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All meetings will be held in the Town Hall
9:00 a. m. BusinessMeeting.
9:30 a. m. ScientificSession.
1. Bronchoscopic Aidin the Management of Postoperative Pulmonary Complications.
Gabriel Tucker, Philadelphia, Pa.
Abst.� The value ofdirect inspection of the interior of the tracheobronchial tree and themechanical aid afforded in the removal of obstruction to ventilation anddrainage by means of the bronchoscope are very well known to the thoracicsurgeon. The use of the bronchoscope in the diagnosis and treatment ofpostoperative pulmonary complications has been applied over a sufficiently longperiod and to a large enough number of cases to establish at least to somedegree its value. Observations in a series of over 150 cases of postoperativepulmonary complications in which bronchoscopy was used as a method of diagnosisand treatment will be presented and an effort made to evaluate the aid renderedby bronchoscopy in the end result in the cases. The presentation will beillustrated by lantern slides and a short moving picture film of the specialtechnic used in the critically ill cases particularly of massive obstructiveatelectasis.
2. TheTreatment of Ruptured Lung Abscess.
Frank S. Dolley, LosAngeles, Calif.
Abst.� A method oftreating massive pyopneumothorax following sudden rupture of a lung abscess isdescribed. The complete and immediate drainage of the empyema cavity, thesimplicity of the operation, and almost total absence of sucking in thethoracostomy wound have given amazingly good results.
3. The Free Transplantation of Fat for theClosure of Pulmonary Cavities.
Harold Neuhof, New York, N. Y.
Abst.� The pulmonarycavity left behind after the evacuation of a destructive suppurative lesion mayrange in size from a small defect to a lattice lung occupying much of a lobe.If such cavities, always featured by bronchial fistulae, do not healspontaneously they present problems for closure which may be simple and easy ofsolution or difficult and complicated. For the closure of these cavities freetransplants of fat have been employed by me. This operation has been performedeven though it has been realized that infection still existed in a number ofinstances, and that the situation in general was far from ideal for the "take"of a graft. Despite the theoretical assumption that failure would followfrequently, the grafts have succeeded in most of the cases. As a result aproblem otherwise difficult of solution has been solved by this exceedinglysimple procedure. An outline of the case reports will be given.
4. Chemotherapy in theTreatment of Streptococcus Infections of the Pleura and Chest Wall.
Harry C. Ballon andAlton Goldbloom, Montreal.
(By Invitation)
Abst.� Experienceswith P-aminophenylsulphonamide (Prontylin) and its derivative (Prontosil) inthe treatment of hemolytic streptococcus infections of the lung, pleura andchest wall are presented. These dyes appear to possess definitechemotherapeutic properties in the presence of infection caused by thehemolytic streptococcus. This fact is particularly well illustrated in the caseof an unusual and apparently hopeless infection of the pleura, chest wall andribs complicating scarlet fever.
5. Roleof the Dual Pulmonary Circulation in Various Pathological Conditions of theLungs; Together with Some Observations on the Sources of Pulmonary Hemorrhageand Attempts at its Control.
D. A. Wood (byinvitation) and Leo Eloesser,
San Francisco.
Abst.� Short review ofprevious attempts at study of this problem. Short description of technique. Normal relation between circulation inpulmonary and bronchial arteries. (Greater and lesser pulmonary circulation.)
Pathologicalrelations:
(a) Due to hypertrophic processes in pulmonary parenchyma.
(b) Due to obstructive lesions, pulmonary and cardiac, sclerotic,congestive, etc.
(c) Due to inflammatory lesions, chronic and acute; pulmonary,cardiac, and mixed.
(d) Due to processes of debatable etiology. Emphysema, asthma, etc.
(e) Congenital anomalies.
Anomaliesof dual circulation as possible etiological factor in various lesions ofundetermined etiology, e.g., hypertrophic pulmonary osteo-arthropathy.
Sourcesof pulmonary hemorrhage. Hemorrhage from lesser circulation (pulmonary),arterial and venous.
Hemorrhagefrom greater circulation (bronchial).
Pulmonarycavity; pulmonary abscess; inflammatory lesions; and Tumors. Ulcerating lymphnodes.
Attemptsat control; mass ligature at lobar hilum, compression, local hemostasis viabronchoscopy.
12:30 p. m. Luncheon.Trudeau Sanatorium.
Monday Afternoon,May 31, 1937
6.
2:00 p. m. Address by Professor Hans C. Jacobaeus,Stockholm, Sweden. Bronchospirometry and Its Use in Determining Indications forThoracoplasty in Bilateral Pulmonary Tuberculosis.
7. TheEffect of Thoracoplasty on the Pathological Physiology of Respiration.
William S. McCann and Nolan L. Kaltreider,
Rochester, N. Y.
(By Invitation)
Abst.� Measurements ofthe total pulmonary capacity and its subdivisions were made in 20 cases ofpulmonary tuberculosis treated by thoracoplasty. In addition, roent-genographicstudies were made, the gaseous content of the arterial blood was determined,the venous pressure and blood velocity were measured and in six instances therespiratory response during exercise was obtained. The measurements were madefrom 7 to 127 months after operation.
It wasfound that thoracoplasty caused a marked reduction in the total and vitalcapacities; the diminution being roughly proportional to the number of ribs resected.The reduction in the mid capacity and the residual volume was less marked thanin the other capacities, resulting in high normal values for the relativevalues. The ability to expand the chest in patients with thoracoplasty wasgreatly diminished. Surgical interference with the chest cage resulted in aslight to moderate anoxic anoxernia. In spite of the presence of arterialanoxemia, no evidence of polycythemia was found. The values for the venouspressure were slightly elevated but were not abnormally high. In about half thepatients the velocity of the blood (arm to tongue time) was slightly delayed.During moderate physical exertion patients with thoracoplastic operations had arapid and shallow type of breathing compared with normal individuals. Theexpression total ventilation was abnormally high and all but one patientcomplained of dyspnea on moderate exertion. The pulmonary reserve was reducedin all cases. Definite correlations existed between the degree of disabilityand the reduction in the vital capacity and the pulmonary reserve and theincrease in the expression . total ventilation.
8. TheLung Volume After Thoracoplasty.
Richard H. Overholt andJohn S. Harter, Boston.
(By Invitation)
Abst.� Thoracoplastyresults in an irreversible and permanent alteration of the volume of thethorax. The ideal operation should, therefore, be one which adequatelycollapses lung involved by disease and at the same time not interfere with thefunction of healthy portions of the lung. Recently reports have appeared in theliterature of greatly reduced values in lung volume studies made soon afterthoracoplasty. The question has been raised "Can the disease (tuberculosis) bearrested without making the patient worse off physiologically than he wasbefore?"
Lung volume(Christie's method) and vital capacity determinations have been made in aseries of 72 thoracoplasty subjects. One-half of this number have now beenrestudied, six to eighteen months after completion of the operation. All casesselected for review are considered apparently arrested and have either returnedto work or are on graduated exercises in the sanatoria. The results showalterations in the lung volume in both directions. Increase in the volume ofthe lung was found after operation in some, values as high as 24% above thepre-operative readings. The majority of cases showed a slight decrease in lungvolume. The vital capacity in all cases showed a decrease from 8% to 30%. Thestudy suggests that the more nearly the operation approaches the ideal, i.e.,selective collapse with preservation of functioning basal portions, the lesschange in respiratory reserve.
9. Studiesand Recent Physiological Tests in Cardio-Respiratory Mechanics.
I. Methods for Estimating Pulmonary and Circulatory Capacity.
Adrian Lambert and (byinvitation)
Dickinson W. Richards, J.and Andre Cournand,
New York, N. Y.
Abst.� Mechanics ofbreathing were studied by the use of respiratory tracings, lung volume andmaximum capacity determinations, as well as by the more common methods offluoroscopy, x-rays, and external chest measurements. Respiratory gas exchangewas estimated by gasometric methods, analysis of expired air, and of thearterial blood gases. Circulatory mechanics were studied by measurement ofcirculation, time, venous and arterial blood pressures, and by the response ofthese and of the vital capacity to intravenous saline injection. In order totest the efficiency of breathing, the adequacy of gas exchange, and thecirculatory adjustments in changing physiological conditions, thesemeasurements were carried out both at rest, during one minute of moderateexercise, and during the period of recovery from exercise.
II. Illustrative Cases of Chronic Pulmonary Disease Before and AfterChest Surgery.
Frank Berry and (by invitation)
Dickinson W. Richards, J.and Andre Cournand,
New York, N. Y.
Abst.� A limited numberof diversified cases of chronic pulmonary tuberculosis has been selected toillustrate the use of this method in relation to phrenicectomy and thoracoplasty.Preoperative and late postoperative status is discussed from the physiologicalstandpoint.
10. AStudy of Changes in Cardio-Respiratory Physiology Following Total Pneumonectomyin Young Developing Animals.
B. N. Carter andJ. J. Longacre, Cincinnati.
Abst.� The anatomicchanges in the remaining lung occurring in young developing animals followingpneumonectomy have been demonstrated by several workers and these changes havebeen contrasted with those occurring in adult animals. The purpose of thispaper is to determine the degree of compensatory return of function in youngpneumonectomized animals and to contrast this degree of return of function withthat in adult animals following pneumonectomy.
Alitter of six puppies were chosen. Three of these animals were pneumonectomizedat the age of one month (the entire left lung being removed at this time) andthe remaining three animals were kept as controls. Six months afterpneumonectomy all the animals were subjected to the following:
A. Strain Experiments
1. Each animal was run for 2 hours in the treadmill (traversing4600 meters) and the alteration in pulse, temperature and respiration, and thesaturation of arterial bloods were noted.
2. Anoxemia test, as measurement of absolutestrain�the oxygen percentage in the inspired air was determined at the criticallevel (as described in our earlier work).
3. Lung volumes were determined by the method described byChristie.
Theseobservations were repeated at monthly intervals throughout the growth period,and the various physiologic changes noted. These findings were now contrastedwith the physiologic changes noted in experiments carried out simultaneously onadult animals. Inasmuch as these strain experiments measure thecardio-respiratory reserve, it is hoped that this work will clearly show theinfluence of the growth factor on compensatory return of function followingtotal pneumo-nectomy.
Tuesday Morning,June 1, 1937
9:00 a. m.
11. Cine-FluorographicStudies of Thoracic Diseases.
William H. Stewart and(by invitation)
F. H. Ghiselin, NewYork, N. Y.
Abst.� By cinefluorography is meant the making of a motion picture record of the image seenon the fluoroscopic screen.
Thedifficulties surrounding this procedure have been greatly lessened by newdevelopments in apparatus recently made available which include a modern lensof the strength of 0.85, a fluoroscopic screen of great intensity and an x-raytube which will sustain a heavy current of 100 K. V. at 125 milliamperes. Allthese requisites are subservient to an extremely fast film which has now beenobtained.
Theadvantages of the method are that moving organs may be intensively studied atleisure as long as desired without undue exposure of the patient or theoperator to the x-ray. It is relatively inexpensive and uncomplicated andfurnishes a good library for teaching purposes. It is especially valuable inall lesions above the diaphragm. Comparative films may be made which can besent any distance for inspection.
12. Carcinomaof the Esophagus: A Report of theSuccessful Removal in One Case and a Review of the Cases Treated at theUniversity of California Hospital.
Harold Brunn and (by invitation)
H. B. Stephens, SanFrancisco.
Abst.� This paper willinclude the report of a successful operative recovery of a patient sufferingfrom a moderately advanced carcinoma involving the midesophagus. The technic ofTorek was employed. The value of pre-operative pneumothorax, positive pressure,intratracheal anesthesia and the prevention of a contralateral pneumothoraxwill be given proper emphasis, as the authors believe attention to thesefactors will give a greater number of operative recoveries.
Thecases treated in the past ten years by the thoracic surgical group at theUniversity of California Hospital will be presented. This review will includethe operability of the tumor, reasons for surgical failure, and the variousmethods employed in the application of radium in those cases consideredinoperable.
13. TheSuccessful Treatment of Carcinoma of the Esophagus by Means of SurgicalDiathermy.
Herman J. Moersch, Rochester,Minnesota.
Abst.� A case ofsquamous-cell carcinoma of the esophagus affecting a man sixty-eight years oldis reported. The growth was destroyed by means of surgical diathermy in 1935.The patient is alive and well, with no evidence of local or metastaticrecurrence of the growth. He is able to eat everything without difficulty andhas gained 21 pounds.
14. TheManagement of Teratoid Tumors of the Chest.
Stuart W. Harrington, Rochester,Minnesota.
Moving picture demonstration.
15. TheAugmentation of Collateral Coronary Circulation by Operation.
C. S. Beck and(by invitation)
F. R. Mautz andA. R. Moritz, Cleveland.
Abst.� In the normalheart abundant anastomoses exist between the major branches of the coronaryarteries. There are . also communications at the base of the heart betweencoronary arteries and extracoronary arteries. There is considerable naturalvariation in the degree of such anastomosis, but functionally the coronaryarteries are end arteries.
As aresult of chronic progressive obstruction of Coronary arteries theintercoronary and extracoronary anastomoses enlarge. Symptoms of coronarydisease are interpreted as failure of collateral blood supply to compensate forthe disease.
TheBeck operation is designed to improve the collateral coronary circulation incoronary disease. The mechanisms by which this may occur are:
1. Development ofnew intercoronary anastomoses to aid in the redistribution of blood in themyocardium.
2. Development of new extracoronaryanastomoses to increase the total blood supply of the heart.
3. Increase in caliber of existingintercoronary and extracoronary anastomoses by the hyperemia and tissuereaction.
16. TuberculousConstrictive Pericarditis. Report of Cases Treated by Pericardectomy.
AlfredBlalock and (by invitation) Sanford E. Levy,
Nashville, Tennessee.
Abst.� Nineteen patientswith chronic constrictive pericarditis have been studied. The disease wasbelieved to be tuberculous in origin in sixteen and was proven to be inthirteen. Pericardectomy was performed in twelve of the nineteen patients. Ofthe twelve cases, tuberculosis was proven in eight and was believed to be theetiological agent in another. The indications for operation, the results andthe prognosis are considered.
12:30 p. m. Luncheon.Ray Brook Sanatorium.
Tuesday Afternoon,June 1, 1937
2:00 p. m. ExecutiveSession.
3:30 p. m. ScientificSession.
Presidential Address.
Leo Eloesser, San Francisco.
BronchostenoticCavities and Other Closed Foci of Tuberculous Suppuration in the Lung.
17. SitusInversus, Bronchiectasis and Chronic Sinusitis.
Ralph Adams (by invitation) and Edward D. Churchill,
Boston.
Abst.� Scattered notes inthe German literature record the coincidence of bronchiectasis, sinusitis andsitus inversus. Six cases of this syndrome are presented. The frequency withwhich this association occurs in the hospital population is statisticallyentirely beyond the possibility of mere chance. Embryologic theories as to thecause of situs inversus suggest that the bronchiectasis may be due toassociated maldevelopment.
18. AnAppraisal of Closed Intrapleural Pneumonolysis in Pulmonary Tuberculosis.
E. C. Drash, University,Va.
Abst.� Based on over twohundred personal cases and a survey of the literature with particular respectto the optimum time for operation and choice of patients. Criteria forselection of this procedure, rather than some other type of operation.
Studyof several cases of tuberculous empyema. Possible explanation of occurrence oftuberculous empyema in cases in which lung tissue was definitely not injured atthe time of operation.
Discussionof other complications�haemorrhage.
19. ATwo Stage Operation for Total Pneumonec-tomy, Demonstrating a New Technique forClosure of the Bronchus.
William F. Rienhoff, Jr., Baltimore,Maryland.
Abst.� Thetotal removal of the right and left lung in two stages is described togetherwith the new method of closure of the primary bronchi. The technique describedpermits of removal of the lower end of the trachea as well. Particularly usefulin very high growths that otherwise would prove inoperable. Emphasis is placedon dissection of the lymphatic glands.
7:30 p. m. AnnualDinner. Hotel Saranac.
Wednesday Morning,June 2, 1937
9:00 a.m.
20. Sterilizationof the Air in the Operative Region withBactericidal Radiant energy.
Deryl Hart, Durham, North Carolina.
Abst.� This studycompares the results obtained in 110 thoracoplasties performed withoutsterilization of the air in the operative field with over 100 similaroperations performed in a field of sterilized air. The comparison covers thenumber of infections, severity of infections, the postoperative temperatureelevation and duration, and the general reaction of the patient.
21. Experiencewith Collapse Therapy for Pulmonary Tuberculosisin the Fifth and Sixth Decades.
H. R. Decker, Pittsburgh,Pa.
Abst.� The paper is basedon the experience of treating cases by means of artificial pneumothorax,thoracoplasty, phrenic nerve operations, and extrapleural pneumolysis. Some 200patients in the fifth and sixth decades have been so treated.
22. PartialThoracoplasty for Pulmonary Tuberculosis: With a Suggested Plan of Operationincluding Preliminary Anterior Chondrectomy, Together with a Review of Results.
Owen H. Wangensteen andHerbert A. Carlson,
Minneapolis, Minnesota.
Abst.� The importantlesion in tuberculosis necessitating the performance of compression-types ofoperation is almost invariably in the upper lobe. The operative attack of thesurgeon should be directed upon the dome of the bony cage of the chest wall.
In thefirst stage in the operative procedure, the writer,, remove the costalcartilages of the upper four ribs. Ten days later, usually complete removal ofthe upper three ribs is done. The previous excision of the upper costalcartilages facilitates considerably complete rib removal from behind. SinceSemb described extra fascial apicolysis, this procedure is also done at thetime of the first posterior operation in suitable cases. Again two to threeweeks later, complete excision of the fourth and subtotal removal of the fifthand sixth ribs are done.
Thistype of operation is apparently much more readily borne by the patient than thecomplete thoracoplasty and the operative collapse more effectual than in theusual Wilms-Sauerbruch or Brauer thoracoplasty. The experiences of the writerswith the method will be reported together with a resume of the resultsobtained.
23. Managementof the Excessively Mobile Mediastinum in the Surgical Collapse of TuberculosisPulmonary Cavities.
B. P. Potter, Secaucus,N. J.
Abst.� The paper dealswith a study of 60 cases in which the mediastinum was fixed by artificialmethods either during the course of pneumothorax or prior to thoracoplasty. Thestudies have been conducted for the past S years and there has been a follow-upof from 2 to 5 years.
24. Studiesof Tuberculous Empyemata Based on 150 PersonalCases.
Pol N. Coryllos, New York, N.Y.
25. TheEffect of Phrenic Nerve Interruption on the Gastro-IntestinalTract.
Fred R. Harper, Tucson,Arizona.
(By Invitation)
Abst.� Following phrenicnerve interruption, gastro-intestinal disturbances of varying degree occur in ahigh percentage of cases. The syndrome following paralysis of the lefthemidiaphragm is characterized by loss of appetite, feeling of fullness,nausea, and vomiting. The syndrome following paralysis of the righthemidiaphragm differs in that it is characterized primarily by pain in theright upper quadrant. Roentgenograms taken before and after phrenicinterruption show anatomical changes in the abdominal viscera of sufficientdegree to explain the symptoms. Temporary phrenic interruption is advised inpreference to permanent phrenic exeresis because in all of the observed casesthe symptoms did not persist after the function of the diaphragm returned. Ifthe possibility of gastro-intestinal symptoms following phrenic nerveinterruption is kept in mind, unnecessary concern over the patients condition,and even useless operations, may be avoided.
12:30 p.m. Luncheon.N. V. A. Sanatorium.
2:00 p. m. TownHall. Presentations by Physicians of Saranac Lake.
A Review of the Results of the Treatment of TuberculousEmpyema.
W. W. Woodruff.
The Virulence of the Tubercle Bacillus Destroyed by theAction of the B. Macerans and the L. Pentoaceticus.
H. A. Bray. JosephKurung.
The Importance of Determining the Vitamin C Content inFruits and Vegetables in the Treatment of Intestinal Tuberculosis.
Mack McConkey.
The Lymphatics of the Pleura in Relation to Cold Abscessesof the Chest Wall.
Hugh E. Burke.
Immediate and late results of Hygienic-Dietetic Treatmentof Pulmonary Tuberculosis.
Homer L. Sampson. Fred H.Heise.
Venous Pressure in Collapse Therapy and other Complicationsof Pulmonary Tuberculosis.
John Steidl.
