Pulmonary Suppuration Research Articles

Domestic researchers who have made important contributions to the study of digestive system diseases: images in art. Georgiy Yosypovych Burchynsky

Georgiy Yosypovych Burchynsky (1908 — 1993) — Doctor of Medical Sciences, Professor, Honored Scientist of Ukraine, and laureate of the State Prize of Ukraine. G. Y. Burchynsky, throughout his life, was brought up on the traditions of the Kyiv therapeutic school. A close relationship with the Kyiv therapeutic school largely determined his personality as a doctor, teacher, scientist, and head of the department. In the years 1954 — 1962, Georgiy Yosypovych was the head of the Department of Therapy at the School of Dentistry. Since 1962, he had been the head of the Department of Faculty Therapy at the Kyiv Medical Institute for 24 years. G. Y. Burchynsky paid much attention to the study of pulmonary pathology. Based on the research materials, the monograph «Suppurative processes in the lungs» was issued in 1950. In particular, G. Y. Burchynsky developed a pathogenetic classification of pulmonary suppurations. One of the first in Ukraine, he applied the technique of endobronchial administration of antibiotics, He developed and introduced into practice the technique of zonal, or local, instillation using a bronchoscope. Gastrointestinal diseases have always been in the focus of Kyiv therapeutic school. G. Y. Burchynsky paid special attention attention to the problems of peptic ulcers. As a result, new data were obtained about this disease, which is outwardly clear but inwardly mysterious. G. Y. Burchynsky and his colleagues did a detailed study on the course of peptic ulcers, even during wartime. They looked at the etiology, pathogenesis, changes in the ultrastructure of the gastric mucosa, general changes, and questions about pathogenetic therapy for this disease. Experimental studies on the model of reproduction of a hypothalamic ulcer, as well as the results of studying the ultrastructure of gastroduodenal mucosa, confirmed the importance of the disturbances of nervous trophism. An experimental study on the pharmacodynamics of anticholinergics, which suppress cholinergic stimulation of the stomach and duodenum, showed that they can be used in clinical practice as a way to treat peptic ulcer disease. Under the supervision of G. Y. Burchynsky, two doctoral dissertations on the problem of peptic ulcers were defended at the department. Observations and results of the studies, performed by Georgiy Yosypovych and his colleagues, are reflected in the papers and monographs, such as “Peptic Ulcer,” “Clinical Gastroenterology,” and the relevant chapters of multi­volume guidelines and the Big Medical Encyclopedia.

Tracheobronchomegaly (Mounier-Kuhn Syndrome) in Old Age - A Case Report

Tracheobronchomegaly or Mounier-Kuhn syndrome is a rare condition affecting the airways and is characterized by dilatation of the trachea and major bronchi secondary to atrophic or absent elastic fibres of the cartilage and thinning of the muscles.[1] The abnormally enlarged flaccid portions of the bronchial tree collapse and fail to maintain patency during expiration and coughing, predisposing the patient to stagnation of contents and recurrent lower respiratory tract infections, emphysema, bronchiectasis and chronic pulmonary suppuration.[2] The diagnosis is usually made on basis of specific radiographic features,[3] particularly on computed tomography (CT) scan. We report a case of a 69-year-old man who presented with recurrent lower respiratory tract infections and was found to have tracheobronchomegaly as an underlying primary airway abnormality on imaging and bronchoscopy that was initially undiagnosed.

A case of bilateral pulmonary suppuration with multiple cavities in a type 1 diabetic hemodialysis patient

症例は61歳女性．21歳時に1型糖尿病を発症し，強化インスリン療法を開始した．56歳時に糖尿病性腎臓病による末期腎不全のため血液透析を導入．内因性インスリン分泌が枯渇しており，強化インスリン療法でも血糖コントロールは非常に不安定であり，FGM（flash glucose monitor）を装着した．透析中に呼吸苦を訴えたため，当院へ入院となった．胸部CTにて両肺に多発浸潤影を認めたため，肺炎と診断した．抗菌薬にて治療を開始したところ，第10病日の胸部CTで多発空洞形成を認め，肺化膿症と診断した．肺化膿症は肺葉を超えて多発することは非常に稀であり，一般的に一つの肺葉に留まる．肺膿瘍が急速に広範囲に進展したのは，本症例に特徴的である血糖変動が大きい1型糖尿病が要因と考えられ，さらに同時に不顕性誤嚥が関与した可能性があると考えた．論文検索した限り，過去に同様な症例報告はされておらず，貴重な症例と考え報告する．

Cytomorphological changes of the liver in patients with pulmonary suppuration and atherosclerosis

The central position occupied by the liver in metabolic processes determines its secondary defeat in various pathological conditions of the body. For a sufficiently complete understanding of these changes, it is necessary to study not only functional abnormalities, but also morphological damage to liver cells. In this regard, the method of puncture liver biopsy has recently become widespread, which allows to identify the initial forms of liver damage, to make dynamic monitoring of the course of the pathological process, to detail the diagnosis.

Treatment of non-tuberculous pulmonary suppuration. Reports at the IV International Congress of Surgeons in Madrid 1932 - (Pr. Med. 1932, 2nd)

Liliеnthal (N.-York). For the surgeon, abscess and bronchiectasis are important from pulmonary suppuration. Surgical intervention is indicated only for progressive abscesses, since a significant part of inpatient and. capable of self-healing. Bronchoscopy, artificial pneumothorax can be performed, but phrenicoecgomy has no effect. The intervention should be carried out with the head down and with local anesthesia, sometimes a two-stage operation is indicated. Postoperative complications in the form of bronchitis, fistulas cause thoracoplasty. Suppurative bronchiectasis usually follows oral surgery after a few weeks. Treatment can be either palliative: drainage, which usually results in fistula, thoracoplasty, apicolysis, or radical: lobectomy. A. reported 40 cases of lobectomies, albeit with a high mortality rate (62%).

Prof. Trutnev VK — An attempt to treat pulmonary suppuration by aspiration using a bronchoscope. Collection of Kazan clinics for diseases of the nose, throat and ears. Issue II. 1931 p. 216-224.

The author, on the basis of his own 5-year experience, believes that this method should take a significant place in the diagnosis and treatment of certain pulmonary diseases, especially with lung abscess.

Monaldi cavernostomy for lung aspergillosis: A case report.

Pulmonary aspergillosis in patients with respiratory failure can severely affect the pulmonary functional status and may aggravate it through pulmonary suppuration, by recruitment of new parenchyma and hemoptysis, which can sometimes be massive, with lethal risk by flooding the bronchus. The treatment consists of a combination of medical therapy, surgery and interventional radiology. In small lesions, less than 2-3 cm, medical therapy methods may be sufficient; however, in invasive forms (larger than 3 cm) surgical resection is necessary. Surgical resection is the ideal treatment; nevertheless, when lung function does not allow it, action must be taken to eliminate the favorable conditions of the infection. In such cases, whenever the lung cavity is peripheral, a cavernostomy may be performed. Four cases of lung cavernous lesions colonized with aspergillus, in which the need for a therapeutic gesture was imposed by repeated small to medium hemoptysis and by the progression of respiratory failure, were evaluated, one of which is presented in the current study. Cavernostomy closure can be realized either surgically with muscle flap or spontaneously by scarring, after closure of the bronchial fistulas by epithelization and granulation. There were no recurrences of hemoptysis or suppurative phenomena. There was one death, a patient with severe respiratory failure caused by superinfection with nonspecific germs. However, in the case presented in this study, the patient recovered following cavernostomy, which seems to be an effective and safe method for cases in which lung resection is not feasible.

Multidisciplinary approach to paediatric aerodigestive disorders: A single-centre longitudinal observational study.

Aerodigestive clinics (ADCs) are multidisciplinary programmes for the care of children with complex congenital or acquired conditions affecting breathing, swallowing and growth. Our objective was to describe the demographic, clinical, etiological and investigational profile of children attending the inaugural ADC at a tertiary paediatric centre in Queensland. Children referred to the ADC at Queensland Children's Hospital from August 2018 to December 2019 were included. Data on clinical, growth and lung function parameters, bronchoscopy and upper gastrointestinal endoscopy findings, thoracic imaging and comorbidities were retrospectively analysed. Fifty-six children (median (range) age 4 years (3 months-15 years); 18 female) attended the ADC during this 17-month period. Forty-six (82%) children had previous oesophageal atresia with tracheo-oesophageal fistula; 43 of these were type C. Previous isolated oesophageal atresia, congenital diaphragmatic hernia and congenital pulmonary malformation were the underlying disorder in three (5%) children each, with one child having a repaired laryngeal cleft. Vertebral Anal Tracheo Esophageal Renal Limb anomalies (VACTERL)/Vertebral Anal Tracheo Esophageal renal anomalies (VATER) association was seen in 21 (38%) children. Growth was adequate (median weight and body mass index z-score -0.63 and -0.48, respectively). Thirty-four (61%) children reported ongoing wet cough, with 12 (21%) requiring previous hospital admission for lower respiratory tract infection. Fourteen (25%) had bronchiectasis on computed tomography chest and 33 (59%) had clinical tracheomalacia, apparent on bronchoscopic examination in 21 patients. Dysphagia was reported in 15 (27%) children, 11 (20%) were gastrostomy feed-dependent and 5 (9%) had biopsy-proven eosinophilic oesophagitis. High proportion of children attending the ADC have ongoing respiratory symptoms resulting in chronic pulmonary suppuration and bronchiectasis. Potential benefits of this model of care need to be studied prospectively to better understand the outcomes.

Social characteristics of HIV patients with suppurative diseases of the lungs and pleura and their effect on the disease outcome

The objective : to study the influence of certain social factors on treatment results of suppurative diseases of the lungs and pleura in HIV positive patients. Subjects and methods : 232 HIV positive patients with suppurative diseases of the lungs and pleura (the mean age made 36.9 ± 7.2 years) who were admitted to the clinic to have treatment. Various surgical interventions were performed in 171 (74%) patients, 10 (5.8%) had postoperative complications. Based on the outcome of suppurative disease, 232 patients were divided as follows: 42 (18.1%) - clinical cure with no X-ray signs in the lungs, 100 (43.1%) - clinical cure with residual changes in the lungs, 55 (23.7%) - improvement, 9 (3.9% ) - no changes. 26 (11.2%) patients died, of them 24 (10.3%) died due to systemic complications, 2 (0.9%) - due to pulmonary/intrapleural hemorrhage. In the patients, relationships between the manifestations and outcomes of the suppurative disease (pulmonary suppuration, pleural empyema, development of complications, fatal outcome) were studied considering each of 9 factors and using Spearman's rank correlation: age, education, employment status, marital status, tobacco smoking, drug abuse, alcohol addiction, the way of infecting with HIV, and in-take of ART. Only the inverse weak correlation was revealed between the level of education and fatal outcome (patients with higher education died less often), as well as employment and development of pleural empyema (in those employed, pleural empyema was less common).

Sergei Ivanovich SPASOKUKOTSKY - academician, Professor, chief surgeon of the Kremlin Medical and sanitary Department
 (to the 150th of birthday)

Sergei Ivanovich Spasokukotsky was born in Kostroma in 1870 in the family of a Zemstvo doctor. In 1879 he entered the Yaroslavl provincial gymnasium, in 1888 the medical faculty of Moscow University. Having received a doctor's degree, Sergey Ivanovich supervised the construction of the hospital on the Arkhangelsk railway, worked in the clinic of Professor L. L. Levshin in Moscow. In 1898, S. I. Spasokukotsky defended his thesis on" Bone grafting in amputation of limbs." In 1900. he makes a report on hernias at the I Congress of Russian surgeons, and 3 years later publishes his report on 600 performed hernias. In 1902, he presented a scientific study on "the gatekeeper's Obstruction and its surgical treatment". By the end of the 1900s, half of the stomach operations in Russia were performed by S. I. Spasokukotsky. In 1909-1911 he worked as the head of the surgical Department of Saratov city hospital, since 1912. Professor of the Department of topographic anatomy and operative surgery, then head of the Department of hospital surgical clinic of Saratov University. S. I. Spasokukotsky studied various aspects of the treatment of ulcers and stomach cancer, problems of acute appendicitis, liver surgery, biliary tract and postoperative complications, neurosurgery. He was the first to use fat swabs to fight bleeding in brain surgery (1913). In 1915, during the First world war, he worked as a consultant surgeon on the South-Western front. Invented a method of skin-bone flap, suggested puncture method of treatment of abscesses of the brain. In 1923 S. I. Spasokukotsky for the first time in the USSR made and highly estimated diagnostic value of encephalography; one of the first began to develop a problem of surgical treatment of brain tumors, made resection of a share of a lung, for the first time pointed to the actinomycotic nature of group of pulmonary suppuration. He demonstrated the advantages of thoracoplasty in his work "the Role of surgery in the treatment of purulent pulmonary diseases. Thoracoplasty" (1925). Since 1926 Sergey Ivanovich is the head of the faculty clinic and the Department of faculty surgery of the 2nd Moscow medical Institute. N. And. Pirogov (now Russian national research medical University named after N. And. Pirogov). He introduced a polyclinic reception, strict adherence to asepsis, visiting patients at certain hours, local anesthesia, developed a method of treating the surgeon's hands. Since 1927, S. I. Spasokukotsky chief surgeon of the Medical and sanitary Department of the Kremlin, head of the surgical sector of the Institute of blood transfusion in Moscow. His experience was summarized in the monograph "blood Transfusion in surgery" (1935). From 1935 to the end of his life S. I. Spasokukotsky was a member of the Board of the all-Union society of surgeons. He was a member of the editorial Board of a number of medical journals and from 1921 to 1932 was editor of the journal "New surgical archive". S. I. Spasokukotsky was awarded the Stalin prize of I degree (1942), the government cash prize of 30 thousand rubles and the ZIS car, orders of Lenin, the red banner of Labor and medals In 1942. Sergey Ivanovich was elected a full member of the Academy of Sciences of the USSR. The scientific school of S. I. Spasokukotsky consists of 35 professors, 33 associate professors and candidate of medical Sciences. He published more than 143 scientific publications, including monographs. On November 17, 1943 Sergey Ivanovich died of liver cancer and was buried at Novodevichy cemetery in Moscow. His name is called surgery (herniation, gastric resection, amputation). The street was named after Spasokukotsky in Kostroma; in Moscow: faculty surgical clinic of the Russian national research medical University named after N. So. Pirogov and city hospital №50 (2015). In front of the main building of the City clinical hospital №1 on Leninsky Prospekt it has a monument-bust.

Un corps étranger bronchique négligé pendant 23 ans

Foreign body inhalation is a clinical emergency requiring prompt action to ensure speedy recovery and minimize the development of complications. It is more common in children than adults. We report a case of a neglected foreign body present in the bronchus of an adult for 23years and treated as intermittent asthma. The diagnosis was revealed following the development of severe sepsis of a pulmonary origin. The foreign body was removed by rigid bronchoscopy, antibiotic therapy instituted and pre- and post-interventional respiratory physiotherapy carried out. Satisfactory progress was marked by the complete clearing of pulmonary suppuration, with only a small localized and asymptomatic focus of bronchial dilatation remaining. The persistence of chronic, unexplained respiratory complaints should prompt the use of imaging and endoscopy to exclude an endobronchial cause, especially to consider the possible presence of a previously unknown foreign body. Early diagnosis and intervention can help to avoid potentially serious complications.

A case of multiple empyema caused by Streptococcus intermedius

We report the case of a patient with multiple empyema present throughout his body, including chronic sinusitis and chronic suppurative otitis media, as well as subsequent epidural empyema, all caused by Streptococcus intermedius. A 38-year-old man presented with chief complaints of headache, left ear discharge, and nasal congestion. Imaging studies revealed pansinusitis, soft tissue signs in the mastoid cells, and otitis media. The patient was treated with meropenem hydrate, 6g/day. While clinical findings indicated improvement of the sinusitis, his headache did not improve. Further examination with contrast computerized tomography (CT) ‘a chest radiography’ blood cultures were performed, and the patient was diagnosed with multiple empyema (with an epidural empyema, pulmonary suppuration) caused by S. intermedius. Subsequent burr hole drainage was implemented to drain the epidural empyema. Long-term administration was required to treat pulmonary suppuration. While they remain rare, there has been a recent upward trend in the frequency of cases in which a young, previously healthy patient has developed multiple empyema throughout their body despite the absence of complicating diseases that pose an immune deficiency risk, such as diabetes or infection with the human immunodeficiency virus (HIV). In order to properly diagnose and treat patients presenting with multiple empyema infection with S. intermedius should be included in the differential diagnosis.

Concurrent acute spontaneous tumor lysis syndrome complicated with multiple organ failure in a patient with pre-existing undiagnosed lung cancer.

Acute kidney injury, a common complication associated with malignancy, occurs in various clinical situations for numerous reasons. Acute tumor lysis syndrome (TLS) is possibly the most significant cause of acute kidney injury in cancer patients, because it is fulminant at onset and associated with severe metabolic derangements. Acute spontaneous tumor lysis syndrome is rare and most of the related malignancies belong to hematologic malignancies but it has seldom been investigated as bulky or advanced metastatic non-hematologic malignancies. TLS comprises a clinical laboratory derangement of cellular metabolism which can lead to acute renal impairments, cardiac arrhythmia, seizures and patient demise. Prevention and treatment of tumor lysis syndrome depends on early recognition of at-risk patients, volume repletion and xanthin oxidase inhibitors. In addition, in patients with high risk tumor types, prophylactic use of rasburicase before chemotherapy is required. If dialysis is required, continuous modalities may be favored, particularly in patients with more severe TLS. This case report discusses a 79-year-old man with controlled Alzheimer's disease presented with picture of septic shock and multiorgan dysfunction (acute kidney injury, acute lung injury, acute brain injury) pulmonary suppuration in the right lung field due to aspiration pneumonia with infection-induced systemic inflammatory response (SIRS) was diagnosed. Further work-up revealed lung cancer on chest CT scan. Antibiotic, respirator and hemodialysis treatment improved his condition but died several days later. Acute spontaneous TLS may present in association with infectious SIRS and multiple organ failure, the combination of which results in significant mortality.

Surgical treatment of late‐diagnosed bronchial foreign body aspiration: a report of 23 cases

Late-diagnosed bronchial foreign bodies can lead to irreversible changes in the bronchi and the lungs. To date, few reports are available concerning surgical treatment for this condition. The present report summarizes clinicopathological features and surgical treatment options for late-diagnosed bronchial foreign body aspiration. Clinical data of 23 patients who underwent surgical treatment for late-diagnosed bronchial foreign body aspiration in our hospital from 1980 to 2010 were reviewed. The patients included 17 male and six female patients, aged 6 to 66 years. To remove the foreign body, bronchotomy was performed in six patients and pulmonary resection in 17 patients. Foreign bodies were located on the right side in 17 cases and on the left side in six cases. The majority of the foreign bodies were of food origin. Postoperative bronchopleural fistula occurred in two patients. One patient died of renal failure subsequent to lung infections. Detailed history, awareness of potential foreign body aspiration and thorough bronchoscopic examination are helpful to avoid pulmonary resection. However, the latter is necessary in patients with the associated substantial lung lesions to prevent these from progressing into serious lung infections such as pulmonary suppuration or empyema.

Cough suppression disorders spectrum

Volitional cough suppression, identified exclusively in females, is an unusual causal mechanism for instances of lobar atalectasis and bronchiectasis. It is a postulated mechanism for the genesis of Lady Windermere Syndrome.

Severe Pulmonary Suppuration with Infection-Induced Systemic Inflammatory Response Syndrome following Tongue Cancer Surgery in a Patient Undergoing Tocilizumab Therapy for Rheumatoid Arthritis.

A 65-year-old woman with rheumatoid arthritis treated by tocilizumab (TCZ) presented with tongue squamous cell carcinoma. While surgery was performed without any complications the aspiration pneumonia rapidly worsened by postoperative day 2 and severe pulmonary suppuration in the right lung field with infection-induced systemic inflammatory response syndrome (SIRS) was diagnosed. Antibiotic and respirator treatment improved her condition. The anti-inflammatory effect of TCZ may mask the symptoms and signs of severe infection with SIRS.

Reply to Terzi et al.

I thank Terzi et al. [1] for their comments on our article [2] and also thank EJCTS for giving me this opportunity to answer this question. Bronchopleural fistula (BPF) is a most serious complication in patients with tuberculosis-destroyed lungs who have undergone pneumonectomy. Halezeroglu et al. [3] consider that tuberculosis and preoperative empyema lead to BPF. We believe that the risk factors for BPF are the surgical suture technique, endobronchial tuberculosis, multidrug-resistant tuberculosis and pleural space infection, although postoperative BPF after pneumonectomy for tuberculosis-destroyed lungs has been decreasing steadily. The prevention of postoperative BPF in patients with tuberculosisdestroyed lungs is very important in chest surgery. The surgical process for a bronchial stump includes suturing and protection. The suturing includes full-thickness suture, stapler suture and so on. Pleural tissue, pericardial tissue and muscle flaps are used to protect the bronchial stump. But when a tuberculosis-destroyed lung is combined with endobronchial lesions, the suture line of the full-thickness suture and the stapler of the stapler suture for endobronchial tuberculosis may cause a ‘drainage effect’, which could lead to an infection in the chest. So, we think that the ‘drainage effect’ may lead to a BPF. Endobronchial tuberculosis has been demonstrated in up to 18% of tuberculosis patients. Vester et al. [4] think that the stapler is contraindicated when the bronchus is thickened, inflamed or of insufficient length. Thus, we think that the way in which we suture is more important than how the bronchial stump is protected. We suggest that the muscle flap that Terzi et al. [5] use to protect a bronchial stump could be used in the repair surgery after BPF. The extramucous suture technique for bronchia is a method that does not cross the bronchia mucous. In 1963, Xin et al. [6] reported 509 cases (including 487 of pulmonary tuberculosis and 22 of pulmonary suppuration) who underwent pulmonary resection. For the extramucous suture in a bronchia group of 200 patients, the incidence of BPF was 0%. For the full-thickness suture in a bronchia group of 200 patients, the incidence of BPF was 3.0% (six cases). For the stapler suture in a bronchia group of 109 patients, the incidence of BPF was 4.5% (five cases). The way we choose to suture is according to the situation of the mucous membrane. In our hospital, the extramucous suture technique has been routine for patients with endobronchial tuberculosis for half a century, and the incidence of BPF is very low. But reinforcing the bronchial stump with the surrounding tissues can decrease the incidence of postoperative BPF in tuberculosis-destroyed lungs. In addition, standard preand postoperative antituberculosis treatments and a careful operation often lead to satisfactory surgical effects. When patients suffer from multidrug-resistant pulmonary tuberculosis and endobronchial tuberculosis, selective operation indication, adequate preoperative antituberculosis treatment and endobronchial ultrasonic atomization are needed.

External fistulous wound with Pseudomonas aeruginosa infection and massive bleeding following rupture of pulmonary suppuration

We present a 54-year old man with a pulmonary infectious cavity continuing to a cutaneous fistula. Before he was admitted to our hospital, he had undergone open-window surgery for a left thoracic empyema due to the rupture of pulmonary suppuration of the left upper lobe. He had then undergone thoracoplasty with the plombage of the cavity using left pectoralis major muscle. However, this procedure had failed and the external fistulous wound remained infected by Pseudomonas aeruginosa and occasional massive bleeding from the cavity occurred. He underwent en bloc left upper lobectomy for the external fistulous wound. The pedicled left latissimus dorsi muscle flap was transposed to fill the dead space and reinforce the bronchial stump. He remained in good health and did not experience intrathoracic infection or haemoptysis.

Complex space-filling procedures for intrathoracic infections — personal experience with 76 consecutive cases☆

The objective of our article is to analyse the results of complex space-filling procedures for chronic intrathoracic suppurations. We performed a retrospective analysis of 76 consecutive patients operated in our unit between 1 January 2003 and 31 December 2008, who presented pleural and/or pulmonary suppurations not amenable to decortication or resection; 36 patients (47%) had tuberculosis (TB) lesions (28 with positive cultures at the moment of surgery, seven with multi-drug-resistant (MDR) infections), 13 patients (17%) had postoperative empyema, 18 patients (24%) presented with frank intrapleural rupture of a pulmonary cavity and 26 patients (34%) presented with bronchial fistula. In these patients, we performed a combination of thoracoplasty (5.3+/-1.3 resected ribs) and intrathoracic transposition of extrathoracic muscles - 148 flaps (60 serratus anterior, 55 latissimus dorsi, 27 pectoralis and 6 subscapularis) with an average of 1.9 flaps per patient; in all patients, we used a closed-circuit irrigation-aspiration system and primary closure of the wound. The overall mortality was 5% (four patients) and four other patients (5%) presented recurrence of infection requiring a modified open-window thoracostomy; other local complications included minor skin necrosis solved through excision (three cases) and external thoracic fistula closed through local lavages (two cases). Postoperative hospitalisation ranged between 4 and 180 days, with an average of 40+/-5 days; all patients were discharged with healed wounds. Statistical analysis performed with the Fischer's exact test suggested that the flap or combination of flaps used to obliterate the space did not influence the rate of recurrence or the incidence of other major postoperative complications (p>0.05). Mild impairment of shoulder function was encountered in five patients. A comparative evaluation of the pre- and postoperative VC and forced expiratory volume of 1s (FEV1) showed no statistically significant difference (Wilcoxon signed-rank test -p>0.05). Patients with complex intrathoracic suppurations not amenable to decortication or lung resection require complex space-filling procedures to achieve complete obliteration of the infected space. The association between thoracoplasty and intrathoracic muscle transposition is a safe and simple solution allowing a quick recovery with good functional and aesthetic postoperative outcome.

Broncholithiasis managed by surgical resection

Broncholithiasis is frequently associated with hemoptysis and infection. The most common cause of the disease is the presence of calcified material in a bronchus or in a cavity communicating with a bronchus. We present two cases of broncholithiasis treated by surgery. Case 1 involves a 57-year-old woman who presented with cough and bloody sputum. She had suffered from recurrent pneumonia in the left lower lobe caused by broncholithiasis for 2 years. We performed left S6 segmentectomy with bronchoplasty after unsuccessful bronchoscopic removal. Case 2 is a 65-year-old man who had had hilar tuberculous lymphoadenopathy at the age of 20. Recently he had suffered from recurrent bloody sputum and pulmonary suppuration for 3 years. We performed right upper lobectomy because the right B3 was occluded by inflammatory granulation with calcification. Postoperatively, these two patients have been alive and well with no complications. The indications of surgery for broncholithiasis include a difficult bronchoscopic broncholithectomy, massive hemoptysis, and irreversible complications such as chronic pulmonary suppurative disease.