Careful preparation, often including anti-tuberculosis cover, and timing of pneumonectomy are essential. Meticulous anaesthetic and surgical technique and co-operation are critical. Bronchus blockers functioned well but are not without risk. Attention to detail makes pneumonectomy safe in childhood.

This ongoing study shows pneumonectomy for inflammatory lung to be safe, with good results. Tuberculosis, being so common, adequate pre-operative and operative cover with anti-tuberculosis drugs may enhance results.

Closed surgical mitral valvotomy is the procedure of choice in most patients with symptomatic pliable mitral stenosis in developing countries. The procedure is efficacious and safe. Mitral valvotomy performed with a balloon has shown similar good results, with infrequent complications in selected subjects. Because there is a paucity of studies comparing the two techniques, this study was undertaken to compare the results of percutaneous balloon mitral valvuloplasty with those of closed commissurotomy as determined by catheterization studies. Forty-five patients with tight pliable mitral stenosis were randomly assigned to one of two groups: 23 patients had balloon valvuloplasty by the single catheter technique (group I) and 22 underwent closed surgical valvotomy (group II). The two groups were similar with regard to clinical and hemodynamic findings before intervention. Mitral valve area increased from 0.8 +/- 0.3 to 2.1 +/- 0.7 cm2 in group I (p less than 0.001) and from 0.7 +/- 0.2 to 1.3 +/- 0.3 cm2 in group II (p less than 0.001). Pulmonary artery pressure and pulmonary vascular resistance decreased in both groups, but these changes did not reach statistical significance in group II. Treadmill exercise time increased from 3.8 +/- 2.3 to 7.3 +/- 2.6 min in group I (p less than 0.001) and from 4 +/- 2.6 to 5.6 +/- 2.6 min in group II (p less than 0.001). There were no deaths. One patient in each group developed moderate (3+) mitral regurgitation. A small interatrial shunt (less than 1.5:1) was detected in three patients in group I immediately after the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

We recommend pulmonary angiography in cavitary tuberculous patients with severe hemoptysis who do not respond to systemic arterial embolization. Rasmussen aneurysms are effectively treated by steel coil occlusion.

Advances in video-assisted thoracoscopic surgery allow investigation and management of a wider range of pleural and pulmonary diseases. After percutaneous cavernostomy, a thoracoscope may be used for removal of foreign material from within an intrapulmonary cavity. A case of a dead hydatid cyst treated by such thoracoscopic evacuation is described. The procedure is simple and effective and is recommended for use when there is a delay in spontaneous resolution.Case report. A 13-year-old black boy came to his local hospital with a productive cough and a fever. Chest radiography revealed a right pulmonary cavity with a fluid level and a left lower lobe spherical opacity. Percutaneous needle aspiration of the lesion on the right side resulted in empyema. The patient was referred for further management.At the referral hospital, it was concluded from radiographic examination that the opacity on the left side was an uncomplicated hydatid cyst 1 and the proven right empyema had resulted from aspiration of a hydatid cyst complicated by infection. Tube thoracostomy effectively drained the right pleural space. By means of the Seldinger technique aided by fluoroscopy, the pulmonary cavity on the right side was intubated and drained of pus. The patient's fever subsequently subsided, and his general condition improved. Something resembling the crumpled remains of a dead hydatid cyst within the pulmonary cavity on the right side could be seen on a chest radiograph (Fig. 1). Despite the presence of a bronchocutaneous fistula, as evidenced by the production of purulent sputum and the cavernostomy tube air leak, the residual remnants of this cyst were not evacuated during a 2-week period. The uncomplicated hydatid cyst on the lefl side was removed through a left thoracotomy, followed by capitonage. The right intrapulmonary tube was removed, and the cavity on the right side was entered thoracoscopically through the cavernostomy track. This allowed inspection of the space and easy removal of the dead hydatid cyst, with the cavity being left clean after suction. Open tube cavernostomy drainage was instituted for a further 2 weeks, by which time there was a satisfactory reduction in the size of the cavity. The tube was removed, and after a further short period of clinical and radiologic surveillance, the patient was dis-From the