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PubMed2004

Airways obstruction in survivors of thoracoplasty: reversibility is greater in non-smokers.

OBJECTIVE: Before the advent of antituberculous chemotherapy, thoracoplasty (TPL) was the definitive form of therapy for cavitary pulmonary tuberculosis. This study aimed to characterize the late functional sequelae of TPL, and to establish the degree of reversibility of any consequent airway obstruction. METHODOLOGY: Pulmonary function was studied in 21 long-term (mean 35 years) survivors of TPL between the years 1990-2001. RESULTS: A mixed obstructive/restrictive defect was found in this patient cohort. After inhalation of bronchodilator, marginal increases in FEV(1) and FVC and marginal decreases in FRC, RV and TLC were observed. Maximum mid-expiratory flow rate was severely reduced (28.8% of predicted), but reversibility after inhaled beta(2)-agonist was highest for this parameter of pulmonary function (mean 11%). Smokers had a higher RV (P = 0.04), suggesting hyperinflation, while non-smokers had a larger increase in FEV(1)/FVC ratio postbronchodilator (P = 0.004), suggesting more marked reversibility of airways obstruction in this group. CONCLUSIONS: Long-term survivors of TPL have an obstructive as well as a restrictive ventilatory defect. These patients have partial reversibility of the obstructive defect. The degree of reversibility found suggests that bronchodilator therapy may help these patients.

Aged↗
PubMed1983

Respiratory failure after thoracoplasty: treatment by intermittent negative-pressure ventilation.

Ten patients with severe respiratory failure secondary to extensive pulmonary tuberculosis and thoracoplasty have been treated with intermittent negative-pressure ventilation. All recovered and have been followed up for from six months to eight years. Two have died from unrelated causes and six have used some form of breathing aid at home. Negative-pressure ventilation, which is a non-invasive form of respiratory support, offers important benefits in selected cases.

Adult↗
PubMed1988

Appearances on computed tomography following thoracoplasty for pulmonary tuberculosis.

Thoracic computed tomography was performed in 32 patients who had undergone thoracoplasty as part of their treatment for pulmonary tuberculosis. Pleural thickening and the prevalence of bronchiectasis were more marked in the operated hemithorax. Bullae were more prevalent in the operated hemithorax but the difference was not statistically significant. In all but one patient, scoliosis was present. Illustrative examples are presented to demonstrate the range of appearances following this operation.

Bronchiectasis↗
PubMed1993

Lung carcinoma in a patient with Lucite sphere plombage thoracoplasty.

A patient with a history of pulmonary tuberculosis was treated in 1949 with Lucite sphere plombage thoracoplasty. She subsequently developed squamous cell carcinoma of the lung despite having no history of exposure to known carcinogens associated with the development of squamous cell carcinoma. The patient's lung carcinoma developed adjacent to the plombage space. Lung carcinoma has not previously been reported in association with Lucite sphere plombage.

Aged↗
PubMed1989

Pulmonary function in long-term survivors of thoracoplasty.

Pulmonary function was assessed in 15 patients who had undergone thoracoplasty (TPL) approximately 30 years previously. Relation was noted to extent of TPL performed, side of TPL, age at TPL, and degree of secondary scoliosis. Test results showed mixed restrictive and obstructive defects. Although extent of TPL did not correlate with current lung function values, the restrictive defect was probably caused by a mixture of (a) compression of lung by TPL and (b) fibrosis from old pulmonary tuberculosis. The obstructive defect might have been due to the TPL procedure itself or to chronic bronchitis related to (a) previous pulmonary TB or (b) cigarette smoking, since 14 subjects were former or current smokers. That Dsb was relatively preserved suggests that pulmonary hypertension as a late sequela of TPL may be reactive (secondary to hypoxemia and respiratory acidemia) rather than obliterative.

Female↗
PubMed1990

Successful closure of chronic BPF by thoracoscopy after failure of endoscopic fibrin glue application and thoracoplasty.

We report a case of chronic debilitating BPF following right upper lobe resection. Despite several endobronchial applications of fibrin glue, we could not close it. Since the patient was extremely debilitated by symptoms due to the BPF, a thoracoplasty was attempted but was not successful. Finally, the BPF was definitely closed by instillation of talc into the pleura through thoracoscopy. To our knowledge, this is the first reported case of chemical closure of a recalcitrant BPF by the route of thoracoscopy. It also shows the failure of endoscopic fibrin glue application in such a condition.

Bronchial Fistula↗
PubMed2000

The history of surgery of empyema, thoracoplasty, Eloesser flap, and muscle flap transposition.

This article discusses the surgical history of empyema, thoracoplasty, the Eloesser flap, and muscle flap transfer. Little has changed in the 2000 years since the treatment of empyema was originally described by Hippocrates. The basic concepts of drainage of the infected empyema and obliteration of the space by allowing the lung to come up to the chest wall, taking the chest wall down to the lung, or by using muscle flaps or antibiotic solution remain the stabilizing forces in the treatment of postresection or postinfectious empyemas.

Empyema, Pleural↗
PubMed2002

Emergent pneumonectomy for hemoptysis in a patient with previous thoracoplasty.

Hemoptysis is a life-threatening episode of respiratory disease. By means of every possible treatment, hemostasis should be obtained to secure the airway as well as to prevent blood loss. We describe an emergency pneumonectomy for massive hemoptysis from destroyed lung in a patient with previous thoracoplasty. After the prolonged ventilation support postoperatively, the patient with compromised lung function recovered well.

Aged↗
PubMed2002

Thoracoplasty with acrylic plate-marlex mesh combination following near total resection of sternum: a case of chondrosarcoma of sternum.

Removal of the whole sternum for malignant tumours results in a large defect, causing severe deformity and possible paradoxical movements of the chest wall. The reconstruction of the resultant large defect of the chest wall is often complex and difficult. Commonly used materials include rib autograft, steel strus acrylic plate and various synthetic meshes such as Goretex or Marlex mesh, with a myocutaneous flap for coverage. A case of a 48-year-old man with sternal chondrosarcoma successfully treated with thoracoplasty using acrylic plate-marlex mesh combination following near total resection of sternum is reported.

Bone Cements↗
PubMedDate not supplied

[Deferred Horner syndrome following thoracoplasty].

INTRODUCTION: Horner syndrome (HS) involves an injury affecting the ocular sympathetic nerve, which gives rise to myosis, palpebral ptosis and enophthalmos, and is accompanied by hemifacial anhidrosis in its complete forms. Its extension means that its involvement can occur in different structures and as a result of different medical and surgical processes. CASE REPORT: We describe the case of two patients who developed a subacute form of HS without involvement of the sweating process and which was not accompanied by any other clinical features affecting the orbit, neck, brain, spinal cord or of a radicular nature. Both of them had been submitted to thoracoplasty as therapy for tuberculosis over 30 years earlier. The complementary studies that were conducted did not reveal involvement of the ocular sympathetic nerve anywhere other than in the pleura. CONCLUSIONS: The lesion would have been produced in the endothoracic fascia, where the cervical sympathetic chain is closely related to the apical pleura, and the physiopathological mechanism would be fibrosis of the aforementioned structures. Many reports have been published that describe the onset of HS as an acute complication following thoracic surgery, but its late development is infrequent.

Aged↗
PubMed2003

[Extrapleural thoracoplasty and its place in the tuberculosis epidemic environment].

The end of 20th century have been noted by tendency of the tuberculosis expansion up to epidemic occurrence in some countries. Primary and secondary resistance of tuberculosis mycobacterium toward antibacterial preparations and the wide-spread affection, which constitute contraindications to pulmonary resection performance, are revealing more and more. Not rarely the patient's general condition didn't permit to perform radical intervention. The author proposes extrapleural thoracoplasty performance as an alter-native and suggests indications to it.

Disease Outbreaks↗
PubMed2004

[The management of extirpation of chronic expanding hematoma after thoracoplasty in the chest].

A 71-year-old man was scheduled for an extirpation of chronic expanding hematoma (CEH) of his right thorax. He had a history of right thoracoplasty for tuberculosis 37 years previously. He complained of dyspnea that had deteriorated over three months. His inflammatory responses including general fatigue and fever due to chronic empyema remained to be resolved. The chest computed tomography revealed that the CEH remarkably compressed the trachea and the heart resulting in the cause of left mediastinal deviation. General anesthesia was induced with fentanyl and propofol, and maintained with sevoflurane. During general anesthesia, mean central venous pressure (CVP) via the right femoral vein and arterial blood pressure (ABP) via the left radial artery were monitored. Bilateral peripheral vein catheters with 16 G could effectively provide huge amount of transfusion. Although his blood loss was 10,000 ml because of superior vena caval rupture and oozing from pleura, prompt and adequate management of hemodynamics could be maintained using CVP and ABP monitoring. The CEH is known as a specific type of chronic empyema and its extraction would require ingenuity since there are number of factors associated with diagnosis, indication and prevention. Each case is to be evaluated individually and managed carefully.

Aged↗
PubMed2004

Emergent pneumonectomy for hemoptysis in a patient with previous thoracoplasty.

Hemoptysis is a life-threatening episode of respiratory disease. By means of every possible treatment, hemostasis should be obtained to secure the airway as well as to prevent blood loss. We describe an emergent pneumonectomy for massive hemoptysis from destroyed lung in a patient with previous thoracoplasty. After prolonged ventilation support postoperatively, the patient with compromised lung function recovered well.

Aged↗
PubMed1991

[The metabolic index of nocturnal hypoxia in patients after lung resection and thoracoplasty].

The authors measured urinary uric acid (UA) and creatinine (CR), serum lactate, and CoQ10 prior to retiring at night and on awakening in the morning in 127 patients (PG) after lung resection and thoracoplasty which were done more than 20 years age for treatment of tuberculosis and in 20 controls (NC). delta UA:CR, delta lactate, and delta CoQ10 were calculated respectively as the overnight changes in urinary UA:CR and in serum lactate and CoQ10. delta UA:CR increased in PG (4.0 +/- 43.6%), whereas it decreased in NC (-22.3 +/- 17.7%) (mean +/- SD) (p less than 0.05). Nocturnal hypoxemia suggested from positive balance of delta UA:CR was seen in 37% of PG, but in only 10% of NC. delta UA:CR showed no relationship with delta lactate and delta CoQ10 and also did not correlate with the nadir of arterial oxygen saturation. PG were divided into PG with a positive balance of delta UA:CR (PG-P) and with a negative balance of delta UA:CR (PG-N). The %VC and PaO2 in the PG-P group were lower and PaCO2 was higher than in PG-N, although the difference did not achieve statistical significance.

Aged↗
PubMed1989

[Postpneumonectomy esophagopleural fistula--successful one-stage repair with omental flap and thoracoplasty].

A 69 year-old man, who had undergone left pneumonectomy for squamous cell carcinoma of the lung 21 months ago, was admitted with a high temperature and chest pain. A diagnosis of empyema was made, and a chest tube was inserted for drainage. Bronchopleural fistula was not noted. Noticing that food was leaking through the drainage tube, a diagnosis of esophagopleural fistula was made radiologically. Surgery was done in October, 1987, after irrigating an empyema space for two months. The fistula was approximately 4 cm below the carina, and it was closed directly. The omentum was sutured around the closed site to reinforce and obliterate the empyema space. Furthermore, additional thoracoplasty was done because the cavity was too large to close only with the omentum. The postoperative course was uneventful. He was able to eat specially prepared foods within 4 weeks, and was discharged on the 60th day after the operation. This patient could possibly be the first case who had undergone an omental flap for the closure of a postpneumonectomy esophagopleural fistula.

Aged↗
PubMedDate not supplied

Thoracoplasty with intercostal myoplasty for closure of an empyema cavity and bronchopleural fistula.

Intercostal myoplasty with thoracoplasty was performed in 42 patients with tubercular and bacterial empyema, after the failure of conventional therapy with antibiotics, antitubercular drugs and closed drainage. In the 18 cases with bronchopleural fistula, this was closed and the drainage tube was removed after 23 to 51 days. The procedure was well-tolerated by all the patients, and is safe and effective in patients with chronic empyema with or without bronchopleural fistula where resectional surgery or decortication is not possible due to extensive bilateral disease or low cardiorespiratory reserve. Successful ligation and closure of bronchopleural fistula without any mortality was a unique feature of this procedure.

Adult↗
PubMed1985

[Thoracoplasty in scoliosis in children].

The article presents results of resection of costal humpback in 102 patients with scoliosis. Subperiosteal resection of the costal humpback without a fixation of the spine gave insufficient results, while resection of the humpback with a fixation of the spine with the Harrington distractor gave satisfactory results. Methods of decompressive thoracoplasty of the concave side of the chest in scoliosis were developed and used in 22 operations. Satisfactory cosmetic and functional results were obtained. No progress of scoliosis was noted. Within a year the lung volume became 2,8% greater as compared with the initial parameters.

Adolescent↗