Factors affecting sentinel lymph node identification rate after neoadjuvant chemotherapy for breast cancer patients enrolled in ACOSOG Z1071 (Alliance).

Objective: To evaluate factors affecting sentinel lymph node (SLN) identification after neoadjuvant chemotherapy (NAC) in patients with initial node-positive breast cancer.

Background: SLN surgery is increasingly used for nodal staging after NAC and optimal technique for SLN identification is important.

Methods: The American College of Surgeons Oncology Group Z1071 prospective trial enrolled clinical T0-4, N1-2, M0 breast cancer patients.

Giant cell arteritis with spontaneous remission.

Background: Clinical manifestations of giant cell arteritis (GCA) are variable. Whether signs and symptoms present in an explosive fashion or insidiously, once manifest the course is usually progressive unless treatment is initiated.

Methods: A retrospective review of patients with GCA seen in an outpatient neuro-ophthalmology clinic.

Statin-associated myasthenia gravis: report of 4 cases and review of the literature.

A few recent individual case reports have suggested that a myasthenic syndrome may be associated with statin treatment, but this association is not well described. We report 4 patients who developed symptoms of myasthenia gravis within 2 weeks of starting treatment with a statin drug. In 1 case the drug appears to have exacerbated underlying myasthenic weakness, whereas in the other 3 cases, de novo antibody formation appears to be most likely.

Repair of tetralogy of Fallot with anomalous coronary arteries coursing across the obstructed right ventricular outflow tract.

Anomalous coronary artery (ACA) anatomy occurs in 2-9% of patients with tetralogy of Fallot (TOF), in which the left anterior descending coronary artery (LAD) originates from the right coronary artery (RCA) crossing the right ventricular outflow tract. The purpose of this study was to review our results of repair for TOF with ACA. Between 1978 and 2001, 43 ACA patients (mean age, 4.

Modified Fontan operation in patients with anomalies of systemic and pulmonary venous connection.

The presence of anomalies of the systemic and pulmonary venous connection associated with single ventricle anomalies has been considered a contraindication for the Fontan operation (FO). The aim of this study is to outline the technical considerations associated with the presence of anomalies of systemic and/or pulmonary venous connections and to identify the risk factors for mortality in this group of patients undergoing the modified FO. Between 1989 and 2004, 63 patients (median age, 3.

Dolichoectatic arterial compression of the anterior visual pathways: neuro-ophthalmic features and clinical course.

Aim: To characterise the clinical findings and natural history of anterior visual pathway compression by dolichoectatic intracranial vessels.

Methods: A retrospective case review of patients evaluated in an outpatient neuro-ophthalmology clinic.

Results: 10 patients with this condition were identified.

Enterococcus faecalis causing empyema in a patient with liver disease.

A 57-year-old man with a history of liver disease had shortness of breath, fever, and pleuritic chest pain. Ascites was not present. Computed tomography (CT) of the chest revealed a large unilateral pleural effusion, compressive atelectasis, and no evidence of consolidation.

Superior segmental optic nerve hypoplasia.

A visually asymptomatic 27-year-old man was found to have inferior altitudinal visual field defects binocularly. Ophthalmoscopy revealed superior segmental optic pallor with superior nerve fiber layer atrophy, nicely highlighted in red-free photographs. The patient's mother had insulin-dependent diabetes mellitus.

Effect of modified ultrafiltration in high-risk patients undergoing operations for congenital heart disease.

Background: Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children decreases body water, removes inflammatory mediators, improves hemodynamics, and decreases transfusion requirements. The optimal target population for MUF needs to be defined. This prospective, randomized study attempted to identify the best candidates for MUF during operations for congenital heart disease.

Dilutional and modified ultrafiltration reduces pulmonary hypertension after operations for congenital heart disease: a prospective randomized study.

Objective: A prospective randomized study was performed to test whether removal of endothelin-1, by ultrafiltration techniques, will reduce pulmonary hypertension after operations for congenital heart disease.

Methods: Twenty-four patients with pulmonary hypertension (systolic pulmonary/systemic arterial pressure ratio > 60%) undergoing cardiac operations were randomized into a control group (n = 12) having conventional ultrafiltration and an experimental group (n = 12) undergoing dilutional ultrafiltration during and modified ultrafiltration after cardiopulmonary bypass. Plasma endothelin-1, nitric oxide metabolites, and cyclic guanosine monophosphate were assayed before bypass, 10 minutes into bypass, after bypass, and 0, 3, 6, and 12 hours after the operation in both groups, as well as in the ultrafiltrates and after modified ultrafiltration in the experimental group.

Dynamic changes of endothelin-1, nitric oxide, and cyclic GMP in patients with congenital heart disease.

Background: Pulmonary hypertension causes major morbidity and mortality after congenital heart surgery, but its mechanism remains unclear.

Methods And Results: Plasma endothelin-1 (ET-1), nitric oxide (NO), and cyclic GMP (cGMP) were assayed at 6 intervals in 50 children undergoing cardiopulmonary bypass (CPB): before CPB, 10 minutes into CPB, and 0, 3, 6, and 12 hours after CPB. Three groups based on pulmonary flow and pressure were analyzed: low flow (LF, n=21), high flow/low pressure (systolic pulmonary pressure/systemic pressure ratio, Pp/Ps<50%, HF-LP, n=11), and high flow/high pressure (Pp/Ps> or =50%, HF-HP, n=19).

Pulmonary hypertension after operations for congenital heart disease: analysis of risk factors and management.

Background: Management of pulmonary hypertension, a potentially fatal complication of operations to correct congenital heart disease, has evolved through the last 15 years. Monitoring of pulmonary arterial pressure and mixed venous saturation became available, and prophylactic use of alpha-blockers and other vasodilators increased. This study examines risk factors for morbidity and mortality from pulmonary hypertension after operations to correct congenital heart disease and evaluates the impact of management changes on outcomes.