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Query: UMLS:C0019079 (hemoptysis)
 6,129 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgery in pulmonary tuberculosis in one form or other gives good results. Indications for surgery include drug resistant pulmonary tuberculosis, massive recurrent haemoptysis, post-tuberculosis bronchiectasis or destroyed lung, empyema with or without bronchopleural fistula and for diagnostic purposes. In all cases a clear indication for surgery is mandatory. Processes of surgery include lung resection, thoracoplasty, decortication, thoracotomy and biopsy, thoracoscopy and ib resection for pleurocutaneous flap procedures. Adequate postoperative management is very important. Complications like atelectasis and pneumonia, empyema, bronchopleural fistula, wound infection, cachexia, etc, add morbidity and prolonged hospital stay.
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PMID:Role of thoracic surgery in pulmonary tuberculosis. 1063 8

We encountered seven cases of pulmonary paragonimiasis. All patients were adult males and 6 of 7 cases were over 50-year-old. Except for one case of chronic pleural empyema, 6 patients were referred to the department of surgery because of having a mass lesion on chest roentgenography which was indistinguishable from malignancy. Although 3 patients had mild hemoptysis, none of them showed classical rusty sputum. Only one patient had high level of eosinophilia, whereas others showed normal or marginal level of eosinophilia. Paragonimus eggs were detected in transbronchial lung biopsy specimens from 4 patients. All patients' sera were positive for Paragonimus-specific IgG antibody by immunodiagnosis. Surgical option was undergone only for one patient with chronic pleural empyema which was not cured by repeated chemotherapy. In the present series, we could avoid surgical options due to an erroneous diagnosis. When a pulmonary mass lesion or empyema is detected in patients who live in paragonimiasis endemic areas, paragonimiasis should always be included in the different diagnosis of lung diseases.
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PMID:Pulmonary paragonimiasis referred to the department of surgery. 1117 34

The authors present an account of their experience with the surgical treatment of 44 patients with pulmonary aspergilloma who were treated at the Clinic of Pneumology and Thoracic Surgery of the Third Medical Faculty Charles University in Prague during 1957-1999. The diagnosis of the disease before surgery was made in 39 patients (88.6%), in five patients it was established only after histological examination following resection of the lung. The presence of an aspergilloma was observed most frequently in a TB cavern (n = 30) and in bronchiectatic cavities (n = 9) with the most frequent localization in the upper pulmonary lobes (n = 38) and prevalence on the right side (n = 23). The most frequent symptom of the disease was haemoptysis (n = 39). All patients with the established diagnosis were treated before surgery by antimycotics. Treatment was however not successful and therefore the patients were indicated for surgery. The preoperative diagnosis of aspergilloma was based on X-ray or CT examination, serological examination (positive in 92.8%) and cultivation of sputum (positive in 58.9%). The most frequent surgical operation was lobectomy (n = 20), segmentectomy (n = 9), atypical resection (n = 8), pneumonectomy (n = 3); cavernostomy was performed in four patients. The most serious postoperative complication was a bronchopleural fistula with subsequent empyema (n = 2). During the postoperative period three patients died from respiratory failure associated with bronchopneumonia (6.8%). The authors recommend, based on their own experience, an active approach in patients with pulmonary aspergilloma and consider surgery as the main therapeutic method.
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PMID:[Surgical treatment of pulmonary aspergilloma and its complications]. 1121 Jun 4

Aspiration of oro-pharyngeal secretions and gastric content is the most frequent cause of formation of primary lung abscess. A compromised mental status (e.g. alcoholism, sedatives, stroke) and esophageal dysfunction (e.g. herniation, vomiting) are important risk factors. Aspiration pneumonia presents as a subacute disease and is usually not distinguishable from other causes of pneumonia, until typical radiological signs of cavitation and putrid sputum appear 8 to 14 days after the initial event of aspiration. Anaerobic bacteria play a pivotal role in an almost exclusively mixed spectrum of causative organisms. Aerobic pathogens are also frequently isolated, but whether they are an active part of infection or merely represent colonizers remains unclear in many instances. Differential diagnosis includes bronchial neoplasms, either as necrotizing carcinoma or as the cause of poststenotic cavernous pneumonia, other infectious diseases like tuberculosis, Pneumocystis carinii pneumonia or endocarditis with septic metastases, and lung artery embolism or vasculitis (M. Wegener). Fiberoptic bronchoscopy is extremely helpful in determining cause and etiology of the disease and should be carried out in all patients presenting with cavernous lung lesions. Bacteriological sampling should be performed using protected specimen brushing (PSB) technique. Broncho-alveolar lavage might serve as a less expensive but also less sensitive alternative measure. Since anaerobic bacteria resemble ubiquitous commensals of the oral cavity, sputum is of no use in anaerobic culture. Principal therapeutic strategy is antibiotic therapy for an extended period, usually four weeks to four months, unless radiologic changes and as well laboratory as clinical indicators of infection are completely resolved. Clindamycin, optionally supplemented with a second or third generation cephalosporin and Ampicillin/Sulbactam proved equally effective in treating aspiration pneumonia and primary lung abscess. The role of Moxifloxacin and other new flouroquinolones with their favorable pharmacodynamics is currently evaluated. Provided that antibiotics are prescribed for a sufficient period of time and patients' compliance is ensured, surgical procedures are limited to a negligible number of complications, e.g. recurrent severe hemoptysis, empyema or broncho-pleural fistula.
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PMID:[Diagnosis and therapy of abscess forming pneumonia]. 1169 90

We report a case of rapidly progressive lymphomatoid granulomatosis. A 48-year-old man was admitted because of hemoptysis and high fever. A chest radiograph and chest computed tomograms revealed multiple nodules, thin-walled cavities in the lungs, some containing ball-like masses. After admission, clinical studies, including percutaneous and transbronchial biopsies failed to provide sufficient evidence for proper diagnosis. Fluoro-deoxyglucose positron emission tomography (FDG-PET) showed strong accumulations of abnormal shadows in the lesions. A VATS biopsy was performed to make possible an exact diagnosis. The histological findings showed angiocentric lesions with infiltration of polymorphous cells, and were compatible with lymphomatoid granulomatosis (LYG). The respiratory failure progressed as the reticular shadows in the chest radiograph increased, so treatment with methylprednisolone pulse therapy (1,000 mg/day for 3 days) was started, and followed with prednisolone therapy (60 mg/day for 3 weeks). Initially, the symptoms improved, but gradually deteriorated, and the pulmonary nodules became enlarged. The patient finally died of progressive respiratory failure in addition to uncontrollable empyema with an MRSA infection. We attributed the cavity formation and ball-like masses in the cavities to the occlusion of small pulmonary arteries and tissue necrosis along the drainage bronchus.
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PMID:[A case of lymphomatoid granulomatosis with multiple thin-walled cavities]. 1209 97

The prevalence of bronchiectasis decreased due to the effective use of vaccines and advances of antibiotic therapy after 1970. However, it remains an important long-term morbidity of lower respiratory tract infection in developing country. To evaluate the clinical features of bronchiectasis in a tertiary hospital, we collected 21 patients with a diagnosis of bronchiectasis in Taipei Veterans General Hospital from May, 1984 to Dec, 2001 in pediatric outpatient with the admission of age below 18 years old. The diagnosis was based on the history of recurrent cough with fetid sputum, hemoptysis, or recurrent lobar pneumonia for months at least and radiological findings of lobar infiltration, tram-track like patterns, bronchiolar dilatation or honeycomb patterns. The diagnostic examinations included chest plain radiography, bronchography and chest computed tomography (CT) scans. Respiratory tract infections were the commonest cause predisposing to bronchiectasis in our study. Tuberculosis is not rare in this study. In recent years, immunodeficiency disorders have been recognized. Most patients suffered from recurrent cough and fetid sputum for years before diagnosis was established. Hemoptysis was the second common symptom in our study. The plain chest radiograph of bronchiectasis revealed dilatation of bronchial trees with honeycomb pattern or infiltration only. In recent years, chest CT became the most accurate and being noninvasive diagnostic tool. The initial treatment was primarily medical conservative therapy. Only five patients in our cases underwent pulmonary resection due to persistent hemoptysis, recurrent bacterial pneumonia or pulmonary parenchyma destruction. Most patients still suffered from recurrent pneumonia or occasional exacerbation in the long-term follow-up. In conclusion, bronchiectasis is not uncommon in pediatric population in northern Taiwan. The history of recurrent cough with fetid sputum, hemoptysis, or recurrent pneumonia were the most important clues to early diagnosis of this disease. Early diagnosis and appropriate treatment are effective in order to prevent lung abscess, empyema and pneumothorax, bronchopleural fistula, hemoptysis or cor pulmonale.
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PMID:Clinical spectrum of bronchiectasis in children. 1260 83

Pulmonary invades the lung parenchyma and vessels, causing necrotizing pneumonia and massive hemoptysis in immunocompromised patients. Medical treatment alone often fails to clear the organism. Early surgical intervention is advocated in localized disease to remove infection near pulmonary vessels. The resection is limited in an attempt to preserve as much lung function as possible. However, preexisting cavitations and lung disease predispose to postoperative space problems, including prolonged air leak, bronchopleural fistula, and empyema. Muscle flaps provide a solution to these problems by obliterating residual space and providing protective coverage to the bronchial stump. The authors present four cases of pulmonary aspergillosis treated by multimodality therapy and extrathoracic muscle flap transposition. Factors that may contribute to successful treatment include underlying condition of the host and history of cancer, radiation therapy, and great vessel involvement. Despite aggressive medical and surgical therapy, pulmonary aspergillosis has a poor prognosis.
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PMID:The role of muscle flaps in pulmonary aspergillosis. 1262 Nov 84

A 67-year-old man with a history of surgical resection of the superior lobe of the left lung and thoracoplasty due to pulmonary tuberculosis occurring approximately 40 years previously, was admitted to the hospital due to recurrent hemoptysis. X-ray films and computed tomography (CT) scans of the chest showed the left thoracic cavity to be filled with empyema, compressing the inferior lobe downward. Since three unsuccessful attempts were made at bronchial artery embolization for hemostasis, yielding hemoptysis of approximately 1,000 ml, emergency surgery was performed. To prevent massive intra-operative hemoptysis, the left pulmonary artery was blocked by median sternotomy. A transverse incision was then made, and thus pleuropneumonectomy could be safely performed. Since it allows early blocking of blood vessels surrounding the hilum of the lung and the main bronchus, anterior approach is useful in treating hemorrhagic empyema and wet pleurisy with internal fistula.
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PMID:[Emergency pleuropneumonectomy via anterior approach to treat chronic hemorrhagic empyema due to massive hemoptysis]. 1293 85

Surgery for pulmonary cavity associated with fungus ball is challenged by chronic lung disease. The purpose of this report was to review patient data, operative procedures and results of surgery. This was a retrospective study. Twenty patients were operated on between January 1997 and December 2002. Fourteen (70%) patients were male and the mean age was 46.30 +/- 13.10 years (range, 24 to 76 years). The most common underlying pulmonary disorder was tuberculosis (70%). Ninety five percent of the patients had a history of hemoptysis, and 35% presented with massive hemoptysis. Lobectomy was performed in 11 (55%) patients and 6 (30%) patients were operated on by cavernostomy with transposition of muscle flap technique. There was no operative mortality and 8 complications (3 prolonged airleaks, 2 wound infections, 1 postoperative bleeding, 1 seroma and 1 empyema). It was also found that emergency surgery and cavernostomy with transposition of muscle flap compromised the postoperative course. Surgery is very effective in controlling and preventing hemoptysis in patients who have pulmonary cavity associated with fungus ball. Elective surgery and formal pulmonary resection may be the proper option for low risk patients. Cavernostomy with transposition of muscle flap may be suitable for patients who have poor pulmonary reserve.
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PMID:Surgical management of pulmonary cavity associated with fungus ball. 1535 65

Antibacterial therapy is the most important component of the complex management of pyo-destructive forms of LRTI. Since the microbial flora is rather variable and polymorphous, antibiotics used in the treatment of LRTI should be active against both aerobic (especially gramnegative) and anaerobic pathogens. The aim of the study was to prove, on the basis of the bacteriological and clinical findings, the validity of the use of cefoperazone/sulbactam (CS), the only inhibitor-protected cephalosporin, for the monotherapy of patients with LRTI. The trial enrolled 32 patients (29 males and 3 females) with various forms of LRTI, including 22 patients with destructive pneumonia, 8 patients with acute and chronic lung abscesses and 2 patients with lung gangrene. Complications of the main disease such as empyema, bronchopleural fistula, pyopneumothorax and hemoptysis in 63.5% of the patients were recorded. To verify the microbiological diagnoses, bacteriological assay of the sputum, endobronchial secretion or the contents of the abscess and pleural cavities was performed. The main component of the complex conservative treatment was the monotherapy with CS administered intravenously in an average daily dose of 5.9+/-1.59 g divided into 2 portions. The maximum daily dose for the patients with lung gangrene was 12 g. The bacteriological efficacy was evaluated by the ESCMID (1993) criteria. The clinicoroentgenologic efficacy was estimated by regression of the main signs of LRTI. The pathogens of LRTI were isolated and identified in 87.5% of the patients. Nonsporulating anaerobic bacteria such as Prevotella spp., Bacteroidesfragilis, Fusobacterium spp., Peptococcus spp. and Peptostreptococcus spp. were isolated from 24 (75%) of them. AD the anaerobic organisms proved to be susceptible to CS (100%). As for the aerobic organisms, 85.5% of them was susceptible to CS. The clinical effect of the antibacterial therapy in 29 (90.6%) patients was registered. In 20 patients (64.5%) both clinical and roentgenologic cure was shown. The lethal outcome in 1 patient (3.1%) was stated.
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PMID:[Clinical and bacteriological substantiation of the use of cefoperazone/sulbactam in complex therapy of patients with pyo-destructive forms of lower respiratory tract infection (LRTI)]. 1562 99


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