Axillary Area Research Articles

MiRNA-105–5p regulates the histone deacetylase HDAC2 through FOXG1 to affect the malignant biological behavior of triple-negative breast cancer cells

BackgroundTriple-negative breast cancer (TNBC) is a specific subtype of breast cancer (BC). Some potential molecular targets have been identified, and miR-105–5p was found to be abnormally expressed in TNBC tissues. ObjectiveThe objective of this study was to probe the effect of miR-105–5p on TNBC via FOXG1/HDAC2-mediated acetylation. MethodsAn animal model of TNBC was established by injecting BC cells into the axillary area of nude mice. The levels of miR-105–5p, FOXG1, HDAC2, Bcl-2, Bax, and Ki67 were detected via RT‒qPCR, Western blotting and immunohistochemistry. Flow cytometry, CCK-8, Transwell and colony formation assays were used to measure apoptosis, proliferation and migration, respectively. Total histone acetylation levels were measured by ELISA. The binding of FOXG1 to HDAC2 was detected by co-immunoprecipitation. The binding relationship between miR-105–5p and FOXG1 was verified using a dual-luciferase reporter gene assay. ResultsIn this study, miR-105–5p and HDAC2 were highly expressed in the MDA-MB-231 and BT-549 BC cell lines, whereas FOXG1 was expressed at low levels. The inhibition of miR-105–5p inhibited the proliferation and migration of MDA-MB-231 and BT-549 cells and promoted their apoptosis. Bioinformatics analysis revealed that miR-105–5p and FOXG1 had a negative targeting regulatory relationship. FOXG1 overexpression had a similar effect on cancer cells as the inhibition of miR-105–5p. Moreover, experiments revealed that FOXG1 and HDAC2 could bind to each other and that HDAC2 overexpression or treatment with the histone acetyltransferase inhibitor Garcinol weakened the effect of FOXG1 overexpression. In addition, FOXG1 knockdown inhibited the effect of the miR-105–5p inhibitor, while Garcinol treatment further enhanced the effect of FOXG1 knockdown, inhibited histone acetylation, promoted the proliferation and migration of cancer cells, and inhibited apoptosis. Moreover, the in vivo results confirmed the in vitro results. ConclusionmiR-105–5p promotes HDAC2 expression by reducing FOXG1, inhibits histone acetylation, and aggravates the malignant biological behavior of TNBC cells.

18F-FDG PET/CT for early prediction of pathological complete response in breast cancer neoadjuvant therapy: a retrospective analysis.

Neoadjuvant treatment has been developed as a systematic approach for patients with early breast cancer and has resulted in improved breast-conserving rate and survival. However, identifying treatment-sensitive patients at the early phase of therapy remains a problem, hampering disease management and raising the possibility of disease progression during treatment. In this retrospective analysis, we collected 2-deoxy-2-[F-18] fluoro-d-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) images of primary tumor sites and axillary areas and reciprocal clinical pathological data from 121 patients who underwent neoadjuvant treatment and surgery in our center. The univariate and multivariate logistic regression analyses were performed to investigate features associated with pathological complete response (pCR). An 18F-FDG PET/CT-based prediction model was trained, and the performance was evaluated by receiver operating characteristic curves (ROC). The maximum standard uptake values (SUVmax) of 18F-FDG PET/CT were a powerful indicator of tumor status. The SUVmax values of axillary areas were closely related to metastatic lymph node counts (R = 0.62). Moreover, the early SUVmax reduction rates (between baseline and second cycle of neoadjuvant treatment) were statistically different between pCR and non-pCR patients. The early SUVmax reduction rates-based model showed great ability to predict pCR (AUC = 0.89), with all molecular subtypes (HR+HER2-, HR+HER2+, HR-HER2+, and HR-HER2-) considered. Our research proved that the SUVmax reduction rate of 18F-FDG PET/CT contributed to the early prediction of pCR, providing rationales for utilizing PET/CT in NAT in the future.

Using an Innovative Protective Sleeve to Reduce Skin Compression Complications in Axillary Osmidrosis Surgery.

Osmidrosis is a condition characterized by malodorous sweat production in the armpits that often necessitates surgical intervention with tie-over bandages in the axillary area. Standard tie-over bandages may cause skin compression-related complications, such as bruising and skin erosion. To address this issue, we developed a novel technique using a modified protective sleeve. We conducted an observational study involving 60 patients undergoing axillary osmidrosis surgery and divided them into groups. In the experimental group we used a novel technique that included using a modified protective sleeve secured with 4-0 silk sutures. In the control group we used standard tie-over bandages. We created the protective sleeve from the tail of a 3mL syringe by drilling holes on both sides and securing it onto a 10 mm-wide Penrose drain. We threaded sutures through the holes and provided padding between the sutures and the skin. We assessed primary outcomes of bruising and skin breakdown at eight anchoring sites. We found that using the novel protective sleeve significantly reduced skin complications. Compared with standard bandages, the incidence of bruising was reduced by 83.33% (i.e., 16.7% vs 70%). The incidence of skin erosion was reduced by 75% (10% vs 40%). Notably, the control group exhibited delayed complications, such as hypertrophic scars.

Intraoperative Hypertonic Saline Irrigation Preventing Seroma Formation in the Treatment of Axillary Bromhidrosis.

Subcutaneous seroma formation (SF) is commonly seen after axillary bromhidrosis surgeries and its treatment can be challenging and long. Current prevention methods are not consistent, and the treatment includes repeated aspirations and drains, both are associated with higher risk for infections. The purpose of this article is to present a novel and simple technique of intraoperative hypertonic saline irrigation (IHSI) to axillary bromhidrosis subcutaneous dead space, which prevents postoperative SF and enables early drain removal due to reduced secretions. From 2015 to 2022, we performed the intraoperative irrigation of the cavity through normal saline in 100 patients with primary axillary bromhidrosis. Through an incision approximately 3 cm long at the central axillary crease, the entire subcutaneous tissues containing apocrine glands were initially dissected with straight scissors within the axillary area, and then, the undermined apocrine glands were removed with curved scissors. The skin was defatted to become a full-thickness skin flap. Any suspected hemorrhagic spots were immediately coagulated electrosurgically. Negative pressure drains were placed, and intraoperative irrigation of the cavity through the drains with 20 ml of NaCl 0.9% or NaCl 10% left at site for 10 min applies different saline solutions in the same patients. The volumeofdrainage on the 1st postoperative day was 6.54±0.36 mL for the group B, which was significantly less than 15.23±0.42 mL for the group A (p < 0.05). The time of drain removal for the group B was 24 h, which was shorter than 48 h for the group A. In group B, 4 percent of axillae showed significant SF postoperatively, which was lower than the 20 percent of axillae associated with the group A (p < 0.05). The rate of incision infection for the group B was 2 percent, which was significantly lower than the 6 percent of axillae in the group A (p < 0.05). Two percent of axillae showed skin edge necrosis postoperatively in the group B, which was lower than the 10 percent of axillae associated with the group A (p < 0.05). IHSI enhances adhesion formation and reduces secretion rate in subcutaneous dissection space after axillary bromhidrosis surgeries, therefore enables early drain removal and prevents SF, incision infection and skin edge necrosis. As a result, reducing the pain of patients, decreasing inconveniency and cost saving of multiple outpatient visits or additional surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract PO5-20-09: LOCOREGIONAL MANAGEMENT OF DE NOVO STAGE IV HORMONE-POSITIVE BREAST CARCINOMA AFTER CDK 4/6 INHIBITOR TREATMENT

Abstract Systemic therapy remains the backbone for treatment of metastatic breast carcinoma. Locoregional treatment of the primary tumor remains controversial. While it has an established role in the palliative setting, its survival benefit remains unclear. The rationale behind locoregional approach is the reduction of tumor burden and the removal of cancer stem cells which may propagate the disease. In previous literature, hormone-positive breast cancer seems to be the best candidate for locoregional treatment in the presence of synchronous metastases. We present a case of a 43 year-old, female, with no known comorbidities, who sought consult due to note of a hard lump on her right breast. Core needle biopsy of the right breast mass was performed which showed invasive breast carcinoma, no special type, Nottingham histologic grade 2. On immunohistochemistry, tumor was ER +8, PR +8, Ki 67 90%, Her-2 neu negative. Baseline positron emission tomography/CT (PET/CT) scan showed hypermetabolic, heterogeneously-enhancing lobulated right breast mass, 3 × 6.7 × 7.7 cm, with smaller hypermetabolic adjacent nodules. There was also note of multiple enhancing, hypermetabolic lung and pleural nodules, and lymphadenopathies in the mediastinal, right axillary, right cardiophrenic and perigastric areas. Well-defined, hypermetabolic heterogeneously hypoenhancing masses were also seen in segments II and VII of the liver. There was also note of right-sided pleural effusion. Ultrasound-guided thoracentesis was done which turned positive for malignant cells on pleural fluid analysis. She underwent 4 cycles of chemotherapy with Doxorubicin and Paclitaxel. Reevaluation PET-CT scan revealed partial response. Patient was then started on Ribociclib plus Letrozole with ovarian function suppression for 18 months. On latest reevaluation PET/CT scan, there was no evidence of hypermetabolic metastatic disease, with demonstration of hypermetabolic activity only in the right breast. The patient then underwent right total mastectomy, with histopathologic findings of residual invasive carcinoma, Nottingham histologic grade 3, residual tumor size of 3.5 cm, with 95% tumor cellularity and lymphovascular invasion identified, ypT2. All surgical margins were negative for tumor. Currently, the patient has no evidence of disease, with ribociclib and letrozole continued until disease progression or unacceptable toxicity. In this case, surgery of the primary tumor was performed in the presence of a responsive metastatic disease, with the primary tumor being the only evidence of disease. With the advent of newer therapy options like cyclin-dependent kinase 4/6 inhibitors offering outstanding survival benefit for metastatic disease, a more aggressive and synergistic approach with locoregional therapy may be done to eradicate the tumor burden, translating to better long-term survival. Locoregional management of the primary tumor should be discussed in the context of a multidisciplinary team approach and should be individualized based on the individual patient’s need. Citation Format: Raye Angeli Abella, Rubi Li. LOCOREGIONAL MANAGEMENT OF DE NOVO STAGE IV HORMONE-POSITIVE BREAST CARCINOMA AFTER CDK 4/6 INHIBITOR TREATMENT [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-20-09.

Eccrine Spiradenoma

First described in 1956, spiradenomas are benign tumors that arise from the bulge of the hair follicle rather than the sweat gland. Epidemiologically, spiradenomas are rare, malignant ones are even rarer, with only around 120 documented cases worldwide. No racial association or sexual predilection for spiradenomas has been reported. Most spiradenomas occur between the ages of 15 and 35. As for malignant spiradenomas, they tend to develop after the age of 50, with a median age of 60 years. Clinically, they are generally skin-colored nodules approximately 1 cm in diameter with a soft consistency, located on the scalp, neck, upper part of the trunk, breasts and rarely the armpits and vulva. While malignant spiradenomas tend to have slightly different characteristics from benign spiradenomas which can metastasize with an estimated rate of 19%. We report the case of a 45-year-old primiparous patient who had been postmenopausal for 5 years and had a maternal aunt who died of breast cancer who consulted for the discovery on self-palpation of a subcutaneous nodule near the left axillary area. The breast examination is unremarkable on D cup breasts with palpation of a subcutaneous nodule measuring 2.5 x 1.5 cm near the left axillary area. Echo mammography finds tissue and cystic lesions of the left breast classified ACR3 and a left axillary subcutaneous lesion measuring 24x13mm that is difficult to characterize. After biopsy of this lesion, the histological and immunohistochemical appearance returned in favor of a cutaneous adnexal tumor compatible with an ECCRINE SPIRADENOMA The extension assessment made by Thoracal abdomino pelvic CT had revealed non-specific pulmonary micronodules to be monitored The patient was sent to multidisciplinary team discussion with the decision to perform a left lumpectomy of the axillary lesion. The management of malignant spiradenomas is multidisciplinary with a surgeon, an oncologist and possibly a radiation oncologist.

Use of Dixon in magnetic resonance breast contrast-enhanced T1 weighted high-resolution imaging for mastectomy patients at 3T: A prospective study in single center

BackgroundFor patients with complete breast resection, conventional contrast-enhanced T1-weighted imaging (CE-T1WI) with frequency-selective spectral attenuated inversion recovery (SPAIR) provides limited fat suppression on the postoperative side due to the uneven skin surface, inhomogeneous tissue environment, and frequency-selective feature of the SPAIR scheme, leading to difficulties in precise diagnosis. This study aimed to investigate the image quality and performance of the Dixon method compared with SPAIR in breast high-resolution CE-T1WI for mastectomy patients. Materials and methodsSixty female patients who had not performed any breast surgeries were randomly selected retrospectively as the control group. Postmastectomy female patients were enrolled to undergone high-resolution CE-T1WI with SPAIR and Dixon breast scans. Subjective scores were rated using a 5-point scale. Objective parameters, including contrast-to-noise ratio (CNR), edge sharpness, and signal uniformity were measured and calculated. The Wilcoxon rank-sum test and Kappa statistic were used. ResultsA total of 114 consecutive postmastectomy patients were included. Subjective scores of T1WI-SPAIR in the control group were all significantly better than those with SPAIR on the postoperative side of mastectomy patients (P < 0.01). Dixon outperformed SPAIR with significantly better subjective scores in regards to uniformity and degree of fat-suppression, anatomical structures depiction, lesion conspicuity, and axillary visibility (p < 0.05) in both post- and non-operative sides and bilateral axillary areas through the paired comparison. The objective parameters of Dixon were significantly better than those of SPAIR. ConclusionThe Dixon method provided better image uniformity and higher fat suppression efficiency, and showed significant advantages in delineating the anatomical structures, with better axillary and lesion visibilities, especially on the completely removed breast side.

Factors related to adolescent women's readiness for menarche

Menarche is the first natural bleeding occurring in teenage women where blood comes out of the vagina or can be called the first menstruation. Menarche is an early sign of other changes such as breast growth, hair growth in the pubic and axillary areas, and fat distribution in the hip area. Objective: This research determines the factors related to the readiness of young women to face menarche in young women at Baitul Aziz High School, Percut Sei Tuan District, Deli Serdang Regency in 2023. This type of research is an Analytical Survey of researchers who try to explore how and why this phenomenon occurs and this research uses a cross-sectional approach, namely finding out what factors are related to the readiness of young women to face menarche. The sample used was 40 people. Data analysis in this study was univariate and bivariate analysis using the Chi-square test with a=0.05. Based on the results of the Chi-square statistical test, this research found that there was a relationship between the readiness of young women to face menarche, namely the knowledge factor with a p-value = 0.001, the attitude factor with a p-value = 0.000, and the family support factor with a p-value -value= 0.003 so all Ho are rejected (p&lt;0.05). Baitul Aziz High School, Percut Sei Tuan subdistrict, Deli Serdang district, to foster more motivation, enthusiasm and increase knowledge when facing menstruation for the first time (menarche).

Identification of a rare MET variant in three siblings with extramammary Paget disease.

Extramammary Paget disease (EMPD) is an intraepithelial adenocarcinoma that primarily affects the genital and axillary areas in older individuals. A limited number of paired patients with familial EMPD (i.e. parent-offspring, siblings) have been reported but the genetics have not yet been adequately studied. We report, to the best of our knowledge, the first familial cases of patients with EMPD involving three affected siblings. The tumour-only multigene panel testing using surgical specimens revealed a heterozygous c.2997A>C (p.Glu999Asp) nonsynonymous variant in the proto-oncogene MET (NM_000245.4) in the three affected siblings. The germline multigene panel testing using peripheral blood lymphocytes revealed the same missense MET variant in all five family members who were tested, including two asymptomatic offspring (51 and 37 years of age). The MET variant we identified could be involved in EMPD carcinogenesis. Further genomic analyses of patients with familial EMPD are warranted to validate the pathogenic relevance of MET variants in EMPD development.

Comparison of efficacy and safety of tretinoin 0.05% and glycolic acid peeling 70% in axillary and neck lesions of acanthosis nigricans: A single-blinded, randomized trial.

Acanthosis nigricans is a non-inflammatory skin pigmentary disorder characterized by a dark, velvety appearance, primarily observed in the neck and axillary areas. It is commonly associated with obesity, diabetes, and insulin resistance. Although the primary treatment is correcting the underlying disorders, many aesthetic modalities have been established to improve appearance owing to cosmetic concerns. We aimed to compare and investigate the effectiveness and side effects of tretinoin 0.05% and glycolic acid 70% in treating acanthosis nigricans lesions of the axillary and neck area. This single-blinded, randomized trial recruited patients with neck or axillary involvement. Each patient was randomized to use cream tretinoin 0.05% every other night on one side, while the other side was treated with glycolic acid 70%, which was applied every 2 weeks at the clinic for four consecutive sessions. The study duration was 8 weeks, and patients were evaluated every 2 weeks based on their response to treatment, satisfaction, and side effects. Thirty patients, including 14 with neck lesions and 16 with axillary lesions, were included. Tretinoin was significantly more effective for axillary lesions in terms of treatment response and patient satisfaction (p = 0.02 and p = 0.008, respectively). It was also shown that as the severity of the lesions increased, the response to treatment and patient satisfaction decreased, specifically when treating axillary lesions with glycolic acid (p = 0.02 and p = 0.03, respectively). Neither method was significantly effective for neck lesions. However, tretinoin 0.05% was shown to be more efficacious in treating axillary lesions of acanthosis nigricans, despite causing minimal side effects.

Development of idiopathic eruptive macular pigmentation in an 11-year-old boy

A case of idiopathic eruptive macular pigmentation in a child demonstrates a variant of skin hyperpigmentation of uncertain etiology. We described an 11-year-old boy with light brown spots in the torso and limbs that developed against the background of normal skin without an established provoking factor. On examination, it was found that the disease had developed within one year. Initially, the process was localized to the elbow folds and axillary areas, but later the rash spread to the trunk, neck and extremities. No inflammatory changes were observed at the base of the rash elements. The patient was examined for the presence of diseases that could underlie the skin manifestations, and histological examination was performed to verify the diagnosis. The established diagnosis of idiopathic eruptive macular pigmentation made it possible to choose a wait-and-see approach in treating the patient, due to the available literature data on the self-resolution of this pathology and ineffectiveness of the availabledermatosis treatment options.

Lymphoadenopathies caused by Bartonella henselae

Bartonella henselae is the causative agent of cat scratch disease, the main manifestation of which is lymphadenopathy, but it can manifest as bacillary angiomatosis, injury to internal organs, joints, eyes, heart, kidneys. This disease is often encountered in the practical work of doctors, especially with an atypical form of the course, which occurs in 20% of adult patients. Often the disease is undiagnosed, mimicking lymphadenopathies caused by tumors of soft tissues and bones or other bacterial pathogens. The purpose of the work was to analyze clinical cases of cat scratch disease by the results of inpatient records data based on the leading clinical symptom – lymphadenitis, to summarize literature data related to morbidity, features of the clinical course and treatment of this disease. The description of two clinical cases of cat scratch disease in adult women aged 19 and 59 is given. The typical course of the disease in one of them at the beginning of the disease, was manifested by symptoms of general intoxication, fever, an increase in lymph nodes in the neck and axillary area, which coincided in time with the previously diagnosed bacterial angina. The diagnostic search ended with the set diagnosis and surgical operation three months after the onset of clinical manifes¬tations of the disease. In the second case, a subfebrile body temperature, a painful lymph node in the right axillary area for 3 weeks, were the reason to perform an invasive surgery twice, diagnosed as a bacterial process of unknown etiology. The reasons for late diagnosis and treatment of cat scratch disease in our patients were insufficient collection of epi¬demiological anamnesis, lack of vigilance of doctors, first of all, surgeons, regarding the clinical manifestations of the disease and late examination to find out the etiological factor of the disease. An elevated titer of IgM antibodies to Bartonella henselae 1:160 and 1:140 in two cases was the basis for confirming cat scratch disease. Based on the results of the literature analysis, an overview of typical and atypical manifestations of cat scratch disease, its diagnosis and treat¬ment is presented. Bartonella henselae infection should be considered in all cases of lymphadenitis of unknown etiology, accompanied by high temperature, intoxication syndrome and a long course. In order to prevent the development of purulent complications and to avoid unreasonable invasive procedures, it is important to make a timely diagnosis and carry out appropriate antibacterial treatment at the initial stage of the manifestation of clinical symptoms of cat scratch disease.

Enhancing Quality of Life: Pre- and Postoperative Assessment in Idiopathic Hyperhidrosis Patients.

This study aimed to characterize patients, describe surgical complications, and evaluate the pre- and postoperative quality of life (QOL) of individuals who underwent surgery for primary hyperhidrosis (PHH). A prospective, non-randomized, uncontrolled study was conducted, documenting cases of patients undergoing surgery for PHH at a reference center in La Habana, Cuba, from January 2016 to December 2022. A total of 49 cases were described, with a median age of 16 years; 59.1% were female. The most common presentation was palmar-plantar-axillary, observed in 53% of cases. The palmar presentation was more frequent in female patients (p<0.05). Within 24 hours post-procedure, 85.7% of patients showed dryness in the palmar and axillary areas, with surgical complications occurring in 14.3% of cases (intercostal neuritis, pneumothorax, and hemothorax). CHof some form was recorded in 89.8% of cases. At least 30 days after the surgery, 95.9% of the patients reported a significant improvement in their QOL. Thoracic sympathectomy is an efficient and safe method for treating hyperhidrosis in adolescents, leading to an enhanced QOL. However, this study reported a higher incidence of complications, particularly CH, compared to previous national and international studies.

Effectiveness of a sodium hypochlorite isotonic solution in decolonization of patients with Candida auris: Learnings from a county health care system

Candida auris (CA) is an organism that has spread globally over the last decade. We conducted a quality improvement project with the aim of decreasing or eliminating skin colonization of patients with CA through a modified bathing protocol. An isotonic hypochlorite solution was added to routine bathing protocols for hospitalized patients colonized with CA. Weekly skin swabs from axillary and inguinal areas were tested for the presence of CA using polymerase chain reaction and culture. Multidisciplinary efforts, such as environmental terminal cleaning, dedicated equipment, education, and signage were reinforced among staff to improve patient outcomes. A total of 24 patients were included. After 4 weeks of a modified bathing protocol, 81.2% of the patients remained colonized with CA. Three patients were discharged safely to their homes and 3 were transferred to long-term care acute hospitals. Nine patients remained hospitalized after 60 days. Localized rash was reported in 3 patients, which resolved after discontinuation of the product. Modification of our bathing protocols by including an isotonic hypochlorite solution did not lead to skin decolonization of CA. Further studies are needed to identify effective measures to eradicate, eliminate or reduce colonization.

Sentinel lymph node biopsy in patients with breast cancer. Experience in implementing at the regional level. Priority issues

Background. Despite the fact that sentinel lymph node biopsy (SLNB) in breast cancer patients has become a routine diagnostic procedure, it is still of great interest to researchers, since the priority issues of choosing methodology, equipment, technology, and stages of use are still being discussed. Although all obstacles to this technique implementation into routine clinical practice have been eliminated, SLNB in locally advanced breast cancer is still rarely used. We describe the experience of implementing SLNB in Nizhny Novgorod Regional Clinical Oncology Dispensary. We also discuss organizational, tactical, and practical approaches aimed to minimize the number of errors in technical terms, as well as to choose a multidisciplinary approach to the development of regulations for the examination and treatment of patients with locally advanced breast cancer.Aim. To assess the efficacy of SLNB implementation for patients with locally advanced breast cancer at the regional level.Materials and methods. This study included 500 patients with invasive (T1–2) breast cancer with clinically negative sentinel lymph nodes of all immunohistochemical subtypes that had undergone SLNB and histological examination. Sentinel lymph nodes were visualized using the radioisotope colloid 99mTc-Nanotop. We present the implementation algorithm for this procedure into routine clinical practice and evaluate short-term results.Results. A total of 500 patients have undergone SLNB. The first 30 cases were considered pilot cases, where all patients positive for sentinel lymph nodes additionally underwent standard axillary lymph node dissection. We observed a 100 % concordance of histological results. Then the surgery was routinely performed for all patients from this category. The assessment of short-term surgical outcomes demonstrated significant improvement of the postoperative period, reduced frequency of postoperative complications (persistent seroma of the axillary area to 2.85 %), reduced length of hospital stay (by 52.7 %) and improved functional and aesthetic results in the majority (&gt;62 %) of patients.Conclusion. Our algorithm of SLNB use in patients with breast cancer in routine clinical practice at the regional level allows for rapid method implementation, reduced length of hospital stay, better functional and aesthetic results, and lower incidence of persistent seroma of the axillary area.

Chronological changes in the rate of surgical field contamination in the shoulder joint

BackgroundIn shoulder surgery, low-virulence bacteria such as Cutibacterium acnes and coagulase-negative staphylococci can cause postoperative infection. However, the degree of sterility during surgery after disinfection is not known, and the efficacy of double skin preparation for such bacteria is unclear. This study aimed to evaluate chronological changes in the surgical field contamination rate in the shoulder joint and to compare single and double skin preparation. MethodsIn total, 126 shoulders in 121 patients undergoing shoulder surgery (64 men, 62 women; mean age 64 years) were enrolled. Patients were divided into two groups: single skin preparation, where the site was painted with 10% povidone iodine, and double skin preparation, where the site was treated with 1% chlorhexidine gluconate/83% isopropyl alcohol and painted 10% povidone iodine. Swab samples from the axillary and proximal areas in the surgical field were collected chronologically before starting surgery and at 30, 60, and 120 min after starting surgery (MAS). The contamination rate of each sample was compared and detected species were evaluated. ResultsThe contamination rate for the axillary area was 48.4%, 85.9%, 95.3%, and 97.1% in the single-preparation group and 32.3%, 72.6%, 87.1%, and 91.2% in the double-preparation group before starting surgery and 30, 60, and 120 MAS, respectively, and that the proximal area was 12.5%, 26.6%, 29.7%, and 35.3% in the single-preparation group and 16.1%, 19.4%, 27.4%, and 38.2% in the double-preparation group, respectively. Significant differences were not seen between the groups by area or time point. Most detected species were Cutibacterium acnes and coagulase-negative staphylococci. ConclusionsThe incidence of surgical field contamination in shoulder joint was high from immediately after starting surgery. In the axillary area, the contamination rates exceeded 70% from 30 MAS in both groups. Measures against infection should be instituted considering these findings when performing shoulder surgery.

Polymicrobial community-acquired pneumonia: Coinfection with tuberculosis, Klebsiella and Staphylococcus

Abstract A 71-year-old male a chronic smoker, who also had diabetes mellitus and hypertension presented with complaints of fever, cough with foul-smelling sputum and dyspnoea for 25 days. Coarse crepitations were evident in the interscapular area, infrascapular, axillary, infra-axillary and mammary areas on the left side. Contrast-enhanced computed tomography of the chest showed necrotic mediastinal lymph nodes and areas of consolidation in the left upper lobe. Bronchoalveolar lavage fluid polymerase chain reaction identified Staphylococcus, New Delhi metallo-β-lactamase (NDM) producing Klebsiella; GeneXpert detected Mycobacterium tuberculosis complex. Pleural fluid analysis was suggestive of exudative effusion with elevated adenosine deaminase. The patient was managed with anti-tuberculosis treatment, ceftazidime-avibactam, aztreonam and linezolid.

Histiocytic Necrotizing Lymphadenitis or Kikuchi–Fujimoto Disease: Clinical Experiences in North Africa

Introduction: Kikuchi-Fujimoto disease or Kikuchi disease (KD) or histiocytic necrotizing lymphadenitis is an uncommon disease more frequent in Asia. It is diagnosed with lymph node histopathological findings.&#x0D; Objective: To perform a systematic review of Kikuchi’s disease (KD) cases and describe clinical manifestations and associated etiology in the Tunisian population.&#x0D; Methods: We conducted a multicentric descriptive study collecting patients with histologically proven KD. Clinical data, laboratory results, histopathologic examination, associated pathologies, and patient evolution were included.&#x0D; Results: The search included 9 patients. They were 7 women and 2 males with a median age of 45 years old [24-72]. Common clinical manifestations were fever (n=8) and arthralgia (n=7). Lymph nodes mainly were bilateral (n=8), multiple (n=9), and in the cervical region (n=8) and axillary area (n=6). Laboratory results showed inflammatory syndrome and elevated lactate dehydrogenase. Areas of necrosis, karyorrhectic debris, and accumulation of histiocytes were specific histologic findings noted for all patients. Systemic Lupus Erythematosus was associated with KD in 2 patients and with Sjögren disease in one of them. Other associated pathologies were Lymphohistiocytic activation syndrome, lymphocytic meningitis, sepsis from a urinary tract infection, and idiopathic interstitial lung disease. Corticosteroids were prescribed in 4 cases. The other 5 cases had spontaneous regression of symptoms. The outcomes were favorable with recovery in 3 cases. Five patients developed Hodgkin lymphoma, myelodysplastic syndrome, and lupus nephropathy after KD diagnosis.&#x0D; Conclusions: KD is exceptional in North Africa. The study noted the same clinical and histological findings in the literature. SLE was the most associated pathology. No ethnic variability was detected.

Long-term efficacy and tolerance of a technique for postmastectomy electron beam radiation therapy of the unreconstructed chest wall and lymph node areas for non-metastatic breast cancers

PurposeTo evaluate the long-term tolerance and outcome of patients irradiated with an electron beam technique used since 2007 on the chest wall and lymph node areas after mastectomy for non-metastatic locally advanced breast carcinoma. Patients and methodsAll patients irradiated with an improved electron beam technique after mastectomy for non-metastatic breast carcinoma between 2007 and 2011 at Institut Curie (France) were included in this descriptive study. The technique has already been described in other studies, as has its 5-year tolerance and non-inferiority compared to photon irradiation. Acute and chronic toxicity were collected using CTCAE v 3.0. A clinical examination was carried out each week during the radiotherapy and at each 6 months consultation with one mammogram per year at the Institut Curie for at least 5 years. The patients then continued to be followed either at the Institut Curie or in private practice with a good transmission of outpatient consultations, thanks to a system of forms to be completed and integrated into the electronic files. Quantitative and qualitative data are defined by mean and proportion. Statistical comparisons were made by computer using the Chi2 test and Fisher's exact test for categorical variables. Recurrence-free survival was defined as the time between the end of treatment and the date of recurrence or death. Overall survival was defined in the same way without taking into account recurrences. Patients who did not report any events were censored at the date of last news. ResultsOf the 796 patients included, 51.3% had multifocal lesions, 10.1% had triple negative status, and 18.8% displayed overexpression of the Her2 receptor, 196 (24.6%) patients received neoadjuvant chemotherapy and 208 (26.1%) systemic treatment during radiotherapy (chemotherapy or targeted therapy); 514 (64.6%) had at least one positive lymph node. The internal mammary chain (IMC) was irradiated in 85.6% of cases, the supraclavicular areas in 88.3% of cases, the infraclavicular in 77.9% of cases and the axillary area in 14.9% of cases. With a median follow-up of 113 months (range: 2–164 months), locoregional recurrence-free survival and overall 10-year survival was respectively 94.02%, (95% CI: 92.13–98.94) and 79.84% (95% CI: 76.83–82.97). Median survival was not reached. In the long term, 29.6% of patients had telangiectasias (grade 1: 23.3%, grade 2: 5.2%, grade 3: 1.1%). There were 279 patients (35.1%) with secondary breast reconstruction on average 21 months after all treatments. IMC irradiation was not associated with a majority of pulmonary toxicity. Thirty-five patients developed chronic heart disease after radiotherapy, 30 of whom had received anthracyclines and 9 had received traztuzumab. Three of these reported a coronary ischaemic event, including 2 irradiated on the left and 1 on the right, the 4 were irradiated in the vicinity of the IMC and the other lymph node areas, but presented many other cardiovascular risk factors (between 2 and 4). During follow-up, 4.9% of patients had a contralateral recurrence (n=39) and 5.5% had a second non-breast cancer (n=44), of the 6 bronchopulmonary cancers diagnosed, none appeared to be related to chest wall radiotherapy. ConclusionThis study confirms that the improved postmastectomy electron beam radiation therapy technique is well-tolerated after nearly 10 years of follow-up.

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Tuberculosis is a more prevalent disease and the leading cause of death from an infectious agent in India. Tuberculosis in India accounts for the highest number of cases and deaths annually in the world. In spite of an efficient National tuberculosis control program for five decades, Tuberculosis is still the number one cause of death due to infectious agents in India and one third of total global deaths occurs in India due to this disease. Burden of drug sensitive and drug resistant cases is highest in the south east Asian region with maximum cases in India and China. India has launched a National strategic plan to end TB in 2017 with a target to eliminate TB by 2025. Main theme of the national strategic plan is ‘TB Free India’ with the vision of zero TB disease, zero deaths due to TB and decreasing poverty due to TB. Tuberculosis is an ancient disease and history traced before the evolution of mankind on this planet. Tuberculosis primarily affects the lung and is classified pathologically as primary, post-primary and progressive primary tuberculosis. In this case report, a 62-year male, presented with constitutional symptoms for six-month duration with partial response to medical treatment. He was having low grade fever, cough, shortness of breath, weight loss and anorexia for 6 months. His symptoms were progressive and empirically treated as enteric or typhoid fever for four to five occasions with oral and intravenous antibiotics with steroids with general physicians and family physicians. Additionally, he received empirical treatment as jaundice, viral fever, bronchitis, asthma, and generalised debilitating disease. Relatives brought to our center worsened general health with increased shortness of breath. Clinically he was having bilateral crepitations with decreased breath sounds right lower axillary and infrascapular area. Chest x-ray showed right pleural effusion with miliary opacities bilateral lung field. HRCT thorax showed typical miliary opacities with conglomerated pattern and pleural effusion on the right side of thorax. Pleural fluid analysis revealed exudative effusion with raised ADA level. He was unable to produce sputum, we have done bronchoscopy and BAL evaluation confirmed pulmonary tuberculosis and sensitivity pattern. BAL cytology documented acid-fast bacilli in smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT). We have recorded near complete radiological resolution, bacteriological cure after eight months of ATT with good compliance. More awareness is required regarding symptoms, diagnosis and treatment of tuberculosis to family physicians and general practitioners as the majority of the rural population receives treatment from these health professionals.