An unusual complication of axillary lymph-node clearance.

We report the case of two elderly patients who developed an unusual striking eruption of the right chest wall, 6 and 8 weeks, respectively, after right axillary lymph-node dissection. The procedures were performed following diagnosis of cutaneous malignant melanoma with regional nodal metastases. Both procedures were complicated by the formation of a seroma, subsequently drained by needle aspiration. On histological examination of the first case, extravasated red cells were found around dilated vessels, which were confirmed by immunohistochemistry to be lymphatic vessels. The eruptions resolved spontaneously within 4-8 weeks. The cause of the eruption remains unclear, but possible reasons are bleeding into the seroma or the occurrence of a temporary lymphovascular anastomosis. To our knowledge, these are the first such cases reported in the literature.

Updates from the British Association of Dermatologists 91st annual meeting, 5-7 July 2011, London, U.K.

This is a synopsis of the significant research and clinical papers presented at the British Association of Dermatologists (BAD) meeting held on the 5-7 July 2011 in London, U.K. The conference and satellite symposia highlighted the recent biological, epidemiological and therapeutic advances in dermatology. This report is not meant as a substitute for reading the conference proceedings and related references quoted in this article.

Psoriasis: an evidence-based update. Report of the 9th evidenced based update meeting, 12 May 2011, Loughborough, UK.

The Centre of Evidence Based Dermatology, University of Nottingham, U.K. holds an annual Evidence Based Update (EBU) Meeting focused on important dermatological topics, which have in the past included eczema, urticaria, blistering disorders, skin infections, skin cancer and hair disorders. These one-day meetings aim to summarize the most recent evidence in the form of systematic reviews and recently completed clinical trials. This year, the 9th EBU meeting took place in Loughborough, U.K. on 12 May 2011 and was devoted to psoriasis. The latest updates on topical treatments, nail psoriasis, genetics and clinical implications, rational use of biologics, new and unpublished studies on combination of phototherapy and biologics for psoriasis, and on treatments of palmoplantar pustular psoriasis were discussed by a panel of renowned international speakers.

[Aortic coarctation with bilateral aneurysms of the subclavian arteries: surgical treatment]. / Coartazione aortica associata ad aneurisma bilaterale della succlavia: trattamento chirurgico.

The natural history of untreated coarctation of the aorta may be complicated by dissection or aneurysms of the ascending as well as of the descending thoracic aorta distal to the coarctation. We report a case of coarctation of the aorta in a young man associated to bilateral aneurysms of the subclavian arteries, one of which of great size. In a review of the most recent and largest series of adult patients undergoing surgery for aortic coarctation we were unable to find a similar case. In such a condition complete repair may be accomplished quite safely, preferably employing a multi-stage technique.

[Removal of an endocavitary electrode with cardiopulmonary bypass for septicemia associated with right atrial thrombosis. Report of a case (author's transl)]. / Rimozione di elettrodo endocavitario mediante bypass cardiopolmonare totale per setticemia e trombosi atriale destra.

A case of staphylococcus epidermidis endocarditis associated with a right atrial thrombosis around a pacemaker electrode is presented. Stuce the antibiotic therapy had proved uneffective, the electrode had to be removed with cardiopulmonary bypass; the infection was subsequently eliminated. When a foreign body cannot be removed by closed techniques, open heart surgery with cardiopulmonary bypass may be necessary.

[Method for radiological recognition of cardiac valve prostheses. Analysis of the various models used at the Cardiosurgery Center of the University of Padua]. / Metodo per il riconoscimento radiologico delle protesi valvolari cardiache. Analisi dei vari modelli in uso presso il Centro di Cardiochirurgia dell'Università di Padova.

A rapid identification of the type of prosthetic heart valve from the plain chest roentgenogram is often of extreme importance in the care of patients who have undergone prosthetic valve replacement. In the present report we have analyzed the radiographic appearances of 9 different models of mechanical and biological prostheses which are or have been employed at our Institution since 1969, with the aim of providing simple guidelines to identify these devices. For this purpose photographs were taken of the postero-anterior and left lateral chest radiograms of patients in whom these particular prostheses were implanted. Once the silhouettes of the radioopaque components of these devices have become familiar, the differentiation of the types and the recognition of the site of implantation is easy and rapid.

Decreased thrombotic mortality and morbidity after valvular cardiac surgery as a consequence of adequate coumarin anticoagulation. A retrospective study in 516 patients.

Two almost identical groups of 258 patients each who underwent surgery for the substitution of one or more than one cardiac valve were taken into consideration. After surgery all patients, with the exception of those who received a porcine allograph, were given coumarin drugs for 1 year for thrombosis prophylaxis. In the first group of patients operated in 1972 and 1973 the laboratory follow-up and the therapeutic range were neither constant nor uniform. In the case of the second group, which included patients operated in 1974 and 1975, adequate laboratory follow-up and constantly adequate therapeutic ranges were always kept. This retrospective study has shown a statistically significant decrease in mortality due to thromboembolism and to unknown causes in the second group of patients (x2 = 8,313, "p" less than 0,0025). A decrease of the non-lethal embolic complications was also noted in the second group of patients (x2 = 6,813, "p" less than 0,0025). On the other hand, bleeding complications were greater in the second group of patients (x2 = 3,485, "p" less than 0,05) and this was interpreted as secondary to the higher anticoagulation administered to the latter patients. The results indicate that an adequate coumarin anticoagulation seems able to decrease the incidence of lethal or non-lethal thromboembolic complications after cardiac valve replacement significantly.

Delayed cardiac tamponade following open heart surgery. Analysis of 12 patients.

The present report reviews our experience with 12 cases of delayed cardiac tamponade following open heart surgery, which occurred at various times after the seventh postoperative day (average 19 days). In each case the diagnosis was made on clinical grounds, supported by the radiographic findings in all, and confirmed by echocardiography in 4. Pericardial effusion was serous in 5 patients, sero-sanguineous in 3, sanguineous in 3, and purulent in one; it was most frequently caused by a postpericardiotomy syndrome (7 cases). A single pericardiocentesis was curative in 6 instances, while repeat procedures were required in 2 because of recurrence. A repeat median sternotomy was performed in 5 patients associated with pericardiocentesis, and a pericardiectomy in 2. Three patients died within one month from the initial operation; no recurrences have been noted so far in the long-term survivors. According to the results of the present investigation, early clinical recognition is considered the clue to a successful outcome. Sole pericardiocentesis is followed by immediate improvement of the patient's state, and is often curative, but recurrences may require other maneuvers for further fluid evacuation. Awareness of this possible complication may contribute to a decrease in the still high mortality rate associated with this condition.

Anomalous origin of the right coronary artery from the main pulmonary artery.

A case of anomalous origin of the right coronary artery from the main pulmonary artery, in a previously asymptomatic young woman, is presented. Direct transposition into the aortic root of the anomalous vessel was performed. To our knowledge this is the 4th case of this malformation to be successfully corrected.

Cardiac myxomas: results of 14 years' experience.

From January 1968 to July 1983, 38 patients with an intracardiac myxoma underwent surgical excision of the tumor at our Institution. There were 15 males and 23 females, ranging in age from 17 to 68 years (mean 47.7). In all but 2 patients, the presence of an intracardiac myxoma was documented preoperatively by angiographic and/or echocardiographic study. The first 2 patients of this series were referred with the diagnosis of mitral stenosis, and the myxoma was an unexpected surgical finding. In 32 cases (84.2%) the myxoma was located in the left atrium, in 4 (10.5%) in the right atrium and in 2 (5.3%) in the right ventricle. Surgery was performed on an emergency basis in 36 patients. Two patients (5.2%) both with a left atrial myxoma, died after surgery: one died intraoperatively of hemorrhage and the other after one month of bowel infarction. Follow-up of the 36 survivors ranges from 3 months to 14.5 years (average 5.2 yr); all were controlled by means of clinical and echocardiographic investigations, and no evidence of tumor recurrence was detected. Surgery for intracardiac myxoma, which should be undertaken on an emergency basis, carries a low operative risk; excision of the tumor appears to be curative with no recurrences at long-term follow-up; non-invasive tools are of the utmost importance in both the preoperative assessment and follow-up of these patients.