The results of this pilot study show that IPCFC improves walking distance in patients with stable intermittent claudication. A significant increase in ICD and ACD was seen at 4 and 6 months of treatment, respectively, and the improvement was sustained at 1 year. The combination of IPCFC with other treatment such as risk-factor modification and daily exercise may prove useful in patients with peripheral arterial occlusive disease. It may be a useful first line of therapy in patients with disabling claudication who are unfit for major reconstructive surgery. Improved walking on long-term follow-up and experience from different centers may establish a role for this treatment modality in the future.
A new technique is described that preserves trapezius muscle function in radical neck surgery while cutting that part of the spinal accessory nerve which courses through the sternocleidomastoid muscle. The technique takes advantage of the little-know fact that, in humans, the trapezius muscle has dual innervation. The C2-3-4 motor root is joined to the distal portion of the spinal accessory nerve to give motor function to the trapezius muscle. This procedure will save shoulder mobility in the majority of patients who undergo radical neck dissection. The technique is accomplished rapidly with the use of the gastrointestinal stapler in the scalene fat pad.
Two cases of infected false aneurysms of the subclavian artery in drug addicts are described. The clinical findings related to the location of these rare lesions are presented, together with an attempt to explain their pathophysiology. The signs and symptoms include a tender supraclavicular mass in an obviously septic patient associated with brachial plexus palsy, a swollen edematous arm, Horner's syndrome, and hemoptysis. Because of the complexity of symptoms, delay in diagnosis is common. It is emphasized that the recognition of this constellation of symptoms should prompt the physician to perform emergency angiography followed by immediate surgery.
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