(2006) The role of preoperative lymphoscintigraphy in surgery planning for sentinel lymph node biopsy in malignant melanoma. Wiener klinische Wochenschrift, was performed four to six hours prior to operation of the patient. Sentinel lymph node biopsy using intraoperative hand-held gamma probe was performed in all patients, as well as wide local excision of biopsy wound or primary lesion (N=56). Immediate complete basin dissection was performed in patients with sentinel node metastases. In four patients delayed complete lymph node dissection was performed due to definitive histopathologic examination of sentinel node. The accuracy of sentinel node biopsy was determined by comparing the intraoperative rates of sentinel node identification and the subsequent development of nodal metastases in regional nodal basins of patients with tumor negative sentinel node and in those with tumor positive sentinel node.Results. By preoperative lymphoscintigraphy we identify sentinel node in all but one patient (99.0%). In 248 nodal basins (1.2/patient) 372 sentinel nodes (1.52 sentinel/basin; 1.8 sentinel/patient) were observed. The highest number of sentinel nodes was noticed in the groin of patients with melanoma on lower extremities (1.5/patient), followed by axilla with 1.3 per patient. Anomalous lymphatic drainage patterns were observed in 15.0% of all patients. Sentinel node identification rate was 99.0% overall; 100% for the groin basins, and 98.0% for the axilla and head and neck basin. Forty-two patients (20.8%) had tumor positive sentinel nodes. Local or distant recurrences had 10 (5.0%) patients during median follow up of 23.1 months (range 2-46 months). The rate of false-negative lymphatic mapping and 3 sentinel node biopsy as measured by nodal recurrence in a tumor-negative SN patients was 1.3%. During the follow-up period three of 201 patients died due to the other diseases and three patients died due to the melanoma metastases, with median follow up of 13.5 months (range 12 to 22). Conclusion.Preoperative lymphoscintigraphy is sensitive, inexpensive and essential method for the identification of drainage basins, determination of number and position of sentinel node and its location outside the usual nodal basins. Scintigraphic findings may lead to changes in surgical management due to the unpredictability of lymphatic drainage. Low incidence of regional disease recurrence in patients with tumor negative sentinel node supports the use of preoperative lymphoscintigraphy and sentinel node biopsy as a safe and accurate procedure for staging the regional nodal basin in patients with malignant melanoma.

Melanoma inhibitory activity (MIA) protein was identified in significant quantities in primary and metastatic malignant melanomas, where it has an important role in promoting tumor development and progression. Our hypothesis was that MIA serum level will be elevated in patients with metastases or local spreading of the disease before any symptom of such progression is clinically apparent. We compared MIA serum levels in two groups of patients with primary melanoma; those with positive as opposed to those with negative sentinel lymph nodes. In addition, MIA serum levels were studied in two control groups; patients with dysplastic nevi and patients with basal cell carcinoma. A blood sample was obtained from each patient included in the study and MIA levels were assessed using standard enzyme-linked immunosorbent assay method. Patients with histologically positive sentinel lymph nodes, meaning that tumor cells were found in the lymph nodes, had much higher mean MIA values than any other patient group considered in this study. With mean value of 14.53 ng/ml, it was almost twice as high as mean MIA value in patients with histologically negative sentinel lymph nodes (7.32 ng/ml) and more than twice as high than any of the two control groups (P<0.001). However, neither the classification by Clarke nor the classification by Breslow could be used to distinguish patients with positive sentinel lymph nodes from those with negative sentinel lymph nodes. In our opinion, MIA serum level is the ideal test for screening the tumor spread to sentinel lymph nodes.

We present a case of left proximal vertebral artery (PVA), internal jugular and subclavian vein rupture after descending necrotizing mediastinitis (DNM) initially treated in another surgical institution with antibiotic therapy and left-sided cervicotomy, collar incision and drainage of the left thorax. On day 23 followed by surgical intervention due to the disease propagation, after daily dressing exchange of wound healed on second intention, a life-threatening complication of mixed, massive arterial and venous bleeding developed. The patient was emergency transferred to University Clinic and undergo prompt surgical repair. The jugular and subclavian veins destroyed by suppurative process were sutured. Vein bypass to the PVA was performed. His postoperative course was uneventful and he was discharged home on the 30th postoperative day. We performed the evaluation of DNM-literature review. The articles were collected from 1970 to 2005 (44 reports). Our search did not find any adequate published studies of the relationship between vascular complications described in these case and DNM. We report this case because there have been no previous reports in the literature.

We would like to congratulate the authors on their detailed cost analysis of VATS lobectomy [1]. Their results and conclusions regarding the differences in intra-operative costs

EuroSCORE topicality. In this work, we have tried to compare EuroSCORE and CABG models. Although 'comparisons' represent interesting and informative analyses, epidemiologists know that a complete variable definition overlapping between studies is quite impossible to reach. We often have to accept intermediate situations, provided that differences are declared in advance and findings interpreted with caution. This concept suits our usual behavior and represents what we actually did in this work.In conclusion, debate on results represents a worthy instrument for the development of scientific research. This is true also for outcome research studies, which can be carried out only with the contribution of different professional figures. Each of them with his own knowledge and limits, admitting and respecting competence and values of all the others. Unfortunately, this does not always happen!