Cases reported "Pleural Diseases"

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1/13. Closure of bronchopleural fistulas using albumin-glutaraldehyde tissue adhesive.

    Bronchopleural fistulas are a life-threatening complication of pulmonary resection. A 21-year-old woman developed a large bronchopleural fistula after undergoing a pneumonectomy for carcinoid tumor. Despite bronchial stump revision and omental coverage, the fistula recurred. The second patient is a 42-year-old woman with a history of multiple thoracotomies who developed a bronchopleural fistula following aortic root replacement. Using either rigid bronchoscopy or thoracoscopy, these fistulas were evaluated and sealed with an albumin-glutaraldehyde tissue adhesive that may have improved strength and biocompatibility compared with other tissue sealants. This approach may be an effective alternative in the treatment of bronchopleural fistulas.
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2/13. Malignant oesophago-pleuro-pericardial fistula in a patient with oesophageal carcinoma.

    Pericardial and cardiac fistulae secondary to oesophageal or gastric tumours are a rare complication. We report about a 50-year-old male patient with a 10-month history of distal oesophageal carcinoma with lung and liver metastases who was referred to our hospital after 6 cycles of palliative chemotherapy at the beginning of March 2004. The patient presented with dysphagia, dyspnea, tachycardia, and hypotension. Purulent pericardial and bilateral pleural effusion was diagnosed, and the patient was treated with antibiotics, repeated pleurocentesis and pericardial drainage with daily polihexanide lavage. Oesophagogastroduodenoscopy, Peritrast swallow and computed tomographic scans of chest revealed a malignant oesophago-pleuro-pericardial fistula. A total of three coated, expandable metal stents were inserted into the oesophagus, which sealed successfully the fistula. Unfortunately, the patient succumbed to his carcinoma three months later.
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3/13. Successful use of a vascularized intercostal muscle flap to seal a persistent intrapleural cerebrospinal fluid leak in a child.

    The diagnosis and management of a persistent intrapleural-dural cerebrospinal fluid fistula following excision of a large mediastinal ganglioneuroma with intraspinal extension is reported. Use of a vascularized intercostal muscle flap to close the dural fistula was curative in this 4-year-old patient.
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4/13. Endoscopic diagnosis and treatment of postoperative bronchopleural fistula.

    The diagnosis and closure of small postresection bronchopleural fistulae can be accomplished with selective bronchography and placement of fibrin sealant through the flexible fiberoptic bronchoscope. This method of diagnosis and closure of the bronchopleural fistula avoids both general anesthesia and a thoracotomy. This technique is successful in small bronchopleural fistulae and patients with multiple postresection bronchial stumps.
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5/13. Closure of a post-pneumonectomy bronchopleural fistula with fibrin sealant (Tisseel).

    A persistent post-pneumonectomy bronchopleural fistula and empyema were successfully treated by draining and cleansing the empyema cavity and then occluding the fistula with fibrin sealant.
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6/13. Closure of subarachnoid-pleural fistulae with fibrin sealant.

    Subarachnoid-pleural fistulae are rare and require closure if conservative therapy has failed. A simple and effective method is described using a pleural graft sealed with fibrin glue. The closure is immediate and long lasting.
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7/13. Endoscopic treatment of bronchopleural fistulas using N-butyl-2-cyanoacrylate.

    Bronchopleural fistulas represent a serious complication of pulmonary surgery. Surgical treatment of bronchopleural fistulas has a high morbidity and mortality rate. Endoscopic sealing procedures are less invasive and more effective. We describe two patients successfully treated for fistulas stemming from pulmonary surgery. Biological (Tissucol) and synthetic glues (N-butyl-2-cyanoacrylate: Histoacryl) have been used. The technique must be chosen according to the fistulas' characteristics: Tissucol for small and medium-size fistulas, Histoacryl for large ones.
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8/13. Treatment of a bronchopleural fistula with a Fogarty catheter and oxidized regenerated cellulose (surgicel).

    A patient with bronchopleural fistula was successfully treated by occluding the fistula with an inflated Fogarty catheter balloon packed with oxidized regenerated cellulose (Surgicel) using a fiberoptic bronchoscope. After 48 h, the balloon was deflated, the fistula had sealed, and the patient did well. This simple and relatively noninvasive therapy was effective in this patient who was not a surgical candidate.
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9/13. Intrathoracic free flaps.

    The utility of pedicled muscle flaps transposed into the thoracic cavity to reconstruct complex intrathoracic defects has been well documented. However, in some patients, local chest-wall muscles have already been either sacrificed or transected by previous thoracotomies and are not available for reconstruction. In these patients, we have successfully employed microvascular techniques to transfer distant muscle flaps into the thoracic cavity. Seven patients with complex intrathoracic defects were reconstructed with three latissimus dorsi, one omental, and three rectus abdominis free flaps. In each case, the microvascular anastomosis was extrathoracic, with the flap transposed into the thoracic cavity. Each of the flaps was revascularized successfully. Four of the five bronchopleural fistulas were sealed, with the remaining patient continuing to demonstrate a reduced but persistent air leak. No infections were encountered, and each flap transfer resulted in a healed wound. When local muscle flaps are not available to reconstruct complex intrathoracic wounds, microvascular transfer of distant muscle flaps can provide abundant well-vascularized tissue for reconstruction of any portion of the thoracic cavity. Versatility is afforded in flap selection and recipient vessel site location, making this technique an important option in the treatment of these difficult wounds.
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10/13. Subarachnoid-pleural fistula as a complication of the lateral-extracavitary approach to thoracic intraspinal neurinoma.

    STUDY DESIGN. This report describes an infrequent but major complication resulting from a lateral extracavitary approach to the spinal cord. The diagnosis was made via myelography-computed tomography. OBJECTIVES. The authors emphasize the importance of a proper approach in diagnosing a subarachnoid-pleural fistula and treating this clinical condition correctly. SUMMARY OF BACKGROUND DATA. myelography-computed tomography was used to diagnose the subarachnoid-pleural fistula. It was necessary to re-open the thoracotomy to seal the dura mater because the pleuroperitoneal shunting was not effective. methods. The patient presented with an intradural and extramedullary thoracic neurinoma located on the anterior part of the spinal canal that was causing anterior spinal cord compression. A lateral extracavitary approach was taken with a thoracotomy, with the tumor being completely removed. During the postoperative period, the patient had a persistent pleural effusion. The diagnosis of a cerebrospinal fluid fistula was made via myelography-computed tomography. Implantation of a pleuroperitoneal shunt was unsuccessful, and it was necessary to re-open the thoracotomy to seal the dura mater. RESULTS. myelography-computed tomography successfully helped diagnose the subarachnoid-pleural fistula and identify the precise anatomic location of the leakage. Pleuroperitoneal shunting was not effective in dealing with the pleural effusion. CONCLUSIONS. This complication should be taken into account when this kind of surgical approach is performed. myelography-computed tomography is the most reliable test for diagnosing this clinical condition and pinpointing the exact location of the leakage.
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