Successful repair of a transected phrenic nerve with restoration of diaphragmatic function.

This report describes the feasibility of restoring motor function of the diaphragm by early repair of a transected phrenic nerve, and discusses causes and consequences of phrenic nerve damage.

Single lung transplantation with cyclosporin immunosuppression. Evaluation of canine and human recipients.

Cyclosporin, a potent new immunosuppressive agent, was used (alone or in combination with other drugs) in 28 canine single lung allograft recipients. Mean recipient survival with good allograft function was 155 days with cyclosporin and far exceeded that obtained in previous single lung allograft recipients treated with standard immunosuppression (15 to 22 days). The results of these experiments were as follows: (1) 20% of the recipient animals exhibited no evidence of rejection whatsoever; (2) four of 28 animals survived more than 350 days with good allograft function; (3) 79% of the animals exhibited some evidence of rejection that was easily reversed in 74% of instances with corticosteroids; (4) 10 of 28 animals exhibited good lung allograft function 5 months or more after operation; (5) in cyclosporin-treated lung allograft recipients, rejection was diagnosed by the presence of infiltrate on chest roentgenogram, analysis of the cellular content of bronchoalveolar lavage samples, and decreased perfusion on 99mtechnetium lung scan; (6) complete healing without stenosis of the bronchial anastomosis occurred in 82% of the animals studied. One of two patients treated with cyclosporin after undergoing single lung allografting survived 7 weeks after transplantation and 4 weeks after contralateral pneumonectomy. Episodes of rejection were reversible, and the bronchial anastomosis healed normally. This overall experience indicates that cyclosporin, although not a perfect immunosuppressive agent, increases the likelihood of success with therapeutic single lung transplantation.

A simple technique for tension-free pericardial closure.

Closure of the pericardium after cardiac operations is desirable but is not always possible to achieve. We describe here a simple technique for tension-free, anterior closure of the pericardium.

Prototype airway management system for use during laser surgery.

A Norton metal endotracheal tube with a Merav parachute cuff cemented to the distal end has solved many of the problems involved in administration of anesthesia for laser surgery of the upper aerodigestive tract. The tube is fireproof and provides an air-tight seal for positive pressure ventilation without the impediment of a cuff channel. It is ideal for laser surgery of the oral cavity and pharynx and may be used effectively for glottic lesions in many instances.

Anaerobic mediastinitis complicating median sternotomy.

Two cases of mediastinitis and bacteremia caused by Bacteroides species following median sternotomy are described. In both patients, purulent sternal drainage and signs of systemic toxicity led to the diagnosis. Surgical reexploration and administration of appropriate antibiotics effected clinical cure. Although there is only a single previous case of anaerobic mediastinitis following median sternotomy incision reported, these two cases suggest that this unusual infection may not be so rare as previously thought.