patients belong to the high risk group of the preantibiotic era in tuberculosis treatment. Early post-operative mortality was high in this group, but those who survived had a relatively good life expectancy. The effect of extensive thoracoplasty (TPL) on the VC, 30 years after surgery, is comparable with that of a pneumonectomy: 49 percent of predicted vital capacity (VCp).

We recently presented data on a 30 year follow-up of a group of 56 patients who had thoracoplasty followed by an ipsilateral pneumonectomy (TPP). Early mortality was 9 per cent (five patients); 25 died during the observation period, mean survival time 18 years (5 to 30); 26 were still alive at the conclusion of our study, mean survival time 31.9 years (29 to 35). In 19 patients, repeated spirography and blood gas determinations were available (Table 1).

The results of Bredin and our findings are comparable in the group of long-term survivors (table 1). Sex, age at surgery and duration of follow-up are almost the same. The average height in our groups was: men 178 cm (SD 2.8), women 165 cm (SD 3.4). Predicted VC (VCp) used are comparable in the two papers. The VC%VCp is somewhat larger in the TPL group, possibly reflecting the presence of a “collapsed lung”. The patients in the TPP group have a somewhat better FEV,%VC, probably due to the fact that in Bredins patients a partially compressed, partially destroyed lung was present, whereas in our cases the hemithorax was empty and collapsed.
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Table 1 —Thoracoplasty (TPL) and TPL + Pneumonectomy Patients (TPP): Comparison of Lungfunction Data 30 Years after the Last Intervention

TPL (Bredin)

TPP (Laros)

M&f

12 + 3

12 + 7

N

15

19

Age at TPL/TPP

31

28.7

Age

60.6

60.6

N of ribs resected

6.4

7.4

VC%VCp

49.1

46.2

FEV,%VC

57.6

66.1

RV%TLC

50.4

45.6

FRC%TLC

65.7

54.7

The somewhat larger RV%TLC and FRC%TLC in the TPL group compared to the TPP group may also point to the presence of the poorly ventilated lung under the thoracoplasty.

In our group of patients the blood gas values at rest were in the normal range: Pa02 75.5 mm Hg (SD 8.2), PaCOz 40.5 mm Hg (SD 5.3), pH 7.395 (SD 0.027) and HC03 24.3 (SD 2.9).

The comparison of the long-term results of patients with an extensive thoracoplasty (TPL) with those of TPL and an additional ipsilateral pneumonectomy (TPP) seems to indicate that the re­maining lung tissue after extensive thoracoplasty hardly contributes to the quality of pulmonary function; it possibly causes a somewhat impaired forced expiratory volume and a somewhat enlarged functional residual capacity. The normal blood gas values in the TPP group indicate that the presence of an extensive thoracoplasty does not significantly impair the VA/QC relationship in the remaining lung. eriacta 100 mg