Search

1. 1. Pulmonary resection with mitral stenosis is discussed and its tolerability determined. 2. 2. The nature of pulmonary hypertension is discussed. 3. 3. The results of obstructing one pulmonary artery in a patient with mitral stenosis are presented.

Athorough knowledge of bronchial anatomy is a prerequisite for proper diagnosis and localization of pulmonary lesions. Advances in thoracic surgery in recent years have stimulated the publication of numerous detailed studies of the bronchial anatomy and its variations (1, 5, 6, 8, 30); as yet, however, there has been no over-all survey of bronchial distribution after pulmonary resection. The need for such a survey became apparent to us when we encountered difficulties in reviewing a series of postoperative bronchograms. We found that individual bronchial identification was not always clear and that the causes of postoperative bronchiectasis, which occurred in some cases and not in others, were not immediately apparent. We therefore studied our bronchographic material with the following questions in mind: 1. Is there a definite and predictable pattern of spatial bronchial rearrangement following segmental resection or lobectomy?2. If so, what factors prevent or modify such rearrangement?3. Does bronchial r...

The potentiated anaesthesia with Pacatal in cardio-pulmonary surgery certainly presents advantages, above all in regard to cardiac protection: absence or marked reduction of ventricular fibrillation in experimental cardiac surgery in dogs, and absence of arrhythmia and cardiac arrest in thoracic pulmonary surgery in man. Moreover, the 500 different studies made on dogs clearly demonstrate that Pacatal is not a dangerous drug. Many times the effective dose of Pacatal has been injected in dogs without any toxic effect. Femoral and intra-cardiac pressures and cardiac output are very slightly changed, as are the blood constituents. Finally, in the remote premedication for anxious subjects, Pacatal is probably the ataraxic that can be prescribed with the minimum of danger and the maximum of efficiency.

1. 1. The methods and technics which have proved successful in resuscitating patients with ventricular asystole and ventricular fibrillation are discussed. 2. 2. Success in cardiac resuscitation depends upon the restoration of the flow of oxygenated blood to the brain within about four minutes. All other considerations are of secondary importance. 3. 3. All surgeons and anesthetists should became familiar with the technic of cardiac resuscitation since the limitations of time do not allow for consultation should the emergency arise. 4. 4. During an eight-year period thirteen patients have been successfully revived at the Hospital of the University of Pennsylvania following sudden death in the operating room.

The history of pulmonary decortication, particularly during and since World War II, has been briefly reviewed. It has been noted that within the past ten years, decortication has been employed in a variety of pathologic conditions. This has necessitated certain variations of surgical technic. The pathogenesis of hemo-organization has been described. The formation of a mature peel in organizing hemothorax and in other pathologic states of the pleurae has been discussed. It has been emphasized that the development of a peel or fibroblastic membrane is a function of the pleurae and is in response to a number of exciting causes. Indications for, and differing technics of decortication have been listed in the following morbid conditions: organizing hemothorax with or without infection; pyogenic empyemas of varying etiologies; specific pleural infections such as tuberculosis and coccidioidomycosis; persisting pneumothorax; either transudates or exudates arising From a variety of irritative, inflammatory or chemical sources, neoplastic effusions.

A case of extensive, bilateral bronchiectasis treated by maximum resection of lung tissue is reported.

1) The effusions of the re-expansion period are not ex-vacuo transudates. 2) When the mean negative intrapleural pressure is greater than −15 cm. of water, the formation of fluid is most likely to occur, if fluid is not already present. 3) When the average mean intrapleural pressure during re-expansion is greater than that before re-expansion was started, by 1.1 cm. of water, then the lung is resisting expansion. Records should be sufficient to permit the observation of this pressure difference to be made. 4) The chief cause of pleural effusion in pneumothorax cases during re-expansion of the lung is trauma to thickened pleura incident to pneumothorax treatment. 5) Gradual re-expansion is usually to be preferred to abrupt cessation of refills. Exception may be made in cases in which the visceral pleura is thin and the lung has been observed to have a strong tendency to re-expand.

Pulmonary resections have been performed successfully for many years, but until 1933 the techniques remained crude and the operations extremely hazardous according to present standards. Staged operations, use of tourniquets and clamps and destruction of lung tissue with cautery all resulted in prolonged morbidity and a mortality horrifying to the surgeon of today. In 1933 Rienhoff1first described the technique of individual isolation and closure of the bronchus and blood vessels at the hilus. This technique, now used in practically all pulmonary resections, has done more than anything else to reduce the operative complications and mortality of these procedures. In 1932 Graham and his colleagues2collected a series of 212 lobectomies in which the operative mortality was 34 per cent. By 1947 Kay and associates3were able to report 258 consecutive cases of lobectomy for bronchiectasis with only one death, and Jones4presented a series of

SEGMENTAL PNEUMONECTOMY IN BRONCHIECTASIS: THE LINGULA SEGMENT OF THE LEFT UPPER LOBE Edward Churchill;Ronald Belsey; Annals of Surgery

SEGMENTAL pulmonary resection for bronchiectasis is based on the concept that it is most advantageous to conserve all healthy tissue and limit resection to the specific pulmonary segments destroyed by the disease. Bronchiectasis may affect any of the eighteen segments of the two lungs. In the majority of cases the disease does not involve the entire group of segments that constitutes a pulmonary lobe. Frequently, the disease is bilateral. It has been noted that the superior segment of both lower lobes and the two top segments of the left upper and right upper lobes are not often involved. When bronchiectasis . . .