RESUMEN
INTRODUCTION: Side-effects occurring after sentinel lymph node excision in malignant melanoma patients have been poorly evaluated to date. The aim of the present study was to assess the side-effects of sentinel lymph node excision in this population. PATIENTS AND METHODS: All consecutive malignant melanoma patients undergoing sentinel lymph node excision between March 2000 and December 2002 were included in this retrospective study. Patients with a metastatic sentinel node subsequently undergoing lymph node dissection were excluded. Median follow-up of patients was 12.6 +/- 8.8 months. Complications were classified as "early" (i.e. occurring the month following surgery), or "late" (after this time). RESULTS: Forty malignant melanoma patients (17 males, 23 females) with a normal histologic examination of their sentinel lymph node were included. They belonged to a series of sixty-one melanoma patients undergoing lymph node excision. Fourteen complications were observed in ten patients. Two early complications were seen: hematoma (n=1) and deep venous thrombosis with pulmonary embolism (n=1). Twelve late complications were observed: mild lymphoedema (n=5), hypertrophic scars (n=2), painful scars (n=4), and one chronic seroma (n=1). Many complications (33%) were observed after excision in the inguinal area. DISCUSSION: The complications of sentinel lymph node excision must be considered in determining the benefit/risk ratio of this technique.
Asunto(s)
Escisión del Ganglio Linfático/efectos adversos , Melanoma/cirugía , Biopsia del Ganglio Linfático Centinela , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Masculino , Melanoma/diagnóstico por imagen , Melanoma/patología , Persona de Mediana Edad , Radiografía , Radiofármacos , Estudios Retrospectivos , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Azufre Coloidal Tecnecio Tc 99mRESUMEN
An osteoid osteoma was discovered at the site of fusion of a mid-third femoral shaft fracture in an 18-year-old girl. This unusual localization was revealed by persistent pain after ablation of the material after fracture healing. Postoperatively, a discharge from the skin wound that persisted for a few days, raised the differential diagnosis between low-grade bone infection and an osteoid osteoma suggested by the patient's age and the clinical presentation. Computed tomography and leukocyte-labeled bone scintigraphy provided the diagnosis of osteoid osteoma that was confirmed at pathology examination after resection. Isotopic mapping of this very small intraosseous lesion that exhibited strong isotope uptake was particularly contributive.
Asunto(s)
Fracturas del Fémur/complicaciones , Neoplasias Femorales/etiología , Osteoma Osteoide/etiología , Adolescente , Anticuerpos Monoclonales , Anticuerpos Monoclonales de Origen Murino , Diagnóstico Diferencial , Femenino , Fracturas del Fémur/diagnóstico , Fracturas del Fémur/cirugía , Neoplasias Femorales/diagnóstico , Neoplasias Femorales/cirugía , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Curación de Fractura , Humanos , Marcaje Isotópico , Leucocitos , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/cirugía , Osteotomía , Dolor/etiología , Tecnecio , Terapéutica , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: In at least 15 % of dilated urinary tracts, diuresis renography fails to assess the presence or absence of urinary obstruction. OBJECTIVE: To determine the shortcomings of (99 m)Tc-DTPA frusemide diuresis renography by reference to pressure flow studies. MATERIALS AND METHODS: Thirty-four patients, aged 1 month to 20 years, with questionable obstruction were evaluated by diuresis renography and pressure flow studies (the Whitaker test) as the reference method during the same short period of time. Discrepancies were analysed. RESULTS: In patients with type I or IIIa renographic response, pressure flow studies never led to any change in management. Poor function, major dilatation and prior surgery were found to be risk factors of inaccurately obstructive pattern (type II) on renography (n = 6). In patients with type IIIb response, pressure flow studies could show low-grade (n = 3) or intermittent obstruction (n = 2). Intermittent obstruction was also demonstrated in two patients with type II response. CONCLUSION: In patients with risk factors, type II response was sometimes inaccurate, and urodynamic evaluation showed absence of obstruction and led to conservative management. Type IIIb response should be considered equivocal rather than partially obstructive, and pressure flow studies could be considered in such patients.
Asunto(s)
Renografía por Radioisótopo , Enfermedades Urológicas/diagnóstico por imagen , Adolescente , Adulto , Niño , Preescolar , Diuresis , Diuréticos , Femenino , Furosemida , Humanos , Lactante , Recién Nacido , Masculino , Presión , Radiofármacos , Pentetato de Tecnecio Tc 99mRESUMEN
Hyaluronectin (HN), a glycoprotein which shows a strong specific affinity for Hyaluronic Acid (HA), a very high molecular weight glycosaminoglycan expressed in the stroma reaction of all tumours, was used to radiolocalize grafted autologous carcinomas (CB33 and CB03) in mice. After conjugation to DTPA (0.5-3.7 DTPA/HN) and radiolabelling with 111In (5 microCi/micrograms HN) HN retained 93% of its affinity for HA. Different preparations of HN purified from lamb brain were assayed. The best results were obtained when the HN molecules reactive with HA were selected by gel permeation to discard unreactive molecules which were unable to complex with HA. At 48 hours the tumour to blood ratio was 7.7 with a localization index of 2.2 in CB33; there was 2.8% uptake of the injected dose (ID) into CB33 and 1.6% into CB03. 111In-HN uptake per gram of tumour was tumour-size dependent: the smaller masses had the higher uptake. Tumours were visualized and either early images of 111In-HN distribution or simultaneous distribution images of 99mTc-phytate or 201Tl-DTPA were used for the subtraction treatments.
Asunto(s)
Proteínas Portadoras , Radioisótopos de Indio , Neoplasias Experimentales/diagnóstico por imagen , Animales , Proteínas Portadoras/farmacocinética , Receptores de Hialuranos , Ácido Hialurónico , Ratones , Ratones Endogámicos DBA , Trasplante de Neoplasias , Cintigrafía , Receptores de Superficie Celular , Distribución TisularRESUMEN
Technetium-labeled heparin kinetics studies were undertaken in 12 hemodialyzed patients, where heparin was used over a long term (1 to 10 years) for anticoagulation of the extracorporeal circuit. The 99mTc-heparin (99mTc VECTOSCINT, Solabco Nuclear, Coutras, France) used has a 10 mCi activity and a labeling efficiency of more than 95%. Two healthy subjects served as control. After an i.v. bolus of 2 ml 99mTc-heparin, corresponding to 170 +/- 10 IU, radioactivity of kidney, liver, knee and shoulder was recorded with a gamma camera at t1-h, t3-h and t6-h during 120, 152 and 215 s, respectively. Radioactivity recorded was computerized, giving quantitative data for comparison. In hemodialyzed patients, accumulation of radioactivity (mean +/- SEM 10(6) x activity count) was significantly higher at the knee (11.3 +/- 1.1 vs. 4.9 +/- 0.4; p < 0.05; 13.4 +/- 1.1 vs. 5.7 +/- 0.7; < 0.02; and 14.7 +/- 0.8 vs. 5.3 +/- 0.6; < 0.001), and on the shoulder (17.3 +/- 1.1 vs. 10.7 +/- 1.4; p < 0.05; 19.9 +/- 1.0 vs. 10.9 +/- 1.7; < 0.01; 20.8 +/- 1.1 vs. 10.1 +/- 0.9; < 0.01) at t1-h, t3-h and t6-h, respectively, than in control subjects at the same areas. Although direct evidence is not in hand, accumulation of heparin in bone tissue due to renal excretion failure could play a role in mineral metabolism resulting in osteopenia in hemodialyzed patients.