Sentinel node detection in cervical cancer with Tc-99m-phytate

Objectives. The aim of this study was to investigate the feasibility of sentinel lymph node (SLN) identification using radioisotopic lymphatic mapping with technetium-99 m-labeled phytate in patients undergoing radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer.Methods. Between July 2001 and February 2003, 56 patients with cervical cancer 1160 stage I (it 53) or stage 11 (it 3) underwent sentinel lymph node detection with preoperative lymphoscintigraphy (Te-99m-labeled phytate injected into the uterine cervix, at 3, 6, 9, and 12 o'clock, at a dose of 55-74 MBq in a volume of 0.8 ml) and intratoperative lymphatic mapping with a handheld gamma probe, Radical hysterectomy was aborted in three cases because parametrial invasion was found intraoperatively and we performed only sentinel node resection. The remaining 53 patients underwent radical hysterectomy with complete pelvic lymphadenectomy, Sentinel nodes were detected using a handheld gamma-probe and removed for pathological assessment during the abdominal radical hysterectomy and pelvic lymphadenectomy.Results. One or more sentinel nodes were detected in 52 out of 56 eligible patients (92.8%). A total of 120 SLNs were detected by lymphoscintigraphy (mean 2.27 nodes per patient) and intraoperatively by gamma probe, Forty-four percent of SLNs were found in the external iliac area, 39% in the obturator region, 8.3% in interiliae region, and 6.7),) in the common iliac area. Unilateral sentinel nodes were found in thirty-one patients (59%). The remaining 21 patients (4100 had bilateral sentinel nodes, Microscopic nodal metastases were confirmed in 17 (32%) cases. In 10 of these patients, only SLNs had metastases. The 98 sentinel node.,, that were negative on hematoxylin and eosin were submitted to cytokeratin immunohistochemical analysis. Five (5.1%) micrometastases were identified with this technique. The sensitivity of the sentinel node was 82.3% (CI 95% - 56.6-96.2) and the negative predictive value was 92.1% (CI 95% 78.6 98.3) the accuracy of sentinel node in predicting the lymph node status was 94.2%,Conclusion. Preoperative lymphoscintigraphy and intraoperative lymphatic mapping with Tc-99-labeled phytate are effective in identifying sentinel nodes in patients undergoing radical hysterectomy and to select women in whom lymph node dissection call be avoided. (c) 2005 Elsevier B.V. All rights reserved.

Clinicopathological features influencing pelvic lymph node metastasis and vaginal and parametrial involvement in patients with carcinoma of the cervix

Purpose: This study was undertaken to evaluate clinical and pathologic findings that predicted pelvic lymph node metastasis and parametrial and vaginal involvement in patients with stage IB carcinoma of the cervix. Methods: 71 patients with diagnosis of stage IB (FIGO) cervical cancer were prospectively studied from December 1997 to August 2002. The patient's age, clinical stage (IB1 or IB2), histological classification, grade of differentiation, tumor volume, and lymphatic vascular space invasion (LVSI) were evaluated. Statistical methods included chi(2) test and Fisher's exact test to evaluate significant differences between the groups. The level of significance was set at p < 0.05. Results: the clinical stage was IB1 in 51 patients (71.8%) and IB2 in 20 patients (28.2%). The histological classification identified squamous cell carcinoma in 60 patients (84.5%) and adenocarcinoma in 11 patients (15.5%). The average tumoral volume was 22.8 &PLUSMN; 8 24.3 cm(3) (0.3-140.0 cm(3)). The tumor was well differentiated (G1) in 8 (11.3%), moderately differentiated (G2) in 40 (56.3%) and poorly differentiated in 23 (32.4%) of the cases. The presence of LVSI was detected in 14 patients (19.7%) and was associated with pelvic lymph node metastasis and vaginal and parametrial involvement (p = 0.002, p = 0.001 and p < 0.001; respectively). The average number of positive pelvic lymph nodes was significantly higher in the patients with LVSI compared with patients without LVSI (2.47 +/- 2.8 vs. 0.33 +/- 0.74; p = 0.001). There was no association of age, clinical stage, histological classification, grade of differentiation or tumor volume with pelvic lymph node metastasis and vaginal and parametrial involvement. Conclusion: the presence of LVSI is significantly associated with pelvic lymph node metastasis and vaginal and parametrial involvement in patients with stage IB cervical carcinoma. Copyright (C) 2005 S. Karger AG, Basel.

On bifurcation and symmetry of solutions of symmetric nonlinear equations with odd-harmonic forcings

In this work we study existence, bifurcation, and symmetries of small solutions of the nonlinear equation Lx = N(x, p, epsilon) + mu f, which is supposed to be equivariant under the action of a group OHm, and where f is supposed to be OHm-invariant. We assume that L is a linear operator and N(., p, epsilon) is a nonlinear operator, both defined in a Banach space X, with values in a Banach space Z, and p, mu, and epsilon are small real parameters. Under certain conditions we show the existence of symmetric solutions and under additional conditions we prove that these are the only feasible solutions. Some examples of nonlinear ordinary and partial differential equations are analyzed. (C) 1995 Academic Press, Inc.

Sentinel node mapping in a pregnant woman with cervical cancer: a case report

The possibility of reducing morbidity associated with surgical dissection while maintaining accurate tumor staging is one of the greatest advantages of the sentinel node approach in surgical oncology. The sentinel node mapping has already proven to be useful in melanoma, breast cancer, and vulvar cancer. We report the first case of sentinel node detection by technetium-labeled radiocolloid in a pregnant woman with cervical cancer. The histologic analysis of the operative specimen showed a poorly differentiated squamous carcinoma with metastasis in the sentinel node and a neoplasic embolus in a blood vessel of the placental bed. The lymphatic mapping and sentinel lymph node detection are feasible during pregnancy.

Bifurcation of limit cycles from a centre in R-4 in resonance 1:N

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A note on non-degenerate umbilics and the path formulation for bifurcation problems

Path formulation can be used to classify and structure efficiently multiparameter bifurcation problems around fundamental singularities: the cores. The non-degenerate umbilic singularities are the generic cores for four situations in corank 2: the general or gradient problems and the ℤ 2-equivariant (general or gradient) problems. Those categories determine an interesting 'Russian doll' type of structure in the universal unfoldings of the umbilic singularities. One advantage of our approach is that we can handle one, two or more parameters using the same framework (even considering some special parameter structure, for instance, some internal hierarchy). We classify the generic bifurcations that occur in those cases with one or two parameters.

Solubilization of proteins from human lymph node tissue and two-dimensional gel storage.

In the present study, we compared six different solubilization buffers and optimized two-dimensional electrophoresis (2-DE) conditions for human lymph node proteins. In addition, we developed a simple protocol for 2-D gel storage. Efficient solubilization was obtained with lysis buffers containing (a) 8 M urea, 4% CHAPS (3-[(3-cholamidopropyl) dimethylammonio]-1-propanesulfonate), 40 mM Tris base, 65 mM DTT (dithiothreitol) and 0.2% carrier ampholytes; (b) 5 M urea, 2 M thiourea, 2% CHAPS, 2% SB 3-10 (N-decyl-N,N-dimethyl-3-ammonio-1-propanesulfonate), 40 mM Tris base, 65 mM DTT and 0.2% carrier ampholytes or (c) 7 M urea, 2 M thiourea, 4% CHAPS, 65 mM DTT and 0.2% carrier ampholytes. The optimal protocol for isoelectric focusing (IEF) was accumulated voltage of 16,500 Vh and 0.6% DTT in the rehydration solution. In the experiments conducted for the sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), best results were obtained with a doubled concentration (50 mM Tris, 384 mM glycine, 0.2% SDS) of the SDS electrophoresis buffer in the cathodic reservoir as compared to the concentration in the anodic reservoir (25 mM Tris, 192 mM glycine, 0.1% SDS). Among the five protocols tested for gel storing, success was attained when the gels were stored in plastic bags with 50% glycerol. This is the first report describing the successful solubilization and 2D-electrophoresis of proteins from human lymph node tissue and a 2-D gel storage protocol for easy gel handling before mass spectrometry (MS) analysis.

3-Dimensional hopf bifurcation via averaging theory

We consider the Lorenz system ẋ = σ(y - x), ẏ = rx - y - xz and ż = -bz + xy; and the Rössler system ẋ = -(y + z), ẏ = x + ay and ż = b - cz + xz. Here, we study the Hopf bifurcation which takes place at q± = (±√br - b,±√br - b, r - 1), in the Lorenz case, and at s± = (c+√c2-4ab/2, -c+√c2-4ab/2a, c±√c2-4ab/2a) in the Rössler case. As usual this Hopf bifurcation is in the sense that an one-parameter family in ε of limit cycles bifurcates from the singular point when ε = 0. Moreover, we can determine the kind of stability of these limit cycles. In fact, for both systems we can prove that all the bifurcated limit cycles in a neighborhood of the singular point are either a local attractor, or a local repeller, or they have two invariant manifolds, one stable and the other unstable, which locally are formed by two 2-dimensional cylinders. These results are proved using averaging theory. The method of studying the Hopf bifurcation using the averaging theory is relatively general and can be applied to other 3- or n-dimensional differential systems.

Path formulation for multiparameter D3-equivariant bifurcation problems

We implement a singularity theory approach, the path formulation, to classify D3-equivariant bifurcation problems of corank 2, with one or two distinguished parameters, and their perturbations. The bifurcation diagrams are identified with sections over paths in the parameter space of a Ba-miniversal unfolding f0 of their cores. Equivalence between paths is given by diffeomorphisms liftable over the projection from the zero-set of F0 onto its unfolding parameter space. We apply our results to degenerate bifurcation of period-3 subharmonics in reversible systems, in particular in the 1:1-resonance.

Network node with wireless and wired interfaces: Nios II processor and uClinux to development of a NCAP embedded (IEEE 1451.1) with two interfaces, wireless (IEEE 1451.5) and wired (IEEE p1451.2)

This paper presents a NCAP embedded on DE2 kit with Nios II processor and uClinux to development of a network gateway with two interfaces, wireless (ZigBee) and wired (RS232) based on IEEE 1451. Both the communications, wireless and wired, were developed to be point-to-point and working with the same protocols, based on IEEE 1451.0-2007. The tests were made using a microcomputer, which through of browser was possible access the web page stored in the DE2 kit and send commands of control and monitoring to both TIMs (WTIM and STIM). The system describes a different form of development of the NCAP node to be applied in different environments with wired or wireless in the same node. © 2011 IEEE.