Total sternectomy for malignant disease.

From 1972 to 1978, six total sternectomies for malignant disease of the sternum were carried out. The clinical data are summarized and the surgical technique is described. After sternectomy, the area of chest wall resection was repaired by suturing a sheet of silicone rubber to the edges of the defect and chest wall stability was assured by using one or two stainless steel struts. Finally the defect was covered with methylmethacrylate prepared and applied inthe operative field. The prosthetic material was shaped until curing by polymerization was complete. We discuss the advantages of this type of reconstruction, the technical details, the use of antibiotics, the surgical drainage, and the need for biopsy prior to carrying out a total sternectomy.

Gastroplasty with partial or total plication for gastroesophageal reflux: manometric and pH-metric postoperative studies.

From January, 1975, to December, 1980, 83 patients with sliding hiatal hernia, gastroesophageal reflux, or both were treated using a modified Collis gastroplasty associated with either partial or total gastric application. When partial plication was used, the five-year clinical results were considered satisfactory in 27 out of 35 patients (77%). When total plication was used, the results were satisfactory in 41 out of 46 patients (89%) after follow-up ranging from 12 to 60 months (average, 36 months), but no symptoms of gastroesophageal reflux reappeared in any patient. In patients undergoing partial plication, the mean preoperative high-pressure zone of 11.20 +/- 8.19 mm Hg increased after operation to 17.31 +/- 10.50 mm Hg, but in the second postoperative studies the value decreased to 13.69 +/- 7.24 mm Hg. When 360 degrees plication was used, the preoperative value of the high-pressure zone--9.36 +/- 4.80 mm Hg--increased after operation to 17.70 +/- 7.53 mm Hg but did not decrease significantly in the second postoperative studies: 16.46 +/- 7.99 mm Hg. When partial plication was used, the positivity of the abdominal compression test was 9 and 28% in the early and late postoperative studies, respectively. Using total plication, the percentage of positivity in the early and late postoperative periods was 0 and 2%, respectively. Concerning the acid reflux test, when partial plication was used, the test was positive in 3 out of 27 patients (11%) in the early postoperative studies and in 7 out of 30 (23%) one year later. For the total plication procedure, the percentage of positive tests was null in the first control and 3% in the second postoperative studies.

The surgical treatment of cancer of the esophagus. Summary of replies to a questionnaire.

In an attempt to assess the different methods of treatment of tumors of the esophagus we contacted 170 surgeons (in 1975-1976). Seventy-six (45%) answered a questionnaire concerning the surgical management of esophageal tumors, the reasons for non operability and non resectability, the place of radiotherapy, the validity of palliative procedures, the exposure and type of resection for tumors at various levels in the esophagus, the technical details of the operations, the resectability and mortality rate, the anastomotic leak rate and its treatment, and the five-year survival rate after operation. The replies to the questionnaire are summarized.

Thoracoscopy in the diagnosis of pleural effusion.

The technique, indications, and complications of diagnostic thoracoscopy are described. Two hundred and eight explorations have been performed in our service in the last seven years. From 137 pleural malignancies we have obtained an unequivocal positive biopsy in 129 (94%) with a minimum number of complications and no mortality. From our experience we conclude that thoracoscopy, when porperly performed, is diagnostic in most pleural conditions.

[Results of surgery in bullous emphysema (author's transl)]. / Résultats de la chirurgie de l'emphysème bulleux.

The authors report a series of 20 patients with single (8) or multiple (12) bullae. In most cases, exeresis of these bullae favorably affected functional signs. Standard spirometry (FEV1, VC) was improved significantly in long-term studies.

Results of surgical therapy for lung carcinoma.

A series of 300 pulmonary resections in patients with lung carcinoma is presented. Total survival rate of the series since the operation, including surgical mortality, was 33% at 3 years and 24% at 5 years. The survival rate and surgical criteria were correlated, having better results when standard surgery was performed. The authors emphasize that the surgical figures of the series are of great value as the surgical indications were large and nonselective, with 85% of resectability in the thoracotomies.