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Between January 1972 and October 1984, 412 aortic valve replacements by Bjork-Shiley disk prosthesis were performed. 183 patients suffered from aortic incompetence, 132 from an aortic disease and 97 from aortic stenosis. 116 associated procedures (28%) were performed = 36 myocardial revascularizations, 61 Bentall operations, 12 patch grafts to the ascending aorta and 7 Wheat operations. The mean age was 53.6 years and 25% of the patients were over the age of 65 years. Fifty percent of the patients had stage III or IV disease according to the NYHA classification. The cardiac index was less than 2.3 l/min/m2 in 44.26% of cases. The early postoperative mortality was 4.85% and 20% of these deaths were related to the prosthesis. The late mortality was 17.25%, with 20% of deaths related to the valve. The mean follow-up 59.75 +/- 2 months (range: 1 to 166 months) with a cumulative survival of 2.092 patients-years. It was significantly influence by the existence of preoperative angina, another operation associated with AVR and a cardiac index less than 2.3 l/min/m2. Seventy-one complications were related to the prosthesis including dysfunction (0.05% patient-year), 3 valve thromboses (0.15% patient-year), 6 infected valves (0.31% patient-year), 12 cases of peri-prosthetic dehiscence (0.61% patient-year), 10 embolic complications (0.61% patient-year) and 37 complications related to anticoagulants, including 26 major complications (1.48% patient-year). The valve failure rate was 1.19% patient-year. The results of our series are comparable to those reported in the literature, which confirm the reliability of the Bjork-Shiley Valve.

Using elastic laces with attached needle for surgery of the coronary arteries ensures adequate exposure, presentation and drying up of these vessels during distal anastomosis.

19 patients with bilateral simultaneous pulmonary metastases were operated on between 1954 and april 1976 at the Marie-Lannelongue surgical centre. Sarcomas were twice as common as carcinomas. In 10 cases the thoracotomy was only unilateral, either because thoracotomy was not attempted on the other side owing to the diffuse nature of the lesions (8 cases) or because prior chemotherapy had permitted complete reduction of the metastases on the opposite side (2 cases). This thoracotomy remained exploratory in 47 p. cent of cases, radical removal of all the tumour nodules was possible in 53 p. cent of cases (10 patients). Peripheral resections of the lesions were the rule. But in 4 cases, lobectomy was carried out on one side. 7 of the 9 bilateral operations were performed during the same stage. There were no operative deaths. The late results are encouraging considering the number of sarcomas in which the prognosis is usually poor. Bilateral lesions are thus not an absolute contra-indication, provided one remains within reasonable anatomical and functional limits, in the fields of well-conducted anti-cancer strategy.

The authors report 21 cases of pulmonary metastases from operated cases of rectal and colonic carcinoma. Half the patients were aged between 60 and 70 years. In all cases except one the primary tumour was known and treated surgically before the metastasis occurred. The authors emphasize the necessity of radiological supervision of the chest after operation and recall that neither chemotherapy nor radiotherapy should be undertaken without prior histological confirmation. It is possible to remove the metastases by surgery but a high percentage require pneumonectomy i.e. it is necessary to take the same precautions before operation as for primary carcinoma of the bronchus. The operative mortality was nil, and the five year survival rate 18 p. 100.

From 96 surgical interventions in the child, the authors studied the repartition of tumours according to their histological nature, their benignity or malignancy. For each kind of tumour they gave its frequency and clinical, radiological and biological data. Above all they studied the distant results of these interventions with an important set back. The results are excellent for benign tumours and promising for malignant ones and enable the deduction of therapeutical indications.

The authors seek to draw statistical conclusions on the basis of 742 surgically treated mediastinal tumours. Tumours of the thymus were the most common (20%). They were followed by tumours of the thyroid, neurogenic tumours, haematosarcomas and mediastinal cysts - all with an occurrence rate of around 12 to 15%. From a histological standpoint, 34.5% of the tumours were malignant or "potentially malignant". After a topographical study of these tumours, the authors discuss the possibilities of surgical treatment, the latter being great even in the case of malignant lesions.