THORACOSCOPY IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Citation
Dr. Flum et al., THORACOSCOPY IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME, Journal of thoracic and cardiovascular surgery, 114(3), 1997, pp. 361-366
Citations number
22
Categorie Soggetti
Cardiac & Cardiovascular System",Surgery
ISSN journal
00225223
Volume
114
Issue
3
Year of publication
1997
Pages
361 - 366
Database
ISI
SICI code
0022-5223(1997)114:3<361:TIA>2.0.ZU;2-B
Abstract
Objective: The role of thoracic surgery in patients with acquired immu nodeficiency syndrome (AIDS) continues to evolve, This review seeks to evaluate the outcome, morbidity, and mortality associated with video- assisted thoracoscopic surgery for empyema and pneumothorax in patient s with AIDS, Methods: A retrospective review was conducted of patients with AIDS in whom video-assisted thoracoscopic surgery was performed for empyema (group 1) or intractable pneumothorax (group 2), Results: Twenty patients with AIDS (95% male, mean age 37.4 years, mean CD4 cou nt 76 cells/ml(3)) underwent thoracoscopy, Surgery was performed for e mpyema (group 1) in 11 (55%) and intractable pneumothorax (group 2) in nine (45%), Three patients (15%) died within 30 days of the operation , At mean follow-up (29 months), overall survival was 55%, For those w ho survived the hospitalization and died within the follow-up period ( 35.3%), mean survival time was 8.2 months (range 1 month to 27 months) , In group 1, surgical procedures were performed after 8 days of chest tube drainage and included pleural debridement and mechanical pleurod esis (n = 11) along with lung biopsy (n = 6), Survivals at 30 days and 29 months' follow-up were 90.9% and 45.4%, respectively, In group 2, significantly depressed CD4 counts (average 33.2 cells/ml(3)) were not ed along with a more prolonged preoperative hospitalization (18.5 days ) with 14.2 days spent with a chest tube before the operation, In this group, operative procedures included mechanical pleurodesis and talc poudrage (n = 9), bleb resection (n = 7), and lung biopsy (n = 1), Two deaths (22%) occurred within 30 days of the operation and survival at 29 months' follow-up was 66%, Conclusion: Video-assisted thoracoscopi c surgery performed in patients with AIDS for the treatment of empyema and intractable pneumothorax is effective, can be performed with litt le operative morbidity and mortality, and is associated with acceptabl e long-term survival, Video-assisted thoracoscopic surgery is best per formed soon after the diagnosis of intractable pneumothorax or empyema has been established.