Primary pulmonary sarcoma with left atrial extension via left superior pulmonary vein. En bloc resection and radical pneumonectomy on cardiopulmonary bypass.

A primary pulmonary sarcoma whose tumor stalk traversed the left superior pulmonary vein to occupy half of the left atrial cavity is reported. Because this extension was suspected and diagnosed preoperatively, appropriate surgical resection was possible. Had this extension not been recognized, an exploratory thoracotomy and division or manipulation of the pulmonary vein might have been undertaken, and systemic embolization might have occurred. By use of the median sternotomy approach and cardiopulmonary bypass, the tumor was removed en bloc through a combined left atrial resection and radical left pericardiopneumonectomy. A lung tumor invading the heart can be safely resected with the use of cardiopulmonary bypass if the extent of cardiac involvement is recognized preoperatively.

Pulmonary lymphangiomyomatosis.

Pulmonary lymphangiomyomatosis is a rare but distinct clinical and pathological entity. It is characterized by hamartomatous proliferation of smooth muscle around the lymphatic vessels of the lung, mediastinum, and retroperitoneum. It occurs only in menstruating women and girls and is manifested by spontaneous pneumothorax and chylous pleural or abdominal effusion. As it progresses, the lungs become increasingly involved with subsequent pulmonary insufficiency and recurrent infection. Eventually death results. This entity has not been reported previously in the surgical literature even though the thoracic surgeon is called on to both establish the diagnosis and aid in palliation. The hypothesis that the disease is estrogen dependent is reviewed and the desirability of estrogen ablation in patients with positive estrogen receptors is suggested.

Cystadenocarcinoma of the pancreas presenting as a splenic cyst.

A report of a cystadenocarcinoma of the pancreas arising in the spleen from pancreatic heterotopia is presented. The fact that the resected pancreatic tail was microscopically normal and separate from the tumor lends strong support that the tumor arose from pancreatic heterotopia rather than from direct extension or metastasis.

Epidural anesthesia following thoracotomy in patients with chronic obstructive airway disease.

Epidural analgesia for control of postoperative thoracotomy pain in patients with carcinoma of the lung and chronic obstructive airway disease is described. The rationale and procedure for its use are presented. Epidural analgesia used in 8 patients requiring pulmonary resection who had chronic obstructive airway disease resulted in an improved postoperative course and avoided use of narcotics or a respirator in 7 of the 8 patients.

Twenty-four hour left ventricular bypass with a centrifugal blood pump.

A new centrifugal blood pump system has been developed for left ventricular bypass by the addition of non-thrombogenic blood surface materials and an ultrathin-walled cannula for the retrograde cannulation of the left ventricle. Partial LV bypass at 3 to 6 L/min was undertaken in 55 calves without thoracotomy. In 20 it was continued for 24 hours, with 13 survivors who were eventually sacrificed. Eleven of the last 14 experiments were completed without mishap. Heparin was employed only during pump insertion. Hematologic changes were limited to moderate platelet depression, and tolerable hemolysis (average serum level 21 mg% in the last 13 experiments). Normal clotting parameters and the absence of significant fibrin split product formation correlated with the absence of gross thrombosis and few minor renal emboli observed at autopsy. This pump system appears to have several advantages over previously described equipment for LV bypass.