Bronchial carcinoid tumor: experience over 20 years.

Nineteen cases of bronchial carcinoid tumor seen over 20 years in a 1,000-bed, tertiary medical center were retrospectively reviewed. They consisted of 0.4 per cent of all patients with lung tumors. Initial complaints were hemoptysis, persistent pulmonary infection, chest pain, and diarrhea. Two of the five patients with atypical carcinoid tumors came to the hospital with diarrhea as a result of their chemically active tumors. However, seven patients (36%) were asymptomatic and were diagnosed after an abnormal chest radiograph was noted incidentally. Of 13 patients receiving bronchoscopic examination, 9 (69%) had visible tumors. Bronchial biopsy was performed in 7 patients and led to a diagnosis in all seven. Significant bleeding was noted in 3 patients as a result of biopsy. Lobectomy was the most common surgical procedure in this series. Follow-up of these patients was from 6 months to 15 years. The general outcome for patients with typical carcinoid was good. However, all patients with atypical carcinoid died as a result of dissemination.

Large soft tissue tumor of the chest occurring after trauma.

The unusual soft tissue tumor we have described may be the largest yet reported. The tumor was considered benign, and its histologic features were most consistent with fibromatosis arising in a region that had been previously traumatized. Although the patient is doing well, it is premature (2 years later) to conclude that the tumor will not recur.

Management of malignant ventricular arrhythmias using antitachycardia devices.

Cardioverter defibrillators were implanted in 26 patients at Charleston Area Medical Center for management of cardiac arrest (7 patients), and drug refractory sustained ventricular tachycardia (19 patients). A variety of operative approaches and concomitant surgical procedures were utilized in the implantation of these devices. No operative deaths occurred. A superficial wound infection was the only operative complication. During the follow-up period (9.3 +/- 5 months), 11 of 26 patients (46 percent) had a defibrillator discharge and one death occurred (3 percent), which was due to heart failure. Patients with malignant ventricular arrhythmias may present with sustained monomorphic ventricular tachycardia with associated syncope, pre-syncope or without any associated symptoms. Unfortunately, cardiac arrest may be the initial presentation. The use of antitachycardia devices such as implantable cardioverter defibrillators and antitachycardia pacemakers has allowed physicians to more successfully treat patients with malignant ventricular arrhythmias. In a significant number of patients with these arrhythmias, such devices are now used as first-line therapy.

Valve replacement and coronary revascularization: combined surgical approach.

Report is presented of sixteen patients who had coronary bypass procedures performed in combination with valvular surgery. There was a hospital mortality of two patients of 12.5%. Significant improvement occurred in the remaining fourteen patients or 87.5%. Of these fourteen patients, one patient required re-operation for mitral valve replacement following an open mitral commissurotomy two years previously. Coronary arteriosclerosis complicating the outcome of patients undergoing valvular surgery is well recognized (1). Hall and associates (2) reported the results of seventy-two patients undergoing combined procedures with seventeen operative deaths, an operative mortality rate of 23.6%. Merin's group (3) reported on a series of fifty patients from the Mayo Clinic with an operative mortality rate of 14%. Loop and coworkers (4) reported an operative mortality rate of 8% in fifty patients undergoing combined procedures. Crouch and associates (5) reported on thirty-six patients with four hospital deaths, an operative mortality of 11%. At the Heart Institute of Michigan, five hundred fifty-six patients under-went coronary bypass surgery from December, 1969 to September, 1974. This is an all inclusive, consecutive experience. Overall mortality in this group was nine patients or 1.6%. Of five hundred forty patients who did not have associated valvular surgery, the mortality was seven patients or 1.3%. The purpose of this presentation is to elaborate on the sixteen patients who had coronary surgery combined with valvular surgery. Mortality in this group was two patients or 12.5%.