Pulmonary aspergilloma: surgical outcome of 79 patients in a Moroccan center

BackgroundPulmonary aspergilloma presents in two clinical and radiological forms: simple and complex aspergilloma. Surgery is the best therapeutic option, most often by anatomic lung resection. Our aim was to report the surgical outcomes according to our experience.MethodsA retrospective study was conducted on data of 79 patients operated on for pulmonary aspergilloma over a period of 10 years. There were 57 (72.15%) men and 22 women (27.84%), with a mean age of 40.45 years.ResultsTuberculosis, all-form combined, was the predominant pathological antecedent in 57 (72.15%) patients, and hemoptysis was the most frequent functional sign in 43 (54.43%). The right side was involved in 39 (49.36%) patients. All patients were operated on via a posterolateral thoracotomy, and an extrapleural plane was necessary in 40 (50.63%). The surgical procedure was a lobectomy in 38 (48.10%) patients and a pneumonectomy in 14 (17.72%). Transfusion of red blood cells was carried out in 10 (12.65%) patients, with one (1.26%) requiring a rethoracotomy for postoperative clotted hemothorax. Two (2.53%) patients presented with empyema after pneumonectomy. The mortality rate was 2.53% (2 patients), and the mean follow-up was 2.5 years.ConclusionSurgery for pulmonary aspergilloma is associated with a high rate of morbidity and mortality. This surgery has been performed in our department with a very acceptable rate of mortality, especially considering that all patients were operated on by open surgery.

External stabilization of the thorax in complex treatment of children with severe chest injuries: Description of clinical cases

Aim. To describe a proposed method of treating children with a traumatic disorder of the thorax. Material and methods. Under the conditions of work in the Tyumen “Center of Medicine of Catastrophes”, doctors of all specialties of the Tyumen region interact with thoracic surgeons. Special attention is given to children with polytrauma. In the Tyumen region for the period 2016–2017, two travels to treat children with multiple floating fractures of the ribs on one side were made. The patients were treated by using an original method of external chest stabilization. We present the advantages of the method in the descriptions of the clinical cases. Results. The chest structure was stabilized by using a V-shaped model of the Cramer tire to increase the area of contact with the chest. The tire was fixed with Kapron thread No 5 by using a large cutting needle, which was wound under the ribs after marking the floating section of the chest. The ribs were stitched for stable areas along the edges and for an unstable fragment of the thorax. Later, the V-shaped model of the Cramer tire was applied and fixed by threads to the chest. This method is simple and acceptable in any hospital and allows early spontaneous breathing with no purulent-septic complications. Conclusions. This method of restoring the skeletal function of the thorax with the help of external fixation of the V-shaped model of the Cramer tire allows reliable minimally invasive stabilization of the chest wall. External stabilization of the thorax allows early transfer of the victims to independent breathing and shortens the duration of treatment in the intensive care unit. The availability and simplicity of the design makes it possible to perform this procedure everywhere. Video thoracoscopic support is needed only if there is a suspicion of a clotted hemothorax.