These data indicate that totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy is safe and feasible, with a low axillary vein access-related complication rate.
The authors have indicated no significant interest with commercial supporters. C arcinosarcoma is a rare biphasic tumor composed of malignant epithelial and mesenchymal elements. Carcinosarcomas of visceral tissue have been described in numerous anatomic locations, including female and male genital tracts, lung, kidney, upper and lower urinary systems, breast, oronasopharynx, larynx, gastrointestinal tract, thyroid, thymus, head, and neck. 1 In contrast to visceral carcinosarcoma, cutaneous carcinosarcoma is rare. We present the clinical and magnetic resonance imaging (MRI) features of this rare case of primary cutaneous carcinosarcoma on the shoulder. Case ReportAn 84-year-old man presented with an ulcerated, exophytic mass over the anterior aspect of his left shoulder. He reported that the lesion had begun as a small nodule 1 month earlier and had rapidly grown. He had no known history of skin cancer. Clinical examination revealed a 5-cm ulcerative mass over the left anterior shoulder (Figure 1). Radiographs of the left humerus showed a large bulging opacity in the left anterior axillary region. MRI showed a 6.0-by 5.4-by 3.2-cm infiltrating mass in the anterior aspect of the left shoulder. This mass was located mainly in the subcutaneous layer and involved the overlying skin, with a large skin defect corresponding to the ulceration. There was muscle invasion to the pectoralis major and deltoid muscles. The mass showed iso-to slight hyperintensity to skeletal muscle on T1-weighted images, hyperintensity on T2-weighted images, and intense diffuse enhancement. There were partial septations and tubular, signal void structures inside the mass. An associated skin defect and peritumoral, subcutaneous enhancement was also present (Figure 2A,B). A blind skin biopsy was performed at the outpatient clinic, and histologic examination revealed skin-related carcinoma. Positron emission tomography (PET) revealed an intense hypermetabolic mass in the left anterior shoulder without evidence of distant metastasis. The lesion was subsequently excised completely, and the remaining skin defect was repaired using a split-thickness skin graft by harvesting a flap from the left thigh. The mass was 7 by 5 by 5 cm grossly, and the cut surface of the mass revealed a homogeneous yellowish appearance. Microscopic examination of the lesion revealed a poorly differentiated squamous cell carcinoma-like component and Figure 1. Clinical examination demonstrates a 5-cm reddish, ulcerative, protruding mass over the left anterior shoulder.
Pressure ulcer (PU), also called pressure injury, is localized damage to the skin and underlying soft tissues, usually over bony prominences, as a result of sustained mechanical loads applied to the tissues. However, in many situations, complete off-loading of sacral PUs is not possible. Minimising the exposure of wounds and their surroundings to elevated mechanical loads is crucial for healing. We for the first time reported the application of Meipicang in the prevention and treatment of intraoperative pressure ulcers in elderly ICU patients with severe illness. We found that the pressure ulcer risk score ( 20.15 ± 2.17 ) in the dressing group after intervention was higher than that ( 17.42 ± 3.62 ) in the regular group. The incidence of pressure sores in the dressing group was 3.77% lower than the 18.88% in the regular group. The psychological concern score ( 31.41 ± 3.15 ) of the dressing group was higher than that ( 26.92 ± 3.43 ) of the regular group. The trust score ( 29.57 ± 2.61 ) of the dressing group was higher than the score ( 24.28 ± 2.29 ) of the regular group. The score of physiological problems in the dressing group ( 34.69 ± 3.82 ) is higher than that in the regular group ( 29.88 ± 3.54 ). The skin complication rate of the dressing group was 5.56% lower than that of the regular group (22.64%). The comfort score (92.46 ± 4.15) of the dressing group was higher than that ( 80.59 ± 5.43 ) of the regular group. The nursing satisfaction score ( 94.53 ± 3.72 ) of the dressing group was higher than that ( 81.79 ± 4.61 ) of the regular group. To conclude, in this study, we found that the Meipicang dressing can reduce the incidence of pressure ulcers in ICU patients with severe ICU and improve the comfort and nursing satisfaction of elderly ICU patients with severe ICU, which is worthy of promotion.
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