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Recurrence is the most common complication of spontaneous pneumothorax. Open thoracotomy with resection of obliteration of blebs and parietal pleurectomy provides the best protection against recurrence. Twenty-seven consecutive patients underwent open thoracotomy for recurrent pneumothorax with no mortality and minimum morbidity and have remained free from recurrence. We believe that thoracotomy should be more widely used in the treatment of what is called spontaneous pneumothorax, since this treatment may remove the real cause of the disease.

Four patients with atrial myxoma underwent successful surgical excision with the aid of cardiopulmonary bypass at the Medical University of South Carolina. This report describes their clinical manifestations and treatment with special emphasis on advances in surgical technique. This report also emphasizes the malignant potential of this tumor and reviews the recent literature.

Various hemodilution agents are now used routinely to prime heart-lung machines for cardiac operations. Hemodilution has resulted in considerable conservation of blood as well as diminution of plasma and corpuscle damage by decreasing the concentration of these elements in blood during extracorporeal circulation. Controversy has existed regarding the relative efficacy of various hemodilution solutions. This study covers 68 patients, divided into three groups, for whom hemodilution was done as follows: (1) the pump was primed with a 5% dextrose solution containing no colloid; (2) Ringer's lactate solution containing approximately 1% low-molecular-weight dextran was used; and (3) a new plasma expander, hydroxyethyl starch, was used as the colloid component of an electrolyte solution. Evaluations and comparisons were carried out for flow rates, blood pressure, urine volume, hematocrit, BUN, blood loss, clotting factors, and the patient's clinical course with regard to pulmonary and neurological complications. We conclude that a colloid is beneficial, especially with longer perfusions.

In an attempt to predict survival of open-heart surgery, particularly among high risk subjects who undergo extra-corporeal circulation [ECG] using pump oxygenation perfusion, a preoperative battery including intellectual, personality and neuropsychological instruments and also ratings of cardiac impairment, was administered to 15 control [cardiac surgery without ECG] and 72 experimental [ECG] subjects. Subjects were divided into survivor [S] and fatality [F] groups, and preoperative test data were analyzed using multivariate stepwise discrimination techniques. In a variety of analyses, at least 86% and as high as 100% of subjects were correctly classified as survivors or fatalities on the basis of variables sampled, indicating the outcome of cardiac surgery may be predicted preoperatively with a high degree of accuracy.