Arco axilar de Langer: serie de casos y revisión de la literatura / Langer's axillary arch: case series and literature review

Introducción. El arco de Langer es una entidad infrecuente, cuya prevalencia depende de la técnica quirúrgica utilizada y usualmente no se asocia con síntomas de compresión vascular o neuronal. El objetivo de este estudio fue describir las características clínicas y morfológicas, y la proporción de síntomas de compresión neurovascular del arco de Langer, en mujeres con cáncer de mama llevadas a cirugía axilar. Métodos. Estudio descriptivo del arco de Langer en mujeres con cáncer de mama, llevadas a cirugía axilar en el registro personal de un cirujano, en Medellín, Colombia, entre el 1 enero de 2017 y el 15 agosto de 2020. Se evaluaron características clínicas, morfológicas y síntomas de compresión neurovascular. Las variables categóricas se agruparon según su frecuencia como porcentajes, y para las variables continuas se calculó la mediana y su rango intercuartílico. Resultados. Entre el 1 enero de 2017 y el 15 agosto de 2020 se realizaron 725 cirugías axilares, 479 biopsias de ganglio centinela y 246 linfadenectomías, encontrando 17 casos de arco de Langer, para una frecuencia de 2,3 %. Fue más frecuente encontrarlo en el curso de una linfadenectomía (n=11, 64,7 %). En 15 (88,2 %) casos se presentó riesgo de ocultamiento ganglionar y en 14 (82,3 %) generó dificultad quirúrgica. No hubo casos con síntomas de compresión vascular o neuronal. En ningún caso se realizó el diagnostico imagenológico prequirúrgico. La conducta quirúrgica predominante fue sección, en 88,2 %, sin presentar complicaciones quirúrgicas asociadas. Discusión. Es importante para el cirujano el conocimiento del arco axilar como una variante anatómica de la axila, que puede ocultar los ganglios o dificultar la disección axilar, por lo que la conducta más usada es la sección

Introduction. Langer's arch is an infrequent entity, the prevalence of which depends on the surgical technique used and is usually not associated with symptoms of vascular or neuronal compression. The objective of this study was to describe the clinical and morphological characteristics, and the proportion of symptoms of neurovascular compression of Langer's arch, in women with breast cancer who underwent axillary surgery.Methods. Descriptive study of Langer's arch in women with breast cancer, who underwent axillary surgery in the personal registry of a surgeon, in Medellín, Colombia, between January 1, 2017 and August 15, 2020. Clinical, morphological and clinical characteristics were evaluated for symptoms of neurovascular compression. Categorical variables were grouped according to their frequency as percentages, and the median and interquartile range were calculated for continuous variables.Results. Between January 1, 2017 and August 15, 2020, 725 axillary surgeries, 479 sentinel node biopsies, and 246 lymphadenectomies were performed, finding 17 cases of Langer's arch, for a frequency of 2.3%. It was more frequently found in the course of lymphadenectomy (n= 11; 64.7%). In 15 (88.2%) cases there was a risk of lymph node concealment and in 14 (82.3%) it generated surgical difficulty. There were no cases with symptoms of vas-cular or neuronal compression. In no case was the pre-surgical imaging diagnosis made. The predominant surgical approach was section, in 88.2%, without presenting associated surgical complications.Discussion. Knowledge of the axillary arch as an anatomical variant of the axilla is important for the surgeon, which can hide the lymph nodes or make axillary dissection difficult, so the most commonly used approach is to cut it

The axillary arch inserted to the coracoid process compressing the brachial plexus / El arco axilar insertado en el proceso coracoideo comprimiendo el plexo braquial

The axillary arch is a variant slip extending between the latissimus dorsi muscle and the pectoralis major. During educational dissection, a variant muscle was found in left arm of 70-year-old female cadaver. A slip muscle originated from the lateral margin of the latissimus dorsi and crossed the axilla obliquely. Therefore, we defined this muscular variation as axillary arch. It ran anterior (superficial) to the medial and lateral cords of the brachial plexus, and then it inserted to coracoid process. We reported this variant muscle and discussed its clinical significances.

El arco axilar es una variante que se extiende entre el músculo dorsal ancho y el pectoral mayor. Durante la disección educativa, se encontró una variante muscular en el brazo izquierdo de un cadáver de una mujer de 70 años. El músculo deslizante se originó en el borde lateral del dorsal ancho y cruzó la axila oblicuamente. Por lo tanto, definimos esta variación muscular como el arco axilar. Se extendió anterior (superficial) a los cordones medial y lateral del plexo braquial, y luego se insertó en el proceso coracoideo. Reportamos esta variante muscular y discutimos sus significados clínicas.

Tradução, adaptação transcultural e validação da Langer Mindfulness Scale de avaliação de Mindfulness / Translation, cross-cultural adaptation and validation of the Langer Mindfulness Scale assessment

A desconexão com o mundo real é um dos muitos desafios a serem enfrentados para alcançarmos a convivência harmônica com os mundos exterior e interior. É nesse contexto social da atualidade que a atenção plena, também conhecida como mindfulness, vem conquistando espaço. Mindfulness é uma habilidade metacognitiva que pode ser desenvolvida com a prática. Na perspectiva conceitual do mindfulness da psicóloga Ellen Langer, o cultivo da atenção plena tem o intuito de promover a melhoria da eficácia pessoal diante das situações do cotidiano por meio de estratégias da psicologia positiva. A maioria dos intrumentos desenvolvidos para avaliar as intervenções baseadas em mindfulness e mensurar os níveis de mindfulness na população seguem as tradições orientais onde a meditação ocupa uma posição importante. Para preencher a lacuna de instrumentos com foco na cultura ocidental, foi elaborada a Langer Mindfulness Scale (LMS), composta por 21 itens divididos em quatro subescalas que avaliam o mindfulness de forma não meditativa. Dessa forma, o objetivo geral deste estudo foi o de realizar a tradução e adaptação cultural, e validar e testar as propriedades psicométricas de construto da escala LMS para o português do Brasil. Tratase de um estudo metodológico cujo processo envolveu duas fases: (1) processo de adaptação cultural e (2) avaliação das propriedades psicométricas do LMS. O processo de adaptação cultural da escala pautou-se em seis estágios sequenciais: tradução, fusão da tradução, retrotradução, comitê de juízes, pré-teste e envio da escala para avaliação dos autores do instrumento original. Os dados coletados foram analisados por meio da versão 25 do SPSS e do software R através da interface RStudio. As propriedades psicométricas foram avaliadas em uma amostra auto-selecionada de 543 pessoas da população geral. Foram analisados os padrões de correlação dos dados, a análise fatorial exploratória, análise fatorial confirmatória, a confiabilidade, a validade de construto convergente e discriminante e a comparação entre grupos distintos. Os resultados mostraram que dos participantes, 74,6% eram do sexo feminino, a idade variou entre 18 e 70 anos, com média de 36,4. A maioria (72%) dos participantes possuía pós-graduação, a profissão predominante foi professor (23%), seguido de enfermeiros (22,7%), servidores públicos (22,7%) e estudantes (6,8%), com os demais (24,8%) distribuídos em uma variedade de profissões, desde diarista até magistratura federal. A análise fatorial confirmatória revelou que o modelo com 19 questões apresentou um ajustamento bom e uma melhora no alpha de Cronbach da subescala envolvimento da LMS quando comparado com o modelo original de 21 itens. A partir dos achados deste estudo, chegamos à conclusão que a versão brasileira da LMS composta por 19 itens confirma as quatro dimensões da versão original e apresentou boas propriedades psicométricas no contexto cultural da população brasileira. Os resultados mostram que existe uma relação positiva entre mindfulness de acordo com a teoria de Langer, a qualidade de vida e o cultivo de atividades criativas

Disconnection from the real world is one of the many challenges to be faced to achieve harmonious coexistence between the inner and the outer world. It is in the current social context that mindfulness has been a topic of extensive popularity. Mindfulness is a metacognitive skill that can develop with practice. In the conceptual perspective of the mindfulness psychologist Ellen Langer, the cultivation of mindfulness aims to promote the improvement of personal efficacy in the face of daily situations through strategies of positive psychology. Most of the instruments developed to evaluate mindfulness-based interventions and to measure the levels of mindfulness in the population follow the Eastern traditions where meditation plays a more prominent role. The Langer Mindfulness Scale was developed to fill the gap of instruments focused on the Western culture, with 21 items divided into four subscales that evaluate mindfulness in a non-meditative way. Thus, the general objective is to perform the translation and cross-culturally adaptation to validate and test the psychometric properties of the LMS construct for Brazilian Portuguese. It is a methodological study whose process involved two phases: (1) cultural adaptation process and (2) evaluation of the psychometric properties of LMS. The cultural adaptation process of the scale followed six sequential stages: translation, translation synthesis, back-translation, a committee of judges, pre-test, and sending the scale for evaluation to the LMS developers. The collected data were analyzed through SPSS version 25 and R software through the RStudio interface. The psychometric properties were evaluated in a self-selected sample of 543 people from the general population. Data correlation patterns, exploratory factorial analysis, confirmatory factorial analysis, reliability, convergent and discriminant construct validity, and comparison between distinct groups were analyzed. The results showed that 74.6% of the participants were female, the age ranged from 18 to 70 years, with an average of 36.4. The majority (72%) of the participants had a postgraduate degree, the predominant profession was teacher (23%), followed by nurses (22.7%), public servants (22.7%) and students (6.8%), with the others (24.8%) distributed in a variety of professions, from cleaners to federal judge. Confirmatory factor analysis revealed that the 19-item model presented a good fit and an improvement in Cronbach's alpha of the engagement subscale when compared to the original LMS 21-item model. From the findings, we conclude that the Brazilian version of the LMS with 19 items confirms the four dimensions of the original version and indicated good psychometric properties in the cultural context of the Brazilian population. The results showed that there is a positive relationship among mindfulness, according to Langer's theory, the quality of life, and the cultivation of creative activities

Langer-Giedion Syndrome with 8q23.1–q24.13 Deletion by Complex Three-way Translocation

Langer-Giedion syndrome is a very rare genetic disorder that is caused by the deletion on chromosome 8q24.1, encompassing the TRPS1 and EXT1 genes. We describe a 5-month-old female patient who was admitted to our hospital with clinodactyly and weakness in both thumbs. The patient's karyotype was 46,XX,der(4)t(4;19)(q27;q11),der(8)t(4;8)(q27;q22.3),der(19)t(8;19)(q22.3;q11)del(8)(q23q24.1). Multiplex ligation-dependent probe amplification (MLPA) analysis showed that the patient had a heterozygous deletion, rsa 8q24(P064)x1 and rsa 8q24(P245)x1. Array comparative genomic hybridization (CGH) analysis further revealed three interstitial deletions spanning a total of 13.7 Mb at 8q23.1–q24.13. Based on clinical findings and confirmation by cytogenetic, MLPA, and array CGH analyses, the patient was diagnosed with sporadic Langer-Giedion syndrome with three-way translocations. This is the first case of Langer-Giedion syndrome with complex chromosomal rearrangements in Korea.

Variation of the Axillary Arch in Korean Cadaver / 체질인류학회지

Axillary arch is relatively common variation of muscle in the axilla. There were several attentions on axillary arch due to its anatomical and surgical importance. During educational dissection, a variant muscle was found in right arm of 68-year-old female cadaver. The variation of muscle originated from the lateral edge of the latissimus dorsi muscle as muscular form. And then, it crossed the axillary artery and median nerve as tendinous form. Finally it became wide as muscular form and inserted into the pectoralis major. We reported this variant muscle and discussed its clinical significances.

Síndrome de Langer-Giedion con deleción 8q23. 1-q24. 12, diagnosticado por hibridación genómica comparativa / Langer-Giedion syndrome with 8q23. 1-q24. 12 deletion diagnosed by comparative genomic hybridization

El síndrome de Langer-Giedion, también conocido como síndrome tricorrinofalángico tipo II, es una enfermedad hereditaria multisistémica que pertenece al grupo de síndromes por deleción de genes contiguos. La causa de este síndrome es una deleción heterocigota que compromete, por lo general, la región 8q23.3-q24.11 y afecta, principalmente, los genes TRPS1, RAD21 y EXT1. Este síndrome se caracteriza por osteocondromatosis múltiple en las extremidades, hipertricosis y fenotipo facial, que incluye pelo escaso en el cuero cabelludo, orejas grandes sobresalientes y nariz larga con una punta bulbosa. Se reporta el caso de un paciente colombiano con hallazgo de deleción en la región cromosómica 8q23.1-q24.12 mediante técnicas de hibridación genómica comparativa y hallazgos clínicos clásicos. Este es el primer caso reportado en Colombia.

The Langer-Giedion syndrome, also known as trichorhinophalangeal syndrome type II, is a hereditary multisystemic disease part of the group of contiguous gene deletion syndromes. The cause of this syndrome is a heterozygous deletion that involves the chromosomal region 8q23.3-q24.11 and mainly affects genes TRPS1, RAD21, and EXT1. This syndrome is characterized by the presence of multiple osteochondromas in limbs, hypertrichosis, and facial phenotype that includes sparse scalp hair, large laterally protruding ears, a long nose with a bulbous tip. We report the case of a Colombian patient with finding of an 8q23.1-q24.12 deletion by comparative genomic hybridization array technique and classical clinical findings, being the first case reported in Colombia.

Líneas de Langer en cirugía dermatológica / Langer lines in dermatologic surgery

En cirugía dermatológica el aspecto final de la cicatriz es un hecho relevante, principalmente en cirugías electivas. En la actualidad existen más de 40 guías clínicas cuya finalidad es orientar al cirujano en la realización de una incisión que le permita obtener el mejor resultado. Las líneas de Langer, son las más conocidas y empleadas en la actualidad, se basan en el seguimiento de líneas de menor tensión en la piel, al momento de realizar la incisión cutánea. Fueron descritas por Dupuytren y luego dadas a conocer por Langer como resultado de experimentos realizados en cadáveres. En la presente revisión, conoceremos los orígenes de estas líneas, la existencia de otras líneas de interés en dermatología, sus aplicaciones clínicas y la evidencia existente a favor y en contra de su uso en cirugías dermatológicas electivas.

In dermatologic surgery, the final appearance of the scar is a significant event, specially in elective surgeries. Currently there are over 40 clinical guidelines which aim to guide the surgeon in performing an incision that allows you to get the best result. Langer lines are the most known and used at present. They are based on the lower skin tension lines, for making the skin incision. Langer lines were described by Dupuytren and then released by Langer as a result of experiments on cadavers. In this review, we will know the origins of these lines, the existence of other lines of interest in dermatology, clinical applications and the evidence for and against its use in elective dermatologic surgery.

A Case of Langer-Giedion Syndrome with a De Novo Del(8)(q23q24.1)

Lange-Giedion syndrome, or trichorhinophalangeal syndrome type 2 (TRPSII), is a clinical syndrome characterized by mild growth restriction, mental retardation, microcephaly and dysmorphic face. Bulbous nose, large protruding ears and loose redundant skin are distinguishing features, as well as lax joints and phalangeal abnormalities of the hands and multiple exostoses. TRPS1 and EXT1 gene deletion are responsible for this. Diagnosis is mainly based on clinical and radiographic features. In Korea, no cases of this disease have been reported thus far. Along with a review of the literature, we report a case of TRPSII in a neonate who had peculiar face representing TRPSII, polydactyly, Mullerian duct cyst, and ptosis and was found to have an interstitial deletion of 8q23-24.1.

Langer’s Axillary Arch and Its Clinical Implications.

Introduction: The axillary arch muscle of Langer is the most common anatomical variant of axillary musculature which is of clinical and surgical importance. It may lead to neurovascular compression syndrome in the cervicoaxillary region and can be misinterpreted while examining axilla and also impairs movements of shoulder joint. Observation: During routine dissection of axilla for undergraduate teaching, an unusual muscular slip in the left axilla was observed .The muscular slip was extending from lattisimus dorsi muscle to undersurface of pectoralis major muscle, arching over axillary vessels and cords of brachial plexus. Conclusion: The axillary arch may cause obstruction to axillary vessels and nerves and may be involved in thoracic outlet syndrome and shoulder instability. The knowledge of this muscular variant could help to minimize intraoperative complications related to surgeries in or nearby axilla such as mastectomy, breast reconstruction and axillary lymphadenectomy or lymph node biopsy.

Axilla; a rare variation: axillary arch muscle.

Axillary arch muscle or the Langer’s muscle is one of the rare muscular variation in the axillary region. It is the additional muscle slip extending from latissimus dorsi in the posterior fold of axilla to the pectoralis major or other neighbouring muscles and bones. In the present article a case of 68 yrs old female cadaver with axillary arch in the left axillary region is reported. It originated from the anterior border of lattissimus dorsi and merged with the short head of biceps and pectoralis major muscles. The arch was compressing the axillary vein as well as the branches of the cords of brachial plexus. The presence of the muscle has important clinical implications, as the position, unilateral presence, axillary vein entrapment, multiple insertions makes the case most complicated. Recognising the presence of axillary arch muscle in such complex form is important in clinical practice as the arch causes the difficulties in staging lymph nodes, axillary surgery, thoracic outlet syndrome, shoulder instability or cosmetic problems. The anatomy, embryological and clinical importance of this muscular variation is discussed in this paper.

Reflexões críticas sobre os processos intersubjetivos: contratransferência, revêrie e o processo de simbolização / Critical reflections on the inter-subjective processes: countertransference, reverie and the process of symbolization / Reflexiones críticas sobre los procesos intersubjetivos: contratransferencia, revêrie y el proceso de simbolización

Os autores traçam uma história dos conceitos de contratransferência e de revêrie desde suas introduções, associando-os aos novos conceitos psicanalíticos correlatos que foram sendo introduzidos e exigiram sua redefinição. Em seguida descrevem o processo que permeia a constituição da contratransferência e, sobretudo, o papel da evocação. Sonhos, narrativas e suas expressões atuadas evocam em nós metáforas que combinam articulações discursivas e não discursivas que dão forma aos sentimentos que estão sendo projetados em nós na transferência. Nós, ao interpretarmos, colocamos essas experiências evocadas numa outra base simbólica, ou seja, transmutamos a linguagem evocativa dos símbolos visuais do sonho ou das metáforas, ou ainda das vivências expressivas da contratransferência, em linguagem verbal descritiva de significados e, desta maneira, ampliamos a capacidade de pensar a experiência ao atribuirmos significado aos sentimentos envolvidos. Os trabalhos de Ogden sobre revêrie são discutidos e considerados seminais na elaboração do conceito de revêrie da forma como o utilizamos hoje.

The authors thread a story of the concepts of countertransference and reverie, since the beginning of their use, associating them to new correlated psychoanalytic notions which were gradually introduced and which demanded the redefinition of these original concepts. Next, they describe the process which permeates the constitution of countertransference and, above all, the role of evocation. Dreams, narrations and their expressions evoke in us metaphors, which combine discursive and non-discursive articulations, which in turn give shape to the feelings which are being projected in us during transference. As we interpret, we place these evoked experiences on another symbolic base, transforming the evocative language of the visual symbols of the dream or metaphor, or yet of the expressive occurrences of countertransference, into a verbal language descriptive of meanings. As such, we amplify the capacity of reflecting upon the experience by attributing meaning to the feelings involved. The works of Ogden on reverie are discussed and considered primary to the elaboration of the concept in the way it is used today.

Los autores trazan una historia de los conceptos de contratransferencia y de revêrie desde que fueron introducidos asociándolos a los nuevos conceptos psicoanalíticos relacionados que fueron siendo introducidos y exigieron su redefinición. A continuación describen el proceso que permea la constitución de la contratransferencia y sobre todo el papel de la evocación. Sueños, narraciones y expresiones actuadas nos evocan metáforas que combinan articulaciones discursivas y no discursivas que dan forma a los sentimientos que están siendo proyectados en nosotros durante la transferencia. Nosotros al interpretar, colocamos estas experiencias evocadas, en otra base simbólica, es decir, transmutamos el lenguaje evocador de los símbolos visuales del sueño o de las metáforas o incluso de las vivencias expresivas de la contratransferencia, en un lenguaje verbal descriptivo de significados y de esta forma ampliamos la capacidad de pensar en la experiencia al atribuir significado a los sentimientos involucrados. Los trabajos de Ogden sobre revêrie son discutidos y considerados fundamentales en la elaboración de los conceptos de revêrie de la forma como los utilizamos hoy.

The existence of axillary arch in human fetus and applied importance and clinical implications in the axillary brachial plexus blocks / La existencia de arco axilar en el feto humano y la importancia aplicadae implicancias clínicas en los bloques de plexo braquial

Axillary arch is the most common muscle variation of axillary fossa that gains importance for regional interventional procedures, screening methods and physical examination. In order to avoid malpractice the variations must be borne in mind. This study has been planned to research the frequency and the features of the axillary arch in human fetus, to mention the potential clinical and functional significance of axillary arch while applying axillary brachial plexus block and reflect on possible complications. Axillary fossa was examined with a stereomicroscope in 20 upper extremities of ten human fetuses. The gestation ages ranged from 16 to 36 weeks. Axillary arch was determined in 2/20 specimen unilaterally. In both specimen, muscular slip detached from latissimus dorsi, passed anterior neurovascular bundle and ended posterior pectoralis major tendon and lateral border of intertubercular groove. In one specimen axillary arch was innervated with medial pectoral nerve whereas the other one did not have a particular innervating nerve branch. The possible effects of axillary arch in the axillary brachial plexus block applications are discussed. Arcus axillaris may have a potential clinical and functional significance with regard the axillary brachial plexus block applications and may have possible effects on failure rate and acute complications. Also, we think that this fetus study which the pure structure of the muscles without any usage effect can be observed will be beneficial regarding this topic.

El arco axilar es la variación muscular más común de la fosa axilar, siendo de importancia para la región en los procedimientos de intervención, los métodos de selección y el examen físico. Con el fin de evitar las negligencias se debe tener en cuenta las variaciones. El objetivo de este estudio fue determinar la frecuencia y las características del arco axilar en el feto humano. Es necesario mencionar la importancia del potencial clínico y funcional del arco axilar en la aplicación de bloqueo axilar del plexo braquial y sus posibles complicaciones. La fosa axilar fue examinada bajo microscopio estereoscópico en 20 miembros superiores de diez fetos humanos. La edad de gestación varió de 16 a 36 semanas. El arco axilar se observó unilateralmente en 2/20 especímenes. En ambos especímenes el músculo cruzó anteriormente el paquete neurovascular y terminó en el tendón del músculo pectoral mayor y en el margen lateral del surco intertubercular. En un especimen el arco axilar se encontraba inervado por el nervio pectoral medial, mientras que en el otro no existía una determinado ramo del nervio. Se discuten los posibles efectos del arco axilar en las aplicaciones de bloqueo axilar del plexo braquial. Puede tener un significado potencial clínico y funcional, en lo que se refiere a la aplicación de bloqueo axilar del plexo braquial y aademás producir efectos de complicaciones agudas.

Arco axilar de langer (músculo axilopectoral): variante supernumeraria inusual del músculo latísimo del dorso: reporte de tres casos / Langers's axillary arch (axillopectoral muscle): inusual supernumerary variant's latissimus dorsi: three cases report

El arco axilar de Langer o músculo axilopectoral es una variación relativamente rara de la inserción del músculo latísimo del dorso. Se identifica en aproximadamente el 1.7 a 7 por ciento de las disecciones axilares y corresponde a un complejo músculofascial, la parte muscular junto con el tendón del músculo pectoral mayor se inserta dentro del labio lateral del surco intertubercular del húmero, mientras que, la parte fascial está formada por bandas fibrosas que se extienden en la parte profunda del músculo pectoral mayor para insertarse en el proceso coracoide entre la unión de los músculos coracobraquial y pectoral menor. El reconocimiento de esta anomalía es importante para los médicos clínicos, cirujanos y fisioterapeutas, ya que obliga a plantearse el diagnóstico diferencial de masas axilares, historia de obstrucción venosa axilar intermitente, o su aparición inesperada en el transcurso de la disección axilar del linfonodo centinela o linfadenectomías. Se presentan tres casos de arco axilar de Langer diagnosticados en la Unidad de Patología Mamaria del Instituto Autónomo Hospital Universitario de los Andes, Mérida, Venezuela, en el periodo 1999-2006, en el transcurso de 210 disecciones axilares practicadas en pacientes con cáncer de mama para identificación del linfonodo centinela o en linfadenectomías.

The Langer's axillary arch or axillopectoral muscle is a is a relatively rare anatomical variation of latissimus dorsi muscle insertion. Langer's arch is identified in up to 1.7 a 7 percent of axillary explorations, and is a musclefascial complex continuous with the iliacal fibers of the latissimus dorsi. The muscular part, together with the tendon of pectoralis major muscle, inserted into the lateral lip of the intertubercular sulcus of the humerus, whereas the fascial part was formed by a fibrous band that extended deep to the pectoralis major muscle to insert into the coracoid process between the attachments of the coracobrachialis and pectoralis minor muscles. The recognition of this anomalies is important to clinicians, surgeons and physical therapist because It should be considered in the differential diagnosis of axillary masses an unexpected finding during axillary dissection by sentinel lymoh nodes or lymphadenectomy. We report three cases of Langer's axillary arch encountered during sentinel lymph node biopsy or lymphadenectomy en 210 patients with breast cancer, at the patology mammary Unit of the University Los Andes Hospital, in 1999-2006 period.

Granuloma eosinofílico orbitário / Orbital eosinophilic granuloma

OBJETIVO: Relatar, de forma retrospectiva, a experiência no diagnóstico e tratamento do granuloma eosinofílico da órbita em serviço de referência. MÉTODOS: Identificados os pacientes com diagnóstico de granuloma eosinofílico orbitário, no Registro do Laboratório de Patologia Ocular do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, no período entre 1974 e 2004. Coletados dados referentes ao diagnóstico, tratamento e realizada revisão das lâminas coradas pela hematoxilina e eosina. RESULTADOS: Foram identificados 3 casos com idade de 1, 6 e 11 anos. Em nenhum caso o diagnóstico de granuloma eosinofílico foi aventado pré-operatoriamente. Todos pacientes foram submetidos a biópsia, exibindo aspecto anatomopatológico típico. Em um dos casos, após a biópsia, havia tomografia computadorizada da órbita disponível, exibindo padrão característico. Todos os pacientes foram tratados com corticoesteróides sistêmicos, com resolução do tumor orbitário. CONCLUSÃO: Trata-se de doença rara, de difícil diagnóstico clínico sem avaliação radiológica. Apesar da grande destruição tecidual, apresenta boa resposta ao tratamento com corticoesteróides.

PURPOSE:To report the retrospective experience of a reference center in the diagnosis and treatment of orbital eosinophilic granuloma. METHODS: A review of the files in the Opththalmic Pathology Laboratory, of the Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, between 1974 and 2004, was conducted to identify cases of orbital eosinophilic granuloma. Data of diagnosis and treatment were collected. The hematoxilin and eosin stained sections were reviewed. RESULTS: Three cases with ages of 1, 6 and 11 years were retrieved. In none of them the clinical diagnosis of eosinophilic granuloma was suspected. All patients underwent diagnostic biopsy with characteristic histological aspect. In one case a orbital computed tomography after biopsy exhibited typical findings. All patients improved with systemic steroids./ CONCLUSIONS: This is a rare disease, with a difficult clinical diagnosis if radiological evaluation is not available. In spite of its aggressiveness at presentation, the disease shows good response to systemic steroids.

A Comparison of Clinical Effect for Root Coverage / 대한치주과학회지

PURPOSE: The purpose of this study was to compare clinical effect of the Langer & Langer technique , the modified Langer & Langer technique and Bruno technique. MATERIAL AND METHODS: 30 patients who have gingiva recession(Miller class I or class II) were carried root coverage. Langer & Langer technique(14 patients/32 tooth), modified Langer & Langer technique(5 patients/10 tooth) and Bruno technique(11 patients/18 tooth) was carried. At baseline and average 3 months after operation, it was estimated clinical index(Pocket depth, gingiva recession, clinical attachment level, keratinized gingiva, scar tissue, root coverage rate) by Williams style probe. RESULT: Root coverage rate is indicated Langer & Langer technique(85%), Modified Langer & Langer technique(86%) and Bruno technique(90%). CONCLUSION: All three of the procedures were effective in gingival recession and improved clinical parameters.

The Axillary Arch of Langer (Axillopectoral Muscle): A Case Report / 한국유방암학회지

The axillary arch of Langer (Axillopectoral muscle) is the most common anatomical variant of the axillary musculature. The incidence of the variant is about 7% or less in the population and despite the reported frequency, its presence has been rarely reported. A 33-yr-old woman visited our institution due to the presence of a right breast mass and was diagnosed with right breast cancer by an ultrasound guided core biopsy. Previously, the patient had had no complaints of sensory and motor dysfunction of the right arm. The patient underwent a modified radical mastectomy and we identified an abnormal muscle that originated from the latissimus dorsi, and was inserted in the trilaminar tendon of the pectoralis major during axillary lymph node dissection. The muscle interfered the level I area due to its longitudinally oblique direction. We separated this muscle, and carefully dissected the medial axillary group and lateral axillary group. After follow-up for two years, there was no evidence of axillary recurrence, lymphedema or any limitation of motion of the right arm. We discuss the definition, clinical complications and clinical importance of the axillary arch of Langer. We report here the first case of axillary arch of Langer that was identified during surgery in Korea.

Successful Treatment of Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis with HLH-94 Protocol

Hemophagocytic lymphohistiocytosis (HLH) is a rare, fatal disorder of children, affecting predominantly the mononuclear phagocytic system. Previous reports indicate that Epstein-Barr virus (EBV)-associated hemophagocytic lymphohistiocytosis (EBV-HLH) can also be fatal in many cases, although the prognosis for EBV-HLH is better than for the familial form of hemophagocytic lymphohistiocytosis. We treated four patients with EBV-HLH using immunochemotherapy including steroid, etoposide (VP-16), and cyclosporin, according to the HLH-94 protocol. All patients experienced persistent fever, cytopenia, and hypertriglyceridemia. Serological testing for EBV showed reactivated EBV infections in all patients. EBV DNA detected by PCR and EBV-encoded small RNA measured by in situ hybridization were confirmed in the patients' bone marrow specimens. Hemophagocytosis was shown in bone marrow aspirates and liver biopsy specimen. Complete remission was achieved in all patients after induction and continuation therapy for 4-10 months (median, 7 months) and was maintained for 15-27 months (median, 19 months) without the need for bone marrow transplantation. These results suggest that EBV-HLH can be effectively controlled by immunochemotherapy using the HLH-94 protocol.

Short Rib Syndrome Beemer-Langer Type with Polydactyly: A Case Report / 대한주산의학회잡지

A female fetus with short rib(polydactyly) syndrome, Beemer-Langer type was terminated at 28 week's gestation because of abnormalities visualized on sonography. We present the clinical, radiological and autopsy findings of this case with a brief review of the literatures.