Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditio...Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.展开更多
Left supraclavicular lymph node metastasis is a rare presentation of hepatocellular carcinoma (HCC).This phenomenon is easily neglected in the clinic.A 56-yearold man presented with HCC.On examination,a 1cm long left ...Left supraclavicular lymph node metastasis is a rare presentation of hepatocellular carcinoma (HCC).This phenomenon is easily neglected in the clinic.A 56-yearold man presented with HCC.On examination,a 1cm long left supraclavicular lymph node was palpated.Auxiliary examination indicated a lesion located in the right lobe of the liver.Fine needle aspiration cytology (FNAC) of the enlarged lymph node was performed;however,only necrosis was found.Hepatectomy was performed and HCC was confirmed by Hematoxylin-Eosin staining.However,14 d after surgery,significantly enlarged left supraclavicular lymph nodes,a new intrahepatic lesion,and pulmonary and mediastinal metastasis appeared.An excisional biopsy of the left supraclavicular lymph node was performed,and its findings confirmed metastatic HCC.The patient's HCC rapidly progressed and he died one month later.It is possible for HCC tometastasize to the left supraclavicular lymph node.Surgeons should always consider an overall physical examination.When left supraclavicular lymphadenopathy of unknown origin is encountered,FNAC should be performed initially.If the results are negative,an excisional biopsy and subsequent Positron emission tomography computed tomography scanning should be performed.These are very important for making the correct diagnosis and for selecting reasonable therapies.展开更多
AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.
Background: Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. Nalbuphine was studied several times as adjuvant to local anesthetics in spinal, epidura...Background: Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. Nalbuphine was studied several times as adjuvant to local anesthetics in spinal, epidural and local intravenous block. The aim of this study was to evaluate the effect of nalbuphine as an adjuvant to local anesthetics in supraclavicular brachial plexus block. Patients and Methods: Fifty-six patients undergoing elective forearm and hand surgery under supraclavicular brachial plexus block were allocated randomly into one of two groups of 28 patients each to receive either 25 ml (0.5%) bupivacaine with 1 ml of NS or 25 ml (0.5%) bupivacaine with 1 ml (20 mg) nalbuphine. Onset time and duration of both sensory and motor block, and post-operative analgesia were observed. Result: Nalbuphine group showed significant increase in the duration of motor block (412.59 ± 18.63), when compared to control group (353.70 ± 29.019) p-value < 0.001, also, there was significant increase in sensory duration in nalbuphine group (718.14 ± 21.04) when compared to control group (610.18 ± 26.33) p-value < 0.001, without affecting the onset time of the blockade. And also, there was a significant increase in the duration of analgesic effect in nalbuphine group (835.18 ± 42.45) when compared to control group (708.14 ± 54.57) p-value < 0.001. Conclusion: The present study demonstrates that addition of 20 mg nalbuphine to bupivacaine in supraclavicular brachial plexus block is associated with significant increase in the duration of both sensory and motor block and also prolong the duration of analgesia.展开更多
Background: Ultrasound-guided for regional anesthesia offers many potential benefits in the emergency setting. Analgesia can be explicitly targeted to the region of pain and provide relief for many hours and decrease ...Background: Ultrasound-guided for regional anesthesia offers many potential benefits in the emergency setting. Analgesia can be explicitly targeted to the region of pain and provide relief for many hours and decrease needing to the large volume of local anesthetic. The aim of the work: Comparing the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in supraclavicular brachial plexus blocks on the onset of sensory, motor blockade and postoperative analgesia. Patients and methods: This prospective, randomized, single-blind clinical study conducted on 60 patients underwent upper limb surgery done by ultrasound-guided supraclavicular brachial plexus block;these patients allocated into two equal groups: Group I (control) received 20 ccs (19 cc bupivacaine 0.5% + 1 cc saline), Group II received 20 cc (19 cc bupivacaine 0.5% + 1 cc volume of Dexmedetomidine 1 ug/kg). Results: Demographic data and surgical characteristics were comparable in both groups. The onset times for sensory and motor blocks were significantly shorter in Group II than Group I (P Conclusion: We recommend adding Dexmedetomidine to local anesthetics in peripheral nerve blocks to take advantage of the prolonged time of both sensory and motor blocks and prolonged postoperative analgesia.展开更多
Background: Procedures that require anesthesia of entire length of the arm should have combined Interscalene block (ISB) and Supraclavicular block (SCB) to ensure adequate block. However, dual block requires high dose...Background: Procedures that require anesthesia of entire length of the arm should have combined Interscalene block (ISB) and Supraclavicular block (SCB) to ensure adequate block. However, dual block requires high dose of local anesthetic (LA). We examined if Ultrasound (U/S) guided block helps to decrease the required volume of LA by visualizing trunks, so we only need injection of LA toward cervical nerve roots C5 and C6 aiming to block branches escaped from supraclavicular block. Patients and methods: Ninety-three patients were randomly allocated into one of three equal groups, each included 31 patients. All patients received SCB 20 ml (10 ml Bupivacaine 0.5% plus 10 ml lidocaine 2%) and ISB with different volumes of LA according to the group as follow: group A: 20 ml, group B: 15 ml, and group C: 10 ml. Result: No significant difference in onset of block (sensory and motor) and duration of block (motor only) between the three groups (P value > 0.05). The duration of sensory block was significantly longer in group A (760.65 ± 30.87 minutes) than in either group B (740.48 ± 21.15 minutes, P value P value P value P value P value P value < 0.001). Conclusion: A reduced volume of LA can be used in ultra sound guided ISB in combined with SCB to give satisfactory level of anesthesia to entire length of the arm, but the sensory block duration and duration of post-operative analgesia will be decreased significantly with decreasing the volume.展开更多
Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the a...Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.展开更多
Background: The risk of carotid vessel stenosis is high after radiotherapy (RT) to neck;however, carotid vessels are unavoidable during supraclavicular (SC-RT) in adjuvant treatment of breast cancer (BC). However, car...Background: The risk of carotid vessel stenosis is high after radiotherapy (RT) to neck;however, carotid vessels are unavoidable during supraclavicular (SC-RT) in adjuvant treatment of breast cancer (BC). However, carotid vessels RT dose is less well-understood. We aimed to determine the carotid vessels doses received by different techniques for SC-RT. Materials and Methods: Thirty consecutive BC patients were planned to receive SC-RT and breast after breast conserving surgery (BCS) after taking 5 mm image slices on computed tomography (CT) simulation. Organs at risk (OAR) including carotid vessels, lungs, spinal cord alongwith clinical target volume (CTV) for primary tumor and lymph nodes were delineated. Comparative analysis was done between two treatment plans;three-field conformal radiation therapy (3F-CRT) and four field conformal RT (4F-CRT) for CTV and carotid vessels doses. Results: The 4F-CRT was found better than 3F-3DCRT regarding coverage and homogeneity of the CTV volume. The 98% of the CTV was covered by 84% dose in 3F-CRT and 95% in 4F-CRT (p 0.001). The carotid vessels maximum dose in the in 3F-CRT was 54.5 ± 1.3 Gy compared to 51.6 ± 1.3 Gy in 4F-CRT (p 0.014), however the mean dose did not differ significantly (p value 0.8). The ipsilateral lung dose did not differ between the two techniques (p Value 0.9). Conclusion: The 4F-CRT plan was found better than 3F-CRT in CTV coverage with minimal dose to the carotid vessel and without significant higher dose to the ipsilateral lung.展开更多
<b>Introduction:</b> Supraclavicular block (SCB) is associated with excellent postoperative patient outcomes for upper limb surgeries. Bupivacainei is a longacting regional anaesthetic, efficacy of which i...<b>Introduction:</b> Supraclavicular block (SCB) is associated with excellent postoperative patient outcomes for upper limb surgeries. Bupivacainei is a longacting regional anaesthetic, efficacy of which is altered with the co-administration of additives. <b>Aim:</b> Aim of the study was to assess the efficacy of supraclavicular block with 0.5% bupivacaine compared to co-administration of additives and the associated complications. <b>Method:</b> Following ethical clearance and informed written consent, over 5 months from July 2020, 152 adult patients at Teaching Hospital Anuradhapura Sri Lanka undergoing upper limb surgeries were divided into 4 groups & prospectively followed-up. All groups received 0.5% of Bupivacaine while additives 2% Lidocaine, 8.4% sodium bicarbonate & 8 mg Dexamethasone were added to the other 3 groups. Sensory and Motor block onset time, duration of post-block analgesia, acute and late complications and patient satisfaction were noted. Data was analysed using descriptive statistics & ANOVA, using SPSS V.25. <b>Results:</b> Successful surgical anesthesia was achieved in all patients with 0 cases of long-term neurological complications with 94% patient satisfaction. The motor & sensory block onset time & post block analgesia duration respectively for Lidocaine (9.74 min, 9.74 min & 7.07 h), Bicarbonate (12.89 min, 16.32 min & 12.09 h), dexamethasone (19.34 min, 17.24 min & 20.87 h) & Bupivacaine were (20.39 min, 18.42 min & 13.15 h). <b>Conclusion:</b> The differences between bupivacaine and lidocaine groups for sensory & motor block onset times & between Bupivacaine & dexamethasone groups for post-block analgesia duration were statistically significant (p < 0.001). Supraclavicular block has minimal associated complications & additives Lidocaine shortens the onset of anaesthesia and the duration of analgesia while dexamethasone prolongs the duration of analgesia significantly.展开更多
We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy.To reconstruct the hypopharynx,upper esophagus,and neck skin...We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy.To reconstruct the hypopharynx,upper esophagus,and neck skin defect,we used a supraclavicular artery island flap(SCAIF)for one-stage reconstruction.SCAIF offered reliable blood supply,minimal donor site morbidity,and excellent cosmetic outcomes.Although a small portion of the flap developed necrosis,it healed without surgical intervention.We also conducted a literature review of previously published articles on SCAIF for head and neck reconstruction.Our review highlights the advantages and limitations of SCAIF as a promising option for one-stage reconstruction of complex hypopharyngeal and upper esophageal defects with neck skin defects in selected patients.This case report provides valuable insights into the use of SCAIF in complex head and neck reconstructions,which can help improve patient outcomes and quality of life.展开更多
We report an unusual case of genitourinary malignancy in an otherwise asymptomatic elderly male, which was discovered via workup of a supraclavicular neck mass. We present his clinical workup as well as the pathologic...We report an unusual case of genitourinary malignancy in an otherwise asymptomatic elderly male, which was discovered via workup of a supraclavicular neck mass. We present his clinical workup as well as the pathological workup and how it influenced our decision-making. A review of the literature is also discussed and demonstrates how uncommon it is for seminomas to present in this manner.展开更多
Introduction: The burden of prostatic cancer is rising in Sudan. Usually, they present late in their disease with urinary tract obstruction, hematuria, bony pain, or cachexia because there is no screening program. Her...Introduction: The burden of prostatic cancer is rising in Sudan. Usually, they present late in their disease with urinary tract obstruction, hematuria, bony pain, or cachexia because there is no screening program. Here we present a patient with prostatic cancer who presented with left axillary mass as his main concern. Case Description: 82-year-old Sudanese male presented with a left axillary and left supraclavicular lymphadenopathy of a few months’ duration. He underwent a decisional biopsy which showed metastatic adenocarcinoma. Upper and lower GI endoscopy were performed but the latter was complicated by a sigmoid perforation with peritonitis. During laparatomy, multiple enlarged pelvic lymphnodes were encountered and a biopsy result suggested a metastatic prostatic neoplasm. Later, prostatic biopsy confirmed the diagnosis. The patient was treated with bilateral orchidectomy. Clinical discussion: Lymphatic metastasis to axillary lymph nodes is a very rare manifestation of prostate cancer and only a few cases have been reported in the literature. It can cause diagnostic difficulty since prostate cancer typically metastasis to the pelvic lymph node and very rarely involves he supradiaphragmatic lymph node. Conclusion: Metastatic prostatic carcinoma should be considered among the causes of supra-diaphragmatic lymph adenopathy. Careful physical and imaging examinations combined with PSA and pathological analysis are essential in the diagnosis of advanced prostate cancer with unusual presentation.展开更多
Objective To observe eflect uf fascial flaps of supraclavicular artery on treatment of neck scar contracture. Methods The supraclavicular flaps were designed according to direction of supraclavicular arteries and tran...Objective To observe eflect uf fascial flaps of supraclavicular artery on treatment of neck scar contracture. Methods The supraclavicular flaps were designed according to direction of supraclavicular arteries and transferred into detective areas caused by scar releasing.展开更多
Chylothorax is a rare complication of neck dissection, and bilateral chylothorax is even rarer. However, both are potentially serious and sometimes life-threatening, especially those that are associated with left neck...Chylothorax is a rare complication of neck dissection, and bilateral chylothorax is even rarer. However, both are potentially serious and sometimes life-threatening, especially those that are associated with left neck dissection for head and neck neoplasms. We report one case of bilateral chylothorax following left supraclavicular dissection for breast cancer. This case was treated successfully with a new conservative management approach.展开更多
Background:Breast cancer patients with ipsilateral supraclavicular lymph node metastasis(ISLNM)but without distant metastasis are considered to have a poor prognosis.This study aimed to develop a nomogram to predict t...Background:Breast cancer patients with ipsilateral supraclavicular lymph node metastasis(ISLNM)but without distant metastasis are considered to have a poor prognosis.This study aimed to develop a nomogram to predict the overall survival(OS)of breast cancer patients with ISLNM but without distant metastasis.Methods:Medical records of breast cancer patients who received surgical treatment at the Affiliated Cancer Hospital of Zhengzhou University,Jiyuan People’s Hospital and Huaxian People’s Hospital between December 21,2012 and June 30,2020 were reviewed retrospectively.Overall,345 patients with pathologically confirmed ISLNM and without evidence of distant metastasis were identified.They were further randomized 2:1 and divided into training(n=231)and validation(n=114)cohorts.A nomogram to predict the probability of OS was constructed based on clinicopathologic variables identified by the univariable and multivariable analyses.The predictive accuracy and discriminative ability were measured by calibration plots,concordance index(C-index),and risk group stratification.Results:Univariable analysis showed that estrogen receptor-positive(ER+),progesterone receptor-positive(PR+),human epidermal growth factor receptor 2-positive(HER2+)with Herceptin treatment,and a low axillary lymph node ratio(ALNR)were prognostic factors for better OS.PR+,HER2+with Herceptin treatment,and a low ALNR remained independent prognostic factors for better OS on multivariable analysis.These variables were incorporated into a nomogram to predict the 1-,3-,and 5-year OS of breast cancer patients with ISLNM.The C-indexes of the nomogram were 0.737(95%confidence interval[CI]:0.660–0.813)and 0.759(95%CI:0.636–0.881)for the training and the validation cohorts,respectively.The calibration plots presented excellent agreement between the nomogram prediction and actual observation for 3 and 5 years,but not 1 year,OS in both the cohorts.The nomogram was also able to stratify patients into different risk groups.Conclusions:In this study,we established and validated a novel nomogram for predicting survival of patients with ISLNM.This nomogram may,to some extent,allow clinicians to more accurately estimate prognosis and to make personalized therapeutic decisions for individual patients with ISLNM.展开更多
Objective: To evaluate the usefulness of supraclavicular artery flap in reconstruc-tion of defects following resection of buccal mucosa cancer. Methods: Twenty-five patients who presented to R.L Jalappa Hospital and R...Objective: To evaluate the usefulness of supraclavicular artery flap in reconstruc-tion of defects following resection of buccal mucosa cancer. Methods: Twenty-five patients who presented to R.L Jalappa Hospital and Research centre and diagnosed as squamous cell carcinoma of buccal mucosa staged T2 and above were included in our study. All patients underwent wide excision of tumour and neck dissection. Six patients un-derwent hemi-mandibulectomy while 4 patients underwent marginal mandibulectomy depend-ing on extent of the tumour along with neck dissection. The defect following surgery was reconstructed using the supraclavicular artery flap and were followed up for minimum 6 months during which they were assessed for the functional and aesthetic outcome using a scoring system. The details of the scoring system comprised of 7 attributes. Each attribute was given a score of 10 if the patients experienced that attribute, while a score of 0 was given if the patient did not experience that particular attribute. Results: Seven (28％) patients had complete necrosis of the flap. One patient had a local recur-rence 2 months following surgery and was lost to follow up. The remaining 17 patients were followed up for a minimum of 6 months and a scoring system was adopted to evaluate the func-tional and aesthetic outcome of the supraclavicular flap. We observed that 14 patients had an excellent outcome score (58％), 3 patients had a good outcome score (13％), while 7 patients (28％) had flap necrosis.Conclusions: We find the supraclavicular flap to be safe, technically simple, sensate, thin, pliable and reliable regional fasciocutaneous flap in reconstructing intra oral defects. Preser-ving the external jugular vein and sacrificing supraclavicular nerves give good outcome.展开更多
Objective:To systematically evaluate the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis (SLNM) versus patients with stage Ⅲb/c or Ⅳ breast cancer,so as to provide evi...Objective:To systematically evaluate the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis (SLNM) versus patients with stage Ⅲb/c or Ⅳ breast cancer,so as to provide evidence for clinical practice and research.Methods:Computer retrieval from PubMed,Cochrane Libratory,CNKI (China National Knowledge Infrastructure),CBM and Wanfang Database with the assistance of other retrieval tools.All the studies evaluating the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage Ⅲb/c or Ⅳ breast cancer were collected.Quality assessment was performed for the included data based on the quality assessment criteria appropriate for this study.Meta-analysis was performed using RevMan 5.3 software.Results:A total of four references (1277 patients) were included.Assessment of influences on prognosis:As compared to the stage Ⅲb/c group,the 5-year survival rate was slightly lower in the SLNM group (relative risk (RR) 0.79; 95％ confidence interval (CI) 0.59-1.06; Z =1.55,P =0.12),but there was no statistical significance; in contrast,the 5-year survival rate was significantly increased in the SLNM group as compared to the stage Ⅳ group (RR =2.70; 95％CI:1.36-5.37; Z =2.84,P =0.005).As compared to the stage Ⅲb/c group,the 5-year disease-free survival rate was lower in the SLNM group (RR =0.65; 95％CI:0.40-1.05; Z =1.75,P =0.08); however,there was no statistical significance.Conclusions:In patients with advanced breast cancer receiving combined therapy,the prognosis in patients with breast cancer with ipsilateral SLNM was significantly better than in those with stage Ⅳ breast cancer,and slightly worse than those with stage Ⅲb/c breast cancer.However,with the scarcity and poor quality of these observational studies,the long-term prognosis remains to be further verified in large-sample,high-quality studies.展开更多
BACKGROUND Tracheoesophageal fistula(TEF)is a life-threatening complication of advanced esophageal squamous cell carcinoma(ESCC).Cervical ESCC is rare and frequently diagnosed at an advanced stage.Managing cervical es...BACKGROUND Tracheoesophageal fistula(TEF)is a life-threatening complication of advanced esophageal squamous cell carcinoma(ESCC).Cervical ESCC is rare and frequently diagnosed at an advanced stage.Managing cervical esophageal cancer(CEC)is challenging,requiring intervention by a multidisciplinary team(MDT)and innovative surgical management.CASE SUMMARY Here,we present a 59-year-old male patient with a 5-month history of CEC and difficulty eating for over 20 days,who developed TEF secondary to recurrent ESCC after chemoradiotherapy.He underwent total pharyngolaryngoesophagectomy,left thyroidectomy,and lymphadenectomy.Gastric pull-up was performed to restore gastrointestinal continuity,and a 7 cm×5 cm supraclavicular artery island flap(SCAIF)was used to reconstruct the lower tracheal defect.Despite severe postoperative complications,he recovered by successful management by a MDT.A 7 cm×6 cm pectoralis major myocutaneous flap was successfully used to repair the necrotic gastric conduit defect.The patient recovered,regaining the ability to eat and breathe effectively.At the 27-month follow-up,he was alive without recurrence or metastasis.CONCLUSION This study highlights the efficacy of gastric pull-up and SCAIF reconstruction in managing TEF secondary to recurrent ESCC.展开更多
基金supported by the Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors(Fujian Medical University)and Clinical Research Center for Radiology and Radiotherapy of Fujian Province(Digestive,Hematological and Breast Malignancies).
文摘Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.
文摘Left supraclavicular lymph node metastasis is a rare presentation of hepatocellular carcinoma (HCC).This phenomenon is easily neglected in the clinic.A 56-yearold man presented with HCC.On examination,a 1cm long left supraclavicular lymph node was palpated.Auxiliary examination indicated a lesion located in the right lobe of the liver.Fine needle aspiration cytology (FNAC) of the enlarged lymph node was performed;however,only necrosis was found.Hepatectomy was performed and HCC was confirmed by Hematoxylin-Eosin staining.However,14 d after surgery,significantly enlarged left supraclavicular lymph nodes,a new intrahepatic lesion,and pulmonary and mediastinal metastasis appeared.An excisional biopsy of the left supraclavicular lymph node was performed,and its findings confirmed metastatic HCC.The patient's HCC rapidly progressed and he died one month later.It is possible for HCC tometastasize to the left supraclavicular lymph node.Surgeons should always consider an overall physical examination.When left supraclavicular lymphadenopathy of unknown origin is encountered,FNAC should be performed initially.If the results are negative,an excisional biopsy and subsequent Positron emission tomography computed tomography scanning should be performed.These are very important for making the correct diagnosis and for selecting reasonable therapies.
基金Supported by grant from Doctoral Startup Project of Liaoning Provincial Science and Technology Department,No.20121133
文摘AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.
文摘Background: Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. Nalbuphine was studied several times as adjuvant to local anesthetics in spinal, epidural and local intravenous block. The aim of this study was to evaluate the effect of nalbuphine as an adjuvant to local anesthetics in supraclavicular brachial plexus block. Patients and Methods: Fifty-six patients undergoing elective forearm and hand surgery under supraclavicular brachial plexus block were allocated randomly into one of two groups of 28 patients each to receive either 25 ml (0.5%) bupivacaine with 1 ml of NS or 25 ml (0.5%) bupivacaine with 1 ml (20 mg) nalbuphine. Onset time and duration of both sensory and motor block, and post-operative analgesia were observed. Result: Nalbuphine group showed significant increase in the duration of motor block (412.59 ± 18.63), when compared to control group (353.70 ± 29.019) p-value < 0.001, also, there was significant increase in sensory duration in nalbuphine group (718.14 ± 21.04) when compared to control group (610.18 ± 26.33) p-value < 0.001, without affecting the onset time of the blockade. And also, there was a significant increase in the duration of analgesic effect in nalbuphine group (835.18 ± 42.45) when compared to control group (708.14 ± 54.57) p-value < 0.001. Conclusion: The present study demonstrates that addition of 20 mg nalbuphine to bupivacaine in supraclavicular brachial plexus block is associated with significant increase in the duration of both sensory and motor block and also prolong the duration of analgesia.
文摘Background: Ultrasound-guided for regional anesthesia offers many potential benefits in the emergency setting. Analgesia can be explicitly targeted to the region of pain and provide relief for many hours and decrease needing to the large volume of local anesthetic. The aim of the work: Comparing the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in supraclavicular brachial plexus blocks on the onset of sensory, motor blockade and postoperative analgesia. Patients and methods: This prospective, randomized, single-blind clinical study conducted on 60 patients underwent upper limb surgery done by ultrasound-guided supraclavicular brachial plexus block;these patients allocated into two equal groups: Group I (control) received 20 ccs (19 cc bupivacaine 0.5% + 1 cc saline), Group II received 20 cc (19 cc bupivacaine 0.5% + 1 cc volume of Dexmedetomidine 1 ug/kg). Results: Demographic data and surgical characteristics were comparable in both groups. The onset times for sensory and motor blocks were significantly shorter in Group II than Group I (P Conclusion: We recommend adding Dexmedetomidine to local anesthetics in peripheral nerve blocks to take advantage of the prolonged time of both sensory and motor blocks and prolonged postoperative analgesia.
文摘Background: Procedures that require anesthesia of entire length of the arm should have combined Interscalene block (ISB) and Supraclavicular block (SCB) to ensure adequate block. However, dual block requires high dose of local anesthetic (LA). We examined if Ultrasound (U/S) guided block helps to decrease the required volume of LA by visualizing trunks, so we only need injection of LA toward cervical nerve roots C5 and C6 aiming to block branches escaped from supraclavicular block. Patients and methods: Ninety-three patients were randomly allocated into one of three equal groups, each included 31 patients. All patients received SCB 20 ml (10 ml Bupivacaine 0.5% plus 10 ml lidocaine 2%) and ISB with different volumes of LA according to the group as follow: group A: 20 ml, group B: 15 ml, and group C: 10 ml. Result: No significant difference in onset of block (sensory and motor) and duration of block (motor only) between the three groups (P value > 0.05). The duration of sensory block was significantly longer in group A (760.65 ± 30.87 minutes) than in either group B (740.48 ± 21.15 minutes, P value P value P value P value P value P value < 0.001). Conclusion: A reduced volume of LA can be used in ultra sound guided ISB in combined with SCB to give satisfactory level of anesthesia to entire length of the arm, but the sensory block duration and duration of post-operative analgesia will be decreased significantly with decreasing the volume.
文摘Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.
文摘Background: The risk of carotid vessel stenosis is high after radiotherapy (RT) to neck;however, carotid vessels are unavoidable during supraclavicular (SC-RT) in adjuvant treatment of breast cancer (BC). However, carotid vessels RT dose is less well-understood. We aimed to determine the carotid vessels doses received by different techniques for SC-RT. Materials and Methods: Thirty consecutive BC patients were planned to receive SC-RT and breast after breast conserving surgery (BCS) after taking 5 mm image slices on computed tomography (CT) simulation. Organs at risk (OAR) including carotid vessels, lungs, spinal cord alongwith clinical target volume (CTV) for primary tumor and lymph nodes were delineated. Comparative analysis was done between two treatment plans;three-field conformal radiation therapy (3F-CRT) and four field conformal RT (4F-CRT) for CTV and carotid vessels doses. Results: The 4F-CRT was found better than 3F-3DCRT regarding coverage and homogeneity of the CTV volume. The 98% of the CTV was covered by 84% dose in 3F-CRT and 95% in 4F-CRT (p 0.001). The carotid vessels maximum dose in the in 3F-CRT was 54.5 ± 1.3 Gy compared to 51.6 ± 1.3 Gy in 4F-CRT (p 0.014), however the mean dose did not differ significantly (p value 0.8). The ipsilateral lung dose did not differ between the two techniques (p Value 0.9). Conclusion: The 4F-CRT plan was found better than 3F-CRT in CTV coverage with minimal dose to the carotid vessel and without significant higher dose to the ipsilateral lung.
文摘<b>Introduction:</b> Supraclavicular block (SCB) is associated with excellent postoperative patient outcomes for upper limb surgeries. Bupivacainei is a longacting regional anaesthetic, efficacy of which is altered with the co-administration of additives. <b>Aim:</b> Aim of the study was to assess the efficacy of supraclavicular block with 0.5% bupivacaine compared to co-administration of additives and the associated complications. <b>Method:</b> Following ethical clearance and informed written consent, over 5 months from July 2020, 152 adult patients at Teaching Hospital Anuradhapura Sri Lanka undergoing upper limb surgeries were divided into 4 groups & prospectively followed-up. All groups received 0.5% of Bupivacaine while additives 2% Lidocaine, 8.4% sodium bicarbonate & 8 mg Dexamethasone were added to the other 3 groups. Sensory and Motor block onset time, duration of post-block analgesia, acute and late complications and patient satisfaction were noted. Data was analysed using descriptive statistics & ANOVA, using SPSS V.25. <b>Results:</b> Successful surgical anesthesia was achieved in all patients with 0 cases of long-term neurological complications with 94% patient satisfaction. The motor & sensory block onset time & post block analgesia duration respectively for Lidocaine (9.74 min, 9.74 min & 7.07 h), Bicarbonate (12.89 min, 16.32 min & 12.09 h), dexamethasone (19.34 min, 17.24 min & 20.87 h) & Bupivacaine were (20.39 min, 18.42 min & 13.15 h). <b>Conclusion:</b> The differences between bupivacaine and lidocaine groups for sensory & motor block onset times & between Bupivacaine & dexamethasone groups for post-block analgesia duration were statistically significant (p < 0.001). Supraclavicular block has minimal associated complications & additives Lidocaine shortens the onset of anaesthesia and the duration of analgesia while dexamethasone prolongs the duration of analgesia significantly.
文摘We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy.To reconstruct the hypopharynx,upper esophagus,and neck skin defect,we used a supraclavicular artery island flap(SCAIF)for one-stage reconstruction.SCAIF offered reliable blood supply,minimal donor site morbidity,and excellent cosmetic outcomes.Although a small portion of the flap developed necrosis,it healed without surgical intervention.We also conducted a literature review of previously published articles on SCAIF for head and neck reconstruction.Our review highlights the advantages and limitations of SCAIF as a promising option for one-stage reconstruction of complex hypopharyngeal and upper esophageal defects with neck skin defects in selected patients.This case report provides valuable insights into the use of SCAIF in complex head and neck reconstructions,which can help improve patient outcomes and quality of life.
文摘We report an unusual case of genitourinary malignancy in an otherwise asymptomatic elderly male, which was discovered via workup of a supraclavicular neck mass. We present his clinical workup as well as the pathological workup and how it influenced our decision-making. A review of the literature is also discussed and demonstrates how uncommon it is for seminomas to present in this manner.
文摘Introduction: The burden of prostatic cancer is rising in Sudan. Usually, they present late in their disease with urinary tract obstruction, hematuria, bony pain, or cachexia because there is no screening program. Here we present a patient with prostatic cancer who presented with left axillary mass as his main concern. Case Description: 82-year-old Sudanese male presented with a left axillary and left supraclavicular lymphadenopathy of a few months’ duration. He underwent a decisional biopsy which showed metastatic adenocarcinoma. Upper and lower GI endoscopy were performed but the latter was complicated by a sigmoid perforation with peritonitis. During laparatomy, multiple enlarged pelvic lymphnodes were encountered and a biopsy result suggested a metastatic prostatic neoplasm. Later, prostatic biopsy confirmed the diagnosis. The patient was treated with bilateral orchidectomy. Clinical discussion: Lymphatic metastasis to axillary lymph nodes is a very rare manifestation of prostate cancer and only a few cases have been reported in the literature. It can cause diagnostic difficulty since prostate cancer typically metastasis to the pelvic lymph node and very rarely involves he supradiaphragmatic lymph node. Conclusion: Metastatic prostatic carcinoma should be considered among the causes of supra-diaphragmatic lymph adenopathy. Careful physical and imaging examinations combined with PSA and pathological analysis are essential in the diagnosis of advanced prostate cancer with unusual presentation.
文摘Objective To observe eflect uf fascial flaps of supraclavicular artery on treatment of neck scar contracture. Methods The supraclavicular flaps were designed according to direction of supraclavicular arteries and transferred into detective areas caused by scar releasing.
文摘Chylothorax is a rare complication of neck dissection, and bilateral chylothorax is even rarer. However, both are potentially serious and sometimes life-threatening, especially those that are associated with left neck dissection for head and neck neoplasms. We report one case of bilateral chylothorax following left supraclavicular dissection for breast cancer. This case was treated successfully with a new conservative management approach.
基金the Science and Technology development plan of He’nan(No.202102310428).
文摘Background:Breast cancer patients with ipsilateral supraclavicular lymph node metastasis(ISLNM)but without distant metastasis are considered to have a poor prognosis.This study aimed to develop a nomogram to predict the overall survival(OS)of breast cancer patients with ISLNM but without distant metastasis.Methods:Medical records of breast cancer patients who received surgical treatment at the Affiliated Cancer Hospital of Zhengzhou University,Jiyuan People’s Hospital and Huaxian People’s Hospital between December 21,2012 and June 30,2020 were reviewed retrospectively.Overall,345 patients with pathologically confirmed ISLNM and without evidence of distant metastasis were identified.They were further randomized 2:1 and divided into training(n=231)and validation(n=114)cohorts.A nomogram to predict the probability of OS was constructed based on clinicopathologic variables identified by the univariable and multivariable analyses.The predictive accuracy and discriminative ability were measured by calibration plots,concordance index(C-index),and risk group stratification.Results:Univariable analysis showed that estrogen receptor-positive(ER+),progesterone receptor-positive(PR+),human epidermal growth factor receptor 2-positive(HER2+)with Herceptin treatment,and a low axillary lymph node ratio(ALNR)were prognostic factors for better OS.PR+,HER2+with Herceptin treatment,and a low ALNR remained independent prognostic factors for better OS on multivariable analysis.These variables were incorporated into a nomogram to predict the 1-,3-,and 5-year OS of breast cancer patients with ISLNM.The C-indexes of the nomogram were 0.737(95%confidence interval[CI]:0.660–0.813)and 0.759(95%CI:0.636–0.881)for the training and the validation cohorts,respectively.The calibration plots presented excellent agreement between the nomogram prediction and actual observation for 3 and 5 years,but not 1 year,OS in both the cohorts.The nomogram was also able to stratify patients into different risk groups.Conclusions:In this study,we established and validated a novel nomogram for predicting survival of patients with ISLNM.This nomogram may,to some extent,allow clinicians to more accurately estimate prognosis and to make personalized therapeutic decisions for individual patients with ISLNM.
文摘Objective: To evaluate the usefulness of supraclavicular artery flap in reconstruc-tion of defects following resection of buccal mucosa cancer. Methods: Twenty-five patients who presented to R.L Jalappa Hospital and Research centre and diagnosed as squamous cell carcinoma of buccal mucosa staged T2 and above were included in our study. All patients underwent wide excision of tumour and neck dissection. Six patients un-derwent hemi-mandibulectomy while 4 patients underwent marginal mandibulectomy depend-ing on extent of the tumour along with neck dissection. The defect following surgery was reconstructed using the supraclavicular artery flap and were followed up for minimum 6 months during which they were assessed for the functional and aesthetic outcome using a scoring system. The details of the scoring system comprised of 7 attributes. Each attribute was given a score of 10 if the patients experienced that attribute, while a score of 0 was given if the patient did not experience that particular attribute. Results: Seven (28％) patients had complete necrosis of the flap. One patient had a local recur-rence 2 months following surgery and was lost to follow up. The remaining 17 patients were followed up for a minimum of 6 months and a scoring system was adopted to evaluate the func-tional and aesthetic outcome of the supraclavicular flap. We observed that 14 patients had an excellent outcome score (58％), 3 patients had a good outcome score (13％), while 7 patients (28％) had flap necrosis.Conclusions: We find the supraclavicular flap to be safe, technically simple, sensate, thin, pliable and reliable regional fasciocutaneous flap in reconstructing intra oral defects. Preser-ving the external jugular vein and sacrificing supraclavicular nerves give good outcome.
基金This study was supported by the grants from the National Natural Science Foundation of China，the Science and Technology Agency of Liaoning Province
文摘Objective:To systematically evaluate the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis (SLNM) versus patients with stage Ⅲb/c or Ⅳ breast cancer,so as to provide evidence for clinical practice and research.Methods:Computer retrieval from PubMed,Cochrane Libratory,CNKI (China National Knowledge Infrastructure),CBM and Wanfang Database with the assistance of other retrieval tools.All the studies evaluating the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage Ⅲb/c or Ⅳ breast cancer were collected.Quality assessment was performed for the included data based on the quality assessment criteria appropriate for this study.Meta-analysis was performed using RevMan 5.3 software.Results:A total of four references (1277 patients) were included.Assessment of influences on prognosis:As compared to the stage Ⅲb/c group,the 5-year survival rate was slightly lower in the SLNM group (relative risk (RR) 0.79; 95％ confidence interval (CI) 0.59-1.06; Z =1.55,P =0.12),but there was no statistical significance; in contrast,the 5-year survival rate was significantly increased in the SLNM group as compared to the stage Ⅳ group (RR =2.70; 95％CI:1.36-5.37; Z =2.84,P =0.005).As compared to the stage Ⅲb/c group,the 5-year disease-free survival rate was lower in the SLNM group (RR =0.65; 95％CI:0.40-1.05; Z =1.75,P =0.08); however,there was no statistical significance.Conclusions:In patients with advanced breast cancer receiving combined therapy,the prognosis in patients with breast cancer with ipsilateral SLNM was significantly better than in those with stage Ⅳ breast cancer,and slightly worse than those with stage Ⅲb/c breast cancer.However,with the scarcity and poor quality of these observational studies,the long-term prognosis remains to be further verified in large-sample,high-quality studies.
基金Supported by the Key R&D Program of Zhejiang,No.2023C03066and National natural science foundation of China,No.82471148.
文摘BACKGROUND Tracheoesophageal fistula(TEF)is a life-threatening complication of advanced esophageal squamous cell carcinoma(ESCC).Cervical ESCC is rare and frequently diagnosed at an advanced stage.Managing cervical esophageal cancer(CEC)is challenging,requiring intervention by a multidisciplinary team(MDT)and innovative surgical management.CASE SUMMARY Here,we present a 59-year-old male patient with a 5-month history of CEC and difficulty eating for over 20 days,who developed TEF secondary to recurrent ESCC after chemoradiotherapy.He underwent total pharyngolaryngoesophagectomy,left thyroidectomy,and lymphadenectomy.Gastric pull-up was performed to restore gastrointestinal continuity,and a 7 cm×5 cm supraclavicular artery island flap(SCAIF)was used to reconstruct the lower tracheal defect.Despite severe postoperative complications,he recovered by successful management by a MDT.A 7 cm×6 cm pectoralis major myocutaneous flap was successfully used to repair the necrotic gastric conduit defect.The patient recovered,regaining the ability to eat and breathe effectively.At the 27-month follow-up,he was alive without recurrence or metastasis.CONCLUSION This study highlights the efficacy of gastric pull-up and SCAIF reconstruction in managing TEF secondary to recurrent ESCC.
