Radioguided occult lesion localization (ROLL) for treatment and diagnosis of malignant and premalignant breast lesions combined with sentinel node biopsy: a prospective clinical trial with 100 patients.

UNLABELLED: Advanced breast cancer screening techniques and their availability increased the number of non-palpable breast lesions requiring surgery. Consequently reliable and efficient therapeutic management permitting accurate localization and removal of these occult lesions is essential. AIMS: In our study we evaluated radioguided occult lesion localization (ROLL) for effectiveness of localization, oncological safety and feasibility of concomitant sentinel node biopsy. METHODS: Hundred patients (120 lesions) underwent ROLL and tumour excision with or without sentinel node biopsy after confirmed histopathological findings via intra-tumoral injection of Tc99m-labelled macro-aggregate albumin for ROLL and Tc99m-labelled nanocolloids with periareolar-subdermal injection for simultaneous sentinel node biopsy. RESULTS: Our detection rate for ROLL was 98.3%, respectively, 98.6% for sentinel nodes in cases of concomitant sentinel node biopsy. We had a radical excision rate of 55 out of 69 cases of invasive ductal cancer and 17 out of 26 cases of DCIS to achieve 1mm, respectively, 10 mm tumour-free margins. CONCLUSIONS: Intra-tumoral tracer injection of for ROLL and periareolar-subdermal tracer injection for simultaneous sentinel node biopsy seem to be a sensitive technique. According to our results ROLL is a safe, precise and simple technique permitting definitive therapeutic removal of malignant or premalignant breast lesions. The high detection rate of the sentinel node in cases with concomitant sentinel node biopsy shows that the combination of both procedures is possible and safe. In our opinion ROLL is an excellent therapeutic option after histological confirmation of malignancy or premalignant disease.

Hemisection for treatment of an advanced endodontic-periodontal lesion: a case report.

AIM: To emphasize the importance of primary endodontic treatment when dealing with endo-perio lesions and to demonstrate the considerable healing potential of the endodontic aspect. CASE REPORT: After several years of unsuccessful symptomatic periodontal treatment, an advanced endo-perio lesion on a right-mandibular first molar was successfully treated by root-canal treatment and hemisection after the re-evaluation of the lesion. This successful treatment appeared to have a positive effect on the patient's general well-being. KEY LEARNING POINTS: The origin of a combined endo-perio lesion is indicated by its clinical and radiographic appearance. The periodontal situation is often misinterpreted. The prognosis for the endodontic element of treatment is excellent. Local pathologic processes in the oral cavity may affect a patient's general health.

[Inferior epigastric artery. An atypical source of bleeding in pelvic fracture]. / A. epigastrica inferior. Atypische Blutungsquelle bei Beckenfraktur.

The most common mechanism of pelvic fractures after blunt trauma is lateral compression of the pelvis. Most of these fractures are of slight severity but it is possible, that a life-threatening hemorrhage can appear. The inferior epigastric artery is an atypical bleeding site but it has to be considered in the search of the origin of the hemorrhage. Diagnostic tools are ultrasound, computed tomography and angiography. After external fixation of the pelvis and persistent haemodynamic active bleeding is the percutaneous transcatheter embolization (PTE) in our opinion the treatment of choice. The introduced case is confirm with this statement.

[Fibromuscular dysplasia of the brachial artery--2 case reports and review of the literature]. / Fibromuskuläre Dysplasie der A. brachialis--zwei Fallberichte und Literaturübersicht.

Yet being an uncommon disease in general, the manifestation of the fibromuscular dysplasia (FMD) in the upper extremities is exceedingly rare. Two patients with FMD of the brachial artery are presented and the literature concerned is reviewed. In this location the formation of microthrombi with subsequent embolization into the periphery instead of progressive vessel stenosis seems to be the leading pathophysiological principle. Therapeutic options are discussed.

[Percutaneous transluminal angioplasty (PTA) of the arteries of the arm in brachial and cerebral ischemia]. / Perkutane transluminale Angioplastie (PTA) der armversorgenden Arterien bei brachialer und zerebraler Ischämie.

35 patients with brachial and/or cerebral ischemia underwent 37 PTA's. Indications for PTA were stenosis (n = 31) or occlusion (n = 1) of the subclavian artery, stenosis of the brachiocephalic trunk (n = 2), stenosis of the axillary artery (n = 2) and stenosis of the brachial artery (n = 1). 23 patients demonstrated a subclavian steal phenomenon. However, the minority of patients (n = 10) presented with neurologic symptoms, which could be provoked by brachial exercise in only 3 patients. 7 of the 10 patients with cerebral ischaemia demonstrated additional significant stenosis of the extracranial arteries. The technical success rate for PTA was 89.2%. Two patients showed relapse of the stenosis. The clinical success rate regarding brachial ischaemia was 94.4% (follow-up: 6-37 months). Neurologic symptoms disappeared after treatment in 72.7%. Minor complications without clinical sequelae occurred in 8.6%.

Dose-dependent haemodynamic response to prenalterol in patients with congestive heart failure.

The effect of three doses of prenalterol, 12.5, 25 and 50 micrograms, on cardiac index (CI), pulmonary artery pressure (PAP), heart rate (HR), and stroke volume index (SVI) was investigated in 18 patients with congestive heart failure (CHF). Twelve patients received only prenalterol, while 6 patients received prenalterol 1 hour after an oral dose of hydralazine and isosorbid dinitrate. In 7 out of 12 patients a dose-dependent increase in HR was observed. The response of HR was inversely correlated to resting catecholamine levels; patients with high resting catecholamines--these are patients with severe CHF--did not show any increase in HR. CI increased in 8 out of 12 patients (average 1 . 1/min m) and SVI in 5 out of 12 patients. This inconsistent response was not dependent on left ventricular ejection fraction or plasma catecholamines at rest. Pretreatment with vasodilators did not improve the haemodynamic response to prenalterol. Four out of 17 patients demonstrated an increase in severity of arrhythmias suggestive of arrhythmogenic properties of prenalterol.

Hyperparathyoidism: influence of glomerular filtration rate on urinary excretion of cyclic AMP.

Urinary cyclic AMP excretion per 24 h or per g creatinine in primary hyperparathyroidism (1 degrees HPT) has been evaluated by several authors with conflicting results. In 50 patients with 1 degrees HPT, 25 patients with secondary (2 degrees) HPT and 35 healthy control persons we determined urinary cyclic AMP per 24 h or per g creatinine. These parameters did not satisfactorily discriminate patients from controls, especially when glomerular filtration rate (GFR) as determined by creatinine clearance was reduced. Since urinary cyclic AMP is derived from plasma by glomerular filtration and from kidney by tubular production-the amount of tubules is reflected by GFR-the cyclic nucleotide was related to GFR. In controls urinary cyclic AMP correlated better with GFR than with creatinine excretion. Additionally, in 45 of 50 patients with 1 degrees HPT and in all with 2 degrees HPT, urinary cyclic AMP/GFR was raised. In 1 degrees HPT serum levels of parathyroid hormone correlated closer with urinary cyclic AMP/GFR than with urinary cyclic AMP/g creatinine. The ratio cyclic AMP/GFR decreased to normal or subnormal values after removal of adenomatous or hyperplastic glands in 1 degrees HPT and during infusion of calcium in 2 degrees HPT. In 50 patients with renal lithiasis caused by diseases other than 1 degrees HPT (anatomical variations, pyelonephritis, immobilization after tetraplegia) the ratio cyclic AMP/GFR was not raised. Urinary cyclic AMP/GFR, therefore, reflects parathyroid hormone excess more reliably than cyclic AMP/g creatinine.

[Primary hyperparathyroidism (1st degree HPT): plasma vitamin D and urinary cyclic AMP during the postoperative phase]. / Primärer Hyperparathyreoidismus (1 degree HPT): Vitamin D im Plasma und cyclisches AMP im Urin in der postoperativen Phase

In 30 controls and 30 patients with primary hyperparathyroidism 25-OH-vitamin D in serum and urinary cyclic AMP were determined by competitive protein binding assays. Removal of hyperplastic or adenomatous parathyroid glands resulted in hypocalcemia with 1. low urinary cyclic AMP in surgical hypoparathyreoidism 2. high urinary cyclic AMP in skeletal calcium deficiency, 3. high urinary cyclic AMP in 25-OH-vitamin D deficiency. In calcium or vitamin D deficiency, therapy with calcium or calcium and vitamin D corrected hypocalcemia and urinary cyclic AMP.