Louis F. Knoepp

Fractures of the ribs

Abstract A series of 386 rib fractures have been presented which comprise those cases admitted to the University Hospital over a five and one-half-year period. These were studied as to cause, symptoms and signs, and location of fractures. When complication accompanied the fracture the mortality varied from 23 per cent to 71 per cent, while the patients in the uncomplicated group all survived. These complications have been studied in relation to location of fracture, other bones fractured and the average number of ribs involved. There are some interesting groups of cases considered, namely, the spontaneous fractures of ribs, double fractures of ribs and the pathological fractures. A few other large series of case reports of other observers are included in the article for comparison of results.

Clinical management of lung abscess

Abstract 1. 1. Bronchial obstruction is the main underlying factor in the determination of progress and treatment in lung abscesses. Most patients exhibit pneumonitis previous to abscess formation, and the virulence of the organisms determine the amount of bronchial inflammation. 2. 2. A period of observation is advocated for each case during which conservative measures are adopted. When cessation of improvement is noted, as evidenced by inadequate bronchial drainage, conservative therapy ceases. 3. 3. Patients are usually bronchoscoped prior to instituting other surgical treatment. If this fails, bronchoscopy is not repeated. 4. 4. Surgical drainage is used in those patients in whom sufficient pulmonary tissue can be salvaged for future use. 5. 5. Lobectomy is advocated when the underlying pathologic process has involved the major portion of a segment of lung. 6. 6. Immediate surgical pleural drainage is utilized in cases presenting empyema as a complication of conservative management. 7. 7. A group of sixty-six cases is analyzed wherein two patients received conservative therapy, thirty-three bronchoscopic treatment, fourteen surgical drainage for the abscess, ten surgical drainage for empyema and seven lobectomy. The percentage of complications incident to treatment is analyzed and, with no mortality, would seem to indicate a basis for treatment of future cases.

Giant hemolymph node of the mediastinum

Abstract There have been six previous cases of giant hemolymph node of the mediastinum reported in the literature. An additional case is reported in which the patient was subjected to surgical removal and has survived four years.