Search

We present the case of a 74-year-old man with a history of a squamous cell carcinoma in the left axilla. The patient underwent a multidisciplinary surgical resection through an extended forequarter amputation with thoracic wall resection and reconstruction. With regard to the complexity of the case, three-dimensional virtual reality–based patient-specific reconstructions were used as a supplemental tool to conventional computed tomography imaging to plan the procedure. With this report, we aim to stimulate further research to improve and automate the workflow and to bring virtual and augmented reality reconstructions into the surgical theater of the future.

P wave centric ambulatory electrocardiographic (ECG) monitoring has emerged as an important tool aiding the diagnosis of arrhythmias. However, their efficacy and user experience in infants and young children are not well established. A retrospective study was performed to detail clinical and user experience of ECG monitoring using the Carnation Ambulatory Monitor (CAM) patch (Bardy Diagnostics Inc., Seattle, WA) in patients less than 10 kg. Additionally, 2 different monitor locations (over the sternum and horizontal over the left axilla) were assessed to address the optimal placement in these patients. A total of 33 CAM reports from 25 patients, aged 0 to15 months were included in the study. Mean patient age was 4.2 months ± 5.0 and mean weight was 5.3 kg ± 2.4. Thirty-six percent of patients (9/25) had known congenital heart disease. Indications for monitoring included: tachyarrhythmia (15/33, 45%), bradyarrhythmia (6/33, 18%), ectopic rhythm (9/33, 27%), cardiac tumor (1/33, 1%), and prolonged QT interval (1/33, 1%). All CAM reports showed clear, identifiable P waves which were diagnostic and lead to changes in medical management for 30% of patients (e.g., medication adjustments or discharge from cardiology care). We found the upright placement over the sternum performed better than the horizontal placement over the left axilla for small infants and children less than 10 kg. A P wave centric single-lead ECG monitor is helpful in providing accurate diagnostics tracings in infants and small children aiding in their clinical management.

Highlights • Seat belt related injuries can cause significant morbidity and mortality in road traffic accidents. • We present a case where an improperly worn seatbelt caused traumatic shearing transection of the gastroduodenal junction. • A systematic multidisciplinary assessment approach enabled all injuries to be identified early. • The patient underwent damage control exploratory laparotomy then delayed reconstruction of the alimentary tract., Introduction Global mortality as a result of road traffic accidents (RTA) has reduced significantly since mandatory implementation of seatbelts. Whilst seatbelt related injury, or “seatbelt syndrome,” is a recognised phenomenon, unrestrained passengers have considerably worse survival outcomes. Improper positioning of seatbelts, as is discussed in the following case, can cause extensive injury. Presentation of case Our patient is a 35-year-old female who was a restrained front seat passenger in a car vs. tree collision at 80 km/h. Her seat belt was worn with the shoulder strap under her left axilla. She sustained multiple injuries including complete transection of the gastroduodenal junction. In addition to this she had splenic, liver, transverse colonic, left lower rib and humeral injury. She underwent damage control laparotomy with splenectomy; re-look with gastrojejunostomy and transverse colonic resection with defunctioning ileostomy. She made a good recovery and was discharged after a 4 week admission. Discussion Improperly worn seatbelts redistribute decelerative forces to sensitive regions. A multidisciplinary approach is required to effectively manage complex multi-system trauma. In trauma the simplest reconstructive measures can be the most effective and minimise risk of further complications for the patient. Conclusion Improperly worn seatbelts pose a significant risk to patients. A traumatic complete gastroduodenal transection can be effectively reconstructed with gastrojejunostomy anastomosis.

An intact 1-year-old female rat (Rattus norvegicus) presented with a mass in the left axilla. Nodulectomy was subsequently performed, and biopsy results revealed a subcutaneous lymphangiosarcoma (LPS). Metronomic chemotherapy with toceranib and meloxicam was initiated. Three months later, a left axillary mass and an inguinal mass were observed. Histopathologic analysis confirmed the recurrence of a subcutaneous lymphangiosarcoma in the left axilla, and a mammary fibroadenoma in the inguinal area. The animal continued treatment with the same protocol of metronomic chemotherapy, and no tumor recurrence was observed. Lymphangiosarcoma is a rare, malignant neoplasm poorly described in animals. In the only previous report in rats, the LPS was located on the lumbosacral vertebrae. Lymphangiosarcoma should be included in the differential diagnosis of subcutaneous masses in rats.

We report a substantial axillary lymphangioma in a fetus delivered at 38 weeks of gestation. Detailed fetal survey at 20 weeks revealed a 5.45 × 3.72 cm nonvascular cystic axillary structure without other malformations; amniocentesis was negative. Serial surveillance was performed throughout the pregnancy. A male infant weighing 3000 g with a 16 × 12 × 9 cm septated cystic mass arising from the left axilla was delivered via cesarean section. The newborn period was complicated by cellulitis overlying the mass and interval cystic hemorrhage requiring sclerotherapy and subsequent excision. Nonnuchal lymphangiomas may be etiologically distinct entities. The prognostic factors include anatomic location, presence of septa, and association with other congenital abnormalities. A thorough evaluation, multidisciplinary approach, and close surveillance should be undertaken to optimize neonatal outcomes., Highlights • There is a paucity of literature describing large prenatal axillary lymphangioma. • Nonnuchal lymphangiomas may be etiologically distinct. • Septate and nonseptate axillary lymphangiomas are potentially different entities. • Compared with nuchal lesions, axillary lymphangioma is less strongly associated with hydrops. • Detailed fetal anatomic survey is imperative to screen for additional anomalies. • Close surveillance should be undertaken to optimize neonatal outcomes.

Although less common than other types of skin cancers, melanoma is accountable for the majority of skin cancer-related deaths. The standard management for patients with clinically negative nodes includes a sentinel lymph node (SLN) biopsy, which is commonly performed using a combination of radioactive tracer (Tc-99) and a blue dye (isosulfan or patent blue). There are numerous drawbacks associated with Tc-99 and blue dyes such as elevated costs, logistical challenges, and anaphylactic reactions among others. In recent years, near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has emerged as a safe, effective, less costly, and more convenient alternative for the identification of SLNs in melanoma. We discuss the case of a 51-year-old man with melanoma in his left upper back. Two SLNs in the left axilla were successfully identified using NIR fluorescence. NIR fluorescence with ICG for SLN identification has proven to increase the sensitivity and accuracy when used in combination with lymphoscintigraphy.

Benign metabolic uptake on fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) is not uncommonly seen after immunization. We report a case of 30-year-old man with Hodgkin's lymphoma who underwent two cycles of chemotherapy. Interim 18F-FDG PET/computed tomography demonstrated complete metabolic response of prior hypermetabolic bilateral supraclavicular and mediastinal lymph nodes. Although multiple new normal-sized hypermetabolic left axillary and subpectoral lymph nodes are noted, relevant history revealed COVID vaccine 7 days prior scan with mild FDG uptake at the left deltoid muscle. These new findings at the left axilla are likely related to recent vaccination. 18F-FDG PET uptake in the lymph nodes is not so uncommon after immunization; relevant history is very important especially in the phase of massive immunization to avoid false interpretation.

A 72-year-old woman was referred for whole-body 111In-pentetreotide scintigraphy with SPECT/CT. There was increased uptake of lymphadenopathy in the left axilla and left deltoid muscle. The patient's history revealed that the patient received the first dose of the COVID-19 vaccine 3 days before the 111In-pentetreotide scintigraphy with SPECT/CT. This case demonstrates that the COVID-19 vaccine can cause 111In-pentetreotide uptake in the lymph nodes and the deltoid muscle.

A bipolar, single-lead electrocardiogram (ECG) device is capable of recording ECGs with an integrated smartphone application. To determine the utility of this device, phone-based ECGs (pECG) were compared with standard six-lead ECGs (sECG) in four female Atlantic bottlenose dolphins ( Tursiops truncatus) at the National Aquarium. Study animals were trained to haul out onto a dry deck in ventral recumbency and allow simultaneous 30-sec ECG acquisition using the two devices. The pECG device was held against the thoracic wall caudal to the left axilla. The sECGs were recorded in the frontal plane. Instantaneous heart rates were obtained from identical QRS complexes on both ECGs. Three boarded cardiologists independently evaluated the rhythm and the polarity of the QRS depolarization for each recording and the results were compared. The mean heart rate was 80 beats/min (range 62-92 beats/min) and 80 beats/min (range 60-92 beats/min) for the pECG and sECGs, respectively. All four dolphins displayed sinus respiratory arrhythmia, and one animal had occasional atrial premature contractions. Rhythm diagnosis and QRS polarity were identical for the pECG and sECG. Dolphin vocalizations created artifacts on the pECG that were not present on the sECG, so pECGs had to be acquired without vocalization. The pECG appears to be an accurate and useful method to monitor the heart rate in Atlantic bottlenose dolphins. This system is inexpensive and portable, making it valuable for health examinations, transport monitoring, and stranding responses.

A 68-year-old man with right cheek melanoma after resection underwent 18F-FDG PET/CT, which was unremarkable except for multiple FDG-avid subcentimeter but rounded lymph nodes in the left axilla. The patient had undergone a COVID-19 vaccination in the left arm 3 weeks prior. As under vaccinations have been documented to cause reactive FDG-avid lymph nodes, the nodes in our patient were considered benign, reactive to the COVID-19 vaccination. Although FDG-avid benign, reactive nodes have been an uncommon finding in the past, the upcoming surge in COVID-19 vaccinations makes this an important finding for the interpreting physician to consider and recognize.

Nevus comedonicus is a rare epidermal abnormality of the pilosebaceous unit, which is congenital in most patients but may also appear early in childhood. It may be localized or have an extensive involvement, the latter showing a unilateral predominance with only a few cases presenting bilaterally. Extensive nevus comedonicus can be associated with musculoskeletal defects, eye and neurological involvement, which constitutes nevus comedonicus syndrome. Uncomplicated nevus comedonicus can be treated with topical keratolytics, diode, erbium laser, and ultrapulse CO2 laser. Surgical excision can be performed to ensure complete removal and nonrecurrence. This case report refers to a young male patient with extensive nevus comedonicus present over left chest, left axilla, and left upper back without systemic involvement, treated with staged surgical excision and resurfacing.

During the dissection of a 79-year-old Caucasian female cadaver, a variant of Langer's axillary arch was found unilaterally in the left axilla. While Langer's axillary arches are not uncommon, this particular variant, attaching to the biceps brachii, is much rarer with a reported prevalence of only 0.25%. The case reported here, however, is only the third example of a Langer's axillary arch that has been found in the last 14 years in the Dissecting Room at St. George's, University of London, giving it an overall prevalence of approximately 1.0% amongst a population of around 280 Caucasian cadavers, much lower than the reported frequency of 7%. Langer's axillary arches can be completely asymptomatic in life, but may also cause a variety of issues both clinically and surgically.

BACKGROUND Excessive hair is undesirable and represents both a social and emotional burden, especially among females. Laser hair removal (LHR) has gained popularity in the past 2 decades. It is a common practice to instruct patients not to pluck or wax their hair before undergoing LHR; only shaving is allowed to improve the efficacy of the LHR. OBJECTIVE To compare the percentage of hair reduction in preshaved versus prewax epilated axillae after LHR in healthy adult Saudi females. METHODS AND MATERIALS This study is a quantitative experimental pilot clinical trial. Twenty female volunteers were enrolled into this study; all underwent 3 laser sessions using a long-pulsed alexandrite laser. Their left axilla was prewaxed and right axilla was preshaved immediately before laser treatment. Hair was counted manually before and 6 months after the third laser session. RESULTS The right and left axillae both showed significant hair reduction, between the first session and the hair count 6 months after the third laser session. However, there was no statistically significant difference between these 2 means (p = .44). CONCLUSION There is no statistical difference in hair reduction after LHR whether the area is preshaved or prewax epilated.

A66-year-old man presented with burning pain and erythema over the left axilla, and pustules that had ruptured and crusted over. The rash also involved the right axilla, trunk, abdomen, and face. He said the symptoms had developed 3 days after starting to use ciprofloxacin eye drops for eye redness

Introduction: Meningioma is mostly a benign tumor, but sometimes it is malignant, and there have been reports of distant metastases. Patient concerns: The patient, a woman in her 40s, was under follow-up after resection of an ectopic malignant meningioma originating in the left axilla. She was referred to our department because of a nodule shadow in the right lung on chest computed tomography (CT) 3 years and 5 months postoperatively. Diagnosis: Chest CT showed a 1.0 cm nodule shadow in the right S4, which was positive on positron emission tomography-CT; no abnormality was found in any other organ. Therefore, it was considered to be a metastatic lung tumor. Interventions: Right middle lobe partial resection was performed using thoracoscopic surgery, and a diagnosis of pulmonary metastasis of ectopic malignant meningioma was made by histopathology and immunohistochemistry. Outcomes: In this case, complete resection was possible. Conclusion: Meningioma occurs mainly in the cranium, and occurrence in the soft tissue of the extremities is extremely rare. To our knowledge, ours is the first report of a histologically malignant ectopic meningioma with metastasis to the thoracic cavity.

Giant condyloma acuminatum (GCA), also known as Buschke -Lowenstein tumor, is a huge, rapidly growing variant of condyloma found in the anogenital region. Extragenital GCA is rare and, in most cases, affecting the intertriginous area and treated by excision. We described a case of refractory extragenital GCA involving the large part of the left axilla area successfully treated with immunotherapy and podophyllotoxin. Considering the large size and the location, the lesions were not treated by wide excision because it might result in scar contracture with limitation of shoulder movement or axillary web syndrome. Our case illustrates that combination therapy of podophyllotoxin, imiquimod plus weekly cryotherapy may be an effective and less invasive option for treating GCA of the axilla with good cosmetic and functional outcomes.

Objectives To objectively and subjectively describe the normal spectrum of two-dimensional echocardiographic findings in the central bearded dragon (Pogona vitticeps). Animals Sixteen central bearded dragons. Methods Central bearded dragons were prospectively evaluated under manual restraint in right and left lateral recumbency to identify imaging planes for reproducible measurements of cardiac chambers, subjective two-dimensional analysis and color Doppler assessment. Results Echocardiography can be performed through windows in the left and right axillae. The window in the left axilla allows for a subjective and objective assessment of cardiac structure and function. The right axillary window allows for evaluation of pulmonary artery flow. Both views provide data for the presence of pericardial effusion or valvular insufficiency. With optimized imaging planes, cardiac chambers and fractional area change along with fractional shortening in the longitudinal and transverse planes can be calculated. Body weight and cardiac chamber dimensions of males were significantly larger than females. Ventricular fractional area change was the most consistent functional assessment. The majority of animals were found to have no evidence of valvular insufficiency, while approximately half had evidence of pericardial fluid. Pulmonary artery flow was assessed in all patients. Left and right aortic velocities cannot be reliably obtained. Conclusions This study is the first to generate reference values for cardiac structure and function in clinically healthy central bearded dragons. Valvular insufficiency is not a normal finding in central bearded dragons, while mild pericardial effusion may be.

A lady presented with a unilateral eruption that started around the left axilla and progressed in a centrifugal pattern to the left side of the trunk. The self-limited nature of this peculiar clinical picture along with a non-specific histology aided the final diagnosis.

Patients diagnosed with quadruple synchronous primary cancers are extremely rare and we present here, to the best of our knowledge, the first case report of this combination of primary cancers. A 70-year-old woman was diagnosed with cervical adenocarcinoma, melanoma on the right leg, invasive ductal cell carcinoma metastasis in the left axilla with no primary breast tumour detected and multiple basal cell carcinomas on the limbs, all within 2 months. The management was conducted in collaboration with six medical specialties. The cancers were surgically managed, with further adjuvant chemotherapy and ongoing hormone therapy for her breast cancer. Four years after the diagnosis, no signs of recurrence or further metastases from any of the cancers are present.

Purpose Intra-aortic balloon pumps (A-IABP), Impella, and the intravascular ventricular assist system (iVAS) are being utilized as bridges to orthotopic heart transplantation (OHT). Benefits of an axillary approach include allowing patients to ambulate prior to transplantation. The purpose of this case series is to examine the safety of this approach as a bridge to OHT since the implementation of the new UNOS donor heart allocation schema in October 2018. Methods We retrospectively reviewed all patients who underwent implantation of an intra-axillary mechanical assist device as a bridge to OHT from December 2018 until August 2019 at a single institution. All devices were inserted via surgical grafts sewn directly to the axillary artery. Primary outcome of interest was successful bridge to OHT. Secondary outcomes included death, time to OHT, stroke, and vascular complications. Results Ten patients were included in the series: 7 treated with A-IABP, 1 with Imeplla, and 2 with iVAS (Figure 1). Mean age was 56 and 20% were female. In the A-IABP group, 5 were implanted in the left axilla and 2 in the right. The proximal right axillary artery was used for Impella and iVAS access. There were no axillary approach related morbidities nor any neurologic or vascular complications. However, 2 patients with A-IABP required return to the OR for A-IABP reimplantation due to device malfunction. 6 patients with A-IABP survived to OHT with mean time to transplant of 25 days (Range: 6-68). One A-IABP and the Impella patient survived to OHT after conversion to CentriMag. 1 iVAS patient survived to OHT after 29 days and 1 is waiting at home for OHT. Conclusion There is growing interest in the use of intra-axillary mechanical support devices in patients awaiting OHT. This approach has the advantage of improved mobility while maintaining adequate hemodynamic support. The use of axillary mechanical support in this series was associated with successful bridge to transplant in all patients.

Seroma formation after axillary dissection is a common problem in breast cancer surgery. We report the case of a 68-year-old female with breast cancer who underwent a wide local excision and axillary clearance due to stage III breast cancer. Patient received post-operative whole breast irradiation therapy and developed a painful, infected seroma one month after surgery. This was treated with antibiotic therapy after which the infection subsided. One year after surgery patient presented with a painful persisting seroma in the left axilla. We decided to surgically treat the seroma by removing the fibrous seroma capsula and closing of the dead space with a latissimus dorsi flap. Six weeks after surgery, patient was pain and seroma free and was happy with the surgical result. Latissimus dorsi flap harvesting is an ideal way to treat persisting fibrous encapsulated seroma pockets after axillary clearance in the treatment of breast cancer.

A 50-year-old woman presented with a mass in the upper outer quadrant of her left breast, which proved to be a mucinous cystadenocarcinoma by biopsy. An F-FDG PET/CT was performed for staging, which showed that the breast tumor was the only lesion with abnormal F-FDG avidity. Breast-conserving surgery was performed following a negative sentinel lymph node biopsy of the left axilla, and primary mucinous cystadenocarcinoma of the breast was finally diagnosed.

We report a 20-year-old boy presenting in OPD, after two and half month’s history of assault and stab wound in left axilla with complaint of weakness and tingling in the left little and ring fingers. A knife blade retained in his chest wall was initially missed in emergency department. This case reminds us that, careful examination on all trauma patients is mandatory, especially those with penetrating injuries. Lack of apparent sign and symptoms, and a seemingly stable patient should not be an excuse for stopping further necessary assessment.

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.

Galactoceles are the most common benign breast lesions during breastfeeding period that can mimic carcinomas. We report a galactocele with malignant appearance on ultrasound in the accessory breast. The patient was a 32-year-old lactating woman presented to our hospital for considerable swelling in the left axilla. Ultrasound examination revealed a hypoechoic mass with heterogeneous echogenicity and irregular shape and margins. Sonography-guided aspiration was performed. Aspiration of milky fluid and resolution of the axillary lump after aspiration confirmed the diagnosis of galactocele. Galactocele can present as a suspicious tumoral lesion in the axillary accessory breast and diagnostic aspiration can help in correct diagnosis of this rare lesion in the accessory breast.

Pancreatic cancer is usually high-grade and metastatic when diagnosed. Skin metastasis is very rare and is usually found in the periumbilical area. Non-umbilical metastasis is extremely rare. Only 19 cases have been reported in the literature. Only one case in the buttock has been described: thus our case is the second one known. In this note, we present a cutaneous metastasis of a pancreatic cancer case that was admitted to the clinic with a mass each on the left buttock and in the left axilla, surgically treated for palliation. We include a review of the literature.

This is a case of a 2-month-old infant who had suppurative lymphadenitis at left axilla after Bacille Calmette Guérin (BCG) vaccination. She presented with a non-healing BCG wound and left axillary swelling associated with one-week fever at 2 months of age. Aspiration under general anaesthesia was done and pus sent for mycobacterium culture grew Mycobacterium tuberculosis complex. The patient improved without anti-tuberculosis treatment.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.283-285

The objective of this study was to examine the effect of metrics-based vs. non-metrics-based feedback on novices learning predefined competencies for acquisition and interpretation of sonographic images relevant to performance of ultrasound-guided axillary brachial plexus block. Twelve anaesthetic trainees were randomly assigned to either metrics-based-feedback or non-metrics-based feedback groups. After a common learning phase, all participants attempted to perform a predefined task that involved scanning the left axilla of a single volunteer. Following completion of the task, all participants in each group received feedback from a different expert in regional blocks (consultant anaesthetist) and were allowed to practise the predefined task for up to 1 h. Those in the metrics-based feedback group received feedback based on previously validated metrics, and they practised each metric item until it was performed satisfactorily, as assessed by the supervising consultant. Subsequently, each participant attempted to perform ultrasonography of the left axilla on the same volunteer. Two trained consultant anaesthetists independently scored the video recording pre- and post-feedback scans using the validated metrics list. Both groups showed improvement from pre-feedback to post-feedback scores. Compared with participants in the non-metrics-based feedback group, those in the metrics-based feedback group completed more steps: median (IQR [range]) 18.8 (1.5 [17-20]) vs. 14.3 (4.5 [11-18.5]), p = 0.009, and made fewer errors 0.5 (1 [0-1.5]) vs. 1.5 (2 [1-6]), p = 0.041 postfeedback. In this study, novices' sonographic skills showed greater improvement when feedback was combined with validated metrics.

An 18-year-old man presented with complaint of large size lump of 22×18×10 cm in the left axilla for >4 years duration. He also had complaint of restricted movement of left upper limb at shoulder joint. His upper limb was always in the abducted position for last 9 months because of large size of

This report reviews literature on splenic infarction. It also describes the case of a 27-year-old female who was bedridden because of a muscular disease and who was admitted to the emergency department with chest pain. She experienced continuous squeezing and compressing pain, which originated from the lower left hemithorax and radiated to the left axilla. A splenic infarct was detected after 24 h follow-up in the emergency room. Emergency physicians should keep in mind that chest pain originating from the lower left thorax and radiating to the left shoulder can be a sign of splenic infarction. (Eurasian J Emerg Med 2015; 14: 154-6)

Pilomatrixoma, a rare benign tumour of sebaceous gland is commonly known as calcifying epithelioma of Malherbe or Tricholemmal cyst. We came across even the rarest form of this benign tumour of skin. Our case report was interestingly detected at a higher age group, unusual site of the body, multiple in nature following postoperative incision drainage of abscess in left axilla.

Summary Background and Objective Alexandrite and diode lasers are commonly used for hair removal. To date, the available spot sizes and repetition rates are defining factors in terms of penetration depth, treatment speed, and efficacy. Still, larger treatment areas and faster systems are desirable. To compare the efficacy, tolerability, and subject satisfaction of a continuously linear-scanning 808 nm diode laser with an alexandrite 755 nm laser for axillary hair removal. Study Design A total of 31 adults with skin types I–IV received 6 treatments at 4-week intervals with a 755 nm alexandrite laser (right axilla) and a continuously linear-scanning 808 nm diode laser (left axilla). Axillary hair density was assessed using a computerized hair detection system. Results There was a significant reduction in axillary hair after the 6th treatment (P

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.

A 30-year-old woman presented with an asymptomatic papular rash of six days’ duration, which began abruptly near her left axilla and spread along her lateral thoracic wall and abdomen. Subsequently, the involvement became bilateral, although a unilateral, left-sided predominance was maintained.

A forty-six-year-old female presented with a history of left axillary pain, discomfort, chronic fatigue and palpitations. Clinical examination revealed large, tender nodules in the left axilla which were thought to represent enlarged axillary lymph nodes. Multiple dilated veins were visible in the left axillary region. The patient was diagnosed with Mondor’s disease based on the typical mammographic and ultrasound features.

Background and Purpose Severe injuries sustained during combat may classify individuals as undeployable for active service. It is imperative that every effort is made to optimize physical function following such injuries. Case Description A 38-year-old man sustained a gunshot wound during armed combat. The bullet entered via the left axilla and exited from the right side of the abdomen, resulting in severe thoracic and abdominal injuries. Five months later, he continued to describe severe dyspnea on exertion. During a cardiopulmonary exercise test on a cycle ergometer, he achieved a maximum rate of oxygen uptake of 2,898 mL·min−1 (114% predicted) and maximum power of 230 W (114% predicted). His maximum forced inspiratory flow was 5.95 L·s−1, and inspiratory reserve volume at test end was ∼80 mL. The test was terminated by the patient due to dyspnea that was too severe to tolerate. Video fluoroscopy demonstrated impaired right hemidiaphragm function. The main goals of therapy were to reduce dyspnea on exertion and to enable return to full work duties. A program of high-intensity, interval-based threshold inspiratory muscle training (IMT) was undertaken. Outcomes An average of 5 sessions of IMT were completed each week for 10 weeks. During a repeat cardiopulmonary exercise test, the patient achieved a similar power and maximum rate of oxygen uptake. His maximum forced inspiratory flow increased by 48% to 8.83 L·s−1, and he was limited by leg fatigue. Discussion High-intensity IMT was safe and well tolerated. It was associated with improvements in maximum forced inspiratory flow and changed the locus of symptom limitation during high-intensity exercise from dyspnea to leg fatigue.

In this manuscript, we report three cases of penetrating abdominal injury: one with pellet injury, one with pellet injury after a bomb explosion and one with gunshot injury. All three patients were successfully managed nonoperatively. A 30-year-old male was admitted to our trauma and emergency service with a pellet injury. His physical examination revealed multiple pellet injuries in the left upper abdominal quadrant, left hemithorax, left axilla, dorsal side of the abdomen, left upper extremity, and left gluteus. The second case was a 16-year-old male admitted with a shrapnel injury after a bomb explosion. His physical examination revealed multiple shrapnel injuries in the thoracal and abdominal regions, extremities and left eye. The third case was a 30-year-old male admitted with gunshot and stab wound injury. He had multiple stab wound injuries in both lower extremities and a gunshot wound in the left posterosuperior hemithorax, left upper abdomen and left dorsolumbar region. All these cases were treated non-operatively. We advocate a policy of selective conservatism based on careful initial and subsequent serial clinical examinations and imaging techniques as needed.

It is currently not fully established whether human individuals have a genetically determined, individual-specific body odour. Volatile carboxylic acids are a key class of known human body odorants. They are released from glutamine conjugates secreted in axillary skin by a specific N α -acyl-glutamine-aminoacylase present in skin bacteria. Here, we report a quantitative investigation of these odorant acids in 12 pairs of monozygotic twins. Axilla secretions were sampled twice and treated with the N α -acyl-glutamine-aminoacylase. The released acids were analysed as their methyl esters with comprehensive two-dimensional gas chromatography and time-of-flight mass spectrometry detection. The pattern of the analytes was compared with distance analysis. The distance was lowest between samples of the right and the left axilla taken on the same day from the same individual. It was clearly greater if the same subject was sampled on different days, but this intra-individual distance between samples was only slightly lower than the distance between samples taken from two monozygotic twins. A much greater distance was observed when comparing unrelated individuals. By applying cluster and principal component analyses, a clear clustering of samples taken from one pair of monozygotic twins was also confirmed. In conclusion, the specific pattern of precursors for volatile carboxylic acids is subject to a day-to-day variation, but there is a strong genetic contribution. Therefore, humans have a genetically determined body odour type that is at least partly composed of these odorant acids.

Acrochordons or fibroepithelial polyps, are very common skin lesions. However, giant acrochordons are extremely rare. We present a case of a morbidly obese diabetic man who was treated with primary excision of a giant 18 cm acrochordon of the left axilla.