular region and axilla to a median dose of 46 Gy. Thirty of the 51 patients received a separate internal mammary port with a mixed beam of photons and electrons. One patient received radiation to the tangents alone without regional nodal irradiation. Adjuvant systemic therapy was used in 49 of the 51 patients (96%) with 27 patients receiving chemotherapy alone, 14 patients receiving cytotoxic chemotherapy and tamoxifen, and 8 patients receiving tamoxifen alone. Results: As of December 1994, with a minimum evaluable follow-up of 5 years and a median follow-up of 9.29 years, there have been 18 distant relapses, 2 nodal relapses, and 5 breast relapses. Actuarial statistics reveal a 10-year distant metastases-free rate of 65%, 10-year nodal recurrence-free rate of 96%, and a 10-year breast recurrence-free rate of 82%. All five patients who

  8. Frontal fibrosing alopecia and lichen planus pigmentosus: diagnosis and therapeutic challenge.

    Science.gov (United States)

    Mulinari-Brenner, Fabiane Andrade; Guilherme, Marina Riedi; Peretti, Murilo Calvo; Werner, Betina

    2017-01-01

    Frontal fibrosing alopecia is a variant of lichen planopilaris with marginal progressive hair loss on the scalp, eyebrows and axillae. We report a case of frontal fibrosing alopecia and lichen planus pigmentosus in a postmenopausal woman, that started with alopecia on the eyebrows and then on the frontoparietal region, with periocular and cervical hyperpigmentation of difficult management. The condition was controlled with systemic corticosteroid therapy and finasteride. Lichen planus pigmentosus is an uncommon variant of lichen planus frequently associated with frontal fibrosing alopecia in darker phototipes. It should be considered in patients affected by scarring alopecia with a pattern of lichen planopilaris and areas of skin hyperpigmentation revealing perifollicular hyperpigmentation refractory to multiple treatments. This case illustrates diagnostic and therapeutic challenge in face of scarring alopecia and perifollicular hyperpigmentation.

  9. Influence of adjuvant irradiation on the development of late arm lymphedema and impaired shoulder mobility after mastectomy for carcinoma of the breast

    DEFF Research Database (Denmark)

    Ryttov, N; Holm, N V; Qvist, N

    1988-01-01

    The influence of postoperative radiation therapy on development of late arm lymphedema and shoulder joint disability following mastectomy was evaluated from a series of 57 women with operable carcinoma of the breast. The patients were divided into three groups. Common for all three groups...... was mastectomy and partial axillary dissection. In addition one group received postoperative irradiation plus systemic therapy and another group systemic therapy alone. The incidence of late arm lymphedema/impaired shoulder mobility was 11%/4% in the group of patients undergoing surgery alone, 46......%/38% in the group of patients receiving adjuvant irradiation and 6%/12% in the group of patients receiving adjuvant systemic therapy. It is concluded that adjuvant irradiation to the axilla in patients with metastatic lymph nodes highly increases the risk of late physical sequelae following modified radical...

  10. 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.

  11. Sentinel Lymph Node Dissection in Locally Recurrent Breast Cancer

    DEFF Research Database (Denmark)

    Uth, Charlotte Caspara; Christensen, Mette Haulund; Oldenbourg, Mette Holmqvist

    2015-01-01

    BACKGROUND: The aim of this study was to investigate the use of sentinel lymph node dissection (SLND) in the treatment of patients with locally recurrent breast cancer. METHODS: A total of 147 patients with locally recurrent breast cancer were included from five different breast surgery departments...... to be a feasible procedure in locally recurrent breast cancer and can spare a clinically significant number of patients an unnecessary ALND and the following risk of sequelae. In patients who had previous ALND, SLNDAR identified metastases that would have been overlooked following the current guidelines. A large...... in Denmark. Data on previous breast and axillary surgery, adjuvant treatment, second operation in the breast and axilla, and lymphoscintigraphy were collected retrospectively from the original patient files. RESULTS: SLND after recurrence (SLNDAR) was successful in 72 of 144 patients (50 %). The detection...

  12. 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.

  13. Neurogenic thoracic outlet syndrome: current diagnostic criteria and advances in MRI diagnostics.

    Science.gov (United States)

    Magill, Stephen T; Brus-Ramer, Marcel; Weinstein, Philip R; Chin, Cynthia T; Jacques, Line

    2015-09-01

    Neurogenic thoracic outlet syndrome (nTOS) is caused by compression of the brachial plexus as it traverses from the thoracic outlet to the axilla. Diagnosing nTOS can be difficult because of overlap with other complex pain and entrapment syndromes. An nTOS diagnosis is made based on patient history, physical exam, electrodiagnostic studies, and, more recently, interpretation of MR neurograms with tractography. Advances in high-resolution MRI and tractography can confirm an nTOS diagnosis and identify the location of nerve compression, allowing tailored surgical decompression. In this report, the authors review the current diagnostic criteria, present an update on advances in MRI, and provide case examples demonstrating how MR neurography (MRN) can aid in diagnosing nTOS. The authors conclude that improved high-resolution MRN and tractography are valuable tools for identifying the source of nerve compression in patients with nTOS and can augment current diagnostic modalities for this syndrome.

  14. Cystic thymoma coexisting with vascular dysplasia.

    Science.gov (United States)

    Papadas, T; Dimopoulos, P A; Sampsonas, F; Mastronikolis, N; Spiropoulos, K; Goumas, P D

    2008-01-01

    We report the case of a 23-year-old female patient, who was admitted to our hospital because of aggravating pain in the right shoulder, right chest and ear accompanied by cough and dyspnea. Imaging revealed a soft tissue mass in the mediastinum in close relation with an additional large mass extending in the right upper thorax, right axilla and neck. The tissue obtained during surgery showed the former mass to be a cystic thymoma, being in contact with an extensive vascular dysplasia. The characteristic clinical presentation, the contribution of imaging, the results of operation, and the follow-up are rather unique. The review of the literature did not reveal similar cases.

  15. A case of sarcoma of the chest wall after radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Izumi, Junko; Nishi, Tsunehiro; Fukuuchi, Atsushi; Takanashi, Riichiro [Mitsui Memorial Hospital, Tokyo (Japan)

    1998-09-01

    A case of radiation-induced sarcoma of the chest wall after radiation therapy for breast cancer is reported. A 69-year-old woman underwent mastectomy with axillary lymph node dissection followed by linac therapy of 50 Gy delivered to the left axilla, left supraclavicular area, and parasternal area. During therapy for bone and liver metastases, a tumor was noted in the left chest wall 15 years after radiation therapy. Incisional biopsy was performed. Histological diagnosis was spindle cell sarcoma. Radiation-induced sarcoma was suspected because the tumor developed 15 years after radiation therapy within the same area. Radiation-induced sarcoma is a rare tumor, but radiation therapy following breast-conserving therapy is widely employed. It is important to be aware of the possibility of radiation-induced sarcoma. (author)

  16. VARIATIONS IN SUBSCAPULAR ARTERY: A STUDY

    Directory of Open Access Journals (Sweden)

    Pushpalatha

    2015-01-01

    Full Text Available OBJECTIVE: To study the variations in the origin of subscapular artery and its branches in the dissecting room. METHOD: The morphological study of 40 formalin fixed adult human cadavers of both sexes was carried out following a standard dissecting manual. OBSERVATION: Variations in origin of Subscapular artery was observed in 15% of the cadavers, origin from 2 nd part of axillary artery in 15%, as a common branch with Lateral thoracic artery in 10%, associated variations of posterior circumflex humeral artery, thoraco dorsal artery and circumflex scapular artery in 10%. CONCLUSION: In comparison with other similar studies, the present one also shows a near to equal scenario which helps us to strengthen the already existing knowledge. Appreciation of these variations is important to vascular surgeons for vascular graft surgeries, general and on co - surgeons while exposure of axilla and axillary artery so also to radiologists and anatomists

  17. Patterns of recurrence in patients with melanoma after radical lymph node dissection.

    Science.gov (United States)

    Nathansohn, Nir; Schachter, Jacob; Gutman, Haim

    2005-12-01

    Previous interventions (excisional biopsy, incomplete dissection) in the regional basin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field. Retrospective analysis. Tertiary care referral center. One hundred forty-one consecutive patients who underwent radical lymph node dissection (RLND) either in the groin or the axilla owing to malignant melanoma were followed up for a median period of 41 months. All of the 141 patients received either elective or therapeutic RLND. Their medical records were analyzed for demographic data, disease history, previous treatments, recurrence patterns, and survival. Patterns of first recurrence after RLND and survival. Radical lymph node dissection was performed on 148 lymph node basins (141 patients; 86 axillae and 62 groins). Nineteen patients (13%) received previous open interventions in the lymph node basin (tampering) other than radical dissection. Radical lymph node dissection was performed prophylactically in 38 basins (26%), for palpable disease in 75 (51%), and for a positive sentinel node in 35 (24%). There were 74 failures (52%) of RLND: 51 patients (70%) with systemic disease, 12 (16%) with recurrence in the surgical field, 9 (11%) with in-transit metastases, and 2 (3%) with local recurrence. On multivariate analysis, the only significant predictors of recurrence after RLND were Breslow thickness of greater than 4 mm (P = .02), tampering (P = .01), and lymph node capsular invasion (P = .001). Tampering was the only independent prognosticator of failure in the surgical field, as tampering was noted in 10 (83%) of 12 patients with failure in the surgical field as compared with 6 (10%) of 62 patients with other types of first failures (Pbasin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field, and they should be avoided. Fine-needle aspiration

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

    International Nuclear Information System (INIS)

    Gross, E.; Cowen, D.; Hannoun-Levi, J.M.; Rouanet, P.; Houvenaeghel, G.; Teissier, E.; Ellis, S.; Resbeut, M.; Tallet, A.; Vaini Cowen, V.; Azria, D.

    2010-01-01

    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)

  19. Comparison of fluorine-18 fluorodeoxyglucose positron emission tomography and technetium-99m methoxyisobutylisonitrile scintimammography in the detection of breast tumours

    Energy Technology Data Exchange (ETDEWEB)

    Palmedo, H.; Bender, H.; Gruenwald, F.; Zamora, P.; Biersack, H.J. [Department of Nuclear Medicine, University of Bonn (Germany); Mallmann, P.; Krebs, D. [Department of Gynecology and Obstetrics, University of Bonn (Germany)

    1997-09-01

    The aim of this study was to compare, in breast cancer patients, the diagnostic accuracy of positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) and scintimammography (SMM) using technetium-99m methoxyisobutylisonitrile (MIBI). A total of 20 patients (40 breasts with 22 lesions) were evaluated serially with MIBI and, on the following day, with FDG. For SMM, planar and single-photon emission tomography imaging in the prone position was performed starting at 10 min following the injection of MIBI (740 MBq). For PET, scans were acquired 45-60 min after the injection of FDG (370 MBq) and attentuation correction was performed following transmission scans. Results from SMM and PET were subsequently compared with the histopathology results. True-positive results were obtained in 12/13 primary breast cancers (mean diameter=29 mm, range 8-53 mm) with both FDG and MIBI. False-negative results were obtained in two local recurrences (diameter <9 mm) with both FDG and MIBI. In benign disease, FDG and MIBI did not localize three fibrocystic lesions, two fibroadenomas and one inflammatory lesion (true-negative), but both localized one fibroadenoma (false-positive). Collectively, the results demonstrate a sensitivity of 92%, and a specificity of 86%, for primary breast cancer regardless of whether FDG or MIBI was used. In contrast to MIBI scintigraphy, FDG PET scored the axillae correctly as either positive (metastatic disease) or negative (no axillary disease) in all 12 patients. The tumour/non-tumour ratio for MIBI was 1.97 (range 1.43-3.1). The mean standard uptake value (SUV) for FDG uptake was 2.57 (range 0.3-6.2). The diagnostic accuracy of SMM was equivalent to that of FDG PET for the detection of primary breast cancer. For the detection of in situ lymph node metastases of the axilla, FDG seems to be more sensitive than {sup 99m}Tc-MIBI. (orig.). With 4 figs., 2 tabs.

  20. Evaluation and Validation of Neo-Adjuvant Response Index (NRI) and It's Correlation with Various Predictive Biomarkers and RECIST in Locally Advanced Breast Cancer.

    Science.gov (United States)

    Bamal, Rahul; Chintamani; Tandon, Megha; Mittal, M K; Saxena, Sunita

    2014-09-01

    Response evaluation following neo-adjuvant chemotherapy in breast cancer is usually done without taking in to account the axillary response and the available tools like 'response evaluation criteria in solid tumors' (RECIST) have this limitation. These criteria rely solely on the response observed in the primary tumour. Neoadjuvant response index is one such attempt to have a comprehensive assessment of response both in the primary tumour and the axilla. 30 cases of locally advanced breast cancer (LABC) were assessed for response using 'Neo-adjuvant Response Index'. The index always gives score between '0' (no response or progressive disease) and '1' (pathological complete response i.e. no invasive tumor in breast as well as axilla). This index includes axillary response as well and provides a spectrum of response rather than dividing patients into simply responders and non-responders . Mean reading of index was found to be 0.2925 in this study. Three patients achieved an index of 1. This index correlates significantly with the existing scales for assessing response. Hormone negative tumors were found to be more chemo responsive with higher rates of pathological complete response (pCR) while ER/PR + Her2- tumors showed a very poor response to NACT. Based on the observations of the present study it may be submitted that Neoadjuvant Response Index (NRI) is a reliable and simple tool that can serve as a comprehensive and accurate method of assessing response to neo-adjuvant chemotherapy as it takes in to consideration both the tumor and axillary response unlike the existing RECIST, binary system (responders are those with greater than 50 % reduction), RCB method and the available biomarkers. This study being first of it's kind in Indian population, in spite of it's limitations, could prove to be a launching ground for further reasearch and contribute substantially to the evidence base.

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

    International Nuclear Information System (INIS)

    Gurleyik, G.; Sekmen, U.; Saglam, A.; Aker, F.

    2005-01-01

    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)

  2. Pre-operative and intra-operative detection of axillary lymph node metastases in 108 patients with invasive lobular breast cancer undergoing mastectomy.

    Science.gov (United States)

    Novak, Jerica; Besic, Nikola; Dzodic, Radan; Gazic, Barbara; Vogrin, Andrej

    2018-02-05

    Despite the recent changes in the treatment of the axilla in selected breast cancer patient, positive sentinel lymph node (SLN) in patients undergoing mastectomy still necessitates axillary lymph node dissection (ALND). In invasive lobular carcinoma (ILC), pre-operative detection of the lymph node metastasis may be demanding due to its unique morphology. The aim of this study was to examine the benefit of preoperative axillary ultrasound (AUS), ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and intra-operative imprint cytology (IIC), in order to avoid two-stage axillary surgery in patients with ILC undergoing mastectomy. The object of this study were 102 patients (median age 52, range 34-73 years) with clinically non-suspicious axilla in whom 108 mastectomies were performed after a pre-operative AUS investigation. Whenever a metastasis was detected in a sentinel lymph node, ALND was done. Reports of the pre-operative AUS investigation, US-FNAB, and IIC were compared with definitive histopathological reports of surgical specimens. In 46 cases lymph node metastases were diagnosed. AUS suspicious lymph nodes were found in 29/108 cases and histopathology confirmed metastases in 22/30 cases. US-FNAB was performed in 29 cases with AUS suspicious lymph nodes. Cytology proved metastases in 11/29 cases. Histopathology confirmed metastases in 10/11 cases with only isolated tumor cells found in one case. IIC investigation was performed in 63 cases and in 10/27 cases metastases were confirmed by histopathology. Pre-operative AUS, US-FNAB, and/or IIC investigation enabled ALND during a single surgical procedure in 20/46 patients with metastases in lymph nodes. Pre-operative AUS, US-FNAB, and/or IIC are/is beneficial in patients with ILC planned for mastectomy in order to decrease the number of two stage axillary procedures.

  3. The sensitivity of pre-operative axillary staging in breast cancer: comparison of invasive lobular and ductal carcinoma.

    Science.gov (United States)

    Topps, A; Clay, V; Absar, M; Howe, M; Lim, Y; Johnson, R; Bundred, N

    2014-07-01

    Axillary ultrasound (AUS) with fine-needle aspiration (FNA) biopsy of abnormal lymph nodes is important for pre-operative staging and planning the surgical management of the axilla. Invasive lobular carcinoma (ILC) metastases are thought to be difficult to detect because the cells are small and on cytology resemble lymphocytes. To investigate this we directly compared the sensitivity of pre-operative axillary staging between ILC and invasive ductal carcinoma (IDC). Consecutive patients that presented in a single breast unit with pure IDC between April 2005 and December 2006 and pure ILC between January 2008 and December 2012 were retrospectively identified from pathology records. Pre-operative axillary ultrasound and FNA biopsy results were compared with post-operative histopathology from the sentinel node biopsy (SNB) or axillary lymph node dissection (ALND). A total of 275 and 142 axillae were identified in the IDC and ILC groups respectively. In the node positive patients there was no significant difference in the sensitivity of AUS (IDC vs. ILC; 58.7% vs. 52.8%). However, there was a significant difference in the sensitivity of ultrasound-guided FNA biopsy of abnormal nodes (IDC vs. ILC; 98.4% vs. 53.6%; p < 0.001). AUS has comparative sensitivities between IDC and ILC populations. In contrast, FNA biopsy of abnormal axillary nodes is clearly less sensitive in the ILC group. In these patients, who have abnormal AUS, we suggest that a core biopsy is required to improve the pre-operative staging and prevent unnecessary surgical procedures. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Deep-Inspiration Breath-Hold Intensity Modulated Radiation Therapy to the Mediastinum for Lymphoma Patients: Setup Uncertainties and Margins.

    Science.gov (United States)

    Aristophanous, Michalis; Chi, Pai-Chun M; Kao, Jeremy; Williamson, Ryan; Tung, Sam; Andraos, Therese; Milgrom, Sarah A; Pinnix, Chelsea C; Dabaja, Bouthaina S

    2018-01-01

    Patient setup for treating large target volumes can be challenging. In the present study, we measured the local uncertainties in the treatment of mediastinal lymphoma and investigated the need for region-specific planning target volume (PTV) margins. The data from 30 patients who had undergone radiation therapy for mediastinal lymphoma were retrospectively analyzed. A computed tomography (CT)-on-rails (CTOR) system in the treatment room was used for daily image guidance. The total PTV was split into 6 regions: neck, supraclavicular fossa, axilla, mediastinum, upper heart, and lower heart. The total PTV and the 6 local regions were separately aligned to the planning CT scan using automatic rigid registration. The residual local errors using 3 setup strategies were investigated: no image guidance, CTOR setup to total PTV, and simulated cone beam CT setup to the mediastinum. Errors were recorded in the anteroposterior, superoinferior, and right-left directions separately. Using the residual error calculations, the margins required to cover 95% of the clinical target volume for 90% of the patients was estimated. For each patient, 12 to 21 days of daily CTOR data were available for analysis. The residual errors for the total PTV and mediastinum setups were both smaller than those with no image guidance. The lower heart region had more uncertainty with all 3 setup strategies. Margin analysis revealed that the magnitude of the margin is dependent on the imaging strategy, direction, and local region inside the PTV. Margins >7 mm are necessary to account for uncertainty in the neck, lower heart, and axilla regions even under daily CT guidance. Setup uncertainties in the mediastinum are not uniform and are dependent on target location and imaging strategy. However, with the appropriate margin, we can target regions that might not be visualized with the available on-board imager system. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Cervical scarless endoscopic thyroidectomy: Axillo-bilateral-breast approach (ABBA).

    Science.gov (United States)

    Bärlehner, Eckhard; Benhidjeb, Tahar

    2008-01-01

    Neck surgery is one of the latest applications of minimally invasive surgery. We applied a new technique for totally endoscopic thyroidectomy, the axillo-bilateral-breast approach (ABBA). This approach does not leave a scar on the neck. Between February 2005 and October 2005, 13 patients were treated by ABBA for uni- or multinodular goitres. Surgery is performed under general anaesthesia and in supine position. 5 mm bilateral skin incisions are made on the margin of the areola of nipple. They are used to insert and subcutaneously push forward a 20 cm long, 5 mm trocar to the jugular fossa. A further 5 mm incision is performed in the right axilla. The right breast trocar is the optical trocar. A Maryland clamp in axillary position and 5 mm harmonic scalpel via the left breast trocar permit a clear view of the further subfascial preparation. The caudal hyoidal muscles are longitudinally split along the linea alba. Using delicate blunt dissection, both thyroid lobes are exposed. After isthmus transection is performed, the upper thyroid pole is being mobilized. The upper pole vessels are isolated and divided close to the thyroid capsule. Preparation of the retrothyroidal area includes visualization of the recurrent laryngeal nerve. The resection is performed without bleeding with a harmonic scalpel. Via the axillary approach, with the incision being widened, a 20 mm trocar is inserted and advanced up to the thyroid lodge to remove the specimen. The average operation time was 132 minutes. No patient had to be converted to a conventional approach. Hypocalcaemia or recurrent laryngeal nerve palsy were not observed postoperatively. Our preliminary results show that the ABBA technique is a feasible, safe procedure with excellent cosmetic benefits. The small scars in the right axilla and bilateral nipple areola are almost invisible.

  6. High Relative Expression of Pannexin 3 (PANX3) in an Axillary Sweat Gland Carcinoma With Osteosarcomatous Transformation.

    Science.gov (United States)

    Romano, Ryan C; Gardner, Jerad M; Shalin, Sara C; Ram, Roopa; Govindarajan, Rang; Montgomery, Corey O; Gilley, Jasen H; Nicholas, Richard W

    2016-11-01

    Primary cutaneous sweat gland carcinomas (SGCs) are rare tumors that commonly involve axillae, have a high local recurrence rate, and rarely show sarcomatoid transformation. A 68-year-old man presented with rapid enlargement of a previously stable, asymptomatic pea-sized nodule in the left axilla. Initial excision (with positive surgical margins) at another institution showed characteristic histologic features of a high-grade osteosarcoma and molecular analysis using a 92-gene real-time quantitative reverse transcription-polymerase chain reaction assay confirmed a diagnosis of osteosarcoma with 96% certainty. Notably, the molecular assay demonstrated consistently high relative expression of pannexin 3 (PANX3), a gene involved in normal osteoblast differentiation which, when highly expressed, strongly predicts osteosarcoma per the assay's algorithm. However, on further histologic review, the tumor also contained focal cystic areas, nests, and ducts composed of malignant epithelial cells reminiscent of SGC; these areas directly transitioned into the osteosarcomatous component and were strongly positive for pancytokeratin, CK7, and p63. Within 2 weeks, the lesion recurred and grew rapidly, prompting complete resection, histologic sections of which showed high-grade osteosarcoma without residual epithelial elements. This is the fifth report, to our knowledge, of osteosarcomatous transformation in a SGC, and the only report to date including molecular data. This case demonstrates that osteosarcoma arising from a SGC has a similar molecular profile to de novo primary osteosarcoma of bone. It also emphasizes the importance of histopathologic findings as the established diagnostic gold standard and the need to interpret molecular results within the clinical context.

  7. [Phyllodes breast tumors].

    Science.gov (United States)

    Zedníková, I; Černá, M; Hlaváčková, M; Hes, O

    2015-01-01

    Phyllodes tumour is a breast tumour occurring very rarely. It accounts for only in 1% of all cases of breast tumour. The diagnosis of phyllodes tumours can be difficult in consideration of the small number of cases. Treatment of phyllodes tumours is always surgical. In 2004-2013, we operated on twelve female patients with phyllodes tumours out of the total number of 1564 surgeries for breast tumours (0.8%) at the Department of Surgery at Teaching Hospital in Pilsen. We evaluated the age, the biological behaviour of the tumour depending on the tumour size and duration, the distant metastases, therapy and survival. The average age at the time of surgery was fifty years (2684), the duration of disease to the surgical solution ranged from one month to ten years. Tumour size was in the range of two to twenty-nine centimetres, tumours measuring less than five centimetres were always benign. Tumour excision for benign phyllodes tumour was performed seven times. Malignant phyllodes tumour was diagnosed five times with mastectomy performed in each case, and the axilla was exenterated in three cases where nodes were benign in each of them. In one case, mastectomy was followed by radiotherapy because the tumour reached the edge of the resected part; the other patients were only monitored. In two patients, tumour spreading into the lungs was diagnosed at five to ten months after breast surgery. One patient with generalized disease died, the other ones live with no local recurrence of this disease. Median survival is fifty-two months; the disease-free interval is fifty months. The results show that if phyllodes tumour is diagnosed in time, it is almost exclusively benign. If the case history is longer and the tumour is growing, the likelihood of malignancy increases. Surgical treatment is also sufficient in the case of malignant forms. The breast surgery does not need to be supplemented with exenteration of axilla.Key words: breast - phyllodes tumour.

  8. Variations in branching of the posterior cord of brachial plexus in a Kenyan population

    Directory of Open Access Journals (Sweden)

    Matakwa Ludia C

    2011-06-01

    Full Text Available Abstract Background Variations in the branching of posterior cord are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of branching show population differences. Data from the African population is scarce. Objective To describe the branching pattern of the posterior cord in a Kenyan population. Materials and methods Seventy-five brachial plexuses from 68 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of the posterior cord was recorded. Representative photographs were then taken using a digital camera (Sony Cybershot R, W200, 7.2 Megapixels. Results Only 8 out of 75 (10.7% posterior cords showed the classical branching pattern. Forty three (57.3% lower subscapular, 8(10.3% thoracodorsal and 8(10.3% upper subscapular nerves came from the axillary nerve instead of directly from posterior cord. A new finding was that in 4(5.3% and in 3(4% the medial cutaneous nerves of the arm and forearm respectively originated from the posterior cord in contrast to their usual origin from the medial cord. Conclusions Majority of posterior cords in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid inadvertent injury. A wider study of the branching pattern of infraclavicular brachial plexus is recommended.

  9. 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.

  10. Radiotherapy of the regional lymph nodes: shooting at the sheriff?

    Science.gov (United States)

    Kunkler, Ian H

    2009-10-01

    The role of immune surveillance in controlling the spread of breast cancer to the regional nodes is poorly understood. In theory regional nodal irradiation (RNI) might compromise this host function. However the clinical evidence suggests that the risk of regional recurrence is lower in patients with early breast cancer whose axilla has been irradiated compared to no axillary treatment. The role of RNI after breast conserving surgery has not been well studied. A policy of level III clearance and only irradiating the axilla for residual disease and a selective policy of axillary irradiation in node positive patients after sentinel node biopsy or lower axillary node sample is recommended. Irradiation of the medial supraclavicular fossa after axillary dissection is suggested where there are four or more nodes involved on axillary dissection. There is little data to inform selection of patients for RNI after neoadjuvant systemic therapy. The role of postmastectomy radiotherapy (PMRT) was largely established on the basis of comprehensive RNI. It is unclear whether irradiating less than the chest wall and peripheral lymphatics confers the same level of benefit. The role of PMRT in women with 1-3 involved nodes remains controversial and investigational. Biological factors such as oestrogen and progesterone receptor status and HER-2 protein expression may play a role in determining benefits from PMRT. The role of internal mammary nodal irradiation is unclear. The individualisation of RNI based on molecular and genetic factors should be a priority for research. The benefits of RNI need to be carefully balanced against the risks of cardiotoxicity, pneumonitis, lymphoedema, brachial plexopathy and secondary malignancy.

  11. Hypofractionated regional nodal irradiation for breast cancer: examining the data and potential for future studies.

    Science.gov (United States)

    Badiyan, Shahed N; Shah, Chirag; Arthur, Douglas; Khan, Atif J; Freedman, Gary; Poppe, Matthew M; Vicini, Frank A

    2014-01-01

    Limited data are available examining the role of hypofractionated radiation schedules in the management of women requiring regional nodal irradiation (RNI). The purpose of this review is to examine the available literature for the efficacy (where available) and toxicity of hypofractionated radiation schedules in breast cancer with RNI limited to the axilla and supraclavicular regions. Multiple randomized and prospective studies have documented the safety and efficacy of hypofractionated schedules delivering whole breast irradiation (WBI) alone. Subsets from these randomized trials and smaller prospective/single-institution studies have documented the feasibility of hypofractionated RNI but the limited numbers prevent definitive conclusions and limited efficacy data are available. With regard to possible toxicity affecting organs at risk with RNI, key structures include the breast, skin, heart, lungs, axilla (lymphedema), and brachial plexus. Based on data from several randomized trials, hypofractionated radiation is not associated with significant changes in breast toxicity/cosmesis or cardiac toxicity; the addition of hypofractionated RNI would not be expected to change the rates of breast or cardiac toxicity. While RNI has been shown to increase rates of pulmonary toxicity, hypofractionated RNI has not been associated with more frequent pulmonary complications than standard RNI. Moving forward, future studies will have to evaluate for increased lung toxicity. With regard to lymphedema, data from randomized hypofractionated WBI trials failed to demonstrate an increase in lymphedema and smaller studies utilizing hypofractionated RNI have failed to as well. Data from head and neck cancer as well as hypofractionated breast radiation with RNI have failed to demonstrate an increase in brachial plexopathy with the exception of older trials that used much larger dose per fraction (>4 Gy/fraction) schedules. At this time, published data support the feasibility of

  12. Initial Report of a Prospective Dosimetric and Clinical Feasibility Trial Demonstrates the Potential of Protons to Increase the Therapeutic Ratio in Breast Cancer Compared With Photons.

    Science.gov (United States)

    Bradley, Julie A; Dagan, Roi; Ho, Meng Wei; Rutenberg, Michael; Morris, Christopher G; Li, Zuofeng; Mendenhall, Nancy P

    2016-05-01

    To compare dosimetric endpoints between proton therapy (PT) and conventional radiation and determine the feasibility of PT for regional nodal irradiation (RNI) in women with breast cancer. From 2012 to 2014, 18 women (stage IIA-IIIB) requiring RNI prospectively enrolled on a pilot study. Median age was 51.8 years (range, 42-73 years). The cohort included breast-conserving therapy (BCT) and mastectomy patients and right- and left-sided cancers. Treatment targets and organs at risk were delineated on computed tomography scans, and PT and conventional plans were developed. Toxicity was prospectively recorded using Common Terminology Criteria for Adverse Events version 4.0. A Wilcoxon signed-rank sum test compared the dose-volume parameters. The primary endpoint was a reduction in cardiac V5. Median follow-up was 20 months (range, 2-31 months). For all patients, the PT plan better met the dosimetric goals and was used for treatment. Proton therapy alone was used for 10 patients (9 postmastectomy, 1 after BCT) and combined proton-photon in 8 (6 BCT, 2 postmastectomy with immediate expander reconstruction). Proton therapy improved coverage of level 2 axilla (P=.0005). Adequate coverage of internal mammary nodes was consistently achieved with PT (median D95, 50.3 Gy; range, 46.6-52.1 Gy) but not with conventional radiation therapy (median D95, 48.2 Gy; range, 40.8-55 Gy; P=.0005). Median cardiac V5 was 0.6% with PT and 16.3% with conventional radiation (PRNI after mastectomy or BCT significantly improves cardiac dose, especially for left-sided patients, and lung V5 and V20 in all patients without excessive acute toxicity. Proton therapy simultaneously improves target coverage for the internal mammary nodes and level 2 axilla, which may positively impact long-term survival in breast cancer patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. The Impact of Axillary Lymph Node Surgery on Breast Skin Thickening During and After Radiation Therapy for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Torres, Mylin A., E-mail: matorre@emory.edu [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Yang, Xiaofeng [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Noreen, Samantha [Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia (United States); Chen, Hao [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Provision Center for Proton Therapy, Knoxville, Tennessee (United States); Han, Tatiana; Henry, Simone; Mister, Donna [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Andic, Fundagal [Department of Radiation Oncology, Cukurova University School of Medicine, Adana (Turkey); Long, Qi [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia (United States); Liu, Tian [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2016-06-01

    Purpose: This prospective study was conducted to determine predictors of epidermal thickening during and after whole-breast radiation therapy (XRT) using objective measurements acquired with ultrasound. Methods and Materials: After breast-conserving surgery, 70 women received a definitive course of whole-breast XRT (50 Gy plus boost). Prior to XRT, at week 6 of XRT, and 6 weeks after XRT, patients underwent objective ultrasound measurements of epidermal thickness over the lumpectomy cavity and all 4 quadrants of the treated breast. A skin thickness ratio (STRA) was then generated normalizing for corresponding measurements taken of the untreated breast. Results: Baseline measurements indicated that 87% of patients had skin thickening in the treated versus untreated breast (mean increase, 27%; SD, 0.29) prior to XRT. The STRA increased significantly by week 6 of XRT (mean, 25%; SD, 0.46) and continued to increase significantly 6 weeks after XRT (mean, 33%; SD, 0.46) above baseline measurements (P<.001 for both time points). On multivariate analysis, breast volume (P=.003) and surgical evaluation of the axilla with full lymph node dissection (P<.05) predicted for more severe changes in the STRA 6 weeks after XRT compared with baseline. STRA measurements correlated with physician ratings of skin toxicity according to Radiation Therapy Oncology Group grading criteria. Conclusions: This is one of the first studies to objectively document that lymph node surgery affects XRT-induced skin thickening in patients with breast cancer. Surgical evaluation of the axilla with complete lymph node dissection was associated with the most severe XRT-induced skin changes after XRT completion. These results may inform future studies aimed at minimizing side effects of XRT and surgery, particularly when surgical lymph node assessments may not alter breast cancer management or outcome.

  14. Human axillary skin condition is improved following incorporation of glycerol into the stratum corneum from an antiperspirant formulation.

    Science.gov (United States)

    Evans, Richard L; Turner, Graham A; Bates, Susan; Robinson, Teresa; Arnold, David; Marriott, Robert E; Pudney, Paul D A; Bonnist, Eleanor Y M; Green, Darren

    2017-11-01

    The study objectives were to demonstrate that glycerol, when topically applied from a roll-on antiperspirant formulation, can be delivered directly to human skin ex vivo and the axillary stratum corneum (SC) in vivo, and to assess whether it improves the quality of the axillary skin barrier. Ex vivo human skin absorption of glycerol was measured following application of a roll-on antiperspirant formulation containing 4% 13 C 3 -glycerol. Skin distribution of 13 C 3 -glycerol over 24 h was assessed using gas chromatography-mass spectrometry. In vivo axillary SC penetration was measured by confocal Raman spectroscopy and multivariate curve-resolution software 1 h after topical application of a roll-on antiperspirant formulation containing 8% deuterated glycerol (d 5 -glycerol). A clinical study was conducted to determine the efficacy of a roll-on antiperspirant formulation containing 4% glycerol in reducing shaving-induced visual irritation and in increasing axillary-skin hydration. Ex vivo skin absorption studies indicated that the formulation delivered 13 C 3 -glycerol into the SC at all timepoints over the 24-h period. In vivo Raman measurements (1 h after application) demonstrated that d 5 -glycerol was detectable to a depth of at least 10 μm in the axillary SC. Application of 4% glycerol from a roll-on antiperspirant formulation to the axilla was associated with significantly less visible irritation and greater skin hydration than observed with the control (glycerol-free) product. These studies demonstrate that glycerol, incorporated in a roll-on antiperspirant formulation, is delivered directly and rapidly to all depths of the axillary SC, and results in improvements in visible irritation and hydration in the axilla.

  15. 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.

  16. Conservative surgery followed by radical radiotherapy in the management of stage I carcinoma of the breast

    International Nuclear Information System (INIS)

    Baeza, M.R.; Arraztoa, J.; Sole, J.; Rodriguez, R.

    1982-01-01

    Since October 1976, the treatment policy in our Radiotherapy Center for Stage I carcinoma of the breast has been excision of the tumor mass, when it was cosmetically suitable, followed by irradiation to the breast and peripheral lymphatics. Eighty-three patients were admitted between October 1976 and March 1980. They underwent local excision of the tumor and then received 5000 rad in 5 weeks to the breast, supraclavicular, axillary and internal mammary chain lymph nodes. Each field was treated every day. A boost was then given to the scar, bringing the dose up to 6500 rad, calculated at maximum tumor depth, depending upon the size of the tumor prior to surgery. Cosmetic results were quite good, and the local control rate at 54 months is 98%. The survival with no evidence of disease (NED) at 54 months (acturarial) is 83%. There have been 10 failures: 8 distant, 1 local (in axilla, controlled by surgery, actually NED), and 1 local and distant (scar and brain). Both failures were found with 12 months after treatment, and 8/10 of the failures within 24 months. Twenty-one out of 83 patients have had complications (25.3%); of these, 28.8% were surgical and the remainder resulted from radiotherapy after surgery, either from radiotherapy alone or from combination of treatments. Of the total of 21 complications 18 were mild and 3 were serious. Of those 3 serious complications (3.6%), 2 were a result of radiotherapy, and one because an ill-advised axillary dissection prior to radiotherapy gave a negative axilla and a serious arm edema and painful shoulder. This was the worst complication in the total of 83 patients. These results compare favorably with the results achieved in the same Hospital with radical surgery as far as local tumor control and survival with no evidence of disease (NED) is concerned

  17. Extensive sonographic ulnar nerve enlargement above the medial epicondyle is a characteristic sign in Hansen's neuropathy.

    Directory of Open Access Journals (Sweden)

    Lokesh Bathala

    2017-07-01

    Full Text Available Earlier studies have shown sonographic enlargement of the ulnar nerve in patients with Hansen's neuropathy. The present study was performed to determine whether sonography or electrophysiological studies can detect the specific site of ulnar nerve pathology in leprosy.Eighteen patients (thirty arms with Hansen's disease and an ulnar neuropathy of whom 66% had borderline tuberculoid (BT, 27% lepromatous leprosy (LL and 7% mid-borderline (BB leprosy were included in the study. Cross-sectional area (CSA of ulnar nerve was measured every two centimeters from wrist to medial epicondyle and from there to axilla. All patients underwent standard motor and sensory nerve conduction studies of the ulnar nerve. Thirty age and sex matched controls underwent similar ulnar nerve CSA measurements and conduction studies.Ulnar nerve was clinically palpable in 19 of the 30 arms of patients. Motor and sensory nerve conduction studies of the ulnar nerve showed a reduced compound motor action potential and sensory nerve action potential amplitude in all patients. Motor Conduction Velocity (MCV in patients were slower in comparison to controls, especially at the elbow and upper arm, but unable to exactly locate the site of the lesion. In comparison to controls the ulnar nerveCSA was larger in the whole arm in patients and quite specific the maximum enlargement was seen between nulnar sulcus and axilla, peaking at four centimeters above the sulcus.A unique sonographic pattern of nerve enlargement is noted in patients with ulnar neuropathy due to Hansen's disease, while this was not the case for the technique used until now, the electrodiagnostic testing. The enlargement starts at ulnar sulcus and is maximum four centimeters above the medial epicondyle and starts reducing further along the tract. This characteristic finding can help especially in diagnosing pure neuritic type of Hansen's disease, in which skin lesions are absent, and alsoto differentiate leprosy from

  18. 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

  19. Anatomia endoscópica da artéria etmoidal anterior: estudo de dissecção em cadáveres Endoscopic anatomy of the anterior ethmoidal artery: a cadaveric dissection study

    Directory of Open Access Journals (Sweden)

    Bernardo Cunha Araujo Filho

    2006-06-01

    to the anterior nasal spine was of 61.72 mm (sd = 4.18 mm; to the lateral nasal wall (nasal axilla was of 64.04 mm (sd = 4.69mm; and from the anterior axilla to the middle turbinate was of 21.14 mm (sd = 3.25 mm. For all the measures there was no statistically significant measures when both sides were compared (p>0.05. CONCLUSIONS: We concluded that the middle conchae axilla is the most reliable point of reference to locate the AEA.

  20. 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

  1. Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer

    Directory of Open Access Journals (Sweden)

    Sarri AJ

    2017-03-01

    Full Text Available Almir José Sarri,1 Rogério Dias,2 Carla Elaine Laurienzo,1 Mônica Carboni Pereira Gonçalves,3 Daniel Spadoto Dias,2 Sonia Marta Moriguchi4 1Department of Physical Therapy, Barretos Cancer Hospital, Barretos, 2Department of Obstetrics, Gynaecology and Mastology, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, 3Department of Nuclear Medicine, Barretos Cancer Hospital, Barretos, 4Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, São Paulo, Brazil Purpose: Compare the lymphatic flow in the arm after breast cancer surgery and axillary lymph node dissection (ALND versus sentinel lymph node biopsy (SLNB using lymphoscintigraphy (LS.Patients and methods: A cross-sectional study with 39 women >18 years who underwent surgical treatment for unilateral breast cancer and manipulation of the axillary lymph node chain through either ALND or SLNB, with subsequent comparison of the lymphatic flow of the arm by LS. The variables analyzed were the area reached by the lymphatic flow in the upper limb and the sites and number of lymph nodes identified in the ALND or SLNB groups visualized in the three phases of LS acquisition (immediate dynamic and static images, delayed scan images. For all analyses, the level of significance was set at 5%.Results: There was a significant difference between the ALND and SLNB groups, with predominant visualization of lymphatic flow and/or lymph nodes in the arm and axilla (P=0.01 and extra-axillary lymph nodes (P<0.01 in the ALND group. There was no significant difference in the total number of lymph nodes identified between the two groups. However, there was a significant difference in the distribution of lymph nodes in these groups. The cubital lymph node was more often visualized in the immediate dynamic images in the ALND group (P=0.004, while the axillary lymph nodes were more often identified in the delayed scan

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

    International Nuclear Information System (INIS)

    Walker, Gary V.; Niikura, Naoki; Yang Wei; Rohren, Eric; Valero, Vicente; Woodward, Wendy A.; Alvarez, Ricardo H.; Lucci, Anthony; Ueno, Naoto T.; Buchholz, Thomas A.

    2012-01-01

    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

  3. Role of axillary lymph node ultra-sound and large core biopsy in the preoperative assessment of patients selected for sentinel node biopsy

    International Nuclear Information System (INIS)

    Nori, Jacopo; Boeri, Cecilia; Vanzi, Ermanno; Nori Bufalini, Filippo; Masi, Andrea; Bazzocchi, Massimo; Londero, Viviana; Mangialavori, Giuseppe; Distante, Vito; Simoncini, Roberta

    2005-01-01

    Purpose: To aim of this study was to evaluate the diagnostic accuracy of axillary lymph node sonography, if necessary in collaboration with US-guided large core biopsy, in the preoperative evaluation of breast cancer patients scheduled for quadrantectomy and sentinel lymph node excision. Materials and methods: From July 2001 to December 2002, we evaluated 117 breast cancer patients with ultrasound and, where indicated, FNAB. Breast lesions has diameters between 4 and 26 mm (mean diameter 11 mm). Fifteen (13%) of the 117 patients were excluded from the series as they did not found fulfil the criteria for preliminary sonography of the axilla: in 9 patients fewer than 4 nodes were detected and in 6 patients the breast lesions were intraoperatively found to be benign. Eleven patients (10.7%) with sonographically suspicious axillary nodes were sampled by US-guided core biopsy using a 14 or 16 Gauge Tru-Cut needle. Results: The ultrasound study aims to evaluate the dimensions and morphology of the breast lesion as well as detect and assess at least 4 axillary nodes. These were evaluated for hilar and cortical thickening and radio between the sinus diameter and the total longitudinal diameter. Lymph nodes with hilar diameters equal to or greater than 50% of the longitudinal diameter were considered normal. Of the 102 patients evaluated, 77 (75.7%) had normal axillary nodes according to the US criteria adopted. Negativity was confirmed by histology in 56 cases (72.7%, true negative); 21 (27.3%, false negative) were found to be positive, in contrast with the sonographic appearance. The false negative cases were due to lymph node micrometastasis which probably did not cause morphologic alterations perceptible at ultrasound. The remaining 25 patients (24.5%) had axillary lymph nodes classified as suspicious. In 13 cases of (52%, true positive) there was agreement with histology, whereas in 12 cases (48%, false positive) the US suspicion was not confirmed at surgery. The most

  4. Topical niacinamide 4% and desonide 0.05% for treatment of axillary hyperpigmentation: a randomized, double-blind, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Castanedo-Cazares JP

    2013-01-01

    Full Text Available Juan Pablo Castanedo-Cazares,1 Gabryela Lárraga-Piñones,1 Adriana Ehnis-Pérez,1 Cornelia Fuentes-Ahumada,1 Cuauhtemoc Oros-Ovalle,2 Bruce R Smoller,3 Bertha Torres-Álvarez11Department of Dermatology, 2Department of Pathology, Hospital Central Dr Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, México; 3Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AK, USABackground: Axillary hyperpigmentation is a frequent cause of cosmetic consultations in dark-skinned women from tropical areas, including Latin America. Currently, there is no widely accepted treatment for the disorder, but it is usually treated with bleaching agents because it is considered a variant of inflammatory hyperpigmentation. The purpose of this study was to assess the efficacy of niacinamide 4% and desonide 0.05% emulsions compared with placebo in the treatment of axillary hyperpigmentation.Methods: Twenty-four women aged 19–27 years with hyperpigmented axillae (phototype III–V were randomly assigned to receive the study treatments in the axillary region. Improvement was assessed at baseline, then clinically and by colorimetry 9 weeks later. Quantitative evaluation including melanin, inflammatory infiltrates, NKI/Beteb, CD1a, CD68, and collagen type IV content was performed by histochemistry and immunohistochemistry, assisted by computerized morphometric analysis.Results: Both niacinamide and desonide induced significant colorimetric improvement compared with placebo; however, desonide showed a better depigmenting effect than niacinamide. A good to excellent response was achieved in 24% of cases for niacinamide, 30% for desonide, and 6% for placebo. We observed a marked disruption of the basal membrane in axillary hyperpigmentation and an inflammatory infiltrate that improved after treatment. Decreased pigmentation in the desonide-treated axillae was associated with recovery of disruption at the basal membrane

  5. Initial Report of a Prospective Dosimetric and Clinical Feasibility Trial Demonstrates the Potential of Protons to Increase the Therapeutic Ratio in Breast Cancer Compared With Photons

    Energy Technology Data Exchange (ETDEWEB)

    Bradley, Julie A., E-mail: jbradley@floridaproton.org; Dagan, Roi; Ho, Meng Wei; Rutenberg, Michael; Morris, Christopher G.; Li, Zuofeng; Mendenhall, Nancy P.

    2016-05-01

    Purpose: To compare dosimetric endpoints between proton therapy (PT) and conventional radiation and determine the feasibility of PT for regional nodal irradiation (RNI) in women with breast cancer. Methods and Materials: From 2012 to 2014, 18 women (stage IIA-IIIB) requiring RNI prospectively enrolled on a pilot study. Median age was 51.8 years (range, 42-73 years). The cohort included breast-conserving therapy (BCT) and mastectomy patients and right- and left-sided cancers. Treatment targets and organs at risk were delineated on computed tomography scans, and PT and conventional plans were developed. Toxicity was prospectively recorded using Common Terminology Criteria for Adverse Events version 4.0. A Wilcoxon signed-rank sum test compared the dose-volume parameters. The primary endpoint was a reduction in cardiac V5. Results: Median follow-up was 20 months (range, 2-31 months). For all patients, the PT plan better met the dosimetric goals and was used for treatment. Proton therapy alone was used for 10 patients (9 postmastectomy, 1 after BCT) and combined proton–photon in 8 (6 BCT, 2 postmastectomy with immediate expander reconstruction). Proton therapy improved coverage of level 2 axilla (P=.0005). Adequate coverage of internal mammary nodes was consistently achieved with PT (median D95, 50.3 Gy; range, 46.6-52.1 Gy) but not with conventional radiation therapy (median D95, 48.2 Gy; range, 40.8-55 Gy; P=.0005). Median cardiac V5 was 0.6% with PT and 16.3% with conventional radiation (P<.0001). Median ipsilateral lung V5 and V20 were improved with PT (median V5 35.3% vs 60.5% [P<.0001]; and median V20, 21.6% vs 35.5% [P<.0001]). Grade 3 dermatitis developed in 4 patients (22%), which was the only grade 3 toxicity. No grade 4+ toxicities developed. Conclusion: Proton therapy for RNI after mastectomy or BCT significantly improves cardiac dose, especially for left-sided patients, and lung V5 and V20 in all patients without excessive acute toxicity

  6. A comparison of axillary and tympanic membrane to rectal temperatures in children

    Directory of Open Access Journals (Sweden)

    Tania Paramita

    2017-02-01

    Full Text Available Background Core body temperature measurement is not commonly done in pediatric populations because it is invasive and difficult to perform. Therefore, axillary and tympanic membrane temperature measurements are preferable, but their accuracy is still debatable. Objective To compare the accuracy of axillary and tympanic temperatures to rectal temperature in children with fever, and to measure the cut-off point for fever based on each temperature measurement method. Methods A diagnostic study was conducted among feverish children aged 6 months to 5 years who were consecutively selected from the Pediatric Outpatient Clinic, Pediatric Emergency Unit, and the inpatient ward in the Department of Child Health, Cipto Mangunkusumo Hospital (CMH, from December 2014 to January 2015. Subjects underwent three measurements within a two minute span, namely, the axillary, tympanic membrane, and rectal temperature measurements. The values obtained from the examination were analyzed with appropriate statistical tests. Results The cut-off for fever on axilla was 37.4oC and on tympanic membrane was  37.4oC, with sensitivity 96% (95%CI 0.88 to 0.98 and 93% (95%CI 0.84 to 0.97, respectively; specificity 50% (95%CI 0.47 to 0.84 and 50% (95%CI 0.31 to 0.69, respectively; positive predictive value/PPV 90% (95%CI 0.81 to 0.95 and 85% (95%CI 0.75 to 0.91, respectively; and negative predictive value/NPV 83% (95%CI 0.61 to 0.94 and 69% (95%CI 0.44 to 0.86, respectively. The optimal cut-off of tympanic membrane and axilla temperature was 37.8oC (AUC 0.903 and 0.903, respectively. Conclusion Axillary temperature measurement is as good as tympanic membrane temperature measurement and can be used in daily clinical practice or at home. By increasing the optimum fever cut-off point for axillary and tympanic membrane temperature to 37.8oC, we find sensitivity 81% and 88%, specificity 86% and 73%, PPV 95% and 91%, and NPV 95% and 91%, respectively.

  7. Measurement of body temperature in adult patients: comparative study of accuracy, reliability and validity of different devices.

    Science.gov (United States)

    Rubia-Rubia, J; Arias, A; Sierra, A; Aguirre-Jaime, A

    2011-07-01

    We compared a range of alternative devices with core body temperature measured at the pulmonary artery to identify the most valid and reliable instrument for measuring temperature in routine conditions in health services. 201 patients from the intensive care unit of the Candelaria University Hospital, Canary Islands, admitted to hospital between April 2006 and July 2007. All patients (or their families) gave informed consent. Readings from gallium-in-glass, reactive strip and digital in axilla, infra-red ear and frontal thermometers were compared with the pulmonary artery core temperature simultaneously. External factors suspected of having an influence on the differences were explored. The cut-off point readings for each thermometer were fixed for the maximum negative predictive value in comparison with the core temperature. The validity, reliability, accuracy, external influence, the waste they generated, ease of use, speed, durability, security, comfort and cost of each thermometer was evaluated. An ad hoc overall valuation score was obtained from these parameters for each instrument. For an error of ± 0.2°C and concordance with respect to fever, the gallium-in-glass thermometer gave the best results. The largest area under the receiver operating characteristic (ROC) curve is obtained by the digital axillar thermometer with probe (0.988 ± 0.007). The minimum difference between readings was given by the infrared ear thermometer, in comparison with the core temperature (-0.1 ± 0.3°C). Age, weight, level of conscience, male sex, environmental temperature and vaso-constrictor medication increases the difference in the readings and fever treatment reduces it, although this is not the same for all thermometers. The compact digital axillar thermometer and the digital thermometer with probe obtained the highest overall valuation score. If we only evaluate the aspects of validity, reliability, accuracy and external influence, the best thermometer would be the

  8. Modifications of transaxillary approach in endoscopic da Vinci-assisted thyroid and parathyroid gland surgery.

    Science.gov (United States)

    Al Kadah, Basel; Piccoli, Micaela; Mullineris, Barbara; Colli, Giovanni; Janssen, Martin; Siemer, Stephan; Schick, Bernhard

    2015-03-01

    Endoscopic surgery for treatment of thyroid and parathyroid pathologies is increasingly gaining attention. The da Vinci system has already been widely used in different fields of medicine and quite recently in thyroid and parathyroid surgery. Herein, we report about modifications of the transaxillary approach in endoscopic surgery of thyroid and parathyroid gland pathologies using the da Vinci system. 16 patients suffering from struma nodosa in 14 cases and parathyroid adenomas in two cases were treated using the da Vinci system at the ENT Department of Homburg/Saar University and in cooperation with the Department of General Surgery in New Sant'Agostino Hospital, Modena/Italy. Two different retractors, endoscopic preparation of the access and three different incision modalities were used. The endoscopic preparation of the access allowed us to have a better view during preparation and reduced surgical time compared to the use of a headlamp. To introduce the da Vinci instruments at the end of the access preparation, the skin incisions were over the axilla with one incision in eight patients, two incisions in four patients and three incisions in a further four patients. The two and three skin incisions modality allowed introduction of the da Vinci instruments without arm conflicts. The use of a new retractor (Modena retractor) compared to a self-developed retractor made it easier during the endoscopic preparation of the access and the reposition of the retractor. The scar was hidden in the axilla and independent of the incisions selected, the cosmetic findings were judged by the patients to be excellent. The neurovascular structures such as inferior laryngeal nerve, superior laryngeal nerve and vessels, as well as the different pathologies, were clearly 3D visualized in all 16 cases. No paralysis of the vocal cord was observed. All patients had a benign pathology in their histological examination. The endoscopic surgery of the thyroid and parathyroid gland can be

  9. Viraemia and Ebola virus secretion in survivors of Ebola virus disease in Sierra Leone: a cross-sectional cohort study.

    Science.gov (United States)

    Green, Edward; Hunt, Luke; Ross, J C Gareth; Nissen, Nina Marie; Curran, Tanya; Badhan, Anjna; Sutherland, Katherine A; Richards, Jade; Lee, James S; Allen, Samuel H; Laird, Steven; Blackman, Mandy; Collacott, Ian; Parker, Paul A; Walbridge, Andrew; Phillips, Rebecca; Sellu, Sia Jammie; Dama, Agnes; Sheriff, Alpha Karim; Zombo, Joseph; Ngegba, Doris; Wurie, Alieh H; Checchi, Francesco; Brooks, Timothy J

    2016-09-01

    In survivors of Ebola virus disease, clinical sequelae including uveitis, arthralgia, and fatigue are common and necessitate systematic follow-up. However, the infection risk to health-care providers is poorly defined. Here we report Ebola virus RT-PCR data for body site and fluid samples from a large cohort of Ebola virus survivors at clinic follow-up. In this cross-sectional cohort study, consecutive survivors of Ebola virus disease attending Kerry Town survivor clinic (Freetown, Sierra Leone), who had been discharged from the Kerry Town Ebola treatment unit, were invited to participate. We collected and tested axillary, blood, conjunctival, forehead, mouth, rectal, semen, urine, and vaginal specimens for presence of Ebola virus using RT-PCR. We regarded samples to be positive for Ebola virus disease if the cycle threshold was 40 or lower. We collected demographic data from survivors of their age, sex, time since discharge from the treatment unit, and length of acute admission in the Ebola treatment unit using anonymised standard forms. Between April 2, and June 16, 2015, of 151 survivors of Ebola virus disease invited to participate, 112 (74%) provided consent. The median age of participants was 21·5 years (IQR 14-31·5) with 34 (30%) participants younger than 16 years. 50 (45%) of 112 participants were male. We tested a total of 555 specimens: 103 from the axilla, 93 from blood, 92 from conjunctiva, 54 from forehead, 105 from mouth, 17 from the rectum, one from semen, 69 from urine, and 21 from the vagina. The median time from Ebola treatment unit discharge to specimen collection was 142 days (IQR 127-159). 15 participants had a total of 74 swabs taken less than 100 days from discharge. The semen sample from one participant tested positive for Ebola virus at 114 days after discharge from the treatment unit; specimens taken from the axilla, blood, conjunctiva, forehead, mouth, rectum, and urine of the same participant tested negative. All specimens from the

  10. Disseminated lupus vulgaris.

    Science.gov (United States)

    Garg, Taru; Ramchander; Shrihar, Rashmi; Gupta, Tanvi Pal; Aggarwal, Shilpi

    2011-01-01

    A 28-year-old woman presented with reddish raised, shiny lesions over the face and ears present for the past 3 years. Four years ago, she developed in her left axilla a nodule that became fluctuant and tender, which ruptured to discharge seropurulent material. It subsided after the patient had received antibiotics for 6 months, leaving puckered scarring. There was no history of antituberculous treatment. After 1 year, she developed papulonodular lesions on her face, nose, and ears. There was now a history of malaise, fever, dry cough, and anorexia and weight loss for the past 2 months. The patient was fully vaccinated in childhood, including against varicella infection. The general physical examination revealed lymphadenopathy involving cervical, axillary, and inguinal lymph nodes 0.5 x 0.5 cm to 1 x 1.5 cm, firm in consistency, and nontender. They were discrete except in the left axilla where multiple matted lymph nodes were present with overlying scarring and a papule. Her systemic examination was normal. Cutaneous examination showed a shiny erythematous plaque 3x2 cm with central atrophy and scarring on the face (Figure). It was comprised of multiple shiny nontender soft papules arranged in annular configuration. Similar discrete papules and nodules with adherent fine scaling were seen bilaterally on the alar prominence of the nose, lower lip, and post-auricular area. On diascopy, apple jelly nodules were seen. The hemogram, liver function tests, and renal function tests were normal, except for an elevated erythrocyte sedimentation rate. The Mantoux test showed erythema and an induration of 20 x 20 cm. A posteroanterior view on the chest x-ray showed fibrotic changes suggestive of pulmonary tuberculosis. Ultrasonography of the abdomen and pelvis showed no tubercular foci. Human immunodeficiency virus serology by enzyme-linked immunosorbent assay with 3 different kits was nonreactive. Histopathology from a nodule showed a focally thinned-out epidermis with

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

    International Nuclear Information System (INIS)

    Bentzen, S.M.; Dische, S.

    2000-01-01

    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

  12. Herpes zoster in breast cancer patients after radiotherapy

    International Nuclear Information System (INIS)

    Dunst, J.; Steil, B.; Furch, S.; Fach, A.; Bormann, G.; Marsch, W.

    2000-01-01

    Purpose: We have studied the incidence of herpes zoster in patients with adjuvant radiotherapy for breast cancer with special emphasis on possible correlations with other prognostic factors or survival. Patients and Methods: From 1/1985 through 12/1993, 1 155 breast cancer patients received postoperative radiotherapy with curative intent in our department. After mastectomy 961 patients were irradiated and after breast-preserving treatment 194 patients. The age ranged from 34 to 79 years, the median follow-up was 3.1 years (range: 0.3 to 12.4 years). There were 443 women (38%) pre- and 712 (62%) postmenopausal. 21% had T3- to T4-tumors, 55% had axillary lymph node involvement, and 65% received additional systemic hormonal and/or cytotoxic therapy. In case of postmastectomy radiotherapy, the lateral chest wall and lymphatics (axilla, parasternal and supraclavicular nodes) were irradiated with an anterior photon field to 50 Gy (axilla 44 Gy) and most of the chest wall with an electron field to 44 Gy in 2-Gy fractions. After breast-preservation, the breast was irradiated via tangential fields with 6- to 8-MV photons up to 50 Gy plus 8 Gy electron boost to the tumor bed. Most of the patients were followed routinely in the department for 2 to 5 years. The frequency of zoster was determined retrospectively by reviewing the patients' records. Results: A zoster after radiotherapy occurred in 41/1 155 patients (3.7%), mostly within the first 2 years after completion of radiotherapy. All infections remained localized and there was no evidence for systemic infections. Type of treatment (mastectomy vs breast-preservation) had no impact on the frequency of herpes zoster (36/961 patients after mastectomy and 5/194 patients after breast-preservation). There was also no correlation with other prognostic factors such as age, menopausal status, stage of disease or the use of adjuvant chemotherapy, nor was the occurrence of zoster linked to the degree of acute skin reaction in the

  13. [Sarcoma of the chest wall after radiotherapy for breast carcinoma - a case report].

    Science.gov (United States)

    Zedníková, I; Safránek, J; Hlaváčková, M; Hes, O; Svoboda, T

    2014-07-01

    Sarcoma occurring in soft tissues after radiotherapy is a rare complication of radiation treatment of tumours. It was most often described after treatment for breast cancer as well as for non-Hodgkin lymphoma and cervical carcinoma. The time interval between the radiation therapy and the development of the sarcoma can be very wide. Treatment demands radical surgical resection of the sarcoma with the edge of the resected tissue without tumour cells. In some cases, this is followed by chemotherapy or radiotherapy. The median survival time is 23 months, the longest survival being associated with sarcomas removed in a radical way. We present the case of a female patient with recurring leiomyosarcoma of the chest wall after radiotherapy for cancer of the right breast. In 2006, this 62-year-old patient was operated on to keep her right breast with axilla exenteration. After the surgery, hormonal therapy was followed by adjuvant radiotherapy of the right breast and the adjacent axilla. We used a linear accelerator and the total amount of radiation was 50 Gy (2 Gy fractionally once a day, five days a week). Four years after the operation, leiomyosarcoma was diagnosed in the pectoral muscle at the site where the tumour of the right breast had been excised. Between 2011 and 2013, a total of five operations of re-occurring sarcoma were performed - two excisions of the tumour, a mastectomy, rib resection and, at last, block resection of the chest wall. Adjuvant oncological treatment was not indicated. The patient, now being 69 years old, is still in a good physical and mental condition without any generalization of the disease. Sarcoma of the chest wall is a relatively rare consequence of radiotherapy for breast cancer. Sarcoma treatment involves radical surgical resection of the tumour whenever possible. The surgery is mostly followed by radiotherapy which, however, is impossible in a patient after breast-preserving surgery for carcinoma with radiotherapy. Chemotherapy is not

  14. A soft wearable robot for the shoulder: Design, characterization, and preliminary testing.

    Science.gov (United States)

    O'Neill, Ciaran T; Phipps, Nathan S; Cappello, Leonardo; Paganoni, Sabrina; Walsh, Conor J

    2017-07-01

    In this paper, we present a soft wearable robot for the shoulder which has the potential to assist individuals suffering from a range of neuromuscular conditions affecting the shoulder to perform activities of daily living. This wearable robot combines two types of soft textile pneumatic actuators which were custom developed for this particular application to support the upper arm through shoulder abduction and horizontal flexion/extension. The advantage of a textile-based approach is that the robot can be lightweight, low-profile, comfortable and non-restrictive to the wearer, and easy to don like an item of clothing. The actuator's ability to fold flat when not in use allows the robot to be almost invisible under clothing, potentially allowing the user to avoid any stigma associated with using assistive devices in public. To abduct the arm, a textilebased pneumatic actuator was developed to fit within the axilla to push the arm upwards, while a pair of smaller actuators pivot the abduction actuator to allow for horizontal extension and flexion. The individual textile actuators were experimentally evaluated before being integrated into a wearable garment. Human subject testing was performed to evaluate the ability of the robot to assist the arm by monitoring changes in biological muscle activity when comparing the robot powered on and off. Preliminary results show large reductions in muscular effort in targeted muscles, demonstrating the feasibility and promise of such a soft wearable robot for the shoulder.

  15. Prevalence of hyperhidrosis among medical students.

    Science.gov (United States)

    Westphal, Fernando Luiz; de Carvalho, Maria Auxiliadora Neves; Lima, Luiz Carlos; de Carvalho, Bruna Cecília Neves; Padilla, Rodrigo; Araújo, Katiúscia Karla Lêdo

    2011-01-01

    To identify the prevalence of hyperhidrosis among medical students of Manaus, State of Amazonas, Brazil. We conducted an observational, transversal, survey which examined the prevalence of primary hyperhidrosis among medical students of the Federal University of Amazonas and its relation to body mass index (BMI) and stress. Students were weighed and interviewed. We used questionnaires with questions recommended by the International Hyperhidrosis Society to relate hyperhidrosis to the daily activities of each person. Results were given by calculating the prevalence ratios and confidence intervals. Among the 293 students examined, it was found that a total of 16 (5.5%) students had barely tolerable or intolerable excessive sweating, interfering with daily activities. None had known causes of hyperhidrosis and 50% had family history. In all suffering from the condition the disease was bilateral, the mainly affected locations being: hands (35.7%), legs (21.4%), axilla (17.9), face (10 7%), back (7.1%), chest (3.6%) and abdomen (3.6%). There was no predominance regarding gender, age or BMI. We found a positive relationship with BMI and observed a prevalence ratio of 2.48 higher in overweight students than in normal weight or underweight ones. The prevalence of primary hyperhidrosis among medical students of Manaus was 5.5%. There is a positive non-statistical relationship with overweight and obesity. It was further noted an observational relationship with stress.

  16. Suppression of microbial metabolic pathways inhibits the generation of the human body odor component diacetyl by Staphylococcus spp.

    Science.gov (United States)

    Hara, Takeshi; Matsui, Hiroshi; Shimizu, Hironori

    2014-01-01

    Diacetyl (2,3-butanedione) is a key contributor to unpleasant odors emanating from the axillae, feet, and head regions. To investigate the mechanism of diacetyl generation on human skin, resident skin bacteria were tested for the ability to produce diacetyl via metabolism of the main organic acids contained in human sweat. L-lactate metabolism by Staphylococcus aureus and Staphylococcus epidermidis produced the highest amounts of diacetyl, as measured by high-performance liquid chromatography. Glycyrrhiza glabra root extract (GGR) and α-tocopheryl-L-ascorbate-2-O-phosphate diester potassium salt (EPC-K1), a phosphate diester of α-tocopherol and ascorbic acid, effectively inhibited diacetyl formation without bactericidal effects. Moreover, a metabolic flux analysis revealed that GGR and EPC-K1 suppressed diacetyl formation by inhibiting extracellular bacterial conversion of L-lactate to pyruvate or by altering intracellular metabolic flow into the citrate cycle, respectively, highlighting fundamentally distinct mechanisms by GGR and EPC-K1 to suppress diacetyl formation. These results provide new insight into diacetyl metabolism by human skin bacteria and identify a regulatory mechanism of diacetyl formation that can facilitate the development of effective deodorant agents.

  17. The Ethanolic Extracts The Gorgonian Isis hippuris Inhibited the Induced Mammary Carcinoma Growth In C3H Mice

    Science.gov (United States)

    Trianto, Agus; Andriyas, Yogi; Ridlo, Ali; Sedjati, Sri; Susilaningsih, Neni; Murwani, Retno

    2018-02-01

    The gorgonian Isis hippuris contains secondary metabolites gorgosterol and hippuristanol which are capable of inhibiting cancer cells. However, in vivo test of the gorgonian Isis hippuris extract as the anticancer drug has not been conducted. The research to study of the effect of ethanolic extract of the gorgonian on the induced tumor growth in C3H mice. The I. hippuris was obtained from Karimunjawa water in Jepara. The extract was prepared by maceration using ethanol. A total 20, 8-10 moths old of C3H mice with an initial weight of 20-25 gram were assigned into control, Ih-1, Ih-2, and Ih-3 groups. Control, Ih-1, Ih-2, and Ih-3 groups each received 0, 0.15, 1.5, and 15 mg extract per mouse per day respectively for two weeks. Cancer cells were introduced to all groups from a donor cancer mouse by injection via left or right axilla and allowed to grow. The cancer mass was removed and processed for histological examination, and cancer growth was determined according to Elston and Ellis criteria. The result showed that histological grade of cancer mass from the control group was in grade 2 or differentiated moderately. The histological grade of cancer mass from Ih-1, Ih-2, and Ih-3 groups were in grade 1 (low grade) or similar to a normal cell. Statistical analysis by Kruskal-Wallis test showed a significant difference (pdrug.

  18. Topical Oxybutynin 10% Gel for the Treatment of Primary Focal Hyperhidrosis: A Randomized Double-blind Placebo-controlled Split Area Study.

    Science.gov (United States)

    Artzi, Ofir; Loizides, Christophoros; Zur, Eyal; Sprecher, Eli

    2017-10-02

    Limited efficacy, costs, side-effects and complications are issues of concern for most current therapeutic modalities for focal hyperhidrosis. This study evaluated the efficacy of topical oxybutynin 10% gel in treating 61 patients with primary focal hyperhidrosis. The gel was applied to the right or left axilla, palms or soles vs. a placebo compound to the contralateral side for 30 days. A blinded visual grading of the change in starch-iodine tests was performed by 2 non-involved physicians. The Hyperhidrosis Disease Severity Scale (HDSS) and Dermatology Life Quality Index (DLQI) questionnaires were administered before and after treatment. The patients rated their satisfaction with treatment. Fifty-three patients completed the 4-week treatment. Sweat reduction in the drug-treated sweating areas was higher than in the control-treated areas. There was a significant mean improvement in pre- and post-treatment HDSS and DQLI (p = 0.001 for both). Thirty-nine subjects (74%) reported moderate-to-high satisfaction. Twice-daily topical application of oxybutynin 10% gel appears to be an effective, safe and well-tolerated treatment for focal primary hyperhidrosis.

  19. Comparison of onabotulinumtoxinA and rimabotulinumtoxinB for the treatment of axillary hyperhidrosis.

    Science.gov (United States)

    An, Jee Soo; Hyun Won, Chong; Si Han, Ji; Park, Hyun Sun; Seo, Kyle K

    2015-08-01

    Recently, rimabotulinumtoxinB has been increasingly used as an off-label treatment of primary axillary hyperhidrosis (PAH). However, the optimal conversion ratios for onabotulinumtoxinA and rimabotulinumtoxinB remain to be determined. To compare effectiveness, satisfaction level, and safety of rimabotulinumtoxinB with onabotulinumtoxinA at a conversion ratio of 1:30 for the treatment of PAH. Adults with PAH were enrolled in this bilaterally paired single-subject study. Each patient was randomly treated with 1,500 U rimabotulinumtoxinB on 1 axilla and 50 U onabotulinumtoxinA contralaterally. Hyperhidrosis Disease Severity Scale was assessed before and after treatment up to 20 weeks. A 10-cm visual analog scale representing improvement of hidrotic symptom and starch-iodine test were also used to assess therapeutic efficacy. Twenty-four patients completed the study. Both groups showed comparable and efficacious anhidrotic effects through 20 weeks for any variable. There were no significant differences in terms of the onset of action or mean duration of action between the 2 groups. Overall satisfaction with the treatment was equally high in both groups. Both toxins showed comparable anhidrotic effect for the treatment of axillary hyperhidrosis at a conversion ratio of 1:30.

  20. Physical function of the upper limb after breast cancer surgery. Results from the SOUND (Sentinel node vs. Observation after axillary Ultra-souND) trial.

    Science.gov (United States)

    Gentilini, O; Botteri, E; Dadda, P; Sangalli, C; Boccardo, C; Peradze, N; Ghisini, R; Galimberti, V; Veronesi, P; Luini, A; Cassano, E; Viale, G; Veronesi, U

    2016-05-01

    The SOUND (Sentinel node vs. Observation after axillary Ultra-souND) trial is an ongoing prospective randomized study comparing sentinel node biopsy vs. no axillary surgical staging in patients with small breast cancer and negative pre-operative ultra-sound of the axilla. The first 180 recruited patients were administered the QuickDASH (Disability Arm and Shoulder) questionnaire at different time points (before surgery, 1 week, 6 months and 1 year after surgery) to evaluate the physical function of the ipsilateral upper limb, The QuickDASH score ranges from 0 (no disability) to 100 (complete disability). 176 patients were available for analysis (94 in SNB arm and 82 in observation arm). The two groups were comparable with respect to age, tumor characteristics and treatments. Pre-surgery score values were 3.0% and 2.7% in the SNB arm and observation arm, respectively (P = 0.730). One week after surgery, the score increased to 24.0% in the SNB arm and 10.6% in the observation arm (P disability in the early post-operative period compared to patients who did not. The avoidance of SNB might translate into a considerable reduction of physical and emotional distress. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Prospective assessment of positioning-related pain in robotic urologic surgery.

    Science.gov (United States)

    Ginsburg, Kevin B; Pape, Kelsey; Heilbronn, Chase; Levin, Michael; Cher, Michael L

    2018-03-01

    This was a prospective study to assess positioning-related pain in 20 awake volunteers in the dorsal lithotomy (DL) and lateral decubitus (LD) positions. Each volunteer was put through the series of discrete, sequential steps used to achieve a final position; each step had two options. The Wong-Baker scale (WB) was used to rate pain for each option and the preferred option and ad lib comments were recorded. We found that awake volunteers could clearly and immediately distinguish differences in pain levels between position options. For the DL position, volunteers favored having the arms slightly flexed and pronated as opposed to being straight and supinated reflected by statistically less painful WB scores and option preference. Volunteers preferred having the neck flexed as opposed to being flat. For the LD position, volunteers reported statistically lower pain scores and preference for a foam roll for axilla support as opposed to a rolled blanket, the table flexed without the kidney rest as opposed to a raised kidney rest, and the over arm board as oppose to stacked blankets for contralateral arm support. Ad lib comments from the volunteers supported the above findings. To our knowledge, ours is the first study to demonstrate objective preferences for variations in surgical positioning using awake volunteers. This exercise with awake volunteers resulted in immediate changes in positioning for real robotic surgery patients in our practice.

  2. Comparison of the effect of diode laser versus intense pulsed light in axillary hair removal.

    Science.gov (United States)

    Ormiga, Patricia; Ishida, Cleide Eiko; Boechat, Alvaro; Ramos-E-Silva, Marcia

    2014-10-01

    Devices such as diode laser and intense pulsed light (IPL) are in constant development aiming at permanent hair removal, but there are few comparative studies between these technologies. The objective was to comparatively assess axillary hair removal performed by diode laser and IPL and to obtain parameters of referred pain and evolution response for each method. A comparative prospective, double-blind, and randomized study of axillary hair removal performed by the diode laser and IPL was conducted in 21 females. Six sessions were held with application of the diode laser in one axilla and the IPL in the other, with intervals of 30 days and follow-up of 6 months after the last session. Clinical photographs and digital dermoscopy for hair counts in predefined and fixed fields of the treated areas were performed before, 2 weeks after the sixth session, and 6 months after the end of treatment. A questionnaire to assess the pain was applied. The number of hair shafts was significantly reduced with the diode laser and IPL. The diode laser was more effective, although more painful than the IPL. No serious, adverse, or permanent effects were observed with both technologies. Both diode laser and the IPL are effective, safe, and able to produce lasting results in axillary hair removal.

  3. 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.

  4. Fine needle aspiration diagnosis of a spontaneously infarcted fibroadenoma mimicking carcinoma: a case report.

    Science.gov (United States)

    Arora, Rajan; Abou-Bakr, Amany; Al Taleb, Ahmed

    2013-02-01

    Spontaneous infarction of fibroadenoma is an extremely rare complication in a nonpregnant/nonlactating female undergoing first-time aspiration. It can be misdiagnosed as carcinoma in all aspects of triple approach used for evaluation of patients with breast lesions. A 37-year-old woman presented to the outpatient surgical clinic with a 6-month history of a breast lump that was slowly increasing in size and had become painful during the past month. There was no history of any trauma or fine needle aspiration, and she was not pregnant or lactating. Mammogram and ultrasound revealed a 2.9-cm heterogenous hypoechoic suspicious lesion. No lymph nodes were detected in the axilla. Fine needle aspiration cytology was performed, and a diagnosis of benign breast lesion with features of infarction was rendered on cytology. The lump was excised surgically, and a histological diagnosis of infarcted fibroadenoma was made. Careful and diligent search for preserved benign epithelial cells on smears is the key to recognize this entity and avoid serious therapeutic implications.

  5. Transaxillary Subcutaneouscopic Excision of Fibroadenoma of the Breast in Children: The Covert Scar Approach.

    Science.gov (United States)

    Gonzalez, Mirtha; Pimpalwar, Ashwin

    2016-02-01

    Fibroadenoma is a common condition in adolescent girls. Most tumors are excised either through a periareolar approach or the inframammary approach. Both approaches produce visible scars in adolescent girls. We propose a new cosmetic approach to this lesion and report our experience with the transaxillary subcutaneouscopic approach for excision of the fibroadenoma of the breast. The purpose of this case report is to delineate an innovative surgical approach to resection of a breast fibroadenoma that yields an adequate resection without possible damage to the ductal system while optimizing cosmetic results by avoiding scars. We retrospectively reviewed the medical records of four adolescent girls who underwent the above approach for excision of fibroadenoma of the breast. The age range was 14-16 years. There were no complications in all 4 patients. The final result at the 3-month follow-up revealed an esthetically pleasing skin incision that healed well and was hidden by the natural skin fold of the axilla. Transaxillary subcutaneouscopic excision of fibroadenoma of the breast in children is a safe and effective technique and should be considered for excision of benign breast lesions in children.

  6. [Axillary ectopic breast tissue fibroadenoma: report of three cases and review of the literature].

    Science.gov (United States)

    Ortiz-Mendoza, Carlos Manuel

    2012-02-01

    Ninety-five percent of women have mammary tissue at the axilla. However, the fibroadenoma seldom occur in this area and there are only isolated case reports of this tumor. This paper presents a series of three cases of this rare entity. Three women came to our hospital by axillary lumps. The patients had a median age of 36 +/- 9-years-old with an average time of evolution of 34 +/- 53 months. One patient had the history of a breast phyllodes tumor previously excised, and two were nulliparous. In two cases, neither ultrasound nor mammogram gave useful information for its diagnosis. Mammary glands of all cases were normal. The tumors were firm and movable, similar to a lymphadenopathy, and one was evident. The mean tumor size was 28 +/- 18 mm; all were oval and with white appearance. Histological diagnosis for all cases was fibroadenoma. Our findings match with literature reports. The axillary fibroadenomas may occur in women aged 30 to 50-years-old, mimicking a lymphadenopathy. Finally, the ultrasound and the mammography are not useful tools for its diagnosis.

  7. MRI of thoracic outlet syndrome in children

    Energy Technology Data Exchange (ETDEWEB)

    Chavhan, Govind B.; Batmanabane, Vaishnavi [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); Muthusami, Prakash [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); The Hospital for Sick Children, Division of Image Guided Therapy, Department of Diagnostic Imaging, Toronto, ON (Canada); Towbin, Alexander J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology and Medical Imaging, Cincinnati, OH (United States); Borschel, Gregory H. [The Hospital for Sick Children and University of Toronto, Division of Plastic Surgery, Department of Pediatric Surgery, Toronto, ON (Canada)

    2017-09-15

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation. (orig.)

  8. Suppression of microbial metabolic pathways inhibits the generation of the human body odor component diacetyl by Staphylococcus spp.

    Directory of Open Access Journals (Sweden)

    Takeshi Hara

    Full Text Available Diacetyl (2,3-butanedione is a key contributor to unpleasant odors emanating from the axillae, feet, and head regions. To investigate the mechanism of diacetyl generation on human skin, resident skin bacteria were tested for the ability to produce diacetyl via metabolism of the main organic acids contained in human sweat. L-lactate metabolism by Staphylococcus aureus and Staphylococcus epidermidis produced the highest amounts of diacetyl, as measured by high-performance liquid chromatography. Glycyrrhiza glabra root extract (GGR and α-tocopheryl-L-ascorbate-2-O-phosphate diester potassium salt (EPC-K1, a phosphate diester of α-tocopherol and ascorbic acid, effectively inhibited diacetyl formation without bactericidal effects. Moreover, a metabolic flux analysis revealed that GGR and EPC-K1 suppressed diacetyl formation by inhibiting extracellular bacterial conversion of L-lactate to pyruvate or by altering intracellular metabolic flow into the citrate cycle, respectively, highlighting fundamentally distinct mechanisms by GGR and EPC-K1 to suppress diacetyl formation. These results provide new insight into diacetyl metabolism by human skin bacteria and identify a regulatory mechanism of diacetyl formation that can facilitate the development of effective deodorant agents.

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

    Energy Technology Data Exchange (ETDEWEB)

    Clauser, P. [University of Udine, Azienda Ospedaliero-Universitaria ' ' S.Maria della Misericordia' ' , Institute of Diagnostic Radiology, Udine (Italy); Medical University of Vienna, Department of Biomedical Imaging and Image-guided interventions, Division of Molecular and Gender Imaging, Vienna (Austria); Pinker, K.; Helbich, T.H.; Kapetas, P.; Bernathova, M.; Baltzer, P.A.T. [Medical University of Vienna, Department of Biomedical Imaging and Image-guided interventions, Division of Molecular and Gender Imaging, Vienna (Austria)

    2014-09-15

    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.)

  10. Innovation in the planning of V-Y rotation advancement flaps: A template for flap design.

    Science.gov (United States)

    Dölen, Utku Can; Koçer, Uğur

    2018-01-01

    Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19-80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

  11. Risk factors associated with sensitization to hydroxyisohexyl 3-cyclohexene carboxaldehyde.

    Science.gov (United States)

    Uter, Wolfgang; Geier, Johannes; Schnuch, Axel; Gefeller, Olaf

    2013-08-01

    Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) is a synthetic fragrance chemical and an important contact allergen, at least in Europe. Despite this importance, little is known about risk factors associated with this allergen. To examine factors from the history and clinical presentation of patch tested patients associated with HICC sensitization. Contact allergy surveillance data of 95 637 patients collected by the Information Network of Departments of Dermatology (IVDK, www.ivkd.org) in 2002-2011 were analysed. Point and interval estimates of the relative risk were derived from multifactorial logistic regression modelling. The overall prevalence of HICC sensitization was 2.24%. The strongest risk factors were polysensitization and dermatitis of the axillae, followed by dermatitis at other sites. No consistent and significant time trend was observed in this analysis. As compared with the youngest patients, the odds of HICC sensitization increased approximately three-fold in the 52-67-year age group, and strongly declined with further increasing age. The risk pattern with regard to age and affected anatomical site differed from that observed with other fragrance screening allergens. Cosmetic exposure, as broadly defined here, was a stronger and more prevalent individual risk factor than occupational exposure. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. 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)

  13. MRI of thoracic outlet syndrome in children

    International Nuclear Information System (INIS)

    Chavhan, Govind B.; Batmanabane, Vaishnavi; Muthusami, Prakash; Towbin, Alexander J.; Borschel, Gregory H.

    2017-01-01

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation. (orig.)

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

    International Nuclear Information System (INIS)

    Bollet, Marc A.; Kirova, Youlia M.; Antoni, Guillemette; Pierga, Jean-Yues; Sigal-Zafrani, Brigitte; Laki, Fatima; Campana, Francois; Dendale, Remi; Salmon, Remy; Cottu, Paul; Fourquet, Alain

    2007-01-01

    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

  15. Sentinel node lymphoscintigraphy in breast cancer: problems, solutions and clinical utility

    International Nuclear Information System (INIS)

    Wye, D.A.; Cohn, D.; Evans, S.G.; Larcos, G.; Ung, O.; Barry, P.

    1999-01-01

    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 99 Tc m -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

  16. Rediscovering the wound hematoma as a site of hemostasis during major arterial hemorrhage.

    Science.gov (United States)

    White, N J; Mehic, E; Wang, X; Chien, D; Lim, E; St John, A E; Stern, S A; Mourad, P D; Rieger, M; Fries, D; Martinowitz, U

    2015-12-01

    Treatments for major internal bleeding after injury include permissive hypotension to decrease the rate of blood loss, intravenous infusion of plasma or clotting factors to improve clot formation, and rapid surgical hemostasis or arterial embolization to control bleeding vessels. Yet, little is known regarding major internal arterial hemostasis, or how these commonly used treatments might influence hemostasis. (i) To use a swine model of femoral artery bleeding to understand the perivascular hemostatic response to contained arterial hemorrhage. (ii) To directly confirm the association between hemodynamics and bleeding velocity. (iii) To observe the feasibility of delivering an activated clotting factor directly to internal sites of bleeding using a simplified angiographic approach. Ultrasound was used to measure bleeding velocity and in vivo clot formation by elastography in a swine model of contained femoral artery bleeding with fluid resuscitation. A swine model of internal pelvic and axillary artery hemorrhage was also used to demonstrate the feasibility of local delivery of an activated clotting factor. In this model, clots formed slowly within the peri-wound hematoma, but eventually contained the bleeding. Central hemodynamics correlated positively with bleeding velocity. Infusion of recombinant human activated factor VII into the injured artery near the site of major internal hemorrhage in the pelvis and axillae was feasible. We rediscovered that clot formation within the peri-wound hematoma is an integral component of hemostasis and a feasible target for the treatment of major internal bleeding using activated clotting factors delivered using a simplified angiographic approach. © 2015 International Society on Thrombosis and Haemostasis.

  17. Expanding the differential of shoulder pain: Parsonage-Turner syndrome.

    Science.gov (United States)

    Schreiber, Adam L; Abramov, Ronnen; Fried, Guy W; Herbison, Gerald J

    2009-08-01

    A 44-year-old man was in his car when it was rear-ended in a minor motor vehicle collision, during which his right forearm contacted the steering wheel. Shortly thereafter, pain in his right shoulder developed, but initial work-up was unremarkable. His pain progressed to shoulder girdle weakness over several months and did not improve after 2.5 years. At the time of consultation, he complained of right-sided neck pain radiating to the right deltoid muscle and axilla as well as right shoulder blade pain with shoulder girdle weakness. Repeated electrodiagnostic studies revealed denervation limited to the serratus anterior and right deltoid muscles without evidence of cervical radiculopathy. He was diagnosed with Parsonage-Turner syndrome, which is a neurologic condition characterized by acute onset of shoulder and arm pain followed by weakness and sensory disturbance. The authors review patient presentation, physical examination, and work-up needed for diagnosis of this syndrome to help physicians avoid administering unnecessary tests and treatment.

  18. 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

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

    International Nuclear Information System (INIS)

    Zaleska-Dorobisz, U.; Koltowska, A.; Moron, K.; Jaworski, W.

    2005-01-01

    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)

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

    International Nuclear Information System (INIS)

    Suzuki, Gen; Ogo, Etuyo; Toda, Yukihiro; Suefuji, Hiroaki; Hayabuchi, Naofumi

    2001-01-01

    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)

  1. 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.

  2. Primary cutaneous secretory carcinoma: A previously overlooked low-grade sweat gland carcinoma.

    Science.gov (United States)

    Llamas-Velasco, Mar; Mentzel, Thomas; Rütten, Arno

    2018-03-01

    Twelve cases of primary cutaneous secretory carcinoma (PCSC) have been published, 9 showing ETV6-NTRK3 translocation, a characteristic finding shared with secretory breast carcinoma and mammary analogue secretory carcinoma. A 34-year-old female presented a solitary nodule on the right groin. Biopsy revealed a secretory carcinoma staining positive with CK7, CAM5.2, mammaglobulin and S100 and negative with GATA3, CK20, podoplanin, calponin and CDX2. ETV6-NTRK3 was demonstrated by Fluorescence in situ hybridization (FISH). PCSC is a rare neoplasm, described in the skin in 2009, that affects more frequently females with a mean age of 42.3 years and it is most commonly located in axilla. Histopathologically, these tumor cells are characterized by bubbly eosinophilic secretions diastase-resistant and bland nuclei and they are arranged in various growth patterns, including microcystic, tubular, solid and papillary. S100, mammoglobin and CK7 are usually positive. We review the main histopathological features to rule out histopathologic mimics such as breast metastasis, salivary tumors, cribriform carcinoma and primary cutaneous adenoid cystic carcinoma. GATA3 negative staining, as in our case, can help to rule out breast metastasis. Moreover, long-term benign follow up (144 months) in this case as well as follow-up data on outcomes from literature review support that PCSC is a low-grade sweat gland carcinoma. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Case series of pectoralis major rupture requiring operative intervention sustained on the Royal Marines 'Tarzan' assault course.

    Science.gov (United States)

    Evans, Jonathan; Smith, Chris; Guyver, Paul Michael

    2015-07-01

    We present (with intra-operative imaging) four patients who sustained pectoralis major (PM) ruptures on the same piece of equipment of the 'Tarzan' assault course at the Commando Training Centre, Royal Marines (CTCRM). Recruits jump at running pace, carrying 21 lbs of equipment and a weapon (8 lbs) across a 6-feet gap onto a vertical cargo-net. The recruits punch horizontally through the net, before adducting their arm to catch themselves, and all weight, on their axilla. All patients presented with immediate pain and reduced function. Two had ruptures demonstrated on magnetic resonance imaging, one on an ultrasound scan and one via clinical examination. All four patients were found, at operation, to have sustained type IIIE injuries. All patients underwent PM repair using a unicortical button fixation and had an uneventful immediate postoperative course. Patient 1 left Royal Marines training after the injury (out of choice; not because of failure to rehabilitate). All other patients are under active rehabilitation, hoping to return to training. Review of 10 years of records at CTCRM reveal no documented PM rupture prior to our first case in October 2013. There has been no change to the obstacle or technique used and all patients deny the use of steroids.

  4. Case series of pectoralis major rupture requiring operative intervention sustained on the Royal Marines ‘Tarzan’ assault course

    Science.gov (United States)

    Smith, Chris; Guyver, Paul Michael

    2015-01-01

    We present (with intra-operative imaging) four patients who sustained pectoralis major (PM) ruptures on the same piece of equipment of the ‘Tarzan’ assault course at the Commando Training Centre, Royal Marines (CTCRM). Recruits jump at running pace, carrying 21 lbs of equipment and a weapon (8 lbs) across a 6-feet gap onto a vertical cargo-net. The recruits punch horizontally through the net, before adducting their arm to catch themselves, and all weight, on their axilla. All patients presented with immediate pain and reduced function. Two had ruptures demonstrated on magnetic resonance imaging, one on an ultrasound scan and one via clinical examination. All four patients were found, at operation, to have sustained type IIIE injuries. All patients underwent PM repair using a unicortical button fixation and had an uneventful immediate postoperative course. Patient 1 left Royal Marines training after the injury (out of choice; not because of failure to rehabilitate). All other patients are under active rehabilitation, hoping to return to training. Review of 10 years of records at CTCRM reveal no documented PM rupture prior to our first case in October 2013. There has been no change to the obstacle or technique used and all patients deny the use of steroids. PMID:27582974

  5. 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.

  6. 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

    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. 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. 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. 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.

  7. 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.

  8. Sentinel Lymph Node Biopsy Following Neoadjuvant Chemotherapy: Review of the Literature and Recommendations for Use in Patient Management

    Directory of Open Access Journals (Sweden)

    Yan Xing

    2004-10-01

    Full Text Available Breast cancer is a significant health problem worldwide and is one of the leading causes of cancer-related mortality in women. Preoperative chemotherapy has become the standard of care for patients with locally advanced disease and is being used more frequently in patients with early-stage breast cancer. Sentinel lymph node biopsy has shown great promise in the surgical management of breast cancer patients, but its use following preoperative chemotherapy is yet to be determined. Eleven studies have been published with respect to the accuracy of sentinel lymph node biopsy following neoadjuvant chemotherapy. Ten studies showed favourable results, with the ability to identify a sentinel lymph node in 84% to 98% of cases, and reported false negative rates ranging from 0% to 20%. The accuracy of sentinel lymph node biopsy following preoperative chemotherapy for breast cancer ranges from 88% to 100%, with higher rates when specific techniques and inclusion criteria are applied. The published literature supports the use of sentinel lymph node biopsy for assessment of the axilla in patients with clinically node-negative disease following preoperative chemotherapy.

  9. Abscess-forming lymphadenopathy and osteomyelitis in children with Bartonella henselae infection.

    Science.gov (United States)

    Ridder-Schröter, Regina; Marx, Aleander; Beer, Meinrad; Tappe, Dennis; Kreth, Hans-Wolfgang; Girschick, Hermann J

    2008-04-01

    Bartonella henselae is the agent of cat-scratch disease (CSD), a chronic lymphadenopathy among children and adolescents. A systemic infection is very rare and most of these cases are found in patients with immunodeficiency. Here, cases involving four children of 6-12 years of age are reported. Three of the children had an abscess-forming lymphadenopathy and surrounding myositis in the clavicular region of the upper arm. The diagnosis was made serologically and, in one case, using eubacterial universal PCR. One child was treated with erythromycin for 10 days, the second received cefotaxime and flucloxacillin for 14 days and the third child was not treated with antibiotics. The fourth child had a different course: a significantly elevated signal intensity affecting the complete humerus was found in magnetic resonance imaging, consistent with osteomyelitis. A lymph node abscess was also found in the axilla. Diagnosis was established by indirect fluorescence assay and lymph node biopsy. Antibiotic therapy using clarithromycin, clindamycin and rifampicin was gradually successful. Immunodeficiency was excluded. All described lesions healed without residues. In immunocompetent patients, infection affects skin and draining lymph nodes; however, prolonged fever of unknown origin as in the fourth patient indicated a systemic complication of CSD.

  10. 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.

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

    International Nuclear Information System (INIS)

    Herst, Patries M

    2014-01-01

    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. A case of vesicular cutaneous lupus erythematosus in a Border collie successfully treated with topical tacrolimus and nicotinamide-tetracycline.

    Science.gov (United States)

    Lehner, Georg M; Linek, Monika

    2013-12-01

    Canine vesicular cutaneous lupus erythematosus (VCLE) is an autoimmune skin disease of the Shetland sheepdog and rough collie, which manifests as an erosive dermatitis of sparsely haired skin of the ventrum and concave pinnae. Reported treatment consists of immunosuppression with glucocorticoids alone or in combination with azathioprine, but successful treatment is unpredictable. To report on the treatment of VCLE in a Border collie dog with topical 0.1% tacrolimus and nicotinamide in combination with tetracycline. An 8-year-old male neutered Border collie was presented with multiple coalescing erosions on the ventral abdomen, groin and axillae and ulceration on the oral commissures. Clinical presentation, routine diagnostics, histology and immunohistochemistry were consistent with VCLE. Remission was achieved with topical 0.1% tacrolimus and combination therapy of nicotinamide and tetracycline. This dog responded well to treatment with topical 0.1% tacrolimus, nicotinamide-tetracycline and sun avoidance. Complete remission was achieved after 2.5 months, and the dog was lesion free during a 1 year follow-up period. © 2013 ESVD and ACVD.

  13. Epidemiology and population structure of Staphylococcus aureus in various population groups from a rural and semi urban area in Gabon, Central Africa.

    Science.gov (United States)

    Ateba Ngoa, Ulysse; Schaumburg, Frieder; Adegnika, Ayola Akim; Kösters, Katrin; Möller, Tina; Fernandes, Jose Francisco; Alabi, Abraham; Issifou, Saadou; Becker, Karsten; Grobusch, Martin Peter; Kremsner, Peter Gottfried; Lell, Bertrand

    2012-10-01

    Little data is available on the epidemiology of Staphylococcus aureus in Africa. In the present study we aim at characterizing the population structure of S. aureus in healthy subjects from a rural and a semi-urban area in Lambaréné, Gabon as well as in hospital staff and inpatients. In total, 500 subjects were screened for S. aureus colonization of the nares, axillae and inguinal region. Overall, 146 (29%) were positive. We found 46 different spa types. The most frequent spa types were t084 (35%) and the agr II was the most prevalent subtype of the accessory gene regulator (56%, n=82). Five isolates (3%) were methicillin resistant S. aureus (MRSA). Carriage rates of S. aureus in Gabon are comparable to developed countries. MRSA is for the first time described and could pose a significant health threat in this region with limited access to microbiological laboratory facilities and to adequate antimicrobial agents. Copyright © 2012 Elsevier B.V. All rights reserved.

  14. Ethylhexylglycerin: a low-risk, but highly relevant, sensitizer in 'hypo-allergenic' cosmetics.

    Science.gov (United States)

    Aerts, Olivier; Verhulst, Lien; Goossens, An

    2016-05-01

    Ethylhexylglycerin is a relatively new cosmetic ingredient that is used for its surfactant, emollient, skin-conditioning and antimicrobial properties. Since 2002, it has been occasionally reported as a contact allergen. To report on 13 patients who presented with allergic contact dermatitis caused by ethylhexylglycerin, evaluated at two Belgian university patch test clinics during the period 1990-2015. The patients were patch tested with the European baseline series, a cosmetic series, and - if indicated - additional series. Both the cosmetic products used and their single ingredients were patch tested. All but one of the ethylhexylglycerin-allergic patients were female, with a median age of 43 years (range: 29-81 years), most often suffering from dermatitis on the face, and sometimes on the hands and/or axillae. As the culprit products, leave-on cosmetics were identified, including a high number of proclaimed 'hypo-allergenic' and 'preservative-free' facial creams, sun protection creams, and deodorants. Ethylhexylglycerin is a rare, but highly relevant, cosmetic sensitizer, even in those products advertised to be safe for consumers. Targeted patch testing with ethylhexylglycerin 5% pet. is very useful, and routine patch testing in a cosmetic series may be considered. Higher test concentrations might be indicated in selected cases. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Berardinelli-Seip Syndrome

    Directory of Open Access Journals (Sweden)

    Sameer I Dal,

    2011-01-01

    Full Text Available We have reported two cases of Berardinelli-syndrome in a family which is a rare autosomal recessive disorder of the adipose tissue, originally described by Berardinelli and Seip, has been reported in approximately 120 patients of various ethnic origins. Assuming that only 1 in 4 patients is reported.Patients present with acanthosis nigricans (dark velvety pigmentation of the skin in the axilla, neck or groin, severe insulin resistance, high levels of serum insulin and serum triglycerides.The other clinical features consist of enlarged hands, feet and prominent mandible (acromegaloid features, increased sweating, umbilical hernia and lytic lesions (bone appear to be eaten-up on X-rays in long bones of the upper and lower extremities (arms, forearm, hands, thigh, calf, legs and feet such as humerus, femur, etc. Hepatomegaly from fatty liver is almost universal and may ultimately lead to cirrhosis. Splenomegaly is common. Nearly all patients have a prominent umbilicus or frank umbilical hernia. Females present with enlarged clitoris, increased body hair, absence of or irregular menstrual cycles, and polycystic ovaries (enlarged ovaries. Only a few affected women have had successful pregnancies, whereas affected men have normal fertility.

  16. 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.

  17. Emergency Stent Grafting After Unsuccessful Surgical Repair of a Mycotic Common Femoral Artery Pseudoaneurysm in a Drug Abuser

    International Nuclear Information System (INIS)

    Lupattelli, Tommaso; Garaci, Francesco Giuseppe; Basile, Antonio; Minnella, Daniela Paola; Casini, Andrea; Clerissi, Jacques

    2009-01-01

    Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.

  18. Microbiological and biochemical origins of human axillary odour.

    Science.gov (United States)

    James, A Gordon; Austin, Corrine J; Cox, Diana S; Taylor, David; Calvert, Ralph

    2013-03-01

    The generation of malodour on various sites of the human body is caused by the microbial biotransformation of odourless natural secretions into volatile odorous molecules. On the skin surface, distinctive odours emanate, in particular, from the underarm (axilla), where a large and permanent population of microorganisms thrives on secretions from the eccrine, apocrine and sebaceous glands. Traditional culture-based microbiological studies inform us that this resident microbiota consists mainly of Gram-positive bacteria of the genera Staphylococcus, Micrococcus, Corynebacterium and Propionibacterium. Among the molecular classes that have been implicated in axillary malodour are short- and medium-chain volatile fatty acids, 16-androstene steroids and, most recently, thioalcohols. Most of the available evidence suggests that members of the Corynebacterium genus are the primary causal agents of axillary odour, with the key malodour substrates believed to originate from the apocrine gland. In this article, we examine, in detail, the microbiology and biochemistry of malodour formation on axillary skin, focussing on precursor-product relationships, odour-forming enzymes and metabolic pathways and causal organisms. As well as reviewing the literature, some relevant new data are presented and considered alongside that already available in the public domain to reach an informed view on the current state-of-the-art, as well as future perspectives. © 2012 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.

  19. Pathological axillary lymph nodes detected at mammographic screening

    Energy Technology Data Exchange (ETDEWEB)

    Lim, E. T.; O' Doherty, A.; Hill, A. D.; Quinn, C. M. E-mail: c.quinn@st-vincents.ie

    2004-01-01

    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.

  20. Diagnosis and treatment of seborrheic dermatitis.

    Science.gov (United States)

    Clark, Gary W; Pope, Sara M; Jaboori, Khalid A

    2015-02-01

    Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms-scaling, erythema, and itching-occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis.

  1. Clinical and diagnosis characteristics of breast cancers in women with a history of radiotherapy in the first 30years of life: A French multicentre cohort study.

    Science.gov (United States)

    Demoor-Goldschmidt, C; Supiot, S; Oberlin, O; Helfre, S; Vigneron, C; Brillaud-Meflah, V; Bernier, V; Laprie, A; Ducassou, A; Claude, L; Mahé, M A; de Vathaire, F

    2017-08-01

    Irradiation (>3Gy) to the breast or axillae before 30years of age increases the risk of secondary breast cancer (SBC). The purpose of this article is to describe the clinical characteristics of SBC and the way of diagnosis in young women (before the age of national screening) in France who had received previous radiotherapy for a childhood or a young adulthood cancer. This retrospective, multicentre study reviewed the medical records of women with SBC before the age of the national screening who had received irradiation (≥3Gy) on part or all of the breast before 30years of age, for any type of tumour except BC. A total of 121 SBC were detected in 104 women with previous radiotherapy. Twenty percent of SBC were detected during regular breast screening and 16% of the women had a regular radiological follow-up. Our results points out that the main proportion of childhood cancer survivors did not benefit from the recommended breast cancer screening. This result is comparable to other previously published studies in other countries. A national screening programme is necessary and should take into account the patient's age, family history, personal medical history and previous radiotherapy to reduce the number of SBC diagnosed at an advanced stage. Copyright © 2017. Published by Elsevier B.V.

  2. Surgical strategy, methods of reconstruction, surgical margins and postoperative complications in oncoplastic breast surgery.

    Science.gov (United States)

    Rose, Michael; Manjer, Jonas; Ringberg, Anita; Svensson, Henry

    2014-01-01

    Oncoplastic breast surgery is an evolving discipline in the surgical treatment of breast cancer aimed to improve the outcome. Oncoplastic breast surgery was performed between January 2008 and December 2010 on 72 women with 74 breast cancers selected from a population of 1,018 primary breast cancer patients. Careful preoperative planning revealed the possibility of partial breast reconstruction with volume reduction, volume displacement or volume replacement depending on breast size as well as tumour size and location. Data were registered consecutively. The surgical plan was successful in all but one case, where a mastectomy had to be performed during the primary surgery. In 53 cases, a contralateral mammoplasty was performed during the operation to achieve symmetry. During the follow-up period until November 2011, only one patient needed corrective surgery. Final histopathological examination indicated that seven cases required extended resection and three cases required a mastectomy. Five patients experienced delayed wound healing, although complications requiring further surgery occurred for the reconstructed breast in four cases, the contralateral breast in three cases and the axilla after exaeresis in two cases because of haematoma. Such complications led to slight delay in adjuvant therapy for four patients. This study demonstrates that it is feasible to implement oncoplastic breast surgery into daily clinical practice as a supplement to conventional breast cancer surgery. As such, oncoplastic breast surgery may provide a markedly better outcome than breast-conserving surgery in terms of shape and symmetry without compromising the surgical margins. Level of Evidence: Level IV, prognostic/risk study.

  3. Paraqueratose granular: relato de seis casos em crianças Granular parakeratosis: a report of six cases in children

    Directory of Open Access Journals (Sweden)

    Susana Giraldi

    2006-02-01

    Full Text Available A paraqueratose granular é alteração da queratinização, primeiramente descrita em adultos, caracterizada por pápulas e placas hiperqueratósicas nas áreas intertriginosas. Os autores descrevem seis casos de paraqueratose granular em crianças. Um paciente apresentava lesões nas regiões glúteas, dois em ambas as axilas e região cervical (apresentações inéditas na literatura. Três pacientes apresentavam lesões em pregas inguinais. Realizam também revisão da literatura e discutem a possível etiologia dessa rara dermatose.Granular parakeratosis is an alteration of keratinization that was first described in adults. It is characterized by hiperkeratotic plaques and papules in intertriginous areas. The authors describe six cases of granular parakeratosis in children. One patient had lesions on the buttocks; two children presented papules in both axillae and cervical region (presentations never described before in the literature. The remaining three patients presented with lesions in the inguinal folds. Review of the literature and discussion on the pathogenesis of this rare dermatosis are presented.

  4. Whole body positron emission tomography in follow-up of high risk melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Koskivuo, Ilkka O.; Suominen, Erkki A. [Dept. of Surgery, Turku Univ. Hospital (Finland); Seppaenen, Marko P.; Minn, Heikki R.I. [Turku PET Centre, Turku Univ. Hospital (Finland)

    2007-07-15

    The aim of this study was to determine the clinical impact of whole body positron emission tomography (FDG PET) to detect clinically silent metastases in the follow-up of patients with high risk melanoma. FDG PET was performed to 30 asymptomatic melanoma patients (AJCC stage IIB-IIIC) 7-24 months after the primary surgery and sentinel node biopsy. FDG PET was able to detect six of seven recurrences, constituting 20% of all study patients. One patient presented with a negative FDG PET finding at the very first scanning, but was positive later in a repeated scan after manifestation of palpable mass in the axilla. The positive PET finding had an impact on treatment decisions in every case: three patients underwent surgical resection and four patients received chemotherapy or interferon. The mean follow-up time was 27 months (range, 12-48 months) and during that time the other 23 patients with true negative FDG PET were disease-free. One of the seven recurrences was in remission after surgical metastasectomy. In conclusion, whole body FDG PET is a valuable follow-up tool in high risk melanoma to diagnose recurrences and to select the patients, who are suitable for surgical metastasectomy.

  5. Clonidine is effective for the treatment of primary idiopathic hyperhidrosis and hot flushes: a case report.

    Science.gov (United States)

    Albadrani, Ahmed

    2017-01-17

    While primary hyperhidrosis can be seen in men, accompanying hot flushes is rarely seen in men. Primary hyperhidrosis is thought to be related to overactivity of the sympathetic nervous system while hot flushes are believed to be related to altered peripheral vascular reactivity and a narrowed thermoregulatory zone. I report the case of a 29-year-old man of Arab origin who presented to a dermatology clinic with a complaint of generalized sweating, with heavier involvement of his inguinal region, axilla, and lower back. His complaint was associated with a transient hot sensation and erythema over the affected areas. He did not respond to topical antiperspirants containing aluminum chloride, topical aluminum chloride, or to botulinum toxin A injected in both inguinal areas. He was then referred to an endocrinology clinic to rule out secondary causes of hyperhidrosis and hot flushes; a primary diagnosis was confirmed. He did not respond to oral glycopyrrolate and additionally was complaining of its anticholinergic side effects. The glycopyrrolate was then replaced with oral clonidine 0.15 mg twice a day. Clonidine was well tolerated without remarkable side effects and he quickly started to feel marked improvement which was maintained for 2 years. I report an atypical presentation of primary hyperhidrosis and hot flushes that was effectively controlled by clonidine without remarkable side effects. Further research on a large number of patients may be required before recommending clonidine in similar conditions.

  6. Report on envenomation by a Gila monster (Heloderma suspectum) with a discussion of venom apparatus, clinical findings, and treatment.

    Science.gov (United States)

    Strimple, P D; Tomassoni, A J; Otten, E J; Bahner, D

    1997-05-01

    Human envenomations by Heloderma species are a rare but clinically important medical problem. We report a case of an adult male bitten on the left hand by a 50-cm male, captive specimen of Heloderma suspectum (Gila monster). Immediate signs and symptoms included pain at the bite site radiating into the arm and axilla and swelling of the hand and forearm. Systemic complaints of nausea, diaphoresis, and dizziness (without a decrease in blood pressure) lasted approximately 1 hour, and laboratory studies were normal. The patient's course was uneventful except for persistent hyperesthesia, which eventually abated. Two types of helodermatid bites produce distinct clinical pictures. The chewing bite potentially causes more envenomation than the slashing bite. The venom contains a number of protein and nonprotein components including serotonin, a bradykinin-releasing substance, protease, hyaluronidase, helodermin, and gilatoxin. The clinical presentation of a helodermatid bite can include pain, edema, hypotension, nausea, vomiting, weakness, and diaphoresis. No antivenin is commercially available. Treatment is supportive, and although first aid measures such as suction or compression may impede venom movement, they are unproved. Cryotherapy, tourniquet, and excision are dangerous and should not be used.

  7. Efficacy of a 2% climbazole shampoo for reducing Malassezia population sizes on the skin of naturally infected dogs.

    Science.gov (United States)

    Cavana, P; Petit, J-Y; Perrot, S; Guechi, R; Marignac, G; Reynaud, K; Guillot, J

    2015-12-01

    Shampoo therapy is often recommended for the control of Malassezia overgrowth in dogs. The aim of this study was to evaluate the in vivo activity of a 2% climbazole shampoo against Malassezia pachydermatis yeasts in naturally infected dogs. Eleven research colony Beagles were used. The dogs were distributed randomly into two groups: group A (n=6) and group B (n=5). Group A dogs were washed with a 2% climbazole shampoo, while group B dogs were treated with a physiological shampoo base. The shampoos were applied once weekly for two weeks. The population size of Malassezia yeasts on skin was determined by fungal culture through modified Dixon's medium contact plates pressed on left concave pinna, axillae, groins, perianal area before and after shampoo application. Samples collected were compared by Wilcoxon rank sum test. Samples collected after 2% climbazole shampoo application showed a significant and rapid reduction of Malassezia population sizes. One hour after the first climbazole shampoo application, Malassezia reduction was already statistically significant and 15 days after the second climbazole shampoo, Malassezia population sizes were still significantly decreased. No significant reduction of Malassezia population sizes was observed in group B dogs. The application of a 2% climbazole shampoo significantly reduced Malassezia population sizes on the skin of naturally infected dogs. Application of 2% climbazole shampoo may be useful for the control of Malassezia overgrowth and it may be also proposed as prevention when recurrences are frequent. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer.

    Science.gov (United States)

    Verma, Vivek; Iftekaruddin, Zaid; Badar, Nida; Hartsell, William; Han-Chih Chang, John; Gondi, Vinai; Pankuch, Mark; Gao, Ming; Schmidt, Stacey; Kaplan, Darren; McGee, Lisa

    2017-05-01

    This study evaluates acute toxicity outcomes in breast cancer patients treated with adjuvant proton beam therapy (PBT). From 2011 to 2016, 91 patients (93 cancers) were treated with adjuvant PBT targeting the intact breast/chest wall and comprehensive regional nodes including the axilla, supraclavicular fossa, and internal mammary lymph nodes. Toxicity was recorded weekly during treatment, one month following treatment, and then every 6months according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Charts were retrospectively reviewed to verify toxicities, patient parameters, disease and treatment characteristics, and disease-related outcomes. Median follow-up was 15.5months. Median PBT dose was 50.4 Gray relative biological effectiveness (GyRBE), with subsequent boost as clinically indicated (N=61, median 10 GyRBE). Chemotherapy, when administered, was given adjuvantly (N=42) or neoadjuvantly (N=46). Grades 1, 2, and 3 dermatitis occurred in 23%, 72%, and 5%, respectively. Eight percent required treatment breaks owing to dermatitis. Median time to resolution of dermatitis was 32days. Grades 1, 2, and 3 esophagitis developed in 31%, 33%, and 0%, respectively. PBT displays acceptable toxicity in the setting of comprehensive regional nodal irradiation. Copyright © 2017. Published by Elsevier B.V.

  9. The Clinical Implications of Poly Implant Prothèse Breast Implants: An Overview

    Directory of Open Access Journals (Sweden)

    Umar Wazir

    2015-01-01

    Full Text Available Mammary implants marketed by Poly Implant Prothèse (PIP were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Prothèse", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635 for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.

  10. Suspensory Ligament of the Mammary Gland: A Case Report.

    Science.gov (United States)

    Santos, Diana Costa; Cardoso, Augusta; Martins, João Matos; da Luz Barroso, Maria; Costa, Horácio

    2016-02-01

    The ligamentous system of the breast comprises a deep component, connecting the breast to the chest wall, and a superficial component, attached to the dermis and defining the breast contour. A female patient with a family history of breast and ovarian cancer and presenting a bilateral fibrocystic mastopathy was submitted to surgical treatment with bilateral subcutaneous mastectomy and immediate reconstruction with implants. Intra-operatively, a strong ligament between the clavicle and the upper pole of the breast was identified. In addition, there was bilateral absence of the suspensory ligament of the axilla. Variations on the anatomy of the ligamentous system of the breast can represent alterations during the embryonic development of the breast and may have an important impact in the development of breast ptosis. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  11. Cutaneous plasmacytosis: A rare entity with unique presentation

    Directory of Open Access Journals (Sweden)

    Subhra Dhar

    2017-01-01

    Full Text Available Primary cutaneous plasmacytosis is a rare cutaneous disorder with extensive cutaneous plaques/papules mainly on the trunk and face. Cases have mostly been documented from Japan. We present here a rare case of cutaneous plasmacytosis from India of Mongolian descent. This 50-year-old female from Mizoram had extensive maculo-papular violaceous plaques distributed on the face, axillae, trunk and lower extremities. Initial and repeat skin biopsy revealed dense perivascular and periadnexal mature plasma cells. She also had lymphadenopathy. Serum protein electrophoresis did not reveal any M band and the Bence Jones protein was negative in urine. The patient had multiple superficial lymph nodes and a biopsy from the cervical lymph node showed effacement of normal nodal architecture by sheets of plasma cells. Immuno histochemistry was done from both skin and lymph node biopsies. The kappa and lambda tight chains were not restricted; there by proving the polyclonal nature of the plasma cells. The novelty of the case lies in its classical clinical presentation with histopathological documentation.

  12. Is subjective hyperhidrosis assessment sufficient enough? prevalence of hyperhidrosis among young Polish adults.

    Science.gov (United States)

    Stefaniak, Tomasz; Tomaszewski, Krzysztof A; Proczko-Markuszewska, Monika; Idestal, Anette; Royton, Anders; Abi-Khalil, Christian

    2013-10-01

    The aim of this work was to assess the prevalence of palmar and axillary hyperhidrosis among young Polish adults. Additionally, this work aimed at comparing the subjective and objective (gravimetric) method of hyperhidrosis assessment. Healthy medical students, volunteering to take part in this study, were included. The participants filled out a questionnaire assessing the occurrence and subjective intensity of hyperhidrosis in different areas of the body. Additionally, the students were subjected to gravimetric assessment in four localizations: the face, palms, axillae and abdomino-lumbar area. Two hundred and fifty-three students (102 males and 151 females, mean age 24.3 ± 3.21 years) were included in the study. Forty-two (16.7%) participants declared that they suffer from hyperhidrosis. Out of the 42 students declaring any type of hyperhidrosis, only 20 (47.6%) exceeded the gravimetric reference values. From among the students that exceeded the normative values for palmar hyperhidrosis, only 10 (55.6%) were aware of their hyperhidrosis. In the group of students that exceeded the normative values for axillary hyperhidrosis, 16 (39%) were aware of their hyperhidrosis. Subjectively declared hyperhidrosis incidence may significantly exceed the real-life occurrence of this disease. Basing studies solely on data gathered from questionnaires, may lead to false results. It is imperative, when assessing patients suffering from hyperhidrosis, to use both objective and subjective methods of evaluation. © 2013 Japanese Dermatological Association.

  13. Safety of available and emerging drug therapies for hyperhidrosis.

    Science.gov (United States)

    Hosp, Christine; Hamm, Henning

    2017-09-01

    Hyperhidrosis affects 4.8% of the U.S. population and has been underestimated by physicians for long time despite considerable interference with quality of life. Many patients suffer from primary (idiopathic) hyperhidrosis which results from over-activity of sympathetic nerves and is restricted to specific body areas, mostly the axillae, palms, soles, or head. Secondary hyperhidrosis is caused by an underlying disease or the intake of medications and often involves large parts of the body. Numerous effective therapies with topical or systemic drugs and surgical options are available. Areas covered: Efficacy and safety data on aluminum salts, anticholinergic drugs for topical or systemic application, and on intradermal botulinum toxin injections used to treat hyperhidrosis are critically evaluated, including data from clinical trials with focus on possible side effects and long-term complications in dispute. Expert opinion: Hyperhidrosis often responds well to available therapies. Depending on the type of hyperhidrosis treatment should be topical/local or systemic. Most of the side effects are mild, transient and easily manageable. In case of systemic treatment with anticholinergics low dosing and up-titration of medication is necessary to avoid severe adverse effects. Concerns about the promotion of breast cancer and Alzheimer disease by topical aluminum salts are unsolved.

  14. Safety and prolonged efficacy of Botulin Toxin A in primary hyperhidrosis.

    Science.gov (United States)

    D'Epiro, S; Macaluso, L; Salvi, M; Luci, C; Mattozzi, C; Marzocca, F; Salvo, V; Scarnò, M; Calvieri, S; Richetta, A G

    Hyperhidrosis is a condition characterized by generalized or localized hyperfunction of the eccrine sweat glands with a deep negative impact on patient's quality of life. To evaluate the efficacy and the safety of Botulin Toxin A (BTX-A) intradermal injection in the treatment of primary axillary and palmar hyperhidrosis, investigating symptoms-free period, and the subjective improving of quality life. 50 consecutive patients with primary hyperhidrosis were evaluated detecting age, gender, hyperhidrosis onset period, disease duration and years of treatment with BTX-A, Minor's iodine test, Hyperhidrosis Disease Severity Scale (HDSS), Dermatology Life Quality Index (DLQI). The treatment is significantly effective both for axillae and palms: the majority of the patients improved their HDSS and Minor's scores from a value of 4 in the two tests, to values of 1 (HDSS) and 0 (Minor test). Patients reported a duration of symptoms relief from 4 to 12 months, with a mean of 5.68 months; specifically, we have observed that the axillary group experienced a longer symptoms-free period (mean RFS 7.2 months) than the palmar group (mean: RFS 4.27 months). Authors suggest that BTX-A is a safe, easy, and fast procedure for the treatment of primary axillary and palmar hyperhidrosis.

  15. Clinical Evaluation of a Microwave Device for Treating Axillary Hyperhidrosis

    Science.gov (United States)

    Hong, H Chih-Ho; Lupin, Mark; O'Shaughnessy, Kathryn F

    2012-01-01

    Background A third-generation microwave-based device has been developed to treat axillary hyperhidrosis by selectively heating the interface between the skin and underlying fat where the sweat glands reside. Materials and Methods Thirty-one (31) adults with primary axillary hyperhidrosis were enrolled. All subjects had one to three procedure sessions over a 6-month period to treat both axillae fully. Efficacy was assessed using the Hyperhidrosis Disease Severity Scale (HDSS), gravimetric weight of sweat, and the Dermatologic Life Quality Index (DLQI), a dermatology-specific quality-of-life scale. Subject safety was assessed at each visit. Subjects were followed for 12 months after all procedure sessions were complete. Results At the 12-month follow-up visit, 90.3% had HDSS scores of 1 or 2, 90.3% had at least a 50% reduction in axillary sweat from baseline, and 85.2% had a reduction of at least 5 points on the DLQI. All subjects experienced transient effects in the treatment area such as swelling, discomfort, and numbness. The most common adverse event (12 subjects) was the presence of altered sensation in the skin of the arm that resolved in all subjects. Conclusion The device tested provided efficacious and durable treatment for axillary hyperhidrosis. PMID:22452511

  16. Botulinum Toxin Treatment of Autonomic Disorders: Focal Hyperhidrosis and Sialorrhea.

    Science.gov (United States)

    Hosp, Christine; Naumann, Markus K; Hamm, Henning

    2016-02-01

    Primary focal hyperhidrosis is a common autonomic disorder that significantly impacts quality of life. It is characterized by excessive sweating confined to circumscribed areas, such as the axillae, palms, soles, and face. Less frequent types of focal hyperhidrosis secondary to underlying causes include gustatory sweating in Frey's syndrome and compensatory sweating in Ross' syndrome and after sympathectomy. Approval of onabotulinumtoxinA for severe primary axillary hyperhidrosis in 2004 has revolutionized the treatment of this indication. Meanwhile further type A botulinum neurotoxins like abobotulinumtoxinA and incobotulinumtoxinA, as well as the type B botulinum neurotoxin rimabotulinumtoxinB are successfully used off-label for axillary and various other types of focal hyperhidrosis. For unexplained reasons, the duration of effect differs considerably at different sites. Beside hyperhidrosis, botulinum neurotoxin is also highly valued for the treatment of sialorrhea affecting patients with Parkinson's disease, cerebral palsy, amyotrophic lateral sclerosis, motor neuron disease, and other neurologic conditions. With correct dosing and application, side effects are manageable and transient. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Metastatic hidradenocarcinoma with demonstration of Her-2/neu gene amplification by fluorescence in situ hybridization: potential treatment implications.

    Science.gov (United States)

    Nash, Jason W; Barrett, Terry L; Kies, Merrill; Ross, Merrick I; Sneige, Nour; Diwan, A Hafeez; Lazar, Alexander J F

    2007-01-01

    A 44-year-old man was referred for a right chest nodule of 3 months duration. A 'benign' nodule had been excised from this location 8 years prior. On examination, palpable nodes were noted in the right axilla. Radiographic studies were significant only for right axillary lymphadenopathy. Histologically, a nodular dermal proliferation composed of poorly differentiated epithelioid cells in nests and focally forming ducts with pseudopapillary architecture comprised the primary tumor. Features of a clear cell hidradenoma were noted focally. Immunohistochemical (IHC) analysis revealed reactivity for HMW cytokeratins, CK5 and CK7, p53, p63, CEA (focal), androgen receptor, EGFR, estrogen receptor (ER), MUC5AC, and strong/diffuse membranous staining for Her-2/neu. Negative stains included villin, TTF-1, CDX2, S-100 protein, vimentin, gross cystic disease fluid protein 15 (GCDFP-15), mammoglobulin, and MUC2. A wide local excision and axillary node dissection was performed. Metastatic tumor involved nine of 28 nodes. Interphase fluorescence in situ hybridization (FISH) demonstrated chromosomal amplification of the Her-2/neu locus within the tumor and a nodal metastasis. The patient has completed adjuvant and radiotherapy, including trastuzumab, and is asymptomatic. We believe this to be the first demonstration of Her-2/neu amplification in a malignant skin adnexal tumor. In analogy to breast carcinoma, these findings suggest the applicability of trastuzumab for patients with metastatic adnexal carcinomas demonstrating Her-2/neu amplification.

  18. Chemosignals of stress influence social judgments.

    Directory of Open Access Journals (Sweden)

    Pamela Dalton

    Full Text Available Human body odors have important communicative functions regarding genetic identity, immune fitness and general health, but an expanding body of research suggests they can also communicate information about an individual's emotional state. In the current study, we tested whether axillary odors obtained from women experiencing psychosocial stress could negatively influence personality judgments of warmth and competence made about other women depicted in video scenarios. 44 female donors provided three types of sweat samples: untreated exercise sweat, untreated stress sweat and treated stress sweat. After a 'washout' period, a commercial unscented anti-perspirant product was applied to the left axilla only to evaluate whether 'blocking' the stress signal would improve the social evaluations. A separate group of male and female evaluators (n = 120 rated the women in the videos while smelling one of the three types of sweat samples. Women in the video scenes were rated as being more stressed by both men and women when smelling the untreated vs. treated stress sweat. For men only, the women in the videos were rated as less confident, trustworthy and competent when smelling both the untreated stress and exercise sweat in contrast to the treated stress sweat. Women's social judgments were unaffected by sniffing the pads. The results have implications for influencing multiple types of professional and personal social interactions and impression management and extend our understanding of the social communicative function of body odors.

  19. 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.

  20. Description of a new species of Cnemaspis (Squamata: Gekkonidae) from Knuckles Range of Sri Lanka.

    Science.gov (United States)

    Batuwita, Sudesh; Udugampala, Sampath

    2017-04-12

    A new species of Cnemaspis Strauch is described from Knuckles Range of Sri Lanka. This new species had been previously confused with Cnemaspis podihuna Deraniyagala. Cnemaspis kandambyi sp. nov. closely resembles C. podihuna and C. molligodai Wickramasinghe & Munindradasa. Cnemaspis kandambyi sp. nov. differs from C. podihuna by having 7-8 (versus 3-6) unpored scales in each side of the precloacal-femoral pores row, lacking (versus having) an internasal scale, body (axilla to groin) relatively long 47.7-48.3 (versus 38.1-38.7)% of SVL and dorsum dark brown (versus bright yellow). Cnemaspis kandambyi sp. nov. also distinguished from C. molligodai by having 4 (versus 5) precloacal pores, 5-6 (versus 7-9) femoral pores on each side, precloacal pores not in an inverted V-shaped arrangement (versus in inverted V-shaped arrangement), lacking (versus having) a distinct black marking on nape and a black lateral stripe begins behind eye extends laterally beyond the origin of forearm (versus not extending beyond the origin of forearm). Additionally, Cnemaspis kandambyi sp. nov. and C. molligodai show discrete distribution: former restricted to Knuckles Range and the latter confined to Lowland wet zone of Sri Lanka. We confirm that, no type material of Cnemaspis podihuna survive in the current collection of the National Museum of Sri Lanka.

  1. Homozygous LIPE mutation in siblings with multiple symmetric lipomatosis, partial lipodystrophy, and myopathy.

    Science.gov (United States)

    Zolotov, Sagit; Xing, Chao; Mahamid, Riad; Shalata, Adel; Sheikh-Ahmad, Mohammed; Garg, Abhimanyu

    2017-01-01

    Despite considerable progress in identifying causal genes for lipodystrophy syndromes, the molecular basis of some peculiar adipose tissue disorders remains obscure. In an Israeli-Arab pedigree with a novel autosomal recessive, multiple symmetric lipomatosis (MSL), partial lipodystrophy and myopathy, we conducted exome sequencing of two affected siblings to identify the disease-causing mutation. The 41-year-old female proband and her 36-year-old brother reported marked accumulation of subcutaneous fat in the face, neck, axillae, and trunk but loss of subcutaneous fat from the lower extremities and progressive distal symmetric myopathy during adulthood. They had increased serum creatine kinase levels, hypertriglyceridemia and low levels of high-density lipoprotein cholesterol. Exome sequencing identified a novel homozygous NC_000019.9:g.42906092C>A variant on chromosome 19, leading to a NM_005357.3:c.3103G>T nucleotide change in coding DNA and corresponding p.(Glu1035*) protein change in hormone sensitive lipase (LIPE) gene as the disease-causing variant. Sanger sequencing further confirmed the segregation of the mutation in the family. Hormone sensitive lipase is the predominant regulator of lipolysis from adipocytes, releasing free fatty acids from stored triglycerides. The homozygous null LIPE mutation could result in marked inhibition of lipolysis from some adipose tissue depots and thus may induce an extremely rare phenotype of MSL and partial lipodystrophy in adulthood associated with complications of insulin resistance, such as diabetes, hypertriglyceridemia and hepatic steatosis. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  2. Ethanol Extract of Haliclona sp. Improved Histological Grade of Mammary Adenocarcinoma in C3H Mice

    Science.gov (United States)

    Murwani, R.; Trianto, A.; Wijayanti, E.; Ridlo, A.; Susilaningsih, N.

    2018-02-01

    The sponge Haliclona sp. contains secondary metabolites belong to alkaloids which are cytotoxic to the human tumor. The following research was conducted to study the effect of a graded level of Haliclona sp. extract on mammary adenocarcinoma in C3H mice. Haliclona sp. was obtained from Bandengan water in Jepara, and the crude extract was prepared by maceration with ethanol. Fifteen C3H mice with an initial weight of 20-25 gram were assigned into control, H-1, and H-2 groups. Control, H1, and H2 groups each received the ethanol extract of 0, 0.15, and 1.5 mg per mouse per day respectively for two weeks. Cancer cells were introduced to all groups from a cancerous donor mouse. The donor cancer cells were injected into each mouse via left or right axilla and allowed to grow. The cancer mass was removed and processed for histological examination, and the cancer growth was determined according to Elston and Ellis criteria. The result showed that histological grade of cancer mass from control group was in grade 2 or differentiated moderately. The histological grade of cancer mass from H-1 and H-2 groups were in grade 1 or similar to a normal cell. Analyses of the data by Kruskal-Wallis showed a significant difference (pdrug.

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

    International Nuclear Information System (INIS)

    Fatima, S.T.; Zahur, Z.; Jeilani, A.; Hussain, S.J.A.

    2015-01-01

    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. Ultrasound imaging of the axillary nerve and its role in the diagnosis of traumatic impairment.

    Science.gov (United States)

    Gruber, H; Peer, S; Gruber, L; Loescher, W; Bauer, T; Loizides, A

    2014-08-01

    The axillary nerve (AN) is frequently injured during shoulder trauma and imaging is required to define the site and extent of nerve injury. However, the AN has a rather complex course through several soft tissue compartments of the shoulder and axilla. Therefore, imaging of the nerve with MRI and sonography is troublesome. Thus detection and sonographic assessment bases on thorough knowledge of local topography. This investigation aimed at defining reliable anatomical landmarks for AN-sonography in 5 volunteers and later validating the proposed sonographic examination protocol in 10 unselected patients. With strict adherence to the proposed examination algorithm, sonography of the AN was feasible in all volunteers and patients. Furthermore, sonographic findings correlated nicely with the golden standard "surgical exploration" concerning severity and topography of neural impairment. Based on our study results we propose our algorithm for AN-sonography as the first-line imaging tool for the assessment of axillary nerve trauma. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Innovation in the planning of V-Y rotation advancement flaps: A template for flap design

    Directory of Open Access Journals (Sweden)

    Utku Can Dölen

    2018-01-01

    Full Text Available Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5, anterior tibia (n=1, posterior axilla (n=1, ischium (n=1, and trochanter (n=2. The template for a bilateral flap was used on the sacrum (n=8, arm (n=1, and anterior tibia (n=1. The causes of the defects were meningocele (n=3, a decubitus ulcer (n=5, pilonidal sinus (n=3, and skin tumor excision (n=10. The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19–80 years. All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

  6. Characterization of Staphylococcus and Corynebacterium clusters in the human axillary region.

    Directory of Open Access Journals (Sweden)

    Chris Callewaert

    Full Text Available The skin microbial community is regarded as essential for human health and well-being, but likewise plays an important role in the formation of body odor in, for instance, the axillae. Few molecular-based research was done on the axillary microbiome. This study typified the axillary microbiome of a group of 53 healthy subjects. A profound view was obtained of the interpersonal, intrapersonal and temporal diversity of the human axillary microbiota. Denaturing gradient gel electrophoresis (DGGE and next generation sequencing on 16S rRNA gene region were combined and used as extent to each other. Two important clusters were characterized, where Staphylococcus and Corynebacterium species were the abundant species. Females predominantly clustered within the Staphylococcus cluster (87%, n = 17, whereas males clustered more in the Corynebacterium cluster (39%, n = 36. The axillary microbiota was unique to each individual. Left-right asymmetry occurred in about half of the human population. For the first time, an elaborate study was performed on the dynamics of the axillary microbiome. A relatively stable axillary microbiome was noticed, although a few subjects evolved towards another stable community. The deodorant usage had a proportional linear influence on the species diversity of the axillary microbiome.

  7. Interspecies transmission of emotional information via chemosignals: from humans to dogs (Canis lupus familiaris).

    Science.gov (United States)

    D'Aniello, Biagio; Semin, Gün Refik; Alterisio, Alessandra; Aria, Massimo; Scandurra, Anna

    2018-01-01

    We report a study examining interspecies emotion transfer via body odors (chemosignals). Do human body odors (chemosignals) produced under emotional conditions of happiness and fear provide information that is detectable by pet dogs (Labrador and Golden retrievers)? The odor samples were collected from the axilla of male donors not involved in the main experiment. The experimental setup involved the co-presence of the dog's owner, a stranger and the odor dispenser in a space where the dogs could move freely. There were three odor conditions [fear, happiness, and control (no sweat)] to which the dogs were assigned randomly. The dependent variables were the relevant behaviors of the dogs (e.g., approaching, interacting and gazing) directed to the three targets (owner, stranger, sweat dispenser) aside from the dogs' stress and heart rate indicators. The results indicated with high accuracy that the dogs manifested the predicted behaviors in the three conditions. There were fewer and shorter owner directed behaviors and more stranger directed behaviors when they were in the "happy odor condition" compared to the fear odor and control conditions. In the fear odor condition, they displayed more stressful behaviors. The heart rate data in the control and happy conditions were significantly lower than in the fear condition. Our findings suggest that interspecies emotional communication is facilitated by chemosignals.

  8. Improvement in both Raynaud disease and hyperhidrosis in response to botulinum toxin type A treatment.

    Science.gov (United States)

    Kossintseva, Iràn; Barankin, Benjamin

    2008-01-01

    A patient with concurrent Raynaud disease presented for hyperhidrosis of the axillae and palms. After a positive response to botulinum toxin type A (BoNTA) for axillary hyperhidrosis, she returned requesting palmar treatment. Our goal was to investigate the effect of BoNTA on Raynaud disease in concurrent hyperhidrosis with respect to color change, swelling, and digital pain. The patient had treatment with 100 units of BoNTA to one hand at first, with the other being a negative control, followed by treatment of the second hand 1 week later. After the injection into the first palm, the patient demonstrated an 85% reduction in palmar hyperhidrosis and a significant improvement in her Raynaud symptoms. Specifically, the BoNTA-treated hand had reduced swelling, color change, and pain, whereas the untreated control hand remained affected. After the second hand was treated, it, too, demonstrated the same positive results. Our case report of concurrent Raynaud disease and palmar hyperhidrosis shows significant improvement in both conditions to BoNTA administration. The physiology is multifactorial and relates to BoNTA's effect on acetylcholine, noradrenaline, substance P, calcitonin gene-related peptide, and glutamate release from nerve terminals. These results present an encouraging novel treatment option in dermatology for patients with Raynaud disease.

  9. October 2001: 40-year-old Xhosa male with back pain and leg weakness.

    Science.gov (United States)

    Rutherfoord, G Stuart; Lamprecht, Deon; Hewlett, Richard H

    2002-04-01

    A 40-year-old Xhosa male presented with progressive upper lumbar back pain and weakness At examination he was emaciated and had enlarged lymph nodes in the groin and axilla. Both lower limbs were severely atrophic and weak. Sensation to touch and pain was decreased below L3 bilaterally. MR of the spine showed a discrete, contrast-enhancing epidural mass. A T10-T12 laminectomy revealed an soft, vascular extradural tumor dorsal to the cord. The mass was loosely applied to the dura and easy to remove. The operative specimen consisted of a sausage-shaped (3.5 x 2.0 x 1.2 cm), thinly-encapsulated mass of reddish-brown tissue. The cut surface had a mottled, vaguely nodular, yellowish-brown appearance. Microscopic examination revealed sheets of hematopoeitic elements, including myeloid, red cell and megakaryocytic lines, the latter showing Factor 8-related positivity. The final diagnosis was extramedullary hematopoiesis (EMH). A bone marrow biopsy performed as a result of the diagnosis showed a myeloproliferative disease and polycythemia vera. EMH in the spinal epidural space is a rare but treatable cause of progressive paraparesis in patients with a variety of hematological disorders. Since 1956 there have been more than 50 reported cases, most of which occurred in association with thalassaemia. In spinal cord compression secondary to EMH, the lesions are commonly localized to the mid-lower thoracic region.

  10. Clinical and pathological features of hair coat abnormalities in curly coated retrievers from UK and Sweden.

    Science.gov (United States)

    Bond, R; Varjonen, K; Hendricks, A; Chang, Y M; Brooks Brownlie, H

    2016-12-01

    To gain information on hair loss amongst curly coated retrievers by questionnaire and to define the clinical and pathological features of hair coat abnormalities in affected dogs in the United Kingdom and Sweden. Questionnaires were completed by members of the Curly Coated Retriever Clubs. Fourteen dogs (six in the United Kingdom, eight in Sweden) were clinically examined and skin/hair samples collected for microscopy and histopathology. Blood was collected for haematological, biochemical and endocrine assays. Of 90 dogs surveyed, 39 had current or previous episodes of symmetrical, non-pruritic alopecia and or frizzy coat changes, usually affecting caudal thighs, axillae, dorsum and neck before 18 months of age; 23 dogs had a waxing/waning course. Examined dogs generally matched the pattern described in questionnaires. Hair shaft anomalies comprised occasional distorted anagen bulbs (10 dogs) and transverse fractures (8 dogs). Vertical histopathological sections showed infundibular hyperkeratosis (28 of 30 sections) and low-grade pigment clumping (17 of 30). Subtle telogenisation of hair follicles was unequivocally confirmed by transverse histomorphometric analyses. The follicular dysplasia of curly coated retriever reported here is similar to that of Irish water spaniels and Chesapeake Bay retrievers but distinct from that of Portuguese water dogs. The genetic basis requires further assessment. © 2016 British Small Animal Veterinary Association.

  11. Sentinel node detection in pre-operative axillary staging

    International Nuclear Information System (INIS)

    Trifiro, Giuseppe; Travaini, Laura Lavinia; Paganelli, Giovanni; Viale, Giuseppe; Gentilini, Oreste

    2004-01-01

    The concept of sentinel lymph node biopsy in breast cancer surgery is based on the fact that the tumour drains in a logical way via the lymphatic system, from the first to upper levels. Since axillary node dissection does not improve the prognosis of patients with breast cancer, sentinel lymph node biopsy might replace complete axillary dissection for staging of the axilla in clinically N0 patients. Sentinel lymph node biopsy would represent a significant advantage as a minimally invasive procedure, considering that about 70% of patients are found to be free from metastatic disease, yet axillary node dissection can lead to significant morbidity. Subdermal or peritumoural injection of small aliquots (and very low activity) of radiotracer is preferred to intratumoural administration, and 99m Tc-labelled colloids with most of the particles in the 100-200 nm size range would be ideal for radioguided sentinel node biopsy in breast cancer. The success rate of radioguidance in localising the sentinel lymph node in breast cancer surgery is about 97% in institutions where a high number of procedures are performed, and the success rate of lymphoscintigraphy in sentinel node detection is about 100%. The sentinel lymph node should be processed for intraoperative frozen section examination in its entirety, based on conventional histopathology and, when necessary, immune staining with anti-cytokeratin antibody. Nowadays, lymphoscintigraphy is a useful procedure in patients with different clinical evidence of breast cancer. (orig.)

  12. 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

  13. Shoulder Strength Requirements for Upper Limb Functional Tasks: Do Age and Rotator Cuff Tear Status Matter?

    Science.gov (United States)

    Santago, Anthony C; Vidt, Meghan E; Li, Xiaotong; Tuohy, Christopher J; Poehling, Gary G; Freehill, Michael T; Saul, Katherine R

    2017-12-01

    Understanding upper limb strength requirements for daily tasks is imperative for early detection of strength loss that may progress to disability due to age or rotator cuff tear. We quantified shoulder strength requirements for 5 upper limb tasks performed by 3 groups: uninjured young adults and older adults, and older adults with a degenerative supraspinatus tear prior to repair. Musculoskeletal models were developed for each group representing age, sex, and tear-related strength losses. Percentage of available strength used was quantified for the subset of tasks requiring the largest amount of shoulder strength. Significant differences in strength requirements existed across tasks: upward reach 105° required the largest average strength; axilla wash required the largest peak strength. However, there were limited differences across participant groups. Older adults with and without a tear used a larger percentage of their shoulder elevation (p tasks indicate the need for evaluating a diversity of functional tasks to effectively detect early strength loss, which may lead to disability.

  14. Airborne particulate concentration during laser hair removal: A comparison between cold sapphire with aqueous gel and cryogen skin cooling.

    Science.gov (United States)

    Ross, Edward V; Chuang, Gary S; Ortiz, Arisa E; Davenport, Scott A

    2017-12-07

    High concentrations of sub-micron nanoparticles have been shown to be released during laser hair removal (LHR) procedures. These emissions pose a potential biohazard to healthcare workers that have prolonged exposure to LHR plume. We sought to demonstrate that cold sapphire skin cooling done in contact mode might suppress plume dispersion during LHR. A total of 11 patients were recruited for laser hair removal. They were treated on the legs and axilla with a 755 or 1064 nm millisecond-domain laser equipped with either (i) cryogen spray (CSC); (ii) refrigerated air (RA); or (iii) contact cooling with sapphire (CC). Concentration of ultrafine nanoparticles cooling methods. For contact cooling (CC), counts remained at baseline levels, below 3,500 parts per cubic centimeter (ppc) for all treatments. In contrast, the CSC system produced large levels of plume, peaking at times to over 400,000 ppc. The CA cooled system produced intermediate levels of plume, about 35,000 ppc (or about 10× baseline). Cold Sapphire Skin cooling with gel suppresses plume during laser hair removal, potentially eliminating the need for smoke evacuators, custom ventilation systems, and respirators during LHR. Lasers Surg. Med. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  15. Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique

    Science.gov (United States)

    De Cupis, Vincenzo; De Cupis, Mauro

    2012-01-01

    Summary Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

  16. Confluent and reticulated papillomatosis: diagnostic and treatment challenges

    Directory of Open Access Journals (Sweden)

    Lim JH

    2016-08-01

    Full Text Available Joel Hua-Liang Lim,1 Hong Liang Tey,1,2 Wei-Sheng Chong,11Department of Dermatology, National Skin Centre, 2Lee Kong Chian School of Medicine, Nanyang Technologicial University, SingaporeAbstract: Confluent and reticulated papillomatosis (CRP of Gougerot and Carteaud was first typified in 1927. With the help of electron microscopy, it has been elucidated that CRP arises due to aberrant keratinization. However, till date, there is no clear consensus on the etiologic trigger for CRP. Prevailing postulates include a bacterial trigger by Dietzia papillomatosis (type strain N 1280T, an exaggerated cutaneous response to Malassezia furfur, an endocrine basis stemming from insulin resistance, ultraviolet light-induced epidermal change, amyloid deposition, and a loss-of-function mutation in keratin 16. CRP typically presents as asymptomatic hyperpigmented papules and plaques with peripheral reticulation over the nape, axillae, upper chest, and upper back, occasionally with extension superior to the forehead and inferior to the pubic region. Dermoscopy may be used in the evaluation of CRP, but its diagnosis is made on clinical grounds given its nonspecific histopathological findings. Although successful treatment with topical keratolytics, retinoids, or antifungals has been reported, antibiotics, such as minocycline, at anti-inflammatory doses have emerged as a preferred therapeutic option. In this article, we review the diagnostic considerations in CRP and its therapeutic options. Keywords: Gougerot, Carteaud, reticulate, papillomatous, diagnosis, treatment

  17. Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer.

    Science.gov (United States)

    DE Aguiar, Paulo Henrique Walter; Aquino, Ranniere Gurgel Furtado DE; Alves, Mayara Maia; Correia, Julio Marcus Sousa; Oliveira, Ayane Layne DE Sousa; Viana, Antônio Brazil; Pinheiro, Luiz Gonzaga Porto

    2017-01-01

    to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99) in patients with locally advanced breast cancer. clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15), and, compared to Tc99 identification, the agreement rate was 94.4%. autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.

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

    Science.gov (United States)

    Vasques, Paulo Henrique Diógenes; Alves, Mayara Maia; Aquino, Ranniere Gurgel Furtado de; Torres, Roberto Vitor Almeida; Bezerra, José Lucas Martins; Brasileiro, Luis Porto; Pinheiro, Luiz Gonzaga Porto

    2015-11-01

    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. 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. 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. Hemosiderin is a safe dye that is equivalent to Technetium in breast sentinel lymph node biopsy.

  19. [Bilateral dorsal sympathectomy for the treatment of primary hyperhidrosis: effects on lung function at 3 years].

    Science.gov (United States)

    Vigil, Laura; Calaf, Núria; Feixas, Teresa; Casan, Pere

    2010-01-01

    Primary hyperhidrosis is characterized by excessive sweating of the palms, soles, and axillae due to overactivity of the sympathetic nervous system at the level of the second and third sympathetic thoracic ganglia. The treatment of choice is bilateral dorsal sympathectomy performed using video-assisted thoracic surgery (VATS). The objective of our study was to determine whether lung function changes observed in a group of patients prior to bilateral dorsal sympathectomy performed using VATS were still evident 3 years after surgery. Of the 20 patients studied at baseline, we were able to obtain data for 18 (3 men and 15 women; mean age, 35 y). They underwent spirometry and a bronchial challenge test with methacholine, and the fraction of exhaled nitric oxide (FE(NO)) was measured. The results were compared with those of the tests performed before surgery. At 3 years from baseline, we detected a statistically significant increase in forced vital capacity from a mean (SD) of 96% (10%) to 101% (11%) (P=.008), and a statistically significant decrease in midexpiratory flow rate from 3.8 (0.9)L/s to 3.5 (0.9)L/s (P=.01). The results of the bronchial challenge test with methacholine and the FE(NO) remained unchanged. The lung function changes detected point toward minimal, clinically insignificant small airway alterations due to sympathetic denervation following bilateral dorsal sympathectomy performed 3 years earlier. Copyright (c) 2008 SEPAR. Published by Elsevier Espana. All rights reserved.

  20. [Prognostic factors in breast cancer with contralateral supraclavicular or axillary lymphatic metastases].

    Science.gov (United States)

    Muñoz-González, D; Mora-Tizcareño, A; Ramírez-Ugalde, M T; Pérez-Sánchez, M; Sánchez-Valdivieso, E; Gómez-Ruiz, C; Zeichner-Gancz, I

    1998-01-01

    To evaluate prognostic factor differences between surviving and decreased breast cancer patients in clinical stage IV with supraclavicular or contralateral axilla metastasis when first seen. From the clinical records of 13 years (1975-88) two groups of ten patients each were obtained. Group 1 were women alive and free of disease for more than five years. Group 2 had similar characteristics but had died of the disease. In both groups clinical data were evaluated (age, menstrual status and survival); from slides the histologic factors like tumor size, nodal status, fibrosis percentage, inflammatory infiltrate, nuclear grade and necrosis were evaluated; immunohistochemistry of CD34 for angiogenesis, cathepsin D, p53 antioncogen, c-erb-B2 oncogen, epidermic growth factor, estrogen and progesterone receptors and cellular kinetics were performed; Kaplan Meier survival curves were constructed for the factors showing intergroup differences. The factors associated to the living patients were: low inflammatory infiltrate (p = 0.001), low fibrosis (p = 0.007), lower p53 expression (p = 0.03) and positive estrogen receptor (p = 0.03); other factors were marginally associated: positive progesterone receptor (p = 0.07) and having less than 6 positive lymph nodes (p = 0.07).

  1. Flame figures in linear IgA bullous dermatosis: a novel histopathologic finding.

    Science.gov (United States)

    Fulton, E; Jan, F; Zimarowski, M J

    2017-11-15

    Linear IgA bullous dermatosis (LABD) is an autoimmune subepidermal blistering disease usually with a neutrophil rich inflammatory infiltrate, and characterized by linear IgA deposition at the basement membrane zone (BMZ), and neutrophil predominant dermal inflammation. We report a case of LABD with numerous eosinophils and flame figure formation, a unique histopathologic finding not previously reported. A 69-year-old woman presented with a rapidly progressive, intensely pruritic rash over forearms, breasts, axillae, hips, and thighs. Thelesions were comprised of annular vesicles and bullae with hemorrhagic crusts and erosions. The clinical differential diagnosis included bullous pemphigoid(BP), LABD, and epidermolysis bullosa aquisita (EBA). A biopsy from a bullous plaque on the wrist revealed a subepidermal blister with neutrophils and numerous eosinophils with flame figure formation.Direct immunofluorescent (DIF) microscopy revealed linear deposition of IgA at the BMZ. Although unusual, the combined findings supported a diagnosis of LABD. Increased eosinophils may be associated with drug-induced LABD and may explain the numerous eosinophils in our case. It is important to be aware of this finding as the pathology may easily be misdiagnosed as BP, or possibly bullousWells syndrome. This case emphasizes that combined clinical, pathologic, and DIF findings are essential in the diagnosis of bullous dermatoses.

  2. 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.

  3. The clinical implications of poly implant prothèse breast implants: an overview.

    Science.gov (United States)

    Wazir, Umar; Kasem, Abdul; Mokbel, Kefah

    2015-01-01

    Mammary implants marketed by Poly Implant Prothèse (PIP) were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Prothèse", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635) for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.

  4. Laser treatment of primary axillary hyperhidrosis: a review of the literature.

    Science.gov (United States)

    Cervantes, Jessica; Perper, Marina; Eber, Ariel E; Fertig, Raymond M; Tsatalis, John P; Nouri, Keyvan

    2018-04-01

    Hyperhidrosis o`ccurs when the body produces sweat beyond what is essential to maintain thermal homeostasis. The condition tends to occur in areas marked by high-eccrine density such as the axillae, palms, and soles and less commonly in the craniofacial area. The current standard of care is topical aluminum chloride hexahydrate antiperspirant (10-20%), but other treatments such as anticholinergics, clonidine, propranolol, antiadrenergics, injections with attenuated botulinum toxin, microwave technology, and surgery have been therapeutically implicated as well. Yet, many of these treatments have limited efficacy, systemic side effects, and may be linked with significant surgical morbidity, creating need for the development of new and effective therapies for controlling excessive sweating. In this literature review, we examined the use of lasers, particularly the Neodynium:Yttrium-Aluminum-Garnet (Nd:YAG) and diode lasers, in treating hyperhidrosis. Due to its demonstrated effectiveness and limited side effect profile, our review suggests that Nd:YAG laser may be a promising treatment modality for hyperhidrosis. Nevertheless, additional large, randomized controlled trials are necessary to confirm the safety and efficacy of this treatment option.

  5. The use of free musculocutaneous flaps to cover chronic radiation ulcers

    International Nuclear Information System (INIS)

    Tsujiguchi, Kounosuke; Tajima, Sadao; Tanaka, Yoshio; Hira, Michiya; Imai, Keisuke; Fukae, Eiichi; Omiya, Yuka.

    1992-01-01

    Three patients with chronic radiation ulcer treated with free musculocutaneous flap transfer are described. The first patient was a 66-year-old woman who developed sacral ulcer 7 years after radiation combined with surgery for uterine cancer. After debridement of this ulcer, interpositional vein grafts 30 cm in length was used to reconstruct an 'extended' latissimus dorsi musculocutaneous flap. The second patient was a 62-year-old woman. She developed ulcer on her chest 15 years after postoperative irradiation for breast cancer. Radiation damage extended to the myocardium and pulmonary parenchyma. After careful debridement, reconstruction was performed by using the free rectus abdominis musculocutaneous flap. The last patient was a 72-year-old woman. Ulcer of the right axilla developed 19 years after postoperative irradiation for breast cancer. Reconstruction was performed by using a free rectus abdominis musculocutaneous flap. In these patients in whom radiation-damaged tissue was not completely excised, favorable results could be attained by using the transfer of the free musculocutaneous flaps. (N.K.)

  6. Postmastectomy electron-beam chest-wall irradiation in women with breast cancer

    International Nuclear Information System (INIS)

    Gez, Eliahu; Ashaf, Nurit; Bar-Deroma, Rachel; Rosenblatt, Edward; Kuten, Abraham

    2004-01-01

    Purpose: This retrospective study evaluates the results of postmastectomy electron-beam chest-wall irradiation in patients with breast cancer. Methods and materials: From 1980 to 1994, 144 women with localized breast cancer received postmastectomy radiotherapy. The chest wall was irradiated by electron beam, 6 to 12 MeV energy, depending on wall thickness, 2.0 Gy daily, 5 times/week for total dose of 50 Gy. Forty-one patients received 16-Gy boosts to the mastectomy scar. In addition, the supraclavicular and axilla areas were irradiated by anterior field with 6-MV photon beam. Results: Median follow-up was 84 months. Fifteen patients (10%) had local-regional recurrence (LRR) and 57 patients (40%) had systemic relapse (SR). Median time from mastectomy to LRR was 20 months and median time to SR was 33 months. Axillary lymph nodes status influenced both LRR and SR. LRR rate was 0% in N0 and 12% in N1 disease; SR rate was 14% in N0 and 45% in N1 disease. Disease-free and overall survival was 58% and 67% in 10 years and 50% and 55% in 20 years, respectively. No cardiac toxicity was related to left chest-wall irradiation. Conclusion: Postmastectomy electron-beam chest-wall irradiation is as effective as photon-beam irradiation in breast cancer

  7. 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.

  8. 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.

  9. The evaluation of dose of TSEI with TLD and diode detector of the uterine cervix cancer

    International Nuclear Information System (INIS)

    Je, Young Wan; Na, Keyung Su; Yoon, Il Kyu; Park, Heung Deuk

    2005-01-01

    To evaluate radiation dose and accuracy with TLD and diode detector when treat total skin with electron beam. Using Stanford Technique, we treated patient with Mycosis Fungoides. 6 MeV electron beam of LINAC was used and the SSD was 300 cm. Also, acrylic speller(0.8 cm) was used. The patient position was 6 types and the gantry angle was 64, 90 and 116 degree. The patient's skin dose and the output were detected 5 to 6 times with TLD and diode. The deviations of dose detected with TLD from tumor dose were CA + 6%, thigh + 8%, umbilicus + 4%, calf - 8%, vertex - 74.4%, deep axillae - 10.2%, anus and testis - 87%, sole - 86% and nails shielded with 4 mm lead + 4%. The deviations of dose detected with diode were - 4.5% ∼ + 5% at the patient center and - 1.1% ∼ + 1% at the speller. The deviation of total skin dose was + 8% ∼ - 8% and that deviation was within the acceptable range(±10%). The boost dose was irradiated for the low dose areas(vertex, anus, sole). The electron beam output detected at the sootier was stable. It is thought that the deviation of dose at patient center detected with diode was induced by detection point and patient position.

  10. 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.

  11. Radiotherapeutic management of primary thyroid lymphoma

    International Nuclear Information System (INIS)

    Blair, T.J.; Evans, R.G.; Buskirk, S.J.; Banks, P.M.; Earle, J.D.

    1985-01-01

    The purpose of this study was to evaluate the radiotherapeutic management of 38 patients, with malignant lymphoma of the thyroid, seen at the Mayo Clinic between 1965 and 1979. There were 8 males and 30 females with ages ranging from 34 to 90 years. A tissue diagnosis was made in all patients and tissue was available for reclassification under the Working Formulation in 31 of the 38 patients. Twenty-six patients had intermediate grade histology, four low grade and one indeterminate. All patients were treated with approximately 4000 rad megavoltage irradiation (range 2400-6000 rad) to the neck only (10 patients) or neck and mediastinum (28 patients). Twenty patients received subdiaphragmatic radiotherapy and four patients received adjuvant chemotherapy. Patients receiving radiation treatment to the neck and mediastinum and those with no gross residual disease at the initation of radiotherapy were less likely to develop a recurrence. Patients receiving a planned break during the course of therapy did not have reduced overall disease-free survival. Only 1 of 4 patients (25%) receiving adjuvant chemotherapy survived one year. Side effects of radiotherapy were minimal. The authors believe the radiotherapeutic management of clinical Stage IE and IIE primary thyroid lymphoma should include treatment of the neck, axillae and mediastinum to a dose of approximately 4000 rad using a continuous course technique. Additionally, gross total removal of the disease surgically may be beneficial

  12. Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer

    Directory of Open Access Journals (Sweden)

    PAULO HENRIQUE WALTER DE AGUIAR

    Full Text Available ABSTRACT Objective: to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99 in patients with locally advanced breast cancer. Methods: clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. Results: identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15, and, compared to Tc99 identification, the agreement rate was 94.4%. Conclusion: autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.

  13. "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.

  14. [Ectopic breast fibroadenoma. Case report].

    Science.gov (United States)

    Senatore, G; Zanotti, S; Cambrini, P; Montroni, I; Pellegrini, A; Montanari, E; Santini, D; Taffurelli, M

    2010-03-01

    Among the rare anomalies of the breast development, polythelia is the most common, between 1% and 5% of women and men present supernumerary nipples. Polymastia, usually presenting as ectopic breast tissue without areola-nipple complex, is seen mostly along the milk line, extending from the axilla to the pubic region. Ectopic breast tissue is functionally analogous to mammary gland and it is subjected to the same alterations and diseases, whether benign or malignant, that affect normal breast tissue. We report the case of a 21 years-old female evaluated by the medical staff after founding a solid nodular mass by suspect axillary lymphadenopathy. Differential diagnosis with lymphoma is the major problem in these cases. The mass was removed and the intraoperative histological examination showed fibroadenoma in axillary supernumerary breast. Presence of ectopic breast tissue is a rare condition; development of benign mass or malignant degeneration is possible, but it is very unusual. In case of polymastia diagnosis is simple; in case of isolated nodule, without local inflammation or infection, there are greater difficulties. Ultrasonography is diagnostic in case of breast fibroadenoma, but it might be inadequate in ectopic localizations owing to the shortage of mammary tissue around the mass. Preoperative diagnosis is important to plan an adequate surgical treatment; lumpectomy is indicated in case of benign tissue; in case of malignancy, therapy is based on the standard treatment used for breast cancer (surgery, chemotherapy and radiation therapy).

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

    Energy Technology Data Exchange (ETDEWEB)

    Schacht, David V., E-mail: dschacht@radiology.bsd.uchicago.edu; Drukker, Karen, E-mail: kdrukker@uchicago.edu; Pak, Iris, E-mail: irisgpak@gmail.com; Abe, Hiroyuki, E-mail: habe@radiology.bsd.uchicago.edu; Giger, Maryellen L., E-mail: m-giger@uchicago.edu

    2015-03-15

    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.

  16. MRI of thoracic outlet syndrome in children.

    Science.gov (United States)

    Chavhan, Govind B; Batmanabane, Vaishnavi; Muthusami, Prakash; Towbin, Alexander J; Borschel, Gregory H

    2017-09-01

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation.

  17. Medical Infrared Thermography assistance in the surgical treatment of axillary Hidradenitis Suppurativa: A case report.

    Science.gov (United States)

    Polidori, G; Renard, Y; Lorimier, S; Pron, H; Derruau, S; Taiar, R

    2017-01-01

    The purpose of this case report is to highlight for the first time the way Medical Infrared Thermography can be a helpful tool to assist the surgeon in the surgical treatment of Hidradenitis Suppurativa inflammatory disease. A 36-year-old man with a 7-year history of Hidradenitis Suppurativa presented inflammatory nodules in the left axilla area corresponding to Hurley stage II. Choice is made to surgically treat this patient using a wide excision protocol combined with a postoperative second intention healing. For the study purpose, an IR FLIR SC620 camera (FLIR Systems, Wilsonville, OR), having a high resolution pixel detector of 640×480 pixels for greater accuracy and higher resolution, has been used. For the first time in the literature, this case report on HS disease supports the idea that real-time medical infrared thermography may be helpful in establishing the true extent of disease preoperatively in the surgical room and in a similar manner, that this technique allows the surgeon to ensure all diseased lesions are removed during surgery. At least, medical infrared thermography seems to be a powerful tool to control the final wide surgical wound, in order to minimize recurrence risk of such a disease. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  18. Nomogram for prediction of level 2 axillary lymph node metastasis in proven level 1 node-positive breast cancer patients.

    Science.gov (United States)

    Jiang, Yanlin; Xu, Hong; Zhang, Hao; Ou, Xunyan; Xu, Zhen; Ai, Liping; Sun, Lisha; Liu, Caigang

    2017-09-22

    The current management of the axilla in level 1 node-positive breast cancer patients is axillary lymph node dissection regardless of the status of the level 2 axillary lymph nodes. The goal of this study was to develop a nomogram predicting the probability of level 2 axillary lymph node metastasis (L-2-ALNM) in patients with level 1 axillary node-positive breast cancer. We reviewed the records of 974 patients with pathology-confirmed level 1 node-positive breast cancer between 2010 and 2014 at the Liaoning Cancer Hospital and Institute. The patients were randomized 1:1 and divided into a modeling group and a validation group. Clinical and pathological features of the patients were assessed with uni- and multivariate logistic regression. A nomogram based on independent predictors for the L-2-ALNM identified by multivariate logistic regression was constructed. Independent predictors of L-2-ALNM by the multivariate logistic regression analysis included tumor size, Ki-67 status, histological grade, and number of positive level 1 axillary lymph nodes. The areas under the receiver operating characteristic curve of the modeling set and the validation set were 0.828 and 0.816, respectively. The false-negative rates of the L-2-ALNM nomogram were 1.82% and 7.41% for the predicted probability cut-off points of level 1 axillary lymph node metastasis. Patients with a low probability of L-2-ALNM could be spared level 2 axillary lymph node dissection, thereby reducing postoperative morbidity.

  19. Liposarcoma: Analysis of radiation therapy results in 38 patients

    International Nuclear Information System (INIS)

    Amendola, B.E.; Kraus, D.; Brady, L.W.; Markoe, A.M.; Micaily, B.

    1986-01-01

    Over a 25-year period, 198 patients with sarcomas were seen in the department of radiation oncology of Hahnemann University. Thirty-eight patients had liposarcomas, and they form the basis of this review. There were 19 neoplasms arising in the extremities, nine in the retroperitoneal area, three in the chest wall, two in the shoulder, two in the buttocks, and one each in the axilla, abdominal wall, and neck. Five patients were seen initially with distant metastases (lung); the remainder had a long history of enlarging masses. Thirty-four patients were treated by radiation therapy. Doses ranged from 6,000 to 7,000 cGy, delivered in 7-8 weeks. Megavoltage treatment was used in all patients. Six patients also received additional boost radiation by interstitial implants. One third of the patients were treated after multiple surgical procedures had failed; five patients received more than one course of radiation. The most serious complication was soft-tissue necrosis at the site of the primary tumor. Analysis of treatment results revealed that patients with peripheral lesions did better than patients with central tumors. Patients treated with postoperative adjuvant irradiation did better than patients treated with postsurgical recurrence. Analysis of treatment results is presented

  20. 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.

  1. Multiple Sites Ultrasonography of Peripheral Nerves in Differentiating Charcot–Marie–Tooth Type 1A from Chronic Inflammatory Demyelinating Polyradiculoneuropathy

    Directory of Open Access Journals (Sweden)

    Jingwen Niu

    2017-05-01

    Full Text Available IntroductionMultiple sites measurement of cross-sectional areas (CSA by ultrasound was performed to differentiate Charcot–Marie–Tooth type 1A (CMT1A and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP.MethodsNine patients with CMT1A, 28 patients with CIDP, and 14 healthy controls (HC were recruited prospectively. Consecutive ultrasonography scanning was performed from wrist to axilla on median and ulnar nerves. CSAs were measured at 10 predetermined sites of each nerve.ResultsCMT1A had significantly larger CSAs at all sites of median and ulnar nerves (p < 0.01. In CMT1A, CSAs increased gradually and homogeneously from distal to proximal along the nerve, except potential entrapment sites. CIDP displayed three different morphological patterns, including mild enlargement in 15 patients, prominent segmental enlargement in 12, and slight enlargement in 1, among which different treatment responses were observed. All patients with mild nerve enlargement treated with intravenous immunoglobulin were responsive (7/7, while less than half of those with prominent segmental enlargement (3/7 were responsive (p < 0.01.DiscussionConsecutive scan along the nerve and multiple sites measurement by ultrasound could supply more detailed morphological feature of the nerve and help to differentiate CMT1A from CIDP.

  2. Effect of Biological Relatedness on Perfume Selection for Others: Preliminary Evidence.

    Science.gov (United States)

    Sobotková, Markéta; Fialová, Jitka; Roberts, S Craig; Havlíček, Jan

    2017-01-01

    People tend to choose perfumes to complement their body odour. As kin share some body odour qualities, their ability to select complementary perfumes for relatives might be higher compared with selection for nonrelatives. We tested this in two studies, comparing selection of a perfume for a target man by himself and by either a familiar but unrelated individual (girlfriend; Study 1) or a relative (sister; Study 2). Target men applied the two perfumes (own or other's choice) to their axillae and then wore cotton pads for 12 hr. Collected perfume-body odour blends and perfumes alone were assessed by rater panels. In Study 1, the blends were rated as nominally more pleasant when body odours were mixed with the perfumes selected by girlfriends compared with those selected by target men themselves. In Study 2, body odours mixed with perfumes selected by sisters were rated significantly more attractive than those mixed with perfumes selected by target men. No significant differences were found for attractiveness and pleasantness ratings when perfumes were rated alone, suggesting that it was the resulting blends that were uniquely different. Our results indicate that sisters might be particularly tuned to select suitable perfumes for their siblings.

  3. Herpes zoster in breast cancer patients after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dunst, J.; Steil, B.; Furch, S.; Fach, A. [Halle-Wittenberg Univ., Halle (Germany). Dept. of Radiotherapy; Bormann, G.; Marsch, W. [Halle-Wittenberg Univ., Halle (Germany). Dept. of Dermatology

    2000-11-01

    Purpose: We have studied the incidence of herpes zoster in patients with adjuvant radiotherapy for breast cancer with special emphasis on possible correlations with other prognostic factors or survival. Patients and Methods: From 1/1985 through 12/1993, 1 155 breast cancer patients received postoperative radiotherapy with curative intent in our department. After mastectomy 961 patients were irradiated and after breast-preserving treatment 194 patients. The age ranged from 34 to 79 years, the median follow-up was 3.1 years (range: 0.3 to 12.4 years). There were 443 women (38%) pre- and 712 (62%) postmenopausal. 21% had T3- to T4-tumors, 55% had axillary lymph node involvement, and 65% received additional systemic hormonal and/or cytotoxic therapy. In case of postmastectomy radiotherapy, the lateral chest wall and lymphatics (axilla, parasternal and supraclavicular nodes) were irradiated with an anterior photon field to 50 Gy (axilla 44 Gy) and most of the chest wall with an electron field to 44 Gy in 2-Gy fractions. After breast-preservation, the breast was irradiated via tangential fields with 6- to 8-MV photons up to 50 Gy plus 8 Gy electron boost to the tumor bed. Most of the patients were followed routinely in the department for 2 to 5 years. The frequency of zoster was determined retrospectively by reviewing the patients' records. Results: A zoster after radiotherapy occurred in 41/1 155 patients (3.7%), mostly within the first 2 years after completion of radiotherapy. All infections remained localized and there was no evidence for systemic infections. Type of treatment (mastectomy vs breast-preservation) had no impact on the frequency of herpes zoster (36/961 patients after mastectomy and 5/194 patients after breast-preservation). There was also no correlation with other prognostic factors such as age, menopausal status, stage of disease or the use of adjuvant chemotherapy, nor was the occurrence of zoster linked to the degree of acute skin reaction in

  4. 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.

  5. [Breast angiosarcoma induced by radiotherapy - surgical treatment options and review of literature].

    Science.gov (United States)

    Kubala, O; Prokop, J; Petráš, L; Ihnát, P; Jelínek, P; Ostruszka, P

    2017-01-01

    Radiation-induced angiosarcoma is a rare but very aggressive tumour. The highest risk of sarcoma development is in patients after breast-conserving surgery.Case 1: The 66 years old patient underwent radical mastectomy with axillary dissection because of ductal carcinoma with consequent radiotherapy, chemotherapy and hormonal therapy. After 6 years, high-grade angiosarcoma was diagnosed and resected with negative resection margins. Within subsequent 24 months, additional three radical re-excisions were performed because of repeated sarcoma recurrence. 29 months from the diagnosis of the first sarcoma, another radical re-excision was performed, this time with positive resection margins and with consequent disease progression. The patient died three years after the first angiosarcoma diagnosis.Case 2: The 68 years old patient underwent breast-conserving surgery with axillary dissection because of ductal carcinoma and radiotherapy. Breast colour changes were observed 6 years later; radical mastectomy was performed after additional 16 months due to locally advanced angiosarcoma. Given positive resection margin, radical re-excision with musculocutaneous musculus latissimus dorsi flap was done. 24 months later, a small sarcoma recurrence was detected near the upper resection margin, which was managed by radical re-excision. 52 months after radical operation, a metastasis was diagnosed by means of PET/CT in the contralateral axilla. Radical axillary dissection was performed (two metastases were found in axillary lymph nodes). According to follow-up, the patient has been free of any recurrence for 66 months from the radical surgery. Recommendations regarding the management of radiotherapy induced breast angiosarcoma are very vague due to limited evidence. Radical surgical excision with negative resection margins (potentially with complementary flap reconstruction) presents the fundamental approach to breast angiosarcoma.Key words: radiation-induced angiosarcoma - breast

  6. Heat loss in air of an Antarctic marine mammal, the Weddell seal.

    Science.gov (United States)

    Mellish, Jo-Ann; Hindle, Allyson; Skinner, John; Horning, Markus

    2015-01-01

    The conflicting needs of homeostasis in air versus water complicate our understanding of thermoregulation in marine mammals. Large-scale modeling efforts directed at predicting the energetic impact of changing sea ice conditions on polar ecosystems require a better understanding of thermoregulation in air of free-ranging animals. We utilized infrared imaging as an indirect approach to determine surface temperatures of dry, hauled-out Weddell seals (Leptonychotes weddellii, n = 35) of varying age and body condition during the Antarctic summer. The study groups provided a fivefold range in body mass and a threefold range in blubber depth. Surface temperature (T s) did not vary by body region (head, shoulder, axilla, torso, hip, flippers). Average seal T s (mean 13.9 ± 11.2 °C) was best described through a combination of the physical traits of body mass and environmental variables of ambient temperature T air, and wind speed. Additional factors of ice temperature (T ice), relative humidity and cloud cover did not improve the model. Heat transfer model estimates suggested that radiation contributed 56.6 ± 7.7 % of total heat loss. Convection and conduction accounted for the remaining 15.7 ± 12.3 and 27.7 ± 9.3 %, respectively. Heat loss by radiation was primarily influenced by body mass and wind speed, whereas convective heat loss was influenced primarily by blubber depth and wind speed. Conductive heat loss was modeled largely as a function of physical traits of mass and blubber depth rather than any environmental covariates, and therefore was substantially higher in animals in leaner condition.

  7. 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.

  8. Staphylococcus aureus intestinal colonization is associated with increased frequency of S. aureus on skin of hospitalized patients

    Directory of Open Access Journals (Sweden)

    Donskey Curtis J

    2007-09-01

    Full Text Available Abstract Background Intestinal colonization by Staphylococcus aureus among hospitalized patients has been associated with increased risk of staphylococcal infection and could potentially contribute to transmission. We hypothesized that S. aureus intestinal colonization is associated with increased frequency of S. aureus on patients' skin and nearby environmental surfaces. Methods Selected inpatients were cultured weekly for S. aureus from stool, nares, skin (groin and axilla, and environmental surfaces (bed rail and bedside table. Investigator's hands were cultured after contacting the patients' skin and the environmental surfaces. Results Of 71 subjects, 32 (45.1% had negative nares and stool cultures, 23 (32.4% had positive nares and stool cultures, 13 (18.3% were nares carriers only, and 3 (4.2% were stool carriers only. Of the 39 patients with S. aureus carriage, 30 (76.9% had methicillin-resistant isolates. In comparison to nares colonization only, nares and intestinal colonization was associated with increased frequency of positive skin cultures (41% versus 77%; p = 0.001 and trends toward increased environmental contamination (45% versus 62%; p = 0.188 and acquisition on investigator's hands (36% versus 60%; p = 0.057. Patients with negative nares and stool cultures had low frequency of S. aureus on skin and the environment (4.8% and 11.3%, respectively. Conclusion We found that hospitalized patients with S. aureus nares and/or stool carriage frequently had S. aureus on their skin and on nearby environmental surfaces. S. aureus intestinal colonization was associated with increased frequency of positive skin cultures, which could potentially facilitate staphylococcal infections and nosocomial transmission.

  9. The epidemiology and transmission of methicillin-resistant Staphylococcus aureus in the community in Singapore: study protocol for a longitudinal household study.

    Science.gov (United States)

    Shankar, Nivedita; Chow, Angela Li Ping; Oon, Jolene; Hsu, Li Yang; Ang, Brenda; Pang, Junxiong; De Sessions, Paola Florez; Periaswamy, Balamurugan; Tambyah, Paul A; Teo, Desmond B; Tam, Clarence C

    2017-10-11

    Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common multidrug-resistant organisms in healthcare settings worldwide, but little is known about MRSA transmission outside of acute healthcare settings especially in Asia. We describe the methods for a prospective longitudinal study of MRSA prevalence and transmission. MRSA-colonized individuals were identified from MRSA admission screening at two tertiary hospitals and recruited together with their household contacts. Participants submitted self-collected nasal, axilla and groin (NAG) swabs by mail for MRSA culture at baseline and monthly thereafter for 6 months. A comparison group of households of MRSA-negative patients provided swab samples at one time point. In a validation sub-study, separate swabs from each site were collected from randomly selected individuals, to compare MRSA detection rates between swab sites, and between samples collected by participants versus those collected by trained research staff. Information on each participant's demographic information, medical status and medical history, past healthcare facilities usage and contacts, and personal interactions with others were collected using a self-administered questionnaire. Understanding the dynamics of MRSA persistence and transmission in the community is crucial to devising and evaluating successful MRSA control strategies. Close contact with MRSA colonized patients may to be important for MRSA persistence in the community; evidence from this study on the extent of community MRSA could inform the development of household- or community-based interventions to reduce MRSA colonization of close contacts and subsequent re-introduction of MRSA into healthcare settings. Analysis of longitudinal data using whole-genome sequencing will yield further information regarding MRSA transmission within households, with significant implications for MRSA infection control outside acute hospital settings.

  10. Guidelines on the use of botulinum toxin Type A

    Directory of Open Access Journals (Sweden)

    Shetty M

    2008-03-01

    Full Text Available Botulinum toxin is available as types A and B. These two different forms need different dosages and hence, the physician needs to be familiar with the formulations. A thorough knowledge of the anatomy and physiology of the muscles in the area to be injected is essential. Indications for botulinum toxin: Dynamic wrinkles caused by persistent muscular contractions are the main aesthetic indications for the use of Botulinum toxin. These include forehead lines, glabellar lines, crow′s feet, bunny lines, perioral wrinkles, and platysmal bands. Non-aesthetic indications include hyperhidrosis of the palms, soles and axillae. Physicians′ qualifications : Any qualified dermatologist may practice the technique after receiving adequate training in the field. This may be obtained either during post-graduation or at any workshops dedicated to this subject. Facility: Botulinum toxin can be administered in the dermatologist′s minor procedure room. Preoperative counseling and informed consent Detailed counseling with respect to the treatment, desired effects, and longevity of the results should be discussed with the patient. The patient should be given brochures to study and adequate opportunity to seek information. A detailed consent form needs to be completed by the patient. The consent form should include the type of botulinum toxin, longevity expected and possible postoperative complications. Pre- and postoperative photography is recommended. Dosage depends on the area, muscle mass, gender and other factors outlined in these guidelines. It is recommended that beginners should focus on the basic indications in the upper third of the face and that they treat the middle and lower parts of the face only after garnering adequate experience.

  11. Colonization with hospital flora and its associated risk factors in neonates hospitalized in neonatal ward of a teaching center in Isfahan, Iran.

    Science.gov (United States)

    Shirani, Kiana; Mostafavizadeh, Kamyar; Ataei, Behrouz; Akhani, Khatere

    2018-01-01

    Due to the high incidence and prevalence of infection in neonatal ward, especially Neonatal Intensive Care Units (NICUs) reported by different studies and the important role of colonization with hospital germs in the development of nosocomial infections, we intended to evaluate the risk of colonization with hospital germs in neonates and its associated risk factors. This cross-sectional, descriptive-analytical study was conducted in 2016 in a Teaching Center in Iran. In total, 51 neonates were selected based on the inclusion criteria, and after recording their information in a checklist, samples were taken by swab from outer ear, axilla, and groin for culture. Neonates with negative culture from mentioned regions were enrolled in the study. The swab samples again were taken and sent for culture from mentioned regions in at least 3 days after hospitalization. Culture results from first and second sampling were collected and analyzed statistically. This study was conducted on 51 neonates. The mean gestational age among the neonates ranged from 35.25 (Week) ± 2.98. 22 girls (43.1%) and 29 boys (56.9%), most of them were born by cesarean. Based on the results of logistic regression, a significant association was found between the occurrence of colonization of hospital flora and the place hospitalization of the newborns (odds ratio (OR): 4.750; 95% confidence interval (CI): 1.26-17.85). This study revealed that the only risk factors of colonization with hospital flora in neonates are the type of delivery and place of hospitalization. Based on findings of the study, it is recommended to focus on efforts in increasing the rate of natural birth as well as improving conditions of infection control in NICUs to reduce the number of incidences of colonization with hospital flora in neonates.

  12. 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)

    Akhtar, M.S.; Kausar, F.

    2010-01-01

    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

  13. Influence of Biologic Subtype of Inflammatory Breast Cancer on Response to Neoadjuvant Therapy and Cancer Outcomes.

    Science.gov (United States)

    Hieken, Tina J; Murphy, Brittany L; Boughey, Judy C; Degnim, Amy C; Glazebrook, Katrina N; Hoskin, Tanya L

    2017-10-07

    Few data exist on the influence of tumor biologic subtype on treatment response and outcomes for inflammatory breast cancer (IBC). We examined a contemporary cohort of IBC patients treated with current targeted systemic therapies, selected on the basis of tumor biologic subtype, to evaluate pathologic treatment response and cancer outcomes across biologic subtypes. We studied 57 clinical stage T4dM0 IBC patients operated on at our institution from October 2008 to July 2015. Comparisons across biologic subtypes were performed by Wilcoxon rank-sum or chi-square tests; Kaplan-Meier and log-rank tests were used to analyze survival outcomes. All patients received neoadjuvant systemic therapy; 54 (95%) completed postmastectomy radiation. Ninety-one percent (52/57) had clinically node-positive disease at presentation. Pathologic complete response (pCR) rates in the breast and axilla differed significantly by approximated biologic subtype, defined as estrogen receptor (ER) positive/human epidermal growth factor receptor 2 (HER-2) negative; and HER-2 positive and ER negative/HER-2 negative (all P biologic subtype. Five-year DFS was 46% for patients with ER-positive/HER-2-negative tumors, 82% for HER-2-positive tumors, and 33% for ER-negative/HER-2-negative tumors (P biologic subtypes. Multimodal treatment and modern systemic therapies have markedly improved DFS and BCSS. These data provide further evidence to suggest that IBC is not a distinct biologic entity transcending standard breast tumor marker subclassification. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. 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.)

  15. 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.

  16. Promoting flowering, lateral shoot outgrowth, leaf development, and flower abscission in tobacco plants overexpressing cotton FLOWERING LOCUS T (FT)-like gene GhFT1.

    Science.gov (United States)

    Li, Chao; Zhang, Yannan; Zhang, Kun; Guo, Danli; Cui, Baiming; Wang, Xiyin; Huang, Xianzhong

    2015-01-01

    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 rate of 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 suggests that sufficient level of transgenic cotton FT might disturb the balance of the endogenous tobacco 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.

  17. Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy for Primary Breast Cancer Comparing Interim Ultrasound, Shear Wave Elastography and MRI.

    Science.gov (United States)

    Evans, Andrew; Whelehan, Patsy; Thompson, Alastair; Purdie, Colin; Jordan, Lee; Macaskill, Jane; Waugh, Shelley; Fuller-Pace, Frances; Brauer, Katrin; Vinnicombe, Sarah

    2017-09-21

    Background  Prediction of pathological complete response (pCR) of primary breast cancer to neoadjuvant chemotherapy (NACT) may influence planned surgical approaches in the breast and axilla. The aim of this project is to assess the value of interim shear wave elastography (SWE), ultrasound (US) and magnetic resonance imaging (MRI) after 3 cycles in predicting pCR. Methods  64 patients receiving NACT had baseline and interim US, SWE and MRI examinations. The mean lesion stiffness at SWE, US and MRI diameter was measured at both time points. We compared four parameters with pCR status: a) Interim mean stiffness ≤ or > 50 kPa; b) Percentage stiffness reduction; c) Percentage US diameter reduction and d) Interim MRI response using RECIST criteria. The Chi square test was used to assess significance. Results  Interim stiffness of ≤ or > 50 kPa gave the best prediction of pCR with pCR seen in 10 of 14 (71 %) cancers with an interim stiffness of ≤ 50 kPa, compared to 7 of 50 (14 %) of cancers with an interim stiffness of > 50 kPa, (p  30 % (sensitivity 50 % and specificity 79 %, p = 0.03) and % reduction in US diameter (sensitivity 47 %, specificity 81 %, p = 0.03). Similar results were obtained from ROC analysis. Conclusion  SWE stiffness of breast cancers after 3 cycles of NACT and changes in stiffness from baseline are strongly associated with pCR after 6 cycles. © Georg Thieme Verlag KG Stuttgart · New York.

  18. The Compartment Syndrome Associated with Deep Vein Thrombosis due to Rattlesnake Bite: A Case Report

    Directory of Open Access Journals (Sweden)

    Radu Ciprian Tincu

    2017-08-01

    Full Text Available Background: Snakebite is a health issue specific to some parts of the world, especially in the tropical area, where it produces many victims. The main clinical damage caused by snake bite involves hemotoxic, neurotoxic and myotoxic reactions. It is also established that the importance of systemic impairment varies according to individual factors and are related to organ dysfunction, shock or hypotension. We report the case of a young woman suffering from snakebite who developed deep vein thrombosis and compartment syndrome. Case Report: We present the case of a 32-year-old Romanian woman who was injured by her own Crotalinae snake (also known as pit viper or rattlesnake on her left forearm. When admitted to our Emergency Department, she was conscious with a Glasgow coma scale of 12/15, somnolent, febrile, suffering of headache, tachypnea; the marks of the snakebite were located in the distal part of the anterior left forearm; she had pain and bleeding at the bite site and swelling of the left upper limb with lymphangitis up to the axilla. She experienced fasciotomy-requiring compartment syndrome of the upper limb and required unfractionated heparin and closed monitored using activated partial thromboplastin time evolution due micro-thrombosis in the brachial vein. Local improvement was achieved in the next 4 days with progressive diminish of local tenderness and swelling. Conclusion: Limb deep vein thrombosis might be induced by snakebite, despite pro-hemorrhagic general condition induced by the envenomation. High index of clinical suspicion is needed for early diagnosis and timely management which can improve survival of these patients

  19. Prevalence and clinical significance of supra- or infraclavicular drainage on preoperative lymphoscintigraphy in women with breast cancer.

    Science.gov (United States)

    Tanaka, T; Sato, S; Tada, A; Inai, R; Taira, N; Doihara, H; Kanazawa, S

    2016-06-01

    Preoperative sentinel lymph node (SLN) mapping by lymphoscintigraphy is helpful to evaluate extra-axillary SLNs over a wider range than the blue dye method. However, the clinical value of extra-axillary SLNs remains uncertain. The goal of this study was to determine the prevalence and clinical significance of supra- or infraclavicular drainage on preoperative lymphoscintigraphy in women with breast cancer. We retrospectively reviewed the files of 942 consecutive breast cancer women who underwent preoperative lymphoscintigraphy for SLN biopsy at our institution between April 2004 and March 2015. Supra- or infraclavicular drainage was detected in 5/942 women (0.5%) on preoperative lymphoscintigraphy. An axillary hot spot was detected in all five women, and a positive axillary SLN was detected in four women. Breast tumor locations were the upper inner or outer quadrants in four women and the lower outer quadrant in one woman. The median follow-up period was 75 months (mean: 92; range: 26-111 months). Recurrence outside the axilla was found in three (60%) women. The woman with a negative SLN status did not undergo adjuvant chemotherapy, but developed extra-axillary lymph node recurrence 3 years after primary surgery. No patient died of metastatic breast cancer at the last follow-up. The detection of the supra- or infraclavicular SLNs on lymphoscintigraphy may provide additional staging information to tailor individual treatment regimens with regard to the potential risk of recurrence or metastasis of breast cancer. Copyright © 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  20. The incidence of breast cancer following mantle field radiation therapy as a function of dose and technique

    International Nuclear Information System (INIS)

    Tinger, Alfred; Wasserman, Todd H.; Klein, Eric E.; Miller, Elizabeth A.; Roberts, Tracy; Piephoff, James V.; Kucik, Nancy A.

    1997-01-01

    Purpose: There is an increased incidence of breast cancer following mantle field radiation therapy for Hodgkin's disease (HD). We reviewed the experience at the Mallinckrodt Institute of Radiology (MIR) for radiation factors related to the development of breast cancer after mantle field radiation therapy for HD. Methods: The radiation therapy records of 152 women treated with mantle field irradiation for HD at MIR between 1966-1985 were reviewed for the development of breast cancer and treatment-related factors. All patients had a minimum of 5 years of follow-up. The treatment era (1966-1974 vs. 1975-1985), stage of HD, mediastinal dose, axillary dose, maximum dose from the anterior field (anterior d max dose), the anterior-posterior:posterior-anterior (AP:PA) ratio, age at the time of treatment, length of follow-up, and history of splenectomy were analyzed as possible contributing factors for the development of breast cancer. The observed number of breast cancers was compared to the expected number based on age-adjusted incidences from the Connecticut Tumor Registry. Results: Ten breast cancers occurred in the population. Eight involved an upper outer quadrant. In a multivariate analysis, the development of breast cancer was significantly associated with axillary dose. Patients in the early treatment era were at an increased risk for the development of breast cancer due to high anterior d max and breast doses from weighting the fields anteriorly on a low energy linear accelerator. The use of current radiation therapy techniques was not related to an increased risk of breast cancer with a median follow-up of 13 years. Conclusions: A high dose to the axilla and the anterior d max point is significantly associated with the development of breast cancer after mantle field irradiation for HD. Efforts to protect the breast from high doses will likely lessen the increased risk of breast cancer in women treated with radiation therapy for HD

  1. 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

  2. A case of primary signet-ring cell/histiocytoid carcinoma of the eyelid: immunohistochemical comparison with the normal sweat gland and review of the literature.

    Science.gov (United States)

    Iwaya, Mai; Uehara, Takeshi; Yoshizawa, Akihiko; Kobayashi, Yukihiro; Momose, Masanobu; Honda, Takayuki; Ota, Hiroyoshi

    2012-12-01

    Primary signet-ring cell/histiocytoid carcinomas of the eyelid are extremely rare tumors considered to originate from sweat glands. Here, we report the case of a 72-year-old man diagnosed with primary signet-ring cell/histiocytoid carcinoma of the eyelid and present immunohistochemical analyses of the eyelid apocrine gland (Moll gland) and apocrine and eccrine sweat glands of perineum and axilla. Widespread infiltration of tumor cells with signet-ring cell or histiocytoid appearance was observed in his left eyelid, orbit, and periocular lesion. Tumor cells expressed mucins and showed immunoreactivity that was similar to that of the Moll gland: MUC6(+), GlcNAcα1→4Gal→R(-), MUC2(-), MUC5AC(-), GCDFP15(+), CD15(+), S100(-), CK7(+), CK20(-), ER(+), PgR (+), HER2(-), E-cadherin(+), p63(-), PSA(-), and TTF-1(-). The tumor cells differed from those of perineal and axillary apocrine and eccrine sweat glands, which were MUC6(-). The Moll gland was ER(-) and PgR(-), whereas perineal and axillar apocrine sweat glands were ER(+) and PgR(+), and perineal and axillary eccrine sweat glands were ER(+) and PgR(-). The tumor showed characteristics similar to that of the eyelid Moll gland, which is demonstrated to be an apocrine gland with a protein expression distinct from that of other apocrine glands. MUC6 and GCDFP15 expression are useful in identifying the Moll gland immunophenotype and GCDFP15, ER and PgR expression are useful in distinguishing primary eyelid signet-ring/histocytoid carcinoma from gastrointestinal malignancies.

  3. Glenohumeral translations during range-of-motion movements, activities of daily living, and sports activities in healthy participants.

    Science.gov (United States)

    Dal Maso, Fabien; Raison, Maxime; Lundberg, Arne; Arndt, Anton; Allard, Paul; Begon, Mickaël

    2015-11-01

    Glenohumeral translations have been mainly investigated during static poses while shoulder rehabilitation exercises, activities of daily living, and sports activities are dynamic. Our objective was to assess glenohumeral translations during shoulder rehabilitation exercises, activities of daily living, and sports activities to provide a preliminary analysis of glenohumeral arthrokinematics in a broad range of dynamic tasks. Glenohumeral translations were computed from trajectories of markers fitted to intracortical pins inserted into the scapula and the humerus. Two participants (P1 and P2) performed full range-of-motion movements including maximum arm elevations and internal-external rotations rehabilitation exercises, six activities of daily living, and five sports activities. During range-of-motion movements, maximum upward translation was 7.5mm (P1) and 4.7mm (P2). Upward translation during elevations was smaller with the arm internally (3.6mm (P1) and 2.9mm (P2)) than neutrally (4.2mm (P1) and 3.7mm (P2)) and externally rotated (4.3mm (P1) and 4.3mm (P2)). For activities of daily living and sports activities, only anterior translation during reach axilla for P1 and upward translation during ball throwing for P2 were larger than the translation measured during range-of-motion movements (108% and 114%, respectively). While previous electromyography-based studies recommended external rotation during arm elevation to minimize upward translation, measures of glenohumeral translations suggest that internal rotation may be better. Similar amplitude of translation during ROM movement and sports activities suggests that large excursions of the humeral head may be caused not only by fast movements, but also by large amplitude movements. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Prone breast forward intensity-modulated radiotherapy for Asian women with early left breast cancer. Factors for cardiac sparing and clinical outcomes

    International Nuclear Information System (INIS)

    Chen Jenny Lingyu; Cheng Jason Chiahsien; Kuo Sunghsin; Chan Hsingmin; Chen Yuhsuan; Huang Yusen

    2013-01-01

    Since December 2009, after breast-conserving surgery for Stage 0-I cancer of the left breast, 21 women with relatively pendulous breasts underwent computed tomography prone and supine simulations. The adjuvant radiotherapy was 50 Gy in 25 fractions to the left breast alone. Four plans-conventional wedged tangents and forward intensity-modulated radiotherapy (fIMRT) in supine and prone positions-were generated. fIMRT generated better homogeneity in both positions. Prone position centralized the breast tissue by gravity and also shortened the breast width which led to better conformity in both planning techniques. Prone fIMRT significantly reduced doses to left lung, Level I and Level II axilla. The mean cardiac doses did not differ between positions. Among the four plans, prone fIMRT produced the best target dosimetry and normal organ sparing. In subgroup analysis, patients with absolute breast depth >7 cm in the prone position or breast depth difference >3 cm between positions had significant cardiac sparing with prone fIMRT. Sixteen patients with significant cardiac sparing in prone position were treated using prone fIMRT and the others using supine fIMRT. All patients received a supine electron tumor bed boost of 10 Gy in 5 fractions. No patients developed Grade 2 or worse acute or late toxicities. There was no difference in the number of segments or beams, monitor units, treatment time, or positioning reproducibility between prone and supine positions. At a median follow-up time of 26.8 months, no locoregional or distant recurrence or death was noted. (author)

  5. Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

    Directory of Open Access Journals (Sweden)

    Atakan Sezer

    2011-06-01

    Full Text Available Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19. Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4. Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80 months.Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients.

  6. Oral contraceptives and fat patterning in young adult women.

    Science.gov (United States)

    Litchfield, R E; Grunewald, K K

    1988-10-01

    90 nulliparous white female college students, selected from 2 undergraduate introductory courses at Kansas University, participated in a cross-sectional study designed to compare the fat distribution of oral contraceptive (OC) users to that of nonusers matched for height and weight. The subjects ranged in age from 18-26 years. The 30 OC users had been using the same brand of OCs for an average of 17.7 months (range of 3-36 months) and had not used another brand previously. Each OC user was matched to 2 nonusers. Each subject's height was measured to the nearest cm. A Detecto sliding-weight balance was used to measure body weights of the women (in light clothing) to the nearest 0.1 kg. Circumference measurements also were taken to determine body shape and fat distribution. The waist girth to hip ratio (WHR) also was calculated. Fat distribution of the OC users was similar to that of nonusers matched for height and weight. Both groups were comparable in their circumference and skinfold measurements, except that the OC users had larger axilla skinfolds. Progestational activity of the combined OCs was not associated with any of the physical measurements. Estrogenic activity of the combined OCs was correlated positively with body mass index, arm and thigh circumference, and peripheral fat distribution. Estrogenic activity also was associated weakly with hip and low chest circumferences but no with any of the 7 skinfold thickness measurements. The women taking the higher estrogen OCs were more likely to have circumference measurements consistent with a more gynoid shape. Thigh skinfold thickness was consistent with those findings, though not statistically significant.

  7. Quantitative assessment of growing hair counts, thickness and colour during and after treatments with a low-fluence, home-device laser: a randomized controlled trial.

    Science.gov (United States)

    Thaysen-Petersen, D; Barbet-Pfeilsticker, M; Beerwerth, F; Nash, J F; Philipsen, P A; Staubach, P; Haedersdal, M

    2015-01-01

    At-home laser and intense pulsed-light hair removal continues to grow in popularity and availability. A relatively limited body of evidence is available on the course of hair growth during and after low-fluence laser usage. To assess growing hair counts, thickness and colour quantitatively during and after cessation of low-fluence laser treatment. Thirty-six women with skin phototypes I-IV and light to dark-brown axillary hairs were included. Entire axillary regions were randomized to zero or eight self-administered weekly treatments with an 810-nm home-use laser at 5·0-6·4 J cm(-2). Standardized clinical photographs were taken before each treatment and up to 3 months after the final treatment for computer-aided quantification of growing hair counts, thickness and colour. Thirty-two women completed the study protocol. During sustained treatment, there was a reduction in growing hair that reached a plateau of up to 59%, while remaining hairs became up to 38% thinner and 5% lighter (P hair' in treated than untreated axilla, and assessed remaining hairs as thinner and lighter (≥ 60%). After treatment cessation, hair growth gradually returned to baseline levels, and 3 months after the final treatment the count and thickness of actively growing hair exceeded pretreatment values by 29% and 7%, respectively (P ≤ 0·04). Sustained usage of low-fluence laser induced a stable reduction of growing hair counts, thickness and colour. The reduction was reversible and hairs regrew beyond baseline values after cessation of usage. Computer-aided image analysis was qualified for quantification of hair counts, thickness and colour after laser epilation. © 2014 British Association of Dermatologists.

  8. Linfangioma mesentérico Mesentery lymphangioma

    Directory of Open Access Journals (Sweden)

    Pedro López Rodríguez

    2012-03-01

    Full Text Available El linfangioma representa el 6 % de los tumores benignos, y su localización más frecuente es la región cervical, seguida de la axila en el 95 % de los casos. Solo un 5 % tiene localización en otro sitio. Dentro de estos, los abdominales representan entre el 2 y el 5 %, y los más frecuentes son los del mesenterio. Se presenta el caso de una paciente de 45 años con el diagnóstico de metrorragia disfuncional, que a pesar del tratamiento hormonal, aumentó en intensidad. Se le practicó un legrado diagnóstico, cuyo resultado fue hiperplasia adenomatosa con ligera atipia, y se le indicó una histerectomía abdominal, que se realizó sin dificultad. En el transcurso de esta intervención se llevó a cabo la extirpación de un tumor del mesenterio del yeyuno, cuyo diagnóstico histológico definitivo fue linfangioma mesentérico.The lymphangioma accounts for the 6 % of the benign tumors and its more frequent location is the cervical region, followed by the axilla in the 95 % of cases. Only the 5 % is located in other site including the abdominal ones accounting for the 2 and the 5 % and the more frequent are those of mesentery. This is the case of a patient aged 45 diagnosed with dysfunctional metrorrhagia that despite the hormonal treatment increased its intensity. A diagnostic curettage was made whose result was an adenomatous hyperplasia with a slight atypia prescribing an abdominal hysterectomy carried out without problem. During this intervention a yeyunal mesenteric tumor was removed with a definitive histological diagnosis of mesenteric lymphangioma.

  9. Lymph Drainage Studied by Lymphoscintigraphy in the Arms after Sentinel Node Biopsy Compared with Axillary Lymph Node Dissection Following Conservative Breast Cancer Surgery

    International Nuclear Information System (INIS)

    Celebioglu, F.; Perbeck, L.; Frisell, J.; Groendal, E.; Svensson, L.; Danielsson, R.

    2007-01-01

    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

  10. 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.

  11. Assessment of leakage dose in vivo in patients undergoing radiotherapy for breast cancer

    Directory of Open Access Journals (Sweden)

    Peta Lonski

    2018-01-01

    Full Text Available Background and purpose: Accurate quantification of the relatively small radiation doses delivered to untargeted regions during breast irradiation in patients with breast cancer is of increasing clinical interest for the purpose of estimating long-term radiation-related risks. Out-of-field dose calculations from commercial planning systems however may be inaccurate which can impact estimates for long-term risks associated with treatment. This work compares calculated and measured dose out-of-field and explores the application of a correction for leakage radiation. Materials and methods: Dose calculations of a Boltzmann transport equation solver, pencil beam-type, and superposition-type algorithms from a commercial treatment planning system (TPS were compared with in vivo thermoluminescent dosimetry (TLD measurements conducted out-of-field on the contralateral chest at points corresponding to the thyroid, axilla and contralateral breast of eleven patients undergoing tangential beam radiotherapy for breast cancer. Results: Overall, the TPS was found to under-estimate doses at points distal to the radiation field edge with a modern linear Boltzmann transport equation solver providing the best estimates. Application of an additive correction for leakage (0.04% of central axis dose improved correlation between the measured and calculated doses at points greater than 15 cm from the field edge. Conclusions: Application of a correction for leakage doses within peripheral regions is feasible and could improve accuracy of TPS in estimating out-of-field doses in breast radiotherapy. Keywords: Breast radiotherapy, TLD, Leakage dose, Dose calculation algorithm

  12. 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. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. 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.

  14. Breaking paradigms in severe epistaxis: the importance of looking for the S-point.

    Science.gov (United States)

    Kosugi, Eduardo Macoto; Balsalobre, Leonardo; Mangussi Gomes, João; Tepedino, Miguel Soares; San da Silva, Daniel Marcus; Cabernite, Erika Mucciolo; Hermann, Diego; Stamm, Aldo Cassol

    2018-01-20

    Since the introduction of nasal endoscopy into the field of Otorhinolaryngology, the treatment paradigm for cases of severe epistaxis has shifted toward early and precise identification of the bleeding site. Although severe epistaxis is usually considered to arise from posterior bleeding, an arterial vascular pedicle in the superior portion of the nasal septum, around the axilla projection of the middle turbinate, posterior to the septal body, frequently has been observed. That vascular pedicle was named the Stamm's S-point. The aim of this study was to describe the S-point and report cases of severe epistaxis originating from it. A retrospective case series study was conducted. Nine patients with spontaneous severe epistaxis, where the S-point was identified as the source of bleeding, were treated between March 2016 and March 2017. Male predominance (77.8%) with age average of 59.3 years old were reported. Most cases presented comorbidities (88.9%) and were not taking acetylsalicylic acid (66.7%). A predominance of left sided involvement (55.6%) and anteroposterior bleeding being the principal initial presentation (77.8%) was seen. Six patients (66.7%) presented with hemoglobin levels below 10g/dL, and four (44.4%) required blood transfusion. Cauterization of S-point was performed in all patients, with complete resolution of bleeding. No patient experienced recurrence of severe epistaxis. The Stamm's S-point, a novel source of spontaneous severe epistaxis, is reported, and its cauterization was effective and safe. Otolaryngologists must actively seek this site of bleeding in cases of severe epistaxis. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  15. 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.

  16. 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

  17. Thoracoscopic bilateral T3 sympathectomy for primary focal hyperhidrosis in children.

    Science.gov (United States)

    Laje, Pablo; Rhodes, Kali; Magee, Leanne; Klarich, Mary Kate

    2017-02-01

    Present our experience in the surgical treatment of primary focal hyperhidrosis of the hands by thoracoscopic bilateral T3 sympathectomy in pediatric patients. Retrospective chart review of all patients operated between 2013 and 2015. We operated and included in the study 28 patients, 22 females and 6 males. Mean age was 14 (6-21) years. All patients had previously tried at least one form of medical therapy with no success. All patients were extensively counseled regarding the potential side effects of the sympathectomy. The operations were done in supine position with the arms extended. All patients were intubated with a double-lumen endotracheal tube for sequential lung isolation. We used a 5-mm port for the scope and a 3-mm port for the instruments, both placed in the axilla. The third rib was identified by fluoroscopy. The sympathectomy was done with monopolar cautery. Mean operative time was 43 (25-71) minutes. No chest tubes were used. The incidence of intraoperative or postoperative complications was zero. All patients were discharged within the first 24 postoperative hours. All patients achieved immediate complete postoperative resolution of the palmar hyperhidrosis, sustained in all cases at a median follow-up of 17 (2-34) months. The mean preoperative quality of life score (based on a multifunctional self-assessment questionnaire) was 41/100, whereas after the operation, it was 92/100. Only 1 patient developed temporary compensatory sweating. All patients were satisfied with the result of the operation. Thoracoscopic bilateral T3 sympathectomy is a safe and effective treatment for children and adolescents with primary focal hyperhidrosis of the hands who failed medical management and have a very low rate of compensatory sweating. IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. A Prospective, Nonrandomized, Open-Label Study of the Efficacy and Safety of OnabotulinumtoxinA in Adolescents with Primary Axillary Hyperhidrosis.

    Science.gov (United States)

    Glaser, Dee Anna; Pariser, David M; Hebert, Adelaide A; Landells, Ian; Somogyi, Chris; Weng, Emily; Brin, Mitchell F; Beddingfield, Frederick

    2015-01-01

    To evaluate the efficacy and safety of onabotulinumtoxinA in adolescents with primary axillary hyperhidrosis. This 52-week, multicenter, nonrandomized, open-label study was conducted in 141 adolescents ages 12 to 17 years with severe primary axillary hyperhidrosis. Patients could receive up to six treatments with onabotulinumtoxinA (50 U per axilla), with re-treatment occurring no sooner than 8 weeks after the prior treatment cycle and no later than 44 weeks after the initial treatment cycle. The primary efficacy measure was treatment response, based on self-assessed hyperhidrosis severity following the first two treatments using the 4-point Hyperhidrosis Disease Severity Scale (HDSS). Other efficacy measures included spontaneous resting sweat production and health outcomes. Fifty-six (38.9%) participants underwent one treatment, 59 (41.0%) underwent two, 20 (13.9%) underwent three, 6 (4.2%) underwent four, and 3 (2.1%) underwent five. OnabotulinumtoxinA significantly improved HDSS scores and decreased sweat production compared with treatment cycle baselines. Seventy-nine patients (54.9%) responded to treatment based on HDSS criteria. From 56.6% to 72.3% of patients experienced a two-grade or more improvement at 4 and 8 weeks after each of the first two treatments. The majority (79.4%-93.2%) had a 75% or greater reduction in sweat production at week 4 (treatments 1-3). The median duration of effect for responders ranged from 134 to 152 days. Using quality of life measures, health outcomes improved markedly. Eight patients (5.6%) had mild or moderate treatment-related adverse events. No unexpected safety signals were observed in this study. Neutralizing antibodies to onabotulinumtoxinA did not develop. OnabotulinumtoxinA injections provided beneficial effects in adolescents with primary axillary hyperhidrosis. © 2015 The Authors. Pediatric Dermatology Published by Wiley Periodicals, Inc.

  19. Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis†

    Science.gov (United States)

    Ibrahim, Mohsen; Menna, Cecilia; Andreetti, Claudio; Ciccone, Anna Maria; D'Andrilli, Antonio; Maurizi, Giulio; Poggi, Camilla; Vanni, Camilla; Venuta, Federico; Rendina, Erino Angelo

    2013-01-01

    OBJECTIVES Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy. METHODS From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group). RESULTS The mean postoperative follow-up period was 12.5 (range: 1–24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome. CONCLUSIONS Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis. PMID:23442937

  20. Herpes Zoster

    Directory of Open Access Journals (Sweden)

    Hamid Ehsani-Nia

    2017-04-01

    Full Text Available History of present illness: A 26-year-old male presented to the emergency department with a burning rash over his left axilla and chest that started 2 days prior to presentation. The pain had been steadily worsening and was exacerbated by touch and the rubbing of his clothes over it. Patient denied fevers, chills, or weakness. Patient denied any past medical history, past surgical history or medications. He was unsure of his vaccination history and endorsed having chicken pox as a child. Significant findings: The patient was in mild distress, afebrile, with stable vital signs. His physical exam revealed an erythematous, grouped vesicular rash in various stages of progression including erythematous papules, clear vesicles, and pustular vesicles. Few lesions were scabbed over. No signs of crusting or scarring were appreciated. The distribution encompassed the entire left T4 dermatome both posteriorly and anteriorly. No other rashes were appreciated elsewhere on the body. Discussion: Herpes Zoster (HZ, also known as “shingles,” is a result of the reactivation Varicella Zoster Virus (VZV that emerges from latency in the sensory dorsal root ganglion. The reactivation causes the spreading of a classic rash of group vesicular lesions in various stages along the unilateral sensory dermatomal distribution over the first 3 days. Ulceration and crusting begin to occur after 3-5 days.1 The diagnosis is usually made clinically; however PCR testing of skin lesions is also available to differentiate between VZV, HSV1, and HSV2.2 The incidence of HZ increases with age due to immunosenesacence of cell mediated immunity, with the mean age between 43 and 53 years old.3 An immunocompromised state, due to factors like human immunodeficiency virus (HIV, medications, and autoimmune disease, also increases the incidence of HZ.4-6 A routine HIV screening in this patient was negative. He was prescribed oral acyclovir 800 mg, five times per day for five days.

  1. 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.

  2. Impact of neoadjuvant single or dual HER2 inhibition and chemotherapy backbone upon pathological complete response in operable and locally advanced breast cancer: Sensitivity analysis of randomized trials.

    Science.gov (United States)

    Bria, Emilio; Carbognin, Luisa; Furlanetto, Jenny; Pilotto, Sara; Bonomi, Maria; Guarneri, Valentina; Vicentini, Cecilia; Brunelli, Matteo; Nortilli, Rolando; Pellini, Francesca; Sperduti, Isabella; Giannarelli, Diana; Pollini, Giovanni Paolo; Conte, Pierfranco; Tortora, Giampaolo

    2014-08-01

    The role of the dual HER2 inhibition, and the best chemotherapy backbone for neoadjuvant chemotherapy still represent an issue for clinical practice. A literature-based meta-analysis exploring single versus dual HER2 inhibition in terms of pathological complete response (pCR, breast plus axilla) rate and testing the interaction according to the chemotherapy (anthracyclines-taxanes or taxanes) was conducted. In addition, an event-based pooled analysis by extracting activity and safety events and deriving 95% confidence intervals (CI) was accomplished. Fourteen trials (4149 patients) were identified, with 6 trials (1820 patients) included in the meta-analysis and 31 arms (14 trials, 3580 patients) in the event-based pooled analysis. The dual HER2 inhibition significantly improves pCR rate, in the range of 16-19%, regardless of the chemotherapy backbone (relative risk 1.37, 95% CI 1.23-1.53, p<0.0001); pCR was significantly higher in the hormonal receptor negative population, regardless of the HER2 inhibition and type of chemotherapy. pCR and the rate of breast conserving surgery was higher when anthracyclines were added to taxanes, regardless of the HER2 inhibition. Severe neutropenia was higher with the addition of anthracyclines to taxanes, with an absolute difference of 19.7%, despite no differences in febrile neutropenia. While no significant differences according to the HER2 inhibition were found in terms of cardiotoxicity, a slightly difference for grade 3-4 (1.2%) against the addition of anthracyclines was calculated. The dual HER2 inhibition for the neoadjuvant treatment of HER2-positive breast cancer significantly increases pCR; the combination of anthracyclines, taxanes and anti-Her2 agents should be currently considered the standard of care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Physical symptoms and working performance in female breast cancer survivors: a systematic review.

    Science.gov (United States)

    Zomkowski, Kamilla; Cruz de Souza, Bruna; Pinheiro da Silva, Fabiana; Moreira, Géssica Maria; de Souza Cunha, Natália; Sperandio, Fabiana Flores

    2018-06-01

    The aim of this systematic review was to summarize and systematize the information about physical symptoms and its relation with work activity on female Breast Cancer Survivors (BCS). A systematic search was performed on the databases MEDLINE/PubMed (via National Library of Medicine), SCOPUS (Elsevier), Web of Science (Thomson Reuters Scientific) and CINAHL with full text (EBSCO), including papers about physical impairments experienced by female workers who have had breast cancer. The search retrieved 238 studies, and another 5 were identified in the articles' references, totaling 243 papers. After removing duplicates and applying the inclusion criteria and a full text reading, 13 articles were included for qualitative analysis. Concerning physical limitations, most complaints were related to the elevation of upper limbs, carrying heavy objects, driving and holding manual movements. The most referred symptoms were breast/arm pain, fatigue, lymphedema, reduced range of motion and weakness in the upper limbs, scar tissue adherence in the breast/axilla and paresthesia in the arm/breast. These symptoms and physical limitations led to the difficulty or impossibility of performing work tasks, which also diminished work productivity, as well as the increase in time to return to work. The present results suggest higher unemployment rates and the need for modifying work conditions. Implication for Rehabilitation Health professionals should include risk assessment at daily routine to identify possible sources of physical impairments for upper limbs. Provide the support and orientations according to personal and job characteristics of the patient. Focus the aims of treatment over upper limbs impairments, reducing the prevalence and the gravity of symptoms.

  4. Acute development of Cushing syndrome in an HIV-infected child on atazanavir/ritonavir based antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Gueorgui Dubrocq

    2017-10-01

    Full Text Available An 11-year-old male with perinatally acquired human immune deficiency virus (HIV infection on antiretroviral regimen, which included abacavir plus lamivudine (Epzicom, didanosine, ritonavir and atazanavir presented with bilateral axillary striae, increased appetite, fatigue, facial swelling and acute weight gain. Two months prior to presentation, the patient had received a diagnostic and therapeutic intra-articular triamcinolone injection in the knee for pain relief and subsequently became progressively swollen in the face, developed striae bilaterally at the axillae, experienced increased appetite, fatigue and an 8 pound weight gain. During the endocrine workup, suspicion for adrenal insufficiency prompted 24-h urine collection for free cortisol, which was found to be undetectable (below LLQ of 1.0 μg/L. This prompted further evaluation of the hypothalamic–pituitary axis (HPA by standard dose adrenocorticotropic hormone (ACTH stimulation test. A 250 μg cosyntropin stimulation test was performed and confirmed HPA axis suppression. Baseline cortisol level was <1 μg/dL and stimulated cortisol level at 30 min was 3.8 μg/dL. The patient was diagnosed with iatrogenic Cushing syndrome and suppression of HPA axis secondary to the drug interaction between ritonavir (RTV and intra-articular triamcinolone injection. Following endocrine evaluation and workup, the patient was admitted for planned orthopaedic procedure including elective left hamstring lengthening, distal femoral osteotomy and patellar tendon advancement. Taking into consideration the diagnosis of iatrogenic Cushing syndrome, at the start of the surgical procedure, 100 mg IV stress dose of hydrocortisone followed by 50 mg hydrocortisone every 8 h for 24 h was administered. Stress dosing was discontinued 24 h after the procedure. Throughout the hospitalization and upon discharge, the patient continued his ART. From initial presentation, patient has remained clinically stable throughout

  5. FDG-PET and ultrasound as complementary modalities in malignant melanoma restaging

    International Nuclear Information System (INIS)

    Schwarz, T.; Aigner, R.M.; Wolf, G.

    2002-01-01

    Full text: Both FDG-PET and ultrasound are common modalities for restaging malignant melanoma patients although ultrasound is still the first quality in restaging lymph nodes (neck, axilla, inguen) and liver. The aim of our study was to show the benefit of complementary use of these modalities in patients with suspicious findings. In our study 37 patients were included. All of them were alter surgical and additionally zytostatic and/or Interferon therapy. Ultrasound and FDG-PET examination happened within 9 weeks. In 19 cases first ultrasound was done and afterwards FDG-PET, in 18 cases FDG-PET was the first examination. Criterion for suspiciousness in ultrasound was size and sonographic texture of lymph nodes and liver lesions relatively. Criterion for suspiciousness in FDG-PET was pathological FDG uptake. The results were verified by histology and /or CT, MR, long-term follow-up. In 22 cases highly suspicious (11) or non suspicious (11) findings in one examination were confirmed by the other one. FDG-PET showed additionally findings in 5 cases (lung/1, lien/2, liver/2) ultrasound in one case (suprarenal gland). In 8 cases suspicious findings in one examination (ultrasound 1/ FDG-PET 7) had been cleared up by the other one. Only 7 cases showed completely different findings (liver/3, lymph nodes/2) or in both modalities not clear findings (liver/1, lymph node/1). Complementary use of FDG-PET and ultrasound for restaging in malignant melanoma patients is a good chance to clear up suspect findings. FDG-PET as whole body examination in a higher rate than ultrasound has the opportunity of additional findings although ultrasound is even out of cost - effectiveness the first quality in restaging. (author)

  6. 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.

    Science.gov (United States)

    Lewis, Lucy; Carson, Sharron; Bydder, Sean; Athifa, Mariyam; Williams, Anne M; Bremner, Alexandra

    2014-11-15

    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. 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. 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). 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 significantly less sweating without increased symptoms of

  7. 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

  8. Use of deodorants during adjuvant breast radiotherapy: a survey of compliance with standard advice, impact on patients and a literature review on safety.

    Science.gov (United States)

    Graham, P H; Graham, J L

    2009-12-01

    Proscription of antiperspirant or deodorant use during adjuvant breast radiotherapy is common. The investigators were seeking an information base to facilitate design of an appropriate controlled trial of the use of deodorants during radiotherapy. The first component consisted of a survey of women after adjuvant breast radiotherapy seeking information about routine deodorant use and potential concern if deodorants were not permitted during radiotherapy. The second component comprised a literature search for any existing controlled evidence regarding harm from deodorant use during radiotherapy. Four hundred fourteen women completed surveys. Two hundred eighty recalled advice against deodorants. Two hundred ninety-nine women routinely used deodorants, 70% of whom used roll-on products. Forty-five continued deodorant use during radiation, 20 of these despite recalling advice not to wear a deodorant. Of the 233 women who routinely wore a deodorant but abstained during radiotherapy, 19% expressed a lot of concern about body odour and 45% were slightly concerned. Three controlled studies totalling 310 patients report specific deodorants versus no deodorant use which did not show statistically significantly increased skin reactions, but had only a small subset with axillary irradiation. The proscription of deodorant use during radiotherapy is of unproven benefit and causes body odour concern to the majority of women who are usual deodorant users. The next most appropriate trial would compare use of the usual deodorant versus no deodorant, would encompass a significant number of women with radiotherapy to the axilla or application of deodorant to irradiated skin areas, and include endpoints other than skin reaction alone.

  9. Clinical and epidemiological features of coryneform skin infections at a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Malcolm Pinto

    2016-01-01

    Full Text Available Background: Skin infections caused by coryneform bacteria are common dermatological conditions. However, to the best of our knowledge, no studies are available on the clinical characteristics and epidemiological features of this group of disorders as one entity from India and abroad. Aims: To study the clinical and epidemiological features of coryneform skin infections Methods: A total of 75 patients presenting with clinically distinctive lesions of pitted keratolysis, erythrasma and trichobacteriosis to our hospital were included in the study. Cases were interviewed with particular emphasis on epidemiological features and the various clinical findings were recorded. Investigations like Gram's stain, Wood's light examination, 10% KOH scrapings, were done in selected cases to ascertain the diagnosis. Results: Pitted keratolysis was more common in the age group of 31-40 years (40% with a male preponderance (76.7%, most commonly affecting pressure bearing areas of the soles with malodour (86.7% and frequent contact with water (58.3% constituting the most important presenting symptom and provocating factor respectively. Erythrasma affected both male and female patients equally and was more commonly detected in patients with a BMI > 23kg/m2 (62.5% and in diabetics (50%. All patients with trichobacteriosis presented with yellow coloured concretions in the axillae. Bromhidrosis (71.4% and failure to regularly use an axillary deodorant (71.4% were the most common presenting symptom and predisposing factor respectively. Conclusion: Coryneform skin infections are common dermatological conditions, though epidemiological data are fragmentary. Hyperhidrosis is a common predisposing factor to all three coryneform skin infections. Asymmetrical distribution of pits has been reported in our study. Diabetic status needs to be evaluated in all patients with erythrasma. Woods lamp examination forms an indispensible tool to diagnose erythrasma and trichobacteriosis.

  10. Under the influence of the active deodorant ingredient 4-hydroxy-3-methoxybenzyl alcohol, the skin bacterium Corynebacterium jeikeium moderately responds with differential gene expression.

    Science.gov (United States)

    Brune, Iris; Becker, Anke; Paarmann, Daniel; Albersmeier, Andreas; Kalinowski, Jörn; Pühler, Alfred; Tauch, Andreas

    2006-12-15

    A 70mer oligonucleotide microarray was constructed to analyze genome-wide expression profiles of Corynebacterium jeikeium, a skin bacterium that is predominantly present in the human axilla and involved in axillary odor formation. Oligonucleotides representing 100% of the predicted coding regions of the C. jeikeium K411 genome were designed and spotted in quadruplicate onto epoxy-coated glass slides. The quality of the printed microarray was demonstrated by co-hybridization with fluorescently labeled cDNA probes obtained from exponentially growing C. jeikeium cultures. Accordingly, genes detected with different intensities resulting in log(2) transformed ratios greater than 0.8 or smaller than -0.8 can be regarded as differentially expressed with a confidence level greater than 99%. In an application example, we measured global changes of gene expression during growth of C. jeikeium in the presence of different concentrations of the deodorant component 4-hydroxy-3-methoxybenzyl alcohol that is active in preventing body odor formation. Global expression profiling revealed that low concentrations of 4-hydroxy-3-methoxybenzyl alcohol (0.5 and 2.5mg/ml) had almost no detectable effect on the transcriptome of C. jeikeium. A slightly higher concentration of 4-hydroxy-3-methoxybenzyl alcohol (5mg/ml) resulted in differential expression of 95 genes, 86 of which showed an enhanced expression when compared to a control culture. Besides many genes encoding proteins that apparently participate in transcription and translation, the drug resistance determinant cmx and the predicted virulence factors sapA and sapD showed significantly enhanced expression levels. Differential expression of relevant genes was validated by real-time reverse transcription PCR assays.

  11. [Utility and advantages of single tracer subareolar injection in sentinel lymph node biopsy in breast cancer].

    Science.gov (United States)

    Armas, Fayna; Hernández, María Jesús; Vega, Víctor; Gutiérrez, Isabel; Jiménez, Concepción; Pavcovich, Marta; Báez, Beatriz; Pérez-Correa, Pedro; Núñez, Valentín

    2005-10-01

    Sentinel lymph node (SLN) biopsy is a reliable technique for determining axillary status in patients with early breast cancer. This technique is a minimally invasive procedure that can avoid the use of lymphadenectomy in patients without axillary involvement. We present a validation study of SLN biopsy with subareolar injection of 99mTc-nanocolloids. We studied 100 patients with early breast cancer (T1 and T2) over a 2-year period. All patients underwent deep subareolar-injection of 99mTc-nanocoloid for localization of the sentinel node. Images were obtained and when the sentinel node was seen, it was marked on the skin. All patients underwent tumor excision and radioguided SLN biopsy followed by complete lymphadenectomy. Histopathological analysis of sentinel nodes was performed by hematoxylin-eosin and immunohistochemistry with cytokeratins. The sentinel node was identified in all patients, and a mean of 1.95 sentinel nodes per patient were found. Lymphatic metastases in the sentinel node were found in 44 patients and in 15 of these tumoral spread was also found in the remaining axillary nodes. In the 56 remaining patients the sentinel node was free of metastasis, but in two of them a non-sentinel node was found to be positive (4.5% false negative rate). Sensitivity was 95.7% (44/46), specificity was 100% (54/54), the positive predictive value was 100% and the negative predictive value was 96.4% (54/56). SLN biopsy is an accurate alternative to complete axillary lymph node dissection in patients with early-stage breast cancer. This technique improves the staging of these patients and decreases the morbidity associated with lymphadenectomy. The advantages of subareolar injection are that a single injection site is required, the tumor does not have to be located by other techniques, it allows rapid visualization of the sentinel node and avoids the "shine through phenomenon" when the tumor is located near the axilla.

  12. Use of gamma-irradiated amnion as a biological dressing in the management of radiation induced ulcers

    International Nuclear Information System (INIS)

    Astrid Lobo Gajiwala; Cynthia D Lima; Urmila Samant; Vilas Mayekar

    2008-01-01

    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)

  13. Extradural spinal arachnoid cysts associated with spina bifida occulta.

    Science.gov (United States)

    Apel, K; Sgouros, S

    2006-02-01

    Spinal extradural arachnoid cysts are an uncommon cause of neural compression in children. Even more uncommon is the association of such cysts with spina bifida occulta. Two girls, 12 and 8-years-old, presented with left leg pain, deteriorating gait, clinical signs of left L5 and S1 root compression, without bladder or bowel symptoms. The first patient had left foot drop. The second patient had muscle wasting and smaller left foot with pes cavus. Radiographs showed spina bifida occulta of S1 in both. MRI revealed an extradural cyst at the S1 level, indenting the thecal sac and the L5 and S1 roots. At operation in both patients a large arachnoid cyst arising from a small dural defect in the axilla of the left S1 root was compressing and displacing it and the dural sac. It was removed and the defect was repaired. The first patient improved with complete recovery of the foot drop. An MRI at 12 months showed no cyst recurrence. The second patient made good recovery initially, but at 10 months developed recurrent symptoms. An MRI scan showed recurrence of the cyst with root compression. On repeat exploration a different dural defect was identified in a more anterior position and was repaired. The coexistence of extradural arachnoid cyst and corresponding bifid spinal segment has not been described previously. It raises the suspicion that the dural defect giving rise to the arachnoid cyst may be due to segmental dural dysgenesis in the context of the dysrhaphic neuroectodermal malformation.

  14. Outcome following nerve repair of high isolated clean sharp injuries of the ulnar nerve.

    Directory of Open Access Journals (Sweden)

    René Post

    Full Text Available 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 brachial plexus. A meta-analysis of the literature concerning high ulnar nerve injuries was performed. Additionally, a retrospective study of the outcome of nerve repair of HICS ulnar nerve injuries at our institution was performed. The Rotterdam Intrinsic Hand Myometer and the Rosén-Lundborg protocol were used. RESULTS: The literature review identified 46 papers. Many articles presented outcomes of mixed lesion groups consisting of combined ulnar and median nerves, or the outcome of high and low level injuries was pooled. In addition, outcome was expressed using different scoring systems. 40 patients with HICS ulnar nerve lesions were found with sufficient data for further analysis. In our institution, 15 patients had nerve repair with a median interval between trauma and reconstruction of 17 days (range 0-516. The mean score of the motor and sensory domain of the Rosen's Scale instrument was 58% and 38% of the unaffected arm, respectively. Two-point discrimination never reached less then 12 mm. CONCLUSION: From the literature, it was not possible to draw a definitive conclusion on outcome of surgical repair of HICS ulnar nerve lesions. Detailed neurological function assessment of our own patients showed that some ulnar nerve function returned. Intrinsic muscle strength recovery was generally poor. Based on this study, one might cautiously argue that repair strategies of HICS ulnar nerve lesions need to be improved.

  15. Performance and quality control of Clear-PEM detector modules

    Energy Technology Data Exchange (ETDEWEB)

    Amaral, Pedro; Carrico, Bruno; Ferreira, Miguel [LIP, Av Elias Garcia 14, 1000-149 Lisbon (Portugal); Moura, Rui [LIP, Av Elias Garcia 14, 1000-149 Lisbon (Portugal)], E-mail: moura@lip.pt; Ortigao, Catarina; Rodrigues, Pedro; Da Silva, Jose C.; Trindade, Andreia [LIP, Av Elias Garcia 14, 1000-149 Lisbon (Portugal); Varela, Joao [LIP, Av Elias Garcia 14, 1000-149 Lisbon (Portugal); IST, Av Rovisco Pais, 1049-001 Lisbon (Portugal)

    2007-10-01

    Clear-PEM is a dedicated PET scanner for breast and axilla cancer diagnosis, under development within the framework of the Crystal Clear Collaboration at CERN, aiming at the detection of tumors down to 2 mm in diameter. The camera consists of two planar detector heads with active dimensions 16.0x14.5 cm{sup 2}. Each head has 96 Clear-PEM detector modules consisting of 32 LYSO:Ce pixels with dimensions 2x2x20 mm{sup 3} packed in a 4x8 BaSO{sub 4} reflector matrix compressed between two Hamamatsu S8550 APD arrays in a double-readout configuration for Depth-of-Interaction (DoI) determination. The modules are individually measured and characterized before being grouped into Supermodules (comprised of 24 modules). Measured properties include photo-peak position, relative gain dispersion, energy resolution, cross-talk and DoI resolution. Optical inspection of matrices was also performed with the aid of a microscope, to search for pixel misalignments and matrix defects. Modules' performance was thoroughly evaluated with a 511 keV collimated beam to exactly determine DoI resolution. In addition, a fast quality control (QC) procedure using flood irradiations from a {sup 137}Cs source was applied systematically. The overall performance of the 24 detector modules complies with the design goals of the Clear-PEM detector, showing energy resolution around 15%, DoI resolution of about 2 mm and gain dispersion among pixels of 15%.

  16. Melanoma and intravascular coagulation disseminated fulminant

    International Nuclear Information System (INIS)

    Aponte, Diego; Garzon, Javier; Burgos, Erick; Abenoza, Lina; Cardona, Andres Felipe; Ramos, Pedro; Reveiz, Ludovic

    2005-01-01

    Clinical discoveries, imaginological and pathological of a 54 year-old woman, with pruritus, ulceration and bled intermittent in dorsal nevus, located in the region left sub-scapular. The biopsy demonstrated the presence of malign melanoma. Two months after having carried out the procedure the reappearance of the tumoral lesion it was documented on the same area by what was practiced wide local resection; the report was compatible with recidivate melanoma, later on (four weeks after the second surgical intervention), she noticed the presence of conglomerate left axillary ganglion of quick growth for metastatic melanoma. To the moment of the initial evaluation, it founded a mass axillary left, of 10 x 6 cm, associated to local swelling and to slight functional limitation for the active and passive mobility of the extremity. It decided to carry out new surgical resection that demonstrated persistence tumoral in the deep borders and commitment in 1 of 9 ganglions for metastasis, associated to reaction inflammatory chronicle. It began treatment adjuvant with interferon alpha 2b with appropriate tolerance and poor answer. In June of the same year it presented progressive dyspnoea, for what decided to suspend the immune-therapy and to begin dacarbacina with palliative intention, also, she received radiotherapy on the left axilla and temozolamida. In March of 2004, it entered to the service of urgencies to present scheme of 8 days of evolution characterized by the presence of progressive asymmetric edema of the left inferior member, associated to functional limitation for the march, with pain during the bipedestation and appearance of multiple lesions nodular hyper-pigmented in the previous thorax and in the face

  17. Evaluation of lymph node metastases of breast cancer using ultrasmall superparamagnetic iron oxide-enhanced magnetic resonance imaging

    International Nuclear Information System (INIS)

    Harada, Tomoaki; Tanigawa, Nobuhiko; Matsuki, Mitsuru; Nohara, Takehiro; Narabayashi, Isamu

    2007-01-01

    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

  18. A prospective study of conservative surgery without radiation therapy in select patients with Stage I breast cancer

    International Nuclear Information System (INIS)

    Lim, May; Bellon, Jennifer R.; Gelman, Rebecca; Silver, Barbara B.A.; Recht, Abram; Schnitt, Stuart J.; Harris, Jay R.

    2006-01-01

    Purpose: The effectiveness of radiation therapy (RT) in reducing local recurrence after breast-conserving surgery (BCS) in unselected patients with early stage invasive breast cancer has been demonstrated in multiple randomized trials. Whether a subset of women can achieve local control without RT is unknown. In 1986, we initiated a prospective one-arm trial of BCS alone for highly selected breast-cancer patients. This report updates those results. Methods and Materials: Eighty-seven (of 90 planned) patients enrolled from 1986 until closure in 1992, when a predefined stopping boundary was crossed. Patients were required to have a unicentric, T1, pathologic node-negative invasive ductal, mucinous, or tubular carcinoma without an extensive intraductal component or lymphatic-vessel invasion. Surgery included local excision with margins of at least 1 cm or a negative re-excision. No RT or systemic therapy was given. Results: Results are available on 81 patients (median follow-up, 86 months). Nineteen patients (23%) had local recurrence (LR) as a first site of failure (average annual LR: 3.5 per 100 patient-years of follow-up). Other sites of first failure included 1 ipsilateral axilla, 2 contralateral breast cancers, and 4 distant metastases. Six patients developed other (nonbreast) malignancies. Nine patients have died, 4 of metastatic breast cancer and 5 of unrelated causes. Conclusions: Even in this highly selected cohort, a substantial risk of local recurrence occurred after BCS alone with margins of 1.0 cm or more. These results suggest that with the possible exception of elderly women with comorbid conditions, radiation therapy after BCS remains standard treatment

  19. Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer.

    Science.gov (United States)

    İyikesici, Mehmet Salih; Slocum, Abdul Kadir; Slocum, Ayshe; Berkarda, Ferhan Bulent; Kalamian, Miriam; Seyfried, Thomas N

    2017-07-07

    Triple-negative breast cancer (TNBC) is more aggressive and metastatic than other breast cancer types. Cytotoxic chemotherapy is presently the predominant systemic therapy for TNBC patients. This case report highlights the influence of metabolically supported chemotherapy (MSCT), ketogenic diet (KD), hyperthermia (HT), and hyperbaric oxygen therapy (HBOT) in an overweight 29-year-old woman with stage IV (T4N3M1) triple-negative invasive ductal carcinoma of the breast. The patient presented with an observable mass in her left breast detected during a physical examination in December 2015. Magnetic resonance imaging revealed a Breast Imaging Reporting and Data System Category 5 tumor and multiple lymphadenomegaly in the left axilla. A Tru-Cut biopsy led to the diagnosis of a triple-negative nuclear grade 2 invasive ductal carcinoma. The patient was admitted to ChemoThermia Oncology Center, Istanbul, Turkey in October 2016, and a whole body (18F)-fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET-CT) scan revealed a 77 mm x 55 mm primary tumor in her left breast, multiple left pectoral and axillary lymph nodes, multiple widespread liver masses, and an upper left nodular abdominal lesion. The patient received a treatment protocol consisting of MSCT, KD, HT, and HBOT. A follow-up whole body 18F-FDG PET-CT scan in February 2017 showed a complete therapeutic response with no evidence of abnormal FDG uptake. The patient continued to receive this treatment protocol and in April 2017 underwent a mastectomy, which revealed a complete pathological response consistent with the response indicated by her PET-CT imaging. This single case study presents evidence of a complete clinical, radiological, and pathological response following a six-month treatment period using a combination of MSCT and a novel metabolic therapy in a patient with stage IV TNBC.

  20. 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.

  1. Does Axillary Boost Increase Lymphedema Compared With Supraclavicular Radiation Alone After Breast Conservation?

    International Nuclear Information System (INIS)

    Hayes, Shelly B.; Freedman, Gary M.; Li Tianyu; Anderson, Penny R.; Ross, Eric

    2008-01-01

    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

  2. Patterns of Failure After MammoSite Brachytherapy Partial Breast Irradiation: A Detailed Analysis

    International Nuclear Information System (INIS)

    Chen, Sea; Dickler, Adam; Kirk, Michael; Shah, Anand; Jokich, Peter; Solmos, Gene; Strauss, Jonathan; Dowlatshahi, Kambiz; Nguyen, Cam; Griem, Katherine

    2007-01-01

    Purpose: To report the results of a detailed analysis of treatment failures after MammoSite breast brachytherapy for partial breast irradiation from our single-institution experience. Methods and Materials: Between October 14, 2002 and October 23, 2006, 78 patients with early-stage breast cancer were treated with breast-conserving surgery and accelerated partial breast irradiation using the MammoSite brachytherapy applicator. We identified five treatment failures in the 70 patients with >6 months' follow-up. Pathologic data, breast imaging, and radiation treatment plans were reviewed. For in-breast failures more than 2 cm away from the original surgical bed, the doses delivered to the areas of recurrence by partial breast irradiation were calculated. Results: At a median follow-up time of 26.1 months, five treatment failures were identified. There were three in-breast failures more than 2 cm away from the original surgical bed, one failure directly adjacent to the original surgical bed, and one failure in the axilla with synchronous distant metastases. The crude failure rate was 7.1% (5 of 70), and the crude local failure rate was 5.7% (4 of 70). Estimated progression-free survival at 48 months was 89.8% (standard error 4.5%). Conclusions: Our case series of 70 patients with >6 months' follow-up and a median follow-up of 26 months is the largest single-institution report to date with detailed failure analysis associated with MammoSite brachytherapy. Our failure data emphasize the importance of patient selection when offering partial breast irradiation

  3. Lichen Planus Pigmentosus: The Controversial Consensus

    Science.gov (United States)

    Ghosh, Aparajita; Coondoo, Arijit

    2016-01-01

    A pigmented variant of lichen planus (LP) was first reported from India in 1974 by Bhutani et al. who coined the term LP pigmentosus (LPP) to give a descriptive nomenclature to it. LP has a number of variants, one of which is LPP. This disease has also later been reported from the Middle East, Latin America, Korea, and Japan, especially in people with darker skin. It has an insidious onset. Initially, small, black or brown macules appear on sun-exposed areas. They later merge to form large hyperpigmented patches. The disease principally affects the sun-exposed areas of the body such as the face, trunk, and upper extremities. The oral mucosa may rarely be involved. However, the palms, soles, and nails are not affected. Histologically, the epidermis is atrophic along with vacuolar degeneration of basal cell layer. The dermis exhibits incontinence of pigment with scattered melanophages and a sparse follicular or perivascular infiltrate. There is a considerable similarity in histopathological findings between LPP and erythema dyschromicum perstans. However, there are immunologic and clinical differences between the two. These observations have led to a controversy regarding the identity of the two entities. While some dermatologists consider them to be the same, others have opined that the two should be considered as distinctly different diseases. A number of associations such as hepatitis C virus infection, frontal fibrosing alopecia, acrokeratosis of Bazex and nephrotic syndrome have been reported with LPP. A rare variant, LPP inversus, with similar clinical and histopathological findings was reported in 2001. As opposed to LPP, this variant occurs in covered intertriginous locations such as groins and axillae and mostly affects white-skinned persons. PMID:27688435

  4. Analysis of the posture pattern during robotic simulator tasks using an optical motion capture system.

    Science.gov (United States)

    Takayasu, Kenta; Yoshida, Kenji; Mishima, Takao; Watanabe, Masato; Matsuda, Tadashi; Kinoshita, Hidefumi

    2018-01-01

    Surgeons are sometimes forced to maintain uncomfortable joint positions during robotic surgery despite the high degree of instrument maneuverability. This study aimed to use an optical motion capture system to analyze the differences in posture patterns during robotic simulator tasks between surgeons at two skill levels. Ten experienced and ten novice surgeons performed two tasks in a da Vinci Skills Simulator: Suture Sponge 1 (SP) and Tubes (TU). The participants' upper body motion during each task was captured, including the joint angles (axilla, elbow, and wrist), the percentage of time when the wrist height was lower than the elbow height (PTW), and the height of the elbow and wrist relative to the armrest. The novice group showed significantly more excess extension in both elbow angles and extension (>50°) in both wrist angles than did the experienced group. The novice group had significantly lower PTW than the experienced group on the right side in both tasks (both p < 0.001), and on the left side in SP (p < 0.001). Compared with the experienced group, the novice group had a significantly higher elbow relative to the armrest on the right side (SP, TU: p < 0.05), and a significantly lower wrist relative to the armrest on the right side (SP, TU: p < 0.05). An optical motion capture system can detect the differences in posture patterns in the positional relationship between the elbow and wrist and the joint angles of the upper limb between two groups of surgeons at different skill levels during robotic simulator tasks.

  5. Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer.

    Science.gov (United States)

    Krynyckyi, Borys R; Shafir, Michail K; Kim, Suk Chul; Kim, Dong Wook; Travis, Arlene; Moadel, Renee M; Kim, Chun K

    2005-11-08

    Current trends in patient care include the desire for minimizing invasiveness of procedures and interventions. This aim is reflected in the increasing utilization of sentinel lymph node biopsy, which results in a lower level of morbidity in breast cancer staging, in comparison to extensive conventional axillary dissection. Optimized lymphoscintigraphy with triangulated body marking is a clinical option that can further reduce morbidity, more than when a hand held gamma probe alone is utilized. Unfortunately it is often either overlooked or not fully understood, and thus not utilized. This results in the unnecessary loss of an opportunity to further reduce morbidity. Optimized lymphoscintigraphy and triangulated body marking provides a detailed 3 dimensional map of the number and location of the sentinel nodes, available before the first incision is made. The number, location, relevance based on time/sequence of appearance of the nodes, all can influence 1) where the incision is made, 2) how extensive the dissection is, and 3) how many nodes are removed. In addition, complex patterns can arise from injections. These include prominent lymphatic channels, pseudo-sentinel nodes, echelon and reverse echelon nodes and even contamination, which are much more difficult to access with the probe only. With the detailed information provided by optimized lymphoscintigraphy and triangulated body marking, the surgeon can approach the axilla in a more enlightened fashion, in contrast to when the less informed probe only method is used. This allows for better planning, resulting in the best cosmetic effect and less trauma to the tissues, further reducing morbidity while maintaining adequate sampling of the sentinel node(s).

  6. COMBINED EFFECT OF PNF STRETCHING WITH CHEST MOBILITY EXERCISES ON CHEST EXPANSION AND PULMONARY FUNCTIONS FOR ELDERLY

    Directory of Open Access Journals (Sweden)

    Vinod Babu .K

    2015-06-01

    Full Text Available Background: PNF stretching and chest mobility exercises found to be effective in elder patients, however the combined effectiveness of these techniques were unknown. The purpose of this study is to find the effect of Hold-relax PNF stretching technique for pectoralis muscle combined with chest mobility exercises on improvement of chest expansion and pulmonary function for elderly subjects. Method: An Experimental study design, 30 subjects with age group above 60 years were randomized 15 subjects each into Study and Control group. Control group received Supervised Active Assisted Exercise Program while Study group received Hold-relax PNF Stretching for pectoralis muscle, Chest Mobility Exercises Program and supervised Active Assisted Exercise Program for a period of one week. Outcome measures such as chest expansion at axilla and xiphisternum and pulmonary function test such as FEV1, FVC and FEV1/FVC were measured before and after one week of treatment. Results: Analysis using paired ‘t’ test within the group found that there is no statistically significant difference within control group where as there is a statistical significant difference within study group. Comparative analysis of pre-intervention means shown that there is no statistically significant difference between the groups. Comparative analysis of post-intervention means shown that there is a statistically significant difference in means of Chest expansion, FEV1/FVC and there is no statistical significant difference in FEV1 and FVC between study and control groups. Conclusion: It is concluded that one week of combined Hold-relax PNF stretching for pectoralis muscle with chest mobility exercises shown significant improvement in chest expansion and pulmonary function test such as forced expiratory volume and forced vital capacity than only active assisted exercise program for elderly subjects.

  7. A Study of Using Massage Therapy Accompanied with Stretching Exercise for Rehabilitation of Mammary Gland Hyperplasia

    Directory of Open Access Journals (Sweden)

    Pin Lv

    2016-01-01

    Full Text Available 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.

  8. 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.

  9. Widespread abnormalities on a whole body iodine scan after therapeutic radioiodine due to clothing contamination

    International Nuclear Information System (INIS)

    Kovacs, J.C.; Chatterton, B.E.; Kirdwood, I.D.; Blefari, C.

    2003-01-01

    Full text: A 53-year-old man with a history of papillary thyroid carcinoma was treated with a thyroidectomy and 2 GBq oral 131-Iodine. Whole body scans showed residual thyroid tissue, so a repeat procedure was performed 12 months later. Whole body and planar 131-Iodine scans were performed 7 days post-swallow. The scans showed tracer uptake in the base of the neck, the nose and mouth, as well as activity in the hip and axillary regions, right sub-mandibular gland, left chest anteriorly, liver, hands and feet. The uptake in the right lower neck was consistent with residual thyroid tissue or thyroid cancer. The uptake in the submandibular region and the chest were suspicious of iodine avid metastases, perhaps involving the internal mammary nodes, however, radiological correlation with CT scan showed no evidence of recurrent disease. The low grade diffuse liver uptake was consistent with radio-thyroxine production. The remaining uptake in the hands, feet, hips and axilla were found to be due to contamination. There was significant contamination from the patient's handkerchief and clothing which were worn as an inpatient during therapy and had not yet been washed. Following removal of the contaminated clothing, planar images of the neck and chest and hips were reacquired and a whole body scan was repeated on the following day. 131-Iodine is excreted via the sweat glands, nasal mucosa and salivary glands. Contamination of patient clothing and effects can yield potential false-positive results. Copyright (2003) The Australian and New Zealand Society of Nuclear Medicine Inc

  10. 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)

    Lewis, Lucy; Carson, Sharron; Bydder, Sean; Athifa, Mariyam; Williams, Anne M.; Bremner, Alexandra

    2014-01-01

    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

  11. [Carriage of group B beta-haemolytic streptococci among pregnant women in Iceland and colonisation of their newborn infants.].

    Science.gov (United States)

    Bjarnadóttir, Ingibjœrg; Kristinsson, Karl G; Hauksson, Arnar; Vilbergsson, Guðjón; Pálsson, Gestur; Dagbjartsson, Atli

    2003-02-01

    To determine the carrier rate of group B beta-haemolytic streptococci (GBS) of pregnant women in Iceland and the colonisation of their newborns. A prospective study was conducted from October 1994 until October 1997, where culture specimens for GBS were taken from vagina and rectum of pregnant women attending the prenatal clinics at the Department of Obstetrics and Gynecology, Landspitali University Hospital and the Reykjavik Health Centre. The samples were taken at 23 and 36 weeks gestation and at delivery. Culture samples were also taken from axilla, umbilical area and pharynx of their newborn infants immediately after birth. Included in the study were pregnant women born on every fourth day of each month. Carrier state was not treated during pregnancy, but Penicillin G was given i.v. at delivery if the last culture before delivery was positive and gestational age was 12 hours before delivery or the mother had a fever >38 degrees C. Cultures were taken from 280 women and their children. GBS carrier rate of pregnant women in Iceland was 24.3%. Twelve newborns had GBS positive cultures. No newborn had a confirmed septicemia. Cultures from 25% of newborns, who s mothers were still GBS carriers at birth, were positive for GBS. Positive predictive value of cultures taken at 23 weeks gestation was 64% and 78% at 36 weeks. Negative predictive value was 95% and 99% respectively. One out of every four pregnant women in Iceland is a GBS carrier. Twentyfive percent of newborns become colonised with GBS if the mother is a GBS carrier at delivery. When screening for GBS carrier state is done cultures from both vagina and rectum is more sensitive than cultures from vagina only. At least five percent of all newborns in Iceland are therefore expected to have positive skin cultures at birth. If the mother does not have positive GBS cultures during pregnancy, the likelihood that she will give birth to a GBS colonised child is almost none.

  12. Influence of previous breast surgery in sentinel lymph node biopsy in patients with breast cancer.

    Science.gov (United States)

    López-Prior, V; Díaz-Expósito, R; Casáns Tormo, I

    The aim of this study was to review the feasibility of selective sentinel lymph node biopsy in patients with previous surgery for breast cancer, as well as to examine the factors that may interfere with sentinel node detection. A retrospective review was performed on 91 patients with breast cancer and previous breast surgery, and who underwent sentinel lymph node biopsy. Patients were divided into two groups according to their previous treatment: aesthetic breast surgery in 30 patients (group I) and breast-conserving surgery in 61 (group II). Lymphoscintigraphy was performed after an intra-tumour injection in 21 cases and a peri-areolar injection in 70 cases. An analysis was made of lymphatic drainage patterns and overall sentinel node detection according to clinical, pathological and surgical variables. The overall detection of the sentinel lymph node in the lymphoscintigraphy was 92.3%, with 7.7% of extra-axillary drainages. The identification rate was similar after aesthetic breast surgery (93.3%) and breast-conserving surgery (91.8%). Sentinel lymph nodes were found in the contralateral axilla in two patients (2.2%), and they were included in the histopathology study. The non-identification rate in the lymphoscintigraphy was 7.7%. There was a significantly higher non-detection rate in the highest histological grade tumours (28.6% grade III, 4.5% grade I and 3.6% grade II). Sentinel lymph node biopsy in patients with previous breast surgery is feasible and deserves further studies to assess the influence of different aspects in sentinel node detection in this clinical scenario. A high histological grade was significantly associated with a lower detection. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  13. Doença de Dowling-Degos: apresentação clínica e histopatológica clássica Dowling-Degos disease: classic clinical and histopathological presentation

    Directory of Open Access Journals (Sweden)

    Carolina Cotta Zimmermann

    2011-10-01

    Full Text Available A doença de Dowling-Degos é uma genodermatose rara que consiste numa desordem pigmentar reticulada. Caracteriza-se pela presença de máculas hiperpigmentadas nas regiões flexurais com distribuição em rede; lesões tipo comedão no dorso e na região cervical; e cicatrizes cribriformes na face, particularmente periorais. Apresentamos um caso de um paciente de 51 anos, masculino, com lesões tipo macrocomedões, cicatrizes cribriformes, cistos e máculas hipercrômicas no dorso, tórax anterior, axilas, pescoço, região genital e face. Relatava ter dois filhos, três irmãos e o pai com quadro semelhante. As biópsias de pele foram características da doença de Dowling-Degos, mostrando dilatação folicular, epiderme digitiforme, com áreas de aspecto de "chifre de veado" e focos de hiperpigmentação da camada basal.Dowling-Degos disease (DDD is a rare genetic disease of the skin (reticulate pigmented anomaly, clinically characterized by flexural brown pigmented reticulate macules, comedo-like papules on the back, neck and pitted perioral or facial scars. We present the case of a 51 year-old man with macrocomedo-like lesions, pitted scars, cysts, hyperpigmented macules in his back, chest, axillae, neck, groin and face. The patient reported having two children, three brothers and a father with a similar condition. The histopathology of the skin biopsies was very characteristic of Dowling-Degos disease, showing dilated follicular, fingerlike projections called rete ridges (dermal pegs, with thinning of the suprapapillary plates, resulting in an "antler-like" pattern and increased pigmentation of the basal layer.

  14. Etonogestrel implant migration to the vasculature, chest wall, and distant body sites: cases from a pharmacovigilance database.

    Science.gov (United States)

    Kang, Sarah; Niak, Ali; Gada, Neha; Brinker, Allen; Jones, S Christopher

    2017-12-01

    To describe clinical outcomes of etonogestrel implant patients with migration to the vasculature, chest wall and other distant body sites spontaneously reported to the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. We performed a standardized Medical Dictionary for Regulatory Activities (MedDRA) query in the FAERS database (through November 15, 2015), with reports coded with one or more MedDRA preferred terms that indicate complications with device placement or migration of the device from the original site of insertion to the vasculature, chest wall and other distant body sites. We excluded any cases previously described in the medical literature. We identified 38 cases of pronounced etonogestrel implant migration. Migration locations included the lung/pulmonary artery (n=9), chest wall (n=1), vasculature at locations other than the lung/pulmonary artery (n=14) and extravascular migrations (n=14) to other body sites (e.g., the axilla and clavicle/neck line/shoulder). The majority of cases were asymptomatic and detected when the patient desired implant removal; however, seven cases reported symptoms such as pain, discomfort and dyspnea in association with implant migration. Three cases also describe pulmonary fibrosis and skin reactions as a result of implant migration to the vasculature, chest wall and other distant body sites. Sixteen cases reported surgical removal in an operating room setting. Our FAERS case series demonstrates etonogestrel implant migration to the vasculature, chest wall and other body sites distant from the site of original insertion. As noted by the sponsor in current prescribing information, a key determinant in the risk for etonogestrel contraceptive implant migration appears to be improper insertion technique. Although migration of etonogestrel implants to the vasculature is rare, awareness of migration and education on proper insertion technique may reduce the risk. Published by Elsevier Inc.

  15. The evolution of the sentinel node procedure in the treatment of breast cancer.

    Science.gov (United States)

    Tvedskov, Tove Filtenborg

    2017-10-01

    patients with micrometastases that might still benefit from an ALND. Efforts should continue to improve the model. As a part of the PhD thesis, new molecular markers were tested for prediction of non-sentinel node metastases. In addition, method of detection of the breast cancer could be a possible predictor of non-sentinel node metastases. It has been hypothesized that breast cancers detected by screening represent a clinical indolent group of cancers with lower risk of non-sentinel node metastases compared to symptomatic cancers. This hypothesis was tested in this thesis in a large Danish dataset. No significant difference in the risk of non-sentinel node metastases was found between patients with screen-detected and symptomatic breast cancers, and a less aggressive treatment of the axilla in patients with screen-detected breast cancers cannot be supported. Likewise, the method of detection is not expected to be able to improve the predictive models. Until 2012, the standard treatment of Danish patients with micrometastases or ITC in the sentinel node was ALND. Still, in selected patients ALND was not performed. This thesis includes a comparison of the risk of axillary recurrence and survival between patients with and without ALND. The overall axillary recurrence rate was only 1.6% after 6 years of follow-up, despite between 9 - 18 % of these patients are expected to have non-sentinel node metastases. No significant difference was seen in axillary recurrence and overall survival between patients with and without ALND. These results support the safety of omitting ALND in patients with only micrometastases or ITC in the sentinel node and since 2012 Danish breast cancer patients with ITC or up to two micrometastatic sentinel nodes are no longer offered an ALND. In Denmark the standard surgical treatment of the axilla in locally recurrent breast cancer is no further treatment of the axilla in case of previous ALND, and ALND in case of previous SLND.  To investigate whether

  16. Lymphoscintigraphic visualization of internal mammary nodes with subtumoral injection of radiocolloid in patients with breast cancer.

    Science.gov (United States)

    Shimazu, Kenzo; Tamaki, Yasuhiro; Taguchi, Tetsuya; Motomura, Kazuyoshi; Inaji, Hideo; Koyama, Hiroki; Kasugai, Tsutomu; Wada, Akira; Noguchi, Shinzaburo

    2003-03-01

    To determine whether subtumoral injection of radiocolloid is useful for lymphoscintigraphic visualization of the internal mammary node and in sentinel lymph node (SLN) biopsy of the axilla in breast cancer patients. The presence of retromammary lymphatics connecting to the axillary and internal mammary basins has been demonstrated by early anatomic studies. Thus, it is hypothesized that some lymph, especially that from the parenchyma under the tumor, may drain into both the axillary and internal mammary basins. Patients (n = 196) with T1-2, N0 breast cancer underwent preoperative lymphoscintigraphy with radiocolloid (technetium 99m tin colloid) injection into various sites of the breast, followed by SLN biopsy using the combined method with blue dye. Patients were divided into four groups: group A (n = 41), peritumoral injection of both radiocolloid and blue dye; group B (n = 70), periareolar radiocolloid and peritumoral blue dye; group C (n = 45), intradermal radiocolloid and periareolar blue dye; and group D (n = 40), subtumoral radiocolloid and intradermal blue dye. A retrospective analysis of 1,297 breast cancer patients who underwent extended radical mastectomy with internal mammary node dissection was also conducted to determine the relationship between vertical tumor location (superficial or deep) and frequency of axillary and internal mammary node metastases. One patient (2%) in group A, 3 (4%) in group B, 0 (0%) in group C, and 15 (38%) in group D exhibited hot spots in the internal mammary region on lymphoscintigraphy (P basin was significantly lower in group D than in the other groups. In contrast, the mismatch rate (some SLNs were identified by radiocolloid and other SLNs were identified by blue dye, but no SLN was identified by both in the same patient) was significantly higher in group D than in the other groups. In patients treated with extended radical mastectomy, positivity of axillary and internal mammary metastases was significantly higher in

  17. Evaluation of bolus electron conformal therapy compared with conventional techniques for the treatment of left chest wall postmastectomy in patients with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Opp, Dan, E-mail: Daniel.Opp@moffitt.org; Forster, Kenneth; Li, Weiqi; Zhang, Geoffrey; Harris, Eleanor E.

    2013-01-01

    Postmastectomy radiation (PMRT) lowers local-regional recurrence risk and improves survival in selected patients with breast cancer. The chest wall and lower axilla are technically challenging areas to treat with homogenous doses and normal tissue sparing. This study compares several techniques for PMRT to provide data to guide selection of optimal treatment techniques. Twenty-five consecutive left-sided patients treated postmastectomy were contoured using Radiation Therapy Oncology Group (RTOG) atlas guidelines then planned using 4 different PMRT techniques: opposed tangents with wedges (3-dimensional [3D] wedges), opposed tangents with field-in-field (FiF) modulation, 8-field intensity modulation radiotherapy (IMRT), and custom bolus electron conformal therapy (BolusECT, .decimal, Inc., Sanford, FL). Required planning target volume (PTV) coverage was held constant, and then dose homogeneity and normal tissue dose parameters were compared among the 4 techniques. BolusECT achieved clincally acceptable PTV coverage for 22 out of 25 cases. Compared with either tangential technique, IMRT and BolusECT provided the lowest heart V{sub 25} doses (3.3% ± 0.9% and 6.6% ± 3.2%, respectively with p < 0.0001). FiF had the lowest mean total lung dose (7.3 ± 1.1 Gy, with p = 0.0013), IMRT had the lowest total lung V{sub 20} (10.3% ± 1.6%, p < 0.0001), and BolusECT had the lowest mean heart dose (7.3 ± 2.0 Gy, p = 0.0002). IMRT provided the optimal dose homogeneity and normal tissue sparing compared with all other techniques for the cases in which BolusECT could not achieve acceptable PTV coverage. IMRT generally exposes contralateral breast and lung to slightly higher doses. Optimal PMRT technique depends upon patient anatomy. Patients whose maximal target volume depth is about 5.7 cm or less can be treated with BolusECT-assisted 12 or 15 MeV electron beams. At these energies, BolusECT has comparable dose-volume statistics as IMRT and lower heart V{sub 25} than opposed

  18. Comparison of intraoperative frozen section analysis for sentinel lymph node biopsy during breast cancer surgery for invasive lobular carcinoma and invasive ductal carcinoma

    Directory of Open Access Journals (Sweden)

    Povoski Stephen P

    2009-03-01

    Full Text Available Abstract Background Sentinel lymph node (SLN biopsy is the standard of care for the surgical assessment of the axilla during breast cancer surgery. However, the diagnostic accuracy of intraoperative frozen section analysis for confirming metastatic involvement of SLNs in cases of invasive lobular carcinoma (ILC versus that of invasive ductal carcinoma (IDC has generated controversy secondary to a frequently low-grade cytologic appearance and an often discohesive pattern displayed by metastatic lymph nodes in ILC. In the current report, we present a comparison of intraoperative frozen section analysis for confirming the presence of metastatic disease within SLNs during breast cancer surgery for ILC and IDC. Methods We evaluated the results of 131 consecutive cases of ILC from 1997 to 2008 and 133 cases of IDC (selected by a random sequence generator program from amongst 1163 consecutive cases of IDC from the same time period. All cases had at least one SLN that had both intraoperative frozen section analysis and confirmatory permanent section analysis performed. Results No statistically significant difference was found in the sensitivity (67% vs. 75%, P = 0.385, specificity (100% vs. 100%, accuracy (86% vs. 92%, P = 0.172, false negative rate (33% vs. 25%, P = 0.385, negative predictive value (81% vs. 89%, P = 0.158, and positive predictive value (100% vs. 100% for frozen section analysis for confirming the presence of metastatic disease within SLNs during breast cancer surgery for ILC and IDC. Conclusion Since there was no statistically significant difference in sensitivity, specificity, accuracy, false negative rate, negative predictive value, and positive predictive value between frozen section analysis of SLNs for patients with ILC and IDC, the clinical accuracy of confirming metastatic involvement of SLNs on frozen section analysis for ILC should not be considered inferior to the clinical accuracy for IDC. Therefore, frozen section analysis

  19. Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated.

    Science.gov (United States)

    Boneti, Cristiano; Arentz, Candy; Klimberg, V Suzanne

    2010-10-01

    Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain. An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics. Average age of the study group was 53.4 ± 12.7 years, and average BMI was 30.4 ± 7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases. Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.

  20. Long-term outcomes in patients with early stage nodular lymphocyte-predominant Hodgkin's lymphoma treated with radiotherapy.

    Directory of Open Access Journals (Sweden)

    Abhishek A Solanki

    Full Text Available PURPOSE: Radiation therapy (RT is commonly used as definitive treatment for early-stage nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL. We evaluated the cause-specific survival (CSS, overall survival (OS, and second malignancy (SM rates in patients with early-stage NLPHL treated with RT. METHODS AND MATERIALS: Patients with stage I-II NLPHL between 1988 and 2009 who underwent RT were selected from the Surveillance, Epidemiology and End Results database. Univariate analysis (UVA for CSS and Os was performed using the Kaplan-Meier method and included age, gender, involved site, year of diagnosis, presence of B-symptoms, and extranodal involvement (ENI. Multivariable analysis (MVA was performed using Cox Proportional Hazards modeling and included the above clinical variables. SM were classified as RT-related or non-RT-related. Freedom from SM and freedom from RT-related SM were determined using the Kaplan-Meier method. RESULTS: The study cohort included 469 patients. Median age was 37 years. The most common involved sites were the head and neck (36%, axilla/arm (26%, and multiple lymph node regions (18%. Sixty-eight percent had stage I disease, 70% were male, 4% had ENI, and 7% had B-symptoms. Median follow-up was 6 years. Ten-year CSS and Os were 98% and 88%, respectively. On UVA, none of the covariates was associated with CSS. Increasing age (p<0.01 and female gender (p<0.01 were associated with worse Os. On MVA, older age (p<0.01, female gender (p=0.04, multiple regions of involvement (p=0.03, stage I disease (p=0.02, and presence of B-symptoms (p=0.02 were associated with worse Os. Ten-year freedom from SM and freedom from RT-related SM were 89% and 99%, respectively. CONCLUSIONS: This is the largest series to evaluate the outcomes of stage I-II NLPHL patients treated with RT and found that this patient population has an excellent long-term prognosis and a low rate of RT-related second malignancies.

  1. 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

  2. The Reconstruction Choice for Giant Phyllodes Tumor of Breast: Bi-pedicled Deep Inferior Epigastric Perforator Flap.

    Science.gov (United States)

    Fang, Chien-Liang; Hsu, Chin-Hao; Tu, Chin-Wen

    2017-08-01

    Phyllodes tumors of the breast are the rarest of all breast neoplasms. Giant phyllodes tumors (>10 cm) of the breast have been less discussed in the literature. Reconstruction of the large defect created after wide excision (safety margin >1 cm) is a challenge in these patients. We present one technique using a bi-pedicled deep inferior epigastric perforator flap for post-mastectomy breast reconstruction for giant phyllodes tumors. We treated three patients with giant phyllodes tumors between 2013 and 2016. The histological characteristics were benign and borderline; tumor sizes were 18 × 13 × 12, 20 × 16 × 9.5, and 18 × 15 × 9 cm. Immediate post-mastectomy reconstruction was performed using bi-pedicled deep inferior epigastric perforator flaps. Flap sizes measured 30 × 11, 28 × 12, and 28 × 13 cm. Total operative time, including that for mastectomy, was 285, 425, and 410 min. The duration of hospital stay was 12, 13, and 9 days. No local recurrence or distant metastasis occurred in the first two patients over a follow-up period of 3 years and in the third patient over a follow-up period of 6 months. A higher local recurrence rate was associated with positive margins, histological grade, tumor size, and necrosis. Immediate post-mastectomy breast reconstruction may become the preferred option for treatment of giant phyllodes tumors. A bi-pedicled deep inferior epigastric perforator flap conferred adequate leverage for wide excision and resolved scar contracture of the axilla. Good functional and cosmetic results were achieved. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  3. 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

  4. Vertical transmission of group B Streptococcus and associated factors among pregnant women: a cross-sectional study, Eastern Ethiopia

    Directory of Open Access Journals (Sweden)

    Yadeta TA

    2018-03-01

    Full Text Available Tesfaye Assebe Yadeta,1 Alemayehu Worku,2 Gudina Egata,3 Berhanu Seyoum,4 Dadi Marami,4 Yemane Berhane5 1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia; 3School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 4Department of Medical Laboratory Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 5Department of Epidemiology, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia Background: Vertically transmitted group B Streptococcus (GBS causes fetal and neonatal infections. However, there is limited information on the vertical transmission of GBS in low-income countries. This study, therefore, aimed to determine the rate of vertical transmission of GBS and associated factors among pregnant women in Eastern Ethiopia.Subjects and methods: A cross-sectional, facility-based study was conducted among pregnant women in Harar town, Eastern Ethiopia, from June to October, 2016. GBS positivity of pregnant women was confirmed by culture of rectovaginal swab. Vertical transmission at birth was confirmed by culture on swabs taken from the ear canal, umbilicus, axilla, groin, and nose within 6 hours after birth. Prevalence ratio (PR along with 95% CI was estimated to examine factors associated with vertical transmission using log binomial regression analysis.Results: Out of 231 GBS-colonized pregnant women at delivery, 104 births were identified as GBS colonized with a vertical transmission rate of 45.02% and 95% CI: 38.49, 51.68. Of 104 vertical transmission cases, 65 (62.50% received no intrapartum antibiotic prophylaxis (IAP, 28 (26.92% received it <4 hours before delivery, and 11 (10.58% received it ≥4 hours before delivery. Pre-labor rupture of membranes at term (PR: 1.93; 95

  5. Breast conservation treatment of early stage breast cancer: patterns of failure

    International Nuclear Information System (INIS)

    Leborgne, Felix; Leborgne, Jose H.; Ortega, Bettys; Doldan, Raquel; Zubizarreta, Eduardo

    1995-01-01

    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

  6. 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)

    Emadi, S. N.; Emadi, S. E.

    2009-01-01

    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

  7. 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

  8. [Analgesic alternatives for the control of postoperatory pain in radical mastectomy].

    Science.gov (United States)

    González-Arrieta, María Leonor; Martínez-Huerta, Mónica Alejandra; Ramírez-Ramírez, María de Lourdes

    2004-01-01

    The purpose of preventive analgesia based on regional blocks with local anesthetics is to avoid sharp and hard-to-control pain in the anterior side of thorax and axilla secondary to radical mastectomy. Our aim was to compare the analgesic effectiveness of direct trans-operational block applied to nerves vs conventional analgesia using analgesic-antipiretic and antiinflammatory (AINES) drugs. We designed a 1-year case-control study at the Hospital de Oncología of the Instituto Mexicano del Seguro Social's (IMSS's) Centro Medico Nacional Siglo XXI (CMN-SXXI) in Mexico City. A total of 112 patients were mastectomized under general anesthesia: Thirty one patients received preventive analgesia (cases) by direct transoperational infiltration of brachial and intercostal nerves III-VI; bupivacaine 1 mg/kg and buprenorphine 0.005 mg/kg in 15 ml were distributed among appropriate nerves accompanied by a single dose of AINES in emersion stage; during anesthetic emersion, 81 patients received conventional analgesia (control), including endovenous AINES alone or combined, and buprenorphine 0.3 mg or nalbuphine 10 mg. Three evaluations employing analog visual scale were conducted: recovery (immediate post surgery); floor (mediate), and following day. We studied 110 women and two men. Demographic, laboratory, anesthetic, and surgical variables were similar in both groups (p = not significant [ns]). In no case was post-surgical pain reported. Among controls, slight pain was reported by 13 patients, moderate pain by 66, and severe pain was reported by two patients, whereas in patients returned to their rooms on the floor, slight pain was reported by 38, moderate by 42, and severe by one. Finally, on the following day all patients reported slight pain. Types of pain included 15 patients with somatic pain, 10 with neuropathic, and 56 patients with mixed pain (p <0.0001). Preventive analgesia by direct transoperational block on nerves turned out to be an effective alternative with

  9. Severe Acne Inversa - Dermatosurgical Approach in a Bulgarian Patient

    Directory of Open Access Journals (Sweden)

    Ilia Lozev

    2017-07-01

    Full Text Available We present a 55-year-old male patient - a smoker, admitted to a Medical Institute of MVR (Ministry of the interior, Sofia, Bulgaria, on occasion of pain and swellings, located in the area of both axillae, accompanied by purulent discharge, with bloody admixtures. Bilateral localised cystic rose above the skin surface, hyperpigmented nodules interconnected with multiple fistulas, was observed within the dermatological examination, resulting in a limitation of the possibility of movement of the hands in all directions. A subjective complaint of pain was obtained on palpation. Solid bilateral axillar cicatrices - formation was also established, which additional impeded the movements of the upper limbs. The disease was generalised affecting additional inguinal, femoral and perineal areas, while at this stage the patient refused categorically eventual photo documentation of them. The diagnosis of acne inversa was made based on the available clinical and para-clinical data, as dual antibiotic therapy with Clindamycin 300 mg, two times per day was initiated for two months, in combination with rifampicin 300 mg, two times per day also for two months. This led to a significant improvement in the clinic symptoms and the patient was hospitalised for radical surgery. A surgical management of the clinical findings was planned by an interdisciplinary team including surgeons and dermatologists. The procedure was performed under general anaesthesia. After a thorough cleaning of the operative field, a radical excision of the lesion in the left axillary and para axillar region was performed, comprising the skin and subcutaneous tissue forward the fascia pectoralis. Tissue was dissected in depth in the form of number 4, thereby creating the conditions for adaptation of the initially encountered communicating with each other skin defects. Two tubular drains were placed, followed by gradual suturing of skin and subcutaneous tissue with final applying of a sterile

  10. Utility of 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT in combination with ultrasonography for axillary staging in primary breast cancer

    Directory of Open Access Journals (Sweden)

    Tamura Katsumi

    2008-06-01

    Full Text Available Abstract Background Accurate evaluation of axillary lymph node (ALN involvement is mandatory before treatment of primary breast cancer. The aim of this study is to compare preoperative diagnostic accuracy between positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (18F-FDG PET/CT and axillary ultrasonography (AUS for detecting ALN metastasis in patients having operable breast cancer, and to assess the clinical management of axillary 18F-FDG PET/CT for therapeutic indication of sentinel node biopsy (SNB and preoperative systemic chemotherapy (PSC. Methods One hundred eighty-three patients with primary operable breast cancer were recruited. All patients underwent 18F-FDG PET/CT and AUS followed by SNB and/or ALN dissection (ALND. Using 18F-FDG PET/CT, we studied both a visual assessment of 18F-FDG uptake and standardized uptake value (SUV for axillary staging. Results In a visual assessment of 18F-FDG PET/CT, the diagnostic accuracy of ALN metastasis was 83% with 58% in sensitivity and 95% in specificity, and when cut-off point of SUV was set at 1.8, sensitivity, specificity, and accuracy were 36, 100, and 79%, respectively. On the other hand, the diagnostic accuracy of AUS was 85% with 54% in sensitivity and 99% in specificity. By the combination of 18F-FDG PET/CT and AUS to the axilla, the sensitivity, specificity, and accuracy were 64, 94, and 85%, respectively. If either 18F-FDG PET uptake or AUS was positive in allixa, the probability of axillary metastasis was high; 50% (6 of 12 in 18F-FDG PET uptake only, 80% (4 of 5 in AUS positive only, and 100% (28 of 28 in dual positive. By the combination of AUS and 18F-FDG PET/CT, candidates of SNB were more appropriately selected. The axillary 18F-FDG uptake was correlated with the maximum size and nuclear grade of metastatic foci (p = 0.006 and p = 0.03. Conclusion The diagnostic accuracy of 18F-FDG PET/CT was shown to be nearly equal to ultrasound, and considering their

  11. Contact allergens for armpits--allergenic fragrances specified on deodorants.

    Science.gov (United States)

    Klaschka, Ursula

    2012-11-01

    According to the so-called "26 allergens rule" 26 supposedly allergenic fragrances must be specified on the containers of cosmetic products if they are present above 0.001% in leave-on products and, 0.01% in rinse-off products. This declaration is meant to inform the consumers of potential risks of skin sensitizers in the products. As many consumers of deodorants suffer from allergic or irritant contact dermatitis in the axillae, the presence of allergens in deodorants deserves special attention. The objective of this study was to find answers to the following questions: Does compulsory labeling lead to omission of strong allergenic fragrances in deodorants? Is there a difference in the use patterns of strong and weak allergens? What is the quantitative exposure to fragrances by deodorants? Is the situation in Germany different from other European countries? Is there a difference between deodorants for men and for women? I tested the implementation of the "26 allergens rule" and compiled which allergenic fragrances are specified on the containers of deodorants. Three market studies were conducted in Germany in 2008, 2010 and 2011. The labels of a total number of 374 deodorants were analyzed as to whether any of the "26 allergens" were listed. The frequency of each allergen in the deodorants was compared with results from previous studies by other authors. It was found that up to 83% of the deodorants contain at least one of the "26 allergens" and that up to 30% of all products contain strong allergens above the threshold for labeling (0.001% in the product). The most frequently listed allergens are medium or weak allergens. In comparison with other authors, the frequency of the "26 allergens" in products is slightly smaller in these recent studies for the German market. There is no significant difference between deodorants for men and women, as far as the labeling of the "26 allergens" is concerned. The results show that the mandatory labeling procedure as designed

  12. Effective axillary malodour reduction by polyquaternium-16-containing deodorants.

    Science.gov (United States)

    Traupe, B; Fölster, H; Max, H; Schulz, J

    2017-04-01

    Worldwide, individuals apply deodorants to combat malodour formation originating from the axillary vault. Considering the globally increasing demand for efficacious, safe deodorants, we investigated the antimicrobial effectiveness of a polymeric quaternary ammonium compound (PQ-16) as a new active in a roll-on formulation against microbial growth and axillary malodour. We utilized an in vivo microbiological assessment to determine antimicrobial effects of the PQ-16-containing deodorant formulation (DEO1) (i) in comparison with a commercially available deodorant roll-on claiming a 24-h protection against body odour (DEO2) and (ii) in comparison with a roll-on containing the same formulation as DEO1 but comprising aluminium chlorohydrate instead of PQ-16 (DEO3) 1, 4, 8, 24 and 48 h after treatment. Also, the axillary malodour intensity 24 and 48 h after application of deodorants was investigated in a controlled in vivo study performed by a trained sniffer panel using direct sniffing. Treatment with DEO1 in comparison with application of DEO2 significantly reduced the log 10 bacterial count at all points in time. After 24 and 48 h, sniffers rated malodour production in the DEO1-treated axillae significantly lower than in the DEO2-treated armpits. Application of DEO1 in comparison with DEO3 decreased the log 10 bacterial count after 1, 4, 8 and 24 h (significant for 4 and 8 h). After 48 h, the log 10 bacterial count showed similar values for both DEO1 and DEO3. The sniffer panel reported no significant differences between axillary malodour in DEO1-treated compared to DEO3-treated armpits after 24 and 48 h. We identified polyquaternium-16 (PQ-16, copolymers of 1-vinyl-2-pyrrolidone and 1-vinyl-3-methylimidazolium chloride) as a highly effective deodorant active. Results showed that a newly developed PQ-16-containing deodorant roll-on formulation (i) significantly reduced axillary malodour 24 and 48 h after treatment, (ii) significantly decreased the amount of axillary

  13. Long-term follow-up of axillary node-positive breast cancer patients receiving adjuvant systemic therapy alone: patterns of recurrence

    International Nuclear Information System (INIS)

    Fisher, Barbara J.; Perera, Francisco E.; Cooke, Andrew L.; Opeitum, Abiola; Venkatesan, Varagur; Dar, A. Rashid; Stitt, Larry

    1997-01-01

    Purpose: Prognostic factors for locoregional failure have been poorly documented. The purpose of this retrospective review is to examine the patterns of failure of 320 patients with Stage II or III axillary node-positive breast cancer who received adjuvant chemotherapy without locoregional radiation. Methods and Materials: The records of 735 patients who were referred to the London Regional Cancer Centre between 1980 and 1989 with a diagnosis of Stage II or III breast cancer were reviewed. Three hundred and twenty patients were identified who underwent segmental mastectomy with axillary dissection or modified radical mastectomy and adjuvant chemotherapy without adjuvant locoregional radiation. Seventy-one percent of these patients had undergone a modified radical mastectomy, 40% had T1 tumors, 49% T2, and 11% T3. Resection margins were positive in 13 patients. The median number of axillary nodes removed was 11. Fifty-four percent had one to three positive axillary nodes, 27% had four to seven positive nodes, and 19% had in excess of seven positive nodes. Results: Median follow-up for the 320 patients was 77 months. One hundred and fourteen patients developed a locoregional recurrence as the site of first relapse (31 in the intact breast, 29 on the chest wall, 21 in the axilla, 22 in the supraclavicular fossa, 1 in the internal mammary chain, and 10 in multiple sites). Thirty-three percent of segmental mastectomy patients and 13% of modified radical mastectomy patients developed local recurrence. Seven percent of patients recurred in axillary or supraclavicular nodes each. Factors with regard to locoregional recurrence which on univariate analysis were significant included type of mastectomy (i.e., segmental vs. modified radical), size of primary tumor, positive resection margins, and percentage of ideal chemotherapy dose intensity ( 5 cm in diameter). Breast or chest wall radiation is recommended for these groups. Supraclavicular radiation is recommended for

  14. Critical Organ Preservation in Reirradiation Brachytherapy by Injectable Spacer

    International Nuclear Information System (INIS)

    Kishi, Kazushi; Sonomura, Tetsuo; Shirai, Shintaro; Sato, Morio; Tanaka, Kayo

    2009-01-01

    Purpose: This case series study evaluated the feasibility and effectiveness of an interstitial high-dose rate brachytherapy (HDR-BT) procedure combined with an at-risk organ-sparing procedure. Methods and Materials: Thirty patients who were scheduled for reirradiation treatment for recurrent cancer after receiving a median dose of 60 Gy (range, 44-70 Gy) in 2-Gy fractions of previous external beam treatment were enrolled. Thirteen patients had lesions in the head and neck, and other lesions were located in the axilla, skeleton, breast, pelvis, and abdominal wall. Chief complaints included local masses (for 25) and refractory pain (for 21). After high-dose rate brachytherapy applicator needle implantation, an optimal CT-based three-dimensional brachytherapy plan was created with a virtual at-risk organ shift from the target. According to the plan, hyaluronic acid gel was injected to maintain the shift during irradiation. The prescribed dose was the result of an individualized tradeoff between target dose and at-risk organ dose, to avoid serious complications. A single-fraction dose of 18.0 Gy (median, equivalent to 75.6 Gy at an α/β value of 3; range, 16-20 Gy) was applied to the tumor. Results: The at-risk organ dose decreased from 9.1 ± 0.9 Gy to 4.4 ± 0.4 Gy (mean ± standard deviation, p < 0.01), and the normal tissue complication probability decreased from 60.8% ± 12.6% to 16.1% ± 19.8% (p < 0.01). The shift effect lasted at least 4 hours and disappeared gradually. Distinct tumor shrinkage in 20 of 21 eligible patients, including tumor disappearance in 6 patients, pain reduction in 18 of 21 eligible patients, and no unexpected late toxicity greater than grade 2 were observed during the 19.5-month observation period. Conclusions: This at-risk organ-sparing preservation procedure may provide a safe and efficient reirradiation treatment.

  15. 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. Follo