Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is a developing alternative to axillary dissection and may prove to be accurate in the detection of micrometastases in lymph nodes of breast cancer patients. Limited studies exist in the use of SLNB after neoadjuvant therapy. This study was undertaken to determine the accuracy of SLNB after neoadjuvant chemotherapy. METHODS: Thirty-one patients with stage I or II breast cancer underwent SLNB after neoadjuvant chemotherapy. RESULTS: Lymphatic mapping was performed by radioisotope, blue dye, or both techniques. Sentinel nodes (SN) were identified in 29 patients (93.5%). The SN was positive in 11 patients (38.0%), and was the only positive node in 5 patients (45.5%). There were no false negative SN by hematoxyin and eosin stain or immunohistochemistry (IHC) studies. CONCLUSIONS: Sentinel node identification rate is similar to that in nonneoadjuvant studies. The sentinel node accurately predicted metastatic disease in the axilla. IHC studies failed to detect any additional micrometastases. This diagnostic technique may provide treatment guidance for patients after neoadjuvant therapy.

Surgical knowledge base augmentation by medical rotations: does it happen?

A study of 4 groups of fifth year medical students taking Surgery during the 4 terms of 1989 at the University of Queensland was undertaken to determine whether there was assimilation of factual material relevant to the surgical knowledge base from the other specialty rotations done during the same year of the course. The records of multiple choice question (MCQ) examination results for the 210 students were retrieved and reviewed. The performance of the same students during their fourth-year rotation in Surgery was checked to make sure that the 4 groups did not already display unusual surgical aptitude or incompetence. The questions were categorized in order to ascertain that the content of all the examinations was similar. The results of students doing Surgery during the first of the 4 terms in 1989 were compared with subsequent groups. The difference between the groups was that those in the first term had not had the benefit of fifth year rotations through Internal Medicine, Psychiatry, General Practice and electives. Subsequent groups had increasing experience in the other specialties. The fourth and final group in the year had undertaken all four of the other rotations before doing Surgery. Significant improvement was found in the performance of each of the subsequent groups of students compared with the first-term group. This implies that there is an escalating accural of factual knowledge related to surgery from the fifth-year courses in Internal Medicine, Child Health and Psychiatry.

Breast lumps after reduction mammaplasty.

This paper examines the diagnostic problems raised when breast lumps develop after a reduction mammaplasty. We postulate the etiology and describe how xerograms can help in the diagnosis. We also make a strong case for preoperative xerography.

Refined liposuction unit.

I present two innovations that may be helpful to anyone who is designing or purchasing a unit for suction lipectomy: dual use of the unit as an ordinary operating room sucker, and cannulas with hand control.

Breast shaping procedures, abdominoplasty, and thighplasty in Australia.

There have been many changes in the last ten years in surgery of the breasts, abdomen, and thighs. This article places these advances in perspective from the point of view of a surgeon practicing in Australia. Careful consideration is given to minor points in operative technique and patient selection, which will help to achieve consistently good results with minimal complication. Great emphasis is placed on tailoring the operations to the needs of the patient.

Lip lifting.

The changing appearance of the upper lip may be a significant component in the "ageing face" syndrome. Its typical features are described. These can be corrected by a simple "lip lift". Complications are few and the manoeuvre has proved to be an excellent adjunct in restoring a more youthful outlook. It has little effect on "purse-string" lines of the upper lip that usually require dermabrasion or a chemical peel.

Nasal obstruction after rhinoplasty.

Nasal obstruction is a frustrating sequel of rhinoplasty to both the patient and the surgeon. Physiologic problems are caused by altered vasomotor mechanisms of the lining. Mechanical obstruction results from (1) over-correction of the nasal supporting structures, (2) infracture of long nasal bones, (3) septal irregularities, and (4) surgical adhesions.Simple and effective techniques for correcting each of these problems are described.

The traumatic pseudolipoma.

A contour deformity, clinically reminiscent of a large lipoma, can develop after a severe shearing-type injury to the upper thigh, hip, or sacrum, particularly in young women. As the injury is rarely dealt with in the first weeks, it usually presents after a deep scar has contracted. At this stage active surgical intervention seriously increases the aesthetic problem. Conservative treatment with massage, pressure, and possibly injection of steroids is more effective. To the best of our knowledge, this condition has not previously been described.