Instillation Of Streptokinase Research Articles

Intrapleural streptokinase with pigtail catheter drainage versus medical thoracoscopy in complicated parapneumonic effusion

Abstract Context Parapneumonic effusion and empyema are commonly encountered by the pulmonologist. The decision regarding management is still challenging. Aim To compare outcomes of intrapleural streptokinase with pigtail catheter drainage versus medical thoracoscopy in complicated parapneumonic effusion. Methods and material Forty patients with complicated parapneumonic effusion were randomly allocated to one of two groups. Twenty patients underwent streptokinase intrapleural instillation via pigtail catheter. The other twenty patients underwent medical thoracoscopy. Results Intrapleural streptokinase instillation procedure was significantly shorter duration (12.80 ± 3.05 min) than medical thoracoscopy procedure (25.26 ± 4.66 min). However medical thoracoscopy showed a significant less days required to remove the drainage system (5.80 ± 1.70 days) versus intrapleural streptokinase instillation procedure (9.40 ± 3.91 days). Both groups had no significant complications. Lung expansion was achieved in 90% of patients treated with intrapleural streptokinase instillation and in 95% of patients treated with a medical thoracoscopy technique, with no statistically significant difference between the two groups. Conclusions Treatment of complicated parapneumonic effusions is undeniably interdisciplinary. Both intrapleural streptokinase with pigtail catheter drainage and medical thoracoscopy are safe and improve outcomes in complicated parapneumonic effusion. Medical thoracoscopy has an advantage of fewer days required for tube withdrawal. Pigtail insertion has an advantage of shorter procedure time compared to medical thoracoscopy

POS-578 SHORT TERM OUTCOMES OF TUNNELED CUFFED CATHETERS- A SINGLE CENTER EXPERIENCE

Tunneled cuffed catheters (TCC) for hemodialysis (HD) play an important role in the patients who require HD for a short time till renal recovery or in patients who are on maintenance HD and lack a functioning arterio-venous fistula (AVF). A retrospective analysis of clinical parameters of all the patients who were put TCC from October 2017 to September 2020 (3 years) was done with follow up from, minimum of 1 month to 3 years. All tunneled catheters were inserted under ultrasound guidance by a trained Nephrologist. A post-insertion chest radiograph was done to confirm the catheter position. All complications and catheter survival were recorded. A total of 128 TCC were put, out of which 3 were repeat, 1 femoral and 1 left sided internal jugular vein (IJV) and rest all were right sided tunneled IJV catheters. Prolonged exit site bleeding was most common procedure related complication (9.6%), and beside this there was no procedure related mortality or significant morbidity. Chronic kidney disease (CKD) of undetermined etiology (44.8%), Diabetes mellitus (40.8%) and IgA Nephropathy (5.6%) were the leading causes of ESRD. Most common indication for inserting TCC was initiation of HD (81.6%), followed by failed AVF (15.2%) and failed peritoneal dialysis (PD) (3.2%). Among 125 TCC, 5 blocked {3 required removal (mean 55.6 days) and 2 were opened with instillation of streptokinase}, 3 had catheter-related blood stream infection (CABSI) (mean 48 days) and required removal and 2 catheters slipped spontaneously (mean 68 days). Overall percentage of functioning catheter was (93.6%). Average catheter survival i.e. including death with functioning catheter, elective catheter removal after AVF creation, kidney transplant and renal recovery beyond one month of catheter insertion (7 patients died with functional catheter in less than a month of insertion) was 142.8 days. Need of the HD initiation was the most common indication for insertion of TCC. Exit site bleeding (9.6%) was the most common procedure related complication and overall percentage of functioning TCC was 93.6%. Although AVF is best mode of vascular access for HD, TCC insertion is safe, immediate and effective mode of vascular access. TCC plays a successful role in patients who require unplanned HD initiation and those with failed AVF.

Adult Primary Intraventricular Hemorrhage: Clinical Characteristics and Outcomes.

Background Adult primary intraventricular hemorrhage (PIVH) is a rare type of hemorrhagic stroke that is poorly understood. The study attempts to define the clinical profile, yield of diagnostic cerebral angiography, and prognosis of patients with PIVH. Patients and Methods Retrospective data analysis of all patients with PIVH admitted between February 2015 and February 2019 at a tertiary care center. Outcome was assessed using the modified Rankin scale (mRS) at 6 months. Results and Discussion Our study group of 30 patients constituted 3.3% (30/905) of our spontaneous intracerebral hemorrhage (SICH) patients in the study period. The mean Glasgow Coma Score on admission was 11 ± 3.33 and the mean IVH Graeb score was 5.2±2.4. All patients underwent angiography. Angiography detected moyamoya disease in four patients (13.3%) and aneurysms in two patients (6.6%) and these patients were managed surgically. Extraventricular drainage with intraventricular instillation of Streptokinase was performed in five patients. The rest of the patients was managed conservatively. At 6-month follow-up, 25 patients (83.33%) achieved favorable outcome (mRS score of 0.1 or 2), whereas five (16.66%) patients had a poor outcome (mRS score of 3 or more. Three patients succumbed to the illness. IVH Graeb score and presence of hydrocephalus have significant correlation with poor outcome. Conclusion PIVH is an uncommon entity but carries a better long-term prognosis than SICH angiography helps in diagnosing surgically remediable underlying vascular anomalies and is indicated in all cases of PIVH.

Complications and residual pleural thickening after intrapleural instillation of streptokinase with pigtail catheter drainage of tuberculous pleural effusion

Background: Tuberculosis is the most common cause of exudative lymphocytic pleural effusion in India. Residual pleural thickening (RPT) is observed in about 50 percent of patients even after proper treatment with ATT. Pleural fluid drainage either with simple aspiration or with intercostal drainage and addition of corticosteroids along with antitubercular drugs have not shown to influence the incidence of RPT. The present study was undertaken to study the complications and residual effects of tubercular pleural effusion on the patients during the follow up period following intrapleural streptokinase instillation.Methods: Clinical profile, hospital course and outcome of tuberculous pleural effusion patients at the end of six months of anti-tubercular treatment of 50 patients from January 2009 to June 2010 were analyzed. These patients were randomly divided into two groups. One group (n=25) received intrapleural streptokinase via pigtail catheter and the other group (n=25) received intercostal drainage without intrapleural streptokinase instillation. All the patients received standard daily anti TB regimen of 2HERZ/4HR for a total duration of six months. All the patients were followed up for a total duration of 1 year for evidence of any residual pleural thickening.Results: Majority of the patients were above 40 years of age (60%). The male to female ratio was 2.3:1. The major symptoms of the patients were, fever in 44 patients (88%), cough in 42 patients (84%), breathlessness in 33 patients (66%), loss of appetite in 25 patients (50%) and chest pain in 25 patients (50%). Most of the patients had ADA levels between 40-70IU/L (48%) and only 6% had ADA levels below 40IU/L. The incidence of residual pleural thickening in the study group was less as compared to the control group (2.36±0.49mm vs 9.28±1.50mm) (p <0.0001).Conclusion: Intrapleural streptokinase instillation with pigtail catheter drainage less number of complications associated with study group and is successful with the decreased incidence of residual pleural thickening during the follow up period.

Efficacy of intrapleural instillation of streptokinase with pigtail catheter drainage in the treatment of tuberculous pleural effusion

Background: Tuberculosis is the most common cause of exudative lymphocytic pleural effusion in India. The present study was undertaken to evaluate the efficacy of intrapleural instillation of streptokinase with pigtail catheter drainage in the treatment of tuberculous pleural effusion.Methods: Clinical profile, hospital course and outcome of tuberculous pleural effusion patients at the end of six months of anti-tubercular treatment of 50 patients from January 2009 to June 2010 were analyzed. These patients were randomly divided into two groups. One group (n=25) received intrapleural streptokinase via pigtail catheter and the other group (n=25) received intercostal drainage without intrapleural streptokinase instillation. All the patients received standard daily anti TB regimen of 2HERZ/4HR for a total duration of six months.Results: Majority of the patients were above 40 years of age (60%). The male to female ratio was 2.3:1. The major symptoms of the patients were, fever in 44 patients (88%), cough in 42 patients (84%), breathlessness in 33 patients (66%), loss of appetite in 25 patients (50%) and chest pain in 25 patients (50%). Most of the patients had ADA levels between 40-70 IU/L (48%) and only 6% had ADA levels below 40 IU/L. The mean pleural drainage was 2615±126.1 ml in the study group (intrapleural streptokinase) and 1858 ± 93.3 ml in the control group (p <0.0001). Mean duration of intercostal drainage in the study group was 3.76 ± 0.144 days and it was 5.08±0.199 days in the control group (p <0.0001). The mean duration of hospitalization in the study group was 6.60±0.91 days and it was 8.60 ± 0.57 days in the control group (p=0.06). Conclusion: Intrapleural streptokinase instillation is successful in increasing the total drainage of pleural fluid and results in effective drainage of tuberculous pleural effusion. It is also associated with increased amount of pleural fluid drainage, decreased duration of intercostal drainage, decreased length of hospital stay.

Comparative Study between Medical Thoracoscope and Intrapleural Fibrinolytic Therapy in Complicated Parapneumonic Effusion and Empyema

Background: patients with parapneumonic effusion and empyema must be managed probably to avoid surgery and decortication, the use of medical thoracoscope and instillation of streptokinase intra pleural through intercostal tube consider a modality of dealing with that medical situation. Aim of study: it was to compare the therapeutic yield of medical thoracoscope and intrapleural fibrinolysis by streptokinase in complicated parapneumonic effusion and empyema. Patients and methods: this study was conducted at Endoscopy Unit in Chest Department, Al- Hussin Hospitals, Al-Azhar University and Damanhur Chest Hospital in the period between May 2016 and May 2019. This study included 50 patients with complicated parapneumonic effusion and empyema. They were divided into 2 groups: Group A (25 patients): managed by medical thoracoscopy, Group B (25 patients): managed by intercostal tube drainage (ICT) plus intrapleural instillation of streptokinase as fibrinolytic agent. Results: twenty three (92%) patients improved and 2(8%) failed in group A (thoracoscopic group) and 16(64%) patients improved and 9(36%) not completely improved in group B (Streptokinase group) with significant statistical difference. Conclusion and Conclusion: we conclude that medical thoracoscope is very effective, successful and safe in management of such cases. Also, the use of streptokinase as fibrinolytic is safe and effective but not with the same degree of medical thoracoscope. Patients with parapneumonic effusion and empyema must be managed probably to avoid the risk of surgery and other complications.

Comparative Study between Medical Thoracoscope and Intrapleural Fibrinolytic Therapy in Complicated Parapneumonic Effusion and Empyema

Background: patients with parapneumonic effusion and empyema must be managed probably to avoid surgery and decortication, the use of medical thoracoscope and instillation of streptokinase intra pleural through intercostal tube consider a modality of dealing with that medical situation. Aim of study: it was to compare the therapeutic yield of medical thoracoscope and intrapleural fibrinolysis by streptokinase in complicated parapneumonic effusion and empyema. Patients and methods: this study was conducted at Endoscopy Unit in Chest Department, Al- Hussin Hospitals, Al-Azhar University and Damanhur Chest Hospital in the period between May 2016 and May 2019. This study included 50 patients with complicated parapneumonic effusion and empyema. They were divided into 2 groups: Group A (25 patients): managed by medical thoracoscopy, Group B (25 patients): managed by intercostal tube drainage (ICT) plus intrapleural instillation of streptokinase as fibrinolytic agent. Results: twenty three (92%) patients improved and 2(8%) failed in group A (thoracoscopic group) and 16(64%) patients improved and 9(36%) not completely improved in group B (Streptokinase group) with significant statistical difference. Conclusion and Conclusion: we conclude that medical thoracoscope is very effective, successful and safe in management of such cases. Also, the use of streptokinase as fibrinolytic is safe and effective but not with the same degree of medical thoracoscope. Patients with parapneumonic effusion and empyema must be managed probably to avoid the risk of surgery and other complications.

Imaging guided streptokinase injected through small bore pigtail tail catheter in management of complicated empyema in pediatrics

PurposeThis study was done targeting the role of streptokinase injected through pigtail catheter in treatment of pleural empyema in pediatric. Subjects and methods15 patients were involved in this study of age ranged from 5months to 15years were subjected to STK injection once daily until the drainage don’t exceed 100ml/day and managed by ultrasound guided insertion of pigtail catheter. Broad spectrum antibiotics were given to all patients, after that the antibiotics were adapted according to result of microbial culture because of failed chest tube drainage intrapleural STK is recommended. Results13 cases show significant improvement, as the total amount of fluid before streptokinase injection was 5cc in average and significantly rose to 220cc after streptokinase instillation, while 2 cases do not response to this treatment. ConclusionImaging guided streptokinase injected through a pigtail catheter provides a powerful protocol for managing of complicated empyema in pediatrics.

Using streptokinase for pleural adhesiolysis in sonographically septated pleural effusion

BackgroundIn dealing with septated pleural effusion, intrapleural fibrinolytics may be a useful alternative for others such as use of video assisted thoracic surgery or the conventional thoracotomy. The use of intrapleural fibrinolytics may be a safer, easier and cost effective management option that can promote pleural fluid drainage. ObjectiveTo evaluate the role of intrapleural streptokinase as a fibrinolytic agent in the management of pleural effusion with adhesions. Patients and methodsThis study was designed as a case series study in a prospective manner. Twenty-five patients were included in the study. All were admitted at Chest Department, Assiut University Hospital .The study was conducted during the period between September 2013 and September 2014. All patients had septated pleural effusion; candidate for drainage with failure of satisfactory pleural fluid drainage 24h following intercostal tube (ICT) placement provided that the tube was properly positioned and not obstructed. Streptokinase was given daily at a dose of 250,000IU dissolved in 40ml of normal saline instilled in the pleural cavity through the chest tube. Instillation was repeated as long as no serious complication occurred and the drained fluid volume was >100cc with a maximum of 14 doses. Patients were assessed by the amount of drainage through intercostal drain, chest X-ray and chest ultrasound. Also patients were assessed carefully for evidence of complications. ResultsThe study revealed increased drainage of pleural fluid through intercostal tube after streptokinase instillation. The observation difference in fluid volume before and after streptokinase instillation is found to be highly significant statistically (p<0.001) .Outcome was defined according to scoring of changes in X-ray and ultrasound with success rate of 60%. Chance of success increases when the adhesions are fine based on the sonographic features. No major adverse effects were noted. ConclusionWe conclude that intrapleural streptokinase therapy may be considered in septated pleural effusion as a safe and effective treatment; it may obviate the need for surgery.Also, the ultrasound echo features of adhesions could be considered as a predictor for the response.

VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax

BackgroundPost-traumatic residual haemothorax (RH) is common and carries significant morbidity. However, its optimal treatment is not clear. AimThe aim of this study was to find the extent of this problem and the choice of treatment between VATS and intra-pleural streptokinase instillation (IPSI). Material and methodsThis RCT, conducted over 18 months period, included all patients of chest trauma between 18 and 70 years of age, admitted with haemothorax or haemopneumothorax requiring inter-costal drain (ICD) insertion. 154 events of haemothorax/haemopneumothorax requiring ICD insertion were enrolled. RH was seen in 48 (31%) patients: 13 patients were excluded from RCT after refusal for treatment. Seventeen (49%) patients of remaining 35 RH cases were randomized to IPSI group and 18 (51%) patients were randomized to VATS group. The outcome parameters were resolution of RH and treatment related complications. ResultsRH resolved equally well in VATS and IPSI group [13 patients (72%) versus 12 patients (71%), respectively; continuity-adjusted p=1]. Morbidity wise no difference (p-value 0.529) was seen in the two groups. ConclusionPost-traumatic RH is seen in 1/3rd patients and is equally well treated by VATS and IPSI.

Medical thoracoscopy versus intrapleural fibrinolytic therapy in complicated parapneumonic effusion and empyema

AimThe aim of this study is to compare the therapeutic yield of medical thoracoscopy and intrapleural fibrinolysis by streptokinase in complicated parapneumonic effusion and empyema regarding both efficacy and safety. Patients and methodsThis study included 40 inpatients with complicated parapneumonic effusion and empyema. Included patients had frank pus, pH<7.20, positive Gram stain or culture. Patients were randomly divided into two groups; first group was managed by medical thoracoscopy (20 patients) and the second group was managed by intercostal tube drainage plus intrapleural instillation of streptokinase (20 patients). Patients who were diagnosed as tuberculosis, bronchial carcinoma, chronic obstructive airway diseases and uncompensated liver cell failure were excluded from the study. Clinical, laboratory, radiological data and hospital stay duration were adopted for comparison between two groups. ResultsComparing both groups, in group 1, 19 patients (95%) had total improvement and 1 patient (5%) had partial improvement, in group 2, 12 patients (60%) had total improvement and 6 patients (40%) had partial improvement in radiological end points which is statistically significant. The duration of hospital stay was 4.70±1.45days in group 1 and 6.95±2.04days in group 2 which is statistically significant. There were no serious complications, and no mortality in both groups. ConclusionMedical thoracoscopy is superior to streptokinase fibrinolysis in complicated parapneumonic effusions and empyema in terms of safety and efficacy.

Management of complicated parapneumonic effusion and empyema using different treatment modalities

To evaluate the efficacy of the 3 treatment modalities (intrapleural instillation of streptokinase, video-assisted thoracoscopic surgery, thoracotomy and decortication) in the management of complicated parapneumonic effusion and empyema, a prospective study was conducted between January 2008 and June 2010. The 69 patients (52 men and 17 women, aged 18-50 years) were divided into 3 groups: 20 patients underwent intrapleural administration of streptokinase, 25 underwent video-assisted thoracoscopic surgery, and 24 had thoracotomy and decortication. Perioperative variables, mortality, and procedure success were compared among groups. In all groups, preoperative variables were well matched for age, sex, and clinical stage according to Light's classification. No allergic or hemorrhagic complication occurred. Operative time was significantly shorter in patients undergoing video-assisted thoracoscopic surgery. There was no intraoperative complication in the 2 surgically treated groups. Length of hospital stay and duration of chest drainage were significantly shorter after video-assisted thoracoscopic surgery. Procedure success was 50% after streptokinase, 92% after video-assisted thoracoscopic surgery, and 100% after thoracotomy and decortication. There was no perioperative mortality in any group. Video-assisted thoracoscopic surgery is a safe and effective treatment modality for complicated parapneumonic effusion and pleural empyema. Earlier intervention with video-assisted thoracoscopic surgery may produce better clinical results.

Formation of obstructing blood clot in the ureter in a patient with Glanzmann's thrombasthenia

Glanzman thrombasthenia is a rare hematologic disorder characterized by qualitative thrombocyte abnormality. Patients present with episodic mucocutaneous bleeding. Thrombosis is a paradox phenomenon observed in patients with Glanzman thrombasthenia and generally considered as a treatment complication. We present a 16-year-old girl referred for severe flank pain beginning after treatment of hematuria due to Glanzman thrombasthenia. The patient underwent endoscopy for further diagnosis and treatment because of the failure of radiologic evaluation. Although the resolution of the large clots was obtained with streptokinase instillation via the ureteral catheter, clot was mobilized with gentle insertion of ureteral catheter in the present case.

Management of Postpneumonic Empyemas in Children

Objective: The optimal treatment of children with empyema remains controversial. The purpose of this clinical retrospective study was to assess different treatment options in the management of postpneumonic pediatric empyemas.Methods: From April 1997 to October 2005, 111 consecutive children (57 boys and 54 girls) were managed for pleural empyema. The mean age was 7.07 years (range: 18 months-14 years). Patients were divided into 3 groups depending on the treatment received: group I, chest tube alone (n = 89); group II, chest tube with fibrinolytics (n = 22); group III, thoracotomy with decortication (n = 19, consisting of 9 patients of group I and 10 of group II with unsuccessful treatment results).Results: Chest tube alone, chest tube with fibrinolytics, and thoracotomy with decortication had complete response rates of 89.9%, 54.5%, and 100%, respectively. The hospital stay was 11.46 ± 3.79 days for group I, 9.08 ± 2.07 days for group II, and 6.32 ± 2.54 days for group III. There was no statistically significant difference between group I and group II with regard to hospital stay (P = 0.040). Mild pain occurred in 4 children of group II after streptokinase instillation. Only one atelectasis appeared in group III during the postoperative period.Conclusion: Chest tube drainage is a safe, effective primary treatment of postpneumonic pediatric empyema. In cases where it is insufficient, thoracotomy with decortication can be used successfully with low morbidity and mortality rates.

Management of Postpneumonic Empyemas in Children

Objective: The optimal treatment of children with empyema remains controversial. The purpose of this clinical retrospective study was to assess different treatment options in the management of postpneumonic pediatric empyemas.Methods: From April 1997 to October 2005, 111 consecutive children (57 boys and 54 girls) were managed for pleural empyema. The mean age was 7.07 years (range: 18 months-14 years). Patients were divided into 3 groups depending on the treatment received: group I, chest tube alone (n = 89); group II, chest tube with fibrinolytics (n = 22); group III, thoracotomy with decortication (n = 19, consisting of 9 patients of group I and 10 of group II with unsuccessful treatment results).Results: Chest tube alone, chest tube with fibrinolytics, and thoracotomy with decortication had complete response rates of 89.9%, 54.5%, and 100%, respectively. The hospital stay was 11.46 ± 3.79 days for group I, 9.08 ± 2.07 days for group II, and 6.32 ± 2.54 days for group III. There was no statistically significant difference between group I and group II with regard to hospital stay (P = 0.040). Mild pain occurred in 4 children of group II after streptokinase instillation. Only one atelectasis appeared in group III during the postoperative period.Conclusion: Chest tube drainage is a safe, effective primary treatment of postpneumonic pediatric empyema. In cases where it is insufficient, thoracotomy with decortication can be used successfully with low morbidity and mortality rates.

Intrapleural streptokinase for the treatment of childhood empyema.

Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients. In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone. We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5 - 10) days vs. 16 (5.8 - 20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5 - 15.5) days vs. 16 (9.5 - 22.5) days, p = 0.14]. None of the SK patients needed additional video-assisted thoracoscopic surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days. Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed.

Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study

A prospective randomized study was conducted in order to analyze the role of fibrinolytics in the treatment of complicated parapneumonic effusion. From 2001 to 2004, 127 consecutive patients were managed for thoracic empyema. In all cases the cause was bacterial pneumonia. Seventy patients were managed with sole tube thoracostomy (group A) and 57 with combination of tube thoracostomy and streptokinase instillation (group B). Groups were statistically compared for the age, gender, duration of symptoms, quality of pleural fluid, chest imaging, complete drainage, length of hospital stay and mortality. Multivariate analysis was used in order to define the factors that affect outcome. Tube thoracostomy was successful in 47 (67.1%) cases (group A), while fibrinolysis led to a favorable outcome in 50 cases (87.7%) (P<0.05). The length of stay in thoracic surgical department was significantly longer for group A (P<0.001). Mortality rate in group A was significantly higher (P<0.001). Multiple regression analysis disclosed as sole independent favorable factor for pleural drainage, the use of fibrinolysis during the course of chest tube drainage (P=0.006, odds ratio 4.29, 95% CI 1.51-12.14). Fibrinolytic agents are a useful adjunct in the management of complicated parapneumonic effusions. Intrapleural fibrinolytics, if used early in the fibrinopurulent stage of a parapneumonic effusion, decrease the rate of surgical interventions (VATS or open decortcation) and the length of hospital stay with minor associated morbidity.

A study of empyema thoracis and role of intrapleural streptokinase in its management.

BackgroundClinical spectrum, microbiology and outcome of empyema thoracis are changing. Intrapleural instillation of fibrinolytic agents is being increasingly used for management of empyema thoracis. The present study was carried out to describe the clinical profile and outcome of patients with empyema thoracis including those with chronic empyema and to study the efficacy and safety of intrapleural streptokinase in its management.MethodsClinical profile, etiological agents, hospital course and outcome of 31 patients (mean age 40 ± 16 years, M: F 25: 6) with empyema thoracis treated from 1998 to 2003 was analyzed. All patients were diagnosed on the basis of aspiration of frank pus from pleural cavity. Clinical profile, response to therapy and outcome were compared between the patients who received intrapleural streptokinase (n = 12) and those who did not (n = 19).ResultsEtiology was tubercular in 42% of the patients (n = 13) whereas the rest were bacterial. Amongst the patients in which organisms could be isolated (n = 13, 42%) Staphylococcus aureus was the commonest (n = 5). Intrapleural streptokinase was instilled in 12 patients. This procedure resulted in increase of drainage of pleural fluid in all patients. Mean daily pleural fluid drainage after streptokinase instillation was significantly higher for patients who received intrapleural streptokinase than those who did not (213 ml vs 57 ml, p = 0.006). Only one patient who was instilled streptokinase eventually required decortication, which had to be done in five patients (16.1%). Mean hospital stay was 30.2 ± 17.6 days whereas two patients died.ConclusionsTubercular empyema is common in Indian patients. Intrapleural streptokinase appears to be a useful strategy to preserve lung function and reduce need for surgery in patients with late stage of empyema thoracis.

Intrapericardial streptokinase for purulent pericarditis.

Purulent pericarditis has become a rare disease since the introduction of antibiotics into clinical practice. Standard management consists of antibiotics and surgical drainage. In this study we also instilled streptokinase to obliterate the loculations and fibrin strands in patients with purulent pericarditis. Between October 1997 and October 2002, we treated nine children with purulent pericarditis by pericardial drainage with streptokinase instillation and antibiotics. There were five boys and four girls aged between 3 and 13 years, with a mean age of 6.7 +/- 2.9 years. Pericardiocentesis revealed purulent effusion of 180-650 ml in the pericardial space in all patients. Blood pressure increased and central venous pressure decreased after the pericardial empyema was evacuated in all patients. None of the patients had systemic bleeding, arrhythmias, or hypotension suggesting an anaphylactic reaction. We found intrapericardial streptokinase to be safe and effective for dissolving fibrin layers and removing loculations, resulting in complete pericardial drainage. Therefore, intrapericardial streptokinase should be instilled to prevent constrictive pericarditis.

Treatment of Complicated Parapneumonic Pleural Effusion With Intrapleural Streptokinase in Children

To evaluate the role of intrapleural streptokinase in the management of complicated parapneumonic effusions in children. Prospective comparative study. Cheng Kung University Hospital, a tertiary medical center in Tainan, Taiwan. We enrolled as our prospective study group 20 consecutive children with complicated parapneumonic effusions who received intrapleural streptokinase treatment between August 2000 and July 2002. We also retrospectively analyzed a comparison group of 22 consecutive children with complicated parapneumonic effusions who received chest tube drainage without streptokinase treatment from January 1992 to July 2000. We then compared the clinical manifestations and outcome of these two patient groups. The patient population (21 boys and 21 girls) ranged in age from 9 to 130 months (mean age, 41.5 +/- 26.3 months [mean +/- SD]). The characters of pleural effusion showed no difference between the two groups. Nineteen patients had positive findings for Streptococcus pneumoniae, 2 patients had positive findings for Staphylococcus aureus, 2 patients had positive findings for Pseudomonas aeruginosa, and 19 patients had undetermined pathogens. All patients were treated with appropriate antibiotics. More pleural fluid was drained from the streptokinase group than from the comparison group during streptokinase treatment (816 +/- 481 mL vs 279 +/- 238 mL, p < 0.01). The duration of fever after chest tube insertion was also significantly lower in the study group (5.3 +/- 3.1 days vs 7.9 +/- 4.6 days, p < 0.05). Only two patients in the streptokinase group required surgical intervention compared with nine patients in the comparison group (p < 0.05). No major side effects were noticed after streptokinase instillation. Intrapleural fibrinolytic treatment with streptokinase is safe and effective, and it can obviate the need for surgery in most cases. The combination treatment should be attempted early on, when complicated parapneumonic effusion is first diagnosed.