RESUMEN
AIMS: Lymph node metastases for papillary thyroid carcinoma are associated with an increased incidence of locoregional recurrence. The use of preoperative lymphoscintigraphy and intraoperative gamma probe detection to localize the sentinel lymph node in papillary thyroid carcinoma was investigated. METHODS: From February 2004 to December 2005 the sentinel lymph node technique was studied in 64 consecutive patients with cytological evidence of papillary thyroid carcinoma. The day before surgery, patients were submitted to US-guided peri-tumoural injection of the radiotracer and a lymphoscintigraphy was performed. In the operating room a total thyroidectomy was done, and thanks to a hand-held gamma probe the sentinel lymph node and all lymph nodes, belonging to the sentinel node compartment, were removed. RESULTS: The gamma probe identified the sentinel lymph node in 62 patients (96.8%). We found 48 (77.5%) sentinel lymph node without metastases; 12 (19.3%) with metastases and 2 (3.2%) with micrometastases. In 7 cases (11.3%), with a negative sentinel lymph node, metastases in other nodes of the same region were recorded. In 22 cases (34.3%) the ultrasound give an erroneous indication (P=0.004). Five patients (8.0%), 4 with multifocal cancer, had a positive postoperative lymphoscintigraphy. CONCLUSION: This study shows that the sentinel lymph node technique for papillary thyroid carcinoma is feasible, repeatable, and more accurate than preoperative ultrasound. In cases of multifocal thyroid lesions more patients should be enrolled to establish the utility of the radio-guided technique.
Asunto(s)
Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/secundario , Rayos gamma , Ganglios Linfáticos/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Papilar/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Cuello , Cuidados Preoperatorios , Cintigrafía , Biopsia del Ganglio Linfático Centinela/métodos , Tiroidectomía , UltrasonografíaRESUMEN
BACKGROUND: Several techniques for localizing pulmonary nodules have been described, but the advantages and disadvantages of each method remain unclear. We reviewed ultrasound, endofinger, finger palpation and wait and watch, radioguided, vital dye, fluoroscopic, agar marking, and needle wire methods for localizing pulmonary nodules. METHODS: Original, peer-reviewed, and full-length articles in English were searched with PubMed and ISI Web of Sciences. Case reports and case series with less than 10 patients were excluded. RESULTS: All localization techniques showed good reliability, but some carry a high rate of major or minor complications and drawbacks. CONCLUSION: No ideal localization technique is available; thus, the choice still depends on surgeon's preference and local availability of both specialists and instruments.
Asunto(s)
Nódulo Pulmonar Solitario/diagnóstico , Toracoscopía/métodos , HumanosAsunto(s)
Divertículo Esofágico/cirugía , Acalasia del Esófago/cirugía , Laparoscopía , Anciano , Divertículo Esofágico/complicaciones , Divertículo Esofágico/diagnóstico por imagen , Acalasia del Esófago/complicaciones , Acalasia del Esófago/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , RadiografíaRESUMEN
BACKGROUND: Preoperative dexamethasone may reduce disabling symptoms such as pain, nausea and vomiting after laparoscopic cholecystectomy. METHODS: This was a randomized, double-blind, placebo-controlled trial. Between March and December 2004, 101 patients undergoing laparoscopic cholecystectomy were randomized to receive 8 mg dexamethasone (n = 49) or placebo (n = 52) intravenously before surgery. Six patients were excluded from the study. All patients received a standardized anaesthetic, surgical and multimodal analgesic treatment. The primary endpoints were: first, postoperative nausea, vomiting and pain; second, postoperative analgesic and antiemetic requirements. The pain scores (visual analogue and verbal response scales), the episodes of nausea (verbal response scale) and vomiting were recorded at 1, 3, 6 and 24 h, respectively, after the operation. Analgesic and antiemetic requirements were also recorded. RESULTS: No apparent drug side-effects were noted. Seven patients (14 per cent) in the treatment group reported nausea and vomiting compared with 24 (46 per cent) in the control group (P = 0.001). In the group of patients treated with dexamethasone, five (10 per cent) required antiemetics versus 23 (44 per cent) of those receiving placebo (P < 0.001). No difference in postoperative pain scores and analgesic requirements was detected between groups. CONCLUSION: Preoperative dexamethasone reduces postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy, with no side-effects, and may be recommended for routine use.
Asunto(s)
Antieméticos/uso terapéutico , Colecistectomía Laparoscópica/efectos adversos , Dexametasona/uso terapéutico , Enfermedades de la Vesícula Biliar/cirugía , Náusea y Vómito Posoperatorios/prevención & control , Analgésicos/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
The aim of our study is to evaluate the frequency of false-negative (FN) sentinel node procedures in patients with breast cancer. A total of 791 breast cancer patients underwent sentinel lymph node (SLN) biopsy at our institution between July 1997 and February 2005. A 2-day protocol was used to localise the sentinel node with the injection of 99mTc-nanocolloid. There were two phases in the study: the learning phase (50 patients) and the application phase (741 patients). In the learning phase, a complete lymphadenectomy was always performed. In the application phase, sentinel nodes were studied postoperatively with breast cancer and lymphadenectomy was performed when considered warranted by the pathological postoperative results. The median follow-up duration in the 741 patients studied during the application phase was 32.3 months (range 6-72 months). In this phase a total of 787 sentinel nodes (719 axillary and 68 intramammary chain) were obtained (range 0-5 per patient, mean 1.01), with 153 (41 with micrometastasis) positive sentinel nodes. We observed a total of three FN SLN results (0.5%). All three presented as an axillary recurrence into 24 months from operation. After a median follow-up of 32.3 months we observed only three clinical recurrences among 741 patients. Our results indicate that the sentinel node protocol can give an adequate local control.
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Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/patología , Adulto , Anciano , Anciano de 80 o más Años , Axila , Neoplasias de la Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Lobular/diagnóstico por imagen , Reacciones Falso Negativas , Femenino , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Invasividad Neoplásica/patología , Cintigrafía , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Biopsia del Ganglio Linfático Centinela/métodos , Agregado de Albúmina Marcado con Tecnecio Tc 99mAsunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Tamizaje Masivo/métodos , Nódulo Pulmonar Solitario/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Diagnóstico por Computador/métodos , Humanos , Imagenología Tridimensional , Tamizaje Masivo/normas , Estadificación de Neoplasias/métodos , Sensibilidad y Especificidad , Factores de Tiempo , Tomografía Computarizada por Rayos X/normasRESUMEN
BACKGROUND/AIMS: An adequate preoperative disease staging is highly required before surgical treatment, even in gastrointestinal malignancies. Our study wants to give a contribution in order to define echolaparoscopy weight in gastrointestinal tumors and its impact in surgical therapy. METHODOLOGY: 33 patients were affected by pancreas, 22 by stomach, 16 by extrahepatic biliary tract and 18 by liver cancers; every patient was considered worthy of radical or palliative surgery according to preoperative staging (thorax-abdominal CT and percutaneous ultrasonography). Paired sample t-tests were used to analyze the results of each methodical and probability values of less than 0.05 were considered significant. RESULTS: Preoperative instrumental examinations gave correct evaluations only in 44 of 89 cases (49%) while echolaparoscopic gave correct evaluations in 82 on 89 cases (92%) (P<0.05). So after echolaparoscopic in only 7 cases we performed an explorative laparotomy. CONCLUSIONS: Laparoscopy and ultrasound impact on therapy is worthy of attention. It seems to be able to give advantages in staging gastrointestinal malignancies, except for pancreas cancers, in which some limits and negative aspects have been demonstrated, regarding the possibility of giving correct diagnosis of portal axis infiltration.
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Neoplasias del Sistema Digestivo/diagnóstico por imagen , Neoplasias del Sistema Digestivo/patología , Endosonografía , Laparoscopía , Estadificación de Neoplasias/métodos , Neoplasias del Sistema Digestivo/cirugía , Humanos , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Reproducibilidad de los Resultados , Ultrasonografía Doppler en ColorAsunto(s)
Algoritmos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Estadificación de Neoplasias , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/patología , Medicina Basada en la Evidencia , Humanos , Metástasis de la Neoplasia , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos XAsunto(s)
Nódulo Pulmonar Solitario/diagnóstico por imagen , Cirugía Torácica Asistida por Video , Ultrasonografía Intervencional , Humanos , Neoplasias Pulmonares/irrigación sanguínea , Neoplasias Pulmonares/diagnóstico por imagen , Valor Predictivo de las Pruebas , Nódulo Pulmonar Solitario/irrigación sanguínea , Nódulo Pulmonar Solitario/patología , Nódulo Pulmonar Solitario/cirugía , Ultrasonografía DopplerRESUMEN
This prospective study, based on 13 patients with single pulmonary nodules of width between 10 and 30 mm, was performed to verify the utility of intrathoracoscopic ultrasound to localize the single pulmonary nodule. In all 13 cases the ultrasound examination was able to localize the position of nodules, but the homogeneous hypoechoic pattern of nodules observed in ten of 13 cases did not prove whether the lesion was benign or malign. In conclusion, we can confirm that intrathoracoscopic ultrasound examination is a safe, risk-free and less expensive method of localizing the single pulmonary nodules.
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Nódulo Pulmonar Solitario/diagnóstico por imagen , Toracoscopía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Nódulo Pulmonar Solitario/cirugía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
BACKGROUND: Although laparoscopic cholecystectomy (LC) results in less pain then open cholecystectomy, it is not a pain-free procedure. The aim of this study was to test a new method of preemptive analgesia. METHODS: By simple randomization 60 patients were assigned to two groups (30 in each group). Group A, the placebo group, received 200 ml of 0.9% saline, and group B received 5 mg/kg of a local anesthetic solution (ropivacaine) in 200 ml of 0.9% saline. Local anesthetic or placebo solution were administer before creation of the pneumoperitoneum. RESULTS: Pain intensity, as rated by visual analog and verbal rating scales, and stress response data were significantly less in the group receiving ropivacaine than in the placebo group. No patients in treatment group received an additional dose of analgesic, whereas two patients in placebo group needed an additional analgesic. CONCLUSIONS: Our results support the clinical validity of preemptive analgesia, but the timing of intraperitoneal administration of local anesthetic is very important. Only application before creation of the pneumoperitoneum may preempt every neuronal central sensitization.
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Analgesia/métodos , Colecistectomía Laparoscópica/métodos , Dolor Postoperatorio/prevención & control , Amidas/sangre , Amidas/uso terapéutico , Analgesia/tendencias , Anestésicos Locales/sangre , Anestésicos Locales/uso terapéutico , Colecistectomía Laparoscópica/tendencias , Femenino , Humanos , Inyecciones Intraperitoneales/métodos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/sangre , Dolor Postoperatorio/patología , Neumoperitoneo Artificial/métodos , Neumoperitoneo Artificial/tendencias , Ropivacaína , Estrés Fisiológico/sangre , Estrés Fisiológico/patología , Estrés Fisiológico/prevención & controlRESUMEN
OBJECTIVES: To determine the diagnosis, treatment and follow-up in patients with a solitary lung nodule and a previous primary extrapulmonary neoplasm. METHODS: The authors evaluated the charts of 45 patients with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule. The histologic characteristics of the nodule were correlated with those of the extrapulmonary neoplasm. RESULTS: The histology of the nodule was not known preoperatively in 43 cases (93.5%); in the remaining three cases cytologic examination had shown the presence of atypical cells. The majority of pulmonary lesions (73.9%) were found during the follow-up of the previous tumour, but a significant percentage of nodules (17.4%) were found incidentally. Pre- or intraoperative localisation of the nodule was done in 19 cases (41.3%), and was successful in nine cases (47.4%). Thoracoscopy was performed in 44 patients (95.6%). The coincidence between the pathology of the previous tumour and that of the nodule was 41.3% (19/46). The coincidence rate was 100% for the tumours of ovary, prostate, and sarcomas. CONCLUSIONS: The advent of minimally invasive surgical techniques has made a definitive diagnosis likely, providing also therapy with a less painful engagement for the patient and a less cost for the community.
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Neoplasias Pulmonares/diagnóstico , Neoplasias/complicaciones , Nódulo Pulmonar Solitario/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Nódulo Pulmonar Solitario/patología , ToracoscopíaRESUMEN
The authors report a case of primary epithelioid (EH) in a 73-year-old female.