A prospective follow up was carried out on 479 consecutive patients who underwent lung resection for non small cell primary bronchogenic carcinoma between 1980 and 1987 under the care of one surgeon at Guy's Hospital and Brook Hospital, London. The mean age of patients was 61.8 years; 16.9% were aged 70 years or over. Of the 479,237 patients had stage I disease, 108 patients stage II disease, and 134 patients stage III. Lobectomy was performed in 280 patients, pneumonectomy in 191, and wedge resection in 8. Operative mortality was 5% overall, 6.8% following pneumonectomy and 3.9% following lobectomy. There was no operative mortality following wedge resection. Old age did not affect operative mortality. Overall actuarial survival was 76.2% and 39.8% at 1 year and 5 years postoperatively, respectively (stage I: 86% and 55%; stage II: 77.8% and 35.5%; stage III: 57.5% and 16.2%). There were statistically significant differences in survival between the stages. Five-year actuarial survival was 45% for squamous cell carcinoma, 36.3% for adenocarcinoma, 31.9% for dimorphic carcinoma and a 21% for undifferentiated carcinoma. There were statistically significant differences in survival between undifferentiated carcinoma and each of the other cell types. The favourable survival in stage I disease lends weight to the concept that there is hope for cure in patients with early non small cell lung cancer.

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Foreign body aspiration occurs when a solid or semisolid object becomes lodged in the larynx or trachea. It can be a life-threatening emergency, especially if it is large enough to occlude the airway. However, small aspirated objects may go unnoticed until symptoms occur. Therefore, it is frequently misdiagnosed. A high level of clinical suspicion, patient's risk factors, and thorough history and physical examination are essential in making the diagnosis. It should be considered in cases where there is unresolved chronic cough with or without associated recurrent pneumonia especially in patients with risks for aspiration.

Bilothorax is a rare cause of an exudative pleural effusion. The diagnosis is confirmed by a pleural fluid to serum bilirubin ratio of greater than 1. Typically, bilothorax presents as a right-sided effusion due to its proximity to the liver and biliary system. Herein, we present a case of isolated left-sided bilothorax in a 43-year-old female admitted with sickle cell crisis. Only one other case of isolated spontaneous left-sided bilothorax has been described in the literature. A thoracentesis performed on admission demonstrated greenish fluid and bilothorax was suspected, with a pleural fluid to serum bilirubin ratio greater than 1 confirming the diagnosis. A magnetic resonance cholangiopancreatography (MRCP) showed an abnormal 90-degree acute angulation in the mid-to-distal common bile duct with proximal common bile duct and intrahepatic bile ducts dilation. This was further confirmed with an endoscopic retrograde cholangiopancreatography (ERCP), which did not reveal any extravasation of contrast into the left pleural space. Ultimately, despite the use of various modalities, no definitive cause of bilothorax was identified. Postthoracentesis imaging revealed evidence of fibrothorax, a direct and permanent complication of bilothorax. The presence of an isolated left-sided bilothorax, along with the lack of a confirmed etiology, makes this case unique.