Tuberculosis (TB) is still a major public health concern, mostly affecting resource-constrained settings and marginalized populations. The fight against the disease is hindered by the growing emergence of drug-resistant forms whose management can be rather challenging. Surgery may play an important role to support diagnosis and treatment of the most complex cases and improve their therapeutic outcome. We conducted a non-systematic review of the literature based on relevant keywords through PubMed database. Papers in English and Russian were included. The search was focused on five main areas of intervention as follows: (I) diagnosis of complicated cases; (II) elimination of contagious persisting cavities, despite appropriate chemotherapy; (III) treatment of destroyed lung; (V) resection of tuberculomas; (VI) treatment of tuberculous pleural empyema. Although specific practical guidelines concerning surgical indications and approaches are currently unavailable, a summary of the evidence emerged from the scientific literature was elaborated to help the clinician in the management of severely compromised TB patients. The decision to proceed to surgery is usually individualized and a careful assessment of the patient's risk profile is always recommended before performing any procedure in addition to appropriate chemotherapy.
Echinococcus granulosus is the aetiological agent of cystic echinococcosis (CE), which is a public health problem in many eastern European countries, particularly in Romania, where the infection causes a high number of human and animal cases. To shed light on the transmission patterns of the parasite, we performed a genotyping analysis on 60 cyst samples obtained from patients who live in south-eastern Romania and who underwent surgery for liver or lung CE. DNA was extracted from the endocysts or the cyst fluids, and fragments of cytochrome c oxidase subunit 1 and NADH dehydrogenase subunit 1 mitochondrial genes (cox1 and nd1, respectively) were amplified by PCR and sequenced. We found that most of the samples analysed (59/60) belonged to the G1-G3 complex (E. granulosus sensu stricto), which contains the most widespread and infective strains of the parasite. We also identified the first human patient infected by a non-G1-G3 genotype of E. granulosus in this country. As the DNA sequence of this cyst sample showed maximum homology with the G6-G10 complex (Echinococcus canadensis), this is, in all likelihood, a G7 genotype, which is often found in pigs and dogs in most countries of eastern and south-eastern Europe.
This study evaluates the clinical outcome following surgery of our patients for the last seven years. Between 2001 and 2008 we performed tracheal resections in 60 patients. There were 46 cases of postintubation stenosis and 14 tumors. The range of resected rings was 1-8. The maximal resection length performed in our series (4 cm) was achieved using only basic releasing maneuvers such as anterior dissection of the trachea and cervical flexion. Emergency tracheal resection with no complications was performed in 12 patients who presented with severe dyspnea due to very tight stenosis. One patient died during the surgical intervention from a stroke. There were two postoperative deaths, both in patients with tracheo-esophageal fistula. As major complications we mention one patient with restenosis who underwent revision surgery. Among the patients with malignant tumors we had one local epidermoid carcinoma recurrence 18 months after surgery and the two patients with thyroid cancer who died six and nine months later. Basic releasing maneuvers allow a good length of the trachea to be resected with no complications. We consider that emergency tracheal resection can be performed with success. Squamous cell carcinoma was the most frequent histological type in our series.
Background/Aim: Thymic lipofibroadenoma is a benign growth of unknown etiology extremely rarely described in the literature, morphologically resembling lipofibroadenoma of the breast. The diagnosis is usually a postoperative surprise and is made by the anatomopathologist. Surgical resection is curative. Case Report: The presented case is the first reported in a woman, to date. The patient was successfully submitted to surgery and complete resection of the giant intrathoracic tumor was performed. The histopathological and immunohistochemical studies came to demonstrated the presence of a thymic lipofibroadenoma while the postoperative outcomes were favorable. Conclusion: In cases presenting large intrathoracic tumors complete resection is able to provide a significant improvement of the general condition of the patient, as well as a chance for cure.Thymic tumors are a rare disease compared to other types of intrathoracic malignancies being reported with an incidence of 1.5 per million (1, 2). The most commonly encountered thymic tumors are represented by thymomas and thymic carcinomas; except these categories, another subgroup, generally known as "thymic tumors of rare histology" has been described. These tumors are usually found randomly by the anatomopathologist, after surgical resection. Information concerning most of them is available in the literature exclusively as case reports, same as the one presented herein.
RezumatIntroducere: Fistula esotraheală postintubaţie este o complicaţie severă, apărută în anumite condiţii la pacienţii care necesită ventilaţie mecanică pentru o perioadă îndelungată de timp. Material şi metodă: Articolul prezintă o serie de 11 pacienţi cu fistula esotraheală postintubaţie operaţi în clinica noastră în perioada 2005 -2015. Abordul anterior cu rezecţie de trahee a fost preferat la 10 dintre aceşti pacienţi, într-un caz cu o fistulă de dimensiuni mari preferând să efectuăm o intervenţie chirurgicală atipică. Trei dintre pacienţii seriei au fost operaţi înainte de sevrarea de ventilator în încercarea de a ajuta la desprinderea de ventilaţia mecanică. Două cazuri au fost operate în urma recidivei fistulei după tentative de închidere în alte servicii chirurgicale. Rezultate: Doi pacienţi (ambii din grupul celor care nu au fost sevraţi de ventilator) au decedat în urma unor complicaţii specifice intubaţiei continuate după rezecţia traheală (dehiscenţă anastomotică cu mediastinită şi fistulă traheo-vasculară în trunchiul arterial brahiocefalic). Restul de 9 pacienţi ai seriei au avut o evoluţie bună, cu restaurarea căii aeriene şi deglutiţie normală. Concluzii: Abordarea chirurgicală a acestei patologii are succes în servicii specializate în chirurgie traheală şi esofagiană. Alegerea momentului operator este de mare importanţă pentru obţinerea unor rezultate bune.Cuvinte cheie: fistula esotraheală, stenoză trahee, rezecţie traheală The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units. Results: Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). The nine remaining patients improved, with their airways restored and having regained normal deglutition. Conclusions: The surgical approach of this pathology is successful in surgical units that are specialised in tracheal and oesophageal surgery. Adequately timing the surgery is crucial for a good outcome.
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