RESUMO
There are few recent prospective studies regarding role of surgery for the treatment and diagnosis of tuberculosis [TB]. We conducted this study in our department and the results are presented. From 20 February 2003 to 21 September 2003, patients who underwent surgery for diagnosis or treatment of TB at the Department of Surgery, Masih Daneshvary Hospital were enrolled in the study. We designed a data form and details of history, radiology, laboratory, bacteriology, operation, complications, histologic studies, as well as results of surgery were recorded. Clinical follow up was scheduled prospectively. Statistical analysis of the data forms were done at the end of the study. During the study period, [7 month] 18 patients enrolled in the study. There were 7 females and 11 males with mean age of 34.16 [range: 12-76 years]. Twenty six operations were performed on 18 patients which are listed below: Thoracotomy 6, surgical bronchoscopy 6, lymph node biopsy 4, laparatomy 2, video assisted thoracoscopy [VATS] 2, chest tube insertion 2, chest wall resection 1, insertion of stent in the right main bronchus 1. Goals of surgery were: diagnosis in 8, diagnosis and treatment in 6, and treatment alone in 4. In all patients goals of surgery were successfully achieved. There was no mortality, but 3 major complications occurred [persistent air leakage in one patient, severe bleeding after right pneumectomy in one patient and occlusion of the stent by granulation tissue in one. All complications resolved with appropriate treatment. Diagnosis of TB was based on histological findings of surgical specimens or isolation of Mycobacterium TB or both. Whenever indicated, surgery has a definite role in the treatment and diagnosis of TB. Results of surgery are good with few complications
RESUMO
Although it is assumed that appropriate care of endotracheal tubes and airway might prevent postintubation airway stenosis [PIAS], but this concept has not been investigated adequately. The purpose of the study was to investigate practical ways for prevention of PIAS in intubated patients. The study was implemented in 3 phases. First we collected information about methods of caring for airways and tubes in intensive care units in Tehran and other cities [control group] and data collection based on filling 10-20 questionnaires in each intensive care unit. Then we assessed patients who had PIAS and had been treated by us during a 6 year period [1994-2000] [study group]. In the final phase, collected data were analyzed and we looked for important pitfalls in caring for airways in intensive care units in our country and also looked for the practical measures to prevent PIAS. In phase I, 341 questionnaires were filled out in 18 intensive care units [12 in Tehran, 6 in other cities]. There were 133 females and 208 males aged 3 month to 98 years [mean 46.1]. Head injury was the commonest cause of intubations in 24%. of patients. Out of 356 tracheal tubes which had been used in these patients, 318 were high volume low pressure types [new tubes], and 32 were high pressure low volume types [old tubes]. In 179 patients [52.4%], there was not any type of care for tubes and airways by attending physicians, in 140 patients [41%] there was some kind of care although not organized or sufficient and in only 21 patients [6.1%] the care was organized and sufficient. Mean time of intubation was 8 days [1-45 days]. Tracheotomy had been undertaken without any established criteria and mostly by junior staff with low experience [usually junior residents]. In phase II, 120 patients were treated for PIAS [36 females, 84 males aging 1-83 years, mean 25.9 years]. Head injury was the cause of intubation in 78 [65%] patients, the site of stenosis was tracheal in 88 and laryngotracheal in 32 patients. More than half of the patients were intubated by inappropriate old tubes. Direct cause of stenosis was the cuff in 92, tip of the tubes in 15 and stoma in 10 patients. In 3 patients more than one factor were the causes. Mean time of intubation was 14.9 days [1-90] and mean length of stenosis was 3.2 cm [1-7]. Caring of tubes and airways was inappropriate and inorganized in all patients. Factors which were statistically different in study and control group were: time of intubation [14.9 day vs 8 days, P=0.000], suicide attempts [12 vs 5, P=0.000], head injuries [65% vs 24% P=0.000], Age [25.9y Vs 46y, P=0.05], using old tubes [50% vs 9% P=0.000], organized caring of tubes and airways [0.0%vs6.1%P=0.000]. The following measures are effective in decreasing the PIAS: decreasing time of intubation, using appropriate tubes, [including PVC tubes], continuous care of airway and tube, cuff monitoring and daily recording of information about tubes and cuff pressure, and special care for intubated young patients who had sustained head injury or had attempted suicide