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E Prokop

Publications and source records attributed to E Prokop.

18 recordsLinked to original sources
PubMed2004

200 Sentinel lymph node biopsies without axillary lymph node dissection -- no axillary recurrences after a 3-year follow-up.

The aim of this study is to evaluate the rate of axillary recurrences in sentinel lymph node (SLN)-negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND). Between May 1999 and February 2002, 333 consecutive patients with primary invasive breast cancer up to 4 cm and clinically negative axillae were entered into this prospective study. Sentinel lymph nodes were identified using the combined method with blue dye (Patent blue V) and technetium 99m-labelled albumin (Nanocoll). Sentinel lymph nodes were examined by frozen sections, standard haematoxylin and eosin staining and immunohistochemistry staining. In SLN-positive patients, ALND was performed. Sentinel lymph node-negative patients had no further ALND. The SLN identification rate was 98.5% (328 out of 333). In all, 128 out of 328 (39.0%) patients had positive SLNs and complete ALND. A total of 200 out of 328 (61.0%) patients were SLN negative and had no further ALND. The mean tumour size of SLN-negative patients was 16.5 mm. The mean number of SLNs removed was 2.1 per patient. There were no local or axillary recurrences at a median follow-up of 36 months. The absence of axillary recurrences after SLNB without ALND in SLN-negative breast cancer patients supports the hypothesis that SLNB is accurate and safe while providing less surgical morbidity than ALND. Short-term results are very promising that SLNB without ALND in SLN-negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumours.

Axilla↗
PubMed2003

Sentinel lymph node biopsy alone without axillary lymph node dissection--follow up of sentinel lymph node negative breast cancer patients.

AIMS: To evaluate the rate of axillary recurrences in sentinel lymph node (SLN) negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND). METHODS: Between May 1999 and February 2001 all patients who had primary invasive breast cancer and were SLN negative were eligible for this prospective study. SLNB was performed by using the combined method with radioactive tracer and blue dye. SLNs were examined by frozen section, standard H/E staining and immunohistochemistry staining. SLN negative patients did not receive further ALND. Follow-up was done three-monthly with clinical controls, blood samples and ultrasound of the breast and axilla. An annual mammogram was performed. RESULTS: 116 patients with T1 or T2 invasive breast cancer were included in this trial. All 116 patients had negative SLNs in frozen sections, in H/E staining and in immunohistochemistry staining. The mean number of removed SLNs was 2.03+/-1.22. Mean tumor size was 17.15+/-7.62 mm. Postmenopausal patients totalled 79.3 and 20.7% of patients were premenopausal. No local or axillary recurrences occurred at a mean duration of follow-up of 22.12+/-6.38 months. CONCLUSION: The absence of axillary recurrences after SLNB without ALND in SLN negative breast cancer patients supports the hypothesis that SLNB is accurate and safe while providing less surgical morbidity. Short term results are very promising. SLNB without ALND in SLN negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumors.

Adult↗
PubMed2003

[Sentinel lymph node biopsy in breast cancer patients--results and experience after 500 sentinel lymph node biopsies].

INTRODUCTION: Sentinel lymph node biopsy (SLNB) is a widely used technique for axillary staging in breast cancer patients. The principle to evaluate the axillary status of a breast cancer patient with a less invasive surgery than axillary lymph node dissection (ALND) meets the new minimally invasive concept in breast cancer surgery. Some breast cancer centers proceed to SLNB without ALND in SLN-negative patients. PATIENTS AND METHODS: Between March 1998 and March 2002, 500 SLNBs were performed. After a learning period with SLNB and ALND in 75 patients with a sensitivity of 96.2% and a false-negative rate of 3.8%, SLNB alone without further ALND was performed in a group of patients. In addition, the feasibility of SLNBin patients with locally advanced breast cancer, in patients after neoadjuvant chemotherapy and in patients with multicentricity was evaluated. The combined method with blue dye and technetium-99m-labeled human albumin for identification of SLNs was applied. RESULTS: 500 SLNBs were performed. The identification rate was 86.2%. After exclusion of patients with neoadjuvant chemotherapy and patients with multicentricity, the identification rate was 94.5%. SLNs were positive in 41.3% of patients and negative in 58.7% of patients. DISCUSSION: SLNB is an excellent method for axillary stag-ing and an alternative for ALND in a certain group of breast cancer patients.

Axilla↗
PubMed2000

Three-dimensional targeting: a new three-dimensional ultrasound technique to evaluate needle position during breast biopsy.

OBJECTIVE: To evaluate the role of three-dimensional (3D) ultrasound (US) following needle breast biopsy under two-dimensional (2D) needle guidance. METHODS: A total of 188 core-needle biopsies and 24 fine-needle aspiration biopsies were 3D US correlated after typical 'freehand' US needle guidance. All cases were examined with a linear 3D US volume scanner (5-13 MHz, Voluson 530D, Medison-Kretztechnik, Zipf, Austria). After core-needle stroke or localization of fine needle, a 3D US data volume set was acquired and a multiplanar analysis performed. This needle position check in all three planes is called '3D targeting'. 66 women with a mean age of 51 years (range, 27-80 years) showed 77 breast lesions (55 solid lesions, 22 cysts) with a mean diameter of 1.5 (range, 0.3-5.0) cm. RESULTS: In 49 women with 55 solid breast lesions, 16 lesions were malignant and 39 lesions benign. In 53 solid breast lesions 188 core-needle biopsies were performed (mean 3.6 biopsies/lesion). After core-needle biopsy 23 lesions (16 malignant, seven benign) were surgically removed. In 22 cases final histology confirmed results of the core-needle specimen. In one case a core-needle specimen of a 5 mm lesion showed atypical lobular hyperplasia. The definitive histology after surgery was invasive lobular carcinoma. Twenty-two cysts and two benign solid lesions were punctured with a fine needle followed by aspiration biopsy. The overall sensitivity of core-needle results in this study was 94% (specificity 100%, accuracy 0.98, positive predictive value 1, negative predictive value 0.97). In 117 core-needle strokes of benign (21) and malignant (12) lesions 3D targeting prospectively revealed 95 lesion hits, Twelve marginal lesion hits and nine out-of-lesion hits. In one case after the initial large core-needle path a 5-mm lesion was disguised by air bubbles, therefore 3D targeting failed during the second biopsy procedure. CONCLUSION: 3D US combined with 3D targeting technique is a reliable and objective tool demonstrating exact spatial positioning of core and fine needle during biopsy procedure.

Adult↗
PubMed1993

An integrated software system for quality assurance-related kappa coefficient analysis of intraoperative transesophageal echocardiography interpretive skills.

This report describes the development of a quality assurance-oriented integrated software system designed for an anesthesiology-based intraoperative transesophageal echocardiography service. Entry data include patient and operation demographics, two-dimensional echocardiographic, saline-contrast, and color flow/pulsed Doppler assessments of the heart and great vessels, presented in a defined sequence. A statistical analysis component (kappa coefficient analysis) allows for comparison of intraoperative real-time interpretations with laboratory interpretations made by experienced full-time echocardiographers on a field-by-field basis. This provides a means of quantifying expertise in each individual aspect of the patient examination sequence. We believe that such self-appraisal data are essential for delineating the status and tracking the progress of service being provided.

Echocardiography, Transesophageal↗
PubMed1993

A clinical computer database entry form for an intraoperative anesthesiology-based transesophageal echocardiography monitoring service.

Transesophageal echocardiography (TEE) has been increasingly applied to supplement and, in instances, to supplant conventional intraoperative cardiac monitoring. Our body of experience (> 1600 intraoperative TEE procedures), combined with insights gleaned from an intramural quality assurance study, and clinical implications of certain recent advances in the field, led us to develop the following TEE computer database entry form. The form, completed intraoperatively, consists of a patient and surgical procedure demographics section, followed by fields based on the TEE examination. The scans encompass transverse plane basal short axis, long axis, and transgastric views of the heart and great vessels. The two-dimensional echocardiographic, saline-contrast, color flow and pulsed Doppler data represent both right and left ventricular performance, valvular function and specific lesions. This database entry form is intended to serve as a guide for performance of a nominally complete intraoperative study and facilitate maintenance of a TEE archive consistent with current advances.

Anesthesia Department, Hospital↗
PubMed1993

Transesophageal two-dimensional echocardiographic analysis of right ventricular systolic performance indices during coronary artery bypass grafting.

Sixteen patients (aged 59 +/- 14 years) undergoing coronary artery bypass surgery were evaluated to delineate the intraoperative course of transesophageal echocardiographic right ventricular (RV) systolic performance indices. Pre-induction data included thermodilution RV ejection fraction (RVEFTD), 0.43 +/- 0.13, RV end-diastolic volume index (EDVI), 110 +/- 33 mL/m2, cardiac index (CI), 3.4 +/- 1.0 L/min/m2, RV end-diastolic pressure (EDP), 7.1 +/- 4.2 mmHg, and mean pulmonary artery pressure (PAP), 21 +/- 6 mmHg. Eleven patients had significant right coronary artery (RCA) disease (> 70% occlusion). Five patients arrived with an ongoing nitroglycerin infusion (1 to 3 micrograms/kg/min), which was maintained intraoperatively. Echocardiographic measurements included longitudinal-axis (LA) and short-axis (SA) planimetered area excursion fractions (2DLA and 2DSA, respectively) and LA maximal major and minor axis shortening fractions (max majorLA and max minorLA, respectively). Hemodynamic measurements included RVEFTD, EDVI, CI, EDP, and PAP. Measurements were determined following induction/endotracheal intubation, following sternotomy/pericardiotomy, and after cardiopulmonary bypass (CPB) with the chest open. All patients were maintained on vasodilator therapy post-CPB (nitroglycerin, 1 to 3 micrograms/kg/min [N = 16] and nitroprusside, 0.5 to 4.5 microgram/kg/min [N = 4]) post-CPB. Two patients received inotropic support (epinephrine, 0.2 to 0.3 microgram/kg/min). CPB was associated with significant decreases in max major axisLA and 2DLA (P < 0.05) as compared to measurements determined prior to CPB. Maximum major axisLA values pre-CPB were 0.35 +/- 0.06 and 0.33 +/- 0.08 versus post-CPB values of 0.24 +/- 0.08.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1993

[Effects of confrontation of medical students and hospital physicians with human cadavers].

Eighty male and female doctors of various ages working in a general hospital were questioned on their feelings on being confronted with human corpses and the possible effects of the experience. Their responses were analysed and compared with those of 100 male and female medical students. The potential short-term effects and lasting consequences are many and varied. Forty-four per cent of the doctors reported that repeated dealings with the bodies of patients known to them did not lead to habituation. A high proportion of the students and doctors stated that exposure to corpses had a positive effect on their dealings with living patients. The reluctance of some doctors to attend autopsies of their patients is connected with their difficulties in coping with the experience. Further, more detailed studies are called for.

Adaptation, Psychological↗
PubMed1978

67Ga-citrate identification of inflammation in the perirenal space.

Two patients are presented who had radiogallium (67Ga-citrate) studies which revealed focal abdominal accumulations identified as the perirenal space. These localizations, to a specific anatomical site, were confirmed surgically. The distinguishing features of the perirenal space on radiogallium scans include the relatively vertical axis, downward conical extension, and sharp cut-off ("sparing") medially to the midline.

Abdomen↗