A型肉毒毒素注射治疗腋窝多汗症或伴腋臭症

目的 探讨A型肉毒毒素(botulinum toxin-A,BTX-A)注射治疗腋窝多汗症或伴腋臭症及单纯液臭的疗效.方法 采用BTX-A每侧腋窝注射50 U治疗,注射选点25个,间距1.5 cm,每点注射2.5 U.结果 共治疗特发性局限性腋窝多汗症或伴腋臭患者42例,其中单纯腋窝多汗症24例全部有效.腋窝多汗症伴有腋臭10例,其中注射后多汗症治疗全部有效,腋臭治疗有效者只有1例.单纯腋臭8例,碘淀粉试验阴性,注射后只有1例显效,无效7例.结论 BTX-A治疗腋窝多汗症有效,副作用轻微、一过性.BTX-A治疗多汗症所伴有的腋臭疗效欠佳,对单纯的腋臭治疗基本无效.     

Gigantomastia with bilateral axillary breasts: Acute onset in pregnancy

The case of a young pregnant woman who developed an acute gigantomastia during pregnancy is presented, in addition to the unusual finding of bilateral axillary breasts. The condition was treated by simple mastectomy and immediate reconstruction with a subpectoral silicone implant. The literature is reviewed, and this rare combination of pathology is discussed.     

肱二头肌和三角肌肌支在臂丛的定位及其临床意义

目的：研究肱二头肌和三角肌肌支在臂丛中的定位。方法：通过对１０具尸体双侧肱二头肌及三角肌肌支的解剖，观察其纤维定位，并测定其截面积。结果：在腋部肱二头肌和三角肌肌支分别位于相应神经的外侧份，其截面积分别占主干截面积的３４％和５３％。在锁骨上，肱二头肌肌支位于上干前股的前正中和前外侧份，其截面积占上干前股的３４％，三角肌肌支位于上干后股的后正中和后外侧份，其截面积占上干后股的３７％。结论：在神经移植或移位手术中，应尽可能将动力神经缝接至肌支相应的神经束上，以提高疗效。     

新生儿双侧腋静脉留置套管交替滴注多巴胺的临床观察

目的观察新生儿双侧腋静脉留置套管交替滴注多巴胺延长留置针平均静脉输液的时间。方法将需多巴胺静脉滴注的新生儿随机分成对照组和试验组。对照组采用四肢静脉持续滴注多巴胺，试验组采用双侧腋静脉交替输入药液。发现穿刺部位皮肤苍白或暗红即拔针。结果试验组腋静脉留置针平均静脉输液时间≥5d，四肢静脉留置针平均静脉输液时间〈5d，差异有显著性（P〈0．01）。结论双侧腋静脉交替滴注多巴胺能减轻血管的损伤。     

Role of frozen section in sentinel lymph node biopsy for breast cancer in the era of the ACOSOG Z0011 and IBCSG 23-10 trials

Background

Intraoperative frozen sections (FS) of sentinel lymph nodes (SLN) were evaluated to avoid the need for deferred axillary lymph node dissection (ALND) in patients with early breast cancer (EBC). However, FS has low sensitivity for detecting micro-metastases (<2 mm), resulting in patients who later undergo deferred ALND. The aim of the study was to determine the best clinical approach for selecting patients who would derive real benefit from ALND, as well as to minimize the functional and psychological damage caused by delayed surgery, and the risk of undertreating EBC patients.

剖胸术后术侧与健侧腋温的比较分析

目的 观察剖胸手术后患者术侧与健侧腋温的变化与差异，为确定测温部位及临床病情观察提供准确依据。方法 自身对照法。结果 术前患者两侧腋温无差异（P〉0．05）；术后患者术侧与健侧腋温具有高度显著性差异（P〈0．01）。结论 剖胸术后患者测试体温应选择健侧腋窝。     

A quantitative analysis of tumour characteristics in breast cancer patients with extranodal extension in non-sentinel nodes

BackgroundThe presence of extranodal extension (ENE) is well documented as a predictor of non-sentinel lymph node (NSLN) metastasis. The ACOSOG Z0011 trial (2011) concluded that patients who satisfy criteria including the absence of sentinel lymph node (SLN) ENE can forgo axillary clearance (AC). Currently there are no studies analysing the rate of ENE in NSLN metastasis in which the sentinel node was positive but had no ENE. Determining this incidence will help determine if current paradigms are resulting in residual ENE in NSLN metastasis by forgoing AC based on the Z0011 trial..MethodsThis study determined incidence of ENE at NSLN metastasis in patients with a positive SLN biopsy without ENE in 162 symptomatic breast cancer patients who underwent AC between 2009 and 2014 at Cork University Hospital Breast Cancer Service, a teaching hospital of University College Cork.ResultsOf 965 sentinel node biopsies performed 251 were identified as SLN positive, 162 (64.5%) underwent further AC. Of the 162 patients, 56.8% (92/162) were positive for ENE at SLN, of these 57.6% (53/92) had NSLN metastasis versus 17.1% (12/70) in the ENE-negative group (χ² test; P < 0.001). On adjusted analysis, ENE at the SLN was a significant predictor of NSLN metastasis (odds ratio [OR] 8.63; 95% confidence interval [CI] 3.26–22.86; P < 0.001). The incidence of NSLN-ENE in patients without SLN-ENE was 1/70 (1.4%) compared with 33.7% (31/92) in patients who had ENE at the SLN (χ² test; P < 0.001).ConclusionENE at the SLN is an independent predictor of NSLN involvement; its absence significantly reduces the likelihood of ENE in NSLN metastasis..     

Is OSNA better than imprint cytology for intraoperative diagnosis of cancer involvement of axillary sentinel node in breast cancer?

ObjectiveThe study aim was to establish Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value (NPV), and Accuracy Values of both imprint cytology (IC) and the OSNA assay for intraoperative assessment of axillary sentinel node (SN) cancer involvement in breast cancer. Specifically, we wished to find out if true positive and false negative results of IC were associated to axillary lymphadenectomy (ALND). Also, we addressed a comparative cost analysis between techniques.Methods244 patients treated for breast cancer in the Breast Unit of Hospital Germans Trias i Pujol from 2011 to 2015 were prospectively included. A transversal, consecutive design was applied to assess IC compared to the reference test (OSNA). Inclusion criteria were: T1 and T2 tumors with negative nodes, both clinically and on ultrasound.ResultsSensitivity of IC for macrometastases was 70%. The NPV of IC for macrometastases was 95,75%. Accuracy of IC was 96,12%. In the comparative cost analysis, the release time of results for OSNA doubled that of IC and was associated with an increased cost of € 370.ConclusionsIC has been stated as a good technique for intraoperative cancer involvement SN with high sensitivity and NPV compared to the OSNA assay. It allows keeping the whole node tissue and thus the possibility of improved histopathological evaluation, which can be useful for adjuvant, and offers the advantage of being less time consuming. Cost analysis shows a higher cost for OSNA, which may exceed the benefit of sorting out false negatives from IC.