M Haris

Total knee prosthesis infected with Mycobacterium tuberculosis

Mycobacterium tuberculosis (MTB) infection of a prosthetic joint is rarely reported in developed countries.1 Typically, MTB infection involves the hips or knees, and the infection can occur secondary to crushing and degradation of the granuloma during surgery or, less commonly, from distant foci spreading through the blood. In the present case, MTB infection likely resulted from haematogenous spread since multiple hot spots suggestive of MTB infection were noted in other sites. Early diagnosis allows for antitubercular therapy with retention of the prosthesis, while late diagnosis frequently results in removal and reimplantation of the joint. To avoid major surgery, a high index of suspicion is required to diagnose prosthetic joint tuberculosis.

S95 Ambulatory management of pneumothorax: is there a need for a dedicated pleural team-led service?

Introduction Small, asymptomatic pneumothoraces may be managed as outpatients. Several studies show that small-bore catheters and Heimlich valves may be used in the treatment of pneumothoraces. A systematic review of the literature1 showed successful outpatient management of pneumothorax. Despite good evidence to support ambulatory approach, there has been slow development of this service across the UK. We wished to assess the number of potential primary spontaneous pneumothorax patients that could be managed as outpatients in a large teaching hospital. Methods Hospital attendances of pneumothorax at a large teaching hospital between 2012–2015 were reviewed. Type of pneumothorax was characterised: primary spontaneous (PSP), secondary spontaneous (SSP), iatrogenic (IP) and traumatic/post-operative. The data for PSP was then correlated against the data retrieved from the systematic review of outpatient pneumothorax management.1 Results Total number of pneumothorax episodes were 877; PSP 266, SSP 229, IP 41 and traumatic/post-operative 341. Average length of stay (LOS) for all episodes of pneumothorax was 12.39 days. LOS for PSP was 6.9 days. Total number of hospital admissions for PSP (266/3 =) 88.7 patients/year. Extrapolated from systematic review1: Successful outpatient PSP management (88.7*78% =) 77.1 patients/year. Potential bed days saved for PSP: (77.1*6.9 =) 532 beds/year. Conclusions Studies show both spontaneous and iatrogenic pneumothorax may be managed safely as outpatients. Dedicated pleural services will result in correct stratification of patients requiring appropriate interventions. Ambulatory chest drains could be used and inserted by professionals trained in their use. Advantages to patients: reduced need for hospital admission, greater patient autonomy, improved patient experience, no need to carry chest drain bottle, reduced likelihood of accidental dislodgement of chest drain, reduced time to discharge. Advantages to trust: admission avoidance, early discharge, reduced costs, reduced complications from chest drain insertions, reduced hospital associated complications, optimised patient care with increased patient satisfaction. Although we would not advocate the use of ambulatory pneumothorax devices in trauma patients, there is scope to establish whether they can be used post procedural (e.g. pneumothorax following pacemaker insertion). Abstract S95 Figure 1 Reference Brims FJ, Maskell NA. Ambulatory treatment in the management of pneumothorax: a systematic review of the literature. Thorax 2013;68(7):664–9.

P108 Lung cancer resection outcomes in the first year: a 5 year review

Introduction Lung cancer survival remains poor despite the use of advanced diagnostic and therapeutic interventions. Surgical resection offers the best chance of cure for those with early stage lung cancer. Those who undergo curative resection for non-small cell lung cancer remain at risk of recurrence. We wished to evaluate thoracotomy outcomes in patients undergoing resection with curative intent. Methods Retrospective review of consecutive surgical resections for suspected or confirmed lung cancer over 5-year period between January 2010 and December 2014 in a tertiary thoracic unit. Patients referred from other centres were excluded. Surgical database and post-operative follow up information was reviewed. Futile thoracotomies were defined as inoperable lung cancer at the time of surgery, benign lung lesion, incomplete tumour resection margins and recurrence or death in the first year.1 Results 298 patients underwent surgical resection; mean age 68 years (range 26–91); male 150 (50%). 48 (16%) had histo-cytological confirmation of lung cancer prior to resection. Post-operative histology revealed 248 (83%) primary lung cancer; 31 (10%) benign pathology; 17 (6%) metastatic tumour from other primaries (breast, colorectal, bladder and renal) and 2 lymphomas. Of the 248 primary lung cancers, 88 (35%) had adjuvant chemotherapy and 27 (11%) had adjuvant radiotherapy including cranial irradiation. A total of 40/298 (13%) patients had recurrence in first year of which 20 died within 1 year. Based on previously used definition,1 the futile thoracotomy rate was 33% (99/298) – see Table 1. If surgical resection of benign lesions is considered diagnostic, the futile thoracotomy rate would be 23% (68/298). Abstract P108 Table 1 Distribution of futile thoracotomy, n(%) Benign lung lesion 31 (31) R2 Resection 3 (3) Stage IIIA-IV 17 (17) Recurrence within 1 year 20 (20) Deaths within 1 year 28 (28) Conclusion The definition of futile thoracotomy is debatable, but the risk remains high. Prior to surgery every effort should be made to minimise the risk by using combined staging modalities including minimally invasive diagnostic tools and appropriate patient selection. Reference Fischer B, Lassen U, Mortensen J, et al. Preoperative staging of lung cancer with combined PET-CT. N Engl J Med 2009;361:32–9.

Primary pulmonary plasmacytoma mimicking lung cancer diagnosed on endobronchial ultrasound (EBUS)-guided biopsy

A 77-year-old woman presented with progressive breathlessness on exertion. Chest radiograph showed a smooth right apical mass and CT of the chest confirmed a bilobed, well-defined right apical mass (figure 1). Positron emission tomography-CT showed a right apical soft tissue mass with marked fluorodeoxyglucose uptake (standardised uptake value max 8.6) with chest wall and likely mediastinal invasion (figure 2). The patient was referred for endobronchial ultrasound (EBUS) and a right paratracheal mass …