Sentinel node biopsy in the staging of breast cancer.

BACKGROUND: The role of axillary lymph node dissection (ALND) in breast cancer is currently being reevaluated. Sentinel node biopsy (SNB) holds promise for replacing full dissection in a large number of patients with breast cancer. MATERIALS: We evaluated SNB utilizing an intraoperative gamma probe localization technique following injection of technetium sulfur colloid in 80 patients with primary breast cancer and clinically negative axillae. Forty-eight patients were evaluated at Baptist Medical Center, Montgomery, Alabama, and 32 at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois. RESULTS: At least one sentinel node was found in 70 of the 80 patients (88%). One patient had a sentinel node in both the axilla and internal mammary chain. The remainder had axillary sentinel nodes only. The sentinel nodes accurately predicted the status of the axilla in 69 of the 70 patients (99%). One of 14 node-positive patients would have been missed with sentinel node biopsy alone, for a false negative rate of 7%. Four node-positive patients would have been missed with routine ALND without serial sectioning (SS) and immunohistochemical staining (IH) of the sentinel node. CONCLUSIONS: Sentinel node biopsy with SS and IH more precisely predicted the status of the axilla than routine ALND in this group of patients. SNB will likely replace full axillary dissection in the majority of patients with breast cancer.

Rickets in premature infants fed different formulas.

To study the role of formula as a cause of rickets, we randomly assigned 46 very-low-birth-weight (VLBW) infants (less than or equal to 1,500 gm) to one of three groups receiving either Isomil, a soy isolate formula, Similac with Iron, a common milk-based formula, or Similac 24 LBW, a hypercaloric milk-based formula designed for low-birth-weight infants during the first three to four months of life. Postnatal changes in serum calcium, phosphorus, alkaline phosphatase, and albumin were monitored during this study. Radiologic diagnosis of rickets was made in 60% of infants fed Isomil and 5% fed Similac with Iron. Significantly low levels of serum phosphorus and high levels of serum alkaline phosphatase were also seen in infants fed Isomil. The exact cause of the biochemical changes and the high incidence of rickets among infants fed Isomil is not clear. Poor solubility and possibly the decreased bioavailability of minerals in soy isolate formula may be important. We conclude that rickets occurs with high frequency among VLBW infants fed soy isolate, but not milk-based formulas. We suggest that prolonged feeding of soy isolate formulas should be avoided in VLBW infants.

Technique of scanning for Meckel's diverticulum.

99mTc-pertechnetate scanning is now recognized as a useful means of detecting Meckel's diverticula. When these contain gastric mucosa and present with ulceration and bleeding, the ectopic gastric mucosa can be identified by its secretion of 99mTc-pertechnetate. However, the secretions of normal gastric and salivary glands can pool in the gut and simulate a Meckel's diverticulum. We believe the diagnostic procedure of choice to include both continuous nasogastric suction and continuous sequential gamma camera images. To support this view, we present cases illustrating 1) that 99mTc-pertechnetate can appear in the bowel within the first few minutes of administering 99mTc-pertechnetate, even in the absence of a Meckel's diverticulum; 2) that rapid sequential camera views are helpful but not definitive in distinguishing such bowel activity from a Meckel's diverticulum; and 3) that continuous nasogastric suction most successfully eliminates this interference.