Management of sentinel lymph nodes in lower extremity melanoma with dual-basin (inguinal and popliteal) drainage on lymphoscintigraphy

PURPOSE: To analyze clinical outcomes of sentinel lymph node (SLN) biopsy in lower extremity melanoma with dual-basin drainage on lymphoscintigraphy.METHODS: We retrospectively analyzed patients with lower extremity melanoma who underwent lymphoscintigraphy and SLN biopsy in a single center between 2006 and 2015. Gamma probe was used to detect SLNs. For dual-basin drainage, we regarded a basin that showed a two-fold greater radioactivity value than the others as a ‘dominant’ basin. SLN biopsy was performed only for the dominant basin. If two basins showed similar radioactivity, biopsy was conducted for both.RESULTS: One hundred and seven patients underwent preoperative lymphoscintigraphy, and 29 dual (popliteal, inguinal) drainages were found. Of the 29 melanomas with dual drainage, seven showed similar radioactivity on both basins, 22 showed inguinal as the dominant basin and no melanoma had a dominant popliteal basin. Among the seven patients who underwent dual-basin biopsy, six had negative results, all of which experienced no recurrence during follow-up. Among the 22 patients who underwent biopsy of the dominant inguinal basin, 19 had negative results. During the follow-up, these patients showed six recurrences, but none of them experienced popliteal recurrence. All three patients who had tumor-positive inguinal node experienced recurrence in the popliteal basin as well as at other sites.CONCLUSION: For melanomas showing dual-basin drainage on lymphoscintigraphy, performing SLN biopsy only on the dominant (inguinal) basin is reliable when the dominant basin shows negative results. However, considering the recurrence pattern of our data, a tumor-positive dominant basin should prompts an SLN biopsy of the other basin.

The Long-term Outcomes of Kidney Transplantation from Donation after Circulatory Death during Brain Death Donor Evaluation in a Single Center in Korea / 대한이식학회지

BACKGROUND: While the number of deceased donor donations has increased in Korea, the organ shortage remains a major limitation for kidney transplantation. Donation after circulatory death (DCD) can be an option to expand the donor pool. In this study we evaluated the short and long term survival of grafts and patients and assessed the risk factors for graft failure. METHODS: In a single center, from August 1997 to December 2013, 28 cases of recipients who received kidney transplantation from DCD were enrolled. Information about donor and recipient factors, graft conditions, and transplant outcomes was collected through review of medical records. We calculated overall graft and patient survival rates and the risk factors for graft failure according to donor criteria and whether or not delayed graft function (DGF) occurred. RESULTS: There was no primary non-function, but DGF developed in 67.9% (19/28). Graft losses occurred in five patients during a median follow-up period of 68.2 months (4~204). There was no significant difference in graft survival rates depending on the donor criteria and the occurrence of DGF. In addition, there were no noteworthy risk factors for graft failure among donor age, donor creatinine, extended criteria donor, recipient age, warm ischemic time, cold ischemic time, and DGF. CONCLUSIONS: In this study, despite the high incidence of DGF, the long-term graft and patient survival in kidney transplantation from DCD were acceptable. Therefore, DCD can be an alternative to expand the donor pool and to shorten the waiting time.