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PubMed1994

Asphyxia while swallowing solid food caused by bronchial compression: a variant of the pneumonectomy syndrome.

A 40 year old man presented with recurrent episodes of dyspnoea whilst swallowing solid food. He had undergone right pneumonectomy and thoracoplasty for recurrent pneumonias and empyema 23 years previously. Solid food boluses appeared to cause bronchial obstruction by compressing the surgically distorted left main bronchus. This is a new variant of the post pneumonectomy syndrome.

Adult↗
PubMed2005

[Thoracic surgery].

Thirty-two patients with shock wave lesions to the chest who did not require invasive ventilatory support were treated. The Injury Severity Score (median 13), the pO2/FiO2 ratio (350) and lung injury severity (Murray score 1.25) were analyzed. Symptoms, mainly chest pain, depended on the severity of barotrauma and respiratory distress. All the lesions developed in the first 24 hours and most patients (75%) presented lung contusion. Although patients with lung contusion had greater intra- and extrathoracic comborbidity, differences in comparison with those without lung contusion were not significant, except in length of hospital stay (13 days vs 5.5 days; p = 0.008). Costal fractures were found in 12 patients (37%), mostly in the first 3 ribs and 60% of the patients had reduction of the upper thoracic contour (traumatic apical thoracoplasty). Outcomes were satisfactory with no mortality.

Adolescent↗
PubMed2002

Noninvasive ventilation for chest wall and neuromuscular disorders.

Neuromuscular and chest wall disorders are individually uncommon but together form an important group of conditions that can lead to chronic ventilatory failure. This is best recognised in scoliosis, kyphosis, following a thoracoplasty, in muscular dystrophies, such as Duchenne muscular dystrophy (DMD), and myotonic dystrophy, after poliomyelitis and with motor neurone disease (amyotrophic lateral sclerosis). If bulbar function is impaired, tracheostomy ventilation may be required, but in other situations, noninvasive ventilation is preferable. Positive pressure techniques using nasal and face masks are usually the first choice, but negative pressure ventilation is an alternative. There are no randomised-controlled trials regarding the indications for initiating noninvasive ventilation, but this is usually provided if there are symptoms due to nocturnal hypoventilation or right heart failure in the presence of a raised carbon dioxide tension in arterial blood (Pa,CO2) either at night or, more usually, in the daytime as well. There is no evidence that "prophylactic" ventilatory support is of benefit if this is provided before ventilatory failure has appeared. Careful selection of patients is required, especially in the presence of progressive neuromuscular disorders such as DMD and motor neurone disease. There are no randomised-controlled trials concerning the outcome of noninvasive ventilation in these conditions, but studies have shown an improved quality of life, physical activity and haemodynamics, normalisation of blood gases and slight improvement in other physiological measures, such as the vital capacity and maximal mouth pressures. Survival in chest wall disorders is approximately 90% at 1 yr and 80% at 5 yrs, and similar figures have been obtained in nonprogressive neuromuscular conditions. If, however, the underlying disorder is deteriorating, particularly if it involves the bulbar muscles, it may limit survival despite the provision of adequate noninvasive ventilatory support.

Humans↗
PubMed1996

Pulmonary vein thrombosis and peripheral embolization.

A 78-year-old-woman was admitted to the hospital with bilateral femoral arterial occlusion. Her medical history disclosed atrial fibrillation and a left thoracoplasty performed 50 years earlier for treatment of tuberculosis. A transesophageal echocardiogram demonstrated intraluminal thrombus in a left pulmonary vein. The patient recovered after thromboembolectomy. This case documents another uncommon cause of cardiac thromboembolism in which a transesophageal echocardiogram was essential to make the diagnosis.

Aged↗
PubMed2005

Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients.

STUDY OBJECTIVE: To review our experience in treatment of complicated parapneumonic effusion and pleural empyema by video-assisted thoracoscopic surgery (VATS). DESIGN: Retrospective chart review. SETTING: Taiwanese medical centers. PATIENTS: A total of 234 patients (108 women, 126 men; median age, 51 years; range, 0.75 to 84 years) underwent procedures for parapneumonic effusion (145 patients) or pleural empyema (89 patients) between May 1995 and December 2003. All patients had chest radiographs, and 188 patients (80.3%) underwent preoperative CT or sonography. More than 85% (200 patients) received preoperative diagnostic or therapeutic thoracentesis, tube thoracostomy, or fibrinolytics. Indications for VATS included empyema refractory to medical control or peel or multiloculated exudates per CT and chest tapping. INTERVENTIONS: Septal lysis and debridement irrigation through one port (31 patients, 13.2%), decortication and debridement through two or three ports (179 patients, 76.5%), or rib resection or larger utility incision for decortication and drainage (24 patients, 10.3%). RESULTS: Mean +/- SD procedural time was 64.3 +/- 22.5 min (range, 26 to 244 min). Sixteen patients (6.8%) needed further surgery for empyema (9 patients required open drainage or thoracoplasty, and 7 patients needed redecortication or repair of bronchopleural fistula). There were no intraoperative deaths and only eight (3.4%) perioperative deaths (< 30 days), which were mostly unrelated to surgery. Of the 234 patients, 202 patients (86.3%) achieved satisfactory results with VATS treatment. Patients requiring open decortication or repeat procedures (40 patients) had a longer mean duration of preoperative symptoms, longer mean duration of preoperative hospitalization, and a higher ratio of pleural empyema (vs complicated parapneumonic effusion) than patients undergoing simple VATS. CONCLUSIONS: VATS is safe and effective for treatment of complicated parapneumonic effusion and pleural empyema. Earlier intervention with VATS can produce better clinical results. A prospective study should be done to identify optimal timing and settings for VATS treatment for both complicated parapneumonic effusion and pleural empyema.

Adolescent↗
PubMed1976

Esophagopleural fistula after pneumonectomy.

Rupture of the esophagus into the space left after pneumonectomy is a rare and often fatal complication. Esophagopleural fistulas occurred in three patients following pneumonectomy. After previous methods failed, two patients were successfully treated by using a one-stage procedure which included (1) suture closure of the fistula, (2) buttressing the repair with a viable, pedicled, two-rib intercostal-muscle flap, and (3) performing an extensive thoracoplasty with a continuous drip infusion of neomycin. Such a procedure offers the maximum opportunity for successful treatment of this catastrophic lesion.

Esophageal Fistula↗
PubMed1985

Successful nonsurgical treatment of tuberculous empyema in an irreducible pleural space.

A 78-year-old woman with empyema due to Mycobacterium tuberculosis in a chronic pleural space was successfully treated with a 24-month course of oral isoniazid, rifampin, ethambutol, and serial space-emptying thoracocenteses. Besides dramatic clinical improvement, follow-up pleural fluid analyses demonstrated gradual replacement of the empyema with a sterile pleural exudate, which has persisted 24 months after cessation of therapy. This case demonstrates a therapeutic program that was an effective alternative to decortication or thoracoplasty for tuberculous empyema in an irreducible pleural space.

Administration, Oral↗
PubMed1982

Further observation on empyema after resection of bronchogenic carcinoma and survival.

Out of 11,247 cases undergoing resectional therapy for bronchogenic carcinoma at 39 institutions, 6,348 were operated before July 1976 and the remaining 4,899 thereafter. Analyzing both series, the following results were obtained: 1) The rate of pneumonectomies to lobectomies was 1:2.3 in the former and 1:3.9 in the latter. Pneumonectomies were more on the left side, whereas the right lobectomies were about twice as many as the left ones. 2) Postoperative empyema occurred in 180 cases (2.8%) in the former and 79 cases (1.6%) in the latter. The incidence was significantly higher in the cases of right pneumonectomy than in the cases of left pneumonectomy, and in the cases of pneumonectomy than in the cases of lobectomy. Although the incidence of postpneumonectomic empyema decreased only slightly, overall incidence decreased significantly because of marked increase of lobectomy cases. 3) Out of 180 cases of empyema in the former series, 17 died within 30 days. 4) The 5-year survival rate of the patients with empyema was 28 per cent. 5) The 5-year survival rate was 30 per cent in 93 cases of squamous cell carcinoma, 30 per cent in 50 cases of adenocarcinoma and 15 per cent in 13 cases of large cell carcinoma. There was no survivor among 7 cases of small cell carcinoma. 6) Out of 259 cases of empyema, micro-organisms were cultured in 161 cases, were negative in 20, and unknown in 78. Although various organisms were found, gram-negative bacteria and Pseudomonas were most frequently isolated, i.e. 37 per cent and 36 per cent, respectively. 7) As for the treatment of 5-year survival cases of empyema, thoracoplasty and bronchial closure were frequent as compared with open thoracic window technics such as Eloesser's and Symbas' operation. And, more than half of the cases of empyema seem to have been complicated with bronchial fistulae.

Adenocarcinoma↗
PubMed1993

Results of surgical treatment for calcified tuberculous empyema: improved pulmonary function obtained with lung preserving policy.

We treated thirteen cases of calcified tuberculous empyema during the nine years from 1984 to 1992. Six patients having mild symptoms were categorized as Type I, and the remaining seven with severe symptoms as Type II. The patients of Type I were all successfully treated by complete empyemectomy with or without lung resection. All the patients of Type II suffered from major symptoms and were burdened by larger empyema cavities with formation of bronchial fistulas. Five of the latter were successfully treated, but two died, one from MRSA infection and another from intestinal necrosis following omentopexy. Our guide lines for the treatment of tuberculous empyema are: Lung resection must be minimal. Type I patients could be managed by simple empyemectomy with or without minor thoracoplasty. Open thoracostomy prior to the empyemectomy is not necessary. If the patient who belongs to Type II is aged and in a critical state, open thoracostomy must be taken as the first choice. Omentopexy is reliable, but it should be restricted to selected cases. Reasonable dead space and minor air leakage may safely be left behind if the cavity is surrounded by noninfected raw surface of the chest wall and diaphragm. Better quality of life was revealed by exercise test with improved oxygen consumption, compared to the preoperative state.

Aged↗
PubMed2005

Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure.

BACKGROUND: The long-term pulmonary function of patients with adolescent idiopathic scoliosis undergoing surgical correction is uncertain. To our knowledge, no report has demonstrated the changes in pulmonary function five years or more following spinal arthrodesis with use of modern segmental spinal instrumentation techniques for the treatment of all types of adolescent idiopathic scoliosis in a similar adolescent population. METHODS: One hundred and eighteen patients with adolescent idiopathic scoliosis undergoing surgical treatment at a single institution were evaluated with pulmonary function tests to assess the absolute and percent-predicted value of forced vital capacity and forced expiratory volume in one second at the preoperative examination and at regular intervals postoperatively. The patients were divided into four groups depending upon the surgical procedure: Group 1 comprised forty-nine patients who had posterior spinal arthrodesis with iliac crest bone graft; Group 2, forty-one patients who had posterior spinal arthrodesis with thoracoplasty; Group 3, sixteen patients who had open anterior spinal arthrodesis with a rib resection thoracotomy; and Group 4, twelve patients who had combined anterior and posterior spinal arthrodesis with a rib resection thoracotomy and iliac crest bone graft, respectively. RESULTS: A comparison of absolute pulmonary function values from the preoperative and final follow-up evaluations demonstrated a significant (p < 0.0001) increase in both the forced vital capacity and the forced expiratory volume in one second for Group 1, whereas no change was seen in those values for Groups 2, 3, and 4. A comparison of the changes in the percent-predicted pulmonary function values demonstrated significant (p < 0.05) decreases in forced vital capacity and forced expiratory volume in one second for Groups 2, 3, and 4, except for the latter value for Group 4, whereas Group 1 had no change. CONCLUSIONS: Patients who have had any type of chest cage disruption during the surgical treatment of adolescent idiopathic scoliosis demonstrate no change in the absolute value and a significant decline in the percent-predicted value of pulmonary functions at five years following surgery. Chest cage preservation is recommended to maximize both absolute and percent-predicted pulmonary function values after surgical treatment of adolescent idiopathic scoliosis.

Adolescent↗
PubMed2006

Superior mesenteric artery syndrome following spinal deformity correction.

BACKGROUND: Superior mesenteric artery syndrome is a known complication associated with the correction of spinal deformity. Recent investigations of this disorder have focused on patient height and weight. We are not aware of any published study examining the degree of deformity, type of curve, or magnitude of correction, and to our knowledge all of the reported literature on this syndrome lacks control data. The purpose of this study was to examine the relationship between the correction of spinal deformity and the development of superior mesenteric artery syndrome in patients with scoliosis. Our hypothesis was that greater correction of spinal deformity would increase the risk of the development of superior mesenteric artery syndrome. METHODS: A case-control study was performed over a five-year period. The primary outcome measure was the development of superior mesenteric artery syndrome. The predictor variables that were considered included demographic characteristics; preoperative height, weight, and body mass index; aspects of the deformity, including curve magnitude, Lenke curve classification, and correction; and operative factors, including surgical approach, estimated blood loss, and the presence of operative hypotension. RESULTS: A review of the records on 364 surgical procedures for scoliosis identified seventeen cases of superior mesenteric artery syndrome. Thirty-four subjects who had had surgery for scoliosis but no superior mesenteric artery syndrome were randomly selected as controls. Eight of the seventeen subjects with superior mesenteric artery syndrome had undergone a two-stage procedure (compared with one of the thirty-four controls, p < 0.001), nine of the seventeen had had combined anterior and posterior procedures (compared with two of the thirty-four controls, p < 0.001), and seven of the seventeen had had a thoracoplasty (compared with two of the thirty-four controls, p < 0.001). No significant differences were noted between the groups with regard to demographic factors. Compared with the controls, the patients in whom superior mesenteric artery syndrome developed were shorter (by a mean of 7.1 cm, p = 0.03), weighed less (by a mean of 11.5 kg, p = 0.001), had a lower body mass index (p = 0.003), had a greater minimal thoracic curve magnitude achieved by bending (a mean of 12 degrees greater [45 degrees for subjects with superior mesenteric artery syndrome and 33 degrees for controls], p = 0.015), had a lower percent correction of the thoracic curve on bending (a mean of 11% lower, p = 0.025), and had more lumbar lateralization (88%, compared with 61% in the control group, had a Lenke lumbar modifier of B or C instead of A, p = 0.008). Multivariate logistic regression analysis identified a staged procedure (odds ratio, 31.0), the lumbar modifier (odds ratio, 9.06), body mass index (odds ratio, 7.75), and thoracic stiffness (odds ratio, 6.67) as the most predictive of the development of superior mesenteric artery syndrome. CONCLUSIONS: Preoperative identification of the risk factors described above in conjunction with preoperative nutritional maximization should be considered in order to limit the prevalence of superior mesenteric artery syndrome in patients undergoing surgical correction of spinal deformity.

Adolescent↗
PubMed1999

[Investigation of pulmonary hemodynamics and chest X-ray findings in patients with pulmonary tuberculosis sequelae and obstructive ventilatory impairment].

We investigated pulmonary hemodynamics and chest X-ray findings to explore significance of obstructive ventilatory impairment in patients with pulmonary tuberculosis sequelae. One hundred and two patients underwent examinations of blood gases, spirometry, and right cardiac catheterization. The patients were divided into two groups, according to forced expiratory volume in one second as the percentage of forced vital capacity (FVC), which was expressed as FEV1%. Group A (n = 38) had FEV1% of 55% or lower and Group B (n = 64), FEV1% above 55%. First, the values of blood gases and hemodynamics were compared between the two groups, regarding the percent predicted value of FVC as a covariate. Secondly, between 26 of Group A and 42 of Group B, the change of pulmonary arteriolar resistance (PAR) before and after 100% oxygen breathing for 10 minutes was compared. These comparisons were made by exploratory data analysis. Lastly, we described every case with five items of chest X-ray findings and the extent of each finding we had defined. The items were emphysematous change; fibrosis, bronchiectasis and/or cavity; pulmonary resection and/or atelectasis; pleural thickening; and thoracoplasty. We explored X-ray findings influenced on airway obstruction by ridit (abbreviation for "relative to an identified distribution") analysis, taking smoking status into consideration. The results were as follows. (1) The patients of Group A tended to show severer hypoxemia and tissue hypoxia than the patients of Group B. (2) The patients of Group A tended to show worse values of pulmonary hemodynamics than the patients of Group B. Under an even level of the arterial oxygen tension that was 60 Torr or lower, pulmonary artery mean pressure was higher in Group A than in Group B. (3) PAR after oxygen breathing was less likely to decrease in Group A than in Group B. (4) As any mean ridit was standardized and adjusted to 0.5 in Group B, every mean ridit of "emphysematous change" in Group A was the largest-0.63 in non-smokers, 0.74 in ex-smokers and 0.70 in current smokers. Therefore, "emphysematous change" was more influenced on airway obstruction than any other finding because of the largest mean ridit. We conclude as follows. Pulmonary hypertension is more serious in patients suffering from severe airway obstruction with pulmonary tuberculosis sequelae, and it may be attributable to reduction in capacity of anatomical pulmonary vascular bed rather than hypoxic pulmonary vasoconstriction. Pathological changes such as "emphysematous change" on the radiograph might be considered as an important cause of obstructive ventilatory impairment.

Adolescent↗
PubMedDate not supplied

[Triple filling plasty in Clagett thoracostomy].

Clagett's thoracostomy is a widely used procedure in the initial treatment of postpneumonectomy empyema. We describe in this paper an original one-step operation of thoracic filling after empyema sterilization. The triple plasty includes an apical thoracoplasty limited to the first 3 ribs, a pedicle flap of the latissimus dorsi transferred inside the thoracic cavity, and an upper translation of the diaphragm to the 4th rib in order to reduce residual pleural space. Three patients were operated and followed up clinically (for 20, 29, and 30 months), and radiologically with a MRI on the 12th month. Complete tissue healing and loss of all residual space was observed in all patients. We therefore recommend the use of this technique rather than thoracic wall coverage procedures.

Adult↗
PubMed1997

[Surgical treatment in pulmonary tuberculosis with sputum long-term Mycobacterium tuberculosis positive].

OBJECTIVE: To evaluate the importance of surgical treatment in pulmonary tuberculosis with sputum long-term Mycobacterium tuberculosis positive. METHOD: Sixty-five patients with pulmonary tuberculosis who failed antituberculosis chemotherapy received lung resection or thoracoplasty. RESULT: Sputum negative conversion was found in sixty-three patients without recurrence during 1-3 year follow-up, while sputum positive conversion was found only in one case during the period of follow-up. Among all the patients, one died of respiratory failure after the operation, three complicated with empyema and recovered from operating again. CONCLUSION: Surgical operation is still important for treating pulmonary tuberculosis patients with sputum long-term Mycobacterium tuberculosis positive.

Adolescent↗
PubMed1999

[Investigation of pulmonary hemodynamics and chest X-ray findings in hypercapnic patients with pulmonary tuberculosis sequelae].

We investigated pulmonary hemodynamics and chest X-ray findings to explore pathophysiological significance of chronic hypercapnia in patients with pulmonary tuberculosis sequelae. One hundred and seven patients underwent examinations of blood gases and right cardiac catheterization. The patients were divided into two groups, according to arterial carbon dioxide tension under room air breathing (PaCO2). Group I (n = 35) was defined as 45 Torr or lower of PaCO2, and Group II (n = 72) was the hypercapnic group whose PaCO2 was over 45 Torr. In addition, spirometry was done in 34 patients of Group I and 68 of Group II. First, the values of blood gases, spirometry and pulmonary hemodynamics were compared between the two groups. Secondly, between 22 of Group I and 50 of Group II, the values of pulmonary arteriolar resistance (PAR) before and after 100% oxygen breathing for 10 minutes were compared. These comparisons were made by exploratory data analysis. Lastly, we described in all cases with five items of chest X-ray findings and the extent of each finding we had defined. The items were emphysematous change; fibrosis, bronchiectasis, and/or cavity (hereafter abbreviated as "fibrosis"); lung resection and/or atelectasis; pleural thickening; and thoracoplasty. We explored the items of X-ray findings which may relate to hypercapnia by ridit (abbreviation for "relative to an identified distribution") analysis. The results were as follows. (1) Hypercapnic patients tended to have severer restrictive ventilatory impairment and hypoxemia. Under an even level of arterial oxygen tension (PaO2), tissue oxygenation was not poorer in Group II than in Group I. (2) Hypercapnic patients tended to have more unfavorable pulmonary hemodynamics. More than half of them had pulmonary hypertension defined as 20 mmHg or higher of pulmonary artery mean pressure (PAm). Under an even level of PaO2, PAm was higher in Group II. Although 34 patients of Group II showed PaO2 over 60 Torr, 23 of them had pulmonary hypertension. (3) PAR after oxygen breathing was more likely to decrease in Group II than in Group I. (4) As any mean ridit was standardized and adjusted to 0.5 in Group I, the maximum was the mean ridit of "pleural thickening" (= 0.67), next "fibrosis" (= 0.65) in Group II. The above two items of X-ray findings, in which each mean ridit was higher than in any other item, were more influential on hypercapnia. We conclude as follows. (1) Pulmonary hypertension is severer in hypercapnic patients with pulmonary tuberculosis sequelae; it may be mainly attributable to hypoxic pulmonary vasoconstriction. (2) An important cause of chronic hypercapnia may be pathological changes such as "pleural thickening" and "fibrosis" seen on the radiogram.

Adult↗
PubMed1999

[Pleural empyema--treatment results of the myoplasty method].

The authors present the results of surgical treatment of pleural empyema by transposition of skeletal muscles into the pleural cavity. 50 patients with chronic pleural empyema of different origin were treated in Thoracic Surgery Department in Lublin in the years 1995-1998. Patients were after thoracotomy with lung tissue resection, in its majority due to neoplastic diseases. The healing process was completed per primam intentionem in 1/3 of the patients who were operated on. After 3 months the number of cured patients increased to 72.0%, and after 1 year to 84%. The hospital death rate after surgery was 6%. Because of partial obliteration of pleural cavity 25 patients were secondary treated with extended drainage or modified Clagett's method. The best results occurred when complete obliteration of pleural cavity was acquired primarily. In large empyemas it was necessary to perform supplementary thoracoplasty or filling the residual cavity with proper antibiotics solution.

Adult↗
PubMed1999

[Surgical management of pulmonary disease due to nontuberculous mycobacteria].

Between 1983 and 1998, 9 patients with nontuberculous mycobacteriosis (NTM) underwent pulmonary resection. 8 patients were men and 1 was woman. Mean length of preoperative period was 20.3 months (range 6 months to 51 months). Most operative indication was localized NTM resistant to multidrug therapy. Lobectomy was performed in 7 patients, segmentectomy in one, partial resection in one. We have no operative mortality but air leaks occurred in one and he needed thoracoplasty. Mean postoperative follow up period was 67.7 months. Only one patients relapsed 34 months after the first operation. For localized NTM, early surgical management results good outcome.

Adult↗