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Over the past 19 years, 278 patients (238 men-40 women) have undergone 325 parietal pleurectomies: 311 transaxillary apical and 14 full pleurectomies. Mean age was 32 +/- 12 years. The overall male:female ratio was 6:1. Surgical treatment was performed for either recurrence of spontaneous pneumothorax or failure to respond adequately to management by tube drainage. Thirty-six patients underwent one stage bilateral apical pleurectomy. On the basis of our experience (idiopathic pneumothorax: 311; chronic obstructive lung disease: 12; histiocytosis X: 2), we advocate the use of transaxillary apical pleurectomy for the younger age group with recurrent idiopathic pneumothorax and a full pleurectomy in the older age group. Major complications occurred in 1.9% of cases (re-exploration for haemorrhage: 5 cases; for air leak: 1 case). The recurrence rate in this group of patients was 1% (3 in 278 patients: one of them has been reoperated).

Thirty-nine patients were operated for bronchial carcinoid tumour between 1967 and 1988 out of a total of 97 so-called benign bronchial tumours. Based on a clinical, radiological and endoscopic assessment of this series, the authors discuss the modalities of surgical treatment which depend on the site of the tumour. Treatment consisted of enucleation for the two peripheral carcinoid tumours and tracheobronchectomy in 6 cases (15%) and pulmonary resection in 31 cases (79%) for the central tumours. Lung resection was performed alone in 25 cases (64%): 1 pneumonectomy, 2 bilobectomies, 19 lobectomies and 3 segmental resections. The lung resection was associated with bronchial resection-anastomosis in 6 cases (15%). The immediate postoperative course was uneventful. There were two deaths: one from myocardial infarction after one year and one from hepatic metastases (malignant carcinoid) after 7 years.

A case of intralobar pulmonary sequestration revealed by hemoptysis is reported. A left lower lobectomy was performed. Anatomical investigations of the lobe showed a normal lung supplied by an aberrant artery arising from the aorta.

The authors report an analysis of the long term results of 45 operated cases: 35 are symptom free in 7 cases more than 10 years later, 9 were improved and only one is worse. Operative mortality was nil; sternotomy is used in all cases. The authors insist on the reduction of therapy before attempting operation which should be carried out after 48 hours.

The quality of the surgical and respiratory functional results of one-stage bilateral apical pleurectomy for alternating or successive bilateral pneumothorax was evaluated in 30 patients operated upon from 1970 to 1984. These 4 women and 26 men represented 15% of the 194 patients surgically treated for pneumothorax during the same period. Among early results figure absence of mortality, moderate blood loss (295 +/- 130 ml) and short stay in hospital (11 +/- 3 days). Late results could be assessed in 23 patients with a mean post-operative follow-up of 50 +/- 21 months; 7 patients were lost sight of. No clinical or radiological recurrence of pneumothorax was observed. No dyspnoea associated by post-operative ventilatory restriction was demonstrated in our 23 patients. Among the 12 patients subjected to a total of 16 spirographic examinations, 4 out of 10 examined after 6 months showed slight restriction. These good functional results are confirmed by the literature which only gives the results of unilateral pleurectomy.

The tracing of venous thromboses of the lower limbs by means of iodine 125 marked fibrinogen is possible in thoracic surgery thanks to the calibration of the apparatus on the femoral surface in cases of left thoracotomy or sternotomy. Twelve patients out of 128, i.c. 9.4%, had a positive test: 11 men and 1 woman of whom 11 had a minimum of 2 risk factors of venous thrombosis. These patients had 7 right and 5 left thoracotomies: 6 pneumonectomies (15.4% of pneumonectomies), 5 lobectomies (13% of lobectomies) and one enucleation; 11 positive tests occurred on patients operated on for cancer. There were 5 thrombo-embolic accidents: 2 fatal and 2 non fatal. Mortality was 4.28%: 6 patients of whom 3 died of infectious causes and 3 of pulmonary embolism: 2 after a pneumonectomy, respectively at 2 days and 2 months, and 1 after a lobectomy at 5 days. This examination was useful to known our percentage of isotopic thrombosis of the lower limb after thoracotomy: 9.4% which is small compared with those of the literature. However these results show the importance of instituting more prophylactic procedures to prevent venous thrombosis and thromboembolism by using heparin in all patients operated an for cancer with an exeresis and presenting 2 or more risk factors of venous thrombosis.