[Unusual traumatic rupture of the thoracic aorta with avulsion of the left subclavian artery]

Of the many cases of traumatic rupture of the aorta diagnosed each year at l"Hôpital du Sacré-Coeur, Montreal, most patients are already in irreversible shock when seen. However, during the period Oct. 1, 1974 to Sept. 30, 1975, prompt surgical treatment saved six patients. One of these six patients had a complete trans-section of the aortic arch between the left carotid and left subclavian arteries with avulsion and slight retraction of the left subclavian artery. Repair of the aortic arch and left subclavian artery was accomplished without extracorporeal circulation. A sutureless temporary bypass shunt was created by (a) cannulating the ascending and descending aorta, the cannulas being secured with purse-string sutures and joined by a 3/8-inch (94-mm) polyvinyl chloride (PVC) tube connected to a "double T" adapter, and (b) joining two small PVC tubes from the adapter with two straight cannulas, a no. 14 being inserted into the innominate artery and a no. 12 being inserted into the left carotid artery. With this temporary bypass created, the ascending and descending aorta and aortic arch vessels were all clamped. Aortic continuity was re-established with a tubular Dacron graft (diameter, 19 mm) to which was anastomosed a side-arm of knitted Dacron (diameter, 10 mm) to repair the left subclavian artery. Throughout the temporary perfusion the brain, spinal cord and all abdominal viscera were well protected. No sign of ventricular distension was detected. This report is the first in which complete transsection of the aortic arch has been managed by a sutureless bypass shunt allowing perfusion of all aortic arch vessels without extracorporeal circulation.

Outpatient management of intercostal tube drainage in spontaneous pneumothorax

In a series of 226 patients with spontaneous pneumothorax, 167 (74%) were managed successfully on an outpatient basis by observation (20%) or by intercostal tube drainage and a flutter valve (54%). Only 59 patients (26%) were hospitalized, and 42 of these were treated surgically (18.6%). Outpatient management with a flutter valve has proved to be safe, efficient, and economical.

[An unusual case of hydatid cyst]

A hydatid cyst of the spleen developed in a Greek-Canadian woman who had lived on a sheep farm. The cyst extended through the diaphragm to the left lower lobe. Splenectomy and left lower lobectomy and excision of contiguous diaphragm were performed. Histopathologic examination confirmed the presence of hydatid cysts in both spleen and lung. Postoperative course was uneventful. In Canada hydatid disease is rare and its occurrence sporadic. It is commoner among Canadian Indians and immigrants than native Canadians. Treatment is surgical; en bloc excision of tissue eliminates the possibility of anaphylaxis of dissemimination of scolices.

Spontaneous pneumothorax: outpatient management with intercostal tube drainage

In a series of 104 episodes of pneumothorax 75 percent of episodes were managed successfully on an outpatient basis by observation (23.1 percent) or by intercostal tube drainage using a flutter valve (51.9 percent). The patients for whom this treatment was not successful were admitted to hospital; 17 of them (16.3 percent of 104) were treated surgically. Bleb suturing with a stapling device and dry sponge abrasion of the pleura was the operation of choice.