Thorax: first published as 10.1136/thx.20.5.477 on 1 September 1965. Downloaded from Itorax (1965), 20, 477. Proceedings of the Thoracic Society The Summer Meeting of the Thoracic Society was held on 9 and 10 July in the Memorial Hall, the Town Hall, Sheffield. Summaries of the symposium and papers follow. SYMPOSIUM ON COMPUTERS IN MEDICINE IN A RENAL FUNCTION SURVEY DURING OPEN-HEART SURGERY PRINCIPLES J. C. A. RAISON said that some data of renal function L. C. PAYNE said that management, whether of a during extracorporeal circulation were used in a pilot hospital, the health and welfare of a community, or study to illustrate the possible use of a hospital board of patients, involves information regarding the hos- computer which had been installed originally for pital, the community, and the patients. It involves finance control. The subject and material provided reference information about disease, its incidence and examples of the theoretical advantages of a computer manifestations, about drugs, their doses, toxicities, system for clinical research, incorporating multiple and interactions, about the multiplicity of medical procedures, complex tabulation, multiple calcula- measurements and their interpretations, about the tions, correlation of accumulating data from different aetiology and epidemiology, and so on. It involves sources, and prediction as 'off-line' features, while current information of what is going on while it is 'on-line' facilities might allow ultimately for thera- going on, for no manager will respond to any element peutic control. The acknowledged difficulty of in a developing situation of which he is unaware, and communicating with a machine was heightened by moreover not do so with all the confidence of not that of communication with a non-scientific pro- even knowing he does not know. The computer is grammer, who spent an uneconomic amount of time the most versatile information engine ever contrived; preparing too limited a programme. The Fortran pro- copyright. it can store knowledge on a scale commensurate with gramme desired seemed almost as great an obstruc- what is known rather than what a single human mind tion to the clinician. Without a computer-conversant can absorb. It can enable more complete and up-to- biomedical specialist available, the clinician with date information to be gathered on developing situa- definite but occasional computer problems may best tions, and it means that the computer-aided doctor is hope for the production of 'package-deal' pro- going to be a more effective doctor than one who grammes dealing with the simple mathematical and relies on human faculties alone, whether he is statistical enquiries which he will most often require, http://thorax.bmj.com/ concerned with diagnosis, prognosis, or therapy, with and the occasional use of a small on-line machine to epidemiology or surgery, with patient care or admini- which he can pose his questions directly. stration. The paper explained some of the basic principles and concepts, so that this prospect would IN MEDICAL BIBLIOGRAPHY be more evident. M. M. CUMMINGS said that the explosive growth of IN MEDICAL RECORDS AND EPIDEMIOLOGY the published biomedical literature has exceeded the ability of medical libraries to organize and dis- seminate it effectively. The United States National W. W. HOLLAND considered that electronic com- on September 24, 2021 by guest. Protected puters are particularly suitable for handling a large Library of Medicine has developed a mechanized amount of data and for performing calculations. Epi- medical literature analysis and retrieval system demiological investigations usually involve the collec- (MEDLARS) which permits efficient bibliographic tion of a large number of facts on many individuals. control of the literature by providing computer-pro- Handling this data on conventional punch-card duced monthly indexes of the world's biomedical machinery or manual sorting is tedious. The use of literature as well as selected current awareness ser- electronic computers in evaluating the effect of vices (recurring bibliographies) and one-time demand environment and smoking on chronic respiratory searches of individual medical subjects. These new disease in surveys in this country and in the United modalities of information handling are proving to be States was illustrated. Medical records are a further of great assistance to teachers, students, researchers, possible application for the use of computers. Large and practitioners who have need for ready access to amounts of data are collected which require the medical literature. prolonged storage with immediate availability. The RUPTURE OF THE TRACHEA AND BRONCHI deficiencies of present methods of keeping patient BY CLOSED INJURY records were revealed by a study of their content and handling. Attempts to utilize an electronic computer J. T. CHESTERMAN reported that the causative type to cope with these problems were described. of injury is one of sudden severe compression of a 477 Thorax: first published as 10.1136/thx.20.5.477 on 1 September 1965. Downloaded from 478 Proceedings of the Thoracic Society wide area of the upper anterior chest wall. This United States. In many ways coccidioidomycosis produces lateral widening of the chest with distrac- resembles tuberculosis, with the important exception tion of the carinal region which is made greater when that it is non-contagious. Clinically, coccidioido- the lungs are inflated, the glottis is closed, and from mycosis produces two types of illness, a primary the backward displacement of the heart. A few cases benign form and a serious disseminated form with are produced by shearing, and a few by a 'blow out' a high mortality. Treatment, when necessary, is laceration of the posterior wall of the trachea and rather unsatisfactory, consisting of the toxic drug larger bronchi. The symptomatology is as suggestive amphotericin B, which must be given intravenously as the type of injury, but it must be noted that 10% for prolonged periods, and surgery. Illustrative cases show no clinical features. Bronchoscopy is urgently were shown. needed to establish the diagnosis in any suspected case. Conservative surgery gives excellent, if not TRACHEOSTOMY OR ENDOTRACHEAL perfect, results in suitable cases, otherwise resection INTUBATION IN THE POST-OPERATIVE is indicated. MANAGEMENT OF CARDIO-THORACIC PATIENTS MEASUREMENT OF THE TRANSFER FACTOR D. S. ROBERTSON compared and contrasted a survey J. E. COTES said the transfer factor or diffusing of experience of the management of respiratory prob- capacity of the lung is usually measured by the single lems in the post-operative period with his own current breath carbon monoxide method; this has been management. developed successively by Marie Krogh, Forster, The indications for tracheal intubation were dis- Ogilvie, Roughton, Jones and Meade, and others. In cussed; the place of endotracheal intubation was its present form the test provides information on lung particularly encouraged against the background of volumes, uniformity of distribution of inspired gas, the morbidity of tracheostomy. diffusing capacity of the alveolar capillary membrane, Particular emphasis was placed on the value of and volume of blood in the alveolar capillaries. The intermittent positive pressure ventilation via an endo- procedure is simple and acceptable for the subject, tracheal tube for the first 24 to 48 hours post- but technical difficulties have so far limited its operatively. The commoner indications for suchcopyright. application. Some of the difficulties and the ways in treatment are respiratory inadequacy following mitral which they can be overcome, including the use of a valvotomy and after thoracotomy for bronchial new apparatus, were discussed. carcinoma. Its place was considered as a supportive measure following open heart surgery, particularly SELECTIVE BRONCHIAL AND INTERCOSTAL where prolonged perfusion has been a feature. ARTERIOGRAPHY IN LUNG DISEASE NEUROLOGICAL INVOLVEMENT IN http://thorax.bmj.com/ C. S. DARKE and N. A. LEWTAS considered the tech- SARCOIDOSIS nical aspects in the light of experience gained from a specially selected group of patients. The procedure C. E. C. WELLS described neurosarcoidosis as a dis- can be accomplished without undue difficulty or risk order of the central, peripheral, and autonomic ner- to the patient. Tumour circulation arising from vous systems, of the meninges and of muscle. Acute systemic vessels, either bronchial or intercostal and chronic phases could be distinguished from one arteries, can be demonstrated in primary broncho- another. This distinction provides a rational basis for genic neoplasms. It provides a new approach to the therapy, and is preferable to the traditional classifica- investigation of solitary peripheral shadows in the tion on anatomical and regional lines. Examples of on September 24, 2021 by guest. Protected lung and may have diagnostic value. Bronchiectasis both acute and chronic neurosarcoidosis were receives a much increased flow of blood from dilated described with illustrations, and the place of A.C.T.H. and tortuous bronchial arteries. Visualization of these and steroid therapy was discussed. The plight of channels is feasible, and on occasions a pre-capillary patients with chronic disease was emphasized and shunt from the bronchial arteries to the pulmonary contrasted with the infrequent mention of neuro- arteries can be recognized. The dye may travel in a sarcoidosis as a cause of death in epidemiological