Superficial Nodes Research Articles

Utilizing skin sparing technique in HN VMAT treatment planning

This study aims to demonstrate a specific treatment planning method and its effectiveness of sparing high dose to superficial skin for head and neck volumetric-modulated arc therapy (VMAT) treatments. A total of 10 patients with bilateral disease encompassing superficial neck nodes were planned as VMAT. Standard VMAT plans were created for each patient per written directive from physician, including target prescriptions, normal structure goals, and plan parameters. After these plans were created, low isodose levels were converted into dose structures, which are used to create a new skin sparing (SS) structure. With the new SS structure made, the original plan was copied to create a new SS plan. The new SS plan was re-optimized utilizing the newly created SS structure to help in decreasing dose to the superficial regions on the skin surface. The result of this treatment planning technique, comparing SS plans to original nonskin sparing (NSS) plans, provides a reduced dose of 10% to 15% to the skin surface in all cases. Although this technique reduces the dose to the skin, it can also reduce the dose to treatment volumes. Depending on physician intent, diagnosis, and disease, this method should only be used when the skin is not at risk, otherwise it could potentially cause underdosing to the disease site. All SS plans were considered clinically acceptable and provided adequate coverage to planning target volume (PTV), while reducing unwarranted high dose to superficial skin tissue.

Atrophy of skin-draining lymph nodes predisposes for impaired immune responses to secondary infection in mice with chronic intestinal nematode infection.

Intestinal nematodes suppress immune responses in the context of allergy, gut inflammation, secondary infection and vaccination. Several mechanisms have been proposed for this suppression including alterations in Th2 cell differentiation and increased Treg cell suppressive function. In this study, we show that chronic nematode infection leads to reduced peripheral responses to vaccination because of a generalized reduction in the available responsive lymphocyte pool. We found that superficial skin-draining lymph nodes (LNs) in mice that are chronically infected with the intestinal nematode Heligmosomides polygyrus, do not reach the same cellularity as worm-free mice upon subsequent BCG infection in the skin. B cells and T cells, all declined in skin-draining LN of H. polygyrus-infected mice, resulting in LNs atrophy and altered lymphocyte composition. Importantly, anti-helminthic treatment improved lymphocyte numbers in skin-draining LN, indicating that time after de-worming is critical to regain full-scale LN cellularity. De-worming, and time for the skin LN to recover cellularity, also mended responses to Bacille Calmette-Guerin (BCG) in the LN draining the footpad injection site. Thus, our findings show that chronic nematode infection leads to a paucity of lymphocytes in peripheral lymph nodes, which acts to reduce the efficacy of immune responses at these sites.

Primary renal lymphoma: a clinical analysis of 5 cases

Objective: To improve the clinical diagnosis and treatment of primary renal lymphoma. Methods: Clinical data of 5 cases ( 2 male cases and 3 female cases) with primary renal lymphoma was reviewed. The age of patients was 55 to 70 years old, with a mean age of 62 years. No history of glomerulonephritis or nephropathy was recorded. All the cases were unilateral, including 3 cases in the left side and 2 cases in right. The major clinical manifestations were as follows: 2 cases of left lumbar pain, 1 case of gross hematuria, 1 case of hematuria under microscope, and 1 case receiving adjuvant chemotherapy after 12 years. The physical examination was as follows: the superficial lymph nodes of 5 cases were not enlarged; the liver, spleen and abdominal mass were not palpable; 2 cases had left upper quadrant tenderness ( with no rebound pain) and left kidney percussion pain. B-ultrasound, CT or MRI examination were performed before the operation, and renal malignant neoplasm was considered. No abnormality was found in bone marrow aspiration after operation. Four cases underwent radical nephrectomy and 1 case accepted partial nephrectomy. Four cases were administered with six cycles of R-CHOP (cyclophosphamide, pirarubicin, vincristine and prednisone) associated with rituximab, and 1 case was given six cycles of CHOP. Results: Five cases were diagnosed as non-Hodgkin's lymphoma, with 4 cases of diffuse large B-cell lymphoma of the kidney and 1 case of marginal zone B-cell non-Hodgkin lymphoma of mucosa-associated lymphoid tissue. The maximum diameter of the tumor was 3.5 to 10 cm, with the median diameter of 6.5 cm. The tumor was grey and white on the cutting surface, and the texture was fine. Under the microscope, the tumor cells were diffusely infiltrating, oval or polygonal, slightly larger than normal lymphocytes, with large irregular hyperchromatic nuclei. Four cases were followed up for 6 months to 2 years, with an average of 16 months. Chest X - ray and abdominal B-ultrasound were performed every 3 months, and abdominal CT or MRI scan was performed every 6 months. One case lost follow-up after 3 months. Except the case, the rest three are all alive. Conclusions: Primary renal lymphoma is rare. Most of the cases reported showed rapid systemic progression and a poor prognosis. There were no distinct characteristics in B-ultrasound and CT examination. Pathological examination is the key to its diagnosis. The surgical treatment combined with systemic chemotherapy can prolong survival of patients.

Comparison of Virtual Touch Tissue Quantification with B-Mode Sonography in the Differential Diagnosis of Superficial Lymph Nodes

Comparison of Virtual Touch Tissue Quantification with B-Mode Sonography in the Differential Diagnosis of Superficial Lymph Nodes

Effect of cryopreservation on lymph node fragment regeneration after autologous transplantation in the minipig model.

Introduction:Lymphoedema is a worldwide pandemic causing swelling of tissues due to dysfunctional transport of lymph fluid. Present management concepts are based in conservative palliation of symptoms through manual lymphatic drainage, use of compression garments, manual lymph drainage, exercise, and skin care. Nevertheless, some curative options as autologous lymph node transplantation were shown to reduce lymphoedema in selected cases. Lately, some concern has arisen due to reports of donor site morbidity. A possible solution could be the development of artificial lymph node scaffolds as niches of lymphatic regeneration. Engineering these scaffolds has included cryopreservation of lymph node stroma. However, the effects of cryopreservation on the regeneration capacities of these organs were unknown.Materials and methods:Here, we used the minipig animal model to assess lymphatic regeneration processes after cryopreservation of autologous lymph nodes. Superficial inguinal lymph nodes were excised and conserved at −80°C for 1 month. Thereafter, lymph node fragments were transplanted in the subcutaneous tissue.Results:Regeneration of the lymph nodes was assessed five months after transplantation. We show that lymph node fragment regeneration takes place in spite of former cryopreservation. Transplanted fragments presented typical histological appearance. Their draining capacity was documented by macroscopic transport of Berlin Blue dye as well as through SPECT-CT hybrid imaging.Discussion:In conclusion, our results suggest that processes of cryopreservation can be used in the creation of artificial lymph node scaffolds without major impairment of lymph node fragments regeneration.

Neural architecture in lymphoid organs: Hard-wired antigen presenting cells and neurite networks in antigen entrance areas.

IntroductionRecently, we found abundant innervation of antigen presenting cells that were reached and enclosed by single neurites. These neurally hard‐wired antigen presenting cells (wAPC) could be observed in the T‐cell zone of superficial cervical lymph nodes of rats and other mammalians, including humans.MethodsAs a consequence, we investigated lymph nodes at many different anatomical positions as well as all primary and secondary lymphoid organs (SLO) in rodents for a similar morphology of innervation regarding antigen presenting cells known in those tissues.ResultsAs a result, we confirmed wAPC in lymph nodes independent from their draining areas and anatomical positions but also in all other T‐cell zones of lymphoid organs, like Peyer's patches, NALT and BALT, as well as in the thymic medulla. Other cells were innervated in a similar fashion but with seemingly missing antigen presenting capacity. Both types of innervated immune cells were observed as being also present in the dermis of the skin. Only in the spleen wAPC could not be detected. Beyond this systematic finding, we also found another regular phenomenon: a dense network of neurites that stained for neurofilament always in antigen entrance areas of lymphoid organs (subsinoidal layer of lymph nodes, subepithelial dome of Peyer's patches, subsinoidal layer of the splenic white pulp, margins of NALT and BALT). Lastly, also thymic epithelial cells (TEC) restricted to the corticomedullary junction of the thymus showed similar neurofilament staining.ConclusionsTherefore, we propose much more hard‐wired and probably afferent connections between lymphoid organs and the central nervous system than is hitherto known.

Diagnostic accuracy of sonoelastography in different diseases.

The objective of this study was to evaluate the diagnostic accuracy of sonoelastography in patients of primary and secondary health care settings. Google scholar, PubMed, Medline, Medscape, Wikipedia and NCBI were searched in October 2017 for all original studies and review articles to identify the relevant material. Two reviewers independently selected articles for evaluation of the diagnostic accuracy of sonoelastography in different diseases based on titles and abstracts retrieved by the literature search. The accuracy of sonoelastography in different diseases was used as the index text, while B-mode sonography, micro pure imaging, surgery and histological findings were used as reference texts. Superficial lymph nodes, neck nodules, malignancy in thyroid nodules, benign and malignant cervical lymph nodes, thyroid nodules, prostate carcinoma, benign and malignant breast abnormalities, liver diseases, parotid and salivary gland masses, pancreatic masses, musculoskeletal diseases and renal disorders were target conditions. The data extracted by the two reviewers concerning selected study characteristics and results were presented in tables and figures. In total, 46 studies were found for breast masses, lymph nodes, prostate carcinoma, liver diseases, salivary and parotid gland diseases, pancreatic masses, musculoskeletal diseases and renal diseases, and the overall sensitivity of sonoelastography in diagnosing all these diseases was 83.14% while specificity was 81.41%. This literature review demonstrates that sonoelastography is characterized by high sensitivity and specificity in diagnosing different disorders of the body.

Evaluation of the Efficacy and Cross-Protective Immunity of Live-Attenuated Chimeric PCV1-2b Vaccine Against PCV2b and PCV2d Subtype Challenge in Pigs.

Porcine circovirus type 2 (PCV2) commercial vaccines are either inactivated PCV2 isolates or subunit vaccine based on the Cap protein of PCV2. Currently, no live-attenuated vaccines are yet available. Although the predominant circulating subtype worldwide is PCV2b, the emerging PCV2d subtype is also increasingly associated with PCV disease. In this study, piglets were inoculated with a live-attenuated chimeric PCV1-2b vaccine before challenged with PCV2b and PCV2d isolates. Thirty-two piglets were randomly divided into seven groups: negative (sham-vaccinated, sham-challenged), VAC+PCV2b (PCV1-2b vaccinated, PCV2b-challenged), VAC+PCV2d (PCV1-2b vaccinated, PCV2d-challenged), CHAL+PCV2b (sham-vaccinated, PCV2b-challenged), CHAL+PCV2d (sham-vaccinated, PCV2d-challenged), CV+PCV2b (commercial-vaccinated, PCV2b-challenged), and CV+PCV2d (commercial-vaccinated, PCV2d-challenged). The results showed that vaccinated challenged groups demonstrated high levels of anti-PCV2 antibody and reduced PCV2b and PCV2d loads both in serum and nasal swabs compared with the challenge-only groups. PCV2 DNA was detected in the superficial inguinal lymph nodes of only one pig in each of the VAC+PCV2b and VAC+PCV2d groups (group mean values, 101.81 and 101.77 genomic copies/g, respectively), which was significantly lower than those in CHAL+PCV2b and CHAL+PCV2d animals (group mean values, 1011.65 and 1010.60 genomic copies/g, respectively; P < 0.01). In addition, PCV2 DNA in each of the VAC+PCV2b and VAC+PCV2d groups was significantly lower than those in CV+PCV2b and CV+PCV2d animals (group mean values, 108.47 and 108.34 genomic copies/g, respectively; P < 0.01), indicating that the live-attenuated PCV1-2b vaccine was more effective than commercial vaccine. The live-attenuated PCV1-2b vaccine was effective in reducing PCV2b/PCV2d viremia, shedding, and tissue viral loads in vaccinated challenged pigs compared with challenge-only piglets, indicating that the PCV1-2b prototype vaccine is a good candidate for a live-attenuated vaccine against both PCV2b and PCV2d subtypes. And we first revealed that the live-attenuated PCV1-2b vaccine could protect piglets from challenge with either PCV2b or PCV2d equivalently.

Management of contralateral axillary lymph node metastasis from breast cancer: a clinical dilemma.

Contralateral axillary lymph node metastasis (CAM) in breast cancer patients is uncommon and the source uncertain. Management is complicated when CAM occurs as the first event of relapse after treatment of the primary tumor, especially in the absence of metastatic disease elsewhere. We reviewed the records of all breast cancer patients treated during 1999-2012. All patients with pathologically confirmed metachronous CAM were included. The examined data were demographic characteristics, tumor features and management modalities. Data from an epidemiological report that described the pathological characteristics of breast cancer in China during 1999-2008 were employed to allow further comparison. Twenty-eight patients with CAM were included in the study; they comprised 0.81% of the total number of patients. The median patient age was 47 years (range, 27-60 years). Half of the initial breast cancers were located at inner and central sites. Initial cancers were generally locally advanced (stage III, 50%) and hormone receptor negative. Treatment modalities included axillary lymph node dissection (ALND), mastectomy, radiation, and chemotherapy (± targeted therapy). After 29 months of follow-up, 25 patients had disease progression with a median progression-free survival of 10 months. Regional recurrence was most commonly seen at sites including bilateral breast, chest wall and superficial lymph nodes, accounting for 44% (n = 11) of patients who progressed. Median progression-free survival was prolonged in patients treated with radiotherapy (10 months vs 22 months). During the observation period, 13 patients died of disease progression. We found that CAM was associated with tumors with aggressive pathological features and had a poor prognosis. CAM is most likely to be distant metastasis from the initial breast cancer through lymphatic drainage rather than regional metastasis from a new occult breast cancer. Comprehensive treatment including chemotherapy and radiotherapy can provide better control; however, ANLD alone is insufficient treatment and mastectomy is not recommended.

Telemedicine Physical Examination Utilizing a Consumer Device Demonstrates Poor Concordance with In-Person Physical Examination in Emergency Department Patients with Sore Throat: A Prospective Blinded Study.

Telemedicine allows patients to connect with healthcare providers remotely. It has recently expanded to evaluate low-acuity illnesses such as pharyngitis by using patients' personal communication devices. The purpose of our study was to compare the telemedicine-facilitated physical examination with an in-person examination in emergency department (ED) patients with sore throat. This was a prospective, observational, blinded diagnostic concordance study of patients being seen for sore throat in a 60,000-visit Midwestern academic ED. A telemedicine and a face-to-face examination were performed independently by two advanced practice providers (APP), blinded to the results of the other evaluator. The primary outcome was agreement on pharyngeal redness between the evaluators, with secondary outcomes of agreement and inter-rater reliability on 14 other aspects of the pharyngeal physical examination. We also conducted a survey of patients and providers to evaluate perceptions and preferences for sore throat evaluation using telemedicine. Sixty-two patients were enrolled, with a median tonsil size of 1.0. Inter-rater agreement (kappa) for tonsil size was 0.394, which was worse than our predetermined concordance threshold. Other kappa values ranged from 0 to 0.434, and telemedicine was best for detecting abnormal coloration of the palate and tender superficial cervical lymph nodes (anterior structures), but poor for detecting abnormal submandibular lymph nodes or asymmetry of the posterior pharynx (posterior structures). In survey responses, telemedicine was judged easier to use and more comfortable for providers than patients; however, neither patients nor providers preferred in-person to telemedicine evaluation. Telemedicine exhibited poor agreement with the in-person physical examination on the primary outcome of tonsil size, but exhibited moderate agreement on coloration of the palate and cervical lymphadenopathy. Future work should better characterize the importance of the physical examination in treatment decisions for patients with sore throat and the use of telemedicine in avoiding in-person healthcare visits.

Bilateral vulval filarial elephantiasis

A 25-year-old unmarried woman, resident of a filarial endemic region, presented with progressive swelling of the vulva along with recent onset redness, dragging pain and consequent difficulty in walking. She...

Spectrum of inflammatory lesions in superficial lymph node biopsies in Uyo, Nigeria (2007 to 2015)

Introduction: The lymph node is commonly involved by a spectrum of inflammatory pathologies, some of which are associated with graven morbidity and mortality if not promptly treated.Objectives: To analyze pathological spectrum of involvement of peripheral lymph nodes by various inflammatory lesions at the University of Uyo Teaching Hospital and a private specialist laboratory in Uyo, Akwa Ibom State, Nigeria between January 2007 and December, 2015.Methodology: A retrospective review of all Haematoxylin and Eosin stained slides of lymph node specimens were undertaken. Relevant data were extracted from their laboratory request forms, registers and reports.Results: A total of 66 histologically confirmed diagnoses of inflammatory lesions of superficial lymph node were made; males outnumbered females in the ratio of 1.2:1. The age of these patients ranged from 0.75 to 78 years with a mean age of 26.5 years. The modal age group was 11-20 years, accounting for 24 cases (36.4%). Fifty - two (78.8%) cases of inflammatory lesion occurred in patients aged below 30 years. Cervical lymph node was the most common biopsied site for inflammatory lesions, constituting 38 (57.6%) cases; followed by axillary and inguinal lymph nodes in order of frequencies of 13 (19.7%) and 7 (11.7%) cases respectively. Tuberculous lymphadenitis was the commonest inflammatory lesion, accounting for 30 out of 66 cases (45.5%); this is followed by reactive hyperplasia representing 18 out of 66 cases (27.3%). Necrotinizing chronic lymphadenitis, HIV - associated lymphadenopathy, benign reticuloses, and Castleman disease were other inflammatory lesions seen in 12.1%, 7.6%, 4.5%, and 3.0% of cases respectively.Conclusion: Tuberculous lymphadenitis and reactive hyperplasia were the most preponderant inflammatory lesions of superficial lymph node in our environment with children and cervical lymph node being more favourably affected.

Vascularized Lymph Node Transfer for Lymphedema.

Advances in our understanding of the lymphatic system and the pathogenesis of lymphedema have resulted in the development of effective surgical treatments. Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes into an extremity to restore physiological lymphatic function. It is most commonly performed by transferring combined deep inferior epigastric artery perforator and superficial inguinal lymph node flaps for postmastectomy breast reconstruction. For patients who do not require or are unable to undergo free abdominal breast reconstruction or have lymphedema affecting the lower extremity, several other VLNT options are available. These include flaps harvested from within the axillary, inguinal, or cervical lymph node basins, and lymph node flaps from within the abdominal cavity. This article reviews the lymph node flap options and techniques available for VLNT for lymphedema.

Acute Phase Response in Enzootic Bovine Leukosis

In the present study, we evaluated acute phase response by detecting haptoglobin (Hp), serum amyloid A (SAA) and fibrinogen in cattle with enzootic bovine leukosis (EBL). A total of 60 Holstein cattle (≤3 years old), comprisingof 40 cattle infected with BLV, and 20 BLV-free healthy controls were enrolled in this study. Diagnosis of the BLV infection was performed by serology (ELISA and AGID) and PCR techniques. APPs were detected by commercial ELISA test kits using validated standard procedures as instructed. All the BLV-infected cattle were in good general health and had normal respiratory rates, pulse rates, body temperatures. However, 5 cattle had enlarged, hard, painless, movable superficial lymph nodes in infected group. APPs including Hp (p&lt;0.001), fibrinogen (p&lt;0.001), and SAA (p&lt;0.05) concentrations were significantly higher in cattle with EBL compared to BLV-free cattle. On hematologic examination, total leukocyte, lymphocyte and granulocytes concentrations were significantly higher in infected cattle when compared tocontrols. In addition, Hp and SAA (p&lt;0. 001) concentrations were significantly higher in symptomatic cattle than asymptomatic. The Pearson correlation revealed significant associations between APPs and total leukocyte and granulocytes; however, there was no correlation with lymphocyte. In conclusion, the results of this study showed increased acute phase response in BLV infected cattle.

Acute Phase Response in Enzootic Bovine Leukosis

In the present study, we evaluated acute phase response by detecting haptoglobin (Hp), serum amyloid A (SAA) and fibrinogen in cattle with enzootic bovine leukosis (EBL). A total of 60 Holstein cattle (≤3 years old), comprising of 40 cattle infected with BLV, and 20 BLV-free healthy controls were enrolled in this study. Diagnosis of the BLV infection was performed by serology (ELISA and AGID) and PCR techniques. APPs were detected by commercial ELISA test kits using validated standard procedures as instructed. All the BLV-infected cattle were in good general health and had normal respiratory rates, pulse rates, body temperatures. However, 5 cattle had enlarged, hard, painless, movable superficial lymph nodes in infected group. APPs including Hp (p&lt;0.001), fibrinogen (p&lt;0.001), and SAA (p&lt;0.05) concentrations were significantly higher in cattle with EBL compared to BLV-free cattle. On hematologic examination, total leukocyte, lymphocyte and granulocytes concentrations were significantly higher In infected cattle when compared to controls. In addition, Hp and SAA (p&lt;0. 001) concentrations were significantly higher in symptomatic cattle than asymptomatic. The Pearson correlation revealed significant associations between APPs and total leukocyte and granulocytes; however, there was no correlation with lymphocyte. In conclusion, the results of this study showed increased acute phase response in BLV infected cattle.

Protective efficacy of a canine brucellosis vaccine candidate based on live attenuated Salmonella expressing recombinant Brucella BCSP31, Omp3b and SOD proteins in Beagles.

The aim of this study was to establish a proof-of-concept of protective efficacy of Salmonella-based B. abortus vaccine candidate in Beagles. Group A Beagles (n=10) were subcutaneously (SC) inoculated with S. Typhimurium delivery strain containing pMMP65 (vector to deliver antigens) only as vector control. Group B Beagles (n=10) were SC vaccinated with the mixture of the three Salmonella delivery strains expressing the recombinant B. abortus BCSP31, Outer membrane protein 3b (Omp3b), and superoxide dismutase (SOD) proteins, respectively. No Salmonella delivery strains were isolated from all tissues tested. Serum IgG, interleukin-4, tumor necrosis factor-alpha, and interferon-gamma concentrations were significantly higher in group B than in group A. Following intraconjunctival challenge with B. abortus 544, among 5 group B Beagles, the challenge strain was isolated from mandibular, and retropharyngeal lymph nodes of three Beagles, and no isolates were observed from all tissues of two Beagle. However, the challenge strains were detected from spleen, uterus (except two Beagles), and mandibular, prescapular, retropharyngeal, and superficial inguinal lymph nodes of all group A Beagles. These results suggest that the mixture of three S. Typhimurium delivery strains be a good vaccine candidate against brucellosis by B. abortus in dogs. Further investigations are needed to improve the protective efficacy of the Salmonella-based B. abortus vaccine candidate and explore its practical application in dogs.

Sustained Remission with Mogamulizumab in Peripheral T Cell Lymphoma with Aberrant CD20 Expression: Case Report and Literature Review

A 82-year-old man presented with an enlarged multiple superficial lymph nodes. The histological diagnosis of lymph node was peripheral T cell lymphoma, not otherwise specified (PTCL-NOS), with an aberrant expression of CD20. Generally, PTCL lacks B cell antigen such as CD19 or CD20, however, rare cases have been reported in the literature that showed PTCL patients expressing the B cell antigens. It is considered that the prognosis of CD20 positive PTCL is poor, however, standard therapy has not been established. He was treated with eight cycles of CHOP regimen, but the enlargement of a part of lymph nodes still remained. Recently, it is reported that C-C Chemokine receptor type 4 (CCR4) is known to be expressed about 50% case of PTCL and CCR4 target therapy is effective. Our case was positive for CCR4 so mogamulizumab (anti-CCR4 antibody) was administered. Consequently, dramatic response was obtained and its combination of these therapy resulted in complete remission for 24 months. This is the first case of sustained remission by administration of mogamulizumab against CCR4/CD20 double positive PTCL. This strategy may be benefit to obtain the good prognosis.

Anatomic distribution and clinical target volume of metastatic inguinal nodes in gynecological malignancies

Objective To determine the anatomic distribution of metastatic inguinal nodes in gynecological malignancies, and to explore the delineation of clinical target volume (CTV). Methods A retrospective study was performed among 34 patients with gynecological malignancies and inguinal lymph node metastases. According to the anatomic distribution of metastatic inguinal nodes, CTV covering more than 95% of inguinal lymph nodes and the relationship of inguinal nodes with the femoral vein, greater saphenous vein and its branches, superficial fascia, and deep fascia were analyzed using vascular enhancement images obtained by computed tomography and magnetic resonance imaging as well as 3D reconstruction using the Eclipse Planning System. Results The 34 patients had a total of 145 positive inguinal nodes. In the 131 superficial nodes below the inguinal ligament, 129 were located between the superficial fascia and the deep fascia; the upper group of superficial nodes, containing 25 nodes, was located at 1 cm above the public symphysis and along superficial iliac circumflex vein; the middle group, containing 85 superficial nodes and 11 patients with single superficial node metastasis, was located at the same level of the public symphysis and close to the junction of the saphenous vein and the femoral vein; the lower group, containing 21 superficial nodes, was beneath the public symphysis and along the greater saphenous vein and medial and lateral superficial femoral veins. The 14 deep nodes were located on the medial side of the femoral vein. There were no positive nodes on the posterolateral side of the link between the posterolateral edge of the femoral vein and medial edge of the sartorius muscle. The upper edge of CTV kept 142 lymph nodes beneath the upper edge of the superior pubis ramus and left 3 lymph nodes up to the upper edge of the femoral head. The lower edge of CTV kept 143 lymph nodes above the lower edge of the lesser trochanter and left 2 lymph nodes at 2 cm beneath the lower edge of the lesser trochanter. Conclusions For CTV covering 98% of positive inguinal nodes, the anterior edge is the superficial fascia; the medial edge is composed by the inguinal ligament and the border of medial muscle to the femoral vessels; the posterolateral edge is the link between the posterolateral edge of the femoral vein and the medial edge of the sartorius muscle; the upper edge is the upper border of the femoral head; the lower edge is the lower border of the lesser trochanter. Key words: Gynecologic oncology; Inguinal metastasis nodes; Anatomic distribution; Clinical target volume

Clinical efficacy of short-course chemotherapy combined with topical injection therapy in treatment of superficial lymph node tuberculosis.

To evaluate the clinical efficacy and safety of short-course chemotherapy combined with regional injection therapy in the treatment of superficial lymph node tuberculosis. 201 patients diagnosed with superficial lymph node tuberculosis were retrospectively analyzed. All patients were randomly divided into the study (n = 100) and control groups (n = 101). In the study group, the patients received 6-month chemotherapy with isoniazid (H), rifampin (R) and ethambutol (E) (6HRE) in combination with regional injection of streptomycin, and their counterparts in the control group underwent systemic regime of 3HRZE/6HRE. In the study group, the overall cure rate was calculated as 98% and the recurrence rate was 2%. Twenty-four of 25 nodular type patients and 36 among 37 inflammatory type patients were recovered and discharged. One patient with huge nodular type mass was treated for 4 months and the mass size was slightly reduced. In the control group, the overall cure rate was 48.5% and the recurrence rate was 7.9%. The recurrent patients were further administered with regional injection of streptomycin based upon the chemotherapy regime until they were recovered. Combined therapy of systemic chemotherapy and regional injection of streptomycin is probably an efficacious and safe approach in the treatment of superficial lymph node tuberculosis, which remains to be validated by more investigations.

Parameters for Contrast-Enhanced Ultrasound (CEUS) of Enlarged Superficial Lymph Nodes for the Evaluation of Therapeutic Response in Lymphoma: A Preliminary Study.

BackgroundThe aims of this preliminary study were to evaluate contrast-enhanced ultrasound (CEUS) imaging and the therapeutic response of enlarged superficial lymph nodes in patients with lymphoma before and after chemotherapy and to determine the most useful CEUS response parameters.Material/MethodsForty-three patients with lymphoma, with 43 enlarged superficial lymph nodes, underwent CEUS and conventional ultrasound (US), before treatment and after the first three cycles of chemotherapy. Clinical responses included overall response (OR) and no response (NR). Imaging parameters by time-intensity curve (TIC) included basic intensity (B), wash-out slope and/or decent slope (K), wash-in slope or rise slope (C), time to peak (TTP), area under the gamma curve (Area), arrive time(ATM), peak intensity (PI), change of peak intensity (I) were compared. And receiver operating characteristic (ROC) curve analysis was operated.ResultsQuantitative parameters of CEUS before and after the first three cycles of chemotherapy showed a significant difference in the AreaΔ, PIΔ, and IΔ in the OR group compared with NR group (P<0.05). There was a significant difference in the Cpre, Areain, PIin, Iin, AreaΔ, PIΔ, and IΔ in the OR group compared with NR group (P<0.05). The effectiveness of the therapeutic response was predicted by the CEUS parameters of IΔ (P<0.05). And ΔArea has the highest diagnostic performance of ineffectiveness.ConclusionsThe findings of this study have shown that quantitative analysis by CEUS may be a useful, and objective, imaging method for the evaluation of the therapeutic response of enlarged superficial lymph nodes in lymphoma before and after chemotherapy.