El síndrome Axillary-web: «frecuente, pero infradiagnosticado» / The Axillary-web syndrome: frequent, but underdiagnosed

Presentamos un caso de síndrome Axillary-web (AWS) visitado en el Hospital de Granollers. El AWS es una de las complicaciones frecuentemente olvidadas tras una linfadenectomía axilar. Consiste en la aparición en el período postoperatorio precoz de unos cordones de tejido subcutáneo que se extienden desde la axila hasta la parte medial del brazo, acompañándose de dolor a nivel axilar y limitación en el balance articular del hombro. Existen muy pocas publicaciones y revisiones de este síndrome en la literatura científica, encontrándose una incidencia variable según si se trata de una linfadenectomía axilar (entre el 6-72%) o solo la técnica del ganglio centinela (0,5-20%). Su desconocimiento puede conllevar a no realizar el diagnóstico diferencial con la limitación del balance articular, el acortamiento muscular o el dolor al movimiento que pueden existir tras una linfadenectomía axilar y, por ello, a proponer pruebas complementarias o tratamientos erróneos o provocar retraso en el inicio de la radioterapia (AU)

We present one case of Axillary-web syndrome (AWS) seen in Granollers Hospital (Barcelona). AWS is one of the most frequently overlook complications following axillary dissection. AWS appears in the early postoperatory period. It consists of subcutaneous tissue cords extending from the axilla into the medial part of the arm, with axillary pain and limited mobility of the shoulder. There are very few articles and reviews in the scientific literature on this syndrome. In addition, the incidence found is variable, depending on whether it refers to axillary dissection (from 6-72%) or simply the sentinel node technique (0.5-20%). Lack of knowledge about AWS may lead to confusion between limited mobility, muscle shortening or pain with movement that can appear after an axillary dissection. This could result in the proposal of complementary tests or erroneous treatments or provoke delay in beginning radiotherapy (AU)

Incidence of complications and mortality in a type 2 diabetes patient cohort study followed up from diagnosis in a primary healthcare centre.

AIMS: To determine the microvascular and macrovascular complications and mortality incidence rates and to identify the related factors in patients recently diagnosed with type 2 diabetes between 1991 and 2000 and followed until 2006. METHODS: Retrospective longitudinal study in a primary healthcare center. Patients without any measure of glycaemia in the 3 years previous to diabetes diagnosis were excluded. Annual incidence rates for microvascular and macrovascular complications and mortality were estimated. Analysis of KaplanMeier survival curves and Cox proportional risk models by gender were done. RESULTS: Of 469 patients [mean age: 60.4 (SD 10.7) years, 53.9% women], 80 died principally of tumoral (38.7%) and cardiovascular (30%) causes. The mean follow-up period was 8.81 years. (SD 3.21). The complication rates per 1000 patients/year (95% CI) were: microvascular complications 29.11 (22.97-36.38), macrovascular complications 24.10 (19.05-30.08) and mortality 19.23 (15.25-23.93), all of those being significantly greater in males except for cerebrovascular disease. Complications and mortality were associated with age, HbA1c, HDL-cholesterol, blood pressure and smoking with a different significance for each gender. HbA1c was related to microvascular complications in both sexes and to macrovascular complications only in women. CONCLUSION: The annual rates for death and complications in a Mediterranean type 2 diabetic patient cohort followed from diagnosis were lower than those published in Anglo-Saxon countries. Males showed higher death and complication rates except in terms of cerebrovascular disease. Predictors of complication and death were different depending on gender. In terms of mortality, unlike in other studies, only one-third of the deaths were for cardiovascular causes.