Surgical treatment of congenital esophageal atresia.

Severe gastroesophageal reflux was found in 9 out of 18 infants with congenital esophageal atresia studied radiographically shortly after primary reconstruction. Pulmonary complications were recorded in 18 out of 32 similar patients in long-term follow-up. Strictures at the level of the anastomosis were detectable in 18 out of 32 patients; eleven strictures were severe enough to require dilation or surgical revision. These findings suggest that early evaluation for gastroesophageal reflux may be useful in management of infants with esophageal atresia. The precautions taken preoperatively to prevent complications of gastroesophageal reflux should be continued in the postoperative interval unless a competent lower esophageal sphincter is demonstrated.

RBC fragmentation and thymoma.

Thrombocytopenia and hemolytic anemia with fragmented RBCs were discovered in a 70-year-old woman with a large mediastinal mass. Investigation of the cause of the hematologic findings was negative. The mass was surgically excised and proved to be a thymoma of spindle cell type. The hemogram findings returned to normal within a month of surgery. We postulate the thymoma as the source of the RBC fragmentation and thrombocytopenia and explore the relationship between tumors and the hematologic findings.

Four-year follow-up on the Albany experience with intrapleural BCG in lung cancer.

One hundred sixty-nine patients were entered into randomized controlled studies of intrapleural bacille Calmette Guérin (BCG) immunotherapy after surgical resection of lung cancer. Long-term follow-up of our initial series of BCG-treated patients with Stage I disease continues to indicate that this treatment was superior to that given to control patients. The recurrence rate in the control population was high, 62% at 3 years. The recurrence rate was 33% at 3 years in the BCG-treated group. A negative preoperative tuberculin test and squamous cell histologic type were favorable prognostic factors for BCG-treated patients. The survival of patients with more advanced disease was not improved by BCG immunotherapy.

Regional immunotherapy with intrapleural BCG for lung cancer.

A living vaccine, the bacille Calmette Guérin (BCG) strain of Mycobacterium tuberculosis bovis, has been administered in a single postoperative intrapleural dose as a controlled equivalent of postoperative empyema in 38 patients following pulmonary resection for lung cancer. This form of regional immunotherapy is reasonably well tolerated if the vaccine is given in a limited dose and if a follow-up course of isoniazid (INH) is administered. In this report, the technical details of this new therapeutic program are reviewed. The preliminary findings in a randomized prospective clinical train of the technique indicate that patients with Stage I lung cancer are significantly benefitted by the treatment. Patients with more advanced disease are unimproved by this form of therapy.

Regional immunotherapy of lung cancer with intrapleural B.C.G.

60 patients have been entered into a randomised prospective study to answer the question-does a single postoperative injection of B.C.G. into the pleural space improve survival after surgery for lung cancer? 40 patients have been followed up for more than a year. B.C.G. improved survival in patients with a limited tumour burden: there were no recurrences and no deaths in 17 stage-I patients treated with intrapleural B.C.G. whereas 9 of 22 comparable control patients developed recurrent cancer and 5 died in the same interval (p=0.003). Intrapleural B.C.G. treatment did not seem to be beneficial in patients with more advanced disease. The hazards associated with injecting these living organisms into the pleural space have been reduced by preclinical laboratory testing in animals, use of a single limited dose of microorganisms, administration of isoniazid, and careful patient monitoring.