Результаты торакальных операций у больных ВИЧ-инфекцией

The objective: substantiation of the possibility of surgical treatment of various lung diseases in HIV-infected patients.Subjects and Methods. Comorbidities, medical history, bad habits, ongoing antiretroviral therapy (ARVT), viral load and CD4+count before and after lung surgery were assessed. Blood loss during the operation, intra- and postoperative complications was analyzed. Causes of postoperative lethality were analyzed.Results. According to results of the study, planned surgical treatment for chronic abscess, tuberculosis, cancer, mycotic pulmonary lesions and cicatricial stenosis of the trachea in HIV-infected patients is justified, and should be performed based on indications common for these diseases. This is confirmed by the level of postoperative complications in HIV-negative patients. The vast majority of complications were temporary, not severe, and were resolved by conservative treatment. Achievment of the best results is facilitated by ongoing ART.Цель исследования: обоснование возможности хирургического лечения различных заболеваний легких у больных ВИЧ-инфекцией.Материалы и методы. Изучены коморбидный фон, анамнез заболевания, вредные привычки, проводимая антиретровирусная терапия (АРВТ), вирусная нагрузка и CD4+ лимфоциты до и после операции на легких. Проведен анализ кровопотери по ходу операции, интра- и послеоперационных осложнений. Проанализированы причины послеоперационной летальности.Результаты. Проведенное исследование свидетельствует, что плановое хирургическое лечение по поводу хронического абсцесса, туберкулеза, рака, микотических поражений легких и рубцового стеноза трахеи у больных ВИЧ-инфекцией оправдано и должно проводиться по общим для этих заболеваний показаниям. Это подтверждается уровнем послеоперационных осложнений у пациентов без ВИЧ. Подавляющее большинство осложнений носили временный, не тяжелый характер и устранены консервативно. Достижению наилучших результатов способствует проводимая АРВТ

The pulmonary outcome of long-term survivors after congenital diaphragmatic hernia repair

BACKGROUND: Congenital diaphragmatic hernia (CDH) represents a chronic condition with significant pulmonary and non-pulmonary complications. The main aim of the present study was to determine the pulmonary outcome in a group of long-term survivors of CDH. METHODS: Clinical records of 46 patients with CDH admitted to the University Children's Hospital Zurich between 1991 and 2001 were reviewed retrospectively. Survivors underwent clinical examination, lung function tests and measurements of exhaled nitric oxide. RESULTS: 30 of 46 (65%) patients survived after repair of CDH and 19 children participated in a follow-up study at the mean age of 7.9 (2.8) years. At least one wheezy episode requiring inhaled bronchodilators was reported by 9/19 (47%) children and 4/19 (21%) children complained of recurrent wheezy episodes. Nine children showed lung function impairment in spirometry as well as in oscillatory resistance. Neither duration of assisted ventilation nor the length of hospitalisation appeared to correlate with lung function. Exhaled nitric oxide was within normal range in our group of CDH survivors. Measurement of respiratory system resistance using a forced oscillation technique detected those CDH survivors, who showed abnormal pattern in spirometry. However, no correlation between oscillatory resistance and specific airway resistance measured by whole body plethysmography was found. CONCLUSIONS: Despite the presence of rather insignificant symptoms, we found mild to moderate pulmonary functional impairment in children surviving CDH repair

Results of Thoracic Surgery in HIV-infected Patients

The objective: substantiation of the possibility of surgical treatment of various lung diseases in HIV-infected patients.Subjects and Methods. Comorbidities, medical history, bad habits, ongoing antiretroviral therapy (ARVT), viral load and CD4+count before and after lung surgery were assessed. Blood loss during the operation, intra- and postoperative complications was analyzed. Causes of postoperative lethality were analyzed.Results. According to results of the study, planned surgical treatment for chronic abscess, tuberculosis, cancer, mycotic pulmonary lesions and cicatricial stenosis of the trachea in HIV-infected patients is justified, and should be performed based on indications common for these diseases. This is confirmed by the level of postoperative complications in HIV-negative patients. The vast majority of complications were temporary, not severe, and were resolved by conservative treatment. Achievment of the best results is facilitated by ongoing ART

Indications for Extrapleural Thoracoplasty in HIV-Positive Patients with Destructive Pulmonary Tuberculosis

The objective: to specify indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection.Subjects and Methods. Results of surgical treatment of 78 destructive pulmonary tuberculosis patients were studied. Those patients underwent extrapleural thoracoplasty in Pulmonary Tuberculosis Surgery Unit of City Tuberculosis Hospital No. 2 in St. Petersburg from 2009 to 2022.Results. The article clarifies the indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection, in whom contraindications to pulmonary resections have been identified. Medical records of 78 patients with destructive tuberculosis were retrospectively analyzed, the patients were divided into two groups according to their HIV status. It has been established that with combination of adequate preoperative preparation and postoperative management, rational anti-tuberculosis chemotherapy and ART, extrapleural thoracoplasty for HIV-positive patients can be performed in accordance with general practice

Pulmonary Function Test Abnormalities in Pediatric Inflammatory Bowel Disease

BACKGROUND Pulmonary involvement in adult patients with inflammatory bowel disease (IBD) seems more common than previously appreciated. Its prevalence and development over time in pediatric IBD patients are largely unknown. OBJECTIVES The aim was to study lung function including fraction of exhaled nitric oxide (FeNO) and transfer capacity for carbon monoxide (TLCO) in pediatric IBD patients and to describe the longitudinal development in a subset of patients with lung function abnormalities. METHODS Sixty-six measurements were made in 48 IBD patients (30 patients with Crohn's disease and 18 with ulcerative colitis) and 108 matched controls. Patients with abnormal TLCO or elevated residual volume/total lung capacity (RV/TLC) ratios were invited for a follow-up. Statistical comparisons were made by nonparametric tests and ANOVA. RESULTS TLCO was decreased in IBD patients [median: 88% predicted (interquartile range, IQR, 22) vs. 99% predicted (IQR 19) in controls]. RV/TLC ratios were mildly elevated in patients with ulcerative colitis [32% (IQR 9) vs. 27% (IQR 8) in controls], and maximum expiratory flows at 50 and 25% of vital capacity were mildly reduced in patients with Crohn's disease. FeNO and disease activity did not correlate with lung function abnormalities. Abnormalities did not consistently persist over a median follow-up period of 34 months. CONCLUSIONS This study supports evidence that variable and fluctuating pulmonary involvement also occurs in pediatric IBD patients. Its clinical significance is unclear. © 2015 S. Karger AG, Basel