Tuberculosis Sequelae Research Articles

Surgical aspects of pulmonary tuberculosis: an update.

Tuberculosis remains a major global medical challenge and concern. In the world's population of over 7.4 billion people, 8.6 million are estimated to be infected with Mycobacterium tuberculosis; another 2.2 billion have latent tuberculosis. There is an annual incidence of 16,000 new cases in the USA and 7-8 million new cases worldwide, of which 440,000 are multidrug-resistant or extensively multidrug-resistant, mainly in developing countries or emerging economies. According to the World Health Organization, the incidence of tuberculosis is 133 cases per 100,000 of the population; 3.3% new cases are drug resistant and 20% are already treated cases. Of the drug-resistant cases, 9.7% are extensively drug-resistant. The annual global mortality attributable to tuberculosis is over 1.3 million people. The association with HIV/AIDS in 430,000 people has compounded the global concern and challenge. This review presents the historical indications for surgical treatment of tuberculosis, reviews the current literature and clinical experience, and collates this into increased awareness and contemporary understanding of the indications and need for surgery in primary active tuberculosis, adjuvant surgical therapy for multidrug-resistant tuberculosis, and the complications of chronic tuberculosis sequelae or previous tuberculosis surgery.

Palatopharyngoplasty for treatment of nasopharyngeal stenosis secondary to extra-laryngeal tuberculosis

Nasopharyngeal stenosis is a rare sequela of extra-laryngeal tuberculosis that can adversely impact the quality of life of afflicted patients. Relying solely on the oropharyngeal airway, patients often complain of inspiratory dryness and decreased sensation of airflow as the nasal mucosa and turbinate complex is entirely excluded from the breathing mechanism. Often times, the oropharyngeal inlet can be narrowed as well, limiting the air flow through the oropharyngeal airway. In those circumstances, patients often require tracheostomy for establishment of a reliable airway. We present the unique case of a previously tracheotomized patient with nasopharyngeal stenosis secondary to tuberculosis successfully treated with a modified palatopharyngoplasty to reestablish a patent naso-oropharyngeal airway. During the follow-up period, the patient was decannulated and highly satisfied with his respiratory status. Although rare and more commonly used in the treatment of sleep apnea, palatopharyngoplasty can be a viable option for the treatment of naso-oropharyngeal stenosis and should be kept in the armamentarium of reconstructive craniofacial surgeons.

Correlation of chest computed tomography findings with dyspnea and lung functions in post-tubercular sequelae.

Aims:To study the correlation between dyspnea, radiological findings, and pulmonary function tests (PFTs) in patients with sequelae of pulmonary tuberculosis (TB).Materials and Methods:Clinical history, chest computed tomography (CT), and PFT of patients with post-TB sequelae were recorded. Dyspnea was graded according to the Modified Medical Research Council (mMRC) scale. CT scans were analyzed for fibrosis, cavitation, bronchiectasis, consolidation, nodules, and aspergilloma. Semi-quantitative analysis was done for these abnormalities. Scores were added to obtain a total morphological score (TMS). The lungs were also divided into three zones and scores added to obtain the total lung score (TLS). Spirometry was done for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC.Results:Dyspnea was present in 58/101 patients. A total of 22/58 patients had mMRC Grade 1, and 17/58 patients had Grades 2 and 3 dyspnea each. There was a significant difference in median fibrosis, bronchiectasis, nodules (P < 0.01) scores, TMS, and TLS (P < 0.0001) between dyspnea and nondyspnea groups. Significant correlations were obtained between grades of dyspnea and fibrosis (r = 0.34, P = 0.006), bronchiectasis (r = 0.35, P = 0.004), nodule (r = 0.24, P = 0.016) scores, TMS (r = 0.398, P = 0.000), and TLS (r = 0.35, P = 0.0003). PFTs were impaired in 78/101 (77.2%) patients. Restrictive defect was most common in 39.6% followed by mixed in 34.7%. There was a negative but statistically insignificant trend between PFT and fibrosis, bronchiectasis, nodule scores, TMS, and TLS. However, there were significant differences in median fibrosis, cavitation, and bronchiectasis scores in patients with normal, mild to moderate, and severe respiratory defects. No difference was seen in TMS and TLS according to the severity of the respiratory defect.Conclusion:Both fibrosis and bronchiectasis correlated with dyspnea and with PFT. However, this correlation was not linear. The overall extent of radiological abnormalities correlated only with dyspnea but not with PFT.

Bronchial artery embolisation in management of hemoptysis – A retrospective analysis in a tertiary university hospital

BackgroundBronchial artery embolisation (BAE) becomes a mainstay in the treatment of hemoptysis. ObjectiveTo characterise patients with hemoptysis undergoing bronchial artery angiography (BAA) for embolisation, evaluating outcomes. MethodsWe retrospectively evaluated patients with acute severe or chronic recurrent hemoptysis admitted to the Pulmonology department and submitted to BAA for purpose of embolisation. ResultsA total of 88 patients were submitted to BAA, 47 (53.4%) were male, with a mean age of 61.4±15.8 years. In 64 (72.7%) patients, hemoptysis presented as chronic recurrent episodes. Hemoptysis was considered severe in 40 (45.5%) patients. Bronchiectasis (other than cystic fibrosis) (n=35; 38.0%) and tuberculosis sequelae (n=31; 35.2) were the major aetiology for hemoptysis. The main angiographic abnormality was hypertrophy and tortuosity (n=68; 77.3%). BAE was performed in 67 (76.1%) of the 88 patients submitted to BAA. Immediate success was achieved in 66 (98.5%) patients. Recurrence of hemoptysis occurred in 25 (37.3%) patients, and was related to presence of shunting (p=0.049). The procedure-related complications were self-limited. ConclusionOur results suggest that BAE is a safe and effective treatment for acute severe and chronic recurrent hemoptysis, supporting the current literature. Besides this, bleeding recurrence was relatively high, and correlated with presence of systemic pulmonary shunting.

Pneumonectomy in the Indian scenario—a review of current indications and results

Pneumonectomy is an important procedure in the armamentarium of the thoracic surgeon dealing with both neoplastic and non-neoplastic diseases of the lung especially in a developing country like India where the sequelae of tuberculosis are still rampant and the incidence of lung cancer is on the rise. The indications for pneumonectomy are varied. The operative techniques are standardized. Assessment of risk-benefit ratio is important as pneumonectomy carries considerable morbidity. We present our experience with 74 cases of pneumonectomy performed for varied etiologies, the outcomes of which are retrospectively analyzed in this study. We retrospectively reviewed our institutional database for patients who underwent a pneumonectomy from January 2009 to April 2015. Demography, patient profile, indications for surgery, details of operative technique, development of perioperative complications, and mortality were analyzed. Seventy-four patients underwent pneumonectomy, with a male to female ratio of 2:1. The age range was 6 to 72 years out of which six were children (8.1 %). Post-tuberculosis-destroyed lung was the predominant indication (43.24 %). Nineteen (25.67 %) underwent pneumonectomy for various tumors. Completion pneumonectomy was done in four (5.40 %). Left pneumonectomy was performed in 48 patients (64.86 %). The operative time ranged between 110 and 385 min. The mean post-operative stay was 4 days. Two patients (2.70 %) required emergency cardiopulmonary bypass for torrential hemorrhage during hilar dissection. Post-operative complications encountered were reactionary hemorrhage (1), empyema (2), bronchopleural fistula (1), and chylothorax (1). There was one early post-operative death due to fulminant respiratory failure. Early mortality rate was 1.35 %. The outcomes following pneumonectomy are favorable when careful attention to patient selection, preoperative patient optimization, meticulous surgical technique, and post-operative principles are followed. Pneumonectomy in post-pulmonary tuberculosis-destroyed lungs did not carry extra morbidity or mortality. Pneumonectomy in malignant lung/bronchial diseases is safe. Pneumonectomy in children was remarkably uncomplicated. Completion pneumonectomy can be done with an acceptable morbidity in selected patients. Use of cardiopulmonary bypass when encountered with torrential intraoperative hemorrhage is an acceptable strategy. Outcomes of hand-sewn bronchial closure technique are comparable to stapling devices and cost effective.

A case of unusual indeterminate biliary stricture

Biliary stricture is a rare sequela of biliary tuberculosis (TB) infection. Early recognition with prompt treatment can result in complete resolution. A 56-year-old man was diagnosed with biliary TB after analysis of bile from ERCP showed positive results for TB. Bile duct brushings were inconclusive. Despite completing 7 months of anti-TB treatment, the patient’s liver function test results were still abnormal. MRCP showed dilated intrahepatic ducts with a stricture at the hilar bifurcation

Complex pulmonary aspergilloma treated by cavernostomy.

To evaluate the effectiveness of cavernostomy in patients with complex fungal balls. We analyzed the medical records of patients undergoing cavernostomy between January 2005 and May 2013, evaluating: age, gender, preoperative signs and symptoms, predisposing disease, preoperative tests, location of the aspergilloma, etiologic agent, cavernostomy indication, postoperative outcome. Ten patients were male. The mean age was 42.9 years (34-56). The most frequent symptom was repeated pulmonary bleeding. Cavernostomy was proposed for patients at high risk for lung resection. It was performed in 17 patients and all of them had pulmonary tuberculosis sequelae, with cavitations. The indication in all cases was hemoptysis and elimination of phlegm. The cavernostomies were performed in a single surgical procedure. In all 17 patients the cavity was left open after the withdrawal of the mycetoma. In all patients hemoptysis ceased immediately. Operative mortality was 9.5% (1). cavernostomy is an effective treatment alternative in patients at high risk. It may be useful in some patients with complex aspergilloma, irrespective of lung function or bilateral disease. It is technically easy, has low-risk, saves parenchyma, and may be performed in a single operative time.

Response: Endobronchial tuberculosis: always a diagnostic challenge

Sir, We thank Dr. Jolobe for his interest in our reported case who developed acute lung collapse due to bronchostenosis as a sequela of undiagnosed endobronchial tuberculosis (EBTB).1 As Dr. Jolobe pointed out, EBTB presenting in the absence of radiologic TB lesions is often a great diagnostic challenge. The diagnosis …

Spontaneous bronchoesophageal fistula in an adult – A possible delayed sequela of pulmonary tuberculosis

Spontaneous bronchoesophageal fistula in the adult is a rare clinical entity. Most bronchoesophageal fistulae are due to malignancy, prolonged endotracheal intubation or trauma. Granulomatous infections like tuberculosis, HIV and mediastinitis are rare causes of acquired bronchoesophageal fistula. We report a case of a 50year old man, treated for pulmonary tuberculosis 15years ago, who developed a spontaneous bronchoesophageal fistula between the mid-esophagus and right main stem bronchus, having no history of malignancy or trauma. Surgical closure of the fistula was done and post operative recovery was uneventful. In this case, the bronchoesophageal fistula probably developed as a delayed sequela of pulmonary tuberculosis as the patient had no active signs of pulmonary tuberculosis clinically or histopathologically.

Acquired spontaneous bronchoesophageal fistula in an adult

Spontaneous bronchoesophageal fistula in adults is a rare clinical entity. Most bronchoesophageal fistulae are due to malignancy, prolonged endotracheal intubation or trauma. Granulomatous infections like tuberculosis, HIV and mediastinitis are rare causes of acquired bronchoesophageal fistula. We report a case of a 50year old man, treated for pulmonary tuberculosis 15years ago, who developed a spontaneous bronchoesophageal fistula between the mid-esophagus and right main stem bronchus, having no history of malignancy or trauma. Surgical closure of the fistula was done and post operative recovery was uneventful. In this case, the bronchoesophageal fistula probably developed as a delayed sequela of pulmonary tuberculosis as the patient had no active signs of pulmonary tuberculosis clinically or histopathologically.

Emergency transcatheter arterial embolization for massive hemoptysis due to pulmonary tuberculosis and tuberculosis sequelae.

To explore the strategy and curative effect of emergency transcatheter arterial embolization (ETAE) in patients with massive hemoptysis due to pulmonary tuberculosis and tuberculosis sequelae. A total of 148 patients with massive hemoptysis due to pulmonary tuberculosis underwent emergency arteriography. After the bleeding artery was located, patients were given embolotherapy using gelfoam strips, coils, and polyvinyl alcohol particles. The arteriography manifestations and therapeutic outcomes in all patients were retrospectively analyzed. ETAE was performed successfully in 143 patients after location of the bleeding arteries. The bleeding arteries could not be located in another five patients, and embolotherapy, therefore, could not be performed. Among these five patients, three underwent surgical resection and two died of complications of tuberculosis/fungal ball coinfection. During a 2-year follow-up period, there were 15 cases of recurrent hemoptysis after initial embolotherapy. Among these, four cases were resolved by re-embolization, 11 patients still had massive hemoptysis after re-embolization who underwent surgical resection and resolved the hemoptysis eventually. Successful hemostasis was achieved by ETAE in 132 patients (89.19%; 132/148). No severe complications occurred after embolotherapy. ETAE is a safe and effective treatment for massive hemoptysis due to pulmonary tuberculosis. The key to successful treatment is thorough and complete embolization of the bleeding arteries. In the event of failure of embolotherapy, surgical resection should be used to resolve the bleeding.

Bronquiectasias y Limitación Funcional en la Tuberculosis Pulmonar Curada

OBJETIVOS: Determinar la frecuencia de bronquiectasias y limitación funcional en pacientes con secuelas por tuberculosis pulmonar. MATERIAL Y MéTODOS: Se evalúa 10 pacientes con el antecedente de haber padecido tuberculosis en una sola oportunidad, a quienes se le realiza radiografía de tórax estándar, tomografía axial computarizada convencional (TAC), broncofibroscopia (BFC) y espirometría. RESULTADOS: La radiografía de tórax es sugestiva de bronquiectasias en 50% de los casos (criterios de Gudbjerg), la TAC de tórax es confirmatoria en 90% de los casos (criterios de Naidich), la broncofibroscopia en el 100% de los casos. El 40% de los casos demuestra limitación funcional restrictiva leve, 40% de los casos limitación funcional restrictiva moderada y 20% tiene espirometría normal. CONCLUSIONES: La tuberculosis pulmonar produce bronquiectasias en casi la totalidad de pacientes que la padecen (90% TAC,100% BFC). La tuberculosis pulmonar produce limitación funcional restrictiva en el 80% de los casos.

Melioidosis Requires Better Data Sharing for Improved Diagnosis and Management in the Mekong Region

Dear Sir: We commend Suntornsut and others for reminding us that pulmonary melioidosis should be considered in every patient with a tuberculosis (TB)–like chest radiographic result and negative acid-fast bacilli (AFB) smears in melioidosis-endemic countries, such as Thailand.1 This finding confirms the conclusion we drew from our analysis of a series of pulmonary melioidosis cases in neighboring Cambodia.2 Among 2,840 acute lower respiratory infections in all-age patients, we found 39 (1.4%) infected with Burkholderia pseudomallei. Six of these patients had a TB-like chest radiographic result. All but one were AFB smear negative. Chronic pulmonary melioidosis and tuberculosis share common clinical features, such as a latency stage for years after initial contact with the bacilli. Two experimental murine models of chronic pulmonary melioidosis showed that the main histopathologic feature was granuloma.3,4 In some cases, the pulmonary lesions were highly suggestive of tuberculosis with large granuloma characterized by a caseous necrotic center.3 This finding might be caused by similar virulence factors.5 Furthermore, in another study in Cambodia, we reported that melioidosis can be associated with pulmonary sequelae mimicking TB sequelae.6 Dysregulation of granuloma formation and of extracellular matrix turnover could lead to similar sequelae in B. pseudomallei and Mycobacterium tuberculosis infections.7 Radiologic and clinical outcomes therefore seem to be closely linked with granuloma formation in TB and melioidosis. We also agree that the burden of pulmonary melioidosis is a heavy one, with a high case-fatality rate (CFR) in low-income countries of the region. In Cambodia, the CFR was 61.5% in our 39-case cohort within two months post-discharge and 52% in another recent series of 58 cases in Cambodia.8 At the time of the study, we linked the high CFR in Cambodia not so much to the severity of the cases, but rather to under-recognition of the disease by clinicians and to the unavailability of appropriate treatment. Since that time, treatment has become available. Pulmonary melioidosis misdiagnosis leads to unnecessary TB treatment. Efforts should be placed on earlier diagnosis of melioidosis and TB. Suntornsut and others proposed that all residual sputum collected from smear-negative patients be cultured to search for B. pseudomallei in countries to which melioidosis is endemic.1 The use of Ashdown's selective agar, which is specific for B. pseudomallei culture, could be easily spread in resource-limited settings. The quality of sputum samples, however, could lead to missing cases. In children, sputum samples are difficult to obtain. In 2011, we suggested the use of throat swab specimens for detecting B. pseudomallei. We believe that this method with 100% specificity (but low sensitivity, 36%)9 could be more useful in children and more easily disseminated in low-income tropical countries in Asia. Tuberculosis diagnosis could also be improved in Cambodia. For 93 consecutive adult patients with at least three AFB smears, 11% discrepancy in AFB smear positivity for TB culture-confirmed samples were observed between two laboratories (Institut Pasteur, unpublished data). New molecular tools, such as GenExpert, could avoid useless TB treatments.10 Larger and smaller case series are documented in tropical countries, especially in the Mekong Basin. A network dynamic and careful aggregation of standardized melioidosis data across the region would help better document the epidemiology and fill knowledge gaps in melioidosis.

Chronic inactive pulmonary tuberculosis and treatment sequelae: chest radiographic features [Perspective

The chest radiograph (CXR) is a key initial tool in the diagnosis of many lung conditions, including pulmonary tuberculosis (TB). With proper use of anti-tuberculosis drugs, TB can be treated effectively and many CXR changes are limited. However, anti-tuberculosis drugs have not always been available, and in some cases they have not been started early in the disease process. The infection has then been able to take hold and cause significant radiologically visible damage, such as calcification and fibrosis. Before the use of anti-tuberculosis drugs, a variety of surgical techniques were employed to control pulmonary infection, including plombage, oleothorax, phrenic nerve crush and thoracoplasty. Each of these led to distinctive CXR features. This article sets out to describe the CXR features of chronic disease and surgical treatments, as their increasing rarity with the passage of time has meant that they can be misinterpreted. However, with increasing life expectancy and the revival of surgery due to the development of anti-tuberculosis drug resistance, the correct interpretation of these CXR changes is still of importance.

Our double valve replacement strategy in a case with pectus carinatum deformity

Background Pectus carinatum is a deformity of the chest characterized by a protrusion of the sternum and ribs. It develops as a result of an overgrowth of cartilage causing the sternum to protrude forward. It is detected most commonly during pubertal growth spurt. Methods Our case was a 63-year-old male. An elective umbilical hernia repair was being planned. During the investigations due to shortness of breath, transthoracic echocardiography (TTE) revealed severe aortic and mitral regurgitation. Left ventricular end-diastolic and end-systolic diameters were measured as 72 and 48 mm, respectively. Left and right atrial diameters were measured as 56 and 55 mm, respectively. Pulmonary arterial pressure was calculated as 35 mm Hg and left ventricular ejection fraction was identified as 60%. Coronary angiography detected no significant stenoses and confirmed aortic and mitral regurgitation with an ejection fraction of 50%. Our case was consulted with Department of Pulmonary Diseases due to dyspnea and moderate pectus carinatum. Fibrotic lesions and pleural thickenings in the upper zones of both hemithoraces were interpreted as sequelae of tuberculosis. Pulmonary function tests were normal. Elective open heart surgery was planned. Results After standard median sternotomy, aortic valve was replaced with 23 mm St. Jude mechanical valve and mitral valve was replaced with 31 mm St. Jude mechanical valve. Left atrial appendix was sutured internally due to atrial fibrillation to avoid embolization and posterior leaflet of the mitral valve was preserved. Postoperative period was event-free. Conclusions Most cases with pectus carinatum are asymptomatic as in our case. Psychological and cosmetic disturbances may be observed as well as respiratory tract infections and exertional dyspnea. We think that technically challenging correction surgery should be avoided if patients are asymptomatic, particularly after completion of calcification process of the bony structures.

Long-Term Oxygen Therapy in Japan: History, Present Status, and Current Problems

Historically, the progress of long term-oxygen therapy (LTOT) in Japan has been characterized by collaboration among academic groups, policy makers, and industrial companies. The public health insurance program has covered the cost of LTOT since 1985. Thomas Petty's group in Denver enthusiastically carried out the public implementation of LTOT and conveyed the concept of pulmonary rehabilitation for the processing with LTOT. Although the target diseases of LTOT in Japan tended to be chronic obstructive pulmonary disease or sequelae of primary lung tuberculosis, it was soon applied for cardiac diseases as well as other pulmonary diseases. Together with increasing medical costs for geriatric patients, the political conversion from hospital based care of a traditional style to home care system has been performed, with two background reasons: the improvement of quality of life of patients and the reduction of the medical expense. Presently, LTOT plays a pivotal role in the successful implementation of home respiratory care for elderly patients. In addition, this promotes comprehensive pulmonary rehabilitation, a team approach, and close liaisons between primary care and hospitals. Currently, the total number of patients using LTOT exceeds 150,000. In Japan, LTOT resulted in an advancement in the medical care as well as in administrative decision to introduce it as a nationwide system after analyzing the results of opinion polls of patients with respiratory failure. However, the recent great earthquake in East Japan revealed that many unresolved problems remain for these patients, and these issues are of great concern.

Impact of multidetector CT-angiography on the emergency management of severe hemoptysis

BackgroundMultidetector CT-angiography (MDCTA) is commonly used in patients with severe haemoptysis requiring admission to intensive care unit. However, the impact of MDCTA on the management of severe haemoptysis in emergency setting is poorly evaluated. MethodsWe prospectively compared data provided by clinical bedside evaluation (clinical examination, chest-X-ray and fiberoptic bronchoscopy) to MDCTA data in terms of lateralization, location of the bleeding site, etiology as well as impact on the treatment choice. ResultsOver a 13-month period, 87 patients (men n=58, median age=61 years, median haemoptysis expectorated volume=180mL) were included. Etiology was mainly (67%) bronchiectasis, tuberculosis sequelae and tumor. MDCTA and clinical bedside evaluation were equally effective in determining lateralization (87.4% and 93.1%, respectively, p=0.23) and location (85% and 82.7%, respectively, p=0.82) of the bleeding site. MDCTA was significantly more accurate than the clinical bedside strategy in determining the haemoptysis cause (86% and 70%, respectively, p=0.007). Moreover, MDCTA suggested the involvement of systemic arteries as bleeding mechanism in 92% of cases, leading to the modification of the treatment initially considered after bedside evaluation in 21.8% of patients. ConclusionMDCTA provides useful information for the management of patients with severe haemoptysis, especially in the treatment choice. Thus, in the absence of emergency fiberoptic bronchoscopy (FOB) requirement for airways management, MDCTA should be the first-line procedure performed in emergency clinical setting.

Avaliação espirométrica de doentes com sequela de tuberculose submetidos à lobectomia

To evaluate pre and post-operative spirometry in patients with tuberculosis sequelae undergoing lobectomy. We selected 20 patients, aged between 15 and 56 years, of both genders, with a history of tuberculosis treatment, with repeated infections or hemoptysis and indication of pulmonary lobectomy. The tuberculosis treatment time was six months, and onset of symptoms, between one and 32. We evaluated and compared vital capacity (VC), forced vital capacity (FVC), forced expiratory volume (FEV1), the FEV1/FVC, forced expiratory flow (FEF) and peak expiratory flow (PEF) preoperatively and after the first, third and sixth postoperative months (POM). The significance level (á) used in all tests was 5%, ie, it was considered significant when p <0.05. The averages found were: Vital Capacity (VC) - Preoperative: 2.83; 1st POM: 2.12; 3rd POM: 2.31; 6th POM: 2.43. Forced Vital Capacity (FVC) - Preoperative: 2.97; 1st POM: 2.21; 3rd POM: 2.35; 6th POM: 2.53. Expiratory Volume in 1 second (FEV1) - Preoperative: 2.23; 1st POM: 1.75; 3rd POM: 1.81; 6th POM 1.97. There was marked decrease in lung function in the first month after surgery, but there was an improvement of the parameters from the third month, with gradual increase up to the sixth month. There was no recovery of preoperative spirometric parameters at six months postoperatively in patients with sequelae of tuberculosis submitted to lobectomy.

Anévrisme géant de l’artère pulmonaire : à propos d’un cas

Pulmonary artery aneurysm is a rare condition accounting for less than 1% of all intra thoracic aneurysms. This paper reports a case of giant aneurysm of the trunk and branches of the pulmonary artery, which was discovered incidentally on a computed tomography angiogram in a 48-year-old man with a past history of pulmonary tuberculosis. Besides the aneurysm there was dilation of the pulmonary annulus with massive pulmonary regurgitation, a tight mitral stenosis and sequelae of pleural and pulmonary tuberculosis. The patient is being followed-up with medical treatment and has been stable clinically for the last ten months.

Preoperative and Postoperative Spirometry in Patients Undergoing Lobectomy for Sequelae of Pulmonary Tuberculosis

Objective: To assess preoperative and postoperative spirometry values in patients undergoing lobectomy for sequelae of pulmonary tuberculosis. Method: A total of 20 patients (10 males) with history of treatment for tuberculosis and presenting with symptomatic sequelae (repeat infection or hemoptysis) who sought assistance at the chest surgery outpatient clinic between 11.09.07 and 04.02.10, were selected for the study. Only patients that met theeligibility criteria (symptomatic, submitted to tuberculosis treatment) were included in the study. The age of patients ranged from 15 to 56 years (mean: 35.75 years). The average treatment time for tuberculosis was 6 months and onset of symptoms occurred between 01 and 32 years after treatment. To assess the impact of surgery on the variables VC, FVC, FEV1, FEV1/FVC, FEF and PEF preoperative values were compared with postoperative values at 1st, 3rd, 6th and 12th month using the paired t test. The level of significance (α) applied for all tests was 5% where a value of p 0.05 was considered significant. Results: 11 patients were treated because of recurrent infections and 9 because of haemoptysis. The most common lobectomy was right upper lobectomy (7 patients), followed by left upper lobectomy (6 patients), left lower lobectomy (6 patients), and right middle lobectomy (1 patient). There were no postoperative complications. There was no postoperative mortality. Conclusion: Based on the results of the present study, it can be concluded that, at the 12th postoperative month, spirometric parameters of patients with tuberculosis sequelae submitted to lobectomy had returned to preoperative levels.