Are sutures better than staples for closing bronchi and pulmonary vessels?

Little is known about the strength of suture lines and stapled closures of the bronchus, pulmonary arteries, and pulmonary veins. This experiment tested and compared the hydrostatic leakage point of each of these structures when closed by either sutures or staples. Fourteen fresh mature porcine cadavers and 8 human cadavers of age greater than 50 years were studied to determine whether the pig could be used as an appropriate model for future in vivo studies. Cadavers were selected so that closures depended only on the material used and not on any clot reinforcing the closure lines. The results of the study suggest that staple closure of the pulmonary artery and the main bronchus is as secure as suture closure. Pulmonary veins leak at a lower pressure when closed with staples; however, this pressure far exceeds physiological pressures in the left atrium. The data also suggest that the pig is an appropriate model for approximating conditions found in patients and is a good model for chronic studies comparing suture and staple closures.

Coronary artery bypass grafting in young patients under 36 years of age.

Results of coronary artery bypass graft (CABG) surgery in patients under age 36 who were operated upon between 1970 and 1980 at two large medical centers were compared to matched control patients, age 45 to 59 years, and 60 years and over. Patient follow-up ranged from one to 13 years (average five years). Event-free survival was significantly worse in the young group (37 percent) vs the middle aged group (61 percent, p less than 0.01) and vs the elderly group (59 percent, p less than 0.02). Failure of the operation was due to failure to improve or worsening of Canadian Cardiovascular Society anginal class, need for reoperation, subsequent myocardial infarction, or death due to cardiac causes. Risk of failure of CABG surgery in young patients was increased with the presence of cardiac risk factors. Because of the high rate of long-term failure of CABG surgery in young patients, its use in this group needs to be reevaluated relative to current aggressive medical therapy for angina.

Development of circulating antiheart antibodies as a result of coronary bypass surgery.

Antiheart antibodies have been implicated as a marker of postcardiotomy syndrome in patients undergoing coronary artery bypass. To assess the frequency of and contributory factors in the development of antiheart antibodies after coronary bypass procedures, 33 patients were examined for evidence of antiheart antibodies before and for seven days after routine coronary artery bypass operations. Overall titers of antiheart antibodies rose in approximately 66% of the patients. However, this rise was not accompanied by any major clinical symptoms. History of previous myocardial infarction or myocardial injury did not correlate with a higher frequency of development of antibodies. Antiheart antibodies appear to be a common consequence of coronary artery bypass operations and are not routinely associated with the development of postcardiotomy syndrome.

Evaluation of serum creatine kinase and lactate dehydrogenase in experimental myocardial infarction, atriotomies, and thoracotomies.

Myocardial infarction causes elevation of the serum myocardial-associated isoenzyme of creatine kinase (CK-MB) and a serum isoenzyme of lactate dehydrogenase (LDH1). Since atrial myocardium has as much CK-MB as ventricular myocardium, surgical manipulation of the atrium could cause elevation of serum CK-MB in the postoperative period. The distribution of LDH isoenzymes is different between atrial and ventricular myocardium. Hence, surgical procedures on the atrium could, theoretically, cause different changes in serum LDH isoenzymes than those seen after acute myocardial infarction. This study was conducted to ascertain whether surgical manipulation of the atrium could cause changes in these two serum enzyme systems that might be confused with those seen after acute myocardial infarction. Right thoracotomies were performed on 20 dogs. Each dog then was assigned randomly to one of four groups: thoracotomy (control), placement of atrial pursestring sutures, atriotomy, or acute perioperative myocardial infarction. Serum total and isoenzyme distributions of CK and LDH were measured for 48 hours in all animals. The results suggest that significant elevations of serum CK-MB occurred even after small atriotomies. Confirmation of a ventricular myocardial origin of postoperative serum CK-MB bands was obtained by analysis of serum LDH isoenzymes in that the ratio of LDH1 to LDH2 and the absolute value of serum LDH1 became elevated only after acute perioperative myocardial infarction and not after atriotomy.

Management of patients with malignant thymoma.

This report documents the results of therapy in 23 patients treated for malignant thymoma between 1944 and 1979. Of the group, 22 patients had neoplasms which invaded mediastinal structures; six had distant metastases. Four patients had myasthenia gravis and one had erythroid hypoplasia associated with collagen vascular disease. No deaths were associated with primary therapy, which included an operative procedure in all cases. Follow-up ranged from 4 months to 18 years (mean 5.63 +/- 1.03 years, SEM). Fifteen patients died, with postoperative survival times ranging from 4 months to 18 years (mean 3.8 +/- 1.27 years). Five patients were alive without recurrence from 3 to 11 years postoperatively (mean 6.8 +/- 1.36 years), and three patients were alive with recurrence or distant metastases from 4 to 17 years postoperatively (mean 10.75 +/- 2.66 years). Differences in survival on the basis of tumor cell type were not statistically significant. Therapeutic groups were analyzed for 5 year survivors, tumor deaths within 5 years of therapy, deaths due to other causes, deaths due to tumor after 5 years, those presently alive, and longest known survivor. The data suggest that complete surgical excision offers the best chance of long-term survival when compared to partial resection plus irradiation (p less than 0.05). No statistical significance could be demonstrated between the groups who had complete resection with versus without postoperative irradiation. There also was no statistically significant difference between the group of patients receiving irradiation following partial excision of most of their tumor and the group receiving irradiation following only biopsy of the lesion. This observation suggests there is no value in so-called "debulking procedures" and suggests that irradiation may be of value in local control of thymoma. Perpetual surveillance is necessary since late recurrence is common.