Decortication Research Articles

Mediastinal pancreatic cysts: review and own clinical observations

To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC). There were 5 patients with MPC. Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide. MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.

Lung decortication in phase III pleural empyema by video-assisted thoracoscopic surgery (VATS)-results of a learning curve study.

Pleural empyema (PE) is a devastating disease with a high morbidity and mortality. According to the American Thoracic Society it is graduated into three phases and surgery is indicated in intermediate phase II and organized phase III. In the latter, open decortication of the lung via thoracotomy is the gold standard whereas the evidence for feasibility and safety of a minimally-invasive video-assisted thoracoscopic approach is still poor. Retrospective single-center analysis of patients undergoing surgery for phase III PE from 02/2011 to 03/2015 [n=138, including n=130 VATS approach (n=3 of them with bilateral disease) and n=8 open approach]. The learning curve was assessed by grouping those 127 patients with unilateral disease who underwent a video-assisted thoracoscopic approach into two groups: VATS-1 (03/2011 to 06/2012, n=43) and VATS-2 (06/2012 to 03/2015, n=84). ASA-scores (P=0.0279) and rate of pre-operative drainage therapy (P=0.0534) were higher in VATS-2 patients. Operating times were longer in VATS-1 (P=0.0308), intra-operative complication as well as conversion to open surgery rates did both not differ. Rates of post-operative vasoconstrictive therapy (P=0.0191) and prolonged mechanical ventilation (P=0.0560) were both higher in VATS-2, however, post-operative length of stay (LOS) at intensive care unit, overall post-operative LOS and post-operative complication rate were similar in both groups. Video-assisted thoracoscopic surgery is feasible for evacuation and decortication in late phase III PE. A learning curve of approximately 40 cases is sufficient to gain procedure-specific surgical skills and thus reduce the operating times sufficiently.

Prevention of recurrence of simple renal cyst after retroperitoneal laparoscopic decortication

Objective To investigate the effective method of reducing the recurrence of renal cyst after retroperitoneal laparoscopic decortication. Methods The clinical and follow-up data of 328 cases of patients with simple renal cyst underwent retroperitoneal laparoscopic renal cyst decompression from January 2014 to March 2016 in our hospital were analyzed retrospectively. One hundred and five patients had a simple decortication (control group, n=105). The remaining 223 patients had a decortication with different intervention method to prevent recurrence, including 60 cases with anhydrous ethanol sclerotherapy (sclerotherapy group, n=60), 78 cases with wadding of the cyst using perirenal fat tissue (fat wadding group, n=78 ) and 85 cases with evaginated and fixed the cyst wall by titanium clips (titanium clips fixed group, n=85). The operation time, intraoperative blood loss, postoperative complications, postoperative hospital stay and recurrence rate after 1 year were compared. Results Compared with the control group, all the 3 intervention methods (sclerotherapy group, fat wadding group and titanium clips fixed) significantly decreased the 1 year recurrence rate (5%, 3.8%, 4.7% vs. 13.3%, F=8.319, P=0.040). However, the operation time [(40.7±12.6)min vs. (30.5±10.2)min, t=5.664, P 0.05). Conclusions Combined with wadding of the cyst using perirenal fat tissue or evaginated and fixed the cyst wall by titanium clips in the retroperitoneal laparoscopic decortication is a safe and effective method to reduce postoperative recurrence. The anhydrous ethanol sclerotherapy may be an inappropriate choice due to increased operation time and complications. Key words: Kidney Diseases; Cysts; Laparoscopes; Decompression, Surgical

Invited Commentary

Invited Commentary

Space Oblitration for Failed Decortication an Experience of 804 Cases Over a Period of 15 Years

Space Oblitration for Failed Decortication an Experience of 804 Cases Over a Period of 15 Years

Decade Experience in Pleurectomy and Lung Decortications for Chronic Empyema Thoracis

Background: Chronic empyema thoracis is a debilitating illness with high morbidity and mortality, and is seen among all age groups in Nigeria. Objective: To review all cases of chronic empyema thoracis treated by pleurectomy and lung decortication and highlight the indications, challenges and the outcome. Materials and Method: In a 10-year period spanning 2007-2016, 90 patients with chronic empyema thoracis were admitted and managed in our institution. A retrospective study of 36 patients who underwent surgery was performed. Results: Ten patients (27.80%) out of 36 patients had unsuccessful one month closed chest tube drainage (CTTD). Six patients (16.67%) were referred from peripheral hospitals as chronic empyema thoracis that had failed CTTD. The remainder, 20 (55.60%) were diagnosed as chronic empyema thoracis de novo. Conclusion: Chronic empyema thoracis is a very difficult disease to manage especially in developing countries like ours, where patients present very late and the requisite facilities are inadequate.

Evaluation of local intra-pleural application of tranexamic acid on postoperative blood loss in lung decortication surgery, a prospective, randomized, double-blind, placebo-controlled study.

Background:During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding.Patients and Methods:A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay.Results:Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay.Conclusion:The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion.

Osteoperiosteal decortication and extracortical bone-bridging for treatment of atrophic humeral nonunions

Objective To assess the effectiveness of osteoperiosteal decortication and extracortical bone-bridging in the treatment of atrophic humeral nonunions. Methods Nineteen patients with atrophic humeral nonuninon were treated by osteoperiosteal decortication and extracortical bone-bridging between March 2008 and April 2016. They were 12 men and 7 women, aged from 23 to 68 years (mean, 36.6 years). The fracture was located at the left side in 10 cases and at the right side in 9. Before admission to our hospital, 8 had received surgery once, 6 twice and 5 thrice. The time from fracture to hospitalization ranged from 12 to 106 months (average, 26.3 months). Shoulder function was evaluated by Neer scoring and elbow function by Mayo elbow performance score (MEPS) at final follow-ups. Results All incisions healed by first intention. Two cases reported transient radial nerve symptoms of numbness. All the 19 patients were followed up for 28.9 months on average (range, from 13 to 78 months). Radiographic examinations showed signs of bone remodeling, disappearance of fracture lines and formation of extracortical bone bridge at 6 to 8 weeks after operation. All of them achieved radiographic union within 10 to 46 weeks (16.8 weeks on average). The Neer scores averaged 82.5 (range, from 70 to 98), giving 12 excellent cases, 5 good ones and 2 fair ones. The MEPS averaged 84.4 (range, from 70 to 96), giving 11 excellent cases, 5 good ones and 3 fair ones. Conclusion Osteope-riosteal decortication and extracortical bone-bridging in treatment of atrophic humeral nonunions can effectively induce osteogenesis and increase stability of broken ends, promoting bone healing. Key words: Shoulder joint; Elbow joint; Humeral fractures; Fractures, ununited; Bone graft

Pyopneumothorax With Bronchopleural Fistula Secondary to Streptococcus Constellatus Infection

SESSION TITLE: Pleural Effusions SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Streptococcus constellatus is a member of the S. milleri group that is recognized as normal human flora of the oral cavity, genitourinary and gastrointestinal tract. Infection due to S. constellatus can range from minor oral infections to life-threatening suppurative infections. We present a rare case of pyopneumothorax with a bronchopleural fistula associated with S. constellatus. CASE PRESENTATION: 54 years old woman with history of brucellosis presented with shortness of breath and left sided back pain for two weeks. She denied fever, cough, arthralgias, illicit drug use or recent travel. She had prior exposure to sheep and cattle over 30 years ago and was treated for brucellosis in Mexico at 18 years old. Two weeks prior to admission she presented to another hospital with similar complaints and chest X-ray was normal. Chest computed tomography (CT) showed small left pleural effusion. On admission she was afebrile, tachycardic (100-110 bpm) and other vitals were within normal limits. Physical examination showed decreased breath sounds and dullness to percussion over the left hemithorax. Laboratory data showed leukocytosis with neutrophil predominance (WBC 25.0 K/uL; 95.0% neutrophils), hemoglobin 11.0 g/dL and abnormal liver function tests (albumin 1.6 g/dL, aspartate aminotransferase 65 U/L, alanine aminotransferase 52 U/L, alkaline phosphatase 193 U/L). Chest x-ray was concerning for a large left hydropneumothorax. Left 14 french chest tube was placed and drained putrid, purulent fluid consistent with empyema. Pleural fluid analysis showed WBC 212 k/UL, glucose <1mg/dL, lactate dehydrogenase 8399 U/L and pH 7.2. She was started on broad-spectrum antibiotics. CT Chest was obtained due to lack of re-expansion after chest tube placement. Imaging showed persistence of left pyopneumothorax and small bronchopleural fistula in the left upper lobe. Pleural fluid gram stain showed multiple organisms suggestive of aspiration. Pleural fluid culture grew S. constellatus. Pleural acid-fast bacilli stain/culture, fungal stain/culture and anaerobic culture were negative. Blood cultures showed no growth. CT maxillofacial showed multiple periapical lucencies. She underwent left thoracotomy with decortication of left lung and drainage of empyema. DISCUSSION: S. constellatus is part of the normal oral flora and aspiration may lead to severe thoracic infections. Our case highlights a rare occurence of pyopneumothorax with a bronchopleural fistula associated with S. constellatus that was likely secondary to aspiration. CONCLUSIONS: Thoracic infections secondary to S. constellatus are associated with significant morbidity and mortality, and often require prolonged antimicrobial therapy, early abscess drainage and operative intervention [1]. Reference #1: Ripley RT et al. Streptococcus milleri infections of the pleural space: operative management predominates. Am J Surg 2006;192(6):817-21. DISCLOSURE: The following authors have nothing to disclose: Joanna Scoon, Jennifer Duke, Maryam Kaous No Product/Research Disclosure Information

Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

BackgroundPatients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression to hepato-bronchial fistulization are rare. We present a case of diverticulitis associated with hepatic abscess leading to hepato-bronchial fistulization, which represents a novel disease course not yet reported in the literature.Case PresentationA 61-year-old Caucasian man presented with a history of unintentional weight loss and dyspnea both at rest and with exertion. He had a significant tobacco and alcohol misuse history. A massive right-sided pleural effusion was found on chest X-ray, which responded partially to chest tube insertion. A computed tomography scan of his thorax confirmed the presence of innumerable lung abscesses as well as a complex pleural effusion. An indeterminate tiny air pocket at the dome of the liver was also noted. A follow-up computed tomography scan of his abdomen revealed a decompressed hepatic abscess extending into the right pleural space and the right lower lobe. A sigmoid-rectal fistula was also revealed with focal colonic thickening, presumed to be the sequelae of remote or chronic diverticulitis. An interventional radiologist inserted a percutaneous drain into the decompressed hepatic abscess and the instillation of contrast revealed immediate filling of the right pleural space, lung parenchyma, and bronchial tree, confirming a hepato-bronchial fistula. After two concurrent chest tube insertions failed to drain the remaining pleural effusion completely, surgical lung decortication was conducted. Markedly thickened pleura were seen and a significant amount of gelatinous inflammatory material was debrided from the lower thoracic cavity. He recovered well and was discharged 10 days post-thoracotomy on oral antibiotics. The percutaneous liver abscess tube was removed 3 weeks post-discharge from hospital after the drain check revealed that the fistula and abscess had entirely resolved.ConclusionsRefractory right-sided pleural effusion combined with constitutional symptoms should alert clinicians to search for possible hepatic abscess, especially in the context of diverticulitis. The rupture of an untreated hepatic abscess could lead to death from profound sepsis or rarely, as in this case, a hepato-bronchial fistula. Timely investigation and a multidisciplinary treatment approach can lead to improved patient outcomes.

The experience of using thoracoscopic surgery for treatment of patients with acute nonspecific parapneumonic pleural empyema

Objective. To evaluate the effectiveness of thoracoscopic operations and to study the clinical and epidemiological characteristic of patients with pleural empyema (PE). Materials and Methods. A retrospective analysis of 51 patients with PE treatment results has been done. All participants were examined by standard clinical and laboratory tests, X-rays and CT scans of the chest, ultrasound of pleural cavities. All patients (n = 51, 100%) were subject to thoracoscopic interventions. Results. The average age of patients was 44.4 ± 14.7 years. Men prevailed among them - 36 (71%). The first stage of PE was diagnosed in 18 (35%) patients, and the second - in 33 (65%). Almost all patients (50 patients – 98%) had been treated in other hospitals before hospitalization to a specialized department. Diagnostics of PE and patients admission to the thoracic surgery department took place on the 2 - 3 week of disease in 70% of cases. The main types of surgery on the first stage of PE were: 1) thoracoscopy with targeted drainage of pleural cavity and pleural biopsy (n = 4, 22%), 2) video-assisted thoracoscopic surgery (VATS) with destruction of fibrinous adhesions (n = 14; 78%). It has been done at the second stage of PE: 1) VATS pneumolysis (n = 22; 67%) and 2) VATS decortication of lung (n = 11; 33%). The positive results of pleural exudates bacteriological analysis have been obtained from 9 patients (18%). The median of pleural exudation duration at the first stage of PE was 5 days (4, 6), at the second stage - 6 (5, 9) days (p = 0.058). Good results were obtained in 33 patients (65%), satisfactory - in 15 (29%), unsatisfactory - in 3 (6%). The median of hospital stay duration was 18 (16; 21). There have not been lethal outcomes. Conclusions. Diagnosis of pleural empyema is a complex task and requires a broad introduction of modern techniques (CT and ultrasound). Standard microbiological testing is not effective in the diagnosis of PE pathogens, due to imperfection of anaerobic bacteria methods of detection and previous antibiotic therapy. The use of VATS in patients with PE on the first and the second stage is effective and reasonable, leads to good and satisfactory results in 95 % and 94 % of cases respectively.

Percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones

Objective To evaluate the curative effects of percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones. Methods A retrospective analysis was performed of the 32 patients who had been treated using osteoperiosteal decortication combined with distraction osteogenesis from September 2011 to December 2014 for nonunion of lower-extremity fractures. They were 23 males and 9 females, with a mean age of 33.4 years (range, from 15 to 62 years). After their former internal or external fixators were removed, the 2 fracture ends were fixated by a retractile monolateral or circular external fixator. Under radiographic monitoring, a percutaneous incision was made with a 5 mm sharp chisel, down to the bone. Scar and ossified tissue between the fracture ends were debrided and cut along the fracture line. After the marrow cavity was reamed, a new irregular wound was created at sclerotic fracture ends. Scale-shaped chips (1 mm thin and 5 mm in diameter) were elevated using a chisel on surface of the cortical bone within 2 cm from the fracture ends. The external fixators were adjusted to compress the fracture sites. On the 8th day after operation, the eternal fixators were applied to distract and compress at nonunion sites to stimulate the osteogenesis. Results All the patients were followed up for an average of 12.5 months (range, from 8 to 42 months). Primary union was successfully achieved in 28 patients while delayed union occurred in 3 patients who finally achieved union after adjuvant therapies like shock wave and or local injection of bone marrow blood. The average time for union was 4.6 months(range, from 4 to 7 months). The mean time for external fixation was 6.2 months (range, from 5 to 8 months). One patient encountered nonunion of lateral tibial cortical bone 6 months after surgery but eventually achieved union by au-tologous ilium grafting. Joint functions in all postoperative patients were similar to those before operation. Conclusion Percutaneous osteoperiosteal decortication combined with distraction osteogenesis is a simple, minimally invasive and effective treatment for nonunion of lower-extremity bones, avoiding disadvan-tages brought by traditional surgery, like massive trauma and excessive bleeding. Key words: Bone lengthening; Fractures, ununited; Surgical procedures, minimally invasive; Percutaneous decortication

Chylothorax as a Complication of Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy is a minimally invasive procedure to remove large renal calculi. Complications can range from infection to bowel damage but only rarely does the procedure result in pulmonary injury. We present the first case of chylothorax secondary to percutaneous nephrolithotomy for removal of a large renal calculus. The patient was treated with a decortication procedure and discharged to rehab shortly thereafter.

Thoracic Endometriosis Syndrome: A Veritable Pandora's Box.

Thoracic endometriosis syndrome is a rare disorder characterised by the presence of functioning endometrial tissue in pleura, lung parenchyma, airways, and/or encompasses mainly four clinical entities-catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and lung nodules. The cases were studied retrospectively by reviewing the records at Amrita Institute of Medical Sciences, for duration of five years i.e., form March 2010-2014 and analysed for the clinical presentation and management of thoracic endometriosis syndrome. Catamenial breathlessness was the main symptom. Pneumothorax and pleural effusion were the findings on investigations. Histopathology report of endometriosis was present in three cases (50%). Conditions with excess oestrogen like endometriosis, fibroid, adenomyosis were diagnosed in these patients by pelvic scan. After the initial supportive treatment with hormones, pleurodesis, hysterectomy and lung decortication were the treatment modalities. Two cases that had multiple recurrences were diagnosed as disseminated TES. They underwent combined treatment of surgery and hormones.

Surgical fire caused by electrocautery in ambient air

Introduction: The fire triangle comprises the ignition source, fuel and oxidizer which is necessary for the initiation of fire. Most surgical fires occur in an oxygen-enriched environment. We report a case of surgical fire in ambient air where an alcohol-based antiseptic was involved. Case report: A 20-year-old male diagnosed with left pleural empyema and respiratory failure, requiring emergent intubation and respiratory support, was brought into the operating theatre for decortication of the left lung. Shortly after induction, the patient desaturated despite 100% oxygen and lung recruitment manoeuvres. The surgical team decided to insert a chest tube emergently to drain the empyema to improve respiratory function. A non-functioning drainage catheter that was in situ was removed and placed on the operating table beside the patient. Skin was prepared using chlorhexidine gluconate 0.5% w/v in methylated spirit solution and iodine. Soon after, cotton drapes were used to cover the patient. After the initial incision for chest tube insertion, electrocautery was introduced. Smoke and a smell of something burning was immediately noted by the surgical team. The drapes were removed and the drainage catheter with a burnt tip was discovered beside the patient. The patient suffered second degree burns to his chest wall. Conclusion: Although it is more common for surgical fires to occur in an oxygen-enriched environment, this case highlights that without adequate precautions they can also occur in ambient air. Recognition that standard anaesthetic and surgical equipment can act as sources of fuel and vigilance for the circumstances that complete the fire triangle are key to the prevention of surgical fires.

Operative procedure choice for surgical management of chronic tuberculous empyema: a series of 461 cases

To study the experiences and operative procedure choice for surgical management of chronic tuberculous empyema. Totally 461 patients of chronic tuberculous empyema were treated surgically in Shandong Provincial Chest Hospital between January 2006 and December 2011. There were 317 male and 144 female patients, aging from 6 to 79 years with a mean age of 32 years. Preoperative duration lasted from 3 months to 50 years, including 347 cases within 1 year, 61 cases 1 to 2 years, and 53 cases above 2 years. Chest tube drainage or pleuracentesis was performed in 395 patients, decortication in 287 patients, thoracoplasty in 13 patients, pleuropneumonectomy and resection of remaining lung in 11 patients, complex operation in 150 patients. There was no death perioperatively. Four hundred and forty-five patients were cured at once, 6 patients were cured by stages. One patient with empyema and bronchial fistula relapsed bronchial fistula after pulmonary lobectomy and pleural decortication, whom was cured by the combination operation which including fistula repair, muscle flap tamponing and local thoracoplasty according to the closed drainage of thoracic cavity after 6 months. Three cases were suffered incision delayed healing and were cured by dressing change. Five cases were suffered abscess of chest wall within 3 months and were cured by local thoracoplasty. One patient died due to respiratory failure in one year which resulted in tuberculosis spreading because of bronchial fistula after pleuropneumonectomy. Surgical management of chronic tuberculous empyema still have irreplaceable roles. Selecting appropriate operations according to different cases will achieve good results.

AB190. Transumbilical single incision for laparoendoscopic bilateral renal cyst decortication using a homemade glove port device (video available)

ObjectiveTransumbilical single incision surgery (TSIS) has recently gained popularity for symptomatic renal cysts. We evaluated the clinical utility and safety of homemade glove port device in bilateral renal cyst decortication patients at our institution.MethodsWe reviewed our series of 42 bilateral symptomatic renal cyst (range, 4-12 cm) decortication performed from November 2010 to December 2013. A homemade port device consisted of two control loops and a glove to form three channels was placed through the umbilical single incision. A homemade single port device was made by fixing a size 7 1/2 surgical glove to the retractor outer ring and securing the glove fingers to the end of 3 trocars with a tie. The homemade port was inserted at the umbilical incision; operation was performed by using a special flexible 30-degree laparoscope and conventional laparoscopic instruments.ResultsAll cases were completed successfully, without conversion to a standard laparoscopic or open approach. The average operative time was 75 min and the estimated blood loss was less than 30 mL, no intraoperative complication occurred. The mean hospital stay was 2.8±1.5 (range, 2-5) days, with a median follow-up of 20 (range, 8-32) months, there was no recurrence.ConclusionsOur homemade single port device is cost-effective and more flexible to deal with bilateral renal cysts especially ventral lesions than the current multichannel port or traditional laparoscopic surgery.

Nursing cooperation of robotic transumbilical laparoendoscopic single-site renal cyst decortication

Objective To explore the nursing efficacy of robotic transumbilical laparoendoscopic single-site renal cyst decortication. Methods Based on the nursing cooperation of 7 patients undergoing robotic transumbilical laparoendoscopic single-site renal cyst decortication, we managed preoperative train, items preparation, bedside mechanical arm system arrangement, cooperation of operation and perioperative devices. Results All the operation of 7 cases were successfully performed, and the nursing cooperation was favorable. Conclusions We well know about the structure, characteristic, procedures and application of the equipment of Robotic Laparoendoscopic Single-Site, combine with the intraoperative communication. All of them play critical roles on the success of the procedure. Key words: Single-site; Robert; Transumbilical; Renal cyst; Nursing care

Ventilatory Response For Inspiratory Muscle Training Versus Aerobic Training On Post Lung Decortication.

Abstract Objective: Decortication is a surgical procedure that consists in restoring the ventilatory function of the lung and there is in need to establish the efficacy of inspiratory muscle training versus aerobic training on pulmonary functions post lung decortications, as the diaphragmatic dysfunction is a major factor in the etiology of postoperative pulmonary complications after lung decortications. Materials and Methods: Thirty patients, second day post lung decortication surgery would participate in this study, the participants from both gender, their age 20-50 years old Patients would be assigned randomly into two equal groups of (15) patients who post lung decortication surgery in each group would receive 12 sessions of treatment, 6 each weeks,Group (I) consist from 15 patients would receive inspiratory muscle training (IMT) in addition to conventional chest physiotherapy,Group (II) consist from 15 patients would receive aerobic training (AT) in addition to conventional chest physiotherapy. Results: The results showed that IMT and AT increased significantly (P< 0.05) FVC, FEV1, MVV within each group, Significant differences of the post treatment mean values between both groups in favor of group AT were recorded (p0.05) on FEV1/FVC ratio within each group or on comparing the two groups. Conclusion: Both IMT and AT provided a significant improvement in the ventilatory functions due to increasing the respiratory muscles strength ,efficiency and endurance , IMT and AT offers important benefits and should be considered in rehabilitation of patients underwent lung decortications surgery.

Management of Pulmonary Hydatid Disease: Review of 66 Cases from Iraq

Background: Hydatid disease is a serious health hazard and a major problem to the community in Iraq. The disease is still endemic as witnessed in everyday surgical practice. The aim of this prospective study was to review the management of pulmonary hydatid disease (PHD) in two major thoracic surgical centers (Ibn-Alnafis and Medical City Teaching Hospitals), Baghdad, Iraq over one year period. Materials and Methods: Sixty six patients (38 females and 28 males) with PHD admitted and treated surgically in the Departments of Thoracic Surgery in the aforementioned hospitals were studied. Demographic and clinical features were obtained by direct patients’ interviews and thorough physical examination. The diagnosis in the vast majority of patients was based on plain chest radiography while few had bronchoscopy. All patients had posterolateral thoracotomy for removal of pulmonary hydatid cysts (PHC). The clinical and radiographic findings as well as operative procedures and postoperative complications were reviewed. Results: The age ranged from two and a half years to 60 years with a mean of 22.3. Sixty percent of patients were in second and third decades. Most patients (n = 51, 77%) lived in rural areas. Housewives and students predominated. A positive family history was obtained in 5. Cough, chest pain, dyspnoea and haemoptysis were the main symptoms whereas 15 were acutely ill. Three patients presented with pathognomonic expectoration of laminated membrane and 2 had intra-pleural cyst rupture. The total number of cysts was 99 (61 intact, 50 solitary, and 55 unilateral). The right lung was more frequently involved (n = 64) and right lower lobe was on the top. Cyst size ranged from 3 to 25 cm with a mean of 8.5. The main radiographic appearance was the “full moon against dark sky” visible in 61.6%. Abdominal ultrasound was carried out in 40 patients who revealed 12 hepatic and one splenic HCs. Lung preserving surgery was done in 76 cysts (91.5%) while lobectomy was necessary in 7. Capitonnage was used in 16 cases only (19.2%). Two patients had lung decortication and four had trans-diaphragmatic removal of liver HCs. Few complications developed mostly managed conservatively. Reoperation was necessary in 4 patients (prolonged air leak, n = 2 and bleeding, n = 2). Two patients died (3%). Conclusion: PHC is endemic in Iraq, mainly diagnosed by plain chest radiography, and can be safely managed by lung preserving surgery with minimal morbidity and mortality.