The contributions of John B. Murphy to thoracic surgery.

John B. Murphy was a prominent surgeon who lived in Chicago from the 1880s until his death in 1916. During his career, he was associated with both Rush Presbyterian and Northwestern Medical Schools. He was responsible for popularizing the use of an artificial pneumothorax as an effective adjunct in the treatment of pulmonary tuberculosis. This modality was not, however, his original concept. In addition to all of the fields of general surgery, Murphy undertook the management of empyema and lesions of the chest wall and also performed thoracoplasty procedures. Although he had done several thoracotomy procedures in his laboratory, he rarely undertook this operation in a clinical setting. Drop ether anesthesia was used for all surgical procedures. Murphy did not use closed water seal drainage of the chest. His oration on thoracic surgery, given at the annual meeting of the AMA, in 1898, was an excellent monograph on the subject and undoubtedly contributed to the increased interest and progress in this field of surgery. Murphy was a wise surgeon, an able technician and a scholarly teacher. The high regard in which he was held by his contemporaries is best expressed by the remark of William Mayo, "...he was the surgical genius of our generation".

Surgical treatment of primary lung cancer and solitary intracranial metastasis.

From 1976 through 1986, 12 patients underwent 14 thoracotomies (two patients had a second thoracotomy for recurrence) and 16 craniotomies (two patients had three craniotomies for recurrence) for carcinoma of the lung and solitary intracranial metastasis. Age ranged from 40 to 65 years. Adjuvant therapy (chemotherapy and thoracic irradiation) was employed in three patients prior to thoracotomy and in four patients following thoracotomy. Whole-brain irradiation was used in four patients after craniotomy. Improvement in neurologic symptoms following craniotomy was noted in 15 of 16 instances. There were no operative mortalities. Overall survival from the time of initial diagnosis ranged from 13 to 63 months. Survival following initial craniotomy ranged from 12 to 56 months. Eight patients are currently alive and well with no disabling neurological symptoms. These results support an aggressive approach to the resection of solitary brain metastasis from bronchogenic carcinoma, both for palliation and prolongation of survival.

Combined tracheal transection and innominate artery disruption from blunt chest trauma.

Both transection of the trachea and injury of the aorta and its arch vessels can occur after blunt chest trauma; however, the combination of these injuries in 1 patient is exceedingly rare. This report of a patient with distal trachea transection and proximal innominate artery disruption from blunt chest trauma reviews some of the important factors to be considered in managing these injuries. Management of the airway must be planned before the operative procedure is begun and can be facilitated by the use of a sterile anesthesia circuit passed on to the operative field. Exposure of tracheal injuries as low as the carina can be achieved through sternotomy incision if this approach is indicated for repair of the associated vascular injury. The use of prosthetic materials should be avoided in vascular injury repair due to contamination of the field from the associated airway disruption. Attention to postoperative bronchial hygiene is mandatory for successful outcome after tracheal anastomosis.

Intrapericardial diaphragmatic hernia in adults.

Intrapericardial diaphragmatic hernia (IDH) is the rarest type of adult diaphragmatic hernia. Only 28 cases have been reported. Indirect blunt trauma has been implicated in most cases, but one resulted from a stab wound to the anterior chest. Patients presented immediately or up to 20 years following trauma with symptoms of intermittent bowel obstruction, including one with strangulation, or cardiac dysfunction, including dyspnea, palpitations, and two patients with cardiac tamponade. Physical findings included bowel sounds in the chest, decreased heart and lung sounds, and an absent point of maximal cardiac impulse. Chest roentgenography usually revealed supradiaphragmatic gas shadows suggestive of bowel in the chest. Thorough examination of both anteroposterior and lateral chest roentgenograms and barium gastrointestinal series may provide positive diagnosis of anterior diaphragmatic hernia, and fluoroscopy after induced pneumoperitoneum may establish its pericardial involvement. Celiotomy is the preferred approach to surgical repair of IDH. Since the symptoms referable to adult IDH can be incapacitating or life threatening, herniorrhaphy should be performed promptly upon diagnosis, with expectation of an uneventful recovery and negligible recurrence rate.

Pulmonary blastoma: an ultrastructural study with a brief review of literature and a discussion of pathogenesis.

A pulmonary blastoma is reported in a 19-year-old black female. The light and electron microscopic characterics are described; they are found to be similar to those of the fetal lung prior to the fourth gestational month. Although the ultrastructural features do not favor any particular theory of histogenesis of this unique tumor, evidence for the commonly held theory that the tumor arises from pluipotential pulmonary blastema seems tenuous. A brief review of the literature disclosed 38 other similar cases. There was a male predominance with an average age of detection at 39 years. Sputum cytology was rarely positive. Among tumors larger than 5 cm in diameter, survival was usually less than 2 years. Metastases were present in approximately half of the cases.