ABSTRACT
BACKGROUND: We examined the effect of exogenous factor XIII (FXIII) concentrate in patients with prolonged air leak (PAL) after pulmonary lobectomy for non-small cell lung cancer. METHODS: We performed a retrospective analysis of 297 patients who underwent pulmonary lobectomy between July 2007 and March 2014: 90 had an air leak on the first postoperative day, which resolved spontaneously within 5 days in 53 cases (SR group). FXIII concentrate was administered to the remaining 37 patients (PAL group) for 5 days. This group was subdivided into those in whom the air leak resolved during FXIII treatment (EF group) and those who needed additional intervention (inEF group). The clinical and perioperative characteristics of the groups were compared. RESULTS: Although plasma FXIII activity did not differ significantly between the SR and PAL groups before surgery or on the fifth postoperative day, the proportional perioperative fall in FXIII activity was significantly greater in the SR group (33%) than the PAL group (22%, p = 0.044) and inEF group (14%, p = 0.048). On the fifth postoperative day, FXIII activity was significantly lower in the EF group than in the inEF group (74% versus 91%, p = 0.030). The optimal cut-off point for postoperative plasma FXIII activity to distinguish between the EF and inEF groups was 86%. CONCLUSIONS: Insufficient plasma FXIII consumption and lower postoperative FXIII activity may play a role in the resolution of PAL, and exogenous FXIII concentrate may be an effective, safe and non-invasive treatment.
Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Factor XIII/therapeutic use , Lung Neoplasms/surgery , Pneumonectomy/adverse effects , Respiratory Tract Fistula/drug therapy , Respiratory Tract Fistula/etiology , Adult , Aged , Aged, 80 and over , Case-Control Studies , Factor XIII/metabolism , Female , Humans , Male , Middle Aged , Respiratory Tract Fistula/blood , Retrospective Studies , Treatment OutcomeABSTRACT
Wegener's granulomatosis (WG) is characterized by systemic granulomatous necrotizing vasculitis, primarily affecting the respiratory tract and kidneys. We describe a rare case in a 28-year-old woman with WG, presenting with a massive lateral pleural effusion, accompanied by an aseptic bronchopleural fistula formed during immunosuppressive treatment. Although any organ can be involved in WG, only left pleuritis and a purpuric lesion on the neck were detected in this case. The pleural effusion and bronchopleural fistula resolved following immunosuppressive treatment for six months. Thus, WG should be considered in the differential diagnosis of a massive pleural effusion, and fistula formation is a possible complication of treatment. Moreover, immunosuppressive treatment was sufficient to resolve the massive pleural effusion and fistula formation without infection (120 words).
Subject(s)
Bronchial Fistula/etiology , Granulomatosis with Polyangiitis/diagnosis , Pleural Diseases/etiology , Pleural Effusion/etiology , Respiratory Tract Fistula/etiology , Adult , Biopsy , Bronchial Fistula/diagnosis , Bronchial Fistula/drug therapy , Female , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/drug therapy , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Pleural Diseases/diagnosis , Pleural Diseases/drug therapy , Pleural Effusion/diagnosis , Pleural Effusion/drug therapy , Positron-Emission Tomography , Respiratory Tract Fistula/diagnosis , Respiratory Tract Fistula/drug therapy , Skin/pathology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Pyriform sinus fistula (PSF) is a rare branchial pouch anomaly. Circumferential chemocauterization of the opening with trichloroacetic acid (TCA) is a simple, reliable treatment of choice with little morbidity. However, we experienced two cases of vocal fold immobility after chemocauterization of the PSF opening with TCA. Vocal fold mobility recovered spontaneously within 8 weeks in both cases. Herein, we report these cases in addition to a review of the literature.