BACKGROUND Sentinel lymph node (SLN) biopsy originally was described as a means of identifying lymph node metastases in malignant melanoma and breast carcinoma. The use of SLN biopsy in patients with oral and oropharyngeal squamous cell carcinoma and clinically N0 necks was investigated to determine whether the pathology of the SLN reflected that of the neck. METHODS Patients undergoing elective neck dissections for head and neck squamous cell carcinoma accessible to injection were enrolled into our study. Sentinel lymph node biopsy was performed after blue dye and radiocolloid injection. Preoperative lymphoscintigraphy and the perioperative use of a gamma probe identified radioactive SLNs; visualization of blue stained lymphatics identified blue SLNs. A neck dissection completed the surgical procedure, and the pathology of the SLN was compared with that of the remaining neck dissection. RESULTS Sentinel lymph node biopsy was performed on 40 cases with clinically N0 necks. Twenty were pathologically clear of tumor and 20 contained subclinical metastases. SLNs were found in 17 necks with pathologic disease and contained metastases in 16. The sentinel lymph node was the only lymph node containing tumor in 12 of 16. CONCLUSIONS The SLN, in head and neck carcinomas accessible to injection without anesthesia, is an accurate reflector of the status of the regional lymph nodes, when found in patients with early tumors. Sentinel lymph nodes may be found in clinically unpredictable sites, and SLN biopsy may aid in identifying the clinically N0 patient with early lymph node disease. If SLNs cannot be located in the neck, an elective lymph node dissection should be considered. Cancer 2001;91:2077–83. © 2001 American Cancer Society.

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(123)I imaging is increasingly used in nuclear medicine but downscatter from high (>300 keV) energy emissions degrades the image and introduces variation in sensitivity with depth when imaging with a low energy collimator. A dual windowing technique using a matched window immediately above the principle window to correct for the effects of downscatter is described. The technique is shown to correct for the variation in sensitivity with depth and to reduce outlying scatter. Quantitative imaging of (123)I using a low energy collimator should always employ downscatter correction.

SummaryThe outlook for patients with colorectal liver metastases is poor. Microspheres have been combined with cytotoxics and administered via the hepatic artery in an attempt to improve tumour drug exposure within the liver. However, it has been suggested that arteriovenous connections might occur in association with intrahepatic tumours causing loss of regional advantage, and that the administration of microspheres further exacerbates arteriovenous shunting. In seven patients with colorectal liver metastases, base-line shunting was measured using a tracer quantity of radio-labelled albumin microspheres. The shunted fraction of a 'therapeutic quantity' of microspheres was subsequently measured in the same group of patients using albumin microspheres carrying a different radio-label. Base-line shunt for 0.5 x 106 microspheres was found to be 2.2 ± 1.8% (mean ± s.d.); the percentage shunt of a therapeutic quantity (40 -80 x 106) of microspheres was 3.0±0.8%. We conclude that arteriovenous shunting in patients with colorectal liver metastases is minimal, and is not significantly increased by the administration of therapeutic quantity of microspheres during regional chemotherapy.Conventional treatment of colorectal liver metastases has yielded disappointing results, and attention has turned to hepatic arterial chemotherapy. The potential advantages of regional therapy over systemic drug administration are that high drug levels can be achieved in the tumour-bearing organ and that systemic drug concentrations fall when the drug is retained within the organ, thereby minimising toxicity.Particle-bound regional chemotherapy has been used in an attempt to improve drug uptake by the target organ. There are two mechanisms of value. Firstly, cytotoxic drugs have been co-administered with biodegradable microspheres which temporarily slow hepatic arterial blood-flow in the tumourbearing liver and increase uptake of drug by the cells (Dakhil et al., 1982;Thom et al., 1989). Secondly, anti-cancer agents, including Adriamycin, mitomycin C, 5 fluorouracil, cis-platin and cytocidal radio-nuclides have been loaded into particles which act as controlled release vehicles in the target tissue Fujimoto et al., 1985;Okamoto et al., 1986;Herba et al., 1988).If, however, arteriovenous shunting were associated with liver metastases (Zeissman et al., 1983), a proportion of arterially administered drug would bypass vascular beds in the tumour-bearing liver and be carried to the lungs. The effect would be to reduce tumour drug exposure, increase systemic side-effects and in the case of some particle-bound cytotoxics, increase pulmonary toxicity.With both approaches for enhancing regional therapy, relatively large numbers of particles may be required, either because of the relatively low drug pay-loads associated with some cytotoxic-loaded microspheres, or in order to optimise the arrest of arterial blood-flow. Unfortunately, there have been reports that very high levels of shunting occur when large numbers of microspheres are injected into th...

Ž. Aims: the echocardiographic assessment of left ventricular ejection fraction LVEF by geometric methods is limited in many patients because of inadequate views and also in the presence of regional wall motion abnormalities due to ischaemic Ž . Ž . heart disease IHD . This study aimed to examine the application of a wall motion index WMI method, using a nine-segment Ž . LV model in patients with chronic heart failure CHF due to IHD. Methods and Results: echocardiography was performed in Ž . 71 consecutive subjects with CHF due to IHD. WMI could be derived in 70 subjects 99% . The inter-observer variability Ž . repeatability coefficient of WMI was 0.66, i.e. LVEF" 20%. In 66 subjects, LVEF was measured, within 4 weeks, using Ž . radionuclide ventriculography RNV-EF . The inter-observer variability of RNV-EF was "3.1%. Using the mean of two Ž . observations for each method, the Bland᎐Altman range of agreement for LVEF was 26% "13% . Conclusion: WMI is a widely applicable echocardiographic method for assessing LV systolic function and has moderate agreement with RNV-EF. Unlike RNV-EF, however, WMI is not likely to be a suitable method for the measurement of small, but prognostically important, changes in LV function that may occur in CHF. ᮊ