Decortication Research Articles

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.

Spontaneous circumferential intramural esophageal dissection complicated with esophageal perforation and esophageal-pleural fistula: a case report and literature review

Spontaneous intramural esophageal dissection (IED) is a rare disease entity. There are few reports of spontaneous IED requiring surgical treatment. Hereby, we report a 37-year-old gentleman who was diagnosed to have spontaneous extensive circumferential IED complicated with esophageal perforation, empyema, and esophageal-pleural fistula. Esophageal stenting and drainage of empyema were unsuccessful. Computed tomography and gastrografin contrast swallow demonstrated a leak to the pleural cavity, suggestive of esophageal-pleural fistula. Subsequently, a two-stage operation was performed: cervical esophagogastrostomy to bypass the perforated esophagus, followed by esophagectomy and decortication of the right lung. The patient recovered and was discharged home after a 3-week hospitalization. The management principles and recent published literature related to IED were reviewed.

Effects of moisture content and feed rate on milling characteristics of wild apricot pits (Prunus armeniaca L.)

Milling with decortication of wild apricot pits was done in wild apricot pit decorticator working on the principle of “impact and compression

Bosniak renal cyst classification : 12 years experience of a single center

Objective To evaluate the clinical value of Bosniak renal cyst classification in the treatment of renal cyst disease.Methods The data of 509 patients,diagnosed with renal cystic disease from 2001 to 2012 in our institution,were retrospectively reviewed.Of those patients,there were 304 males and 205 females.The average age was 54 years (range 15-82 years).The average diameter of renal cysts was 6.8 cm (range,1.0-16.0 cm).According to Bosniak classification,there were 371 cases of category Ⅰ,60 cases of category Ⅱ,23 cases of category Ⅱ F,41 cases of category Ⅲ and 14 cases of category Ⅳ.Laparoscopic decortication of renal cysts was performed in 439 cases.Nephron sparing surgery was performed in 45 cases,including laparoscopic procedure in 20 cases.Radical nephrectomy was performed in 25 cases,including laparoscopic procedure in 5 cases.Results Benign lesions were diagnosed in 470 cases,including simple renal cyst in 448 cases,multilocular renal cyst in 15 cases,cystic nephroma in 3 cases,old hematoma in 2 cases,teratoma in 1 case and angiomyolipoma in 1 case.Malignant tumors were diagnosed in 39 cases,including clear cell carcinoma in 20 cases,multilocular renal cell carcinoma in 18 cases,and papillary renal cell carcinoma in 1 case.Based on Fuhrman nuclear grade classification,there were 28 cases (72％) of grade Ⅰ,9 cases (23％) of grade Ⅱ,2 cases (5％) of grade Ⅲ.In pathologic stage,T1 was diagnosed in 36 cases (92％),T2 was diagnosed in 3 cases (8％).The malignant rate was 1％ in Bosniak category Ⅰ (3/371),3％ in category Ⅱ (2/60),17％ in category ⅡF(4/23),44％ in category Ⅲ (18/41),and 86％ in category Ⅳ (12/14).Thirty-seven cases of malignancy were followed up for 3-144 months (median 53 months).All cases survived without recurrence or metastasis.Conclusions The Bosniak classification is helpful for diagnosis and management of renal cystic disease.There is a low malignant rate in category Ⅰ and Ⅱ cysts,but category Ⅲ and Ⅳ usually require surgical removal due to their high malignant rate.It should make effort to undertake laparoscopy and nephron-sparing surgery if technically feasible. Key words: Kidney diseases, cystic ; Bosniak classification ; Laparoscopes ; Nephron-sparing surgery

Rare Cavitary MAC Lung Disease Causing a Serious Broncho-Pleural Air Leak in an Immune Competent Patient

Mycobacterium avium - intracellulare complex (MAC) is a non-tuberculous mycobacterium that can cause a variety of pathologies in both immune-competent and immune-deficient individuals. In this paper, I present a rare and unique case of severe MAC cavitary pulmonary disease complicated by a serious broncho-pleural air leak and persistent hydropneumothorax in a patient with normal immunity. His successful recovery took a lengthy antibiotic course and a segmental lung resection with pleural decortication. A brief discussion about MAC lung disease follows this presentation. J Med Cases • 2013;4(12):825-827 doi: http://dx.doi.org/10.4021/jmc1578w

Lung Decortication and Lobectomy in a Child With Unrepaired Tetralogy of Fallot

Patients with uncorrected tetralogy of Fallot (TOF) have been reported as undergoing emergency noncardiac surgeries such as cesarean section, brain abscess drainage, and major abdominal surgery. The uncorrected TOF group presents a great challenge with issues related to long-term effects of chronic hypoxemia and decreased pulmonary blood flow modifying patient physiology. We report a rare case of a child with uncorrected TOF with necrotizing streptococcal pneumonia complicated by empyema and bronchopleural fistula. The child successfully underwent lung decortication and right middle lobectomy in the first stage followed by an intracardiac repair (ICR) 15 days later. This staged approach was directed at controlling the infective focus, improving the pulmonary status, and following it up with a definitive ICR electively.

Single-port retroperitoneoscopic decortication for renal cysts

Objective To discuss a method of single-port retroperitoneal laparoscopy for the treatment of renal cysts.Methods From April 2009 to May 2011,42 patients (24 males and 18 females with mean age of 45 yrs) were performed single-port retroperitoneoscopic decortication of renal cysts.The renal cysts size ranged from 4.4 cm to 12.6 cm,mean size 6.5 cm.The cysts were on the left side in 21 cases,on the right in 18 cases,on both sides in three cases.In the operative procedure,only one 10mm Trocar were used to pass a laparoscope that had a work channel.By dissected along the margin of the cyst and incised,the roof of the cyst was divided.Then the roof of cyst was peeled away from the perirenal adipose tissue.Results The procedure was completed successfully in all of the cases except two cases of which the cavity of the cyst was not open up well,and one additional 5 him Trocar was used to assist completing the task.All the procedures were accomplished with no assistant.The operating time was 20-65 min (mean 36 min) and intraoperative blood loss was 0-115 ml (mean 18 ml).Postoperative hospital stay were 1-5 d (mean 2.6 d).37 patients were available during the follow-up of 3-19 months (mean 8.2 months),no complication was found.Conclusions Compared to the conventional ones in the decoration of renal cyst,the method of single-port retroperitoneoscopy has the cosmetic benefit,it could reduce the trauma of dissection and the complication. Key words: Renal cyst; Retroperitoneal space ; Single-port

Management of Boerhaave's syndrome with an over-the-scope clip

Boerhaave's syndrome is a spontaneous barotraumatic disruption of the distal oesophagus secondary to an abrupt increase in intraoesophageal pressure during vomiting. Management ranges from a conservative approach to an oesophagectomy. The over-the-scope-clip (OTSC, Ovesco Endoscopy GmbH, Tuebingen, Germany) system is a newly designed clipping method for tissue mechanical compression in the gastrointestinal tract. We report the case of a patient referred with a delayed diagnosis of Boerhaave's syndrome and successfully treated by OTSC application followed by lung decortication.

Application of 3D video techniques in urological laparoscopic surgery

Objective To explore the 3D imaging system in laparoscopic surgery in urology.Methods From Dec.2012 to Feb.2013,a total of 62 cases of laparoscopic surgery were completed by using Viking 3D HD laparoscopy system.Those included 12 cases of adrenal tumor resection (7 cases of pheochromocytoma resection),3 cases of renal cyst decortication,15 cases of radical nephrectomy,19 cases of partial nephrectomy,6 cases of pyeloplasty,5 cases of radical prostatectomy,2 cases of total cystectomy.The data of operative time,bleeding volume,renal pedicle occlusion time and suture time were counted.Results All the surgeries were successful.The surgery time was 30 to 190 min,with the time of adrenal tumor resection of 30-80 min,renal cyst decortication of 30-45 min,radical nephrectomy of 45-90 min,partial nephrectomy of 60-80 min,pyeloplasty of 60-90 min,radical prostatectomy of 120-150 min,and total cystectomy of 170-190 min.The time of renal pedicle clamping of partial nephrectomy surgery was 12-25 min,with an average of 18 min.The time of ureteropelvic forming surgical anastomosis was 30-55 min,with an average of 40 min.The time of urethra anastomosis was 15-25 min,with an average of 20 min.The blood loss was 20-300 ml,and the postoperative hospital time was 2-8 d with an average of 5 d.Conclusions 3D imaging system can provide anatomical layering similar to open surgery.Anatomy is more accurate and the suture is relatively easy compared with traditional laparoscopic imaging system.The system has the advantages of both laparoscopic and open surgery. Key words: Imaging, three-dimensional ; Laparoscopes ; Urologic surgical procedures ; Surgery time

Empyema Thoracis Due to Intrapleural Migration of Retained Vascular Catheter

Intravascular retention and embolization of fragment of central venous catheters is a rare but well-documented complication of in-dwelling vascular access devices and ports. We describe the case of a 39-year-old male with fracture of the central venous catheter during removal of subcutaneous vascular access port. Over the next 3 years, the catheter fragment embolized through the pulmonary circulation and subsequently migrated into the left pleural space. He presented with empyema thoracis associated with thoracolumbar vertebral osteomyelitis. He required video-assisted thoracoscopy for retrieval of the catheter fragment, left lung decortication, and subsequent multilevel vertebral corpectomy and spine stabilization procedures.

Indwelling Pleural Catheter Insertion Following Inefficient Thoracoscopic Decortication in Postpneumonic Empyema: Beneficial or Contraindicated?

Video assisted thoracic surgery in advanced stage postpneumonic empyema aims for thorough debridement and washout of the pleural space followed by an attempt to release the entrapped lung (decortication). When the latter isn’t successful, and the patient is in a poor performance status, applying tube thoracostomy is the usual routine, to avoid conversion to thoracotomy and open decortication. Tube thoracostomy, however, is associated with complications necessitating further surgery, needs long term follow up and also entails quality of life distorting issues. To overcome these disadvantages, we instead inserted a PleurX&reg indwelling pleural catheter in four patients in the above situation. The method brought success (lung re-expansion and complete or partial pleurodesis) without the need for further surgery or quality of life problems in either patient. Although the use of the indwelling pleural catheter in infected pleural space is not recommended by manufacturers, we noted no complications.

Analysis of cumulative series of laparoendoscopic single-site surgery in urology : with 209 consecutive cases report

Objective To report a 4-year cumulative series (209 cases) of laparoendoscopic singlesite surgery (LESS) in urology and assess its clinical utilization. Methods Consecutive LESS cases done between December 2008 and July 2012 at our institution were prospectively recorded and retrospective analyzed in this study.Demographic data,main perioperative outcomes,and information related to the surgical technique were collected and analyzed.There were 209 patients ( 121 males and 88 females) with a mean age of (52.8 ±14.5) years,a mean B MIof (23.5 ±3.12) kg/m2 and a mean ASA score of (2.0±0.3).20.1％ (42 cases) of patients had previous abdominal or pelvic surgeries.29.2％ (61 cases) and 12.9％(27 cases) of patients had diabetes mellitus and hypertension. Indications were renal tumors (70 cases,33.5％),adrenal tumors (42,20.1％),renal cyst (22 cases,10.5％),ureteral calculi (22 cases,10.5％),nonfunctional kidneys (19 cases,9.1％),BPH (10 cases,4.8％),and others (24 cases,11.5％ ).Surgical conversions were evaluated,as well as intraoperative and postoperative complications.Two periods were arbitrarily dcfined:the first was from December 2008 to Septcmber 2010 (22 mon) and the second.was from October 2010 to July 2012 (22 mon).A comparative analysis between these two periods was conducted. Results There were 209 LESS surgeries included in this study.Most common procedures ( 92.3％ ) were done on the upper urinary tract,with 55.5％ of the whole cohort being tumor-related indications and only 16.3％ being reconstructive procedures.The transperitoneal approaches were preferentially adopted in 80.9％ cases,and transvesical access in 5.3％ cases. The transumbilical access was used in 46.9％ of cases.The overall conversion rate was 8.1％,with 4.3％ of cases converted to reduced - port laparoscopy,1.9％ to conventional laparoscopy,and 1.9％ to open surgery.The intraoperative complication rate was 4.8％ ( 10/209 ) and postoperative complications,mostly low grade,were encountered in 11.5％(24/209) of cases.There was a significant increase in the number of LESS cases during the second study period; the rate of some procedures (ie,transumbilical LESS,renal cyst decortication and transvesical single-port enucleation of the prostate) was lower,whereas some other procedures were performed more frequently (ie,tumor-related LESS procedures,radical nephrectomy and adrenalectomy). Conclusions A broad range of urological procedures can be finished with LESS technique in the experienced hands of a laparoscopic surgeons.However,LESS is still in its infancy with a certain risk of surgical complication and conversion.Stringent patient selection criteria should be applied,especially during the learning curve.Complex reconstructive procedures or malignant tumor related indications are not appropriate as the start of this kind of procedure.We need always put patient's safety and treatment efficacy first. Key words: Laparoendoscopic single-site surgery; Laparoscopy; Urologic surgery

Application and innovation of urological laparoendoscopic single-site surgery in China

Objective To evaluate the status of urological laparoendoscopic single-site surgery (LESS) technique in China. Methods We had conducted a systematic review of literatures of urological laparoendoscopic single-site surgery published from Chinese institutions using WanFang,CNKI,VIP,CBM,GoogleScholar and MEDLINE databases.All relevant articles were selected with consensus and analyzed according to the inclusion and exclusion criteria. Results Overall,205 articles from 66 different centers all over China published between January 2009 and June 2012 were included in the analysis. Of which,there were 26 articles of science citation index papers and 179 articles from Chinese academic journals.The included literature was mainly composed of case series reports ( 133 articles,64.9％ ),comparison studies (13 articles,6.3％ ),reviews or comments (20 papers,9.8％ ),nursing related papers (28 pieces,13.7％ ),animal surgery studies (6 articles,2.9％ ),and training (5 articles,2.4％ ).A total of 1790 clinical cases were reported during the study period,56.9％ of these were procedures done in the upper urinary tract,only 5.8％ were in the lower urinary tract,and 37.3％ were genital or other procedures.Procedures of tumor-related and reconstruction required accounted for 18.8％ and 18.7％,respectively.Pure single-port technique was applied on 58.3％ of cases.In cases of a single-port platform used,45.6％ used the commercially available devices and 54.4％ used homemade devices.Transperitoneal accesses were adopted in 59.5％ of cases and the other 40.5％ were performed through extraperitoneal approaches.The umbilicus was used as the site of access in 58.5％ of cases.A total of 25 indications were reported,including adrenalectomy,nephrectomy and ureterolithotomy,etc. in the upper urinary tract,radical cystectomy,radical prostatectomy and transvesical enucleation of the prostate,etc.in the lower urinary tract,and varicocelectomy,orchidopexy and others. The three most often done procedures were varicocelectomy (601 cases,33.6％ ),renal cyst decortication (408 cases,22.8％ ) and adrenalectomy ( 179 cases,10.0％ ).The overall conversion rate was 5.5％,and complications were encountered in 3.4％ of cases. Conclusions Laparoendoscopic single-site surgery has been widely adopted by Chinese urologists and largely covered the spectrum of conventional urologic laparoscopic procedures,with most of these being non-reconstructive operations for the treatment of benign diseases.In large,we are still under the initial stage of LESS application in urology.And more work on creative innovation and well-designed studies are needed to further evaluate its role in the urological minimally invasive surgery. Key words: Laparoendoscopic single-site surgery, LESS; Minimally invasive surgery; Urologic surgery

Comparison of preoperative and postoperative arterial blood gas analysis, respiratory function test and lung perfusion scintigraphy of adult patients undergoing lung decortication surgery

Background: In this study, we aimed to determine the effect of lung decortication surgery on the postoperative respiratory function, comparing pre- and postoperative findings of arterial blood gas analysis, respiratory function test and lung perfusion scintigraphy of the adult patients. Methods: Between January 2000 and November 2008, the clinical data of 37 patients over 15 years of age (25 males, 12 females; mean age 37.3 years; range 15 to 73 years) were retrospectively analyzed, who underwent lung decortication surgery due to chronic empyema in Thoracic Surgery Department of the Faculty of Medicine of Dicle University, Diyarbakır. Pre- and postoperative findings of arterial blood gas analysis, respiratory function test and lung perfusion scintigraphy were analyzed statistically. Results: Sixteen (43.24%) of the patients underwent right thoracotomy, while 21 (56.75%) underwent left thoracotomy. Histopathologic examination revealed chronic fibrinous pleuritis in 28 patients (75.6%) and tuberculous pleuritis in nine patients (24.3%). Statistical significance was found in PO2, SO2 (p

Thoracomyoplasty in the treatment of empyema: current indications, basic principles, and results.

Empyema remains a challenge for modern medicine. Cases not amenable to lung decortication are particularly difficult to treat, requiring prolonged hospitalizations and mutilating procedures. This paper presents the current role of thoracomyoplasty procedures, which allow complete and definitive obliteration of the infected pleural space by a combination of thoracoplasty and the use of neighbourhood muscle flaps (latissimus dorsi, serratus anterior, pectoralis, rectus abdominis, omentum, etc). Recent publications show an overall rate of success of 90%, with a quick and definitive healing. Although rarely indicated in our days, this kind of procedures remain in the armamentarium of modern thoracic surgery. The importance of thoracomyoplasty derives from the fact that it may be a simple and definitive solution for complicated cases of chronic empyema not amenable to standard decortication.

Long-Term Results of Lung Decortication in Patients with Trapped Lung Secondary to Coronary Artery Bypass Grafting

To evaluate long-term results of decortications in patients with symptomatic restrictive pleurisy and trapped lung after coronary bypass grafting. Twenty consecutive patients undergoing lung decortications for trapped lung after coronary bypass grafting were prospectively evaluated. Pulmonary function tests were used as objective criteria, and quality of life was assessed by the Medical Research Council dyspnea scale. A p value <0.05 was considered significant. Twenty patients, 3 women and 17 men, with a median age of 59 years were evaluated. The median time interval between coronary bypass grafting and decortications was 9.3 months. The mean preoperative forced expiratory volume in one second and forced vital capacity were 63.8% ± 7.4% and 50.5% ± 6.6% of the predicted value, respectively, and the improvement rates after decortications were 14.97% ± 6.3% and 17.62% ± 6.38%, respectively. Dyspnea scores improved after decortications (p <0.05). The median follow-up was 25 months. After surgery, 3 patients developed superficial wound infections, and out of 7 patients with prolonged air leaks, 2 underwent re-operation. After surgery, one patient died on day 34 and another, after 3 years. Lung decortications, re-expanding the affected lung, ensures symptom remission and improves quality of life of patients with trapped lung after coronary bypass grafting in the long-term.

Successful treatment of parapneumonic empyema after H1N1 infection in a heart transplant recipient

Pandemic influenza A H1N1 virus is likely to cause severe disease in patients who have received solid organs transplants. In these patients pneumonia is the most frequent clinical feature. Parapneumonic empyema (PPE) may represent the evolution of secondary bacterial respiratory infections. To our knowledge this is the first reported case of PPE during H1N1 influenza A in an adult heart transplanted patient. The patient was treated successfully with surgical empyemectomy and lung decortication, broad-spectrum antibiotics and oseltamivir. Eradication of influenza was obtained in the fifth postoperative day.

George Ryerson Fowler

The Fowler position, widely used in surgery and obstetrics for patient placement, marks a fraction of 19th-century Brooklyn surgeon George Ryerson Fowler's prodigious accomplishments. Fowler was a pioneer who refined the appendectomy, performed the first lung decortication, advocated for sterile techniques, introduced first aid in the US Army, and helped start a precursor to Annals of Surgery. His publications include the first US textbook on appendicitis--ironically, the disease that killed him.

A pathological complete response after preoperative chemotherapy with carboplatin and pemetrexed in malignant pleural mesothelioma: A case report.

Malignant pleural mesothelioma is an aggressive tumour with poor prognosis and short duration of response probably due to the high chemo-refractoriness. Multimodality treatment based on preoperative chemotherapy, surgery and adjuvant radiotherapy seems to be a feasible and effective therapeutic option in selected patients.We report on a case of pathological complete response in a patient affected by malignant pleural mesothelioma who was treated with four cycles of preoperative chemotherapy based on carboplatin plus pemetrexed followed by parietal pleurectomy and lung decortication. Carboplatin plus pemetrexed was a well tolerated regimen without grade 3-4 haematological toxicity, and this confirm the feasibility of such a treatment as an alternative to the current golden standard based on cisplatin plus pemetrexed.Complete resection allows the pathologist to better describe biological markers of mesothelioma cells, in order to select patients with different treatment outcome and prognosis.