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2.
Kyobu Geka ; 73(11): 901-904, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130710

RESUMO

A 35-year-old man underwent adjuvant chemoradiation therapy to the surgical margin of the thymoma. Five years after the therapy, an area of the right upper lung lobe, which was included in the irradiation field, developed destroyed lung, resulting in Aspergillus empyema with bronchopleural fistula. To control the infection, an open window thoracostomy was performed. As the bronchopleural fistula resulted in pneumonia, bronchial embolization was performed with an Endobronchial Watanabe Spigot. After the empyema cavity was cleaned, the empyema space was closed with omental and muscular flap, thoracoplasty. Negative pressure wound therapy was carried out because of poor wound healing. The patient is doing well without relapse 15 months after the thoracoplasty.


Assuntos
Fístula Brônquica , Empiema Pleural , Empiema , Doenças Pleurais , Timoma , Neoplasias do Timo , Adulto , Aspergillus , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Empiema Pleural/etiologia , Humanos , Masculino , Recidiva Local de Neoplasia , Doenças Pleurais/etiologia , Timoma/complicações , Timoma/radioterapia , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/radioterapia , Neoplasias do Timo/cirurgia
3.
Medicine (Baltimore) ; 99(41): e22485, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031281

RESUMO

RATIONALE: Bronchopleural fistula (BPF) is a dreaded complication after lobectomy or pneumonectomy and is associated with high morbidity and mortality. Successful management remains challenging when this condition is combined with empyema, and the initial treatment is usually conservative and endoscopic, but operative intervention may be required in refractory cases. PATIENT CONCERNS: Two patients diagnosed with BPF with empyema were selected to undergo surgery in our hospital because they could not be cured by conservative and endoscopic therapy for 1 or more years. One was a 70-year-old man who had a 1-year history of fever and cough after he received a minimally invasive right lower lobectomy for intermediate lung adenocarcinoma and chemotherapy 2 years ago; the other was a 73-year-old man who had a 2-year history of cough and fever after he underwent a minimally invasive right upper lobectomy for early lung adenocarcinoma 3 years earlier. DIAGNOSIS: Both patients were diagnosed with BPF with empyema. INTERVENTIONS: After receiving conservative and endoscopic therapies, both patients underwent pedicled latissimus dorsi muscle flap transfers for complete filling of the empyema cavity. OUTCOMES: The patients recovered very well, with no recurrence of BPF and empyema during postoperative follow-up. LESSONS: It is crucial to not only completely control infection and occlude BPFs, but also obliterate the empyema cavity. Thus, pedicled latissimus dorsi muscle flap transfer associated with conservative and endoscopic therapies for BPF with empyema is a useful treatment option, offering feasible and efficient management with promising results.


Assuntos
Fístula Brônquica/cirurgia , Empiema Pleural/cirurgia , Fístula/cirurgia , Músculos Superficiais do Dorso/transplante , Idoso , Fístula Brônquica/etiologia , Empiema Pleural/etiologia , Fístula/etiologia , Humanos , Masculino , Pneumonectomia/efeitos adversos , Retalhos Cirúrgicos
4.
Khirurgiia (Mosk) ; (10): 11-22, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047581

RESUMO

OBJECTIVE: To summarize our experience in transsternal occlusion of main bronchus fistula. MATERIAL AND METHODS: We have performed 146 transsternal occlusions of the main bronchi for the period from 1979 to 2018. There were 123 (84.2%) men and 23 (15.7%) women. Mean age of patients was 63 years. Lung tuberculosis was diagnosed in 36 (24.7%) patients, lung cancer - 91 (62.3%) patients, non-specific suppurative lung diseases - 14 (9.6%) patients, trauma - 5 (3.4%) patients. All patients underwent transsternal occlusion of the main bronchi fistulae with or without pericardial cavity dissection. Wedge-shaped bronchial resection or tracheal bifurcation resection were carried out for a short stump fistula. RESULTS: Perioperative complications occurred in 28 (19.2%) out of 146 patients. Intraoperative complications developed in 4 (2.6%) patients. Postoperative complications were observed in 25 (17.1%) patients. Intraoperative mortality rate was 1.4% (n=2), postoperative mortality - 6.2% (n=9). Thus, overall mortality rate was 7.6% (n=11 It should be noted that intraoperative complications were absent if dissection of the pericardium and pulmonary artery stump ligation were not performed. CONCLUSION: Transsternal occlusion of the main bronchi fistulae was successful in 80.8% of patients. In these cases, healing of fistulae was not associated with any complications. Thus, we believe that transsternal occlusion of the main bronchial stump fistula should be considered as preferable surgical strategy.


Assuntos
Brônquios/cirurgia , Fístula Brônquica/cirurgia , Pneumopatias/cirurgia , Pneumonectomia/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Brônquios/lesões , Fístula Brônquica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esterno/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos
5.
Leg Med (Tokyo) ; 47: 101774, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32777694

RESUMO

Radiotherapy, one of the standard therapies for lung cancer management, may cause severe late complications. In this case report, we describe the forensic autopsy report of a middle-aged man who died from a massive hemoptysis due to a bronchus-pulmonary artery fistula that developed 19 years after radiotherapy. The man, in his 50 s, suddenly developed hemoptysis at home and collapsed. He was in complete remission with no signs of recurrence. Autopsy revealed massive hemorrhage from the bronchus-pulmonary artery fistula, where radiotherapy had been focused. Histopathological findings showed chondronecrosis of the bronchus, disruption of elastic fibers of the pulmonary artery, and marked thickening of the intima of the small arteries around the fistula, which were compatible with radiation reaction. Neither cancer recurrence nor infection was evident. This case suggests that a late complication of radiotherapy should be considered in the differential diagnosis of a patient who was previously received radiotherapy and presents with massive hemoptysis. In such cases, a detailed history on previous therapies and careful examination of the origin of hemorrhage are necessary to determine the cause of death.


Assuntos
Autopsia , Fístula Brônquica/etiologia , Medicina Legal , Neoplasias Pulmonares/radioterapia , Artéria Pulmonar , Radioterapia/efeitos adversos , Fístula Vascular/etiologia , Fístula Brônquica/diagnóstico , Fístula Brônquica/patologia , Diagnóstico Diferencial , Evolução Fatal , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/patologia , Índice de Gravidade de Doença , Fatores de Tempo , Fístula Vascular/diagnóstico , Fístula Vascular/patologia
7.
Thorac Surg Clin ; 30(3): 347-358, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32593367

RESUMO

Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and 1-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often caused by development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required.


Assuntos
Fístula Brônquica/terapia , Doenças Pleurais/terapia , Pneumonectomia/efeitos adversos , Pneumotórax/terapia , Fístula do Sistema Respiratório/terapia , Fístula Brônquica/etiologia , Broncoscopia , Humanos , Doenças Pleurais/etiologia , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Fístula do Sistema Respiratório/diagnóstico , Fístula do Sistema Respiratório/etiologia , Fatores de Risco
8.
Khirurgiia (Mosk) ; (5): 49-57, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500689

RESUMO

OBJECTIVE: To evaluate an effectiveness of endobronchial valve treatment of patients with bronchopleural fistulas and prolonged air leakage. MATERIAL AND METHODS: Endobronchial valve treatment was analyzed in 115 patients with bronchopleural fistulas or postoperative air leakage. All patients were divided into 5 groups depending on disease: bullous emphysema, acute purulent lung diseases, chronic purulent lung and pleural diseases, bullous emphysema complicated by pneumothorax with failed pleural cavity, other lung diseases associated with prolonged postoperative air leakage. RESULTS: Endobronchial valve treatment was effective in more than 70% patients. There were no intraoperative and postoperative complications. CONCLUSION: Endobronchial valve treatment is a highly effective minimally invasive method for treating patients with bronchopleural fistulas and postoperative air leakage.


Assuntos
Fístula Anastomótica/cirurgia , Fístula Brônquica/cirurgia , Broncoscopia/métodos , Pneumopatias/cirurgia , Doenças Pleurais/cirurgia , Fístula Anastomótica/etiologia , Brônquios/cirurgia , Fístula Brônquica/etiologia , Humanos , Pneumopatias/etiologia , Doenças Pleurais/etiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Fístula do Sistema Respiratório/etiologia , Fístula do Sistema Respiratório/cirurgia , Supuração/etiologia , Supuração/cirurgia
9.
Gan To Kagaku Ryoho ; 47(3): 469-471, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32381918

RESUMO

We report the case of a patient with esophageal cancer accompanied by esophago-bronchial fistula and pneumonia, who experienced improved quality of life following multimodal therapy that included esophageal bypass surgery. A 56-year-old man was diagnosed with advanced esophageal cancer with an esophago-bronchial fistula on computed tomography scan. He underwent esophageal bypass surgery followed by definitive chemoradiotherapy. He started eating 12 days after the surgery and was discharged home after the completion of chemoradiotherapy. On follow-up, the primary lesion was found to be significantly decreased in size and the esophago-bronchial fistula was closed. Although the patient ultimately died owing to distant metastases, he enjoyed a prolonged period of survival following surgery. Multimodal therapy including esophageal bypass surgery is an useful strategy for treating patients with critical conditions such as esophago-bronchial fistula induced by esophageal cancer.


Assuntos
Fístula Brônquica , Fístula Esofágica , Neoplasias Esofágicas , Fístula Brônquica/etiologia , Fístula Esofágica/etiologia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
11.
Surg Today ; 50(2): 114-122, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31493198

RESUMO

PURPOSE: Bronchopleural fistula (BPF) is a potentially fatal complication of pneumonectomy. We analyze its occurrence rate, risk factors, and the methods used for its prevention. METHODS: We reviewed the medical records of patients who underwent pneumonectomy at our Institution between January, 1990 and March, 2016. The risk factors for postoperative BPF were analyzed by univariate analysis and multiple logistic regression. RESULTS: Over the study period, 511 patients underwent pneumonectomy for non-small cell lung cancer (NSCLC) and had the bronchus closed by manual suturing. BPF developed in 23 patients (4.5%). Multiple logistic regression identified no coverage of the bronchial stump, right-sided pneumonectomy, residual tumor in the bronchial stump, postoperative ventilatory support, and completion pneumonectomy, as independent risk factors for BPF. The cumulative rate of BPF decreased significantly over time from 18% between 1990 and 1995 to 1% between 2011 and 2016 (p < 0.001). Concurrently, the data of several patients showed a significant positive trend over time, including bronchial stump coverage (BSC). DISCUSSION: Several known risk factors for BPF were confirmed. The more frequent usage of tissue flaps for coverage of the bronchial stump may have contributed to the reduction in the rate of postoperative BPF over time.


Assuntos
Brônquios/cirurgia , Fístula Brônquica/etiologia , Fístula/etiologia , Doenças Pleurais/etiologia , Pneumonectomia , Complicações Pós-Operatórias/epidemiologia , Fístula Brônquica/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Fístula/epidemiologia , Humanos , Neoplasias Pulmonares/cirurgia , Doenças Pleurais/epidemiologia , Fatores de Risco
13.
Ann Thorac Surg ; 109(5): e339-e341, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31604094

RESUMO

Herpes simplex virus is an uncommon cause of esophagitis and particularly so in immunocompetent individuals. Although the common presentation tends to be odynophagia and/or dysphagia, fever, and retrosternal chest pain, there are variations and rarely it can present more ominously as esophageal rupture. We report a rare case of esophageal perforation with penetration into the vertebral space secondary to chronic herpes simplex virus esophagitis in a 71-year-old immunocompetent woman. This is the second known such occurrence. The patient had a long stay in the hospital but recovered from the condition and was followed up for 1 year after initial presentation.


Assuntos
Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Esofagite/complicações , Esofagite/cirurgia , Herpes Simples/complicações , Herpes Simples/cirurgia , Idoso , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Doença Crônica , Endoscopia do Sistema Digestório , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Perfuração Esofágica/diagnóstico por imagem , Esofagite/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/cirurgia , Feminino , Seguimentos , Herpes Simples/diagnóstico por imagem , Humanos , Tempo de Internação , Stents , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Interact Cardiovasc Thorac Surg ; 30(2): 249-254, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31603203

RESUMO

OBJECTIVES: A bronchopleural fistula after pneumonectomy is a relatively rare but very serious complication. The development of endoscopic methods of treatment opens a new page in treating this condition. The goal of this paper was to confirm that the atrial septal defect Amplatzer device can be used for bronchopleural fistula closure in properly selected patients. METHODS: A retrospective study of 13 patients with bronchopleural fistula after pneumonectomy was performed. There were 11 men and 2 women aged 26-70 years. Right-sided fistulas occurred in 10 patients and left-sided fistulas occurred in 3. The underlying disease was lung cancer in 7 patients and pulmonary tuberculosis in 6. Video-assisted thoracoscopic surgery (N = 7) and open-window thoracostomy (N = 6) were used to treat the empyema. To treat occlusion of the bronchial fistulas, we used Amplatzer atrial septal defect occluders originally intended for closure of ventricular and interatrial septal defects. The occluder was inserted from the bronchus by flexible bronchoscopy with the patient under local anaesthesia, with the help of video-assisted thoracoscopy or through a window thoracostomy from the pleural cavity. RESULTS: We noted 3 complications after the procedure. In 2 patients, displacement of the occluders required re-installation in 1 patient and latissimus dorsi muscle coverage in the other. In the third patient, the occluder became dislodged during severe exacerbation of tuberculosis that occurred after the patient violated the treatment regimen. She died of tuberculosis 6 months after the occluder was inserted. The course in the remaining 10 patients was uneventful. CONCLUSIONS: Our experience suggests that the use of an atrial septal defect occluder for the treatment of a bronchial fistula after pneumonectomy is a reliable option.


Assuntos
Fístula Brônquica/cirurgia , Broncoscopia/instrumentação , Doenças Pleurais/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Dispositivo para Oclusão Septal , Adulto , Idoso , Fístula Brônquica/etiologia , Empiema/etiologia , Feminino , Humanos , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracostomia/efeitos adversos
15.
Ann Thorac Surg ; 109(2): e99-e101, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31276644

RESUMO

A 46-year-old female patient exhibited massive endobronchial bleeding after dilation of a left bronchial anastomotic stenosis after lung transplantation, consistent with a bronchopulmonary artery fistula (BPAF). The BPAF was treated with a bronchial covered self-expandable metallic stent and percutaneous transcatheter pulmonary artery stent placement. BPAF is rare and leads to death in most cases because of massive hemoptysis. We describe a case of successful combined management of BPAF using both bronchial and pulmonary stent placement.


Assuntos
Implante de Prótese Vascular/métodos , Brônquios/cirurgia , Artérias Brônquicas/cirurgia , Fístula Brônquica/cirurgia , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias , Fístula Vascular/cirurgia , Brônquios/diagnóstico por imagem , Artérias Brônquicas/diagnóstico por imagem , Fístula Brônquica/diagnóstico , Fístula Brônquica/etiologia , Broncoscopia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Pessoa de Meia-Idade , Enfisema Pulmonar/cirurgia , Fístula Vascular/diagnóstico , Fístula Vascular/etiologia
17.
Gen Thorac Cardiovasc Surg ; 68(6): 609-614, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31858404

RESUMO

OBJECTIVE: Bronchial fistulae following lung surgery are associated with high mortality. We examined the histological effects of mucosal ablation as a technique for closing bronchial stumps to prevent bronchial fistulae in an animal model. METHODS: Left lower lobectomy was performed in beagles under general anesthesia. The bronchial stumps were closed using one of the following four methods: (A) manual suturing using 3-0 absorbable sutures, (B) ablation of bronchial mucosa with electric cautery and manual sutures, (C) stapling and reinforcement with manual sutures, or (D) ablation and stapling followed by reinforcement with manual sutures. Bronchial stumps were histologically evaluated on postoperative day 14. RESULTS: No bronchial fistulae were noted in the animals during the observation period. Histologically, there were no adhesions between the bronchial mucosae at the suture and staple lesions in groups A and C. The bronchial mucosae were adherent at the ablation sites in groups B and D. Inflammatory cells, myofibroblasts, and neovascular vessels were abundant around the ablated lesions. CONCLUSIONS: Bronchial mucosal ablation may play a key role in mucosal adhesion and tight union of the bronchial stump.


Assuntos
Brônquios/cirurgia , Fístula Brônquica/prevenção & controle , Pneumonectomia/métodos , Mucosa Respiratória/cirurgia , Animais , Fístula Brônquica/etiologia , Modelos Animais de Doenças , Cães , Feminino , Pneumonectomia/efeitos adversos , Mucosa Respiratória/patologia , Grampeamento Cirúrgico , Suturas , Aderências Teciduais/etiologia
20.
Transplant Proc ; 51(10): 3399-3402, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810508

RESUMO

Aortobronchial fistulae (ABF) are uncommon but potentially fatal anomalies. Patients may initially present with small volume hemoptysis, which can rapidly lead to massive hemoptysis and death if not diagnosed and intervened upon early. Diagnosis by imaging and bronchoscopy is not always conclusive; thus, a high index of suspicion is necessary to diagnose this life-threatening condition. Herein, we describe a case of a young man who had a late presentation of ABF 21 years following heart transplantation. This case illustrates the diagnostic and clinical challenge of ABF as a late sequela of cardiac transplantation and highlights the rarity of this anomaly.


Assuntos
Doenças da Aorta/etiologia , Fístula Brônquica/etiologia , Transplante de Coração/efeitos adversos , Hemoptise/etiologia , Adulto , Humanos , Masculino , Fatores de Tempo
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