[Predictive factors for non-sentinel lymph nodes affection in breast carcinoma--outcomes of a Czech multicenter study of sentinel lymph nodes]

BACKGROUND

The aim of the study was to assess positivity nonsentinel lymph nodes in patients with macro, micro and submicrometastases in sentinel lymph nodes and find predictive factors of positivity nonsentinel lymph nodes. Study was conducted at the Department of Surgery in Pardubice, Pilsen, Ostrava and Zlín.

MATERIAL AND METHODS

Sentinel lymph nodes were assessed based on standards of Czech Pathological Society. Detection of sentinel lymph nodes was performed based on radionavigation or combination of radionavigation and blue dye method.

RESULTS

In group N1 (macrometastases) there was found positivity of nonsentinel lymph nodes in 50% (45 from 90 patients). In group N1 Mi (micrometastases) there was found positivity of nonsentinel lymph nodes in 26.7% (16 from 60 patients). In group NO I+ (sub-micrometastases) there was found positivity of nonsentinel lymph nodes in 6.7% (1 from 15 patients). Predictive factors were size of metastasis, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor of positivity nonsentinel lymph nodes.

DISCUSSION

High positivity of nonsentinel lymph nodes in pacients with macro and micrometastases in sentinel lymph nodes advocates to perform axillary lymph nodes dissection. Due to small number of patients with submicrometastases it is not possible to assess if axillary dissection is necessary or not. Predictive factors of positivity of nonsentinel lymph nodes are size of metastasis in sentinel lymph nodes, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor due to small tumors in the study. In spite of this it is necessary to consider it like a predictive factor of positivity nonsentinel lymph nodes.

CONCLUSION

In patients with macro and micrometastases it is necessary to perform axillary dissection. In patients with submicrometastases in sentinel lymph nodes it is necessary to consider predictive factors.

[Our experience with the sentinel lymph node detection]

BACKGROUND

Axillary lymph node staging is the most powerful predictor of survival in breast cancer women. Sentinel lymph node biopsy (SLNB) is more accurate method in evaluation of axillary lymph node staging than complete axillary lymph node dissection (CALND) because of more precious histological and imunohistochemical assessment of the first draining lymph nodes. Furthermore, SLNB eliminates complications resulting from CALND.

MATERIAL AND METHODS

SLNB is either performed using blue dye technique or using of combination of blue dye and radioguided technique. We prefer two days protocol in application of Tc 99 radiocolloid. There were used both techniques for detection sentinel lymph nodes and results were compared.

RESULTS

There were performed 21 SLNBs using blue dye technique, Group A, and 20 SLNBs using combination of blue dye and radioguided technique, Group B, from October 2001 to November 2003. Sentinel lymph nodes were not detected in Group A in two cases, false negativity occurred two times in this group. Sentinel lymph nodes were detected in all cases in Group B and there was no false negativity present in this group.

CONCLUSION

Combination of blue dye and radioguided technique is more precious in detection of sentinel lymph node than blue dye technique itself. Two days protocol of application of Tc 99 radiocolloid enables performing this method even in hospitals, where the Department of Nuclear Medicine is not available.

DNA topoisomerase II-alpha in pulmonary carcinoid tumors

Fifty-four pulmonary carcinoid tumors of surgically treated patients were diagnosed according to modified Arrigoni histological criteria (WHO 1999). Forty-seven typical (TC) and seven atypical carcinoids (AC) formed the basic groups. Four subgroups were selected from the TCs and consisted of cases with higher tumor size (T2) or those associated with nodal involvement (N1), tumor satellites, and tumorlets. Subgroup tumors were regarded as affections with possible increased proliferation potential. The proliferate activity was examined immunohistochemically by topoisomerase II-alpha (clone SWT3D1) on paraffin material and calculated by the number of positive nuclei per 10 HPF. The topoisomerase expression was found to be statistically different in both principal groups made up of typical and atypical carcinoids with a mean value of 49 and 135 positive nuclei per 10 high power field in TC and AC, respectively. The remaining subgroups of the TCs associated with examined characteristics (larger tumor diameter, metastases, satellites, tumorlets) were not found to be statistically different. The topoisomerase II-alpha is a marker giving valuable information about the diagnosis of pulmonary typical and atypical carcinoids.

[Testing of implants used in the correction of abdominal wall defects in hernia surgery]

The aim of this study is experimental testing of various kinds of meshes. They are used for correction of abdominal wall defects during operations of hernias (especially by the laparoscopic technique). The following implants were tested: Goretex, Prolen, Mersilen and Vicryl. Each of them represents one group of artificial materials (nonabsorbable, monofilaments multifilament, absorbable) which are usually used. Semiabsorbable materials were not tested because they are not usually used. The objects of testing were firstly constant quality of implants lasting in the time and secondly the reaction of tissues after implantation of those materials.

[Proliferative activity in pulmonary carcinoids]

AIM

On the basis of known Ki-67 dependence on tumor malignancy in some lesions, we compared this marker expression quantitatively in pulmonary typical and atypical carcinoid tumors and attempted to predict their biological behavior especially in cases associated with tumorous lymphadenopathy, satellites, and carcinoid tumorlets.

METHOD

Using material from surgically treated patients, we examined 54 cases of pulmonary carcinoids divided into five groups. 1. Forty-two typical carcinoids (TC), 2. Twelve atypical carcinoids (AC) diagnosed according to modified Arrigoni's criteria (Travis et al., 1998), 3. Thirty-two TC without metastases, satellites, and tumorlets (M, S, T), 4. Eight AC without M, S, T, and 5. Fourteen TC and AC associated with M, S, T. Groups 3, 4, and 5 were formed of cases selected from group 1 and 2. The proliferate activity was evaluated by Ki-67 (MIB-1, Immunotech France, 1:25). Its nuclear labeling was counted in more than 50 HPF and calculated as a number of positive nuclei in 10 HPF. The Fisher exact test was used for statistical analysis.

RESULTS

The Ki-67 nuclear expression was found in 19 (45%) out of 42 TC and in 9 (75%) out of 12 AC. In the set of TC without metastases (M, S, T), the Ki-67 positive labeling was found in 14 (44%) out of 32 cases (group III) and in six (75%) out of eight AC (group IV). In all TC and AC tumors with M, S, T (group V), the Ki-67 expression was encountered in 8 (57%) out of 14 cases. The Fisher exact test showed no significant difference between all examined groups.

CONCLUSION

No statistically significant difference was found in Ki-67 expression in pulmonary typical and atypical carcinoids. It appears to be a factor which can not be used for tumor prognosis prediction or adjuvant therapy indication in surgically treated patients.

[Fibrin glue and wound healing]

Bioadhesive systems used in medicine must meet certain prerequisites on which their application depends. A very important relationship is that of glue and tissue, irritability, the influence on regeneration of tissue cells and histotoxicity. The authors evaluated in an experimental study the necroptic appearance of the peritoneal cavity, the microscopic character of the scar and histological appearance of tissue after treatment of an induced hepatic and lienal rupture in 28 rabbits and 28 baby pigs, using fibrin tissue glue. The typical properties of the adhesive fibrin system ensue from its physiological properties. Filling the wound enhances natural biological processes of healing. The tissue reaction to the applied tissue fibrin coagulum is favourable. The treated parenchymatous organs, liver and spleen, healed by a smooth scar. The number of adhesions in the peritoneal cavity in all thus treated experimental animals after treatment of the spleen was similar. Fewer adhesions were observed when using glue for repairing liver injuries in rabbits. The macroscopic appearance of the scar was similar, the scar was less visible in the liver parenchyma. The histological appearance was similar. The glue did not damage the tissue surrounding the parenchyma and did not act as a foreign body. The assessed results confirm the harmlessness of the fibrin glue, tissue tolerance and satisfactory healing with out a reaction to alien material. After healing the fibrin glue replaced by natural fibrous tissue.

[Metastasizing basalioma at an early age]

The case is described of a woman who suffered since her early childhood from four foci of basalioma and died aged 29 years of metastatic lung involvement. The case appears unique comprising several rare features, e. g. a basalioma in childhood, a metastatic basalioma, and a small-sized metastasizing primary tumour. The disease may be congenital, however, it differs from the typical nevoid basal cell carcinoma syndrome.

[Heart rupture in acute myocardial infarct--analysis of 110 cases]

One hundred and ten cases of heart rupture (27%) were found among 408 postmortems of acute myocardial infarction from 1976 to 1982. After intensive care units were introduced the rate of rupture increased from 17% to 30% and reached 39% of the total. Ruptures were more frequent in women (32%) than in men (24%), their frequency increasing with the age; average age was 70 years in men and 72 years in women. Sudden death occurred in 16% of the patients; the interval between the first symptoms of infarction and death was 24 hours in 39% and 1 week or less in 90% of those affected. Most cases with extremely short history showed a fully developed infarction at autopsy. The rupture was, in fact, the first manifestation of latent ("silent") infarction. Less usual types of heart rupture (incomplete rupture, i. e. dissection of the free wall of the left ventricle and rupture of interventricular septum or papillary muscles of the left ventricle) are discussed in detail. Practical experience of the study is summarized in comments on heart autopsy.