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Giant pulmonary cyst is a rare clinico-pathological entity. It was described as a "windy tumor" by John Floyer in 1726. Since that time, there have been numerous reports on this unique manifestation of emphysema by many authors. In this report, we report one such interesting case who was diagnosed as tension pneumothorax.

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Tumors of the carotid body are relatively rare and may pose a difficult surgical problem because of their vascularity and compression of cranial nerves in the neck. This article reviews the physiology of the carotid body, its surgical history, and retrospectively reviews the management and outcome of 17 carotid body tumors occurring in 14 patients over an 18-year period at the University of Louisville Hospitals. The average age at presentation was 54.4 years. Three patients had bilateral tumors. Two patients (12%) had postoperative cranial nerve paralysis lasting greater than 6 months. One patient had a postoperative stroke after discharge from the hospital and subsequently died 2 months later from a pulmonary embolus. One patient had a malignant carotid body tumor and pulmonary metastasis and died 11 years after her original operation during an attempted embolization of recurrent carotid lesion. Early operation for the tumor is indicated to prevent nerve dysfunction due to compression and stretch injury as the lesion increases in size.

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Anatomic placement of a synthetic graft from the infrarenal aorta to the iliofemoral vessels has been a long recognized technique used to bypass occlusive disease of the distal aorta and iliofemoral arteries. However, in a few select patients with failure or infection of the abdominal graft, or in patients with a "hostile" abdomen from multiple prior operations, the descending thoracic aorta may be used as an inflow source for the iliofemoral vessels. This paper will discuss the indications, patency data, and technique of descending thoracic aorta to femoral artery bypass with a case presentation.

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Blunt trauma causing a retropharyngeal hematoma without an associated cervical fracture is a relatively rare occurrence. This article presents the case of a patient with airway compromise from a retropharyngeal hematoma, and discusses the diagnosis, airway management, and treatment of this condition.

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Pulmonary arteriovenous malformation (AVM) is a congenital condition, but because the symptoms usually do not occur until middle age, the diagnosis is often delayed. The authors report on a neonate, diagnosed at 2 weeks of age, who was treated by lobectomy at 35 months of age. This prompted a review of the diagnosis, pathophysiology, and treatment of pulmonary AVM. In the literature there are approximately 500 cases of pulmonary AVM. Special attention is given to the reports involving children. Eight cases have been reported in which the diagnosis was made in the first year of life. In two series, a chest roentgenogram showed abnormalities in all affected patients. Because of the strong association of pulmonary AVM with hereditary telangiectasia (Rendu-Osler-Weber syndrome), it is recommended that family members of affected patients be screened by chest roentgenograms for pulmonary AVM.

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The ability of surgeons to accelerate wound healing through pharmacologic intervention is limited. The effects of locally applied, biosynthetic human epidermal growth factor (EGF) and transforming growth factor-beta (TGF-beta) on tensile strength of experimental incisions were investigated. A single dose of EGF in saline failed to increase tensile strength over controls. Thus, EGF was incorporated into multilamellar liposomes, which prolonged the exposure of incisions to EGF (p less than 0.001). A single dose of EGF in multilamellar liposomes produced a 200% increase in wound tensile strength over controls between 7 and 14 days (p less than 0.05). Light and electron microscopy of the wounds revealed increased collagen formation and fibroblast proliferation. A single dose of TGB-beta in a collagen vehicle stimulated a 51% increase in wound tensile strength at 9 days (p less than 0.01). We conclude that addition of EGF and TGF-beta in appropriate vehicles stimulates early transient increases in wound tensile strength in normal rats.

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A non-vitellogenin, estrogen-induced protein has been detected for the first time in the plasma of male Rana catesbeiana. A greater than 90% purification of this plasma protein was achieved by salt fractionation with Mg(II) followed by ion-exchange chromatography on DEAE- and CM-cellulose. Immunoelectrophoretic analysis with various antisera showed no immunological cross-reactivity between this protein and vitellogenin. The molecular mass of the purified protein was determined to be 116 000 daltons by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis and 105 000 daltons by analytical ultracentrifugation. Sedimentation studies indicate the protein is a nonaggregating spherical monomer with a sedimentation coefficient of 7.5 S. Amino acid analysis demonstrated a composition different from that of vitellogenin and lipovitellin A. Limited proteolysis with trypsin, chymotrypsin, and Bacillus subtilis protease revealed no common peptides on SDS-polyacrylamide gels. Phosphate analysis indicated that, on a molar basis, the non-vitellogen, estrogen-induced protein had less than or equal to 3% of the phosphate found in vitellogenin. Further studies of the structure, function, and metabolism of this protein may reveal information relating to the hormonal control of vitellogenesis.

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