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The effects of continued smoking were studied in 187 consecutive patients who underwent aorto-iliac or aorto-femoral grafting because of Leriche disease and who left the hospital with well-functioning grafts. The patients were divided into the following groups: (1) never smoked, (2) stopped smoking after the operation, (3) continued to smoke less than a pack a day, and (4) continued to smoke more than a pack a day. The patency of the grafts was evaluated at regular intervals during a follow-up period ranging from 6 months to 10 years. A significant difference in the patency in the favor of the nonsmokers was found, with the “more than one pack a day” group having more than triple the occlusion rate of the nonsmokers, both absolutely and in month-patency time. We recommend that the surgeon make a most sincere effort to induce patients undergoing vascular operations for occlusive vascular disease to give up smoking. Failure to promise to stop the smoking habit should be regarded as a relatively strong contraindication for surgery in patients not directly threatened with loss of an extremity.

Anomaliesof the subclavian arteries are infrequent, but certainly not unknown. The rise of one or both subclavian arteries from the posterior or right side of the aortic arch,3the origin of the right subclavian artery from the descending aorta,2or as a branch of the left subclavian artery,3,7as well as congenital stricture or absence of the left subclavian artery12have been described as rarities.

The majority of unresolved problems in the present era of heart surgery are biologic rather than technical. The advances made in total body perfusion, the improvement in the protection of the myocardium in artificially induced cardiac arrest, etc., have made it possible to deal quite successfully with several types of congenital and acquired heart anomalies. The operative results, however, are still discouraging if the procedure is aimed not only at repair of a defect, but at replacement of a malfunction or destroyed vital structure of the heart, as well. A practical application of this problem is the surgical management of valvular incompetence.Valvular insufficiency can be successfully repaired in some instances by valvuloplasty. In most cases, however, the calcific degeneration of the valve tissue makes plastic correction futile. The only effective way to handle such situations seems to be the complete excision and replacement of the valvular apparatus.Different materials

Bacterial endocarditis following cardiac surgery is a well-known clinical entity. Recent reports indicate a number of Candida endocarditis cases have been seen as a complication of cardiac surgery. The literature is reviewed, and 2 additional cases of Candida endocarditis are reported. One patient developed a mycotic aneurysm of the aorta following open operation for correction of aortic stenosis. This patient had widespread mycotic emboli and died suddenly following rupture of the mycotic aneurysm of the aorta. The second patient developed a Candida blood stream infection following repair of a ventricular septal defect. This patient recovered after treatment with amphotericin-B. Possible portals of entry of the infection are cardiac catheterization, cardiopulmonary by-pass, and prolonged intravenous fluids.

Before utilizing a special ultraviolet irradiation unit for sterilizing the air in the operative region, with resultant exposure of the open wound, it seemed desirable to test the effect of radiation on wound healing in experimental animals.As has been previously reported,1 this unit consists of eight tubes 30 inches (75 cm.) long, mounted with two parallel tubes occupying the central part of each side of a square 5 feet (150 cm.) to the side. This square was mounted in a horizontal plane with its center approximately 4 feet 6 inches (137 cm.) above the operative site so as to place the center of each of the tubes about 5 feet from the incision. Over 80 per cent of the output of these radiation tubes is at 2,537 angstrom units. The intensity of radiation at the operative site, as measured by a photoelectric cell sensitive to this wavelength and

The "scimitar syndrome" is a complex malformation of the heart, lungs, and blood vessels. The pathology of this disease was described in detail by Park19 in 1912, but it was not until 1949 when Dotter et al.6 made the first clinical diagnosis of this anomaly. Since then clinical observations have been published with increasing frequency,1-27 indicating that the scimitar syndrome is not as rare as previously suspected.The purpose of this paper is to discuss briefly the pathology, hemodynamics, and clinical characteristics of this disease and to report five additional cases—four of whom underwent corrective surgery.The main feature of this malformation is the anomalous drainage of the pulmonaryveins into the inferior vena cava. In most cases the anomalous drainage is restricted to the lower lobe of the right lung. In some patients, however, the venous blood of the entire right lung is collected into a