ABSTRACT
BACKGROUND: Minimally invasive approaches have changed the practice of surgery in several specialties. The purpose of this study was to develop a reproducible endoscopic technique for the evaluation of the axilla in breast cancer patients. METHODS: A total of 23 patients with biopsy-proven breast carcinoma were enrolled. Patients were positioned in the supine position with the ipsilateral arm abducted at 90 degrees. A 1-cm skin incision was made at the superior aspect of the axilla. Dissection was carried bluntly to the lateral border of the pectoralis major. A balloon distention device was inserted into the tract and distended under endoscopic vision to create a working space. Insufflation was initiated up to a pressure of 8 mmHg. A 30 degrees laparoscope was introduced for visualization of axillary contents. One or two additional 5-mm cannulas were placed as needed under direct visualization. Manipulation of axillary contents was performed, and in 19 patients a sentinel node identification technique was applied. RESULTS: In all patients, using insufflation and minimal instrument dissection, the axillary vein, long thoracic, and thoracodorsal nerves were found in their usual anatomical locations. Utilizing blunt and sharp dissection, the axilla was thoroughly inspected, and individual lymph nodes were easily identified and extracted. In 11 of 19 patients, a sentinel node or blue dye was identified using isosulfan blue. There was a procedure concordance of 84%, and there were no complications. CONCLUSIONS: We describe a novel endoscopic technique for the evaluation of the axilla in breast cancer patients. This technique allows (a) creation of a minimally invasive working space within the axilla, (b) recognition of key axillary anatomic landmarks, and (c) instrument manipulation within the axilla to identify and extract lymph nodes, and apply the sentinel node technique. This is the first report of a minimally invasive approach to axillary exploration to employ sentinel lymph node mapping.
Subject(s)
Breast Neoplasms/pathology , Endoscopy , Lymph Node Excision/methods , Lymph Nodes/pathology , Axilla , Biopsy, Needle , Breast Neoplasms/surgery , Female , Humans , Lymphatic Metastasis/diagnosis , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Although mycotic aneurysms of small visceral arteries are rare, they have a high morbidity and mortality due to rupture and sepsis. Any patient with abdominal pain and bacterial endocarditis should be suspected of having a mycotic aneurysm. Selective arteriography confirms the diagnosis. In the case we have reported, diagnosis of a mycotic aneurysm of the inferior pancreaticoduodenal artery was established by angiography, and the patient was treated by percutaneous transcatheter embolization. This case demonstrates that mycotic aneurysms of small visceral arteries may be managed nonoperatively with antibiotics and percutaneous transcatheter embolization therapy.
Subject(s)
Aneurysm, Infected/therapy , Duodenum/blood supply , Embolization, Therapeutic , Pancreas/blood supply , Aneurysm, Infected/diagnosis , Female , Humans , Middle AgedABSTRACT
Tumors from patients with primary colon cancer were studied for the presence of steroid hormone receptors for estrogen (E2), progesterone (Prog), dihydrotestosterone (DHT) and glucocorticoid. Ten of 33 (30%) tumors contained high affinity E2 receptors. Four were males and six females with positive assays predominantly from the left colon. Twenty-three of these tumors were also assayed for DHT and Prog and six (26%) contained all three receptors. An additional twelve tumors had at least one receptor, so that 70% of the tumors studied contained one or more receptors. Five of 22 (23%) samples were positive for glucocorticoid receptors. Common etiological factors associated with colon and breast cancer were briefly discussed. These factors, along with the presence of hormone receptors in primary colon malignancies suggest that some large bowel cancers may be endocrine-dependent.
Subject(s)
Colonic Neoplasms/analysis , Receptors, Steroid/analysis , Breast Neoplasms/analysis , Breast Neoplasms/etiology , Colonic Neoplasms/etiology , Dihydrotestosterone , Female , Humans , Male , Neoplasms, Hormone-Dependent/analysis , Receptors, Androgen/analysis , Receptors, Estrogen/analysis , Receptors, Glucocorticoid/analysis , Receptors, Progesterone/analysisABSTRACT
Malignant lymphoma of the parotid gland not infrequently presents as a solitary mass indistinguishable from other commonly occurring lesions. Two new cases are presented here with a comprehensive literature review. When encountered, the lesion should be excised with the superficial lobe of the gland. If it is within the deep lobe, the tumor should also be excised with preservation of the facial nerve. Recommendations for further evaluation and treatment are given.
Subject(s)
Lymphoma/diagnosis , Parotid Gland/surgery , Parotid Neoplasms/diagnosis , Aged , Hodgkin Disease/pathology , Humans , Lymphoma/pathology , Lymphoma/therapy , Male , Middle Aged , Parotid Neoplasms/pathology , Parotid Neoplasms/therapy , Prognosis , RadiotherapyABSTRACT
External irradiation of the head and neck has been shown to increase the incidence of thyroid carcinoma. Fourteen cases have also been reported of thyroid cancer developing in individuals treated with radioiodine for hyperthyroidism. Another patient's case is reported here to emphasize the possible role of I131 on the genesis of thyroid malignancy and the importance of surgery in the treatment of hyperthyroidism.
