Treatment Of Empyema Research Articles

Decortication with uniport video-assisted thoracoscopic surgery for empyema due to postoperative esophageal leakage: a report of two pediatric cases

BackgroundVideo-assisted thoracoscopic surgery (VATS) is considered useful for the treatment of parapneumonic empyema in children. However, thoracoscopic management of empyema due to esophageal leakage as an operative complication has not been well described in the literature.Case presentationWe successfully decorticated severe empyema using uniport VATS in 2 children (a 2-year-old boy who suffered esophageal perforation after laparoscopic anti-reflux surgery, and a 7-month-old girl who had anastomotic leakage after thoracoscopic repair of esophageal atresia). In these patients, we noticed that pleural effusion rapidly progressed to empyema and caused respiratory insufficiency due to wide-range coverage by fibrotic pleural rind that was successfully decorticated under video-assisted vision from a mini-thoracotomy, followed by spontaneous healing of the leakage.ConclusionsWe did not attempt to closely approach or try to repair the esophageal leakage. We believe that this is an important tip for these situations.

FEATURES OF ANTIBACTERIAL AND LYMPHOTROPIC THERAPY IN PATIENTS WITH PLEURAL EMPYEMA

Abstract. Acute empyema belongs to the category of severe surgical pathology. The difficulty of its treatment is caused by a number of objective and subjective reasons, in particular such as wide spread of antibiotic-resistant microflora and population allergy. Carefully collected analysis, patient’s examination, study of lungs function indicators, data of laboratory and X-ray studies, performing of serological, immunological and allergic tests do not always allow to identify the cause of acute empyema and are often not sufficient to identify its etiology. In spite of a great number of proposed methods of acute pleural empyema treatment, study of long-term results of all types of treatment shows that they do not guarantee 100% success. The outlined data indicates the necessity of improvement of etiotropic therapy in patients with pleural empyema. Constant search for new effective methods of treatment of the aimed pathology proves the relevance of the theme. The data outlined in this article indicates the necessity of improvement of etiotropic therapy in patients with pleural empyema.

A Path Less Traveled: Xanthogranulomatous Pyelonephritis Presenting with Thoracic Empyema and Complicated By Rare Pyeloduodenal Fistula

Xanthogranulomatous pyelonephritis (XGP) is a rare and diffusely destructive variant of pyelonephritis. Diagnosis is made using the characteristic radiological findings of renal enlargement with pelvicalyceal dilatation (the ‘bear paw’ sign) with histological analysis demonstrating replacement of renal parenchyma with foamy lipid-laden histiocytes. Treatment of XGP invariably requires nephrectomy. Two particularly rare complications of XGP are thoracic empyema and pyeloduodenal fistula; this case, to our knowledge, is the first such instance of XGP complicated by both. The patient underwent chest drain placement for treatment of empyema, and, following the identification of the pyeloduodenal fistula on antegrade pyelography, underwent surgical treatment with partial right-sided colectomy, radical nephrectomy, and primary duodenal fistula closure. XGP was subsequently identified on pathological analysis of the removed kidney.

A retrospective study to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema.

Medical treatment of pediatric empyema consists of appropriate antibiotics, chest tube insertion, and intrapleural fibrinolytic drugs to facilitate pleural drainage. There is a lack of consensus about the drug of choice for fibrinolytic therapy, so this study was designed to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema. The medical records of all children with empyema treated with intrapleural alteplase at a university hospital between January 2016 and December 2020 were retrospectively reviewed. Efficacy outcomes were assessed by chest tube output before and after the first dose of alteplase, pleural fluid volume before and after therapy, a need for surgical intervention, and length of hospital stay. Safety was assessed by the frequency and severity of side effects. 40 children aged 2 months to 9 years hospitalized with empyema received intrapleural alteplase. Thirty patients (75%) experienced full recovery after three doses of intrapleural alteplase. The median length of hospital stay was 16 days. Chest tube output increased significantly after the first dose of alteplase. Pleural fluid volume decreased significantly after treatment. The most common side effect was pain (30%). Two patients experienced severe complications: 1 had a pulmonary hemorrhage and the other experienced a bronchopleural fistula. These patients recovered fully spontaneously. According to our results, the administration of intrapleural alteplase was safe and effective in facilitating pleural drainage in pediatric patients with empyema. However, further clinical trials will be needed to determine the optimal dose, frequency, and duration of intrapleural alteplase treatment.

ВОЗМОЖНОСТИ УЛУЧШЕНИЯ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ЭМПИЕМОЙ ПЛЕВРЫ НА ФОНЕ БРОНХОПЛЕВРАЛЬНЫХ СВИЩЕЙ

Background. Treatment of pleural empyema in combination with bronchial fistula is aggravated by severe purulent-resorptive intoxication, which often leads to long periods of treatment with chronicity of the process and is still considered an urgent problem of modern pulmonology and thoracic surgery. Objective. To analyze the results of treatment of patients with chronic pleural empyema accompanied by bronchopleural fistulas using controlled vacuum aspiration, including in combination with the installation of a reverse endobronchial valve. Material and methods. The results of treatment of 38 patients with chronic pleural empyema in combination with bronchopleural fistula using controlled vacuum aspiration technology, including implantation of an endobronchial blocker in 15 of them were analyzed. Results. A method of hybrid surgical treatment of pleural empyema based on application of vacuum aspiration with implantation of an endobronchial blocker was developed. The technique of using adjustable vacuum aspiration in combination with endobronchial blocker implantation provides long-term and adequate blocking of the fistula-bearing bronchus without the risk of pneumonic complications in the blocked part of the lung. Vacuum aspiration based on the creation of local negative pressure accelerates the healing process of empyema cavity and eliminates intoxication syndrome, while their combination makes it possible to reduce the average duration of unstable pneumostasis from 295 days to 3 days, to shorten the total duration of treatment measures almost 4 times as well as to decrease mortality (from 6.2% in the comparison group to 0% in the main group). Conclusions. The use of endobronchial blocking in combination with vacuum aspiration of contents from the purulent cavity for the treatment of patients with chronic pleural empyema reduces the average duration of pneumostasis stabilization, the total duration of therapeutic measures as well as mortality.

The Epidemiology, Management and Therapeutic Outcomes of Subdural Empyema in Neonates with Acute Bacterial Meningitis.

Background: Subdural empyema is one of the more serious complications of bacterial meningitis and therapeutic challenges to clinicians. We aimed to evaluate the clinical characteristics, treatment, and outcome of subdural empyema in neonates with bacterial meningitis. Methods: A retrospective cohort study was conducted in two medical centers in Taiwan that enrolled all cases of neonates with subdural empyema after bacterial meningitis between 2003 and 2020. Results: Subdural empyema was diagnosed in 27 of 153 (17.6%) neonates with acute bacterial meningitis compared with cases of meningitis without subdural empyema. The demographics and pathogen distributions were comparable between the study group and the controls, but neonates with subdural empyema were significantly more likely to have clinical manifestations of fever (85.2%) and seizure (81.5%) (both p values < 0.05). The cerebrospinal fluid results of neonates with subdural empyema showed significantly higher white blood cell counts, lower glucose levels and higher protein levels (p = 0.011, 0.003 and 0.006, respectively). Neonates with subdural empyema had a significantly higher rate of neurological complications, especially subdural effusions and periventricular leukomalacia. Although the final mortality rate was not increased in neonates with subdural empyema when compared with the controls, they were often treated much longer and had a high rate of long-term neurological sequelae. Conclusions: Subdural empyema is not uncommon in neonates with acute bacterial meningitis and was associated with a high risk of neurological complications, although it does not significantly increase the final mortality rate. Close monitoring of the occurrence of subdural empyema is required, and appropriate long-term antibiotic treatment after surgical intervention may lead to optimized outcomes.

Incidence of Secondary Osteoarthritis after Primary Shoulder and Knee Empyema and Its Risk Factors.

Empyema of the joint is an orthopedic emergency that is associated with a prolonged healing process despite adequate surgical and medical therapy. The risk of developing postinfectious osteoarthritis (OA) after successfully treated joint empyema is unknown. Both incidence and risk factors are important for prognostication and would therefore be clinically relevant for the selection of an adequate infectious therapy as well as for the individual follow-up of patients. The aim of this retrospective clinical study was to describe the risk of secondary OA after empyema based on knee and shoulder joint infections after successful primary infection treatment and its risk factors. Thirty-two patients were examined clinically and radiographically after completion of treatment for primary empyema of the knee or shoulder joint. Patients with previous surgery or injections in the affected joint were excluded from the study. The cumulative incidence of new-onset radiographic OA was 28.6%, representing a 5.5-fold increased risk of developing OA compared to the normal population. A figure of 25% of patients underwent total knee arthroplasty after knee empyema. Identified risk factors for primary empyema were obesity, hyperuricemia, and rheumatoid arthritis. Only about 60% of the patients tested positive for bacteria. Staphylococcus aureus, the most common pathogen causing joint empyema, was present in approximately 40% of cases. Secondary osteoarthritis, as a possible secondary disease after joint empyema, could be demonstrated and several risk factors for the primary empyema were identified.

Costal cartilage as a promising technique for large bronchial fistula closure in fistulous empyema: a case report

BackgroundThere is no high level of evidence for the treatment of fistulous empyema. We report here a promising technique for closure of a bronchopleural fistula using costal cartilage as a bronchial embolus.Case presentationThe patient is a 79-year-old man. A computed tomography scan diagnosed a fistulous empyema associated with perforation of lung abscess of right middle lobe. After thoracoscopic curettage of the right empyema cavity, right middle lung resection and intercostal muscle flap coverage over the bronchial stump were performed. Seven months after the surgery, a bronchopleural fistula developed. Bronchoscopy revealed fistulas in the middle lobe bronchus and B3b. After the open window thoracostomy, the empyema cavity was cleaned up. The empyema cavity remained from the anterior to the lateral thoracic region of the second to fourth ribs. A part of the second through fourth ribs that formed the ceiling of the pleural empyema cavity was removed to create space for skin and thickened parietal pleura to fill the cavity. The costal cartilage obtained from the rib resection was trimmed and harvested to fit into the diameter of the bronchopleural fistula. The free costal cartilage was sutured and fixed with five stitches with 3-0 PDS. The visceral pleura was covered with the thickened parietal pleura and skin and fixed airtight. To maintain a tight seal, a Blake® silicone drain was inserted between the visceral pleura and the thickened parietal pleura, and a suction reservoir was utilized to sustain negative pressure. The drain was removed on the 21st day. As of 21 months postoperatively, the skin and thickened parietal pleura flap has maintained its integrity, and there has been no evidence of pus or recurrence of air leaks.ConclusionIn the case of a fistulous empyema extending anteriorly, costal cartilage can be easily harvested, making it a promising option as a lid for fistula closure.

An investigation on causes of delayed referral of patients with pleural empyema

Background: In the treatment of pleural empyema, medical therapy is typically sufficient for the 1st or 2nd stage. However, surgical intervention becomes the optimal modality in the 3rd stage. A significant number of patients experience delayed diagnosis and treatment, leading to the conversion of non-surgical pleural empyema into complicated surgical empyema&#x0D; Methods: A cross-sectional study was conducted on patients with pleural empyema who were admitted to NRITLD in Tehran from 2015 to 2016. Initially, 66 patients were selected; however, after the exclusion of 12 patients, a total of 54 patients were included in the study&#x0D; Results: Delays were attributed to the medical system in 62% of cases and to the patient in 29% of cases. The median (IQR) of the total delay time attributed to the system was 38 (25) days. No significant difference was found in the median of delayed referrals between genders. A significant correlation was observed between the interval of the first and last visit and the interval between the onset of symptoms and chest x-ray (CXR), as well as the interval between the performance of CXR and the insertion of chest tube drainage (CTD).&#x0D; Conclusions: The delay in referral and treatment can be attributed to the patient, practitioners, or both. In this study, it was found that the medical system is the primary cause of delay, primarily due to the long waiting times for admission and operation in hospitals. Patients who experience a delay in CXR and CTD insertion will face a significant delay in referral and their course of treatment. It is suggested that delayed referral could be prevented by providing patients with basic medical education, offering specialized training to general practitioners for early referral, and managing waiting lists effectively.

Empyema in children.

Empyema is the infection of the fluid in the pleural space due to different causes. The most common cause of empyema in children is parapneumonic effusion. Although its frequency has decreased significantly with the use of antibiotics, it is still a significant cause of morbidity and mortality worldwide. The main aim in the treatment of empyema is to drain the pleural cavity to provide reexpansion of the compressed lung, to treat the parenchymal infection with appropriate antibiotic therapy, and to prevent complications that may develop in the acute and chronic periods. Treatment options for this disease vary depending on the stage of the disease. Treatment success in childhood empyema detected at an early stage is high. The diagnosis and treatment of empyema in children differs from adults. Due to rapid tissue regeneration in childhood, healing can occur without the need for aggressive treatment options.

Fungal empyema thoracis, a rare but an emerging entity: a retrospective case series from Pakistan.

Fungal empyema is a rare entity which is associated with high mortality. It is mostly seen in immune-compromised hosts. However, there is limited data available on fungal empyema from developing countries regarding risk factors, treatment, and outcome. This study was conducted to determine the risk factors, clinical features, treatment, and outcome of fungal empyema. A retrospective observational study was performed on proven fungal empyema cases, admitted at Aga Khan University Hospital, Karachi, Pakistan during January 2018 to May 2021. We excluded all those patients with polymicrobial bacterial and fungal empyema or with negative pleural fluid cultures. A preformed questionnaire was filled out for each case. A total of 26 patients were diagnosed with fungal empyema with a mean age of 43.6 ± 20.3 years. Of these, 16 (61.5%) patients were male. Diabetes mellitus was the most frequent comorbidity (n = 11, 42.3%), followed by hypertension (n = 9, 34.6%), malignancy (n = 6, 23.1%), and asthma (n = 1, 3.8%). Ten (38.5%) patients had multiple comorbidities. Candida spp. was isolated in 21 (80.8%) patients and Aspergillus spp. in 7 (26.9%) patients. Fusarium spp. was isolated from one (3.9%) patient. Video-assisted thoracoscopy surgery was done in 14 (53.8%) patients and 12 (46.1%) patients were managed with tube thoracostomy. Twenty-one (80.8%) patients received antifungal agents. Overall, in-hospital mortality was 38.5% (n = 10) and all patients developed respiratory failure. Clinical improvement was seen in 16 (61.5%) patients. Our data suggest that fungal empyema has a poor outcome as almost one-third of our patients died. Early diagnosis and intervention can improve outcome.

Pleural drainage vs video-assisted thoracoscopic debridement in children affected by pleural empyema

BackgroundBoth thoracic drainage and video-assisted thoracic surgery (VATS) are available treatment for pleural empyema in pediatric patients.Materials and methodsThis retrospective multicenter study includes pediatric patients affected by pleural empyema treated from 2004 to 2021 at two Italian centers. Patients were divided in G1 (traditional approach) and G2 (VATS). Demographic and recovery data, laboratory tests, imaging, surgical findings, post-operative management and follow-up were analyzed.Results70 patients with a mean age of 4.8 years were included; 12 (17.1%) in G1 and 58 (82.9%) in G2. Median surgical time was 45 min in G1, 90 in G2 (p < 0.05). Mean duration of thoracic drainage was 7.3 days in G1, 6.2 in G2 (p > 0.05). Patients became afebrile after a mean of 6.4 days G1, 3.9 in G2 (p < 0.05). Mean duration of antibiotic therapy was 27.8 days in G1, 25 in G2 (p < 0.05). Mean duration of postoperative hospital stay was 16 days in G1, 12.1 in G2 (p < 0.05). There were 4 cases (33.3%) of postoperative complications in G1, 17 (29.3%) in G2 (p > 0.05). 2 (16.7%) patients of G1 needed a redosurgery with VATS, 1 (1.7%) in G2.ConclusionsVATS is an effective and safe procedure in treatment of Pleural Empyema in children: it is associated to reduction of chest tube drainage, duration of fever, hospital stay, time of antibiotic therapy and recurrence rate.

Multidisciplinary treatment of thoracic fistulous empyema caused by pulmonary infection: a retrospective study.

In cases of thoracic empyema, the presence of a fistula is known to be difficult to treat and associated with a poor prognosis. Few reports have described the management of fistulous empyema caused by lung parenchymal infection. The aim of this study was to describe the outcomes of multidisciplinary management of fistulous empyema caused by pneumonia or lung abscess due to common bacteria and mycobacteria. Among 108 cases of empyema surgically treated at Kanagawa Hospital over a 10-year period, 14 patients with fistulous empyema due to common bacteria (CBFE) or fistulous empyema due to mycobacteria (MFE) were analyzed. Fistulous empyema due to lung resection was excluded. Eight out of the 9 patients with CBFE and 4 out of the 5 patients with MFE were male. Patients with CBFE were more likely to be >65 years of age (p=0.052) and to have a poor performance status (p=0.078). The time from onset to first surgical treatment was significantly longer in MFE (median, 5 months; p=0.004). Five patients with CBFE and two patients with MFE underwent open window thoracostomy, while three patients with CBFE and four patients with MFE underwent endobronchial occlusion (EBO). Six patients (66%) with CBFE and 3 patients (60%) with MFE achieved fistula closure. Of the patients who underwent EBO, fistula closure was achieved in 3 (100%) of the patients with CBFE and in 2 (50%) of the patients with MFE. Fistula closure was not achieved in any case with non-tuberculous mycobacteria. Fistulous empyema caused by common bacteria or Mycobacterium tuberculosis could be cured by surgical treatment and endobronchial intervention with adequate antimicrobial therapy, but fistulous empyema caused by non-tuberculous mycobacteria proved to be intractable. The challenge in the treatment of fistulous empyema due to non-tuberculous mycobacteria is the achievement of bacterial negativity.

Video Assisted Thoracoscopic Surgery as a Primary and Effective Treatment for Empyema: A Case Report

Video Assisted Thoracoscopic Surgery as a Primary and Effective Treatment for Empyema: A Case Report

The effects of etiological factors on timing of decortication

Aim: Tube drainage is the primary method in the treatment of empyema with 80-90% cure rates. In patients with empyema who have not received adequate treatment, the result is pleural fibrosis. Decortication is the only treatment option for chronic empyema that has caused fibrothorax that prevents lung expansion. In our study, we aimed to determine the relations between etiological base of the disease, the consequences and the decision of decortication timing. Methods: The patients who were admitted and hospitalized with pleural effusion between 1994 and 2000 were included in the study. We examined the duration of pretreatment, pleural thickness and the duration of postoperative hospital stay of these cases, with who have undergone decortication surgery. Results: A total of 82 cases of decortication were enrolled, which consisted of 61 male (74.3%) and 21 female (25.6%). The cases were examined in two groups: tuberculosis [12 (25%) empyema, 27 (56.3%) tuberculous pachypleuritis, 9 (18.8%) pleurisy + parenchymal involvement] and non-tuberculosis [2 (5.9%) trauma, 5 (14.7%) pneumonia + empyema, 23 (%) 67.6% empyema, 4 (11.8%) hydatid cyst]. The effects of preoperative treatment durations on the thickness of the decortication materials and the duration of postoperative hospital stay were investigated. The preoperative treatment period of the tuberculosis group was significantly higher, the decortication pleural thicknesses were found to be greater. (p&lt;0.01) There was no statistically significant difference in the duration of postoperative hospital stay between the tuberculosis and other group (p&gt;0.05). Conclusion: In cases that do not respond to closed tube drainage and appropriate antibiotic therapy, decortication should be performed without delay considering the etiological factors. If decortication is performed earlier than 2 weeks, the visceral pleura can be easily separated; parietal decortication is rarely needed which might be an advantage of the procedure.

Uniportal thoracoscopic thorough debridement for tubercular empyema with abscess of the chest wall

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.

Minimally invasive intrathoracic negative-pressure therapy and flexible thoracoscopy (FlexVATS) for patients with pleural empyema

To determine whether a new surgical method using a flexible endoscope (FlexVATS) to perform sparing debridement and apply negative-pressure therapy without extensive decortication may be an alternative treatment option for empyema. Surgical treatment of pleural empyema is associated with considerable postoperative complications and mortality rates, and alternative treatment options are being explored to improve patient outcomes. This was a prospective case series. Seventeen consecutive patients treated with FlexVATS between February 2021 and August 2022 were included in the study. Only patients for whom FlexVATS was the first therapeutic intervention for pleural empyema were included. Treatment success, defined as infection resolution, was the primary endpoint of the study. The secondary endpoints were length of hospital stay, 90-day mortality, and empyema cavity volume reduction. Patients who had previously been treated for pleural empyema by either drainage or surgery were excluded. The trial was performed as a single-centre study at a tertiary medical centre in Germany. In total, 17 patients with pleural empyema were included in the study. The median (IQR) duration of vacuum treatment was 15 days (8–35 days). Twelve of the 17 (71%) patients were successfully treated, and a significant reduction in the empyema cavity volume was observed. 41% of the dressing changes were performed outside the operating room. Compared with a historic cohort of conventionally treated patients (decortication via VATS or thoracotomy), the 90-day mortality rates tended to be lower without reaching statistical significance. Three patients (18%) died in hospital during treatment. No negative pressure-therapy-related complications were observed. FlexVATS therapy is a promising alternative therapy for both healthy and debilitated patients with pleural empyema. Larger randomised trials are required to validate this treatment option.

Targeting the PAI-1 Mechanism with a Small Peptide Increases the Efficacy of Alteplase in a Rabbit Model of Chronic Empyema.

The incidence of empyema is increasing and associated with a mortality rate of 20% in patients older than 65 years. Since 30% of patients with advanced empyema have contraindications to surgical treatment, novel, low-dose, pharmacological treatments are needed. A Streptococcus pneumoniae-induced rabbit model of chronic empyema recapitulates the progression, loculation, fibrotic repair, and pleural thickening of human disease. Treatment with single chain (sc) urokinase (scuPA) or tissue type (sctPA) plasminogen activators in doses 1.0-4.0 mg/kg were only partially effective in this model. Docking Site Peptide (DSP; 8.0 mg/kg), which decreased the dose of sctPA for successful fibrinolytic therapy in acute empyema model did not improve efficacy in combination with 2.0 mg/kg scuPA or sctPA. However, a two-fold increase in either sctPA or DSP (4.0 and 8.0 mg/kg or 2.0 and 16.0 mg/kg sctPA and DSP, respectively) resulted in 100% effective outcome. Thus, DSP-based Plasminogen Activator Inhibitor 1-Targeted Fibrinolytic Therapy (PAI-1-TFT) of chronic infectious pleural injury in rabbits increases the efficacy of alteplase rendering ineffective doses of sctPA effective. PAI-1-TFT represents a novel, well-tolerated treatment of empyema that is amenable to clinical introduction. The chronic empyema model recapitulates increased resistance of advanced human empyema to fibrinolytic therapy, thus allowing for studies of muti-injection treatments.

Uniportal versus triportal video-assisted thoracic surgery in the treatment of tuberculous empyema

To examine the effectiveness of decortication to treat chronic tuberculous empyema (TE) using uniport video-assisted thoracoscopic surgery (VATS) versus conventional triport VATS. Data from consecutive patients with stage II or III TE who underwent decortication with either uniport VATS (uniportal group) between July and December 2017, or triport VATS between January and July 2018 (triportal group), were retrospectively analysed. VATS procedures were performed under general anaesthesia with double lumen endotracheal intubation and clinical outcomes were compared between the two groups. Clinical data were comparable between the groups (20 patients in each) regarding demographic and baseline characteristics, operative and postoperative characteristics, surgical procedure-related complications, and postoperative adverse events. No surgical procedure-related complications occurred during the perioperative period in either group. Threshold values for mechanical pain at 8 h postoperatively were significantly higher in the triportal group versus the uniportal group. Furthermore, the incidence of nausea and vomiting was significantly lower in the uniportal versus triportal group. In the triportal group, one patient required readmission and further intervention due to recurrence. Uniport VATS decortication for stages II and III TE may be a feasible and safe procedure in selected patients. Moreover, uniport VATS may be less painful than triport VATS.

Intrathoracic negative pressure therapy for pleural empyema using an open-pore drainage film.

We report our initial experience with intrathoracic negative pressure therapy (ITNPT) in the stage-adjusted treatment of pleural empyema (PE) based on acase series. ITNPT represents afurther development for intrathoracic use. After thoracic surgical open debridement, an intrathoracic negative pressure dressing was inserted. The drainage elements were athin open-pore double-layer drainage film (OF) with open-pore polyurethane foams (PUF). Only the OF was placed in direct contact with the lung parenchyma. Negative pressure was generated using an electronic pump (continuous suction, -75 mm Hg). In revision thoracotomies, ITNPT was stopped or continued depending on local findings. In total, 31patients with stageII andIII pleural empyema underwent ITNPT, which was administered during the primary procedure (n = 17) or at revision (n = 14). Treatment duration was amean of 10days (2-18days) with amean change interval of 4days (2-6days). Intrathoracic negative pressure dressings were applied amean of 3.5 (1-6) times. The empyema cavity continuously reduced in size and was cleansed by the suction. The OF has aminimum intrinsic volume with maximum absorption surface. Once negative pressure is established, there is no intrathoracic dead volume and the parenchyma can expand. The protective material properties of OF make ITNPT suitable for the treatment of pleural empyema. Targeted local intrathoracic drainage of the septic focus is apossible adjunct to surgery. The surgical dressings must be changed repeatedly. The method is suitable for the treatment of complex stageII andIII pleural empyemas. The OF can be used as an intrathoracic drainage element for ITNPT in pleural empyema. This new application option expands the range of indications for negative pressure therapy.