A procedure for the rapid detection of depleted uranium in metal shrapnel fragments

Depleted uranium is now widely used in the armor of military vehicles as well as in kinetic-energy penetrators designed to defeat enemy armor. As a result, the potential that personnel will be wounded by depleted uranium fragments has increased. Because toxicities associated with depleted uranium fragments may ultimately require different treatment protocols than those used for traditional metal fragment injuries, a method to rapidly detect the presence of depleted uranium in surgically excised shrapnel fragments is required. By treating the shrapnel fragment with an extracting agent, such as nitric acid, for 5 minutes in an ultrasonic cleaner, sufficient metal is solubilized to allow for colorimetric detection using a pyridylazo dye. Although several metals are capable of being detected under these conditions, the reaction can be made specific for depleted uranium through the use of masking agents such as sodium citrate and ethylenediaminetetraacetic acid. This procedure allows for the rapid (< 15 minutes) extraction and detection of depleted uranium in metal shrapnel fragments.     

Cervical approach for large thyroid mass with substernal extension

The large thyroid mass with substernal extension often requires a combination of cervical and thoracic approach for its access and removal. We have developed a technique that uses a cervical incision and combines clear access to the mass with low morbidity. The principle features include complete sternocleidomastoid mobilization, early identification of the neurovascular pedicle through a lateral approach, and finger dissection to deliver the substernal component of the mass. This article also describes the elements of our technique in detail, from preoperative considerations through wound closure and discusses the debate concerning the ideal treatment of these challenging tumors.     

Reconstruction of the high-risk chest wall with endoscopically assisted latissimus dorsi harvest and expander placement

Certain patients requesting breast reconstruction may be described as having a high-risk chest wall with regard to implant loss and well-documented high complication rates. Such patients have a combination of one or more of the following: previous chest wall radiotherapy, heavy smoking, and thin, tethered chest wall flaps. If autologous transfer is not appropriate for such patients then reconstruction may be difficult. In this specific patient group the assistance of endoscopy has been used to raise the latissimus dorsi muscle to cover an expander placed within an endoscopically created chest wall pocket. The first 12 consecutive cases using this technique are discussed, showing an expander loss rate of 8% for the primary implant placement.     

Health-related quality of life and morbidity in patients receiving brachytherapy for clinically localized prostate cancer

Health-related quality of life must be a factor when treatment options are discussed with a patient. Quality of life is measured by validated questionnaires that include generic and disease-targeted measures. Urinary and rectal symptoms and sexual function are evaluated after treatment for prostate cancer. Quality of life is adversely affected in the early post-brachytherapy period primarily by the urinary morbidity. Urinary symptoms peak 2 months after treatment and decline thereafter, although severe long-term urinary toxicity occurs in 3% to 12% of patients. Urinary symptoms are generally treated with alpha-blocker and anticholinergic drugs, but 2% to 5% of patients require transurethral resection of the prostate to relieve persistent obstruction. However, 6 months after treatment, overall satisfaction is excellent, and the majority of patients would recommend the procedure to a friend.     

Soft tissue sarcomas of adults: state of the translational science.

Sarcomas--like leukemias, which are also mesodermal malignancies--carry biological significance disproportionate to their clinical frequency. Identification of mutations and translocations associated with these tumors has illuminated aberrant signaling pathways that cause these diseases, determine their behavior, and are therapeutic targets. Activated receptor-associated tyrosine kinase c-kit, mutated in most gastrointestinal stromal tumors, has proven a clinically effective target for enzyme inhibition. A translocation involving a single gene family, consisting of EWS and related genes, has been identified in five different sarcomas, and its chimeric protein products could prove similarly amenable to inhibitors. Resolution of the histopathological complexity is being aided by data from molecular and chromosomal characterization. Improvements in imaging, definition of prognostic factors, and surgical and radiotherapeutic treatment have resulted in improved local control. Continued progress will depend on further adapting the rapidly evolving technologies of genomics and proteomics. It will also depend upon accurate histopathological diagnosis based on validated reagents and consistent methodologies applied to adequate tissue samples derived from patients with complete clinical data. Finally, multicenter, coordinated trials, such as those that occurred with assessment of imatinib mesylate in metastatic gastrointestinal stromal tumors, will assure the most rapid reductions in morbidity and mortality.     

Frontal sinus surgery 2004: update of clinical anatomy and surgical techniques

Endoscopic frontal sinus surgery is still considered difficult, risky to perform, and likely to result in a high failure rate. We have previously reported on our technique of endoscopic frontal sinus surgery, stressing the importance of identification and preservation of natural outflow tract. Our study of frontal sinus anatomy shows that the mean frontal ostium anterior—posterior and transverse dimensions are 7.22 ± 2.78 mm and 8.92 ± 2.95 mm, respectively; therefore, dissection of obstructive structures in frontal recess leads to a wide opening of frontal sinus outflow. A key surgical landmark in our technique is the superior attachment of the uncinate process. This article provides an update of the surgical anatomy of the frontal recess region and our surgical technique, as well as a discussion of our approach to frontal sinus revision surgery.