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The oncogenes c-myc, bcl-2 and c-jun, are abnormally expressed in some carotid body tumors. Their expression may contribute to the genesis of carotid body tumors.

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Radiation injury to arteries supplying the upper limb following treatment for carcinoma of the breast has been the subject of occasional case reports'-'. Damage to subclavian and axillary arteries can eventually result in critical ischaemia endangering the upper limb. The surgical options available in such cases are illustrated by recent experience in the management of four patients, all of whom were operated on by the second author. Case reports Case 1A 45-year-old woman presented with an acute critically ischaemic right hand which was preceded by a 5-month history of claudication in the right arm. Six years previously she had undergone a simple mastectomy for carcinoma followed by radiotherapy. On examination the fingers of her right hand were pale, cold and tender. The right brachial and radial pulses were absent and blood pressure could not be recorded in the arm.Arch aortography was normal except for the distal right axillary artery, a I-cm segment of which was severely stenosed. Dilatation by percutaneous transluminal angioplasty restored the radial pulse to normal, but ischaemic symptoms returned 1 year later. Angiography revealed an occluded axillary-brachial artery segment, and a further radiological attempt at recanalization not only failed but rendered the forearm and hand critically ischaemic. Urgent operative intervention took the form of an axillobrachial reversed vein bypass graft, restoring) distal pulses and skin circulation which have been sustained for 5 years. Ca.ve 2A 62-year-old woman presented with two pallid and painful fingers of the left hand preceded by a 3-year history of claudication in the left arm. Carcinoma of the left breast, diagnosed 11 years previously, had been treated by radical mastectomy and radiotherapy. Seven years later a similar diagnosis in the opposite breast led to simple mastectomy. On examination she had a left infraclavicutar bruit, a poor brachial pulse and an absent left radial pulse. The skin over the irradiated area was thin and had scattered telangiectasiae.Doppler ultrasound examination of the right brachial artery revealed a high amplitude triphasic pulse waveform with an occlusion pressure of 185 mmHg; on the left side it was low-amplitude and monophasic with an occlusion pressure of 120 mmHg. Arch aortography revealed critical stenosis of a 2-cm segment of the second part of the left subclavian artery. All other vessels in the study were normal.A supraclavicular incision was employed, but the absence of normal tissue planes made dissection and identification of anatomical structures difficult and periarterial fibrosis rendered arterial control hazardous. The diseased arterial segment was, however, replaced by an interposed 6-mm polytetrafluoroethylene (GORE-TEX", W. L. Gore and Associates Ltd, Woking, UK) graft. Normal arm pulses, a rise in left arm pressure to 175mmHg and a normal pulse waveform were corroborated by immediate and continued relief of symptoms. Case 3A 74-year-old woman had been treated for carcinoma of the right breast .by radical mastect...