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A method is described for segmental esophageal replacement in dogs, with one of three types of tissue substitute: pericardium, fascia lata and aortic homograft. The experiments involving the thoracic esophagus failed owing to the development of acute mediastinitis and sepsis. The most promising results were obtained in animals in which an aortic homograft was used to replace the cervical sigment of the esophagus. Eight of the 12 animals with aortic homograft survived and gained weight until killed one to six months after operation. The overall results suggest that aortic homograft may have a potential clinical application in cases in which esophageal replacement is necessary.

This study was undertaken to examine the value of rapid atrial pacing (RAP) combined with left-ventricular nuclear (LVN) angiography in the diagnosis of ischemic heart disease. It included 32 patients: 12 normal subjects and 20 with clinical coronary artery disease (CAD) and greater than 50% narrowing of a coronary artery (significant CAD). The ECG and an LVN angiogram (LVNA) were recorded at rest and during graded RAP. In the normal subjects, left-ventricular wall motion was normal at rest and during atrial pacing, but a wall motion abnormality (WMA) appeared in one subject. Left-ventricular ejection fraction (EF) did not change significantly. In the 20 patients with significant CAD, the diagnostic sensitivity of the ECG during RAP was 100% and 90% for the nuclear angiogram (presence or appearance of WMA at rest and during RAP). The mean EF in this group decreased from 0.38 to 0.31. WMA on the LVNA was present in 79% of patients with significant left-anterior descending, in 44% of those with right, and in 33% of those with circumflex coronary artery disease. WMA (at rest or on pacing) occurred in 17% of patients with 50 to 89% narrowing of an artery, in 50% with 90 to 99% narrowing and in 68% with total obstructions. The LVNA (rest and/or RAP) identified patients with significant single-vessel disease, but underestimated the extent of double-and triple-vessel disease. The LVNA at rest and during atrial pacing was an excellent method of evaluating significant coronary artery disease.

Forty-two patients were treated for combat injuries of the chest, caused by shrapnel fragments, bullet wounds, blunt trauma and blast injury. Twenty-three required only intercostal tube drainage, while 19 underwent thoracotomy. There were two deaths, both unrelated to the thoracic injury. Our indications for emergency thoracotomy were hemorrhage of 1,000 ml with the initial insertion of the chest tube or 500 ml of fresh bleeding during the first 2 hr after insertion of the chest tube, massive air leak, extensive chest wall injury, the location of metal fragments in the mediastinum, evidence of cardiac tamponade or significant mediastinal shift. The positive results obtained in this series of cases were due to the effective first aid treatment on the battlefield and in field hospitals, and to an aggressive policy of operative intervention where indicated, together with intensive postoperative care.