Treatment of breast cancer with ipsilateral supraclavicular node metastases

During 1954-1977, among 2803 cases of breast cancer 99 (3.5%) had ipsilateral supraclavicular node mestastases. The results of treatment are reported, based on follow-up for more than 10 years. According to the treatment modality, the patients were divided into 4 groups: I. surgery with postoperative adjuvant chemotherapy and radiation therapy; II. radiation and chemotherapy; III. chemotherapy; IV. no treatment. In group I, surgical procedures consisted of segmental mastectomy in 6; simple mastectomy in 7; modified radical mastectomy in 16; standard radical mastectomy in 12, and extended radical mastectomy in 3. The over-all five-year survival rate was 9%. It was 18% (8/44) in group I, but only 5% (1/21) in group II. None survived for 5 years in group III and group IV. The results seem to indicate that more aggressive multi-modality treatment of breast cancer with ipsilateral supraclavicular lymph node metastases is indicated to expect better survival.     

Aggressive fibromatosis in the supraclavicular region: findings with computerized tomography and magnetic resonance in a case

A case of Mycobacterium shimoidei in a 75 year old man is reported. He had been a smoker, with a past history of bullous emphysema and a lung abscess. He had a 12 month history of weight loss, night sweats, with increased cough and sputum, and progressive opacification of the left apex with cavity formation. Sputum repeatedly grew M. shimoidei, identification of which was confirmed with high-pressure liquid chromatography (HPLC). He was treated for 45 days with three drugs to which the organism was sensitive, but failed to respond. His death was attributed to mycobacterial infection.     

Trichogenic trichoblastoma arising on the supraclavicular fossa with an immunohistochemical study of cytokeratin expression

Efforts to address facility-wide educational topics in one staff development department have resulted in the development of innovative strategies to reach the maximum number of nurses with the greatest positive outcome. We were faced with the challenge of trying to improve discharge planning. A random chart review completed by the hospital utilization coordinator showed an appalling lack of discharge planning on the part of most hospital nursing staff. How would we entice nurses to attend inservice programs concerning such a potentially "dry" topic? Enter Olga and Bertha Smith, two characters devised to inject humor and entertainment into the educational sessions. The characters were role played by the authors and videotaped to show a standard scenario that demonstrated the intricate discharge planning needs of a young single mother (Olga) and her dependent mother (Bertha). Evaluations revealed extremely positive feedback for the characters as an enjoyable and effective way of teaching. Since then, Olga and Bertha have attracted, entertained, and educated nurses about three subsequent inservice topics.     

The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures

Mentosternal contractures represent a surgical challenge to the plastic and reconstructive surgeon. We add the supraclavicular artery island flap to the armamentarium of surgical procedures to improve the function and cosmesis of disfigured patients. Since July of 1994, the supraclavicular artery island flap has been used at our institution for releasing postburn mentosternal contractures in eight patients. The flap was planned to be 4 to 10 cm in width and 20 to 30 cm in length with the supraclavicular vessels running axially. All donor defects could be closed primarily without significant postoperative complications in seven of the eight patients. All flaps healed primarily, achieving a good functional result by complete removal of contracting scar tissue for all patients; one donor site healed by secondary intention. We found the supraclavicular artery island flap both reliable and safe for immediate resurfacing after resection of cervical scars. The anatomy, operative procedure, and postoperative results of the supraclavicular artery island flap are outlined in this paper.     

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

The purpose of this study was to evaluate the efficacy and safety in placement of Hickman catheters via the supraclavicular route without fluoroscopic guidance. We studied 81 consecutive percutaneous placements of dual lumen Hickman catheters via the supraclavicular route without the use of fluoroscopic guidance. Success rates, technical problems, complications, infections and reasons for explantation were recorded prospectively. Seventy-nine punctures were successful (97.5%). One pneumothorax (1.2%) and three accidental arterial punctures (3.7%) occurred. Difficulties in introducing the catheter through the peel away sheath or misplacement were not observed. The catheters remained in place for a total of 7657 days (mean 94.5, range 3-392 days). Sixteen blood cultures were positive (2.1/1000 catheter days). Five catheters (6.1%) were lost because of mechanical complications. Forty-two lines (52%) were removed electively, 23 (28.4%) because of suspected infection, and two (2.5%) because of tunnel infection. Nine patients died with a functioning catheter. We conclude that the supraclavicular approach to the subclavian vein is safe and efficient for introduction of Hickman catheters. Using this access, routine fluoroscopic or sonographic guidance is not required for proper placement. Implantation of the lines in an intensive care unit did not lead to higher infection rates than those reported in the literature.     

Quantitative analysis of respiratory, motor, and sensory function after supraclavicular block

The incidence and clinical significance of hemidiaphragmatic paresis after supraclavicular block of the brachial plexus is unknown. Eight healthy volunteers received a supraclavicular block with a standard technique using 30 mL of 1.5% lidocaine. Respiratory function was assessed with ultrasound of the diaphragm, respiratory inductive plethysmography (RIP), and pulmonary function tests (PFT) every 20 min. Sensory block was assessed with pinprick and motor block with isometric force dynamometry every 20 min. Four of eight subjects demonstrated hemidiaphragmatic paresis on both ultrasound and RIP. No subject experienced changes in PFT values or subjective symptoms of respiratory difficulty. Motor and sensory blockade outlasted hemidiaphragmatic paresis. These results are contrasted to the often symptomatic, 100% incidence of hemidiaphragmatic paresis seen after interscalene block. In this study of healthy volunteers, supraclavicular block was associated with a 50% incidence (95% confidence interval 14-86) of hemidiaphragmatic paresis that was not accompanied by clinical evidence of respiratory compromise. Implications: Interscalene block is always associated with diaphragmatic paralysis and respiratory compromise. The significance of these side effects after supraclavicular block is unknown. Using sensitive measures of respiratory function, we determined that diaphragmatic paralysis occurs less often with the supraclavicular approach and is not associated with respiratory difficulties in healthy subjects.     

Comparison of S(-)-bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block

Control of heart rate in critically ill patients who develop atrial fibrillation or atrial flutter can be difficult. Amiodarone may be an alternative agent for heart rate control if conventional measures are ineffective. We retrospectively studied intensive care unit patients (n = 38) who received intravenous amiodarone for heart rate control in the setting of hemodynamically destabilizing atrial tachyarrhythmias resistant to conventional heart rate control measures. Atrial fibrillation was present in 33 patients and atrial flutter in 5 patients. Onset of rapid heart rate (mean 149 +/- 13 beats/min) was associated with a decrease in systolic blood pressure of 20 +/- 5 mm Hg (p <0.05). Intravenous diltiazem (n = 34), esmolol (n = 4), or digoxin (n = 24) had no effect on heart rate, while reducing systolic blood pressure by 6 +/- 4 mm Hg (p <0.05). The infusion of amiodarone (242 +/- 137 mg over 1 hour) was associated with a decrease in heart rate by 37 +/- 8 beats/min and an increase in systolic blood pressure of 24 +/- 6 mm Hg. Both of these changes were significantly improved (p <0.05) from onset of rapid heart rate or during conventional therapy. Beneficial changes were also noted in pulmonary artery occlusive pressure and cardiac output. There were no adverse effects secondary to amiodarone therapy. Intravenous amiodarone is efficacious and hemodynamically well tolerated in the acute control of heart rote in critically ill patients who develop atrial tachyarrhythmias with rapid ventricular response refractory to conventional treatment. Cardiac electrophysiologic consultation should be obtained before using intravenous amiodarone for this purpose.     

Ozone formation in the greater Cairo area

Ozone formation in the greater Cairo area was studied in 1990 in a 3-week measurement period performed at three sites (Shoubra El-Kheima, Mokattam Hill, Helwan), covering a north-south direction of 27 km, and in 1991, from the beginning of April until the end of October, by measurement of the seasonal variation of ozone at one site at El-Kobba. The sinusoidal shape in the diurnal volume fraction plots with peak values of 120 ppb and daily mean value of 50 ppb throughout the year indicate a substantial contribution of photochemistry to the ozone content of the atmosphere. Ozone is produced predominantly over the industrial area in the north and in the centre of Cairo and transported southward by the prevailing northerly winds. Contrary to many urban areas in Europe and in North America, fairly high average ozone levels of 40 ppb are observed during the night throughout the spring and the summer. This may imply that health hazards and crop damage are higher in the greater Cairo area than in Central Europe.     

Lesions of area 17 in newborn kittens cause selective changes in the development of area 18

In the cat, areas 17 and 18 interconnect soon after birth. To test the hypothesis that the normal development of area 18 depends on interactions with area 17, unilateral lesions of area 17 were created in newborn kittens, and the animals allowed to mature. Horseradish peroxidase was then injected into both lateral geniculate nuclei. The major abnormalities of area 18 in the lesioned hemispheres were a thinning of specifically layers 2 and 3 and abnormally faint geniculocortical labelling of layer 4. Cell densities in layers 2 and 3 of the lesioned hemispheres were similar to or lower than normal. Neonatal destruction of area 17 therefore produced a selective loss of cells in layers 2 and 3 in area 18 (the layers that normally interconnect with area 17), and may have reduced thalamic innervation of layer 4.     

三塘湖地区某矿区水文地质研究

三塘湖地区位于哈萨克斯坦-准噶尔板块(Ⅱ)一级构造单元,二级构造单元属准噶尔微板块(Ⅱ1),三级构造单元为三塘湖晚古生代弧间盆地(Ⅱ14)。已探明的地下水类型主要为松散岩类孔隙潜水及碎屑岩类裂隙孔隙水,由上至下根据地层时代可分为第四系松散岩孔隙潜水、古近-新近系碎屑岩类裂隙孔隙水、白垩系碎屑岩类裂隙孔隙水、侏罗系碎屑岩类裂隙孔隙水,现对三塘湖地区某矿区水文地质特征展开分析与研究,希望能为相关工作的开展提供一定的参考作用。     

Retinal efferents from the pretectal area in the rat

Horseradish peroxidase (HRP) labeled neuronal somas were consistently found in the medial pretectal area after intraocular injection of HRP. The labeled cells represent the source of centrifugal fibers to the rat retina.     

Research in the clinical area: the ethical issues

Healthcare professionals have a duty to undertake research, say the authors of this article, yet the patient's perspective is rarely considered. Here, they review the ethical aspects of clinical research.