Frederick H. Taylor

Intrapulmonary Foreign Body: Sponge Retained for 43 Years

We present a patient who had a left thoracotomy 43 years previously. Since that surgery he experienced intermittent hemoptysis, and a recent thoracotomy revealed an intrapulmonary foreign body (retained sponge) in the left lower lobe. The liability potential of this case is discussed.

Hemangioma of the esophagus

Hemangioma of the esophagus is a rare tumor. Fewer than 100 cases have been found in the literature. The present case report describes a patient who experienced a sudden massive hematemesis and demonstrated unusual changes on the computed tomographic scan.

Complete bypass of the right heart

Abstract The right ventricle is generally considered to be an organ that is indispensible to the circulation and essential in maintaining normal venous pressure and adequate pulmonary blood flow. This concept has been recently challenged by several investigators. These observations, even though very valuable, are still not adequate to prove that circulation could exist without any participation of the right ventricle. Such a proof could be obtained only by completely bypassing the right heart. We have presented our experiments in which the right heart was completely bypassed by an anastomosis of the superior vena cava to the right pulmonary artery and transplantation of the inferior vena cava into the left atrium. It is demonstrated that the entire right heart could be excluded from the circulation for a period as long as 7 days without significant changes in the arterial and venous pressure. However, the concept that a compensated circulation can be maintained for more prolonged periods without any participation of the right heart still awaits further experimental and clinical proof.

Aortic Origin of the Right Pulmonary Artery with Patent Ductus Arteriosus

rigin of the right pulmonary artery from the ascending aorta is a peculiar anomaly which stands halfway between a true 0 aplasia and a ductus arteriosus. Fraentzel [6], who in 1867 first described this malformation, regarded it only as an anatomical curiosity; however, recent reports [2-5, 7, 8, 101 indicate that this condition is a distinct clinical entity with an extremely dim prognosis. In the following we present a case of a 2-year-old child who, besides suffering from this disease, also had a large patent ductus arteriosus. Our patient was a 2-year-old boy who was known to have had a heart murmur since birth. He had normal mental but retarded physical development. There was no history of cyanosis or congestive heart failure. Physical Examination. Physical examination revealed a somewhat underdeveloped child not in apparent distress. Pulse rate was 122 per minut,e; blood pressure, 115/55 mm. Hg on the left arm and 125/50 on the right arm. Peripheral pulses were all palpable. The heart appeared to be enlarged to the left, with the forceful apical beat located in the left fifth interspace in the anterior axillary line. Pulmonary second sound was accentuated and split. There was a Grade 1 systolic murmur audible over the entire precordium with a maximum point of intensity in the left third interspace parasternally. X-ray and ECG. X-ray examination of the chest showed both ventricles to be enlarged. The pulmonary conus was prominent, and the vascular markings were equally heavy on both sides. Electrocardiogram indicated biventricular hypertrophy antl strain. Laboratory findings were noncontributory. Catheterization. A right heart catheterization was done through the dissected right saphenous vein. The catheter entered the right atrium, right ventricle, and main and left pulmonary arteries. The right pulmonary artery could not be entered. From the left pulmonary artery the catheter passed repeatedly through a patent ductus arteriosus and appeared in the descending aorta. The pressure was 85/2mm.Hg in the right ventricle, 80/45 in the pulmonary artery, antl 98/62 in the aorta. The oxygen saturation was 33.8% in the right ventricle, 48% in the pulmonary artery, antl 84% in the aorta. Cineangiography. Cineangiography was clone in three different catheter positions: With the catheter tip at the base of the right ventricle (Fig. lA), 10ml. of Angio-Conray were injected manually. The dye filled the right ventricle, which

Multiple leiomyomas of the esophagus

A case report of multiple leiomyomas of the esophagus with the clinical, radiologic, and pathologic findings is presented.

Studies on the poststenotic dilation. IV. Spontaneous performation of the aorta distal to the coarctation.

* From the Department of Thoracic Surgery and The Heineman Research Laboratory, Charlotte Memorial and Mercy Hospitals, Charlotte, North Carolina. † This work was supported by grants from the John A. Hartford Foundation, and by the United Medical Research Foundation of North Carolina. The classic animal experiments of William Halstedt,8 and the clinical investigations of Emile Holmanl° call attention to the hemo-

The flexible fiberoptic bronchoscope: diagnostic tool or medical toy?

We began using the fiberoptic bronchoscope March 1, 1971, and after more than 2,800 examinations are convinced it is a highly useful diagnostic tool. We pass the open-end straight bonchoscope into the upper trachea under local anesthesia. Then, the fiberoptic bronchoscope is passed through this conduit. The advantages of the technique are discussed. The greatest advantage of fiberoptic bronchoscopy is the extended visibility it provides of peripheral lesions in the tracheobronchial tree. In this series, which includes more than 700 patients with primary bonchogenic carcinoma, the tumor was visible in one-third of the patients when only the straight bronchoscope was used while in two-thirds it was visible with the flexible bronchoscope. There were no deaths, and complications were rare and of little consequence. Thoracic surgeons are urged to use this instrument.

INTERMITTENT OCCLUSION OF THE INTERNAL CAROTID ARTERY BY DETACHED INTIMA.

piratory or digestive systems were detected. The pupils were round and equal, reacted well to light and accomodation. Optic discs were cupped and the retinal arteries were slightly narrowed. There was a slight drop of the right corner of the mouth; the cranial nerves otherwise appeared to be functioning normally. The deep tendon reflexes were equal and active. There was a marked motor weakness of the

Synchronized Countershock: an Adjuvant To Surgical Therapy*†

Synchronized direct current countershock has recently proven to be a remarkable achievement in modern cardiology. This method was described by Lown and associates> 2 and underwent an extensive study in the laboratory of Harken .3, 4 It was shown to be a simple and effective way of terminating immediately different ectopic cardiac arrhythmias. The theory of this procedure is based upon the fact that the initiating factors of arrhythmia are different from those factors which sustain it. Once the ectopic site is extinguished, the sinus node will take over again as the cardiac pacemaker. This is accomplished by a momentary depolarization of the heart with direct current electroshock. To accomplish this, a new instrument (Cardioverter) was developed by Lown and associates which consists of two main