Chest Wall Excision Research Articles

The Association of Lung Distention, PEEP and Biventricular Failure

Although positive and expiratory pressure (PEEP) is known to depress the cardiac output, the mechanism remains debated. Two series of experiments were designed to explore this mechanism. In the first study, the application of 15 cm H(2)O of PEEP to nine anesthetized, ventilated dogs led to a reduction of cardiac index from (mean +/- one standard error of the mean) 2.71 L/min .m (2) +/- 0.35 to 2.19 L/min m(2) +/- 0.22 (p < .05) and a drop in mean arterial pressure (MAP) from 117 mm Hg +/- 8 to 91 mm Hg +/- 11 (p < .01). The mean net (vascular minus pleural pressure) pulmonary artery pressure (MPAP) rose from 15.3 mm Hg +/- 1.2 to 20.6 mm Hg +/- 1.8 (p < .02). The mean net central venous pressure (CVP) rose from 5.2 mm Hg +/- 0.9 to 8.4 mm Hg +/- 0.9 (p < .05) and the net pulmonary arterial wedge pressure (PAWP) rose from 6.7 mm Hg +/- 0.7 to 9.5 mm Hg +/- 0.9 (p < .01). There was a nonsignificant rise in the mean net left atrial pressure (LAP). As PEEP was raised in increments from 0 to 20 cm H(2)O, both LAP and PAWP increased. The rise in PAWP was always greater than the increase in LAP. The difference between PAWP and LAP was strongly correlated with the increase in MPAP (r = 0.98). This relationship was useful in correcting the PAWP during PEEP. The problem of cardiac depression was evaluated in a second series of eight dogs. These animals underwent complete chest wall excision to eliminate any possible direct effects of increased pleural pressure on the heart and great vessels. The absence of the chest wall permitted hyperexpansion of the lungs, particularly with positive end expiratory pressure. At 15 cm H(2)O of PEEP, the mean cardiac index fell in these animals from 2.36 L/min. m(2) +/- 0.26 to 1.47 L/min.m(2) +/- 0.18 (p < .01) and the MAP fell from 105 mm Hg +/- 16.2 to 68 mm Hg +/- 4.8 (p < .001). The CVP rose from a mean of 5.5 mm Hg +/- 0.4 to 8.3 mm Hg +/- 0.6 (p < .01) and the LAP rose from 6.3 mm Hg +/- 0.8 to 8.0 mm Hg +/- 1.1 (p < .05). The MPAP rose from 18.0 mm Hg +/- 0.6 to 23.3 mm Hg +/- 1.6 (p < .01). Comparison of Group I and II showed a significantly greater depression of the cardiac output and MAP in the open-chested animals. At the same time LAP was significantly higher. These data strongly suggest that PEEP and particularly pulmonary hyperinflation induce biventricular failure.

The Value of Chest Wall Resection in the Treatment of Superior Sulcus Tumors of the Lung

The diagnosis of superior sulcus tumor was established in 35 patients at the University of Michigan Medical Center over the sixteen-year period from 1955 through 1970. Twelve patients underwent preoperative irradiation with cobalt 60 followed by radical en bloc excision of the chest wall. None of these patients survived five years. Twenty-three patients received radiation therapy with cobalt 60 only. Three of these patients survived five years free of disease. The absolute five-year survival in the entire group of patients was 8.6%. This study raises the question of the role of radical chest wall excision in the treatment of superior sulcus tumor.

Clinical experience and results of excision of the internal mammary lymph node chain in primary operable breast cancer

CancerVolume 12, Issue 1 p. 14-22 ArticleFree Access Clinical experience and results of excision of the internal mammary lymph node chain in primary operable breast cancer Jerome A. Urban M.D., Jerome A. Urban M.D. Breast Service, Memorial Center for Cancer and Allied Diseases, New York, N.Y.Search for more papers by this author Jerome A. Urban M.D., Jerome A. Urban M.D. Breast Service, Memorial Center for Cancer and Allied Diseases, New York, N.Y.Search for more papers by this author First published: January/February 1959 https://doi.org/10.1002/1097-0142(195901/02)12:1<14::AID-CNCR2820120106>3.0.CO;2-LCitations: 41AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Andreassen, M.; Dahl-Iverson, E., and Sorensen, B.: Glandular metastases in carcinoma of breast. Lancet 1: 176– 187, 1954. 2 Haagensen, C. D.: Diseases of the Breast. Philadelphia, Pa. W. B. Saunders Company. 1956; p. 570. 3 Handley, R. S.: Personal communication. 4 Handley, R. S., and Thackray, A. C.: Invasion of internal mammary lymph nodes in carcinoma of breast. Brit. M. J. 1: 61– 63, 1954. 5 Sugarbaker, E. D.: Radical mastectomy combined with in-continuity resection of homolateral internal mammary node chain. Cancer 6: 969– 979, 1953. 6 Urban, J. A.: Radical excision of chest wall for mammary cancer. Cancer 4: 1263– 1285, 1951. 7 Urban, J. A.: Radical mastectomy in continuity with en bloc resection of internal mammary lymphnode chain; new procedure for primary operable cancer of breast. Cancer 5: 992– 1008, 1952. Citing Literature Volume12, Issue1January/February 1959Pages 14-22 ReferencesRelatedInformation