[Radioguided surgery in neuroendocrine tumors. A review of the literature]. / Cirugía radioguiada de tumores neuroendocrinos. Revisión de la literatura.

Radioguided surgery can be a useful technique in the localization of neuroendocrine tumors. It detects more and smaller lesions compared to pre-surgical imaging and intraoperative digital palpation by the surgeon. It detects residual lesions and also indicates the shortest access route to the lesion. Nevertheless, its use has not become widespread because of technical difficulties. There is a limited number of published series, a lack of standardized protocol because of the great variability regarding type of radiopharmaceutical, dose of radiotracer, timing between injection and surgery. In this paper, we review these issues, describing the experience of different authors in diverse tumors.

Contribution of perioperative imaging to radioguided surgery.

Radioguided surgery has been investigated and applied to almost any neoplastic disease that is surgically treated. The impact of radioguided surgery on the surgical management of cancer patients includes relevant and real-time information to the surgeon regarding the location and extent of the disease, as well as regarding the assessment of surgical resection margins. Despite the fact that sentinel lymph node biopsy has been worldwide accepted as a highly accurate staging method for various solid cancers (among which breast cancer and cutaneous melanoma), some potential intraoperative drawbacks still remain. This article provides an update on currently available perioperative techniques regarding the use of radiotracers for radioguided surgery and sentinel lymph node mapping and biopsy, in particular in combination with vital dyes or other agents. The integration of computer technology and data processing makes it possible to integrate anatomic and functional images together with 3D rendering systems. This facilitates the targeted-tissue perioperative localization, especially in anatomically complex areas. Furthermore, we provide an update on advances in the integration of intraoperative imaging devices as well as optical tracers for the surgical management of patients. Evidence is emerging that these devices, together with new potential tracers, may improve intraoperative identification of sentinel nodes and/or tumors. A detailed presentation on a portable gamma camera in breast cancer patients, and the application of perioperative imaging devices in gynaecological cancers are included. Other important procedures, such as ROLL and RSL for occult lesion excision in the breast and other organs, are extensively discussed.

Sentinel lymph node biopsy in selected cases of ductal carcinoma in situ

INTRODUCTION: Axillary lymphadenectomy is nowadays not recommended to treat ductal carcinoma in situ (DCIS), but there is controversy surrounding the indication for sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS: A prospective study of a selected group of patients diagnosed preoperatively with DCIS was performed between 2004 and 2009. Indications for SLNB were histologically determined high-grade tumours, tumour size >2 cm and patients scheduled to undergo a mastectomy. RESULTS: Sixty-five patients were analysed. Surgical technique was mastectomy in 39 patients (60%) and conservative breast surgery in 26 (40%). Definitive histological study of the resected breast tumour revealed 43 cases (66.2%) of DCIS, 15 (23.1%) of ductal invasive carcinoma and seven (10.7%) microinvasive tumours. In confirmed DCIS, only 6.9% of sentinel lymph nodes were positive, in microinvasive carcinoma 28.5% and in invasive carcinoma 40% were positive. Total number of patients with positive sentinel lymph nodes was 11 (16.9%). Of 39 mastectomies, 12 corresponded to microinvasive or invasive carcinoma and six (50%) showed a positive SLNB. CONCLUSIONS: Performing SLNB avoids an unnecessary second surgery to study axillary lymph nodes in invasive carcinoma diagnosed after definitive histological study. In patients undergoing a mastectomy, this study requires an axillary lymphadenectomy that is not useful in up to 50% of cases. We think that in a selected group of patients with DCIS, SLNB improves tumour staging, adapts the treatment and avoids second surgery in this group of patients (AU)

Phytophthora Species Associated with Crown and Root Rot of Apple in Chile.

Phytophthora cactorum, P. cryptogea, P. gonapodyides, and P. megasperma were isolated from necrotic root and crown tissues or the rhizospheres of apple trees exhibiting typical symptoms of Phytophthora root and crown rot in the Central Valley of Chile. Representative isolates of all four species were pathogenic on a variety of apple rootstocks and scions in trials conducted on excised shoots and 1-year-old MM.106 rootstock grown for 4 months in infested potting medium. P. cactorum was the most frequently isolated species and the most virulent in pot tests, although a significant Phytophthora sp.-apple genotype interaction was observed. This is the first report of any species other than P. cactorum causing root and crown rot of apple trees in Chile.

Síndrome de Charles Bonnet: un caso de difícil manejo / Charles Bonnet syndrome: a difficult case to treat

Se llama síndrome de Charles Bonnet a la aparición de alucinaciones visuales en pacientes con deprivación sensorial, en ausencia de otras enfermedades mentales. Presentamos aquí un caso de difícil manejo de este síndrome, y realizamos una revisión de la literatura reciente sobre el mismo, especialmente en los problemas diagnósticos y terapéuticos que plantea. No hay aún una definición comunmente aceptada de esta entidad, aunque empieza a existir acuerdo en algunos aspectos que exponemos. Además, el diagnóstico se realiza por exclusión de otras enfermedades psiquiátricas, neurológicas o sistémicas que puedan causar un cuadro similar. En cuanto al tratamiento, no hay ningún estudio sistemático en la literatura, sólo series muy cortas de casos: ningún medicamento parece más eficaz que los otros. Lo más importante podría ser intentar reducir la deprivación sensorial (AU)