CORRESPONDENCE

Daniel A. Reid, MD: December 5,1941-September 10, 1991

To the Editor:

Associates of Daniel A. Reid, MD, somberly report his death in a climbing accident on Mt Kenya, September 10, 1991.

Dr Reid and his wife, Barbara, were ascending Mt Kenya in Africa when they suddenly were swept off the mountain side by a rock avalanche, and both died instantly. Both were experienced mountain climbers, and Dr Reid was among five other Americans who were the first to reach the top of Mt Everest from the Tibetan side in 1983. His wife, Barbara, worked in support at the base camp.

Dr Reid received his thoracic surgery training at Albany Medical College from 1976 through 1978. He was certified by the Board of Thoracic Surgery in 1979 and recertified in 1991. Upon completing his training in Albany, NY, he started to practice thoracic surgery in Concord and Walnut Creek, CA.

His patients will recall his interest, empathy, kindness, and dedication. His colleagues will remember his “through the night” bedside attendance of critical postoperative patients.

Dr Reid’s interests spanned beyond medicine. He was an avid runner, polo player, and advocate of physical fitness. In 1984 at the age of 44 he ran the grueling Western States 100-mile endurance run. To qualify for this race, 3 weeks prior to the event, he flew from California to Baffin Island to run a 50-mile course. He was a leader and participant in climbing expeditions to Patagonia, Alaska, and the Pacific Northwest, and had previ- ously climbed in Africa. During the Vietnam war Dr Reid served three tours of duty where he earned his Green Beret and worked in the capacity of a physician equipping and operating field hospital units dedicated to the care of both military personnel and civilians. At a reception in his home following the successful 1983 Mt Everest expedition he gifted his treasured Green Beret to an astonished and pleased Sir Edmund Hillary.

His military career continued as a reservist until the present. He served with the 352nd Army Evacuation Hospital, Oakland, CA, with the rank of Lieutenant Colonel. He saw active duty for 4 months during the Persian Gulf call up.

Dr Reid is a recent applicant to The Society of Thoracic Surgeons and holds membership in The Western Thoracic Asso- ciation, American College of Surgeons, and The American Col- lege of Chest Physicians. Dr Reid served on the board or was a

member of a multitude and variety of organizations reflecting his diverse interests.

American Alpine Club St. Andrew Society, San Francisco Explorers Club Diablo Valley Fly Fishermans Society California Trout Trout Unlimited Sierra Club United Polo Association Nature Conservancy Clan Donnachaidh Society American Himalayan Foundation Foundation for Glaciological & Environmental Research Association United States Army American Medical Joggers Association Diablo Interpretative Society

Rolf G . Sommerhaug, M D Steven F . Wolfe, M D David E . Lindsey, M D

2700 Grant St, Suite 320 Concord, C A 94520

The Council of The Society of Thoracic Surgeons, at its meeting in Chicago on October 22 , 1991, voted to recommend to the members of The Society the posthumous election to membership of Dr Daniel A . Reid. This action was taken in response to requests from many of his teachers and peers.

As a personal observation, 1 became acquainted with Dan and his wife, Barbara, during his years of general surgical education at the Virginia Mason Hospital. There is very little good in the loss of two such people. However, what there is, is contained in our remembrance of the sort of people they were, the values they held, the great good that they did in their lives, and, most of all, their inspiration which challenges us to be a little better, to t y a little harder, and to do a little more than we think we can.

Richard P. Anderson, M D

Secreta y The Society of Thoracic Surgeons

Bronchogenic Carcinoma With Chest Wall Invasion To the Editor:

The recent article by Allen and associates [l] is an outstanding contribution to the literature on the operability for cure in bronchogenic carcinoma with chest wall invasion. The authors provide us with detailed information about how patients were selected, how those with mediastinal nodes were excluded, and how many operations were performed on all cases of lung cancer during this period. Although this report is much more detailed than many reports about “radical operation” in lung cancer, I wonder if some other information obtained from the Massachu- setts General Hospital tumor registry would firm up the relative merits of chest wall resection as compared with symptomatic treatment: (1) Were the results of the 10 patients with rib destruction on plain chest roentgenograms as good as in the 42 patients without this finding? (2) How many patients with the same TMN staging were seen by a surgeon and refused resection during this period? We need to know the criteria for the refusals

0 1992 by The Society of Thoracic Surgeons Ann Thorac Surg 1992;53:363-8 0003-4975/92/$5.00

364 CORRESPONDENCE Ann Thorac Surg 1992;53:363-8

if we are to apply these data to our own patients. (3) How many patients were offered this procedure but refused for their own reasons? (4) How does the Kaplan-Meier plot look on the patients in groups 2 and 3?

Although this article-and several reports referenced in it- makes it clear that chest wall involvement is not an absolute contraindication for operation, I believe the addition of the above information would better define for the practitioner who should be considered for resective procedures. I would also humbly plead with the editors to request this information on all reports considered for publication, so that the mountains of data accu- mulated by tumor registries will not be for naught.

Yossef Aelony, M D

Intensive Care Unit Kaiser-Permanente 25825 Vermont South Harbor City, C A 90710

Reference 1. Allen MS, Mathisen DJ, Grillo HC, Wain JC, Moncure AC,

Hilgenberg AD. Bronchogenic carcinoma with chest wall invasion. Ann Thorac Surg 1991;51:948-51.

Reply To the Editor:

My colleagues and I would like to thank Dr Aelony for his questions. They are indeed important questions and would add additional important information. Unfortunately, we have no way of retrieving information about which patients refused operation. This decision is usually made in the individual sur- geon’s office and not available. In addition, our TNM staging is a surgical staging. Comparison of a clinical TNM stage to a surgical TNM stage would be quite misleading. Our feeling about selec- tion of patients can be stated simply: surgical resection should be considered if there is no sign of metastatic disease, the medias- tinal nodes are negative by mediastinoscopy, and the patient has adequate pulmonary function to withstand the loss of the ex- pected pulmonary tissue. We did not find any differences in survival related to depth of invasion of tumor. The 10 patients with rib destruction did just as well as those without rib destruc- tion.

Douglas I . Mathisen, M D

Massachusetts General Hospital Boston, M A 02114

Retrograde Cerebral Perfusion To the Editor:

We read with interest a recent article by Crittenden and associ- ates [l] entitled “Brain protection during circulatory arrest.” As commented on by the authors, the reason retrograde infusion cerebroplegia did not yield a benefit and resulted in a poor outcome is unclear. In addition to their speculation, there is a prominent difference in the venous drainage system from the brain between humans and other mammals. In humans, the internal jugular veins are the major drainage vessels and they contain no functional valves. On the other hand, the external jugular veins are dominant vessels that have many functioning valves, and the internal jugular veins are rudimentary in mam- mals [2]. Those valves in the external jugular vein might obstruct

retrograde infusion of cerebroplegia, causing the cerebroplegia to range over a restricted area, not the central nervous system.

Crittenden and associates speculated that diminishing of the transcerebral pressure led to accumulation of cerebroplegia. We wonder how cerebroplegia drained from the arterial system in their experiment. They did not mention that point in detail. We have clinical experience with continuous retrograde cerebral perfusion during systemic circulatory arrest for operations on the aortic arch. Continuous retrograde cerebral perfusion can be performed through the superior vena cava and the returned blood can be sucked from the opened aortic arch [3]. Clinical results were satisfactory, and the recovery of cerebral function in patients with continuous retrograde cerebral perfusion was bet- ter than in patients with conventional circulatory arrest. We expect that retrograde cerebroplegia in humans has cerebropro- tective potential.

Yuichi Ueda, M D Shigehito Miki, M D

Department of Cardiovascular Surgery Tenri Hospital 200 Mishima, Tenri, Nara 632 Inpan

References 1. Crittenden MD, Roberts CS, Rosa L, et al. Brain protection

during circulatory arrest. Ann Thorac Surg 1991;51:942-7. 2. Kalbag RM. Anatomy and embryology of the cerebral venous

system. In: Vinken PJ, Bruyn GW, eds. Vascular diseases of the nervous system, part I. In: Handbook of clinical neurol- ogy. Vol 11. Amsterdam: North-Holland Publishing Com- pany, 1975.

3. Ueda Y, Miki S, Kusuhara K, Okita Y, Tahata T, Yamanaka K. Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch, utilizing circulatory arrest and retrograde cerebral perfusion. J Cardiovasc Surg 1990;31: 55M.

Reply To the Editor:

We appreciate the opportunity to reply to the letter of Ueda and Miki in which they question the methodology of retrograde perfusion in our study and detail their results [l] with clinical retrograde perfusion. As their letter indicates, the external jugu- lar vein is the dominant vessel for venous return of both cranial and extracranial blood in rudimentary mammals. Inasmuch as any animal model is flawed with respect to its applicability to humans, we agree that this anatomic variation may be important. We do not believe that the venous valves provide a serious impediment to cerebral perfusion in our model for two reasons. First, we performed postmortem angiographic studies in 2 sheep. Contrast medium was injected in a retrograde fashion into the external jugular veins. We found that all of the cerebral vessels filled and drained into the aorta. Second, as noted in the manuscript, if the antegrade group is excluded, the nasopharyn- geal temperatures for our retrograde group had the greatest diminution after the first hour of circulatory arrest. Thus, if nasopharyngeal temperatures are truly reflective of core brain temperatures, we believe that the cerebroplegic solution reached the target organ.

Our perfusion circuit had a reservoir connected to a venous line. Once the extracorporeal circulation had ceased, all of the animals were exsanguinated; therefore, blood from the venous circulation would fill the reservoir, usually within the first 5 to 10