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1994-09-24
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Document 0497
DOCN M9490497
TI Thoracotomy for pulmonary mycoses in non-HIV-immunosuppressed patients.
DT 9411
AU Temeck BK; Venzon DJ; Moskaluk CA; Pass HI; Surgical Pathology
Department, National Cancer Institute,; National Institutes of Health,
Bethesda, MD 20892.
SO Ann Thorac Surg. 1994 Aug;58(2):333-8. Unique Identifier : AIDSLINE
MED/94346902
AB Pulmonary mycoses can be life threatening in patients who are in an
immunocompromised state stemming from defective host defenses or the use
of certain treatment regimens. In 36 immunosuppressed patients
undergoing thoracotomy for the treatment of pulmonary fungal disease,
the underlying cause of immunosuppression was malignancy (n = 9),
Wegener's granulomatosis (n = 4), hematologic disorders (aplastic
anemia, 5-Q minus syndrome, or myelofibrosis) (n = 6), or chronic
granulomatous disease of childhood (n = 17). The mean age of the
patients was 25 years, and 89% were symptomatic (fever, n = 27; cough, n
= 20; chest pain, n = 14; and other, n = 13). Chest x-ray studies
revealed the presence of cavitary disease (n = 7), a mass (n = 8),
infiltrates (n = 20), or cavity and infiltrate (n = 1). A preoperative
diagnosis was lacking in 23 of the 36 patients. Procedures included
wedge biopsy (n = 13), segmentectomy with or without wedge or chest wall
resection (n = 5), lobectomy with or without chest wall resection (n =
16), wedge resection plus completion pneumonectomy (n = 1), and
segmentectomy plus completion pneumonectomy (n = 1). Fungi identified
included Aspergillus (n = 23), Zygomycetes (n = 4), Cryptococcus (n =
3), and other (n = 6; 1 each), and specific antifungal treatment was
instituted in 34 of the patients (94%). The 31% operative (ie, < 30-day
or inhospital) mortality was chiefly due to multiorgan system failure
(9/11).(ABSTRACT TRUNCATED AT 250 WORDS)
DE Adolescence Adult Aspergillosis/IMMUNOLOGY/MORTALITY/SURGERY Child
Child, Preschool Female Human *HIV Seronegativity *Immunocompromised
Host Lung Diseases, Fungal/IMMUNOLOGY/MORTALITY/*SURGERY Male Middle
Age Postoperative Complications/MORTALITY Prognosis Risk Factors
*Thoracotomy JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).