Recent surgical experience for pulmonary tuberculosis

Whyte, Richard I.; Deegan, S.; Kaplan, David K.; Evans, Cyril; Donnelly, R. J.

doi:10.1016/s0954-6111(89)80213-6

Cited by 11 publications

(5 citation statements)

References 11 publications

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“…As emphasized by other authors, percutaneous needle aspiration appears to be of limited value in these cases. 6 Our series was particular in that operations were also performed for lesions with unusual radiologic and clinical characteristics (solitary adenopathy, interstitial pneumonitis) for which a diagnosis of tuberculosis is not always entertained. These atypical clinical lesions, first reported some 10 years ago, 3 are observed especially in HIV-seropositive patients at an advanced stage of disease (CD4 <200 cells/ram3).…”

Section: Discussionmentioning

confidence: 99%

Surgical management of pleuropulmonary tuberculosis

Mouroux

Maalouf²,

Padovani³

et al. 1996

The Journal of Thoracic and Cardiovascular Surgery

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To define the current indications for surgical management of pleuropulmonary tuberculosis and analyze the results of operative procedures, the records of 59 patients operated on between January 1987 and December 1993 were reviewed. Three patient categories were defined. Group I patients (n = 25) underwent operation for diagnostic purposes: solitary mediastinal node or mediastinal adenopathy associated with pulmonary lesions (n = 10), pulmonary infiltrates (n = 4), pulmonary nodules or masses (n = 10), or chronic pleurisy (n = 1). Postoperative mortality and morbidity rates in this group were both 4%. Group II patients (n = 18) underwent operation for active lesions: intrapulmonary cavity (n = 6), destroyed lung parenchyma (n = 6), or chronic loculated pleural effusion (n = 6). Postoperative morbidity and mortality rates were 16.6% and 5.5%, respectively. Group III patients (n = 16) underwent operation for a complication of therapy or for sequelae of previously "cured" tuberculosis: calcified pyothorax (n = 8), empyema (n = 2), fistulized nodes (n = 2), bronchiectasis (n = 3), or aspergilloma (n = 1). Morbidity and mortality rates in this group were 31.25% and 12.5%, respectively. Surgery continues to have both diagnostic and therapeutic indications for management of pleuropulmonary tuberculosis, despite the morbidity and mortality rates associated with operative procedures.

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Section: Discussionmentioning

confidence: 99%

Surgical management of pleuropulmonary tuberculosis

Mouroux

Maalouf²,

Padovani³

et al. 1996

The Journal of Thoracic and Cardiovascular Surgery

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“…This helps for simultaneous diagnosis of the mass lesion and treatment of tuberculosis. [18] 4. Massive life-threatening hemoptysis or recurrent severe hemoptysis.…”

Section: Lobectomy and Pneumonectomymentioning

confidence: 99%

Management of empyema - Role of a surgeon

Gupta

Sharma

2005

J Indian Assoc Pediatr Surg

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ABSTRACT ABSTRACT ABSTRACTPostpneumonic empyema still remains quite common in developing countries, especially during the hot and humid months. While most cases would respond to antibiotic therapy, needle aspiration and intercostal drainage, few cases require further surgical management. The most common nontubercular etiological agent is Staphylococcus. Tubercular etiology is not uncommon in India, especially due to delayed presentation, multiresistant strains, mismanaged cases, and noncompliance with antitubercular treatment amidst malnutrition and anemia. Clinical symptoms, a skiagram chest followed by thoracentesis are enough for diagnosis. Pleural fluid is usually diagnostic and helps in choosing the appropriate antibiotics. Further investigations and management depends on the stage of the disease. Thoracentesis alone may be sufficient for the exudative phase. In fibrinopurulent stage, a properly sized and well-placed tube thoracostomy with underwater seal is curative in most cases. Interventional radiologists have placed small-bore catheters, specifically directed to the loculated collection and have used fibrinolytics like urokinase, streptokinase, and tissue plasminogen activator (TPA) to break loculations, ameliorate fibrous peel formation, and fibrin deposition. Thoracoscopic debridement and thoracoscopic decortication is an alternative with distinct advantages over thoracotmy and are indicated if there was no response with intercostal drainage procedure. In the organizing stage, a thoracotomy (for decortication) would be required if there is a loculated empyema, underlying lung disease or persistently symptomatic effusions. Timely institution of proper management prevents the need for any surgical intervention and avoids long-term morbid complications. KEY WORDS: Children, Empyema, Surgery Review ArticleEmpyema thoracis constitutes approximately 5-10% cases seen by a pediatrician in India. Culture positivity has decreased significantly over the years as the patients receive antibiotics before presentation.Tube drainage is used in 80-90% of fibro-purulent cases, and is successful in 70-80% cases. At a tertiary center, approximately 10% of cases need limited thoracotomy, and 3-5% require decortication. Surgery is mainly required by children with persistent pleural sepsis after 10 days of tube drainage. Delaying surgery has a significantly higher potential of requiring decortication. DefinitionEmpyema is a localized or free collection of purulent material in the pleural space as a result of combination of pleural dead space, culture medium of pleural fluid, and inoculation of bacteria. It is an advanced parapneumonic effusion.Full text online at http://www.jiaps.com ETIOLOGYThe etiological factors include:

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“…Although surgery is of limited value for the treatment of active tuberculosis, it still plays a complementary role for selected patients [12,16]. In the current study, surgery was indicated in three situations as a method of treatment: drainage of a large pericardial effusion, decortication of a trapped lung, and Decompression of brachial plexus.…”

Section: Discussionmentioning

confidence: 92%

“…Wedge resection provides a definitive diagnosis essential for the further management of old tuberculoma lesions using VATS. Wedge resection usually is curative, although the patient should take antituberculous drugs for 2 to 4 months postoperatively [9,12,16]. Among all the patients there was no perioperative mortality or morbidity and a relatively short hospitalization time.…”

Section: Discussionmentioning

confidence: 99%