Release of severe post-burn axillary contracture with the latissimus dorsi flap

Summary One stage reconstruction of the anterior axillary fold, in a case of severe post-burn axillary contracture, with the island latissimus dorsi musculocutaneous flap is described. Postoperatively the patient had a full range of active abduction and a good cosmetic result.     

负压引流在小切口根治腋臭术中的应用

目的:在众多腋臭治疗方法中,探索出一种能有效根治腋臭且并发症少的治疗方案。方法:利用小切口,肿胀麻醉,把带有汗腺及毛囊的皮肤修剪薄至全厚及中厚皮片厚度,术毕放置负压引流,使皮肤与基底贴合良好,并加压包扎。结果:本法共治疗32例腋臭患者,其中其他方法治疗复发者11例。除2例术后有轻微气味外,其余均得到根治,术后瘢痕不明显。结论:负压引流在小切口根治腋臭中可有效减少并发症,提高治愈率。     

Left thoracotomy approach in reoperative off-pump coronary revascularization

Objective: Reoperative coronary bypass grafting is at high risk. Particularly in redo cases where the patent graft is running near the midline of the sternum, the graft may be exposed to injury by a median sternotomy and subsequent dissection. Whereas, off-pump bypass grafting from the left axillary artery or descending thoracic artery by a left thoracotomy approach is safe for preventing graft damage.Methods: From March 1998 to February 2002, we performed off-pump coronary artery bypass grafting by a left thoracotomy approach in 9 patients. The left axillary artery was used as the inflow vessel in 4 cases, and the descending thoracic, aorta in 5.Results: The radial artery was anastomosed proximally to the axillary artery in 4 cases and the descending thoracic aorta in one case. The saphenous vein graft was anastomosed, proximally to the descending thoracic aorta in 4 cases. Transdiaphragmatic minimally invasive bypass grafting for the right coronary artery was simultaneously performed in 3 cases. Postoperative cardiac events were ventricular arrhythmia in 6 cases and supraventricular arrhythmia in 3 cases. There was no damage to the patent grafts. Postoperative coronary angiography performed, in 8 cases revealed all the grafts to be patent without stenosis. Cardiac symptoms were not found after the operation in any of the cases.Conclusions: These procedures can prevent the injury to patent grafts caused by a median sternotomy, and will be one of the useful strategies for reoperative off-pump coronary artery bypass grafting.     

Minimally Invasive Axillary– Coronary Artery Bypass

Axillary artery-to-coronary artery bypass using reversed saphenous vein provides a simple method of applying the minimally invasive coronary bypass grafting procedure when the internal thoracic artery is not an adequate conduit. Although this may allow extended use of the minimally invasive coronary bypass procedure, the long-term patency of this technique is unknown.     

Paralysis of the axillary nerve with Complete compensation – a case report

Summary Two patients with complete paralysis of the axillary nerve are reported on. One case is well documented. In both cases there was very good functional adaptation, resulting from hypertrophy of the rotator cuff so that there was only a slight or no loss of movement. The rotator cuff should therefore be exercised at an early stage when there is isolated axillary nerve damage. The function of the supraspinous muscle is also discussed.      

神经移位治疗火器性肌皮神经和腋神经损伤

在观察和测量100个上肢解剖标本的基础上,我们设计了带血管的胸背神经和下肩胛下神经移位,一期修复一例火器性肌皮神经和腋神经损伤.术后8个月复查功能恢复甚为满意.     

An unusual bandlike web in an infant with lethal multiple pterygium syndrome

We report on a patient with a lethal multiple pterygium syndrome who also had an unusual, bandlike web across one axilla and partial intestinal atresia. Umbilical cord wrapping with subsequent vascular compromise appears to be the most likely pathogenetic mechanism for the additional anomalies.     

Histopathology of tumour associated sarcoid-like stromal reaction in breast cancer

Summary In 5 cases of invasive ductal and lobular carcinoma of the breast multiple epithelioid and giant cell containing granulomas were detected, localized mainly in circumferential regions, but also in the center of the carcinomas. These granulomas were interpreted as sarcoid-like stromal reactions, occurring as sarcoid-like lesions in uni- and bilateral primaries, in a recurrent tumour, and also in axillary lymph nodes. Histopathologically, these granulomas were not quite uniform, some of them corresponding to typical sarcoidosis, others showing marked proliferations of epithelioid or giant cells or containing fibrinoid exudate or necroses. The granulomas were surrounded by dense infiltrates of mononuclear cells. Tuberculosis and mycosis was excluded. There were no hints of generalized sarcoidosis. Pathogenetically, these are reactions in the tumour stroma of varying intensity, and are not caused by necroses of the tumour tissue nor by microbial infections. Such tumour-associated sarcoid-like stroma reactions are interpreted as a T-cell mediated immune response to an antigen expression of the carcinoma acting as the local trigger; in 2 cases they were connected with sarcoid-like lesions of the axillary lymph nodes. Their occurrence in bilateral carcinoma of the breast points to an immunological disposition for this special kind of host-versus-tumour response. The intensity of these changes in a recurrent tumour reflects an immunological hypersensitivity reaction.The pathogenetic and differential diagnostic aspects of epithelioid granulomas of the female breast in chronic granulomatous mastitis, panniculitis, foreign body reaction, rare infections, and in therapeutically induced sarcoidosis are described and discussed.Dedicated to Prof. Dr. K. Lennert, Kiel, in Honour of his 65th Birthday