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Surgery of the Shoulder
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Nick Aresti, Omar Haddo, Mark Falworth
It is very important to identify and draw on the landmarks of the shoulder, particularly given the difficulty in identifying them once it has swollen with fluid. These landmarks should include Spine of the scapula.Acromion – the posterolateral corner, lateral acromion, and anterolateral corners.Supraclavicular fossa.Distal clavicle and acromioclavicular joint (ACJ).Tip of the coracoid.A line from the anterolateral corner of the acromion heading towards the upper arm signifies the position of the long head of the biceps tendon.Lateral orientation line, which aids in the placement of a lateral portal.
Oncological emergencies
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Oedema of the face, neck and arms can be apparent with fixed engorged jugular veins and dilatation of superficial skin veins over the chest, neck, face and upper limbs. There might be obvious respiratory distress or stridor. A tumour mass might be palpable arising out of the mediastinum in the supraclavicular fossae. Papilloedema can be present on fundoscopy.
Integrative hyperthermia treatments for different types of cancer
Published in Clifford L. K. Pang, Kaiman Lee, Hyperthermia in Oncology, 2015
Clifford L. K. Pang, Kaiman Lee
Auxiliary examination: Positron emission tomography (PET)-CT examination, which was done 1 month ago, showed the following: (1) postoperative transitional cell carcinoma of renal pelvis; the left kidney was absent, the right kidney was atrophic with multiple cysts, and the transplanted kidney in the right iliac fossa had normal development. (2) Small high metabolic lesions could be seen at the left supraclavicular fossa, which were considered as small lymph node metastasis foci. (3) Multiple high metabolic lesions could be seen at the side of lesser curvature; hepatic portal area; and retroperitoneal area of the upper, middle, and lower abdomen, which were considered as multiple lymph node metastasis foci. (4) Multiple small high metabolic lesions in the pancreas were considered as pancreatic tumor infiltration. (5) Obsolete inflammation could be seen in the left lung; small calcification foci could be seen in the right lobe of the liver; and small amount of fluid was found in the pelvic cavity. Blood routine: RBC 3.1 × 1012/L, Hb 101 g/L, WBC 4.65 × 109/L, and PLT 97 × 109/L. Biochemistry: ALT 34 U/L, AST 37 U/L, TBIL 32 U/L, DBIL 16 U/L, ALB 28 g/L, ALP 89 U/L, GGT 112 U/L, BUN 12.8 mmol/L, Cr 32 µmol/L, Ua 176 µmol/L, and GLU 6.1 mmol/L. Tumor markers were normal. Eight items of immune function were as follows: IgM 12.8 g/L, IgG 4.3 g/L, TG 1.96 mmol/L, GHO 6.13 mmol/L, K+ 3.7 mmol/L, Na+ 136 mmol/L, Cl− 92 mmol/L, and Ca2+ 2.01 mmol/L. Trace elements such as copper, zinc, lead, mercury, cadmium, and nickel were normal.
Efficacy of tramadol versus dexamethasone in ultrasound guided supraclavicular block for forearm fractures. Does it make a difference?
Published in Egyptian Journal of Anaesthesia, 2023
Wesam Nashat Ali, Mohamed Hassan Bakri, Marwa Mahmoud AbdelRady, Norhan M Bakri, Esraa Gamal Abdel Nasser Fathy, Ola Wahba
The ultrasound machine was on one side, while the anesthesiologist was behind the patient’s head. Without a pillow, the patient’s head was directly on the operation table, facing the opposite direction. The patient’s jaw was being pressed by the hand carrying the probe. The coronal oblique plane of the supraclavicular fossa received the probe. The lateral side was used to insert the needle. It was possible to identify the pulsing hypoechoic supraclavicular artery. The bed’s head was slightly lifted to allow for a small amount of shoulder flexion and opening of the supraclavicular joint. The pleura and first rib could be seen because of the probe’s position. The subclavian artery is generally surrounded by a collection of hypoechoic circular formations that look like a bunch of grapes and are superior and posterolateral to the subclavian artery, typically representing the nerve structures (trunks or divisions).
Application of CUBE-STIR MRI and high-frequency ultrasound in contralateral cervical 7 nerve transfer surgery
Published in British Journal of Neurosurgery, 2023
Ai-Ping Yu, Su Jiang, Hua-Li Zhao, Zong-Hui Liang, Yan-Qun Qiu, Yun-Dong Shen, Guo-Bao Wang, Chunmin Liang, Wen-Dong Xu
All studies were performed in clinic using a linear 12-MHz transducer on the LOGIQ e platform (GE Healthcare). Sonography was performed from a supraclavicular approach, as described by Wang et al.15 The patient was placed supine and the arm was positioned by the side and the shoulder was placed in neutral rotation. The head was tilted to one side and the ultrasound probe was placed in the supraclavicular fossa in a transverse orientation, aimed caudad into the thoracic cavity, to visualize the brachial plexus near the subclavian artery. Once identified, the plexus was followed cephalad where it is found in the interscalene groove. The C5 and C6 roots were also followed to where they appear joined as the superior trunk. Ideally, this location should be proximal to where the suprascapular nerve branches. The long axis of the cervical vertebrae was used as the axis to move the prove. The anterior scalene muscle was considered as the reference object. The anatomic positional relationship between the nerve root and the transverse process of the anterior and middle scalene muscles in the cross section was used. Then, rotate the probe 90 degrees to the oblique sagittal plane of the lateral side of the neck. Take the anterior tube of the vertebral body as the reference and scan along the long axis of the bilateral brachial plexus nerves.
Complications in lymph node excision in the head and neck area
Published in Acta Oto-Laryngologica, 2022
Minna Rehell, Timo Atula, Laura K. Tapiovaara, Leif J. J. Bäck, Anni I. M. Koskinen, Johanna Ruohoalho, Katri L. S. Aro
Most lymph nodes with a histopathological diagnosis of carcinoma after LNE were excised from the supraclavicular fossa. The histology referred commonly to a metastasis from an intra-abdominal site, which is often the primary site for these metastases [16,17]. LNE can lead to a set of complications in head and neck squamous cell carcinoma (HNSCC), which is the most common type of cancer of the head and neck [18]. The complications can include wound-related problems, distortion of anatomy, or even tumor cell seeding [19], and thus affect future treatment options and increase the need for radiotherapy, which then increases patient’s treatment burden as well as affects costs of care [20]. In our series we did not have any HNSCC patients undergoing LNE. All patients at the outpatient clinic undergo comprehensive otorhinolaryngological examination including endoscopy of the upper airways that undoubtedly diminishes the risk for unknown primaries and prevents unnecessary LNEs. Thus, our management protocol seems to work efficiently.