Surgical intervention for pulmonary tuberculosis: analysis of indications and perioperative data relating to diagnostic and therapeutic resections.

OBJECTIVE: To analyze the data on patients operated on for pulmonary tuberculosis (TB) with (Group I) or without (Group II) a correct TB diagnosis and preoperative anti-TB treatment. METHODS: Between 1980 and 1997, 144 resections for TB (Groups I+II) were performed. The 80 patients in Group I underwent therapeutic resections: 32 cases involved recurrent cavities or tuberculomas, three involved post-TB bronchiectasis, 13 involved progression of cavities or tuberculomas, and 32 involved persistent tuberculomas after 6 months of anti-TB therapy. The 64 patients in Group II were operated on for a suspicion of malignancy in 49 cases, for cavitary lesions with haemophthysis in six cases, for multiple lesions in seven cases, and for recurrent hydrothorax in two cases. RESULTS: Groups I and II included 0 and five pneumonectomies, 32 and 29 lobectomies, 48 and 20 wedge resections, 0 and nine videothoracoscopic biopsies, and 0 and one hilar lymphadenectomy, respectively. In Groups I and II, the mean duration of postoperative hospitalization was 13.2 and 10.4 days, and the frequency of postoperative pneumothorax was 11.25 and 4.6%, respectively. The incidence of bronchopleural fistula was 1.25 and 0%, the mortality was 0 and 3.1%, and the morbidity was 53.7 and 35.9% in Groups I and II, respectively. Two patients with active disease died in Group II. Pathology demonstrated that the frequency of acid-fast bacilli in Groups I and II was 40 and 25%, respectively. CONCLUSIONS: Patients without a correct preoperative TB diagnosis underwent more extensive parenchyma resection. Postoperative complications increased when acid-fast bacilli were present. The lack of preoperative anti-TB treatment did not involve a higher risk of minor complications, but death occurred only in this group.

Thoracic core needle biopsy using ultrasound guidance.

This article demonstrates the usefulness of ultrasound (US)-guided core needle biopsy in the diagnosis of thoracic lesions. Between January 1997 and June 2000, 45 US-guided core needle biopsies were performed in the department of radiology. This method was chosen in every case when the lesion abutted the chest wall. Conventional histologic examinations supplemented by immunohistochemical methods were performed. The location and size of the mass, the number of samplings, the needle size, the histologic results, and any complications were recorded. Twenty-two lesions reached the anterior, six reached the lateral, and 14 reached the posterior chest wall. Biopsies were performed on three masses from the supraclavicular region. The mean diameter was 4.5 cm and the number of passes was 1.8; 18-G, 16-G, and 14-G needles were used in 41, two, and two cases, respectively. In 43 of the 45 cases (95.68%), an exact histologic diagnosis could be provided. In two cases, only necrotic tissue was seen in the biopsy sample. No major complications occurred. Minor complications, including pain and collaptiform weakness, were documented in four patients. Ultrasound-guided core needle biopsy of thoracic lesions is a safe, quick, and accurate method. For diagnosing thoracic lesions, a single sample with an 18-G biopsy needle is sufficient to achieve a final diagnosis when using appropriate histologic methods.

Video-assisted thoracic surgery (VATS) for the treatment of primary pneumothorax (PTX): early indications and "blind resection".

AIM: To report our VATS procedure and results in the treatment of PTX. METHODS: Between 1992-1995, 156 patients with primary PTX were admitted and drained. On the basis of permanent air leak, lung reexpansion and type of PTX, 78 patients were operated on by VATS with early indications. In first episode PTX cases we performed "emergency VATS" in haemopneumothorax and "early or late acute VATS" between 8-48 hours after acute drainage in the others. In recurrent cases "late acute VATS" was done in 24 hours after acute drainage with permanent air leak. We performed "under water-test". In 57 Vanderschueren stage II-III-IV cases the lung disorders and the place of air leakage were resected. In 21 Vanderschueren stage I cases "blind apical resection" was performed. We carried out pleural abrasion, and two pleural drains were inserted. RESULTS: In every "blind resection" case the pathology revealed lung disorders: cystic deformation, fibrosis or inflammation. We had no operative deaths. In 1 case because of intercostal artery bleeding, thoracotomy had to be performed. We had 1 recurrent PTX. There was no late complications. CONCLUSION: The early indications reduced the hospitalization. The "blind apical resections" remove abnormal lung tissue, diagnose the underlying lung disease and the metal staples can cause adhesion reaction in the apex region.

[Value of CT-guided biopsy compared to fluoroscopy-guided transthoracic biopsy and bronchoscopic sampling in the diagnosis of pulmonary nodules]. / CT-vezérelt szövethenger biopszia jelentösége gócos tüdöelváltozások diagnosztikájában--átvilágítás ellenörzésével végzett transthoracalis biopsziával és bronchoscopos mintavétellel összehasonlítva.

CT-guided histological sampling is nowadays used routinely in the differential diagnosis of focal lung diseases with no characteristic morphology. The aim of this study was to determine the value of the method. CT-guided core biopsy was performed in 25 patients with pulmonary nodules. 16 patients underwent bronchoscopy where cytological sampling was also carried out, while 5 patients underwent fluoroscopically guided biopsy. The histological diagnosis resulting from CT-guided biopsy specimens was compared with the findings from the other diagnostic procedures (bronchoscopy or fluoroscopically guided biopsy), with the results of surgery and/or chemotherapy and with the follow-up data. The result of CT-guided biopsy was true in 20/25 and falls in 5/25 cases. Of the 16/25 patients undergoing bronchoscopy, 13/16 gave negative results. In 11/16 cases, the result of the CT-guided biopsy was positive. The fluoroscopically guided biopsy was negative in 4/5 cases, and in 3/5 of these cases the diagnostic CT-guided biopsies proved positive. Our results demonstrate the better diagnostic value of CT-guided core biopsy relative to fluoroscopically guided biopsy or bronchoscopic sampling in those cases where the size and localization of the nodule make it inaccessible with the latter two methods.

[Esophago-pericardial fistula caused by recurrent esophageal tumor]. / Recidív nyelócsótumor által okozott oesophago-pericardialis fistula.

The esophago-pericardial fistula is a rare disease that causes a rather high mortality. Up to now less than 70 cases were published in the literature. The authors report an esophago-pericardial fistula caused by recurrent esophageal tumor one year after resection in the lower third esophagus for esophageal cancer. With conservative treatment the patient was kept alive for a month. No case report can be found in the literature of an esophago-pericardial fistula of the same etiology.

[Subtotal duodenal necrosis as a surgical complication (A case successfully treated with multiple-stage surgery)]. / Subtotalis duodenum elhalás, mint mútéti szövódmény (Többszakaszos mútéttel kezelt gyógyult eset).

A 53 year-old woman was admitted to our Department with serious sepsis, biliary-, fecal peritonitis, and subtotal duodenal necrosis following 5 previous operations. The first surgical intervention ceased the insufficiency of the small intestine anastomosis, and the marsupialization of Vater's papilla was achieved. After the sepsis and peritonitis ceased the authors performed a successful reconstruction. For two and a half years the patient has been free from complaints.