- Email: [email protected]
411-PA11 Pulmonary mucormycosis
74
Tubercle and Lung Disease: Supplement 2
therapy, treatment had to be discontinued due to adverse effects. In the end of the period as many as 41 patients had died, and of them approximately 16 from the mycobacterial disease. Between diagnosis and death there was an average time span of 4 years. Monitored as weight gain, decreased cough and mucous production, and life expectancy, treatment was successful in 25 patients, whereas it impaired quality of life in 15 patients. Two of the patients with no previously known immunodeficiency, having serious infection with extensive progressing destruction of lung tissue, weight loss and deterioration, were shown to have a T-cell dysfunction with very low levels of T-Interferon production during in vitro stimulation. They were treated with conventional chemotherapy combined with s. c. injected IFN-,/and the results are so far promising.
364-PAll Atypical mycobacteria - clinical course, diagnostic, treatment Videnovi~ J., Durid 0., Zugic, V., Vudinic, V. Institute for Pulmonary Diseases and TB, Clinical Center of Serbia, Belgrade, Yugoslavia
Nine pts with radiographic signs of a specific process were hospitalized in the period 1989-1991 at the Institute of Pulmonary Diseases and TB, Belgrade. All were men, mean age 54 + 2 yrs. Four of them had history of specific process and relapse in two. M. avium complex was isolated in three pts; symptoms of respiratory infection were mild, X-ray findings suggested cavernous phthysis unilaterally, while cicatrization was noted contralaterally. Moderately manifested obstructive ventilatory symptoms were present in two pts. Resistance to INH and Rifadin was evidenced. M. kansasii was evidenced in 4 pts with symptoms of marked generalized infection and radiographic signs of unilateral phthysis. Mixed, more severe ventilatory symptoms and resistance were evidenced in 2 pts on INH therapy. In four pts 114. xenopi was verified after persistence of radiographic findings and ARB in smear. Symptoms of infection were relatively mild, radiographic images revealed micronodular shadows with caverns in the mid pulmonary field. Functionally, ventilatory obstructive symptoms were present. Treatment of all pts was prolonged in accordance with the drug sensitivity test.
384-PAll Selective mediastinoscopy in the preoperative study of bronchogenic carcinoma Ldpez, L., Rodrfguez de Castro, F., Facal, P.*, Quevedo, S., Cruz, F., Hussein, M., Freixinet, J. Dept. Thoracic Surgery, *Dept of Radiology, University Hospital, Ntra Sra del Pino. Las Palmas de Gran Canaria, Spain
The aim of this study was to evaluate the reliability of selective mediastinoscopy in the preoperative assessment of non-small cell lung cancer. Between January 1991 and June 1993, 100 patients (96 male and 4 females with an age range of 38 to 76 years, x -- 58) with clinically operative bronchogenic carcinoma were evalu-
ated. All patients underwent: a) CT scanning on a third generation scanner, b) continuous 1 cm thick sections from the lung apices through the adrenal glands, c) bolus intravenous injection of contrast material for accurate evaluation through the pulmonary hila. Patients with enlarged mediastinal lymph nodes at CT (> 1 cm) underwent standard or extended mediastinoscopy. Otherwise a thoracotomy was performed. Fifty-six patients had squamous carcinoma, 31 adenocarcinoma and 13 large cell tumours. The most frequent location was in both upper lobes. CT scan yielded a positive result in 22 cases. Mediastinoscopy confirmed mediasfinal involvement in 17 of the 22 patients. CT scan provided false negative result in 12 instances, only 8 of them involving stations accessible to mediastinoscopy. Out of these 12 cases, 9 were located in the left lung. Six (6) of the 8 cases involving the aortic-pulmonary window were central tumours (5 LUL, 1 LLL) and 2 were peripheral (LLL). We conclude that selective mediastinoscopy according to the findings of CT has a high accuracy, except for left central tumours.
390-PAll Treatment of pulmonary aspergilloma with itraconazole Wierzbicka, M., Podsiato, B., Wesotowski, S., Bestry, L Institute for Tuberculosis and Lung Disease, Warsaw, Poland
The study aimed to assess effectiveness of itraconazole in treating pulmonary aspergilloma. Treatment with this triazole derivative was employed in 11 patients with pulmonary aspergilloma. Nine patients underwent a complete 6 month treatment at 200-400 mg dose. The treatment was discontinued in 2 patients who demonstrated progression of changes. Haemoptysis withdrew in 5 patients, the same number of patients displayed negative fungus culture. Only in 1 patient radiological appearances improved and negative sputum culture as well as cessation of haemoptysis were observed. No significant adverse events were reported for any patients. Six months after completion of the treatment haemoptysis recurred in 2 patients, renewed growth of A. fumigatus was quoted for 3 patients and intensified precipitating test results for 2 patients. Only 1 patient improved within all the required parameters. The results of the conducted study indicate that itraconazole by infiltrating lung cavity inhibits fungus growth on the surface of aspergilloma, which, in isolated cases can lead to aspergilloma necrosis. The results of itraconazole treatment are not sufficiently satisfactory to justify application of itraconazole in routine treatment of pulmonary aspergilloma.
411-PAll
Pulmonary mucormycosis
Canan, ~;., Murat, K., Muharrem, ~., Semih, H., Biilent, A. Heybeliada Chest Disease and Chest Surgery Center, Istanbul, Turkey
Pulmonary mucormycosis is an uncommon disease
Abstracts
caused by fungi of the class zygomycetes. These fungi are ubiquitous in nature and rarely cause pathogenic disease in humans. Morbidity and mortality are very high. Recovery depends upon underlying disease and upon early diagnosis. The diagnosis is achieved by demonstrating broad, non-septate hyphae with right branching in a tissue biopsy specimen. It is very difficult to diagnose this disease preoperatively and requires a high index of suspicion together with invasive diagnostic techniques. Persistent pulmonary lesions are resistant to antifungal therapy with amphotericin-B. Surgical resection of localized lesions remains the treatment of choice. We report a 26 year old female patient with granulomatous pulmonary mucormycosis without underlying disease who presented with a pulmonary mass. This report reviews the successful surgical experience with this patient in whom segmental resection was performed.
412-PAll
Pulmonary aspergilloma
Canan, ~., Muharrem, ~., Aziz, U., Semih, H., Murat, K. Benan, ~., Ibrahim, O. Heybeliada Chest Disease and Chest Surgery Center, Istanbul, Turkey
Pulmonary aspergitloma develops as a result of the saprophytic colonization of Aspergillus fumigatus in cavities from healed pulmonary tuberculosis and other cavitary pulmonary disease. Hemoptysis is the most common and life-threatening symptom. Between 1987 and 1994, 11 secondary pulmonary aspergilloma cases were operated and analyzed according to their clinical, radiological, bacteriological and histopathological findings in this study. All these patients had pulmonary tuberculosis with hemoptysis. Six of these were treated with upper lobectomy, 3 with pneumonectomy, 1 with lower lobectomy and 1 with pneumonectomy. Histopathological findings revealed that all cases were demonstrating secondary noninvasive aspergilloma. In this study, we discussed the incidence of pulmonary aspergilloma in tuberculosis, its treatment and especially the importance of the surgical treatment.
429-PAll Study of aerobic microbial flora of upper respiratory tract of chemical war wounded Heidarnajad, H., Ahmadyan, A. Tabriz University of Medical Sciences, Department of Medicine and Microbiology, Iran
Chronic bronchitis is the main complication following pulmonary wound due to mustard gas. Upper respiratory tract's microbial flora play an important role in pulmonary infections and changes in the microbial flora influences the incidence of pulmonary infections. Changes in microbial flora and the following lung infection have been reported by different research groups from all over the world and probably unreasonable use of routine antibiotics plays a role in these changes. 82 sputums collected from chemical war wounded were studied
75
from May 1994 to February 1995 having stopped antibiotic use for at least 3 weeks prior to sample collection. All of the sputums were stained by gram staining method and also were cultured onto a chocolate agar for isolation of bacteria. Results of this study indicated the presence of Branhamella catarrhalis in 77 patients (93.9%), beta-haemolytic streptococci in 44 patients (53.6%), non-beta haemolytic streptococci in 35 patients (42.6%), streptococcal pneumonia in 8 patients (9.7%), Haemophilus influenzae in 6 patients (7.3%), Corynebacterium spp. in 6 patients (7.3%), coagulase - negative staphylococci in 3 patients (2.4%), diphtheroides in 2 patients (2.4%), Pseudomonas spp. in 2 patients (2.4%), diphtheroides in 2 patients (2.4%), and E. coli in one patient (1.2%). Candida spp. was isolated in sputum samples of 13 patients and finally 2 cases were recorded as negative. Thus our results indicate an outstanding presence of B. catarrhalis comparing the other isolated organisms, which probably is due to a widespread and unreasonable use of antibiotics such as ampicillin and amoxicillin which are not effective against B. catarrhalis. Also our findings indicate need for effective antibiotics to prevent pulmonary infection and the resultant bronchitis.
430-PAll Diagnostic value of fiberoptic bronchoscopy in the diagnosis of pulmonary hydatid cyst Heidarnajad, H., Azar, S.S. Department of Internal Medicine, Tabriz University of Medical Science, Iran
Hydatid cyst is one of the most prevalent parasitic infestations of the lung in Tabriz. Diagnosis is made usually on radiologic, CT scan, sonography and immunologic findings. Bronchoscopy is not used routinely in our hospital for this purpose. Observation of white germinative layer in the lumen of bronchi may be useful in the diagnosis in the absence of other definite diagnostic findings. We reviewed records of 25 patients who had undergone bronchoscopic investigation and were suspected to have pulmonary hydatid cyst in our hospital during last 7 years. In 18 cases the disease was confirmed through pathologic examination postoperatively. There was serosanginous and purulent secretion associated with mucosal inflammation and hyperemia in 14 cases, pressure effect over the bronchus in five cases and intrabronchial white substance (germinative layer like) in 10 cases. The sensitivity and specificity of the latter was estimated in the light of final pathologic confirmation of hydatid cyst. In seven cases out of 10 in whom intrabronchial white substance was observed, presence of hydatid cyst was established. We conclude that the observation of white germinative layer has sensitivity of 38.88% and specificity 57.14%. Therefore, due to low sensitivity and specificity of bronchoscopy, it is not warranted for routine work-up of pulmonary hydatid cyst.
Tubercle and Lung Disease: Supplement 2
therapy, treatment had to be discontinued due to adverse effects. In the end of the period as many as 41 patients had died, and of them approximately 16 from the mycobacterial disease. Between diagnosis and death there was an average time span of 4 years. Monitored as weight gain, decreased cough and mucous production, and life expectancy, treatment was successful in 25 patients, whereas it impaired quality of life in 15 patients. Two of the patients with no previously known immunodeficiency, having serious infection with extensive progressing destruction of lung tissue, weight loss and deterioration, were shown to have a T-cell dysfunction with very low levels of T-Interferon production during in vitro stimulation. They were treated with conventional chemotherapy combined with s. c. injected IFN-,/and the results are so far promising.
364-PAll Atypical mycobacteria - clinical course, diagnostic, treatment Videnovi~ J., Durid 0., Zugic, V., Vudinic, V. Institute for Pulmonary Diseases and TB, Clinical Center of Serbia, Belgrade, Yugoslavia
Nine pts with radiographic signs of a specific process were hospitalized in the period 1989-1991 at the Institute of Pulmonary Diseases and TB, Belgrade. All were men, mean age 54 + 2 yrs. Four of them had history of specific process and relapse in two. M. avium complex was isolated in three pts; symptoms of respiratory infection were mild, X-ray findings suggested cavernous phthysis unilaterally, while cicatrization was noted contralaterally. Moderately manifested obstructive ventilatory symptoms were present in two pts. Resistance to INH and Rifadin was evidenced. M. kansasii was evidenced in 4 pts with symptoms of marked generalized infection and radiographic signs of unilateral phthysis. Mixed, more severe ventilatory symptoms and resistance were evidenced in 2 pts on INH therapy. In four pts 114. xenopi was verified after persistence of radiographic findings and ARB in smear. Symptoms of infection were relatively mild, radiographic images revealed micronodular shadows with caverns in the mid pulmonary field. Functionally, ventilatory obstructive symptoms were present. Treatment of all pts was prolonged in accordance with the drug sensitivity test.
384-PAll Selective mediastinoscopy in the preoperative study of bronchogenic carcinoma Ldpez, L., Rodrfguez de Castro, F., Facal, P.*, Quevedo, S., Cruz, F., Hussein, M., Freixinet, J. Dept. Thoracic Surgery, *Dept of Radiology, University Hospital, Ntra Sra del Pino. Las Palmas de Gran Canaria, Spain
The aim of this study was to evaluate the reliability of selective mediastinoscopy in the preoperative assessment of non-small cell lung cancer. Between January 1991 and June 1993, 100 patients (96 male and 4 females with an age range of 38 to 76 years, x -- 58) with clinically operative bronchogenic carcinoma were evalu-
ated. All patients underwent: a) CT scanning on a third generation scanner, b) continuous 1 cm thick sections from the lung apices through the adrenal glands, c) bolus intravenous injection of contrast material for accurate evaluation through the pulmonary hila. Patients with enlarged mediastinal lymph nodes at CT (> 1 cm) underwent standard or extended mediastinoscopy. Otherwise a thoracotomy was performed. Fifty-six patients had squamous carcinoma, 31 adenocarcinoma and 13 large cell tumours. The most frequent location was in both upper lobes. CT scan yielded a positive result in 22 cases. Mediastinoscopy confirmed mediasfinal involvement in 17 of the 22 patients. CT scan provided false negative result in 12 instances, only 8 of them involving stations accessible to mediastinoscopy. Out of these 12 cases, 9 were located in the left lung. Six (6) of the 8 cases involving the aortic-pulmonary window were central tumours (5 LUL, 1 LLL) and 2 were peripheral (LLL). We conclude that selective mediastinoscopy according to the findings of CT has a high accuracy, except for left central tumours.
390-PAll Treatment of pulmonary aspergilloma with itraconazole Wierzbicka, M., Podsiato, B., Wesotowski, S., Bestry, L Institute for Tuberculosis and Lung Disease, Warsaw, Poland
The study aimed to assess effectiveness of itraconazole in treating pulmonary aspergilloma. Treatment with this triazole derivative was employed in 11 patients with pulmonary aspergilloma. Nine patients underwent a complete 6 month treatment at 200-400 mg dose. The treatment was discontinued in 2 patients who demonstrated progression of changes. Haemoptysis withdrew in 5 patients, the same number of patients displayed negative fungus culture. Only in 1 patient radiological appearances improved and negative sputum culture as well as cessation of haemoptysis were observed. No significant adverse events were reported for any patients. Six months after completion of the treatment haemoptysis recurred in 2 patients, renewed growth of A. fumigatus was quoted for 3 patients and intensified precipitating test results for 2 patients. Only 1 patient improved within all the required parameters. The results of the conducted study indicate that itraconazole by infiltrating lung cavity inhibits fungus growth on the surface of aspergilloma, which, in isolated cases can lead to aspergilloma necrosis. The results of itraconazole treatment are not sufficiently satisfactory to justify application of itraconazole in routine treatment of pulmonary aspergilloma.
411-PAll
Pulmonary mucormycosis
Canan, ~;., Murat, K., Muharrem, ~., Semih, H., Biilent, A. Heybeliada Chest Disease and Chest Surgery Center, Istanbul, Turkey
Pulmonary mucormycosis is an uncommon disease
Abstracts
caused by fungi of the class zygomycetes. These fungi are ubiquitous in nature and rarely cause pathogenic disease in humans. Morbidity and mortality are very high. Recovery depends upon underlying disease and upon early diagnosis. The diagnosis is achieved by demonstrating broad, non-septate hyphae with right branching in a tissue biopsy specimen. It is very difficult to diagnose this disease preoperatively and requires a high index of suspicion together with invasive diagnostic techniques. Persistent pulmonary lesions are resistant to antifungal therapy with amphotericin-B. Surgical resection of localized lesions remains the treatment of choice. We report a 26 year old female patient with granulomatous pulmonary mucormycosis without underlying disease who presented with a pulmonary mass. This report reviews the successful surgical experience with this patient in whom segmental resection was performed.
412-PAll
Pulmonary aspergilloma
Canan, ~., Muharrem, ~., Aziz, U., Semih, H., Murat, K. Benan, ~., Ibrahim, O. Heybeliada Chest Disease and Chest Surgery Center, Istanbul, Turkey
Pulmonary aspergitloma develops as a result of the saprophytic colonization of Aspergillus fumigatus in cavities from healed pulmonary tuberculosis and other cavitary pulmonary disease. Hemoptysis is the most common and life-threatening symptom. Between 1987 and 1994, 11 secondary pulmonary aspergilloma cases were operated and analyzed according to their clinical, radiological, bacteriological and histopathological findings in this study. All these patients had pulmonary tuberculosis with hemoptysis. Six of these were treated with upper lobectomy, 3 with pneumonectomy, 1 with lower lobectomy and 1 with pneumonectomy. Histopathological findings revealed that all cases were demonstrating secondary noninvasive aspergilloma. In this study, we discussed the incidence of pulmonary aspergilloma in tuberculosis, its treatment and especially the importance of the surgical treatment.
429-PAll Study of aerobic microbial flora of upper respiratory tract of chemical war wounded Heidarnajad, H., Ahmadyan, A. Tabriz University of Medical Sciences, Department of Medicine and Microbiology, Iran
Chronic bronchitis is the main complication following pulmonary wound due to mustard gas. Upper respiratory tract's microbial flora play an important role in pulmonary infections and changes in the microbial flora influences the incidence of pulmonary infections. Changes in microbial flora and the following lung infection have been reported by different research groups from all over the world and probably unreasonable use of routine antibiotics plays a role in these changes. 82 sputums collected from chemical war wounded were studied
75
from May 1994 to February 1995 having stopped antibiotic use for at least 3 weeks prior to sample collection. All of the sputums were stained by gram staining method and also were cultured onto a chocolate agar for isolation of bacteria. Results of this study indicated the presence of Branhamella catarrhalis in 77 patients (93.9%), beta-haemolytic streptococci in 44 patients (53.6%), non-beta haemolytic streptococci in 35 patients (42.6%), streptococcal pneumonia in 8 patients (9.7%), Haemophilus influenzae in 6 patients (7.3%), Corynebacterium spp. in 6 patients (7.3%), coagulase - negative staphylococci in 3 patients (2.4%), diphtheroides in 2 patients (2.4%), Pseudomonas spp. in 2 patients (2.4%), diphtheroides in 2 patients (2.4%), and E. coli in one patient (1.2%). Candida spp. was isolated in sputum samples of 13 patients and finally 2 cases were recorded as negative. Thus our results indicate an outstanding presence of B. catarrhalis comparing the other isolated organisms, which probably is due to a widespread and unreasonable use of antibiotics such as ampicillin and amoxicillin which are not effective against B. catarrhalis. Also our findings indicate need for effective antibiotics to prevent pulmonary infection and the resultant bronchitis.
430-PAll Diagnostic value of fiberoptic bronchoscopy in the diagnosis of pulmonary hydatid cyst Heidarnajad, H., Azar, S.S. Department of Internal Medicine, Tabriz University of Medical Science, Iran
Hydatid cyst is one of the most prevalent parasitic infestations of the lung in Tabriz. Diagnosis is made usually on radiologic, CT scan, sonography and immunologic findings. Bronchoscopy is not used routinely in our hospital for this purpose. Observation of white germinative layer in the lumen of bronchi may be useful in the diagnosis in the absence of other definite diagnostic findings. We reviewed records of 25 patients who had undergone bronchoscopic investigation and were suspected to have pulmonary hydatid cyst in our hospital during last 7 years. In 18 cases the disease was confirmed through pathologic examination postoperatively. There was serosanginous and purulent secretion associated with mucosal inflammation and hyperemia in 14 cases, pressure effect over the bronchus in five cases and intrabronchial white substance (germinative layer like) in 10 cases. The sensitivity and specificity of the latter was estimated in the light of final pathologic confirmation of hydatid cyst. In seven cases out of 10 in whom intrabronchial white substance was observed, presence of hydatid cyst was established. We conclude that the observation of white germinative layer has sensitivity of 38.88% and specificity 57.14%. Therefore, due to low sensitivity and specificity of bronchoscopy, it is not warranted for routine work-up of pulmonary hydatid cyst.