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Marc A Judson – One of the best experts on this subject based on the ideXlab platform.

  • a modern series of percutaneous intracavitary instillation of amphotericin b for the treatment of severe hemoptysis from pulmonary Aspergilloma
    Chest, 2013
    Co-Authors: Jared N Kravitz, Max W Berry, Stephen I Schabel, Marc A Judson

    Abstract:

    Background Pulmonary Aspergillomas may cause life-threatening hemoptysis. The treatment of this condition is problematic because poor pulmonary function often precludes definitive surgical resection. Methods We retrospectively reviewed all patients hospitalized at our institution for hemoptysis associated with an Aspergilloma over an 8-year period and who underwent percutaneous intracavitary instillation of amphotericin B (ICAB). ICAB consisted of catheter placement into the Aspergilloma cavity with subsequent instillation of 50 mg amphotericin B in 20 mL 5% dextrose solution daily for 10 days. Results ICAB was attempted for 23 distinct episodes of severe hemoptysis in 20 individual patients. Catheter placement was successful in 21 of the 23 episodes (91%), and of these, ICAB instillation was successfully completed in 20 episodes (95%). In these 20 episodes, hemoptysis ceased by hospital discharge in 17 of 20 patients (85%) and in all 18 who survived until a follow-up visit 1-month after treatment. Pneumothorax occurred in six of 23 (26%) catheter placement attempts without long-term complications. Recurrence of serious hemoptysis occurred after six of 18 episodes for which follow-up was available. Potential risk factors associated with severe, recurrent hemoptysis were a size increase or reappearance of the Aspergilloma on a chest CT scan ( P = .001), bleeding diathesis ( P = .08), and lack of bronchial artery embolization during index hospitalization ( P = .07). Conclusions Our data suggest that ICAB is an effective short-term treatment to control severe hemoptysis caused by pulmonary Aspergilloma. The long-term benefit of this procedure is unknown. We identified several potential risk factors for recurrent hemoptysis after ICAB that could be examined prospectively in future trials.

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Qiankun Chen – One of the best experts on this subject based on the ideXlab platform.

  • video assisted thoracic surgery for pulmonary Aspergilloma a safe and effective procedure
    The Annals of Thoracic Surgery, 2014
    Co-Authors: Qiankun Chen, Chang Chen, Xiaofeng Chen, Gening Jiang

    Abstract:

    Background A variety of complications occur in patients with pulmonary Aspergilloma. The safety and feasibility of a thoracoscopic approach to therapeutic lung resection for pulmonary Aspergilloma have not been well evaluated. Methods The medical records of patients who underwent video-assisted thoracic surgery (VATS) or a thoracotomy for therapeutic resection of pulmonary Aspergilloma between January 2005 and December 2012 were retrospectively reviewed for age, sex, indications for surgery, approach and procedures, postoperative pain, operative time, blood loss, hospital stay, cost, and complications. Results A total of 310 patients underwent thoracotomy, 76 patients underwent attempted VATS lobectomy. Seventy-six patients from 310 patients for thoracotomy were selected and compared with the VATS group. Nine cases (11.8%) in the VATS group were converted to a thoracotomy for the following reasons: bleeding (n =2); dense fibrous adhesions (n =3); fused interlobar fissure (n =2); and hilar lymphadenopathy (n = 2). Lesions treated with pneumonectomy failed to be done using VATS. There was no difference in the blood loss and median operative time between the 2 groups, but the patients with VATS had shorter length of stay in the hospital ( p  = 0.035) and fewer complications ( p  = 0.032) than those with thoracotomy. Conclusions Video-assisted thoracic surgery is an alternative to open procedures in the management of pulmonary Aspergilloma. Simple Aspergilloma and complex Aspergilloma without infiltration of the hilum are good candidates for VATS resection. Aspergilloma lesions that require a pneumonectomy are still a major challenge for VATS.

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  • surgical treatment for pulmonary Aspergilloma a 35 year experience in the chinese population
    Interactive Cardiovascular and Thoracic Surgery, 2012
    Co-Authors: Qiankun Chen, Gening Jiang, Jiaan Ding

    Abstract:

    The surgical treatment of pulmonary Aspergilloma is challenging and controversial. This study was designed to evaluate the clinical profile, indications and surgical outcomes of pulmonary Aspergilloma operated on in our institute. A total of 256 patients with pulmonary Aspergilloma underwent surgical treatment from 1975 to 2010. The patients were divided into two groups: Group A (simple Aspergilloma, n= 96) and Group B (complex Aspergilloma, n= 160). The principal underlying lung disease was tuberculosis (71.1%). The surgical procedures consisted of 212 lobectomies in both groups; eight cavernoplasties, 10 bilobectomies, 16 pneumonectomies and six thoracoplasties in Group B; four segmentectomies and six wedge resections in Group A. Postoperative complications occurred in 40 patients (15.6%). The major complications were residual pleural space (3.9%), prolonged air leak (3.1%), bronchopleural fistula (1.6%), excessive bleeding (1.6%), respiratory insufficiency (1.9%) and empyema (1.2%). No intraoperative deaths occurred. The overall mortality within 30 days post-operation was 1.2%, occurring only in Group B. There was no statistically significant difference in the postoperative morbidity between Groups A and B (P= 0.27). With the good selection of patients, meticulous surgical techniques and good postoperative management, aggressive surgical treatment with anti-fungal therapy for pulmonary Aspergilloma is safe and effective, and can achieve favourable outcomes.

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Gening Jiang – One of the best experts on this subject based on the ideXlab platform.

  • video assisted thoracic surgery for pulmonary Aspergilloma a safe and effective procedure
    The Annals of Thoracic Surgery, 2014
    Co-Authors: Qiankun Chen, Chang Chen, Xiaofeng Chen, Gening Jiang

    Abstract:

    Background A variety of complications occur in patients with pulmonary Aspergilloma. The safety and feasibility of a thoracoscopic approach to therapeutic lung resection for pulmonary Aspergilloma have not been well evaluated. Methods The medical records of patients who underwent video-assisted thoracic surgery (VATS) or a thoracotomy for therapeutic resection of pulmonary Aspergilloma between January 2005 and December 2012 were retrospectively reviewed for age, sex, indications for surgery, approach and procedures, postoperative pain, operative time, blood loss, hospital stay, cost, and complications. Results A total of 310 patients underwent thoracotomy, 76 patients underwent attempted VATS lobectomy. Seventy-six patients from 310 patients for thoracotomy were selected and compared with the VATS group. Nine cases (11.8%) in the VATS group were converted to a thoracotomy for the following reasons: bleeding (n =2); dense fibrous adhesions (n =3); fused interlobar fissure (n =2); and hilar lymphadenopathy (n = 2). Lesions treated with pneumonectomy failed to be done using VATS. There was no difference in the blood loss and median operative time between the 2 groups, but the patients with VATS had shorter length of stay in the hospital ( p  = 0.035) and fewer complications ( p  = 0.032) than those with thoracotomy. Conclusions Video-assisted thoracic surgery is an alternative to open procedures in the management of pulmonary Aspergilloma. Simple Aspergilloma and complex Aspergilloma without infiltration of the hilum are good candidates for VATS resection. Aspergilloma lesions that require a pneumonectomy are still a major challenge for VATS.

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  • surgical treatment for pulmonary Aspergilloma a 35 year experience in the chinese population
    Interactive Cardiovascular and Thoracic Surgery, 2012
    Co-Authors: Qiankun Chen, Gening Jiang, Jiaan Ding

    Abstract:

    The surgical treatment of pulmonary Aspergilloma is challenging and controversial. This study was designed to evaluate the clinical profile, indications and surgical outcomes of pulmonary Aspergilloma operated on in our institute. A total of 256 patients with pulmonary Aspergilloma underwent surgical treatment from 1975 to 2010. The patients were divided into two groups: Group A (simple Aspergilloma, n= 96) and Group B (complex Aspergilloma, n= 160). The principal underlying lung disease was tuberculosis (71.1%). The surgical procedures consisted of 212 lobectomies in both groups; eight cavernoplasties, 10 bilobectomies, 16 pneumonectomies and six thoracoplasties in Group B; four segmentectomies and six wedge resections in Group A. Postoperative complications occurred in 40 patients (15.6%). The major complications were residual pleural space (3.9%), prolonged air leak (3.1%), bronchopleural fistula (1.6%), excessive bleeding (1.6%), respiratory insufficiency (1.9%) and empyema (1.2%). No intraoperative deaths occurred. The overall mortality within 30 days post-operation was 1.2%, occurring only in Group B. There was no statistically significant difference in the postoperative morbidity between Groups A and B (P= 0.27). With the good selection of patients, meticulous surgical techniques and good postoperative management, aggressive surgical treatment with anti-fungal therapy for pulmonary Aspergilloma is safe and effective, and can achieve favourable outcomes.

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