Thorax
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The technique, indications, and complications of diagnostic thoracoscopy are described. Two hundred and eight explorations have been performed in our service in the last seven years. From 137 pleural malignancies we have obtained an unequivocal positive biopsy in 129 (94%) with a minimum number of complications and no mortality. From our experience we conclude that thoracoscopy, when porperly performed, is diagnostic in most pleural conditions.
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Measurements of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, functional residual capacity (FRC), total lung capacity (TLC), residual volume (RV), and RV/TLC ratio have been made in 331 normal Cantonese subjects (134 male and 197 female). The results have been expressed in multiple regression equations relating the volumes to age, height, and weight and have been compared with those of other workers. Lung volumes obtained in this study are in general lower for Chinese subjects than those reported for Caucasians. ⋯ Our series is unbalanced because of an uneven distribution of age groups. In fact in none of the reported studies on Chinese subjects, including that of da Costa (1971), is the series large or balanced. Clearly, further research is required in this ethnic group to get more reliable predictive formulae for lung volumes.
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Case Reports
Successful surgical repair of congenital total cleft sternum with partial ectopia cordis.
Total bifid sternum with or without ectopia cordis is a rare congenital anomaly which is treated successfully in a limited number of cases. Several methods of correction have been described using tissue grafts (cartilage, bone), inert artificial prostheses (acrylic plaques, marlex mesh), and techniques to approximate the sternal bands by relaxation of costal cartilages. In our case the method described by Verska was used to approximate the bifid sternal bands. The successful result in our patient proves the efficiency of this technique.
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Review Case Reports
Anomalous origin of the left coronary artery from the pulmonary artery with coronary artery steal in adults. Report of two cases and review of the literature.
Patients with anomalous left coronary artery arising from the pulmonary artery rarely survive to adult life. Those who attain adulthood may present with angina indistinguishable from coronary artery disease and are liable to sudden death. Myocardial infarction, though rare in young adults, may occur and may be due to coronary artery steal. ⋯ Two further cases of coronary artery steal in adults with anomalous origin of the left coronary artery from the pulmonary artery are presented. In both patients aortocoronary bypass grafting using a reversed autogenous saphenous vein with closure of the origin of the anomalous left coronary artery was successfully performed. This operation provided complete symptomatic relief and may protect patients against the risk of sudden death.
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A case of necrotizing sarcoid angiitis and granulomatosis (NSG) presenting as a peripheral lung 'tumour' in a 63-year-old man is recorded, and the clinical and pathological features are compared with those of Liebow's original cases. Resection may be avoided if the diagnosis is made by biopsy as the disease is possibly steroid responsive and the prognosis appears favourable. The aetiology is obscure but an immune disturbance is suspected.