Lumbar sympathectomy in the treatment of severe lower limb ischaemia in old people.

One hundred and twenty lumbar sympathectomies were performed in 110 old people (over 65 years of age) as the treatment for severe lower limb ischaemia. Only one quarter of the patients benefited from the operation. In nearly half the cases the limb was ultimately amputated. The operative mortality was 7%, with pneumonia the most common cause of death. Age and mild diabetes mellitus had no effect on the result of treatment. Diabetics on insulin, however, derived no benefit from the operation. the degree of severity of the ischaemia, and the location of the arterial occlusion affected the result of treatment.

Surgical treatment of pulmonary metastases.

Pulmonary metastases from many primary sources were treated by surgery in 42 patients. The seven-year survival rate was 10%. A long time interval between the operation on the primary tumor and the metastatic lung lesion was associated with a better prognosis. The survival rates for patients with carcinomas and sarcomas were nearly equal equal after removal of pulmonary metastases. The patients with melanoma died soon after lung resections. The location of the metastases in the lower lung lobes had a better prognosis than that of metastases in the upper lobes. In this material there was a patient who, after treatment of the primary tumor, needed three thoracotomies to remove eight pulmonary metastases from both lungs. The patient was alive and free from all signs of recurrence 20 years after the first removal of pulmonary metastases.

Mediastinal tumours. A follow-up study of 208 patients.

During the twenty-year period 1954--1973, 208 patients were referred to the Department of Thoracic and Cardiovascular Surgery for treatment of mediastinal tumours. Forty-nine patients had malignant tumours (24%), 86 benign tumours and 73 non-neoplastic lesions. The most common histologic types were neurogenic tumours and malignant lymphomas, followed by thymomas and germinal tumours. Most non-neoplastic lesions were cysts. The mediastinal tumours were often asymptomatic, the malignant tumours in 31%, the benign tumours and tumourlike lesions in 65% of the cases. The most common symptom was pain, which occurred in one-fifth of the patients. The most useful diagnostic method was X-ray examination of the chest. However, a final diagnosis could usually be made only at operation. Thirteen malignant tumours were excised radically, 18 palliatively and 18 were only biopsied. Almost all benign tumours were radically excised. Forty-four patients received postoperative radiation therapy and 6 received chemotherapy. The hospital mortality was 8.2% for the patients with malignant tumours and 1.9% for those with benign tumours. At the end of the follow-up period, which varied from 2 to 21 years (median 10.3 years), 41% of the patients with malignant tumours were alive. Two patients with benign tumours had died of an apparently malignant change in a neurofibroma.

Thoracic duct cyst of the mediastinum. A case report.

There are only a few reports in the literature on cysts of the thoracic duct. This case report concerns a 56-year-old female patient, who was operated on because of a mediastinal mass that later proved to be a cyst of the thoracic duct. The operation and immediate postoperative course were uneventful. Six months later, the patient was doing well and no further investigations were recommended.

Thymomas and thymic cysts.

During a period of 20 years, 19 patients with thymomas and 5 with thymic cysts were surgically treated at this clinic. Excluding one operative death, none of these patients had died of causes related to the tumour 7.4 years (average) after operation. Two patients had died of unrelated causes, and in one case a recurrent mediastinal tumour was observed 3.5 years postoperatively. Myasthenia gravis, present at the time of operation in 3 cases, had been alleviated in one case, remained unchanged in another and become aggravated in the third case. In addition, one patient had developed myasthenia 7 years after resection of thymoma. In one case, a preoperative tentative diagnosis of lupus erythematosus disseminatus had been confirmed. Infiltrative growth was mascroscopically observed in only 2 cases. One of these patients died of haemorrhage during the operation; the other patient was in good health 1.5 years after partial resection and subsequent irradiation of the tumour. Four patients received radiotherapy. In one of the 15 cases treated solely by operation, the tumour fell to pieces on resection; a recurrent mediastinal tumour (cf. above) was removed 3,5 years later.

Acute coeliac artery occlusion: initial collateral blood flow from the superior mesenteric artery. An experimental study.

The collateral blood flow from the superior mesenteric artery after acute occlusion of the coeliac truck was measured in experiments in dogs. Immediately after clamping of the coeliac axis the collateral flow was about 30 % of the original coeliac blood flow. During an observation time of three hours the collateral flow increased, the corresponding value at the end of experiment being about 50 %. At the same time the blood pressure in the coeliac artery rose from a mean value of 20 mmHg to 35 mmHg. The initial collateral blood flow was evidently not sufficient, since after this short occlusion period ischaemic changes, even necrosis, were observed in the liver and stomach in some of the test animals.

Spontaneous perforation of the proximal colon following lung surgery.

Three cases of spontaneous perforation of the proximal colon following lung surgery are reported. The caecum was the site of the lesion in two cases and transverse colon in one. Gastric inflation due to assisted artificail respiration resulting in over-distension of the colon is considered to be the cause of these complications. The treatment was by immediate laparotomy and suture of the perforation in two cases and transverse colostomy in one. All the patients made a complete recovery.