[Clinical analysis of 102 cases of chronic tuberculous empyema treated with modified Heller's thoracoplasty (author's transl)].
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A 64-year-old woman was attacked cardiac and respiratory failure in 3 times within a year. Aortic regurgitation (III degrees) and left anterior descending coronary artery 90% stenosis was recognized. %VC: 33% and %FEV1.0 75% were established. Aortic valve replacement (SJM 23 nm) and coronary arterial bypass grafting (SVG) were performed with cardiopulmonary bypass. Post operative course was no trouble and patient was discharged within 60 days.
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Two basic methods of prevention of early- and late-occurring complications after thoracoplastic and myoplastic surgery are defined by the authors: I. The function protective surgical method and technique: by the retention of rib 1, the extramuscular periosteal thoracoplastic surgery, resection of as few ribs as possible, total performance of thoracoplastic and myoplastic surgery, epidural assuaging of pain. II. Perioperative physiotherapy and correct rehabilitative treatment, where gymnastics plays the most important role, and also combined application of the different special methods of physiotherapy, can also contribute to favourable results. 17 patients data have been processed and set out in the report. They show the efficiency of the applied methods. Planned and purposeful co-operation between the surgeon and the physiotherapist is needed in the medical treatment of patients.
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A 49-year-old male with pulmonary aspergilloma secondary to pulmonary tuberculosis was admitted and treated by administration of itraconazole. However, as he continued to display fever and purulent sputum, we chose surgical treatment. We performed cavernostomy, thoraco plasty and muscle plombage with the pedicled latissimus dorsi and serratus anterior flap because pulmonary resection was seem to be life-threatening. The postoperative course was uneventful and satisfactory. We considered that this technique was safe and useful for the case of pulmonary aspergilloma which might be difficult to pulmonary resection.
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