The worse survival outcomes reported for melanoma patients having sentinel node biopsy after lymphoscintigraphy the previous day do not appear to be due to overnight migration of Tc99m-nanocolloid tracer

INTRODUCTION

It has been reported that the survival of patients having sentinel node (SN) biopsy for melanoma the day after lymphoscintigraphy using Tc99m-nanocolloid is worse than that of patients having lymphoscintigraphy and SN biopsy on the same day [1,2]. A possible explanation suggested is that overnight migration of the tracer from SNs to 2nd-tier nodes occurs, causing failure to remove true SNs.

MATERIALS AND METHODS

The possibility of overnight tracer migration leading to errors in SN-identification was investigated in 12 patients scheduled for lymphoscintigraphy the day before surgery by repeating SPECT-CT imaging the next morning, before their SN biopsy. The aim was to check whether onward migration of colloid from previously-identified SNs had occurred.

RESULTS

No significant migration of Tc99m-nanocolloid occurred overnight in any patient. All nodes reported to be SNs on day 1 imaging were also present and regarded as SNs on day 2 images. No new foci were visualised on day 2, but some that had been identified on day 1 were not seen on day 2.

CONCLUSIONS

Since migration of nanocolloid overnight did not occur, this cannot explain the reported survival disadvantage for patients undergoing SN biopsy the day after lymphoscintigraphy. A likely alternative possibility is that inadequate doses of radioisotope were used for next-day procedures, causing the mistaken removal of 2nd-tier nodes instead of true SNs more frequently. Further research is required to explain the reported reduction in survival of patients having next-day SN biopsy procedures, since the possibility has important clinical implications.

Indocyanine green retention test in cirrhosis and portal hypertension: Accuracy and relation to severity of disease

BACKGROUND AND AIMS

Patients with cirrhosis and portal hypertension often develop complications relating to hepatic excretory dysfunction. The standard measurement of the hepatic excretion is the constant infusion indocyanine green clearance (ICG_CI ) technique. The ICG 15-min retention test (ICG-r15) is faster, more patient friendly, and cheaper. The aims were to compare the ICG-r15 test with the standard method, to assess relations to patient characteristics and survival, and to assess the ICG-r15 level in healthy control subjects.

METHODS

This study included 68 patients with cirrhosis and portal hypertension (Child class A/B/C:17/37/14). All patients underwent a full liver vein catheterization and hemodynamic evaluation with determination of ICG-r15 and ICG_CI as the reference in a subset of 38 patients. Sixteen healthy control subjects were included for compiling a reference interval.

RESULTS

The ICG-r15 was increased in the cirrhotic patients with increasing values in parallel with liver dysfunction (15/41/58%) in Child class A/B/C compared with 7% in the controls (P < 0.001). ICG-r15 correlated highly significantly with the ICG_CI (r = -0.96, P < 0.0001) and in a multivariate regression analysis with hepatic venous pressure gradient, markers of liver dysfunction and hyperdynamic circulation (P < 0.05-0.005). In the control group, normal reference values ranged from 0% to 13%. In addition, ICG-r15 was significantly related to mortality in the patient group (P = 0.02).

CONCLUSIONS

Indocyanine green-r15 reflects portal hypertension, the degree of hepatic failure, and survival and may replace the standard ICG_CI . A more elaborated reference interval needs to be compiled, and the prognostic value of ICG-r15 should be validated.

Erythropoietin improves place learning in an 8-arm radial maze in fimbria-fornix transected rats

Systemically administered human recombinant erythropoietin (EPO) may have the potential to reduce the cognitive and behavioral symptoms of mechanical brain injury. In a series of studies, we address this possibility. We previously found that EPO given to fimbriafornix transected rats at the moment of injury could substantially improve the posttraumatic acquisition of an allocentric place learning task when such a task is administered in a water maze. Due to the clinical importance of such results, it is important to scrutinize whether the therapeutic effect of EPO is specific to the experimental setup of our original experiments or generalizes across test situations. Consequently, here we studied the effects of similarly administered EPO in fimbria-fornix transected and control operated rats, respectively, evaluating the posttraumatic behavioral/cognitive abilities in an allocentric place learning task administered in an 8-arm radial maze. The administration of EPO to the hippocampally injured rats was associated with a virtually complete elimination of the otherwise severe behavioral impairment caused by fimbria-fornix transection. In contrast, EPO had no detectable effect on the task acquisition of non-lesioned animals. The results of the present study confirm our previous demonstration of EPO's ability to reduce or eliminate the behavioral/cognitive consequences of mechanical injury to the hippocampus, while adding the important observation that such a therapeutic effect is not restricted to the specific experimental setup previously studied.