Subject(s)
Fecal Incontinence/surgery , Rectal Prolapse/complications , Rectal Prolapse/surgery , Urinary Incontinence/surgery , Abdomen/surgery , Fecal Incontinence/etiology , Female , Humans , Medical Illustration , Minimally Invasive Surgical Procedures , Perineum/surgery , Surgical Mesh , Urinary Incontinence/etiologySubject(s)
Fecal Incontinence , Rectal Prolapse , Urinary Incontinence , Combined Modality Therapy , Fecal Incontinence/diagnosis , Fecal Incontinence/epidemiology , Fecal Incontinence/etiology , Fecal Incontinence/therapy , Humans , Patient Selection , Rectal Prolapse/diagnosis , Rectal Prolapse/epidemiology , Rectal Prolapse/etiology , Rectal Prolapse/surgery , Risk Factors , Severity of Illness Index , Treatment Outcome , United States/epidemiology , Urinary Incontinence/diagnosis , Urinary Incontinence/epidemiology , Urinary Incontinence/etiology , Urinary Incontinence/therapyABSTRACT
BACKGROUND: The principal role of sentinel lymph node (SLN) sampling and ultrastaging in colon cancer is enhanced staging accuracy. The utility of this technique for patients with colon cancer remains controversial. PURPOSE: This multicenter randomized trial was conducted to determine if focused assessment of the SLN with step sectioning and immunohistochemistry (IHC) enhances the ability to stage the regional nodal basin over conventional histopathology in patients with resectable colon cancer. PATIENTS AND METHODS: Between August 2002 and April 2006 we randomly assigned 161 patients with stage I-III colon cancer to standard histopathologic evaluation or SLN mapping (ex vivo, subserosal, peritumoral, 1% isosulfan blue dye) and ultrastaging with pan-cytokeratin IHC in conjunction with standard histopathology. SLN-positive disease was defined as individual tumor cells or cell aggregates identified by hematoxylin and eosin (H&E) and/or IHC. Primary end point was the rate of nodal upstaging. RESULTS: Significant nodal upstaging was identified with SLN ultrastaging (Control vs. SLN: 38.7% vs. 57.3%, P = 0.019). When SLNs with cell aggregates < or =0.2 mm in size were excluded, no statistically significant difference in node-positive rate was apparent between the control and SLN arms (38.7% vs. 39.0%, P = 0.97). However, a 10.7% (6/56) nodal upstaging was identified by evaluation of H&E stained step sections of SLNs among study arm patients who would have otherwise been staged node-negative (N0) by conventional pathologic assessment alone. CONCLUSION: SLN mapping, step sectioning, and immunohistochemistry (IHC) identifies small volume nodal disease and improves staging in patients with resectable colon cancer. A prospective trial is ongoing to determine the clinical significance of colon cancer micrometastasis in sentinel lymph nodes.
Subject(s)
Colonic Neoplasms/pathology , Lymph Nodes/pathology , Sentinel Lymph Node Biopsy , Aged , Chi-Square Distribution , Coloring Agents , Female , Humans , Immunoenzyme Techniques , Keratins , Logistic Models , Lymphatic Metastasis , Male , Middle Aged , Military Personnel , Neoplasm Staging , Prognosis , Prospective Studies , Rosaniline Dyes , Treatment Outcome , United StatesSubject(s)
Rectal Diseases/diagnosis , Rectal Diseases/surgery , Abscess/diagnosis , Abscess/surgery , Condylomata Acuminata/diagnosis , Condylomata Acuminata/surgery , Fecal Incontinence/diagnosis , Fecal Incontinence/surgery , Fissure in Ano/diagnosis , Fissure in Ano/surgery , Hemorrhoids/diagnosis , Hemorrhoids/surgery , Humans , Pruritus Ani/diagnosis , Pruritus Ani/surgery , Rectal Fistula/diagnosis , Rectal Fistula/surgery , Rectal Neoplasms/diagnosis , Rectal Neoplasms/surgery , Rectal Prolapse/diagnosis , Rectal Prolapse/surgery , Skin Neoplasms/diagnosis , Skin Neoplasms/surgeryABSTRACT
Tropical pyomyositis is a suppurative infectious disease of skeletal muscles. The most common causative organism is Staphylococcus aureus. Penicillin-resistant strains are frequently encountered. Abscesses may develop in muscle groups or body cavities remotely located from one another. We report a case of tropical pyomyositis presenting as a suppurative process in the left foreleg. Further workup, including CT scanning, demonstrated large, multi-loculated intraabdominal and pelvic abscesses. The abdominal and pelvic components were managed by laparoscopic exploration and drainage. This is the first known report of laparoscopic management of abdominopelvic abscesses associated with tropical pyomyositis.
