[Evaluation of a method to reduce the number of sentinel nodes removed in melanoma patients: prospective study]. / Vers une meilleure sélectivité dans la technique de prélèvement du ganglion sentinelle: étude prospective.

INTRODUCTION: Since 1992, sentinel node (SLN) biopsy was generally applied to melanoma for carcinologic staging. Literature points out an increase of nodes removed for each procedure. It means to a high cost for this procedure and it wanders from the defining concept of SLN. The aim of our study was to evaluate whether, we can minimize number of SLN removed, without influencing the reliability of carcinologic staging. MATERIAL AND METHODS: We conducted a prospective study about 50 patients with stage one melanoma. For each patient, the SLN was identified with hand-held gamma probe technique. We removed only the hottest and all nodes greater than 70% of the hottest. We analysed the characteristics of melanoma, the success rate of this procedure, how many nodes have been removed and how many have had micro-metastases. This result was compared to two main studies with chi(2) test. RESULTS: The success rate of this technique was 100%. We dissected 1,3 SLN for each patient, with 22% positive SLN. Statistical analyse pointed out a better selectivity of our study, rate of pathological positivity and recurrence was alike. DISCUSSION: Our technique decreasing number of removed SLN is reliable. A minimal number of nodes doesn't distort sensitivity of carcinologic staging, and reduce cost of the procedure.

Impairment of diastolic function during short-term anthracycline chemotherapy.

OBJECTIVE: To assess the early changes in left ventricular diastolic and systolic function due to anthracycline treatment. DESIGN: A prospective study of cardiac function by radionuclide angiography in adults before and one month after the end of anthracycline treatment. PATIENTS: 60 patients without cardiac disease treated with chemotherapy containing anthracycline. METHODS: Cardiac function was assessed by radionuclide measurement throughout treatment. Ejection fraction, peak ejection rate, time to peak ejection rate, filling rate, and time to peak filling rate were measured before and after treatment. To normalise radionuclide measurements of the left ventricular diastolic function the ratio of the filling rate to the ejection fraction and the ratio of the filling rate to the peak ejection rate were calculated. RESULTS: No patient developed symptomatic congestive cardiac failure. The ejection fraction decreased from 58% (5%) to 55% (6%) (P < 0.001), the peak ejection rate fell from 2.99 (0.41) to 2.77 (0.41) of the end diastolic volume per second (P < 0.001), and the peak filling rate from 2.71 (0.47) to 2.55 (0.44) of the end diastolic volume per second (P < 0.01) after treatment. No difference was observed in the normalised ratios. CONCLUSIONS: This report shows simultaneous impairment of left ventricular systolic and diastolic radionuclide parameters. The absence of variation in normalised measurements suggests similar changes in ejection fraction, peak ejection rate, and peak filling rate throughout treatment.

Exploración radisotopica de la función ventricular basal izquierda del tránsito esofágico, de la vía urinaria superior y de la función vesical en pacientes chagásicos cronicos predominantemente asintomáticos / Radioisotopic exploration of basal left ventricular function of the esophageal transit, of upper urinary duct and of bladder function of patients with chronic Chagas' disease predominantly en assymptomatic

Estudou-se em 56 pacientes chagásicos crônicos (45 assintomáticos e os restantes portadores de transtornos cardiovasculares e digestivos) a funçäo ventrícular esquerda (ejeçäo basal, motilidade parietal segmentar e o histograma); em 29 deles, o trânsito esofagiano e em outros 25 enfermos explorou-se a via urinária, respectivamente com o 99m - TC coloidal e o 99ml - TC b + PA. Observou-se que a fraçäo de ejeçäo do ventrículo esquerdo entre os indivíduos normais era de 0,66 + ou - 0,07, enquanto nos chagásicos crônicos com alteraçöes cardiovasculares (Grupo II) verificou-se 0,49 + ou - 0,21. A motilidade parietal esteve alterada em 60% do mesmo grupo de enfermos e o desvio standard do histograma foi de 1,98 + ou - 0,45, para 1,29 + ou - 0,17 no grupo de voluntários. O trânsito esofágico foi considerado normal em 9 casos e alterado em 20, sendo que em 6 foi do tipo prolongado, em 4 adinâmico e em 10 incoordenado. Nos 25 pacientes nos quais investigaram a via urinária superior, foi encontrada alteraçäo em 22 (dilataçäo piélica uni ou bilateral) e a funçäo vesical nestes pacientes foi normal em apenas quatro casos. Concluem os pesquisadores que o 99 - TC representa um grande avanço tecnológico no estudo da funçäo cardíaca, esofágica e das vias urinárias em pacientes chagásicos crônicos e assintomáticos