Sentinel node biopsy and neoadjuvant chemotherapy in the treatment of breast cancer.

PURPOSE: Sentinel lymph node biopsy (SLNB) has become a safe and accurate alternative to axillary lymph node dissection (ALND) in the surgical management of early breast cancer. The aim of this study was to determine the false negative rate of SLNB in patients with advanced breast cancer after neoadjuvant chemotherapy. METHODS: Forty-eight patients with 49 advanced breast cancers (one patient had bilateral disease) underwent neoadjuvant chemotherapy. All of them had SLNB, followed by standard level I/II ALND. SLNs were identified in 47 out of 49 tumors (detection rate 95.9%). RESULTS: Axillary nodal metastases were detected in 28 patients; SLNs were positive only in 14 patients. Four sentinel internal mammary nodes were removed in 4 patients, while one of them was positive with micrometastasis but axillary nodes were negative. False-negative results occurred in 2 (7.14%) patients. The results of our study confirm that SLNB in patients with advanced breast cancer is not significantly altered by the preoperative chemotherapy. Biopsy results were very similar to those without any neoadjuvant chemotherapy. CONCLUSION: ALND, known for its serious complications, can be replaced in some cases by SLNB.

[Local recurrences after conservative surgery in breast carcinoma]. / Lokální recidivy po konzervativních výkonech u karcinomu prsu.

BACKGROUND: Local recurrences in breast after conservative surgery are failure of primary therapy. The aim of the study was monitoring of local recurrences after conservative surgery and also relationships of local recurrences with disease free interval and survival. MATERIALS AND METHODS: Between 1.12.1998 and 30.06.2004, 143 patients with breast carcinoma were treated at Department of Surgery Atlas Hospital Zlin by conservative surgery. All patients received radiotherapy and boost in breast. Macroscopic free margins were 10 mm and reexcision were done in all patients with free margins less than 5 mm. Dose of the radiotherapy whole breast and cavity were 50 Gy, interval 5-6 weeks, daily 2Gy. Brachytherapy received all patients, combination of chemotherapy and hormonal therapy were 56x, only chemotherapy 31x, only hormonal therapy 31x and without adjuvant therapy 25x. RESULTS: Median follow-up was 32 month. Tumor size according to TNM classification: TIS 10, pT1a 1x, pTb 28x, pTc 55x, pT2 44x, pT3 5x. Stage: 0 1x, I 58x, IIA 56x, IIB 24x, IIIA 4x. Local recurrences in breast were 5x, (3.49%), distant metastases 6x, (4.1%) and 3x (2.09%) appeared distant metastases and death at breast carcinoma without local recurrence. Only in one patient local recurrence were followed by distant metastases and death. Interval from local recurrence and death was 12 month. Size of the original tumor with local recurrences was from 10mm to 45 mm. Interval from the time of initial treatment to local recurrences was from 12 to 42 month. Surgical treatment of local recurrences included mastectomy 4x and conservative surgery 1x. CONCLUSION: Number of local recurrences is in correspondence with international guideline and results of modern multimodal therapy.

[Sentinel lymph node biopsy in the breast carcinoma in clinical practice]. / Biopsie sentinelové uzliny u karcinomu prsu v klinické praxi.

AIM: In the management of early breast carcinoma, biopsy of sentinel lymph nodes has gradually replaced dissection of Level I and II axillary nodes. The aim of the study is to assess feasability and reliability of the method in our conditions. METHOD: From June 1998 to June 2007, a total of 458 sentinel node biopsies (SLNB) were performed. Originally, patent blue sentinel node mapping was used. Since 2000, a combination of radiocolloid application and a gamma- probe (detector), as well as the patent blue, has been used. Originally, SLNBs were followed by axillary dissections, however, in 2002, the procedure was waived in cases of negative sentinel nodes findings. RESULTS: Out of the total of 458 SLNB patients, 382 female patients were included in the study. SLNB, without concomitant axillary dissection, was performed in 170 subjects. In 70 subjects, the sentinel node was positive and they were indicated for axillary dissections. Positive non-sentinel nodes were detected 17 times. In total, 899 sentinel nodes were examined in the study group of 382 biopsies. The mean was 2.35. False negative nodes were recorded in three cases in female patients with SLNB and axillary dissection (4.6%). No local relapses in the axilla were recorded in negative sentinel node findings without subsequent axillary dissections. CONCLUSION: Sentinel node biopsy is a safe alternative to axillary dissection in the surgical management of early breast carcinoma.

[Benefits of intraoperative n. laryngeus recurrens neuromonitoring in thyroid surgery]. / Prínos peroperacního neuromonitoringu n. laryngeus recurrens v tyreoidální chirurgii.

INTRODUCTION: N. laryngeus reccurens injury is a serious complication in thyroid surgery. Nerve visualization is a procedure preventing its traumatization. The visualization with additional intraopertive neuromonitoring results in further reduction of the n. laryngeus reccurens injury rates. AIM: Verification of the intraoperative neuromonitoring effects on reduction of the n. laryngeus reccurens injury rates. MATERIAL, METHODOLOGY: 309 operated patients were included in the intraoperative neuromonitoring prospective study. A total of 295 patients were included in the study and intraoperative monitoring was performed per protocol. RESULTS: Out of the total of 295 subjects, 1 patient sufferred from permanent paresis, ie. 0.33%, nerves at risk 0.2%. 6 subjects sufferred from transient pareses, i.e. 2.03%, nerves at risk 1.2%, with a prevailing 8-week recovery period of the ORL findings. CONCLUSION: Intraoperative neuromonitoring in thyroid surgery is yet another option for reduction of the n. laryngeus reccurens intraoperative injury rates.

[Initial results of the bipolar RFITT coagulation in advanced stages of hemorrhoidal disorder study]. / První výsledky studie bipolární RFITT koagulace vyssích stadií hemoroidální nemoci.

AIM OF THE STUDY: The aim is to verify a new methodology of radiofrequency bipolar coagulation for treatment of hemorrhoids in practice. USED METHODS: The method of bipolar radiofrequency-induced thermotherapy of internal and external hemorrhoids using the Olympus Celon apparatus. Radiofrequency bipolar electrode was applied to perform coagulation of internal and external hemorrhoids under visual control and feedback. RF energy was applied, on average, at 12 sites above the dentate line to treat internal, stage III hemorroids. In stage IV hemorrhoids, based on the prolapse extent, it was applied to external hemorrhoids, as well. In four subjects, the method was used in combination with a standard Parks management to perform excision of perianal fibromas. RESULTS: From September 2007 to June 2008, the method was used in 18 patients with stage III and IV hemorrhoids. 15 patients underwent a per- protocol follow up on postoperative Day 7 and Day 21. Then, the first 5 subjects were checked in a 6- month interval and will be re-assessed in 12 months. The average duration of the procedure was 20 minutes and duration of hospitalization was 24 hours. Postoperative bleeding lasted for average 0-10 days. Major postoperative edema occured in 2 subjects. The average pain intensity (on 0-10 scale) was 1.5 on Day 7; 0.46 on Day 21. The postoperative complications included anal fissures with increased pain intensity in 2 subjects with a preoperative history of anal procedures. Transient edema of external hemorrhoids occured upon management of the stage IV hemorrhoidal disorder. CONCLUSION: Bipolar radiofrequency-induced thermotherapy of hemorrhoids is a new, semiinvasive method of the management of hemorrhoids. It is safe, with minimal rates of early postoperative complications. It is well-tolerated and evaluated by patients. Long-term results will be published further.

[Cavernous haemangioma of the small intestine leading to haemoperitoneum]. / Kavernózní hemangiom tenkého streva jako prícna hemoperitonea.

The authors present a case-review of a cavernous haemangioma of the small intestine as a cause of haemoperitoneum in a young female. The authors discuss the patient's history, completed examinations and surgical management of the case including a detailed histological examination of the intestinal resecate with cavernous haemangioma. Discussion includes literature data of the published case-reviews.

[Crossectomy--the most important step in varices surgery]. / Crossectomia - nejdulezitejsí krok v operaci krecových zil.

The authors present ethiology and aethilogy-based surgical techniques of the disorder on a group of 3458 patients operated for varices of lower extremities. Crossectomy is flashed out as a key moment of the procedure in cases of sapheno-phemoral junction insufficiencies. The results are presented on two patient groups comparing relaps rates of the disorder following completion of partial selective and radical complete crossectomies. A subject of neovascularization and its relation to the procedure and relapses is discussed.

[Distribution of metastatic affection in colorectal carcinoma using lymphatic mapping and radiation-navigated biopsy of the sentinel lymph node]. / Distribuce metastatického postiienif u kolorektálního karcinomu s pouzitím metody lymfatického mapování a radiacne navigované biopsie sentinelové uzliny.

AIM: The aim is to define distribution of the lymphonode metastatic affection in colorectal carcinoma and to evaluate a new methodology of lymphatic mapping and the sentinel lymphonode detection during colorectal carcinoma procedures in practice. USED METHODS: A method of peroperative lymphatic mapping using a Patentblue method in vivo. Rectoscopic peritumoral application of a radiocoloid in a two-day or a single-day protocol, scintigraphy, peroperative quants of radioactivity detection using a gamma probe. Radical or paliative tumor resection. Detection of the sentinel and non-sentinel nodes on a preparation ex vivo, divided according to levels. The metastatic affection distribution is assessed in three levels, marked U1 - U3, a S1 - S3. Histopathological examination of the nodes on series sections and, event, immunohistochemistry. RESULTS: The methods were used in 66 patients. A total of 970 nodes have been examined, with an average of 14.6 nodes/ patient. The metastases quantity decreases with distance from the tumor. The peritumoral levels (U1a S1) record the highest rates of metastases. In our patient group, 92% of the metastases were recorded in the S1 level, 4% in the S2 level and 4 % in the S3 level. CONCLUSIONS: The highest rate of metastases was recorded in the levels, closest to the tumor, therefore, in case of negative findings of sentinel nodes in the S1 level, the nodes from this level may be closely examined (using the method of series sections and immunhistochemistry) and the staging be established more precisely.

[Lymphadenectomy in the early gastric carcinoma]. / Lymfadenektomie u casného karcinomu zaludku.

AIM: The method of extended lymphadenectomy in the early gastric carcinoma treatment remains controversial. The aim of this prospective study is to assess the above method feasibility with acceptable rates of complications, in our conditions. METHODOLOGY: From 2000 to 2003, 11 patients with early carcinomas of the stomach were treated using the method of extended lymphadenectomy. The study group included 7 males and 4 females. RESULTS: In 6 cases, the tumors were located in the distal, in 4 cases in the middle and once in the proximal third of the stomach. In a single case, the IIIA stadium was concerned, the other cases were rated lower. In total, 205 lymphonodes measuring 18.6 on average (median of 16) were examined. The total of 5 lymphonodes were malignant, all of them were found in one patient. The method of the sentinel lymphonode biopsy was applied once. A cardiopulmonary complication was reported once, a punction of the subphrenic absces was reported once, a primary disorder causing a death was reported once and the patient concerned exited after a 14-month-period of his follow-up. Once, a local relaps of the disorder was reported 43 months after the procedure. The follow-up median was 27 months. CONCLUSION: The method of extended lymphadenectomy can be conducted even in our conditions with acceptable rates of complications.

[Mini-invasive radiation-navigated parathyreoidectomy--MIRP]. / Miniinvazivní radiacne navigovaná paratyreoidektomie--MIRP.

AIM: The aim was to introduce a new surgical method and to verify its validity. METHODOLOGY: In 20 patients whose ultrasound findings correlated with the MIBI scintigraphic results, a radiation-navigated parathyreoidectomy using a C-Track was conducted, following a radionucleotide application. RESULTS: From 2001 to 2003, 20 patients with hyperparathyreosis were operated. In all cases, an altered parathyroid gland with increased activity was detected using radionavigation. After the surgery, the calcium and the parathormone blood levels decreased. CONCLUSION: The MIRP is a miniinvasive surgical method indicated for the use in cases when hyperparathyreosis is confirmed and the ultrasound findings correlate with the MIBI-scintigraphic findings.

[Spontaneous bacterial peritonitis in the Czech Republic]. / Spontánní bakteriální peritonitida v Ceské republice.

The objective of the study was to assess the prevalence and more detailed data pertaining to the incidence of spontaneous bacterial peritonitis (SBP) in the Czech Republic. The authors examined 99 patients with cirrhosis of the liver and ascites. SBP was diagnosed in a high percentage--35 patients, i.e. 35.4%. It was found more frequently in patients with an alcoholic etiology of cirrhosis who had a history of subfebrile and febrile temperatures and increasing trend of ascites. For the diagnosis the increase of leucocytes in serum and C reactive protein levels may prove useful. Lower values of total protein and albumin in ascites predispose to the development of this infection. Reduction of the number of thrombocytes in the group of patients with SBP indicates the influence of portal hypertension in the etiology of this disease.