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CARDIOVASCULAR DISORDERS
560
Conferences CARDIOVASCULAR DISORDERS FROM A CORRESPONDENT
THE.fourth Meeting of the International Cardiovascular was held in Munich from Sept. 18 to 20.
Society
Changing Concepts in Vascular Surgery Dr. M. E. DEBAKEY (Houston, Texas), in the Rene Leriche lecture, spoke of the variety of ways in which the haemodynamics of obstructed or diseased vessels can be restored: by endarterectomy; by excision and grafting; or by a bypass in which a channel is reconstituted without excision. The methods which he illustrated included multiple anastomoses, sometimes over a considerable length of blood-vessel. He emphasised that arteriosclerotic lesions were sometimes localised, and even though multiple could often be treated adequately. Subsequent speakers included Prof. R. FONTAINE (Strasbourg) who, despite the current popularity of arterial homografts and prostheses, found that the use of veins in replacing arteries had proved valuable. The remarks of other speakers suggested that crimped, knitted Dacron’and ’Teflon’ tubes are in widespread use. Prof. C. G. ROB (London) described the results of reconstruction operations after follow-ups of more than eighteen months. His preference was for a prosthesis in replacing or bypassing the aorta and larger vessels and for arterial homografts for vessels smaller than the femoral artery. He stressed that with artery grafts the best results were obtained by deep freezing and sterilisation with antibiotics.
between the early and bad-risk cases and the later and betterrisk ones was striking, and illustrated clearly the progress that had been achieved. Dr. C. DUBosT (Paris) discussed extracorporeal circulation in a series of over 150 cases. He pointed to the danger of operating on ventricular septal defects with severe pulmonary hypertension, cyanotic Fallot’s tetrad, and auriculoventricular canals, where the mortality lay between 20 and 30%. The views and results mentioned by different speakers were remarkably alike. Whereas the results of more simple operations under perfusion were steadily improving, these could not approach the good results obtained in the treatment of atrial septal defects and pure pulmonary stenosis under hypothermia, The problems of the auriculoventricular canal, hypertensive ventricular septal defects, and cyanotic Fallot’s tetrad were still some way from solution.
High Atmospheric Pressure Prof. I. BOEREMA (Amsterdam) demonstrated experimental work on animals under increased atmospheric pressure. By reducing the hxmoglobin as low as 5% it was possible to keep the animal alive in a pressure of three atmospheres. The plasma became saturated with oxygen, and this physical solution appeared to be adequate for the animal’s basic needs. Open Heart Surgery Dr. W. G. BIGELOW (Toronto) said that open heart operations under hypothermia were undertaken at 29-3lC (the level accepted as the most suitable by subsequent speakers). 130 cases of atrial septal defect had been operated on under hypothermia, with 6 deaths. Extracorporeal circulation was reserved for more complicated atrial septal defects and for other conditions in which cooling was unsuitable. 10 cases of mitral insufficiency had been treated by annuloplasty with promisingearly results; there were 3 deaths. Prof. H. SWAN (Denver) also advocated surface cooling in simple cases and cited his experience in 280 cases, of which 149 were simple atrial septal defects (8 deaths) and 54 were pulmonary stenoses (no death). He also reserved perfusion for ventricular defects, auriculoventricular canals, and Fallot’s tetrad; he was finding increasing benefit from a combination of perfusion and moderate hypothermia. Mr. T. HoLnsES SELLORS (London), discussing the surgery of atrial septal defects, cited 201 cases of secundum defect with 7 deaths;the mortality in 150 good-risk cases was less than 1%. Hypothermia was used exclusively in all secundum cases and perfusion was reserved for ostium primum defects. Prof.’ E. DERRA (Dusseldorf) said that atrial septal defect had been operated on in 273 cases with 20 deaths and .210 good results. His figure for anomalous venous drainage in secundum defects (20", ) was four times greater than that given by Mr. Sellors. Prof. C. CRAFOORD (Stockholm) emphasised how in the early stages of open-heart work the risks taken were often considerable and the results consequently much inferior to those obtained when technical problems had been solved and more suitable types of case were encountered. The difference
’
Extracorporeal Circulation Dr. DEBAKEY read a paper for Dr. D. A. COOLEY (Houston) on experiences with 600 cases treated with extracorporeal circulation. These included cases of acquired valvular disease and of aneurysm of the left ventricle, in addition to the types of cases already discussed. They also included 4 cases of myxoma of the left atrium in which the operation was successful. Altogether 12 cases of successful removal of myxoma were reported at the meeting. Dr. DENIS MELROSE, Mr. W. P. CLELAND, and Mr. H. H. BENT ALL (London) illustrated important aspects of extracorporeal circulation, including the necessity for keeping the venous pressure constant and for economy in the use of blood, the association of persistent ductus arteriosus with ventricular septal defects, and the problem of aortic incompetence during bypass. Prof. R. ZENKER (Munich) reported 70 cases of extracorporeal circulation, Iwith the help of hypothermia.
POLIOMYELITIS FROM A CORRESPONDENT
THE sixth
European Symposium
on
Poliomyelitis,
with the participation of the German Society of Struggle
against Poliomyelitis, was held in Munich on Sept. 6-9. As Prof. H. LASSEN said in his introduction, it was in Bavaria, at Stuttgart, that Heine in 1840 first described poliomyelitis, calling it Spinale Kinderldhmung. Vaccination and
Epidemiology
morning session was devoted to vaccination and epidemiology; a change from two years ago, when statistics of notifications was still the rule. Nearly all delegates spoke of the safety of the Salk or kindred vaccines. In the German Federal Republic, however, among 165,000 persons vaccinated 1 developed paralysis five days later and 3 had high pyrexia and transitory paralyses. None of the other 12 countries had serious trouble and even this exception did not seriously challenge the benefits, for in Germany 3 among 121,000 vaccinated and 153 among 539,000 non-vaccinated controls got poliomyelitis, the rates per 100,000 being 2-51 and 28-31. In some countries where vaccination is voluntary and free, the percentages immunised were very high; in Denmark 99% of those aged 9 months to 14 years had been immunised, 93% aged 15 to 19, and 85% aged 20 to 39. The incidence in Denmark in 1951-55. which included major epidemics in 1952 and 1953, was 15 per 100,000, and in 1956-59, the years of vaccination, 0-65. Dr. H. VON MAGNUS (Denmark) said that in a group of children, admitted to hospital for non-febrile illnesses, 5-8% excreted The first
"
"
poliovirus. In the United Kingdom satisfactory conversion-rates hd been recorded, as judged by the production of antibodies, hu: the rates varied with different vaccines. Type-I virus was Ke chief invader. 3200 of children up to 15 and 73% of those aged 15-26 were unvaccinated. In Norway the occurrence of new cases among children vaccinated two or three times was ? lower than in children vaccinated once or not at all.
Conferences CARDIOVASCULAR DISORDERS FROM A CORRESPONDENT
THE.fourth Meeting of the International Cardiovascular was held in Munich from Sept. 18 to 20.
Society
Changing Concepts in Vascular Surgery Dr. M. E. DEBAKEY (Houston, Texas), in the Rene Leriche lecture, spoke of the variety of ways in which the haemodynamics of obstructed or diseased vessels can be restored: by endarterectomy; by excision and grafting; or by a bypass in which a channel is reconstituted without excision. The methods which he illustrated included multiple anastomoses, sometimes over a considerable length of blood-vessel. He emphasised that arteriosclerotic lesions were sometimes localised, and even though multiple could often be treated adequately. Subsequent speakers included Prof. R. FONTAINE (Strasbourg) who, despite the current popularity of arterial homografts and prostheses, found that the use of veins in replacing arteries had proved valuable. The remarks of other speakers suggested that crimped, knitted Dacron’and ’Teflon’ tubes are in widespread use. Prof. C. G. ROB (London) described the results of reconstruction operations after follow-ups of more than eighteen months. His preference was for a prosthesis in replacing or bypassing the aorta and larger vessels and for arterial homografts for vessels smaller than the femoral artery. He stressed that with artery grafts the best results were obtained by deep freezing and sterilisation with antibiotics.
between the early and bad-risk cases and the later and betterrisk ones was striking, and illustrated clearly the progress that had been achieved. Dr. C. DUBosT (Paris) discussed extracorporeal circulation in a series of over 150 cases. He pointed to the danger of operating on ventricular septal defects with severe pulmonary hypertension, cyanotic Fallot’s tetrad, and auriculoventricular canals, where the mortality lay between 20 and 30%. The views and results mentioned by different speakers were remarkably alike. Whereas the results of more simple operations under perfusion were steadily improving, these could not approach the good results obtained in the treatment of atrial septal defects and pure pulmonary stenosis under hypothermia, The problems of the auriculoventricular canal, hypertensive ventricular septal defects, and cyanotic Fallot’s tetrad were still some way from solution.
High Atmospheric Pressure Prof. I. BOEREMA (Amsterdam) demonstrated experimental work on animals under increased atmospheric pressure. By reducing the hxmoglobin as low as 5% it was possible to keep the animal alive in a pressure of three atmospheres. The plasma became saturated with oxygen, and this physical solution appeared to be adequate for the animal’s basic needs. Open Heart Surgery Dr. W. G. BIGELOW (Toronto) said that open heart operations under hypothermia were undertaken at 29-3lC (the level accepted as the most suitable by subsequent speakers). 130 cases of atrial septal defect had been operated on under hypothermia, with 6 deaths. Extracorporeal circulation was reserved for more complicated atrial septal defects and for other conditions in which cooling was unsuitable. 10 cases of mitral insufficiency had been treated by annuloplasty with promisingearly results; there were 3 deaths. Prof. H. SWAN (Denver) also advocated surface cooling in simple cases and cited his experience in 280 cases, of which 149 were simple atrial septal defects (8 deaths) and 54 were pulmonary stenoses (no death). He also reserved perfusion for ventricular defects, auriculoventricular canals, and Fallot’s tetrad; he was finding increasing benefit from a combination of perfusion and moderate hypothermia. Mr. T. HoLnsES SELLORS (London), discussing the surgery of atrial septal defects, cited 201 cases of secundum defect with 7 deaths;the mortality in 150 good-risk cases was less than 1%. Hypothermia was used exclusively in all secundum cases and perfusion was reserved for ostium primum defects. Prof.’ E. DERRA (Dusseldorf) said that atrial septal defect had been operated on in 273 cases with 20 deaths and .210 good results. His figure for anomalous venous drainage in secundum defects (20", ) was four times greater than that given by Mr. Sellors. Prof. C. CRAFOORD (Stockholm) emphasised how in the early stages of open-heart work the risks taken were often considerable and the results consequently much inferior to those obtained when technical problems had been solved and more suitable types of case were encountered. The difference
’
Extracorporeal Circulation Dr. DEBAKEY read a paper for Dr. D. A. COOLEY (Houston) on experiences with 600 cases treated with extracorporeal circulation. These included cases of acquired valvular disease and of aneurysm of the left ventricle, in addition to the types of cases already discussed. They also included 4 cases of myxoma of the left atrium in which the operation was successful. Altogether 12 cases of successful removal of myxoma were reported at the meeting. Dr. DENIS MELROSE, Mr. W. P. CLELAND, and Mr. H. H. BENT ALL (London) illustrated important aspects of extracorporeal circulation, including the necessity for keeping the venous pressure constant and for economy in the use of blood, the association of persistent ductus arteriosus with ventricular septal defects, and the problem of aortic incompetence during bypass. Prof. R. ZENKER (Munich) reported 70 cases of extracorporeal circulation, Iwith the help of hypothermia.
POLIOMYELITIS FROM A CORRESPONDENT
THE sixth
European Symposium
on
Poliomyelitis,
with the participation of the German Society of Struggle
against Poliomyelitis, was held in Munich on Sept. 6-9. As Prof. H. LASSEN said in his introduction, it was in Bavaria, at Stuttgart, that Heine in 1840 first described poliomyelitis, calling it Spinale Kinderldhmung. Vaccination and
Epidemiology
morning session was devoted to vaccination and epidemiology; a change from two years ago, when statistics of notifications was still the rule. Nearly all delegates spoke of the safety of the Salk or kindred vaccines. In the German Federal Republic, however, among 165,000 persons vaccinated 1 developed paralysis five days later and 3 had high pyrexia and transitory paralyses. None of the other 12 countries had serious trouble and even this exception did not seriously challenge the benefits, for in Germany 3 among 121,000 vaccinated and 153 among 539,000 non-vaccinated controls got poliomyelitis, the rates per 100,000 being 2-51 and 28-31. In some countries where vaccination is voluntary and free, the percentages immunised were very high; in Denmark 99% of those aged 9 months to 14 years had been immunised, 93% aged 15 to 19, and 85% aged 20 to 39. The incidence in Denmark in 1951-55. which included major epidemics in 1952 and 1953, was 15 per 100,000, and in 1956-59, the years of vaccination, 0-65. Dr. H. VON MAGNUS (Denmark) said that in a group of children, admitted to hospital for non-febrile illnesses, 5-8% excreted The first
"
"
poliovirus. In the United Kingdom satisfactory conversion-rates hd been recorded, as judged by the production of antibodies, hu: the rates varied with different vaccines. Type-I virus was Ke chief invader. 3200 of children up to 15 and 73% of those aged 15-26 were unvaccinated. In Norway the occurrence of new cases among children vaccinated two or three times was ? lower than in children vaccinated once or not at all.