T1N0M0 bronchogenic carcinoma: assessment by CT

We reviewed medical records and conventional chest radiographs that showed a solitary T1N0M0 nodule in 23 patients who had non-oat-cell bronchogenic carcinoma. No patient had evidence of metastases, either on the chest radiograph or clinically. All patients underwent computed tomography (CT) examination of the thorax, including the adrenal glands. Only one patient (4%) had mediastinal lymph nodes greater than 1 cm in diameter accessible to mediastinotomy; anterior mediastinotomy confirmed metastatic spread in this patient, which precluded curative resection. Three patients each had a mildly enlarged (2 cm or less) adrenal gland; however, follow-up study suggested that metastasis was not the cause of adrenal enlargement in these patients. This study reinforces concern over whether CT is warranted in the preoperative assessment of T1N0M0 bronchogenic carcinoma.     

Effect of vasopressin on plasma volume and renin release in man.

1. Arginine vasopressin was infused into seven healthy young male volunteers at 12-5 and 25 units/min for 1 h at each dose. Plasma renin activity fell sharply and progressively in each subject. The mean fall was 47% and 66% of the initial value at the end of the lower and higher rates of arginine vasopressin infusion respectively; over 70% of the observed fall in plasma renin activity occurred at the end of the first infusion period. 2. The majority of the plasma arginine vasopressin concentrations achieved were within the physiological range observed after fluid deprivation and orthostatic stress in man, particularly at the lower rate of infusion. 3. There was no change of arterial pressure, despite a slight bradycardia at the lower rate of infusion; at the higher rate of infusion, there was only a very slight pressor response. 4. There was a concomitant and significant fall of plasma protein concentration and peripheral venous packed cell volume without any significant change of plasma sodium concentration or plasma osmolality, implying an expansion of plasma volume. 5. The results indicate that, in man, physiologically relevant amounts of arginine vasopressin suppress the rate of renin secretion indirectly by increasing the plasma volume at the expense of the extravascular fluid volume.     

An improved ruptured-balloon retrieval set

The authors describe instrumentation for easy retrieval of a ruptured balloon on a dilatation catheter used for transluminal angioplasty. A sheath is introduced which has a larger lumen than the outer size of the dilatation catheter; this permits removal of the balloon.     

Cervical esophageal anastomosis following cervical esophageal diversion: a new use for an old instrument

Proximal cervical esophageal diversion is occasionally employed in the management of distal esophageal perforation. However, subsequent esophageal reconstruction can pose a formidable surgical challenge. The DeBakey femoral tunneling device has proven helpful in identifying the distal defunctionalized segment of esophagus during certain types of reconstruction. We describe the use of this instrument to reestablish esophageal continuity in two instances.