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European Journal of Nuclear Medicine... Jul 2008To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable...
PURPOSE
To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer.
METHODS
In the period 2001-2006, 138 patients with prior diagnostic excisional biopsy (96 non-palpable and 42 palpable breast cancer) and 328 without previous surgery (32 non-palpable; 296 palpable cancer) were treated. The combined technique ((99m)Tc-colloidal rhenium and isosulfan blue dye) was the approach for sentinel lymph node (SLN) detection. Axillary lymph node dissection (ALND) was completed only when the SLN was positive for metastasis or not located.
RESULTS
Detection rate, if there was prior surgery, was 95% for non-palpable and 98% for palpable cancer, and 99% for one-time treatment group. Metastasis rate in the SLN was 15% in non-palpable cancer (14/91), significantly smaller than in palpable breast cancer (39% if prior surgery and 37% in one-time surgery). According to tumoral size, ALND metastasis rate was similar for T1 and T2 tumors (43-44%). In the follow-up of the groups with prior diagnostic biopsy or surgery of the breast cancer we have not found any false negative in the axilla.
CONCLUSION
The detection of the SLN is also feasible in patients with previous surgery of breast cancer. Because SLN metastasis rates are significantly smaller in non-palpable lesions, the effort in screening programs for early detection of breast cancer and also in improving histopathological confirmation of malignancy with ultrasound or stereotactic guided core biopsies must continue.
Topics: Adult; Aged; Aged, 80 and over; Axilla; Breast Neoplasms; Coloring Agents; Female; Humans; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Palpation; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Rosaniline Dyes; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid
PubMed: 18274744
DOI: 10.1007/s00259-008-0730-4 -
Immunology Series 1989Human hypersensitivity angiitis is a disease involving deposition of immune complexes in which patients present with palpable purpuric lesions most often on the lower... (Review)
Review
Human hypersensitivity angiitis is a disease involving deposition of immune complexes in which patients present with palpable purpuric lesions most often on the lower extremities and sometimes associated with multiple organ involvement. There are numerous potential antigens in the immune complex and the disease may be derived from an infectious organism such as Streptococcus or the hepatitis virus, from a drug, or from a variety of other chemicals which may be ingested or inhaled. In addition, the antigen may be part of another systemic disease. This complex of circulating antigen and antibody may become fixed within the vessel wall activating the complement cascade with elaboration of factors chemotactic for neutrophils. These cells then release lysosomal enzymes which result in destruction of the vessel wall and leakage of red blood cells into the tissue. This produces the typical purpura and palpability seen clinically. A central question in the pathogenesis of this disease is to explain why the immune complex is seemingly so selective in its site of deposition as it may be deposited in postcapillary venules in some patients and medium-sized muscular arteries in other patients. Part of the reason for this must be related to the lattice formation of a particular complex, while other reasons are likely related to alterations in vascular permeability, to the integrity of clearance mechanisms for the complex, or possibly even to a genetically determined defect of the phagocytic system.
Topics: Animals; Antigen-Antibody Complex; Complement System Proteins; Disease Models, Animal; Histamine; Humans; IgA Vasculitis; Immune Complex Diseases; Neutrophils; Rabbits; Vasculitis, Leukocytoclastic, Cutaneous
PubMed: 2535132
DOI: No ID Found -
The Journal of Hand Surgery Mar 1989Peripheral nerve mucoid degeneration of the upper extremity is an extremely rare entity. Four new cases encountered in a 14-year period are added to the 10 cases... (Review)
Review
Peripheral nerve mucoid degeneration of the upper extremity is an extremely rare entity. Four new cases encountered in a 14-year period are added to the 10 cases reported in the world literature. Usually affecting males in their forties, it is heralded by an entrapement type syndrome. Pain, paresthesias, paralysis, and possible palpability, succinctly summarizes the order and frequency of the appearance of the differential diagnostic symptoms and signs. Soft part imaging may aid in the preoperative diagnosis. Therapeutically, conservative neurolysis, pertinent arcade sectioning, prudent neural dissection, partial pseudocyst wall excision, and content drainage all under optical enlargement is the treatment of choice. There are no recurrences with this treatment; however, the functional results depend on early diagnosis and surgical intervention before neural fiber destruction is complete.
Topics: Adult; Arm; Cysts; Humans; Male; Middle Aged; Nerve Compression Syndromes; Peripheral Nervous System Diseases
PubMed: 2539406
DOI: 10.1016/0363-5023(89)90004-x -
Clinical Radiology Nov 1993Complex sclerosing lesion (CSL)/radial scar and carcinoma of breast can both present mammographically as stellate lesions. The mammographic features used to distinguish...
Complex sclerosing lesion (CSL)/radial scar and carcinoma of breast can both present mammographically as stellate lesions. The mammographic features used to distinguish these two entities are reported as being unreliable. All reports to date indicate that CSLs are not palpable. Of the 54,407 women screened in the first 2 1/2 years of the Warwickshire, Solihull and Coventry Breast Screening Service, 24 histologically-proven CSLs were identified. This represents an incidence of 0.04%. In six (25%) of these patients a corresponding clinically-palpable abnormality was identified. We found no imaging or histological features that differentiated the palpable lesions from the impalpable lesions. It is important not to assume that a palpable stellate lesion is a carcinoma.
Topics: Breast; Breast Diseases; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Palpation; Radiography
PubMed: 8258222
DOI: 10.1016/s0009-9260(05)81239-5 -
The Journal of Craniofacial SurgeryThe purpose of this study is to estimate the incidence of fixation-related complications following ultrasound-activated biodegradable osteosynthesis (UBO) in the...
The purpose of this study is to estimate the incidence of fixation-related complications following ultrasound-activated biodegradable osteosynthesis (UBO) in the treatment of craniosynostosis. The authors searched MEDLINE, PubMed, Embase, Google Scholar, and Cochrane Library from January 2005 to January 2020 for clinical studies reporting the use of UBO for fixation in the treatment of craniosynostosis. The primary outcome was the incidence of fixation-related complications, including unstable fixation; swelling, plate visibility, or palpability; infection; inflammation, sinus formation, and discharge; implant exposure; reoperation or implant removal. The pooled incidence rates were estimated using random-effects models. Of 155 studies identified, 10 were included, representing 371 patients. Forty-six (12.4%) patients presented fixation-related complications. The incidence rates of swelling/visibility/palpability, infection, and reoperation/implant removal were pooled based on the available data. The pooled incidence rate of chronic swelling/visibility/palpability was 0.21 (95% confidence interval [CI], 0.05-0.43). Sensitivity analysis by omitting the outlier study demonstrates that the incidence of swelling/visibility/palpability was 0.07 (95% CI, 0.04-0.11). The pooled incidence rate of infection and reoperation/implant removal was 0.07 (95% CI, 0.01-0.16) and 0.04 (95% CI, 0.01-0.09), respectively. Results show that although UBO can provide stable fixation, chronic swelling/visibility/palpability, infection, and reoperation for removal are not uncommon. Based on the literature, the authors recommend judicious use of UBO in patients with large frontorbital advancement and in the area of the coronal suture or other sites with thin overlying skin/subcutaneous tissue. The high possibility of chronic swelling/palpability/visibility during degradation, needs to be discussed preoperatively.
Topics: Absorbable Implants; Bone Plates; Craniosynostoses; Dental Implants; Fracture Fixation, Internal; Humans; Treatment Outcome
PubMed: 32675769
DOI: 10.1097/SCS.0000000000006791 -
American Family Physician Nov 2008Scrotal masses can represent a wide range of medical issues, from benign congenital conditions to life-threatening malignancies and acute surgical emergencies. Having a...
Scrotal masses can represent a wide range of medical issues, from benign congenital conditions to life-threatening malignancies and acute surgical emergencies. Having a clear understanding of scrotal anatomy allows the examiner to accurately identify most lesions. Benign lesions such as hydroceles and varicoceles are often found incidentally by the patient or physician on routine examination. Epididymitis is bacterial in origin, readily diagnosed on physical examination, and treated with antibiotics. Indirect inguinal hernias usually are palpable separate from the normal scrotal contents and are a surgical emergency if strangulation is suspected based on symptoms of abdominal pain, tenderness, and nonreducibility. Testicular swelling may be caused by orchitis, cancer, or testicular torsion. Orchitis is usually viral in origin, subacute in onset, and may be accompanied by systemic illness. Testicular carcinomas are more gradual in onset; the testis will be nontender on examination. Testicular torsion has an acute onset, often with no antecedent trauma; the involved testis may be retracted and palpably rotated, and will be tender on examination. The swollen testis is always a true emergency. Although history and examination may suggest the diagnosis, testicular torsion can be reliably confirmed only with color Doppler ultrasonography, which must be obtained immediately. If torsion is suspected, surgical consultation should be obtained concurrently with ultrasonography, because the ability to successfully salvage the affected testis declines dramatically after six hours of torsion.
Topics: Algorithms; Genital Diseases, Male; Humans; Male; Scrotum
PubMed: 19035065
DOI: No ID Found -
Dermatology (Basel, Switzerland) 2011The natural evolution of melanocytic nevi is a complex, multifactorial process that can be studied by monitoring nevi on a long-term basis.
BACKGROUND
The natural evolution of melanocytic nevi is a complex, multifactorial process that can be studied by monitoring nevi on a long-term basis.
METHODS
To assess the evolution pathway of Spitz nevi, lesions with clinical and dermoscopic features suggestive of Spitz nevi were monitored and baseline and follow-up images compared.
RESULTS
Sixty-four patients (mean age 10.4 years) with lesions suggestive of Spitz nevi were included. Lesions were monitored for a mean follow-up period of 25 months. Upon side-by-side evaluation of baseline and follow-up images, 51 (79.7%) lesions showed an involution pattern and 13 (20.3%) lesions showed a growing or stable pattern. No significant differences were found between growing and involving lesions in terms of patient age and sex and the location and palpability of lesions. The great majority of growing lesions were pigmented or partially pigmented (92.3%), whereas 47.1% of lesions in involution were amelanotic (p = 0.005).
CONCLUSION
In this series of lesions clinically and dermoscopically diagnosed as Spitz nevi, spontaneous involution seems to be the most common biologic behavior.
Topics: Adolescent; Child; Dermoscopy; Female; Follow-Up Studies; Humans; Male; Nevus, Epithelioid and Spindle Cell; Remission, Spontaneous; Skin Neoplasms; Young Adult
PubMed: 21494025
DOI: 10.1159/000326109 -
Veterinary Surgery : VS Feb 2021To evaluate the use of the Leipzig distractor during canine shoulder arthroscopy.
OBJECTIVE
To evaluate the use of the Leipzig distractor during canine shoulder arthroscopy.
STUDY DESIGN
Experimental, ex vivo.
SAMPLE POPULATION
Paired shoulder joints from 15 large breed canine cadavers.
METHODS
Standard lateral shoulder arthroscopy was performed with or without the use of the Leipzig distractor (n = 15 each). Joint space width, procedure time, and visibility and palpability of the intra-articular structures were assessed during the arthroscopy. After the arthroscopic evaluation, each shoulder joint was disarticulated to assess the area and number of iatrogenic articular cartilage injury (IACI) lesions. Sites around the distraction device were assessed for the presence of iatrogenic injury.
RESULTS
With shoulder distraction, median joint space width was 4 mm larger (P = .01), IACI area was 9.5 mm lower (P = .003), and there were two fewer total number of IACI lesions (P = .004) compared with nondistracted shoulders. The mean total surgery time was 93 seconds shorter (P = .01) in distracted shoulders. Although distraction was associated with increased visibility of the supraglenoid tubercle (P = .015), no significant differences were found for other intra-articular structures for their visibility and palpability. Unexpected lesions at the sites around the distraction device were not encountered.
CONCLUSION
Use of the distraction device decreased the area and incidence of IACI lesions and shortened the arthroscopy time. However, no improvement was found in the visibility or palpability of the intra-articular structures.
CLINICAL SIGNIFICANCE
Although additional clinical studies are required to evaluate the effect of the distraction device on pathologic articular conditions and intraoperative manipulation, the use of a shoulder distraction device might improve the outcomes of shoulder arthroscopy by decreasing IACI and arthroscopy time.
Topics: Animals; Arthroscopy; Cadaver; Dog Diseases; Dogs; Joint Diseases; Shoulder; Shoulder Joint
PubMed: 33400311
DOI: 10.1111/vsu.13562 -
The New England Journal of Medicine Jun 1985We describe a simple bedside procedure (which we call "Osler's maneuver") that differentiates patients with true hypertension from those whose blood pressure is...
We describe a simple bedside procedure (which we call "Osler's maneuver") that differentiates patients with true hypertension from those whose blood pressure is spuriously elevated because of excessive sclerosis of the large arteries ("pseudohypertension"). The maneuver is performed by assessing the palpability of the pulseless radial or brachial artery distal to a point of occlusion of the artery manually or by cuff pressure. We classified 24 elderly hypertensive patients as either Osler-positive (n = 13) or Osler-negative (n = 11), and measured their intraarterial pressure, arterial compliance, and systemic hemodynamics. Patients with pseudohypertension (Osler-positive) had falsely elevated blood-pressure readings, with a difference of 10 to 54 mm Hg between cuff and intraarterial pressure. Arterial compliance was lower in Osler-positive subjects and correlated with the difference between cuff and intraarterial pressures, indicating that the stiffer the artery, the more pronounced the degree of pseudohypertension. Pseudohypertension is common in the elderly and becomes more severe as arterial compliance decreases and sclerosis of large arteries progresses.
Topics: Aged; Arm; Arteriosclerosis; Blood Pressure; Brachial Artery; Diagnosis, Differential; Female; Hemodynamics; Humans; Hypertension; Male; Methods; Palpation
PubMed: 4000185
DOI: 10.1056/NEJM198506133122405 -
Revista Internacional de Andrologia 2022In 2002, Steve Wilson pioneered new procedures for alternative placement of reservoirs for inflatable prostheses in patients who have suffered damage to the space of...
In 2002, Steve Wilson pioneered new procedures for alternative placement of reservoirs for inflatable prostheses in patients who have suffered damage to the space of Retzius following pelvic surgery or obliteration of the transversalis fascia by mesh hernia repair. Since then, surgical techniques and tools for ectopic reservoir placement have gradually gained acceptance to minimize palpability, and the risk of visceral and vascular lesions for high risk patients has been all but eliminated. Lockout valves and high submuscular placement techniques are now recommended, and reports of vascular, bowel or bladder injuries are uncommonly rare. While surgeons continue their search for safer and more effective placement methods, new skills and instruments are constantly being introduced to make recommendations to minimize complications and provide safety and functionality. Additional studies and comparisons of techniques are needed to achieve a consensus of best practice for reservoir placement solutions.
Topics: Abdominal Wall; Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Prosthesis; Prosthesis Design
PubMed: 35337772
DOI: 10.1016/j.androl.2020.12.002