Robert M. Vanecko

Site of Recurrence in Patients with Stages I and II Carcinoma of the Lung Resected for Cure

Ninety-nine patients with Stage I or II lung carcinoma that was other than the small cell type and who survived for more than 30 days after a curative resection were followed for five years or until death if it occurred prior to the five-year anniversary. Recurrent disease developed in 44 patients. Clinical data and data from postmortem examination were reviewed in these 44 patients in an attempt to classify each recurrence as either initially local or distinct metastatic disease. The site of the first documented recurrence was local in 18 patients and distance metastases in 26. When the patients with recurrence were separated into TNM categories, it was apparent that in those patients without lymph nodes metastases demonstrated in the resected specimen (N0), the initial recurrence tended to be a distant metastases, whereas in those with such involvement (N1), the initial occurrence was more often local. In light of these data, selection of appropriate initial adjuvant therapeutic modalities may be different for each type of patient.

Clostridial myonecrosis of the chest wall complicating spontaneous esophageal rupture

Spontaneous rupture of the esophagus (Boerhaaves syndrome) has a dismal survival rate without prompt surgical management. A variety of surgical regimens have achieved survival of 70% or greater; however, the postoperative course is frequently complicated by fistula, would infection, empyema, and sepsis. We report an unusual postoperative chest wound infection of clostridial myonecrosis, which presumably originated from the patients gastric microflora. He was treated with immediate surgical debridement of all involved tissue, prolonged ventilation, total parenteral nutrition, and frequent dressing changes. The remaining defect was closed with a skin graft. Anaerobic wound infections of the chest wall and their management are discussed.

Emergency approach to the subclavian and innominate vessels.

he operative approach to an acutely injured subclavian vesselprotected by clavicle, sternum, the costal cartilages, and ribs T -is by no means an easy one in the presence of active bleeding. We wish to describe a new emergency approach to these vessels which provides rapid exposure for control of bleeding and excellent visualization for arterial and venous reconstruction.

A method for vital microscopy of the hepatic microcirculation in large animals and man

Abstract A method for inspection and photographic documentation of the microcirculation in solid parenchymal organs is described. This method makes use of reflected light for continuous observation and a quartz electronic light placed in the light path for photographic documentation.