Penetrating neck wounds. Mandatory versus selective exploration.

We reviewed the records of 257 patients (ages, 16-83 years) with penetrating neck wounds (119 gunshot and 138 stab) managed at Harlem Hospital Center. Among the first 148 patients, 134 were managed by mandatory neck exploration; 42 had injuries (31%), and 92 (69%) had no injury. There were four deaths (3%) and seven (5%) morbidities. Because of the high rate of unnecessary operations, the following 109 patients were managed selectively, 40 by exploration, and nine of the 40 (22%) had no injury; 69 were observed and did not require subsequent operative intervention. There were six deaths (5.5%) and six morbidities (5.5%) among the second group. Morbidity and mortality were unrelated to the method of management but related to the type and severity of injuries, associated injuries, preexisting illnesses, and age of the patients. The frequency of operations for penetrating neck wounds without structural injuries was minimized in the selective exploration group.     

Percutaneous extraction of urinary calculi: use of the intercostal approach

The authors achieved successful percutaneous extraction of urinary calculi via an intercostal approach in 24 patients. In one patient, a large hydrothorax developed and thoracentesis was required; 2 patients had moderate and 6 minimal pleural fluid collections which did not require treatment. No patient had pneumothorax. Intercostal puncture provides direct access to the upper and middle poles of the kidney when they lie above the twelfth rib and subcostal angulation is not feasible. Such an approach is advantageous for stones in the ureter, as well as renal stones which are inaccessible from the lower pole. Fluoroscopy should be performed when planning the puncture in order to avoid the lung, and a working sheath is recommended.     

Lymphedema of the face

Lymphedema of the extremities is well documented in the literature. We present a case of lymphedema involving the face of a 27-year-old man and discuss the clinical presentation, microscopic findings, and surgical treatment. To our knowledge, this is the first such case report in the literature.     

Effects of dimethylnitrosamine on organ-cultured adult human pancreas

Portions of adult human pancreas from 20 donors were organ-cultured in a chemically defined medium in the absence or presence of DMNA for up to 12 weeks. In the absence of DMNA, necrosis of some acini occurred during the first week, while some clusters of well-preserved acini were maintained for up to 3 weeks. Proliferation of the epithelial linings of main and smaller ducts and ductules was noted during the first 2 weeks of culture. Ductal epitheliums thereafter showed some degeneration but remained viable during the 12 weeks of culture. In contrast to controls, the DMNA-treated explants showed better preservation of both acinar and ductal cells. DMNA induced both ductal hyperplasia and atypia of the epithelial linings of main ducts, smaller ducts, and ductules within 6 weeks, and carcinoma by the tenth week of culture. At the end of the first week cells devoid of zymogen within the acinar complex proliferated and progressively replaced necrotic cells. During the ninth and tenth weeks, foci of atypical cells developed among these cells. Cells derived from 10-week-old DMNA-treated explants produced multiple nodules of carcinoma when injected subcutaneously into nude mice.