Surgical treatment of pulmonary aspergilloma is the most effective treatment; pulmonary resection is the treatment of choice when indicated and in unstable surgical patients, palliative procedures chosen in bad cardiopulmonary function.

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Hemoptysis due to pulmonary tuberculous lesions is a common cause of morbidity, and occasionally mortality. The aim of this study is to evaluate the surgical outcome of hemoptysis in patients with various tuberculous pulmonary lesions. A total of 45 cases who underwent surgical procedures for various pulmonary tuberculous lesions with hemoptysis were included in this study. Sixteen patients underwent surgical management within one week of the attack of hemoptysis (group A), the other 29 patients underwent surgery one week after the attack (group B). Hemoptysis was classified into minor, major and massive hemoptysis. Major and massive hemoptysis were the common presentation of group A and tuberculous cavities were the most common lung lesions in both groups (37.7%). Lobectomy was the main surgical procedure performed in both groups (51.1%). Bronchopleural fistula occurred in one case in each group after right pneumonectomy. There was one case (6.2%) of mortality in group A. Tuberculous cavity is the common pulmonary lesion which can result in major and massive hemoptysis, therefore, we recommend early surgical resection of tuberculous cavities to avoid life-threatening hemoptysis. Limited resection should be avoided to prevent recurrence.

Usage of bilateral ITAs and selecting the orientation of the I-graft to LCX and RCA branches provide maximal distal anastomotic sites with satisfactory graft patency rate, and simultaneously minimized the incidence of reverse and competitive flow.

Background: Tracheobronchial disruption as a result of blunt thoracic trauma is a rare entity and only clinically serious lesions come to our notice, which can be life-threatening and need prompt recognition and treatment. Objectives: To review the authors' experience with tracheobronchial injuries to emphasize the need for prompt diagnosis and treatment to avoid lethal complications including severe hypoxic organ failure, sepsis, mediastinitis and bronchopleural fistula. Patients and methods: A retrospective study of total 32 patients with tracheobronchial injury from 2001 to 2011. This study limited to patients with thoracic tracheal or bronchial injury, excluding those with cervical injuries. The study includes collected information about mechanism of injury, presentation, time until diagnosis and treatment, anatomical site of injury, type of treatment, diagnostic methods, duration of follow up and outcome. Results: Twenty-four patients were male (75%) and eight were females (25%). Patient's ages ranged from 7-53 years. Majority of cases was referred because of blunt trauma in 15 cases (46.8%), 6 (18.75) motor vehicle accident, 5 (15.6%) fall from a height and 4 (12.5%) with trauma by heavy object, while 8 cases (25%) were referred due to penetrating injury and 2 cases (6.25%) due to iatrogenic injury. In initially diagnosed group, the predominant clinical signs that give a suspicion of tracheobronchial disruption were increased subcutaneous surgical emphysema, shortness of breath, hemoptysis. After the admission to emergency unit, all of them were examined radiologically by chest X-ray film. Longitudinal tear of right upper lobe bronchus was found in 8 cases (32%), complete cut of right upper lobe bronchus in 4 cases (16%), tear of right intermediate bronchus in 4 cases (16%), 3 cases with clear cut left upper lobe (12%), longitudinal tear of distal lateral tracheal wall extend to right upper lobe in 2 cases (8%), 2 cases (8%) showed complex disruption of distal trachea right main with carinal tear and 2 cases (8%) with longitudinal tear of membranous wall of the trachea. 17 patients from early diagnosed cases had concomitant comorbid extra thoracic injuries at the time of diagnosis in the form of abdominal trauma in 12 cases, skeletal fractures in 9 cases and head injury in 5 cases. Conclusion: In a patient with a complex bronchial rupture, primary repair of the bronchus can be possible with complete functional preservation of the lung tissue.

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Purpose To assess the efficacy of primary sternal closure technique compared to vacuum-assisted closure technique in treatment of post-cardiac surgery mediastinitis in paediatric age group. Additionally, assessed postoperative need for IV drug use, hospital stay length, wound and sternal healing and survival. Hypotheses: primary sternal closure is a reliable technique for treatment of poststernotomy mediastinitis following cardiac surgery in paediatric age group. Materials and Methods A prospective randomized controlled trial included 217 pediatric patients developed post-cardiac surgery mediastinitis from 2016 to 2022. They were randomly divided into primary sternal closure group (A) and vacuum-assisted closure group (B) and operated by two cardiothoracic surgeons. Follow-up of the patients was done for 6-months duration following treatment of mediastinitis to assess postoperative need for hospitalization, IV drug use, wound complications, sternal stability and survival. Results The final analysis included 101 patients in each group. The chance of survival over 6 months after surgery was more for primary sternal closure group (175.2) days versus (157.6) days for the vacuum-assisted closure group, with significant difference Log Rank test p-value (0.005). Duration for IV antibiotics use in the primary closure group was 8.55±3.57 and it was 32.61±8.39 showing high statistically significant difference (p<0.001). Patients in the primary closure group had earlier discharge from hospital 15.77±4.18 than vacuum assisted group 42.61±8.39, with high statistically significant difference (p<0.001). Primary closure group showed better sternal stability and sternotomy wound healing on clinical follow-up. Conclusion Primary sternal closure technique is a favorable technique over vacuum-assisted closure technique for treatment of paediatric mediastinitis following cardiac surgery. The reinforced sternal closure technique is a reliable technique with promising results regarding IV drugs need, hospitalization duration, survival and sternotomy wound healing.