Sentinel node and radioguided surgery in breast cancer of limited size. Preliminary experience at ASL 1, Massa e Carrara.

The aim of this study was to evaluate the effectiveness of sentinel node (SN) biopsy in breast cancer. Twenty-five female patients classified as T1N0 according to the TNM system of the UICC were evaluated with this procedure from April to October 1999. The day before surgery a subdermal injection of 99mTc-nanocoll within the tissue overlying the neoplastic lesion and subsequent lymphoscintigraphy were performed. In all patients the SN was detected with a radioguided probe during scintigraphy and surgery. Histological examination of the SN for detection of metastases was positive in four patients who subsequently underwent axillary dissection. In the remaining patients with normal SNs no axillary dissection was performed. The preliminary results confirm the validity of the sentinel node procedure.

Long-term follow-up of stents implanted to relieve peripheral pulmonary arterial stenosis: hemodynamic findings and results of lung perfusion scanning.

In recent years, percutaneous placement of stents has been used as an alternative to surgery or balloon angioplasty for the treatment of adults with peripheral pulmonary arterial stenosis. This therapy has also been proposed for children, but questions still remain about its indications in this group of patients. We describe here the results of intravascular placement of stents in a group of 29 patients, with a mean age of 12+/-7 (range 3-31) years and weighing 35+/-19 (range 11-74) kg. All were affected by postsurgical or congenital isolated pulmonary arterial stenosis, and have now been followed for 38+/-19 (range 6-65) months. The early hemodynamic results have been excellent, with a significant reduction of the pulmonary arterial systolic pressure, the systolic pressure gradient, and the ratio of systolic pressures in the pulmonary and systemic circuits, and with a significant increase of the diameter of the stented vessels in all the patients. Of the 29 patients, 24 have been recatheterized 18+/-10 months after the procedure, demonstrating the stability of the results, with a low incidence of late restenosis, this seen in only 1 patient (2%). Lung perfusion scanning, performed in 17 patients each year after the follow-up catheterization, has showed that the results are maintained at long-term follow-up (51+/-9 months).

[An aggressive exercise test is suitable for myocardial scintigraphy]. / Un test da sforzo aggressivo adatto per la scintigrafia miocardica.

Exercise myocardial scintigraphy is frequently used as a second step tool in the assessment of coronary artery disease. Little attention has been paid on the exercise protocol used as a stress during scintigraphy. However, the diagnostic accuracy of the test is better if higher heart rate is achieved. The aim of this study was to evaluate if an aggressive exercise protocol was safe and more effective than a standard protocol in achieving higher heart rate. Eighty-four patients (64 men and 20 women, mean age 56 +/- 10 years, range 34-78 years) underwent a standard exercise test (cycloergometry; SET: 25 W increments every 2 min starting from 25 W load) and an aggressive exercise test (AET: 50 W increments every 2 min starting from 50 W load); during AET a myocardial scintigraphy (Tc-99m sestamibi; SPECT) was performed. Heart rate and blood pressure were monitored during the tests and the rate-pressure product was calculated. No patients had major adverse events during either tests. During AET with respect to the SET, higher maximal heart rate (142 +/- 15 vs 134 +/- 16 b/min; p < 0.01) and rate-pressure product (27,293 +/- 4341 vs 25,773 +/- 6690 b/min x mmHg; p < 0.05) were obtained. During AET higher number of maximal (55/84 vs 34/84; p < 0.05) and positive tests (45/84 vs 29/84; p < 0.05) were detected with respect to the SET. Using myocardial scintigraphy as a reference test, the diagnostic accuracy of the SET and AET was 54 and 73% respectively. In conclusion, an aggressive protocol during exercise stress test can safely be used to obtain a greater number of maximal and positive exercise tests.

Gallium-67 scintigraphy in an AIDS patients presenting tuberculous pericarditis.

The case of a 31-year-old HIV-positive male drug addict, with a history of recurrent intermittent fever is presented. Chest x-ray showed right ilar-node enlargement and moderate venous congestion. A 67Ga-citrate scan of the chest was highly suggestive of Mycobacterial infection. Scans showed right supraclavicular, right costophrenic, hilar node, pericardial and low grade pulmonary tracer uptake. Therapy with streptomycin, ethambutol, isoniazid and pyrazinamide was started. After 8 weeks, a chest roentgenogram was normal and 67Ga-citrate scintigraphy showed only right hilar node tracer uptake. Biopsy specimen cultures then confirmed the diagnosis of Mycobacterium tuberculosis infection. This case is interesting because of (1) the uncommon pericardial tracer uptake, and (2) because it confirms the usefulness of 67Ga-citrate scan for the early diagnosis of Mycobacterial infection.

[Changes in pulmonary gas exchange in chronic obstructive bronchopneumopathies and their modifications induced by therapy]. / Le alterazioni degli scambi gassosi polmonari nelle broncopneumopatie croniche ostruttive e loro modificazioni indotte dalla terapia.

In order to assess the mechanisms of gas exchange disturbances (i.e. to what extent shunting and diffusion impairment contribute to hypoxemia) in chronic obstructive pulmonary disease (COPD) and respiratory failure, ventilation-perfusion relationships (V/Q) by the multiple inert gas elimination technique were obtained in 16 patients with respiratory failure breakthrough. In 6 instances the study was repeated after long-term treatment with the aim to analyze V/Q changes after therapy. Initially, patients showed severe hypoxemia and hypercapnia and they presented signs of marked bronchoconstriction. A great dispersion of V and Q distribution was present as indicated by the marked increase of the second moment of V and Q distributions. Interestingly, few patients presented a unimodal distribution of both V and Q, whereas most-patients had bimodal distributions where the ventilation was distributed in a mode such that high V/Q areas were present between 10 and 100 of V/Q ratio and blood flow was displaced leftward or toward lower V/Q values. No correlations were found between V and Q distribution and clinical types A or B of COPD. Significant relationships were found between measured and calculated arterial PO2 (r = 0.90, p less than 0.001) and between measured PO2 and the sum of the fractional perfusion to regions with V/Q ratio less than 0.1, suggesting that V/Q inequality and shunting, instead of the impairment of diffusion equilibration, can account for all the hypoxemia. Finally, the reduced inhomogeneity of ventilation after treatment, especially in the fraction located in high V/Q regions is mostly related to some functional and reversible damages in COPD.