Hemodynamic alterations in bronchiectasis: A base for a new subclassification of the disease

On the basis of the morphologic and hemodynamic features in 17 patients with bilateral bronchiectasis, a new subclassification is proposed. Accordingly, two types of bronchiectasis were recognized: perfused and nonperfused. Whereas perfused bronchiectasis has intact pulmonary artery flow and cylindrical bronchiectatic changes, the nonperfused type involves an absent pulmonary artery flow, retrograde filling of the pulmonary artery through the systemic circulation, and cystic bronchiectatic changes. A policy of unilateral resection of nonperfused bronchiectasis and preservation of the perfused type was adopted in 17 patients with bilateral bronchiectasis during an 8-year period. There were 9 women and 8 men with an average age of 28.6 ± 7 years (range 18 to 48 years). Fifteen patients had mixed bronchiectasis (perfused type on one side and nonperfused on the other side) and two had localized bilateral nonperfused type. The average duration of follow-up was 38.3 ± 24.9 months (range 13 to 111 months). In the 15 patients with mixed bronchiectasis, excellent ( N = 8) or good ( N = 7) results were achieved in all cases. On the other hand, the two patients with bilateral nonperfused bronchiectasis did not benefit from unilateral resection. This outcome implies that with perfused bronchiectasis the deranged function is likely to resolve with time. In the face of the general criticism of the traditional morphologic classification system, the proposed functional classification not only reflects the degree of severity of the disease process, but also predicts whether the involved lung will have a measure of respiratory function with regard to gas exchange. Thus the question of which side to resect and which to preserve is defined more precisely. (J Thorac Cardiovasc Surg 1996;112:328-34)     

Surgical resection of unilateral lung metastases: is bilateral thoracotomy necessary?

urgical resection of lung mestastases is routine procedure for selected patients with pulmonary nodules and solid tumors. In some cases, patients present with unilateral pulmonary metastases amenable to surgical resection. Surgeons are still divided between unilateral approach directed to the radiologically detected nodules, or bilateral exploratory thoracotomy. This study evaluates the need for bilateral thoracotomy in patients diagnosed with unilateral lung metastases. A retrospective evaluation was made of a prospective database from a single institution (1990–1997) of all consecutive patients (n = 267) diagnosed on admission with unilateral (n = 179) or bilateral (n= 88) lung nodules. Ipsilateral thoracotomy was performed on all patients with unilateral disease. Bilateral thoracotomy was performed on all patients with bilateral lung metastases. Histology: adenocarcinoma (25%), osteosarcoma (23%), squamous cell carcinoma (18%), soft-tissue sarcoma (18%), and other (16%). Median follow-up was 17 months. Contralateral disease-free survival and overall survival were determined. Univariate and multivariate analyses were performed to determine prognostic factors for overall and contralateral disease-free survival. The two groups of patients with confirmed bilateral metastases (synchronous or metachronous) were compared. Actuarial overall 5-year survival was 34.9%. Contralateral recurrence-free 6-month, 12-month, and 5-year survival were 95%, 89%, and 78%, respectively. Patients who experienced recurrence in the contralateral lung within 3, 6, or 12 months had an overall 5-year survival rate of 24%, 30%, and 37%, respectively. When patients with recurrence in the contralateral lung were compared to patients with bilateral metastases on admission, there was no significant difference in overall survival. Only histology and the number of pathologically proven metastases significantly (p <0.05) predicted recurrence in the contralateral lung. Bilateral exploration of unilateral lung metastases is not warranted in all cases. Most patients will have only unilateral disease, and delaying contralateral thoracotomy until disease is detected radiologically does not appear to affect outcome.     

Morphologic grading of emphysema is useful in the selection of candidates for unilateral or bilateral reduction pneumoplasty

Objective: Radiologic morphology of emphysema proves useful in the selection of candidates for bilateral reduction pneumoplasty. We developed a simple morphologic grading system capable of identifying subsets of patients who had maximal functional improvement after unilateral or bilateral operation. Methods: Fifty-two patients who underwent unilateral (n=34) or bilateral (n=18) reduction pneumoplasty were evaluated. Emphysema morphology was visually scored by digital roentgenograms and high-resolution computed tomography. In each lung, severity of emphysema (ES), heterogeneity (DHT) and hyperinflation (DHF) degrees, were assessed. Asymmetric ratio of emphysema (ARE) between the lungs was expressed as: higher ES/lower ES scores. Morphometric data were correlated with absolute preoperative–postoperative FEV₁ change (ΔFEV₁). Results: No difference was found between the unilateral and the bilateral group for ES and DHT. DHF was greater in the bilateral group (3.1 vs. 2.7, P=0.02) whereas ARE was greater in the unilateral group (1.29 vs. 1.05, P=0.0001). Stepwise logistic regression extracted as best predictors of maximal ΔFEV₁, ARE (odds ratio=238, Wald test P=0.04) in the unilateral group, and DHT (odds ratio=24, P=0.03) in the bilateral group. Unilateral group ΔFEV₁ was greater in patients with ARE≥1.3 (0.44 vs. 0.24 l, P=0.02). Bilateral group ΔFEV₁ was greater in patients with DHT>1 (0.50 vs. 0.31 l, P=0.03). No difference was found when comparing ΔFEV₁ resulting from unilateral RP and ARE≥1.3, and bilateral RP (0.44 vs. 0.41 l, not significant). Conclusions: This morphologic grading system identified subsets of patients who had maximal functional benefit from unilateral or bilateral reduction pneumoplasty and might be useful in the preoperative screening of candidates for either approach.     

Comparison of exhaled and nasal nitric oxide and exhaled carbon monoxide levels in bronchiectatic patients with and without primary ciliary dyskinesia

BACKGROUND: Primary ciliary dyskinesia (PCD) is associated with chronic airway inflammation resulting in bronchiectasis. METHODS: The levels of exhaled nitric oxide (eNO), carbon monoxide (eCO) and nasal NO (nNO) from bronchiectatic patients with PCD (n=14) were compared with those from patients with non-PCD bronchiectasis without (n=31) and with cystic fibrosis (CF) (n=20) and from normal subjects (n=37) to assess the clinical usefulness of these measurements in discriminating between PCD and other causes of bronchiectasis. RESULTS: Exhaled NO levels were lower in patients with PCD than in patients with non-PCD non-CF bronchiectasis or healthy subjects (median (range) 2.1 (1.3-3.5) ppb v 8.7 (4.5-26.0) ppb, p<0.001; 6.7 (2.6-11.9) ppb, p<0.001, respectively) but not lower than bronchiectatic patients with CF (3.0 (1.5-7.5) ppb, p>0.05). Nasal levels of nNO were significantly lower in PCD patients than in any other subjects (PCD: 54.5 (5.0-269) ppb, non-PCD bronchiectasis without CF: 680 (310-1000) ppb, non-PCD bronchiectasis with CF: 343 (30-997) ppb, control: 663 (322-1343) ppb). In contrast, eCO levels were higher in all patient groups than in control subjects (PCD: 4.5 (3.0-24.0) ppm, p<0.01, other bronchiectasis without CF: 5.0 (3.0-15.0) ppm, p<0.001; CF: 5.3 (2.0-23.0) ppm, p<0.001 v 3.0 (0.5-5.0) ppm). Low values in both eNO and nNO readings (<2.4 ppb and <187 ppb, respectively) identified PCD patients from other bronchiectatic patients with a specificity of 98% and a positive predictive value of 92%. CONCLUSION: The simultaneous measurement of eNO and nNO is a useful screening tool for PCD.     

胸椎黄韧带骨化症的CT分型及手术方式选择

目的:探讨胸椎黄韧带骨化症的CT分型及手术治疗方法.方法:1997年1月至2006年12月手术治疗胸椎黄韧带骨化症患者48例102个节段,根据CT表现分为3型,单侧型18个节段,双侧型45个节段,两侧融合型39个节段.单侧型将椎板、关节突内侧和未骨化处磨薄,再把骨化物对侧和头尾侧充分减压使其孤立,用枪状咬钳将关节突内侧磨薄处咬开使其游离,齿镊夹住骨块轻提起由中间向外侧剥离摘除骨块;双侧型将椎板、关节突内侧和未骨化处磨薄,先将骨化物头尾侧充分减压,将中间未骨化黄韧带咬除分隔,使两侧骨化物孤立,再按单侧型手术方法逐块处理;两侧融合型将椎板、关节突内侧和未骨化处磨薄,先将骨化物头尾侧充分减压,从对侧关节突内侧磨薄处咬开使骨化物孤立,再将术侧关节突内侧磨薄处咬开使骨化物游离,齿镊夹住骨块轻提起由对侧向术者侧剥离摘除骨块.术前术后采用改良JOA下肢运动功能评分评价运动功能.结果:全部患者顺利完成手术.手术时间平均2.8h,出血量平均290ml.术后无症状加重病例,1例出现脑脊液漏,经保守治疗后痊愈.40例患者随访5～62个月,平均28个月,JOA下肢运动功能评分术前1.8±1.1分,末次随访时为3.7±0.6分,与术前比较差异有显著性(P<0.01).疗效按JOA评分改善率优32例,良6例,可2例,优良率为95%.结论:对胸椎黄韧带骨化症患者根据CT分型采取不同的手术方式可取得满意的治疗效果.     

Resection of more than 10 lung segments. A 30-year survey of 30 bronchiectatic patients

A series of 30 bronchiectatic patients, treated by bilateral resection of 11, 12, or 13 lung segments, has been followed up for 30 years. The progress of the patients is analyzed and the results of treatment are evaluated. Ten patients required further resections for persisting collapse, kinking of the apical segment of a lower lobe, or because the previous resection had been too limited. The long-term results of these extensive bilateral resections in our group of patients are excellent. The quantitative function, more than 20 years after the last resection, lies markedly above the predicted value for the number of remaining segments. The qualitative function did not deteriorate over the years. It is clear that extensive bilateral bronchiectasis does not, per se, constitute a contraindication to resection, provided that at least six normal segments can be preserved.     

Heart and liver transplantation. Consistent survival after prolonged donor heart preservation.

Twelve dogs underwent orthotopic cardiac transplantation after donor heart preservation for 24 hr in a hypothermic hypertonic intracellular solution. Donors were divided into two groups: continuous oxygenated perfusion and nonperfusion. After 24 hr, transplantation was performed. All six perfused and four nonperfused donors hearts survived a 24-hr postoperative period. Survivors had normal cardiac output, right and left atrial pressures, and aortic pressures. After transplantation, all perfused hearts demonstrated mild left ventricular damage while nonperfused hearts had severe damage. Hypothermic hypertonic intracellular perfusion may allow improved protection for short-term myocardial preservation and survival after extended myocardial preservation.     

Bilateral lung transplant for bronchiectasis in asymmetric thorax: a case report

Patients with suppurative lung diseases such as bronchiectasis and cystic fibrosis can be treated surgically, which leads to an asymmetric thorax, making lung transplant difficult in a volume-reduced hemithorax. We report a 52-year-old man with bronchiectasis and ventilation, dependent on a severe asymmetric thorax, who underwent bilateral lung transplant without cardiopulmonary bypass or extracorporeal membrane oxygenation support. This report suggests that bilateral lung transplant might be an efficient therapeutic option for such patients. Lung transplant is generally accepted as an effective way to deal with end-stage pulmonary diseases. Particularly, in patients with bronchiectasis or cystic fibrosis, single lung transplant may lead to infectious complications more easily. Thus, bilateral lung transplant is a better choice for such patients. However, some patients with bronchiectasis may have a history of surgical resection of target areas, which leads to an asymmetric thorax and makes lung transplant more difficult. We described 1 case of bilateral lung transplant for bronchiectasis in asymmetric thorax.     

Surgical management of bronchiectasis: analysis and short-term results in 238 patients.

OBJECTIVE: Bronchiectasis is defined permanent dilatations of bronchi with destruction of the bronchial wall. It is still a major cause of morbidity and mortality in developing countries. The aim of this retrospective study is to present our surgical experiences, the early and long-term results of 238 patients with bronchiectasis during a 10-year period. METHODS: We reviewed the medical records of 238 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2001, at Gülhane Military Medical Academy (GMMA) Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and type of operation, mortality, morbidity and the result of surgical therapy were analyzed. RESULTS: There were 205 (86.13%) male and 33 (13.87%) female patients with an average age of 23.7 and a range of 15-48 years. The presenting symptoms were productive cough in 133 (55.88%), fetid sputum in 116 (48.73%), recurrent infections in 84 (35.29%), and hemoptysis in 39 (12.18%) patients. The disease was bilateral in 31 patients (13.02%) and mainly confined to the lower lobes in 162 (68.06%). The surgical treatment was as follows: pneumonectomy in 13 patients (5.46%), lobectomy in 189 (79.40%), lobectomy+segmentectomy in 31 (13.02%), and wedge resection or segmentectomy in five (2.1%). Staged bilateral thoracotomy was used in 14 patients. There was no operative mortality. Complications occurred in 21 patients and the morbidity rate was 8.82%. Complete resection was achieved in 154 (64.7%) patients. Follow-up data were obtained for 229 (96.21%) of the patients. Nine patients were lost to follow-up. The mean follow-up of these patients was 9 months (range, 3 months to 4 years). The symptoms disappeared in 189 patients (79.41%) and 29 patients (12.18%) had improved, whereas 11 patients (4.62%) had no improvement. Significantly better results were obtained in patients who had undergone a complete resection. CONCLUSIONS: Surgical resection for bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.     

Pulmonary contusions in patients with rib fractures: The need to better classify a common injury

BackgroundPulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion.MethodsWe identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality.ResultsAmong 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16–33%], respiratory failure 40% [95%CI: 31–50%], and intubation 46% [95%CI: 33–61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications.ConclusionsThere is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.     

Survival after unilateral versus bilateral lung volume reduction surgery for emphysema

OBJECTIVE: Bilateral staple lung volume reduction surgery (LVRS) immediately improves pulmonary function and dyspnea symptoms in patients with advanced heterogeneous emphysema to a greater degree than do unilateral procedures. However, the long-term outcome after these surgical procedures needs to be critically evaluated. We compare 2-year survival of patients who underwent unilateral versus bilateral video-assisted LVRS in a large cohort treated by a single surgical group. METHODS: The cases of all 260 patients who underwent video-assisted thoracoscopic stapled LVRS from April 1994 to March 1996 were analyzed to compare results after unilateral versus bilateral procedures. Overall survival was calculated by Kaplan-Meier methods; Cox proportional hazard methods were used to adjust for patient heterogeneity and baseline differences between groups. RESULTS: Overall survival at 2 years was 86.4% (95% CI 80. 9%-91.8%) after bilateral LVRS versus 72.6% (95% CI 64.2%-81.2%) after unilateral LVRS (P =.001 for overall survival comparison). Improved survival after bilateral LVRS was seen among high- and low-risk subgroups as well. Average follow-up time was 28.5 months (range, 6 days to 46.6 months) for the bilateral LVRS group and 29.3 months (range, 6 days to 45.0 months) for the unilateral LVRS patients. CONCLUSIONS: Comparison of unilateral versus bilateral thoracoscopic LVRS procedures for the treatment of emphysema reveals that bilateral LVRS by video-assisted thoracoscopy resulted in better overall survival at 2-year follow-up than did unilateral LVRS. This survival study, together with other studies demonstrating improved lung function after bilateral LVRS, suggests that bilateral surgery appears to be the procedure of choice for patients undergoing LVRS for most eligible patients with severe heterogeneous emphysema.     

Lung volume reduction surgery results in pulmonary emphysema. Changes in pulmonary function.

From December 1993 to August 1998, we conducted 57 lung volume reduction surgeries on patients with severe pulmonary emphysema but without giant bullae. Of these, 26 underwent unilateral lung volume reduction surgery and 31 bilateral surgery. We analyzed the results of thoracoscopic lung volume reduction surgery (unilateral: 25; bilateral: 16) and volume reduction surgery by median sternotomy (unilateral: 1; bilateral: 15). Bilateral surgery via thoracoscope and median sternotomy significantly improved symptoms and pulmonary functions; mean improvement in forced expiratory volume in 1 second was 42.4% for bilateral thoracoscopic volume reduction surgery and 60.0% for median sternotomy. Unilateral volume reduction surgery produced a mean improvement in forced expiratory volume in 1 second of 28.9%. No significant complications were seen with either procedure. Reevaluation at 1 and 2 years after lung volume reduction surgery showed improvement to be well maintained.     

Lung volume reduction surgery results in pulmonary emphysema

From December 1993 to August 1998, we conducted 57 lung volume reduction surgeries on patients with severe pulmonary emphysema but without giant bullae. Of these, 26 underwent unilateral lung volume reduction surgery and 31 bilateral surgery. We analyzed the results of thoracoscopic lung volume reduction surgery (unilateral: 25; bilateral: 16) and volume reduction surgery by median sternotomy (unilateral: 1; bilateral: 15). Bilateral surgery via thoracoscope and median sternotomy significantly improved symptoms and pulmonary functions; mean improvement in forced expiratory volume in 1 second was 42.4% for bilateral thoracoscopic volume reduction surgery and 60.0% for median sternotomy. Unilateral volume reduction surgery produced a mean improvement in forced expiratory volume in 1 second of 28.9%. No significant complications were seen with either procedure. Reevaluation at 1 and 2 years after lung volume reduction surgery showed improvement to be well maintained.     

Clinicopathological features and prognosis of synchronous bilateral renal cell carcinoma: an international multicentre experience

OBJECTIVE: To present a multicentre experience and the largest cohort to date of nonmetastatic (N0M0) synchronous bilateral renal cell carcinoma (RCC), as because it is rare the single-institutional experience is limited. PATIENTS AND METHODS: We retrospectively studied 10 337 patients from 12 urological centres to identify patients with N0M0 synchronous bilateral RCC; the clinicopathological features and cancer-specific survival were compared to a cohort treated for N0M0 unilateral RCC. RESULTS: In all, 153 patients had synchronous bilateral solid renal tumours, of whom 135 (88%) had synchronous bilateral RCC, 118 with nonmetastatic disease; 91% had nonfamilial bilateral RCC. Bilateral clear cell RCC was the major histological subtype (76%), and papillary RCC was the next most frequent (19%). Multifocality was found in 54% of bilateral RCCs. Compared with unilateral RCC, patients did not differ in Eastern Cooperative Oncology Group performance status (ECOG PS) and T classification, but bilateral RCCs were more frequently multifocal (54% vs 16%, P < 0.001) and of the papillary subtype (19% vs 12%), and less frequently clear cell RCC (76% vs 83%, P = 0.005). For the outcome, patients with nonmetastatic synchronous bilateral RCC and unilateral RCC had a similar prognosis (P = 0.63); multifocality did not affect survival (P = 0.60). Multivariate analysis identified ECOG PS, T classification, and Fuhrman grade, but not laterality, as independent prognostic factors for cancer-specific survival. CONCLUSIONS: Patients with N0M0 synchronous bilateral RCC and N0M0 unilateral RCC have a similar prognosis. The frequency of a familial history for RCC (von Hippel-Lindau disease or familial RCC) was significantly greater in bilateral synchronous than in unilateral RCC. The significant pathological findings in synchronous bilateral RCC are papillary subtype and multifocality.     

Thoracoscopic lung volume reduction surgery for emphysema. Evaluation using ventilation-perfusion scintigraphy.

Thoracoscopic lung volume reduction surgery was conducted in 28 consecutive patients (bilateral 21, unilateral 7). The bilateral procedure was conducted simultaneously in 16 and as a planned staged approach in 5, using stapler resection with Nd:YAG laser ablation. Perfusion and ventilation scintigraphy were used to evaluate status before and after surgery. One operative death (3.6%) due to pneumonia occurred after a simultaneous bilateral procedure. Three to 6 months after surgery, the forced expiratory volume in 1 second (FEV1.0) had improved an average of 44% after the bilateral procedure and 17% after unilateral. Improved ventilation and perfusion distribution in the lower lung field correlated significantly with improved dyspnea scale (p < 0.01). Mean transit time was shortened significantly in each lung field (p < 0.01). Improved mean transit time correlated significantly with improved FEV1.0 and maximum oxygen consumption (VO2max) (p < 0.05). In conclusion, we found that bilateral thoracoscopic lung volume reduction surgery produces short-term functional outcomes superior to those of the unilateral procedure, and should be considered the procedure of choice for most patients. Ventilation and perfusion scintigraphy are useful both in determining target areas for resection and in evaluating lung volume reduction surgery effects.     

Lung volume reduction surgery--a comparison of the long term outcome of unilateral vs. bilateral approaches.

OBJECTIVE: Bilateral lung volume reduction surgery (LVRS) is thought to be preferable to unilateral surgery due to greater initial benefit but the subsequent rate of decline may also be greater. We compared the long term physiological and health status outcome of LVRS performed on one or simultaneously on both lungs. METHODS: Prospective data were collected on a consecutive series of 65 patients undergoing LVRS who were all suitable for bilateral surgery. Twenty-six patients: age 59 (8) years underwent bilateral LVRS by video-assisted thoracoscopy (VAT) or sternotomy and 39 patients: age 60 (6) years underwent unilateral VAT. The perioperative effects of LVRS on spirometry were prospectively recorded at 3, 6, 12 and 24 months. RESULTS: The unilateral group had similar preoperative lung volumes to the bilateral patients: forced expiratory volume in 1s (FEV(1)) 26 vs. 30% predicted, RV 275 vs. 246% predicted and total lung capacity (TLC) 148 vs. 142% predicted. Unilateral LVRS was associated with significantly lower weight of lung resected: 80 (31) vs. 118 (46) g; hospital stay: 16 (10) days vs. 28 (22) days. Thirty-day mortality was 3% in the unilateral and 8% in the bilateral group (P=0.34). Postoperative ventilation occurred in 5% in the unilateral and in 42% in the bilateral group (P=0.0002). The decline of FEV(1) during the first postoperative year was significant in the bilateral group (-313 ml/y, P=0.04) but not significant in the unilateral group (-50 ml/y, P=0.18). SF 36 scores in all eight domains were similar in both groups preoperatively and at any postoperative interval. CONCLUSION: We have found no benefit from bilateral simultaneous LVRS and prefer unilateral LVRS because of the lower morbidity, resulting in earlier discharge, and slower decline in physiological benefit.     

Variability in ciliary beat frequency in normal subjects and in patients with bronchiectasis.

BACKGROUND--There is a wide variation in tracheobronchial clearance of inhaled aerosol in normal subjects and in patients with bronchiectasis, but little information is available on the variability in ciliary beat frequency (CBF). METHODS--The variability in CBF was measured in 10 nasal mucosal samples from each of 19 normal controls and 23 stable bronchiectatic subjects. RESULTS--The CBF varied at different mucosal sites in both normal subjects and bronchiectatic patients. Although the CBF of the fastest beating cilia was similar in both groups, the CBF of the slowest beating cilia was, on average, lower and showed greater within subject variation in bronchiectatic than in normal subjects. CONCLUSIONS--There is a wide variation in CBF in nasal mucosal samples and this is significantly wider in bronchiectatic subjects with some cilia beating slowly. This may be a consequence of chronic inflammation or infection.     

Ergebnisse der bilateralen Resektionsbehandlung bei doppelseitigen Bronchektasien

Summary According to our experience with 18 patients suffering from bilateral bronchiectasis good clinical and functional results can be obtained with bilateral resection when the patients are under the age of 25 years and when not more than 7 segments have to be removed, altogether. In patients older than 30 years bilateral lung resections are contraindicated. Extensive resections of more than 8 segments are to be avoided in any way.

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Pneumonectomy for severe inflammatory lung disease. Results in 64 consecutive cases

Severe inflammatory lung disease resulting in severe unilateral pulmonary pathology necessitating pneumonectomy is still encountered in third world populations. A retrospective study of the last 64 patients undergoing pneumonectomy was performed. The underlying lung pathology was: destroyed lung due to tuberculosis in 33 patients; severe bronchiectasis in 25; necrotizing pneumonia in 4; lung abscess in 1 and hypoplastic lung in 1 patient. The perioperative management of these patients is outlined. Perioperative complications included respiratory failure in 4, secondary haemorrhage in 2 and post-pneumonectomy empyema in 5 patients. There were 2 mortalities (3.1%), both due to contralateral spillage with fulminant respiratory failure. Excellent results were achieved in 89% of the patients.     

First 3 Years of the Hungarian Lung Transplantation Program

In this article we summarize the results of the first 3 years after launching the Hungarian Lung Transplantation Program.Patients and MethodsThe first lung transplant in Hungary was carried out on December 12, 2015, with the collaboration of the National Institute of Oncology and the Semmelweis University. Up to December 31, 2018, a total of 62 lung transplants were performed. Data were analyzed retrospectively. Patients were listed for lung transplant after the indication was established by the National Lung Transplantation Committee. Donor lungs were procured from brain-dead donors only.ResultsWithin this period our team was involved in 87 lung procurements, 61 of which resulted in bilateral lung transplant and 1 in single-sided transplant. The operative approach was unilateral thoracotomy (n = 1), bilateral thoracotomy (n = 1), or clamshell incision (n = 60) with venoarterial extracorporeal membrane oxygenation support. The underlying disease of the recipients was obstructive lung disease (n = 30), lung fibrosis (n = 11), cystic fibrosis (n = 18), primary pulmonary hypertension (n = 2), histiocytosis-X syndrome (n = 1), bronchiectasis (n = 2), lymphangioleiomyomatosis (n = 1), and retransplant because of bronchiolitis obliterans syndrome (n = 1). The youngest patient was 13 years of age, while the oldest was 65 years. Three patients died in the early postoperative phase. One-year survival was 80%.DiscussionThe number of cases rises steadily in the Hungarian Lung Transplantation Program, which is exceptional compared with the start of other centrums. The incidence of complications and mortality is comparable with those of other experienced centers around the world. Our future goal is to broaden our waiting list, thus increasing the number of lung transplants carried out.