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Maladaptive Daydreaming (MD) is an excessive absorption in vivid fantasies interfering with individuals' daily functioning, which has been associated with adverse psychological outcomes and adult attachment insecurities. However, no study to date has addressed the relationships between MD, parental care, unresolved attachment, and psychological symptoms (depression/anxiety and obsessive-compulsive disorder; OCD) in a sample of young adults. In this study, 1295 young adults (401 males) completed an online survey including the Parental Bonding Instrument, Maladaptive Daydreaming Scale, Adult Unresolved Attachment Questionnaire, and the DSM-5 Level 1 Cross-Cutting Symptom Measure. The results evidenced the differential contribution of maternal and paternal care on individuals' psychological symptoms; whilst higher maternal care was negatively related to OCD symptoms, higher paternal care was negatively linked to depression/anxiety symptoms. A relationship between unresolved attachment, MD and psychopathological symptoms emerged; specifically, MD mediated the relationships between unresolved attachment and depression/anxiety and OCD symptoms. Overall, paternal and maternal care may have distinct roles in predicting individuals' psychopathological outcomes. In the presence of unresolved attachment, MD may represent a dissociative response that allows individuals to deal with negative experiences through psychopathological symptoms. Understanding the specific pathways that lead to different psychopathological outcomes could have important implications in developing preventive clinical interventions., Competing Interests: Declaration of competing interest None., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study aimed to explore the experiences, needs, and interests of queer people who are also neurodivergent, or live with a chronic illness or disability (i.e. IMMI: individuals with multi-minority identities) in Italy and the Netherlands. Five focus groups were conducted in Italy with 22 queer IMMI to identify their most relevant topics regarding and experiences with sex education. Building on the discussion topics of the focus groups, a survey in Italian and English was distributed via snowball sampling. The survey was created to explore the experiences related to sex education in the two countries. The final sample of respondents included 138 (97 Italian, 41 Dutch) queer IMMI. Results indicated that sex education received in both formal (e.g. school) and informal (e.g. family) contexts failed to include information that was sensitive and supportive of queer community's experiences. Participants reported the need to explore more topics addressing the specific needs of different identity intersections. Cross-cultural differences related to the experiences of Italian and Dutch participants were found. Overall, current sex education in Italy and the Netherlands is far from meeting the sexual health needs of queer people living with different intersections. Practical implications are discussed.

Context: The ballet institution is known for its aesthetic and performative standards. In professional dancers' everyday lives, self-improvement and body awareness entwine with striving for artistic excellence. In this context, 'health' has primarily been explored in relation to eating disorders, pain, and injuries., Aim: This paper explores dancers' health practices, namely how they are shaped by the ballet institution and how they relate to broader health discourses., Methodology: A reflexive thematic analysis was conducted upon interviews with nine dancers (each interviewed twice) using a theoretical framework based on the concepts of greedy institutions and biopedagogies., Analyses: Two themes were developed: What it takes to be an 'insider' of the ballet institution and Learning to develop an acute embodied self-awareness . Dancers described ballet as a 'lifestyle' rather than a 'job'; practices of self-care defined by continuous self and body work were framed as necessary to meet the demands of this lifestyle. Participants 'played with' institutional and societal norms, often resisting docile bodies promoted within the ballet institution., Conclusion: Dancers' constructions of health and the art of ballet as not fitting neatly into 'good' nor 'bad' make room to consider the tensions between adopting and resisting dominant health discourses in this institution.

Background: The quality of early experiences with caregivers affects individual adjustment and can modulate adults' responses to salient social stimuli, like infant faces. However, in the framework of Interpersonal Acceptance-Rejection Theory (IPARTheory), no research to date has examined whether early experiences of acceptance or rejection from caregivers are associated with individual differences in the electrophysiological (EEG) responses to infant faces., Objective: This study examined the associations between the perceived quality of care during childhood and the behavioral and EEG responses to infant and adult faces in non-parent young adults., Methods: N = 60 non-parent young adults (30 males; 30 females) completed an Emotion Recognition task displaying emotional and unemotional infant and adult faces during an EEG recording. Memories of past care experiences with mothers and fathers were collected using the short form version of the Parental Acceptance-Rejection scale., Results: At the behavioral level, slower Reaction Times (RTs) in recognizing all faces were related to higher levels of perceived maternal rejection in young adults; in particular, males who reported higher levels of maternal rejection displayed longer RTs in recognizing faces compared to females. At the neurophysiological level, as the level of perceived paternal rejection increased, the N170 amplitude to infant faces increased. Females who reported higher levels of paternal rejection, compared to males, had a larger increase in the N170 amplitude and a larger decrease in the LPP amplitude in response to emotional faces., Conclusions: While a higher perception of maternal rejection hindered the behavioral responses of adults in recognizing faces, those who felt more rejected by their own father during childhood showed an enhanced N170 amplitude to infant faces. This might reflect a greater need for discrimination resources, at a very early stage of infant face processing, in those adults who perceived higher levels of paternal rejection. Adults' sex modulated the associations found at the behavioral and neurophysiological levels. Overall, our findings extended the IPARTheory postulates that being neglected during childhood might trigger perceptual changes in adults, hindering the elaboration of social cues like infant and adult faces at different levels., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

While research has shown that the attentional bias to infant faces predicts the quality of infant care, the antecedents of this cognitive process have been less established. In particular, it remains unknown whether the attentional bias to infant faces might be affected by the interplay between different factors, including memories of past experiences of care, adults' sex, and the experience of parenthood. To extend previous results, we examined the attentional bias to infant faces in a mixed sample of parents ( n = 99) and nonparents ( n = 102), and whether it varied in relation to parental status, sex, the quality of past experiences of care, and the interactions between these factors. A modified go/no-go task was used to compare the effect of adult and infant faces in retaining adults' attention. Memories of past experiences of paternal and maternal care were collected using the short form of the Italian version of the Parental Acceptance-Rejection scale. Results confirmed that infant faces induced greater attentional interference compared to adult faces. A heightened attention to all types of faces was found in parents versus nonparent. Women, as compared to men, were slower in the task performance, and allocated more attention to infant versus adult faces. Consistent with previous evidence, the attentional prioritization of infant faces varied in relation to previous experiences of care with one's own mother; individuals who remembered a more accepting maternal care allocated more attention to infant versus adult faces. Parental status did not modulate this effect, but sex of participants did. Grounded in the interpersonal acceptance-rejection theory (IPARTheory), this study provides new insights for discerning processes that might regulate global adult caregiving. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An attentional bias toward infant versus adult faces has been detected in parents and positively associated with sensitive caregiving behaviors. In previous research, the attentional bias has been measured as the difference in attention, in terms of reaction times, captured by infant versus adult faces; the larger the difference, the greater the cognitive engagement that adults deployed to infant faces. However, research so far has been mostly confined to samples of mothers, who have been more represented than fathers. Moreover, new family forms, especially same-sex families of men, have been left out of research. To clarify potential sex differences and extend previous findings to diverse family forms, we implemented a modified Go/no-Go attentional task measuring attentional bias to infant faces in parents with children aged from 2 to 36 months. The sample (N = 86) was matched and included 22 fathers and 22 mothers from different-sex families and 20 fathers and 22 mothers from same-sex families. Overall, the results confirmed that infant faces induced a greater attentional bias compared to adult faces. Moreover, we found that neither the type of family nor parents' sex modulated the attentional bias toward infant faces. The findings are discussed in relation to the importance of understanding the correlates of parental response to infant cues going beyond a heteronormative perspective on parenting., (© 2024. The Author(s).)

Background: Attentional bias toward infant faces is associated with parental sensitivity and supports the infant-caregiver attachment relationship, ultimately fostering child health outcomes. However, experience-related determinants of parents' attentional bias to infant faces have been poorly investigated. We examined attentional bias to infant versus adult faces in a sample of same-sex mothers ( N  = 76), and whether it varied depending on maternal involvement in childcare and the perceived quality of past experiences of care., Method: A Go/no-Go attentional task was used to compare the effects of infant and adult faces in retaining attention. Maternal involvement in childcare was measured using items addressing nurturing behaviors. Memories of past experiences of care were collected using the short-form version of the Parental Acceptance-Rejection scale., Results: Results confirmed that infant faces induced greater attentional bias compared to adult faces. More involved mothers were more biased, in terms of attention, to infant versus adult faces. Attentional bias to infant versus adult faces increased as mothers felt more rejected by their own fathers during childhood., Discussion: Our findings suggested that attentional bias to infant faces might be associated with past experiences of care and direct commitment in childcare in same-sex mothers. Robust and accurate empirical findings on same-sex parent families are essential to inform social policies supporting these families' well being., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Objective: The objective of this review is to investigate what is known about culture-based prescribing to improve mental health and well-being., Introduction: Culture-based prescribing, where a person is referred by a clinical professional to an arts or cultural activity aimed at improving mental health and well-being, is increasingly used as a community-based source of support. Although culture-based prescribing seems promising, the field is heterogeneous with respect to definition, underlying hypotheses, and cultural activity. This hampers its further development and implementation., Inclusion Criteria: We will consider publications that report on or explore culture-based prescribing to improve mental health and well-being for adults with symptoms related to mental health conditions who are seeking care from any clinical professional., Methods: We will search 8 electronic literature databases for published or unpublished reports on culture-based prescribing, without date limits. We will also search for gray literature and screen reference lists of relevant reviews. No language restrictions will be applied during the screening process, but for data extraction, we will only extract studies in languages our team has proficiency in. The screening and data extraction will be performed by 2 reviewers, independently. Data analysis will be descriptive, with results tabulated separately for each subquestion. The results will be complemented with a narrative summary., Review Registration: Open Science Framework https://osf.io/ndbqj., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 JBI.)

Infant faces are prioritized by the attentional system in parents, resulting in a greater cognitive engagement in terms of response time. However, many biological, contextual and environmental factors relating to this cognitive mechanism have been left unexplored. To fill this gap, this study aims to (i) confirm that infant faces engage more attention compared to adult faces; (ii) investigate whether the attention to infant faces is affected early care experiences of parents; (iii) explore the effect of parents' sex by taking the amount of involvement with early childcare into consideration. 51 mothers and 46 fathers completed a modified Go/no-Go task, a brief sociodemographic questionnaire, the short version of the Adult Parental Acceptance-Rejection scale, and an ad-hoc question relating to the amount of parental involvement with early childcare. Parents' response times were slowed in the presence of infant versus adult faces. Parents whose mother was perceived as more sensitively accepting were more engaged by infant cues. By considering the amount of early parental involvement, the sex of parents did not significantly interact with the type of face. These findings provide new insights on the attention process in response to infant cues in parents and suggest that the investigation of experience-based factors may shed further light on this topic.

During the Covid-19 pandemic, the restriction of free movement and the sheltering-in-place became worldwide strategies to manage the virus spread. Especially at the beginning of the pandemic, community-based affective events helped people feel less isolated and support each other. In this manuscript, we explore how two of these social practices-clapping and singing-were useful to counter the emotions entailed in the subjectivation processes that accompanied the pandemic. We then argue that, seen as affective happenings, singing and clapping heightened emotions and affects that were already implicit in neoliberalism, mainly anxiety, loneliness, and a sense of precariousness, disposability, and inadequacy. On one hand, singing and clapping were liberatory practices of solidarity and resistance against the changes induced by the pandemic and its biopolitics. On the other hand, they contributed to the primary narratives on social resilience, docile bodies, and biopolitics that informed the crisis management. Singing and clapping also operated as neoliberal technologies of the self by bringing the focus on individual agency, behavioral control, and the sacrifice of specific subjects (e.g., the healthcare workers described as heroes). In short, singing and clapping were affective happenings that instantiated an entanglement of subjectivation practices in which the power to affect and the power to resist coincided., Competing Interests: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (© 2022 Elsevier Ltd. All rights reserved.)

As fathering research has flourished, a growing body of studies has focused on behavioral and neurobiological mechanisms, respectively associated with caregiving sensitivity and responsiveness to infant stimuli. However, the association between these aspects and the key concept of paternal involvement in childcare (i.e., contribution in infant care in terms of time, availability, and responsibility) has been poorly investigated. The current work aims to systematically review the role of involvement in childcare on both neural activations and sensitive behaviors in fathers by examining (a) how paternal involvement has been measured and (b) whether paternal involvement has been associated with neurobiological activation and behavioral sensitive responses. Inclusion criteria were peer-reviewed quantitative studies, concerning fathers responding to infant stimuli at neurobiological or behavioral level, and including a quantitative measurement of paternal involvement in childcare. A quality rating for each study has been performed based on the measurements adopted to assess paternal involvement. Of 2,529 articles, 27 studies were included. According to our quality rating, 10 out of 27 studies included fairly good-standard measures for measuring paternal involvement, whereas 17 studies used good-standard measures. In addition, 11 studies provided details of paternal involvement in the context of neurobiological responses to infant stimuli, whereas 16 addressed paternal sensitive behaviors. Overall, only 8 studies reported relevant findings about the relationship between paternal involvement and neurobiological responses or sensitive behaviors in fathers. The present study is the first systematically evaluating the scope of paternal involvement in the field of Paternal Brain and fathers' sensitive responsiveness research. When high-standard measures are used, paternal involvement seems to play a significant role in modulating both the hormonal and the neural pathways associated with paternal behaviors. Remarkably, the role of paternal engagement may underpin an adaptive nurturance that is not dependent on pregnancy and childbirth but on caregiving experience. A promising positive link between paternal involvement and behavioral sensitivity may be expected in further studies, which will need to corroborate our conclusion by adopting detailed and appropriate measures assessing paternal involvement. As a future line of research, the inclusion of gay fathers may be beneficial for the field., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Giannotti, Gemignani, Rigo, Venuti and De Falco.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The present paper proposes a methodology based on the implementation and assessment of autoregressive (AR) solar radiation models for generating synthetic series and providing guidance on bidding strategies for power purchase agreements. The work considered conventional and periodic AR models with different lag orders, assessing the models against real solar radiation measurements. The synthetic series generation process developed 1000 1-year monthly solar radiation scenarios that were later employed for simulating electric energy production and power purchase agreement models. This application allowed one to evaluate the risk associated with the energy supply security, supporting bidding strategies in energy auctions. A real study case is also illustrated in detail, referring to a spot in the Brazilian best irradiance area.

The purpose of this study is to determine in the athletes a sonographic grading of the patellar tendinopathy correlated to prognosis and therapy. The 298 patellar overuse tendinopathies were divided in four grades according to the extension of the injured area of the tendon in the axial sonograms. Grades 1, 2, and 3 were managed with medical and physical therapy. A surgical treatment was performed in grade 4 and in grades 1, 2, and 3 tendinopathies not responding to our conservative therapy. There were 21.8% injuries in grade 1 (100% responding; prognosis 20 days), 61.2% injuries in grade 2 (94.5% responding; prognosis 40 days), 16.4% injuries in grade 3 (85.7% responding; prognosis 90 days), and 0.6% injuries in grade 4. The sonographic study is fundamental to characterize adequately the patellar tendinopathy. The conservative therapy is the first option for grades 1, 2, and 3 as it determines a complete healing in most of cases.

Objectives: To describe the surgical and pathologic findings of fertility-sparing radical abdominal trachelectomy using a standardized surgical technique, and report the rate of post-trachelectomy adjuvant therapy that results in permanent sterility., Methods: A prospectively maintained database of all patients with FIGO stage IB1 cervical cancer admitted to the operating room for planned fertility-sparing radical abdominal trachelectomy was analyzed. Sentinel node mapping was performed via cervical injection of Technetium and blue dye., Results: Between 6/2005 and 5/2008, 22 consecutive patients with FIGO stage IB1 cervical cancer underwent laparotomy for planned fertility-sparing radical abdominal trachelectomy. Median age was 33 years (range, 23-43). Histology included 13 (59%) with adenocarcinoma and 9 (41%) with squamous carcinoma. Lymph-vascular invasion was seen in 9 (41%) cases. Only 3 (14%) needed immediate completion radical hysterectomy due to intraoperative findings (2 for positive nodes, 1 for positive endocervical margin). Median number of nodes evaluated was 23 (range, 11-44); and 6 (27%) patients had positive pelvic nodes on final pathology - all received postoperative chemoradiation. Sixteen (73%) patients agreed to participate in sentinel node mapping which yielded a detection rate of 100%, sensitivity of 83%, specificity of 100% and false-negative rate of 17%. Eighteen of 19 (95%) patients who completed trachelectomy had a cerclage placed, and 9/22 (41%) patients had no residual cervical carcinoma on final pathology. Median time in the operating room was 298 min (range, 180-425). Median estimated blood loss was 250 ml (range, 50-700), and median hospital stay was 4 days (range, 3-6). No recurrences were noted at the time of this report., Conclusions: Cervical adenocarcinoma and lymph-vascular invasion are common features of patients selected for radical abdominal trachelectomy. The majority of patients can undergo the operation successfully; however, nearly 32% of all selected cases will require hysterectomy or postoperative chemoradiation for oncologic reasons. Sentinel node mapping is useful but until lower false-negative rates are achieved total lymphadenectomy remains the gold standard. Investigating alternative fertility-sparing adjuvant therapy in node positive patients is needed., Competing Interests: statement YS has received research support from Plasma Surgical, has served as a consultant for Covidien and a speaker for Genzyme. All other authors have no conflicts of interest to declare.

Objective: To determine whether perioperative packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusions during ovarian, tubal, or peritoneal cancer surgery increase the risk of symptomatic postoperative venous thromboembolism (VTE) and adversely affect overall survival., Methods: We conducted a retrospective review of all cases of surgical exploration for resection of stage IIIC-IV adnexal/peritoneal cancer between November 1998 and May 2002 at Memorial Sloan-Kettering Cancer Center. Patients with a history of prior or active preoperative VTE were excluded. Routine intraoperative and postoperative VTE prophylaxis including lower extremity external pneumatic compression with or without postoperative subcutaneous heparin was utilized in all cases. Symptomatic postoperative VTE was diagnosed by lower extremity Doppler or computerized tomography (excluding cases with only ovarian vein thrombosis). Clinical parameters were examined by a logistic regression analysis to identify independent prognostic predictors of postoperative symptomatic VTE, which occurred within 30 days of surgery. Survival was calculated using the Kaplan-Meier method., Results: In all, 174 patients underwent exploratory surgery, and 6 (3.4%) were excluded due to active or prior history of VTE. Of the remaining 168 patients, 71 (42%) received at least one perioperative transfusion of PRBC or FFP. Postoperative VTE was documented in 5 of 46 (11%) patients who received a postoperative transfusion compared to 3 of 122 (2.5%) patients who did not (P = 0.04; odds ratio, 4.8); moreover, VTE was noted in 3:16 (19%) patients who received postoperative FFP compared to 5:152 (3.3%) patients who did not (P = 0.01, odds ratio of 6.78). Age, stage, body mass index, length of the operation, blood loss, presence of ascites, volume of ascites, residual disease status, preoperative hemoglobin level and coagulation profile were not associated with increased risk for VTE. When survival results were stratified by transfusion utilization and controlling for optimal debulking status, perioperative transfusions had no apparent effect on overall survival., Conclusion: In women with stage IIIC-V disease, postoperative blood product transfusions particularly FFP were associated with increased risk of DVT and PE, but transfusions had no impact on overall survival.

Objective: We sought to identify the rate of axillary recurrence after sentinel lymph node (SLN) biopsy for breast cancer., Summary Background Data: SLN biopsy is a new standard of care for axillary lymph node staging in breast cancer. Nevertheless, most validated series of SLN biopsy confirm that the SLN is falsely negative in 5-10% of node-positive cases, and few studies report the rate of axillary local recurrence (LR) for that subset of patients staged by SLN biopsy alone., Methods: Through December of 2002, 4008 consecutive SLN biopsy procedures were performed at Memorial Sloan-Kettering Cancer Center for unilateral invasive breast cancer. Patients were categorized in 4 groups: SLN-negative with axillary lymph node dissection (ALND; n = 326), SLN-negative without ALND (n = 2340), SLN-positive with ALND (n = 1132), and SLN-positive without ALND (n = 210). Clinical and pathologic characteristics and follow-up data for each of the 4 cohorts were evaluated with emphasis on patterns of axillary LR., Results: With a median follow-up of 31 months (range, 1-75), axillary LR occurred in 10/4008 (0.25%) patients overall. In 3 cases (0.07%) the axillary LR was the first site of treatment failure, in 4 (0.1%) it was coincident with breast LR, and in 3 (0.07%) it was coincident with distant metastases. Axillary LR was more frequent among the unconventionally treated SLN-positive/no ALND patients than in the other 3 conventionally treated cohorts (1.4% versus 0.18%, P = 0.013)., Conclusions: Axillary LR after SLN biopsy, with or without ALND, is a rare event, and this low relapse rate supports wider use of SLN biopsy for breast cancer staging. There is a low-risk subset of SLN-positive patients in whom completion ALND may not be required.

Objective: The objective was to describe the results, technique, and complications of transperitoneal laparoscopic (LSC) pelvic and aortic lymph node dissection (LND) using the argon-beam coagulator (ABC) and monopolar electrosurgical instruments in women with gynecologic malignancies., Methods: A retrospective chart review of 114 patients who underwent LSC pelvic and/or aortic LND in addition to other LSC procedures between 1/1994 and 12/2001 was conducted. All intraoperative complications and complications that occurred within the first 30 postoperative days were included. Complications were graded according to an institutional surgical secondary events reference. During the same time period, 89 patients underwent LSC followed immediately by laparotomy that included LND, resulting in a total of 203 cases. These 203 total cases are used as a denominator to determine the etiology of cases converted from LSC to laparotomy. Monopolar electrosurgical instruments or the 10-mm ABC (Conmed) set at 70 W with argon flow of 3-4 L/m min were used for laparoscopic nodal dissection., Results: Sixty-one of 114 (53%) patients underwent pelvic LND, 35 (31%) underwent both pelvic and aortic LND, and 18 (16%) underwent aortic LND only. Mean patient age and body mass index were 53.3 years (range, 16 to 87 years) and 25 (range, 16 to 40), respectively. In addition, the mean number of pelvic and aortic lymph nodes removed was 10.7 (range, 1 to 39) and 5.7 (range, 0 to 21), respectively. The mean estimated blood loss was 151 mL (range, 25 to 600 ml) and the mean hospital stay was 2.8 days (range, 0 to 35 days). Overall, complications occurred in eight (7%) cases. There were no fatal complications, and no patient required conversion to laparotomy due to uncontrollable bleeding from the laparoscopic nodal dissection. Only 17 of 203 (8%) patients required conversion to laparotomy secondary to adhesions and unsatisfactory exposure., Conclusion: Laparoscopic pelvic and aortic LND for gynecologic malignancies can be satisfactorily performed in the majority of patients, with only 8% of patients requiring conversion to laparotomy due to adhesions or unsatisfactory exposure. The overall complication rate was 7% and was limited to grade 3 or less.

Unlabelled: In the United States, identification of the sentinel lymph node (SLN) requires the use of (99m)Tc-labeled colloid, 1% isosulfan blue dye, or both to trace the lymphatic drainage of a given neoplasm. We report our experience with adverse reactions to isosulfan blue dye during SLN mapping in breast cancer. A chart review of the breast cancer SLN database was performed; it included 2392 sequential patients who underwent SLN biopsy involving isosulfan blue dye at Memorial Sloan-Kettering Cancer Center from September 12, 1996, to August 17, 2000. Thirty-nine of 2392 patients (1.6%) had a documented allergic reaction during the mapping procedure. Most reactions (69%) produced urticaria, blue hives, a generalized rash, or pruritus. The incidence of hypotensive reactions was 0.5%. Although anaphylaxis after the injection of isosulfan blue dye is rare, this article highlights the need to suspect anaphylaxis when hemodynamic instability occurs after the injection of this compound. Our experience indicates that bronchospasm and respiratory compromise are unusual and that most patients do not require emergent intubation and can be managed with short-term pressor support. In addition, our data indicate that patients with a sulfa allergy do not display a cross-sensitivity to isosulfan blue dye., Implications: We report the largest single-institution review of adverse reactions to injection of isosulfan blue dye during sentinel lymph node mapping in breast cancer. Bronchospasm and respiratory compromise are unusual, and most patients can be treated with short-term pressor support. Patients with a sulfa allergy do not display a cross-sensitivity to isosulfan blue dye.

Surgery is the most effective therapeutic intervention available for the treatment of breast cancer. It has been responsible for obtaining local control and long-term disease-free intervals in more patients over the past century than any other treatment modality. Trends toward earlier stage at diagnosis are likely to increase the importance of surgery and to secure its central role in the treatment of this disease. Unfortunately, during the 1990s the value of excellent local control of breast cancer has been minimized as the disease has come to be considered systemic from inception and as the results of adjuvant-therapy trials in patients with early-stage breast cancer have revealed survival advantages in patients receiving systemic therapy. Only rarely is it acknowledged that surgery alone achieves long-term disease-free states in 70% to 80% of all patients. At the core of this paradigmatic controversy is management of the axilla. The status of the axilla remains the most powerful predictor of outcome in patients with invasive carcinoma of the breast, and it is likely that a small but identifiable subset of patients obtains a survival benefit from the removal of disease-containing nodes. It is believed that no benefit is derived from the removal of negative nodes, and indeed there are even patients in whom complete elimination of the exploration of the axilla may be considered-all of which underscores the need to investigate the axilla selectively. Lymphatic mapping and sentinel lymph node (SLN) biopsy represents the most exciting development to date toward this end. The challenge today, as we move closer to a selective approach to the axilla, is to ensure that patients with positive nodes have those nodes identified and removed and patients with negative nodes experience minimal disturbance of their axilla.