Neuroanatomy
E Glucksman in MCQs in Neurology and Neurosurgery for Medical Students, 2022
This chapter provides that the themed presentation encourages quick, focused study and detailed answers aid comprehension and encourages familiarity with each topic with essential diagrams, colour images and sample MRIs. The dorsal scapular nerve supplies the rhomboid muscles and levator scapulae muscle. The suprascapular nerve supplies supraspinatus and infraspinatus (two of the rotator cuff muscles; teres minor is supplied by the axillary nerve and subscapularis by the upper and lower subscapular nerves). The axillary nerve supplies the deltoid muscles; this nerve is commonly injured in shoulder dislocations; always check the sensation over the ‘regimental badge area’ before attempting shoulder reduction to assess if damage has already occurred. The sinus itself receives a venous blood supply from the ophthalmic vein. Thus, the cavernous sinus is unique since an artery passes through a venous structure.
The skin and subcutaneous tissues
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
The skin is a complex organ that provides protection from ultraviolet light and microbiological invasion. A carbuncle is a spreading necrotizing infection in the subcutaneous tissues, with pus and slough formation, similar to the changes that occur in a boil, but with many points of discharge through holes in the skin that appear when patches of necrotic skin slough. Erysipelas is an infection in the skin and subcutaneous tissues caused by a pathogenic Streptococcus. Tuberculosis of the skin is a rarity. Primary tuberculosis of the skin produces a persistent ulcer with undermined edges. Scattered soft macules may appear in the skin flexures, especially in the submammary areas and axillae of obese females. The word ‘mole’ is a lay term used to describe a brown spot or blemish on the skin. Prolonged exposure of the skin to sunlight can cause areas of hyperkeratosis of the skin, which may undergo malignant change.
Diagnosis of Leukemia, Lymphoma, and Myeloma
Tariq I Mughal, John M Goldman, Sabena T Mughal in Understanding Leukemias, Lymphomas, and Myelomas, 2017
This chapter discusses the clinical aspects, including the presentations and how diagnoses are made for leukemias, lymphomas, and myelomas. Patients with leukemia often present with signs and symptoms arising from bone marrow failure and organ infiltration by the leukemia cells. The marrow of patients with acute leukemia is densely packed with cells, most of them blast cells. In chronic lymphocytic leukemia, the cells normally present in the marrow are replaced to varying degrees by small lymphocytes similar to those found in excess in the blood. The majority of patients have asymmetric painless enlargement of lymph nodes in one or more peripheral lymph node regions, such as neck and axillary or groin. The diagnosis of all lymphomas is typically made by histological examination of an excised lymph node. Most patients with myeloma present with bone pain and symptoms of anemia. Undoubtedly a revised staging system should follow soon, particularly as more sophisticated analysis of myeloma molecular biology is applied.
Superficial location of the brachial plexus and axillary artery in relation to pectoralis minor: a case report
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
Knowledge of the anatomy of the infraclavicular fossa is important as this region is a target site for anaesthesia of the upper limb during infraclavicular approaches to brachial plexus blocks and in central venous cannulation of the axillary or subclavian veins. The cords of the brachial plexus and the axillary artery and vein are classically described as being located deep to the pectoralis minor and major muscles in the infraclavicular fossa. A rare variation was observed on one side of an individual, out of a total of 170 dissections, in which the brachial plexus and axillary artery were located between the pectoralis minor and major muscles. This variation was observed on the right-hand side of a male cadaver, and resulted in a more superficial position of the cords of the brachial plexus and axillary artery in relation to the skin. This superficial position of these vital structures may lead to an increased risk of complications during clinical procedures, such as infraclavicular brachial plexus blocks, central venous cannulation or surgery. Ultrasound should be used whenever possible to visualise variant positions of arteries, veins, nerves or muscles during these and other procedures.
Axillary sentinel node biopsy in prone position for melanomas on the upper back or nape
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Lutz Kretschmer, Simin Hellriegel, Naciye Cevik, Franziska Hartmann, Kai-Martin Thoms, Michael P. Schön
In patients with melanomas on the upper back or nape, axillary sentinel lymph node (SLN) biopsy (SLNB), when performed in the traditional supine position, is often disturbed by scattered radiation emitted from the primary tumor site. The results from the present study suggestthat axillary SLNB performed in the prone position can solve this problem. We compared two consecutive groups of patients with melanomas of the dorsal trunk or nape who received axillary SLNB performed either in the supine (n = 119) or in the prone position (n = 130). The number of SLNs detected and excised was significantly higher in prone position group (2.4 ± 1.5 SLNs versus 1.9 ± 0.95 SLNs, p = 0.002). Using the prone position, intra-operative repositioning of the patient for excision of a primary site of the upper back or neck was not necessary. The SLN identification rates and the SLN-positivity rates did not differ significantly between the two types of intraoperative patient positioning. There were no significant differences in survival outcomes or false-negative rates. In conclusion, axillary SLNB in prone position yields a higher number of excised SLNs in patients with melanomas of the upper back or nape. Axillary SLNB in prone position is easy to perform and reliable. Intraoperative repositioning of the patient is not necessary, which saves time and resources.
Ultrasonography of the axilla in the follow-up of breast cancer patients who have a negative sentinel node biopsy and who avoid axillary clearance
Published in Acta Oncologica, 2006
Junnu Leikola, Tiina Saarto, Heikki Joensuu, Krista Sarvas, Jaana Vironen, Karl Von Smitten, Pekka Virkkunen, Brita Vanharanta, Pekka Mäkelä, Marjut Leidenius
The clinical value of ultrasonography of the axilla in detection of breast cancer recurrence is not known among patients who have a negative sentinel node biopsy and avoid axillary clearance. We studied a cohort of 205 such patients using ultrasonography one and three years after breast surgery. A recurrent tumour was found in the axilla in only two (0.5%) of the total of 383 ultrasound examinations performed during the study, and only one (0.3%) of the 369 examinations performed at the scheduled study visits revealed cancer. None of the ultrasound examinations was false positive, and no study participant was subjected to unnecessary surgery due to ultrasound monitoring. We conclude that the rate of breast cancer recurrence in the ipsilateral axilla is low following sparing of the axillary contents, and that monitoring of such patients with repeated ultrasound examinations is unlikely to be cost-effective.
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