Esophageal resection was performed in 119 patients between 1968 and 1977. The esophagus was replaced by stomach in 94 patients with a hospital mortality rate of 17%, and by an interposed segment of colon in 25 patients with a hospital mortality rate of 20%. Anastomotic leakage occurred in 10 patients (8.4%), of whom 6 died. Anastomotic leakage in the neck was not fatal, while two‐thirds of patients with intrathoracic leakage died. Stenosis of the anastomosis developed in 11 patients (9%), 6 of whom required dilatation or resection. The incidence of stricture was highest in patients with esophagocolic anastomoses in the neck. Development of esophageal reflux was investigated in 55 patients with gastroesophageal anastomoses 6–46 months postoperatively by questions about symptoms, x‐ray examination and, in 37 patients, by endoscopy. Mild symptoms of reflux occurred in 6 of 26 patients with high intrathoracic anastomoses, while regular symptoms of reflux were reported by 17 of 29 patients with low intrathoracic anastomoses and only 2 such patients were free of symptoms. Similarly, 25 of 26 patients with high anastomoses had no reflux on x‐ray or had reflux only in the head‐down position, while all 29 patients with low anastomoses had reflux on x‐ray, and 24 had reflux in the upright and/or supine positions. On endoscopy, 12 of 17 patients with high anastomoses had no esophagitis, while only 1 of 20 patients with low anastomoses had no esophagitis and in 9 patients, esophagitis was moderate or severe. There was a low incidence of reflux in patients with colon interposition. These results indicate that replacement of the esophagus with a high intrathoracic gastroesophageal anastomosis or with interposed colon is the preferable procedure.

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Two case reports of thymolipoma are presented. In a review of the literature on the subject, the clinical and etiologic features of this nonmalignant tumor in the anterior mediastinum are discussed. Although rare, thymolipoma should be considered in the differential diagnosis of mediastinal tumors.

Multiple large and small emphysematous bullae were resected in 27 patients with chronic obstructive lung disease (COLD). Twenty-two patients were operated on one side, and 5 patients underwent bilateral consecutive operations. Twenty-five patients were male, 2 female, and they were between 22 and 67 years old (mean 49.5 years). All patients had a follow-up examination between 3 and 48 months postoperatively. As operative techniques, resection by means of a clamp, plication of cysts according to Nissen, resection with homologous dura plasty (7 patients) and pericardial plasty (7 patients) were used. In 19 patients preoperative and postoperative pulmonary function was compared. Functional improvement occurred in 17 patients - including all of the 5 bilateral procedures. Postoperative improvement was more pronounced with decreasing preoperative pulmonary function, measured as VC, RV, IGV and Raw. Partial pulmonary insufficiency could be improved in 9 patients and global pulmonary insufficiency was improved in 5. In 16 cases physical work capacity was increased. The hemodynamics of the pulmonary circulation were improved in all patients with increased preoperative pulmonary artery pressure (latent pulmonary hypertension in 7 patients, overt pulmonary hypertension in 5). FEV1 was least influenced by surgery, especially in patients more than 50 years old. The long-term prognosis, thus has to be judged cautiously. One patient died postoperatively (mortality 4%). The technique of dura and pericardial plasty, aiming at functional adaptation, is described. Sutures inverting or folding pulmonary tissue are avoided. The aspect of at least temporary (up to 3 years) functional improvement leads us to advocate the use of extended criteria of operability.

Between 1975 and 1980, 9 patients with traumatic rupture of the thoracic aorta were operated at our institution. All patients showed additional multiple limb and internal organ injuries. Leading symptoms of aortic rupture were mediastinal widening (8), left-sided hemothorax (6), and acute aortic coarctation (2). Aortic rupture was proven by angiography in 8 patients and during exploratory thoracotomy in another. The time interval between trauma and operation was one to 48 hours, in 6 patients less than 4 hours. Atrio-femoral bypass was used in 3 patients, TDMAC-heparin shunt in 4 patients and 2 patients were operated without bypass. Prosthesis interposition was required in 3 patients while direct suture was possible in 6 patients. Long-term survival was achieved in 7 patients, one patient died from shock sequelae and another had suffered inoperable multiple rupture along the ascending and transverse aorta. It is concluded that patients with traumatic aortic rupture have a relatively good prognosis if diagnosis is established immediately and if surgery is feasible. The operative result is influenced substantially by the degree of preoperative shock and the presence of additional injuries.