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Oncologic follow-up and surveillance after curative therapy for invasive breast cancer serves as a quality control of the primary treatment results, enables the early diagnosis and immediate treatment in case of recurrent disease, the detection and therapy of treatment-related side effects and late sequelae, and finally includes the psychologic support of tumor-free patients over decades, during which they are at risk for recurrent disease.

Unlabelled: Axillary clearance provides prognostic information, determines adjuvant therapy and reduces axillary recurrences. However significant morbidity may follow axillary dissection. Patients with small tumors (pT1a-c) may benefit from new less invasive (endoscopic lymph node dissection) or more selective (sentinel lymph node biopsy) axillary procedures which recently have been introduced. In this prospective study the axilloscopic approach was evaluated., Patients and Methods: 55 clinically node negative patients (mean age: 60 years [30-86]) had endoscopic axillary surgery by one single surgeon (1.1996-6.1998). After axillary liposuction individual lymph nodes (level I + II) were identified and removed under direct vision by means of a laparoscope (successful procedure in 95%; n = 52). Patients were followed every four months according to a institution based follow up protocol. Results of 51 patients (1 refused) were analyzed after a median follow up of 22 (7-37) months by self-evaluation questionnaire, interview and clinical examination (including: range of motion of the shoulder joint, circumferences of the upper extremities)., Results: An average of 13.3 (5-25) lymph nodes was endoscopically removed. Patients (n = 16; 31%) had involved nodes with a mean of 3.1 nodes positive per individuum. Seromas necessitated needle aspiration in 8 patients (15%). There were no hematomas and one low grade infection (2%). After a median follow up period of 22 (7-37) months no axillary relapse but one trocar site implantation metastasis (1/55, 2%) was detected and resected. No lymph edema was observed. Early range of motion of the shoulder joint was excellent., Conclusion: This technique allows the removal of an adequate number of lymph nodes for staging as well as for regional control. The morbidity is low and the medium-term follow-up results are promising. The atraumatic and very well tolerated endoscopic axillary dissection is being replaced by the selective sentinel lymph node procedure.

Background: Stereotactic biopsy techniques supersede conventional hook-wire localization followed by open excision to clarify the dignity of nonpalpable mammographic lesions. The advanced breast biopsy instrumentation (ABBI) allows stereotactically guided excision of a specimen up to 20 mm in diameter on an outpatient basis under local anaesthesia., Methods: Demographic information, mammographic and pathological findings, complications, subsequent interventions and sensitivity as well as efficiency of a series of 144 planned ABBI procedures were documented (largest published single institution series)., Results: The ABBI procedure was successfully performed in 93.8% (135/144); accurate diagnosis was made in 99.3% (134/135), sensitivity for malignant lesions was 96.9% (31/32) and morbidity was 1.5%. Consistent with other published series margins of the biopsy cylinder containing a malignant lesion were involved in 83.9% (26/31)., Conclusions: Excisional biopsy using the ABBI system is a reliable diagnostic tool with a low incidence of morbidity. The therapeutic use is of limited potential.

Background: Axillary lymph node dissection (ALND) is an integral part in the therapy of breast cancer. Axillary lymph node involvement and tumour size are the most important prognostic factors. Restriction of ALND to level I and II (Berg) reduced high morbidity. The increasing proportion of patients with early breast cancer and negative axillary nodes led to a more selective method to avoid unnecessary ALND. The sentinel lymph node (SLN)--the first draining lymph node of a tumour--represents the status of the axilla. A negative SLN prevents from further completion ALND., Patients and Methods: From 9/97 to 1/99 44 patients with invasive breast cancer underwent a prospective trial of lymphatic mapping with isosulfanblue and/or lymphoscintigraphy with 99m technetium-labelled human colloid. During the operation a hand-held gamma probe was used for detection. The SLN was removed selectively and examined by routine histopathology (H&E) and immunohistochemistry (IHC). ALND of level I and II was performed in all patients for correlation., Results: The SLN were identified in 41 of 44 patients (93%). 2.4 SLN per patient were harvested, overall 17.6 axillary lymph nodes. Of the 41 patients, 21 patients had positive, 20 patients negative SLN. In the 20 patients with negative SLN only one patient (5%) had metastatic disease on complete dissection (negative predictive value of 95%). In 17 patients with positive axillary lymph nodes 16 were found to have positive SLN, only one SLN was negative (false negative rate of 5.9%). In two of 41 patients micrometastases were detected by IHC. Lymphoscintigraphy revealed drainage to the axilla and internal mammary nodes in two of 28 cases (7%)., Summary: Our validation study proves the reproducibility and reliability of the SLN procedure. A multidisciplinary approach is indispensable. The SLN procedure has the potency for becoming the selection criterion whether to perform an ALND or not. Multiple sections and IHC staining improve the detection rate of metastatic disease. Ongoing long time investigations will determine the impact on overall survival. Our own data are discussed in an extended review of the literature.

Recurrent inguinal hernia represents a great problem in surgery given the frequency of this operation, with a recurrence rate of 0.5-8%. Re-recurrence after repair without implantation of a prosthesis occurs in 1-23% of cases. We analyzed our results of patients with recurrent inguinal hernia, operated according to the method of Stoppa. Between 1989 and July 1994 there were 58 operations upon 55 patients with an average age of 65 years, 79% of whom had unilateral and 21% bilateral hernias. 89% of all patients underwent surgery because of a recurrent inguinal hernia. A Marlex mesh was used in 79% of the case. All patients were followed up (mean 35 months, minimum 12 months). Early complications consisted in one hematoma (1.7%), which had to be drained, as well as one early recurrence (1.7%). No infections were observed. The overall recurrence rate was 12%. However, 60% of all recurrences occurred in the few first years after introduction of this technique at our clinic; with growing number of operations and experience with Stoppa's technique, we obtained a recurrence rate of 6-7% per year. In our opinion, supported by the results of other studies, Stoppa's technique is a successful method in the treatment of recurrent inguinal hernia.

The question of separation of the epiphyses in infants and small children of the type Salter-Harris affecting the distal humerus is discussed. The indications for open reduction of the distal humerus epiphyseal separation is rarely indicated and should only be utilised when there is associated injury to the nerves of vessels or a total disruption of the chondyle. Provided that accurate re-position and fixation can be performed, the prognosis of this injury is satisfactory.