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Iida T, Sato M, Fukami T. Clinical analysis of progressive destroyed lung after lung cancer surgery. J Thorac Dis 2024; 16:5097-5109. [PMID: 39268100 PMCID: PMC11388225 DOI: 10.21037/jtd-24-452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/28/2024] [Indexed: 09/15/2024]
Abstract
Background "Progressive destroyed lung (PDL)" refers to a state in which the normal structure and function of the lung are permanently disrupted owing to repeated inflammation. After lung cancer surgery, the remaining lung tissue can experience progressive destruction; however, the exact cause remains unclear. In this study, we retrospectively analyzed cases in which the remaining lung deteriorated after lung cancer surgery and investigated the associated risk factors. Methods A case-control study was conducted on 31 cases of PDL and 247 cases of non-PDL among 1,234 patients who underwent surgery for primary lung cancer from 2006 to 2021. The following factors were analyzed: age, sex, medical history, smoking status, surgical procedure, lung cancer histology, surgical approach, postoperative complications, chemotherapy, radiation therapy, and lung cancer recurrence. Patients were matched 1:1 based on preoperative factors, and postoperative risk factors were evaluated using multivariate logistic regression analysis. Results A higher proportion of men and higher prevalence of chronic lung diseases, smokers, squamous cell carcinoma (SCC), postoperative acute pneumonia, chronic pneumonia, air leak, and history of radiation therapy were noted in the PDL group than in the non-PDL group. In the analysis following propensity score matching, chronic pneumonia [odds ratio (OR): 10.1, 95% confidence interval (CI): 2.9 to 35.8] was identified as an independent risk factor for PDL. Conclusions In this study, PDL after lung cancer surgery was associated with postoperative chronic pneumonia, including Aspergillus infection and aspiration pneumonia.
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Affiliation(s)
- Takahiro Iida
- Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Fukami
- Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
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Sollitto F, Ardò NP, De Bellis R, Marasco RD, Loizzi D. Extrapleural pneumonectomy in atypical mycobacteriosis: the modern use of "Sarot procedure". Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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3
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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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Issoufou I, Rabiou S, Belliraj L, Ammor FZ, Harmouchi H, Diarra AS, Lakranbi M, Serraj M, Ouadnouni Y, Smahi M. [The place of surgery in bilateral sequelae bronchiectasis]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:127-134. [PMID: 28365046 DOI: 10.1016/j.pneumo.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/04/2017] [Accepted: 02/27/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of our study is to report our surgery results in bilateral sequelae bronchiectasis and to assess its impact on the life quality of our patients. METHOD This is a retrospective descriptive study in thoracic surgery department of Teaching Hospital Hassan II of Fez in Morocco. It involved all patients with bilateral bronchiectasis which is predominant on a few lobes or segments (localized) and who underwent surgery during the period 2010-2015. The epidemiological, clinical and paraclinical data, the surgery results, the evolution and the impact on life quality were assessed. RESULTS From a total of 47 patients with bilateral bronchiectasis, 13 were operated, thus a frequency of 27.6%. The average age was 32years, ranging from 15 to 54years. Women were in majority (61.5%) representing a sex ratio of 1.6. The association of chronic bronchorrhea and hemoptysis was the main reason of medical consultation in 46.16%, followed by isolated chronic bronchorrhea in 38.46%. Surgical resection involved the left side in 61.5% of cases. The left lower lobectomy was the most accomplished gesture. An improvement in symptoms was found in 11 patients (84.6%) as a decrease in bronchorrhea, hemoptysis episodes and decreasing use of antibiotics. CONCLUSION Bilateral bronchiectasis surgery can be performed with acceptable morbidity and mortality in well-selected patients with an improvement in symptoms.
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Affiliation(s)
- I Issoufou
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc.
| | - S Rabiou
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - L Belliraj
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - F Z Ammor
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - H Harmouchi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - A S Diarra
- Laboratoire d'épidémiologie, recherche clinique et santé communautaire, faculté de médecine et de pharmacie de Fès, 3000 Fès, Maroc
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - M Serraj
- Service de pneumologie, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
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Varona Porres D, Persiva O, Pallisa E, Andreu J. Radiological findings of unilateral tuberculous lung destruction. Insights Imaging 2017; 8:271-277. [PMID: 28197882 PMCID: PMC5359149 DOI: 10.1007/s13244-017-0547-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/26/2017] [Accepted: 02/01/2017] [Indexed: 01/15/2023] Open
Abstract
Objectives The aim of this report is to identify the radiological findings of unilateral tuberculous lung destruction (UTLD). Materials and methods Thirteen patients with (UTLD) were reviewed from 1999 to 2014. Only patients with radiological evidence of absence of pulmonary parenchyma preserved were included. Clinical and demographic data were obtained and radiological studies (chest radiograph and CT) were retrospectively reviewed. Results The left lung was more commonly involved (85%). The following radiological findings were found in all cases: a decrease in the diameter of the pulmonary vessels of the affected lung, herniation of the contralateral lung and hypertrophy of the ribs and/or thickening of extrapleural fat. Two radiological patterns were identified: UTLD with cystic bronchiectasis (85%) and UTLD without residual cystic bronchiectasis (15%). Forty-six per cent of cases had respiratory infection symptoms with presence of air-fluid levels in the affected lung as the most common finding in these patients. Conclusions Total unilateral post-tuberculous lung destruction is an irreversible complication with the following main radiological features: predominantly left-sided location, decreases in the diameter of the ipsilateral pulmonary vessels, herniation of the contralateral lung and hypertrophy of the ribs and/or thickening of extrapleural fat. Teaching Points • Unilateral tuberculous lung destruction is an irreversible complication of tuberculosis. • Left-side predominance and herniation of the contralateral lung are characteristic. • Decreased diameter of the ipsilateral pulmonary vessels occurred in all patients. • The pattern with residual cystic bronchiectasis is the most frequent. • Superimposed non-tuberculous infections may affect the destroyed lung.
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Affiliation(s)
- Diego Varona Porres
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain.
| | - Oscar Persiva
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain
| | - Esther Pallisa
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain
| | - Jordi Andreu
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain
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Issoufou I, Sani R, Belliraj L, Ammor FZ, Moussa Ounteini A, Ghalimi J, Lakranbi M, Ouadnouni Y, Smahi M. [Pneumonectomy for tuberculosis destroyed lung: A series of 26 operated cases]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:288-292. [PMID: 27576025 DOI: 10.1016/j.pneumo.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 06/25/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
UNLABELLED Pneumonectomy keeps a greatest place in the treatment of tuberculosis lung destroyed despite high morbidity and mortality. The aim of our study was to analyze the results of pneumonectomy in the treatment of tuberculosis lung destroyed in our institution. METHOD A retrospective study over a period of 5 years (2009 to 2014) was realized. Are involved in the study all patients admitted to the thoracic surgery department of CHU Hassan II with tuberculosis lung destroyed and operated during the study period. RESULTS This is a series of 26 patients, including 17 men and 9 women treated and cured for pulmonary tuberculosis of which 2 for multiresistant tuberculosis. The average age was 38.8 years. Hemoptysis (77 %) and recurrent respiratory infections (65.4 %) were the major clinical signs. Aspergilloma have been reported on cavitary lesion in 23 % of cases and in 11.5 % pyothorax was associated. Extra-pericardial pneumonectomy was performed in 65.4 %, intra-pericardial pneumonectomy in 19.3 % and pleural-pneumonectomy in 15.3 %. The outcome was favorable in 23 patients. We noted a pyothorax on pneumonectomy cavity in 3 patients. Postoperative mortality was 7.7 %. The regularly clinical and radiological control of all patients is satisfactory with a mean of 41 months. CONCLUSION Pneumonectomy for tuberculosis lung destroyed remains effective in young patients with an acceptable complication rate.
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Affiliation(s)
- I Issoufou
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc.
| | - R Sani
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - L Belliraj
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - F Z Ammor
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - A Moussa Ounteini
- Service de pneumologie, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - J Ghalimi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
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Kosmidis C, Newton P, Muldoon EG, Denning DW. Chronic fibrosing pulmonary aspergillosis: a cause of ‘destroyed lung’ syndrome. Infect Dis (Lond) 2016; 49:296-301. [DOI: 10.1080/23744235.2016.1232861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Chris Kosmidis
- National Aspergillosis Centre, Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Manchester, UK
| | - Pippa Newton
- National Aspergillosis Centre, Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Manchester, UK
| | - Eavan G. Muldoon
- National Aspergillosis Centre, Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Manchester, UK
| | - David W. Denning
- National Aspergillosis Centre, Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Manchester, UK
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Abstract
The surgical management of pulmonary tuberculosis has evolved since collapse therapy was the mainstay of treatment. Despite this, resection for active tuberculosis is viewed with circumspection. Details of 106 patients with pathologically proven active pulmonary tuberculosis, who were operated on from January 1997 to January 2005, were reviewed retrospectively. Demographic data, radiographic profiles, indications for surgery, sputum status, and preoperative drug therapy were analyzed in relation to outcomes. The indications for surgery included multidrug-resistant tuberculosis in 27 patients, hemoptysis in 44, bronchiectasis in 27, and diagnostic dilemmas where a tumor could not be excluded in 8. All patients were operated on while receiving antituberculous therapy, and 17 were sputum positive at the time of surgery. Two (1.9%) patients died postoperatively. Morbidity was 16.9%, including 6 cases of postpneumonectomy empyema and one of bronchopleural fistula. Surgery for active tuberculosis may be undertaken with acceptable morbidity and mortality.
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Affiliation(s)
- Rishendran Naidoo
- Department of Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa.
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9
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Unilateral post-tuberculosis lung destruction and massive haemoptysis in pregnancy with successful outcome. ALEXANDRIA JOURNAL OF MEDICINE 2016. [DOI: 10.1016/j.ajme.2015.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Porres DV, Morenza OP, Pallisa E, Roque A, Andreu J, Martínez M. Learning from the pulmonary veins. Radiographics 2014; 33:999-1022. [PMID: 23842969 DOI: 10.1148/rg.334125043] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this article is to review the basic embryology and anatomy of the pulmonary veins and the various imaging techniques used to evaluate the pulmonary veins, as well as the radiologic findings in diseases affecting these structures. Specific cases highlight the clinical importance of the imaging features, particularly the findings obtained with multidetector computed tomography (CT). Pulmonary vein disease can be broadly classified into congenital or acquired conditions. Congenital disease, which often goes unnoticed until patients are adults, mainly includes (a) anomalies in the number or diameter of the vessels and (b) abnormal drainage or connection with the pulmonary arterial tree. Acquired disease can be grouped into (a) stenosis and obstruction, (b) hypertension, (c) thrombosis, (d) calcifications, and (e) collateral circulation. Pulmonary vein stenosis or obstruction, which often has important clinical repercussions, is frequently a result of radiofrequency ablation complications, neoplastic infiltration, or fibrosing mediastinitis. The most common cause of pulmonary venous hypertension is chronic left ventricular failure. This condition is difficult to differentiate from veno-occlusive pulmonary disease, which requires a completely different treatment. Pulmonary vein thrombosis is a rare, potentially severe condition that can have a local or distant cause. Calcifications have been described in rheumatic mitral valve disease and chronic renal failure. Finally, the pulmonary veins can act as conduits for collateral circulation in cases of obstruction of the superior vena cava. Multidetector CT is an excellent modality for imaging evaluation of the pulmonary veins, even when the examination is not specifically tailored for their assessment.
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Affiliation(s)
- Diego Varona Porres
- Department of Radiology, Hospital Vall d'Hebrón, Passeig Vall d'Hebrón 119, 08035 Barcelona, Spain.
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Massard G, Olland A, Santelmo N, Falcoz PE. Surgery for the Sequelae of Postprimary Tuberculosis. Thorac Surg Clin 2012; 22:287-300. [DOI: 10.1016/j.thorsurg.2012.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Chae JN, Jung CY, Shim SW, Rho BH, Jeon YJ. CT Radiologic Findings in Patients with Tuberculous Destroyed Lung and Correlation with Lung Function. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.71.3.202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jin Nyeong Chae
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Chi Young Jung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sang Woo Shim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byung Hak Rho
- Department of Radiology, Keimyung University School of Medicine, Daegu, Korea
| | - Young June Jeon
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Pezzella AT, Fang W. Surgical aspects of thoracic tuberculosis: a contemporary review--part 1. Curr Probl Surg 2008; 45:675-758. [PMID: 18774374 DOI: 10.1067/j.cpsurg.2008.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
PURPOSE OF REVIEW The role of thoracic surgery in pulmonary tuberculosis, in either a diagnostic or a therapeutic role, is well established. This review aims to underline the current indications for lung resection, surgical strategy and outcomes associated with surgery. RECENT FINDINGS There has been a renewed interest in surgery, mainly in the multidrug-resistant tuberculosis (MDRTB) group as an adjunct to medical therapy. Lung resection in this group of patients has been undertaken with acceptable morbidity and mortality, and with cure rates of over 90%. The current strategy favours early surgical intervention for patients with multidrug-resistant tuberculosis to prevent the development of bilateral disease. Early surgery for haemoptysis is advocated, for sometimes it is necessary to operate on these patients without a full course of antituberculous therapy. Medical stabilization and early inpatient surgery is favoured in view of the excessive mortality associated with emergency surgery. There is still no consensus on the management of the bronchial stump at the time of lung resection, although the current trend favours closure, either sutured or stapled, without muscle reinforcement. SUMMARY Lung resection for pulmonary tuberculosis, in carefully selected and prepared patients, is safe with acceptable morbidity and mortality.
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Haciibrahimoglu G, Fazlioglu M, Olcmen A, Gurses A, Bedirhan MA. Surgical management of childhood bronchiectasis due to infectious disease. J Thorac Cardiovasc Surg 2004; 127:1361-5. [PMID: 15115993 DOI: 10.1016/j.jtcvs.2003.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to estimate operative risk and to identify indicators of adverse prognosis in patients undergoing resection for childhood bronchiectasis. METHODS From January 1985 to February 2001, patients undergoing resection for bronchiectasis were studied. The indications for operation were failure of medical therapy in 33 patients (94.2%) and hemoptysis in 2 (5.7%). The mean duration of symptoms was 4.2 years (range, 1-9 years). Surgical treatment included lobectomy in 17 patients (48.5%), pneumonectomy in 7 (20%), lobectomy plus segmentectomy in 5 (14.2%), bilobectomy in 2 (5.7%), and segmentectomy in 4 (11.4%). RESULTS The operative mortality rate was 2.8%, and the morbidity rate was 17.6%. The mean follow-up in 34 patients was 5.4 years (range, 1-12 years). Overall, 22 patients (64.7%) were asymptomatic after surgery. Clinical improvement was noticed in 8 patients (23.5%), and no improvement was noticed in 4 (11.7%). Complete resection resulted in a significantly better clinical outcome than incomplete resection (P <.05). CONCLUSIONS Surgery for childhood bronchiectasis can be performed with low mortality and morbidity. Complete resection should be performed when possible.
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Affiliation(s)
- Gokhan Haciibrahimoglu
- Yedikule Hospital for Chest Disease and Thoracic Surgery Center, Department of Thoracic Surgery, Istanbul, Turkey.
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Thoracic Surgery for Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Lung function in cases of chronic airflow obstruction (CAO) due to tuberculous destroyed lung, which is still common in Korea, has not been objectively investigated. We evaluated lung functions and postbronchodilator responses in 21 CAO patients with a forced expiratory volume in 1 s (FEV1) of 30-65% of the predicted value, and compared some of these results with those of age-, sex- and FEV1% predicted-matched patients with chronic obstructive pulmonary disease (COPD). In addition, we analyzed the lung functions of CAO patients with respect to wheezing. The forced vital capacity (FVC) (P < 0.05) and postbronchodilator FEV1 of CAO patients were lower than those of COPD patients (P < 0.05). When a positive bronchodilator response was defined as an absolute change of FEV1 (FEV1 delta(abs)) of more than 0.2 l (P < 0.05) and a percentage of initial FEV1 (FEV1 delta%init) of more than 12%, the positive rates in CAO patients were lower than in COPD patients (P < 0.05). Among the CAO patients, patients with wheezing showed lower forced expiratory flow 25%-75% (FEF(25-75%)) (P < 0.05) and higher airway resistance than those without wheezing (P < 0.05). CAO patients with wheezing were more responsive to bronchodilator than those without wheezing. Although the pathophysiology of CAO differs from that of COPD, bronchodilator therapy could be useful for treating CAO, especially in cases presenting with wheezing.
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Affiliation(s)
- J H Lee
- Department of Internal Medicine, Medical Research Center, Mokdong Hospital, Ewha Womans University, 911-1 Mokdong YangCheon-Ku, Seoul 158-710, South Korea
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Abstract
OBJECTIVES Destroyed lung introduces irreversible changes in lung parenchyma. This condition is uncommon in children. Operative intervention is essential for children in this state. We demonstrate our experience with this condition and report on the respective long-term results. METHOD Seventeen children who underwent pneumonectomy for destroyed lung during a 15-year period were retrospectively analyzed. Long-term results were detected in 13 patients. RESULTS Seventeen children underwent pneumonectomy. Five children were female (29.4%), and 12 children were male (70.5%). The median age of the study group children was 9.1 years (3-16 years). Sputum was the most common presenting symptom (n = 13, 76.4%). Bronchiectasis (n = 11), tuberculosis (n = 4), and necrotizing lung disease (n = 2) were the main underlying conditions. Destroyed lung was detected on the left side in 14 children (82.4%) and on the right side in 3 children (17.6%). Main bronchial stenosis was found in 4 children and mucosal thickening or congestion in 5 children. The median length of hospital stay was 15.5 days. The mortality rate was 11.7% (n = 2), and the morbidity rate was 23.5% (n = 4). Follow-up information was available for 13 patients, and this ranged from 1 year to 12 years (median 5.2 years). The respiratory capacity and scoliosis level of the patients were examined. CONCLUSIONS Although pneumonectomy is considered a difficult procedure in children, its use for destroyed lung resolves complications and improves a patient's quality of life. In time, the remaining lung expands to compensate for the loss of the removed lung. Children grew and developed normally after pneumonectomy. Patients tend not to have major skeletal deformation as the result of pneumonectomy in the short term.
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Affiliation(s)
- Sevval Eren
- Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, 21100 Diyarbakir, Turkey.
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Halezeroglu S, Keles M, Uysal A, Celik M, Senol C, Haciibrahimoglu G, Arman B. Factors affecting postoperative morbidity and mortality in destroyed lung. Ann Thorac Surg 1997; 64:1635-8. [PMID: 9436548 DOI: 10.1016/s0003-4975(97)00999-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The presence of specific risk factors can increase the postoperative complication rate of pneumonectomy for destroyed lung. METHODS Our experience in 118 consecutive patients who underwent pneumonectomy for destroyed lung over a 10-year period was retrospectively analyzed to evaluate the effect of specific risk factors on postoperative complications. The significance of tuberculosis, right pneumonectomy, preoperative empyema, and duration of illness longer than 36 months was examined by univariate analyses. RESULTS The most common underlying diseases were nonspecific bronchiectasis (n = 52) and tuberculosis (n = 43). Sixty-day or in-hospital morbidity and mortality rates were 11.9% and 5.9%, respectively. The combined morbidity and mortality rate was significantly higher in patients with preoperative empyema (p < 0.003), tuberculosis (p < 0.03), and right pneumonectomy (p < 0.03). The prevalence of bronchopleural fistula was higher in patients with preoperative empyema (p < 0.02) and patients with tuberculosis (p < 0.03). CONCLUSIONS The postoperative complication rate of pneumonectomy for destroyed lung is acceptably low. However, it is increased by preoperative empyema, tuberculosis, and right-sided resection.
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Affiliation(s)
- S Halezeroglu
- Heybeliada Chest Disease and Chest Surgery Center, Istanbul, Turkey.
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Rosha D, Dandona PK, Jayaswal R. MULTIDRUG RESISTANT PULMONARY TUBERCULOSIS A CLINICAL PROFILE OF 28 CASES. Med J Armed Forces India 1997; 53:159-162. [PMID: 28769476 DOI: 10.1016/s0377-1237(17)30707-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The clinical profile of 28 cases of multidrug resistant pulmonary tuberculosis was studied. All cases were sputum culture proved, with individual patterns of drug resistance. All were exhibited appropriate second-line antitubercular treatment. Seven (25%) patients defaulted, 2 (7.1%) had second line drug failure, but one of these was salvaged and cured after surgery, 3 (10.7%) were cured after drug therapy and 16 (57%) patients were still under treatment, 8 (28.5%) have converted at 6 months.
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Affiliation(s)
- D Rosha
- Classified Specialist (Medicine and Chest Diseases), Army Hospital Delhi Cantt 110010
| | - P K Dandona
- Classified Specialist (Medicine and Chest Diseases), Army Hospital Delhi Cantt 110010
| | - R Jayaswal
- Commandant, Armed Forces Medical College, Pune 411040
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22
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Abstract
Resectional surgery is recommended for patients with localized multidrug-resistant tuberculosis if adequate pulmonary reserve is present. Appropriate drug specific therapy is employed for approximately 3 months preoperatively and for 18 to 24 months postoperatively. Nutrition is emphasized both pre- and postoperatively. Technically, the use of bronchoscopy, double lumen endotracheal tubes, and muscle or omental flaps is stressed. With the above, cure rates should be better than 90%.
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Affiliation(s)
- M Pomerantz
- Division of Cardiothoracic Surgery, University of Colorado Health Sciences Center, Denver, USA
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23
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Wu MH, Lin MY, Tseng YL, Lai WW. Results of surgical treatment of 107 patients with complications of pulmonary tuberculosis. Respirology 1996; 1:283-9. [PMID: 9441117 DOI: 10.1111/j.1440-1843.1996.tb00044.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objective of this study was to evaluate the results of surgical intervention performed on 107 patients with pulmonary tuberculosis complications. Between September 1988 and December 1995, 107 patients underwent a total of 126 operations for major complications of pulmonary tuberculosis. One hundred and twenty-six operations consisted of lobectomies only or plus other lung resections performed in 55 cases, pneumonectomies in 20 cases, segmentectomies in 18 cases, wedge resections in two cases, tracheobronchoplasties in four cases, decortications in two cases, cavernostomies with concomitant muscle transpositions in seven cases, thoracoplasties reserved for the previously failed operations or to be a supplement for pulmonary resections in 18 cases. The operative mortality rate was of 1.8%, and the major complication rate was of 16.8%. Twenty-eight (26.1%) patients with tuberculosis bacilli in sputum before operation have converted except one diabetic patient. In conclusion, surgery is indicated in pulmonary tuberculosis complications that are life-threatening or unresponsive to chemotherapy. Pulmonary resection is the procedure of choice for most cases that require surgery.
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Affiliation(s)
- M H Wu
- Department of Surgery, National Cheng-Kung University Hospital, Tainan, Taiwan, Republic of China
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24
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Massard G, Dabbagh A, Wihlm JM, Kessler R, Barsotti P, Roeslin N, Morand G. Pneumonectomy for chronic infection is a high-risk procedure. Ann Thorac Surg 1996; 62:1033-7; discussion 1037-8. [PMID: 8823086 DOI: 10.1016/0003-4975(96)00596-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to estimate operative risk, and to identify indicators of adverse prognosis, in patients undergoing pneumonectomy for chronic infection. METHODS Twenty-five patients aged 41 +/- 15 years underwent pneumonectomy (three completions) for chronic infection: sequelae of tuberculosis, 15; cystic bronchiectasis, 9; and radiation pneumonitis, 1. Eight patients had aspergilloma (7 after tuberculosis, 1 with radiation pneumonitis). RESULTS Operative mortality was 4%. Operative blood loss was estimated at 1,983 +/- 1,424 mL, ranging from 150 to 5,600 mL. A single patient required reexploration. Eight patients (32%) had empyema, and a further 3 (12%) had bronchopleural fistula; thoracoplasty was required for 10 (40%). Sequelae of tuberculosis heralded increased operative bleeding (t = 2.884; p < 0.005). Incidence of empyema or bronchopleural fistula was increased in patients with sequelae of tuberculosis (chi 2 = 3.896; p < 0.05), patients with aspergilloma (chi 2 = 4.588; p < 0.05), patients in whom the parenchymal cavities were entered (chi 2 = 11.5; p < 0.001), and those in whom blood loss was in excess of 1,000 mL (chi 2 = 4.911; p < 0.05). CONCLUSIONS We conclude that pneumonectomy is a high-risk procedure, especially in patients with sequelae of tuberculosis.
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Affiliation(s)
- G Massard
- Department of Thoracic Surgery, University Hospital of Strasbourg, France
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25
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Ashour M, Al-Kattan KM, Jain SK, Al-Majed S, Al-Kassimi F, Mobaireek A, Al-Hajjaj M, Al-Zear A. Surgery for unilateral bronchiectasis: results and prognostic factors. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1996; 77:168-72. [PMID: 8762853 DOI: 10.1016/s0962-8479(96)90033-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
SETTING King Khalid University Hospital referral centre for thoracic surgery, Riyadh, Saudi Arabia. OBJECTIVE To assess the results of surgery and factors influencing its outcome in patients with unilateral bronchiectasis. DESIGN A retrospective analysis of 40 patients with unilateral bronchiectasis who were operated upon consecutively at King Khalid Hospital, between July 1987 and May 1993. RESULTS Left-sided disease was seen in 60% (n = 24) and right-sided in 40% (n = 16) of the patients. The entire lung was involved in 30% of cases (n = 12). Of these, the left lung was totally involved in 22.5% (n = 9) and the right in 7.5% (n = 3). A lobectomy was performed on 21 patients, basal segmentectomy with preservation of apical segment on 7, and pneumonectomy on 12. There was no operative mortality in this series. Six patients (15%) developed postoperative complications, bleeding (n = 4) and prolonged air leak (n = 2). During an average follow-up period of 30.7 months (+/- 15.4 months), 29 patients (72.5%) were cured and the remaining 11 (27.5%) improved. No patients with Pseudomonas aeruginosa infection (n = 3) or obstructive airway disease (n = 5) were cured (P = 0.02 and P = 0.002 respectively). CONCLUSION Curative resection for selected patients with unilateral bronchiectasis can be performed safely with good results and low morbidity. Pseudomonas aeruginosa infection and obstructive airway disease have an adverse effect on postoperative cure.
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Affiliation(s)
- M Ashour
- Division of Thoracic Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
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26
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Rizzi A, Rocco G, Robustellini M, Rossi G, Della Pona C, Massera F. Results of surgical management of tuberculosis: experience in 206 patients undergoing operation. Ann Thorac Surg 1995; 59:896-900. [PMID: 7695415 DOI: 10.1016/0003-4975(95)00011-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Between January 1978 and December 1990, 206 operations for pulmonary tuberculosis were performed at our institution, a former sanatorium located in northern Italy. Patients with tuberculoma and pleural tuberculous disease were excluded from this series. Cavitary sequelae, bronchiectases, and hemoptysis were the most common indications for resection. Scar cancer and mycetoma were associated diseases in more than 60% of the patients. Healing was achieved in 90% of the patients. Operative mortality was 3%. Overall morbidity was 29.1%. Patient stratification showed that sputum-positive patients had a higher morbidity (30%) and a lower healing rate (86.2%). Before operation, an accurate assessment of both the performance status and the functional reserve of the surgical candidates is emphasized. Despite a high complication rate, aggressive surgical treatment of drug-resistant tuberculosis or its stabilized sequelae is warranted to achieve anatomobiological eradication of the disease, thus avoiding long-term troublesome complications.
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Affiliation(s)
- A Rizzi
- Division of Thoracic Surgery, E. Morelli Regional Hospital, Sondalo, Italy
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27
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Abstract
This explanation of the previously described left bronchus syndrome (Ashour et al., 1990, Thorax, 45:210-212) is based on a prospective study of 17 additional cases with unilateral lung destruction. It is likely that the anatomic peculiarities of the left main bronchus predispose the left lung to more frequent bronchial obstruction and hemodynamic changes than the right. Broncho-pulmonary shunt formation and retrograde filling of the pulmonary artery most likely lead to increased oxygen tension and impaired lymph flow in the entire lung, thus spreading tuberculosis in the lung and ultimately leading to left lung destruction.
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Affiliation(s)
- M Ashour
- Division of Thoracic Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
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28
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Pomerantz M, Madsen L, Goble M, Iseman M. Surgical management of resistant mycobacterial tuberculosis and other mycobacterial pulmonary infections. Ann Thorac Surg 1991; 52:1108-11; discussion 1112. [PMID: 1953131 DOI: 10.1016/0003-4975(91)91289-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Between August 1983 and October 1990, 42 patients with resistant Mycobacterium tuberculosis underwent 44 pulmonary resections. During the same time, 38 patients with mycobacterial infections other than tuberculosis had 41 pulmonary resections. All patients either were poor candidates for medical therapy alone or had existing complications requiring surgical intervention. There was one operative death in each group, both from adult respiratory distress syndrome (postpneumonectomy pulmonary edema). Complications were high, with bronchopleural fistula most commonly occurring after right pneumonectomy in patients infected with Mycobacterium avium with superimposed infection with nonmycobacterial pathogens. In patients undergoing pneumonectomy for resistant Mycobacterium tuberculosis, the left lung was most often resected. It is recommended that if localized disease is present and medical treatment is likely to fail, pulmonary resection should be performed for resistant Mycobacterium tuberculosis infection after 3 months of drug-specific therapy. Muscle flaps were used frequently to avoid residual space and bronchial stump problems. Earlier resection in patients with indolent nontuberculous mycobacterial pulmonary infections is advocated before extensive polymicrobial contamination and right lung destruction.
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Affiliation(s)
- M Pomerantz
- Department of Surgery, Porter Memorial Hospital, Denver, Colorado
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el-Kassimi FA, Abdullah AK, al-Orainey IO, Lambourne A, Bener AB, al-Hajjaj MS. Tuberculin survey in the Eastern Province of Saudi Arabia. Respir Med 1991; 85:111-6. [PMID: 1887127 DOI: 10.1016/s0954-6111(06)80287-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We present the results of the Mantoux test (5 units tuberculin) survey in the Eastern Province of Saudi Arabia, which was conducted as part of a nationwide epidemiological survey of tuberculosis. A total of 1105 subjects were screened out of whom 630 gave a history of BCG vaccination in the past and 363 were BCG-negative. Among BCG-negative children aged 5-14 years, only 5% had a positive Mantoux, a rate lower than most Third World countries but higher than developed countries were under 2% of children are tuberculin reactors. This calls for continuation of free treatment of active cases and increased efforts towards screening of contacts. The results also vindicate the current policy of giving BCG vaccine at birth and probably indicates the need to revaccinate at school leaving age, in accordance with WHO recommendations. Tuberculin reactivity rose steeply with age (32% at age 15-24 and 72% at age 45-64 years) indicating the presence of a large pool of subjects at risk of breaking into active disease. Finally, 71% (201/283) of children aged 5-14 years who had received BCG vaccine at birth, reacted negatively to the Mantoux test. This supports the findings of previous studies that in the majority of subjects, BCG-induced tuberculin sensitivity fades a few years after vaccination.
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Affiliation(s)
- F A el-Kassimi
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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