Risk factors associated with surgical intervention in childhood pleural tuberculosis.

Surgical intervention use is common in the management of childhood pleural tuberculosis (TB), however, its associated risk factors remain unclear. Between January 2006 and December 2019, consecutive children patients (≤ 15 years old) who had a diagnosis of pleural TB were included for the analysis. Surgical intervention was defined as debridement (such as breaking loculations), decortication, and thoracic surgery (such as lobectomy or segmental resection). Patients undergoing surgery were included as surgical group, without surgery were classified as non-surgical group, surgical risk factors were then estimated. Univariate and multivariate logistic regression analysis were performed to evaluate the risk factors for surgical interventions. A total of 154 children diagnosed as pleural TB (definite, 123 cases; possible, 31 cases) were included in our study. Of them, 29 patients (18.8%) were classified as surgical group and 125 patients (81.2%) were classified as non-surgical group. Surgical treatments were analyzed in 29 (18.8%) patients, including debridement (n = 4), decortication (n = 21), and thoracic surgery (n = 4). Further multivariate analysis revealed that empyema (age- and sex-adjusted OR = 27.3, 95% CI 8.6, 87.1; P < 0.001) and frequency of hospitalization (age- and sex-adjusted OR = 1.53, 95% CI 1.11, 2.11; P < 0.01) were associated with the use of surgical interventions in children with pleural TB. In China, surgical interventions are still required in a significant proportion of children with pleural TB, and the surgical risk is found to be associated with the frequency of hospitalization and empyema. These findings may be helpful to improve the management of children with pleural TB and minimize the risk of poor outcomes.

EFFECTIVENESS OF EARLY VIDEO-ASSISTED MINI-ACCESS SURGERY IN TREATMENT OF COMPLICATED FORMS OF TUBERCULOUS PLEURISY.

The efficacy and safety of mini-thoracotomy with video tracking in the treatment of complicated forms of tuberculous pleurisy was studied. The study included 78 patients who were treated in the department of extrapulmonary surgery of the Aktobe Regional TB Dispensary in the period from 2016 to 2019. A mini-thoracotomy with video-assistant, and a control (41 patients) group - standard thoracotomy was performed in patients of the main (37 patients) group. Early surgical interventions according to the VATS method in the treatment of complicated forms of tuberculous pleurisy reduced the patient's stay in the ICU by 1.6 times, reduced intraoperative blood loss by 3.3 times, the average duration of surgery 2.5 times, improve the dynamics of the restoration of external respiratory function, reduce the number of postoperative complications 2.1 times. The timing of reexpansion (straightening) of the lung, the elimination of residual cavities and a smaller number of patients with chest deformity indicated a greater efficacy of VATS in comparison with traditional surgical interventions.

Advances and Controversies in Thoracentesis and Medical Thoracoscopy.

Pleural effusions are common and associated with high morbidity and mortality. Whereas thoracentesis can assist in achieving a diagnosis or therapy, advances in education and in the technique may prevent morbidity associated with the procedure. Medical thoracoscopy is often useful for undiagnosed effusions, as well as for therapeutic purposes. There is much enthusiasm about techniques for biopsies that extend beyond forceps. These include biopsies using a diathermic knife as well as cryoprobes. Similarly, adhesiolysis or other techniques to improve therapy in multiloculated effusions using medical thoracoscopy are contested. This review attempts to synthesize recent advances and controversies in thoracentesis and medical thoracoscopy as clinicians head into the next decade of treatment.

Tubercular liver abscess rupturing into the pleural cavity: a rare complication.

Liver abscesses, either pyogenic or amoebic, with or without the involvement of the pleura, are not infrequently encountered in children. Isolated tubercular liver abscess without active pulmonary, gastrointestinal or other clinical evidence of tuberculosis is, however, rare and more so its rupture into the pleura. We report a case of a 14-year-old girl who presented with a liver abscess rupturing into the pleura causing an empyema. Successful management was achieved by intercostal tube drainage and antitubercular treatment.

[Tuberculous Pleurisy Diagnosed by Thoracoscopic Lung Biopsy].

A 44-year-old woman was referred to our hospital with pleural effusion and unknown fever. Mycobacterium tuberculosis was not detected by culture of pleural effusion and sputum and gastric fluid. Pleural fluid was serous and exudative, and cytological examination showed no malignant cells. Computed tomography revealed a little pleural thickening of the right middle lobe and massive pleural effusion. As acute pleurisy was suspected based on the findings of imaging studies, thoracoscopy was performed under general anesthesia. Many yellowish-white, small nodules were seen on the parietal pleura, and white small nodule were seen on the visceral pleura of the right middle lobe. Mycobacterium tuberculosis was not detected by culture and polymerase chain reaction for Mycobacterium tuberculosis( TB-PCR) of parietal pleura and pleural effusion, but was detected by only culture and TB-PCR of visceral pleura, yielding a diagnosis of tuberculous pleurisy. Her symptoms improved and the right pleural effusion decreased with isoniazid (INH), rifampicin (RFP), ethambutol (EB) and pyrazinamide(PZA) treatment.

Two Rare Cases Involving the Spread of Tuberculosis: A Tuberculous Abscess of the Chest Wall Invading the Liver by Way of the Diaphragm.

We herein report two separate cases in which a tuberculous abscess of the chest wall invaded the liver by penetrating through the diaphragm. After confirming the presence of tuberculous lesions in the chest wall and liver, both patients received preoperative anti-tuberculosis (TB) medications for two weeks; after which, the lesions were surgically removed. Following surgery, both patients fully recovered and were asymptomatic, but continued to receive routine postoperative care involving anti-TB medications. Neither patient showed recurrence of TB during a 15-month follow-up period.

[PLEURECTOMY--AS THE LEADING METHOD OF FUNCTIONAL PATIENTS REHABILITATION WITH CHRONIC TUBERCULOUS PLEURISY].

The authors are analyzing the epidemic situation in Ukraine and the epidemiology of chronic tuberculous pleuritis (CTP). They are suggesting 206 pleurectomy results of operated patiens. Restrictive type of venting disorders before surgery occurred are in 26.4% cases, 36.2% and 100%, respectively at 1; 2 and 3 stages of CTP. Reducing the number of patients with this type of violations occurred if 6.9 times, 11.7 times and 3.3 times respectively to operated in case of 1, 2 and 3 stages of CTP. Improvements and other positive functional parameters are submitted. The authors conclusion: pleurectomy is the method of functional rehabilitation at CTP cases.

[Surgery for thoracic tuberculosis]. / La chirurgie dans la tuberculose thoracique.

Tuberculosis is mainly a medical disease. Surgery has been the unique therapeutic tool for a long time before the advent of specific antituberculous drugs, and the role of surgery was then confined to the treatment of the sequelae of tuberculosis and their complications. The resurgence of tuberculosis and the emergence of multidrug-resistant TB combined to immunosuppressed patients represent a new challenge for tuberculosis surgery. Surgery may be indicated for a diagnostic purpose in patients with pulmonary, pleural, mediastinal or thoracic wall involvement, or with a therapeutic purpose (drainage, resection, residual cavity obliteration). Modern imaging techniques and the advent of video-assisted thoracic surgery allowed a new approach of this pathology; the majority of diagnostic interventions and selected cases requiring lung resection can be performed through a mini-invasive approach. Patients proposed for aggressive surgery may be treated with the best results thanks to a good evaluation of the thoracic lesions, of the patients' nutritional, infectious and general status combined with a good coordination between the specialized medical team for an optimal preparation to surgery.

Chest CT findings of pleural tuberculosis: differential diagnosis of pleural tuberculosis and malignant pleural dissemination.

BACKGROUND: The imaging features of pleural tuberculosis (PTB) can be similar to those of malignant pleural dissemination (MPD) with several case reports of CT findings in atypical presentations of PTB. PURPOSE: To describe the computed tomography (CT) features of PTB by comparing these imaging findings with those of MPD and to use the results to differentiate between the two diseases. MATERIAL AND METHODS: The study included 135 patients with PTB and 69 with MPD. The CT images were assessed in terms of the presence, extent, and contour of pleural thickening. Pleural nodules were analyzed in terms of number, size, and location. The CT findings of PTB and MPD were compared. RESULTS: The CT findings of PTB included circumferential pleural thickening (32.6%), mediastinal pleural involvement (31.9%), nodular thickening (8.9%), and pleural thickening >1 cm (2.2%). The CT features of MPD included nodular pleural thickening (56.5%), mediastinal pleural involvement (40.6%), circumferential thickening (23.2%), and pleural thickening >1 cm (7.2%). Comparing PTB and MPD, nodular pleural thickening was observed more frequently with MPD than PTB (P <0.001). CONCLUSION: Nodular pleural thickening is observed in 8.9% of the patients with PTB on chest CT. Comparing PTB and MPD, nodular pleural thickening was the only finding significantly associated with MPD, particularly with nodules >10 mm.

[Experience of various parietal pleurectomies with decortication of lungs in pleural lesions].

During 2006-2012 years different types of parietal pleurectomy (PE) with lung decortication (LD) were performed for 135 patients. Among them: 42 (31.1%)--had standart PE with LD (with performing usual thoracotomy); 34 (25.2%)--had video-assisted thoracic surgery (VATS) PE with LD; 36 (26.7%)--videothoracoscopy (VTS) PE with LD; 23 (17.0%)--standart PE with LD combined with lung resection. Common effectiveness of surgical treatment was 96.3%, mortality level--1.5%, postoperative complication level--8.9%. On the early stage of pleural diseases VATS PE with LD and VTS PE with LD are more preferable. To unclear and difficult cases for performing standart PE with LD we consider that operation should begin by VTS pleural space investigation. In some cases minithoracotomy is possible with performing VATS PE with LD or standart PE with LD (performing usual thoracotomy).

Outcomes following surgery for complicated tuberculosis: analysis of 108 patients.

BACKGROUND: Both incidence and complications of pleuropulmonary tuberculosis (TB) have increased due to recent increase of immunocompromising conditions. The aim of this study was to assess surgical outcomes in patients suffering from complicated pleuropulmonary TB. METHODS: This study included 108 patients with pleuropulmonary TB who underwent surgery. Age, sex, surgical indications, operative techniques, complications, mortality, and morbidity were evaluated. RESULTS: Male-female ratio was 1:11 with mean age of 40 years; 72.2 and 27.8% of the patients underwent surgery due to parenchymal and pleural complications. In the parenchymal group, the most common indication was parenchymal destruction (27.7%) and the most common procedure was lobectomy (50.9%). Out of 20 sputum smear-positive patients, 15 had multidrug-resistant tuberculosis (MDR-TB) and 5 had smear-positive open cavity. Overall 13 of the MDR-TB group and all smear-positive open cavity group became sputum-negative after the surgery. There were 13 patients with undiagnosed masses, among whom 3 patients had adenocarcinoma. In the pleural group, the most common surgical indication was empyema (13.8%) and the most common procedure was decortication and pleurectomy (13.8%). In the bronchopleural fistula group (6.4%), patients showed good results after surgery. There were 19.4% of patients who showed postoperative complications. The most common complication was residual space (5.5%). The main factors leading to major postoperative complications included positive preoperative sputum smear and history of immunocompromising condition. Mortality rate was 2.7%. CONCLUSION: Considering the favorable results achieved by surgery in patients with pleuropulmonary TB, this treatment can be recommended for this group of patients.

[Concurrent interventions for pulmonary tuberculosis complicated by chronic pleural tuberculosis].

Basing on the literature data analysis the authors suppose the insufficient studying of issues, concerning simultant interventions for pulmonary tuberculosis, coinciding with chronic phthysic pleurytis. Surgical treatment of such processes was performed in 181 patients, total pleurectomy--in 172 (95%) of them, partial--in 9 (5%). Various kinds of pulmonary resection as the additional intervention were performed in 172 (95%) patients, extrapleural thoracoplasty--in 15 (8.3%), diaphragmatic plasty--in 15 (8.3%). In early postoperative period the tuberculosis micobacteria have had disappeared in all the patients, permitting to interpret surgical intervention as a sanation one for every patient, and as a socially directed antiepidemic measure.

[Significance of different kinds of correction of the hemothorax volume in surgical treatment of patients with lung and pleura tuberculosis].

In the article, with 72 patients, taken as an example, with tuberculosis of respiratory organs the authors present their clinical experience with using various methods of surgical correction of the hemithorax volume (by means of extrapleural, intrapleural extra-intrapleural correcting thoracoplasties and diaphragm plasty) during performing resections on the lungs and/or pleura. Substantiation is given to the necessity of correcting hemithorax volume in patients with tuberculosis of respiratory organs in performing resections of great volume.

Minithoracoscopy: a complementary technique for medical thoracoscopy.

Minithoracoscopy, currently defined as thoracoscopy with instruments of a diameter between 2 and 5 mm, is part of the general evolution of endoscopy towards mini-invasiveness. Its most relevant indications in the field of medical thoracoscopy are small effusions, pleural effusions in patients with narrow intercostal spaces and suspected tuberculous pleurisy in areas of low incidence of tuberculosis. In general, it increases the versatility of medical thoracoscopy.

[A case of cold abscess of the chest wall due to thoracic drainage for tuberculous pleuritis].

A 56-year-old man underwent thoracic drainage for two weeks for tuberculous pleuritis. He was put on antituberculosis chemotherapy with INH (400 mg), RFP (450 mg), and EB (750 mg). Two months later, he developed an elastic hard subcutaneous mass in the area of the previous thoracic drainage. The mass was 10 cm in diameter, warm, reddish and painful. Chest computed tomography (CT) revealed localized and encapsulated empyema in the left thoracic space and a subcutaneous abscess with rim enhancement in the left lateral chest wall. Magnetic resonance imaging (MRI) demonstrated a dumbbell abscess in the subcutaneous tissue communicating with the empyema through the chest wall. A needle aspiration of the subcutaneous abscess had acid-fast bacilli smears of 2+ and tested positive by polymerase chain reaction (PCR) for Mycobacterium tuberculosis. Thus, he was diagnosed with a cold abscess of the chest, with the empyema in the thoracic space draining into the chest wall through the cut for artificial drainage. Continuation of the anti-tuberculosis treatment and the drainage of the empyema with repeated aspiration reduced the subcutaneous mass, and the clinical and radiological course was favorable. Both the smear and culture for acid-fast test became negative. After completion of chemotherapy, there has been no disease recurrence.