The surgical treatment of spontaneous pneumothorax by parietal pleurectomy. Long-term results with special reference to pulmonary function studies

A series of 125 patients with recurrent or persistent spontaneous pneumothorax were treated at the Regional Cardiothoracic Centre, North Middlesex Hospital, London, between 1972 and 1978. These patients received surgical treatment by parietal pleurectomy with no significant complications. The 2-8 years of follow-up has shown no recurrence. The postoperative pulmonary function tests have proved that there is no significant impairment of the mechanical efficiency of respiration. This series indicates that pleurectomy is a safe and reliable procedure and gives excellent results.

The changing trend in surgical reconstruction of pectus excavatum

The purpose of this presentation is to review our experience in the correction of pectus excavatum deformity over the past 25 years, to draw attention to some details of importance in securing an excellent end result, and to describe a slight technical modification which improves the cosmetic effect of the surgical procedure. Seventy-five operations were performed between 1951 and 1975 at the North Middlesex Hospital, Regional Cardiothoracic Centre, Edmonton, London, according to the various techniques known during that period. Results were variable until the introduction, 10 years ago, of an operation combining extensive resection of costal-cartilages (34, 35) and stabilization of the sternum (2, 3). Of 37 operations performed during the last 10 years, 35 have given excellent long-term results. The cosmetic results in our hands have been achieved by the use of a stainless steel plate passed beneath the sternum and left in situ for not more than 6 months.

Surgical correction of pectus excavatum and carinatum

This paper contains an analysis of the long-term results in 85 patients who had pectus excavatum or carinatum deformities repaired at the North Middlesex Hospital between 1951 and 1977. Seventy-seven patients had operations for correction of pectus excavatum and eight for pectus carinatum. A variety of surgical techniques was used. In the excavatum deformities the best results were obtained by the extensive resection of all deformed cartilages, the correction of the sternal deformity by a simple transverse wedge osteotomy, and by stabilising the chest with a stainless steel plate. For pectus carinatum, the involved cartilages were resected and an osteotomy of the sternum was performed. We preferred in most cases to stabilise the chest wall with a metal strut in this deformity as well. The best cosmetic results were achieved by the use of a stainless steel plate passed beneath the sternum and left for not more than six months.

Surgery for oesophageal reflux and hiatus hernia. Long-term results in 250 patients

A series of 250 patients with oesophageal reflux and hiatus hernia were treated at North Middlesex Hospital, London, the Regional Cardiothoracic Centre, between 1968-72. These patients received surgical treatment by the "Belsey Mark IV technique" and there were no significant complications. The 7--10 year follow-up showed in 8.4% actual recurrence which was of a combined functional and anatomical nature. In 2% of the cases hernia was demonstrated only by radiology, but there was no evidence of recurrent reflux. The majority of recurrences occurred within two years of initial operation. The patients with recurrences, who underwent the second Mark IV repair, had excellent results. The improving quality of the life in the successful cases was dramatic. This series indicates that the Belsey Mark IV repair is a safe and reliable procedure and gives excellent results with relief of all symptoms.

Present concept of the Belsey mark IV procedure in gastro-oesophageal reflux and hiatus hernia

One hundred patients with gastro-oesophageal reflux and hiatus hernia were treated at the North Middlesex Hospital, Regional Cardiothoracic Centre, between 1968 and 1969. All patients received surgical treatment by the Belsey mark IV technique with no significant complications. The 9-10 year follow-up has shown a recurrence rate of 10 per cent. The majority of recurrences occurred within 2 years of the initial operation. Seven of these recurrences had excellent results after a second mark IV repair. The improved quality of life in the successful cases was dramatic. This series indicates that a left transthoracic mark IV type of repair is a safe and reliable procedure and gives excellent results with relief of symptoms.

Current status of parietal pleurectomy in recurrent pneumothorax

Parietal pleurectomy was devised as definitive treatment in a series of 50 patients with persistent or recurrent pneumothorax. There have been no significant complications; 3-5 year follow-up has shown no recurrence, indicating that pleurectomy is a safe and reliable procedure and preferred to chemically or mechanically induced pleuritis because it entails fewer complications and shortens hospitalization.

Effect of the essential oils of garlic and onion on alimentary hyperlipemia

SUMMARY

The effect of garlic and onion on alimentary hyperlipemia, induced by feeding 100 g butter, has been studied in 10 healthy subjects. The freshly extracted juice of 50 g of garlic or onion, as well as an equivalent amount of their ether-extracted essential oils, was administered randomly on four different days during a one-week period. Garlic and onion have a significant protective action against fat-induced increases in serum cholesterol and plasma fibrinogen and decreases in coagulation time and fibrinolytic activity. The essential oil fraction, which contains all the taste and odour, exactly duplicated the beneficial effects of whole garlic and onion. It is, therefore, concluded that the active principle of garlic and onion is the essential oil, which chemically is a combination of sulphur-containing compounds, mainly allyl propyl disulphide and diallyl disulphide.