[Sentinel node and operable breast cancer: utilization of blue dye injection. Pilot study]. / Ganglion sentinelle et cancer opérable du sein: utilisation du bleu patent. Etude pilote.

STUDY AIM: Sentinel node detection in breast cancer can be realized with colorimetric and isotopic procedures often associated. The aim of this study was to report results obtained with blue dye injection only. PATIENTS AND METHOD: From September 1998 to July 1999, blue dye injection was performed in 73 consecutive patients (mean age: 51 years, range: 36-71 years); 51/70 70% were post-menopausal and half of them were under substitute hormonal treatment; 70% of cancers were discovered through routine mammography. There were 12 bilateral cancers, six of them synchronous, and 84% of cancers were located in the external quadrants. Individualization of sentinel node was performed through blue dye injection into the tumor in case of preoperative diagnosis or in the tumoral site in case of discovery of the cancer through extemporaneous histological examination. RESULTS: 71 out of 73 cancers were classified pT1 and 70% measured 10 mm and over. Individualization of sentinel node failed in two obese patients. Sentinel node invasion concerned one node (n = 7), two nodes (n = 1) and three nodes (n = 1). Conservative treatment was performed in 72 patients out of 73; in case of sentinel node invasion, axillary irradiation was performed without reoperation. CONCLUSION: Blue dye injection for sentinel node individualization is an accurate technique in selected patients in case of small tumors. Reoperation can be avoided and replaced by axillary irradiation in case of N+ tumors. Duration of hospitalization was 48 hours or under in 70/73 patients. Nevertheless isotopic procedure must be recommended as a routine technique in learning centers and for most surgical teams.

[Pleural plaque fibrosis: a clinical case]. / Fibrosi pleurica a placche: caso clinico.

A recent case of pleural plaques fibrosis in a worker exposed since 20 years to asbestos induced us to report our experience. A 52-year-old man was seen because of chest multiple opaques of soft tissue density without any symptoms. The CT-scan of thorax with i.v. contrast showed multiple lesions of diameter 0.5-4 cm on the posterolateral pleura bilaterally. FNAB of one lesion CT guided was not diagnostic. The pleural biopsy obtained at surgical exploration showed hyaline tissue, avascular, almost acellular, with calcifications and inflammation of low grade. The pleural plaques are generally multifocal and bilateral. They usually affect the parietal pleura. The connection between asbestos and plaques is firmly established. The pathogenesis is not well known. The pleural plaques fibrosis is a benign disease and a very common manifestation of asbestos exposure; it is not related to mesothelioma and it does not need any treatment. Because of the lack of symptoms it must be searched for in high risk subjects.

[The integrated radiosurgical treatment of rectal cancer]. / Trattamento integrato radiochirurgico del cancro rettale.

The value of radio-surgical protocols in the treatment of advanced rectal cancer has been studied retrospectively. 21 patients operated between 1986 and 1990 fulfilling some criteria were considered for this study. They were 9 men and 12 women with rectal cancer Duke's stage B2-C; 16 were treated with preoperative radiotherapy (30-35 Gy), 5 were treated with postoperative radiotherapy (40-60 Gy). The operative procedures were 12 anterior resections and 9 Miles operations. The 5 years results were: a) cancer free survival 52%; 2 patients alive with relapse; 2 patients with non cancer related death (DIC, radiation enteritis); d) cancer related deaths 28%; e) local recurrence was observed (3 pts) only in association with metastatic disease; f) no isolated local recurrence was observed. Preoperative radiotherapy with 30-35 Gy is judged the preferred protocol for decreasing the rate of isolated local recurrence and for increasing the survival rate. Omental flap transposition plays an important role in the radio-surgical treatment of advanced rectal cancer.