The Experts below are selected from a list of 1497 Experts worldwide ranked by ideXlab platform
Geert Lauwers - One of the best experts on this subject based on the ideXlab platform.
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salvage lobectomy to treat necrotizing sars cov 2 pneumonia complicated by a Bronchopleural Fistula
The Annals of Thoracic Surgery, 2021Co-Authors: Karen Peeters, D Mesotten, Xavier Willaert, Karen Deraedt, Sigi Nauwelaers, Geert LauwersAbstract:We report a case of necrotizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia complicated by a Bronchopleural Fistula and treated by decortication and salvage lobectomy. Owing to the unknown characteristics of the underlying SARS-CoV-2 infection, treatment of the abscess and Bronchopleural Fistula was delayed. This may have resulted in further deterioration of the patient, with ensuing multiple organ dysfunction. Complications of SARS-CoV-2 pneumonia, such as a bacterial abscess and a Bronchopleural Fistula, should be treated as if the patient were not infected with SARS-CoV-2.
Lorenzo Spaggiari - One of the best experts on this subject based on the ideXlab platform.
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Bronchopleural Fistula after pneumonectomy risk factors and management focusing on open window thoracostomy
Seminars in Thoracic and Cardiovascular Surgery, 2017Co-Authors: Antonio Mazzella, Francesco Petrella, Lorenzo Spaggiari, Alessandro Pardolesi, Patrick Maisonneuve, Domenico Galetta, Roberto GasparriAbstract:We evaluated principal risk factors and different therapeutic approaches for post-pneumonectomy Bronchopleural Fistula (BPF), focusing on open-window thoracostomy (OWT). We retrospectively reviewed all patients treated by pneumonectomy for lung cancer from 1999 to 2014; we evaluated preoperative, operative, and postoperative data; time between operation; and Fistula formation, size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. P values
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stem cell transplantation effectively occludes Bronchopleural Fistula in an animal model
The Annals of Thoracic Surgery, 2014Co-Authors: Francesco Petrella, Francesca Toffalorio, Stefano Brizzola, Tommaso De Pas, Stefania Rizzo, Massimo Barberis, Pier Giuseppe Pelicci, Lorenzo Spaggiari, Fabio AcocellaAbstract:Background Bronchopleural Fistula after lung resection still represents a challenging life-threatening complication for thoracic surgeons. Considering its extremely high mortality rate, an effective treatment is urgently required. Our project investigated the hypothesis of experimental Bronchopleural Fistula closure by bronchoscopic injection of autologous bone marrow–derived mesenchymal stem cells into the cavity of the Fistula, evaluating its feasibility and safety in a large animal model. Methods An experimental Bronchopleural Fistula was created in 9 goats after right upper tracheal lobectomy. The animals were randomly assigned to two groups: one received autologous bone marrow–derived mesenchymal stem cell bronchoscopic transplantation; the other received standard bronchoscopic fibrin glue injection. Results All animals receiving bronchoscopic stem cell transplantation presented Fistula closure by extraluminal fibroblast proliferation and collagenous matrix development; none (0%) died during the study period. All animals receiving standard treatment still presented Bronchopleural Fistula; 2 of them (40%) died. Findings were confirmed by pathology examination, computed tomography, and magnetic resonance imaging. Conclusions Bronchoscopic transplantation of bone marrow–derived mesenchymal stem cells effectively closes experimental Bronchopleural Fistula by extraluminal fibroblast proliferation and collagenous matrix development. Stem cells may play a crucial role in the treatment of postresectional Bronchopleural Fistula after standard lung resection. Although these results provide a basis for the development of clinical therapeutic strategies, the exact mechanism by which they are obtained is not yet completely clear; further studies are required to understand exactly how stem cells work in this field.
Guowei Che - One of the best experts on this subject based on the ideXlab platform.
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diabetes mellitus and risk of Bronchopleural Fistula after pulmonary resections a meta analysis
The Annals of Thoracic Surgery, 2016Co-Authors: Jun Fan, Jian Zhou, Yutao Ren, Cheng Shen, Guowei CheAbstract:We conducted this meta-analysis to evaluate the association between diabetes mellitus and the risk of Bronchopleural Fistula in patients undergoing pulmonary resection. The PubMed and EMBASE databases were searched, and 15 retrospective observational studies were included. The pooled analysis showed that diabetes mellitus was significantly associated with the formation of Bronchopleural Fistula after pulmonary resection (odds ratio = 1.97; 95% confidence interval = 1.39 to 2.80; p < 0.001). This association remained statistically prominent in the subgroups classified by statistical analysis, diagnoses and operative modes and in Asian patients. Therefore, diabetes mellitus can be an independent risk factor for Bronchopleural Fistula after pulmonary resection.
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neoadjuvant therapy and risk of Bronchopleural Fistula after lung cancer surgery a systematic meta analysis of 14 912 patients
Japanese Journal of Clinical Oncology, 2016Co-Authors: Jun Fan, Jian Zhou, Yutao Ren, Cheng Shen, Jing Liu, Guowei CheAbstract:Objective Neoadjuvant therapy has been extensively analyzed in studies addressing the risk factors of Bronchopleural Fistula, but their results vary hugely. Therefore, we conducted this meta-analysis to determine the association between neoadjuvant therapy and risk of Bronchopleural Fistula in patients undergoing lung cancer surgery. Methods We searched PubMed and EMBASE to identify the full-text literatures that met our eligibility criteria. Odds ratio with 95% confidence interval served as the summarized statistics. Heterogeneity within this meta-analysis was evaluated by Q-test and I (2) statistic. Sensitivity analysis was performed for further assessments of robustness. Publication bias was detected by Begg's test and Egger's test. Results Thirty studies enrolling 14 912 lung cancer cases were included into this meta-analysis. The incidence of Bronchopleural Fistula was 2.4% (354/14 912) in the large scale. Overall, neoadjuvant therapy significantly increased the risk of Bronchopleural Fistula after pulmonary resections (odds ratio: 2.166; 95% confidence interval: 1.398-3.357; P = 0.001). In subgroup analysis, neoadjuvant radiotherapy (odds ratio: 3.914; 95% confidence interval: 1.401-10.935; P = 0.009) and chemo-radiation (odds ratio: 2.533; 95% confidence interval: 1.353-4.741; P = 0.004) were significantly associated with the Bronchopleural Fistula risk but neoadjuvant chemotherapy was not (odds ratio: 1.857; 95% confidence interval: 0.881-3.911; P = 0.104). The impact of neoadjuvant therapy on Bronchopleural Fistula occurrence remains statistically prominent in the other subgroups. Conclusions Neoadjuvant therapy is significantly associated with the occurrence of Bronchopleural Fistula after lung cancer surgery. Both neoadjuvant radiotherapy and chemo-radiation significantly increase the Bronchopleural Fistula risk but neoadjuvant chemotherapy does not. Some limitations still exist in this meta-analysis. The updated high-quality studies can help to further confirm and enrich our discoveries in the future.
Hiroaki Osada - One of the best experts on this subject based on the ideXlab platform.
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use of a modified dumon stent for postoperative Bronchopleural Fistula
The Annals of Thoracic Surgery, 2005Co-Authors: Hisashi Tsukada, Hiroaki OsadaAbstract:This report describes a case of a postoperative Bronchopleural Fistula successfully managed with a modified Dumon stent. Surgical interventions for the Bronchopleural Fistula with empyema were subsequently avoided. Dumon stent is an acceptable option for the treatment of postoperative Bronchopleural Fistulas.
Jules M M Van Den Bosch - One of the best experts on this subject based on the ideXlab platform.
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transsternal closure of Bronchopleural Fistula after pneumonectomy
The Annals of Thoracic Surgery, 1997Co-Authors: Aart Brutel De La Riviere, J Defauw, Paul J Knaepen, Henry A Van Swieten, Roland C Vanderschueren, Jules M M Van Den BoschAbstract:Abstract Background . Bronchopeural Fistula after pneumonectomy, with associated empyema, has no standard therapy. The transsternal, transpericardial approach was used in all patients presenting with a large Fistula. Methods . From 1974 through 1995, 55 patients underwent transsternal, transpericardial closure of a Bronchopleural Fistula. Mean age was 62.7 years (range, 33 to 78 years). Malignant disease had been the indication for pneumonectomy in 50 patients and benign lesions in 5 patients. The Fistula was right-sided in 41 patients (74.5%), and the bronchial stump was less than 2 cm in 25 (45.5%). Treatment of the concomitant empyema was by closed drainage in 2 patients, by repeated needle aspiration in 17, and by open thoracostomy in 36 patients. Reamputation and closure of the stump was possible in 51 patients; in 4 a primary carinal resection was done. Results . Three patients died within 30 days after operation (5.4%, 70% confidence interval 2.4%–10.7%). Ten patients died late during hospitalization, total hospital mortality, 23.6% (70% confidence interval 17.3% to 31.0%). Recurrent Fistula symptoms were caused by a large recurrency in 6 patients (all died), by a small one in 7 (one death due to pulmonary embolism). Mean duration of hospital stay was 56 days (range, 2 to 174 days). At follow-up of 42 patients, there were no recurrent Fistulas. All patients with benign lesions are alive and well. Of 37 cancer patients, 29 died, more than half due to malignancy. Risk factors for death included recurrent Fistula, short interval between pneumonectomy and onset of Fistula, and closing technique. Risk factors for recurrent Fistula were a short bronchial stump and the nonuse of an open thoracostomy. Conclusions . Long-term results of transsternal closure are good, but hospital mortality is high. The present treatment of patients with large postpneumonectomy Bronchopleural Fistula includes early open thoracostomy, improvement of nutritional status, transsternal closure using resorbable sutures, and closure of the pleural space 3 weeks later.
