ABSTRACT
BACKGROUND: Treatment outcome with only chemotherapy for multi-drug resistant tuberculosis is usually considered not to be satisfactory. However, the combined therapy of chemotherapy with surgical treatment has been producing higher sputum AFB negative conversion and longer survival rates, and this treatment strategy is expected to be a set-up for the patients with multi-drug resistant tuberculosis. MATERIAL AND METHOD: A retrospective review was performed with the medical records and laboratory findings in 49 patients with multi-drug resistant tuberculosis of 130 patients who underwent pulmonary resection for pulmonary tuberculosis between January 1995 and December 1999 at National Masan Tuberculosis Hospital. RESULT: A mean number of the resistant drugs was 4.5 with a mean age of 35 years. Cavitary lesions on plain chest x-ray were shown in 43 patients of 49(87.8%). Thirty one had positive sputum cultures preoperatively(63.3%). Operative techniques were as follows; 12 pneumonectomies, 28 lobectomies, 7 lobectomies with segmentectomies or wedge resections, one wedge resection and a cavernoplasty. Sputum AFB negative conversion rate was 93.5 % with continuous postoperative chemotherapy. There was no death after operation. Air leakage over a week, postoperative bleeding and wound disruption were developed as postoperative complications. CONCLUSION: We experienced the higher effectiveness of postoperative chemotherapy with pulmonary resection on multi-drug resistant tuberculosis. Although there are several different ideas about operative indications, postoperative drug regimens and length of postoperative medications, pulmonary resection should be considered actively as a effective combination measure with chemotherapy to give a treatment for multi-drug resistant pulmonary tuberculosis.
Subject(s)
Humans , Drug Therapy , Hemorrhage , Hospitals, Chronic Disease , Mastectomy, Segmental , Medical Records , Pneumonectomy , Postoperative Complications , Retrospective Studies , Sputum , Survival Rate , Thorax , Treatment Outcome , Tuberculosis, Multidrug-Resistant , Tuberculosis, Pulmonary , Wounds and InjuriesABSTRACT
Castleman's disease is a relatively rate disorder of lymphoid tissue and poorly understood etiology. The disease may occur anywhere along the lymphatic chain, but is most commonly found as a solitary mass in the mediastinum. The hyaline vascular type represents 91% of Castlemen's disease, and these are most often discovered in the asymptomatic patient on routine chest film. Patients with the plasma cell type often exhibit systemic symptoms, including fever, night sweats, anemia, and hypergammaglobulinemia. Surgical excision effects cure, although resection of the hyaline vascular type may be associated with significant hemprrage owing to extreme vascularity. We recently experienced a case of hyaline vascular type Castleman's disease which was treated by surgical resection through the anterior mini-thoracotomy, and report with its review.
Subject(s)
Humans , Anemia , Fever , Castleman Disease , Hyalin , Hypergammaglobulinemia , Lymphoid Tissue , Mediastinal Neoplasms , Mediastinum , Plasma Cells , Sweat , ThoraxABSTRACT
Although dysphagia in patients with acute leukemia is usually related to reflux esophagitis, infectious esophagitis, chemotherapy1) and leukemic infiltration2), acute esophageal stricture resulting from chemotherapy in the patient with leukemia is very rare. A 40-year-old man with acute myelogenous leukemia was admitted for operation of esophageal stricture which was developed within 1 month of chemotherapy. An esophagectomy and esophagogastrostomy with pyloroplasty was carried out. Histology showed mucosal infiltration of mononuclear cells and transmural fibrosis involving submucosa and the muscle layer.