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At least 145 records · Page 8Linked to original sources
PubMed1983

Intraoperative brachial plexus injuries during reconstruction of the burned axilla.

Since opening of the Shriners Burns Institute, Cincinnati Unit, 501 operations for release of burn scar-related contractures of the axilla have been carried out with skin grafting. Six of these cases, 1.2%, resulted in intraoperative stretch injuries to the brachial plexus. In two cases, isolated axillary nerve involvement was encountered. In four cases, additional diffuse injury to the brachial plexus was present. Intraoperative motion and postoperative splinting in a position of abduction were believed to be possible etiological agents. Prompt removal of the splint and institution of physical therapy were carried out. In all cases, there was full return of neurologic function. Indications for surgery were preoperative limitation of abduction at the shoulder due to scar in five cases; one operation was performed for cosmetically disfiguring webbing. Final range of motion, 1 year postoperatively, was normal in all cases. Time to full recovery varied from 2 to 9 months. The importance of preventing the problem by keeping intraoperative motion to a minimum and checking neurologic function promptly in the postoperative period is stressed.

Adolescent↗
PubMed1997

Audit of a conservative management policy of the axilla in elderly patients with operable breast cancer.

Between April 1982 and February 1994, 344 women aged > 70 years with cancers < 5 cm in diameter were treated at the City Hospital Breast Unit. The majority were enrolled in two successive randomized trials. One hundred and sixty patients had primary therapy with tamoxifen alone and were subsequently treated with mastectomy if the primary cancer progressed. Fifty-three women with a high oestrogen receptor (ER) status in the tumour received mastectomy and post-operative tamoxifen. One hundred and thirty-one patients underwent primary surgery (104, mastectomy; 27, wide local excision) and did not receive adjuvant tamoxifen. Only the 184 (131 + 53) patients who underwent primary definitive surgery have been included in this study. Patients undergoing primary surgery without palpable lymph nodes (n = 159) did not undergo axillary exploration. Twenty-five women who were noted pre-operatively to have clinically palpable lymph nodes underwent excision of obviously enlarged lymph nodes in the axilla in addition to primary surgery; small nodes that measured less than around 1 cm were left in place. None received axillary clearance or axillary irradiation. The median follow-up is 54 months. Twenty-three of 159 (14%) patients without palpable nodes, and four of 25 (16%) with palpable nodes, have subsequently developed axillary recurrence. Grade 3 tumours were associated with a higher rate of regional recurrence. Regional relapse was treated successfully with different therapeutic modalities (surgery, radiotherapy or endocrine manipulation) and none have died from uncontrolled regional disease.

Aged↗
PubMed1998

Staging the axilla in breast cancer: an audit of lymph-node retrieval in one U.K. regional centre.

AIMS: Many surgeons undertake a level 1 axillary dissection in patients with invasive breast cancer. This dissection yields a variable number of lymph nodes for histological study. In this study, we report the consequences of this policy for staging of the axilla. METHODS: Between January 1995 and December 1995, 236 patients with a diagnosis of invasive breast cancer underwent axillary surgery. RESULTS: A median of eight nodes was identified (range 0-30). In only 11 patients less than four nodes were identified. An increase in the number of nodes harvested was associated with a higher proportion of node-positive patients and a higher number of metastatic nodes identified. CONCLUSIONS: We concluded that a standardized approach to axillary dissection consistently yields an adequate sample of lymph nodes for staging purposes. Most importantly, larger node samples yield higher detection rates for metastasis. This has a significant bearing on patient selection for adjuvant chemotherapy when compared with more limited sampling practices, including solitary sentinel node detection and biopsy.

Adult↗
PubMed2003

Microbial pathways leading to steroidal malodour in the axilla.

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

Androstadienes↗
PubMed2004

[Myositis ossificans circumscripta in the axilla].

Myositis ossificans circumscripta (MOC) is a rare benign hereditary disorder characterized by heterotopic bone formation in soft tissue and muscle. This disorder is rarely seen in childhood. MOC is most commonly located in the extremities. We describe a 15-year-old girl with nontraumatic MOC in the axilla. Imaging studies (radiographic, ultrasound) did not provide the correct diagnosis and did not rule out malignancy. Incisional biopsy of the mass and histopathologic examination gave the diagnosis of MOC. Some reports suggest that magnetic resonance imaging may be the first-choice diagnostic option and may avoid unnecessary biopsy. However, in many cases diagnosis is still histological. Differential diagnosis between these lesions and malignant sarcomas and fibrodysplasia ossificans progressiva is required. This entity has a good prognosis in childhood.

Adolescent↗
PubMed2002

New technique to assess the axilla for breast cancer metastases using cell separation technology.

INTRODUCTION: Accurate staging of the axilla for metastatic disease is critical in deciding on the optimal management of patients with breast cancer. Lymph node status is the most powerful prognostic factor. Current standard surgical management of breast cancer involves axillary dissection for staging. Pathological staging by routine histology, however, is known to understage the disease extent because only one or two sections are taken from each node, a sampling of less than 1% of most nodes. Sentinel node biopsy is currently under trial to determine if thorough pathological staging of the most likely involved node is more accurate than standard pathological assessment of all nodes. The present pilot study was undertaken to investigate an alternative method of assessing all axillary nodes for cancer cells. METHODS: After routine material was taken from lymph nodes for standard pathological assessment, discarded parts of nodes were used for the study technique. These node parts were mechanically disaggregated, and the cell suspension centrifuged on a density gradient to separate any tumour cells (into the pellet) from lymphocytes (at the top of the gradient). The pellet was then assessed by haematoxylin and eosin and immunohistochemistry. RESULTS: The results of the present study proved highly significant. The technique detected metastatic cells in three nodes which were negative on routine pathology, in one case changing the status of the patient from node-negative to node-positive. DISCUSSION: It is concluded that the technique examined in the present paper has the potential to reduce sampling error, may offer far more accurate axillary staging than routine histopathology, and should be further evaluated in a controlled trial.

Axilla↗
PubMed2001

Buzz in the axilla: a new physical sign in hemodialysis forearm graft evaluation.

The value of physical signs in predicting flow rates or polytetrafluoroethylene (PTFE) hemodialysis graft survival is not well known. Simultaneous physical examination and flow measurements were performed in 67 dialysis patients with PTFE grafts over a period of 1 month. Physical signs included the presence and location of a palpable thrill, location and auscultatory nature of the bruit, and presence or absence of a pulsation. Patients were followed up for 1 year to detect the time to failure defined by angioplasty, clotting, or surgical revision. There was a fair correlation between physical signs and graft flow rates. In a multivariate model, systolic blood pressure, location of the thrill, and patient age were the best predictors of graft flow. During follow-up, there were 68 graft failures (30 grafts, angioplasty alone; 38 grafts, thrombosis followed by interventional or surgical revisions). The median survival of a graft without a thrill in the axilla was 154 days compared with 321 days when a thrill was present (P = 0.05, log-rank test). Dialysis graft physical examination is a useful test to predict graft flows, as well as graft failure. The single best test is the location of the thrill along the venous limb of the graft. Average flow rates for no thrill, thrill but distal to the midarm, and axillary buzz were approximately 500, 750, and 1,000 mL/min, respectively. This single physical sign also correlated with subsequent graft failure and should be incorporated into physical examinations of all dialysis grafts.

Arteriovenous Shunt, Surgical↗
PubMed2002

The sentinel node negative axilla: is it a no-go zone?

The technique of sentinel node biopsy (SNB) presents a great opportunity to reduce the morbidity of surgical treatment of breast cancer. Using either dye, isotope or a combination, after completing a learning process a sensitivity of 80-99% may be achieved. Most surgeons would aim for a sensitivity of 95% but this will mean that 5% of patients will be under-staged, with disease within the axilla and possibly inappropriate advice with regard to adjuvant systemic therapy. Injudicious use of sentinel biopsy will lead to more local relapses and may diminish or neutralize gains from systemic therapy.

Axilla↗
PubMed1998

[Preoperative axilla sonography in breast tumor suspected of malignancy--a diagnostic advantage?].

PURPOSE: To assess the value of preoperative axillary sonography possibly malignant for breast tumours. METHOD: We performed preoperative axillary sonography on 89 patients with suspicious breast tumours. In 78 cases, among which there were 74 invasive carcinomas, the surgery that followed included an axillary lymph node dissection and a comparison with the histology was possible. RESULTS: The sonographic detection of axillary lymph node metastases has a sensitivity of 90% and a specificity of 91.7% in relation to all tumour stages and a sensitivity of 100% and specificity of 89.6% in relation to T1 tumours. In our analysis, therefore, it is vastly superior to a clinical examination of the axilla. CONCLUSION: Ultrasonography is an accurate imaging method for the diagnosis of axillary lymph node metastases. Broadening this analysis to include more patients will validate this conclusion. The results of our preliminary study suggest that this diagnostic method could help reduce unnecessary radical surgery in the treatment of breast cancer.

Adenocarcinoma↗
PubMedDate not supplied

[Mamma aberrata in the axilla--case report and review of literature].

BACKGROUND: Polymastia is a common developmental abnormality of the breast. Supernumerary breast tissue usually develops along the mammary line. Polymastia in the most woman has been diagnosed by hormonal influence, cancer or other pathologic changes. PATIENTS: We report a localisation of polymastia in the axilla of a 14 year old girl. The lesion was removed to microscopic examination and to eliminate the possibility of a malignancy developing.

Adolescent↗
PubMedDate not supplied

Clinical importance of the muscular arch of the axilla (axillopectoral muscle, Langer's axillary arch).

The muscular arch of the axilla is described in a male cadaver on the left side. The condition may be the result of a factor affecting the intrauterin development. Because this muscular arch causes difficulties in staging lymph nodes, axillary surgery, thoracic outlet syndrome, shoulder instability or cosmetic problems, it should be kept in mind for axillary pathologies.

Axilla↗
PubMed1975

The sexual significance of the axillae.

The present paper will review the existing material on the relationships between the axillae and sexuality, present examples of the relationship from clinical practice, everyday life, art, anthropology, mythology, and literature, and consider the relevant human and primate physiological knowledge.

Anthropology↗
PubMed2006

Porokeratosis of Mibelli of the axillae: treatment with topical imiquimod.

Porokeratosis of Mibelli is a rare genodermatosis characterized by a disorder of keratinization. None of the currently available therapies is effective in all cases and this situation exposes the patient to multiple treatment cycles. We describe the successful use of topical imiquimod 5% cream in the management of porokeratosis of Mibelli of the axillae in a 12-year-old girl. Treatment with imiquimod was effective, probably due to the area of application, where large hydrated skin folds are found, which helps penetration of the drug on the stratum corneum.

Adjuvants, Immunologic↗
PubMed1992

Fatal tracheal compression after haemorrhage into the axilla.

We report a case of fatal ventilatory obstruction as a result of haemorrhage into the axilla after a comminuted spiral fracture of the upper one-third of the humerus. Guidelines are presented as to the early recognition of such complications and their subsequent management.

Aged↗
PubMed2001

Management of the axilla in breast cancer: a comparative study between sentinel lymph node biopsy and four-node sampling procedure.

BACKGROUND: The aim of this study was to compare the efficacy of sentinel lymph node biopsy and that of four-node sampling for predicting other nodal status in breast cancer. METHODS: 206 patients with operable breast cancer were enrolled. The identification of sentinel lymph nodes (SLNs) was carried out in 110 patients using a gamma probe after injection of radioactive tin colloids. Four palpable lymph nodes (FNs) were removed from the lower axilla at the first step of axillary dissection in 98 patients. The predictive value of nodal status was compared between SLNs and FNs, based on the pathological findings of all dissected lymph nodes. To examine the relationship between SLNs and FNs, we chose the FNs retrospectively (defined as rFNs) from among all nodes in SLNs. RESULTS: SLNs were identified in 108 (98%) of 110 patients. With one patient having skip metastasis, the accuracy and sensitivity were 99 and 98%, respectively. In the four-node sampling (FNS) group, two in 98 patients had skip metastasis and the accuracy and sensitivity were 98 and 96%, respectively. Findings on the relationship between these methods of biopsy were as follows: (i) rFNs included SLNs in 79 patients (73%); (ii) rFNs partially included SLNs in 24 patients (22%); and (iii) no relationship was evident in five patients (5%). CONCLUSIONS: The accuracy/sensitivity of FNs was comparable to that of SLNs. FNS can be considered to represent a highly promising approach and may be used as an alternative procedure that can be performed safely and easily in any institute.

Adult↗
PubMed1991

Diagnosis of Lafora's disease in apocrine sweat glands of the axilla.

A case of Lafora's disease diagnosed by skin biopsy is reported. Lafora's bodies, the hallmark of myoclonal epilepsy, were present in the epithelial cells of the apocrine glands. Therefore, the skin biopsy of the axilla proved to be very useful in the diagnosis of this entity. A striking feature of the case was that Lafora's bodies were only found in apocrine glands, whereas the eccrine glands were free of them.

Adult↗
PubMed2002

Extramammary Paget Disease of the Axilla Associated With Comedo-like Apocrine Carcinoma In Situ.

Extramammary Paget disease of the axilla with underlying apocrine carcinoma has been reported only in six cases until now. This report deals with a seventh case characterized by the unique finding of comedo-like features evocative of large cell ductal breast carcinoma within an otherwise typical in situ apocrine carcinoma. This is characterized by spiral-shaped foci of epithelial proliferation with decapitation secretion and central masses of necrotic debris. A possible connection between the solid neoplasm and the overlying Paget disease is illustrated by a few apocrine-follicular units colonized by both the Paget cells and the structured adenocarcinoma. Here, although they display the same immunohistologic pattern of glandular differentiation, the two populations seem to be cytologically different and do not show signs of gradual transition to one another. Thus, they give the impression of parallel but distinct processes, which is consistent with the hypothesis of proliferative induction of a preexisting intraepidermal scattered population from the underlying adnexal carcinoma. The observed resemblance between apocrine carcinoma and comedo carcinoma of the breast, with its ontogenetic and phylogenetic implications, links not only the two neoplasms and the corresponding glands of origin but also mammary and extramammary Paget disease. This reinforces the unifying conception of Paget disease.

Aged↗
PubMed1994

Management of the axilla in patients with breast cancers one centimeter or smaller.

Very small breast cancers are being diagnosed with increased frequency, and, until recently, little information regarding the incidence of axillary lymph node metastases in these most favorable tumors was available. Moreover, scarce data exist regarding axillary failure in this cohort as a function of initial treatment, be it surgery, radiation, or simply observation. In the present study, limited to women with invasive cancers measuring no more than 10 mm, the incidence of pathologically positive axillary nodes was 12.3%. The incidence of nodal metastases was influenced by tumor size (albeit not quite significantly, p = .08); not one patient with a tumor < or = 5 mm had axillary node metastases, compared to 14.7% in those with cancers 6 to 10 mm. The histologic grade and tumor location were also important in predicting nodal positivity. The incidence of positive nodes was 38% in those with poorly differentiated cancers, compared to 8% and 7% in women with well and moderately differentiated cancers, respectively, p = .03. Axillary nodal positivity was seen in 17% of outer quadrant vs 3% of central and inner quadrant primaries, p < .01. The axilla was managed with surgery alone (76%), radiation alone (6%), surgery and radiation (6%), or simply observation (10%). With a median follow-up of 55 months, not one patient has suffered a nodal recurrence, and in our experience, survival free of distant relapse was not adversely affected by the omission of axillary surgery.

Axilla↗