Decortication Research Articles

Effectiveness of autologous fibrin glue in preventing post-thoracotomy air leaks: a randomized controlled trial.

Post-thoracotomy air leaks remain a significant challenge in thoracic surgery. This randomized controlled trial assessed the efficacy of autologous fibrin glue in reducing air leaks following thoracotomy procedures. Conducted as a single-center, single-blind, randomized clinical trial, the study enrolled adult patients undergoing lung resection or decortication at a thoracic surgery clinic. Participants were randomly assigned to either the intervention group, receiving autologous fibrin glue application during surgery, or the control group, undergoing standard surgical procedures without glue application. Key inclusion criteria were adult patients undergoing elective thoracotomy for lung resection or decortication, while exclusion criteria included patients with severe comorbidities or contraindications to fibrin glue. A total of 40 patients were enrolled and randomized equally to the two groups. The group treated with autologous fibrin glue demonstrated a significant reduction in the duration of air leakage and chest tube drainage, along with a shorter hospital stay, compared to the control group. There were no statistically significant differences in postoperative complications between the groups. The application of autologous fibrin glue during thoracotomy procedures significantly reduces postoperative air leaks and hospitalization duration without increasing complication rates. This finding suggests a beneficial role of fibrin glue in thoracic procedures requiring lung resection or decortication.

Effectiveness of Surgical Treatment of Patients with Respiratory Tuberculosis Complicated with Chronic Pleural Empyema Depending on Spread of Intrapleural Pathological Alterations

INTRODUCTION: Chronic tuberculous pleural empyema (CTPE) is a severe form of tuberculous lesion characterized by a purulent-destructive process in the residual pleural cavity, gross irreversible morphofunctional specific alterations in the pleura forming within three-five months after appearance of clinical signs of pleurisy. Patients with respiratory tuberculosis (RT) complicated with pleural empyema, are the most severe contingent of patients in tuberculosis (TB) hospitals.
 AIM: To study effectiveness of surgical treatment of patients with RT complicated with CTPE depending on spread of pathological alterations in the parietal pleura.
 MATERIALS AND METHODS: The study included 65 patients (43 men, 66.2%, aged 2361 years; 22 women, 33.8%, aged 2665 years) with RT complicated with CTPE, who underwent surgical treatment in the volume of pleurectomy with decortication of lung. Patients were divided to 3 groups depending on spread of pathological alterations in the parietal pleura: group 1 (n = 40, 61.5%) with spread of CTPE not exceeding the surface area of one anatomical wall of the pleural cavity; group 2 (n = 15, 23.1%) with CTPE involving 23 anatomical walls of the pleural cavity; group 3 (n = 10, 15.4%) with CTPE involving all anatomical walls of the pleural cavity.
 RESULTS: The effectiveness of complex treatment of patients with RT complicated with CTPE was 92.3% (n = 60). In the period from 2014 to 2021, the rate of postoperative complications after pleurectomy with decortication of lung including simultaneous resection, was 12.3%, mortality rate 0% and postoperative recurrences of empyema 7.7%. Despite adequate postoperative conservative treatment, the achievement of clinical effect and the absence of postoperative recurrences were directly proportional to the spread of intrapleural alterations. The destructive widespread forms of PT with multiple and wide-range drug resistance of mycobacterium tuberculosis are more common among the patients with subtotal and total forms of CTPE.
 CONCLUSION: The obtained results evidence a high effectiveness of surgical treatment of the given category of patients irrespective of spread of pathological alterations in the pleura and lung.

Re-expansion Pulmonary Edema: A Rare Complication of Chest Drain Insertion in Spontaneous Pneumothorax.

Re-expansion pulmonary edema (RPE) after chest drain insertion is rare. The objective of this clinical case report is to highlight the importance of this chest drain insertion complication. A 35-year-old man presented to the emergency department with a chief complaint of shortness of breath and pleuritic chest pain. Further physical examination and radiographic investigations showed a left-sided hemipneumothorax. A chest drain was inserted, but subsequently the patient developed worsening shortness of breath, desaturation, and coughed out pink frothy sputum. Repeated chest radiographic and computed tomographic thorax findings suggested RPE. A nonrebreathable mask with high-flow oxygen was given to the patient to maintain his oxygen saturation. The patient was referred to the cardiothoracic team and was admitted to the hospital. Despite conservative management in the ward, the patient underwent lung decortication. Postdecortication, the left-sided lung re-expanded well, and the patient was discharged home. This case highlighted this rare, potentially fatal complication of chest drain insertion for spontaneous pneumothorax.

Local-Anaesthetic-Induced Myotoxicity in Interfascial Plane Blocks: A Comparative Study between Bupivacaine and Ropivacaine

Objective: Local-anaesthetic (LA)-induced myotoxicity in the use of peripheral nerve blocks has emerged as a topic of interest recently. Very few studies on human subjects have been done in this field, though the technique of nerve blocks is being widely practiced both for anaesthesia and analgesia. Studies have shown that bupivacaine induces reproducible skeletal muscle degeneration. The present study is thus aimed at comparing the myotoxicity induced by bupivacaine and ropivacaine in interfascial plane blocks.Material and Methods: The study was a randomized comparative study done at a tertiary care hospital. The subjects were randomly assigned into 3 groups of 50 patients each:- Group B, with patients in whom bupivacaine was used; Group R, comprised of patients in which ropivacaine was used, Group N, who received no fascial plane block during their procedures. An erector spinae block (ESP block) was performed for patients undergoing unilateral lung decortication or lobectomy. Creatine phosphokinase (CPK) levels at 6 and 24 hours after completion of surgery were taken in all 3 groups and compared with baseline values using Repeated Measures Analysis of Variance.Results: Baseline serum CPK levels were similar in all 3 study groups. Significant increases in serum CPK levels were noticed in group B compared to group R at 6 hours and 24 hours, with no increase in group N.Conclusion: The study showed that serum CPK, a marker of skeletal muscle injury and local-anaesthetic-induced myotoxicity, significantly rose at 24 hours after an ESP block and this increase was considerably higher in group B (bupivacaine) compared to group R (ropivacaine), indicating significantly higher myotoxicity with bupivacaine.

862 Successful Surgical Management of Chylothorax Secondary to Gorham-Stout Disease

Abstract Introduction Gorham-Scout Disease (GSD) is a rare skeletal disorder of unknown aetiology characterised by progressive osteolysis and excessive lymphovascular proliferation. Chylothorax is a severe and life-threatening complication of GSD that confers a poor prognosis. Literature review reveals only one previous case of successful surgical management for chylothorax secondary to GSD. Case presentation A teenage asylum seeker presented with a large left pleural effusion on a background of chronic left flank collection secondary to lymphovascular malformation. Cytological analysis of the fluid drained from chest drain insertion confirmed a chylothorax. A posterior rib excision biopsy helped to confirm the diagnosis of GSD. She had VATS ligation of the thoracic duct and talc pleurodesis, however, due to recollection and ongoing symptomatic discomfort, she subsequently underwent left thoracotomy, decortication of lung and pleurectomy. These surgical interventions helped to stabilise the chylothorax with ongoing management for GSD related to radiotherapy and pain control via the administration of bisphosphonates. Conclusions GSD is a rare disease that can develop a number of severe complications including a chylothorax. Management via surgical and radiotherapeutic techniques can provide long term remission, however, other modalities may be needed in order to optimise analgesic requirements.

Emergency thoracic surgery patients have worse risk-adjusted outcomes than non-emergency patients

BackgroundOutcomes for patients undergoing emergency thoracic operations have not been well described. This study was designed to compare postoperative outcomes among patients undergoing emergency versus nonemergency thoracic operations. MethodsWe retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program database (2005–2018). We identified patients who underwent emergency thoracic operations using current procedural technology codes. Patients were then sorted into 1 of 4 cohorts: lung and chest wall, hiatal hernia, esophagus, and pericardium. Emergency versus nonemergency outcomes were compared. Univariate logistic regression was performed with “emergency status” as the independent variable and 30-day postoperative outcomes as the dependent variables. Multiple logistic regression models were performed to control for preoperative factors. ResultsOf 90,398 thoracic operations analyzed, 4,044 (4.5%) were emergency. Common emergency operations were pericardial window (n = 580, 10.2%), laparoscopic hiatal hernia repair (n = 366, 8.9%), thoracoscopic partial lung decortication (n = 334, 8.1%), thoracoscopic wedge resection (n = 301, 7.3%), thoracoscopic total lung decortication (n = 256, 6.2%), and open repair of hiatal hernia without mesh (n = 254, 6.2%). In all 4 cohorts, 30-day postoperative complications occurred more frequently after emergency surgery. After controlling for patient characteristics, 8 complications were more frequent after emergency lung and chest wall surgery, 5 complications were more frequent after emergency hiatal hernia surgery, and 3 complications were more frequent after emergency pericardium surgery. Risk-adjusted complications were not different after emergency esophageal surgery. ConclusionPatients undergoing emergency thoracic operations have worse risk-adjusted outcomes than those undergoing nonemergency thoracic operations. Subset analysis is needed to determine what factors contribute to increased adverse outcomes in specific patient populations.

The complexities of complex treatment of a patient with widespread destructive pulmonary tuberculosis against the background of severe pulmonary bullous dystrophy after exogenous exposure to fine particles of coal dust in the anamnesis

An observation from practice is given – a staged surgical treatment of a patient with widespread destructive pulmonary tuberculosis with preXDR MBT against the background of severe bullous lung dystrophy after prolonged exogenous exposure to fine particles of coal dust in the anamnesis. Patient M., 42 years old, smoker, has been working as a loader at a railway station since the age of 20, unloading wagons with bags of coal at high temperatures without using personal protective equipment. He was ill with pulmonary tuberculosis 12 years ago, the original form: infiltrative tuberculosis of the upper lobe of the right lung in the phase of decay and insemination. He was treated with positive dynamics, was removed from the register 10 years ago, the real changes were revealed during a routine examination when applying for a vertebral hernia. According to computed tomography of the chest organs, a picture of fibrous-cavernous tuberculosis of the right lung with a system of polymorphic caverns with multiple foci of dropout in the left lung against the background of pronounced emphysema of both lungs was noted upon admission. He was admitted to the clinic with complaints of shortness of breath at rest (mMRC 3). The patient was selected therapy based on sensitivity data and individual intolerance. The patient underwent EC installation at the mouth of the upper lobe bronchus on the right, successfully, then at the mouth of the bronchus B6, the blocker was coughed up. Against the background of treatment, tuberculomas formed in the left lung. S1-2 resection of the left lung was performed. The patient suffered SARS CoV-2. After that, spontaneous pneumothorax occurred on the left, and therefore the pleural cavity was drained. Against the background of the lack of dynamics, a month after drainage, the patient was taken for revision of the left pleural cavity with suturing of defects, partial pleurectomy and decortication of the left lung. After 3 months, the patient had a bronchoblocker removed from the mouth of the ULB on the right and a combined resection of the right lung (upper lobectomy with S6) was performed, after which, in order to reduce the right hemithorax and reduce the overstretch of the right lung, thoracoplasty was performed with resection of the I-IV ribs on the right. Histological examination confirmed pulmonary tuberculosis against the background of exogenous exposure to fine particles of coal dust (by the type of hypersensitive pneumonitis of chronic course). As a result of treatment, the patient's symptoms of shortness of breath (mMRC 1) decreased, the patient was steadfastly abaculated and returned to a normal lifestyle.

ЕФЕКТИВНІСТЬ РІЗНИХ ВИДІВ ПАРІЄТАЛЬНОЇ ПЛЕВРЕКТОМІЇ З ДЕКОРТИКАЦІЄЮ ЛЕГЕНІ ПРИ ПАТОЛОГІЇ ПЛЕВРИ У ХВОРИХ НА ТУБЕРКУЛЬОЗ З МНОЖИННОЮ/ШИРОКОЮ ЛІКАРСЬКОЮ СТІЙКІСТЮ (МЛС/ШЛС-ТБ)

The aim was to compare the effectiveness of the use of “classical”, video-assisted, video-thoracoscopic pleurectomy with lung decortication in pleural disease in patients with tuberculosis with multiple/extensive drug resistance (MDR/EDR–TB) and to justify the optimal terms of application of these surgical interventions in accordance with the pathological process. Materials and methods. The results of treatment of 168 patients with pleural disease in patients with tuberculosis with MDR/EDR–TB in the Department of Thoracic Surgery and Invasive Diagnostic Methods of the National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky of the National Academy of Medical Sciences of Ukraine during 2006–2023. The operated patients were divided into four groups: Group I — 47 (28.0 %) patients who were operated on using “classic” pleurectomy with lung decortication using wide thoracotomy (“Classic” PE with DC); group II — 43 (25.6 %) patients who were operated on using video-assisted pleurectomy with lung decortication (VATS PE with DC); group III — 54 (32.1%) patients who were operated on using video thoracoscopic pleurectomy with lung decortication (VTS PE with DC); group IV — 24 (14.3%) patients who were operated on using “classical” pleurectomy with lung decortication and resection of the part of the lung parenchyma affected by the pathological process (Lung resection with PE with DC). Results and discussion. The overall effectiveness of surgery was 96,4 %, mortality — 1,2 %, morbidity — 10,1 %. In the early stages of the disease less invasive intervention should be preferred. In case of challenge to perform standard parietal pleurectomy with decortication of the lung, operation should start with videothoracoscopic revision. In certain cases, conversion to minithoracotomy using video-assisted decortication of the lung or wide lateral thoracotomy with the performance of “classic” pleurectomy decortication of the lung could be performed. When disease lasts less then 4 weeks, videothoracoscopic parietal pleurectomy with decortication of the lung achieves better results, and later wide thoracotomy with pleurectomy and decortication of the lung or video-assisted pleurectomy and decortication of the lung can be applied. Key words: pleurectomy with decortication, video-assisted pleurectomy, videothoracoscopic pleurectomy.

Physiotherapy management in the case of thoracotomy for right lung decortication: A case study

Thoracotomy is used to manage a variety of medical conditions, including lung cancer, pulmonary infections, and chest injuries. Decortication surgery is indicated in the case of a thickened pleural layer leading to atelectasis of the underlying lung parenchyma. It is done to prevent further restriction of the lung parenchyma. Atelectasis, pleural effusion, pneumonia, and consolidation following decortication are common complications of the surgery. Physiotherapy following decortication helps in preventing damage to the lungs and also helps in maintaining and regaining good lung function postsurgery. This is a right-sided lung decortication thoracotomy surgical procedure where physiotherapy interventions were given preoperatively and early postsurgical care was taken for adequate lung expansion and to reduce respiratory complications following it. Incentive spirometer (4 times/day) with breath hold technique (3 s.) along with conventional physiotherapy interventions such as chest mobility exercise, breathing exercises, breath control techniques, and early mobilization in the form of long sitting at the end of a bed, high sitting, chair sitting, standing, walking, and stair climbing were improved in chest expansion, functional activities, rating of perceived exertion level, and reduced pain level.

Pioneer of Cardiothoracic Surgery - Joaquim Cavalcanti.

Joaquim de Souza Cavalcanti was a pioneer among us - the Brazilian State of Pernambuco and North-Northeast region - in cardiac surgery in its initial phase (Blalock-Taussig surgery and mitral valvulotomy), in thoracic surgery (pneumectomy, lung lobectomy and segmentectomy, lung decortication, and mediastinal tumor resection), and in numerous techniques and operative tactics in general surgery.

Use of embolectomy catheter for lung isolation in pediatric patients undergoing lung decortication surgery: experience of ten cases

AbstractBackgroundPediatric one lung ventilation is challenging to achieve; smaller the child greater is the challenge. Challenge gets bigger due to unavailability of proper sized lung isolation devices. The aim of this case series was to assess the feasibility of using embolectomy catheter for lung isolation in 10 children who were planned to undergo lung decortication surgery.ResultsAge wise predictions of airway diameters were used to select sizes of endotracheal tube and embolectomy catheter. We used a Fogarty catheter, with its tip bent to 30° and placed parallel to a cuffed endotracheal tube, under fiberoptic bronchoscope guidance to achieve lung isolation. Desired lung was deflated passively after achieving lung isolation. Embolectomy catheter cuff position was reconfirmed with bronchoscopy after patient positioning. Ages of children ranged from 2 to 6 years. Four patients required right lung isolation while six required left lung isolation. Dislodgement of embolectomy catheter while positioning or during surgery did not occur in any case. Surgeons reported good to excellent lung isolation in all the cases. All cases were successfully extubated at the end of surgery.ConclusionsEmbolectomy catheter for one lung ventilation in pediatric cases maybe a useful alternative in absence of customized devices.

Aspergillus pleural empyema in a chronic smoker – A case report and review of literature

Aspergillus species are ubiquitous saprophytic fungi that are present in the air, water, soil, and decaying vegetables. Clinical features of Aspergillus infection largely depend on the interplay between the fungi and the host immune status. We present a case of a chronic smoker with shortness of breath who was found to have diffuse bronchiectatic changes and empyema of the right lung. Emphysema was also noticed in the left lung. Rare Aspergillus fumigatus was identified in the pleural fluid, while the acid-fast stain and bacterial cultures were negative. The patient's serum Aspergillus fumigatus IgG antibody and galactomannan antigen were negative; however, the pleural galactomannan antigen was elevated. He was treated with video-assisted thoracoscopic surgery (VATS) and partial decortication of the right lung, along with intravenous voriconazole. Despite aggressive therapeutic measures, he died after a prolonged hospital stay. Aspergillus pleural empyema is rare but can be fatal; however, it is not included in the classification for pulmonary aspergillosis. Clinicians should be vigilant to evaluate for fungal empyema in patients with chronic obstructive pulmonary diseases, even without profound immunosuppression.

A RARE CASE OF ACTINOMYCES TURICENSIS EMPYEMA IN AN IV DRUG USER

A RARE CASE OF ACTINOMYCES TURICENSIS EMPYEMA IN AN IV DRUG USER

Thoracic Epithelioid Hemangioendothelioma: clinical demonstration and therapeutic procedures.

Epithelioid hemangioendotheliomais a low to intermediate grade malignant vascular tumors that can involve any organ. About 60-80%of patients are women, patient ages range 7 to 81 years, with a median age of 38 years. Four cases of thoracic epithelioid hemangioendotheliomas with different clinical presentation and disease progression are reported. Cases 1 and 2 are pulmonary epithelioid hemangioendotheliomas diagnosed at different advanced stages and patients died after 6 and 2,5 months of medical treatment, respectively. Case 3 corresponds to pleural epithelioid hemangioendothelioma, submit- ted to left lung decortication and pleuro-pericardial window; patient is free either from symptoms and radiographic manifestations for 10 months of follow-up. Case 4, of mediastinal epithelioid hemangioendothelioma, represented by a mass in the upper left mediastinum adherent to the aortic arch; patient underwent block excision of the mass followed by chemotherapy; subsequent recurrence 41 months later and the patient died 8 months after. The reported 4 cases reveal the heterogeneous clinical presentation of epithelioid hemangioendotheliomas with behavior in between benign and high-grade tumors, raising difficulty in either differentiating from other vascular tumors and previewing clinical outcome.

Surprise evidence of a bronchial rent in a case of pulmonary Koch’s posted for lung decortication using the one-lung ventilation protocol

Tracheobronchial injury is a potentially life-threatening clinical scenario. In the case of surprise evidence of bronchial wall tear while doing lung surgery, tracheal tube extubation and post-operative management pose a challenge to the anaesthesiologist. We present a case of a 16-year-old girl, a known case of pulmonary Koch’s taking anti-Koch’s treatment, admitted with hydropneumothorax, who was posted for left lung decortication. She presented with complaints of left-sided chest pain and cough since 3 months and a weight loss of 13 kg in 3 months. An inter-costal drain was inserted on the left side.Her high-resolution computed tomography thorax showed multiple cavitatory lesions with ground glass opacities in right lung parenchyma,Hydropneumothorax from the upper lobe to lower lobe of the left lung; consolidation, calcification in the left lower lobe; mediastinal shift toward the right.In the Operation theatre, the patient was pre-oxygenated, induced with Inj Propofol + Inj Fentanyl + Inj Suxamethonium according to the patient’s weight, and intubated with a 28 Fr’ left-sided double lumen tube (DLT). Left-sided decortication was performed uneventfully. On conclusion of surgery, while checking for leaks, it was noted that the exhaled tidal volume was unacceptably low and a rent on the left main bronchus of around 2 x 2 cm with scarred borders was detected, which was repaired with tissue patch suturing by the surgeons. After closure, the DLT was removed and re-intubation was performed with endotracheal tube no. 6. The patient was shifted to the intensive care unit, electively ventilated, and gradually weaned off in 2 days. Then, the patient was discharged in a week.To conclude, meticulous planning, vigilant monitoring of vital parameters, and close communication between the surgeons and the anaesthesiologists are essential to timely manage a life-threatening complication.

CT findings predicting lung resection in children with complicated community-acquired pneumonia.

To investigate computed tomography (CT) features which predict lung resection in children with complicated community-acquired pneumonia. A retrospective study of CT findings of patients with complicated pneumonia treated between January 2010 and December 2019. Fisher's exact test and ROC curves were used for statistical analysis. The study cohort consisted of 84 patients who underwent chest CT for complicated pneumonia. Lung resection was performed in 36 patients, 3 patients were treated by lung decortication, 45 patients were cured conservatively. Seven CT features were found statistically significant among the patients who underwent lung resection. 80.5% of patients from the resection group had two or more of these features on the initial CT scan, 64% had three or more. According to ROC analysis, simultaneous occurrence of multiple cavities equal to or greater than 3cm and lung abscess predicted a pulmonary resection. The combination of CT features which clearly predict lung resection are the simultaneous occurrence of multiple cavities ≥ 3cm and lung abscess. The most common triple combination of CT signs in the resected group of patients were multiple cavities ≥ 3cm, consolidation of lung tissue and pleural effusion < 3cm.

Early video-assisted thoracoscopic surgery (VATS) for non-emergent thoracic trauma remains underutilized in trauma accredited centers despite evidence of improved patient outcomes

Thoracic injury is a major contributor to morbidity in trauma patients. There is limited data regarding practice patterns of video-assisted thoracoscopic surgery (VATS) across trauma-accredited hospitals in the United States. We hypothesized that early VATS remains underutilized affecting patient outcomes. We evaluated a cohort of patients who underwent non-urgent thoracic surgical intervention for trauma from the ACS-TQIP database in 2017 excluding patients who were discharged within 48-h or died within 72-h. We selected patients who underwent partial lung resection and decortication to assess the effect of early (day 2-5) versus late VATS. Univariate followed by multivariate regression analyses were utilized to evaluate the independent impact of timing. Over 12months, 997,970 patients were admitted to 850 trauma-accredited centers. Thoracic injury occurred in 23.5% of patients, 1% of whom had non-urgent thoracic procedures. A total of 406 patients underwent VATS for pulmonary decortication with/out partial resection, 39% were Early VATS (N = 159) compared to 61% late VATS (N = 247). Both groups had comparable demographics and comorbidities with exception of a higher ISS score in the late surgical group (17.9 ± 9.8 vs 14.9 ± 7.6, p < 0.01). The late VATS patients' group had higher rates of superficial site infection, unplanned intubation, and pneumonia. Early VATS was associated with shorter ICU stay and HLOS. Multivariate analysis confirmed the independent effect of surgical timing on postoperative complications and LOS. The conversion rate from VATS to thoracotomy was 1.9% in early group compared to 6.5%, p = 0.03. There was no difference in surgical pattern among participating facilities. Despite established practice guidelines supporting early VATS for thoracic trauma management, there is underutilization with less than half of patients undergoing early VATS. Early VATS is associated with improved patient outcomes.

РЕЗУЛЬТАТИ ПАТОГІСТОЛОГІЧНОГО ДОСЛІДЖЕННЯ ОПЕРАЦІЙНОГО МАТЕРІАЛУ З ВИЗНАЧЕННЯМ СТУПЕНЮ МОРФОЛОГІЧНОЇ АКТИВНОСТІ ТУБЕРКУЛЬОЗНОГО ПРОЦЕСУ ТА КЛІНІЧНА КАРТИНА ХВОРИХ З ТБ ПІСЛЯ VATS РЕЗЕКЦІЙ ТА VATS ПЛЕВЕКТОМІЙ З ДЕКОРТИКАЦІЄЮ ЛЕГЕНІ

RESULTS OF HISTOLOGICAL EXAMINATION OF POST-OPERATIVE SPECIMENS WITH DETERMINATION OF DEGREE OF MORPHOLOGICAL ACTIVITY OF TUBERCULOSIS AND CLINICAL PRESENTATION OF TUBERCULOSIS PATIENTS AFTER VATS RESECTION AND VATS PLEUROECTOMY WITH DECORTICATION OF LUNG M. S. Opanasenko, I. V. Liskina, V. I. Lysenko, L. M. Zagaba, O. V. Tereshkovich, B. M. Konik, L. I. Levanda, S. M. Shalagai, M. I. Kalinichenko, M. U. Shamrai Abstract Patients with pulmonary tuberculomas of different histological structure, as well as pulmonary fibrous-cavernous tuberculosis (FCT) are subject to surgical treatment. These phase-forms require careful morphological examination, which provides an objective determination of the degree of activity of a specific inflammatory process. Materials and methods. 165 patients were examined: 130 (78,8 %) patients with different forms of tuberculosis and 35 (21,2 %) patients with tuberculosis of pleura. Morphological determination of the degree of activity of specific inflammation was performed according to the developed classification using hematoxylin and eosin staining. Specific lung lesions were detected in 130 (78.8 ± 3.2)% of cases, pleural TB was histologically detected in 35 (21.2%). Results and discussion. Most VATS resections were performed on tuberculosis - 98 (75.4%), 19 (14.6%) cases were operated on with FCT, 11 (8.5%) patients had post-tuberculosis changes. 2 (1.5%) patients underwent surgery for infiltrative tuberculosis. The following degree of morphological activity of tuberculous inflammation was established in the resection samples: high - 28 (21.5%), moderate - 42 (32.3%) and low - 60 (46.2%) cases. The degrees of morphological activity of the operative material and clinical symptoms were compared: low activity was found in 60 (46.2%) patients, 14 (10.8%) of them had typical symptoms of TB; measurable activity was found in 42 (32.4%), of which 21 (16.2%) patients had a clinical picture of TB; 28 (21.5%) patients had high activity, 22 (78.6%) of them showed symptoms, and in 8 (36.4%) patients of this subgroup the sputum was positive for Mycobacteria. These data do not demonstrate clear correlation, but suggest a a significant difference between groups. Chronic TB pleurisy was detected in 18 (51.4%) cases. It was characterized by the growth of coarse fibrous connective tissue with the presence of epithelioid-cell granulomas, and typical clinical and radiological symptoms. Conclusions. Determining the morphological degree of activity of specific inflammation allows to prescribe additional courses of anti-TB therapy. Low activity - 60 observations (46.2%), moderate degree - 42 cases (32.3%), high morphological degree - 28 (21.5%) cases. Different types of tuberculoma show different degrees of morphological activity. A significant difference was found between the presence of the clinical picture of TB in morphologically high and low levels of specific inflammatory activity. In tuberculosis of pleura patients with subacute or chronic course should receive surgery. Typical clinical presentation is usually observed in these patients. Key words: tuberculosis, morphological degree of activity, tuberculoma. Ukr. Pulmonol. J. 2022;30(4):28–33.

Catamenial pneumothorax – are there benefits of cooperation between the surgeon and the gynaecologist?

Catamenial pneumothorax (CP) is an uncommon disease related to thoracic endometriosis or diaphragmatic perforation. It is defined as an occurrence of spontaneous pneumothorax around the time of menstruation in the population of women of reproductive age with no other lung diseases. Catamenial pneumothorax is often misdiagnosed and classified as a spontaneous pneumothorax, and no in-depth gynaecological diagnostic is performed. Here we present 3 cases of female patients admitted to the Department of Thoracic Surgery with the aim of surgical treatment of recurrent CP. In all 3 cases, a temporal association between pneumothorax and menstruation was identified. In 2 presented cases the patients were diagnosed with endometriosis and other gynaecological diseases. The previous incidents of CP were treated conservatively, with suction drainage of the pleural cavity or with thoracocentesis, but the treatment did not prevent relapses. In the Department of Thoracic Surgery, each patient was operated on with the use of video-assisted thoracoscopic surgery, which is considered to be a good therapeutic option. In the case of 2 patients the surgery eliminated the relapses, 1 patient required radical lung decortication. The literature on the subject indicates the potential benefits of hormonal treatment of CP. It is suggested that using such pharmacological treatment may reduce the risk of relapse after surgery.

THE PROBLEM OF THE SURGICAL TREATMENT OF NON-SPECIFIC CHRONIC PLEURAL EMPYEMA: LITERATURE REVIEW

Despite the rapid development of thoracic surgery, the problem of the surgical treatment of non-specific chronic pleural empyema remains relevant. The variability of the proposed treatment methods: puncture and drainage interventions aimed at pleural cavity sanitation, minimally invasive videothoracoscopic surgeries and traditional lung decortication, dictates the need for case-by-case surgical tactics and determining the stages and duration of the above methods. Treatment outcomes are significantly worsened by the presence of bronchial fistulas, which either cause the development of chronic pleural empyema or develop as a result of its presence and late treatment. Some answers to these key questions are provided in this paper, which aims to identify them in the Ukrainian and foreign literature.