Decrease in Pulse Oximeter Readings Following Injection of Isosulfan Blue Dye / 한국유방암학회지

PURPOSE: A sentinel lymph node mapping with blue dye has been well accepted as a common procedure in breast cancer surgery. However, it is well known that blue dye absorbed into the circulation may interfere pulse oximetery reading. The aim of this study was to evaluate the change of pulse oximetery reading by isosulfan blue dye injection during sentinel lymph node mapping. METHODS: Thirteen breast cancer patients with normal preoperative cardiopulmonary functions were studied. Four ml of isosulfan blue dye was injected subdermally when the patient became stable after induction of general anesthesia. The pulse oximetery was monitored continuously. Multiple arterial blood gas analyses (ABGA) were performed before dye injection and 10, 30, 40 minutes after dye injection. The results of oxygen saturturation by oximetery (SpO2) and the results of arterial oxygen tension (SaO2) and arterial oxygen saturation (SaO2) by ABGA were compared. RESULTS: The value of both SaO2 and PaO2 measured by ABGA has not been altered by isosulfan dye injection. However SpO2 decreased by isosulfan dye injection. SpO2 decrease started 8.2+/-1.5 (2~0) minutes after dye injection and returned to preinjection level by 85.7+/-5.6 (60~126) minutes after injection. The lowest vaule of SpO2 was 95.6+/-1.2% (93~97). Mean duration of SpO2 decrease was 77.5+/-6.2 (40~117) minutes. The duration of SpO2 decrease was longer in the aged patients, but it was not statistically significant (p=0.3). There was no siginificant difference in duration of SpO2 decrease according to injection site, operation method, and body mass index (BMI). CONCLUSION: .Isosulfan dye injection using for sentinel lymph node mapping causes no change in true ABGA results but causes a mild reversible decrease in SpO2, It is important to look for other causes when SpO2 decrease is significant and persistent.

C-erbB-2 Expression Predicts Tamoxifen Efficacy in Breast Cancer Patients

PURPOSE: It has been reported that c-erbB-2 overexpression is associated with a resistance to tamoxifen therapy in many trials, but this is controversial. The aim of this study was to evaluate the c-erbB-2 status, and the response to tamoxifen, in breast cancer patients. METHODS: We enrolled 294 patients who had been treated with tamoxifen, 261 (88.8%) were ER and 33 PR positive respectively. The expressions of c-erbB-2 were analyzed using immunohistochemical methods. The median follow up was 36 months. We medical records retrospectively reviewed, and the recurrence rate analyzed and compared with other prognostic factors and survival rates, according to the c-erbB-2 status. RESULTS: The mean age of the patients was 45.23+/-10.47 (20~83). The incidence of invasive ductal carcinomas, invasive lobular carcinomas and DCIS were 91.2, 4.8 and 4.1%, respectively. The recurrence rate was 10.9% (32/294), and 22 of 225 (9.8%) in ER/PR (+/+), 7 of 36 (19.4%) in ER/PR (+/-) and 3 of 33 (9.1%) in ER/PR (-/+). The recurrence rates, according to the TNM stages 0, I, IIa, IIb, III were 0, 5.4, 6.5, 15.2 and 36.7%, respectively (P=0.000). The recurrence rates, according to the c-erbB-2 stati, were 16.5 and 8.4% in the positive and negative groups, respecively (P=0.039). The nuclear grade was higher in the c-erbB-2 positive group than in the negative group, but there was no relationship between the c-erbB-2 status and the other prognostic factors, such as axillary lymph node status, TNM stage or histological grade. The overall and disease free survivals were significantly shorter in the c-erbB-2 positive than the negative group (P<0.05). CONCLUSION: The patients with tumors positive for c-erbB-2 had shorter overall and disease free survivals, compared to patients with tumors negative for c-erbB-2, when treated with tamoxifen. Overexpression of c-erbB-2 may reduce the efficacy of tamoxifen therapy, although our number of patients was small and the follow up relatively short.

Patency Rates of Femoro-Femoral Bypass Graft

PURPOSE AND METHOD: To access the value and results of femoro-femoral bypass for the treatment of unilateral iliac artery occlusion, the clinical data of 53 patients who underwent femoro-femoral bypass graft at Yeungnam University Hospital between January 1994 to December 2000 were analyzed retrospectively. The influence of several variables (such as, age, sex, preoperative symptom, risk factors and associated medical illness, status of distal artery, preoperative ABI) on the long term patency was evaluated by univariate statistical analysis. RESULT: The patients were 47 males and 6 females ranging from 37 to 84 years of age. The mean age was 65, with the highest incidence among people in their 60s, followed by those in their 70s and then in their 50s. Associated diseases were hypertension in 28 cases (52.8%), diabetes mellitus in 10 cases (18.8%), cardiac disease in 19 cases (32.0%) and cerebrovascular disease in 4 cases (7.5%). History of smoking was noted in 77.4% of the cases. Focal stenosis of donor site iliac artery has been found in 2 cases and combined distal outflow occlusion has been found in 21 cases. 2 donor site iliac artery ballon angioplasty was performed preoperatively and 14 adjuvant procedures (9 femoro-popliteal bypass, 2 femoro-tibial bypass, 3 profundoplasty) was performed simultaneously during the operation. Cumulative 1, 3, 5,-year primary and secondary patency rates of all femoro-femoral bypass were 87.0%, 76.6%, 68.1% and 91.7%, 85.7%, 73.5%. There was no operative mortality and major perioperative complications. Univariate analysis showed that the patients without distal arterial occlusion had significantly better 1-, 3- and 5-year primary patency rates (93.0%, 89.0% and 74.2% versus 76.6%, 45.9% and 45.9%, P=0.02) compared with the patients with distal arterial occlusion. No significant effect was exerted by all other variables on long term results. CONCLUSION: These results suggest that femoro-femoral bypass is a safe and durable operation that results in good patency in a good runoff.