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Aim. To establish the usefulness of dual time-point PET/CT imaging in determining the response to radiofrequency ablation (RFA) of solitary lung metastases from gastrointestinal cancer. Materials and methods. This prospective study included 18 cases (3 female, 15 male, mean age 71 ± 15 yrs) with solitary lung metastases from malignant digestive tract tumors candidates for RFA. PET/CT images 1 h after injection of 4.07 MBq/kg of 18F-FDG (standard images) were performed at baseline, 1 month, and 3 months after RFA. PET/CT images 2 h after injection centered in the thorax at 1 month after RFA were also performed (delayed images). A retention index (RI) of dual time-point images was calculated as follows: RI = (SUVmax delayed image − SUVmax standard image/SUVmax standard image) * 100. Pathological confirmation of residual tumor by histology of the treated lesion was considered as local recurrence. A negative imaging follow-up was considered as complete response. Results. Local recurrence was found in 6/18 lesions, and complete response in the remaining 12. The mean percentage change in SUVmax at 1 month and at 3 months showed a sensitivity and specificity for PET/CT of 50% and 33%, and 67% and 92%, respectively. The RI at 1 month after RFA showed a sensitivity and specificity of 83% and 92%, respectively. Conclusions. Dual time point PET/CT can predict the outcome at one month after RFA in lung metastases from digestive tract cancers. The RI can be used to indicate the need for further procedures to rule out persistent tumor due to incomplete RFA (AU)
Objetivo. Establecer la utilidad de las imágenes PET/TC en 2 tiempos en la determinación de la respuesta a la ablación por radiofrecuencia (RFA) de las metástasis pulmonares de tumores digestivos. Material y métodos. Estudio prospectivo con 18 casos (3 mujeres, 15 varones) y edad media de 71 ± 15 años con metástasis pulmonar única de cáncer digestivo candidato a tratamiento mediante RFA. Se realizaron imágenes PET/CT 1 h tras inyección de 4,07 MBq/Kg de 18F-FDG (imagen estándar) basal, un mes y 3 meses después de la RFA y una imagen tardía 2 h tras la inyección centrada en tórax un mes después de la RFA. Se calculó el índice de retención (RI): RI = (SUVmáx imagen tardía − SUVmáx imagen estándar/SUVmáx imagen estándar) * 100. La recurrencia local se confirmó con estudio histológico de la lesión tratada con RFA. Un resultado negativo en las pruebas de imagen durante el seguimiento se consideró como respuesta completa. Resultados. Se diagnosticó recidiva local en 6/18 lesiones y respuesta completa en 12/18. El cambio porcentual medio de SUVmáx al mes y a los 3 meses mostró una sensibilidad y especificidad para evaluar la respuesta a la RFA de 50% y 33% y 67% y 92%, respectivamente. El RI un mes posradiofrecuencia mostró una sensibilidad y especificidad del 83% y 92%. Conclusiones. Las imágenes en 2 tiempos con PET/TC un mes posradiofrecuencia pueden predecir el resultado de la RFA de las metástasis pulmonares de origen digestivo. El RI se puede utilizar para indicar la necesidad de otros procedimientos para descartar recurrencia tumoral debido a una RFA incompleta (AU)
Assuntos
Humanos , Masculino , Idoso , Neoplasias do Sistema Digestório , Neoplasias Pulmonares/complicações , Metástase Neoplásica , Fluordesoxiglucose F18/análise , Ablação por Cateter/métodos , Tratamento por Radiofrequência Pulsada/métodos , Tomografia por Emissão de Pósitrons/instrumentação , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
AIM: To establish the usefulness of dual time-point PET/CT imaging in determining the response to radiofrequency ablation (RFA) of solitary lung metastases from gastrointestinal cancer. MATERIALS AND METHODS: This prospective study included 18 cases (3 female, 15 male, mean age 71±15 yrs) with solitary lung metastases from malignant digestive tract tumors candidates for RFA. PET/CT images 1h after injection of 4.07MBq/kg of (18)F-FDG (standard images) were performed at baseline, 1 month, and 3 months after RFA. PET/CT images 2h after injection centered in the thorax at 1 month after RFA were also performed (delayed images). A retention index (RI) of dual time-point images was calculated as follows: RI=(SUVmax delayed image-SUVmax standard image/SUVmax standard image)*100. Pathological confirmation of residual tumor by histology of the treated lesion was considered as local recurrence. A negative imaging follow-up was considered as complete response. RESULTS: Local recurrence was found in 6/18 lesions, and complete response in the remaining 12. The mean percentage change in SUVmax at 1 month and at 3 months showed a sensitivity and specificity for PET/CT of 50% and 33%, and 67% and 92%, respectively. The RI at 1 month after RFA showed a sensitivity and specificity of 83% and 92%, respectively. CONCLUSIONS: Dual time point PET/CT can predict the outcome at one month after RFA in lung metastases from digestive tract cancers. The RI can be used to indicate the need for further procedures to rule out persistent tumor due to incomplete RFA.
Assuntos
Ablação por Cateter , Fluordesoxiglucose F18 , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias Gastrointestinais/patologia , Humanos , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
La Modelación y el Remodelado de hueso son llevados a cabo a través del proceso de Recambio Óseo en sitios específicos llamados Unidades de Remodelación Ósea (URO). Este proceso puede evaluarse a través de marcadores bioquímicos de Formación y de Resorción que reflejan cambios globales del metabolismo esquelético. Estos marcadores de remodelado óseo son utilizados para investigación de enfermedades óseo-metabólicas, porque proveen información dinámica del metabolismo del hueso y pueden ser cuantificados en suero o en orina. La variación de estos marcadores se deben principalmente a variables preanalíticas, analíticas y biológicas y debe interpretarse teniendo en cuenta el Valor de Referencia para el Cambio significativo (VRC), que resulta de un cálculo en el que intervienen la variabilidad biológica (VB) del analito y el error aleatorio del método utilizado en el laboratorio.
The Modeling and Remodeling processes are conducted through the process of replacement bone at specific sites called Units Bone Remodeling (URO).These can be evaluated by biochemical markers of formation and resorption that reflect changes in skeletal metabolism. These markers of bone turnover are used for research óseo-metabolic diseases because they provide dynamic information of bone metabolism and can be quantified in serum or urine. The variation of these markers is mainly due to preanalytical, analytical and biological variables and should be interpreted taking into account the Reference Value Change (VRC), which results from a calculation in which the biological variability (VB) of the analyte and the random error of the method used in the laboratory are involved.
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Introducción: La fiebre entérica (término que incluye la fiebre tifoidea y paratifoidea) es una infección sistémica causada por Salmonella typhi y Salmonella paratyphi. En los países desarrollados, la fiebre entérica dejó de ser endémica para convertirse en una enfermedad frecuentemente asociada a los viajes a zonas endémicas. Pacientes y métodos: Revisión de los casos de fiebre entérica confirmados por hemocultivo, en el periodo comprendido entre el 1 de enero de 2009 y el 31 de diciembre de 2010. Resultados: Se recogieron cuatro casos: fiebre tifoidea en una niña de 12 años natural de Pakistán y en una niña de 13 años originaria de la India que residían en Barcelona y viajaron en vacaciones a su país de origen; fiebre paratifoidea en un niño inmigrante procedente de Senegal, y fiebre paratifoidea en un lactante asociada a una tortuga como vector de transmisión. En todos ellos la fiebre se presentó como síntoma y signo principal de la enfermedad. Todos respondieron bien al tratamiento con amoxicilina-ácido clavulánico. Ningún paciente presentó complicaciones graves. Discusión: Los niños inmigrantes que viajan a sus países de origen para visitar a amigos y familiares presentan un mayor riesgo de enfermar. Los reptiles, portadores habituales de diferentes serovariedades de Salmonella, pueden actuar como posibles vectores de transmisión(AU)
Introduction: Enteric fever (term including typhoid and paratyphoid fever) is a systemic infection caused by Salmonella typhi and Salmonella paratyphi. In developed countries, enteric fever is no longer an endemic disease and has become an infection frequently related to travel to endemic areas. Patients and methods: Review of cases of enteric fever confirmed by blood culture, during the period from January 1st2009 to December 31st 2010.Results: We present four cases: typhoid fever in a 12-yearold girl native of Pakistan and in a 13-year old girl from India, who both lived in Barcelona and traveled on vacation to their country of origin; paratyphoid fever in an immigrant child from Senegal and paratyphoid fever in an infant with a turtle as the vector of transmission. In all cases, fever was the main symptomand sign of the disease. All responded well to treatment with amoxicillin-clavulanate. None of the patients had serious complications. Discussion: Immigrant children who travel to their countries of origin to visit friends and/or relatives are at increased risk of disease. Reptiles, which are common carriers of different Salmonella serovars, may act as potential transmission vector(AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Febre Tifoide/epidemiologia , Febre Tifoide/prevenção & controle , Febre Paratifoide/epidemiologia , Febre Paratifoide/prevenção & controle , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Espanha/epidemiologia , Salmonella typhi/isolamento & purificação , Salmonella paratyphi C/isolamento & purificação , Salmonella paratyphi A/isolamento & purificação , Salmonella paratyphi B/isolamento & purificação , Cefotaxima/uso terapêuticoRESUMO
Botulism is a severe neuroparalytic disorder that can be potentially life-threatening. In Barcelona, Spain, no outbreaks had been reported in the past 25 years. However, in September 2011, two outbreaks occurred involving two different families. A rare case of Clostridium baratii which produced a neurotoxin F outbreak was detected in five family members who had shared lunch, and several days before that another family was affected by C. botulinum toxin A which was probably present in homemade pâté.
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Botulismo/epidemiologia , Clostridium/classificação , Clostridium/isolamento & purificação , Surtos de Doenças , Toxinas Botulínicas/análise , Saúde da Família , Feminino , Humanos , Masculino , Espanha/epidemiologiaRESUMO
Objetivo. Analizar el potencial de la PET/TC usando imagen tardía del hígado en pacientes con sospecha de recidiva de cáncer colorrectal. Material y métodos. Se han incluido prospectivamente 71 pacientes (22 mujeres, 49 hombres) con edad de 65±11 años y sospecha clínica, analítica o radiológica de recurrencia. Se realizó PET/TC después de la inyección de 4,07MBq/kg de 18F-FDG con imagen de cuerpo entero a los 60min (imagen estándar) y hepática a las 2h (imagen tardía). Se efectuó análisis visual y cuantitativo mediante SUV de los hallazgos de la PET/TC. Se obtuvo confirmación de las lesiones por estudio histopatológico y/o seguimiento mínimo de 6 meses. Resultados. Se diagnosticaron metástasis hepáticas en 37/71 pacientes (79 metástasis). Un total de 38/71 pacientes mostraban enfermedad extra-hepática en forma de recidiva local (10), adenopatías abdominopélvicas (3) o mediastínicas (3), metástasis óseas (1) o pulmonares (16) y carcinomatosis (10). Se calculó la sensibilidad y especificidad para el diagnóstico de metástasis hepáticas en base a cada paciente para la imagen estándar (81 y 91%) y la imagen tardía (95 y 97%). El número de metástasis hepáticas diagnosticadas fue mayor con la imagen tardía (66/79) que con la imagen estándar (57/79). La sensibilidad y especificidad de la PET/TC en lesiones extra-hepáticas fue de 84 y 70%, contribuyendo al diagnóstico no sospechado de 5 tumores sincrónicos. Conclusiones. La PET/TC es recomendable para descartar enfermedad extra-hepática en sospecha de recidiva de cáncer colorrectal. La realización de imagen tardía mejora la sensibilidad de la PET/TC en el diagnóstico de metástasis hepáticas(AU)
Aim. To analyze the potential improvement of 18F-fluorodeoxyglucose (FDG) PET/CT using additional delayed images of the liver in operated colorectal cancer. Material and Methods. The study prospectively included 71 patients (22 women, 49 men) with mean age of 65±11 years with clinical, analytic or radiological suspicion of current disease. A whole body PET/CT scan was performed at 60min. (standard images) and after 2 hr (delayed images) post-injection of 4.07 MBq/Kg of 18F-FDG. Visual and quantitative SUV analysis of PET/CT findings was done. All findings were confirmed by histopathology and/or at least 6 months follow-up. Results. Thirty-seven out of 71 patients were diagnosed of liver metastases (79 metastases). In 38/71 cases there was extra-hepatic disease in the form of local recurrence (10), abdominopelvic (3) or mediastinal (3) lymph nodes, bone (1) or lung metastases (16) and carcinomatosis (10). Sensitivity and specificity in the diagnosis of liver metastases in a patient-by-patient basis in standard (81% and 91%) and in delayed images (95% y 97%) was calculated. The number of lesions detected in delayed images was significantly higher (66/79) than in standard images (57/79). Sensitivity and specificity for PET/CT in the diagnosis of extra-hepatic disease was 84% and 70%, contributing to the detection of synchronous tumors in 5 patients. Conclusions. PET/CT may be useful in the diagnosis of extra-hepatic disease in suspected recurrence of colorectal cancer. Delayed images on PET/CT may increase the sensitivity to identify liver metastases(AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Fluordesoxiglucose F18 , Neoplasias Colorretais/diagnóstico , Carcinoma/complicações , Carcinoma/diagnóstico , Fluordesoxiglucose F18/metabolismo , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais , Estudos Prospectivos , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/ultraestrutura , Sensibilidade e EspecificidadeRESUMO
AIM: To analyze the potential improvement of (18)F-fluorodeoxyglucose (FDG) PET/CT using additional delayed images of the liver in operated colorectal cancer. MATERIAL AND METHODS: The study prospectively included 71 patients (22 women, 49 men) with mean age of 65 ± 11 years with clinical, analytic or radiological suspicion of current disease. A whole body PET/CT scan was performed at 60 min. (standard images) and after 2 hr (delayed images) post-injection of 4.07 MBq/Kg of (18)F-FDG. Visual and quantitative SUV analysis of PET/CT findings was done. All findings were confirmed by histopathology and/or at least 6 months follow-up. RESULTS: Thirty-seven out of 71 patients were diagnosed of liver metastases (79 metastases). In 38/71 cases there was extra-hepatic disease in the form of local recurrence (10), abdominopelvic (3) or mediastinal (3) lymph nodes, bone (1) or lung metastases (16) and carcinomatosis (10). Sensitivity and specificity in the diagnosis of liver metastases in a patient-by-patient basis in standard (81% and 91%) and in delayed images (95% y 97%) was calculated. The number of lesions detected in delayed images was significantly higher (66/79) than in standard images (57/79). Sensitivity and specificity for PET/CT in the diagnosis of extra-hepatic disease was 84% and 70%, contributing to the detection of synchronous tumors in 5 patients. CONCLUSIONS: PET/CT may be useful in the diagnosis of extra-hepatic disease in suspected recurrence of colorectal cancer. Delayed images on PET/CT may increase the sensitivity to identify liver metastases.
Assuntos
Adenocarcinoma/secundário , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Fígado/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Imagem Multimodal/métodos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Neoplasias Colorretais/terapia , Feminino , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/diagnóstico por imagem , Neoplasias Pélvicas/secundário , Estudos Prospectivos , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Fatores de TempoRESUMO
OBJECTIVES: The acquisition of adequate vaccine-induced humoral immunity is especially important in HIV-infected individuals, who are at increased risk of infections. The aim of the study was to assess the safety of administering a complete vaccination programme to successfully treated HIV-infected adults and to evaluate specific humoral responses and the effect of highly active antiretroviral therapy (HAART) interruption on these responses. METHODS: A placebo-controlled, double-blind clinical trial was designed and 26 HIV-infected adults enrolled. Study participants were randomized to receive either a complete immunization schedule with commercial vaccines or placebo for 12 months. HAART was then discontinued for 6 months. Specific humoral responses were evaluated at baseline, at month 12 and after HAART interruption and compared between groups. RESULTS: There were neither local nor systemic secondary effects related to vaccination. Specific humoral responses to vaccines were adequate, but a loss of immunoglobulin G titres was observed after HAART interruption in 12 study participants. CONCLUSIONS: HAART interruption may cause impairment of previously acquired vaccine-induced immunity in HIV-infected adults.
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Antirretrovirais/administração & dosagem , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/imunologia , HIV-1 , Vacinas Virais/imunologia , Adulto , Antirretrovirais/imunologia , Anticorpos Antivirais/imunologia , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Placebos , Vacinação , Carga ViralRESUMO
No disponible
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Humanos , Feminino , Pessoa de Meia-Idade , Trombose/complicações , Trombose/diagnóstico , Renografia por Radioisótopo/instrumentação , Renografia por Radioisótopo/métodos , Renografia por Radioisótopo , Tecnécio , Hepatopatias Alcoólicas/complicações , Hepatopatias Alcoólicas/diagnóstico , Trombose , Transplante , Anastomose CirúrgicaAssuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Isquemia/diagnóstico por imagem , Transplante de Rim , Complicações Pós-Operatórias/diagnóstico por imagem , Compostos Radiofarmacêuticos , Artéria Renal/diagnóstico por imagem , Tecnécio Tc 99m Mertiatida , Trombose/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Feminino , Hematoma/diagnóstico por imagem , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Rim/irrigação sanguínea , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Cintilografia , Artéria Renal/cirurgia , Espaço Retroperitoneal , Trombectomia , Trombose/cirurgiaRESUMO
UNLABELLED: The sentinel lymph node (SLN) is the first node in a lymph node basin to receive direct drainage from the primary tumour. However, in some cases, lymphoscintigraphy images demonstrate the presence of lymph nodes located in the area between the primary tumour and the first regional lymph node basin. These nodes are called in-transit nodes and have to be considered SLNs as well. AIM: It was to determine the incidence and location of in-transit SLNs in patients with malignant melanoma and to evaluate whether it is necessary to harvest them. METHOD. Nine hundred patients with malignant melanoma were included. Lymphoscintigraphy was performed on the day before surgery following intradermal injection of 74-111 MBq of 99mTc-Nanocolloid in four doses around the primary lesion or the biopsy scar. RESULTS: The presence of in-transit SLNs was revealed in 80 patients. During surgery, in-transit SLNs were identified and excised in all but 3 patients (96.2 %). Metastatic cell deposits were identified in these in-transit SLNs in 15 patients (19.4 %), with 4 patients with no tumour involvement of the regional lymph node basin. CONCLUSIONS: Lymphoscintigraphy is mandatory in the location of in-transit SLNs. Moreover, although the incidence of these nodes is relatively low in malignant melanoma, the presence of metastatic cells in these in-transit SLNs reaches a significant percentage. Therefore, excision of in-transit SLNs is necessary in all cases.
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Metástase Linfática/diagnóstico por imagem , Melanoma/diagnóstico por imagem , Melanoma/secundário , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática/patologia , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Cintilografia , Compostos Radiofarmacêuticos , Neoplasias Cutâneas/cirurgia , Agregado de Albumina Marcado com Tecnécio Tc 99m , Procedimentos Desnecessários , Adulto JovemRESUMO
El ganglio centinela (GC) es el primer ganglio linfático de un determinado lecho ganglionar que recibe directamente drenaje linfático del tumor primario. Sin embargo, en algunos pacientes existen nódulos linfáticos que se sitúan entre el tumor primario y la primera estación ganglionar regional. Se trata de "ganglios en tránsito" y deben ser considerados GC. Objetivo. Fue determinar el porcentaje y la localización de los GC en tránsito obtenidos de una muestra de pacientes con melanoma maligno y valorar la necesidad de resecar este tipo de ganglios. Método. Se incluyeron en el estudio un total de 900 pacientes con melanoma maligno. El día previo a la cirugía se realizó la linfogammagrafía mediante la administración de 4 inyecciones intradérmicas de 74-111 MBq de 99mTc-Nanocoloide alrededor de la lesión primaria o en la zona de la biopsia escisional. Resultados. Las imágenes revelaron la presencia de GC en tránsito en 80 pacientes (8,9 %). Durante el acto quirúrgico se consiguieron extirpar los GC en tránsito en 77 de los 80 pacientes (96,2 %). En el análisis histológico se hallaron metástasis en 15 pacientes (19,5 %) y, de éstos, 4 no presentaron afectación tumoral del lecho linfático regional. Conclusiones. La linfogammagrafía es imprescindible en la localización de los GC en tránsito. Asimismo, aunque el porcentaje de GC en tránsito en pacientes afectos de melanoma maligno es relativamente bajo, la afectación tumoral de los mismos alcanza un porcentaje significativo. Por ello, creemos que la resección de los GC en tránsito es necesaria en todos los casos
The sentinel lymph node (SLN) is the first nodein a lymph node basin to receive direct drainage from the primary tumour. However, in some cases, lymphoscintigraphy images demonstrate the presence of lymph nodes located in the area between the primary tumour and the first regional lymph node basin. These nodes are called in-transit nodes and have to be considered SLNs as well. Aim. It was to determine the incidence and location of in-transit SLNs in patients with malignant melanoma and to evaluate whether it is necessary to harvest them. Method. Nine hundred patients with malignant melanoma were included. Lymphoscintigraphy was performed on the day before surgery following intradermal injection of 74-111 MBq of99mTc-Nanocolloid in four doses around the primary lesion or the biopsy scar. Results. The presence of in-transit SLNs was revealed in 80 patients. During surgery, in-transit SLNs were identified and excised in all but 3 patients (96.2 %). Metastatic cell depositswere identified in these in-transit SLNs in 15 patients (19.4 %), with 4 patients with no tumour involvement of the regional lymph node basin. Conclusions. Lymphoscintigraphy is mandatory in the locationof in-transit SLNs. Moreover, although the incidence ofthese nodes is relatively low in malignant melanoma, the presence of metastatic cells in these in-transit SLNs reaches a significant percentage. Therefore, excision of in-transit SLNs is necessary in all cases (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia de Linfonodo Sentinela/métodos , Melanoma , Melanoma/cirurgia , Estudos Prospectivos , Compostos Radiofarmacêuticos , Excisão de Linfonodo , Melanoma/patologiaRESUMO
OBJECTIVE: To assess the validity of radioguided sentinel node biopsy in squamous cell penile carcinoma. MATERIAL AND METHODS: Fifteen patients were studied. The first 5 patients were included in a group for validation of the technique, in which a standard inguinal lymphadenectomy was performed after the procedures described below. The remaining 10 patients were included in the technique application group. The day before surgery, lymphoscintigraphy was performed on all patients. During the operation, radioguided biopsy to locate the sentinel node was done. Methylene blue dye was injected shortly before surgery in 10 patients. All patients were followed for an average of 32 months. RESULTS: In the validation group, lymphoscintigraphy revealed inguinal drainage in 5/5 patients. Unilateral metastases were detected in 3/5 patients. No metastatic nodes were detected among the nodes removed during inguinal lymphadenectomy. In the application group, lymphoscintigraphy showed inguinal drainage in 9/10 patients. Nineteen nodes were removed, none of which showed tumour involvement. During the follow-up period, no disease progression or recurrence were observed in either patient group. CONCLUSIONS: Radioguided localization and biopsy of the sentinel nodes can avoid unnecessary lymphadenectomies in patients with squamous cell penile carcinoma and high or intermediate risk of lymph node involvement. This technique shows high reliability and negative predictive value in penile carcinoma.
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Carcinoma de Células Escamosas/secundário , Metástase Linfática/diagnóstico , Neoplasias Penianas/patologia , Biópsia de Linfonodo Sentinela/métodos , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Corantes , Virilha , Humanos , Excisão de Linfonodo , Metástase Linfática/diagnóstico por imagem , Masculino , Azul de Metileno , Radiologia Intervencionista , Cintilografia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Procedimentos DesnecessáriosRESUMO
Objetivo. Valorar la validez de la técnica de biopsia radioguiada del ganglio centinela (GC) en el carcinoma escamoso de pene. Material y métodos. Se han estudiado un total de 15 pacientes con carcinoma escamoso de pene. Los 5 primeros pacientes constituyeron un grupo de validación de la técnica al cual se le realizó linfadenectomía inguinal reglada, tras los procedimientos descritos a continuación. Los 10 pacientes restantes constituyeron el grupo de aplicación de la técnica. El día previo a la cirugía se realizó linfogammagrafía a todos los pacientes, y durante el acto quirúrgico se procedió a la biopsia radioguiada de los GC. En 10 de los pacientes se realizó inyección de azul de metileno antes de la intervención. Se ha realizado un seguimiento de los pacientes durante una media de 32 meses. Resultados. En el grupo de validación la linfogammagrafía mostró drenaje inguinal en 5/5 pacientes. Fueron detectadas metástasis unilaterales en 3 de ellos. No mostró infiltración tumoral ninguno de los ganglios linfáticos extirpados en la linfadenectomía. En el grupo de aplicación, la linfogammagrafía mostró drenaje inguinal en 9/10 pacientes. Se extirparon un total de 19 GC, sin detectarse infiltración tumoral en ninguno de ellos. En el seguimiento no se ha detectado progresión de la enfermedad en ningún paciente. Conclusiones. La localización del GC mediante biopsia radioguiada del mismo permite evitar linfadenectomías innecesarias en pacientes con carcinoma escamoso de pene y riesgo intermedio o alto de presentar afectación ganglionar. La técnica ofrece una elevada fiabilidad y valor predictivo negativo en el carcinoma escamoso de pene
Objective. To assess the validity of radioguided sentinel node biopsy in squamous cell penile carcinoma. Material and methods. Fifteen patients were studied. The first 5 patients were included in a group for validation of the technique, in which a standard inguinal lymphadenectomy was performed after the procedures described below. The remaining 10 patients were included in the technique application group. The day before surgery, lymphoscintigraphy was performed on all patients. During the operation, radioguided biopsy to locate the sentinel node was done. Methylene blue dye was injected shortly before surgery in 10 patients. All patients were followed for an average of 32 months. Results. In the validation group, lymphoscintigraphy revealed inguinal drainage in 5/5 patients. Unilateral metastases were detected in 3/5 patients. No metastatic nodes were detected among the nodes removed during inguinal lymphadenectomy. In the application group, lymphoscintigraphy showed inguinal drainage in 9/10 patients. Nineteen nodes were removed, none of which showed tumour involvement. During the follow-up period, no disease progression or recurrence were observed in either patient group. Conclusions. Radioguided localization and biopsy of the sentinel nodes can avoid unnecessary lymphadenectomies in patients with squamous cell penile carcinoma and high or intermediate risk of lymph node involvement. This technique shows high reliability and negative predictive value in penile carcinoma
Assuntos
Masculino , Humanos , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Penianas/patologia , Carcinoma de Células Escamosas/patologia , Excisão de Linfonodo , Biópsia por Agulha Fina , Espectrometria gamaRESUMO
PURPOSE: The role of the radioguided occult lesion localisation (ROLL) technique in breast cancer has been increasing in recent years. One of the important drawbacks of such a technique is radiotracer spillage within the mammary gland that makes the precise lesion resection difficult, and this requires the use of a hook-wire collocation to reach the lesion. The possibility of obtaining an intraoperative image of the specimen could help to confirm whether the lesion is correctly removed. Some types of portable gamma cameras have been designed, but up to now, intraoperative use has been confined to surgery of parathyroid adenomas and sentinel lymph node location. The aim of the study was to value the usefulness of an intraoperative gamma camera to assess the resection of non-palpable breast lesions. MATERIALS AND METHODS: The study involved 42 women diagnosed with non-palpable early breast cancer. Lymphoscintigraphy was performed on the day before surgery by injection of (99m)Tc-labelled nanocolloid. During surgery a gamma probe was used to guide the surgeon, and afterwards images of the surgical bed and the tumoral specimen were acquired by means of a portable gamma camera, fitted with a pinhole collimator. A (99m)Tc pointer was used to draw an outline image around the specimen. RESULTS: On lymphoscintigraphy, radiotracer was concentrated in 31 cases. During surgery, all lesions were removed. In the images acquired by the portable gamma camera, the lesion was centred inside the surgical specimen in 23 of 42 cases, non-centred in 15 and in contact in 4 cases. Congruence of 60% was found between the intraoperative images and the histopathological results. The posterior margin was the most frequently involved. The whole acquisition time for the tumoral specimen with its margins was 5 min at most. CONCLUSION: The use of portable gamma cameras in theatre is in an early phase. The short period of time required during the surgical procedure will allow the surgical team to improve this technique until it can replace hand-held probes. The intraoperative acquisition of such images can predict the involvement of surgical margins, avoiding future surgical procedures.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Câmaras gama , Mastectomia/instrumentação , Cirurgia Assistida por Computador/instrumentação , Adulto , Idoso , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Miniaturização , Projetos Piloto , Cintilografia , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of this study was to evaluate the detection of intravascular injection or hematic aspiration in relation to (a) the particular combination of syringe system and needle (there being 3 different syringe systems [2 self-aspirating and 1 non-self-aspirating] and 3 different needles); (b) the anesthetic technique used (direct or indirect) to induce inferior alveolar nerve block; (c) patient sex; and (d) the operator performing the block. STUDY DESIGN: Two operators performed 246 inferior alveolar nerve blocks (on 90 male and 156 female patients) using 3 syringe systems (1 non-self-aspirating (Uniject K) and 2 self-aspirating (Aspiject and Inibsaject)) and 3 types of needle in terms of length and gauge combination (30G/25 mm, 27G/25 mm, and 27G/35 mm) for conventional and surgical extractions of lower third molars. Three aspirations were made at each of 3 different times in each block. Hematic aspiration was accepted only if a blood jet rose forcefully along the cartridge on aspiration. In each block, the age and sex of the patient was recorded, along with the latency or time elapsed from introduction of the anesthetic solution to onset of the anesthetic effect, the depth of the needle at contact with the mandibular ramus, and the operator performing the block. RESULTS: Significant differences (P <.05) were observed with respect to hematic aspiration and the syringe system used, the Uniject K system yielding higher percentage hematic aspirations (5.69%) than either of the self-aspirating systems, Inibsaject (2.03%) and Aspiject (1. 21%). However, no significant differences (P >.05) were observed with respect to number of aspirations, needle length, needle gauge, anesthetic technique performed, patient's sex, or operator performing the inferior alveolar nerve block. The incidence of hematic aspirations was 8.9%. The mean latency time was 39.03 seconds, and the mean needle depth at contact with the mandibular ramus was 20.72 mm. CONCLUSIONS: The Uniject K non-self-aspirating syringe system was associated with a higher number of hematic aspirations than the self-aspirating systems (Inibsaject and Aspiject). However, the detection of hematic aspirations was not dependent on length or gauge of the needles used, anesthetic technique performed (direct or indirect), patient's sex, or operator who performed the block.