bluuebunny/crossref_metadata_2025 huggingface dataset:
Reframing Canada’s Great War: Liberalism, sovereignty, and the British Empire c. 1860s–1919
Authors: Thompson Graeme
Published: April 2018

This article examines how Canadian Liberals understood Canada’s international relations in the late nineteenth and early twentieth centuries, situating their political thought within the British imperial world and their views of the Great War in a broader historical context. It argues that while Liberals regarded Canadian participation in the war as an affirmation of nationhood, they nonetheless conceived of Canada as a “British nation” and an integral part of a British imperial community in international politics. The article further illuminates the growth of an autonomous Canadian foreign policy within the British Empire, and shows that even the staunchest Liberal proponents of independence upheld the Dominion’s British connection. In so doing, it connects the history of Canadian Liberalism to a wider British Liberal tradition that advocated the transformation of the relationship between the United Kingdom and its settler Dominions from one of imperial dependence to that of equal, sovereign, and freely associated nations.
Optimization of cure profile for thick composite parts based on finite element analysis and genetic algorithm
Authors: Dolkun Dilmurat , Zhu Weidong , Xu Qiang , Ke Yinglin
Published: April 2018

Cure process is the most crucial stage for manufacturing composite parts and final quality of the part is strongly dependent on the cure profile used in the curing process. In this paper, a novel approach based on cure simulation using finite element method and multi-objective genetic algorithm is developed to optimize cure profile for thick thermoset composites. Three objectives are considered simultaneously, which include the maximum difference in degree of cure, the maximum temperature difference, and the total cure time. Optimal Pareto front is obtained and the optimized cure profile is selected from Pareto front for the given application. A 24-mm thick unidirectional laminate is taken as an example and the results show that compared to typical cure profile, the optimized cure profile leads to approximately 56% reduction in the maximum difference in degree of cure, 71% decrease in the maximum difference in temperature during cure, and 33% reduction in the total cure time. It is also indicated that the residual stress can be remarkably decreased and the cure efficiency is significantly improved using the present method. The present method can also be applied to various geometries with various thicknesses and is able to provide an important reference for determination of cure profiles for the manufacturing of composite structures.
Lethal explosions in a non-terrorist civilian setting
Authors: Byard Roger W.
Published: April 2018

A study was undertaken to investigate the range and nature of deaths that may result from explosions in a civilian population that has not been exposed to terrorist attacks or significant military activities. A search was conducted of autopsy files at Forensic Science SA, Adelaide, Australia, from July 2000 to June 2017 for all cases where death had been attributed to an explosion. Twenty cases were identified, consisting of 10 accidents, five suicides, two homicides, one murder-suicide with two decedents and one case where the manner of death was undetermined. Explosives were involved in nine deaths, petrol in seven and propane/butane/natural gas in a further four. Deaths caused by explosions were a rare event, with most cases being caused by accidents in a domestic or industrial environment. Although suicides formed the next most-common group, it is possible that explosions caused by petrol in cases of self-immolation were not intended.
Toxicological hair analysis: Pre-analytical, analytical and interpretive aspects
Authors: Khajuria Himanshu , Nayak Biswa Prakash , Badiye Ashish
Published: April 2018

Background and aims

Hair analysis for drug detection is one of the widely accepted imperative techniques in the field of forensic toxicology. The current study was designed to investigate the efficacy of chromatography for detection of drugs of abuse in hair.

Method

A comprehensive review of articles from last two decades on hair analyses via PubMed and similar resources was performed. Issues concerning collection, decontamination and analytical techniques are summarised. Physiochemical nature of hair, mechanism of drug incorporation and its stability in hair are briefly discussed. Furthermore, various factors affecting results and interpretation are elucidated.

Result

A hair sample is chosen over traditional biological samples such blood, urine, saliva or tissues due to its inimitable ability to provide a longer time frame for drug detection. Its collection is almost non-invasive, less cumbersome and does not involve any specialised training/expertise. Recent advances in analytical technology have resulted in better sensitivity, reproducibility and accuracy, thus providing a new arena of scientific understanding and test interpretation.

Conclusion

Though recent studies have yielded many insights into drug binding and drug incorporation in hair, the major challenge in hair analysis lies in the interpretation of results, which may be affected by external contamination and thus lead to false-positives. Therefore, there is a need for more sensitive and selective analysis methods to be developed in order to minimise factors that induce the effect of melanin, age and so on, and this would certainly provide a new dimension to hair analysis and its applications.
Validating the adaptation of the first career measure in isiXhosa: the South African Career Interest Inventory–isiXhosa version
Authors: Rabie Stephan , Naidoo Anthony V
Published: April 2018

South African career counselling practices have predominantly been informed by vocational theories and models developed in the United States and Europe. In view of South Africa’s peculiar history and its unique cultural and linguistic environment, the indiscriminate application of Western career models has become increasingly contentious, as the majority of these models fail to account for culture-specific values that influence an individual’s career interests, decision-making, and development. The South African Career Interest Inventory was developed to address this contention, through operationalising John Holland’s vocational personality theory in South Africa. This study adapted and translated the South African Career Interest Inventory into isiXhosa, in the process constructing the first career interest inventory in a South African indigenous language. Subsequently, we investigated the structural validity of the South African Career Interest Inventory, and therefore Holland’s model, on a sample of isiXhosa-speaking secondary school learners ( n = 266). The randomisation test of hypothesised order relations, multidimensional scaling, and covariance structure modelling were employed to examine the structural validity of the inventory. The results demonstrated the South African Career Interest Inventory–isiXhosa version to be a reliable and valid measure of vocational interest on an early isiXhosa adolescent sample, suggesting the tenability of Holland’s model in the South African context. Implications for research and practice are discussed.
An Automated Image Analysis Method to Quantify Veterinary Bone Marrow Cellularity on H&E Sections
Authors: Kozlowski Cleopatra , Brumm Jochen , Cain Gary
Published: April 2018

Bone marrow toxicity is a common finding when assessing safety of drug candidate molecules. Standard hematoxylin and eosin (H&E) marrow tissue sections are typically manually evaluated to provide a semiquantitative assessment of overall cellularity. Here, we developed an automated image analysis method that allows quantitative assessment of changes in bone marrow cell population in sternal bone. In order to test whether the method was repeatable and sensitive, we compared the automated method with manual subjective histopathology scoring of total cellularity in rat sternal bone marrow samples across 17 independently run studies. The automated method was consistent with manual scoring methodology for detecting altered bone marrow cellularity and, in multiple cases, identified changes at lower doses. The image analysis method allows rapid and more quantitative assessment of bone marrow toxicity compared to manual examination of H&E slides, making it an excellent tool to aid detection of bone marrow cell depletion in preclinical toxicologic studies.
Tamil Dalit Art and Identity
Authors: Hons Pavel
Published: April 2018

Based mainly on printed sources in Tamil, as well as interviews with Dalit activists, this article seeks to map current divergent attitudes of Dalits towards folklore and especially towards the drum. While most activists argue for the rejection of drumming as a symbol of oppression and untouchability, some try to use it as a means of mobilisation. Others speak in favour of the resignification of the instrument and its protection and preservation as a part of their cultural legacy, which they consider to be different from the mainstream. The article also sets out to correlate these attitudes with the ideology of the eradication of caste and points to the ensuing dilemmas connected with emphasising caste-based identities.
Salvage Treatment with Epirubicin and/or Paclitaxel in Metastatic Breast Cancer Patients Relapsed after High-dose Chemotherapy with Peripheral Blood Progenitor Cells
Authors: Tartarone Alfredo , Sirotovà Zuzana , Aieta Michele , Lelli Giorgio
Published: April 2018

Aims and Background

To evaluate feasibility and efficacy of paclitaxel as a single agent or in combination with epirubicin in breast cancer taxane-naive patients who have failed previous high-dose chemotherapy.

Methods

Since February 1995, we have treated 32 patients in first relapse or progression after high-dose chemotherapy. Nineteen patients had metastatic breast cancer, 12 more than 3 involved axillary lymph nodes, and 1 inflammatory breast cancer at inclusion to the program. The median time to relapse after high-dose chemotherapy was 12 months (range, 2-43). At relapse, 12 patients were treated with epirubicin (90 mg/m2) plus paclitaxel (175 mg/m2) administered on day 1 every 21 days. In 20 patients who had previously received more than 350 mg/m2 of a cumulative dose of epirubicin and in one patient pretreated with chemotherapy containing mitoxantrone, we employed paclitaxel (175 mg/m2) alone. A median number of five courses was administered (range, 2-10).

Results

The overall response rate after 3 courses (29 of 32 patients were assessable) was 55% and after 6 courses (21 of 32 patients were assessable) was 57%. The median time to progression was 7 months (95% CI, 5.7-9.2), and median survival was 27.5 months (95% CI, 17.8-37.0). Toxicity was recorded for 180 cycles (epirubicin + paclitaxel for 62 cycles and paclitaxel alone for 118 cycles). The main toxicity in both regimens was hematologic. We observed WHO grade 3-4 neutropenia (in 8 patients, 25%), for which G-CSF (5 μg/kg/day sc) was employed. WHO grade 3-4 thrombocytopenia occurred in 2 patients (6%) and WHO grade 3 anemia in 1 patient (3%).

Conclusions

Our study showed that paclitaxel (alone or in combination with epirubicin) is feasible as salvage treatment in heavily pretreated patients.
Results of a Prospective Study with High-dose Etoposide, Thiotepa and Carboplatin and Peripheral Blood Stem Cell Rescue for High-risk Stage II-IIIA and Selected Stage IV Breast Cancer Patients
Authors: Gori Stefania , Mosconi Anna Maria , Tabilio Antonio , Falzetti Franca , Aristei Cynthia , Basurto Carlo , Cherubini Roberta , Latini Paolo , Martelli Massimo Fabrizio , Tonato Maurizio , Colozza Mariantonietta
Published: April 2018

Aims and Background

To investigate the safety and efficacy of a high-dose chemotherapy regimen with etoposide, carboplatin and thiotepa in high-risk stage II-IIIA breast cancer and in responsive metastatic patients.

Study Design

From April 1992 to December 1998, 24 patients with high-risk stage II-IIIA breast cancer (≥9 positive nodes) and 9 responsive metastatic patients were enrolled in the trial. After induction chemotherapy with an anthracycline-based regimen, peripheral blood stem cells were mobilized with cyclophosphamide (7 g/m2) and G-CSF (5-16 μg/kg/sc/day). The high-dose chemotherapy regimen consisted of etoposide (1000 mg/m2), carboplatin (800 mg/m2) and thiotepa (500 mg/m2). At the end of the high-dose chemotherapy, all stage II-IIIA patients received radiotherapy to the breast or chest wall and draining nodes; stage IV patients were irradiated to sites of disease, if feasible. All ER+ and/or PgR+ patients were treated with hormone therapy.

Results

For stage II-IIIA high-risk patients, the median follow-up was 4.36 years (range, 1.93-6.94), and the Kaplan-Meier estimate at 5 years of disease-free survival and overall survival was 54.8 ± 11% SE and 76.73 ± 9.4% SE, respectively. For metastatic patients, the median follow-up was 4.93 years (range, 4.15-7.95), and the Kaplan-Meier estimate at 5 years of progression-free survival and overall survival was 22.2 ± 13.9% SE and 76.2 ± 14.8% SE, respectively. No treatment-related deaths were observed.

Conclusions

Our results are comparable to those obtained in other high-dose chemotherapy trials but do not seem to be superior to conventional-dose therapy given to similar patients.
Radioimmunoguided Breast Surgery Using Radiolabeled Antibody NR-LU-10 FAB: A Pilot Study
Authors: Burak William E , De Palatis Louis , Mosic Jennifer L , Soble Denise , Hinkle George , Hitchcock Charles L
Published: April 2018

Aim and Background

Radioimmunoguided surgery using radiolabeled NR-LU-10 Fab was evaluated as a method of intraoperative breast cancer detection.

Methods

Breast cancer patients were injected intravenously with 125I (74 MBq) labeled NR-LU-10 Fab (5 mg) and then underwent tumor excision 2, 4 or 7 days later, during which time the gamma detector probe was used to evaluate the primary tumor for evidence of radioactive uptake.

Results

Intraoperative probing revealed tumor localization in 7 of 10 patients (70%). Gamma probe counts of the excised tumor were elevated in all patients, although high counts in surrounding nonmalignant tissue obscured the ability to detect the tumor in vivo in 3 patients. One patient with bilateral breast cancer was found to have a separate focus of occult tumor in each breast using the gamma detector probe.

Conclusions

Radiolabeled NR-LU-10 Fab possesses favorable pharmokinetics and tumor-binding ability as a targeting agent. However, binding to nonmalignant tissue limits its role in the intraoperative evaluation of tumor margins in breast cancer patients. Its role in other malignancies should be explored.
Radiotherapy-related Fatigue: How to Assess and how to Treat the Symptom. A Commentary
Authors: Jereczek-Fossa Barbara Alicja , Marsiglia Hugo Raul , Orecchia Roberto
Published: April 2018

Acute and chronic radiotherapy-related fatigue occurs in up to 80% and 30%, respectively, of patients undergoing irradiation for cancer. Frequently, the symptom is not expected by the patients and is underestimated by medical and nursing staff. Fatigue can affect global quality of life more than pain, sexual dysfunction and other cancer- or treatment-related symptoms. Its etiology and correlates are not clear. Published reports are mainly descriptive, and in many of them numerous methodological biases are present. One of the limitations is lack of a standard method of assessment that could simplify the comparison between different series. In the last decade, modern instruments have been designed to measure fatigue. They include uni- and multidimensional tools. Use of these specific instruments is highly recommended for research on radiation-related fatigue. In daily practice when time is limited, simple assessment is necessary. For example, systemic use of plain and easily understandable questions about fatigue, its level and impact on daily life could be sufficient and reliable. Therapeutic strategies for radiotherapy-induced fatigue have not yet been clearly defined, but a few randomized studies have been recently published. Physical exercise, group psychotherapy and relaxation therapy have been demonstrated to be effective. Moreover, pharmacological treatment of concomitant disturbances (anemia, pain, insomnia, depression, dehydration, infection, malnutrition) and other radiotherapy side effects (diarrhea, hormonal insufficiency etc.) should be considered. Further methodologically correct studies are warranted to better define the causes, optimal prevention, assessment and management of this symptom.
Immunohistochemical Study of 49 Cutaneous Melanomas: P53, PCNA, Bcl-2 Expression and Multidrug Resistance
Authors: Loggini Barbara , Rinaldi Isabella , Pingitore Raffaele , Cristofani Renza , Castagna Maura , Barachini Paolo
Published: April 2018

Aims and Background

Thickness and level of invasion are the main morphological elements for an approximate but not sufficiently sensitive prognostic evaluation of cutaneous melanomas. By using immunohistochemical methods it is possible to detect biological markers related to prognosis. We have studied p53, PCNA, Bcl-2 and P-gp expression in 49 primary cutaneous melanomas.

Materials

We used the immunophosphatase APAAP immunohistochemical method. The percentage of labeled cells (according to four classes of positivity: <5%; 5-25%; 25-50%; >50%) and the localization of immunoreactivity were expressed for each marker. Statistical analysis was performed to determine the correlations between markers and level or thickness of melanomas.

Results

We found a good correlation between p53 expression and melanoma thickness (P <0.005), PCNA and P-gp expression. No relationship was observed between Bcl-2 expression and the different variables considered or other markers.

Conclusions

Our data seem to indicate an unfavorable prognostic role of higher nuclear p53 expression. However, we believe that our results need to be integrated with patients’ clinical follow-up and with the study of the expression of these markers in benign melanocytic lesions to gain more accurate information about their prognostic significance.
Breast Cancer and Pregnancy
Authors: Crivellari Diana , Lombardi Davide , Scuderi Cristina , Spazzapan Simon , Magri Maria Donatella , Giorda Giorgio , Berretta Massimiliano , Veronesi Andrea
Published: April 2018

The diagnosis of breast cancer during pregnancy is a rare event, but the young age of the patient together with the emotional impact for both the family and the doctors make therapeutic choices usually very difficult. Until recently, the occurrence of pregnancy associated breast cancer was thought to hold a grave prognosis and therapeutic abortion was very often advised in common practice. The hormonal environment with the increase in estrogens and progesterone was the main factor for the fear of tumor stimulation. The course of breast cancer, however, does not appear to be adversely affected by continuation of pregnancy. In the last years it was realized that potentially curative therapies can be administered even when pregnancy is continued. Of course in the medical literature there is no randomized clinical trial helping in taking decision in this setting; however, a significant experience already exists in some institutions and can guide management in these difficult cases.

The aim of our review is to give an answer to questions usually coming from various specialists who collaborate with the oncologists in treating these patients and furthermore to try and find some basic guidelines which can be used in the information of the patients regarding previous experience in this field.

The problem of a pregnancy after treatment for breast cancer is also analyzed, as this aspect is an emerging issue in clinical oncology. The decision should be evaluated for each single patient, taking into account the prognosis of the patient and her desire of pregnancy.
Breast Microcalcifications Studied with 3d Contrast-enhanced High-field Magnetic Resonance Imaging: More Accuracy in the Diagnosis of Breast Cancer
Authors: Trecate Giovanna , Tesoro Tess John David , Vergnaghi Daniele , Bergonzi Silvana , De Simone Tiziana , Mariani Gabriella , Musumeci Renato
Published: April 2018

Aims

To evaluate the reliability of magnetic resonance imaging (MRI) performed with three-dimensional (3D) sequences in mammographically detected breast microcalcifications.

Methods

During an 8-month period, a group of 28 patients with mammographically detected microcalcifications suspicious for malignancy underwent MRI. Their ages ranged from 33 to 65 years. Examinations were performed with a 1.5 Tesla MR unit and a 3D T1 weighted sequence. Images were interpreted on the basis of morphologic parameters and dynamic behavior in the uptake of contrast medium (Gd-DTPA). Histologic findings were considered as the gold reference.

Results

Histologic analysis revealed invasive carcinoma in 7 patients, 3 of which were associated with foci of lobular carcinoma in situ. Intraductal carcinoma was diagnosed in 8 patients, 1 of which was associated with a tubular carcinoma. Benign lesions accounted for 13 patients. All the neoplastic conditions showed enhancement on MR images (sensitivity, 100%), whereas early and intense enhancement was noted in 5 of 13 benign lesions (specificity, 61%). The positive predictive value was 75% and negative predictive value, 100%.

Conclusions

Although an overlap in the enhancement behavior of malignant and some benign lesions is clearly evident, a careful interpretation of MR images is helpful in detecting and mainly ruling out breast cancer combined with mammographically suspicious microcalcifications.
Interobserver Agreement of the Dermoscopic Diagnosis of 129 Small Melanocytic Skin Lesions
Authors: Pizzichetta Maria Antonietta , Talamini Renato , Piccolo Domenico , Trevisan Giusto , Veronesi Andrea , Carbone Antonino , Soyer H Peter
Published: April 2018

Aim and background

Dermoscopic diagnosis of pigmented skin lesions is based on the evaluation of dermoscopic criteria (classical pattern analysis) and on alternative diagnostic methods, such as the ABCD (A, asymmetry; B, border; C, color; D, differential structures) rule based on the total dermatoscopic score. The aim of the study was to investigate the interobserver agreement of standard dermoscopic criteria between two observers and the diagnostic validity of dermoscopic diagnosis by pattern analysis and by the ABCD rule.

Study design

The study included a total of 129 small (≤5 mm) melanocytic skin lesions selected from all lesions observed in consecutive patients between April 1996 and September 1998. Before surgery, each lesion was photographed with a Dermaphot. Dermoscopic images were examined independently by two observers to evaluate the presence or absence of standard dermoscopic criteria and to establish the dermoscopic diagnosis by pattern analysis and by the ABCD rule.

Results

Interobserver agreement for dermoscopic criteria varied from moderately good to good, with the highest agreement for radial streaks (k = 0.96) and the lowest for pseudopods (k = 0.49). Interobserver agreement was moderately good in dermoscopic diagnosis by pattern analysis (k = 0.48) and by the total dermatoscopic score (k = 0.44). The sensitivity and specificity of dermoscopic diagnosis by pattern analysis were 40% and 99%, respectively, for both observers. As regards the total dermatoscopic score (a cutoff score of ≤5.45 vs >5.45), sensitivity ranged from 80% to 100% and specificity from 48% to 59%.

Conclusions

The study showed that the pattern analyses as well as the ABCD rule give a poor discrimination between benign and malignant lesions and do not add relevant information for management decision in small melanocytic lesions. However, close follow-up examinations of small equivocal melanocytic lesions using digital equipment allow evaluation of their dermoscopic features during progression and whether their rather commonly found atypical dermoscopic features are lost during their natural course of growth.
Pain Mechanisms Involved and Outcome in Advanced Cancer Patients with Possible Indications for Celiac Plexus Block and Superior Hypogastric Plexus Block
Authors: Mercadante Sebastiano , Fulfaro Fabio , Casuccio Alessandra
Published: April 2018

Aims and Background

There is controversy about the role of neurolytic sympathetic blocks in advanced cancer, when pain syndromes may assume other characteristics, with a possible involvement of structures other than visceral. The aim of the present study was to assess the pain characteristics and the analgesic response of a consecutive sample of home care patients with pancreatic and pelvic pain, which would have possible indications for a celiac plexus block and a superior hypogastric block, respectively.

Methods

From January 1999 to December 1999, 400 consecutive advanced cancer patients were surveyed for a prospective longitudinal survey. We considered only patients who had pancreatic cancer or pelvic cancer with pain.

Results

Thirty-six patients were surveyed: 22 patients had pelvic cancers and 14 had pancreatic cancer. Patients with pelvic cancers showed a longer survival than those with pancreatic cancer (P = 0.019). Patients with pelvic cancers more frequently showed a neuropathic component associated with a visceral or somatic mechanism than patients with pain due to pancreatic cancer (P = 0.019). When the pain mechanism was taken into consideration, patients with pelvic cancers with a neuropathic component showed worse pain relief than patients with pain due to pancreatic cancer (P = 0.040).

Conclusions

Sympathetic procedures for pain conditions due to pancreatic and pelvic cancers should be intended as adjuvant techniques to reduce the analgesic consumption, and not as a panacea, given that multiple pain mechanisms are often involved because progression of disease is able to change the underlying pain mechanisms. Pancreatic pain seems to maintain visceral characteristics amenable to sympathetic block more than pain due to pelvic cancer.
Prognostic and Therapeutic Impact of Sentinel Node Micrometastasis in Patients with Invasive Breast Cancer
Authors: Carcoforo P , Bergossi L , Basaglia E , Soliani G , Querzoli P , Zambrini E , Pozza E , Feggi L
Published: April 2018

Aims and Background

Locoregional lymph node status is one of the most important prognostic factors determining the need for adjuvant chemotherapy in patients with breast cancer. Many authors have reported that micrometastases were not detected by routine sectioning of lymph nodes but were identified by multiple sectioning and additional staining. Among lymph node-negative patients 15-20% had an unfavorable outcome at five years from primary surgery. Sentinel lymph node (SLN) biopsy is an accurate technique for identifying axillary metastases because the pathologist utilizes hematoxylin-eosin (H-E) staining together with immunohistochemistry (IH) to examine all lymph node sections. Sentinel node micrometastasis has therefore become an important tumor-related prognostic factor.

Methods and Study Design

From November 1997 to October 2001 we examined in 210 patients the pathological features of primary breast lesions and SLN metastases and we correlated these with the tumor status of non-SLNs in the same axillary basin. We applied IH examination to both SLNs and non-SLNs of patients who were negative for metastasis by standard H-E examination.

Results

In this study lymph node staging was based on SLN findings, primary tumor size, and the presence of peritumoral lymphovascular invasion (LVI). We found 18 SLN micrometastases (9%) in 210 patients and one of these (5.5% of patients with SLN micrometastasis) also had one non-SLN metastasis: this patient had LVI and a larger primary tumor than patients with SLN micrometastasis without non-SLN metastasis. We also found 24 SLN macrometastases (11.5%) in 210 patients and 13 of these (54.2% of patients with SLN macrometastases) had one or more non-SLN metastases.

Conclusions

According to the results reported in the literature, tumor cells are unlikely to be found in non-SLNs when the primary lesion is small and SLN involvement micrometastatic (5.5% in our experience, 7% in Giuliano's). Our findings suggest that axillary lymph node dissection may not be necessary in patients with SLN micrometastasis from T1 lesions.
Radiolabeled Localization of the Sentinel Lymph Node: Dosimetric Evaluation in Personnel Involved in the Procedure
Authors: Pelosi E , Arena V , Bellò M , Cesana P , Lamberti L , Spandonari T , Ropolo R , Sandrucci S , Bisi G
Published: April 2018

Aims and Background

Peritumoral injection of 99mTc-labeled colloids for lymphoscintigraphy and radioguided surgery does not entail any relevant radiation burden to the patients. The real issue about radiation protection concerns the personnel involved in the procedure besides the nuclear medicine personnel. The aim of our study was to evaluate the cumulative doses to personnel involved during the injection of radiolabeled compounds under ultrasound or stereotactic guidance and the radiation burden to the personnel involved in the surgical incision of the tumor 24 hours after the administration of 99mTc-labeled colloids.

Methods and Study Design

We performed environmental contamination tests (SMEAR TEST) and exposure evaluation in the operating room.

Results

In the operating room the removed activity in the analyzed samples was less than 0.5Bq/g and exposure to the personnel was less than 6μSv/h. The evaluations made during ultrasound guidance demonstrated an equivalent and effective dose less than 20μSv.

Conclusions

Our results show that during ultrasound or stereotactic administration of radiolabeled compounds the radiation burden to the personnel involved in the procedure is virtually negligible. The surgeons too are exposed to a negligible radiation dose.
Breast Cancer Takes up 99mTc Bombesin. A Preliminary Report
Authors: Scopinaro F , Varvarigou A , Ussof W , De Vincentis G , Archimandritis S , Evangelatos G , Corleto V , Pulcini A , Capoccetti F , Remediani S , Massa R
Published: April 2018

Background

Several tumors including lung, prostate, ovarian, colon, and exocrine pancreatic cancer show receptors for the amphibian neurotransmitter and growth factor bombesin (BN) and its mammalian counterparts gastrin-releasing peptide and neuromedin B. Also breast cancer has been reported to show such receptors: the presence of BN receptors in primary breast cancer has been demonstrated on cultured cells and by autoradiography on breast tissue samples. Authors who have studied BN receptors in breast cancer do not agree on their frequency in primary cancer, but indicate that 100% of metastatic breast cancers show such receptors.

Methods

We examined three primary breast cancer patients with 99mTc BN and 99mTc sestamibi one week before surgery. One of them showed axillary node invasion. The same acquisition technique was used for breast and chest imaging with both radiopharmaceuticals, whereas total body images were acquired only with 99mTc BN. Also the administered radioactivity was different: 20 mCi of 99mTc sestamibi and 5-8 mCi of 99mTc BN. Dynamic images were acquired for 20 mins after iv injection with the patient in ventral decubitus and the gamma camera positioned in lateral view, as is generally done in Khakhali's prone scintimammography. Anterior chest images were acquired for 30 mins. Prone scintimammography was performed one hour after administration of both tracers. ROIs were drawn on tumors and surrounding breast with the same technique in order to calculate the tumor to breast ratio (T/B). In addition, total body scan was performed one hour and three hours after 99mTc BN administration. All three patients underwent breast conserving surgery with lymphadenectomy. Postoperative pathologic assessment showed the following T and N stages in the three patients: T1bN0, T1cN0. and T1cN1.

Results

All three cancers were imaged with both tracers. The T/B of 99mTc BN was always higher than that of 99mTc sestamibi. Chest uptake was always much higher with 99mTc sestamibi than with 99mTc BN. Comparison between 99mTc BN and 99mTc sestamibi images gave other intriguing results: in the N1 patient both tracers clearly imaged the invaded node, but on the 99mTc BN image the primary tumor was larger than on the 99mTc sestamibi image and the node was smaller. It is known that 99mTc BN is not taken up by vessels and inflammatory tissue. The time activity curves of the two tracers were significantly different in all patients, with an increase in 99mTc BN uptake in the first three to five minutes, followed by a less sharp uprise of the curve, quite similar to a plateau.

Conclusions

Our first impression is that 99mTc BN is a useful breast cancer seeking agent and very promising for lymph node staging.
Sentinel Lymph Node Detection by Lymphoscintigraphy in Malignant Melanoma
Authors: Caprio MG , Carbone G , Bracigliano A , Acampa W , Mainolfi C , Molea G , Salvatore M
Published: April 2018

Aims and Background

Sentinel lymph node (SLN) detection is currently employed in patients with malignant melanoma (MM) to spare them unnecessary lymph node dissection.

Methods and Study Design

We investigated 241 patients (130 men and 111 women, median age, 50 years (range, 14-92)) with MM (192 before and 51 after surgical biopsy); two of them had more than one melanoma lesion. In each patient approx. 10 MBq of 99mTc Nanocoll in 0.1 mL (Nycomed Amersham Sorin; particle size range, 3-80 nm) was injected intradermally around the MM lesion or surgical scar. Dynamic acquisition was performed for 20 minutes (20 frames/min) and the study was concluded within four hours of injection. Using an external radioactive marker, the skin over the SLN was marked with China ink.

Results

294 SLNs were scintigraphically identified: 117 in the inguinal region, 147 in the axillae, four in the submandibular region, three in the laterocervical region and 23 at other sites. In two patients no drainage was detected. In 43 patients more than one sentinel node was identified. In 13 patients with lesions located in the trunk the tracer drained towards multiple lymph node stations or unexpected lymph nodes (nine cases). Histology and immunohistochemistry diagnosed MM in 25 SLNs; 19 were positive for metastasis with hematoxylin-eosin staining, five with Hmb45 and one with CD68 immunostaining. All 25 detected lymphatic basins were excised. In nine of these basins there was metastatic involvement of at least one other lymph node besides the SLN. During follow-up, which ranged from six to 86 months, metastatic disease was found in only one patient with a histologically negative SLN six months after surgery.

Conclusions

This study confirms the utility of scintigraphic SLN detection in patients with MM. In most of the cases the procedure led the surgeon to evaluate the drainage area, which is unpredictable for lesions in the trunk and may be difficult to delineate using only patent blue dye. Furthermore, in approximately 10% of cases we observed dual drainage from individual lesions, mainly those located on the trunk. We will proceed to compare the results obtained during follow-up with those of an investigational group of patients with melanoma who were not subjected to lymphoscintigraphy for SLN detection in order to obtain well-founded information on the prognostic value of this technique.
Surgical Approach to Cervical Lymph Node Metastasis in Differentiated Thyroid Cancer
Authors: Goss M , D'Amico S , Mobiglia A , Sargiotto A , Deandrea M
Published: April 2018

Background

Precautionary locoregional lymph node dissection in thyroid carcinomas for diagnostic and/or staging purposes is useless both in differentiated (papillary and follicular) and undifferentiated forms. It is only indicated in medullary carcinomas because of their frequent spread to regional lymph nodes. The objective of lymphadenectomy is to contain tumor spread; however, the procedure may be associated with intraoperative complications and postoperative sequelae. In order to improve the therapeutic management of patients with thyroid carcinoma, diagnostic scintigraphy with 201Tl or 99mTc-sestamibi is used in the advanced and undifferentiated forms of this tumor.

Methods

We have treated a woman submitted three years previously to total thyroidectomy for papillary carcinoma (pT3) without subsequent radiometabolic treatment. On physical examination we noticed a swelling on the left side of the neck. The lesion was confirmed by ultrasonography, CT scan, and scintigraphic examination with 99mTc-sestamibi 24 hours before planned lymphadenectomy. During the surgical procedure we performed radiodetection to localize metastatic lesions.

Results

Intraoperative radiodetection may help to identify residual disease, which is often difficult to trace in the presence of post-surgical fibrosis. In our patient, histological examination of the removed tissue specimens demonstrated that intraoperative radiolocalization had been highly accurate. The eradication of residual disease was confirmed by scintigraphic follow-up after 12 months.

Discussion and conclusions

Scintigraphy with 99mTc-sestamibi has been proposed as a means to localize metastatic spread and possible residual disease after a supposedly radical thyroidectomy. Surgical eradication of all residual tumor guarantees the best disease control without having to resort to radiometabolic therapy. This approach will reduce the incidence of iatrogenic comorbidity and consequently improve the patients' quality of life.
Intraoperative Sentinel Node Detection by an Innovative Imaging Probe
Authors: Campisi C , Soluri A , Stella S , Valenti G , Scopinaro F
Published: April 2018

Intraoperative tumor detection has been used in many applications, and today the sentinel node technique is a widely employed surgical procedure in breast cancer. Different detector systems are employed but several problems have been reported in clinical practice, in particular the difficulty to accurately detect the sentinel node within the axillary soft tissue. The problem is even greater for abdominal and thoracic tumors. We propose an innovative Imaging Probe (IP) able to visualize on a monitor the primary tumor and secondary lesions, if appropriately radiolabeled. The IP can be optimally applied for minimally invasive surgery in breast cancer treatment, and a preliminary experience related to 15 patients and 20 sentinel nodes is reported here. We compared the results obtained with the IP to those obtained with an Anger camera and a traditional scintillation detector, and found them to be very promising. In particular the surgeon's work is greatly facilitated by direct visual guidance instead of a generic acoustic signal.
Sentinel Lymph Node Analysis in Squamous Carcinoma of the Oral Cavity and Oropharynx
Authors: Pastore A , Turetta GD , Tarabini A , Turetta D , Feggi L , Pelucchi S
Published: April 2018

Aims

The aim of our study was to evaluate the usefulness and applicability of sentinel lymph node (SLN) identification in NO carcinomas of the oral cavity and oropharynx.

Study design

We carried out a prospective evaluation of SLN identification in 20 patients with oral cavity or oropharynx carcinomas with no clinical evidence of lymph node metastases.

Methods

Peritumoral infiltration with technetium-99-labeled nanocolloid followed by lymphoscintigrapy was carried out approximately 18 hours prior to surgery. A vital dye was injected intraoperatively and the SLN was identified with the aid of a gamma probe. All patients underwent routine neck dissection.

Results

While multiple radioactive nodes were generally identified on lymphoscintigraphy, the number of nodes ranging from one to five with variable degrees of uptake, intraoperative gamma probe scanning allowed the identification of a single more radioactive lymph node in 19 of the 20 patients. In only one patient did this method lead to the identification of two equally highly radioactive SLNs, with no uptake in the remaining nodes. All SLNs were ipsilateral to the neoplastic lesion. In 15 cases the SLN was tumor negative and so were the remaining nodes obtained by comprehensive neck dissection. In five cases the SLN was the only lymph node containing micrometastasis among those obtained by dissection. There were no instances of node positivity not involving the SLN.

Conclusions

Sentinel lymph node identification in ENT surgery may indicate intraoperatively if node metastases are present, thereby avoiding overtreatment in a substantial proportion of patients with NO carcinomas of the oral cavity or oropharynx.
A Simplified Procedure for Continuous Intraoperative External Monitoring of Systemic Leakage during Isolated Limb Perfusion
Authors: Casara D , Rubello D , Pilati PL , Scalerta R , Foletto M , Rossi CR
Published: April 2018

Aims

Isolated limb perfusion (ILP) with high doses of an alkylating agent alone or in combination with tumor necrosis factor (TNF) in hyperthermic conditions (HAP) has been proposed for the treatment of locoregional tumors. A critical step in ILP/HAP is accurate monitoring of systemic leakage to prevent the toxic effects of chemotherapy, and in particular of TNF. Ten percent systemic leakage from the perfusion circuit is considered the maximum acceptable leakage. In this study we report our experience of a new leakage monitoring system.

Materials and methods

This new simplified procedure is based on the use of 99mTc-labeled soluble human serum albumin (HSA) and a hand-held gamma probe as detector. The procedure consists of the following steps: 1) A standardized 99mTc-HSA dose of 0.5 MBq/kg body weight is injected into the perfusion circuit before chemotherapy/TNF perfusion, and a hand-held gamma probe (IGP) is placed over the precordial area in a zone that was marked on the skin during a simulation test; 2) 48-72 hours before ILP/HAP a complete simulation test is performed with a 99mTc-HSA dose corresponding to 10% of the total dose calculated for the patient's body weight; 3) during the simulation test the maximum countrate zone on the precordial area is detected by IGP and marked on the patient's skin; 4) a 60-min curve of effective 99mTc-HSA radioactivity decay (physical and biological) is calculated and fitted; 5) to compare external counting with the effective circulating radioactivity, patient blood samples and circuit blood samples are taken every five minutes during ILP/HAP and measured by a laboratory gamma counter and very convenient thanks to the favorable characteristics of IGP. The placed in the operating room.

Results

External counting with a hand-held gamma probe was easy to perform time/activity curves obtained during simulation tests showed a regular and constant effective decay with a mean decay rate of 30% at 60 minutes compared to baseline values. The external measurements obtained by IGP proved to be well correlated with blood samples measured in vitro by a laboratory gamma counter. The results of this procedure, in particular the data of the simulation test for each patient, allowed us to correct the limit of 10% maximum leakage during ILP/HAP in accordance with the time/activity curve.

Conclusions

Although 99mTc-HSA has some unfavorable characteristics, it offers many advantages over 131I-HSA. The procedure proposed by us, which was based on the use of an IGP and 99mTc-HAS at a standardized dose of 0.5 MBq/kg body weight and on an individual simulation test for each patient performed 48 hours before ILP/HAP, proved to be simple and accurate in monitoring systemic leakage during ILP/HAP anticancer therapy.
Colorectal Cancer in Korea: Characteristics and Trends
Authors: Kim Dong-Wan , Bang Yung-Jue , Heo Dae Seog , Kim Noe Kyeong
Published: April 2018

Aims and Background

Colorectal cancer is the fourth leading cause of malignancy in Korea. However, there have been few reports concerning the clinical or pathological characteristics of patients in this area. The aim of this study was to examine the characteristics and trends of colorectal cancer in Korea.

Methods

The 1,468 patients with a histologic diagnoses of colorectal cancer between 1990 and 1997 at the Seoul National University Hospital, Seoul, Korea, were retrospectively examined. The data source was the medical record database of the Hospital.

Results

The mean age at diagnosis was younger than in Western countries (57.4 years for colon cancer and 55.6 years for rectal cancer). Rectal cancer was found to be more frequent than colon cancer. However, the proportion of colon cancer has been steadily increasing with time. The changes in the colon-to-rectal ratio mainly arose from an increase in left-sided colon cancer. Moderately differentiated adenocarcinoma was also increasing. Colon cancer patients demonstrated a more advanced stage than the rectal cancer patients. Surgery was performed in 93.7% of the patients as a first course of treatment.

Conclusions

The characteristics of Korean colorectal cancer patients were remarkably different from those seen in Western countries in age and primary tumor site distribution. However, the differences were less evident with time. A nationwide population-based registry is required to confirm the results of the study.
Survival after Pleural Malignant Mesothelioma a Population-based Study in Italy
Authors: Magnani Corrado , Viscomi Silvia , Dalmasso Paola , Ivaldi Cristiana , Mirabelli Dario , Terracini Benedetto
Published: April 2018

Aims and Background

The study analyzed survival after malignant mesothelioma in the population-based Registry of Malignant Mesothelioma of Piedmont (NW Italy, 4.5 million total population). It focused on possible differences related to period of diagnosis a proxy of changes in diagnostic or therapeutic procedures.

Methods

Cases were actively searched in pathology units and files of hospital admissions and discharges. In 1990-1998, 693 incident cases were diagnosed in residents in the region: 590 of them had a histologic diagnosis of pleural mesothelioma in life and were included in the study. Vital status was ascertained at the municipality of residence as of January 1, 2000.

Results

Fifty-eight cases were alive (9.8%) and 20 were lost (3.6%) at the end of the follow-up. Median survival was 0.71 years (95% Cl, 0.64-0.78). Cumulative survival was 35.9% at 1 year (95% Cl, 32.0-39.8) and 14.2% at 2 years (95% Cl, 11.2-17.1). Survival was associated to age (longer survival for younger subjects at diagnosis; P <0.0001) and to histology (longer survival for epithelial mesothelioma, shorter for fibrous and intermediate for mixed or unspecified types; P <0.0001). There was no difference in survival for period of diagnosis. The results were confirmed in multivariate analyses. Analyses according to type of hospital (with vs without thoracic surgery) did not show any statistically significant difference.

Discussion

The study on survival after malignant mesothelioma is the second largest of the three population-based studies in the world, which showed results similar to ours. Survival measured in published clinical series ranged between 18.4% and 57.6% at 1 year for pleural and 24.1% and 33.8% for peritoneal mesothelioma. The most striking effect of the present study was the absence of improvement in survival with period of diagnosis. Either there was no change in treatment efficacy or the effect was limited to small subgroups and could not be noticed when the analysis included larger categories.