Hand exercise effect in maturation and blood flow of dialysis arteriovenous fistulas ultrasound study.

With the help of the Doppler Ultrasound we have measured the radial artery blood flow of 20 healthy volunteers and the fistula flow of 40 uraemic patients. The measurements were made at rest and repeated one, three and five minutes after initiation of hand exercise, and one minute after the exercise had finished. Radial artery mean flow increased significantly with the exercise (p less than 0.001); radial arteries with greater baseline flow had less flow increase (p less than 0.002). However, we were not able to demonstrate any fistula flow increase with the hand exercise. Therefore, we conclude that there is no benefit in advising uraemic patients to squeeze a rubber ball which, otherwise, supposes an unnecessary preoccupation for these patients.

[Incidence of axillary recurrence after a negative sentinel lymph node result in early stages of breast cancer: a 5-year follow-up]. / Incidencia de recurrencia axilar tras un ganglio centinela negativo en cáncer de mama en estadios iniciales: seguimiento de 5 años.

UNLABELLED: The sentinel lymph node (SLN) biopsy is currently the procedure of choice for axillary node staging in initial stages of breast cancer. The purpose of this study is to establish our false negative rate within a 5-year follow-up period in 258 patients with breast cancer staged with this procedure. METHODS: A retrospective study on 258 consecutive T1-T2<3 cm pN0 staged breast carcinomas treated from January 1, 2001 to December 31, 2005 was performed. The combined technique of isotope plus blue dye was used for detection. The subjects underwent a minimum follow-up of 5 years, mean 81 months, with an end of follow-up at December 31, 2010. Evidence of axillary recurrence, tumor recurrence in the breast and signs of disease progression or death were the events collected and analyzed. RESULTS: Of the 258 patients, 3 false negatives (1.1%) with axillary recurrence were detected at 10, 11 and 29 months of the surgery. This did not have a significant repercussion in the survival analysis on the contrary to the existence of breast recurrence or the appearance of distant metastasis in 4.7% and 6.2% patients, respectively. Global survival related with the cancer was 93.0 (240/258) and disease free survival was 89.1% (230/258). CONCLUSION: The risk of developing axillary recurrence after a negative SLN without axillary node dissection is low enough to consider the SLN procedure to be the best approach for axilla staging in early breast cancer. This staging technique also makes it possible to achieve local disease control without diminishing the survival of the patients.

Surgical venous cannulation with Doppler ultrasound.

We describe herein a technique by which surgical venous catheterization ("cut down") is easily and quickly performed with a minimal incision even in the obese patient or patient with shock, with the help of a slightly modified Doppler apparatus.

The sialyl Lewis X analogue, CY-1503, down-regulates leucocyte-endothelium interactions and the inflammatory response.

OBJECTIVE: To elucidate mechanisms of protection of ischaemic liver with the sialyl Lewis X analogue CY-1503 by regulation of inflammatory mediators such as oxygen free radicals and cytokines as well as blocking the migration of leucocytes. DESIGN: Laboratory study. SETTING: Teaching hospital, Spain. ANIMALS: 122 male Sprague-Dawley rats divided into four groups: normal (n = 18), sham-operated (n = 28), ischaemic controls (n = 38), and CY-1503 (n = 38). INTERVENTIONS: Warm total hepatic ischaemia for 90 minutes followed by various periods of reperfusion. MAIN OUTCOME MEASURES: Survival, liver histology, liver function, neutrophil infiltration, and free radical and cytokine concentrations. RESULTS: 2/20 ischaemic controls survived, compared with 14/20 given CY-1503. Liver function was better, as was histological appearance judged by the Suzuki score); myeloperoxidase activity was significantly decreased (n = 6 in each group, p<0.01) as were concentrations of free radicals (n = 12 in each group, p<0.05) in the group given CY-1503. CY-1503 had no effect on concentrations of the cytokines tumour necrosis factor-alpha or interleukin 1-alpha. CONCLUSIONS: CY-1503 exerts a protective effect in that it able to down-regulate concentrations of free radicals in our rat model. It is a potent inhibitor of neutrophil migration, but has no effect on cytokine concentrations.

Flow of dialysis fistulas. Noninvasive study performed with standard Doppler equipment.

Ultrasound was used for the measurement of the flow of 50 dialysis fistulas. Mean flow was 806.2 ml/min. There was no difference between the flow of the different types of fistula. It has been observed that although the vein diameter determines the fistula flow, and the former continues to increase even after the fistula has matured, blood flow through the fistula does not increase as its velocity decreases with greater diameters. Flow measurements with ultrasound have important advantages and indications, which are commented.

Incidencia de recurrencia axilar tras un ganglio centinela negativo en cáncer de mama en estadios iniciales: seguimiento de 5 años / Incidence of axillary recurrence after a negative sentinel lymph node result in early stages of breast cancer: a 5-year follow-up

La biopsia selectiva del ganglio centinela (GC) es en la actualidad el procedimiento de elección en la estadificación axilar en cánceres de mama en estadios iniciales. El objetivo de este trabajo es establecer nuestra tasa de falsos negativos a lo largo de un período mínimo de 5 años de seguimiento de 258 pacientes con cáncer de mama estadificados mediante este procedimiento. Método. Estudio retrospectivo de 258 pacientes con cáncer de mama consecutivos T1-T2<3cm estadificados como pN0 mediante GC entre enero-2001 y diciembre-2005.Se empleó la técnica combinada isotópica y colorante para la detección. Fueron sometidos a seguimiento con un período mínimo de 5 años, la media fue 81 meses, siendo el punto final del seguimiento el 31 de diciembre de 2010. La evidencia de recurrencia axilar, recidiva tumoral en la mama, presencia de enfermedad a distancia, y muerte fueron los eventos recogidos y analizados. Resultados. De las 258 pacientes, se detectaron 3 falsos negativos (1,1%), con recurrencia axilar a los 10, 11 y 29 meses de la cirugía. En el análisis de supervivencia este hecho no tuvo repercusión significativa, a diferencia de la existencia de recidiva mamaria o la aparición de metástasis a distancia que ocurrieron en un 4,7 y un 6,2% de las pacientes. La supervivencia global relacionada con el cáncer fue de un 93,0% (240/258) y la supervivencia libre de enfermedad del 89,1% (230/258). Conclusión. El riesgo de recurrencia axilar tras un ganglio centinela negativo sin vaciamiento linfático completo es lo suficientemente bajo como para considerar a este procedimiento como de elección en la estadificación axilar del cáncer de mama en estadios iniciales. Además, permite alcanzar un adecuado control local de la enfermedad sin disminuir la supervivencia de los pacientes(AU)

The sentinel lymph node (SLN) biopsy is currently the procedure of choice for axillary node staging in initial stages of breast cancer. The purpose of this study is to establish our false negative rate within a 5-year follow-up period in 258 patients with breast cancer staged with this procedure. Methods. A retrospective study on 258 consecutive T1-T2<3cm pN0 staged breast carcinomas treated from January 1, 2001 to December 31, 2005 was performed. The combined technique of isotope plus blue dye was used for detection. The subjects underwent a minimum follow-up of 5 years, mean 81 months, with an end of follow-up at December 31, 2010. Evidence of axillary recurrence, tumor recurrence in the breast and signs of disease progression or death were the events collected and analyzed. Results. Of the 258 patients, 3 false negatives (1.1%) with axillary recurrence were detected at 10, 11 and 29 months of the surgery. This did not have a significant repercussion in the survival analysis on the contrary to the existence of breast recurrence or the appearance of distant metastasis in 4.7% and 6.2% patients, respectively. Global survival related with the cancer was 93.0 (240/258) and disease free survival was 89.1% (230/258). Conclusion. The risk of developing axillary recurrence after a negative SLN without axillary node dissection is low enough to consider the SLN procedure to be the best approach for axilla staging in early breast cancer. This staging technique also makes it possible to achieve local disease control without diminishing the survival of the patients(AU)