Robert J. Demuth

Complications of embolization treatment for problem cavernous hemangiomas.

Radiologists trained in selective angiography can now deliver sclerosing or occluding materials to the arterial supply of vascular tumors. Such skills require special training and there are limitations to the use of these materials. Specific obliteration can be carried out if this technique is quality controlled. Materials being used for embolization are continually being studied and are changing as new materials are developed. Radiologists can assist surgeons in managing some of these very difficult problems. A large series of patients with various vascular lesions treated at the Oregon Health Sciences University was reviewed. The complications of embolization used for cavernous hemangiomas have tempered our enthusiasm for it as an adjunct form of therapy. We do feel that this method of treatment remains useful in selected cases. The occlusion achieved caused a decrease in both symptoms and size of lesions treated. The decrease in size excluded the need for surgery in 3 cases, aided resection in 1, but caused significant complicating slough in 1. Five cases are presented to demonstrate problems of tissue necrosis encountered.

Juvenile aponeurotic fibroma with disseminated fibrosarcoma

Juvenile aponeurotic fibromas, although locally recurrent, generally do not metastasize. This observation supports the practice of incomplete excision of the tumor to preserve the function of the involved extremity. We report on a patient with a juvenile aponeurotic fibroma of the palm, who returned 5 years after the second local surgical excision with metastatic fibrosarcoma of the lungs and bones.

Effectiveness of prophylactic mastectomy in the prevention of breast tumors in C3H mice.

The effectiveness of prophylactic mastectomy in the prevention of breast tumors was studied in spontaneous breast-tumor-forming C3H mice. Prolactin levels were assayed to determine if this hormone was related to the incidence of mammary tumors. Two-hundred and fifty-six 1-month-old C3H mice were divided into four groups (control, 1; sham surgery, 2; mammectomy 50 percent, 3; and mammectomy 100 percent, 4). At the time of sacrifice (0 to 1 year postoperatively) estrus cycles were determined, ventral skin (breast) and ovaries were removed for histology, and serum was collected for prolactin assays. Prolactin levels 24 hours postoperatively were significantly elevated (p less than 0.01) in groups 2 to 4 when compared with group 1. Six months postoperatively, prolactin levels were significantly higher (p less than 0.05) in mice with tumors compared with those without tumors in groups 3 and 4. There were no differences in tumor incidence between the four groups. At 12 months postoperatively, no differences in prolactin levels were noted, but group 2 animals had the highest incidence of mammary tumors (89 percent; p less than 0.01) when compared to groups 3 and 4. Mammary tumor incidence was not decreased by 50 percent or 100 percent mammectomy in C3H mice. Prolactin levels rose in response to surgery and/or anesthesia and remained elevated only in tumor-bearing mice who underwent mammectomy, an occurrence similar to that reported in humans.

Potentiation of infection by epinephrine.

A subinfective dose of Staphylococcus aureus (6 X 10(6)) does not produce wound infection in the rat model. Reducing the dosage (concentration) of epinephrine results in decreased numbers of viable bacteria in tissue and a lower incidence of wound infection in this model.

Biostereometrics and computergraphics for patients with craniofacial malformations: diagnosis and treatment planning.

Utilizing the techniques of biostereometric photography and current state-of-the-art computergraphics, topographic contourgrams have been generated in a series of patients with complex craniofacial malformations. These contourgrams are considered useful in diagnosis and treatment planning and as an aid in postoperative follow-up. We hope that the technique will provide a means to study longitudinal growth in unoperated and operated patients with craniofacial malformations. Comparisons between these groups and normal patients are currently being investigated.

Alterations in local blood flow and tissue–gas tension caused by epinephrine

Subcutaneous injection of epinephrine markedly reduced local tissue pO2 levels and blood flow while increasing tissue pCO2 in a rat model. The duration and magnitude of these effects were correlated with prolonged elevation of tissue levels of epinephrine and were proportional to the amount of epinephrine injected.

The effectiveness of prophylactic subcutaneous mastectomy in Sprague-Dawley rats induced with 7,12-dimethylbenzanthracene.

Fifty-day-old female, albino Sprague-Dawley rats were induced with DMBA, a potent carcinogen that reliably causes multiple breast tumors. Prophylactic subcutaneous mastectomy was performed 2 weeks after injection. Control animals had no breast tissue removed and developed 5.14 tumors per animal, or 1.3 tumors per quadrant. Animals subjected to 50 percent (unilateral) mastectomy developed 5.4 tumors per animal, with 0.72 tumors per surgical quadrant. Animals that underwent 75 percent (three quadrant) mastectomy developed 4.33 tumors per animal, or 0.48 tumors per surgical quadrant. The incidence of tumors was significantly reduced in the surgical areas. However, the risk of any animal developing a breast neoplasm was not reduced in direct proportion to the percentage of breast tissue removed. We believe that this model may prove valuable in evaluating prophylactic subcutaneous mastectomy.

Inadvertent intraradial arterial injection of cocaine.

Injection of a chemical irritant into the radial artery at the wrist causes acute discoloration of the skin, edema, and pain in the hand. Subsequent damage due to vasospasm, endarteritis, particulate embolization, and vascular thrombosis may result in ischemic contractures, amputations, and other functional hand deficits. Injection of a street cocaine preparation into the radial artery of a 22-year-old man produced a constellation of signs and symptoms similar to that described for other irritants. Current thoughts with regard to the pathophysiology and treatment of these injuries are reviewed.

Angiokeratoma circumscriptum of the index finger in a child.

A case of angiokeratoma circumscriptum in an unusual location is described and the literature reviewed. Angiokeratomas clinical resemblance to malignant melanoma is emphasized. Excisional biopsy is advocated as treatment when the diagnosis is in doubt.

Use of ultrasound to locate a "lost" tissue expander injection port.

We have presented a rapid and reliable method of finding lost injection valves. (A frustrating footnote, however, is that 1 week later the port had again migrated and could not be located. Since the further anticipated gain was marginal, the bladder was already nearly expanded, and the expense for repeated ultrasound was a consideration, no further attempts were made to locate this port by ultrasound for further filling).