1/22. Microvascular vastus lateralis muscle flap for chronic empyema associated with a large cavity.Thoracic empyema can be disabling and may need microvascular free flaps in some intractable cases. After repeated failure of conventional thoracic surgical procedures, 2 patients with empyema were treated with microvascular free vastus lateralis muscle flaps for obliteration of the large empyema cavity. The reconstruction was successful in wound closure and eradication of infection. The donor site morbidity was minimal, and the patients resumed normal daily activities. Microvascular vastus lateralis muscle flap is the best option if free flaps are required for reconstruction of empyema.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/22. Bilateral empyema caused by adult-onset Still's disease.Empyemas are usually of infectious origin. Noninfectious causes of empyema may be a considerable diagnostic challenge, as exemplified in the present case report. A 21-year-old male presented with high fever, sore throat and myalgias of 1 week duration. In the following days, bilateral pleural effusions developed, with cellular counts in the pleural fluid up to 117 x 10(9)/liter (98% neutrophils). Despite institution of empiric antibiotic therapy, spiking fever continued. All culture studies resulted in being negative. Following the report of a serum ferritin concentration of 6,975 microg/l, adult-onset Still's disease was diagnosed and successfully treated with anti-inflammatory drugs. This case adds adult-onset Still's disease to the list of noninfectious causes of empyema and underlies the value of measuring serum ferritin as a diagnostic tool.- - - - - - - - - - ranking = 0.033693968496445keywords = drug (Clic here for more details about this article) |
3/22. The use of a Dumon stent for the treatment of a bronchopleural fistula.We report the successful management of a bronchopleural fistula with bronchial stent placement combined with irrigation of the empyema cavity. A bronchopleural fistula occurred in a 67-year-old man after a right upper lobectomy for lung cancer. Resuturing of the bronchial stump plus omental wrapping and subsequent closure of the open stump with a pedicled flap of intercostal muscle were not effective. Consequently, we placed a Dumon stent in the right main bronchus to close the stump.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
4/22. Transsternal transpericardial closure of a postlobectomy bronchopleural fistula.We report a case of chronic empyema and bronchopleural fistula after lobectomy for tuberculosis. The patient had undergone four different surgical procedures to correct his bronchopleural fistula during an interval of seven years. Finally, he had a successful closure of the fistula using the transsternal transpericardial approach.- - - - - - - - - - ranking = 5keywords = closure (Clic here for more details about this article) |
5/22. empyema complicating muscle-sparing thoracotomy: the role of wound management.The fascial layers bordering the latissimus dorsi and anchoring the serratus muscles often do not lend themselves to impervious closure during muscle-sparing thoracotomy. Fluid from the subcutaneous space may therefore drain into the pleural cavity after such procedures. If this fluid is contaminated with microorganisms the potential for development of empyema is present. Two patients are presented in whom this scenario was presumed to have occurred. Early intervention in the second patient was felt to have avoided the development of a major empyema.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
6/22. Delayed closure of persistent postpneumonectomy bronchopleural fistula.A 73-year-old man with a history of postpneumonectomy empyema and a long-term chest tube since 1979 presented with fever, chills, leukocytosis, and purulent fluid from the left tube thoracostomy. CT scan and bronchoscopy demonstrated a right lower lobe pneumonia and a left mainstem dehiscence with direct communication to the left tube thoracostomy. He underwent primary closure of the bronchopleural fistula with latissimus dorsi muscle flap coverage after antibiotic therapy for right lower lobe pneumonia.- - - - - - - - - - ranking = 5keywords = closure (Clic here for more details about this article) |
7/22. haemophilus segnis polymicrobial and monomicrobial bacteraemia identified by 16S ribosomal rna gene sequencing.This paper reports a case of haemophilus segnis polymicrobial bacteraemia and a case of H. segnis monomicrobial bacteraemia identified by 16S ribosomal rna gene sequencing. In the first case, a gram-negative aerobic coccobacillus was isolated with streptococcus intermedius and S. sanguis from the blood culture of a 32-year-old intravenous drug addict with left thoracic empyema. In the second case, a gram-negative aerobic coccobacillus was isolated from the blood culture of an 82-year-old woman with clostridium difficile colitis and septicaemic shock. Both gram-negative coccobacilli grew on chocolate agar as colonies of 1 mm in diameter after incubation for 24 h at 37 degress C in air with CO2 5%, but only to pinpoint sizes on blood agar under the same incubation conditions. Both strains were factor v-dependent, but not factor x-dependent. For the first isolate, the Vitek system (NHI) showed that it was 56% likely to be actinobacillus actinomycetemcomitans and 40% neisseria subflava; whereas the API system (NH) showed that it was 58% likely to be H. aphrophilus/paraphrophilus and 42% H. parainfluenzae. For the second isolate, the Vitek system (NHI) showed that it was 95% likely to be H. influenzae VIII; whereas the API system (NH) showed that it was 58% likely to be H. aphrophilus/paraphrophilus and 42% H. parainfluenzae. 16S rRNA gene sequencing showed that there were four base differences between isolate 1 and H. segnis and two base differences between isolate 2 and H. segnis, indicating that both isolates most closely resembled a strain of H. segnis. Only two cases of H. segnis bacteraemia were found in the English scientific literature, one in a case of infective endocarditis and the other in a case of pancreatic abscess. Including the present two cases, the overall mortality of H. segnis bacteraemia was 50%.- - - - - - - - - - ranking = 0.033693968496445keywords = drug (Clic here for more details about this article) |
8/22. Simultaneous bronchopleural and esophagopleural fistulas after pneumonectomy.The simultaneous occurrence of bronchopleural fistula (BPF) and esophagopleural fistula (EPF) after pneumonectomy is very rare. We describe a 60-year-old man who developed empyema associated with bronchopleural fistula as a complication of a right pneumonectomy. Initial chest tube drainage and antibiotic therapy were ineffective. Five months later ingested food particles appeared in the drainage fluid. esophagoscopy revealed an esophageal fistula of 10 mm in diameter. After nutritional support by feeding jejunostomy both BPF and EPF were repaired by subscapular muscle myoplasty and extensive thoracoplasty through a right thoracotomy. Endoscopic examination performed 1 month after surgery showed complete closure of both fistulas and 9 months after surgery the patient was eating and gaining weight. The patient's death was due to aspiration pneumonia of another origin.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
9/22. Pedicled intercostal muscle flap: a simple technique of closing pancreatico-pleural fistula from a thoracic approach.A simple technique to close a pancreatico-pleural fistula in the course of thoracotomy and decortication for multiloculated empyema complicating acute haemorrhagic pancreatitis is described. Friable diaphragmatic tissue around the fistula made direct closure not a suitable option. The intercostal muscle flap of the thoracotomy space was mobilized on the anterior intercostal artery, tagged around the fistula into healthy diaphragmatic tissue. This simple technique was successful in closing the fistula and helping control the sepsis.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
10/22. Iatrogenic pleuropulmonary charcoal instillation in a teenager.Activated charcoal given through a nasogastric tube is a standard intervention for many types of toxic ingestions in the emergency department. This case study describes a teenage girl whose multidrug overdose was complicated by accidental charcoal instillation into her left lung and pleural space through a misplaced nasogastric tube. The ensuing empyema did not respond to antibiotic therapy alone, probably due to the inherent properties of charcoal, and required a chest tube placement with continuous irrigation. Unlike previously reported cases, this patient did well clinically, without long-term morbidity.- - - - - - - - - - ranking = 0.033693968496445keywords = drug (Clic here for more details about this article) |
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