Radiation-Induced Soft-Tissue Fibrosarcoma: Surgical Therapy and Salvage

Soft-tissue fibrosarcomas of the chest wall that occur after radiation therapy for breast carcinoma are rare and usually lethal. The histories of the 10 previously reported patients emphasize the dismal prognosis for untreated patients and suggest that surgical intervention offers the only hope of reasonable palliation. We report another patient, now alive and free from disease 3½ years after radical resection. The cases of these 11 patients are reviewed, with emphasis on the clinical presentation, the difficulty of making the diagnosis, and the significant palliation that may be achieved with radical chest wall resection.     

Use of erythrocyte hemolysis kinetics in the purification of complex cardiotoxin mixtures

A human erythrocyte hemolysis kinetic method provides a useful way to follow the purification of cobra venom cardiotoxins or other hemolytic factors. Initial rates of hemolysis, measured as hemoglobin released with time for the separated cardiotoxins from the venom of the Thailand cobra Naja naja siamensis, vary over a greater range than do other commonly used measures of their biological activity. Recovery of the hemolytic activity of the gross cardiotoxin fraction in the subsequently separated fractions has been demonstrated. The method employs submilligram quantities of mixed or purified cardiotoxins.     

Neuro-ophthalmologic dilemma: Chronic optic neuritis?

A patient with an 8-month history of chronic progressive visual loss was referred to the Neuro-ophthalmology Consult Office of Washington University with a diagnosis of chronic optic neuritis. Previous diagnostic studies, including CAT scan, had been negative. Because chronic progressive visual loss is considered a hallmark of mass lesion, more vigorous investigation, including repeat CAT scans, was undertaken, leading to the diagnosis and removal of a 2 cm meningioma.     

Transoral robotic surgery: supraglottic laryngectomy in a canine model

OBJECTIVES/HYPOTHESIS: To develop a technique for computer enhanced robotic transoral supraglottic partial laryngectomy in the canine model. STUDY DESIGN: Surgical procedure on the larynx in a canine model with a commercially available surgical robot. METHODS: With use of the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), the supraglottic partial laryngectomy was performed on a mongrel dog that had been orotracheally intubated using general anesthesia. The videoscope and the 8 mm end-effectors of the robotic system were introduced through three ports, transorally. The surgical procedure was performed remotely from the robotic system console. The procedure was documented with still and video photography. RESULTS: Supraglottic partial laryngectomy was successfully performed using the da Vinci Surgical Robot, with 8 mm instrumentation. The robotic system allowed for celerity and accuracy secondary to findings specific to the surgical approach, including excellent hemostasis, superb visualization of the operative field with expeditious identification of laryngeal submucosal soft tissue and skeletal landmarks, and multiplanar transection of tissues. In addition, the use of the robotic system also was found to have technical advantages inherent in robotic surgery, including the use of "wristed" instrumentation, tremor abolition, motion scaling, and three-dimensional vision. CONCLUSIONS: The da Vinci Surgical Robot allowed for successful robotic transoral supraglottic partial laryngectomy in the canine model.