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Georgios Chalkiadakis - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracoscopic surgery for thoracic Empyema primarily or after fibrinolytic therapy failure
American Journal of Surgery, 2004Co-Authors: Ioannis E Petrakis, Nektarios Kogerakis, Ioannis Drositis, Kostas G Lasithiotakis, Demosthenes Bouros, Georgios ChalkiadakisAbstract:Abstract Background Traditional and modern treatments are proposed for thoracic Empyema. The efficacy of video-assisted thocoscopic surgery (VATS) has been studied when the method is applied either as primary treatment for thoracic Empyema or after the failure of fibrinolytic therapy. Methods Thirty-eight patients treated with VATS for thoracic Empyema have been reviewed. Of those, 20 patients (group 1) with Empyema thoracis were referred to VATS after failure of the fibrinolytic treatment. Another 18 patients (group 2) with primary Empyema thoracis were treated thoracoscopically immediately when Empyema was diagnosed. Both groups were staged 5, 6, or 7 according to Light's criteria. Results The group 2 patients showed a higher Empyema resolving rate (95% versus 85%), shorter hospital stay (4.5 versus 7.5 days), and significantly shorter duration of the procedure (70 ± 14 versus 62 ± 10 minutes) in comparison with the patients of group 1. Conclusions The VATS technique for thoracic Empyema is a well-tolerated, minimally invasive technique, with excellent therapeutic results, mild postoperative complications, and reduced hospitalization. VATS should be considered as the treatment of choice for thoracic Empyema, in the fibrinopurulent stage, as it is more effective when applied primarily than when applied after fibrinolytic therapy.
John E. Greenlee - One of the best experts on this subject based on the ideXlab platform.
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Subdural Empyema
Current Treatment Options in Neurology, 2003Co-Authors: John E. GreenleeAbstract:Subdural Empyema represents loculated infection between the outermost layer of the meninges, the dura, and the arachnoid. The Empyema may develop intracranially or in the spinal canal. Intracranial subdural Empyema is most frequently a complication of sinusitis or, less frequently, otitis or neurosurgical procedures. Spinal subdural Empyema is rare and may result from hematogenous infection or spread of infection from osteomyelitis. The most common organisms in intracranial subdural Empyema are anaerobic and microaerophilic streptococci, in particular those of the Streptococcus milleri group ( S. milleri and Streptococcus anginosus ). Staphylococcus aureus is present in a minority of cases, and multiple additional organisms, including Gramnegative organisms, such as Escherichia coli , and anaerobic organisms, such as Bacteroides , may be present. Pseudomonas aeruginosa or Staphylococcus epidermidis may be present in cases related to neurosurgical procedures, and Salmonella species have been detected in patients with advanced AIDS; multiple organisms may be present simultaneously. Spinal subdural Empyemas are almost invariably caused by streptococci or by S. aureus . Subdural Empyema—whether it occurs in the skull or the spinal canal—may cause rapid compression of the brain or spinal cord, and represents an extreme medical and neurosurgical emergency. The diagnostic procedure of choice for intracranial and spinal subdural Empyema is MRI with gadolinium enhancement. Computed tomography scan may miss intracranial subdural Empyemas detectable by MRI. Conversely, occasion spinal subdural Empyemas may be detected by CT myelography where MRI is negative. Treatment in virtually all cases of intracranial or spinal subdural Empyema requires prompt surgical drainage and antibiotic therapy. Pus from the Empyema should always be sent for anaerobic, as well as aerobic, culture. Because intracranial subdural Empyemas may contain multiple organisms, provisional antibiotic therapy of intracranial subdural Empyema, where the organism is unknown, should be directed against S. aureus , microaerophilic and anaerobic streptococci, and Gram-negative organisms. Antibiotics should include 1) nafcillin, oxacillin, or vancomycin; plus 2) a third generation cephalosporin; plus 3) metronidazole. Provisional antibiotic therapy of spinal subdural Empyemas should be directed against S. aureus and streptococci, and should include nafcillin, oxacillin, or vancomycin. Morbidity and mortality in intracranial and spinal subdural Empyema relate directly to the delay in institution of therapy. Both conditions should, thus, be treated with great urgency.
Ioannis E Petrakis - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracoscopic surgery for thoracic Empyema primarily or after fibrinolytic therapy failure
American Journal of Surgery, 2004Co-Authors: Ioannis E Petrakis, Nektarios Kogerakis, Ioannis Drositis, Kostas G Lasithiotakis, Demosthenes Bouros, Georgios ChalkiadakisAbstract:Abstract Background Traditional and modern treatments are proposed for thoracic Empyema. The efficacy of video-assisted thocoscopic surgery (VATS) has been studied when the method is applied either as primary treatment for thoracic Empyema or after the failure of fibrinolytic therapy. Methods Thirty-eight patients treated with VATS for thoracic Empyema have been reviewed. Of those, 20 patients (group 1) with Empyema thoracis were referred to VATS after failure of the fibrinolytic treatment. Another 18 patients (group 2) with primary Empyema thoracis were treated thoracoscopically immediately when Empyema was diagnosed. Both groups were staged 5, 6, or 7 according to Light's criteria. Results The group 2 patients showed a higher Empyema resolving rate (95% versus 85%), shorter hospital stay (4.5 versus 7.5 days), and significantly shorter duration of the procedure (70 ± 14 versus 62 ± 10 minutes) in comparison with the patients of group 1. Conclusions The VATS technique for thoracic Empyema is a well-tolerated, minimally invasive technique, with excellent therapeutic results, mild postoperative complications, and reduced hospitalization. VATS should be considered as the treatment of choice for thoracic Empyema, in the fibrinopurulent stage, as it is more effective when applied primarily than when applied after fibrinolytic therapy.
Surinder K Jindal - One of the best experts on this subject based on the ideXlab platform.
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clinical characteristics and outcomes of Empyema thoracis in 117 patients a comparative analysis of tuberculous vs non tuberculous aetiologies
Respiratory Medicine, 2007Co-Authors: Pankaj Malhotra, Ashutosh N Aggarwal, Ritesh Agarwal, Pallab Ray, Dheeraj Gupta, Surinder K JindalAbstract:Summary Background Empyema thoracis remains a major problem in developing countries. Clinical outcomes in tuberculous Empyema are generally believed to be worse than in non-tuberculous aetiologies because of the presence of concomitant fibrocavitary parenchymal disease, frequent bronchopleural fistulae and poor general condition of patients. We performed a prospective study over a 2-year period with the objective of comparing the clinical characteristics and outcomes of patients with tuberculous vs. non-tuberculous Empyema. Methods Prospective study of all cases of non-surgical thoracic Empyema seen at a tertiary care centre in North India over a 2-year period. A comparative analysis of clinical characteristics, treatment modalities and outcomes of patients with tuberculous vs. non-tuberculous Empyema was carried out. Factors associated with poor outcomes were analysed using multivariate logistic regression. Results One hundred and seventeen cases of Empyema were seen in the study period of which 95 had non-tuberculous and 41 had tuberculous Empyema. Malnutrition and bronchopleural fistulae (BPF) were more common and duration of symptoms longer in the tuberculous Empyema group. Time to resolution of fever, duration of pleural drainage and pleural thickening >2 cm were significantly greater as well. Eight (10.5%) patients with non-tuberculous Empyema and four (9.8%) with tuberculous Empyema succumbed. Presence of a BPF was significantly associated with poor outcomes on multivariate logistic regression analysis. Conclusions Tuberculous Empyema remains a common cause of thoracic Empyema in India though it ranked second amongst all causes of Empyema after community acquired lung infections in this study. Tuberculous Empyema is associated with longer duration of symptoms, greater duration of pleural drainage and more residual pleural fibrosis.
Elspeth S Kay - One of the best experts on this subject based on the ideXlab platform.
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surgical versus non surgical management of pleural Empyema
Cochrane Database of Systematic Reviews, 2009Co-Authors: Nicky Coote, Elspeth S KayAbstract:BACKGROUND Pleural Empyema is a collection of pus between the lungs and the chest wall. Approximately 50% of cases complicate pneumonia. There are a variety of treatment options ranging from intravenous antibiotics alone to open thoracotomy and debridement, depending in part on the stage of the Empyema and the severity. The condition changes with time, becoming loculated and more difficult to drain. There is much debate about the most appropriate therapy particularly with the advent of new treatments such as fibrinolytic enzymes (e.g. streptokinase, urokinase) and video-assisted thoracoscopic surgery (VATS). OBJECTIVES To determine which is more effective for the management of Empyema: surgical (e.g. thoracoscopy, thoracotomy) or non-surgical techniques (e.g. thoracocentesis, chest tube drainage) and to establish whether there is an optimum time for intervention. SEARCH STRATEGY The Cochrane Controlled Trials Register and DARE database were searched in addition to the Cochrane Acute Respiratory Infections Group's own register of trials. A specialised topic search with no language restrictions was used to search MEDLINE and EMBASE using Silverplatter. Bibliographies and the reference lists of identified studies and review articles were handsearched. Personal communication with authors and experts in the field is ongoing. SELECTION CRITERIA Randomised controlled trials (RCTs) of surgical techniques versus non-surgical approaches for treatment of pus in the pleural cavity in children and adults but not neonates. Studies of Empyema associated with tuberculosis or malignancy were excluded. DATA COLLECTION AND ANALYSIS Trial quality was assessed using Jadad criteria as recommended by the ARI group (Jadad 1996). The primary outcomes were death or resolution of the Empyema. Secondary outcomes addressed length of time chest tubes were required, pain, hospital stay and any complications. MAIN RESULTS Only one small randomised study was identified which met the inclusion criteria. It was conducted in a university thoracic surgery department. There were some methodological quality considerations which cast some doubt on validity ( patient selection, unclear allocation concealment and outcome assessor blinding) and it scored 'B' overall (Jadad score 3). The main results of the study were that when compared with chest tube drainage combined with streptokinase, the video-assisted thoracoscopic surgery (VATS) group had a significantly higher primary treatment success and spent less time in hospital. Each group suffered one mortality. REVIEWER'S CONCLUSIONS It would appear that for large, loculated pleural Empyemas VATS is superior to chest tube drainage with streptokinase in terms of duration of chest tubes and hospital stay. However there are questions about validity and the study is also too small to draw conclusions. There are risks of complications (associated with all treatments) which may not apparent with small numbers. VATS is performed under general anaesthetic and one lung ventilation. Fibrinolytics are also associated with side effects. Further larger multicentre studies need to be conducted.