ROYAL YORK HOTEL

9:00 a. m. Scientific Session.

14. Surgical Significance of Metastasis in Primary Carcinoma of Lung: Report of Two Cases with Unusual Site of Metastasis.

Alton Ochsner and Michael E. BeBakey,

New Orleans, Louisiana.

Abst. At present, primary carcinoma of the lung has a high incidence of metastasis at the time that the diagnosis is made. On the other hand, a large number of these lesions are characterized by late and limited metastasis. For this reason the incidence of operability can be increased. The means of accomplishing this are emphasized. The various methods of metastasis and their relative significance are discussed. The frequency of the various sites of metastasis is presented, based upon an analysis of collected cases. The clinical considerations of metastasis from the standpoint of manifestation, diagnosis, and surgical significances are discussed. Two cases are reported which, several months following pneumonectomy, developed metastasis in the sentinel axillary node. The routes of extension to this area are discussed.

15. A Topographic Classification of Cancer of the Lung with Special Reference to the Surgical Implications of the Circumscribed Variety.

Harold Neuhof, and (by invitation), Coleman B.

Rabin and Irving A. Sarot, New York City.

Abst. Carcinoma of the lung on the basis of topographic features was the subject of a communication presented before the American Association for Thoracic Surgery in 1934. That study was based upon an examination of 250 cases in various stages of the disease with about 100 autopsies. A classification into non-circumscribed and circumscribed tumors was made on topography and not on microscopic features. The diffuse neoplasms were found to arise preponderantly from main bronchi and also in smaller proportion of cases from branch bronchi. The circumscribed tumors were of two varieties: (1) Branch bronchus tumors which spread outwards into the periphery (peripheral carcinomata), and (2) tumors which were more or less sharply circumscribed within the substance of the lung (without demonstrable bronchial origin on gross examination). In the non-circumscribed group, early regional lymph node invasion was common. In the circumscribed group, it was rare. Since that publication, many additional cases have been studied. In particular, there has been the study of a considerable number of specimens removed at operation, or in others, autopsies performed shortly after exploratory or radical operation. As a result of these studies there is now evidence that in not a few instances main bronchus cancers are not characterized by early regional node involvement. On the other hand, there is additional evidence that the circumscribed cancers comprise an important group (about 25 per cent of all cases) in which regional lymph node involvement is usually limited or absent even when these tumors attain a large size. Such tumors, therefore, comprise fundamentally a particularly favorable group for surgical eradication. There are discussed the basis for the diagnosis of the circumscribed variety of cancer and the operative procedures for its eradication.

16. Pneumonectomy for Carcinoma of the Lung.

Stuart W. Harrington, Rochester, Minnesota.

17. Experiences in Total Pneumonectomy.

Norman S. Shenstone (by imitation),

Toronto, Ontario, Canada.

Abst. A presentation of the results of operations for carcinoma, adenoma and inflammatory conditions of the lung performed at the Toronto General Hospital during the past four years with a description of the method used in dealing with the hilar structures.

18. Pulmonary Function after Pneumonectomy in Children.

Charles W. Lester, and (by invitation), Andre

Cournand and Robert L. Riley, New York City.

Abst. Four children who underwent pneumonectomies for infection were studied one and a half to three and a half years after operation. The ages of the children varied from six to fourteen years at the time of operation. Observation by the usual clinical methods including X-ray bronchogram and bronchoscopic examination supplemented in one instance by secondary operation showed that the shifted heart and mediastinum had permitted the remaining lung to extend into the contralateral hemithorax. Pulmonary function was studied for lung volume, maximum breathing capacity and respiratory gas exchange under conditions of rest, moderate exercise and exhausting exercise. In addition normal children of the corresponding age groups were studied for the purpose of establishing normal values for comparison. The studies show that in the single remaining lung no emphysema had developed, that lung volume and maximum breathing capacity were above normal for one lung and that gas exchange was efficiently managed. This would seem to indicate that in these children at this time compensatory growth had taken place in that lung.

Tuesday Afternoon, June 10, 1941

ROYAL YORK HOTEL

2:00 p. m. Executive Session.

3:00 p. m. Presidential Address: Pulmonary Abscess.

Fraser B. Gurd, Montreal, Quebec, Canada.

19. Pulmonary Abscess.

Robert R. Shaw, Dallas, Texas.

20. Chronic Non-tuberculous Thoracic Empyema.

Albert O. Singleton, and (by invitation),

Robert M. Moore, Galveston, Texas.

Abst. This represents a study of 200 consecutive cases of thoracic empyema treated in the Surgical Service of the John Sealy Hospital, the teaching hospital of the Medical Department of the University of Texas. 170 of these cases were treated in the primary stage by us, 6 of which resulted in chronic empyema. 28 other chronic cases were treated primarily elsewhere. The 170 acute cases were all drained by trocar and cannula, a method of closed drainage. The paper deals more particularly with a detailed study of the 28 chronic empyema cases with special reference to the etiology and the method of treatment used. Of the 28 cases, 23 were cured and 5 died.

We have gone into the etiology of chronic empyema and given a detailed report of our experience in the treatment of this condition, with a review of the various procedures which have been reported by others and those which have been most successful in our hands. While we have not been able to formulate a definite plan of treatment for this condition in general, our experience has taught us some important points in regard to the course of procedure in a majority of them. We have emphasized the serious problem involved and the importance of treating each individual case as a separate problem, keeping in mind the various procedures which may be advised in certain particular cases. We have also reported and discussed in detail the deformities of the skeleton resulting from chronic empyema in children.

21. Surgery of the Chest in War.

A. L. Lockwood, Toronto, Ontario, Canada.

Abst. A summary of the author's experiences in the last World War is combined with a resume of recent experiences of others in China, Spain and the present World War. A consideration of the need for protective chest armour will be discussed. The case of a man carrying a rifle bullet embedded in his heart since 1916 will be presented.

7:30 p. m. Annual Dinner-Royal York Hotel.

Address: Aviation Medicine.

Wing Commander G. E. Hall, R. C. A. F.