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VATS decortication for Tuberculosis

There’s a new video over at VUmedi by Turkish thoracic surgeon, Dr. Cagatay Tezel.  In this video, as well as a related article over at CTSnet, Dr. Tezel talks about modern day surgical treatment for tuberculosis related complications.  Tuberculosis, unlike measles, polio or other diseases associated with the 19th (and earlier centuries) has not faded into the past, despite the availability of a (partially effective) tuberculosis vaccine.  Tuberculosis continues to carry a heavy morbidity and mortality burden globally. In fact, for all of the news media surrounding Ebola, HIV, SARS and Bird/ swine and various flu, Tuberculosis is the real killer; and is responsible for 1.8 million deaths a year*.

Complicated multi-drug regimens and poor patient adherence have resulted in the development of new strains of resistant TB.  Decreased immune resistance in specific populations such as diabetics, or patients with HIV infection has resulted in a greater number of people with active disease.  This means, that thoracic surgery remains a critical component in the treatment of this deadly disease.

Surgical treatment of Tuberculosis and TB related complications

As long time readers know, Thoracics.org has been following the rise of multi-drug resistant (MDR-TB) and extreme/ extensive drug resistant (XDR-TB) versions of the age-old scourge of the ‘white plague‘ as well as the evolution of the surgical treatment of this disease, from the early era of thoracoplasty, as well as more modern treatment of TB related empyemas such as VATS.

In fact, the surgical treatment of tuberculosis is the foundation on which the thoracic surgery specialty emerged, out the operating theaters of TB sanitariums around the world. However, as the development and successful use of antibiotics spread from the late 40’s thru the 50’s and 60’s – surgery took a backseat to drug therapy.  The development of these drug resistant strains means that it is imperative that the thoracic surgery community continue to research, innovate and operate on patients with tuberculosis.

We welcome articles and video submissions on this topic from our colleagues around the world.

*Several statistics give the annual death toll at 2 to 3 million.We have cited the most recent WHO figures above.

Additional articles/ posts/ references

Mystery Diagnosis: Pleural Plaques

The Tuberculosis Vaccine: information about the vaccine, and who should get it (according to current CDC recommendations).

Freixinet JG1, Rivas JJ, Rodríguez De Castro F, Caminero JA, Rodriguez P, Serra M, de la Torre M, Santana N, Canalis E. (2002).  Role of surgery in pulmonary tuberculosis.  Med Sci Monit. 2002 Dec;8(12):CR782-6.

Somocurcio JG1, Sotomayor A, Shin S, Portilla S, Valcarcel M, Guerra D, Furin J. (2007).  Surgery for patients with drug-resistant tuberculosis: report of 121 cases receiving community-based treatment in Lima, Peru. Thorax 2007 May;62(5):416-21. Epub 2006 Aug 23.  A particularly interesting article, with an in-depth look at the surgical treatment outcomes in patients with MDR TB. Mortality was 5.0 % in this study.

Man MA1, Nicolau D. (2012). Surgical treatment to increase the success rate of multidrug-resistant tuberculosis.  Eur J Cardiothorac Surg. 2012 Jul;42(1):e9-12. doi: 10.1093/ejcts/ezs215. Epub 2012 Apr 24.

Park SK, Kim JH, Kang H, Cho JS, Smego RA Jr. (2009). Pulmonary resection combined with isoniazid- and rifampin-based drug therapy for patients with multidrug-resistant and extensively drug-resistant tuberculosis.   Int J Infect Dis. 2009 Mar;13(2):170-5. doi: 10.1016/j.ijid.2008.06.001. Epub 2008 Sep 2.

 

About K Eckland

World of Thoracic Surgery is a blog about the work, research, and practices of thoracic surgeons around the world. It includes case studies, [sometimes] dry research, interviews with thoracic surgeons along with patient perspectives, and feedback.

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