Friday Morning, June 7, 1940

AUDITORIUM

MEDICAL LIBRARY ASSOCIATION

9:00 a. m. Business Session.

9:30 a. m. Scientific Session.

1. Extrapleural Pneumonolysis.

E. C. Janes and (by invitation) D. B. Aitchison,

and A. Forsberg, Hamilton, Ont., Canada.

Abst. The paper deals with the operative technique, postoperative care, complications and end results as computed from a study of seventy cases performed at the Mountain Sanatorium since November 17, 1937. The subject is introduced by a short historical note, with references. This is followed by a description of the operative technique and the after-care employed. Special reference is made to our use of a Carrol-Dakin preparation, because of unfortunate complications in some of our first cases. These included clotting with subsequent obliteration and secondary infection. The instillation of this mild antiseptic solution before closure and its postoperative manipulation is dealt with, as well as other measures to insure an adequate and efficient collapse. One reoperation and one case of bilateral extrapleural collapse is mentioned. The use of oleothorax in maintaining a permanent collapse is also discussed. Complications and their method of control are reviewed. These include, secondary infection, tuberculous empyema, bloody effusion, bronchial fistula, surgical emphysema, perforation of an unsuspected partial pleural space, con-tralateral spontaneous intrapleural pneumothorax, the tendency to obliteration of the space, cerbral embolism and right heart failure.

The indications are listed including certain advantages in picked cases over pre-existing choices of treatment. Its use to prepare a very ill patient for more drastic surgery is pointed out. Contraindications are listed with a short reference to the use of planigraph x-rays in the selection of cases.

A table of results is included, which reveals a gratifying-percentage of cavity closures. Illustrative diagrams and x-ray reductions are also included.

2. Extrapleural Pneumonolysis in Artificial Pneu-mothorax. A report of twenty-eight cases.

John S. Harter and Allen A. Lilienthal

(by invitation), Sanatorium, Mississippi.

Abst. The paper reports on twenty-eight cases of tuberculosis on whom pneumothorax was started. The pneumo-thoraces were not effective due to adhesions, the adhesions being of a type that could not be severed by the closed method or the open method of pneumonolysis, in most cases because of symphysis of the pleura. The first of these was operated on in February, 1939. Twenty-six of the patients had bilateral disease. The operation consists of a parascapular incision, a portion of one rib being removed, the rib selected being in closest proximity to the adhesions. The parietal pleura is separated from the chest wall in the region of the adhesion and the pleura opened and cut around so as to leave parietal pleura attached to the free adhesion. The removal of the pleura around the adhesion transforms a small extrapleural pneumothorax into a complete intrapleural pneumothorax, of course leaving an area of the chest wall denuded of parietal pleura. The anas-thesia used was ether induced with cyclopropane. The operation has been successful in twenty-seven cases in obtaining an effective pneumothorax. In spite of the fact that in half of these cases the procedure was carried out as a last resort in saving the patient, only one has died. In our opinion the operation is useful in obtaining an effective pneumothorax in a small group of patients with ineffective pneumothorax, due to adhesions that cannot be severed by the usual methods and who either do not need thoracoplasty or are too sick to consider for thoracoplasty.

Discussion to be opened by E. J. O'Brien,

Detroit, Michigan.

3. Bronchospirography.

(1) A new bronchospirographic catheter and the technique of intubation.

William A. Zavod (by invitation), New York City.

Abst. A double-channeled rubber catheter for intrabronchial intubation is described. When properly intubated, it permits accurate measurement of the respired air, gaseous analysis of the expired air and thus the physiological and pathologico-physiological function of each lung separately. The technique for intubation is given in detail and the causes of failure are discussed. The contraindications to bronchospirometry are listed. The technical experience gained in over sixty intubations is analysed.

(2) Application to Collapse Therapy.

George Leiner (by imitation), Max Pinner and

William A. Zavod (by invitation), New York City

Abst. With the aid of Dr. Zavod's soft-rubber bronchial catheter, bronchospirographic observations were made on patients with pulmonary tuberculosis. One group was examined only once in an effort to gain additional information for indication and contraindication for collapse therapy.

In another group the studies were done before and after collapse therapy, in order to show the functional changes caused by certain forms of collapse therapy.

It seems particularly important to point out that neither clinical nor roentgenological findings are reliable indices of the functional capacity of the lung and that broncho-spirographic records sometimes confirm, but frequently correct the impression gained by other methods of observation.

Bronchospirographic observations add significant data to the mechanism of compensation following pulmonary collapse.

Discussion to be opened by Samuel O. Freedlander,

Cleveland, Ohio.

4. Rest and Collapse in Pulmonary Tuberculosis.

David Salkin and A. V. Cadden (by invitation),

Hopemont, West Virginia.

Abst. A. Proposed New Classification of Pulmonary Tuberculosis

(1) On admission

(2) On discharge

Discussion of the faults of the present N.T.A. classification and the need for a more thorough one.

B. Using the proposed system, 3204 cases have been studied very thoroughly to evaluate three different programs of therapy.

(1) Mild activity program-556 cases

(2) Strict bed rest program-886 cases

(3) Collapse therapy program-1762 cases Discussion of the selection of the material, analysis of each type of therapy, use of strict bed rest as a standard by which to measure other treatments, inferred newer indications and contraindications.

Discussion to be opened by Emil Bogen (by invitation),

Olive View, California, and John N. Hayes,

Saranac Lake, N. Y.

1:15 p. m. Luncheon-University Hospital

(Harvey House Dining Room)

Friday Afternoon Session

June 7, 1940

AUDITORIUM

MEDICAL LIBRARY ASSOCIATION

2:00 p. m. Executive Session.

3 :00 p. m. Presidential Address.

Adrian V. S. Lambert, New York City.

6. Angina Pectoris.

Peter Heinbecker, St. Louis, Missouri.

Abst. The presentation will cover a general review of our knowledge of the mechanism of painful sensations and in particular those arising in the heart. Much of the evidence to be presented has been derived from the results of original investigations. An evaluation of some of the surgical procedures advocated for relief from angina pectoris will be made.

Discussion to be opened by Claude S. Beck,

Cleveland, Ohio.

7. The Surgical Treatment of Patent Ductus Arteriosus Complicated by Subacute Bacterial Endocarditis.

Arthur S. W. Touroff, New York City.

Abst. Four cases of patent ductus arteriosus complicated by subacute bacterial endocarditis have been subjected to operation. The first patient has been free from all evidence of the original lesions for more than three months. Two died from hemorrhage, and the fourth has been improved. A discussion of the problem will be given.

Discussion to be opened by John W. Strieder,

Boston, Mass.

Exhibits, Films, Demonstrations:

8. A Mechanism for Intermittent Pulmonary Insufflation in Thoracic Surgery.

Frederick R. Mautz, Cleveland, Ohio.

9. Exhibit of experimental work on the heart.

Claude S. Beck, Cleveland, Ohio.

10. Cine-roentgenographic Studies of the Pulmonary Circulation, the Chambers of the Heart, and the Greater Blood Vessels, in Health and Disease.

W. H. Stewart, H. C. Maier, C. W. Breimer

(by invitation), New York City.

8:00 p. m. Annual Dinner-Wade Park Manor.