Role of Intraoperative Sentinel Lymph Node Mapping in the Management of Carcinoma of the Esophagus

Background/Aim:

Precise evaluation of lymph node status is one of the most important factors in determining clinical outcome in treating gastro-intestinal (GI) cancer. Sentinel lymph node (SLN) mapping clearly has become highly feasible and accurate in staging GI cancer. This study aims to investigate the feasibility and accuracy of detection of SLN using methylene blue dye in patients with carcinoma of the esophagus and assess its potential role in determining the rational extent of lymphadenectomy in esophageal cancer surgery.

Materials and Methods:

Thirty-two patients of esophageal cancer diagnosed on endoscopic biopsy were enrolled in this prospective study. After laparotomy, patent methylene blue was injected into the subserosal layer adjacent to the tumor. SLNs were defined as blue stained nodes within a period of 5 min. Standard radical esophagogastrectomy with lymphadenectomy was performed in all the patients. All the resected nodes were examined postoperatively by routine hematoxylin and eosin stain for elucidating the presence of metastasis, and the negative SLNs were examined further with cytokeratin immunohistochemical staining.

Results:

SLNs were detected in 26 (81.25%) patients out of 32 patients who were studied. The number of SLNs ranged from 1 to 4 with a mean value of 1.7 per case. The SLNs of esophageal cancer were only found in N1 area in 21 (80.77%) cases, and in N2 or N3 area in only 19.33%. The overall accuracy of the procedure was 75% in predicting nodal metastasis. SLN had a sensitivity of 85.71% in mid esophageal tumors and 93.33% in lower esophageal tumors. The SLN biopsy had sensitivity of 87.5% in the case of squamous cell carcinoma and 92.86% in the cases of adenocarcinoma of the esophagus. The accuracy of the procedure for squamous cell carcinoma and adenocarcinoma was 60% and 76.47%, respectively.

Conclusion:

SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with esophageal cancer and may indicate rational extent of lymphadenectomy in these patients. SLN mapping provides “right nodes” to the pathologists for detailed analysis and appropriate staging, thereby helping in individualizing the multi-modal treatment for esophageal cancer.     

Pre-, intra- and post-operative plasma levels of soluble P-selectin in diabetics under thoracic paravertebral block versus general anaesthesia

Platelet activation that occur after tissue injury increases the expression of P-selectin. General anaesthesia and surgery may lead to peri-or post-operative hypercoagulability state that may lead to thrombotic complications, especially in high risk patients as diabetics. Administration of local anaesthesia was suggested to limit this hypercoagulability. The aim of this work was to evaluate the pre-, intra-and postoperative plasma levels of soluble P-selectin, as a predictor of thrombotic events, in diabetics receiving paravertebral block versus general anaesthesia during mastectomy operation for cancer breast. Forty type-2 diabetic females were included. They were randomly divided into two equal groups: group I received general anaesthesia and group II received thoracic paravertebral block. All females were subjected to preoperative thorough clinical examination, electrocardiography and laboratory investigations including complete blood picture, prothormbin activity, glycated hemoglobin A1c, fasting plasma levels of glucose, creatinine, lipid profile and alanine aminotransferase activity. Creatine kinase (CK), total and CK-MB, activities were also done preoperatively and six hours postoperatively. Plasma soluble(s) P-selectin levels were estimated preoperatively, 15 minutes after skin incision and one hour postoperatively. The results revealed that the preoperative plasma P-selectin levels did not significantly differ in the two groups. Its intra-and postoperative levels showed significantly higher levels in both groups than those preoperative, but the increase in group II is significantly less than those in group I. In conclusion, in high risk patients as diabetics undergoing major surgery, the use of paravertebral block is preferable as a good and effective alternative to general anaesthesia, to reduce the possibility of occurrence of thrombotic complications.     

Cold stress offered modulation on chlorpyrifos toxicity in aging rat central nervous system

The adverse effects produced by chlorpyrifos (CPF) or cold stress alone in humans and animals are well documented, but there is no information available relating to the consequences of their co- exposure in an age-related manner. In this study, effects of sublethal doses of CPF were carried out in vivo, for 48 h to assess the biochemical perturbations in relation to interactions with cold stress (15°C and 20°C) in different age group rat CNS. A positive interaction of CPF with age of animal and cold exposure was observed resulting in marked decrease in the activity levels of AChE (P<0.05), ChAT (P<0.05), Na(+), K(+)-ATPase (P<0.05), Ca(2+)-ATPase (P<0.05), and Mg(2+)-ATPase (P<0.05). The ANOVA and posthoc analysis showed that regulatory enzymes decreased significantly (P<0.05) on CPF exposure. Overall, the effect of co-exposure was appreciably different from either of the exposures. Synergistic interaction of CPF and cold stress at 15°C showed higher inhibition in comparison with CPF and cold stress alone and together at 20°C. Further, this study reveals that young animals are significantly vulnerable and sensitive than adults.     

Real‐time single‐heartbeat fast strain‐encoded imaging of right ventricular regional function: Normal versus chronic pulmonary hypertension

Patients with pulmonary hypertension and suspected right ventricular (RV) dysfunction often have dyspnea at rest, making reliable assessment of RV function using traditional breath‐holding methods difficult to perform. Using single‐heartbeat fast strain encoding (Fast‐SENC) imaging, peak systolic RV circumferential and longitudinal strains were measured in 11 healthy volunteers and 11 pulmonary hypertension patients. Fast‐SENC RV longitudinal strain and circumferential strain measurements were compared to conventional SENC and MR tagging, respectively. Fast‐SENC circumferential and longitudinal RV shortening correlated closely with SENC measurements (r = 0.86, r = 0.90, P < 0.001 for all). Circumferential strain, by conventional tagging, showed moderate correlation with Fast‐SENC in pulmonary hypertension patients only (r = 0.5, P = 0.003). A nonuniform pattern of RV circumferential shortening was depicted in both groups. Peak systolic circumferential strain was significantly reduced at the basal RV in pulmonary hypertension patients (?18.06 ± 3.3 versus ?21.9 ± 1.9, P < 0.01) compared to normal individuals, while peak systolic longitudinal strain was significantly reduced at all levels (P < 0.01 for all). Fast‐SENC is a feasible and reliable technique for rapid quantification of RV regional function in a single‐heartbeat acquisition. Information derived from Fast‐SENC allows characterization of RV regional function in normal individuals and in pulmonary hypertension patients. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Comparing panic disorder uncomplicated and panic disorder with agoraphobia in cardiology patients with atypical or nonanginal chest pain

Thirty-eight cardiology patients with either atypical or nonanginal chest pain and current panic disorder were divided into two groups, those with agoraphobia (N = 8) and those without agoraphobia (N = 30). The agoraphobia group reported marginally longer duration of panic disorder (17.0 ± 21.1 years vs. 3.0 ± 3.2 years) and significantly more panic symptoms (10.6 ± 3 vs. 7.3 ± 2.2) during the last major attack. The agoraphobia group also scored significantly higher on measures of anxiety, depression, phobic avoidance, somatization, interpersonal sensitivity, and psychoticism and also scored higher on three of three global measures of distress. This agoraphobia group differed from previously reported agoraphobics with panic attacks in that they all had current panic disorder, while previously reported groups were categorized according to DSM-III, which required only a history of panic attacks. These findings suggest that patients who have current panic disorder and agoraphobia are more symptomatic. Of interest is the low proportion of agoraphobics compared to nonagoraphobics found in this panic disorder population.     

Cycloheximide Efficacy Varies Temporally in Improving Postharvest Performance of Cool Wet Stored Dianthus chinensis L. Cut Sprays

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - An experiment was designed to determine the synergistic effect of cold temperature and cycloheximide (CHI) on...