Therapy of cancer patients with concurrent critical atherosclerosis of the aorta and peripheral arteries

The results are presented of 5-year experience with therapy of concurrent neoplasia and atherosclerotic lesions of the aorta and peripheral arteries gained at the Center for Oncosurgery, Regional Oncological Dispensary, Chelyabinsk. The analysis was concerned with the treatment received by 118 patients, irrespective of tumor stage or localization: surgical correction of blood flow was carried out in 60. Clinically significant atherosclerotic lesions of the aorta and peripheral arteries in a cancer patient should not be regarded as absolute or relative contraindication for combined treatment. Atherosclerotic occlusion of the femoral or shin arteries was managed conservatively in most cases (p<0.05). In cases of similar lesions of the carotid arteries and aortal aneurysm, surgical correction of blood flow was mostly used.     

Accidental injuries by HIV-contaminated instruments in health provider or research environments: can seroconversion be prevented?

The rate of seroconversion from percutaneous needlestick exposure to HIV infection is approximately 0.3 per cent. To investigate the possibility of local confinement of HIV, 100 to 200 nm Tc-99m sulfur colloid particles were injected in the canine model subcutaneously at the knee level and collected proximally at the groin from the cannulated femoral vein and lymphatic channel. Tourniquet compression (250 mm Hg) was used as an intervention to possibly restrict particle spread. It was found that particles arrived in the blood at 2.81 +/- 0.54 minutes, with later arrival in the lymph at 6.0 +/- 1.47 minutes. Tourniquet application delayed the appearance of the particulate matter in the blood up to 7.11 +/- 1.5 minutes and in lymph up to 40.0 +/- 5.10 minutes. The concentration of radioactivity in the lymph was higher than in the venous blood. The distribution of the particles reflected by flux was comparable in both pathways. The accumulation curves did not reach plateaus during 45 minutes in lymph and 15 minutes in blood. Radioactive scanning revealed that about 90 per cent of the injected particles remained locally with gradual release for at least 45 minutes. Our results suggest that HIV, introduced by needlestick injury, can be contained for possible viricidal treatment if the response includes rapid immobilization and tourniquet of the area.     

Anterior tibial syndrome resulting from acute arterial insufficiency

From the experience with 11 patients the authors show that in acute patency disorders of the iliac, femoral and popliteal arteries some symptoms of the injury mainly to the muscles and sometimes to the nerves of the anterior bed of the leg--"anterior tibial syndrome"--are likely to occur. An urgent reconstructive surgical intervention upon the artery, anterior fasciotomy is of a crucial importance in the treatment of this condition. Depending on the cause of the disease embol- and thrombectomy, circular suture or autovenous plasty of the artery were performed. 6 patients recovered, 3 patients developed a considerable functional disorder of the foot and toes extensors, in 2 patients the process resulted in the development of gangrene of the extremity.     

Surgical correction of pectus excavatum and carinatum

The author presents three decades of experience in the management of anterior chest wall deformities. During this period more than 800 operations were performed on patients with pectus excavatum and carinatum. In this series, there was no death and serious complications were rare. The author believes that the principles on which surgical treatment of pectus excavatum should be based are as follows: (1) bilateral removal of the "culprit" costal cartilages, (2) adequate mobilization of the sternum and correction of the sternal positional deformity by transverse osteotomy, (3) stabilizing the corrected position of the sternum with a substernal "hammock" support. Using this technique the author developed new surgical techniques for the correction of different varieties of chest wall deformities: Pectus excavatum, asymmetric pectus excavatum, pectus carinatum with xiphoid angulation, horizontal pectus excavatum, asymmetric pectus carinatum, chondrosternal prominence with chondrogladiolar depression, and recurrent pectus excavatum. The present method applied for correction of pectus excavatum utilizes the above principles and a substernal Marlex mesh support with bilateral muscle coverage. For carinatum repair, the author routinely uses positional correction of the sternum and sternal shortening. Patients who have significant pectus deformities should undergo surgical repair, preferably between one and eight years of age.