Extensive Empyema Research Articles

CT in the evaluation of pleural versus pulmonary disease in children.

Post pneumonic empyema in children is the result of infection by Staphylococcus aureus in approximately 80% of cases. Approximately 93% of children with empyema respond well to treatment with appropriate antibiotics and drainage of the pleural space. We present seven children in whom such therapy failed to produce an adequate response. Computed tomography alone clearly excluded persistent pneumonia as a cause of symptoms while in all seven patients revealing an unexpectedly extensive empyema rind. This information, coupled with the lack of clinical improvement and the specific organism isolated, led to a change in clinical management. These children were infected by organisms other than Staphylococcus aureus and required surgical decortication of the fibrinous pleural rind to alleviate persistent symptoms.

Massive empyema due to Citrobacter diversus.

Citrobacter diversus is a gram-negative rod member of the Enterobacteriacease family. A patient is described from whom this organism was isolated twice in pure culture from empyema fluid. Our isolates of Citrobacter diversus were resistant to ampicillin and carbenicillin and sensitive to cephalothin. Citrobacter diversus should be distinguished from Citrobacter freundii, Enterobacter cloacae and Klebsiella pneumoniae. This organism joins Streptococcus pyogenes, bacteroids species, anaerobic streptococci and Escherichia coli as a cause of slight pneumonia with extensive empyema.

Massive Empyema Due to Citrobacter Diversus

Citrobacter diversus is a gram-negative rod member of the Enterobacteriaceae family. A patient is described from whom this organism was isolated twice in pore culture from empyema fluid. Our isolates of Citrobacter diversus were resistant to ampicillin and carbenicillin and sensitive to cephalotbin. Citrobacter diversus should be distinguished from Citrobacter freundii, Enterobacter cloacae and Klebsiella pneumoniae. This organism joins Streptococcus pyogenes, bacteroides species, anaerobic streptococci and Escherichia coli as a cause of slight pneumonia with extensive empyema.

Treatment of Esophageal Atresia With a Short Proximal Esophageal Segment

ESOPHAGEAL atresia occurs once in approximately every 4,000 births. Because this anomaly is uncommon, few medical centers have had sufficient experience to make a reliable analysis of the results of operative treatment. The Surgical Section of the American Academy of Pediatrics recently surveyed the results obtained from observation of 916 patients who had esophageal atresia with tracheoesophageal fistulas to the distal esophageal segments. 1 In the retropleural and transpleural approaches to the esophageal anastomosis there was no difference in the incidence of anastomotic leakage. However, when the anastomosis leaks into the retropleural space, infection is confined, extensive empyema is prevented, and the survival rate (60% vs 37%) is considerably higher than in the transpleural approach (Fig 1). Furthermore, the overall survival rate is better in retropleural anastomosis without leakage (78% vs 72%). This study as well as others have shown that premature infants have a poorer survival rate than full-term

Subphrenic abscess in children: With special reference to roentgen signs of transphrenic infection

<h2>Summary</h2> Ten cases of subphrenic abscess in children are reported in detail, illustrations of three additional cases are included. The x-ray examination is an important adjunct to the history and clinical findings and seldom fails to offer important evidence in this disease, often making the diagnosis almost singlehanded. Fixation of the diaphragm is the earliest roentgenographic sign, the evidence of diaphragmatic pleurisy next, then the signs of a small accumulation of fluid which tends to remain small in amount, and later, even in neglected cases with extensive empyema, the evidence of an almost normal contact of the visceral and diaphragmatic pleurae (in overexposed films). The x-ray signs, which are almost pathognomonic of this disease, are the shadows of "gas and fluid level" beneath the right leaf of the diaphragm. However, these latter signs were present in only one-fourth of this group of children. The x-ray signs of pneumonitis and collapse of the lower lobe are occasionally associated findings as the infection invades or surrounds the lung tissue. A local basal pneumothorax is prone to follow a bronchial fistula, with or without spontaneous healing. A rest cavity is more common than in primary pulmonary disease. The majority of cases follow appendicitis. Small perforations in other viscera are thought to account for most left-sided cases. These have a greater tendency to heal spontaneously than right-sided cases. Waiting for definite x-ray signs of a loculation before establishing drainage seems to be judicious treatment.

THE TREATMENT FOR PENETRATING WOUNDS OF THE PLEURAL CAVITY

The treatment for wounds that penetrate the pleura is diametrically opposed in many respects to the treatment for wounds that penetrate the peritoneal cavity. The treatment for wounds that penetrate the abdominal cavity usually is radically operative; for those wounds which penetrate the thoracic cavity, the conservative nonoperative treatment is often the best. The presence of blood within the abdominal cavity is of little moment. It may be left undisturbed. Blood left within the pleural cavity may lead to extensive empyema and death. The surgical principles that govern the treatment for wounds of the peritoneal cavity cannot be applied to the treatment for wounds of the pleural cavity. This distinction is important. It saves life. If the surgeon performs an exploratory thoracotomy on the same premises that he does an exploratory laparotomy, for example, for a penetrating gunshot wound, many patients whose chests are explored will die who otherwise would

A Bacteriophage Active Against a Virulent Hemolytic Streptococcus.

We reported1 last year the finding of a bacteriophage against a virulent hemolytic streptococcus. Such a lytic principle active against streptococcus has been reported so rarely, if at all, that it seems desirable to state our results in some detail.The organism against which the phage was originally active was isolated about 3 years ago from a spontaneous fatal infection in a stock rabbit. At autopsy, the animal showed marked thoracic lesions, myocarditis, pericarditis, bronchopneumonia, fibrino-purulent pleurisy, extensive empyema with relatively little grossly noticeable below the diaphragm save an acute splenic tumor. The organism was readily obtained in pure culture from these lesions and also from the heart's blood. It grows on sheep blood agar as a very moist, translucent, mucoid colony, somewhat similar to that of Pneumococcus mucosus, but it produces a wide zone of hemolysis on the plate. One cc. of a 12 hour broth culture will cause complete hemolysis of a 5 per cent suspension of washed sheep r...