Sentinel node localization in primary melanoma: preoperative dynamic lymphoscintigraphy, intraoperative gamma probe, and vital dye guidance.

Background: Sentinel node (SN) biopsy can be used to select patients with primary melanoma for therapeutic lymphadenectomy. The aim of the study was to assess the efficacy of 3 methods to locate the SN: preoperative dynamic lymphoscintigraphy, intraoperative patent blue dye (PBD), and gamma-detecting probe (GDP).

Methods: We studied 133 patients with cutaneous melanoma and clinically negative lymph nodes.

Five risk factors identify patients with gastroesophageal intussusception.

Hypothesis: Risk factors in patients with gastroesophageal intussusception who have noncardiac chest pain need to be identified and analyzed.

Design: Prospective consecutive series of 43 patients with gastroesophageal intussusception.

Setting: Outpatient gastrointestinal endoscopy suite for 42 patients; 1 patient sustained gastroesophageal intussusception during labor and delivery and underwent an emergency laparotomy.

Sentinel node localisation: A new prospective in the treatment of nodal melanoma metastases.

Sentinel node (SN) mapping and biopsy is a procedure that accurately stages the regional lymph node (LN) basin. Defined patterns of lymphatic drainage allow intraoperative determination of the first (sentinel) lymph node in the regional basin, and the absence of metastatic disease in the SN accurately reflects the absence of melanoma in the remaining regional nodes. The use of radiocolloid and a hand-held gamma detecting probe (GDP) together with a vital blue dye provides optimal results, and allows for the successful identification of the SN in over 99% of the procedures.

Pretargeting strategies for radio-immunoguided tumour localisation and therapy.

The selective recognition of tumour cells by monoclonal antibodies, labelled with radioactive isotopes, for use in diagnosis and treatment, forms the basis of immunoscintigraphy, radio-immunoguided surgery and radio-immunotherapy. Research into the application of these systems has encountered multiple difficulties, most notably a low tumour to non-tumour ratio of radioactivity. The development of pretargeting systems, separating the individual steps of tumour cell targeting and the introduction of the radioactive label, have led to significant increments in tumour to non-tumour ratios and an improvement in diagnostic accuracy.

Radioimmunoguided surgery and colorectal cancer.

Radioimmunoguided surgery is a technique that aims to delineate the extent of epithelial neoplasms (primary/recurrent) and their spread (local, regional, and distant) which are not adequately visualized by conventional imaging techniques. The target lesion binds radiolabelled, tumour-associated monoclonal antibodies which are administered in the days before surgery and which bind to the target lesion. The radiotracer is detected intraoperatively using a hand-held gamma detecting probe.

Small bowel obstruction following endoscopic extraperitoneal-preperitoneal herniorrhaphy.

Laparoscopic hernia repair has a number of unique potential complications. These include complications of pneumoperitoneum, general anesthesia, trocar injuries and complications of small bowel obstruction related to trocar site fascial defects, intraabdominal adhesions, and reaction with the synthetic mesh. A totally extraperitoneal approach should, in theory, eliminate postoperative small bowel obstruction in that the peritoneal space is never entered.

Hemodialysis access operations performed upon patients with human immunodeficiency virus.

Hemodialysis in known patients infected with human immunodeficiency virus (HIV) has been a subject of controversy. During a 60 month period, 28 hemodialysis access operations were performed upon 22 HIV infected patients. The indication for all procedures was need of dialysis access secondary to end-stage renal failure (ESRF).