[An unusual complication after tracheal resection for cicatricial stenosis]. / Neobvyklá komplikace po resekci prudusnice pro jizevnatou stenózu.

The authors describe the case of a patient where after segmental resection of the trachea on account of cicatricial postcannulation stenosis of the trachea osteomyelitis of the sternum developed with a tracheocutaneous fistula. The cause of the fistula was probably a small dehiscence not detected after operation at the site of the anastomosis with subsequent development of chronic inflammatory changes in the anterior mediastinum and sternum. The authors describe the diagnostic procedure and surgical solution of this uncommon complication.

[Surgical treatment of pulmonary aspergilloma and its complications]. / Chirurgická lécba plicního aspergilomu a její komplikace.

The authors present an account of their experience with the surgical treatment of 44 patients with pulmonary aspergilloma who were treated at the Clinic of Pneumology and Thoracic Surgery of the Third Medical Faculty Charles University in Prague during 1957-1999. The diagnosis of the disease before surgery was made in 39 patients (88.6%), in five patients it was established only after histological examination following resection of the lung. The presence of an aspergilloma was observed most frequently in a TB cavern (n = 30) and in bronchiectatic cavities (n = 9) with the most frequent localization in the upper pulmonary lobes (n = 38) and prevalence on the right side (n = 23). The most frequent symptom of the disease was haemoptysis (n = 39). All patients with the established diagnosis were treated before surgery by antimycotics. Treatment was however not successful and therefore the patients were indicated for surgery. The preoperative diagnosis of aspergilloma was based on X-ray or CT examination, serological examination (positive in 92.8%) and cultivation of sputum (positive in 58.9%). The most frequent surgical operation was lobectomy (n = 20), segmentectomy (n = 9), atypical resection (n = 8), pneumonectomy (n = 3); cavernostomy was performed in four patients. The most serious postoperative complication was a bronchopleural fistula with subsequent empyema (n = 2). During the postoperative period three patients died from respiratory failure associated with bronchopneumonia (6.8%). The authors recommend, based on their own experience, an active approach in patients with pulmonary aspergilloma and consider surgery as the main therapeutic method.