Sentinel Lymph Node (SLN) laparoscopic assessment early stage in endometrial cancer.

BACKGROUND: The aim of the study was to demonstrate the validity of sentinel lymph node (SLN) detection after injection of radioactive isotope and patent blue dye in patients affected by early stage endometrial cancer. The second purpose was to compare radioactive isotope and patent blue dye migration. METHODS: Between September 2000 and May 2001, 11 patients with endometrial cancer FIGO stage Ib (n=10) and IIa (n=1) underwent laparoscopic SLN detection during laparoscopic assisted vaginal hysterectomy with bilateral salpingo-oophorectomy and pelvic bilateral systematic lymphadenectomy. Radioactive isotope injection was performed 24 ours before surgery and blue dye injection was performed just before surgery in the cervix at 3, 6, 9 and 12 hours. A 350 mm laparoscopic gamma-scintiprobe MR 100 type 11, (99m)Tc setted (Pol.Hi.Tech.), was used intraoperatively for detecting SLN. RESULTS: Seventeen SLN were detected at lymphoscintigraphy (6 bilateral and 5 monolateral). At laparoscopic surgery the same locations were found belonging at internal iliac lymph nodes (the so called "Leveuf-Godard" area, lateral to the inferior vescical artery, ventral to the origin of uterine artery and medial or caudal to the external iliac vein). Fourteen SLN were negative at histological analysis and only 3 positive for micrometastasis (mean SLN sections = 60. All the other pelvic lymph nodes were negative at histological analysis. The same SLN locations detected with g-scintiprobe were observed during laparoscopy after patent blue dye injection. CONCLUSIONS: If the sensitivity of the assessment of SLN is confirmed to be 100%, this laparoscopic approach could change the management of early stage endometrial cancer. The clinical validity of this technique must be evaluated prospectively.

Preliminary study of sentinel node identification with 99mTc colloid and blue dye in patients with endometrial cancer.

AIMS AND BACKGROUND: Intraoperative lymphatic mapping and sentinel node (SLN) biopsy have generated a tremendous amount of interest and are already established as part of the standard practice in the surgical management of breast cancer and melanoma. To reduce extensive radical procedures and decrease the morbidity in the treatment of gynecologic malignancies, much effort is being made to use less aggressive interventions. The purpose of our study was to determine the feasibility of SLN mapping in a group of patients with endometrial cancer at early stages. METHOD AND STUDY DESIGN: Between September 2000 and May 2001 11 patients with endometrial cancer FIGO stage Ib (n = 10) and IIa (n = 1) underwent laparoscopic SNL detection during laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy and bilateral systematic pelvic lymphadenectomy. Radioactive isotope injection was performed 24 hours before surgery and blue dye injection was performed just before surgery in the cervix at 3,6, 9 and 12 hours. A 350 mm laparoscopic gamma scintyprobe MR 100 type 11, 99mTc settled (Pol Hi Tech), was used intraoperatively for SLN detection. RESULTS: Seventeen (17) SLNs were detected with lymphoscintigraphy (six bilateral and five unilateral). At laparoscopic surgery we found the same locations belonging at internal iliac lymph nodes (the so-called Lebeuf-Godard area, lateral to the inferior vesical artery, ventral to the origin of the uterine artery and medial or caudal to the external iliac vein). Fourteen (14) SLNs were negative on histological analysis and three were positive for micrometastases (mean SLN sections = 60). All other pelvic lymph nodes were negative at histological analysis. The same SLN locations detected with the gamma scintyprobe were observed at laparoscopy after patent blue dye injection. CONCLUSIONS: Our preliminary data suggest that combined 99mTc-labeled colloid and vital blue-dye techniques are feasible for SLA detection in endometrial cancer; they represent a very promising tool to transform the management of early-stage endometrial cancer. The clinical validity of this combined technique should be evaluated prospectively.

Retrospective study of couples with a history of recurrent spontaneous abortion.

Clinical treatment of recurrent spontaneous abortion (RSA) is still a matter of debate due to the absence of an univocal definition of the term. As a consequence of the reproductive history of the couple, there is still uncertainty regarding the moment when the problem of recurrent abortion arises and this prevents the start of diagnostic evaluation and therapy. In addition to a critical review of the literature, the aim of this study was to evaluate whether two successive abortions with the same partner are sufficient to suggest that the couple should undergo diagnostic test, or if it would be more sensible to wait for other reproductive failures. The study was performed in 50 couples suffering from recurrent abortion who attended the Laboratory of Cytogenetics in the Department of Animal Biology at Turin University for caryotyping in order to exclude the presence of chromosomal aberrations. Interviewed by telephone, out of 50 couples 41 presented the necessary requisites for being included in the study. Follow-up ranged between a maximum of 8.5 years and a minimum of 1 year (mean of 4.7 years). From the data collected it emerged that the probable cause of RSA was identified in 21 out of 41 couples enrolled in the study group (51.2 per cent). In the remaining 20 couples tests were within normal ranges. In all diagnosed cases the reproductive problem was identified with one or more alterations present in women. Among the hypothesized cause of RSA, uterine abnormalities were the most frequent (19.5 per cent), followed by immunological problems (17.1 per cent), etiologic factors of hormonal origin (12.2 per cent), one single case of genital infection (2.4 per cent), one balanced chromosomal translocation (2.4 per cent) and at last only one case of cervical incompetence of (2.4 per cent). The diagnosis was determined effectively in 85.7 per cent of couples. Of 20 couples who had not shown any abnormalities, 80 per cent had had a healthy child without any abortions and with the same partner. In conclusion, diagnostic tests performed finally identified the cause of RSA in 43.9 per cent of the couples who completed the procedure; vice versa, 39.0 per cent of couples solved the problem without the need for diagnostic tests; finally, the remaining 18.1 per cent were unable to carry pregnancy to term. By comparing our results to those reported by other authors, we believe that the probability of identifying the cause of RSA and curing it is sufficiently high to justify the start of the diagnostic evaluation of the problem as early as the second abortion in view of the stress on the couple produced by repeated reproductive failures.

Use of an endolaparoscopic probe in conservative management of Fallopian pregnancy.

The incidence of extrauterine pregnancy has shown an increasing trend, exceeding one out of every 100 term pregnancies. This has resulted in the development of more and more conservative surgical treatments in order to retain the fertility of women. The use of operative laparoscopy has led to progress being made in this direction, due to reduced tissue trauma and a reduction in the number of peritoneal adhesions. Tubal isthmic pregnancies tend to cause an irregular increase in the size of the whole tube, which causes problems for pinpointing the exact site of the ectopic implantation. It is often necessary to make a longitudinal incision in the tubal wall to identify the chorionic tissue and remove it completely. In an attempt to avoid this unnecessarily extensive surgery, we used an echographic sector probe under laparoscopic control to locate the exact area of the ectopic implantation. We found it was possible to remove the villous tissue through a very short and precise cut in the tubal wall which facilitated the drainage of the lumen and reduced the bleeding normally associated with more extensive tubal surgery. Hysterosalpingographic follow-up studies after 2 months showed good tubal recanalization.

Chromosome analysis in operating room personnel.

Cytogenetic tests were performed on operating room personnel working in a Turin hospital. The aim of our study was to determine if any chromosome damage was caused by the use of anaesthetic gases. Blood samples were collected from 45 hospital workers: 15 exposed to anaesthetic gases, 15 exposed to both anaesthetic gases and ionizing radiations and 15 controls. An examination of sister-chromatid exchanges did not highlight significant differences when exposed subjects were compared to controls. Chromosomal aberrations were significantly higher (P = 0.029) in all the exposed personnel, while no statistically significant increase was observed in staff exclusively in contact with anaesthetic gases. Moreover there was a positive correlation for chromosome aberrations with the years of employment, when the entire exposed population was considered and when personnel from the different operating rooms were considered separately. Both sister-chromatid exchange and chromosomal aberrations were higher among smokers though differences were not statistically significant.

Cytogenetic monitoring of hospital workers exposed to low-level ionizing radiation.

In the present study the cytogenetic effects in hospital workers exposed to low-level radiation were evaluated. Samples of peripheral blood were collected from 63 subjects working in radiodiagnostics and from 30 subjects, working in the same hospitals, who were used as controls. A higher number of cells with chromosome-type aberrations (CA) was observed in the exposed workers vs. the controls and the difference was statistically significant (p less than 0.05). No correlation was, on the contrary, found between CA and years of exposure. A significant difference was observed in the incidence of cells with CA between smokers and non-smokers, but in the control group only. In contrast, in the workers exposed to ionizing radiation, the frequency of cells with CA was very similar in smokers and non-smokers.