Laparoscopic visualization and dissection of retroperitoneal lymph nodes after patent blue dye injection: a pilot study

PURPOSE: Retroperitoneal lymph node dissection (RPLND) for testicular cancer is an important treatment modality for patients with stage I or IIA disease. Several urologists have previously reported the feasibility and usefulness of laparoscopic RPLND for such patients. The aim of this experimental pilot-feasibility study was to investigate whether visualization of retroperitoneal lymph nodes with patent blue violet (PBV) dye application is a feasible and an effective method during laparoscopic RPLND in a pig model. MATERIALS AND METHODS: Four 12-month-old white male pigs were included in the study. After PBV dye injection into the spermatic funicular and intratesticular parenchyma, the color changes in the retroperitoneal region were examined during transperitoneal laparoscopic visualization of the retroperitoneum. The time interval between the injection and the staining of lymphatic structures was measured for each intervention. Blue-stained retroperitoneal nodal tissues were dissected and removed by the laparoscopic approach and histologic examination was performed. RESULTS: After PBV dye injection, intense staining of the ipsilateral retroperitoneal lymphatic vessels and nodes was seen. Distribution of the PBV and the color changes of the retroperitoneal lymphatic structures were examined under laparoscopic vision in all pigs. All blue-stained retroperitoneal nodular tissues were removed laparoscopically and examined histologically. Histopathologic examination noted all specimens as lymph nodes with no toxic effects of PBV dye. CONCLUSION: We demonstrated that spermatic funicular injection of PVB dye is an effective and accurate method for retroperitoneal lymph node visualization in pigs. The use of this technique in combination with a laparoscopic approach makes RPLND easier and more effective.     

Xanthoma disseminatum with hepatic involvement in a child

Xanthoma disseminatum is a rare, usually self-healing dermatologic disease of unknown etiology. Involvement of other organs and tissues including bone marrow, bone, and brain may be seen rarely in children. However, to date, hepatic involvement has not been reported. We describe a child with xanthoma disseminatum who had hepatic involvement, and discuss his course and treatment with steroid and azathioprine.     

Long-term results of adjunctive use of mitomycin C in external dacryocystorhinostomy

Objective To assess the long-term results of intraoperative mitomycin C (MMC) in external dacryocystorhinostomy (EXT-DCR). Methods In this prospective randomized controlled study, 35 patients (40 eyes) with primary acquired nasolacrimal duct obstruction were assigned randomly into two groups. In the control group, a standard EXT-DCR procedure was performed. In the MMC group 0.2 mg/ml MMC was applied to the osteotomy site for 30 min. The results of EXT-DCR in both groups were evaluated by both asking patients about the tearing condition and examining the patency of irrigation at one-year follow up. Results Eighteen (90%) of the 20 eyes in the MMC group remained totally symptom-free and one eye (5%) improved; while 12 (60%) of 20 eyes in the control group were reported to be symptom-free and five (25%) of the eyes to have an improvement in the tearing symptoms (P = 0.087). The success rate in the MMC group was 95% compared with 85% in the control group (P = 0.605). No surgical complications occurred. Conclusions The satisfaction and success rates of the MMC group were higher than those of the control group and no deleterious effect was noted with MMC application, however the differences did not reach statistical significance. Intraoperative MMC application seems to be a safe adjuvant that could help in increasing the success rates of EXT-DCR surgery in primary acquired nasolacrimal duct obstruction ,however further studies with larger series are needed to make definite statements.     

Orbital color Doppler imaging in Behçet’s disease with or without ocular involvement

Purpose

To investigate the value of color Doppler imaging (CDI) of orbital vasculature in the assessment of ocular involvement in patients with Behçet’s disease (BD) without clinical ophthalmologic abnormalities.

Methods

CDI of the orbital vessels were performed on 26 eyes of 13 patients who were diagnosed as having BD with ocular involvement (group 1), 65 eyes of 33 patients who had BD without ocular involvement (group 2) and 40 eyes of 20 healthy volunteers (group 3). Peak systolic (PSV) and end-diastolic (EDV) blood flow velocities and resistivity index (RI) measurements were obtained for the ophthalmic artery (OA) and central retinal artery (CRA). The mean velocity of the central retinal vein (CRV) was also measured.

Results

For the OA, PSV and EDVs were significantly lower and RIs were significantly higher in group 2 than in control subjects. In group 1, only the EDVs of OA were significantly lower than in healthy subjects. For the CRA, PSV and EDVs were significantly lower, and RIs were significantly higher in both BD groups than those in group 3. When group 1 and group 2 were compared, the differences between PSV, EDV and RI measurements for the CRA and OA were statistically insignificant. There was no significant difference in blood flow velocity of the CRV between the three groups.

Conclusion

Major hemodynamic changes were observed in the ophthalmic vasculature of Behçet’s patients with or without ocular involvement by CDI. CDI may detect ocular blood flow alterations before initial clinical manifestations.

     

The effects of vitamin E on the skin lipid peroxidation and the clinical improvement in vitiligo patients treated with PUVA.

Solar-simulated UV-irradiation causes changes in the enzymic antioxidant defence system in the human epidermis. The aim of this study was to investigate the effects on the skin lipid peroxidation and clinical improvement in vitiligo patients treated with PUVA. The first group of patients was treated for six months with psoralen plus UV-A (n = 15). The second group of patients was treated for six months with psoralen plus UV-A vs vitamin E (900 IU daily perorally) (n = 15). There was no significant difference in the clinical improvement between the group of patients who were treated with PUVA and vitamin E and the group of patients treated with PUVA alone (p > 0.05). Statistical analysis revealed a significant difference between the levels of lipoperoxides before and after treatment in the first group (p < 0.05), but there was no significant difference between the levels of lipoperoxides before and after treatment in the second group (p > 0.05). According to our results, vitamin E may prevent oxidative distress resulting from PUVA therapy, but does not affect the clinical improvement of the vitiligo lesions.