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Gasless Endoscopic Thyroidectomy Via an Axillary Approach

Gasless Endoscopic Thyroidectomy Via an Axillary Approach

HAbstract: EAbstract: Purpose: Surgery for thyroid disease requires skin incisions that can result in postsurgical problems, such as prominent scars, adhesions and hypesthesia, as well as paresthesia of the neck. To overcome these problems we performed a gasless endoscopic thyroidectomy via an axillary approach. Methods: Between November 2001 and April 2005, 141 patients underwent a gasless endoscopic thyroidectomy via an axillary approach. The surgical outcomes were evaluated in terms of the operating time, length of hospital stay and the incidence of perioperative complications. Patient opinions were assessed using a verbal response scale at two and four months after surgery. Results: The mean operating time and length of hospital stay were 122.7±32.8 minutes and 3.4±0.9 days, respectively. No cases required either conversion to open surgery or involved significant intraoperative complications. Two months after surgery, 75 patients (53.2%) complained of hypesthesia or paresthesia in the anterior chest wall. The number of patients with such complaints (9.9%) had decreased 4 months after surgery (P<0.001). Four months after surgery, only 4 patients (2.8%) complained of hypesthesia or paresthesia in the neck, and 10 (7.1%) complained of discomfort while swallowing. All patients were satisfied with the cosmetic results. Conclusion: A gasless endoscopic thyroidectomy via an axillary approach is feasible and safe, and provides excellent cosmetic results, with a minimal degree of postoperative complaints. This procedure provides another surgical optionfor the treatment of benign thyroid disease in selected patients. (J Korean Surg Soc 2006;70:357-362)
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A Comparison of Axillary Approach and Humeral Approach for Four Injection Brachial Plexus Block using Peripheral
Nerve Stimulator

A Comparison of Axillary Approach and Humeral Approach for Four Injection Brachial Plexus Block using Peripheral Nerve Stimulator

The surgical procedures involving the hand, forearm, and elbow can be done by performing the brachial plexus block. Various approaches are available for blocking the brachial plexus at different levels. The success rate of the brachial plexus block varies depending on the type of approach used. The Axillary approach is one of the most commonly practised technique of brachial plexus block at the level of the axilla.This technique can be done by either eliciting paresthesia ,transfixation of the axillary artery , using peripheral nerve stimulator or ultrasound. Lavoie et al.(12) reported that when performing an axillary block using a peripheral nerve stimulator (PNS), stimulation of the musculocutaneous nerve, plus another nerve innervating the surgical site, resulted in a success rate similar to that obtained with the stimulation of all four major nerves at the axillary crease. The Humeral approach described by Dupre et al.(1) is a technique of multiple nerve blocks at the humeral canal with a neurostimulator . This approach provides a selective block of each major nerve from the brachial plexus and results in a high success rate .
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Quality of life and cosmetic result of single-port access endoscopic thyroidectomy via axillary approach in patients with papillary thyroid carcinoma

Quality of life and cosmetic result of single-port access endoscopic thyroidectomy via axillary approach in patients with papillary thyroid carcinoma

not only focused but also the patients are increasingly inter- ested in the cosmetic satisfaction and postoperative QOL. Although the technical limitations of endoscopic thyroi- dectomy have been reviewed in large series of patients, the newly developed endoscopic operative methods, including the transaxillary or axillary-breast gasless approach, the bilateral axillary-breast approach, the postauricular and axillary approach, the facelift gasless approach, and the infraclavicular approach, were introduced to clinical therapy of thyroid disease. 21 Among them, the transaxillary approach
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Comparative study comparing endoscopic thyroidectomy using the axillary approach and open thyroidectomy for papillary thyroid microcarcinoma

Comparative study comparing endoscopic thyroidectomy using the axillary approach and open thyroidectomy for papillary thyroid microcarcinoma

skilled assistants because of the lack of human resource- sin our department. Despite the longer operation time in the COT group than reported in the literature, the oper- ation time in the ET group in our study was even longer than that inthe COT group. Recently, we decreased the operation time in the ET group to about 120 min (data not shown). We investigated short-term postoperative pain to evaluate the invasiveness of endoscopic thyroi- dectomy using the axillary approach. Both groups showed no significant difference in neck discomfort 3 months after the operation, but endoscopic thyroidect- omy definitely was more painful than COT in the short term. We assumed that this disadvantage was due to wider dissection in the ET group than in the COT group. To minimize this disadvantage, other methods such as a single-port surgery will be helpful.
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Evaluation of the Effect of Local Anesthetic Volume and Patient Age on Brachial Plexus Block with Axillary Approach

Evaluation of the Effect of Local Anesthetic Volume and Patient Age on Brachial Plexus Block with Axillary Approach

We hypothesized that the efficacy of axillary block might be changed as patients get older, be- cause of a downward functional change in the related nerves. This study aimed to retrospectively evaluate the block efficacy in orthopedic upper extremity sur- gery patients of different age groups. These patients had brachial plexus blockade with axillary approach and multiple nerve stimulation. However, in this ret- rospective study, after recognizing the importance of variable dose or volume applied, we revised the research method as the volume or dose of local an- esthetic administered was taken into consideration.
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Gasless Endoscopic Thyroidectomy using the Trans-axillary Approach for Benign Thyroid Tumor

Gasless Endoscopic Thyroidectomy using the Trans-axillary Approach for Benign Thyroid Tumor

Conclusion: According to our experience, gasless endo- scopic thyroidectomy using a trans-axillary approach is a feasible and safe method for treating benign thyroid tumor. Moreover, the cosmetic benefits can be maximized by this method as compared with the other methods. Endoscopic thyroid surgery has become a new treatment modality for selected patients with benign thyroid tumors. (Korean J Endocrine Surg 2008;8:200-205)

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Axillary lymphadenectomy for breast cancer in elderly patients and fibrin glue

Axillary lymphadenectomy for breast cancer in elderly patients and fibrin glue

was associated with extended time spent in hospital and post-operative pain. Soon [30] showed that, among patients who underwent quadrantectomy or mastectomy with axillary lymphadenectomy, there was no difference in terms of the incidence of seromas with or without the use of suction drainage, and that, for the group of patients without drainage, the seromas formed in greater magnitude and for a longer duration, but with a lower percentage of complications. Kuroi [31] in a Medline search about one meta-analysis, 51 randomized con- trolled trials, 7 prospective studies and 7 retrospective studies showed that there was moderate evidence to sup- port a risk for seroma formation in individuals with hea- vier body weight, extended radical mastectomy and greater drainage volume in the initial 3 days; with regard to the use of adhesive glue many retrospective studies failed to show any significant effect on seroma formation. Based on our experience and reviewing data from the lit- erature [3,10,21,31-37], it seems that the magnitude and duration of the seromas are limited, but they are present in over 80% of patients, without significant differences between mastectomy and quadrantectomy. Use of har- monic scalpel can reduce the magnitude of seromas and acute blood loss after axillary dissection [38-48]. The use of fibrin glue may therefore be useful, in our opinion, in traditional breast cancer surgery for reducing seroma magnitude and duration, and shortening the stay in hos- pital which, in this pathology too, is increasingly con- ducted in day surgery.
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Effect of auxin type on growth in vitro of Kiwifruit axillary buds

Effect of auxin type on growth in vitro of Kiwifruit axillary buds

Actively growing shoots were cut from female vine of A. deliciosa cv. Hayward. Initially expanded leaves were removed and axillary bud explants were surface sterilized by vigourous stirring for 30 second in ethanol (70% v/v) and 20 min in a 0.3% solution of commercial bleach containing 0.1 % Tween 20 that was used as a wetting agent (Jafari Najaf-Abadi and Hamidoghli, 2009). The explants were then rinsed three times in sterile distilled water, the first rinse lasting 2 min, the second 5 min and the final rinse lasted for 15 min. All plant tissue visibly

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Treatment of Axillary Hyperhidrosis:

Treatment of Axillary Hyperhidrosis:

results and conclusion. The combination of the starch- iodine technique and tumescent liposuction is safe and effective for therapy of axillary hyperhidrosis. ONE OF MY patients, a college professor, was aware that each day his students would place bets as to the likelihood that his axillary sweat stain would reach his belt line before the bell would ring at the end of the lecture! Needless to say, his self-confidence, likelihood of achieving a promotion, and ability to teach were se- verely tested. For those possessing this malady, how- ever, axillary hyperhidrosis is no laughing matter. Hy- perhidrosis, though subjective, may be defined as sweating in excess of physiologic needs. 1
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Variations of Median Nerve from Axillary Region to Cubital Fossa

Variations of Median Nerve from Axillary Region to Cubital Fossa

branches of the brachial plexus (BP). It is normally formed by union of lateral (C5, C6, C7) and medial (C8, T1) spinal roots, which arise from lateral and medial cords of BP. These roots fuse together at anterior or lateral side of the third part of the axillary artery to form MN [1]. At first, the nerve passes lateral to brachial artery and then near the insertion of coracobrachialis muscle (CBM) where it most often crosses in front of or rarely behind the artery, going down medial to it into cubital fossa where it passes ante- rior to brachialis muscle and posterior to the bicipital apo- neurosis. Typically, this nerve has no branches in the axilla or the arm [2]. MN is commonly associated with several variations, which include abnormalities in origination [3- 8], communication with other branches of BP [9-11], re- gion of formation [12-15], pattern of innervations in arm [16-19], and its course to cubital fossa [20-23]. Therefore, descriptions of these variations are useful for anatomists, radiologists, and surgeons to perform surgical procedures, as well as to improve ability of anesthesiologists guiding needle to nerve without danger [24, 25]. This article aimed to review the literature on these variations of MN from axillary region to cubital fossa.
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Sonographic Findings of Axillary Masses: What Can Be Imaged in This Space?

Sonographic Findings of Axillary Masses: What Can Be Imaged in This Space?

In addition, lymphomas have coarse internal echo - genicity and are seen as hypoechoic masses with eccentric cortical thickening. Color Doppler imaging shows increased vascularity in both the periphery and center of enlarged lymph nodes. 6,47 Color Doppler imaging is useful for differential diagnosis between lymphomas and lymphadeni- tis. A single vascular pole with linear and regular branches is a sign of benignity, whereas multiple peripheral poles with distortion and displacement of the internal vessels indicate malignancy. 42 Mammography shows a well-circumscribed irregular uncalcified hyperdense oval mass in the axillary area (Figure 9B). 46–48 Computed tomography shows a large heterogeneous soft tissue mass in the right axilla (Figure 9C). 46 Histologically, lymphomas show diffuse replacement of the nodal architecture with malignant lym- phoid cells. 6
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Cytokinins and polar transport of auxin in axillary pea buds

Cytokinins and polar transport of auxin in axillary pea buds

Conclusions. The several fold increase in the ex- pression of auxin carrier genes and the more rapid decrease of dormancy associated gene expres- sion a er BAP application than a er decapitation suggest that cytokinins are factors of ultimate im- portance for the activation of axillary bud out- growth. Increased expression of the auxin–induci- ble PsAUX1 and PsPIN1 genes (Hoshino et al., 2005; Vie ten et al., 2005) a er BAP application indeed in- dicates that the level of auxin in the buds is increas- ing. There was reported not only the direct eff ect of CK on auxin carrier genes, but also increased IAA levels due to CK increase. This eff ect was measured in cytokinin-overproducing transgenic lines of to- bacco (Binns et al., 1987), in pea root tips a er exoge- nous BAP application (Bertell et Eliasson, 1992) and in maize roots a er zeatin application (Bourquin et
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Axillary Nodal Metastasis from Papillary Thyroid Carcinoma

Axillary Nodal Metastasis from Papillary Thyroid Carcinoma

Although breast carcinoma has a predilection for metastasis to auxiliarylymph nodes, auxiliary nodal metastasis from papillary thyroid carcinoma is extremely rare, and to our knowledg[r]

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DCIS and axillary nodal evaluation: compliance with national guidelines

DCIS and axillary nodal evaluation: compliance with national guidelines

Miller et al. recently reported on DCIS and axillary evaluation using the NCDB database, looking specifically at which factors were predictive of tumor upstaging and the relationship to appropriate utilization of SLNB [8]. While our study population has overlap with the recent paper by Miller et al., in order to best capture compliance with axillary surgery for DCIS patients, we excluded from our analysis the subset of DCIS patients upgraded to inva- sive cancer, for whom SLNB is concordant with care guide- lines. Similarly, a study by Nicholson et al., described practice patterns for DCIS care in the United Kingdom and again provided information on axillary staging, but also included patients upgraded to invasive cancer [9]. While these studies collectively provide insight on practice patterns, including axillary interventions, in DCIS patients, our study, focused on the subset with pure DCIS without upgrade, is best positioned to address the question of compliance with axillary staging and hence rates of overtreatment of DCIS patients. We emphasize that our findings provide a benchmark for current practice patterns regarding DCIS and axillary evaluation in the United States, and offer opportunity for improvement in compliance with guidelines.
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IN VITRO CULTURE OF AXILLARY BUDS OF BOUGAINVILLEA CULTIVAR 'MARYPALMER'

IN VITRO CULTURE OF AXILLARY BUDS OF BOUGAINVILLEA CULTIVAR 'MARYPALMER'

was thus observed that the most suitable medium for the sprouting and further growth of the sprouted buds along with moderate callus formation is one having the combination of kine[r]

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Primary Hydatid Cyst of the Axillary Region: A Case Report

Primary Hydatid Cyst of the Axillary Region: A Case Report

Introduction. Hydatid disease is a disease caused by the cestode Echinococcus. Echinococcus granulosus is the most common Echinococcus species affecting human. It may affect any organ and tissue in the body, most in the liver and lung. Disease is endemic in some regions of the world, and is common in Iran. Primary hydatid cyst of the axillary region is an unusual and rare localization of hydatid disease. So far, only sixteen cases have been published in the all medical literature. Case Report. Herein, we present a 33-year-old woman because of a mass in the axillary region of four months duration. Axillary ultrasonography showed a thick wall cystic lesion. No abnormality was found in mammographic examination of either breast, or in abdominal ultrasonography and chest X-ray. The mass was excised for pathological examination that showed a typical laminated membrane of hydatid cyst. Postoperative IgG- ELISA serology in this case was negative. Based on pathology an axillary hydatid cyst was diagnosed. Conclusion. Hydatid cyst should be considered in endemic areas in patients presenting with a soft tissue mass in the axillary region.
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Spontaneous melanotic lesions in axillary seabream, Pagellus acarne (Risso)

Spontaneous melanotic lesions in axillary seabream, Pagellus acarne (Risso)

Melanomacrophage centres (MMC) are focal accumulations of pigmented macrophages, and may contain melanin pigments, and they are, therefore, considered a component of the reticuloendothelial system and, hence, part of the fish’s defence system (Roberts 1975). These structures serve as material deposits, such as melanin, which are metabolically inert or necessary for recycling such as iron pigments or lipofucsin. The proliferation of MMC was associated with various natural factors such as age (Blazer, Wolke, Brown & Powell 1987), malnutrition and infectious diseases (Wolke 1992), and, also, in response to environmental stress (Fournier, Summers, Courtney & Engle 2001). Given that melanin has the ability to link to aromatic and cyclic compounds and cations, it can selectively take up harmful compounds (Roberts 1975). Notwithstanding the fact that the presence of extra-cutaneous melanin was highly variable between different species of fish (Zuasti, Ferrer, Aroca & Solano 1990), there was high concentration of melanin in the spleen, liver and kidney of axillary seabream with altered skin pigmentation. The changes observed in the internal organs may reflect a close relationship between the appearance of the skin and the overall health of axillary seabream. The sporadic nature of the occurrence of pigmented lesions may point towards the existence of specific conditions in that geographical area, whether concerning the fish per se, or concerning the environment.
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Intra ocular melanoma metastatic to an axillary lymph node: A case report

Intra ocular melanoma metastatic to an axillary lymph node: A case report

A 51 year old Caucasian lady presented to the breast care center with two week duration of left axillary mass. No other breast symptoms. Past medical history is sig- nificant for right eye choroidal melanoma diagnosed 1.5 years ago treated with brachytherapy and followed at an eye institute.

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EFFECT OF KINETIN CONCENTRATION ON AXILLARY SHOOT BUD PROLIFERATION OF BAMBUSA VULGARIS

EFFECT OF KINETIN CONCENTRATION ON AXILLARY SHOOT BUD PROLIFERATION OF BAMBUSA VULGARIS

Zang et al., (2016) [6] developed a stable and efficient regeneration system in D. hamiltonii by using easily obtained shoot tips as explants which provide a useful tool for genetic and transformation in bamboo species. While in this experiment inter nodal explants for axillary shoot bud proliferation in bamboo species through micro-propagation.

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Sonographic evaluation of the axillary artery during simulated overhead throwing position

Sonographic evaluation of the axillary artery during simulated overhead throwing position

of such injury include baseball pitchers, handball, tennis, and volleyball players (Arko, Harris, Zarins, & Olcott, 2001; Fields, Lemak, & Benmenachem, 1986; Ishitobi et al., 2001; Rohrer, Cardullo, Pappas, Phillips, & Wheeler, 1990; Todd, Benvenisty, Hershon, & Bigliani, 1998; Vlychou, Spanomichos, Chatziioannou, Georganas, & Zavras, 2001). The proposed mechanisms for compressive trauma of the second and third portions of the axillary artery are a tight or hypertrophied pectoralis minor muscle (Dijkstra & Westra, 1978; Finkelstein & Johnston, 1993) and anterior translation of the humeral head (Dijkstra & Westra, 1978; Durham, Yao, Pearce, Nuber, & McCarthy, 1995; Vlychou et al., 2001) combined with repetitive overhead activity.
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