Utilização da cromoendoscopia com azul de toluidina mais solução de Lugol para diagnóstico precoce de lesões pré-malignas esofágicas e neoplasias superficiais em pacientes de alto risco / Chromoendoscopy using toluidine blue plus lugol's solution for early diagnosis of esophageal premalignant lesions and superficial neoplasms in high-risk patients

ABSTRACT BACKGROUND: Esophageal cancer is the eighth most common cancer. The prognosis is bleak in patients with advanced stages. Patients with early disease have a better prognosis than those with advanced stage. There are several techniques for the screening of premalignant and superficial lesions including chromoendoscopy. OBJECTIVE: This article aimed to determine the effectiveness of chromoendoscopy with toluidine blue combined with Lugol's solution for diagnosis of esophageal premalignant and superficial neoplastic lesions in high risk patients. METHODS: Routine white light upper endoscopy was performed. Toluidine blue was sprayed from the gastroesophageal junction to 20 cm of the dental arch. Then the uptake dye areas were characterized. Later Lugol's solution was sprayed. Areas with less-intense staining were characterized. Biopsy of the toluidine blue capturing areas and areas with less-intense staining of Lugol's solution were taken. In the cases where lesions were not evidenced after application of dyes, biopsies four quadrants of the esophageal mucosa were taken. The samples were evaluated by a digestive pathologist. RESULTS: Barrett's esophagus was the most common premalignant lesion and the early neoplastic lesion was adenocarcinoma with a sensitivity of 100%, specificity 85.7%, positive predictive value 30%, negative predictive value 100%, positive likelihood ratio 7 negative likelihood ratio 0. CONCLUSION: Chromoendoscopy with toluidine blue combined with Lugol's solution is a useful tool in the screening of esophageal premalignant lesions and superficial neoplasms.

RESUMO CONTEXTO: O câncer de esôfago é o oitavo câncer mais comum. O prognóstico é sombrio em pacientes com estágios avançados. Pacientes com doença precoce têm um melhor prognóstico do que aqueles com estágio avançado. Existem várias técnicas para a triagem de lesões pré-malignas e superficiais, incluindo cromoendoscopia. OBJETIVO: Este artigo objetivou determinar a efetividade da cromoendoscopia com azul de toluidina combinada com a solução de Lugol para o diagnóstico de lesões neoplásicas pré-malignas e superficiais esofágicas em pacientes de alto risco. MÉTODOS - A endoscopia de luz branca de rotina foi realizada de forma rotineira. O azul do toluidina foi pulverizado desde a junção gastroesofágica até 20 cm da arcada dentária. As áreas impregnadas pela tintura da tomada foram então caracterizadas. Mais adiante a solução de Lugol foi pulverizada. Áreas com coloração menos intensa foram caracterizadas. Foram realizadas biópsias das áreas de captura de azul de toluidina e áreas com coloração menos intensa da solução de Lugol. Nos casos onde as lesões não foram evidenciadas após a aplicação das tinturas, foram feitas biópsias em quatro quadrantes da mucosa esofágica. As amostras foram avaliadas por um patologista especializado. RESULTADOS: O esôfago de Barrett foi a lesão pré-maligna mais frequente e a lesão neoplásica precoce foi adenocarcinoma com sensibilidade de 100%, especificidade de 85,7%, valor preditivo positivo de 30%, valor preditivo negativo 100%, razão de verossimilhança positiva 7 e razão de verossimilhança negativa 0. CONCLUSÃO: A cromoendoscopia com azul de toluidina combinada com a solução de Lugol é uma ferramenta útil na triagem de lesões pré-malignas esofágicas e neoplasias superficiais.

Which is best method for instillation of topical therapy to the upper urinary tract? An in vivo porcine study to evaluate three delivery methods

ABSTRACT Purpose: To compare the staining intensity of the upper urinary tract (UUT) urothelium among three UUT delivery methods in an in vivo porcine model. Materials and methods: A fluorescent dye solution (indigo carmine) was delivered to the UUT via three different methods: antegrade perfusion, vesico-ureteral reflux via in-dwelling ureteric stent and retrograde perfusion via a 5F open-ended ureteral catheter. Twelve renal units were tested with 4 in each method. After a 2-hour delivery time, the renal-ureter units were harvested en bloc. Time from harvesting to analysis was also standardised to be 2 hours in each arm. Three urothelium samples of the same weight and size were taken from each of the 6 pre-defined points (upper pole, mid pole, lower pole, renal pelvis, mid ureter and distal ureter) and the amount of fluorescence was measured with a spectrometer. Results: The mean fluorescence detected at all 6 predefined points of the UUT urothelium was the highest for the retrograde method. This was statistically significant with p-value less than <0.05 at all 6 points. Conclusions: Retrograde infusion of UUT by an open ended ureteral catheter resulted in highest mean fluorescence detected at all 6 pre-defined points of the UUT urothelium compared to antegrade infusion and vesico-ureteral reflux via indwelling ureteric stents indicating retrograde method ideal for topical therapy throughout the UUT urothelium. More clinical studies are needed to demonstrate if retrograde method could lead to better clinical outcomes compared to the other two methods.

Effects of intracameral brilliant blue on the corneal endothelium of swine: in vitro study / Avaliação do endotélio corneano suíno por microscopia eletrônica de varredura após aplicação de azul brilhante a 0, 05% na câmara anterior: estudo in vitro

The aim was to investigate the ultrastructural changes in the corneal endothelium of pigs induced by intracameral 0.05% brilliant blue. Twenty swine corneas were separated into two groups, the right eye bulbs (control group) and the left eye bulbs (experimental group) of the same animal. All the eye bulbs were evaluated with specular microscopy. The cornea of the right eye bulbs was excised and in the left eye bulbs 0.2ml of 0.05% brilliant blue vital dye (OPTH-blue±) was injected into the anterior chamber, where it remained for one minute. Then the anterior chamber was cleaned with a balanced salt solution injection and the cornea was excised too. All the corneas were evaluated by scanning electron microscopy to evaluate the changes on the endothelium caused by the brilliant blue dye. There were no significant differences between the right corneal endothelium cells and the left corneal endothelium cells with scanning electron microscopy after intracameral use of 0.05% brilliant blue dye. The 0.05% brilliant blue dye concentration did not cause deleterious effects for the swine corneal endothelium after intracameral use and can be a choice for safe staining of the anterior capsule of the lens in cataract surgery.(AU)

Com o objetivo de avaliar as alterações ultraestruturais no endotélio corneano suíno induzidas pela aplicação intracameral do corante azul brilhante 0,05%, vinte córneas suínas foram separadas em dois grupos: olhos direitos (grupo controle) e olhos esquerdos (grupo experimental). Inicialmente todos os bulbos oculares foram avaliados por microscopia especular. As córneas dos bulbos oculares do grupo controle foram excisadas, enquanto nos bulbos oculares do grupo experimental foram injetados 0,2ml do corante vital azul brilhante 0,05% na câmara anterior e mantido por um minuto. Após esse período a câmara anterior foi lavada com solução salina balanceada e as córneas foram excisadas. Todas as córneas excisadas foram avaliadas por microscopia eletrônica de varredura para verificar a ocorrência possíveis alterações no endotélio corneano causadas pelo corante. Não foram observadas diferenças ultraestruturais durante a avaliação endotelial por microscopia eletrônica de varredura das córneas do grupo controle e experimental após a aplicação do azul brilhante 0,05% na câmara anterior. O corante azul brilhante na concentração 0,05% não causou danos endoteliais após seu uso intracameral em suínos e pode ser uma alternativa segura para a coloração da cápsula anterior da lente na cirurgia de catarata.(AU)

Methylene blue-related corneal edema and iris discoloration / Edema de córnea e descoloração de íris associados ao azul de metileno

ABSTRACT We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes.

RESUMO Paciente do sexo feminino com 70 anos de idade desenvolveu edema da córnea e descoloração da íris após o uso inadvertido de 1% de azul de metileno em vez de 0,025% de azul tripano para corar a cápsula anterior do cristalino durante a cirurgia de catarata por facoemulsificação. Foi realizada irrigação abundante quando detectou-se que o corante incorreto tinha sido usado. Edema da córnea e descoloração íris que ocorreu no período pós-operatório precoce persistiu durante 24 meses de seguimento; no entanto, a ceratoplastia não foi necessária. O uso intracameral de 1% de azul de metileno tem efeitos citotóxicos sobre o endotélio da córnea e epitélio da íris. A irrigação abundante durante pelo menos 30 minutos, utilizando um mantenedor de câmara anterior pode resultar em um prognóstico melhor.

Sentinel node biopsy using blue dye and technetium99 in advanced gastric cancer: anatomical drainage and clinical application

Lymph node metastases are an independent prognosis factor in gastric carcinoma (GC) patients. Radical lymphadenectomy can improve survival but it can also increase surgical morbidity. As a principle, sentinel node (SN) navigation surgery can avoid unnecessary lymphadenectomy without compromising prognosis. In this pilot study, 24 patients with untreated GC were initially screened for SN navigation surgery, of which 12 were eligible. Five patients had T2 tumors, 5 had T3 tumors and 2 had T1 tumors. In 33% of cases, tumor diameter was greater than 5.0 cm. Three hundred and eighty-seven lymph nodes were excised with a median of 32.3 per patient. The SN navigation surgery was feasible in all patients, with a median of 4.5 SNs per patient. The detection success rate was 100%. All the SNs were located in N1 and N2 nodal level. In 70.9% of cases, the SNs were located at lymphatic chains 6 and 7. The SN sensitivity for nodal staging was 91.6%, with 8.3% of false negative. In 4 patients who were initially staged as N0, the SNs were submitted to multisection analyses and immunohistochemistry, confirming the N0 stage, without micrometastases. In one case initially staged as negative for nodal metastases based on SN analyses, metastases in lymph nodes other than SN were found, resulting in a 20% skip metastases incidence. This surgery is a reproducible procedure with 100% detection rate of SN. Tumor size, GC location and obesity were factors that imposed some limitations regarding SN identification. Results from nodal multisection histology and immunohistochemistry analysis did not change initial nodal staging.

Intraureteral and intravenous indocyanine green to facilitate robotic partial nephroureterectomy in a patient with complete ureteral triplication

A patient with a complete right ureteral triplication presented with recurrent pyelonephritis and flank pain that was refractory to medical management. Evaluation showed that the atrophic upper-most renal moiety had been chronically obstructed and was associated with a dilated ureter. Intraureteral and intravenous indocyanine green (ICG) were used as real-time contrast agents intraoperatively to facilitate right robotic partial nephroureterectomy of the diseased system. Intraureteral ICG was used to accurately distinguish the pathologic ureter and associated renal pelvis from its normal counterparts. Intravenous ICG was used to assess perfusion in the right kidney and delineate the margins of diseased renal parenchyma.

Reacción a un tatuaje de henna negra tratado con furoato de mometasona y gel de silicona: Caso clínico / Reaction to a black henna tattoo treated with mometasone furoate and silicone gel: case report

Black henna tattoos have paraphenylenediamine (PPD), which contains a product of herbal origin, which due to its molecular characteristics is capable of inducing, in susceptible individuals, a type IV hypersensitivity reaction. It clinically manifests as a contact dermatitis that usually when it disappears, scarring and hypopigmentation are left in the injured area. Objective: To describe the case of a patient with hypersensitivity to henna tattoo and to present the most relevant phenomena associated with this condition. Case report: The case of a 6 year-old patient with a black henna tattoo on his right leg, who was diagnosed with contact dermatitis probably attributed to PPD, is presented. Mometasone furoate and topical silicone gel treatment was started with good response. Conclusion: Mometasone furoate and silicone gel are a good possible therapeutic option for treating contact dermatitis caused by PPD as the dermatosis was resolved without residual lesions.

Los tatuajes de henna negra son aquellos que contienen parafenilendiamina (PPD), que contienen un producto de origen herbal, que por sus características moleculares es capaz de inducir, en individuos susceptibles, una reacción de hipersensibilidad tipo IV. Se manifiesta clínicamente como una dermatitis de contacto, que generalmente al desaparecer, persiste de manera residual una cicatriz hipertrófica e hipopigmentación en la zona lesionada. Objetivo: Describir el caso de un paciente con hipersensibilidad al tatuaje de henna, y presentar los fenómenos más relevantes asociados a esta patología. Caso clínico: Paciente de 6 años de edad, que se realizó un tatuaje con henna negra en la pierna derecha, en quien se diagnosticó posteriormente una dermatitis de contacto atribuida probablemente a la PPD. Se comenzó tratamiento con furoato de mometasona y gel de silicona con buena respuesta por vía tópica. Conclusión: El furoato de mometasona y gel de silicona son una posible opción terapéutica de utilidad para tratar la dermatitis de contacto causada por el PPD, debido a que la dermatosis se resolvió sin lesiones residuales.

State of the art in chromovitrectomy / Estado da arte da cromovitrectomia

Vitrectomy is a surgery that involves complex and delicate techniques that treat diseases such as macular hole, epiretinal membrane and diabetic macular edema. Chromovitrectomy is one of these techniques and includes the use of coloring agents such as vital dyes or crystals to enhanced visibility of transparent structures during vitrectomy. The aim of this study was to present a modern approach, based on scientific evidence, about the application and indication of vital coloring agents during vitrectomy. The use of such agents has made this surgery more predictable and has increased its post-operative prognosis. Although research on chromovitrectomy is currently expanding there is still not an established gold standard dyeing agent.

A cirurgia vitreorretiniana é uma cirurgia que envolve técnicas complexas e delicadas que tratam doenças como buraco macular, membrana epirretiniana e o edema macular diabético. A cromovitrectomia é uma dessas técnicas que incluem o uso de corantes compostos de pigmentos vitais ou cristais para melhorar a visibilização de estruturas transparentes durante a cirurgia de vitrectomia. O objetivo desse artigo foi apresentar uma abordagem atual, baseada em evidências, sobre a aplicação e indicação de corantes vitais durante a cirurgia vitreorretiniana. O emprego desses corantes possibilitou uma maior previsibilidade para a cirurgia, melhorando assim seu prognóstico pós-operatório. Apesar do campo da cromovitrectomia está em plena expansão de pesquisas, um corante gold standard para cromovitrectomia ainda não está estabelecido.

A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

PURPOSE: To determine the minimum volume of methylene blue (MB) to completely color the brachial plexus (BP) nerves, simulating an effective anesthetic block in cats. METHODS: Fifteen adult male cat cadavers were injected through subscapular approach with volumes of 2, 3, 4, 5 and 6 ml in both forelimbs, for a total of 30 brachial plexus blocks (BPB). After infusions, the specimens were carefully dissected preserving each nervous branch. The measurement of the effective area was indicated by the impregnation of MB. Nerves were divided into four segments from the origin at the spinal level until the insertion into the thoracic limb muscles. The blocks were considered effective only when all the nerves were strongly or totally colored. RESULTS: Volumes of 2, 3 and 4 ml were considered insufficient suggesting a failed block, however, volumes of 5 and 6 ml were associated with a successful block. CONCLUSIONS: The injection of methylene blue, in a volume of 6 ml, completely colored the brachial plexus. At volumes of 5 and 6 ml the brachial plexus blocks were considered a successful regional block, however, volumes of 2, 3 and 4 ml were considered a failed regional block. .

Osmotic induction marking with Alizarin Red S on juveniles of pejerrey, Odontesthes bonariensis (Atherinopsidae)

Juveniles of pejerrey, Odontesthes bonariensis, were exposed to 0.1% Alizarin Red S (ARS) alone or with a previous immersion in 2.2% saline solution (Osmotic Induction, OI) to enhance the ARS marking method. Fish were marked in the field and immediately released in 1 m3 cages in "La Salada de Monasterio" lagoon, Chascomús, Buenos Aires , Argentina. After 73 days, clear marks were observed in the otoliths, caudal fin rays and scales with both treatments, being the intensity of the signal in the scales of OI+ARS treated fish higher. On the other hand, no marks were observed in the control group on the same structures. Approximately one year post-treatment (385 days), only marks in caudal fin rays were found clearly in OI+ARS treated fish. After this period, no significant differences in total length or weight between marked or control fish were observed and the mortality ranged between 30-40 % in all cages. These results provide strong evidence for the potential applicability of this cost-effective marking technique in differentiation of wild and hatchery-produced pejerrey. The success in the caudal fin rays marking is also important because it is easy to do and does not require the sacrifice of fish.

Juvenis de pejerrey, Odontesthes bonariensis, foram expostos a Vermelho de Alizarina S (ARS) 0,1% de duas formas, sozinho ou com uma imersão anterior em 2,2% de solução salina (Indução osmótica, IO) para melhorar o método de marcação ARS. Os procedimentos foram realizados no campo e os peixes foram liberados em gaiolas (tanques-rede) de 1 m3 na lagoa "La Salada de Monasterio", Chascomús, Buenos Aires, Argentina. Após 73 dias, marcas claras foram observadas nos otólitos, raios da nadadeira caudal e escamas em ambos os tratamentos, sendo que a intensidade do sinal nas escalas de IO + ARS de peixe tratado foi superior. Por outro lado, não foram observados marcas no grupo controle sobre as mesmas estruturas. Aproximadamente um ano pós-tratamento (385 dias), apenas marcas nos raios da nadadeira caudal foram encontrados claramente nos peixes tratados com IO+ARS. Entre os peixes observados, após este período, não houve diferenças significativas no comprimento total ou peso entre o grupo controle e marcados, ademais, a mortalidade variou entre 30-40% em todas as gaiolas. Estes resultados fornecem fortes evidências e um grande potencial para aplicação desta técnica rentável de marcação que diferencia o pejerrey selvagem e o produzido em cativeiro. O sucesso na marcação dos raios da nadadeira caudal também é de grande importância, pois sua verificação é fácil e não requer o sacrifício de peixes.

Novel use of trypan blue in ocular surface staining: redefining implications for this vital dye / Nova aplicação do azul de tripano para superfície ocular: redefinindo corantes vitais

Different applications of trypan blue (TB) for intraocular surgery have been reported, with very high levels of safety and efficacy. We describe the use of TB as an alternative vital dye for staining the ocular surface to assess the integrity of superficial cell layers of the cornea and the surface environment. This facilitates the diagnosis of various ocular surface disorders, including screening for dry eye disease (DED) among refractive and cataract patients. TB staining properties are different from fluorescein and both are stable in a solution, so that a double staining technique is introduced.

Diferentes aplicações do azul de tripano (AT) foram descritas para cirurgia intraocular, com elevados patamares de eficácia e segurança. Neste relato, é descrito a aplicação do AT como corante vital para superfíce ocular, de modo a estudar a integridade das células da superfície corneana e conjuntival na superfície ocular. Tal abordagem permite um diagnóstico mais sensível de desordens da superfície ocular, destacando-se disfunção lacrimal ou síndrome do olho seco. O AT tem propriedades distintas da fluoresceína, com a qual se mantém estável em solução permitindo a técnica de coloração dupla que é introduzida.

Acute Generalized Exanthematous Pustulosis Due to Oral Use of Blue Dyes

Acute generalized exanthematous pustulosis is a rare severe pustular cutaneous adverse reaction characterized by a rapid clinical course with typical histological findings. It is accompanied by fever and acute eruption of non-follicular pustules overlying erythrodermic skin. The causative agents are most frequently antibacterial drugs. We present a patient with acute generalized exanthematous pustulosis caused by methylene blue and indigotin dyes.

A Case of Vogt-Koyanagi-Harada Disease in a Patient With Graves Disease

A case of Vogt-Koyanagi-Harada disease (VKH) that developed in a 36-year-old woman with Graves' disease was described. The patient was treated with Lugol's solution and presented with bilateral serous retinal detachment. She had also suffered from methimazole-induced hypersensitivity and steroid-induced myopathy. Fluorescein angiography showed multiple leakage points and a lumbar puncture revealed pleocytosis, which was compatible with VKH. High dose steroid pulse therapy was successful. Altered immune regulation associated with drug-induced hypersensitivity may contribute to the development of VKH in patients with Graves' disease.

Retinal pigment epithelial atrophy following indocyanine green dye-assisted surgery for serous macular detachment.

To report subretinal migration of indocyanine green dye (ICG) and subsequent retinal pigment epithelial (RPE) atrophy during macular surgery for serous macular detachment. A 65-year-old woman presented with residual epiretinal membrane and serous detachment of the macula following vitreoretinal surgery for epiretinal membrane. She underwent resurgery with ICG-assisted internal limiting membrane peeling and intraocular tamponade. Intraoperatively a large area of subretinal ICG was seen with subsequent RPE mottling and atrophy of the macula in the area involved during follow-up. This case demonstrates that subretinal migration of ICG is possible and can be toxic to RPE.

Resultado funcional e índice macular em portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna / Functional outcome and macular index in macular hole patients who underwent surgery with internal limiting membrane removal

OBJETIVOS: Avaliar o resultado funcional e o índice macular dos portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna. MÉTODOS: Quinze olhos de 15 pacientes com buraco macular estágios 2, 3 e 4 foram incluídos no estudo. Todos foram submetidos à cirurgia de buraco macular convencional com remoção da membrana limitante interna corada pelo azul de tripan. Melhor acuidade visual com correção e cortes transversais medidos por tomografia de coerência óptica (OCT) foram avaliados no pré- e pós-operatório. O índice macular (razão entre a altura e base do buraco macular) foi calculado e correlacionado com o diâmetro mínimo do buraco macular e o ganho de acuidade visual pós-operatória. RESULTADOS: Obteve-se fechamento do buraco macular em todos pacientes operados. Em 86,7 por cento, houve ganho de pelo menos três linhas de visão. O índice macular demonstrou correlação negativa significante com o diâmetro mínimo (r=0,811). Não foi observada correlação significante entre o índice macular e o ganho de acuidade visual pós-operatória (r=0,351). CONCLUSÃO: Os resultados funcionais na cirurgia do buraco macular com remoção da membrana limitante interna foram bons neste grupo de pacientes. O índice macular demonstrou ser compatível com a configuração espacial do buraco macular, porém não foi preditor de resultados visuais.

PURPOSE: To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS: Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT) were evaluated pre- and postoperatively. The macular hole index (ratio of hole height to base diameter of the hole) was calculated and correlated with minimum diameter of the macular hole and postoperative gain in visual acuity. RESULTS: Macular hole closure was observed in all operated patients. In 86.7 percent, there was a visual gain of at least three lines. Macular hole index was significantly negative correlated with the minimum diameter of the macular hole (r=0.811). There was no significant correlation between macular index and postoperative gain in visual acuity (r=0.351). CONCLUSION: Functional outcomes with internal limiting membrane removal were good in this group of patients. Macular index was compatible with spatial configuration of the macular hole, however visual outcomes were not predictable.

Caso clínico: un tratamiento alternativo a la parotiditis crónica / Clinical case: an alternative treatment for chronic parotitis

La parotiditis crónica conocida también como parotiditis juvenil recurrente, se define como la inflamación recurrente de la glándula parótida, asociada a la aparición de sialectasias o dilataciones no obstructivas de los conductos glandulares. Como tratamiento se emplea habitualmente la sialografía que tiene una tasa de éxito que va de 62 por ciento a 94 por ciento. Se presenta aquí un caso de un niño de 4 años de edad con parotiditis crónica, que persiste con episodios de parotiditis, pese a la realización de dos sialografías con un intervalo de 1 año entre ambas. Se decide inyectar violeta genciana, procedimiento que no tuvo complicaciones, después de la inyección remitió la enfermedad

Chronic parotitis, also known as juvenile recurrent parotits, is defined as the recurrent inflammation of the parotid gland, associated to the appearance of sialectasis or non-obstructive dilation of the glandular ducts. Sialography is regularly employed as a treatment, with success rates ranging between 62 and 94 percent. Here we present the case of a 4 year old child with chronic parotitis, that persisted with parotitis episodes despite having two sialographies performed, with one year interval between them. We decided to inject methyl violet, a procedure that was carried out without any complications; and the disease resolved shortly after the injection

Contribuição para detecção do linfonodo sentinela em câncer da mama - comparação dos métodos radioguiados e de corante vital / Contribution for the detection for the the sentinel lymph node in breast cancer - comparison of radioguided and vital dye methods

No sentido de comparar os métodos de corante vital e radioguiado para identificar linfonodo sentinela e determinar a eficácia do exame histológico intra-operatório ou de congelação do linfonodo sentinela em relação ao exame histológico definitivo, foi realizado estudo descritivo, prospectivo, tipo série de casos. Oitenta e seis pacientes com câncer da mama, atendidos no Serviço de Mastologia da Clínica Professor Antônio Simão dos Santos Figueira Filho, entre janeiro de 1999 e outubro de 2002, foram divididos em: Grupo 1 – Submetidos à técnica do azul patente; e Grupo II – ao método radioguiado. Os dois grupos não diferiram quanto à detecção do câncer da mama, à imagem mamográfica, ao estadiamento lesional e clínico e às características dos linfonodos sentinelas. Embora o método radioguiado tenha apresentado acurácia e exatidão maiores que do azul patente, não houve diferença estatisticamente significante. Comprovou-se que ambos os métodos são inócuos, de fácil execução, reprodutíveis e confiáveis na definição da abordagem do linfonodo sentinela da mama. Recomenda-se a identificação do linfonodo sentinela pelo método do azul patente nas regiões em que não se tenha medicina nuclear, realizada por mastologia comprovadamente capacitado em centro de referência, após ter cumprido a curva de aprendizado.

To compare vital dye method and radioguided for the identification of sentinel limph node, as well as to determine the efficacy of intra surgery histological examination of sentinel lymph node, compared to histological definitive examination, the authors performed a descriptive, prospective, serie of cases. Eighty six patients, at Mastology Service at Professor Antonio Simão dos Santos Figueira Filho Clinic, from January 1999 to October 2002, with mammary tumors, were divided into two groups: group I of patients submitted to blue dye technique for detecting sentinel lymph node and and group II, submitted to radioguided technique. The groups did not differ on technique for breast cancer diagnosis, mammography images characteristics, clinical and lesional stage and sentinel lymph nodes characteristics. Although radioguided technique presented accuracy as well as exactitude higher than patent blue technique, these differences had no statistical significance. The authors concluded that both methods are innocuous, easy to perform, reproducible and secure for the detection of mammary sentinel lymph node and suggested the utilization of patent blue technique for detecting sentinel lymph nodes in regions where nuclear medicine are not available, performed by a mastologist, trained and capable, after completing the learning curve.

Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: a case report.

Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards.

Sentinel node localization in breast cancer using intradermal dye injection: results, influencing factors and learning curve.

To evaluate the identification rate, false negative rate, concordance, negative predictive value of sentinel node localization in breast cancer using intradermal isosulfan blue injection whether this is accurate enough for surgical approach in breast cancer surgery and whether there is a significant learning curve for this technique. Factors affecting the outcomes of the procedure are also determined. From August 2002 to September 2003, 66 cases of stage 0-IIIB operable breast cancer patients underwent sentinel lymph node biopsy before standard breast cancer operation. Overall, identification rate was 80.3%, false negative rate was 10.6%, concordance was 86.8%, negative predictive value was 83.3%, sentinel node was the only node that was positive in 45.5%, and mean operative time was 55.1 minutes. Factors found to lower sentinel node identification rate are neoadjuvant chemotherapy and large tumor (T3-4) while previous excision was not found to affect the identification rate. There is significant learning curve in this technique and this should be performed at least 40-45 cases in the learning phase to accomplish a high identification rate and lower false negative rate before implicating into clinical practice.