371 research outputs found
Laparoscopic indocyanine green sentinel lymph node mapping in endometrial cancer. Papadia A, Imboden S, Siegenthaler F, Gasparri ML, Mohr S, Lanz S, Mueller MD.
No full textAbstract
BACKGROUND:
In endometrial cancer (EMCA), indocyanine green (ICG) sentinel lymph node (SLN) mapping has been reported, mainly in conjunction with robotic surgery.
OBJECTIVE:
We aimed to evaluate detection rates, sensitivity, and false negative (FN) rate of laparoscopic ICG SLN mapping in EMCA, and to evaluate differences in surgical outcomes between patients subjected to SLN biopsy only versus lymphadenectomy.
METHODS:
A retrospective analysis of EMCA patients undergoing ICG SLN mapping ± pelvic (PLND) and/or para-aortic lymphadenectomy (PALND) was performed. Detection rates were calculated for the entire cohort. Sensitivity and FN rates were calculated for patients undergoing lymphadenectomy after SLN mapping, and surgical outcome was compared among patients undergoing SLN mapping only versus lymphadenectomy.
RESULTS:
Of 75 patients, 33 underwent SLN mapping and 42 underwent SLN mapping followed by PLND/PALND. Overall and bilateral detection rates were 96 % (72/75) and 88 % (66/75), respectively, and the median number of removed SLNs, pelvic non-SLNs (NSLN) and para-aortic NSLNs was 3, 27, and 19, respectively. With a FN rate of 8.3 %, only one patient had bilateral FN SLNs and a metastatic para-aortal NSLN. Estimated blood loss (EBL) and operative (OR) time were significantly lower in patients undergoing SLN mapping only. No differences in complication rates between patients undergoing SLN mapping only and patients undergoing lymphadenectomy were recorded.
CONCLUSIONS:
Laparoscopic ICG SLN mapping has excellent overall and bilateral detection rates and a low FN rate. Compared with lymphadenectomy, SLN biopsy is associated with significantly lower EBL and shorter OR time
i lembi miocutanei di gran pettorale e di omento nel trattamento chirurgico delle sternotomie infette
No full textMyo-cutaneous and greater omentum flaps in the surgical treatment of infected sternotomies
No full text
Comparison of different pilot scale bioreactors for the treatment of a real wastewater from the textile industry
No full textPortomesenteric venous thrombosis: An early postoperative complication after laparoscopic biliopancreatic diversion
No full textThe number of bariatric operations, as well as the incidence of perioperative complications, has risen sharply in the past ten years. Perioperative acute portal vein thrombosis is an infrequent and potentially severe postoperative complication that has not yet been reported after biliopancreatic diversion (BPD). Three cases are presented of portal vein thrombosis that occurred following BPD treatment for morbid obesity and type 2 diabetes. The thromboses were detected CASE REPORT WJG|www.wjgnet.com 2546 February 28, 2015|Volume 21|Issue 8| by abdominal ultrasound and computed tomography with intravenous contrast. The portomesenteric venous thromboses in all three cases presented as unexpected abdominal pain several days after discharge from the hospital. The complications occurred despite adequate perioperative prophylaxis and progressed to bowel gangrene in the diabetic patients only. These cases demonstrate the occurrence of this rare type of complication, which may be observed by physicians that do not routinely treat bariatric patients. Awareness of this surgical complication will allow for early diagnosis and prompt initiation of adequate therapy
Biopolymeric Carriers for Nanomedical Applications
No full textNanomedicine offers the opportunity to develop novel nano and microcarriers for targeted drug therapy, reducing the undesirable side effects. This communication will discuss about multifunctional, highly biodegradable and biocompatible, (natural) biopolymeric drug carriers, having the following functionalities: 1) protection of drugs from chemical and biological degradation; 2) control of in vivo and in vitro distribution; 3) specific cell targeting. Several type of carriers will be examined. The first type is composed of biodegradable polyelectrolyte pairs (e.g. polysaccharides) with opposite charges, subsequently dissolved to obtain hollow capsules ready to encapsulate drugs [1, 2]. Selected fluorophores and magnetic nanoparticles have been included in the coating to allow in vitro and in vivo monitoring of microcapsule fate. In order to obtain cellular targeting, specific ligands can also be conjugated to the coating layers. The second type of carriers is represented by novel monodisperse micro and nanogels [3]. These are challenging drug delivery systems for the release of bioactive molecules, able to undergo reversible volume transition, when triggered by environmental factors such as temperature, ionic strength, or pH [4]. Nanogels, internalised inside cells through phagocytic pathways, release natural or synthetic drugs inside endosomes by pH-induced polymer removal. Biomolecules and biopolymers are therefore protected and released in a controlled manner. The third category of carriers discussed is the naturally “green” and cytocompatible halloysite nanotubes [5], used as novel hydrophobic drug carriers for targeted delivery into neoplastic cells. The internalisation and cytotoxicity of drug-loaded carriers has been evaluated in vitro on different cell lines.
Acknowledgments: “Con il contributo del Ministero degli Affari Esteri, Direzione Generale per la promozione e la Cooperazione Sociale ” (Large Scale ITA –USA Bilateral Project “Nano-trasportatori per la terapia del cancro”). G.L. thanks Regione Puglia for "Ritorno al Futuro" Fellowship INCANTO.
References
[1] V. Vergaro, F. Scarlino, C. Bellomo, R. Rinaldi, D. Vergara, M. Maffia, F. Baldassarre, G. Giannelli, X. Zhang, Y. M. Lvov and S. Leporatti Advanced Drug Delivery Review (2011), 63, 847-864.
[2] I.E Palamà, S. Leporatti, E. de Luca, N. Di Renzo, M. Maffia, C. Gambacorti-Passerini, R.Rinaldi, G. Gigli, R. Cingolani, A.ML Coluccia Nanomedicine Future Medicine Lt (2010) 5(3), 419-431.
[3] S. Argentiere, L. Blasi, G. Ciccarella, G. Barbarella, A. Cazzato, R. Cingolani, G. Gigli Small (2009) 4101-4103.
[4] S. Argentiere, L. Blasi, G. Ciccarella, G.Barbarella, R.Cingolani, G. Gigli Journal of Applied Polymer Science (2010), 116(5), 2808-2815.
[5] V.Vergaro, E.Abdullayev, Y.M. Lvov, A.Zeitoun, R. Cingolani, R. Rinaldi and S. Leporatti Biomacromolecules (2010) 11, 820–826
FIGO stage IIIC endometrial cancer identification among patients with complex atypical hyperplasia, grade 1 and 2 endometrioid endometrial cancer: laparoscopic indocyanine green sentinel lymph node mapping versus frozen section of the uterus, why get around the problem?
No full textPURPOSE
To compare two surgical strategies used to identify lymph node metastases in patients with preoperative diagnosis of complex atypical hyperplasia (CAH), grade 1 and 2 endometrial cancer (EC).
METHODS
Data on patients with preoperative diagnosis of CAH, grade 1 and 2 EC undergoing laparoscopic indocyanine green (ICG) sentinel lymph node (SLN) mapping followed by frozen section of the uterus were collected. When risk factors were identified at frozen section, patients were subjected to a systematic lymphadenectomy. False negative (FN) rates, negative predictive values (NPV), positive predictive values (PPV) and correlation with stage IIIC EC were calculated for the systematic lymphadenectomy based on frozen section of the uterus and for the SLN mapping.
RESULTS
Six (9.5%) out of 63 patients had lymph nodal metastases. Based on frozen section of the uterus, 22 (34.9%) and 15 (22.2%) patients underwent a pelvic and a pelvic and paraaortic lymphadenectomy, respectively. Five patients with stage IIIC disease were identified with a FN rate of 16.7% and a NPV and PPV of 97.6 and 27.3%, respectively. Overall and bilateral detection rates of ICG SLN mapping were 100 and 97.6%, respectively; no FN were recorded. The identification of patients with stage IIIC disease with ICG SLN mapping showed a NPV and PPV of 100%. Correlation between indication to lymphadenectomy and stage IIIC disease was poor (κ = 0.244) when based on frozen section of the uterus and excellent (κ = 1) when based on SLN mapping.
CONCLUSIONS
ICG SLN mapping reduces the number of unnecessary systematic lymphadenectomies and the risk of underdiagnosing patients with metastatic lymph nodes
Conventional perimetry, short-wavelength automated perimetry, frequency-doubling technology, and visual evoked potentials in the assessment of patients with multiple sclerosis.
No full textPU R P O S E. To evaluate the diagnostic power of conventional, achromatic, automated perimetry (CAP), shortwavelength
automated perimetry (SWAP), frequency-doubling technology (FDT) perimetry, and visual evoked
potentials (VEP) in a group of patients with multiple sclerosis (MS) with or without a history of optic neuritis.
ME T H O D S. Thirty eyes of 15 patients (5 male, 10 female, average age 38±7 years) with confirmed diagnosis
of MS underwent CAP, SWAP (Humphrey 750–II VFA, program central 30-2, full-threshold strategy),
FDT perimetry (program N-30), and pattern VEPs. Sixteen eyes (53.3%) had no history of ocular involvement
and a negative ophthalmologic examination. They were matched with a control group of 10
healthy volunteers (4 male, 6 female, average age 31±10 years). The mean deviation (MD) and the patt
e rn standard deviation (PSD) of the two groups were compared (t-test). Fourteen eyes (46.7%) had, on
the contrary, a history of optic neuritis. Inside this group, the MD and the PSD of the three techniques
w e re correlated (Spearm a n ’s rank test), in order to investigate whether any significant differences might
be revealed by these techniques in pointing out the total amount of visual field damage.
RE S U LT S. When comparing MS patients without signs or symptoms of ocular involvement and a control
group, no significant differences were found for CAP MD, CAP PSD, and FDT PSD. Significant differe n c e s
w e re found, on the contrary, for SWAP MD (p=0.0014), SWAP PSD (p=0.0001), and FDT MD (p=0.0001).
When considering the MD and the PSD of the three techniques in the group of MS patients who had a
h i s t o ry of optic neuritis, a significant correlation was found only between CAP MD and SWAP MD (r=0.0057),
with a tendency by SWAP to reveal a higher rate of visual field loss. The other correlations were not significant.
According to predefined criteria, the group of asymptomatic subjects had abnormal CAP in 1 eye
(6.25%), abnormal SWAP in 9 (56.2%), abnormal FDT in 11 (68.7%), and abnormal VEPs in 7 (43.7%). The
combined use of all techniques allowed us to identify silent optic nerve impairment in 15 (93.7%) eyes.
CO N C L U S I O N S. Short-wavelength automated perimetry and FDT perimetry are two non-conventional perimetric
techniques that were mainly developed for the early detection of glaucomatous damage. The results
of this study demonstrate their efficacy also in detecting early visual field deficits in MS patients
without clinical signs of optic neuropathy. Frequency doubling perimetry, in particular, proved to be an
e a s y, fast, and sensitive technique in the assessment of patients with MS. Our results also suggest that
subclinical visual involvement in MS can be better diagnosed using multiple (neurophysiologic and psychophysical)
tests. (Eur J Ophthalmol 2005; 15: 7 3 0- 8 )
KE Y WO R D S. Visual field, Short-wavelength automated perimetry, Frequency-doubling technology, Vi s ual
evoked potentials, Multiple sclerosi
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