Anaphylactic Reaction Rates to Blue Dyes Used for Sentinel Lymph Node Mapping: Systematic Review and Meta-analysis.

OBJECTIVE: The primary objective of this study was to quantify the risk of anaphylaxis to blue dyes used in SLNB for cancer. Secondary outcomes included the identification of factors that may influence this risk. SUMMARY OF BACKGROUND DATA: Blue dyes are widely used to help identify sentinel lymph nodes in oncological surgery. The rate of severe allergic reactions to blue dyes remains a controversial topic, with the true incidence and influencing factors uncertain. METHODS: A systematic review and meta-analysis was performed to identify all studies which report on the incidence of severe adverse reactions and anaphylaxis to blue dyes (patent blue, isosulfan blue, methylene blue, and indigo carmine), when used for SLNB. Collected data included cancer and dye type, volume, and method of injection. Incidence was estimated using the arcsine method of statistical analysis. RESULTS: One hundred nine studies documenting 94 episodes of anaphylaxis in a total of 61,951 SLNB procedures, resulting in a weighed anaphylaxis rate of 0.061%. SLNB for breast cancer carries an anaphylaxis risk of 0.083%, with the risk markedly lower in melanoma surgery (0.0043%). Low dye volume (<2 mL) and intradermal injection are both associated with lower rates of anaphylaxis (0.031% and 0.0068%). Isosulfan blue seems to be the most anaphylactogenic amongst blue dyes with a rate of 0.16%. There were no reported cases of death in this cohort. CONCLUSION: Anaphylaxis to blue dyes in SLNB is rare. Methylene blue, patent blue, lower dye volumes, and intradermal administration are all associated with a lower incidence of anaphylaxis.

Long-term seizure recurrence after eclampsia: A systematic review and meta-analysis.

BACKGROUND: Seizure recurrence after a fit has implications for both individuals and healthcare providers guiding neurologic prognosis, treatment, and driving and work restrictions. A systematic review of long-term seizure recurrence after eclampsia will help to quantify recurrence risk in this setting. OBJECTIVE: To evaluate the long-term recurrence of seizures after eclampsia. SEARCH STRATEGY: After PROSPERO registration, Medline (Ovid), Embase, and Cochrane Library were searched by using the terms (eclampsia OR eclamp* OR eclamptic seizure* OR eclamptic fit*) AND (recur* OR recurrent fit* OR recurrent seizure*) for studies published up until December 2019. SELECTION CRITERIA: Studies describing long-term seizure recurrence after a diagnosis of eclampsia were included. DATA COLLECTION AND ANALYSIS: Data were extracted from studies independently by two authors. Pooled prevalence was calculated and weighted based on sample size with a 95% confidence interval (CI). MAIN RESULTS: Initially, 1754 unique studies were identified and 4 were included in the final analysis. The studies involved 1896 women, of whom 7 (0.37%) were affected by a further seizure. The weighted pooled prevalence of seizure recurrence was 0.18% (95% CI, 0.03-1.02). CONCLUSION: The absolute rate of long-term seizure recurrence after eclampsia is extremely low and within safe limits for driving.

Cerebral venous sinus thrombosis complicating traumatic head injury.

Cerebral venous sinus thrombosis (CVST) is a rare complication of traumatic head injury. Here we present a patient with traumatic extradural haematoma successfully evacuated with good clinical recovery. However, the patient then deteriorated and died. The cause, at post mortem, was a propagating CVST, sustained at the time of head injury. CVST, although rare, is therefore an important cause of deterioration in traumatic head injury. This patient with CVST is unique in that CVST was not considered as a diagnosis in the face of more obvious pathology and was responsible for late deterioration. We discuss the potential difficulties in both the detection and management of such a complication, particularly in association with extradural haematoma.