Regional and Global Lung Function in Unilateral Fibrothorax after Conservative Therapy and Decortication

Abstract

Twenty-six patients suffering from unilateral fibrothorax were investigated before surgery or conservative therapy (decortication, n = 15; conservative treatment, n = 11) and followed up after 24.5 and 18.6 months respectively. Global lung function analysis was done by body plethysmography, ventilation and gas exchange analysis and blood-gas analysis under resting and exercise conditions. Regional lung function analysis included the semiquantitative description of fibrothorax by X-ray photos, and ventilation-perfusion scintigraphy. The functional result of unilateral fibrotic pleurisy is restriction which is also persistent after therapy, but to a lesser degree. This restriction is shown in an increased dead space ventilation as well as in ventilatory inhomogeneities, which causes a distortion of respiratory gas exchange. A decrease of compliance of the lung and chest wall is not measurable after therapy. Conservative treatment leads to a functional improvement to the same degree as decortication in cases of severe preoperative functional disturbances of the operated patients. After a course of 1.5 and 2 years respectively, the reference value has not been reached in either group. The regional pattern after therapy is characterized by a restriction and under-perfusion of the formerly affected site. The regional improvement of lung function is independent of the type of therapy, however, it shows a close correlation to the amount of pleurisy prior to therapy. Conservative treatment is the therapy of choice as long as no complications of insufficient recovery impede the course of the illness.

Decortication of the Lung

“…Here it must be mentioned, however, that the values rose by a relatively moderate degree; in the best subgroup the average improved function was only 13.8 % above preoperative values. These results correlate with those of Petro and co-workers (6) . One the othe r hand, we could not identify any decrease in pulmonary functioning within the first 3 postoperative mont hs (Fig.…”

Lung Function in Patients Operated for Chronic Pleural Empyema

“…In our series six patients had very low values for both VC and FEV1 and the majority did not reach the lowest reference value of FEV1 for a healthy population. Konietzko et al showed in his study that gradual improvement of FVC can be observed within two years after treatment for CPE [6,19]. Similarly to Toomes et al [8] and contrary to other series [7] we did not observe any influence of the time of decortication on the spirometric values.…”

Early Functional Results of Surgery for Organizing Phase of Empyema Thoracis in a High Output Centre for Thoracic Surgery

“…Earlier studies have shown arguably, that there is no significant improvement in the functional status (spirometry results) of chronic ET patients undergoing PD [7,8]. Recent studies have, however, supported the importance of PD as the cornerstone intervention in the effective management of chronic ET both in tuberculous and non-tuberculous patients [9][10][11][12][13][14][15].…”

“…In the past, studies have reported no improvement in functional outcomes in terms of spirometry for patients undergoing PD [7,8]. Recent studies have supported the importance of PD in terms of improvement of spirometric parameters in terms of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) [9][10][11][12].…”