Elective drainage of the apical chest by posterior approach.

Pneumothorax due to incomplete reexpansion of remaining lung after a thoracic operation is difficult to drain via standard access routes. Apical chest drainage can be placed through a upper posterior point of the back, located in the laterovertebral area at the level of the first or second intercostal space. This technique, which is very safe and well tolerated, avoids the necessity to use thoracoplasty or muscle flap plombage of those residual cavities.

Cold abscess of the chest wall: a surgical entity?

Background: Cold abscesses of the chest wall are rare tuberculous locations. Because of the resurgence of tuberculosis, this diagnosis must be considered more frequently.

Methods: During a 15-year period (1980 to 1995), 18 patients with one or more cold abscesses of the chest wall were managed in our department.

[Lung volume reduction surgery in emphysema].

Lung volume reduction surgery in emphysema has, as an objective, the reduction of dyspnoea and an increase in the exercise tolerance in patients with respiratory insufficiency suffering from diffuse emphysema. In principle the resection of the most diseased areas of emphysema leads to improvement in the mechanical properties of the emphysematous lung and correct pulmonary hyperinflation. The respiratory function benefits both objective and subjective, produced by surgery are real but transitory and inconstant depending in particular on the evolutionary profile of the emphysematous disease.

Prognostic value of T and N in non small cell lung cancer three centimeters or less in diameter.

Objective: Peripheral tumors 3 cm or less in diameter are classified T1, T2 when rupturing the visceral pleura, T3 when invading parietal pleura, chest wall, mediastinal pleura or pericardium and T4 when invading vertebra or mediastinal structures. Our objective was to assess the prognostic significance of T and N status according to the size of such tumors.

Patients And Methods: Patients (918) were operated upon between April 1984 and December 1991.

[Place of radical surgery in the treatment of non-small cell lung cancer. Apropos of 969 cases].

Purpose: Retrospective analysis of the results of radical surgery in a series of 969 patients presenting with non-small cell lung cancer.

Patients And Methods: From April 1984 to December 1981, 969 patients underwent radical surgery with mediastinal node dissection for non-small cell lung cancer. Surgery included 507 pneumonectomies, 447 lobectomies and 15 segmentectomies (for patients suffering from respiratory failure).

[Pulmonary emphysema: surgical indications].

Surgery for pulmonary emphysema, with the exception of lung transplantation, is limited at present to resection of the emphysematous areas. The resection of a unique bulla within an otherwise healthy parenchyma can be indicated in case of complications but rarely in asymptomatic patients. When the bullae are large (i.

[Prognostic factors of operated non-small-cell bronchogenic cancer: critical analysis of T.N.M].

A prospective study of prognosis factors for operated non-small-cell bronchogenic cancer was conducted to assess those proposed by the T.N.M.

[Tuberculous adenopathies of the mediastinum: surgical experience in adults].

Fifty eight patients were treated for mediastinal tuberculous adenopathies in the thoracic surgery department from 1986 to 1992. Surgery was diagnostic in 49: mediastinoscopy n = 42, left anterior mediastinotomy n = 3, thoracotomy n = 3 and video assisted surgery n = 1. Surgery was in view of cure in 9: bronchial fistula despite medical treatment n = 6, recurrence under medical treatment n = 3.

[Video thoracoscopy of pulmonary nodules. Can one avoid preoperative markers?].

For a period of 35 months, 50 patients presenting with a total of 61 peripheral pulmonary nodules were operated on under videothoracoscopy. As a matter of principle none of these nodules were marked radiologically pre-operatively. All the scanners were reviewed retrospectively by a radiologist and a thoracic surgeon without knowing the results of the thoracoscopic intervention: 23 of these patients on the evidence would have quite obviously required preoperative marking (group I), and 27 would have been presented for direct thoracoscopy (group II).

Surgical management of thoracic manifestations in human immunodeficiency virus-positive patients: indications and results.

The records of 97 patients with thoracic complications of human immunodeficiency virus (HIV) were analysed to determine the reasons for surgery and the results of these procedures. Of the patients, 79 underwent surgery; the remaining 18 were managed non-surgically. A total of 36 procedures were performed for diagnostic purposes: mediastinoscopy (21 patients), lung biopsy (15 patients).

[The surgical management of pneumothorax in patients with AIDS].

The occurrence of a pneumothorax occurring as a complication of AIDS is a poor prognostic sign. We have undertaken a review of 26 patients admitted to hospital for a pneumothorax of whom 25 were admitted for therapy: five resolved under simple drainage; twenty required a pleurodesis which was performed on thirteen under video thoracoscopy: these were recurrent pneumothoraces and were bilateral in half the patients; all had failed under simple drainage. The hospital mortality was 30%; the follow-up was unusually long in the majority of cases and only 20% had a simple follow-up.

Factors determining survival in resected N2 lung cancer.

This retrospective study was based on 237 patients with non-small cell lung cancer (NSCLC) and nodal N2 disease. All accessible mediastinal lymph nodes (LN) were removed and classified according to their anatomical location in LN chains. The pulmonary resections performed were: pneumonectomy (n = 187), lobectomy (n = 44) and segmentectomy (n = 4).

[Prognostic factors of survival in resected N2 bronchial cancer].

This study was based on 206 patients with non small cell lung cancer and N2 nodal disease submitted to curative surgery: pneumonectomy 163, lobectomy 39 and segmentectomy 4. All accessible mediastinal lymph nodes were removed and classified according to their anatomical location in lymph node chains; "skip" metastases were present in 24.8% of cases.

[A rare tumor of the thoracic wall: synovial sarcoma].

The synovial sarcoma is a tumour of the soft tissues. Its thoracic localisation is unusual. The authors report a case of a recurrent tumour of the scapula, whose excision required major plastic surgery to the dorsal chest wall.

Anatomic basis of lymphatic spread of lung carcinoma to the mediastinum: anatomo-clinical correlations.

Correlation of the anatomic and surgical features in 360 cadavers and in 260 patients operated for bronchial carcinoma reveals that the lymphatics of the lung reach the ipsilateral mediastinum, sometimes directly and sometimes by sites which do not correspond to the anatomic site of the injection or of the pulmonary lesion. This implies the need for systematic eradication of all the lymph nodes of the ipsilateral mediastinum during surgery for bronchial carcinoma. In cases of tumoral lesions (N2), the prognosis is better when only one site is involved, whether the nodal disease is microscopic, uni- or multiglandular, with or without rupture of the capsule and whatever treatment is carried out, even when resection seems macroscopically complete to the surgeon.

[Surgery of bronchial cancer in patients aged 75 and over].

From April 1984 to December 1990, 66 patients 75 years of age or older underwent curative mediastinal lymph node dissection. There were 37 pneumonectomies. Post-operative mortality was 12% and was not affected by the type of dissection.

Near-haploid karyotype in a squamous cell lung carcinoma.

Cytogenetic analysis of a squamous cell lung carcinoma revealed a near-haploid karyotype with 27 chromosomes, in both primary cultures and an established cell line. The only chromosomes with two homologs present were chromosomes X, 5, 7, and 22. The two X chromosomes were early and late replicating, respectively.

[Excision of mediastinal nodes using video-thoracoscopy].

A man of seventy-one years with gross respiratory failure was suspected of having a cancer of the right upper lobe with metastases to the right pretracheal and intertracheobronchial nodes. A diagnostic mediastinoscopy did not achieve a diagnosis, and a right sub-bronchial node biopsy was performed, using videothoracoscopy and this revealed the presence of tuberculosis without any further delay.

[Chylomediastinum after mediastinoscopy. Apropos of a case].

A mediastinal chylous effusion occurred in a young woman after a mediastinoscopy. This effusion healed rapidly with medical treatment. An understanding of the anatomy of these intra-thoracic/lymphatic channels explains that intra-thoracic chylous effusions may occur in case of incontinence of the lymphatic vessels which connect the tracheo-bronchial nodes to the thoracic duct in the mediastinum.

[Lymphatic drainage of the heart].

The study was carried out on 91 adult cadavers to point out clearly the lymphatic drainages of the heart into the blood circulation. 45 right and 63 left ventricles and 9 right and 5 left atria were injected by means of a green modified gerota medium. A right collecting trunk received its afferents from 29 right and 5 left ventricles, ran upwards in front of the ascending aorta, involved the left brachiocephalic nodes and opened into the left subclavicular veins but also in 1 case in 5 into thoracic duct.