Lysine-urethane-based tissue adhesion for mastectomy-an approach to reducing the seroma rate?

PURPOSE: Postoperative seromas are a problem in the surgical treatment of breast cancer. The aim of the study was to evaluate whether the lysine-urethane-based tissue adhesive TissuGlu® without drainage is equal/ non-inferior to standard mastecomy with drainage. METHODS: The study was designed as a prospective, randomized, multicentre non-inferiority study comparing the use of TissuGlu® without drainage with standard wound care with a drain insertion in ablative breast procedures. The number of clinical interventions, quality of life and wound complications were followed-up for 90 days in both groups. RESULTS: Although the statistical power was not reached, twice as many clinical interventions were performed in the TissuGlu® group than in the drainage group, especially aspirations of clinically relevant seromas (p = 0.014). The TissuGlu® group produced overall less wound fluid, but developed a clinically relevant seroma (100% vs. 63%) which made an intervention necessary. Less hospitalisation time was observed in the TissuGlu® group, but the complication rate was higher. There was no significant difference in regards to postoperative pain. In summary the non-inferiority of TissuGlu® compared to standard drainage couldn't be reached. DISCUSSION: The present evaluation shows no advantage of the tissue adhesive TissuGlu® in terms of seroma formation and frequency of intervention compared to a standard drainage for mastectomies, but the shorter inpatient stay certainly has a positive effect on the quality of life.

ICG Fluorescence Technique for the Detection of Sentinel Lymph Nodes in Breast Cancer: Results of a Prospective Open-label Clinical Trial.

Introduction: Detection of sentinel lymph nodes (SLN) is the standard procedure to evaluate axillary lymph node status in breast cancer. In addition to known and established procedures such as the blue dye method and scintigraphy, this study investigated the efficacy of a method based on use of the fluorescent dye indocyanine green (ICG). Patients and Method: A total of 126 women with breast cancer histologically verified by punch biopsy were studied during surgical removal of SLN. In addition to SLN marking with technetium and scintigraphy, intra-individual comparison was done using indocyanine green (ICG) for marking instead of the standard blue dye. Results: Scintigraphy had a detection rate of 96 %; the detection rate with ICG was just under 89 %. A body mass index (BMI) > 40 was found to be a limiting factor for the fluorescent method. Investigation into potential toxicities associated with the use of the fluorescent dye ICG revealed no systemic or even local side effects. The fluorescent method was found to be significantly less expensive than the scintigraphy method. Conclusion: The ICG fluorescence technique for the detection of SLN was found to be a valid and feasible method in clinical practice when compared directly with the blue dye method and scintigraphy.

The HER2 status of disseminated tumor cells in the bone marrow of early breast cancer patients is independent from primary tumor and predicts higher risk of relapse.

Overexpression of the HER2-receptor in early breast cancer (EBC) patients is associated with aggressive tumor behavior. However, women suffering from HER2-positive EBC benefit from trastuzumab treatment. As the HER2 status of the primary tumor may differ from that of disseminated tumor cells (DTC) in bone marrow (BM), the aim of this study was (1) to compare the HER2 status of the primary tumor (prim-HER2-status) with that of DTC (DTC-HER2-status) and (2) to analyze the influence of the DTC-HER2-status on patient survival. For this purpose, BM aspirates from 569 EBC patients were analyzed for the presence of DTC. The DTC-HER2-status was identified by a double-staining procedure against cytokeratin and the HER2-receptor. DTC were detected in 151 (27 %) patients. The concordance between the HER2 status of DTC and the primary tumor was 51 %. In patients with detectable DTC, mean disease-free survival was 77.44 (95 % CI 74.72-80.17) months for DTC-HER2-negative and 55.15 (95 % CI 48.57-61.79) months for DTC-HER2-positive patients (p = 0.044). The multivariate analysis showed that the DTC-HER2-status was an independent predictor of disease-free survival. In conclusion, the presence of HER2-positive DTC in EBC patients is associated with an increased risk of relapse. Due to the low concordance between the HER2 status of the primary tumor and DTC, only a minority (13 %) of the DTC-HER2-positive patients was treated with trastuzumab. These patients might, however, benefit from HER2-directed therapy.

[Patent blue V : inert dye or potent allergen]. / Patentblau V : Inerter Farbstoff oder potentes Allergen?

Patent blue V is widely used as a food dye. Clinically, patent blue V dye has been increasingly used in oncological surgery to identify the sentinel lymph nodes in breast cancer and other malignancies. The case of a patient who developed severe anaphylactic shock to subcutaneous injection of patent blue V during breast surgery is presented. The clinical course and the anesthesiological management are presented, and the pitfalls that may delay the correct diagnosis are highlighted.

Putrid infectious pubic osteitis: case report and review of the literature on the differential diagnosis and treatment of infectious pubic osteitis and inflammatory pubic osteitis.

INTRODUCTION: The differential diagnosis of osteolytic, destructive, and inflammatory processes around the symphysis, the os pubis, and the ramus ossis pubis includes infectious osteitis pubis, inflammatory osteitis pubis, posttraumatic benign pubic osteolyses in elderly women, and malignant neoplasia. Accurate diagnosis can be a challenge and requires a methodical approach and the use of a variety of diagnostic measures. MATERIALS: A case study of an 83-year-old female suffering from infectious pubis osteitis sheds light on the differential diagnosis of these conditions, particularly the distinction between infectious pubic osteitis and inflammatory pubis osteitis. In addition to the diagnostic indicators and methodologies, differential treatments are considered and a review of current literature on the topic is presented.

Massive cavernous lymphangioma of the breast and thoracic wall: case report and literature review.

Lymphangiomas are benign lesions but are associated with high morbidity when they become very large, occur in critical locations, or when surgically removed, develop secondary wound infections. Almost all lesions require surgical treatment. Complete excision is curative; however, relapses must be anticipated with incomplete excision. We report the case of a patient with a long history of massive cavernous lymphangioma of the breast and thoracic wall extending into the axilla in whom complete excision was not possible.

Evolving medical informatics: from diagnosis to prognosis.

The application of computers to the medical field is not new; however, the leisurely rate of integration has left the medical field in the "dark ages" of technology. A brief overview of how computers and technology have been used in the medical field is necessary to understand medical computer science. The recent advances of the internet infrastructure and personal computing, combined with the ubiquitous nature of their application, have allowed everyday people to incorporate technology into their daily routine. Only a few have ventured into the ill-defined world of medical computer science, some with great success, others with hopeful failures. The purpose of this paper is to sustain the recent advances in medical computer science and to provide support for shifting the focus of medical technology from diagnosis towards patient prognosis.

Different hemagglutinin cleavage site variants of H7N7 in an influenza outbreak in chickens in Leipzig, Germany.

The hemagglutinin (HA) genes from four avian H7N7 influenza A isolates, from a single outbreak, were shown to possess different cleavage sites that contain varying numbers of basic amino acid residues (KKKKR, KRKKR, KKRKKR, KKKKKKR). All four variants are highly pathogenic in chickens and share an immediate common ancestral HA with A/tern/Potsdam/342-6/79 (H7N7) and A/swan/Potsdam/63-6/81 (H7N7). These viruses are nonpathogenic and contain no extra basic amino acids at the cleavage site of their HA. During evolution a common precursor virus acquired different sequences at the cleavage site of the HA and became highly pathogenic in chickens. In vitro assays revealed that the HA from A/chicken/Leipzig/79 with KKKKR at the cleavage site was only partially cleaved (41%), compared to 93-100% cleavage of the other HAs. Since all four viruses were highly pathogenic in chickens, these findings confirm that the degree of pathogenicity in vivo is not exclusively determined by the degree of HA cleavability.

Characterization of a novel influenza hemagglutinin, H15: criteria for determination of influenza A subtypes.

Two viruses with a novel hemagglutinin (HA), A/duck/Australia/341/83 and A/shearwater/West Australia/2576/79, have been isolated from a duck and a shorebird in Australia. Hemagglutination inhibition and double immunodiffusion assays failed to reveal cross-reactivity with any of the known subtypes (H1 to H14). We therefore propose that these viruses constitute a new HA subtype, H15. Sequence analysis of the HA genes confirmed the serologic findings. When compared at the amino acid level, the HA1 region of the H15 subtype differs from those of the other subtypes by 30% and more. This degree of heterogeneity is also found among HA genes of other subtypes. Thus we propose that amino acid sequence data should be evaluated when determining the HA subtypes of influenza A viruses. Sequence comparison and phylogenetic analysis suggested that the HA subtype H15 is most closely related to the H7. Compared to the H7 HA, the H15 acquired a 30-nucleotide insertion within HA1 at position 253 which is located in the globular head of the molecule. This finding suggests that RNA recombination, although a rare event in nature, may play an important role in the evolution of influenza viruses.

Do hemagglutinin genes of highly pathogenic avian influenza viruses constitute unique phylogenetic lineages?

Avian influenza A viruses of the H5 and H7 subtypes periodically cause severe outbreaks of disease in poultry. The question we wished to address in this study is whether these highly pathogenic strains constitute unique lineages or whether they and related nonpathogenic viruses are derived from common ancestors in the wild bird reservoir. We therefore compared the nucleotide and amino acid sequences of the hemagglutinin (HA) genes of 15 H5 and 26 H7 influenza A viruses isolated over 91 years from a variety of host species in Eurasia, Africa, Australia, and North America. Phylogenetic analysis indicated that the HA genes of H5 and H7 viruses that cause severe disease in domestic birds do not form unique lineages but share common ancestors with nonpathogenic H5 and H7 viruses. These findings predict that highly pathogenic avian H5 and H7 influenza A viruses will continue to emerge from wild bird reservoirs. Another important question is whether H7 influenza viruses found in mammalian species are derived from avian strains. We included eight equine influenza viruses and one seal isolate in the phylogenetic analysis of H7 HA genes. We could show that the HA genes of both, the equine and the seal viruses, shared ancestors with avian H7 HA genes. This indicates that currently circulating H7 viruses with an avian HA gene may have the potential to adapt to mammalian species and to cause an influenza outbreak in the new host.

The effects of atrazine on microcosms developed from four natural plankton communities.

Comparisons were made among Leffler microcosms developed from four different natural communities and exposed to 0, 20, 100, 200, 500, 1,000, and 5,000 micrograms/L atrazine, a commonly used herbicide. Atrazine reduced net primary productivity, pH, and net productivity/respiration ratios in all four microcosm communities. In three of the four communities, the lowest observed (P less than 0.05) effect concentration (LOEL) was 100 micrograms/L. In the fourth community the LOEL was 200 micrograms/L atrazine. The sensitivity and accuracy of bioassays with four different microcosm communities were evaluated by comparing results with values reported for acute and chronic single species bioassays, other types of microcosms, and experimental ponds exposed to similar concentrations of atrazine. The ranges of sensitivity noted in these experiments were less than the range reported for single species bioassays using common test organisms and similar to those reported for other microcosms. The similarity between Leffler microcosm results and the responses reported for the experimental ponds suggests that the Leffler microcosms accurately reflected concentrations causing ecosystem level changes in the experimental ponds.