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Background . Tracheobronchial injuries are encountered with increasing frequency because of improvements in prehospital care and early initiation of the Advanced Trauma Life Support protocol. We review our experience with these injuries with the hypothesis that the leading determinant of patient outcome is the time interval to diagnosis. Methods . Patients with tracheobronchial injury were identified from the registry of our level 1 trauma center during a 10-year period ending December 1997. Clinical presentation, diagnostic evaluation, surgical management, and outcome were reviewed. Results . Twenty patients with ten cervical tracheal injuries and ten intrathoracic tracheobronchial injuries were treated. The mechanism of injury involved blunt trauma in 11 and penetrating trauma in 9. All patients underwent surgical debridement and primary repair. Patients with isolated airway injuries were discharged home after a mean hospital stay of 6 days and had no early complications. Three patients had delayed diagnosis (> 24 hours), and all sustained complications including death (1 patient) and multiorgan system failure (2 patients). The overall mortality rate was 15%. Conclusions . Operative management of tracheobronchial injuries can be achieved with acceptable mortality. Independent of mechanism or anatomic location of injury, delay in diagnosis is the single most important factor influencing outcome. Early recognition of tracheobronchial injury and expedient institution of appropriate surgical intervention are essential in these potentially lethal injuries.

We analyzed the long-term results in 87 patients who had pectus deformities repaired at Fitzsimons Army Medical Center during the period 1953 to 1975. Seventy-one patients had operations for correction of pectus excavatum; 16 had pectus carinatum deformities repaired. A variety of surgical techniques was used in these patients. Our findings show that in excavatum deformities the best results were obtained by removing all deformed cartilage, mobilizing the sternum, using an anterior osteotomy, and stabilizing the chest with a metal strut (which was removed after one year). For carinatum defects, the Ravitch procedure has produced good results. We are encouraged to be more aggressive in advocating repair of the deformities, not only for cosmetic results but because the patients seem to feel healthier both physically and mentally after repair. For these reasons we advocate operation for pectus deformity at any age.

An analysis of our experience with 48 patients having bronchiolar or alveolar cell carcinoma is reported. The remarkable biological variability of this peripheral tumor has important surgical implications. Basically, two dominant clinical presentations occur. In the less common diffuse or multinodular form, prolonged survival is infrequent regardless of the therapeutic approach. Often these patients die from respiratory compromise due to the tumor itself. In the more common localized or solitary form the prognosis for cure is good, approximating 47% or higher. Based on the material presented, lobectomy is the preferred method of surgical treatment. In patients manifesting multinodular disease, surgical resection rarely seems warranted. The concept of preserving pulmonary tissue is stressed.

A clip technique for ligation of the ductus arteriosus in premature infants is presented.