Gordon K. Danielson

Histiocytoma (fibrous xanthoma) of the lung.

Abstract A case of histiocytoma of the lung in a five year old child is presented. The appearance of the lesion at operation suggested that it was a malignant neoplasm, but subsequent study showed that it was benign. Several histiocytic tumors in locations other than the lung have proved to be malignant, and recurrence has followed incomplete removal of benign extrapulmonary lesions. Of twenty-two other reported pulmonary histiocytic tumors, including five in children, none has been malignant. It is suggested that these tumors should be treated conservatively by a wide local excision which includes a margin of uninvolved lung.

Circumflex Coronary Artery Injury During Mitral Valve Replacement

he recent development of satisfactory prosthetic heart valves has greatly advanced the treatment of acquired mitral valve disease. T Although excision of a hopelessly damaged mitral valve and replacement with a prosthesis can usually be accomplished without difficulty, valve replacement may be associated with certain operative hazards. One of the more serious of these is injury to structures which lie in close proximity to the valve, particularly the circumflex coronary artery. T h e actual incidence of injury to this vessel is probably not reflected in published reports. In a recent review, Hughes [2] cites ten reported complications of Starr-Edwards mitral valve replacement but does not include injury to the circumflex coronary artery. It is listed, however, as a theoretical or possible complication. In order to emphasize the possibility of injury to the circumflex coronary artery during prosthetic valve insertion in the mitral area, three cases are presented below. They have been collected from a total of 178 mitral valve replacements which were performed at the University of Pennsylvania between February 26, 1962, and December 31, 1965, and at the University of Kentucky between January 1, 1966, and December 31, 1966. Mitral valve replacements done as single valve operations are included as well as those performed in combination with multiple valve procedures. Four of the prostheses used were of the Kay-Shiley type, two were Gott-Daggett valves, and the remainder were Starr-Edwards valves. A total of three senior cardiac surgeons performed or supervised the operations.

Measurement of Transpleural Collateral Blood Flow After Pleurectomy

Since the report of Barrett and Daley in 1949 (2), pleurectomy has been advocated as a means of increasing pulmonary blood flow in patients with cyanotic congenital heart disease and low pulmonary artery pressure. In 1965, Helwig et al. (4) reported the case of a child with pseudotruncus arteriosus in whom pulmonary hypertension developed after a Potts shunt procedure. The pulmonary and systemic pressures were equalized, and the systemic arterial blood became unsaturated with reversal of the shunt. In order to increase pulmonary blood flow, they performed a right pleurectomy and instilled asbestos into the pleural space. Exercise tolerance increased immediately. Subsequent catheterization showed a decrease in hematocrit and an increase in oxygen saturation from 64 to 78 per cent. Arterio-graphically, intercostal blood was seen to drain into the pulmonary veins. The purpose of our study was to develop a radiographic and physiologic method of detecting and quantitating transpleural collateral blood flow in ...

Influence of thoracotomy and intrathoracic dissection on regional pulmonary blood flow

Abstract Serial lung scintiscans were made in 43 dogs to determine the influence of the operative incision, pulmonary hilar dissection, lung manipulation, and atelectasis on the regional distribution of pulmonary blood flow following thoracic operations. Control thoracotomy without hilar dissection was performed in 6 animals, 15 dogs had segmental or lobar resections, and segmental or lobar bronchial ligation was performed in 18. After control thoracotomy a maximal decrease in regional distribution of pulmonary blood flow to the operative side occurred 2 to 4 days after operation. Mechanical ventilation before performance of the lung scans restored regional blood flow to a near-normal state, and the effects of the operative incision had disappeared by the fourteenth day. Characteristics defects in regional blood flow occurred after segmental and lobar resections, but abnormal distribution was greatest from 2 to 7 days after operation. Redistribution of blood flow occurred earlier and was more complete after lower lobe than after upper lobe resections. The changes in arteriolar-capillary perfusion following induced atelectasis were nearly identical to those resulting from pulmonary resection.