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Stilwell R, Silva C, Alves R, Afonso I, Calvinho P, Malta AC. Pneumonectomy in a child with necrotic lung after ingestion of a button battery. Pediatr Pulmonol 2023; 58:2966-2968. [PMID: 37417803 DOI: 10.1002/ppul.26588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/01/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Rosário Stilwell
- Unidade de Pneumologia Pediátrica, Centro Hospitalar Universitário Lisboa Central-Hospital Dona Estefânia, Portugal
| | - Cláudia Silva
- Unidade de Pneumologia Pediátrica, Centro Hospitalar Universitário Lisboa Central-Hospital Dona Estefânia, Portugal
| | - Rui Alves
- Unidade de Cirurgia Pediátrica, Centro Hospitalar Universitário Lisboa Central-Hospital Dona Estefânia, Portugal
| | - Isabel Afonso
- Unidade de Gastroenterologia Pediátrica, Centro Hospitalar Universitário Lisboa Central-Hospital Dona Estefânia, Portugal
| | - Paulo Calvinho
- Unidade de Cirurgia Torácica, Centro Hospitalar Universitário Lisboa Central-Hospital de Santa Marta, Portugal
| | - Ana Casimiro Malta
- Unidade de Pneumologia Pediátrica, Centro Hospitalar Universitário Lisboa Central-Hospital Dona Estefânia, Portugal
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Giller DB, Koroev VV, Kesaev OS, Enilenis II, Dobrin RR, Martel II. Surgical Treatment of Cavernous and Fibrous-Cavernous TB in Children. Thorac Cardiovasc Surg 2023; 71:67-72. [PMID: 35995065 DOI: 10.1055/s-0042-1754318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Treatment of cavernous and fibrous cavernous tuberculosis in children, especially in the presence of multiple drug resistance-tuberculosis or extremely drug resistance-tuberculosis, presents a major challenge. MATERIALS AND METHODS We analyzed results of treatment of 65 patients (mean age 14.8 + 2.9 years) with cavernous TB (group I) and 116 patients (mean age 15.6 + 1.9 years) with fibrous-cavernous TB (group II). Evaluation of treatment efficiency was performed directly at discharge and 1 year after treatment according to Lazerson's criteria. RESULTS In group I, after 80 operations, two (2.5%) cases showed delayed expansion of the lung after combined resections, in group II, postoperative complications after 160 operations occurred in eight (5.0%) cases (the difference is reliable p ≤0,05). There was no hospital fatality. The effectiveness at the time of discharge from surgery (cessation of bacterization and elimination of decay cavities in the lung) was 100% in groups I and II, respectively. A year later, according to Lazerson's criteria, the efficiency in group I was 100%, in group II was 97.4%. CONCLUSION Operations in patients with cavernous tuberculosis performed after 10 to 12 months of conservative treatment present a lower risk of postoperative complications and relapses of cavernous tuberculosis than operations in patients with fibrous cavernous tuberculosis performed after 22 months or more of treatment.
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Affiliation(s)
- Dmitry Borisovich Giller
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
| | - Vadim Valerievich Koroev
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
| | - Oleg Shamilievich Kesaev
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
| | - Inga Igorevna Enilenis
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
| | - Roman Romanovich Dobrin
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
| | - Ivan Ivanovich Martel
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
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Cheng K, Liu X, Yuan M, Yang G, He T, Luo D, Liu C, Xu C. Thoracoscopic anatomic pulmonary segmentectomy for the treatment of congenital lung malformation in children. Asian J Surg 2023; 46:532-538. [PMID: 35780025 DOI: 10.1016/j.asjsur.2022.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/28/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung-sparing surgery has been used to treat congenital lung malformation in children, and segmentectomy has been advocated as a lung-preservation strategy. However, thoracoscopic pulmonary segmentectomy has gained limited popularity considering the complications, the potential for residual lesions, and the technical difficulties associated with this procedure. Therefore, this study aimed to investigate the safety and feasibility of pediatric thoracoscopic anatomic pulmonary segmentectomy for the treatment of congenital lung malformations. METHODS We conducted a retrospective review of the medical records of 568 patients who were treated at West China Hospital, Sichuan University, from January 2014 to January 2020. The patients were divided into segmentectomy and lobectomy groups according to the surgical procedures they underwent. Clinical and follow-up outcomes were compared between the two groups. RESULTS The segmentectomy and lobectomy groups included 206 and 361 cases, respectively. The mean intraoperative blood loss was significantly higher in the segmentectomy group (6.9 mL vs. 4.5 mL; p = 0.03). The mean surgical time was also significantly longer in the segmentectomy group, (55.6 min vs. 41.5 min; p = 0.018). However, the incidence of complications did not differ significantly between the two groups (2.9% vs. 1.1%, p = 0.21). Patients in both groups did not require reoperation or show residual lesions during hospitalization and follow-up. CONCLUSIONS Thoracoscopic anatomic pulmonary segmentectomy is a safe and feasible definitive lung-sparing treatment for specific cases of congenital lung malformation, and has a complication rate comparable to that of thoracoscopic lobectomy.
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Affiliation(s)
- Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Xiaojuan Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Chenyu Liu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China.
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4
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Diboun I, Cyprian FS, Anwardeen NR, Yassine HM, Elrayess MA, Rahmoon SM, Sayed SK, Schuchardt S, Khatib M, Bansal D, Farag EABA, Emara MM, Abdallah AM. Identification of Prognostic Metabolomic Biomarkers at the Interface of Mortality and Morbidity in Pre-Existing TB Cases Infected With SARS-CoV-2. Front Cell Infect Microbiol 2022; 12:929689. [PMID: 35937683 PMCID: PMC9354137 DOI: 10.3389/fcimb.2022.929689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/10/2022] [Indexed: 12/03/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection currently remains one of the biggest global challenges that can lead to acute respiratory distress syndrome (CARDS) in severe cases. In line with this, prior pulmonary tuberculosis (TB) is a risk factor for long-term respiratory impairment. Post-TB lung dysfunction often goes unrecognized, despite its relatively high prevalence and its association with reduced quality of life. In this study, we used a metabolomics analysis to identify potential biomarkers that aid in the prognosis of COVID-19 morbidity and mortality in post-TB infected patients. This analysis involved blood samples from 155 SARS-CoV-2 infected adults, of which 23 had a previous diagnosis of TB (post-TB), while 132 did not have a prior or current TB infection. Our analysis indicated that the vast majority (~92%) of post-TB individuals showed severe SARS-CoV-2 infection, required intensive oxygen support with a significantly high mortality rate (52.2%). Amongst individuals with severe COVID-19 symptoms, we report a significant decline in the levels of amino acids, notably the branched chains amino acids (BCAAs), more so in the post-TB cohort (FDR <= 0.05) in comparison to mild and asymptomatic cases. Indeed, we identified betaine and BCAAs as potential prognostic metabolic biomarkers of severity and mortality, respectively, in COVID-19 patients who have been exposed to TB. Moreover, we identified serum alanine as an important metabolite at the interface of severity and mortality. Hence, our data associated COVID-19 mortality and morbidity with a long-term metabolically driven consequence of TB infection. In summary, our study provides evidence for a higher mortality rate among COVID-19 infection patients who have history of prior TB infection diagnosis, which mandates validation in larger population cohorts.
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Affiliation(s)
- Ilhame Diboun
- Medical and Population Genomics Lab, Sidra Medicine, Doha, Qatar
| | - Farhan S. Cyprian
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Hadi M. Yassine
- Biomedical Research Center (BRC), QU Health, Qatar University, Doha, Qatar
| | | | - Samreen Mumtaz Rahmoon
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sarah Khaled Sayed
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sven Schuchardt
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Malkan Khatib
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Devendra Bansal
- Department of Public Health, Ministry of Public Health, Doha, Qatar
| | | | - Mohamed M. Emara
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
- *Correspondence: Abdallah M. Abdallah, ; Mohamed M. Emara,
| | - Abdallah M. Abdallah
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
- *Correspondence: Abdallah M. Abdallah, ; Mohamed M. Emara,
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Baldes N, Bölükbas S. Entzündliche und infektiöse Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen. Zentralbl Chir 2022; 147:287-298. [DOI: 10.1055/a-1720-2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungEntzündliche Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen umfassen ein weites Spektrum von der komplizierten Pneumonie, der Tuberkulose, Mykosen bis hin zur Echinokokkose.
Die Häufigkeit hängt stark von der geografischen Herkunft ab. Diese Übersichtsarbeit gibt einen Überblick von der Diagnostik bis hin zur chirurgischen Therapie dieser Erkrankungen beim
pädiatrischen Kollektiv.
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Affiliation(s)
- Natalie Baldes
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
| | - Servet Bölükbas
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
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Hameury F, Marec-Berard P, Eymery M, Wijnen MHW, van der Kaaij N, Mure PY, Tronc F, Chotel F, Libbrecht C, van Boven WJP, Haveman LM. Pleuropneumonectomy as Salvage Therapy in Children Suffering from Primary or Metastatic Sarcomas with Pleural Localizations. Cancers (Basel) 2021; 13:cancers13153655. [PMID: 34359557 PMCID: PMC8345037 DOI: 10.3390/cancers13153655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Pediatric sarcoma patients with pleuropulmonary lesions have a dismal prognosis because the impossibility to achieve local control. Local therapy with radiotherapy, whether in combination with chemotherapy, appears to be insufficient to eliminate the tumor cells. The aim of this study was to determine if pleuropneumonectomy (PP) could be a therapeutic option. We retrospectively reviewed nine patients who underwent PP for pleuropulmonary localization of primary localized sarcoma or metastatic recurrence. Surgery and complications were analyzed, pulmonary function tests were conducted, and quality of life was determined. Outcome is variable, four patients died within 14 months after PP, one patient suffered from local recurrence, and four patients are in long-lasting remission. This extended operation is quite well tolerated. Lung function seems preserved, and quality of life is generally good. Because it gives improvement of survival in patients with pleural lesions, PP can be considered as effective salvage therapy in selected patients. Abstract Pediatric sarcoma patients with pleuropulmonary lesions have a dismal prognosis because the impossibility to obtain local control. The aim of this study was to determine if pleuropneumonectomy (PP) could be a therapeutic option. We retrospectively reviewed nine patients who underwent salvage PP for pleuropulmonary localization of primary localized sarcoma or metastatic recurrence. Surgery and complications were analyzed, pulmonary function tests were conducted, and quality of life was determined with EORTC-QLQ-C30 questionnaire. At the time of PP age was between 9–17 years. Underlying disease included metastatic osteosarcoma (n = 5), Ewing sarcoma (two metastatic, one primary), and one primary undifferentiated sarcoma. Early complications occurred in three patients. Mean postoperative hospitalization stay was 14.5 days. Pulmonary function test showed 19–66% reduction of total lung capacity which led to mild exercise intolerance but did not affect daily life. Four patients died of multi-metastatic relapse <14 months after PP, one patient had a local recurrence, and four patients are in complete remission between 1.5 and 12 years after PP. In conclusion, in this small patient group treated with a pleuropneumonectomy for primary or metastatic lesions, outcome is variable; however, this extended surgical technique was generally quite well tolerated. Postoperative lung function seems well preserved, and it seems to lead to at least an extension of life with good quality and therefor can be considered as salvage therapy.
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Affiliation(s)
- Frédéric Hameury
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - Perrine Marec-Berard
- Institute of Hematology and Pediatric Oncology, 69008 Lyon, France; (P.M.-B.); (M.E.); (C.L.)
| | - Mathilde Eymery
- Institute of Hematology and Pediatric Oncology, 69008 Lyon, France; (P.M.-B.); (M.E.); (C.L.)
| | - Marc H. W. Wijnen
- Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Niels van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Pierre-Yves Mure
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - François Tronc
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - Franck Chotel
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - Clara Libbrecht
- Institute of Hematology and Pediatric Oncology, 69008 Lyon, France; (P.M.-B.); (M.E.); (C.L.)
| | - Wim Jan P. van Boven
- Department of Cardiothoracic Surgery, Amsterdam University Center, Location AMC, 1105 AZ Amsterdam, The Netherlands;
| | - Lianne M. Haveman
- Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-88-972-7272; Fax: +31-88-972-5009
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Kabiri EH, Hammoumi ME, Bhairis M, Oueriachi FE, Slaoui O, Amraoui M. Clinical and surgical analysis of lobectomy for destroyed lobe of the lung: A series of 47 patients. Asian Cardiovasc Thorac Ann 2021; 29:772-778. [PMID: 33975468 DOI: 10.1177/02184923211017101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Destroyed lobe of the lung is always secondary to chronic or recurrent lung infections with irreversible damage of pulmonary parenchyma. In this study, we analyzed surgical technique, post-operative complications, mortality, and long-term outcomes of patients undergoing lobectomy of pulmonary lobe destruction. MATERIALS AND METHODS A retrospective study of 47 patients that underwent lobectomy due to a destroyed lung parenchyma between January 2010 and December 2019 were reviewed with an average follow-up period of 39 months. RESULTS The study included 47 patients with a mean age of 39.4 years. The etiology of lobe destroyed was tuberculosis in 15 (31.9%), non-tuberculosis bronchiectasis in 20 (42.5%), aspergilloma in 09 (19.1%), hydatid cyst in 2 (4.3%), and a mis-diagnosed intrabronchic foreign body in 1 (2.1%). Surgical approach was through posterolateral thoracotomy in 44 (93.6%) patients and video-assisted thoracoscopic surgery in only 3 patients. Mean operative time was 153 min and mean post-operative hospital stay was 7.9 days. The post-operative complications occurred in five (10.6%): atelectasis (n = 2), wound site infection (n = 1), prolonged air leak (n = 1), and hemothorax in one case. No post-operative mortality was noted. A good clinical result was observed in 87.2% of cases. CONCLUSION Surgical treatment of destroyed lobe is a high risk associated surgery. Tuberculosis and aspergilloma are the most common etiologies. Favorable result was obtained in selected patient with an excellent perioperative care.
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Affiliation(s)
- El Hassane Kabiri
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco.,Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
| | - Massine El Hammoumi
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Mohamed Bhairis
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Faycal El Oueriachi
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Omar Slaoui
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Mouaad Amraoui
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
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Drug Regimen for Patients after a Pneumonectomy. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pneumonectomy is an entire lung removal and is indicated for both malignant and benign diseases. Due to its invasiveness and postoperative complications, pneumonectomy is still associated with high mortality and morbidity. Appropriate postoperative management is crucial in pneumonectomy patients to improve quality of life and overall survival rates. Diverse drug regimens are under development to be used in adjuvant chemotherapy or to improve respiratory health after a pneumonectomy. The most common causes for a pneumonectomy are non-small cell lung cancer, malignant pleural mesothelioma, and tuberculosis; thus, an appropriate drug regimen is necessary. The uncommon incidence of pneumonectomy cases remains the major obstacle in studies of postoperative drug regimens. As the majority of current studies include post-lobectomy and post-segmentectomy patients, it is highly recommended that further research of postoperative drug regimens be focused on post-pneumonectomy patients.
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Lung destruction secondary to intrapulmonary migration of a ventriculoperitoneal shunt catheter: report of an unusual case and literature review. Childs Nerv Syst 2021; 37:989-993. [PMID: 32514761 DOI: 10.1007/s00381-020-04716-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Ventriculoperitoneal shunt placement for the treatment of hydrocephalus is one of the most common pediatric neurosurgical procedures. Complications, including infections, catheter obstruction, shunt breakdown, and hemorrhage, have been described in the literature. Occasionally, however, uncommon and devastating complications occur. We report a case of a 10-year-old female patient who at birth underwent surgical closure of lumbar myelomeningocele and placement of a CSF shunt at another center. Her neurosurgical follow-up was poor. She presented at our institution with a history of recurrent pneumonia. Control chest X-rays showed a right pulmonary infiltrate with lung retraction and mediastinal shift. Chest and brain CT scans confirmed the intrapulmonary location of the distal catheter tip and ventricular dilation. Surgical shunt revision was performed with removal of the intrapulmonary catheter and placement of a new intraperitoneal catheter. Subsequently, right pneumonectomy was performed with good postoperative recovery of the patient. Intrathoracic migration of the distal catheter of the CSF shunt is an extremely rare complication that may produce severe morbidity. To our knowledge, there have been no previous reports on extensive lung destruction secondary to intrathoracic and intrapulmonary ventriculoperitoneal shunt migration. In patients with CSF shunts and pulmonary symptoms, intrapulmonary catheter migration should be considered.
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Waguaf S, Boubia S, Idelhaj N, Fatene A, Ridai M. Video-assisted thoracoscopic pneumonectomy for destroyed lung. Asian Cardiovasc Thorac Ann 2020; 29:111-115. [PMID: 33175560 DOI: 10.1177/0218492320974516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Destroyed lung refers to destruction of a large portion of a lung induced by chronic or recurrent lung infections. The aim of this single-center retrospective review was to evaluate patients with a diagnosis of destroyed lung undergoing pneumonectomy via video-assisted thoracoscopic surgery, in terms of surgical technique, postoperative morbidity and mortality, and long-term outcomes. METHODS Data of 15 patients who underwent video-assisted thoracoscopic pneumonectomy for destroyed lung during a 4-year period were analyzed retrospectively. There were 9 (60%) males and 6 (40%) females with a median age of 33.87 years (range 8-52 years). Bronchiectasis (n = 7), tuberculosis (n = 5), and fungal infection (n = 3) were the main etiologies. Hemoptysis was the most common presenting symptom (n = 8, 53.3%). Destroyed lung was detected on the left side in 13 (86.7%) patients and on the right side in 2 (13.3%). Seven patients showed narrowing or thickening of the main bronchus. RESULTS Video-assisted thoracoscopic pneumonectomy was attempted in all patients but 5 (33.3%) were converted to a thoracotomy. The mean operative time was 273.8 min. The postoperative morbidity rate was 13.3%. The mortality rate was 6.67%. The median length of hospital stay was 3.5 days. The mean follow-up period was 23.7 months. Significant improvement was observed in inflammatory symptoms and quality of life in all patients. The overall 1-year survival was 93.3%. CONCLUSION Video-assisted thoracoscopic pneumonectomy for destroyed lung is a safe and feasible option in selected patients, which can be used as an alternative to thoracotomy.
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Affiliation(s)
- Sara Waguaf
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Souheil Boubia
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Najat Idelhaj
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Abdellah Fatene
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Mohamed Ridai
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
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Rocha G. Pulmonary pneumatoceles in neonates. Pediatr Pulmonol 2020; 55:2532-2541. [PMID: 32691976 DOI: 10.1002/ppul.24969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
Pulmonary pneumatoceles were relatively common in neonates in the pre-surfactant era. In the current era of surfactant, noninvasive and gentle invasive ventilation there is a paucity of data on clinical characteristics and outcomes of pneumatoceles in neonates. The lesion generally resolves spontaneously, but a few cases follow a complicated course with formation of extensive and expanding lesions. To better understand the pathophysiology, clinical significance, natural history, complications, treatment options and prognosis of pulmonary pneumatoceles in neonates, an extensive research was performed on the databases of medical literature. The information collected in this review is important for the clinicians in decision-making, especially in the most difficult cases.
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Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Wong MNL, Tang IP, Chor YK, Lau KS, John AR, Hii KC, Lee OPY, Lim WK, Tan HPK. Unilateral pulmonary vein atresia presenting with recurrent haemoptysis in a child: a case report. BMC Pediatr 2020; 20:448. [PMID: 32972390 PMCID: PMC7513278 DOI: 10.1186/s12887-020-02348-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Haemoptysis is an uncommon presenting symptom in children and is usually caused by acute lower respiratory tract infection or foreign body aspiration. We report a rare case of right unilateral pulmonary vein atresia (PVA) as the underlying aetiology of recurrent haemoptysis in a child. CASE PRESENTATION A 4 years old girl presented with history of recurrent haemoptysis. Bronchoscopic evaluation excluded a foreign body aspiration but revealed right bronchial mucosal hyperaemia and varices. Diagnosis of right unilateral PVA was suspected on transthoracic echocardiography which demonstrated hypoplastic right pulmonary artery and non-visualization of right pulmonary veins. Final diagnosis was confirmed on cardiac CT angiography. A conservative treatment approach was opted with consideration for pneumonectomy in future when she is older. CONCLUSION Rarer causes should be considered when investigating for recurrent haemoptysis in children. Bronchoscopy and cardiac imaging are useful tools to establish the diagnosis of unilateral PVA in our case.
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Affiliation(s)
| | - Ing Ping Tang
- Department of ORL HNS, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Yek Kee Chor
- Department of Paediatric, Sarawak General Hospital, Kuching, Malaysia
| | - Kiew Siong Lau
- Department of Radiology, Sarawak General Hospital, Kuching, Malaysia
| | - Anne Rachel John
- Department of Paediatric Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - King Ching Hii
- Department of ORL HNS, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Olive Pei Yi Lee
- Department of ORL HNS, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Wooi Kok Lim
- Paediatric Cardiology Unit, Sarawak Heart Center, Kota Samarahan, Malaysia
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Shiraishi T, Yanagida H, Koga Y, Ohga S, Fujita M, Hiratsuka M, Miyahara S, Waseda R, Sato T, Iwasaki A. Severe scoliosis with an impaired pulmonary allograft function after pediatric unilateral lung transplantation. Gen Thorac Cardiovasc Surg 2020; 69:375-378. [PMID: 32930959 DOI: 10.1007/s11748-020-01447-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
Left-unilateral single-lobe lung transplantation from a living donor was performed in a 4-year-old boy who suffered from severe respiratory failure caused by bronchiolitis obliterans (BO) as a result of graft versus host disease (GVHD) after peripheral blood stem cell transplantation (PBSCT). The patient grew well during his early childhood years, with an excellent lung allograft function. However, severe thoracic scoliosis occurred 7 years after lung transplantation, which ultimately resulted in compression of the lung allograft followed by severe respiratory dysfunction, and the patient became dependent on mechanical ventilation support. Posterior spinal fusion of Th2-L3 with instrumentation and bone grafting was performed to correct scoliosis in the hope of recovering his thoracic capacity. The left thoracic volume was dramatically improved immediately after spinal fusion surgery, and the patient was ultimately weaned off of mechanical ventilation after a year of pulmonary rehabilitation.
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Affiliation(s)
- Takeshi Shiraishi
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan.
| | - Haruhisa Yanagida
- Department of Orthopedic Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yuhki Koga
- Department of Pediatrics, Faculty of Medicine, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Faculty of Medicine, Kyushu University, Fukuoka, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masafumi Hiratsuka
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - So Miyahara
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Ryuichi Waseda
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Toshihiko Sato
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Akinori Iwasaki
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
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Pneumonectomy for Pediatric Tumors-a Pediatric Surgical Oncology Research Collaborative Study. Ann Surg 2020; 274:e605-e609. [PMID: 32209902 DOI: 10.1097/sla.0000000000003795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe utilization and long-term outcomes of pneumonectomy in children and adolescents with cancer. SUMMARY BACKGROUND DATA Pneumonectomy in adults is associated with significant morbidity and mortality. Little is known about the indications and outcomes of pneumonectomy for pediatric tumors. METHODS The Pediatric Surgical Oncology Research Collaborative (PSORC) identified pediatric patients <21 years of age who underwent pneumonectomy from 1990 to 2017 for primary or metastatic tumors at 12 institutions. Clinical information was collected; outcomes included operative complications, long-term function, recurrence, and survival. Univariate log rank, and multivariable Cox analyses determined factors associated with survival. RESULTS Thirty-eight patients (mean 12 ± 6 yrs) were identified; median (IQR) follow-up was 19 (5-38) months. Twenty-six patients (68%) underwent pneumonectomy for primary tumors and 12 (32%) for metastases. The most frequent histologies were osteosarcoma (n = 6), inflammatory myofibroblastic tumors (IMT; n = 6), and pleuropulmonary blastoma (n = 5). Median postoperative ventilator days were 0 (0-1), intensive care 2 (1-3), and hospital 8 (5-16). Early postoperative complications occurred in 10 patients including 1 death. Of 25 (66%) patients alive at 1 year, 15 reported return to preoperative pulmonary status. All IMT patients survived while all osteosarcoma patients died during follow-up. On multivariable analysis, metastatic indications were associated with nonsurvival (HR = 3.37, P = 0.045) CONCLUSION:: This is the largest review of children who underwent pneumonectomy for cancer. There is decreased procedure-related morbidity and mortality than reported for adults. Survival is worse with preoperative metastatic disease, especially osteosarcoma.
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Pneumonectomy in a Child with Multilobar Pneumatocele Secondary to Necrotizing Pneumonia: Case Report and Review of the Literature. Case Rep Pediatr 2019; 2019:2464390. [PMID: 31396429 PMCID: PMC6664550 DOI: 10.1155/2019/2464390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/07/2019] [Indexed: 11/19/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) is common within pediatrics and contributes disproportionately to morbidity and mortality. Necrotizing pneumonia is a well-documented complication of CAP. It is thought to be caused by necrosis and liquefaction of consolidated lung and can result in damage to lung parenchyma, including pneumatocele development. Management of necrotizing pneumonia with pneumatocele may include hospitalization, intensive care unit admission, and lengthy antibiotic courses. Severe cases may need invasive procedures. Case Presentation We present a case of severe necrotizing pneumonia requiring prolonged venovenous extracorporeal membrane oxygenation (V-V ECMO) with development of persistent pneumatoceles, requiring pneumonectomy while on ECMO support to allow for decannulation and extubation. Conclusions In critically ill patients with extensive unilateral necrotizing pneumonia with pneumatocele development, surgical intervention can be considered when attempts to wean ventilation have been unsuccessful. This case provides evidence that V-V ECMO and pneumonectomy is a viable salvage therapy in the most critically unwell children.
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Clinical analysis of pneumonectomy for destroyed lung: a retrospective study of 32 patients. Gen Thorac Cardiovasc Surg 2019; 67:530-536. [DOI: 10.1007/s11748-018-01055-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/19/2018] [Indexed: 11/27/2022]
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Yarmus L, Nguyen PT, Montemayor K, Jennings M, Bade B, Shafiq M, Silvestri G, Steinfort D. Year in review 2017: Interventional pulmonology, lung cancer, pleural disease and respiratory infections. Respirology 2018; 23:628-635. [PMID: 29641840 DOI: 10.1111/resp.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lonny Yarmus
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phan T Nguyen
- The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kristina Montemayor
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Jennings
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brett Bade
- Division of Pulmonary and Critical Care Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Majid Shafiq
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gerard Silvestri
- Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, VIC, Australia
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Liew Z, Mallikarjuna S, Hasan A, Gould FK, Bunn S, Thomas MF, Lordan JL, O'Brien C, Brodlie M. Successful outcome following pneumonectomy in a teenage boy with cystic fibrosis: a case report. BMC Pulm Med 2017; 17:17. [PMID: 28086849 PMCID: PMC5237202 DOI: 10.1186/s12890-016-0350-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystic fibrosis lung disease is generally a diffuse process however rarely one lung may become particularly damaged through chronic collapse and consolidation resulting in end-stage bronchiectasis with relative sparing of the contralateral lung. This clinical situation is sometimes referred to as "destroyed lung". Lung resection surgery is seldom indicated in cystic fibrosis and the associated medical literature is relatively sparse. CASE PRESENTATION A 14 year old boy was referred to our centre for lung transplantation assessment. He had a chronic history of complete collapse and consolidation of his entire right lung. This was causing severe morbidity in terms of a continuous requirement for intravenous antibiotics over the last year, poor exercise tolerance with forced expiratory volume in 1 s of 35-40% predicted and need for home tuition. He also had significant nutritional problems and gastrointestinal symptoms following a Nissen's fundoplication operation a year earlier. His nutritional status was firstly improved by the institution of jejunal feeding, which also greatly improved his distressing symptoms of nausea and wretching. After thorough multidisciplinary assessment the therapeutic option of performing a right pneumonectomy was considered due to relative sparing of the left lung, which demonstrated only mild bronchiectasis on computed tomography scan. This was performed uneventfully with a smooth peri-operative course. Targeted antimicrobials were used to treat the multiresistant organisms colonising his airways. Subsequently his quality of life, nutritional status and lung function all improved significantly and requirement for lung transplantation has been delayed. CONCLUSIONS We report a successful outcome following pneumonectomy in a teenage boy with cystic fibrosis referred to our centre for lung transplantation assessment with chronic unilateral collapse and consolidation of his right lung. We believe that improvement of nutritional status pre-operatively and targeted antimicrobial therapy, all contributed to the smooth peri-operative course. Pneumonectomy can be a feasible option in this clinical situation in cystic fibrosis but the associated risks must be considered carefully on a case-by-case basis.
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Affiliation(s)
- Zheyi Liew
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Santosh Mallikarjuna
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Asif Hasan
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - F Kate Gould
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Su Bunn
- Department of Paediatric Gastroenterology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Matthew F Thomas
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Jim L Lordan
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Christopher O'Brien
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Institute of Cellular Medicine, Newcastle University and Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Level 3 Clinical Resource Building, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
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Giubergia V, Alessandrini F, Barrias C, Giuseppucci C, Reusmann A, Barrenechea M, Castaños C. Risk factors for morbidities and mortality in children following pneumonectomy. Respirology 2016; 22:187-191. [PMID: 27511212 DOI: 10.1111/resp.12867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/31/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Pneumonectomy (PNE) is a procedure infrequently performed in children. A high morbidity/mortality rate associated with PNE has been described. Few series have been published in the last 15 years. Risk factors associated with morbidity/mortality after PNE were evaluated. Indications, course, survival and complications of PNE in children were also analized. METHODS In a case series of 51 children who underwent PNE, death within 30 days of surgery, pneumonia, empyema, sepsis, adult respiratory distress syndrome, bronchopleural fistula, bleeding, pneumothorax and post-PNE syndrome were considered major morbidities. Scoliosis, wound infection and atelectasis were considered minor morbidities. RESULTS Median age at PNE was 7.4 years; 45% were males. Indications of pneumonectomy were postinfectious bronchiectasis (61%), tumours (17%), pulmonary malformations (17%), aspiration syndrome (14%), cystic fibrosis (6%), immunodeficiency (4%) and trauma (2%). Mortality rate was 4% at 1 month. Major and minor morbidities were present in 23% and 27% of patients, respectively. Risk factors for development of morbidities after PNE were age ≤ 3 years (OR: 16.7; 95% CI: 2.4-117) and the need for mechanical ventilation for at least 4 days (OR: 8; 95% CI: 1.5-43.6). CONCLUSION Children are at high risk of death, major and minor morbidities following PNE. Caution is recommended for this group of patients.
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Affiliation(s)
- Verónica Giubergia
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Florencia Alessandrini
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Carolina Barrias
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Carlos Giuseppucci
- General Surgery Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Aixa Reusmann
- General Surgery Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Marcelo Barrenechea
- General Surgery Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Claudio Castaños
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
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Andrade CF, Melo IA, Holand ARR, Silva ÉF, Fischer GB, Felicetii JC. Surgical treatment of non-cystic fibrosis bronchiectasis in Brazilian children. Pediatr Surg Int 2014; 30:63-9. [PMID: 24105331 DOI: 10.1007/s00383-013-3420-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine the clinical characteristics of patients submitted to surgical treatment for non-cystic fibrosis (CF) bronchiectasis, the indications for surgery, and the results obtained at a referral facility for pediatric thoracic surgery. METHODS Between January 1998 and December 2009, we retrospectively reviewed the medical charts of 109 pediatric patients with non-CF bronchiectasis who underwent surgical treatment. These findings were subsequently analyzed by focusing on postoperative complications and long-term results. RESULTS Of the 109 patients undergoing pulmonary resection, the mean age was 7.6 years (ranging from 1 to 15.5 y-o) with male predominance (59 %). The most common procedure was segmentectomy (43 %) followed by left lower lobectomy (38 %). Minor postoperative complications occurred in 36 % of the patients; the most common was transient atelectasis (26 %), followed by air leak (6 %), and postoperative pain (4 %). There was one death within the 30-day postoperative period, but it was unrelated to the procedure. Eighty-three children were followed after discharge, with a mean follow-up period of 667 days. Sixty-five (76 %) patients showed improvement of clinical symptoms after surgery. CONCLUSIONS Lung resection for the treatment of non-CF bronchiectasis in children is a safe procedure, with no life-treating morbidity and low mortality. This procedure also leads to significant improvements in symptoms and quality of life.
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Affiliation(s)
- Cristiano Feijó Andrade
- Postgraduate Program in Pulmonary Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,
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Odev K, Guler I, Altinok T, Pekcan S, Batur A, Ozbiner H. Cystic and cavitary lung lesions in children: radiologic findings with pathologic correlation. J Clin Imaging Sci 2013; 3:60. [PMID: 24605255 PMCID: PMC3935260 DOI: 10.4103/2156-7514.124087] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/11/2013] [Indexed: 11/04/2022] Open
Abstract
A number of diseases produce focal or multiple thin-walled or thick-walled air- or fluid-containing cysts or cavitary lung lesions in both infants and children. In infants and children, there is a spectrum of focal or multifocal cystic and cavitary lung lesions including congenital lobar emphysema, congenital cystic adenomatoid malformation, pleuropulmonary blastoma, bronchogenic cyst, pulmonary sequestration, Langerhans cell histiocytosis, airway diseases, infectious diseases (bacterial infection, fungal infection, etc.), hydatid cysts, destroid lung, and traumatic pseudocyst. For the evaluation of cystic or cavitary lung lesion in infants and children, imaging plays an important role in accurate early diagnosis and optimal patient management. Therefore, a practical imaging approach based on the most sensitive and least invasive imaging modality in an efficient and cost-effective manner is paramount. We reviewed the conventional radiographs and computed tomography findings of the most common cystic and cavitary lung lesions in infants and children.
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Affiliation(s)
- Kemal Odev
- Department of Radiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Ibrahim Guler
- Department of Radiology, Konya Research and Education Hospital, Konya, Turkey
| | - Tamer Altinok
- Department of Thoracic Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Chest Diseases, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Abdussamed Batur
- Department of Radiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Hüseyin Ozbiner
- Department of Radiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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Sritippayawan S, Treerojanapon S, Sanguanrungsirikul S, Deerojanawong J, Prapphal N. Pulmonary function and exercise capacity in children following lung resection surgery. Pediatr Surg Int 2012; 28:1183-8. [PMID: 23076456 DOI: 10.1007/s00383-012-3187-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To study lung function and exercise capacity in children following lung resection surgery. METHODS Children aged 6-18 years who had lung resection surgery were studied and compared to normal children (age and sex matched). All had spirometry/body plethysmography and exercise stress test (performed by treadmill and modified Balke protocol). RESULTS 13 Patients and 13 controls were studied (age 13.2 ± 3.3 years; 46.2 % male). The age at the time of lung resection surgery was 6.5 ± 4.7 years. The time interval between post-surgery and the tests was 6.8 ± 4.4 years. The most common indication for lung resection surgery was congenital lung malformations (61.5 %). 76.9 % of the patients had abnormal lung function. Exercise intolerance due to pulmonary limitations was found in 23.1 % of the patients. At the anaerobic threshold, the V(O2) was not different between the patients and the controls. However, at the end of the exercise, the patients demonstrated lower peak V(O2) than the controls (33.6 ± 6.0 vs. 39.3 ± 8.7 ml/min/kg; p < 0.01). CONCLUSIONS Abnormal lung functions and exercise intolerance were found in children following lung resection surgery. Children who had lung resection surgery had lower exercise capacity than normal children if the exercise was beyond the anaerobic threshold.
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Affiliation(s)
- Suchada Sritippayawan
- Division of Pulmonology and Critical Care, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Rama IV Rd., Bangkok 10330, Thailand.
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Cardak ME, Tukel M, Demirhan R, Batırel HF. False appearance of bilateral pneumothorax in a patient with hypoplastic left lung. J Thorac Cardiovasc Surg 2011; 143:e19-20. [PMID: 22153856 DOI: 10.1016/j.jtcvs.2011.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/13/2011] [Accepted: 10/31/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Murat Ersin Cardak
- Thoracic Surgery Clinic, Dr Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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Consunji-Araneta R, Higgins R, Qing G, Bouhasan L. Tuberculous damaged lung in a child. Pediatr Pulmonol 2011; 46:1247-50. [PMID: 21815276 DOI: 10.1002/ppul.21503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/23/2011] [Indexed: 11/07/2022]
Abstract
Tuberculosis (TB) remains the "great pretender." We report the case of a 10-year-old female, who presented with a mass in the left chest that was suspected initially to be a tumor. This was later confirmed to be tuberculous in nature, with dissemination to the liver. A large granuloma eventually replaced the left lung, leaving her with "tuberculous destroyed lung" (TDL), an extremely rare, life-threatening sequela of the disease. We review the pathophysiology, radiologic findings, and management options, which includes pneumonectomy, for this seldom seen but preventable condition.
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Affiliation(s)
- Raquel Consunji-Araneta
- Department of Pediatrics and Child Health, Pediatric Respirology, University of Manitoba, Winnipeg, Manitoba, Canada.
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Saatvedt K, Hoel T, Westvik J, Lindberg H. Correction of postpneumonectomy syndrome in infants with saline-filled expandable prosthesis. Interact Cardiovasc Thorac Surg 2011; 13:89-90. [PMID: 21422160 DOI: 10.1510/icvts.2010.261164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report two infants who underwent right pneumonectomy in infancy and developed postpneumonectomy syndrome with obstruction of the left main bronchus causing severe airway obstruction in one patient and gastrointestinal reflux due to a displaced and grossly dilated oesophagus in the other patient. Both patients were operated with implantation of an expandable breast prosthesis.
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Affiliation(s)
- Kjell Saatvedt
- Department of Pediatric Cardiac Surgery, Oslo University Hospital, Oslo, Norway.
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Pneumonectomy in children for destroyed lung: evaluation of 18 cases. Ann Thorac Surg 2010; 89:226-31. [PMID: 20103241 DOI: 10.1016/j.athoracsur.2009.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 10/05/2009] [Accepted: 10/06/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Destroyed lung is an uncommon condition; it describes a nonfunctional lung and is most often caused by inflammatory diseases. Surgical resection is used to resolve or prevent complications and improve quality of life. We reviewed our experience in surgery for destroyed lung in children. METHODS The records of 18 children aged 16 years and younger who had undergone pneumonectomy for destroyed lung between 1991 and 2007 were analyzed retrospectively. RESULTS Eighteen children, 10 males (55.5%) and 8 females, aged 5 to 16 years, with a mean age of 12.3 underwent pneumonectomy. Cough was the major presenting symptom (n = 18, 100%). The median preoperative period for symptoms was 6 years. Radiologic diagnostic methods included chest radiograph, computed tomography, bronchoscopy, and bronchography. Bronchiectasis (n = 13), tuberculosis (n = 4), and aspergillosis (n = 1) were the main pathologies. Five patients had tuberculosis history, and tuberculosis culture was positive in 2 patients. Pneumonectomy was applied to the left side in 14 and right side in 4 patients. There was no mortality. Complication occurred in 3 patients (atelectasis [n = 1], fistula and empyema [n = 1], and wound infection [n = 1]). Atelectasis was treated with bronchoscopy and stoma was needed for another patient for empyema. The mean follow-up was 64.9 months (range, 19 to 164 months). In their follow-up period, scoliosis was found in 1 patient. CONCLUSIONS The morbidity and mortality rates of pneumonectomy are acceptable for selected and well prepared children. Antibiotics and antituberculosis treatment in certain cases and good timing in pneumonectomy are essential. Children grew and developed normally after pneumonectomy.
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Irino ET, Stopiglia AJ, Larsson MH, Fantoni DT, Aiello VD, Kavhegian MA, Simões EA, Santos AL, Gama Filho HA. Avaliação eletrocardiográfica em cães submetidos à pneumonectomia direita. PESQUISA VETERINÁRIA BRASILEIRA 2009. [DOI: 10.1590/s0100-736x2009000800001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O propósito das ressecções pulmonares em cães e gatos, quer sejam por lobectomia ou pneumonectomia, é a cura ou paliação de processos broncopulmonares sempre que os meios conservadores de tratamento clínico sejam considerados ineficientes. Tendo em vista as significativas alterações resultantes da pneumonectomia, novos estudos experimentais devem ser feitos para avaliar as vantagens dessa intervenção cirúrgica e determinar a maneira como aplicá-la com segurança. O presente estudo tem como objetivo avaliar as alterações eletrocardiográficas em dez cães adultos de ambos os sexos, sem raça definida, com 10-30 kg, submetidos à pneumonectomia direita. Foram avaliados diariamente os parâmetros clínicos de cada cão e as alterações em todas as derivações do eletrocardiograma. Todos os cães apresentaram um bom desenlace pós-operatório. Apenas um cão apresentou alteração de relevância clínica, um caso de complexos ventriculares prematuros, possivelmente decorrente da parada cardiorrespiratória, que foi revertido com sucesso. Houve diminuição da amplitude dos complexos QRS nos primeiros 14 dias, retornado ao normal após 60 dias de pós-operatório.
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Pezzella AT, Fang W. Surgical Aspects of Thoracic Tuberculosis: A Contemporary Review—Part 2. Curr Probl Surg 2008; 45:771-829. [DOI: 10.1067/j.cpsurg.2008.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Anselmo DM, Perez IA, Shaul DB. Thoracoscopic Pneumonectomy for Severe Bronchiectasis in a 9-Year-Old Female. J Laparoendosc Adv Surg Tech A 2008; 18:775-7. [DOI: 10.1089/lap.2007.0214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dean M. Anselmo
- Department of Surgery, Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California
| | - Iris A. Perez
- Department of Pediatrics, Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California
| | - Donald B. Shaul
- Department of Surgery, Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California
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Goussard P, Gie RP, Kling S, Kritzinger FE, van Wyk J, Janson J, Andronikou S. Fibrin glue closure of persistent bronchopleural fistula following pneumonectomy for post-tuberculosis bronchiectasis. Pediatr Pulmonol 2008; 43:721-5. [PMID: 18500738 DOI: 10.1002/ppul.20843] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report a case of a persistent bronchopleural fistula following a pneumonectomy for post-tuberculosis bronchiectasis. The patient had two unsuccessful surgical attempts at closing of the fistula. Further surgical attempts were technically were not possible. Bronchoscopic closure was achieved by injecting human fibrin glue into the fistula via a catheter. Closure of the broncho-pleural fistula was confirmed by repeated ventilation scan over a period of 2 months. Endoscopic closure of small bronchopleural fistulae is an attractive option in children with significant underlying lung disease.
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Affiliation(s)
- P Goussard
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg Children's Hospital, Tygerberg, South Africa.
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Abstract
The lung is a relatively quiescent tissue comprised of infrequently proliferating epithelial, endothelial, and interstitial cell populations. No classical stem cell hierarchy has yet been described for the maintenance of this essential tissue; however, after injury, a number of lung cell types are able to proliferate and reconstitute the lung epithelium. Differentiated mature epithelial cells and newly recognized local epithelial progenitors residing in specialized niches may participate in this repair process. This review summarizes recent discoveries and controversies, in the field of stem cell biology, that are not only challenging, but also advancing an understanding of lung injury and repair. Evidence supporting a role for the numerous cell types believed to contribute to lung epithelial homeostasis is reviewed, and initial studies employing cell-based therapies for lung disease are presented. As a detailed understanding of stem cell biology, lung development, lineage commitment, and epithelial differentiation emerges, an ability to modulate lung injury and repair is likely to follow.
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Affiliation(s)
- Darrell N Kotton
- Boston University Pulmonary Center, Boston University School of Medicine, 715 Albany Street, R-304, Boston, MA 02118, USA.
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Choudhury SR, Chadha R, Mishra A, Kumar V, Singh V, Dubey NK. Lung resections in children for congenital and acquired lesions. Pediatr Surg Int 2007; 23:851-9. [PMID: 17671788 DOI: 10.1007/s00383-007-1940-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2007] [Indexed: 11/25/2022]
Abstract
We reviewed a single-center experience of pediatric lung resections for various congenital and acquired benign lung conditions. Thirty-five children underwent lung resections between 1998 and 2006, their age ranging from 8 days to 12 years (mean 3 years), with a male:female ratio of 4:1. Twelve patients were neonates. Antenatal diagnosis was available in only one patient. The presenting symptoms were respiratory distress and respiratory tract infections. Imaging with chest X-ray with/without a CT scan picked up the lesion in all cases. Preoperative ventilation was required for five patients. One patient had pneumothorax at presentation; however, ten patients had inadvertent intercostal tube insertion before surgical referral. The surgical procedures performed included lobectomy (28), segmentectomy (3), and pneumonectomy in 4 cases. Twenty-one patients underwent emergency surgery. Six patients required postoperative ventilation. The histopathological diagnosis was congenital lobar emphysema (CLE) (9), congenital cystic adenomatoid malformation (CCAM) (9), bronchiectasis (9), sequestration (3), atelectasis (1), lung abscess (1), unilobar tuberculosis (1), hydatid cyst (1), and foreign body with collapse (1). There was considerable discrepancy between the preoperative diagnosis based on imaging and the postoperative histopathological diagnosis. Postoperative complications included atelectasis (2), pneumothorax (2) and fluid collection (4 cases). Three patients died, one from compromised cardiac function, one from overwhelming sepsis and one from respiratory failure due to severe bilateral CCAM; the rest of the patients made a satisfactory recovery. At short-term follow-up all patients were doing well. Pulmonary resections are necessary for various congenital and acquired lung lesions in children and can be done safely in a pediatric hospital setup. Proper preoperative diagnosis can avoid inadvertent intercostal tube insertion in patients with congenital cystic lung lesions. The histopathological diagnosis often differs from the radiological diagnosis. Emergency lobectomies for acute respiratory distress, even in neonates, result in a satisfactory outcome.
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Affiliation(s)
- Subhasis Roy Choudhury
- Department of Pediatric Surgery, Kalawati Saran Children's Hospital and Lady Hardinge Medical College, New Delhi 110001, India.
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Eren S, Esme H, Avci A. Risk factors affecting outcome and morbidity in the surgical management of bronchiectasis. J Thorac Cardiovasc Surg 2007; 134:392-8. [PMID: 17662778 DOI: 10.1016/j.jtcvs.2007.04.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 04/02/2007] [Accepted: 04/11/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bronchiectasis continues to be a major cause of morbidity and mortality in developing countries. The purpose of this study was to present the results of our 14 years of surgical experience to re-evaluate our indications for using surgical therapy and to analyze several factors that might affect the outcome and postoperative complications of this disease. METHOD Age, sex, etiologic factors, symptoms, the duration of symptoms, radiologic and radionuclide examinations, preoperative evaluation, surgical procedures, postoperative morbidity and mortality, and the follow-up results from 143 patients operated on for bronchiectasis between January 1992 and January 2006, were reviewed retrospectively. RESULTS One hundred forty-three patients underwent 148 operations for bronchiectasis. The mean age was 23.4 years. Complete resection was achieved in 118 patients. The morbidity rate was 23.0% and the mortality rate was 1.3%. Postoperatively, 75.9% of the patients were free of symptoms, 15.7% were improved, and 8.2% showed no improvement or were worse. The logistic regression analysis showed that a history of tuberculosis and incomplete resection were independent predictors of the operative result. Moreover, the lack of a preoperative bronchoscopic examination, a forced expiratory volume in 1 second of less than 60% of the predicted value, a history of tuberculosis, and incomplete resection were independent predictors of postoperative complications. CONCLUSIONS A history of tuberculosis and incomplete resection were risk factors both for postoperative complications and for a worse operative result. The lack of a preoperative bronchoscopic examination and a low forced expiratory volume in 1 second were risk factors for postoperative complications. Surgery for multiple segments on different lobes should be performed whenever possible.
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Affiliation(s)
- Sevval Eren
- Department of Thoracic Surgery, Dicle University, School of Medicine, Diyarbakir, Turkey.
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Abstract
BACKGROUND/PURPOSE Extrapleural pneumonectomy (EPP) is an en bloc resection of the pleura, lung, diaphragm, and pericardium. EPP in the pediatric population has not been reported in the literature. We report our experience of using EPP in children to treat a variety of malignancies that involve the pleural surface. METHODS We performed a retrospective review of all children treated through EPP at our institution. Data were obtained from patient charts and a pediatric database. All patients underwent en bloc resection of the pleura, lung, diaphragm, and pericardium and reconstruction. RESULTS Four patients underwent EPP from 2000 to 2004 for inflammatory myofibroblastic tumor, spindle cell sarcoma, metastatic neuroblastoma, and malignant mesothelioma. The patients' ages were from 6 to 11 years. The patient with metastatic neuroblastoma had recurrent disease in the left chest 1 year after EPP and died of sepsis; the patient with mesothelioma died of disease extension into the abdomen 1.5 years later. The other 2 patients are free of disease. CONCLUSIONS EPP can be performed with curative intent in selected pediatric patients with pleural-based malignancies. EPP should be included in the armamentarium of the pediatric thoracic surgeon and evaluated in larger studies.
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Affiliation(s)
- Raja M Flores
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Kendja F, Tanauh Y, Kouamé J, Demine B, Amani A, Kangah M. [Surgical management of lungs destroyed by tuberculosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2006; 62:171-4. [PMID: 16840994 DOI: 10.1016/s0761-8417(06)75433-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The purpose of this work was to report our experience with surgical management of lungs destroyed by tuberculosis and to analyze our results. MATERIAL AND METHODS We reviewed the cases of 45 patients who underwent surgery between January 1978 and December 2004 after medical treatment for pulmonary tuberculosis considered successful. The series included 31 men and 14 women, mean age 31 years (range: 7-55 yr). Indications for surgery were chronic bronchorrhea (91.1%) and hemoptoic sputum associated with bronchorrhea (8.9%). Lung function tests were preformed in 42 patients and noted a restrictive syndrome with shunt in all: mean FEV1 was 1 890 ml. All patients were given a preoperative medical regimen for at least four weeks. Pneumectomy (17 right and 28 left) was performed; all bronchial sutures were made manually and protected. Operative bleeding was a constant feature and blood transfusion was needed (mean 1,500 cc). RESULTS Operative mortality was 4.4% from hemorrhagic and infectious causes. Complications were non-fatal (16.3%) and marked by bleeding (0.9%) empyema with bronchopleural fistulae (8.9%). Mean postoperative hospital stay was 13 days without empyema and 150 days with empyema. Long-term outcome was satisfactory after a mean 7.5 years follow-up (range: 4 months - 20 years). CONCLUSION Indications are patient comfort and necessity. Morbidity and mortality are acceptable with adequate preoperative preparation.
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Affiliation(s)
- F Kendja
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, BPV 2006, Abidjan, Côte d'Ivoire.
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Brady KM, Harris ZL, Hammer GB, Berkowitz ID, Easley RB. Lung isolation in a child with unilateral necrotizing Clostridium perfringens pneumonia. Crit Care Med 2005; 33:2676-80. [PMID: 16276197 DOI: 10.1097/01.ccm.0000186776.40271.6a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe lung isolation and the selective application of continuous positive airway pressure using an endobronchial blocker in a patient with sickle cell disease and unilateral necrotizing Clostridium perfringens pneumonia. DESIGN Case report. SETTING Pediatric intensive care unit. PATIENT A 12-yr-old male with sickle cell disease developed persistent necrotizing pneumonia of the left lung following exchange transfusion for acute chest syndrome and hyper-hemolytic syndrome. INTERVENTIONS An endobronchial blocker was placed into the left main stem bronchus for lung isolation and application of continuous positive airway pressure to the left lung for 48 hrs. MEASUREMENTS AND MAIN RESULTS After 14 days of persistent atelectasis of the left lung despite thorascopic decortication and multiple bronchoscopies, our patient had substantial lung aeration within 48 hrs of continuous positive airway pressure applied via the endobronchial blocker. Lung resection was avoided and the patient was successfully extubated 2 days after removal of the blocker. CONCLUSIONS This case report demonstrates a therapeutic application of prolonged lung isolation and differential ventilation in a patient with an airway too small for commercially available double-lumen endotracheal tubes. The apparent success of this intervention suggests the feasibility of selective ventilation in pediatric patients and highlights a novel application of the bronchial blocker.
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Affiliation(s)
- Ken M Brady
- Department of Anesthesiology/Critical Care Medicine and Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
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Govaere E, Van Raemdonck D, Devlieger H, Smet MH, Verbeken E, Proesmans M, De Boeck K. Massive lung collapse with partial resolution after several years: a case report. BMC Pediatr 2005; 5:39. [PMID: 16242028 PMCID: PMC1276800 DOI: 10.1186/1471-2431-5-39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 10/21/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchitis obliterans is a severe and extremely rare complication of respiratory tract infections in children and is characterized by massive atelectasis and collapse of the affected lung. Of the rare cases reported in the literature all surviving children underwent surgical resection of the collapsed lung. CASE PRESENTATION We report an infant with bronchitis obliterans that was treated conservatively. 5 years after the initial event, partial lung re-expansion was documented. CONCLUSION This case therefore supports a conservative treatment whenever possible with pneumonectomy only as a last treatment option.
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Affiliation(s)
- Elke Govaere
- University Hospital of Leuven, Dept of Pediatrics, Herestraat 49, 3000 Leuven, Belgium
| | | | - Hugo Devlieger
- University Hospital of Leuven, Dept of Pediatrics, Herestraat 49, 3000 Leuven, Belgium
| | | | - Eric Verbeken
- Dept of Pathology, Herestraat 49, 3000 Leuven, Belgium
| | - Marijke Proesmans
- University Hospital of Leuven, Dept of Pediatrics, Herestraat 49, 3000 Leuven, Belgium
| | - Kris De Boeck
- University Hospital of Leuven, Dept of Pediatrics, Herestraat 49, 3000 Leuven, Belgium
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Mackey JE, Anbar RD. High-dose ibuprofen therapy associated with esophageal ulceration after pneumonectomy in a patient with cystic fibrosis: a case report. BMC Pediatr 2004; 4:19. [PMID: 15363106 PMCID: PMC518969 DOI: 10.1186/1471-2431-4-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Accepted: 09/13/2004] [Indexed: 11/28/2022] Open
Abstract
Background Lung disease in patients with cystic fibrosis is thought to develop as a result of airway inflammation, infection, and obstruction. Pulmonary therapies for cystic fibrosis that reduce airway inflammation include corticosteroids, rhDNase, antibiotics, and high-dose ibuprofen. Despite evidence that high-dose ibuprofen slows the progression of lung disease in patients with cystic fibrosis, many clinicians have chosen not to use this therapy because of concerns regarding potential side effects, especially gastrointestinal bleeding. However, studies have shown a low incidence of gastrointestinal ulceration and bleeding in patients with cystic fibrosis who have been treated with high-dose ibuprofen. Case presentation The described case illustrates a life-threatening upper gastrointestinal bleed that may have resulted from high-dose ibuprofen therapy in a patient with CF who had undergone a pneumonectomy. Mediastinal shift post-pneumonectomy distorted the patient's esophageal anatomy and may have caused decreased esophageal motility, which led to prolonged contact of the ibuprofen with the esophagus. The concentrated effect of the ibuprofen, as well as its systemic effects, probably contributed to the occurrence of the bleed in this patient. Conclusions This report demonstrates that gastrointestinal tract anatomical abnormalities or dysmotility may be contraindications for therapy with high-dose ibuprofen in patients with cystic fibrosis.
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Affiliation(s)
- Jennifer E Mackey
- Department of Pediatrics, University Hospital, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Ran D Anbar
- Department of Pediatrics, University Hospital, State University of New York Upstate Medical University, Syracuse, NY, USA
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