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The efficacy of blue dye and radioisotope as an intraoperative method of axillary sentinel lymph node detection in invasive breast cancer
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Abstracts / Annals of Medicine and Surgery 3 (2014) 47–50
value ¼ 0.0484). RPI caused microcracks in 33% (n¼4) of samples, although these were not greater in length than those formed under physiological cortical loading (Burr and Martin, 1993). Conclusions: Preliminary testing indicates the RPI instrument is safe to use on bones from children with medical conditions, including osteogenesis imperfecta, at 2N indentation force. There is not convincing evidence that low 25(OH)D, high PTH or abnormal calcium levels correlate with bone fragility in children. Further research involving ex vivo from a larger patient cohort could clarify how RPI testing correlates to bone strength. EFFECTS OF HYDROGEN SULPHIDE ON CYCLOSPORIN INDUCED NEPHROTOXICITY AT REPERFUSION G. Lee*, S. Hosgood, C. Crotty, M. Patel, K. Shah, M.L. Nicholson. Leicester Aims: The shortage of kidneys for transplantation has increased use of donation after circulatory death (DCD). These grafts are more susceptible to reperfusion injury and delayed graft function (DGF). Hydrogen sulphide (H2S) is an anti-inflamatory gasotransmitter which may reverse the nephrotoxic side effects of the commonly used immunosuppressant cyclosporine (CsA). The aim of this study was to assess the effects of CsA and H2S in a porcine DCD reperfusion model. Methods: Porcine kidneys underwent 15 minutes warm ischaemia and 16 hours cold storage to emulate DCD Kidney retrieval. They were reperfused with an oxygenated autologous blood preparation on an ex-vivo normothermic perfusion apparatus. Renal haemodynamics, function & injury were assessed. There were three groups of kidneys: CsA (levels 186 27ng/ml) (n ¼ 6), CsA+ H2S (20mg Na2S (aq) infused over 40 min) (n ¼ 4). And control (n ¼ 6). Results: CsA caused a significant decrease in renal blood flow, H2S numerically increased this:Area under the curve (AUC) renal blood flow; control: 680 182, CsA 298 62*, CsA & H2S 407 106ml/min/100g.h; *P ¼0.001). CsA decreased urinary IL-1b. CsA & H2S decreased it further: Control 100 56, CsA 45 34, CsA & H2S 27 15.1 pg/ml; P¼0.04. Creatinine clearance (CrCL) was equivalent (P ¼ 0.1). H2S did not improve renal function. (AUC CrCl; C 6.1 3.8, CsA 3.1 1.5, CsA+ H2S 3.9 0.7ml/ min/100g.h; P ¼ 0.151). Levels of endothelin-1 (ET-1) were similar: (ET-1; C 37 8, CsA 32 13, CsA + H2S 34 14pg/ml; P ¼ 0.76). Conclusions: The synergistic suppression of IL-1b may suggest that the coadministration of H2S and CsA during reperfusion may preserve early immunosuppressive benefits. Further work is needed to determine whether H2S can reverse CsA induced vasoconstriction.
detected all SLN metastases, resulting in more accurate staging of the axilla in invasive breast cancer patients. The correlation found between LVI and SLN metastases suggests that when investigating breast tumours demonstrating LVI, should the SLN yield be low, caution may perhaps be warranted when ruling out axillary lymph node metastases following a negative SLN result. COMPARISON OF NON-UNION RATES FOLLOWING FIRST METATARSOPHALANGEAL JOINT FUSION WITH THREE DORSAL PLATING SYSTEMS E.J. Bass*, S. Sirikonda, C. Walker. Liverpool Aims: This study reports a comparison of non-union rates of the 1st metatarsophalangeal joint (MTPJ) with the current Memometal AnchorageTM dorsal plate system used at our Trust, and the previously used HallufixTM and CharlotteTM systems. The objectives of the study are to demonstrate whether or not patient outcome has been improved after changing practice to use the Memometal AnchorageTM system. Methods: Between 01/2009 and 07/2012 174 consecutive 1st MTPJ fusions were performed for 153 patients (Mean age 62, range 42 to 83) by three surgeons at one University teaching hospital. 40 patients (23%) were male and 132 (77%) female. 20 patients received Hallu-fixTM plates, 76 CharlotteTM plates and 76 Memometal AnchorageTM plates. Radiographs of the feet were taken four weeks postoperatively and reviewed for signs of nonunion. Ratios of failure rates between plates were compared using Fisher's exact tests (p ¼ 0.05). Results: 12 (7.0%) non-unions were identified in total during followup. A single (5.0%) Hallu-fixTM system, 9 (11.8%) CharlotteTM systems and 2 (2.6%) Memometal AnchorageTM plating systems did not fuse satisfactorily. There was no significance in failure rate ratios between all three groups (p ¼ 0.08). The difference in failure ratios between Memometal AnchorageTM and CharlotteTM systems was significant (p ¼ 0.03). Followup in patients in whom there were no postoperative complications and who developed satisfactory bony union was 12 weeks. Those with non-unions were followed until revision procedures were successful. Conclusion: The mean non-union rate of all 1st MTPJ fusions during the period compares favourably with published literature. The Hallu-fixTM shows favourable results when compared with authors using the same system. The CharlotteTM system's non-union rate compared poorly with published literature. The Memometal AnchorageTM system demonstrated promising results and would appear to be a clinical improvement compared to the previously used plating systems.
THE EFFICACY OF BLUE DYE AND RADIOISOTOPE AS AN INTRAOPERATIVE METHOD OF AXILLARY SENTINEL LYMPH NODE DETECTION IN INVASIVE BREAST CANCER
OUTCOMES OF RADIAL HEAD ARTHOPLASTY FOLLOWING MASON III AND IV RADIAL HEAD FRACTURES
J. Sibbel*, M. Yassin, Z. Khanzada, Q. Baker, B. Zeiden, T. Graja. Dorset
A.R.M. Asp*, N. Jacobs, A. Nicholls, D.J. Watkinson. Portsmouth
Aims: Axillary sentinel lymph node (SLN) status remains one of the most important prognostic indicators in invasive breast cancer patients, and guides further management. Various methods exist for intraoperative SLN detection. The use of blue dye alone, with average detection rates of 78%, has generally been superseded by a combination technique using blue dye and radioisotope technicium 99, with average detection rates of 98%. The aim of this study was to compare SLN detection rates at our hospital using both of the above techniques. Methods: Retrospective study of SLN detection rates using blue dye alone in 99 patients undergoing excision of invasive breast cancer from April 2011 – April 2012 at our hospital. Following the introduction of the combination technique at our hospital using blue dye and radioisotope, SLN detection rates in 39 patients undergoing excision of invasive breast cancer from October 2012 – March 2013 were re-audited. Operation notes and histopathology reports were used to collect the data. Results: SLN detection rate in the blue dye alone group was 78% (95% C.I: 68.7% - 84.8%). SLN detection rate in the blue dye and radioisotope group was 100% (95% C.I: 91.0% - 100%). Lymphovascular invasion (LVI) was observed in 9 tumours, 7 of which (78%) had also metastasized to lymph nodes. Conclusion: Blue dye alone is an unreliable method of intraoperative SLN detection. A combination technique using both blue dye and radioisotope
Aims: The purpose of this study was to determine long term patient satisfaction and functional outcomes following radial head arthroplasty. Methods: We present a consecutive series of 40 radial head replacements undertaken for trauma between 2002 and 2011. Patients were contacted via telephone or post and invited to undergo a clinical and functional outcome assessment by completing the Quick Dash questionnaire and Mayo Elbow Performance Score. Their clinical records and available radiographs were also reviewed. Results: Metalwork was removed in 5 patients due to loosening and subsequent failure. The study population demonstrated functional recovery with mean range of flexion of 130 degrees (range 70-150, standard deviation 24.8), extension of 23 (range 0-55, standard deviation 17.5), pronation of 75 degrees (range 30-80, standard deviation 13) and supination of 72 degrees (range 40-80, standard deviation 24). Radiographs revealed heterotrophic ossification in 7 patients. Radiocapitellar wear was seen in 16 patients. Loosening of the prosthesis was seen in 7 patients. Conclusions: The Corin prosthesis used in patients following a Mason III or IV radial head fracture has shown to be advocated in the long term with respect to patient satisfaction and functional outcomes however radiocapitellar wear and loosening are a concern.
Abstracts / Annals of Medicine and Surgery 3 (2014) 47–50
value ¼ 0.0484). RPI caused microcracks in 33% (n¼4) of samples, although these were not greater in length than those formed under physiological cortical loading (Burr and Martin, 1993). Conclusions: Preliminary testing indicates the RPI instrument is safe to use on bones from children with medical conditions, including osteogenesis imperfecta, at 2N indentation force. There is not convincing evidence that low 25(OH)D, high PTH or abnormal calcium levels correlate with bone fragility in children. Further research involving ex vivo from a larger patient cohort could clarify how RPI testing correlates to bone strength. EFFECTS OF HYDROGEN SULPHIDE ON CYCLOSPORIN INDUCED NEPHROTOXICITY AT REPERFUSION G. Lee*, S. Hosgood, C. Crotty, M. Patel, K. Shah, M.L. Nicholson. Leicester Aims: The shortage of kidneys for transplantation has increased use of donation after circulatory death (DCD). These grafts are more susceptible to reperfusion injury and delayed graft function (DGF). Hydrogen sulphide (H2S) is an anti-inflamatory gasotransmitter which may reverse the nephrotoxic side effects of the commonly used immunosuppressant cyclosporine (CsA). The aim of this study was to assess the effects of CsA and H2S in a porcine DCD reperfusion model. Methods: Porcine kidneys underwent 15 minutes warm ischaemia and 16 hours cold storage to emulate DCD Kidney retrieval. They were reperfused with an oxygenated autologous blood preparation on an ex-vivo normothermic perfusion apparatus. Renal haemodynamics, function & injury were assessed. There were three groups of kidneys: CsA (levels 186 27ng/ml) (n ¼ 6), CsA+ H2S (20mg Na2S (aq) infused over 40 min) (n ¼ 4). And control (n ¼ 6). Results: CsA caused a significant decrease in renal blood flow, H2S numerically increased this:Area under the curve (AUC) renal blood flow; control: 680 182, CsA 298 62*, CsA & H2S 407 106ml/min/100g.h; *P ¼0.001). CsA decreased urinary IL-1b. CsA & H2S decreased it further: Control 100 56, CsA 45 34, CsA & H2S 27 15.1 pg/ml; P¼0.04. Creatinine clearance (CrCL) was equivalent (P ¼ 0.1). H2S did not improve renal function. (AUC CrCl; C 6.1 3.8, CsA 3.1 1.5, CsA+ H2S 3.9 0.7ml/ min/100g.h; P ¼ 0.151). Levels of endothelin-1 (ET-1) were similar: (ET-1; C 37 8, CsA 32 13, CsA + H2S 34 14pg/ml; P ¼ 0.76). Conclusions: The synergistic suppression of IL-1b may suggest that the coadministration of H2S and CsA during reperfusion may preserve early immunosuppressive benefits. Further work is needed to determine whether H2S can reverse CsA induced vasoconstriction.
detected all SLN metastases, resulting in more accurate staging of the axilla in invasive breast cancer patients. The correlation found between LVI and SLN metastases suggests that when investigating breast tumours demonstrating LVI, should the SLN yield be low, caution may perhaps be warranted when ruling out axillary lymph node metastases following a negative SLN result. COMPARISON OF NON-UNION RATES FOLLOWING FIRST METATARSOPHALANGEAL JOINT FUSION WITH THREE DORSAL PLATING SYSTEMS E.J. Bass*, S. Sirikonda, C. Walker. Liverpool Aims: This study reports a comparison of non-union rates of the 1st metatarsophalangeal joint (MTPJ) with the current Memometal AnchorageTM dorsal plate system used at our Trust, and the previously used HallufixTM and CharlotteTM systems. The objectives of the study are to demonstrate whether or not patient outcome has been improved after changing practice to use the Memometal AnchorageTM system. Methods: Between 01/2009 and 07/2012 174 consecutive 1st MTPJ fusions were performed for 153 patients (Mean age 62, range 42 to 83) by three surgeons at one University teaching hospital. 40 patients (23%) were male and 132 (77%) female. 20 patients received Hallu-fixTM plates, 76 CharlotteTM plates and 76 Memometal AnchorageTM plates. Radiographs of the feet were taken four weeks postoperatively and reviewed for signs of nonunion. Ratios of failure rates between plates were compared using Fisher's exact tests (p ¼ 0.05). Results: 12 (7.0%) non-unions were identified in total during followup. A single (5.0%) Hallu-fixTM system, 9 (11.8%) CharlotteTM systems and 2 (2.6%) Memometal AnchorageTM plating systems did not fuse satisfactorily. There was no significance in failure rate ratios between all three groups (p ¼ 0.08). The difference in failure ratios between Memometal AnchorageTM and CharlotteTM systems was significant (p ¼ 0.03). Followup in patients in whom there were no postoperative complications and who developed satisfactory bony union was 12 weeks. Those with non-unions were followed until revision procedures were successful. Conclusion: The mean non-union rate of all 1st MTPJ fusions during the period compares favourably with published literature. The Hallu-fixTM shows favourable results when compared with authors using the same system. The CharlotteTM system's non-union rate compared poorly with published literature. The Memometal AnchorageTM system demonstrated promising results and would appear to be a clinical improvement compared to the previously used plating systems.
THE EFFICACY OF BLUE DYE AND RADIOISOTOPE AS AN INTRAOPERATIVE METHOD OF AXILLARY SENTINEL LYMPH NODE DETECTION IN INVASIVE BREAST CANCER
OUTCOMES OF RADIAL HEAD ARTHOPLASTY FOLLOWING MASON III AND IV RADIAL HEAD FRACTURES
J. Sibbel*, M. Yassin, Z. Khanzada, Q. Baker, B. Zeiden, T. Graja. Dorset
A.R.M. Asp*, N. Jacobs, A. Nicholls, D.J. Watkinson. Portsmouth
Aims: Axillary sentinel lymph node (SLN) status remains one of the most important prognostic indicators in invasive breast cancer patients, and guides further management. Various methods exist for intraoperative SLN detection. The use of blue dye alone, with average detection rates of 78%, has generally been superseded by a combination technique using blue dye and radioisotope technicium 99, with average detection rates of 98%. The aim of this study was to compare SLN detection rates at our hospital using both of the above techniques. Methods: Retrospective study of SLN detection rates using blue dye alone in 99 patients undergoing excision of invasive breast cancer from April 2011 – April 2012 at our hospital. Following the introduction of the combination technique at our hospital using blue dye and radioisotope, SLN detection rates in 39 patients undergoing excision of invasive breast cancer from October 2012 – March 2013 were re-audited. Operation notes and histopathology reports were used to collect the data. Results: SLN detection rate in the blue dye alone group was 78% (95% C.I: 68.7% - 84.8%). SLN detection rate in the blue dye and radioisotope group was 100% (95% C.I: 91.0% - 100%). Lymphovascular invasion (LVI) was observed in 9 tumours, 7 of which (78%) had also metastasized to lymph nodes. Conclusion: Blue dye alone is an unreliable method of intraoperative SLN detection. A combination technique using both blue dye and radioisotope
Aims: The purpose of this study was to determine long term patient satisfaction and functional outcomes following radial head arthroplasty. Methods: We present a consecutive series of 40 radial head replacements undertaken for trauma between 2002 and 2011. Patients were contacted via telephone or post and invited to undergo a clinical and functional outcome assessment by completing the Quick Dash questionnaire and Mayo Elbow Performance Score. Their clinical records and available radiographs were also reviewed. Results: Metalwork was removed in 5 patients due to loosening and subsequent failure. The study population demonstrated functional recovery with mean range of flexion of 130 degrees (range 70-150, standard deviation 24.8), extension of 23 (range 0-55, standard deviation 17.5), pronation of 75 degrees (range 30-80, standard deviation 13) and supination of 72 degrees (range 40-80, standard deviation 24). Radiographs revealed heterotrophic ossification in 7 patients. Radiocapitellar wear was seen in 16 patients. Loosening of the prosthesis was seen in 7 patients. Conclusions: The Corin prosthesis used in patients following a Mason III or IV radial head fracture has shown to be advocated in the long term with respect to patient satisfaction and functional outcomes however radiocapitellar wear and loosening are a concern.