Este estudo visa identificar o linfonodo sentinela por meio da injeção exclusiva de radiofármaco periareolar subdérmico em quatro pontos, independente da topografia do tumor. A biópsia do linfonodo sentinela diminui a morbidade no estadiamento da axila. Foram realizadas 57 biópsias do linfonodo sentinela, em pacientes com câncer de mama, prospectivamente, em dois grupos: grupo A (25 pacientes) e grupo B (32 pacientes). Realizamos a injeção do radiofármaco peritumoral no grupo A, e nova técnica periareolar em quatro pontos no grupo B. A biópsia do linfonodo sentinela foi estudada por "imprint" citológico e hematoxilina e eosina, seguida de linfadenectomia axilar no grupo A e nos casos positivos do grupo B. No grupo A foram identificados 88% (22/25) de linfonodos sentinelas, não houve falso-negativo, com sensibilidade e especificidade de 100%; no grupo B foram identificados 96% (31/32) de linfonodos sentinelas e valor preditivo positivo de 100%. O número de linfonodos sentinelas variou de 1 a 7, moda de 1 e média de 2,7, a área de maior captação variou de 10 a 100 vezes. A injeção periareolar em quatro pontos se apresenta como bom método no mapeamento linfático para identificação do linfonodo sentinela. A padronização deste sítio pode ser o de escolha para identificação do linfonodo sentinela, sendo necessário maior número de casos para confirmação destes achados.
A reliable correlation was found for left ventricular ejection fraction as obtained by gated SPECT and magnetic resonance imaging in patients undergoing CABG. For ventricular volumes, however, the correlation is not adequate.
Takotsubo syndrome, which has been recently described by Japanese authors, is characterized by a reversible abnormality of the ventricular wall movement, with a morphological aspect similar to a balloon, or more precisely, from a semantic point of view, to an amphora-like octopus trap, at the apical segment levels of the heart and hypercontraction of the basal segments observed during the coronary arteriography with ventriculography, associated with electrocardiographic ST-T segment alterations, similar to an acute myocardial infarction episode, with minimal elevation of cardiac enzymes, affecting preferentially elderly females and being induced by physical or emotional stress 1 . The diagnosis of this entity is reinforced by the almost complete absence of coronary circulation morphostructural alterations. Another aspect that is noteworthy is the rapid duration of the asynergy of the ventricular wall movement, eventually contrasting with the longer duration of the clinical manifestations. The etiology of the disease is not fully known, and the role of coronary microcirculation involvement at a multivascular level (severe expression of microvascular angina), and, more recently, the possibility of the participation of altered adrenergic catecholamine dynamics at myocardial level has been hypothesized 2,3 . The exceptional circumstances of the case reported here are due to the simultaneous presence of two conditions that are potentially harmful to the heart, i.e., systemic lupus erythematosus and morbid obesity, associated with this unusual form of cardiomyopathy induced by acute stress. Pericardial and endocardial alterations, vasculitis of the coronary circulation as well as congenital heart block in neonatal lupus briefly constitute the classical cardiac alterations of this auto-immune disease. The impact of morbid obesity on the cardiovascular system is basically caused by the effect of systemic arterial hypertension, dyslipidemia, diabetes and hypoxemic pulmonary arterial hypertension, being broadly known aspects of the disease in the specialized literature.
Aspectos cintilográficos da perfusão miocárdica no bloqueio de ramo esquerdo e sua correlação com a ecocardiografia de contraste e a ressonância magnética.
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