Thursday Morning, May 30, 1946

9:00 A.M. Scientific Session.

11. The Use of Curare in Anasthesia for Thoracic Surgery.

H. brodie Stephens and (by invitation)

Phyllis Harroun and Frederick E. beckett,

San Francisco, California.

Curare has been used routinely in patients undergoing intra-thoracic operations at the University of California Hospital since February, 1945. This paralyzing agent because of its temporary action is delivered to the patients at intervals, by intravenous route throughout the operation. Nitrous Oxide and Oxygen are administered intratrachealy to provide the necessary anaesthesia. A report on the use of curare in fifty-six patients who underwent thoracic surgical operations is presented. The patients ranged in age from sixteen months to seventy-two years. The advantages of this type of anaesthesia are threefold:

1. The high frequency cautery unit can be utilized throughout the entire operation.

2. The patients demonstrate little of any physiological change from the normal during operations that averaged five hours and eighteen minutes.

3. The patients are awake and responding consciously when they reach the ward.

The report embodies the technique of administering curare to produce apnoea in thoracic surgical patients anaesthetized with Nitrous Oxide and Oxygen. The type of operations, the condition of the patients during their operations, the postoperative course of the patients are then summarized in appropriate tables. The compiled data has favorably impressed the authors and it is our impression that curare may be generally accepted as a valuable supplement to anaesthesia in thoracic surgery.

12. Surgery of the Thymus in Myasthenia Gravis.

O. T. Clagett, and (by invitation)

L. M. Eaton, Rochester, Minn.

The association of abnormalities of the thymus with myasthenia gravis has been a matter of interest. We have had experience with fourteen cases of thymic tumors in individuals with myasthenia gravis. About fourteen additional thymectomies were performed on individuals with myasthenia gravis who had hyperplasia but no tumors. Complete study of the problem from the standpoint of clinical diagnosis, x-ray diagnosis, pathology, and surgical treatment will be presented, as well as evaluation of the results of surgical treatment of myasthenia gravis.

13. Surgical Lesions of the Esophagus Seen in an Army Thoracic Surgical Center.

Earle B. Kay (by invitation), Memphis, Tenn.

During the past three years over 130 patients with diseases and injuries of the esophagus have been seen at this Army Thoracic Surgery Center. Forty major esophageal operations were performed by the staff with only one operative mortality, an incidence of 2.5 per cent. The treatment of the nonoperative cases is also discussed.

In 11 of the 14 caustic strictures, the caustic was contained in sabotaged alcoholic beverages and consumed accidentally while overseas. There were six patients with undilatable esophageal strictures, four of whom had intrathoracic esophagoplasties and the fifth an antethoratic esophagoplasty. A sixth patient has had a first stage antecutaneous esophagoplasty. One of the intrathoracic esophagoplasties was total, another approximately an inch below the thoracic inlet, and the other two at the level of the aortic arch. The other 19 strictures responded to instrumental dilatation.

There were eight benign intramural esophageal cysts and tumors. Seven of these were excised locally, and the eighth required esophageal resection and esophagogastric anastomosis. Of the five malignant tumors, three were inoperable, and two were treated by resection and esophagogastric anastomosis.

Eleven cardioplasties were performed for cardiospasm. They were completely improved by operation and there was a marked decrease in the caliber of the esophagus postoperatively.

Ten patients had traumatic injuries to the esophagus (war wounds). Eight others had large shell fragments adjacent to the esophagus, two of which had caused localized perforations or diverticuli.

Twenty patients with congenital short esophagi were seen. The complications occurring in this condition are discussed.

14. Technical Problems in Surgical Treatment of Carcinoma of Esophagus and Upper Stomach.

John H. Garlock, New York.

In this paper the author discusses the various technical features concerned with resection of the esophagus and upper stomach. There is described a new abdomino-thoracic approach which simplifies the operation considerably. In addition, some technical changes in the operation of total gastrectomy by the thoracic route are also described.

15. Section of the Vagus Nerves to the Stomach in the Treatment of Peptic Ulcer.

Lester R. Dragstedt, Chicago, Ill. (by invitation)

During the past three years, section of the vagus nerves to the stomach has been performed on 60 patients. The operation has been performed through a transthoracic supra-diaphragmatic approach and by a transabdominal sub-diaphragmatic exposure. Complete division of the vagus nerves to the stomach has been found to produce a marked decrease in the secretion of gastric juice, a marked decrease in the tonus and motility of the stomach, and an immediate and persistent relief of the epigastric pain and distress characteristic of the disease. In addition, objective evidence of healing of the ulcers by means of x-ray or gastroscopic examination has been obtained in almost all cases. The implication of these findings on the concept of peptic ulcer as a psychosomatic disease will be discussed.

16. The Management of Thoracic Surgery in the Hospitals of the Veterans Administration.

Brian Blades, Washington, D. C.

Thursday Afternoon, May 30, 1946

2:00 P.M. Executive Session.

2:30 P.M. Scientific Session.

Presidential Address-The Direct Approach to Cardiovascular Disease.

Claude S. Beck

17. Tetralogy of Fallot: Diagnosis and Indications for Operation.

Helen B. Taussig, Baltimore, Md. (by invitation)

This paper will discuss the diagnosis of the tetralogy of Fallot, the different diagnosis, and give brief mention to other types of malformations ‘which may be amenable to operation, and finally the indication for operation in the various age groups.

18. The Surgical Treatment of the Tetralogy of Fallot.

Alfred Blalock, Baltimore, Md.

Approximately 90 patients with the tetralogy of Fallot have been operated on during the last fifteen months. The surgical technic and the results of operation will be considered.

19. Complications of the Surgery of Patent Ductus Arteriosus.

John Jones, Los Angeles, Calif.

A discussion of the various complications arising in a series of patients operated on for persistent patent ductus arteriosus. This series includes both the ligation of the ductus and the division and suture technique of Gross.

20. "Complete Division of the Patent Ductus Arteriosus."

Robert E. Gross, Boston, Mass.

In a series of 130 cases of surgically treated patent ductus arteriosus, some form of ligation was employed in 43 instances. In about 80 per cent of these the result was perfect, in about 10 per cent the ligature partly cut through and some fistula was re-established, in about 10 per cent the ligature was not tied lightly enough to close off all of the shunt. This experience has led to the development and adoption of a technique for complete division of the ductus, which has now been, carried out in 87 cases. This method of division is discussed in detail and is illustrated with appropriate drawings. Some post-operative observations on these patients are summarized. The complete division of the ductus has been so satisfactory that simple ligation of the vessel has now been completely abandoned.

21. The Surgical Treatment of Coarctation of the Aorta.

Clarence Cratoord, Stockholm, Sweden.

7:00 P.M. Cocktail Party-Statler Hotel.

8:00 P.M. Banquet-Statler Hotel.