Leaving a mark: the frequency and accuracy of tattooing prior to laparoscopic colorectal surgery

AIM

Intra-operative localization of small cancers and polyps during laparoscopic colorectal surgery is difficult due to reduced tactile feedback. The consequences of failing to identify the lesion for resection can result in open conversion or removal of the wrong segment of bowel.

METHOD

Data were collected from a prospectively-kept database over a 12-month period from April 2008 to March 2009 and analysed retrospectively. Details concerning the documentation, visibility and accuracy of tattoos were recorded.

RESULTS

Eighty-five patients (88 lesions) underwent laparoscopic resection for a benign or malignant colorectal tumour during 1 year from April 2008. Eighty-one patients underwent endoscopic visualization of the tumour as a first or second procedure. Of these 81 patients, 83 lesions were visualized endoscopically and 54 (65.1%) were tattooed in 52 patients. In the 52 patients, 36 (69%) of the tattoos were carried out on the first endoscopy. At operation the tattoo was judged to be visible and accurate in 70%, visible but inaccurate in 7% and not visible in 15%. It was significantly easier to see the tattoo in women (19/21 women vs 21/29 men; P=0.03) but there was no relationship between tattoo visibility and BMI. An accurate tattoo did not reduce the conversion rate (P=0.71). No tattoo-related complications were encountered.

CONCLUSION

The practice of tattooing colorectal cancers is variable in frequency, technique and accuracy. We advocate that all colonic lesions suspicious for cancer should be tattooed during endoscopy at a defined distance below the tumour, adhering to a departmental protocol in case surgery is required.

Toxicity of hypofractionated adjuvant radiation after breast-conserving surgery for DCIS

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Background: Traditional fractionation for whole breast radiation therapy after breast-conserving surgery has been 50Gy in 25 fractions over a 5-week period, with or without a 10 Gy boost. Hypofractionation has recently been adapted for early-stage invasive breast cancer, typically treating with 42.5 Gy in 16 daily fractions. This approach has been shown to have equivalent efficacy as the more traditional schedule. Its application to patients with DCIS has been an extrapolation of these data, and warrants further examination. This retrospective analysis reviews toxicity outcomes in women with DCIS treated with hypofractionation at our institution.

Methods: 59 women with DCIS treated with lumpectomy and hypofractionated radiotherapy with or without boost between 2006 and 2010 at the Einstein-Montefiore Cancer Center were identified. Median age was 65 (39-85). Median follow-up was 13.7 months (2–37.6). Surgical margin status was negative in 55, positive in 1, and unknown in 3. Thirteen patients had high-grade DCIS, 17 intermediate-grade, and 13 low-grade nuclear features, and 16 did not have grade delineation. 68% of patients (40 women) had disease that was positive both for ER and PR receptors, 2 women were simultaneously positive for ER and PR, 5 women had ER-only positive disease, 2 women had HER2-neu-only positive disease, 1 woman was positive for both ER and HER2-neu receptors, 1 woman was positive only for PR receptors, and 6 women were negative for all receptors; receptor status of specimens from 2 patients is not known. All women were treated with whole-breast hypofractionated therapy (42.4 Gy, in 16 fractions of 2.65 Gy each). 49 women received a boost to the lumpectomy cavity consisting of 10Gy in 5 fractions or 9.6 Gy in 4 fractions at the physician’s discretion.

Results: With this regimen, no patient experienced acute RTOG grade 3 or higher skin, or other toxicity. No treatment breaks were required due to toxicity. The most common side effects were grade 1 dermatitis, followed by grade 2 dermatitis with mild edema of the treated breast.

Conclusions: Our results suggest that postoperative hypofractionated radiation to the breast is well tolerated by women with DCIS and does not result in untoward acute toxicity.

Dynamic heterogeneities, boson peak, and activation volume in glass-forming liquids

There are various arguments and models connecting the characteristic length associated with the boson peak vibrations ξ to the length scale of dynamical heterogeneity L(het). ξ is usually defined as the ratio of the transverse sound velocity to the boson peak frequency. Here we present pressure, temperature, and molecular weight dependencies of ξ, estimated using light scattering, in a few molecular and polymeric glass formers. These dependencies are compared with respective dependencies of the activation volume ΔV(#) in the same materials. Good agreement is found for the pressure and molecular weight dependencies of ξ and ΔV(#) measured at the glass transition temperature T(g). These results provide more evidence for a possible relationship between the sensitivity of structural relaxation to density (activation volume) and the heterogeneity volume. However, contrary to the expectations for L(het), ξ does not decrease with temperature above T(g) in most of the studied materials. The temperature dependence of ξ is compared to that of L(het) in glycerol and orthoterphenyl (OTP) estimated from literature data. The analysis shows a clear difference in the behavior of ξ(T) and ΔV(#)(T) at temperatures above T(g), although ΔV(#)(T)(1/3) and L(het)(T) have similar temperature dependence. Possible reasons for the observed difference are discussed.

The role of serum basic fibroblast growth factor, estradiol and urine basic fibroblast growth factor in differentiating infantile haemangiomas from vascular malformations

OBJECTIVE

To investigate the role of serum basic fibroblast growth factor (bFGF), estradiol (E2) and urine bFGF in differentiating infantile haemangiomas from vascular malformations.

METHOD

Between October 2007 and January 2009, 97 patients with haemangiomas and 25 patients with vascular malformations who had not been treated previously were included in this prospective study. Forty-eight patients with cleft lip and/or palate were selected as controls. The age of all subjects ranged from 1 to 30 months. The serum and urine levels of bFGF were determined by enzyme-linked immunosorbent assay (ELISA). The serum levels of E2 were examined via radioimmunoassay. All data were analysed with SPSS 11.5 software package.

RESULTS

The concentration of serum and urine bFGF was significantly different among the three groups (haemangiomas, vascular malformations and controls) (P = 0.027, P = 0.001). Significantly different urine bFGF levels were found in patients with proliferating and involuting haemangiomas (P = 0.04). The serum E2 levels were significantly higher in patients with haemangiomas than vascular malformations (P = 0.001) and controls (P = 0.001).

CONCLUSION

Serum bFGF and E2 as well as urine bFGF can be used to supplement the clinical diagnosis of congenital vascular anomalies. Urine bFGF combined with serum E2 may be the most potential markers for diagnosing haemangiomas and determining the proliferating stage of haemangiomas.

Application of a self-made swivel intravenous transfusion device in constructing allogenic small bowel transplantation rejection model in rats

BACKGROUND

Lacking a long-term continuous intravenous infusion device for experimental animals is the biggest obstacle to constructing an allogenic small bowel transplantation rejection model.

OBJECTIVE

To establish a rat heterotopic small bowel transplantation model with the use of a swivel device for intravenous transfusion.

METHODS

The randomized block design of controlled observations included 90 inbred male F344/NCrl BR rats as donors and 90 LEW/Crl rats as recipients. On the basis of body weight, the rats were divided into three groups each with 30 pairs of rats. Group 1, the control group, underwent small bowel transplantation. Group 2, the transfusion group, received small bowel transplantation and continuous infusion of parenteral nutrient solution. Group 3, the tacrolimus (FK506) treatment group, received small bowel transplantation, continuous infusion of parenteral nutrient solution, and intravenous injection of FK506. The general status and survival time of transplanted rats were observed for 5 weeks.

RESULTS

The operative success rate was 100%. The survival rate was 83.3% (25/30) in the control group; and 96.7% (58/60) in groups 2 and 3 (P = .039). The mean survival time of the FK506 group was 22.1 +/- 13.4 days, which was significantly higher than that in the transfusion group (10.4 +/- 2.9 days, P = .023).

CONCLUSION

The simple, practical swivel intravenous infusion device provided treatment for more than 30 days, a useful tool for heterotopic segmental small bowel transplantation.

Laparoscopic sacral colpopexy for uterine prolapse with prolene mesh

OBJECTIVE

To analyze the clinical effects of laparoscopic sacral colpopexy using prolene mesh for patients with pelvic organ prolapse.

METHODS

Laparoscopic placement of prolene mesh in the rectovaginal septum and veslcovaginal septum of 42 women with uterine prolapse with bladder and rectum prolapse. One mesh was fixed to the round ligaments and another to the periosteum of the sacral vertebrae. Operation time, blood loss, complication rate and follow-up surgery results were recorded monthly and analyzed according to the POP-Q system. The uterus was preserved in all cases.

RESULTS

The mean operating time was 92 +/- 12 min and the mean blood loss during surgery was 98 +/- 11 ml. Postoperatively, both prolapse and symptoms were highly significantly improved (p < 0.001) according to the pelvic organ prolapse quantification (POP-Q) system.

CONCLUSIONS

Laparoscopic sacral colpopexy for uterine prolapse using prolene mesh is a minimally invasive and effective new technique that offers a chance for patients who desire to preserve their uterus.