Is there any role for sentinel node mapping in colorectal cancer staging? Personal experience and review of the literature.

BACKGROUND: We explored the role of lymphatic mapping and sentinel lymphadenectomy (originally described for melanoma and breast cancer) in colon cancer. Pathologic techniques can successfully identify micrometastatic disease in lymph nodes, but they are not suitable for clinical routine use. We evaluated the role of sentinel node (SN) mapping in refining the staging of colorectal cancer. METHODS: A total of 56 open colorectal resections were performed, and Patent Blue V dye was injected under the serosa surrounding the tumor immediately after opening the abdomen. SNs were analysed by immunohistochemistry to find micrometastatic disease. A literature search for the role of SNs in colorectal cancer was also performed. RESULTS: We identified the SN in 100% of patients, with a mean of 2.02 SNs/patient (range 1-5). After immunohistochemical staining, we could upstage 21 out of 56 patients (37.5%), and we observed 10.7% false negative SNs (6/56 patients). Fewer than half of the articles described false negative rates of <15%, and most articles showed an upstaging rate of >5% of patients. These differences are probably the result of different sensitivities of the methods used in identifying the lymph node micrometastases. CONCLUSIONS: SN mapping is an easy and cost-effective technique that holds promise and warrants further investigations.

[Hepatic injuries: diagnostic and therapeutic features]. / I traumi epatici: aspetti diagnostici e terapeutici.

Sixty-four consecutive patients with hepatic trauma were examined. Five (7.8%) patients were managed nonoperatively and 59 (92.2%) underwent immediate laparotomy. Nonoperative management is appropriate in hemodinamically stable patients. It requires increasing use of computed tomography instead of peritoneal lavage to evaluate stable patients with blunt abdominal trauma. Patients with complicated associated injuries must be excluded. Analysis of patients who underwent immediate abdominal exploration showed that grade I through grade III injuries of AAST classification are the most common in blunt hepatic trauma (84.75%). Associated intra-abdominal injuries requiring operation for ongoing hemorrhage were observed in 50% of these patients. In the management of grade I through grade III hepatic injuries a simple suture was a safe and highly effective treatment. More complex injuries actively bleeding were controlled by finger fracture technique to achieve intrahepatic hemostasis with selective vascular ligation. Hepatic resection was exceptionally required (2%). On the contrary, resection was required in grade IV injuries with extensive parenchymal destruction and in grade V lesions for a better vascular control of the ruptured suprahepatic veins.

[Indications and short and medium time results of crossover bypasses in the treatment of obstructive arteriopathies of the lower limbs]. / Indicazioni e risultati a breve e medio termine dei pontaggi cross-over nel trattamento della arteriopatia ostruttiva degli arti inferiori.

The authors evaluate the indications, the hemodynamical aspects, the short and medium term results over their track record of 49 crossover bypass (44 dacron and 5 PTFE grafts) performed between 1981 and 1993. Crossover bypass grafts were mainly inserted for unilateral iliac arterial disease in order to avoid aortic manipulation. This procedure was particularly selected when in presence of: young patients (< 60 years old), high surgical risk, poor run-off, high risk of prosthetic infection, thrombosis and/or infection of orthotopic grafts. 3 ilio-iliac, 27 iliofemoral, 18 femorofemoral and 1 femoropopliteal bypass have been performed. The postoperative resting pressure Index increase was highly significant in recipient limbs. There wasn't perioperative mortality; during the follow up (mean 24.4 months) no amputation of recipient limb was observed. 4 patients died of A.M.I. and 1 of neoplastic disease. Late cumulative patency rate was 81% at 2 years and 67.3% at 3 years. These values rise to 97.2% and 86.1% respectively when considering patients with "ideal" indication (excluding 7 patients operated on for complications of previous bypass grafts and 6 with extremely poor run-off). An accurate evaluation of the lesion topography and haemodynamic pattern of donor and recipient iliofemoral districts are stressed as key points for a correct surgical indication.