Risk factors associated with postoperative respiratory failure in tuberculous empyema patients.

ABSTRACT: Our objective was to identify independent risk factors for predicting which patients in the Chinese population would likely develop respiratory failure.A descriptive analysis was conducted of demographic and clinical data of patients with tuberculous empyema (TE) admitted to the Beijing Chest Hospital, Capital Medical University between January 2001 and January 2020. Risk factors associated with postsurgical respiratory failure in TE patients were identified based on results of analyses based on univariable and multivariable logistic regression models.A total of 139 TE patients who underwent surgical treatment in the Beijing Chest Hospital, Capital Medical University from January 2001 to January 2020 were enrolled in this study. Cases included 109 male and 30 female patients, with an overall mean age (range 17-73) of 39.3 years. Of 139 TE patients, 26 (18.7%) experienced respiratory failure after surgery. Among significant risk factors for postsurgical respiratory failure, intraoperative blood loss volume greater than 1000 mL had the highest odds ratio value of 6.452. In addition, a pathologic preoperative pulmonary function test result showing a high partial pressure of carbon dioxide level was an independent risk factor for respiratory failure. Moreover, the presence of tuberculosis lesions in the contralateral lung was another significant risk factor for respiratory failure, as determined using multivariate analysis.Respiratory failure is a predominant complication experienced by TE patients undergoing surgery. High intraoperative blood loss, high preoperative high partial pressure of carbon dioxide level, and tuberculosis lesion(s) in the contralateral lung of TE patients were associated with increased risk of postoperative respiratory failure.

Evaluation of extra pulmonary tuberculosis in Bangladeshi patients.

This is a retrospective study of 200 cases of Extra Pulmonary Tuberculosis (EPTB) and this study was conducted from January 2010 to July 2011 at Sheheed Ziaur Rahman Medical College Hospital and TB clinic, Bogra, Bangladesh. Data were collected from the Hospital records on demographics, clinical, laboratory and treatment out come status. The incidence of EPTB was high in 16-45 years age group (55%), mean age was 35.67±14.6 years and predominated in Female patients (60%). Extra pulmonary Tuberculosis (EPTB) still constitutes an important clinical problem in Bangladesh. The objective of this study was to evaluate the demography and features of patients with EPTB in our high burden tuberculosis country. Lymph nodes are the most common site of involvement (50%) followed by tubercular pleural effusion (15%) and virtually every site of the body can be affected by tuberculosis. Since the clinical presentation of EPTB is atypical, tissue samples for the confirmation of diagnosis can sometimes be difficult procedure and conventional diagnostic method have a poor yield, so the diagnosis is often delayed. EPTB constitutes about 15-20% of all cases of TB patients and it is more common in low socio-economic group (60%) Biopsy and/ or surgery, FNAC is required to procure tissue samples and pus and/or aspirated fluids are required for diagnosis and for managing complications. The EPTB usually responds to standard anti tubercular drug regimen.

Lung cancer in patients with chronic pyothorax.

BACKGROUND AND OBJECTIVE: The aim of this study was to describe the features of lung cancers associated with chronic tuberculous pyothorax. METHODS: Clinicopathological data from patients with coexisting lung cancer and chronic latent pyothorax caused by tuberculosis (TB) were analysed, and cancer tissue samples were investigated for the presence of Epstein-Barr virus. RESULTS: Twelve patients were identified, and all had a history of tuberculous pleuritis or surgical intervention for TB. The interval between the onset of TB and lung cancer was more than 30 years in nine patients and the most frequent symptom was chest pain (six patients). All cancers were in the ipsilateral lung to the pyothorax, and in nine of the 12 patients the cancers were located adjacent to the pyothorax. In situ hybridization analysis for Epstein-Barr virus-encoded small RNA failed to show positive signals in any of the six cancer tissues examined. CONCLUSIONS: Lung cancer associated with chronic pyothorax always developed in the ipsilateral lung to the pyothorax, and there was no evidence for the presence of Epstein-Barr virus in the cancer tissues examined.

[Use of endobronchial valve in postresection empyema and residual cavities with bronchopleural fistulas].

The results of treatment are analyzed in 78 patients with brochopleural fistilas after lung surgery. A method for imaging the draining bronchus under endoscopic guidance, by using the foamed dye administered into the residual cavity, has been developed. A valvular bronchial blocker for abolishing the function of bronchopleural fistular inserted into the lobular and segmental bronchus at bronchoscopy was designed and clinically tested. This procedure allows resurgery to be avoided in 91.7% of cases.

[Clinical features of tuberculous pleurisy in viral hepatitis and HIV infection at penitentiaries].

In 1999 to 2005, the penitentiaries of Saint Petersburg and the Leningrad Region saw a drastic (almost 30-fold) increase in the number of patients with tuberculous pleurisy concurrent with viral hepatitis and HIV infection. The convicts with concomitant stages IVa, IVb, and IVc HIV infection currently fall ill with tuberculous pleurisy more frequently. In patients with viral hepatitis concurrent with HIV infection, tuberculous pleurisy develops and runs more gravely in proportion to the number of mixed infections than in those without infectious comorbidity. The patients with tuberculous pleurisy concurrent with viral hepatitis and HIV infection show a preponderance of acute progressive pleurisy with the frequently observed tuberculosis generalization and high mortality rates.

Clinical characteristics and outcomes of empyema thoracis in 117 patients: a comparative analysis of tuberculous vs. non-tuberculous aetiologies.

BACKGROUND: Empyema thoracis remains a major problem in developing countries. Clinical outcomes in tuberculous empyema are generally believed to be worse than in non-tuberculous aetiologies because of the presence of concomitant fibrocavitary parenchymal disease, frequent bronchopleural fistulae and poor general condition of patients. We performed a prospective study over a 2-year period with the objective of comparing the clinical characteristics and outcomes of patients with tuberculous vs. non-tuberculous empyema. METHODS: Prospective study of all cases of non-surgical thoracic empyema seen at a tertiary care centre in North India over a 2-year period. A comparative analysis of clinical characteristics, treatment modalities and outcomes of patients with tuberculous vs. non-tuberculous empyema was carried out. Factors associated with poor outcomes were analysed using multivariate logistic regression. RESULTS: One hundred and seventeen cases of empyema were seen in the study period of which 95 had non-tuberculous and 41 had tuberculous empyema. Malnutrition and bronchopleural fistulae (BPF) were more common and duration of symptoms longer in the tuberculous empyema group. Time to resolution of fever, duration of pleural drainage and pleural thickening >2 cm were significantly greater as well. Eight (10.5%) patients with non-tuberculous empyema and four (9.8%) with tuberculous empyema succumbed. Presence of a BPF was significantly associated with poor outcomes on multivariate logistic regression analysis. CONCLUSIONS: Tuberculous empyema remains a common cause of thoracic empyema in India though it ranked second amongst all causes of empyema after community acquired lung infections in this study. Tuberculous empyema is associated with longer duration of symptoms, greater duration of pleural drainage and more residual pleural fibrosis.

Pleural tuberculosis.

Pleural effusions in tuberculosis are commonly seen in young adults as an immunological phenomenon occurring soon after primary infection. However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease. Pleural biopsy for histology and culture is the mainstay of diagnosis with closed needle biopsy adequate in the majority of cases. Techniques such as PCR of biopsy specimens and the role of pleural fluid ADA are still being evaluated as a diagnostic aid. Tuberculous empyema is less commonly seen in the western world and the diagnostic yield from pleural fluid here is greater than in "primary" effusions. Treatment with appropriate antituberculous chemotherapy is generally successful though there is currently insufficient evidence to recommend the routine use of corticosteroids in this condition.

[The efficiency of complex treatment of tuberculous spontaneous pneumothorax and its complications].

The incidence of spontaneous pneumothorax and pleural empyema and the outcomes of their medical and surgical treatments in 1982 to 2003 were studied in 541 patients with destructive pulmonary tuberculosis. In the past decade, the incidence of spontaneous pneumothorax and pleural pneumonia has increased from 2.6 to 12.1% due to the aggravated epidemic situation and the worse structure of pulmonary tuberculosis. The clinical severity of the disease and the extent of a pulmonary-and-pleural process did not allow radical reparative operations to be performed in 11.3%. Complex medical and surgical treatment for pulmonary tuberculosis complicated by spontaneous pneumothorax and pleural empyema could yield good and fair results in 71.5% of patients with severe pulmonary-and-pleural comorbidity despite high hospital mortality (17.2%).

[Long-term results of treatment in patients with pulmonary tuberculosis, by using main bronchial occlusion, impact of pulmonary hemodynamics].

The outcomes of treatment were analyzed in 108 patients with disseminated and complicated pulmonary tuberculosis. The patient's mean age was 38.3 +/- 4.2 years. Transsternal occlusion of the main bronchus was performed. Concurrently, the following draining interventions were made: thoracostomy, cavernotomy, cavernostomy, or stepwise thoracoplasty. Nine (8.3%) patients intraoperatively died; 20 (18.5%) patients developed recanalization of the main bronchus. Twenty-four (22.2%) patients had a progressive tuberculous process in the contralateral lung. The operation was effective and ensured recovery or stabilization of the tuberculous process in 55 (50.9%) patients. After surgery, dilatation of the pulmonary trunk was 2.8 cm; stroke volume in the pulmonary trunk was 42.4 ml and its distribution along the branches was 83% on the side of the least affection and 17% on that of the greatest affection. At diastole, there was a retrograde blood flow in the branch of the pulmonary artery of the collapsed lung in the volume of 61% of the systolic stroke volume. The calculated pulmonary pressure was 52 mm Hg. Transsternal occlusion of the main bronchus, involving stepwise draining interventions, should be considered the method of choice in treating these patients.

Miliary tuberculosis as a cause of acute empyema.

Adult respiratory distress syndrome (ARDS) and sepsis are known, life-threatening complications of miliary tuberculosis. This report describes a patient with miliary tuberculosis who rapidly developed an acute tuberculous empyema. She had a fulminant course culminating in ARDS, sepsis and subsequent death. This case highlights the rare association of acute empyema with miliary tuberculosis.

[Nonspecific pleural exudate and pleural layer injury: epidemiologic, etiologic and patho-anatomic aspects]. / Nespetsificheskii plevral'nyi vypot i porazhenie listkov plevry: épidemiologicheskie, étiologicheskie i patologoanatomicheskie aspekty.

Modern epidemiologic data about prevalence and etiology of the nonspecific pleural exudates syndrome were suggested in patients of phthisio-pulmonary specialty, and also its dynamic during last 7 years. The main trends of change of frequency of the different etiology pleural exudates occurrence taking into account the patients gender were determined. The most wide spread forms of pleural exudates: parapneumonic, purulent, reactive, phthisic, cardiogenic were detailed.

[Risk of increase in nosocomial infections incidence in a surgical clinic. A case-control study]. / Riscul cresterii incidentei infectiilor nosocomiale într-un serviciu de chirurgie. Studiu caz-control.

The complex activities of epidemiological surveillance of nosocomial infections (NI) have, among the main objectives, the identification of the causes and the assessment of risk factors. In 2002, the Clinic Hospital of Pneumology Iasi had 220 beds and was divided into the following units: Pneumophtisiology Unit (PPU), Thoracic Surgery Unit (TSU) and Intensive Care Unit (ICU). The global incidence of NI was of 0.85%. The incidence of cases with NI in the TSU and ICU increased to 5.39% in the interval April-June 2002 so that urgent epidemiological measures were applied to limit the phenomenon. After that, a case-control study was proposed in order to identify and assess the risk levels. The retrospective study met the methodological conditions such as case definitions for NI and post-surgical NI, for extrinsic and intrinsic risk factors, the selection of cases according to inclusion and exclusion criteria, the formation of the representative sample. The study included 16 patients with pleural NI and 55 controls with the pleurotomy performed between April-June in the TCU, as a common feature. The factors that increased the probability of a post-surgical NI development were: the external pleural drainage maintained more than 30 days (OR = 185.5; p < 0.0001 for CI = 95%), tuberculosis as the most important associated disease among the patients' pathological history records (OR = 28.0; p < 0.0001; CI = 95%); the antibiotherapy with multiple associations (OR = 3.30; p < 0.04; CI = 95%). The conclusions underlined that the patients suffered from tuberculosis since the very admission, which need pleurotomy have an increased risk to develop a NI. This fact should require an appropriate epidemiological, clinical and microbiological surveillance and the empirical antibiotic strategy or that conducted by the antibiogram results has to be performed adequately, according to the operative recommendations.

[Tuberculous pyothorax. 28 cases]. / Le pyothorax tuberculeux. 28 cas.

OBJECTIVES: Despite the efforts in the fight against tuberculosis (Tb) and the decrease in its incidence, severe forms persist. Tubercular pyothorax (TP), which was a frequent complication, is still difficult to treat. We studied the epidemiological, diagnostic, therapeutic and progressive aspects of this particular localization. METHODS: Retrospective study collecting all the TP reported between 1990 and 1999 in the department of pneumology in Ariana. The inclusion criterion was any patient presenting with pleural-parietal empyema of tubercular origin. We excluded patients presenting with negative bacilliferous pyothorax cultures. RESULTS: Twenty-eight cases of TP were retained among 875 cases of tuberculosis, i.e., 3.2%. The mean age of patients was of 44 years (range: 15-75) and they were moderate smokers: 27 PA. Infectious fever concomitant to a pleural syndrome was the typical clinical manifestation. In some patients empyema (3 cases) or cutaneous fistula (2 cases) were the circumstances in which the disease was discovered. Thoracic imaging is a very useful tool: standard radiography, tomodensitometry and magnetic resonance imaging permit analysis of the pleural wall and cavity. In 9 cases, pneumothorax was concomitant. A co-infection with pyogenic germs was present in 4 patients. Treatment of TP is triple; it associates specific poly-chemotherapy, thoracic draining and respiratory physiotherapy. The progression was satisfactory in the recent forms concomitant to a bacilliferous pulmonary Tb. Complications such as pleural-pulmonary after effects are inherent to the severe forms. Surgery was necessary for 9 patients (5 drainages, 2 rib resections and 2 decortications). CONCLUSION: TP is a menace for functional prognosis. Treatment is double: early, curative and effective, and preventive of Tb and its risk factors.

Childhood chronic pleural empyema: a continuing surgical challenge in developing countries.

BACKGROUND: Surgical treatment may be necessary in childhood chronic pleural empyema. METHODS: Over a 21-year period 642 children with pleural empyema were hospitalized and 104 of them underwent surgical treatment. The records of the children who underwent surgery for the treatment of empyema were retrospectively reviewed to describe the role, indications, and results of surgical treatment of childhood chronic pleural empyema. RESULTS: Etiologic diseases or conditions leading to empyema were pneumonia in 69 patients, tuberculosis in 13, hydatid cyst in eight, postpneumonectomy empyema in five, and other causes in nine patients. Indications for surgery were severe pleural thickening in 54 cases (51.9%), trapped lung in 36 cases (34.6%), loculated empyema in eight cases (7.7%) and broncho-pleural fistula in six cases (5.8%). Operations performed were decortication in 90 patients, pulmonary resection and decortication in seven, muscle flap closure in five, and pneumonectomy in two. Success rates in the treatment of nonspecific and tuberculous empyema were 93% and 54%, respectively. CONCLUSIONS: Surgical treatment is still necessary in childhood pleural empyema in developing countries, and success rates are very high in nonspecific pleural empyema and acceptable in tuberculous pleural empyema.

Thoracic empyema in Dar es Salaam, Tanzania.

A review of 114 thoracic empyema cases attended in the thoracic unit of the Muhimbili Medical Centre from July 1986 to July 1990 is presented. 87.7% of the cases were males. Their ages ranged from 9 to 79 years with a mean of 32 years. Tuberculosis was the major cause accounting for 63.2% of all the cases. 53.4% of the patients underwent either open chest drainage decortication or thoracoplasty. The duration of hospital stay ranged from 2-8 months with a mode around 3.5 months. A 7% mortality was noted.

[Treatment of empyema and pyopneumothorax of infectious origin and chronic evolution by drainage-lavage with iodized polyvinylpyrrolidone]. / Traitement des pyothorax et pyopneumothorax d'origine infectieuse d'évolution chronique par drainage-lavage à la polyvinylpyrrolidone iodée.

Thirty five patients, twenty nine men and six women with a mean age of twenty six and suffering from a pyothorax 23% or a pyopneumothorax 77% of whom 41% had a bronchopleural fistula on chronic evolution (greater than one month before drainage), had been treated using drainage and lavage with iodised polyvinylpyrrolidine without local or general antibiotics. This treatment enabled thirty four patients to be cured with some moderate radiological sequelae, a 50% restitution "ad integrum". The importance of the sequelae was correlated with increased aged (P less than 0.001), a delay before drainage (P less than 0.001) and a prolonged duration of drainage (P less than 0.01), to multiple organisms (P less than 0.01) and the presence of a pneumothorax (P less than 0.02) and to a tuberculous origin of the effusion (P less than 0.01). These two latter factors were the cause of a prolongation of the duration of drainage (P less than 0.01). Tuberculous patients who on average were older (P less than 0.05) and had a prolonged period of drainage (P less than 0.01) presented with major immediate radiological sequelae (P less than 0.01). In conclusion the technique of drainage using iodised polyvinylpyrrolidine gave excellent results in cases of non-tuberculous pyothorax in young subjects, but gave less impressive results in subjects suffering from tuberculosis, because of the significant radiological sequelae.