A model for the treatment of accidental severe hypothermia.

Central to the controversy that surrounds the treatment of accidental severe hypothermia is the question of how the method of rewarming affects myocardial performance, and therefore survival. We induced severe hypothermia and cardiac arrest in 15 mongrel dogs. Each dog was rewarmed by one of three methods: partial cardiac bypass (Group I); peritoneal dialysis (Group II); or external rewarming with a fluid-circulated blanket (Group III). The cardiac arrest state was supported by partial cardiac bypass in Group I and by standard mechanical cardiopulmonary resuscitation (CPR) in Groups II and III. In all dogs, the hypothermically depressed myocardial performance returned to normal upon rewarming. Groups I and II had similar rewarming times and required similar volumes of crystalloid and bicarbonate solutions to maintain adequate cardiac filling pressures and arterial pH. However, Group III had a significantly slower rewarming time and required significantly greater volumes of crystalloid and bicarbonate solutions. The sole procedural death occurred in Group III. Our results show that partial cardiac bypass, peritoneal dialysis, and the fluid-circulated blanket are equally effective in rewarming severely hypothemic dogs with cardiac arrest, provided that the cardiac arrest is relieved by partial cardiac bypass or standard mechanical CPR and that physiologic levels of intravascular volume, oxygenation, and pH are maintained.

Radiation carcinogenesis in man: new primary neoplasms in fields of prior therapeutic radiation.

Nine patients are presented in whom new malignant neoplasms developed in fields of prior irradiation. The prior irradiation had been administered to these patients for previously confirmed cancers, lesions suspected of being cancer (but never confirmed as such), and for non-neoplastic disorders. Each of these cases is relatively unique and several present the first association between prior radiation therapy and the subsequent neoplasm or neoplasms which developed.

Head and neck cancer: early detection.

Tumors of the head and neck have a wide variety of presentations. Simply stated however, a sore or soreness that persists, a lump that persists, particularly if non-tender, or evidence of nerve dysfunction such as hoarseness, facial weakness, or dysphagia should alert the astute observer to the probable existence of a neoplastic rather than an inflammatory process. High-risk factors brought out in a careful history enhance the probability. Careful inspection and palpation may reveal the probable diagnosis. A skillful biopsy is essential. In this regard, aspiration needle biopsy as well as large gauge needle biopsy are receiving renewed interest. Our colleagues in biochemistry, radiology, and nuclear medicine are providing increasing support in detection and delineation of extent of tumor for the physician. Biochemical studies, particularly for the detection and delineation of extent of tumor for the physician. Biochemical studies, particularly for the detection of thyroid cases, are important. Ultrasound equipment is being developed that may give much improved delineation of lesion consistency. Xerography is superior in some instances to radiography. Nuclear scanning remains integral in the evaluation of thyroid nodules. Modifications upgrading computerized axial tomography apparatus show promise of giving better delineation of the extent of disease. Arteriography remains essential in the diagnosis of carotid body tumors.

Neck mass caused by thrombus in the external jugular vein.

Three cases of lateral neck tumors caused by thrombosis of the external jugular vein have been presented. Microscopic examination of the excised thrombosed veins revealed all of them to have a dilated architecture with somewhat degenerated vessel walls much like an aneurysm. Such a dilatation would cause some stasis and eddy currents and make the vessels more susceptible to thrombus formation. The final factor which induced these thrombi remains unknown. Indeed, when the interrelation of the factors discussed previously is considered, multiple etiologic factors appear most likely. Some form of minor trauma, although not documented, would still seem the most likely cause of thrombosis of a vein in a patient with no previous symptoms. In case III, trauma of inflammatory changes in a mass already noted to be present for some time could have induced thrombosis within the dilated vessel. Thrombosis of the external jugular vein is yet another lesion in the extensive differential diagnosis of a mass in the lateral neck.

Trace metal levels in cancer of the breast.

Twenty sample pairs of cancerous and noncancerous tissue from the human breast were analyzed for trace metals. Samples were dissolved by wet digestion with ultrapure grade nitric and perchloric acids. The sample solutions was analyzed by conventional atomic absorption for calcium and magnesium. Ten other elements--iron, zinc, copper, lead, calcium, manganese, chromium, silver, strontium and aluminum--were determined in the solution by the graphite furnace technique. Magnesium and zinc levels were significantly higher in the cancerous than in the noncancerous tissue.

Malignant melanoma. Role of node dissection reappraised.

Two hundred and fifty-nine patients with malignant melanoma have been reviewed. One hundred and fifty of these were determinate. A primary excision and dissection in continuity of the tumor, the intervening lymphatics, and the regional lymph nodes achieved a 5-year survival free of disease for 67.5% of the patients. When the nodes were clinically negative but microscopically positive, 45% survived. An electric discontinuous node dissection offers no better prognosis than does a therapeutic dissection and is not indicated in the primary treatment of malignant melanoma.

Advances in detection and diagnosis of head and neck tumors.

Cancers of the head and neck are accessible to both inspection and palpation in the majority of patients. This accessibility allows for improvements in detection, through education of the medical profession and also of the allied health personnel. Some of the new advances in detection and diagnosis have been associated with development of new instruments. A new lens system developed by Hopkins allows a brighter endoscopic image and a significantly greater breadth of field. Needle aspiration biopsy techniques have also improved both in facility of performance and in accuracy of diagnosis. Asteriography aids in the detection of carotid body tumors. Selective parathormone studies have considerably improved the preoperative accuracy of evaluating parathyroid disease. Scans, both using ultrasound and a fluorescent iodine scan have also improved the preoperative evaluation of thyroid tumors. A challenge of detection is the realization that there is an increased risk of the development of thyroid cancer in childhood and in adults in those patients who received radiation therapy to the head and neck during infancy or childhood. A national campaign to alert potential individuals at risk should be a prime objective of the American Cancer Society.

Adult thyroid cancer after head and neck irradiation in infancy and childhood.

We report the surgical-pathologic findings in 15 adults who had a history of irradiation of the head and neck in childhood. These patients we selected for thyroid surgery because of a "cold" area or areas detected on 99mTc thyroid scan, with or without palpable thyroid abnormalities. Eight of the fifteen patients had thyroid cancer, and 3 had atypical adenomas. We found multiple lesions in 12 patients. Macroscopic and microscopic malignancy in a location different from the cold area or areas occurred in 5 of the 8 cancer patients. In vitro of these findings, we recommend that adults who received irradiation to the head and neck in childhood and who have been found to have an abnormal thyroid scan or thyroid examination, or both, have a total thyroidectomy...