Upper Extremity Lymphedema After Axillary Lymph Node Dissection: Prospective Lymphoscintigraphic Evaluation.

This prospective study was designed to evaluate changes in upper extremity lymphatic drainage after ALND in comparison to the preoperative status using lymphoscintigraphy. The study enrolled 44 women (mean age: 57.95; range: 35-80) with a new diagnosis of unilateral invasive breast carcinoma who had been scheduled to undergo ALND. This was a substudy of the physiotherapeutic project, in which subjects after ALND were randomized into 4 groups treated with: 1) rehabilitation exercises; 2) manual lymphatic drainage; 3) pneumatic compression pump; and 4) education only. Clinical evaluation which included arm measurements and lymphoscintigraphy was performed in every subject before surgery and 3 times after surgery (1-6 weeks, 1 and 2 years after ALND). Follow-up was completed in 44 subjects at 1 year and in 32 subjects at 2 years. Lymphedema diagnosis was made in 4 subjects 1 year after ALND (9%) and in 8 subjects 2 years after ALND (25%). Among them, respectively, only 50% and 62% noticed and reported lymphedema. Quantitative analysis of lymphoscintigrams and photoplethysmography results did not reveal upper extremities lymphatic transport and/or venous function impairment after the ALND procedure. Qualitative analysis of lymphoscintigrams revealed most commonly disappearance of previously functional lymph nodes and appearance of dermal backflow in subjects who developed lymphedema. Conversely, appearance of functional lymph nodes in different locations after ALND may indicate protection from development of upper extremity lymphedema.

Axillary lymph nodes and arm lymphatic drainage pathways are spared during routine complete axillary clearance in majority of women undergoing breast cancer surgery.

Alterations in axillary lymph nodes (ALNs) after complete axillary lymph node dissection (ALND) in comparison to the preoperative status were evaluated using lymphoscintigraphy performed preoperatively and 1-6 weeks after surgery in 30 women with a new diagnosis of unilateral, invasive breast carcinoma. Analysis of lymphoscintigrams revealed that ALNs after surgery were present in 26 of 30 examined women. In comparison to preoperative status, they were visualized in the same location (12 women), in the same and additionally in different locations (9 women), or only in different locations (4 women). No lymph nodes were visualized in one woman and lymphocoele were in 4 women. Thus, after ALND, a variable number of axillary lymph nodes remain and were visualized on lymphoscintigraphy in the majority of women. The classical ALND, therefore, does not allow complete dissection and removal of axillary nodes with total disruption of axillary lymphatic pathways, accounting in part for the variable incidence and severity of lymphedema after the procedure.

[Back pain in pregnant women]. / Bóle kregoslupa u kobiet w okresie ciazy.

In the paper a problem of spinal ailments in women in the third trimester of pregnancy is presented. The study concerns the changes of both body posture and pulvis position. Some disadvantageous situations pregnant women meet with, which cause feeling of pain in spine are analyzed. The alarming lack of proper knowledge about phenomenon of spinal pain in pregnant women is also pointed out.

CT-guided suprasternal approach for mediastinal biopsy.

A case involving the use of the suprasternal approach for CT-guided biopsy of small retrosternal lesions is discussed, with the mention of some technical details.

Effect of fluphenazine on the footshock-induced opioid analgesia and leu-enkephalin concentration in the rat brain.

The effect of post-shock injection of 5 mg/kg fluphenazine on stress-induced analgesia (tail immersion test) and leu-enkephalin content in discrete brain areas (radioimmunoassay) was studied in male Wistar rats. The stress-induced analgesia, which was naloxone-reversible, was attenuated and shortened by fluphenazine, the drug also antagonized the stress-induced fall in hypothalamic leu-enkephalin content. Fluphenazine alone depressed the leu-enkephalin content in the medulla oblongata, and this effect was less marked in rats subjected to footshock.

Angiographic preoperative bowel segment localization using methylene blue, isosulfan blue, and fluorescein.

A canine model was used to determine the feasibility of preoperative, angiographic staining of bowel segments. Because methylene blue (MB) is contraindicated in patients with glucose-6-phosphate dehydrogenase deficiency or unstable hemoglobins, two alternate dyes, isosulfan blue (lymphazurin) and fluorescein were also studied. These three dyes were injected into 27 different mesenteric arterial branches in seven dogs following transfemoral catheterization. The duration of staining was evaluated over periods ranging from hours to 14 days, and pathologic sections were obtained to detect possible toxic effects. MB staining adequate for surgical resection persisted consistently up to 6 hours. Isosulfan blue and fluorescein produced adequate staining for only 30 to 60 minutes. Toxic mucosal changes were noted in four of 12 segments harvested within hours of the injection of MB and in none of the five MB injected segments harvested at four of 14 days. These changes varied greatly from focal regions of superficial necrosis to more generalized regions of transmucosal necrosis. All of the segments injected with isosulfan blue or fluorescein were free of histologic damage. It is concluded that the duration of staining produced by MB is sufficiently long to allow injection at angiography rather than at surgery. This allows decreased catheter time, and more importantly, precludes the possibility of interval catheter displacement. However, its clinical use should be viewed with some caution until its safety is established by further investigation. Isosulfan blue and fluorescein appear as alternate injectables, particularly for patients in whom MB is contraindicated. Because of their relatively short staining durations, injections with these agents should be made during surgery after angiographic catheter placement, although this method risks interval catheter dislodgement.

Abscesses with enteric communication: a potential pitfall in computed tomography.

We retrospectively reviewed the clinical and radiologic records of 17 patients with proven abdominal abscesses with enteric communication. Computed tomography was able to correctly diagnose an abdominal abscess in only 11 of these 17 patients. The six patients whose abscesses were missed with CT fell into three categories. Two patients had near water density fluid collections mistaken for fluid-filled loops of bowel. Two patients had large gas and fluid-filled collections mistaken for bowel, and two patients had collections containing a large amount of orally administered contrast material that were mistaken for contrast-filled loops of bowel. Retrospective examination of plain abdominal and/or digital scout radiography revealed findings suggestive of an abscess in 48% of the 17 patients, including two of the six CT false-negatives.

Adventitial cystic disease of the popliteal artery.

In a 27-year-old man with claudication, computed tomography (CT) demonstrated a popliteal cyst and an adventitial cyst of the popliteal artery. Adventitial cystic disease was unexpected because the patient had a diminished pedal pulse on plantar flexion of the foot, a physical finding suggesting popliteal artery entrapment syndrome. CT was useful in the initial examination of this young patient with suspected popliteal vascular disease because of its accuracy and noninvasiveness.

CT and ultrasound in abscess detection at specific anatomic sites: a study of 198 patients.

Records of 902 patients with possible abdominal abscess were reviewed and of these 198 had abscesses on at least one occasion imaged either with ultrasound (US) or computed tomography (CT). There were 235 episodes of either one or simultaneous multiple abscesses. Sensitivities of CT and US were analyzed according to anatomic site. The nature of errors made was tabulated. CT was significantly more sensitive than US for the detection of abdominal abscess. Causes of CT and US error in abscess detection are discussed, and recommendations regarding choice of exam and means of improving performance are made.

Computed tomography of renal oncocytomas.

A retrospective analysis of 5 renal oncocytomas studied with CT was performed. Oncocytomas appeared as rounded hypodense solid masses with sharp margination from the normal renal parenchyma. They showed uniform homogeneous enhancement on CT scans performed after drip infusion of urographic contrast. One oncocytoma studied with dynamic CT scanning demonstrated a stellate (spoke-wheel) pattern of enhancement. No evidence of involvement of adjacent renal parenchyma, perinephric fat, renal veins or regional lymph nodes was present at CT and the findings were confirmed at surgery. Although the differential diagnosis between renal oncocytoma and hypernephroma may not be possible, preoperative awareness of a potentially benign lesion may guide the surgeon to attempt renal preserving surgery instead of the customary nephrectomy.