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Chest Trauma, Iatrogenic Trauma including drainage tubes and some Post-surgical Conditions and Complications of Radiotherapy.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
A thoracoplasty was often performed to reduce the volume of the upper part of a pleural cavity in the treatment of tuberculosis, and occasionally was done on both sides. This procedure is still occasionally carried out with a persistent empyema, or lung infection. Examples are shown under Illus. THORACOPLASTY.
The Surgical Management of Tuberculosis and Its Complications
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
There are a number of such techniques available to the surgeon. A “trimming” thoracoplasty is an old and welltried operation.13 This involves the subperiosteal resection of the upper ribs sufficient to reduce the chest cavity to the size that will accommodate the residual lung. The first rib is removed from the sternum to the neck, protecting the neurovascular structures at the apex and usually two to four other ribs, from the head of the rib forward over a sufficient arc of the rib. The anterior extent of the resection of these ribs is progressively tailored to leave the new apex of the chest cavity configured to the shape of the remaining lung segments (Figure 17.9). In this context, it is not usually necessary to resect the transverse processes of the vertebrae. The removal of up to three ribs has little cosmetic impact, although physiotherapy is necessary to preserve posture and good shoulder movement, but more than this is probably now unacceptable (Figure 17.10) because other techniques are available.
The Twentieth Century
Published in Arturo Castiglioni, A History of Medicine, 2019
surgery of the chest. Ferdinand sauerbruch (b. 1875), of Berlin, was among the first pioneers of thoracic surgery, which had lagged behind the surgery of other parts of the body. This lag was undoubtedly due to the difficulties produced by collapse of the lungs as soon as pressure was equalized by opening the thoracic cage, a condition only partly relieved by Sauerbruch’s cumbersome cabinet. In 1909, however, S. J. meltzer and J. auer showed that respiration could be indefinitely maintained by air introduced intratracheally under positive pressure, a fact known to both Vesalius and Robert Hooke. With the use of these and other physiological methods intrathoracic surgery could be practised as deliberately as surgery in other parts of the body without fear of pulmonary collapse or asphyxia. Sauerbruch also had a large part in devising a new method of thoracoplasty, dividing the operation into stages and limiting the extent of the resection.
Pleural infection: a closer look at the etiopathogenesis, microbiology and role of antibiotics
Published in Expert Review of Respiratory Medicine, 2019
Eihab O. Bedawi, Maged Hassan, David McCracken, Najib M. Rahman
Consideration has been given to the role of administering antimicrobial directly into the pleural space, particularly to help circumvent the problem in those classes of antibiotics, which would be considered to have poorer pleural penetration when administered intravenously. This appears to be widely practiced in the management of postpneumonectomy empyema (PPE), which has an incidence of approximately 5–10%. Historically, this would have been managed with further aggressive surgical techniques such as rib resection or procedures to obliterate the space such as thoracoplasty, with associated mortality rates of 9–13%. The evidence base of administering antibiotics in this way is limited to retrospective case series. Ng et al. found that VATS debridement (in patients without bronchopleural fistula) with subsequent intrapleural antimicrobial irrigation (over a mean period of 40 days) resulted in successful management, with no treatment associated morbidity and mortality and no empyema recurrence within the two-year follow-up period [82].
Early simultaneous esophagopleural and bronchopleural fistula after right pneumonectomy
Published in Acta Chirurgica Belgica, 2018
Marek Szkorupa, Josef Chudacek, Olga Klementová, Cestmir Neoral, Martin Stasek
Another fundamental step in the treatment algorithm is sanation of the pleural cavity. This is most often achieved by creation of a thoracostomy [9]. It enables direct visual evaluation of the extent of the fistulas, their changes over time, as well as local therapy of the infected pleural cavity, for example, using the VAC® system. The use of the VAC® system has actually been described repeatedly in cases of postpneumonectomy empyema, fulfilling the condition of stabilized mediastinum [10]. Closure of the thoracostomy and postpneumonectomy cavity is recommended in second phase, usually after 3–12 months, depending on the local findings, reduction of the pleural cavity or persistent infection. An omental flap with vascular pedicle or muscle flap may be used to fill the residual pleural cavity. In extreme cases, a thoracoplasty may be performed [5].
Chapter 3: Diagnosis of tuberculosis disease and drug-resistant tuberculosis
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Marcel A. Behr, Simon Grandjean Lapierre, Dennis Y. Kunimoto, Robyn S. Lee, Richard Long, Inna Sekirov, Hafid Soualhine, Christine Y. Turenne
Older age and immunosuppressing conditions that are known to increase the risk of TB (eg, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), transplant immunosuppression7,8 and renal failure9–11 also increase the likelihood of an atypical radiographic presentation of PTB. Another high-risk medical condition, silicosis, can, itself, alter the appearance of the chest radiograph in such a way as to make it difficult to discern concomitant PTB. Patients with past PTB treated with collapse therapy, such as thoracoplasty, can relapse years later with atypical radiographic abnormalities, most of which are unrelated to the current episode.