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CAVITARY PULMONARY HISTOPLASMOSIS
31 2
ARNE MALM
catheterization before and after operation (one to ten years after operation). The decrease in pressure in the right heart and in the pulmonary circulation was invariably significant (Fig. 4- ) • Some preoperative findings may often be of prognostic value in cases where surgery is considered (Table 1) . Enlargement of the heart, atrial fibrillation and a slight diastolic dip of the right ventricular curve give reason to expect myocardial involvement and seem to be prognostically unfavorable. The prognosis of longstanding constrictive pericarditis with irreversible liver damage (cardiac cirrhosis), is poor and those cases cannot be substantially improved by operation. This is reflected in the persistent hypoproteinemia as in the three late deaths in the present series (Table 1). On the other hand, the pericardial calcification per se appears to be of no definite prognostic value. If the mechanical factor, i.e. the pericardial thickening, is eliminated in time before the myocardium and the liver have
Disease, 01 the Chest
developed irreversible changes, complete or substantial relief can be obtained by resection of the pericardium. Therefore, once a firm diagnosis of constrictive pericarditis has been established, operation is indicated . This should be performed as soon as possible after medical regulation. REFERENCES BIGELOW, W. G., DOLAN, F. G ., WILSON, D . R. AND GUNTON, R. W . : "Subtotal Pericardectomy for Constrictive Pericarditis," Surger)!, 41: 102, 1957 .
2 JOHANSSON, L.: "Surgical Treatment of Chronic Constrictive Pericarditis," Kungl. Boktryck, P. A. Nontedt and Soner, Stockholm, 1958. 3 MALM, A.: "Pericardectomy for Constrictive Pericarditis," Acta Ch ir. Seandinau., 117: 116, 1959. 4 MARSHALL, J. R. AND PANTRIOOE, J . F . : " Pericardectomy for Chronic Constrictive Pericarditis," Lancet, 1038 , 1957. 5 SAWYER, C. G., BURWELL, C . S., DEXTER, L., EpPINGER, E. C., GOODALE, W . T., GORLlN, R ., HARKEN, D . E. AND HAYNES, F. W . : "Chronic Constrictive Pericarditis: Further Consideration of the Pathologic Physiology of the D isease," Am. Heart I ., 44:207, 1952. For reprints, please write Dr. Maim at Allmanna Sjukhuset, Malmo, Sweden.
CAVITARY PULMONARY HISTOPLASMOSIS Experience with US patients with cavitary hlst()plasmasls treated by pulmonary resectlon between March, 1952 and July. 1961 , Is reported. No patieRt receIved amphotericin B. DIsease In the contralateral lung recurred In two patients; the contralateral lesIon was removed from one of these patients. Two patients had bilateral dlaease at the time operation was performed. There has been no pOStoperative spread of pulmonary disease or pleural space Infection due to H. ",ps.14I.",. No patient has had recur-
rence of dIsease on the side of operation. Three patients who developed postoperative pleural space problems were managed succesfully by performance of a limIted thoracoplasty. All patients have been followed since operation for a period varying from nIne months to ten years. DIVELEY, W ., McCRAIXBN, R., STONY, W., GUBST, ] . AND McCoNNBLL, V. : "Surgical Treatment 01 Cavitary Pulmonary Histnplasmosis," T. Thor . _J CMJiof1lU. S.r,., 4' : 101, 1963.
ESOPHAGUS LINED BY COLUMNAR EPITHELIUM A condition Is described In whIch as much as the lower halt of the esophagus has been found to be lined by a sheet of columnar (gastric-like) epithelium . It Is usually first discovered In later life as a result of a stricture or ulcer. The physIcian unfamiliar with the condItion will commonly make the mIstaken diagnosis of carcinoma. Although generally held to be of congenital origin, a concept Is
discussed which suggests that this state of a1faIrs represents an adaptive epithelial change In response to the chronic abnormal (acid-pepsin) environment within the esophagus. The commonly associated hiatal hernia Is usually responsible for the gastr()esophageal Incompetence and refiux esophagltll. AnLBa. R. H. : "The Lower Esophagus Lined by Columnar Epithelium ," T. Thor. ""J C.,Jiof1lU. S." •• 45:13, 1963.
ARNE MALM
catheterization before and after operation (one to ten years after operation). The decrease in pressure in the right heart and in the pulmonary circulation was invariably significant (Fig. 4- ) • Some preoperative findings may often be of prognostic value in cases where surgery is considered (Table 1) . Enlargement of the heart, atrial fibrillation and a slight diastolic dip of the right ventricular curve give reason to expect myocardial involvement and seem to be prognostically unfavorable. The prognosis of longstanding constrictive pericarditis with irreversible liver damage (cardiac cirrhosis), is poor and those cases cannot be substantially improved by operation. This is reflected in the persistent hypoproteinemia as in the three late deaths in the present series (Table 1). On the other hand, the pericardial calcification per se appears to be of no definite prognostic value. If the mechanical factor, i.e. the pericardial thickening, is eliminated in time before the myocardium and the liver have
Disease, 01 the Chest
developed irreversible changes, complete or substantial relief can be obtained by resection of the pericardium. Therefore, once a firm diagnosis of constrictive pericarditis has been established, operation is indicated . This should be performed as soon as possible after medical regulation. REFERENCES BIGELOW, W. G., DOLAN, F. G ., WILSON, D . R. AND GUNTON, R. W . : "Subtotal Pericardectomy for Constrictive Pericarditis," Surger)!, 41: 102, 1957 .
2 JOHANSSON, L.: "Surgical Treatment of Chronic Constrictive Pericarditis," Kungl. Boktryck, P. A. Nontedt and Soner, Stockholm, 1958. 3 MALM, A.: "Pericardectomy for Constrictive Pericarditis," Acta Ch ir. Seandinau., 117: 116, 1959. 4 MARSHALL, J. R. AND PANTRIOOE, J . F . : " Pericardectomy for Chronic Constrictive Pericarditis," Lancet, 1038 , 1957. 5 SAWYER, C. G., BURWELL, C . S., DEXTER, L., EpPINGER, E. C., GOODALE, W . T., GORLlN, R ., HARKEN, D . E. AND HAYNES, F. W . : "Chronic Constrictive Pericarditis: Further Consideration of the Pathologic Physiology of the D isease," Am. Heart I ., 44:207, 1952. For reprints, please write Dr. Maim at Allmanna Sjukhuset, Malmo, Sweden.
CAVITARY PULMONARY HISTOPLASMOSIS Experience with US patients with cavitary hlst()plasmasls treated by pulmonary resectlon between March, 1952 and July. 1961 , Is reported. No patieRt receIved amphotericin B. DIsease In the contralateral lung recurred In two patients; the contralateral lesIon was removed from one of these patients. Two patients had bilateral dlaease at the time operation was performed. There has been no pOStoperative spread of pulmonary disease or pleural space Infection due to H. ",ps.14I.",. No patient has had recur-
rence of dIsease on the side of operation. Three patients who developed postoperative pleural space problems were managed succesfully by performance of a limIted thoracoplasty. All patients have been followed since operation for a period varying from nIne months to ten years. DIVELEY, W ., McCRAIXBN, R., STONY, W., GUBST, ] . AND McCoNNBLL, V. : "Surgical Treatment 01 Cavitary Pulmonary Histnplasmosis," T. Thor . _J CMJiof1lU. S.r,., 4' : 101, 1963.
ESOPHAGUS LINED BY COLUMNAR EPITHELIUM A condition Is described In whIch as much as the lower halt of the esophagus has been found to be lined by a sheet of columnar (gastric-like) epithelium . It Is usually first discovered In later life as a result of a stricture or ulcer. The physIcian unfamiliar with the condItion will commonly make the mIstaken diagnosis of carcinoma. Although generally held to be of congenital origin, a concept Is
discussed which suggests that this state of a1faIrs represents an adaptive epithelial change In response to the chronic abnormal (acid-pepsin) environment within the esophagus. The commonly associated hiatal hernia Is usually responsible for the gastr()esophageal Incompetence and refiux esophagltll. AnLBa. R. H. : "The Lower Esophagus Lined by Columnar Epithelium ," T. Thor. ""J C.,Jiof1lU. S." •• 45:13, 1963.