Diagnostic yield of sentinel lymph node biopsy in oral squamous cell carcinoma T1/T2-N0: systematic review and meta-analysis.

The objective of this study was to conduct a systematic review and meta-analysis on the efficacy of sentinel lymph node biopsy (SLNB) in T1/T2-N0 oral squamous cell carcinoma (OSCC). A systematic review of the literature on SLNB until March 2019 was conducted. The review was organized according to the PRISMA protocol, considering the following PICO (population, intervention, comparison, outcome) question: What is the sensitivity of sentinel lymph node biopsy in OSCC? 'P' was patients with head and neck squamous cell carcinoma T1/2-N0; 'I' was SLNB; 'C' was neck treated with elective neck dissection and haematoxylin-eosin histopathology; 'O' was sensitivity and specificity. A meta-analysis and meta-regression were performed on the selected studies. The sensitivity of SLNB was up to 88% (95% confidence interval (CI) 72-96%) and specificity was up to 99% (95% CI 96-100%). The area under the summary receiver operating characteristic curve was 0.99 (95% CI 0.98-1.00). In the four studies where immunohistochemistry was performed, both the sensitivity and specificity were higher than in the studies without immunohistochemistry: 93% (95% CI 88-97%) and 98% (95% CI 96-100%), respectively. In conclusion, SLNB is an effective technique for treating patients with some types of stage T1/2-N0 OSCC. Some parameters such as immunohistochemistry could determine the level of diagnostic accuracy.

A technique to control the deleterious effects of retrograde blood flow and to improve myocardial protection in surgery of acute dissection of the ascending aorta.

In surgery of the acute dissection of the ascending aorta, a technique is described for routine cannulation through a Dacron graft in order to produce antegrade flow in the true aortic lumen and higher pressures than in the false lumen. This is a useful method to avoid the deleterious effects of the retrograde blood flow through the false lumen, when femoral cannulation is used, as well as to improve the myocardial protection by reperfusing the myocardium while the graft distal end anastomosis is carried out.

Expanded use of the right and left internal mammary arteries for myocardial revascularization.

While the use of the left internal mammary artery (IMA) has become routine in many cardiac surgery units there is some reluctance to utilize the right IMA. The reasons for this are the higher morbidity and mortality observed in the initial experience with bilateral IMA grafting, the limited length of the right IMA, and its potential injury in reoperations when used to revascularize the left anterior descending artery. In this series of 50 patients the right IMA was used as a conduit for myocardial revascularization. One hundred and fifty-nine coronary vessels were grafted (3.2 per patient) 67.3% with IMA and only 32.7% with vein grafts. The right IMA was used for 51 anastomoses and the left for 56, either as simple, sequential or Y type grafts. The refinement of techniques for constructing the IMA grafts used in this series show that the right IMA can reach in most of the cases the anastomotic sites of the right coronary artery beyond the acute margin of the heart, and it is hoped that the lateral positioning of the IMA pedicles will lessen the chance of graft injury at reoperation. On the basis of early clinical results (2% mortality and 4% sternal complications), the application of the right IMA seems justified electively for the revascularization of both left and right coronary artery systems or as a free graft in conjunction with the left IMA.

Carpentier's flexible ring versus De Vega's annuloplasty. A prospective randomized study.

To compare the efficacy of Carpentier's tricuspid annuloplasty with De Vega's, we prospectively randomized 159 patients, operated upon between January, 1977, and January, 1980, to one of the two techniques: 76 patients were assigned to the Carpentier group and 83 to the De Vega group. The criterion for inclusion in the study was the presence of moderate to severe tricuspid regurgitation. There were no significant differences in mean age, male proportion, type of mitral lesion, incidence of aortic valvulopathy, and other preoperative and perioperative characteristics between the two groups. However, organic tricuspid damage on macroscopic intraoperative examination was more common in the Carpentier group. At the end of follow-up (average 64 months) in patients with satisfactory left heart hemodynamics, there was a significant difference in the incidence of moderate or severe tricuspid insufficiency between the two groups (De Vega, 14/41; Carpentier, 4/40; p less than 0.01). In 76 patients (40 with Carpentier's annuloplasty and 36 with De Vega's technique), contrast right ventriculography was performed postoperatively and the degree of tricuspid regurgitation assessed semiquantitatively. In both groups, control of tricuspid regurgitation was poor in patients with either high total pulmonary resistances or organic tricuspid damage. If patients with these characteristics are excluded, then significant tricuspid regurgitation was encountered in only one patient in the Carpentier group but in nine of 19 in the De Vega group (p less than 0.01). In conclusion, in the treatment of tricuspid regurgitation, better results are obtained with Carpentier's than with De Vega's annuloplasty, especially if there is no organic tricuspid damage and pulmonary resistances decrease postoperatively.

Enanismo parastrematico. / Parastremmantic dwarfism

Se describe un caso de enanismo parastrematico, displasia osea, caracterizada por enanismo acentuado, cifoscoliosis, distorsion y abombamiento de las extremidades y contracturas de las grandes articulaciones. Radiologicamente se caracteriza por disminucion de la densidad osea, abombamiento de los extremos proximales y distales de los huesos largos; platispondilia y osificacion irregular endocondral, dando un aspecto peculiar aborregado. Las epifisis son radiolucentes y fragmentadas

[Dwarfism due to familial panhypopituitarism]. / Enanismo por panhipopituitarismo familiar.

Three sisters of 27 7/12, 13 8/12 and 9 1/12 years of age, respectively, with proportionate dwarfism, high pitched voice and lack of sexual development are described. All the patients had very low serum levels of immunoreactive growth hormone (GH), as well as of LH and FSH. Hypoglycemia induced by insulin and arginine infusion failed to increase GH levels, and the administration of the hypothalamic LH-FSH releasing hormone (LH-RH) did not elicit any response in the secretion of gonadotropins. The oldest sister developed hypothyroidism in recent years, since the I131 thyroid uptake was normal ten years before; her serum TSH was low and did not change with TRH stimulation. In addition, a low pituitary ACTH reserve was demonstrated by the hypoglycemia and metirapone tests. Case 2 showed partial pituitary TSH and ACTH reserve, whereas the youngest child only had low TSH pituitary reserve. These patients had all the clinical and laboratory characteristics of familial panhypopituitarism, with normal sella turcica. Genetic transmission in this cases is consistent with the autosomal recessive form, which is the most frequent type of inheritance of this entity. Consanguinity can not be ruled out. The results of the hypothalamic-pituitary functional tests apparently suggest that the primary defect could be located at the pituitary level. It is also possible that the pathological process may have a progressive evolution.