1/27. Etiologic diagnosis of intrapleural empyema by counterimmunoelectrophoresis.Cultural methods failed to identify the infecting organism in 4 patients with intrapleural empyema. Antimicrobial drugs had been administered to 3 of the patients before their admssion to the hospital. In each case, soluble polysaccharides believed to be those of pneumococcus or hemophilus were detected in the empyema fluid by counterimmunoelectrophoresis. These findings provided a rational basis for management of antimicrobial therapy for 3 of the patients and useful information on the origins of the empyema in the fourth patient. counterimmunoelectrophoresis is a useful additional method for presumptively identifying the infecting organism in patients with intrapleural empyema.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/27. The syndrome of inappropriate secretion of antidiuretic hormone associated with anaerobic thoracic empyema.The syndrome of inappropriate secretion of antidiuretic hormone has been associated with many pulmonary diseases, including tuberculosis and bacterial and viral pneumonia: however, it has not been reported with anaerobic infections or empyema in the absence of pneumonia. We report a patient with empyema due to bacteroides melaninogenicus, bacteroides oralis, and peptostreptococcus who developed the syndrome. Eight hours before the start of therapy, his serum sodium concentration was 127 mEq per liter; serum osmolality, 255 mOsm per kg; urine osmolality, 522 mOsm per kg; urinary sodium concentration, 39 mEq per liter. The creatinine clearance and the adrenocorticotropic hormone stimulation test were normal, and there was no evidence of dehydration. No other causes of the syndrome of inappropriate secretion of antidiuretic hormone were apparent. With drainage and antimicrobial drug therapy, the empyema cleared, and the syndrome resolved in 8 days. The patient has been well, without evidence of inappropriate secretion of antidiuretic hormone, for 9 months. Anaerobic infections and/or empyema without pneumonia can be associated with the syndrome of inappropriate secretion of antidiuretic hormone.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
3/27. A novel procedure using a tissue expander for management of persistent alveolar fistula after lobectomy.We treated a patient with postlobectomy persistent alveolar fistula using a tissue expander, which is a prosthesis widely used in plastic surgery. The patient had thoracic empyema develop after right bilobectomy for lung cancer, and consequently underwent drainage of empyema followed by muscle flap closure for alveolar fistula. A residual space remained, and air leak persisted. However, implanting and expanding a tissue expander enabled us to tightly fix the flap on the raw pulmonary surface, which eventually solved the air leak. The tissue expander greatly contributed to muscle flap closure for a persistent alveolar-pleural fistula with a large remaining thoracic space.- - - - - - - - - - ranking = 16.485334438398keywords = closure (Clic here for more details about this article) |
4/27. Closure of a large bronchial fistula with a latissimus dorsi myocutaneous flap.We describe a case of a large bronchial fistula and empyema after right upper lobectomy that was treated successfully with open window thoracostomy followed by a latissimus dorsi myocutaneous flap and limited thoracoplasty. A latissimus dorsi myocutaneous flap can provide immediate airtight closure of a large bronchial fistula, allowing lavage and curettage of the empyema cavity to reduce the chance of postoperative infection. An important aspect of this technique is that the deepithelialized skin side rather than muscle is sutured to an opening of the bronchus. As compared with other techniques, a latissimus dorsi myocutaneous flap is superior in that it requires a single incision and does not require an intraoperative change of position. In addition, the technique causes little dysfunction of the chest and shoulder and preserves the vascular supply to ensure the viability of the flap even if it was divided in a previous operation.- - - - - - - - - - ranking = 8.2426672191989keywords = closure (Clic here for more details about this article) |
5/27. Management of empyema cavity with the vacuum-assisted closure device.Management of empyema after pulmonary resection remains a challenging problem. Along with mandatory drainage of the thoracic cavity and investigations to rule out bronchopleural fistula, a reliable method of thoracic cavity closure is needed. The open thoracic window and Eloesser flap techniques rarely represent definitive therapy. Muscle flap and thoracoplasty procedures may provide well-vascularized tissue to close bronchopleural fistula and obliterate the empyema cavity, but they are quite complex and involve significant patient morbidity. We report a case of empyema without bronchopleural fistula after lobectomy in which the vacuum-assisted closure device was used to achieve complete wound healing after open drainage.- - - - - - - - - - ranking = 49.456003315194keywords = closure (Clic here for more details about this article) |
6/27. Necrotizing pneumonitis and empyema caused by Streptococcus cremoris from milk.A 24-year-old heterosexual male, hiv-infected intravenous drug addict, with necrotizing pneumonitis and empyema due to Streptococcus cremoris is presented. The patient had fever, severe dyspnea and chest pain. Chest roentgenogram demonstrated pleural effusion on the left side. A thoracocentesis revealed purulent exudate and S. cremoris was isolated. fever and pleural effusion disappeared with penicillin and clindamycin therapy. The most likely source of the infection was ingestion of unpasteurized milk and cheese.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
7/27. Microvascular free muscle flaps for chronic empyema with bronchopleural fistula when the major local muscles have been divided--one-stage operation with primary wound closure.It should be emphasized that most cases of chest empyema can be successfully treated with conventional thoracic surgery procedures. For chronic empyema with a bronchopleural fistula complicated by previous division of major local muscles following repeated thoracotomies, free muscle flaps are employed. Five such cases treated with this method resulted in successful closure of the airway fistula, as well as complete obliteration of the empyema cavity in a single operation. This method is very effective in eradicating infection and achieves prompt wound healing, decreased morbidity, and gradual improvement of pulmonary function after surgery. Analysis of roentgen ray and computed tomographic scans before and after surgery shows lung expansion when the transferred muscles atrophy. The results are satisfactory. The method described here is not the only solution to this problem, but it is a new approach that has advantages not seen in conventional methods. It is indicated only in patients who have been operated on many times and who have no remaining available local muscles.- - - - - - - - - - ranking = 41.213336095995keywords = closure (Clic here for more details about this article) |
8/27. Contained thoracic empyema presenting as an anterior chest wall abscess: empyema necessitatis revisited.Protean manifestation of pulmonary and pleural space infections can be expected in drug addicts. Because of the need to establish strict environmental protection for staff and patients, even simple drainage procedures should be performed in the operating room. Without testing, these patients should be considered as potential carriers of the AIDS virus. If a subcutaneous abscess is found to extend into the pleural space, drainage and full lung expansion are attempted through a limited rib resection. If this is unsuccessful, a full thoracotomy should be done to meet these surgical objectives.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
9/27. Bilateral pyopneumothorax secondary to intravenous drug abuse.An intravenous drug abuser presented with bilateral pyopneumothoraces and bacteremia which is a previously unreported complication of jugular vein self-injection. The patient sustained direct pleural trauma and resultant infection by injecting herself with contaminated needles.- - - - - - - - - - ranking = 5keywords = drug (Clic here for more details about this article) |
10/27. A modified pectoralis muscle flap for closure of postpneumonectomy esophagopleural fistula: technique and results.In surgical treatment of late postpneumonectomy esophagopleural fistula, closure of the empyema space is of prime importance. A wide thoracoplasty and ample decapitation of the empyema cavity allow sufficient room for a modified pectoralis muscle flap, which provides sufficient mass to obliterate the entire empyema cavity. We present the cases of 2 patients in whom an esophagopleural fistula occurring 3 and 16 years after pneumonectomy was successfully closed by this method.- - - - - - - - - - ranking = 41.213336095995keywords = closure (Clic here for more details about this article) |
| | Next -> |