Selectively sparing of the supraclavicular area during intensity-modulated radiotherapy in nasopharyngeal carcinoma: A double-center observation study.

BACKGROUND AND PURPOSE: This study was aimed at evaluating the feasibility of sparing the supraclavicular area, namely levels IVb and Vc, during intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC) patients with N1-2 disease[except N1 disease with purely restropharyngeal lymph nodes(RPN) involvement], and providing a basis for the revision of International Guideline for the delineation of the clinical target volume (CTV). PATIENTS AND MATERIALS: Patients with NPC (stage TanyN1-2M0) diagnosed pathologically in Fujian Cancer Hospital (Center 1, Only Lin SJ's attending group) from January 2014 to March 2018 and Jiangxi Cancer Hospital(Center 2) from January 2014 to December 2015 were included. According to our principle, the supraclavicular area (levels IVb and Vc) were excluded from the CTVnd. Survival outcomes focused on regional recurrence-free survival (RRFS) and recurrence rates of levels IVb and Vc were analysed. RESULTS: A total of 672 eligible patients were recruited (Center 1, n = 362; Center 2, n = 310). There was no significant difference in 5-year RRFS (97.33 % vs. 97.24 %, p = 0.980), overall survival (OS) (89.14 % vs. 88.56 %, p = 0.327), local recurrence-free survival (LRFS) (94.90 % vs. 95.30 %, p = 0.593) and distant metastasis-free survival (DMFS) (89.38 % vs. 86.60 %, p = 0.130) between Center 1 and Center 2. Twenty patients developed regional failure (median: 36 months), among them, only one case (0.15 %) was recorded as levels IVb and Vc recurrence. CONCLUSION: Omitting the supraclavicular area (levels IVb and Vc) during IMRT should be safe and feasible for N1-2 disease (except N1 disease with purely RPN involvement). Well-designed multicenter prospective trials should be conducted to confirm our findings.

Retained bullet in the neck after gunshot wounds to the chest and arm in combat patient injured in the war in Ukraine: A case report.

INTRODUCTION AND IMPORTANCE: A gunshot wound is the most common injury in armed conflicts, resulting in severe trauma and increased morbidity usually due to damage to major vessels. Gunshot injury could be associated with the projectile location in one anatomical area, but the initial inlet place in another. PRESENTATION OF CASE: A 33-years old male patient received gunshot injuries to the left axillary area of the chest and left upper extremity in the battlefield area near Kyiv (Ukraine). The patient was diagnosed with multiple gunshot injuries, as judged from the presence of inlet and outlet holes in the chest and left upper arm. Without having any major complaints, the patient was examined by chest X-ray, showing a metal density fragment in the area of the first left rib, behind the left clavicle and adjacent to the left common carotid artery (CCA) and internal jugular vein (IJV). Surgery revealed 25 mm retained bullet in the area between CCA and IJV. CLINICAL DISCUSSION: Our case report is in line with others, showing that identification of the bullet or projectile fragment in unexpected locations was made by chance or due to routine application of protocols for the clinical evaluation of combat patients, including those without clinical signs or specific complaints. CONCLUSION: A gunshot injury could be associated with an unusual bullet trajectory. A routine whole-body CT scan or chest and abdominal X-ray should be performed for all patients with gunshot injury of any localization for early detection of a possible retained bullet.

Primary Leiomyoma of the Chest Wall in a Pediatric Patient / 임상소아혈액종양

Primary leiomyoma of the chest wall is extremely rare. A 13-month-old boy presented to outpatient clinic of the department of pediatrics with a soft, movable, and palpable mass in the right supraclavicular area. Neck computed tomography revealed a 2.5-cm-sized soft tissue mass in the right anterior supraclavicular area. The mass was completely resected, and histopathological examination showed a localized primary leiomyoma with cystic change. The patient was followed up and has been disease-free for more than 11 months since surgery. To the best of our knowledge, 13 cases of leiomyoma of the chest wall have been reported to date, but this is the second case of primary leiomyoma of the chest wall in a pediatric patient. This report describes the clinical course of this case and presents a review of relevant literature.

Imaging and identification of brown adipose tissue on CT scan.

Two types of adipose tissue (AT) have been described in the field of physiology: white (W) and brown (B) AT. Although WAT is well identified on human imaging, BAT imaging aspect remains to be further explored. The aim of this study was to investigate imaging aspect of BAT and its identification on CT (computed tomography) with iodine-based contrast media injection. We retrospectively reviewed 464 positron emission tomography (PET)/CT, performed during 21 months on adults younger than 37 years. In 39 cases only, the PET revealed the presence of activated BAT. ROI was placed on both white and brown adipose tissue simultaneously on both PET and CT. Several patients' characteristics (blood sugar level, gender, age, body mass index) as well as BAT and WAT parameters were assessed. Mean CT densities for WAT and BAT were -99·5 HU versus -32·6, mean SUV were 1·38 versus 13·2 and SUVmax were 1·79 versus 16·57, respectively. We found a statistically significant inverse relation between BMI and BAT density. BAT has a higher density than WAT. In this manner, BAT can be misinterpreted as an infiltration of adipose tissue in neoplasic and inflammatory context. Contrast-enhanced CT scan allows visualization and identification of BAT.

Applied sonoanatomy of the posterior triangle of the neck.

The posterior triangle of the neck is an area of the body frequently visited by regional anesthesiologists, acute and chronic pain physicians, surgeons of all disciplines, and diagnosticians. It houses the entire brachial plexus from the roots to the divisions, the scalene muscles, the cervical sympathetic ganglions, the major blood vessels to and from the brain, the neuroforamina and various other structures of more or less importance to these physicians. Ultrasound (US) offers a handy visual tool for these structures to be viewed in real time and, therefore, its popularity and the need to understand it. We will discuss pertinent clinical anatomy of the neck and offer a basic visual explanation of the often-difficult two-dimensional (2-D) images seen with US.

A Case of Cervical Tab / 대한피부과학회지

Cervical tab is one of the congenital anomalies, originated from an accessory tragus or a remnant of branchial cartilage on the head a.nd neck. A 41 year old male patient was seen with 1.1 x0.8cm sized cartilage consistent intredermal nodule on the left supraclavicular area. Histopathologic findings showed the oval shaped cartilags surrounded with connective tissue and interstitial substance stained black with Verhoeff van Gieson stain.