One-stage thoracoscopic resection of bilateral bronchiectasis

Objective To evaluate the results of one-stage thoracoscopic resection of bilateral bronchiectasis. Methods Between June 2009 and December 2020, there were 23 patients selected for one-stage thoracoscopic resection of bilateral bronchiectasis. Their average age was 58.5 (36–73). Female patients were more common, accounting for 17 (74%). Preoperatively, 17 (74%) patients mainly presented with hemoptysis and the other 6 (26%) patients with purulent sputum. Results In these 23 patients, a total of 121 segments were resected, with an average of 5.26 segments, ranging from 3 to 9 segments. Five of 17 patients with massive hemoptysis underwent ligation of bronchial arteries in addition to lung resections. The average operating time was 271 min, ranging from 145 to 500 min. The average blood loss was 108 ml, ranging from 20 to 600 ml. The average postoperative hospital stay was 8 days, ranging from 3 to 20 days. There was no surgical morbidity or surgical death. Hemoptysis and purulent sputum of all patients was almost controlled after surgery. Conclusion One-stage thoracoscopic resections of bilateral localized bronchiectasis could be well-tolerated and safe for these selected patients. The one-stage operation could shorten the course of treatment.

Analysis of Pulmonary Surgery in Children and Adolescents in Germany: Who Is doing What?

Introduction In Germany, pediatric surgery is organized in a decentralized manner. A nationwide clinical registry does not exist. The aim of this research is to analyze the current status of pulmonary surgery in the country in respect of children and adolescents. Materials and Methods Claims data have been extracted from two health insurance databases representing 34% of the German population. Operative diagnoses and procedures, as well as patients' characteristics, were recorded from 2016 to 2019. Results The incidence of the four index diagnoses investigated matched the current literature in three of four entities. The main indications <8 years were congenital lung malformations (61%) and spontaneous pneumothorax at age 8 to 17 years (77%). Furthermore, 1,668 pediatric pulmonary procedures (0–17 years) were identified (668 pulmonary resections). Two age peaks were identified: 13% of patients were operated on before 1 year old and 50% of patients were between 15 and 17 years old. Video-assisted-thoracoscopic-surgery (VATS) for pulmonary resections was applied in 62% of cases. 96% of pulmonary resections in patients <1 year and 70% of pulmonary resections in children between 1 and 14 years were performed by pediatric surgeons. Of patients between 15 and 17 years old, only 14% were operated on in pediatric surgery. The estimated average pulmonary resection caseload was 3.2 cases per year and per institution for pediatric surgery and 1.5 for adult surgery. Conclusion Indications for pulmonary surgery in children arise from rare diagnoses. In total, 66% of lung resections are performed in patients <1 year and >14 years. The majority of lung resections are performed as VATS. Patients ≤14 years are predominantly operated on by pediatric surgeons. The accessibility of pediatric pulmonary surgery is acceptable, but there is a low caseload per center.

Genomic analyses of Mycobacterium tuberculosis from human lung resections reveal a high frequency of polyclonal infections

Polyclonal infections occur when at least two unrelated strains of the same pathogen are detected in an individual. This has been linked to worse clinical outcomes in tuberculosis, as undetected strains with different antibiotic resistance profiles can lead to treatment failure. Here, we examine the amount of polyclonal infections in sputum and surgical resections from patients with tuberculosis in the country of Georgia. For this purpose, we sequence and analyse the genomes of Mycobacterium tuberculosis isolated from the samples, acquired through an observational clinical study (NCT02715271). Access to the lung enhanced the detection of multiple strains (40% of surgery cases) as opposed to just using a sputum sample (0–5% in the general population). We show that polyclonal infections often involve genetically distant strains and can be associated with reversion of the patient’s drug susceptibility profile over time. In addition, we find different patterns of genetic diversity within lesions and across patients, including mutational signatures known to be associated with oxidative damage; this suggests that reactive oxygen species may be acting as a selective pressure in the granuloma environment. Our results support the idea that the magnitude of polyclonal infections in high-burden tuberculosis settings is underestimated when only testing sputum samples.

Application of video-assisted thoracoscopic lung resections for differential diagnosis of lung diseases

The objective of the study: to determine the place and effectiveness of video-assisted thoracoscopic lung resection (VATS resections) in the differential diagnostic procedure for examination of patients with chest diseases.Subjects and methods. In 2017-2019, 1,190 patients with suspected respiratory tuberculosis were examined in the differential diagnostic department of TB Dispensary, the Ministry of Health of the Kabardino-Balkarian Republic; 106 (8.9%) needed VATS since it was impossible to verify their diagnosis despite various biopsies. The age of 106 patients varied from 18 to 80 years old, there were 66 men (62.0%), and 40 women (38.0%). The preoperative diagnosis was as follows: single or multiple lung lesions – 83 (76.9%) cases, disseminated lung disease of unknown etiology or interstitial lung disease of unspecified etiology – 25 (23.1%) cases.In all cases, the surgical specimens were sent for comprehensive tests, including histological tests, microbiological tests (fluorescent microscopy with Ziehl-Nielsen staining, culture for Mycobacterium tuberculosis (MTB) by Bactec, and culture for secondary flora and fungi), and molecular genetic tests to detect MTB DNA.Results. The diagnostic efficiency when using VATS resections, histological and microbiological testing of surgical specimens made 98.1% (95% CI 93.38-99.48; Wilson's method). Among the diagnosed diseases, pulmonary tuberculosis was confirmed in 47/106 (44.3%) patients, cancer – 37/106 (34.9%), the rest of patients were diagnosed with some other disorders including orphan diseases.