Metachronous primary melanoma and lymphoma.

The association of cutaneous melanoma and non-Hodgkin lymphoma has been well documented. We identified 117 patients from the Connecticut Tumor Registry between 1973 and 2002 with diagnoses of both melanoma and non-Hodgkin lymphoma. Charts were reviewed based on patients identified with these diagnoses in the Tumor Registry at Yale-New Haven Hospital between 1926 and 2004. Data were analyzed for age at diagnosis, interval between diagnoses, survival, and gender comparisons were also made. Males comprised 62% of the patients. Females diagnosed initially with non-Hodgkin lymphoma developed melanoma after a longer interval than males. All patients diagnosed with non-Hodgkin lymphoma first had decreased survival. No gender-specific survival difference was seen regardless of which malignancy occurred first. The study patients had overall decreased survival than that expected with either melanoma or non-Hodgkin lymphoma alone. The effects of treatment, immunosuppression, viral induction, and genetic mutations may play various roles in the development of these neoplasms. Further research is required to provide insight into the link between melanoma and non-Hodgkin lymphoma.

Recombinant factor VIIa: hemostatic adjunct in the coagulopathic burn patient.

INTRODUCTION: Recombinant factor VIIa (rFVIIa; NovoSeven) is well recognized as an effective hemostatic agent in the management and prophylaxis of patients with hemophilia. We report here the successful use of rFVIIa in a coagulopathic burn patient. METHODS: A 63-year-old man was admitted with significant upper-body burns in a total body surface area of 60%. Initial management included early intubation and escharotomies, with subsequent admission to the burn unit. Fascial excision was carried out with allograft placement. During a complicated hospital course, decline in platelet function was noted and was associated with the development of a generalized coagulopathy with elevated international normalized ratio. Following a routine follow-up debridement and autografting, extensive bleeding was noted from donor sites. A period of increasing hemodynamic instability followed in the burn unit, with serial hematocrit measurements pointing toward ongoing bleeding from the surgical sites. Following administration of significant amounts of blood product, it was decided to administer rFVIIa per pharmacy protocol. RESULTS: Within 4 hours of administration of rFVIIa, the patient was noted to be hemodynamically stable with unchanging serial hematocrit measurements. Hemostasis was attributed to the use of rFVIIa with prior administration of platelets. CONCLUSIONS: Our case demonstrates the successful use of rFVIIa in the severely coagulopathic burn patient.

Utilization of postcranioplasty skull molding caps in the treatment of Apert syndrome.

Patients with Apert syndrome have bilateral coronal craniosynostosis as one of their many distinguishing features. Surgical correction of this deformity is the mainstay of treatment. Abnormal widening of the skull base progresses despite cranioplasty. We describe a patient for whom a skull molding cap (SMC) was used after barrel-stave osteotomy and orbital rim advancement. This successfully restricted widening of her skull base while allowing growth in other dimensions. Utilization of skull molding caps after cranial surgery shows promise in this setting.

Staged arterial embolization and surgical resection of a giant splenic artery aneurysm.

Splenic artery aneurysms (SAAs) are increasingly being diagnosed as incidental findings. Management modalities include operative treatment, percutaneous embolization, laparascopic ligation, and observation. Giant SAAs larger than 8 cm are a rare entity. We report the case of a 78-year-old woman with an 11 cm SAA who underwent successful percutaneous embolization, followed by surgical excision. We discuss the management of this patient and provide a review of the relevant literature. The approach to SAA should remain individualized.

Prosthetic vascular graft infection: a multi-center review of surgical management.

A multi-center retrospective review of major prosthetic graft infection outcomes was undertaken to determine graft preservation and limb salvage rates. The management of infected prosthetic vascular grafts continues to be controversial. The purpose of this study was to review the surgical management of major extracavitary prosthetic vascular graft infections and to correlate the outcomes on the basis of bacteriology and grade. The change in patient population seen by vascular surgeons and the recent emergence of more virulent bacterial strains should influence surgical management. Bacteriology and severity of infection based on grade must play a greater role in the selection criteria for graft salvage. Despite advancement in the understanding of these interactions and the emergence of new management algorithms, we are continuing to operate without a uniform standard in managing this difficult and rapidly evolving clinical problem.

Managing extracavitary prosthetic vascular graft infections: a pathway to success.

Prosthetic vascular graft infections portend grave consequences if not treated expediently. Despite the low incidence of infection, the potential for limb loss or death greatly magnifies this complication. The surgical management of prosthetic graft infections has evolved over the last 2 decades. With the myriad therapeutic options now available, an algorithm is necessary to provide the optimal surgical treatment of Samson groups 1 through 5 extracavitary infected vascular prostheses. An extensive review of the literature was undertaken to evaluate the most effective management schemes. The authors found that 3 factors--Samson classification, bacteriology, and patient vascular anatomy--are vital to the surgical strategy. These 3 criteria were examined, and an algorithm was developed based on successful clinical and experimental results. This review provides a step-by-step rationale for the surgical management of extracavitary prosthetic graft infections according to the most successful reported outcomes.

Necrobiosis lipoidica resulting in squamous cell carcinoma.

Necrobiosis lipoidica is a chronic degenerative disease of dermal connective tissue, of unknown etiology, which occurs mostly in diabetic patients. It may occasionally be complicated by squamous cell carcinoma. Since this combination is rare, a high index of suspicion is necessary to establish the diagnosis. We present a case and a review of the literature.

Endovascular repair of transplant nephrectomy external iliac artery pseudoaneurysm.

The formation of a pseudoaneurysm at the site of transplant nephrectomy is a rare complication, having been reported only six previous times in the literature. Possible causes of this occurrence include infection or rejection of the anastomotic remnant. Diagnosis of the pseudoaneurysm with radiological imaging is necessary. The first successful repair of a noninfected pseudoaneurysm of a transplant nephrectomy patient is described using an endovascular graft.

Head and neck angiosarcomas.

Angiosarcoma of the head and neck is a rare and lethal neoplasm. Data from the Connecticut Tumor Registry was analyzed for all head and neck angiosarcomas between 1980 and 2001. The authors also present the first reported case of familial angiosarcoma of the head and neck region. The 1-year mortality was 48% for all patients with angiosarcomas (38% for males, 69% for females). The 5-year survival was 28% for all patients (38% for males, 15% for females). The combination of surgery and radiotherapy resulted in improved survival compared with either treatment alone.

Traumatic frontal bone fracture resulting in intracerebral pneumocephalus.

Gas within the brain parenchyma, known as intracerebral pneumocephalus, has been infrequently reported. Head trauma is the most common cause. A case of intracerebral pneumocephalus resulting from a golf club injury and a review of the literature are presented.