Stage Of Empyema Research Articles

Impact of Initial Surgical Interventions on Empyema Outcomes: Insights From a Cohort Study in Yemen.

Purpose The study aimed to evaluate the effectiveness of different initial interventions, including thoracostomy drain tubes, open thoracotomy with decortication, and video-assisted thoracoscopic surgery (VATS) thoracoscopy in the management of empyema. Methods This prospective cohort study was conducted at two teaching hospitals in Sana'a, Yemen, over a two-year period from 2022 to 2024. The study included 40 patients diagnosed with empyema, categorized according to the type of initial intervention received. Demographic data, clinical presentation, imaging findings, intervention details, and outcomes were systematically collected and analyzed. Statistical analyses were performed to identify associations between demographic characteristics, empyema stage, intervention type, and treatment success. Results The study included 40 patients with a higher proportion of males (67.5%) than females (32.5%). The mean age was 47.1 years (standard deviation (SD): 12.85). The overall success rate of the initial interventions was 55%, with significant variation based on empyema stage, comorbidities, and intervention type. Stage I empyema had the highest success rate (80%), followed by Stage II (50%) and Stage III (27.3%), with a statistically significant difference (p = 0.034). Smoking history was identified as a significant negative predictor of success (p = 0.001). Higher pleural fluid pH was associated with better outcomes (p = 0.015). The most common complications were chest infections (20%) and bronchopleural fistulas (10%), with a mortality rate of 7.5%. Conclusion The empyema stage significantly affects the success rate, with early stages showing better outcomes. Early and appropriate intervention, particularly in later stages, is crucial for better outcomes. Effective management of postoperative complications is vital. This study highlights the need for early diagnosis and tailored interventions based on the empyema stage to improve patient outcomes. Future research should focus on larger multicenter studies to validate these findings and develop standardized treatment protocols.

COMPARISON OF TUBE THORACOSTOMY VS VATS IN THE MANAGEMENT OF EMPYEMA THORACIS IN FIBRINO-PURULENT STAGE IN CASES OF PNEUMONIA & CHEST TRAUMA

Empyema thoracis has been considered a serious problem. Different treatment options are available for the management of empyema thoracis, and each of these procedures has its own merits and demerits. This study was designed to compare the outcome of Tube Thoracostomy and VATS in the fibrino-purulent stage of empyema due to pneumonia and chest trauma in terms of hospital stay and empyema resolution in the adult age group. Ninety patients in the study were randomly divided into two groups of equal numbers, i.e., 45 in each group, by lottery method. Patients in Group A underwent tube thoracostomy, and patients in Group B had VATS. Five days postoperatively, clinical examination and relevant investigations like CXR, USG Chest of all patients were done to find empyema resolution. The mean age, BMI, and duration of hospital stay of the patients in group A vs. B was 36±16.5 vs 28±11.4, 26.03±3.39 and 26.1±3.63 and 10±4.1 vs 5±1.24 respectively. In Group A vs. B, there were 96.7% vs. 80% males and 3.3% vs 20% females, respectively. Resolution of symptoms of empyema in group A vs. B was seen in 26.7% vs. 43.3% respectively (p=0.005). Short duration of hospital stay was seen in 15% vs. 48.3% of patients in Group A vs. B, respectively (p=0.000). The Fibrino-purulent stage of Empyema Thoracis, VATS, and Decortication led to early resolution compared to tube thoracostomy alone.

The Efficacy of Intrapleural Fibrinolytic Agents Following Surgical Intervention for Empyema Thoracis: A Prospective Cross-Sectional Study in a Pediatric Population

Background: Intrapleural instillation of fibrinolytic agents is novel in treating empyema. Although the efficacy of this method for treating empyema remains a topic of debate among experts, several studies have shown that the results of this technique are almost equivalent to surgical operations in the lower stages of the disease. However, in more advanced stages of empyema, surgery may be required. Despite the worldwide use of fibrinolytic agents instead of surgical procedures, the benefits of using these agents postoperatively still need to be defined. Objectives: In this prospective study, we aimed to compare the effects of streptokinase and alteplase in managing empyema in patients who underwent any surgical operations. Methods: We prospectively compared the outcomes of using alteplase and streptokinase in children who underwent surgical operations for empyema between 2015 and 2022. Following the surgery, fibrinolytic agents were instilled through thoracostomy tubes according to a specific protocol. The length of stay, frequency of complications, need for another surgery, and mortality were measured in each group. Results: Among 53 patients who met the inclusion criteria, 31 (58.5%) patients received streptokinase postoperatively, while the others were treated using alteplase. The length of stay after the surgery, wound infection, and mortality rate did not differ significantly between the groups (P-value = 0.394, 0.080, 0.767, respectively). However, the need for another surgery due to unexpanded lungs was significantly lower in the alteplase group (0% vs. 19.4%, P = 0.028). Conclusions: Alteplase as an intrapleural fibrinolytic is more effective than streptokinase in patients who underwent surgical operations due to empyema. The need for another surgery following the instillation of alteplase through chest tubes postoperatively may be decreased.

Results of two fibrinolytics in treatment of the early stage of empyema

Results of two fibrinolytics in treatment of the early stage of empyema

Perimammary uniportal VATS decortication in a patient with chronic renal failure on dialysis and empyema stage III who was initially treated with chest tube insertion and multiple doses of intrapleural alteplase.

Perimammary uniportal VATS decortication in a patient with chronic renal failure on dialysis and empyema stage III who was initially treated with chest tube insertion and multiple doses of intrapleural alteplase.

Anaesthesia for Video Assisted Thoracoscopic Surgery in A 7 year Old Child

ONCLUSION Video assisted thoracoscopic surgery is a safe and effective procedure to treat empyema thoracis, when tube thoracostomy fails or if the empyema is loculated with dense pleura. All the stages of empyema can effectively and safely be treated by VATS. Empyema at later stages can be treated effectively with VATS. Open thoracotomy should be reserved when VATS fails as thoracotomy, as it leads to more morbidity and prolongs the hospital stay Our experience in this case, leads us to conclude that appropriate choice of anaesthesia is essential for outcome of the patient. Epidural analgesia for thoracic surgeries in conjunction with general anaesthesia, is effective as it reduces surgical stress, decreases anaesthetic requirement, and helps extubation on table with faster recovery.

Comparative study of open thoracotomy and thoracoscopy on the efficacy of treatment and complications of patients with stage ΙΙ thoracic empyema

Background. Thoracic empyema is an inflammatory condition of the pleura that can cause many complications and can even threaten people's lives. So, choosing the right treatment method from all available methods can improve the prognosis, reduce costs and post-treatment complications, thus improving the health of patients after the disease. Video-assisted thoracoscopic surgery (VATS) and open thoracotomy are the most commonly used surgical methods. In this study, these two surgical methods have been investigated, in terms of duration of hospitalization, postoperative pain level and the possibility of air leakage (as postoperative complications). Methodology. Patients with thoracic empyema stage II referred (between 2011 and 2020) to the Poursina and Razi Hospital Medical Center, Rasht, Iran were included in a retrospective cohort study. SPSS software and other statistical tests such as the Shapiro-Wilk test, Mann-Whitney non-parametric test, and Chi-square test were used for statistical analysis, and a P-value of less than 0.05 was considered an acceptable value. Results. The investigation on different qualitative and quantitative factors and complications after surgery showed that patients who underwent a VATS procedure had a shorter hospital stay (5.09±1.67 vs. 7.61±2.03), had a lower pain level (4.81±2.22 vs. 8.24±2.39), and the possibility of air leakage as a postoperative complication (41% vs. 56%) was lower than in the case patients who have undergone open thoracotomy. Conclusions. It can be concluded that choosing the VATS method instead of the open thoracotomy can reduce postoperative complications (such as length of hospital stay, pain level and possibility of air leakage) and can reduce the costs of treatment and the degree of health system use, especially during Covid-19 pandemic.

Evolving Fibrinolytic Option in the Management of Second Stage of Empyema

Evolving Fibrinolytic Option in the Management of Second Stage of Empyema

Effectiveness of Uniportal VATS as the First Line Treatment in Early Stage Empyema: A Single Center Clinical Experience

Background: Development of multiloculation and septation in complicated parapneumonic pleural effusion (PPE) may lead to difficult treatment. The studies pointed out that as fibrinolytic therapy might have the potential of complications and a time consuming character, so we should change our management strategy in such patients. In this study, we aimed to investigate whether or not uniportal video-assisted thoracoscopic surgery (UVATS) is an initial effective therapy based on clinical and radiologic manifestations. Methods: İn this retrospective study, sixty patients who underwent UVATS as the initial intervention with the diagnosis of multiloculated PPE were evaluated between 2016-2019. The patients comorbidities, ASA scores, durations of hospital stay and tube thoracostomy, rate of thoracotomy/decortication, the type of pleural fluid cell and also broad-spectrum antibiotic use, culture results, % neutrophil (NE) ratio with other biochemical parameters before and after VATS were recorded and analyzed. Results: Of the patients, 46 of them (77%) underwent UVATS and a subsequent second port incision was inserted in 14 patients,. Shortening of broad-spectrum antibiotic use after VATS was found to be statistically significant in the patients underwent early VATS (p <0.05). We found a statistically significant decrease in the rate of NE % after VATS (p <0.05), that is consistent with the clinical and radiological improvements. The radiological improvement was detected in 96.6% of the patients. Conclusions: We conclude that early UVATS without prior tube thoracostomy is a simple, effective and reliable method as the first-line treatment in patients with complicated PPE. It also confirms that earlier administration of UVATS and more aggressive therapy in the proper indications offers better clinical results

Video-Assisted Thoracoscopic Surgery in Community-Acquired Thoracic Empyema: Analysis of Risk Factors for Mortality.

Background: Thoracic empyema is a disease with high mortality and morbidity. Video-assisted thoracoscopic surgery (VATS) is recommended to treat advanced stage empyema. The purpose of this study was to explore risk factors associated with post-surgery mortality for community-acquired empyema. Patients and Methods: We retrospectively reviewed 440 patients who received VATS for community-acquired empyema, higher than stage 2, in a tertiary medical center in Taiwan. Patients' age, comorbidities, pleural effusion analysis, and post-surgery outcome were compiled. Cox regression model for survival was applied to identify risk factors of 90-day death after surgery. Results: Fifty-three patients (12.05%) had died within 90 days post-surgery. The risk factors of mortality were advanced age (hazard ratio [HR], 1.027; 95% confidence interval [CI], 1.001-1.052), chronic kidney disease (HR, 5.322; 95% CI, 2.635-10.746), cancer (HR, 6.038; 95% CI, 2.737-13.321), pleural effusion pH ≤7 (HR, 2.61; 95% CI, 1.344-5.069), pleural effusion protein ≤4 (HR, 2.021; 95% CI, 1.035-3.947), and late surgery (HR, 3.014; 95% CI, 1.595-5.696). The 90-day mortality in the early surgery group versus the late group was 6.85% versus 26.05%. The increased mortality risk from late surgery was observed in most subgroups, except for patients who were female, had chronic renal disease, and had coronary artery disease. Conclusions: Patients who are elderly, have chronic kidney disease, cancer history, low pleural effusion pH, low pleural effusion protein, and late surgery are associated with post-surgery mortality for community-acquired advanced empyema. Early VATS surgery for advanced empyema or treatment failure of chest tube drainage appears to beneficial and is recommended.

From Bedside to the Bench-A Call for Novel Approaches to Prognostic Evaluation and Treatment of Empyema.

Empyema, a severe complication of pneumonia, trauma, and surgery is characterized by fibrinopurulent effusions and loculations that can result in lung restriction and resistance to drainage. For decades, efforts have been focused on finding a universal treatment that could be applied to all patients with practice recommendations varying between intrapleural fibrinolytic therapy (IPFT) and surgical drainage. However, despite medical advances, the incidence of empyema has increased, suggesting a gap in our understanding of the pathophysiology of this disease and insufficient crosstalk between clinical practice and preclinical research, which slows the development of innovative, personalized therapies. The recent trend towards less invasive treatments in advanced stage empyema opens new opportunities for pharmacological interventions. Its remarkable efficacy in pediatric empyema makes IPFT the first line treatment. Unfortunately, treatment approaches used in pediatrics cannot be extrapolated to empyema in adults, where there is a high level of failure in IPFT when treating advanced stage disease. The risk of bleeding complications and lack of effective low dose IPFT for patients with contraindications to surgery (up to 30%) promote a debate regarding the choice of fibrinolysin, its dosage and schedule. These challenges, which together with a lack of point of care diagnostics to personalize treatment of empyema, contribute to high (up to 20%) mortality in empyema in adults and should be addressed preclinically using validated animal models. Modern preclinical studies are delivering innovative solutions for evaluation and treatment of empyema in clinical practice: low dose, targeted treatments, novel biomarkers to predict IPFT success or failure, novel delivery methods such as encapsulating fibrinolysin in echogenic liposomal carriers to increase the half-life of plasminogen activator. Translational research focused on understanding the pathophysiological mechanisms that control 1) the transition from acute to advanced-stage, chronic empyema, and 2) differences in outcomes of IPFT between pediatric and adult patients, will identify new molecular targets in empyema. We believe that seamless bidirectional communication between those working at the bedside and the bench would result in novel personalized approaches to improve pharmacological treatment outcomes, thus widening the window for use of IPFT in adult patients with advanced stage empyema.

Pleural empyema management: The impact of Video-assisted thoracoscopic surgery

In recent years, Video-assisted Thoracoscopic Surgery (VATS) has caused many changes in thoracic surgery practice. This study aimed to analyze the results of early VATS surgery in patients with empyema. Thirty-two cases of empyema who underwent VATS drainage, debridement, pleural pouch jointing, and partial decortication between November 2018 and June 2022 were included in the study retrospectively. The cases were examined for demographic information, the duration of symptoms, the stages of empyema, treatment outcomes, and complications. Twenty-three (79.9%) cases were male, 9 (28.1%) were female, and the mean age was 46.4±19.9. Preoperative symptom duration was 2.68±1.46 weeks. 28 (87.5%) cases were in stage 2 and 4 (12.5%) cases were in stage 3 empyema. A single incision VATS was performed in 23 (71.9%) cases, and double incision VATS was performed in 9 (28.1%) cases. Postoperative hospital stay was 12.1±3.3 days. Acceptable symptomatic and radiological improvement was observed in 28 (87.5%) cases after VATS. Pleural decortication with thoracotomy was used in four (12.5%) cases of stage 3 empyema. In cases of stage 2 empyema, which occurs within the first four weeks of the onset of symptoms, the VATS procedure with drainage, debridement, pouch jointing, and partial decortication provides curative results. We recommend evaluating VATS as the first-line therapy in treating early-stage empyema.

Combination of Biochemical and Cytological Findings for Better Diagnosis in Pleural Effusions.

Serous pleural effusions result from increased permeability and changed hydrostatic or colloid osmotic pressure. Laboratory biochemical findings provide conclusions about the effusion compositions. Together with the anamnesis and clinical assessment, they enable the evaluation of the effusion nature. The present study retrospectively analyzed combined biochemical and morphological findings in 2307 effusions of patients from two clinical centers: LungenClinic Grosshansdorf in Germany and Duzce University in Turkey. The effusion cytology results of 1771 and 536 patients from the respective centers were combined with clinical/radiological/biochemical findings and counter compared with the final diagnoses. Cytology verified 738 malignant tumors (643 and 95, respectively). Most effusions were benign (n=1569; 77%) and 367 of them were paramalignant (293 and 74, respectively) and 594 were inflammatory (465 and 129, respectively). There was a distinctly lower number of malignant tumors in transudates than exudates (87 vs. 725; p<0.0001). Squamous cell carcinoma was more frequent in paramalignant pleura effusions (122 cases out of the 367 effusions) than pleural carcinomatosis (32 cases out of the 780 malignant tumors; p<0.0001). The cell formula was a suitable marker for malignant mesothelioma, predominantly mesothelial, or neutrophilic characterized by elevated LDH (>500U/L) in the early stage of empyema or its late manifestation. İn conclusion, most effusions are benign. Cytologists, assisted by clinical and biochemical data and microscopic findings, can make significant differential diagnostic contributions beyond the sole detection of malignancy.

Effect of Circumference of Open Window Thoracostomy on Chest Wall Closure, Pleural Cavity Clearance, and Lung Expansion.

IntroductionManaging chronic empyema thoracis (CET) due to tuberculosis (TB) in debilitated patients is complicated. Open window thoracostomy (OWT) is one of the ways to manage these high-risk patients. Closure of OWT is sometimes difficult to attain. The purpose of this study is to compare the outcome of OWT in terms of chest wall closure in two similar groups. The only difference between these groups was the circumference of the OWT created. This study will benefit patients of CET with OWT to attain early chest wall closure without being subjected to another surgical trauma.MethodsThis is a prospective comparative study, conducted in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from August 2019 to July 2020. A total of 48 patients, 22 and 26 patients in group A and group B, respectively, were included in this study. Both groups were matched for age, gender, diagnosis, body mass index, and stage of empyema, with the difference only in the OWT circumference.ResultsBoth groups had a history of multiple chest tube intubations. Among group A patients, a smaller circumference of OWT (20-24 cm; mean 22 cm) was created as compared to group B (30-34 cm; mean 33 cm). Spontaneous OWT closure was seen in 21 (95.5%) patients in group A and seven (26.9%) patients in group B in a time period of 6.2 ± 1.5 and 11.4 ± 0.5 months, respectively (p-value: ≤ 0.001). Pleural cavity clearance was attained in 21 (95.5%) patients in group A and 24 (92.35%) patients in group B in a time duration of 4 ± 1.4 months and 4 ± 4.1 months, respectively (p-value: ≤ 0.97). Complete lung expansion was found in 21 (95.5%) patients in group A and 24 (92.3%) patients in group B in a time duration of 5 ± 1.7 months and 4.7 ± 1.6 months, respectively (p-value: ≤ 0.62).ConclusionThis prospective single-center study shows that successful spontaneous early closure of OWT primarily depends on the size of the OWT created. A smaller-sized OWT, if created judiciously, not only closes spontaneously but also facilitates the clearance of purulent discharge and potentially helps in the definitive healing of bronchopleural fistulae and consequent lung expansion, thereby avoiding more invasive procedures like decortication in a debilitated patient. Furthermore, there is no need for a second surgery for closure of OWT.

V-212 Additional Lobectomy for Empyema Stage 3 with concurrent Lobe Destruction – A surgical Option?

V-212 Additional Lobectomy for Empyema Stage 3 with concurrent Lobe Destruction – A surgical Option?

Uniportal thoracoscopic surgery for difficult late stage empyema: Case series

Early, aggressive, and minimally invasive approach is an advanced surgical approach for chronic empyema management. The traditional video-assisted technique is considered superior over open thoracotomy for empyema management; however, with further modification, the uniportal video-assisted thoracoscopic surgery (UVATS) has greater advantage for surgeons, providing better anatomical view of target tissues, allowing bimanual instrumentation similar to open approach, and nullifying the creation of dihedral angle by instruments that are not favorable in traditional VATS. The present case series describes different clinical scenarios including chronic empyema secondary to traumatic hemothorax, recurrent tubercular empyema following postoperative open decortication, and methicillin-resistant staphylococcus aureus chronic empyema in pediatric patient, which are effectively managed with UVATS approach.

Decortication and Pleurectomy

The pleural space is a potential cavity between the lung and the chest wall—more specifically, between the visceral and parietal pleura. The pleura typically is less than 1 mm thick in the normal, healthy patient. However, a variety of pathologic processes can occur that alter the transport of cell and fluid within the pleural space. The processes compromising the pleural space can lead to severe clinical symptoms and resultant patient compromise. Blood and infection (bacterial and mycobacterium) remain the common causes of fibrothorax. The authors review the common causes, pathophysiology, and diagnosis of fibrothorax; management and indications for decortication; technical aspects of the operation and management of residual pleural space issues; and the expected outcomes.Comparative data as to optimal therapy are lacking, and clinical judgment is typically the driver of care decisions. As such, a multidisciplinary approach is a key factor to ensuring optimal patient outcomes. Thoracoscopy appears to have a clear clinical advantage over open thoracotomy in managing the earlier stages of empyema and clotted hemothorax. Technical goals of thoracoscopy must not be compromised. Complete lung expansion and avoidance of pulmonary parenchymal injury are critical. The successful management of the patient with fibrothorax requires adherence to basic surgical tenets: appropriate patient selection for surgery, preoperative optimization, exacting attention to the technical aspects of the procedure, and timely interventions for perioperative events. The combined expertise of the pulmonary medicine team, radiology, and the surgical team is typically needed to ensure optimal patient-centered outcomes.This review includes:5 Figures, 3 Tables, and 24 References.

EMPYEMA THORACIS: A COMPARATIVE ANALYSIS OF TB AND NON-TB ETIOLOGY AND THEIR OUTCOMES

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: 1. To study the tuberculous and non-tuberculous patterns in the etiology of Empyema. 2. To compare the age, sex distribution among tuberculous and non-tubercluous groups. 3. To know the effect of early intervention, prognosis, treatment modalities and outcomes in tuberculous and non-tuberculous empyema. METHODS: A prospective study of empyema thoracis was conducted on 52 consecutive patients with empyema thoracis admitted to the tuberculosis and chest diseases ward of a teaching hospital over one-and-a-half-year period with the objective of comparing the etiology, clinical profiles and outcomes of patients. The demographic data, clinical presentation, microbiological findings, etiology, the clinical course and management were recorded as per a planned pro forma and analyzed. RESULTS: Out of 52 cases, 30 (57.7%) cases were of non TB etiology where as TB constitute 42.3%. Gram negative organisms 28.8% cases, Gm+ve 15.3%. In TB empyema mean age of presentation was 35.8 years & 44.46 yrs in non TB. Average duration of symptom presentation in TB & non TB empyema are 40.35 & 21.13 days respectively. Mean duration of intercostal tube drainage in TB was 33.55 days vs 18.36 days in non TB empyema. Bronchopleural fistula present in 54.54% of tuberculous versus 20% of non-tuberculous empyema. Good lung expansion with minimal pleural thickening seen in 25(83.33%) cases of non TB cases but only 59% cases of TB empyema had good resolution. CONCLUSIONS: Empyema continues to be prevalent in our country particularly in the lower socioeconomic strata due to the delay in seeking medical care, inappropriate antibiotics and dosages and duration of antibiotic treatment. Pleural fluid biochemical parameters would also vary depending on the stage of empyema, severity and previous antibiotic therapy. Management of primary empyema continues to be controversial in terms of duration of antibiotic therapy and the indications for and timing of surgery. There is a need for randomized controlled trials for strict guidelines on the management of empyema Tuberculous empyema differs from non-tuberculous empyema in the age profile, Clinical presentation, management issues, and has a significantly poorer outcome. All cases of empyema with bronchopleural fistula should be managed by intercostal drainage tube connected to water seal. It was also observed that all cases of empyema complicated by bronchopleural fistula were difficult to manage and needed major surgery. CLINICAL IMPLICATIONS: Tuberculous empyema remains a significant cause of empyema thoracis in India. Further studies are needed to evaluate the role of rapid diagnostic tools like CBNAAT with reliable sensitivity and specificity in the diagnostic algorithm for the early diagnosis of tuberculous empyema which would help in planning the treatment of empyema. DISCLOSURES: No relevant relationships by PRAPULLA CHANDRA DAVULURI, source=Web Response

The Utility of Intraoperative Microbiological, Cytological, and Histopathological Sampling in the Setting of an Empyema Necessitating Lung Decortication Surgery.

Introduction and Aims: Empyema thoracis is a pleural space pathology that indicates accumulation of purulent material in the pleural space. It is often associated with an underlying infectious process, such as pneumonia, but can also be a ramification of a more sinister etiology, such as lung carcinoma, often warranting lung decortication surgery for prompt resolution. Although radiological imaging is used to form a preliminary diagnosis, its true predictive value remains questionable, and intraoperative microbiological, cytological, and histopathological samples are thus instrumental in yielding helpful diagnostic information. This study aims to gauge whether intraoperative microbiological, cytological, and histopathological analyses yield any additional diagnostic information in establishing the etiology underlying empyema, necessitating decortication surgery. Methods: Microbiological, cytological, and histopathological records of 43 patients undergoing decortication surgery were included in this study. Only patients who were diagnosed with late stages of empyema and subsequently underwent decortication surgery were included in this study. Results: The sample consisted of 43 patients, including 23 males and 20 females. For microbiology, 4.88% of the bronchoalveolar lavage (BAL) samples, 7.69% of tissue fluid samples, and 7.32% of pleural fluid samples were positive for an infectious microorganism. For cytology/histopathology, 0.00% of BAL samples, 5.41% of pleural fluid samples, and 7.32% of tissue samples were positive for an underlying infective etiology. Conclusion: For the study and analysis of the microbiological samples, a myriad of all three different modalities of diagnosis is essential. However, tissue sampling is the preferred modality of diagnosis for cytology/histopathology owing to its ability to detect positive cases that might otherwise evade prompt detection.

Video assisted thoracoscopic surgery in the management of acute fibrinopurulent empyema in paediatric patients

Background: Empyema is the presence of pus in the pleural space that usually follows an episode of pneumonia in pediatric age group. The aim of this study was to assess the efficacy of management of acute fibrinopurulent stage of empyema by early video assisted thoracoscopic surgery (VATS) in paediatric patients.Methods: The study was carried out at a tertiary care hospital in India. It was a prospective interventional observational study. The study included 40 children between age group 0-12 years attending the surgery in-patient department referred for further management of parapneumonic effusions who had clinical and radiological evidence of empyema and thoracocentesis confirmed purulent exudate in pleural cavity, were subjected to early VATS after thorough pre-operative workup.Results: The mean age was 7.22 years. Average operative time was 135.5 minutes. The mean duration of hospital stay was 7.5 days. Few complications were bleeding, superficial wound infection, bronchopleural fistula, pneumothorax, recurrence of empyema and incomplete expansion of lung.Conclusions: VATS facilitates the management of fibrinopurulent and organised pyogenic pleural empyema with less post-operative discomfort and complications and reduced hospital stay. However larger sample size study is required to come to a definitive conclusion.