Radical surgical resection combined with lymphadenectomy-directed antimicrobial therapy yielding cure of severe axillary hidradenitis.

BACKGROUND: The current gold standard therapy for hidradenitis suppurativa (HS) is surgical resection. However, despite complete resection, the reoperation rate is reported as high as 54% due to wound infections and disease recurrences. Our hypothesis is that this high recurrence rate is related to retained disease and infected tissue not included in soft tissue resection, namely the lymph nodes. Therefore, performing a superficial lymphadenectomy with nodal microbacterial analysis would remove all infected tissue, eradicate the disease, and allow more specific targeted antibiotic therapy. METHODS: From 2004 to 2009, 11 patients underwent 15 wide en bloc resections including superficial lymphadenectomy with flap reconstruction for axillary HS. A retrospective review was performed with the following outcomes assessed: culture results, hospital stay, and recurrences of HS. RESULTS: Patients were followed up for an average of 4.3 years. During this time, there were no wound complications or disease recurrences. Positive bacterial cultures occurred in 12 of 14 nodes with results that differed from the soft tissue purulence. This led to a 75% change in antibiotic regimen. Superficial abscess cultures were uniformly covered, whereas only 3 of 12 nodal cultures where sensitive to our empiric antibiotic coverage. No patients developed lymphedema or any loss of function in the involved upper extremity. CONCLUSIONS: Axillary HS has traditionally been a challenge due to the morbidity of care and high recurrence. Our data show that an en bloc resection with a superficial lymphadenectomy and subsequent antimicrobial therapy based on both the soft tissue and the lymph nodes can provide a definitive cure.

Neonatal and infant feeding: effect on bone density at 4 years.

OBJECTIVE: The aim of this study was to determine whether the type of feeding during the first 4 months of life affects bone mineral density at 4 years of age. METHODS: Healthy 4-year-old children were recruited from the offices of primary health care providers. After confirming the type of infant feeding by history, dual energy x-ray absorptiometry analysis was obtained at the University of Nebraska Medical Center and evaluated by a radiologist blinded as to feeding type. RESULTS: One hundred and seventy-eight children completed the study (58% male, 85% Caucasian; mean age, 4.5 years). All children had exclusively consumed human milk (n = 57), an infant formula containing no palm olein oil (n = 56) or an infant formula containing palm olein oil (n = 65) during the first 4 months of life. At 4 years of age, no significant differences were noted in bone mineral content or bone mineral density (P = 0.51 and 0.89, respectively) among the three feeding groups as measured by dual energy x-ray absorptiometry. Total body bone mineral content and bone mineral density varied by gender, with males having significantly higher values than females regardless of feeding type (P = 0.028 and P < 0.001, respectively). CONCLUSION: There is no association between the use of palm olein formula during the first 4 months of life and subsequent bone mineral content and bone mineral density in healthy 4-year-old children.