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The purpose of this study is to emphasize the usefulness of combined intraoperative gamma-detecting-probe (C-Trak) and blue dye guided research of sentinel nodes (SN) in the treatment of cutaneous melanoma.At the Department of General Surgery of Macerata Hospital, after informed consent, 22 consecutive patients (10 males and 12 females) with mean age 53 years (20-78 years) affected by histologically proved cutaneous malignant melanoma in stage I (TC, ultrasonography and bone scintigraphy) were studied by dynamic lymphoscintigraphy with 10.8-22.2 MBq of 99mTc albumin microcolloids 18-22 hours before surgery and by intradermal injection of blue dye at induction of anaesthesia. Intraoperative mapping technique to localize SN has been done by using a combination of a vital blue dye and a radioactive tracer.A total of 42 SN were identified. Micrometastases were found in 2 (9.1%) patients; 13 SN were well-coloured (31%), 23 SN were poorly-coloured (55%), and 6 SN were not coloured (14%). Overall localization with blue dye was 86%. All SN were radiolabeled, but identification with gamma detecting probe was possible only in 41 cases (95%). Combined techniques was effective in 100% of cases.Combined use of radiocolloids and blue dye is the gold standard for correct identification and biopsy of SN with 100% of favourable results. The technique is simple, fast and effective and permits to select the patients that need other surgical and oncologic procedures.

The authors present an original reconstruction technique after pancreaticoduodenectomy, with anastomosis between the pancreatic stump and the posterior wall of the stomach, using two Roux-en-Y loops to separate the hepaticojejunostomy from the pancreaticogastrostomy and gastrojejunostomy in order to reduce postoperative complications and mortality. Eighteen consecutive patients underwent the procedure. There was no mortality and no pancreaticogastrostomy leaks occurred. Two (11.1%) gastric bleeds occurred in the first two cases. Twelve cases (66.6%) presented alimentary emesis on postoperative day 5 or 6 after food intake. Three patients (16.6%) had postoperative diarrhea. There were no complications calling for reoperation. The mean hospital stay was 14.4 days. No significant late complications were observed. The procedure is easy and safe with no mortality and with one of the lowest complication rates in the literature.

Lymphadenectomy for rectal cancer, whether by open surgery or laparoscopy, is still a controversial subject. If we consider that approximately 20% of patients have nodal obturator metastases, then we must concede that extended lymphadenectomy is useless in the other 80% of patients. We set out to determine whether lymphoscintigraphy could show the lymphatic drainage from the cancer toward the obturator lymph nodes and thus help us to select the patients who would benefit by their removal. We also analyzed the possibility of applying the concept of the sentinel node to the treatment of rectal cancer.Among 42 people who underwent laparoscopy for rectal cancer 11 patients with TNM stages T2-T3N0M0 were studied by CTMRI, rectal ultrasonography, and lymphoscintigraphy with a colloidal injection of human albumin labeled with 99mTc at the base of the neoplasm. Afterward, the 11 patients underwent a lymphadenectomy that extended to the obturator nodes.In two patients, lymphoscintigraphy showed lymphatic drainage toward the obturator nodes. In one case, there were metastases. Lymphoscintigraphy did not show lymphatic drainage toward the obturator nodes in any of the other patients, and there were no metastases among them. It was not possible to identify a sentinel node.Lymphoscintigraphy can be used to select patients with rectal cancer who will be helped by a lymphadenectomy extended to the obturator nodes. However, the concept of the sentinel node cannot be applied to rectal cancer.

We investigated the efficacy of interventional radiology procedures in some patients with iatrogenic injuries of the biliary tree from laparoscopic cholecystectomy.In the last two years, 8 patients with complications of laparoscopic cholecystectomy were treated in the Department of Radiology of Umberto I Hospital, Ancona, Italy. Five of them had a subhepatic biliary collection due to a cystic duct stump leak, 2 has a leak of the Roux-en-Y hepaticojejunostomy (from a iatrogenic injury of the common biliary duct) and 1 had a right hepatic biliary duct stricture from a clip. In the patients with a cystic duct stump leak, we treated the biloma with percutaneous catheter drainage and the endoscopist positioned a nasobiliary tube, while a percutaneous abdominal catheter was positioned to drain the biloma and a percutaneous transhepatic catheter was positioned through the biliary duct tract or through the hepaticojejunostomy.All injuries were completely repaired within 5-8 weeks of the procedure. There were no maneuver-related complications. All patients had normal serum levels of bilirubin, alkaline phosphatase and transaminase at the monthly follow-up tests performed for 3 months. US and MR cholangiopancreatography at 3 months excluded strictures, fistulas or bilomas of the biliary tree.The prompt detection of the injuries is essential to the success of interventional radiology procedures: the patients are less debilitated, small caliber catheters can be used and recovery is quicker. The combined effort of surgeons, endoscopists and radiologists is necessary to optimize the management of patients with laparoscopic cholecystectomy-related biliary complications.We obtained positive results with minimally invasive procedures costing less than another operation. Thus, we suggest that interventional radiology procedures become the method of choice in patients with iatrogenic injuries of the biliary tree after laparoscopic cholecystectomy.