Frozen section analysis of sentinel lymph nodes in patients with breast cancer does not impair the probability to detect lymph node metastases

Intra-operative frozen section analysis (FS analysis) of sentinel lymph nodes (SLNs) in patients with breast cancer can prevent a second operation for axillary lymph node dissection. In contrast, loss of tissue during FS analysis may impair the probability to detect lymph node metastases. To determine the effect of tissue loss on the probability of detection of metastases, dimensions and tissue loss resulting from intra-operative frozen section analysis were measured for 21 SLNs. In a mathematical model, the influence of tissue loss on the probability to detect metastases was calculated in relation to SLN size for various pathology protocols: an American, a widely used European, the extensive ‘Milan’ and the Dutch protocol. For median-sized SLN 11 × 8 × 5 mm (length × width × height), FS analysis led to a median loss of 680 μm (13.6%) of the height of the SLN. Irrespective of SLN size or used pathology protocol, the probability of detecting 2 mm metastases remained unchanged or even increased (0–12.8%). Moreover, the probability to detect 0.2 mm metastases increased for the majority of tested combinations of SLN size, tissue loss and used protocol. Only when combining maximum tissue loss and smallest SLN size in the Dutch protocol, or when applying the extensive Milan protocol on a median-sized SLN, the probability to detect 0.2 mm metastases decreased by 2.7% and 14.3%, respectively. Contrary to ‘common knowledge’, doing FS analysis of SLNs does not impair the probability to detect lymph node metastases

Timely withdrawal of G-CSF reduces the occurrence of thrombocytopenia during dose-dense chemotherapy.

Contains fulltext : 48504_pub.pdf (publisher's version ) (Open Access) Contains fulltext : 48504.pdf (publisher's version ) (Open Access)BACKGROUND: Post chemotherapy Granulocyte colony stimulating factor (G-CSF) reduces leucopenia, while G-CSF priming shortly before chemotherapy increases myelotoxicity. We performed a trial with a two-schedule crossover design to determine the optimal G-CSF schedule for densified 2-weekly chemotherapy. METHODS: During 2-weekly chemotherapy days 1 and 2, G-CSF was given on days 3-10, with a G-CSF-free interval before the next chemotherapy cycle of 5 days, or on days 3-13, with a G-CSF-free interval of 2 days. In schedule A, cycle II was preceded by a 5 days, cycle III and IV by a 2 days and cycle V by a 5 days G-CSF free interval. In schedule B, this was 2, 5, 5, and 2 days, respectively. RESULTS: Intra-patient comparison for cycles II versus III and cycles IV versus V showed that platelet (PLT) nadir count was significantly lower for cycles preceded by a 2-days compared to a 5-days G-CSF free interval: mean difference 45.7 x 10(9)/l (95% CI 33.2-58.2, p = 0.0001). Neutrophil count did not differ significantly (p = 0.85). CONCLUSION: Timely withdrawal of G-CSF in dose-dense chemotherapy reduces chemotherapy-related thrombocytopenia. Leucopenia was not aggravated, reflecting a protective effect of post-chemotherapy G-CSF

Residues of pesticides in grain

Het onderzoek had betrekking op 169 graanmonsters (92 tarwe, 47 rijst, 20 gerst en 10 rogge) die onderzocht werden op residuen van 78 bestrijdingsmiddelen of metabolieten daarvan. In 24 monsters werden overschrijdingen gevonden van in de Residubeschikking vermelde maximaal toegelaten gehalten, waarvan 14 voor chloorpyrifos-methyl en 10 voor bromide. De overschrijdingen voor chloorpyrifos-methyl werden alle geconstateerd in Franse importgranen ; in Nederland is het gebruik van dit middel op graan niet toegelaten, maar de Residubeschikking zal in die zin worden aangepast, dat legale import van met dit middel behandeld graan mogelijk wordt. De overschrijdingen voor bromide zijn alle gevonden in rijst ; vergeleken met een soortgelijk onderzoek in 1976-1978 is de situatie met betrekking tot dit residu verslechterd. De oorzaak van de te hoge gehaltes aan bromide is waarschijnlijk een onjuist gebruik van broomhoudende voorraadbeschermingsmiddelen zoals methylbromide en/of dibroomethaan.Abstract not availableHI