[Results of 100 pulmonary and cardiopulmonary transplants in 95 patients at the Louis Pradel Hospital (Lyon) from 1988 to 1994]. / Risultati di 100 trapianti polmonari e cardio-polmonari in 95 pazienti all'ospedale Louis Pradel (Lyon) dal 1988 al 1994.

From June 1989 to December 1994, 95 patients underwent 100 pulmonary and cardiopulmonary transplants. The patients were 58 men and 37 women with an average age of 39 +/- 15 years. In 15 of the cases, indication for a transplant was infectious pathology, in 35 of the cases; vascular pathology, in 23 of the cases; emphysema and in 22 of the cases the causes were various. 31 of the patients underwent a heart/lung transplant, 14 underwent a sequential two-lung transplant, 14 underwent a sequential two-lung transplant and 50 underwent a single lung transplant; 5 patient underwent a second transplant. The global survival percentage is 56,4 +/- 5,2 to one year, 48,5 +/- 5,4 to two years, 42,9 +/- 5,7 to three years. There are non significant statistical differences for the survival level according to the type of transplant. The best functional results were obtained from patients affected with emphysema. The survival data for patients affected with infectious pathology are not very encouraging.

[Alveolar proteinosis. Prolonged favorable course after total pulmonary lavage]. / Protéinose alvéolaire. Evolution favorable prolongée après lavage pulmonaire total.

We report the outcome in a case of alveolar proteinosis diagnosed histologically in a 43 year old female. The increase in dyspnoea and the deterioration in the pulmonary function tests have lead to the realisation that a total pulmonary lavage was required under general anaesthesia. This was performed in two stages. A biochemical analysis of the lavage liquid showed an accumulation of phospholipids, proteins, and LDH. A subjective improvement was obtained in a few weeks followed by a slow radiological improvement as well as on CT scanning, and in respiratory function. Radiological and blood gas improvement was noted 19 months after total bilateral pulmonary lavage. Broncho-alveolar lavage is thus able to induce long-term improvement in pulmonary alveolar proteinosis.

[Spontaneous recurrent pneumothorax in young patients. Treatment by bilateral one stage apical pleurectomy by axillary approach]. / Pneumothorax spontané et récidivant du sujet jeune. Traitement par pleurectomie apicale bilatérale en un temps par voie axillaire.

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.

[Spinal anesthesia and multiple sclerosis]. / Rachianesthésie et sclérose en plaque.

Spinal anaesthesia was performed in 9 patients with multiple sclerosis for 14 surgical procedures: urological surgery 13 times and plastic surgery once. No complication was observed. except for a transient exacerbation in one case. Spinal anaesthesia appeared to be an innocuous procedure in multiple sclerosis as no neurotoxicity was observed. Exacerbation of multiple sclerosis was similar to that seen with general anaesthesia. Moreover, spinal anaesthesia improved the operating conditions by relieving bladder spasticity; it was also often asked for by patients who feared the loss of consciousness of general anaesthesia.