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Marc A Judson - One of the best experts on this subject based on the ideXlab platform.
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a modern series of percutaneous intracavitary instillation of amphotericin b for the treatment of severe hemoptysis from pulmonary Aspergilloma
Chest, 2013Co-Authors: Jared N Kravitz, Max W Berry, Stephen I Schabel, Marc A JudsonAbstract: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.
Qiankun Chen - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracic surgery for pulmonary Aspergilloma a safe and effective procedure
The Annals of Thoracic Surgery, 2014Co-Authors: Qiankun Chen, Chang Chen, Xiaofeng Chen, Gening JiangAbstract: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, 2012Co-Authors: Qiankun Chen, Gening Jiang, Jiaan DingAbstract: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.
Gening Jiang - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracic surgery for pulmonary Aspergilloma a safe and effective procedure
The Annals of Thoracic Surgery, 2014Co-Authors: Qiankun Chen, Chang Chen, Xiaofeng Chen, Gening JiangAbstract: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, 2012Co-Authors: Qiankun Chen, Gening Jiang, Jiaan DingAbstract: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.
A Khan - One of the best experts on this subject based on the ideXlab platform.
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Aspergilloma complicating newly diagnosed pulmonary echinococcal hydatid cyst a rare occurrence
British Journal of Radiology, 2008Co-Authors: M U Manzoor, Z S Faruqui, Q Ahmed, N Uddin, A KhanAbstract:Aspergilloma is a saprophytic infection that colonizes pre-existing lung cavities. Typically, Aspergilloma develops in cavities formed as a result of diseases such as tuberculosis, sarcoidosis, bronchiectasis, lung abscess and cavitatory neoplasia. Coexistence of fungi with a pulmonary echinococcal (hydatid) cyst is seen more commonly in immunocompromised patients. Although Aspergilloma has occasionally been described in operated hydatid cyst cavities, only one case has been reported previously in an unoperated case. We report on the case of a 40-year-old man with normal immune status and histologically proven concurrent infection of aspergillus in a previously unoperated pulmonary hydatid cyst.
Gilbert Massard - One of the best experts on this subject based on the ideXlab platform.
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surgery for Aspergilloma time trend towards improved results
Interactive Cardiovascular and Thoracic Surgery, 2011Co-Authors: Anne Lejay, Pierreemmanuel Falcoz, Nicola Santelmo, Olivier Helms, E A Kochetkova, My Jeung, Romain Kessler, Gilbert MassardAbstract:Surgery of Aspergilloma has been renowned to be technically challenging and has a high complication rate. We have already demonstrated an improved outcome as a result of a reduction in complex cases related to history of tuberculosis. In this paper we will evaluate whether this time trend has continued during recent years. Initial presentation and postoperative outcome of 33 patients who underwent surgical treatment between 1998 and 2009 were reviewed and compared with two previous reports (group 1: 55 patients from 1974 to 1991; group 2: 12 patients from 1992 to 1997). Underlying disease was tuberculosis in 15% of patients (57% in group 1, 17% in group 2), and 12% of patients had complex Aspergillomas (80% in group 1, 41% in group 2). Postoperatively, there was no mortality (5% in group 1, 0% in group 2). Morbidity decreased progressively in terms of bleeding (44% in group 1, 9% in group 2, and 6% in recently, accrued patients), of pleural space problems (47%, 18% and 12%, respectively), and of prolonged hospital stay (32%, 8% and 6%, respectively). With a decreased postoperative complications rate after resection, contemporary surgery of Aspergilloma is safe and offers satisfactory early and long-term results.
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Bronchopulmonary Aspergilloma: A Reappraisal
The Annals of Thoracic Surgery, 1998Co-Authors: Antonis Chatzimichalis, Gilbert Massard, Romain Kessler, Pierre Barsotti, Bertrand Claudon, Jean Ojard-chillet, Jeanmarie WihlmAbstract:Abstract Background . Classically, most complications observed after operations for Aspergilloma occurred in patients with sequelae of tuberculosis. Because the incidence of tuberculosis has declined over the past two decades, Aspergilloma is expected to develop with increasing frequency in patients without previous tuberculosis. Therefore, our hypothesis was that operative outcome should have improved during the most recent years in comparison with our previous experience. Methods . Operative outcome of 12 recently accrued patients was evaluated and compared with a historic control group of 55 patients, previously reported by the same center. Results . As expected, only 17% of patients of the present series had a history of tuberculosis, compared with 57% in the former series. Postoperatively, there was no mortality. Major morbidity has decreased, although this difference is not statistically significant: bleeding decreased from 44% to 9% of patients; space problems decreased from 47% to 18%; and prolonged hospital stay (>30 days) decreased from 32% to 9%. Conclusions . Our results support a trend toward improved postoperative outcome of operations for Aspergilloma owing to a decreased incidence of Aspergilloma growing in tuberculous cavitations.
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Surgical treatment of pulmonary and bronchial Aspergilloma
Annales de chirurgie, 1993Co-Authors: Gilbert Massard, Jeanmarie Wihlm, Roeslin N, Dumont P, Morand GAbstract:From 1974 to 1990, 61 patients were admitted for pulmonary (55) or bronchial (6) Aspergilloma; 50 were treated by surgery. Operative treatment was mandatory because of disabling symptoms in 17 patients, rapid growth on radiological survey in 7 others, diagnostic doubt in 10 and association with bronchogenic cancer in 2. 14 were operated on in order to prevent evolutive complications. Complete resection was possible in 39 patients: with lobectomy or segmentectomy in 34 and with pleuro-pneumonectomy in 5. In 10 others, respiratory failure only allowed speleotomy and thoracoplasty. One thoracotomy was exploratory because of an associated unresectable cancer. Postoperative complications frequently occurred with pulmonary Aspergilloma: 4 postoperative deaths, 33 experienced non-fatal complications (28 major bleedings, 16 rehabititation defects, 6 empyemas, 5 respiratory failures). Nevertheless, among 10 patients with either bronchial Aspergilloma or pulmonary Aspergilloma without underlying disease, only one had a complicated outcome. In conclusion, surgical treatment is well tolerated in the absence of underlying parenchymal disease. However, despite the major operative risk, surgery remains the only efficient treatment in symptomatic patients.
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pleuropulmonary Aspergilloma clinical spectrum and results of surgical treatment
The Annals of Thoracic Surgery, 1992Co-Authors: Gilbert Massard, Norbert Roeslin, Jeanmarie Wihlm, Pascal Dumont, Jeanpaul Witz, Georges MorandAbstract:From 1974 to 1991, 77 patients were admitted for pulmonary (55), pleural (16), or bronchial (6) Aspergilloma. About 50% were asymptomatic. Sixty-three underwent operation. Pulmonary Aspergillomas were operated on for therapeutic need in 26 and on principle in 18; the procedures were 28 lobar or segmental resections, 10 thoracoplasties, and 5 pleuropneumonectomies (1 patient had exploration only). Pleural aspergillosis was treated by operation on principle in 5 and for therapeutic need in 8 patients; 10 thoracoplasties, 1 attempt at pleuropneumonectomy, and 2 decortications were performed. All six bronchial lesions were operated on as a rule. Overall postoperative mortality was 9.5%. Major complications were bleeding (n = 37), pleural space problems (n = 24), respiratory failure (n = 6), and postpneumonectomy empyema (n = 4). All patients with pleural disease experienced complications. The outcome was better after lobar or segmental resection than after thoracoplasty (mortality, 6% versus 15%). Asymptomatic and nonsequellary pulmonary or bronchial Aspergilloma also had an improved outcome. We conclude that operation is at low risk in pulmonary or bronchial locations in asymptomatic patients and in the absence of sequellae; the risk is high in symptomatic patients for whom operation is the only definite treatment. Pleuropneumonectomy should be avoided. Only symptomatic pleural Aspergilloma should be operated on.
