No abstract

BACKGROUND: Lymphatic mapping and sentinel lymph node (SLN) biopsy are new techniques used in the surgical treatment of patients with malignant melanoma. These procedures have the potential to change the surgical treatment of the disease to provide a more rational approach to adjuvant therapy. METHODS: A prospective database of melanoma patients undergoing lymphatic mapping and SLN biopsy was reviewed to identify prognostic factors for overall and disease-free survival in this patient population. RESULTS: Five-year overall and disease-free survival was 92.3% and 79.0%, with a median follow-up of 17 months. The number of histologically positive SLNs was the most powerful predictor of overall and disease-free survival. Patients with no histologically positive SLNs had a five-year overall and disease-free survival of 97.9% and 93.3%, respectively. Tumor ulceration and Clark level greater than or equal to III were the significant prognostic factors for survival. CONCLUSIONS: The use of lymphatic mapping and SLN biopsy effectively stages patients with primary cutaneous melanoma. Additionally, the presence of histologically positive SLNs is the most powerful indicator of overall and disease-free survival for these patients.

These data support the fact that cutaneous lymphatic drainage patterns are maintained in patients with grossly involved basins, thus buttressing the idea that the SLN is the node most likely to develop metastatic disease. Gross disease in the basin does not significantly alter cutaneous lymphatic flow into the regional basin, as the sentinel lymph node identified under these circumstances is the same as with the grossly involved node. Preoperative lymphoscintigraphy in patients who present with grossly involved nodes in one basin may identify other regional basins with micrometastatic disease and deserves further study in this setting.

<p class="abstract"><strong>Background:</strong> The aims of the study were to evaluate the various etiological factors of obstructive sleep apnoea syndrome and to make recommendations based on study findings.</p><p class="abstract"><strong>Methods:</strong> The study group consists of 60 patients who are diagnosed clinically and polysomnographically to have obstructive sleep apnoea syndrome at ENT and Pulmonary Medicine outpatient departments.  </p><p class="abstract"><strong>Results:</strong> Most cases of severe OSA were in age group of 21-40 (47.8%). No significant association was observed between age distribution and severity of OSA (p=0.295). A significant association was observed between obesity and increasing severity of OSA (p&lt;0.05). The mean AHI of patients with mild, moderate and severe OSA was 8.45, 23.31 and 49.07 respectively (p&lt;0.05). Enlarged adenoids, narrow oropharyngeal inlet, bulky tongue, enlarged tonsils and greater neck circumference were significantly associated with OSA (p&lt;0.05). No significant association between DNS, ITH, concha bullosa and enlarged adenoids with OSA (p&gt;0.05).</p><p class="western"><strong>Conclusions:</strong> Certain naso-oro-pharyngeal parameters were found to be significantly associated with obstructive sleep apnoea syndrome viz. enlarged adenoids, bulky tongue, greater neck circumference and narrow<strong> </strong>oropharyngeal inlet. Patients with these features should further be investigated with CPAP titration polysomnography and surgical intervention. </p>