Aims: The aim of this study was to evaluate the role, if any, of sentinel lymph node mapping (SLNM) with biopsy (SLNB) in patients with cutaneous melanoma of the head and neck. Methods: Consecutive ...patients with cutaneous melanoma of the head and neck regions undergoing SLNM with biopsy were identified from a departmental database comprising 480 patients in total from 2000–2007. Factors examined included demographic data, histological subtype, site and depth of lesion, pre-operative lymphoscintigraphy, percentage of positive SLNs, regional recurrence in the setting of a negative SLNB result (false-negative rate), complications, further lymphadenectomy, percentage of skin grafting required and follow-up. Results: The median patient age was 51 years (range 18–90 years). The mean Breslow depth was 3.25mm (range 1–19mm). Five patients presented with stage III/IV disease. A SLN was identified in 27/40 patients who underwent head and neck SLN mapping (mean two lymph nodes per patient). Of these, six (22%) patients were positive for metastatic melanoma. The false-negative rate was 9.5%. The median follow up for patients was 39.6 months (range 12–96 months). No facial nerve injury or other major morbidity occurred. Conclusions: This study indicates that SLNB is a reliable and safe technique to diagnose regional spread from head and neck cutaneous melanoma. It is more difficult than at other sites. These lesions have a higher incidence of failed SLN mapping and a higher rate of recurrence following negative SLNB, when compared to truncal and extremity lesions. Nodular melanomas are more likely to fail the sentinel lymph node mapping procedure than other histological subtypes.
Taurine (2-aminoethane sulphonic acid), a ubiquitous β-amino acid not incorporated into proteins but found either free or in some simple peptides is considered as a conditionally semi-essential amino ...acid in man. Once thought of as no more than an innocuous end product of cysteine metabolism, taurine has in recent years generated much interest due to research findings indicating a role in numerous physiological processes. These roles are varied and include membrane stabilization, detoxification, antioxidation, osmoregulation, maintenance of calcium homeostasis, and stimulation of glycolysis and glycogenesis. Intracellular and plasma taurine levels are high and although cellular taurine is tightly regulated, plasma levels are known to decrease in response to surgical injury and numerous pathological conditions including cancer, trauma and sepsis. Decreased plasma concentrations can be restored with supplementary taurine. Although the importance of taurine as a physiological agent with pharmacological properties is now recognised, the potential advantages of dietary supplementation with taurine have not as yet been fully exploited and this is an area which could prove to be of benefit to the patient.
Background: Surgical extirpation of solid tumors may not be entirely possible, and the consequence of surgical excision is invariably the release of tumor cells into the systemic circulation. The aim ...of this study was to determine whether laparotomy affects the establishment of spontaneous pulmonary metastases after excision of the primary tumor in a murine flank tumor model and to determine possible underlying immune abnormalities.
Methods: An initial experiment was carried out to compare the development of gross spontaneous pulmonary metastases in the presence of a primary flank tumor and after excision of the tumor in C57/BL6 female mice. Another group of mice had flank tumors excised and were simultaneously randomized to undergo anesthetic only (control), laparoscopy, or laparotomy, after which the subsequent development of pulmonary metastases was determined. Finally, a third experiment entailed determination of natural killer cell (NK) cytotoxicity and the effect of splenic macrophages on NK cytotoxicity at days 1, 7, and 14 after tumor excision.
Results: Excision of the primary tumor resulted in a significant increase in the number of pulmonary metastases in mice compared with mice that did not have tumors excised (
P = .01). Both laparotomy and laparoscopy significantly increased the number of spontaneous pulmonary metastases after tumor excision compared with controls (
P ≤ .01), and there was also a significant difference between laparotomy and laparoscopy groups (
P = .00). NK cytotoxicity was significantly suppressed at all time points after operation in the laparotomy group compared with both the laparoscopy group and the controls (
P ≤ .01). Suppression occurred after laparoscopy at 24 hours after the procedure compared with controls (
P = .00); by day 7 this difference was not significant, but at day 14 there was again a significant suppression (
P ≤ .03). Splenic macrophages appeared to be a suppressor to natural killer cell cytotoxicity (NKCC) in the corresponding groups and at the corresponding time points.
Conclusions: The differential establishment of spontaneous metastases after tumor excision and laparotomy and, to a lesser extent, laparoscopy results in lowered host antitumor surveillance and may be mediated at least in part by the generation of splenic suppressor cells in the early postoperative period, causing a more marked and prolonged effect after laparotomy than after laparoscopy. (Surgery 1998;124:516-25.)
Endothelial cell (EC) death may play an important role in the development of increased vascular permeability and capillary leak syndrome during systemic inflammatory response syndrome. However, the ...mode of EC death and the mechanisms involved remain unclear. In this study we employed the proinflammatory mediators lipopolysaccharide (LPS) and tumor necrosis factor-alpha (TNF-alpha), the chemical reagent sodium arsenite, and heat shock to trigger the stress gene responses. Human ECs were used as surrogates of the microvasculature to test the hypothesis that the induction of the heat shock response and the oxidative stress response might combine to induce apoptosis rather than necrosis in human ECs. Sodium arsenite at 80-320 microM, which induced heat shock protein 72 (HSP72) expression and reactive oxygen intermediate (ROI) generation in ECs, resulted in EC apoptosis. TNF-alpha alone (5-75 ng/ml) increased EC ROI generation but did not induce EC apoptosis. Heat shock alone (42 degrees C, 45 min) or sodium arsenite (40 microM) alone, each of which induced HSP72 expression, did not result in EC apoptosis. However, the combination of TNF-alpha with heat shock or 40 microM sodium arsenite led to EC apoptosis as HSP72 expression and ROI were induced. Furthermore, sodium arsenite (80 microM) in the presence of antioxidants failed to induce EC apoptosis. Apoptotic ECs also exhibited functional disturbances as represented by the depression of intercellular adhesion molecule-1 expression as well as the disruption of EC monolayer integrity. These results indicate that the simultaneous induction of a heat shock response and an oxidative stress response is responsible for human EC apoptosis.
Background
“Consent is a process by which a patient is informed and becomes a participant in decisions regarding their medical management.” It is argued, however, that providing a signature to a form ...adds little to the quality of this process.
Methods
Views regarding the consent ritual of nonselected patients undergoing endoscopy (cystoscopy or sigmoidoscopy) were prospectively studied together with those of the attending staff. Patient volunteers were randomly assigned to one of two groups and given verbal explanation before the procedure, either alone (group A) or with a request to sign a form in addition (group B). A standardized questionnaire regarding preferences then was applied.
Results
A total of 37 patients (22 men) were studied along with seven staff members. Most surveyed felt that signing a consent form helped to empower the patient (group A, 84%; group B, 83%; staff, 100%). Although the patients mainly believed that it functioned primarily to protect the hospital and doctor (group A, 89%; group B, 67%), only one patient (3% of total) felt that such a formality undermined the patient–doctor relationship. Most staff members favored signing a form (86%). The majority of patients either favored it (group A, 47%; group B, 78%) or expressed no strong preference (group A, 32%; group B, 11%). Interestingly, more women than men preferred signing (73 vs. 55%;
p
= 0.25), perhaps because more women believed that it functioned to preserve autonomy (93 vs. 77% of men). Age was no particular determinant of perspective.
Conclusion
Although it may be viewed as primarily serving to protect the doctor and hospital, the formal process of signing written consent forms appeals to patients and staff.
Activated protein C (APC) is an endogenous anti-coagulant with anti-inflammatory properties. The purpose of the present study was to evaluate the effects of activated protein C in the setting of ...skeletal muscle ischaemia reperfusion injury (IRI). IRI was induced in rats by applying rubber bands above the levels of the greater trochanters bilaterally for a period of 2
h followed by 12
h reperfusion. Treatment groups received either equal volumes of normal saline or activated protein C prior to tourniquet release. Following 12
h reperfusion, muscle function was assessed electrophysiologically by electrical field stimulation. The animals were then sacrificed and skeletal muscle harvested for evaluation.
Activated protein C significantly attenuated skeletal muscle reperfusion injury as shown by reduced myeloperoxidase content, wet to dry ratio and electrical properties of skeletal muscle. Further in vitro work was carried out on neutrophils isolated from healthy volunteers to determine the direct effect of APC on neutrophil function. The effects of APC on TNF-α stimulated neutrophils were examined by measuring CD18 expression as well as reactive oxygen species generation. The in vitro work demonstrated a reduction in CD18 expression and reactive oxygen species generation.
We conclude that activated protein C may have a protective role in the setting of skeletal muscle ischaemia reperfusion injury and that this is in part mediated by a direct inhibitory effect on neutrophil activation.
Clin. Otolaryngol. 2010, 35, 468–473
Objectives: Calcium levels are often measured to diagnose postoperative hypocalcaemia following thyroidectomy. The aims of this study were to (i) prospectively ...determine the incidence of symptomatic and biochemical hypocalcaemia following thyroidectomy, (ii) to identify if any associations exist between hypocalcaemia, type of surgery, histological diagnosis, specimen size/weight and the presence of histological parathyroid tissue and (iii) to evaluate the necessity of routine measurement of calcium levels following all thyroidectomies.
Design: Prospective clinical study.
Settings: University teaching hospital.
Participants: Eighty‐six patients presenting consecutively for thyroid surgery.
Outcome measures: Type of surgery, indications, perioperative calcium levels, symptoms of hypocalcaemia and histology were documented.
Results: Fifty‐four patients underwent thyroid lobectomy and isthmusectomy, 19 underwent total and 13 completion thyroidectomy. Significantly, no patient undergoing thyroid lobectomy developed hypocalcaemia versus 26% of total thyroidectomies (P = 0.001) and 23% of completion thyroidectomies (P = 0.006). All eight patients with hypocalcaemia required treatment. Seven were initially identified clinically. Logistic regression analysis revealed that operation type was the only independent risk factor for developing hypocalcaemia (P = 0.021).
Conclusions: No patient developed hypocalcaemia following thyroid lobectomy and isthmusectomy. Considering the majority (63%) of thyroid surgeries were lobectomies, most patients tested appear low risk for hypocalcaemia. Definitive prediction of hypocalcaemia postoperatively remains a challenge. However, our results suggest that analysing calcium levels routinely following thyroid lobectomy is unwarranted.
