[Late post-pneumonectomy hematogenous pyothorax. Apropos of 3 cases]. / Pyothorax tardifs d'origine hématogène après pneumonectomie. A propos de trois cas.

The authors describe three cases of patients who had previously undergone a pneumonectomy (two for cancer, one for bronchiectasis) with a favourable postoperative course, who subsequently developed pyothorax in the thoracic cavity. The bacteria isolated where in the first patient, Pasteurella Multocida; in the second, Campylobacter foetus foetus; in the third, a variety of anaerobic organisms. The characteristic of the organisms allow us to exclude the possibility that these cases of pyothorax were due to a contamination during the operation, in favour of transient bacteraemia with contamination of the fluid of the thoracic cavity. In a patient who has undergone pneumonectomy (as in patients with a joint or valve prosthesis) it is important to avoid (or to treat early) any infections which could give rise to bacteraemia, especially dental infections.

[Cicatricial stenoses of the trachea. Etiological and therapeutic aspects. Apropos of thirty operated patients]. / Les sténoses cicatricielles de la trachée. Aspects étiologiques et thérapeutiques. A propos de trente malades opérés.

From January 1984 to march 1990, we performed 30 tracheal resections for post-intubation or post-tracheostomy inflammatory stenosis. After discussing the mechanism and the pathology of the tracheal lesions, we emphasise the importance of careful history taking when evaluating a patient with tracheal stenosis in order to distinguish patients with normal lungs (who needed respiratory resuscitation for acute and reversible respiratory failure) from patients with compromised lungs (patients with chronic pulmonary disease who needed respiratory resuscitation for acute respiratory failure). When selection of the patients was good and evaluation careful, tracheal resection was rater easy, with uneventful postoperative course and good long-term results.

[Tracheobronchial cylindroma. Success after left pneumonectomy and plastic repair of a large right tracheobronchial break with a musculo-pleural pedicle and bone graft around a temporary Dumont prosthesis]. / Cylindrome trachéo-bronchique. Succès après pneumonectomie gauche et plastie d'une grosse brèche trachéo-bronchique droite avec pédicule musculo-pleural et greffon osseux autour d'une prothèse provisoire de Dumon.

A 54-year-old woman with a cylindroma of the lower trachea underwent exploration with dissection of the tracheobronchial junction. The main left bronchus was invaded and there was major tissue loss of membranous tracheo-bronchial substance. Histology showed both tracheal and bronchial involvement. Left pneumonectomy was performed and a Dumon prosthesis was installed on the right. The prosthesis was enveloped in a musculopleural plasty reinforced with a vone graft. Good air flow was established immediately allowing secondary reconstruction of a perfectly functional neobronchus. Outcome was quite favorable with a 3 year follow-up.