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1.
BMC Pulm Med ; 21(1): 2, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407289

RESUMO

BACKGROUND: Congenital bronchial atresia is a rare pulmonary abnormality characterized by the disrupted communication between the central and the peripheral bronchus and is typically asymptomatic. Although it can be symptomatic especially when infections occur in the involved areas, fungal infections are rare complications in patients with bronchial atresia. We report a case of congenital bronchial atresia complicated by a fungal infection. CASE PRESENTATION: A 30-year-old man with no previous history of immune dysfunction was brought to a nearby hospital and diagnosed with a left lung abscess. Although antimicrobial treatment was administered, it was ineffective, and he was transferred to our hospital. Since diagnostic imaging findings and bronchoscopy suggested congenital bronchial atresia and a fungal infection, he was treated with voriconazole and surgical resection was subsequently performed. A tissue culture detected Aspergillus fumigatus and histopathological findings were compatible with bronchial atresia. After discharge, he remained well and voriconazole was discontinued 5 months after the initiation of therapy. CONCLUSION: Bronchial atresia is a rare disease that is seldom complicated by a fungal infection, which is also a rare complication; however, physicians should consider fungal infections in patients with bronchial atresia who present with infections resistant to antimicrobial treatment.


Assuntos
Aspergilose/microbiologia , Aspergillus fumigatus/isolamento & purificação , Brônquios/anormalidades , Abscesso Pulmonar/microbiologia , Anormalidades do Sistema Respiratório/complicações , Adulto , Aspergilose/patologia , Aspergilose/terapia , Brônquios/cirurgia , Broncoscopia , Humanos , Abscesso Pulmonar/patologia , Abscesso Pulmonar/cirurgia , Masculino , Radiografia Torácica , Anormalidades do Sistema Respiratório/diagnóstico , Tomografia Computadorizada por Raios X , Voriconazol/uso terapêutico
3.
Artigo em Inglês | MEDLINE | ID: mdl-32033391

RESUMO

Background: The management of lung abscess may be a challenge in elderly patients undergoing chemotherapy and/or radiotherapy for previous malignancy. Herein, we reported a case series of elderly patients with previous lymphoma undergoing endoscopic treatment followed by pulmonary rehabilitation for lung abscess. Methods: Our study population included a consecutive series of elderly patients with previous lymphoma and lung abscess. Suppurative infection was refractory with specific antibiotic therapy. In all cases, drainage was endoscopically inserted in lung abscess via video-bronchoscopy. This strategy allowed performing daily therapy with the installation of gentamicin directly into the abscess cavity. All patients underwent a respiratory rehabilitation program to speed up convalescence and allow early discharge. Results: After positioning the catheter through a bronchoscopic route and subsequent washing with gentamicin, all the patients in our study showed an improvement in clinical conditions with resolution of fever within a few days of starting the procedure with normalization of blood tests (mean hospital length 7 ± 0.73 days). A follow-up chest computed tomography scan showed a resolution of lung abscess within a mean of 27 ± 1.53 days. Conclusions: Endoscopic treatment with a rehabilitation program may be a valuable strategy for the management of lung abscess that is refractory to standard antibiotic therapy. Further and larger studiesshould be done to confirm our results.


Assuntos
Broncoscopia/métodos , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/cirurgia , Linfoma/complicações , Terapia Respiratória/métodos , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
4.
Thorac Surg Clin ; 30(1): 33-39, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761282

RESUMO

Chest infection is a health care problem in many regions of the world, and pleural empyema is the most common type of surgical chest infection. In the past decennium, the introduction of nonintubated surgery and uniportal video-assisted thoracic surgery changed considerably surgical treatment of pleural empyema. Although the advantages seem evident, the need for randomized controlled trials is necessary to confirm the usefulness. Moreover, in the future, an education and training program for thoracic surgeons and anesthesiologists would allow increasing the number of awake surgical options in caring for patients with stages II to III empyema.


Assuntos
Empiema Pleural/cirurgia , Abscesso Pulmonar/cirurgia , Administração dos Cuidados ao Paciente/métodos , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Resultado do Tratamento
5.
Ann Thorac Surg ; 108(6): e405-e407, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31470008

RESUMO

Chest tube thoracostomy is a standard procedure in every intensive care unit. Although it is regarded as a safe procedure in experienced hands, rare complications do occur. This report describes iatrogenic perforation of the left ventricle after placement of an intercostal catheter and the successful surgical management of this injury. Various operative situations that may arise in relation to iatrogenic perforation of the left ventricle are also discussed, as well as steps to manage this potentially life-threatening complication.


Assuntos
Tubos Torácicos/efeitos adversos , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Abscesso Pulmonar/cirurgia , Toracostomia/métodos , Idoso , Seguimentos , Humanos , Doença Iatrogênica , Abscesso Pulmonar/diagnóstico , Masculino , Medição de Risco , Esternotomia/métodos , Resultado do Tratamento
6.
Pathol Int ; 69(4): 211-218, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30990957

RESUMO

We aimed to propose a biosafety algorithm for the protection of pathology staff during intraoperative examinations of pulmonary lesions when working with cytological imprints and/or frozen sections for the intraoperative diagnosis of pulmonary lesions. We examined 148 pulmonary surgical tissues obtained intraoperatively for imprint cytology (IC) and for frozen sectioning and compared the diagnoses against the final pathological diagnoses. We analyzed concordance and non-concordance rates and then used the data to produce a biosafety algorithm. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scratch-IC were 91%, 100%, 100%, 50% and 92%, respectively, and those of frozen sectioning were 99%, 100%, 100%, 96% and 99%, respectively. Our data indicate that frozen sectioning is unnecessary if scratch-IC yields a 'malignant' diagnosis but recommended with a 'benign' diagnosis. When a scratch-IC preparation deemed inadequate for a diagnosis or an abscess, the pathologist must consult the surgeon concerning the possibility of granuloma with caseous necrosis and should ask the surgeon to be prepared for a frozen section. If granuloma with caseous necrosis is found in the frozen section, the pathologist must immediately communicate the information to entire staff and perform a PCR test before making a permanent section.


Assuntos
Algoritmos , Granuloma/diagnóstico , Abscesso Pulmonar/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Contenção de Riscos Biológicos , Citodiagnóstico , Feminino , Secções Congeladas , Granuloma/patologia , Granuloma/cirurgia , Humanos , Cuidados Intraoperatórios , Abscesso Pulmonar/patologia , Abscesso Pulmonar/cirurgia , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Manejo de Espécimes
8.
J Cardiothorac Surg ; 14(1): 41, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808391

RESUMO

BACKGROUND: Only 4.1% of tricuspid valve IE cases require surgical intervention. The complication after tricuspid valve IE with lung abscess and empyema is rare. CASE PRESENTATION: We report the case of a 38-year-old male (an intravenous drug abuser) diagnosed with tricuspid valve IE who underwent tricuspid valve replacement. The case was complicated by multiple lung abscesses and thoracic empyema. The pathogens causing the lung abscesses and empyema were Acinetobacter baumannii complex and Candida albicans, which were different from those causing the endocarditis. After 4 weeks of antibiotic treatment, chest X-ray revealed bilateral clear lung markings with only mild blunting of the right costophrenic angle. CONCLUSION: The pathogen causing the lung abscess is not always compatible with that causing the endocarditis. Thoracoscopic incision of the abscess with 4 to 6 weeks of broad-spectrum antibiotic treatment is effective and safe.


Assuntos
Empiema Pleural/microbiologia , Endocardite Bacteriana/microbiologia , Abscesso Pulmonar/microbiologia , Abuso de Substâncias por Via Intravenosa/microbiologia , Valva Tricúspide/cirurgia , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/cirurgia , Acinetobacter baumannii/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Candidíase/cirurgia , Empiema Pleural/tratamento farmacológico , Empiema Pleural/etiologia , Empiema Pleural/cirurgia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Abscesso Pulmonar/tratamento farmacológico , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/cirurgia , Masculino , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus/isolamento & purificação , Abuso de Substâncias por Via Intravenosa/complicações , Toracoscopia , Valva Tricúspide/microbiologia
9.
Intern Med ; 58(1): 97-100, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29984758

RESUMO

Lung abscess is usually treated with long-term antibiotic therapy. Due to the lack of a safe and easy drainage technique, drainage is only applied in refractory cases. We herein describe three cases in which drainage was successfully performed by endobronchial ultrasonography using a modified guide sheath. This procedure may have advantages in the detection of causative pathogens and early infection source control, and may therefore lead to the appropriate selection of antibiotics and reduce the duration of antibiotic therapy.


Assuntos
Broncoscopia/métodos , Drenagem/métodos , Abscesso Pulmonar/cirurgia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Drenagem/instrumentação , Feminino , Humanos , Abscesso Pulmonar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
11.
Ann Thorac Surg ; 106(1): e15-e17, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29530775

RESUMO

Utilization of a left ventricular assist device as a bridge to myocardial recovery is an established therapy for acute systolic heart failure. However, device removal can present a technical challenge, with no clear consensus on preferred method. In this case report, we describe a complex patient who underwent successful explantation of a left ventricular assist device using an intraoperatively constructed apical plug. This method utilizes inexpensive and easily accessible materials, minimizes ventricular distortion during device removal, and preserves the ventricular sewing ring for future reimplantation.


Assuntos
Remoção de Dispositivo/métodos , Insuficiência Cardíaca Sistólica/cirurgia , Coração Auxiliar , Ajuste de Prótese/métodos , Adulto , Bioprótese , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Craniectomia Descompressiva , Empiema Pleural/etiologia , Empiema Pleural/terapia , Insuficiência Cardíaca Sistólica/etiologia , Humanos , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/cirurgia , Masculino , Miocardite/complicações , Politetrafluoretileno , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Volume Sistólico , Técnicas de Sutura , Toracotomia
12.
Khirurgiia (Mosk) ; (8): 33-39, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28805776

RESUMO

AIM: To assess an efficacy of diagnostic and curative bronchoscopy in patients with purulent-destructive pulmonary diseases. MATERIAL AND METHODS: Diagnosis and treatment of 34 patients with purulent-destructive pulmonary diseases including small-focal destruction (14) and lung abscesses (19) were analyzed. 33 patients underwent diagnostic fibrobronchoscopy (FBS) with brush and transbronchial biopsy. Curative endoscopy included bronchial tree sanation, peribronchial administration of antibiotics (5) and transbronchial drainage of abscess (14). RESULTS: Atrophic bronchitis and cicatricial deformity of the 2-3rd segmental bronchi were revealed in 81.8% and 15.2% respectively. Transbronchial biopsy confirmed malignant neoplasms (15.2%) and pulmonary tuberculosis (6.1%). Peribronchial administration of amikacin in patients with small-focal pulmonary destruction and transbronchial drainage of abscesses accelerated pulmonary tissue repair and complete recovery. CONCLUSION: Transbronchial biopsy in patients with destructive pulmonary diseases verifies pathological process and excludes malignant and specific pulmonary damage. Complex use of endoscopic methods is associated with positive clinical result in all patients with pulmonary destruction.


Assuntos
Broncoscopia/métodos , Drenagem/métodos , Abscesso Pulmonar , Neoplasias Pulmonares , Tuberculose Pulmonar , Adulto , Biópsia/métodos , Diagnóstico Diferencial , Feminino , Humanos , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/cirurgia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Federação Russa , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/patologia
13.
J Radiol Case Rep ; 11(2): 8-15, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28580068

RESUMO

Mucoepidermoid carcinoma (MEC) of the airways is a rare entity most often found in young patients. We present a case of a 23 year old patient with symptoms of pneumonia, which progresses to a pulmonary abscess within a week. Diagnostic work-up reveals an endobronchial obstruction by a pedunculated low grade MEC. A literature review is provided and radiological appearances are described.


Assuntos
Carcinoma Mucoepidermoide/diagnóstico por imagem , Abscesso Pulmonar/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Carcinoma Mucoepidermoide/patologia , Carcinoma Mucoepidermoide/cirurgia , Meios de Contraste , Diagnóstico Diferencial , Progressão da Doença , Humanos , Abscesso Pulmonar/patologia , Abscesso Pulmonar/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Gradação de Tumores , Pneumonia/patologia , Pneumonia/cirurgia , Adulto Jovem
14.
Rev. cuba. cir ; 56(2): 1-11, abr.-jun. 2017. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-900970

RESUMO

Introducción: el diagnóstico y tratamiento de las colecciones de pus del pulmón ha variado a través del tiempo. Objetivo: evaluar los resultados del tratamiento quirúrgico de los enfermos en los que fracasó el tratamiento médico. Métodos: estudio descriptivo observacional de 45 enfermos con colecciones de pus del pulmón en los que se realizó algún procedimiento quirúrgico. Resultados: predominó el sexo masculino, 82,2 por ciento entre la sexta y séptima década de la vida, todos presentaban factores de riesgo. El absceso pulmonar primario fue el más frecuente, seguido por cáncer de pulmón abscedado, las bullas, bronquiectasia y el absceso por tuberculosis, 91,1 por ciento eran ASA II o III y 8,9 por ciento IV. Predominaron los gérmenes gran negativos. El pulmón derecho fue el más afectado. Las intervenciones más realizadas fueron las resecciones con predominio de la lobectomía. El drenaje percutáneo y la pleurostomía, la supuración por TB fue tratada con drenaje y drogas antituberculosas. Las complicaciones más frecuentes fueron: infección respiratoria, arritmias e infecciones del sitio quirúrgico, la morbilidad fue inferior al 25 por ciento y la mortalidad 3,8 por ciento. Conclusiones: la selección individual del procedimiento a utilizar -teniendo en cuenta la causa, el estado físico y los factores de riesgo quirúrgico- permiten obtener resultados satisfactorios(AU)


Introduction: diagnosis and treatment of lung abscess has varied throughout the time. Objective: to evaluate the results of the surgical treatment in patients whose medical treatment failed. Methods: observational and descriptive study of 45 patients with lung abscess, who had undergone some type of surgery. Results: males predominated; 82.2 percent aged 60 to 70 years and all presented with risk factors. Primary lung abscess was the most common, followed by abscessed lung cancer, bullas, bronchiectasis and tuberculosis abscess. In the group, 91.1 percent were classified as ASA II or III and 8.9 percent as ASA IV. Gram-negative germs prevailed. Right lung was the most affected one. The most performed surgeries were resections, mainly lobectomy. Percutaneous drainage and pleurostomy; tuberculosis suppuration was treated with drainage and anti-tuberculosis drugs. The commonest complications were respiratory infections, arrhythmias and surgical site infections. The morbidity rate was below 25 percent and the mortality rate was 3.8 percent. Conclusions: taking into account the cause, the physical condition and the surgical risk factors, the individual selection of the procedure to be used allows achieving satisfactory outcomes(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Abscesso Pulmonar/cirurgia , Pneumonectomia/efeitos adversos , Procedimentos Cirúrgicos Pulmonares/métodos , Estudos Transversais , Drenagem Postural/métodos , Epidemiologia Descritiva , Estudo Observacional , Resultado do Tratamento
15.
Rev. cuba. cir ; 56(2): 1-11, abr.-jun. 2017. ilus, tab
Artigo em Espanhol | CUMED | ID: cum-72108

RESUMO

Introducción: el diagnóstico y tratamiento de las colecciones de pus del pulmón ha variado a través del tiempo. Objetivo: evaluar los resultados del tratamiento quirúrgico de los enfermos en los que fracasó el tratamiento médico. Métodos: estudio descriptivo observacional de 45 enfermos con colecciones de pus del pulmón en los que se realizó algún procedimiento quirúrgico. Resultados: predominó el sexo masculino, 82,2 por ciento entre la sexta y séptima década de la vida, todos presentaban factores de riesgo. El absceso pulmonar primario fue el más frecuente, seguido por cáncer de pulmón abscedado, las bullas, bronquiectasia y el absceso por tuberculosis, 91,1 por ciento eran ASA II o III y 8,9 por ciento IV. Predominaron los gérmenes gran negativos. El pulmón derecho fue el más afectado. Las intervenciones más realizadas fueron las resecciones con predominio de la lobectomía. El drenaje percutáneo y la pleurostomía, la supuración por TB fue tratada con drenaje y drogas antituberculosas. Las complicaciones más frecuentes fueron: infección respiratoria, arritmias e infecciones del sitio quirúrgico, la morbilidad fue inferior al 25 por ciento y la mortalidad 3,8 por ciento. Conclusiones: la selección individual del procedimiento a utilizar -teniendo en cuenta la causa, el estado físico y los factores de riesgo quirúrgico- permiten obtener resultados satisfactorios(AU)


Introduction: diagnosis and treatment of lung abscess has varied throughout the time. Objective: to evaluate the results of the surgical treatment in patients whose medical treatment failed. Methods: observational and descriptive study of 45 patients with lung abscess, who had undergone some type of surgery. Results: males predominated; 82.2 percent aged 60 to 70 years and all presented with risk factors. Primary lung abscess was the most common, followed by abscessed lung cancer, bullas, bronchiectasis and tuberculosis abscess. In the group, 91.1 percent were classified as ASA II or III and 8.9 percent as ASA IV. Gram-negative germs prevailed. Right lung was the most affected one. The most performed surgeries were resections, mainly lobectomy. Percutaneous drainage and pleurostomy; tuberculosis suppuration was treated with drainage and anti-tuberculosis drugs. The commonest complications were respiratory infections, arrhythmias and surgical site infections. The morbidity rate was below 25 percent and the mortality rate was 3.8 percent. Conclusions: taking into account the cause, the physical condition and the surgical risk factors, the individual selection of the procedure to be used allows achieving satisfactory outcomes(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Abscesso Pulmonar/cirurgia , Pneumonectomia/efeitos adversos , Procedimentos Cirúrgicos Pulmonares/métodos , Estudos Transversais , Drenagem Postural/métodos , Epidemiologia Descritiva , Estudo Observacional , Resultado do Tratamento
16.
J Cardiothorac Surg ; 12(1): 44, 2017 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-28549477

RESUMO

BACKGROUND: Intratumoral lung abscess is a secondary lung abscess that is considered to be fatal. Therefore, surgical procedures, although high-risk, have sometimes been performed for intratumoral lung abscesses. However, no studies have examined the surgical outcomes of non-small cell lung cancer patients with intratumoral lung abscesses. The aim of this study was to investigate the surgical and survival outcomes of non-small cell lung cancer patients with intratumoral lung abscesses. METHODS: Eleven consecutive non-small cell lung cancer patients with intratumoral lung abscesses, who had undergone pulmonary resection at our institution between January 2007 and December 2015, were retrospectively analysed. The post-operative prognoses were investigated and prognostic factors were evaluated. RESULTS: Ten of 11 patients were male and one patient was female. The median age was 64 (range, 52-80) years. Histopathologically, 4 patients had Stage IIA, 2 patients had Stage IIB, 2 patients had Stage IIIA, and 3 patients had Stage IV tumors. The median operative time was 346 min and the median amount of bleeding was 1327 mL. The post-operative morbidity and mortality rates were 63.6% and 0.0%, respectively. Recurrence of respiratory infections, including lung abscesses, was not observed in all patients. The median post-operative observation period was 16.1 (range, 1.3-114.5) months. The 5-year overall survival rate was 43.3%. No pre-operative, intra-operative, or post-operative prognostic factors were identified in the univariate analyses. CONCLUSION: Surgical procedures for advanced-stage non-small cell lung cancer patients with intratumoral lung abscesses, although high-risk, led to satisfactory post-operative mortality rates and acceptable prognoses.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Abscesso Pulmonar/cirurgia , Neoplasias Pulmonares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Feminino , Humanos , Japão/epidemiologia , Abscesso Pulmonar/complicações , Abscesso Pulmonar/mortalidade , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências
17.
Kyobu Geka ; 70(5): 389-391, 2017 May.
Artigo em Japonês | MEDLINE | ID: mdl-28496088

RESUMO

We herein report the case of a patient demonstrating a lung abscess with acute empyema which improved after performing pnemumonotomy and lung abscess drainage. A 60-year-old male was referred to our hospital to receive treatment for a lung abscess with acute empyema. At surgery, the lung parenchyma was slightly torn with pus leakage. After drainage of lung abscess by enlarging the injured part, curettage in the thoracic cavity and decortication were performed. The postoperative course was uneventful. Direct drainage of an abscess into the thoracic cavity is thought to be a choice for the treatment of lung abscesses.


Assuntos
Empiema Pleural/cirurgia , Abscesso Pulmonar/cirurgia , Doença Aguda , Drenagem , Empiema Pleural/complicações , Empiema Pleural/diagnóstico por imagem , Humanos , Abscesso Pulmonar/complicações , Abscesso Pulmonar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Pulmonares , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
18.
Asian Cardiovasc Thorac Ann ; 25(4): 315-317, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28387128

RESUMO

While some cases of nocardial pneumonia develop secondary empyema, tension pyopneumothorax is a very rare and lethal complication. A 74-year-old man who exhibited thrombocytopenia during steroid therapy for autoimmune hepatitis, presented to our department with a nocardial tension pyopneumothorax. He underwent a left lower lobectomy after chest drainage, and was discharged without any complication other than reoperation to remove a postoperative hematoma.


Assuntos
Abscesso Pulmonar/microbiologia , Nocardiose/microbiologia , Infecções Oportunistas/microbiologia , Pneumonia Bacteriana/microbiologia , Pneumotórax/microbiologia , Corticosteroides/efeitos adversos , Idoso , Drenagem , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/imunologia , Abscesso Pulmonar/cirurgia , Masculino , Nocardiose/diagnóstico , Nocardiose/imunologia , Nocardiose/cirurgia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/cirurgia , Pneumonectomia , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/imunologia , Pneumonia Bacteriana/cirurgia , Pneumotórax/diagnóstico , Pneumotórax/imunologia , Pneumotórax/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Thorac Cardiovasc Surg ; 65(7): 535-541, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28249343

RESUMO

Background Surgery for lung abscess is a challenging task. Timing and indications for surgery are not well established. Identification of predictors of outcome could help to clarify the role of surgery. Methods Patients who underwent major thoracic surgery for infectious lung abscess were identified at six centers for general thoracic surgery in Germany, Spain, the United Kingdom, and the United States. Study period was 2000 to 2016. Results There were 91 patients. Pulmonary sepsis (48), pleural empyema (43), persistent air leakage (25), acute renal failure (12), and respiratory failure with mechanical ventilation (25) were already preoperatively present. The mean Charlson index of comorbidity was 3.0 (median: 2.0; interquartile range: 3). Procedures were segmentectomy (18), lobectomy (58), and pneumonectomy (15). The 30-day mortality following surgery was 13/91.Preoperative sepsis (odds ratio [OR]: 13.69; 95% confidence interval [CI]: 1.86-610.53; p < 0.01), preoperative persistent air leak (OR: 13.46, 95% CI: 3.00-85.37, p < 0.01), respiratory failure (OR: 5.60; 95% CI: 1.41-24.84; p < 0.01), acute renal failure (OR: 6.15 ; 95% CI: 1.24-29.56 ; p = 0.01), and Charlson index of comorbidity ≥ 3 (OR: 7.19 ; 95% CI: 1.43-71.21 ; p < 0.01) are associated with higher mortality, whereas age > 70 years (p = 0.46) and the extent of pulmonary resection (segmentectomy, lobectomy, pneumonectomy) have no significant influence on mortality. Patients with fatal outcome have significantly higher Charlson index of comorbidity (p < 0.01). Conclusions Delayed referral for surgery is common. Significant predictors for fatal outcome are pulmonary sepsis, septic complications (air leak, pleural empyema), septic organ failure (respiratory, acute renal failure), and preexisting comorbidity (Charlson index of comorbidity ≥ 3). The extent of surgical resection shows no significant influence.


Assuntos
Abscesso Pulmonar/cirurgia , Pneumonectomia , Adulto , Fatores Etários , Idoso , Comorbidade , Europa (Continente) , Feminino , Humanos , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
20.
Intern Med ; 56(1): 109-113, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28049987

RESUMO

We herein report the case of 75-year-old Japanese female with a community-acquired lung abscess attributable to Streptococcus pneumoniae (S. penumoniae) which extended into the chest wall. The patient was admitted to our hospital with a painful mass on the left anterior chest wall. A contrast-enhanced chest computed tomography scan showed a lung abscess in the left upper lobe which extended into the chest wall. Surgical debridement of the chest wall abscess and percutaneous transthoracic tube drainage of the lung abscess were performed. A culture of the drainage specimen yielded S. pneumoniae. The patient showed a remarkable improvement after the initiation of intravenous antibiotic therapy.


Assuntos
Antibacterianos/uso terapêutico , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/cirurgia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/cirurgia , Parede Torácica/fisiopatologia , Parede Torácica/cirurgia , Idoso , Grupo com Ancestrais do Continente Asiático , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/cirurgia , Feminino , Humanos , Japão , Abscesso Pulmonar/fisiopatologia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/patogenicidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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