Surgical management of congenital lung cysts: a 16-year review.
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Biomedical subjects
Publications and source records attributed to S P Saha.
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Spontaneous pneumothorax is more frequent during the newborn period than at any other time in childhood. Intubation, vigorous resuscitation, aspiration of meconium-stained amniotic fluid, and hyaline membrane disease have been associated most often with the occurrence of spontaneous pneumothorax; however, it may occur in the absence of any of these precursors. Most pneumothoraces occur in term babies (64%); however, the premature infant is more susceptible. Signs and symptoms are due chiefly to lung compression and include grunting, tachypnea, cyanosis, and retraction. The accumulation of air serves as an intrathoracic space-occupying lesion, an emergency condition that demands prompt diagnosis and treatment.
Acute nontuberculous empyema treated conventionally by thoracentesis, thoracostomy drainage, and antibiotics has an unacceptably high rate of morbidity and mortality. Early open thoracotomy to eliminate the empyema with decortication of the fibrinous peel and reexpansion of the lung has proven safe and effective for 25 years. The goals of treatment of acute nontuberculous empyema are: (1) to save life, (2) to eliminate the empyema, (3) to reexpand the trapped lung, (4) to restore mobility of the chest wall and diaphragm, (5) to return respiratory function to normal, (6) to eliminate complications or chronicity, and (7) to reduce the duration of hospital stay. Our studies confirm the normal values to be expected in patients who have had complete recovery from the acute empyema, and we lay to rest any concern that decortication might, in time, limit pulmonary function. We present the cases of 21 children who had acute and mature empyemas that were treated by open thoracotomy and decortication, with an average follow-up of 18 years, among whom there were no deaths or complications.
Ninety-eight patients with middle lobe syndrome were reviewed. There were 31 male and 67 female patients ranging in age from 4 to 80 years. The most common presenting symptoms were cough, dyspnea, fever, hemoptysis, and chest pain. Diagnostic studies included chest roentgenogram, bronchoscopy, and bronchography. Sixty-five patients had full recovery following intensive medical therapy. Thirty-one patients underwent surgical resection for persistent disease. There were five post-operative complications and 1 death in this series.
Of ten patients with anterior diaphragmatic hernia treated by operation, only three had shortness of breath and chest pain. The remainder of the patients were referred to us because of a roentgenographic abnormality. All patients have had follow-up of between six months and 11 years without recurrence. Surgical repair is recommended to prevent incarceration and strangulation.
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