Wednesday Afternoon, March 30, 1949

2:00 P.M. Executive Session.

3:00 P.M. Scientific Session.

Address of the President-Edward D. Churchill, M.D.,

Boston, Mass.

18. Mediastinal "Tuberculoma"-Surgical Removal in Four Patients.

Paul C. Samson, M.D., David J. Dugan, M.D., Oakland, Calif.,

and (by invitation) Brig. Gen. Leonard Heaton, U.S.A.

The scarcity of information in the literature concerning tuberculomas of the mediastinum prompts this report. Four patients have been subjected to surgery. The correct diagnosis was unsuspected in all prior to exploration. Various preoperative diagnoses were entertained: dermoid tumor; bronchiogenic cyst; intrapulmonary cyst; aneurysm. One patient was asymptomatic. In the others, symptoms ranged from vague thoracic discomfort to severe cough and dyspnea because of partial tracheal obstruction.

The tuberculin test was repeatedly negative in one patient and was positive only in 1-100 dilution in another. Tubercle bacilli were not recovered from any of the specimens. Pathologically, there were caseation, epithelioid tissue and multinucleated giant cells.

The discussion will include consideration of certain problems. 1. Are these "tumors" always due to tuberculous infection or may other organisms cause the pathological picture? 2. What steps may be taken preoperatively to establish more certainly a diagnosis of "Tuberculoma"? 3. When exploratory operation in a patient without symptoms reveals a caseo-granulomatous mass, should it be removed?

19. Pneumonectomy Followed by Immediate Thoracoplasty.

H. L. Skinner, M.D., Medical Director, USPHS,

New York, N. Y. (by invitation)

Pulmonary resection is rapidly assuming its proper place in the treatment of pulmonary tuberculosis. Amazing progress has been made in this field of surgery but certain complications arise from time to time which happens in any new, radical procedure. In order to circumvent these complications it has become routine practice in most thoracic clinics to follow pneumonectomy by one or two stages of thoracoplasty.

It is our opinion that it is still better to do a thoracoplasty immediately following pneumonectomy in certain selected cases. In doing the thoracoplasty the transverse processes and posterior rib stumps are not resected. The first rib is left in place and occasionally the second is left in place. We have been particularly impressed with the benign postoperative course. Report of cases with lantern slides demonstration. The procedure has the following advantages:

1. Necessity of only one operation.

2. Prompt obliteration of pleural cavity to lessen the danger of bronchial fistula and empyema.

3. Mediastinal displacements are avoided.

4. A more effective coughing mechanism is present in the immediate postoperative period.

20. Funnel Chest and Allied Thoracic Cage Deformities.

Charles W. Lester, M.D., New York, N. Y.

A congenital shortening of the anteroposterior measurements of the diaphragm commonly produces a funnel chest deformity but may also produce other deformities of the thoracic cage associated with the funnel deformity or existing separately. These allied deformities consist, for the most part, of abnormal depressions, either unilateral or transverse, or abnormal protrusions of one or more ribs. During the past five years numerous thoracic cage deformities of diaphragmatic origin have been observed and 27 have been operated upon. Modifications of the procedures described by Brown have been employed for the funnel deformities. The others have required individualized operations. This experience has produced certain concepts regarding etiology, selection of cases for surgery, optimum age for operation, type of operation to be employed, complications and results. These are discussed.

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

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