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The aim of this report was to evaluate perioperative antibiotherapy and antiseptic irrigation of the operative site in the prevention of post-pneumonectomy empyema. From 1984 to 1986, 171 patients undergoing pneumonectomy at our institution for bronchogenic carcinoma were randomly selected in 2 groups: group I (85 patients) received a "classical" prophylaxis: irrigation of the operative site with saline, plus a 7-day antibiotherapy (minocycline 200 mg/24 h) started the evening following surgery; group II (86 patients): irrigation of the operative site was performed with Povidone iodine (dilution 5%); antibiotherapy (cefotiam was given for a short period (2 g intraoperatively, 2 g 12 hours and 24 hours following surgery). We used a "pragmatic" approach in order to choose, whatever the results would be, a type of perioperative antibiotherapy. We thus accepted the choice, without the help of statistical tests, of the therapy that would best prevent infection, and, if both regimens would demonstrate the same efficacy, to leave the choice at random. The only statistical test was to calculate the "gamma-risk" that we choose the worst among the 2 regimens. Although no significant difference in the overall infection rate was observed between the 2 groups, there were 9 empyemas (5 of those with bronchial fistula) in group I and 3 empyemas (2 of those with bronchial fistula) in group II. The cefotiam-povidone iodine regimen is thus better than the minocycline-saline regimen in the prevention of post-pneumonectomy empyema (3.5% v.s. 10.5%). The "gamma-risk", ie the probability that the minocycline-saline regimen is the best, calculated from these percentages, is 0.03.

The authors report a case of epithelioid hemangioendothelioma of the azygos vein diagnosed during the investigation of a superior vena cava syndrome. Venography and thoracic CT and nuclear magnetic resonance scans showed an endovenous tumour with spinal and lymph node invasion. Cavographic-controlled biopsies allowed histological identification of the tumour. Palliative therapy consisted in tumour ablation and superior vena cava bypass. Epithelioid hemangioendothelioma is a rare vascular tumour characterised by the presence of epithelioid endothelial cells. It is slowly progressive and its potential malignancy justifies surgical excision whenever possible.

This article summarizes 5 years of systematic observation of 17 patients presenting with benign pheochromocytoma. The diagnosis was based on clinical and biological findings which were consistently positive. The topographical diagnosis was based on CT scans, and a combination of intravenous urograms and nephrotomography. The preoperative preparations were made with labetalol, and the anesthetic used was narconeuroleptanalgesic. The hemodynamic study was carried out with a Swann-Ganz catheter, which proved indispensable in the surveillance of the patient at operation. The surgical procedure is best performed with transperitoneal subcostal incisions, which the authors prefer. Morbidity was negligible, and mortality, zero.

Intrabronchial lipomas are rare and benign tumours. Sixteen cases treated between 1956 and 1988 at the Marie Lannelongue Surgical Centre, Paris, are reviewed. The patients presented with various symptoms such as cough, haemoptysis, infection or dyspnoea. Radiography was abnormal in 15 cases, and the lesion was regularly located at bronchoscopy. Treatment was chiefly surgical. Owing to the slow and silent growth of intrabronchial lipomas, there is a risk of progressive bronchial obstruction resulting in bronchopulmonary lesions. With an early detection, treatment should be as conservative as possible.