Sternal resection and reconstruction after malignant tumours.

AIM: We present our experience of the resection of sternal tumours (both primary and metastatic), followed by reconstruction of soft-tissue and skeletal defects with a mesh and musculocutaneous flap. METHODS: Eleven patients were included in this study, all of which underwent sternal tumour resection and immediate chest wall repair. Reconstruction was accomplished with prosthetic material (polytetrafluoroethylene [PTFE]), a sandwich of polypropylene (Marlex-methylmethacrylate or titanium/polypropylene) and a pedicled musculocutaneous flap (pectoralis major, latissimus dorsi or rectus abdominis). Sternal tumours may arise from both primary (chondrosarcoma and neurofibrosarcoma) and secondary (local recurrence of breast carcinoma and metastatic disease from other organs) disease. RESULTS: Extubation did not result in paradoxical respiration in any of the patients in the study. The post-operative mortality rate was seen to be zero. One patient with a PTFE prosthesis had chest failure requiring immediate intubation and posterior prosthesis replacement. One mesh was removed two months after surgery. There was local recurrence in one patient and five patients died from distal metastases. The final patient is still alive with metastases at the time of presenting our results. CONCLUSIONS: Wide resection of sternal tumours provides good local control. Reconstruction with mesh and musculocutaneous flap is an effective technique for repairing such defects.

Multiple colon tumors. Diagnosis and follow-up of 450 patients with colorectal carcinoma.

OBJECTIVE: Failure to diagnose synchronous tumors leads to errors in patient treatment and prognosis. The existence of metachronous tumors requires strict patient follow-up to ensure early identification of the second tumor. The present study evaluates the results obtained in the application of a structured procedure for the diagnosis and follow-up of multiple colorectal carcinoma. MATERIALS AND METHODS: A structured procedure was used to follow for 5 years a group of 12 patients with multiple colorectal tumors (7 synchronous and 5 metachronous) of a series of 450 colorectal neoplasms. RESULTS: Six synchronous tumors were diagnosed preoperatively and one intraoperative. Of the 5 metachronous neoplasms, 4 strictly adhered to the follow-up protocol, as a result of which the second tumor was detected at an early stage. The remaining case involved no follow-up, and the second tumor was diagnosed in an advanced stage as a result of bowel occlusion. The left colon was predominantly involved; polyps were detected in 9 cases, while two patients had 3 malignancies detected by histopathological study. COMMENTS: We emphasize the need for a full evaluation of the colon in all patients with colorectal carcinoma. In the case of incomplete preoperative evaluation, intraoperative colonoscopy is to be considered; if this is not feasible it should be performed one month after surgery. A structured follow-up procedure permits the early detection of these tumors, there by improving patient prognosis.

Estudio del ganglio centinela en cáncer de mama mediante la utilización de la técnica combinada (radiotrazadores y colorantes): ¿qué aporta la combinación de ambos? / No disponible

Objetivo: Ha sido la valoración estadística del empleo de la técnica isotópica, con los factores que pueden influir en la visualización linfogammagráfica del ganglio centinela (GC) y el empleo de colorantes en combinación con marcadores isotópicos, las ventajas que pueden aportar y los inconvenientes. Pacientes y métodos: En la fase de validación de la técnica del GC fueron intervenidas 256 pacientes con diagnóstico de cáncer de mama. En 42 casos se empleó solo el radiotrazador, mientras que en 214 se utilizó además el colorante azul de isosulfán. Resultados: Los parámetros que influyeron de forma independiente en la captación isotópica han sido: la edad de la paciente y la invasión metastásica del GC con rotura capsular, mientras que los parámetros independientes para la tinción con colorante han sido la ubicación del tumor en la mama y la técnica diagnóstica empleada. Conclusión: La utilización del colorante complementa al radiotrazador para la búsqueda del GC ya que mejora la tasa de detección en las pacientes con tumores localizados en cuadrante externos de la mama y en los casos en que existe afectación ganglionar con rotura capsular(AU)

Aim: The statistical assessment of the use of radiotracer technique and which factors may influence the lymphogammagraphic detection, and the use of dyes in combination with isotopic tracers, the potential advantages and disadvantages. Patients and methods: In the validation phase of the sentinel lymph node (SLN) biopsy 256 breast cancer patients were included. In 42 cases only the radiotracer was used, while in 214 patients isosulfhan blue dye was also used. Results: The parameters that independently influenced the isotopic uptake were patient age and SLN metastatic invasion with capsular invasion, while the independent parameters for the dye stain has been the location of the tumor and diagnostic technique used. Conclusion: The use of blue dyes complements the radiotracer for the pursuit of SLN since it improves the detection rate in patients with tumors in the outer quadrants of the breast and in the cases where there is lymph node involvement with capsular invasion(AU)

Sternal resection and reconstruction after malignant tumours

AIM: We present our experience of the resection of sternal tumours (both primary and metastatic), followed by reconstruction of soft-tissue and skeletal defects with a mesh and musculocutaneous flap. METHODS: Eleven patients were included in this study, all of which underwent sternal tumour resection and immediate chest wall repair. Reconstruction was accomplished with prosthetic material (polytetrafluoroethylene [PTFE]), a sandwich of polypropylene (Marlex-methylmethacrylate or titanium/polypropylene) and a pedicled musculocutaneous flap (pectoralis major, latissimus dorsi or rectus abdominis). Sternal tumours may arise from both primary (chondrosarcoma and neurofibrosarcoma) and secondary (local recurrence of breast carcinoma and metastatic disease from other organs) disease. RESULTS: Extubation did not result in paradoxical respiration in any of the patients in the study. The post-operative mortality rate was seen to be zero. One patient with a PTFE prosthesis had chest failure requiring immediate intubation and posterior prosthesis replacement. One mesh was removed two months after surgery. There was local recurrence in one patient and five patients died from distal metastases. The final patient is still alive with metastases at the time of presenting our results. CONCLUSIONS: Wide resection of sternal tumours provides good local control. Reconstruction with mesh and musculocutaneous flap is an effective technique for repairing such defects (AU)

No disponible

Protocol for the implantation of a venous access device (Port-A-Cath System). The complications and solutions found in 560 cases

INTRODUCTION: The cannulation of suitable peripheral veins may be a very painful experience. Implantable venous access systems have to some degree relieved this problem and help to provide an improvement in terms of quality of life. MATERIAL AND METHODS: We have evaluated 560 patients during a follow up period of two years. A low overall complication percentage of 7.32% was seen when using the venous access device. RESULTS: Complications and treatments were: pneumothorax; portal rotation or infection; catheter infection; embolism and migration; extravasation; partial or total obstruction of the device; rupture of the catheter or the membrane. CONCLUSIONS: There is no other system that allows repeated venous access on such a long term basis. Placing the devices completely under the skin allows the patient to conduct a normal life style, and its maintenance does not need any special care, with the exception of the monthly heparinised serum infusion. The preferred option is to insert the catheter through the cephalic vein in the delto pectoral groove (AU)

Valor de la mamografía isotópica en el diagnóstico del cáncer de mama / Value of scintimammography in the diagnosis of breast cancer

Introducción. La mamografía es la técnica diagnóstica más utilizada en el cáncer de mama, pero en ocasiones debe complementarse con otras exploraciones para intentar llegar a un diagnóstico correcto. Objetivo. Valorar la utilidad del estudio isotópico con 99mTcsestamibi en el diagnóstico del cáncer de mama. Material y métodos. Se han estudiado 120 pacientes con sospecha clínica y/o radiológica de patología maligna. Se administraron 20 mCi (740 MBq) de 99mTc-sestamibi i.v. en el brazo contralateral a la lesión, obteniendo imágenes a los 10 min en proyecciones anteroposterior y lateral en decúbito prono (mama péndula).Resultados. El 74 por ciento de las lesiones fueron histológicamente malignas. Los resultados fueron para el tumor: sensibilidad 90 por ciento, especificidad 83 por ciento, valor predictivo positivo 94 por ciento, valor predictivo negativo 74 por ciento, precisión 88 por ciento, prevalencia de enfermedad maligna 74 por ciento; para la afectación ganglionar: sensibilidad 41 por ciento, especificidad 99 por ciento, valor predictivo positivo 93 por ciento, valor predictivo negativo 81 por ciento, precisión 82,5 por ciento, prevalencia de afectación metastásica ganglionar 32 por ciento. En las 45 lesiones no palpables estudiadas se obtuvieron los siguientes resultados: sensibilidad 61 por ciento, especificidad 100 por ciento, valor predictivo positivo 100 por ciento, valor predictivo negativo 61 por ciento, precisión 69 por ciento y prevalencia 80 por ciento. En 11 pacientes existía sospecha de recidiva local tras tratamiento conservador. La sensibilidad fue del 50 por ciento, la especificidad del 89 por ciento, el valor predictivo positivo del 50 por ciento y el valor predictivo negativo del 89 por ciento.Se valoraron como parámetros que pudieran incidir en la captación isotópica: el tamaño del tumor, el tipo histológico y el grado de carff-Bloom-Richardson. Conclusiones. El estudio isotópico con 99mTc-sestamibi es una técnica complementaria válida en el diagnóstico del cáncer de mama, especialmente en los casos en los que la clínica y la radiología no son concluyentes (AU)