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Lymphoscintigraphy
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Rimma Axelsson, Maria Holstensson, Ulrika Estenberg
The rule of thumb is that the first visualized lymph node with the highest uptake of the radiotracer, located closest to the injection site, is defined as an SLN. In practice there could be more than one lymph node in a nodal basin. All lymph nodes in the same basin with tracer uptake are considered SLNs and are removed during surgery. This surgical procedure is called a Sentinel Lymph Node Biopsy (SLNB).
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
How would you treat it?Request a full thickness punch biopsy for diagnosis6 (shave would miss a deep cancer in the skin).Make a wide local excision with minimum margin of 4 mm − wider (6 mm) for poorly differentiated and larger lesions. Lymph node dissection and radiotherapy are considered for metastatic nodal spread.
Cardiology
Published in Paul Bentley, Ben Lovell, Memorizing Medicine, 2019
Escape beats: When another area of the heart generates the impulseUsually occurs when sinus node not working/going too slowTypes: AtrialAV nodal: Ongoing AV escape beats = nodal or ‘junctional’ rhythmVentricular: Fast ventricular rhythm = ventricular tachycardia (VT)Slow rhythm = idioventricular rhythms (occurs in complete HB)
Cardiovascular responses to hot skin at rest and during exercise
Published in Temperature, 2023
Ting-Heng Chou, Edward F. Coyle
The heart rate invariably increases with core hyperthermia [21,65,75,79,80]. Heart rate is affected by temperature in two ways: 1) the direct effects on intrinsic heart rate through cardiac nodal cells (sinoatrial and atrioventricular) and 2) the effects on autonomic nervous system activity. The direct effect of temperature on intrinsic heart rate, independent of autonomic nervous system activity, has been demonstrated in animals [81,82], isolated heart [83,84], embryo [85–87], and human [46]. Heat stress is a hyperadrenergic state that increases sympathetic noradrenergic signaling and circulating catecholamines [61,75,76]. Heat stress also decreases cardiac parasympathetic effects [88–91]. During passive heat stress in baboons, Gorman and Proppe [92] reported that ~40% of the increase in heart rate was accounted for by cardiac temperature and ~60% was due to autonomic influences. In addition, the autonomic control of the increases in heart rate with heat stress was attributed to ~25% sympathetic activation and ~75% parasympathetic vagal withdrawal.
Unilateral Retinal Arteritis and Macroaneurysm in Sarcoidosis
Published in Ocular Immunology and Inflammation, 2022
Raziyeh Mahmoudzadeh, Anand Gopal, Rebecca Soares, James P. Dunn
During inpatient evaluation, the patient developed complete atrioventricular (AV) nodal block requiring pacemaker placement. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging demonstrated innumerable hyper-metabolic nodules in the mediastinum, liver, spleen, and bony skeleton in addition to hilar lymphadenopathy, prompting subsequent diagnostic bronchoscopy. Histop-athologic examination of the biopsied hilar nodes revealed non-caseating granulomas, confirming the diagnosis of sarcoidosis in this clinical context. She was treated with intravenous (IV) methylprednisolone 1 gram daily for 3 days and discharged on a course of oral prednisone. On discharge, her vision in the left eye had improved to 20/100. She was subsequently referred to a rheumatologist and initiated on methotrexate and later transitioned to infliximab for systemic disease control.
In-Silico Analysis of Differentially Expressed Genes and Their Regulating microRNA Involved in Lymph Node Metastasis in Invasive Breast Carcinoma
Published in Cancer Investigation, 2022
Anupama Modi, Purvi Purohit, Ashita Gadwal, Shweta Ukey, Dipayan Roy, Sujoy Fernandes, Mithu Banerjee
Axillary lymph node status is an important prognostic factor in BC. An increase in the number of metastatic lymph nodes is associated with decreased OS and DFS (4,5). Axillary lymph node status is also pivotal in determining the course of management, e.g. radiotherapy in patients with LNM metastasis (23,24). Accordingly, the better prognosis of node-negative patients of BC is attributed to timely resection before distant metastasis via the axillary lymphatics has occurred (25). The number of these metastatic lymph nodes are those that are dissected by the surgeon and examined by the pathologist. However, various studies have shown that the metastatic lymph nodes are greater in number with an increasing number of removed nodes. Thus, it is difficult to assess the axillary lymph node status reliably without removing and identifying sufficient lymph nodes depending on the surgeon and pathologist (26–28). Further, nodal status identification involves lymph node biopsy, which can potentially cause secondary complications. Therefore, there is a need for an appropriate non-invasive method to identify patients with and without LNM. Identifying candidate genes related to nodal metastasis can aid in the better evaluation and subsequent management of these patients. Furthermore, BC metastasis is molecularly distinct from its primary tumor counterparts. In our study, all the hub genes were tumor suppressors, and hence, we see a downregulation for all the hub genes except KRT81 (Figure 7(e)). Accordingly, a decreased OS is associated with a low expression of these genes, as observed in Figure 6.