Frederick S. Cross

A Survey of the Current Status of Pulmonary Embolectomy for Massive Pulmonary Embolism

DURING RECENT YEARS there has been increasing interest in pulmonary embolectomy for massive pulmonary embolism. Although a few authors have recently reported a number of successful embolectomies without the use of heart-lung machines,1-4 the majority of surgeons still prefer cardiopulmonary bypass techniques in this procedure.5-8 Since the first successful embolectomy with cardiopulmonary bypass was done only 5 years ago,9 and since the experience of most surgeons with this operation is limited, it was decided to consolidate the diverse experience of cardiovascular surgeons in a cumulative survey. The principal aim of the study has been to review the total experience of cardiovascular surgeons doing this operation in an attempt to gain data on problems

Evaluation of a rotating disc type reservoir-oxygenator.

Summary 1. A rotating disc type reservoir-oxygenator is described. 2. Its effectiveness in maintaining circulation and oxygenation is discussed. 3. It has proven satisfactory in both its laboratory and clinical application.

Abnormal Esophageal Manometry in Globus Hystericus

Globus hystericus means the “hysterical ball or lump in the throat,” and is generally assumed to be of psychic origin. True dysphagia is usually absent. Twelve patients with the globus syndrome were studied at the Esophageal Motility Laboratory of the Saint Lukes Hospital of Cleveland. An organic cause for their symptomatology was ruled out by physical examination, laryngoscopy, esophagoscopy and cineesophagograms. Ten patients showed significant elevations in esophageal resting pressures and nine had evidence of disordered motor activity in the body of the esophagus. Knowing from previous investigations that a suprasternal discomfort may be elicited from stimulation of the esophagus at different levels, we propose that the globus sensation is a referred one coming from the hypertonic and frequently incoordinated body of the esophagus.

Clinical study of forty‐nine patients with malignant melanoma

A study of 49 patients with malignant melanoma of the skin occurring over an 18‐year period is presented. The over‐all 5‐year survival was 43%. The prognosis was uniformly better for females and for lesions less than one cm. A poor prognosis was associated with primary lesions on the trunk, ulceration or hemorrhage of the primary and clinically and microscopically positive nodes. The authors conclude that a wide local excision of the primary lesion, including a 3 to 5 cm margin of skin, combined with an in‐continuity regional lymph node dissection should be the treatment of choice.

LXXV Esophageal Diverticula Related Neuromuscular Problems

The esophagus is a dynamic neuromuscular tube suspended in the chest between its muscular attachments in the neck above and the diaphragm and phrenicoesophagealligament below. It is served by smooth and striated muscle divided into two layers and by enervation from the voluntary and involuntary nervous systems. It is a pressure-developing chamber that must work efficiently in pressure gradients ranging from atmospheric in the pharynx to negative in the chest to positive in the abdomen. Food is discharged into the esophagus by voluntary contraction of the pharyngeal muscles, and is then carried to the stomach by precise smooth muscle integration. Derangement of this integrated function may lead to the formation of esophageal diverticula.

Bacteremia and thrombus accumulation on prosthetic heart valves in the dog

Abstract A consecutive series of 134 mitral valve replacement experiments in dogs is reported in which survival rate is related to the presence or absence of postoperative bacteremia. Of 89 animals surviving the operation (24 hours), only 21% lived for longer than 1 month if bacteremia was demonstrated postoperatively; whereas, of the animals in which no bacteria could be cultured from peripheral blood samples, 94% lived for more than 1 month. The dogs with bacteremia most frequently died from pulmonary edema secondary to massive thrombus accumulation around the valve or to septic dehiscence of the valve. It is suggested that the bacteremia may arise because of autocontamination of the portal blood from the dogs intestine. The long-term survival rate was improved from 21% to 93% in the last 14 dogs by antibiotic therapy based upon this hypothesis. The successful regimen consisted of preoperative oral neomycin-polymyxin and an elemental diet combined with postoperative cephaloridine for broad-spectrum antibiotic coverage. Valves examined after 1 month to 1 year in animals free of bacteremia showed minimal thrombus accumulation despite the fact that anticoagulants were not used. This technique makes it unnecessary to resort to the calf as the experimental animal for evaluation of prosthetic heart valves.

Bacteremia and Thrombus on Prosthetic Heart Valves in Dogs

Gram-negative bacteria are a frequent contaminant during cardiopulmonary bypass in dogs. The source of bacteria may be the donor blood or the experimental animal, presumably as a consequence of release from the gastrointestinal tract. The bacteremia is easily controlled with prophylactic cephaloridine therapy. Over 90% of dogs living more than one day after prosthetic valve replacement have survived for longer than one month. Control of this bacteremia allows meaningful evaluation of heart valve prostheses in the dog.

Evaluation of Procedures Designed to Enhance Coronary Collateral Blood Flow

Three procedures reported to improve the coronary collateral circulation were carried out in dogs: (1) placement of 0.25 to 0.5 Gm. of sterile shredded asbestos over the surface of the heart; (2) suturing of the mediastinal fat pad to the abraded left lateral surface of the heart in conjunction with the application of asbestos; (3) implantation of the internal mammary artery into the left ventricular wall in conjunction with application of Ivalon sponge to the denuded surface of the left ventricle. The effectiveness of these measures was determined in dogs with previously narrowed left circumflex coronary arteries. As judged by retrograde flows and peripheral coronary pressures, the collateral vessel development was not increased over and above that produced by narrowing alone. Coronary artery injection studies revealed that only internal mammary artery implantation produced vascular connections between cardiac and extra-cardiac vessels.

Oxygen consumption of the hypothermic potassium arrested heart.

Summary Oxygen consumption of the potassium arrested heart averaged 2.1 ml/min/100 g of perfused heart at normal body temperature, and 0.66 ml/min/100 g of perfused heart at 21.5 to 25°C.

Lymphatic extension of carcinoma of the lung to the anterior chest wall

Abstract 1. 1. A case of lymphatic metastases from carcinoma of the lung to the skin of the anterior chest wall after anterior scalene node removal is discussed. 2. 2. It is believed that this is the first time this complication of scalene fat pad excision has been reported.