IntroductionHaemorrhoidal disease is the most frequent benign anorectal disease. Conservative, minimally invasive and surgical methods are used in the treatment of haemorrhoidal disease. Radiofrequency thermoablation is a popular new technique in the treatment of varicose veins.AimAssessment of the use of the method in the treatment of haemorrhoidal disease using bipolar radiofrequency-induced thermotherapy (RFITT or so-called Celon method).Material and methodsWe used the CelonLab PRECISION (Celon AG medical instruments, Teltow, Germany) with the bipolar RFITT applicator Celon ProBREATH for the treatment of haemorrhoidal disease stages III and IV.ResultsIn the Department of Surgery at the Atlas Hospital in Zlin, Czech Republic, a total of 71 patients were treated from 9/2007 to 10/2010 with this new treatment approach. The success rate was 100%, local recurrence rate was 2.8%, and medium-term satisfaction of patients who underwent the procedure was 99.5%. Complications appeared in 4.26% of cases.ConclusionsThe new RFITTH technique for treatment of advanced stages of haemorrhoidal disease is a new treatment modality with good curative response, low level of complications, minimum pain and quick return of patients to their usual activities.

Sentinel lymph node biopsy (SLNB) has emerged as an alternative to axillary lymph node dissection during breast cancer surgery during the last 2 decades. However, there are several controversies regarding the indication of the sentinel node biopsy after neoadjuvant chemotherapy which can convert positive lymph nodes to negative. The false negative rate after neoadjuvant chemotherapy is unacceptably high. This high false negative rate can be decreased by marking of the positive lymph nodes and removal during sentinel lymph node biopsy procedure in addition to the sentinel lymph nodes. The aim of this study was to investigate the possibility of carbon tattooing of the positive sentinel lymph nodes before neoadjuvant chemotherapy. In 2016, a prospective protocol was launched investigating the black carbon tattooing procedure of the suspective and positive axillary lymph nodes by injecting 0.1-0.5 carbon ink in normal saline under ultrasound guidance. All patients underwent black carbon tattooing of the suspected or positive axillary lymph nodes before the chemotherapy or one week before the primary surgery when chemotherapy was not indicated in the neoadjuvant setting. Sentinel lymph nodes together with lymph nodes marked by the black carbon ink were removed and histologically evaluated. So far 27 patients were treated under this protocol. Breast saving surgery was performed in 22 cases and mastectomy in 5 cases. All patients had invasive ductal carcinoma. In 20 patients neoadjuvant chemotherapy was indicated and in 7 patients primary surgery was performed. All lymph nodes marked by black carbon ink were successfully identified and removed. Sentinel lymph node biopsy was performed in 8 cases and sentinel lymph node biopsy followed by axillary dissection in 15 cases. Axillary dissection alone was performed in 4 cases. In 19 cases the black carbon ink was present in the sentinel lymph node at the same time and in 4 cases carbon dye was present in other lymph nodes than lymph node identified during SLNB, which corresponds to 17.4%. In the group of patients undergoing primary surgery, in one case from six, the sentinel lymph node was negative and the lymph node marked with carbon ink positive which represents false negative lymph node and failure of the SLNB procedure. After neoadjuvant chemotherapy, there was no false negative lymph node identified, but the conversion of the positive lymph nodes to negative was present in 10 cases (50%). There were no complications attributed to carbon ink tattooing.

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4047 Background: Lymph node (LN) status is the most important prognostic factor in colon cancer (Cca). In various trials, the average nodal positivity of conventional surgery in Cca is about 33%. Ultrastaging of SLNs results in higher and more accurate nodal staging of patients (pts) with Cca. However, some recent publications of SLNM in Cca have shown variable results with differing conclusions. Hence, prospective data from 3 continents were analyzed to study the international experience of SLNM in Cca. Methods: Only centers with experience of 40 or more cases of SLNM in Cca were included in the study. SLNM was performed by peri-tumoral injections of 1–3 ml of 1% lymphazurin. First 1–4 blue nodes marked as SLNs were ultrastaged by multilevel microsections for H&E and IHC. Data for calculating the success rate, accuracy, skip metastases (mets), sensitivity, negative predictive value; nodal positivity and upstaging were collected from each center. Results: Our study included a total of 1,216 Cca pts from 9 centers over 3 continents. SLNM was successful in 92.9% pts ( Table 1 ). The average number of LN/pt was 18.5 and the average number of SLN/pt was 2.7. The overall sensitivity, accuracy rate and negative predictive value were 78.3%, 89.4% and 82.8% respectively. Nodal mets were found in 52.9% pts. Of these, SLNs were the exclusive site for mets in 30.1% pts while 18.3% pts were upstaged by SLNM. Skip mets were seen in 21.7% pts (range 9.5% - 44.1%). Conclusions: SLNM is highly successful in Cca when performed by experienced surgeons worldwide. Nodal positivity was found to be much higher in pts undergoing SLNM compared to conventional surgery. Upstaged pts may benefit from adjuvant chemotherapy. Though the variation of skip mets was wide, the clinical impact of skip mets in Cca is negligible compared to that in melanoma and breast cancer, since all pts undergo standard lymphadenectomy and all node positive pts (true +ve & skip mets) are usually treated with adjuvant chemotherapy. [Table: see text] No significant financial relationships to disclose.

Karcinom prsu u mužů je řídké onemocnění a reprezentuje pouze 1 % všech karcinomů prsu. Histologicky dominuje invazivní duktální karcinom s 10% podílem karcinomu in situ. Další histologické typy jsou výjimečné. Na rozdíl od žen, u kterých molekulární subtypy vykazují značnou diverzitu, u mužů významně převažují typy citlivé na hormonální receptory. V chirurgické terapii dominuje mastektomie s biopsií sentinelové uzliny nebo disekcí axily. Adjuvantní radioterapie vždy navazuje na prs záchovný výkon a po mastektomii je indikována dle rozsahu onemocnění. V adjuvantní systémové terapii převažuje hormonální terapie s dominancí Tamoxifenu. Mužský karcinom má množství společných vlastností s ženským karcinomem, proto léčba vychází ze zkušeností s léčením ženského karcinomu. Nové poznatky o mužském karcinomu potvrdily i odlišné vlastnosti, a tak vzniká naléhavá potřeba nových studií, které jsou zaměřeny pouze na karcinom u mužů.Klíčová slova: mužský karcinom, epidemiologie, chirurgická terapie, adjuvantní terapie. Male breast cancerMale breast cancer is rare disease and it represents 1 % breast cancer. Invasive ductal cancer dominates in histology with 10 % portion in situ carcinoma. Other histology types are extraordinary. Female breast carcinoma has different diversion in molecular subtype than male carcinoma, which is predominant hormonal sensitive. Mastectomy is procedure of choice with sentinel node biopsy or axillary dissection in surgery. Radiotherapy is used after breast conservative procedure. Indication after mastectomy depends on stage of the carcinoma. Hormonal therapy is mainly applied in adjuvant therapy and mostly with Tamoxifen. Male carcinoma is very similar with female carcinoma but is not identical. Medical care come out from experience with treatment female carcinoma. Contemporary knowledge about male carcinoma needs new trials oriented on male carcinoma.