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Objective:To investigate the surgical procedure and outcome of uniportal thoracoscopic decortication in the treatment of chronic tuberculous empyema.Methods:From March 2019 to December 2019, the clinical data of 53 patients with chronic tuberculous empyema, who underwent uniportal thoracoscopic decortication in the Surgical Department of Wuhan Pulmonary Hospital were retrospectively analyzed. There were 40 males and 13 females. Age ranged from 16 to 69, averaged 36 years old.36 cases were on the right side and 17 cases on the left side, 38 cases were complicated with pulmonary tuberculosis. All cases had been diagnosed as tuberculous empyema by pathogeny and pathology test in preoperative or postoperative, and received tuberculosis management treatment between 2 and 12 months prior to surgery.The surgical procedure and clinical efficacy of uniportal thoracoscopic decortication were expounded in treatment of chronic tuberculous empyema.Results:Among the 53 patients, 49(92.45%) cases underwent uniportal thoracoscopic decortication, and 4(7.55%) cases changed to thoracotomy. The duration of surgery was 100-370 min, mean(234.53±56.06)min. Intraoperative hemorrhage was 50-1 400 ml, median value 300(175.0, 402.5)ml. Catheter retention time was 3-22 days, median value 8(6.00, 11.25)days. The incidence of surgical complications was 1.89%(1/53), the cure rate was 92.45%(49/53).Conclusion:If the perioperative evaluation and treatment are appropriate, and the operator is experienced, the uniportal thoracoscopic decortication is feasible, safe and effective in the therapy of chronic tuberculous empyema.
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@#Objective To explore the value of the single-direction lobectomy in the treatment of complicated pulmonary tuberculosis. Methods A retrospective analysis was performed on 88 patients with complicated pulmonary tuberculosis who received lobectomy in our hospital from 2017 to 2019. There were 64 males and 24 females, with an average age of 21-70 (47.67±13.39) years. According to the surgical procedure, patients who received single-direction lobectomy were divided into a single-direction group (n=32), and those who received traditional lobectomy were divided into a control group (n=56). Results The two groups had no statistical differences in gender, age, primary disease and complications, lesion morphology, clinical symptoms, operative site, interlobitis adhesion or hilar mediastinal lymph node calcification (P>0.05). Operation time [210.0 (180.0, 315.0) min vs. 300.0 (240.0, 320.0) min], intraoperative blood loss [200.0 (100.0, 337.5) mL vs. 325.0 (200.0, 600.0) mL], postoperative lung air leak time [3.0 (2.0, 5.0) d vs. 9.0 (6.8, 12.0) d] and the postoperative hospital stay [11.5 (8.0, 14.8) d vs. 18.0 (14.0, 22.0) d] of the single-direction group were less or shorter than those of the control group (P<0.05). There was no statistical difference between the single-direction group and the control group in the incidence of surgical complications [1 patient (3.12%) vs. 10 patients (17.86%)] or the cure rate [32 patients (100.00%) vs. 54 patients (96.43%)]. Conclusion The single-direction lobectomy can reduce lung injury and bleeding, shorten the duration of operation and accelerate the postoperative recovery in patients with complicated pulmonary tuberculosis, which has certain advantages compared with traditional lobectomy.
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Objective:To investigate the risk and efficacy of the decortication in treatment of drug-resistant tuberculous empyema.Methods:A retrospective analysis was conducted on the 146 patients with tuberculous empyema, who underwent decortication in Wuhan Pulmonary Hospital from March 2016 to November 2018, according to the drug-susceptibility testing of the pleural effusion or tissue specimens, the patients had been divided into drug-resistant group(29 cases) and control group(117 cases), compared the clinical datas such as operation time, intraoperative blood loss, postoperative drainage duration, pulmonary reexpansion duration, postoperative complications and curative ratio between both groups, and the factors that influence the risk and efficacy of surgery had been analyzed.Results:The operative time, intraoperative blood loss, postoperative drainage duration and postoperative complications in the drug-resistant group were larger than those in the control group, and the differences were statistically significant ( P<0.05). There was no significant difference in pulmonary reexpansion duration and curative ratio in the two groups( P>0.05). Conclusion:Decortication is safety, effective and feasible in the treatment of drug-resistant tuberculous empyema, although the operation is difficult and risky.
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BACKGROUNDThe worldwide COVID-19 pandemic is increasing exponentially and demands an effective and promising therapy at most emergency. METHODSWe have assembled a cohort consisting 504 hospitalized COVID-19 patients. Detailed information on patients characteristics and antiviral medication use during their stay at designated hospitals along with their pre and post treatment results were collected. The study objective is to evaluate the treatment efficacy of Arbidol, together with the concurrent drugs Oseltamivir and Lopinavir/Ritonavir on mortality and lesion absorption based on chest CT scan. FINDINGSThe overall mortality rate was 15.67% in the cohort. The older age, lower SpO2 level, larger lesion, early admission date, and the presence of pre-existing conditions were associated with higher mortality. After adjusting for the patients age, sex, pre-existing condition, SpO2, lesion size, admission date, hospital, and concurrent antiviral drug use, Arbidol was found promising and associated with reduced mortality. The OR for Arbidol is 0{middle dot}183 (95% CI, 0{middle dot}075 to 0{middle dot}446; P<0{middle dot}001). Furthermore, Arbidol is also associated with faster lesion absorption after adjusting for patients characteristics and concurrent antiviral drug use (P=0{middle dot}0203). INTERPRETATIONThe broad-spectrum antiviral drug Arbidol was found to be associated with faster
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BackgroundWuhan, China was the epicenter of the 2019 coronavirus outbreak. As a designated hospital, Wuhan Pulmonary Hospital has received over 700 COVID-19 patients. With the COVID-19 becoming a pandemic all over the world, we aim to share our epidemiological and clinical findings with the global community. MethodsIn this retrospective cohort study, we studied 340 confirmed COVID-19 patients from Wuhan Pulmonary Hospital, including 310 discharged cases and 30 death cases. We analyzed their demographic, epidemiological, clinical and laboratory data and implemented our findings into an interactive, free access web application. FindingsBaseline T lymphocyte Subsets differed significantly between the discharged cases and the death cases in two-sample t-tests: Total T cells (p < 2{middle dot}2e-16), Helper T cells (p < 2{middle dot}2e-16), Suppressor T cells (p = 1{middle dot}8-14), and TH/TS (Helper/Suppressor ratio, p = 0{middle dot}0066). Multivariate logistic regression model with death or discharge as the outcome resulted in the following significant predictors: age (OR 1{middle dot}05, p 0{middle dot}04), underlying disease status (OR 3{middle dot}42, p 0{middle dot}02), Helper T cells on the log scale (OR 0{middle dot}22, p 0{middle dot}00), and TH/TS on the log scale (OR 4{middle dot}80, p 0{middle dot}00). The McFadden pseudo R-squared for the logistic regression model is 0{middle dot}35, suggesting the model has a fair predictive power. InterpretationWhile age and underlying diseases are known risk factors for poor prognosis, patients with a less damaged immune system at the time of hospitalization had higher chance of recovery. Close monitoring of the T lymphocyte subsets might provide valuable information of the patients condition change during the treatment process. Our web visualization application can be used as a supplementary tool for the evaluation. FundingThe authors report no funding.
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BACKGROUND: Currently there is no guideline based on preoperative clinical parameters for assessing the prognosis of the adjunctive surgery for drug-resistant tuberculosis. METHODS: We retrospectively analyzed 138 patients who had undergone surgical resection as a treatment for drug- resistant tuberculosis after 24 months. Four clinical parameters on lesion type, treatment history, body physiological status, and surgery approach were evaluated. Categorical preoperative clinical parameters were analyzed by ordinal logistic regression model when considering postoperative complications as outcomes ordered in terms of severity. Statistically significant parameters were then combined in a single classification system for predicting the outcomes of the adjunctive surgery. FINDINGS: Diffused, progressive bilateral lesions, or active/progressive extra pulmonary tuberculosis (L3), and history of less than 2 months treatment before surgery (T3) were the strongest predicative parameters for postoperative complications and for surgery failure. Classification systems based on the four parameters were found to have a statistically significant effect on postoperative complications and postoperative efficacy. 24- month follow up indicated a high cure rate (above 95.5%) among patients without T3, L3, or severe physiological complications (B3). INTERPRETATION: A classification system based on objective clinical parameters showed predicative value for the prognosis of the adjunctive surgery and could guide management of drug-resistant Tuberculosis.
