The present paper describes eight patients (two teenagers and six adults) who had chronic symptoms (haemoptysis, cough, recurrent pneumonia) caused by foreign body (FB) inhalation which went undetected for 3 months to 25 yr. None of the patients had the usual predisposing conditions like mental retardation, seizures or brain tumour. The diagnosis of FB was made by radiography in one patient only. Computerized tomography visualized one FB (a beef bone), and bronchoscopy identified FB in another two patients. The remaining four cases were diagnosed at thoracotomy. Removal of FB was curative in three of five cases who required surgical resection for irreversible bronchiectatic changes. The severity of pulmonary changes correlated with duration of symptoms. It is concluded that chronic, unexplained respiratory symptoms should warrant further investigation to exclude FB despite negative history and normal chest radiography. Finding of granulation tissue or cicatricial stenosis of the bronchus could be the only clue to the presence of a FB. Early diagnosis would avoid irreversible parenchymal changes which necessitate lung resection.

Forty patients with myasthenia gravis underwent maximal thymectomy. Complete histologic study findings were available for 38 patients. The prevalence of ectopic thymic tissue was 39.5% (15 of 38). On the basis of the presence or absence of ectopic thymic tissue, patients were divided into two groups: group I had ectopic thymic tissue and group II had no ectopic thymic tissue. Male/female ratio was almost equal (1.1:1) in group I, whereas in group II the ratio was 1:2.8. The duration of the disease was less than 1 year in 80% of group I and 47.8% of group II patients (p = 0.05). Furthermore, ectopic thymic tissue (group I) was associated with poor outcome of operation (p = 0.003). Only 2 (13.3%) of 15 patients in group I had complete remission as compared with 11 (47.8%) of 23 patients in group II. Thus it appears that the presence of ectopic thymic tissue not only modifies some of the clinical parameters of myasthenia gravis, but also could serve as a prognostic factor in predicting the outcome of operation.

The ideal classification system for bronchiectasis continues to be debated. As an alternative to the present morphologic classification, a hemodynamic-based functional classification is proposed. This study examines the rationale for and outcome of surgery based on this classification in patients with unilateral or bilateral bronchiectasis. Between July 1987 and January 1997 the morphologic and hemodynamic features in 85 bronchiectatic patients were examined: 18 with bilateral bronchiectasis and 67 with unilateral disease. A policy of unilateral lung resection of the nonperfused bronchiectasis and preservation of the perfused type was adopted in all patients. The mean age at operation was 29.4 +/- 9.7 years (range 6-55 years) with a mean follow-up period of 45.2 +/- 21.0 months (range 2-120 months). Left-sided predominance of bronchiectasis was evident in this series both in frequency and severity. In those with unilateral disease, bronchiectasis was left-sided in 49 (73.1%) patients and right-sided in 18 (26.9%). The left lung was totally bronchiectatic in 11 (16.4%) patients and the right in 3 (4.4%). Moreover, among the patients with bilateral bronchiectasis, 14 of 18 (77.7%) patients had the left lung more severely involved. Based on the morphologic and hemodynamic features in the investigated patients, two types of bronchiectasis were recognized: a perfused type with intact pulmonary artery flow and a nonperfused type with absent pulmonary artery flow. Lobectomy was performed in 55 patients, basal segmentectomy and preservation of the apical segment in 16, and pneumonectomy in 14. There was no mortality in this series. Altogether 63 patients (74.1%) achieved excellent results, 19 (22.4%) scored good results, and 3 (3.5%) patients had not benefited from surgery at last follow-up. In the face of the general criticism of the traditional morphologic classification, the proposed classification not only predicts whether the involved lung will have a measure of respiratory function with regard to gas exchange but reflects the degree of severity of the disease process. Thus the question of which side to resect and which to preserve is defined more precisely. This classification was found to be logical, physiologically sound, and of proven benefit.

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Laparoscopy has proven to be the only diagnostic modality where the findings provide a clear, dependable direction for definitive management of impalpable testes. It allows an accurate diagnosis and simultaneous definitive treatment.

In a prospective study of 13 patients requiring pneumonectomy for unilateral post-tuberculous lung destruction the left side was found to be affected in 12. Review of a further 172 cases showed the left lung to have been destroyed in 109 (63%). It is suggested that this predominance of the left side is due to the anatomical characteristics of the left main bronchus and that disordered haemodynamics also appear to play a part.Unilateral total post-tuberculous lung destruction is a well recognised cause ofmorbidity and mortality.' 2 In Saudi Arabia late presentation and poor compliance with treatment for tuberculosis (as low as 30%') account for an appreciable number of patients presenting in this way, but very few studies have dealt with the problem in detail.4 We report the clinicopathological and haemodynamic findings in 13 patients coming to surgery at King Khalid University Hospital. The left lung was affected more frequently than the right, and we discuss the reasons for this predilection. Patients and methodsWe studied 13 patients with unilateral lung destruction before elective pneumonectomy, by bronchoscopy, bronchography, pulmonary angiography, thoracic aortography, ven-

On the basis of the morphologic and hemodynamic features in 17 patients with bilateral bronchiectasis, a new subclassification is proposed. Accordingly, two types of bronchiectasis were recognized: perfused and nonperfused. Whereas perfused bronchiectasis has intact pulmonary artery flow and cylindrical bronchiectatic changes, the nonperfused type involves an absent pulmonary artery flow, retrograde filling of the pulmonary artery through the systemic circulation, and cystic bronchiectatic changes. A policy of unilateral resection of nonperfused bronchiectasis and preservation of the perfused type was adopted in 17 patients with bilateral bronchiectasis during an 8-year period. There were 9 women and 8 men with an average age of 28.6 +/- 7 years (range 18 to 48 years). Fifteen patients had mixed bronchiectasis (perfused type on one side and nonperfused on the other side) and two had localized bilateral nonperfused type. The average duration of follow-up was 38.3 +/- 24.9 months (range 13 to 111 months). In the 15 patients with mixed bronchiectasis, excellent (N = 8) or good (N = 7) results were achieved in all cases. On the other hand, the two patients with bilateral nonperfused bronchiectasis did not benefit from unilateral resection. This outcome implies that with perfused bronchiectasis the deranged function is likely to resolve with time. In the face of the general criticism of the traditional morphologic classification system, the proposed functional classification not only reflects the degree of severity of the disease process, but also predicts whether the involved lung will have a measure of respiratory function with regard to gas exchange. Thus the question of which side to resect and which to preserve is defined more precisely.