Tuesday Afternoon, March 30, 1965
2:00 P.M. Executive Session (Limited to Active and
Senior Members) International Room
3:00 P.M. Scientific
Session: REGULAR PROGRAM
International Room
Address by the President
John C. Jones, Los
Angeles
Address by Honored Guest
Dr. A. Gerard Brom
Professor in Thoracic Surgery
University Hospital, Leiden
"Narrowing of the Aortic Isthmus and
Enlargement of the Mind"
28. Tracheal and Tracheobronchial Resections: Technic and Results (20
Cases)
J. Mathey*, J. P. Binet*, J. J. Galey*, C. Evrard*,
G. Lemoine*, and B. Denis*, Paris, France
Sponsored by O. Theron Clagett
This communication reports on 20 cases of tracheal and
tracheobronchial resections. The study period extends from 1951 until 1964. In
16 cases, annular resection was elected and repair completed by end to end
tracheal or bronchotracheal anastomosis. Four technical points are emphasized:
1) at the time of resection, ventilation and anesthesia must be provided
through the distal airway, 2) annular resection with end to end anastomosis is
to be preferred when technically feasible, 3) following resection of the
tracheal bifurcation, reconstruction of the bronchial tree is essential, and 4)
when dealing with malignant lesions, complete removal of the tumor must always
be controlled by quick section. Two additional technical aids, extracorporeal
circulation and the Marlex mesh prosthesis are currently fashionable. They are
discussed in relation to our results. Lateral as opposed to annular resection
is only used when the latter is technically impossible. The choice of incision
resides between a lateral and anterior sternum-splitting incision. The latter
affords broad exposure of the trachea and its bifurcation. Immediate results
are as follows: 10 high and 6 low (including the bifurcation) tracheal annular
resections with end to end anastomosis - 3 hospital deaths. 3 high and 1 low
lateral resections - 2 hospital deaths. Late results with follow up from 8
months to 5 years will be presented.
29. Non-metastatic
Neurological Complications of Bronchogenic Carcinoma: The Carcinomatous
Neuromyopathies
Donald L. Morton*, Hideo Itabashi*, and Orville F. Grimes,
San Francisco, Calif.
The carcinomatous neuromyopathies are a group of
neurological syndromes which occur in association with carcinoma and may
involve almost any level of the neuromuscular system, but are unrelated to the
presence of metastases. These neurological syndromes are probably the most
frequent non-metastatic manifestations of bronchogenic carcinoma, but they have
received little attention in the thoracic surgical literature. However, the
recognition of these neuromyopathies and their differentiation from metasta-tjc
lesions deserves special emphasis when considering the surgical treatment of
bronchogenic neoplasms. The experience of the University of California
Hospitals (San Francisco) and the Langley Porter Neuropsychiatric Institute
with this syndrome will be reviewed. Patients with bronchogenic carcinoma may
have a wide variety of non-metastatic neurological lesions, including cortical
cerebellar degeneration, peripheral neuropathies, encephalomyelitis,
polymyositis and myasthenia-like syndromes. The frequency, clinical picture,
differential diagnosis and neuropathological findings of these lesions will be discussed.
Sixteen cases of this syndrome which were proved at autopsy will be presented.
The severity of the syndrome has no relationship to the size or growth rate of
the tumor. A surgical approach to the treatment of carcinoma is indicated in
these patients, especially since the carcinomatous neuropathy may undergo
remission following removal of the primary neoplasm.
30. Preoperative
Irradiation in Patients Undergoing Pneumo-nectomy for Carcinoma of the Lung:
Incidence of Postoperative Cardiac Complications
James B.
D. Mark, San Jose, Calif.,
Edward P. Call*, and Carl F. Von Essen*, New
Haven, Conn.
In recent years, preoperative irradiation as part of
the treatment plan for patients with carcinoma of the lung has undergone
critical appraisal at several institutions. Emphasis has been on long-term
cure. No evaluation of postoperative complications in previously irradiated
patients has been undertaken. During the past six years, 60 patients have
undergone pneumonectomy for carcinoma of the lung at the Yale-New Haven Medical
Center. Twenty of these patients received planned preoperative irradiation
under a selective protocol. Patients in the irradiated and non-irradiated
groups were found to be comparable relative to age, sex, stage of disease (TNM
classification) and preoperative cardiac status. Postoperative bronchopleural
fistula did not occur in either group. The incidence of postoperative cardiac
complications in the irradiated group was found to be more than twice as great
as that in the non-irradiated group. Operative mortality in the irradiated
group was eight times that in the non-irradiated group (4/20 vs. 1/40).
Additional correlations with postoperative morbidity, length of survival and
post-mortem findings have been carried out. Based on this data, it appears that
preoperative irradiation in patients undergoing pneumonectomy for lung cancer
is associated with a higher incidence of postoperative cardiac complications
and mortality.
*By
Invitation
Tuesday Evening, March 30, 1965
7:00 P.M. Reception
International Room
8:00 P.M. Banquet
and Dancing
International Room
Attendance limited to Members
of the Association and their ladies, Invited Speakers and their ladies, Invited
Guests and their ladies
Dinner dress preferred
