Severe anaphylactic shock due to methylene blue dye

A Feasibility Study of Sentinel Lymph Node Biopsy in Endometrial Cancer Using Technetium 99m Nanocolloid

To study the feasibility of sentinel node biopsy in early-stage endometrial cancer and to analyse the detection rate of sentinel lymph node (SLN) using preoperative cervical injection of Tc99m nanocolloid. Thirty-five patients with preoperative histological diagnosis of endometrial cancer without any extrauterine involvement on imaging were included in the study. Sentinel node mapping was done by cervical injection of Tc99m nanocolloid on the evening before surgery. Scintigraphic images were taken using gamma camera. Intraoperatively, nodes showing radioactivity were detected using hand-held gamma probe, dissected out separately and labelled as sentinel lymph nodes. Detection rate was calculated and analysed with respect to various parameters. Sentinel lymph node biopsy (SLNB) is feasible in endometrial cancer using cervical injection of Tc99m nanocolloid. SLN detection was done in 33 (94.3%) out of 35 patients. Bilateral detection was feasible in 19 patients (54.3%) with detection in left and right hemipelvis being 74.3%. Detection rate of SLN was 93.7% in endometrioid adenocarcinoma. Sentinel node was detected in all the patients with non-endometrioid histology. The SLNB using cervical injection of Tc99m nanocolloid is feasible in endometrial cancer. It is a safe and easily reproducible technique with good detection rate and high sensitivity. Stage of the tumour, grade and myometrial invasion do not seem to have an influence on sentinel node detection. Cervical involvement, enlarged lymph nodes and obstructed lymphatics can affect sentinel node mapping adversely.

Hidden Causes of Anaphylaxis

PURPOSE OF REVIEW

This study aimed to review important hidden causes of anaphylaxis in ingestants, non-ingestants, and uncommon settings.

RECENT FINDINGS

Multiple new and elusive causes of anaphylaxis have been described over the past 35 years. Further research is required to identify the epidemiology, pathophysiology, and clinical impact of these hidden causes. Although these culprits should be considered in the appropriate clinical scenarios, many remain exceedingly rare.

Methylene Blue Injection as an Alternative to Antegrade Nephrostography to Assess Urinary Obstruction After Percutaneous Nephrolithotomy

AIMS AND OBJECTIVES

Percutaneous nephrolithotomy (PCNL) remains an effective treatment for large stones. When nephrostomy tube (NT) is left post operation, antegrade urine flow is often confirmed with antegrade nephrostography (ANG) before tube removal. We compare methylene blue (MB) test combined with NT capping trial against ANG to assess antegrade urine flow after PCNL.

MATERIALS AND METHODS

One hundred one consecutive patients undergoing PCNL were prospectively enrolled between 7/2014 and 4/2015. An NT cap was placed the morning of postoperative day 1 (POD1). Failure was defined as need to uncap the NT for any reason. Two hours after capping, 7cc MB was injected into the NT. Positive MB test was defined as presence of blue per bladder Foley. ANG was then performed to assess antegrade urine flow. NTs were removed before discharge home when antegrade flow was documented. Primary outcomes included presence of antegrade flow on ANG and NT removal before discharge home. Receiver operating characteristic (ROC) and areas (Area under the ROC [AUC]), as well as Cohen's kappa coefficient (κ), were calculated comparing agreement of capping trial, MB, and ANG with NT removal.

RESULTS

One hundred one subjects were included in this analysis. 52.9% were left-sided surgeries and 60.4% utilized lower pole punctures. On ROC areas evaluating tests for agreement with NT removal before discharge, MB AUC 0.71 (95% CI 0.60-0.83), capping trial AUC 0.66 (95% CI 0.57-0.75), combed capping trial and MB AUC 0.72 (95% CI 0.61-0.84), and ANG AUC 0.78 (95% CI 0.68-0.88). In predicting NT removal, ANG performed better than capping trial alone (p = 0.042), but no differences were seen between MB and ANG (p = 0.229), combining the capping trial with MB test and ANG (p = 0.266) or combined testing and MB alone (p = 0.972).

CONCLUSIONS

Combining capping trial with MB injection is similarly accurate for predicting NT removal after PCNL compared to ANG. Capping trial and MB may be used in combination to obviate the need for ANG.

Melanin nanoparticles derived from a homology of medicine and food for sentinel lymph node mapping and photothermal in vivo cancer therapy

The use of non-toxic or low toxicity materials exhibiting dual functionality for use in sentinel lymph node (SLN) mapping and cancer therapy has attracted considerable attention during the past two decades. Herein, we report that the natural black sesame melanin (BSM) extracted from black sesame seeds (Sesamum indicum L.) shows exciting potential for SLN mapping and cancer photothermal therapy. Aqueous solutions of BSM under neutral and alkaline conditions can assemble into sheet-like nanoparticles ranging from 20 to 200 nm in size. The BSM nanoparticles were encapsulated by liposomes to improve their water solubility and the encapsulated and bare BSM nanoparticles were both non-toxic to cells. Furthermore, the liposome-encapsulated BSM nanoparticles (liposome-BSM) did not exhibit any long-term toxicity in mice. The liposome-BSM nanoparticles were subsequently used to passively target healthy and tumor-bearing mice SLNs, which were identified by the black color of the nanoparticles. BSM also strongly absorbed light in the near-infrared (NIR) range, which was rapidly converted to heat energy. Human esophagus carcinoma cells (Eca-109) were killed efficiently by liposome-BSM nanocomposites upon NIR laser irradiation. Furthermore, mouse tumor tissues grown from Eca-109 cells were seriously damaged by the photothermal effects of the liposome-BSM nanocomposites, with significant tumor growth suppression compared with controls. Given that BSM is a safe and nutritious biomaterial that can be easily obtained from black sesame seed, the results presented herein represent an important development in the use of natural biomaterials for clinical SLN mapping and cancer therapy.