Gamma probe sentinel node localization and biopsy in breast cancer patients treated with a neoadjuvant chemotherapy scheme

The aim of this study was to analyse the accuracy of scintigraphic and gamma probe sentinel node (SN) localization in breast cancer patients who have been submitted to neoadjuvant chemotherapy (NC). Seventy-six patients with single breast cancer were included in the study, and were classified into two groups. Group 1 consisted of 40 women who had received NC, and Group 2 consisted of 36 women who did not receive NC. All patients received 111 MBq (3 mCi) of 99Tcm-nanocolloid in 3 ml, by peritumoural injection. Anterior and lateral thoracic scans were obtained 2 h post-injection. The following day (18-24 h post-injection) the patients underwent surgery and sentinel nodes were localized by using a gamma probe. Complete axillary lymph node dissection was performed in all patients. Histological analysis included haematoxylin-eosin in all cases and immunohistochemistry in 10 cases. In Group 1, SNs were localized in 36/40 patients, histological analysis was performed in 34 and there were four false negatives (22%). In Group 2, SNs were localized in 32/36 patients, histological analysis was performed in 29 and there were two false negatives (9%). Predictive negative values were 78% and 90% in Groups 1 and 2, respectively. In summary, sentinel node localization in breast cancer patients submitted to previous neoadjuvant chemotherapy is less accurate than in patients who do not receive this therapy. The procedure is not sufficiently accurate to localize the sentinel node, thus it cannot be recommended in these patients

Aflojamiento séptico o aséptico de la prótesis total de cadera. Evaluación diagnóstica mediante gammagrafía con tecnecio, galio y leucocitos marcados con indio-111. Estudio comparativo

Resumen. Los autores han estudiado 28 pacientes portadores de prótesis total de cadera dolorosa en los que se sospechaba su infección. En todos los casos se efectuó una valoración clínico-radiológica, una gammagrafía con MDP-Tc 99m y Ga 67, usados secuencialmente, y después una gammagrafia con L-In 111. El diagnóstico de infección se basó en la clínica, la valoración quirúrgica, la anatomía patológica y los cultivos positivos. En 21 casos se descartó la infección. Las gammagrafies con Ga 67 y con L-ln 111 fueron normales en 19 ocasiones y patológicas en las dos restantes. La gammagrafía con MDP-Tc 99m fue normal en 15 casos y patológica en los seis restantes. En siete casos se demostró la infección periprotésica. La gammagrafía con L-ln 111 fue positiva en todos ellos, mientras que el Ga 67fue negativo en dos casos y el MDP-Tc 99m lo fue en tres casos. La sensibilidad, especificidad v flabilidad fueron, respectivamente: MDP-Tc 99m: 57,7, 71,4 v 67,8 por 100; Ga 67: 71,4, 90,4y 85,7por 100; L-ln 111: 100, 90,4y 92,8por 100. Los valores predictivos positivos y negativos para la exploración con leucocitos marcados alcanzaron cifras de 77,7 y 100 por 100, respectivamente, no superadas por el resto de pruebas. Los autores consideran que los resultados conseguidos confieren una superioridad a la gammagrafía con leucocitos marcados con ln-111-oxina sobre el resto de trazadores en el diagnostico diferencial entre aflojamiento séptico y aséptico de la prótesis total de cadera, y recomiendan su utilización tras la gammagrafía ósea convencion

Meeting the Needs of Gifted and Talented Students

Researchers used case study methods to investigate a virtual learning lab (VLL) in a rural school district that was created in 2011 as a way to better meet the unique needs of exceptional students who are considered gifted. Data were collected through focus groups, classroom observations, interviews, and reviewing relevant documents. Topics include an in-depth explication of the learning lab, lessons learned and suggestions by teachers and administrators, and benefits for improved teaching and learning. Findings are that VLL programming, specifically online instruction that takes place in brick-and-mortar public schools, can be an effective means for providing accelerated coursework to exceptional middle school students who are gifted. Benefits include cost-effectiveness, parent and student satisfaction, allowing for individualized work pace in talent area, and others

Dibuix I: apunts, programa i exercicis

2010/201

Dibuix I: apunts, programa i exercicis

2010/201