[Soft-tissue tumors: primary excision or wait and see?]. / Lipom, Atherom, Fibrom. Wann muss ein Weichteiltumor raus?

Soft tissue tumors are relatively commonly seen lesions in the doctor's office. An initial differentiation between malignant and benign tumors is usually possible on the basis of the case history and a careful physical examination. In adults, primary excision under local anesthesia is the treatment of choice in many cases, while in children and in the case of large tumors suspected of being malignant, a histological diagnosis must always be obtained. A number of procedures are available for biopsy taking. If the definitive histological work-up confirms malignancy, or if the findings are uncertain, the diagnostic investigation should be extended to include such imaging procedures as CT scanning or MRI.

[Application of polarized light in purulent-septic surgery]. / Vykorystannia poliaryzovanoho svitla v hniino septychnii khirurhiï.

Influence of polarized light on general state and healing of wounds and trophic ulcers in 57 patients with obliterating atherosclerosis of lower extremities, chronic venous insufficiency of extremities, purulent postoperative complications, purulent-septic complications in patients with diabetes mellitus was analyzed. Main mechanisms of the polarized light action in "Bioptron" apparatus were enlighted, effective schemes of its usage were determined.

Dexamethasone inhibits macrophage accumulation after balloon arterial injury in cholesterol fed rabbits.

Macrophages play a critical role in the development and progression of atherosclerosis. This study was designed to examine the effect of the glucocorticoid, dexamethasone, (Dex), on macrophage accumulation after acute arterial injury. Twenty New Zealand white rabbits were fed a 2% cholesterol, 6% peanut oil, rabbit chow diet for one month prior to bilateral balloon dilatation of the femoral arteries. Ten rabbits received Dex (1 mg/kg, im.) the day before and then daily for 7 days after arterial injury; control rabbits received vehicle only. Seven days after injury, Dex treatment resulted in a 96% and 77% reduction (P < 0.002) in the mean number of macrophages accumulating in the intima and media, respectively. This effect was apparently not due to a reduction in the number of circulating monocytes or to the ability of monocytes from Dex treated animals to adhere to endothelium or migrate in response to a chemotactic signal, determined in vitro under static conditions. It was associated with a 61% reduction in monocyte chemoattractant protein-1 (MCP-1) antigen (P < 0.004) in the injured arterial wall (media+intima). Glucocorticoids may be useful in attenuating the inflammatory response and subsequent foam-cell accumulation after arterial injury.

Short-chain fatty acid enemas stimulate plasminogen activator inhibitor-1 after abdominal aortic graft surgery: a double-blinded, placebo-controlled study.

Colonic ischaemia may complicate aortic graft surgery with high mortality from associated colonic necrosis. Loss of the mucosal barrier function due to ischaemia may promote translocation of endotoxins with secondary systemic disseminated coagulation leading to multiple organ failure. Short-chain fatty acids (SCFAs) stimulate the microcirculation in the human rectum. The aim of this study was to investigate whether SCFA enemas influence systemic endotoxinaemia and fibrinolytic activity during and after elective aortic graft surgery for arteriosclerosis. Thirty-two patients were randomized to SCFA or placebo enemas twice daily from the day before surgery to 7 days after. Blood samples for endotoxin, plasminogen activator inhibitor-1 (PAI-1) activity, tissue-type plasminogen activator (t-PA) antigen, and cross-linked fibrin degradation products (XL-FDP) were drawn before, during, and 7 days after surgery. Four patients, two in each treatment group, developed postoperative endotoxinaemia. PAI-1 was significantly higher on days 2 and 4 in SCFA-treated patients, whereas t-PA was comparable Petween the groups. During the postoperative course, a progressive and near-identical XL-FDP increase was found in the two groups. In elective aortic graft surgery for arteriosclerosis, SCFA enemas likely stimulate systemic PAI-1 activity by promoting colonic tissue reperfusion following aortic unclamping. Endotoxinaemia and fibrinolytic shutdown are uncommon findings.

Cigarette smoking and transcutaneous oxygen tensions: a case report.

We report the effects of acute smoking cessation on transcutaneous oxygen (PtcO2) measurements in room air and with hyperbaric oxygen (HBO2) of an extremity at risk for amputation. The reports on cigarette smoking and PtcO2 do not discuss acute smoking cessation. PtcO2 measured 46 h after smoking cessation increased 10% while breathing room air and 34% with HBO2, as compared to measurements made before smoking cessation.

Phlebosclerotic colitis: value of radiography in diagnosis--report of three cases.

Three cases sharing the following radiologic features are reported: (a) abdominal conventional radiography-vascular calcifications at the right hemicolon, (b) abdominal computed tomography-colonic wall thickening and venous calcifications, and (c) barium enema examination-luminal narrowing of the right hemicolon and thumbprinting. There were no clinical or laboratory findings suggestive of portal hypertension. The disease entity, "phlebosclerotic colitis," should be differentiated from ordinary ischemic colitis.

[Activation of bradykinin formation cascade on receiving autologous blood transfusion through a white cell-reduction filter in a patient treated with an ACE inhibitor].

We have experienced a case of anaphylactoid reaction on receiving autologous blood transfusion through a WBC filter for packed red blood cell (PRBC). The patient was a 71-year-old man with a history of hypertension treated with oral antihypertensive drug; enalapril, an angiotensin converting enzyme (ACE) inhibitor, who received anesthesia for Y-graft replacement. Autologous blood was obtained after the induction of general anesthesia in the operating room. Upon starting to return the stored blood with an unintentional use of a WBC filter, arterial blood pressure (ABP) fell within the first minute of the transfusion. We obtained three blood samples; pre-filtered blood (PRE), postfiltered blood (POST) and arterial blood (CIRC) after the event, and analyzed concentrations of bradykinin (BK), high molecular weight kininogen (HMWK) and high molecular weight kininogen-light chain (HMWK-LC). BK was higher in POST than in PRE. HMWK was lower in POST than in PRE, while HMWK-LC was higher in POST than in PRE. HMWK in CIRC was lower than in PRE, and HMWK-LC was higher in CIRC than in PRE. HMWK and HMWK-LC changes after the event suggest that BK formation cascade in the patient was activated on receiving the transfusion. ACE inhibitors were reported to augment such activation. The WBC filter has the negatively charged surface on filteration material and may activate the cascade. While WBC filters can avoid transfusion related reactions, hemodynamic responses should be watched closely in patients treated with ACE inhibitors.

Intraoperative autotransfusion in aortic surgery: comparison of whole blood autotransfusion versus cell separation.

OBJECTIVE: Differences concerning alteration of hemostatic, hemolysis, and hematologic parameters after transfusion of blood from a cell-separation (CS) device or whole blood autotransfusion (WBA) were prospectively evaluated during major aortic surgery. METHOD: Thirty-two patients were randomly selected to receive autologous retransfusion by using either WBA or a CS device. Coagulation and hematologic parameters and levels of hemolytic degradation products (HDP) were assessed in the retransfused blood and in the patients' plasma preoperatively and until 24 hours after autologous retransfusion, respectively. RESULTS: Mean volume of retransfused blood was 1072 +/- 473 ml in the WBA group and 556 +/- 504 in the CS group. Level of HDP (bilirubin, free hemoglobin [free HB], and lactic dehydrogenase [LDH] and hemostatic disturbances (d-dimer value, fibrin degradation products) were significantly higher in the WBA device compared with the CS blood. Blood samples taken from the WBA group revealed significantly higher level of HDP (free HB, LDH) and of d-dimer values after autotransfusion compared with the CS group. CONCLUSION: Levels of HDP and the degree of hemostatic disturbances were significantly higher in retransfused whole blood compared with CS blood. Hemostatic disturbances and levels of HDP were significantly pronounced in the patients' plasma after WBA compared with CS. CS retransfused blood seems to be of superior quality compared with WBA and the degree of hemolysis and hemostatic disturbances is minor after CS retransfusion.

Influence of carbon dioxide gas perfusion to thermal distribution of sapphire probe. A comparative study with saline.

RATIONALE AND OBJECTIVES: A previous study confirmed that the direct laser-thermal conduction of the sapphire probe with carbon dioxide gas perfusion increased the width of the laser-recanalized channel. This caused us to further investigate the thermal distribution characteristics of the sapphire probe when lasing with CO2 gas perfusion. METHODS: The surface temperature of a sapphire probe in a circulation model using 37 degrees C flowing whole blood was measured. Two hundred and sixteen measurements were obtained by directly contacting a flexible thermocouple wire onto the sapphire probe at different sites: 1) metal connector; 2) lateral side of the sapphire crystal; 3) top of the sapphire crystal; and 4) 3 mm in front of the sapphire probe. During lasing with a neodymium-yttrium-aluminum garnet (Nd-YAG) laser, the CO2 gas or saline was infused through the sapphire probe at different flow rates. RESULTS: The lateral side of the sapphire crystal was heated up to 75 degrees C when lasing without any perfusion, but up to 220 degrees C when lasing with CO2 gas perfusion. At all four sites, the mean temperature increases were statistically higher (P < .01) with CO2 gas than with saline perfusion. The mean peak temperatures increased with increasing flows of CO2 gas perfusion and decreased with increasing flows of saline perfusion. CONCLUSIONS: The thermal conduction from the sapphire probe can be significantly enhanced by increasing flows of CO2 gas perfusion. This may play an important role in creating a greater diameter of the recanalized channel and in better delaying the formation of restenosis or re-occlusion after laser recanalization of atheromatous arteries.

XeCl laser ablation of atherosclerotic aorta: luminescence spectroscopy of ablation products.

XeCl laser ablation of atherosclerotic aorta tissue was investigated. Luminescence spectra of ablation products were measured for soft and hard arterial tissues. A pronounced difference observed between plume luminescence for various plaques and normal vessel wall correlates with the chemical composition of the tissue. The mechanism of plume luminescence appeared to be thermochemical excitation ablation products (particles, atoms, molecules, etc.) in the air. The process of soft tissue ablation was delayed with respect to the exciting laser pulse at relatively low laser fluences close to the ablation threshold. The kinetics of the ablation process as a function of laser-pulse energy fluence is reported. The data indicate that tissue ejection mechanism, which involves vapor bubbles formation, expansion and explosion, is suitable for the description of the XeCl excimer laser ablation of soft tissues.

[Role of loco-regional anesthesia in the surgical treatment of atheromatous lesions of the carotid bifurcation]. / Ruolo dell'anestesia locoregionale nel trattamento chirurgico delle lesioni ateromasiche della biforcazione carotidea.

The Authors report a case of carotid bifurcation endarterectomy under loco-regional anesthesia. Despite a stump pressure of 44 mmHg, considered by the most of the Authors, the borderline value for carotid endarterectomy without shunt, the patient had a cerebral ischemic attack after 30 seconds of carotid clamping. So, the local anesthesia represents a valid alternative in order to detect an intolerance to clamping and underlines the importance of cerebral protection in this kind of surgical approach.

[Arteriosclerosis of the lower extremities--patients' contacts with alternative therapists]. / Underekstremitetsarteriosklerose--patientkontakt til alternative terapeuter.

During the period July 1987-April 1988, ninety-one patients with arterial insufficiency in the lower limbs were referred to the Department of Thoracic and Vascular Surgery at Aalborg Hospital. The mean delay between contact with the general practitioner and the vascular surgeon was nine months. Twenty-nine of the patients contacted alternative therapists before referral to the vascular surgeon. Twenty-five of these patients had suffered from intermittent claudication for at least two years and the total cost of treatment was 76,013 Danish crowns (900 Danish crowns or approximately pounds 75 per patient).

Parenteral supplementation with zinc in surgical patients corrects postoperative serum-zinc drop.

Zinc has been known for a long time to facilitate wound healing. But, so far, supplementation trials in patients treated by major severity surgery gave either partial or controversial results. In a double-blind, randomized study including 30 patients, we show that zinc supplements (30 mg/d for 3 d) administered by a drip correct postoperative drop of serum zinc, that this correction concerns the available part of serum zinc (i.e., zinc that is bound to compounds other than alpha-2 macroglobulin in serum), and that this supplementation can improve clinical wound healing. Possible influence of increased urinary output after the intervention is discussed, and we found that serum cortisol remains stable when zinc/albumin ratio is stable, and increases sharply when the same ratio drops. Cortisol, therefore, seems to play a major role in zinc redistribution after surgery.

[Advantages of endarterectomy of the carotid arteries under local anesthesia]. / Preimushchestva éndarterektomii iz sonnoi arterii v usloviiakh mestnoi anestezii.

Analysis of the postoperative results of carotid endarterectomy under local anesthesia in 40 patients showed the possibilities of this type of anesthesia in evaluation of cerebral collateral circulation. The method allowed the use of temporary intraluminal shunt to be rejected in all patients and intraoperative ischemic complications on the part of the brain were not encountered in any of them. A high correlation between the results of EEG and the intraoperative evaluation of tolerance of the brain to ischemia was registered.

The practical consequences of research in arteriosclerosis.

Despite the impressive volume of work that has been undertaken, the successful medical therapy of arteriosclerosis continues to elude us--preventive measures and surgical treatment of its complications persist as the primary modalities of treatment. While research into the fundamental pathophysiology surrounding arteriosclerosis is not complete and our understanding is plagued by the current plethora of confusing and contradictory reports, the cellular mechanisms underlying this process are gradually being clarified. As yet, this basic research has had limited impact for vascular surgical patients, who have benefited more as a result of epidemiological studies. For instance, we are more diligent in looking for occult disease, less ready to operate on obvious lesions, and more persuasive in our attempts to alter the patient's lifestyle--particularly smoking habits.

[A new transluminal angioplasty for the treatment of arteriosclerosis obliterans].

A Peripheral Simpson Atherectomy Catheter (PSAC), which permits transluminal excision and removal of diseased intima, has been tested experimentally and clinically. The device consists of a tubular housing and a cutting mechanism to excise the intima protruding into the housing. Experimentally, vascular clay model was used to estimate its efficacy. Multiple passages improved lumen size and inner smoothness, and there was some difficulty to treat curved models. Clinically, 9 lesions in 7 patients of iliofemoral atheromatous disease were treated with PSAC. Recanalization was achieved successfully except for two lesions, one a soft atheroma and the other a curved vessel. No angiographic dissections or acute arterial occlusions occurred. Despite the procedure was complicated, it seemed safe and effective. In order to improve this method, an angioplastic catheter which had a laser probe in its housing was newly designed. Nd-YAG laser was irradiated with this catheter to the atherosclerotic lesions which were induced by a high cholesterol diet in rabbit. It left smoother surface and less thermal injury than usual irradiation with contact laser probe, but it needed more energy. These results showed that PSAC can be an alternative transluminal angioplasty and the new designed laser catheter is useful, but more experiments are required to establish these procedures.

Precision surgery with an electromagnetically induced current convergence probe application in aneurysm treatment, angioplasty, and brain tumor resection in in vivo and in vitro models.

A hand-held probe, or one introduced through a catheter, rapidly produces an extremely high, tissue-vaporizing temperature in a precisely defined manner enabling surgeons or interventional radiologists to perform angioplasty, thrombose aneurysms, and vaporize tumors. The probe is operated in a near field of an inductive coil, and the current induced in the biologic tissue is converged maximally at the tip of the probe at the resonance frequency of both the inductor and the probe, producing a maximum temperature in excess of 1400 degrees C. Radio-frequency power controls the probe-tip temperature. The operation of the probe is comparable to that of a CO2 or YAG laser and is complementary to laser-surgical techniques. The low cost relative to lasers and simplicity of the device including its disposable components make the prospect of commercialization of this device promising.