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At least 1,099 records · Page 61Linked to original sources
PubMed1999

Role of thoracic surgery in pulmonary tuberculosis.

Surgery in pulmonary tuberculosis in one form or other gives good results. Indications for surgery include drug resistant pulmonary tuberculosis, massive recurrent haemoptysis, post-tuberculosis bronchiectasis or destroyed lung, empyema with or without bronchopleural fistula and for diagnostic purposes. In all cases a clear indication for surgery is mandatory. Processes of surgery include lung resection, thoracoplasty, decortication, thoracotomy and biopsy, thoracoscopy and ib resection for pleurocutaneous flap procedures. Adequate postoperative management is very important. Complications like atelectasis and pneumonia, empyema, bronchopleural fistula, wound infection, cachexia, etc, add morbidity and prolonged hospital stay.

Humans↗
PubMed2000

History of resectional surgery for tuberculosis and other mycobacterial infections.

Resectional surgery for tuberculosis became increasingly common in the 1940s; however, thoracoplasty remained the most popular treatment of choice until the introduction of effective antituberculosis agents. With the development of rifampin in 1966, surgery was seldom needed except for the occasional massive hemoptysis, bronchial stenosis bronchopleural fistula, or to rule out cancer. With the rise of MDR-TB and the increasing MOTT infections requiring surgery, resectional procedures are again being needed in the treatment of mycobacterial disease.

History, 20th Century↗
PubMed2000

Chronic expanding hematoma in the chest.

We report the successful surgical treatment of chronic expanding hematoma in the chest. Four patients who had previously undergone artificial pneumothorax, thoracoplasty or tumor extirpation more than 30 years earlier recently became aware of a slowly growing mass. Chronic expanding hematoma which developed into very large masses over a long period of time were thus successfully resected. These patients are now all in good health with no recurrence after the operation. It is important to monitor such patients' laboratory data for hemostasis including the platelet cell counts, the % prothrombin time and the D-dimer, both before and immediately after operation, and the intraoperative bleeding volume.

Aged↗
PubMedDate not supplied

[Current role of open window thoracostomy].

The Open Window Thoracostomy (OWT) surgical method find its origin in the treatment of chronic tuberculous empyemas, in the cases where the drainage alone not permitted a sufficient cleaning of pleural cavity. In the recent years the indications for the execution of this method are extended also to metapneumoniae and post-pneumonectomy empyemas (for benign and malignant pathology), with or without bronco-pleural fistula, when these pathologies produces a general severe decline in the patient (septic shock). This method permit to effect a daily cleaning of a pleural cavity, through the introduction of a sterile gauzes imbued of specific antibiotic, reducing at least the purulent infection effects's previously present and favouring the reduction of the same cavity, in prevision of other reconstructive operations (thoracoplasty). Generally not many beloved by surgeons and patients (for the difficult management, aesthetic outcomes, the long stay in hospital), the OWT can often reestablish a dangerous situation, especially in the patients with a risk of septic shock. This study aims to analyse present indications, problems and therapeutics outcomes of this method, through the evaluation of 27 cases of OWT treated in the Department of Thoracic Surgery University of L'Aquila between the 1984 and the 1998.

Aged↗
PubMed2000

[Fifty years of research on tuberculosis. Lessons I have learnt during 50 years and topics to be investigated in the future].

I have engaged in the research on tuberculosis for 50 years, and lessons I have learnt during this period could be summarized in the following ten topics. First is great research achievements by our predecessors on the establishment of so-called primary infection theory on the pathogenesis of TB, planning of TB control principles based on the theory and development of new technologies used for TB control, such as mass miniature X-ray examination and BCG vaccination in 1920s and 1930s. TB control law was enforced in 1951, and the modern TB programme was initiated. Second, the field is a treasure house of interesting data. Several interesting data on TB soon after the World War II in Tokyo and a rural area were collected and analyzed from the mass health examination. Third, looking at the increase of tuberculin positivity with age, it was found that the tuberculin negativity decreased as the exponential function of age, and the current concept of the annual risk of TB infection was already developed in late 1940s. It was 18.1% in male and 11.6% in female in Tokyo in late 1940s. Based on this concept, age specific TB mortality was analyzed by the type of TB, and the rates of miliary TB and TB meningitis were similar to the rate of newly infected to the total population, while the rate of all forms could be divided into early and late death as shown in Fig. 1. Fourth, I suffered from TB by myself from 1951 to 1953, receiving first thoracoplasty in two stages under local anaesthesia, then right upper lobectomy and segmentectomy of superior segment of right lower lobe. From this experience, I learnt a lot about the psychology and suffering of TB patients. Fifth, the importance of recognition of real magnitude of the problem in such a disease as TB in which many TB cases did not aware of their disease. The answer to this was the first TB prevalence survey in 1953 using stratified random sampling method, and based on the results of the survey, the mass health examination originally focussed on youth was expanded to the total adult population of Japan. Sixth, TB could be reduced rapidly by applying appropriately planned control programme. In big enterprises, the application of intensive case-finding programme brought about the rapid decline of severe TB cases, contributed to the increase of the productivity of the enterprises, thus to the rapid increase of GDP of whole Japan, and the growing spiral between the improvement of health and the economic development was formed by successful TB control. In addition to the mass health examination, BCG vaccination and spread of appropriate treatment in the original TB control law, the registration and case management system and the more extensive application of hospitalization for infectious cases were introduced in early 1960s. Observing the proportion of TB care expenditure to the national medical expenditure, it was 28% in 1954, and it dropped down to 0.4% in recently as shown in Fig. 2. The decline of TB in Japan during 1950s and 1960s was one of fastest in the world. Seventh, there had been marked differences in the prevalence of TB as well as the coverage and quality of TB programmes in several areas of Japan though it was often said that Japan is homogeneous country. To know the real status in various areas of Japan, a chart to express graphically the magnitude of TB and coverage and quality of TB programmes was developed (Fig. 3), and it was finally refined to the current form. Eighth difficulty in changing existing programmes, and we are grateful for kind cooperation of Niigata Prefecture for making several new attempts. Ninth, it has been needed to observe TB problems from global standpoint, and it was actually done through participation to the bilateral cooperation projects on TB control and conducting the international training courses sponsored by JICA. Tenth, TB is a pertinacious disease. As shown in Fig. (ABSTRACT TRUNCATED)

Adult↗
PubMed2000

[Domiciliary noninvasive positive pressure ventilation in chronic alveolar hypoventilation].

Effectiveness of treatment with domiciliary nocturnal noninvasive positive pressure ventilation is analyzed in a group of patients with chronic alveolar hypoventilation of different etiologies. It was applied with two levels of pressure (BiPAP) via nasal mask. Criteria for evaluation were symptomatology and improvement in gas exchange. Data were analyzed by Student t tests. A total of 13 patients were included, mean age 55.7 range 20 to 76 years (5 male 8 female). Main diagnosis was tuberculosis in 6, four of them having had surgical procedure (thoracoplasty 2, frenicectomy 1 and neumonectomy 1), myopathy 3 (myasthenia gravis 1, muscular dystrophy 1 and diaphragmatic paralysis 1), obesity-hypoventilation syndrome 1, escoliosis 1, bronchiectasis 1 and cystic fibrosis 1. These last two patients were on waiting list for lung transplantation. At the moment of consultation, the symptoms were: dysnea 13/13 (100%), astenia 13/13 (100%), hypersomnolency 10/13 (77%), cephalea 9/13 (69%), leg edema 6/13 (46%), loss of memory 6/13 (46%). Regarding gas exchange, they showed hypoxemia and hypercapnia. Mean follow up was of 2.2 years (range 6 months to 4 years). Within the year, all 13 patients became less dyspneic. Astenia, hypersomnolency, cephalea, leg edema and memory loss disappeared. Improvement in gas exchange was: PaO2/FiO2 from 269 +/- 65.4 (basal) to 336.7 +/- 75.3 post-treatment (p = 0.0018). PaCO2 from 70.77 +/- 25.48 mmHg (basal) to 46.77 +/- 8.14 mmHg (p = 0.0013). Ventilatory support was discontinued en 5 patients: three because of pneumonia requiring intubation and conventional mechanical ventilation, two of them died and one is still with tracheostomy; One patient with bronchiectasis and one with cystic fibrosis were transplanted. The remaining eight patients are stable. In conclusion, chronic alveolar hypoventilation can be effectively treated with domiciliary nocturnal noninvasive ventilation. Long term improvement in symptomatology and arterial blood gases can be obtained without significant complications.

Adult↗
PubMed1975

[Results of treatment of postoperative bronchopleural complications in lung cancer].

An analysis of the results of treatment in 138 patients with bronchopleural complications after 1400 operations on the lung for cancer is given. Conservative methods of therapy (punctures and drainage of the pleural cavity, instillation and of the fisula with 30% silver nitrite and intratracheal injections of antibiotics) were utilized in 105 patients with bronchial fistulas and pleural empyemas. Thirty there patients were treated surgically (tamponade, thoracoplasty, rethoracotomy with suturing of the bronchial fistula, transsternal suturing of the bronchial fistulas). The rate of mortality from bronchopleural complications was 4.8%, i.e. one third of all causes of death. However, recently it reduced more than twice in comparison with the initial period. The direct causes of lethal issues are complications on the part of other organs: pneumonia of the remained lung (24), septicopyemia (12), hemorrhage (10), and others (19).

Anti-Bacterial Agents↗
PubMed1999

[Malformative giant emphysema bulla. Report of a case in childhood].

Bullous pneumopathy is considered a surgical disease, although her treatment is still discussed. The initial attempts of surgical treatment were founded on erroneous physiopathological concepts and date back to early years of 1900. These surgical treatments intended to external drainage of giant bullae, their marsupialized or to reduction of extension of bullae by pneumoperitonaeum, section of phrenic nerve or thoracoplasty. The definition of emphysematous bullae has been much improved with the development of computed tomography. A precise study of their size, of their position and of condition of residual pulmonary parenchyma may be considered important to decide the surgical treatment: this must determine the removal of bulla and the reexpansion of compressed pulmonary parenchyma. The Authors report a case of giant bulla, initially wrong interpreted as pneumothorax, of exceptional observation for her malformative origin, diagnoses and surgical treated on an eleven years old child.

Child↗
PubMed2001

[Usefulness of gallium-67 scintigraphy in diagnosing pyothorax-associated lymphoma].

Two cases of pyothorax-associated malignant lymphoma were reported. The presence of chronic tuberculous pyothorax after thoracoplasty and the development of non-Hodgkin's lymphoma on the chest wall are closely related. Both patients had suffered from tuberculous pyothorax for more than thirty years, and developed new painful chest wall tumors. CT and MRI delineated both malignant lymphoma and pyothorax. Gallium-67 accumulated strongly in malignant lymphoma, however did not in pyothorax. Gallium-67 scintigraphy was useful for detection of malignant lymphoma in both cases; therefore it could be a useful test for diagnosing of pyothorax-associated lymphoma.

Aged↗
PubMed2001

[A case of giant dumbbell shaped schwannoma with massive pleural effusion].

A 58-year-old female was admitted to the hospital complaining of dyspnea. The chest roentgenogram and CT scan revealed a large mediastinum tumor and massive pleural effusion in the right hemithorax. The diagnosis of lung cancer with carcinomatous pleulitis was performed through thoracocentesis an treatment of chemotherapy was chosen. After 6 years, she was admitted again to the hospital complaining of dull pain in the right leg. Chest CT scan and MRI showed a giant dumbbell shaped mass connected to the spinal canal. The tumor was larger than that of six years ago and diagnosed as schwannoma by CT-guided pericutaneous needle biopsy. At operation, hemilaminectomy of Th 1-3 was done first, and total tumor resection was performed through posterolateral thoracotomy. Intrathoracic adhesion was severe and it was difficult to control air leakage from the lung, thoracoplasty was performed.

Female↗
PubMedDate not supplied

[The first anti-cancer center in Lyon (1923): surgeon Leon Berard and Auguste Lumiere].

At present, little is known about the creation of cancer hospitals. I will report on that of Lyons, France, with the famous surgeon, Léon Bérard (1870-1956). A specialist of neck surgery, he was the first to carry out major thoracoplasties. The cancer hospital was inaugurated in 1923 under the Great Dome of the hôtel-Dieu hospital. (The dome is the creation of the famous architect Germain Soufflot (1748)). In 1933, the cancer hospital moved in the newly-built Edouard Herriot Hospital; it became independent in 1958, two years after the famous surgeon's death, and it was rightly named after him: "Centre anticancéreux Léon Bérard". Its creation and its quick development owes a lot to generosity of Auguste Lumière, one of the two inventors of cinematograph. Auguste Lumière sponsored radiotherapy material and, at Léon Bérard's request (as there was a lack of space in Edouard Herriot hospital), created a centre for cancer patients (Bon Abr Hospital, rue Mistral, with Dr Vigne). A Lumière gave his time as well as his money for the centre; he was the car-driver, he helped L. Bérard with his university classes, and he often comforted the patients while running a private clinic (La Clinique Lumière), which combined dispensary services with research. (Micheline Bonin)

Cancer Care Facilities↗
PubMed2002

[Tuberculous pleural empyema: surgical aspects].

The outcomes of surgical treatment in 323 patients aged 18 to 87 years who had chronic tuberculous empyema are analyzed. The duration of the disease ranged from 4 to 54 years. The clinical picture was mild with few symptoms and a stable phase to severe with signs of pyoresorptive fever in an acute phase. A programme has been developed to treat patients with tuberculous empyema, which is based on a combination of total specific chemotherapy, local action on a tuberculous process, and final surgical intervention. The basic surgical interventions were pleurectomy and decortication of the lung in 124 (38.8%) patients; pleurectomy with decortication and resection of the lung in 31 (9.6%); pleurectomy, decortication with resection of the lung in 11 (3.4%). Forty three (13.3%) patients underwent plastic surgery with thoracoplasty and pleuropulmonectomy and 110 (34%) patients had palliative interventions as closed drainage. Postoperative complications occurred in 12.6% of patients. One patient died from progressive tuberculosis.

Adolescent↗
PubMed2002

Chest wall resection in general thoracic surgery.

To clarify the incidence, indications, and efficacy of chest wall resection, a comprehensive review is needed. Chest wall resection was performed in 23 of 162 operations for thoracic disease over a nine-year period. Eight surgeries requiring chest wall resection for benign disease (8/79) were classified as fenestration or thoracoplasty for empyema, or resection of a benign neoplasm. Fifteen patients who underwent chest wall resections for malignant disease (15/83) were classified as contiguous extension of neoplasms of neighboring organs, primary tumor, or local recurrence. The most common procedure in the malignant disease group was resection for contiguous spread of primary lung cancer (n = 7). The survival rate was 50% at 4 years. There were no serious postoperative complications. In some malignant diseases, complete local control with such a procedure may even lead to a long-term survival. This is a safe and an effective procedure for a variety of diseases.

Adolescent↗
PubMed2002

[Empyemectomy-treatment of pleural empyema].

Empyema thoracis has been recognized as a disease entity since the time of Hippocrates and historically has been associated with high mortality. Over 30 years ago, the American Thoracic Society described three stages in the natural course of empyema, namely the exudative, fibrinopurulent, and organizing phases. Decortication and suction drainage usually result in lung re-expansion, otherwise pleurocutaneous window, intrathoracic transposition of skeletal muscle, or thoracoplasty remain life-saving but now uncommon options for treating a closed-space infection. During last 9 years (1993-2001) 50 patients underwent empyemectomy due to pleural empyema. Three patients died (6%). In 4 cases we had complications-hydropneumothorax. They received punction (3 patients) and 1 received tube toracostomy. In one case urgent retoracotomy was performed due to acute intrapleural bleeding. After successful empyemectomy 47 patients stay at hospital 14 days approximately.

Adult↗
PubMedDate not supplied

[Application of pneumoperitoneum in collapse surgical procedures during tuberculosis outbreak].

Under conditions of tuberculosis epidemic resective methods come to be used more and more seldom, the causes of which fact being resistance of Koch's bacilli to antibacterial drugs, extension and duration of the process. Collapsosurgical interventions constitute an alternative to resecting methods but such operations are accompanied by complications in 11 to 22 percent of cases. The author suggests that pneumoperitoneum be used to prevent complications developing in thoracoplasty, substantiating his suggestion, validating it by submitting the relevant statistical material.

Collapse Therapy↗
PubMed2003

[Anesthetic management of a patient with squeezed heart by huge sternal tumor].

We experienced perioperative management for excision of a huge sternal chondrosarcoma squeezing the heart. A 46-year-old woman could not sleep due to dyspnea for 6 months. Dyspnea increased in the right decubitus and disappeared in the left decubitus. This suggested that the heart was squeezing the tumor. MRI and echocardiography revealed no invasion to the heart. Surgical removal was proposed. Anesthesia was induced with propofol and fentanyl. As this tumor composed of bone-like tissue and was tightly connected with thoracic cage, we thought that the use of muscle relaxant at the induction of anesthesia would not cause cardiovascular collapse and ventilation insufficiency even if the tumor was huge. Vecuronium was administered to facilitate endotracheal intubation. Hemodynamic variables were stable and mask ventilation was uneventful. Anesthesia was maintained with propofol, sevoflurane, supplemental dose of fentanyl and epidural anesthesia. The tumor had invaded the myocardium and was successfully flaked off from the myocardium without using any assisted devices. The tumor was excised including thoracic wall (sternum and parts of 3rd to 12th ribs, 20 cm in diameter). Thoracoplasty was performed using Marlex Mesh. Muscle relaxant was reversed after the end of the operation. Respiration was stable without flail chest. Endotracheal tube was successfully removed in the operation room. The postoperative course was uneventful.

Anesthesia, Epidural↗
PubMed2003

[Emergency pleuropneumonectomy via anterior approach to treat chronic hemorrhagic empyema due to massive hemoptysis].

A 67-year-old man with a history of surgical resection of the superior lobe of the left lung and thoracoplasty due to pulmonary tuberculosis occurring approximately 40 years previously, was admitted to the hospital due to recurrent hemoptysis. X-ray films and computed tomography (CT) scans of the chest showed the left thoracic cavity to be filled with empyema, compressing the inferior lobe downward. Since three unsuccessful attempts were made at bronchial artery embolization for hemostasis, yielding hemoptysis of approximately 1,000 ml, emergency surgery was performed. To prevent massive intra-operative hemoptysis, the left pulmonary artery was blocked by median sternotomy. A transverse incision was then made, and thus pleuropneumonectomy could be safely performed. Since it allows early blocking of blood vessels surrounding the hilum of the lung and the main bronchus, anterior approach is useful in treating hemorrhagic empyema and wet pleurisy with internal fistula.

Aged↗
PubMed1992

Managing complications of posterior spinal instrumentation and fusion.

Complications of posterior spinal instrumentation for adolescent idiopathic scoliosis are often preventable. Preoperative planning helps to minimize intraoperative and postoperative problems. Late recurrence of rotational deformity (crankshaft) in skeletally immature patients can be prevented by adding anterior surgery. Intraoperative complications are minimized by controlled hypotensive anesthesia and sequencing of surgical steps to allow for autocoagulation, reducing blood loss. Use of spinal cord monitoring, Stagnara wakeup test, and careful distraction decreases the risk of neurologic deficit. Good hook-site preparation helps avoid dural tears. The incidence of postoperative pneumothorax and hemothorax is decreased by careful hook attachment, avoiding pleural penetration, judicious use of rib excision thoracoplasty, and roentgenographic verification of central venous pressure line position. Postoperative recommendations include bed position at 30 degrees, frequent log rolling, incentive spirometry, early sitting and standing, early Foley catheter and nasogastric tube removal, prophylactic antibiotics, and prompt attention to wound infections. Postoperative orthotic wear, prescribed exercise, and activity restriction decrease the risk of early instrumentation failure and help correct early postoperative trunk imbalance. The late complications include suspected pseudarthrosis; this should be surgically treated again if there is persistent pain or marked loss of curve correction.

Adolescent↗