Radioguided sentinel lymph node detection in vulvar cancer.

Lymph node status is the most important prognostic factor in vulvar cancer. Histologically, sentinel nodes may be representative of the status of the other regional nodes. Identification and histopathologic evaluation of sentinel nodes could then have a significant impact on clinical management and surgery. The aim of this study was to evaluate the feasibility and diagnostic accuracy of sentinel lymph node detection by preoperative lymphoscintigraphy with technetium-99 m-labeled nanocolloid, followed by radioguided intraoperative detection. Nine patients with stage T1, N0, M0, and 11 patients with stage T2, N0, M0 squamous cell carcinoma of the vulva were included in the study. Only three cases had lesions exceeding 3.5 cm in diameter. Sentinel nodes were detected in 100% of cases. A total of 30 inguinofemoral lymphadenectomies were performed, with a mean of 10 surgically removed nodes. Histological examination revealed 17 true negative sentinel nodes, 2 true positive, and 1 false negative. In our case series, sentinel lymph node detection had a 95% diagnostic accuracy, with only one false negative. Based on literature evidence, the sentinel node procedure is feasible and reliable in vulvar cancer; however, the value of sentinel node dissection in the treatment of early-stage vulvar cancer still needs to be confirmed.

Treatment of keratoconus with laser in situ keratomileusis, photorefractive keratectomy, and radial keratotomy.

BACKGROUND: The authors investigated the refractive treatment of keratoconus to give patients better and more comfortable vision with and without glasses or soft contact lenses. METHODS: Patients with spectacle-corrected visual acuity worse than 20/40 and conus apex greater than 350-micron thick were treated. We used the Nidek EC-5000 excimer laser with a 130-mm plate and special multi-design masks for the conus treatment and the Chiron ALK microkeratome. Patients were followed for 2 years postoperatively. We also used sector radial keratotomy to treat keratoconus. RESULTS: The authors report the advantages of using these new techniques to treat keratoconus. Excimer laser ablation should be performed only when the cornea surrounding the conus is flat, so that it can join the ablated zone (small optical zone) forming a new flat shape, without regression. Ablation did not exceed 50 microns with a 3- to 4-mm ablation diameter for up to -6.00 D myopic correction. CONCLUSION: The authors hope to avoid or delay the need for corneal transplant in keratoconus eyes, giving these patients better vision with and without glasses or soft contact lenses.

[Prevention of preeclampsia with low-dose acetyl salicylic acid: critical assessment]. / Prevenzione della preeclampsia con acido acetil salicilico a basse dosi: valutazione critica.

The Authors present a critical review of the published literature about the effect of low dose of acido acetilsalicilico on prevention and treatment of preeclampic. Beginning from the effects of low daily dose of acido acetilsalicilico on the pregnancy, the Authors present the published datas from 1970 until today, and suggest the present directions for use of acido acetilsalicilico in pregnancy.

Comparative study of the analgesic efficacy of flurbiprofen and diclofenac in patients following excimer laser photorefractive keratectomy.

This randomized, patient-masked, crossover trial compared the analgesic efficacy of flurbiprofen and diclofenac in 16 patients following excimer laser photorefractive keratectomy. Patients were randomly assigned to receive one study medication after surgery on the first eye and the other medication after surgery on the second eye (approximately 30 days later). After both surgeries, patients instilled one drop of the assigned medication six times daily for the first 3 days postsurgery and one drop four times daily on postsurgery days 4 through 7. Patients assessed the intensity of postsurgical pain beginning at postsurgery hour 5 and pain relief beginning at postsurgery hour 8 and continued to do so daily thereafter. On the last day (day 7), patients rated the global efficacy of the analgesic treatment. All assessments were performed by patients using descriptor and visual ordinal scales and were recorded in diaries. Patients were queried as to the presence, severity, and duration of any adverse events. Flurbiprofen produced significantly greater reductions in pain intensity than did diclofenac at all evaluations through day 4 and significantly greater relief of pain than did diclofenac at all evaluations through day 3. Significantly more patients treated with flurbiprofen reported being pain free on days 3 and 4 (11 [69%] and 16 [100%], respectively) compared with those treated with diclofenac (3 [19%] and 9 [56%], respectively). Based on patient ratings, flurbiprofen had significantly better global analgesic activity than diclofenac. Both treatments were well tolerated. Mild and transient ocular burning after instillation was the only reported adverse event; it was reported by all patients in both study groups at approximately 50% of study visits.

[Conventional and computerized tomographic study of blow-out fractures of the orbit (author's transl)]. / Le fratture blow-out del pavimento orbitario. Considerazioni su due casi studiati con tomografia convenzionale e computerizzata.

The authors describe two cases of blow-out fractures of the orbit studied by conventional and computerized tomography and stress the opportunities and limits of the procedures.

Improved radiological technique for evaluating the lacrimal pathways with special emphasis on functional disorders.

A radiological study of the lacrimal drainage apparatus was made in 50 patients with temporary or permanent epiphora. The authors state that the present radiologic technique (macrography, seriography, subtraction) allows the detection on the various lacrimal levels of not only organic lesions but also of functional disorders. They assert the definite superiority of dacryocystography over the other clinical and radiological investigations (scintigraphy, roentgencinematography) in identifying the site and the nature of the various organic lesions, in evaluating and interpreting the functional alterations as well as following and judging the effectiveness of treatments.