Medical versus surgical management in patients with bronchiectasis

Recent advancements in the fields of antibiotic therapy, vaccination and general health have decreased the number of surgical interventions for the treatment of bronchiectasis. On the other hand, improvements made in the field of lung surgery prompt some physicians and patients to pursue surgical treatment. We assessed the results of surgical treatment of bronchiectasis and compared them with the results of medical treatment during the same period of time. The study population consisted of all patients who had referred to Masih Daneshvari Hospital and were admitted for treatment of bronchiectasis during a period of seven and a half years [March 1999 to September 2006]. In this descriptive study, surgical or non-surgical treatment was adopted according to the usual indications for the treatment of bronchiectasis. Response to treatment was evaluated by referring to the patient's medical records and out-patient visits. The results were categorized into the following categories: Sputum production and other major signs completely disappeared. Satisfactory: Signs and symptoms did not totally disappear, but the patient was satisfied with the treatment results. Poor: No significant change was seen after the treatment. Technique of surgery was postero-lateral thoracotomy under one lung ventilation and lobar or segmental resections. Medical treatment consisted of physiotherapy, antibiotic administration and vaccination against influenza and pneumococcus. Statistical analysis was performed using Access and SPSS software. Fisher exact and chi square tests were used for qualitative comparison of the results. The mean duration of follow- up was 35.9 months [range 1-96 months]. Eighty-three patients were studied [48 females, 35 males, mean age 37.8 years, range: 8-71 years]; 40 patients underwent surgery while 43 underwent medical treatment. The results of surgery were good in 16[55.2%], satisfactory in 10 [34.5%] and poor in 2 [6.9%] patients. The results of medical treatment were good in 4 [13.8%], satisfactory in 11[37.9%], and poor in 13 [44.8%] patients. Good results were significantly more [P=0.002] and poor results were significantly less [P=0.002] after surgical treatment. In each group, one death occurred during the treatment course. Fourteen patients in the medical group and 11 patients in the surgical group were lost during the follow-up period. When indicated, surgical therapy offers advantages over medical therapy in the treatment of bronchiectasis

History of thoracic surgery in Iran

The field of thoracic surgery is a postgraduate sub-specialty of general surgery and has developed considerably in Iran during the recent decades. Nowadays, thoracic surgery procedures are performed by specialists who have been trained specifically in this field and the quality of care given is in line with international standards. This paper addresses the history of thoracic surgery in Iran. Data were collected through interview of professors, review of archives and personal albums and data present in the council of medical education. Almost 80 years ago, general surgeons used to perform thoracic surgical procedures. But closed-circuit anesthesia was not prevalent in Iran until 1940 and there was no training available in the country for thoracic surgeons. Antibiotics were not available and surgeons were not acquainted with new methods to evacuate the pleural space [chest tube and under water seal drainage]. The only procedures performed were limited to management of emergencies, trauma and abscess drainage. Surgical intervention for treatment of tuberculosis in some patients was one of the factors responsible for development of this field of surgery. General surgeons trained abroad that came back to Iran were familiar with the principles of thoracic surgery and would perform it. In some army medical centers and some centers affiliated to foreign countries, thoracic surgeries were performed by Iranian or foreign physicians. Professor Yahya Adl used to perform thoracic surgeries and taught it to his residents. In 1951, Dr. Sadegh Ghazi and shortly after, Dr. Anwar Shakki started operations in Bou-Ali and Abo-Hossein Hospitals at the request of the TB charity foundation. They were the pioneers who started to perform TB, lung and thoracic surgeries. They were educated in France. The period of 1951-1961 can be considered as the initiation period of thoracic surgery as a subspecialty in Iran. Afterwards, this field was extended to the Masih Daneshvari, Sorkheh Hesar and army medical centers. In early 1950, cardiac and vascular surgeon graduates from the USA and other countries who had returned home established the field of thoracic surgery at Tehran University and other universities. Thus, official training in this field was started. In 1984, thoracic surgery became a postgraduate sub- specialty field approved by the medical education council. Thus far, over 80 physicians have graduated in this field most of which are working in academic fields throughout the country. Tehran, Shaheed Beheshti and Tabriz Universities of Medical Sciences have departments approved for training thoracic surgery fellows. In many universities and several medical centers, trained surgeons have established thoracic surgery wards and are working in this field