Minimally invasive vacuum-assisted closure therapy in the management of complex pleural empyema.

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Sziklavari, Zsolt; Grosser, Christian; Neu, Reiner; Schemm, Rudolf; Szöke, Tamas; Ried, Michael; Hofmann, Hans-Stefan

2013-07-01

The pool of potential candidates for pleural empyema is expanding. In a previous technical report, we tested the feasibility of the minimally invasive insertion of a vacuum-assisted closure (Mini-VAC) system without the insertion of an open-window thoracostomy (OWT). In this study, we describe a consecutive case series of complex pleural empyemas that were managed by this Mini-VAC therapy. In this retrospective study, we investigated 6 patients with multimorbidity (Karnofsky index ≤ 50%) who were consecutively treated with Mini-VAC for a primary, postoperative or recurrent pleural empyema between January 2011 and February 2012. Local control of the infection and control of sepsis were satisfactory in all 6 of the patients treated by Mini-VAC therapy. The suction used did not create any air leaks or bleeding from the lung or mediastinal structures. Mini-VAC therapy allowed a reduction of the empyema cavity and improved the re-expansion of the residual lung. Mini-VAC therapy resulted in a rapid eradication of the empyema. The chest wall was closed in all patients during the first hospital stay. All patients left the hospital in good health (Karnofsky index >70%) and with a non-infected pleural cavity at a mean of 22 ± 11 days after Mini-VAC installation. Pleural empyema was not detected in any of the 6 patients at the 3-month follow-up appointment. The Mini-VAC procedure with the abdication of an OWT offers a rapid treatment for complex pleural empyema with minimal surgical effort and the opportunity for a primary closure of the empyema cavity.

Spinal epidural empyema in two dogs

International Nuclear Information System (INIS)

Dewey, C.W.; Kortz, G.D.; Bailey, C.S.

1998-01-01

Extensive, diffuse, epidural spinal cord compression was visualized myelographically in two dogs presented for rapid development of nonambulatory tetraparesis and paraplegia, respectively. Purulent fluid containing bacterial organisms was aspirated percutaneously under fluoroscopic guidance from the epidural space of each dog. One dog responded poorly to aggressive medical therapy, which included installation of an epidural lavage and drainage system. Both dogs were euthanized due to the severe nature of their disorder and the poor prognosis. Spinal epidural empyema (i.e., abscess) is a rare condition in humans and has not been reported previously in the veterinary literature. Spinal epidural empyema should be considered as a differential diagnosis in dogs presenting with painful myelopathies, especially when accompanied by fever

Empyema Necessitans Complicating Pleural Effusion Associated with Proteus Species Infection: A Diagnostic Dilemma

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M. S. Yauba

2015-01-01

Full Text Available Background. Empyema necessitans, a rare complication of pleural effusion, could result in significant morbidity and mortality in children. It is characterized by the dissection of pus through the soft tissues and the skin of the chest wall. Mycobacterium tuberculosis and Actinomyces israelii are common causes but Gram negative bacilli could be a rare cause. However, there were challenges in differentiating between Mycobacterium tuberculosis and nontuberculous empyema in a resource poor setting like ours. We report a child with pleural effusion and empyema necessitans secondary to Proteus spp. infection. Methods. We describe a 12-year-old child with empyema necessitans complicating pleural effusion and highlight management challenges. Results. This case was treated with quinolones, antituberculous drugs, chest tube drainage, and nutritional rehabilitation. Conclusion. Empyema necessitatis is a rare condition that can be caused by Gram negative bacterial pathogens like Proteus species.

Secondary encephalocele in infant following subdural empyema repaired endoscopically-A case report.

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Verma, Roshan K; Kaur, Navjot

2017-09-01

Subdural empyema (SDE) is an uncommon entity, mostly associated with meningitis and can be life threatening in infants. Rarely, a subdural empyema can lead to nasal encephalocele which can be challenging situation to manage especially in infant. We present a case of 7 month old infant who presented with subdural empyema that led to formation of nasal encaphalocele after 4 months which was managed endoscopic route. Copyright © 2017 Elsevier B.V. All rights reserved.

Calcified pleural scars and pleural empyema with mural calcification

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Schmitt, W.G.H.; Huebener, K.H.

1981-06-01

The differential diagnosis between calcified pleural scars and pleural empyemas with mural calcification was studied by computer tomography, bearing in mind the patient's history. In view of the high complication rate of pleural empyemas, such as internal or external fistulae, it is desirable to elucidate every form of pleural shadowing which is more than 20 mm thick. Criteria are offered, which permit the differentiation of the pleural changes by means of conventional radiological examinations. Valuable additional information can be obtained by computer tomography. Forty-nine patients with calcification in the pleura were found among 1.900 chest x-rays which had been examined. Out of these, seven had a pleural empyema. In one case an echinococcus cyst with mural calcification was punctured under X-ray control.

Calcified pleural scars and pleural empyema with mural calcification

International Nuclear Information System (INIS)

Schmitt, W.G.H.; Huebener, K.H.

1981-01-01

The differential diagnosis between calcified pleural scars and pleural empyemas with mural calcification was studied by computer tomography, bearing in mind the patient's history. In view of the high complication rate of pleural empyemas, such as internal or external fistulae, it is desirable to elucidate every form of pleural shadowing which is more than 20 mm thick. Criteria are offered, which permit the differentiation of the pleural changes by means of conventional radiological examinations. Valuable additional information can be obtained by computer tomography. Forty-nine patients with calcification in the pleura were found among 1.900 chest x-rays which had been examined. Out of these, seven had a pleural empyema. In one case an echinococcus cyst with mural calcification was punctured under X-ray control. (orig.) [de

Developing risk factors for post traumatic empyema in patients with chest trauma

Institute of Scientific and Technical Information of China (English)

Mara del Pilar Quiroga; Jos Daniel Charry; Nicols Becerra; Juan Camilo Garcia; Eliana Karina Muoz; Rodrigo Lara

2015-01-01

Objective:To establish the risk factors associated to development of empyema posttraumatic in patients with chest trauma managed with closed thoracostomy. Methods: It was a descriptive and observational study of patients with chest trauma who were admitted between January 2013 and May 2014. The variables were evaluated and the results according to management with closed thoracostomy in patients with thoracic trauma was determined. Univariate analysis was performed and measures of central tendency were calculated. Results: In total 240 patients were analyzed. Among them, 10.4% (25) developed posttraumatic empyema. In patients who developed empyema, the mean age was 34.2 years, and the mean injury severity score was 20.6. It was identified as a risk factor closed chest trauma in 68%(17) and 84%coagulated hemothorax trauma. Empyema management thoracoscopy was in 100%of cases. Conclusions: The posttraumatic empyema is a complication that occurs in patients with thoracic trauma. One of the most important risk factors is coagulated hemothorax which could be identified and treated in time to avoid comorbidities during hospital stay.

Thoracoscopy in the management of pediatric empyemas

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R. Lamas-Pinheiro

2016-05-01

Full Text Available Introduction: Thoracoscopy is increasingly being used in the treatment of empyema. This study assesses feasibility, efficacy and safety in children. Material and methods: Clinical files of patients who underwent primary thoracoscopy for empyema between 2006 and 2014 were reviewed. Demographic, clinical and surgical data were analyzed and a comparison between the period before (period1 and after (period2 the learning curve was performed. Results: Ninety-one patients (53 males, 58% were submitted to thoracoscopy at a median age of 4 years. There were 19 conversions to thoracotomy with a steady decrease of conversion rate until 2009 (period1 and no conversions thereafter (period2. There was no difference in any of the analyzed parameters between patients submitted to thoracoscopy alone and those requiring conversion in period1. Six cases (6.6% needed redo-operation (five in period2 and thoracotomy was the elected approach in four. Necrotizing pneumonia was present in 60% of the reoperated cases; in other words, in period2 3 out of 9 cases with necrotizing pneumonia required reintervention (p = 0.07. Thoracotomy was avoided in sixty-eight (75% patients (62% in period1 versus 92% in period2, p = 0.001. Discussion and conclusions: Thoracoscopic approach for empyema is feasible and safe avoiding a significant number of thoracotomies after a short learning curve. An increase of reintervention rate should be expected, but throracoscopy alone is effective in the great majority of the cases. Necrotizing pneumonia may be associated with a higher risk of reintervention, as it is a contra-indication to thoracoscopy and probably surgery. Keywords: Thoracoscopy, Empyema, Children, Conversion, Reintervention

[Lung abscess and thoracic empyema: retrospective analysis in an internal medicine department].

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Monteiro, Rita; Alfaro, Tiago M; Correia, Lurdes; Simão, Adélia; Carvalho, Armando; Costa, J Nascimento

2011-12-01

Lung abscess is a collection of necrotic and suppurated tissue located at the pulmonary parenchyma. Empyema is defined as the presence of pus in the pleural space. To study the clinical and microbiological characteristics, treatment and prognosis of patients with lung abscess and/or empyema admitted to an Internal Medicine ward. A retrospective analysis of medical records was performed, including all patients admitted to an Internal Medicine ward for lung abscess or empyema, between 2000 and 2008. Thirty patients were included (22 males/ eight females), accounting for 0.18% of all patients admitted in this ward in the same period. Three patients had pulmonary abscess, 18 empyema, and nine both diseases. The average age was 68.5 years (31 to 90). The most frequent complaints were dyspnoea (90%), fever (73.3%), cough (66.7%), weight loss (60%) and chest pain (53.3%). The most frequent associated disorders were stroke associated disability (46.7%), heart failure (43.3%) and arterial hypertension (33.3%). Thoracentesis was performed in all patients with empyema. In one patient with lung abscess an anaerobic microorganism was identified. In patients with empyema, cultures were positive in 61.1% of cases, with a slight predominance of methicillin-resistant Staphylococcus aureus (27.3%) and Prevotella intermedia (18.2%). In patients with both abscess and empyema, cultures of the abscess were positive in 44.4% and of the pleural fluid in 33.3%, with no predominant microorganism. Empiric antimicrobial therapy was started in all patients and later adapted to the antibiotic sensitivity test results. Surgery was performed in three patients. Seven patients (23.3%) died during admission. The average age of the patients who died was 81.3 years and of those who survived was 64.5 years. Lung abscess and empyema are infrequent diseases in an Internal Medicine ward, affect mostly males and have unspecific clinical manifestations. The chest X-ray, computed tomography (CT) and

Radiologically-guided catheter drainage of intrathoracic abscesses and empyemas

International Nuclear Information System (INIS)

Berger, H.; Steiner, W.; Bergman, C.; Anthuber, M.; Dienemann, H.

1993-01-01

Radiologically guided percutaneous catheter drainage was used in 38 patients to treat pleural empyemas (35 patients) and pulmonary abscesses (3 patients). Drainage was successful in 85.7% of empyemas including 11 cases with fistulous communications. Three percutaneously drained pulmonary abscesses required subsequent lobectomy. One patient died during the drainage procedure due to sepsis. No major complications related to the drainage procedure were observed. Guided percutaneous drainage proved to be a safe and successful alternative to closed drainage of pleural fluid collections. (orig.)

Survey of childhood empyema in Asia: Implications for detecting the unmeasured burden of culture-negative bacterial disease

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Shen Xuzhuang

2008-07-01

Full Text Available Abstract Background Parapneumonic empyema continues to be a disease of significant morbidity and mortality among children despite recent advances in medical management. To date, only a limited number of studies have assessed the burden of empyema in Asia. Methods We surveyed medical records of four representative large pediatric hospitals in China, Korea, Taiwan and Vietnam using ICD-10 diagnostic codes to identify children Results During the study period, we identified 1,379 children diagnosed with empyema or pleural effusion (China, n = 461; Korea, n = 134; Taiwan, n = 119; Vietnam, n = 665. Diagnoses of pleural effusion (n = 1,074 were 3.5 times more common than of empyema (n = 305, although the relative proportions of empyema and pleural effusion noted in hospital records varied widely between the four sites, most likely because of marked differences in coding practices. Although pleural effusions were reported more often than empyema, children with empyema were more likely to have a cultured pathogen. In addition, we found that median age and gender distribution of children with these conditions were similar across the four countries. Among 1,379 empyema and pleural effusion specimens, 401 (29% were culture positive. Staphylococcus aureus (n = 126 was the most common organism isolated, followed by Streptococcus pneumoniae (n = 83, Pseudomonas aeruginosa (n = 37 and Klebsiella (n = 35 and Acinetobacter species (n = 34. Conclusion The age and gender distribution of empyema and pleural effusion in children in these countries are similar to the US and Western Europe. S. pneumoniae was the second leading bacterial cause of empyema and pleural effusion among Asian children. The high proportion of culture-negative specimens among patients with pleural effusion or empyema suggests that culture may not be a sufficiently sensitive diagnostic method to determine etiology in the majority of cases. Future prospective studies in different countries would

Subdural Empyema Presenting with Seizure, Confusion, and Focal Weakness

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David I Bruner

2012-12-01

Full Text Available While sinusitis is a common ailment, intracranial suppurative complications of sinusitis are rare and difficult to diagnose and treat. The morbidity and mortality of intracranial complications of sinusitis have decreased significantly since the advent of antibiotics, but diseases such as subdural empyemas and intracranial abscesses still occur, and they require prompt diagnosis, treatment, and often surgical drainage to prevent death or long-term neurologic sequelae. We present a case of an immunocompetent adolescent male with a subdural empyema who presented with seizures,confusion, and focal arm weakness after a bout of sinusitis.

Subdural Empyema Presenting with Seizure, Confusion, and Focal Weakness

Science.gov (United States)

Bruner, David I.; Littlejohn, Lanny; Pritchard, Amy

2012-01-01

While sinusitis is a common ailment, intracranial suppurative complications of sinusitis are rare and difficult to diagnose and treat. The morbidity and mortality of intracranial complications of sinusitis have decreased significantly since the advent of antibiotics, but diseases such as subdural empyemas and intracranial abscesses still occur, and they require prompt diagnosis, treatment, and often surgical drainage to prevent death or long-term neurologic sequelae. We present a case of an immunocompetent adolescent male with a subdural empyema who presented with seizures, confusion, and focal arm weakness after a bout of sinusitis. PMID:23358438

Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

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Lin, Hsien-Feng; Liao, Kuan-Fu; Chang, Ching-Mei; Lin, Cheng-Li; Lai, Shih-Wei

2017-01-01

Objective This study aimed to investigate the association between splenectomy and empyema in Taiwan. Methods A population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20–84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities. Results The overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone. Conclusion The incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities. PMID:28947439

Percutaneous catheter drainage of empyema and loculated pleural effusion

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Im, Jung Gi; Park, Kyung Joo; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1988-08-15

Closed thoracotomy by using a chest tube in cases of thoracic empyema is known to be an effective and popular way of treatment. However, it happens commonly that chest tube drainage is not appropriate because of either malpositioning of the tube or undesirable patient's general condition such as bleeding tendency or debilitation. We performed fluoroscopy-guided percutaneous catheter drainage (PCD) in 14 cases of empyema and loculated pleural effusion and in 2 cases of lung abscess. In most of the patients, PCDs were performed because chest tube drainage was considered to be inappropriate or after failed chest tube drainage. In all patients, catheters were successfully placed into the fluid collections, which were drained effectively. Ten of the 11 febrile patient showed improvement of feverishness within 24 hours after PCD. 10 patients were cured without further treatment. Complications were few and minimal. We believe that the safety, effectiveness and good patients tolerance of PCD makes it an excellent alternative method of treatment in cases of empyema and loculated pleural effusion.

Short- and long-term effectiveness of intracavitary urokinase in loculated thoracic empyema

International Nuclear Information System (INIS)

Jeong, Tae Gon; Han, Young Min; Chang, Suk Kyeong; Chung, Gyung Ho; Sohn, Myung Hee; Kim, Chong Soo; Choi, Ki Chul

1995-01-01

The purpose of this study was to evaluate the short-and long-term effectiveness of intracavitary urokinase with percutaneous catheter drainage in loculated thoracic empyemas. 15 patients were identified as second stage of loculated thoracic empyema by estimating nature of pleural fluid, chest PA, lateral decubitus view and CT scan. Under the guidance of fluoroscopy or ultrasound, catheter was inserted percutaneously. Instillation of urokinase was started when amount of drained fluid became less than 30 ml per day with 100,000U of urokinase mixed with 100 ml of normal saline. Trial of urokinase was repeated until complete drainage of empyema was demonstrated on plain chest film obtained after 48 hours. Successful complete drainage was achieved in 14 of 15 patients. In long-term study, complete resorption was demonstrated in 11 of 12 patients. Average dosage of used urokinase was 330,000U and mean duration of catheter insertion was 35 days. Intracavitary urokinase with percutaneous catheter drainage is a safe and effective method to facilitate drainage of loculated empyema and to prevent recurrence

Chronic tuberculous empyema: relationships between preoperative CT findings and postoperative improvement measured by pulmonary function testing

International Nuclear Information System (INIS)

Kim, D.J.; Im, J.-G.; Goo, J.M.; Lee, H.J.; You, S.Y.; Song, J.W.

2005-01-01

AIMS: To evaluate whether preoperative computed tomography (CT) findings correlate with postoperative improvements in forced vital capacity (FVC) and forced expiratory volume during 1 s (FEV1) in persons who have undergone unilateral decortication because of unilateral chronic tuberculous empyema. METHODS: A retrospective study was carried out of 67 individuals who had undergone decortication because of chronic tuberculous empyema between January 1996 and December 2000. Of these, 13 subjects who had had preoperative chest CT and preoperative and postoperative pulmonary function tests (PFTs) were included in the investigation. On preoperative CT, the degree of volume reduction of the affected side was compared with that of the contralateral normal lung. The relative volume of empyema was calculated by dividing the volume occupied by the empyema by the sum of the total volume of the ipsilateral lung and the empyema volume. The thicknesses of pleura and extrapleural fat in the involved hemithorax were measured by CT at their thickest points, and the degree of atelectasis adjacent to the empyema in the diseased lung was assessed and classified. These five CT parameters and the ages of the patients were compared with preoperative and postoperative FVC and FEV1 changes. RESULTS: A significant negative correlation was found between FVC changes and the relative volume of the affected lung (FVC: p=0.039, RS=-0.58). FVC and FEV1 were found to be significantly and positively correlated with the relative volume of the empyema (FVC: p=0.005, RS=0.72; FEV1: p=0.014, RS=0.66) and the degree of atelectasis (FVC: p=0.007, RS=0.71; FEV1: p=0.029, RS=0.60) by Spearman's nonparametric correlation test. Other CT parameters and the ages of the patients were not found to be correlated with PFT changes. CONCLUSION: The relative volume of the affected side, the relative volume of empyema and the degree of atelectasis can predict improvements in FVC and FEV1 after decortication in patients

Bilateral empyema thoracis treated simultaneously with video ...

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Keywords: bilateral empyema, children, pneumonia, simultaneous ... Department of Pediatric Surgery, J.J. Hospital and Grant Medical College, ... occurrence of an acute inflammatory reaction. ... specific organism has been associated with the patients of ... 8 Santos Jw. Community-acquired staphylococcal pneumonia.

Evaluation of management of postpneumonic empyema thoracis in ...

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evaluate different management options of postpneumonic empyema in children. .... free fluid was evacuated and loculations were drained, the fibrinous adhesions were ... Atelectasis was treated with respiratory exercise and nasotracheal ...

Nontyphi Salmonella Empyema with Bronchopleural Fistula in a Patient with Human Immunodeficiency Virus

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Douglas Bretzing

2018-01-01

Full Text Available Patients with human immunodeficiency virus (HIV have an increased risk of inoculation with nontyphoid Salmonella compared to the general population. While nontyphoid Salmonella commonly manifests as gastroenteritis, Salmonella bacteremia can be seen in patients with HIV. We present a case of disseminated Salmonellosis in a patient with HIV complicated by bronchopleural fistula and secondary empyema. Case Presentation. A 40-year-old African American male with HIV noncompliant with HAART therapy presented with complaints of generalized weakness, weight loss, cough, night sweats, and nonbloody, watery diarrhea of four weeks’ duration. A computed tomography (CT scan demonstrated a bilobed large, thick-walled cavitary lesion in the right upper lobe communicating with the pleural space to form a bronchopleural fistula. Thoracentesis yielded growth of nontyphi Salmonella species consistent with empyema; he was treated with intravenous Ceftriaxone and underwent placement of chest tube for drainage of empyema with instillation of alteplase/dornase twice daily for three days. Repeat CT chest showed a hydropneumothorax. The patient subsequently underwent video-assisted thoracoscopy with decortication. The patient continued to improve and follow-up CT chest demonstrated improved loculated right pneumothorax with resolution of the right bronchopleural fistula and resolution of the cavitary lesions. Discussion. We describe one of the few cases of development of bronchopulmonary fistula and the formation of empyema in the setting of disseminated Salmonella. Empyema complicated by bronchopulmonary fistula likely led to failure of intrapleural fibrinolytic therapy and the patient ultimately required decortication in addition to antibiotics. While Salmonella bacteremia can be seen in immunocompromised patients, extraintestinal manifestations of Salmonella infection such as empyema and bronchopleural fistulas are uncommon. Bronchopleural fistulas most commonly

[Subdural empyema due to gemella morbillorum as a complication of acute sinusitis].

Science.gov (United States)

Boto, Leonor Reis; Calado, Cláudia; Vieira, Marisa; Camilo, Cristina; Abecasis, Francisco; Campos, Alexandre R; Correia, Manuela

2011-01-01

Subdural empyema is a life-threatening infection that may complicate acute sinusitis. The authors report the case of a previously healthy 10 year-old girl who presented with subdural empyema due to Gemella morbillorum after an untreated maxillary, ethmoidal and esphenoidal sinusitis. Despite immediate drainage of the empyema and underlying primary infection and treatment with broad spectrum antibiotics, she later developed frontal cerebritis and refractory intracranial hypertension, needing urgent decompressive craniectomy. She recovered gradually, maintaining to date slight right hemyparesis and aphasia. Even though it is considered a low virulence organism, G. morbillorum has been increasingly described in central nervous system infection. In this case, the prompt institution of broad spectrum antibiotics and surgical drainage, as well as the agressive treatment of complications, including decompressive craniectomy, were crucial to the patient's recovery.

A rare case of empyema developed after transarterial chemoembolization for hepatocellular carcinoma

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Sur, Young Keun; Won, Je Hwan; Hwang, Hee Jung; Kim, Jinoo [Ajou University Hospital, Ajou University School of Medicine, Suwon (Korea, Republic of)

2015-01-15

A 60-year-old male patient who previously underwent transarterial chemoembolization for recurrent hepatocellular carcinoma three months ago presented to the emergency department with pleural effusion and hemoptysis. On serial review of plain radiographs and chest CT, transdiaphragmatic migration of Lipiodol from the treated area of the liver into the ipsilateral pleural cavity was demonstrated. The patient consequently developed empyema in the right thorax. Therefore, percutaneous drainage was performed. Empyema and pleural effusion regressed after 10 days of medical treatment and drainage. After that, the patient was transferred back to the local clinic upon full symptomatic recovery. Herein, we describe a rare complication of transarterial chemoembolization for hepatocellular carcinoma manifesting as an empyema secondary to the migration of the ethiodized oil content from the liver into the ipsilateral pleural cavity.

Comparison of diagnostic modalities in the differentiation of lung abscess and empyema

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Choe, Kyu Ok; Lee, Jong Doo; Yoo, Hyung Sik; Oh, Ki Keun [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

1988-06-15

The potential difficulties in distinguishing a pleural based parenchymal abscess from a loculated pleural effusion or empyema on the basis of plain radiographs have been well documented. However chest ultrasonography can provide valuable information about disease processes abutting the chest wall, despite the physical limitations imposed by aerated lung and bony thorax that restrict the potential usefulness of sonography in chest diagnosis. Some authors proposed that chest CT can diagnose them more accurately and provides more valuable information than ultrasonography can. We evaluated chest radiographs, CT and ultrasonography of 36 patients with suspected pleural based lung abscess or empyema for the comparison of diagnostic modalities in the differentiation of these two disease entities. The result were as follows. 1. CT scan could accurately differentiate empyema from parenchymal lesions by observing wall characteristics, split pleura, adjacent lung compression and internal septations. 2. In 90% of patients with suspected lung abscess or empyema, they could be differentiated with ultrasonography alone, by identifying internal septation, echogenic layering along pleural surface and internal echo patterns. 3. Ultrasonography assisted plain radiography could also distinguish them as accurately as chest CT. 4. Chest ultrasonography was more valuable than CT in the evaluation of pleural thickening, septation and compartmentalization of pleural cavity.

Comparison of diagnostic modalities in the differentiation of lung abscess and empyema

International Nuclear Information System (INIS)

Choe, Kyu Ok; Lee, Jong Doo; Yoo, Hyung Sik; Oh, Ki Keun

1988-01-01

The potential difficulties in distinguishing a pleural based parenchymal abscess from a loculated pleural effusion or empyema on the basis of plain radiographs have been well documented. However chest ultrasonography can provide valuable information about disease processes abutting the chest wall, despite the physical limitations imposed by aerated lung and bony thorax that restrict the potential usefulness of sonography in chest diagnosis. Some authors proposed that chest CT can diagnose them more accurately and provides more valuable information than ultrasonography can. We evaluated chest radiographs, CT and ultrasonography of 36 patients with suspected pleural based lung abscess or empyema for the comparison of diagnostic modalities in the differentiation of these two disease entities. The result were as follows. 1. CT scan could accurately differentiate empyema from parenchymal lesions by observing wall characteristics, split pleura, adjacent lung compression and internal septations. 2. In 90% of patients with suspected lung abscess or empyema, they could be differentiated with ultrasonography alone, by identifying internal septation, echogenic layering along pleural surface and internal echo patterns. 3. Ultrasonography assisted plain radiography could also distinguish them as accurately as chest CT. 4. Chest ultrasonography was more valuable than CT in the evaluation of pleural thickening, septation and compartmentalization of pleural cavity

Evaluation of usefulness of pleural fluid adenosine deaminase in diagnosing tuberculous pleural effusion from empyema

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Vijetha Shenoy

2014-02-01

Full Text Available Objective: To evaluate the utility of adenosine deaminase activity in the pleural fluid for the diagnosis of tuberculous pleural effusion from empyema of non-tubercular origin. Method: A retrospective analysis of data was performed on patients who were diagnosed to have tuberculous pleural effusion and empyema of non tubercular origin. Among 46 patients at Kasturba Hospital, Manipal University, Manipal, Karnataka, India, from November 201 2 to February 2013 who underwent pleural fluid adenosine deaminase estimation, 25 patients with tuberculous pleural effusion and 21 patients with empyema were diagnosed respectively. Adenosine deaminase in pleural fluid is estimated using colorimetric, Galanti and Guisti method. Results: Pleural fluid Adenosine Deaminase levels among tuberculous pleural effusion(109.38依 53.83 , empyema (141.20依71.69 with P=0.27. Conclusion: Pleural fluid adenosine deaminase alone cannot be used as a marker for the diagnosis of tuberculous pleural effusion.

Streptococcal Subdural Empyema as a Complication of Varicella

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J Gordon Millichap

2005-01-01

Full Text Available A 3-month-old male infant who presented with a group A streptococcal subdural empyema on day 5 of a varicella skin rash is reported from the University of British Columbia, Vancouver, BC, Canada.

Aggregatibacter aphrophilus in a patient with recurrent empyema: a case report

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Olver William J

2011-09-01

Full Text Available Abstract Introduction Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus and H. paraphrophilus is classically associated with infective endocarditis. Other infections reported in the literature include brain abscess, bone and joint infections and endophthalmitis. There are only two cases of empyema ever reported due to this organism. We report the isolation of A. aphrophilus from pleural fluid on three separate hospital admissions in a patient with recurrent empyema. Case presentation A 65-year-old female patient of Caucasian origin presented with a three-week history of fever, shortness of breath and dry cough. She was found to have a pleural empyema so a chest drain was inserted and a sample of pus was sent to the microbiology laboratory. After overnight incubation, a chocolate blood agar plate incubated in 5% carbon dioxide showed a profuse growth of small, round, glistening colonies which were identified as Gram-negative coccobacilli. They were oxidase- and catalase-negative. Biochemical testing using RapID NH confirmed the identity of the organism as A. aphrophilus. It was susceptible to amoxicillin, levofloxacin and doxycycline. Our patient was treated with intravenous amoxicillin with clavulanic acid and clarithromycin followed by oral doxycycline, but was re-admitted twice over the next three months with recurrent empyema and the same organism was isolated. Each episode was managed with chest drainage and a six-week course of antibiotic--doxycycline for the second episode and amoxicillin for the third episode, after which she has remained well. Conclusion This is the first case report of recurrent empyema due to A. aphrophilus. Our patient had no underlying condition to explain the recurrence. Although our isolate was doxycycline susceptible, our patient had recurrent infection after treatment with this antibiotic, suggesting that this antibiotic is ineffective in treatment of deep-seated A. aphrophilus infection. This

Differentiating lung abscess and empyema: radiography and computed tomography

International Nuclear Information System (INIS)

Stark, D.D.; Federle, M.P.; Goodman, P.C.; Podrasky, A.E.; Webb, W.R.

1983-01-01

Conventional chest radiographs and computed tomographic (CT) scans of 70 inflammatory thoracic lesions in 63 patients were reviewed and scored for diagnostic features. Pathologic confirmation of the final diagnosis was available in 42% (5/12) of lung abscesses and 31% (18/58) of empyemas. CT alone was sufficient to correctly diagnose 100% (70/70) of cases. Diagnostic information not available from conventional chest radiographs was obtained in 47% (33/70) of cases; in an additional 34% of patients, CT more accurately defined the extent of disease. The most reliable CT features for the differential diagnosis of lung abscess and empyema were wall characteristics, pleural separation, and lung compression. Conventional radiographic features such as size, shape, and the angle of the lesion with the chest wall were less helpful, though also best assessed by CT

Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema.

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Majercik, Sarah; Vijayakumar, Sathya; Olsen, Griffin; Wilson, Emily; Gardner, Scott; Granger, Steven R; Van Boerum, Don H; White, Thomas W

2015-12-01

Retained hemothorax (RH) is relatively common after chest trauma and can lead to empyema. We hypothesized that patients who have surgical fixation of rib fractures (SSRF) have less RH and empyema than those who have medical management of rib fractures (MMRF). Admitted rib fracture patients from January 2009 to June 2013 were identified. A 2:1 propensity score model identified MMRF patients who were similar to SSRF. RH, and empyema and readmissions, were recorded. Variables were compared using Fisher exact test and Wilcoxon rank-sum tests. One hundred thirty-seven SSRF and 274 MMRF were analyzed; 31 (7.5%) had RH requiring 35 interventions; 3 (2.2%) SSRF patients had RH compared with 28 (10.2%) MMRF (P = .003). Four (14.3%) MMRF subjects with RH developed empyema versus zero in the SSRF group (P = .008); 6 (19.3%) RH patients required readmission versus 14 (3.7%) in the non-RH group (P = .002). Patients with rib fractures who have SSRF have less RH compared with similar MMRF patients. Although not a singular reason to perform SSRF, this clinical benefit should not be overlooked. Copyright © 2015 Elsevier Inc. All rights reserved.

Investigation of therapeutic strategy for acute empyema

International Nuclear Information System (INIS)

Mochinaga, Koji; Akamine, Shinji; Muraoka, Masashi; Morino, Shigeyuki

2011-01-01

Recently, it has been reported that video-assisted thoracoscopic chest drainage is a useful treatment for acute empyema, but its indication has not been clarified. We retrospectively reviewed acute empyema patients by dividing them into 3 groups: operation group (7 patients), drainage group (6 patients), and antibiotic treatment group (9 patients), and then we evaluated the therapeutic strategy by examining the radiological findings, drainage period, and hospital stay. In the antibiotic treatment group, the ratio of pleural effusion on chest radiograph was under 1/4 in all patients. There were 5 patients who showed multilocular findings on chest CT, and all patients underwent an operation. Regarding the drainage period, the operation group showed a significantly shorter period than the drainage group. Concerning the hospital stay, the drainage group showed a significantly longer stay than the other 2 groups. The ratio of pleural effusion on chest radiograph was under 1/4, giving an indication for antibiotic treatment. With multilocular findings on CT, an indication for surgery is needed. Patients requiring drainage, which necessitates a long hospital stay, should be advised to consider surgery. (author)

Management of Pleural Effusion, Empyema, and Lung Abscess

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Yu, Hyeon

2011-01-01

Pleural effusion is an accumulation of fluid in the pleural space that is classified as transudate or exudate according to its composition and underlying pathophysiology. Empyema is defined by purulent fluid collection in the pleural space, which is most commonly caused by pneumonia. A lung abscess, on the other hand, is a parenchymal necrosis with confined cavitation that results from a pulmonary infection. Pleural effusion, empyema, and lung abscess are commonly encountered clinical problems that increase mortality. These conditions have traditionally been managed by antibiotics or surgical placement of a large drainage tube. However, as the efficacy of minimally invasive interventional procedures has been well established, image-guided small percutaneous drainage tubes have been considered as the mainstay of treatment for patients with pleural fluid collections or a lung abscess. In this article, the technical aspects of image-guided interventions, indications, expected benefits, and complications are discussed and the published literature is reviewed. PMID:22379278

Paediatric empyema: a case report and literature review.

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Parsons, S J; Fenton, E; Williams, M

2005-06-01

To present a case of bilateral parapneumonic effusions in a child with Pneumococcal pneumonia and bacteraemia managed aggressively with early thoracotomies. The literature from peer reviewed journals is summarized and the different management strategies are discussed. Articles and reviews from peer reviewed journals on the management of empyema in children and adults. Staging of parapneumonic pleural effusions is difficult to assess clinically and radiologically. Most cases can be successfully managed with simple chest tube drainage, plus appropriate antibiotic therapy. However, based on the available evidence for children, thoracotomy with decortication and direct drainage may provide the most effective treatment in terms of length of hospital stay and duration of chest tube insertion, when compared with video assisted thoracoscopic surgery (VATS) or chest tube drainage, with or without intrapleural fibrinolytic therapy. More conservative approaches to treatment of empyema may be appropriate initially to avoid the cosmetic and other disadvantages of thoracotomy. However, delayed surgical drainage increases morbidity and may potentially increase mortality.

Interhemispheric subdural empyema diagnosed by CT and cured by antibiotic therapy

International Nuclear Information System (INIS)

Hayakawa, Isao; Fukui, Mitsufumi; Furuhashi, Norihisa; Kanda, Tadashi; Tazaki, Yoshiaki

1981-01-01

A case of interhemispheric subdural empyema cured by high doses of antibiotics was reported. A 23-year-old man was admitted with complaints of headache, fever and motor weakness of the left lower leg of 2 days' duration. The neurological examination revealed neck stiffness, motor weakness and sensory disturbance of left lower leg. The WBS count was 26,000/cumm, and ESR was 74 mm/hour. The CSF showed a pressure of 230 mm H 2 O and contained 1001/3 cells (63% polymorphonuclears, 37% lymphocytes) in association with slight elevation of protein but with normal sugar content. The CSF culture was negative. Administration of high doses of antibiotics was started on the first hospital day. On the fourth hospital day, Jacksonian seizures occurred in the left lower extremity, and were controlled by anticonvulsants. CT scans with contrast enhancement revealed an area of low density in the right interhemispheric space with irregular marginal enhancement. Right carotid arteriography demonstrated a small oval avascular space along the interhemispheric cistern. The abnormalities on CT scan disappeared after one month, when the patient was discharged without neurological deficit. Unlike the previously reported cases with interhemispheric subdural empyema commonly associated with a collection of pus over the cerebral convexities, a localized interhemispheric subdural empyema as was found in the present case appears to be a very rare condition. The interhemispheric subdural empyema has been thought to be exclusively surgical indication and, to the best of our knowlage, there is no report in the literature of a case with successful medical treatment. However, successful treatment by antibiotics alone may become more practical if the diagnoses could be made in the early stage with the aid of CT scan. (author)

Interhemispheric subdural empyema diagnosed by CT and cured by antibiotic therapy

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Hayakawa, I.; Fukui, M.; Furuhashi, N.; Kanda, T.; Tazaki, Y. (Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine)

1981-09-01

A case of interhemispheric subdural empyema cured by high doses of antibiotics was reported. A 23-year-old man was admitted with complaints of headache, fever and motor weakness of the left lower leg of 2 days' duration. The neurological examination revealed neck stiffness, motor weakness and sensory disturbance of left lower leg. The WBS count was 26,000/cumm, and ESR was 74 mm/hour. The CSF showed a pressure of 230 mm H/sub 2/O and contained 1001/3 cells (63% polymorphonuclears, 37% lymphocytes) in association with slight elevation of protein but with normal sugar content. The CSF culture was negative. Administration of high doses of antibiotics was started on the first hospital day. On the fourth hospital day, Jacksonian seizures occurred in the left lower extremity, and were controlled by anticonvulsants. CT scans with contrast enhancement revealed an area of low density in the right interhemispheric space with irregular marginal enhancement. Right carotid arteriography demonstrated a small oval avascular space along the interhemispheric cistern. The abnormalities on CT scan disappeared after one month, when the patient was discharged without neurological deficit. Unlike the previously reported cases with interhemispheric subdural empyema commonly associated with a collection of pus over the cerebral convexities, a localized interhemispheric subdural empyema as was found in the present case appears to be a very rare condition. The interhemispheric subdural empyema has been thought to be exclusively surgical indication and, to the best of our knowlage, there is no report in the literature of a case with successful medical treatment. However, successful treatment by antibiotics alone may become more practical if the diagnoses could be made in the early stage with the aid of CT scan.

Minimally invasive surgical treatment of patients with bilateral pulmonary tuberculosis complicated with pleural empyema

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Korpusenko I.V

2015-03-01

Full Text Available Objective of our study was to increase the effectiveness of surgical treatment of bilateral destructive pulmonary tuberculosis complicated by pleural empyema by using VTS-technologies. The study was done in Dnepropetrovsk regional clinical therapeutic and prophylactic association "Phthisiology" in the period from 2008 to 2013. A retrospective analysis of 43 cases of bilateral destructive pulmonary tuberculosis complicated by pleural empyema on one side and dissemination focus or limited destructive process on contralateral side has been performed. Selected cases were divided into 2 groups: main (eighteen cases where the following procedures were done: performed transsternal occlusion of the main bronchus, sanation of empyema cavity using videothoracosopy, in 30-45 days followed by pleuropneumectomy with usage of minithoracothomy and control (nineteen cases who had undergone drainage of the empyema cavity, sanation, in 45-60 days followed by pleuropmeumectomy with usage of anterolateral access. The distribution of main and control groups for analyzed parameters was representative. Sanation of pleural cavity with videothoracosopy usage compared with Bulau’s drainage provides better antibacterial effect, effective sanitation of the pleural cavity as evidenced by following changes: significant decrease in the number of microbial cells; normalization of total white blood cells count and rod-shaped granulocytes in the peripheral blood 10 days after treatment; normalization of leukocyte intoxication index. The use of minimally invasive surgical treatment allowed to reduce intraoperative complications by 2 times, amount of intraoperative blood loss and hemotrasfusions by 1.5 times, postoperative mortality by 2.5 times. Pleural cavity sanation with videothoracoscopy usage with following pneumoectomy leads to reduce in the incidence and severity of postoperative complications. The most promising is stage-by-stage surgical approach with consecutive use

Thoracic empyema caused by Campylobacter rectus.

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Ogata, Tomoyuki; Urata, Teruo; Nemoto, Daisuke; Hitomi, Shigemi

2017-03-01

We report a case of thoracic empyema caused by Campylobacter rectus, an organism considered as a periodontal pathogen but rarely recovered from extraoral specimens. The patient fully recovered through drainage of purulent pleural fluid and administration of antibiotics. The present case illustrates that C. rectus can be a cause of not only periodontal disease but also pulmonary infection. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Co-existence of Posttraumatic Empyema Thoracis and Lung Abscess in a Child After Blunt Chest Trauma: A Case Report

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Chang-Hung Kuo

2010-01-01

Full Text Available Posttraumatic empyema is a rare complication of trauma with an incidence of 1.6–2.4% in trauma patients. However, it is rarely reported in children. We report the case of a 15-year-old boy who was involved in a traffic accident and diagnosed with a pulmonary contusion at a local hospital. Fourteen days after the accident, posttraumatic empyema thoracis and lung abscess developed with clinical presentations of fever, productive cough and right chest pain. He was successfully treated with computed tomography-guided catheter drainage and intravenous cefotaxime. We emphasize that posttraumatic empyema thoracis and lung abscess are very rare in children, and careful follow-up for posttraumatic lung contusion is essential. Image-guided catheter drainage can be an adjunctive tool for treating selected patients, although most complicated cases of post-traumatic empyema thoracis require decortication therapy.

Prevalence and clinical significance of pleural microbubbles in computed tomography of thoracic empyema

International Nuclear Information System (INIS)

Smolikov, A.; Smolyakov, R.; Riesenberg, K.; Schlaeffer, F.; Borer, A.; Cherniavsky, E.; Gavriel, A.; Gilad, J.

2006-01-01

AIM: To determine the prevalence and clinical significance of pleural microbubbles in thoracic empyema. MATERIALS AND METHODS: The charts of 71 consecutive patients with empyema were retrospectively reviewed for relevant demographic, laboratory, microbiological, therapeutic and outcome data. Computed tomography (CT) images were reviewed for various signs of empyema as well as pleural microbubbles. Two patient groups, with and without microbubbles were compared. RESULTS: Mean patient age was 49 years and 72% were males. Microbubbles were detected in 58% of patients. There were no significant differences between patients with and without microbubbles in regard to pleural fluid chemistry. A causative organism was identified in about 75% of cases in both. There was no difference in the rates of pleural thickening and enhancement, increased extra-pleural fat attenuation, air-fluid levels or loculations. Microbubbles were diagnosed after a mean of 7.8 days from admission. Thoracentesis before CT was performed in 90 and 57% of patients with and without microbubbles (p=0.0015), respectively. Patients with microbubbles were more likely to require repeated drainage (65.9 versus 36.7%, p=0.015) and surgical decortication (31.7 versus 6.7%, p=0.011). Mortalities were 9.8 and 6.6% respectively (p=0.53). CONCLUSION: Pleural microbubbles are commonly encountered in CT imaging of empyema but have not been systematically studied to date. Microbubbles may be associated with adverse outcome such as repeated drainage or surgical decortication. The sensitivity and specificity of this finding and its prognostic implications need further assessment

Feasibility of a simple drainage system in Cameroonian children after thoracotomy and decortication for empyema thoracis

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Bernadette Ngo Nonga

2012-01-01

Full Text Available Background: To analyse the outcome of children with empyema thoracis treated by decortication followed by a simple drainage system. Patients and Methods: Retrospective chart review from July 2001 to June 2010 of all cases of children who had a thoracotomy for empyema. We used an endotracheal tube as chest drain and a urinary bag as a collector. Statistical analyses were done using EXCEL and SPSS 9.0. Results: Forty one children underwent thoracotomy and decortication for empyema, there were 23 boys and 18 girls with a sex ratio of 1, 21. The mean age was 2½ years with a minimum of 1 month and a maximum of 15 years of age; 27 children were below two years of age. All the patients have received antibiotic for a long period before surgery. The culture was negative, except in two cases where we found Klebsiella pneumonia and Staphylococcus aureus. In five cases, the empyema was due to Mycobacterium tuberculosis. Three children presented a complication: One child had a persistent purulent drainage for 2 weeks; another one was re-operated upon because of necrotic lung abscess and one child died of sepsis. In most cases, the chest tube was removed between day 4 and day 6 post-operatively. The average length of hospital stay after the surgery was 10 days. Conclusion: Thoracotomy and decortication in children with empyema can be safely done in Cameroon using a simple drainage system with good results compared to those in the literature.

Nonsteroidal Anti-Inflammatory Drug without Antibiotics for Acute Viral Infection Increases the Empyema Risk in Children: A Matched Case-Control Study.

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Le Bourgeois, Muriel; Ferroni, Agnès; Leruez-Ville, Marianne; Varon, Emmanuelle; Thumerelle, Caroline; Brémont, François; Fayon, Michael J; Delacourt, Christophe; Ligier, Caroline; Watier, Laurence; Guillemot, Didier

2016-08-01

To investigate the risk factors of empyema after acute viral infection and to clarify the hypothesized association(s) between empyema and some viruses and/or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). A case-control study was conducted in 15 centers. Cases and controls were enrolled for a source population of children 3-15 years of age with acute viral infections between 2006 and 2009. Among 215 empyemas, 83 cases (children with empyema and acute viral infection within the 15 preceding days) were included, and 83 controls (children with acute viral infection) were matched to cases. Considering the intake of any drug within 72 hours after acute viral infection onset and at least 6 consecutive days of antibiotic use and at least 1 day of NSAIDs exposure, the multivariable analysis retained an increased risk of empyema associated with NSAIDs exposure (aOR 2.79, 95% CI 1.4-5.58, P = .004), and a decreased risk associated with antibiotic use (aOR 0.32, 95% CI 0.11-0.97, P = .04). The risk of empyema associated with NSAIDs exposure was greater for children not prescribed an antibiotic and antibiotic intake diminished that risk for children given NSAIDs. NSAIDs use during acute viral infection is associated with an increased risk of empyema in children, and antibiotics are associated with a decreased risk. The presence of antibiotic-NSAIDs interaction with this risk is suggested. These findings suggest that NSAIDs should not be recommended as a first-line antipyretic treatment during acute viral infections in children. Copyright © 2016 Elsevier Inc. All rights reserved.

Male gender and sonographic gall bladder wall thickness: important predictable factors for empyema and gangrene in acute cholecystitis

International Nuclear Information System (INIS)

Khan, M.L.U.; Jawed, M.; Shaikh, U.; Abbassi, M.R.

2014-01-01

Objective: To underline the status of male gender and gall bladder wall thickness as significant risk factors for acute cholecystitis complications. Methods: The retrospective study, with purposive sampling of the patients of acute cholecystits in age above 18 years, who were operated within 10 days of onset of symptoms, was conducted at the Department of Surgery, Dow University Hospital, Karachi, by reviewing the patients' medical record from March 2010 to August 2012. Correlation of incidence of acute cholecystitis complications (empyema and gangrene) to male gender and to the sonographic gall bladder wall thickness more than 4.5mm was analysed using SPSS 16. Result: Out of 62 patients, 8 (13%) patients had gangrene while 10 (16.12%) had empyema. Overall, there were 21 (33.87%) males in the study. Ten (47.6%) of the male patients developed empyema or gangrene of the gall bladder as a complication of acute cholecystitis. Of the 41 (66.12%) female patients, only 8 (19.5%) developed these complications. There were 22 (35.48%) cases of gall bladders with sonographic wall thickness more than 4.5mm who were operated for acute cholecystitis. Of them, 16 (72.7%) had empyema or gangrene. Conclusion: Male gender and sonographic gall bladder wall thickness more than 4.5mm were statistically significant risk factors for suspicion of complicated acute cholecystitis (empyema/gangrene) and by using these risk factors, we can prioritise patients for surgery in the emergency room. (author)

A Simple Method for Differentiating Complicated Parapneumonic Effusion/Empyema from Parapneumonic Effusion Using the Split Pleura Sign and the Amount of Pleural Effusion on Thoracic CT.

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Tsujimoto, Naoki; Saraya, Takeshi; Light, Richard W; Tsukahara, Yayoi; Koide, Takashi; Kurai, Daisuke; Ishii, Haruyuki; Kimura, Hirokazu; Goto, Hajime; Takizawa, Hajime

2015-01-01

Pleural separation, the "split pleura" sign, has been reported in patients with empyema. However, the diagnostic yield of the split pleura sign for complicated parapneumonic effusion (CPPE)/empyema and its utility for differentiating CPPE/empyema from parapneumonic effusion (PPE) remains unclear. This differentiation is important because CPPE/empyema patients need thoracic drainage. In this regard, the aim of this study was to develop a simple method to distinguish CPPE/empyema from PPE using computed tomography (CT) focusing on the split pleura sign, fluid attenuation values (HU: Hounsfield units), and amount of fluid collection measured on thoracic CT prior to diagnostic thoracentesis. A total of 83 consecutive patients who underwent chest CT and were diagnosed with CPPE (n=18)/empyema (n=18) or PPE (n=47) based on the diagnostic thoracentesis were retrospectively analyzed. On univariate analysis, the split pleura sign (odds ratio (OR), 12.1; ppleural effusion (≥30 mm) (OR, 6.13; ppleural fluid were significantly higher in the CPPE/empyema group than in the PPE group. On multivariate analysis, only the split pleura sign (hazard ratio (HR), 6.70; 95% confidence interval (CI), 1.91-23.5; p=0.003) and total amount of pleural effusion (≥30 mm) on thoracic CT (HR, 7.48; 95%CI, 1.76-31.8; p=0.006) were risk factors for empyema. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of both split pleura sign and total amount of pleural effusion (≥30 mm) on thoracic CT for CPPE/empyema were 79.4%, 80.9%, 75%, and 84.4%, respectively, with an area under the curve of 0.801 on receiver operating characteristic curve analysis. This study showed a high diagnostic yield of the split pleura sign and total amount of pleural fluid (≥30 mm) on thoracic CT that is useful and simple for discriminating between CPPE/empyema and PPE prior to diagnostic thoracentesis.

Post-pneumonectomy empyema and dosimetric CT scan. Report of two cases and review of literature

International Nuclear Information System (INIS)

Latorzeff, I.; Bachaud, J.M.; Aziza, R.; Arboucalot, F.; Berjaud, J.; Dahan, M.; Giron, J.

1999-01-01

Following a pneumonectomy for cancer, the patients are classically observed by clinical examination and standard chest X-ray. However, torpid empyemas can be missed when they occur after the period of hospitalization and when they are not accompanied by a fever, At the time of postoperative radiotherapy, the dosimetric CT scan constitutes the first examination providing objective information of the endo-thoracic content. It is therefore necessary on this occasion to assure the normality of the post-pneumonectomy pleural space while checking that the substituted liquid is homogeneous and above all that the internal mediastinal part of the cavity has a concave appearance. If that is not the case, an empyema should be suspected. The diagnosis, confirmed by a cyto-bacteriological examination of the pleural fluid, constitutes a counter-indication of the radiotherapy. We present two cases of post-pneumonectomy pauci-symptomatic empyema which were diagnosed during the course of postoperative radiotherapy when the initial dosimetric CT scan was pathologic and could have allowed an earlier diagnosis. (author)

A 3- Year Review of Patients with Chronic Empyema Treated ...

African Journals Online (AJOL)

The right {32(51.6%)} and left pleural space, {29(46.8%)} were affected with similar incidence. Only one patient was admitted with bilateral empyema. In the majority of patients, 46(74.2%), open thoracotomy with abscess drainage and decortications were done. In addition to this, either lobectomy or pnemonectomy was ...

Management of empyema - Role of a surgeon

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Gupta D

2005-01-01

Full Text Available Postpneumonic empyema still remains quite common in developing countries, especially during the hot and humid months. While most cases would respond to antibiotic therapy, needle aspiration and intercostal drainage, few cases require further surgical management. The most common nontubercular etiological agent is Staphylococcus. Tubercular etiology is not uncommon in India, especially due to delayed presentation, multiresistant strains, mismanaged cases, and noncompliance with antitubercular treatment amidst malnutrition and anemia. Clinical symptoms, a skiagram chest followed by thoracentesis are enough for diagnosis. Pleural fluid is usually diagnostic and helps in choosing the appropriate antibiotics. Further investigations and management depends on the stage of the disease. Thoracentesis alone may be sufficient for the exudative phase. In fibrinopurulent stage, a properly sized and well-placed tube thoracostomy with underwater seal is curative in most cases. Interventional radiologists have placed small-bore catheters, specifically directed to the loculated collection and have used fibrinolytics like urokinase, streptokinase, and tissue plasminogen activator (TPA to break loculations, ameliorate fibrous peel formation, and fibrin deposition. Thoracoscopic debridement and thoracoscopic decortication is an alternative with distinct advantages over thoracotmy and are indicated if there was no response with intercostal drainage procedure. In the organizing stage, a thoracotomy (for decortication would be required if there is a loculated empyema, underlying lung disease or persistently symptomatic effusions. Timely institution of proper management prevents the need for any surgical intervention and avoids long-term morbid complications.

Empyema of preexisting subdural hemorrhage caused by a rare salmonella species after exposure to bearded dragons in a foster home.

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Tabarani, Christy M; Bennett, Nicholas J; Kiska, Deanna L; Riddell, Scott W; Botash, Ann S; Domachowske, Joseph B

2010-02-01

An infant had a subdural empyema caused by the rare Salmonella species enterica subspecies houtenae (IV) serotype 44:z4,z23:- after only indirect exposure to exotic reptiles in her foster home. Infants recovering from preexisting subdural hematoma are at risk for development of empyema. Copyright 2010 Mosby, Inc. All rights reserved.

Empyema Thoracis in Children: Clinical Presentation, Management and Complications

International Nuclear Information System (INIS)

Saleem, A. F.; Shaikh, A. S.; Khan, R. S.; Khan, F.; Faruque, A. V.; Khan, M. A. M.

2014-01-01

Objective: To determine the etiology, clinical manifestation, management (medical and surgical) and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan. Study Design: Descriptive, analytical study. Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010. Methodology: Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight (kg) and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated. Results: Among the 112 patients, 59 (53%) were younger than 5 years of age. Males (n=83, 74%) were predominant. Fifty (45%) children were admitted in winter. Thirty (27%) children found unvaccinated and one fourth (n=27; 24%) were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six (59%) were on some antibiotics prior to admission. Staphylococcus aureus (n=13) and Streptococcus pneumoniae (n=5) were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention (n=86). Surgically managed children were younger (p=0.01); had less weight (p=0.01) and prolonged fever (p=0.02); and stayed longer in hospital (p < 0.001) as compared to medically managed children. Requiring readmission (n=8), subcutaneous emphysema (n=5) and recollection of pus (n=5) were the major complications. Conclusion: Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric

Vaccine-Induced Waning of Haemophilus influenzae Empyema and Meningitis, Angola

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Peltola, Heikki; Bernardino, Luis; Monteiro, Lurdes; Silvestre, Silvia da Conceição; Anjos, Elizabete; Cruzeiro, Manuel Leite; Pitkäranta, Anne; Roine, Irmeli

2014-01-01

In Angola during 2003–2012, we detected Haemophilus influenzae in 18% of 2,634 and 26% of 2,996 bacteriologically positive pleural or cerebrospinal fluid samples, respectively, from children. After vaccination launch in 2006, H. influenzae empyema declined by 83% and meningitis by 86%. Severe H. influenzae pneumonia and meningitis are preventable by vaccination. PMID:25340259

Impact of fibrinolytics on the outcome of empyema in South African ...

African Journals Online (AJOL)

Results. One hundred and forty-two children with empyema, median age 17 months (interquartile range 8 - 43), were admitted during the study period. Excluding children who did not have a chest tube inserted and those in whom fibrinolysis was contraindicated, there were 99 patients, 52 of whom received fibrinolytics.

Tuberculous brain abscess and subdural empyema in an immunocompetent child: Significance of AFB staining in aspirated pus

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B Vijayakumar

2012-01-01

Full Text Available Tuberculous brain abscess and subdural empyema are extremely rare manifestations of central nervous system tuberculosis. Here, we report a case of an 11-year-old immunocompetent child who developed temporal lobe abscess and subdural empyema following chronic otitis media. A right temporal craniotomy was performed and the abscess was excised. The Ziehl Nielsen staining of the aspirated pus from the temporal lobe abscess yielded acid fast bacilli. Prompt administration of antituberculous treatment resulted in complete recovery of the child. Even though the subdural abscess was not drained, we presume that to be of tubercular aetiology. Ours is probably the first case of brain abscess and subdural empyema due to Mycobacterium tuberculosis reported in the same child. This case is being reported because of its rarity and to stress the importance of routine staining for tubercle bacilli in all cases of brain abscess, especially in endemic areas, as it is difficult to differentiate tuberculous from pyogenic abscess clinically as well as histopathologically.

EMPYEMA THORACIS IN CHILDREN- EARLY SURGICAL TREATMENT IS BETTER

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Shyam Bihari Sharma

2016-11-01

Full Text Available BACKGROUND Prolonged intercostal drainage for empyema thoracis in children is difficult to manage by parents at home and at the same time prolonged stay at hospital increases the financial burden on them. Hence, aim of this study is to get rid of intercostal drainage earliest by performing surgery thereby decreasing the morbidity and mortality. This is a prospective study done in infant and children below age of 12 at Paediatric Surgery Department, National Institute of Medical Science, Jaipur-Delhi Highway, Jaipur, from May 2012 to April 2016. Total number of cases in which surgical intervention done were 13 out which 2 required lobectomy whereas in 11 cases decortication and removing of peel was done. MATERIALS AND METHODS Out of all thirteen patients, the age ranging from 6 months to 10 years, a proforma was made and kept in OPD and ward filling with investigation, symptomatology, treatment and follow up. RESULTS Out of all 13 cases, lung expansion was complete and all are symptom free, follow up 3 years to 1 month was there. CONCLUSION Early surgical intervention of empyema thoracis is beneficial in children as prolonged intercostal drainage increase the misery of the patients as well as their parents.

Lung Cancer in Patients With Tuberculous Fibrothorax and Empyema: Computed Tomography and 18F-Fluorodeoxyglucose Positron Emission Tomography Findings.

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Xu, Hai; Koo, Hyun Jung; Lee, Han Na; Lim, Soyeoun; Lee, Jae Wook; Choi, Chang-Min; Kim, Mi Young

The aim of this study was to describe the characteristics of lung cancers in patients with tuberculous fibrothorax or empyema. We retrospectively evaluated 138 consecutive patients with a diagnosis of lung cancer combined with fibrothorax (n = 127) or empyema (n = 11) from January 2005 to May 2015. All patients underwent computed tomography, and 105 underwent F-fluorodeoxyglucose positron emission tomography. Clinical, pathologic, and computed tomography characteristics and maximum standardized uptake values on positron emission tomography of 76 cancers ipsilateral to the fibrothorax or empyema (group 1) were compared with those of 62 contralateral cancers (group 2). The median age at diagnosis of patients was 70 years, with a male-to-female ratio of 8.9:1. The most common type was squamous cell carcinoma (41.3%) followed by adenocarcinoma (39.1%). Most were in the peripheral lung (70.3%), and half abutted the pleura. The median maximum standardized uptake value was 8.9. Tumors in group 1 were larger (median, 48.5 vs 42.8 mm, P = 0.036) and more advanced (T3 or T4) (P = 0.014) than those in group 2. Lung cancers ipsilateral to tuberculous fibrothorax or empyema presented larger and advanced T stages, and the diagnosis could be delayed. The most common type cancer was squamous cell carcinoma.

A colonic splenic flexure tumour presenting as an empyema thoracis: a case report.

LENUS (Irish Health Repository)

Murphy, K

2009-01-01

The case report describes the rare presentation of a 79-year-old patient with a locally perforated splenic flexure tumour of the colon presenting with an apparent empyema thoracis in the absence of abdominal signs or symptoms.

Surgical versus non-surgical management for pleural empyema.

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Redden, Mark D; Chin, Tze Yang; van Driel, Mieke L

2017-03-17

Empyema refers to pus in the pleural space, commonly due to adjacent pneumonia, chest wall injury, or a complication of thoracic surgery. A range of therapeutic options are available for its management, ranging from percutaneous aspiration and intercostal drainage to video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage. Intrapleural fibrinolytics may also be administered following intercostal drain insertion to facilitate pleural drainage. There is currently a lack of consensus regarding optimal treatment. To assess the effectiveness and safety of surgical versus non-surgical treatments for complicated parapneumonic effusion or pleural empyema. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015 to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015), Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS (1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for ongoing studies (December 2016). Randomised controlled trials that compared a surgical with a non-surgical method of management for all age groups with pleural empyema. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. We included eight randomised controlled trials with a total of 391 participants. Six trials focused on children and two on adults. Trials compared tube thoracostomy drainage (non-surgical), with or without intrapleural fibrinolytics, to either VATS or thoracotomy (surgical) for the management of pleural empyema. Assessment of risk of bias for the included studies was generally unclear for selection and blinding but low for attrition and reporting bias. Data analyses compared

emergency laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy

International Nuclear Information System (INIS)

Rangarajan, M.; Palanivelu, C.; Madankumar, M.V.

2007-01-01

This report describes a pregnant patient on whom emergency laparoscopic cholecystectomy was performed for empyema gallbladder. The patient was in her second trimester of pregnancy. The distended gallbladder was decompressed before dissection was commenced. There was no mortality, morbidity or conversion. There were no complications for either mother or child related to general anesthesia. (author)

Surgical management of stage III pediatric empyema thoracis.

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Singh, Aditya Pratap; Shukla, Arvind Kumar; Sharma, Pramila; Shukla, Jyotsna

2018-01-01

This study aims to report 100 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response to surgical intervention, and follow-up. All the children who underwent open decortication for stage III empyema thoracis during the study period January 2015-December 2016 were included. Preoperative workup included hemogram, serum protein, chest radiographs, and contrast-enhanced computed tomographic (CECT) scan of the chest. One hundred (65 males, 35 females) (age 2 months-13 years, mean 4.5 years) were operated during a 2-year period. Among them, 90% patients were referred 3 weeks after the onset of disease. Intercostal chest drainage (ICD) had been inserted in (95) 95% cases. Thickened pleura, multiloculated pus, and lung involvement were invariably seen on CECT scan. Bronchopleural fistula was present in five patients. Decortication and removal of necrotic tissue were performed in all the patients. Mean duration of postoperative ICD was 4 days. Follow-up ranged from 1 month to 2 years (mean 12 months). There was no mortality. Five patients had proven tuberculosis. Only 10% presented within the early period of the disease. The duration of the disease had a direct relationship with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery. Meticulous open surgical debridement gives gratifying results. The status of the lung at the end of surgery is a major prognostic factor.

Nested polymerase chain reaction (PCR) targeting 16S rDNA for bacterial identification in empyema.

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Prasad, Rajniti; Kumari, Chhaya; Das, B K; Nath, Gopal

2014-05-01

Empyema in children causes significant morbidity and mortality. However, identification of organisms is a major concern. To detect bacterial pathogens in pus specimens of children with empyema by 16S rDNA nested polymerase chain reaction (PCR) and correlate it with culture and sensitivity. Sixty-six children admitted to the paediatric ward with a diagnosis of empyema were enrolled prospectively. Aspirated pus was subjected to cytochemical examination, culture and sensitivity, and nested PCR targeting 16S rDNA using a universal eubacterial primer. Mean (SD) age was 5·8 (1·8) years (range 1-13). Analysis of aspirated pus demonstrated total leucocyte count >1000×10(6)/L, elevated protein (≧20 g/L) and decreased glucose (≤2·2 mmol/L) in 80·3%, 98·5% and 100%, respectively. Gram-positive cocci were detected in 29 (43·9%) and Gram-negative bacilli in two patients. Nested PCR for the presence of bacterial pathogens was positive in 50·0%, compared with 36·3% for culture. 16S rDNA PCR improves rates of detection of bacteria in pleural fluid, and can detect bacterial species in a single assay as well as identifying unusual and unexpected causal agents.

Computer tomographic diagnosis of lung abscesses and pleural empyemas

Energy Technology Data Exchange (ETDEWEB)

Luetgemeier, J.; Wunschik, F.

1983-06-01

Lung abscesses are characterised by irregular air spaces with non-homogeneous necrosis. Pleural empyemas often assume a sickle shape up against the thoracic wall and tend to be homogeneous. Problems in differential diagnosis may occur if the process is not confined to an exact anatomic position. A peripheral perforating abscess is isolated from the tracheobronchial system by thickened pleura and by its capsule; even if computer tomography does not show clear-cut findings, operative intervention is indicated.

Factors associated with recurrent bacterial empyema thoracis

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Apichat Tantraworasin

2018-07-01

Full Text Available Summary: Background: Empyema thoracis (ET is one of the common thoracic diseases frequently found in developing countries. In the past, only a few studies have analyzed recurrent ET, and none had clearly identified the prognostic factors for recurrence. The aim of this study is to identify the prognostic factors of recurrent ET in Northern Thailand. Methods: A retrospective cohort study was conducted. All patients diagnosed with Stage II and III ET at Maharaj Nakorn Chiang Mai Hospital (a tertiary-care hospital in northern Thailand between January 1, 2007 and November 31, 2012 were enrolled in this study. All clinical data were extracted from the medical recording system. The primary outcome was recurrent disease. Multivariable Cox’s proportion hazard model was used to identify the independent prognostic factors for recurrence. Results: There were 382 patients enrolled in this study, and 34 patients (8.9% had recurrent disease. The most common gram-positive and gram-negative pathogens found were Staphylococcus aureus and Acinetobacter baumannii, respectively. Three independent prognostic factors for recurrent disease were nonsepsis status prior to the surgery [hazard ratio (HR = 12.3; 95% confidence interval (CI, 4.25–35.43], nonperforming decortication (HR = 5.4; 95% CI, 1.82–15.92, and persistent pleural spaces (HR = 4.1; 95% CI, 1.93–8.68. Conclusions: Clinical characteristics, surgical procedure, and persistent pleural spaces were independent prognostic factors for ET recurrence in this study. Decortication and early thoracoplasty in patients who had persistent pleural space should be considered. Large cohort studies are warranted to support these findings. Keywords: empyema thoracis, incidence, prognostic factor, pyothorax, recurrence

Hippocrates Quoted "If an Empyema Does Not Rupture, Death Will Occur": Is Medical Thoracoscopy Able to Make It Rupture Safely?

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Hardavella, Georgia; Papakonstantinou, Nikolaos A; Karampinis, Ioannis; Papavasileiou, Gerasimos; Ajab, Shereen; Shafaat, Mohammed; Malagaris, Stavros; Anastasiou, Nikolaos

2017-01-01

The aim of this study was to evaluate the safety and efficacy of medical thoracoscopy through a single port [single-port medical thoracoscopy (S-MT)] for the treatment of empyema thoracis in its early stages. We performed a retrospective analysis reviewing the medical records of 84 patients referred for empyema and treated by medical thoracoscopy at our Thoracic Departments from January 2001 until November 2014. S-MT was performed under local anesthesia with neuroleptoanalgesia and spontaneous breathing using a single 1-cm incision for debridement and lavage of the pleural cavity. A total of 84 patients underwent S-MT for pleural empyema stage I (9 patients, 10.7%) or II (75 patients, 89.3%). Median age was 61.8 years (range, 18 to 84 y). Male to female ratio was 3.76. Surgery was performed 5 to 26 days after the onset of symptoms. Macroscopically complete debridement of the pleural cavity was achieved in 71 patients (84.5% of cases). The rest 15.5% of cases required video-assisted thoracoscopic surgery or open decortication due to trapped-lung syndrome. Median operation time was 45 minutes (range, 30 to 94 min). No intraoperative complications occurred. In-hospital mortality was zero, whereas in-hospital morbidity rate was 16.7%. Median hospital stay was 7.8 days (range, 3 to 18 days). Recurrence rate was 4.8% as 4 patients experienced a relapse of empyema. It seems that S-MT is a minimally invasive, safe and effective procedure for the treatment of pleural empyema with very good results in early stages of the disease and reduced time of hospital stay.

Unilateral empyema impacts the assessment of regional lung ventilation by electrical impedance tomography

International Nuclear Information System (INIS)

Bläser, D; Becher, T; Schädler, D; Elke, G; Weiler, N; Frerichs, I; Pulletz, S

2014-01-01

Several studies have shown the ability of electrical impedance tomography (EIT) to assess regional ventilation distribution in human lungs. Fluid accumulation in the pleural space as in empyema, typically occurring on one chest side, may influence the distribution of ventilation and the corresponding EIT findings. The aim of our study was to examine this effect on the assessment of regional ventilation by EIT. Six patients suffering from unilateral empyema and intubated with a double-lumen endotracheal tube were studied. EIT data were acquired during volume-controlled ventilation with bilateral (tidal volume (V T ): 800 ml) and unilateral ventilation (V T : 400 ml) of the right and left lungs. Mean tidal amplitudes of the EIT signal were calculated in all image pixels. The sums of these values, expressed as relative impedance change (rel. ΔZ), were then determined in whole images and functionally defined regions-of-interest (ROI). The sums of rel. ΔZ calculated during the two cases of one-lung ventilation either on the affected or unaffected side were significantly smaller than during bilateral ventilation. However, in contrast to previous findings in patients with no pleural pathology, very low values of rel. ΔZ were found when the lung on the affected side was ventilated. ROI-based analysis rendered higher values than the whole-image analysis in this case, nonetheless, the values were significantly smaller than when the unaffected side was ventilated in spite of identical V T . In conclusion, our results indicate that the presence of empyema may affect the quantitative evaluation of regional lung ventilation by EIT. (paper)

Massive empyema caused by Mycoplasma pneumoniae in an adult: A case report

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Ron Merav

2006-02-01

Full Text Available Abstract Background Mycoplasma pneumoniae is responsible for more than 20% of community acquired pneumonia cases, and capable of causing upper respiratory illness as well. Complications of M.pneumoniae infections include CNS involvement but other as pericarditis were also reported. The lack of feasible culture methods and under appreciation of the pathogens ability to cause invasive disease leads to reduced number of diagnosed M.pneumoniae related complications. In contrast to many other respiratory pathogens causing pneumonia, M. pneumoniae related severe pleural complications were almost never reported. Case presentation We report a previously healthy 57 years old woman presented with indolent massive right pleural effusion, leukocytosis and elevated ESR. Extensive microbiological evaluation didn't reveal any pathogen in the pus even before antibiotic treatment was started. Surprisingly, M.pneumoniae DNA was detected in the pus from the empyema using PCR designed to detect M.pneumoniae. A serological assay (Serodia-Myco II using convalescent serum was indeterminate with a titer of 1:80. The patient responded well to a treatment that included right thoracotomy with pleural decortication and a combination of antibiotics and anti-inflammatory medications. Conclusion M.pneumoniae related empyema was never reported before in adult patients and was reported in only a few pediatric patients. In our patient there was no evidence to any common pathogens even before initiating antibiotic treatment. The only pathogen detected was M.pneumoniae. In this patient, serology was not helpful in establishing the diagnosis of M.pneumoniae related diseases, as was suggested before for older patients. We suggest that M.pneumoniae related empyema is probably under-diagnosed complication due to insensitivity of serology in older patients and under use of other diagnosis methods.

Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients.

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Hsiao, Chen-Hao; Chen, Ke-Cheng; Chen, Jin-Shing

2017-04-01

Parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction are risky to receive surgical decortication under general anesthesia. Non-intubated video-assisted thoracoscopy surgery is successfully performed to avoid complications of general anesthesia. We performed single-port non-intubated video-assisted flexible thoracoscopy surgery in an endoscopic center. In this study, the possible role of our modified surgery to treat fibrinopurulent stage of parapneumonic empyema with high operative risks is investigated. We retrospectively reviewed fibrinopurulent stage of parapneumonic empyema patients between July 2011 and June 2014. Thirty-three patients with coronary artery disease and reduced left ventricular ejection fraction were included in this study. One group received tube thoracostomy, and the other group received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. Patient demographics, characteristics, laboratory findings, etiology, and treatment outcomes were compared. Mean age of 33 patients (24 males, 9 females) was 76.2 ± 9.7 years. Twelve patients received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication, and 21 patients received tube thoracostomy. Visual analog scale scores on postoperative first hour and first day were not significantly different in two groups (p value = 0.5505 and 0.2750, respectively). Chest tube drainage days, postoperative fever subsided days, postoperative hospital days, and total length of stay were significantly short in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication (p value = 0.0027, 0.0001, 0.0009, and 0.0065, respectively). Morbidities were low, and mortality was significantly low (p value = 0.0319) in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. Single-port non-intubated video-assisted flexible thoracoscopy surgery

Encapsulated subdural empyema. A case report with special reference to CT findings and operative indications

Energy Technology Data Exchange (ETDEWEB)

Tokunaga, Yoshiharu; Inoue, Masaru; Ishizaka, Hiroaki; Koga, Hiroaki; Kawano, Teruaki; Mori, Kazuo

1985-04-01

A case of encapsulated subdural empyema was reported. This 1.5-year-old boy was admitted with the increasing confusion and convulsion. Eight months prior to admission, he had craniotomy for traumatic acute epidural hematoma on the left side. Following a coagulation of the middle meningeal artery which was the bleeding source, the dura was opened but no cortical damage was noted at that time. The computed tomographic (CT) scan on admission revealed a large subdural collection with a thin enhancing rim on the left side. Emergency craniotomy revealed a collection of subdural pus, which was irrigated and a catheter was put for continuous drainage. Postoperatively, the patient did well, however, following removal of the catheter, three weeks after the first operation, the subdural empyema was reexpanded with a very thick enhancing rim on CT scan. Ultrasonography also clearly demonstrated the formation of the thick membranes. The large craniotomy was performed and empyema with the outer and inner memberanes of 8mm thick was totally excised. Post-operative CT scan did not show any enhancing rim, indicating that enchancement was caused by newly formed vessels within the membranes per se. This findings are totally different from those observed in the brain abscess in which ring enhancement on CT continues months to years following so-called extracapsular excision of abscess. In the brain abscess, surrounding glial tissue with plenty neovascularization is left intact, even after the operation. (author).

Pediatric pleural empyema: one of the management challenges in children of Democratic Republic of Congo.

Science.gov (United States)

Simbi, Kibwe Alphonse; Kazadi, Valentin; Aissi, Louis-Marie; Katsuva, François Mbahewaka; Luboya, Numbi Oscar; Tshilolo, Léon; Zanardo, Vincenzo

2017-06-23

Empyema is a serious complication characterized by purulent exudate and bacteria in the pleural space, which may progress to necrosis, cavitations or fistulas in the thoracic cavity. It remains a major challenge throughout low-income countries. Objectives were to emphasize the role of basic medical and radiologic approach and to resolve a severe lung complication when facilities are inadequate. A five-year-old female was referred with distress respiratory to the Emergency Unit of Monkole, a large public-private missionary hospital in Kinshasa, Congo. Chest X-ray showed a massive empyema that was resolved by immediate drainage and antibiotiocs. Results were rapid improvement and discharge after 3 weeks. A classic medical and imaging approach is a winning return in low-income countries. According to the British Thoracic Society guidelines, pleural effusion with compromising respiratory function can be managed by drainage and antibiotics.

[Transformation from chronic subdural hematoma into subdural empyema following cat bites: a case report].

Science.gov (United States)

Konno, Takuya; Yamada, Kei; Kasahara, Sou; Umeda, Yoshitaka; Oyake, Mutsuo; Fujita, Nobuya

2015-01-01

A 69-year-old man developed motor aphasia and right hemiparesis with severe headache, during the treatment of cellulitis and sepsis due to cat bites. Brain CT showed a low density, crescent-shaped lesion in the left subdural space, which was hypointense on brain diffusion-weighted imaging (DWI). One week later, when his neurological symptoms had worsened, the signal of the subdural lesion had changed to hyperintense on DWI. The lesion was capsule-shaped when enhanced by Gadolinium. The signal changes on DWI of the lesion indicated the existing hematoma had changed to an empyema, or so-called infected subdural hematoma, due to a hematogenous bacterial infection. Pasteurella multocida, a resident microbe in the oral cavity of cats, could be the responsible pathogen in this case. The patient recovered completely after treatment with intravenous high dose antibiotics. This is an important case report describing the transformation from a chronic subdural hematoma into a subdural empyema by DWI.

Subdural empyema following lumbar facet joint injection: An exceeding rare complication.

Science.gov (United States)

Fayeye, Oluwafikayo; Silva, Adikarige Haritha Dulanka; Chavda, Swarupsinh; Furtado, Navin Raoul

2016-01-01

Chronic low back pain is extremely common with a life time prevalence estimated at greater than 70%. Facet joint arthrosis is thought to be the causative aetiological substrate in approximately 25% of chronic low back pain cases. Facet joint injection is a routine intervention in the armamentarium for both the diagnostic and therapeutic management of chronic low back pain. In fact, a study by Carrino et al. reported in excess of 94,000 facet joint injection procedures were carried out in the US in 1999. Although generally considered safe, the procedure is not entirely without risk. Complications including bleeding, infection, exacerbation of pain, dural puncture headache, and pneumothorax have been described. We report a rare case of a 47-year-old female patient who developed a left L4/5 facet septic arthrosis with an associated subdural empyema and meningitis following facet joint injection. This case is unique, as to the best of our knowledge no other case of subdural empyema following facet joint injection has been reported in the literature. Furthermore this case serves to highlight the potential serious adverse sequelae of a routine and apparently innocuous intervention. The need for medical practitioners to be alert to and respond rapidly to the infective complications of facet joint injection cannot be understated. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Delayed intracranial subdural empyema following burr hole drainage: Case series and literature review.

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Kim, You-Sub; Joo, Sung-Pil; Song, Dong-Jun; Kim, Sung-Hyun; Kim, Tae-Sun

2018-05-01

A subdural empyema (SDE) following burr hole drainage of a chronic subdural hematoma (CSDH) can be difficult to distinguish from a recurrence of the CSDH, especially when imaging data is limited to a computed tomography (CT) scan. All patients underwent burr hole drainage of the CSDH at first, and the appearance of the SDE occurred within one month. A contrast-enhanced magnetic resonance imaging (MRI) scan, with diffusion-weighted imaging (DWI), revealed both the SDE and diffuse meningitis in all patients. In Case 1, because the patient was very young, burr hole drainage of the SDE, rather than craniotomy, was performed. However, subsequent craniotomy was required due to recurrence of the SDE. In Cases 2 and 3, an initial craniotomy was performed without burr hole drainage. Symptoms improved for all patients, and each was discharged without any neurologic deficits or subsequent recurrence. Neurosurgeons should consider the possibility of infection if recurrence of CSDH occurs within 1 month following drainage of a subdural hematoma. A contrast-enhanced MRI with DWI should be performed to differentiate SDE from CSDH. In addition, surgical evacuation of the empyema via wide craniotomy is preferred to burr hole drainage.

Primary Pulmonary Amebiasis Complicated with Multicystic Empyema

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Ali Zakaria

2016-01-01

Full Text Available Amebiasis is a parasitic infection caused by the protozoan Entamoeba histolytica. While most infections are asymptomatic, the disease could manifest clinically as amebic dysentery and/or extraintestinal invasion in the form of amebic liver abscess or other more rare manifestations such as pulmonary, cardiac, or brain involvement. Herein we are reporting a case of a 24-year-old male with history of Down syndrome who presented with severe right side pneumonia complicated with multicystic empyema resistant to regular medical therapy. Further investigation revealed a positive pleural fluid for E. histolytica cysts and trophozoites. The patient was diagnosed with primary pleuropulmonary amebiasis and he responded promptly to surgical drainage and metronidazole therapy. In patients from endemic areas all physicians should keep a high index of suspicion of amebiasis as a cause of pulmonary disease.

Does videothoracoscopy improve clinical outcomes when implemented as part of a pleural empyema treatment algorithm?

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Ricardo Mingarini Terra

Full Text Available OBJECTIVE: We aimed to evaluate whether the inclusion of videothoracoscopy in a pleural empyema treatment algorithm would change the clinical outcome of such patients. METHODS: This study performed quality-improvement research. We conducted a retrospective review of patients who underwent pleural decortication for pleural empyema at our institution from 2002 to 2008. With the old algorithm (January 2002 to September 2005, open decortication was the procedure of choice, and videothoracoscopy was only performed in certain sporadic mid-stage cases. With the new algorithm (October 2005 to December 2008, videothoracoscopy became the first-line treatment option, whereas open decortication was only performed in patients with a thick pleural peel (>2 cm observed by chest scan. The patients were divided into an old algorithm (n = 93 and new algorithm (n = 113 group and compared. The main outcome variables assessed included treatment failure (pleural space reintervention or death up to 60 days after medical discharge and the occurrence of complications. RESULTS: Videothoracoscopy and open decortication were performed in 13 and 80 patients from the old algorithm group and in 81 and 32 patients from the new algorithm group, respectively (p<0.01. The patients in the new algorithm group were older (41 +1 vs. 46.3+ 16.7 years, p = 0.014 and had higher Charlson Comorbidity Index scores [0(0-3 vs. 2(0-4, p = 0.032]. The occurrence of treatment failure was similar in both groups (19.35% vs. 24.77%, p = 0.35, although the complication rate was lower in the new algorithm group (48.3% vs. 33.6%, p = 0.04. CONCLUSIONS: The wider use of videothoracoscopy in pleural empyema treatment was associated with fewer complications and unaltered rates of mortality and reoperation even though more severely ill patients were subjected to videothoracoscopic surgery.

Intracavitary application of contrast medium in the follow-up of complicated tube-drained pleural empyema: Conventional radiography vs CT

International Nuclear Information System (INIS)

Duex, M.; Bischoff, H.; Schmaehl, A.; Tuengerthal, S.

1997-01-01

Purpose: To define the value of conventional radiography compared with CT in the follow-up of complicated, long-term tube drained pleural empyema after intracavitary application of contrast medium. Methods: 28 patients with complicated pleural empyema (stage III) and longterm tube drainage were submitted to fluoroscopy of the pleural cavity and a CT of the thorax after contrast medium had been instilled into the pleural space. Both examinations were judged by the following criteria: Number and morphology of pleural cavities, quality of drainage and accompanying thoracic disease. Results: 49 pleural cavities were diagnosed. Judgement of drainage corresponded in 79% of cases and differed 21% with proof of further not drained cavities only on CT. 4 bronchopleural fistulas were diagnosed by fluoroscopy, of which only 2 were evident on CT. Accompanying thoracic disease was reliably detected by CT only. Conclusions: Diagnosis of bronchopleural fistulas and judgement of the pleural drainage is best possible using fluoroscopy after application of contrast medium into the pleural space. CT is most accurate to detect further cavities that have not been drained, to look for concomitant thoracic disease, and to judge the morphology of the pleural cavity. Conventional radiography of the pleural space is effective and recommended to be used as a first line investigation for the follow-up of stage III empyemas. Patients in poor general condition (fever, elevated blood markers indicating inflammation) should be examined by both fluoroscopy and CT. (orig.) [de

[Lung Abscess with Acute Empyema Which Improved after Performing by Video Assissted Thoracic Surgery( Including Pneumonotomy and Lung Abscess Drainage);Report of a Case].

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Gabe, Atsushi; Nagamine, Naoji

2017-05-01

We herein report the case of a patient demonstrating a lung abscess with acute empyema which improved after performing pnemumonotomy and lung abscess drainage. A 60-year-old male was referred to our hospital to receive treatment for a lung abscess with acute empyema. At surgery, the lung parenchyma was slightly torn with pus leakage. After drainage of lung abscess by enlarging the injured part, curettage in the thoracic cavity and decortication were performed. The postoperative course was uneventful. Direct drainage of an abscess into the thoracic cavity is thought to be a choice for the treatment of lung abscesses.

Fatal pneumonia and empyema thoracis caused by imipenem-resistant Nocardia abscessus in a cancer patient.

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Lai, Chih-Cheng; Tsai, Hsih-Yeh; Ruan, Sheng-Yuan; Liao, Chun-Hsing; Hsueh, Po-Ren

2015-12-01

We describe a case of pneumonia and empyema thoracis caused by trimethoprim-sulfamethoxazole-susceptible, but imipenem-resistant Nocardia abscessus in a cancer patient. The isolate was confirmed to the species level by 16S rRNA sequencing analysis. The patient did not respond to antibiotic therapy, including ceftriaxone and imipenem, and died of progressing pneumonia and multiple organ failure. Copyright © 2013. Published by Elsevier B.V.

Short-term and long-term outcomes of intrathoracic vacuum therapy of empyema in debilitated patients

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Zsolt Sziklavari

2016-10-01

Full Text Available Abstract Background This retrospective study analyzed the effectiveness of intrathoracic negative pressure therapy for debilitated patients with empyema and compared the short-term and long-term outcomes of three different intrapleural vacuum-assisted closure (VAC techniques. Methods We investigated 43 consecutive (preseptic patients with poor general condition (Karnofsky index ≤ 50 % and multimorbidity (≥ 3 organ diseases or immunosuppression, who had been treated for primary, postoperative, or recurrent pleural empyema with VAC in combination with open window thoracostomy (OWT-VAC with minimally invasive technique (Mini-VAC, and instillation (Mini-VAC-Instill. Results The overall duration of intrathoracic vacuum therapy was 14 days (5–48 days. Vacuum duration in the Mini-VAC and Mini-VAC-Instill groups (12.4 ± 5.7 and 10.4 ± 5.4 days was significantly shorter (p = 0.001 than in the group treated with open window thoracostomy (OWT-VAC (20.3 ± 9.4 days. No major complication was related to intrathoracic VAC therapy. Chest wall closure rates were significantly higher in the Mini-VAC and Mini-VAC-Instill groups than in the OWT-VAC group (p = 0.034 and p = 0.026. Overall, the mean postoperative length of stay in hospital (LOS was 21 days (median 18, 6–51 days. LOS was significantly shorter (p = 0.027 in the Mini-VAC-Instill group (15.1 ± 4.8 than in the other two groups (23.8 ± 12.3 and 22.7 ± 1.5. Overall, the 30-day and 60-day mortality rates were 4.7 % (2/43 and 9.3 % (4/43, and none of the deaths was related to infection. Conclusions For debilitated patients, immediate minimally invasive intrathoracic vacuum therapy is a safe and viable alternative to OWT. Mini-VAC-Instill may have the fastest clearance and healing rates of empyema.

Short-term and long-term outcomes of intrathoracic vacuum therapy of empyema in debilitated patients.

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Sziklavari, Zsolt; Ried, Michael; Zeman, Florian; Grosser, Christian; Szöke, Tamas; Neu, Reiner; Schemm, Rudolf; Hofmann, Hans-Stefan

2016-10-21

This retrospective study analyzed the effectiveness of intrathoracic negative pressure therapy for debilitated patients with empyema and compared the short-term and long-term outcomes of three different intrapleural vacuum-assisted closure (VAC) techniques. We investigated 43 consecutive (pre)septic patients with poor general condition (Karnofsky index ≤ 50 %) and multimorbidity (≥ 3 organ diseases) or immunosuppression, who had been treated for primary, postoperative, or recurrent pleural empyema with VAC in combination with open window thoracostomy (OWT-VAC) with minimally invasive technique (Mini-VAC), and instillation (Mini-VAC-Instill). The overall duration of intrathoracic vacuum therapy was 14 days (5-48 days). Vacuum duration in the Mini-VAC and Mini-VAC-Instill groups (12.4 ± 5.7 and 10.4 ± 5.4 days) was significantly shorter (p = 0.001) than in the group treated with open window thoracostomy (OWT)-VAC (20.3 ± 9.4 days). No major complication was related to intrathoracic VAC therapy. Chest wall closure rates were significantly higher in the Mini-VAC and Mini-VAC-Instill groups than in the OWT-VAC group (p = 0.034 and p = 0.026). Overall, the mean postoperative length of stay in hospital (LOS) was 21 days (median 18, 6-51 days). LOS was significantly shorter (p = 0.027) in the Mini-VAC-Instill group (15.1 ± 4.8) than in the other two groups (23.8 ± 12.3 and 22.7 ± 1.5). Overall, the 30-day and 60-day mortality rates were 4.7 % (2/43) and 9.3 % (4/43), and none of the deaths was related to infection. For debilitated patients, immediate minimally invasive intrathoracic vacuum therapy is a safe and viable alternative to OWT. Mini-VAC-Instill may have the fastest clearance and healing rates of empyema.

Cerebral Abscess and Extraaxial Empyema in a Patient with Kartagener Syndrome

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Idil Gunes Tatar

2013-06-01

Full Text Available The triad of situs inversus totalis, bronchiectasis and sinusitis is known as Kartagener syndrome which is among the diseases with ciliopathies. Herein we present a case of cerebral abscess and extraaxial empyema detected in a 21-year-old male patient with Kartagener syndrome and a 10-year history of substance abuse. Preoperative CT, MRI findings and postoperative complications are presented with clinical and radiological review of primary ciliary dyskinesia. The consideration of primary ciliary dyskinesia in the differential diagnosis of frequent occurence of cough, rhinitis and otitis media in children is crucial since early diagnosis is known to affect the short term and long term morbidity.

New therapy of pleural empyema by deoxyribonuclease

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Grzegorz Kacprzak

2013-02-01

Full Text Available Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on patient general condition, but in all cases the essential procedure is to insert a drain into the pleural cavity and to evacuate the pus. Sometimes pus is very thick and its evacuation and following re-expansion of the lung is rather impossible. In these patients surgical intervention is needed. The use of intrapleural enzymes to support the drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal deoxyribonuclease. Nowadays, purified streptokinase has come into widespread use, but recent studies reported no streptokinase effect on pus viscosity. On the other side, deoxyribonuclease reduces pus viscosity and may be more useful in treatment. We report two cases of intrapleural administration of Pulmozyme (alfa dornase - deoxyribonuclease (HOFFMANN-LA ROCHE AG in dosage 2 × 2.5 mg with a significant improvement caused by changes in pus viscosity.

New therapy of pleural empyema by deoxyribonuclease

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Grzegorz Kacprzak

Full Text Available Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on patient general condition, but in all cases the essential procedure is to insert a drain into the pleural cavity and to evacuate the pus. Sometimes pus is very thick and its evacuation and following re-expansion of the lung is rather impossible. In these patients surgical intervention is needed. The use of intrapleural enzymes to support the drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal deoxyribonuclease. Nowadays, purified streptokinase has come into widespread use, but recent studies reported no streptokinase effect on pus viscosity. On the other side, deoxyribonuclease reduces pus viscosity and may be more useful in treatment. We report two cases of intrapleural administration of Pulmozyme (alfa dornase - deoxyribonuclease (HOFFMANN-LA ROCHE AG in dosage 2 × 2.5 mg with a significant improvement caused by changes in pus viscosity.

TRAUMATIC GASTROPLEURAL FISTULA COMPLICATED BY EMPYEMA AND PNEUMOTHORAX

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Vijay Kumar

2015-02-01

Full Text Available We herein report a case of traumatic gastropleural fistula complicated by empyema and pneumothorax which is a rare entity. A 22 year old male was admitted with alleged history of stab injury to left lower chest. Patient was f ound to have left sided pneumothorax, for which intercostal drainage tube was inserted and the patient stabilised. Chest radiograph taken three days after the chest tube insertion showed persistent hydropneumothorax for which the patient underwent a contra st enhanced computed tomography of thorax (CECT. CECT of thorax revealed herniation of fundus of stomach through a defect in the left dome of diaphragm into the left thoracic cavity with leakage of oral contrast into the left pleural cavity. Preoperative diagnosis of gastropleural fistula was made and the same was confirmed in the intraoperative findings. The patient underwent laparotomy with repair of the diaphragmatic defect and closure of the gastric perforation. The patient made an uneventful recovery

Empyema Necessitans in the Setting of Methicillin-Susceptible Staphylococcus aureus Causing Pneumonia and Bacteremia

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Sindhura Bandaru

2018-01-01

Full Text Available Empyema necessitans (EN is a rare phenomenon that refers to an insidious extension of the empyema through parietal pleura and subsequent dissection into subcutaneous tissue of the chest wall. A 29-year-old man presented to the hospital with fever and chills a few days after an inadvertent needle stick while injecting heroin. His left forearm was warm with an area of fluctuance. He underwent incision and drainage of the left forearm abscess with fluid submitted for Gram stain and culture. His condition rapidly deteriorated due to sepsis, and he required transfer to the intensive care unit. A new 4 × 3 cm area over the left pectoralis muscle had become increasingly indurated, fluctuant, and erythematous. CT of the chest demonstrated extensive cavitary lung lesions and a large loculated left-sided pleural effusion with extension through the chest wall. TEE revealed a 3 cm complex lesion on the superior septal leaflet of the tricuspid valve. The patient underwent incision and drainage of the pectoralis major EN with placement of a drain. Blood and sputum cultures grew methicillin-susceptible Staphylococcus aureus (MSSA at which time antibiotic therapy was tailored to oxacillin. Our case highlights a rare occurrence of EN due to MSSA in a patient with intravenous drug use (IDU and underscores the importance of prompt diagnosis and treatment.

A fatal case of empyema thoracis by Nocardia farcinica in an immunocompromised patient

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Parande M

2010-01-01

Full Text Available Empyema thoracis by Nocardia farcinica infection is uncommon. Here we report a rare and fatal infection in a 27-year-old HIV- seropositive male who presented with cough, expectoration, and breathlessness. Nocardia farcinica was isolated from sputum and pus from the pleural cavity. Confirmation of the isolate and minimum inhibitory concentrations (MIC for various antibiotics was done at the Aerobic Actinomycetes Reference Laboratory, Centres for Disease Control and Prevention (CDC, Atlanta. Patient was treated with suitable antibiotics and antiretroviral drugs in spite of which he eventually succumbed to the disease.

Acute exacerbation of idiopathic pulmonary fibrosis triggered by Aspergillus empyema

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Atsushi Suzuki

Full Text Available Acute exacerbation (AE is a severe and life-threatening complication of idiopathic pulmonary fibrosis (IPF. In 2016, the definition and diagnostic criteria for AE-IPF were updated by an international working group. The new definition includes any acute, clinically significant respiratory deterioration (both idiopathic and triggered events characterized by evidence of new widespread alveolar abnormality in patients with IPF. There are no currently proven beneficial management strategies for idiopathic and triggered AE-IPF. This is the first report describing AE-IPF triggered by Aspergillus empyema, which was improved by a combination of corticosteroid, systemic antifungal therapy, local antifungal therapy, and additional pharmacological therapies. Future research may reveal optimal strategies for both idiopathic and triggered AE-IPF. Keywords: Idiopathic pulmonary fibrosis, Acute exacerbation, AE-IPF, Triggered AE, Aspergillus infection

Detection of Fusobacterium nucleatum in two cases of empyema and lung abscess using paromomycin-vancomycin supplemented Brucella HK agar.

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Nagaoka, Kentaro; Yanagihara, Katsunori; Morinaga, Yoshitomo; Kohno, Shigeru

2017-02-01

Fusobacterium nucleatum was found in patients with empyema or pulmonary abscess, using paromomycin-vancomycin Brucella HK agar. In vitro examination revealed that growth of the strains differed significantly in different media. Clinicians should be aware that suboptimal F. nucleatum cultivation methods may result in an underestimation of its frequency. Copyright © 2016 Elsevier Ltd. All rights reserved.

Thoracic empyema and pectoral abscess resulting from attempting suicide by injection of benzene in the pleural cavity

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Sjaak Pouwels

Full Text Available Background: Exposure to hydrocarbon compounds, such as benzene may cause injury to several organ systems. It occurs accidentally or intentionally by ingestion, inhalation, cutaneous exposure and either subcutaneous injection or intravenous injection. We report a patient who injected benzene into the left hemithorax and secondly attempted to commit suicide with paracetamol. Case presentation: A 52-year old man was admitted in the hospital because of an attempted suicide with an injection of benzene in the left hemithorax and ingestion of 50 tablets of 500 mg paracetamol. He developed a hydro-tensionpneumothorax due to inflammatory pleural effusion as a reaction to intrathoracic benzene. Therefore a chest-tube was inserted. A few days later he developed an empyema in the left lung and secondly a pectoral abscess, which required surgical debridement. After surgery, recovered fully and after 23 days of hospitalisation he was discharged to a psychiatric care facility. Conclusion: Hydrocarbon poisoning is either accidentally or intentionally and leads to thoracic pathology in rare cases. The most affected organ system is the respiratory system, and the cytotoxic effects of hydrocarbons can manifest as respiratory failure, pneumonitis and even acute respiratory distress syndrome (ARDS. Keywords: Benzene intoxication, Thoracic empyema, Hydrocarbon poisoning

Invasive pneumococcal disease in healthy adults: increase of empyema associated with the clonal-type Sweden(1-ST306.

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Imma Grau

Full Text Available BACKGROUND: Adult invasive pneumococcal disease (IPD occurs mainly in the elderly and patients with co-morbidities. Little is known about the clinical characteristics, serotypes and genotypes causing IPD in healthy adults. METHODS: We studied 745 culture-proven cases of IPD in adult patients aged 18-64 years (1996-2010. Patients were included in two groups: 1. adults with co-morbidities, and 2. healthy adults, who had no prior or coincident diagnosis of a chronic or immunosuppressive underlying disease. Microbiological studies included pneumococcal serotyping and genotyping. RESULTS: Of 745 IPD episodes, 525 (70% occurred in patients with co-morbidities and 220 (30% in healthy adults. The healthy adults with IPD were often smokers (56% or alcohol abusers (18%. As compared to patients with co-morbidities, the healthy adults had (P<0.05: younger age (43.5+/-13.1 vs. 48.7+/-11.3 years; higher proportions of women (45% vs. 24%, pneumonia with empyema (15% vs. 7% and infection with non-PCV7 serotypes including serotypes 1 (25% vs. 5%, 7F (13% vs. 4%, and 5 (7% vs. 2%; and lower mortality (5% vs. 20%. Empyema was more frequently caused by serotype 1. No death occurred among 79 patients with serotype 1 IPD. There was an emergence of virulent clonal-types Sweden(1-ST306 and Netherlands(7F-ST191. The vaccine serotype coverage with the PCV13 was higher in healthy adults than in patients with co-morbidities: 82% and 56%, respectively, P<0.001. CONCLUSION: In this clinical study, one-third of adults with IPD had no underlying chronic or immunosuppressive diseases (healthy adults. They were often smokers and alcohol abusers, and frequently presents with pneumonia and empyema caused by virulent clones of non-PCV7 serotypes such as the Sweden(1-ST306. Thus, implementing tobacco and alcohol abuse-cessation measures and a proper pneumococcal vaccination, such as PCV13 policy, in active smokers and alcohol abusers may diminish the burden of IPD in adults.

Angiosarcoma of the Chest Wall associated with Chronic Empyema and Pulmonary Metastasis: A Case Report

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Kim, Dong Won; Lee, Ki Nam; Lee, Sang Yun; Roh, Mee Sook

2011-01-01

Angiosarcoma of the chest wall is a very rare tumor and it is difficult to radiologically differentiate this tumor from other malignant tumors. Chronic tuberculous empyema is a predisposing factor that has been associated with angiosarcoma. We report here on a case of a 66-year-old man with angiosarcoma that arose in the chest wall. Computed tomography (CT) demonstrated a heterogeneous enhancing mass in the chest wall with calcified pleural thickening and multiple pulmonary nodules with the halo sign, which all indicated the presence of sarcoma with hypervascular metastases

Empyema and bacteremic pneumococcal pneumonia in children under five years of age

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Maria Regina Alves Cardoso

2014-01-01

Full Text Available We compared bacteremic pneumococcal pneumonia (BPP and pneumococcal empyema (PE, in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP, was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.

An intractable empyema proceeded from radiation pneumonitis after operation of lung cancer

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Masuya, Daiki; Gotoh, Masashi; Nakashima, Takashi; Okamoto, Taku; Liu, Dage; Ishikawa, Shinya; Yamamoto, Yasumichi; Huang, Cheng-Long; Yokomise, Hiroyasu

2005-01-01

A 54-year-old man underwent left upper lobectomy with c-stage IIIA lung squamous cell carcinoma after concurrent chemo-radiotherapy. Radiation pneumonitis focusing on the residual left S 6 appeared after operation. Following steroid pulse treatment, the pneumonitic focus was cavitated and proceeded to pulmonary abscess. Although chest drainage was performed, control of the pulmonary fistula was poor, so an operation was performed. Pulmonary decortication and pleurodesis were performed, but failed to control the fistula and infection. Finally, thoracoplasty, omentoplasty and free rectus abdominis musculocutaneous flap were filled in intrathorasic to manage the fistula. In this case of operation following concurrent chemo-radiotherapy, the original recovery power declined. We therefore conclude this was an intractable case of empyema. (author)

Post-pneumonectomy empyema and dosimetric CT scan. Report of two cases and review of literature; Empyeme thoracique postpneumonectomie et scanographie dosimetrique. A propos de deux observations et revue de la litterature

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Latorzeff, I.; Bachaud, J.M.; Aziza, R.; Arboucalot, F. [Centre Claudius-Regaud, 31 - Toulouse (France); Berjaud, J.; Dahan, M.; Giron, J. [Centre Hospitalier Universitaire Purpan, 31 - Toulouse (France)

1999-12-01

Following a pneumonectomy for cancer, the patients are classically observed by clinical examination and standard chest X-ray. However, torpid empyemas can be missed when they occur after the period of hospitalization and when they are not accompanied by a fever, At the time of postoperative radiotherapy, the dosimetric CT scan constitutes the first examination providing objective information of the endo-thoracic content. It is therefore necessary on this occasion to assure the normality of the post-pneumonectomy pleural space while checking that the substituted liquid is homogeneous and above all that the internal mediastinal part of the cavity has a concave appearance. If that is not the case, an empyema should be suspected. The diagnosis, confirmed by a cyto-bacteriological examination of the pleural fluid, constitutes a counter-indication of the radiotherapy. We present two cases of post-pneumonectomy pauci-symptomatic empyema which were diagnosed during the course of postoperative radiotherapy when the initial dosimetric CT scan was pathologic and could have allowed an earlier diagnosis. (author)

Community-Acquired Pneumonia and Empyema Caused by Citrobacter koseri in an Immunocompetent Patient

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Miguel Angel Ariza-Prota

2015-01-01

Full Text Available Citrobacter species, belonging to the family Enterobacteriaceae, are environmental organisms commonly found in soil, water, and the intestinal tracts of animals and humans. Citrobacter koseri is known to be an uncommon but serious cause of both sporadic and epidemic septicemia and meningitis in neonates and young infants. Most cases reported have occurred in immunocompromised hosts. The infections caused by Citrobacter are difficult to treat with usual broad spectrum antibiotics owing to rapid generation of mutants and have been associated with high death rates in the past. We believe this is the first case described in the literature of a community-acquired pneumonia and empyema caused by Citrobacter koseri in an immunocompetent adult patient.

Right Hemithorax Empyema in a Known Case of Caroli Syndrome

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R. Ebrahimian

2015-10-01

Full Text Available Introduction: Caroli disease is a rare congenital disorder characterized by segmental, nonob-structive dilatation of intrahepatic bile ducts. The term Caroli syndrome is used for the asso-ciation of Caroli disease with congenital hepatic fibrosis. Case Report: A 37 year old woman, a diagnosed case of Caroli syndrome, was admitted to hospital because of fever, cough and sputum. During the clinical examination and imaging, thoracic empyema and lung abscess was seen in the right hemithorax. Also, pneumobilia was seen in abdominal CT scan. Conclusion: Tube thoracostomy was done but lung did not expand. Therefore , right thora-cotomy was performed. Intraoperative finding was as fallows :because of biliary tract infec-tion and abccess formation the tracts were fistulated to the lung parenchyma and pleural space. Irrigation and drainage was performed. After 2 weeks the patient was discharged. He was being fallowed up for 1 year after the surgery and no serious problem was observed. (Sci J Hamadan Univ Med Sci 2015; 22 (3: 263-267

Thoracic empyema and lung abscess resulting from gastropulmonary fistula as a complication of esophagectomy.

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Osaki, Toshihiro; Matsuura, Hiroshi

2008-06-01

A benign fistula between the gastric tube and the airway resulting from esophagectomy is a rare complication, but it is a potentially life-threatening status. We present a 59-year-old man with thoracic empyema and lung abscess resulting from a benign gastric tube-to-pulmonary fistula caused by a penetration of the peptic ulcer in the gastric tube four years after an esophagectomy for esophageal cancer. After a thorough conservative management of infection and nutrition, the fistula was successfully repaired surgically with direct closure. The postoperative course was uneventful. Two years and nine months later, the patient retains satisfactory oral feeding status and is in good general condition.

[A case showing a complete response by weekly paclitaxel associated with severe empyema and mediastinal abscess caused by reduction of a recurrent lung metastatic tumor originating from adenocarcinoma of the esophagogastric junction after primary operation].

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Kimura, Akiharu; Hiramatsu, Kiyoshi; Sakuragawa, Tadayuki; Ito, Takaaki; Otsuji, Hidehiko; Tsuchiya, Tomonori; Hara, Tomohiro; Maeda, Takao; Tanaka, Hiroshi; Machiki, Yuichi; Hosoya, Jun; Kojima, Tsuyoshi; Kato, Kenji

2010-02-01

The patient was a 57-year-old man who presented with cancer of the esophagogastric junction. He underwent total gastrectomy, lower esophagectomy, distal pancreatectomy and splenectomy with para-aortic lymphnode dissection by the transthoracoabdominal approach. He was given a daily dose of 100 mg of S-1 as adjuvant chemotherapy. About one year after the operation, lung metastasis was recognized by enhanced CT examination. He began weekly paclitaxel as second-line chemotherapy. Paclitaxel was infused once a week. About two weeks after the first infusion therapy, he was admitted to our hospital with fever and dyspnea. A chest enhanced CT revealed remarkable empyema and mediastinal abscess. Chest drainage and mediastinal drainage were performed.After one month of drainage, the empyema and mediastinal abscess had improved. The metastastic tumor of the lung disappeared at the time of discharge. CR has been maintained for more than a year without chemotherapy.This case suggests that remarkable reduction of the tumor induced by chemotherapy may have caused the empyema and mediastinal abscess.

Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction.

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Cariati, Paolo; Cabello-Serrano, Almudena; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas

2016-10-01

Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words: Meningitis, subdural empyema, odontogenic infections.

Indução de empiema em ratos através da inoculação pleural de bactérias Experimental empyema in rats through intrapleural injection of bacteria

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José Carlos Fraga

2001-12-01

Full Text Available OBJETIVOS: avaliar a indução experimental de empiema em ratos, através da inoculação intrapleural de duas bactérias (Pasteurella multocida e Staphylococcus aureus, utilizando técnica cirúrgica simples e de fácil execução. MÉTODOS: foram utilizados 24 ratos albinos da raça Wistar, de ambos os sexos, pesando entre 250 e 300g, que, após a anestesia geral, foram submetidos à toracotomia anterior direita, afastamento da musculatura e inoculação de 0,2ml de solução, conforme descrição a seguir: grupo I (n=12, inoculação de Pasteurella multocida, 10(10 unidades formadoras de colônia/ml cultivados em caldo cérebro-coração; grupo II (n=8, inoculação de Staphylococcus aureus, 10(10 unidades formadoras de colônia/ml cultivados em caldo cérebro-coração; e grupo III (n=4, inoculação de caldo cérebro-coração estéril (controle. Os animais foram sacrificados em até 7 dias e a intensidade da reação pleural, analisada macroscopicamente conforme escala padronizada. Também foram avaliados a mortalidade, o volume de líquido na cavidade pleural e o exame bacteriológico (animais mortos e líquido pleural. RESULTADOS: no grupo I (Pasteurella multocida, sete ratos morreram nas primeiras 48 horas de experimento. Cinco ratos foram sacrificados no período programado, mas nenhum deles apresentava empiema. No grupo II (Staphylococcus aureus, somente um animal morreu nas primeiras 24 horas, os outros 7 (88% foram sacrificados e apresentavam empiema. No grupo III, considerados controles, todos os animais sobreviveram, não se observando nenhuma anormalidade torácica ao sacrifício. Analisando conjuntamente os grupos, a indução de empiema esteve associada de maneira significativa à inoculação de Staphylococcus aureus no espaço pleural (p OBJECTIVE: to evaluate empyema formation in rats through the injection of two bacteria (Pasteurella multocida and Staphylococcus aureus, using a simple, easy-to-use surgical technique

Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome.

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Benevides, Gabriel Núncio; Salgado, German Alcoba; Ferreira, Cristiane Rúbia; Felipe-Silva, Aloísio; Gilio, Alfredo Elias

2015-01-01

The symptoms of a previously healthy 14-year-old female with an initial history of tooth pain and swelling of the left maxillary evolved to a progressive headache and altered neurological findings characterized by auditory hallucinations, sleep disturbances, and aggressiveness. She was brought to the emergency department after 21 days of the initial symptoms. An initial computed tomography (CT) scan showed frontal subdural empyema with bone erosion. The symptoms continued to evolve to brain herniation 24 hours after admission. A second CT scan showed a left internal jugular vein thrombosis. The outcome was unfavorable and the patient died on the second day after admission. The autopsy findings depicted rarefaction of the cranial bone at the left side of the frontal sinus, and overt meningitis. The severe infection was further complicated by thrombophlebitis of the left internal jugular vein up to the superior vena cava with septic embolization to the lungs, pneumonia, and sepsis. This case report highlights the degree of severity that a trivial infection can reach. The unusual presentation of the sinusitis may have wrongly guided the approach of this unfortunate case.

Hippocrates (ca 460-375 bc), Introducing Thoracotomy Combined With a Tracheal Intubation for the Parapneumonic Pleural Effusions and Empyema Thoracis.

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Tsoucalas, Gregory; Sgantzos, Markos

2016-12-01

Hippocrates was the first physician to describe in accuracy pleural effusion and pneumonia. To treat empyema thoracis he had introduced a combined method of tracheal intubation with a simultaneously thoracotomy. The surgical incision was used for the pus to be progressively drainaged. If the patient was too weak to eat, he had suggested for nutritional mixtures to be administered through an oral-gastric tube. Thus Hippocrates composed in his operating theatre, an icon similar to modern surgical operations. © The Author(s) 2016.

Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

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J. Zhang

Full Text Available A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

A case report of secondary Budd-Chiari syndrome due to chronic empyema diagnosed by NMR-CT

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Takagi, Sayumi; Hattori, Akira; Yamauchi, Masayosi; Kimura, Kazuo; Suzino, Hajime; Sibata, Koji; Watanabe, Reijiro; Kameda, Haruo

1985-01-01

A 34-year-old male patient complained of general fatigue, ascites, and edema of the lower extremities. A chest x-ray film showed atelectasis of the right lung and pleural effusion of the right side. Liver ultrasonography revealed stenosis of the middle and right hepatic veins. Venacavography revealed stenosis of the inferior vena cava and collateral circulation. Finally, abdominal NMR-CT clearly visualized lunate stenosis and antero-lateral deviation of the inferior vena cava. He was diagnosed as having secondary Budd-Chiari syndrome resulting from the deviation and stenosis of the inferior vena cava due to distortion of the surrounding tissues by the thickened pleura which was caused by chronic empyema. (Namekawa, K.)

Treatment of complicated parapneumonic pleural effusion and pleural parapneumonic empyema.

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Rodríguez Suárez, Pedro; Freixinet Gilart, Jorge; Hernández Pérez, José María; Hussein Serhal, Mohamed; López Artalejo, Antonio

2012-07-01

We performed this observational prospective study to evaluate the results of the application of a diagnostic and therapeutic algorithm for complicated parapneumonic pleural effusion (CPPE) and pleural parapneumonic empyema (PPE). From 2001 to 2007, 210 patients with CPPE and PPE were confirmed through thoracocentesis and treated with pleural drainage tubes (PD), fibrinolytic treatment or surgical intervention (videothoracoscopy and posterolateral thoracotomy). Patients were divided into 3 groups: I (PD); II (PD and fibrinolytic treatment); IIIa (surgery after PD and fibrinolysis), and IIIb (direct surgery). The statistical study was done by variance analysis (ANOVA), χ2 and Fisher exact test. The presence of alcohol or drug consumption, smoking and chronic obstructive pulmonary disease (COPD) were strongly associated with a great necessity for surgical treatment. The IIIa group was associated with increased drainage time, length of stay and complications. No mortality was observed. The selective use of PD and intrapleural fibrinolysis makes surgery unnecessary in more than 75% of cases. The selective use of PD and fibrinolysis avoids surgery in more than 75% of cases. However, patients who require surgery have more complications, longer hospital stay, and more days on PD and they are more likely to require admittance to the Intensive Care Unit.

Eikenella corrodens and Porphyromonas asaccharolytica pleural empyema in a diabetic patient with obstructive sleep apnea syndrome on noninvasive ventilation

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J. Caiano Gil

2013-03-01

Full Text Available Eikenella corrodens is a normal inhabitant of the human oral cavity and gastrointestinal and genitourinary tracts.Pleuropulmonary infections by this microorganism are uncommon. Pulmonary aspiration is a chief predisposing condition. Although the outcome is usually favorable, its distinctive antibiotic sensitivity pattern makes bacterial identification an important feature in dealing with this infection.The authors report a case of pleural empyema caused by co-infection with E. corrodens and Porphyromonas asaccharolytica, in an immunocompetent diabetic patient with obstructive sleep apnea syndrome, followed by a discussion on the role of noninvasive ventilation in the development of this infection. Resumo: A Eikenella corrodens é um microrganismo habitualmente encontrado na mucosa oral, trato gastrointestinal e trato geniturinário de humanos.Os casos de infeção pleuropulmonar por este agente são raros em indivíduos imunocompetentes, sendo a aspiração um fator importante na sua patogenia. Apesar de apresentar geralmente um prognóstico favorável, o reconhecimento desta infeção é essencial dado o perfil de sensibilidades característico.Os autores apresentam um caso de empiema pleural por E. corrodens, em coinfeção com Porphyromonas asaccharolytica, numa doente diabética imunocompetente com síndrome de apneia obstrutiva do sono, discutindo o papel da ventilação não invasiva como fator predisponente da referida infeção. Keywords: Pleural empyema, Continuous positive airway pressure, Obstructive sleep apnea, Eikenella corrodens, Porphyromonas, Palavras-chave: Empiema pleural, Ventilação não invasiva, Apneia obstrutiva do sono, Eikenella corrodens, Porphyromonas

Management of empyema of gallbladder with percutaneous cholecysto-duodenal stenting in a case of hilar cholangiocarcinoma treated with common bile duct metallic stenting

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Sheo Kumar

2011-01-01

Full Text Available Empyema of the gallbladder develops when the gallbladder neck is obstructed in the presence of infection, preventing pus from draining via the cystic duct. Treatment options include cholecystectomy or, in patients with comorbidities, drainage via percutaneous cholecystostomy, later followed by cholecystectomy. Here, we describe a 59-year-old man who presented with complaints of recurrent hiccups and was found to have cholangiocarcinoma causing obstruction to cystic duct drainage. The patient was managed successfully by percutaneous transhepatic cholecysto-duodenal self-expandable covered metal stent.

A rare constellation of empyema, lung abscess, and mediastinal abscess as a complication of endobronchial ultrasound-guided transbronchial needle aspiration.

Science.gov (United States)

Huang, Chun-Ta; Chen, Chung-Yu; Ho, Chao-Chi; Yu, Chong-Jen

2011-07-01

The introduction of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) brought about significant advancement in the field of bronchoscopy. The major indications for EBUS-TBNA are lung cancer staging and diagnosis of mediastinal lymphadenopathy. This procedure is minimally invasive and cost saving, and no complications have been described in large-scale studies. In this report, we present a case of empyema, lung abscess, and mediastinal abscess that developed in a patient undergoing EBUS-TBNA; the patient subsequently recovered uneventfully after aggressive surgical debridement and antimicrobial therapy. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Pleural empyema and streptococcal toxic shock syndrome due to Streptococcus pyogenes in a healthy Spanish traveler in Japan

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Tetsuya Sakai

2017-01-01

Full Text Available Group A Streptococcus (GAS, Streptococcus pyogenes causes invasive infections including streptococcal toxic shock syndrome (STSS and local infections. To our knowledge, this is the first report of a case of an invasive GAS infection with pneumonia and pleural empyema (PE followed by STSS (disseminated intravascular coagulation [DIC] and acute renal insufficiency in a healthy male adult. He received combined supportive therapies of PE drainage, anti-DIC agent, hemodialysis, and antimicrobials and eventually made a clinical recovery. GAS isolated from PE was found to have emm1/speA genes, suggestive of a pathogenic strain. Clinicians should be aware of the possibility of this disease entity (pneumonia, PE, and STSS in healthy male adults as well as children and adult women.

Mini-open vacuum-assisted closure therapy with instillation for debilitated and septic patients with pleural empyema.

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Sziklavari, Zsolt; Ried, Michael; Neu, Reiner; Schemm, Rudolf; Grosser, Christian; Szöke, Tamas; Hofmann, Hans-Stefan

2015-08-01

This prospective study is an evaluation of the mini-open vacuum-assisted closure with instillation (Mini-VAC-Instill) therapy for the treatment of complicated pleural empyema. We investigated septic patients in poor general physical condition (Karnofsky index ≤50%) with multimorbidity and/or immunosuppression who were treated by minimally invasive intrathoracic VAC-Instill therapy without the insertion of an open-window thoracostomy (OWT) between December 2012 and November 2014. All patients underwent mini-thoracotomy with position of a tissue retractor, surgical debridement and local decortication. Surgery was followed by intrathoracic vacuum therapy including periodic instillation using antiseptics. The VAC dressings were changed under general anaesthesia and the chest wall was closed during the same hospital stay. All patients received systemic antibiotic therapy. Fifteen patients (13 males, median age: 71 years) underwent intrathoracic Mini-VAC-Instill dressings for the management of pleural empyema without bronchopleural fistula. The median length of vacuum therapy was 9 days (5-25 days) and the median number of VAC changes per patient was 1 (1-5). In-hospital mortality was 6.7% (n = 1) and was not related to Mini-VAC-Instill therapy or intrathoracic infection. Control of intrathoracic infection and closure of the chest cavity was achieved in 85.7% of surviving patients (12 of 14). After the follow-up at an average of 13.2 months (range, 3-25 months), we observed recurrence once, 21 days after discharge. Two patients died in the late postoperative period (Day 43 and Day 100 after discharge) of fulminant urosepsis and carcinoma-related multiorgan failure, respectively. Analysis of the follow-up interviews in the outpatient clinic showed a good quality of life and a subjectively good long-term aesthetic result. Mini-VAC-Instill therapy is an upgrade of Mini-VAC, which guarantees the advantage of an open treatment, including flushing but without OWT. This

Computed tomography and ultrasound in parapneumonic effusions and empyema

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Kearney, S.E.; Davies, C.W.H.; Davies, R.J.O.; Gleeson, F.V

2000-07-01

AIM: Imaging of pleural empyema by ultrasound (US) or computed tomography (CT) is used to confirm the diagnosis and facilitate drainage. However, the information gained from US and CT may also have prognostic significance. The aim of the present study was to determine if CT and US appearances correlated with the severity of infection as determined by established microbiological and biochemical indicators, and to establish whether either technique could predict those patients who will fail drainage and require surgery. MATERIALS AND METHODS: Fifty patients with parapneumonic effusions were assessed. All had thoracic CT and the results of thoracic US were available in 36 patients. Imaging features were compared to the stage of the effusion and clinical outcome. RESULTS: At US, 7/36 (19%) pleural collections were anechoic, 5/36 (14%) were hyperechoic without septae and 24/36 (67%) were hyperechoic with septae. There was no relationship between US appearances and the presence of pus, the effusion stage or the need for surgical treatment. On CT pleural enhancement was seen in all patients. There was evidence of pleural thickening in 46/50 (92%) and thickening of extrapleural fat in 38/50 (76%). There was a trend for mean pleural thickness to increase with an increasing stage of pleural infection. However, a wide range of appearances were seen and overall the thickness of pleural/extrapleural tissues was not significantly related to the stage of effusion or to the requirement for surgery. CONCLUSIONS: Although US and CT have established roles in the investigation of parapneumonic effusions, neither technique reliably identifies the stage of pleural infection or predicts those patients who subsequently require surgical intervention after failed management by chest tube drainage and intrapleural fibrinolytics. Kearney, S.E. (2000)

Computed tomography and ultrasound in parapneumonic effusions and empyema

International Nuclear Information System (INIS)

Kearney, S.E.; Davies, C.W.H.; Davies, R.J.O.; Gleeson, F.V.

2000-01-01

AIM: Imaging of pleural empyema by ultrasound (US) or computed tomography (CT) is used to confirm the diagnosis and facilitate drainage. However, the information gained from US and CT may also have prognostic significance. The aim of the present study was to determine if CT and US appearances correlated with the severity of infection as determined by established microbiological and biochemical indicators, and to establish whether either technique could predict those patients who will fail drainage and require surgery. MATERIALS AND METHODS: Fifty patients with parapneumonic effusions were assessed. All had thoracic CT and the results of thoracic US were available in 36 patients. Imaging features were compared to the stage of the effusion and clinical outcome. RESULTS: At US, 7/36 (19%) pleural collections were anechoic, 5/36 (14%) were hyperechoic without septae and 24/36 (67%) were hyperechoic with septae. There was no relationship between US appearances and the presence of pus, the effusion stage or the need for surgical treatment. On CT pleural enhancement was seen in all patients. There was evidence of pleural thickening in 46/50 (92%) and thickening of extrapleural fat in 38/50 (76%). There was a trend for mean pleural thickness to increase with an increasing stage of pleural infection. However, a wide range of appearances were seen and overall the thickness of pleural/extrapleural tissues was not significantly related to the stage of effusion or to the requirement for surgery. CONCLUSIONS: Although US and CT have established roles in the investigation of parapneumonic effusions, neither technique reliably identifies the stage of pleural infection or predicts those patients who subsequently require surgical intervention after failed management by chest tube drainage and intrapleural fibrinolytics. Kearney, S.E. (2000)

ON THE MODE OF ACTION OF SULFANILAMIDE IN EXPERIMENTAL STREPTOCOCCUS EMPYEMA.

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Gay, F P; Clark, A R

1937-10-31

Sulfanilamide prevents the evolution of an invariably fatal streptococcus empyema in rabbits when it is given repeatedly and in sufficient doses subcutaneously. Complete sterilization of the inoculated cavity occurs on approximately the 2nd day. The serum, defibrinated blood and artificial pleural exudate of similarly treated animals inhibits the growth of the same streptococcus in the test tube but even repeated doses of such treated blood serum fail to sterilize the culture. The coccal chains grown in such drugged serum are elongated and present pleomorphic and metachromatic organisms and may give rise to colonies that are at first less predominantly mucoid in appearance. Such organisms have, however, lost little if any of their virulence. Cooperation on the part of locally derived clasmatocytes is apparently required in complete sterilization of the animal body. This conclusion is reached not only by a process of exclusion from comparison with the test tube results, but through the direct histological demonstration of a precocious and increasing mobilization of clasmatocytes in the parietal and visceral pleura of treated animals. In other words, sulfanilamide apparently produces a bacteriostasis sufficiently marked to protect the accumulated leucocytes and to allow the natural defense macrophages to accumulate. There is direct evidence that the drug does not in itself stimulate the mobilization of the macrophages. There is no evidence that the cell reaction which finally accounts for disposal of the organisms is other than local.

MULTIPLE HEPATIC ABSCESSES FROM A RUPTURED GALLBLADDER EMPYEMA – A CASE REPORT AND REVIEW OF THE LITERATURE

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Ayodele Atolagbe

2016-08-01

Full Text Available An unusual complication of gallbladder empyema is its rupture into the liver forming giant multiloculated pyogenic abscesses. This condition is rapidly fatal in diabetic and immunocompromised patients. We present a 79-year-old African American woman resident in New York City with a medical history of diabetes mellitus who presented at the ED with constitutional symptoms and right upper quadrant pain of a few days duration. She was tender and had a positive murphy’s sign on clinical examination coupled with tachycardia and a low-grade fever. Laboratory findings of leukocytosis, and metabolic acidosis, lactic academia and elevated ketones with moderately deranged hepatic function tests and negative tumor markers. Management consisted of broad spectrum antibiotics and an urgent open cholecystectomy and drainage of multiple multi-loculated hepatic abscesses. A repeat ultrasonogram showed a remnant collection which was drained by interventional radiology and drains left in-situ. She was discharged after four weeks of parenteral antibiotics with repeat sonogram showing complete resolution of hepatic abscess.

Differentiation of Lung Cancer, Empyema, and Abscess Through the Investigation of a Dry Cough.

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Urso, Brittany; Michaels, Scott

2016-11-24

An acute dry cough results commonly from bronchitis or pneumonia. When a patient presents with signs of infection, respiratory crackles, and a positive chest radiograph, the diagnosis of pneumonia is more common. Antibiotic failure in a patient being treated for community-acquired pneumonia requires further investigation through chest computed tomography. If a lung mass is found on chest computed tomography, lung empyema, abscess, and cancer need to be included on the differential and managed aggressively. This report describes a 55-year-old Caucasian male, with a history of obesity, recovered alcoholism, hypercholesterolemia, and hypertension, presenting with an acute dry cough in the primary care setting. The patient developed signs of infection and was found to have a lung mass on chest computed tomography. Treatment with piperacillin-tazobactam and chest tube placement did not resolve the mass, so treatment with thoracotomy and lobectomy was required. It was determined through surgical investigation that the patient, despite having no risk factors, developed a lung abscess. Lung abscesses rarely form in healthy middle-aged individuals making it an unlikely cause of the patient's presenting symptom, dry cough. The patient cleared his infection with proper management and only suffered minor complications of mild pneumoperitoneum and pneumothorax during his hospitalization.

Síndrome de Claude Bernard-Horner associada ao empiema pleural Claude Bernard-Horner syndrome resulting from pleural empyema

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Fernando Luiz Westphal

2006-04-01

Full Text Available A síndrome de Claude Bernard-Horner apresenta várias etiologias, ocorre por interrupção do estímulo nervoso em qualquer ponto do trajeto do nervo e pode ser intra ou extratorácica. É relatado um caso dessa síndrome causado por empiema pleural septado, localizado em região paravertebral, no terço superior do hemitórax direito. O paciente foi submetido à toracotomia para drenagem da cavidade pleural. A evolução foi satisfatória, com regressão do quadro infeccioso, expansão pulmonar e remissão da síndrome.Claude Bernard-Horner syndrome presents various etiologies and occurs as the direct result of interrupted nerve signaling at any point along the nerve trajectory, be it intrathoracic or extrathoracic. Herein, we report a case of Claude Bernard-Horner syndrome caused by loculated pleural empyema located in the paravertebral region of the upper third of the right hemithorax. The patient was submitted to thoracotomy in order to drain the infected fluids. The end result was satisfactory, including resolution of the infection, pulmonary expansion, and remission of the syndrome.

Dose dependency of outcomes of intrapleural fibrinolytic therapy in new rabbit empyema models

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Florova, Galina; Azghani, Ali O.; Buchanan, Ann; Boren, Jake; Allen, Timothy; Rahman, Najib M.; Koenig, Kathleen; Chamiso, Mignote; Karandashova, Sophia; Henry, James; Idell, Steven

2016-01-01

The incidence of empyema (EMP) is increasing worldwide; EMP generally occurs with pleural loculation and impaired drainage is often treated with intrapleural fibrinolytic therapy (IPFT) or surgery. A number of IPFT options are used clinically with empiric dosing and variable outcomes in adults. To evaluate mechanisms governing intrapleural fibrinolysis and disease outcomes, models of Pasteurella multocida and Streptococcus pneumoniae were generated in rabbits and the animals were treated with either human tissue (tPA) plasminogen activator or prourokinase (scuPA). Rabbit EMP was characterized by the development of pleural adhesions detectable by chest ultrasonography and fibrinous coating of the pleura. Similar to human EMP, rabbits with EMP accumulated sizable, 20- to 40-ml fibrinopurulent pleural effusions associated with extensive intrapleural organization, significantly increased pleural thickness, suppression of fibrinolytic and plasminogen-activating activities, and accumulation of high levels of plasminogen activator inhibitor 1, plasminogen, and extracellular DNA. IPFT with tPA (0.145 mg/kg) or scuPA (0.5 mg/kg) was ineffective in rabbit EMP (n = 9 and 3 for P. multocida and S. pneumoniae, respectively); 2 mg/kg tPA or scuPA IPFT (n = 5) effectively cleared S. pneumoniae-induced EMP collections in 24 h with no bleeding observed. Although intrapleural fibrinolytic activity for up to 40 min after IPFT was similar for effective and ineffective doses of fibrinolysin, it was lower for tPA than for scuPA treatments. These results demonstrate similarities between rabbit and human EMP, the importance of pleural fluid PAI-1 activity, and levels of plasminogen in the regulation of intrapleural fibrinolysis and illustrate the dose dependency of IPFT outcomes in EMP. PMID:27343192

Classificação ultra-sonográfica do derrame pleural e do empiema parapneumônico Ultrasound classification of pleural effusion and parapneumonic empyema

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Luís Marcelo Inaco Cirino

2002-03-01

Full Text Available Os autores correlacionam as alterações anatomopatológicas da cavidade pleural com os achados ultra-sonográficos no derrame pleural e no empiema parapneumônico e apresentam uma classificação baseada nestes dados. Concluem que a ultra-sonografia é método diagnóstico fidedigno para inferir a fase anatomopatológica da doença pleural, bem como auxiliar na escolha da alternativa de tratamento.We correlated the anatomopathological abnormalities of the pleural space with the ultrasound findings in patients with pleural effusion and/or parapneumonic empyema and proposed a classification based on these results. Ultrasonography is a reliable method to infer the anatomopathological phase of pleural disease and consequently may be of help in the choice of the most suitable treatment.

Clinical Application of Fully Covered Self-Expandable Metal Stents in the Treatment of Bronchial Fistula.

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Cao, Ming; Zhu, Qiang; Wang, Wei; Zhang, Tian Xiao; Jiang, Min Zhong; Zang, Qi

2016-09-01

Background The study was designed to access the feasibility, safety, and efficacy of fully covered self-expandable metal stents in the treatment of bronchial fistula. Methods Clinical data of nine patients (seven males and two females) who were treated with placement of tracheobronchial or bronchial fully covered self-expandable metal stents from August 2005 to November 2011 were analyzed retrospectively. Among these patients, seven were diagnosed with bronchopleural fistula, one with tracheopleural fistula, and one with left main bronchoesophageal fistula. Eight had accompanying thoracic empyema. The fistula orifices ranged from 3.5 mm to 25 mm in diameter. All patients received topical anesthesia. L-shaped stents were placed in six patients and I-shaped stents in three under fluoroscopic guidance. After stent placement, patients with empyema were treated with pleural lavage. Results Stent placement in the tracheobronchial tree was successful in all patients, without procedure-related complications. The operating time was 5 to 16 minutes. A small amount of bubble overflowed from the intrathoracic drainage tube of only one patient. In the other patients, the bubble in the intrathoracic drainage tube disappeared immediately or angiography showed no overflow of contrast agent from the fistula orifice. The effective rate of fistula orifice closure after stent placement was 100%, with 88.9% rated as excellent. One patient coughed the stent out 5 days after placement and hence a new stent was placed. Among the patients with empyema, one died of septicemia arising from empyema on day 8 and another died of brain metastases of lung cancer 6 months after stent insertion with persistent empyema. In the other six patients, empyema resolved after 2 to 5 months (cure rate 75%). Seven patients were followed up for 3 to 36 months. During follow-up, one stent was removed 8 months after implantation due to difficult expectoration, without recurrent empyema. The remaining

[Clinical application of a fully covered self-expandable metallic stent in treatment of airway fistula].

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Zhu, Qiang; Zang, Qi; Jiang, Zhong-min; Wang, Wei; Cao, Ming

2013-06-01

To assess the feasibility, safety and efficacy of the use of a fully covered self-expandable stent for the treatment of airway fistula. From August 2005 to November 2011, 9 patients underwent treatment by the introduction of a tracheo-bronchial or bronchial fully covered self-expandable metallic stent. There were 7 males and 2 females, aged from 28-65 years with a mean of 46 years. In this group, 7 cases were diagnosed as bronchopleural fistula, 1 case as tracheopleural fistula, 1 case as broncho-esophageal fistula, 8 cases with thoracic empyema. The fistula orifices were from 3.5-25.0 mm in diameter with a mean 8.4 mm. All patients received topical anesthesia, and L-shaped stent was placed in 6 patients and I-shaped stent in 3 patients under fluoroscopic guidance. After the stent placement, the patients with empyema were treated with continual irrigation of the empyema cavity. Stent placement in the tracheo-bronchial tree was technically successful in all patients, without procedure-related complications. The operating time was from 5-16 minutes, mean time (10 ± 4) minutes. Except for 1 patient, immediate closure of the airway fistula was achieved in the other patients after the procedure, as shown by the immediate cessation of bubbling in the chest drain system or the contrast examination. In this study, 1 patient coughed the inserted stent out due to irritable cough on the 5th day and had to receive repositioning of a new stent. Among the patients who were with empyema, 1 patient died of septicemia on the 8th day and 1 patient died of brain metastases from lung cancer 6 months after the stent insertion with empyema not cured, the other 6 patients' empyema healed from 2-5 months, mean time 3.7 months. Seven patients were followed from 3 to 36 months with a median of 13.5 months. During follow-up, 1 stent was removed from a patient 8 months after the stent implantation without empyema recurred. The remaining patient presented good tolerability to the existence of

Cerebral and subdural abscess with spatio-temporal multiplicity 12 years after initial craniotomy for acute subdural hematoma. Case report.

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Wakui, Daisuke; Nagashima, Goro; Takada, Tatsuro; Ueda, Toshihiro; Itoh, Hidemichi; Tanaka, Yuichiro; Hashimoto, Takuo

2012-01-01

A 34-year-old man presented with a case of subdural empyema and cerebral abscess that developed 12 years after initial neurosurgical intervention for a traffic accident in 1998. Under a diagnosis of acute subdural hematoma and cerebral contusion, several neurosurgical procedures were performed at another hospital, including hematoma removal by craniotomy, external decompression, duraplasty, and cranioplasty. The patient experienced an epileptic seizure, and was referred to our hospital in March 2010. Magnetic resonance imaging revealed a cerebral abscess extending to the subdural space just under the previous surgical field. Surgical intervention was refused and antimicrobial treatment was initiated, but proved ineffective. Surgical removal of artificial dura and cranium with subdural empyema, and resection of a cerebral abscess were performed on May 12, 2010. No organism was recovered from the surgical samples. Meropenem and vancomycin were selected as perioperative antimicrobial agents. No recurrence of infection has been observed. Postneurosurgical subdural empyema and cerebral abscess are recently emerging problems. Infections of neurosurgical sites containing implanted materials occur in 6% of cases, usually within several months of the surgery. Subdural empyema and cerebral abscess developing 12 years after neurosurgical interventions are extremely rare. The long-term clinical course suggests less pathogenic organisms as a cause of infection, and further investigations to develop appropriate antimicrobial selection and adequate duration of antimicrobial administration for these cases are needed.

Perforeret akut akalkuløs kolecystitis forårsaget af hepatitis A

DEFF Research Database (Denmark)

Cuk, Pedja; Iqbal, Mozammil; Lykke, Jakob

2014-01-01

Acute acalculous cholecystitis is a rare condition associated with a high risk of gangrene, empyema and perforation of the gallbladder. In this case report it is described how hepatitis A infection leads to a fulminant perforated acalculous chole-cystitis, which is described sporadically in the l......Acute acalculous cholecystitis is a rare condition associated with a high risk of gangrene, empyema and perforation of the gallbladder. In this case report it is described how hepatitis A infection leads to a fulminant perforated acalculous chole-cystitis, which is described sporadically...

X-ray appearance of anaerobic pulmonary and pleural lesions

International Nuclear Information System (INIS)

Ishchenko, B.I.; Kochetkov, A.V.; Stolbovoj, A.V.

1984-01-01

The authors describe a clinical and X-ray appearance of the suppurative affections of the lungs and pleural empyemas in 57 patients. Extensive one- or two-lobar affections, massive necrosis of the pulmonary tissue in the form of single focal destructions or multiple cavities of different sizes in the presence of extensive pneumonic infiltration, frequent development of pyopneumothorax as a complication are typical of anaerobic pulmonary processes. The signs of the anaerobic nature of pleural empyemas are fast division of the pleural cavity into separate chambers, gas formation with the presence of several horizontal levels of liquid

Managment of thoracic empyema.

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Sherman, M M; Subramanian, V; Berger, R L

1977-04-01

Over a ten year period, 102 patients with thoracic empyemata were treated at Boston City Hospital. Only three patients died from the pleural infection while twenty-six succumbed to the associated diseases. Priniciples of management include: (1) thoracentesis; (2) antibiotics; (3) closed-tube thoracostomy; (4) sinogram; (5) open drainage; (6) empyemectomy and decortication in selected patients; and (7) bronchoscopy and barium swallow when the etiology is uncertain.

Computed tomography of chest wall abscess

International Nuclear Information System (INIS)

Ikezoe, Junpei; Morimoto, Shizuo; Akira, Masanori

1986-01-01

Inflammatory lesions of the chest wall become less common because of the improvement of antibiotics and chemotherapeutic agents. Over a 5-year period, 7 patients with chest wall inflammatory diseases underwent chest computed tomography. These were 2 tuberculous pericostal abscesses, 2 empyema necessitatis, 1 spinal caries, and 2 bacterial chest wall abscesses (unknown organisms). Computed tomography (CT) helped in demonstrating the density, border, site, and extent of the lesions. CT images also demonstrated the accompaning abnormalities which included bone changes, pleural calcification, or old tuberculous changes of the lung. CT was very effective to demonstrate the communicating portions from the inside of the bony thorax to the outside of the bony thorax in 2 empyema necessitatis. (author)

Spondylodiscitis of the lumbar spine in a non-immunocompromised host caused by Yersinia enterocolitica O:9.

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Ellenrieder, Martin; Zautner, Andreas E; Podbielski, Andreas; Bader, Rainer; Mittelmeier, Wolfram

2010-04-01

Here presented is an extremely rare case of a spinal osteomyelitis (L5-S1) with epidural empyema in a non-immunocompromised 62-year-old man caused by Yersinia enterocolitica O:9. The infection occurred acutely and required immediate surgical treatment. Y. enterocolitica was cultured from the empyema fluid, wound swabs of the intervertebral disc L5-S1 and stool cultures. Following the surgical decompression and antibiotic treatment, the patient recovered completely, without neurological deficits. A review of the literature revealed only sparse cases of spondylodiscitis due to other Y. enterocolitica serogroups. To our knowledge, we report here the first case of a spondylodiscitis of the lumbar spine caused by Y. enterocolitica serovar O:9 in a non-immunocompromised patient.

Anaerobes in pleuropulmonary infections

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De A

2002-01-01

Full Text Available A total of 76 anaerobes and 122 aerobes were isolated from 100 patients with pleuropulmonary infections, e.g. empyema (64, pleural effusion (19 and lung abscess (13. In 14% of the patients, only anaerobes were recovered, while a mixture of aerobes and anaerobes was encountered in 58%. From all cases of lung abscess, anaerobic bacteria were isolated, alone (04 or along with aerobic bacteria (13. From empyema and pleural effusion cases, 65.6% and 68.4% anaerobes were recovered respectively. Amongst anaerobes, gram negative anaerobic bacilli predominated (Prevotella melaninogenicus 16, Fusobacterium spp. 10, Bacteroides spp. 9, followed by gram positive anaerobic cocci (Peptostreptococcus spp. 31. Coliform bacteria (45 and Pseudomonas aeruginosa (42 were the predominant aerobic isolates.

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conditions including liver abscess, empyema. (pus in lungs), endocarditis and chronic diarrhea, pneumonia ..... Prevalence and Risk. Factors for Opportunistic Infections in ... Chene G, Grarup J and Kirk O 2013 Risk. Factors and Outcomes for ...

www.tjs.udsm.ac.tz www.ajol.info/index.php/tjs/ IN VITRO ...

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Cyprian

conditions including liver abscess, empyema. (pus in lungs), endocarditis and chronic diarrhea, pneumonia ..... Prevalence and Risk. Factors for Opportunistic Infections in ... Chene G, Grarup J and Kirk O 2013 Risk. Factors and Outcomes for ...

CASE REPORT Uncommon Pathogen Bacillus Cereus Causing ...

African Journals Online (AJOL)

2018-01-01

Jan 1, 2018 ... Causing Subdural Empyema in a Child. Ethiop J ... 1Department of Child Health,. Airlangga ... secondary to middle ear infection, meningitis, brain surgery, ... classic clinical syndrome is an acute febrile illness punctuated by.

Indications and Complications of Tube Thoracostomy with ...

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... surgeon and patients were followed up with serial chest X‑rays until certified cured. ... Others were trauma, 44 (26.3%), Parapneumonic effusion, 20 (12%), ... more frequent complications been empyema (5.6%) and pneumothorax (3.6%).

Pleural effusion

Science.gov (United States)

Complications of pleural effusion may include: Lung damage Infection that turns into an abscess, called an empyema Air in the chest cavity ( pneumothorax ) after drainage of the effusion Pleural thickening (scarring of the lining of the ...

Evaluation of CT findings for diagnosis of pleural effusions

International Nuclear Information System (INIS)

Arenas-Jimenez, J.; Alonso-Charterina, S.; Fernandez-Latorre, F.; Gil-Sanchez, S.; Sanchez-Paya, J.; Lloret-Llorens, M.

2000-01-01

Computed tomography studies are usually used to assess patients with pleural effusions, and radiologists should be aware of the significance of different CT findings for the diagnosis of the effusion. The purpose of this study was to evaluate CT findings for etiological diagnosis of pleural effusions. Contrast-enhanced CT of the chest of 211 patients with pleural effusion of definite diagnosis were evaluated. The CT images were evaluated for the presence and extent of pleural effusion, thickening or nodules, extrapleural fat and other changes in the mediastinum or lung. The CT scans were read by two independent observers and correlation between them was evaluated. Comparison of CT findings between benign and malignant effusions, between exudates and transudates, and between empyemas and the other parapneumonic effusions were carried out. Kappa values for most CT findings were >0.85. Loculation, pleural thickening, pleural nodules, and extrapleural fat of increased density were only present in exudative effusions. Multiple pleural nodules and nodular pleural thickening were the only pleural findings limited to malignant pleural effusions. The signs were also more frequently seen in empyemas than in other parapneumonic effusions. Computed tomography findings can help to distinguish between transudates and exudates. Although there is some overlap between benign and malignant pleural effusions, pleural nodules and nodular pleural thickening were present almost exclusively in the latter. Although differences between CT findings of empyemas and the other parapneumonic effusions exist, there is no finding which can definitely differentiate between them. (orig.)

ECAJS Vol 15 no 1 FINAL April 2010 _Repaired_ to Bioline 6th ...

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user

2010-06-06

Jun 6, 2010 ... antituberculosis, drainage with chest tube, and surgical treatment when .... The cause of death was septic shock in 7 and respiratory failure in ... India, pulmonary tuberculosis caused thoracic empyema in 21% of cases.6 The ...

Pleural fluid drainage: Percutaneous catheter drainage versus surgical chest tube drainage

International Nuclear Information System (INIS)

Illescas, F.F.; Reinhold, C.; Atri, M.; Bret, P.M.

1987-01-01

Over the past 4 years, 55 cases (one transudate, 28 exudates, and 26 empymas) were drained. Surgical chest tubes alone were used in 35 drainages, percutaneous catheters alone in five drainages, and both types in 15 drainages. Percutaneous catheter drainage was successful in 12 of 20 drainages (60%). Surgical tube drainage was successful in 18 of 50 drainages (36%). The success rate for the nonempyema group was 45% with both types of drainage. For the empyema group, the success rate for percutaneous catheter drainage was 66% vs 23% for surgical tube drainage. Seven major complications occurred with surgical tube drainage, but only one major complication occurred with percutaneous catheter drainage. Radiologically guided percutaneous catheter drainage should be the procedure of choice for pleural fluid drainage. It has a higher success rate for empyemas and is associated with less complications

Mediastinal Mature Teratoma Revealed by Empyema

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Mohammed Raoufi

2016-01-01

Full Text Available Teratomas are germ cell tumors, manifested with a great variety of clinical features; the most common extragonadal site is the anterior mediastinum. In this case, we report the patient with a large mature mediastinal teratoma with several components of ectodermal and endothermal epithelium. A 24-year-old female patient presented with history of persistent chest pain and progressively aggravating dyspnea for the previous 3 months. A chest X-ray showed a large opacity of the entire left hemithorax. Transcutaneous needle aspiration revealed a purulent fluid. The tube thoracostomy was introduced and the effusion was evacuated. Some weeks later, patient was seen in emergency for persistent cough and lateral chest pain. CT scan revealed a mass of the left hemithorax. The mass showed heterogeneous density, without compressing mediastinum great vessels and left hilar structures. Lipase value was elevated in needle aspiration. The patient underwent a total resection of the mediastinum mass via a left posterolateral thoracotomy. Microscopy revealed a mature teratoma with cystic structures. The patient subsequently made a full recovery. This case provide benign mediastinal teratoma with total atelectasis of left lung and elevated lipase value in needle transcutaneous aspiration; this event is explained by pancreatic component in the cystic tumor. Total removal of the tumor is adequate treatment for this type of teratoma and the prognosis is excellent.

SUBDURAL EMPYEMA, A PATIENT CASE REVIEW

African Journals Online (AJOL)

user

Presented with a Glasgow coma scale of 8/15, left sided hemiplegia ... brain at 4weeks showed localised right parietal and occipital parafalcine .... Normal liver and kidney function tests. Lumbar ... patient developed the condition post frontal.

Subdural Empyema: Clinical Presentations and Management ...

African Journals Online (AJOL)

2017-12-05

Dec 5, 2017 ... 2017 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer ‑ Medknow. Original Article. Background: Controversy .... Nigeria – Memfys Hospital for Neurosurgery and. University of Nigeria Teaching ... The surgical evacuation methods used were BAAD of the abscess cavity and craniotomy.

Subdural Empyema: Clinical Presentations and Management ...

African Journals Online (AJOL)

[craniotomy vs. burr hole, aspiration, and drainage. (BAAD)] depends on the ... the dura and the subarachnoid mater within the brain ambient ... presentations. Posterior fossa right-sided SDE was seen ... the left side of the brain, 15 (83.3%).

Pediatric Pulmonary Abscess

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Kyle Barbour

2018-04-01

Full Text Available History of present illness: A 6-year-old previously healthy male presented to the emergency department with three days of left upper quadrant abdominal pain. Family endorsed one week of fevers, cough productive of yellow sputum, and non-bilious, non-bloody emesis. He denied shortness of breath and chest pain. On exam, the patient was febrile with otherwise normal vital signs. He had diffuse tenderness to his abdomen but clear lungs. Laboratory studies revealed leukocytosis to 25,000/mm3 with a left shift. Significant findings: Upright posterior-anterior plain chest films show a left lower lobe consolidation with an air-fluid level and a single septation consistent with a pulmonary abscess (white arrows. A small left pleural effusion was also present, seen as blunting of the left costophrenic angle and obscuration of the left hemidiaphragm (black arrows. Discussion: Pediatric pulmonary abscesses are rare, most commonly caused by aspiration, and the majority consequently arise in dependent portions of the lung.1 The most common pathogens in children are Streptococcus pneumoniaeand Staphylococcus aureus.1 Immunocompromised patients and those with existing pulmonary disease more commonly contract Pseudomonas aeruginosaor Bacteroides, and fungal pathogens are possible.1 Common symptoms include tachypnea, fever, and cough. Imaging is necessary to distinguish pulmonary abscesses from pneumonia, empyema, pneumatocele, and other etiologies. Plain film radiography may miss up to 18% of pulmonary abscesses yet is often the first modality to visualize an intrathoracic abnormality.2 If seen, pulmonary abscesses most often appear as consolidations with air-fluid levels. Generally, pulmonary abscesses are round with irregular, thick walls, whereas empyemas are elliptical with smooth, thin walls.3 However, these characteristics cannot definitively distinguish these processes.2 Advantages of plain films include being low cost and easily obtained. Computed

Late diagnosis of odontogenic sinusitis with near-fatal outcome - a case report

DEFF Research Database (Denmark)

Stevens, Elizabeth M; Frendø, Martin; von Buchwald, Christian

2016-01-01

Subdural empyema is a rare but potentially life-threatening complication to sinusitis. Awareness of infection and early diagnosis is of the essence when dealing with a putatively immunosuppressed patient. Furthermore, patients at increased risk of infections due to immunosuppression need to be fu...

Cryptococcal rib osteomyelitis as primary and only symptom of idiopathic CD4 penia

DEFF Research Database (Denmark)

Legarth, Rebecca A; Christensen, Merete; Calum, Henrik

2014-01-01

A 59-year old man with idiopathic CD4 lymphopenia presented with extensive disseminated Cryptococcus neoformans infection including a large rib cryptoccocoma, vertebral spondylitis and pleural empyema. Complete resection of the affected part of the rib was necessary after failure of initial antif...

WAJM 29(6) final corr.pmd

African Journals Online (AJOL)

user1

West African Journal of Medicine Vol. ... Empyema thoracis and death occurred .... The three hospitals chosen had high admission rates and were situated in three ... negative radiological survey and .... cancer (prostrate and breast), multiple .... for multiple health outcomes. American. Journal Clinical Nutrition 2006; 84:.

Omental Pedicled Flap for Pulmonary Tuberculosis Sequelae ...

African Journals Online (AJOL)

The omental flap should be prophylactically used in post-pneumonectomy bronchial stump reinforcement where the underlying chronic inflammatory condition poses high risk for bronchial dehiscence. We present a unique case of pulmonary tuberculosis (TB) complicated by empyema, chronic pulmonary aspergillosis and ...

Vacuum-assisted closure device for the management of infected postpneumonectomy chest cavities.

Science.gov (United States)

Perentes, Jean Yannis; Abdelnour-Berchtold, Etienne; Blatter, Jeannine; Lovis, Alban; Ris, Hans-Beat; Krueger, Thorsten; Gonzalez, Michel

2015-03-01

Infected postpneumonectomy chest cavities may be related to chronic postpneumonectomy empyema or arise in rare situations of necrotizing pneumonia with complete lung destruction where pneumonectomy and pleural debridement are required. We evaluated the safety and efficacy of an intrathoracic vacuum-assisted closure device (VAC) for the treatment of infected postpneumonectomy chest cavities. A retrospective single institution review of all patients with infected postpneumonectomy chest cavities treated by VAC between 2005 and 2013. Patients underwent surgical debridement of the thoracic cavity, muscle flap closure of the bronchial stump when a fistula was present, and repeated intrathoracic VAC dressings until granulation tissue covered the entire chest cavity. After this, the cavity was obliterated by a Clagett procedure and closed. Twenty-one patients (14 men and 7 women) underwent VAC treatment of their infected postpneumonectomy chest cavity. Twelve patients presented with a chronic postpneumonectomy empyema (10 of them with a bronchopleural fistula) and 9 patients with an empyema occurring in the context of necrotizing pneumonia treated by pneumonectomy. In-hospital mortality was 23%. The median duration of VAC therapy was 23 days (range, 4-61 days) and the median number of VAC changes per patient was 6 (range, 2-14 days). Infection control and successful chest cavity closure was achieved in all surviving patients. One adverse VAC treatment-related event was identified (5%). The intrathoracic VAC application is a safe and efficient treatment of infected postpneumonectomy chest cavities and allows the preservation of chest wall integrity. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Thoraxdrains bij traumapatiënten

NARCIS (Netherlands)

Ijpma, Frank F. A.; van Westreenen, H. L. Erik; van Acker, Gijs J. D.

2009-01-01

Adequate training for the insertion of chest drains in a trauma setting reduces the occurrence of procedure-related complications. Prophylactic antibiotics reduce the risk of infectious complications and empyema. For drainage of a traumatic pneumo- or haemothorax a large drain (28-36 French) is

ECAJS Vol 15 no 1 FINAL April 2010 _Repaired_ to Bioline 6th ...

African Journals Online (AJOL)

user

2010-06-06

Jun 6, 2010 ... Thoracic empyema (TE) is characterized by bacterial organisms seen on gram stain or aspiration of ... caused by pneumonia, lung abscess, tuberculosis, and chest trauma and predisposing factors include ... for drainage are therapeutic aspiration and intercostal drainage tube connected to water seal.

Surinfection des contusions cerebrales par voie hematogene ...

African Journals Online (AJOL)

Eleven days after admission, right hemiparesis, aphasia appeared, in a febrile context (Ø 39.4). A control scan showed a left empyema associated with a right parietal abscess. Blood culture and bacteriological sampling of wound isolated a staphylococcus aureus. A triple antibiotic had allowed a favorable evolution.

Posterolateral diaphragmatic hernia with small-bowel incarceration ...

African Journals Online (AJOL)

cm defect in the posterior diaphragm repaired with interrupted polydiaxonone sutures, and the abdomen closed. The patient required organ support postoperatively and was transferred to the intensive care unit (ICU). Postoperatively, gut function was slow to return and a small empyema resolved with sustained drainage ...

Relationship between Vitamin D Levels and Outcome of Pneumonia ...

African Journals Online (AJOL)

BACKGROUND: Pneumonia, a common childhood infection in. Nigerian children with a number of debilitating complications such as empyema thoracis, has been linked to vitamin D deficiency due to its ability to modulate the T lymphocyte of the immune system . OBJECTIVE: To determine the relationship between vitamin ...

Dec 2011 NJS for Prof Anyanwu

African Journals Online (AJOL)

Ed; Appleton and Lange, Stanford Connecticut. 1996: 537-555. 2. Aderele WI. Pleural Effusion, Pneumothorax and. Bronchiectasis. In Azubuike JC, Nkanginieme. KEO Eds. Pediatrics and Child Health in a. Tropical Region. Owerri. African Educational. Services, 1999, p. 246-53. 3. Anyanwu CH. Empyema. In: Badoe EA,.

[Emergency Surgery and Treatments for Pneumothorax].

Science.gov (United States)

Kurihara, Masatoshi

2015-07-01

The primary care in terms of emergency for pneumothorax is chest drainage in almost cases. The following cases of pneumothorax and the complications need something of surgery and treatments. Pneumothorax with subcutaneous emphysema often needs small skin incisions around the drainage tube. Tension pneumothorax often needs urgent chest drainage. Pneumothorax with intractable air leakage often needs interventional treatments like endobroncheal occlusion (EBO) or thoracographic fibrin glue sealing method (TGF) as well as urgent thoracoscopic surgery. Pneumothorax with acute empyema also often needs urgent thoracoscopic surgery within 2 weeks if chest drainage or drug therapy are unsuccessful. It will probably become chronic empyema of thorax after then. Pneumothorax with bleeding needs urgent thoracoscopic surgery in case of continuous bleeding over 200 ml/2 hours. In any cases of emergency for pneumothorax, respiratory physicians should collaborate with respiratory surgeons at the 1st stage because it is important to timely judge conversion of surgical treatments from medical treatments.

Current updates on HIV-related pulmonary disease in children: What ...

African Journals Online (AJOL)

2015-12-11

Dec 11, 2015 ... ... findings and current management of pulmonary HIV infection in infants and children. .... spp. and Eschericia coli.5,6 Factors complicating treatment of bacterial infection ... Children with HIV also have an increased risk of malignancy most commonly ... such as lung abscess and empyema (Figure 3).5,15.

Experience of thoracic surgery performed under difficult conditions ...

African Journals Online (AJOL)

We did not use post-operative suction drainage but simple "under water seal" bottle drainage. Results: Thoracic surgery was performed in 32 patients in Medina Hospital. Most of these cases underwent pleural decortications for chronic empyema (18 patients), 7 patients had removal of bronchial foreign bodies, 4 patients ...

Disseminated Rhodococcus equi infection in a patient with Hodgkin’s lymphoma

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Mikić Dragan

2014-01-01

Full Text Available Introduction. Rhodococcus (R equi is an opportunistic, uncommon human pathogen that causes mainly infection in immunocompromised hosts. The disease is usually presented as subacute pneumonia that is mostly cavitary and sometimes bacteremic. Case report. We reported the extremly rare case of a 43-year-old woman with Hodgkin's lymphoma, who developed R. equi pulmonary infection after recieving multiple courses of chemotherapy. Secondary, the patient developed bacteremia, leading to sepsis and dissemination of R. equi infection in many extrapulmonary sites. At addmission the patient was febrile, tachypnoic, tachycardic, hypotensive, with facial edema, splenomegaly, positive meningeal signs, left hemiparesis and paraparesis. Laboratory data included erythrocyte sedimentation rate (ESR > 140 mm/h, C-reactive protein (CRP 143.0 mg/L, red blood cells (RBC 2.14 × 1012/L, whyite blood cells (WBC 2.8 × 109/L, lactate dehydrogenase (LDH 706 U/L, serum albumin 26 g/L, sodium 127 mmol/L and potassium 2.7 mmol/L. Blood culture and culture of sputum and empyema were positive for R. equi. Imaging studies demonstrated a large right cavitary pneumonia and abscess, empyema, pericarditis, mediastinal and intra-abdominal lymphadenopathy, brain and psoas abscesses, osteomyelitis and spondylodiscitis. The patient recovered completely after a 12-month treatment with combinations of parenteral and oral antibiotics (meropenem, vancomycin, teicoplanin, ciprofloxacin, rifampicin, macrolides etc, including drainage of abscesses and empyema. Eight years after completition of the treatment the patient was without recurrence of R. equi infection and lymphoma. Conclusion. Since the eradication od R. equi is very difficult, it is very important to make the diagnosis and initiate appropriate antibiotic therapy as soon as possible.

Browse Title Index

African Journals Online (AJOL)

Items 1 - 50 of 223 ... Vol 9, No 4 (2013), Letter to the Editor: Direct inguinal hernia ... cyst treated by adrenal-sparing surgery: case report and review of the literature, Abstract PDF ... Vol 10, No 1 (2014), Bilateral empyema thoracis treated simultaneously with video-assisted thoracic surgery and open decortication: A case ...

Pleural Empyema due to Group D Salmonella

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Jennifer C. Kam

2012-01-01

Full Text Available Non-typhi Salmonella normally presents as a bacteremia, enterocolitis, and endovascular infection but rarely manifests as pleuropulmonary disease. We present a case of a 66-year-old female with underlying pulmonary pathology, secondary to an extensive smoking history, who presented with a left-sided pleural effusion. The causative agent was identified as being group D Salmonella. Decortication of the lung was performed and the patient was discharged on antibiotics with resolution of her symptoms. This case helps to support the inclusion of Salmonella group D as a possible etiological agent of infection in the differential causes of exudative pleural effusions.

Download this PDF file

African Journals Online (AJOL)

abp

2013-03-10

Mar 10, 2013 ... Aspiration pneumonia. 0. Bacterial peritonitis. 0. Empyema or sepsis. 0. Table 3 Causes of death (N=37). Causes of death. N (%). Death of procedure. 5 (13.5%). Death of rebleeding. 13 (35%). Death of spontaneous ascites infection. 10 (27%). Death of liver failure. 7 (19%). Death of non-liver related cause.

Repair of extensive radionecrosis of the thoracic wall using soft tissues from the paralyzed upper limb

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Delacroix, R; Wallaert, C; Soulier, A; Delepoulle, E; Francois, C; Grignet, J P

1975-04-01

The authors report one case of extensive radionecrosis after postoperative radiotherapy for breast cancer, with overt pyothorax, deep axillary ulceration, and brachial paralysis. The plastic use of the musculo-aponeutrotic tissues of the paralysed upper limb resulted in spectacular success, complicated only by empyema of the hemithoracic cavity, for which treatment with neomycin is recommended.

CT findings of pleural lesions: differential diagnosis between malignant benign diseases

Energy Technology Data Exchange (ETDEWEB)

Baek, Seung Yon; Lim, Tae Hwan; Kim, Woo Sun; Park, Kwang Gil [Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of)

1991-05-15

A number of benign and malignant diseases may cause pleural abnormalities. Since the resolution of computed tomography (CT) has been improved, the detailed anatomy of pleura can now be well delineated in various pleural diseases. We reviewed retrospectively the CT findings of 60 patients with pathologically proved pleural diseases in order to find out the differential points between benign and malignant diseases. Thirty-six patients had malignant diseases (20 adenocarcinoma, 8 squamous cell carcinoma, 4 small cell carcinoma, 2 lung metastasis, 1 large cell carcinoma, 1 small and large cell carcinoma), and 24 patients had benign diseases (16 tuberculosis including empyema, 3 bacterial empyema, 3 pneumonia, 1 lung abscess, 1 lung contusion). The CT features that suggested malignant pleural diseases were high-grade mediastinal involvement (57.9%, {rho} < 0.1), thick and irregular thickening with nodularity and mass formations (38.5%, {rho} < 0.1), Circumferential pleural thickening 132.1%, {rho} < 0.01), and aggressive pleural effusion 122.2%, {rho} < 0.05). Benign pleural lesions were typically represented by pleural calcification (50%) and extrapleural fat accumulation (45.8%)

Traumatic chest injury in children: A single thoracic surgeon′s experience in two Nigerian tertiary hospitals

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Kelechi Emmanuel Okonta

2015-01-01

Full Text Available Background: This study was to determine the extent and outcome of childhood chest injury in Nigeria, and to compare results with that of other literatures. Patients and Methods: A Prospective study of all children under 18 years of age with chest trauma in two tertiary hospitals in Southern Nigeria from January 2012 to December 2014 was reviewed. The aetiology, type, associated injury, mechanism, treatment and outcome were evaluated. The patients were followed up in the clinic. The data were analysed using SPSS version 20.0 with a significant P 12-h versus 2 who presented <12-h and 6 of children between 0 and 9 years versus 3 at 10-18 years of age had empyema thoracis (P value not significant. One death was recorded. Conclusion: Chest trauma in children is still not common, and blunt chest injury from falls and automobile accidents are more common than penetrating chest injury. Treatment with tube thoracostomy is the major management modality with empyema thoracis as the most common complication.

Empiema por Fusobacterium necrophorum

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ML. Valle Feijoo

2014-09-01

Systemic infection by Fusobacerium necrophorum is characterized by the classic triad of thrombosis of the jugular internal vein, bacteriemia and metastatic spread and it is known as Lemiere syndrome (LS, post-amigdalitis sepsis or necrobacillosis. Pulmonary impairement due to septic embolism is very common in LS, but Fusobacterium necrophorum is hardly ever found in empyemas without LS. We report a new case.

Diffusion-weighted imaging in acute bacterial meningitis in infancy

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Jan, W.; Zimmerman, R.A.; Bilaniuk, L.T.; Hunter, J.V.; Simon, E.M.; Haselgrove, J. [Department of Radiology, Children' s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, PA 19104, Philadelphia (United States)

2003-09-01

Bacterial meningitis is frequently fatal or leads to severe neurological impairment. Complications such as vasculitis, resulting in infarcts, should be anticipated and dealt with promptly. Our aim was to demonstrate the complications of meningitis by diffusion weighted imaging (DWI) in patients who deteriorated despite therapy. We studied 13 infants between the ages of 1 day and 32 months who presented with symptoms ranging from fever and vomiting to seizures, encephalopathy and coma due to bacterial meningitis, performing MRI, including DWI, 2-5 days after presentation. Multiple infarcts were found on DWI in 12 of the 13, most commonly in the frontal lobes (in 10). Global involvement was seen in four children, three of whom died; the fourth had a very poor outcome. In one case abnormalities on DWI were due to subdural empyemas. We diagnosed vasculitis in three of five patients studied with MRA. We think DWI an important part of an MRI study in infants with meningitis. Small cortical or deep white-matter infarcts due to septic vasculitis can lead to tissue damage not easily recognized on routine imaging and DWI can be used to confirm that extra-axial collections represent empyemas. (orig.)

Diffusion-weighted imaging in acute bacterial meningitis in infancy

International Nuclear Information System (INIS)

Jan, W.; Zimmerman, R.A.; Bilaniuk, L.T.; Hunter, J.V.; Simon, E.M.; Haselgrove, J.

2003-01-01

Bacterial meningitis is frequently fatal or leads to severe neurological impairment. Complications such as vasculitis, resulting in infarcts, should be anticipated and dealt with promptly. Our aim was to demonstrate the complications of meningitis by diffusion weighted imaging (DWI) in patients who deteriorated despite therapy. We studied 13 infants between the ages of 1 day and 32 months who presented with symptoms ranging from fever and vomiting to seizures, encephalopathy and coma due to bacterial meningitis, performing MRI, including DWI, 2-5 days after presentation. Multiple infarcts were found on DWI in 12 of the 13, most commonly in the frontal lobes (in 10). Global involvement was seen in four children, three of whom died; the fourth had a very poor outcome. In one case abnormalities on DWI were due to subdural empyemas. We diagnosed vasculitis in three of five patients studied with MRA. We think DWI an important part of an MRI study in infants with meningitis. Small cortical or deep white-matter infarcts due to septic vasculitis can lead to tissue damage not easily recognized on routine imaging and DWI can be used to confirm that extra-axial collections represent empyemas. (orig.)

Community-acquired pneumonia

International Nuclear Information System (INIS)

Poetter-Lang, S.; Herold, C.J.

2017-01-01

The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging. The radiological findings serve as proof or exclusion of pneumonia and can also be used to evaluate the extent of the disease (e.g. monolobular, multilobular, unilateral or bilateral). In cases of prolonged disease, suspicion of complications (e.g. pleural effusion or empyema, necrotizing pneumonia or abscess) or comorbid conditions (e.g. underlying pulmonary or mediastinal diseases) computed tomography is an important diagnostic tool in addition to chest radiography. Ultrasound is often used to diagnose pleural processes (e.g. parapneumonic effusion or pleural empyema). (orig.) [de

Rhinogenic subdural empyema in-older children and teenagers

African Journals Online (AJOL)

1993-12-13

Dec 13, 1993 ... Twenty-two had depressed levels of consciousness and 7 had Glasgow .... recorded separately. The lateral hemisphere was the commonest site (20 patients). Sixteen had interhemispheric collections lying in the parafalcine.

Surgery of a nocardia lung abscess presenting as a tension pyopneumothorax.

Science.gov (United States)

Fujimoto, Ryo; Omasa, Mitsugu; Ishikawa, Hiroyuki; Aoki, Minoru

2017-05-01

While some cases of nocardial pneumonia develop secondary empyema, tension pyopneumothorax is a very rare and lethal complication. A 74-year-old man who exhibited thrombocytopenia during steroid therapy for autoimmune hepatitis, presented to our department with a nocardial tension pyopneumothorax. He underwent a left lower lobectomy after chest drainage, and was discharged without any complication other than reoperation to remove a postoperative hematoma.

Computerized tomography in the diagnosis of early and late complications after lung surgery

International Nuclear Information System (INIS)

Jeschke, W.; Linder, M.; Weiss, A.; Kihm, W.D.; Kempmann, G.

1980-01-01

The advantages of computerized tomography over conventional radiography for correctly interpreting doubtful findings after lung surgery are illustrated by 4 cases histories. In the immediate post-operative period the technique generally succeeds in identifying the nature of the abnormal findings and in differentiating between effusion, infiltration, abscess and empyema. Leakage from the bronchial stump can be clearly demonstrated without inconveniencing the patient. (orig.) [de

The value of molecular techniques to diagnose Ureaplasma urealyticum and Nocardia farcinica pleuropneumonia in a patient with diffuse large B-cell lymphoma

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Etienne Canouï

2017-11-01

Full Text Available An unusual case of pleural empyema related to Nocardia farcinica and Ureaplasma urealyticum, occurring after autologous haematopoietic stem cell transplantation in a 30-year-old patient with lymphoma, is reported. This case illustrates the role of repeated and comprehensive microbiological investigations and the contribution of molecular techniques in reaching the aetiological diagnosis. Keywords: Nocardia farcinica, Ureaplasma urealyticum, Pleuropneumonia, Immunocompromised patient, Molecular microbiological diagnosis

To drain or not to drain? Predictors of tube thoracostomy insertion and outcomes associated with drainage of traumatic hemothoraces.

Science.gov (United States)

Wells, Bryan J; Roberts, Derek J; Grondin, Sean; Navsaria, Pradeep H; Kirkpatrick, Andrew W; Dunham, Michael B; Ball, Chad G

2015-09-01

Historical data suggests that many traumatic hemothoraces (HTX) can be managed expectantly without tube thoracostomy (TT) drainage. The purpose of this study was to identify predictors of TT, including whether the quantity of pleural blood predicted tube placement, and to evaluate outcomes associated with TT versus expected management (EM) of traumatic HTXs. A retrospective cohort study of all trauma patients with HTXs and an Injury Severity Score (ISS) ≥12 managed at a level I trauma centre between April 1, 2005 and December 31, 2012 was completed. Mixed-effects models with a subject-specific random intercept were used to identify independent risk factors for TT. Logistic and log-linear regression were used to compute odds ratios (ORs) for mortality and empyema and percent increases in length of hospital and intensive care unit stay between patients managed with TT versus EM, respectively. A total of 635 patients with 749 HTXs were included in the study. Overall, 491 (66%) HTXs were drained while 258 (34%) were managed expectantly. Independent predictors of TT placement included concomitant ipsilateral flail chest [OR 3.03; 95% confidence interval (CI) 1.04-8.80; p=0.04] or pneumothorax (OR 6.19; 95% CI 1.79-21.5; p<0.01) and the size of the HTX (OR per 10cc increase 1.12; 95% CI 1.04-1.21; p<0.01). Although the adjusted odds of mortality were not significantly different between groups (OR 3.99; 95% CI 0.87-18.30; p=0.08), TT was associated with a 47.14% (95% CI, 25.57-69.71%; p<0.01) adjusted increase in hospital length of stay. Empyemas (n=29) only occurred among TT patients. Expectant management of traumatic HTX was associated with a shorter length of hospital stay, no empyemas, and no increase in mortality. Although EM of smaller HTXs may be safe, these findings must be confirmed by a large multi-centre cohort study and randomized controlled trials before they are used to guide practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Bacterial lung abscess

International Nuclear Information System (INIS)

Groskin, S.A.; Panicek, D.M.; Ewing, D.K.; Rivera, F.; Math, K.; Teixeira, J.; Heitzman, E.R.

1987-01-01

A retrospective review of patients with bacterial lung abscess was carried out. Demographic, clinical, and radiographical features of this patient group are compared with similar data from patients with empyema and/or cavitated lung carcinoma; differential diagnostic points are stressed. The entity of radiographically occult lung abscess is discussed. Complications associated with bacterial lung abscess are discussed. Current therapeutic options and treatment philosophy for patients with bacterial lung abscess are noted

Radiation diagnosis of a complicated course of acute lung abscess

International Nuclear Information System (INIS)

Churilyin, R.Yu.

2011-01-01

X-ray investigation is a leading diagnostic modality in case of purulent destructive diseases, especially with the purpose to correct the treatment and determining the indications to surgery. Almost in half of the patients (46.5 %), the course is complicated by the development of one or several accompanying pathological processes (pleurisy, empyema, gangrene, etc), which complicate the course and require additional therapeutic measures, frequently determining the outcome of the disease.

Prevention of Trauma/Hemorrhagic Shock-Induced Mortality, Apoptosis, Inflammation and Mitochondrial Dysfunction

Science.gov (United States)

2015-02-01

a new class of signal transducer and activator of transcription 3 inhibitors that suppresses growth of prostate and breast tumors through induction...trauma deaths in the US in 2005, more Americans died of in- juries than from cancers of the breast , colon, prostate, liver and pancreas combined.3...Pneumonia 11 Intra-abdominal abscess 9 Bacteremia and sepsis 5 Urinary tract infection 4 Wound infection 4 Other (empyema) 1nucleosome levels in

Omental Herniation: A Rare Complication of Vacuum-Assisted Closure of Infected Sternotomy Wound

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Philemon Gukop

2012-01-01

Full Text Available Vacuum-assisted closure (VAC has recently been adopted as an acceptable modality for management of sternotomy wound infections. Although generally efficacious, the use of negative pressure devices has been associated with complications such as bleeding, retention of sponge, and empyema. We report the first case of greater omental hernia as a rare complication of vacuum-assisted closure of sternal wound infection following coronary artery bypass grafting.

Clinico-radiological features of subarachnoid hyperintensity on diffusion-weighted images in patients with meningitis

International Nuclear Information System (INIS)

Kawaguchi, T.; Sakurai, K.; Hara, M.; Muto, M.; Nakagawa, M.; Tohyama, J.; Oguri, T.; Mitake, S.; Maeda, M.; Matsukawa, N.; Ojika, K.; Shibamoto, Y.

2012-01-01

Aim: To investigate the clinical and radiological features of meningitis with subarachnoid diffusion-weighted imaging (DWI) hyperintensity. Materials and methods: The clinical features, laboratory data, and radiological findings, including the number and distribution of subarachnoid DWI hyperintense lesions and other radiological abnormalities, of 18 patients seen at five institutions were evaluated. Results: The patients consisted of eight males and 10 females, whose ages ranged from 4 months to 82 years (median 65 years). Causative organisms were bacteria in 15 patients, including Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, Klebsiella pneumoniae, and Listeria monocytogenes. The remaining three were fungal meningitis caused by Cryptococcus neoformans. Subarachnoid DWI hyperintense lesions were multiple in 16 of the 18 cases (89%) and predominantly distributed around the frontal lobe in 16 of the 18 cases (89%). In addition to subarachnoid abnormality, subdural empyema, cerebral infarction, and intraventricular empyema were found in 50, 39, and 39%, respectively. Compared with paediatric patients, adult patients with bacterial meningitis tended to have poor prognoses (7/10 versus 1/5; p = 0.1). Conclusion: Both bacterial and fungal meningitis could cause subarachnoid hyperintensity on DWI, predominantly around the frontal lobe. This finding is often associated with poor prognosis in adult bacterial meningitis.

Perpheral bronchopleural fistula: CT evaluation in 22 patients

International Nuclear Information System (INIS)

Lee, Ye Ri; Kim, Min Young; Choi, Seong Hee; Kim, Eung Jo; Lee, Jin Joo; Kim, Oak

1999-01-01

To determine the usefulness of CT for the evaluation of peripheral bronchopleural fistulas. CT scans of 22 patients with persistent air leak, as seen on serial chest PA, and a clinical history, were retrospectively evaluated. We determined the visibility of direct communication between the lung and pleural space, and the frequency and location of this, and if direct communications were not visualized the probable cause. A bronchopleural fistula(n=13) or its probable cause(n=6) was visualized in 19 patients(86%). Direct communications between the lung and pleural space were seen in 13 patients(59%) ; there were six cases of tuberculous empyema, three of tuberculosis, two of necrotizing empyema, one of trauma, and one of postobstructive pneumonitis. In six patients, bronchiectatic change in peripheral lung adjacent to the pleural cavity was noted, and although this was seen as a probable cause of bronchopleural fistula, direct communication was invisible. Bronchopleural fistula or its probable cause was multiple in 18 of 19 patients, involving the upper and lower lobe in eight, the upper in nine, and the lower in two. CT is useful for evaluating the presence of bronchopleural fistula, and its frequency and location, and in patients in whom the fistula is not directly visualized, the cause of this

Chest tube drainage of pleural effusions--an audit of current practice and complications at Hutt Hospital.

Science.gov (United States)

Epstein, Erica; Jayathissa, Sisira; Dee, Stephen

2012-05-11

The aims of the study were to review small-bore chest tube insertion practices for drainage of pleural fluid at Hutt Valley District Health Board (HVDHB), to assess complications, and compare the findings with international data. Retrospective analysis of clinical records was completed on all chest tube insertions for drainage of pleural fluid at HVDHB from December 2008 to November 2009. Descriptive statistics were used to present demographics and tube-associated complications. Comparison was made to available similar international data. Small-bore tubes comprised 59/65 (91%) chest tube insertions and 23/25 (92%) complications. Available comparative data was limited. Ultrasound was used in 36% of insertions. Nearly half of chest drains placed for empyema required subsequent cardiothoracic surgical intervention. Chest drain complication rates at HVDHB were comparable to those seen internationally. Referral rates to cardiothoracic surgery for empyema were within described ranges. The importance of procedural training for junior medical staff, optimising safety of drain insertions with ultrasound guidance, and clear clinical governance for chest tube insertions are important in minimising harm from this procedure. Specialist societies need to take a leadership in providing guidance on chest drain insertions to secondary and tertiary hospitals in Australia and New Zealand.

Clinico-radiological features of subarachnoid hyperintensity on diffusion-weighted images in patients with meningitis

Energy Technology Data Exchange (ETDEWEB)

Kawaguchi, T., E-mail: madarafuebuki@yahoo.co.jp [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Sakurai, K.; Hara, M. [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Muto, M. [Department of Radiology, Okazaki City Hospital, Okazaki, Aichi (Japan); Nakagawa, M. [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Tohyama, J. [Department of Radiology, Toyota-kai Medical Corporation Kariya Toyota General Hospital, Kariya, Aichi (Japan); Oguri, T. [Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Mitake, S. [Department of Neurology, Tosei General Hospital, Seto-shi, Aichi (Japan); Maeda, M. [Department of Radiology, Mie University School of Medicine, Tsu, Mie (Japan); Matsukawa, N.; Ojika, K. [Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Shibamoto, Y. [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan)

2012-04-15

Aim: To investigate the clinical and radiological features of meningitis with subarachnoid diffusion-weighted imaging (DWI) hyperintensity. Materials and methods: The clinical features, laboratory data, and radiological findings, including the number and distribution of subarachnoid DWI hyperintense lesions and other radiological abnormalities, of 18 patients seen at five institutions were evaluated. Results: The patients consisted of eight males and 10 females, whose ages ranged from 4 months to 82 years (median 65 years). Causative organisms were bacteria in 15 patients, including Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, Klebsiella pneumoniae, and Listeria monocytogenes. The remaining three were fungal meningitis caused by Cryptococcus neoformans. Subarachnoid DWI hyperintense lesions were multiple in 16 of the 18 cases (89%) and predominantly distributed around the frontal lobe in 16 of the 18 cases (89%). In addition to subarachnoid abnormality, subdural empyema, cerebral infarction, and intraventricular empyema were found in 50, 39, and 39%, respectively. Compared with paediatric patients, adult patients with bacterial meningitis tended to have poor prognoses (7/10 versus 1/5; p = 0.1). Conclusion: Both bacterial and fungal meningitis could cause subarachnoid hyperintensity on DWI, predominantly around the frontal lobe. This finding is often associated with poor prognosis in adult bacterial meningitis.

Computed tomography. CT and prognosis of hemophilus influenza meningitis

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Suzuki, H.; Ogawa, K.; Shiihara, H.; Ohkubo, O.; Utsumi, Y. (Nihon Univ., Tokyo. School of Medicine)

1981-06-01

CT scanning was performed on 18 patients with hemophilus influenza meningitis. These findings were classified into 4 groups, i.e., focal cortical necrosis (F.C.N.), subdural effusion (S.Ef.), ventricular dilatation (V.D.), and subdural empyema (S.Em.). These findings reflect the process developing encephalopathy, and can be graded mild, moderate, and severe concerning the prognosis. Therefore, follow-up CT scanning is of value in elucidating the mechanism of encephalopathy and predicting the prognosis.

Empiema torácico – Revisão baseada em três casos clínicos

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Antonio Murinello

2009-05-01

Full Text Available Resumo: O derrame parapneumónico caracteriza-se pela ne-cessidade de um processo invasivo para a sua resolu-ção e o empiema pela presença de pus na cavidade pleural. Em ambos os casos, o diagnóstico por TAC e o tratamento precoces resultando em menores morbi-lidade e mortalidade. São indicação para um tratamento invasivo os derrames loculados, os que ocu-pam mais de 50% do tórax, os que revelam coloração por Gram e exame cultural positivos, ou derrames com pH inferior a 7,20, glucose inferior a 60 mg/dl, e nível de DHL superior a três vezes o limite normal no soro. Estas características resultam da evolução através de três estádios dos derrames incorrectamente tratados: 1 exsudativo; 2 fibrino-purulento; 3 fibrótico. Dependendo do estádio evolutivo, a aborda-gem terapêutica varia entra toracentese terapêutica, colocação de drenagem torácica com ou sem instila-ção de fibrinolíticos, cirurgia toracoscópica vídeo-assistida e decorticação pulmonar. Os autores fazem uma revisão do estudo destas situações baseados em três casos clínicos com apresentações muito díspares: uma doente com empiema por Streptococcus pyogenes que faleceu rapidamente por hemoptise maciça; um doente com empiema resultante de pneumonia agu-da ocorrida durante um voo de avião; uma doente com empiema e bacteriemia por Streptococcus pneumoniae conduzindo a diagnóstico até então desco-nhecido de infecção por VIH.Rev Port Pneumol 2009; XV (3: 507-519 Abstract: Complicated parapneumonic effusion is one in which an invasive procedure is necessary for its resolution and empyema means pus in the pleural space. An early diagnosis and therapy of these conditions results in less morbidity and mortality. CT of the chest is important to study complex pleural effusions. Loculated effusions, those occupying more than 50% of the thorax, or which show

Actinomyces meyeri brain abscess following dental extraction

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Clancy, U; Ronayne, A; Prentice, M B; Jackson, A

2015-01-01

We describe the rare occurrence of an Actinomyces meyeri cerebral abscess in a 55-year-old woman following a dental extraction. This patient presented with a 2-day history of hemisensory loss, hyper-reflexia and retro-orbital headache, 7?days following a dental extraction for apical peridonitis. Neuroimaging showed a large left parietal abscess with surrounding empyema. The patient underwent craniotomy and drainage of the abscess. A. meyeri was cultured. Actinomycosis is a rare cause of cereb...

Suppurative intracranial processes in 15 domestic ruminants

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Antônio Carlos Lopes Câmara

2014-05-01

Full Text Available In addition to listeriosis which is relatively common in ruminants, there are three other uncommon suppurative intracranial processes (SIP identifiable in adult ungulates as brain abscess, basilar empyema and suppurative meningitis. The present paper reports the epidemiological, clinical, laboratorial, pathological and microbiological findings of 15 domestic ruminants with SIP. A total of 15 animals were selected (eight sheep, four cattle and three goats; with the definitive diagnoses of basilar empyema (n=3, brain abscess (n=1, listeriosis (n=5 and suppurative meningitis (n=6. Hematology revealed leukocytosis with inversion of the lymphocyte/ neutrophil ratio in 4 cases. In the majority of animals, cerebrospinal fluid (CSF presented light yellow coloration and cloudy aspect due to neutrophilic pleocytosis (15 - 997 leukocytes/µL. Microbiological culture of CSF or central nervous system (CNS fragments resulted on isolation of Trueperella (Arcanobacterium pyogenes,Listeria monocytogenes,Escherichia coli and Stenotrophomonas sp. In a goat with thalamic abscess, microbiological assay was not performed, but Gram positive bacilli type bacteria were observed in histology. The diagnosis of these outbreaks was based on the association of epidemiological, clinical, pathological and bacteriological findings; reiterating that the infectious component remains an important cause of CNS disease in domestic ruminants and also shows the need for dissemination of information about the most effective preventive measures for the ranchers.

Moxifloxacin pharmacokinetics and pleural fluid penetration in patients with pleural effusion.

Science.gov (United States)

Chatzika, Kalliopi; Manika, Katerina; Kontou, Paschalina; Pitsiou, Georgia; Papakosta, Despina; Zarogoulidis, Konstantinos; Kioumis, Ioannis

2014-01-01

The aim of this study was to evaluate the pharmacokinetics and penetration of moxifloxacin (MXF) in patients with various types of pleural effusion. Twelve patients with empyema/parapneumonic effusion (PPE) and 12 patients with malignant pleural effusion were enrolled in the study. A single-dose pharmacokinetic study was performed after intravenous administration of 400 mg MXF. Serial plasma (PL) and pleural fluid (PF) samples were collected during a 24-h time interval after drug administration. The MXF concentration in PL and PF was determined by high-performance liquid chromatography, and main pharmacokinetic parameters were estimated. Penetration of MXF in PF was determined by the ratio of the area under the concentration-time curve from time zero to 24 h (AUC24) in PF (AUC24PF) to the AUC24 in PL. No statistically significant differences in the pharmacokinetics in PL were observed between the two groups, despite the large interindividual variability in the volume of distribution, clearance, and elimination half-life. The maximum concentration in PF (CmaxPF) in patients with empyema/PPE was 2.23±1.31 mg/liter, and it was detected 7.50±2.39 h after the initiation of the infusion. In patients with malignant effusion, CmaxPF was 2.96±1.45 mg/liter, but it was observed significantly earlier, at 3.58±1.38 h (Ppleural effusion.

Bronchopleural cutaneous fistula due to Eikenella corrodens.

Science.gov (United States)

Wong, Kin-Sun; Huang, Yhu-Chering

2005-01-01

The aim of this paper is to review the subject and to report on and discuss a case of bronchopleural cutaneous fistula due to Eikenella corrodens. A 16-year-old girl was brought to our hospital with fever and blood-tinged sputum 2 weeks prior to her admission. She suffered from neurologic sequelae of herpetic encephalitis and had been bed-ridden since 5 years of age. A longitudinal paraspinal soft mass had been noted in the previous week by her mother. She had been given oral feeding despite frequent choking for the past few years. On palpation, the mass can be squeezed to follow the least resistance of subcutaneous space longitudinally extending to the lower thoracic region. Chest computed tomography scan revealed right lower lobe necrotizing pneumonitis and a pleuro-cutaneous fistula leading to the subcutaneous air locules. A protracted course of antibiotics was prescribed and subcutaneous air trapping decreased in size over 8 weeks. Eikenella corrodens has increasingly been implicated as a potential causative pathogen in pleuropulmonary infections. Pleuro-cutaneous fistula and abscess formation complicating empyema and necrotizing pneumonitis due to E. corrodens infection have not been reported. A bulging thoracic subcutaneous lesion waxes and wanes with respiration suggest the possibility of a pleruo-cutaneous fistula. Treatment of Eikenella empyema using antibiotics without surgical decortication requires a prolonged course of antibiotic therapy.

Magnetic resonance imaging of lung infections in children

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Peltola, Ville; Ruuskanen, Olli [Turku University Hospital, Department of Paediatrics, Turku (Finland); Svedstroem, Erkki [Turku University Hospital, Department of Radiology, Turku (Finland)

2008-11-15

The advantages and limitations of MRI in lung infections in children have not been well established. This article illustrates the MRI findings in children with pneumonia caused by Mycoplasma pneumoniae, Streptococcus pneumoniae, and other pathogens. Lung parenchymal, pleural, and lymph node abnormalities are well characterized by MRI. Loculation of pleural fluid is detected in children with empyema. Contrast enhancement may be useful in the differentiation of active inflammation from noninflammatory changes. MRI can be particularly useful in the follow-up of children with chronic pulmonary diseases. (orig.)

Predictors of Outcome in Modern Surgery for Lung Abscess.

Science.gov (United States)

Schweigert, Michael; Solymosi, Norbert; Dubecz, Attila; John, Joseph; West, Doug; Boenisch, Paul Leonhard; Karmy-Jones, Riyad; Ospina, Carlos F Giraldo; Almeida, Ana Beatriz; Witzigmann, Helmut; Stein, Hubert J

2017-10-01

Background  Surgery for lung abscess is a challenging task. Timing and indications for surgery are not well established. Identification of predictors of outcome could help to clarify the role of surgery. Methods  Patients who underwent major thoracic surgery for infectious lung abscess were identified at six centers for general thoracic surgery in Germany, Spain, the United Kingdom, and the United States. Study period was 2000 to 2016. Results  There were 91 patients. Pulmonary sepsis (48), pleural empyema (43), persistent air leakage (25), acute renal failure (12), and respiratory failure with mechanical ventilation (25) were already preoperatively present. The mean Charlson index of comorbidity was 3.0 (median: 2.0; interquartile range: 3). Procedures were segmentectomy (18), lobectomy (58), and pneumonectomy (15). The 30-day mortality following surgery was 13/91.Preoperative sepsis (odds ratio [OR]: 13.69; 95% confidence interval [CI]: 1.86-610.53; p   70 years ( p  = 0.46) and the extent of pulmonary resection (segmentectomy, lobectomy, pneumonectomy) have no significant influence on mortality. Patients with fatal outcome have significantly higher Charlson index of comorbidity ( p  < 0.01). Conclusions  Delayed referral for surgery is common. Significant predictors for fatal outcome are pulmonary sepsis, septic complications (air leak, pleural empyema), septic organ failure (respiratory, acute renal failure), and preexisting comorbidity (Charlson index of comorbidity ≥ 3). The extent of surgical resection shows no significant influence. Georg Thieme Verlag KG Stuttgart · New York.

Ultrasonographic examination in chest disease

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Choe, K.O.; Lee, J.D.; Yoo, H.S. [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1983-12-15

Ultrasonographic examination is not widely applied to chest disease, but is may give useful information when the acoustic window for a lesion exist. We did perform ultrasound examination in 68 cases of chest disease. 1. The cases of pleural diseases was predominant; pleural effusion 35 cases, pleural metastatic tumor 2 case, mesothelioma 2 cases and fibrous thickening 1 case, total 40 cases. It was useful to differentiate pleural effusion and fibrous thickening or parenchymal lesion simulating pleural disease, to localize the optimal aspiration site for a loculated empyema, to detect pleural bumorhidden by effusion such as metastatic tumor or mesothelioma. 2. 15 cases of parenchymal lesion and 2 cases of extra pleural mass was examined. The echo pattern of consolidation and atelectasis shows typical multiple tubular streaks within the echogenic area. The echogenicity of the peripheral mass due to primary bronchogenic carcinoma, parenchymal or extrapleural metastatic tumor and granuloma were compared. 3. In the cases of pleural or parenchymal cystic lesions, such as loculated empyema or lung abscess, because of strong reverberation artifact from posterior border of the lesion, the prediction of cystic and solid lesion is sometimes difficult. 4. In 7 cases of mediastinal lesion, cystic lesion show free echo and posterior enhancement. In contrast, solid or fat component show characteristic echo pattern. 5. In the cases of juxta diaphragmatic lesion, sonogram can confirm the underlying intraabdominal pathology, in this case subphrenic abscess

Plain chest film findings of staphylococcal pneumonia in children

International Nuclear Information System (INIS)

Kim, Sook Young; Cha, Seong Sook; Kim, Jong Deok; Chung, Duck Hwan

1991-01-01

Infants during the first year of life are particularly prone to the development of staphylococcal pneumonia: in fact, it is the commonest bacterial cause of death due to respiratory tract infection in this age group. Pneumatoceles within the lungs and pleural complication such as pleural effusion, empyema, pyopneumothorax and pneumothorax are characteristics in this pneumonia. Retrospectively we reviewed 22 patients of staphylococcal pneumonia in children diagnosed by pleural fluid or blood culture, throat suction cytology, or culture of pus from thigh, joint fluid or ear discharge in one or combining them during the recent 5 years from January, 1985 to December, 1989 and obtained the following results: Male to female ratio was 1:1 and peak incidence was between 1 month and 1 year of age (45.5% : 10/22). Fever, coughing and dyspnea were the predominant symptoms, and duration of symptoms was 4 to 7 dyas in 59%. Plain chest film findings on admission day: 1) 27.3% (6/22) showed the lesion almost entirely restricted to the lung with ratio of 2:1 of right and left involvement and these were treated without complication. 2) Only one case (4.5%) showed pneumatoceles combined with pneumonic infiltration and pleural effusion. 3) Pleural lesion occurred in 72.7% (16/22) : 22.7% (5/22) without pneumonic infiltration and 50% (11/22) with pneumonic infiltration. They were empyema, pyopneumothorax, and pleural effusion in descending order. Mortalty was 4.5% (1/22)

Ultrasonographic examination in chest disease

International Nuclear Information System (INIS)

Choe, K.O.; Lee, J.D.; Yoo, H.S.

1983-01-01

Ultrasonographic examination is not widely applied to chest disease, but is may give useful information when the acoustic window for a lesion exist. We did perform ultrasound examination in 68 cases of chest disease. 1. The cases of pleural diseases was predominant; pleural effusion 35 cases, pleural metastatic tumor 2 case, mesothelioma 2 cases and fibrous thickening 1 case, total 40 cases. It was useful to differentiate pleural effusion and fibrous thickening or parenchymal lesion simulating pleural disease, to localize the optimal aspiration site for a loculated empyema, to detect pleural bumorhidden by effusion such as metastatic tumor or mesothelioma. 2. 15 cases of parenchymal lesion and 2 cases of extra pleural mass was examined. The echo pattern of consolidation and atelectasis shows typical multiple tubular streaks within the echogenic area. The echogenicity of the peripheral mass due to primary bronchogenic carcinoma, parenchymal or extrapleural metastatic tumor and granuloma were compared. 3. In the cases of pleural or parenchymal cystic lesions, such as loculated empyema or lung abscess, because of strong reverberation artifact from posterior border of the lesion, the prediction of cystic and solid lesion is sometimes difficult. 4. In 7 cases of mediastinal lesion, cystic lesion show free echo and posterior enhancement. In contrast, solid or fat component show characteristic echo pattern. 5. In the cases of juxta diaphragmatic lesion, sonogram can confirm the underlying intraabdominal pathology, in this case subphrenic abscess

Pneumonia due to Rhodococcus equi in a non-Hodgkin's lymphoma patient: case report

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Iuri de França Bonilha

Full Text Available The authors reported a lung infection by Rhodococcus equi in a 25 years-old male patient admitted to hospital with cough, dyspnea, fever, and previous diagnosis of pleural effusion. R. equi was isolated from pleural fluid and the patient acquired nosocomial infection by Acinetobacter baumannii, isolated from chest drain. The patient was treated with antibiotics. During hospitalization, he was diagnosed with non-Hodgkin lymphoma of precursor T-cell lymphoblastic lymphoma subtype in biopsy of pleura. After undergoing surgery for pulmonary decortication for drain empyema, the patient died due to septicemia.

Pleural tuberculosis: A concise clinical review.

Science.gov (United States)

Shaw, Jane A; Irusen, Elvis M; Diacon, Andreas H; Koegelenberg, Coenraad F

2018-05-01

Tuberculosis (TB) is the leading infectious cause of death worldwide, and the commonest cause of death in people living with HIV. Globally, pleural TB remains one of the most frequent causes of pleural exudates, particularly in TB-endemic areas and in the HIV positive population. Most TB pleural effusions are exudates with high adenosine deaminase (ADA), lymphocyte-rich, straw-coloured and free flowing, with a low yield on mycobacterial culture. TB pleurisy can also present as loculated neutrophil-predominant effusions which mimic parapneumonic effusions. Rarely, they can present as frank TB empyema, containing an abundance of mycobacteria. Up to 80% of patients have parenchymal involvement on chest imaging. The diagnosis is simple if M. tuberculosis is detected in sputum, pleural fluid or biopsy specimens, and the recent advent of liquid medium culture techniques has increased the microbiological yield dramatically. Where the prevalence of TB is high the presence of a lymphocyte-predominant exudate with a high ADA has a positive predictive value of 98%. In low prevalence areas, the absence of an elevated ADA and lymphocyte predominance makes TB very unlikely, and pleural biopsy should be performed to confirm the diagnosis. Pleural biopsy for liquid culture and susceptibility testing must also be considered where the prevalence of drug resistant TB is high. Treatment regimens are identical to those administered for pulmonary TB. Initial pleural drainage may have a role in symptom relief and in hastening the resolution of the effusion. Surgical intervention may be required in loculated effusions and empyemas. © 2018 John Wiley & Sons Ltd.

Co-Transcriptomes of Initial Interactions In Vitro between Streptococcus Pneumoniae and Human Pleural Mesothelial Cells.

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Claire J Heath

Full Text Available Streptococcus pneumoniae (Spn is a major causative organism of empyema, an inflammatory condition occurring in the pleural sac. In this study, we used human and Spn cDNA microarrays to characterize the transcriptional responses occurring during initial contact between Spn and a human pleural mesothelial cell line (PMC in vitro. Using stringent filtering criteria, 42 and 23 Spn genes were up-and down-regulated respectively. In particular, genes encoding factors potentially involved in metabolic processes and Spn adherence to eukaryotic cells were up-regulated e.g. glnQ, glnA, aliA, psaB, lytB and nox. After Spn initial contact, 870 human genes were differentially regulated and the largest numbers of significant gene expression changes were found in canonical pathways for eukaryotic initiation factor 2 signaling (60 genes out of 171, oxidative phosphorylation (32/103, mitochondrial dysfunction (37/164, eIF4 and p70S6K signaling (28/142, mTOR signaling (27/182, NRF2-mediated oxidative stress response (20/177, epithelial adherens junction remodeling (11/66 and ubiquitination (22/254. The cellular response appeared to be directed towards host cell survival and defense. Spn did not activate NF-kB or phosphorylate p38 MAPK or induce cytokine production from PMC. Moreover, Spn infection of TNF-α pre-stimulated PMC inhibited production of IL-6 and IL-8 secretion by >50% (p<0.01. In summary, this descriptive study provides datasets and a platform for examining further the molecular mechanisms underlying the pathogenesis of empyema.

Sustained release of bactericidal concentrations of penicillin in the pleural space via an antibiotic-eluting pigtail catheter coated with electrospun nanofibers: results from in vivo and in vitro studies.

Science.gov (United States)

Chao, Yin-Kai; Lee, Cheng-Hung; Liu, Kuo-Sheng; Wang, Yi-Chuan; Wang, Chih-Wei; Liu, Shih-Jung

2015-01-01

Inadequate intrapleural drug concentrations caused by poor penetration of systemic antibiotics into the pleural cavity is a major cause of treatment failure in empyema. Herein, we describe a novel antibiotic-eluting pigtail catheter coated with electrospun nanofibers used for the sustained release of bactericidal concentrations of penicillin in the pleural space. Electrospun nanofibers prepared using polylactide-polyglycolide copolymer and penicillin G sodium dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol were used to coat the surface of an Fr6 pigtail catheter. The in vitro patterns of drug release were tested by placing the catheter in phosphate-buffered saline. In vivo studies were performed using rabbits treated with penicillin either intrapleurally (Group 1, 20 mg delivered through the catheter) or systemically (Group 2, intramuscular injection, 10 mg/kg). Penicillin concentrations in the serum and pleural fluid were then measured and compared. In vitro studies revealed a burst release of penicillin (10% of the total dose) occurring in the first 24 hours, followed by a sustained release in the subsequent 30 days. Intrapleural drug levels were significantly higher in Group 1 than in Group 2 (Ppenicillin concentrations remained above the minimum inhibitory concentration breakpoint throughout the entire study period. In contrast, serum penicillin levels were significantly higher in Group 2 than in Group 1 (P<0.001). Notably, all Group 2 rabbits showed signs of systemic toxicity (paralytic ileus and weight loss). We conclude that our antibiotic-eluting catheter may serve as a novel therapeutic option to treat empyema.

Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy.

Science.gov (United States)

Helling, T S; Gyles, N R; Eisenstein, C L; Soracco, C A

1989-10-01

Tube thoracostomy (TT) is required in the treatment of many blunt and penetrating injuries of the chest. In addition to complications from the injuries, TT may contribute to morbidity by introducing microorganisms into the pleural space or by incomplete lung expansion and evacuation of pleural blood. We have attempted to assess the impact of TT following penetrating and blunt thoracic trauma by examining a consecutive series of 216 patients seen at two urban trauma centers with such injuries who required TT over a 30-month period. Ninety-four patients suffered blunt chest trauma; 122 patients were victims of penetrating wounds. Patients with blunt injuries had longer ventilator requirements (12.6 +/- 14 days vs. 3.7 +/- 7.1 days, p = 0.003), longer intensive care stays (12.2 +/- 12.5 days vs. 4.1 +/- 7.5 days, p = 0.001), and longer periods of TT, (6.5 +/- 4.9 days vs. 5.2 +/- 4.5 days, p = 0.018). Empyema occurred in six patients (3%). Residual hemothorax was found in 39 patients (18%), seven of whom required decortication. Recurrent pneumothorax developed in 51 patients (24%) and ten required repeat TT. Complications occurred in 78 patients (36%). Patients with blunt trauma experienced more complications (44%) than those with penetrating wounds (30%) (p = 0.04). However, only seven of 13 patients developing empyema or requiring decortication had blunt trauma. Despite longer requirements for mechanical ventilation, intensive care, and intubation, victims of blunt trauma seemed to have effective drainage of their pleural space by TT without increased risk of infectious complications.

The diagnostic significance of thickening of extrapleural fat

International Nuclear Information System (INIS)

Zhao Weifeng; Pan Jixu; Liu Fugeng

1999-01-01

Objective: To determine the role of thickening of extrapleural fat (EPF) in the diagnosis of pleural and/or para-pleural lung disease. Methods: 166 patients with pleural and/or para-pleural lung disease were studied by CT. Any EPF demonstrated would be near the diseased area, its thickness, and CT number were measured and compared with the CT number of the subcutaneous fat. The anterior thoracic wall of 50 normal subjects were also observed for the normal EPF appearances. Results: In normal group 28(56%) cases showed EPF, its thickness being 1-2 mm. In patient group 106(63.9%) cases showed EPF, among these 88 cases showed the thickness of EPF>2 mm. The mean thickness of the thickened EPF was 5.6 mm. Its mean CT number was -90.3 HU. Higher than that of the subcutaneous fat, the latter's mean CT number was -116.8HU. In this group, the causative disease included radiation lung injury, empyema, chronic lung tuberculosis, thickened and calcified pleura, calcified tuberculoma and lung injury, empyema, chronic lung tuberculosis, thickened and calcified pleura, calcified tuberculoma and lung fibrosis. In the remaining 18 cases, the thickness of EPF was less than 2 mm. No EPF was demonstrated in the other 60 patients. In the latter group the disease included carcinomatous effusion, pleural transudates, peripheral lung caner, thickened pleura, pleural metastasis, tuberculous pleural effusion, acute pneumonia and pleural fibroma. Conclusions: The thickening of EPF was mostly seen in chronic inflammatory and tuberculous diseases. This sign was helpful in differential diagnosis of pleural and/or parapleural lung disease

Lung abscess; Percutaneous catheter therapy

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Ha, H.K. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Kang, M.W. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Park, J.M. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Yang, W.J. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Shinn, K.S. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Bahk, Y.W. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of))

1993-07-01

Lung abscess was successfully treated with percutaneous drainage in 5 of 6 patients. Complete abscess resolution occurred in 4 patients, partial resolution in one, and no response in one. The duration of drainage ranged from 7 to 18 days (mean 15.5 days) in successful cases. The failure of drainage in one neurologicall impaired patient was attributed to persistent aspiration. In 2 patients, concurrent pleural empyema was also cured. CT provided the anatomic details necessary for choosing the puncture site and avoiding puncture of the lung parenchyma. Percutaneous catheter drainage is a safe and effective method for treating lung abscess. (orig.).

Lung abscess

International Nuclear Information System (INIS)

Ha, H.K.; Kang, M.W.; Park, J.M.; Yang, W.J.; Shinn, K.S.; Bahk, Y.W.

1993-01-01

Lung abscess was successfully treated with percutaneous drainage in 5 of 6 patients. Complete abscess resolution occurred in 4 patients, partial resolution in one, and no response in one. The duration of drainage ranged from 7 to 18 days (mean 15.5 days) in successful cases. The failure of drainage in one neurologicall impaired patient was attributed to persistent aspiration. In 2 patients, concurrent pleural empyema was also cured. CT provided the anatomic details necessary for choosing the puncture site and avoiding puncture of the lung parenchyma. Percutaneous catheter drainage is a safe and effective method for treating lung abscess. (orig.)

Neonatal opaque right lung: delayed fluid resorption

International Nuclear Information System (INIS)

Swischuk, L.E.; Hayden, K.; Richardson, J.

1981-01-01

Eight newborn infants with opaque right lungs were examined. Clinically, the main problem associated with the opaque right lung is mild respiratory distress, and radiographyically, the findings consist of (a) a totally opaque right lung, (b) a semiopaque right lung, or (c) an opaque right upper lobe only. These findings are usually interpreted as representing pneumonia, empyema, or hydrochlothorax, but the fact that they clear within 24 to 48 hours indicates that none of these diseases is the cause. It is thought that neonatal opaque right lung results from the transient retention of normal fetal fluid in the right lung

Internal Drainage of an Esophageal Perforation in a Patient with a High Surgical Risk

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Hongsun Kim

2017-10-01

Full Text Available A 71-year-old man presented with a productive cough and fever, and he was diagnosed as having an esophageal perforation and a mediastinal abscess. He had a history of traumatic hemothorax and pleural drainage for empyema in the right chest and was considered unable to tolerate thoracic surgery because of sepsis and progressive aspiration pneumonia. In order to aggressively drain the mediastinal contamination, we performed internal drainage by placing a Levin tube into the mediastinum through the perforation site. This procedure, in conjunction with controlling sepsis and providing sufficient postpyloric nutrition, allowed the esophageal injury to completely heal.

Impact of fibrinolytics on the outcome of empyema in South African ...

African Journals Online (AJOL)

cause of childhood morbidity and mortality, with an estimated ... of CAP, with Streptococcus pneumoniae and Staphylococcus aureus leading causes. ... predominance or pus cells present on microscopy; bacterial organism seen by Gram stain ...

Computed tomography in epidural abscess, subdural empyema, meningitis, and brain abscess

International Nuclear Information System (INIS)

Schadel, A.; Boettcher, H.D.; Haverkamp, U.; Wagner, W.; Schmilowski, G.M.; Muenster Univ.

1983-01-01

Computerised tomography cannot be of great help in diagnosing meningitis. Examination of the cerebrospinal fluid remains essential. After the inflammation of the meninges has progressed to some stage of encephalitis, the formation of an abscess can be located via computed tomography. It is characterised by the ring-type abscess capsule. Computed tomography for diagnostic purposes is superior to cerebral scanning, which demonstrates enhanced activity, but does not show the formation of a membrane, so essential for differential diagnosis. Furthermore, computed tomography shows the adjacent anatomical structures and answers the questions of displacements and threatening invasion of the ventricle system. Epidural and subdural abscesses can also be located by computed tomography. Therapy can begin directly after computerised tomography, whereas in scintigraphy only a non-specific enhanced activity is present, which often does not allow differentiation between epidural and subdural location. (orig.) [de

Ultrasound-guided pigtail catheters for drainage of various pleural diseases.

Science.gov (United States)

Liu, Yi-Heng; Lin, Yu-Chao; Liang, Shinn-Jye; Tu, Chih-Yen; Chen, Chia-Hung; Chen, Hung-Jen; Chen, Wei; Shih, Chuen-Ming; Hsu, Wu-Huei

2010-10-01

Little is known about the efficacy and safety of ultrasound-guided pigtail catheters for the management of various pleural diseases in the emergency department, ward, and intensive care unit. We conducted a retrospective study in a university hospital during a 1-year interval. A total of 276 patients (178 men and 98 women) underwent 332 pigtail catheters (the drain size ranged from 10F to 16F) under ultrasound guidance. The mean ± SEM patient age was 59 ± 18 years, and mean duration of drainage was 6.1 ± 2 days. A total of 64 drains (19.2%) were inserted for pneumothoraces; 98 drains (29.5%), for malignant effusions; 119 drains (35.8%), for parapneumonic effusions/empyemas; and 38 drains (11.4%), for massive transudate pleural effusions. The overall success rate was 72.9%. The success rate was highest when the drain was used to treat massive transudate effusions (81.6%) and malignant pleural effusions (75.5%), followed by parapneumonic effusions/empyemas (72.2%), hemothoraces (66.6%), and pneumothoraces (64.0%). Only 10 (3.0%) drains had complications due to the procedure, including infection (n = 4, 1.2%), dislodgment (n = 4, 1.2%), wound bleeding at the pigtail catheter puncture area complicated with hemothoraces (n = 1, 0.3%), and lung puncture (n = 1, 0.3%). There was no significant difference in success rate when different catheter sizes were used to treat pleural diseases. Ultrasound-guided pigtail catheters provide a safe and effective method of draining various pleural diseases. We strongly suggest that ultrasound-guided pigtail catheters be considered as the initial draining method for a variety of pleural diseases. Copyright © 2010 Elsevier Inc. All rights reserved.

Treatment of esophagopleural fistulas using covered retrievable expandable metallic stents.

Science.gov (United States)

Kim, Tae-Hyung; Shin, Ji Hoon; Kim, Kyung Rae; Park, Jung-Hoon; Kim, Jin Hyoung; Song, Ho-Young

2014-04-01

To evaluate the clinical efficacy of placement of covered retrievable expandable metallic stents for esophagopleural fistulas (EPFs). During the period 1997-2013, nine patients with EPF were treated using covered retrievable expandable metallic stents. The underlying causes of EPF were esophageal carcinoma (n = 6), lung cancer (n = 2), and postoperative empyema for Boerhaave syndrome (n = 1). Technical success was achieved in eight patients (88.9%). In one patient, incomplete EPF closure was due to incomplete stent expansion. Clinical success, defined as complete EPF closure within 7 days, was achieved in five patients (55.6%). Overall fistula persistence (n = 1) or reopening (n = 4) occurred in five patients (55.6%) 0-15 days after stent placement. The causes of reopening were due to the gap between the stent and the esophagus (n = 3) or stent migration (n = 1). For fistula persistence or reopening, additional interventional management, such as gastrostomy, stent removal, or stent reinsertion, was performed. Stent migration occurred as a complication in one patient with EPF from a benign cause secondary to postoperative empyema. In the eight patients who died during the follow-up period, the mean and median survival times were 78.8 days and 46 days, respectively. Placement of a covered expandable metallic esophageal stent for the palliative treatment of EPF is technically feasible, although the rate of clinical success was poor secondary to fistula persistence or reopening. Fistula reopening was caused by the gap between the stent and the esophagus or by stent migration, and additional interventional treatment was useful to ensure enteral nutritional support. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Empiema pleural por Eikenella corrodens e Porphyromonas asaccharolytica numa doente diabética sob ventilação não invasiva por síndrome de apneia obstrutiva do sono

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J. Caiano Gil

2013-03-01

Full Text Available Resumo: A Eikenella corrodens é um microrganismo habitualmente encontrado na mucosa oral, trato gastrointestinal e trato geniturinário de humanos. Os casos de infeção pleuropulmonar por este agente são raros em indivíduos imunocompetentes, sendo a aspiração um fator importante na sua patogenia. Apesar de apresentar geralmente um prognóstico favorável, o reconhecimento desta infeção é essencial dado o perfil de sensibilidades característico. Os autores apresentam um caso de empiema pleural por E. corrodens, em coinfeção com Porphyromonas asaccharolytica, numa doente diabética imunocompetente com síndrome de apneia obstrutiva do sono, discutindo o papel da ventilação não invasiva como fator predisponente da referida infeção. Abstract: Eikenella corrodens is a normal inhabitant of the human oral cavity and gastrointestinal and genitourinary tracts. Pleuropulmonary infections by this microorganism are uncommon. Pulmonary aspiration is a chief predisposing condition. Although the outcome is usually favorable, its distinctive antibiotic sensitivity pattern makes bacterial identification an important feature in dealing with this infection. The authors report a case of pleural empyema caused by co-infection with Eikenella corrodens and Porphyromonas asaccharolytica, in an immunocompetent diabetic patient with obstructive sleep apnea syndrome, followed by a discussion on the role of noninvasive ventilation in the development of this infection. Palavras-chave: Empiema pleural, Ventilação não invasiva, Apneia obstrutiva do sono, Eikenella corrodens, Porphyromonas, Keywords: Pleural empyema, Continuous positive airway pressure, Obstructive sleep apnea, Eikenella corrodens, Porphyromonas

Diagnostic significance of pleural fluid pH and pCO2

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K.E. Sobhey

2015-10-01

Results: We conducted this study on 50 patients with pleural effusions of different causes. The patients were classified into 5 groups according to the cause. For all the patients, measurement of pleural pH, pCO2, pO2, HCO3, protein, LDH, glucose and WBC was done. We observed lowest pH in complicated parapneumonic effusion (empyema 6.80 ± 0.15 and highest pH was observed in transudative effusion 7.47 ± 0.07. Tuberculous effusion has pH lower than pH of malignant effusion 7.17 ± 0.017 and 7.39 ± 0.08, respectively. Post pleurodesis malignant effusion has pH lower than pH of malignant effusion 7.28 ± 0.17 and 7.39 ± 0.08, respectively. There is a strong inverse correlation between pH and pCO2, WBC, LDH and protein (r = −0.813 and p < 0.001, (r = −0.796 and p, 0.001, (r = −0.829 and p, 0.001 and (r = −.837 and p, 0.001, respectively. While there is a weak correlation between pH and glucose of pleural fluid (r = 0.249 and p = 0.066. The highest increase of PNL numbers was in empyema (20169 ± 8094.8 cells/cc.The highest increase of lymphocytes was in malignant effusions (4285.00 ± 2948.20 cells/cc and tuberculous effusion (3977.7 ± 3169 cells/cc.

Computed tomography of chest trauma

International Nuclear Information System (INIS)

Dinkel, E.; Uhl, H.; Reinbold, W.D.; Wimmer, B.; Wenz, W.

1987-01-01

Chest CT scans were obtained in 86 patients suffering from serious blunt or penetrating chest trauma. The finding of mediastinal widening was by far the most common CT indication. CT proved to be a more sensitive method for detection of parenchymal lung lesions and occult pneumothorax than bedside radiographs. CT contributed substantially in differentiation of lung abscess and empyema, exclusion of mediastinal pathology and spinal injuries. Aortography is still indicated, even when CT findings are normal, if aortic laceration is clinically suspected. Despite all technical problems combined with CT examinations in the critically ill patient, we consider CT a valuable diagnostic tool for selected problems in the traumatized patient. (orig.) [de

Computed tomography of chest trauma

Energy Technology Data Exchange (ETDEWEB)

Dinkel, E.; Uhl, H.; Reinbold, W.D.; Wimmer, B.; Wenz, W.

1987-09-01

Chest CT scans were obtained in 86 patients suffering from serious blunt or penetrating chest trauma. The finding of mediastinal widening was by far the most common CT indication. CT proved to be a more sensitive method for detection of parenchymal lung lesions and occult pneumothorax than bedside radiographs. CT contributed substantially in differentiation of lung abscess and empyema, exclusion of mediastinal pathology and spinal injuries. Aortography is still indicated, even when CT findings are normal, if aortic laceration is clinically suspected. Despite all technical problems combined with CT examinations in the critically ill patient, we consider CT a valuable diagnostic tool for selected problems in the traumatized patient.

Pleuropulmonary amebiasis

Energy Technology Data Exchange (ETDEWEB)

Lee, Dong Hoon; Suh, Soo Ji; Ra, Woo Youn; Woo, Won Hyung [Kyungpook National University, School of Medicine, Taegu (Korea, Republic of)

1972-03-15

Nineteen cases of pleuropulmonary amebiasis was proved by needle aspiration or surgery as complication of amebic liver abscess during the period from June, 1969 to August, 1971 at Kyungpook National University Hospital. The results obtained are as follows: 1. Male to female ratio was about 3:1 and most of cases belonged to the 4th through 6th decades. 2. The most frequent complaint was upper abdominal pain and the most frequent abnormal physical finding was hepatomegaly. 3. Abnormalities seen in the chest films were: (a) Elevation of right diaphragm: (b) Empyema and (c) Pulmonary consolidation. 4. The pleuropulmonary amebiasis was seen in 26% of amebic liver abscess.

Streptococcus anginosus infections: crossing tissue planes.

Science.gov (United States)

Sunwoo, Bernie Y; Miller, Wallace T

2014-10-01

Streptococcus anginosus has long been recognized to cause invasive pyogenic infections. This holds true for thoracic infections where S. anginosus has a propensity for abscess and empyema formation. Early diagnosis is important given the significant morbidity and mortality associated with thoracic S. anginosus infections. Yet, distinguishing thoracic S. anginosus clinically is difficult. We present three cases of thoracic S. anginosus that demonstrated radiographic extension across tissue planes, including the interlobar fissure, diaphragm, and chest wall. Few infectious etiologies are known to cross tissue planes. Accordingly, we propose S. anginosus be considered among the differential diagnosis of potential infectious etiologies causing radiographic extension across tissue planes.

The 'wandering appendicolith'

Energy Technology Data Exchange (ETDEWEB)

Betancourt, Sonia L.; Palacio, Diana [The University of Texas, Thoracic Imaging, MD Anderson Cancer Center, Houston, TX (United States); Bisset, George S. [Texas Children' s Hospital, Department of Radiology, Baylor College of Medicine, Houston, TX (United States)

2015-07-15

Acute appendicitis is a common pediatric surgical emergency. Successful surgical appendectomy requires removal of the appendix and its contents. A retained appendicolith is a complication that occurs when the appendicolith is expulsed from the appendix as a result of perforation or failure of removal during surgery. An ectopic appendicolith can migrate to a variety of ectopic locations, acting as a nidus for abscess. Clinical presentation may be delayed by days, weeks or even months after surgery. We present and discuss an unusual case of empyema caused by migration of an appendicolith into the chest cavity. Management of these retained appendicoliths requires drainage of the abscess and extraction of the appendicolith. (orig.)

Paediatric invasive pneumococcal disease on the island of Gran Canaria: 16-year prospective study (2001-2016).

Science.gov (United States)

Santana Hernández, Milagrosa; Aguiar-Santana, Ione Ahedey; Artiles Campelo, Fernando; Colino Gil, Elena

2017-11-24

To calculate the incidence of invasive pneumococcal disease (IPD) in the paediatric population of Gran Canaria (Spain), its clinical and epidemiological characteristics, serotype distribution, antibiotic resistance, and variations in these variables before and after the introduction of the PCV13 vaccine. Prospective hospital-based study including all patients (190) aged 0-14 years admitted with confirmed IPD between January 2001-May 2010 (152 cases) and June 2010-December 2016 (38 cases). Patients were divided into 3 age groups (5 years). Clinical symptoms were mutually-exclusively classified as meningitis, bacteraemic pneumonia, pleural effusion (PE), empyema or bacteraemia without a focus. Most cases occurred in boys (59.47%), during autumn-winter (65.79%), in children aged <2 years (55.79%) and with mean age increasing from the pre-PCV13 to the post-PCV13 period (2.5 vs 3.1 years). Incidence between periods reduced by 66.4% (p<0.001): from 13.1/100,000 to 4.4/100,000. PEs (3.9% vs 18.4%, p<0.005) and empyemas (1.5% vs 16.7%, p=NS) increased in the post-PCV13 period whereas all other symptoms decreased, although this was not statistically significant. Vaccine serotypes (77% vs 40.6%, p=0.000), particularly serotypes 19A (23.9% vs 12.5%) and 14 (14.2% vs 9.4%), as well as erythromycin resistance (57.2% vs 7.9%, p=0.000) decreased in the post-PCV13 period. IPD incidence, vaccine serotypes and erythromycin resistance decreased in the post-PCV13 period whereas PEs increased. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Infeção por staphylococcus aureus meticilina-resistente da comunidade em Portugal

Directory of Open Access Journals (Sweden)

R. Nazareth

2012-01-01

Full Text Available Resumo: Recentemente assistiu-se à emergência de infeções na comunidade por Staphylococcus aureus meticilina-resistente (MRSA em indivíduos sem fatores de risco. O MRSA associado à comunidade (CA-MRSA parece ser mais virulento, causando desde infeções superficiais da pele e tecidos moles até fasceíte necrosante e, raramente, pneumonia.O CA-MRSA foi inicialmente identificado na Austrália no início da década de 80 e, após cerca de duas décadas, surgiu nos EUA e em vários países da Europa, Ásia e América do Sul. Não existe informação disponível acerca da prevalência em Portugal.Os autores reportam o primeiro caso de infeção por CA-MRSA em Portugal, num adulto jovem com pneumonia necrotizante grave complicada por empiema bilateral e insuficiência respiratória. Abstract: Methicillin-resistant Staphylococcus aureus (MRSA has recently emerged as a cause of community-acquired infections among individuals without risk factors. Community-associated MRSA (CA-MRSA appears to be more virulent, causing superficial mild skin and soft tissue infections to severe necrotizing fasciitis, and in rare cases, pneumonia.Community-associated MRSA was first reported in Australia in the early 80s, after almost two decades in the USA, and then in several countries in Europe, Asia and South America. No data exists in Portugal.We report the first case of CA-MRSA infection in Portugal, in a young adult with severe necrotizing pneumonia, complicated with bilateral empyema and respiratory failure. Palavras-chave: comunidade associada, MRSA, Staphylococcus aureus, pneumonia necrosante, empiema, Keywords: Community-associated, MRSA, Staphylococcus aureus, Necrotizing pneumonia, Empyema

Community-associated methicillin-resistant Staphylococcus aureus infection in Portugal

Directory of Open Access Journals (Sweden)

R. Nazareth

2012-01-01

Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA has recently emerged as a cause of community-acquired infections among individuals without risk factors. Community-associated MRSA (CA-MRSA appears to be more virulent, causing superficial mild skin and soft tissue infections to severe necrotizing fasciitis, and in rare cases, pneumonia.Community-associated MRSA was first reported in Australia in the early 80s, after almost two decades in the USA, and then in several countries in Europe, Asia and South America. No data exists in Portugal.We report the first case of CA-MRSA infection in Portugal, in a young adult with severe necrotizing pneumonia, complicated with bilateral empyema and respiratory failure. Resumo: Recentemente assistiu-se à emergência de infeções na comunidade por Staphylococcus aureus meticilina-resistente (MRSA em indivíduos sem fatores de risco. O MRSA associado à comunidade (CA-MRSA parece ser mais virulento, causando desde infeções superficiais da pele e tecidos moles até fasceíte necrosante e, raramente, pneumonia.O CA-MRSA foi inicialmente identificado na Austrália no início da década de 80 e, após cerca de duas décadas, surgiu nos EUA e em vários países da Europa, Ásia e América do Sul. Não existe informação disponível acerca da prevalência em Portugal.Os autores reportam o primeiro caso de infeção por CA-MRSA em Portugal, num adulto jovem com pneumonia necrotizante grave complicada por empiema bilateral e insuficiência respiratória. Keywords: Community-associated, MRSA, Staphylococcus aureus, Necrotizing pneumonia, Empyema, Palavras-chave: comunidade associada, MRSA, Staphylococcus aureus, pneumonia necrosante, empiema

Indications and complications of tube thoracostomy with improvised underwater seal bottles

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Sunday A Edaigbini

2014-01-01

Full Text Available Background: Tube thoracostomy is a lifesaving and frequently performed procedure in hospitals where the expertise and necessary tools are available. Where the ideal drainage receptacle is unavailable, the underwater seal device can be improvised with bottled water plastic can especially in emergency situations. Aims and Objectives: To determine the frequencies of the various indications and complications of tube thoracostomy with improvised underwater seal. Materials and Methods: A cross-sectional study with a structured proforma was used for assessment over a 3-year period (May 2010-April 2013. The proforma was filled at the time of the procedure by the performing surgeon and patients were followed up with serial chest X-rays until certified cured. A 1.5 L bottled water container was used as the underwater seal receptacle. The data was analysed with SPSS 15 software program. Results: A total of 167 patients were managed. There were 106 (63.5% males and 61 (36.5% females. The mean age was 34.85 ± 16.72 with a range of 1-80 years. The most frequent indication was for malignant/paramalignant effusion, 46 (27.5%. Others were trauma, 44 (26.3%, Parapneumonic effusion, 20 (12%, postthoracotomy 14 (8.4%, empyema thoracis 12 (7.2%, heart disease and tuberculous effusion 11 (6.6% each, pneumothorax 8 (4.8% and misdiagnosis 1 (0.6%. A hundred and one (60.5% of the procedures were performed by registrars, 41 (24.6% by consultants, house officers 15 (9% and senior registrars 10 (6%. The overall complication rate was 16.8% with the more frequent complications been empyema (5.6% and pneumothorax (3.6%. The average duration of tube placement was 13.02 ± 12.362 days and range of 1-110 days. Conclusion : Tube thoracostomy can be a relatively safe procedure with acceptable complication rates even with improvised underwater seal drainage bottles.

Laparoscopic Cholecystectomy by Sectorisation of Port Sites

International Nuclear Information System (INIS)

Sindhu, M. A.; Haq, I.; Rehman, S.

2013-01-01

Objectives: To evaluate the results of 160 consecutive laparoscopic cholecystectomy using sectorisation based port site selection to improve ergonomics for surgeons. Design: Descriptive study. Place and Duration of study: PNS Shifa Karachi, Pakistan from Feb 2011 to Feb 2012. Patients and Methods: In this prospective study, 160 consecutive patients had undergone laparoscopic cholecystectomy in a tertiary care hospital using sectorisation for trocar placement. All patients with symptomatic gallstones, acute calculous cholecystitis and empyema gallbladder were included. Patients with choledocholithiasis were excluded from the study. The collected data included age, sex, diagnosis, history of previous surgery, conversion to open surgery and its reasons, operative time, post-operative hospital stay, complications and laparoscopy related complications to the surgeon such as shoulder pain, wrist stress and pain, finger joint pain and stress exhaustion. Result: One hundred and sixty patients underwent laparoscopic cholecystectomy with mean age 45 +- 12.9 years. Female to male ratio was 7.8:1. A total of 110 patients had chronic cholecystitis / biliary colic, 34 patients were with acute cholecystitis and 16 patients had diagnosis of empyema gallbladder. The mean operative time was 35.3+-14.6 min. Conversion rate to open surgery was 1.2%. Complications included bleeding from cystic artery (n=1) and injury to common hepatic duct (CHD) (n=1). One patient developed port site hernia post operatively. There was no incidence of laparoscopy related complications in surgeon such as pain shoulder, strains on the wrist joint, stress exhaustion and hand-finger joint pain. Conclusion: Sectorisation technique can be used in laparoscopic cholecystectomy in order to avoid the physical constraints of laparoscopic shoulder, hand finger joint pain, tenosynovitis, stress exhaustion, and hand muscle injury without increasing any morbidity to the patients. (author)

Utility of semi-rigid thoracoscopy in undiagnosed exudative pleural effusion.

Science.gov (United States)

Nattusamy, Loganathan; Madan, Karan; Mohan, Anant; Hadda, Vijay; Jain, Deepali; Madan, Neha Kawatra; Arava, Sudheer; Khilnani, Gopi C; Guleria, Randeep

2015-01-01

Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed pleural effusion. Literature on its utility from developing countries is limited. We herein describe our initial experience on the utility of semi-rigid thoracoscopy from a tertiary care teaching and referral center in north India. We also perform a systematic review of studies reporting the utility of semi-rigid thoracoscopy from India. The primary objective was to evaluate the diagnostic utility of semi-rigid thoracoscopy in patients with undiagnosed exudative pleural effusion. Semi-rigid thoracoscopy was performed under local anesthesia and conscious sedation in the bronchoscopy suite. A total of 48 patients underwent semi-rigid thoracoscopy between August 2012 and December 2013 for undiagnosed pleural effusion. Mean age was 50.9 ± 14.1 years (range: 17-78 years). Pre-procedure clinico-radiological diagnoses were malignant pleural effusion [36 patients (75%)], tuberculosis (TB) [10 (20.83%) patients], and empyema [2 patients (4.17%)]. Patients with empyema underwent the procedure for pleural biopsy, optimal placement of intercostal tube and adhesiolysis. Thoracoscopic pleural biopsy diagnosed pleural malignancy in 30 (62.5%) patients and TB in 2 (4.17%) patients. Fourteen (29.17%) patients were diagnosed with non-specific pleuritis and normal pleura was diagnosed on a pleural biopsy in 2 (4.17%) patients. Overall, a definitive diagnosis of either pleural malignancy or TB was obtained in 32 (66.7%) patients. Combined overall sensitivity, specificity, positive predictive value and negative predictive value of thoracoscopic pleural biopsy for malignant pleural effusion were 96.77%, 100%, 100% and 66.67%, respectively. There was no procedure-related mortality. On performing a systematic review of literature, four studies on semi-rigid thoracoscopy from India were identified. Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed exudative

Radiologic guidance of drainage of infected and noninfected thoracic fluid collections

International Nuclear Information System (INIS)

Van Sonnenberg, E.; Casola, G.; Stavas, J.; Neff, C.C.; Wittich, G.R.; Varney, R.A.; Christensen, R.; Friedman, P.

1987-01-01

This exhibit illustrates the spectrum and benefits of radiologic guidance of drainage of 100 thoracic fluid collections. Collections which underwent drainage include: empyemas, lung abscesses, bronchopleural fistulas (BPF), mediastinal abscesses, paracardial collections, bronchogenic cysts, sequestrations, lymphocoeles, malignant effusions, and necrotic tumors. Sclerotherapy catheterization also is described. The modalities for guidance were CT, US, and fluoroscopy. Inadequate thoracostomy tube drainage occurred in a third of the patients prior to radiologic drainage. Drainages were effective in 85% of cases sparing surgery or another thoracostomy tube. Complications occurred in 7% of patients, most being minor and none requiring operation. Pitfalls and caveats are highlighted. Criteria for drainage of lung abscesses and BPF are emphasized, as are techniques and methods of follow-up

Radiologic drainage of infected and noninfected thoracic fluid collections

International Nuclear Information System (INIS)

Van Sonnenberg, E.; Casola, G.; Stavas, J.; Neff, C.C.; Varney, R.A.; Wittich, G.R.; Dillard, J.; Christensen, R.A.; Friedman, P.J.

1987-01-01

Radiologically guided drainage of 100 thoracic fluid collections is described in this paper. Collections that underwent drainage include empyemas, lung abscesses, bronchopleural fistulas (BPFs), mediastinal abscesses, paracardial collections, bronchogenic cysts, sequestrations, lymphoceles, lymphangiomas, malignant effusions, and necrotic tumors. Catheters were placed for sclerotherapy in nine patients. Guidance modalities (in descending order of frequency) were CT, US, fluoroscopy, and MR. Inadequate thoracostomy tube drainage occurred in a third of the patients prior to radiologic drainage. Drainages were effective in 85% of cases, sparing surgery or another thoracostomy tube. Complications occurred in 7% of patients, most being minor and none requiring operation. Criteria for drainage of lung abscess and BPF will be emphasized, as will techniques and methods of follow-up

CT-findings in ARDS

Energy Technology Data Exchange (ETDEWEB)

Stark, P; Greene, R; Kott, M M; Hall, T; Vanderslice, L

1987-08-01

The CT features of 28 patients with ARDS are described. Diffuse lung consolidation, multifocal patchy involvement and lobar or segmental disease were observed. Large lung cysts as well as small cysts producing a 'swiss-cheese' appearance of the parenchyma, were detected. These findings were not regularly appreciated on chest radiographs. The overall mortality of our 28 patients was 72.7% (22 out 28). Patients with lung cysts showed a trend toward higher mortality (87.5% or 13 out 16). Other unexpected findings were basilar lung abscesses and an empyema. In 15 out of 28 patients, CT scans provided additional information, not obvious on bedside chest radiographs and led to a change in management in five patients.

Comparison of ultrasound and computer tomography in the diagnosis of pleural shadowing

Energy Technology Data Exchange (ETDEWEB)

Kurtz, B.; Schmitt, W.G.H.

1983-05-01

Sonography was performed in 40 patients with pleural shadowing of uncertain origin in order to complement conventional X-ray examination. Where the findings were not clear-cut, computer tomography was performed subsequently and the diagnosis ascertained by biopsy or operation. Fluid-containing pleural lesions, such as encysted effusions and empyemas, pericardial cysts and one echinococcus cyst were identified by sonography from their appearance and biopsy was performed; computer tomography adds little additional information in these conditions. Solid pleural masses, on the other hand, can be more accurately defined by computer tomography. This shows the entire pleura, including small areas of calcification. Density measurements are able to differentiate various tissues, and particularly fat.

A comparison of ultrasound and computer tomography in the diagnosis of pleural shadowing

International Nuclear Information System (INIS)

Kurtz, B.; Schmitt, W.G.H.

1983-01-01

Sonography was performed in 40 patients with pleural shadowing of uncertain origin in order to complement conventional X-ray examination. Where the findings were not clear-cut, computer tomography was performed subsequently and the diagnosis ascertained by biopsy or operation. Fluid-containing pleural lesions, such as encysted effusions and empyemas, pericardial cysts and one echinococcus cyst were identified by sonography from their appearance and biopsy was performed; computer tomography adds little additional information in these conditions. Solid pleural masses, on the other hand, can be more accurately defined by computer tomography. This shows the entire pleura, including small areas of calcification. Density measurements are able to differentiate various tissues, and particularly fat. (orig.) [de

Brain abscess: Current management

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Hernando Alvis-Miranda

2013-01-01

Full Text Available Brain abscess (BA is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.

Chronic granulomatous disease: Value of the newer imaging modalities

International Nuclear Information System (INIS)

Stricof, D.D.; Glazer, M.; Amendola, A.

1984-01-01

The contribution of computed tomography (CT), ultrasound (US), and nuclear medicine studies in the evaluation and management of seven patients with chronic granulatous disease was retrospectively reviewed. These modalities proved valuable in detecting sites of infection, particularly in the abdomen. Three patients had liver abscesses, two had suppurative retroperitoneal lymphadenopathy, one had empyema, and one hand a scrotal abscess. Furthermore, CT or US-guided percutaneous aspiration and/or drainage of infected material was successfully performed on three separate occasions in a single patient, obviating the need for surgery. The newer imaging modalities are useful in the prompt diagnosis and in some instances non-operative therapy of complications of chronic granulomatous disease. (orig.)

Percutaneous drainage of 100 subphrenic abscesses

International Nuclear Information System (INIS)

Casola, G.; Sonnenberg, E. van; D'Agostino, H.; Kothari, R.; May, S.; Taggart, S.

1990-01-01

PURPOSE: Percutaneous drainage of subphrenic abscesses is technically more difficult because lung and pleura may be transgressed during catheter insertion. The purpose of this paper is to determine the incidence of thoracic complications secondary to subphrenic abscess drainage and to determine factors that may alter this. The authors' series consists of 100 subphrenic abscesses that were drained percutaneously. Patients range in age from 14 to 75 years. Abscesses were secondary to surgery (splenectomy, pancreatectomy, partial hepatectomy, gastrectomy), pancreatitis, and trauma. Catheters ranged in size from 8 to 14 F and were inserted via trocar or Seldinger technique. Thoracic complications of pneumothorax or empyema were determined from follow-up chest radiographs or CT scans

Differentiation of subdural effusions

International Nuclear Information System (INIS)

Wetterling, T.; Rama, B.

1989-01-01

Although X-ray computerized tomography facilitates the diagnosis of intracranial disorders, differentiation of the lesions like extracerebral effusions is often unsatisfactory. Epidural and acute subdural haematoma shown as hyperdensity in CT requires an emergency neurosurgical operation, so that differentiation of these hyperdense effusions may not be required. But the discrimination of the effusions shown as hypodensity in CT (chronic subdural haematoma, subdural hygroma, subdural empyema as well as arachnoid cysts) is urgent because of the different treatment of these effusions. The clinical differentiation is hampered by unspecific neurologic symptoms and the lack of adequate laboratory tests. Some aspects facilitating the diagnostic decision are presented. Recent magnetic resonance (MR) studies promise further progress in differentiating between subdural effusions. (orig.) [de

Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction

OpenAIRE

Cariati, Paolo; Cabello Serrano, Almudena; Monsalve Iglesias, Fernando; Román-Ramos, María; García Medina, Blas

2016-01-01

Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the pre...

Combined spinal subdural tuberculous empyema and intramedullary tuberculoma in an HIV-positive patient

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Alessi, Giovanni [Department of Neurosurgery, AZ St Lucas, Groenebriel 1, 9000 Gent (Belgium); Lemmerling, Marc [Department of Neuroradiology, AZ St Lucas, Groenebriel 1, 9000 Gent (Belgium); Nathoo, Narendra [Department of Neurosurgery, Wentworth Hospital, Nelson R. Mandela School of Medicine, University of Natal, Durban (South Africa)

2003-08-01

Tuberculous involvement of the spinal subdural and intramedullary compartments is extremely uncommon. Simultaneous involvement of both compartments has never been reported, to our knowledge. We present an HIV-positive patient with such kind of combined involvement. Diagnosis was made on the basis of a prior history of pulmonary tuberculous infection and a positive therapeutic response to antituberculous chemotherapy. Magnetic resonance imaging is the diagnostic procedure of choice in order to determine the exact level, site, and size of the disease. Tuberculosis of the spine should always be considered in the differential diagnosis of spinal cord compression if the patient lives in or comes from a region where tuberculosis is endemic or if the patient is immunocompromised. (orig.)

Cardiac disturbances after pneumonectomy--the value of prophylactic digitalization.

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Järvinen, A; Mattila, T; Appelqvist, P; Meurala, H; Mattila, S

1978-01-01

The incidence of postoperative cardiac disturbances and the value of prophylactic digitalization were studied retrospectively in 143 patients undergoing pneumonectomy for carcinoma of the lung. Cardiac arrhythmias occurred in 29% and tachycardia episodes in 30% of the patients. The incidence of myocardial infarction was 2%. Operative mortality was 4%. The cardiac disturbances developed more often after left than after right pneumonectomy. The age of the patients, a history of angina pectoris or hypertension did not markedly increase the incidence of cardiac disturbances, neither did operative factors, such as pericardiotomy, left atrial resection, major bleeding nor postoperative empyema. Prophylactic digitalization significantly reduced postoperative cardiac disorders, their frequency being 33% in the group of patients who received prophylactic digitalis compared with 65% in the group that did not.

Comparative Analysis of the Solid Phases of Bronchoalveolar Lavage and Oral Fluid in Children with Acute Necrotizing Pneumonia

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V.N. Grona

2014-05-01

Full Text Available The growing number of acute lung abscesses, and pleural empyema, high invalidization and mortality determine the necessity for search of new methods of its diagnosis and treatment. The aim of this research was to study the morphological characteristics of in bronchoalveolar lavage and oral fluid facies in children with acute destructive pneumonias and to find out correlations between them. We examined 24 patients of department of purulent surgery in age from 1 to 14 years. Collection of mixed unstimulated oral fluid was carried out by spitting into special tubes, bronchoalveolar lavage was obtained by bronchoscopy. There has been revealed a correlation between morphological pattern of bronchoalveolar lavage and oral fluid in children depending on the pathological condition of the body.

MINIMALLY INVASIVE TECHNIQUES IN THE INTEGRATED TREATMENT OF THOSE SUFFERING FROM SEVERE CONCURRENT INJURY WITH DOMINATING CHEST TRAUMA

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E. A. Tseymakh

2016-01-01

Full Text Available Treatment outcomes of 226 patients have been analyzed. Treatment and diagnostic algorithm has been developed for the management of patients with severe concurrent injury and dominating chest trauma. The indications for the following interventions have been formulated: emergency thoracotomy, emergency and urgent video-assisted thoracoscopy, local fibrinolytic therapy in case of clotted hemothorax and post-traumatic pleural empyema, valve bronchial block in tension and continuously persistent pneumothorax, osteosynthesis of fragmentary costal fractures. Using minimally invasive treatment techniques allowed decreasing the number of surgeries in the patients and increasing the number of recovered patients when discharged from the hospital.

Tuberculous Pleural Effusion

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Cohen, Leah A.; Light, Richard W.

2015-01-01

When a patient presents with new pleural effusion, the diagnosis of tuberculous (TB) pleuritis should be considered. The patient is at risk for developing pulmonary or extrapulmonary TB if the diagnosis is not made. Between 3% and 25% of patients with TB will have TB pleuritis. The incidence of TB pleuritis is higher in patients who are human immunodeficiency virus (HIV)-positive. Pleural fluid is an exudate that usually has a predominance of lymphocytes. The easiest way to diagnose TB pleuritis in a patient with lymphocytic pleural effusion is to demonstrate a pleural fluid adenosine deaminase level above 40 IU/L. The treatment for TB pleuritis is the same as that for pulmonary TB. Tuberculous empyema is a rare occurrence, and the treatment is difficult. PMID:29404070

Pleural effusion adenosine deaminase: a candidate biomarker to discriminate between Gram-negative and Gram-positive bacterial infections of the pleural space

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Ruolin Li

2016-05-01

Full Text Available OBJECTIVES: Delay in the treatment of pleural infection may contribute to its high mortality. In this retrospective study, we aimed to evaluate the diagnostic accuracy of pleural adenosine deaminase in discrimination between Gram-negative and Gram-positive bacterial infections of the pleural space prior to selecting antibiotics. METHODS: A total of 76 patients were enrolled and grouped into subgroups according to Gram staining: 1 patients with Gram-negative bacterial infections, aged 53.2±18.6 years old, of whom 44.7% had empyemas and 2 patients with Gram-positive bacterial infections, aged 53.5±21.5 years old, of whom 63.1% had empyemas. The pleural effusion was sampled by thoracocentesis and then sent for adenosine deaminase testing, biochemical testing and microbiological culture. The Mann-Whitney U test was used to examine the differences in adenosine deaminase levels between the groups. Correlations between adenosine deaminase and specified variables were also quantified using Spearman’s correlation coefficient. Moreover, receiver operator characteristic analysis was performed to evaluate the diagnostic accuracy of pleural effusion adenosine deaminase. RESULTS: Mean pleural adenosine deaminase levels differed significantly between Gram-negative and Gram-positive bacterial infections of the pleural space (191.8±32.1 U/L vs 81.0±16.9 U/L, p<0.01. The area under the receiver operator characteristic curve was 0.689 (95% confidence interval: 0.570, 0.792, p<0.01 at the cutoff value of 86 U/L. Additionally, pleural adenosine deaminase had a sensitivity of 63.2% (46.0-78.2%; a specificity of 73.7% (56.9-86.6%; positive and negative likelihood ratios of 2.18 and 0.50, respectively; and positive and negative predictive values of 70.6% and 66.7%, respectively. CONCLUSIONS: Pleural effusion adenosine deaminase is a helpful alternative biomarker for early and quick discrimination of Gram-negative from Gram-positive bacterial infections of the

The clinical features of respiratory infections caused by the Streptococcus anginosus group.

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Noguchi, Shingo; Yatera, Kazuhiro; Kawanami, Toshinori; Yamasaki, Kei; Naito, Keisuke; Akata, Kentaro; Shimabukuro, Ikuko; Ishimoto, Hiroshi; Yoshii, Chiharu; Mukae, Hiroshi

2015-10-26

The Streptococcus anginosus group (SAG) play important roles in respiratory infections. It is ordinarily difficult to distinguish them from contaminations as the causative pathogens of respiratory infections because they are often cultured in respiratory specimens. Therefore, it is important to understand the clinical characteristics and laboratory findings of respiratory infections caused by the SAG members. The aim of this study is to clarify the role of the SAG bacteria in respiratory infections. A total of 30 patients who were diagnosed with respiratory infections which were caused by the SAG bacteria between January 2005 and February 2015 were retrospectively evaluated. Respiratory infections caused by the SAG were mostly seen in male patients with comorbid diseases and were typically complicated with pleural effusion. Pleural effusion was observed in 22 (73.3%) patients. Empyema was observed in half of the 22 patients with pleural effusion. S. intermedius, S. constellatus and S. anginosus were detected in 16 (53.3 %), 11 (36.7 %) and 3 (10.0 %) patients, respectively. Six patients had mixed-infections. The duration from the onset of symptoms to the hospital visit was significantly longer in "lung abscess" patients than in "pneumonia" patients among the 24 patients with single infections, but not among the six patients with mixed-infection. The peripheral white blood cell counts of the "pneumonia" patients were higher than those of the "lung abscess" patients and S. intermedius was identified significantly more frequently in patients with pulmonary and pleural infections (pneumonia and lung abscess) than in patients with bacterial pleurisy only. In addition, the patients in whom S. intermedius was cultured were significantly older than those in whom S. constellatus was cultured. Respiratory infections caused by the SAG bacteria tended to be observed more frequently in male patients with comorbid diseases and to more frequently involve purulent formation. In

Single-shot echo-planar MR sequences in the diagnosis of intracranial infectious diseases

International Nuclear Information System (INIS)

Tsuchiya, Kazuhiro; Katase, Shichiro; Yoshino, Ayako; Yamakami, Norio; Hachiya, Junichi

1998-01-01

The purpose of this study was to present our preliminary experience in the application of echo-planar-imaging (EPI) MR sequences for the diagnosis of intracranial infectious diseases and to assess the value of these sequences. We reviewed single-shot EPI MR images obtained at 1.5 T in 17 patients and compared these images with conventional or fast spin-echo (SE) or fluid attenuated inversion-recovery (FLAIR) images. The clinical diagnoses for the 17 patients were meningitis (2 patients), encephalitis or meningoencephalitis (7 patients), brain abscess (5 patients), epidural empyema (2 patients) and Creutzfeldt-Jakob disease (1 patient). We obtained EPI-T 2 -weighted (T 2 W) images in 8 patients, EPI-FLAIR images in 13 patients and EPI-diffusion-weighted (DW) images in 14 patients. Among the 8 patients for whom EPI-T 2 W imaging was performed, EPI-T 2 W imaging yielded superior results compared with SE-T 2 W imaging in 3 patients as a consequence of patient motion and equal results compared with SE-T 2 W imaging in 5 patients. Among the 13 patients for whom EPI-FLAIR imaging was performed, the EPI-FLAIR images were superior to conventional FLAIR images in 3 unstable patients. In the remaining 10 patients for whom EPI-FLAIR imaging was performed, EPI-FLAIR images were equivalent or inferior to conventional FLAIR images. In 6 patients with encephalitis or meningoencephalitis, the encephalitic lesions showed hyperintensity in EPI-DW images to a greater extent than in images obtained with the other techniques. In 3 patients, EPI-DW images also demonstrated hyperintensity for the contents of abscesses or areas of empyema that was not seen with the other imaging techniques. The value of EPI-T 2 W and EPI-FLAIR imaging is limited in uncooperative patients. EPI-DW imaging was found to be of value for the evaluation of several intracranial infectious diseases. (author)

Single-shot echo-planar MR sequences in the diagnosis of intracranial infectious diseases

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Tsuchiya, Kazuhiro; Katase, Shichiro; Yoshino, Ayako; Yamakami, Norio; Hachiya, Junichi [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

1998-06-01

The purpose of this study was to present our preliminary experience in the application of echo-planar-imaging (EPI) MR sequences for the diagnosis of intracranial infectious diseases and to assess the value of these sequences. We reviewed single-shot EPI MR images obtained at 1.5 T in 17 patients and compared these images with conventional or fast spin-echo (SE) or fluid attenuated inversion-recovery (FLAIR) images. The clinical diagnoses for the 17 patients were meningitis (2 patients), encephalitis or meningoencephalitis (7 patients), brain abscess (5 patients), epidural empyema (2 patients) and Creutzfeldt-Jakob disease (1 patient). We obtained EPI-T{sub 2}-weighted (T{sub 2}W) images in 8 patients, EPI-FLAIR images in 13 patients and EPI-diffusion-weighted (DW) images in 14 patients. Among the 8 patients for whom EPI-T{sub 2}W imaging was performed, EPI-T{sub 2}W imaging yielded superior results compared with SE-T{sub 2}W imaging in 3 patients as a consequence of patient motion and equal results compared with SE-T{sub 2}W imaging in 5 patients. Among the 13 patients for whom EPI-FLAIR imaging was performed, the EPI-FLAIR images were superior to conventional FLAIR images in 3 unstable patients. In the remaining 10 patients for whom EPI-FLAIR imaging was performed, EPI-FLAIR images were equivalent or inferior to conventional FLAIR images. In 6 patients with encephalitis or meningoencephalitis, the encephalitic lesions showed hyperintensity in EPI-DW images to a greater extent than in images obtained with the other techniques. In 3 patients, EPI-DW images also demonstrated hyperintensity for the contents of abscesses or areas of empyema that was not seen with the other imaging techniques. The value of EPI-T{sub 2}W and EPI-FLAIR imaging is limited in uncooperative patients. EPI-DW imaging was found to be of value for the evaluation of several intracranial infectious diseases. (author)

CT findings of the pulmonary tuberculosis in patients with diabetes mellitus

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Yang, Chang Kyu; Hong, Deok Hwa; Kim, Yeong Tong; Kim, Hyung Lyul; Lee, Jong Myeong; Kim, Jong Kun; Lee, So Hyun; Jeong, Gun Young [Taejon Sun General Hospital, Taejon (Korea, Republic of)

1998-07-01

To evaluate the CT findings of pulmonary tuberculosis in patients with diabetes mellitus (MD),according to the diabetic control state. Materials and Methods: We retrospectively studied 34 cases of pulmonary tuberculosis accompanied by DM. We divided the right lung three lobes and ten segments and the left into two lobes and eight segments and analyzed CT findings of bronchogenic spread, cavitary lesion, ill-defined nodule, lobular consolidation, lobar and segmental consolidation, atelectasis, interlobular septal thickening, fibrotic band, and associated findings such as lymph node enlargement, pleural effusion and empyema. We also tried to determine the typical CT findings of pulmonary tuberculosis according to diabetic duration and controlled state of DM focusing by FBS 160 and HbA1C 8.0. Results: Among 34 CT scans, bronchogenic spread was seen on 29 (85.3%), cavitary lesion on 26 (76.5%), ill-defined nodules on 11 (32.4%), lobular consolidation on 14 (41.2%), lobar and segmental consolidation on 12 (35.3%), atelectasis on four (14.7%), and fibrotic band on eight (23.5%). Multiple cavities were present in 76.9% of total cavitary lesions, and consolidation with bronchogenic spread in 75%; associated findings were as follows: lymph node enlargement (n=1), pleural effusion (n=10), empyema (n=2), and pericardial effusion (n=2). In 46.7% of cases, general tubercular lesions were in an unusual location, but among cases of secondary pulmonary tuberculosis, 73.9% of lesions were in the usual location. More lobular consolidation was seen in patients with less than FBS 160 on admission, and this result was statistically significant (p<0.05); CT findings did not, however, differ according to diabetic duration and HbA1C. Conclusion: In patients with DM,general fubercular lesions were found infrequently, but in secondary tubereulosis, multiple cavitary lesions-in the usual location-were very frequent. In patients with DM, CT findings of pulmonary tuberculosis did not vary

Benign emptying of the postpneumonectomy space.

Science.gov (United States)

Merritt, Robert E; Reznik, Scott I; DaSilva, Marcelo C; Sugarbaker, David J; Whyte, Richard I; Donahue, Dean M; Hoang, Chuong D; Smythe, W Roy; Shrager, Joseph B

2011-09-01

A fall in the postpneumonectomy fluid level is considered a sign of bronchopleural fistula (BPF) requiring surgical intervention. We have discovered however that in rare asymptomatic patients, this event may not require aggressive surgical treatment. After seeing a case of benign emptying of the postpneumonectomy space (BEPS), we surveyed 28 surgeons to determine its incidence and characteristics. Forty-four cases of BEPS were reported by 23 survey respondents. Among 7 fully documented cases from 4 institutions, we defined the following criteria: the patient must be asymptomatic (no fever, white cell count elevation, or fluid expectoration), negative culture results if fluid sampled (patient not receiving antibiotics), no BPF at bronchoscopy or ventilation scintigraphy scan (or both), and recovery without drainage, or retrospective assessment that the intervention was unnecessary. BEPS occurred between 5 days and 152 days after pneumonectomy (6 cases right pneumonectomy and 1 case left pneumonectomy). Four patients underwent no treatment, 1 patient underwent thoracoscopic exploration (sterile) and closure after antibiotic irrigation, 1 patient underwent thoracoscopic exploration alone, and 1 patient underwent open window thoracostomy (sterile) with eventual closure. In all 7 patients (except the patient who underwent the open window procedure) the space refilled within 8 weeks; no patient experienced a subsequent empyema/BPF. Four patients who met the initial criteria for BEPS went on to experience empyema. The incidence of BEPS appears related to pneumonectomy volume, particularly extrapleural pneumonectomy. Using surgeon volume assumptions, the incidence of BEPS is 0.65%. To our knowledge, BEPS is a previously unreported occurrence. We hypothesize that it results from postoperative intrapleural pressure shifts, with or without a microscopic BPF, that drive fluid out of the pleural space while failing to cause contamination. Awareness of BEPS' existence may allow

CT findings of the pulmonary tuberculosis in patients with diabetes mellitus

International Nuclear Information System (INIS)

Yang, Chang Kyu; Hong, Deok Hwa; Kim, Yeong Tong; Kim, Hyung Lyul; Lee, Jong Myeong; Kim, Jong Kun; Lee, So Hyun; Jeong, Gun Young

1998-01-01

To evaluate the CT findings of pulmonary tuberculosis in patients with diabetes mellitus (MD),according to the diabetic control state. Materials and Methods: We retrospectively studied 34 cases of pulmonary tuberculosis accompanied by DM. We divided the right lung three lobes and ten segments and the left into two lobes and eight segments and analyzed CT findings of bronchogenic spread, cavitary lesion, ill-defined nodule, lobular consolidation, lobar and segmental consolidation, atelectasis, interlobular septal thickening, fibrotic band, and associated findings such as lymph node enlargement, pleural effusion and empyema. We also tried to determine the typical CT findings of pulmonary tuberculosis according to diabetic duration and controlled state of DM focusing by FBS 160 and HbA1C 8.0. Results: Among 34 CT scans, bronchogenic spread was seen on 29 (85.3%), cavitary lesion on 26 (76.5%), ill-defined nodules on 11 (32.4%), lobular consolidation on 14 (41.2%), lobar and segmental consolidation on 12 (35.3%), atelectasis on four (14.7%), and fibrotic band on eight (23.5%). Multiple cavities were present in 76.9% of total cavitary lesions, and consolidation with bronchogenic spread in 75%; associated findings were as follows: lymph node enlargement (n=1), pleural effusion (n=10), empyema (n=2), and pericardial effusion (n=2). In 46.7% of cases, general tubercular lesions were in an unusual location, but among cases of secondary pulmonary tuberculosis, 73.9% of lesions were in the usual location. More lobular consolidation was seen in patients with less than FBS 160 on admission, and this result was statistically significant (p<0.05); CT findings did not, however, differ according to diabetic duration and HbA1C. Conclusion: In patients with DM,general fubercular lesions were found infrequently, but in secondary tubereulosis, multiple cavitary lesions-in the usual location-were very frequent. In patients with DM, CT findings of pulmonary tuberculosis did not vary

Emergencies and acute diseases in the collected works of Hippocrates: observation, examination, prognosis, therapy.

Science.gov (United States)

Askitopoulou, Helen; Stefanakis, Georgios; Astyrakaki, Elisabeth E; Papaioannou, Alexandra; Agouridakis, Panagiotis

2016-12-01

The collected works οf Hippocrates include a wealth of references to emergencies and acute conditions; if the physician could treat these, he would be considered superior to his colleagues. Works most relevant to current Emergency Medicine are presented. They indicate Hippocrates' remarkable insight and attention to the value of close observation, meticulous clinical examination, and prognosis. Hippocrates and his followers disdained mystery and were not satisfied until they had discovered a rational cause to diseases. They assigned great significance to distressing signs and symptoms - the famous Hippocratic face, the breathing pattern, pain, seizures, opisthotonus - pointing to a fatal outcome, which they reported to their patient. The principles of treatment of emergencies, such as angina, haemorrhage, empyema, ileus, shoulder dislocations and head injuries, are astonishingly similar to the ones used nowadays.

Acute pulmonary infections

International Nuclear Information System (INIS)

Juhl, J.H.

1987-01-01

Acute pulmonary infection may be caused by a variety of organisms. In some instances they produce a reasonably characteristic, gross pathologic pattern and, therefore, a recognizable roentgenographic pattern. In the subsequent discussions the most common gross anatomic findings in the pneumonias of various causes as reflected in chest roentgenograms will be described. The roentgenographic manifestations of pulmonary infections are so varied that the pattern observed often gives us little information regarding the causative organism. Therefore, in each instance it should be remembered that roentgenographic findings must be correlated with clinical, bacteriological, and laboratory data to ascertain the correct etiologic diagnosis upon which treatment is based. The role of the radiologist is to locate and define the extent of the disease and any complicating findings such as lung abscess and pleural effusion or empyema

Benign emptying of the post-pneumonectomy space: recognizing this rare complication retrospectively.

Science.gov (United States)

Kanakis, Meletios A; Misthos, Panagiotis A; Tsimpinos, Michalis D; Rapti, Nicoletta G; Chatzis, Andrew C; Lioulias, Achilleas G

2015-11-01

Patients presenting with a sudden drop in the pleural fluid level after a pneumonectomy in the absence of a recognizable bronchopleural fistula (BPF) have been classified as cases of benign emptying of the post-pneumonectomy space (BEPS). A retrospective study of 1378 pneumonectomies identified 4 cases of BEPS (0.29%). The patients were men; median age 64 years and all had undergone a right pneumonectomy. The median time at diagnosis was 31 days postoperatively and the median follow-up time was 31 months. None of the patients experienced a documented BPF or empyema. Although BEPS is an extremely rare complication, early recognition and close patient monitoring will prevent unnecessary interventional strategies. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Sepsis from dropped clips at laparoscopic cholecystectomy

International Nuclear Information System (INIS)

Hussain, Sarwat

2001-01-01

We report seven patients in whom five dropped surgical clips and two gallstones were visualized in the peritoneal cavity, on radiological studies. In two, subphrenic abscesses and empyemas developed as a result of dropped clips into the peritoneal cavity during or following laparoscopic cholecystectomy. In one of these two, a clip was removed surgically from the site of an abscess. In two other patients dropped gallstones, and in three, dropped clips led to no complications. These were seen incidentally on studies done for other indications. Abdominal abscess secondary to dropped gallstones is a well-recognized complication of laparoscopic cholecystectomy (LC). We conclude that even though dropped surgical clips usually do not cause problems, they should be considered as a risk additional to other well-known causes of post-LC abdominal sepsis

Chronic obstructive pulmonary disease and risk of infection

DEFF Research Database (Denmark)

Lange, Peter

2009-01-01

This review article focuses on the risk of infections in patients with chronic obstructive pulmonary disease (COPD). Throughout the years there have been a number of studies describing the risk of pulmonary infections in patients with COPD, whereas only few studies have focused on the risk...... of infection outside the lungs. With increasing severity of COPD the risk of respiratory tract infection also increases. The impairment of the innate immune system is most likely responsible for both the colonization of respiratory tract with bacteria and for an increased risk of infection with new strains...... of bacteria causing acute exacerbations. Also lung infections like pneumonia, lung abscess and empyema are more often seen in patients with COPD than in healthy subjects. With regard to extrapulmonary infections, it seems that COPD patients are not at higher risk of infection compared with subjects without...

Interventional radiology in benign diseases of the biliary tract

International Nuclear Information System (INIS)

Juliani, G.; Gandini, G.

1986-01-01

Most references in the literature on interventional radiology of the biliary tract refer to the treatment of cancer; only occasionally are benign conditions mentioned. An updated list of radiosurgical instruments on the market in Italy is presented. The operating technique from the preparation of the patient to the performance of percutaneous transhepatic cholangiography (PTC), biliary drainage, transhepatic bilioplasty, percutaneous extraction and chemical cholelitholisis of biliary calculi and drainage of biliary collections is then described. A personal series is then presented. It consist of 93 patients in whom one or more of the following conditions were diagnosed: exclusively intrahepatic calculosis (3 cases), calculosis of the common bile duct (23 percutaneous treatments), empyema of the gallbladder (6 cases), suppurating cholangitis (46 cases), sclerotic or inflammatory stenosis (16 cases), biliary collections (14 cases). Results are reported and commented on

Ultrasound for critical care physicians: neutropenic patient with fever snd shortness of breath

Directory of Open Access Journals (Sweden)

Kraai E

2014-06-01

Full Text Available No abstract available. Article truncated after first page. A 63 year old female with a history of acute myelogenous leukemia presents with shortness of breath, fever and hypotension to the ICU. She is in septic shock on norepinephrine, and has been treated on the oncology unit with vancomycin, cefepime, acyclovir and voriconazole. She has been neutropenic for 1 month. The patient develops a progressive right lower chest opacity. This opacity has progressed in spite of antibiotics and antifungals. The portable AP chest radiograph is presented below (Figure 1. An ultrasound of the right chest was performed for further evaluation of the opacity (figure 2. Question: What pathology does the ultrasound reveal in the right hemithorax? 1. Air filled cavity; 2. Chest wall abscess; 3. Fractured ribs; 4. Pleural effusion and suspected empyema; 5. Simple consolidation ...

Percutaneous transcatheter drainage of intrathoracic air and fluid collections

International Nuclear Information System (INIS)

Klein, J.S.; Salmon, C.J.

1991-01-01

In this paper, the authors review their experience with radiologically guided percutaneous, small-bore catheter drainage of 89 intrathoraic air or fluid collections in 81 patients to determine the effect of various clinical and radiographic features and fluid characteristics on successful treatment of the collections. The majority of patients underwent drainage for malignant pleural effusion. Patients with pneumothorax, complicated parapneumonic effusion or empyema, hemothorax, chylothorax, and lung abscess were included. Each patient's diagnosis and symptoms; the size, position, and characteristics of the fluid collection; catheter type and size, and use of urokinase were recorded; their effect on clinical and radiographic resolution was determined with logistic regression analysis. The vast majority of malignant effusions were successfully drained and sclerosed with small bore (8-F) pigtail catheters. In patients with pneumothorax, those from Pneumocystis carinii pneumonia required prolonged suction and pleurodesis

COMPLICAÇÃO NEUROLÓGICA DE AFECÇÃO OTORRINOLARINGOLÓGICA EM PEDIATRIA: UM RELATO DE CASO

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Annah Rachel Graciano

2015-06-01

Full Text Available Objective: To report a case of a pediatric patient with acute otitis media and sinusitis who evolved with intracranial complications. Case description: Male child, 4 years old, was admitted with persistent purulent otorrhea, mental confusion, irritability signals. The patient developed fever, convulsive seizures and motor impairment. The CT scan has accused hypodense subdural collection, front and unilateral. Antibiotic therapy was started and The patient was transferred for neurological and neurosurgical consultation for subsequently drainage of empyema. Comments: Otitis media and sinusitis correspond to the majority pediatric consultations, being the most common reason for drug prescription of antibiotics for children. The suppurative complications are rarely seen in developed countries, but occur frequently in children who have limited medical assistance. Although these diseases are often autolimited, there are complications with difficult management and high mortality rate.

[How to do - the chest tube drainage].

Science.gov (United States)

Klopp, Michael; Hoffmann, Hans; Dienemann, Hendrik

2015-03-01

A chest tube is used to drain the contents of the pleural space to reconstitute the physiologic pressures within the pleural space and to allow the lungs to fully expand. Indications for chest tube placement include pneumothorax, hemothorax, pleural effusion, pleural empyema, and major thoracic surgery. The most appropriate site for chest tube placement is the 4th or 5th intercostal space in the mid- or anterior- axillary line. Attention to technique in placing the chest tube is vital to avoid complications from the procedure. Applying the step-by-step technique presented, placement of a chest tube is a quick and safe procedure. Complications - frequently occurring when the tube is inserted with a steel trocar - include hemothorax, dislocation, lung lacerations, and injury to organs in the thoracic or abdominal cavity." © Georg Thieme Verlag KG Stuttgart · New York.

Community-acquired pneumonia; Ambulant erworbene Pneumonien

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Poetter-Lang, S.; Herold, C.J. [Medizinische Universitaet Wien, Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Wien (Austria)

2017-01-15

The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging. The radiological findings serve as proof or exclusion of pneumonia and can also be used to evaluate the extent of the disease (e.g. monolobular, multilobular, unilateral or bilateral). In cases of prolonged disease, suspicion of complications (e.g. pleural effusion or empyema, necrotizing pneumonia or abscess) or comorbid conditions (e.g. underlying pulmonary or mediastinal diseases) computed tomography is an important diagnostic tool in addition to chest radiography. Ultrasound is often used to diagnose pleural processes (e.g. parapneumonic effusion or pleural empyema). (orig.) [German] Anhand der klinischen Symptome und laborchemischen Befundkonstellation alleine ist es oft nicht moeglich, die Diagnose einer ambulant erworbenen Pneumonie (''community-acquired pneumonia'', CAP) zu stellen. Bei jedem Patienten mit Verdacht auf CAP sollte eine Roentgenthoraxaufnahme in 2 Ebenen angefertigt werden. Weiter muss eine Risikostratifizierung im Sinne der Entscheidung ambulante Therapie vs. Hospitalisierung erfolgen. Anhand der Analyse radiologischer Muster sowie deren Verteilung und Ausdehnung koennen eine grobe Zuordnung zu sogenannten Erregergruppen sowie eine Differenzierung zwischen viralen und bakteriellen Infektionen gelingen. Da

Intrathoracic application of a vacuum-assisted closure device in managing pleural space infection after lung resection: is it an option?

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Haghshenasskashani, Alireza; Rahnavardi, Mohammad; Yan, Tristan D; McCaughan, Brian C

2011-08-01

Empyema after lung resection is a challenging condition to manage and is associated with a high mortality. Intrathoracic application of a vacuum-assisted closure (VAC) device is recently introduced as an adjunct in the management of this condition. A best evidence topic was constructed to address whether this approach is effective in successful chest closure and reducing hospital stay. Twenty-three papers were found using the reported search, of which nine papers were identified that provided the best evidence to answer the question. All papers were retrospective and included a total of 69 patients treated with intrathoracic VAC. There was only one cohort study and the rest were either case series or case reports. In a cohort of 19 patients reported by Palmen et al. the average duration of an open window thoracostomy in a group of patients with VAC (n=11) was 39 ± 17 days and in those without VAC (n=8) was 933 ± 1422 days. Median length of VAC treatment was 22 days (range 6-66 days) in a series of 28 patients reported by Saadi et al. Some authors excluded patients with a bronchopleural fistula (BPF) from VAC treatment. However, Groetzner et al. have safely used VAC in patients with BPF after covering the bronchus stump with an intrathoracic muscle flap. The mediastinum and the bronchus can be covered using a polyvinyl-alcohol foam. Polyurethane foam is commonly used to fill the intrathoracic cavity up to the superficial wound. The suggested starting level of negative pressure is as low as -25 mmHg to -75 mmHg depending on the presence or absence of signs of mediastinal traction; this negative pressure can gradually be increased to -125 mmHg over time. The recommended interval between VAC changes is two to five days. Accumulated evidence in this article, although limited, suggests that VAC, as an adjunct to the standard treatment, can potentially alleviate the morbidity and decrease hospital stay in patients with empyema after lung resection. VAC can reduce

Impact of CT in patients with sepsis of unknown origin

International Nuclear Information System (INIS)

Barkhausen, J.; Stoeblen, F.; Mueller, R.D.

1999-01-01

Purpose: To evaluate the diagnostic relevance of CT in patients with sepsis of unknown origin. Material and Methods: Sixty-three consecutive intensive care patients with suspicion of an abscess and negative or inconclusive previous radiological examinations were included. CT was performed using the helical technique. A total of 45 abdominal and 38 chest examinations were evaluated. Results: 5/38 examinations of the chest revealed the source of sepsis (pleural empyema 2, lung abscess 1, mediastinitis 1, retrosternal abscess 1). 7/45 abdominal CT examinations showed the source of sepsis (intraabdominal abscess 2, hepatic abscess 3, intestinal perforation 1, gangrenous colitis 1). Conclusion: CT is useful for the evaluation of patients with fever or sepsis without a known source. Due to the detection of a spetic focus by CT, 19% of the patients in our study could be immediately referred to causal therapy as percutaneous drainage or surgery. (orig.)

Impact of CT in patients with sepsis of unknown origin

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Barkhausen, J.; Stoeblen, F.; Mueller, R.D. [University Hospital Essen (Germany). Dept. of Radiology; Dominguez-Fernandez, E. [University Hospital Essen (Germany). Dept. of General Surgery; Henseke, P. [Nycomed-Amersham Arzneimittel GmbH, Muenchen (Germany)

1999-09-01

Purpose: To evaluate the diagnostic relevance of CT in patients with sepsis of unknown origin. Material and Methods: Sixty-three consecutive intensive care patients with suspicion of an abscess and negative or inconclusive previous radiological examinations were included. CT was performed using the helical technique. A total of 45 abdominal and 38 chest examinations were evaluated. Results: 5/38 examinations of the chest revealed the source of sepsis (pleural empyema 2, lung abscess 1, mediastinitis 1, retrosternal abscess 1). 7/45 abdominal CT examinations showed the source of sepsis (intraabdominal abscess 2, hepatic abscess 3, intestinal perforation 1, gangrenous colitis 1). Conclusion: CT is useful for the evaluation of patients with fever or sepsis without a known source. Due to the detection of a spetic focus by CT, 19% of the patients in our study could be immediately referred to causal therapy as percutaneous drainage or surgery. (orig.)

Pulmonary Artery Perforation as a Complication of Pleural Drainage - Case Report.

Science.gov (United States)

Gołota, Janusz Jacek; Kiliańczyk, Michał; Szmyt, Piotr

2016-10-01

The case presented is a drainage of empyema of the left pleural cavity complicated with the penetration of the lung parenchyma and perforation of the left pulmonary artery with drain displacement to the right pulmonary artery. The cause of complications has been shown along with the possible ways of conduct. Drainage of the pleural cavity is a primary surgery in the chest. The presence of pleural air or fluid is an indication for its implementation. This procedure usually has no complications. Time pressure, anatomical anomalies, changes of the topography in the course of co-morbidities are the factors allowing for the creation of many complications. The aim of the work is to remind about the technical performance of this simple surgical procedure and to note that its complications may directly threaten the life of the patient. This is the first case reported in Polish literature.

[Community acquired pneumonia in children: Treatment of complicated cases and risk patients. Consensus statement by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Chest Diseases (SENP)].

Science.gov (United States)

Moreno-Pérez, D; Andrés Martín, A; Tagarro García, A; Escribano Montaner, A; Figuerola Mulet, J; García García, J J; Moreno-Galdó, A; Rodrigo Gonzalo de Lliria, C; Saavedra Lozano, J

2015-09-01

The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Medical image of the week: actinomycosis

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Siddiqi TA

2015-05-01

Full Text Available No abstract available. Article truncated at 150 words. A 55-year-old man with history of tobacco and alcohol abuse, presented with unresolving pneumonia despite treatment with moxifloxacin. It was thought to be possible coccidioidomycosis and an azole was started. However, he returned with increasing dyspnea and hypoxemia. He had leukocytosis with a thoracic CT revealing a loculated empyema, multifocal necrotizing infection and a large intrapulmonary abscess (Figure 1. He was admitted to MICU, intubated and ventilated. He was in septic shock requiring fluid resuscitation, vasopressors, and broad antibiotics. Bronchoscopy revealed erythematous and edematous airways, with drainage of over one liter of purulent fluid. A chest tube was placed to drain pleural fluid with removal of around two liters of blood-tinged, purulent fluid. His condition worsened with development of disseminated intravascular coagulation leading to hemorrhagic shock. He arrested and died. Gram stain on bronchoalveolar lavage fluid showed mixed gram negative and gram variable rods, and cultures grew lactobacillus species. GMS ...

Computed tomographic findings of intracranial pyogenic abscess

International Nuclear Information System (INIS)

Kim, S. J.; Suh, J. H.; Park, C. Y.; Lee, K. C.; Chung, S. S.

1982-01-01

The early diagnosis and effective treatment of brain abscess pose a difficult clinical problem. With the advent of computed tomography, however, it appears that mortality due to intracranial abscess has significantly diminished. 54 cases of intracranial pyogenic abscess are presented. Etiologic factors and computed tomographic findings are analyzed and following result are obtained. 1. The common etiologic factors are otitis media, post operation, and head trauma, in order of frequency. 2. The most common initial computed tomographic findings of brain abscess is ring contrast enhancement with surrounding brain edema. 3. The most characteristic computed tomographic finding of ring contrast enhancement is smooth thin walled ring contrast enhancement. 4. Most of thick irregular ring contrast enhancement are abscess associated with cyanotic heart disease or poor operation. 5. The most common findings of epidural and subdural empyema is crescentic radiolucent area with thin wall contrast enhancement without surrounding brain edema in convexity of brain

Actinomyces meyeri brain abscess following dental extraction.

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Clancy, U; Ronayne, A; Prentice, M B; Jackson, A

2015-04-13

We describe the rare occurrence of an Actinomyces meyeri cerebral abscess in a 55-year-old woman following a dental extraction. This patient presented with a 2-day history of hemisensory loss, hyper-reflexia and retro-orbital headache, 7 days following a dental extraction for apical peridonitis. Neuroimaging showed a large left parietal abscess with surrounding empyema. The patient underwent craniotomy and drainage of the abscess. A. meyeri was cultured. Actinomycosis is a rare cause of cerebral abscess. The A. meyeri subtype is particularly rare, accounting for less than 1% of specimens. This case describes an unusually brief course of the disease, which is usually insidious. Parietal lobe involvement is unusual as cerebral abscesses usually have a predilection for the frontal and temporal regions of the brain. Although there are no randomised trials to guide therapy, current consensus is to use a prolonged course of intravenous antibiotics, followed by 6-12 months of oral therapy. 2015 BMJ Publishing Group Ltd.

March 2016 pulmonary case of the month

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Sista RR,

2016-03-01

Full Text Available No abstract available. Article truncated after first page. History of Present Illness: A 74-year-old man was referred for a recently identified right pleural effusion and dyspnea on exertion. Past Medical History, Family History and Social History: He has a history of anemia, hypertension, and prostate cancer with a prostatectomy in 2015. He is a life-long nonsmoker and has no occupational exposures. Family history is noncontributory. Physical Examination: He had diminished breath sounds at the right lung base and a palpable spleen. Otherwise the physical examination was unremarkable. Laboratory: CBC: hemoglobin 8.5 g/dL, white blood count 7.7 X 109 cells/L, platelets 357 X 109 cells/L. Radiography: A chest X-ray showed a right pleural effusion. Representative images from the CT scan are shown in Figure 1. Which of the following is the most likely diagnosis? 1. Empyema; 2. Lung cancer; 3. Tuberculosis; 4. Usual interstitial pneumonia; 5. Valley fever (coccidioidomycosis. ...

Outcome of ultrasound-guided small-bore catheter drainage in exudative pleural effusions.

Science.gov (United States)

Kiranantawat, Nantaka; Sungsiri, Jitpreedee; Geater, Sarayut L

2014-05-01

To evaluate the outcome and safety of ultrasound-guided percutaneous catheter drainage of exudative pleural effusion. The present study was a retrospective analysis of 412 pleural effusions from 373 patients that underwent ultrasound-guided small-bore catheter drainage in exudative pleural effusions between 2004 and 2009. The two most common causes for drainage were parapneumonic effusion or empyema (52.2%) and malignant effusion (30.3%), while the remains were trauma, iatrogenic, and others. Overall clinical success rate was 76.5%. The success rate was lower among malignant pleural effusion (p = 0.003). Causes of effusion were the only independent predictors related to success. Only five (1.2%) patients developed complication during the procedure. Seventy-five of 412 effusions (15.8%) developed complication during the period of drainage; the majority were drain blockage (9%) and accidental dislodgment (4.1%). Ultrasound-guided small-bore catheter drainage was a safe and efficient procedure for exudative pleural effusions.

Esophageal rupture caused by explosion of an automobile tire tube: a case report.

Science.gov (United States)

Yu, Yongkang; Ding, Sheng; Zheng, Yifeng; Li, Wei; Yang, Lie; Zheng, Xiushan; Liu, Xiaoyan; Jiang, Jianqing

2013-08-23

There have been no reports in the literature of esophageal rupture in adults resulting from an explosion of an automobile tire. We report the first case of just such an occurrence after an individual bit into a tire, causing it to explode in his mouth. A 47-year-old Han Chinese man presented with massive hemorrhage in his left eye after he accidentally bit an automobile tire tube which burst into his mouth. He was diagnosed with esophageal rupture based on a chest computed tomography scan and barium swallow examination. Drainage of empyema (right chest), removal of thoracic esophagus, exposure of cervical esophagus, cardiac ligation and gastrostomy were performed respectively. After that, esophagogastrostomy was performed. Successful anastomosis was obtained at the neck with no postoperative complications 3 months after the surgery. The patient was discharged with satisfactory outcomes. We present this case report to bring attention to esophageal rupture in adults during the explosion of an automobile tire tube in the mouth.

Treatment of radiation-induced vesicovaginal fistulae

International Nuclear Information System (INIS)

Parm Ulhoei, B.; rosgaard, A.; Harling, H.

1994-01-01

The records of 23 patients with vesicovaginal fistulae (VVF) probably caused by irradiation treatment for cancer of the uterine cervix were analyzed. The median latency between irradiation and fistula formation was 17 years. Ten patients had histologically verified cancer recurrence besides a VVF. In addition, nine patients had a rectovaginal- and one an ileovaginal fistula. Twelve patients were treated primarily with ureteroileocutaneostomy a.m. Bricker. Six had bladder drainage, and four of these had ureteroileocutaneostomy performed at a later stage. Four patients initially underwent percutaneous nephrostomy. One patients had a unilateral ureteroileocutaneostomy performed. Eight patients are alive today (median observation time 2.5 years), and all of these had had ureteroileocutaneostomy performed. Three of these patients (39%) were completely relieved of symptoms while the rest occasionally experienced pain, vaginal discharge and bladder empyema. We conclude that ureteroilocutaneostomy a.m. Bricker is a satisfactory procedure for vesicovaginal fistulae because the socially incapacitating symptoms disappear or are considerably diminished. (au) (9 refs.)

Latissimus-sparing thoracotomy in the pediatric patient: a valuable asset for thoracic reconstruction.

Science.gov (United States)

Malczewski, M C; Colony, L; Cobb, L M

1994-03-01

The traditional posterolateral thoracotomy involves division of the latissimus dorsi muscle (LD). While the division results in no functional disability, it does negate the potential for possible future thoracic reconstruction if required in individual cases (eg, bronchopleural fistula, empyema, etc). A latissimus-sparing thoracotomy (LST) mobilizes the muscle dorsad and does not compromise the operation. Thus, the ipsilateral LD can be used when chest wall reconstruction is required. This option has been used frequently for adults; however, its use in children has not been extensively documented. Microvascular anastomoses for a contralateral LD free-flap may be tenuous in the small vessels of the child; thus, reconstruction using the ipsilateral LD could be beneficial and safer. The feasibility of LST has not been established with regard to the chest of the child. The authors present three pediatric thoracic cases that illustrate the value of this procedure, and discuss different situations in which latissimus-sparing thoracotomy is advantageous.

Percutaneous cholecystostome; 60 cases of experience

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Kang, Sung Gwon; Song, Ho Young; Yoon, Hyun Ki; Lee, Young Suk; Ki, Won Woo; Sung, Gyu Bo [Ulsan Univ College of Medicine, Seoul (Korea, Republic of)

1996-01-01

To review the effectiveness and complication of percutaneous cholecystostomy (PCCS). We performed PCCS in 60 patient who presented with acute cholecystitis. The causes of acute cholecystitis were as follows; acalculous cholecystitis(n=8), calculous cholecystitis(n=23), GB hydrops (n=3), GB empyema(n=15), septic cholangitis(n=11). Of 60 patients, 36 patients had high risk factor for cholecystectomy; underlying malignancy(n=13), severe trauma(n=6). Cholecystostomy was done under ultrasonographic and fluoroscopic guide. The cholecystostomy was successfully in 59 patients, and failed in 1 patient. 15 patients improved without other procedure. 16 patients underwent cholecystectomy after improvement of their general condition. Severe complications of PCCS are as follows; bile peritonitis(n=6), hemoperitoneum(n=1), subphrenic abscess(n=1). Mild complication, such as pain, occurred in most patients. Emergency operation was done in one patient who developed bile peritonitis. Cholecystostomy is effective and safe, especially in cases of inoperable patients who represent acute cholecystitis. Percutaneous cholecystostomy may substitute surgical cholecystostomy.

Re-discovering the heimlich valve: Old wine in a new bottle

Directory of Open Access Journals (Sweden)

Ajay Narasimhan

2017-01-01

Full Text Available A 14-year-old boy came to our outpatient department with pleuritic chest pain and dyspnea. He was found to have a loculated empyema on the right side. He was taken up for surgery and decortication was done. He developed air leak in the postoperative period. When the air leak did not settle until the 10th day, we decided to attach the atrium Pneumostat™, a modified version of the Heimlich valve to his Intercostal drainage tube and sent him home. On further follow-up, his lung expanded, and ICD could be removed. The patient remains well until the current follow-up. We present this case in an attempt to change the perceptions about various options available to drain the chest. The Heimlich valve appears to be a more compliant option than the conventional underwater seal drainage in terms of early mobility, reduced length of stay, and patient compliance.

[Isolation of anaerobes during a 30-month observation at a hospital microbiology laboratory].

Science.gov (United States)

Pistono, P G; Rapetti, I; Stacchini, E; Vironda, N; D'Usi, M P; Guasco, C

1989-01-01

The authors evaluate retrospectively the results obtained from the research of anaerobial bacteria on 1313 samples received at the Microbiology Laboratory of the "Ospedale Civile di Ivrea" over a period of 31 months (6/1/86-12/31/88). From this evaluation, high percentages of detection of anaerobic bacteria are emerging in the following infections: appendiculare abscesses (60%), intestinal operations (71%), wounds (57%), tubovarian abscesses (100%), as well as thoracic empyema (50%). Also relevant are the isolations from skin and subcutaneous tissues: breast infections (50%) preputial infections (60%), perineal and perirectal abscesses (60%). The incident of anaerobic bacteria in bacteriemia is 17%. The most representative anaerobic bacteria group are: Bacteroides spp. (56%), Peptostreptococcus spp. (12%), Propionibacterium spp. (9%), Fusobacterium spp. (7%) Clostridium spp. (6%), Veillonella spp. and Eubacterium spp. (3%). In the intraabdominal infections prevails the Bacteroides group, particularly fragilis species, while in the skin and subcutaneous infections prevails the Peptostreptococcus group.

Primary pulmonary lymphoma mimicking a refractory lung abscess: A case report.

Science.gov (United States)

Matsumoto, Takeshi; Otsuka, Kojiro; Funayama, Yuki; Imai, Yukihiro; Tomii, Keisuke

2015-04-01

The current study presents a case of primary pulmonary lymphoma (PPL) mimicking refractory lung abscess that was diagnosed at autopsy. An 80-year-old male with clinically inapparent aspiration presented with a large cavitated mass and pleural effusion. A lung abscess and empyema was diagnosed, therefore, antibiotics were administered and the pleural effusion was drained. Various examinations, including a biopsy, yielded no specific diagnosis. The lesion was considered inoperable due to the poor general condition of the patient. Subsequently, the mass that had been diagnosed as a refractory lung abscess became enlarged and a repeat biopsy resulted in a diagnosis of diffuse large B-cell lymphoma. The patient succumbed to sudden respiratory failure, and the final diagnosis of PPL was confirmed at autopsy. PPL is a rare disease that accounts for 0.45% of all pulmonary malignant tumors and is difficult to diagnose in inoperable cases. Therefore, patients with PPL who do not undergo surgery can be misdiagnosed and consequently treated inappropriately. PPL should therefore be considered in the differential diagnosis of a refractory lung abscess.

Lung abscess due to non-tuberculous, non-Mycobacterium fortuitum in a neonate.

Science.gov (United States)

Glatstein, Miguel; Scolnik, Dennis; Bensira, Liat; Domany, Keren Armoni; Shah, Mansi; Vala, Snehal

2012-10-01

Although Mycobacterium fortuitum (MF) is a non-tuberculous mycobacterium that rarely causes disease, there are reported cases of pneumonia, lung abscess, and empyema in subjects with predisposing lung disease. We report a neonate, without predisposing disease or risk factors, who manifested pneumonia and lung abscess. The patient was initially treated with amoxicillin-clavulanic acid and gentamycin, and subsequently with piperazilin, tazobactam, and vancomycin when there was no improvement. Pleural nodules were detected on computed tomography, and microbiology revealed MF in the absence of other pathogens and a week later the organism was identified in culture as MF, confirmed on four separate samples. The MF was sensitive to amikacin and clarithromycin and the patient was continued on oral clarithromycin for two more weeks until full recovery. To our knowledge, this is the first reported case of MF abscess in a neonate. MF should be sought in similar patients, especially when microbiology fails to detect the usual pathogens, and when the clinical picture is unclear. Copyright © 2012 Wiley Periodicals, Inc.

Brain abscess mimicking brain metastasis in breast cancer

International Nuclear Information System (INIS)

Khullar, P.; Datta, N.R.; Wahi, I.K.; Kataria, S.

2016-01-01

61 year old female presented with chief complaints of headache for 30 days, fever for 10 days, altered behavior for 10 days and convulsion for 2 days. She was diagnosed and treated as a case of carcinoma of left breast 5 years ago. MRI brain showed a lobulated lesion in the left frontal lobe. She came to our hospital for whole brain radiation as a diagnosed case of carcinoma of breast with brain metastasis. Review of MRI brain scan, revealed metastasis or query infective pathology. MR spectroscopy of the lesion revealed choline: creatinine and choline: NAA (N-Acety- laspartate) ratios of 1.6 and 1.5 respectively with the presence of lactate within the lesion suggestive of infective pathology. She underwent left fronto temporal craniotomy and evacuation of abscess and subdural empyema. Gram stain showed gram positive cocci. After 1 month of evacuation and treatment she was fine. This case suggested a note of caution in every case of a rapidly evolving space-occupying lesion independent of the patient’s previous history

High recurrence rate of lymphadenitis due to nontuberculous mycobacteria and its association with concurrent Salmonella infection in Taiwan.

Science.gov (United States)

Hsiao, Cheng-Hsiang; Lai, Chih-Cheng; Hsueh, Po-Ren

2014-06-01

The objective of this study is to investigate the clinical characteristics of lymphadenitis due to nontuberculous mycobacteria (NTM) in Taiwan. We retrospectively reviewed the medical records of all patients who presented to the National Taiwan University Hospital with culture-positive NTM lymphadenitis during the period 2000-2010. Patients with concurrent extranodal involvement were excluded. From 2000 to 2010, 15 patients with lymphadenitis caused by nontuberculous mycobacteria were identified. Most patients (80%, n = 12) were infected with rapidly growing mycobacteria. Mycobacterium abscessus was the most common infective species (n = 8). Recurrence of infection involving multiple organs occurred 2-7 years after the completion of treatment in 11 (73%) patients. Five (33.3%) patients had concurrent Salmonella infections (4 patients with bacteremia and 1 patient with empyema thoracis) during the course of the disease. In Taiwanese patients, we found a high recurrence rate of NTM lymphadenitis that was closely associated with Salmonella infections. We also noted that the clinical and epidemiological manifestations of NTM lymphadenitis in Taiwan differed from their manifestations in western countries. Copyright © 2012. Published by Elsevier B.V.

Bright intracranial lesions on diffusion-weighted images: a pictorial review

International Nuclear Information System (INIS)

Choi, Dae Seob

2006-01-01

Diffusion-weighted imaging (DWI) is a MR sequence that is used to evaluate the rate of microscopic water diffusion within the tissues. The ability to measure the rate of water diffusion is important because this is frequently altered in various disease processes. Generally, the lesions with restricted water diffusion show bright intensity on DWI, but the lesions without restricted water diffusion can also show bright intensity on DWI, which is called the 'T2 shine through effect'. With DWI, we can sensitively detect hyperacute infarction (within 6 hours after symptom onset), and this is difficult to detect with using CT and the conventional MR sequenced. The acute and subacute lesions of hypoxic-ischemic encephalopathy and carbon monoxide intoxication also show bright intensity on the DWI. The other diseases that can show bright intensity on the DWI include acute and subacute diffuse axonal injury lesion, hyperacute and late subacute hematomas, cerebral abscess, subdural empyema, acute herpes encephalitis, various tumors and such degenerative and demyelinating diseases as multiple sclerosis, posterior reversible encephalopathy syndrome, Wilson's disease and Wernicke's encephalopathy

Bright intracranial lesions on diffusion-weighted images: a pictorial review

Energy Technology Data Exchange (ETDEWEB)

Choi, Dae Seob [Gyeongsang National University College of Medicine, Jinju (Korea, Republic of)

2006-06-15

Diffusion-weighted imaging (DWI) is a MR sequence that is used to evaluate the rate of microscopic water diffusion within the tissues. The ability to measure the rate of water diffusion is important because this is frequently altered in various disease processes. Generally, the lesions with restricted water diffusion show bright intensity on DWI, but the lesions without restricted water diffusion can also show bright intensity on DWI, which is called the 'T2 shine through effect'. With DWI, we can sensitively detect hyperacute infarction (within 6 hours after symptom onset), and this is difficult to detect with using CT and the conventional MR sequenced. The acute and subacute lesions of hypoxic-ischemic encephalopathy and carbon monoxide intoxication also show bright intensity on the DWI. The other diseases that can show bright intensity on the DWI include acute and subacute diffuse axonal injury lesion, hyperacute and late subacute hematomas, cerebral abscess, subdural empyema, acute herpes encephalitis, various tumors and such degenerative and demyelinating diseases as multiple sclerosis, posterior reversible encephalopathy syndrome, Wilson's disease and Wernicke's encephalopathy.

Computed tomographic localization of Rt. Juxtadiaphragmatic lesions

International Nuclear Information System (INIS)

Lee, Jong Doo; Choe, Kyu Ok; Kim, Ki Whang; Hong, In Soo

1989-01-01

Since several reports were published about CT differentiation of peridiaphragmatic fluid collection using 4 useful signs-diaphragm, displaced crus, bare area and interface signs. Transverse CT scans of 20 patients with abnormal diaphragmatic position due to large intrathoracic or intraabdominal lesion were analysed on the basis of those signs. Difficulties were encounted with differentiation when laterally located lesions did not extend to as far medially as crus, and when diaphragmatic stripe could not be distinguished from thickened pleura or adjacent wall of lesions. As a result, limited cases can be adequately assessed by diaphragm or displaced crus sign. Furthermore, bare area and interface signs seemed to be not useful at all. However relationship between caudal tip of lesions and thoracoabdominal wall was always constant in each thoracic or abdominal lesions. All of intrathoracic masses or empyemas were attached to thoracic wall displacing properitoneal and perirenal fat medially or inferiorly. By contraries, all of intraabdominal masses were separated from abdominal wall displacing properitoneal fat or peritoneum laterally. The key to accurate localization seemed to be identification of such relationship

Abdominal wall sinus due to impacting gallstone during laparoscopic cholecystectomy: an unusual complication.

Science.gov (United States)

Pavlidis, T E; Papaziogas, B T; Koutelidakis, I M; Papaziogas, T B

2002-02-01

During laparoscopic cholecystectomy, perforation of the gallbladder can occurs in extraction of the gallbladder. The fate of such lost gallstones, which can lead to the formation of an abscess, an abdominal wall mass, or a persistent sinus, has not been studied adequately. Herein we report the case of a persistent sinus of the abdominal wall after an emergent laparoscopic cholecystectomy in an 82-year-old woman with gangrenous cholecystitis and perforation of the friable wall in association with an empyema of the gallbladder. The culture of the obtained pus was positive for Escherichia coli. After a small leak of dirty fluid from the wound of the epigastric port site of 4 months' duration, surgical exploration under local anesthesia revealed that the sinus was caused by spilled gallstones impacting into the abdominal wall between the posterior sheath and left rectus abdominalis muscle. The removal of the stones resulted in complete healing. Long-term complications after laparoscopic cholecystectomy involving the abdominal wall are rare but important possible consequences that could be avoided.

Surveillance of surgical site infection after cholecystectomy using the hospital in Europe link for infection control through surveillance protocol.

Science.gov (United States)

Bogdanic, Branko; Bosnjak, Zrinka; Budimir, Ana; Augustin, Goran; Milosevic, Milan; Plecko, Vanda; Kalenic, Smilja; Fiolic, Zlatko; Vanek, Maja

2013-06-01

The third most common healthcare-associated infection is surgical site infection (SSI), accounting for 14%-16% of infections. These SSIs are associated with high morbidity, numerous deaths, and greater cost. A prospective study was conducted to assess the incidence of SSI in a single university hospital in Croatia. We used the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol for surveillance. The SSIs were classified using the standard definition of the National Nosocomial Infections Surveillance (NNIS) system. The overall incidence of SSI was 1.44%. The incidence of infection in the open cholecystectomy group was 6.06%, whereas in the laparoscopic group, it was only 0.60%. The incidence density of in-hospital SSIs per 1,000 post-operative days was 5.76. Patients who underwent a laparoscopic cholecystectomy were significantly younger (53.65±14.65 vs. 64.42±14.17 years; pconcept for the monitoring of SSI, but in the case of cholecystectomy, additional factors such as antibiotic appropriateness, gallbladder entry, empyema of the gallbladder, and obstructive jaundice must be considered.

[Invasive infections caused by Haemophilus influenzae type b after the institution of the conjugated vaccine on the expanded programm on immunization in Chile].

Science.gov (United States)

Cruces R, Pablo; Donoso F, Alejandro; Camacho A, Jorge; Llorente H, Marcela

2006-03-01

After almost a decade since the introduction of Haemophilus influenzae type b (Hib) conjugate vaccines in Chile (in a 2-4-6 month schedule), Hib invasive infections have dramatically decreased, albeit they remain to occasionally produce disease in pediatric patients. We report our experience with children whom developed Hib invasive disease in children since 2000 to 2004. Medical records of children with Hib were reviewed in order to describe the epidemiology, main clinical and laboratory findings, management and complications. Twenty three patients (17 male), between 1 and 71 months (median 30 months) were identified: pneumonia (7), meningitis (4), pleuropneumonia (2), empyema (2), sepsis (2), cellulitis (2), meningitis and pleuropneumonia (1), purpura fulminans (1), miositis (1) and epiglottitis (1). No deaths were observed and four patients presented severe sequelae at hospital discharge. Twenty patients were considered vaccine failures. Hib remains as a sporadic cause of severe disease in Chile and thus for physicians should still keep it in mind. Case analysis and active surveillance are necessary to monitor the current immunization regimen.

Spontaneous Pneumothorax: A retrospective study of twenty-five patients and literature review

International Nuclear Information System (INIS)

Batouk, A.; Jastaniah, S.; Grillo, I.A.; Malatani, T.S.; Al-Saigh, A.H.; Al-Shehri, M.Y.; Softah, A.; Ali, K.A.M.; Teklu, B.

1996-01-01

We present a retrospective study of 25 patients with spontaneous pneumothorax (three recurrent) comprising 16 Saudis (nine males and seven females) and eight non-Saudi's (eight males and one female), seen at the Asir Central Hospital, Abha, over a period of 45 months. Almost one-third of patients (9/25) had no underlying cause discernible by our investigational facilities (chest x-ray, ultrasonography, computed tomographic scan and flexible bronchofiberscopy). Underlying pneumonia (three patients), pulmonary tuberculosis (two patients), lung abscess (one patient) and congenital bullae (one patient) constituted the etiology in another third of the spontaneous pneumothorax patients. Other underlying pulmonary diseases, precipitating spontaneous pneumothorax in the group included pulmonary fibrosis, metastatic mesothelioma and immunosuppression in a medulloblastoma patient undergoing chemotherapy with the development of chickenpox. Closed thoracostomy tube drainage was the only method of treatment in 20 out of 25 patients, with three failures of closed thoracostomy tube drainage needing thoractomy and resection of blebs/bullae. The only complication was empyema in two of the patients. Two patients were successfully treated conservatively with observation alone. (author)

Infectious pleural effusion status and treatment progress

Science.gov (United States)

Yang, Wei; Zhang, Ze-Ming

2017-01-01

Pleural cavity infection continuously seriously threatens human health with continuous medical progress. From the perspective of pathophysiology, it can be divided into three stages: exudative stage, fibrin exudation and pus formation stage, and organization stage. Due to the pathogenic bacteria difference of pleural cavity infection and pulmonary infection, it is very important for disease treatment to analyze the bacteria and biochemical characteristics of the infectious pleural effusion. Most prognoses of patients have been relatively good, while for some patients, the complicated parapneumonic effusion or empyema could be evolved. Antibiotic treatment and sufficient drainage are the foundation for this treatment. No evidence can support the routine use of a fibrin agent. However, it has been reported that the plasminogen activator and deoxyribonuclease can be recommended to be applied in the pleural cavity. In case of failure on conservative medical treatment, operative treatment can be applied such as thoracoscopy and pleural decortication. According to the clinical characteristics of these patients, it is a key to research prognosis, as well as early evaluation and stratification, in the future. PMID:29268539

Effect of lung resection and sham surgery on the frequency of infection in alloxan-diabetic rats

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A.C. Seidel

2003-03-01

Full Text Available The present study was carried out in order to determine the effect of lung resection on the frequency of infections in alloxan-diabetic rats. Adult female Wistar rats were injected with alloxan (40 mg/kg, iv to induce diabetes mellitus (group D; N = 45 or with vehicle (1.0 ml/kg, iv to be used as controls (group C; N = 45. Thirty-six days after receiving alloxan both groups were randomly divided into three subgroups: no operation (NO; N = 15, sham operation (SO; N = 15, and left pneumonectomy (PE; N = 15. The rats were sacrificed 36 days after surgery and their lungs were examined microscopically and macroscopically. The occurrence of thoracic wall infection, thoracic wall abscess, lung abscess and pleural empyema was similar in groups D and C. In contrast, the overall infection rate was higher (P<0.05 in the diabetic rats (SO-D and PE-D subgroups, but not in the NO-D subgroup. Considering that the overall infection rate was similar in the SO-D and PE-D subgroups, we suggest that surgery but not pneumonectomy was related to the higher prevalence of infection in diabetic rats.

Percutaneous catheter drainage of lung abscess

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Kim, Young Shin; Chun, Kyung Ah; Choi, Hyo Sun; Ha, Hyun Kown; Shinn, Kyung Sub [Catholic University Medical college, Seoul (Korea, Republic of)

1993-09-15

From March 1987 to July 1989, six patients (five adults and one child) with lung abscess (size, 5-13 cm in diameter) were treated with percutaneous aspiration and drainage. In each case, the puncture was made where the wall of the abscess was in contact with the pleural surface. An 8 to 10 Fr cartheter was inserted for drainage. Five of 6 had a dynamatic clinical response within 24 hours of the drainage. Percutaneous drainage was successful with complete abscess resolution in four and partial resolution in one patient. No response was seen in the rest one. The duration of drainage ranged from 7 to 18 days(average, 15.5 days) in successful cases. One case of the failure in drainage was due tio persistent aspiration of the neurologically impaired patient. In one patient, the abscess resolved after drainage but recurred after inadvertent removal of the catheter 7 days after insertion. In two patients, concurrent pleural empyema was resolved completely by the drainage. Computed tomography provide anatomic details necessary for choosing the puncture site and avoiding a puncture of the lung parenchyma. Percutaneous catheter drainage is safe and effective method for treating patient with lung abscess.

Percutaneous catheter drainage of lung abscess

International Nuclear Information System (INIS)

Kim, Young Shin; Chun, Kyung Ah; Choi, Hyo Sun; Ha, Hyun Kown; Shinn, Kyung Sub

1993-01-01

From March 1987 to July 1989, six patients (five adults and one child) with lung abscess (size, 5-13 cm in diameter) were treated with percutaneous aspiration and drainage. In each case, the puncture was made where the wall of the abscess was in contact with the pleural surface. An 8 to 10 Fr cartheter was inserted for drainage. Five of 6 had a dynamatic clinical response within 24 hours of the drainage. Percutaneous drainage was successful with complete abscess resolution in four and partial resolution in one patient. No response was seen in the rest one. The duration of drainage ranged from 7 to 18 days(average, 15.5 days) in successful cases. One case of the failure in drainage was due tio persistent aspiration of the neurologically impaired patient. In one patient, the abscess resolved after drainage but recurred after inadvertent removal of the catheter 7 days after insertion. In two patients, concurrent pleural empyema was resolved completely by the drainage. Computed tomography provide anatomic details necessary for choosing the puncture site and avoiding a puncture of the lung parenchyma. Percutaneous catheter drainage is safe and effective method for treating patient with lung abscess

Brain abscess mimicking brain metastasis in breast cancer.

Science.gov (United States)

Khullar, Pooja; Datta, Niloy R; Wahi, Inderjeet Kaur; Kataria, Sabeena

2016-03-01

61 year old female presented with chief complaints of headache for 30 days, fever for 10 days, altered behavior for 10 days and convulsion for 2 days. She was diagnosed and treated as a case of carcinoma of left breast 5 years ago. MRI brain showed a lobulated lesion in the left frontal lobe. She came to our hospital for whole brain radiation as a diagnosed case of carcinoma of breast with brain metastasis. Review of MRI brain scan, revealed metastasis or query infective pathology. MR spectroscopy of the lesion revealed choline: creatinine and choline: NAA (N-Acetylaspartate) ratios of ∼1.6 and 1.5 respectively with the presence of lactate within the lesion suggestive of infective pathology. She underwent left fronto temporal craniotomy and evacuation of abscess and subdural empyema. Gram stain showed gram positive cocci. After 1 month of evacuation and treatment she was fine. This case suggested a note of caution in every case of a rapidly evolving space-occupying lesion independent of the patient's previous history. Copyright © 2015 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

International Nuclear Information System (INIS)

Kim, Young Hwan; Kim, Yong Joo; Shin, Tae Beom

2011-01-01

To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

Tube Thoracostomy: Complications and Its Management

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Emeka B. Kesieme

2012-01-01

Full Text Available Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended.

[Foreign Body in Esophagus].

Science.gov (United States)

Domeki, Yasushi; Kato, Hiroyuki

2015-07-01

An esophageal foreign body is the term for a foreign body in the esophagus. The 2 age groups most prone to this condition are children age 9 and under (and especially toddlers age 4 and under) and elderly individuals age 70 and over. A foreign body often lodges where the esophagus is most constricted. In toddlers, the foreign body is often currency or coins or a toy. In adults, the body is often a piece of fish, dentures, a piece of meat, a pin or needle, or a drug in its blister pack packaging. In children, an esophageal foreign body is treated by fluoroscopically guided removal of the body with a balloon catheter or magnetic catheter or removal of the body via endoscopy or direct esophagoscopy under general anesthesia. In adults, the best choice for treating an esophageal foreign body is removing the body with an endoscope but there are instances where surgery is performed because the body is hard to remove endoscopically, a puncture has occurred, or empyema or mediastinitis has developed. This paper reviews the diagnosis and treatment of an esophageal foreign body.

Osteoarthritis in the neonate

International Nuclear Information System (INIS)

Weigel, W.; Hayek, W.H.; Bens, G.

1979-01-01

A fatally ending index case of sepsis osteoarthritis that was diagnosed retrospectively initiated this report. This patient had severe, asymmetrically distributed metaphyseal growthdisturbances, many long bones. In order to determine the features of early radiologic diagnosis we report the findings of 7 further patients with neonatal septic osteoarthritis with clinical and radiological follow-up. The most important observation for early radiologic diagnosis of osteoarthritis is the displacement of fat layers along the metaphysis. Other findings of the soft tissues have the same diagnostic value as bone destruction and subperiosteal new bone formation found one to three weeks later on roentgenfilms. Detecting early signs of osteoarthritis helps in localizing the focus for bacteriologic diagnosis, which is to be more successful than blood cultures. Diagnosing a joint empyema initiates surgical intervention for pressure relief in order to avoid necrosis of the epiphysis as seen in the femoral bone in septic arthritis of the hip joint. Early diagnosis and treatment to destruction of growing cartilage is necessary to avoid gross disturbances and length discrepancies of long bones. In cases of sepsis called 'babygram' and a repeat examination 10 to 14 days later is mandatory. (orig.) [de

Total lymphoid irradiation of intractable rheumatoid arthritis

International Nuclear Information System (INIS)

Herbst, M.; Fritz, H.; Sauer, R.

1986-01-01

Eleven patients with intractable rheumatoid arthritis were treated with fractionated total lymphoid irradiation, (total dose 20 Gy). Lasting improvement in clinical symptoms was found in four patients during treatment and the remaining patients experienced similar benefit within 2 months of irradiation. There was marked reduction in exacerbations and number of joints involved. Morning stiffness, joint swelling and tenderness decreased. Complications included severe fatigue during treatment and acute bacterial arthritis in multiple joints in one patient. Four patients have since died, one of renal failure, another of cardiogenic shock following surgery 3 and 24 months after total lymphoid irradiation. Both had generalised amyloidosis. The third patient developed joint empyema and died of toxic cardiac failure. The fourth died 3 months after resection of a Kaposi's sarcoma complicated by wound infection which responded to treatment. Immunologically, total lymphoid irradiation resulted in suppression of the absolute lymphocyte count and reduction in T-helper cells, the number of T-suppressor cells remaining unchanged. These data provide evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis. Total lymphoid irradiation can induce sustained improvement in clinical disease activity, but severe, possibly fatal, side-effects cannot be ignored. (author)

Total lymphoid irradiation of intractable rheumatoid arthritis

Energy Technology Data Exchange (ETDEWEB)

Herbst, M.; Fritz, H.; Sauer, R.

1986-12-01

Eleven patients with intractable rheumatoid arthritis were treated with fractionated total lymphoid irradiation, (total dose 20 Gy). Lasting improvement in clinical symptoms was found in four patients during treatment and the remaining patients experienced similar benefit within 2 months of irradiation. There was marked reduction in exacerbations and number of joints involved. Morning stiffness, joint swelling and tenderness decreased. Complications included severe fatigue during treatment and acute bacterial arthritis in multiple joints in one patient. Four patients have since died, one of renal failure, another of cardiogenic shock following surgery 3 and 24 months after total lymphoid irradiation. Both had generalised amyloidosis. The third patient developed joint empyema and died of toxic cardiac failure. The fourth died 3 months after resection of a Kaposi's sarcoma complicated by wound infection which responded to treatment. Immunologically, total lymphoid irradiation resulted in suppression of the absolute lymphocyte count and reduction in T-helper cells, the number of T-suppressor cells remaining unchanged. These data provide evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis. Total lymphoid irradiation can induce sustained improvement in clinical disease activity, but severe, possibly fatal, side-effects cannot be ignored.

"To afford the wounded speedy assistance": Dominique Jean Larrey and Napoleon.

Science.gov (United States)

Skandalakis, Panagiotis N; Lainas, Panagiotis; Zoras, Odyseas; Skandalakis, John E; Mirilas, Petros

2006-08-01

Dominique Jean Larrey (1766-1842) has been described as the father of modern military surgery and is considered even today as the model military surgeon. He developed a plan of rapid evacuation of wounded soldiers from the battlefield during combat, using flexible medical units which he named ambulances volantes ("flying ambulances"). He won the admiration of Napoleon Bonaparte (1769-1821), who was amazed by the results of Larrey's sanitary system. Larrey spent almost 18 years with Napoleon, accompanying him in 25 campaigns, 60 battles, and more than 400 engagements. Napoleon's enormous military success was due not only to his strategy and skill but also to the medical services provided by Larrey. The surgeon became a master of wound management and limb amputation. In his vivid battlefield journals, Larrey documented the course of tetanus, the pathophysiology of cold injury, the effective control of hemorrhage, the drainage of empyema and hemothorax, the aspiration of pericardial effusion or hemopericardium, and the packing of sucking chest wounds. Larrey established a categorical rule for the triage of war casualties, treating the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality.

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

Energy Technology Data Exchange (ETDEWEB)

Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

2011-04-15

To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

Surgery and pleuro-pulmonary tuberculosis: a scientific literature review

Science.gov (United States)

Subotic, Dragan; Yablonskiy, Piotr; Sulis, Giorgia; Cordos, Ioan; Petrov, Danail; Centis, Rosella; D’Ambrosio, Lia; Sotgiu, Giovanni

2016-01-01

Tuberculosis (TB) is still a major public health concern, mostly affecting resource-constrained settings and marginalized populations. The fight against the disease is hindered by the growing emergence of drug-resistant forms whose management can be rather challenging. Surgery may play an important role to support diagnosis and treatment of the most complex cases and improve their therapeutic outcome. We conducted a non-systematic review of the literature based on relevant keywords through PubMed database. Papers in English and Russian were included. The search was focused on five main areas of intervention as follows: (I) diagnosis of complicated cases; (II) elimination of contagious persisting cavities, despite appropriate chemotherapy; (III) treatment of destroyed lung; (V) resection of tuberculomas; (VI) treatment of tuberculous pleural empyema. Although specific practical guidelines concerning surgical indications and approaches are currently unavailable, a summary of the evidence emerged from the scientific literature was elaborated to help the clinician in the management of severely compromised TB patients. The decision to proceed to surgery is usually individualized and a careful assessment of the patient’s risk profile is always recommended before performing any procedure in addition to appropriate chemotherapy. PMID:27499980

Tube Thoracostomy: Complications and Its Management

Science.gov (United States)

Kesieme, Emeka B.; Dongo, Andrew; Ezemba, Ndubueze; Irekpita, Eshiobo; Jebbin, Nze; Kesieme, Chinenye

2012-01-01

Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended. PMID:22028963

Chest wall tuberculosis; CT findings in 14 patients

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Han, Young Min; Lee, Sang Yong; Lee, Dong Won; Kim, Chong Soo; Chung, Gyung Ho; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National Univ. School of Medicine, Chonju (Korea, Republic of); Kim, Dong Woo [Daejoen Eulji Hospital, Daejon (Korea, Republic of); Juhng, Seon Kwan [Wonkwang Univ. Medical School, Iksan (Korea, Republic of)

1996-01-01

To present CT findings of chest wall tuberculosis. CT scans were obtained in 14 patients with proven chest wall tuberculosis. Diagnosis was confirmed by means of right open thoracostomy with abscess evacuation (n=1), excision and curettage (n=11) or excision and curettage along with resection of the involved lung (n=2). The images were assessed with emphasis for the extrapleural, pleural, and pulmonary lesions. All patients showed juxtacostal soft tissue mass with central low attenuation and peripheral rim enhancement. The lesions were located in the left hemithorax in eight patients and in the right in six. Multiple lesions were found in three patients (two in one and three in two). Rib destruction was observed in four patients. Intercostal muscle involvement of thickening and enhancement were shown in all patients. Thirteen patients (93%) had evidence of pulmonary tuberculosis: active pulmonary tuberculosis in nine and stable tuberculosis in four. Pleural lesions, including empyema necessitatis in six, were observed in eleven (79%). On CT scan, chest wall tuberculosis is characterized by juxtacostal soft tissue lesion with central low attenuation and peripheral rim enhancement. Rib destruction may be associated. Additionally, enhancing intercostal muscle suggest direct inflammatory process of tuberculosis and spread channel to the chest wall involvement of pleuropulmonary tuberculosis.

Meningitis in a Chinese adult patient caused by Mycoplasma hominis: a rare infection and literature review.

Science.gov (United States)

Zhou, Menglan; Wang, Peng; Chen, Sharon; Du, Bin; Du, Jinlong; Wang, Fengdan; Xiao, Meng; Kong, Fanrong; Xu, Yingchun

2016-10-12

Mycoplasma hominis, a well known cause of neonatal infection, has been reported as a pathogen in urogenital infections in adults; however, central nervous system (CNS) infections are rare. We report here the first case of M. hominis meningitis in China, post neurosurgical treatment for an intracerebral haemorrhage in a 71-year-old male. We describe a 71-year-old man who developed M. hominis meningitis after neurosurgical treatment and was successfully treated with combined azithromycin and minocycline therapy of 2 weeks duration, despite delayed treatment because the Gram stain of cerebrospinal fluid (CSF) yielded no visible organisms. The diagnosis required 16S rDNA sequencing analysis of the cultured isolate from CSF. Literature review of M. hominis CNS infections yielded 19 cases (13 instances of brain abscess, 3 of meningitis, 1 spinal cord abscess and 1 subdural empyema each). Delay in diagnosis and initial treatment failure was evident in all cases. With appropriate microbiological testing, antibiotic therapy (ranging from 5 days to 12 weeks) and often, multiple surgical interventions, almost all the patients improved immediately. Both our patient findings and the literature review, highlighted the pathogenic potential of M. hominis together with the challenges prompted by rare infectious diseases in particular for developing countries laboratories with limited diagnostic resources.

Frequency and prevention of laparoscopic port site infection.

Science.gov (United States)

Taj, Muhammad Naeem; Iqbal, Yasmeen; Akbar, Zakia

2012-01-01

The present study was conducted to evaluate the usefulness and safety of the nonpowder surgical glove for extraction of the gallbladder in laparoscopic cholecystectomy. The study was carried out in Capital Hospital Islamabad and in a private hospital. The duration of study was from March 2009 to March 2012. This was an observational study carried out in 492 patients who underwent laparoscopic cholecystectomy using the surgical glove for extraction of the gallbladder and compared with the conventional method of gall bladder removal in two hospitals were analyzed. The operative findings, port site infection and co morbid conditions were evaluated. Postoperative wound infection was found in 27 (5.48%) of 492 cases. Umbilical port infection was found in 26 (5.28%) of cases in which gall bladder was removed without endogloves and only one case (0.2%) had infection when gall bladder was removed with the endogloves. Wound infection was more in acute cholecystitis (25.9%) and empyema of Gall Bladder (44.4%). Among the co morbid conditions, diabetes mellitus has got higher frequency of wound infection (44%). The use of the surgical glove for extraction of the gallbladder is safe, cheap, simple and potentially reduces significant morbidity. Its routine use at laparoscopic cholecystectomy is mandatory in all cases.

Early complications after pneumonectomy: retrospective study of 168 patients.

Science.gov (United States)

Alloubi, Ihsan; Jougon, Jacques; Delcambre, Frédéric; Baste, Jean Marc; Velly, Jean François

2010-08-01

The purpose of this study was to assess the mortality and risk factors of complications after pneumonectomy for lung cancer. Between 1996 and 2001, we reviewed and analysed the demographic, clinical, functional, and surgical variables of 168 patients to identify risk factors of postoperative complications by univariate and multivariate analyses with Medlog software system. The mean age was 60+/-10 years, overall mortality and morbidity rates were 4.17% and 41.6%, respectively. All frequencies of respiratory complications were 1.2% for acute respiratory failure, 10.1% for pneumonia, 2.4% for acute pulmonary oedema, 4.17% for bronchopleural fistula, 2.4% for thoracic empyema and 18.5% for left recurrent nerve injuries. Postoperative arrhythmias developed in 46% of our patients. The risk factors for cardiopulmonary morbidity and mortality with univariate analysis were advanced age (P<0.01), preoperative poor performance status (P<0.015), and chronic artery disease (P<0.008). Factors adversely affecting morbidity with multivariate analysis included age (P=0.0001), associated cardiovascular disease (P=0.001), and altered forced expiratory volume in 1 s (P=0.0005). Complications after pneumonectomy are associated with high mortality. Careful attention must be paid to patients with advanced age and heart disease. Chest physiotherapy is paramount to have uneventful outcomes.

Acute cholecystitis from typhic origin in children

Directory of Open Access Journals (Sweden)

Komla Gnassingbé

2013-01-01

Full Text Available Background: To evaluate the particularities of typhoid cholecystitis in children. Materials and Methods: This was a 5-year prospective study of typhoid cholecystitis in children under 15 years old at Djougou and Sylvanus Olympio teaching hospital. The diagnosis of typhoid cholecystitis was based on clinical and investigation findings, confirmed by operative findings at cholecystectomy. Results: Six children with typhoid acalculous cholecystitis were treated over a five-year period (4 males and 2 females. Their ages ranged from five to 13 years (median 8.8 years. The mean duration of symptoms was six to 21 days. The clinical signs were fever, abdominal pain, which predominated at the right upper abdominal quadrant, and type II Hackett splenomegaly. The diagnosis was confirmed by a positive Widal′s test and Salmonella typhi isolation from the culture in all patients; four patients had ultrasound evidence of acalculous cholecystitis. Open cholecystectomy was successful in the six cases. The operative findings were gangrene (3, perforation (2 and empyema (1. All the patients made an uneventful recovery, and have remained symptom free one and three months on follow-up. Conclusion: Typhoid acalculous cholecystitis is a frequent complication in children. Late presentation and diagnosis is associated with complications. Cholecystectomy in association with antibiotic is the treatment of choice.

Scan Manifestation and Trace-Dose Radiogold Clearance Rates in Obstructive Jaundice

International Nuclear Information System (INIS)

Kim, Dong Jip; Bahk, Yong Whee; Shinn, Kyung Sub

1969-01-01

The present study has been undertaken to analyze scan manifestation in obstructive jaundice. Scan changes were correlated with the duration of jaundice. In addition, clearance rates of trace dose of colloidal radiogold were assessed in each case. The materials were consisted of 19 cases with surgically and/or histopathologically verified obstructive jaundice from various causes including common duct stone, empyema of the gall bladder and carcinoma of the pancreas head etc. Blood clearance rates of colloidal 198 Au were determined after the injection of 8 uCi by simple geometrical drawing of recorded strip charts. Scan was performed following additional injection of the sam radiogold. In 16 out of 19 cases, the scan rather typical 'arborifrom' mottlings around the porta hepatis. The intensity and appearance of such mottlings on the scan was related with the duration of jaundice and level of serum bilirubin and alkaline phosphatase. The blood clearance rates remained to be within normal range in 74 percent of the patients. In the remaining 26 percent, clearance rate ranged between 4.1 and 6 minutes. It is concluded that the association of 'arboriform' mottlings and normal or mildly delayed clearance rates in the patients with jaundice is characteristic of obstructive change in the biliary system.

Carcinoma transverse colon masquerading as carcinoma gall bladder.

Science.gov (United States)

Munghate, Anand; Kumar, Ashwani; Singh, Harnam; Singh, Gurpreet; Singh, Bimaljot; Chauhan, Mahak

2014-04-01

Colorectal cancer is one of the most common cancer worldwide .Its incidence is reported to be increasing in developing countries. It commonly presents with weight loss, anaemia, lump abdomen, change of bowel habit, obstruction or fresh rectal bleeding. Beside these common modes of presentations, there are some rare manifestations which masqueraded as different disease like obstructive jaundice, empyema gall bladder or cholecystitis. A 60-year-old male presented to hospital with right sided pain abdomen. On abdominal examination mild tenderness was present in right hypochondrium. Intra operatively gall bladder was separated from the adjoining gut, peritoneum and liver bed and was removed. On further exploration, there was a large mass in the vicinity of the gall bladder related to transverse colon. Extended right hemicolectomy was done. Histopathological examination of gut mass revealed adenocarcinoma of transverse colon with free margins and gall bladder showed cholecystitis with no evidence of malignancy. We present an interesting case of colon cancer colon that caused diagnostic confusion by mimicking as cholecystitis. Colorectal cancer constitutes a major public health issue globally. Therefore, public awareness, screening of high-risk populations, early diagnosis and effective treatment and follow-up will help to reduce its occurance and further complications.

Complex Pulmonary Aspergilloma: Surgical Challenges in a Third World Setting

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Bernadette Ngo Nonga

2018-01-01

Full Text Available Background. Surgery for pulmonary aspergilloma (PA, especially complex forms, is greatly challenging in a resource-poor setting such as Cameroon. We report our experience of surgical management of PA in this environment. Method. We prospectively assessed patients who underwent surgery for PA from January 2012 to May 2015, at the University Hospital Center of Yaoundé. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures, and outcomes. The study has received approval from the institutional ethics committees. Results. In total, 20 patients (17 males and 3 females (sex ratio, 5.66; mean age, 30 years; range, 23–65 years with a past history of tuberculosis were assessed. The median follow-up was 21.5 months. The primary symptom was hemoptysis, followed by cough and chest pain. All patients underwent surgical treatment and lung resection. Postoperative complications (bleeding, air leak, empyema, and severe anemia occurred in 4 patients and 1 patient died. Although 3 patients were lost to follow-up, the survival rate was 80% with improvement of the preoperative symptoms. Conclusion. Although surgery for complex aspergilloma is very challenging in environments such as ours, we believe that it is the best treatment modality for symptomatic diseases in our setting.

Sonographic diagnosis of gallbladder cancer: analysis of mis-diagnosed cases

International Nuclear Information System (INIS)

Park, Ji Hyun; Moon, Jung Mi; Ahn, Sang Won; Song, Ik Hoon

1993-01-01

Ultrasonography is the most valuable diagnostic tool in the evaluation of gallbladder (GB) diseases. Although sonographic findings in GB cancer have been well described, the diagnostic accuracy has not been clearly analyzed. Our purpose of this report was to discuss diagnostic difficulties and analyze causes of misdiagnosis of GB cancer based on our recent experience and so may result in more accurate diagnosis of GB cancer. We analyzed 13misdiagnosed cases out of 24 cases of GB cancer with special emphasis on diagnostic difficulties and causes of misidagnosis. The most common type of misdiagnosed GB cancer was thickened wall type which was found in 10 cases. Preoperative sonographic diagnosis of these cases was empyema in 4 cases, cholecystitis in 3, and non-specific GB wall thickening in 1. In 2 cases, any lesion could not be detected at ultrasonography. Two cases with intraluminal type of GB cancer were misdiagnosed ; one being misdiagnosed as cholecystitis with stone, and the other being completely missed. Three cases that were completely missed consist of 2 with focal wall thickening and 1 involving GB neck. In conclusion, sonographic diagnosis of GB cancer is difficult, because the wall thickening type, that mimicks the cholecystitis, is frequent. Thorough and careful investigation of GB is mandatory for eliminating misdiagnosis

Medical Applications of Laser Induced Breakdown Spectroscopy

International Nuclear Information System (INIS)

Pathak, A K; Rai, N K; Singh, Ankita; Rai, A K; Rai, Pradeep K; Rai, Pramod K

2014-01-01

Sedentary lifestyle of human beings has resulted in various diseases and in turn we require a potential tool that can be used to address various issues related to human health. Laser Induced Breakdown Spectroscopy (LIBS) is one such potential optical analytical tool that has become quite popular because of its distinctive features that include applicability to any type/phase of samples with almost no sample preparation. Several reports are available that discusses the capabilities of LIBS, suitable for various applications in different branches of science which cannot be addressed by traditional analytical methods but only few reports are available for the medical applications of LIBS. In the present work, LIBS has been implemented to understand the role of various elements in the formation of gallstones (formed under the empyema and mucocele state of gallbladder) samples along with patient history that were collected from Purvancal region of Uttar Pradesh, India. The occurrence statistics of gallstones under the present study reveal higher occurrence of gallstones in female patients. The gallstone occurrence was found more prevalent for those male patients who were having the habit of either tobacco chewing, smoking or drinking alcohols. This work further reports in-situ LIBS study of deciduous tooth and in-vivo LIBS study of human nail

Chest wall tuberculosis; CT findings in 14 patients

International Nuclear Information System (INIS)

Han, Young Min; Lee, Sang Yong; Lee, Dong Won; Kim, Chong Soo; Chung, Gyung Ho; Sohn, Myung Hee; Choi, Ki Chul; Kim, Dong Woo; Juhng, Seon Kwan

1996-01-01

To present CT findings of chest wall tuberculosis. CT scans were obtained in 14 patients with proven chest wall tuberculosis. Diagnosis was confirmed by means of right open thoracostomy with abscess evacuation (n=1), excision and curettage (n=11) or excision and curettage along with resection of the involved lung (n=2). The images were assessed with emphasis for the extrapleural, pleural, and pulmonary lesions. All patients showed juxtacostal soft tissue mass with central low attenuation and peripheral rim enhancement. The lesions were located in the left hemithorax in eight patients and in the right in six. Multiple lesions were found in three patients (two in one and three in two). Rib destruction was observed in four patients. Intercostal muscle involvement of thickening and enhancement were shown in all patients. Thirteen patients (93%) had evidence of pulmonary tuberculosis: active pulmonary tuberculosis in nine and stable tuberculosis in four. Pleural lesions, including empyema necessitatis in six, were observed in eleven (79%). On CT scan, chest wall tuberculosis is characterized by juxtacostal soft tissue lesion with central low attenuation and peripheral rim enhancement. Rib destruction may be associated. Additionally, enhancing intercostal muscle suggest direct inflammatory process of tuberculosis and spread channel to the chest wall involvement of pleuropulmonary tuberculosis

Craniofacial Trauma in Pediatric Patients Following Winnowing Blade Injury-review of Literature.

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Huliyappa, Harsha; Ojha, Balakrishna; Chandra, Anil; Singh, Sunil Kumar; Srivastava, Chhitij

2018-01-01

In developing countries, during the harvest season, winnower blade injuries occur very frequently in children and results in lifelong disability. Nine children were managed during 1 month, all resulting due to winnower blade induced craniofacial trauma. PubMed search for "fan blade injury" showed two case series and three case reports. In our study, 88% had compound depressed fracture; brain matter leak in 56%, cerebrospinal fluid (CSF) leak alone in 22%. 66.7% had injury involving the frontal bone. Two patients had eye injury with visual loss. Seven underwent debridement craniectomy, five augmentation duroplasty and three contusectomy. All had vegetable material, sand particles. Complications in 66.6% with two cases of CSF leak settled with lumbar drain, one case of CSF otorrohea, 22.2% of wound infection, 44.4% wound dehiscence requiring redebridement and suturing in five patients. Two patients had postoperative seizures, two patients had hemiparesis both improved. Two low Glasgow Coma Scale remained so on postoperative period. One case of subdural empyema needed debridement and duroplasty with glue. No mortality noted. These findings were consistent with previous reports. Follow-up at 1.5 months showed good functional recovery. Early surgery debridement, steps to minimize postoperative infections, identifying putative risk factors early in the management are the principles of a successful treatment regimen.

[The diagnostic value of medical thoracoscopy for unexplained pleural effusion].

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Jiang, Shu-juan; Mu, Xiao-yan; Zhang, Song; Su, Li-li; Ma, Wei-xia

2013-05-01

To explore the endoscopic features of patients with unexplained pleural effusion, and to evaluate the diagnostic value of medical thoracoscopy. A retrospective analysis of 2380 patients with unexplained pleural effusion (1320 males and 1060 females; age 15-94 years) in Shandong Provincial Hospital from 1992 to 2011 were performed .The diagnosis was confirmed by medical thoracoscopy. The endoscopic findings of malignant pleural effusion mostly showed nodules of varying sizes. The nodules could be grape-like, cauliflower-like, fused into masses, or diffused small nodules . The appearance of cancerous nodules was more diversified compared to tuberculous nodules. Tuberculous pleurisy was manifested as diffuse pleural congestion and miliary changes, multiple small gray-white nodules, fibrin deposition and adhesion in the pleural cavity, pleural thickening and loculation . The pathological diagnosis was as follows: pleural metastases in 899 (37.8%), primary pleural mesothelioma in 439 (18.4%), tuberculous pleurisy in 514 (21.6%), non-specific inflammation in 226 (9.5%), empyema in 190 (8.0%), hepatic pleural effusion in 36 (1.5%) and pleural effusion of unknown causes in 76 (3.2%) cases. The diagnostic positive rate of medical thoracoscopy was 96.8%. No serious complications were observed. Medical thoracoscopy is a relatively safe procedure and has an important application value in the diagnosis of unexplained pleural effusion.

Scan Manifestation and Trace-Dose Radiogold Clearance Rates in Obstructive Jaundice

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Kim, Dong Jip; Bahk, Yong Whee; Shinn, Kyung Sub [Catholic University College of Medicine, Seoul (Korea, Republic of)

1969-09-15

The present study has been undertaken to analyze scan manifestation in obstructive jaundice. Scan changes were correlated with the duration of jaundice. In addition, clearance rates of trace dose of colloidal radiogold were assessed in each case. The materials were consisted of 19 cases with surgically and/or histopathologically verified obstructive jaundice from various causes including common duct stone, empyema of the gall bladder and carcinoma of the pancreas head etc. Blood clearance rates of colloidal {sup 198}Au were determined after the injection of 8 uCi by simple geometrical drawing of recorded strip charts. Scan was performed following additional injection of the sam radiogold. In 16 out of 19 cases, the scan rather typical 'arborifrom' mottlings around the porta hepatis. The intensity and appearance of such mottlings on the scan was related with the duration of jaundice and level of serum bilirubin and alkaline phosphatase. The blood clearance rates remained to be within normal range in 74 percent of the patients. In the remaining 26 percent, clearance rate ranged between 4.1 and 6 minutes. It is concluded that the association of 'arboriform' mottlings and normal or mildly delayed clearance rates in the patients with jaundice is characteristic of obstructive change in the biliary system.

[Bacteremic pneumococcal pneumonia].

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Pineda Solas, V; Pérez Benito, A; Domingo Puiggros, M; Larramona Carrera, H; Segura Porta, F; Fontanals Aymerich, D

2002-11-01

mean length of stay was 9.2 days. The mean duration of fever was 2 days and was 4.2 days in patients with pleural empyema. All patients presented fever and its mean duration before admission was 4 days. Fifty-eight percent of the patients had cough. Thirty-nine percent appeared generally unwell, vomiting was present in 47% and abdominal pain in 28%. Respiratory auscultation detected rales in 30% of the patients, hypophonesis in 28% and polypnea or dyspnea in 35%. Most patients showed alveolar bilateral infiltrations and 20% had pleural empyema. Seventy-eight percent had WBC counts > 15,000 and 93% showed neutrophilia of > 60%. Erythrocyte sedimentation rate and C-reactive protein were elevated in 77% and 85% of the patients, respectively. Overall, 40% of the isolates showed intermediate susceptibility to penicillin and 5% were resistant. Eighteen percent showed intermediate susceptibility to cefotaxime and 18% were resistant to erythromycin. Thirty-four strains were resistant to erythromycin. Thirty-four strains were serogroups and in children vaccine. The significant morbidity of bacteremic pneumococcal pneumonia and the implicated serogroups supports the use of the new heptavalent vaccine in the pediatric age group.

High-resolution magnetic resonance imaging (HR-MRI) of the pleura and chest wall: Normal findings and pathological changes

International Nuclear Information System (INIS)

Bittner, R.C.; Schnoy, N.; Schoenfeld, N.; Grassot, A.; Loddenkemper, R.; Lode, H.; Kaiser, D.; Krumhaar, D.; Felix, R.

1995-01-01

To determine the value of high-resolution MRI in pleural and chest wall diseases, the normal and pathologic costal pleura and adjacent chest wall between paravertebral and the axillar region were examined with contrast enhanced high-resolution T 1 -weighted MRI images using a surface coil. Normal anatomy was evaluated in 5 healthy volunteers and a normal specimen of the thoracic wall, and correlation was made with corresponding HR-CT and histologic sections. CT-proved focal and diffuse changes of the pleura and the chest wall in 36 patients underwent HR-MRI, and visual comparison of MRI and CT was done retrospectively. Especially sagittal T 1 -weighted HR-MRI images allowed accurate delineation of the peripleural fat layer (PFL) and the innermost intercostal muscle (IIM), which served as landmarks of the intact inner chest wall. PFL and IIM were well delineated in 3/4 patients with tuberculous pleuritis, and in all 7 patients with non-specific pleuritis, as opposed to impairment of the PFL and/or the IIM, which was detected in 15/18 malignancies as a pattern of malignant chest wall involvement. In one case of tuberculous pleural empyema with edema of the inner chest wall HR-MRI produced false positive diagnosis of malignant disease. HR-MRI images improved non-invasive evaluation of pleural and chest wall diseases, and allowed for differentiation of bengin and malignant changes. (orig./MG) [de

After laparoscopic Heller myotomy, do emergency department visits or readmissions predict poor long-term outcomes?

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Ross, Sharona; Villadolid, Desiree; Al-Saadi, Sam; Boyle, Robert; Cowgill, Sarah M; Rosemurgy, Alexander

2008-12-01

Laparoscopic Heller myotomy is a first-line treatment for achalasia. To improve outcomes after myotomy and to determine if poor early results predict later outcomes, emergency department (ED) visits and readmissions within 60 days following laparoscopic Heller myotomy were studied. Since 1992, 352 patients have undergone laparoscopic Heller myotomy and are followed through a prospectively maintained registry. Causes of ED visits and readmissions within 60 days after myotomy were determined. Patients scored their symptoms of achalasia before myotomy and at last follow-up; scores were compared to determine if the reasons leading to ED visits and/or readmissions impacted long-term outcome after myotomy. Fourteen (4%) patients had ED visits, and 18 (5%) patients had readmissions within 60 days following myotomy. Sixty-four percent of ED visits were for dysphagia/vomiting and 36% were for abdominal/chest pain, while 37% of readmissions were for dysphagia/vomiting. Pneumonia was complicated by empyema in four patients, all without leaks; two patients expired. Despite ED visits/readmissions, achalasia symptom (e.g., dysphagia, regurgitation, choking, heartburn, and chest pain) frequency and severity scores improved after myotomy (p Heller myotomy. ED visits were generally due to complaints related to achalasia or edema after myotomy, while readmissions were generally related to complications of operative intervention or chronic ill health. Despite ED visits or readmissions early after myotomy, symptoms of achalasia are well palliated by myotomy long-term.

The frequency and treatment of pneumothorax associated with pulmonary nontuberculous mycobacterial infection.

Science.gov (United States)

Ikeda, Masaki; Takahashi, Koji; Komatsu, Teruya; Tanaka, Toru; Kato, Tatsuo; Fujinaga, Takuji

2017-02-01

Characteristics of pneumothorax associated with nontuberculous mycobacterium (NTM) infection are rarely reported, especially in terms of surgical treatments. Our objectives were to show the tendency and clinical courses of pneumothorax due to NTM and discuss the way of therapy in our hospital. We retrospectively analyzed 557 patients with NTM infection over a period of 5 years at the Nagara Medical Center. A total of 12 out of the 557 patients (2.2%) suffered from pneumothorax caused by NTM infection without other pulmonary diseases. The diagnosis of all NTM cases was mycobacterium avium complex. Of these 12 patients, three required observation only (25%), five required drainage only (42%), and four required surgery after drainage (33%). The four surgically treated patients suffered from empyema as well as pneumothorax. They were in worse nutritional condition than non-surgically treated patients. For the patients requiring surgery, we selected reasonable surgical methods; we sutured the fistula of lung in all cases and covered it with muscle or omentum or polyglycolic acid sheets without a case in which endobronchial embolization was performed in advance before surgery. Finally, all pneumothorax healed. Thereafter, three of these four patients took unfavorable courses: progressing malnutrition, complications worsening or contralateral pneumothorax. We should select an appropriate treatment including surgery against NTM-associated pneumothorax without losing an opportunity because of its intractability and exhausting effect.

Evaluation of chest computed tomography in patients after pneumonectomy to predict contralateral pneumothorax

International Nuclear Information System (INIS)

Maniwa, Tomohiro; Saito, Yukihito; Saito, Tomohito; Kaneda, Hiroyuki; Imamura, Hiroji

2009-01-01

Contralateral pneumothorax is a severe complication after pneumonectomy. We evaluated the mediastinal shift and the residual lung in patients who had undergone pneumonectomy to predict the incidence of contralateral pneumothorax. We evaluated 21 cases of pneumonectomy performed from 1996 to 2006. For this study, we excluded patients with recurrent neoplasm, empyema, or hemothorax. We reviewed the computed tomography (CT) results of 13 patients who had undergone pneumonectomy to compare the bullae in the residual lungs, carina shifts, and herniation of the residual lungs before and after pneumonectomy. When evaluating the degree of herniation 4-6 cm below the carina, the anterior and posterior pulmonary hernias were classified as grade A, B, or C. We also investigated the preoperative respiratory function in all 13 patients. Two patients suffered contralateral pneumothorax after left pneumonectomy. Both patients who suffered contralateral pneumothorax after pneumonectomy had bullae. The percentage forced expiratory volume in 1 s (FEV 1.0% ) was <70% in these two patients. Carina shifts and lung herniation were found to be greater after left pneumonectomy than after right pneumonectomy. The bullae in the lung and obstructive pulmonary disease are associated not only with spontaneous pneumothorax but also with contralateral pneumothorax after pneumonectomy. Lung herniation and mediastinal shift are greater after left pneumonectomy than after right pneumonectomy, which may be related to contralateral pneumothorax after pneumonectomy. (author)

Pleurodesis Using Mistletoe Extract Delivered via a Spray Catheter during Semirigid Pleuroscopy for Managing Symptomatic Malignant Pleural Effusion.

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Eom, Jung Seop; Ahn, Hyo Yeong; Mok, Jeong Ha; Lee, Geewon; Jo, Eun-Jung; Kim, Mi-Hyun; Lee, Kwangha; Kim, Ki Uk; Park, Hye-Kyung; Lee, Min Ki

Talc poudrage during thoracoscopy is considered the standard procedure for patients with symptomatic malignant pleural effusion (MPE). Until now, no alternative technique other than talc poudrage for pleurodesis during medical thoracoscopy has been proposed. Liquid sclerosants, such as mistletoe extract, have been sprayed evenly into the pleural cavity during semirigid pleuroscopy for chemical pleurodesis. We conducted a retrospective study using the database of semirigid pleuroscopy to identify the usefulness of pleurodesis using a mistletoe extract delivered via a spray catheter during semirigid pleuroscopy for symptomatic MPE. All consecutive patients with symptomatic MPE who underwent semirigid pleuroscopy from October 2015 to September 2016 were registered. The responses were evaluated using chest X- ray or computed tomography 4 weeks after pleurodesis. The study included 43 patients who underwent pleurodesis with mistletoe extract via a spray catheter during semirigid pleuroscopy. Complete and partial responses were seen in 21 (49%) and 19 (44%) patients, respectively. The median duration of chest tube placement after pleurod-esis was 7 days (range 6-8 days) in the 40 patients with complete or partial responses. No cases of severe hemorrhage, empyema formation, respiratory failure, or procedure-related mortality were observed in the subjects at 4 weeks after semirigid pleuroscopy. Pleurodesis with mistletoe extract delivered via a spray catheter during semirigid pleuroscopy is a safe and effective procedure for managing symptomatic MPE. © 2017 S. Karger AG, Basel.

Laparoscopic cholecystectomy in double gallbladder with dual pathology

Directory of Open Access Journals (Sweden)

Sumanta Kumar Ghosh

2014-01-01

Full Text Available Double gallbladder is a rare embryological anomaly of clinical significance. Despite availability of modern imaging, only 50% of recently reported cases had preoperative diagnosis, which is desirable in every case to avoid serious operative complications. Double pathology in double gallbladder is extremely rare with only 3 reporting′s available till date to the best of author′s knowledge. With a preoperative diagnosis of double gallbladder, laparoscopic cholecystectomy can be safely and successfully performed with meticulous dissection, aided by operative cholangiogram. However in all such attempts a lower threshold should be kept for conversion to open surgery. Awareness about this anomaly amongst radiologists and surgeons is of crucial importance. Double gallbladder does not present with any specific symptom, neither it increases disease possibility in either lobe. Prophylactic cholecystectomy has no role in asymptomatic cases diagnosed accidentally. Author reports a case of a symptomatic young male with double gallbladder who presented with short history of dyspepsia, abdominal pain and fever. Definite preoperative diagnosis was reached with ultrasound scan and magnetic resonance cholangio pancreatography and subsequently dealt with laparoscopically. Calculous cholecystitis affected one lobe and acalculous empyema the other. While the 1st lobe drained though a cystic duct into common bile duct (CBD, the 2nd was without any communication with either CBD or its counterpart, thus remained as a blind vesicle.

Laparoscopic cholecystectomy in double gallbladder with dual pathology.

Science.gov (United States)

Ghosh, Sumanta Kumar

2014-04-01

Double gallbladder is a rare embryological anomaly of clinical significance. Despite availability of modern imaging, only 50% of recently reported cases had preoperative diagnosis, which is desirable in every case to avoid serious operative complications. Double pathology in double gallbladder is extremely rare with only 3 reporting's available till date to the best of author's knowledge. With a preoperative diagnosis of double gallbladder, laparoscopic cholecystectomy can be safely and successfully performed with meticulous dissection, aided by operative cholangiogram. However in all such attempts a lower threshold should be kept for conversion to open surgery. Awareness about this anomaly amongst radiologists and surgeons is of crucial importance. Double gallbladder does not present with any specific symptom, neither it increases disease possibility in either lobe. Prophylactic cholecystectomy has no role in asymptomatic cases diagnosed accidentally. Author reports a case of a symptomatic young male with double gallbladder who presented with short history of dyspepsia, abdominal pain and fever. Definite preoperative diagnosis was reached with ultrasound scan and magnetic resonance cholangio pancreatography and subsequently dealt with laparoscopically. Calculous cholecystitis affected one lobe and acalculous empyema the other. While the 1st lobe drained though a cystic duct into common bile duct (CBD), the 2nd was without any communication with either CBD or its counterpart, thus remained as a blind vesicle.

Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell

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Hersey, N., E-mail: naomi.hersey@sth.nhs.uk [Sheffield Teaching Hospitals NHS Trust, Department of Radiology, Northern General Hospital (United Kingdom); Goode, S. D., E-mail: s.goode@sheffield.sc.uk [Sheffield Teaching Hospitals NHS Trust, Sheffield Vascular Institute (United Kingdom); Peck, R. J., E-mail: robert.peck@sth.nhs.uk; Lee, F., E-mail: fred.lee@sth.nhs.uk [Sheffield Teaching Hospitals NHS Trust, Department of Radiology, Northern General Hospital (United Kingdom)

2015-08-15

PurposeThere have been few case reports describing cystic duct stent insertion in the management of acute cholecystitis secondary to benign disease with no case series published to date. We present our series demonstrating the role of cystic duct stents in managing benign gallbladder disease in those patients unfit for surgery.Materials and MethodsThirty three patients unfit for surgery in our institution underwent cystic duct stent insertion for the management of acute cholecystitis in the period June 2008 to June 2013. Patients underwent a mixture of transperitoneal and transhepatic gallbladder puncture. The cystic duct was cannulated with a hydrophilic guidewire which was subsequently passed through the common bile duct and into the duodenum. An 8Fr 12-cm double-pigtail stent was placed with the distal end lying within the duodenum and the proximal end within the gallbladder.ResultsTen patients presented with gallbladder perforation, 21 patients with acute cholecystitis, 1 with acute cholangitis and 1 with necrotising pancreatitis. The technical success rate was 91 %. We experienced a 13 % complication rate with 3 % mortality rate at 30 days.ConclusionCystic duct stent insertion can be successfully used to manage acute cholecystitis, gallbladder empyema or gallbladder perforations in those unfit for surgery and should be considered alongside external gallbladder drainage as a definitive mid-term treatment option.

Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell

International Nuclear Information System (INIS)

Hersey, N.; Goode, S. D.; Peck, R. J.; Lee, F.

2015-01-01

PurposeThere have been few case reports describing cystic duct stent insertion in the management of acute cholecystitis secondary to benign disease with no case series published to date. We present our series demonstrating the role of cystic duct stents in managing benign gallbladder disease in those patients unfit for surgery.Materials and MethodsThirty three patients unfit for surgery in our institution underwent cystic duct stent insertion for the management of acute cholecystitis in the period June 2008 to June 2013. Patients underwent a mixture of transperitoneal and transhepatic gallbladder puncture. The cystic duct was cannulated with a hydrophilic guidewire which was subsequently passed through the common bile duct and into the duodenum. An 8Fr 12-cm double-pigtail stent was placed with the distal end lying within the duodenum and the proximal end within the gallbladder.ResultsTen patients presented with gallbladder perforation, 21 patients with acute cholecystitis, 1 with acute cholangitis and 1 with necrotising pancreatitis. The technical success rate was 91 %. We experienced a 13 % complication rate with 3 % mortality rate at 30 days.ConclusionCystic duct stent insertion can be successfully used to manage acute cholecystitis, gallbladder empyema or gallbladder perforations in those unfit for surgery and should be considered alongside external gallbladder drainage as a definitive mid-term treatment option

Percutaneous drainage of fluid collection in the pleural and pericardial spaces. Perkutan pleura- og perikarddrenasje

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Drolsum, A.; Skjennald, A. (Ullevaal sykehus, Oslo (Norway))

1994-11-01

Both MRI, CT and sonography will give a good presentation of fluid collection in pleura and pericardium. Sonography is the ideal imaging method for monitoring interventional procedures. Its ability to visualize superficial fluid collection and its real-time capability allows precise control of needle and catheter insertions. If the abnormality is poorly seen with ultrasound, often because of air in the collection, CT can be used as a guidance system. Diagnostic thoracocentesis and pericardiocentesis are performed mainly to exclude malignancy and infections, and the punctions are made with small needles. Therapeutic thoracocentesis is usually performed to relieve dyspnoe and small catheters are used. Drainage of empyema is performed with larger catheters because of the high viscosity of the infected fluid. Patients with threatening cardiac tamponade will often respond immediately to drainage of the pericardial space by catheter. These procedures can be done with local anesthesia only. If complications occur, it is mainly the pneumothorax that has to be treated. This can be managed directly under the procedure as the drainage catheter is attached to continuous pleural suction, or a catheter can be inserted in the pleural space after diagnostic punction. Patients with coagulation abnormalities must be evaluated especially before any intervention, otherwise there are no contraindications for these image-guided percutaneous procedures. 14 refs., 6 figs.

Early symptomatic and late seizures in Kosovar children with bacterial meningitis.

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Namani, Sadie A; Kuchar, Ernest; Koci, Remzie; Mehmeti, Murat; Dedushi, Kreshnike

2011-11-01

Despite the dramatic decrease of mortality rate among children with bacterial meningitis in recent decades, some patients are left with neurologic sequelae. The purpose of this study was to analyze the occurrence of seizures as predictors for meningitis-related deaths or neurological sequelae including late seizures. This study uses a retrospective chart review of 277 children (aged 0-16 years, median 2 years, 162 boys) treated for bacterial meningitis in University Clinical Centre in Prishtina (Kosovo). Of the 277 children treated for bacterial meningitis, 60 children (22%) manifested seizures prior to admission, 57 children (21%) had seizures after admission, and late seizures were diagnosed in 24 children (9%). The risk for adverse outcome was significantly higher in patients who had seizures prior to admission (52/60) and in patients who manifested seizures later than 24 h (41/41; RR 8.17 and 6.78 respectively, p < 0.0001). All children who manifested late seizures were diagnosed with meningitis-related acute neurologic complications: subdural effusion (18), hydrocephalus (6), intracranial bleeding (1), and subdural empyema (2). Of the 60 children who presented seizures prior to admission, only 11 manifested late seizures. Seizures prior to admission were predictors of high risk of adverse outcome in bacterial meningitis in children. The risk of secondary epilepsy (9%) occurred only in children with evident structural neurologic complications during the acute phase of bacterial meningitis.

Role of imaging procedures in clarification of complications of pneumonia

International Nuclear Information System (INIS)

Lampichler, K.

2017-01-01

Despite a considerable number of antimicrobial agents and interdisciplinary treatment options, lower respiratory tract infections are still associated with high morbidity and mortality rates. Infections of the respiratory tract can lead to severe complications, such as empyema, lung abscesses and acute respiratory distress syndrome (ARDS). Besides intrapulmonary complications pneumonia can also impair other organs due to a systemic inflammatory response. Underlying cardiovascular diseases, such as chronic heart failure, arteriosclerosis and dysrhythmia can either deteriorate due to infections or be newly manifested as a result of pneumonia. Early diagnosis and therapy of these sometimes life-threatening complications are crucial and can have a severe impact on disease outcome. The most important imaging techniques include chest X-ray and computed tomography (CT) of the chest. Although a definite diagnosis is sometimes difficult or even impossible to establish using chest X-ray or CT, there are several findings indicative of intrapulmonary or extrapulmonary complications of pneumonia. Another useful and portable tool is thoracic ultrasound directly on the patient, which can be used to further define the underlying disease or as guidance during procedures. The chest X-ray is useful in initial diagnosis and follow-up. If complications or disease progression are suspected or the clinical course differs from the X-ray interpretation, a subsequent CT of the chest should be performed. (orig.) [de

Bacteriology of hospital-acquired infection and antibiotic resistance in a hospital university of Bushehr Port Fatemeh Zahra (s in 2002-2003

Directory of Open Access Journals (Sweden)

Katayoon Vahdat

2005-02-01

Full Text Available Nosocomial infection is an increasing problem. The global problem of antimicrobial resistance is particularly pressing in developing countries, where the infectious disease burden is high and cost constraints prevent the widespread application of newer, more expensive agents. In a prospective study, 203 consecutive cases with hospital-acquired infection in a university hospital in Bushehr port were evaluated. The most common hospital-acquired infection was urinary (76 cases, conjunctivitis (16 cases, bacteremia (8 cases, meningitis (5 cases, wound (3 cases, empyema (2 cases and peritonitis (1 case. The patients with hospital-acquired infection were from surgical and internal medicine I.C.Us (53.2% & 15.6%, respectively. The most frequent isolated organisms were Pseudomonas aeruginosa (25.6%, Acinetobacter baumannii (19.7%, E. coli (13.3%, Klebsiella pneumoniae (11.3%, Staphylococcus aureus (8.4%, Staphylococcus epidermidis (7.9%, Enterobacter species (7%, Streptococcus species (6.4%, and Proteus mirabilis (0.5%. The most resistant organisms to antimicrobial agents were Acinetobacter baumannii and Pseudomonas aeruginosa 97 & 93.3% of these bacteria were resistant to third generation cephalosporins. The isolated Staphylococcal species were resistant to amikacin (94%. In conclusion, gram negative bacteria were the most common etiologic agent of hospital-acquired infection and had a high level of resistance to amikacin and third generation cephalosporins. Therefore, new therapeutic strategies should be designed to combat these microorganisms.

Classification and management of chest trauma

International Nuclear Information System (INIS)

Farooq, U.; Raza, W.; Zia, N.; Hanif, M.; Khan, M.M.

2006-01-01

Objective: To classify the predominant pattern of injuries following blunt and penetrating chest trauma and to assess the adequacy of treatment strategies, complications and mortality associated with such injuries. Design: Descriptive study. Place and Duration of Study: Surgical Unit I, Holy Family Hospital, Rawalpindi, from December 2000 to December 2003. Patients and Methods: One hundred consecutive patients with thoracic trauma either blunt or penetrating, admitted in the ward were evaluated. Their injuries were classified, treatment strategies outlined and complications and mortality were documented on a specially-designed proforma. Results: Out of the 100 patients presenting in emergency, 44% presented with blunt and 56% with penetrating trauma. Pneumothorax was detected in 39% of the patients, hemopneumothorax in 29%, hemothorax in 12%, flail chest in 9%. Two had involvement of the heart and major vessels, 4% had injury to the diaphragm and 5% had multiple trauma. During treatment, 3% of all the patients were managed conservatively, 83% of patients required chest intubations, 6% needed ventilatory support and 8 % required thoracotomy. Complications were experienced in 28% of the patients of which 9% had pneumonias, 14% empyema and 5% suffered from wound infections. The overall mortality was 7%. Conclusion: This series showed the pattern of injuries following blunt and penetrating chest trauma. Furthermore, it was found that chest incubation and simple resuscitation was adequate for majority of the cases. (author)

The value of early CT in complicated childhood pneumonia

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Tan Kendrick, A.P. [Department of Diagnostic Imaging, Kandang Kerbau Women' s and Children' s Hospital (Singapore); Ling, Ho [Department of Paediatric Medicine, Kandang Kerbau Women' s and Children' s Hospital (Singapore); Subramaniam, Ramnath; Joseph, Vijeyakaran T. [Department of Paediatric Surgery, Kandang Kerbau Women' s and Children' s Hospital (Singapore)

2002-01-01

Objective. To investigate the value of CT in complicated childhood pneumonia and its role in early intervention when chest radiography (CXR) is non-contributory. Materials and methods. Forty-two immunocompetent children, aged 1-11 years, admitted for community-acquired pneumonia from October 1997 to September 1999, had 42 contrast-enhanced CT scans and frontal chest radiographs on the same day, which were assessed independently. CT was performed when the patient remained unwell and the CXR images showed failure of resolution despite 7-10 days of antibiotics and/or drainage with urokinase therapy. Results. Compared to CT, CXR revealed suboptimal accuracy rates of lobar involvement (84%), chest tube placement (73%), fluid loculation (42%), abscess formation (40%) and bronchopleural fistulae (33%). It could not assess parenchymal or pleural complications such as cavitary necrosis, early abscess formation, empyemas or pericardial effusions. On the basis of the CT findings and poor clinical progress, 16 patients underwent surgical intervention with the aid of video-assisted thorascopic surgery (VATS). The CT features correlated well with surgical findings. Ten cases required pleural decortication while six with destructive or necrotic lung lesions had surgical resection. Debridement was difficult when the pleura had become thick and fibrotic. Streptococcus pneumoniae was the offending organism in 81% of cases. The right side was affected in 67% of cases. Conclusions. In complicated childhood pneumonia, CT is far superior to CXR in revealing pleural and parenchymal complications, which may require early surgical intervention. (orig.)

Pneumonia in the immunocompetent patient.

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Reynolds, J H; McDonald, G; Alton, H; Gordon, S B

2010-12-01

Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Streptoccocus pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest radiographic appearance, into lobar pneumonia, bronchopneumonia and pneumonia producing an interstitial pattern. Lobar pneumonia is most commonly associated with community acquired pneumonia, bronchopneumonia with hospital acquired infection and an interstitial pattern with the so called atypical pneumonias, which can be caused by viruses or organisms such as Mycoplasma pneumoniae. Most cases of pneumonia can be managed with chest radiographs as the only form of imaging, but CT can detect pneumonia not visible on the chest radiograph and may be of value, particularly in the hospital setting. Complications of pneumonia include pleural effusion, empyema and lung abscess. The chest radiograph may initially indicate an effusion but ultrasound is more sensitive, allows characterisation in some cases and can guide catheter placement for drainage. CT can also be used to characterise and estimate the extent of pleural disease. Most lung abscesses respond to medical therapy, with surgery and image guided catheter drainage serving as options for those cases who do not respond.

Parapneumonic pleural effusion: reality and strategies in an Amazon university hospital

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CLAUDIA GISELLE SANTOS ARÊAS

Full Text Available ABSTRACT Objective: to define the profile and analyze the postoperative evolution of children with parapneumonic pleural effusion (PPE, and to evaluate strategies used in the presence of diagnostic and therapeutic limitations, emphasizing the open thoracic drainage (OTD . Methods: we conducted a cross-sectional, prospective, analytical study in which we followed children admitted in an Amazon university hospital with surgically addressed PPE, from October 2010 to October 2011. Results: we studied 46 patients, most children under three years of age (74%, with no gender predominance. A significant portion of the sample (28% had inappropriate body mass index. We found short stature in five patients (11%, which tended, in general, to a worst postoperative outcome when compared with children of normal height (p=0.039. The average duration of symptoms till admission was 16.9 days. Empyema was a common diagnosis in the first surgery (47.8%, and its bearers had longer duration of chest tube drainage (p=0.015. Most children (80.4% were operated only once. The mean length of hospital stay was 25.9 days. Thoracic drainage (water-sealed was the most common procedure (85%, with conversion to OTD in 24% of the sample, thoracotomy being rare (4%. There were no deaths. Conclusion: the studied individuals often had advanced disease and nutritional disorders, affecting outcome. OTD remains a valid option for specific situations, and further studies are needed for confirmation.

Surgical management of spontaneous pneumothorax: are there any prognostic factors influencing postoperative complications?

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Delpy, Jean-Philippe; Pagès, Pierre-Benoit; Mordant, Pierre; Falcoz, Pierre-Emmanuel; Thomas, Pascal; Le Pimpec-Barthes, Francoise; Dahan, Marcel; Bernard, Alain

2016-03-01

There are no guidelines regarding the surgical approach for spontaneous pneumothorax. It has been reported, however, that the risk of recurrence following video-assisted thoracic surgery is higher than that following open thoracotomy (OT). The objective of this study was to determine whether this higher risk of recurrence following video-assisted thoracic surgery could be attributable to differences in intraoperative parenchymal resection and the pleurodesis technique. Data for 7647 patients operated on for primary or secondary spontaneous pneumothorax between 1 January 2005 and 31 December 2012 were extracted from Epithor®, the French national database. The type of pleurodesis and parenchymal resection was collected. Outcomes were (i) bleeding, defined as postoperative pleural bleeding; (ii) pulmonary and pleural complications, defined as atelectasis, pneumonia, empyema, prolonged ventilation, acute respiratory distress syndrome and prolonged air leaks; (iii) in-hospital length of stay and (iv) recurrence, defined as chest drainage or surgery for a second pneumothorax. Of note, 6643 patients underwent videothoracoscopy and 1004 patients underwent OT. When compared with the thoracotomy group, the videothoracoscopy group was associated with more parenchymal resections (62.4 vs 80%, P = 0.01), fewer mechanical pleurodesis procedures (93 vs 77.5%, P pneumothorax, videothoracoscopy is associated with a higher rate of recurrence than OT. This difference might be attributable to differences in the pleurodesis technique rather than differences in the parenchymal resection. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Histological evaluation of 400 cholecystectomy specimens

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H Kumar

2015-09-01

Full Text Available Background: A majority of gallbladder specimens show changes associated with chronic cholecystitis; however few harbour a highly lethal carcinoma. This study was conducted to review the significant histopathological findings encountered in gallbladder specimens received in our laboratory.Materials and Methods: Four hundred cholecystectomy specimens were studied over a period of five years (May, 2002 to April, 2007 received at department of pathology, Kasturba Medical College, Mangalore, India. Results: Gallstones and associated diseases were more common in women in the 4th to 5th decade as compared to men with M: F ratio of 1:1.33. Maximum number of patients (28.25% being 41 to 50 years old. Histopathologically, the most common diagnosis was chronic cholecystitis (66.75%, followed by chronic active cholecystitis (20.25%, acute cholecystitis (6%, gangrenous cholecystitis (2.25%,xanthogranulomatous cholecystitis (0.50%, empyema (1%, mucocele (0.25%, choledochal cyst (0.25%, adenocarcinoma gallbladder (1.25% and  normal  gallbladders (1%.Conclusion: All lesions were found more frequently in women except chronic active cholecystitis. Gallstones were present in (80.25% cases, and significantly associated with various lesions (P value 0.009. Pigment stones were most common, followed by cholesterol stones and mixed stones. Adequate  sectioning  is  mandatory  in  all  cases  to  assess  epithelial changes arising from cholelithiasis and chronic cholecystitis as it has been known to progress to malignancy in some cases.

Toxicity of inhaled 91YCl3 in beagle dogs. VII

International Nuclear Information System (INIS)

Muggenburg, B.A.; Benjamin, S.A.; Boecker, B.B.; McClellan, R.O.

1974-01-01

Studies on the metabolism, dosimetry, and effects of inhaled 91 YCl 3 in Beagle dogs are being continued to provide information that will aid in assessing the biological consequences of nuclear accidents in which 91 Y or other radionuclides that produce a similar radiation dose pattern may be released. Forty-two dogs with 91 Y initial body burdens from 64 to 1300 μCi/kg body weight were placed in four groups with mean lung burdens of 310, 180, 75, and 40 μCi/kg body weight. These dogs and 12 control dogs are being maintained for lifetime observation. An additional group of four dogs with a mean initial 91 Y body burden of 180 μCi/kg body weight were placed in a sacrifice study. Eleven dogs within the highest activity level groups died or were euthanized at 12 to 33 days after inhalation of 91 Y with changes related to severe bone marrow damage and associated paycytopenia. Two dogs died approximately one year after 91 Y inhalation with convulsive seizures that were presumed to be unrelated to the 91 Y exposure. Four 91 Y-exposed dogs died or were euthanized due to neoplasms 2000 to 2560 days after exposure. Two dogs had squamous cell carcinomas involving the maxillary and nasal regions, one a bronchiolo-alveolar carcinoma of the lung and another, a mast cell sarcoma. One control dog died of empyema. Serial observations are continuing on all surviving dogs. (U.S.)

Clinical characteristics and distribution of pathogens in fungal keratitis

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Tian Tian

2016-01-01

Full Text Available AIM:To investigate the clinical characteristics and distribution of pathogens in patients with fungal keratitis and to provide evidence for diagnosis and treatment of this disease.METHODS:The clinical data of 98 cases(98 eyeswith fungal keratitis from January 2012 to July 2015 in the First Affiliated Hospital of Yangtze University were retrospectively reviewed.RESULTS:The main cause for fungal keratitis was corneal injury by plants. The inappropriate use of contact lenses and glucocorticoids therapy were the next cause. Almost all of the patients had hyphae moss, pseudopodia, immune ring, and satellite signs. A few of patients had endothelial plaque and anterior chamber empyema. The majority pathogens of fungal keratitis was Fusarium spp(73.5%,followed by Aspergillus spp(13.2%,Candida spp(9.2%and others(4.1%.Sixty-five patients(65 eyestreated with 5% natamycin were cured. The condition of 15 patients was improved. Eighteen patients were invalid, in which 13 patients became better and 5 patients became worse after voriconazole was added into the therapy, leading to amniotic membrance cover in 3 patients and eyeball removal in 2 patients at last.CONCLUSION:Fusarium genus is the predominant pathogen for fungal keratitis in Jingzhou. Natamycin can be used as the preferred drug for the prevention and treatment for fungal keratitis. The clinicians should pay attention to the fungal keratitis, in order to early diagnosis and timely treatment.

Pleural Drainage and its Role in Management of the Isolated Penetrating Chest Injuries During the War Time in Sarajevo, 1992.-1995.

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Ademir Hadžismajlović

2007-05-01

Full Text Available Penetrating chest injuries are the most frequent causes of serious demage and death in wounded indivisuals. In reports from the last wars where wounds caused by high velocity projectiles predominated, thoracotomies were perfomed in about 15% of the wounded individuals, mostly encompassing injuries of the heart and great vessels, accomanied by massive bleeding that could not be resolved by chest tube insertion. This retrospective analysis was performed on the medical records of 477 patients tretaed for isolated penetrating chest injuries in Department of Thoracic Surgery Clinical Center of the University in Sarajevo between april 1992 - june 1995. We analised the ways of their menagement with special view on pleural drainage, indication for this method and results of treatment. 398 (83,4% wounded individuals have been treated with pleural tube inserting as definitive mesaure and for the urgent thoracotomy there were 79 (16,6% patients left. Average hospital treatment in wounded drained patients was 7,68 days. With shrapnels there were 357 (74,84% wounded individuals, and with bullet 120 (25,16% wounded individuals. The complications of plaural tube inserting were - empyema in 34 (7,13% patients and there were no other complications. Chest tube inserting as definitive mesaure was used in 398 (83,44% patients. Chest tube inserting as preoperative measure (urgent thoracotomy was used in 79 (16,56% patients. There were 460 (96,44% healed patients. Death occurred in 17 (3,56% patients.

Toxicity of inhaled 91YCl3 in beagle dogs. X

International Nuclear Information System (INIS)

Muggenburg, B.A.; Benjamin, S.A.; Boecker, B.B.; McClellan, R.O.

1976-01-01

Studies on the metabolism, dosimetry, and effects of inhaled 91 YCl 3 in Beagle dogs are being continued to provide information that will aid in assessing the biological consequences of nuclear accidents in which 91 Y or other radionuclides that produce a similar radiation dose pattern may be released. Forty-two dogs with 91 Y initial body burdens from 64 to 1300 μCi/kg body weight were placed in four groups with mean lung burdens of 310, 180, 75 and 40 μCi/kg body weight. These dogs and 12 control dogs are being maintained for lifetime observation. An additional group of four dogs with a mean initial 91 Y body burden of 180 μCi/kg body weight were placed in a sacrifice study. Eleven dogs within the highest activity level groups died or were euthanized at 12 to 33 days after inhalation of 91 Y with changes related to severe bone marrow damage and associated pancytopenia. Two dogs died approximately 1 yr after 91 Y inhalation with convulsive seizures that were presumed to be unrelated to the 91 Y exposure. Five 91 Y-exposed dogs died or were euthanized due to neoplasms 2000 to 3341 days after exposure. Three dogs had nasal squamous cell carcinomas, one had a bronchioloalveolar carcinoma and another, a mast cell sarcoma. One dog died of renal failure 2660 days after exposure and one control dog died of empyema. Serial observations are continuing on all surviving dogs

Pleural drainage and its role in management of the isolated penetrating chest injuries during the war time in Sarajevo, 1992.-1995.

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Hadzismajlović, Ademir; Pilav, Alen

2007-05-01

Penetrating chest injuries are the most frequent causes of serious demage and death in wounded indivisuals. In reports from the last wars where wounds caused by high velocity projectiles predominated, thoracotomies were perfomed in about 15% of the wounded individuals, mostly encompassing injuries of the heart and great vessels, accomanied by massive bleeding that could not be resolved by chest tube insertion. This retrospective analysis was performed on the medical records of 477 patients tretaed for isolated penetrating chest injuries in Department of Thoracic Surgery Clinical Center of the University in Sarajevo between april 1992 - june 1995. We analised the ways of their menagement with special view on pleural drainage, indication for this method and results of treatment. 398 (83,4%) wounded individuals have been treated with pleural tube inserting as definitive mesaure and for the urgent thoracotomy there were 79 (16,6%) patients left. Average hospital treatment in wounded drained patients was 7,68 days. With shrapnels there were 357 (74,84%) wounded individuals, and with bullet 120 (25,16%) wounded individuals. The complications of plaural tube inserting were - empyema in 34 (7,13%) patients and there were no other complications. Chest tube inserting as definitive mesaure was used in 398 (83,44%) patients. Chest tube inserting as preoperative measure (urgent thoracotomy) was used in 79 (16,56%) patients. There were 460 (96,44%) healed patients. Death occurred in 17 (3,56%) patients.

Role of medical thoracoscopy in the treatment of tuberculous pleural effusion

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Gao, Xusheng; Zhu, Huaiyang; Ding, Caihong

2016-01-01

Background Fibrous tuberculous pleural effusion (TPE) represents common disease in tuberculous clinic. Medical thoracoscopy has been used to treat pleural empyema and shown promising outcomes, but data of its use in multiloculated and organized TPE remains limited to know. Methods The study was performed on 430 cases with TPE. The cases were divided into free-flowing, multiloculated effusion and organized effusion group. Each group was subdivided into two or three types of therapeutic approaches: ultrasound guided pigtail catheter, large-bore tube chest drainage and medical thoracoscopy. Patients with multiloculated or organized effusions received streptokinase, introduced into the pleural cavity via chest tubes. The successful effectiveness of the study was defined as duration of chest drainage, time from treatment to discharge days and no further managements. Results Patients with organized effusion were older than those with free-flowing effusion and incidence of organized effusion combined with pulmonary tuberculosis (PTB) was higher than those of multiloculated effusion and free-flowing effusion respectively. Positive tuberculosis of pleural fluid culture was higher in organized effusion than that in free-flowing effusion. Sputum positive for acid-fast bacillus (AFB) in organized effusion was higher than that in multiloculated effusion and free-flowing effusion. Medical thoracoscopy showed significant efficacy in the group of multiloculated effusion and organized effusion but free-flowing effusion. No chronic morbidity and mortality related to complications was observed. Conclusions Medical thoracoscopy was a safe and successful method in treating multiloculated and organized TPE. PMID:26904212

Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature.

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Ramos, Alexander D; Rolston, John D; Gauger, Grant E; Larson, Paul S

2016-07-12

BACKGROUND Spinal subdural abscesses, also known as empyemas, are rare infectious lesions, the exact incidence of which is unknown. Presentation is typically dramatic, with back pain, fever, motor, and sensory deficits. Rapid identification and surgical intervention with laminectomy, durotomy, and washout provides the best outcomes. While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery. CASE REPORT Here we present 2 cases: 1) an 87-year-old man with type 2 diabetes, schizophrenia, mild cognitive impairment, and symptomatic lumbar spinal stenosis and 2) a 62-year-old man with a prior L3-4 spinal fusion with symptomatic lumbar spinal stenosis. In both cases, patients underwent laminectomy for spinal stenosis and developed epidural abscess. Following successful drainage of the epidural abscess, they continued to be symptomatic, and repeat imaging revealed the presence of a subdural abscess that was subsequently evacuated. Case 1 had significant improvement with residual lower-extremity weakness, while Case 2 made a complete neurological recovery. CONCLUSIONS These cases illustrate patients at increased risk for developing this rare spinal infection, and demonstrate that rapid recognition and surgical treatment is key to cure and recovery. Review of the literature highlights pertinent risk factors and demonstrates nearly one-third of reported cases have an iatrogenic etiology. The cases presented here demonstrate that a subdural process should be suspected in any patient with intractable pain following treatment of an epidural abscess.

Percutaneous catheter drainage of thoracic fluid: the usefulness and safety of bedside trocar placement under ultrasound guidance

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Lee, Heon [Seoul Medical Center, Seoul (Korea, Republic of)

2006-07-15

The author wanted to evaluate the usefulness and safety of the trocar technique for US-guided bedside catheter placement into thoracic fluid collections, and this technique has generally been reserved for the larger or superficial fluid collections. 42 drainage procedures were performed in 38 patients at the bedside. The patients were positioned supine or semi-upright. A drainage catheter system with a stylet and cannula assembly was used and all of the catheters were inserted using the trocar technique. The procedures consisted of drainage of empyema (n=14), malignant effusion (n=13), lung abscess (n=3), massive transudate (n=8), hemothorax (n=2) and chest wall hematoma (n=2). The clinical results were classified as successful (complete and partially successful), failure or undetermined. The medical records and images were retrospectively reviewed to evaluate the success rate, the complications and the procedure time. Technical success was achieved in all of the 42 procedures. With using the trocar technique, all the catheters were placed into even the small collections without significant complications. Drainage was successful in 36 (85.7%) of the 42 procedures. The average volume of thoracic fluid that was aspirated manually at the time of catheter placement was 420 mL (range: 35 to 1470 mL). The procedure time was less than 10 minutes from US-localization to complete catheter placement in all of the procedures. The trocar technique under US guidance can be an efficient and safe alternative to the Seldinger or guide-wire exchange technique for bedside catheter placement in the critically ill or hemodynamically unstable patients.

Traumatic interhemispheric subdural hematoma extending above the tentorium demonstrated as a low-density mass

International Nuclear Information System (INIS)

Katagiri, Kunihiko; Takaki, Tadahiro; Fukushima, Takeo; Tomonaga, Masamichi

1984-01-01

This report presents a case of traumatic interhemispheric subdural hematoma extending above the right tentorium, which showed a low-density mass in the CT scan and which brought up a problem of differential diagnosis from subdural empyema because the patient had a long history of bilateral chronic otitis media. The 47-year-old man fell downstairs while drunk; this accident was followed by an increasing member of incidents of headache and vomiting, and he was admitted on the 15th day after the episode. Upon admission, his mental state was slightly dull; a neurologic examination revealed a mild choked disc and increased DTRs on the left. There was otorrhea and hearing difficulty on the left side, and his blood pressure was slightly elevated (170/110 mmHg). The laboratory data were negative except for an increased blood-sedimentation ratio (50/80 mm) and 1 + CRP. The precontrast CT scan demonstrated a lentiform low-density mass in the posterior part of the interhemispheric fissure extending above the right tentorium, with an unusual mass effect for the volume and a location of this mass. The postcontrast CT scan showed a marked enhancement of the falx and the tentorium around the mass. Furthermore, the pneumatization of the mastoid cells was markedly decreased. An operation was performed following the day of admission; when subdural hematoma was confirmed, it was evacuated and irrigated. The postoperative course was excellent, and the low-density mass had disappeared by the time of a follow-up CT scan 19 days after the operation. (J.P.N.)

Mediastinitis after cardiac transplantation

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Noedir A. G. Stolf

2000-05-01

Full Text Available OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6% of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±10.0 years and 10 (83.3% patients were males. Seven (58.3% patients showed sternal stability on palpation, 4 (33.3% patients had pleural empyema, and 2 (16.7% patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7% patients. Staphylococcus epidermidis was identified in 2 (16.7% patients, Enterococcus faecalis in 1 (8.3% patient, and the cause of mediastinitis could not be determined in 1 (8.3% patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7% patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3% patient. Out of this series, 5 (41.7% patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3% patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

TYPHOID FEVER WITH FATAL OUTCOME IN PEOPLE WITH SEVERE TROPHOLOGICAL FAILURE IN EXTREME CONDITIONS

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Yu. I. Lyashenko

2017-01-01

Full Text Available For purpose of clinical and morphological characterization of typhoid fever with fatal outcome was perform analysis of medical documentation as well as postmortem studies of internal tissues in 36men aged 21 to 34 years with severe body weight loss and in the conditions of combat stress in period from 1983 to 1985. The results of the study find a number of clinical and pathomorphological features of typhoid fever in patients with body weight deficiency that were in extreme conditions. Focal changes of the central nervous system were detected. The defeat of the respiratory system was characterized from the first days of the disease by bronchitis, and in the subsequent development of pneumonia, plevritis and empyema of the pleura. Majority of patients had symptoms of cardiovascular and renal failure. In died in the first week of the disease and in 2/3 parts – in a later period were combined with the symptoms of infectious-toxic encephalopathy and severe acute respiratory failure. All died had postmortem dystrophic changes of cardiomyocytes, and in patients had fatal outcome in 2–5 weeks – also focal or diffuse myocarditis. In a third of the patients who died, the disease was complicated by intestinal perforations. In a number of cases, peritonitis was a consequence of necrosis of mesenteric lymph nodes. In all patients with a fatal outcome, hemorrhagic (thrombohemorrhagic syndrome was diagnosed. A significant proportion of patients posthumously detected signs of sepsis and other complications, many of which could be the cause of death.

Post-thoracotomy wound separation (DEHISCENCE: a disturbing complication

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Aydin Nadir

2013-01-01

Full Text Available OBJECTIVES: We described the treatment of dehiscence of thoracotomy incisions in patients who underwent thoracic surgery in the present study. METHODS: Twenty-four patients with either partial or complete dehiscence of their thoracotomy incisions were included in the study from 2005 to 2010. The patients were evaluated regarding their age, sex, indication for thoracotomy, and surgical approaches. We also described our method of re-closure. RESULTS: The male/female ratio was 17/7. The youngest and oldest patients were 15 and 75 years old, respectively, and the mean age was 43 years. Among the indications for thoracotomy, empyema was the most common reason (determined in eight [33%] patients, followed by vertebral surgery (determined in six [25%] patients. Bacterial growth was detected in the wound site cultures from 13 (54% patients. For the patients with dehiscence of their thoracotomy incisions, an en block approximation technique with debridement was performed under general or local anesthesia in 16 (66% and eight (33% of the cases, respectively. Three patients exhibited an open thorax with dehiscence of the thoracotomy incision. Thoracoplasty was required in two patients. Using this method, successful closure was obtained in 91.7% (n = 22 of the patients with dehiscence of their thoracotomy incisions. CONCLUSION: Dehiscence of the thoracotomy incision is an important complication that causes concern in patients and their thoracic surgeons and strongly affects the success of the surgery. An en block approximation technique with significant debridement that enables removal of the necrotic tissues from the wound site can successfully be applied to patients with dehiscence of their thoracotomy incisions.

Structure-based functional annotation of putative conserved proteins having lyase activity from Haemophilus influenzae.

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Shahbaaz, Mohd; Ahmad, Faizan; Imtaiyaz Hassan, Md

2015-06-01

Haemophilus influenzae is a small pleomorphic Gram-negative bacteria which causes several chronic diseases, including bacteremia, meningitis, cellulitis, epiglottitis, septic arthritis, pneumonia, and empyema. Here we extensively analyzed the sequenced genome of H. influenzae strain Rd KW20 using protein family databases, protein structure prediction, pathways and genome context methods to assign a precise function to proteins whose functions are unknown. These proteins are termed as hypothetical proteins (HPs), for which no experimental information is available. Function prediction of these proteins would surely be supportive to precisely understand the biochemical pathways and mechanism of pathogenesis of Haemophilus influenzae. During the extensive analysis of H. influenzae genome, we found the presence of eight HPs showing lyase activity. Subsequently, we modeled and analyzed three-dimensional structure of all these HPs to determine their functions more precisely. We found these HPs possess cystathionine-β-synthase, cyclase, carboxymuconolactone decarboxylase, pseudouridine synthase A and C, D-tagatose-1,6-bisphosphate aldolase and aminodeoxychorismate lyase-like features, indicating their corresponding functions in the H. influenzae. Lyases are actively involved in the regulation of biosynthesis of various hormones, metabolic pathways, signal transduction, and DNA repair. Lyases are also considered as a key player for various biological processes. These enzymes are critically essential for the survival and pathogenesis of H. influenzae and, therefore, these enzymes may be considered as a potential target for structure-based rational drug design. Our structure-function relationship analysis will be useful to search and design potential lead molecules based on the structure of these lyases, for drug design and discovery.

Risk factors and treatment of pneumothorax secondary to granulomatosis with polyangiitis: a clinical analysis of 25 cases.

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Shi, Xuhua; Zhang, Yongfeng; Lu, Yuewu

2018-01-15

To investigate the risk factors and treatment strategies for pneumothorax secondary to granulomatosis with polyangiitis (GPA). Retrospective analysis of cases with pneumothorax secondary to GPA from our own practice and published on literature. A total of 25 patients, 18 males and 7 females, mean age 44 ± 15.7 years, were analyzed. Diagnosis included pneumothorax (11 cases), hydropneumothorax (n = 5), empyema (n = 8) and hemopneumothorax (n = 1). 88% (22/25) patients showed single/multiple pulmonary/ subpleural nodules with/without cavitation on chest imaging. Erythrocyte sedimentation rate and C-reactive protein were both elevated. Corticosteroids and immunosuppressive agents were used in 16 cases. Five cases received steroid pulse therapy, of which 4 patients survived. Pleural drainage was effective in some patients. Seven patients underwent surgical operations. In the 10 fatal cases, infection and respiratory failure were the most common cause. Lung biopsy/ autopsy showed lung/pleural necrotizing granulomatous vasculitis, breaking into the chest cavity, pleural fibrosis, bronchial pleural fistula, etc. The mean age in the death group was greater than the survival group (53 ± 12.9 years vs 40.1 ± 14.7 years, p = 0.05), the ineffective pleural drainage was also higher in the death group (5/5 vs 0/7, p = 0.01). Pneumothorax was seen in the active GPA, due to a variety of reasons, and gave rise to high fatality rate. Aggressive treatment of GPA can improve the prognosis. Older and lack of response for pleural drainage indicates poor prognosis.

Conservative use of chest-tube insertion in children with pleural effusion.

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Epaud, R; Aubertin, G; Larroquet, M; Pointe, H Ducou-le; Helardot, P; Clement, A; Fauroux, B

2006-04-01

The aim of this work was to evaluate the effect of a more conservative use of chest-tube insertion on the short-term and long-term outcome of pleural infection. Sixty-five patients with pleural infection, aged 1 month to 16 years were each treated according to one of the two protocols: classical management with chest-tube insertion (classical group, n = 33), or conservative use of chest-tube insertion (conservative group, n = 32), with drainage indicated only in the case of voluminous pleural effusion defined by a mediastinal shift and respiratory distress and/or an uncontrolled septic situation. The two groups were comparable with regard to age, baseline C-reactive protein (CRP) value and white blood cell counts, pleural thickness, identified bacteria, and antibiotic treatment. Chest-tube insertion was performed in 17 patients (52%) of the classical group compared to eight patients (25%) of the conservative group (P = 0.03). Duration of temperature above 39 degrees C was shorter in the conservative group (10 +/- 1 vs. 14 +/- 1 days, P = 0.01), as was the normalization of CRP (13 +/- 1 vs. 17 +/- 1 days, P = 0.03). Duration of hospitalization and intravenous (IV) antibiotherapy as well as the delay of chest-radiograph normalization was not significantly different between the two groups. A more conservative use of chest-tube insertion did not change short- and long-term outcome of the pleural infection in children. Drainage could be restricted to the most severely affected patients with pleural empyema causing a mediastinal shift and respiratory distress and/or presenting with an uncontrolled septic situation.

Pleural space infections after image-guided percutaneous drainage of infected intraabdominal fluid collections: a retrospective single institution analysis.

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Avella, Diego M; Toth, Jennifer W; Reed, Michael F; Gusani, Niraj J; Kimchi, Eric T; Mahraj, Rickeshvar P; Staveley-O'Carroll, Kevin F; Kaifi, Jussuf T

2015-04-11

Percutaneous drainage of infected intraabdominal fluid collections is preferred over surgical drainage due to lower morbidity and costs. However, it can be a challenging procedure and catheter insertion carries the potential to contaminate the pleural space from the abdomen. This retrospective analysis demonstrates the clinical and radiographic correlation between percutaneous drainage of infected intraabdominal collections and the development of iatrogenic pleural space infections. A retrospective single institution analysis of 550 consecutive percutaneous drainage procedures for intraabdominal fluid collections was performed over 24 months. Patient charts and imaging were reviewed with regard to pleural space infections that were attributed to percutaneous drain placements. Institutional review board approval was obtained for conduct of the study. 6/550 (1.1%) patients developed iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections. All 6 patients presented with respiratory symptoms and required pleural space drainage (either by needle aspiration or chest tube placement), 2 received intrapleural fibrinolytic therapy and 1 patient had to undergo surgical drainage. Pleural effusion cultures revealed same bacteria in both intraabdominal and pleural fluid in 3 (50%) cases. A video with a dynamic radiographic sequence demonstrating the contamination of the pleural space from percutaneous drainage of an infected intraabdominal collection is included. Iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections occur at a low incidence, but the pleural empyema can be progressive requiring prompt chest tube drainage, intrapleural fibrinolytic therapy or even surgery. Expertise in intraabdominal drain placements, awareness and early recognition of this complication is critical to minimize incidence, morbidity and mortality in these patients.

Empiema pleural: Resultados del tratamiento en el Hospital Clinicoquirúrgico Docente "Comandante Manuel Fajardo

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Jesús Valdés Jiménez

1999-04-01

Full Text Available Se realizó un estudio prospectivo de 15 pacientes con empiema pleural, ingresados en el Hospital Clinicoquirúrgico Docente "Comandante Manuel Fajardo", en el período de enero de 1995 a diciembre de 1997. La forma aguda se presentó en 5 enfermos, mientras que la crónica se presentó en 10. La neumopatía inflamatoria fue la causa más frecuente. La mayoría fue tratada con combinaciones de antibióticos betalactámicos y aminoglucósidos, complementada con terapéutica quirúrgica. En la forma aguda resultó útil el lavado pleural, mientras que en la crónica el proceder más utilizado fue la decorticación, seguido de la ventana torácica y la resección pulmonar. Sólo falleció un enfermo con un cáncer de pulmón avanzadoA prospective study of 15 patients with pleural empyema admitted at the "Comandante Manuel Fajardo" Clinical and Surgical Teaching Hospital from January, 1995, to December, 1997, was conducted. The acute form was observed in 3 patients and the chronic form in 10. The inflammatory neumopathy was the most frequent cause. Most of the patients were treated with combinations of lactam and amynoglycoside antibiotics, complemented with surgical therapeutics. In the acute form pleural lavage proved to be useful, whereas in the chronic form the most used procedure was decortication, followed by thoracic window and pulmonary resection. Only one patient died with advanced lung cancer

Use of an Amplatzer Device for Endoscopic Closure of a Large Bronchopleural Fistula following Lobectomy for a Stage I Squamous Cell Carcinoma

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A. Ottevaere

2013-11-01

Full Text Available Bronchopleural fistulas can occur as a rare but severe complication after pulmonary resection. Established guidelines for the proper treatment of patients with bronchopleural fistulas do not exist. Apart from attempts to close the fistula, emphasis is placed on preventive measures, early treatment with antibiotics, drainage of the empyema and aggressive nutritional and rehabilitative support. For inoperable patients, endoscopic procedures are the only therapeutic option. Unfortunately, large (>8 mm or central bronchopleural fistulas are usually not suitable for such endoscopic management. Recently, some groups have published a few case reports about a novel technique for the endobronchial closure of bronchopleural fistulas, using an Amplatzer device, originally designed for transcatheter closure of cardiac septal defects. We applied the same technique as a life-saving treatment in a ventilated patient who was considered inoperable due to a high oxygen need. The operation was successful. The patient could be weaned from ventilation and was eventually discharged from the hospital to a rehabilitation facility several weeks after the insertion of the device. Until now, endoscopic techniques have only been useful for the treatment of small, peripheral, bronchopleural fistulas and even then only as a bridge to surgery in high-risk surgical patients. In this case report, we demonstrate that the use of an Amplatzer device can expand the importance of endoscopic techniques in the treatment of bronchopleural fistulas. An Amplatzer device, for endobronchial closure, can indeed be administered for large and central bronchopleural fistulas. Moreover, it can be considered as a definite alternative to surgery in inoperable patients.

Classificação ultra-sonográfica do derrame pleural e do empiema parapneumônico Ultrasound classification of pleural effusion and parapneumonic empyema

OpenAIRE

Luís Marcelo Inaco Cirino; Miguel José Francisco Neto; Erasmo Magalhães Castro de Tolosa

2002-01-01

Os autores correlacionam as alterações anatomopatológicas da cavidade pleural com os achados ultra-sonográficos no derrame pleural e no empiema parapneumônico e apresentam uma classificação baseada nestes dados. Concluem que a ultra-sonografia é método diagnóstico fidedigno para inferir a fase anatomopatológica da doença pleural, bem como auxiliar na escolha da alternativa de tratamento.We correlated the anatomopathological abnormalities of the pleural space with the ultrasound findings in pa...

Video-thoracoscopic enucleation of esophageal leiomyoma

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Luh Shi-Ping

2012-03-01

Full Text Available Abstract Background Leiomyoma is the most common benign tumor of the esophagus. Surgical enucleation is indicated in case of symptoms or an unclear diagnosis, and open thoracotomy has long been the standard approach for this procedure. However, enucleation through video assisted thoracoscopic surgery (VATS has been developed as a preferred approach for most lesions in recent years. Method Herein we report our twelve patients (seven men and five women, with median age of 42 years from 2001 to 2009, who underwent enucleation through VATS for esophageal leiomyomas, with a size from 1 to 8 cm in diameter (median: 5, and at different locations, from the thoracic outlet to near the diaphragmatic level of the thoracic esophagus. Intraoperative fiberoptic esophagoscopy was performed in two patients for localization by illumination. A right-sided approach was performed in eight cases (upper two thirds of esophagus and the left-sided in another four cases (lower third of esophagus. Result The median operative time was 95 minutes (70 to 230 minutes. Four of them required small utility incisions (4-6 cm for better exploration and manipulation. There were no major complications, such as death or empyema due to leaks from mucosal tears, and the presenting symptoms were improved during the follow-up period, from 12 to 98 months. Conclusion VATS can be considered as an initial approach for most patients with esophageal leiomyomas, even large in size, irregular in shape, or at unfavorable location. It is a safe, minimally invasive, and effective treatment. However, conversion to open thoracotomy should be required for the sake of clinical or technical concern.

Sequential antimicrobial treatment with linezolid for neurosurgical infections: efficacy, safety and cost study.

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Martín-Gandul, Cecilia; Mayorga-Buiza, M J; Castillo-Ojeda, E; Gómez-Gómez, M J; Rivero-Garvía, M; Gil-Navarro, M V; Márquez-Rivas, F J; Jiménez-Mejías, M E

2016-10-01

Evidence for the effectiveness of linezolid in neurosurgical infections (NSIs) is growing. The comfortable oral dosage and tolerance of linezolid opens the possibility for sequential antimicrobial treatment (SAT) in stable patients after a period of intravenous treatment. To evaluate the efficacy and safety of SAT with oral linezolid in patients with NSI and to analyse the cost implications, an observational, non-comparative, prospective cohort study was conducted on clinically stable consecutive adult patients at the Neurosurgical Service. Following intravenous treatment, patients were discharged with SAT with oral linezolid. A total of 77 patients were included. The most common NSIs were: 41 surgical wound infections, 20 subdural empyemas, 18 epidural abscesses, and 16 brain abscesses. Forty-four percent of patients presented two or more concomitant NSIs. Aetiological agents commonly isolated were: Propionibacterium acnes (36 %), Staphylococcus aureus (23 %), Staphylococcus epidermidis (21 %) and Streptococcus spp. (13 %). The median duration of the SAT was 15 days (range, 3-42). The SAT was interrupted in five cases due to adverse events. The remainder of the patients were cured at the end of the SAT. A total of 1,163 days of hospitalisation were saved. An overall cost reduction of €516,188 was attributed to the SAT. Eight patients with device infections did not require removal of the device, with an additional cost reduction of €190,595. The mean cost saving per patient was €9,179. SAT with linezolid was safe and effective for the treatment of NSI. SAT reduces hospitalisation times, which means significant savings of health and economic resources.

Clinical presentation and characteristics of 25 adult cases of pulmonary sequestration.

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Polaczek, Mateusz; Baranska, Inga; Szolkowska, Malgorzata; Zych, Jacek; Rudzinski, Piotr; Szopinski, Janusz; Orlowski, Tadeusz; Roszkowski-Sliz, Kazimierz

2017-03-01

Pulmonary sequestration (PS) is a rare congenital abnormality of lung tissue. Only few series of adult cases are reported. The aim was to describe clinical characteristics in adult cases of PS and to compare outcomes in different clinical situations. Using MSD engine we searched for cases of PS that have been diagnosed between Jan 1st, 2005 and Dec 31st, 2015. Clinical data was retrospectively gathered. Statistica v.12 (StatSoft, Inc.) was used for statistical analyses. We found 25 cases (18 females, 7 males), which underwent surgery and were histologically proven. There were 22 cases of intralobar PS. 7 cases were asymptomatic, 12 had infectious history (including 3 cases of lung abscess and pleural empyema), 4 presented with hemoptysis, 2 with chest pain. The average age to undergo surgery was 38.24, in the asymptomatic group 34, in symptomatic 39.89. In the latter the symptoms preceded the surgery for 2.45-year. Great majority of sequestrations was located in lower lobes (96%), 52% on the left. Symptomatic cases were at higher than expected risk of surgical complications, comparing to asymptomatic (chi 2 , P=0.04). In most cases there were surgical and histological signs of infection, only in 9 cases etiological factor was determined: in 5 cases it was A. fumigatus . A 0.53-day longer post-surgical hospital stay was observed in the symptomatic group, no statistical significance was found (U-test, P=0.45). Surgical treatment of symptomatic cases of PS is characterized by slightly longer post-surgical hospital stay and higher risk of surgical complications. Fungal infections are the most likely to occur in PS.

Complications of otitis media - a potentially lethal problem still present

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Norma de Oliveira Penido

Full Text Available ABSTRACT INTRODUCTION: It is an erroneous but commonly held belief that intracranial complications (ICCs of chronic and acute otitis media (COM and AOM are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care. OBJECTIVE: This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM. METHODS: Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period. RESULTS: 80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention. CONCLUSION: ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.

A low morbidity surgical approach to the sheep femoral trochlea

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Orth Patrick

2013-01-01

Full Text Available Abstract Background The ovine stifle joint is an important location for investigations on the repair of articular cartilage defects in preclinical large animals. The classical medial parapatellar approach to the femoral trochlea is hazardous because of the high risk of postoperative patellar luxation. Here, we describe a low morbidity surgical exposure of the ovine trochlea without the necessity for intraoperative patellar luxation. Methods Bilateral surgical exposure of the femoral trochlea of the sheep stifle joint was performed using the classical medial parapatellar approach with intraoperative lateral patellar luxation and transection of the medial patellar retinaculum in 28 ovine stifle joints. A low morbidity approach was performed bilaterally in 116 joints through a mini-arthrotomy without the need to transect the medial patellar retinaculum or the oblique medial vastus muscle nor surgical patellar luxation. Postoperatively, all 72 animals were monitored to exclude patellar luxations and deep wound infections. Results The novel approach could be performed easily in all joints and safely exposed the distal two-thirds of the medial and lateral trochlear facet. No postoperative patellar luxations were observed compared to a postoperative patellar luxation rate of 25% experienced with the classical medial parapatellar approach and a re-luxation rate of 80% following revision surgery. No signs of lameness, wound infections, or empyema were observed for both approaches. Conclusions The mini-arthrotomy presented here yields good exposure of the distal ovine femoral trochlea with a lower postoperative morbidity than the classical medial parapatellar approach. It is therefore suitable to create articular cartilage defects on the femoral trochlea without the risk of postoperative patellar luxation.

The role of external drains and peritoneal conduits in the treatment of recurrent chronic subdural hematoma.

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Santarius, Thomas; Qureshi, Hammad U; Sivakumaran, Ram; Kirkpatrick, Peter J; Kirollos, Ramez W; Hutchinson, Peter J

2010-06-01

A considerable body of evidence supporting the use of external drainage after evacuation of primary chronic subdural hematoma (CSDH) exists in the literature. However, no systematic study of the value of postoperative drainage in the treatment of recurrent CSDH has been published. The aim of the study was to investigate external drains and subdural-to-peritoneal conduit in the treatment of recurrent CSDH. A retrospective review of cases of CSDH treated in our institution between October 2002 and October 2006 was conducted. During the study period, 408 patients had burr hole evacuation. Sixty-four patients (15.9%) had treatment for recurrence. One patient had craniotomy, and the remaining 63 had another burr hole evacuation: 36 without placement of a drain (BHO), 14 with external drainage (SED), and 13 with placement of subdural-peritoneal catheter (SPC). Fifteen patients (24%) developed a secondary recurrence requiring a third drainage procedure. Postoperative drainage (SED or SPC) was associated with a significantly lower secondary recurrence rate when compared to BHO: 3/27 (11%) versus 12/36 (33%) (χ(2), P=.040). There was no significant difference in recurrence rates between SED and SPC. Postoperative complications included acute subdural hematoma (2), subdural empyema (2), brain edema (2), pneumonia (3), and in-hospital death (2). None of the complications was associated with the use of a specific technique. The results indicate that, as in the treatment of primary CSDHs, the use of drain (SED or SPC) with burr hole evacuation is safe and is associated with lower recurrence rate. Further investigation is needed to clarify the indications of currently available surgical techniques in the treatment of recurrent CSDH. Copyright © 2010 Elsevier Inc. All rights reserved.

[Synchronous acute cholecystolithiasis and perforated acute appendicitis. Case report].

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Padrón-Arredondo, Guillermo; de Atocha Rosado-Montero, Manuel

2016-01-01

Acute appendicitis and acute cholecystitis are among the most common diagnoses that general surgeons operate on. However, it is rarely described in its synchronous form. A 43 year-old woman attending the clinic for right upper quadrant pain of 11 days duration. The patient refers to intermittent radiating pain in the right side, with positive Murphy, tachycardia, and fever. The laboratory results showed white cells 16,200/mm(3), glucose 345 mg/dl, abnormal liver function tests. Acute cholecystitis was reported with ultrasound. A Masson-type incision was made, noting an enlarged pyogenic gallbladder with thickened walls, sub-hepatic abscess of approximately 300 ml, greenish-yellow colour, and foetid. An anterograde subtotal cholecystectomy is performed due to difficulty in identifying elements of Calot triangle due to the inflammatory process, opening it and extracting stones. The right iliac fossa is reviewed, finding a plastron and a sub-serous retrocaecal appendix perforated in its middle third with free fecalith and an abscess in the pelvic cavity. An anterograde appendectomy was performed and the patient progressed satisfactorily, later being discharged due to improvement. In this patient, with a history of recurrent episodes of gallbladder pain and disseminated acute abdominal pain without peritoneal irritation, clinical suspicion was exacerbated cholecystitis with probable empyema of the gallbladder. Open surgery approach for this patient allowed access to both the appendix and gallbladder in order to perform a complete exploration of the abdominal cavity. The synchronous presentation of cholecystolithiasis and complicated appendicitis has not been reported in the literature. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Severe Infections are Common in Thiamine Deficiency and May be Related to Cognitive Outcomes: A Cohort Study of 68 Patients With Wernicke-Korsakoff Syndrome.

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Wijnia, Jan W; Oudman, Erik; van Gool, Willem A; Wierdsma, André I; Bresser, Esmay L; Bakker, Jan; van de Wiel, Albert; Mulder, Cornelis L

Wernicke encephalopathy can have different clinical outcomes. Although infections may precipitate the encephalopathy itself, it is unknown whether infections also modify the long-term outcome in patients developing Korsakoff syndrome. To determine whether markers of infection, such as white blood cell (WBC) counts and absolute neutrophil counts in the Wernicke phase, are associated with cognitive outcomes in the end-stage Korsakoff syndrome. Retrospective, descriptive study of patients admitted to Slingedael Korsakoff Center, Rotterdam, The Netherlands. Hospital discharge letters of patients with Wernicke encephalopathy were searched for relevant data on infections present upon hospital admission. Patients were selected for further analysis if data were available on WBC counts in the Wernicke phase and at least 1 of 6 predefined neuropsychological tests on follow-up. Infections were reported in 35 of 68 patients during the acute phase of Wernicke-Korsakoff syndrome-meningitis (1), pneumonia (14), urinary tract infections (9), acute abdominal infections (4), sepsis (5) empyema, (1) and infection "of unknown origin" (4). The neuropsychological test results showed significant lower scores on the Cambridge Cognitive Examination nonmemory section with increasing white blood cell counts (Spearman rank correlation, ρ = -0.34; 95% CI: -0.57 to -0.06; 44 patients) and on the "key search test" of the behavioral assessment of the dysexecutive syndrome with increasing absolute neutrophil counts (ρ= -0.85; 95% CI: -0.97 to -0.42; 9 patients). Infections may be the presenting manifestation of thiamine deficiency. Patients with Wernicke-Korsakoff syndrome who suffered from an infection during the acute phase are at risk of worse neuropsychological outcomes on follow-up. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Intracranial suppuration: Review of an 8-year experience at Umtata General Hospital and Nelson Mandela Academic Hospital, Eastern Cape, South Africa.

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Anwary, M A

2015-09-21

Intracranial suppuration (ICS) is a life-threatening condition caused by various disease processes and consisting of brain abscess and extradural and subdural empyema. The major causes have changed over the decades. To the author's knowledge, the incidence of ICS in South Africa (SA) has not been established. To determine the incidence of ICS, overall and according to age and gender, and to identify the source and distribution of ICS. The archive of the radiology departments at Umtata General Hospital and Nelson Mandela Academic Hospital in the Transkei region, Eastern Cape Province, SA, was searched retrospectively for computed tomography (CT) reports of patients diagnosed with ICS. Cases in which the CT images, patients' clinical information and CT reports were available for an uninterrupted period of at least 1 year were included. Five time frames were established, encompassing 8 years of data. The first time frame established an incidence of ICS of 1/100,000/year for the Transkei region. All the time frames were utilised to determine the incidence according to gender and age, and the source and distribution of ICS. The incidence of ICS was higher among males than females, and highest in the age groups 0-10 and 11-20 years. A seasonal variation in the incidence of sinusitis- and meningitis-related ICS was noted. Numbers of cases declined during the last 3 years of the study period. Sinusitis, head trauma, ear infection and meningitis were the major sources of ICS. A pulmonary source was not a major feature. In the last 4 years, trauma became the commonest source of ICS. A steady decline in ear infection- and meningitis-related ICS was noted.

Toxicity of inhaled 91YCl3 in beagle dogs. XI

International Nuclear Information System (INIS)

Muggenburg, B.A.; Rebar, A.H.; Benjamin, S.A.; Boecker, B.B.; Jones, R.K.; McClellan, R.O.; Pickrell, J.A.

1977-01-01

Studies on the metabolism, dosimetry and effects of inhaled 91 YCl 3 in Beagle dogs are being continued to provide information that will aid in assessing the biological consequences of nuclear accidents in which 91 Y or other radionuclides that produce a similar radiation dose pattern may be released. Forty-two dogs with 91 Y initial body burdens from 64 to 1300 μCi/kg body weight were placed in four groups with mean lung burdens of 310, 180, 75 and 40 μCi/kg body weight. These dogs and 12 control dogs are being maintained for lifetime observation. An additional group of four dogs with a mean initial 91 Y body burden of 180 μCi/kg body weight were placed in a sacrifice study. Twenty-one of the exposed dogs have died and two of the control dogs have died. Eleven dogs within the highest activity level groups died or were euthanized at 12 to 33 days after inhalation of 91 Y with changes related to severe bone marrow damage and associated pancytopenia. Two dogs died approximately one year after 91 Y inhalation with convulsive seizures that were presumed to be unrelated to the 91 Y exposure. Seven 91 Y-exposed dogs died or were euthanized due to neoplasms 2000 to 3341 days after exposure. Three dogs had nasal squamous cell carcinomas, one had a bronchioloalveolar carcinoma, one, a mast cell sarcoma, one a mammary adenocarcinoma and one with a malignant lymphoma. One dog died of renal failure 2660 days after exposure, one control dog died of empyema and another control dog died with a mammary adenocarcinoma. Serial observations are continuing on all surviving dogs

Vacuum-assisted closure device: a useful tool in the management of severe intrathoracic infections.

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Saadi, Alend; Perentes, Jean Yannis; Gonzalez, Michel; Tempia, Adrien Caliera; Wang, Yabo; Demartines, Nicolas; Ris, Hans-Beat; Krueger, Thorsten

2011-05-01

This study is an evaluation of the vacuum-assisted closure (VAC) therapy for the treatment of severe intrathoracic infections complicating lung resection, esophageal surgery, viscera perforation, or necrotizing pleuropulmonary infections. We reviewed the medical records of all patients treated by intrathoracic VAC therapy between January 2005 and December 2008. All patients underwent surgical debridement-decortication and control of the underlying cause of infection such as treatment of bronchus stump insufficiency, resection of necrotic lung, or closure of esophageal or intestinal leaks. Surgery was followed by intrathoracic VAC therapy until the infection was controlled. The VAC dressings were changed under general anesthesia and the chest wall was temporarily closed after each dressing change. All patients received systemic antibiotic therapy. Twenty-seven patients (15 male, median age 64 years) underwent intrathoracic VAC dressings for the management of postresectional empyema (n=8) with and without bronchopleural fistula, necrotizing infections (n=7), and intrathoracic gastrointestinal leaks (n=12). The median length of VAC therapy was 22 days (range 5 to 66) and the median number of VAC changes per patient was 6 (range 2 to 16). In-hospital mortality was 19% (n=5) and was not related to VAC therapy or intrathoracic infection. Control of intrathoracic infection and closure of the chest cavity was achieved in all surviving patients. Vacuum-assisted closure therapy is an efficient and safe adjunct to treat severe intrathoracic infections and may be a good alternative to the open window thoracostomy in selected patients. Long time intervals in between VAC changes and short course of therapy result in good patient acceptance. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Management of Pleural Space After Lung Resection by Cryoneuroablation of Phrenic Nerve: A Randomized Study.

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Pan, Xiao-Jie; Ou, De-Bin; Lin, Xing; Ye, Ming-Fang

2017-06-01

Residual air space problems after pulmonary lobectomy are an important concern in thoracic surgical practice, and various procedures have been applied to manage them. This study describes a novel technique using controllable paralysis of the diaphragm by localized freezing of the phrenic nerve, and assesses the effectiveness of this procedure to reduce air space after pulmonary lobectomy. In this prospective randomized study, 207 patients who underwent lobectomy or bilobectomy and systematic mediastinal node dissection in our department between January 2009 and November 2013 were randomly allocated to a cryoneuroablation group or a conventional group. Patients in the cryoneuroablation group (n = 104) received phrenic nerve cryoneuroablation after lung procedures, and patients in the conventional group (n = 103) did not receive cryoneuroablation after the procedure. Data regarding preoperative clinical and surgical characteristics in both groups were collected. Both groups were compared with regard to postoperative parameters such as total amount of pleural drainage, duration of chest tube placement, length of hospital stay, requirement for repeat chest drain insertion, prolonged air leak, and residual space. Perioperative lung function was also compared in both groups. Recovery of diaphragmatic movement in the cryoneuroablation group was checked by fluoroscopy on the 15th, 30th, and 60th day after surgery. There was no statistically significant difference in patient characteristics between the 2 groups; nor was there a difference in terms of hospital stay, new drain requirement, and incidence of empyema. In comparison with the conventional group, the cryoneuroablation group had less total drainage (1024 ± 562 vs 1520 ± 631 mL, P phrenic nerve offers a reasonable option for prevention of residual air space following major pulmonary resection.

Pleural effusion: diagnosis, treatment, and management

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Karkhanis, Vinaya S; Joshi, Jyotsna M

2012-01-01

A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions. Laboratory testing helps to distinguish pleural fluid transudate from an exudate. The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process. Immunohistochemistry provides increased diagnostic accuracy. Transudative effusions are usually managed by treating the underlying medical disorder. However, a large, refractory pleural effusion, whether a transudate or exudate, must be drained to provide symptomatic relief. Management of exudative effusion depends on the underlying etiology of the effusion. Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence. Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease. Percutaneous closed pleural biopsy is easiest to perform, the least expensive, with minimal complications, and should be used routinely. Empyemas need to be treated with appropriate antibiotics and intercostal drainage. Surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of bronchopleural fistula. PMID:27147861

Abscesso pulmonar de aspiração: análise de 252 casos consecutivos estudados de 1968 a 2004 Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004

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José da Silva Moreira

2006-04-01

and therapeutic results of 252 consecutive cases of lung abscess seen in patients hospitalized between 1968 and 2004. RESULTS: Of the 252 patients, 209 were male, and 43 were female. The mean age was 41.4 years, and 70.2% were alcoholic. Cough, expectoration, fever and overall poor health were seen over 97% of patients. Chest pain was reported by 64%, 30.2% presented digital clubbing, 82.5% had dental disease, 78.6% reported having lost consciousness at least once, and 67.5% presented foul smelling sputum. In 85.3% of the patients, the lung lesions were located either in the posterior segments of the upper lobe or in the superior segments of the lower lobe, and 96.8% were unilateral. Concomitant pleural empyema was seen in 24 (9.5% of the patients. Mixed flora was identified in the bronchopulmonary or pleural secretions of 182 patients (72.2%. All patients were initially treated with antibiotics (mainly penicillin or clindamycin, and postural drainage was performed in 98.4% of cases. Surgical procedures were performed in 52 (20.6% of the patients (drainage of empyema in 24, pulmonary resection in 22 and drainage of the abscess in 6. Cure was obtained in 242 patients (96.0%, and 10 (4.0% died. CONCLUSION: Lung abscess occurred predominantly in male adults presenting dental disease and having a history of loss of consciousness (especially as a result of alcohol abuse. Most of the patients were treated clinically with antibiotics and postural drainage, although some surgical procedure was required in one-fifth of the study sample.

A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis

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Sehitogullari Abidin

2011-12-01

Full Text Available Abstract Background Although the prevalence of bronchiectasis decreased significantly in developed countries, in less developed and in developing countries, it still represents a significant cause of morbidity and mortality. The aim of this retrospective study is to present our surgical experiences, the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis. Methods We reviewed the medical records of 129 patients who underwent surgical resection for bronchiectasis between April 2002 and April 2010, at Van Training and Research Hospital, Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and surgical procedures, mortality, morbidity and the result of surgical therapy were analyzed retrospectively. Results Mean age was 21.8 year (the eldest was 67 year, the youngest was 4 years-old. Male/female ratio was 1.86 and 75% of all patients were young population under the age of 40. Bilateral involvement was 14.7%, left/right side ratio according to localization was 2.1/1. The most common reason for bronchiectasis was recurrent infection. Surgical indications were as follows: recurrent infection (54%, hemoptysis (35%, empyema (6%, and lung abscess (5%. There was no operative mortality. Complications occurred in 29 patients and the morbidity rate was 22.4%. Complete resection was achieved in 110 (85.2% patients. Follow-up data were obtained for 123 (95% of the patients. One patient died during follow-up. The mean follow-up of this patient was 9 months. Mean postoperative hospitalization time was 9.15 ± 6.25 days. Significantly better results were obtained in patients who had undergone a complete resection. Conclusions Surgical treatment of bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.

[Pulmonary infections in patients with rheumatoid arthritis].

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Takayanagi, Noboru; Tsuchiya, Yutaka; Tokunaga, Daidou; Miyahara, Yousuke; Yamaguchi, Shouzaburo; Saito, Hiroo; Ubukata, Mikio; Kurashima, Kazuyoshi; Yanagisawa, Tsutomu; Sugita, Yutaka

2007-06-01

We studied 149 rheumatoid arthritis (RA) patients (mean age 68.0 years; 68 men, 81 women) with pulmonary infections. The mean age at the onset of RA and the duration of RA was 57.2 +/- 15.2 years and 10.9 +/- 11.5 years, respectively. Pulmonary infections included nontuberculous mycobacteriosis in 59 patients (Mycobacterium avium complex infection, 50 cases : Mycobacterium kansasii infection, 4 cases; others, 5 cases), pneumonia in 46 patients, pulmonary tuberculosis in 28 patients, pulmonary aspergillosis in 12 patients, pulmonary cryptococcosis in 5 patients, Pneumocystis jiroveci pneumonia in 5 patients, lung abscess in 9 patients, exacerbation of bronchiectasis in 7 patients, and empyema in 4 patients. One hundred percent of patients with exacerbation of bronchiectasis, 91.7% of patients with pulmonary aspergillosis, 87% of patients with pneumonia, and 81.4% of patients with nontuberculous mycobacteriosis had underlying lung diseases. The pulmonary infections during therapy with steroids were pulmonary tuberculosis (78.6%), pneumonia (65.2%), and pulmonary aspergillosis (58.3%), while the pulmonary infections during methotrexate treatment were Pneumocystis jiroveci pneumonia (80%), pulmonary cryptococcosis (40%), and pulmonary tuberculosis (28.6%). Pulmonary infections in RA patients who were taking TNFalpha inhibitors included 1 patient each with nontuberculous mycobacteriosis, pneumonia, pulmonary tuberculosis, and Pneumocystis jiroveci pneumonia. Among the RA patients with lung abscess, malignancy was noted in 55.6%, and diabetes mellitus in 22.2%. Pseudomonas aeruginosa was the second-most-common cause of pneumonia and cause of all exacerbations of bronchiectasis. As well as immunosuppressive medications (steroids, methotrexate, TNFalpha inhibitors) and systemic comorbid diseases, underlying lung diseases could be one of the risk factor for pulmonary infections in patients with RA. The dominant risk factor for each pulmonary infection in patients with RA

Demography, types, outcome and relationship of surgically treated intracranial suppuration complicating chronic suppurative otitis media and bacterial rhinosinusitis

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Olufemi Emmanuel Idowu

2014-01-01

Full Text Available Introduction: Surgically treated intracranial suppurations (ICS are uncommon, life-threatening neurosurgical emergencies. They can result from complication of chronic suppurative otitis media (CSOM and bacterial rhinosinusitis (BRS. The objective of this study was to know the frequency of BRS and CSOM and relate it to its rare complication of surgically treated ICS while also describing the demography, type and outcome of ICS that resulted from BRS and CSOM. Materials and Methods: All patients that presented to the Otorhinolaryngological department and Neurosurgical unit of the same institution with clinical and radiological features of CSOM, BRS, and ICS were prospectively studied over a 5-year period. Patients were followed up for a minimum of 3 months. Results: Two thousand, two hundred and seventy-nine patients presented during the 5-year study period. Of all these patients, 1511 had CSOM (66.3% and 768 (33.7% presented with features of BRS. Eleven (0.73% had ICS complicating their CSOM while 8 (1.04% cases of surgically treated ICS followed BRS. Bacterial rhinosinusitis was not more likely to lead to ICS (P = 0.4348. The Odds ratio (OR of a child ≤ 18 years of age with CSOM developing ICS was 5.24 (95% Confidence interval 1.13-24.34; P = 0.0345, while it was 7.60 (95% Confidence interval 1.52-37.97; P = 0.0134 for children with BRS. Conclusions: The most common type of ICS complicating CSOM and BRS was brain abscess and subdural empyema, respectively. Children are more prone to develop surgical ICS following CSOM and BRS. The proportion of males that had ICS was higher in both CSOM and BRS patients. Optimal outcome is achieved in patients that presented with GCS of 13 and above.

Clinical management of Brucella suis infection in dogs and implications for public health.

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James, D R; Golovsky, G; Thornton, J M; Goodchild, L; Havlicek, M; Martin, P; Krockenberger, M B; Marriott, Dje; Ahuja, V; Malik, R; Mor, S M

2017-01-01

Brucellosis caused by Brucella suis is a notifiable disease that has recently emerged in dogs in New South Wales (NSW). Given the potential for zoonotic transmission, euthanasia of affected dogs is recommended, but this action is not mandatory. We report the clinical management of three dogs that underwent treatment at their owners' request. A 14-month-old spayed female crossbreed originally obtained from an urban animal shelter underwent extensive investigations in 2011-12 for lameness and back pain, culminating in decompressive laminectomy. Diagnosis of multifocal discospondylitis and spinal empyema was made, with B. suis cultured from surgical biopsy specimens. The dog responded to long-term treatment using rifampicin and doxycycline. A second case of B. suis infection was diagnosed in January 2016 in a 3-year-old crossbreed pig-hunting dog with unilateral testicular enlargement. Following serological diagnosis the dog was given preliminary therapy using rifampicin and doxycycline, the affected testis was resected and the patient given a further month of combination therapy. In March 2016 a 7-year-old crossbreed pig-hunting dog with brucellosis was handled similarly, although both testes were removed. Brucellosis should be considered in the differential diagnosis of back pain, discospondylitis, lameness, abortion, prostatic abscessation and testicular/epididymal enlargement in dogs, especially if there is exposure to feral pigs or consumption of uncooked feral pig meat. Euthanasia is the only guarantee of reducing the public health risk to zero. However, where treatment is desired by the owner, combination therapy using rifampicin and doxycycline appears to be effective, when combined with surgical resection of infected tissues. Further monitoring of dogs during and after treatment is required to document cure. © 2017 Australian Veterinary Association.

Restricted Diffusion of Pus in the Subarachnoid Space: MRSA Meningo-Vasculitis and Progressive Brainstem Ischemic Strokes – A Case Report

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David Z. Rose

2010-08-01

Full Text Available Extra-axial restriction on diffusion weighted imaging (DWI is an unusual finding on brain magnetic resonance imaging (MRI. Intra-axial restriction on DWI, however, is common, and can represent brain parenchymal infarction, tumor, abscess, or toxic-metabolic process. The infrequency of extra-axial DWI restriction and the paucity of clinico-pathological correlation in the literature limit its differential diagnosis. Scant case reports suggest that extra-axial DWI restriction could be a lymphoma, neurenteric cyst, or, in one patient, subdural empyema [1–3]. We postulate that pus formation must be excluded first, because it can provoke an aggressive meningo-vasculitis with rapidly fatal, intra-axial infarctions. Our patient was a 45-year-old man, presenting to our hospital with left facial droop and right (contralateral arm and leg weakness. Initial MRI revealed DWI restriction in the left lateral pons, consistent with a classic Millard-Gubler stroke. Also noted was a subtle, extra-axial area of curvilinear diffusion restriction in the left cerebellar-pontine angle’s subarachnoid space. Days later, the patient had a headache, and repeat MRI revealed extension of the two DWI lesions – both the intra-axial pontine infarction and the extra-axial area of restricted diffusion in the subarachnoid space. The patient became comatose, a third MRI revealed more extensive DWI restrictions, and he expired despite aggressive care. Autopsy revealed massive brainstem infarcts, a thick lymphoplasmacytic infiltrate, copious Gram-Positive cocci (likely MRSA and arteries partially occluded with fibrointimal proliferation. This emphasizes the concept that extra-axial DWI restriction can represent pus development in the subarachnoid space – a radiographic marker to identify a patient at risk for demise due to septic, meningo-vasculitic infarctions.

Ward-based, nurse-led, outpatient chest tube management: analysis of impact, cost-effectiveness and patient safety.

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Tcherveniakov, Peter; De Siqueira, Jonathan; Milton, Richard; Papagiannopoulos, Kostas

2012-06-01

Prolonged drainage and air leaks are recognized complications of elective and acute thoracic surgery and carry significant burden on inpatient stay and outpatient resources. Since 2007, we have run a ward-based, nurse-led clinic for patients discharged with a chest drain in situ. The aim of this study is to assess its cost-effectiveness and safety. We present a retrospective review of the activity of the clinic for a period of 12 months (November 2009-10). An analysis of the gathered data is performed, focusing specifically on the duration of chest tube indwelling, the indications, complications and cost efficiency. The nurse-led clinic was housed in the thoracic ward with no additional fixed costs. Seventy-four patients were reviewed (53 males, 21 females, mean age of 59) and subsequently discharged from the clinic in this time period, accounting for 149 care episodes. Thirty-three (45%) of the patients underwent a video-assisted thoracoscopic surgery procedure, 35 (47%) of them a thoracotomy and 7 (9%) had a bedside chest tube insertion. Following hospital discharge, the chest tubes were removed after a median of 14 days (range 1-82 days). Fifty-eight percent of the patients were reviewed because of a prolonged air leak, 26% for persistent fluid drainage and 16% due to prolonged drainage following evacuation of empyemas. For the care episodes analysed, we estimate that the clinic has generated an income of €24,899 for the department. Hourly staffing costs for the service are significantly lower compared with those of the traditional outpatient clinic: €15 vs. €114. Our results show that a dedicated chest tube monitoring clinic is a safe and efficient alternative to formal outpatient clinic review. It can lead to shorter hospital stays and is cost effective.

Bacteriophages show promise as antimicrobial agents.

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Alisky, J; Iczkowski, K; Rapoport, A; Troitsky, N

1998-01-01

The emergence of antibiotic-resistant bacteria has prompted interest in alternatives to conventional drugs. One possible option is to use bacteriophages (phage) as antimicrobial agents. We have conducted a literature review of all Medline citations from 1966-1996 that dealt with the therapeutic use of phage. There were 27 papers from Poland, the Soviet Union, Britain and the U.S.A. The Polish and Soviets administered phage orally, topically or systemically to treat a wide variety of antibiotic-resistant pathogens in both adults and children. Infections included suppurative wound infections, gastroenteritis, sepsis, osteomyelitis, dermatitis, empyemas and pneumonia; pathogens included Staphylococcus, Streptococcus, Klebsiella, Escherichia, Proteus, Pseudomonas, Shigella and Salmonella spp. Overall, the Polish and Soviets reported success rates of 80-95% for phage therapy, with rare, reversible gastrointestinal or allergic side effects. However, efficacy of phage was determined almost exclusively by qualitative clinical assessment of patients, and details of dosages and clinical criteria were very sketchy. There were also six British reports describing controlled trials of phage in animal models (mice, guinea pigs and livestock), measuring survival rates and other objective criteria. All of the British studies raised phage against specific pathogens then used to create experimental infections. Demonstrable efficacy against Escherichia, Acinetobacter, Pseudomonas and Staphylococcus spp. was noted in these model systems. Two U.S. papers dealt with improving the bioavailability of phage. Phage is sequestered in the spleen and removed from circulation. This can be overcome by serial passage of phage through mice to isolate mutants that resist sequestration. In conclusion, bacteriophages may show promise for treating antibiotic resistant pathogens. To facilitate further progress, directions for future research are discussed and a directory of authors from the reviewed

Neonatal pleural effusions in a Level III Neonatal Intensive Care Unit

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Mariana Barbosa

2015-04-01

Full Text Available Pleural effusions are rare in the newborn. Still, being familiar with this condition is relevant given its association with a wide range of disorders. Only two large series of cases on this matter have been published, with no solid conclusions established. The aim of this study is to determine the etiology, management and prognosis of pleural effusions in a population of high-risk neonates.The authors performed a retrospective study in the Neonatal Intensive Care Unit of "Hospital de São João", Porto (Portugal, between 1997 and 2014, of all newborns with the diagnosis of pleural effusion, chylothorax, hemothorax, empyema, fetal hydrops or leakage of total parenteral nutrition (TPN.Eighty-two newborns were included, 48 males and 34 females. Pleural effusions were congenital in 19 (23.2% newborns and acquired in 63 (76.8%. Fetal hydrops was the most frequent cause (15 cases, 78.9% of congenital effusions while postoperative after intrathoracic surgery was the most common cause (39 cases, 61.9% of acquired effusions, followed by leakage of TPN (13 cases, 20.6%. Chylothorax was the most common type of effusion (41.5% of cases. Pleural effusions after intrathoracic surgery were mainly (64.1% chylothoraces. Regarding use of octreotide for treatment of acquired chylous effusions, the comparative analysis showed no statistical differences between the group of alive newborns who received octreotide and the group who did not. Twenty-seven (32.9% newborns died; the causes of death were related to underlying diseases and not to the pleural effusion. Clinical outcome is generally good, except in hydropic neonates. Blood albumin level appears to be predictive of prognosis and further investigation on its clinical significance should be encouraged.

The role of diagnostic VATS in penetrating thoracic injuries

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Guasti Guido

2006-10-01

Full Text Available Abstract Background Penetrating chest injuries account for 1–13% of thoracic trauma hospital admissions and most of these are managed with a conservative approach. Nevertheless, 18–30% of cases managed only with tube thoracostomy have residual clotted blood, considered the major risk factor for the development of fibrothorax and empyema. In addition, 4–23% of chest injury patients present persistent pneumothorax and 15–59% present an injury to the diaphragm, which is missed in 30% of cases. In order to make a correct diagnosis, reduce the number of missed injuries, chronic sequelae and late mortality we propose performing surgical exploration of all patients with a penetrating injury of the pleural cavity. Methods 1270 patients who sustained thoracic trauma were admitted to our hospital between 1994 and 2004. Of these, 16 patients had penetrating injuries: thirteen were surgically explored by means of Video Assisted Thoracic Surgery (VATS, and 3 with thoracotomy due to hemodynamic instability or suspected lesion of the heart or great vessels. Results In the 13 patients who underwent VATS, 5 injuries to the diaphragm, 3 lesions to an intercostal artery, and 1 lesion to the diaphragmatic artery were detected. In 12 of these patients a laceration of the pulmonary parenchyma was also present. A conversion to thoracotomy was necessary due to a broad laceration of the diaphragm and due to hemostasis of an intercostal artery. In all but one case, which was later converted, diagnostic imaging missed the diagnosis of laceration of the diaphragm. There was no intra- or postoperative mortality, and average hospital stay was five days. Conclusion VATS is a safe and effective way to diagnose and manage penetrating thoracic injuries, and its extensive use leads to a reduction in the number of missed, potentially fatal lesions as well as in chronic sequelae.

Does intrapleural length and position of the intercostal drain affect the frequency of residual hemothorax? A prospective study from north India

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Sunil Kumar

2014-01-01

Full Text Available Context: Thoracic trauma causes significant morbidity; however, many deaths are preventable and few patients require surgery. Intercostal chest drainage (ICD for hemo/pneumothorax is simple and effective; the main problem is residual hemothorax, which can cause lung collapse and empyema. Aims: Our study aimed to analyze the relationship between radiological chest tube parameters (position and intrathoracic length and the frequency of residual hemothorax. Settings and Design: This prospective analytical study was conducted in a large tertiary care hospital in north India over 2 years till March 2013. Materials and Methods: Patients of chest trauma aged 18-60 years, with hemothorax or hemopneumothorax requiring ICD insertion were included in the study. Bedside ICD insertion was performed as per current standards. Immediate post-ICD chest radiographs were used to record lung status and ICD position (chest tube zone and intrapleural length. Residual hemothorax was defined as any collection identified on radiological investigations after 48 hours of ICD placement. Statistical Analysis: Univariate analysis was performed with the chi-square test or Student′s t-test as appropriate, while multivariate analysis using stepwise logistic regression; a P-value < 0.05 was significant. Results: Out of 170 patients of chest trauma, 154 underwent ICD insertion. Most patients were young (mean age: 31.7 ± 12 years males (M:F = 14:1. Ninety-seven patients (57.1% had isolated chest injuries. Blunt trauma (n = 119; 77.3% and motor vehicle accidents (n = 72; 46.7% were the commonest causes. Mean hospital stay was 9 ± 3.94 days, and mortality 2/154 (1.1%. Residual hemothorax was seen in 48 (31%. No ICD zone or length was significantly associated with residual hemothorax on univariate or multivariate analysis. Conclusion: Intrapleural ICD zone or length does not affect the frequency of residual hemothorax.

[Increase in the incidence of invasive pneumococcal disease caused by serotype 19A prior to the implementation of the expanded pneumococcal vaccines].

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González Martínez, F; Saavedra Lozano, J; Navarro Gómez, M L; Santos Sebastián, M M; Rodríguez Fernández, R; González Sánchez, M; Hernández-Sampelayo Matos, T

2013-11-01

To describe the epidemiology, clinical syndromes and microbiological characteristics of serotype 19A as the main cause of invasive pneumococcal disease (IPD) in children admitted to a tertiary hospital in Spain. A retrospective (1998-2004) and prospective (2005-2009) study was conducted on children with IPD produced by serotype 19A. The study was divided into three periods (P): P1 (1998-2001) when PCV7 had not been commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. A total of 155 isolates of Streptococcus pneumoniae (SP) producing IPD were analysed, with 21 of them being serotype 19A (14%). An increased prevalence of serotype 19A was found: 2/45 cases (4.4%) in P1, 3/41 cases (7.3%) in P2 and 16/69 cases (23.2%) in P3. It occurred mostly in children younger than 2 years (16/21; 76%). This serotype was the main cause of meningitis (5/20; 25%), pleural empyema (3/22; 14%) and bacteraemic mastoiditis (2/4; 50%). Thirteen isolates (61.5%) had an MIC ≥ 0.12μ/ml for penicillin in extra-meningeal infections, and 3 of the 5 isolates causing meningitis (60%) had an MIC ≥ 1μ/ml for cefotaxime. Serotype 19A was the main causal agent of IPD in the PCV7 era (P3), with high antibiotic resistance rates. This serotype was responsible for all types of IPD, being the main cause of meningitis. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Diagnostic difficulties resulting from morphological image variation in spondylodiscitis MR imaging

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Dziurzyńska-Białek, Ewa; Kruk-Bachonko, Joanna; Guz, Wiesław; Łosicki, Marek; Krupski, Witold

2012-01-01

Spinal infection (discitis; spondylodiscitis) presents a wide spectrum of pathologies. The method of choice for spondylodiscitis imaging is magnetic resonance (MR). It provides detailed anatomical information, especially concerning epidural space and spinal cord. The main aim of this article is the description and evaluation of spondylodiscitis morphological variation visible in magnetic resonance imaging. In this article we retrospectively analysed the patients diagnosed at the Department of Radiology of the Provincial Hospital No 2 in Rzeszów between October 2009 and October 2011. The subjects involved a group of five women aged 41–74 (mean 56.3 years) and eight men aged 46–69 (mean 61,3 years). All patients had spondylodiscitis symptoms. All patients underwent MRI examination before and after the contrast enhancement. In three patients additional CT examination was performed. Following the MRI procedure all patients were diagnosed with typical symptoms of spondylodiscitis. It also revealed a number of pathologies resulting from morphological spondylodiscitis variation. Other pathologies found on the MR images of the study group patients involved epidural intra-canal spinal pathological masses causing spinal cord compression, lung abscess, pyothorax, paravertebral abscesses and epidural empyemas, abscess between adjacent vertebral bodies, abscesses beneath anterior longitudinal ligament, and iliopsoas muscle abscesses. In all cases a destruction of vertebral bodies with end plates loss restriction and cortical layer discontinuity was observed. Moreover, one person was diagnosed with pathological vertebral body fractures and liquefactive necrosis of the vertebral body. Spondylodiscitis manifests itself in a great number of morphological variations visible on the radiological images. Apart from ordinary features of vertebral bodies and discs, progressive spinal destruction is observed together with reactive bone changes and soft tissue infiltration. The latter

Evolution of rhinology.

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Kaluskar, S K

2008-06-01

The study of the nose is as old as civilisation. Various conditions affecting its structure and function has been documented in Edwin Smith Papyrus in hieroglyphic script, an Egyptian writing system of the mid -4th Millennium BC.The major contribution for the complete reconstruction of the nose originated in India by Sushruta in around 600 BC. Writing in Sanskrit in the form of verses he described in detail the technique of total reconstruction, which is still being practiced today as Indian Rhinoplasty. This surgical reconstruction paved the way to modern plastic surgery in Europe and United States in 18th century. Sushruta contributed not only to the plastic surgery of the nose, but described entire philosophy of Head and Neck and other surgery as well. Other notable contributors were Greek physicians, Hippocrate and Galen, and at the birth of the Christianity, Celsus wrote eight books of medical encyclopaedia, which described various conditions affecting nose.Septal and Sinus surgery, in comparison to rhinoplasty did not develop until 17th century. Septal surgery began with total septectomy, sub mucous resection by Killian & Freer in early 20th century and later septoplasty by Cottle in middle of 20th century.Sinus surgery probably originated in Egypt, where instruments were used to remove brain through the ethmoid sinuses as part of the mummification process. In 18th century, empyema of the maxillary sinus was drained through the tooth socket or anterior wall of the sinus, which lead to the evolution of radical procedures of removal of mucous membrane and inferior meatal antrostomy. In the late 20th century, improved understanding of the mucociliary mechanism described by Prof. Messerklinger and Nasal Endoscopy described by Prof. Draf with the development of fibre optics and CT imaging, heralded a new era, which evolved in functional endoscopic sinus surgery. New technology further enhanced the scope of endoscope being used "around and beyond" the nose.

Update on pleural diseases - 2007

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Bishay Ayman

2007-01-01

Full Text Available Background : New information is available on pleural diseases. The authors selected articles to make recommendations on diagnostic and treatment aspects of pleural diseases. Materials and Methods: Eleven articles published in the English language between 2004 and 2007 were chosen. The basis of selection of the articles was the impact on daily practice, change in prior thinking of a disease process or specific treatment modality, as well as proper design and execution of the study. 5-amino-laevulinic acid with fluorescent light combined with white light may allow further diagnostic yield in undiagnosed pleural disease. FDG-PET may allow prognostication of patients with pleural tumors. Utilizing ultrasound by trained Emergency Department physicians is a rapid and effective technique to evaluate non-traumatic pleural effusions in symptomatic patients. Serum osteopontin levels may distinguish patients exposed to asbestos with benign disease from those with pleural mesothelioma. Administration of streptokinase in patients with empyema does not need for surgical drainage, length of hospital stay, or mortality as compared to conventional treatment with chest tube drainage and intravenous antibiotics. Silver nitrate may be an alternative agent to talc for producing pleurodesis. Routine use of graded talc (50% particles greater than 25 microns is recommended to reduce the morbidity associated with talc pleurodesis. Study design does not permit us to conclude that aspiration of spontaneous pneumothorax is as effective as chest tube drainage. Pleural catheter may prove to be an important palliative modality in treating debilitated patients or patients with trapped lung who show symptomatic improvement with drainage; however, at the present time, these catheters cannot be considered a first line treatment option for patients with malignant pleural effusion. One of the studies reviewed showed no significant difference in tract metastasis in patients with

Use of F-18 fluoro deoxyglucose (FDG) positron emission tomography (PET) in the assessment of malignant mesothelioma

International Nuclear Information System (INIS)

Brown, F.M.M.; Pathmaraj, K.; Berlangieri, S.U.; Knight, S.; Clarke, C.P.; Scott, A.M.

2002-01-01

Full text: Australia has the highest mesothelioma incidence rate in the world and the incidence of Mesothelioma is increasing. Therapy for Mesothelioma involves surgery (including phototherapy), radiotherapy and chemotherapy. Computed tomography (CT) is frequently used to stage the extent of Mesothelioma. This study aimed to evaluate the utility of FDG PET in staging Mesothelioma and monitoring response to therapy. Nineteen F-18 FDG PET was performed at the A and RMC Centre for PET in 14 patients (13M: 1F, age range 39-77 years, mean age 58 years) with biopsy proven malignant pleural Mesothelioma. Patients were referred for staging (5 patients) or evaluation of patients post surgery or phototherapy (9 patients). 3 patients had more than 1 PET scan. FDG scans were reviewed with full access to the CT report. Standardised Uptake Values (SUV) were performed in all scans in regions of maximal FDG uptake corresponding to CT abnormality. Normal lung SUVs were also calculated. Follow-up was possible in all patients to the time of death or December 2001 (Follow-up 4 - 45 months, mean 16 months; 3 patients still alive). All FDG PET scans were positive for FDG-avid pleural tissue. No surgery was deferred due to FDG PET findings. In 3 patients mediastinal nodes were identified pre-surgery. Post surgical therapy assessment by FDG PET (9 patients) guided therapy by confirming disease progression or further characterising post-operative changes when CT findings were uncertain. FDG PET was able to more accurately distinguish between collapse/consolidation and recurrent disease than CT scan. Almost all post-surgical scans were performed in patients who received phototherapy. Different Mesothelioma histological subtypes could not be differentiated by SUV criteria. False positive FDG PET studies were seen in 3 patients, all of whom had post-surgical empyemas. In conclusion, FDG PET has a potential role in the management of malignant mesothelioma patients, particularly in the post

Complications of laparoscopic cholecystectomy: an analysis of 400 consecutive cases

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Afzal, M.; Butt, M.Q.

2014-01-01

To analyze the complications of first 400 laparoscopic cholecystectomies (LC) for patients with symptomatic gall stone disease at a tertiary care hospital. Study Design: Quasi-experimental study. Place and Duration of Study: PNS Shifa Karachi and CMH Lahore, Pakistan from Nov 2009 to Jan 2013. Patients and Methods: A prospective analysis of complications occurring in first 400 consecutive laparoscopic cholecystectomies by a single consultant/unit at a tertiary care hospital was made. Out of total 421 patients presenting with symptomatic gall stone disease in a single unit, 21 cases that underwent open cholecystectomy were excluded from the study. Laparoscopic cholecystectomies were performed using three port and four port technique and data including age, sex, diagnosis, number of trocar placements, conversion to open surgery and its reasons, operative time, post-operative hospital stay and complications was collected on personal computer and analyzed using Statistical package for social sciences (SPSS) version 13. Results: Total 400 patients were included in study with median age of 44 years. Female to male ratio was 5.3: 1. Depending upon the preoperative diagnosis and laparoscopic findings, patients had diagnosis of Chronic cholecystitis / biliary colic 68.25%, acute cholecystitis 23.75%, empyema gall bladder 7.25%, gallstone pancreatitis 0.5% and mucocele gallbladder 0.25%. Median operating time was 30min. Median hospital stay was 1 days (range 1 -20 days). Conversion rate was 1.25%. Postoperative complications included bleeding 0.5%, biliaryperitonitis due to cystic duct leak 0.25%, biloma 0.25%, sub hepaticabscess 0.25%, subcutaneous fat necrosis right flank at drain site 0.25%, umbilical trocarsite infection 2%, keloid at umbilical port site 0.25% and incisional hernia at umbilicus 0.25%. There was one hospital death due to myocardial infarction on 2nd post-operative day. Conclusion: Laparoscopic Cholecystectomy is associated with some serious complications

Toxicity of inhaled 91YCl3 in Beagle dogs. XII

International Nuclear Information System (INIS)

Muggenburg, B.A.; Rebar, A.H.; Boecker, B.B.; Jones, R.K.; McClellan, R.O.; Pickrell, J.A.

1978-01-01

Studies on the metabolism, dosimetry and effects of inhaled 91 YCl 3 in Beagle dogs are being continued to provide information that will aid in assessing the biological consequences of nuclear accidents in which 91 Y or other radionuclides that produce a similar radiation dose pattern may be released. Forty-two dogs with 91 Y initial body burdens from 64 to 1300 μCi/kg body weight was placed in four groups with mean lung burdens of 310, 180, 75 and 40 μCi/kg body weight. These dogs and 12 control dogs are being maintained for lifetime observation. An additional group of four dogs with a mean initial 91 Y body burden of 180 μCi/kg body weight was placed in a sacrifice study. Twenty-six of the exposed dogs and four of the control dogs have died. Eleven dogs within the highest activity level groups died or were euthanized at 12 to 33 days after inhalation of 91 Y with changes related to severe bone marrow damage and associated pancytopenia. Two dogs died approximately one year after 91 Y inhalation with convulsive seizures that were presumed to be unrelated to the 91 Y exposure. Nine 91 Y-exposed dogs died or were euthanized due to neoplasms 2012 to 4115 days after exposure. Three dogs had nasal squamous cell carcinomas, one had a bronchioloalveolar carcinoma, one a mast cell sarcoma, one a mammary adenocarcinoma, one a malignant lymphoma, one a melanosarcoma in the mouth and one heart base tumor. Two dogs died of renal failure 2663 and 4086 days after exposure. One dog died with autoimmune hemolytic anemia 3888 days after exposure and one died with congestive heart failure 4042 days after inhalation exposure. One control dog died of empyema, another control dog died with a mammary adenocarcinoma, one died with congestive heart failure and one with malabsorption syndrome. Serial observations are continuing on all surviving dogs

Effect of analgesia on the changes in respiratory parameters in blunt chest injury with multiple rib fractures.

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Ekpe, Eyo Effiong; Eyo, Catherine

2017-01-01

Blunt chest injury with multiple rib fractures can result in such complications as pneumonia, atelectasis, bronchiectasis, empyema thoracis, acute respiratory distress syndrome, and prolonged Intensive Care Unit and hospital stay, with its concomitant mortality. These may be prevented or reduced by good analgesic therapy which is the subject of this study. This was a prospective study of effects of analgesia on changes in pulmonary functions of patients with traumatic multiple rib fractures resulting from blunt chest injury. There were 64 adult patients who were studied with multiple rib fractures caused by blunt chest trauma. Of these patients, 54 (84.4%) were male and 10 (15.6%) were female. Motorcycle (popularly known as "okada") and tricycle (popularly known as keke napep) accidents significantly accounted for the majority of the multiple rib fractures, that is, in 50 (78.1%) of the patients. Before analgesic administration, no patient had a normal respiratory rate, but at 1 h following the administration of analgesic, 21 (32.8%) of patients recorded normal respiratory rates and there was a significant reduction in the number (10.9% vs. 39.1%) of patients with respiratory rates> 30 breaths/min. Before commencement of analgesic, no patient recorded up to 99% of oxygen saturation (SpO2) as measured by pulse oximeter, while 43.8% recorded SpO2of 96%. This improved after 1 h of administration of analgesics to SpO2of 100% in 18.8% of patients and 99% in 31.3% of patients and none recording SpO2of 100% of predicted while only 9 (14.1%) patients were able to achieve a PEFR value in the range of 91%-100% of predicted value. One hour after analgesia, a total of 6 (9.4%) patients were able to achieve PEFR values> 100% predicted, while 35 (54.7%) patients achieved PEFR values in the range of 91%-100% predicted. Adequate analgesia is capable of reversing the negative effects of chest pain of traumatic multiple rib fractures on pulmonary function parameters through

Case report of disseminated nocardiosis during immunosppressive treatment

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Maria Teresa Gallo

2010-03-01

Full Text Available Infection caused by Nocardia spp. Is unusual and presents with a variety of clinical manifestations in both immunocompromised patients and in immunocompetent hosts.The diagnosis of Nocardia is often difficult, and further hampered by the absence of specific clinical symptoms.A man, 63 years old, caring for about a month from multiple erosions of the oral cavity and Inca intergluteale associated with blisters and erosions scattered in the face, scalp and trunk.The routine laboratory tests, including serological testing for HIV and the determination of circulating CD4 lymphocytes, were negative.The chest X-ray was also negative. Due to the diagnostic suspicion of Pemphigus vulgaris (PV, therapy with methylprednisolone and azathioprine was initiated. After 15 days the patient’s condition worsened and it became necessary hospitalization in intensive care. A CT scan found: pleural empyema, abscess, and paravertebral muscle abscess. The cultural examination of pleural fluid and synovial fluid gave positive results for Nocardia asteroides. On this basis, sulphamethoxazole was administered in association with trimethoprim for 2 months, with a complete remission of the symptoms.At a median follow up of 2 years the patient’s general condition was excellent, without residual signs of infection.The cultured samples from pleural and synovial fluids gave a clear positivity after 5 days of incubation at 37 ° C on blood agar and chocolate agar plates; the colonies showed chalky and thin filaments, slide as branched Gram-positives and appeared partially acid-alcohol resistant by modified Kinyoun staining (1% H2SO4. The presumptive identification of Nocardia spp. was additionally confirmed by biochemical tests for the identification of species with the following results: catalase test positive, oxidase test negative, aesculin hydrolysis, reduction of nitrite to nitrate and urease test positive. Given the low incidence of Nocardia spp. infection, and the non

Simultaneus bilateral spontaneus pneumothoraces: A Retrospective Analysis of 11 Cases

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Ufuk Cobanoglu

2011-09-01

Full Text Available Spontaneous pneumothorax (SP is relatively common in clinical practice and occurs more frequently in young, tall thin men, and in smokers. However, simultaneous bilateral spontaneous pneumothorax (SBSP is a rare clinical condition that often presents with significant respiratory distress. It is often dangerous; therefore, the chest drain should be inserted immediately. In this study, simultaneus bilateral spontaneus pneumothoraces cases were divided into two groups and retrospectively evaluated according to age, sex, diagnostic methods, treatments, and results. Material and Methods :Between January 2006 and May 2009, 11 patients with SBSP were enrolled into our study. Age, gender, underlying lung disease, smoking history, symptoms, diagnosis, treatment type, surgical indication, morbidity, recurrence, mortality, duration of chest tube and postoperative hospital stay of the patients were reviewed. Arterial blood gas values (before and after intervention in patiens with primary and secondary spontaneous pneumothorax were evaluated. Results; 7 patients (63.63 % were male and 4 patients (36.37 % were female and their mean age was 34,5±6.81 years. There were 4 (36.37% primary SP and 4 (36.37% secondary SP patients. Chronic obstructive pulmonary disease (COPD was the most common cause in secondary SP patients. In two (18.18% patients recurrency were observed. Eight (72.72% patients had smoking history. The most common symptom in both groups was dyspnea. All patients had immediate bilateral chest tubes on admission. We treated these patients with chest drain insertion, VATS (Video-Assisted Thoracoscopic Surgery, axillary thoracotomy, and chemical pleurodesis. Postoperative morbidity was detected in 3 (27.27% patients (prolonged air leak in 1 case, empyema in 1 case and pneumonia in 1 case. No mortality was observed in alll cases. Recurrence developed in 3 (27.27% patients in this series. Conclusions: An urgent and effective treatment requires in the

Heller myotomy with esophageal diverticulectomy: an operation in need of improvement.

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Bowman, Ty A; Sadowitz, Benjamin D; Ross, Sharona B; Boland, Andrew; Luberice, Kenneth; Rosemurgy, Alexander S

2016-08-01

This study was undertaken to evaluate the outcomes after laparoscopic Heller myotomy with anterior fundoplication and diverticulectomy for patients with achalasia and esophageal diverticula. 634 patients undergoing laparoscopic Heller myotomy and anterior fundoplication from 1992 to 2015 are prospectively followed up; patients were stratified for those undergoing concomitant diverticulectomy. Patients graded symptom frequency and severity before and after myotomy, using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Median data are presented (mean ± SD). Forty-four patients, age 70 years (65 ± 14.2), underwent laparoscopic Heller myotomy, anterior fundoplication, and diverticulectomy. Operative time was 182 min (183 ± 54.6). Fifty percentage of patients had a postoperative complication: Most notable were leaks at the diverticulectomy site (n = 8) and pulmonary complications (n = 11; 10 effusion, 1 empyema). Length of stay (LOS) was 3 days (5 ± 8.3). All leaks occurred after discharge and resolved without sequelae using transthoracic catheter drainage and parenteral nutrition; two patients received endoscopic esophageal stents. Median follow-up is 39 months. Symptoms amelioration was significant postoperatively, including severity of dysphagia [6 (6 ± 3.9) to 2(4 ± 3.6)]. Seventy-six percentage of patients rated their symptoms at last follow-up as satisfying/very satisfying. Seventy-seven percentage of patients had symptoms once per week or less. Eighty-one percentage would have the operation again knowing what they know now. Laparoscopic Heller myotomy, anterior fundoplication, and diverticulectomy well palliate the symptoms of achalasia with accompanying esophageal diverticulum. The operations are generally longer than those without diverticulectomy and are accompanied by a relatively longer LOS. Complications are relatively frequent and severe (e.g., leaks and pneumonia). In particular, leaks at the

Efficacy and Safety of Procalcitonin-Guided Antibiotic Therapy in Lower Respiratory Tract Infections

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Werner C. Albrich

2013-01-01

Full Text Available Background: In 14 randomized controlled studies to date, a procalcitonin (PCT-based algorithm has been proven to markedly reduce the use of antibiotics along with an unimpaired high safety and low complication rates in patients with lower respiratory tract infections (LRTIs. However, compliance with the algorithm and safety out of controlled study conditions has not yet been sufficiently investigated. Methods: We performed a prospective international multicenter observational post-study surveillance of consecutive adults with community-acquired LRTI in 14 centers (Switzerland (n = 10, France (n = 3 and the United States (n = 1. Results: Between September 2009 and November 2010, 1,759 patients were enrolled (median age 71; female sex 44.4%. 1,520 (86.4% patients had a final diagnosis of LRTI (community-acquired pneumonia (CAP, 53.7%; acute exacerbation of chronic obstructive pulmonary disease (AECOPD, 17.1%; and acute bronchitis, 14.4%. Compliance with the PCT-guided therapy (overall 68.2% was highest in patients with bronchitis (81.0% vs. AECOPD, 70.1%; CAP, 63.7%; p < 0.001, outpatients (86.1% vs. inpatients, 65.9%; p < 0.001 and algorithm-experienced centers (82.5% vs. algorithm-naive, 60.1%; p < 0.001 and showed significant geographical differences. The initial decision about the antibiotic therapy was based on PCT value in 72.4%. In another 8.6% of patients, antibiotics were administered despite low PCT values but according to predefined criteria. Thus, the algorithm was followed in 81.0% of patients. In a multivariable Cox hazard ratio model, longer antibiotic therapy duration was associated with algorithm-non-compliance, country, hospitalization, CAP vs. bronchitis, renal failure and algorithm-naïvety of the study center. In a multivariable logistic regression complications (death, empyema, ICU treatment, mechanical ventilation, relapse, and antibiotic-associated side effects were significantly associated with increasing CURB65-Score, CAP

Timing of antibiotics, volume, and vasoactive infusions in children with sepsis admitted to intensive care.

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van Paridon, Bregje M; Sheppard, Cathy; G, Garcia Guerra; Joffe, Ari R

2015-08-17

Early administration of antibiotics for sepsis, and of fluid boluses and vasoactive agents for septic shock, is recommended. Evidence for this in children is limited. The Alberta Sepsis Network prospectively enrolled eligible children admitted to the Pediatric Intensive Care Unit (PICU) with sepsis from 04/2012-10/2014. Demographics, severity of illness, and outcomes variables were prospectively entered into the ASN database after deferred consent. Timing of interventions were determined by retrospective chart review using a study manual and case-report-form. We aimed to determine the association of intervention timing and outcome in children with sepsis. Univariate (t-test and Fisher's Exact) and multiple linear regression statistics evaluated predictors of outcomes of PICU length of stay (LOS) and ventilation days. Seventy-nine children, age median 60 (IQR 22-133) months, 40 (51%) female, 39 (49%) with severe underlying co-morbidity, 44 (56%) with septic shock, and median PRISM-III 10.5 [IQR 6.0-17.0] were enrolled. Most patients presented in an ED: 36 (46%) at an outlying hospital ED, and 21 (27%) at the Children's Hospital ED. Most infections were pneumonia with/without empyema (42, 53%), meningitis (11, 14%), or bacteremia (10, 13%). The time from presentation to acceptable antibiotic administration was a median of 115.0 [IQR 59.0-323.0] minutes; 20 (25%) of patients received their antibiotics in the first hour from presentation. Independent predictors of PICU LOS were PRISM-III, and severe underlying co-morbidity, but not time to antibiotics. In the septic shock subgroup, the volume of fluid boluses given in the first 2 hours was independently associated with longer PICU LOS (effect size 0.22 days; 95% CI 0.5, 0.38; per ml/kg). Independent predictors of ventilator days were PRISM-III score and severe underlying co-morbidity. In the septic shock subgroup, volume of fluid boluses in the first 2 hours was independently associated with more ventilator days

Quilotórax: A propósito de um caso clínico

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Ricardo José Brito Pereira de Lima

2009-05-01

Full Text Available Resumo: O quilotórax caracteriza-se pela presença de linfa no espaço pleural devido a lesão ou obstrução do ducto torácico. O diagnóstico é feito com base no elevado conteúdo de triglicéridos e na presença de quilomí-crons. A etiologia do quilotórax pode ser dividida em traumática e não traumática. A ruptura traumática ocorre após acidentes ou cirurgias. Das causas não traumáticas, a mais comum é o linfoma e, na presença de um quilotórax de etiologia desconhecida, a primei-ra suspeita diagnóstica deverá ser dirigida para esta entidade, sendo o tipo mais frequente o não Hodgkin. Os autores apresentam o caso de um doente com quilotórax, cujo diagnóstico etiológico foi de linfoma não Hodgkin, discutem os aspectos particulares do quilotórax, bem como a investigação e modalidades de tratamento desta entidade.Rev Port Pneumol 2009; XV (3: 521-527 Abstract: Chylothorax is the occurrence of lymph in the pleu-ra due to damage or obstruction of the thoracic duct. High content of triglycerides and the presence of chylomicrons make the diagnosis of chylothorax. Its aetiology can be divided in traumatic and non-traumatic. Traumatic rupture occurs after accidents or surgery. Within non-traumatic aetiology, lymphoma is the most common and in the presence of a chylothorax of unknown origin this should be the first suspicion, being non-Hodgkin type the most frequent.The authors present a case report of a patient with chylothorax due to non-Hodgkin lymphoma, discuss the particularities of chylothorax as well as the investigation and its treatment options.Rev Port Pneumol 2009; XV (3: 521-527 Palavras-chave: Quilotórax, empiema, pleurodese, toracoscopia, linfoma, Key-words: Chylothorax, empyema, pleurodesis, thoracoscopy, lymphoma

Surgical Management of Complicated Necrotizing Pneumonia in Children.

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Lai, Jin-Yao; Yang, Wendy; Ming, Yung-Ching

2017-08-01

There are no well-established indications for the surgical management of acute necrotizing pneumonitis in children. This study presents our experience regarding this challenging topic. Between 2002 and 2009, 56 necrotizing pneumonitis patients with empyema were treated surgically. The outcomes were analyzed retrospectively. Computed tomography findings of massive lung necrosis or large cavities involving more than 50% of the involved lobe were deemed to be complicated necrotizing pneumonitis. Patients without the above indications were considered uncomplicated. Thirty-one cases were uncomplicated and 25 were complicated. Operative procedures included 38 decortications (31 uncomplicated and seven complicated), 14 wedge resections, and four lobectomies (complicated only). Preoperatively, patients with complicated necrotizing pneumonia had a higher incidence of pneumothorax (32% vs. 14.3%; p = 0.001), endotracheal intubation (44% vs. 9.7%; p = 0.008), and hemolytic uremic syndrome (20% vs. 3.2%; p = 0.01). These patients also had higher incidences of intraoperative transfusion (68% vs. 9.7%; p = 0.03), major postoperative complications (16% vs. 0%; p = 0.02), reoperations (16% vs. 0%; p = 0.02), and longer postoperative stay (19.8 ± 24.2 days vs. 11.2 ± 5.8 days; p = 0.03). Four complicated patients, who initially had decortications and limited resections, underwent reoperations. Compared with uncomplicated patients, those who underwent decortications and wedge resection required longer postoperative stays (23.6 ± 9.9 days, p < 0.01 and 21.1 ± 30.7 days, p = 0.04, respectively), whereas patients who had lobectomy had a similar duration of recovery (9.0 ± 2.1 days, p = 0.23). All patients improved significantly at follow-up. Children with complicated necrotizing pneumonitis have more preoperative morbidities, more major postoperative complications, and require longer postoperative stays. Aggressive surgical treatment results in

Empiema pleural no tuberculoso: resultados en el Hospital «Abel Santamaría Cuadrado» (2000 a 2004 Non-tuberculous pleural empyema: results in “Abel Santamaría Cuadrado” Hospital (2000-2004

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Ivanis Ruizcalderón Cabrera

2007-03-01

Full Text Available El empiema pleural es una enfermedad infecciosa de incidencia moderada en nuestro medio, de diagnóstico fácil y de tratamiento exitoso cuando se logra descubrir a tiempo. Sin embargo, su persistencia determina la aparición de secuelas con impacto importante en la morbilidad y mortalidad del paciente. Realizamos un estudio retrospectivo, transversal y descriptivo en el que se hace una evaluación del tratamiento de los pacientes con empiema pleural no tuberculoso tratados en el Servicio de Cirugía General del Hospital «Abel Santamaría Cuadrado» entre enero de 2000 y diciembre de 2004. En una muestra de 34 pacientes fueron estudiadas las variables: edad, sexo, causa, gérmenes, tratamiento adoptado. Se observó que el grupo de edad más afectado fue el de 41 a 60 años (17 pacientes; 50 % y sobre todo, los pacientes del sexo masculino (82,4 %, con una relación de 3,8:1. En el 61,8 % de los pacientes se encontraron enfermedades pulmonares asociadas y los gérmenes patógenos más frecuentes fueron el Staphylococcus aureus (29,4 % y el Streptococcus pneumoniae(20,6 %. El mayor porcentaje de los casos fue resuelto mediante cirugía torácica videoasistida (32,4 %. La mayoría de los pacientes llegó a los servicios quirúrgicos en las fases avanzadas de la afección y se apreció un incremento de los cultivos mixtos de gérmenes patógenos. El tratamiento más agresivo de las colecciones purulentas fue el de mejor resultado

Role of imaging procedures in clarification of complications of pneumonia; Rolle der bildgebenden Verfahren zur Abklaerung von Pneumoniekomplikationen

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Lampichler, K. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Allgemeines Krankenhaus, Wien (Austria)

2017-01-15

Despite a considerable number of antimicrobial agents and interdisciplinary treatment options, lower respiratory tract infections are still associated with high morbidity and mortality rates. Infections of the respiratory tract can lead to severe complications, such as empyema, lung abscesses and acute respiratory distress syndrome (ARDS). Besides intrapulmonary complications pneumonia can also impair other organs due to a systemic inflammatory response. Underlying cardiovascular diseases, such as chronic heart failure, arteriosclerosis and dysrhythmia can either deteriorate due to infections or be newly manifested as a result of pneumonia. Early diagnosis and therapy of these sometimes life-threatening complications are crucial and can have a severe impact on disease outcome. The most important imaging techniques include chest X-ray and computed tomography (CT) of the chest. Although a definite diagnosis is sometimes difficult or even impossible to establish using chest X-ray or CT, there are several findings indicative of intrapulmonary or extrapulmonary complications of pneumonia. Another useful and portable tool is thoracic ultrasound directly on the patient, which can be used to further define the underlying disease or as guidance during procedures. The chest X-ray is useful in initial diagnosis and follow-up. If complications or disease progression are suspected or the clinical course differs from the X-ray interpretation, a subsequent CT of the chest should be performed. (orig.) [German] Pneumonien sind trotz antimikrobieller Therapien und multidisziplinaerer Behandlungsstrategien unveraendert mit einer hohen Morbiditaets- und Mortalitaetsrate verbunden. Eine Infektion des Respirationstrakts kann zu Komplikationen wie Lungenempyem, -abszess und akutem Lungenversagen fuehren. Zusaetzlich kommt es neben den intrapulmonalen Komplikationen haeufig auch zur Beeintraechtigung anderer Organe. Kardiovaskulaere Grunderkrankungen wie Herzinsuffizienz, Arteriosklerose

MINIMALLY-INVASIVE TUBE THORACOSTOMY MADE EASY WITH A COMBINATION OF THORACIC ULTRASOUND AND SMALL BORE CHEST DRAIN KITS (12F TO 16F USING GUIDEWIRE TECHNIQUE

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Venkateswararao

2017-11-01

Full Text Available BACKGROUND Minimally-invasive tube thoracostomy made easy with a combination of thoracic ultrasound and small bore chest drain kits (12F to16F using guidewire technique. The present study is aimed at easy and safe insertion of small bore chest drains (12F to 16F using Seldinger technique under ultrasound guidance with least discomfort to the patient. Large bore chest drains of size >20F using blunt dissection technique is painful, difficult to place in thick chest walls and technically more demanding. Placing the drains blindly basing on chest x-ray image may sometimes injure the underlying lung. MATERIALS AND METHODS Present study included 21 cases, of which 12 cases (57.1% were of pleural effusion and 9 cases (42.8% were of pneumothorax. Thoracic ultrasound was utilised by the operator for all pleural effusions and for those cases of pneumothorax who were on ventilator before tube insertion. Small bore chest drains (12F to 16F designed for guidewire technique were used in the present study. RESULTS Complete and sustainable lung expansion was seen in 19 of 21 cases (90.4%. It failed in remaining 2 cases (9.5% who had complex empyemas and hepatic hydrothorax. Pleurodesis was attempted in 6 cases (28.5% using tetracycline injectable form with success rate of 90%. Patient tolerance was good with numeric pain rating score of 1 to 3 (range 0 to 10; 0 = no pain; 5 = moderate pain; 10 = worst possible pain. CONCLUSION Using small bore chest tubes of sizes 12F to 16F designed for guidewire technique of insertion and utilising thoracic ultrasound, while insertion made the procedure easy and safe, less painful and good tolerance from patient’s point of view. Complete and sustainable lung expansion was seen in 90.4% of cases and highly efficacious for spontaneous and iatrogenic pneumothorax and in noncomplex and malignant pleural effusions. The technique is less demanding and thoracic ultrasound knowledge can be easily learnt and a combination of this

Infectious and inflammatory disorders of the circulatory system as risk factors for stroke in Saudi children

International Nuclear Information System (INIS)

Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Kentab, Anal Y.; Zahraa, Jihad N.; Abdel-Gader, Mohamed O.; Gadelrab, Mohamed O.; Alorainy, Ibrahim A.; Hassan, Hamdy H.

2006-01-01

Objective was to report on the role of infectious and inflammatory disorders as risk factors for stroke in a prospective and retrospective cohort of Saudi children. Children, who presented with stroke, were evaluated at the Division of Pediatric Neurology or admitted to King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the periods July 1992 to February 2001 (retrospective study) and February 2001 to March 2003 (prospective study). Investigations for suspected cases included haemostatic assays, microbiological and serological tests. Neuroimaging included cranial CT, MRI magnetic resonance angiography (MRA), magnetic resonance venography (MRV) and single photon emission computed tomography (SPECT) brain scan. Of the 104 Saudi children with stroke, seen during the combined study periods of 10 years and 7 months, infectious and inflammatory disorders of the circulatory systems were identified risk factors in 18 (17.3%). Five children had stroke following acute bacterial meningitis at ages ranging between 5-21 months. The causative organism was identified in 3 of them and consisted of Haemophilus influenza (in a 5-months-old girl), Streptococcus pneumonia (in a 21-months-old girl complicated by subdural empyema and sinovenous thrombosis), and Staphylococcus aureus in a 6-months-old boy who had an underlying chronic granulomatous disease. Unspecified meningitis/meningoencephalitis affected 4 patients, whereas 3 children had an underlying congenital infection as a cause for their stroke. Two of the latter 3 children were diagnosed to have congenital toxoplasmosis, and the third had congenital rubella syndrome. Two girls had stroke following septicemia at ages of one and 2 months. Neurobrucellosis caused stroke in 2 boys at the ages of 4 1/2 and 4 years. In both patients, neuroimaging revealed lacunar and other infects involving mainly the deep cerebral nuclei, secondary to occlusion of small penetrating end

Manejo escalonado en la supuración pleural

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Bruk Bekele Jembere

2002-12-01

Full Text Available Se realizó un estudio de 36 enfermos con empiema pleural, atendidos por el grupo de Cirugía Torácica del Hospital Universitario "Comandante Manuel Fajardo" entre enero de 1995 y diciembre del 2000. Los enfermos se clasificaron en 3 estadios evolutivos: exudativo, fibrinopurulento y organizado, los que sirvieron de guías para establecer el proceder quirúrgico que se debía realizar. La principal causa fue la neumopatía inflamatoria seguida por las posquirúrgicas. Los gérmenes hallados con mayor frecuencia en los cultivos fueron: el estafilococo, las bacterias gran negativas y el estreptococo. Las intervenciones más realizadas fueron: la pleurotomía mínima con lavado pleural y sin él y la decorticación pleural en sus diferentes variantes. A 3 pacientes se les realizó algún tipo de resección pulmonar. En la fase fibrinopurulenta el 50 % requirió decorticación precoz con el 100 % de curación. En la fase organizada el tratamiento de elección fue la decorticación clásica (62,5 % o la tardía (18,8 %; los 2 fallecidos fueron de esta fase. Las complicaciones fueron escasas, infecciosas en su gran mayoría; el índice de mortalidad quirúrgica fue 5,6 %A study of 36 patients with pleural empyema that were attended by the Group of Thoracic Surgery from Comandante Manuel Fajardo Teaching Hospital from January, 1995, to December, 2000, was conducted. Patients were classified into 3 evolutive stages:exudative, fibrinopurulent and organized, which were used as guides to determine the surgical procedure to be performed. The main cause was inflammatory pneumopathy followed by the postsurgical ones. The germs most commonly found in cultures were: staphylococcus, Gram-negative bacteria and streptococcus. The most used operations were: minimum pleurotomy with and without pleural lavage and pleural decortication in its different variants. 3 patients underwent some type of lung resection. In the fibrinopurulent stage, 50 % required early

Incidence of infectious complications following tube thoracostomy with and without use of antibiotic therapy: meta-analysis study Incidência de complicações infecciosas pós-drenagem pleural fechada com e sem uso da antibioticoterapia: estudo de meta-análise

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Mauro José Fontelles

2001-12-01

Full Text Available Objective - Thoracic lesions and resulting complications have gained increased importance in literature because they present a serious problem despite the generalized use of antibiotic therapy. Our study, therefore, aims at obtaining better estimates regarding the benefits obtained using antibiotic therapy in patients with isolated thoracic trauma and who have undergone closed chest drainage. Methods - Eight prospective and randomized studies were selected and meta-analysis was used to statistically associate the results. Results - The results demonstrated a statistical significance which favored the use of antibiotic therapy in preventing pleural empyema and a 9.25 (IC 95% 2.85 - 30.01 total relative risk for patients who did not receive antibiotic therapy. The total risk regarding all the infectious complications that occurred was 4.29 (IC 95% 2.70 - 8.97. Conclusion - The results of this meta-analysis study showed that antibiotic therapy effectively reduces the incidence of infectious complications in patients with isolated thoracic trauma, who have undergone closed pleural drainage.Objetivo - A literatura aponta para a crescente importância das lesões torácicas com sua possíveis complicações e, apesar do uso generalizado da antibioticoterapia, estas continuam a ser um grave problema. Assim, o propósito do presente estudo, foi de desenvolver melhores estimativas da quantidade de benefícios quanto a utilização da antibioticoterapia nos pacientes com trauma isolado do tórax, submetidos, unicamente, à drenagem pleural fechada. Métodos - Através do estudo de meta-análise, oito trabalhos, prospectivos e randomizados, foram selecionados para associação de seus resultados dentro de um modelo de análise estatística quantitativa. Resultados - Os resultados mostraram uma significância estatística favorável ao uso da antibioticoterapia na prevenção do empiema pleural, com risco relativo total de 9,25 (IC 95% 2,85 - 30,01 para os

Penetrating cardiothoracic war wounds.

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Biocina, B; Sutlić, Z; Husedzinović, I; Rudez, I; Ugljen, R; Letica, D; Slobodnjak, Z; Karadza, J; Brida, V; Vladović-Relja, T; Jelić, I

1997-03-01

Penetrating cardiothoracic war wounds are very common among war casualties. Those injuries require prompt and specific treatment in an aim to decrease mortality and late morbidity. There are a few controversies about the best modality of treatment for such injuries, and there are not many large series of such patients in recent literature. We analysed a group of 259 patients with penetrating cardiothoracic war wounds admitted to our institutions between May 1991 and October 1992. There were 235 (90.7%) patients with thoracic wounds, 14 (5.4%) patients with cardiac, wounds and in 10 (3.7%) patients both heart and lungs were injured. The cause of injury was shrapnel in 174 patients (67%), bullets in 25 patients (9.7%), cluster bomb particles in 45 patients (17.3%) and other (blast etc.) in 15 patients (6%). Patients, 69, had concomitant injuries of various organs. The initial treatment in 164 operated patients was chest drainage in 76 (46.3%) patients, thoracotomy and suture of the lung in 71 (43.2%) patients, lobectomy in 12 (7.3%) patients and pneumonectomy in 5 (3%) patients. Complications include pleural empyema and/or lung abscess in 20 patients (8.4%), incomplete reexpansion of the lung in 10 patients (4.2%), osteomyelitis of the rib in 5 patients (2.1%) and bronchopleural fistula in 1 patient (0.4%). Secondary procedures were decortication in 12 patients, rib resection in 5 patients, lobectomy in 2 patients, pneumonectomy in 4 patients, reconstruction of the chest wall in 2 patients and closure of the bronchopleural fistula in 1 patient. The cardiac chamber involved was right ventricle in 12 patients, left ventricular in 6 patients, right atrium in 7 patients, left atrium in 3 patients, ascending aorta in 2 patients and 1 patient which involved descending aorta, right ventricle and coronary artery (left anterior descending) and inferior vena cava, respectively. The primary procedure was suture in 17 patients (in 10 patients with the additional suture of the

Aktueller Stand der plastisch-rekonstruktiven Chirurgie aus der Sicht der Thoraxchirurgie

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Rupprecht, Holger

2012-12-01

Full Text Available Bronchoplastic techniques: Plastic-reconstructive techniques in thoracic surgery have led to significant reductions of morbidity and mortality. Particulary the so-called sleeve resections are now commonplace in non-small cell carcinoma in stage I–IIIA, with rather similar five-year survival as conventional resections. Even with infiltration of large vessels (T4-stage, this technique can be applied even in the curative approach, e.g., replacement of the pulmonary artery by a vascular prosthesis (“double sleeve resection”.Extended resection of the anterior and lateral chest wall: Malignant tumors of the chest wall are caused by infiltration of the so-called T3-carcinoma of the lung, by primary bone tumors (e.g., chondrosarcoma or by osseous metastases from extrathoracic malignancies (e.g., breast cancer. After “en bloc-resection” of the chest wall including the surrounding lung parenchyma, the large defect is covered by a muscle rotation flap (M. latissimus dorsi. Sometimes these muscle flaps can not be used, for example in cachexia. In these cases, the bony thoracic defect is reconstructed by a Goretex-patch (Goretex Dualmesh. Then the patient undergoes laparotomy or laparoscopy and dissection of the omentum of the great curvature of the stomach while preserving the right epiploic artery. Through a subcutaneous tunnel, the omentum is displaced to the thoracic wall to cover the Goretex-patch. To accelerate the wound healing, the omentum is covered with a polyurethane sponge, which is pressed with a suction of 125 mm Hg (vacuum therapy. At about 4 weeks, the healed omentum can be covered with a split skin graft.Intrathoracic infections: Severe thoracic infections (empyema, lung abscess are usually caused by a pneumonia (80% or are the consequence of operative complications (e.g., bronchial stump insufficiency.The infection is not curable with the conventional irrigation drains. Often the muscle rotation flaps fail, too. The combination of

Profile of chest trauma in Zaria Nigeria: A prelminary report

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S A Edaigbini

2011-01-01

Materials and Methods A prospective study of trauma patients admitted to Ahmadu Bello University Teaching Hospital through the Accident and Emergency units was commenced in January 2008.This preliminary report is for the period of 27months.The clinical history, physical examination and outcome of management recorded in a predesigned proforma, were analysed with SPSS 15 and the patients were followed up in the surgical outpatient department. Results A total of 4784 patients (3143 men and 1641 women were admitted during this period for trauma. There were a total of 628(13.13% deaths. Of the 42 consecutive patients identified with chest trauma35 (83.3% were males and 7(16.7% were females. The age range was from 5-75years and the mean age was 35.4years, while the most affected ages were in the range of 20 to 49years. Blunt injury constituted 71.4% and penetrating injury constituted 28.6%. Road traffic accident was responsible for 61.9%, stab injury 21.4%, falls 7.1%, gunshot injury 4.8%, impalement 2.4% and animal attack also 2.4%. The average time taken between accident and admission was 31hours,40minutes and 12seconds while the average duration of hospital stay was 16.10 days. The injury pattern included rib fracture(s (23.8%, hemopneumothorax (14.3%, hemothorax (7.1%, pneumothorax (4.8%, combinations of chest injuries (7.1%, chest laceration 7.1%, bruises 11.9%, lung contusion 4.8%, subcutaneous empyema 2.4%, flail chest 4.8% and no specific injury (11.9%. Associated injuries included head injury (63.6%, orthopaedic injury (27.3% and combinations (abdominal, head, orthopaedic (9.1%. The fatality of road traffic accident was 36.8%. No patient was attended to by paramedics at the scene of accident while 21.9% of the patients had pre-hospital resuscitation in peripheral clinics before admission. The transfusion requirement was 14.3%. One patient (2.4% required a median sternotomy and cardiopulmonary bypass, 54.8% required tube thoracostomy while 42.9% had general

The efficacy and safety of a novel posterior scleral reinforcement device in rabbits

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Yuan, Yongguang; Zong, Yao; Zheng, Qishan [State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou (China); Qian, Garrett [University of New South Wales (Australia); Qian, Xiaobin; Li, Yujie; Shao, Wanwen [State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou (China); Gao, Qianying, E-mail: gaoqy@mail.sysu.edu.cn [State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou (China)

2016-05-01

Purpose: To evaluate the efficacy and safety of posterior scleral reinforcement (PSR) device for myopia suppression in rabbits' eyes. Methods: PSR surgery was performed on the normal 12 8-week-old New Zealand white rabbits' right eyes. To determine efficacy of the device, ophthalmic examination would be taken at pre-operation and post-operation (1 week, 1 month, 3 months, 6 months, and 1 year), such as A-ultrasound, diopter and B-ultrasound. Evaluation of safety were based on the following indicators: intraocular pressure (IOP), slit lamp, fundus photography, fundus fluorescein angiography and pathological examination after surgery. The efficacy and safety of PSR device were evaluated by comparison (treated eyes and contralateral eyes) of pre and post-operation. Results: The novel PSR device could significantly shorten axial length (preoperative axial length: 16.36 ± 0.14 mm, postoperative 1 week, 1 month, 3 months, 6 months and 1 year axial lengths: 15.03 ± 0.28 mm, 15.23 ± 0.32 mm, 15.39 ± 0.31 mm, 15.45 ± 0.22 mm and 15.45 ± 0.22 mm; P = 0.00037 < 0.001) in the treated eyes (right eyes) after surgery. At different postoperative time points, the B-ultrasound images showed that the PSR located in appropriate position and supported the posterior sclera very well. At the same time, IOP of treated eyes kept a relatively stable level (preoperative IOP: 12.56 ± 2.01 mmHg, postoperative IOP: ranging from 11.33 ± 1.23 mmHg to 13.44 ± 2.19 mmHg, P > 0.05) post-operation 1 year. During observation period, there was no significant inflammatory reaction and complications such as anterior chamber flare, empyema, endophthalmitis, vitreous hemorrhage, retina detachment and retinal choroid neovascularization by slit lamp, fundus photography and fundus fluorescein angiography. In addition, there were no pathologic changes be found by comparison treated eyes group and contralateral group eyes based on pathological examinations. Conclusions: In vivo study

Penetrating abdomino-thoracic injuries: report of four impressive, spectacular and representative cases as well as their challenging surgical management.

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Eder, Frank; Meyer, Frank; Huth, Christof; Halloul, Zuhir; Lippert, Hans

2011-03-01

towels, removed after 2 days), suture of the diaphragm, and pleural drainage. 4. A man was stabbed in the left thorax, resulting in pneumothorax and lesions of the diaphragm and left third of the transversal colon, and the neck, resulting in lesions of the pharynx and internal jugular vein. These injuries were approached with left thoracic drainage and suture of the colon and diaphragm lesions. Subsequent right thoracotomy was required to treat right pleural empyema caused by bronchopneumonia as a consequence of blunt thoracic trauma. In addition, the patient required relaparotomy to drain an abscess within the Douglas space and Billroth II gastric resection to control recurrent Forrest-Ia bleeding. Penetrating abdomino-thoracic injuries demand immediate life-saving measures, transfer to a trauma centre, appropriate resuscitative care, prompt diagnosis, and surgical intervention by an interdisciplinary team of abdominal, vascular, and cardiac surgeons. If these measures are provided, outcomes are maximized, mortality is minimized, and permanent damage can be avoided.

Evaluation of Esophageal Anastomotic Integrity With Serial Pleural Amylase Levels.

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Miller, Daniel L; Helms, Gerald A; Mayfield, William R

2018-01-01

An anastomotic leak is the most devastating and potentially fatal complication after esophagectomy. Current detection methods can be inaccurate and place patients at risk of other complications. Analysis of pleural fluid for amylase may be more accurate and place patients at less of a risk for evaluating the integrity of an esophageal anastomosis. We retrospectively reviewed prospective data of 45 consecutive patients who underwent an Ivor Lewis esophagectomy over an 18-month period and evaluated their anastomotic integrity with serial pleural amylase levels (PAL). There were 40 men (89%), and median age was 63 years (range, 35 to 79). Indication for esophagectomy was cancer in 38 patients (84%); 27 (71%) underwent neoadjuvant chemoradiation. A barium swallow was performed in the first 25 patients at median postoperative day (POD) 5 (range, 5 to 10); the swallow was negative in 23 patients (93%). Serial PALs were obtained starting on POD 3 and stopped 1 day after toleration of clear liquids. The PALs in the no-leak patients were highest on POD 3 (median 42 IU/L; range, 20 to 102 IU/L) and decreased (median 15 IU/L; range, 8 to 34 IU/L) to the lowest levels 1 day after clear liquid toleration (p = 0.04). Two patients had a leak and had peak PALs of 227 IU/L and 630 IU/L, respectively; both leaks occurred on POD 4, 1 day before their scheduled swallow test. The last 20 patients underwent serial PALs only, without a planned swallow test or computed tomography scan for anastomotic integrity evaluation. One of these patients had a leak on POD 5 with a low PAL of 55 IU/L the day before the spike of more than 4,000 IU/L. Two of the leaks were treated with esophageal stent placement and intravenous antibiotics, and the remaining patient's leak resolved with intravenous antibiotics, no oral intake, and observation only. None of the leak patients required transthoracic esophageal repair or drainage of an empyema. There was 1 postoperative death (2%) secondary to aspiration

Tube thorocostomy: management and outcome in patients with penetrating chest trauma.

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Muslim, Muhammad; Bilal, Amer; Salim, Muhammad; Khan, Muhammad Abid; Baseer, Abdul; Ahmed, Manzoor

2008-01-01

expansion or pneumothorax was present in three (60%) in group I and 10 (20%) in group II. One patient in group I and three (6%) patients in group II had no response. The mean time to removal of chest drains were 8.2 +/- 3.14 days in group I and 12.6 +/- 4.20 days in group II. The length of hospital stay was 7.2 +/- 2.07 days and 12.4 +/- 3.63 days in group I and II respectively. Clotted Haemothorax requiring surgery developed in three (6%) patients in group I and 8 (16%) patients in group II. Placing chest tubes on continuous low pressure suction after penetrating chest trauma helps evacuation of blood, expansion of lung and prevents the development of clotted Haemothorax. It also reduces the time to removal of chest drains, the hospital stay and the chances of surgery for clotted Haemothorax or Empyema.

Nonbronchial systemic arteries: incidence and endovascular interventional management for hemoptysis

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Jiang Sen; Zhu Xiaohua; Sun Xiwen; You Zhengqian; Ma Jun; Yu Dong; Peng Gang; Jie Bing; Sun Chunyi

2009-01-01

Objective: To investigate the incidence and relation to primary diseases of the nonbronchial systemic arteries (NBSA) supply to the pulmonary lesions, and to evaluate the clinical value of transcatheter arterial embolization (TAE) of the responsibly NBSA for hemoptysis. Methods: The aortography and subclavian artery angiography were performed in 139 patients with hemoptysis, including pulmonary tuberculosis in 66 cases (2 cases with post-thoracoplasty, 1 case with post-lobectomy, and 1 case with ventricular septal defect), bronchiectasis in 41 (1 case with post-lobectomy and 1 case with post-ligation of patent ductus arteriosus), bronchiogenic carcinoma in 15, unknown hemoptysis in 7, silicosis in 3, broncholithiasis in 3, bronchial cysts in 1, empyema in 1, postoperative lung cancer in 1, and chronic pulmonary embolism in 1, respectively. TAE was performed in patients with the discoverable responsible NBSA. The frequency, distribution and relation to primary diseases of the responsible NBSA were evaluated and the clinical results and complications were observed. Follow-up time ranged from 6 months to 5 years. Results: Seventy-three patients (52.5%) had nonbronchial systemic contributions, including 5 cases of post-thoracotomy with pulmonary lesions, 1 case complicating with ventricular septal defect, 1 case with post-ligation of patent ductus arteriosus, and 1 case of chronic pulmonary embolism. The total number of NBSA were 181 including posterior intercostal arteries (n=88), internal thoracic arteries (n=27), inferior phrenic arteries (n=21), proper esophageal arteries (n=20), lateral thoracic arteries (n=9), subscapular arteries (n=7), costocervical trunks (n=5) and thyrocervical trunks (n=4). Main responsible NBSA were posterior intercostal arteries (n=75) and branches of subclavian and axillary artery (n=44) in patients with pulmonary tuberculosis, and proper esophageal arteries (n=16) and inferior phrenic arteries (n=17) in bronchiectasis. The clinical

Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central Pleurodesis for malignant pleural effusions: a survey of physicians in South and Central America

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Evaldo Marchi

2010-12-01

performance status scales were rarely used as indications for the procedure. Nearly 75% of the respondents in Brazil and in Central America preferred to perform pleurodesis only for recurrent effusions and stated that lung expansion should be 90-100%. Talc slurry, instilled via medium-sized chest tubes, was the agent most often employed. Thoracoscopy was performed in less than 25% of cases. Fever and chest pain were the most common side effects, and empyema occurred in < 14% of cases. The mean survival time after the procedure was most often reported to be 6-12 months. CONCLUSIONS: There was considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil. Pleurodesis is an effective procedure that has few side effects, as evidenced by the low complication rates and high survival times.

Infecção de prótese vascular em cirurgia da aorta torácica: revisão da experiência e relato de caso tratado por técnica não convencional Vascular prosthesis infection in thoracic aorta surgery: review of the experience and a case report illustrating treatment with an unconventional technique

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Ronaldo Ducceschi Fontes

2004-03-01

toxemia. Pleural empyema was diagnosed, and she underwent an exploratory thoracotomy that did not confirm this diagnosis, but revealed intense effusion thickening. Four months after the exploratory thoracotomy, Klebsiella pneumoniae and Enterobacter sp were isolated in a blood culture. Magnetic resonance imaging revealed shapes compatible with perigraft infection. With this clinical and laboratory picture, graft removal was indicated as was axillo-bifemoral grafting. Surgery was successfully performed, the patient was discharged in good condition, and remains well after a 57-month follow-up without complications. The methods used for diagnosis and treatment of prosthesis infection in thoracic aorta surgery are discussed.

Phase II trial of combined surgical resection, intraoperative high dose rate brachytherapy (IORT), and external beam radiation therapy (EBRT) for malignant pleural mesothelioma (MPM)

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Raben, A.; Rusch, V.; Mychalczak, B.; Schupak, K.; Ginsburg, R.; Burt, M.; Bains, M.; Harrison, L.B.

1996-01-01

respiratory distress and expired. Two pts developed a postoperative empyema with bronchial stump leak; with 1 pt developing bleeding from mediastinal vessels at 7 months. This was felt to be related to late radiation toxicity. Wound dehiscence of the thoracotomy incision occurred in 1 pt. Of the 4 pts undergoing PD, 1 pt developed a tracheoesophageal fistula, and 1 developed a postoperative chest tube leak. IORT in conjunction with EPP led to prohibitive local complications and has been discontinued. Although follow-up is short, IORT with PD shows no improvement in local control compared to our historical experience. Local control with EPP/EBRT has thus far been excellent with most patients relapsing outside of the EBRT field, in distinct contrast to the reported pattern of disease progression in MPM, emphasizing the need for improved systemic therapy

Adult bacteremic pneumococcal pneumonia acquired in the community: A prospective study on 101 patients Neumonía neumocóccica bacteriémica de la comunidad: Un estudio prospectivo en 101 pacientes

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J. H. Gentile

2003-01-01

Full Text Available Our objective was to describe incidence, clinical, radiographic and microbiological features of bacteremic pneumococcal pneumonia (BPP in our environment. A total of 101 patients (7 were treated as outpatients, older than 18 years of age suffering BPP were prospectively evaluated. The incidence was 2.8 cases per 1000 admissions, 50 were males, mean age was 59.9 years (19-97, mortality was 11.8%. Eighty three percent of fatalities occurred within 3 days of admission. Mortality rate increased with advancing age. Fever, cough and chest pain were the commonest presenting symptoms and 44% of patients had extrapulmonary manifestations. Cigarette smoking, chronic obstructive lung disease, alcoholism and congestive heart failure (CHF were the commonest underlying conditions. CHF was more frequent in non-survivors (p = 0.002. A lobar pattern at chest radiograph predominated in survivors and a diffuse pattern in non-survivors (p = 0.007. Pleural effusion (20.7%, empyema (7.9% and respiratory failure (7.9% were the main complications. Underlying diseases were present in 100% of non-survivors (p = 0.03. Ninety four percent of patients were treated with beta-lactam antibiotics. Streptococcus pneumoniae was isolated from sputum in 6 cases. Three out of 101 S. pneumoniae isolates recovered from blood samples (one from each patient presented organisms resistant to penicillin. We observed an incidence of BPP that is similar to the observed in other countries. There are clinical and radiographic differences between survivors and non-survivors. Penicillin-resistant S. pneumoniae is still an unusual problem in our area.Se evaluaron en forma prospectiva 101 pacientes > 18 años admitidos al hospital con diagnóstico de NNB. El objetivo fue conocer la incidencia y describir las características de la enfermedad, así como la susceptibilidad antibiótica de cepas invasivas de Streptococcus pneumoniae. Se halló una incidencia de 2.8 casos/1000 admisiones; 50 fueron

Osteomielitis vertebral piógena Pyogenic vertebral osteomyelitis

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Pedro P. Perrotti

2009-10-01

patients who attended a medical clinic with this disease to emphasize its unusual presentation and difficult diagnosis. Lumbar and dorsal spine were the most common sites affected. Dorsolumbar pain and paraparesis were the most frequent symptoms. Staphylococcus aureus were isolated in eight patients, Escherichia coli in one and Haemophilus sp. in other Leukocytosis was observed in only three patients. Erythrocyte sedimentation rate was higher than 100 mm in the first hour in two patients. Typical images of pyogenic vertebral osteomyelitis were observed in all these patients with magnetic resonance imaging. The main complications were paravertebral and epidural abscesses that were found in five patients. One patient also presented an empyema, seven of them initially received empiric medical treatment, and later specific antibiotics according to the culture and sensitivity results. The rest of the patients were initially treated according to the sensitivity of the isolated germ. Surgical intervention was performed in two patients to drain soft tissue involvement, and in two other to stabilize the spine. All four surgical patients had a full recovery. This report is intended to point out that in patients with dorsolumbar pain and neurological symptoms pyogenic vertebral osteomyelitis is a possible diagnosis and has to be treated without delay.

Os espaços cervicais profundos e seu interesse nas infecções da região Deep neck spaces and their interest in cervical infections

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M.D. Durazzo

1997-06-01

series of deep neck space infections is presented. MATERIAL AND METHOD. Four clinical cases are reported: 1 a case of Ludwig's angina with several complications (mediastinitis, pericarditis, pneumonia, pleural effusion and empyema, esophageal fistula and septic shock, 2 a case of cervical abscess that appeared without apparent cause, in a young diabetic patient, 3 a case of abscess of the submandibular triangle, and 4 a case of parapharyngeal abscess that came forth after a dental treatment. Data from history taking, physical examination, X-rays, echography, CT scan and treatment and the follow-up are presented. The image tests were valuable and, in two of the cases, they demonstrated that more than one deep neck space were affected. CONCLUSIONS. The literature reinforces the high mortality and morbidity rates, the diversified etiology (dental infection, intravenous drug abuse, infections of the upper aerodigestive tract and others, and the tracheostomy indication made in about half of the cases. It stresses also the need for combined therapy (antibiotics and surgery. Evaluation with CT scan and other radiologic methods is indispensable to determine the site and extent of the process and to plan properly the treatment.

Tuberculosis in ancient times

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Louise Cilliers

2008-09-01

, tended to affect groups of people living close together, and young people in particular. Pregnancy exacerbated phthisis which was characterised by a chronic cough (worse at night, prominent sputum, often blood streaked and presumably arising from necrotic lung tissue. The face was typically flushed with sunken cheeks, sharp nose and very bright eyes. There was atrophy of all muscles with prominent (“winged” shoulder blades, fever and perspiration often associated with shivering. Symptoms were described which would fit in with complicating lung abscess and empyema. Hippocrates also mentions disease entities which would fit in with extra-pulmonary tuberculosis, like Pott’s disease of the spine and cervical lymphadenopathy (scrofula, although he did not associate this with phthisis. Minimal specific therapy was prescribed. Subsequent writers in the Hellenistic and Roman eras added little to the classic Hippocratic clinical picture of phthisis, but Celsus (1st century AD and Galen (2nd century first suggested that it was a contagious condition. From Themison (1st century BC onwards, therapeutic regimes became more drastic with the addition of inter alia strict dietary regimes, purges, enemas and venesection. Celsus suggested long sea voyages with ample relaxation and a change of climate. Aretaeus (1st century AD stressed the importance of not exacerbating the suffering of people with chronic disease by imposing aggressive therapy. Except for the introduction of more drastic therapy the concept of phthisis (tuberculosis had thus not progressed materially in the course of the millennium between Hippocrates and the end of the Roman era – and it would indeed remain virtually static for the next 1 000 years up to the Renaissance. There is, however, some evidence that the incidence of tuberculosis decreased during the major migration of nations which characterised the late Roman Empire.

Phase II trial of combined surgical resection, high dose rate intraoperative radiation therapy, and external beam radiotherapy for malignant pleural mesothelioma

International Nuclear Information System (INIS)

Raben, A.; Rusch, V.; Mychalczak, B.; Ginsberg, R.; Burt, M.; Bains, M.; Francois, Damien; Harrison, L.B.

1997-01-01

Purpose: To determine the feasibility of combining extrapleural pneumonectomy (EPP) or pleurectomy / decortication (PD), high dose rate intraoperative radiation therapy (HDR-IORT) and postoperative external beam radiation hemithoracic radiation (EBHRT) to treat malignant pleural mesothelioma (MPM). Materials and Methods: From 3/94 through 9/94, 15 patients (pts) were enrolled on this trial. This included 3 females and 12 males with a median age of 59 (Range: 45-75). Eligibility criteria included biopsy proven MPM, no evidence of T4 or N3 disease by exam/CT/MRI, no evidence of metastatic disease, no previous treatment, and a Karnofsky performance status of ≥ 80%. Pts with pulmonary function tests permitting EPP, underwent EPP and HDR-IORT (N=7). The rest underwent PD/HDR-IORT (N=4). An intraoperative dose of 15 Gy was prescribed to a depth of 5 mm in tissue to the ipsilateral mediastinum, diaphragm, and chest wall. Postoperatively, 54 Gy of EBHRT was prescribed to the hemithorax, surgical scar and surgical drain site. The median surgical procedure time, median IORT time and median overall operating time was 554 minutes, 240 minutes, and 649 minutes respectively. The median dose of EBHRT was 50.4 Gy (Range 50-54 Gy). The median follow-up time is 8 months (Range: 3.5 to 28 months). Four of 15 pts had unresectable disease at the time of surgery and were taken off study. Results are presented in crude and actuarial analysis. Results: A complete resection of all visible gross disease was accomplished in 10 pts. One pt had a single focus of gross residual disease (less than 5 mm in size) left behind in the chest wall. The overall complication rate was 54%. Treatment related mortality occurred in 2 pts (18%) at 1 and 7 months respectively. This was attributed to ARDS in 1 pt (EPP/HDR-IORT) and radiation pneumonitis combined with a tracheoesophageal fistula in 1 pt (PD/HDR-IORT). Of the 6 remaining pts undergoing EPP/HDR-IORT, 2 pts developed a postoperative empyema with

Doença pleural e síndroma de imunodeficiência adquirida

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Adelina Amorim

2004-05-01

immune deficiency virus (HIV and can occur at all CD4 level. Pleural complications are uncommon but they have some distinctive aspects from HIV-negative patients.The PTX occurrence in HIV-positive patients was described for the first time in 1984. The total incidence of pneumothorax (PTX in patients with acquired immune deficiency syndrome (AIDS varies from 2,7% to 4,9%. The great majority occurs in patients with current or previous Pneumocystis carinii infection, who present subpleural pulmonary cavities with necrosis. The treatment of spontaneous PTX in patients with AIDS is difficult, with an increased tendency to bronchopleural fistula persistance. The use of tube thoracostomy, with or without pleural sclerose, can be insufficient to resolve PTX. Other therapeutic options are attachment of a Heimlich valve or surgical intervention.The prevalence and the etiology of pleural effusion (PE among hospitalized patients with AIDS varies widely. One reason that can contribute to this variability is the diference on risk factors associated with HIV infection, in the studied population. Parapneumonic effusions, tuberculosis and Kaposi’s sarcoma are the most common causes. Empyemas are a rare pleural complication. Although Pneumocystis carinii pneumonia is a common cause of pneumonias in AIDS patients, it is an unusual cause of pleural effusion. Other possible causes of pleural effusion are non-Hodgkin’s lymphoma, namely body cavity-based lymphoma.REV PORT PNEUMOL 2004; X (3: 217-225 Palavras-chave: doença pleural, pneumotórax, derrame pleural, síndroma de imunodeficiência adquirida, VIH, Key-words: pleural disease, pneumothorax, pleural effusion. acquired immune deficiency syndrome, HIV

C3. Pneumonias da comunidade num serviço de Pneumologia

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Sandra André

2003-11-01

tuberculosis diagnosis started four antituberculous agents (HRZE, streptomycin was addicted in two patients because of radiological evidence of cavitation.A second line antibiotic regimen was implemented in 10 patients after 10,7±6,7 days, being clinical unresponsiveness to therapy the major cause (6.The most common complications were: parapneumonic pleural effusion -4; empyema -1; pneumothorax -1; necrotizing pneumonia -4.Low diagnostic rate may be related to the fact that microbiological exams were made after antibiotics starting. Average stay length seems to be related with antibiotic duration and presence of complicated events. Radiological pattern was not correlated with the duration of hospital stay. Palavras-chave: Pneumonia adquirida na comunidade (PAC, Key-words: Community-acquired pneumonia (CAP