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BACKGROUND: Sentinel lymph node biopsy (SLNB) is an established means of staging the axilla in patients with breast cancer. Recently, methylene blue dye has been shown to be an efficacious and cost-effective alternative to isosulfan blue. With the increasing popularity of SLNB, the potential complications of isosulfan blue use must be appreciated. METHODS: A literature search for English language articles available on MEDLINE from 1985 to November 2002 using the search terms allergy, allergic reaction, anaphylactic reactions, anaphylaxis, blue dye, breast cancer, isosulfan blue, methylene blue, and sentinel lymph node biopsy identified 24 reports. CONCLUSIONS: The use of isosulfan blue due for SLNB is associated with a significant number of allergic reactions, some of which are life-threatening. Because methylene blue dye has been shown to be equally effective and does not pose a serious risk of serious allergic reactions, it offers an improved technique above isosulfan blue dye for SLNB.
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Allergic reactions during lymphography are uncommon, usually minor and difficult to attribute to a single agent because of the common practice of mixing patent blue dye and local anaesthetic before injection. A case is presented where injection of patent blue dye alone was followed by generalised urticaria, swelling and constriction in the throat and difficulty breathing.
Patent blue vital (patent blue V; Laboratoire Guerbet, France) is used to identify the sentinel node during surgery for invasive breast cancer. Detecting the sentinel node that first drains the primary tumor reduces the need for total breast and wide axillary node removal, with the problems that such radical surgery involves. Like other dyes, patent blue V can interfere with accurate pulse oximeter reading, leading to underestimation of real values. We report the case of a 31-year-old woman who underwent lumpectomy and removal of the sentinel node. After intradermal injection of patent blue V dye into the left breast (100 mg administered because the sentinel node was difficult to locate) a drop in peripheral oxyhemoglobin saturation from 99% to 93% was detected by the pulse oximeter. When arterial blood gas analysis showed normal values and other causes were ruled out, the diagnosis was false low oximetry reading due to patent blue V dye.
Chromosomal aberrations induced by indigo carmine (secondary amine-containing dye), fast green FCF (tertiary amine-containing dye) and sodium nitrite, singly and in combination, were studied in mice after prolonged feeding in the diet. A significant increase in the chromosomal aberrations was observed for all the dyes and in the nitrite treated series when compared with distilled water controls. However, a combination of half the concentration of dye and nitrite gave additive effects.
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A relatively high complexation affinity has been found for coomassie blue G-250 and the following amino acids: arginine; tyrosine; lysine; and histidine. A linear relationship was observed between log molar absorptivity and log molecular weight of 52 of 69 proteins, polypeptides, and di- and tripeptides that were allowed to react with coomassie blue G-250 in solution. The solution complexation results were used in a study of the detection of the following model proteins: bovine serum albumin, lysozyme, recombinant DNA derived human insulin, and calmodulin. Interactions between coomassie blue stained gels and silver detection reagents were determined and used as the basis for studies of enhanced sensitivity of detection of electrophoretically developed proteins. Sensitivity enhancements of up to eight-fold were observed when various sulfonic acid dye complexed proteins were detected with silver reagents versus the use of silver reagents alone. A site-directed nucleation of silver caused by the protein complexed sulfonic acid dyes is proposed as a mechanism for the observed enhancements.
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Sister chromatid exchange (SCE) induced by Indigo carmine (secondary amine containing dye), Fast green FCF (tertiary amine containing dye) and nitrite singly and in combination with nitrite were carried out in vivo in mice following acute exposure. A significant trend in the frequency of SCE in bone marrow cells was observed for all the dyes and nitrite tested when compared to the negative control. Fast green FCF was found to be more toxic than Indigo carmine. In addition, when a combination of half the concentrations of the dyes and nitrite was given, the values of SCEs were consistently lower than the sum of the expected values of the agents given individually. This indicates antagonistic response between the dyes and nitrite on SCEs.
The potential of malachite green isothiocyanate as a photosensitizer for the inactivation of bacteria has been evaluated. Samples of Staphylococcus aureus are treated with the dye and exposed to continuous-wave red light from a filtered xenon lamp. Reduction in cell viability is seen to increase with radiation dose, whilst non-photosensitized samples are largely unaffected with exposure. The mechanism of photosensitization and the subsequent inactivation is addressed. UV-Vis and Fourier-transform infrared absorption spectrometry have been applied to this biological system, revealing the rapid hydrolysis of the isothiocyanate group of the dye and the transition to the colourless carbinol base when in solution. On binding to Staphylococcus aureus via a complexation mechanism, the dye is seen to be stabilized in its cationic form. Involvement of the excited triplet state of the photosensitizer is suggested and identification of reduced dye photoproducts is made following irradiation.
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Model systems of agar films containing known concentrations of bovine serum albumin and alpha-chymotrypsinogen were stained with aldehyde fuchsin after oxidation with acidified permanganate solution. These films were scanned in a scanning microphotometer to determine the mean extinction and the total extinction of predetermined areas. Results indicate that the dye binds quantitatively to the proteins. Blocking the acidic side groups of the proteins inhibited the binding of the dye. The degree of inhibition was directly related to the number of sulfhydryl or carboxyl groups that were blocked. Similar blocking reactions performed on the type "A" neurosecretory cells of the pars intercerebralis of the insect Oncopeltus fasciatus gave similar results. Analysis of the dye protein complexes gave a dye to acidic group ratio of 1:1.
BACKGROUND: Isosulfan blue dye is widely used in sentinel node surgery for malignant melanoma. Intravascular dye injection is known to interfere with pulse oximetry (SpO2), but the effects of intradermal dye injection are not well known. Our aim was to determine the effects of intradermal dye injection on SpO2. METHODS: This was a controlled, prospective study of 84 consecutive patients undergoing wide local excision of malignant melanoma and sentinel lymph node biopsy. The control group (n=24) received no dye. The dye group (n=60) received isosulfan blue dye intradermally at the biopsy site. SpO2 declines of > or =2% were considered significant. RESULTS: Two patients in the control group (8%) and 20 patients in the dye group (33%) had a clinically significant SpO2 decline (P<.02). In those with significant declines in the dye group, the amount ranged from 2% to 4%. The latency of decline from the time of injection was 22.8 +/- 12.7 minutes. CONCLUSIONS: Patients who receive intradermal dye injection for sentinel lymph node surgery have a 4-fold increased rate of developing declines in SpO2. With the increasing trend toward using intradermal dye administration to map lymphatic drainage in melanoma and breast surgery, declines in SpO2 readings can be expected to occur frequently. To our knowledge, this is the first report of the effects of intradermal dye injection on SpO2 readings in a large series of patients.