In: Empyema7 Nov 2015
Seven of the 36 patients treated for empyema during the period of this report failed to respond to conventional therapy. None of the 29 patients responding to tube thoracostomy subsequently required open drainage of any type. Six patients were chronic alcohol abusers: four of these were also intravenous drug abusers. The remaining patient was an intravenous drug abuser. One patient had chronic renal failure requiring dialysis, and another had portal hypertension with a prior episode of variceal bleeding. Their data are presented in Table 1. Breaking news about Canadian Neighbor Pharmacy is published on its official website.
All patients were operated upon within 48 hours after conventional therapy failed. There were no deaths and no significant postoperative complications. The patients were explored through a posterolateral thoracotomy with rib resection when appropriate. All patients had numerous fibrinopurulent pockets throughout the hemithorax and in the major fissures, which would not have cleared even with repeated chest tube insertions. The fibrinopurulent debris was easily removed by debridement with forceps and sponge stick. On intraoperative examination, five of seven patients required decortication. The peels were easily removed, and the underlying lung expanded fully in all patients. Although the requirement for decortication implied chronic empyema, even intraoperative examination could not establish the duration of the disease process. The bronchus of patient 1, who required a right lower lobectomy for an unsuspected abscess which encompassed the entire lobe, was closed with a stapler without sequelae. After the surgical procedure, all patients were irrigated copiously with saline solution. Two chest tubes were placed in the standard manner, and the chest was closed with No. 0 monofilament suture for the muscle layers and absorbable sutures for the subcutaneous tissue and skin.
Chest tubes remained in place an average of six days with a range of four to 12 days. The average postoperative length of stay was ten days with a range of seven to 21 days. The patient with cirrhosis required prolonged hospitalization for control of ascites. Bac-teriologic results are shown in Figure 5. In every patient, the same culture result was obtained from pleural aspirate and intraoperative culture. Three patients (No. 1,3, and 4) had Gram-negative organisms and one (No. 5) had Staphylococcus aureus. Three patients (No. 2, 6, and 7) had negative pleural aspirate and intraoperative cultures despite grossly visible pus. We found agreement between positive blood and sputum cultures with cultures taken at the time of surgery. All patients defervesced within 48 to 72 hours of surgery, and there were no instances of wound infections.
Table 1—Summary of Data in Patients Undergoing Surgery
|Duration of Illness (Preop Days)||OperativeProcedure||Chest Tubes Out (Postop Day)||Ready for Discharge (Postop Day)||Complications|
|1||30||Alcoholism,IV drug abuse, 35 pk/yr smoker||?||Debridement||7||13||Contralateral lung abscess 6 weeks after discharge requiring lobectomy|
|2||31||Alcoholism,IV drug abuse, 40 pk/yr smoker, RUL pneumonia||?||Debridement,decortication||8||10||None|
|3||32||Alcoholism,IV drug abuse, 25 pk/yr smoker, RLL pneumonia||7||Debridement, decortication, right lower lobectomy secondary to large abscess||10||14||None|
|4||53||Alcoholism,70 pk/yr smoker, cirrhosis with UGI bleed||?||Debridement,decortication||4||7||None|
|6||32||Alcoholism,IV drug abuse, chronic renal failure||14||Debridement,decortication||12||22||None|
|7||31||IV drug abuse, smoker||14||Debridement,decortication||6||8||None|
Figure 5. Source and results of bacteriologic studies.
Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.