Percutaneous electrical cordotomy in the relief of intractable pain.

Carcinoma of Bronchus-Garnett et al. MEDICALIJSUHNAL the explanation for the absent lobar perfusion in the other four patients in group 1. However, it is also possible that the bronchial tumour was producing obstructive emphysema, in which case it is postulated that the intra-alveolar pressure may then have been sufficient to prevent the radioactively labelled microemboli from entering the emphysematous zone. Wagner et al. (1965) reported four cases of bronchogenic carcinoma in which the scan indicated obstruction of the pulmonary blood flow to a degree unsuspected from the size of the lesion on the chest radiography. These workers inflated balloons in the bronchi of anaesthetized dogs and produced a decrease in pulmonary blood flow, as shown by lung scanning. They postulated that the effect may have resulted from regional hypoxia, but in our group 1 patients the breathing of 100% oxygen from a facemask before and during the scan produced no alteration in the pattern of perfusion. In a patient with carcinoma of the bronchus one is not usually concerned with the function of the contralateral lung, provided the overall function of the lungs is reasonable. It was therefore especially interesting to find that in patients in group 2 the perfusion in the contralateral lung was less than that in the lung already partially destroyed by tumour. Thus in almost 20% of the patients studied it is possible that pneu-monectomy would have produced severe respiratory disability or even early postoperative death. Necropsy studies have not as yet been performed on any of these patients, and it can only be conjectured that the "healthy" lung has been previously damaged by thromboembolic or bronchiolar disease. Patchy areas of decreased perfusion in both lungs in patients presumed to have emphysema, as well as carcinoma of the bronchus (group 3), or in patients with old tuberculous disease (group 4), were not unexpected. Lopez-Majano et al. (1966) described similar changes in emphysema. Nor was it surprising to find areas of decreased perfusion which coincided with the area of radiological abnormality in 21 of the 32 patients in group 5. However, in the remaining 11 patients areas of decreased perfusion were found in radiologically unaffected areas of the same lung, and in five of these there was no evidence of obstruction to lobar or segmental bronchi. As yet we are unable to explain this finding. Summary Lung scans were performed in 50 patients with carcinoma of the …