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PubMed1989

[Early and late pleural decortication--indications and technique].

Our experience with 224 decortications performed between 1957 and 1987 is reported. Insufficient drainage of tuberculous and unspecific pleural empyema was the main indication. Haemothorax, pleural loculation and chronic serofibrinous pleuritis were indications of secondary importance. Mortality following decortication was on the order of 0.1% and postoperative morbidity, 3%. However, in the past 10 years there has been a general reduction of aggressive surgical treatment. Whereas decortication and thoracoplasty account for 12% and 4% respectively of our surgical pulmonary procedures, therapy with closed-tube drainage has increased to 84%.

Acute Disease↗
PubMed1989

[Closure method of bronchopleural fistula with omental pedicle flap in three cases following pneumonectomy].

This report presents that successful closure of bronchopleural fistula was performed by using omental pedicle flap for three postpneumonectomy patients. In our department, these cases were experienced among 142 pneumonectomies from January 1984 to July 1989. The initial operations were a pleuropneumonectomy for empyema, a pneumonectomy and a sleeve pneumonectomy for lung cancer. Our technique was direct closure of bronchopleural fistula with omental pedicle flap without thoracoplasty. Although none of them had recurrence of bronchopleural fistula nor other complications in postoperative course, two patients died of cancer.

Bronchial Fistula↗
PubMed1989

[The use of an omental pedicle flap in the closure of a wide bronchial fistula after pneumonectomy: a case report].

A 52-years-old man with pulmonary hypofunction had a squamous cell lung carcinoma and underwent the right upper lobectomy. Bronchial fistula with lung abscess developed on the 6th post-operative day. So, the right middle and lower lobectomy (completion pneumonectomy) were done. But, bronchial fistula again appeared at the time of weaning from respirator. It increased in size to about 4.0 x 2.0 cm. Then, transposition of an omental pedicle flap for closure on a wide bronchial fistula, and muscular plombage and thoracoplasty for semifilling up a secondary empyema cavity were performed. On bronchoscopy performed 14 days after operation, the fistula was completely closed, and the transposed omentum did not project into the trachea. We accomplished our first aim to close the wide bronchial fistula with omentum. However, he died 59 days after the 3rd operation because we failed to control infection of the remaining empyema cavity of about 100 ml. The management of an empyema cavity remains to be a difficult therapeutic problem.

Bronchial Fistula↗
PubMed1989

[A case of omentopexy for bronchial fistula and pyothorax following the right completion pneumonectomy with combined resection of pericardium, diaphragm and chest wall].

A 68-year-old male underwent the right completion pneumonectomy with combined resection of pericardium, diaphragm and chest wall. Three months later, he was diagnosed as a bronchial fistula with bloody sputum and decreasing of right pleural effusion level on chest X-ray film. The conservative therapy with pleural drainage and endoscopic practice with fibrin matrix was failed to close a fistula and pyothorax was developed. Therefore, surgical treatment with simple omentopexy without thoracoplasty and/or muscle transposition was performed onto fistula and SILASTIC sheet used for the repair of diaphragm at initial operation was left in the thoracic cavity. Although pleural fluid remained the contamination with bacteria for one month postsurgically, infection did not develop and fistula closed successfully. Moreover, infection did not prolong in the presence of artificial SILASTIC sheet followed by simple omentopexy. Omentopexy may be very useful for the treatment of bronchial fistula with the presence of infection.

Aged↗
PubMed1989

[A study on clinical findings and surgical treatment of pulmonary mycosis].

Between 1974 and 1987, 14 patients (10 male and 4 female) underwent thoracotomy for treatment of pulmonary mycosis. They were studied on their clinical findings and surgical treatment. The median age was 48 years (range 19 to 71 years). Fourteen cases consisted of 9 aspergillosis and 5 cryptococcosis. None of them was either debilitated or immunosuppressed before falling ill. Five of the 14 patients had other pulmonary disease and 11 had symptoms; i.e. hemoptysis or bloody sputum in 4 cases, chest pain in 3, fever in 3, cough and sputum in 2. Nine aspergillosis consisted of 4 aspergilloma, 3 aspergillus pneumonia and 2 aspergillus empyema. Three cases of aspergillosis occurred in preexisting cavity. Five cryptococcosis consisted of 3 pseudotumorous, 1 disseminated small nodular, and 1 infiltrative types. Preoperative diagnosis was as follows; pulmonary mycosis 5, pulmonary tuberculosis 4, lung cancer 3, empyema 1 and hydropneumothorax 1. Four patients underwent partial resection, 8 lobectomy, 1 pneumonectomy, 1 muscle prombage and thoracoplasty. The prognosis is satisfactory. All patients are alive and has no recurrence. On histopathological examination, in aspergilloma cases, invasion of aspergillus to surrounding lung tissue was not seen. In addition to well-known fact that blood-borne dissemination hardly occurred in aspergilloma in contrast to cryptococcosis. These findings suggest that aspergilloma and solitary lesion of cryptococcosis should be resected, and adjuvant chemotherapy should be accompanied for cryptococcosis.

Adult↗
PubMed1989

[Evaluation of the degree of infundibuliform abnormality of the thorax and technics of the fixation of the sternum].

The author proposes an original method of determination of the degree of deformation in angular values on the basis of his experience in the treatment of 27 patients with infundibulum-like deformation of the chest. In case of surgical treatment the method of thoracoplasty after N. I. Kondrashin is preferable. The design formula of the size of the resected rib area is proposed. To stabilize the framework of the chest fixation by crossing wires on the ring support after G. A. Ilizarov is suggested. Submerged crossing wires with bent supporting ends were used for more continuous fixation.

Adolescent↗
PubMed1989

[Clinical and functional manifestations of infundibuliform deformity of the chest].

The clinical picture, respiration function, the condition of the cardiovascular system and metabolism were studied in 102 patients with congenital funnel chest; their ages ranged from 16 to 34 years. The revealed cardio-respiratory and metabolic shifts were caused by the deformity of the chest. After thoracoplasty with a good cosmetic effect the functional disorders are normalized 1-2 years after the operation.

Adolescent↗
PubMed1988

The effects of one year of nocturnal cuirass-assisted ventilation in chest wall disease.

The effects of one year of nocturnal cuirass-assisted ventilation using individually designed cuirass respirators have been investigated in twenty-five patients with chest wall disease. After one year, 22 (88%) of the patients were alive. Daytime arterial blood gases had improved. Functional residual capacity (FRC) had increased but there was no significant change in other lung volumes. Maximum inspiratory pressure (MIP) improved in the subjects with a scoliosis but not in those with a thoracoplasty or neuromuscular disease. Maximum expiratory pressure (MEP) was unchanged. Maximum voluntary ventilation (MVV), the ventilatory response to carbon dioxide and six minute walking distance had all increased. There was no improvement in respiratory symptoms, but a decrease in depression scores and in the time taken to complete a trail test. The mean (SD) number of days spent in hospital over the year was 21.5 (15.1) per patient, with patients consulting their general practitioners less frequently than in the year prior to commencing nocturnal cuirass-assisted ventilation. The cost of commencing a patient on domiciliary nocturnal cuirass-assisted ventilation is estimated as 2470 pounds, and of maintaining them at home for one year as 3302 pounds.

Female↗
PubMed1987

Pulmonary aspergilloma--indications for surgical intervention. An analysis of 22 cases.

Surgical resection of aspergillomas has generally been associated with excess mortality and morbidity; 22 patients who had a resection of complicated mycetomas were studied retrospectively. Indications for surgery were serious haemoptysis (14), massive haemoptysis (6), and recurrent infection (2). Extrapleural pneumonectomy was required in 9 patients and extrapleural lobectomy in 12; thoracoplasty alone was done in 1 patient. There was 1 hospital death (4.5%); 4 patients developed postoperative empyemas (18%), 2 with associated bronchopleural fistulas. Two further patients (9%) had stable postresectional spaces. Surgery for complicated aspergilloma was associated with significant postoperative morbidity.

Adult↗
PubMed1985

Pneumonectomy through an empyema.

In the 10 year period from May, 1973, to May, 1983, a total of 251 pneumonectomies were undertaken. Total unilateral bronchiectasis, the consequence of previous tuberculosis, occurred in 67.3% of cases and was the major indication for pneumonectomy. Of the 251 pneumonectomies, 14.7% were done through an empyema. The management of patients undergoing this procedure is discussed. There were two operative deaths among the 37 patients. Postpneumonectomy empyema developed in 16 patients (45.7%), and five of these patients required thoracoplasty, five left the hospital with an open drain or sinus, and in six the empyema was sterilized.

Adolescent↗
PubMedDate not supplied

[True and false problems in surgery of pulmonary aspergilloma. Study of 220 cases (author's transl)].

Different problems involved in the surgery of 220 cases of pulmonary aspergilloma are analyzed. The operatory blood loss, which was more abundant than usual, did not bring about any complication. The authors believe that pleural cavities were observed for only 6% of the partial excisions, probably because of the complementary thoracoplasties they performed. The true problem is raised by the patients suffering from respiratory failure for whom techniques of direct approach are the only solution.

Aspergillosis, Allergic Bronchopulmonary↗
PubMedDate not supplied

[True and false problems in surgery of pulmonary aspergilloma. Study of 220 cases (author's transl)].

Different problems involved in the surgery of 220 cases of pulmonary aspergilloma are analyzed. The operatory blood loss, which was more abundant than usual, did not bring about any complication. The authors believe that pleural cavities were observed for only 6% of the partial excisions, probably because of the complementary thoracoplasties they performed. The true problem is raised by the patients suffering from respiratory failure for whom techniques of direct approach are the only solution.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1966

Pyogenic postpneumonectomy empyema.

The Clagett method of managing postpneumonectomy empyema was used on two patients and proved efficacious. After tube drainage (if a bronchopleural fistula is present), treatment is begun by creating a pleurostomy in a dependent site. The patient may then be cared for as an outpatient, and dressings may be changed at home. After a few months, when the pleura is clean, the pleurostomy is closed surgically and the space is filled with (1/4)% neomycin solution. If a fistula is present, this is closed at the same time. The treatment depends on the ability of the neomycin to sterilize any residual infection, after temporary drainage of the empyema. It makes unnecessary a major and mutilating thoracoplasty or even permanent tube drainage, which is usually difficult to manage on an outpatient basis.

Aged↗
PubMed1978

[Surgical treatment of tumors of the ribs and clavicles].

The authors report 32 patients with different lesions of ribs and 6 patients with clavicular lesions. Due attention is given to the difficulties in establishing the differential roentgenological diagnosis between reticulosarcoma. Ewing's sarcoma, fibrosarcoma, metastases of other tumors in the rib and fibrous dysplasia. Great diagnostic value of trephine biopsy in establishing the morphological diagnosis is emphasized. To close large defects in the thoracic wall following the resection of some ribs a new variant of autodermal thoracoplasty is suggested.

Adolescent↗
PubMed1984

Management of bronchopleural fistulas.

During the ten years 1972 to 1981, 16 patients with persistent bronchopleural fistulas were treated. Eleven patients had postoperative fistulas, and five had fistulas which were spontaneous in origin. The spontaneous fistulas were due to tuberculosis (three) and lung abscess (two). The postoperative bronchopleural fistulas occurred after pulmonary resections for cancer (six), aspergillosis (three) and bronchiectasis (two). All of the postoperative fistulas developed in patients in whom the nonresected lung failed to fill the pleural cavity. The pneumothorax space then became infected, and breakdown of the sutured bronchus followed. Two patients died before any surgical intervention could be carried out. Two patients had successful resuture of a leaking bronchial stump two and eight days after their initial operation. Two healed after prolonged chest tube drainage. In ten patients, a thoracoplasty was required before closure of the fistula was accomplished. One of these patients died eight weeks postoperatively of sepsis involving the other lung.

Adult↗
PubMedDate not supplied

[About 35 cases of pleural aspergillosis (author's transl)].

Considering 36 observations, the authors show the relative infrequency of pleural aspergillosis localizations by comparison with pulmonary aspergillomas. Twenty four pleural aspergilloses developed on post-operative residual cavities, particularly after pulmonary exeresis and not only for aspergilloma; 11 forms were apparently primitive after therapeutical pneumothorax; 3 anatomo-clinical forms were found, aspergillomas and pyothoraxes were the most frequent. Pleural involvement can be associated to pulmonary, even bronchial involvement. Discovery circulstances vary: 4 times symptomatology was noisy, other times diagnosis was founded on radiological changes or hemoptysis or on the systematic fungal detection. Therapeutical indications are discussed. A major intervencal changes or hemoptysis or on the systematic fungal detection. Therapeutical indications are discussed. A major intervention with a radical aim (pulmonary decortication or pleuro-pneumonectomy) is rarely envisaged (7 times out of 35). Parietopleurectomy and rooting out with thoracoplasty are often the only possible ways or even a simple pleurotomy or a medical treatment with is modalities. Post-operative complications are often serious, particularly acute mycotic outbursts. Out of 35 patients, one was never seen again, 13 died, rather late of cardio-respiratory insufficiency, 21 are still alive but only 13 can truly be considered cured.

Aged↗
PubMed1982

The operative management of acute post-pneumonectomy bronchopleural fistula after flush bronchial amputation.

Acute disruption of the bronchial closure after pneumonectomy causes severe problems in patient management. Radical attempts at closure of the fistula and space obliteration (thoracoplasty) carry a high mortality. The management of this condition by a series of staged operative procedures is described. Pneumonectomy has usually been performed for bronchogenic carcinoma and prognosis is therefore guarded. Several low-risk operative interventions, with discharge from hospital between procedures, provide a safe and effective management method in the case described.

Bronchi↗
PubMed1981

First rib resection in the treatment of the thoracic outlet syndrome.

The thoracic outlet syndrome is now generally accepted as an entity that involves all neurovascular compression symptoms of the upper extremities at the tight thoracic outlet. We have treated 19 patients who developed significant symptoms of neurological, arterial or venous compression. Twelve patients presented predominantly and their angiograms demonstrated tight thoracic outlets as the underlying cause of vascular compression. Twenty three first rib resections were performed through the transaxillary approach with apparently complete relief of the syndrome. The similar etiology of the thoracic outlet syndrome and subclavian vein thrombosis was discussed on the basis of angiographic findings. We emphasize to thoracic and cardiovascular surgeons that first rib removal through the transaxillary route is an easy and safe method as a modified thoracoplasty.

Adolescent↗