Modified Lymphoscintigraphy in Primary Lymphatic Insufficiency of the Lower Limb.

Primary lymphedema of the foot and toes could be sometimes misdiagnosed by lymphoscintigraphy as a whole lower limb lymphatic insufficiency (LLLI). This is caused by using standard lymphoscintigraphic protocol based on one interstitial injection of radiotracer applied into the first interdigital space followed by image analysis of lower limb lymphatic vessels and lymph nodes. Here, we show that a modification of the lymphoscintigraphic protocol and introduction of a second dose of radiotracer right above the inner ankle to the clinically healthy tissue can more accurately describe morphological abnormalities of the superficial lymphatic system at the lower limb and thereby refine the diagnosis of the LLLI. Fourteen patients with swelling of the foot and toes (16 lower limbs) were examined using standard lymphoscintigraphic protocol. Subsequently, modified lymphoscintigraphy was performed. While standard lymphoscintigraphy showed severe lymphatic insufficiency of the superficial lymphatic system in all 14 patients (in 16 lower limbs), including significantly reduced number of inguinal nodes, modified lymphoscintigraphy revealed almost normal morphology of superficial lymphatic vessels in 11 patients (in 13 lower limbs) throughout the entire lower limb proximal to the application site. In conclusion, using the modified lymphoscintigraphy protocol in patients with foot and toes primary lymphedema can refine diagnosis and follow-up medical management.

[Sentinel lymph node biopsy in oral and oropharyngeal carcinomas]. / Biopsie sentinelové uzliny u pacientu s karcinomem ústní dutiny a orofaryngu.

BACKGROUND: The aim of our study was to assess feasibility and accuracy of sentinel lymph node biopsy in patients with head and neck squamous cell carcinoma with clinically N0 neck. METHODS AND RESULTS: The sentinel lymph node was localised preoperatively by lymphoscintigraphy and intraoperatively by hand-held gamma probe after peritumoral injection of a Tc99m-labeled colloidal human serum albumin. The histology of the sentinel lymph node was compared with the histology of the nodes of the elective neck dissection performed in all patients. 27 patients with oral and oropharyngeal carcinomas accessible to injection in local anaesthesia were enrolled into a prospective trial between July 1993 and December 2005. The sentinel lymph node was localised by preoperative lymphoscintigraphy in 26 of 27 patients. Sentinel lymph node was identified perioperatively by hand-held gamma probe in all 28 necks of 27 patients. Occult metastases were found in 4 sentinel lymph nodes in 4 cases. In one case (3.6 %) the result of sentinel lymph node biopsy was false negative. The sentinel lymph node biopsy correctly predicted the positivity and negativity of the neck in 27 of 28 cases (96.4 %). CONCLUSIONS: Sentinel lymph node biopsy in patients with oral and oropharyngeal carcinomas is feasible and seems to accurately predict the status of the regional lymph nodes.

[New method for detection of nonpalpable breast cancer]. / Nová metoda detekce nehmatných karcinomu prsu.

OBJECTIVE: The objective of the study was to evaluate the feasibility of radio guided occult lesion localization (ROLL) in the cases of nonpalpable breast cancers with sentinel lymph node biopsy. DESIGN: Prospective clinical study SETTING: Department of Gynecology and Obstetrics, 2nd Medical Faculty and Teaching Hospital, Praha METHODS: Thirty-eight patients with nonpalpable breast cancer diagnosed by core cut biopsy underwent an injection of the radiopharmaceutical 18-20 hours before surgery. The dose of the radiopharmaceutical was 45 MBg into tumor and 15 MBg subdermaly. Surgical excision of radioactive breast tissue with nonpalpable tumor was carried out using the hand held gamma probe and the same technique was performed for biopsy of sentinel lymph node. Standard localization technique with hook-wire was performed in the control group of fifty-one patients. RESULTS: Radioguided surgery of nonpalpable tumor was successful in all cases. Surgical margins were clear in all cases, in four cases (10.5%) the margins were only 2 mm. The sentinel node was identified in all cases, in 3 patients (7.9%) the sentinel node was involved by tumor and axillary lymphadenectomy was performed. Infiltrating carcinomas were diagnosed in the "hook-wire" group in 21 cases (41.2%), all with clear margins over 3mm. Proportion of margins status between ROLL and hook-wire was the same. It seems that the health tissue loss around the tumor is in hook-wire technique bigger but it requires next study. CONCLUSION: Simultaneous performance of ROLL and sentinel node biopsy is useful and practicable methods in the management of nonpalpable breast cancer. In comparison to hook-wire, radioguided removal allows reduced excision volume and better lesion centering within the specimen.

[Sentinel lymphatic node biopsy for breast cancer in practice]. / Biopsie sentinelové lymfatické uzliny u karcinomu prsu v praxi.

OBJECTIVE: This paper reviewed the feasibility and accuracy of sentinel lymph node status in women with breast cancer. DESIGN: Clinical retrospective study. SETTING: Dept. of Obstetrics and Gynecology, 2nd Medical School, Teaching Hospital Motol, Praha. METHODS: Our trial involved 169 patients with breast cancer in the T1 and T2 stage without suspicion for axillary lymph node involvement. Lymphatic mapping was performed by sub dermal or subareolar injection of 99mTc labeled collodial human albumin (Senti-Scint) in the dose of 15 MBg one day before surgery. During the operation lymphatic mapping with vital blue dye (patent blau) was performed. Then the hand-held gamma-ray detector probe was used to locate the sentinel node. From a small axillary incision the blue-stained sentinel node was removed. Both methods of detection were compared, the sentinel lymph node has to be hot-radioactive and blue-stained. Complete axillary lymphadenectomy was then done. All removed lymph nodes were prepared for histopathological examination. RESULTS: Failures of sentinel lymph node detection were in 9 cases (5.3%) of the 169 patients. There was one case of false negative sentinel lymph node biopsy (0.6%). Most failures occurred during the learning phase of lymphatic mapping and were associated with excessive tumor involvement of axillary lymph nodes. Success of sentinel lymph node detection was in 160 cases (94.7%) and in our trial both methods of lymphatic mapping were equally effective. Tumor involvement of sentinel lymph nodes were in 43 patients (26.9%), in 19 (11.9%) of them, the sentinel nodes were the only metastasis nodes, whereas in the remaining 24 (15%) patients other axillary nodes were positive. The concordance between negative sentinel node and axillary lymph node status was in 117 (73.1%) cases. CONCLUSION: The introduction of sentinel lymph node biopsy allows directed and accurate assessment of axillary involvement with minimal morbidity. Sentinel node accurately predicts the status of all axillary nodes in more than 94.7% of cases.

Detection of the sentinel node in breast carcinoma using method of a single subcutaneous injection of radiopharmaceutical.

The objective of this work is retrospective evaluation of results of the intraoperative detection of sentinel node in breast carcinoma after a single subcutaneous injection of radiopharmaceutical (RF) within a two-day protocol. From May/2001 to June/2002, lymphoscintigraphy of the sentinel node (SN) and its subsequent radioguided intraoperative detection (RGS) was performed in 43 women having stage T1-T2, N0 breast carcinoma. The static scans in the anterior and relevant lateral projections were performed using a gamma camera at approximately 30-minute intervals after the subcutaneous administration of 15 MBq 99mTc Senti-Scint, until the SN was displayed. The localization of the SN was marked on the overlying skin with a water-resistant permanent marker in 1-2 projections. RGS was accessed within 18-24 hours after the injection of the RF and all patients underwent an axillary dissection. The SN was detected in all patients, and in all cases was localized in the ipsilateral axilla. In 26 patients (60%), no metastatic process was found either in the SN or in any other axillary node. However, in one node, deposits of the carcinoma were detected in surrounding fatty tissue with propagation along the vessels and nerve. In 16 patients (37%), metastases in the SN were proved, in 7 cases (16%), a metastatic process was proved at the same time even in further lymph nodes. A number of false negative findings (5.8%) is consistent with the literature data. The method fails in the detection of intramammary localized SNs.

[131I meta-iodobenzylguanidine in combination with hyperbaric oxygen therapy in the treatment of prognostically high-risk forms of neuroblastoma]. / 131I metajodobenzylguanidin v kombinaci s hyperbarickou oxygenoterapií v lécbe prognosticky vysoce nepríznivých forem neuroblastomu.

BACKGROUND: Despite of improving diagnostics, development of new drugs and treatment strategies, patients with biologically unfavourable, advanced or relapsed neuroblastoma remain practically incurable. Treatment related toxicity, requirement for personnel and financial costs have became limiting. Tumor specific therapy represented by 131I-meta-iodobenzylguanidine (MIBG) administration could become an alternative improving the overall survival. In comparison with standard external radiotherapy the targeted therapy enables to achieve radiation 5 to 10 times higher with lower organ toxicity. Data published by European and American colleagues brought evidence of high efficacy of this method. It motivated us to set and develop the method at our department. TYPE OF STUDY: Retrospective analysis of therapeutic results and side effects of the administration of 131I-meta-iodobenzylguanidine in high-risk neuroblastoma patients cured at the Department of Pediatric Oncology in Prague since 1997 till 2000. METHOD AND RESULTS: 131I-meta-iodobenzylguanidine was fourteen times therapeutically administered in seven high-risk relapsed neuroblastoma patients. Four children received a single dose of 131I-meta-iodobenzylguanidine, three patients were treated repeatedly. The first dose represented 5.5 GBq, repeated dose 3.7 GBq, irrespective to the body weight. Each MIBG administration was followed by four days hyperbaric oxygen therapy. The treatment was well tolerated, acute and late side effects were not serious and only rarely reached grade 3 or 4 according to the International North American Children's Cancer Group Classification. Three of the seven children have survived with no evidence of the disease. Four children died of the disease progress. CONCLUSIONS: 131I-meta-iodobenzylguanidine treatment combined with hyperbaric oxygen therapy becomes a well-tolerated therapy for high-risk neuroblastoma patients non-responding to the conventional treatment. Though the 131I-meta-iodobenzylguanidine administration probably cannot cure these patients, the repeated administration can bring long lasting remission.

Determination of uranium in technological waters by ion-pair liquid chromatography.

U(VI) can be efficiently determined in the range 0.3-1OmM after its separation from Th(IV), Zr(IV), Al(III), Fe(III), lanthanides and other ions by ion-pair liquid chromatography on a 3 x 150 mm glass column packed with Separon SGX C18 modified with sorbed ammonium dodecyl sulphate. Traces of uranium can be preconcentrated directly on the analytical column from acidified water solutions and separated from Th, Zr, Al, Fe, lanthanides and other elements, with an enrichment factor of $ 100 and recovery of 98 +/- 8%, by isocratic or pH or concentration gradient elution with ammonium 2-hydroxy-2-methylpropionate or ammonium citrate solution. Post-column derivatization with 25muM Arsenazo III in 0.1M formate buffer at pH 2.7 is used for detection and quantification.