Lobectomy with sleeve resection in the treatment of tumors of the bronchus.

We evaluated the results of right upper lobectomy with a sleeve resection of the right main bronchus in 50 patients with a bronchial neoplasm. Four patients (8 percent) died during surgery or postoperatively. Eight of the 22 patients who underwent surgery for carcinoma between the years 1960 and 1974 had tumor-positive hilar lymph nodes. They died as a result of subsequent extension of the resected carcinoma. Fourteen of the 22 patients had no lymph node metastasis and nine of them (64 percent) were alive after five years without detectable recurrence. The finding of positive hilar lymph nodes contraindicates sleeve resection. In these cases, when pneumonectomy is impossible from a functional point of view, sleeve resection is to be regarded as a palliative procedure.

Long-term follow-up after pacemaker implantation in sick sinus syndrome.

In 74 symptomatic patients suffering from sick sinus syndrome, survival after pacemaker implantation and additional drug therapy was determined. The 5-year survival was poor (47.2%). Evidence of other cardiac disease (present in 44.6%) influenced the prognosis unfavorably, especially in combination with continuing symptoms. As yet the phase of SSS in which chronic cardiac pacing is required, should be considered as a critical stage.

Extensive myocardial revascularization--influence of cardioplegia on operative results.

Experience with extensive myocardial revascularization (5 or more distal anastomoses) during a one-year period is reviewed. Intermittent hypothermic aortic occlusion was used in 68 patients (non-cardioplegia group), and cold cardioplegia in 70 patients. The 2 groups were similar in regard to age, sex, extension of coronary artery disease, number of previous myocardial infarctions, preoperative diagnosis of impending myocardial infarction and preoperative left ventricular function. Five patients in the non-cardioplegia group died early postoperatively, while no cardiac death occurred in the cardioplegia group (p = 0.02). The incidence of perioperative infarction and postoperative catecholamine requirement was lower in the cardioplegia group (p-values 0.04 and < 0.01 respectively). The major determinant of the postoperative catecholamine requirement in the non-cardioplegia group was the total aortic cross-clamp time, while in the cardioplegia group it was the preoperative left ventricular end-diastolic pressure. A policy of "complete revascularization" in diffuse coronary artery disease seems to be justified only if cold cardioplegia is used for myocardial preservation.