The effect of postoperative radiation therapy on pharyngoesophageal reconstruction with free jejunal interposition.

Free tissue transfer of a jejunal segment was undertaken for laryngopharyngoesophageal reconstruction in 20 patients who received postoperative irradiation therapy. Treatment consisted of 1.8- to 2-Gy-fractions, the average total dose was 55.57 Gy (range, 40 to 66 Gy). Anastomotic strictures (six) were encountered early in the series and associated with stapled anastomoses. Hand-sewing the jejunoesophagostomy eliminated the problem. Enteric cutaneous fistula, bowel necrosis, and hemorrhagic enteritis were not observed. We conclude that the application of postoperative irradiation therapy to patients requiring jejunal interposition grafts is feasible.

The expression of alpha vascular smooth-muscle actin in salivary gland tumors.

In an attempt to determine if both pleomorphic adenomas and adenoid cystic carcinomas are derived from myoepithelial cells, 23 pleomorphic adenomas, 22 adenoid cystic carcinomas, and 17 normal salivary glands were examined immunohistochemically by using monoclonal antibodies directed against actin (HUC1-1, 1A4), keratin (AE-1, 34 beta E 12), and vimentin (V9). In normal salivary glands, the myoepithelial cells demonstrated a positive reaction to the monoclonal antibodies against actin and only rarely reacted with those against vimentin. No reaction to those against keratin was noted. In pleomorphic adenomas, cells that histologically resembled myoepithelial cells displayed a positive reaction to HUC1-1 in 60.9% and to 1A4 in 65.2%. In adenoid cystic carcinoma, 59.1% of cases demonstrated a positive reaction to both HUC1-1 and 1A4. These results supported the hypothesis that the majority of pleomorphic adenomas and adenoid cystic carcinomas arise from cells of myoepithelial origin.

Clinical observations on the effect of carotid artery occlusion on cerebral blood flow mapped by xenon computed tomography and its correlation with carotid artery back pressure.

Xenon computed tomographic cerebral blood flow mapping was correlated with internal carotid artery stump pressures and clinical neurologic assessment during temporary internal carotid artery occlusion. One hundred fourteen patients with skull base tumors or intracranial aneurysms potentially requiring carotid resection or ligation underwent angiography, xenon CT cerebral blood flow mapping, and internal carotid artery blood pressure monitoring. The internal carotid artery was then temporarily occluded with a balloon catheter, stump pressure was measured through the catheter, and the xenon CT cerebral blood flow mapping was repeated. Adequate xenon CT cerebral blood flow was defined as greater than 30 cc/100 gm/min. All patients had normal xenon CT cerebral blood flow before internal carotid artery occlusion. During internal carotid artery occlusion, xenon CT cerebral blood flow was found to be normal (group I, 40 patients), globally reduced but still within the normal range (group II, 50 patients), or low in the distribution of the ipsilateral middle cerebral artery (group III, 13 patients). With balloon occlusion, an immediate neurologic deficit developed in 11 patients (9%) requiring deflation of the balloon preceding xenon CT cerebral blood flow measurement (group IV). In group I internal carotid artery blood pressure was 128 mm Hg. (range 85 to 171 mm Hg) with stump pressure 86 mm Hg (range 46 to 125 mm Hg). In group II internal carotid artery blood pressure was 130 mm Hg. (range 78 to 199 mm Hg), with stump pressure 86 mm Hg (range 31 to 150 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)

The syndrome of spontaneous iliac arteriovenous fistula: a distinct clinical and pathophysiologic entity.

While the development of a spontaneous iliac arteriovenous fistula is an uncommon complication of arteriosclerotic aneurysmal disease, its association with a distinct clinical syndrome allows timely operative intervention for this potentially life-threatening event. A review of cases reported in the literature reveals a triad of symptoms consistently associated with the presence of a spontaneous iliac arteriovenous fistula: high-output cardiac failure of precipitous onset, a pulsatile abdominal mass accompanied by a thrill and bruit, and unilateral lower-extremity ischemia or venous engorgement. Survival may be anticipated if an aggressive diagnostic and operative approach is employed.