Association between screw prominence and vascular complications after clavicle fixation

Context:

Fixation of clavicle fractures has become more common to prevent symptomatic malunion and nonunion. The subclavian and axillary vessels are in close proximity to the medial two-thirds of the clavicle, placing them at risk from prominent metalware. Injury to these major vessels has the potential to be life or limb-threatening. Despite this anatomical risk, iatrogenic vascular injury associated with clavicle fixation is rare.

Aims:

The aim of this study was to identify risk factors associated with modern fixation techniques in reported cases of vascular injury after clavicle fixation.

Materials and Methods:

A literature search was performed, and all identified cases of iatrogenic vascular injury associated with prominent clavicle fixation were analyzed. Clinical details, the total length of the prominent screws and the distance that they protruded from the far cortex were recorded.

Results:

Five cases were identified; there were four pseudoaneurysms and one arteriovenous fistula. The total length of the offending screw was identifiable in two cases, measuring 26 and 30 mm. The length of screw prominence was identifiable in 3 cases (8, 10 and 10 mm). The pseudoaneurysms presented at 2-10 years following clavicle fixation. Three of these cases developed limb-threatening ischemia.

Conclusions:

Vascular complications associated with clavicle fixation are uncommon but potentially limb-threatening. Several associated factors are identified. The authors provide a number of detailed recommendations aimed at preventing these complications.     

Ex vivo perfusion of human lymph nodes†

In a recent study published in The Journal of Pathology, Barrow-McGee et al described a feasibility study of a real-time ex vivo perfusion model of the axillary lymph nodes (ALNs) from breast cancer patients for immune-oncological investigations. The study showed that perfused ALNs remain viable for up to 24 h, and perfusion of therapeutic antibodies confirmed the ability to reach ALN-resident cells. This work is a highly encouraging demonstration of feasibility for further research into lymphatic system function, with applications to immune function, vaccinations, and cancer. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.     

Association between molecular subtypes and lymph node status in invasive breast cancer

Background: The predictors for the involvement of lymph node (LN) have been widely studied. But the implication of the molecular type has not been well studied. Using the database of our institution, we investigated this relation. Methods: Patients with T1 and T2 primary breast cancer without distant metastasis were included in our study from 2012 Jan to 2013 Dec. All patients undertook the resection of the primary and the axillary lymph nodes (ALNs). We collected the clinical data including age at diagnosis, the status of ER, PR and HER2, tumor size, nodal status, and histological type. The relationship between demographic, tumor characteristics and lymph node status was evaluated. Results: 814 patients were included in our study. The number and the percentage (in parentheses) of each type of breast cancer is as follows: Luminal A 230 (28.3%), Luminal Her2- 284 (34.9%), Luminal Her2+ 104 (12.8%), HER2+ 72 (8.8%), TNBC 124 (15.2%). On univariate and multivariate analysis, tumor size and tumor subtype show statistical significance with LN involvement. Using TNBC as a reference, both Luminal B type (Luminal HER2-, Luminal HER2+) shows significant higher probability of LN involvement. Conclusions: LN involvement is an intrinsic characteristic for molecular subtype of breast cancer. Triple positive and triple negative breast cancer accounts the most and least possibility of LN involvement.     

改良的引流条安置方法对腋臭术后早期并发症的影响

目的比较改良的引流条安置方法与传统的引流条安置方法对腋臭小切口顶泌汗腺修剪术术后早期并发症的影响。方法利用抛硬币的方法将入选的81例腋臭患者左右两侧随机分为AB两组。两组均采用小切口顶泌汗腺修剪术。A组采用改良的引流条安置方法,引流条分别从腋窝术区上臂侧、切口、胸壁侧穿出。B组采用传统的引流条安置方法,引流条从上臂侧或胸壁侧穿出。对比腋臭术后早期并发症的发生情况。结果改良的引流条安置方法组在皮下积血评分第一天(1.57±0.76)、第二天(1.23±0.43)、皮瓣贴附(95.06%)、拆线时间(11.33±1.80天)均优于传统组皮下积血评分第一天(1.94±0.99)、第二天(1.49±0.59)、皮瓣贴附(85.19%)、拆线时间(12.41±1.99天),差异有统计学意义(P<0.05)。改良的引流条安置方法组在皮瓣血供评分(1.27±0.48)、感染情况(2.5%)与传统组皮瓣血供评分(1.31±0.54)、感染情况(4.9%)差异无统计学意义(P>0.05)。结论改良的引流条安置方法可以降低腋臭小切口顶泌汗腺修剪术术后皮下积血、皮下空腔形成等早期并发症的发生,有利于腋臭术后的恢复。     

An axillary arch

An axillary (axillopectoral) muscle (arch) was observed extending between the upper border of the latissimus dorsi and the lower border of the pectoralis major muscles in a 48-year-old male cadaver during our dissections. In the same cadaver, the pectoralis major muscle has entirely inserted into the most distal part of the tendon of deltoideus. © 1996 Wiley-Liss, Inc.     

乳腺癌新辅助化疗后腋窝淋巴结转移综合预测模型的建立

目的:建立乳腺癌新辅助化疗后淋巴结转移的综合预测模型,评估新辅助化疗后淋巴结转移情况,指导临床手术方案选择。方法:回顾分析2015年1月至2018年12月143例乳腺癌新辅助化疗患者的临床、病理及影像资料,并根据术后淋巴结病理分为转移组与无转移组。采用χ2/t检验对两组指标进行单因素分析;将P<0.05的指标纳入多因素Logistic回归分析。用多因素分析有统计学意义(P<0.05)的指标构建乳腺癌新辅助化疗后淋巴结转移综合预测模型的列线图,并应用受试者工作特征（receiver operation characteristic,ROC)曲线评价此模型的性能。结果:单因素分析表明化疗方案、化疗前淋巴结穿刺病理、术前查体、术前彩超、术前CT/MRI、RECIST分级对腋窝淋巴结转移有预测作用;多因素分析表明,化疗前淋巴结穿刺病理、术前彩超、RECIST分级是新辅助化疗后腋窝淋巴结转移的独立预测因素。乳腺癌新辅助化疗后淋巴结转移的预测模型的曲线下面积为0.785,特异度为85.4%,敏感度为59.8%。结论:乳腺癌新辅助化疗后淋巴结转移的综合预测模型对腋窝淋巴结有较好的预测能力,可为选择合适的手术方式提供临床指导。     

腹股沟与腋窝测温法的对比研究

目的 探讨大面积烧伤患腹股沟测温法的可行性。方法 选择住院患200名,分成4组,每位患同时测量腋窝／腹股沟体温。结果 将每组患的左右腋下体温、左右腹股沟体温和同侧腋窝／腹股沟体温进行样本均数的t检验,P＞0．05。结论 腹股沟测温法代替常规腋窝测温法,在大面积烧伤及特殊患上的应用是科学可行的。     

腋臭外科治疗的临床与病理观察

目的:探讨既可达到治疗彻底、疗效持久、局部美观,又无功能影响,为大家公认的腋臭外科手术术式.方法:对临床588例病例回顾总结及30例病理组织进行观察对比分析.结果:四种主要手术方法(术式)中传统的腋臭根治性切除术272例(其中一半行Z成形术)治疗彻底,只有3例(1.1%)有残留气味,但切口瘢痕长,要求修复瘢痕者有36例(包括外院手术后).吸刮抽吸术46例中治疗不够彻底近期发现残留气味者就有5例.超声抽吸者共43例,经过病理学检查30例中有22例有顶泌汗腺残留,说明单靠超声不能达到治疗目的.腋窝皱襞横形小切口分二层修剪掏出术共227例,有3例有残留气味,但从2007年后进一步改进修剪技术后从病理学观察证实可以达到无顶泌汗腺残留.结论:改良后的腋窝皱襞1～2个横切口(2.5～3cm),翻转皮瓣分二层剥离修剪(简称小切口分层修剪术)可以达到清除大小汗腺,使治疗彻底、并发症少、疗效持久、外形美观、无功能影响的效果.