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Titolo:
Invasive aspergillosis and surgery. Literature review
Autore:
Bernard, A; Caillot, D; Benoit, L; Casasnovas, O; Couaillier, JF; Guy, H; Favre, JP;
Indirizzi:
CHU Hop Bocage, Serv Chirurg Thorac, F-21034 Dijon, France CHU Hop BocageDijon France F-21034 hirurg Thorac, F-21034 Dijon, France
Titolo Testata:
JOURNAL DE MYCOLOGIE MEDICALE
fascicolo: 2, volume: 9, anno: 1999,
pagine: 97 - 102
SICI:
1156-5233(199907)9:2<97:IAASLR>2.0.ZU;2-G
Fonte:
ISI
Lingua:
FRE
Soggetto:
BONE-MARROW TRANSPLANTATION; LIPOSOMAL AMPHOTERICIN-B; PULMONARY ASPERGILLOSIS; NEUTROPENIC PATIENTS; IMMUNOCOMPROMISED PATIENTS; SURGICAL RESECTION; ACUTE-LEUKEMIA; MASSIVE HEMOPTYSIS; LUNG RESECTION; MANAGEMENT;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
32
Recensione:
Indirizzi per estratti:
Indirizzo: Bernard, A CHU Hop Bocage, Serv Chirurg Thorac, Bd Lattre Tassigny, F-21034 Dijon, France CHU Hop Bocage Bd Lattre Tassigny Dijon France F-21034 France
Citazione:
A. Bernard et al., "Invasive aspergillosis and surgery. Literature review", J MYCOL MED, 9(2), 1999, pp. 97-102

Abstract

Purpose. The aim of this literature review is to determine the role of surgery in the treatment of invasive aspergillosis, to estimate the postoperative mortality and to assess long-term benefit of this strategy. Patients. Methods. For invasive pulmonary aspergillosis (IPA), 141 patients were treated by surgery and antifungal agent. In elective surgery 114 patients were operated for residual aspergillosis lesion despite antifungal therapy. The time between the diagnosis of IPA and the operation was 16 days to 42 days. The CT scan showed peripheral aspergillosis lesions in all patients and a pulmonary cavitation in 54 % of patients. In the following weeks, a new hematologic therapy (chemotherapy, bone marrow transplantation) wasindicated. In emergency, the operation was performed for massive hemoptysis in 5 patients after marrow recovery. Results. Ten patients were operated in emergency for prevention of massivehemoptysis. At the time of surgery, 9 patients had less than 1000 absoluteneutrophils cells/mu L. The criteria for operation were repeated CT scans showing an aspergillosis lesion near a pulmonary artery and disappearance of the fatty border between the vessel wall and the aspergillosis lesion. Mortality was 7 % for elective surgery and 7 % for emergency. Mortality for all patients operated TPA was 7 %. At long-term no hemoptysis was reported. Among 111 patients followed, 12 patients (11 %) presented a new aspergillosis infection. At long-term 48 patients (43 %) died, the causes of death were relapse of hematologic disease in 37 patients, relapse of aspergillosis infection in 9 patients, cytomegalovirus infection in one patient and bacterial sepsis in one patient. For Aspergillus rhinosinusitis, 76 cases were treated by surgery and antifungal agent. Three patients (4 %) died postoperatively due to intracerebralhemorrhage. For cerebral aspergillosis, 15 patients were treated by surgery and antifungal agent. Among three deaths (20 %), two patients died post-operative from intracerebral hemorrhage by destruction of vessel wall, the resection hadbeen incomplete. For aspergillosus endocarditis, 12 patients were operated and the mortality was 50 % (6/12). For Aspergillus osteomyelitis one case of a vertebral localization was successfully treated by laminectomy and antifungal agent after follow-up period of 14 months. Conclusion. Despite insufficient scientific evidence, we can recommend: ifa aspergillosis lesion localized in lung or sinuses or brain persists despite antifungal agent, surgery is indicated especially when a new immunosuppressive therapy is indicated in the next weeks. When a aspergillosis lesionis located near a pulmonary artery, we recommend emergency operation before marrow recovery for the prevention of massive hemoptysis. For other sites, scientific evidence is too scant to recommend a strategy.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 14/07/20 alle ore 07:25:48