Einzelreferate und Buchbesprechungen

Ohne Zusammenfassung     

EXPERIMENTAL PNEUMONIA BY INTRABRONCHIAL INSUFFLATION

The numerous attempts made in the last twenty-five years to reproduce lobar pneumonia in animals practically failed in all instances. By intrabronchial insufflation of pure cultures of pneumococcus in dogs, we produced experimental pneumonia successively in forty-two cases, with a mortality of at least 16 per cent. The fatal cases resembled closely lobar pneumonia in man. In the non-fatal cases, the pathological and bacteriological findings were again in accord with the findings in man. Clinically, however, the cases of nonfatal experimental pneumonia run a milder and shorter course than in man. In a few instances, lobar pneumonia has been produced experimentally also with the Pneumococcus mucosus and with Friedländer''s pneumobacillus. The anatomical findings in these experiments have shown some characteristics agreeing with the findings in the pneumonias of man produced by these organisms. The quantity of the injected culture seemed to have a definite influence upon the outcome of the disease; in the fatal cases larger quantities of the culture had been injected. The animals were neither selected nor prepared in any manner. The experimental success did not, therefore, appear to depend upon the degree of resistance of the individual hosts. It is suggested that the uniformly successful results of the experiments were due to the obliteration of a large number of bronchi by the injected culture, through which mechanical effect a favorable opportunity was provided the pneumococci to develop and display their pathogenic activities consisting in the calling forth of a characteristic local, more or less effective, widespread, inflammatory reaction of the lung tissue.     

AN EXPERIMENTAL STUDY OF THE QUESTION OF ASPIRATION OF FOREIGN MATERIAL INTO THE AIR PASSAGES DURING INTRATRACHEAL INSUFFLATION

The foregoing experiments clearly justify the following conclusions :— Intratracheal insufflation protects the respiratory tract very efficiently against any invasion from the pharynx. The filling up of the pharynx with extraneous material, whether it be from the stomach or from the mouth, brings no danger to the trachea and bronchi. This holds true even if the animal is under deep anesthesia. On the other hand, the presence of a tube in the trachea or larynx without the protection of an effective recurrent air stream, definitely facilitates the entrance of foreign material from the pharynx into the trachea. Anesthesia, which removes the protective action of deglutition, greatly increases the danger from aspiration in these cases.     

Minimally invasive surgery for thoracoabdominal aortic aneurysms

Open surgical repair of thoracoabdominal aortic aneurysms (TAAA) remains a highly morbid procedure. In recent years, several minimally invasive techniques have been introduced to treat TAAA. These include hybrid procedures and purely endovascular approaches using modified aortic endografts. Although still investigational, this burgeoning technology has the potential to improve outcomes in TAAA repair, as well as to circumvent the morbidity and mortality associated with the traditional surgical approach to TAAA. While the reported experience is limited to several institutional case series, results are encouraging, and suggest that fenestrated and branched endografts are likely to figure prominently in the management of TAAA in the future. An overview of these minimally invasive techniques, as well as the role of computer-assisted imaging analysis, is provided.     

Myocardial perfusion imaging in humans by contrast echocardiography using polygelin colloid solution

This study evaluated the myocardial contrast effect and safety of polygelin colloid solution selectively injected into the coronary arteries in 25 patients during two-dimensional echocardiography. Six patients (group I) had selective intracoronary injections of nonagitated and 19 (group II) of hand-agitated polygelin colloid solution. Myocardial contrast was seen on two-dimensional echocardiographic cross sections in three patients of group I and in all patients of group II; in 16 patients it was also seen on M-mode echocardiograms. The contrast effect lasted for 15 to 60 seconds. The intensity of myocardial opacification was not significantly influenced by the amount of polygelin colloid solution injected, heart rate or cardiac size. The total number of contrast-enhanced segments after right and left coronary artery injections delineated the entire cross-sectional area in any given view. None of the patients developed symptoms during or immediately after the injections. One patient had transient second degree atrioventricular block after a right coronary wedge injection, one patient showed a QRS axis shift and two others had transient T wave changes. There were no aortic blood pressure changes and no significant serum enzyme (creatine kinase [CK], CK-MB fraction, glutamic oxaloacetic transaminase) elevation or alterations of left ventricular function assessed echocardiographically. It is concluded that hand-agitated polygelin colloid solution is a useful and safe intracoronary contrast agent for delineating myocardial perfusion areas on two-dimensional echocardiography in humans.     

电视腹腔镜外科手术在胃肠道肿瘤的临床应用

目的探讨腹腔镜外科技术在胃肠道肿瘤手术中的应用。方法经电视腹腔镜行胃肠道肿瘤手术１８例,其中右半结肠切除术４例,横结肠癌根治术３例,乙状结肠癌根治术５例,乙状结肠癌姑息切除术并肝转移癌电凝固化１例,胃癌术后复发转移行探查活检１例,胃巨大恶性淋巴瘤行探查活检１例,晚期回肠癌行小肠侧侧吻合术１例,乙状结肠腺瘤切除术２例。结果均获成功,无中转开腹,手术时间平均１６５．０分钟。术后平均３１．２小时胃肠功能恢复,无并发症发生,术后平均住院８．２天。１３例切除肿瘤的结肠癌术后随访２月～３０月,仅１例横结肠癌术后２３月出现肺转移。结论腹腔镜胃肠肿瘤手术损伤小、恢复快、胃肠干扰小、术后疼痛轻,值得进一步探索开展。