Indocyanine green fluorescence-guided sentinel lymph node biopsy in dermato-oncology

Sentinel lymph node biopsy (SLNB) for cutaneous malignancies usually carried out with radioactive nanocolloids (Tc-99m). The SLNE is controversially discussed internationally. This is especially given to the high false-negative rate up to 44 %. An alternative could be the fluorescent dye indocyanine green (ICG).

Origin of the high upconversion green luminescence efficiency in -NaYF4:2% Er3+,20% Yb3+

Site-selective spectroscopy in hexagonal beta-NaYF4:Er3+,Yb3+ has revealed different environments for Er3+ ions (multisite formation). The low-temperature S-4(3/2) -> (I15/2Er3+)-I-4 green emission depends on the excitation wavelength associated with the F-4(7/2) Er3+ level. We have studied the effect of hydrostatic pressure on the green, red, and blue Er3+ emission upon NIR excitation at similar to 980 nm, in order to establish the role played by energy resonance conditions and the multiple Er3+ sites due to the disordered structure for the upconversion (UC) process (energy tuning). The variation of photoluminescence spectra and lifetimes as a function of pressure and temperature reveals that the origin of the high green UC efficiency of the beta-NaYF4:Er3+,Yb3+ compound is mainly due to the multisite distribution, and the low phonon energy of the host lattice.

Incomplete ovariosalpingectomy and subsequent malignant granulosa cell tumor in a female green iguana (Iguana iguana)

Case Description-A 9-year-old spayed female green iguana (Iguana iguana) was evaluated because of a distended coelom and weight loss. History included a single episode of egg binding and subsequent bilateral ovariosalpingectomy.;Clinical Findings-Physical examination revealed a mass within the coelomic cavity. Ultrasonography revealed a large, irregular mass with hypoechoic regions and coelomic effusion. Clinicopathologic derangements included heterophilia, monocytosis, lymphopenia, basophilia, hypocholesterolemia, hypoproteinemia, and hypercalcemia. Results of cytologic evaluation of the mass were suggestive of malignant epithelial neoplasia, but neoplastic cells were not found in the effusion. An ovarian tumor was suspected on the basis of clinical signs, clinicopathologic findings, and results of cytologic evaluation of the mass.;Treatment and Outcome-Surgical exploration revealed a large left ovary, a normal-appearing contralateral ovary, and a mass in the fat body, all of which were removed and submitted for histologic examination. The histologic diagnosis was granulosa cell tumor with metastasis to the fat body. The patient died 11 months after evaluation, and disseminated granulosa cell tumor was confirmed at necropsy; histologic examination at that time also identified systemic mastocytosis.;Clinical Relevance-Granulosa cell tumors are uncommon in reptiles, and this was the first granulosa cell tumor described antemortem cytologically, histologically, and ultrastructurally in an iguana. Findings in this iguana underscored concerns associated with incomplete oophorectomy of iguanas; cytologic and histopathologic findings were similar to those observed in other domestic animals. Oophorectomy should be considered as an alternative to standard ovariosalpingectomy to avoid potential complications in pet reptiles, and use of microsurgical instruments and vascular clips is advised. (J Am Vet Med Assoc 2011239:237-242)

Runoff Water Quality and Pollutant Mass Loads From Extensive Green Roofs

Green roof mitigation of volume and peak flow-rate of stormwater runoff has been studied extensively. However, due to the common practice of green roof fertilization, there is the potential for introduction of nutrients into local bodies of water. Therefore, this study compares green roof runoff quality with the water quality of precipitation and runoff from a bare shingle roof. The runoff from a demonstration-scale extensive green roof was analyzed during the summer of 2011 for its effect on runoff volume and analyzed during eleven storm events in the fall and winter for concentrations of copper, cadmium, zinc, lead, nitrogen species, total nitrogen, total organic carbon, sulfate, orthophosphate, and other monovalent and divalent ions. The green roof reduced the overall volume of runoff and served as a sink for NO3 - and NH4 +. However, the green roof was also a source for the pollutants PO4 3-, SO4 2-, TOC, cations, and total nitrogen. Metals such as zinc and lead showed trends of higher mass loads in the bare roof runoff than in precipitation and green roof runoff, although results were not statistically significant. The green roof also showed trends, although also not statistically significant, of retaining cadmium and copper. With the green roof serving as a source of phosphorous species and a sink for nitrogen species, and appearing to a retain metals and total volume, the life cycle impact analysis shows minimum impacts from the green roof, when compared with precipitation and bare roof runoff, in all but fresh water eutrophication. Therefore, the best environments to install a green roof may be in coastal environments.

Green Man

Mixed Media/Mylar 24 x 24"

Indocyanine green plasma disappearance rate during the anhepatic phase of orthotopic liver transplantation

Non-invasive pulse spectrophotometry to measure indocyanine green (ICG) elimination correlates well with the conventional invasive ICG clearance test. Nevertheless, the precision of this method remains unclear for any application, including small-for-size liver remnants. We therefore measured ICG plasma disappearance rate (PDR) during the anhepatic phase of orthotopic liver transplantation using pulse spectrophotometry. Measurements were done in 24 patients. The median PDR after exclusion of two outliers and two patients with inconstant signal was 1.55%/min (95% confidence interval [CI]=0.8-2.2). No correlation with patient age, gender, body mass, blood loss, administration of fresh frozen plasma, norepinephrine dose, postoperative albumin (serum), or difference in pre and post transplant body weight was detected. In conclusion, we found an ICG-PDR different from zero in the anhepatic phase, an overestimation that may arise in particular from a redistribution into the interstitial space. If ICG pulse spectrophotometry is used to measure functional hepatic reserve, the verified average difference from zero (1.55%/min) determined in our study needs to be taken into account.

Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography

OBJECTIVE: Perforating arteries are commonly involved during the surgical dissection and clipping of intracranial aneurysms. Occlusion of perforating arteries is responsible for ischemic infarction and poor outcome. The goal of this study is to describe the usefulness of near-infrared indocyanine green videoangiography (ICGA) for the intraoperative assessment of blood flow in perforating arteries that are visible in the surgical field during clipping of intracranial aneurysms. In addition, we analyzed the incidence of perforating vessels involved during the aneurysm surgery and the incidence of ischemic infarct caused by compromised small arteries. METHODS: Sixty patients with 64 aneurysms were surgically treated and prospectively included in this study. Intraoperative ICGA was performed using a surgical microscope (Carl Zeiss Co., Oberkochen, Germany) with integrated ICGA technology. The presence and involvement of perforating arteries were analyzed in the microsurgical field during surgical dissection and clip application. Assessment of vascular patency after clipping was also investigated. Only those small arteries that were not visible on preoperative digital subtraction angiography were considered for analysis. RESULTS: The ICGA was able to visualize flow in all patients in whom perforating vessels were found in the microscope field. Among 36 patients whose perforating vessels were visible on ICGA, 11 (30%) presented a close relation between the aneurysm and perforating arteries. In one (9%) of these 11 patients, ICGA showed occlusion of a P1 perforating artery after clip application, which led to immediate correction of the clip confirmed by immediate reestablishment of flow visible with ICGA without clinical consequences. Four patients (6.7%) presented with postoperative perforating artery infarct, three of whom had perforating arteries that were not visible or distant from the aneurysm. CONCLUSION: The involvement of perforating arteries during clip application for aneurysm occlusion is a usual finding. Intraoperative ICGA may provide visual information with regard to the patency of these small vessels.