Complications of attempted central venous injections performed by drug abusers.

Intravenous abuse of drugs has become an integral part of various subcultures within American communities. The continued use of peripheral veins in this setting eventually leads to their obliteration through a sclerotic or infectious process. Inveterate drug abusers often turn to using larger veins in the groin and neck. Some real or imagined technical aspects of subclavian and internal jugular venous injections are well known to drug abusers in many locales. Undoubtedly as these skills are passed from one user to another, the fine points of anatomy and needle positioning are distorted with resultant mishaps. Twelve patients have been seen with complications arising from attempted supra- or subclavicular injections of drugs in the "street" setting: unilateral pneumothorax, six cases; bilateral pneumothorax, one case; mycotic subclavian carotid artery aneurysm, two cases; neck abscesses, three cases (one also listed under pneumothorax); and paraplegia, one case. Since this type of injury may occur in greater frequency due to increasing drug abuse, recognition and proper treatment of these potentially life-threatening problems may prevent mortality and reduce morbidity.

Role of brachytherapy in the management of pulmonary and mediastinal malignancies.

Brachytherapy, the permanent or temporary implantation of radioactive sources, has been performed in limited numbers of patients with lung cancer over the last 50 years. Because of renewed interest in this modality, we reviewed our experience with 103 patients treated over a 7-year period. The mean age of this group was 55.5 years (range, 1 to 84 years). Primary lung cancer accounted for 82 patients (79.6%); metastatic lesions to the lung, 13 (12.6%); and mediastinal malignancies, 8 (7.8%). Indications for brachytherapy included mediastinal and chest wall invasion in 42 patients (40.8%), unresectable tumors and mediastinal adenopathy in 30 (29.1%), medical contraindications to extensive pulmonary resection in 20 (19.4%), and irradiation of excised lymph node beds in 11 (10.7%). Seeds labeled with radioactive iodine 125 alone were used in 65 patients (63.1%), afterloading catheters containing iridium 192 sources in 25 (24.3%), and both in 13 (12.6%). There were no operative deaths. With a mean follow-up of 18.6 months, the mean and median survivals for the entire group were 17.3 and 14.0 months, respectively. The 1-year, 2-year, and 3-year survivals for the entire group were 67.9%, 38.7%, and 27.8%, respectively. In summary, brachytherapy offers a useful surgical approach in patients in whom unresectable pulmonary or mediastinal malignancies are found at the time of thoracotomy or in patients previously treated with other modalities for whom limited therapeutic alternatives exist.