Methylene Blue Dye Injection Research Articles

A novel extraoral ultrasound-guided approach for mandibular nerve block in Rahmani sheep

BackgroundRegional anesthesia is the favored choice in ruminant animals compared to general anesthesia, primarily due to its high safety margin and reduced demand for cost-intensive equipment in addition to its field applicability. Ultrasound-guided nerve block has gained significant attention in the field of veterinary medicine. This study utilized twenty-seven sheep of the native Rahmani breed to both demonstrate and evaluate the effectiveness of the ultrasound guided inferior alveolar nerve block technique.MethodsThe research comprised three phases: Phase 1 involved an anatomical examination of mandibles and sheep heads to locate the mandibular foramen and delineate the mandibular nerve course. Phase 2 included ultrasound-guided injection of methylene blue dye at specific sites along the mandibular nerve in cadaveric sheep heads. In Phase 3, clinical implementation of ultrasound-guided inferior alveolar nerve blocks was conducted in 27 live sheep, assessing efficacy, onset, and duration.ResultsVertical extraoral ultrasound-guided nerve block was achieved successfully in 25 sheep (98%). A preliminary cadaveric study showed good distribution of the injectate at the mandibular nerve site. The mean onset time was 138 ± 18 s, and the mean duration time was 54 ± 4.1 min. Prominent analgesia of the ipsilateral mandible, medial surface of the cheek, and lateral border of the tongue was observed.ConclusionsUltrasound-guided mandibular nerve block holds promise as a technique for providing effective and safe anesthesia in sheep undergoing mandibular procedures.

Intranipple injection with methylene blue for tracing axillary sentinel lymph nodes in rats: A preliminary feasibility study

Background and purpose: Investigate the feasibility of intranipple injection (INN) of methylene blue dye (MB) for tracing the axillary sentinel lymph node (SLN) in rats, to provide different injection methods for finding SLN injection tracers and offer an experimental basis for specific localization of SLN. Methods: Eleven Sprague-Dawley female rats with body masses of 150-400g. Ten rats were randomly selected to use the third pair of mammary glands as the tracer injection site, and the left side was injected with MB (0.05 mL, 1% concentration) by intracutaneous injection of areola (IAA), while the right side was injected with MB(0.05 mL, 1% concentration) by INN. After 5 minutes, the rats were dislocated and dissected, and the blue-stained SLNs were found and recorded, The effectiveness evaluation was based on the number and rate of detection of SLNs as indicators, and the differences between the indicators of the two injection methods of IAA and INN were compared and analyzed. The safety evaluation was based on whether the nipple showed blood flow disorders and necrosis after MB injection by INN in the remaining 1 rat as the criteria. The data were stored and analyzed using Microsoft Excel and SPSS 25.0 statistical software. Νon-normally distributed measurement data were expressed as M (Q1, Q3) and compared by rank sum test, and count data were expressed as cases or percentages and compared by 2 test. p < 0.05 was considered a statistically significant difference. Results: (i)100% (10/10) detection rate of SLNs by applying MB to both INN and IAA modalities;(ii) median number of SLNs detection was 2.0 (1.0,2.0) vs. 1.5 (1.0,2.0) for INN and IAA, respectively (P=0.66), and the difference was not statistically significant;(iii) No nipple necrosis was observed for 4 consecutive days after INN with MB. Conclusion: Tracer detection of SLNs by INN injection in rats is feasible, and the detection rate of SLNs by INN is the same as that of IAA; there is no significant difference in the median number of detected SLNs between the two injection methods. No nipple necrosis was observed after INN with MB.

Use of methylene blue dye for lymphatic basin mapping and sentinel lymph node biopsy in breast cancer patients in Enugu, Nigeria.

Sentinel lymph node biopsy is the current standard of care for axillary staging and further treatment planning in patients with clinical axillary node-negative breast cancer. Sentinel node (SN) biopsy was designed to accurately stage the axilla and minimize the side effects of conventional axillary-lymph-node dissection without sacrificing oncologic outcomes. Sentinel lymph node biopsy is normally performed with nuclear scan and patent blue violet or isosulfan blue. These are expensive and not commonly available in resource-poor regions such as West Africa. Methylene blue dye is a commonly used agent in a wide range of clinical diagnostic procedures and has been used by other investigators to perform this procedure. This study was designed to demonstrate the feasibility and effectiveness of SN biopsy in the management of axillary node-negative breast cancer in resource-limited populations using methylene blue dye. To determine the efficacy of methylene blue dye as a single tracer in lymphatic basin mapping and sentinel lymph node biopsy in patients with clinical axillary node-negative breast cancer. This was a prospective, case-controlled study involving 28 consecutively presenting female patients with clinical axillary node-negative breast cancer at the University of Nigeria Teaching Hospital, Enugu. Each of the patients had lymphatic basin mapping and sentinel lymph node biopsy with a sub-areola-subdermal injection of methylene blue dye. The SN (s) were then removed using the dye as the marker. Each patient then had a mastectomy or wide local excision as appropriately planned and conventional levels I and II axillary dissection was performed in the same sitting. The SNs and other axillary nodes were reviewed independently by our institution's pathologist. Each patient's axillary dissection specimen acted as her control for the study. The SNs were identified in 24 (85.7%) patients. There was a demonstrable learning curve with an improvement in identification rate in the later half of the cases (92.9%) compared to the earlier half of the cases (78.6%). A range of 1-3 nodes and a mean of 1.78 nodes were obtained. A sensitivity of 90.9%, specificity of 79.6%, false-positive rate of 28.6%, false-negative rate of 9.1%, and accuracy of 95.8% were obtained. There was no incidence of allergic/hypersensitivity reaction. Sentinel lymph node biopsy with methylene blue dye can be applied with high accuracy within resource-limited environments. However, there is a definite short learning curve that must be overcome and the procedure validated before clinical application in decision-making.

Successful localization of abnormal parathyroid tissue with ultrasound-guided methylene blue dye injection before surgery for metastatic or recurrent thyroid cancers and parathyroid adenomas

ObjectivesA surgery to be performed on a previously operated neck includes difficulties such as increased risk of complications and prolonged operation time. The aim of the present study is to analyze the benefit of pre-anesthetic ultrasound-guided injection of methylene blue into parathyroid adenomas and abnormal lymph nodes to simplify their safe and satisfactory extraction. MethodsWe analyzed the case series records of 14 patients who were operated for reoperative neck surgery due to recurrent thyroid cancer (8 patients) and parathyroid adenoma (6 patients) and in the technique; 0.2 ml of a 1:5 dilution of 1 % methylene blue solution was injected directly onto the target during real-time ultrasound guidance before the operating room. ResultsIn adenomas, ultrasound-guided methylene blue injection was successfully applied in all cases, an average of 33.1 min before entering the operating room (range = 28–38 min). There were no complications related to dye injection. For patients with recurrent thyroid tumors, preoperative ultrasound-guided methylene blue injection was successfully applied in all patients, on average 27.5 min before entering the operating room (range = 20–35 min). No complications occurred due to dye injection. The blue stained lesion was easily identified during surgery. ConclusionsWe analyzed the feasibility of the injection process, the certainty of defining pathological lymph nodes, and the complications of the procedure. Preoperative administration of methylene blue preserved its intraoperative efficacy and maintained the easy the detection of reoperative or primary pathologies. The present study suggest that methylene blue dye injection is a safe, sufficient, and quietly effective method for identifying recurrent tumors and parathyroid adenomas in scarred reoperative neck surgeries. Our cases had comparatively short operative times and lower complication rates.

Preoperative Axillary Ultrasound-guided Wire Localization and Lymphoscintigraphy for Sentinel Lymph Node Biopsy in Breast Cancer Patients

Background: Breast cancer has the highest incidence and mortality among female malignant tumors. Breast cancer with negative axillary lymph nodes has been diag- nosed mainly at an early stage. Sentinel lymph node biopsy (SLNB) is a standard screening technique for patients with early-stage breast cancer and clinically nega- tive lymph nodes. Lymphoscintigraphy (sentinel lymph node mapping) has been reg- ularly used as the standard method for SLNB. Today, ultrasound-guided wire locali- zation (USGWL) is a well-established technique with superior outcomes. Therefore, we attempted to determine whether preoperative UGWL and lymphoscintigraphy (blue dye and isotope injection) improve SLN detection and false-negative rate in breast cancer patients undergoing SLNB and identify clinical factors that may affect the diagnostic accuracy of axillary ultrasound (AUS). Methods: Between December 2018 and June 2019, 55 patients with clinical T1- 3N0 breast cancer eligible for an SLNB at Imam Khomeini Hospital in Tehran were included in our study. Tumor characteristics and demographic data were collect- ed by reviewing medical records and questionnaires prepared by our surgical team. The day before SLNB, all patients underwent ultrasound-guided wire localization of SLN. Lymphoscintigraphy was performed with an unfiltered 99mTc-labelled sulfur colloid peritumoral injection followed by methylene blue dye injection. The results were analyzed based on the permanent pathology report. Results: Among the 55 patients, 71.8% of SLNs were detected by wire localization, while 57.8% were found by methylene blue mapping and 59.6% by gamma probe detection. Compared with wire localization and isotope injection, the methylene blue dye technique had a low sensitivity (72.2%), while both wire localization and isotope injection reached 77.8%. The sensitivity, specificity, and accuracy of UGWL were 77.8%, 42.1%, and 65.4%, respectively. Otherwise, methylene blue dye and isotope injection accuracy was 47.3% and 50.1%, respectively. Furthermore, there was a significant relationship between BMI, tumor size, laterality, reactive ALN, and the accuracy of preoperative AUS. But there was no significant correlation between age, weight, height, tumor biopsy, tumor location, the time interval between methylene blue dye and isotope injection to surgery, and also the type of surgery to the accuracy of preoperative AUS. Conclusion: Preoperative UGWL can effectively identify SLNs compared to lym- phoscintigraphy (blue dye and isotope injection) in early breast cancer patients un- dergoing SLNB.

Sentinel Lymph Node Mapping in Early Stage Endometrial Cancer Patients in Low-Resource Settings

Background: Lymph node status has a prognostic role in endometrial cancer patients and it determines the adjuvant therapy to be administered postoperatively. Complete lymphadenectomy carries the risk of serious complications. Sentinel Lymph Node mapping (SLN) may be a good option to reduce these complications. Cervical injection of methylene blue may be a suitable technique for SLN mapping, which can be applied in low-resource institutes. Objective: Assessment of the detection rate, sensitivity and false negative rate of SLN mapping using cervical injection of methylene blue. Methods: A total of 76 patients with early stage endometrial cancer were included. Methylene blue was injected into the cervix prior to surgery and open surgical approach was used. SLNs were detected by direct visualization of stained lymph nodes after opening of pelvic spaces. SLNs were excised and pelvic lymphadenectomy was performed. Para-aortic lymphadenectomy was performed when indicated and surgically feasible. Specimens were examined by H&E staining. Results: The SLN detection rate was 47.4% and all detected SLNs were pelvic nodes. All patients with lymph node metastasis had metastatic disease in their SLNs. The technique had 100% sensitivity, 100% negative predictive value and a 0% false-negative rate. An inverse relationship between SLN detection and BMI was detected. Conclusion: Cervical injection of methylene blue dye with an open approach to detect SLNs in patients with early stage endometrial cancer has a low detection rate. The most important factor associated with failed mapping is increased BMI. Further trials are needed to investigate the usefulness of this technique.

Flexible Bronchoscopy Diagnosis of Uncommon Congenital H-type Tracheoesophageal Fistula, Dual Fistulae, Bronchoesophageal Fistula, and Recurrence of Fistula in Children: A 20-year Experience.

Interventional pediatric flexible bronchoscopy has many advantages over radiologic investigations in diagnosing uncommon congenital H-type tracheoesophageal fistula (TEF), dual TEF, bronchoesophageal fistula (BEF) and fistula recurrence including higher rates of identification and anatomic localization with guide wire cannulation. We compare the diagnostic utility of flexible bronchoscopy to radiologic techniques for congenital aerodigestive fistula. A single center retrospective review was completed of all cases of pediatric TEF and BEF diagnosed with flexible bronchoscopy between January 2000 and November 2020. Fistulae were diagnosed 21 times in 18 patients at a median age of 1.22 years (interquartile range: 0.50 to 2.99). The median time from diagnosis to repair was 17.5 days (interquartile range: 5.5 to 43). Symptoms commonly related to fistula were found in all patients. Uncommon fistulae included single H-type TEF (n=10, 47.6%), dual H-type TEF (n=2, 9.5%), dual proximal and distal TEF with esophageal atresia (n=5, 23.8%), TEF recurrence (n=2, 14.3%), BEF (n=1, 4.8%), and a BEF recurrence (n=1, 4.8%). Flexible bronchoscopy confirmed the diagnosis in all fistulae using a guide wire cannulation or methylene blue dye injection. A combined procedure with simultaneous bronchoscopy and esophagoscopy was used for 6 fistulae. The positive examination rate was 75% for bronchoscopy compared with 2.6% for contrast swallow studies and 28.6% for tube esophagograms. Flexible bronchoscopy should be considered as a first line investigation in uncommon aerodigestive fistulae. In the absence of a skilled bronchoscopist, the best radiologic investigation is a pull-back tube esophagogram but may still require endoscopic confirmation at the time of fistula repair.

Efficacy of Periareolar Versus Peritumoral Injection of TC99-Labelled Sulphur Colloid and Methylene Blue Dye for Detection of Sentinel Lymph Node in Patients with Early Breast Cancer: a Comparative Study.

Sentinel lymph node biopsy using dual methods of blue dye and radioactive isotope is what is practised as the standard of care at most of the centres. The combined use of radioactive colloid and blue dye injection is considered the gold standard for axillary sentinel lymph node biopsy in breast cancer with a 97% accuracy rate. The aim of this study is to determine the optimal injection site for methylene blue dye and Tc99-labelled sulphur colloid for sentinel lymph node biopsy in early breast cancer. In both periareolar and peritumoral groups of patients, overall rate of identifying sentinel lymph node (hot, blue and hot and blue nodes) with dual dye was comparable (100% and 96.36%) with p value = 0.475. Also in both groups of patients, overall rate of getting pathological positive sentinel lymph node on final histopathological report was comparable (52.73% and 45.28%) with p value = 0.561. Periareolar versus peritumoral injection of dual dye shows comparable success rates for axillary sentinel lymph node identification and can be considered rapid and reliable method. However, the periareolar route is technically simple and especially privileged in nonpalpable (T0) and upper outer quadrant lesions mainly for the prevention of the shine through phenomenon.

Sentinel lymph node biopsy alone in the management of early cervical carcinoma

ObjectiveSentinel lymph node (SLN) biopsy aims to assess lymph node status with reduced surgical morbidity. The aim of the study was to determine the accuracy and safety of SLN biopsy...

Fallopian tubal obstruction is associated with increased pain experienced during office hysteroscopy: a retrospective study.

This study aimed at evaluating the pain experienced during office hysteroscopy, with selective tubal cannulation and chromopertubation, by women with and without tubal obstruction in order to determine if such condition would be associated with increased pain during the examination. Women with a history of infertility underwent in-office hysteroscopy with selective chromopertubation using a continuous flow office hysteroscope with a 5Fr operating channel fitted with a 4Fr catheter for the injection of methylene blue dye. Experienced pain was recorded on a Visual Analog Scale (VAS) during diagnostic hysteroscopy after access to the uterine cavity. Of 90 women, 58 (66.4%) were found with at least one patent fallopian tube and inserted in the group "any", meanwhile 32 (33.6%) were categorized into group "none" as both tubes were judged obstructed. There was no significant difference between groups in BMI and primary infertility rate, but the difference was significant concerning mean age (32.6 vs. 35.8; p < 0.001). The mean VAS score was 3.34 (± 1.07) in the group "any" and 4.25 (± 1.11) in "none". Comparing the VAS score of the two groups, the difference was significant (p < 0.001). Tubal occlusion may have a potential role in the pain experienced by women undergoing in-office hysteroscopy. Women with bilateral tubal occlusion experienced a higher level of pain compared with patients with at least one patent fallopian tube. Operators may use milder intrauterine pressure of fluid distension medium when these patients are undergoing in-office hysteroscopy to reduce discomfort.

Sentinel lymph node mapping in early breast cancer using methylene blue dye

Background: With the introduction of the concept of sentinel lymph node biopsy (SLNB), the surgical management of the axilla has undergone a paradigm change in clinically node-negative early breast cancer, and complete axillary dissection is avoided if the sentinel lymph node (SLN) is negative for metastasis. Aim: The purpose of this study was to identify the reliability, accuracy, and safety of using methylene blue dye (MBD) in SLNB for early-stage carcinoma of the breast. Materials and Methods: A prospective study was conducted among 151 early breast carcinoma patients (T1/2N0M0) from December 2012 to February 2016. Intraoperative identification of the SLN was done by injecting 5 ml of 1% MBD into the subareolar region of the breast. All the blue-stained lymph nodes were then surgically excised and sent for frozen section examination. Results: The mean age of presentation was 54.10 years. Thirty out of 151 cases had SLN metastasis and 115 cases were negative for malignancy on the frozen section. On the final histopathological examination, 36 cases had metastasis and 115 cases were negative for malignancy. The false-negative rate was 5%. No patients developed anaphylactic/allergic or any type of skin reaction following MBD injection. The accuracy, positive predictive value, and negative predictive value of sentinel node identification using MBD were 96.02%, 100%, and 95.04%, respectively. After a mean follow-up of 10 months, no patient was found to be with ipsilateral axillary or supraclavicular recurrence. Conclusion: The use of MBD in SLNB for the diagnosis of axillary metastasis is reliable, accurate, and safe.

Ultrasound scanning helped surgeons to locate the buried metal work: A case series

Removal of metalwork in children can be a challenging procedure, particularly if the metalwork is deeply buried and not palpable.This article proposes a surgical tip to help locate the position of metalwork just before the operation using an ultrasound machine and methylene blue dye.The technique involves using the ultrasound machine to locate the position of metalwork and marking the tract by injection of methylene blue dye just before prepping and draping the skin. This allows the operation to be performed through a smaller wound with less trauma to the soft tissues and avoids radiation exposure to the patient and theatre personnel. Our experience in a case series of 5 patients have found this a useful technique for removing threaded wires following a Salters osteotomy, where the wires can end up being buried beneath the iliac apophysis. It could however, be used to aid removal of any metal work where difficulty finding it is anticipated. Study expanded to include case series of patients rather than just one example. We have tracked a further 4 patients who have had the same technique used to include them in the paper. Reviewer 2 wanted further examples.

Sentinel Lymph Node Sampling for Early Gastric Cancer—Preliminary Results of A North American Prospective Study

IntroductionAlthough endoscopic resection for early gastric cancer is well established, anatomical resection with regional lymphadenectomy is recommended for lesions at high risk for occult lymph node metastasis (e.g., lymphovascular invasion, poor grade, and deep submucosal invasion). However, 75–95% high-risk early gastric cancer (HR-EGC) patients ultimately have node-negative disease and could potentially have undergone organ-sparing resection. Due to the inadequacy of standard modalities to reliably rule out nodal metastases in HR-EGC patients, sentinel lymph node (SLN) sampling was developed in Asia with promising results. However, the applicability of this technique in the West has been brought into question due to potential differences in tumor histology and body habitus. This prospective study aimed to test SLN sampling for North American EGC patients. MethodsAll patients with biopsy-confirmed T0–2 N0–1 M0 gastric adenocarcinoma at the Montreal General Hospital-McGill University Health Centre were eligible for enrollment. Esophageal and GEJ cancers were excluded due to the high rate of intrathoracic lymph node involvement. Peritumoral submucosal injection with T99 radiocolloid was performed endoscopically 24–30 h prior to surgery. Methylene blue dye injection was performed after induction of anesthesia. SLN basins were identified as those having > 10% of baseline tumor radiation signal or blue color, or both. After basins were individually removed, standard laparoscopic anatomical resection was then performed with D2 lymphadenectomy. (ClinicalTrials.gov identifier: NCT03049345). Data are presented as median (interquartile range). ResultsFrom July 2016–April 2018, 253 patients with esophagogastric adenocarcinoma were evaluated. Of these, 10 met inclusion criteria (90% male, age 66(30) years). Subtotal gastrectomy was performed in nine patients (90%) and length of stay was 4 (2) days. At least one SLN basin was identified in nine cases (90%). The median #SLN basins identified was 2(2) with a median of 5(5) total SLNs retrieved per patient. In the one case for which no SLN basins were identified, only blue dye injection was used, whereas SLNs were identified in all cases using the dual tracer method. Final T-stage was pT1b/T2 in four (40%), pT1a in two (20%), and Tx in four (40%). Two patients (20%) had lymph node metastases on final pathological analysis, both of which were identified by SLN sampling (accuracy 100%; false negative rate 0%). No adverse events related to SLN retrieval were identified. ConclusionsThis study represents the first prospective feasibility evaluation of sentinel lymph node sampling for early gastric cancer in North America with promising preliminary results. The dual tracer method was superior to single agent blue dye in identifying sentinel nodal basins. Considerable further study is necessary to verify the safety and utility of SLN mapping in North American patients with early gastric adenocarcinoma.

Endoscopic submucosal dissection using a novel endoscopic articulating knife for clinical staging of early esophageal neoplasia.

114 Background: Clinical staging of early esophageal neoplasia traditionally involves histological confirmation and imaging with endoscopic ultrasound (EUS), CT, and PET which have low sensitivity and specificity for staging esophageal cancer (EC). Endoscopic submucosal dissection (ESD) therapy is traditionally used for treatment, but not diagnosis as it is felt to be technically challenging and have a high risk for complications. We applied a new articulating endoscopic knife that permits safe ESD (ESD-CC) to evaluate early neoplasia with potential curative resection. Methods: We performed a retrospective study of patients undergoing ESD to stage or treat suspected early EC (cT1-T2). Clinical stage was done by EUS, CT, and PET. Two expert GI pathologists reviewed all histology. Lesions were examined with high resolution white light endoscopy and narrow band imaging. ESD was done with 1:200,000 epinephrine and methylene blue dye injection for lifting and staining the submucosal space. A 5mm, scissors-like articulated knife was used to perform ESD and hemostasis. Complications during post-ESD observation or follow-up were recorded. Results: A total of 35 patients who underwent ESD-CC were included with median age 70 (IQR 12), 26 males (74%), and followed for a median 3.4 months (IQR 6.4). This group consisted of 32 potential adenocarcinomas and 3 squamous cell cancers. The clinical Pre-ESD diagnoses were cT1 EC (24, 69%) and suspected EC in Barrett’s esophagus (BE) (11, 31%). The cT1 EC cases had ESD staged at least T1b (5, 21%), T1a (11, 46%), EC in situ (1, 4%), and dysplastic BE (7, 29%). The suspected EC cases had ESD staged at least T1b (1, 9%), T1a (2, 18%), and DBE (8, 73%). ESD-CC up-staged 4 (11%), down-staged 10 (29%), and confirmed prior diagnosis in 21 (60%). No complications including bleeding, perforation, or stricture formation regardless of size of ESD, age of patient, or co-morbidities. Conclusions: Staging of early esophageal cancer can be improved using ESD with an articulating knife, without increase in complications. ESD may be used as a staging modality in early esophageal cancer.

The Identification of Recurrent Laryngeal Nerve by Injection of Blue Dye into the Inferior Thyroid Artery

Background: Thyroidectomy creates a potential risk for injury of the recurrent laryngeal nerve (RLN). The identification and dissection of the RLN is the gold standard for preserving its function. Aim of the work: was to evaluate the value of injection of methylene blue dye into the inferior thyroid artery for help of the identification and dissection of RLN. Patients and Methods: This study included 60 selected patients who underwent thyroid surgery divided into 2 groups. In group A (30 patients) the branches of the inferior thyroid artery (ITA) near to the capsule of the thyroid lobe were isolated, and then 0.5 ml methylene blue dye was injected into the artery. In group B (30 patients) the RLN identified without help of dye to be compared with group A cases. Results: During injection of dye bleeding from the ITA occurred in 7 patients. The identification of the RLN within the painted tissue was succeeded 28 patients and failed in 2 patients due to extravasation of the dye. Regarding the amount of blood loss, there was a significant difference between the groups as the average amount of blood loss in group A was 85±22 ml (range 70-120) and in group B was 105±37 ml (range 90-160) P = 0.01. Also, by comparing the time taken for RLN identification in one side, there was a significant difference between the groups, as the median time taken for single RLN identification in each case in group A was 9±2 min (range 7-12 min) and in group B was 14±3 min (range 10-20 min) P = 0.008. Conclusion: the injection of methylene blue dye into the inferior thyroid artery or its branches is a feasible, effective, reliable way that can be used as a method for the identification of the RLN during thyroidectomy.

The Identification of Recurrent Laryngeal Nerve by Injection of Blue Dye into the Inferior Thyroid Artery

Background: Thyroidectomy creates a potential risk for injury of the recurrent laryngeal nerve (RLN). The identification and dissection of the RLN is the gold standard for preserving its function. Aim of the work: was to evaluate the value of injection of methylene blue dye into the inferior thyroid artery for help of the identification and dissection of RLN. Patients and Methods: This study included 60 selected patients who underwent thyroid surgery divided into 2 groups. In group A (30 patients) the branches of the inferior thyroid artery (ITA) near to the capsule of the thyroid lobe were isolated, and then 0.5 ml methylene blue dye was injected into the artery. In group B (30 patients) the RLN identified without help of dye to be compared with group A cases. Results: During injection of dye bleeding from the ITA occurred in 7 patients. The identification of the RLN within the painted tissue was succeeded 28 patients and failed in 2 patients due to extravasation of the dye. Regarding the amount of blood loss, there was a significant difference between the groups as the average amount of blood loss in group A was 85±22 ml (range 70-120) and in group B was 105±37 ml (range 90-160) P = 0.01. Also, by comparing the time taken for RLN identification in one side, there was a significant difference between the groups, as the median time taken for single RLN identification in each case in group A was 9±2 min (range 7-12 min) and in group B was 14±3 min (range 10-20 min) P = 0.008. Conclusion: the injection of methylene blue dye into the inferior thyroid artery or its branches is a feasible, effective, reliable way that can be used as a method for the identification of the RLN during thyroidectomy.

Perioperative Algorithm as a Novel Method for Lymph Node Assessment in Stage I Endometrial Cancer

Background: The uterus has a complex lymphatic drainage consisting of many groups that are in danger of endometrial cancer (EC) spread. Lymph node metastasis is a genuine pointer of poor prognosis requiring adjuvant therapy. Lymphatic mapping surgically can be done by blue dye labeling and perioperative algorithm. Aim: To assess the role of perioperative sentinel lymph nodes (SLN) mapping algorithm in reducing the necessity of pelvic lymphadenectomy. Methods: Fifty patients with early stage I EC underwent surgical staging. Transcervical injection of methylene blue was used, laparotomy was done and retroperitoneal spaces were opened. All lymph nodes were histopathologically examined and the negative SLN were ultrastaged. Results: Methylene blue dye injection resulted in blue lymph nodes in 20 (40%) cases, suspicious in 2 (4%) and negative in 28 (56%). Histopathological examination of sampled lymph node showed metastases in 18/20 (90%) of blue nodes, 1/2 (50%) of suspicious nodes and 0/28 (0%) of negative nodes. There were no false negative cases in this study and the detection rate was 89%. Conclusion: Perioperative algorithm accuracy and simplicity make it a reliable approach for lymph node assessment in early stage EC.

A New Composite Eyeball-Periorbital Transplantation Model in Humans: An Anatomical Study in Preparation for Eyeball Transplantation.

Vascularized composite allotransplantation offers a new hope for restoration of orbital content and perhaps vision. The aim of this study was to introduce a new composite eyeball-periorbital transplantation model in fresh cadavers in preparation for composite eyeball allotransplantation in humans. The composite eyeball-periorbital transplantation flap borders included the inferior border, outlined by the infraorbital rim; the medial border, created by the nasal dorsum; the lateral border, created by the lateral orbital rim; and the superior border, created by the superior part of the eyebrow. The pedicle of the flap included the facial artery, superficial temporal artery, and external jugular vein. The skin and subcutaneous tissues of the periorbital region were dissected and the bony tissue was reached. A coronal incision was performed and the frontal lobe of the brain was reached by means of frontal osteotomy. Ophthalmic and oculomotor nerves were also included in the flap. After a "box osteotomy" around the orbit, the dissection was completed. Methylene blue and indocyanine green injection (SPY Elite System) was performed to show the integrity of the vascular territories after facial flap harvest. Adequate venous return was observed within the flap after methylene blue dye injection. Laser-assisted indocyanine green angiography identified a well-defined vascular network within the entire composite eyeball-periorbital transplantation flap. For the first time, a novel composite eyeball-periorbital transplantation model in human cadavers was introduced. Good perfusion of the flap confirmed the feasibility of composite eyeball-periorbital transplantation in the clinical setting. Although harvesting of the flap is challenging, it introduces a new option for reconstruction of the periorbital region including the eyeball.

Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection

Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection

Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection.

Urinary tract junction obstruction defects are congenital anomalies inducing hydronephrosis and hydroureter. Murine urinary tract junction obstruction defects can be assessed by tracking methylene blue dye flow within the urinary system. Methylene blue dye is injected into the renal pelvis of perinatal embryonic kidneys and dye flow is monitored from the renal pelvis of the kidney through the ureter and into the bladder lumen after applying hydrostatic pressure. Dye accumulation will be evident in the bladder lumen of the normal perinatal urinary tract, but will be constrained between the renal pelvis and the end point of an abnormal ureter, if urinary tract obstructions occur. This method facilitates the confirmation of urinary tract junction obstructions and visualization of hydronephrosis and hydroureter. This manuscript describes a protocol for methylene blue dye injection into the renal pelvis to confirm urinary tract junction obstructions.