Heart donation after lightning strike.

We present the first reported case of heart donation after lightning strike. Approximately 150 to 300 generally young and healthy people die from lightning strike in the United States each year. These unfortunate victims may make good heart donors. Pertinent pathophysiology of lightning strike is briefly reviewed.

Polymorphism of metabolizing genes and lung cancer histology: prevalence of CYP2E1 in adenocarcinoma.

The relationship between genetic predisposition and development of specific cancers has not been adequately elucidated. In this study, the involvement of three polymorphic genes (CYP2E1, GSTM1, and GSTT1) in the development of different histological types of lung cancer was investigated. DNA was extracted from peripheral blood lymphocytes of lung cancer patients who have been long-term cigarette smokers (n = 52). Allelic variants of CYP2E1 were detected using PCR followed by PstI restriction enzyme digest and RFLP analysis, which detects a specific mutation causing over-expression of the gene. GSTM1 and GSTT1 genotypes were detected using two separate differential PCR methods. Our results indicate a 13.5% allele frequency for the CYP2E1 rare PstI site among the lung cancer patients which represents a 3.4-fold increase over the normal controls (OR = 3.5, 95% CL = 0.65-25.8). A novel observation is that all the patients with this polymorphism had adenocarcinomas only, resulting in a significant association between them (OR = 16.17, 95% CL = 0.95-73, P = 0.02). The frequency of the null GSTM1 gene was 42.3% among the lung cancer patients with no preferential tendency towards developing squamous cell carcinoma versus adenocarcinoma (OR = 1.10, 95% CL = 0.3-4.14, P = 0.5). The GSTT1 gene was absent in 21.1% of the patients with a non-significant tendency towards developing squamous cell carcinoma (OR = 1.23, 95% CL = 0.25-6.1, P = 0.5). Another important observation is the significant predominance of the three predisposing polymorphic alleles among the adenocarcinoma patients (OR = 3.4, 95% CL = 0.78-16.1, P = 0.05) compared with the squamous cell carcinoma patients. The results of this study indicate that the inheritance of several polymorphic metabolizing genes, particularly the CYP2E1 gene, contributes not only to the development of lung cancer but also to the development of specific types of cancer.

Cricothyrotomy: the anatomical basis.

Cricothyrotomy is an important surgical technique. We studied the anatomy of the cricothyroid membrane in 13 adult fresh cadavers preserved at 45 degrees F and examined at 70 degrees F. The working dimensions of the cricothyroid membrane were measured for emergency cricothyrotomy and placement of an airway tube. The vertical measurement ranged from 8-19 mm (mean 13.69 +/- SE 0.96 mm) and the maximal width between the cricothyroid muscles ranged between 9 and 19 mm (mean 12.38 +/- SE 0.91 mm). The distance from the upper limit of the cricothyroid membrane to the vocal cord was 9.78 +/- SE 0.52 mm. Eight subjects (62%) had an artery delineated transversely across the cricothyroid membrane. Two subjects (15%) had sclerosis of the cricothyroid joint. To promote the safe use of cricothyrotomy, the anatomy of the cricothyroid membrane is defined and clinically relevant data are presented.

Transhiatal esophagectomy.

Transhiatal esophagectomy (THE) with cervical esophogastric anastomosis avoids thoracotomy and the potential for sepsis from an intrathoracic anastomotic leak. Knowledge of anatomy, careful attention to details of the operation, and good judgment toward patient selection will allow THE to be a valuable tool in the surgical palliation of esophageal carcinoma.

Surgery of the thoracic trachea.

Surgery of the trachea has progressed significantly over the years to resolve difficult anatomic and technical problems. Various techniques are now available to improve the outcome of such cases. This article reviews the principles of tracheal surgery, the anatomy, and the operative approach, as well as the three most common indications for tracheal surgery: trauma, tracheal tumors, and tracheal stenosis.