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Boudaya M.S.,University Hospital Abderrahmen Mami | Smadhi H.,University Hospital Abderrahmen Mami | Marghli A.,University Hospital Abderrahmen Mami | Mouna M.,University Hospital Abderrahmen Mami | And 3 more authors.
Asian Cardiovascular and Thoracic Annals | Year: 2012

Background: diagnosis and treatment of thoracic actinomycosis is difficult. In most cases, surgery is performed to rule out lung cancer or to control severe symptoms such as hemoptysis. Methods: 6 patients with a mean age of 42 years underwent pulmonary resection and were given a pathologic diagnosis of thoracic actinomycosis at our institution between 2003 and 2010. We reviewed preoperative clinical characteristics, computed tomography findings, surgical indication, postoperative clinical course and outcome. Results: All patients were symptomatic. One patient had a history of cervical actinomycosis. The mean interval between radiographic identification of the abnormality and surgical intervention was 8 months (range, 4-17 months). Radiographic findings in all cases included a mass-like appearance, simulating lung malignancy or chronic suppuration. The various histological and bacteriological examinations had failed to make the diagnosis. Thoracic actinomycosis was confirmed after thoracic surgery. All patients received penicillin-based antibiotic treatment for at least 2 to 3 months. Good clinical results were observed in 5 patients. In one patient, we noted recurrence of actinomycosis after 10 months; it was a multidrug-resistant form. Conclusion: diagnosis of actinomycosis can be problematic because of difficulty in isolating actinomyces. In these cases, surgery is very helpful. © The Author(s) 2012.


Boudaya M.S.,University Hospital Abderrahmen Mami | Smadhi H.,University Hospital Abderrahmen Mami | Zribi H.,University Hospital Abderrahmen Mami | Mohamed J.,University Hospital Abderrahmen Mami | And 3 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2013

Objective A bronchopleural fistula (BPF) is a serious complication after pulmonary resection and carries a high mortality rate. It remains a therapeutic challenge. The lack of a consensus suggests that no optimal therapy is available; however, endoscopic closure of a fistula may avoid extensive and potentially risky surgery. Methods Seventeen patients (15 men and 2 women) with a BPF after a pneumonectomy (n = 2) or a lobectomy (n = 15), seen between 1995 and 2010, were reviewed. Their median age was 50 years (range, 14-75 years). Underlying diseases were malignant (n = 4) and nonmalignant (n = 13). Results The mean interval between surgery and fistula development was 20 days (range, 5-270 days). Clinical symptoms leading to a diagnosis of BPF were a persistent air leak (n = 2), a persistent air leak associated with pleural empyema (n = 3), pleural empyema alone (n = 11), and dyspnea (n = 1). Mean fistula size was 3.3 mm (range, 2-9 mm). Treatment consisted of oriented pleural drainage, adequate antibiotic therapy, and endoscopic closure of the fistula with local application of silver nitrate through a flexible bronchoscope (3-15 sessions, 3 times per week). Fistula closure was successful in 16 patients, but failed in 1 patient, who died from acute respiratory distress. Conclusions BPF is a severe complication in thoracic surgery. The combination of pleural drainage, adequate antibiotic treatment, and mucosal application of silver nitrate, through a flexible bronchoscope, is an efficient alternative and avoids extensive surgical intervention. © 2013 by The American Association for Thoracic Surgery.


PubMed | University Hospital Abderrahmen Mami
Type: Journal Article | Journal: Asian cardiovascular & thoracic annals | Year: 2012

Diagnosis and treatment of thoracic actinomycosis is difficult. In most cases, surgery is performed to rule out lung cancer or to control severe symptoms such as hemoptysis.6 patients with a mean age of 42 years underwent pulmonary resection and were given a pathologic diagnosis of thoracic actinomycosis at our institution between 2003 and 2010. We reviewed preoperative clinical characteristics, computed tomography findings, surgical indication, postoperative clinical course and outcome.All patients were symptomatic. One patient had a history of cervical actinomycosis. The mean interval between radiographic identification of the abnormality and surgical intervention was 8 months (range, 4-17 months). Radiographic findings in all cases included a mass-like appearance, simulating lung malignancy or chronic suppuration. The various histological and bacteriological examinations had failed to make the diagnosis. Thoracic actinomycosis was confirmed after thoracic surgery. All patients received penicillin-based antibiotic treatment for at least 2 to 3 months. Good clinical results were observed in 5 patients. In one patient, we noted recurrence of actinomycosis after 10 months; it was a multidrug-resistant form.Diagnosis of actinomycosis can be problematic because of difficulty in isolating actinomyces. In these cases, surgery is very helpful.

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