Identification of the sentinel lymph node stained with blue dye in breast cancer patients.

PURPOSE: This study aimed to evaluate the reproducibility of sentinel lymphadenectomy in breast cancer patients (T1N0M0 and T2N0M0) and its possibility of predicting the total axillary behavior. METHODS: A total of 25 patients were evaluated, all presenting palpable mammary nodes between 1.5 and 5 cm (T1 and T2), with clinically negative axillary lymph nodes (N0). After an incisional biopsy of the tumor and histopathological confirmation of invasive breast carcinoma, a study of the sentinel lymph node took place with a peritumoral injection of 4 ml of blue dye at 2.5%. After waiting for 15 to 20 minutes, a search for the blue stained lymphatic vase in the axillary fat was carried out, which would lead to the sentinel lymph node, stained or not. At that point, a mastectomy (20 patients) or a quadrantectomy (5 patients) was performed, both with axillary lymphadenectomy at grades 1, 2 and 3. The sentinel lymph nodes and the material from the axillary dissection were sent separately for an anatomicopathological test in paraffin. RESULTS: The lymph nodes were identified in 19 patients, which represented a 76% detection rate. There was a concordance between the sentinel lymphadenectomy and the standard axillary dissection in 68.4% of the patients. The false-positive and the false-negative rates observed were 10% and 55.5%, respectively. A higher detection rate was found in tumors larger than 2 cm and situated in external quadrants. CONCLUSIONS: Sentinel lymphadenectomy identified the sentinel lymph node in the majority of the patients in this study, although the high rate of false-negatives observed prevented an accurate staging.

[Obstetric factors associated with low birth weight]. / Fatores obstétricos associados ao baixo peso ao nascer.

An analysis was made of 18,804 of 19,446 consecutive births of the number analysed 15.93% presented low birth-rate. Significant statistical association was found in relation to maternal age, pre-natal care, previous pregnancies, smoking and gestational age at birth. Measures with a view to the attenuation of the problem are proposed, among them being: educational programs for teenagers on human reproduction, programs designed to create awareness of the harm done by smoking, amplification of antenatal assistance, medical programs for the limitation of premature labor, all of these and others, in association with programs of socio-economic support.

Sentinel lymph node in endometrial cancer.

The aim of this study was to evaluate the possibility of identifying the sentinel lymph node and involvement of neoplastic cells in patients with endometrial carcinoma limited to the uterus, and also its correlation with the conditions of other pelvic and para-aortic lymph nodes. Forty patients with endometrial carcinoma, clinical staging I and II, were submitted to complete surgical staging through laparotomy, as recommended by FIGO in 1988. The sentinel node was investigated using patent blue dye in the myometrial subserosa. The sentinel node was excised and submitted to frozen section examination of specimen, stained with hematoxylin and eosin (H&E). Afterward, selective bilateral para-aortic and pelvic lymphadenectomy, total hysterectomy with bilateral salpingo-oophorectomy were performed. The lymph nodes excised were examined by means of paraffin-embedded slices stained with H&E and of imunohistochemistry with antikeratin antibody AE1/AE3. The sentinel lymph node was identified in 77.5% of patients (31/40), and 16.1% (5/31) presented neoplastic involvement in the node. In 25 cases of negative sentinel node, 96% (24/25) had no neoplastic involvement, and 4% (1/25) had other lymph node affected (false negative). In nine cases with no sentinel node identified, 55.5% (5/9) had lymph node involvement. The results of this study allow us to conclude that it is possible to identify the sentinel node using the methods described, and the pathologic examination significantly represents the same conditions of other pelvic and para-aortic lymph nodes.

[Cerclage of the cervix uteri via a transabdominal route: report of 2 cases]. / Circlagem do colo uterino por via transabdominal: relato de dois casos.

The authors present two cases of transabdominal cervicouterine cerclage using Benson and Durfee's technique. In both cases the surgery was successful and the patients gave birth at 37 and 40 weeks, respectively, to healthy newborns. The technique is recommended by the authors since technical details are observed.

[Myasthenia gravis and pregnancy: review of the literature and report of 6 cases occurring in 5 patients]. / "Miastenia gravis" e gestação: revisão da literatura e relato de seis casos ocorridos em cinco pacientes.

The authors report six cases of myasthenia gravis during pregnancy. Three patients experienced increasing severity of their disease and one death occurred in the puerperium. The infants were born with no evidence of neonatal myasthenia. The patients should be closely monitored during labor and puerperium. This disease is characterized by unpredictable exacerbations, and the association of myasthenia gravis and pregnancy increases the risk for the patient.