Spontaneous pneumothorax (SP) is commonly observed in young, tall, thin subjects without apparent underlying lung disease and in the elderly with chronic emphysematous lung disease. We present our experience in treating SP during the last decade. From December 1986 to November 1996 a total of 417 consecutive patients with SP were admitted to our department. There were 349 males (83.7%) and 68 females, ranging in age from 14 to 93 years. A right-side SP was detected in 234 cases (56.1%), a left-side SP in 175 (42.0%), and a bilateral SP IN 8 (1.9%). Treatment included observation/aspiration (n = 16, 3.8%), tube thoracostomy (n = 372, 89.2%), multiple tubes (n = 29, 7.0%) blood pleurodesis (n = 13, 3.1%), midsternotomy (n = 3, 0.7%), and minithoracotomy (n = 92, 22.1%). Primary indications for operation were recurrent SP (n = 49) and persistent air leak (n = 46). Blebs or bullae were found in all patients and were ablated by stapling. Pleural abrasion was also performed. All showed good lung expansion postoperatively. Perioperative mortality was zero. The mean hospital stay was 6.5 days. Follow-up of 89 patients who had undergone surgical treatment (93.75) at 1 to 100 months revealed only one recurrence. Tube thoracostomy is still in cases of recurrent SP or persistent air leak. Minithoracotomy is a safe surgical approach with satisfactory cosmetic results.

A case of idiopathic subglottic tracheal stenosis in a 50-year-old female is presented. A procedure of single-stage resection of the lesion and end-to-end anastomosis was performed with excellent results 1 year after the operation. The clinical, paraclinical, diagnostic, therapeutic and histopathological aspects of this rare pathologic condition are discussed and the literature on this topic is reviewed.

Most thoracic surgeons overlook the fact that spontaneous pneumothorax is one of the pulmonary complications of connective tissue disorders such as Marfan or Ehlers-Danlos syndromes, and they consider it as primary. In the following report we describe a unique case of spontaneous rupture of the sigmoid secondary to a spontaneous recurrent contralateral pneumothorax in a young patient with undiagnosed Marfan syndrome. The aim of this presentation is to raise a high index of suspicion of every thoracic surgeon to include in his differential diagnosis the connective tissue disorders in any case of spontaneous pneumothorax and if so, to follow further diagnostic procedures to anticipate any other visceral complications.

The simultaneous existence of thoracic aortic aneurysm and lung cancer is a rare finding, especially if the malignancy is primary and does not involve the aortic wall. In this report, we present a case of a typical descending thoracic aneurysm combined with a primary adenocarcinoma of the left lower lobe. The aneurysm was repaired with a Dacron graft without use of extra corporeal circulation and a typical left lower lobectomy was performed. In such cases, aneurysms should be treated primarily with endovascular stents. However, if this is not possible, a combined operation can be performed with good outcome.

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