Monday, January 30, 2012


For certain types of cancers (Melanoma, Merkel Cell Carcinoma, and other Cancers showing aggressive characteristics), it is sometimes helpful to perform lymphoscintigraphy and sentinel lymph node excision.

The lymphatic system is composed of channels running throughout the body that pick up lymphatic fluid and cells (fluid and cells within the tissues), filter this fluid through lymph nodes, and eventually return the fluid and cells to the heart and back into the blood stream.

Some cancers with more aggressive characteristics have the potential for spreading to lymph nodes. Lymph nodes act as a filter and trapping mechanism to capture cells that may be harmful to the body (cancer cells and infection). It is helpful in terms of treatment, predicting prognosis, and improving the cure rate and survival if we can determine if these cancers have spread to regional lymph nodes.

The Sentinel Lymph Node is the first lymph node that will accept drainage from a particular region of the body. For example, if we have a more aggressive cancer on the face, there is a chance that the cancer could spread to a lymph node or nodes in the neck. There are multiple lymph nodes in the neck, so the trick is to determine to which lymph node or nodes this cancer would spread if it decided to get into the lymphatic system and spread. To determine the first node or nodes that may accept drainage, the patient is evaluated in the Nuclear Medicine Department of Radiology the morning of surgery or the day before. A radioactive tracer is injected near the cancer, and this tracer is picked up by the lymphatic system and migrates within the lymphatic vessels until it reaches the sentinel lymph node. By taking X-rays during this process, the radiologist is able to determine where this sentinel lymph node is located. A mark is usually made over the lymph node to identify it. Sometimes, there is more than one lymph node identified, and sometimes the lymphatic system does not pick up the tracer and no sentinel lymph node can be detected. This pre-operative study is called Lymphoscintigraphy. The patient then presents to the surgical suite, and the primary cancer is removed and the defect reconstructed. The sentinel lymph node is then addressed. An incision is made over the marking, and using a sterile Nuclear Detection Probe, the dissection into the lymph node basin is performed until a "radioactively hot" node(s) is identified. The lymph node(s)is removed and sent for permanent pathology. For most cases, it takes about a week to get the results. Keep in mind, just because we have identified and removed a sentinel lymph node, this does not necessarily mean that the lymph node is involved with cancer. It just means that if the cancer is going to spread into the lymphatic system, this will be the first lymph node that it goes to.

If no cancer is identified in the lymph node, that is a good sign which tells us at the current time, the cancer has not spread into the lymphatic system. If we identify cancer in the sentinel lymph node, additional surgery is usually necessary (complete lymph node dissection of the all lymph nodes in that particular regional basin).

Wednesday, January 18, 2012


The rate of health care costs continue to spiral out of control. Factors to consider:
(1) Malpractice Costs: Premiums and the cost of Defensive Medicine

(2) Drug Costs: In 2010, the United States spent $262 billion on prescription drugs which is about 10% of total health care spending (JAMA, January, 2012). New and better drugs require a tremendous investment in R&D.

(3) The "Million Dollar Baby": Babies who consume more than $250,000 in Neonatal and Pediatric Intensive Care Units require sophisticated interventions to save lives.

(4) Chronic Conditions: Approximately 10% of the population consumes about 64% of health are expenditures related to coronary artery disease, congestive heart failure and diabetes. Patients need
to alter their diets, stop smoking, exercise and come to grips with the fact that many chronic conditions can be improved and altered by better life-styles and preventive measures.

(5) End of Life Costs: Cost related to the last few years of life with medical and surgical interventions are ethical issues that are complicated and individual. Every patient should have "An Advance
Directive for Health Care".  This is a legal document which contains your wishes regarding both a
"living will" and the appointment of a health care proxy.

Friday, January 13, 2012


A 33-year-old woman was charged in December with international drug trafficking after she was found carrying more than five pounds of cocaine - with an estimated value of £250,000 that had been molded inside artificial breast and buttocks implants.

The woman, a model identified only as MFM, was detained by security personnel at Rome's Fiumicino Airport after a flight from Buenos Aires, Argentina - a route not uncommon to drug traffickers, according to the Daily Mail of London.

"She tried to distract them with a plunging neckline and tight outfit, but they stopped her for questioning because she was so alluring," Fiumicino Airport Police Chief Antonio DiGreco told the Daily Mail. Two female officers found the cocaine inside the inserts, he added.

Authorities began their search of the suspect after she failed to adequately explain the reason behind her trip to Argentina, the newspaper reported.


Nanoparticles could treat wounds with nitric oxide

Nanoparticles that slowly release nitric oxide could be used to treat skin and soft tissue infection, including methicillin-resistant Staphylococcus aureus, researchers report in the journal Virulence. Nitric oxide has been shown to reduce infection, but the reactive gas is difficult to use in a clinical setting. Using nanoparticles allows for topical and intralesional treatment, the researchers said. Nanowerk (1/4)


Demand increases for stretched earlobe repair

More people who stretched their earlobes using disc earrings and plugs are seeking repair procedures, plastic surgeons report. ASPS member Dr. David Kahn, who has performed repair procedures for the past two years, recently helped a 21-year-old patient who was about to start studies at the University of California, Berkeley. "I don't regret doing it. And I don't regret fixing it, either. You learn something from all of it," the patient said. San Francisco Chronicle (1/6)

I am seeing more patients with this condition.  To correct the problem, a reconstruction and re-shaping of the ear lobe is needed after excising excess tissue and removing the large hole.  This can usually be done in the office under local anesthesia.  EBG