Interscapulothoracic amputation.

Interscapulothoracic or "forequarter" amputation is an ablative surgical procedure that is physically mutilating and potentially psychologically traumatic. We have performed this operation on five occasions over the past 30 years for various indications: osteosarcoma, metastatic breast cancer, skin cancer and electrical burn. The operation was originally described by Berger in 1883 and was intended for use in traumatic injuries. Currently, its use is generally reserved for cases of ascending infection and for curative purposes in cases of bone and soft tissue sarcoma, but may be used for palliation.

Differential expression of chemokines in a mouse model of wound healing.

Macrophages have a multifaceted role in wound healing. While their initial activity may be in the degradation and elimination of damaged tissue, macrophages also produce and secrete a variety of mediators that can participate in the repair process as well. To perform these functions, macrophages must be recruited to a wound site. Our purpose was to examine the temporal and spatial expression of macrophage chemoattracting cytokines (chemokines) at a surgical wound site. A surgical wound was prepared on the dorsal aspect of B6AF1/J mice. Biopsies were obtained from the wound and a comparable nonwounded area between 6 and 72 hr after wounding. The presence or absence of various chemokine mRNAs was detected by the reverse transcriptase-polymerase chain reaction (RT-PCR). Immunohistochemical staining and in situ RT-PCR determined localization of cells producing chemokines. In wounded tissue, both macrophage chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-1 (MIP-1) were detected; however, the time of expression differed for each molecule. MCP-1 mRNA was detected at 6 hr after wounding, with decreased expression at subsequent time periods. In contrast, MIP-1 messages were not observed until 24 hr after wounding, and steadily increased thereafter. MCP-1 and MIP-1 mRNA and protein were localized predominantly in keratinocytes. The rapid and strong expression of MCP-1 and MIP-1 messages within the wound site suggests a pivotal role for these chemokines in the repair process. The differences in appearance and level of expression over time, however, suggest distinctive functions for each chemokine and indicate that the local milieu, rather than a single cytokine, influences macrophage recruitment and/or activation.

Blunt traumatic subclavian artery injury.

Subclavian artery injury secondary to blunt trauma is uncommon, accounting for only 3% of traumatic injuries of the upper extremity. Associated injuries of nerve, bone and joint are common. Early recognition and appropriate surgical intervention are essential to reduce disability. Long-term limb dysfunction usually results from concomitant nerve injury. This article describes our experiences treating four patients at two Level II trauma centers in Huntington, W.Va., and reviews the literature on the subject of subclavian artery injury secondary to blunt trauma.

Video-assisted thoracoscopic surgery for management of spontaneous pneumothorax.

Spontaneous pneumothorax is a common problem facing thoracic surgeons, occurring in about nine individuals per 100,000 each year. Treatment options include observation, chest tube thoracostomy, and thoracotomy with or without pleurodesis. When surgery is indicated, thoracoscopic surgery has been shown to provide excellent results with low morbidity, low recurrence, high patient acceptance, a shorter hospital stay and possibly decreased costs. In this article, we present the successful treatment of two cases of recurrent pneumothorax via video-assisted thoracoscopic surgery, combined with mechanical and chemical pleurodesis.