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Acute pleural empyema which is not amenable to pleural puncture or closed thoracic drainage should be treated operatively by decortication or, in persistent cavities, by open thoracostomy drainage. In the last 2 years we have instilled 500,000 IU of fibrinolysines (streptokinase and streptodornase) per day into the pleural cavity of 27 patients with pleural infections requiring closed intrapleural drainage. By means of this treatment, pus and fibrinous membranes are liquefied and necrotic tissue is discharge. Therapeutic success is indicated by considerably increased fluid drainage about one hour after instillation. This therapy was performed for an average of 5 days. In 12 patients (44%) pleural empyema could be cured. In the other 15 cases decortication, and in 3 of them open thoracostomy drainage, was necessary. In our opinion intrapleural instillation of fibrinolytic enzymes should be added to the well-recognized method of treatment of pleural empyema, although not replace them.

Prolonged postoperative neuropathic pain along the distal and proximal incision or the bypass tunnel exists in one fourth of patients after femoropopliteal bypass surgery. Patients should be informed of this kind of complication before surgery. The results of our study justify further investigations of the origin and treatment of this pain, to find effective methods to reduce the incidence of prolonged postoperative pain after femoropopliteal bypass surgery.

Cardiac pacing in children still presents problems concerning the most favorable placement of the generator and, in particular, the growth-induced electrode complications. Whereas in infants epicardial implantation is unavoidable, one would prefer transvenous placement in older children to permit replacement or removal without extensive operative measures. The use of actively anchorable endocardial leads seems advantageous because of the possibility of placing long electrode loops in the cavity of the right atrium without increasing the risk of dislodgement. In this way overextension of the lead during growth may be avoided. Since June 1975 we have performed ventricular pacing in 10 children, aged 2 to 9 years, by using a transvenous screw-in electrode (surface 6 mm2). Acute threshold values ranged from 0.4 to 0.7 mA ap a pulse duration of 1.0 msec and sensitivity between 6.5 and 8.7 mV. Electrode function has been without complications up to now. In 6 patients we implanted programmable pacemaker systems which allowed postoperative threshold measurements. The chronic threshold value has not increased above 2.3 mA in any of these cases. In our opinion, actively anchorable endocardial leads present significant advantages for pacing in childhood.