Brian Blades

Pulmonary artery aneurysms; report of a case treated by surgical intervention.

The successful surgical treatment of an aneurysm of the left main pulmonary artery is reported. It appears that, after ligation of the main pulmonary artery, it is desirable not to remove the lung but preserve it as a space occupying organ which will retain some function. Literature on the subject of pulmonary aneurysms is reviewed.

The surgical treatment of intractable asthma.

This is a preliminary report on the surgical treatment of intractable asthma. While temporary dramatic relief has been obtained in severe cases of intractable asthma by unilateral left sided parasympathetic denervation and destruction of the pulmonary plexus, none of the cases in this series has been followed for a long enough period to predict the final outcome. Although final adoption of the surgical treatment of asthma must await extensive clinical and laboratory investigations, this report is published primarily to revive an interest in the subject.

Stable bronchogenic carcinoma.

Five cases are presented in which repeated roentgenographs examinations were made of intrapulmonary noncalcified opacities which remained stable in size for an average of three and a half years.In each case, following a prolonged observation period, the lesion was found to be a primary malignant tumor of the lung. A plea is made for histologic diagnosis of all persistent, apparently static, noncalcified intrapulmonary opacities.

SURGICAL TREATMENT OF HIATAL HERNIA.

Indications for surgical treatment of hiatal hernia are persistent symptoms after a trial of medical therapy, continued bleeding as a result of esophagitis or gastritis, stenosis of the esophagus, and incarceration of the hernia. The objectives, return of the displaced viscera to their normal position and restoration of competence of the esophagogastric junction, can be accomplished by the abdominal or the thoracic route but the approach may be dictated by other disease states that must also be corrected. In a series of 234 patients with hiatal hernia operated on by the transthoracic approach, mortality was less than 1 per cent and the recurrence rate less than 4 per cent.

Emergency and Elective Surgical Treatment of Abdominal Aneurysms: A Comparative Study

Rupture is the most frequent cause of death in abdominal aneurysm. Only surgical intervention can prevent death from exsanguination. In view of the high surgical mortality in the presence of perforation, elective resection of abdominal aneurysm is recommended. Advanced age does not contraindicate surgery.

Combined Gas and Heat Exchange in Extracorporeal Circulation.

Summary The advantages of combining oxygenation and heat exchange in a single unit are described. A modification of the vertical screen oxygenator is proposed in which the screens are replaced by plates, on the surface of which blood is filmed for oxygenation, and through the center of which liquid flows to effect heat exchange. The oxygenating and heat exchange capacity of one plate are studied and compared with similar functions in separate oxygenators and heat exchangers. The data suggest that a multi-plate unit should provide adequate oxygenating capacity and superior heat exchange capacity.

SURGICAL MANAGEMENT OF EMPHYSEMATOUS BLEBS AND BULLAE

It would appear from a study of available sources that the incidence of generalized pulmonary emphysema is increasing in rather direct proportion to longevity (1, 2). Although the basic pathogenesis of this disease remains in doubt, the morphologic changes in the alveolar and vascular patterns are fundamentally atrophic in nature (3). In terms of pulmonary function this atrophy leads to serious interference with efficient air transfer and gas exchange. The condition may be reflected in a clinical picture of progressive dyspnea and perhaps even respiratory failure. Unfortunately, at the present level of knowledge, the therapeutic approach to this aspect of atrophy remains rather empiric and supportive.