Identification and preservation of arm lymphatics in axillary lymph node dissection to prevent arm lymphedema: a single center randomized controlled trial / 中华肿瘤杂志

Objective: To evaluate the feasibility of identification and preservation of arm lymphatics (DEPART) in axillary lymph node dissection (ALND) for breast cancer to prevent arm lymphedema. Methods: A randomized controlled study method was used. Two hundred and sixty-five patients who underwent breast cancer surgery at the Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University from November 2017 to June 2018 were included, and the patients were randomly divided into ALND+ DEPART group (132 patients) and standard ALND group (133 patients) by random number table method. In the ALND+ DEPART group, indocyanine green and methylene blue were injected as tracers before surgery, and the arm sentinel nodes was visualized by staged tracing during intraoperative dissection of axillary lymph nodes. Partial frozen sections were made of arm lymph nodes >1 cm in length and hard and suspicious of metastasis, and arm lymph nodes and lymphatic vessels were selectively preserved. Patients in the standard ALND group underwent standard ALND. Objective and subjective indexes of arm lymphedema were evaluated by 5-point circumference measurement and Norman questionnaire. Results: Among 132 breast cancer patients in the ALND+ DEPART group, 121 (91.7%) completed DEPART. There were no statistically significant differences in age, body mass index, pathological type, dissection number of axillary lymph node, N stage, TNM stage, molecular typing, and regional radiotherapy between the ALND+ DEPART and standard ALND groups (P>0.05). At a median follow-up of 24 months, assessment by the 5-point circumference measurement showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.0% (6/121) and 15.8% (21/133), respectively, with statistically significant differences (P=0.005). Assessment by the Norman questionnaire showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.8% (7/121) and 21.8% (29/133), respectively, with a statistically significant difference (P<0.001). No local regional recurrence was observed in either group during the follow-up period. Conclusion: For breast cancer patients with positive axillary lymph nodes, the administration of DEPART during ALND can reduce or avoid the occurrence of arm lymphedema without compromising oncology safety.

Hypopigmented macules of the limbs in two sisters: report on familial Bier spots

AbstractBier spots are asymptomatic, small, irregular, hypopigmented macules characterized by a normal histological appearance, which are usually found on the arms and legs of young adults. We describe the simultaneous presence of Bier spots in two siblings. This finding is unusual since, to the best of our knowledge, concurrent familial cases have never been reported in the literature.

Braquioplastia pós-gastroplastia: avaliação da satisfação dos pacientes / Brachioplasty after bariatric surgery: evaluation of patient satisfaction

Introdução: A deformidade dos membros superiores, causada pela perda ponderal maciça, pode ser corrigida por meio da braquioplastia. Essa cirurgia plástica visa melhorar o contorno dos membros, facilitar a higiene e possibilitar o uso de determinadas vestimentas. Objetivo: Demonstrar casuística, relatar intercorrências e complicações e avaliar a satisfação de pacientes submetidos à braquioplastia após gastroplastia. Método: Trinta e quatro pacientes (97% mulheres, idade 46,6 ± 12 anos) submetidos à braquioplastia após cirurgia bariátrica foram recrutados para o estudo. Descrevemos a ocorrência de intercorrências e complicações associadas ao procedimento cirúrgico e avaliamos a satisfação de 33 pacientes por meio de entrevista qualitativa e questionário específico. Resultados: Como complicações menores, observou-se pequena deiscência em cinco pacientes (14,7%); não foram observadas complicações cirúrgicas maiores. O grau de satisfação foi obtido em 81,8% dos pacientes e o resultado alcançado ficou próximo das expectativas de 69,7% deles. Conclusões: As técnicas utilizadas de braquioplastia pós-bariátrica restabeleceram o adequado contorno braquial, com baixo índice de complicações menores e alto grau de satisfação dos pacientes avaliados.

Introduction: Upper limb deformity caused by massive weight loss can be corrected by brachioplasty. This plastic surgery improves limb contour, facilitates hygiene, and enables use of certain clothing. Objective: To present the cases, describe interventions and complications, and evaluate the satisfaction of patients who underwent brachioplasty after bariatric surgery. Method: Herein, 34 patients (including 33 females) aged 46.6 ± 12 years, who underwent brachioplasty after bariatric surgery, were recruited for the study. Interventions and complications associated with the surgical procedure were described, and the satisfaction of 33 patients was evaluated by a qualitative interview and specific questionnaire. Results: As a minor complication, slight dehiscence was observed in five patients (14.7%), but no major surgical complications were seen. Some degree of satisfaction was reported by 81.8% of the patients, and the outcome achieved in 69.7% was close to that expected. Conclusions: The brachioplasty techniques that were used restored proper arm contour with a low rate of minor complications, and a high degree of satisfaction among the patients evaluated.

Hamartoma fibroso de la infancia. Presentación de un caso / Fibrous hamartoma of the childhood. Presentation of a case

Presentación de un caso de hamartoma fi broso de la infancia, en un niño de 8 meses de edad. El tumor es benigno, muy poco frecuente y en el diagnóstico diferencial están los fi brosarcomas.

A rare case of fi brous hamartoma of childhood, in an eight month old child is presented. These are benign and very infrequent tumors. Fibrosarcoma have to be considered in diff erential diagnosis.

Plexiform Neurofibroma in a 16 year old boy

Plexiform Neurofibroma appeared at the age of 5 years, with little pain and itching at the site. Increase in size and weight of Plexifom was gradual with age. In this case the Plexiform developed on lower right arm. All over the body, the patient also showed other signs of NFl, Caf‚-au-lait spots [CLSs] and sessile neurofibroma. Freckles were seen in the arm pits and over the stomach skin. The Lisch nodules were also present in the eyes of the subject. Pedigree of the patient confirms that the case is familial one where his mother had NFl but no Plexiform. Biopsy confirms that neurofibromatosis tumors were benign

Deep penetrating nevus: A distinct variant of melanocytic nevus.

Deep penetrating nevus (DPN) is a variant of melanocytic nevus which goes unrecognized due to its relative rarity and may be misinterpreted as malignant melanoma. It commonly presents in young adults as a dark pigmented lesion on the face, neck, or shoulder. A 60-year-old lady presented with a mole over the left arm of 8 years duration. A biopsy of the lesion was performed under the clinical impression of a compound nevus with suspicion of malignancy. Based on the histologic features, a diagnosis of DPN was put forward.

Calcinose universal idiopática: apresentação em recém-nascido / Idiopathic calcinosis universalis: infant presentation

A calcinose universal idiopática é uma doença rara, de diagnóstico difícil e que se manifesta em recém-nascidos e crianças. Relatamos o caso de um paciente recém-nascido, do sexo masculino, apresentando calcificação limitada ao tecido subcutâneo do membro superior direito.

The idiopathic calcinosis universalis is a rare disorder of unknown cause which affects infants and children. This article reports on a case of a recent born male patient showing limited calcification inthe subcutaneous tissue of the right upper arm.

A fisioterapia aquática no tratamento do linfedema pós-mastectomia / The aquatic physical therapy in the treatment for the limphoedema post mastectomy

O tratamento cirúrgico para o câncer de mama é descrito desde 1894 até a atualidade, como um dos mais eficazes, sendo o linfedema de braço uma das mais freqüentes complicações crônicas. Esta complicação, hoje em dia, é abordada através da fisioterapia em diversos aspectos e com resultados crescentes na melhora da sintomatologia geral, que envolve sintomas físico-funcionais e emocionais. Com o conhecimento dos efeitos fisiológicos benéficos que o tratamento utilizando a fisioterapia aquática oferece, seria de grande valia verificar a aplicabilidade destes efeitos no linfedema de braço, pós-mastectomia, em relação à fisioterapia em solo, considerada como a convencional. Esta técnica fundamenta-se nos conceitos e efeitos causados pela pressão hidrostática, que a água exerce sobre os tecidos e corpos imersos, que é diretamente proporcional à profundidade e a densidade do fluido, e opõe-se a tendência dos líquidos em acumular-se nas extremidades, promovendo a redução de edemas. Com a experiência no emprego da fisioterapia aquática para o tratamento de linfedema de braço, pós-mastectomia, realizada em nosso serviço, observamos que esta é uma alternativa interessante, haja vista propiciar amplos benefícios quando comparada a fisioterapia convencional.

Fatores predisponentes ao linfedema de braço referidos por mulheres mastectomizadas / Fatores predisponentes ao linfedema de braço referidos por mulheres mastectomizadas

Estudo descritivo, exploratório, que objetivou identificar os motivos referidos por mulheres mastectomizadas para o surgimento de linfedema no membro superior homolateral à cirurgia. Desenvolvido no Núcleo de Ensino, Pesquisa e Assistência na Reabilitação de Mastectomizadas da Escola de Enfermagem da Ribeirão Preto da Universidade de São Paulo, com 32 mulheres mastectomizadas, por meio de entrevista e de um questionário em forma de check list, em 2005. Os motivos por elas referidos relacionam-se a: esforço físico exagerado, à própria cirurgia, radioterapia, calor excessivo no braço, falta de orientação para prevenção do linfedema e problemas com o dreno. Concluiu-se que a maioria das mulheres tem dificuldade de relacionar o aparecimento do linfedema com alguns de seus fatores predisponentes. É necessário que os profissionais da saúde despendam esforços na prática educativa das mulheres mastectomizadas, visando à prevenção e controle do linfedema de braço.

Fibrous hamartoma of infancy

Fibrous hamartoma of infancy [FHI] is one of the rare tumor-like malformation. This benign tumor can cause much concern and confusion about being malignancy. We report a case of 10 months old infant who presented with a mass at posteriomedial surface of left upper arm. The mass was excised completely and histopathology confirmed the lesion as FHI

Keloidal granuloma faciale with extrafacial lesions.

Granuloma faciale (GF) is a rare cutaneous disorder characterized by one to several soft, erythematous to livid papules, plaques or nodules, usually occurring on the face. Extrafacial lesions are uncommon. A 52-year-old lady with multiple asymptomatic, variously sized brownish-black colored, firm, sharply circumscribed plaques resembling keloids on both cheeks and extrafacial lesions on the right arm and the right breast is presented for its unusual keloidal appearance and typical histopathological findings. She failed to respond to oral dapsone 100 mg daily administered for 3 months. Local infiltration of triamcinolone combined with cryotherapy led to only partial flattening of the lesions. All the skin lesions were excised surgically followed by flap transfer grafting on both cheeks. The cosmetic outcome was highly satisfactory.

A Study of Skin Color by Melanin Index According to Site, Gestational Age, Birth Weight and Season of Birth in Korean Neonates

Human skin color shows variations throughout life and influenced by various factors such as race, sex, age and hormones. Since the development of spectrophotometer, many studies on human skin color have been done. However, few studies have been carried out to measure the skin color of neonatal infants. The aim of our study was to assess the variations in skin color according to site, gestational age, birth weight and season of birth in Korean neonates. A total of 447 healthy neonates (3 days after birth, 213 males and 234 females) were enrolled in the present study. Skin pigmentation was measured by reflectance spectrophotometer (Derma-Spectrophotometer(R), Cortex technology, Hadsund, Denmark) at four different sites (forehead, upper arm, abdomen, and inguinal area). The forehead showed highest melanin index in all sites measured (p<0.05). There was no significant difference according to gestational age, birth weight, and season of birth. This result imply that the skin color in neonates is mainly determined genetically.

Bathing trunk naevus and neurofibromatosis type 1: a unique association of Friedrich's ataxia.

A 15-year-old male presented with history of progressive instability of gait for last 6 months. General examination revealed multiple subcutaneous nodules all over the body. There was a large pigmented naevus over the lower back area along with a subcutaneous bosselated swelling over right arm. Neurological examination revealed features of gait ataxia. Plantar reflexes were extensor on both sides. Skin biopsy from the pigmented naevus showed features of melanocytic naevus. Electrophysiological studies of both common peroneal and sural nerves revealed features of axonal neuropathy. With the above clinical and laboratory findings a diagnosis of neurofibromatosis type 1 accociated with bathing trunk naevus and Friedrich's ataxia was entertained.

Syringomyelia as a cause of limb hypertrophy.

A case of limb hypertrophy secondary to syringomyelia is presented.