Multiple primary lung cancers. Results of surgical treatment

During a 13-year period, multiple primary lung cancers were diagnosed in 80 consecutive patients. Forty-four patients had metachronous cancers. The initial pulmonary resection was lobectomy in 36 patients, bilobectomy in 3, pneumonectomy in 1, and wedge excision or segmentectomy in 4. The second pulmonary resection was lobectomy in 16 patients, bilobectomy in 2, completion pneumonectomy in 7, and wedge excision or segmentectomy in 19. There were two 30-day operative deaths (mortality rate, 4.5%). Actuarial 5- and 10-year survival rates after the first pulmonary resection for stage I disease were 55.2% and 27.0%, respectively. Five-year and 10-year survival rates for stage I disease after the second pulmonary resection were 41.0% and 31.5%, respectively. The remaining 36 patients had synchronous cancers. The pulmonary resection was lobectomy in 18 patients, bilobectomy in 3, pneumonectomy in 10, and wedge excision or segmentectomy in 8. There were two 30-day operative deaths (mortality rate, 5.6%). Actuarial overall 5- and 10-year survival rates after pulmonary resection were 15.7% and 13.8%, respectively. We conclude that an aggressive surgical approach is safe and warranted in most patients with multiple primary lung cancers and that the presence of synchronous primary cancers is ominous.     

Ductal adenoma of the breast

Ductal adenoma is a recently described benign tumour of the breast that can be mistaken for carcinoma in both frozen and paraffin sections. Such a case is presented. Fortunately a mastectomy was not performed, but the patient did undergo axillary node dissection. Surgeons and pathologists should familiarize themselves with this lesion so that patients do not have to undergo unnecessary mastectomies and axillary node dissections.     

Lyme disease presenting as urinary retention

We report a case of Lyme disease that presented with urinary retention. The individual then experienced lower extremity paralysis. Paralysis and urinary retention resolved with intravenous ceftriaxone antibiotic. To our knowledge this is the first report of a urological manifestation as the initial clinical presentation of Lyme disease. Recognition of clinical symptoms and urological complications of Lyme disease also are discussed.     

Prevention of microbial contamination of surgical wounds

Comparative analysis of 3707 operations on the organs of the abdominal cavity has shown the significant advantage of the suggested by the authors method for intraoperative wound protection with latex rubber in combination with placing the longitudinal removable sutures over the subcutis and skin, and dressing-free management of the wounds in prophylaxis of the postoperative purulent wound complications. After 310 operations of different contamination degree performed with the use of the given method, no suppuration of the operative wounds was noted.     

Late results of lymphovenous anastomoses in lymphedema of the lower extremities

The authors examined 152 patients with lymphedema of the lower limbs 2-6 years after operation for lymphovenous anastomoses (LVA). They evaluated the dynamics of edema according to Alberton's formula, the changes in the character of the episodes of erysipelas, and the patient's feeling of heaviness in the involved limb. The function of the anastomosis was studied by the radioisotope method. Positive results were recorded in 99 patients. In the remaining patients the LVA did not function and the symptoms of lymphedema did not change or progressed. The effect of LVA was found to be positive in 51 patients in the group of 69 patients with secondary form of lymphedema and in 48 of 83 patients with the primary form of the disease. The last-mentioned was connected with congenital insufficiency of lymph drainage. The condition of the collecting lymphatics is an important factor of LVA efficacy: the effect of LVA was positive in 68 patients in hyperplasia and in 31 patients in hypoplasia of the lymphatics. The results of LVA are improved by regular nonoperative management for the correction of endocrine-immunological and hemostatic factors as well as by stimulation of lymph drainage in the limb and prevention of inflammatory complications.     

Characteristics of the ventilatory status of the lungs in workers in the electronics industry

To establish the effects of occupational respiratory noxae on the state of the bronchopulmonary system a study of the working environment and examinations of workers from the electronics industry whose workplaces were near tin baths and in conductor soldering shops were carried out. The following chemical noxae were found to be present in the working environment: lead, tin, calophonium and ethyl alcohol, all in permitted concentrations. Comparison of the state of lung ventilation in workers from the electronics industry (n = 120) and control workers (n = 129) pointed to a major increase in total air flow resistance during calm breathing in the exposed workers. The obstructive changes were mainly localized in the small airways.     

Emergency endoscopy in acute gastrointestinal hemorrhage in aerospace medicine

Air-surgeons of the sanitary aviation department of the Vologda Regional Hospital analysed 279 summons to patients with acute gastrointestinal hemorrhage living in the districts of the region. They came to the conclusion that emergency gastroduodenoscopy allowed air-surgeons to identify the source of the bleeding in 97.64% of patients, determine the rational therapeutic tactics, and reach a well-grounded decision on evacuation of the patients to the regional hospital, as a result of which mortality reduced by more than half.     

Electrophysiological diagnosis in partial optic nerve atrophy syndrome

Vision conduction routes were examined in 75 patients with the syndrome of optic nerve partial atrophy by recording the visual evoked potentials, threshold of electric sensitivity emergence, critical frequency of phosphene disappearance, electroretino- and electroneurograms. The findings of these examinations correlated best of all with the clinical picture when visual evoked potentials (latency increase, decrease of the amplitude with atrophy augmentation, interhemispheric asymmetry in chiasmal and retro-chiasmal involvement) or the critical frequency of phosphene disappearance (reliably reduced if a disease was developing) were recorded. Introduction of electrodes with therapeutic and diagnostic purpose permitted assessment of optic nerve function from the electroneurogram amplitude and time parameters.     

Destructive ocular myiasis in a noncompromised host

A case of destructive ocular myiasis resulting in complete loss of the globe in two days time is documented. To the best of our knowledge this is the first report of such a severe involvement in a healthy and non-compromised host. Mechanical removal and good local hygiene helped heal the wound. The larvae were isolated to be that of Chrysomyia bezziana (screwworm fly). This is possibly the first report of destructive ocular myiasis caused by Chrysomyia bezziana from the Indian subcontinent and the second in world literature. Infestation of human eyes with larvae of flies (myiasis) has been reported. Serious consequences of destructive myiasis are seen in emaciated and diseased patients. Only one report of total destruction of the globe by maggots of Chrysomyia bezziana exists in the literature. As in previous communications, the patient in this report had no predisposing factors both systemic and local. We here in document a case of orbital myiasis leading to rapid destruction of the globe within two days in a healthy and a non-compromised patient.