The Chondroepitrochlearis Muscle: A Rare Cause of Axillary Vein Thrombosis and Lymphedema.

The chondroepitrochlearis muscle is a rare anomaly of the pectoralis major crossing over the neurovascular bundle in the axilla. Often associated with other supernumerary muscles like the arch of Langer, it has been reported in the past as a cause of restriction of arm abduction, cosmetic defects and compression of the ulnary nerve. This case report describes the first known vascular complication due to a chondroepitrochlearis muscle, causing intermittent compression of the axillary vein and thrombosis, associated with pain, upper limb lymphedema, and impaired movements. The diagnosis was suspected from the medical history and confirmed by palpation and dynamic ultrasonography. Surgery was performed to divide the muscle slip with the help of lymphofluoroscopy to prevent damage to the lymphatic structures. Pain and impairment of movement disappeared within a few days after surgery and lymphedema decreased significantly.

Breast implant infection with pasteurella canis: First case-report.

Zoonotic infections represent an uncommon phenomenon. Few people with pets realise the infectious risk this entails. This case describes a Pasteurella canis infection of a breast implant following close contact between a patient and her cat. A 59-year-old woman developed infection of her breast implant 7 months after implantation. Surgical revision was performed after failure of conservative treatment with antibiotics. Perioperative samples from the periprosthetic fluid were positive for P. canis, a Gram-negative coccobacillus that is present in the oropharyngeal commensal flora of cats and dogs. History revealed that the patient owned a cat for 2 years. This case highlights the possible risk of zoonotic infections in humans with protheses following close contact with a cat. Antibiotic therapy and surgical revision, with or without removal of the prosthesis constitute the cornerstone of treatment in such cases.

Radiation-induced sarcoma: analysis of 46 cases.

A retrospective analysis was performed of 46 cases of sarcoma treated in our institution between 1989 and 2007 that occurred in a previously irradiated area. Eight male and 38 female patients had received radiotherapy, mainly for breast cancer and genitourinary tumours. The interval between irradiation and the diagnosis of sarcoma ranged from 1 to 54 years (median 15 y). The most common clinical findings were a mass, pain and skin dislocation. Angiosarcoma and sarcoma non-otherwise-specified were the most common histological types. Surgical resection was performed in 34 patients (74%) and 5-year survival was 45% when a radical resection was obtained. No 5-year survival was noticed after non-radical resection and in the absence of surgery. Stage and location of the sarcoma were other prognostic factors. Overall 5-year survival was 27% for the whole group.

Life saving surgery in polytrauma patients.

Life saving surgery is the surgery which has to be performed during the acute or reanimation period (1 to 3 h) and during the primary or stabilisation period (first day surgery). During the reanimation period lifethreatening conditions are identified and management is begun simultaneously. Many trauma surgeons talk about the first "golden hours" as the time interval starting immediately after the injury when rapid intervention will save lives and a lack of intervention will result in life loss. Most common, these critical conditions are exsanguinating hemorrhage, acute pump failure, obstruction of airways, mechanical failure of ventilation or severe brain damage with tentorial herniation. During this period, the following acts are necessary: surgical access to live support systems (airway, veins), life saving decompression of body cavities, resuscitative thoracotomy, control of exsanguinating external hemorrhage and control of exsanguinating hemorrhage into the body cavities. The primary or stabilisation period starts when vital functions stabilise. This period consists of further diagnostic procedures and treatment of injuries that are not directly life-threatening, but which may become life endangering or severely disabling if not treated promptly. The priorities of the surgical treatment are: brain injuries, eye- and facial injuries, progressive compression of the spinal cord, visceral injuries, musculoskeletal injuries. By improving prehospital care, rapid transport and last but not least immediate life saving surgical treatment preventable deaths can be reduced from 20-30% to 2-9% (5).

Computerised 3D evaluation of the functional eyelid deficit in facial palsy.

Facial palsy is often characterised by a severe dysfunction of the eyelids, leading to corneal ulceration and even blindness. A precise evaluation of the exposed ocular surface is very important in order to estimate the risks of these ocular symptoms. In the literature, most authors use a comparison between the heights of lagophthalmus and corneal exposure in the pre- and postoperative situations to evaluate the surgical correction of the eyelids in facial paralysis. The heights are not representative of the real exposed surfaces. We propose another method to evaluate these surfaces, using a computer-assisted design (CAD) software analysing standardised photographs and giving a precise assessment of the surface of the eye not covered by the eyelids. The exposed surface is more representative of the risks of ocular symptoms than the height. Our goal in this study was to improve the quality of the measurements, which allows to get a better estimation of the clinical situation and provides a tool that permits comparison of results between different surgical approaches.