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Postoperative infections are a dreaded complication in pulmonal surgery. Besides the optimal preparation of the patients and careful operative technique, perioperative antibiotic prophylaxis represents an important factor in avoiding infectious consequences. Owing particularly to the high proportion of patients with malignant, consumptious illnesses in thorax surgery, immune deficiencies must be reckoned with in this group of patients. The spectrum of germs to be expected within the framework of pulmonal surgery determines to some extent which antibiotic shall be used. We have investigated the efficacy of a standardized antibiotic prophylaxis using cefotaxime (Claforan) in 200 pulmonal patients. Pleural empyema is a rare, but nonetheless important infectious illness, as a consequence of pulmonal operations, or also following pneumonia. Whilst the early stages of an empyema can often be successfully treated using only drainage treatment, chronic empyema usually requires a thoracotomy with empyema dissection and excortication, as well as subsequent irrigation-suction drainage treatment. In spite of specific surgical sanitation and irrigation-suction drainage treatment, therapy is often complicated by persistent germs in the thoracic cavity. Instillation therapy with taurolidine can lead to faster healing of the infection in such cases. Purulent mediastinitis is an extremely rare illness, but dreaded owing to its high mortality. The causes of the illness lie in injuries of the trachea, of the bronchial tubes, and of the oesophagus. With the introduction of medial sternotomy as operative entry, mediastinitis as a postoperative complication has increased noticeably in frequency. Mediastinitis occurs as a descending infection as a consequence of odontogenic affections. Owing to frequently late diagnosis, infection is usually advanced, so that simple drainage treatment of the mediastinum no longer suffices in many cases. We introduce our concept of treatment using our own patient collective.

In the years 1979 to 1985 (period I) 717 (102 per annum), in 1986 to 1989 (period II) 295 (73 per annum) pacemaker procedures had been performed at the cardiothoracic surgery division of Würzburg University. Indications for pacemaker therapy were in 35.4% vs. 36.6% (period I vs. period II) an atrioventricular block grade II or III, in 18.1% vs. 26.4% sick sinus syndrome, in 15.3% vs. 18.0% bradycardic rhythm disturbances, in 9.5% vs. 6.1% a sinuatrial block, in 6.5% vs. 2.4% a bradycardic sinus rhythm, in 12.4% vs. 3.7% others. While 41% of the procedures were performed under general anesthesia during the first period of observation, local anesthesia was predominant later on. Preferred venous access (79% vs. 74%) was the right cephalic vein followed by the subclavian vein (12% vs. 14%). The amount of the two chamber systems rose form 11% (period I) to 24% (period II). Intraoperative complications occurred in 2.5% vs. 5.8% and postoperative (within 14 days) complications occurred in 4% vs. 5.8%, respectively. No death was to be registered. The reasons for the increase of intra- and postoperative complications are discussed.