Sentinel lymph node in endometrial cancer: an overview

The role of complete pelvic and para-aortic lymphadenectomy in early endometrial cancer remains controversial in gynecologic oncology. Sentinel lymph node detection is an alternative to assess lymphatic spread in several solid tumors. The authors review the literature related to the detection of sentinel lymph node in endometrial cancer, the techniques employed, and its results and feasibility. The authors review reported case series of endometrial cancer in which the sentinel lymph node biopsy was performed. A systematic literature review was conducted using the PubMed database. Different techniques were used considering lymphatic imaging mapping (colorimetric, isotopic, and fluorescence procedures) and injection site (subserous, hysteroscopic, and cervical). Detection rates of sentinel lymph node were heterogeneous, varying between 44 and 100 % with false-negative rates between 0 and 33 %. Although technically demanding, hysteroscopy approach was associated with the highest detection rate. The largest trials showed a good detection rate with cervical injection, a more reproducible procedure. The laparoscopic route improved the results. Immunohistochemistry staining improved the micrometastasis detection in sentinel lymph node. Cost-effectiveness of systematic lymphadenectomy compared with sentinel lymph node procedure and its value on adjuvant therapies as well as a standardized reproducible and reliable technique must be assessed.     

PFAPA syndrome in siblings. Is there a genetic background?

“PFAPA syndrome” is an autoinflammatory entity composed of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis. There have been many reports of children with the disease, but only occasionally have been described in siblings, and no specific genetic mutation has been determined yet. Corticosteroids are the mainstay in the treatment of the acute attacks. The role of surgery in long-term follow-up (tonsillectomy with or without adenoidectomy) is controversial. We report two brothers affected with the syndrome, in whom corticosteroids as the only treatment led to an improvement. A genetic work-up was performed, making very unlikely other possible syndromes of recurrent fever. Conclusion: PFAPA syndrome is the most common recurrent periodic fever disorder described in childhood. Its genetic background has not been elucidated yet. Our contribution with two siblings affected with PFAPA syndrome further support the genetic basis for the entity.     

Effects of water temperature on surfactant-induced skin irritation

Surfactant-induced irritant reactions may be elicited by several endogenous and exogenous factors. Among these, surfactant concentration, and duration and frequency of exposure play important rotes. The study focuses on the influence of water temperature in determining damage of the skin barrier. 10 subjects of both sexes entered the study. 4 areas (4×4 cm²) were randomly selected on the volar forearm and were treated with a daily open application of 5% sodium lauryl sulphate for 4 days. The solutions were at 3 temperatures: 4®, 20® and 40 ®C. One site served as untreated control. On the 5th day, skin irritation was evaluated using transepidermal water loss (TEWL) measurements, erythema ( a * value), skin reflectance ( L * value), hydration (capacitance) and desquamation (stripping). The results show a significant effect of the solution's temperature in determining skin irritation ( P < 0.001), Skin damage was higher in sites treated with warmer temperatures and a highly significant correlation ( P < 0.001) between irritation and temperature was found. In conclusion, the study shows that water temperature during washing has an important effect on the onset of irritant contact dermatitis.     

Lower facial remodeling with botulinum toxin type A for the treatment of masseter hypertrophy

BACKGROUND

Masseter hypertrophy has been treated with botulinum toxin injections because of esthetic complaints especially in Asians.

OBJECTIVES

The goal of the present study was to evaluate the efficacy of abobotulin toxin use in masseter hipertrophy treatment in Brazilians.

METHODS

Ten Brazilian female patients with masseter hypertrophy were subjected to injections of 90U of abobotulinum toxin A applied on each side respecting the safety zone stabilished in literature and were followed up for 24 weeks.

RESULTS

When analyzing the coefficients between measures of middle and lower third of the face obtained from standardized photographs, an increase was observed, with statistical significance at 2 weeks (p=0.005) and 12 weeks (p=0.001). The progression of lower third reduction was 3.94%, 5.26%, 11.99%, and 5.47% (2, 4, 12, and 24 weeks respectively). All patients showed improvement in bruxism after treatment. Observed adverse effects were masticatory fatigue, smile limitation, and smile asymmetry.

CONCLUSION

The use of abobotulinum toxin A for masseter hypertrophy is effective in Brazilians and reached its maximum effect of facial thinning at 12 weeks. Smile limitation had a higher incidence compared to that reported in the literature and may result from risorius muscle blockage caused by toxin dissemination. Despite its side effects, 80% of the patients would like to repeat the treatment.