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The primary purpose of this study was to evaluate whether preservation of lung function parallels preservation of anatomy following elective bronchial sleeve-lobectomy (BSL). Between January 1984 and July 1988, 21 male patients (median age 51 years) with non-small cell lung cancer (n = 18), atypical carcinoid (n = 2) and inflammatory stenosis (n = 1) entered the study. Pulmonary function tests were performed pre- and postoperatively (at 3 and 12 months) and included spirometry, a quantitative perfusion lung scan and arterial blood gas analysis. The majority of operations were performed on the right lung (n = 15, 71%), with no operative deaths or major complications. Three months after surgery, the values of PaO2, PaCO2 and overall perfusion improved significantly (P less than 0.05), while there was a non significant improvement of the forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). The only parameter correlating (r = 0.46) and significantly (p = 0.032) predicting outcome after resection was overall perfusion. The preserved, reimplanted lobe rather than contralateral lobe(s) significantly (p = 0.014) contributed to remaining overall function. In 16 patients examined 12 months post-operatively a further improvement in pulmonary function occurred. The data presented demonstrate that preservation of pulmonary function parallels preservation of anatomy following BSL and that the functional contribution of reimplanted, ipsilateral lobe(s) is of paramount importance.

Anesthesia for patients with Steinert's syndrome (myotonic dystrophy, MD) is a challenge for the anaesthetist. MD is a multisystemic disease and the neuromuscular symptoms can be associated with sleep apnea, endocrine disorders (diabetes, hypogonadism, hypothyroidism), cardiac, gastroenteric or cognitive disorders (mental deficiency, attention disorders). The diagnosis is facilitated when one or more of these symptoms are associated with the neuromuscular symptoms; however, the latter are not always present at the onset, which makes the diagnosis of MD a difficult and often late one. The choice of drugs and the choice of anesthesia in these patients can be very challenging for many reasons. A myotonic crisis can be triggered by several factors including hypothermia, shivering and mechanical or electrical stimulation. These patients are very sensitive to the usual anesthetics such as hypnotics and paralyzing agents (both depolarizing and nondepolarizing). The following case report describes pathophysiological considerations and a technique for anaesthesia during thoracic surgery that has been able to assure hemodynamic peroperative stability, early extubation and prolonged respiratory autonomy in a patient affected by this genetic disorder.

Endothelin-1 (ET-1) is found in bronchoalveolar lavage fluid in patients following lung transplantation. ET-1 causes contraction of isolated pulmonary vessels and bronchi and stimulates proliferation of smooth muscle cells in culture. Therefore, ET-1 could contribute to the smooth muscle hyperplasia and stromal proliferation seen in chronic rejection of lung allografts. Experiments were designed to determine whether (1) ET-1 stimulates proliferation of pulmonary tissue, (2) proliferation is increased in rejecting allotransplanted lungs, (3) endothelin-A receptors mediate the proliferative response, and (4) ET-1 is produced by activated infiltrating immunocompetent cells. Lung organ cultures were prepared from unoperated dogs and dogs with rejecting single lung allografts. Incubation of organ cultures from unoperated dogs with ET-1 (10(-9) to 10(-7) M)) increased positive staining for proliferation cell nuclear antigen (PCNA) in lung parenchyma. PCNA staining was not decreased by the endothelin-A antagonist BQ123 (10(-6) M). In addition, immunostaining for endothelin-B receptors was present in sections of unoperated but not rejecting lungs. PCNA staining in lung cultures from rejecting allotransplanted dogs was significantly greater than that from unoperated dogs. Positive immunohistochemical staining for ET-1 was found in mononuclear cells infiltrating rejecting transplanted lungs. In conclusion, exogenous ET-1 is mitogenic in lung organ cultures through receptors other than endothelin-A. Proliferation in rejecting transplanted lungs is increased compared with unoperated lungs. Mononuclear cells may be a source of endothelin-1 in the rejecting lung. ET-1, therefore could, in synergism with other cytokines, contribute to acute and chronic pathological changes seen in pulmonary rejection.