Monday Morning, April 24, 1961

8:30 A.M. Business Session (Limited to Members)

Grand Ballroom

8:45 A.M. Scientific Session: REGULAR PROGRAM

Grand Ballroom

1. Traumatic Tracheal Rupture

Robert R. Shaw, Donald L. Paulson, and John L. Kee, Jr.,

Dallas, Tex.

Traumatic tracheal rupture due chiefly to sharply localized blunt trauma to the upper anterior chest and neck is being recognized with increasing frequency. Experience with 13 such patients is reported. The problems presented by reconstruction of the airway when stenosis of the trachea results from faulty healing or delayed reconstruction of an unrepaired tracheal rupture are discussed The advantages of immediate surgical repair of the torn trachea in preventing stenosis, preserving a normal voice, and eliminating a prolonged period of invalidism are stressed.

2. The Surgical Management of Metastatic Neoplasms in the Lung

Earle W. Wilkins, Jr., John F. Burke (by invitation),

and John M. Head (by invitation), Boston, Mass.

In the years between 1933-1960, 67 patients have undergone surgical excision of metastatic pulmonary disease. The majority of these have been primary in the colon or kidney, but origins in various other organs are recognized. Survival figures for 100% of these patients indicate a cumulative survival curve not unlike that for primary carcinoma of the lung. The various factors affecting survival are discussed, along with symptomatology, methods of diagnosis, selection of candidates for operation, morbidity, and mortality.

3. Bronchiolar Cell Carcinoma of the Lung: A Review of 33 Patients

Hugh F. Fitzpatrick, Robert E. Miller (by invitation),

Malcolm S. Edgar, Jr. (by invitation), and Charles F. Begg

(by invitation), New York, N. Y.

Since 1953 we have seen 33 patients with bronchiolar cell carcinoma - 11 of them in the past ten months. 60% were asymptomatic There were no consistent physical findings. A chest x-ray is the key to diagnosis. This is not necessarily a diffuse bilateral disease and often there is significant association of chronic inflammation and fibrosis with it. We have 5 patients who are living following lobectomy for 10 to 40 months. Experience with this series will stress the practical aspects of the problem.

4. Routine Use of the Carlens Double-Lumen Endobronchial Catheter: An Experimental and Clinical Study

Robert W. Newman, George E. Finer (by invitation), and

James E. Downs (by invitation), Knoxville, Term.

The Carlens double-lumen endobronchial catheter has been used for all adult pulmonary resections (200 consecutive patients) and certain other intrapleural procedures for the past two years. Laboratory data from experiments on dogs and from 20 clinical cases studied during pulmonary resection are available. The technique employed in the placement of the catheter and in maintenance of ventilation and anesthesia is given. The routine use of the Carlens tube for pulmonary resections offers definite advantages.

5. Complete Functional Restitution of the Food Passage in Extensive Stenosing Caustic Burns

Joseph H. Ogura (by invitation), Charles L. Roper

(by invitation), and Thomas H. Burford, St. Louis, Mo.

Caustic burns involving the upper food passage have long posed insuperable surgical problems. Stenosis of the hypopharynx, cricopharyngeus pinchcock, and esophagus, have usually resulted in the tragedy of permanent gastrostomy. Involvement of the supraglottic structures, by caustic burns, has occasioned serious airway problems, and destruction of the cricopharyngeal pinchcock has limited the superior margin of anastomosis for any type of reconstruction below. Principles in the management of supraglottic and pharyngeal malignancy which preserve laryngeal function and deglutition have been applied to severe burns of the hypopharynx and esophagus. The right colon has been brought up to the pharynx with eminently satisfactory results in a significant series of cases. The technique, cineradiographic studies, and functional results will be presented.

6. Incompetence of the Gastric Cardia without Radiological Evidence of Hiatus Hernia

Clement A. Hiebert (by invitation), and Ronald Belsey

(by invitation), Bristol, England.

A clinical and pathological entity consisting of gastroesophageal reflux in the absence of a radiologically demonstrable hiatus hernia is presented. The symptoms are high epigastric discomfort, regurgitation, dysphagia, heartburn, and back pain. A pathognomonic feature is postural aggravation of symptoms on bending or lying down. Diagnosis is established by the history, plus the finding of a characteristically patulous cardia at esopha-goscopy. Since 1951, 71 cases of this syndrome have been uncovered. 62 have been operated on, with improvement in 58 (93%). The follow-up period ranged from two months to eight years Only 4% are unaccounted for. The complications of the untreated condition are those of gastroesophageal reflux. Surgical treatment consists of restoring competency to the hiatal closing mechanism. Since chronic gastrointestinal symptoms not explained by x-rays or blood chemistries are apt to be labelled "functional", awarenesss of the existence of this lesion is of importance.