Iatrogenic seeding of osteosarcoma in a tracheotomy tract - a case report.

Here, we describe the first reported case of osteosarcoma occurring postsurgically in a tracheotomy tract, highlighting the possibility of osteosarcoma seeding during head and neck surgery. Preventative measures such as performing the tracheostomy after the tumor resection while walling off the tracheostomy site from the operative field should be considered.

Ultrasound-guided fine needle aspiration diagnosis of supraglottic laryngeal cancer.

BACKGROUND: Although intraoperative laryngoscopic examination and biopsy of patients who present with locally advanced supraglottic carcinomas remains the standard of care, there are occasions when a more expedited biopsy can be helpful. METHODS AND RESULTS: We describe a quick diagnostic technique of ultrasound-guided fine needle aspiration of endolaryngeal advanced supraglottic carcinomas, which can be performed in the clinic without any preparation. Ultrasound scanning is performed through the thyrohyoid membrane. The tumor is visualized as an irregular hypoechoic mass. While continuing to visualize the mass, a 21-gange needle attached to a syringe is passed through the contralateral thyrohyoid membrane into the mass. Suction is applied, and the aspirate is sent for cytologic study. CONCLUSIONS: When formal intraoperative laryngoscopy and biopsy is not feasible or timely, ultrasound-guided fine-needle aspiration biopsy enables a rapid diagnosis and eliminates the cost, side effects, and risks of a direct laryngoscopy.

Recurrent abscess after MammoSite brachytherapy.

Recently a new catheter was introduced to facilitate brachytherapy in a lumpectomy cavity. Data are limited on the side effects of high-dose brachytherapy to the lumpectomy cavity with the MammoSite catheter. We present a case of recurrent abscesses over a 7-month period in the lumpectomy cavity after MammoSite brachytherapy.

Locating the axillary vein and preserving the medial pectoral nerve.

The exposure for an axillary dissection has become more limited as surgical treatment for breast cancer has evolved from a radical mastectomy to a limited axillary dissection. Exposure of the axillary vein is made more difficult by the smaller incisions, by preservation of intercostobrachial nerves, and by the induration resulting from a previous sentinel node biopsy. To assist in the identification of the axillary vein, I describe the course of a visible but small vein adjacent to the medial pectoral nerve. The vein can be easily identified at the lateral edge of the pectoralis major. It, frequently together with the medial pectoral nerve, traverses in a craniomedial direction and leads to either the lateral thoracic vein (near its junction with the axillary vein) or directly to the axillary vein. Dissection of this vessel identifies the axillary vein, preserves the medial pectoral nerve and allows a more complete and safe level II dissection.

Radioguidance is not necessary during parathyroidectomy.

BACKGROUND: Improvements in the accuracy of preoperative localization and the availability of the rapid parathyroid hormone assay have permitted minimally invasive parathyroidectomy in patients with primary hyperparathyoidism. HYPOTHESIS: The use of intraoperative radioguidance is beneficial during targeted parathyroid operations. DESIGN: A retrospective analysis of a prospective database of patients. SETTING: Tertiary care referral center. PATIENTS: During a 2(1/2)-year period, 130 patients underwent minimally invasive, targeted parathyroidectomy with intraoperative monitoring of the parathyroid hormone level. Of these, 60 patients underwent radioguided parathyroidectomy. Prior to surgery, a solitary parathyroid adenoma was visualized on technetium Tc 99m sestamibi scintigraphy in all patients selected for radioguided parathyroidectomy. A gamma probe was used to guide the surgical dissection. RESULTS: All patients were cured following radioguided parathyroidectomy. In 29 patients (48%), the probe provided confusing or inaccurate information; however, a unilateral neck exploration with excision of a parathyroid adenoma was successfully completed in each of these patients. Forty-three cases were completed under local anesthesia and 85% were discharged home on the same day of surgery. There was 1 temporary recurrent laryngeal nerve palsy. CONCLUSION: In the era of improved preoperative localization and intraoperative parathyroid hormone monitoring, the routine use of radioguidance is not recommended during parathyroidectomy.