Septic arthritis of the sternoclavicular (SC) joint is an uncommon disease with some risk factors. Because of being rare and insidious, a diagnosis could probably be difficult, delayed, or even missed until complications occur, resulting in severe and life-threatening outcomes. It should be noted that early recognition and diagnosis, followed by immediate treatment, play an essential role in the patient’s prognosis. Septic arthritis of the SC joint is a relatively infrequent infection. Clinical symptoms are mostly sudden, and from days to months, the patients may have pain in the chest, shoulder, or neck, limited movement in the upper extremities, and fever.

We report a patient without predisposing factors who developed septic SC arthritis with infraclavicular abscess and was rapidly treated with partial clavicular resection

Diagnosis of septic arthritis in the SC region is often deferred. Early diagnosis allows more accessible medical or surgical treatment and a significant prognosis.

Minor complications have been reported following extracorporeal shock wave lithotripsy (ESWL), including renal colic, gross hematuria, urinary obstruction, and hematoma. Some rare major complications have been also reported, such as abscess formation, acute pancreatitis with abscess, and splenic rupture. Here, we present the computed tomographic (CT) findings of a patient with necrotizing fasciitis, along with abscess formation after ESWL, which rapidly invaded the neck, chest, and abdominal wall.

A 67-year-old woman presented with persistent cough, intermittent nausea, and progressive right flank pain for one month after ESWL, which was performed for a right upper ureteral stone, measuring 1.2 × 0.3 cm, with right hydronephrosis detected on abdominal X-ray and renal ultrasound. The initial abdominal CT scan showed perirenal and pararenal hematoma of the right kidney, extending to the right posterior pararenal space, right psoas muscle, and right paraspinal region. Empiric antibiotic treatment was prescribed for the patient. After one week of treatment, the follow-up CT scan showed perirenal and pararenal abscesses with necrotizing fasciitis, invading the posterior region up to the paraspinal region and then migrating upward to the chest wall, axillary, supra-clavicular, and infra-clavicular regions, and the neck. The abscess also caused downward damage to the abdominal wall. Four weeks after a surgical intervention, the inflammatory process almost resolved.

Although the possibility of post-ESWL necrotizing fasciitis is acutely low, it is important to consider this fatal complication.

This study aimed to evaluate the relationship between clavicular fracture and associated injuries in multi-traumatic patients. In this prospective cohort study, 185 multi-traumatic patients referred to the Emergency Department of Imam Reza (AS) Hospital of Tabriz University of Medical Sciences were selected between August 2019 and September 2021. The census sampling method was used until the required sample size was achieved. The following patient information was recorded and studied: mechanism of trauma, age, gender, Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), the presence of clavicular fracture, concomitant injuries, hospital outcome, duration ofhospitalization, and severity of trauma. The participants were divided into two groups based on the presence of a clavicular fracture. Data were analyzed using SPSS software. Of all 185 patients, 51 had clavicular fractures. The mean age of the patients was 34.72±12.99. Of all patients, 27.6% had clavicular fractures. There was no statistically significant difference in GCS scores between the two groups (P=0.927). The highest percentage of injuries associated with clavicular traumas was traumatic brain injuries, with rates of 22.4% and 19.6% in the study and control groups, respectively. There were statistically significant differences inconcomitant injuries between the two groups (P

Cleidocranial dysplasia is a rare congenital bone formation inherited as an autosomal dominant trait. The incidence is one per 200000 live births. Major symptoms include delayed ossification of the skull, excessively large fontanels and clavicular hypoplasia or aplasia, allowing the shoulders in front of the chest. Delayed eruption of teeth, high arched palate and wide pelvic joint may also be present. The case was a newborn boy who had admitted in neonatal ward of Ekbatan hospital because of respiratory distress. Anterior and posterior fontanels were completely large and connected. His shoulders were a little depressed. Chest X ray revealed bilateral clavicular agenesia and skull X-ray failed to demonstrat vortex bone.

Head and neck oncologic resections leave complex defects which are challenging to reconstruct. In head and neck region, aesthetic facial units should be considered and a thin, malleable, suitable texture and color flap should be applied. Supraclavicular artery Island flap is fasciocutaneous flap, that taken from skin on the shoulder and supraclavicular area that based on supra clavicular artery. One of the advantages of the supraclavicular artery Island flap is the possibility of one-stage reconstruction with minimal morbidity. The objective of our study were to describe our initial experience using the supra clavicular artery Island flap in conjunction with karapandzic flap for reconstruction of lower facial defects.

The main objective of this study was to assess the impacts of an increasing the number of IMRT beams on cardiac dose distribution in left-sided breast irradiation so that we can reduce the heart’s mean dose  up to clinically acceptable level. For this study 107 female patients, diagnosed with left-sided breast cancer were selected retrospectively. In 107 patients, there were 52 patients of chest wall irradiation including supra-clavicular fossa, while 22 patients were of breast-conserving surgery excluding supra-clavicular fossa and internal mammary lymph nodes, and 33 patients were of chest wall irradiation including internal mammary lymph nodes and supra-clavicular fossa. Exclusion criteria were previous history of left-sided breast radiation therapy, uncommon fractionated dose delivered in past, and indication of palliative radiation therapy. Intensity modulated radiotherapy plans were generated using 7, 9 and11 beams for each patient and the prescribed dose was 40.05 Gy in 15 fractions (2.67 Gy /fraction) for the targets. Heart: V5Gy(cc): This was a low-dose volume of our study in which the 11-bIMRT technique yielded better result as compared to 9- and 7-bIMRT. Maximum and minimum values of V5 were found 539.60cc in 9-bIMRT and 141.32cc in 11-bIMRT techniques respectively.V25Gy(cc): The maximum value of V25Gy was found 41.73cc in 7-bIMRT technique, while the lowest value was 0.29cc in 11-bIMRT. The IMRT technique with 11 beams showed comparatively better result on this parameter as well as 3-5cc volume of V25Gy was spared. Mean dose (Gy): Maximum value of mean dose was found 8.51Gy in 7-bIMRT while it was 6.53Gy in 11-bIMRT technique.    The study indicates that increasing the number of IMRT beams reduces heart’s high-dose volume and improves the quality of treatment plans. It is judicious to use 11-bIMRT technique in left-sided breast irradiation as it produces clinically acceptable mean heart dose.

The aim of this survey was to determine the occurrence of liver abscesses and identification of associated bacterial etiology in cattle carcasses of Tabriz industrial abattoir. A total of 355 cattle carcasses were inspected for the presence of liver abscesses. In the case of liver abscess presence, some characteristics of the carcasses were recorded; such as cattle’s age, gender, pregnancy and also abscesses’ characteristics (i.e., number, size and location of abscesses on liver). Abscesses as whole, were sampled and kept cold until microbiological examinations. Microbial analysis was performed on samples and cultures were incubated at aerobic, anaerobic and microaerophilic atmospheres. From 355 cattle carcasses, liver abscess was found in 28 (7.8%). Among positive results, 22 (78.57%) of livers had only 1, while 6 (21.42%) had 2 or more abscesses. Fusobacterium necrophorum was isolated from 15 53.57%) and Arcanobacterium pyogenes from 10 (35.71%) of abscesses. According to the results ofthis study, Fusobacterium necrophorum was found as the most frequent bacterial causative agent of cattle liver abscess in Tabriz industrial abattoir, while Arcanobacterium pyogenes was considered as the second most frequent agent.

The aim of the present study was to evaluate the incidence of liver abscess in lactating and dry Holstein cows and its effect on some blood parameters and histology of hepatocytes. The liver of 577 lactating and dry Holstein cows at the time of slaughter in two abattoirs in Iran were examined. Blood collection from cows was carried out at the time of slaughter. Sixty healthy cows, i.e., the same number of cows with liver abscesses (which had no problem in terms of autopsy and splanchnic checking), were considered as control group according to herd and number of gestation. Immediately after slaughter, the livers of the cows was divided into 4 groups of liver without abscess score 0, liver with one or two small abscesses or scars; score A, liver with two to four well-organized abscesses; score A, and liver with one or more large open abscesses, with or without adhesions; score A. The slaughterhouse survey showed that, 10.4% (60 cows) had liver abscesses (25, 31.7 and 43.3 % for A-, A and A). Data from histological studies showed that in livers with abscesses in compare to healthy livers, natural form of hepatocytes close to sinusoids in liver with abscesses had changed, parts of the affected tissue showed necrosis and the numbers of Kupffer cells were increased. The concentration of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyltransferase (GGT) in the blood serum of cattle with liver abscesses with A, A and A scores were higher than that of healthy cows (P≤0.01), while the concentration of creatine kinase (CK) in the cows affected by the abscess was lower than the healthy group (P≤0.01). Cows with liver abscesses with scores A-, A and A had lower concentrations of albumin and serum cholesterol than healthy cows (P≤0.01). The results of this study showed that the higher concentrations of liver enzymes and low blood concentrations of albumin and cholestrol in cows with liver abscesses may be due to the destruction of liver cells and inflammation. In conclusion, some blood parameters can be used as an indicator for assessing the status of liver abscess.

We review abscess management by Ibn al-Quff in the 12 century, described in his book al Omdaa (Arabic version). He explained in detail how an abscess presents, access for drainage, the proper preparation by the surgeon and patient for a procedure, and technical guidelines. It is considered advanced in ensuring the best results of managing this pathology. Much of his advice is already in use, and the rest has either never been considered or has not been studied well. A comprehensive literature review was conducted using PubMed and Google Scholar. Articles were sought about Ibn al-Quff and his contribution to medical knowledge, medical education and quality control for surgical practice. Included were studies of abscess management, options for drainage after maturation, methods of incision and packing after drainage, and preparations to be made by the patient and surgeon for a procedure to be completed correctly. Chapter 10 of the original manuscript of Ibn al-Quff (in Arabic) describes in detail how to manage an abscess, which was compared to current practice. Ibn al-Quff gave clear practice guidelines for abscess management and discussed abscess maturation and the timing of incisions, which are poorly addressed in the current literature. The role of eruptive medicine in helping spontaneous abscess rupture was addressed in the book. The direction of incisions in relation to the location and involvement of organs for all abscess are not explored in detail. These are considered common sense in the preparation by a surgeon and patients for surgery in modern health care, and they are well explained by Ibn al-Quff. Ibn al-Quff addressed abscess management in an unmatchable manner for his time. Some points that he addressed, like abscess maturation, use of eruptive medicine through local skin applications to help an abscess erupt spontaneously, pus smell in relation to the causative organism, and the direction of incisions based on abscess location, are still areas of active research.