Open Journal of Thoracic Surgery

Journal Information
ISSN / EISSN : 2164-3059 / 2164-3067
Published by: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 149
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SHERPA/ROMEO
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Emmanuel De Tandt, Marc Nauwynck
Open Journal of Thoracic Surgery, Volume 12, pp 11-20; https://doi.org/10.4236/ojts.2022.121002

Abstract:
We aimed to investigate the risk factors and reason for initiation of high-flow nasal cannula (HFNC), its benefit on re-intubation rate, mortality, and length of stay (LOS) in the postoperative cardiac surgery patient in the ICU. Methods: In a retrospective and descriptive study, 200 patients, who underwent cardiac surgery, were randomly included, and screened for initiation of postoperative respiratory support. Demographic patient data and pre-operative patient measurements were sampled. Data concerning the P/F ratio at arrival- and post-extubation, LOS at ICU and overall mortality were sampled. A comparison of those variables was performed between patients with and without need of respiratory support. Results: HFNC was initiated in approximately 22.45% in 2018, and 25% in 2020, of the patients. Comparing both years didn’t reveal a significant rise, but we saw a quicker use of HFNC in 2020. The all-case re-intubation rate and mortality was approximately 3%. The body mass index (BMI) was the only correlation with a higher chance of initiation of HFNC. Other data like age, pre-operative renal- or left ventricle function didn’t show a correlation. Conclusion: In case of respiratory insufficiency in the postoperative cardiac surgery setting, HFNC is a worthy first line treatment option which is initiated if conventional oxygen therapy doesn’t suffice. The mortality was low, and the mean LOS was 4.38 days. If respiratory support was started with HFNC mean LOS rose to 8.35 days. The BMI seems to have a correlation with the development of respiratory failure, which confirms the latest recommendation to start preventive HFNC in the post-extubation cardiac surgery setting and which could be implemented in the daily practice.
Montaser Elsawy Abd Elaziz, Eman Gomaa Saleh, Mohamed Gaber Elsayed, Bassem A. Hafez
Open Journal of Thoracic Surgery, Volume 12, pp 21-32; https://doi.org/10.4236/ojts.2022.122003

Abstract:
Background: The aim of this study is to assess the necessity of temporary cardiac pacing and identify the predictors of pacing after coronary artery bypass graft (CABG). Methods: This was a retrospective observational study of 150 patients who had isolated CABG between November 2013 and December 2021. Patients were classified into two groups: group A, (n = 135) who did not need to be paced and group B, (n = 15) who needed temporary epicardial pacing. Only 10% (15/150) of patients in the study needed pacing. The primary outcome variable was assessment of the need for postoperative temporary cardiac pacing (TCP) (patients were paced during chest closure or at any time during hospital admission). The incidence of pacing during the postoperative period was observed. Univariate and multivariate predictors for postoperative pacing were determined and specicific predictors for cardiac pacing were found. Results: In both univariate and multivariate analysis, Old age > 65 years, diabetes mellitus, pacing to come off cardiopulmonary bypass (CPB), CPB time > 100 min, cardioversion to leave OR, antiarrhythmics to leave OR and new onset of atrial fibrillation (AF), were found to be significant predictors for the need to cardiac pacing. Conclusion: After coronary artery bypass surgery, a small percentage of patients require TCP. We emphasize unique predictors for postoperative pacing in this study.
Abir Tazim Chowdhury, Sohail Ahmed, Zulfiqur Haider, S. M. A. Zulker Nine, Kamrul Hasan, Estiak Ullah Sahid, Musfaqus Shalehin, Abdullah Al-Mahammud Kabir, Niaz Ahmed, Munama Magdum
Open Journal of Thoracic Surgery, Volume 12, pp 1-10; https://doi.org/10.4236/ojts.2022.121001

Abstract:
Among chronic pulmonary infections, pulmonary actinomycosis is a rare one, caused by a gram-positive microaerophilic bacterium called Actinomyces. Aside from cervicofacial or abdominopelvic actinomycosis, pulmonary involvement is rare, and sometimes this type of infection results in a misdiagnosis of pulmonary tuberculosis or carcinoma. Clinical presentation of pulmonary actinomycosis could be acute or subacute, with lobar involvement. However, the disease is most commonly diagnosed at the chronic phase, with patients presenting mild fever, weight loss, and occasional hemoptysis. Here, we described the case of a 30-year-old male patient, presented with a history of respiratory complaints for more than three years and was diagnosed clinically and radiologically as a case of a destroyed left lung. Later on, post-operative tissue diagnosis was confirmed—pulmonary actinomycosis.
Mohamed Alhaj Moustafa
Open Journal of Thoracic Surgery, Volume 11, pp 96-106; https://doi.org/10.4236/ojts.2021.114013

Abstract:
Background: Esophageal strictures are considered to be one of the most challenging matters for gastroenterologist, general and thoracic surgeons in diagnosis and management. They can be grouped into three general categories: intrinsic diseases, extrinsic diseases, and diseases that disrupt esophageal peristalsis and/or lower esophageal sphincter (LES) function. Crohn’s disease (CD) is a very rare cause of esophageal stricture. The prevalence of esophageal CD ranges from 1% to 2% in adults with CD. It is almost diagnosed lately when complications have occurred as Strictures, fissures, esophagobronchial fistulas, and mediastinal abscesses. Case Report: Thirty-nine years old Kurdish patient, referred to our department for evaluation. Although many consultations during the last two years, the Pt was still undiagnosed. She had progressive dysphagia, and weight loss of about 25 kg. She had no other digestive or extra digestive complaint, nor caustic ingestion history and nor drug history. Chest CT scan and UGI Contrast study revealed diffuse smooth and regular esophageal stenosis. Attempts to do upper endoscopy and biopsy failed due to severe stenosis. Prolonged medical history and radiologic signs exclude malignancy, so esophagectomy with stomach pull-through was done by the aid of VATS and laparoscopy with excellent results. Pathological finding of the resected esophagus suggested the diagnosis of Crohn’s disease CD. Conclusions: CD is a rare cause of esophageal stricture and still to be a challenging early diagnosis due to the low specificity of clinical manifestations (aphthous ulcers), histologic findings (absence of granulomas), and endoscopic findings. So many patients have been diagnosed with complications (esophageal strictures, fistulas) which needed surgical treatment, adding greater morbidity and mortality. MIS (thoracoscopy-laparoscopy) is valuable in decreasing the morbidity and mortality and improving the quality of life for those patients.
Mamadou Diakité, Abdoulaye Kanté, Bréhima Coulibaly, Mamadou Almamy Keita, Mariam Daou, Demba Yattera, Samba Sidibe, Souleymane Coulibaly, Boureima Dembele, Alou Sangaré, et al.
Open Journal of Thoracic Surgery, Volume 11, pp 11-17; https://doi.org/10.4236/ojts.2021.111002

Abstract:
Tuberculosis is a public health problem in Mali. Pulmonary localization is the most frequent and extra-pulmonary involvement, in particular serous, is possible. In this study, we analyze our results of surgical pericardial drainage in tuberculous pericarditis. Methodology: We carried out a retrospective study at the CHU Point G over a period of five years from January 2012 to December 2017. The histological examination carried out on all the surgical specimens made it possible to retain the diagnosis of tuberculous pericarditis. Results: We identified and operated on 49 cases of tuberculous pericarditis, i.e. 70% of the pericardial drainage performed during the same period. The average age was 31.5 years (28 men and 21 women). The most common clinical signs were dyspnea (61.2%), chest pain (26.6%) and fever (12.2%). Pericardial drainage with pericardial biopsy was performed by xiphoid route in all of our patients. The mortality and morbidity rates were 4.1% and 8.2%, respectively. Conclusion: Pericardial tuberculosis attacks are frequent in Mali. The etiological diagnosis is based on the histology of the pericardial biopsy which can only be obtained surgically.
Ramzi A. Addas, Ahmed M. Alsabban, Abdullah A. Fallatah, Aqeel S. Binaqeel, Salman W. Bafageeh
Open Journal of Thoracic Surgery, Volume 11, pp 69-75; https://doi.org/10.4236/ojts.2021.113009

Abstract:
Ocular metastasis is an uncommon occurrence that usually has a poor prognosis. The most frequent causes of intraocular metastases as reported in the literature are breast and lung cancers. Intraocular metastasis originating from esophageal cancer is very rare. We discuss a case of 58 years old man known case of adenocarcinoma of the esophagogastric junction presenting with ocular metastasis in King Abdulaziz Medical City, Jeddah, Saudi Arabia. Clinical symptoms led to the investigations and diagnosis of the ocular metastasis which without these symptoms it would have been missed. We concluded that a careful and good review of the whole body is essential in the optimal diagnosis of metastatic lesions especially when it comes to a rare metastasis like ocular metastasis from esophageal cancer.
Montaser Abd Elaziz, Mohammed Eltaweel, Mohamed Elsayed, Mohammed El-Hag-Aly
Open Journal of Thoracic Surgery, Volume 11, pp 47-57; https://doi.org/10.4236/ojts.2021.112007

Abstract:
Background: Aspiration of foreign body is popular in pediatric age group and is considered as an important cause of respiratory distress and chocking in these children. Management strategies are different according to the mode of presentation. This study aims to assess the efficacy of rigid bronchoscopy and the role of bronchotomy as a safe alternative for failed removal of inhaled foreign body. Methods: We enrolled 254 patients with foreign body aspiration (FBA) up to 14 years old in a retrospective observational study. Our patients were reviewed from the Cardiothoracic Surgery Department and cases referred from Otorhinolaryngology Department, Menoufia University Hospital between June 2010 and July 2017. Using jet ventilation technique, foreign body was removed by the rigid bronchoscopy with either extracting forceps or postural drainage. Surgical interference such as bronchotomy needed in distally impacted foreign bodies (FBs). Results: Our study included 254 patients prepared for bronchoscopic FBs extraction. Most of cases (68.8%) presented early within first week (174 cases). No FBs detected in 44 cases by rigid bronchoscopy, although it was successful in 176 (69.5%) cases with non- impacted inhaled FBs. 14 cases only needed postural drainage due to inaccessible FBs, another 12 cases failed to extract FB with rigid bronchoscopy but they were managed with flexible bronchoscopy. Bronchotomy was needed for impacted FBs in eight cases (3%). Conclusion: This study’s findings support that rigid bronchoscopy is the gold standard in the diagnosis and removal of foreign body aspirations in pediatrics, but rigid bronchoscopy demonstrated less capability in the diagnosis and removal of small distally located foreign bodies. Bronchotomy is safe and effective alternative.
Israel Salgado Adame, Alberto Manuel González Chávez, Brisa del Mar Leslie Villanueva Bardales, Luis Roberto Jiménez Hernández
Open Journal of Thoracic Surgery, Volume 11, pp 89-95; https://doi.org/10.4236/ojts.2021.114012

Abstract:
Diaphragmatic hernias may be acquired or congenital. Among congenital hernias, the most common is Bochdalek hernia and eight out of ten Bochdalek hernias occur on the left side. They are usually diagnosed in the paediatric age group, and it is exceedingly rare for the diagnosis to be established in adulthood. Renal ectopy associated with a Bochdalek hernia is extremely rare, and very few cases are reported worldwide. We are reporting a case of a 73-year-old male patient with a right-sided Bochdalek hernia and renal ectopy. In this case, promp diagnosis and treatment could help to reduce the high risk of death in this kind of patients.
Kayo Sugiyama, Hirotaka Watanuki, Yasuhiro Futamura, Masaho Okada, Hiroki Numanami, Masayuki Yamaji, Satoshi Makino, Katsuhiko Matsuyama
Open Journal of Thoracic Surgery, Volume 11, pp 25-30; https://doi.org/10.4236/ojts.2021.111004

Abstract:
Background: Residual aneurysms after graft replacement are rare, but they can be detrimental if they are saccular and large. The etiology of residual aneurysms remains unknown, and their management is controversial. One treatment option is late open surgical conversion; however, postoperative respiratory complications resulting from the dissection of pleural adhesions, which is frequently necessary with this approach, are often unavoidable. Case presentation: Herein, we report a case of open surgical repair of a residual distal aortic arch aneurysm that occurred after total arch replacement and thoracic endovascular aortic repair. Contrast-enhanced magnetic resonance imaging was not possible in this case due to the patient’s severe renal dysfunction; however, contrast-enhanced computed tomography using minimal contrast did not detect remarkable leakage through the graft or stent graft into the aneurysm. Late open surgical conversion using video-assisted thoracic surgery was performed by thoracic surgeons, and the adhesion between the aortic wall and the lung was safely and effectively dissected. Because there was no significant pulsation or evidence of feeding arteries in the aortic wall, the aortic wall was opened carefully. No bleeding or backflow from any branch arteries into the aneurysm was noted, so the aortic wall was ligated with continuous sutures. The patient recovered without experiencing any major complications. Conclusions: This case report demonstrates that video-assisted thoracic surgery is safe and effective for late open conversion in cases of residual aneurysm; furthermore, this case suggests that video-assisted thoracic surgery may be particularly beneficial for the dissection of adhesions between the aortic wall and lung in these cases.
Camara Alpha Kabinet, Camara Soriba Naby, Balde Oumar Taibata, Diallo Amadou Sarah, Camara Mama Aissata, Magassouba Aboubacar Sidiki, Balde Abdoulaye Korse, Toure Aboubacar, Diallo Aissatou Taran, Diallo Biro
Open Journal of Thoracic Surgery, Volume 11, pp 83-88; https://doi.org/10.4236/ojts.2021.114011

Abstract:
Pyothoraxes, also called thoracic empyemas, are defined by the presence between the two layers of the pleura, of a frankly purulent liquid, or of a shady or clear liquid but containing a majority of altered polynuclear cells with germs direct examination. They are said to be traumatic when they follow a thoracic trauma whatever the mechanism; usually a pre-existing post-traumatic pleural effusion. The general objective of this study was to help identify the epidemiological and prognostic factors in the management of post-traumatic pyothorax in the Thoracic Surgery Department of the Donka National Hospital. Methodology: This was a descriptive retrospective study covering a period of 2.5 years from 01/06/2016 to 31/12/2018 carried out in the Thoracic Surgery Department of the Donka National Hospital. Results: During the study period, 17 cases of post-traumatic pyothorax were observed among the 288 files of admitted and hospitalized patients. In the course of this study, a rate was 5.90%. The most affected age group was 1 to 5 years old. The male sex was in the majority (76.5%). The most common occurrence was the fall, i.e. 41.2%. 47% of patients consult after 60 days. Chest pain and dyspnea were the main symptoms during our study (82.3%). Antibiotics and analgesics dominated the medical treatment used in 100% of the cases and pleural drainage was the first line surgical treatment practiced in 88.2% of the cases. The prognosis is favorable without sequelae in 52.9% of cases with an average hospital stay of 9 days. Post-traumatic pyothorax is a serious pathology involving the vital and functional respiratory prognosis, hence the need to diagnose and treat it early.
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