Dynamical footprints of hurricanes in the tropical dynamics.

Hurricanes-and more broadly tropical cyclones-are high-impact weather phenomena whose adverse socio-economic and ecosystem impacts affect a considerable part of the global population. Despite our reasonably robust meteorological understanding of tropical cyclones, we still face outstanding challenges for their numerical simulations. Consequently, future changes in the frequency of occurrence and intensity of tropical cyclones are still debated. Here, we diagnose possible reasons for the poor representation of tropical cyclones in numerical models, by considering the cyclones as chaotic dynamical systems. We follow 197 tropical cyclones which occurred between 2010 and 2020 in the North Atlantic using the HURDAT2 and ERA5 data sets. We measure the cyclones instantaneous number of active degrees of freedom (local dimension) and the persistence of their sea-level pressure and potential vorticity fields. During the most intense phases of the cyclones, and specifically when cyclones reach hurricane strength, there is a collapse of degrees of freedom and an increase in persistence. The large dependence of hurricanes dynamical characteristics on intensity suggests the need for adaptive parametrization schemes which take into account the dependence of the cyclone's phase, in analogy with high-dissipation intermittent events in turbulent flows.

The French Advanced Course for Deployment Surgery (ACDS) called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX): history of its development and future prospects.

INTRODUCTION: The composition of a French Forward Surgical Team (FST) has remained constant since its creation in the early 1950s: 12 personnel, including a general and an orthopaedic surgeon. The training of military surgeons, however, has had to evolve to adapt to the growing complexities of modern warfare injuries in the context of increasing subspecialisation within surgery. The Advanced Course for Deployment Surgery (ACDS)-called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX)-has been designed to extend, reinforce and adapt the surgical skill set of the FST that will be deployed. METHODS: Created in 2007 by the French Military Health Service Academy (Ecole du Val-de-Grâce), this annual course is composed of five modules. The surgical knowledge and skills necessary to manage complex military trauma and give medical support to populations during deployment are provided through a combination of didactic lectures, deployment experience reports and hands-on workshops. RESULTS: The course is now a compulsory component of initial surgical training for junior military surgeons and part of the Continuous Medical Education programme for senior military surgeons. From 2012, the standardised content of the ACDS paved the way for the development of two more team-training courses: the FST and the Special Operation Surgical Team training. The content of this French military original war surgery course is described, emphasising its practical implications and future prospects. CONCLUSION: The military surgical training needs to be regularly assessed to deliver the best quality of care in an context of evolving modern warfare casualties.

Use of SPECT/CT for improved sentinel lymph node localization in endometrial cancer.

OBJECTIVE: To assess the usefulness of adding SPECT/CT to planar images for pre-surgical sentinel lymph node (SLN) identification in endometrial cancer (EC), a technique that could have an important clinical impact on the staging, treatment, and prognosis of EC patients. METHODS: We compared the planar and SPECT/CT lymphoscintigraphic images of 44 patients with high-risk EC who underwent sentinel lymph node procedure (SLN) using an injection technique recently developed at our center known as TUMIR (Transvaginal Ultrasound Myometrial Injection of Radiotracer). 148 MBq (4 mCi) of 99mTc-nanocolloid were injected, guided by transvaginal ultrasound imaging. Planar and SPECT/CT images were performed in all 44 patients. RESULTS: SLNs were seen on planar images in 32 cases (73%) and in 34 cases (77%) using SPECT/CT. A total of 88 SLNs were depicted by planar lymphoscintigraphy while SPECT/CT visualized a total of 110 SLNs. SPECT/CT changed the assessment of the SLNs visualized in planar lymphoscintigraphy in 26 cases, either by modifying the number and/or the location of the SLNs detected. External iliac chain was the most frequent location of SLN detection (71%) in the 34 cases. Fifteen of these patients (44%) showed para-aortic SLNs. One case had exclusive para-aortic drainage (3%) that was only visualized by SPECT/CT. In another case, SPECT/CT was able to localize the only pelvic metastatic lymph node not visualized by planar images. CONCLUSIONS: SPECT/CT combined with planar imaging improves preoperative SLN detection and provides valuable anatomic information that enhances the presurgical stage of the SLN technique in endometrial cancer.

Patients with cirrhosis and ascites have false values of bone density: implications for the diagnosis of osteoporosis.

UNLABELLED: The effect of ascites on bone densitometry has been assessed in 25 patients with advanced cirrhosis, and it was concluded that ascites over 4 l causes inaccuracy of BMD measurements, particularly at the lumbar spine. This fact must be considered when assessing bone mass in patients with decompensated cirrhosis. INTRODUCTION: Bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA) is the best procedure for assessment of osteoporosis and fracture risk, but BMD values at the central skeleton may be influenced by changes in soft tissues. Therefore, we have studied the effect of ascites on BMD. METHODS: BMD was measured by DXA at the lumbar spine, femoral neck and total hip, just before and shortly after therapeutic paracentesis in 25 patients with advanced liver cirrhosis. Changes in BMD, lean and fat mass, abdominal diameter and weight, as well as the amount of removed ascites were measured. RESULTS: The amount of drained ascites was 6.6 ± 0.5 l (range: 3.0 to 12.7 l). After paracentesis, BMD increased at the lumbar spine (from 0.944 ± 0.035 to 0.997 ± 0.038 g/cm(2), p < 0.001) and at the total hip (from 0.913 ± 0.036 to 0.926 ± 0.036 g/cm(2), p < 0.01). Patients with a volume of drained ascites higher than 4 l showed a significant increase in lumbar BMD (7.0%), compared with patients with a lower amount (1.5%) (p < 0.03). The decrease in total soft tissue mass correlated with the amount of removed ascites (r = 0.951, p < 0.001). Diagnosis of osteoporosis or osteopenia changed after paracentesis in 12% of patients. CONCLUSION: Ascites over 4 l causes inaccuracy of BMD measurements, particularly at the lumbar spine. This fact must be considered when assessing bone mass in patients with advanced cirrhosis.

Experiments and numerical simulations on hovering three-dimensional flexible flapping wings.

In this paper, the applicability and accuracy of high-fidelity experimental and numerical approaches in the analysis of three-dimensional flapping (revolving and pitching) wings operating under hovering flight conditions, i.e. where unsteady and three-dimensional rotational effects are strong, are assessed. Numerical simulations are then used to explore the role of mass and frequency ratios on aerodynamic performance, wing dynamics and flow physics. It is shown that time-averaged lift increases with frequency ratio, up to a certain limit that depends on mass ratio and beyond which upward wing bending and flexibility induced phase lag between revolving an pitching motions at stroke reversal become strong and contribute to phases of negative lift that counterbalances the initial lift increase. This wing dynamics, which is dominated by spanwise bending, also affects wing-wake interactions and, in turn, leading edge vortex formation.

Impact of mothers' IPV-PTSD on their capacity to predict their child's emotional comprehension and its relationship to their child's psychopathology.

Background: Previous studies demonstrated that when the violence-exposed child becomes a mother and interacts with her own child during early sensitive periods for social-emotional development, she may have difficulties providing sensitive responsiveness to the child's emotional communication. Such difficulties place the child's development of emotional comprehension (EC) and related self-regulation at risk. The aim of this study was to examine how mothers' interpersonal violence-related posttraumatic disorder (IPV-PTSD) would affect their children's EC and their own ability to predict their children's EC. We also investigated how mothers' predictive ability would correlate with child psychopathology. Methods: Sixty-one mother-child dyads (36 with IPV-PTSD) participated in this study. Children's (mean age = 7.0 years, SD = 1.1) EC was assessed with the Test of Emotion Comprehension (child TEC) and their psychopathology as reported by the mother was assessed with the Child Behaviour Checklist (CBCL) and as evaluated by a clinician using selected modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Mothers were measured for IPV-PTSD with the Clinician Administered PTSD Scale (CAPS) and for their capacity to predict their child's emotional comprehension (mother-responding-as-child TEC; mTEC). Results: We found no significant between-group differences in children's level of EC. Maternal PTSD was associated with lower scores on the mTEC, however. Reduced maternal scores on the mTEC were significantly associated with maternal report of increased aggressive child behaviour and with depression symptoms on the K-SADS. Further, scores on the mTEC interacted with maternal report of child aggression on child oppositional defiant disorder (ODD) symptoms on the K-SADS. Conclusion: These findings support that improving maternal emotional comprehension may help reduce child risk for psychiatric morbidity in this population.

Antecedentes: Los estudios previos demostraron que cuando la niña expuesta a violencia llega a ser madre e interactúa con su propio hijo durante periodos críticos tempranos para el desarrollo socioemocional, ella podría tener dificultades para brindar una respuesta sensible a la comunicación emocional del niño. Tales dificultades podrían poner en riesgo el desarrollo de la comprensión emocional del niño (CE) y la autorregulación asociada a ella. El objetivo de este estudio fue evaluar cómo el trastorno de estrés postraumático por violencia interpersonal de las madres (TEPT-VIF) podría afectar tanto la CE de sus hijos como su propia capacidad de predecir la CE en sus hijos. También investigamos cómo la capacidad predictiva de las madres podría correlacionarse con psicopatología infantil.Métodos: En este estudio participaron sesenta y una diadas madre-hijo (36 con TEPT-VIF). La CE de los niños (edad media = 7.0 años, DE = 1.1) fue evaluada mediante la prueba de Comprensión Emocional (TEC en sus siglas en inglés) del niño. Asimismo, la psicopatología del niño, según lo reportado por la madre, fue evaluada con la Lista de Chequeo Conductual del Niño (CBCL en sus siglas en inglés) y según la evaluación de un médico utilizando módulos seleccionados de la Escala Infantil para Trastornos Afectivos y Esquizofrenia (K-SADS por sus siglas en inglés). En las madres, se midió tanto el TEPT-VIF mediante la Escala para el Trastorno de Estrés Postraumático Administrada por el Clínico (CAPS en sus siglas en ingles) como su capacidad de predecir la comprensión emocional del niño mediante la prueba de Comprensión Emocional en la que la madre responde como el niño (mTEC en sus siglas en inglés).Resultados: No encontramos diferencias significativas entre los grupos en los niveles de CE de los niños. Sin embargo, el trastorno de estrés postraumático materno estuvo asociado a puntajes más bajos en el mTEC. Los puntajes maternos bajos en el mTEC estuvieron significativamente asociados en la K-SADS a un reporte materno de un aumento de la conducta agresiva del niño y a síntomas depresivos. Adicionalmente, los puntajes en el mTEC estuvieron relacionados en la K-SADS con un reporte materno de agresión del niño dentro de los síntomas del trastorno oposicionista desafiante (TOD).Conclusión: Estos hallazgos respaldan que el mejorar la comprensión emocional materna podría ayudar a disminuir el riesgo infantil de morbilidad psiquiátrica en esta población.

Acute Myocarditis after COVID-19 vaccination: A case report.

INTRODUCTION: The etiology of myocarditis often remains undetermined. A large variety of infectious agents, systemic diseases, drugs, and toxins can cause the disease. We report the case of a 19-year-old man who developed myocarditis three days after Pfizer-BioNTech COVID-19 booster vaccination. CASE REPORT: A 19-year-old man, presenting with troponin-positive acute chest pain, was referred to our department. He had received the Pfizer-BioNTech COVID-19 vaccine three days prior to his admission. The diagnosis of acute myocarditis was confirmed by cardiovascular magnetic resonance imaging. Patient hemodynamic status remained stable during hospitalization. The left ventricular ejection fraction was preserved during hospital stay and at one-month follow-up. We found no evidence for another infectious or autoimmune etiology. CONCLUSION: Although imputability of the vaccine cannot be formally established on the basis of this case report, the findings raise the possibility of an association between mRNA COVID-19 vaccination and acute myocarditis.

[Acute autoimmune myocarditis secondary to Graves' disease: a case report]. / Myocardite aiguë auto-immune secondaire à une maladie de Basedow : à propos d'un cas.

INTRODUCTION: Interactions between heart and thyroid are strong. Main cardiac complications of Graves' disease are supra-ventricular tachycardia or high output cardiac failure, without real myocardial involvement. OBSERVATION: A 40-year-old man with history of refractory Graves' disease was hospitalized for an acute chest pain with elevated cardiac biomarkers and normal coronarography. Acute myocarditis was confirmed by cardiac MRI. We found no evidence for an infectious etiology. We retained the hypothesis of acute autoimmune myocarditis in the context of active Graves' disease. CONCLUSION: Acute myocarditis is an exceptional complication of Graves' disease, with most likely an autoimmune mechanism. Possible occurrence of fulminant rhythmic or hemodynamic complications justify minimal cardiological check-up before introducing beta blockers.

[Particularities of African descent patient's electrocardiogram]. / Particularités de l'électrocardiogramme du patient d'origine Africaine.

Particularities of African descent patient's electrocardiogram have been described for many years. Variations such as higher QRS voltage, early repolarization pattern, precordial T-wave inversion and anterior ST segment elevation associated with T-wave inversion are more frequently observed. Ignorance of these variations can lead to misdiagnosis or therapeutic negligence. We present the electrocardiographic particularities attributed to the patient of African origin.

A general analytical solution to the geometrical problem of field matching in radiotherapy.

PURPOSE: Several authors studied the problem of geometrical matching of fields produced by medical linear accelerators. However, a general solution has yet to be published. Currently available solutions are based on parallelism arguments. This study provides a general solution, considering not only parallelism but also field sizes. METHODS: A fixed field with arbitrary field size, gantry, collimator, and couch angle is considered, and another field with a fixed gantry angle is matched to it. A single reference system attached to the treatment couch is used, and two approaches are followed. In the first approach, fixed field sizes are assumed and parallelism of the adjacent field-side planes is imposed. In the second approach, fixed isocenter positions are considered and both parallelism and coincidence between field-side planes are required. RESULTS: When fixed field sizes are assumed, rotation angles are obtained; however, the isocenters may need to be shifted to make side planes coincident and therefore achieve a proper match. When fixed isocenter positions are considered, solutions for all parameters, including the field size, are obtained and an exact geometrical match is achieved. CONCLUSIONS: General expressions to the field-matching problem are found for the two approaches followed, fixed field sizes, and fixed isocenter positions. These results can be applied to any treatment technique and can easily be implemented in modern treatment planning systems.

Prognostic value of tyrosinase reverse transcriptase PCR analysis in melanoma sentinel lymph nodes: long-term follow-up analysis.

OBJECTIVE: To determine the prognostic value of detecting tyrosinase transcripts in melanoma sentinel lymph nodes (SLNs). METHODS: Reverse transcription (RT) PCR for tyrosinase mRNA was performed on negative SLNs of 76 patients with melanoma. RESULTS: Tyrosinase mRNA was found in 39 patients (51.3%). After a median follow-up period of 51 months, significant differences were found in overall survival (OS) but not in disease-free survival (DFS). The 5-year OS and DFS rates were 97.2% and 80%, respectively, for RT-PCR tyrosinase-negative (TN) patients vs. 78.67% and 66.24% for RT-PCR tyrosinase-positive (TP) patients (P = 0.019 and P = 0.38, respectively). Of four progressing patients in the TN group, three relapsed with subcutaneous, soft-tissue or lymph-node metastases, while seven out of nine progressing patients in the TP group relapsed at visceral sites. CONCLUSIONS: No significant differences in DFS were found by RT-PCR tyrosinase expression analysis at melanoma SLNs. Significant differences in OS could be related to a different pattern of relapse and must be confirmed after a longer follow-up time.

Monitoring system for isolated limb perfusion based on a portable gamma camera.

BACKGROUND: The treatment of malignant melanoma or sarcomas on a limb using extremity perfusion with tumour necrosis factor (TNF-alpha) and melphalan can result in a high degree of systemic toxicity if there is any leakage from the isolated blood territory of the limb into the systemic vascular territory. Leakage is currently controlled by using radiotracers and heavy external probes in a procedure that requires continuous manual calculations. The aim of this work was to develop a light, easily transportable system to monitor limb perfusion leakage by controlling systemic blood pool radioactivity with a portable gamma camera adapted for intraoperative use as an external probe, and to initiate its application in the treatment of MM patients. METHODS: A special collimator was built for maximal sensitivity. Software for acquisition and data processing in real time was developed. After testing the adequacy of the system, it was used to monitor limb perfusion leakage in 16 patients with malignant melanoma to be treated with perfusion of TNF-alpha and melphalan. RESULTS: The field of view of the detector system was 13.8 cm, which is appropriate for the monitoring, since the area to be controlled was the precordial zone. The sensitivity of the system was 257 cps/MBq. When the percentage of leakage reaches 10% the associated absolute error is +/-1%. After a mean follow-up period of 12 months, no patients have shown any significant or lasting side-effects. Partial or complete remission of lesions was seen in 9 out of 16 patients (56%) after HILP with TNF-alpha and melphalan. CONCLUSION: The detector system together with specially developed software provides a suitable automatic continuous monitoring system of any leakage that may occur during limb perfusion. This technique has been successfully implemented in patients for whom perfusion with TNF-alpha and melphalan has been indicated.

Decrease in viral load at weeks 12 and 24 in patients with chronic hepatitis B treated with lamivudine or adefovir predicts virological response at week 48.

AIM: The aim of our study was to evaluate the decrease in viral load (VL) that is able to predict antiviral treatment response at one year in patients with chronic hepatitis B. METHODS: The clinical records of 66 patients, 31 treated with lamivudine (LAM) and 35 treated with adefovir (ADF), were retrospectively reviewed. We measured viral DNA at months 1, 3 and 6. RESULTS: The LAM group showed virological response (VR) in 51.6% of patients. Baseline VL was higher in non responders (5.37 +/- 1.16 vs. 7.01 +/- 1.05; p < 0.001). Responders showed a higher percentage of VL decrease at month 3 from baseline (49.2 vs. 38.3%; p = 0.03). We designed a ROC curve and established a cutoff point for decrease of 30% that had 80% of negative predictive value (NPV).The ADF group showed VR in 57.1% of patients. Baseline VL was higher in nonresponders (4.67 +/- 1.22 vs. 5.78 +/- 1.34; p = 0.01). We observed a significant decrease in VL (log) at months 3 (2.6 +/- 1.1 vs. 1.3 +/- 1.3; p = 0.03) and 6 (2.6 +/- 1.2 vs. 1.3 +/- 1.2; p = 0.006). The percentage of decrease of VL from baseline was also statistically significant. We created ROC curves at months 3 and 6, and established the best cutoff points. At month 6 a decrease of 1 log in VL had a NPV of 80%, and a decrease of 20% in VL from baseline had 100% NPV. CONCLUSION: The decrease in viral DNA at weeks 12 and 24 can predict VR at one year in patients with chronic hepatitis B treated with LAM or ADF. This could optimize treatment.

[Right ventricular failure as the presenting manifestation of a carcinoid syndrome]. / Atteinte cardiaque droite révélatrice d'un syndrome carcinoïde.

We report a 75-year-old woman with a severe and symptomatic valvular tricuspid dysfunction, revealing a carcinoid syndrome, confirmed by an octreotid scan and liver biopsy. Carcinoid heart disease is a common complication of carcinoid syndrome associated with poor prognosis. Despite new pharmacological treatment, valve replacement surgery is the only curative treatment. Early diagnosis and multidisciplinary management could improve prognosis and quality of life of these patients.

[Sentinel node in gynaecological cancers. Our experience]. / Ganglio centinela en cánceres ginecológicos. Nuestra experiencia.

UNLABELLED: Although sentinel lymph node (SLN) identification is widespread used in melanoma and breast cancer some concerns exist in other malignancies, such gynaecologic cancers, and this staging method has not been adopted in many centers due to lack or large validation studies. AIM: To evaluate the applicability and results of SLN technique in gynaecological malignancies referred to our institution. METHOD: We studied 155 patients with different malignancies (70 vulvar, 50 cervical and 35 endometrial cancers). The day before surgery a lymphoscintigraphy was performed by injecting 111 MBq of (99m)Tc-nanocolloid in several ways depending on the type of cancer studied. Intraoperative detection of the SLN was always performed by using a hand-held gammaprobe and, in 100 cases with the aid of blue dye injection (70 vulvar and 30 in cervical cancer) few minutes before surgical intervention. Pathological study of SLN was performed in all cases. Lymphadenectomy was done in all cervix and endometrial cancer patients and in the first 35 vulvar cancer patients. RESULTS: Pre-surgical lymphoscintigraphy demonstrated one, at least, SLN in 97% of vulvar cancer patients, 92% in the cervical malignancy and 64% in the endometrial cancer patients. During surgery, SLN was harvested in 97%, 90% and 62% of patients, respectively. The pathological study showed metastases in 24.2%, 8.8 and 4.5% of patients with vulvar, cervical and endometrial cancer, respectively. The false negative percentage was 5.5% in vulvar cancer patients, with 2 cases in the endometrial cancer and without any case in the cervical cancer patients. CONCLUSION: Lymphoscintigraphy is a relatively simple and useful technique to identify the SLN in this kind of tumours. However, in endometrial cancer more effort has to be made to reach a suitable result. Sentinel lymph node biopsy seems to be a reliable technique in vulvar and cervical malignancies.

[Peri-ictal SPECT in temporal lobe epilepsy: post-surgical evaluation]. / SPECT periictal en la epilepsia del lóbulo temporal: valoración tras cirugía.

INTRODUCTION: our aim was to evaluate the usefulness of peri-ictal SPECT in localising the epileptogenic region (ER) in candidates for temporal lobectomy to treat medically refractory complex partial seizures (CPS). Interictal and ictal SPECT, MRI and video-EEG results were compared and the positive predictive value (PPV) was calculated in those patients with good surgical outcome. MATERIALS AND METHODS: 37 patients who had a minimum of 3 years follow-up after surgery were studied retrospectively. Pre-surgical evaluation had included video-EEG monitoring, MRI and interictal and ictal SPECT. These results were compared to the surgically treated ER and successful outcome confirmed by post-surgical clinical follow-up. 29/37 patients remained seizure-free in the post-surgical follow-up. Interictal and peri-ictal SPECT were performed using 740 MBq of 99mTc-HMPAO. Peri-ictal SPECT was ictal in 25 patients and postictal in 12. RESULTS: ER concordance with video-EEG and peri-ictal SPECT was 86% (32/37 patients). It was 84% (31/37) for MRI and 54% (20/37 patients) for interictal SPECT. Peri-ictal SPECT localised the ER in 8/11 patients with discordant MRI and video-EEG results. Ictal SPECT localised the ER in the correct temporal lobe in 23/25 patients (92% concordance). In the 29 patients with a good surgical outcome, the PPV of video-EEG was 95% (27/29) and it was 90% (26/29) for both MRI and peri-ictal SPECT. CONCLUSIONS: peri-ictal brain SPECT is well able to localize ER in patients with temporal lobe epilepsy. Periictal SPECT concordance with ER was as good as video-EEG and MRI and its PPV was as good as that of MRI. We strongly recommend its use in the pre-surgical evaluation of temporal lobe epilepsy, especially when MRI and EEG are discordant.

Localising imaging in secondary hyperparathyroidism.

Preoperative imaging has proved its use successful in the localization of solitary parathyroid adenomas in patients with suspected primary hyperparathyroidism. However, due to multiglandular disease at presentation patients with renal hyperparathyroidism need to be analyzed separately, making the usefulness of imaging techniques controversial. Recently, improved methods of functional imaging like parathyroid scan with 99mTc-sestamibi or positron emission tomography, especially when combined with computed tomography, can provide additional quantitative and qualitative information that has yet to be assessed. Nuclear medicine procedures could prove useful not only in preoperative diagnosis, but also in the selection of medical or surgical therapeutic alternatives in secondary hyperparathyroidism patients. There is evidence that 99mTc-sestamibi uptake in parathyroid hyperplasia or adenoma is related to biochemical markers of parathyroid function. We are only beginning to identify the factors involved in radiotracer uptake by parathyroid cells and how it can be modulated to obtain more accurate results. This review analyzes the current use of non-invasive imaging modalities in patients with secondary hyperparathyroidism, taking into account the latest trends in the field combining anatomic and functional modalities and the relevant factors linked to radiotracer uptake in abnormal hyperfunctioning parathyroid glands.

[Application of the ROLL technique in a case of bilateral multifocal breast cancer]. / Aplicación de la técnica ROLL en un caso de cáncer de mama multifocal bilateral.

The increasing number of non-palpable breast lesions and the trend to perform less aggressive surgical procedures have prompted the development of radioguided surgery in breast lesions, alone (ROLL) or with sentinel node detection. We present a 55-year-old woman with four mammary lesions diagnosed by magnetic resonance. The ROLL technique allowed not only their characterisation but also the study of the lymphatic drainage of malignant lesions. Moreover, it was useful as a guide for surgical biopsy of the benign lesions. The combination of different colloid size allowed an accurate study of each lesion and avoided radical surgery. The applications of radioguided surgery are ever increasing. Individualisation of each indication will benefit a greater number of patients.

[In-transit sentinel lymph nodes in malignant melanoma. What is their importance?]. / Ganglios centinela ''en tránsito'' en el melanoma maligno. Cuál es su importancia?

UNLABELLED: The sentinel lymph node (SLN) is the first node in a lymph node basin to receive direct drainage from the primary tumour. However, in some cases, lymphoscintigraphy images demonstrate the presence of lymph nodes located in the area between the primary tumour and the first regional lymph node basin. These nodes are called in-transit nodes and have to be considered SLNs as well. AIM: It was to determine the incidence and location of in-transit SLNs in patients with malignant melanoma and to evaluate whether it is necessary to harvest them. METHOD. Nine hundred patients with malignant melanoma were included. Lymphoscintigraphy was performed on the day before surgery following intradermal injection of 74-111 MBq of 99mTc-Nanocolloid in four doses around the primary lesion or the biopsy scar. RESULTS: The presence of in-transit SLNs was revealed in 80 patients. During surgery, in-transit SLNs were identified and excised in all but 3 patients (96.2 %). Metastatic cell deposits were identified in these in-transit SLNs in 15 patients (19.4 %), with 4 patients with no tumour involvement of the regional lymph node basin. CONCLUSIONS: Lymphoscintigraphy is mandatory in the location of in-transit SLNs. Moreover, although the incidence of these nodes is relatively low in malignant melanoma, the presence of metastatic cells in these in-transit SLNs reaches a significant percentage. Therefore, excision of in-transit SLNs is necessary in all cases.