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PubMed1981

[Early pleurectomy for acute suppurative pleurisy in high-risk patients].

The results of 73 pleurectomies in complicated acute purulent pleurisy are discussed. Of the operated high risk patients one patient died. Recurrent empyemas were eliminated by means of 2--3 ribs thoracoplasty. The authors believe early pleurectomy to be quite endurable for most patients under conditions of pronounced intoxication and having severe associated diseases. In their opinion, pleurectomy can quickly liquidate the intoxication and favourably influence the development of the disease.

Acute Disease↗
PubMed1979

Role of surgery in the management of pulmonary sporotrichosis.

Management of four patients with sporotrichosis is summarized; one was treated medically and three were treated surgically. Thirty-seven cases from the literature are reviewed. The role of surgery in the management of pulmonary sporotrichosis is outlined as follows: (1) diagnosis of pulmonary infiltrates and/or pulmonary cavities of undetermined origin, (2) surgical intervention in patients with persistent infiltrates with cavitary lesions resulting from sporotrichosis, following failed medical treatment, and (3) resection of associated pulmonary cavitary lesions in patients in spite of adequte medical control of sporotrichosis. Surgical principles that must be observed in the management of pulmonary sporotrichosis follows:(1) Resection is the procedure of choice. The magnitude ranges from segmental resection to pneumonectomy. Clean resection is necessary. (2) Antifungal drug therapy--preferably with amphotericin B--is advisable preoperatively and postoperatively, since the major cause of late death is progression of the disease when clean resection has not been feasible. (3) Resection combined with drug therapy can be curative without increased risk in physiologically operable and anatomically resectable disease. (4) Thoracoplasty can be a lifesaving procedure for bilateral cavitary lesions with severe hemoptysis in patients with impaired pulmonary functions.

Adult↗
PubMed1995

[The diagnosis and treatment of benign esophagotracheo-bronchial fistula: a report of 26 cases].

Twenty six patients with esophagotracheal fistula or esophagobronchial fistula were treated from 1960 to 1991. There were 18 males and 8 females with age ranging from 19 to 69. Trauma and complication of esophageal diverticulum were the main causes of fistula. Among 23 patients surgically treated, 10 underwent direct repair, and 13 either closure of esophageal defect or tracheal or bronchial defect. The concomitant procedures were permanent tracheostomy, tracheal resection and reconstruction, pulmonary resection, thoracoplasty esophagectomy, and esophagogastric anastomosis. All patients resumed normal eating. Complications included paralysis of recurrent nerves, empyema, injury and ligation of subclavian artery, dehiscence of tracheal anastomosis, and contralateral pneumohydrothorax in each patient. Prognosis of 3 nonsurgical treatments of fistulas was poor. Surgical intervention should be done as soon as the diagnosis is established in order to minimize pulmonary complication.

Adult↗
PubMed1995

A technical report on video-assisted thoracoscopy in thoracic spinal surgery. Preliminary description.

STUDY DESIGN: This report is a preliminary description of the efficacy of video-assisted thoracoscopic surgery in thoracic spinal procedures that otherwise require open thoracotomy. OBJECTIVE: This report sought to describe the efficacy of video-assisted thoracoscopic surgery in thoracic spinal procedures that otherwise require open thoracotomy. SUMMARY OF BACKGROUND DATA: In a landmark study that compared video-assisted thoracoscopic surgery for peripheral lung lesions with thoracotomy, video-assisted thoracoscopic surgery reduced postoperative pain, improved early shoulder girdle function, and shortened hospital stay. METHODS: Video-assisted thoracoscopic surgery was performed in 12 thoracic spinal patients (herniated nucleus pulposus, infection, tumor, or spinal deformity) and is described in detail in this report. RESULTS: Video-assisted thoracoscopic surgery in thoracic spinal surgery resulted in little postoperative pain, short intensive care unit and hospital stays, and little or no morbidity. In the short follow-up period, there was no post-thoracotomy pain syndrome nor neurologic sequelae in these patients. Operative time decreased dramatically as experience was gained with the procedure. CONCLUSION: Given consistently improving surgical skills, a number of thoracic spinal procedures using video-assisted thoracoscopic surgery, including thoracic discectomy, internal rib thoracoplasty, anterior osteotomy, corpectomy, and fusion, can be performed safely with no additional surgical time or risk to the patient.

Adult↗
PubMedDate not supplied

[Speleoplasty, a possible alternative in the surgical treatment of cavitary pulmonary tuberculosis].

Speleoplasty is a method of surgical treatment of cavitary pulmonary tuberculosis. The proposed surgical procedure differs from thoracoplasty and from pulmonary resection by a direct approach of the pulmonary cavernae. Speleoplasty is a simple, reliable technique, reducing significantly the surgical time as well as the operatory and post-operatory strike risks. This procedure does not diminish the respiratory surface and preserves the architecture of the thorax wall by keeping the anatomical integrity of the pulmonary parenchyma and of the thorax.

Humans↗
PubMed1995

[Two cases of empyema treated with rectus abdominis myocutaneous flap and muscle flap].

A rectus abdominis myocutaneous flap (RAM flap) has often been useful in breast reconstructions after the surgical therapy for breast cancer, or in other plastic surgeries. However, there have been few reports concerning about its applications for intrathoracic diseases. In this paper, we report two cases of recurrent empyema treated with RAM flap and muscle flap from rectus abdominis. One case is 75-year-old male with right-empyema and bronchial fistula after the thoracoplasty due to lung tuberculosis. The bronchial fistula was successfully closed with muscle flap from the right rectus abdominis. The other is 33-year-old male with left empyema and cutaneous fistula after the hemothorax due to traffic accident. He contracted with MRSA in his thoracic cavity. We resected the fistula and reconstructed his left chest wall with left RAM flap. The muscle flap from rectus abdominis or RAM flap has been very effective for the therapy of bronchial fistula after lung tuberculosis, and for the reconstruction of chest wall.

Adult↗
PubMed1994

[Modern surgical treatment of pulmonary tuberculosis].

Correctly performed antituberculous chemotherapy, together with the early diagnostics of tuberculosis, significantly lowered the need for surgery. Surgery is limited to patients with poor or no response to chemotherapy. In the period between 1983-1992 212 tuberculous patients were operated in the Clinic for Thoracic surgery, the Institute for the Pulmonary Disease the operated patients had the following form of the disease: primary tuberculosis in 4 patients (1.87%), 104 patients (49.06%) had the postprimary form of the disease, 67 patients (31.60%) had tuberculoma (causative lesion) cavernous tuberculosis existed in 33 patients (15.57%), while only 4 patients (1.87%) had diffuse pulmonary lesion. Diagnosis of post-tuberculous syndrome was made in 68 patients (32.08%). Secondary aspergylloma existed in 36 patients while the frequency of bronchial stenosis and bronchiectasis was the same -m 31 patients (16.98% and 14.63% respectively). One patient had broncho-oesophageal fistula. Tuberculous empiema, complicating the disease, existed in 36 patients (16.98%). Comparing the two 5-years periods, (1983-87 and 1988 to 1992) the authors conclude that the number of operations for tuberculosis is decreasing. Treatment was successful in all patients except in a patient with a broncho-esophageal fistula, who died postoperatively slow lung reexpansion existed in 5 patients, and in two cases partial upper thoracoplasty had to be done in order to solve the complication of the initial treatment. In all cases postoperative antituberculous chemotherapy was performed taking in consideration the problem of possible drug-resistance. There were no recurrences.

Adolescent↗
PubMed1994

[A case of intractable pulmonary tuberculosis complicated by idiopathic thrombocytopenic purpura (ITP)].

The authors describe a case of pulmonary tuberculosis with multiple drug resistance and complicated by severe idiopathic thrombocytopenic purpura (ITP). The patient was initially treated with high-dose gamma globulin therapy and splenectomy. These procedures resulted in improvement of the patient's condition; the platelet count increased from 7,000/mm3 to 230,000/mm3 and the bleeding time fell from 15 min to 1 min 30 s. Given the significant improvement in the patient's condition, it was considered safe to carry out left pulmonary upper lobectomy and thoracoplasty. There have been no reports describing pulmonary resection performed for inflammatory lung disease in patients with ITP. High-dose gamma globulin therapy rapidly brings about an increase in the platelet count and a reduction of the bleeding time, and it thus extremely useful as preoperative treatment in surgical cases complicated by thrombocytopenia.

Humans↗
PubMed1994

[Treatment of chronic empyemas in the pleural cavity].

The authors present the results of surgical treatment of chronic empyemas of the pleural cavity in 294 patients treated at the Surgical Department in the years 1980-1992. The methods of treatment are discussed taking in consideration the etiology of the empyemas, clinical presentation, coexistent diseases. In 86 patients (29.3%) decortication with partial resection of the lung was carried out (most often a lobe), in 123 patients (41.8%) a decortication was performed, in 8 (2.7%) thoracoplasty, in the remaining 41 (13.9%) drainage of the pleural cavity was carried out. Out of the 245 subjects treated surgically 3 (1.2%) died; in the remaining patients a full recovery was noted. A full recovery was noted in 22 (53.7%) out of the 41 treated with pleural cavity drainage. Eight patients with esophageal-pleural fistulas in the course of a advanced esophageal cancer died due to advanced malignancy. 11 were discharged with chronic drainage. The latter could not be treated surgically due to a existence of high risk factors.

Adult↗
PubMed1994

Management of postpneumonectomy bronchopleural fistulae. A review.

The management of postpneumonectomy bronchopleural fistulae continues to constitute a major therapeutic challenge. Refinements of surgical techniques have reduced the incidence of this dreaded complication although it cannot be totally prevented. Management remains controversial. We report our recent experience of three patients with bronchopleural fistulae following a right pneumonectomy, two for bronchogenic carcinoma and another for non-tuberculous, suppurative lung disease. Our treatment of choice for these patients is, immediate pleural drainage together with parenteral broad spectrum antibiotics followed by endoscopic closure of the fistula with monomeric n-butyl-2-cyanoacrylate glue (Histoacryl blue, B Braun, Melsungen, Germany). The pleural space is then irrigated with Povidone Iodine to sterility following which the closed bronchial stump is reinforced following which the closed bronchial stump is reinforced and the pleural space obliterated by decortication, omentopexy and by a tailored thoracoplasty. This cosmetically acceptable treatment produces minimal functional disability and is achieved with minimal morbidity and mortality in these critically ill patients.

Aged↗
PubMed1994

[The relationship between pulmonary hemodynamics and chest X-ray findings in patients with sequelae of pulmonary tuberculosis].

For better understanding of pathophysiological aspects of tuberculosis sequelae, we investigated the relationship between pulmonary hemodynamics and chest X-ray findings. One hundred and seven patients with sequelae of pulmonary tuberculosis were examined by the right cardiac catheterization, and pulmonary hemodynamic values were measured and calculated. Chest X-ray findings were defined and classified into the following five items. The items were emphysematous change; fibrosis, bronchiectasis and/or cavity (hereafter abbreviated as "fibrosis"); pulmonary resection and/or atelectasis; pleural thickening; and thoracoplasty. The extent of each finding was defined. We tried to describe chest X-ray findings by applying and categorizing these classifications and the extent to each case. First, we tried to estimate the grade of pulmonary hypertension by categorized X-ray findings. Further, we analyzed what kinds of findings were most influential on the increase of pulmonary artery mean pressure (PPA) and pulmonary arteriolar resistance (PAR). Secondly, we investigated whether PPA, cardiac index (CI) and PAR changed before and after oxygen administration. Thirdly, we analyzed what kind of X-ray findings most affected pulmonary hemodynamics under 100% oxygen administration for 10 minutes. The results were as follows: (1) Out of 107 cases, it was possible to predict PPA by categorized chest X-ray findings in 75 cases by Hayashi's first method of quantification, one of multivariative analyses. "Pleural thickening" was the most influential finding on the increase of PPA. "Fibrosis" was the most influential on the increase of PAR. (2) The values of PPA, CI and PAR decreased more after 100% oxygen administration than under room air breathing. Therefore, PAR was used as the index to estimate pulmonary hemodynamics under the condition of oxygen administration. (3) It was possible to measure PAR under oxygen administration (PARO2) in 72 cases. "Emphysematous change" was the most influential X-ray finding on the increase of PARO2. From these results, it was thought that pulmonary circulatory disorder in patients with tuberculosis sequelae was caused by the combination of various chest X-ray findings with the different extent. It was possible to predict pulmonary hypertension to a certain degree from categorized chest X-ray findings. It was suggested that "emphysematous change" less related to hypoxic pulmonary vasoconstriction than "fibrosis" and "pleural thickening" from the results of comparison among the partial correlation coefficients, which were associated with the increase of PAR under room air breathing and oxygen administration.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1994

[A case of hypogamma-globulinemia with thymoma (Good's syndrome) follow-up for 8 years].

A 58-year-old woman, who had a past history of left upper lobectomy with thoracoplasty for pulmonary tuberculosis and resection of thyroid cancer, was diagnosed as having a mediastinal tumor by chest X-ray examination. It was found to be a malignant thymoma (spindle cell type) after resection. The level of serum gammaglobulin, which had been low before resection, progressively decreased. Afterward, she frequently suffered from airway infections which resulted in severe bronchiecatsis. She died due to respiratory failure 8 years later. In the early stage, though the percentage of pan T cells in peripheral blood lymphocyte subsets was normal, CD4 T cells decreased and CD8 T cells increased. A decrease in helper T cells and an increase in cytotoxic T cells were especially marked. In the late stage, all T cells subsets decreased. In particular, naive T (CD45RA* CD3+ T) cells decreased markedly. However, the percentage of B cells remained normal and that of NK cells was elevated. From the findings of lymphocyte subsets and lymphocyte reactivity to PHA stimulation, it is suggested that T cell dysfunction caused hypogrammaglobulinemia in this case.

Agammaglobulinemia↗
PubMed1994

[A case of gauzeoma with recurrent massive hemoptysis mimicking aspergilloma].

A 52-year-old woman who had received a right upper lobectomy and thoracoplasty for the treatment of pulmonary tuberculosis 30 years prior to the present disorder, was admitted to out hospital with massive hemoptysis. We diagnosed aspergilloma clinically because chest X-ray showed a fungus ball-like mass with meniscus sign. Right middle and lower lobectomies were performed after the 7th bronchial arterial embolization for recurrent hemoptysis. The resected specimen showed a mass of old gauze, a so-called "gauzeoma". We have found no previous reports of gauzeoma with both meniscus sign and recurrent massive hemoptysis mimicking aspergilloma.

Aspergillosis↗
PubMed1993

[Surgical treatment of pulmonary and bronchial aspergilloma].

From 1974 to 1990, 61 patients were admitted for pulmonary (55) or bronchial (6) aspergilloma; 50 were treated by surgery. Operative treatment was mandatory because of disabling symptoms in 17 patients, rapid growth on radiological survey in 7 others, diagnostic doubt in 10 and association with bronchogenic cancer in 2. 14 were operated on in order to prevent evolutive complications. Complete resection was possible in 39 patients: with lobectomy or segmentectomy in 34 and with pleuro-pneumonectomy in 5. In 10 others, respiratory failure only allowed speleotomy and thoracoplasty. One thoracotomy was exploratory because of an associated unresectable cancer. Postoperative complications frequently occurred with pulmonary aspergilloma: 4 postoperative deaths, 33 experienced non-fatal complications (28 major bleedings, 16 rehabititation defects, 6 empyemas, 5 respiratory failures). Nevertheless, among 10 patients with either bronchial aspergilloma or pulmonary aspergilloma without underlying disease, only one had a complicated outcome. In conclusion, surgical treatment is well tolerated in the absence of underlying parenchymal disease. However, despite the major operative risk, surgery remains the only efficient treatment in symptomatic patients.

Adolescent↗
PubMed1993

[The use of the reverse latissimus dorsi muscle flap in the management of bronchopleural fistula].

The management of a postoperative bronchopleural fistula remains a major challenge for the thoracic surgeon. We present a series of three patients who underwent closure of the fistulas with the distal flap of the divided latissimus dorsi muscle (the reverse latissimus dorsi muscle flap) and a limited thoracoplasty. The primary resections, which were performed through a standard posterolateral thoracotomy, were right lower lobectomy in two patients and right middle and lower bilobectomy in the other. The initial myoplasty produced prompt fistula closure in 2 patients and failed in the other patient because of a large empyema space. The reverse latissimus dorsi muscle flap could be used for the management of bronchopleural fistula in selected patients who underwent lower lobectomy or middle and lower bilobectomy.

Aged↗
PubMed1993

Classification of chest wall diseases.

Several disorders of the thoracic cage are known to cause respiratory failure, by means of relatively simple mechanisms, such as the increased work of breathing, which results in alveolar hypoventilation. A variety of pathogenic mechanisms may be considered, as functions of the types of thoracic disorders present. As causes of these additional potential mechanisms, we considered the following: 1) ventilation-perfusion (V/Q) inhomogeneity; 2) inability to cough; 3) malformation or acquired defect of the respiratory centres; and 4) excess blood volume and fluid retention, which aggravate work of breathing and V/Q inhomogeneity. All of these disorders can be grouped into two major categories (which nevertheless have some of the pathophysiology in common): the mechanical syndrome and the neuromuscular or paralytic syndrome. In this paper we discuss chest wall diseases falling into the first category; namely, kyphoscoliosis, fibrothorax, thoracoplasty, ankylosing spondylitis and obesity-hypoventilation. Congenital deformities of the thoracic cage, which do not have important effects on ventilatory apparatus (e.g. pectus excavatum and pectus carinatum), were also considered.

Humans↗
PubMed1993

[A case report on progressive hematomatous organizing empyema accompanied with intrathoracic hemangioma].

The patient, a 63-year-old woman, who had undergone extra-pleural plombage due to tuberculosis in 1961, was regularly treated for chronic empyema at our outpatient clinic since 1988. The patient who complained of difficulty in breathing because of a recent increase in empyema was admitted to our facility. On a test puncture, pure blood was aspirated without limitation, suggesting the presence of hematoma. On August 5, 1991, pleural decortification, excision of the left upper lobe and thoracoplasty were performed. Perioperative findings included repletion of hematoma and sphacelus in the lumen of thick fibrous capsule, with partial subcutaneous fenestration. Pathologically, cavernous hemangiomas were observed dispersely under the capsule.

Empyema, Pleural↗
PubMed1995

[Results of repeated pulmonary resection in new homolateral neoplastic localization after conservative resection].

From 1978 through 1992, 93 patients with a previous lobectomy for bronchogenic cancer were referred for homolateral cancer recurrence. Forty-six patients were contraindicated for carcinologic reasons (30 stage IIIb and 16 stage IV). Forty-seven patients (50.5%) were resectable, but 17 did not undergo surgery for associated medical problems (n = 11) or refusal (n = 6). The remaining 30 patients form the population of the present study: 29 males and 1 female; mean age of 61 years (range 47-72). The previous cancer was stage I in 26 and stage II in 4. The mean interval between the 2 cancer diagnoses was 30 months (range 6-97). Three patients underwent an exploratory thoracotomy (10%): 2 had mediastinal involvement and 1 had pleural metastases. Twenty-two (73%) underwent a completion pneumonectomy, and 5 had miscellaneous conservative resections. There were 4 operative deaths (13%): one intraoperative bleeding, 1 postoperative bleeding, 1 pulmonary embolism, 1 pneumonia. Four patients had nonfatal surgical complications: 2 clottings (reexploration), 1 empyema (lavage) and 1 bronchopleural fistula (thoracoplasty). Resected patients were staged as follows: 13 stage I, 4 stage II, 10 stage III. Survival following resection including operative mortality at 3 an 5 years was estimated as 52.5% and 44% for the whole series (72% for stage I). We conclude that repeat surgery conveys an increased risk, but may achieve valuable long-term results.

Aged↗