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.

Departme nt of T ho rac ic an d Vascul ar Su rge ry. Heidehaus Hos p ital, Hann ove r, F RG Tab le 1 58 ope rat ions in 53 patients over 70 years of age Tab le 2 Histological diagnosis a nd tumo r stage of 4 2 bro nc hial ca rcino mas N o. % Lobec tomy

133 patients with inflammatory or tumorous metastases of the thoracic spine were operated upon within the last 11 years. Radical removal of inflammatory lesions with consecutive corticalis-spongiosa-plasty, taken from the christa pelvis, and chemotherapy are a therapeutical unit. Excision of the tumor with supplement bone grafting or "Pallacosplombe" and stabilization according to the principals of osteosynthesis are rewarding in individual cases. Four out of nine tumor patients survived two years after surgery.

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