TUESDAY AFTERNOON, APRIL 1, 1969
2:00
P.M. Executive Session (Limited to
Active and Senior Members)
Grand Ballroom
3:00 P.M. Scientific
Session: REGULAR PROGRAM
Grand Ballroom
Address by the President
Edward M. Kent, Pittsburgh, Pennsylvania
Address by Honored Guest
E. J. Zerbini, M.D.
University of Sao Paulo Medical School
Sao Paulo, Brazil "The Surgical Treatment of
Tetralogy of Fallot"
34. Surgical Considerations in "Atypical" Mycobacterial Pulmonary
Disease
R. T. Fox, K. V. Veerraju,*
William M. Lees, and T. W.
Shields,
Chicago,
Ill.
The medical management of pulmonary disease caused by
Mycobacteria other than M. Tuberculosis is fairly well accepted, with use of
varying combinations of "first-line" and "second-line" drugs. Despite the
rather poor success rate of this management the role of surgery has been
controversial. As in any other type of surgery, the fate of the non-operated
patient must be weighed against the mortality, morbidity, and ultimate
favorable results in the surgically treated patient. In order to document the
excellent results and minimal adverse effects of surgery we have analyzed our
series of patients with "Atypical" Mycobacterial disease From 1951 through
1967, 163 patients with such disease have had definitive surgery. There have
been 153 resections (12 bilateral) and 27 plombage thoracoplasties (5
bilateral). Major complications consisted of seven instances (4.5%) of
broncho-pleural fistula, two with post-operative bleeding necessitating
re-operation, and two of lobar atelectases. Twenty four patients (156%) had
minor space problems. There was no surgical mortality in the entire group. Five
of the resected patients ultimately needed further surgery to achieve control
of the disease. Two of the plombage patients needed additional surgery. The
final success rate has been approximately 96%.
35. Pulmonary Complications in Burn Patients: A Comparative Study of
700 Patients
Robert J. Flemma,* Frank C. DiVincenti,* Basil A. Pruitt, Jr.,*
and
Franklin D.
Foley,* Fort Sam Houston, Texas
Sponsored by W. Glenn Young, Jr.
Comparison of 311 burn patients in 1962-1963 with 389
in 1967 reveals that with the advent of topical chemotherapy, pulmonary
complications are now the leading cause of death in burn patients Pneumonia is
foremost, occurring in 17% of all burn patients and in 50% of mortalities in
1967. Complications of tracheostomy, including pneumothorax, are the second
leading complication. Pulmonary edema, suppurative thromboem-bolism, pulmonary
melioidosis, and empyema as a result of pneumothorax treatment are less common
but difficult in management because of the burn. Bronchiectasis as a late
sequela to smoke inhalation is rare but of unusal interest. Greater use of
respirators in 1967 led to an increased recognition of "oxygen toxicity,"
although identical histologic findings have been noted in patients who did not
require respiratory support. The pneumonias currently seen are considered to be
airborne in contrast to hematogenous pneumonia which was common in 1962-1963.
Increased use of respirators and unnecessary tracheostomy are considered
important in this relative increase in airborne pneumonia. Prolonged hypoxemia
and alkalosis occur in most burn patients, suggesting ventilation-perfusion
abnormalities. The application of the basic principles of thoracic surgery as
modified in the treatment of the burn patient and as related to these
complications is emphasized and discussed in detail.
36. Respiratory Failure in Infants Following Cardiovascular Surgery
J. J. Downes,* H. Nicodemus,* and J. A. Waldhausen,
Philadelphia, Pa.
Acute respiratory failure commonly follows operations
for congenital heart disease in infants because of the associated abnormal
pulmonary circulation. Our criteria for respiratory failure include: abnormal arterial
carbon dioxide tension (PaCO2), physiologic dead space-tidal volume
ratio greater than 0.50, increased respiratory frequency, and excessive work of
breathing. Of 99 infants operated in a 2 year period, 41 met these criteria and
received mechanical ventilation. Despite severe, complex lesions, 17 (42%)
survived after mechanical ventilation of 24 hours to 3 months duration. Of the
58 infants without respiratory failure, all but one survived. Pulmonary
sequelae of high alveolar oxygen tensions contributed to the deaths of 3
infants early in the series. Subsequently, the inspired oxygen concentrations
were maintained at the minimum level consistent with an arterial oxygen tension
(PaO2) above 35 mmHg (cyanotic lesions) or 70 mmHg (acyanotic
lesions). Controlled constant volume ventilation aided by morphine and chest
physiotherapy provided optimal distribution of gas and minimal
alveolar-arterial oxygen tension gradients. An indwelling systemic arterial
catheter permitted frequent determination of pH, PaCO2, and PaO2,
and continuous pressure monitoring. We conclude that respiratory failure
following cardiovascular surgery in infants can be successfully treated with
mechanical ventilation.
*By
Invitation
TUESDAY
EVENING, APRIL 1, 1969
7:00 P.M. Reception
Pavilion Room
8:00 P.M. Dinner
and Dancing
Terrace Room
Attendance limited to Members of the Association and their ladies,
Invited Speakers and their ladies, Invited Guests and their ladies.
Dinner dress preferred
