Sentinel node total tumour load as a predictive factor for non-sentinel node status in early breast cancer patients - The porttle study.

OSNA is a molecular assay for the detection of sentinel node metastasis. TTL emerged as a concept that seems to accurately predict the status of the NSN. Authors tried to confirm this motion. This is a retrospective and multicentric study that analyzed 2164 patients, 579 of whom had positive SN and completion AD. Logistic regression models were performed in order to identify a suitable cutoff to identify patients who benefit from AD. Univariate and multivariate regression analysis showed a relationship between TTL>30000 and the presence of NSN metastasis (OR 2.84, CI 1.99-4.08, p < 0.001). Logistic regression indicated that the cutoff of 30000 copies/µL better discriminates patients with NSN positivity and allows wide use of these criteria. This cutoff value may safely assist clinicians and patients to decide to proceed or not with an AD.

Laparoscopic resolution of intussusception after Roux-en-Y gastric bypass.

INTRODUCTION: Roux-en-Y gastric bypass (RYGB) has been the most common surgical operation used to treat obesity and its inherent co-morbidities. Intussusception with bowel obstruction after RYGB is a rare complication and its physiopathology remains unclear. The diagnosis is generally based on typical image of computed tomography (CT) scan and a surgical exploration is generally recommended. CASE PRESENTATION: A 54-year-old female patient with history of a gastric bypass six years before, presented herself on the emergency department with acute onset of abdominal pain, nausea, and nonbilious vomiting. Her vital signs were stable. On abdominal evaluation a mass in the left flank was identified. The CT scan showed a small bowel intussusception. MANAGEMENT: Laparoscopic surgical exploration was performed and the diagnosis confirmed: retrograde jejunojejunal intussusception without vascular impairment. Reduction of the intussusception was possible without the need for bowel resection. A laparoscopic "second look" was made on the following day, revealing no signs of ischemia. There were no postoperative complications and the patient was discharged home on postoperative day 8. DISCUSSION: Intussusception after a RYGB is rare and the diagnosis is generally based on CT scan exam. Surgical exploration should be performed as soon as possible to prevent bowel ischemia and the need for resection.