77

cognized to be an extremely uncommon com-

plication of this technique. A case is pre-

sented in which such a spread appears to have occurred to the chest wall 13 months after a transthoracic aspiration biopsy of a bronchogenic tumor.

Percutaneous Lung Biopsy. blanagement 0 f Tracheobronchial llaemorrhage. Rocke, D.A. Department of Anaesthetics, The Middlesex Hospital, London Wl, United King- dom. Anaesthesia 39: 888-890, 1985.

A case is reported in which percutaneous lung biopsy was followed by haemorrhage in- to the tracheobronchial tree. Hypoxia follow- ed, precipitating a cardiac arrest. The haemorrhage was isolated by the insertion of a double-lumen tube. Complications arising from this method of biopsy are re- viewed and the measures necessary to control the potentially fatal problems are discus-

sed.

6, SURGERY

Blood Transfusions and Survival a f t e r Lun~ Cancer Resection. Hyman, N.H., Foster, R.S. Jr., DeMeules, J.E., Costanza, M.C. Department of.gurgery, University of Vermont, Burlington, VT, U.S.A. Am. J. Surg. 149: 502-507, 1985.

The immunosuppressive effects of blood transfusions in renal transplantation pa- tients are now well documented. The question arises as to whether the possible immuno- suppresive effects of blood transfusions in cancer patients cause a more favorable host environment for tumor growth. One hundred fifty-five patients undergoing resection for lung carcinoma were analyzed retrospectively, and it was shown that the use of blood transfusions was associated with a significant decrease in survival time in patients undergoing curative re- secti,,rh of lung carcinoma despite multi- variate adjustments for age, sex, cell type, right lung versus left lung location, type of operation, and stage. This associ- ation supports, but does not prove, the hypothesis that blood transfusions, possibly through an immunosuppressive mechanism, are responsible for a poorer prognosis in patients who undergo resection for carci- noma of the lung.

bbchanical Ventilation for Acute Postope- rative Respiratory Failure after Surgery for Bronchial Carcinoma. Hirschler-Schulte, C.J.W., Hylkema, B.S., Meyer, R.W. Department of Pulmonary Disea- ses, The University Hospital of Groningen, 9713 EZ Groningen, The Netherlands. Thorax

40: 387-390, 1985. From 1978 to 1982 365 patients were

treated surgically for bronchicial carci-

noma. Lobectomy was performed in 250 and pneu-

monectomy in 115. Sixteen (4.4%) needed mecha- nical ventilation for acute respiratory failure. Six out of eight with a lobectomy, but only two out of eight with a pneumonectomy, survi- ved initially. Of these eight survivors, five died from recurrent malignancy within a year but three were alive and well at two years. The complications leading to acute respiratory fai- lure were unpredictable in most patients. Im- proving techniques of mechanical ventilation and intensive care may lead to better results in the future.

Surgically Treated Bronchial Carcinoma Patients. Results of Systematic Foll~-up. Hamelmann, H., Thermann, M., Muller-Schwefe, T. et al. Department of General Surgery, Surgical University Clinic, D-2300 Kiel, Germany. Thorac. Cardiovasc. Surg. 31: 41-44, 1983.

A systematic follow-up was carried out on 63 patients treated surgically for bronchial carcinoma. Thirty-four patients died within 2 years after the operation. No evident benefit was noted when comparing their preoperative and postoperative physical status. The quality of life was considerably influenced by surgery and adjuvant therapies. While 19 patients died from the tumor disease alone, the death of 14 patients was caused by additional therapeutic complications (surgery,,irradiation, cytostatic treatment). Eighteen patients survived more than 2 years without evidence of recurrence. Perfor- mance status reached the preoperative level after 9 months. All had good or excellent objective findings, but the disease had altered the lives of 7 patients considerably, psychological pro- blems being the main reason.

Surgical Treatment of Primary Ltmg Cancer and Solitary Brain ~tastasis. Mussi, A., Janni, A., Postolesi, M., et al. Thoracic Section of the Institute of General Surgery, National Research Council Institute of Clinical Physiology, University of Pisa, Pisa, Italy. Thorax 40: 191-193, 1985.

Twenty patients with carcinoma of the lung and a brain metastasis have undergone combined lung and brain surgery, which was synchronous in five. There were no operative deaths. Survi- val from the first surgical intervention was less than one year (3-10 months) in four pa- tients (20%), one to two years in four (20%) and more than two years (26-66 months) in five patients (25%). Seven patients (35%) are alive and well after an average period of three years and three months (15-66 months). ActUarial sur- vival at five years is 33.6%. All patients had severe neurological symtoms and 18 (90%) had a complete remission. Our experience and data reported in the literature point to the effec- tiveness of combined lung and brain surgery in prolonging symptom free survival in patients with lung cancer and solitary brain metastasis.