The Surgical Management of Tuberculosis and Its Complications
Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies in Clinical Tuberculosis, 2020
For patients in whom embolization has failed repeatedly, and who are unfit for conventional surgery, the surgeon may have to resort to unconventional techniques. Injecting antifungal agents such as brilliant green, natamycin and “Polish paste” into the cavity, bronchoscopically or percutaneously, has been advocated,31 but the results are unconvincing. Cavernostomy has been tried in the emergency setting with limited success.32 Cavernostomy in the elective situation is successful at relieving cough and less dramatic bleeding, and the cavity may remain radiologically free of colonization. Transposing a myoplastic flap into the cavity seems to be beneficial even if the flap fails to fill all the interstices of the cavity. Perhaps the muscle with its blood supply exudes cytokines that prevent further colonization. Simultaneous thoracoplasty to collapse the cavity should also be considered.33
The Surgical Management of Tuberculosis and Its Complications
Peter D O Davies, Stephen B Gordon, Geraint Davies in Clinical Tuberculosis, 2014
For patients in whom embolisation has failed repeatedly, and who are unfit for conventional surgery, the surgeon may have to resort to unconventional techniques. Injecting antifungal agents such as brilliant green, natamycin and ‘Polish paste’ into the cavity, bronchoscopically or percutaneously, has been advocated [31], but the results are unconvincing. Cavernostomy has been tried in the emergency setting with limited success [32]. Cavernostomy in the elective situation is successful at relieving cough and less dramatic bleeding, and the cavity may remain radiologically free of colonisation. Transposing a myoplastic flap into the cavity seems to be beneficial even if the flap fails to fill all the interstices of the cavity. Perhaps the muscle with its blood supply exudes cytokines that prevent further colonisation. Simultaneous thoracoplasty to collapse the cavity should also be considered [33].
Clinical Cases
S. J. Copley, J. P. Kanne, D. M. Hansell in Thoracic Imaging, 2014
93i. The radiograph shows the appearances of plombage, which involved the instillation of inert material, such as paraffin (as in this case), adipose tissue, Lucite® spheres or plastic, into the pleural space as a treatment for TB. It was used in place of thoracoplasty as it was less deforming for the patient and lung function was preserved. The practice was commonplace in the middle part of the 20th century, but became very uncommon until relatively recently, although there has been a resurgence in areas of the world where multidrug-resistant TB is gaining a foothold. Complications include extrusion of plombage material outside the pleural space, bronchopleural fistula and, rarely, the development of carcinoma or sarcoma.
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.
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