Computed tomography and the TNM classification of lung cancer.

Computed tomography (CT) of the thorax and upper abdomen was prospectively evaluated in 84 patients with potentially operable lung cancer. Invasion into the thoracic wall and the mediastinal structures was not accurately demonstrated by CT. For metastatic mediastinal lymph nodes, the sensitivity and specificity of CT were, respectively, 86% and 61% and the positive and negative predictive indices 49% and 91%.

57Co-bleomycin scintigraphy for the preoperative detection and staging of lung tumors.

Twenty-five consecutive patients with lung tumors were classified according to the presence of metastases by the use of 57Co-Bleomycin scintigraphy. Twenty-two of the tumors were visualized but metastatic spread to hilar lymph nodes was not detected. Reliable separation of central tumors with and without growth into neighbouring organs was not possible.

Five years experience with treatment of lung cancer. The role of mediastinoscopy.

Over a five-year period, 304 patients with non small cell carcinoma of the lung were evaluated for pulmonary resection. The patients were divided into three groups: 1) 180 patients operated without preoperative mediastinoscopy based on a normal appearing mediastinum on plain chest x-ray; 2) 107 patients with resection of both lung tissue and mediastinal tissue due to localised positive mediastinoscopic findings; 3) 17 patients who were found inoperable either due to poor lung function or diffuse mediastinal seeding. In group 1, 24% were peroperatively found to be inoperable due to mediastinal involvement.

Transcervical thymectomy in patients with nonthymomatous myasthenia gravis.

Transcervical thymectomy was performed during a 13-year period in 21 patients with nonthymomatous myasthenia gravis. Follow-up showed that only eight patients benefited from the operation. These eight were among the younger patients in the series.

Surgical improvement of patients with pulmonary insufficiency due to localized bullous emphysema or giant cysts.

Patients with continuous expansion of either giant lung cysts or areas of localized bullous emphysema will eventually deteriorate into a state of extreme respiratory distress due to compression of the remaining healthy pulmonary tissue. Thirty-one patients with these 2 types of lung disease having very poor respiratory function underwent surgery for the release of compromised healthy lung by resection of the expanding processes. A rational investigation program including respiratory tests, ventilation and perfusion scintigraphy and pulmonary angiography was gradually developed and analyzed.

Early surgical intervention in non-specific pleural empyema.

During a 4-year period, 18 patients were treated for non-specific pleural empyema. Nine patients were treated by closed intercostal drainage and 9 by early decortication. The length of time from initial treatment until complete resolution of the empyema and healing of the wound was compared between the groups and highly favored early surgery.

Immediate and long-term results in aortic valve replacement.

In a 12-year period, 127 patients with isolated aortic valve disease underwent valve replacement surgery. Long-term results are presented in regard to patients with operation between 1967 and 1974 and immediate results in the later cases. The main conclusions from the study are that the type of myocardial protection is important for the perioperative mortality rate.

A hemodynamic study of the Carpentier-Edwards and Hancock porcine xenografts in the mitral position.

A hemodynamic study was performed on 11 female and 3 male patients with porcine xenograft (9 Carpentier-Edwards, 5 Hancock) in mitral position on average 32.5 months (range 10-65 months) after the operation. In comparison with the preoperative values, the following parameters showed statistically significant post-operative decrease (mean values): wedge pressure (from 22.

Clinical experience with porcine xenografts in the mitral position.

In a 7-year period, 120 porcine xenografts, 16 of Hancock and 104 of Carpentier-Edwards type, were implanted in the mitral position in patients with isolated mitral valve disease. The operative mortality was 4.2%.

Primary malignant fibrous histiocytoma of the lung. A case report.

A case of malignant fibrous histiocytoma of the lung is presented and the literature concerning this rare tumour is reviewed. The advisability of postoperative chemotherapy in the cases remains to be clarified and further data are required to establish the optimum management.

Myocardial preservation during anoxic arrest. Premedication with propranolol, verapamil or methylprednisolone.

Anoxic cardiac arrest was studied for one hour in five groups of dogs. Groups I-III were given methylprednisolone (30 mg/kg b.w.

Intramyocardial temperature following various cooling procedures.

In 12 dogs on cardiopulmonary bypass, the intramyocardial temperatures in the anterior and the posterior wall of the left ventricle and in the septum were measured with microthermoelectrodes when different cooling procedures were used during 60 min of anoxic cardiac arrest. External cooling with 4 degrees C glucose (5.5%) solution dripping into the pericardial sac did not lower the temperature in the septum or in the posterior wall.

Myocardial preservation during anoxic arrest. Chemical cardioplegia.

Two types of cardioplegic solution--the potassium arrest and the Bretschneider solution, both at 4 degrees C--were compared with regard to protective effect against ischemic damage during 60 min of anoxic cardiac arrest in the dog heart. Both solutions provided equally good protection, which was superior to that given by hypothermia alone.

Surgical treatment of bacterial endocarditis.

Valve replacement was performed during a 7-year period in 27 patients with acute or subacute infective endocarditis. Twenty-three patients had single valve affection--16 aortic and 7 mitral--and 4 patients had affection of both the aortic and mitral valves. Eight of the patients with aortic valve lesion had congenital aortic valve stenosis and 2 of the mitral patients had mitral prolapse.

Myocardial preservation during anoxic arrest. Experimental model ventricular fibrillation.

An experimental model with anaesthetized healthy mongrel dogs on extracorporeal circulation is described. Anaesthesia and cardiopulmonary bypass are the same as used in clinical practice. Various methods of myocardial preservation were investigated and their protective effect was judged by cardiac performance after termination of 60 min of anoxic arrest.

Pre- and postoperative lung function after pulmonary resection.

For many years, the use of simple spirometric measurements has formed the physiological basis for evaluation of the possible extent of pulmonary resections. Comparison is made between pre-operative and 3-month postoperative spirometric results in patients subjected to enucleation of hamartomas, lobectomies or pneumonectomies. The finding of normal MBC and FEV1 has proven to be a sufficiently safe guideline for surgery and only abnormal MBC or FEV1 are regarded as indicating more extensive pulmonary function studies.

Results of pulmonary resection in cases of unilateral bronchiectasis.

Follow-up studies of 22 patients treated surgically for unilateral bronchiectasis showed that all patients were improved postoperatively following an average observation time of 9 years, 50% being completely free of respiratory symptoms. In all patients the number of days of recurrent illness had declined significantly after surgery. As mortality and morbidity rates in this kind of surgery are not negligible, a most careful pre-operative selection of patients suffering from bronchiectasis is indicated.

Myocardial protection during aortic valve replacement.

Peri-operative myocardial damage during aortic valve replacement is evaluated by analysis of S-GOT and LDH in the early postoperative phase. Combining the mortality figures and enzyme changes postoperatively, it is demonstrated that the peri-operative myocardial damage is significantly lower in the group operated on under cold cardioplegia a.m.