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Prilozi (Makedonska Akademija Na... Sep 2017Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced...
UNLABELLED
Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need to use extensive surgery - decortications or thoracoplasty. Early recognition of the parapneumonic effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally invasive, is possible not to prograde the process and not to become empyema.
AIM
To analyze the results of the surgical treatment in patients with empyema treated at Clinic for thoracic surgery.
MATERIAL AND METHODS
In the retrospective study we analyzed 234 patients with empyema which were treated at the Clinic for Thoracic Surgery in 5 year period (2011-2015). The mean age of the patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty.
RESULTS
With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total of 108/234 (46.15%) were treated with decortications from which, primary decortications were indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty - 3 of the patients with decortications and 2 with primary indicated thoracoplasty according to the local findings, long term untreated empyema and bad general condition. The Mean hospitalization was 17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and 2/5 (40%) in the group with thoracoplasty.
CONCLUSION
Early detection of the parapneumonic effusion and the adequate treatment will prevent the appearance of empyema. If the empyema is detected it is necessary as early as possible to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to use less invasive decortications, using VATS than the open thoracotomy decortication which is more extensive surgical intervention.
Topics: Drainage; Empyema, Pleural; Female; Humans; Length of Stay; Male; Middle Aged; Postoperative Complications; Republic of North Macedonia; Retrospective Studies; Risk Factors; Thoracoplasty; Time Factors; Treatment Outcome
PubMed: 28991771
DOI: 10.1515/prilozi-2017-0027 -
Journal of Thoracic Disease Mar 2020The long history of the struggle against tuberculosis (TB) inspired us to develop a new minimally invasive technique of thoracoplasty with videothoracoscope control...
BACKGROUND
The long history of the struggle against tuberculosis (TB) inspired us to develop a new minimally invasive technique of thoracoplasty with videothoracoscope control (VATP). The aim of this study was to determine its efficacy.
METHODS
We conducted a retrospective single-center study of a cohort of patients operated on between 1999 and 2017. Two hundred eight patients who were indicated for thoracoplasty with verified TB with cavities in the upper lobe/S6 were enrolled in this study. Treatment outcomes were assessed based on Laserson criteria and active TB absence verified with CT.
RESULTS
Intraoperative and postoperative complications were observed in 15 (7.2%) and 4 (2.0%) cases, respectively. There were no 30-day mortalities. VATP with curative intent succeeded in 88% of cases according to Laserson criteria and active TB absence verified with computed tomography (CT). Clinical improvement (sputum negativity, closure of caverna, and lack of reactivation for 3 years) was achieved in 81% of cases.
CONCLUSIONS
Comparing the successful results of this technique in the cohort of multidrug-resistant (MDR) TB patients with the outcomes of treatment of MDR TB worldwide (77% vs. 55%, respectively), the VATP technique is shown to be efficacious and thus recommended.
CLINICAL TRIAL REGISTRY NUMBER
ISRCTN67743278.
PubMed: 32274167
DOI: 10.21037/jtd.2019.11.67 -
BMC Musculoskeletal Disorders Jul 2020Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity in children and adolescents which presents as complex three-dimensional (3D) deformity... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity in children and adolescents which presents as complex three-dimensional (3D) deformity of the spine and rib cage. This study aimed to estimate the effectiveness and safety of surgical interventions for AIS using Bayesian meta-analysis.
METHODS
The PubMed, EMBASE, and Cochrane Controlled Register of Trials were searched through Oct 1, 2019, without language restrictions. Relevant studies evaluating combined effectiveness and safety of surgical interventions for AIS were included according to eligibility criteria. The primary outcome measures included pulmonary function (change of absolute forced vital capacity and forced expiratory volume in 1 second from pre-operation to post-operation) and incidence of complications. The secondary outcome measure was change of Cobb angle from pre-operation to post-operation. Data was pooled using a random effects model in pairwise meta-analysis. Bayesian meta-analysis combined direct and indirect evidence using a Bayesian framework.
RESULTS
Twenty-eight case-controlled studies with totally 1970 participants were included. This Bayesian meta-analysis combining direct and indirect evidences indicated that posterior fusion with instrumentation without thoracoplasty (PSF) had the highest probability to achieve better pulmonary function and lower complication rate; video assisted anterior fusion with instrumentation without thoracoplasty (VAT) had the highest probability to obtain better Cobb angle correction based on analysis of rank probability.
CONCLUSION
This Bayesian meta-analysis demonstrated that PSF had the highest probability to achieve better post-surgical pulmonary function and lower complication rate, which gives a practical recommendation of PSF as a primary surgical treatment for AIS. The results also support statistics that current surgeries adopted more PSF but less open anterior approach surgery and thoracoplasty. More research work is required to address the effectiveness and safety of VAT for treating AIS more convincingly.
Topics: Adolescent; Bayes Theorem; Humans; Lumbar Vertebrae; Respiratory Function Tests; Scoliosis; Spinal Fusion; Thoracic Vertebrae; Thoracoplasty; Treatment Outcome
PubMed: 32615956
DOI: 10.1186/s12891-020-03233-1 -
Pediatric Surgery International Mar 2023Malignant chest wall tumors are rare in pediatrics. They require multimodal oncological treatment and local surgical control. Resections are extensive; therefore,...
PURPOSE
Malignant chest wall tumors are rare in pediatrics. They require multimodal oncological treatment and local surgical control. Resections are extensive; therefore, thoracoplasty should be planned to protect intrathoracic organs, prevent herniation, future deformities, preserve ventilatory dynamics, and enable radiotherapy.
METHODS
We present a case series of children with malignant chest wall tumors and our surgical experience with thoracoplasty using absorbable rib substitutes (BioBridge), after local surgical control. BioBridge is a copolymer made of a polylactide acid blend (70% L-lactic acid y 30% DL-lactide).
RESULTS
In 2 years, we had three patients with malignant chest wall tumors. Resection margins were negative, without recurrence at follow-up. We achieved good cosmetic and functional results, and no postoperative complications.
CONCLUSION
Alternative reconstruction techniques such as absorbable rib substitutes provide protection, guarantee a flexible chest wall, and do not interfere with adjuvant radiotherapy. Currently, there are no management protocols in thoracoplasty. This option represents an excellent alternative for patients with chest wall tumors. Knowledge of different approaches and reconstructive principles is essential to offer children the best onco-surgical option.
Topics: Humans; Child; Thoracoplasty; Thoracic Wall; Combined Modality Therapy; Neoplasms; Ribs
PubMed: 36869935
DOI: 10.1007/s00383-023-05413-1 -
Bulletin of the New York Academy of... Mar 1973
Review
Topics: Aminosalicylic Acids; Collapse Therapy; Europe; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; History, Modern 1601-; Hospitals, Special; Humans; Isoniazid; Phrenic Nerve; Pneumothorax, Artificial; Radiography; Rest; Streptomycin; Sulfonamides; Thoracoplasty; Tuberculosis, Pulmonary; United States
PubMed: 4572586
DOI: No ID Found -
Journal of Medicine and Life 2015Up to the middle of the last century, the thoracic spine, especially in its upper part, has been considered an unapproachable site, a no-man's land, but the constant... (Review)
Review
BACKGROUND
Up to the middle of the last century, the thoracic spine, especially in its upper part, has been considered an unapproachable site, a no-man's land, but the constant evolution of medicine imposed techniques of the spine at these levels in order to solve a large area of pathology (infectious, tumoral, traumatic, and last but not least, deformative). This way, a series of anterior approaches allowed surgeons to gain access to the anterior part of the spine and the posterior mediastinum. The approaches described by Hodgson, Mirbaha or transthoracic transpleural approach (T4-T11), are enumerated. The idea to allow a more visible and extensive approach, but to avoid respiratory issues due to the lesion of the pleura, led to the description of a new anterior approach by Burnei in 2000.
MATERIAL AND METHOD
Burnei's approach represents an anterior approach to the thoracic spine, being a transthoracic and retropleural one. This approach allows a large area of spinal pathology due to infectious, traumatic, tumoral and degenerative (idiopathic or congenital scoliosis) causes. Statistically, this approach has been performed more frequently in cases of spinal instrumentation after diskectomy, in order to perform a partial correction of severe, rigid idiopathic scoliosis with more than 70 degrees Cobb and in cases of congenital scoliosis for hemivertebra resection and somatic synthesis to correct the scoliotic curve.
RESULTS
This kind of anterior approach allows the surgeon a large visibility of the anterior thoracic spine, diskectomies of up to 5 levels to tender the curve of the deformity and to ensure somatic or/ and transpedicular synthesis of up to 6 thoracic vertebrae. By performing a thoracotomy involving the resection of the posterior arches of the ribs, a thoracoplasty is also ensured with functional and aesthetic effects, by ameliorating the thoracic hump due to the scoliotic deformity.
CONCLUSIONS
Burnei's approach joins all the other anterior approaches of the spine, addressing a large area of pathology of the thoracic spine. Even if difficult to be performed, requiring a thorough and perfect technique in the hands of a skilled surgeon, it will ensure satisfaction due to the detailed and visible exposure of the thoracic spine.
Topics: Brunei; Humans; Pleura; Plastic Surgery Procedures; Scoliosis; Spinal Cord Diseases; Thoracic Vertebrae
PubMed: 25866572
DOI: No ID Found -
Interactive Cardiovascular and Thoracic... Jun 2021Minimally invasive repair of pectus excavatum (MIRPE) is the most popular surgical approach for paediatric patients with pectus excavatum. A substernal stainless still...
OBJECTIVES
Minimally invasive repair of pectus excavatum (MIRPE) is the most popular surgical approach for paediatric patients with pectus excavatum. A substernal stainless still bar is inserted and left in place for 3 years and then removed. Our goal was to investigate blood metal levels after MIRPE and to correlate them with surgical details, such as the numbers of bars and stabilizers and the length of time the bar was in place.
METHODS
Blood levels of iron, chromium, manganese, molybdenum and nickel were analysed in 130 teenagers (108 boys and 22 girls) who had MIRPE using inductively coupled plasma mass spectrometry. A total of 62 patients were operated on using MIRPE (study group) and 68 patients were evaluated at implant time (control group). Differences between the numbers of bars implanted and the presence or absence of stabilizers were also considered.
RESULTS
Significant increases in the levels of abnormal chromium were found in patients in the study group compared with the controls (P = 0.02). When we compared the group of patients with 2 or more bars with the group with 1 bar, the percentage of patients with a value above the threshold increased by 29 (P = 0.05). A significant increase in chromium levels was observed in patients with stabilizers (P = 0.03). Above-threshold levels of molybdenum were found in 5.1% of patients in the control group, but the number was not statistically significant (P = 0.09).
CONCLUSIONS
We demonstrated that stainless steel devices used in MIRPE can elevate blood metal levels in paediatric patients. Moreover, we demonstrated that the use of metal stabilizers is associated with higher metal levels, probably due to increased dispersion.
Topics: Adolescent; Child; Female; Funnel Chest; Humans; Male; Minimally Invasive Surgical Procedures; Prostheses and Implants; Plastic Surgery Procedures; Retrospective Studies; Thoracoplasty
PubMed: 33686408
DOI: 10.1093/icvts/ivab052 -
Spine Aug 2018In a treatment-control animal study expansion thoracoplasty (ET) was performed in a juvenile rabbit model of thoracic insufficiency syndrome (TIS) and benefits to...
STUDY DESIGN
In a treatment-control animal study expansion thoracoplasty (ET) was performed in a juvenile rabbit model of thoracic insufficiency syndrome (TIS) and benefits to thoracic development and respiratory function quantified. Rabbits treated early versus late were compared to age-matched normal and disease control rabbits through to skeletal maturity.
OBJECTIVE
Evaluate (1) how ET changes the natural TIS disease trajectory and (2) how timing of ET affects changes in spine growth, lung growth, and respiratory mechanics.
SUMMARY OF BACKGROUND DATA
Pulmonary growth potential is thought to diminish with age; thus, early therapeutic intervention may increase pulmonary growth in children with TIS. However, no direct empirical evidence exists to support this treatment paradigm.
METHODS
Convex left scoliosis and resultant TIS was induced in 3-week-old rabbits via surgical rib tethering. We compare the efficacy of ET performed at 7 weeks and expanded at 11 weeks (early, n = 7) versus only at 11 weeks of age (late, n = 7) in preserving lung growth and respiratory function relative to normal (n = 8) and disease (n = 10) rabbits. Sequential computed tomography images and pulmonary function testing was performed to quantify spine curvature, lung growth, and respiratory volumes. At 28 weeks of age chest wall elastance was measured in vivo then acinar complexity analyzed histologically via radial alveolar counts.
RESULTS
ET performed early or late altered the predicted trajectory of spine deformity, pulmonary growth inhibition, and respiratory dysfunction seen in disease rabbits. Growth was not significantly different between early and late rabbits and post-treatment gains remained below those of age-matched normal rabbits. Chest wall elastance was impaired by ET and more so in early rabbits, there were no differences in pulmonary elastance.
CONCLUSION
ET interrupted the natural progression of deformity and pulmonary hypoplasia associated with spine curvature in disease rabbits. However, growth benefits are only seen in cases of the most severe initial deformity and must be balanced against the further impairment to chest wall function associated with repetitive surgery.
LEVEL OF EVIDENCE
N/A.
Topics: Animals; Lung; Lung Volume Measurements; Models, Animal; Rabbits; Respiratory Function Tests; Respiratory Insufficiency; Ribs; Scoliosis; Thoracoplasty; Treatment Outcome
PubMed: 29985869
DOI: 10.1097/BRS.0000000000002573 -
International Journal of Surgery... 2013To study the effect of the thoracoplasty on the pulmonary function after the posterior scoliosis correction operation.
OBJECTIVE
To study the effect of the thoracoplasty on the pulmonary function after the posterior scoliosis correction operation.
METHODS
From June 2001 to June 2010, 60 thoracic scoliosis patients (24 males, 36 females) were collected. Their average age was 17.6 ± 5.0 years. All patients underwent posterior 3-dimensional operation and thoracoplasty. The pulmonary function was examined preoperatively, 3 months, and 24 months after the operation. The correlation between the postoperative decrease ratio of pulmonary function parameters and postoperative recovery time was analyzed by Pearson correlations.
RESULTS
The average Cobb's angle in the coronal plane was corrected from 99.1° ± 17.6° preoperatively to 49.8° ± 11.8° postoperatively, with the average correction ratio of (44.3 ± 12.6) %. There were significant decrease in the pulmonary function parameters 3 months after the operation [vital capacity (VC), 14.4%; percentage of the VC with measured/predicted value (VC%), 14.7%; forced vital capacity (FVC), 15.7%; percentage of the FVC with measured/predicted value (FVC%), 16.6%; the first second forced expiratory volume (FEV1), 13.2%; the percentage of FEV1 with measured/predicted value (FEV1%), 12.9%] (P < 0.05). The pulmonary function parameters at the last follow-up were slightly higher than the preoperative parameters, but the statistical difference was not significant (P > 0.05). The decrease ratio of postoperative pulmonary function parameters and the postoperative recovery time was positively correlated.
CONCLUSION
The pulmonary function will be decreased obviously after the thoracoplasty and the posterior scoliosis correction operation in the short time, but returns to the normal level after 2 years.
Topics: Adolescent; Adult; Female; Follow-Up Studies; Forced Expiratory Volume; Humans; Lung; Male; Scoliosis; Thoracoplasty; Vital Capacity; Young Adult
PubMed: 23747977
DOI: 10.1016/j.ijsu.2013.05.035 -
Pneumologie (Stuttgart, Germany) Aug 2015Pleural empyema in a post-pneumonectomy cavity (PEC) occurs with a frequency of 2% -15% and a mortality of more than 10%. It can occur with or without bronchopleural... (Review)
Review
INTRODUCTION
Pleural empyema in a post-pneumonectomy cavity (PEC) occurs with a frequency of 2% -15% and a mortality of more than 10%. It can occur with or without bronchopleural fistula (BPF). The treatment of empyema in the PEC requires a strict algorithm: drainage, bronchoscopy, closure of the fistula, thorough cleaning of the PEC, filling the cavity, thoracoplasty.
METHODS
39 cases with an empyema in the PEC were analysed retrospectively (men: n = 38; women: n = 1; mean age: 60.3 ± 7.6 years). In 32 (82.1%) of the patients, a BPF was detected (right: n = 26, left: n = 6). The average length of stay in hospital was 125 days (22 - 293 days). Cleaning of the PEC was achieved in all surviving patients (n = 23, 65.1%). All patients (n = 39) underwent bronchoscopy with placement of a chest tube for drainage. The BPF was closed in three cases (7.7%) with a stent while in 12 cases (30.8%) a vascularized flap was used. In 14 patients (35.9%) the bronchial stump was either reclosed with sutures or resected. In three cases (7.7%) a re-anastomosis was performed.
RESULTS
The PEC became sterile by regular flushing with antibiotic solution in three patients (7.7%). In 35.9% of the patients (n = 14), aggressive surgical debridement (Weder procedure) was necessary. A thoracic window was applied in 22 patients (56.4%), followed by negative pressure wound therapy (NPWT) and change of dressing every three to four days or a tamponade of the thoracic cavity with simple dressings. In 19 patients (48.7%) the thoracic cavity was sealed with an antibiotic solution. In 5 cases an Alexander thoracoplasty took place.
CONCLUSIONS
Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Thus, two problems arise at the same time – fistula and infection in the pleural cavity. Through a strict algorithm, both problems can be dealt with in stages. After sealing the fistula, the thoracic cavity is thoroughly cleaned and finally the thorax is closed. Only in a small number of patients (1.3%) in whom these measures remain ineffective (persistent MRSA, aspergillus colonization) should the cavity be obliterated by thoracoplasty.
Topics: Adult; Anti-Bacterial Agents; Bronchoscopy; Chest Tubes; Combined Modality Therapy; Drainage; Empyema, Pleural; Female; Humans; Male; Negative-Pressure Wound Therapy; Symptom Assessment; Treatment Outcome
PubMed: 26258420
DOI: 10.1055/s-0034-1392330