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R Kusminsky

Publications and source records attributed to R Kusminsky.

5 recordsLinked to original sources
PubMed2001

Gamma probe guided biopsy of the sentinel node in malignant melanoma: a multicentre study.

Sentinel lymph node biopsy was attempted in 336 patients with clinically node-negative cutaneous melanoma. All patients were injected with technetium-99m labelled radiocolloid, with 108 patients simultaneously receiving vital blue dye for sentinel node identification. Sentinel lymph nodes were identified in 329 patients, giving a technical success rate of 97.9%. Metastatic disease was identified in 39 (11.9%) of the patients in whom sentinel nodes were found. Patients with negative sentinel nodes were observed and patients with positive sentinel nodes underwent comprehensive lymph node dissection. The presence of metastatic disease in the sentinel nodes and primary tumour depth by Breslow or Clark levels were joint predictors of survival based on Cox proportional hazards modelling. Disease recurrences occurred in 26 (8.8%) patients with negative sentinel lymph nodes, with isolated regional recurrences as the first site in 10 (3.4%). No patients with Clark level II primary tumours were found to have positive sentinel nodes or disease recurrences. One patient with a thin (<0.75 mm) Clark level III primary had metastatic disease in a sentinel node. Patients with metastases confined to the sentinel nodes had similar survival rates regardless of the number of nodes involved.

Adolescent↗
PubMed1998

The sentinel node in breast cancer--a multicenter validation study.

BACKGROUND: Pilot studies indicate that probe-guided resection of radioactive sentinel nodes (the first nodes that receive drainage from tumors) can identify regional metastases in patients with breast cancer. To confirm this finding, we conducted a multicenter study of the method as used by 11 surgeons in a variety of practice settings. METHODS: We enrolled 443 patients with breast cancer. The technique involved the injection of 4 ml of technetium-99m sulfur colloid (1 mCi [37 MBq]) into the breast around the tumor or biopsy cavity. "Hot spots" representing underlying sentinel nodes were identified with a gamma probe. Sentinel nodes subjacent to hot spots were removed. All patients underwent a complete axillary lymphadenectomy. RESULTS: The overall rate of identification of hot spots was 93 percent (in 413 of 443 patients). The pathological status of the sentinel nodes was compared with that of the remaining axillary nodes. The accuracy of the sentinel nodes with respect to the positive or negative status of the axillary nodes was 97 percent (392 of 405); the specificity of the method was 100 percent, the positive predictive value was 100 percent, the negative predictive value was 96 percent (291 of 304), and the sensitivity was 89 percent (101 of 114). The sentinel nodes were outside the axilla in 8 percent of cases and outside of level 1 nodes in 11 percent of cases. Three percent of positive sentinel nodes were in nonaxillary locations. CONCLUSIONS: Biopsy of sentinel nodes can predict the presence or absence of axillary-node metastases in patients with breast cancer. However, the procedure can be technically challenging, and the success rate varies according to the surgeon and the characteristics of the patient.

Axilla↗
PubMed1988

Parietal cell vagotomy for bleeding duodenal ulcers.

From January 1978 to December 1985, 22 parietal cell vagotomies for bleeding peptic ulcers were performed at the Charleston Area Medical Center. Twenty of these operations were done for acute bleeding with an overall complication rate of 27 per cent. There was only one operative mortality, and these results coincide with those of the world literature. Follow-up ranges from 1 month to 6 years with an average of 2 and one half years. Seventy-eight per cent of our patients had a good result defined as either Visick class I (ten patients) or Visick class II (four patients). All of the patients, with the exception of the one mortality, had control of the bleeding. Therefore, the authors believe parietal cell vagotomy should be considered in the treatment of acute bleeding peptic ulcer disease.

Adult↗
PubMedDate not supplied

Long term follow-up of prophylactic caval clipping.

120 high risk patients who underwent prophylactic inferior vena cava clipping were retrospectively evaluated to determine the incidence of post clipping leg swelling and pulmonary embolism. Each one of those patients had at least two criteria for the clipping. These criteria of high risk factors were precisely identified. There were two patients who had postoperative pulmonary embolism but none of them was fatal, i.e. less than two per cent. Two patients developed severe leg swelling (less than two per cent) and six had mild leg swelling (less than six per cent). Prophylactic inferior vena cava clipping is a safe and effective mean to prevent post-operative pulmonary embolism.

Adult↗