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Autopsy material from a case of Niemann-Pick disease was subjected to lipid analysis. Among the six tissues investigated, lymph nodes exhibited the greatest storage of several lipids. Since lymph nodes are relatively easy to obtain by biopsy, they may be utilized for chemical diagnosis of this type of lipidosis.
Wound complications in the postoperative period of the inguinal lymph node dissection are frequent events. The main factor in wound complications is due to dissection of the vascular architecture. In most of the cases the impaired wound healing occurs distal to Poupart's ligament. Suggestion for its prevention is the use of an oblique, subinquinal, wide spindle-S-shaped skin excision crossing over Scarpa's triangle with an extension to the anterior superior iliac spine from its lateral and a vertical prolongation onto the thigh from its medial end. The wide spindle-S-shaped excision minimizes the later devascularisation of skin flaps. The anatomic outline of the inguinal lymphatic basin to be removed can easily be reached by the extend of these two incision lines. Besides an undisturbed healing the technique offers two further possibilities. If malignant skin tumors are in anatomical positions which lend themselves to incontinuity dissection, removing primary tumor, intervening lymphatics and regional lymph nodes en bloc can be combined with the incision lines. Furthermore the excised groin skin can be used for a free flap to cover the excision wound of the primary tumor. The method is described in ten cases.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
One hundred and fifty patients with invasive cervical carcinoma underwent preradiation therapy celiotomy and para-aortic node excision. The incidence of histologically documented metastases in these nodes was 33% (34/102) in Stage IIIB. The last 23 patients with positive para-aortic nodes had left sclanene node excision; nodes were positive in eight patients (34.8%). Sixteen patients had visceral metastases including 11 with small and large bowel metastases, two with liver metastases, and one with metastases to the liver and intestine. Pretreatment celiotomy with para-aortic lymph node excision and, where positive, followed by scalene lymph node excision is valuable in treatment planning in advanced cervical carcinoma limited to the pelvis.
A therapeutic concept dependent on staging of breast carcinoma is presented: 1. Stage T0-T1 N0 M0: wide local excision or quadrant resection with axillary lymph-node excision. 2. Stage T2 and T3 N0-N1: simple mastectomy (Patey). 3. Stage T4 or N2: radical mastectomy (Rotter). 4. Stage N3 or M1: tumour excision according to the T-stage, lymph-node excision, local excision of affected distant lymph nodes. With equal therapeutic results the smaller and cosmetically-preferable surgical procedure is to be recommended.
We describe a technique that facilitates excisional biopsy of the axillary lymph nodes. The arm is suspended anterior to the chest in an adducted position that displaces the pectoralis major muscle medially and positions the axillary lymph nodes immediately deep to the hair-bearing area of the skin. This position permits biopsy of the lymph nodes with a relatively short incision and a minimum of dissection.
To aid in the selection of breast cancer patients for adjuvant chemotherapy, 263 patients with primary breast carcinoma undergoing curative surgery at the Yale-New Haven Medical Center were examined with respect to axillary lymph node involvement and prognosis. Thirty-five percent of patients with one to three axillary nodes histologically involved with cancer relapsed within five years, as did 61% of patients with four or more cancer-positive nodes. Equally important was the clinical stage. Stage III patients had a poor prognosis (71% relapse rate) regardless of their axillary status. Stage I patients with metastasis to one to three axillary nodes did just as well as stage I patients with no nodal involvement (13% relapse rate). Relapse rates within the nodal categories are significnatly less (P less than .05) than those reported by the National Surgical Adjuvant Breast Project.
This study was undertaken to find out if there are any factors of prognostic significance that can help the surgeon in the management of osteogenic sarcoma. One hundred and thirty-nine cases of osteogenic sacrocma were treated during a 30-year period and their survival figures have been analysed with respect to age, sex, extent of disease, previous treatment, and value of lymphadenectomy. We found that patients in whom the lymph nodes were preserved had a better survival as compared to patients in whom the lymph nodes were removed en bloc with the primary tumour. This further supports our contention that the regional lymph nodes have an important role to play in the immune response against osteosarcoma. The experimental work of the cytotoxic action of regional lymph node cells against osteosarcoma cell lines has been studied in our laboratory. The results of this study stimulated us to undertake this retrospective analysis.
A survey was made of 714 radical neck dissections done alone or in combination with resection of a primary malignancy. Sixty-four (8.9%) of the patients had had a cervical node biopsy before diagnosis and definitive treatment. The complications of wound necrosis, local cervical recurrence, and distant metastasis were significantly higher in those patients than in patients who had had no biopsy or who had biopsy only at the time of definitive treatment. When 40 of the 64 patients were matched on the basis of age, sex, histological diagnosis, site and stage of the lesion and treatment protocol with 40 patients who had had no biopsy, this trend toward a higher complication rate when previous biopsy was done continued and was significantly higher for distant metastasis. The authors believe that these findings quantitatively confirm the accepted belief that, except for instances when no primary lesion can be found and the cervical mass must be biopsied for the purposes of diagnosis, such biopsy increases local complications and, by increasing the incidence of distant metastasis, decreases the chance for survival.
A patient who had metastasis from a focus of invasive carcinoma confined to the head of an otherwise benign pedunculated adenomatous polyp of the sigmoid colon is described. That only 20 such cases have been reported previously attests to the rarity of this phenomenon. Because the morbidity and mortality of radical surgery far outweigh the liklihood of metastasis from such foci of invasive carcinoma in pedunculated adenomatous colonic polyps, local removal is recommended.
Benign glandular inclusions in para-aortic lymph nodes are a relatively common occurrence. The chance of finding these benign glandular inclusions in the para-aortic lymph nodes is dependent on the intensity with which one searches. In our series of 106 para-aortic lymphadenectomies performed on patients with gynecologic malignancies, there were five patients in whom these benign Müllerian rests were found. Other series report up to a 40.8 per cent incidence of benign inclusions in nodes of patients with cervical cancer. They may have been either congenital or acquired. It is critical that these Müllerian tissues are not confused with metastatic disease. The significance of these benign glandular inclusions is discussed.
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A retrograde method for mastectomy that performs the axillary dissection first is described, and experience with eighty-six cases of infiltrating carcinomas of the breast treated in that manner is presented. The method has reduced the number of standard radical procedures by more than half, and a decrease in operative bleeding was noted.