The role of lymph node sampling and radiotherapy in the management of the axilla in early breast cancer.

Management of the axilla in early breast cancer is an issue of ongoing debate. We reviewed our experience in 312 patients who underwent axillary lymph node sampling between 1994 and 1998, of whom 81 patients (24%) had axillary lymph node metastasis. There have been two axillary recurrences, one associated with local recurrence to the breast and one presenting with distant metastasis. There were no patients with isolated axillary disease as their only site of recurrence and no axillary failures in the node-positive group treated with axillary sampling and radiotherapy. Axillary lymph node sampling effectively stages the axilla. This can safely be followed by radiotherapy to the axilla in case of lymph node metastasis. Axillary lymph node sampling forms a sound basis to develop new techniques, such as sentinel lymph node biopsy currently investigated by ongoing trials.

Laparoscopic cholecystectomy in the presence of a lumboperitoneal shunt.

Laparoscopic cholecystectomy was performed safely in a 70-year-old man with a lumboperitoneal shunt. Techniques for preventing retrograde flow of carbon dioxide are described.