Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Operating Room Technicians”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources
PubMed1980

Waste anesthetic gas and vapor exposures in veterinary hospitals and clinics.

A survey of veterinary hospitals and clinics was conducted to determine the extent of usage of inhalation anesthetics and measure exposures of veterinarians and their assistants to waste anesthetic gases and vapors. A questionnaire survey indicated 80.8 percent of practices in the study area used inhalation of anesthetics, with a wide range noted between types of practices. Exposures to waste anesthetics were less in veterinary hospitals than reported in human hospitals. Mean methoxyflurane concentrations were 1.9 ppm and 1.7 ppm in breathing zones of small animal veterinarians and animal technicians, respectively. Waste methoxyflurane concentrations were significantly affected by size of patient, type of breathing system, and use of scavenging systems. Dilution ventilation had no significant effect on breathing zone concentrations of waste methoxyflurane.

Air↗
PubMed1999

Implementing a multiple-isolator unit for centralized preparation of cytotoxic drugs in a cancer center pharmacy.

Due to numerous reasons: assuring safety (technicians, patients, nurses, environment), preventing medication errors, cost, maintaining pharmaceutical quality, rules and regulations, it was decided to create a dedicated room within the pharmacy for the preparation of intravenous cytotoxic drugs. After a preliminary study, the following choices were made: isolator unit instead of a vertical laminar air-flow hood, rigid surface instead of flexible film, a multiple-unit structure (one half suit unit for storage and one isolator unit for passthrough, two preparation units, each with four double-gloving portals) instead of a single-unit structure. After the equipment was installed, the physical and microbiological processes were validated and a medical/pharmaceutical catalog of protocols was created. Then the technicians were trained and the standard operating procedures were written. Updated every six months, they describe the general organization, gaseous sterilization of the isolators, the drugs and the medical devices, prescription analysis and circuit, preparation of nominative forms and labels, double checking the preparations delivery, cleaning and maintenance, documentation and reports, waste disposal, safety and protection and instructions for emergency. The pharmacists, pharmacy staff, physicians and nurses were all included in a work group responsible for the isolator unit project. The unit was opened in January 1997.

Antineoplastic Agents↗
PubMed2001

Impact of active monitoring of infection control practices on deep sternal infection after open-heart surgery.

BACKGROUND: Deep-sternal infection is a devastating complication after open-heart surgery. However, the association between infection control practices and deep-sternal infection rates is unclear. METHODS: To identify contributors to increased deep-sternal infection rates in our institution, consecutive open-heart surgery patients were prospectively studied during two periods (75 and 40 days), including 66 and 40 patients, respectively. Active monitoring including 149 infection control practices was performed in the operating room and intensive care unit. End-points were deep-sternal infection rates and their relation to infection control practices. RESULTS: Mean age was 62+/-11 years and 68% were males. Coronary bypass was performed in 82%. Clinical and surgical features were comparable, except that patients in period 2 were more likely to have heart failure (15% vs 1.5%, p = 0.01) and had a longer mean duration of surgery (277 vs 217 minutes, p < 0.005). Only 57 practices (38%) were adequately performed. The main categories showing inadequate practices were disinfection, traffic, hand-washing, and surgical attire of nonscrubbed personnel, anesthesiologists, and pump technicians. Many categories showed a statistically significant improvement between periods. Deep-sternal infection rates in prestudy and poststudy periods were 10% and 2.8%, respectively (p = 0.007). CONCLUSIONS: Active monitoring among personnel involved in open-heart surgery resulted in a significant and sustained decrease in deep-sternal infection rates, through modification of human behavior and improvement of performance standards, probably mediated by the Hawthorne effect. Periodic active monitoring may be a valuable tool to achieve and even sustain such a decrease with tremendous implications on morbidity, costs, and quality of care.

Aged↗
PubMedDate not supplied

An on-line system for electrocardiogram interpretation using the Bonner program.

An on-line system for electrocardiogram (ECG) interpretation using the Bonner program has been developed. The system consists of a telephone network, a process computer, a host computer, a computer interface and an electrocardiograph equipped with transmitting options. The signal acquisition program offered by IBM was modified so as to be equipped with the following functions: The technician can distinguish whether the process computer is ready or not, even if he is working in an examination room which is distant from the computer room. The data received by the process computer is transferred to the host computer in real time. In cases where the host computer is unable to receive the data, the process computer restarts transmission quickly after the host computer recovers the function of receiving. The host computer interprets transferred data in real-time by the Bonner program. The interpretation report is printed in real time on a remote printer. As the result of these modifications, a series of data processing operations may be executed without intermediary operators. The printed interpretation report begins to appear about ten seconds after completion of transmission.

Electrocardiography↗
PubMedDate not supplied

The bispectral index monitor: a new tool for air medical personnel.

The bispectral index monitor (BIS) is commonly used in the operating room to help anesthesiologists quantitate the level of anesthesia. The BIS has been shown to reduce the incidence of anesthetic overuse and decrease costs. The device has made its way into critical care areas, where it has proven effective in monitoring sedation levels, specifically in reducing the incidence of oversedation. This article explores the possibility of using the monitor in the air medical environment.

Air Ambulances↗
PubMed1998

Paramedic judgment of the need for trauma team activation for pediatric patients.

OBJECTIVE: To determine the value of paramedic judgment in determining the need for trauma team activation (TA) for pediatric blunt trauma patients. METHODS: A prospective, observational study was conducted at the ED of Children's Hospital Medical Center of Akron between July 12, 1996, and February 28, 1997, in cooperation with Akron Fire Department emergency medical technician-paramedics (EMT-Ps). The ED provides on-line and off-line medical control for pediatric transports. Patients with minor or no identifiable injuries are released at the scene with the instructions to see a physician. The remainder are transported to the ED. The decision for TTA is based on ED trauma protocols as well as emergency physician judgment of injury severity in combination with the judgment of the treating paramedic. During the study, EMT-Ps were asked (before physician input) whether, based solely on their judgment, a patient needed TTA. Patients 0-14 years old who were involved in motor vehicle crashes, bike crashes, or falls from a height of >10 feet were included in the study. TTA was defined as necessary if the patient was admitted to the intensive care unit (ICU) or operating room (OR) for nonorthopedic surgical procedures. Out-of-hospital, ED, and hospital records were reviewed. Coroners' records as well as medical records of all trauma admissions during the study period were reviewed to ensure that the patients released at the scene were not mistriaged. RESULTS: One hundred ninety-two patients met study criteria. Eighty-five patients (44%) were transported to the ED, of whom 12 had TTA. EMT-Ps requested TTA for 10 of these patients, and 2 patients had TTA per ED trauma protocol. Two of the patients who were judged by EMT-Ps to need TTA were admitted to the ICU/OR, and neither of the patients identified by ED trauma protocol to require TTA were admitted to the ICU/OR. Two initially stable patients who did not have TTA deteriorated after arrival to the ED. Both were admitted to the ICU. The sensitivity and specificity of paramedic judgment of the need for TTA for pediatric blunt trauma patients were 50% (95% CI 9.2-90.8) and 87.7% (95% CI 78.0-93.6), respectively. The positive and negative predictive values were 16.7% (95% CI 2.9-49.1) and 97.3% (95% CI 89.6-99.5). None of the patients released at the scene was mistriaged based on the review of the coroners' and trauma admission records. CONCLUSION: Results of this investigation indicate that a small percentage of pediatric blunt trauma patients require TTA. EMT-P judgment alone of the need for TTA for pediatric blunt trauma patients is not sufficiently sensitive to be of clinical use. The low sensitivity is explained by the deterioration in the clinical condition of 2 initially stable patients. The paramedic disposition decisions from the scene were always accurate. Nontransport by emergency medical services (EMS) may be acceptable in some uninjured pediatric trauma patients. Injured pediatric trauma patients who appear to be stable may deteriorate shortly after injury. However, if a pediatric patient appears injured, transport from the scene and examination by a trauma specialist are needed. Finally, the role of paramedic judgment must be further defined by larger studies with urban, rural, and suburban EMS systems before it can be used as a sole predictor of TTA.

Adolescent↗
PubMed2005

A computerised communication aid for people with aphasia.

PURPOSE: To develop a portable computerised communication aid for aphasic people to support communication in everyday life. METHOD: A multidisciplinary team of aphasiologists, augmentative and alternative communication specialists, speech and language therapists and technicians developed a portable, modular system, PCAD (portable communication assistant for people with dysphasia), running on a commercially available handheld computer. The system was tested in a multiple case study. Aphasia therapy services In the UK, Portugal and The Netherlands referred 28 people with aphasia, who were considered eligible for a computerised communication aid. Participants were trained following a protocol and used the device in self-chosen real life settings. RESULTS: Six of the 28 selected aphasic patients decided not to test the device; 22 participated in the training. All 22 learned to operate the aid, 17 used it functionally, in everyday life. Five people did not use the aid outside the therapy room, although they were able to operate the aid and to use it in role play. These unsuccessful clients were younger, and tended to have a shorter duration of the aphasia. CONCLUSIONS: Carefully selected aphasic patients may benefit from a computerised communication aid, using it functionally in everyday communicative settings.

Adult↗
PubMedDate not supplied

[Reception of the ASL 3 "Genovese": the point of view of the citizens and operators].

The quality of the reception of the patients in the health services is one of the projects of one of the Local Health Authorities of Genova, with the aim of improving its personalization, information and humanization and, therefore, its perceived quality. The judgements of patients and health workers were collected. Ten focus groups with 146 patients representing different populations (mothers, elderly, people living in suburbs) were activated, and 2644 questionnaires were distributed to the health workers (nurses, technicians, clerks etc) of the hospitals and districts (response rate 62%). Efficiency is the key meaning of reception for health care workers (giving information, orienting receiving with politeness and kindness); whilst patients value more other aspects such as the interpersonal relationship and the humanization (empathy, listening, answer to needs). Both stress the need of easing procedures and clinical pathways. Patients and health care workers judge physical environments (rooms, furnitures, signs, bathrooms) inadequate and for patients this judgement is more negative for the hospital compared to the district. Scarcity of readily accessible personnel and a non-individual centered approach are the two main specific complaints, while a general observation of dissatisfaction is attributed to the fact that everything seems to be left to the good will of individual health care workers. The data collected are now used to plan educational initiatives, protocols more broadly to redefine procedures of reception. Because of their role and number nurses may certainly play a pivotal role in this process.

Adult↗
PubMed2006

Validation of primary CD4 gating as an affordable strategy for absolute CD4 counting in Cambodia.

OBJECTIVE: To validate primary CD4 gating in lysed whole blood for absolute CD4 counts in fresh and aged blood using an affordable compact volumetric commercial flow cytometer. DESIGN: Comparison of CD4 counts between the FACSCount and the 2-parameter CyFlow SL Green. METHODS: One hundred twenty fresh blood samples from patients likely to be infected with HIV were simultaneously run on a FACSCount at the Pasteur Institute of Cambodia and on a CyFlow SL Green at the Sihanouk Hospital Center of Hope (SHCH), Phnom Penh, Cambodia. Intra- and interrun precision was assessed using 2 blood samples. Stability of CD4 counting in blood stored up to 96 hours at room temperature was assessed using 27 blood samples. RESULTS: CD4 counts on the CyFlow SL Green and on the FACSCount correlated well apart from a relative bias (R = 0.993, bias of -9.5%, 95% confidence interval [CI]: -11.8% to -7.1%, limits of agreement: -32.5% to 13.6%). Intra- and interrun variability ranged from 3% to 5% and from 5% to 6%, respectively. CD4 counts on aged blood using the CyFlow SL Green showed an interassay variability of <10%. CONCLUSIONS: Primary CD4 gating in lysed whole blood using the CyFlow SL Green is an affordable and precise method for CD4 counting. Because the fluorescence (FL) and light scatter signals have to be analyzed manually, however, intensive training of the technician and/or operator is imperative.

CD4 Antigens↗
PubMed2006

Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis.

AIMS: To perform a comprehensive analysis of all aspects of patient and in-room personnel radiation dosimetry in interventional electrophysiology. METHODS AND RESULTS: Measurements were performed during 19 diagnostic electrophysiology studies and 24 catheter ablations. Kerma-area product and exposure time values were 48.7 (6.4-230) Gy cm2 and 25.5 (4.4-79.2) min for ablation, and 12.5 (4.5-117.2) Gy cm2 and 4.5 (1.2-31) min for diagnostic studies, respectively. Patient effective doses were 15.2 (2.1-59.6) mSv for ablation and 3.2 (1.3-23.9) mSv for diagnostic procedures. Radiation risk to the patient was estimated to be up to eight cases of fatal cancer in 10,000 procedures. The risk of development of fatal cancer was less than 3x10(-6) per procedure to the primary operator. The risk for the nurse and technician was much lower. The dose per procedure for the primary operator was 7.1 microGy at the eyes, 0.79 microGy at the chest under the lead apron, 13.68 microGy at the chest over the apron, 3.82 microGy at the thyroid, 17.76 microGy at the left hand, and 12.11 microGy at the left knee. CONCLUSION: As far as radiation exposure is concerned, electrophysiology studies followed by radiofrequency ablation are safe procedures for both patient and personnel when performed in catheterization laboratories with modern equipment, experienced operators, and standard safety precautions.

Catheter Ablation↗
PubMed2003

[The history of dental technology instruction and its leading scholars at the Budapest university].

The preconditions for university level education on odontotechnology was first set in 1900 with the establishment of the first Odontotechnological Laboratory in the Dental Institute of the Medical Faculty. The first head of the laboratory and the lecturer of the subject was Dr. Lajos Hattyassy who obtained a senior lecturer (private docent) position in the faculty. Both the technical and personal preconditions substantially improved with the opening of the new clinic of Stomatology in 1909. The dental residents could provide comprehensive prothodontic treatment in the dental lab with its 18 working place and also in the auxiliary practical units. They were supervised by dental specialist and assisted by laboratory technicians. The senior lecturer of the subject was Dr. Henrik Salamon the internationally well know dental researcher. During the mid 20's Dr. Dénes Máthé succeeded him, who also became the director of the whole dental clinic. It was him, who introduced the systematic curriculum in odontotechnology. After World War II according to the requirements of the new health insurance system the independent dental training program started in 1952 besides the traditional stomatologist training. The old dental laboratory could not meet the requirements imposed by the large number of dental students. The new teaching laboratory was organized by Dr. Imre Földvári. This new teaching laboratory made room for the teaching of dental materials and metallurgy, odontotechnology and the phantom head training on operative dentistry and prosthodontics. The technical level of the lab was continuously improved. Dr. Imre Földvári was succeeded by Dr. György Huszár. The previously independent dental subject were first merged and later incorporated into the subject of prosthodontics. In the practical training several modern devices, mimicries and articulators were used. Lately Dr. György Götz succeeded Dr. Huszár, and the subjects of dental materials, odontotechnology and phantom head prosthodontics became again independent dental subjects. With the total refurbishment of the teaching laboratory it became one of the most up to date dental teaching laboratories of Europe. The structure and the curriculum of these newly established dental subjects have also changed and upgraded. The international connections has recently improved and many dental students came from all over the world to study dentistry. Recently for a very short period of time Dr. Pál Tóth jr. was the head of this teaching unit of the Dental Faculty.

Education, Dental↗
PubMed2005

Central processing technician internship--a unique learning opportunity.

A critical shortage of qualified central processing technicians and the opening of a new central processing department (CPD) were driving forces behind the development of a CPD technician internship program at one facility. Classes focused on the principles and practices of central processing, and an OR observation gave interns the opportunity to see the impact that the work of the CPD has on OR function and patient care and safety. Program evaluations have been positive, and staff vacancies have been filled with the graduates of the internship program.

Allied Health Personnel↗
PubMed1985

Ineffectiveness of the trauma score and the CRAMS scale for accurately triaging patients to trauma centers.

Both the Trauma Score (TS) and the CRAMS scale have been advocated for field triage of trauma victims to trauma centers. To determine which scale best serves this purpose, both scores were calculated by computer for 5,130 trauma cases in our statewide computer file of ambulance rescue runs from 1981 through 1983. A total of 3,231 patients (63%) were treated in the ED and released; 1,857 (36.2%) were admitted to the hospital (202 of whom were transferred directly from the ED to the operating room [OR] for immediate operation); and 42 (0.8%) were DOA or died in the ED. Major trauma was defined as a TS of 12 or less or a CRAMS scale of 8 or less. Both scales correctly identified as major trauma all patients who were DOA or died in the ED. The TS identified as major trauma more patients admitted to the hospital than did the CRAMS scale (33% vs 21%; P less than .0001). The TS identified as major trauma more patients transferred from the ED to the OR than did the CRAMS scale (37% vs 21%; P less than .002). Both scales failed to identify as major trauma almost two out of three patients brought directly from the ED to the OR. The paramedics', or emergency medical technicians' qualitative judgements about injury severity, reflected in their coding injuries as life- or limb-threatening, was almost as good (more than 90% sensitive and specific) as either score (100% sensitive and specific) in identifying patients who died, and was better in identifying patients sent from the ED to the OR.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis-Related Groups↗
PubMed1999

On-line computer system to minimize laser injuries during surgery: preliminary system layout and proposal of the key features.

The aim of this paper is to investigate some new user interface ideas and related application packages which aim to improve the degree of safety in an operating room during surgical operations in which an invasive laser beam is deployed. The overall value of the proposition is that a means is provided which ensures the successful completion of the surgical case while minimizing the risk of thermal and mechanical injuries to healthy tissues adjacent to the surgical field. According to surgeons operating with a variety of CO2 lasers available at both the National Cancer Institute in Milan, Italy, and the Sackler School of Medicine, Tel Aviv University, Israel, each laser device presents different cutting and coagulation properties. In order to identify which 'ideal' procedure might corroborate the subjective impression of each surgeon and also to provide one common tool to ensure procedures with a high level of safety, the author has worked for several months with surgeons and technicians of both Institutions to define the general design of a new on-line surgical operation planning and design system to be used during the pre-operative briefing activities and also as a consultation tool during operation. This software package will be developed and tested on both 'C' and FORTRAN compilers running on a commercially available PC which is driving a continuous wave (CW) CO2 laser device via its Instrument Bus interface. The present proposal describes the details of a software package called LCA (Laser-beam Controller and Adviser) which performs several controls in parallel on the key output parameters of a laser beam device during its utilization in delicate surgical operations. The required performances of this device needed during a given surgical operation are pre-simulated and compared against the well-known safety limits, which are stored in the computer's mass storage. If the surgeon's decision about the laser device set-up are considered to be too close to the required physiological safety limits, then the SW alerts the surgeon and proposes alternatives based on other combinations of both HW and SW configurations. An additional application of LCA uses this SW as a warning tool during the operation itself. If a wrong set-up of the laser device is accidentally used, an alarm will be generated and the laser beam automatically switched-off prior to an 'incident report' printout. The operation will continue only when the surgeon validates the choices that the SW suggests for implementation. If necessary, the surgeon can switch off the device and continue to operate it manually. In this case, the surveillance mode will be totally excluded.

Bone Cements↗
PubMed1990

[Intraoperative diagnosis of the heart and great vessels--measuring blood pressure].

The measurement and registration of pressures and pressure tracings in the cavities of the heart and the great vessels by means of direct punction during cardiac operation follows the same methods as in the catheter-laboratory. The pressure-curves should also be displayed on satellite-screens in sight of the operating surgeon, the anesthetist, and the pump-technician, together with the intraoperatively most important ECG-leads. In our opinion, four pressure-lines for simultaneous registration are necessary. The patient control requires two systems (arterial or aortic pressure, central-venous or left atrial pressure) for the estimation of global myocardial function, conduct of anesthesia and drug therapy, volume-steering, and for the control of the extracorporeal circulation. The intraoperative control or completion of the diagnostic criteria of the underlying cardiac lesion demands at least two additional pressure lines, that also serve for quality control after the corrective procedure. Transitory alteration caused by a particular operative situation can be differentiated from a lesion needing surgical intervention by making use of such functional tests as volume variation, pharmacological provocation, pacemakerstimulation, etc. The careful interpretation of intraoperatively derived pressure-tracings seems to be a useful and unavoidable surgical method in the cardiac operating room that can be easily realized without any harm to the patient, and with reliable results and with low costs.

Blood Pressure↗
PubMed2000

Prehospital hypotension as a valid indicator of trauma team activation.

BACKGROUND: Criteria for trauma team activation are continually being evaluated to ensure proper utilization of resources. We examined the impact of prehospital (PH) hypotension (systolic blood pressure < or = 90) on outcome (operative intervention and mortality) and its usefulness as an indicator for trauma team activation. METHODS: A database was created by using the trauma registry for all nonburned, injured patients from July of 1993 through October of 1998 at our Level I trauma center. RESULTS: Of 6,976 patients (83% blunt injury) in the database, 4,437 had a PH blood pressure recorded. Documented PH hypotension was present in 791 patients. Hypotension persisted in the emergency department (ED) in 299 patients, but 193 of them showed minimal or no signs of life on arrival. Four hundred ninety-two patients had PH hypotension but normal ED systolic blood pressure, and 130 patients developed ED hypotension after normal PH systolic blood pressure. Nearly half of the patients with hypotension were taken from the ED directly to the operating room primarily for hemorrhage control procedures. The early and late mortality rates of patients with PH and ED hypotension were 12% and 32%, respectively. Other PH interventions had minimal effect on mortality in the hypotensive patient. CONCLUSION: Prehospital hypotension remains a valid indicator for trauma team activation. Even though most of the non-DOA patients (492 of 598) were stable on arrival to the ED, nearly 50% required operative intervention, and an additional 25% required intensive care unit admission. The trauma team should be activated and involved with these patients early.

Adult↗
PubMed2000

[Problems with organization and operation of emergency medical services in the post-war period in districts with a population of up to 60,000 inhabitants].

Demographic characteristics of Gracanica municipality:--Organization of the municipality on 15 local communities that are 5-20 km away from the centre of municipality.--Road conditions--Starting of industry within Gracanica municipality and social status of the employed population.--There are two main roads that are passing through the territory of municipality--These highways are passing through densely inhabited areas and traffic is heavy. Distance of Tuzla Clinical centre. Services of Gracanica Outpatient Department organize their work although lacking professional staff and equipment. Significance of Emergency Medical Service (EMS) for the municipality and broader community under these circumstances. Present EMCS organization in Gracanica is the following: EMS in Gracanica is organized as a separate service with three permanent teams and temporary engagement of 2 doctors who are on specialization in pediatrics and lungs diseases. A team comrising of a specialist of emergency medicine, three medical technicians and one driver works from 7.00 to 15.00 on regular working days and other doctors work at EMCS from 15.00 to 7.00 and on weekend as well. EMS doesn't examine patients outside the EMS rooms. EMS equipment consists of one ECG, one defibrillator, two aspirators, one oxygen concentrator and a resuscitation set. The Japanese Government donated equipment. Lack of intravenous solutions, drugs and other material for the emergency treatment is notified as permanent problem in emergency care service. Next problem is unsuitable and non-functional space with difficult access and lack of ambulances because the whole rolling stock was destroyed by shelling in 1992. In any case, all these circumstances diminish a team efficiency in providing emergency care. Even under these circumstances EMS had 10,415 examinations during the first sixth months in 2000, provided 45,265 services and treated 912 injuries out of which 64 were traffic injuries. Concerning the complicity of work in EMS Gracanica, standards and norms related to emergency medical care, which have been proposed by the Federal Ministry of Health couldn't be met. By these standards one team covers 20,000 inhabitants and EMS from 19.00 one day until 7.00 the next day and Saturdays and Sundays as well. The question is what to do between 15.00 and 19.00, when every Outpatient Department is closed? For normal functioning of EMS in Gracanica municipality we should do more work on the prevention and work organization in the surgeries of General Medicine in a distant local communities. In that way, EMS wouldn't be a surgery of General Medicine after 15.00. It's necessary to ensure an adequate space, professional staff (at least 4 teams with their leaders) new equipment, ambulances, medicaments, disposable material and furniture. It is necessary:--to develop a system of communication tha could cover municipality and Clinical Centre area,--make educational plan and to respect it,--to establish a cooperation with EMS in neighboring municipalities,--to discuss EMS role in relation to family medicine organization within General hospital in Gracanica.

Bosnia and Herzegovina↗
PubMedDate not supplied

Improved lymphatic mapping technique for breast cancer.

Breast sentinel lymph node biopsy is becoming more common. However, the best injection technique is not well established. Currently the gold standard is peritumoral injection. However, for upper outer quadrant tumors there is considerable axillary "shine through" which makes the identification of the radioactive sentinel lymph node difficult. We undertook a study to compare an injection in Sappey's subareolar plexus to the gold standard of peritumoral injection. Between December 1997 and March 1998, 85 patients with breast cancer were enrolled in the study. All patients were injected with 2 cc of normal saline containing 1.0 mCi of unfiltered technetium sulfur colloid in Sappey's subareolar plexus in the clock position of the breast cancer. In the operating room the patients underwent a peritumoral injection of 5 cc of 1% isosulfan blue. All blue and radioactive lymph nodes were identified and removed. The majority of the tumors were in the upper outer quadrant and were diagnosed by core biopsy. Only half of the patients had palpable tumors and approximately 25% had previous upper outer quadrant biopsy incisions. Peritumoral blue dye injection yielded an identification rate of 94%, with 99% of these being blue and radioactive. Three patients had radioactive lymph nodes with no blue lymph nodes identified. One of these patients had a micrometastasis. Injection in Sappey's subareolar plexus in the clock position of the tumor drained to the same sentinel lymph node as peritumoral injection. This injection technique solved the two major problems confronting the wide adoption of sentinel lymph node biopsy for breast cancer staging. First, it eliminates axillary "shine through" which will allow nonspecialist surgeons to more easily identify the radioactive axillary sentinel lymph node. Second, it allows for easier isotope injection by the technician or nuclear medicine physician, by eliminating the need for three-dimensional localization. This new technique should allow the majority of breast cancer patients who are treated by nonspecialist surgeons to be offered this less morbid, more accurate procedure.

Adult↗