The Use of Indocyanine Green and Near-Infrared Fluorescence Imaging Versus Blue Dye in Sentinel Lymph Node Biopsy in Cutaneous Melanoma: A Retrospective, Cohort Study.

BACKGROUND: The use of indocyanine green (ICG) and near-infrared fluorescence imaging is a promising option for sentinel lymph node (SLN) mapping in cutaneous melanoma. The study objective was to compare the performance of ICG and blue dye at detecting SLNs with radioisotope nanocolloid (technetium-99). METHODS: Between April 2018 and June 2022, 293 consecutive patients with cutaneous melanoma (Breslow thickness ≥ 0.8 mm) underwent wide local excision and SLN biopsy. Patients were divided into group A (ICG; n = 122) and group B (blue dye; n = 163). All patients underwent SPECT/CT imaging preoperatively. SLN detection parameters and complications were compared between the groups. RESULTS: A total of 285 patients had complete data and were included in the analysis. The median age was 62.0 (range 10-91) years, and 139 (48.8%) were female patients. The mean Breslow thickness was 2.6 mm, 89 (31.2%) patients had ulceration, and 179 (62.8%) patients had mitosis ≥ 1 mm2. The mean number of SLNs detected per patient in group A was 1.58 and group B was 1.48. In groups A and B, the SLN detection rate was 96.7% versus 89.6% (p = 0.022) and the pathological SLN detection rate was 92.3% versus 97.1% (p = 0.481), respectively. CONCLUSIONS: ICG had a higher SLN detection rate and equal pathological SLN detection rate to blue dye. ICG may not be inferior to blue dye and is a useful adjunct to radioisotope in SLN biopsy in cutaneous melanoma.

Role of Recombinant Activated Factor VIIa (rFVIIa) in Bleeding Mycotic Aneurysm of the Abdominal Aorta.

Mycotic aortic aneurysm is an infective disease of the aorta with high mortality rate despite surgical repair. Recombinant activated factor VIIa (rFVIIa) is approved for the treatment of bleeding in hemophilia and used (off-labeled) in acute bleeding related to the trauma, cardiac surgery, and intracranial bleed. A 38-year female was admitted with abdominal pain, and was subsequently diagnosed with bleeding mycotic aneurysm of the abdominal aorta. She was given rFVIIa and the bleeding stopped successfully. We recommend further evaluation of the role of rFVIIa in bleeding mycotic abdominal aortic aneurysm, as it can bring a novel change in the management of this devastating disease. Key Words: Mycotic aortic aneurysm, Factor VIIa (rFVIIa), Abdominal aorta, Bleeding.

Organochlorine residual concentrations in cattle egret from the Punjab Province, Pakistan.

In this study, residual concentration of organochlorine pesticides (OCPs) in the sediments, prey, and eggs of Bubulcus ibis were measured from three breeding heronries from the Punjab province of Pakistan. Pattern of contamination in eggs followed the order: DDTs>HCHs>heptachlor>aldrin. Overall, pesticide residual concentrations were greater in eggs of cattle egrets collected from heronry on the River Ravi. Among HCHs, γ-HCH was more prevalent in eggs, whereas DDTs followed the order: DDD>DDE>p,p'-DDT>o,p'-DDT. Eggshell thinning was detected which showed negative relationship with residual concentration of DDE. In prey samples, residual concentration of POPs followed the order: DDTs>HCHs>dicofol>heptachlor; however, contamination pattern in sediments followed a slightly different order: DDTs>heptachlor>dicofol>HCHs>dieldrin>aldrin. Concentration of ß-HCH was more prevalent in sediments and comparatively greater concentrations of POPs were measured in sediments collected from the River Ravi. Dicofol was found for the very first time in the biological samples from Pakistan, and its concentration was measured as relatively high in eggs from heronry from the River Chenab. Residual concentrations measured in eggs were below the levels that could affect egret populations. Biomagnification of the total OCPs through the food chain was evident in three breeding heronries. The concentration of DDE measured in eggs of the cattle egret suggests the need for monitoring this contaminant in other bird species at different trophic levels.