Surgery for pulmonary aspergiloma: curative?

Introduction.In lhe last few decades, there has been an increase in fungal diseases, especially in those caused by Aspergillus.The aim of this retrospective study was to confirm or ascertain whether surgical intervention to pulmonary aspergiloma can result in a cure or long term palliative treatment with improvement of quality of life. Methods and materiais. From 1989 to 2001, 23 patients with mean age of 44.1 years (18-69 years) were submitted to pulmonary surgery for excision of aspergilloma. Sixteen patients were mate (70%). The most frequent indication for surgery was haemoptysis in 16 patients (70%) followed by abundant sputum in 3 patients (3%). Four patients (17%) were asymptomatic. Old tuberculosis lesions (87%) or pulmonary abscesses (13%) were lhe basic conditions for lhe aspergilloma. Pre-operative evaluation of respiratory function showed a mean vital capacity of 69.8% (61-84% limits) and lhe mean Fevl was 66% (53-82% limits). Results. This group of patients were submitted to 18 lobectomies (82%), 2 bilobectomies (7%), 2 wedge resections and 1 pneumonectomy (4%). There was no operative mortality and lhe morbidity in lhe post-operative period was: persistent air leak in 7 patients (30%), post-operative bleeding in 2 patients (7%) and residual cavities in 2 patients (7%). The mean time of follow-up was 7.2 years (limits 1.5-14 years) and 3 deaths were registered. Two deaths were related to intestinal neoplasia and 1 related to lhe original disease, 5 years after surgery. All surviving patients referred good improvement of symptoms and quality of life. Conclusions. The resection of pulmonary aspergilloma could be performed with a low morbidity and mortality. The patients referred good improvement of symptoms and quality of life after surgery. Consequently, we suggest that surgical therapy is an option for both symptomatic and asymptomatic patient

Distinção de fenómenos de bulking em lamas activadas por técnicas de análise de imagem

No corrente trabalho pretendeu-se detectar e identificar diferentes tipos de perturbações em lamas activadas (bulking filamentoso, bulking viscoso e crescimento de flocos pin point) por técnicas de processamento e análise de imagem. Para o efeito foram determinados os parâmetros operacionais sólidos suspensos totais (SST) e índice volumétrico de lamas (IVL), assim como diversos parâmetros morfológicos (conteúdo e morfologia da biomassa agregada e filamentosa), obtidos por análise de imagem. Os resultados obtidos permitiram o esclarecimento das diferentes inter-relações presentes entre cada uma das condições estudadas e os parâmetros que caracterizaram a biomassa microbiana, assim como a aferição do parâmetro operacional IVL, a partir da caracterização da biomassa

Estimation of effluent quality parameters from an activated sludge system using quantitative image analysis

Abstract The efficiency of an activated sludge system is generally evaluated by determining several key parameters related to organic matter removal, nitrification and/or denitrification processes. Off-line methods for the determination of these parameters are commonly labor, time consuming, and environmentally harmful. In contrast, quantitative image analysis (QIA) has been recognized as a prompt method for assessing activated sludge contents and structure. In the present study an activated sludge system was operated under different experimental conditions leading to a variety of operational data. Key parameters such as chemical oxygen demand (COD) and ammonium (N-NH4+), and nitrate (N-NO3-) concentrations, throughout the experimental periods, were measured by classical analytical techniques. QIA was further used for the microbial community characterization. Partial Least Squares (PLS) models were used to correlate QIA information and the aforementioned key parameters. It was found that the use of the morphological and physiological data allowed predicting, at some extent, the effluent COD, N-NH4+, and N-NO3- concentrations based on chemometric techniques.The authors thank the FCT Strategic Project of UID/BIO/04469/2013 unit and the project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462). The authors also acknowledge the financial support to Daniela P. Mesquita through the postdoctoral Grant (SFRH/BPD/82558/2011) provided by FCT - Portugal

Mediastinitis after aorto-coronary bypass surgery

OBJECTIVES: To identify risk factors in 60 cases of mediastinitis amongst 2512 patients (2.3%) subjected to isolated coronary bypass surgery from March 1988 through December 1995, treated by a closed irrigation/drainage system. PATIENTS AND METHODS: The mean age of the 60 patients was 56.9 +/- 6.8 years (45-81 years) and 55 (91.6%) were male. Early mediastinal reexploration was performed in all cases immediately after the diagnosis of mediastinitis, with debridement of necrosed tissues, followed by implantation of a closed-circuit irrigation system of the mediastinum constituted by irrigation catheter and drain, closure of the sternum and skin, and specific systemic antibiotic therapy. The mean interval between the original surgery and reexploration was 9.4 days (range 6-14 days). No patient required more extensive procedures, namely omental or muscular flaps. Twenty potential risk factors in patients with mediastinitis, including diabetes mellitus, obesity, coexistence of peripheral vascular disease, decreased LV function, use of inotropes, mediastinal blood drainage and utilization of double IMA, were compared with the group without mediastinitis. RESULTS: Mean cardiopulmonary bypass time was 74.1 +/- 8.1 min, anesthetic time 3.5 +/- 0.8 h and postoperative mechanical ventilation 18 +/- 3 h. A total of 23 patients (38.3%) received one IMA and 35 (58.3%) two IMAs. In the postoperative period, 7 of the 60 patients (11.6%) had required inotropes because of low output. Mediastinal blood loss was 1112cc +/- 452cc and 9 patients (15%) were transfused. Cultures were positive in 40 cases (66.6%) and the most frequent infecting agent was the Staph. epidermidis in 25 cases (62.5%), followed by Candida albicans and Enterobacter and Serratia species (7.5% each); 1 patient (1.7%) died and 9 (15%) had renal failure. The irrigation/drainage was maintained for a mean of 9.1 days (5-83 days). Patients with mediastinitis had a significantly higher prevalence of diabetes (41.6% vs. 18.8%; P < 0.01), obesity (48.3% vs. 15.2%; P < 0.001), peripheral vascular disease (11.6% vs. 4.0%; P < 0.05), but a lower incidence of poor LV function (18.3% vs. 32.7%; P < 0.05). A double IMA was used more frequently in patients who had mediastinitis (58.3% vs. 23.5%; P < 0.001) CONCLUSIONS: Diabetes mellitus, obesity, co-existence of peripheral vascular disease and use of double IMA are risk factors for mediastinitis after coronary artery surgery. The efficacy of the closed method of treatment with a mediastinal irrigation/drainage system was increased with early diagnosis and reintervention

Diaphragmmatic eventration: long-term follow-up and results of open-chest plicature

Objective: Diaphragmmatic eventration is a relatively uncommon entity with a simple surgical correction technique - plication of the diaphragm. This study aims to assess the clinical and ventilatory impact of this technique. Materials: From April 1988 to February 2007, we operated on 20 patients (12 men) with diaphragmmatic eventration using the postero-lateral approach and correction by radial plication. The mean age of the patients studied was 56.3+/-15.6 years (range: 13-74 years). A traumatic cause was identified in 13 patients; one patient had a congenital cause and the remainder were of idiopathic origin. Chronic obstructive pulmonary disease and arterial hypertension were present in one-half of the study group, while diabetes mellitus was present in three patients. Dyspnoea was the most common complaint in 75% of the patients, and thoracic pain was present in 25%. The mean forced expiratory volume in 1s (FEV(1)) and vital capacity (VC) were 66.2+/-15.3% and 70.4+/-16% of the predicted values, respectively. Results: There was no operative mortality. Apart from a patient with moderate/severe pain and another who had pneumonia, there were no other important perioperative complications. Average drainage time was 3.3+/-1.6 days (range: 2-7 days). Hospitalisation time was 6.2+/-1.6 days (5-10 days). Follow-up was complete, for a mean of 59.6+/-55.1 months (4-206 months). There were three late deaths (one sudden, one stroke and one trauma). Eight of the 17 survivors (47%) are asymptomatic. According to the MRC/ATS grading system, the dyspnoea score was 2.06+/-0.97 preoperatively and 1.06+/-1.14 postoperatively (p=0.007). At follow-up, the FEV(1) was 76.1+/-20.1% and the VC was 78.4+/-17.3% (p>0.1). Two patients had chronic pain. Conclusion: Plication of the diaphragm is a safe and efficient procedure. Most patients experienced significant clinical improvement with enhancement of the FEV(1) and VC. Chronic surgical pain still remains a potential problem with the classical approach

Lung metastases from colorectal cancer: surgical resection and prognostic factors

OBJECTIVE: To analyse our experience with excision of lung metastases from colorectal carcinoma (CRC), and to evaluate clinically relevant prognostic factors, identifying the cluster of patients who would benefit from this procedure. METHODS: Sixty-one patients, 42 men (69%), with primary CRC who underwent 94 curative resections of pulmonary metastases were retrospectively reviewed. Age was 30-80 years (mean 61.2+/-15). Population was analysed for age, sex, disease-free interval (DFI), prethoracotomy carcinoembryonic antigen (CEA) level, location and histology of primary tumour, number of lung lesions (and size of largest resected metastasis), type of lung resection, nodal involvement (hilar/mediastinal), use of adjuvant treatment, morbid-mortality and immediate and follow-up survival. RESULTS: Mean DFI was 29+/-22 months (range 5-132 months). There was no hospital mortality and significant morbidity occurred in five patients (8.2%). Mean follow-up was 39+/-4 months (range 4-173 months). Mean overall survival and disease-free survival were 67+/-16 months and 52+/-6 months, respectively. Three-, 5- and 10-year survival rates from date of primary colorectal resection were 83%, 71% and 43%, respectively. Three-, 5- and 10-year survival rates from date of lung resection were 61%, 48% and 11%, respectively. Five-year survival was 57% in patients with normal prethoracotomy CEA levels and 18% for those with high levels (>5 ng/ml) (p=0.039). CONCLUSIONS: Pulmonary metastasectomy has potential survival benefit for patients with metastatic colorectal carcinoma. Low morbidity and mortality rates, contrasting with lack of any other effective therapy, justify aggressive surgical management. Single deposits, DFI >36 months and normal prethoracotomy serum CEA were significant independent prognostic factors

Diagnostic value of surgical lung biopsy: comparison with clinical and radiological diagnosis

OBJECTIVE: To determine overall and disease-related accuracy of the clinical/imagiological evaluation for pulmonary infiltrates of unknown aetiology, compared with the pathological result of the surgical lung biopsy (SLB) and to evaluate the need for the latter in this setting. METHODS: We conducted a retrospective review of the experiences of SLB in 366 consecutive patients during the past 5 years. The presumptive diagnosis was based on clinical, imagiological and non-invasive or minimally invasive diagnostic procedures and compared with the gold standard of histological diagnosis by SLB. We considered five major pathological groups: diffuse parenchymal lung disease (DPLD), primitive neoplasms, metastases, infectious disease and other lesions. Patients with previous histological diagnosis were excluded. RESULTS: In 56.0% of patients (n=205) clinical evaluation reached a correct diagnosis, in 42.6% a new diagnosis was established (n=156) by the SLB, which was inconclusive in 1.4% (n=5). The pre-test probability for each disease was 85% for DPLD, 75% for infectious disease, 64% for primitive neoplasms and 60% for metastases. Overall sensitivity, specificity, positive and negative predictive values for the clinical/radiological diagnosis were 70%, 90%, 62% and 92%, respectively. For DPLD: 67%, 90%, 76% and 85%; primitive neoplasms: 47%, 90%, 46% and 90%; metastases: 99%, 79%, 60% and 99%; infectious disease 38%, 98%, 53% and 96%. CONCLUSIONS: Despite a high sensitivity and specificity of the clinical and imagiological diagnosis, the positive predictive value was low, particularly in the malignancy group. SLB should be performed in pulmonary infiltrates of unknown aetiology because the clinical/imagiological assessment missed and/or misdiagnosed an important number of patients

Excision of pulmonary metastases of osteogenic sarcoma of the limbs

OBJECTIVE: The combination of surgery and chemotherapy improves the prognosis of patients with osteogenic sarcoma of the limbs without detectable metastases at presentation. However, lung metastases are a frequent complication. To evaluate the role of the resection of pulmonary metastases of osteogenic sarcoma of the limbs, we have reviewed our experience with this type of surgery, combined with a multidrug chemotherapy protocol. PATIENTS AND METHODS: From January 89 to December 97, 198 patients operated on for osteogenic sarcomas of the limbs were followed in our centre. Of these, 31 patients (15.7%), with a mean age of 25 years (range 10-54 years), developed lung metastases and had undergone 45 thoracotomies. All patients received chemotherapy, followed by resection of metastatic lesions and additional chemotherapy. The mean time interval between resection of the primary tumour and the diagnosis of lung metastases was 22 months (4-122 months). Eight patients (25.8%) needed more than one (2-4) thoracotomy. The mean time interval between the first and second thoracic surgeries was 9.2 months (2-14 months). RESULTS: There was no operative mortality or major morbidity. During the 45 thoracotomies, five lobectomies and 40 wedge resections were necessary. The mean number of metastases resected per thoracotomy was 3.4 (range 1-10). The degree of necrosis was evaluated by seriated sections for a histologic study. In the end the mean necrotic volume was calculated. A strong correlation was found between the degree of necrosis of the metastases and the need for reoperation for new metastatic lesions, because all the patients who needed more than one operation had less than 80% of necrosis of metastases. The patients were followed for a mean period of 28 months (6-72 months). Ten patients (32.2%) died of related causes at a mean of 19.4 months after thoracic surgery, three of whom had more than one operation. The 3-year survival after metastasectomy was 61%. Patients without pulmonary metastases had a 3-year survival of 79%. CONCLUSIONS: In patients with lung metastases of an osteogenic sarcoma, the combination of chemotherapy and surgery improves the outcome. In our series the mortality was not influenced by the number or thoracotomies required