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K al-Kattan

Publications and source records attributed to K al-Kattan.

11 recordsLinked to original sources
PubMed2000

Spontaneous chylothorax--case report.

A-19-year old male patient complained of shortness of breath. Aspiration of the pleural fluid revealed chylothorax. Right chest tube was inserted. His ABG showed hypoxaemia with relative hypercarbia. He underwent right thoracotomy and thoracic duct ligation under general anaesthesia and double lumen endobroncheal intubation. During surgery he lost 1.5 L of blood and 4 L chyle. He was transferred to the SICU intubated and on mechanical ventilation. On the subsequent days chyle leak was reduced to a minimum of 10 ml/hr. On the 9th postoperative day the patient was extubated. He was receiving TPN 2600 kcal/day. He was transferred to the normal floor on the 15th day. After 7 day he was readmitted, his chest showed severe lung fibrosis and consolidation. His ABG showed severe hypercarbia (PaCO2 = 126 mmHg). The patient was intubated. His condition deteriorated and he was considered for lung transplantation. No donor was available. Later he arrested and died. Anaesthesia and surgical management of spontaneous chylothorax is challenging. The mortality rate is high.

Adult↗
PubMed1997

Overlooked inhaled foreign bodies: late sequelae and the likelihood of recovery.

The present paper describes eight patients (two teenagers and six adults) who had chronic symptoms (haemoptysis, cough, recurrent pneumonia) caused by foreign body (FB) inhalation which went undetected for 3 months to 25 yr. None of the patients had the usual predisposing conditions like mental retardation, seizures or brain tumour. The diagnosis of FB was made by radiography in one patient only. Computerized tomography visualized one FB (a beef bone), and bronchoscopy identified FB in another two patients. The remaining four cases were diagnosed at thoracotomy. Removal of FB was curative in three of five cases who required surgical resection for irreversible bronchiectatic changes. The severity of pulmonary changes correlated with duration of symptoms. It is concluded that chronic, unexplained respiratory symptoms should warrant further investigation to exclude FB despite negative history and normal chest radiography. Finding of granulation tissue or cicatricial stenosis of the bronchus could be the only clue to the presence of a FB. Early diagnosis would avoid irreversible parenchymal changes which necessitate lung resection.

Adolescent↗
PubMed1997

Disease recurrence after resection for stage I lung cancer.

OBJECTIVE: To asses the incidence of local recurrence and distant metastases after complete resection for stage I lung cancer in order to predict the predominant prognostic factors. METHODS: We retrospectively reviewed 123 patients with stage I lung cancer who underwent curative resection over a 2-year period between January 1987 and December 1988. There were 83 male and 40 female patients with a mean age of 64.8 +/- 12 years (range between 39 and 82 years). Multivariate analysis of prognostic factors for long term survival was undertaken. RESULTS: T1N0 lesions were found in 34 patients and T2N0 in 89. The histological diagnosis was Squamous carcinoma in 75, Adenocarcinoma in 38, large cell carcinoma in 6 and small cell carcinoma in 4 patients. Pneumonectomy was performed in 27 patients (5 T1 and 22 T2) while 96 required lobectomy (29 T1 and 67 T2). At 5 years 50 patients died. This was due to local recurrence in 12, distant metastasis in 24, second primary in 1, unrelated disease in 3, while the cause was unknown in 10 patients. At 5 years, 10 patients were alive with evidence of recurrence. The mean interval for local recurrence was 19.8 months and for distant metastasis was 18 months. The overall 5 year survival was 67% +/- 4 for T1 and 56% +/- 5 for T2 lesions (NS). The rate of recurrence was significantly less for T1 lesions (P = 0.02). Survival was significantly less for patients requiring pneumonectomy rather than lobectomy (P = 0.01) whether for T1 or T2. CONCLUSION: In stage I lung cancer T2 lesions requiring pneumonectomy for complete resection had a worse prognosis and higher incidence of local recurrence.

Adult↗
PubMed1996

Pneumothorax in AIDS: case reviews and proposed clinical management.

BACKGROUND: Pneumothorax is a not uncommon complication of advanced HIV infection, and may prove difficult to manage in view of its recalcitrant and recurrent nature. In this group where immunosuppression and reduced life expectancy are a feature, standard protocols are often abandoned in favour of a more conservative approach. This is often unsuccessful. METHODS: Patients attending the Department of Genitourinary Medicine, Chelsea and Westminster Hospital who sustained pneumothorax between 1988 and 1992 were identified retrospectively and their notes reviewed. RESULTS: Fifteen patients were identified of whom three had post-procedural pneumothoraces. In the remaining 12 patients, 10 had previously had Pneumocystic carinii pneumonia (PCP), whilst all 12 had some evidence to suggest current PCP (seven proven, five presumptive). In those six patients with a single, unilateral pneumothorax, four were managed successfully with intercostal drainage alone (one patient died early, one required pleurectomy). In those with recurrent pneumothoraces or pneumothoraces that did not respond to prolonged intercostal drainage, failure of medical treatment was judged to have occurred and surgery was performed. Overall, conservative management failed in 7/11 patients. Conversely surgery resulted in resolution in 7/7 with recurrence seen in one individual. Median survival was similar in the two groups. CONCLUSIONS: Pneumothorax in patients with AIDS is associated with a high rate of intercurrent PCP; a low threshold for treating this infection presumptively is indicated. Intercostal drainage was successful in patients with a single, unilateral pneumothorax. However, in patients with recurrent or bilateral pneumothorax extended periods on intercostal drainage were uniformly unsuccessful. Early surgical referral should be considered in this group.

AIDS-Related Opportunistic Infections↗
PubMed1996

Factors affecting long term survival following resection for lung cancer.

BACKGROUND: Survival following pulmonary resection for primary lung cancer is considered to be principally dependent on the clinical stage of the disease. A study was undertaken to verify this and to identify other contributing factors. METHODS: The case records of all patients who underwent surgery for lung cancer over a two year period between January 1987 and December 1988 were reviewed retrospectively. RESULTS: One hundred and forty-seven lobectomies and 60 pneumonectomies were performed with 2.8% and 5.3% operative mortality, respectively. Squamous carcinoma was the commonest pathology (60%) followed by adenocarcinoma (30%). The overall five year survival was 45.5% (95% CI 44.1% to 57.9%). There were 123 patients with stage I disease, 40 with stage II, and 37 in stage IIIa with five year survival of 59.4% (95% CI 50.8% to 68%), 30% (95% CI 15.9% to 44.1%), and 16.2% (95% CI 3.5% to 31%), respectively. There were no differences in survival with respect to sex, extent of resection, or cell type. In patients with stage II disease the five year survival of those with T1 lesions (50%, 95% CI 37.3% to 62.9%) was better than those with T2 (28.1%, 95% CI 16.9% to 39.3%). Of eight patients over the age of 70 with stage IIIa disease none survived more than 24 months. CONCLUSIONS: Stage at operation is the most accurate predictor of long term survival in early lung cancer and surgery remains an effective treatment, particularly in stage I and II disease. Further study is needed to assess the prognostic value of subdividing stage II disease into T1 and T2 lesions. Major resection for locally advanced disease in older patients may be relatively ineffective.

Adenocarcinoma↗
PubMed1995

Completion pneumonectomy: indications and outcome.

Completion pneumonectomy has been associated with higher rates of morbidity and mortality and this is reflected in the selection of cases and the indications for the procedure. During a period of 14 years from January 1980 to November 1993, 38 completion pneumonectomies were done by our surgical team, representing 5.1% of all pneumonectomies. There were 24 right and 14 left completion pneumonectomies done in 26 male and 12 female patients with an average age of 61 years (range from 29 to 77 years). Lung malignancy accounted for 26 of these cases in which the indication included local recurrence in 10, second primary tumor in 9, malignancy that developed after resection for benign disease in 2, and pulmonary metastasectomy in 5 cases. Benign diseases were the indication in 12 cases: tuberculosis in 4, bronchiectasis in 4, aspergillosis in 1, and postoperative complications in 3. Additional surgical procedures were necessary in 7 cases: chest wall resection with insertion of prosthesis in 3, thoracoplasty in 2, and omental flap in 2. There was 1 early postoperative death after 5 weeks from adult respiratory distress syndrome. There was no occurrence of bronchopleural fistula, and the 18% associated morbidity rate was a result of bleeding necessitating reexploration in 3 cases, prolonged ventilation in 2, and chronic empyema in 2. Six of these complications (86%) occurred in the group with benign disease. Completion pneumonectomy can be done with an acceptable morbidity in selected patients. Careful technique is important to secure hemostasis and to avoid fistulas. The complication rate is higher when infective disease is involved.

Adult↗
PubMed1995

Bronchopleural fistula after pneumonectomy for lung cancer.

Bronchopleural fistula (BPF) after pneumonectomy is a life-threatening complication. Over a period of 14 years (January 1980 to November 1993), 471 pneumonectomies were performed byone surgical team using a uniform suture technique for primary lung cancer. Non-small cell lung cancer accounted for 451 cases and 20 cases were small cell cancer. All operations were performed using a uniform hand suture technique. There were seven cases of BPF giving an incidence of 1.5%. All fistulas occurred within 15 days postoperatively and there were no late fistulas. The bronchial stump was free of tumor in all cases. No fistula occurred in the 24 (5.1%) completion pneumonectomies. The experience of the surgeon was important as the senior author performed 374 pneumonectomies with two fistulas (0.5%) while other surgeons in training performed 97 pneumonectomies with five fistulas (5.1%). Bronchial dehiscence was confirmed by bronchoscopy in all cases and an attempt at resuturing the stump through the same thoracotomy incision was made within 2 days of the diagnosis. Closure was successful in five patients, while the other two developed fatal complications. We conclude that suture closure to the bronchial stump after pneumonectomy provides a cheap and reliable technique, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk.

Adult↗
PubMed1994

Bronchopleural fistula after pneumonectomy with a hand suture technique.

We have reviewed the incidence of bronchopleural fistula among 530 consecutive pneumonectomies, all carried out by one surgical team using a uniform suture technique between January 1980 and November 1993. There were 7 fistulas (1.3%); all of them occurred within 15 days postoperatively. There were no cases of late fistula during a mean follow-up period of 23 months. The pathology for which pneumonectomy was undertaken was primary lung malignancies in 488 cases (92.1%), metastatic disease in 15 cases (2.8%), and benign diseases in 27 cases (5.1%). All fistulas developed after pneumonectomy for lung cancer. Other risk factors included age, preoperative radiotherapy, and the surgeon's level of experience, as only two fistulas occurred with the consultant who performed 410 pneumonectomies (0.5%). The bronchial stump was free of tumor in all cases. There were no fistulas in the 37 completion pneumonectomies (7%). All fistulas were treated within 2 days of diagnosis by resuturing the stump through the initial thoracotomy incision. That was successful in 5 patients, whereas fatal complications developed in the other 2 patients. We believe that suture closure of the bronchial stump at pneumonectomy provides a cheap and reliable technique that gives good results in all situations.

Adult↗
PubMedDate not supplied

Wrapping the anastomosis with omentum or an internal mammary artery pedicle does not improve bronchial healing after single lung transplantation: results of a randomized clinical trial.

Between May 1989 and March 1990, 36 patients undergoing a first single lung transplantation were randomized to three groups. In the omentum group the bronchial anastomosis was wrapped with an omental pedicle. In the internal mammary artery group, the anastomosis was wrapped in a pedicle of tissue surrounding the internal mammary artery. In the no wrap group, no attempt was made to revascularize the anastomosis. No significant differences were found in the indications for transplantation, recipient age, organ ischemic time, or preoperative steroid use in the three groups. There were two early deaths: one in the omentum group as a result of infection and one in the internal mammary artery group as a result of multiorgan failure. During a mean follow-up period of 21 months (range 9 to 32), there were two additional deaths in the no wrap group and four in the omentum group, one of which involved an anastomotic complication. Actuarial survival at 1 year was 75%, 92%, and 80% in the omentum, internal mammary artery, and no wrap groups, respectively (p = 0.25). Granulation tissue at the site of the anastomosis requiring cryotherapy or bronchial dilatation occurred in two patients in the omentum group, three in the internal mammary artery group, and three in the no wrap group. Bronchial stents were required in one patient in the omentum group and one in the internal mammary artery group. Actuarial survival free of anastomotic complications was similar in the three groups. The incidence of bronchial anastomotic complications after single lung transplantation is not affected by wrapping the anastomosis with either omentum or an internal mammary artery pedicle.

Actuarial Analysis↗
PubMedDate not supplied

Evaluation of the long-term results of single lung versus heart-lung transplantation for emphysema.

BACKGROUND: Heart and lung transplantation used to be the standard operation for patients with emphysema. Because of the shortage of donors, more patients are having single lung transplantation with satisfactory short-term results. METHODS: This study was performed to evaluate the long-term results of both groups. During the period between December 1985 and December 1993, 89 patients underwent lung transplantation, and 68 patients (43 male and 25 female) underwent single lung transplantation. There were 31 right and 37 left single lung transplantations with 24 bronchial revascularization procedures. RESULTS: The actuarial 5-year survival was 67% +/- 0.3% in single lung and 60% +/- 0.2% in heart-lung groups (p = 0.947). In the single lung group, two patients required a second single lung for air trapping and 11 patients (16%) had obliterative bronchiolitis, two of whom required retransplantation. In the heart-lung group, four patients (19%) had obliterative bronchiolitis, two of whom required retransplantation. The cumulative probability of developing obliterative brochiolitis at 3 and 5 years was 17% and 38% in the heart-lung transplantation group and 23% and 48% in the single lung transplantation group, respectively. The average forced expiratory volumes in 1 second at 3 and 5 years were 1.6 and 1.4 (L/min) (standard error +/- L/min) for single lung and 3 and 2.9 (L/min) standard error +/- 0.25) for heart-lung transplant recipients, respectively. The percentage of the predicted maximum oxygen consumption was 42% and 58% in single lung and heart lung groups, respectively. CONCLUSIONS: The long-term results in respiratory function, exercise capacity, and the quality of life of heart-lung transplant recipients are significantly better with survival compared with single lung transplant recipients. Although single lung transplantation for patients with emphysema makes better use of organs, the long-term results when compared with those of the heart-lung group needs to be evaluated further.

Adult↗