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Background: Temperature is considered one of the primary vital signs for detection of complications such as infections. Continuous wireless real-time axillary temperature monitoring is technologically feasible at the general ward, but no clinical validation studies exist. Methods: This study compared axillary temperature with a urinary bladder thermometer in 40 major abdominal postoperative patients. The primary outcome was changes in axillary temperature registrations. Secondary outcomes were mean bias between the urinary bladder and the axillary temperatures. Intermittent frontal and tympanic temperature recordings were also collected. Results: Forty patients were monitored for 50 min with an average core temperature of 36.8 °C. The mean bias was −1.0 °C (LoA −1.9 to −0) after 5 min, and −0.8 °C (LoA −1.6 to −0.1) after 10 min when comparing the axillary temperature with the urinary bladder temperature. After 20 min, the mean bias was −0.6 °C (LoA −1.3–0.1). During upper arm abduction, the axilla temperature was reduced to −1.6 °C (LoA −2.9 to −0.3) within 1 min. Temporal skin temperature measurement had a resulted in a mean bias of −0.1 °C (LOA −1.1 to −1.0) compared with central temperature. Compared with the mean tympanic temperature, it was −0.1 °C (LoA −0.9 to −1.0) lower than the urinay bladder temperature. Conclusions: Axillary temperature increased with time, reaching a mean bias of 1 °C between axillary and core temperature within 5 min. Opening the axillary resulted in rapidly lower temperature recordings. These findings may aid in use and designing corrections for continuous axillary temperature monitoring. [ABSTRACT FROM AUTHOR]

Flap-based reconstruction techniques have shown promise in preventing scar contractures and enhancing healing in fold areas by providing vascularized and thick tissue. We report a septic rupture of the superficial femoral artery treated with an arterial allograft and covered with a contralateral pedicled Deep Inferior Epigastric Artery Perforator (DIEP) flap. The patient presented favorable outcomes, including optimal healing at 8 months, with no functional limitation. A literature review also discusses alternative pedicled perforator flaps. These modern techniques present several advantages, including reliability, and can be of great interest in complex vascular surgery cases. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare rectal temperature (RT) with temperatures measured in the pinna, cornea, medial canthus, gingiva, metacarpal pad and axillary region of cats in a home environment. Animals Studied: Five healthy mixed‐breed cats (two females and three males) owned by a veterinarian were used. Procedures: All temperature measurements were conducted by the owner by using an infrared camera in the same room and initiated with the pinna, followed by the cornea, medial canthus, gingiva and metacarpal pad. Subsequently, axillary temperature (AT) and RT were recorded by a digital thermometer, respectively. The time taken for a single AT and RT measurements was recorded. Results: The average measurement time for RT was 17.34 ± 0.89 s, with a range of 8–32 s, whereas AT measurements took an average of 46.72 ± 1.16 s, with a range of 29–69 s. AT emerged as a superior alternative measurement site compared to others, exhibiting the lowest bias and the highest proportion of readings within the limits of clinical agreement. The mean difference between RT and AT, with 95% limits of agreement for the differences, was −0.26 (−1.13 to 0.61). Conclusions: Anatomical regions were not all interchangeable with the rectum for assessing body temperature (BT), with AT recording the highest level of agreement with RT. When RT is not possible, AT could be considered as an alternative for monitoring BT in clinically healthy cats that live in a home environment. [ABSTRACT FROM AUTHOR]

Background: Acute type A aortic dissection (ATAAD) is a cardiovascular emergency and has high mortality and morbidity. We retrospectively compared the effects on outcomes of single arterial cannulation via axillary artery (AAC) with double arterial cannulation via axillary and femoral artery (DAC) in patients who underwent cardiopulmonary bypass (CPB) for ATAAD. Methods: Between January 2017 and May 2021, four hundred 29 patients who underwent aortic arch repair with circulatory arrest for ATAAD were divided into AAC group (n = 283) and DAC group (n = 146). The propensity score-matched (PSM) analysis were performed to compare the characteristics and outcomes of the groups. Results: After PSM (n = 137 in each), the DAC group had a longer duration of CPB (229 vs 244, p = 0.011), aortic cross-clamp time (121 vs 149, p < 0.001), durations of Intensive Care Unit (ICU) stay (7 vs 8, p = 0.014) and hospital stay (19 vs 25, p < 0.001) compared with AAC group. The incidences of dialysis (21% vs. 31%, p = 0.073), postoperative stroke (9% vs 15%, p = 0.143), ECMO support (2% vs 7%, p = 0.077), in-hospital mortality (7% vs 14%, p = 0.071) and follow-up mortality (10% vs 19%, p = 0.059) showed no significant difference between two groups. Multivariate logistic regression analysis showed postoperative ECMO (OR: 16.69, 95% CI: 1.78–156.29; p = 0.014) or stroke (OR: 11.34, 95% CI: 2.64–48.72; p < 0.001) were associated with in-hospital mortality. Univariate Cox regression results showed stroke history (OR: 4.61, 95% CI: 1.90–11.16; p = 0.001), aortic valvuloplasty (OR: 0.21, 95% CI: 0.07–0.59; p = 0.003), postoperative ALT day1 (OR: 1.00, 95% CI: 1.00–1.00; p = 0.008), ECMO (OR: 16.30, 95% CI: 4.78–55.61; p < 0.001), tracheotomy (OR: 3.78, 95% CI: 1.08–13.20; p = 0.037), postoperative stroke (OR: 4.61, 95% CI: 1.90–11.16; p < 0.001) and re-exploration for bleeding (OR: 3.52, 95% CI: 1.01–12.27; p = 0.048) were associated to follow-up mortality. Conclusions: For surgical treatment of ATAAD with CPB when compared to double axillary and femoral artery, single axillary cannulation was associated with shorter durations of CPB and ACC as well as ICU and hospital stays but no with significant difference in mortality. [ABSTRACT FROM AUTHOR]

A 9‐year‐old premenarchal female presented to pediatric dermatology with a 6‐month history of periodically tender, bilateral and symmetric axillary masses. Magnetic resonance imaging and subsequent surgical excision confirmed the diagnosis of bilateral accessory axillary breast tissue. Accessory axillary breast tissue is a rare condition seen most in pubertal, pregnant and breastfeeding women. However, it can arise in pre‐adolescent patients and should be added to the differential diagnosis of an axillary mass. [ABSTRACT FROM AUTHOR]

Key clinical message: Unicentric Castleman disease, particularly the hypervascular variant subtype, commonly presents as a localized lymphadenopathy without systemic symptoms. Surgical excision is often curative for this subtype, leading to a good prognosis. However, some patients with autoimmune complications may require additional systemic therapy along with surgery. Accurate diagnosis through a combination of clinical, radiological, and pathological findings is crucial for optimal management. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We conducted a systematic review and meta-analysis to assess the effectiveness of real-time dynamic ultrasound-guided subclavian vein cannulation as compared to landmark technique in adult patients. DATA SOURCES: PubMed and EMBASE until June 1, 2022, with the EMBASE search restricted to the last 5 years. STUDY SELECTION: We included randomized controlled trials (RCTs) comparing the two techniques (real-time ultrasound-guided vs landmark) for subclavian vein cannulation. The primary outcomes were overall success rate and complication rate, whereas secondary outcomes included success at first attempt, number of attempts, and access time. DATA EXTRACTION: Independent extraction by two authors according to prespecified criteria. DATA SYNTHESIS: After screening, six RCTs were included. Two further RCTs using a static ultrasound-guided approach and one prospective study were included in the sensitivity analyses. The results are presented in the form of risk ratio (RR) or mean difference (MD) with 95% CI. Real-time ultrasound guidance increased the overall success rate for subclavian vein cannulation as compared to landmark technique (RR = 1.14; [95% CI 1.06–1.23]; p = 0.0007; I 2 = 55%; low certainty) and complication rates (RR = 0.32; [95% CI 0.22–0.47]; p < 0.00001; I 2 = 0%; low certainty). Furthermore, ultrasound guidance increased the success rate at first attempt (RR = 1.32; [95% CI 1.14–1.54]; p = 0.0003; I 2 = 0%; low certainty), reduced the total number of attempts (MD = –0.45 [95% CI –0.57 to –0.34]; p < 0.00001; I 2 = 0%; low certainty), and access time (MD = –10.14 s; [95% CI –17.34 to –2.94]; p = 0.006; I 2 = 77%; low certainty). The Trial Sequential Analyses on the investigated outcomes showed that the results were robust. The evidence for all outcomes was considered to be of low certainty. CONCLUSIONS: Real-time ultrasound-guided subclavian vein cannulation is safer and more efficient than a landmark approach. The findings seem robust although the evidence of low certainty. [ABSTRACT FROM AUTHOR]

Introduction: Vascular access is required for most cardiac electrophysiology procedures. Over the past 2 decades, ultrasound guidance has increased in utilization as the primary method for assisting operators in gaining access to cardiac implantable electronic device (CIED) implantation. Methods: Ultrasound guidance using a technique that includes both short‐axis and long‐axis views combined with a twisting needle motion after maximal tenting provides an extremely safe and reproducible technique for vascular access for all CIED procedures. Results and Conclusions: In this manuscript and accompanying videos, a step‐by‐step guide is explained for optimal ultrasound‐guided visualization and needle maneuver technique to maximize safety and efficiency for vascular access in all CIED procedures. [ABSTRACT FROM AUTHOR]

Background: The use of therapeutic algorithms for the reconstruction of defects in different anatomical locations is common in plastic surgery. Nevertheless, axillary reconstruction has been unnoticed in this regard. The aim of this article is to review the surgical techniques employed in the reconstruction of axillary defects focusing on the indication for each one, with the aim of creating a therapeutic algorithm that serves as a guide for decision-making in axillary defect reconstruction. Methods: A systematic review was performed using the MEDLINE, EMBASE and Cochrane library databases and including articles published between 2000 and 2020. Results: After excluding case reports, duplicates and non-relevant articles, we selected a total of 11 relevant articles. Relevant information was extracted and employed to create a therapeutic algorithm. We suggest a reconstructive algorithm that classifies the defects according to their size in three categories. Conclusions: We propose the use of local flaps for smaller defects (less than 30 cm2), regional flaps for medium-sized defects (30 to 200 cm2) and microsurgical fasciocutaneous flaps for large defects (more than 200 cm2). Regarding regional flaps, we consider the TDAP flap as the first choice for axillary reconstruction. Level of evidence: Not ratable [ABSTRACT FROM AUTHOR]

Axillary accessory breast is an uncommon condition and is rarer in males. Though rare, unilateral axillary accessory breast should be considered in the differentials for an axillary lump in males also. MRI can unequivocally help in the diagnosis. [ABSTRACT FROM AUTHOR]

Galactocele is a benign breast lesion that occurs commonly during lactating period. It can occur either in normal breast tissue or in accessory breast tissue. We report a galactocele in the left accessory breast tissue. The patient is a 23-year-old female, a mother of two children, who presented with a considerable painful swelling in the left axilla, which is clinically diagnosed as lipoma; however, subsequent investigation revealed it to be a galactocele. The diagnosis of ectopic breast tissue is important as it can undergo the same pathological changes in normal breast tissue, such as mastitis, galactocele, fibrocystic disease, and carcinoma. Galactocele can sometimes also present as suspicious tumoral lesions in axillary accessory breast tissue. [ABSTRACT FROM AUTHOR]

Early breast cancer staging involves radiological and pathological evaluation of the tumour and regional lymph nodes. The internal mammary nodes (IMN) are an important site of possible metastasis and influence disease stage and prognosis. However, the recommendation for routine IMN assessment remains unclear. Internal mammary sentinel lymph node biopsy (SLNB) is associated with increased morbidity and an unknown survival benefit. Furthermore, the IMN are traditionally thought to be involved only synchronous with, or following, axillary node (AXN) metastasis. The aim of this review is to determine the prevalence of IMN metastasis in patients with axilla-negative early breast cancer. A narrative review of studies assessing IMN metastasis was performed. The literature search was completed using the database Medline (Ovid). Twenty-two retrospective studies were identified. The studies included data from SLNB, US, MRI, PET/CT and opportunistic biopsy during free-flap reconstruction (FFR). The prevalence of isolated IMN metastasis ranged from 1.2% to 17.9%. [ABSTRACT FROM AUTHOR]

Οbjective: This study aimed at comparing survival outcomes between systematic axillary lymph node dissection (ALND) vs sentinel lymph node and axillary lymph node dissection only if sentinel positive (SLN ± ALND) in early-stage, clinically node-negative breast cancer patients. Μethods: A systematic review and meta-analysis adhered to PRISMA guidelines was performed. Included studies were prospective randomized controlled trials (RCTs) comparing survival outcomes of ALND vs. SLN ± ALND in early-stage, node-negative breast cancer patients. Patients enrolled were only those with tumor size lower than 4 cm, clinically negative nodes and treated with breast-conservative surgery. Primary endpoints were locoregional recurrence, overall death and cancer-related death. Results: There were four studies included in the analysis, enrolling overall 2982 patients, of which 1494 in ALND arm and 1488 in the SLN ± ALND arm. No statistically significant difference was observed in locoregional recurrence, breast cancer-related death and overall death. Locoregional recurrence was observed in 2.8% (ALND) vs. 4.1% (SLND ± ALND), (RR 0.69, 95% CI 0.20–2.30). Overall death rate was 7.0% vs. 6.8% respectively, (RR 1.00, 95% CI 0.73–1.39, I2 = 28.7%). Breast cancer-related death was 3.6% vs. 3.5%, respectively (SLN ± ALND), (RR 1.11, 95% CI 0.70–1.78, I2 = 0%). No statistically significant difference was observed in any of secondary study outcomes. Conclusions: Systematic axillary axillary lymph node dissection provides no survival benefit compared with sentinel lymph node dissection for early-stage clinically node-negative breast cancer patients. [ABSTRACT FROM AUTHOR]

Objective To compare and study the breast morphological changes after dual-plane augmentation through different approaches. Methods Fifty patients underwent primary breast augmentation from February 2018 to December 2019 were divided into 3 groups. There were 20 patients in the trans-axillary approach group, 10 patients in the inframammary fold (IMF) approach group and 20 patients in the periareolar approach group. All patients were asked to take 3D images by Vectra 3D system before and 6 months after surgery. The 3D images were analyzed by Geomagic Studio 19.0 software. Results There was no statistically significant difference of the straight-line distance from suprasternal notch to nipple (SN-N) and the distance from nipple to the midline of sternum (N-M) before and after surgery among 3 groups (P>0.05). There was statistically significant difference between preoperative and postoperative SN-N and N-M in the trans-axillary approach group (P<0.05). There was no statistically significant difference in the IMF approach group and periareola approach group (P>0.05). In the IMF approach group, the distance of suprasternal notch at the level of the lowest point of the inframammary fold (SN-LIMF) was changed after surgery (P<0.05). There was no statistically significant difference in the trans-axillary approach group and periareolar approach group (P>0.05). The total breast volume in 3 groups increased after surgery. The total breast volume in each group after surgery was smaller than the expected volume (P<0.05). The volume percentage decreased above the level of nipple, while increased below the level of nipple after surgery. The difference in preoperative and postoperative volume and percentage among 3 groups was not statistically significant (P>0.05). Conclusion The dual-plane augmentation through 3 approaches can achieve good and nature appearance of breast. The difference of breast morphological changes among 3 groups is low. [ABSTRACT FROM AUTHOR]

Objectives: Many of the complications arising from cardiac device implantation are associated to the venous access used for lead placement. Previous analyses reported that cephalic vein cutdown (CVC) is safer but less effective than subclavian vein puncture (SVP). However, comparisons between these techniques and axillary vein puncture (AVP) – guided either by ultrasound or fluoroscopy – are lacking. Thus, we aimed to compare safety and efficacy of these approaches. Methods: We searched for articles assessing at least two different approaches regarding the incidence of pneumothorax and/or lead failure (LF). When available, bleeding and infectious complications as well as procedural success were analyzed. A frequentist random effects network meta‐analysis model was adopted. Results: Thirty‐six studies were analyzed. Most articles assessed SVP versus CVC. Compared to SVP, both CVC and AVP were associated with reduced odds of pneumothorax (OR: 0.193, 95%CI: 0.136–0.275 and OR: 0.128, 95%CI: 0.050–0.329; respectively) and LF (OR: 0.63, 95%CI: 0.406–0.976 and OR: 0.425, 95%CI: 0.286–0.632; respectively). No significant differences between AVP and CVC were demonstrated. Limited data suggests no major impact of different approaches on infectious and bleeding complications. Initial CVC approach required significantly more often an alternate/additional venous access for lead placement, compared to both AVP and SVP. No differences between these two were identified. Conclusion: Both AVP and CVC seem to decrease incident pneumothorax and LF, compared to SVP. Initial AVP approach seems to decrease the need of alternate venous access, compared to CVC. These results suggest that AVP should be further clinically tested. [ABSTRACT FROM AUTHOR]

Background: Endoscopic thoracic sympathectomy/sympathotomy is gold standard of treatment for primary hyperhidrosis. Compensatory hyperhidrosis following surgery and partial response to surgery in some patients can significantly affect surgery outcome and patient satisfaction. In this study we investigated predictors of success rate, side effects, and satisfaction of our patients following ETS over a 10-year period. Methods: We retrospectively reviewed result of 200 Endoscopic thoracic sympathotomy surgeries that was performed in a single center to treat craniofacial, palmar, or axillary primary hyperhidrosis over a 10-year period. Patients were asked to report success of surgery to resolve their primary hyperhidrosis, development of compensatory hyperhidrosis, its severity, and their overall satisfaction with surgery. Results: Palmar hyperhidrosis was resolved in 167 (94%) patients. Craniofacial hyperhidrosis was resolved in 66 (84%) patients. Axillary hyperhidrosis was resolved in 68 (50%) patients. Compensatory hyperhidrosis developed in 176 (88%) patients. 44 (22%) patients had mild CHH, 79 (40%) patients developed moderate CHH, and 52 (26%) patients experienced severe CHH. A total of 173 (87%) patients were satisfied with surgery. 19 (9%) patients were not satisfied with ETS and 8 (4%) patients regretted ETS. Lower body mass index and grade IV primary hyperhidrosis were found to be independent predictors of patient satisfaction. Pure axillary primary hyperhidrosis was a negative predictor of patient satisfaction. Conclusion: Best results of ETS are achieved in patients with grade IV PHH and lower body mass indexes. Outcome of ETS for treating axillary PHH is not favorable. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the efficacy and safety of a fractional microneedle radiofrequency device (FMRD) for the treatment of primary axillary hyperhidrosis (PAH). The FMRD adopted insulated microneedles, which could be located at a depth of up to 4.5 mm and deliver a radiofrequency current in a fractional manner. Also, the device could automatically regulate the amount of the delivered energy. Sixteen Korean patients with PAH received two FMRD treatment sessions at a 3-week interval and were followed-up until week 15. The primary outcome was Patient Satisfaction Scale (PSS) score at each visit. Hyperhidrosis Disease Severity Scale (HDSS) and Global Aesthetic Improvement Scale (GAIS) were also assessed. The area and amount of sweat produced were evaluated by specific tests. Mean PSS score significantly improved from 1.6 at week 3 to 2.5 at week 15 by 56%. More than a 50% improvement in sweating assessed by the PSS score was seen in 63% and 50% of patients at weeks 11 and 15, respectively. Mean HDSS score significantly decreased by week 3 and further decreased by week 7. Mean GAIS scores improved from the first follow-up visit at week 3 and improved again at week 7. The mean hyperhidrosis area assessed by starch–iodine test significantly decreased by 36% at week 15 compared with baseline. Mean transepidermal water loss level significantly decreased by 42% at week 15 compared with baseline. No patients experienced any serious adverse events. FMRD can be an effective and safe treatment modality for PAH. [ABSTRACT FROM AUTHOR]

Objective To observe the influence of the intravenous application of dexamethasone and butorphanol on ultrasound-guided axillary brachial plexus block anestihesia with 0.5% ropivacaine. Methods A total of 60 patients with axillary brachial plexus block who underwent hand surgery in this hospital from November 2020 to June 2021 were randomly divided into group D and group B, with 30 patients in each group. Five minutes before nerve block, patients in group D began to receive dexamethasone (load 8 mg+ maintenance 1 mg/h, the maximum dose was 13 mg), and patients in group B began to receive butorphanol (load 0.8 mg+ maintenance 0.2 mg/h, the maximum dose was 1.8 mg), then the two groups received ultrasound-guided axillary brachial plexus block with 0.5% ropivacaine 40 m L. The surgery time, sensory block onset time, the duration time of sensory block and motor block, the score of visual analogue scale (VAS), Motor block score (M BS) (at the time of 4,6,8,10,12,24 h after nerve block), successful block rate, the score of rest disturbance degree and adverse reaction incidence within 24 h after nerve block were recorded. Results Compared with group B, group D had a shorter onset time [12.00（9.00,18.00） min vs. 16.50（13.50,18.75） min],a longer duration time of sensory block [1 025.50（825.50,1 274.50） min vs. 685.50（592.00,840.50） min] and motor block [903.00 (762.75,1 115.25) min vs. 623.50（557.75,931.25） min],a lower score of rest disturbance degree within 24 h after nerve block[0.50（0.50,0.50）points vs.1.75（0.50,6.00）points],the differences were statistically significant (P<0.05). There was no statistical difference in the aspects of success block rate and adverse reaction incidence between two groups (P>0.05）.The pain degree (VAS score) at 12 h and 24 h after anesthesia in group D was less than those in group B, and the differences were statistically significant (P<0.05）.The comparison of MBS of hand motor ability between the two groups at 10 h and 12 h after anesthesia showed a statistically significant difference (P<0.05）.However,there was no significant difference in MBS of hand motor ability between the two groups at 24 h after anesthesia (P>0.05）.Conclusion Compared with butorphanol, the intravenous application of dexamethasone produces a stronger assistant influence for ultrasound-guided 0.5% ropivacaine axillary brachial plexus block anesthesia. [ABSTRACT FROM AUTHOR]

Aims: Ultrasound guidance has led to marked improvement in the success rate and characteristics of peripheral nerve blocks. However, effects of varying the volume or concentration of a fixed local anaesthetic dose on nerve block remains unclear. The purpose of our study was to evaluate whether at a fixed dose of lidocaine, altering the volume and concentration will have any effect on the onset time of ultrasound-guided axillary brachial plexus block.Material and Methods: Twenty patients were randomised to receive an ultrasound-guided axillary brachial plexus block with either lidocaine 2% with epinephrine (20 ml, Group 2%) or lidocaine 1% with epinephrine (40 ml, Group 1%). The primary endpoint was block onset time. Secondary outcomes included duration of the block, performance time, number of needle passes, incidence of paraesthesia and vascular puncture.Results: The median [IQR] onset time of surgical anaesthesia was shorter in Group 1% when compared to Group 2% (6.25 [5-7.5] min vs 8.75 [7.5-10] min; p=0.03). The mean (SD) overall duration of surgical anaesthesia was significantly shorter in Group 1% compared to Group 2% (150.9±17.2 min vs 165.1±5.9 min; p=0.02). Group 1% had a shorter performance time with fewer needle passes. The incidence of vascular puncture and paraesthesia was similar in the two groups.Conclusion:  Ultrasound-guided axillary brachial plexus blocks performed using a higher volume of lower concentration lidocaine was associated with shorter onset time and duration of surgical anaesthesia. [ABSTRACT FROM AUTHOR]

Post-burn contractures are a common problem and functionally limiting for upper limbs. Many different techniques have been described in the literature for their treatment. Z-plasty and release with SSG cover are the commonest procedures done for post-burn contractures. In this study we assess the use of the square flap technique in post-burn contractures of upper limb. Eleven patients with a total number of twelve upper limb contractures (mild to moderate) involving axilla, elbow and finger underwent release by standard square flap technique. All cases were followed up for at least 6 months and analyzed for range of motion and aesthetic outcome. Patient and surgeon satisfaction was recorded. All operated cases achieved a satisfactory range of movement post-operatively without any recurrence. The number of patients who were satisfied with the surgery were 7 out of 11, and 4 patients were somewhat satisfied with the results obtained. In contrast, the surgeons were satisfied in all cases. Square flap is shown to be an easy and reliable flap for mild to moderate contractures of the anterior or posterior axillary folds, elbow contractures and finger contractures with low recurrence rate. [ABSTRACT FROM AUTHOR]

Purpose: Traditional treatment of axillary-subclavian venous thrombosis is resource intensive due to the need for advanced nursing care and increased utilization of intensive care units for thrombolysis procedures. We recently encountered this in the management of 2 patients with effort-induced upper extremity venous thrombosis following COVID-19 infection and offer a treatment paradigm for consideration. Case Reports: A 30-year-old presented with 2 weeks of left upper extremity symptoms following COVID-19 infection. Duplex ultrasound demonstrated axillary-subclavian venous thrombosis and venogram confirmed total occlusion of the axillary and subclavian veins with profuse collaterals around the occlusion. Suction thrombectomy was performed successfully and veins remained patent at 6 month follow up. The patient declined first rib resection and stopped lifting weights. A 16-year-old presented with 4 days of right arm symptoms 1 month after testing positive for COVID-19. Duplex ultrasound revealed acute axillary and subclavian vein thrombosis and she underwent successful thrombectomy followed by balloon angioplasty with improvement in symptoms. Conclusion: The pandemic has strained health care resources such that the treatment of non-life-threatening conditions must be triaged to conserve resources. While axillary-subclavian venous occlusion is usually not life-threatening, timely treatment leads to decreased morbidity and better outcomes. Percutaneous aspiration and thrombectomy without adjunctive thrombolysis may be of benefit in reducing healthcare resource utilization while still achieving good outcomes during the COVID pandemic and beyond. [ABSTRACT FROM AUTHOR]

Valid body core temperature measurements are essential for diagnosing and monitoring athletes with exertional heat stroke (EHS). Experts question the validity of body temperature sites that vary by >±0.27°C from the gold standard, rectal temperature (TREC). No research has established the validity of body temperature sites when American football uniforms (PADS) are worn during simulated EHS scenarios. Thirteen men (age, 22 ± 2 y; mass, 77.5 ± 8.8 kg; height, 181.3 ± 5.7 cm) donned PADS and entered an environmental chamber (38.7 ± 0.8°C, 38.9 ± 2.4% relative humidity). We compared TREC to a forehead liquid crystal temperature monitor (TFHD), axillary (TAXL), oral (TORL), and aural temperatures (TEAR) 34 times over four consecutive periods: 10-minutes of rest; exercise until participants TREC was between 39.7°C and 39.8°C; cold-water immersion (CWI, 10.0 ± 0.1°C) until all temperature sites indicated ≤38°C; and a 15-minute post-immersion recovery period. Body temperatures varied between sites during all periods (F36,432 ≥ 2.5, P ≤ 0.001). TAXL and TORL statistically differed from TREC and exceeded the 0.27°C bias threshold at all 34 measurement times (100%). TFHD differed from TREC eight times during rest; eight times during exercise; 0 times during CWI; and twice during recovery (18/34, 53%). TFHD exceeded the bias threshold 28 times (82%). TEAR differed from TREC five times during rest; 0 times during exercise; five times during CWI; and once during recovery (11/34, 32%). TEAR exceeded the 0.27°C bias threshold 15 times during testing (44%). TAXL, TFHD, TEAR, and TORL should not be used to diagnose or monitor American football players with EHS. Abbreviations ANOVA: analysis of variance; CWI: cold water immersion; EHS: exertional heatstroke; PADS: full American football uniform consisting of a helmet; shoulder, knee, thigh, hip and tailbone pads; a jersey top; undergarments; and half-length pants; TAXL: axillary temperature; TEAR: aural temperature; TFHD: liquid crystal temperature monitor; TORL: oral temperature; TREC: rectal temperature [ABSTRACT FROM AUTHOR]

Objective: Lipoblastomas are benign tumors developing from embryonic fat tissue with few cases reported in the head and neck region. Herein, we aim to present the management of a rare type of lipoblastoma in childhood. Material and Methods: A retrospective chart review was performed on all patients who were admitted due to a mass in the neck and axillary region between January 2015 and December 2019. Data were collected on demographics, comorbidities, preoperative characteristics, operative interventions, and postoperative complications and outcomes. The patients with lipoblastoma were further analyzed. Results: There were 52 patients operated on due to a mass in the neck or axillary region during the study time. The mean age was 5.42±4.16. The majority of the patients (40/52) were diagnosed with enlarged lymph nodes of which 32 (80%) were diagnosed with lymphoma. Among these populations, only two (3.8%) of them were diagnosed with lipoblastoma. Both cases were asymptomatic other than a painless mass. The histopathological examination confirmed the diagnosis of lipoblastoma after surgical excision. Both cases have been uneventful for four years postoperatively. Conclusion: In conclusion, lipoblastomas emerge as a slowly growing mass in early childhood and are mostly seen on the trunk and extremities. Although benign, they have the potential to increase in size and invade adjacent tissues. The gold standard treatment is complete surgical excision. Due to the possibility of recurrence, regular follow-up is strongly recommended after surgery. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to compare the rates of successful first attempt and mechanical complications between internal jugular vein (IJV) and axillary vein (AXV) cannulation. Methods: This prospective, randomized, comparative, controlled study included 220 pediatric patients with age range 1 to 12 years scheduled for cardiac surgery. Patients were allocated into 2 equal groups as IJV and AXV groups. The rates of successful first, second and third puncture attempts and the mechanical complications (arterial puncture, pneumothorax, catheter occlusion, catheter malposition, nerve injury) were investigated. Results: There was no statistically significant difference (p=0.053) in the first skin puncture success rates in both groups (AXV group 80% and IJV group 68%). There were no significant differences regarding the second and third skin puncture success rates. The incidence rates of failed vein punctures were similar in IJV (3%) and AXV (2%) groups. The vein puncture and catheter insertion times and the rates. Arterial puncture, pneumothorax and catheter malposition were similar in IJV and AXV groups (12% vs 11%, 4% vs 1%, 3% vs 5% respectively). The rates of catheter occlusion with sternal retraction were significantly higher (p=0.029) in AXV than IJV group (6% vs 0%). Postoperative phrenic (IJV group) or brachial plexus nerve injury (AXV group) was not developed in any patient. Conclusion: Ultrasound-guided cannulation of both infraclavicular AXV and IJV were similarly associated with high success rates and low incidence of mechanical complications. [ABSTRACT FROM AUTHOR]

Franklinia is a monotypic genus of the family Theaceae that is now extinct in the wild. F. alatamaha Bartram ex Marshall has been maintained in cultivation for nearly 250-y because of the ornamental appeal of its flowers and foliage. The goal of this research was to develop an in vitro propagation system to increase the availability of this rare tree for commercial horticulture and restoration. Immature zygotic embryos were cultured on semi-solid Woody Plant Medium containing 34 different plant growth regulator treatments. Shoot organogenesis was induced from dark-grown explants with indole-3-butyric acid in combination with 6-benzylaminopurine. Shoot organogenesis was also obtained with thidiazuron, N-(2-Chloro-4-pyridyl)-N′-phenylurea, and indole-3-butyric acid in combination with meta-Topolin, although shoot development was abnormal. Adventitious buds were produced on the epidermal surfaces of immature zygotic embryos while exposed to the above plant growth regulator treatments. Once the adventitious buds elongated into shoots, these adventitious shoots were further multiplied by axillary shoot production. Elongated shoots from axillary shoot production were rooted on Woody Plant Medium supplemented with 0.25 g L−1 activated charcoal, but no plant growth regulators. The resulting plantlets were transferred to soil and acclimatized to the greenhouse and outdoor environments. Tissue culture-derived trees flowered within one and a half years in the greenhouse under an extended photoperiod. [ABSTRACT FROM AUTHOR]

Surgical subclavian (SC) and direct aortic (DA) access are established alternatives to the default transfemoral route for transcatheter aortic valve implantation (TAVI). We sought to find differences in survival and procedure-related outcomes after SC- versus DA-TAVI. We performed an observational cohort analysis of cases prospectively uploaded to the UK TAVI registry. To ensure the most contemporaneous comparison, the analysis focused on SC and DA procedures performed from 2013 to 2015. Between January 2013 and July 2015, 82 (37%) SC and 142 (63%) DA cases were performed that had validated 1-year life status. Multivariable regression analysis showed procedure duration was longer for SC cases (SC 193.5 ± 65.8 vs. DA 138.4 ± 57.7 min; p <.01) but length of hospital stay was shorter (SC 8.6 ± 9.5 vs. DA 11.9 ± 10.8 days; p =.03). Acute kidney injury was observed less frequently after SC cases (odds ratio [OR] 0.35, 95% confidence interval [CI 0.12–0.96]; p =.042) but vascular access site-related complications were more common (OR 9.75 [3.07–30.93]; p <.01). Procedure-related bleeding (OR 0.54 [0.24–1.25]; p =.15) and in-hospital stroke rate (SC 3.7% vs. DA 2.1%; p =.67) were similar. There were no significant differences in in-hospital (SC 2.4% vs. DA 4.9%; p =.49), 30-day (SC 2.4% vs. DA 4.2%; p =.71) or 1-year (SC 14.5% vs. DA 21.9%; p =.344) mortality. Surgical subclavian and direct aortic approaches can offer favourable outcomes in appropriate patients. Neither access modality conferred a survival advantage but there were significant differences in procedural metrics that might influence which approach is selected. Unlabelled Image • Similar 30-day and 1-year survival after subclavian versus direct-aortic access • Acute kidney injury occurred less frequently after subclavian access. • Procedure duration was significantly longer using subclavian access. • Subclavian access site-related complications were more frequent. • Similar bleeding and stroke events after subclavian versus direct-aortic access [ABSTRACT FROM AUTHOR]

Body temperature is an important component in the diagnosis and treatment of disease in canines. The rectal temperature remains the standard of obtaining temperature within the clinical setting, but there are many drawbacks with this method, including time, access, animal stress, and safety concerns. Interest in using infrared thermometry in canines to obtain body temperature has grown as animal scientists and veterinarians search for non-invasive and non-contact methods and locations of obtaining canine temperatures. Here, we review evidence on axillary, auricular, and ocular region canine thermometry and the degree to which measurements in these locations are representative of rectal temperature values. Instrumentation refinement and development, as well as morphologic differences, play an important role in the potential correlation between the rectal temperature and these other locations. These caveats have yet to be fully addressed in the literature, limiting the options for those seeking alternatives to rectal thermometry. [ABSTRACT FROM AUTHOR]

In patients with melanomas on the upper back or nape, axillary sentinel lymph node (SLN) biopsy (SLNB), when performed in the traditional supine position, is often disturbed by scattered radiation emitted from the primary tumor site. The results from the present study suggestthat axillary SLNB performed in the prone position can solve this problem. We compared two consecutive groups of patients with melanomas of the dorsal trunk or nape who received axillary SLNB performed either in the supine (n = 119) or in the prone position (n = 130). The number of SLNs detected and excised was significantly higher in prone position group (2.4 ± 1.5 SLNs versus 1.9 ± 0.95 SLNs, p = 0.002). Using the prone position, intra-operative repositioning of the patient for excision of a primary site of the upper back or neck was not necessary. The SLN identification rates and the SLN-positivity rates did not differ significantly between the two types of intraoperative patient positioning. There were no significant differences in survival outcomes or false-negative rates. In conclusion, axillary SLNB in prone position yields a higher number of excised SLNs in patients with melanomas of the upper back or nape. Axillary SLNB in prone position is easy to perform and reliable. Intraoperative repositioning of the patient is not necessary, which saves time and resources. [ABSTRACT FROM AUTHOR]

Background It has been estimated that 20% of the general population will suffer shoulder pain throughout their lives, with a prevalence that can reach up to 50%. The suprascapular nerve (SSN) provides sensation for the posterior and superior regions of the glenohumeral joint, whereas the anterior and inferior zones and the skin are innervated mostly by the axillary nerve. Pulsed radiofrequency on the SSN has been proposed as a therapeutic option in chronic shoulder pain. Axillary nerve block has been proposed in the context of surgical analgesia as an adjuvant to SSN block. Interventions Ultrasound (US)-guided techniques target the nerve selectively, minimizing patients' and physicians' exposure to harmful radiation while increasing success rates by better needle placement. We perform both US-guided techniques with the patient in a lateral decubitus position with the affected shoulder on the upper side. Objective The aim of this report is to describe the adaptation of a US-guided technique that targets both the suprascapular and axillary nerves for the treatment of painful shoulder syndrome. The simultaneous pulsed radiofrequency on the suprascapular and axillary nerves for the treatment of the chronic condition of shoulder pain has been scarcely studied, with very few references in the literature. Conclusions By adapting an approach developed in acute pain management, we can safely deliver pulsed radiofrequency to the suprascapular and axillary nerves for the treatment of shoulder pain. [ABSTRACT FROM AUTHOR]

The restoration of shoulder function after brachial plexus injury is a high priority. Shoulder abduction and stabilization can be achieved by nerve transfer procedures including spinal accessory nerve (SAN) to suprascapular nerve (SSN) and radial to axillary nerve transfer. The objective of this study is to compare functional outcomes after SAN to SSN transfer versus the combined radial to axillary and SA to SSN transfer. This retrospective chart review included 14 consecutive patients with brachial plexus injury who underwent SAN to SSN transfer, 4 of whom had both SA to SSN and radial to axillary nerve transfer. SAN to SSN transfer achieved successful shoulder abduction (≥M3) in 64.3% of this cohort (9/14). During the long-term follow-up, patients achieved an average increase of 67.5° in shoulder abduction. There was no association between motor recovery and time from injury to surgery, age, body mass index (BMI), sex, or smoking status. The 4 patients who had SAN to SSN combined with radial to axillary nerve transfer demonstrated a statistically significant increase in the range of abduction (median, 90° vs. 42.5°, respectively; P = 0.022) compared with those who had SAN to SSN transfer alone; however, the difference in Medical Research Council (MRC) grades (MRC > M3) did not reach statistical significance (P = 0.07). Patients with brachial plexus injury and an intact C7 root could benefit from radial to axillary transfer in addition to SAN to SSN transfer. There was no association between recovery of shoulder abduction and time interval from injury to surgery, age, sex, smoking, and BMI. [ABSTRACT FROM AUTHOR]

Staging of the axillary lymph nodes is an essential step to determine the appropriate treatment for breast cancer. Sentinel lymph node biopsy (SLNB) is currently the first step in staging and the gold standard. However, if the sentinel node is positive, a full dissection of the axillary lymph nodes should be performed (axillary lymph node dissection or ALND). This technique used to be the gold standard but had considerable sequelae which diminished quality of life. SLNB still has sequelae but the incidence is much lower. The goal of this systematic review is to assess whether MRI can replace or assist the current gold standard for axillary lymph node staging in breast cancer. With the use of these non-invasive techniques, the risk of morbidity could be reduced even more. A comprehensive search and an additional brief search in several databases has been performed using PRISMA. Studies were selected based on titles and abstracts and were included or excluded using predetermined criteria. The studies were assessed for validity and applicability using the QUADAS-2 tool by two readers. Data of three studies using diffusion-weighted imaging (DWI) were pooled and statistical analysis was performed. A total of seven studies were included for review. Three studies used DWI, others used T2-weighted imaging, contrast-enhanced imaging, T1-weighted imaging or an MRI scoring system. Due to the heterogeneously divided MRI modalities, a small meta-analysis of DWI was performed. Other studies were evaluated qualitatively. DWI reached a sensitivity of 87.67% (95% CI 77.88-94.20) and a specificity of 59.31% (95% CI 50.85-67.38), a positive predictive value (PPV) of 52.03% (95 CI 42.84-61.12), and a negative predictive value (NPV) of 90.53% (95% CI 82.78-95.58). MRI can aid in the detection of axillary lymph node metastasis, but it cannot replace the current gold standard (SLNB/ALND). [ABSTRACT FROM AUTHOR]

Microwave energy technology treats axillary hyperhidrosis through thermolysis of the apocrine and eccrine glands. Successful short-term reduction of sweating has been studied, but there is limited information on long-term efficacy and safety. To evaluate patient satisfaction with microwave energy device for axillary hyperhidrosis performed within the last 5 years. From June to August 2019, a standardized telephone survey was conducted of 24 patients who received microwave energy device treatment for bilateral axillary hyperhidrosis between June 2014 and June 2018. Demographic information, previous treatment modalities, sweat reduction scores, and side effects were reported. Eighteen patients completed the survey with a mean follow-up of 38 months (range 12–52). The mean hyperhidrosis disease severity scale (HDSS) was reduced by 1.6 (95% CI 1.2–2.0, p <.01). The mean sweat reduction was 61–70%. Sixty-seven percent of patients experienced a reduction in odor and 54% did not require deodorant after treatment. Adverse effects included bruising (67%), pain (56%), swelling (44%), numbness (28%), and nodules (22%). Sixty-six percent of side effects resolved within 2 weeks and all side effects resolved within 12 weeks. The microwave energy device is an effective, durable therapy for axillary hyperhidrosis associated with minimal downtime and a high degree of long-term patient satisfaction. [ABSTRACT FROM AUTHOR]

A 27-year-old male patient with a wound due to a gunshot in right upper thoracic area who was diagnosed as a pseudoaneurysm of right axillary artery underwent open resection and bypass graft with saphenous vein. Today, most vascular surgeons tend to treat these complications with endovascular procedure, but because of this patient's young age and his occupation and the necessity for brachial plexus repair, we decided the open procedure method. [ABSTRACT FROM AUTHOR]

A granular cell tumor (GCT) is a rare neoplasm occurring usually in submucosal and subcutaneous tissues anywhere in the body, affecting mainly the head and neck. GCTs at unusual anatomic sites, such as the breast or the axillary extension, could be taken for invasive carcinoma. We report the case of a 30-year-old male who presented himself with an axillary nodule. A physical examination revealed a firm and painless subcutaneous tumor on ulcerated skin. Lymphoma and lymph node metastasis were suspected. An imaging survey was negative outside the axillary nodule. The tumor was surgically removed. A microscopic examination showed the typical features of a benign GCT. Surgical margins were negative. No recurrence has been observed within a 6-month follow-up period. A GCT can mimic a malignancy since it presents itself as an axillary nodule, and requires complete surgical resection with clear margins. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the agreement between temperature measured at the axilla or tympanic to rectum using standard techniques. Patients and Methods: We studied 50 neonates and 50 infants admitted to special care baby unit and Pediatric Gastroenterology Department with or without fever. Preterm, sick, malnourished neonates and uncooperative and crying infants were excluded from the study. Verbal consent from mothers was taken before the measurements. To adjust for rectal temperature, 0.55°C added to neonates and 0.65°C to infants' axillary temperature, 0.1°C to neonates, and 0.45°C to infants' tympanic membrane temperature. Results: There was a strong correlation (r) between 0.79 and 0.89 for axillary temperature with rectal temperature in neonates and infants, males and females, and for tympanic temperature with rectal in male infants. However, moderate correlation (r) was between 0.73 and 0.76 for tympanic temperature with rectal temperature in overall neonates and male and female infants. Axillary temperature missed 1% of pyrexia cases, whereas tympanic membrane measurements overestimate pyrexia in 5% of cases. Conclusion: It is safe reliable and convenient to use the axillary route for measurements of temperature in neonates and infants with or without fever. [ABSTRACT FROM AUTHOR]

We report a case of a patient with triple synchronous primary malignancies (breast, colon, kidney) which has not been previously reported in the literature. A 70-year-old woman was diagnosed with invasive ductal carcinoma of the left breast with axillary lymph node metastasis. During the staging period, renal cell carcinoma on the left kidney and mucinous adenocarcinoma in the proximal colon were found. Since the breast tumour demonstrated favourable biology, aromatase inhibitor therapy had been started and simultaneous right colectomy and left nephrectomy was performed. Six months after the first diagnosis, left sector excision and axillary block dissection were performed. Adjuvant FEC chemotherapy was administered, followed by radiotherapy. During the 16-month follow-up period disease recurrence was not detected. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy, as an adjuvant treatment, plays a well-known role in prevention of locoregional recurrence in breast cancer patients. This study aims to investigate the impact of radiotherapy in patients with N1 disease. Methods: In this retrospective study, we reviewed the characteristics and treatment outcomes of 316 patients with a biopsy proven diagnosis of breast carcinoma and 1-3 positive axillary lymph nodes. The patients received treatment between 1995 and 2014. The patients had a median follow-up of 60 (range: 6-182) months. Results: This study was conducted on 316 patients with a median age of 48 (range: 26-86) years. Among patients, 215 underwent modified radical mastectomy and 101 had breast-conserving surgery before adjuvant treatment. Indeed, 259 patients received radiotherapy (radiation group) and 57 did not (control group). There was locoregional recurrence in one control group patient and two patients in the radiation group. Multivariate analysis results indicated hormone receptor status as an independent prognostic factor for the 5-year disease-free survival rate. Estrogen and progesterone receptor negativity (HR = 1.80, 95% CI: 1.02-3.19, P=0.043) also had a negative influence on the 5-year disease-free survival rate. However, radiotherapy had no significant effect on disease-free survival (P=0.446) and overall survival (P=0.058) rates. Conclusion: The results showed that adjuvant radiotherapy had no prognostic impacts on locoregional and distant disease control in breast cancer patients with N1 disease. [ABSTRACT FROM AUTHOR]

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 starchiodine 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 posttreatment HDSS and DQLI (p = 0.001 for both). Thirtynine 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. [ABSTRACT FROM AUTHOR]

Background: Enlarged lymph glands almost always represent a local or systemic disease that may be benign or malignant. We see many patients including the referred ones in our OPD clinic and subsequently do the excision of quite a big proportion of the enlarged glands especially the cervical glands. Study Design: Descriptive study. Setting: Retrospect by reviewing the operative and histopathology department of King Edward Medical University. Period: April 2016 to April 2017. Methods: We will analyse the record of 121 patients who had peripheral lymph gland enlargement and presented to us. Results: Ours results show that the mean age of our patients was 25.03±18.06 years. We found that 40% of our patients had a definitive diagnosis from the histopathology of excised lymph nodes while 35.5% of the patients had reactive hyperplasia and 25% of the patients had inconclusive results and we were unable to help them. Conclusion: Our results conclude that the lymph nodes are a very good source of getting the diagnosis especially the cervical lymph nodes with a diagnostic yield of 76.4% and we may need to have a more robust criteria for excising the peripheral lymph glands in order to improve the diagnostic yield from 40%. [ABSTRACT FROM AUTHOR]

Background: Dexmedetomidine has been proposed as a perineural local anaesthetic (LA) adjunct to prolong peripheral nerve block duration; however, results from our previous meta-analysis in the setting of brachial plexus block (BPB) did not support its use. Many additional randomized trials have since been published. We thus conducted an updated meta-analysis.Methods: Randomized trials investigating the addition of dexmedetomidine to LA compared with LA alone (Control) in BPB for upper extremity surgery were sought. Sensory and motor block duration, onset times, duration of analgesia, analgesic consumption, pain severity, patient satisfaction, and dexmedetomidine-related side-effects were analysed using random-effects modeling. We used ratio-of-means (lower confidence interval [point estimate]) for continuous outcomes.Results: We identified 32 trials (2007 patients), and found that dexmedetomidine prolonged sensory block (at least 57%, P < 0.0001), motor block (at least 58%, P < 0.0001), and analgesia (at least 63%, P < 0.0001) duration. Dexmedetomidine expedited onset for both sensory (at least 40%, P < 0.0001) and motor (at least 39%, P < 0.0001) blocks. Dexmedetomidine also reduced postoperative oral morphine consumption by 10.2mg [-15.3, -5.2] (P < 0.0001), improved pain control, and enhanced satisfaction. In contrast, dexmedetomidine increased odds of bradycardia (3.3 [0.8, 13.5](P = 0.0002)), and hypotension (5.4 [2.7, 11.0] (P < 0.0001)). A 50-60µg dexmedetomidine dose maximized sensory block duration while minimizing haemodynamic side-effects. No patients experienced any neurologic sequelae. Evidence quality for sensory block was high according to the GRADE system.Conclusions: New evidence now indicates that perineural dexmedetomidine improves BPB onset, quality, and analgesia. However, these benefits should be weighed against increased risks of motor block prolongation and transient bradycardia and hypotension. [ABSTRACT FROM AUTHOR]

The surgical treatment of breast cancer has been enhanced throughout the years in order to offer oncologically safer and more effective results with lower esthetic impact and fewer sequelae. The lymphedema of the upper limb is still an iatrogenic result of great incidence and morbidity after this treatment. A possible existence of independent breast and upper limb lymphatic pathways has become the issue of many researchers willing to minimize its occurrence. This review aims to compare the lymphatic pathways in the axilla described by traditional anatomy books and recently published articles about Axillary Reverse Mapping (ARM). With this purpose, a comparative table was made with the descriptions found in books and articles, a statistic table of the data collected, a flowchart of anastomoses among nodes and an analytical drawing of the most statistically mentioned drained areas. It was observed that there is great variability in the descriptions of drainage and anastomoses among the lymph nodes in the references used, so there should be a consensus of a universal description which also assembles possible anatomical variations. Furthermore, the findings brought about by recent studies show possible anastomoses among pathways and lymph nodes, however they have not been taken into consideration when ARM was initially proposed. Therefore, the axillary resection with the preservation of the posterior and lateral axillary lymph nodes is theoretically possible to avoid lymphedema of the upper limb, but the development of an updated universal description that involves all possible anatomical variations will provide a safer and more effective treatment. [ABSTRACT FROM AUTHOR]

Angiomatoid fibrous histiocytoma (AFH), is a rare soft tissue tumor most commonly occurring in children and young adult. Many different settlessments are described in literature. In this case report, it has been discussed that a four-yea-rold male patient was admitted with swelling in his armpit and he had pathologically diagnosis and AFH after surgery. All radiological data of the patient have been interpreted and compared with his pathological diagnosis. As a result, there has been inferences about the methods to be applied in the evaluation and follow-up of these patiens for radiological and pathological diagnoses of AFH. [ABSTRACT FROM AUTHOR]

Objective: We hypothesized that ultrasound (US)-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB) will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI). Intercosto brachial and medial brachial cutaneous nerves will be blocked separately because they are not a part of the brachial plexus. Methods: This is a prospective randomized observer-blinded study. The three approaches of the USguided BPB without neurostimulation were compared for quality, performance time, and correlation between performance time and BMI. Intercostobrachial and medial brachial cutaneous nerve blocks were used in all patients. Results: A total of 101 patients were randomized into three groups: SCL (supraclavicular), ICL (infraclavicular), and AX (axillary). Seven patients were excluded due to various factors. All three groups were similar in demographic data, M:F proportion, preoperative diagnosis and type of surgery, anesthesiologists who performed the block, and surgical staff that performed the surgical intervention. The time between the end of the block performance and the start of the operation was also similar. The quality of the surgical anesthesia and discomfort during the operation were identical following comparison between groups. No direct positive correlation was observed between BMI and the block performance time. The time for the axillary block was slightly longer than the time for the supra- and infraclavicular approaches, but it had no practical clinical significance. Transient Horner syndrome was observed in three patients in the SCL group. No other adverse effects or complications were observed. Conclusions: All three approaches can be used for US-guided BPB with similar quality of surgical anesthesia for operations of below the shoulder. A block of the intercostobrachial and medial brachial cutaneous nerves is recommended. Obesity is not a significant factor in relation to the time of US-guided BPB performance, or the quality of surgical anesthesia. [ABSTRACT FROM AUTHOR]

Axillary region is one of the areas where primary hydatid cyst is rare. In this study, we present a case of isolated axillary hydatid cyst in a 40 year-old female patient having applied to our polyclinic with swelling and pain on right axillary. During the breast examination of the patient on right axillary, well-circumscribed semi-mobile mass lesion was detected. On mammary ultrasonography, both breasts were natural. There was necrotic lymphadenopathy on right axillary that was roughly 10x10 cm sized, and locally included cystic patency. Axillary LAP excision was planned for histopathologic diagnosis. Patient was taken to the operation. After it was understood that cyst was hydatic, it was excised with germanium membrane by encircling it with savlon compresses. In order to differentiate primary secondary on post-operative patient, the patient was taken to thoracic and abdomen tomography. No cystic lesions were detected on tomography. Having no problems on follow-ups, the patient was discharged on 3 post-op days with recommendations, and with starting albendazole 10 mg/kg. [ABSTRACT FROM AUTHOR]

The cutaneous apocrine carcinomas are malignant tumors rare adnexal, slowly and preferably located in the axillary growth. A girl aged 24 with no particular medical history was addressed to a right axillary mass slowly evolving for two years, associated with pain in the right upper limb. The echo mammogram had shown a mass in the axilla and supraclavicular and axillary MRI had objectified mass axillary measuring 171mm. Pathological examination with immunostaining was in favor of apocrine carcinoma. The cutaneous apocrine carcinomas are well-known in the mammary glands, but it is difficult to morphologically distinguish between breast cancer and apocrine carcinoma. [ABSTRACT FROM AUTHOR]

We report a 65 year old patient who presented with both an aneurysm of the axillary artery and, some years later, with an acute aortic dissection type Stanford A. After surgical intervention of the dissection in the further workup, no specific etiology could be found. The most likely reason for the two aneurysms was the inadequately treated hypertension. Therefore, follow-up strategies aim to treat the risk factors which are known to promote aneurysm growth. [ABSTRACT FROM AUTHOR]

Background: Neutropenic patients often become febrile and require frequent temperature monitoring. Monitoring core body temperature is considered the gold standard for accuracy. Taking oral temperature is the recommended noninvasive practice when core body temperature cannot be obtained; however, neutropenic patients often, for various reasons, are unable to tolerate an oral probe. Objectives: The purpose of this article is to determine the equivalence of temperatures taken via temporal artery, axillary, and oral methods, and to determine the best alternative to the oral method in the adult hematology/oncology population. Methods: A repeated measures equivalence design was used. A convenience sample of 40 data sets (N = 33 inpatients) was tested on a hematology/oncology inpatient unit in a National Cancer Institute--designated comprehensive cancer center in the southeastern United States. A Latin squares design was employed with three possible sequences of measurement. Demographic data were analyzed using descriptive statistics, and equivalence was tested using the two one-sided tests method. Acceptance criterion for difference between methods was set at 0.2°F from the oral method. Findings: The temporal method is a potential noninvasive alternative to the oral method for the adult hematology/oncology population. [ABSTRACT FROM AUTHOR]

Background: The treatment of lymph nodes engaged in breast cancer with radiotherapy leads to improved locoregional control and enhanced survival rates in patients after surgery. The aim of this study was to compare two treatment techniques, namely single anterior posterior (AP) supraclavicular field with plan depth and two anterior and posterior opposed (AP/PA) supraclavicular fields. In the study, we also examined the relationships between the depth of supraclavicular lymph nodes (SCLNs) and the diameter of the wall of the chest and body mass index (BMI). Methods: Forty patients with breast cancer were analyzed using computed tomography (CT) scans. In planning target volume (PTV), the SCLNs and axillary lymph nodes (AXLNs) were contoured, and, with the attention to PTV, supraclavicular (SC) depth was measured. The dosage that reached the aforementioned lymph nodes and the level of hot spots were investigated using two treatment methods, i.e., 1) AP/PA and 2) AP with threedimensional (3D) planning. Each of these methods was analyzed using the program Isogray for the 6 MV compact accelerator, and the diameter of the wall of the chest was measured using the CT scan at the center of the SC field. Results: Placing the plan such that 95% of the target volume with 95% or greater of the prescribed dose of 50 Gy (V95) had ≥95% concordance in both treatment techniques. According to the PTV, the depth of SCLNs and the diameter of the wall of the chest were 3-7 and 12-21cm, respectively. Regression analysis showed that the mean SC depth (the mean Plan depth) and the mean diameter of the wall of the chest were related directly to BMI (p<0.0001, adjusted R²=0.67) and (p<0.0001, adjusted R²=0.71), respectively. Conclusion: The AP/PA treatment technique was a more suitable choice of treatment than the AP field, especially for overweight and obese breast cancer patients. However, in the AP/PA technique, the use of a singlephoton, low energy (6 MV) caused more hot spots than usual. [ABSTRACT FROM AUTHOR]

Assessment of body temperature is important for decisions in nursing care, medical diagnosis, treatment and the need of laboratory tests. The definition of normal body temperature as 37°C was established in the middle of the 19th century. Since then the technical design and the accuracy of thermometers has been much improved. Knowledge of physical influence on the individual body temperature, such as thermoregulation and hormones, are still not taken into consideration in body temperature assessment. It is time for a change; the unadjusted mode should be used, without adjusting to another site and the same site of measurement should be used as far as possible. Peripheral sites, such as the axillary and the forehead site, are not recommended as an assessment of core body temperature in adults. Frail elderly individuals might have a low normal body temperature and therefore be at risk of being assessed as non-febrile. As the ear site is close to the hypothalamus and quickly responds to changes in the set point temperature, it is a preferable and recommendable site for measurement of body temperature. [ABSTRACT FROM AUTHOR]

Assessment of body temperature is important for decisions in nursing care, medical diagnosis, treatment and the need of laboratory tests. The definition of normal body temperature as 37°C was established in the middle of the 19th century. Since then the technical design and the accuracy of thermometers has been much improved. Knowledge of physical influence on the individual body temperature, such as thermoregulation and hormones, are still not taken into consideration in body temperature assessment. It is time for a change; the unadjusted mode should be used, without adjusting to another site and the same site of measurement should be used as far as possible. Peripheral sites, such as the axillary and the forehead site, are not recommended as an assessment of core body temperature in adults. Frail elderly individuals might have a low normal body temperature and therefore be at risk of being assessed as non-febrile. As the ear site is close to the hypothalamus and quickly responds to changes in the set point temperature, it is a preferable and recommendable site for measurement of body temperature. [ABSTRACT FROM AUTHOR]