Rectus turnover flaps for the reconstruction of large midline abdominal wall defects.

Large midline abdominal hernias are reconstructed with bilateral rectus turnover flaps in a series of 15 patients. Each rectus muscle is turned over from a retracted lateral position to the midline, providing a complete abdominal closure with fascia and muscle. The repairs were frequently reinforced with synthetic materials, but synthetic material was not placed over bowel and simply sutured to the edge of a large hernial defect.

Gemfibrozil increases apolipoprotein A-I and cholesterol concentrations in human peripheral lymph.

Peripheral lymph lipoproteins were studied in four hyperlipidaemic men before and after 6 weeks of treatment with gemfibrozil, a drug which is known to increase the fractional catabolic rate of very low density lipoproteins (VLDL) by raising lipoprotein lipase activity in peripheral tissues. Decreases in plasma triglycerides of 18-60% (mean, 45%) were accompanied by increases in lymph apolipoprotein (apo) A-I concentration of 30-108% (mean, 66%; P < 0.01), and in lymph cholesterol concentration of 35-100% (mean, 59%; P < 0.

Human peripheral lymph lipoproteins are enriched in sphingomyelin.

The concentrations of total choline-containing phospholipids and of sphingomyelin have been determined in peripheral lymph from six volunteers. The concentration in lymph of total phospholipids was 14.6 +/- 6.

Lipoproteins of human peripheral lymph. Apolipoprotein AI-containing lipoprotein with alpha-2 electrophoretic mobility.

Evidence from diverse sources has implicated a central role of apolipoprotein AI (apo AI), the most abundant protein of plasma high-density lipoproteins, in the transport of cholesterol from peripheral tissues to the liver (reverse cholesterol transport). Particles containing only apo AI appear to be more effective as cholesterol acceptors in tissue culture than do particles which also contain apo AII. The apo AI-containing lipoproteins of plasma have been extensively studied, but there is less information on those in tissue fluids, to which most peripheral cells are exposed.

A new injection portal for brachially inserted central venous catheter. A multicenter study.

Totally implantable portal systems are widely used for long-term central venous access. A new venous portal system inserted via the brachial veins (P.A.

Chemoinfusion of the hepatic artery for metastases to the liver.

During a five year period, 69 patients were treated for carcinoma of the liver (seven primary tumors and 62 metastatic tumors) with 5-fluorodeoxyuridine (5-FUDR) administered through a hepatic artery (n = 62) or portal vein (n = 3) implantable infusion pump. Ten patients proved to have previously unsuspected extrahepatic nodal metastases at laparotomy for pump insertion. 5-FUDR was given in 14 day cycles for three months.

Detection of liver involvement in Hodgkin's disease.

Liver involvement with Hodgkin's disease is determined at our institution by a combination of wedge biopsy and needle biopsy at the time of staging laparotomy. This retrospective study was undertaken to determine whether the wedge or the needle biopsy method is the more accurate. All staging laparotomies (n = 116) during the period 1972-1986 were reviewed.

Cellular blue nevus simulating metastatic melanoma: report of an unusually large lesion associated with nevus-cell aggregates in regional lymph nodes.

A young Caucasian woman had a large area of blue-gray discoloration on the flank and palpable axillary lymph nodes. The discolored area had enlarged during a recent pregnancy, contained multiple subcutaneous nodules, demonstrated increased cellularity and mitotic activity, and was associated with an axillary lymph node containing black streaks within the capsule. Although the lesion was initially considered to be a metastatic malignant melanoma, re-evaluation showed it to be a benign cellular blue nevus with benign nevus-cell aggregates within a regional lymph node.

Colon and rectal carcinoma. Forty years and 1400 cases.

One thousand four hundred cases of colorectal carcinoma were treated primarily at the Wake Forest University Medical Center between 1945 and 1985. The surgical approach was constant in all patients without obvious stage IV disease: wide resection, including at least the primary-level and intermediate-level lymph nodes. There were 812 women and 588 men in the series.

Primary leiomyosarcoma of the inferior vena cava: a case report and review of the literature.

Sixty-six cases of leiomyosarcoma of the inferior vena cava (IVC) have been reported. We present another case and review the characteristics and treatment of this rare tumor. IVC leiomyosarcomas spread by extension into adjacent tissue planes.

Operative technique for insertion of a totally implantable system for venous access.

A totally implantable venous access device is described and a step by step technique for implanting the device is given. Among 203 patients in whom the technique has been used, thrombosis of the subclavian or jugular vein has occurred in only three. There have been no pulmonary complications, and only three devices have been removed because of infection.

Occult lesions of the breast.

The biopsy of 148 clinically occult lesions of the breast found at mammographic examination yielded 21 instances of carcinoma (14.2 per cent). Five malignant lesions were lobular or in situ carcinoma, 16 were infiltrating ductal carcinomas and 11 were minimal carcinoma of the breast.

Pseudocalculus sign. A pitfall of static cholangiography.

The pseudocalculus formation was first noted by Caroli in 1960, and was first called a sign by Beneventano and Schein in 1968. It is a cholangiographic illusion that appears as a filling defect in the distal common bile duct when static or "spot" films are exposed during the contractile phase of choledochal sphincter activity. Although first noted and most frequently seen in T-tube cholangiography, it is seen also during intravenous and intraoperative cholangiography.

Hepatic artery infusion for metastatic neoplastic disease.

Specific conclusions can be drawn concerning HAI in the treatment of neoplastic hepatic disease. Over-all, a rate of response of 50 per cent is noted, with the results of more recent studies showing improved response rates as measured by a CEA marker. There are extremely few, if any, complete responders.

A randomized trial of adjuvant chemotherapy and immunotherapy in Stage I and Stage II cutaneous melanoma. An interim report.

Seventy patients with Stage I and II malignant melanoma were randomized to treatment with either intravenous dacarbazine alone or intravenous dacarbazine plus intradermal injection of the methanol-extracted residue of bacillus Calmette-Guerin (BCG). Analysis of treatment failed to reveal a statistically significant difference between these two forms of treatment in Stage I and II patients. It is possible that chemoimmunotherapy may increase survival in Stage II patients, but this possibility should be interpreted with caution.

Postmastectomy angiosarcoma.

Six cases of postmastectomy angiosarcoma of the upper extremity have been treated at the North Carolina Baptist Hospital/Wake Forest University Medical Center over the past 25 years. Five patients had typical ductal carcinoma; one patient had mammary Paget's disease. Two patients, including the patient with Paget's disease, had bilateral mastectomies.

The risk of improperly staging Hodgkin's disease with partial splenectomy.

Partial splenectomy has been proposed for staging Hodgkin's disease, but the risk of thereby missing limited splenic involvement is unknown. To assess that risk, we reviewed all spleens removed during staging laparotomies for Hodgkin's disease at our institution, assessing splenic weight, the characteristics of all nodules, and grossly visible subcapsular disease. Among 180 spleens, 65 had splenic disease.

Hepatic intra-arterial infusion of vincristine.

Currently the chemotherapeutic agents available for intra-arterial infusion in metastatic liver cancer are limited to only a few. The recent demonstration of the feasibility of prolonged IV infusion of vincristine led to exploration of hepatic intra-arterial infusion of this agent. A continuous infusion of 0.

A method of securing the arterial catheter for hepatic artery infusion.

The infusion of chemotherapeutic agents through the liver is an important part of the non-surgical treatment of metastatic carcinoma of the liver. A stable catheter position is essential to the maintenance of good hepatic infusion. This technique assures that stable position.

Evaluation of technique for autotransplantation of the spleen in dogs.

Preservation of the human spleen is important in the prevention of overwhelming sepsis, particularly in infants and immunosuppressed patients. When that preservation is not possible, due to disease or severe trauma, it has been suggested that autotransplantation of splenic tissue might provide adequate immunological protection. This study looked at the feasibility of autotransplantation via subcutaneous implantation in the dog.

Continuous intravenous infusion of vinca alkaloid using a subcutaneously implanted pump in a canine model.

A major drawback of infusions of the vinca alkaloids is the lengthy period of hospitalization which is often required for this novel technique of cancer therapy. A potentially useful system to deliver outpatient therapy has been investigated in a preclinical study. A self-contained infusion pump powered by a self-charging fluorocarbon system has been implanted SC in three dogs.

Multiple primary carcinomas of the colon and associated extracolonic primary malignant tumors.

A review of 308 cases of colorectal carcinoma showed 12 cases (3.9%) of colorectal multiple primary malignant tumors and 14 cases (4.5%) of colorectal primary malignant tumor associated with extracolonic primary malignant tumor.