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Nakano K, Seimiya M, Yamazaki K, Yasuda K, Yamashita N, Goto H, Teshima T. Patent blue interferes with the measurement of lipemia index in a patient with sentinel lymph node. Lab Med 2024:lmae028. [PMID: 38619047 DOI: 10.1093/labmed/lmae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Lipids interfere with absorbance measurements conducted using colorimetric methods. To monitor lipemia, some systems measure absorbance using an analyzer. This report describes a novel case of interference with the lipemia index without lipemia. A 64-year-old woman with giant basal cell carcinoma underwent resection and sentinel lymph node biopsy. The patient had been subcutaneously injected with patent blue during sentinel lymph node resection. After surgery, her serum and urine were yellow-green, and the lipemia index, calculated by measuring absorbance at 658 nm (main wavelength) and 694 nm (secondary wavelength) using a JCA-BM8040 chemistry analyzer, was high. The absorbance spectrum of the patient's serum and patent blue solution were compared to determine the cause of the high lipemia index. The patient's serum and the patent blue solution showed absorption at wavelengths between 540 and 698 nm. Moreover, the absorbance was concentration-dependent for patent blue. These results thus indicated that the patient's serum contained patent blue. Here, we report a case wherein patent blue affected the lipemia index. Thus, it must be noted that patent blue injection may yield inaccurate results when evaluating lipemia index.
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Affiliation(s)
- Keiichi Nakano
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Medical Technology and Sciences, School of Health Sciences at Narita, International University of Health and Welfare, Chiba, Japan
| | - Masanori Seimiya
- Department of Medical Technology and Sciences, School of Health Sciences at Narita, International University of Health and Welfare, Chiba, Japan
| | - Kojiro Yamazaki
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
| | - Keiko Yasuda
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Naoki Yamashita
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hideki Goto
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takanori Teshima
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
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Tacquard C, Serrier J, Viville S, Chiriac AM, Franchina S, Gouel-Cheron A, Giraudon A, Le Guen M, Le Quang D, Malinovsky JM, Petitpain N, Demoly P, Mertes PM. Epidemiology of perioperative anaphylaxis in France in 2017-2018: the 11th GERAP survey. Br J Anaesth 2024:S0007-0912(24)00093-X. [PMID: 38493055 DOI: 10.1016/j.bja.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/21/2023] [Accepted: 01/28/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Perioperative anaphylaxis is rare but is associated with significant morbidity. This complication has been well described in France by the GERAP (Groupe d'Etude des Réactions Anaphylactiques Périopératoires), a network focused on its study. The epidemiology of perioperative anaphylaxis is evolving, influenced by environmental factors and clinical practice. The aim of this study was to update the epidemiology of perioperative anaphylaxis in France. METHODS This multicentre retrospective study was performed in 26 allergy clinics of the GERAP network in 2017-8. RESULTS There were 765 patients with perioperative anaphylaxis included. Most cases were severe, with 428 (56%) reactions graded as 3 or 4 according to the Ring and Messmer classification. Skin test results were available for 676 patients, with a culprit agent identified in 471 cases (70%). Neuromuscular blocking agents were the main cause of perioperative anaphylaxis (n=281; 60%), followed by antibiotics (n=118; 25%) and patent blue dye (n=11; 2%). Cefazolin was the main antibiotic responsible for perioperative anaphylaxis (52% of antibiotic-related reactions). Suxamethonium and rocuronium were the main neuromuscular blocking agents responsible for perioperative anaphylaxis with 7.1 (6.1-8.4) and 5.6 (4.2-7.4) reactions per 100,000 vials sold, respectively, whereas cefazolin-related cases were estimated at 0.7 (0.5-0.9) reactions per 100,000 vials sold. CONCLUSIONS Our results confirm that most commonly identified triggering agents remain neuromuscular blocking agents. Reactions to antibiotics, particularly cefazolin, are becoming increasingly frequent. The origin of sensitisation to cefazolin is unknown, as no cross-sensitisation has been described, and it should be the subject of further study. Perioperative anaphylaxis should be followed over the years and understood given the changing triggers. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT04654923).
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Affiliation(s)
- Charles Tacquard
- Department of Anesthesia and Intensive Care, Strasbourg University Hospital, Strasbourg, France.
| | - Julien Serrier
- Department of Immunology and Histocompatibility, Caen University Hospital, Caen, France
| | - Simon Viville
- Department of Anesthesia and Intensive Care, Strasbourg University Hospital, Strasbourg, France
| | - Anca-Mirela Chiriac
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, IDESP, University of Montpellier, Montpellier, France
| | - Sébastien Franchina
- Perioperative Allergic Reaction Exploration Unit, Department of Anesthesia and Intensive Care, Rouen University Hospital, Rouen, France
| | - Aurélie Gouel-Cheron
- Paris City University, Paris, France; Department of Anaesthesiology and Critical Care Medicine, Bichat Hospital, AP-HP, Paris, France; Antibody in Therapy and Pathology, Pasteur Institute, INSERM, Paris, France
| | - Antoine Giraudon
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Morgan Le Guen
- Department of Anesthesia and Pain Medicine, Université de Versailles Saint-Quentin, Versailles, France
| | - Diane Le Quang
- Department of Anaesthesia and Intensive Care, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Nadine Petitpain
- Regional Centre of Pharmacovigilance, University Hospital of Nancy, Nancy, France
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, IDESP, University of Montpellier, Montpellier, France
| | - Paul M Mertes
- Department of Anesthesia and Intensive Care, Strasbourg University Hospital, Strasbourg, France
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do Brasil MJ, Branco CVC, Cappelli N, da Silva JB, Rodrigues RL, Fernandes MEDSL. Illustrated technique of superficial lymphadenectomy of dogs and cats: preliminary study. Braz J Vet Med 2024; 46:e004823. [PMID: 38282830 PMCID: PMC10811725 DOI: 10.29374/2527-2179.bjvm004823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Superficial lymphadenectomy is an easy-to-perform and cost-effective routine technique. Despite its simplicity, it remains underutilized in veterinary medicine, with most practitioners being oncological surgeons. This study aims to enhance accessibility to the surgical procedure by providing anatomical representations of superficial lymphadenectomy in the carcasses of dogs and cats. A preliminary study involving two canines and two felines was conducted, with each group comprising a dog and a cat. Group A was designated to superficial lymphadenectomy techniques to create an illustrated step-by-step procedure, while group B underwent anatomical dissection to expose lymph nodes and their adnexa. The approach to superficial lymph nodes in dogs and cats is simple, allowing for the demonstration of superficial lymphadenectomy techniques in the corpses of dogs and cats without complications. This includes the dissection and presentation of anatomical structures adjacent to the lymph nodes. In conclusion, the techniques applied to subjects in groups A and B proved effective, successfully demonstrating and excising all superficial lymph nodes in the corpses of dogs and cats. These findings suggest that the developed set of techniques developed for lymph node excision holds promise for safe and effective application in live animals.
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Affiliation(s)
- Matheus Junger do Brasil
- Undergraduate in Veterinary Medicine, Universidade Castelo Branco, Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Naomi Cappelli
- Undergraduate in Veterinary Medicine, Universidade Castelo Branco, Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Joice Bento da Silva
- Veterinarian, Universidade Estácio De Sá. Vargem Pequena, Rio de Janeiro, RJ, Brazil
| | | | - Maria Eduarda dos Santos Lopes Fernandes
- Veterinarian, MSc., Programa de Pós-graduação em Medicina Veterinária, Departamento de Medicina e Cirurgia Veterinária, Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brazil
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de Souza MCC, Flecher MC, Arrais FM, de Sena BV, Giuliano A, Horta RDS. Comparison of surgical resection of Axillary Lymph Nodes in Dogs with Mammary Gland Tumors with or without sentinel lymph node visualization with patent blue dye. Front Vet Sci 2023; 10:1149315. [PMID: 37252402 PMCID: PMC10213635 DOI: 10.3389/fvets.2023.1149315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Dogs' axillary lymph node (ALN) is often difficult to locate before surgical resection. The anatomical location of ALN often discourages Veterinarians from surgical lymphadenectomy. Considering the limited literature available, the actual incidence of metastases and the prognostic relevance are poorly understood. Methods A non-randomized, prospective clinical study was conducted with female dogs (n = 41) with mammary gland tumor (MGT) in the thoracic or cranial abdominal mammary glands. The study investigated the risks of ALN metastasis based on tumors clinical findings, tumor size, histopathological diagnosis and grade. The main aim of this study was to compare ALN resection with or without patent blue 2.5% (PB) dye injection for sentinel lymph node visualization. A total of 46 mastectomies were performed and five animals underwent two mastectomies. In the first group, 17 patients underwent a mastectomy and lymphadenectomy without PB injection (G1). In contrast, in the second group, 24 patients also received PB injections for sentinel lymph node mapping (G2). The ALN was identified in 38/46 cases (82%). The ALN was identified and excised in only 58% of surgeries in G1(19/46), while in group 2, the lymph node was identified in 92% of the cases and resected in 100% of the cases. The use of PB improves ALN's identification and reduces the surgical resection time in dogs with MGT. Results and discussion Surgical time differed between the two groups, as it was significantly shorter in the PB injection group compared to group 1 (80 vs. 45 min) (p < 0.0001). The overall frequency of ALN metastasis was 32%. Macroscopic abnormalities in the lymph nodes, tumor size (>3 cm), and diagnosis of anaplastic carcinoma or grade II/III mammary gland tumors were associated with a higher probability of ALN metastasis. Metastases in the ALNs are more common, in dogs presenting with tumors larger than 3 cm and diagnosed with aggressive histological subtypes. The ALNs should be removed for correct staging, prognostic evaluation, and decision for adjuvant therapy.
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Affiliation(s)
| | - Mayra Cunha Flecher
- Departament of Veterinary Medicine, Universidade Vila Velha, Vila Velha, Espírito Santo, Brazil
| | - Fernanda Ming Arrais
- Departament of Veterinary Medicine, Universidade Vila Velha, Vila Velha, Espírito Santo, Brazil
| | - Bruna Voltolin de Sena
- Departament of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Antonio Giuliano
- Departament of Veterinary Clinical Science, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Rodrigo dos Santos Horta
- Departament of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Jeand'heur A, Pelletier F, Girardin P, Moumane L, Aubin F, Castelain F. A case of immediate hypersensitivity reaction after an oral administration of patent blue dye. Contact Dermatitis 2019; 82:116-118. [PMID: 31566746 DOI: 10.1111/cod.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/17/2019] [Accepted: 09/22/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Anne Jeand'heur
- Department of Dermatology and EA3181, University Hospital and University of Franche Comté, Besançon, France
| | - Fabien Pelletier
- Department of Dermatology and EA3181, University Hospital and University of Franche Comté, Besançon, France
| | - Pascal Girardin
- Department of Dermatology and EA3181, University Hospital and University of Franche Comté, Besançon, France
| | | | - François Aubin
- Department of Dermatology and EA3181, University Hospital and University of Franche Comté, Besançon, France
| | - Florence Castelain
- Department of Dermatology and EA3181, University Hospital and University of Franche Comté, Besançon, France
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Korbi A, Khaskhoussy A, Cherif O, Hajji A, Gaddab I, Chaabene A, Gara M, Jbeli F, Grati L, Rhim MS, Faleha R. Anaphylactic shock due to patent blue: case report and review of literature. Pan Afr Med J 2019; 31:7. [PMID: 30918536 PMCID: PMC6430938 DOI: 10.11604/pamj.2018.31.7.15576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/03/2018] [Indexed: 11/11/2022] Open
Abstract
Intraoperative search for the sentinal node using patent blue is considered a non risk procedure. We emphasize the highly exceptional nature of this adverse effect previously observed in other disciplines using this coloring agent. We present a case of allergic reaction to patent blue in a patient who underwent left mastectomy with sentinel lymph node. About 25 min after the dye injection, the patient developed increased heart frequency and allergic skin reaction. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. The patient recovered uneventfully and was discharged from the PACU 3h after the end of surgery without skin changes and was discharged from hospital on the morning after surgery. Allergic reactions with the use of patent blue are far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Skin tests done later confirmed allergy to patent blue dye; the tests induced a small syndrome reaction. Surgical personnel who use patent blue dye should be made aware of the risk of allergic reactions, sometimes severe, to this dye.
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Affiliation(s)
- Asma Korbi
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Amel Khaskhoussy
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Ons Cherif
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Ahmed Hajji
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Imen Gaddab
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Amel Chaabene
- Service de Pharmacologie Clinique, CHU Fattouma Bourguiba Monastir, 5000 Monastir, Tunisia
| | - Mouna Gara
- Département d'Anesthésie Réanimation Monastir CMNM 5000 Monastir, Tunisia
| | - Fathi Jbeli
- Département d'Anesthésie Réanimation Monastir CMNM 5000 Monastir, Tunisia
| | - Lotfi Grati
- Département d'Anesthésie Réanimation Monastir CMNM 5000 Monastir, Tunisia
| | - Med Salah Rhim
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Raja Faleha
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
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Filho WMNE, de Medeiros Neto AM, de Melo Rodrigues RM, Alves ACBR, Vieira SC. Use of the Patent Blue and Air in the Preoperative Marking of Impalpable Breast Lesions. Eur J Breast Health 2019; 15:7-12. [PMID: 30816361 DOI: 10.5152/ejbh.2018.4321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/15/2018] [Indexed: 11/22/2022]
Abstract
Objective The goal of this study is to analyze the applicability of the patent blue dye and air in the preoperative marking of impalpable mammary lesions with indication of surgical resection. Materials and Methods A prospective cohort study was performed. We selected 49 patients with detection of impalpable lesions on a breast mammography or breast ultrasonography. The patients received the dye injection as close to their surgery time as possible. The criteria analyzed included: 1) complete marking and identification of the lesion; 2) complete removal of the lesion; 3) in cases of malignant lesions, presence of free margins for successful surgery; 4) occurrence of allergic events; 5) necessity of reoperation; and 6) difficulty in locating lesions. Results All lesions were marked, and they were successfully excised. In cases of malignancy, free margins were obtained in 100% of the cases. There were no allergic events or reoperations. Only 8.9% of the lesions were difficult to locate. Conclusion The marking with patent blue and air is an effective alternative for the labeling of impalpable breast lesions, and it has satisfactory surgical oncology results. All lesions were resected, 91.1% of them were performed with no difficulties, and free margins were obtained in 100% of cases of malignancy.
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Peek MC, Kovacs T, Baker R, Hamed H, Kothari A, Douek M. Is blue dye still required during sentinel lymph node biopsy for breast cancer? Ecancermedicalscience 2016; 10:674. [PMID: 27729939 PMCID: PMC5045297 DOI: 10.3332/ecancer.2016.674] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Indexed: 12/12/2022] Open
Abstract
Background In early breast cancer, the optimal technique for sentinel lymph node biopsy (SLNB) is the combined technique (radioisotope and Patent Blue V) which achieves high identification rates. Despite this, many centres have decided to stop using blue dye due to blue-dye-related complications (tattoo, anaphylaxis). We evaluated the SLNB identification rate using the combined technique with and without Patent Blue V and the blue-dye-related complication rates. Methods Clinical and histological data were analysed on patients undergoing SLNB between March 2014 and April 2015. SLNB was performed following standard hospital protocols using the combined technique. Results A total of 208 patients underwent SLNB and 160 patients (342 nodes) with complete operation notes were available for final analysis. The identification rate with the combined technique was 98.8% (n = 158/160), with blue dye alone 92.5% (n = 148/160) and with radioisotope alone 97.5% (n = 156/160). A total of 76.9% (263/342) of nodes were radioactive and blue, 15.5% (53/342) only radioactive and 2.3% (8/342) only blue, 5.3% (18/342) were neither radioactive nor blue. No anaphylactic reactions were reported and blue skin staining was reported in six (3.8%) patients. Conclusion The combined technique should continue be the preferred technique for SLNB and should be standardised. Radioisotope alone (but not blue dye alone) has comparable sentinel node identification rates in experienced hands. National guidelines are required to optimise operative documentation.
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Affiliation(s)
- Mirjam Cl Peek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK; Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Tibor Kovacs
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Rose Baker
- School of Business, 612, Maxwell Bldg, University of Salford, Salford M5 4WT, UK
| | - Hisham Hamed
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Ash Kothari
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Michael Douek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK; Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
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Abstract
A 42-year-old female teetotaller presented via the accident and emergency department with a 2-day history of vomiting and upper abdominal pain. She was diagnosed with acute pancreatitis. The aetiology of the pancreatitis was identified as hypercalcaemia secondary to oral calcium supplementation. The hypercalcaemia was corrected by stopping calcium supplements and aggressive fluid resuscitation. A thorough literature search did not show any case reports in which the aetiology of pancreatitis was oral calcium supplement over-replacement.
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