Bronchial dehiscence in lung transplantation is still a significant and threatening cause of morbidity, even if several progresses have been made in this field. In the present report we discuss a case of incomplete dehiscence of the right bronchial anastomosis in a patient who underwent sequential double lung transplantation for bronchiectasis. This complication has been successfully treated with endobronchial stent positioning, with the aim to allow the healing of the anastomosis around a rigid endobronchial support and to prevent the airway stenosis. The usefulness of 3D spiral CT reconstruction of bronchial tree is also underlined, for its capacity to detect the dehiscence and to monitor the healing of this complication.

To assess the diagnostic impact of transesophageal echocardiography in the evaluation of mediastinal masses, 30 patients with mediastinal abnormalities detected by routine chest roentgenogram underwent transthoracic and transesophageal echocardiography. Subsequently, 29 of the patients underwent computed tomography and 16 underwent magnetic resonance imaging. The location and structure of the masses as well as their relationship to the surrounding structures were assessed. Anatomic confirmation and histopathologic diagnosis of the mediastinal masses by surgical resection and biopsy was available for all patients. Transesophageal echocardiography was more accurate than transthoracic echocardiography in detecting mediastinal masses (90% versus 73%), in identifying their structure (100% versus 90%), and in evaluating their relationship to contiguous organs (89% versus 81%). No complication was observed during the examinations. Computed tomography correctly diagnosed the location, structure, and relationships in all patients but one; magnetic resonance imaging correctly evaluated the mediastinal masses in all 16 patients. Our study suggests that transesophageal echocardiography is a valuable and safe complementary method of evaluating mediastinal masses. Moreover, this technique allows the obstruction of vessels and heart cavities, valve regurgitation, and right and left ventricular function to be easily assessed.

The authors present one case report of a patient with acquired immunodeficiency syndrome affected by empyema who was also a drug abuser. He was treated and cured with direct use of vancomycin in the pleural cavity through an inserted pleural drainage tube. The good therapeutic result and comparison with further studies using the same technique led the authors to propose this direct approach for the treatment of patients with similar problems. The treatment was noteworthy considering the lack of side effects due to drug administration.

From January 1975 to April 1987, 27 patients underwent surgical resection of non oat cell lung cancer and a single brain metastasis. There were 25 men and 2 women ranging in age from 37 to 70 years. In 21 cases the brain metastasis was synchronous while in 6 cases the onset was metachronous. In 17 cases, the site of the brain metastasis was supratentorial and in 10 cases it was located in the posterior fossa. The chest X-ray confirmed the primary lung tumour in 24 cases. In 3 cases, only bronchoscopy and cytology revealed the primary focus of the tumour. The lung cancer was located in the upper lobe in 25 patients. Upper lobectomy was performed in 23 patients, pneumonectomy in 3, and lower lobectomy in 1. There were no operative deaths. The cell type was adenocarcinoma in 19 cases, squamous cell carcinoma in 4 patients and large cell carcinoma in 4. Only the tumour and nodes were used for staging at thoracotomy. The classification was: 12 patients in stage I, 2 in stage II, and 13 in stage III. At conclusion of the study the longest survival was 68 months after thoracotomy. There was no significant difference in the duration of survival in patients over or under 50 years old. Better results were obtained in patients without node metastases at thoracotomy (median survival of 30 months and an overall 5-year survival of 35%), and in patients with supratentorial metastases (median survival of 22 months and an overall 5-year survival of 23.4%). Our experience confirms that combined surgery prolongs survival and improves the quality of life.

Operative and late post-operative results in 52 patients undergoing operation for chronic postinfarction left ventricular aneurysm are described. Aneurysm resection was performed in 33 patients. This procedure was combined with myocardial revascularization by means of insertion of a venous aorto-coronary by-pass graft in 14 cases. Hospital mortality for the total group was 3,8% (2 deaths). Surviving patients were followed-up 3 to 66 months. Two late deaths occurred. Clinical and functinal improvement occurred in the majority of surviving patients. The impact of simultaneous aorto-coronary by-pass grafting on operative results is discussed.

Early and late results of 273 mitro-aortic, 66 mitro-tricuspid, 28 mitro-aortic-tricuspid valvular replacements performed between 1964-1973, were evaluated. The hospital mortality rate was 17, 5 percent for mitro-aortic, 30, 5 percent for mitro-tricuspid, 10, 7 percent for mitro-aortic-tricuspid replacement. The best results obtained in patients with mitro-aortic replacement, the worse one in patients with mitro-tricuspid replacement, that present also a poor functional rehabilitation. The actuarial curves were calculated: 9 years after operation the probability of survival was of 67 percent for patients operated of mitro-aortic valvular replacement and 47 percent for patients operated of mitro-tricuspid replacement.