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Abstract Objective Maintaining normothermia is crucial for neonatal survival, especially in preterm infants prone to temperature instability. This study evaluates the correlation and variability between axillary and rectal temperatures at Neonatal Intensive Care (NICU) admission across gestational age ranges of 23–28, 29–32, 33–36, and ≥ 37 weeks, aiming to inform improved neonatal thermal management strategies. Methods This cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, from October 2023 to April 2024, involving 160 infants. Admission temperatures were measured using digital thermometers. Data analysis included ANOVA/Kruskal-Wallis for continuous variables, Chi-square tests for categorical data, Bland-Altman method for agreement assessment, and Pearson correlation coefficients to evaluate temperature correlations. Results Mean axillary temperature increased from 36.4 °C in the 23–28 weeks gestational group, to 36.5 °C in the 29–32 weeks group, and to 36.7 °C in the 33–36 weeks and ≥ 37 weeks groups, (p = 0.033). Rectal temperature increased from 36.5 °C in the 23–28 weeks group, to 36.6 °C in the 29–32 weeks group, and reached 36.8 °C in both the 33–36 weeks and ≥ 37 weeks groups (p = 0.006). Notable differences between measurement methods were observed in the 33–36 and ≥ 37 weeks groups (p

Upper arm glomus tumors are uncommon, benign vascular growths originating from skin glomus bodies. They typically cause severe, paroxysmal pain triggered by cold, pressure, or touch. Diagnosis can be complex due to mimicry of other conditions, but histopathological examination confirms the presence of glomus cells. In a case study, a 46-year-old woman with an Upper arm glomus tumor experienced pain and a lump in her left arm. Ultrasound identified a well-circumscribed, heterogeneous, hypoechoic, pedunculated mass with internal vascularity and MRI showed a lobulated soft-tissue mass with skin involvement and polypoid projection, alongside axillary lymphadenopathy and skin thickening. Following an open biopsy that confirmed the diagnosis of a glomus tumor, the patient experienced complete resolution of symptoms after surgical excision, with no recurrence during the 24-month follow-up period.

Objective: To assess the accuracy of ultrasound-guided core biopsy in staging axillary lymph nodes in clinically node-negative invasive breast cancer patients using histopathology as the gold standard. Methods: This cross-sectional study was conducted in the Department of Pathology at Mekran Medical College, Turbat, Pakistan, from April 2023 to September 2023. The study included breast cancer patients who were clinically negative for lymph node involvement. Ultrasound-guided core biopsies were performed on suspicious axillary lymph nodes by experienced radiologists, with histopathological analysis serving as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated to assess diagnostic performance. Patient demographics, tumor characteristics, and axillary ultrasound findings were also recorded. Results: A total of 132 invasive breast cancer patients were included, with a mean age of 57.67 ± 13.03 years. The majority of patients were diagnosed with invasive ductal carcinoma, accounting for 113 (85.6%) cases. Hormone receptor positivity was prevalent, with estrogen receptor positivity in 119 (90.2%) and progesterone receptor positivity in 116 (87.9%) cases. The most common immunohistochemistry subtype was Luminal B, present in 66 (50%) patients, followed by Luminal A in 51 (38.6%) patients. Most tumors were of moderate grade 77 (58.4%) and early-stage (pT1) 63 (47.7%). Ultrasound-guided core biopsy exhibited a sensitivity of 87.9% and specificity of 100%, with positive and negative predictive values of 100% and 89.2% respectively, resulting in a diagnostic accuracy of 93.9%. Conclusion: Ultrasound-guided core biopsy demonstrates strong diagnostic performance in identifying metastatic axillary lymph nodes in clinically node-negative invasive breast cancer patients.

Lipoma is a benign mesenchymal tissue tumor, mainly composed of mature adipose cells; it is most common in adults and is rarely observed in children. The clinical data of an infant diagnosed with a giant axillary lipoma admitted to our hospital were analyzed. A 12-month-old girl presented with a large mass in the right axillary region. Imaging examination suggested a mesenchymal tissue tumor and postoperative pathology confirmed lipoma.

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]

Ovarian cancer is usually confined intraperitoneally. Distant metastases at presentation is unusual. Its spread via lymphatics is uncommon, and metastasis to axillary lymph nodes is very rare. We report two cases with presentation of axillary lymphadenopathy without breast involvement. Computed tomography scan identified the ovarian masses. Both had elevated Serum Ca 125. The first case had a Grade 2 ovarian endometrioid carcinoma. The second case had a high-grade serous ovarian carcinoma. These cases illustrate the rarity of axillary lymphadenopathy from ovarian cancer. It is important to identify the primary ovarian carcinoma in order to offer appropriate management. Despite surgery and chemotherapy, both succumbed within 3 years from diagnosis. [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]

Hyperhidrosis is associated with social and emotional stress, affecting quality of life. Microwave energy technology treats primary axillary hyperhidrosis by thermolysis of sweat glands. The successful reduction of sweating in patients with primary axillary hyperhidrosis after microwave treatment has been studied, but there is limited evidence on the psychological and long-term effects. This study examined patient- reported outcome measures including depression and anxiety in patients with primary axillary hyperhidrosis and the effect of microwave therapy on these parameters. Patients received 1 or 2 microwave-based treatments, within 3-month intervals. All patients were finally examined at approximately 1 year after the first treatment using the Hyperhidrosis Disease Severity Scale, Hyperhidrosis Quality of Life©, Dermatology Life Quality Index, and Hospital Anxiety and Depression Scale©. A total of 103 individuals with primary axillary hyperhidrosis were included in the study, with a Hyperhidrosis Disease Severity Scale score of 3 or 4. Statistically significant improvement in quality of life, anxiety, and depression scores were observed at 1-year follow-up. The primary endpoint, Hyperhidrosis Disease Severity Scale of 2 or less 1 year after the first treatment, was achieved by 88.2% of patients. No serious adverse side effects were observed.

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]

Background: Pathologic evaluation of sentinel lymph node biopsy (SLNB) samples is crucial for axillary staging in patients newly diagnosed with breast cancer. Patients with pathologic evidence of nodal metastasis scheduled for upfront surgery typically also undergo axillary lymph node dissection (ALND). Although SLNB is the gold standard method for detecting nodal metastasis, axillary lymph node fine‐needle aspiration biopsy (FNAB) utility has not been thoroughly explored. Methods: Ultrasound‐guided axillary lymph node FNAB samples along with concurrent ipsilateral breast tissue samples were searched and reviewed. The control group included histologic findings of axillary dissection or intraoperative SLNB results. Results: A total of 354 axillary lymph node FNAB samples with matched histology were included. Of these, 187 (52.8%) were positive for metastatic carcinoma of breast origin; 143 (40.4%) were negative for metastasis; 12 (3.4%) showed atypical cells; six (1.7%) were suspicious for metastasis; and six (1.7%) were nondiagnostic because of a lack of lymphoid tissue and malignant cells. Of the 143 negative FNAB samples, 22 (15.4%) were positive on either intraoperative SLNB or ALND. When only the positive and negative FNAB samples were accounted for (n = 330; 93.2%), overall diagnostic sensitivity and specificity were 89.4% and 99.2%, respectively. Conclusions: Although axillary SLNB is the standard procedure for detecting nodal metastasis of breast origin, axillary lymph node FNAB appears to be a suitable alternative in a significant proportion of patients. A standard SLNB should be performed in cases of negative axillary lymph node FNAB findings, particularly nodes with abnormal imaging findings. The conventional approach for detecting nodal metastasis in patients with breast cancer is axillary sentinel lymph node biopsy. However, axillary lymph node fine‐needle aspiration biopsy (FNAB) is emerging as a viable alternative in a substantial proportion of cases. Axillary lymph node FNAB is beneficial in terms of its efficient turnaround time, cost‐effectiveness, and convenience for patients. [ABSTRACT FROM AUTHOR]

ObjectivesThe purpose of this research was to evaluate the differences between rectal and axillary temperature measurements in preterm infants who were born less than 32 weeks’ gestation using digital thermometers upon their admission to the Neonatal Intensive Care Unit (NICU).MethodsProspective, observational, single centre study. Rectal and axillary temperatures measurements were performed using a digital thermometer. The study examined various maternal and neonatal factors to describe the study group, including the use of prenatal corticosteroids, the occurrence of maternal diabetes and hypertension, a history of maternal prolonged rupture of membranes (PROM), maternal chorioamnionitis, the mode of delivery, along with the neonate's gender, birth weight, and gestational age. The Pearson correlation coefficient (R) was calculated to ascertain the linear relationship between the temperatures taken at the rectal and axillary sites. The concordance between the two sets of temperature data was analyzed using the Bland-Altman method.ResultsEighty infants with a mean gestational age of 28.4 weeks (SD = 2.9) and a mean birth weight of 1,229 g (SD = 456) were included in the study. The mean axillary temperature was 36.4 °C (SD = 0.7), which was lower than the mean rectal temperature of 36.6 °C (SD = 0.6) (p = 0.012). Rectal temperatures surpassed axillary measurements in 59% of instances, while the reverse was observed in 21% of cases. Rectal and axillary temperatures had a strong correlation (Pearson correlation coefficient of 0.915, p

Abstract 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.

Ovarian cancer is usually confined intraperitoneally. Distant metastases at presentation is unusual. Its spread via lymphatics is uncommon, and metastasis to axillary lymph nodes is very rare. We report two cases with presentation of axillary lymphadenopathy without breast involvement. Computed tomography scan identified the ovarian masses. Both had elevated Serum Ca 125. The first case had a Grade 2 ovarian endometrioid carcinoma. The second case had a high-grade serous ovarian carcinoma. These cases illustrate the rarity of axillary lymphadenopathy from ovarian cancer. It is important to identify the primary ovarian carcinoma in order to offer appropriate management. Despite surgery and chemotherapy, both succumbed within 3 years from diagnosis.

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]

Accessory breast tissue (supernumerary breast tissue) is due to the absence of regression of the primitive milk lines during embryonic life which extends from the axilla to the groin. It is mostly located in the axilla where it is often confused with the axillary extension of the breast, or any pathological process occurring in armpits. Ectopic mammary glands should not be misdiagnosed as it can potentially undergo the same pathological processes that occur in a normally located breast including benign or malignant breast tumors. We report the case of an intracystic papilloma arising from left axillary accessory breast tissue in a 63-year-old woman. The principal symptom was pain in a palpable left axillary mass without inflammatory signs. Subsequent imaging and histopathologic examination proved it to be a papillary tumor in ectopic breast tissue.

Abstract Background Echinococcosis is a multisystem disease that might affect all organs, especially the liver and the lungs among adults. Axillary hydatid cyst, an extremely uncommon disease, was rarely reported in the literature. We report herein a case of axillary hydatid cyst which revealed a disseminated hydatid disease among a previously healthy woman. Case presentation A previously healthy woman, aged 53 years old, presented with a painful mass in her right axillary region. Physical examination revealed a painful semi-mobile right axillary mass, of 12 cm in size. Thoracoabdominal computed tomography scan revealed numerous cystic lesions: right axillary, pulmonary, hepatic, pancreatic, splenic and intraperitoneal lesions. The diagnosis of disseminated hydatid disease was suspected in front of the cystic lesions and the positive serology result for hydatid disease. An excisional biopsy of the axillary mass lesion was performed, confirming the diagnosis of a hydatid cyst. The patient received albendazole after hospital discharge. Conclusions Although axillary hydatid cyst is an extremely uncommon disease, the diagnosis should be rule out in front of the presence of a mass in the axillary region. Imaging results associated with serological tests might suspect the diagnosis, which can only be confirmed with parasitological or/and histopathological examination. Its management include surgical and medical therapy.

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]

The absence of an adequate ileo-femoral access is usually considered an absolute contraindication to fenestrated and branched aortic repairs. Alternative routes and dedicated stent-graft designs have been advocated. Hereby, we describe the case of a 73-year-old man with a recurrent type IV thoracoabdominal aortic aneurysm and complete thrombotic pararenal aortic occlusion treated successfully with a tri-branch custom-made endograft deployed via a transaxillary access. [ABSTRACT FROM AUTHOR]

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.

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.

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]

Background: Accurate diagnosis of axillary lymph node metastasis (ALNM) of breast cancer patients is important to guide local and systemic treatment. Purpose: To evaluate the diagnostic performance of different imaging modalities for ALNM in patients with breast cancer. Study Type: Systematic review and network meta‐analysis (NMA). Subjects: Sixty‐one original articles with 8011 participants. Field Strength: 1.5 T and 3.0 T. Assessment: We used the QUADAS‐2 and QUADAS‐C tools to assess the risk of bias in eligible studies. The identified articles assessed ultrasonography (US), MRI, mammography, ultrasound elastography (UE), PET, CT, PET/CT, scintimammography, and PET/MRI. Statistical Analysis: We used random‐effects conventional meta‐analyses and Bayesian network meta‐analyses for data analyses. We used sensitivity and specificity, relative sensitivity and specificity, superiority index, and summary receiver operating characteristic curve (SROC) analysis to compare the diagnostic value of different imaging modalities. Results: Sixty‐one studies evaluated nine imaging modalities. At patient level, sensitivities of the nine imaging modalities ranged from 0.27 to 0.84 and specificities ranged from 0.84 to 0.95. Patient‐based NMA showed that UE had the highest superiority index (5.95) with the highest relative sensitivity of 1.13 (95% confidence interval [CI]: 0.93–1.29) among all imaging methods when compared to US. At lymph node level, MRI had the highest superiority index (6.91) with highest relative sensitivity of 1.13 (95% CI: 1.01–1.23) and highest relative specificity of 1.11 (95% CI: 0.95–1.23) among all imaging methods when compared to US. SROCs also showed that UE and MRI had the largest area under the curve (AUC) at patient level and lymph node level of 0.92 and 0.94, respectively. Data Conclusion: UE and MRI may be superior to other imaging modalities in the diagnosis of ALNM in breast cancer patients at the patient level and the lymph node level, respectively. Further studies are needed to provide high‐quality evidence to validate our findings. Evidence Level: 3 Technical Efficacy: Stage 2 [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]

Extramammary masses are infrequently encountered in breast examinations. They may occur in the chest wall and axilla as neighbors of the breast. It is important to determine the nature of the lesion. However, some benign tumors, such as granular cell tumors (GCTs), also show malignant characteristics, which leads to misdiagnosis. To the best of our knowledge, multimodal ultrasound features of GCT have not been elucidated. We report two cases of women with GCTs encountered upon breast cancer screening; the tumor was not located in breast tissue. The first patient was a 37-year-old woman who presented with a slow-growing mass in the right breast and the GCT was located in the pectoralis major muscle. The second patient was a 52-year-old woman who presented with a palpable left axillary mass and the GCT was located in the axilla. Mammography failed to detect the masses in the two patients upon breast cancer screening. However, two-dimensional ultrasonography revealed a solid heterogeneous hypoechoic mass. Shear wave elastography showed that the masses had an increased hardness compared with the surrounding tissue. Further contrast-enhanced ultrasonography showed that the contrast patterns of the two masses were different. In case one, contrast-enhanced ultrasonography showed an inhomogeneous annular high enhancement, and the dynamic curve showed rapid enhancement and regression. In case two, contrast enhanced ultrasound showed slight enhancement around the lesion but no enhancement inside. Postoperative pathology confirmed that the GCT was benign in both cases. The patients showed no signs of recurrence at the 2-year follow-up. Here, we report two cases and present the multimodal ultrasonography findings of this tumor for the first time. Radiologists and surgeons should be aware of these imaging manifestations and include them in their differential diagnoses. [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]

Hidradenitis suppurativa (HS) is a chronic recurrent debilitating condition that affects the skin near to the follicular glands. The disease manifests with the formation of abscesses that can be complicated by rupture, sinus tracts, and scarring leading to pain, chronic discharge, malodor, and scar contractures. The management of HS is multidisciplinary, involving general lifestyle modification, medical treatment, and surgery. A wide range of surgical interventions has been described for HS disease control and management. However, surgical management strategies are highly variable. We describe the case of a 33-year-old female with refractory HS which was reconstructed with Matriderm® and an immediate split-thickness skin graft. Acellular dermal skin substitutes may be an alternative to conventional means of HS reconstruction, producing subtle, pliable, and durable skin.

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]

Several methods have been used to detect infectious respiratory diseases, for example, by taking samples from blood, saliva, and phlegm. Although these methods generated high accuracy, they raised more problems that increased the risk of spreading and required more time to detect. Therefore, an accurate, quick, and low-cost device is required to help detect infectious respiratory diseases. This study proposes a new approach for detecting infectious respiratory diseases using an electronic nose (E-nose) through sweat samples from the human axilla. E-nose became safer by taking samples through the axillary because infectious respiratory diseases are not transmitted through sweat. This study proposes two new feature extraction techniques called stable value and highest slope. This study also proposes a stacked Deep Neural Network (DNN) for effective infectious respiratory disease detection. In the proposed stacked DNN, five fine-tuned DNN models obtained from hyperparameter tuning are stacked then the output of each DNN model became the input of the meta-model in the form of a fully connected layer. The proposed feature extraction method outperformed the existing feature extraction and was able to separate data between classes better. Furthermore, the proposed stacked DNN model generated an accuracy of 0.934 in the testing data, outperforming DNN single models and other state-of-the-art machine learning algorithms.

Upper extremity access sites are the preferred access sites for hemodialysis. With the improvement of the survival in dialysis population, most patients outlive the dialysis access lifespan. As such, some patients exhaust the vascular access options of the upper extremities, which necessitates the search for new access sites. While lower extremity grafts and hemodialysis reliable outflow devices are potential alternatives, these access sites are plagued with recurrent lesions at the venous anastomosis and subsequent thrombosis leading to poor access survival. Within this framework, the axillary-based dialysis access was developed to address these challenges. In this report, we describe a 70-year-old woman who exhausted her upper extremity access sites and eventually underwent a chest wall arteriovenous graft (AVG) that connected the right axillary artery to the right axillary vein. This chest wall AVG remained functional without any intervention for more than 3 years. In conclusion, chest wall AVG access can be a viable option for hemodialysis patients who have exhausted the access sites of the upper extremities, while potentially minimizing complications seen in other methods of vascular access.

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]

Polymastia or supernumerary breast is an anomaly of the embryonic development of the mammary gland resulting in ectopic breast tissue. We report an exceptional case of a unilateral axillary supernumerary breast in a 71-year-old patient which became enlarged after menopause. The diagnosis was confirmed on anatomopathological study which revealed no sign of malignancy otherwise. In our case, it was a proliferation of glandular tissue, without areola or nipple, rarely reported in the literature, and corresponding to Kajava class IV. The patient underwent surgical treatment in order to resolve the problem of aesthetic discomfort and to limit the risk of malignant transformation.

The primary objective of this study is to describe and illustrate the technique of ultrasound-guided percutaneous proximal axillary artery (PAA) access, and secondarily to evaluate the versatility and safety of this approach in peripheral, visceral, and aortic endovascular interventions. This is a single-center retrospective review of all peripheral, visceral, and aortic endovascular cases using percutaneous PAA access from February 2019 to March 2021 compared with a sample of an equivalent number of consecutive cases completed via percutaneous common femoral artery (CFA) access during the same time period. Access entry success, minor and major access site complications within 30 days, major adverse events within 30 days, demographics, and procedural details were analyzed using standard statistical analyses. A total of 115 accesses—59 PAA and 56 CFA—were reviewed during the study period. Group demographics were not significantly different. Access entry success was achieved in 58 (98.3%) and 56 (100%) of PAA and CFA accesses, respectively, with no statistically significant difference. There were no significant differences in minor access-site complications (13.6% vs 5.4%; P =.21) major access site complications (3.4% vs 7.1%; P =.43), or major adverse events (6.8% vs 5.4%). between the PAA and CFA groups. With respect to versatility, PAA cases had a significantly greater mean number of vessels intervened on per procedure compared with CFA access (2.59 ± 1.31 vs 1.95 ± 0.98; P <.01). A wide range of target vessels were intervened on in both groups. PAA cases had significantly more bilateral lower leg interventions (28.8% vs 12.5%; P =.04). PAA access had a significantly longer mean procedure time (103.2 minutes vs 58.63 minutes; P <.001) and fluoroscopy time (18.21 minutes vs 12.87 minutes; P =.02). The PAA is a feasible, versatile, and safe percutaneous access option for endovascular intervention. The in-line trajectory from this site facilitates visceral, renal, aortic, and bilateral lower extremity interventions with ease. Outcomes, complications, and major adverse events are similar to those of conventional CFA access in the short term. [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]

• In total, 241 patients underwent axillary intra-aortic balloon pump (IABP) support for heart failure. • Ambulation was possible in 90.0% during axillary IABP support. • Overall, 86.7% were successfully bridged to intended therapy. • IABP-related stroke occurred in 2.5%. The axillary intra-aortic balloon pump has an advantage over the femoral intra-aortic balloon pump in terms of mobility. While axillary intra-aortic balloon pump has been widely used recently as a mode of mechanical circulatory support, the number of reported cases is limited. The purpose of this study is to summarize our experience and to evaluate the safety and efficacy of axillary intra-aortic balloon pump support. Between July 2009 and July 2019, 241 patients underwent axillary intra-aortic balloon pump support for heart failure. The intended therapeutic goals were bridge to heart transplantation (n=146), left ventricular assist device (n=66), and recovery (n=29). Intra-aortic balloon pumps were inserted through a graft sutured onto the axillary artery in 142 patients (58.9%) and percutaneously in 99 patients (41.1%). It was placed from the right axillary artery in 147 patients (61.0%) and left in 94 patients (39.0%). Primary outcome measures of interest included achievement of intended therapeutic goal, hemodynamic data, ambulatory data, intra-aortic balloon pump-related death, and complications. Ambulation was possible in 217 patients (90.0%) during support. Hemodynamic parameters improved significantly after axillary intra-aortic balloon pump support. In total, 13 patients (5.4%) died and 10 patients (4.1%) required escalation of mechanical support. There were no deaths directly attributable to intra-aortic balloon pumps. Intra-aortic balloon pump-related stroke occurred in 6 patients (2.5%). Overall, 86.7% were successfully bridged to intended therapy (transplantation 90.4%, left ventricular assist device 90.9%, and recovery 58.6%). Axillary intra-aortic balloon pumps allow most patients to ambulate during support, improve hemodynamics, and lead to the intended goals successfully. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Determining the frequency of invasive breast cancer (IBC) immunophenotypes in the General County Hospital Vinkovci, examining a difference between the ages of patients with respect to immunophenotypes and axillary lymph node (ALN) status, and determining differences in the frequency of positive ALNs with respect to immunophenotypes and the proliferation index (Ki67), regardless of the immunophenotype. Materials and Methods: A monocentre cross-sectional study which included 289 patients diagnosed with invasive breast cancer was conducted in the period from 1 January 2011 to 31 December 2018. The expression of IBC biomarkers was determined by immunohistochemistry. Results: The most common immunophenotype (41.54 %) was luminal B-like HER2-negative (LumB/HER2-). The mean age was 65.24 (± 12.04), with no age difference with respect to immunophenotypes (F = 0.64, P = 0.43) or ALN status (t = 1.59; P = 0.11). A total of 167 patients (58 %) had their ALNs removed, 66 % of which were positive. LumB/HER2- appeared to have significantly more positive ALNs compared to the luminal A-like immunophenotype (P < 0.01), while a difference in the size of primary tumours between metastatic breast cancers of these two immunophenotypes has not been detected (P = 0.17). ALNs were more likely to be positive in those tumours with Ki67 values higher than 20 % compared to the tumours in which Ki67 was lower than or equal to 20 % (P < 0.01). Conclusions: LumB/HER2- is the most prevalent IBC immunophenotype in patients in our institution and has significantly more positive ALNs compared to the luminal A-like immunophenotype. Also, metastases to ALNs, regardless of the immunophenotype, are more common in patients with Ki67 higher than 20 % than in those with Ki67 lower than or equal to 20 %.

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]

Background: The axillary nerve (AXN) is one of the more commonly injured nerves during shoulder surgery. Prior anatomic studies of the AXN in adults were performed using cadaveric specimens with small sample sizes. Our research observes a larger cohort of magnetic resonance imaging (MRI) studies in order to gain a more representative sample of the course of the AXN and aid surgeons intraoperatively. Methods: High-resolution 3T MRI studies performed at our institution from January 2010 to June 2019 were reviewed. Four blinded reviewers with musculoskeletal radiology or orthopedic surgery training measured the distance of the AXN to the surgical neck of the humerus (SNH), the lateral tip of the acromion (LTA), and the inferior glenoid rim (IGR). Intraclass correlation coefficient was calculated to assess reliability between reviewers. The nerve location was assessed relative to rotator cuff tear status. Results: A total of 257 shoulder MRIs were included. Intraclass correlation coefficient was excellent at 0.80 for the SNH, 0.90 for the LTA, and 0.94 for the IGR. All intraobserver reliabilities were above 0.80. The mean distance from the AXN to SNH was 1.7 cm (range, 0.7-3.1 cm; interquartile range, 1.38-2.00) and that from the AXN to IGR was 1.6 cm (range, 0.6-2.6 cm; interquartile range, 1.33-1.88). The mean AXN to LTA distance was 7.1 cm, with a range of 5.2-9.0 cm across patient heights; there was a large effect size related to the LTA to AXN distance and patient height with a correlation of r = 0.603 (P < .001). Rotator cuff pathology appears to affect nerve location by increasing the distance between the AXN and SNH (P = .027). Discussion/Conclusion: The AXN is vulnerable to injury during both open and arthroscopic shoulder procedures. This injury can be either a result of direct trauma to the nerve or secondary to traction placed on the nerve with reconstructive procedures that distalize the humerus. Our study demonstrates that the AXN can be found as little as 5.6 mm from the IGR and 6.9 mm from the SNH. In addition, we illustrate the relationship between patient height and the LTA to AXN distance and complete rotator cuff tears and the SNH to AXN distance. Our study is the first to demonstrate the nerve's proximity to important surgical landmarks of the shoulder using a large sample size of high-resolution images in living human shoulders.

Since the human body reacts to a variety of different diseases with elevated body temperature, measurement of body temperature remains relevant in clinical practice. The absolute temperature value for fever definition is still arbitrary and depends on the measuring site, as well as underlying disease and individual factors. Hence, a simple threshold for fever definition is outdated and a definition which relies on the relative changes in the individual seems reasonable as it takes these individual factors into account. In this prospective multicentric study we validate an adhesive axillary thermometer (SteadyTemp®) which allows continuous non-invasive temperature measurements. It consists of a patch to measure temperature and a smartphone application to process and visualize gathered data. This article provides information of the new diagnostic possibilities when using this wearable device and where it could be beneficial. Furthermore, it discusses how to interpret the generated data and when it is not practical to use, based on its characteristics and physiological phenomena.