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PubMed2002

Significance of temperature difference between cerebral cortex and axilla in patients under hypothermia management.

It is believed that the brain temperature is about 1 degree C higher than the other peripheral temperature. But the result has been mostly obtained in normothermia patients. The objective of this study was to evaluate whether the brain temperature is still higher than the axillary one in the hypothermia patients. Sixty-three patients who underwent craniotomy with implantation of the thermal diffusion thermometer were included in this study. Fifty-four patients were in normothermia and nine patients were managed with mild to moderate hypothermia (about 32 degrees C). The temperature of the cerebral cortex and axilla was measured simultaneously every 2 hours. 1900 paired sample data were collected and analyzed. The temperature difference between the cerebral cortex and the axilla was 1.04 +/- 0.67 degrees C in normothermia patients and 0.91 +/- 0.84 degree C in hypothermic patients. The temperature difference has no statistical significance between the two groups (unpaired t-test, P > 0.05). Our results demonstrate that the brain temperature in the patients under hypothermia management appears to be still about 1 degree C higher than the axilla throughout the study period almost in the same fashion as in normothermia patients.

Adolescent↗
PubMed2000

Optimal management of the axilla in patients with breast cancer.

BACKGROUND: Although most surgeons perform some form of axillary lymph node dissection (ALND) as part of locoregional management of operable breast cancer, the extent of dissection remains controversial. PATIENTS AND METHODS: Observation of the axilla trial (protocol I) and partial dissection trial (protocol I) began in January 1996. Between January 1996 and May 2000, 45 post-menopausal and 207 women with clinically node-negative breast cancer were enrolled into protocol I and protocol II respectively. RESULTS: The 4-year cumulative incidence rate of axillary recurrence was 7% in patients with untreated the axilla. The 4-year overall survival rate was 98% in patients with untreated the axilla. The 4-year disease-free and overall survival rates were 96% and 98% respectively in patients treated with partial dissection. CONCLUSION: Total axillary dissection seems to be unnecessary in Japanese breast cancer patients with relatively small tumors.

Adult↗
PubMed2004

Regional radiotherapy to axilla and supraclavicular fossa for adjuvant breast treatment: a comparison of four techniques.

PURPOSE: The three techniques commonly used to treat the axilla and supraclavicular nodes in adjuvant radiotherapy all have significant disadvantages, including underdosing the deeper nodes, excessively irradiating normal tissues, or producing undesirable hot spots. We assessed whether an anterior field with posterior boost field to the axilla with customized compensation of the anterior beam (APcomp-PAboost) would minimize these drawbacks. METHODS AND MATERIALS: The axillary and supraclavicular nodal volumes, planning target volume (PTV), irradiated volume, and brachial plexus were contoured for 10 patients. The plans for each technique-single anterior field (AP); anterior to posterior parallel pair (AP-PA); anterior field with posterior boost (AP-PAboost); and APcomp-PAboost-were then generated for each patient using CadPlan and compared. RESULTS: The AP plan gave poor PTV coverage in 60% of cases. The AP-PA provided good PTV coverage and minimal hot spots, but resulted in consistent unnecessary RT to the medial posterior neck. The skin and tissue of the medial posterior neck and chest wall (i.e., the tissue overlying the posterior half of the ribs and posterior to the latissimus dorsi muscle, which forms the posterior wall of the axilla) was incidentally included in the radiation fields of the AP-PA and the exit of the AP beam. No nodal tissue is present in this region, and, therefore, this tissue was unnecessarily irradiated to higher doses with the AP-PA technique. The AP-PAboost provided adequate PTV coverage and a limited dose to the medial posterior neck, but produced hot spots in excess of 120% in 90% of cases. The APcomp-PAboost provided good PTV coverage, a limited dose to the medial posterior neck, and hot spots to <120% in all cases. CONCLUSION: In most cases, the APcomp-PAboost technique offered the best compromise, but the AP-PA technique may be preferred if a less intense hot spot is sought.

Axilla↗
PubMed1999

Management of the axilla in primary breast cancer.

Treatment of the axilla with either radiotherapy or surgery remains an integral part of the management of patients with invasive breast cancer. In general, the standard treatment of the axilla involves a partial ALND (surgical clearance of axillary nodes from levels I and II). There is as yet no evidence that axillary treatment improves survival, but the issue remains controversial. Axillary lymph node dissection is an effective staging procedure and is essential for local control of disease in the axilla, although, with increased emphasis on mammographic screening and early detection, the incidence of node-positive breast cancers is decreasing. Today, only about 30% to 40% of all invasive breast cancers are node-positive. Thus, in most cases, the potential morbidity of ALND could be avoided if the status of the axillary nodes were ascertained with a less invasive procedure. The SLNB may eventually prove to be a preferred alternative to routine ALND. It must first be demonstrated, however, that SLNB (without completion ALND) does not adversely affect outcome. Randomized controlled trials must address these concerns, and surgeons must await completion of these studies before accepting SLNB as the standard of care.

Axilla↗
PubMed2003

An evaluation of functional improvement following surgical corrections of severe burn scar contracture in the axilla.

This report present an evaluation 13 consecutive cases of severe burn scar contracture of the axilla and investigates the factors that influence functional improvement. The operation was performed at various times during the period from 3 months to 63 years after the initial burn wound healed. The active range of shoulder abduction before the operation in these patients was restricted to 30-90 degrees. The scar contractures in the axilla were released in all cases and the defects of the axillary region were covered with musculocutaneous flaps or fasciocutaneous flaps. Following operation rehabilitation was performed with the range of shoulder abduction had reached a plateau. The relations between the improved range of shoulder abduction, time to reach a stable range of abduction, patient age and duration of illness in each patient are discussed. Patient with long post-injury periods required a longer time to reach a stable range of abduction. Furthermore, the patients with an extremely long period before operation had difficulties such as nerve injury or stiff joint which restricted improvement. In conclusion, adequate surgical treatment in early period after occurrence of contracture is desirable for burn scar contracture of the axilla.

Adolescent↗
PubMed1994

[Ultrasound pathology of the axilla. Part II].

In comparison with other diagnostic modalities axillary sonography undoubtedly is highly valuable examining unclear palpation findings, in the staging of tumours with lymphatic drainage to the axilla and in posttherapeutic screening of cancer patients. Usually pathologic changes of the axilla are due to diseases of the lymph nodes. Infrequently there are soft tissue tumours, inflammations, diffuse changes of the axillary soft tissue, vascular diseases and pathologic findings of the shoulder joint. Provided the most common sonographic features of morphologic changes of the axillary tissues are known, sonography of the axilla is a very important diagnostic tool and is extremely helpful in deciding on further diagnostic and therapeutic procedures. Part I deals with the pathology of the axillary lymph nodes, whereas in part II pathological changes of the other soft tissues are discussed in detail.

Axilla↗
PubMed1993

[Sonographic pathology of the axilla. Part I].

In comparison with other diagnostic modalities axillary sonography undoubtedly is highly valuable in when examining unclear palpation findings, in the staging of tumours with lymphatic drainage to the axilla and in post-therapeutic screening of cancer patients. Usually pathologic changes of the axilla are due to diseases of the lymph nodes. Infrequently there are soft tissue tumours, inflammations, diffuse changes of the axillary soft tissue, vascular diseases and pathologic findings of the shoulder joint. Provided the most common sonographic features of morphologic changes of the axillary tissues are known, sonography of the axilla is a very important diagnostic tool and is extremely helpful in deciding on further diagnostic and therapeutic procedures. Part I deals with the pathology of the axillary lymph nodes, whereas in part II pathological changes of the other soft tissues are discussed in detail.

Axilla↗
PubMed2006

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

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

Adult↗
PubMed2004

Drainage across midline to sentinel nodes in the contralateral axilla in breast cancer.

The authors report a case of recurrent breast carcinoma in the right chest in a patient who earlier had a right breast mastectomy. Injection of Tc-99m sulfur colloid into the lesion site in the right midchest revealed drainage to a very faint node in the contralateral axilla on the left, an unexpected site, and none to the ipsilateral axilla, the expected site. Disease was found in the left axilla in the sentinel nodes. Lymphoscintigraphy added valuable information in the management of this patient.

Adult↗
PubMed2000

Double involvement of extramammary Paget's disease in the genitalia and axilla.

We here reported a case of an 82-year-old man with double involvement of extramammary Paget's disease in the genitalia and axilla. Physical examination revealed erythema and reddish tumors on the pubic area and scrotum and irregular-shaped erythema on the left axilla. The skin biopsy sample from the genital area showed Paget's cells in the epidermis and upper dermis. The specimen from the left axilla showed Paget's cells scattered in the epidermis but not in the dermis.

Aged↗
PubMed1980

Thermal features of the female axilla.

Axillary (Tax), vaginal (Tv), and sublingual (Tsl) temperatures were measured in 12 women between 0600 and 0730 h prior to their arising from bed. Isothermal maps made of closed axilla 30 min after thermojunctions had been inserted showed a distribution of several temperatures, the lowest Tv-Tax isotherm occupying approximately 40% of the anteroposterior distance. Tax at this point was 0.1 to 0.5 degrees C less than Tv and -0.03 to 0.26 degrees C less than Tsl. The time course of Tax rise varied considerably among subjects, with the slowest still rising 30 min after insertion, whereas the fastest was almost steady after 3 min. The width of the 0.5 degrees C isotherm along the fold averaged 5.8 cm and occupied about 60% of the axillary width. A significant negative correlation was noted between width of the 0.5 degrees C isotherm and Tv-Tax. Effects on the time course of 1) preexposure to air of the axilla for 5 min and 2) different initial thermometer temperatures (10 and 30 degrees C) were studied in 6 women. Analysis of variance showed a significantly higher value of Tax (10 min)-Tax (3 min), i.e., a slower time course with the cooler thermometer. The effects of exposure of the axilla were much more pronounced.

Adult↗
PubMed2000

Fibroadenoma of the supernumerary breast of the axilla.

Supernumerary breast or polymastia is a well documented anomaly of the breast, and commonly presents along the embryonic milk line extending between the axilla and groin. However, cases of polymastia have been recorded in the face, vulva and perineum. The clinical significances of these anomalies include their susceptibility to inflammatory and malignant changes, and their association with other congenital anomalies of the urinary and cardiovascular systems. The present article reports a case of fibroadenoma developing in the supernumerary breast of the right axilla in a 28 year old woman. Clinical and mammography examination of both breasts revealed no abnormalities and no lymph nodes were detected in the axillae or the neck. No associated urologic or cardiovascular abnormalities were found, and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated intracanalicular type of fibroadenoma similar to that of eutopic mammary tissue. The article also outlines the common congenital anomalies of the breast, and emphasizes on their proper clinical assessment for any other associated anomaly together with adequate surgical excision and regular follow up of the treated patients.

Adult↗
PubMed2004

[Repairing the defects in the chest, back and axilla with a split-breast flap].

OBJECTIVE: To evaluate a method to repair the defects after the secondary tumor excision and radiation ulcer in the chest, back and axilla. METHODS: Eight patients, with the defects after the secondary tumor excision and the radiation ulcer in the chest, back and axilla, were undergoing the treatment. A "T" shape incision or up-side-down "T" shape incision was designed above the breast or along the inframammary fold below breast, just close to the defect. A split-breast flap was raised above the pectoralis major or deep fascia. The defect was then repaired with a rotating and advancing way. RESULTS: Eight patients were repaired in one stage. Blood circulation of the flaps was abundant except one with distal edge necrosis. The ptosis breast was corrected and the fullness of the chest wall was also achieved. But, the Nipple of the opposite health breast was lost the original position to the lateral or medial. CONCLUSIONS: The above-mentioned technique may be an efficient method to repair the defects after the secondary tumor excision and radiation ulcer in the chest, back and axilla. It is adapt to the old patients whose health is worse, but it is not good for the young patients resulted from the injury breast.

Adult↗
PubMed2002

The role of lymph node sampling and radiotherapy in the management of the axilla in early breast cancer.

Management of the axilla in early breast cancer is an issue of ongoing debate. We reviewed our experience in 312 patients who underwent axillary lymph node sampling between 1994 and 1998, of whom 81 patients (24%) had axillary lymph node metastasis. There have been two axillary recurrences, one associated with local recurrence to the breast and one presenting with distant metastasis. There were no patients with isolated axillary disease as their only site of recurrence and no axillary failures in the node-positive group treated with axillary sampling and radiotherapy. Axillary lymph node sampling effectively stages the axilla. This can safely be followed by radiotherapy to the axilla in case of lymph node metastasis. Axillary lymph node sampling forms a sound basis to develop new techniques, such as sentinel lymph node biopsy currently investigated by ongoing trials.

Journal Article↗
PubMed1993

Reflex reversal of nostril dominance by application of pressure to the axilla by a crutch.

Effect of pressure application by a crutch to the axilla of the side of the dominant right nostril on the pattern of nostril dominance with emphasis on the time sequence of changes and recovery was studied in the young male Nigerians. The nostril dominance was assessed from the percentage of tidal volume flowing through the right and left nostril passages during expiratory phase (7). Application of pressure to right axilla for 20 min caused tidal volume flowing through left nostril to change from the control value of 20.3 +/- 15.8% (SD) to 74.1 +/- 10.4% while the rest of the tidal volume passed through the right nostril. The effect started in the first minute; air flow through both nostrils was equalized by 4 min; reversal of nostril dominance occurred thenceforth; and peak change was obtained by 17 min after application of pressure to the axilla. Removal of crutch could not lead to recovery.

Adolescent↗
PubMed1987

Axilla skin biopsy: a reliable test for the diagnosis of Lafora's disease.

Skin biopsies from the axilla were examined in 7 patients with clinical signs and symptoms of Lafora's disease, in 9 relatives (7 parents and 2 siblings), and in 17 patients with chronic or progressive degenerative neurological disorders and chronic epilepsy, who served as controls. In the biopsies of all patients with Lafora's disease, typical periodic acid-Schiff (PAS)-positive inclusions were present in the myoepithelial cells of the secretory acini of the apocrine glands and/or in the cells of the eccrine duct. No abnormalities were found in the biopsies from relatives and controls. We conclude that axilla skin biopsy is an easy and reliable test for diagnosing Lafora's disease, and is preferable to liver biopsy, but has no value for carrier detection.

Axilla↗
PubMed1991

Adult polyglucosan body disease: the diagnostic value of axilla skin biopsy.

The diagnostic value of axilla skin biopsy has been investigated in a patient with adult polyglucosan body disease. The biopsy data have been compared with those of control subjects and with those from previously reported patients with Lafora's disease. In a patient with adult polyglucosan body disease and in patients with Lafora's disease, an abundance of polyglucosan bodies was found in the myoepithelial cells of the axillary apocrine glands. In the control group of subjects, polyglucosan bodies were only sporadically seen. Axilla skin biopsy is, therefore, an easy and reliable method for confirming the diagnosis of adult polyglucosan body disease.

Adolescent↗
PubMed2006

Clinical implications of sentinel nodes outside the axilla and internal mammary chain in patients with breast cancer.

PURPOSE: The aim of this study was to determine the incidence, location, surgical identification rate, tumor status, and clinical implications of sentinel nodes outside the axilla and internal mammary chain. PATIENTS AND METHODS: In 785 breast cancer patients, pre-operative lymphoscintigraphy was performed after intratumoral injection of 116 MBq 99mTc-labeled nanocolloid (0.2 ml; 3.1 mCi). Sentinel nodes were pursued using a gamma-ray detection probe and vital blue dye. RESULTS: Lymphoscintigraphy visualized sentinel nodes outside the axilla and internal mammary chain in 91 of the 785 patients (12%). Sentinel nodes (106) were identified in 80 patients. These nodes were found in the following locations: 50 in the breast, 31 in the infraclavicular fossa, 19 between the pectoral muscles, and 6 within the supraclavicular bed. Eighteen nodes contained a metastasis (17%) and were removed from 16 patients. The treatment strategy was adjusted in 12 of them with the addition of adjuvant local or systemic therapy. Two additional patients with an unusually situated tumor-negative sentinel node were spared an axillary node dissection that would otherwise have been performed. CONCLUSION: Unusually situated sentinel nodes were visualized in 12% of the patients. The treatment was adjusted in 18% of patients in whom these nodes were identified.

Adolescent↗