Isidore Mandelbaum

Surgical resection in disseminated testicular cancer following chemotherapeutic cytoreduction.

Platinum combination chemotherapy will regularly produce a 70% complete response rate in testicular cancer. Many patients failing to achieve complete remission can still be rendered disease‐free with surgical resection of residual localized disease. Twenty‐one patients underwent resection for residual pulmonary lesions and 41 underwent lymphadenectomy for persistent retroperitoneal disease. There were no characteristic radiographic findings for fibrous tissue versus mature teratoma versus carcinoma. Although elevated HCG or AFP levels indicated the presence of carcinoma, negative HCG and AFP did not rule out such a diagnosis as 12 of 22 resected carcinoma patients were seronegative. Of 35 patients, 31 (89%) with fibrous tissue or mature teratomas and all four patients with immature teratomas have been continuously free of disease with a minimal postoperative follow‐up time of six months. However, only two of 22 patients with resected carcinomas have been continuously disease‐free. Postoperative chemotherapy for mature teratoma or fibrous tissue is probably not necessary. However, we feel that further aggressive chemotherapy is needed in the resected carcinoma patient with at least two courses of platinum combination chemotherapy. Surgical resection of residual disease following chemotherapy‐induced cytoreduction with platinum combination chemotherapy may be therapeutic in some cases and helps to define the optimal subsequent treatment strategy.

The Importance of One-Stage Median Sternotomy and Retroperitoneal Node Dissection in Disseminated Testicular Cancer

More than 350 patients with testicular germ cell cancer have been treated with cisplatin combination chemotherapy. Seventy-two with metastases to the thorax who had operation are discussed here. In a subgroup of 24 patients with additional retroperitoneal disease, a one-stage median sternotomy was performed in 18 patients, and a thoracotomy in 6, with retroperitoneal node dissection. Seventeen patients had similar pathological lesions in the thorax and retroperitoneum; in 7, the lesions differed. There was no operative mortality in the entire group. Overall, chemotherapy altered the metastases to mature teratoma in 28 patients, and 27 are long-term survivors. Among 22 patients with fibrotic, necrotic masses, 19 are long-term survivors; 6 of the 22 with persistent carcinoma had chemotherapy postoperatively and are long-term survivors. The overall cure rate for patients with disseminated testicular cancer is approximately 80%. Among those who had a one-stage thoracoretroperitoneal procedure, long-term survival is 83%; for the entire thoracic surgical group, it is 74%.

Intrathoracic Cystic Hygroma A Report of Three Cases

Three cases of cystic hygroma in adults are presented. Cystic hygroma is a type of lymphangioma with large dilated cystic lymph spaces which usually occur in the neck or axillae in infants. The mediastinal type of cystic hygroma is rare (less than 1%) and is usually not discovered until adulthood because of its asymptomatic nature and deep location. Roentgen findings are not specific, but features which help differentiate cystic hygroma from other malignant processes include a sharp border and uniform density to the mass, macroscopic cystic lymph spaces, and little lobulation of the surface of the mass. Treatment is early surgical excision.

SURGICAL CONSIDERATIONS IN THE MANAGEMENT OF SUPRAVALVULAR AORTIC STENOSIS.

Nine cases of surgically treated supravalvular aortic stenosis have been presented. The pertinent literature has been reviewed. It is concluded that this anomaly can be managed satisfactorily by insertion of a large patch graft into an aortic incision placed across the stenotic area and extended well beyond it in both directions. Total cardiopulmonary bypass is utilized. Left ventricular decompression and coronary arterial perfusion are valuable adjuvants. The risk of operation appears to be small and the results rewarding.

Selected cardiovascular effects of adenosine diphosphate

Abstract Six intact dogs were studied before, during, and after an 8 minute infusion of ADP, 0.4 mg./min./Kg. There was a significant decrease in aortic pressure, systemic vascular resistance and platelets, and an increase in cardiac output, central blood volume, stroke volume, heart rate, and pulmonary artery pressure. Pulmonary vascular resistance did not change. Platelets remained depressed, but other parameters returned to normal 5 minutes after completion of the infusion. The increase in pulmonary artery pressure appears related to increased flow. The decrease in platelets does not seem relevant to the increase in pulmonary artery pressure. Six dogs were studied with right-heart bypass and constant pulmonary blood flow during 4 minutes of ADP, 0.3 mg./min./Kg. Aortic pressure decreased significantly but pulmonary artery and left atrium pressure did not change. There was systemic arteriolar vasodilation and pulmonary artery pressure did not change when flow was unchanged. The majority of left ventricular function curves showed some improvement during ADP infusion.

Chronic pulmonary histoplasmosis with declining complement fixation titers and persistence of positive sputum culture. A case report.

A patient with culturally proved chronic pulmonary histoplasmosis was treated with amphotericin B. Complement fixation titers decreased but sputum cultures remained positive for Histoplasma capsulatum 5 months after original therapy. Lobectomy and a subsequent course of amphotericin B were necessary. Exceeding the minimal inhibitory concentrations of amphotericin B did not eradicate the organism and declining complement fixation titers failed to have prognostic significance.