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PubMed2004

[The surgical treatment of tuberculosis in adults in the first half of the 20th century in the journal 'Gruźlica' (tuberculosis)].

Against the backdrop of the journal 'Gruilica', which appeared from 1909 to 1961, the author traces the changes taking place in the surgical treatment of TB patients over that period. She describes such things as pneumoperitoneal treatment (extrapulmonary, intrapulmonary, peritoneal), suction drainage of the tubercular cavity by the Monaldi method and finally thoracoplasty. She also mentions the contributions Polish physicians have made to those treatment methods.

Adult↗
PubMed1991

[The role of surgery in pulmonary tuberculosis infected by tubercle bacilli with multiple drug resistance].

The first, definition of pulmonary tuberculosis bacilli with multiple drug resistance was decided as "bacilli completely resistant to RFP 50 mcg + SM 20 mcg and/or INH 1 mcg + KM 100 mcg and/or EB 5 mcg and/or another antituberculosis drug" based on 118 cases examined for drug resistance pre-operatively in 35 institutions belonging to the Tuberculosis Research Committee, during the 6 years period 1984 to 1989. Next, 48 pulmonary tuberculous cases with multiple drug resistance were analysed, and the following conclusions were obtained: 1) Pulmonary tuberculosis cases with multiple drug resistance were 36% of 133 cases of positive tuberculosis bacilli before operation. 2) 52% were more than 50 years old. One third showed less than 40 in respiratory index. 3) Most of them did not have effective anti-tuberculosis drug to be used after operation. 4) There was a high rate of pneumonectomy and collapse therapy such as thoracoplasty. 5) Successful rate of treatment was 72.9%, which is rather good for multiple drug resistant tuberculous cases. But bacilli positive rate after operation and mortality were 12.5% and severe complications such as bronchial or pulmonary fistula, thoracic empyema and worsening of tuberculosis after operation was 25%. Therefore surgical treatment for pulmonary tuberculosis with multiple drug resistance needed careful application considering sensitive drug to be used after testing of resistance for all anti-tuberculosis drugs. Surgical treatment should be considered especially if pulmonary tuberculosis cases have complete resistance to RFP and to one drug among SM, INH, KM and EB.

Adult↗
PubMed1991

[Role of surgical treatment in atypical mycobacteriosis of the lung].

During the 15 year period from January, 1976 to September, 1990, we treated 77 patients with atypical mycobacteriosis (AM) of the lung surgically with satisfactory results. There were 56 men and 20 women, a ratio of 2.9 : 1. The age of the patients ranged from 20 to 76, with an average of 50.7 years. The operative rate was 3.7% against the patients admitted with a diagnosis of atypical mycobacterial infection. The number of the patients and the types of bacilli classified according to Runyon's criteria were 4 for Group I (M. kansasii), 63 for Group III (M. avium complex), 3 for Group IV, and 7 unknown. The operative indications we adopted were, 1) the resistance to most antituberculotics, 2) localized lesion, and 3) progressive deteriorations. Sensitivity study showed that over 90% of the patients had bacilli with complete or incomplete resistance against all antituberculotics except cycloserine. The area of major involvement was localized in the upper lobe in 47, but was bilateral in 14 patients. The period of conservative therapy prior to the surgical treatment ranged from 2 to 164 months, with an average of 28 months. As to the operative procedures, 58 had lobectomy, 12 pneumonectomy , 11 segmentectomy or wedge resection, 12 thoracoplasty, and 17 combined procedures. The incidence of post-operative complication was 16.9%. The recurrences were observed in 8 patients (10.4%), who had multiple and bilateral lesions. Complete cure rate was 83.1% and 64 patients were able to resume normal life. Our results indicate that, if properly selected, time required for the treatment may become shorter and the patients with AM may get better results by surgical treatment.

Adult↗
PubMed1991

[A case of bronchial anastomotic stenosis after right upper sleeve lobectomy treated with silicone stent].

A case treated with silicone stent for bronchial granulomatous stenosis caused by anastomosis after right upper sleeve lobectomy was reported. A 68-year-old man complained of atelectasis of right upper lobe due to squamous cell carcinoma was admitted to our department. We performed right upper sleeve lobectomy. Four weeks after the operation, hemoptysis and dyspnea appeared with developing local empyema. We performed closure of pleural fistula and thoracoplasty, however, did not improve the symptoms. We performed tracheotomy for deteriorating dyspnea. In addition, granulomatous stenosis of bronchial anastomotic site was observed endoscopically. We tried to insert silicone stent into stenotic site. Although, first trial was in failure, we modified the design of the stent and succeeded in fixation of the stent. The airway was completely re-opened and good patency had been maintained for 7 months until his death due to pneumonia.

Aged↗
PubMed1991

[Bronchopleural fistulas developing after pulmonary resections for lung cancer predisposing factors, management, and prognosis].

During the past 28 years, 55 bronchopleural fistulas (BPFs) have developed after pulmonary resections for 52 primary and 3 recurrent lung cancers at the National Cancer Center Hospital, Tokyo. During the same period, there were 2446 pulmonary resections for primary lung cancer, the incidence of BPF being 2.1%. As an operative mode of initial resections, pneumonectomy (26 cases) was most common, followed by lobectomy (20 cases), bronchoplasty (8 cases), and stump resection for recurrence (1 case). The following predisposing risk factors for BPF development were identified: resection for locally advanced lung cancer (80.8%); residual carcinomatous tissue at the resected end of bronchus or anastomosis line (29.1%); hypoalbuminemia, diabetes, or steroid administration (20%); pre- and postoperative adjuvant therapy (49.1%). Seven cases received no treatment for BPF because of sudden deaths by massive airway bleeding (5 cases), worsening pneumonia (1 case), and spontaneous recovery (1 case). Remaining 48 cases underwent treatment; tube thoracostomy only in 7 cases and surgical interventions in 41 cases, one case of which was lost during rethoracotomy due to vascular rupture. Initial surgical interventions were composed of combinations of the following procedures; direct re-suture of fistula (16 cases); amputation of the stump and re-closure (3 cases); completion pneumonectomy (6 cases); reinforcement and wrapping of fistula (27 cases); thoracoplasty (29 case). Among these 40 surgical repairs, fistula was successfully closed in 11 cases. In 5 cases, the fistula closure could be achieved after subsequent surgical procedures. Direct re-suture was successful only in 4 cases. In spite of various kinds of treatment, overall prognosis was quite poor; 37 cases died of BPF-related complications (67.3% mortality).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Post pneumonectomy empyema with bronchopleural fistula--a successful management using pedicled intercostal muscle flap on an atypical mycobacteriosis following the irradiation].

A 48-year-old woman underwent a right pneumonectomy for advanced mycobacterial disease (M. avium Complex), which followed the postoperative radiotherapy against a malignant schwannoma of the right lower chest wall treated seven years ago. On the 13th postoperative day, re-suture of the bronchial stump was performed urgently because of early bronchopleural fistula development. On the heels of that, reclosure of the bronchial fistula with coverage of the stump by parietal pleural flap was performed on the forty-first post operative day. On the 110th day, however, open drainage with thoracoplasty was performed because development of insidious aspergillous empyema was detected. Since then, local instillation of amphotellisin B, with an oral administration of antifungus drug was started. After succeeding to control the mycotic infection, reclosure of the bronchofistula, covered with pedicled intercostal muscle flap were performed on the 280th postoperative day and extraperiostal air-plombage for reducing empyema cavity. Postoperative course was uneventful and the patient was discharged one year later. With respect to pathogenetic relationship between radiation pneumonitis and feasibility of infection to atypical mycobacteria, preoperative radiotherapy and concurrence of postoperative bronchofistula, and some problems on management of empyema bronchofistula were briefly discussed.

Bronchial Fistula↗
PubMed1991

[What has tuberculosis medical care contributed to modern medicine in Japan].

About 40 years ago, we had a huge number of tuberculosis patients which were about three to five millions. And a great deal of effort has been given in order to conquer tuberculosis. The philosophy and the technology used in there efforts are thought to have made considerable contributions to the development of modern medicine in other fields in Japan. The controlled clinical trial used to test new antituberculous agents has been a basis for a modern judgment on the effectiveness of any new drugs and it has brought good clinical practices. Scientific procedures for diagnosis, bronchoscopy and pulmonary function tests started in the field of tuberculosis to have more detailed diagnosis included differential one, preoperative evaluation, and evaluation for respiratory failure. Philosophy and methods of modern rehabilitation for the patients started from the care for the patient with pulmonary tuberculosis. Occupational therapy has been used for confirmation of curability of tuberculosis and restoration of the physical strength. Physiotherapy also started from exercises preventing deformities of the thorax after thoracoplasty. Terminal care for patients with cancer and other incurable diseases is now most new medical way, but in the field of tuberculosis before chemotherapeutic era, these were good experiences for this kind of care. A pain control using morphine or cocaine for spinal caries and laryngeal tuberculosis, and also telling the truth to the patients were the good examples. Holistic medicine, which is also a modern topic, has been considered in tuberculosis medical care, because the disease has so much psycho-social problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Medicine↗
PubMed1991

[Legionnaires' disease with mediastinal lymph nodes swelling, diagnosed by open lung biopsy--a case report].

Legionnaires' disease in a 37-year-old male who had had silicosis was reported. He was admitted because of dyspnea. The chest X-ray film and CT scan showed infiltrative shadow and swelling of mediastinal lymph nodes. Open lung biopsy was done and Legionella pneumohila was detected. REP and EM were started and infiltrative shadow of X-ray was disappeared. Pleuro-pneumonectomy and thoracoplasty were performed because of hemoptysis and postoperative empyema. The patient is now well.

Adult↗
PubMed1991

[Surgical correction of early forms of funnel chest in children with Marfan's and Ehlers-Danlos syndromes].

A prophylactic trend was developed in surgical treatment of funnel chest on basis of a syndromal approach to solution of applied problems of clinical medicine. Patients with an established diagnosis of progressive funnel deformity underwent early prophylactic sparing one-stage thoracoplasty according to the authors' own method, which made it possible to prevent progress of the deformity in the early stage; such treatment had a positive effect on further physical and mental development of the child. Besides, the method of operation had a lesser injurious effect and reduced the number of complications; it also considerably reduced the expenditures and shortened the period of treatment.

Age Factors↗
PubMed1990

[Tuberculosis sequelae: clinical aspects].

We studied the pulmonary diseases which had developed as consequent deformities after healing of tuberculosis, which we called tuberculosis sequelae. Results are described as follows. 1. The frequency of tuberculosis sequelae was about 6% in the patients with pulmonary diseases admitted to our hospital. 2. 93 cases of them consisted of 4 groups, which were 39 of repeated bacterial infection of lower respiratory tract, 23 of pulmonary aspergilloma, 13 of atypical mycobacteriosis and 28 of chronic respiratory failure. 3. Patients with tuberculosis sequelae were distributed more in the younger age group than others with resembled pulmonary diseases. The men to women ratio was about 2:1. Patients with pulmonary aspergilloma were younger than those with atypical mycobacteriosis. 4. Death rate in tuberculosis sequelae was about 5% per year. 46% of patients with atypical mycobacteriosis and 44% with chronic respiratory failure died within 4 years. 5. In chest X-ray findings, fibrosis and shrinkage of the lung, compensatory pulmonary emphysema, deformity or dilatation of bronchi, bulla formation and residual tuberculous cavities were recognized in 40 to 65% of the cases. Severe pleural thickness or past thoracoplasty were frequently recognized in the patients with chronic respiratory failure. All the patients with pulmonary aspergilloma had one or more residual cavities. 6. The frequency of systemic complications was not more than in the control population matched by age. Comparatively, serum IgG and IgA were elevated and PHA-induced lymphocyte activation was not lowered in the patients with pulmonary aspergilloma and atypical mycobacteriosis. From these results, the main factor in the development of tuberculosis sequelae seemed to be local defects of the chest.

Adult↗
PubMed1990

[Tuberculosis sequelae: pathological findings].

Pathological examination of tuberculosis sequelae was carried out to clarify the nature and pathogenesis of sequela. Twenty-one cases were chosen from autopsied cases in the past 15 years; male 20, female 1, and age ranged from 43 to 78 and mean age was 59 years. Sequela cases were divided into two subgroups; low lung function subgroup (LLFS) and non-low lung function subgroup (NLLFS). LLFS had 10 cases and mean age was 55 years. Ten cases of bilateral fibrotic cavities, 10 cases of bilateral upper lobe atelectatic indurations, 4 cases of pneumonectomy, 4 cases of thoracoplasty, and others were basic lesions of sequela. Lobar atelectatic induration was formed of organized destructive pneumonia and suspected to follow the tuberculous granulomatous pneumonia. Seven cases of localized emphysema, 11 cases of bullae were seen as the secondary change. Mean heart weight was 335 gr and left ventricle + septum: right ventricle (LV+S: RV) ratio decreased to 1.24 among LLFS and mean heart weight 273 gr and Lv+S: RV ratio was 2.35 in NLLFS. Remaining of cavities were observed in 15 cases and Aspergillus infection was seen in 11 cases (7 cases formed fungus ball, 4 cases showed semi-invasive growth and 2 out of 4 showed necrotizing pneumonia and formed direct cause of the death). Terminal infection was seen in 10 cases. According to our data, chronic lung failure with cor pulmonale, secondary fungus infection in the remained cavity, and terminal infectious pneumonia were serious consequence of tuberculosis sequela.

Adult↗
PubMed1990

[Tuberculosis sequelae: pathophysiological aspects (pulmonary circulation)].

223 cases with pulmonary tuberculosis sequelae underwent the examinations of arterial blood gases, pulmonary function or right cardiac catheterization. Especially 86 cases were investigated of pulmonary hemodynamics. We discussed about the findings on chest X-ray film--emphysematous change; fibrosis, bronchiectasis, cavity; atelectasis, pneumonectomy; pleural peel; thoracoplasty--in tuberculosis sequelae to influence pulmonary hypertension, about pulmonary hemodynamics, in the past history, with or without right heart failure, about the difference between tuberculosis sequelae and chronic obstructive pulmonary disease (COPD) in pulmonary hemodynamics, and about prognosis in patients with tuberculosis sequelae. The summary of results was as follows: 1. The most influential chest X-ray finding on pulmonary hypertension is pleural peel. 2. In cases without right heart failure in the past, the values of arterial blood gases, pulmonary function and pulmonary hemodynamics were better. The effect of reduction of pulmonary arteriolar resistance was good in cases without right heart failure under the condition of oxygen inhalation. 3. Pulmonary artery mean pressure in tuberculosis sequelae tended to be higher than in COPD under the even conditions of PaO2 and FEV1/prVC%. Nocturnal desaturation was more in tuberculosis sequelae. 4. Prognosis of tuberculosis sequelae was poor in patients with pulmonary hypertension though there was no statistical significance at present. In conclusion, for the early diagnosis and management of pulmonary circulatory disorder in tuberculosis sequelae, we thought it was important to follow the clinical course with special attention to chest X-ray findings, to start oxygen therapy before right heart failure takes place, and to make an effort to extend the indication of home oxygen therapy.

Adult↗
PubMed1990

[Surgical tactics in bilateral resections of the lungs].

The article generalizes experience in 118 bilateral resections of the lungs carried out within 4 years at the Chelyabinsk Regional Antituberculosis Hospital, among which 63% (74) were one-stage bilateral operations. A clinical effect was produced in 97.5% of patients. Postoperative mortality was 1.7%. The authors prefer one-stage bilateral resections and resort to stage-by-stage operations only in cases with severe concomitant diseases, marked respiratory insufficiency, in a large volume of the resection, particularly if it is combined with thoracoplasty. A transsternal approach in one-stage bilateral resections is indicated when the upper parts of the lung must be resected in a large volume, in cases in which difficulties in exposure of the lungs are not expected; one-stage opening of both pleural sacs is recommended in this case for adequate inspection of the lungs before their resection.

Adult↗
PubMed1990

The contributions of John B. Murphy to thoracic surgery.

John B. Murphy was a prominent surgeon who lived in Chicago from the 1880s until his death in 1916. During his career, he was associated with both Rush Presbyterian and Northwestern Medical Schools. He was responsible for popularizing the use of an artificial pneumothorax as an effective adjunct in the treatment of pulmonary tuberculosis. This modality was not, however, his original concept. In addition to all of the fields of general surgery, Murphy undertook the management of empyema and lesions of the chest wall and also performed thoracoplasty procedures. Although he had done several thoracotomy procedures in his laboratory, he rarely undertook this operation in a clinical setting. Drop ether anesthesia was used for all surgical procedures. Murphy did not use closed water seal drainage of the chest. His oration on thoracic surgery, given at the annual meeting of the AMA, in 1898, was an excellent monograph on the subject and undoubtedly contributed to the increased interest and progress in this field of surgery. Murphy was a wise surgeon, an able technician and a scholarly teacher. The high regard in which he was held by his contemporaries is best expressed by the remark of William Mayo, "...he was the surgical genius of our generation".

Chicago↗
PubMed1990

[Use of carbon dioxide laser in the surgery of pulmonary tuberculosis].

Results of 120 operations for pulmonary tuberculosis performed by using a carbon dioxide laser were analyzed. Eighty patients were subjected to saving resection of the lung. Lobectomy, pulmonectomy and pulmonary cystorhaphy were carried out in 15, 6 and 8 patients, respectively. Thoracoplasty with myoplasty of the residual pleural cavity was applied to 11 patients. The early results of the surgical treatment of pulmonary tuberculosis in all the patients were satisfactory.

Adolescent↗
PubMed1990

[Successful use of an omental pedicled flap for obliterating empyema associated with a large bronchial fistula].

We transferred the omentum up into the thorax through the diaphragm and succeeded in obliterating the empyema with a large bronchial fistula. A 52 year-old man with 30 years history of empyema was referred because of purulent discharge through the cutaneous fistula starting one year before. Open thoracotomy revealed a round opening 13 mm in diameter to the cavity, which resulted from lobectomy performed 30 years before. After a month of dress changing pseudomonas aeruginosa in the empyema space disappeared. Thereafter radical operation was performed in order to close the fistula. The omental flap supplied by the right gastroepiploic artery was transferred into the empyema space. The flap was sutured to the orifice of the bronchial stump. The residual space was obliterated by the thoracoplasty using the chest wall with ribs and lateral side of the empyema wall. Postoperative course was uneventful and bronchoscopy at two months after the operation revealed that the bronchial mucosa developed and covered over the large bronchial fistula.

Bronchial Fistula↗
PubMed1990

[Status of the myocardium and heart valves in funnel chest].

Examinations of 70 patients with keeled deformation of the chest (KDC) have revealed signs of connective tissue dysplasia in all the examinees, as well as heart rhythm and conduction disorders. Echography has shown ventricular and atrial septal defects, mitral valve prolapse, dilatation of the aortic root, tricuspidal valve prolapse, abnormally located chorda. The development of KDC in the presence of external connective tissue stigmata, involvement of the cardiovascular system, changed dermatoglyphic pattern of the palms and fingers (as evidenced by dermatoglyphic analysis), as well as findings of histologic examinations of the cartilage removed in the course of thoracoplasty may indicate a generalized abnormality of the connective tissue in this patient population and KDC may be regarded as one of its manifestations.

Abnormalities, Multiple↗
PubMedDate not supplied

Treatment of postpneumonectomy empyema with or without bronchopleural fistula.

Bronchopleural fistula with empyema is an uncommon but tragic complication after pulmonary resection. The possible therapeutic procedures are discussed. The patient often requires multiple surgical interventions and prolonged hospitalisation. According to the literature, open window thoracostomy (OWT) and even mutilating interventions such as myoplasty or thoracoplasty have to be performed when simple chest-tube drainage and antibiotic therapy do not suffice as illustrated by the present case.

Bronchial Fistula↗