Dynamic sentinel node biopsy for penile cancer: an initial experience in an Irish Hospital

BACKGROUND

The presence of nodal metastases is the single most important prognostic factor in penile cancer. However, reliable assessment of nodal status in clinically node-negative (cN0) patients poses a challenge. Approximately 20% of these patients harbour occult nodal metastases. Currently available non-invasive radiological investigations are unreliable in excluding micrometastatic disease.

AIM

Dynamic sentinel node biopsy (DSNB) is a minimally invasive procedure for assessing lymph node involvement. We report our initial experience with DSNB in assessing the status of regional lymph nodes in cN0 penile cancer patients.

METHODS

DSNB was performed in penile cancer patients with at least one cN0 groin. All patients undergoing DSNB at our institution were included. Lymphoscintigraphic images were obtained from all patients, after intradermal, peritumoral injection of a Technetium-99m nanocolloid. The sentinel nodes were defined as the nodes identified on lymphoscintigraphy, which were also radioactive intraoperatively using a gamma probe.

RESULTS

In total, 18 groins from 11 patients underwent DSNB. Of these, 11 patients underwent bilateral DSNB and 4 had unilateral DSNB. The mean (range) age of patients at the time of presentation of their primary tumour was 63 (39-78) years. A mean of 1.2 nodes per groin was retrieved. One lymph node was positive in one patient, who subsequently underwent a bilateral inguinal lymph node dissection. Overall, the median (range) follow-up was 12.8 (2.7-31.3) months with no local or regional recurrences.

CONCLUSION

Further cases and longer follow-up will define the accuracy of this technique in the Irish population.

Eicosapentaenoic acid and gamma-linolenic acid increase hippocampal concentrations of IL-4 and IL-10 and abrogate lipopolysaccharide-induced inhibition of long-term potentiation

Inflammatory changes in brain exert a negative impact on cognitive function and in animal studies, these changes are associated with impairment in hippocampal-dependent learning paradigms and in long-term potentiation (LTP), which is a putative biological substrate for learning and/or memory. Lipopolysaccharide (LPS), a component of the cell wall of gram negative bacteria, induces inflammatory changes in the brain and leads to impairment of LTP. Since eicosapentaenoic acid (EPA) inhibits LPS-induced changes in vitro, we assessed the possibility that treatment of rats with EPA, alone or in combination with gamma-linolenic acid (GLA) might inhibit LPS-induced changes in vivo. The data presented indicate that the LPS-induced inhibition of LTP and decrease in hippocampal concentration of anti-inflammatory cytokines IL-10 and IL-4 are blocked in rats treated with EPA, GLA or both. The evidence suggests that these effects may be coupled with fatty acid-induced up-regulation of peroxisome proliferator-activated receptor-gamma which possesses known anti-inflammatory effects.