[PLEURECTOMY--AS THE LEADING METHOD OF FUNCTIONAL PATIENTS REHABILITATION WITH CHRONIC TUBERCULOUS PLEURISY].

The authors are analyzing the epidemic situation in Ukraine and the epidemiology of chronic tuberculous pleuritis (CTP). They are suggesting 206 pleurectomy results of operated patiens. Restrictive type of venting disorders before surgery occurred are in 26.4% cases, 36.2% and 100%, respectively at 1; 2 and 3 stages of CTP. Reducing the number of patients with this type of violations occurred if 6.9 times, 11.7 times and 3.3 times respectively to operated in case of 1, 2 and 3 stages of CTP. Improvements and other positive functional parameters are submitted. The authors conclusion: pleurectomy is the method of functional rehabilitation at CTP cases.

[Experience of various parietal pleurectomies with decortication of lungs in pleural lesions].

During 2006-2012 years different types of parietal pleurectomy (PE) with lung decortication (LD) were performed for 135 patients. Among them: 42 (31.1%)--had standart PE with LD (with performing usual thoracotomy); 34 (25.2%)--had video-assisted thoracic surgery (VATS) PE with LD; 36 (26.7%)--videothoracoscopy (VTS) PE with LD; 23 (17.0%)--standart PE with LD combined with lung resection. Common effectiveness of surgical treatment was 96.3%, mortality level--1.5%, postoperative complication level--8.9%. On the early stage of pleural diseases VATS PE with LD and VTS PE with LD are more preferable. To unclear and difficult cases for performing standart PE with LD we consider that operation should begin by VTS pleural space investigation. In some cases minithoracotomy is possible with performing VATS PE with LD or standart PE with LD (performing usual thoracotomy).

Unexpandable lung.

Unexpandable lung is a mechanical complication by which the lung does not expand to the chest wall, impeding a normal apposition between the two pleural layers. The main mechanism involved is the restriction of the visceral pleura due to the formation of a fibrous layer along this pleural membrane. This happens because of the presence of an active pleural disease (lung entrapment), which can be resolved if proper therapeutic measures are taken, or a remote disease (trapped lung), in which an irreversible fibrous pleural layer has been formed. The clinical suspicion arises with the presence of post-thoracocentesis hydropneumothorax or a pleural effusion that cannot be drained due to the appearance of thoracic pain. The diagnosis is based on the analysis of the pleural liquid, the determination of pleural pressures as we drain the effusion and on air-contrast chest CT. As both represent the continuity of one same process, the results will depend on the time at which these procedures are done. If, when given a lung that is becoming entrapped, the necessary therapeutic measures are not taken, the final result will be a trapped lung. In this instance, most patients are asymptomatic or have mild exertional dyspnea and therefore they do not require treatment. Nevertheless, in cases of incapacitating dyspnea, it may be necessary to use pleural decortication in order to resolve the symptoms.

Spontaneous haemoptysis as a late complication of plombage in a tuberculosis patient.

The endemic spread of tuberculosis after World War II and the deficiency of appropriate antituberculous drugs had led to a renaissance of the surgical tuberculosis therapy until the early 1950s. Late complications of plombage performed decades before are rare and are mainly related to infection and/or migration of the inserted foreign material and are scarcely recognized today. We report on a 73-year-old male patient, who was admitted to the emergency room of our hospital with acute massive haemoptysis for four days. On physical examination the patient presented with decreased breath sounds over the left lung and an old left-sided thoracotomy scar. Radiological findings and bronchoscopy revealed an empyema and a fistula as late complications 53 years after collapse therapy with insertion of a plombage for the treatment of pulmonary tuberculosis. The endobronchial nylon threads in the left bronchial tree and the fistula ending in the left lower bronchus confirmed our diagnosis. The patient was successfully treated by resection of the affected lower lobe. The present casuistic demonstrates a rare cause of spontaneous haemoptysis: late complications after extrapleural pneumolysis and plombage for cavitary tuberculosis over 50 years after the initial operation.

Manifestaciones pulmonares en pacientes con lupus eritomatoso generalizado / Pulmoray manifestations in patients with wide spread lupus erythematosus

El presente estudio fue realizado en el período comprendido de julio 1998 a enero del 2001. El objetivo general fue conocer la frecuenciade las manifestaciones pulmorares en pacientes con lupus eritematoso generalizado (LEG), desde el punto de vista clínico, radiolólgico, espirométrico y su correlación con otras manifestaciones de actividad de la enfermedad. Se diseño un estudio de casos y controles anidados en una cohorte, se estudiaron 20 casos y 31 controles. La recolección de la información se realizó a través del archivo clínico (expedientes) y registros de la Clínica de Reumatología y el propio paciente. La evaluación se realizó a través de una ficha de recolección de datos, espirometría y pletismografía, radiografía de toráx y el índice Mex-SLEDAI (indice deactividad de la enfermedad en el lupus erimatoso sistémico con modificación simplificada), para evaluar indice de actividad de la enfermedad. Dentro de los resultados más relevantes encontramos lo siguiente: El derrame pleural fue observadoen el 50 porciento de los casos, seguido del infiltrado insterticial con un 25 porciento. Con respecto a las manifestaciones clínicas se encontró artritis en el95 porciento de los casos y 87.1 porciento en el grupo control, estableciéndose asociación estadísticamente significativa (P= 0.001). Se observó anemia en el 70porciento de los casos y 67.7 porciento en el grupo control, acercándose a la significancuia estadística (P= 0.06). En conclusión el derrame pleural (clínico, radiológico) el patrón obstructivo (espirométrico) y la debilidad de los músculosinspiratorios fueron las manifestaciones observadas con mayor frecuencia. Hubo una asociación significativa entre artritis y anemia(actividad), neumonía (complicación) y la presenccia de manifestaciones pulmonares (derrame pleural)...

[Delayed complications after extrapleural pneumonolysis for lung tuberculosis]. / Spätkomplikationen nach extrapleuraler Pneumolyse wegen Lungentuberkulose.

The epidemic spread of tuberculosis after World War II and the deficiency of appropriate antituberculotic drugs led to a renaissance of surgical procedure such as plombage thoracoplasty, initiated in 1891 by Tuffier. Especially in Germany the insertion of paraffin and polyethylene was used in order to achieve an extrapleural pneumothorax in order to collapse the tuberculous cavities in the upper lobes. Due to a high rate of early complications and the assumed cancerogenicity, in a considerable number of cases the material was removed soon after its deployment. In some cases with the filling remaining in place, 30-40 years later infections and/or neoplasms occurred. From 1985 to 1996 in two centers of thoracic surgery 13 patients underwent procedures for removal of filling material. The patients suffered from infections (n = 11), malignant lymphoma associated with infection of the plombage (n = 1) and bronchial carcinoma (n = 1). Technically, we performed the thoracoplasty described by Schede (n = 9). Schede's thoracoplasty in combination with a muscle flap repair (n = 1) or partial resection of the thoracic wall (n = 1), an empyemectomy (n = 1), and an en-bloc pleuropneumonectomy (n = 1). All patients suffered from multiple underlying diseases (COPD, coronary heart disease, diabetes mellitus). However, apart from beside two procedure related deaths (pulmonary embolism n = 1, pneumonia complicated by multi-organ failure n = 1) no other major complications were observed. The plombage material in the case of malignant lymphoma is probably carcinogenic in relation to the time of exposure and should be removed in all cases.

Long-term complications of extraperiosteal plombage.

BACKGROUND: As soon as complications due to migration of extraperiosteal plombage material had been documented, early removal became the rule. Some patients who have escaped this rule may still present with long-term complications. METHODS: Since 1980, 14 patients aged 54 +/- 10 years were admitted 28 +/- 11 years after collapse therapy. Eight presented with signs of infection, 4 with hemoptysis, and 2 with periscapular pain. Vascular erosion, suspected in 3 patients, was demonstrated with angiograms in 1. RESULTS: Ablation of the material was combined with excision of the devitalized ribs in 13 patients. Femorofemoral bypass was used in 2 patients for repair of an aortic erosion. Single ablation of subcutaneously migrated material was performed in a poor-risk patient. Operative bleeding was moderate except in 2 patients; 1 of them died intraoperatively during repair of an aortic erosion. A second patient died postoperatively with a massive pulmonary embolus on day 11. Infection was diagnosed in 8 patients (Mycobacterium tuberculosis, 4; and pyogens, 4). Operative outcome was satisfactory in all 12 operative survivors. A single patient presented with an infected apical space at 1 year and underwent complementary resection of the first rib. CONCLUSIONS: We recommend routine ablation of any residual plombage material whenever operative risk is acceptable because of the high incidence of spontaneous complications.

Surgical treatment of complications 45 years after extraperiosteal pneumonolysis and plombage using acrylic resin balls for cavitary pulmonary tuberculosis.

An infected axillary sinus tract discharged balls made of an acrylic resin consisting essentially of polymerized methyl methacrylate (Lucite) 45 years following performance of an extraperiosteal pneumonolysis and Lucite ball plombage for collapse therapy of right upper lobe cavitary tuberculosis. Surgical extraction of the balls was performed, followed by a partial decortication of the lung and intrathoracic transposition of a pectoralis major muscle flap to fill the residual pleural space. Primary healing was attained, and the patient is well 1 1/2 years after surgery.

Derrame pleural neoplásico (DPN): normatización para su tratamiento / Neoplasic pleural effusion: treatment guide

El derrame pleural neoplásico es una manifestación de enfermedad avanzada y su tratamiento debe dirigirse a mejorar la calidad de vida con baja morbilidad. Se expone la conducta seguida utilizando un flujograma terapéutico para la indicación del sellamiento pleural con tetraciclinas o pleurectomia. Se trataron 32 pacientes con derrame y sintomatología invalidante, en 29 se realizó pleurodesis con tetraciclina con un 97// de respuestas. La hipertemia (28//) y el dolor (24//) fueron complicaciones más frecuentes. En los 3 restantes se efectuó pleurectomía y no recidivó el derrame, pero dos se complicaron (infección de herida y defecto de reexpansión). La supervivencia media fue de 9,2 meses

Derrame pleural neoplásico (DPN): normatización para su tratamiento / Neoplasic pleural effusion: treatment guide

El derrame pleural neoplásico es una manifestación de enfermedad avanzada y su tratamiento debe dirigirse a mejorar la calidad de vida con baja morbilidad. Se expone la conducta seguida utilizando un flujograma terapéutico para la indicación del sellamiento pleural con tetraciclinas o pleurectomia. Se trataron 32 pacientes con derrame y sintomatología invalidante, en 29 se realizó pleurodesis con tetraciclina con un 97// de respuestas. La hipertemia (28//) y el dolor (24//) fueron complicaciones más frecuentes. En los 3 restantes se efectuó pleurectomía y no recidivó el derrame, pero dos se complicaron (infección de herida y defecto de reexpansión). La supervivencia media fue de 9,2 meses