Bilateral carotid-body resection.

FIGuRE 1. Lateral tomogram of neck showing forward displacement of trachea by soft tissue mass (hollow arrows) with luminal narrowing (single solid arrow). extrinsic obstruction of the trachea is an extremely rare phenomenon. Elderr mentioned a rare patient with medias-tinal lymphoma may require immediate tracheostomy. Our patient did not present with peripheral bulky disease and her chronic lymphatic leukemia was in partial remission. For these reasons we did not suspect upper airway obstruction due to adenopathy until tomogram and subsequent surgical removal of enlarged lymph nodes was performed. We can find no previous mention of this occurrence and we suggest stridor occurring in patients with chronic lymphatic leukemia requires a thorough evaluation to rule out this etiologic possibility. REFERENCES 1 Rundles RW: Chronic lymphatic leukemia. Primary solitary lymphoma of the trachea. 4 Elder JS, Touloukian RJ: Surgical diagnosis of mediastmnal lymphoma of childhood. In reply to the letter by Dr. Chai (Chest 75:534, 1979), his outline of medical therapy for treatment of severe asthma in children is not unique, but is in common use by competent physicians and may correctly be called " conventional " therapy. However, this therapy, although competently administered, may fail to control the disease in a certain percentage of " intractable " patients. For such patients , the Winter technique of bilateral carotid body resec-tion can be recommended as safe, and capable of substantial long-term benefits. Warning symptoms of hypoxemia are not necessarily present following this surgery, and most patients report ability to sense hypoxic environmental conditions. A few, against advice, have remained in such environments in spite of symptoms, and have reported loss of symptoms through some adaptive mechanism. As to the abstracts in my bibliography which appeared to confuse Dr. Chai, the studies of pulmonary function' concerned adult patients with chronic obstructive airways disease and showed mean values for FEV,% of predicted to be improved 13 percent at two days postoperation, with 24 percent improvement at one year or more. The " deterioration " reported for 23 percent of the study group, referred to all reduced postoperative values as compared to preopera-tive data points including minor differences, and indicated statistical information without clinical relevancy. Since all consecutive patients were included, some adult severe asthmatic subjects with little underlying obstructive airways and normal, m((d, or moderate pulmonary impairment, were included. The studies of perfusion lung scans' concerned adult patients with chronic obstructive airways disease, for …