Alexander A. Fokin

Poland’s syndrome revisited

Polands syndrome is a rare congenital anomaly characterized by unilateral chest wall hypoplasia and ipsilateral hand abnormalities. Literary data suggest its sporadic nature. The prevailing theory of its cause is hypoplasia of the subclavian artery or its branches, which may lead to a range of developmental changes. The incidence of Polands syndrome varies between groups (male versus female patients, congenital versus familial cases, and so on) and ranges from 1 in 7,000 to 1 in 100,000 live births. Cases of Polands syndrome associated with leukemia, carcinoma of the hypoplastic breast, and other conditions, confirm the relationship between developmental defects and tumors, and require oncologic awareness. Various manifestations, age, and gender require different surgical approaches. Our experience, which includes 27 patients (15 male, 12 female), 20 of whom (12 male, 8 female) underwent operation, suggests that the repair should be done in two stages in children and in a single stage in adults. Reconstruction and/or stabilization of the aplastic ribs may be achieved using bone grafts or prosthetic mesh. Muscle flaps and breast implants may be used to correct muscle deficiency and breast hypoplasia and to help achieve a complete cosmetic repair.

Anatomical, Histologic, and Genetic Characteristics of Congenital Chest Wall Deformities

There is a large and diverse group of congenital abnormalities of the thorax that manifest as deformities and/or defects of the anterior chest wall and, depending on the severity and concomitant anomalies, may have cardiopulmonary implications. Pectus excavatum, the most common anterior chest deformity, is characterized by sternal depression with corresponding leftward displacement and rotation of the heart. Pectus carinatum, the second most common, exhibits a variety of chest wall protrusions and very diverse clinical manifestations. The cause of these conditions is thought to be abnormal elongation of the costal cartilages. Collagen, as a major structural component of rib cartilage, is implicated by genetic and histologic analysis. Poland syndrome is a unique unilateral chest/hand deficiency that may include rib defects, pectoral muscle deficit, and syndactyly. Cleft sternum is a rare congenital defect resulting from nonfusion of the sternal halves, which leaves the heart unprotected and requires early surgical intervention.

Propagation of Viral‐Size Particles in Lymph and Blood after Subcutaneous Inoculation

Objective: We investigated the propagation of viral‐size particles by lymph and blood after subcutaneous injection.

Transport of Viral-Size Particulate Matter after Intravenous versus Intralymphatic Entry

Objective: Investigation of the transport of viral‐size particles after intravenous versus intralymphatic injection and the functional validity of lymphatico‐venous communications.

Inhibition of needlestick-induced simulated viremia by local measures

BACKGROUND The possibility of confinement of simulated retrovirus to the inoculation site after needlestick injuries to enhance chances of local intervention and function of lymphaticovenous communications was investigated. METHODS Using the canine model, technetium-99 m sulfur colloid particles were injected subcutaneously and into the vein and lymphatics. Blood and lymph were collected at a higher level from the femoral vein and the major lymphatic. Flow rates, particle arrival times, concentrations, and other variables were evaluated for 45 minutes by gamma counting. A tourniquet was used to slow dissemination after subcutaneous injection. RESULTS After subcutaneous inoculation, particles arrived in the blood at 2.81 +/- 0.54 minutes and in the lymph at 6.0 +/- 1.47 minutes. Application of a tourniquet delayed appearance in the blood to 7.11 +/- 1.5 minutes and in the lymph to 40.0 +/- 5.1 minutes. Concentration of particles in lymph was 1,000 times higher than in the blood. Flux values were comparable in both pathways, but accumulation patterns were different. After intravenous injection, particles arrived in lymph at 25.4 +/- 6.44 minutes. After intralymphatic injection particles arrived in the blood within 4 seconds. CONCLUSIONS There are functional lymphaticovenous communications at the peripheral level. The period between virus inoculation and blood and lymph invasion may be extended by application of a tourniquet; therefore, time could be gained for local intervention.

Where does the lymph flow

To investigate the rapid seroconversion after injuries with retrovirus contaminated instruments and to assess the spread of the infection by venous and lymphatic pathways after different methods of inoculation. In the feline and canine models, subcutaneous, intralymphatic and intravenous injections of radioactive particles equal in size to retroviral bodies (100–200 nm) were performed. Blood and lymph samples were collected proximally to the inoculation site for 45 minutes and evaluated by gamma counting. Flow rates, particle arrival time, concentration, flux, accumulation, etc. were compared. After intralymphatic injection, particles arrived in venous samples within 4 seconds. After subcutaneous injection, arrival time in blood was 2.10±0.46 minutes. Appearance in lymph, regardless of the method of injection was significantly longer. Lymph carried more particles at a slower speed, while blood transported smaller amounts at higher speeds. After subcutaneous inoculation, accumulation in lymph continued to rise for a prolonged time due to continuous release from the site of injection. There are extensive communications between the lymph and blood systems at the peripheral level, which are functional under physiological conditions and may provide the transport of particulate matter in both directions. This may explain the fast spread of inoculum by blood, even if initial entry occurred only into the lymphatic system.