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Between 6/87 and 3/92 22 out of 24 patients were treated (22 by surgery) for pulmonary and pleural Aspergillus disease. The most frequent lung disorder was tuberculosis (9 x), followed by bronchiectasis (5 x), congenital lung cysts (2 x), pneumonia with abscess formation (2 x), sarcoidosis (2 x), and bronchial cancer (4 x). More than half the patients had further severe secondary diseases. 4 patients with "simple aspergilloma" and 5 patients with "complex aspergilloma" underwent lobectomy or segmentectomy without complications or recurrence. Special surgical problems occurred in 13 patients with inflammation involving pleura and chest wall (pleuro-pulmonary aspergillosis, pleural aspergillosis) and invasive lung changes (invasive pulmonary aspergillosis). 7 patients developed an empyema after lung resection, on 4 occasions with bronchopleural fistula. In 4 cases myoplasty, in 2 cases thoracomyoplasty, on 2 occasions completion pneumonectomy with omentoplasty, in one case omentoplasty alone, and on 2 occasions decortication with pleurectomy and lung resection lead to a complete cure. 2 open window thoracostomies were constructed. In 15 cases a single operation was adequate. In 7 patients up to 3 further operations were necessary. 17 patients had haemoptysis, in 10 of these cases it was recurrent. On 7 occasions life-threatening haemorrhage took place, causing death in 2 cases. These were the only deaths resulting from the lung disease. Our results show that aggressive surgical action can be successful. Myoplasty, thoracomyoplasty, and omentoplasty are, in our view, the most suitable measures for healing pleura empyemas and bronchopleural fistulae coincident with pleuro-pulmonary aspergillosis.(ABSTRACT TRUNCATED AT 250 WORDS)

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The aim of the study was to search delayed results and to characterize patients with heterogeneous emphysema which do not improve their quality of life after lung volume reduction surgery. Retrospective analysis was done based on medical history reports from July, 1994, to January, 1998. The surgical lung volume reduction was performed in 81 patients (45 males and 13 females, the average age was 61.9 yrs). Postoperative mortality was 6.9 % (4 patients). Twenty-three patients died within 5 yrs after the intervention; their mean follow-up period was 33.3 months. The average follow-up period was 54.3 months. Functional parameters for patients survived 3 to 5 yrs were: FEV1 50 ± 23.8 %, RV 35.6 ± 29.1 %, RV / TLC 12.3 ± 12 %, the 6-min walk distance was 96.7 ± 62 m. The total 5-year survival was 63.8 %, the survival for the patients having FEV1> 30 % was 83.8 % and that for the patients with FEV1 < 30 % was 50 %. Age and lung function parameters did not differ in survivors and died patients. On the contrary, differences in the blood gas parameters, oxygen therapy time and 6-min walk distance were significant between these groups. Some negative factors were revealed: predominant injury of the lower lung fields, FEV1 < 30 % pred., respiratory failure (PaCO2 ≥ 48 mm Hg), oxygen therapy longer than 6 months, the 6-min walk distance shorter than 80 m.