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Thorax May 1968Pancreatitis, in common with many other upper abdominal diseases, often leads to pleuropulmonary complications. Radiological evidence of pleuropulmonary abnormality was... (Review)
Review
Pancreatitis, in common with many other upper abdominal diseases, often leads to pleuropulmonary complications. Radiological evidence of pleuropulmonary abnormality was found in 55% of 58 cases examined retrospectively. The majority of such abnormalities are not specific for pancreatitis; but a particular category of pleural effusions, rich in pancreatic enzymes, is a notable exception. A patient with this type of effusion, complicated by a spontaneous bronchopleural fistula and then by an empyema, is reported. The literature relating to pancreatic enzyme-rich pleural effusions (pathognomonic of pancreatitis) is reviewed. Of several possible mechanisms involved in pathogenesis, transdiaphragmatic lymphatic transfer of pancreatic enzymes, intrapleural rupture of mediastinal extensions of pseudocysts, and diaphragmatic perforation are the most important. The measurement of pleural fluid amylase, at present little employed in this country, has considerable diagnostic value. Enzyme-rich effusions are more commonly left-sided, are often blood-stained, are frequently associated with pancreatic pseudocysts, and—if long standing—may be complicated by a bronchopleural fistula.
Topics: Biological Transport; Bronchial Fistula; Empyema; Fistula; Humans; Lung Diseases; Lymphatic System; Male; Middle Aged; Pancreas; Pancreatitis; Pleural Diseases; Pleural Effusion; Radiography
PubMed: 4872925
DOI: 10.1136/thx.23.3.297 -
Journal of Thoracic Disease Mar 2023Bronchopleural fistula (BPF) is a relatively rare postoperative complication with high mortality. The management is tough and controversial. The aim of this study was to...
BACKGROUND
Bronchopleural fistula (BPF) is a relatively rare postoperative complication with high mortality. The management is tough and controversial. The aim of this study was to compare the short and long-term outcomes between the conservative and the interventional therapy in postoperative BPF. We also concluded our own strategy and experience of treatment in postoperative BPF.
METHODS
Postoperative BPF patients with malignancies, aged from 18 to 80 years old who had undergone thoracic surgery between June 2011 and June 2020, were included in this study and followed up from 20 months to 10 years. They were retrospectively reviewed and analyzed.
RESULTS
Ninety-two BPF patients were included in this study, 39 of whom underwent interventional treatment. Significant differences were found in the 28-day and the 90-day survival rates between the conservative and the interventional therapy (P=0.001, 43.40% 76.92%; P=0.006, 35.85% 66.67%). Simple conservative therapy was independently associated with 90-day mortality between the groups in postoperative BPF [P=0.002, hazards ratio (HR) =2.913, 95% confidence interval (CI): 1.480-5.731].
CONCLUSIONS
Postoperative BPF is notorious for its high mortality. Surgical and bronchoscopic interventions are recommendable in postoperative BPF as they guarantee better short and long-term outcomes compared with the conservative therapy.
PubMed: 37065580
DOI: 10.21037/jtd-22-1426 -
Journal of Personalized Medicine Nov 2023Stem cells are undifferentiated cells presenting extensive self-renewal features and the ability to differentiate "in vitro" and "in vivo" into a range of lineage cells,... (Review)
Review
Stem cells are undifferentiated cells presenting extensive self-renewal features and the ability to differentiate "in vitro" and "in vivo" into a range of lineage cells, like chondrogenic, osteogenic and adipogenic lineages when cultured in specific inducing media. Two major domains of clinical applications of stem cells in thoracic surgery have been investigated: regenerative medicine, which is a section of translational research in tissue engineering focusing on the replacement, renewal or regeneration of cells, tissues and organs to re-establish damaged physiologic functions; drug loading and delivery, representing a new branch proposing stem cells as carriers to provide selected districts with anti-cancer agents for targeted treatments.
PubMed: 38138859
DOI: 10.3390/jpm13121632 -
Heliyon Nov 2022To explore the effects of autologous free dermal graft combined with free myocutaneous flap on bronchopleural fistula (BPF) with empyema, we summarized and analyzed two...
OBJECTIVES
To explore the effects of autologous free dermal graft combined with free myocutaneous flap on bronchopleural fistula (BPF) with empyema, we summarized and analyzed two cases.
METHODS
Two patients with refractory empyema and BPF were treated with autologous free dermal graft combined with free myocutaneous flap. The treatment included debridement of empyema, rib resection drainage, repair of bronchopleural fistula, and free vastus lateralis myocutaneous flap transplantation to eliminate the empyema. After the free dermal graft was harvested from the healthy skin around the incision, it was inserted into the fistula and sutured with the surrounding pleural tissue. The keys to the operation lies in the anastomosis of the lateral circumflex femoral artery (LCFA), vein and nerve that supply the vastus lateralis muscle flap to the thoracodorsal vessels and nerves. After surgery, the empyema, air leakage, and the survival of the myocutaneous flap were observed.
RESULTS
There was no disease recurrence after follow-up for seven and six months, respectively. Re-examination of the chest computed tomography (CT) or magnetic resonance imaging (MRI) indicated that the abscess cavity had disappeared. No necrosis of the myocutaneous flap was observed after surgery.
CONCLUSION
The application of autologous free dermal graft combined with free vastus lateralis myocutaneous flap transplantation is effective in the treatment of patients with bronchopleural fistula with refractory chronic empyema, and the clinical effect is satisfactory.
PubMed: 36339755
DOI: 10.1016/j.heliyon.2022.e11251 -
Seminars in Plastic Surgery Feb 2011Intrathoracic defects continue to provide one of the most challenging problems faced by the reconstructive surgeon, particularly in the presence of bronchopleural...
Intrathoracic defects continue to provide one of the most challenging problems faced by the reconstructive surgeon, particularly in the presence of bronchopleural fistula. We review the principles of management of bronchopleural fistulae and empyema, with an emphasis on the Clagett principle, pedicled and free muscle flaps, and the concept of a "designed air fistula" in bronchopleural fistula management. Although the importance of muscle flap closure in intrathoracic defects is undisputed, the timing and relative superiority of muscle flap closure versus conventional thoracic-surgical techniques remains an unanswered question.
PubMed: 22294945
DOI: 10.1055/s-0031-1275173 -
Indian Journal of Cancer Dec 2015Bronchopleural fistula (BPF) complicating lung tumor ablation is rare but severe. The purpose of this article was to study its characteristics and treatments. (Review)
Review
BACKGROUND
Bronchopleural fistula (BPF) complicating lung tumor ablation is rare but severe. The purpose of this article was to study its characteristics and treatments.
MATERIALS AND METHODS
Two of 682 (0.3%) sessions of lung microwave ablation (MWA) were complicated with BPF and documented. Two electronic databases were searched for reported cases of BPF after lung tumor ablation. Case selection and data collection were done by 3 independent reviewers.
RESULTS
A 56-year-old man and a 61-year-old woman developed BPF after MWA and died. Thirteen cases (mean age 63.8, 61.5% male) of BPF with adequate information were identified from 8 articles. Of the 13 cases, 5 (38.5%) had pulmonary co-morbidity, 3 (23.1%) had a history of pulmonary surgery, 7 (53.8%) had a target tumor adjacent or abutting pulmonary pleura, and 6 (46.2%) developed severe infections. After chest tube placement, pleurodesis, endoscopic therapy, surgery, and other treatments, 12 were cured and 1 died of BPF and pneumonia.
CONCLUSION
BPF is a rare but severe complication of lung ablation, and the management needs a multidisciplinary and individualized treatment strategy.
Topics: Bronchial Fistula; Catheter Ablation; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pleural Diseases; Pneumothorax; Prognosis
PubMed: 26728673
DOI: 10.4103/0019-509X.172512 -
Interactive Cardiovascular and Thoracic... May 2013A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In pneumonectomy patients, is buttressing the... (Review)
Review
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In pneumonectomy patients, is buttressing the bronchial stump associated with a reduced incidence of bronchopleural fistula?'. Fifty-seven papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. One prospective randomized controlled trial was identified, which found significantly lower rates of bronchopleural fistula and empyema after pneumonectomy with the use of pedicled intercostal flap buttressing. Intercostal muscle flaps and pericardial flaps have been used in case series of high-risk patients, e.g. those with neoadjuvant therapy or extended resections, with low rates of subsequent bronchopleural fistulae. There is the least-reported evidence for thoracodorsal artery perforator and omental flaps. There is relatively little published evidence beyond the single randomized trial identified, with only a few comparison studies to guide clinicians. We conclude that there is evidence for flap buttressing in reducing the risk of bronchopleural fistulae after pneumonectomy in diabetic patients. Flap coverage in other high-risk situations, such as extrapleural or completion pneumonectomy, has been reported in case series with good results. Of the reported techniques, the evidence is strongest for the pedicled inter-costal flap.
Topics: Benchmarking; Bronchial Fistula; Comorbidity; Diabetes Mellitus; Evidence-Based Medicine; Humans; Incidence; Patient Selection; Pleural Diseases; Pneumonectomy; Respiratory Tract Fistula; Risk Assessment; Risk Factors; Surgical Flaps; Treatment Outcome
PubMed: 23357525
DOI: 10.1093/icvts/ivt002 -
Operative Techniques in Thoracic and... 2020Although rare, bronchopleural fistula (BPF) following anatomic lung resection is a serious complication associated with high rates of mortality (25%-71%). Risk factors...
Although rare, bronchopleural fistula (BPF) following anatomic lung resection is a serious complication associated with high rates of mortality (25%-71%). Risk factors for BPF include surgical approach, neoadjuvant therapy, diabetes mellitus, and chronic obstructive pulmonary disease. As neoadjuvant treatment is increasingly being administered to patients with locally advanced lung cancer, and as more patients are being diagnosed with lung cancer at an older age-elderly patients present with a higher index of multiple comorbidities-the incidence of BPF among patients undergoing anatomic resection for lung cancer is expected to increase. In this manuscript, we detail risk factors and considerations for BPF and describe a stepwise approach to treat BPF following lobectomy for lung cancer.
PubMed: 34177378
DOI: 10.1053/j.optechstcvs.2019.11.005 -
The Korean Journal of Internal Medicine Jul 2023
Topics: Humans; Bronchial Fistula; Pleural Diseases; Pneumonectomy; Postoperative Complications
PubMed: 36967593
DOI: 10.3904/kjim.2023.060 -
The Annals of Thoracic Surgery Nov 2022Bronchopleural fistulas (BPFs) represent a rare catastrophic complication of pulmonary resection and carry a high mortality rate. Surgical treatments of BPF are often...
Bronchopleural fistulas (BPFs) represent a rare catastrophic complication of pulmonary resection and carry a high mortality rate. Surgical treatments of BPF are often technically difficult and can be tolerated only by a limited number of patients, while less invasive endoscopic approaches show variable success rates, mainly related to the size of the fistula. In this report, we describe the successful treatment of a large BPF by means of endoscopic autologous fat implantation; we also discuss the technical details of this surgical procedure.
Topics: Humans; Pneumonectomy; Bronchial Fistula; Pleural Diseases; Endoscopy; Bronchi
PubMed: 35216996
DOI: 10.1016/j.athoracsur.2022.02.014