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Cancer
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Elyce Cardonick, Charlotte Maggen, Puja Patel
Sentinel node mapping and biopsy (SLNB) is commonly used for non-pregnant women to avoid the complications of lymphedema after complete axillary lymphadenectomy. Accuracy of SLNB does not appear affected by the physiologic modification of lymphatic drainage during pregnancy [41]. Sentinel node biopsy can be safely performed in pregnancy with Tc-99m sulfur colloid, which identifies the first draining node(s) relative to the site of the primary invasive tumor [42]. For sentinel node imaging, only a minimal dose (500–600 mCi) of double-filtered Tc-99m sulfur colloid is injected at the site of the breast tumor. The entire radioisotope stays trapped at the sight of injection or within the lymphatics until decay occurs (half-life = 6 hours), not traveling throughout the body to expose the fetus [42]. Use of blue dyes such as lymphazurin for sentinel node mapping in pregnancy is discouraged as this carries a risk of anaphylaxis in 0.5% of procedures, while indocyanine green has been safely used in pregnant patients [43]. The current recommendation is to use Tc-99 as a same day procedure.
Special Consideration of Drug Disposition
Published in Gary M. Matoren, The Clinical Research Process in the Pharmaceutical Industry, 2020
Unfortunately, there does not appear to be any means of precisely assessing hepatic dysfunction on a quantitative basis. Antipyrine, d-propanolol, and indocyanine green clearances were studied in patients with chronic liver disease [33]. Antipyrine has a low intrinsic hepatic clearance and is slowly, but completely, metabolized prior to excretion [ 34], Indocyanine green is not metabolized but is eliminated exclusively by active uptake into hepatic parenchymal cells. Indocyanine green is excreted via bile and does not undergo reabsorption after excretion into the small intestine. These properties make it suitable for the estimation of liver blood flow using the Fick principle with the direct measurement of the hepatic extraction ratios.
Kinetics of Blood to Cell Uptake of Radiotracers*
Published in Lelio G. Colombetti, Biological Transport of Radiotracers, 2020
James B. Bassingthwaighte, Bernd Winkle
Disappearance of plasma proteins from the circulation has been studied extensively over the years because of their use in the estimation of blood volume. Mixing of tracer-labeled proteins throughout the plasma space in the body has been a major feature of the reviews on blood volume estimation by Lawson63 and Sjostrand.94131I and Evans blue dye (T-1824) have been excellent markers with which to label albumin since they bind firmly to the protein. On the other hand, indocyanine green is stripped from the albumin relatively readily during its passage through the liver, so much so that the rate of disappearance of indocyanine green from the plasma has been used as a method of estimating hepatic blood flow.28
Clipping inguinal lymphatics decreases lymphorrhoea after lymphadenectomy following cancer treatment: results from a randomized clinical trial
Published in Scandinavian Journal of Urology, 2021
Palaniappan Ravisankar, Kanuj Malik, Anand Raja, Kathiresan Narayanaswamy
The concept of intraoperative mapping of identifying lymphatic leak has been applied by few researchers previously. Indocyanine green is being increasingly used to visualise lymphatic channels and assessment of lymphedema status. Bernier et al. in their review concluded that ICG increases the sentinel node detection sensitivity rate when used along with radiotracer [13]. However, when Mistry et al. used indocyanine green to identify transected lymphatics in breast axillary dissection, 70% of the patients still developed seroma [14]. Patent Blue V has been used to identify groin lymph leaks [15,16]. Isosulfan blue has been used extensively for identification of sentinel nodes in cutaneous melanoma, squamous cell carcinoma, merkel cell carcinoma and breast malignancy. Nakamura et al. performed a similar study by injecting isosulfan blue circumferentially around the inguinal dissection wound. In their study, the mean number of lymphatics identified and clipped were 3 (Range: 0−6), which is comparatively less than those in our study. They also found a significant decrease in the mean number of days of suction catheter insertion along with a reduction in the mean drain output [17].
Current concepts on diffuse choroidal hemangioma in Sturge Weber syndrome
Published in Ophthalmic Genetics, 2021
Martina Formisano, Maria Chiara di Pippo, Luca Scuderi, Solmaz Abdolrahimzadeh
FFA in DCH reveals diffuse leakage similar to circumscribed choroidal hemangioma but with more widespread and variable involvement, therefore, it is not generally diagnostic. Indocyanine green is a tricarbocyanine dye that is more highly bound to protein with respect to sodium fluorescein that diffuses gradually from the fenestrated choroidal vessels, thus, enabling better delineation of the choroidal circulation. The arterial phase of ICG-A demonstrates rapid filling and hyperfluorescence of intratumoral vessels on a hyperfluorescent tumoral background. The venous phase is when the hemangioma reaches maximal fluorescence, with evenly distributed hyperfluorescence and overlying hyperfluorescent extratumoral spots. Generalized hypofluorescence with residual hyperfluorescent caverns characterizes the late phase along with a well-delineated, but complex, border structure (24).
Self-assembled non-covalent protein-drug nanoparticles: an emerging delivery platform for anti-cancer drugs
Published in Expert Opinion on Drug Delivery, 2020
Islam A. Hassanin, Ahmed O. Elzoghby
In another study, Indocyanine Green was encapsulated in HSA. HSA-ICG NPs were prepared with a size distribution of 75 nm, which was confirmed by DLS. These NPs showed a temperature increase to 59.4°C upon NIR laser irradiation, which was sufficient for damaging tumor cells. In addition, these NPs showed an enhanced accumulation in the tumor cells up to 24 h post-injection, while free ICG concentrated in the liver with minimal retention in the tumor tissue. It was shown that fluorescence intensity of HSA-ICG NPs in 4T1 cancer cells was increased 10.3 folds in the HSA-ICG treated group compared to HSA-ICG treated with HSA blocking agent group, demonstrating higher cellular uptake attributed to SPARC targeting. Furthermore, free ICG fluorescence signals were detected to be extensively accumulated in the liver after 0.5 h post-injection and completely disappear after 24 h. However, tumor the fluorescence was enhanced and maximized 24 h post-injection in case of HSA-ICG NPs and fluorescence was further sustained and detected 7 days post-injection [93].