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[Thoracic empyema. Focus on bacteriology and therapy].
Acta Chirurgica Belgica
|March 1, 1985
Summary
Effective pleural drainage is key for treating empyema thoracis. Surgical intervention is crucial if initial drainage fails, with specific procedures like pleural debridement or open-window thoracostomy chosen based on cavity size and lung condition.
Area of Science:
- Thoracic Surgery
- Infectious Diseases
- Pulmonary Medicine
Context:
- Empyema thoracis presents significant treatment challenges, particularly with large residual pleural cavities or bronchopleural fistulas.
- The study analyzed 63 patients, including post-surgical cases (pneumonectomy, lobectomy) and those without prior surgery.
Purpose:
- To evaluate treatment strategies and outcomes for empyema thoracis.
- To identify effective interventions for complex cases involving residual pleural space or bronchopleural fistula.
Summary:
- Initial treatment involved pleural drainage, irrigation, and systemic antibiotics in 87% of patients.
- Enzymatic debridement (40%) and intrapleural antibiotics (30%) were employed. Subsequent surgical interventions included pleural debridement (12), pleuropneumonectomy (2), and open-window thoracostomy (12).
- Bacteriology revealed Staphylococcus aureus (43%), Gram-negative bacilli (40%), and anaerobes (21.5%).
Impact:
- 43 patients were cured, 11 died, and 8 developed chronic infections.
- Highlights the importance of timely pleural drainage and appropriate surgical selection (debridement, pleuropneumonectomy, or thoracostomy) based on clinical presentation.
- Emphasizes open-window thoracostomy for extensive residual spaces or bronchopleural fistulas post-failure of other treatments.