Role of intra-operative sentinel lymph node biopsy in oral cavity and oropharynx squamous cell carcinoma: preliminary data.

In patients with squamous cell carcinoma of the oral cavity and oropharynx, the presence of latero-cervical lymph node metastases was found to be the most important of the better known prognostic factors. Still, today, the most reliable technique by which to detect the presence of lymph node metastases is surgery aimed at the dissection of the latero-cervical space; albeit, this surgical procedure has been shown to be an over-treatment in a large percentage of patients presenting squamous cell carcinoma, clinically, radiologically and histologically negative, at neck level. The technique of intra-operative biopsy of sentinel lymph node, routinely used in the staging and treatment of tumours with elective lymphatic involvement such as carcinoma of the breast and malignant cutaneous melanoma, has progressively caught the attention of head and neck surgeons in the most important referral centres in the world, and, indeed, its role has been hypothesised in the treatment of patients with squamous cell carcinoma of the oral cavity and oropharynx with clinically N0 neck. Preliminary results are reported, concerning the use of this intraoperative sentinel lymph node biopsy technique with double tracer in patients presenting squamous cell carcinoma originating in the mucosa of the upper air-digestive tract, clinically and radiologically free from disease at latero-cervical level.

[Thallium-201 myocardial perfusion imaging after aortocoronary bypass in patients treated with sulodexide or ASA-dipyridamole]. / Analisi con tallio-201 del quadro perfusionale miocardico dopo bypass aortocoronarico in pazienti trattati con sulodexide ed in pazienti trattati con ASA-dipiridamolo.

The aim of this investigation was to compare the preventive effect of sulodexide, a glycosaminoglycan drug, tested versus ASA-dipyridamole association, on the occlusion of venous aortocoronary bypass. A group A of 23 patients, for a total of 22 anastomosis with internal mammary artery and 46 venous bypass, was treated with sulodexide 500 USL/day. A group B of 18 patients for a total of 19 anastomosis with internal mammary artery and 33 venous bypass, was treated with ASA-dipyridamole 300 mg + 400 mg/day. Three and 9 months after surgery, all patients underwent thallium-201 myocardial perfusion imaging, associated with ergometric test. At the first control after 3 months, reversible perfusion defect in one or more myocardial segments was observed in 8 patients of group A and 3 patients of group B (2 A patients and 1 B patient in non revascularized myocardial segments); after 9 months, reversible perfusion defects were observed in 4 A patients and in 4 B patients. After 3 months, non reversible perfusion defect imaging in non infarcted myocardial segments was observed in 2 A patients and in 1 B patient; after 9 months, in 1 patient of both groups. This research shows higher incidence, at first control after 3 months, of ischemic reversible perfusion defects in patients treated with sulodexide, with an evident improvement in some patients recontrolled after 9 months. At the last control after 9 months, the scintigraphic findings showed similar evidence of perfusion defects in both groups treated with sulodexide or ASA-dipyridamole, with concordant angiographic findings (78.6%). Our preliminary results are encouraging and suggest further widespread studies on sulodexide therapy.

67Ga citrate scanning, X-ray computed tomography and chest X-ray in the study of interstitial pneumonia in patients with AIDS.

Problems in the investigation of pulmonary interstitial pneumocystis carinii in AIDS patients in the early phase with 67Ga, high-resolution CT scan and chest X-ray are discussed, and a clinical study of 12 individuals is presented. The combination of the three examinations is useful in reducing false negative cases. The use of 67Ga scanning, chest X-ray and high-resolution CT is also proposed in the follow-up of AIDS patients during remission of their lung pathology.