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Thorac Surg Clin ; 29(1): 47-58, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454921


Multidrug-resistant tuberculosis (TB), extensively drug-resistant TB, and TB-human immunodeficiency virus (HIV) coinfection require a special approach in anti-TB treatment. Most patients cannot be successfully cured by conventional chemotherapy alone. They need a modern approach using minimally invasive therapeutic and surgical techniques. The novel approaches of collapse therapy techniques and minimally invasive osteoplastic thoracoplasty increase the effectiveness of complex anti-TB therapy. Achieving the required selective collapse of lung tissue in destructive pulmonary TB, especially in cases of drug resistance and/or HIV coinfection, leads to bacteriologic conversion, cavity closure, and successful cure.

Colapsoterapia/métodos , Toracoplastia/métodos , Tuberculose Pulmonar/cirurgia , Adulto , Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/cirurgia , Tuberculose Extensivamente Resistente a Medicamentos/terapia , Feminino , Humanos , Pulmão/cirurgia , Masculino , Tuberculose Resistente a Múltiplos Medicamentos/cirurgia , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Tuberculose Pulmonar/terapia
Rev Port Cir Cardiotorac Vasc ; 24(3-4): 139, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29701371


INTRODUCTION: In the 1930-50s, before the introduction of antimicrobial drugs and development of techniques of pulmonary resssection, collapse therapy was the mainstream of treatment for cavitary pulmonary tuberculosis. The methods to achieve the collapse included artificial pneumothorax with air refills, phrenic nerve crush, thoracoplasty and extrapleural plombage. The plombage involves creating a cavity surgically under the ribs in the upper chest wall and filling the space with inert material, such fat, paraffin wax, rubber ballons, oil and methyl-methacrylate (Lucite) balls. The theory behind Plombage treatment is that collapse of the lung promote de healing process and limit the spread of tuberculous infection to other areas of the lung. However, with time, the presence of these materials for a prolonged period of time resulted in complications, such as erosion of major vessels, respiratory insufficiency, infection and migration. METHODS: We present a clinical case of one patient presented with a late complication of lucite ball plombage after 55 years. RESULTS: An 78-year-old man with a history of pulmonary tuberculosis treated with plombage in 1962, ischemic heart disease, hypertension and diabetes mellitus, was admitted to hospital for axillary swelling and pleurocutaneous fistula. The x-ray of the chest and computed tomography showed the apex of the left hemithorax filled with multiple lucite balls, each approximately 2,5cm in diameter, and extrusion of a ball into the axillary fistuluous tract. In this context, the patient complied with multiple antibiotic regimens without success. So, the patient was submitted to surgical extraction of 21 lucite balls, pleurocutaneous drainage and thoracoplasty (7 ribs and the tip of the scapula was remove). The cultures turned out to be negative and the patient made an uneventful recovery with discharge on the 19th postoperative day. Pathologic examination revealed active chronic inflammatory process and negative microorganism screening. CONCLUSION: Despite the rapid decline in collapse therapy since the appearance of antitubercular chemotherapy, there are still such elderly patients who remain asymptomatic while carrying residual plombage material. There is no need for routine ablation of any this material, however if any foreign material becames a source of complication should be extracted without delay. As the number of living patients treated by plombage is attenuating rapidly, fewer and fewer will be seen in the future, and no one is likely to accumulate considerable experience with this problem.

Colapsoterapia , Corpos Estranhos , Toracoplastia , Tuberculose Pulmonar , Idoso , Humanos , Masculino , Polimetil Metacrilato , Tuberculose Pulmonar/terapia
Respiration ; 92(5): 316-328, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27728916


BACKGROUND: The poor treatment outcomes of multidrug-resistant tuberculosis (TB) and the emergence of extensively drug-resistant TB and extremely and totally drug-resistant TB highlight the urgent need for new antituberculous drugs and other adjuvant treatment approaches. OBJECTIVES: We have treated cavitary tuberculosis by the application of endobronchial one-way valves (Zephyr®; Pulmonx Inc., Redwood City, Calif., USA) to induce lobar volume reduction as an adjunct to drug treatment. This report describes the feasibility, effectiveness and safety of the procedure. METHODS: Patients with severe lung destruction, one or more cavities or those who were ineligible for surgical resection and showed an unsatisfactory response to standard drug treatments were enrolled. During bronchoscopy, endobronchial valves were implanted in the lobar or segmental bronchi in order to induce atelectasis and reduce the cavity size. RESULTS: Four TB patients and 1 patient with atypical mycobacteriosis were treated. The mean patient age was 52.6 years. Complete cavity collapses were observed on CT scans in 4 of the 5 cases. All patients showed improvements in their clinical status, and sputum smears became negative within 3-5 months. There were no severe short- or long-term complications. The valves were removed in 3 of the 5 patients after 8 months on average; there was no relapse after 15 months of follow-up. CONCLUSION: These data suggest that endobronchial valves are likely to be useful adjuncts to the treatment of therapeutically difficult patients. More data are required to confirm our findings.

Antituberculosos/uso terapêutico , Broncoscopia/métodos , Colapsoterapia/métodos , Infecções por Mycobacterium não Tuberculosas/terapia , Implantação de Prótese/métodos , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Tuberculose Pulmonar/terapia , Adulto , Idoso , Colapsoterapia/história , Terapia Combinada , Estudos de Viabilidade , Feminino , História do Século XIX , História do Século XX , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax Artificial/história , Pneumotórax Artificial/métodos , Resultado do Tratamento , Tuberculose Pulmonar/história
Rev Pneumol Clin ; 70(4): 240-4, 2014 Aug.
Artigo em Francês | MEDLINE | ID: mdl-24210158


Extensively drug-resistant (XDR) tuberculosis is rare in France. Treatment of XDR tuberculosis is difficult and therapeutic failures are frequent. Surgery is considered as one of the therapeutic options, but is of little use regarding its high morbi-mortality. We report successful treatment of a XDR tuberculosis case with a 21-month antibiotic regimen followed by a surgical collapse therapy because of persistence of a large cavity. No relapse was observed after five years. Surgery in the XDR tuberculosis treatment is discussed.

Colapsoterapia , Tuberculose Extensivamente Resistente a Medicamentos/cirurgia , Antituberculosos/uso terapêutico , Terapia Combinada , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , França , Humanos , Masculino , Adulto Jovem
Pneumologia ; 62(3): 176-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24274003


Plombage thoracoplasty using different synthetic materials was a popular procedure in the management of tuberculosis (TB) in the 1940-50's, being then abandoned. We report an 81-year-old patient who underwent a plombage thoracoplasty with balls at the age of 35; at the moment of examination in our unit, the patient had no chest complaints and no complications related to the surgical procedure was noted. CT scan showed the presence of the plombage material (balls) surrounded by fibrosis and calcifications but without other significant lesions. In our knowledge, this is the first modern detailed imaging description of a plombage thoracoplasty with uncomplicated outcome 46 years after surgery.

Colapsoterapia , Toracoplastia , Tuberculose Pulmonar/diagnóstico por imagem , Idoso de 80 Anos ou mais , Colapsoterapia/métodos , Seguimentos , Humanos , Masculino , Polietilenos , Radiografia , Toracoplastia/métodos , Fatores de Tempo , Tuberculose Pulmonar/cirurgia
Khirurgiia (Mosk) ; (6): 83-7, 2013.
Artigo em Russo | MEDLINE | ID: mdl-23887270


The study aimed to increase the efficacy of the newly diagnosed destructive lung tuberculosis with elimination of bacilli, using the collapsotherapeutic and surgical methods combined with intensive chemotherapy. 334 patients were diagnosed with lung tuberculosis in 2009 in Pensa region. Different methods of collapsotherapeutic and/or surgery were used in 255 (76.4%) patients. The comparative analysis of treatment results with patients, diagnosed with tuberculosis in 2006 and 2007 years, before the introduction of the new treatment modality, showed almost two-fold increase of the efficacy and 3-fold decrease of mortality rate.

Antituberculosos/uso terapêutico , Colapsoterapia/métodos , Mycobacterium tuberculosis/isolamento & purificação , Pneumonectomia/métodos , Tuberculose Pulmonar , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidade do Paciente , Radiografia , Federação Russa/epidemiologia , Escarro/microbiologia , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/mortalidade , Tuberculose Pulmonar/fisiopatologia , Tuberculose Pulmonar/terapia
Acta Med Port ; 26(3): 288, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23815849
Thorac Surg Clin ; 22(3): 257-69, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22789591


Thoracic surgical procedures evolved from surgical management of tuberculosis; lung resections, muscle flaps, and thoracoscopy all began with efforts to control the disease. The discovery of antituberculosis drugs in 1944 to 1946 made sanatorium therapy and collapse therapy in all its forms obsolete and changed thoracic surgery dramatically. Currently, management of tuberculosis is primarily medical, and surgery has a minimal role. Today surgery is usually only performed in patients with tuberculosis when the diagnosis is necessary, who have complications or sequelae of the disease, or who have active disease resistant to therapy.

Procedimentos Cirúrgicos Pulmonares/história , Tuberculose Pulmonar/história , Antituberculosos/história , Colapsoterapia/história , Drenagem Postural/história , História do Século XIX , História do Século XX , Hospitais de Doenças Crônicas/história , Humanos , Parafina/administração & dosagem , Pneumotórax Artificial/história , Toracoscopia/história , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/cirurgia
Thorac Surg Clin ; 22(3): 287-300, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22789594


This review describes diagnosis and management of sequelae of post-primary tuberculosis. It addresses elementary lesions such as bronciectasis, fibrostenosis, cavitation and broncholithiasis, the more complex situation of destroyed lung, and complications such as aspergilloma, hemoptysis and broncho-esophageal fistula.

Pneumonectomia/efeitos adversos , Tuberculose Pulmonar/complicações , Broncopatias/complicações , Broncopatias/etiologia , Broncopatias/cirurgia , Fístula Brônquica/etiologia , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/etiologia , Bronquiectasia/cirurgia , Colapsoterapia/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Hemoptise/etiologia , Hemoptise/terapia , Humanos , Litíase/etiologia , Litíase/cirurgia , Aspergilose Pulmonar/etiologia , Aspergilose Pulmonar/cirurgia , Radiografia , Tuberculose Pulmonar/cirurgia