Evaluation of axillary lymphadenectomy without axillary drainage for patients undergoing breast-conserving therapy

Background: The routine use of drainage after axillary node dissection in patients undergoing breast-conserving therapy (BCT) is being questioned. To determine the value of routine drainage, we evaluated the postoperative course of patients with primary breast carcinoma who underwent axillary dissection with or without axillary drainage. Methods: A retrospective review of 69 patients prompted a prospective randomized trial of 46 patients undergoing BCT at our tertiary cancer center. Variables studied were age, treatment (drain or no drain), number and tumor status of excised lymph nodes, size of primary tumor, duration of drainage or aspiration, number and volume of aspirations, number of office visits, incidence of complications and degree of pain, change in arm or forearm circumference, and body mass index (BMI). Data from prospective and retrospective studies were pooled for analysis. Results: Of 115 patients, 72 were treated with a drain (Drain group) and 43 were not (No-drain group). Overall there was no difference in the number or tumor status of excised nodes, the size of the primary tumor, or the incidence of complications between the two groups. Aspiration was required in 50% of the No-drain patients and 8.3% of the Drain patients. The incidence of drain placement or replacement postoperatively was 9.3% for the No-drain patients and 4.2% for the Drain patients. The No-drain patients had more office visits (5.1±0.4 vs. 3.6±0.1;P=.0002) and a longer interval between operation and last aspiration or drain removal (16.2±1.4 days vs. 11.3±0.6 days;P=.0040). Findings were similar in the subgroup of 46 prospectively studied patients, who included 24 Drain patients and 22 No-drain patients. In this group, pain evaluation using a scale of 0 to 10 showed a mean rating of 4.2±2.6 in Drain patients and 2.7±0.4 in No-drain patients (P=.0062). Conclusions: Axillary node dissection can be managed with or without a drain. More office visits but less pain can be expected if a drain is not used.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, IL, March 20–23, 1997.The views expressed herein are those of the authors and do not necessarily reflect the views of the United States Army, United States Navy, Uniformed Services University of the Health Sciences, or the Department of Defense.     

A new method of protection against the effects of acceleration on the cardiovascular system

A closed water immersion system for the protection of the cardiovascular systems of human centrifuge subjects against the effects of acceleration is described. One subject was exposed to accelerations as high as 31 G. The first subject had frontal sinus hemorrhage at 28 G, possibly due to high respiratory system pressure used to protect the chest but which was later found to be unnecessary. The second subject stopped at 26 G due to anxiety. The third subject successfully sustained a 31 G exposure for 5 seconds without injury. The only clearcut evidence of cardiovascular system dysfunction was frontal sinus hemorrhage. An additional advantage of the system was found to be that movement of the extremities during high accelerations was not hindered.     

Oncocytoid artifact of the parotid gland: A newly reported artifact

Electrocautery can induce significant alterations in the connective tissues and epithelium of specimens removed for diagnostic or therapeutic purposes. When electrocautery is used during parotid surgery, it can cause an oncocytoid artifact. The alterations described in this article are enlarged, tightly packed serous acinar cells with coarse to granular eosinophilic cytoplasm, distinct cell borders, and round basal nuclei that on cursory microscopic examination resemble oncocytes with respect to morphology. These changes are seen in conjunction with other, more recognized changes secondary to electrocautery and are believed to occur as a consequence of the electrothermal discharge. On the basis of our findings, this artifact is common in parotid surgical specimens and was misdiagnosed as benign oncocytic lesions in 5 cases.     

TRICHO-RHINO-PHALANGEAL SYNDROME

The major characteristics of tricho-rhino-phalangeal syndrome (TRPS) include shortened and deviated digits, a typical facies with a pear-shaped nose, a long philtrum and slow-growing, fine, sparse hair. Cone-shaped digital epiphyses are seen on x-ray. A few patients with TRPS are mentally retarded. Associated endocrine abnormalities have been reported. Autosomal dominant and recessive patterns of inheritance have been described with most cases showing a dominant mode of inheritance.