The thoracic surgical spectrum of acquired immune deficiency syndrome

The acquired immune deficiency syndrome has presented a complex and, as yet, unsolvable spectrum of pulmonary disease characterized by bizarre infections, pneumothoraces, respiratory distress, and death. Thirty-eight patients underwent 49 surgical procedures during 42 months. Ages of the patients ranged from 24 to 56 years. Surgical procedures included tracheostomy, closure of air leaks, mediastinoscopy, lobectomy, open lung biopsy, and esophagogastrectomy. Hospital mortality was 10 of 38 (24%); the 1 year survival rate was 13 of 38 (34%). Pulmonary infections included Pneumocystis carinii, cytomegalovirus, Microbacterium avium, toxoplasmosis, candidiasis, and Cryptococcus neoformans. Open lung biopsy and surgical closure of air leaks can be accomplished safely with low morbidity. Tracheostomy and ventilatory support should be avoided at present in the majority of patients with this syndrome, as the mortality has been 100% when that stage of the disease is reached.