Bilateral skin fold rotation-advancement flaps for the closure of large lumbosacral wounds in three dogs

Three dogs were presented for the management of disease processes resulting in large skin defects over the dorsal lumbosacral region. One had severe dog bite wounds, one had a large burn sustained from a heating pad and one had a large myxosarcoma in the region. In each case, the extent and location of the resulting skin defect were assessed as factors likely to prevent reconstruction using simple tension-relieving techniques alone or in combination with established reconstructive techniques, such as axial pattern flaps or skin stretching devices. Bilateral skin fold rotation-advancement flaps (SFRAFs) based on the flank folds were mobilised dorsally and allowed complete wound closure in two dogs and subtotal closure in the other dog. All wounds healed without major complications and an acceptable cosmetic outcome was achieved in each case. Minor flap debridement was required in two dogs. The use of bilateral SFRAFs is a useful technique alone or in combination with other reconstructive techniques for the closure of large dorsal lumbosacral skin defects when existing techniques are not sufficient. Small flank folds, such as those of obese dogs, may yield unexpectedly large SFRAFs.

Melphalan monitoring during hyperthermic perfusion of isolated limb for melanoma: pharmacokinetic study and 99mTc-albumin microcolloid technique

BACKGROUND

The kinetics of melphalan leakage from extracorporeal fluid to the peripheral blood was studied in ten patients undergoing hyperthermic isolation perfusion of the lower limbs as an adjuvant treatment in high-risk melanoma.

MATERIALS AND METHODS

Systemic leakage was monitored by a new technique using 99mTc-albumin microcolloid. Serial samples were drawn from a peripheral vein and from the perfusion circuit during surgical treatment and analysed by HPLC.

RESULTS

The leakage measured with 99mTc-albumin microcolloid ranged from 1.5 to 18%/h (mean 8%/h). The average concentrations in the perfusate were 200-300-fold those found in the systemic circulation. A good correlation (R=0.945) was obtained between systemic AUC (0 to 1 hour) and leakage measured through the 99mTc procedure. Negligible toxicity was found and the survival rate yielded 92% of objective response.

CONCLUSION

By studying the pharmacokinetic data of melphalan in the circuit and in the systemic circulation, we were able to validate the 99mTc procedure used during clinical perfusion. Moreover, considering the efficiency of the system as well as the minimum toxicity and the high survival rate, a reduction of perfusion time may be considered.

[Fine needle aspiration biopsy (FNAG) guided with tomodensitometry of pulmonary and mediastinal masses. Personal experience]

CT-guided fine-needle aspiration biopsy (FNAB) was performed on the patients with pulmonary or mediastinal masses to obtain material for cytologic/histologic diagnosis. Diagnostic accuracy and safety of the technique were evaluated in 75 patients affected with thoracic lesions still undiagnosed after thorough radiological and endoscopic investigations. The cytologic and/or microhistologic samples allowed a correct diagnosis to be made in 61 cases (81%), with no false positives and 7 false negatives (9%). The samples were inadequate for diagnostic purposes in 7 cases (9%). Specificity, sensitivity, and diagnostic accuracy were 68%, 76%, and 81%, respectively. No major complication was recorded and a case of asymptomatic pneumothorax resolved spontaneously within 48 hours. CT-guided FNAB of space-occupying lesions in the lung and mediastinum is therefore a rapid and valuable diagnostic tool and is quite safe when performed by skilled operators.

[Ferritin, CEA and TPA as tumor markers in breast neoplasms]

In order to assess the sensitivity and specificity of Ferritin, CEA and TPA as neoplastic markers in breast carcinomas, 91 patients all classified according to the TNM-UICC system were studied in a cancer clinic. The results of the analyses indicate that ferritin is apparently only influenced by the presence of metastatic neoplasias and that greater sensitivity is obtained if all three markers are employed simultaneously.

[Study of blood ferritin in cancer patients and its possible use as an indicator of an unfavorable prognosis]

Ferritinaemia levels were measured in 97 neoplastic patients and compared with the levels found in a healthy control group, in order to discover whether ferritinaemia had any significance as a neoplastic marker. Higher levels were encountered in all neoplastic patients (P less than 0.005) than in the control group. Levels were particularly high in the patients with metastasised tumours (especially breast cancer: P less than 0.001). The highest ferritinaemia levels were found in terminal patients (P less than 0.001).