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A series of seventeen patients with flail chest injuries, in which the piston respirator was utilized, have been compared with a similar series of sixteen patients in whom this respirator was not used. The comparison shows that “wet lung syndrome,” a major cause of death, can be prevented or reversed by the use of the piston respirator, with a significant reduction in mortality. These findings indicate that piston respirator therapy should be instituted immediately on all major flail chest injuries.

Convulsions during anesthesia are rather uncommon but it is important for physicians to be on the alert to treat these unfortunate occurrences and prevent them if possible. Six convulsions during anesthesia were encountered in one year. The etiology of these convulsions is extremely vague. The literature is replete with possible causes, many of which contradict each other, thereby making the situation more confusing. Despite lack of knowledge concerning the causative factors, we should give strict attention to the preoperative care of our patients, particularly those who are acutely ill and toxic, thereby very likely lessening the number of convulsions during anesthesia. The authors recommend the prompt administration of sodium pentothal as advocated by Lundy. Heretofore the mortality in patients having convulsions during anesthesia was extremely high. With sodium pentothal at hand, this figure should be lower. There was only one death among the six patients herein presented and this was attributable, not to the convulsion but to hepatorenal failure on the fifth postoperative day.

1. 1. A review of the literature on non-parasitic cyst of the liver is given. 2. 2. Surgical interference is the treatment of choice. 3. 3. A case of non-parasitic cyst of the liver is reported, with recovery. 4. 4. In this case, as in several others reported, evisceration occurred, which illustrates the necessity for care to prevent such an accident.

One hundred forty-five cases of acute penetrating gunshot wounds of the chest encountered in civilian practice during a six year period are analyzed. The treatment, which was based on a specific set of guidelines, consisted mainly of intercostal tube drainage, thoracotomy, and thoracoabdominal exploration. Thoracoabdominal injuries occurred in forty-four cases (30 per cent) and were fatal in eight (18 per cent). The over-all mortality in this series was 14.4 per cent (twenty-one catients died whiases). Thirteen ple on the operating table, four more patients died within twenty-four hours and four others died between one and fifteen days. The rapid transport of patients as well as our emergency surgical plan has been a factor in the dramatic salvage of some cases.

T ORSION of the spermatic cord and torsion of the testicIe are comparativeIy rare conditions, and are practicaIIy aIways surgica1. Those cases that have not been treated surgicaIIy and have been foIIowed up, have reveaIed eventuaIIy a compIeteIy atrophied testicIe. C. Moncanyl reported a case in a ten-months-oId chiId in which he performed a detorsion without operation, and he reports atrophy and fina disappearance of the testis. Perhaps many other cases which have been reIieved by detorsion without operation wouId show a simiIar fina result. What was probabIy the first case was reported by DeIasiauve2 in 1840. Since then Vanvaerts3 coIIected 44 cases, reporting them in 1904. O’Connor,4 in rgrg, collected 124 cases. More recentIy Keyes5 and his associates at BeIIevue HospitaI reported seven cases from the records of the genitourinary service at that hospita1. CIute6 reported 3 persona1 cases in rgrg. Max Thorek’ reported I case in rgrg, and 2 in 1925. Papin,* Murray,g PoweII,‘O Begg,” Nash , l2 Young, l3 MeItzer14 and others have reported cases, which indicates that the condition is more frequentIy recognized and recorded than formerIy.

Forty-four acute cases of thoracoabdominal injuries in civilian practice are presented. Injury to multiple abdominal organs occurred in 50 per cent. The mortality in those with multiple organ injuries was 33 per cent whereas among those with injury to a solitary organ it was 4.5 per cent. The liver was injured in 61 per cent of cases. Although intercostal tube drainage (50 per cent) usually suffices in the management of the chest injury, thoracotomy was indicated in a number of cases. We advocate preservation of the thoracoabdominal barrier, by making a separate thoracic and abdominal wound, to prevent thoracic contamination, diaphragmatic hernia, and to achieve a thorough abdominal exploration. The total complication rate is 25 per cent. There were nine deaths (20 per cent) in the entire series, eight of which were directly related to the thoracoabdominal injury, yielding a corrected mortality of 18 per cent. One patient died from a separate gunshot wound to the brain.

1. 1. A case of congenital obstruction at the duodenojejunal junction is reported. 2. 2. Posterior gastroenterostomy was done in an eight day old infant with recovery.