ABSTRACT
INTRODUCTION: The role of sentinel lymph node biopsy (SLNB) in patients with locally advanced breast cancer (LABC) with potentially sterilized axillary lymph nodes after neoadjuvant chemotherapy (NAC) remains unclear. PATIENTS AND METHODS: Between 2002 and 2008, SLNB with both blue-dye and radioisotope injection was performed in 77 patients with LABC whose cytopathologically confirmed positive axillary node(s) became clinically negative after NAC. Factors associated with SLN identification and false-negative rates, presence of non-sentinel lymph node (non-SLN) metastasis were analyzed retrospectively. RESULTS: SLNB was successful in 92% of the patients. Axillary status was predicted with 90% accuracy and a false-negative rate of 13.7%. Patients with residual tumor size >2 cm had a decreased SLN identification rate (p=0.002). Axillary nodal status before NAC (N2 versus N1) was associated with higher false-negative rates (p=0.04). Positive non-SLN(s) were more frequent in patients with multifocal/multicentric tumors (versus unifocal; p=0.003) and positive lymphovascular invasion (versus negative; p=0.0001). SLN(s) positive patients with pathologic tumor size >2 cm (versus
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/pathology , Lymphatic Metastasis , Neoadjuvant Therapy , Sentinel Lymph Node Biopsy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Axilla , Breast Neoplasms/drug therapy , Cyclophosphamide/administration & dosage , Docetaxel , Doxorubicin/administration & dosage , Female , Fluorouracil/administration & dosage , Humans , Middle Aged , Taxoids/administration & dosageABSTRACT
Cardiac injuries remain the most challenging of all injuries seen in the field of trauma surgery. Penetrating injury to the heart generally occurs less frequently than blunt injury and most commonly injures the large anterior right ventricle. We present an unusual, and to our knowledge a previously unreported, cause of cardiac penetrating trauma in a child, involving a hooked needle (a 15 cm long, metallic device usually used for crocheting or lacemaking). A ventricular septal defect was managed conservatively shortly after the primary cardiorrhaphy. Evaluation methods for this rare presentation and its possible surgical treatments are discussed.
Subject(s)
Heart Injuries/surgery , Needles , Wounds, Penetrating/surgery , Child, Preschool , Female , Foreign Bodies/complications , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Heart Injuries/diagnostic imaging , Heart Injuries/etiology , Heart Ventricles/injuries , Humans , Radiography , Wounds, Penetrating/diagnostic imaging , Wounds, Penetrating/etiologyABSTRACT
BACKGROUND: Appendiceal anomalies are extremely rare malformations that are usually found in the adult population as an incidental finding during laparotomy performed for other reasons. Abnormal development of the appendix usually takes the form of a double appendix. Accompanying intestinal, genito-urinary or vertebral malformations may be present when appendiceal duplications are detected in childhood. CASE REPORT: Presented herein is a case of perforated double appendix, which causes acute abdomen in a child, without any co-existing pathology. CONCLUSION: Appendiceal anomalies are of great practical importance and a surgeon must bear them in mind during an operation. If he overlooks them, the patient undergoing surgery may experience grave consequences. They also may be a forensic issue in cases when a second explorative laparotomy reveals 'previously removed' vermiform appendix.
