Friday Morning, May 9, 1952

9:00 A.M. Scientific Session.

13. Traumatic Aneurysm of the Thoracic Aorta.

R. K. Hollingsworth and W. Johnston (by invitation),

Martinsburg, West Virginia

Traumatic aneurysm of the thoracic aorta is a rare entity. While traumatic rupture of the aorta, also rare, has a predilection for either of two locations, the first portion or the junction of the arch with the descending aorta, all aneurysms reported have been in the first portion. The longest survival time from the date of injury has been eleven months.

In this communication, four cases of traumatic aneurysm of the distal portion of the arch are reported. In one case, reported in detail, it was possible, by serial X-ray studies, to watch the development of the aneurysm following chest trauma in an auto accident. Treatment was by cellophane wrapping of the aneurysm. The patient is alive and well two years later with no further change in size of the aneurysm. The second case is alive and well seven years following trauma, also an auto accident. No specific therapy was given to this patient. Proof of the traumatic nature of the lesion is present in a pre-injury X-ray of the chest. The third and fourth cases are likewise of interest.

A review of the literature and a discussion of the mechanism of the factors involved in the production of this lesion are included.

In view of the ever increasing incidence of accidents of violence, it is felt that by calling the attention of the profession to this entity, more cases may be diagnosed while some surgical therapy is still possible.

14. Healing of Extensive Cardiac Wounds.

C. G. Thomas, Jr. (by invitation), Chapel Hill, N. C., and

S. E. Ziffren (by invitation), Iowa City, Iowa

The consequences of carrying out extensive incisions and partial excisions of the left ventricular wall were studied in a series of dogs. Following incisions and excisions of the entire thickness of the cardiac wall, periodic observations were made over a four-year interval. Particular attention was directed toward the incidence and prevention of wound dehisccnce, development of mural thrombi and emboli, constructive pericarditis, and aneurysm. In general, healing followed a definite pattern depending upon the type of incision, characteristics of the myocardium, method of closure, and the elapse of time. Conclusions as to the optimum methods to minimize morbidity and mortality will be presented. The findings will be illustrative by photographs and photomicrographs.

15. Traumatic Hemopericardium and Constrictive Pericarditis.

Johann L. Ehrenhaft and Rodman E. Taber, Iowa City, Iowa

The occurrence of hemopericardium due to nonpenetrating trauma has been recognized. Occasional case reports have appeared in the literature. The development of constrictive pericarditis as a late sequella of unrelieved hemopericardium is discussed. A case with extensive pre-operative and postoperative cardiovascular studies to illustrate this point is presented.

Attempts to produce constrictive pericarditis in dog experiments are reported. These were carried out by injection of homologous blood and lipid extract of dog blood into the pericardial sac.

16. Rupture of the Esophagus.

Robert A. Anderson (by invitation), Tulsa, Oklahoma, and

George M. Curtis, Columbus, Ohio

This paper is concerned largely with so-called "spontaneous" rupture of the esophagus. The etiology, pathology, symptomatology, diagnosis and treatment of this condition are discussed.

It is suggested that the term "spontaneous" as applied to these cases is a misnomer in many of the cases because of the fact that by definition the rupture is not spontaneous and the cause of the rupture is apparent. It is emphasized that the findings in most of these cases are typical and that the diagnosis is usually made without too much difficulty if the condition is considered. A diagnostic triad that was first suggested by Barrett in his original paper is again emphasized.

As a result of our experience, it is felt that the treatment of choice for this condition is immediate thoracotomy with closure of the perforation. While there may be some disagreement on this point, a consideration of the pathology and physiology, together with the good clinical results after immediate operation will substantiate the fact that immediate thoracotomy will definitely reduce mortality and morbidity. A review of the more recent cases reported shows that nine out of the last twelve cases reported have survived. Two of the deaths were in cases where early operation was not carried out.

Four cases of rupture of the esophagus are reported and discussed. These cases underwent thoracotomy with repair of the perforation. All survived.

17. The Effects of Atelectasis on Pulmonary Arterial Blood Flow in Dogs.

Richard M. Peters (by invitation) and Albert Roos

(by invitation), St. Louis, Mo.

In a series of acute and chronic experiments the blood flow through atelectatic lungs was studied. In one group of dogs the right or left main stem bronchus was transected and sutured. From one day to six months after operation oxygen content and saturation of left and right heart blood were determined and from these values the percentage flow to each lung calculated by application of the Fick principle. On some of the dogs intravenous angiograms were done at periods of from four to six months after operation. Significant and consistent reductions to 40-10% of original flow occur as early as 24 hours after ligation.

In a second group of dogs the acute effects of atelectasis in the open chest after oxygen breathing were studied. Calculations similar to those in the first group showed reduction to 40-0% of original flow occurs in 30-120 minutes. Pulmonary artery pressure showed no significant change from the control level.

18. Surgical Management of Pulmonary Emphysema.

Gerald L. Crenshaw (by invitation) and Donald F. Rowles

(by invitation), Oakland, Calif.

This is a preliminary report of 14 surgically managed cases of pulmonary emphysema. Thoracotomy was performed for the purpose of supplying secondary nutrient blood through collaterals to the anemic emphysematous lung, which was accomplished by parietal pleurectomy and ploudrage. In some cases complete dencrvation and resection of bullae, blebs, and degenerated lung were also done.

A brief resume is given of the etiology, pathology, and routine management of pulmonary emphysema.

It has been noted in previous observations that there is an absence of emphysema in areas of lung where vascular adhesions have been present. In certain cases of tetralogy of Fallot life has been maintained where extensive parietal parenchymal vascularity has been abundant.

The procedure has been used in patients with far advanced pulmonary emphysema who were marked respiratory cripples. The surgery was tolerated satisfactorily because of positive pressure anesthesia. Clinical improvement has been so striking that only one side of the chest has had such management to date. Pulmonary function studies are presented. One postoperative death has occurred in this series.