[Surgical management of pulmonary aspergilloma]. / A tüdöaspergilloma sebészi kezelése.

Between 1983 and 1996., 79 patients'--operated on for pulmonary aspergilloma--clinical data has been analysed. The patients were comprised of 67 males and 12 females, with a mean age of 49 years (range, 24 to 69). Previous lung disorders were observed in about half of the cases (most frequently tuberculosis), while in the other half aspergilloma was developed on the basis of (sub)-acute infections. The most common symptom was haemoptysis (in 45% of cases). Aspergilloma was diagnosed preoperatively (especially by typical chest x-ray) in 62 patients. In the other cases tb, lung cancer, pyosclerosis were suspected. 67 patients underwent pulmonary resection (50 lobectomies, 12 wedge resections, 5 pneumonectomies), 12 cavities were opened by cavernostomy. The postoperative mortality rate was 10.1%. The most frequent complications were bleeding, prolonged air leak, pleural rest space, empyema, bronchial fistula and wound infection, which were occurred in cases with bigger cavities near chest wall. In most cases with pulmonary aspergilloma surgery remains the only effective treatment. Operation has a lower risk in asymptomatic patients, without chest wall involvement. In several cases cavernostomy might be applied successfully.

Surgery for pulmonary aspergillosis.

OBJECTIVE: Surgery of pulmonary aspergillosis followed by higher incidence of post-operative complications. This was the purpose to evaluate our material. METHODS: Between January 1983 and December 1995, the operation was carried out on a total of 84 patients for pulmonary aspergillosis. The patients were comprised of 71 males and 13 females, with a mean age of 49 years (range, 24-71). Previous lung disorders were observed in about half of the cases (most frequently tuberculosis), while in the other half aspergillosis was developed on the basis of (sub)-acute infections. Haemoptysis was present in 48% of patients. The diagnosis was suspected in 47 cases by chest X-ray. Aspergilloma was diagnosed in 50 patients pre-operatively (excluding 12 typical aspergillomas for cavernostomies), with the other pre-operative diagnoses being tuberculosis, lung cancer, pyoscelrosis, etc. RESULTS: In 71 cases pulmonary resection was carried out (52 lobectomies, 13 wedge resections and six pulmonectomies). A total of 12 cavities were opened by cavernostomy and one lung biopsy was performed for disseminated lung disease. The post-operative mortality rate was 9.5%. The most common complications were bleeding, empyema, bronchial fistula and wound infection. In 23 patients with developed prolonged air leak and/or residual air space, complications were observed more frequently in patients with greater cavitation near the chest wall. CONCLUSIONS: In most cases of pulmonary aspergilloma surgical intervention remains the only effective therapy. The operation has a lower risk factor in asymptomatic patients and in patients without pleural or chest wall involvement. In some cases, cavernostomy may be the only remaining surgical choice.

[Central bronchoplastic procedures in Hungary and their outcome (198-1993)]. / Centrális hörgöplasztikai megoldások és eredményeik Magyarországon (1980-1993).

Bronchoplastic procedures involving the main carina are declared as central bronchoplasties. A nation-wide collection of these interventions performed between 1980 and 1993 is analysed. The study is on a total of 154 operations, that were 16 bifurcation resections and 14 stem bronchus resections without parenchyma sacrifice, 61 sleeve or wedge pneumonectomies and 63 tracheal sleeve or wedge right upper lobectomies or carina-plasties. Surgery alone-without multimodality therapy-was the choice of treatment almost exclusively. About 90% of these interventions were performed for highly malignant, histologically peripheral-type, but centrally located bronchial cancers. The hospital mortality and morbidity were found up to 30% (an average of appr. 17%), depending on surgical subsets. Cause of death were surgical at 11% (leakage, anastomotic dehiscence and bleeding) and non surgical at 5.8% respectively. Complications at another 9% were related to surgery. Data of survival suggest, that nodal state is the strongest predictor, but the unfavourable N2 group comprises longer survivors as well. Certain part of this kind of interventions is to be chosen without alternatives (isolated tracheobronchial resections without parenchyma-resection, extended pneumonectomies) while extended lobectomies are alternatives of the extended pneumonectomies in strict conditions. A central bronchoplastic procedure is justified only with hope of complete resection for its high complication rate.

[Surgical treatment of pulmonary metastases from colorectal tumors]. / A colorectalis daganatok tüdömetasztázisainak sebészi kezelése.

Authors analysed 25 colorectal cancer lung metastases. Among them were 13 male 12 female. Ages ranged from 45 to 70 years. The lung nodules were discovered without any symptoms in 19 cases. The disease was localized on the right in 16 patients, in 7 on the left side and 2 others were bilateral. There were 19 solitary and 6 multiple nodules. In two-third of the cases developed metastases within 3 years of colorectal interventions. In 23 cases was performed partial lung resection (wedge or lobectomy) except one pneumonectomy. In one of the patients lung biopsy was just carried out. A case presentation is detailed where the right upper lobe metastasis was resected by videothoracoscopic method. They observed no postoperative mortality. The cumulative five year survival rate is 28% (for solitary lesions 31.6%, for multiple nodules 17%).

[Experience with the surgical treatment of lung cancer in young adults]. / A fiatalkori tüdörák sebészi kezelésével szerzett tapasztalatokról.

There was found 287 patients (7.3%) under 45 years among 3911 operated primary lung cancer between 1970-1980. 36.9% of the diseases was discovered by x-ray screening, 63.1% by complaints. The operability of the patients in the first 3 months (55.8%) after discovery was 81.25% versus 63% later than 3 months. There were distributed by histology 34.1% squamous cell, 31% adenocarcinoma, 31.4% small cell and 3.5% large cell lung cancer. According to the stages there were 17.4% Stage I, 3.5% Stage II, 79.1% Stage III. In the first two stages were the operability rate 100%, in Stage III. 66.1%. There were resected 210 patients (73.2%), and 127 were performed standard, 83 extended resections. The 30-day operative mortality was 5.9%. The 5-year survival time was 26.5% of all patients, 36.2% of resected patients. The rates of 5-year survival showed 39.8% with squamous cell, 22.5% with adenocarcinoma and 13.3% with small cell lung cancer. The author compares the own results to literature, expresses his opinion and standpoint of surgical possibilities for patients with lung cancer under 45.

[Analysis of reoperations after 10,000 lung resections]. / Analyse von Reoperationen nach 10 000 Lungenresektionen.

Within a period of 17 years (1965 to 1981) 10,000 patients underwent lung resections at our dept. A reoperation was required in 392 cases. The reinterventions are classified into three groups: urgent, early and late reoperations. The proportion of urgent and early interventions is 1.2%. 392 cases are also analysed according to the type of complications, character of primary disease, as well as method of treatment. Detailed discussion is provided for the most frequent complications requiring reoperation, such as bleeding, bronchus fistula and pulmonary infarction. Viewpoints of treatment are described and method of prevention are emphasized.