Axilla

Intra-individual comparison of the cutaneous safety and efficacy of calcitriol 3 lg g )1 ointment and calcipotriol 50 lg g )1 ointment on chronic plaque psoriasis localized in facial, hairline, retroauricular or flexural areas Summary Background Psoriasis involving sensitive skin areas remains difficult to treat because of the sideeffects of topical corticosteroids and the irritancy potential of vitamin D 3 derivatives. Several clinical trials have demonstrated that calcitriol, the naturally occurring and hormonally active form of vitamin D 3 , is effective and safe at the dose of 3 lg g )1 for the treatment of psoriasis affecting the trunk and limbs. Methods We compared the safety and efficacy of calcitriol 3 lg g )1 ointment and calcipotriol 50 lg g )1 ointment in a multicentre, randomized, investigator-blinded, left-right comparison in mild to moderate chronic plaque psoriasis affecting sensitive areas, defined as being the face, hairline, retroauricular and flexural areas. One pair of symmetrical and bilateral target lesions was selected from each area and assessed for perilesional erythema, oedema, and stinging ⁄ burning. Global assessment of local tolerability and global improvement were rated by the investigator, and the subjects were asked to evaluate the tolerability and efficacy of each product and to express their global preference. Results In the 75 subjects, calcitriol and calcipotriol both led to clearing of at least one target lesion in 21 (28%) of the subjects each. Perilesional erythema (P < 0AE001), perilesional oedema (P < 0AE02) and stinging ⁄ burning (P < 0AE001) were all significantly less severe with calcitriol than with calcipotriol. The subjects' evaluation of local tolerability was significantly (P < 0AE0001) in favour of calcitriol. Ten treatment-related dermatological events occurred in eight subjects, including one subject who experienced skin discomfort on both sides. All other events occurred only on the calcipotriol-treated side (irritant dermatitis, six subjects; contact dermatitis, one subject). Global assessment of improvement from baseline by the investigators was significantly greater for the calcitriol-treated lesions (P < 0AE02). The subjects' global preference was significantly in favour of calcitriol (P < 0AE02). Conclusions In the present study, calcitriol ointment was found to be better tolerated and would appear to be more effective than calcipotriol ointment in the treatment of psoriasis in sensitive areas.

This paper describes a middle-aged patient who developed repeated episodes of swelling of the orofacial tissues after dental treatment. On investigation, C1 inhibitor, C1q, C2, and C4 levels were all markedly reduced, and a diagnosis of acquired C1 inhibitor deficiency was made. The patient had been diagnosed with non-Hodgkin's lymphoma (NHL) 2 years previously and had undergone a successful course of chemotherapy. The development of her episodes of angioedema prompted thorough reinvestigation and a recurrence of NHL was identified. Therefore, acquired C1 inhibitor deficiency heralded a recurrence, although this had not been a manifestation when NHL was first diagnosed. The patient underwent a further course of chemotherapy and remains well, although C1 inhibitor, C1q, C2, and C4 levels remain reduced.

Quadrilateral space syndrome (QSS) arises from compression or mechanical injury to the axillary nerve or the posterior circumflex humeral artery (PCHA) as they pass through the quadrilateral space (QS). Quadrilateral space syndrome is an uncommon cause of paresthesia and an underdiagnosed cause of digital ischemia in overhead athletes. Quadrilateral space syndrome can present with neurogenic symptoms (pain and weakness) secondary to axillary nerve compression. In addition, repeated abduction and external rotation of the arm is felt to lead to injury of the PCHA within the QSS. This often results in PCHA thrombosis and aneurysm formation, with distal emboli. Because of relative infrequency, QSS is rarely diagnosed on evaluation of athletes with such symptoms. We report on 9 patients who presented at Mayo Clinic with QSS. Differential diagnosis, a new classification system, and the management of QSS are discussed, with a comprehensive literature review. The following search terms were used on PubMed: axillary nerve, posterior circumflex humeral artery, quadrilateral space, and quadrangular space. Articles were selected if they described patients with symptoms from axillary nerve entrapment or PCHA thrombosis, or if related screening or imaging methods were assessed. References available within the obtained articles were also pursued. There was no date or language restriction for article inclusion; 5 studies in languages besides English were reported in German, French, Spanish, Turkish, and Chinese.

Background: A positive sentinel lymph node (SLN) has been reported in 6% to 13% of patients with ductal carcinoma in situ (DCIS). Although it is well established that nodal status for invasive disease is prognostically important, the clinical relevance of a positive SLN in patients with DCIS remains undetermined.

Following massive weight loss, patients evolve severe arm deformity, extending through the axilla and on to the chest. The L brachioplasty was developed to treat the entire deformity through the excision of two unequal ellipses at right angles in the form of an &quot;L.&quot; More than 50 patients have been treated since 2002 with esthetic reshaping of the upper arm, leaving inconspicuous scars and only minor complications. There have been eight scar revisions, including two Z-plasties for contracture. The rationale and results compare favorably with contemporary techniques. L brachioplasty is our procedure of choice for the patient who has had massive weight loss, and it can be applied selectively to the aging arm.

Introduction: Sentinel lymph node biopsy is an accepted standard of care for staging the axilla in patients with early-stage breast cancer. Little attention has been placed to the presence of intramammary sentinel lymph nodes (intraMSLNs) on preoperative lymphoscintigraphy.

Axillary lymph node metastases from adeno carcinoma or poorly differentiated carcinoma of unknown primary (CUPAx) represent a rare clinical entity without consensus on its biology, management and outcome. We systematically reviewed published CUPAx series and identified 24 retrospective studies enrolling 689 patients from 1975 till 2006. CUPAx affected women at a mean age of 52 years, 66% of whom post-menopausal harbouring low-volume (N1, 48%) or high-volume (52%) nodal disease from ductal adenocarcinoma (83%). Among a total of 446 patients managed with mastectomy, a small breast primary was identified histologically in 321 (72% of cases). Hormone receptor protein expression was observed in 40-50% of cases, while HER2 overexpression in 31%. CUPAx patients were managed with axillary lymph node dissection coupled to mastectomy (59%), primary breast irradiation (26%) or observation (15%). Observation was associated with high locoregional relapse rates (42%) and risk of metastatic spread. Mastectomy or radiotherapy provided locoregional disease control in 75-85% of cases, while adjuvant systemic therapy was associated with a nonsignificant trend for improved survival in few series. Five-year survival ranged from 59.4 to 88% at a median follow-up of 62 months (mean 5-year survival 72%), with axillary tumour burden being the pivotal prognostic factor. CUPAx is associated with similar presentation, biology and outcome to resected node-positive overt breast cancer and should be treated accordingly.

Background. Laser-assisted hair removal has become a popular treatment for eradication of body hair. Many studies have been published concerning the safety and efficacy of several laser systems. Adverse events are hyperpigmentation, hypopigmentation, erythema, oedema, scarring, pain and blistering. Changes in sweating have not previously been reported. Aim. To investigate the effects on axillary sweating of hair removal by a 1064-nm neodymium:yttrium-aluminium-garnet (Nd:YAG) laser. Methods. The sweating function of both axillae was evaluated objectively by the iodine starch test for planimetry measurement and subjectively using a visual analogue scale (VAS) before the treatment, and 1 month and 1 year after the last session. Results. The difference in hyperhidrotic activity before and after treatment was significant (P < 0.05), and these differences persisted 1 year after the last evaluation.

Background If treatment of the axilla is indicated in patients with breast cancer who have a positive sentinel node, axillary lymph node dissection is the present standard. Although axillary lymph node dissection provides excellent regional control, it is associated with harmful side-eff ects. We aimed to assess whether axillary radiotherapy provides comparable regional control with fewer side-eff ects.