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During the past 10 years, both diagnosis and surgical treatment of many forms of congenital heart disease have become simplified and are performed routinely and successfully in many centers. Problems associated with management of the less common, more complex cardiac anomalies are, however, still far from solved. One of the most interesting, relatively less common, groups are the patients with total anomalous pulmonary venous drainage. Without treatment, the majority of these patients die in infancy. The lesions appear to be anatomically correctable, and yet the first few years of surgical experience with such patients have been disappointing.The purposes of this paper are to present 4 infants with total anomalous pulmonary venous return treated surgically, to review the reported surgical results, and to discuss the present status of surgical treatment of this group of patients. REPORT OF CASES Case 1.—This 6-month-old white female was admitted to the Children's Memorial

Experience with five patients requiring arterial reconstruction for injury distal to the popliteal trifurcation indicates that such operations are both feasible and valuable. Fractures and associated nerve and venous injury are common but do not preclude successful limb salvage. The importance of early diagnosis and prompt surgical repair is emphasized. Preservation of the ipsilateral saphenous vein and exclusion of vascular anastomoses from the wound are useful technical adjuncts.

RUPTURE of the interventricular septum is an uncommon but usually lethal complication of acute myocardial infarction. It is estimated that 1% to 2% of deaths attributable to acute myocardial infarction are associated with septal perforation. The average interval between septal rupture and death is 2 weeks, with 50% of the deaths occurring within the first week. Only 3 patients with this lesion are known to have survived more than 5 years.Until recently, the only treatment available for septal rupture consisted of those measures commonly employed in the treatment of congestive heart failure. Cooley was the first to suggest the surgical closure of interventricular septal rupture with utilization of cardiopulmonary bypass. He closed a 3- × 2-cm. septal defect in a 49-year-old man 11 weeks after infarction. The patient showed remarkable improvement for a few weeks but died of sepsis on the 45th postoperative day. Shickman et al. reported the

In the past year, 3 infants from a single hospital service developed a condition following the description of sclerema neonatorum. Sclerema appeared to be a major factor in the deaths of two of the infants. Because so little attention has been paid this process in surgical literature, it seems pertinent to report the experience with these 3 patients and to review the more recent literature. REPORT OF CASES CASE 1. —A white male infant was brought to the Hospital at 3 days of age. Details of birth and past history were not available. Physical examination on admission revealed a 4 lb. 6½ oz. (2 kg.) infant with a rectal temperature of 95 F. The baby was cyanotic and moderately dehydrated and appeared acutely ill. There was obvious respiratory distress, with coarse rales and rhonchi audible throughout the chest. Subcutaneous tissue over the buttocks and lower extremities was cold, firm, and

To the Editor.—The design of any piece of equipment for the initial resuscitation of the critically ill or injured must be functional and instanteously available. During the conceptual period of the development of the Emergency Medicine and Trauma Center at Oklahoma Memorial Hospital, concern was raised about the difficulty of maneuvering around a critical patient inundated by many tubes, wires, and intravenous (IV) lines. Frequently, it is almost impossible to move from the left side of the stretcher to the right because of the suction tubing coming from the wall behind the patient's head, the ECG monitor position on the right side, the oxygen lines from the left side, and IV tubing dangling from the ceiling. It was decided, therefore, to design life support and resuscitation areas for the critically ill and injured that would allow for the majority of tubes and wires to approach the patient from one

INTRODUCTION Open heart surgery, using extracorporeal circulation, requires large numbers of blood donors, and obtaining these donors has been a limiting factor in some programs. One suggestion for alleviating this problem has been to increase the utilization of available donors by operating on 2 consecutive patients utilizing a single, initial blood priming volume in the pump.1 It is the purpose of this paper to report the successful perfusion of 2 patients with the same pump and priming blood on 3 separate occasions. REPORT OF CASES CASE 1. —A 10-year-old, 26 kg. girl with congenital aortic stenosis underwent open correction on January 20, 1960, using extracorporeal circulation. Bypass was utilized for 12 minutes with a perfusion rate of 3,740 cc. Surgical correction was successful. CASE 2. —A 9-year-old, 11 kg. girl with congenital aortic stenosis and patent ductus arteriosus was the second patient done on January 20, 1960. One hour