Adipose-only sentinel lymph nodes: a finding during the adaptation of a sentinel lymph node mapping algorithm with indocyanine green in women with endometrial cancer.

OBJECTIVE: To identify factors that affect successful adaptation of sentinel lymph node mapping and those that lead to unintended adipose-only sentinel lymph node identification. METHODS: Surgical and pathological data were prospectively collected on patients with endometrial cancer who underwent sentinel lymph node mapping with indocyanine green with or without pelvic and/or para-aortic lymph node dissection between November 2013 and April 2017. All mapping cases were performed with the robotic system. Adipose-only specimens were defined as a sentinel lymph node without a pathologically identified lymph node after ultrastaging. RESULTS: A total of 202 patients were included: 83% had endometrioid pathology, 12% serous, 3% carcinosarcoma, and 2% clear cell, with mixed pathology noted in 2%. The bilateral sentinel lymph node detection rate was 66%, and the rate of mapping at least a unilateral sentinel lymph node was 86%. Neither the bilateral nor the unilateral sentinel lymph node mapping rate changed with increased surgeon experience. The rate of adipose-only sentinel lymph node identification was more frequent when comparing the first 10 cases (37%), cases 11 - 30 (28%), and > 30 cases (9%) (P = 0.006). Body mass index > 30 kg/m2, uterine fibroids, The International Federation of Gynecology and Obstetrics (FIGO) grade, and histology were not found to have a statistically significant impact on either sentinel lymph node identification or adipose-only sentinel lymph node identification. Adipose-only sentinel lymph nodes were more likely with increased time from cervical injection to identification of the sentinel lymph node in the right hemipelvis. The median range was 28 min (14-73) for true sentinel lymph node identification vs 33 min (23-74) for adipose-only sentinel lymph node identification (P = 0.02). CONCLUSION: Patient and surgeon factors did not impact the identification of sentinel lymph nodes over time. Adipose-only sentinel lymph nodes were more frequently identified in the initial cases and represent a potential complication to adapting sentinel lymph node biopsy without lymphadenectomy. The increase in adipose-only sentinel lymph node identification that was associated with time from cervical injection may represent delayed or disrupted uptake of indocyanine green.

IPI59: An Actionable Biomarker to Improve Treatment Response in Serous Ovarian Carcinoma Patients.

Despite improvements in operative management and therapies, overall survival rates in advanced ovarian cancer have remained largely unchanged over the past three decades. Although it is possible to identify high-risk patients following surgery, the knowledge does not provide information about the genomic aberrations conferring risk, or the implications for treatment. To address these challenges, we developed an integrative pathway-index model and applied it to messenger RNA expression from 458 patients with serous ovarian carcinoma from the Cancer Genome Atlas project. The biomarker derived from this approach, IPI59, contains 59 genes from six pathways. As we demonstrate using independent datasets from six studies, IPI59 is strongly associated with overall and progression-free survival, and also identifies high-risk patients who may benefit from enhanced adjuvant therapy.

Paraneoplastic cerebellar degeneration in ovarian carcinoma: case report with review of immune modulation.

Paraneoplastic cerebellar degeneration (PCD) is a rare nonmetastatic complication of a carcinoma. It is typically mediated by antibodies generated against tumor antigens. These antigens are the same proteins as expressed on Purkinje cells within the cerebellum; immune activation in the central nervous system (CNS) results in the syndrome. A 56-year-old woman with stage IIIC serous ovarian carcinoma diagnosed 3 years prior developed progressive limb ataxia. Serum anti-Yo antibodies were positive, confirming the diagnosis of PCD. Treatment with plasmaphoresis, intravenous immune globulin, and immune modulation with corticosteroids and tacrolimus was unsuccessful. Although the syndrome can be debilitating and treatment options are limited, it may also be an example of a successful host immune response in certain cases.

The safety and effectiveness of an implanted electromagnetic hearing device.

The records of 184 patients implanted with the XOMED Audiant Bone Conductor (XOMED Inc, Jacksonville, Fla) prior to March 1988 were reviewed retrospectively to determine the safety of this device. Complications were few and minor in nature. Effectiveness was judged from the audiometric data obtained from the 96 patients in the hearing part of this study, all of whom had improved hearing with the device. The mean preoperative pure-tone air-conduction three-frequency average threshold +/- SD in the implanted ear was 55.8 +/- 10.7-dB hearing level; postoperative average aided warble-tone threshold was 19.9 +/- 8.5-dB hearing level. The average improvement in threshold was 36.0 +/- 13.3 dB. Ninety-three percent of patients achieved socially adequate hearing, ie, mean aided sound-field thresholds of at least 30-dB hearing level, and 81% had thresholds of at least 25-dB hearing level. We conclude that the XOMED Audiant Bone Conductor is a safe and effective device for the surgical correction of conductive hearing loss.

A bacterium capable of using phytol as its sole carbon source, isolated from algal sediment of Mud Lake, Florida.

A species of Flavobacterium that consistently attacks pure phytol and can use it as a sole source of carbon has been isolated from the blue-green algal sediment of Mud Lake, Florida. Biochemical tests demonstrate that this bacterium also readily uses various other organic compounds. This bacterium may account for the degradation products of chlorophyll and its side chain phytol, which have been found in the Mud Lake algal sediment. Phytol and its degradation products play a role in Refsum's disease, but phytol is also the most promising precursor of the isoprenoid hydrocarbons found in oil shale of the Green River Formation (Eocene) of Colorado, Utah, and Wyoming. The discovery of this species of Flavobacterium is a significant product of a protracted study of the bacteriology, phycology, zoology, and geochemistry of the algal sediment forming in Mud Lake, which is believed to be a modern analogue of the kind of algal sediment that, through geologic time, became oil shale.