ABSTRACT
Studies in cardiac surgical patients have shown an association of hyperglycemia with increased incidences of sepsis, mediastinitis, prolonged mechanical ventilation, cardiac arrhythmias and longer intensive care and hospital stay. There is considerable controversy regarding appropriate glycemic management in these patients and in the defi nition of hyperglycemia and hypoglycemia or the blood sugar levels at which therapy should be initiated. There is also dilemma regarding the usage of “tight glycemic control” with studies showing confl icting evidences. Part of the controversy can be explained by the differing designs of these studies and the variable defi nitions of hyperglycemia and hypoglycemia.
Subject(s)
Blood Glucose/adverse effects , Blood Glucose/analysis , Cardiac Surgical Procedures/complications , Glycemic Index , Humans , Hyperglycemia/analysis , Hyperglycemia/complications , Hyperglycemia/prevention & control , Hyperglycemia/therapy , Insulin/therapeutic useABSTRACT
BACKGROUND: The objective of this study was to evaluate the immediate and long-term result of resectional surgery in pulmonary aspergilloma. METHODS: Seventy-two patients who underwent pulmonary resectional surgery for symptomatic aspergilloma between 1990 to 2002 were studied. Seventy-nine definitive operations were carried out, including one bilateral lobectomy for recurrent lesions and six thoracoplasties to deal with post-operative complications, besides 21 pneumonectomies and 51 lobectomies. There were 10 bilobectomies as well, included in the lobectomy group. RESULTS: At a mean follow-up of 3.5 years, there were two post-operative deaths and a few complications occurred in 20 cases translating into a morbidity of 28.57% and a mortality of 2.77 percent. Major complications included were persistent air leak, persistent pleural space, empyema, bronchopleural fistula and massive haemorrhage. All events were seen in cases of complex aspergilloma; cases of simple aspergillomas had an uneventful course. CONCLUSIONS: Surgery offers definitive and long-term symptom-free survival in cases of pulmonary aspergilloma at a negligible risk; though almost one-third of those undergoing surgery develop some complications, these are largely manageable.