Friday Morning, July 7, 1939

9:00 a. m. Scientific Session.

16. A Comparative Report on Infection of Thoracoplasty Wounds: Experience with the Ultra-Violet Irradiation of Operating Room Air.

Richard H. Overholt and (by invitation)

Reeve H. Betts, Boston, Massachusetts.

Abst. The report is based on the study of two large series of thoracoplasty cases in one of which ultra-violet irradiation of the operating room air was used. In this group with irradiated air the incidence of wound infection was found to be definitely lower than in the control group.

17. Polypoid Bronchial Tumors.

H. Brodie Stephens and (by invitation)

Alfred Goldman, San Francisco, California.

Abst. This paper is a general consideration of polypoid bronchial tumors; an attempt to classify according to their life history, growth potentialities and histological characteristics those tumors which project into bronchi visible through the bronchoscope.

In particular, bronchial adenomata are distinguished on the one hand from metastasizing carcinomatous polypoid tumors; on the other from benign polypoid tumors endowed with the least growth potentialities, namely, fibromata, papillomata, lipomata, ecchondromata, etc.

Difficulties in making diagnoses, both clinical and histological, are described. The clinical management of bronchial adenomata is presented together with clinical and pathological evidence supporting our views. Indications for Sronchoscopic removal, lobectomy and pneumonectomy are based upon these findings in seventeen previously unreported cases from the University of California and San Francisco Hospital Thoracic Surgi­cal Services. The histories of these seventeen patients illustrate the interesting manifestations and various treatments of the disease.

18. The Diagnosis and Surgical Therapy of Patent Ductus Arteriosus.

John C. Jones, F. S. Dolley and (by invitation)

Lewis T. Bullock, Los Angeles, California.

Abst. A detailed discussion of the diagnosis of ductus arteriosus will be presented, along with pulse pressure tracings and electrocardiographic studies. The surgical technique of ligation of the patent ductus arteriosus will be discussed, and a series of cases recently operated upon will likewise be presented.

19. Operation for Development of Collateral Circula-lation to the Heart.

Peter Heinbecker and (by invitation)

Wesley A. Barton, St. Louis, Missouri.

Abst. The report describes an experimental study in dogs of an operative procedure for the development of collateral circulation to the myocardium. It consists of the production of a sterile adhesive pericarditis by the use of aleuronat plus 1/2 of 1 per cent sodium morrhuate or, carborundum dust plus 1/2 of 1 per cent sodium morrhuate. The two pericardial surfaces are first desensitized by the injection into the pericardial cavity of a small amount of 2 per cent novocaine. The materials used to produce the pericarditis are inserted into the pericardial cavity through a small opening in its anterior surface. The opening is then closed and the parietal pericardium is sewed to the retrosternal tissues. Observations made at periods from 3 weeks to 16 weeks after the operation demonstrate that it results in a rich collateral circulation to the myocardium derived chiefly from the branches of the internal mammary arteries. The procedure is considered applicable to human cases of myocardial ischaemia resulting from a variety of well known causes.

20. Dorsal Sympathetic Ganglionectomy for Intractable Asthma.

Duane Carr, Memphis, Tennessee.

Abst. The control of otherwise intractable asthma has been attempted surgically by various types of attack upon the autonomic nervous system. Levin contends that by interrupting either the afferent or efferent fibers of the reflex arc the spasm of the bronchi and bronchioles may be eliminated. Three cases are reported in which a bilateral resection of the third and fourth dorsal sympathetic ganglia was performed, two of them more than two years ago. The favorable results in these two cases lend weight to the assertions of Levin and others.

The apparent failure in the third and more recent case suggests that the "trigger" area is not always in the bronchial mucosa.

The slightly modified operation described gives ready access to the sympathetic ganglia by the extrapleural approach, a clear view of all connecting fibers, and has been performed with local anesthesia without shock or respiratory embarrassment.

Friday Afternoon, July 7, 1939

2:00 p. m. Scientific Session.

21. Large Infected Pulmonary Cysts Simulating Empyema.

Herman C. Maier, New York, New York.

Cameron Haight, Ann Arbor, Michigan.

Abst. Although cystic disease of the lung is now being recognized with greatly increased frequency, large infected solitary pulmonary cysts are frequently incorrectly diagnosed both clinically and roentgenologically. The large infected cysts are often treated as encapsulated empyemas. The true nature of the lesion is sometimes not recognized at the time of drainage of the purulent contents, and only after the cavity persists in spite of adequate drainage may suspicion be aroused that one is dealing with a pulmonary cyst.

Three cases with large infected solitary pulmonary cysts are presented. The cases illustrate various points in differential diagnosis and therapy. Features of the pathology of pulmonary cysts which influence treatment are considered. After drainage of the purulent contents of the cyst, two of the three cases herewith reported were treated successfully by lobectomy and the third case by enucleation of the cyst wall. The indications for radical surgery are discussed.

22. Acute Putrid Abscess of the Lung.

Harold Neuhof and Arthur Touroff,

New York, New York.

Abst. A survey of more than eighty-four cases of acute putrid lung abscess which have been operated upon is given with reference to operative indications, operative pathology, the one stage operation, and the results of operation. The results will be considered from the viewpoint of mortality (three deaths in eighty-four cases), morbidity, immediate results and end results.

23. Joint Manifestations Associated with Lung Tumors.

Willard Van Hazel, Chicago, Illinois.

Abst. Clubbing of the fingers is common in suppurative diseases of the chest. However, arthritic changes sometimes accompany the presence of intrathoracic tumors. These manifestations have been seen to be the initial symptom on several occasions. In two instances complete disappearance of symptoms followed a pneumonectomy for bronchiogenic carcinoma, in one case, and the removal of a large intrathoracic fibroma in the other.