Bypass Drainage Research Articles

Combined 68Ga-NOTA-Evans Blue Lymphoscintigraphy and 68Ga-NOTA-RM26 PET/CT Evaluation of Sentinel Lymph Node Metastasis in Breast Cancer Patients.

In this study, we applied a new strategy to identify sentinel lymph node (SLN) metastasis by combining 68Ga-NOTA-Evans Blue (68Ga-NEB) for SLN mapping and 68Ga-NOTA-RM26 for LN metastasis detection in breast cancer patients. A total of 24 female patients with breast cancer diagnosed by core biopsy or suspected by mammography or ultrasonography were recruited and provided informed consent. All patients underwent 68Ga-NEB and 68Ga-NOTA-RM26 PET/CT imaging. Visual analysis of 68Ga-NEB PET/CT images was used to determine SLNs, and then compared with the 68Ga-NOTA-RM26 results and histopathological findings. SLNs were visualized in 24 of 24 patients (100.0%) within 4.0-10.0 (5.6 ± 1.4) min. All patients were pathologically diagnosed with breast cancer, and 12 patients had ipsilateral lymph node metastasis. By combining 68Ga-NEB and 68Ga-NOTA-RM26 images, 7/12 (58.3%) patients showed mild to intense uptake of 68Ga-NOTA-RM26 in SLNs, 1/12 patient (8.3%) had moderate uptake of 68Ga-NOTA-RM26 in the non-SLNs rather than SLN, indicating possible bypass lymphatic drainage, partially accounting for the false negatives in SLN biopsy during surgery. No false positives were found. The SUVmax of 68Ga-NOTA-RM26 activity in metastatic SLNs was significantly higher than that in non-metastatic SLNs (2.2 ± 2.3 vs 0.7 ± 0.1, P = 0.047). This study manifests the value of combination of 68Ga-NEB and 68Ga-NOTA-RM26 dual tracer PET/CT in preoperative evaluation of SLN metastasis in breast cancer patients, especially in those patients with lymphatic obstruction and bypass drainage. In general, positive 68Ga-NOTA-RM26 uptake in either SLN or other lymph nodes can apply lymph node dissection rather than intraoperative SLN biopsy.

Deep drainage in a Grey Vertosol under furrow-irrigated cotton

Deep drainage under irrigated cotton is not only a waste of a scare resource but also has the potential to cause groundwater levels to rise and cause salinity. Drainage is difficult and expensive to measure directly, so most estimates have relied on modelling or chloride mass-balance calculations. However, direct, accurate measurements of drainage are required to understand drainage processes in cracking clay soils and to provide some certainty about other estimates. A variable-tension lysimeter was installed at 2.1 m depth in a Grey Vertosol under a furrow-irrigated, cotton–wheat rotation. The collection trays were installed without disturbing the overlying soil. A vacuum was applied to the trays and was continuously adjusted to match the matric potential in the surrounding soil at the same depth, thus maintaining the same hydraulic gradient as in the surrounding soil. The lysimeter was used to measure drainage and other components of the water balance from 2006 to 2011, including three cotton crops, one wheat crop and a long fallow. During this period, two types of drainage were observed. Matrix drainage occurred after an extended period during which rainfall exceeded evapotranspiration. This caused a wetting front to move through the soil over a period of months until it reached the lysimeter and was measured as drainage. Matrix drainage extended over a period of 1 month but at a low rate of ~0.5 mm/day. During the cotton season, the earlier irrigations generally caused a sharp peak in drainage of up to 3.5 mm day–1 ~25 h after irrigation. However, the water content and soil-water potential at 2.1 m were largely unaffected, and in some cases, the hydraulic gradient was upwards while drainage was occurring. This suggests this drainage is caused by irrigation flowing rapidly through the profile bypassing the soil matrix. Later in the season, when soil-water deficits developed in the subsoil at 0.5–1.0 m between irrigations, the peaks in drainage rate became much smaller. Bypass drainage appears to account for most of the drainage during the measurement period. Apart from lowering the water use efficiency, it is also more unpredictable and difficult to manage. In addition, bypass drainage is less efficient at removing salt from the soil profile, so that a higher leaching fraction may be required to prevent excessive salt accumulation.

Clinical application of self-made drainage tube with balloon for iatrogenic colonic perforation

To investigate the clinical efficacy of colonic bypass drainage by self-made drainage tube with balloon for iatrogenic colonic perforation. A retrospective analysis of 8 patients with iatrogenic colonic perforations from January 2009 to March 2011 was performed. Self-made drainage tubes with balloon were placed in the bowel lumen endoscopically after perforations were closed with endoclips or endoloops under endoscope. The inflatable balloon at the front-end of the tube was fixed at the mouth side of colonic perforation to achieve continuous drainage of stool and intestinal juice. Endoscopic bypass continuous drainage by using self-made drainage tube with balloon was successfully carried out in all the 8 patients. All the perforations healed and no surgical intervention required. Bypass drainage continued for 3-10 days(mean 7.6 days). One patient received colonoscopy 3 days after the procedure, and displacement of the drainage tube was noticed requiring endoscopic adjustment. All the drainage tubes were removed uneventfully, and no ulceration or perforation occurred at balloon fixed site after removal. After follow up ranging from 12 to 36 months, no chronic fistula, adhesive obstruction, or abdominal infection occurred. Colonic bypass drainage by self-made drainage tube with balloon for iatrogenic colonic perforation is simple, feasible, safe and reliable.

Endoscopic above and below approach with frontal septotomy in a patient with frontal mucocele: a contralateral bypass drainage procedure through the frontal septum

Frontal sinus has complex anatomy and is the most difficult sinus to dissect under the nasal endoscope. In case of difficult accessibility through the frontal recess, we can make a detour to more invasive and external procedures to treat chronic or intractable frontal sinus diseases. However, these approaches usually need advanced surgical skills and sometimes can result in minor and/or major complications. Therefore, we developed a new surgical technique to treat frontal mucocele in a patient with severe new bone formation at the frontal recess and presented our experiences with literature review.

Venous Bypass Drainage of the Small Saphenous Vein in the Neurovascular Pedicle of the Sural Flap: Anatomical Study and Clinical Implications

Little is known about the necessary dimensions of the neurovascular pedicle of the sural flap for inclusion of the concomitant bypass veins of the small saphenous vein to secure sufficient retrograde venous flow. Therefore, the authors evaluated the anatomical basis for venous outflow of the sural flap and were able to give recommendations as to the necessary pedicle width for the flap to be transferred safely. The collateral bypass pathway of the small saphenous vein was studied in five formalin-preserved cadaver legs. The authors evaluated the usefulness of duplex sonography to visualize the venous collateral system of the small saphenous vein in five legs of healthy volunteers. The pedicle width necessary to bypass the small saphenous vein ranged from 1.4 to 3.1 cm in the human cadavers and 0.09 to 1.5 cm in the duplex group. In both groups, only one side, medial or lateral to the small saphenous vein, was responsible for a total proximal-to-distal bypass. The opposite side partly bypassed the vein. Ultrasonography alone without Doppler was sufficient to visualize this variable suprafascial venous network. Preoperative evaluation of the venous system through duplex sonography is essential to localize on which side the bypass veins are present, making it possible to decrease the width of the pedicle without interfering with the reliability of the sural flap.