Pelvic + Anatomy: A new interactive pelvic anatomy model. Prospective randomized control trial with first-year midwife residents.

Detailed knowledge of female pelvic floor anatomy is essential for midwifery and other professionals in obstetrics. Physical models have shown great potential for teaching anatomy and enhancing surgical skills. In this article, we introduce an innovative physical anatomy model called "Pelvic+" to teach anatomical relationships in the female pelvis. The Pelvic+ model's value was compared to a traditional lecture in 61 first-year midwifery students randomly allocated to either the Pelvic+ (n = 30) or a control group (n = 32). The primary outcome measure was a quiz comprised of 15 multiple choice questions on pelvic anatomy. Participants were assessed at baseline (Pre-Test), upon completion of the intervention (Post-Test1) and 4 months afterward (Post-Test2). Satisfaction with the approach was assessed at Post-Test1. Increase in knowledge was greater and the approach more accepted among resident midwives when Pelvic+ was used instead of standard lectures. Four months after the intervention, the improvement in knowledge was preserved in the Pelvic+ group. This randomized study demonstrates that the Pelvic+ simulator is more effective than classical learning for pelvic anatomy education, and offers a higher level of satisfaction among students during the educational process. Medical students training in obstetrics and gynecology, or any professional who specializes in the female pelvic floor might also benefit from incorporation of the Pelvic+ model into their training program.

Arachnoid membrane as a source of sphingosine-1-phosphate that regulates mouse middle cerebral artery tone.

Growing evidence indicates that perivascular tissue is critical to modulate vessel function. We hypothesized that the arachnoid membrane surrounding middle cerebral artery (MCA) regulates its function via sphingosine-1-phosphate (S1P)-induced vasoconstriction. The MCA from 3- to 9-month-old male and female wild-type (Oncine France 1 and C57BL/6) mice and sphingosine kinase 2 knockout (SphK2-/-) mice in the C57BL/6 background was mounted in pressure myographs with and without arachnoid membrane. Raman microspectroscopy and imaging were used for in situ detection of S1P. The presence of arachnoid tissue was associated with reduced external and lumen MCA diameters, and with an increase in basal tone regardless of sex and strain background. Strong S1P-positive signals were detected in the arachnoid surrounding the MCA wall in both mice models, as well as in a human post-mortem specimen. Selective S1P receptor 3 antagonist TY 52156 markedly reduced both MCA vasoconstriction induced by exogenous S1P and arachnoid-dependent basal tone increase. Compared to 3-month-old mice, the arachnoid-mediated contractile influence persisted in 9-month-old mice despite a decline in arachnoid S1P deposits. Genetic deletion of SphK2 decreased arachnoid S1P content and vasoconstriction. This is the first experimental evidence that arachnoid membrane regulates the MCA tone mediated by S1P.

Anatomical study of the pial arterial network in human spinal cords.

INTRODUCTION: Multiple collaterals originate from three main longitudinal vessels to perfuse the human spinal cord. Only a few classic studies published in the last century have investigated these collaterals. The current work proposes a possible classification of these vessels and analyzes their relative abundance along spinal cord segments. MATERIALS AND METHODS: Human spinal cords (n = 30) from male and female cadavers were injected with colored latex through the vertebral, ascending cervical, costocervical trunk and segmental arteries and then fixed in formaldehyde solution. Afterwards, spinal vessels were dissected and the relative abundances of each type of collateral were quantified and compared between different spinal cord segments. RESULTS: Collaterals of the anterior longitudinal pathway can be classified as central arteries and arteries for the anterior and lateral columns. Collaterals for the anterior column can be classified into two types: anteromedial and anterolateral. Arteries for the lateral column can be classified, according to their relationship with the dentate ligament, as either preligamentous or post-ligamentous. The collaterals of posterior longitudinal pathways can be divided between those for the posterior and those for the lateral column. In turn, the arteries for the posterior column can be classified into three types: median posterior, posteromedial and posterolateral. The collaterals for the lateral column were also classified as either pre- or post-ligamentous. CONCLUSION: The relative abundance of the various types of collateral and anastomoses between longitudinal pathways was inhomogeneous along the spinal cord, with several statistically significant differences observed between spinal segments.

Evaluation of the human petrotympanic fissure using anatomized cadaveric specimens and multi-detector CT imaging.

PURPOSE: The purpose of the current study is twofold. First, to investigate the variability of the petrotympanic fissure's (PTF) morphology in anatomized human cadaveric specimens using multi-detector computed tomography (MDCT), and second, to compare the resulting measurements to investigate the possibilities of applying MDCT in the determination of PTF morphology in living humans. METHODS: Specimens (n = 15) containing the temporal bone and TMJ were obtained from embalmed adult female (53.3%) and male (46.7%) cadavers and imaged using a helical 16-row scanner. Afterwards, cryosections were obtained and morphometric parameters were measured. Degree of agreement between both determinations was investigated and morphometric variables were also compared between PTF types. RESULTS: Three different types of PTF were identified. Type 1 was a wide tunnel-shaped structure. It was found in 20% of the cases. Type 2 was wide in the entrance but gradually narrows to the tympanic cavity. It was found in 46.7% of specimens. Finally, type 3, which was observed in 33.3% of the cases, was wide at the entrance of the mandibular fossa, followed by a middle region with flat-shaped tunnel structure and a narrow exit. The PTF's vertical diameters at the mandibular fossa, midpoint, and tympanic cavity and the width at the mandibular fossa all were significantly greater in type 1 specimens. CONCLUSIONS: MDCT is suitable for investigating the variable morphology of human PTF and its association with middle ear's and TMJ pathologies.

[Fatal spotted fever in Salta province]. / Fiebre manchada de evolución fatal en la provincia de Salta.

We describe the case of a 17-year-old male patient living in Salta city who, 10 days after visiting a rural area in Salta province, was hospitalized for febrile seizures. Shortly after admission, he developed an exanthema followed by a multiple organ dysfunction that evolved to irreversible septic shock followed by death 48 hours after admission. Serological diagnosis -high IgM and IgG anti-Rickettsia spp. antibody titres as detected by indirect immunofluorescence- arrived post mortem. Spotted fever group rickettsioses are tick-borne diseases distributed worldwide and continue being under diagnosed in several countries mainly due to a low clinical suspicion. In the north-western provinces of Argentina there is also the limitation of not counting with a regional laboratory to perform the etiological diagnosis. This is crucial because the severe forms of the disease, which are commonly caused by R. rickettsii, have been already documented in the region. Given that spotted fevers have broadly unspecific febrile presentations and the components of the enzootic cycle are present even in geographic areas not yet considered to be endemic for tick borne diseases, their diagnosis should not be underestimated. If the adequate antibiotic treatment is administered timely, the prognosis of this group of life-threatening diseases improves drastically.

Fiebre manchada de evolución fatal en la provincia de Salta / Fatal spotted fever in Salta province

Describimos el caso de un varón de 17 años oriundo de la ciudad de Salta quien, 10 días después de visitar una zona rural de la provincia homónima, ingresó a nuestro hospital por convulsiones febriles. Durante la internación presentó exantema seguido de disfunción orgánica múltiple, la que evolucionó rápidamente hacia shock séptico irreversible y muerte a las 48 horas de su admisión. El diagnóstico serológico -altos títulos de IgM e IgG anti-Rickettsia spp. por inmunofluorescencia indirecta- arribó post mortem. Las rickettsiosis del grupo de las fiebres manchadas son transmitidas por garrapatas, tienen distribución global y en varios países continúan siendo subdiagnosticadas debido a una baja sospecha clínica. En las provincias del noroeste argentino se agrega la carencia de un laboratorio regional capacitado para efectuar el diagnóstico etiológico. Esta limitación es crítica porque en esa región del país ya ha sido documentada la presencia de las formas graves de la enfermedad, usualmente debidas a R. rickettsii. Dado que las fiebres manchadas se presentan como sindromes febriles inespecíficos y los componentes del ciclo enzoótico están presentes en vastas áreas geográficas, incluso en algunas aún no consideradas endémicas para rickettsiosis, su diagnóstico nunca debe ser subestimado. Con el tratamiento antibiótico adecuado instaurado en tiempo oportuno, el pronóstico de este grupo de enfermedades potencialmente mortales mejora en forma drástica.

We describe the case of a 17-year-old male patient living in Salta city who, 10 days after visiting a rural area in Salta province, was hospitalized for febrile seizures. Shortly after admission, he developed an exanthema followed by a multiple organ dysfunction that evolved to irreversible septic shock followed by death 48 hours after admission. Serological diagnosis -high IgM and IgG anti-Rickettsia spp. antibody titres as detected by indirect immunofluorescence- arrived post mortem. Spotted fever group rickettsioses are tick-borne diseases distributed worldwide and continue being under diagnosed in several countries mainly due to a low clinical suspicion. In the north-western provinces of Argentina there is also the limitation of not counting with a regional laboratory to perform the etiological diagnosis. This is crucial because the severe forms of the disease, which are commonly caused by R. rickettsii, have been already documented in the region. Given that spotted fevers have broadly unspecific febrile presentations and the components of the enzootic cycle are present even in geographic areas not yet considered to be endemic for tick borne diseases, their diagnosis should not be underestimated. If the adequate antibiotic treatment is administered timely, the prognosis of this group of life-threatening diseases improves drastically.

Variations in vascular anatomy and unilateral adrenal agenesis in a female cadaver with situs inversus totalis.

PURPOSE: Situs inversus totalis is mirror transposition of thoracic and abdominal organs. Very few reports have been published on anatomic dissections of cadavers with this condition. METHODS: This work describes a case of situs inversus totalis identified during the anatomical dissection of a 91-year-old woman. RESULTS: Thoracic and abdominal viscera were inverted, but otherwise normal. The aorta originated from the right ventricle, which exhibited characteristics of the systemic ventricle. The pulmonary artery originated from the left ventricle, which had a tricuspid valve, three papillary muscles, thick trabeculae, a supraventricular crest, and septomarginal trabecula. The atrial situs was concordant with ventricular morphology. Lungs and paranasal sinuses were not suggestive of Kartagener's syndrome. Only the right adrenal gland was present, and variations in vascular anatomy were observed. The latter included: the celiac trunk branching into a phrenic artery, the splenic artery and a right gastric artery; the common hepatic artery originating from the superior mesenteric artery; and, on the left side, two inferior thyroid arteries, both originating from thyrocervical trunk. The occurrence of a double inferior thyroid artery and agenesis of adrenal gland was never communicated in situs inversus. Embryonic origin of celiac trunk and superior mesenteric artery variations could be explained by the separation at higher levels of the longitudinal anastomoses formed between the four roots of omphalomesenteric artery. CONCLUSION: It can be hypothesized that this phenomenon could occur more frequently in situs inversus than in situs solitus. However, the number of cases investigated in such detail is too small to draw firm conclusions.

Variable anatomic configuration of the posterior spinal arteries in humans.

Posterior spinal arteries (PSAs) arise from the vertebral (VA) or posterior inferior cerebellar (PICA) artery. We identified variations in their origins and their anastomosis with the first posterior radiculomedullary branches in human spinal cords. Spinal cords from male and female cadavers (n = 30) were injected with colored latex through the vertebral, ascending cervical, costocervical trunk and segmental arteries. Specimens were fixed in formalin and the spinal arteries were dissected under a surgical microscope. PSAs arise from the PICA and from the atlantoaxial (V3) or intracranial (V4) segments of the VA. Their origins can be at V3 between the axis and the transverse processes of the atlas (V3i) or between the processes and the occipital bone (V3s). Half of our specimens exhibited a symmetrical and half an asymmetrical origin of the PSAs. A symmetrical origin from V4 was the most common configuration, identified in 30% of specimens. There was a symmetrical origin from either segment of V3 or PICA in 10%. Asymmetrical configurations were observed from V4/V3 (23.7%), V3/PICA (16.7%), V4/PICA (6.7%) and V3i/V3s (3.3%). PSAs are supplied by the posterior radiculomedullary arteries along the spinal cord. The first of these anastomoses could be located at any level between C4 and T8, though most commonly at C6-C7 or T3-T4. PSAs can originate from either the VA or the PICA in a symmetrical or asymmetrical configuration. Variations in the origin and level of the first posterior radiculomedullary anastomosis could affect surgical approaches, endovascular procedures, and the posterior spinal cord's susceptibility to ischemia. Clin. Anat. 31:1137-1143, 2018. © 2018 Wiley Periodicals, Inc.

Vascular configurations of anastomotic basket of conus medullaris in human spinal cord.

The arterial basket of the conus medullaris is one of several anastomoses between the anterior and posterior spinal arteries. The anatomy of this structure has attracted little attention. This work sought to investigate its configuration in human spinal cords. Spinal cords from male and female cadavers (n = 32) were injected with colored latex through the intercostal, lumbar, medial sacral and the posterior trunks of the hypogastric arteries. After injection, specimens preserving the dural sac were obtained and fixed in formaldehyde solution. Finally, the spinal arteries were microdissected. In 18.75% of the specimens, the anterior spinal artery divided symmetrically and formed anastomoses with the posterior spinal arteries. In 81.25%, the branching pattern observed was asymmetrical. In 21.87% there were differences in the diameter of the anastomotic arteries, and 40.63% originated at different levels along the craniocaudal axis. Interestingly, 12.5% of the specimens presented an intraparenchymatous anastomosis that has not been described previously. True unilateral anastomosis was only observed in 6.25% of the spinal cords. The most frequent configuration of the anastomotic basket of the conus medullaris is a bilateral asymmetric anastomosis. The asymmetry of the branches could be caused by differences in their diameters or in their origins along the craniocaudal axis. Symmetrical patterns are less frequent, and unilateral anastomoses are rare. In reality, some cases of apparently unilateral anastomosis present an intramedullary course of the anastomotic artery. Clin. Anat. 31:441-448, 2018. © 2017 Wiley Periodicals, Inc.

A case of unusual configuration of the right bronchial arteries combined with cryptogenic severe bilateral hypertrophy.

Bronchial arteries commonly originate from thoracic aorta between T5 and T6. Ectopic origins from aortic arch, supraortic trunks and their branches, coronary arteries, and even abdominal aorta have been described in the literature. In some circumstances, such as pulmonary artery malformations, chronic embolism, or inflammatory diseases of the lung, the bronchial arteries become hypertrophied and eventually could be the only supply of pulmonary circulation. Here, we describe a case of an elderly man who presented an unusual pattern of bronchial arteries of the right lung combined with severe bilateral hypertrophy of bronchial vessels. In the right side, one bronchial artery originated from the descendent aorta and anastomosed with a branch descending from the thyrocervical trunk, which, in turn, received in its path an anastomosis from the superior intercostal artery. The right lung also received a second bronchial artery that originated from the internal thoracic artery. This arterial configuration could be explained by the persistence of precostal longitudinal anastomoses during the embrionary development. Left bronchial arteries presented an orthotopic origin from the descending aorta. Arteries of both sides were very hypertrophic and tortuous resembling major aortopulmonary collateral arteries described in patients with pulmonary atresia. Hypertrophy was more pronounced in the right lung with some segments presenting a lumen diameter of 10 mm. No cardiac or vascular malformations that could explain the hypertrophy of bronchial arteries were observed. In contrast, both lungs showed clear signs of chronic inflammation and fibrosis that could be the cause of bronchial artery hypertrophy.

Widespread microglial activation in patients deceased from traumatic brain injury.

PRIMARY OBJECTIVE: The role of microglial activation in traumatic brain injury (TBI) has been extensively described in established animal models. In contrast, very few studies have analysed this process in human patients, the majority being focused on the local reaction in the contused parenchyma. In this work, the main objective was the analysis of microglial activation in brain regions distant from the primary lesion. RESEARCH DESIGN: Morphological changes of microglia were evaluated in the cerebral cortex of patients deceased from TBI in comparison with control subjects. METHODS AND PROCEDURES: Cortical samples from five cases with TBI and 10 controls were evaluated using Ricinus communis lectin histochemistry and conventional Hematoxylin-eosin staining. MAIN OUTCOMES AND RESULTS: It was observed that microglial cells from patients with TBI presented shorter and thicker cellular projections compared with controls. Moreover, the percentage of histological area reactive to lectin was statistically higher in samples from subjects with TBI. These signs of microglial activation were observed in all of the analysed cortical areas, thus indicating a generalized effect on the whole cerebral cortex. The results are consistent with previous imaging PET studies performed in living patients with the 11C-PK11195 radiotracer. CONCLUSIONS: The findings indicate that TBI induces a widespread activation of brain microglia which affects all cortical areas, including those distant from the contusion site.

Correlación radiológico-neuropatológica. Lesión traumática de la médula espinal / Radiological-neuropathological correlation. Traumatic injury of the spinal cord

Se presentan los hallazgos neuropatológicos de la autopsia de una mujer de 80 años de edad que, tras una caída casual en su domicilio, sufrió un síndrome de compresión medular agudo, falleciendo 9 días después del ingreso en el contexto de un cuadro respiratorio agudo. Se realizó estudio neuropatológico mediante extracción del bloque cervical, congelación y cortes sagitales seriados del bloque para evaluación de las lesiones traumáticas. El caso mostró una buena correlación con los estudios de neuroimagen efectuados. El examen macroscópico de la columna cervical constató la presencia de diversas roturas discales y del ligamento longitudinal anterior, diversos focos hemorrágicos paravertebrales, epidurales y centromedulares, y una compresión aguda del cordón medular, sugiriendo un mecanismo lesivo de aceleración anteroposterior del raquis. La remoción y el estudio del bloque cervical, en casos de sospecha de patología traumática, ofrece al patólogo las ventajas de un segundo tiempo de autopsia, la posibilidad de comparar con los diagnósticos de neuroimagen y, en última instancia, una óptima evaluación de las lesiones neuropatológicas. Implementar la correlación radiológico-patológica en el campo de la neuropatología forense puede contribuir al conocimiento epidemiológico y etiopatológico de las lesiones traumáticas del sistema nervioso central (AU)

We report the neuropathological findings in a 80-years-old woman with acute spinal cord compression after an accidental fall at home, who died of acute respiratory failure 9 days after admission. Neuropathological examination was performed by cervical bloc removal, and the examination of frozen serial sagittal sections to assess the presence of traumatic injuries. The case showed a good correlation with previous imaging studies. Gross examination of the cervical spine confirmed the presence of numerous disc lesions and anterior longitudinal ligament rupture, several paravertebral, epidural and centromedullar hemorrhagic foci, and an acute compression of the spinal cord, suggesting an anteroposterior acceleration mechanism of injury of the spine. The removal and study of the cervical block in cases of suspected traumatic pathology, offers the advantages of a second time autopsy, the opportunity to compare with the diagnostic imaging, and ultimately an optimal evaluation of histopathological changes. Implementing radiologic-pathologic correlation in the field of forensic neuropathology, could contribute to the epidemiological and etiopathologic knowledge of the central nervous system injuries (AU)

Factors affecting surgical margins in nonpalpable breast tumors excised with the radioguided occult lesion localization approach.

AIM: Most breast surgeons generally assume that obtaining negative margins in nonpalpable tumors is a matter of concern. The aim of this study was to examine whether it is easier to obtain negative margins in palpable tumors than in nonpalpable tumors excised with the radioguided occult lesion localization (ROLL) technique. METHODS: A retrospective review was made of nonpalpable breast cancers excised with the ROLL technique (ROLL group, n = 83) and palpable breast cancers in which breast conservative therapy was performed (Palpable group, n = 77). The margin status and the size of the minimum margin obtained when it was negative were reviewed. RESULTS: The percentage of resections with negative margins was similar in both groups: 51.9% in the Palpable group and 61.4% in the ROLL group. There was no difference between the two groups in the minimum margin obtained: mean ± SD, 5.53 ± 3.146 mm in the Palpable group and 5.96 ± 3.039 mm in the ROLL group. Risk factors for failing to obtain negative margins were analyzed in both groups and were similar. These risk factors included histological grade, extensive intraductal carcinoma and c-erbB2 status. CONCLUSION: It is concluded that excision of nonpalpable breast tumors with the ROLL approach obtains similar results for margins as conservative surgery performed for palpable tumors.

Assessment of migration of HIV-1-loaded dendritic cells labeled with 111In-oxine used as a therapeutic vaccine in HIV-1-infected patients.

Monocyte-derived dendritic cells (DCs) loaded with heat-inactivated HIV are used in therapeutic immunizations. It is not known whether they migrate in vivo to lymph nodes. We used an (111)In-oxine-labeled DC (ILDC) method to visualize the migration of DCs. The activity, time and incubation medium were investigated to obtain the highest cellular viability and radiolabeling yield. A trypan-blue exclusion test was used to determine the cellular viability. In five patients, 2 x 10(6) ILDCs were injected subcutaneously in the arm. An initial dynamic study was performed during the first 5 min after injection. This was followed by static acquisitions at several time points, using a high-resolution (general electric) gamma-camera and quantifying the activity at regions of interest drawn on the injection point. The sensitivity of the gamma-camera was evaluated. The highest number of viable DCs (>83%) and the best radiolabeling yield (>70%) were obtained with 1.11 MBq (111)In-oxine, after 10 min of incubation at 37 degrees C in sodium chloride solution 0.9%. We did not observe migration of ILDCs to local lymph nodes in any patient. However, focal uptake at the place of injection continued during the study period. We observed a higher than expected loss of activity from the injection point (median A(t)/A(0) = 0.60 at day 2), which correlated with an increase in total cytotoxic T lymphocytes (CD8(+) and granzyme B(+) cells) in the lypmphoid tissue observed after immunization (R(2) = 0.92, p = 0.03). If more than 20,000 ILDCs had migrated, they could have been detected. In future trials, a higher number of DCs or alternative methods should be used to assess the migration of DCs to lymph nodes.

Pleiotrophin receptor RPTP-zeta/beta expression is up-regulated by L-DOPA in striatal medium spiny neurons of parkinsonian rats.

L-DOPA is still the drug of choice to treat Parkinson's disease although adverse side effects appear after several years of treatment. These are thought to be the consequence of plastic re-arrangements of the nigrostriatal connections, such as sprouting of the dopaminergic terminals or post-synaptic changes. Pleiotrophin, a trophic factor that we have shown to be up-regulated in the striatum of parkinsonian rats after long-term L-DOPA treatment may play a role in these plastic changes. To determine whether one of the three known pleiotrophin receptors [N-syndecan, receptor protein tyrosine phosphatase type zeta beta (RPTP-zeta/beta) and anaplastic lymphoma kinase] might be implicated in these putative plastic effects, we quantified their expression levels by real-time RT-PCR in the striatum and mesencephalon of rats with partial lesions of the nigrostriatal pathway undergoing L-DOPA treatment. Both pleiotrophin and RPTP-zeta/beta expression was up-regulated in the striatum but not in the mesencephalon of lesioned rats and RPTP-zeta/beta expression was even further increased by L-DOPA. The levels of the RPTP-zeta/beta protein were also increased in the striatum of L-DOPA-treated lesioned rats. Immunofluorescence labeling showed the protein to be constitutively expressed in striatal medium spiny neurons, which are innervated by both the corticostriatal glutamatergic and nigrostriatal dopaminergic systems. RPTP-zeta/beta might therefore be implicated in the plastic changes triggered by L-DOPA treatment and might merit further study as a potential candidate for Parkinon's disease therapy.

[Feasibility of the sentinel lymph node technique in cervical and vulvar cancers]. / Aplicabilidad de la técnica del ganglio centinela en carcinomas de cérvix y de vulva.

BACKGROUND AND OBJECTIVE: Our goal was to investigate the feasibility of identifying the sentinel lymph node (SLN) in patients undergoing surgery for cervical and vulvar carcinomas. We also evaluated the advantages that such procedure can offer in this kind of tumors. PATIENTS AND METHOD: We detected the sentinel lymph node through preoperative lymphoscintigraphy (Technetium-99m colloid) and intraoperative visualization with blue dye by a hand-held or laparoscopic gamma-probe in 7 patients with invasive cervical carcinoma (clinical stage Ib1) and in 6 patients with vulvar carcinoma (clinical stages Ib and II) . RESULTS: At least one sentinel lymph node was identified in each patient. SNL was more commonly found in patients with invasive cervical carcinoma. We observed neoplastic infiltration in 3 nodes, all of them corresponding to cases of vulvar carcinoma. CONCLUSIONS: Sentinel lymph node identification is a feasible technique in the management of vulvar and cervical carcinomas. Our preliminary data show that SLN in gynecological carcinomas have similar uses as in other anatomical sites, identifying women in whom lymph node dissection can be avoided.

Aplicabilidad de la técnica del ganglio centinela en carcinomas de cérvix y de vulva / Feasibility of the sentinel lymph node technique in cervical and vulvar cancers

Fundamento y objetivo: Los objetivos del presente trabajo son, por un lado, estudiar la aplicabilidad de las técnicas de ganglio centinela (GC) en un grupo de pacientes con cáncer de cérvix y cáncer de vulva en estadios iniciales, y, por otro, valorar las ventajas que el procedimiento puede ofrecer en estos tumores en función de nuestros resultados preliminares. Pacientes y método: Practicamos la técnica de GC mediante trazador radiactivo en combinación con colorante vital en 7 pacientes con cáncer de vulva (estadios clínicos Ib y II) y 6 pacientes con cáncer de cérvix en estadio Ib1, en 2 casos mediante abordaje laparoscópico. Los hallazgos obtenidos con la técnica no modificaron el tratamiento previsto en cada caso, que se realizó de acuerdo con protocolos preestablecidos. En el estudio histológico del GC se aplicaron técnicas de ultraestadificación. Resultados: Identificamos GC en todos los casos, excepto en una paciente con adenocarcinoma endocervical. El número de GC identificados por paciente fue mayor en los casos de cáncer de cérvix. Tres GC mostraron infiltración neoplásica, uno con micrometástasis, en 3 pacientes con cáncer de vulva. Ningún ganglio no centinela resultó metastásico. No constatamos complicaciones asociadas al procedimiento. Conclusiones: La técnica de GC es aplicable en carcinomas de cérvix y vulva. A partir de nuestros resultados preliminares coincidimos con otros autores en que su aplicación en los tumores ginecológicos estudiados puede aportar beneficios similares a los descritos para tumores de otras localizaciones

Background and objective: Our goal was to investigate the feasibility of identifying the sentinel lymph node (SLN) in patients undergoing surgery for cervical and vulvar carcinomas. We also evaluated the advantages that such procedure can offer in this kind of tumors. Patients and method: We detected the sentinel lymph node through preoperative lymphoscintigraphy (Technetium-99m colloid) and intraoperative visualization with blue dye by a hand-held or laparoscopic gamma-probe in 7 patients with invasive cervical carcinoma (clinical stage Ib1) and in 6 patients with vulvar carcinoma (clinical stages Ib and II) . Results: At least one sentinel lymph node was identified in each patient. SNL was more commonly found in patients with invasive cervical carcinoma. We observed neoplastic infiltration in 3 nodes, all of them corresponding to cases of vulvar carcinoma. Conclusions: Sentinel lymph node identification is a feasible technique in the management of vulvar and cervical carcinomas. Our preliminary data show that SLN in gynecological carcinomas have similar uses as in other anatomical sites, identifying women in whom lymph node dissection can be avoided

[Impact of the availability of an external nuclear medicine service in the application of sentinel lymph node biopsy in breast cancer surgery]. / Impacto de la disponibilidad de un servicio externo de medicina nuclear en la aplicación de la biopsia del ganglio centinela en cirugía del cáncer de mama.

INTRODUCTION: To perform sentinel lymph node biopsy (SLNB), nuclear medicine services that have previously undergone a validation phase are required. The aim of the present study was to analyze the possibility of performing this technique with a previously validated, external nuclear medicine service and to study its impact on the indication for radical axillary lymphadenectomy (RAL) and on length of postoperative hospital stay. PATIENTS AND METHODS: We performed a prospective study in a cohort of patients with breast cancer starting from the introduction of SLNB in our center, which was made possible by collaboration with an external nuclear medicine service that performed lymphoscintigraphy and sentinel node detection. Intraoperative detection was performed through a portable probe. The feasibility of the project and its clinical impact were analyzed, taking a reduction in the number of lymphadenectomies and length of hospital stay as endpoints. RESULTS: A total of 196 patients with 201 breast carcinomas were treated. The most frequent interventions were tumorectomy (TC) with SLNB in 124 patients (62%), and TC with SLNB and RAL in 62 patients (31%). Sentinel node visualization on lymphoscintigraphy was achieved in 187/201 carcinomas (93.1%) and sentinel nodes were detected during the intervention in 182/187 carcinomas (97.4%). Sentinel node detection in the internal mammary chain was achieved in 23/201 carcinomas (11.4%). RAL was avoided in 131 of the 201 carcinomas (65%). Days of postoperative hospital stay with or without RAL showed a mean difference of 1.8 days (3.1 vs. 1.3; P < .001). CONCLUSION: SLNB is feasible with the collaboration of an external nuclear medicine service. This technique avoids 65% of RAL and reduces length of postoperative stay by 1.8 days.

Impacto de la disponibilidad de un servicio externo de medicina nuclear en la aplicación de la biopsia del ganglio centinela en cirugía del cáncer de mama / Impact of the availability of an external nuclear medicine service in the application of sentinel lymph node biopsy in breast cancer surgery

Introducción. La realización de la técnica de la biopsia selectiva del ganglio centinela (BSGC) en el tratamiento del cáncer de mama requiere disponer de un servicio de medicina nuclear (SMN) y de la validación de su técnica. El objetivo del presente estudio es analizar la posibilidad de realizar esta técnica con un SMN externo ya validado, y estudiar su impacto en la indicación de la linfadenectomía axilar radical (LAR) y en la estancia postoperatoria. Pacientes y métodos. Estudio prospectivo en una cohorte de pacientes con cáncer de mama a partir de la implantación en nuestro centro de la técnica de la BSGC gracias a la colaboración de un SMN externo que realizaba la linfogammagrafía y la detección del ganglio centinela (GC), en tanto que su identificación intraoperatoria se llevaba a cabo mediante una sonda portátil. Se analiza la viabilidad del proyecto y su impacto clínico tomando como resultados finales la disminución del número de linfadenectomías y la estancia hospitalaria. Resultados. Se ha tratado a 196 pacientes, con 201 carcinomas de mama. Las intervenciones mayoritarias fueron la tumorectomía (TC) con BSGC en 124 casos (62%), y la TC con BSGC y LAR en 62 casos (31%). La visualización del GC en la linfogammagrafía se obtuvo en 187 de 201 casos (93,1%) y se ha detectado el GC durante la intervención en 182 de los 187 (97,4%) casos. La detección de GC en la cadena mamaria interna se ha producido en 23 de los 201 casos (11,4%). Se ha evitado la LAR en 131 de los 201 casos (65%). La diferencia de días de ingreso postoperatorio con o sin LAR fue de una media de 1,8 días (3,1 frente a 1,3; p < 0,001). Conclusiones. La técnica de BSGC ha sido factible con la colaboración de un SMN externo; se evitó el 65% de las LAR y disminuyó la estancia media en 1,8 días (AU)

Introduction. To perform sentinel lymph node biopsy (SLNB), nuclear medicine services that have previously undergone a validation phase are required. The aim of the present study was to analyze the possibility of performing this technique with a previously validated, external nuclear medicine service and to study its impact on the indication for radical axillary lymphadenectomy (RAL) and on length of postoperative hospital stay. Patients and methods. We performed a prospective study in a cohort of patients with breast cancer starting from the introduction of SLNB in our center, which was made possible by collaboration with an external nuclear medicine service that performed lymphoscintigraphy and sentinel node detection. Intraoperative detection was performed through a portable probe. The feasibility of the project and its clinical impact were analyzed, taking a reduction in the number of lymphadenectomies and length of hospital stay as endpoints. Results. A total of 196 patients with 201 breast carcinomas were treated. The most frequent interventions were tumorectomy (TC) with SLNB in 124 patients (62%), and TC with SLNB and RAL in 62 patients (31%). Sentinel node visualization on lymphoscintigraphy was achieved in 187/201 carcinomas (93.1 %) and sentinel nodes were detected during the intervention in 182/187 carcinomas (97.4%). Sentinel node detection in the internal mammary chain was achieved in 23/201 carcinomas (11.4%). RAL was avoided in 131 of the 201 carcinomas (65%). Days of postoperative hospital stay with or without RAL showed a mean difference of 1.8 days (3.1 vs. 1.3; P<.001). Conclusion. SLNB is feasible with the collaboration of an external nuclear medicine service. This technique avoids 65% of RAL and reduces length of postoperative stay by 1.8 days (AU)