[Spontaneous and recurrent pneumothorax. Surgical treatment. Apropos of 278 cases]. / Pneumothorax spontané et récidivant. Traitement chirurgical. A propos de 278 observations.

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).

[Our experience of the surgical treatment of thirty-nine tracheobronchial carcinoid tumors]. / Notre expérience du traitement chirurgical de trente-neuf carcinoïdes trachéo-bronchiques.

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.

[Acute neoplastic arterial embolism after pneumonectomy for primary bronchial cancer. Clinical and therapeutic consequences apropos of a case]. / Embolie artérielle néoplasique aiguë après une pneumonectomie pour cancer bronchique primitif. Conséquences cliniques et thérapeutiques à propos d'un cas.

We report a case illustrating the therapeutic consequences of an intravenous metastasis to the left superior pulmonary vein following resection of a voluminous primary lung carcinoma. Arterial spread of malignant cells occurred because the size of the tumor did not allow immediate clamping of the left superior pulmonary vein. The embolism was situated at the aortic bifurcation and lower limb ischemia persisted despite also emergency embolectomy. Distal (lower popliteal) embolectomy was also unsuccessful, and lower limb amputation was inevitable. This case illustrates the problems encountered in surgical treatment of pulmonary vein invasion by lung carcinoma and the role of adjuvant chemotherapy and radiotherapy.

Seventeen years of surgical treatment of thymoma: factors influencing survival.

We report on 17 years experience of the surgical treatment of thymoma in 65 patients, 11 with and 54 without myasthenia gravis. Patients were staged using the French "GETT" classification; 38 were in stage I (no invasive tumor), 6 in stage II, 13 in stage III and 8 in stage IV. In 45 patients, surgical excision was total while the remaining 20 underwent partial resection only. Postoperative radiotherapy was given in 12 cases, and 17 received a combination of radiotherapy and chemotherapy. One patient was lost to follow up, but no operative death occurred in the series. The mean survival for all patients was 70 +/- 7 months, and the 5- and 10-year survival was 91% +/- 4% and 69% +/- 8%, respectively. Follow-up for the 47 patients still alive and 4 patients deceased from unrelated causes ranged from 1.5 to 180 months (mean 142 +/- 10 months). Our data indicate that the prognosis of thymoma relates to radiological discovery (P less than 0.01), total surgical resection (P less than 0.01) and stage of tumor (P less than 0.01). It is not influenced by age, sex, tumor cell type or the presence or absence of myasthenia gravis.

[Acute arterial neoplastic embolism after pneumonectomy for primary bronchial cancer. Clinical and therapeutic consequences apropos of a case]. / Embolie artérielle néoplasique aiguë après une pneumonectomie pour cancer bronchique primitif. Conséquences cliniques et thérapeutiques à propos d'un cas.

We report a case illustrating the therapeutic consequences of an intravenous metastasis to the left superior pulmonary vein following resection of a voluminous primary lung carcinoma. Arterial spread of malignant cells occurred because the size of the tumor did not allow immediate clamping of the left superior pulmonary vein. The embolism was situated at the aortic bifurcation and lower limb ischemia persisted despite also emergency embolectomy. Distal (lower popliteal) embolectomy was also unsuccessful, and lower limb amputation was inevitable. This case illustrates the problems encountered in surgical treatment of pulmonary vein invasion by lung carcinoma and the role of adjuvant chemotherapy and radiotherapy.