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M. C. Overton III, John Derrick and S. R. Snodgrass

). Because of our experience with Case No. 1, it was decided to place the shunt in this patient's right atrium by direct transthoracic approach. This was accomplished by a right submammary incision entering the chest near the sternum between the 4th and 3rd ribs. The thrombosis of the superior vena cava and azygos veins were confirmed by gentle palpation after the pericardium had been opened. The valve tip was then relocated in the mid atrium after placing it in the heart by using the auricular appendage ( Fig. 2 ). Access to the chest from above was via the root of the

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Phanor L. Perot Jr. and Darrell D. Munro

right transthoracic approach, the sixth and seventh ribs were resected posteriorly and their heads and necks removed. During removal of the rib attachments to the spine, the intercostal artery was torn and was clipped on the lateral aspect of the vertebral body proximal to the intervertebral foramen. The intercostal nerve was followed to the intervertebral foramen. After some bone and disc had been removed with the Hall drill in the adjacent vertebral bodies, the dural tube was seen and noted to be pushed back markedly in the midline by a large, rounded, bony, hard

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Joseph Ransohoff, Frank Spencer, Fred Siew and Lyle Gage Jr.

extradural, anterior cord compression directly opposite an interspace at times associated with collapse and arthritic changes at the same level. 2 The anteroposterior myelographic projection can be indistinguishable from that seen with tumors ( Fig. 1 ). Fig. 1. Myelogram of thoracic disc protrusion. Left: Anteroposterior projection suggests a tumor. Right: Lateral projection confirms diagnosis of thoracic disc protrusion. The transthoracic approach offers the best opportunity for removal of the compressive lesion with the least manipulation of the

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Frank P. Smith

segment of the thoracotomy scar. We sought an approach for interrupting the pathways relaying this segmental causalgia, since it was not possible to perform a classical transthoracic approach for sympathectomy of the intercostal segments concerned with her pain because of the carcinoma invading the pleural surface of the chest wall. Surgical Procedure The trans-spinal procedure ( Fig. 1 ) was designed to sever neural fibers between the intercostal segment and the sympathetic chain. This consisted of lateral thoracic laminotomy with rhizotomy through the dural cuff

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George Wortzman, Ronald R. Tasker, N. Barry Rewcastle, J. Clifford Richardson and F. Griffith Pearson

the center of the bodies of T6–8 showing a corticated bony defect in the dorsal aspect of the body of T-7 at the level of the block. Fig. 3. Lateral projection of myelogram showing displacement of the shadow of the spinal cord ( arrows ) toward the body of T-7 at the site of the lesion shown in Fig. 2 . Operation On December 9, 1970, the right dorsal quarter of the body of T-7 was resected using a transthoracic approach through the bed of the seventh right rib. A smooth-walled, corticated, roughly spherical, nearly midline cavity 1 cm

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Ronald L. Paul, Roger H. Michael, James E. Dunn and J. Powell Williams

T he authors have recently encountered three cases of traumatic anterior cord compression resulting in incomplete myelopathies which were treated surgically by the anterior transthoracic approach. The purpose of this paper is to present these cases and describe their surgical management in detail. Case Reports Case 1 This 43-year-old man was involved in a light airplane crash on September 2, 1973. He was taken to a nearby hospital where he was noted to be in hemodynamic shock, with a distended abdomen and moderate respiratory distress (a chest film

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Melvyn M. Gelch

lid, dilator pupillae muscle, and involuntary muscle of Müller, which maintains the normal position of the eye. Thus, compression of the anterior root of T-1 by a herniated disc can result in a complete Horner's syndrome. Surgery was performed with the patient in the sitting position, using a standard posterior approach. The prone position can be used to decrease the possibility of air embolus. The transthoracic approach as described by Ransohoff, et al. , 5 and Perot and Munro 4 is not indicated at this level. An anterior thoracic approach, similar to that

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Russel H. Patterson Jr. and Ehud Arbit

stress the need for a careful search for disc fragments even by opening the dura, because sometimes a fragment may be embedded in the spinal cord. The risk that such a fragment may be overlooked appears greater with the transpleural, transthoracic approach, which is why we favor it least among the various lateral or oblique approaches. However, all these approaches have given better results than the old posterior approach ( Table 1 ). TABLE 1 Summary of the results of various approaches in surgery for thoracic discs * Result

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Chun-Jen Shih and Mao-Tsun Lin

the sympathetic nervous system. J Lancet 69: 377–384, 1949 14. Nadel ER , Bullard RW , Stolwijk JAJ : Importance of skin temperature in the regulation of sweating. J Appl Physiol 31 : 80 – 87 , 1971 Nadel ER, Bullard RW, Stolwijk JAJ: Importance of skin temperature in the regulation of sweating. J Appl Physiol 31: 80–87, 1971 15. Palumbo LT : Anterior transthoracic approach for upper thoracic sympathectomy. Arch Surg 72 : 659 – 666 , 1956 Palumbo LT: Anterior transthoracic

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Richard K. Shaw, William W. L. Glenn, James F. Hogan and Mildred L. Phelps

potentials were 0.4 mV and 0.3 mV, respectively, and contraction of each hemidiaphragm was clinically satisfactory. Exploration of the right phrenic nerve on May 16, 1979, was hampered by an extremely large internal jugular vein and, therefore, a transthoracic approach was used for implantation of a diaphragm pacemaker on the right side on June 4. The transcervical approach had been used for implantation of a diaphragm pacemaker on the left side on May 22. Although the right conduction time and muscle action potential were normal postoperatively (8 msec and 0.7 mV