Low-energy electron attachment to the dichlorodifluoromethane (CCl2F2) molecule.

Results from a joint experimental study of electron attachment to dichlorodifluoromethane (CCl(2)F(2)) molecules in the gas phase are reported. In a high resolution electron beam experiment involving two versions of the laser photoelectron attachment method, the relative cross section for formation of the dominant anion Cl(-) was measured over the energy range 0.001-1.8 eV at the gas temperature T(G) = 300 K. It exhibits cusp structure at thresholds for vibrational excitation of the nu(3)(a(1)) mode due to interaction with the attachment channels. With reference to the thermal attachment rate coefficient k(T = 300 K) = 2.2(8) x 10(-9) cm(3) s(-1) (fitted average from several data), a new highly resolved absolute attachment cross section for T(G) = 300 K was determined. Partial cross sections for formation of the anions Cl(-), Cl(2)(-), F(-), ClF(-), and CCl(2)F(-) were measured over the range 0-12 eV, using three different electron beam experiments of medium energy resolution. The dependence of the attachment rate coefficient k(T(e);T(G) = 300 K) on electron temperature T(e) was calculated over the range 50-15 000 K, based on a newly constructed total cross section for anion formation at T(G) = 300 K. R-matrix calculations for Cl(-) production have been carried out for comparison with the experimental data. The R-matrix results are in line with the main experimental observations and predict the dependence of the DEA cross section on the initial vibrational level nu(3)() and on the vibrational temperature. Furthermore, the cross section for vibrational excitation of the nu(3) mode has been computed.

Management of blunt rupture of the heart.

Ten patients with blunt heart rupture arrived in our emergency center alive during an 11-year period ending in 1984. Ages ranged from 19 to 65 years (mean, 35), and seven patients were male. Six patients presented with tamponade, three with hemorrhagic shock, and one with combined symptoms. Associated injuries averaged 2.25 organ systems per patient. All but one patient had surgery within 90 minutes of arrival. All patients had primary closure of the defect without cardiopulmonary bypass, five patients had subxiphoid window followed by sternotomy, two had right thoracotomy, two underwent left thoracotomy, and one patient was subjected to immediate sternotomy. Seven patients survived. Three deaths were due to irreversible hemorrhagic shock, two secondary to heart injury, and one from an associated liver injury. Prompt pericardial window with subsequent median sternotomy was successful for patients presenting with tamponade and immediate thoracotomy for those bleeding into a pleural cavity.

Carcinoma of the esophagus. An aggressive one-stage palliative approach.

We reviewed the records of 44 consecutive patients with advanced esophageal carcinoma treated at either a Veterans Administration or a city-country hospital. The patients, 38 men and six women, ranged in age from 27 to 72 years and had been referred for operative management. The average duration of dysphagia was 5 months. All patients underwent a one-stage esophagogastrectomy with esophagogastrostomy. The last 34 patients also had a modified fundoplication. Lesions at the gastroesophageal junction were approached via a low left thoracotomy and the others via a simultaneous right thoracotomy and laparotomy. All patients had preoperative enteral or parenteral hyperalimentation. Seven patients died within 30 days after operation (operative mortality 16%). Twenty-six patients lived from 3 to 28 months postoperatively (average 11.5 months). Eleven are alive at present (average 10 months). Postoperative complications were as follows: anastomotic leak, three patients (two died); respiratory failure, four (two died); stricture, three; myocardial infarction, two (two died); cholecystitis, one; and pulmonary embolus, one (patient died). Thirty-four patients had modified fundoplication, and an inconsequential anastomotic leak developed in one. In contrast, two of the 10 patients who did not have modified fundoplication died as a result of anastomotic leak. Preoperative hospital stay ranged from 10 to 28 days (average 18); postoperative stay ranged from 10 to 40 days (average 16). Except for the three patients in whom stricture developed, all patients (92%) had continuous relief of dysphagia. We conclude that one-stage esophagogastrectomy with esophagogastrostomy is applicable in most cases and is associated with both satisfactory long-term palliation and a reasonable period of hospitalization. The addition of a modified fundoplication results in a relatively low rate of anastomotic leak.

Cholecystitis and delayed emptying of the gallbladder.

A number of patients with symptoms of biliary colic have biliary tract disorders despite repeatedly normal oral cholecystograms. These patients will benefit from cholecystectomy. To better define such disorders, a test is needed that is noninvasive, relatively inexpensive and highly accurate. Delayed emptying of the gallbladder after a standard dosage oral cholecystogram using Telepaque is such a test. Twenty-eight patients with this finding underwent cholecystectomy. All gallbladder specimens exhibited both gross and pathologic changes. Twenty-six of the patients had relief of symptoms.

Intimal disruption of major cerebral vasculature following blunt trauma.

A child with blunt traumatic intimal disruption involving the major vessels responsible for cerebral circulation was treated by operation. The injured vessels included both common carotid arteries, both vertebral arteries, and the left subclavian artery. The carotid injuries were treated by saphenous vein interposition grafts, whereas the left subclavian and vertebral arteries were ligated. The patient sustained no neurological deficit and is now completely well 2 years after treatment. The case reported herein is unique in that total intimal disruption of the four major vessels responsible for cerebral flow was treated by operation, resulting in complete recovery. The successful outcome underscores the importance of complete angiographic evaluation and adequate operative exposure in such cases.

Comparison of lobectomy and wedge resection for carcinoma of the lung.

To evaluate comparatively lobectomy and wedge resection for carcinoma of the lung, we reviewed retrospectively 1,000 consecutive cases of lung cancer at a Veterans Administration Hospital. Of these cases, 252 were operable; 199 were resectable. Thirty-three patients underwent resection of their lesion as primary treatment. The indications for wedge resection were (1) insufficient pulmonary reserve, (2) resectable cerebral metastasis, (3) frozen-section results reportedly benign. One hundred twelve patients underwent standard lobectomy procedures. Of these patients, 40 were comparable to those patients undergoing wedge resection on the basis of age, histopathological examination, tumor size and location, and the presence of metastatic disease. One, 2, and 5 year survival rates were 85%, 58%, and 26%, respectively, for wedge resection and 75%, 55%, and 25%, respectively, for lobectomy. The operative mortality rate was 0% for wedge resection and 5% for lobectomy. These results indicate that for the patient with a peripheral lung carcinoma and no evidence of metastatic disease a wedge resection offers comparable survival rates with minimal risk of death.