ABSTRACT
Eighty-five patients were surgically treated for postmastectomy edema of the upper extremity. In 20 of them, phlebolysis of the subclavian vein was performed. It was established that the vein was most often compressed by a long stump of the small pectoral muscle. Surgery and subsequent radiation treatment create unfavorable conditions for the muscle leading to its morphologic restructuring. Classic mastectomy after Halsted-Meier is recommended.
Subject(s)
Mastectomy, Radical/methods , Pectoralis Muscles/surgery , Arm , Breast Neoplasms/complications , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Combined Modality Therapy , Edema/epidemiology , Edema/etiology , Edema/pathology , Female , Humans , Mastectomy, Radical/adverse effects , Mastectomy, Radical/statistics & numerical data , Pectoralis Muscles/pathology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/pathology , Retrospective Studies , Russia/epidemiology , Subclavian Vein/surgery , Time FactorsABSTRACT
Based on examinations and treatment of 210 patients with postmastectomy edema of the extremity (with operations made on 75 of them) the authors have developed a clinico-surgical classification of the postmastectomy edema with special reference to the character of morphologic alterations of soft tissues which determinates tactics of treatment and choice of surgical methods (LVA, phlebolysis of the subclavian vein, RRO or their combination in different succession). Phlebographic and tonometric examinations are shown to be necessary, their findings being compared for the establishment of indications for phlebolysis for stenosis of the vein resulting from X-ray therapy and long stump of the musculus pectoralis minor in radical mastectomy after Holsted.
Subject(s)
Arm , Breast Neoplasms/surgery , Lymphedema/surgery , Mastectomy/adverse effects , Adult , Aged , Female , Humans , Lymphedema/etiology , Middle AgedABSTRACT
The analysis of the results of 74 experiments involving large bowel resection for intestinal obstruction in rabbits demonstrated advantages offered by microsurgical procedures intended to form large bowel anastomosis. The results were used in clinical practice. The immediate results of surgery, postoperative complications and lethality were evaluated in 133 cases of large bowel cancer (anastomosis formed by microtechnique-67; by standard procedures-66). In group I, heart-lung complications resulted in one death (lethality-1.5%); group II--in 18, 13 of them being caused by anastomotic leakage and peritonitis development (lethality-27.3%). It was clinically confirmed that precision formation of large bowel anastomosis by microsurgery prevents suture failure--the main factor of postoperative lethality.
Subject(s)
Colonic Neoplasms/surgery , Microsurgery/methods , Adult , Aged , Animals , Female , Humans , Male , Middle Aged , Postoperative Complications , RabbitsABSTRACT
Patients with stage III and IV cancers of different sites revealed a 47-76% increase in serum total antitrypsinic activity. A mean 40% increase was observed in cases of inflammatory pathology. Both study groups demonstrated raised alpha 1-antitrypsin levels, while that of alpha 2-macroglobulin did not show any significant changes. The level of alpha 1-antitrypsin accounted for 89 and 83% of total antitrypsinic activity in cases of inflammation and controls, respectively, while in cancer patients this index was significantly lower (70%). The diagnostic value of total antitrypsinic activity appeared to be higher than that of alpha 1-antitrypsin level determination. It is inferred that, apart from alpha 1-antitrypsin, malignant growth is associated with raised levels of more specific endogenous proteinase inhibitors, except alpha 2-macroglobulin.
Subject(s)
Clinical Enzyme Tests , Neoplasms/diagnosis , Protease Inhibitors/blood , Humans , alpha 1-Antitrypsin/analysis , alpha-Macroglobulins/analysisABSTRACT
Results of the surgical treatment of 172 patients with tumors of the proximal part of the stomach and colon are analyzed. The patients were divided into 2 groups according to the method of forming the esophago-intestinal and colono-intestinal anastomoses. Suture incompetence and peritonitis were shown to appear much more rarely after using a microsurgical technique than after using surgical methods.
Subject(s)
Colectomy/methods , Colonic Neoplasms/surgery , Gastrectomy/methods , Rectal Neoplasms/surgery , Stomach Neoplasms/surgery , Adult , Aged , Female , Humans , Male , Microsurgery/methods , Middle Aged , Peritonitis/prevention & control , Postoperative Complications/prevention & control , Surgical Wound Dehiscence/prevention & control , Suture TechniquesABSTRACT
Femoral regional perfusions and continuous intraarterial infusions were used for the treatment of 84 patients. The 0,15-0,25% solution of H2O2 was used as the oxygenator. The methods used when combined with sympathectomy allowed to restrict the operation by a parcimonious amputation of the extremity and to retain the knee joint in most of the patients.
Subject(s)
Arteriosclerosis Obliterans/therapy , Endarteritis/therapy , Hydrogen Peroxide/administration & dosage , Leg/blood supply , Adult , Aged , Amputation, Surgical/methods , Animals , Cats , Combined Modality Therapy , Dogs , Femoral Artery , Humans , Infusions, Intra-Arterial , Leg/surgery , Lumbosacral Region/innervation , Male , Middle Aged , Rabbits , Sympathectomy/methodsABSTRACT
Reconstructive microsurgery carried out in 25 cases of postmastectomy edema of the upper extremity proved to be the most effective and safest in treatment of the said complication. The procedure should be supplemented with phlebolysis of the subclavicular vein (when occlusion of the latter exceeds 50%) or with resection of dermatofascial flap of the brachial area (fibrous stage of lymphostasis). Sequence of stages and the results of the surgical treatment are discussed.
Subject(s)
Lymphedema/surgery , Mastectomy/adverse effects , Microsurgery/methods , Postoperative Complications/surgery , Adult , Aged , Arm , Female , Humans , Lymph Node Excision/adverse effects , Lymphedema/etiology , Middle Aged , Radiography , Subclavian Vein/diagnostic imaging , Time FactorsABSTRACT
Changes in lymphocyte and monocyte counts in peripheral blood of patients who had undergone combined treatment for malignant cutaneous melanoma of low extremities were evaluated. The posttreatment counts were compared with those for mononuclear cell infiltration of tumor stroma. Mononuclear cell levels in blood and in tumor stroma versus patients' survival time were analysed. A moderate correlation between lymphocyte and monocyte (macrophage) levels in tumor stroma, on the one hand, and survival time, on the other, was established.
Subject(s)
Melanoma/immunology , Monocytes/immunology , Skin Neoplasms/immunology , Combined Modality Therapy , Female , Humans , Immunity, Cellular , Leg , Leukocyte Count , Male , Melanoma/pathology , Melanoma/therapy , Neoplasm Staging , Postoperative Period , Skin Neoplasms/pathology , Skin Neoplasms/therapy , Time FactorsABSTRACT
The clinical picture and long-term results of the treatment of 123 patients with melanoblastoma of the limbs have been studied. 39 patients were subjected only to the surgical treatment, 84 patients with a developed tumor process were subjected to the combined treatment -- surgery with perfusional chemotherapy. 3 years survival has proved to be similar in both groups; (70.0% and 72.9%); 5 years survival has been 10% higher in the group subjected to the combined treatment (54.5% and 64.0%).
Subject(s)
Chemotherapy, Cancer, Regional Perfusion , Extremities , Melanoma/drug therapy , Melphalan/administration & dosage , Thiotepa/administration & dosage , Adult , Aged , Extremities/surgery , Female , Humans , Male , Melanoma/surgery , Melphalan/therapeutic use , Middle Aged , Thiotepa/therapeutic useABSTRACT
Under examination were 3--5--10 year results of ilioinguinal lymphadenectomy in 83 patients with skin melanoblastoma of the lower extremity. It is found that the status of inguinal and especially iliac lymphnodes is of primary importance for patients' survival. The latter were metastases involved in 24 cases (28.9%). Metastases may also develop in intact inguinal lymphnodes (in 4 cases). A 3-year survival, if one group of regional lymphnodes is involved (inguinal or iliac), is 20% lower than in the intact noes. With both groups of the nodes involved it is 4 times lower. A 5--10 year survival with involved inguinal nodes is 2 twice as low as with intact nodes. In iliac lymphnodes metastases there was no 5-year survival. Most poor results were noted in melanoblastoma located on the foot.
Subject(s)
Leg , Lymph Node Excision , Melanoma/surgery , Skin Neoplasms/surgery , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Time FactorsSubject(s)
Goiter/surgery , Adult , Female , Goiter/diagnosis , Humans , Male , Middle Aged , Sternum , ThoraxABSTRACT
In the paper, the data on the immediate and late results of skin tranplantation in the complex treatment of limb melanoblastomas are reported. The latter consisted in a one-moment massive regional chemotherapy by perfusion of the extremity (iliac, femoral, brachial) with antitumor drugs, against which background melanoblastoma was excised electrosurgically, and lymphadenectomy was performed. The defect of the limb tissues, which was located on the foot or leg in 61 cases, was replaced by a free skin graft. The results of the plastic repair were followed up within the terms from 1 to 10 years.
