Pre-operative lymphoscintigraphy before sentinel lymph node biopsy for breast cancer

Pre-operative lymphoscintigram for axillary sentinel lymph node biopsy (SLNB) may not be required for successful SLNB. The 117 consecutive patients who underwent SLNB had pre-operative lymphoscintigraphy. The operating surgeon was blinded to the results of the lymphoscintigram before SLNB. After SLNB was complete, the surgeon was unblinded to the results of the lymphoscintigram; re-exploration carried out if more nodes were predicted on the lymphoscintigram. 116 patients (99%) had successful SLNB before unblinding. In 85 patients (73%), operative findings corresponded with scintigraphic findings. In 26 patients (22%), the lymphoscintigram predicted more sentinel nodes than had been found; further nodes were identified and excised in only 4 patients (3%). None were positive for cancer. SLNB was successful in 99% of cases without pre-operative lymphoscintigraphy. Only 3% of patients had further nodes identified as a result of the lymphoscintigram. Pre-operative lymphoscintigraphy does not improve the ability to perform axillary SLNB during breast cancer surgery.     

Continuing Medical Education Program in Echocardiography

Article Title: Study of Left Ventricular Rotation and Torsion in the Acute Phase of ST-Elevation Myocardial Infarction by Speckle Tracking Echocardiography (Echocardiography 2010;27:44)     

Cloning and characterization of voltage‐gated calcium channel alpha1 subunits in Xenopus laevis during development

Voltage‐gated calcium channels play a critical role in regulating the Ca²⁺ activity that mediates many aspects of neural development, including neural induction, neurotransmitter phenotype specification, and neurite outgrowth. Using Xenopus laevis embryos, we describe the spatial and temporal expression patterns during development of the 10 pore‐forming alpha1 subunits that define the channels' kinetic properties. In situ hybridization indicates that Ca_V1.2, Ca_V2.1, Ca_V2.2, and Ca_V3.2 are expressed during neurula stages throughout the neural tube. These, along with Ca_V1.3 and Ca_V2.3, beginning at early tail bud stages, and Ca_V3.1 at late tail bud stages, are detected in complex patterns within the brain and spinal cord through swimming tadpole stages. Additional expression of various alpha1 subunits was observed in the cranial ganglia, retina, olfactory epithelium, pineal gland, and heart. The unique expression patterns for the different alpha1 subunits suggests they are under precise spatial and temporal regulation and are serving specific functions during embryonic development. Developmental Dynamics 238:2891–2902, 2009. © 2009 Wiley‐Liss, Inc.     

Levels, temporal trends, and tissue distribution of perfluorinated surfactants in freshwater fish from Asian countries

Perfluorinated surfactants (PFSs) in Asian freshwater fish species were analyzed to investigate tissue distribution, temporal trends, extent of pollution, and level of PFS exposure through food intake. Freshwater fish species, namely carp, snakehead, and catfish, were collected in Japan, Vietnam, India, Malaysia, and Thailand, and 10?PFSs, including perfluorooctanesulfonate (PFOS) and perfluorooctanoate, were analyzed by liquid chromatography?Ctandem mass spectrometry. PFSs in carp in Tokyo were more concentrated in kidneys (??10 PFSs?=?257?±?95?ng/g wet weight [ww]) and livers (119?±?36?ng/g?ww) than in ovaries (43?±?2?ng/g?ww) and muscles (24?±?17?ng/g?ww). Concentrations of PFOS and its precursor, perfluorooctane sulfonamide, in livers of carp and in waters in Tokyo showed a dramatic decrease during the last decade, probably because of 3?M??s phasing-out of the manufacture of perfluorooctanesulfonyl-fluoride-based products in 2000. In contrast, continuing contamination by long-chain perfluorocarboxylates (PFCAs) with????9 fluorinated carbons was seen in multiple media, suggesting that these compounds continue to be emitted. PFS concentrations in freshwater fish species in tropical Asian countries were generally lower than those in developed countries, such as Japan, e.g., for PFOS in muscle, Vietnam?<?0.05?C0.3?ng/g?ww; India?<?0.05?C0.2?ng/g?ww; Malaysia?<?0.05?C0.2?ng/g?ww; Thailand?<?0.05?ng/g?ww; and Japan (Tokyo)?=?5.1?C22?ng/g?ww. Daily intake of short-chain PFCAs with????8 fluorinated carbons from freshwater fish species in Japan was approximately one order of magnitude lower than that from drinking water, whereas daily intake of PFOS and long-chain PFCAs with????9 fluorinated carbons from freshwater fish species was comparable with or greater than that from drinking water. Because the risk posed by exposure to these compounds through intake of fish species is a matter of concern, we recommend the continued monitoring of PFS levels in Asian developing countries.     

Hepatic alveolar hydatidosis — A malignant masquerade

A 43-year-old male presented with clinical features of obstructive jaundice. Biochemical tests and radiologic imaging were suggestive of intrahepatic cholangiocarcinoma with hilar block. Multiple attempts to obtain tissue diagnosis in the form of USG-guided FNAC & tru-cut biopsy failed. Exploratory laparotomy and wedge biopsy confirmed E. multilocularis (alveolar hydatid disease). The patient was managed with albendazole therapy. At 8-month follow-up, the patient was clinically asymptomatic with near normalization of biochemical parameters and significant regression of the lesion as shown by computed tomography. E. Multilocularis infection of the liver is quite rare in the Indian subcontinent and poses a diagnostic dilemma. Nonetheless, despite its rarity, it should be considered in the differential diagnosis when a patient presents with clinical and radiological features of a space-occupying lesion of the liver while attempts to set pathological diagnosis by FNA/ tru-cut biopsy are inconclusive. Awareness of this emerging infectious disease could prevent a fatal outcome, particularly amongst patients who have been exposure to wild life.