The effects of postinjection massage on the sensitivity of lymphatic mapping in breast cancer.

BACKGROUND: The technique of lymphatic mapping and sentinel lymph node (SLN) biopsy is rapidly becoming the preferred method of staging the axilla of the breast cancer patient. This report describes the impact of postinjection massage on the sensitivity of this surgical technique. STUDY DESIGN: Lymphatic mapping at the H Lee Moffitt Cancer Center is performed using a combination of isosulfan blue dye and Tc99m labeled sulfur colloid. Data describing the rate of SLN identification and the node characteristics from 594 consecutive patients were calculated. Patients who received a 5-minute massage after injection of blue dye and radiocolloid were compared with a control group in which the patients did not receive a postinjection massage. RESULTS: When compared with controls, the proportion of patients who had their SLN identified using blue dye after massage increased from 73.0% to 88.3%, and the proportion of patients who had their SLN identified using radiocolloid after massage increased from 81.7% to 91.3%. The overall rate of SLN identification increased from 93.5% to 97.8%. The proportion of nodes that were stained blue among those removed increased from 73.4% to 79.7% after massage. CONCLUSIONS: As experience increases with this new procedure, the surgical technique of lymphatic mapping continues to evolve. The addition of a postinjection massage significantly improves the uptake of blue dye by SLNs and may also aid in the accumulation of radioactivity in the SLNs, further increasing the sensitivity of this procedure.

[Surgical treatment of Parkinson disease and essential tremor]. / Kirurgisk behandling af Parkinsons sygdom og essentiel tremor.

Recognition of the often failing effect of levodopa treatment as Parkinson's disease (PD) progresses has led to the resumption of surgical treatment. In the 1950'ies and 1960'ies pallidotomy and thalamotomy were commonly performed to reduce parkinsonian symptoms, whilst today these permanent lesions are replaced by Deep Brain Stimulation (DBS) of implanted leads. The advantages of DBS in either the subthalamic nuclei (STN) or the internal part of the globus pallidus are that implantation of leads into these nuclei can be performed bilaterally, and that DBS is a reversible treatment. Pallidotomy and thalamotomy are permanent lesions and if performed bilaterally these lesions often cause unacceptable complications. Bilateral stimulation of the STN is often preferred due to the reduction of rigidity, hypokinesia and tremor as well as the significant reduction of dyskinesias and off-periods. The motor functions are significantly improved and stabilized.

[Treatment of severe Parkinson disease with electric stimulation of the subthalamic nuclei]. / Behandling af svaer Parkinsons sygdom med elektrisk stimulation i nucleus subthalamicus.

INTRODUCTION: Patients with Parkinson's disease suffering from severe fluctuations, i.e. dyskinesias and on-off periods and/or severe tremor, who cannot be improved by adjustment of the medical treatment, can be treated with deep brain stimulation via leads implanted bilaterally into the subthalamic nuclei. METHODS: Nine patients with advanced idiopathic Parkinson's disease were treated with stereotactic and bilateral implantation of leads into the subthalamic nuclei. All patients had levodopa responsive Parkinson's disease and levodopa induced fluctuations in the form of on-off periods and dyskinesias. The mean age was 61 years and the mean duration of disease 15 years. The patients were followed for 12 months and evaluated with the Unified Parkinson's Disease Rating Scale off and on medications before and after lead implantation. RESULTS: The Hoehn & Yahr stage fell from 3.9/2.8 before lead implantation and off/on medication to 3.0/2.3 with lead stimulation turned on and off/on medication. The activity of daily living (ADL) index was significantly improved and reduced from 27/13 before lead implantation and off/on medication to 12/7 with the stimulation turned on and off/on medication i.e. with 55%/46% on stimulation. The motor score was likewise significantly improved and reduced from 55/28 to 24/17 i.e. with 56%/39% on stimulation. The most important results of deep brain stimulation in the subthalamic nuclei is the significant reduction of the motor fluctuations. On stimulation off periods were reduced from 30% to 6% and the dyskinesias were significantly reduced from 47% to 14% of the daytime. The mean dose of levodopa equivalent medication was reduced with 26%. DISCUSSION: In conclusion, patients with advanced Parkinson's disease and levodopa induced fluctuations can be successfully treated with bilateral high frequency electric stimulation of leads implanted into the subthalamic nuclei.

Blood transfusion practice in Belgium. As assessed by a national survey.

In April 1995 the Ministry of Public Health invited all Belgian hospitals to participate to a survey on the use of blood transfusion. The questionnaire presented two parts, the first one devoted to products transfused and the second one to the transfusion organisation in the hospital. 71 hospitals answered: 7 university and 64 general hospitals. All hospitals reported the use of red cells, 31 of them still used whole blood. Surgical departments transfused the greatest absolute amount of units, but the highest intensity (units/bed/year) was observed in intensive care units. 52 hospitals mentioned the use of autologous predeposit. The highest consumption of platelets occurred in medicine but intensive care showed the highest intensity of platelet transfusion. In 41 hospitals platelets were obtained by cytapheresis. The number of plasma units transfused was highly correlated with the quantities of packed red cells and whole blood transfused. Ten hospitals didn't report the use of any blood conservation technique. Returning unused units to the blood bank was allowed in 80% of the hospitals, their return to the transfusion center was permitted in 65% of the hospitals. A transfusion committee existed in only 11 hospitals. Transfusion should be improved by a better education of all physicians and nurses involved with transfusion and by improving standardisation, by better documentation, better reporting and information of all health care workers involved.

Epoetin alfa facilitates presurgical autologous blood donation in non-anaemic patients scheduled for orthopaedic or cardiovascular surgery.

Patients expected to need at least three units of blood for their elective cardiovascular or orthopaedic surgery, were allocated randomly to receive intravenous (i.v.) Epoetin alfa 600 IU kg-1 (n = 27), 300 IU kg-1 (n = 30) or placebo (n = 23), on days 1, 4 and 7. Provided haemoglobin > or = 11 g dL-1, one unit of blood was collected on days 1, 4, 7, 11 and 14. Iron supplementation was given throughout the study. Surgery was scheduled between days 18 and 21. Significantly more patients treated with Epoetin alfa (100% for 600 IU kg-1; 97% for 300 IU kg-1) were able to donate > or = 4 units of blood compared with placebo (78%) (P = 0.011 and P = 0.032). No significant differences were seen in total patient exposure to homologous blood (7.4%, 3.3% and 17.4%, respectively). Mean red cell volume donated (P = 0.005 for 600 IU kg-1; P = 0.158 for 300 IU kg-1 both vs. placebo) and production (P < 0.001 and P = 0.012, respectively) were dose related. Twenty-four patients became iron deficient. No differences in the incidence of adverse events were seen between the groups.

[Novel autograft method using positive selection of CD34 stem cells]. / Méthode nouvelle d'autogreffe par sélection positive de cellules souches sanguines CD34.

High dose chemotherapy with autologous blood stem cell rescue becomes widely used for patients with hematologic malignancies and solid tumors. Recently, it has been demonstrated that stem cells characterized by the CD34 antigenic marker could be positively selected using an anti CD34 monoclonal antibody and an avidin biotin immunoabsorption device. We report our experience of twelve selections and ten grafts. A CD34+ cells enrichment of 1.9 log (purity: 72%) and a CFU-GM cells concentration of 1.6 log have been obtained. In ten transplanted patients, the hematological recovery was similar to that obtained with non selected blood stem cells. The CD34+ cells purification allows mini graft infusion and purge of residual tumor cells implicated in relapse after autologous stem cells transplantation.

Immortalized hypothalamic luteinizing hormone-releasing hormone neurons express a connexin 26-like protein and display functional gap junction coupling assayed by fluorescence recovery after photobleaching.

Expression of gap junction proteins was studied in the LHRH neuronal cell line, GT1-7, as a first step in defining the signalling mechanisms responsible for the pulsatile secretion of LHRH. GT1-7 cells were found to express a connexin 26-like protein that comigrated with mouse liver connexin 26 and that reacted with connexin 26-specific antibodies on Western blots. Immunofluorescent staining revealed punctate staining in a fraction of the cells, often present at points of apparent contact with neighboring cell bodies or processes. Fluorescence recovery after photobleaching analysis of 5,6-carboxyfluorescein loaded GT1-7 cells showed dye coupling among 20-30% of cells that made contact with other cells, suggesting the presence of functional gap junctions in this cell line.

Ontogenesis of 3 beta-hydroxysteroid dehydrogenase delta 5-delta 4 isomerase in the rat ovary as studied by immunocytochemistry and in situ hybridization.

The enzyme complex 3 beta-hydroxy-5-ene-steroid dehydrogenase and steroid 5-4-ene isomerase (3 beta-HSD) is involved in the biosynthesis of all classes of active steroids, namely glucocorticoids, mineralocorticoids, and sex steroids. To obtain more information about the age-specific expression and localization of 3 beta-HSD during development in the rat ovary, two complementary cytochemical techniques were used, immunocytochemical localization with antibodies against purified human placental 3 beta-HSD, and 3 beta-HSD mRNA localization achieved by in situ hybridization with a [35S]-labeled cDNA encoding 3 beta-HSD. In the fetal ovary, no significant immunolabeling or hybridization signal could be observed. The first expression of the enzyme was observed 6 days after birth, immunolabeling as well as autoradiographic reaction being found in a few interstitial gland cells. At the 10th day of postnatal life, the theca interna cells of growing follicles appeared to be labeled with both techniques. The granulosa cells of growing follicles also exhibited hybridization signal, whereas no immunostaining could be detected in these cells at any of the time intervals studied. At puberty, 3 beta-HSD was localized in theca interna and granulosa cells of the growing and mature follicles as well as in the interstitial gland and corpus luteum cells. Similar results were obtained in 40-day-old and adult animals. The present data indicate a progressive expression of 3 beta-HSD in different morphological structures during ovarian development in the rat.

[Creation of a planned autologous transfusion unit in a hospital distinct from a transfusion center]. / Création d'une antenne de transfusion autologue programmée dans un hôpital distinct d'un centre de transfusion.

Autologous blood predonation now widely used for programmed surgery has been recently regulated by a law from january 9 1992. It establishes that the procedure must be performed under the responsibility of an accredited blood transfusion center. This work discloses that the establishment of an autotransfusion unit in a hospital endowed with an active surgical program is feasible, the major objective being improvement of the quality of life of elderly patients with invalidating diseases. We report the one year experience of a collaboration between the Braine-l'Alleud-Waterloo hospital and the Red Cross Erasme-Brabant Wallon blood transfusion center. Eighty patients enrolled in programmed surgery consisting mostly in orthopedic surgery have given 187 units of packed red blood cells and fresh frozen plasma. Sixty two patients (83%) were transfused solely with autologous blood. Tolerance was excellent as only 4 slight malaise episodes were observed. Our study also indicates that programmed predonation should be proposed mainly to patients for whom the prescribed blood is effectively transfused. Creation of such autotransfusion units in hospitals distinct from a blood transfusion center is feasible with the deep collaboration between physicians in charge of the patients, the hospital laboratory and the blood transfusion center.

Ontogenesis of 3 beta-hydroxysteroid dehydrogenase/delta 5-delta 4 isomerase in the rat adrenal as revealed by immunocytochemistry and in situ hybridization.

The enzyme 3 beta-hydroxy-5-ene-steroid dehydrogenase/5-ene-4-ene isomerase (3 beta-HSD) catalyzes an essential step in the biosynthesis of all classes of active steroids, namely glucocorticoids, mineralocorticoids, progesterone, and sex steroids. To obtain further information on the expression and localization of 3 beta-HSD during development in the rat adrenal, two complementary cytochemical techniques were used: immunocytochemical localization with antibodies against purified human placental 3 beta-HSD, and 3 beta-HSD messenger RNA localization achieved by in situ hybridization with a rat 3 beta-HSD complementary DNA probe. During foetal development, the first detection of 3 beta-HSD messenger RNA was achieved on day 16 by in situ hybridization, the silver grains being located on the cortical cells. Between days 17 and 20, on the other hand, immunostaining became positive in the cytoplasm of the same cortical cells, the capsule being negative by both immunostaining and in situ hybridization. Interestingly, two distinct zones of intensity of 3 beta-HSD localization could be distinguished, namely the highly labeled reticular and fascicular zones and the less positive glomerular zone. This observation coincides with the onset of fetal ACTH secretion on days 17-18 and with accelerated adrenocortical growth and differentiation. After birth and until day 25, strong immunolabeling was observed in the cytoplasm of adrenocortical cells, the glomerular zone being labeled at a lower degree than the remaining cortex. The same localization was obtained by in situ hybridization. This low labeling of the glomerular zone might be related to the low plasma levels of angiotensin II observed in the immature rat. From day 25 after birth, the three zones of the cortex were uniformly labeled and no immunostaining was seen in the medulla or capsule. Similarly, by in situ hybridization, silver grains were located exclusively in the adrenal cortex. The present data suggest that 3 beta-HSD expression could well play a major role in regulating adrenal function during foetal and postnatal development.

Glutathione peroxidase in early and advanced Parkinson's disease.

A defective antioxidant scavenging system plays a major role in one of the theories of the pathogenesis of Parkinson's disease. The aim of this study was to investigate whether there is a general difference in antioxidant activity between early and advanced cases of Parkinson's disease. Twenty five recently diagnosed patients, without any clinical fluctuations (group A), and 25 patients in a late phase of the disease with severe fluctuations in response to levodopa therapy (group B) were included in the study. Erythrocyte glutathione peroxidase was determined as a measure of antioxidant activity and significantly lower values were found in group B than in group A. Regression analyses in groups A and B showed significant correlation between glutathione peroxidase and duration of disease, but not between glutathione peroxidase and age of patients.

Localization of 3 beta-hydroxysteroid dehydrogenase/delta 5-delta 4-isomerase in rat gonads and adrenal glands by immunocytochemistry and in situ hybridization.

The enzyme complex delta 5-3 beta-hydroxysteroid dehydrogenase/delta 5-delta 4 isomerase (3 beta HSD) is involved in the biosynthesis of all classes of steroids, namely glucocorticoids, mineralocorticoids, progesterone, and sex steroids. To obtain information on the precise localization of 3 beta HSD in rat gonads and adrenal glands, two complementary cytochemical techniques were used; immunocytochemical localization was achieved with antibodies developed against purified human placental 3 beta HSD, while 3 beta HSD mRNA localization was achieved by in situ hybridization performed with a recently cloned rat 3 beta HSD cDNA. In the testis, specific immunostaining was restricted to the cytoplasm of the interstitial cells, while by in situ hybridization, specific silver grains were also seen over the interstitial cells. In the ovary, immunostaining was found in the cytoplasm of cells of the corpus luteum and theca interna, while the granulosa cells of the follicles showed no positive reaction. By in situ hybridization, a specific hybridization signal was observed over granulosa cells of the corpus luteum, which are mainly responsible for progesterone secretion, and to a lesser extent over theca interna cells, known for their role in secreting C19 androgens. In the adrenals, the three zones of the cortex were equally immunolabeled, whereas no staining could be detected in the medulla. Similarly, by in situ hybridization, silver grains were located over the zona glomerulosa, fasciculata, and reticularis, while no specific autoradiographic reaction could be observed on the chromaffin cells of the medulla. The present study provides new information about the precise cellular localization of 3 beta HSD in the adrenal glands and gonads in the rat, thus providing useful information about the site of action of 3 beta HSD, especially in the gonads. Moreover, the approaches used for localization studies, especially quantitative in situ hybridization, should provide a useful tool for assessing the role of hormones on 3 beta HSD expression in the different compartments of the gonads and adrenal glands.

Regulation of pro-gonadotropin-releasing hormone gene expression by sex steroids in the brain of male and female rats.

The fine modulation of gonadotropin gene expression and secretion is well recognized to be regulated by sex steroids through their direct action both at the anterior pituitary level and on the pulsatile pattern of GnRH secretion at the hypothalamic level. Since the influence of sex steroids on hypothalamic GnRH mRNA levels remains to be elucidated, quantitative in situ hybridization was used to study the effect of sex steroids on cellular levels of pro-GnRH mRNA in adult rats of both sexes. The effects of 14-day gonadectomy as well as administration of 17 beta-estradiol (E2, 0.25 micrograms) or dihydrotestosterone (DHT, 100 micrograms) twice a day during 14 days to gonadectomized animals were evaluated. In addition, the effect of progesterone (P, 2 mg, twice daily) alone or in the presence of E2 was also studied in ovariectomized animals. Hybridization was performed using a 35S-labeled cDNA probe encoding rat pro-GnRH and the corresponding mRNA levels were assessed by counting the number of silver grains overlying labeled neurons. In male rats, castration induced a highly significant 65% increase (compared to intact rats) in the mean number of grains per neuron. Administration of E2 or DHT to castrated animals completely prevented the post castration rise in pro-GnRH mRNA levels. In female animals, the effect of ovariectomy was less striking than in the male, a 25% increase (P less than 0.001) being observed. Treatment with E2 or DHT also completely prevented the increase in pro-GnRH mRNA levels induced by ovariectomy. Moreover, treatment with P in ovariectomized animals markedly potentiated the inhibitory effect of E2 on pro-GnRH mRNA levels.(ABSTRACT TRUNCATED AT 250 WORDS)