Field Of Thoracic Surgery Research Articles

From the practice of recognizing congenital heart defects

The brilliant achievements in the field of thoracic surgery in recent years have opened up great prospects for surgical interventions for congenital malformations, since these operations relieve patients from a serious illness, make them practically healthy. However, accurate and timely recognition of the disease is a prerequisite for this.

血胸 (肺虚脱) と大量出血の持続, 並びに解除の血液化学組成に及ぼす影響

In order to investigate the influence of postoperative hemothorax in the field of thoracic surgery, the author performed experiments on 73 normal hybrid dogs in which liquid paraffin was poured into the left thoracic cavity, thus intrathoracic condition simulating hemothorax being produced, and hypotension averaging 50mmHg was maintained by means of massive hemorrhage.Influence of the stated condition with the pulmonary compression and hemorrhagic stress, influence of removing the condition, and effect of oxygen inhalation and blood transfusion were scrutinized from the standpoint of blood gas volume, amino N and fluctuation of the acid-base balance.1. Fluctuations in chemical composition of the blood were slight in degree when only liquid paraffin was present in the thoracic cavity, while, when hemorrhagic stress was added to the condition, fluctuations in the form of decrease of blood gas volume, decline of pH and increase of amino N were all more prominent than in simple bleeding. The group with massive paraffin injection showed particularly rapid changes and died in a short period of time.2. The acid-base balance tended to develop compensatory respiratory alkalosis by the intrathoracic injection of liquid paraffin and it shifted to the side of compensatory acidosis after hemorrhage occurred.3. Improvement in the composition of blood chemistry was induced by removal of intrathoracic liquid paraffin, oxygen inhalation and blood transfusion. Combined administration of removal and oxygen inhalation showed a prominent effect on the survival time, and combination of removal and blood transfusion showed more remarkable results in these respects.

Bronchography with water-soluble contrast medium.

The great progress in the field of thoracic surgery during recent years has created increased interest in bronchography. Lipiodol, i.e., iodized poppy seed oil, was introduced as a contrast medium by Forestier thirty years ago. Iodized oil, however, is not an ideal contrast medium for bronchographic studies. The oil does not mix with the bronchial secretion; it has a tendency to droplet formation, which may give a false impression of a stop. The oil may be retained in the alveoli for a considerable time, often several months. This circumstance increases the risk of postoperative complications after thoracic surgery, especially the development of atelectasis. The interpretation of follow-up roentgenograms is made difficult by the retained contrast material, and there are reports indicating that the continued presence of oil in the lung may cause delayed pneumonia and oil granuloma (1, 3, 8). In 1948, Morales and Heiwinkel (5, 6) introduced a water-soluble contrast medium called “Umbradil-Viskos B” for bron...

Some observations on thoracic surgery in general and pectus excavatum in particular.

THE PAST decade has witnessed rather definite changes in the content of thoracic surgery. An ever-increasing employment of antibiotic drugs in the management of acute respiratory tract infections has decreased sharply the incidence of pneumonia, postpneumonic empyema, and pulmonary abscess, at least as seen in general hospital practice. The latter two diseases at one time furnished a considerable fraction of thoracic surgical case material, especially in the winter months, but are now reduced to a minor role. Despite this and other results of chemotherapy, the field of thoracic surgery continues to expand. Almost every year brings its new surgical procedure or new therapeutic concepts. By way of illustration one has only to recall the enormous progress made in the area of cardiovascular surgery since the first successful ligation of a patent ductus arteriosus was performed in 1938. One development in thoracic surgery which has contributed in a minor way to

The Roentgenologic Features of Mediastinal Tumors

Although mediastinal tumors are not common, their incidence is frequent enough to warrant further investigation. Up to the present time their preoperative classification has proved difficult or impossible, but in view of the continued progress in the field of thoracic surgery, their differentiation prior to operation has become increasingly important. The present study was undertaken in an effort to determine whether any of these tumors had characteristic roentgenologic features. During the period from 1938 through 1942, 44 cases of proved mediastinal tumor were found among approximately 60,000 chests examined at the Massachusetts General Hospital. Malignant lymphoma and metastatic involvement of the mediastinal lymph nodes were not included in this study. Heuer and Andrus (3), in a monograph covering the literature up to 1940 and including their own cases, reviewed a great variety of mediastinal tumors and discussed their diagnosis and treatment. Our group is smaller and does not include as many different types of tumor, but all of the 44 cases were proved by operation, aspiration, or autopsy. The series included 25 congenital tumors—15 “bronchiogenic” cysts (6), 7 dermoid cysts, and 3 malignant teratomata—14 tumors of neurogenic origin, 1 malignant tumor, unclassified, and 4 tumors of the thyroid, parathyroid, or thymus glands. The last 4 included 2 intrathoracic goiters, one thymic tumor, and one tumor of the parathyroids. Congenital Tumors Bronchiogenic Cysts (6): From the roentgenologic point of view the most important diagnostic feature of a bronchiogenic cyst is a smooth, round or ovoid shadow arising anywhere within the mediastinum without evidence of bone erosion or calcification. Demonstration of tracheal attachment offers additional diagnostic evidence, but is not conclusive, since a substernal thyroid, an aneurysm of the innominate artery, and other masses may be attached to the trachea and may present a similar appearance. It should be remembered also that bronchiogenic cysts may grow within the lung as well as in the mediastinum. Unless the cyst becomes infected, its discovery is usually incidental. Those cysts in our series which became infected simulated lung abscess, or empyema with a bronchial fistula, in symptomatology and somewhat in their roentgen appearance. In the group of 15 the sex distribution was about equal, 8 males and 7 females. Dermoid Cysts (Fig. 1): All of the 7 dermoid cysts were in the anterior mediastinum. Only one was found in the upper portion; the others were located in the middle and inferior portions. As a rule, the outline of the dermoid cyst was slightly irregular as compared to the smooth, rounded outline of the bronchiogenic cyst. In size the dermoid cysts varied from 7 cm. to 17 cm. in diameter. Three showed calcification in the wall, one with actual bone formation. In one case, the cyst communicated with a bronchus and showed a fluid level, as well as what was apparently semisolid material.

SPONTANEOUS PNEUMOTHORAX FOLLOWING POSITIVE PRESSURE INTRATRACHEAL ANESTHESIA

Since the introduction of intratracheal anesthesia by Elsberg in 1909, this method of administration has become increasingly popular, especially in the field of thoracic surgery. Elsberg1mentioned the difficulties in determining the size of the catheter to be used in order to produce the desired distention of the lung. The determining factor is the freedom of outflow around the catheter. The importance of this is well illustrated in a case recently reported by Bradshaw.2 As to the exact amount of positive pressure which may be safely used, there seem to be marked differences in opinion. Coryllos,3as a result of his experimental work on human beings and dogs with the E and J resuscitator (using from plus 14 mm. to minus 9 mm. of mercury through the face mask), concluded that it was impossible to cause even the slightest trauma to the lungs with this pressure. He

THE NEGATIVE CHAMBER IN OPEN PNEUMOTHORAX

Open pneumothorax is the complete, sudden collapse of the lung which inevitably occurs when an operation requires the wide opening of the chest wall, in the absence of adhesions between visceral and costal or diaphragmatic pleura, or when an attempt is made to drain the chest after the method employed in other parts of the body. The importance of preventing this physical phenomenon was fully realized by Dr. Matas more than twenty years ago, when, as one of the pioneers in the field of thoracic surgery in America, he had his assistant, Dr. Parham of New Orleans, excise a tumor of the chest wall with the help of a differential pressure apparatus, the Fell-O'Dwyer combination, as modified by Matas. Ever since that time, open pneumothorax has been a topic for discussion. Our association considered it, at the second annual meeting, in 1919, when the president's address, which dwelt on the