Preliminary results of streptokinase in the treatment of exudative \r\n', u'pleural effusions and empyema \r\n', u'

Background: Standard treatment for pleural infection includes of drainage and antibiotics. Chest tube drainage often fails if the fluid is loculated by fibrinous adhesions. Intrapleural fibrinolysis may facilitate pleural drainage. Objective: To evaluate the role of Streptokinase (STK) in the treatment of empyema and exudative pleural effusions. Subjects and method: A study included 34 patients (21 patients with exudative pleural effusions, 13 patients with empyema), aged 15-77 years. All patients received intrapleural STK daily with dose of 300.0000-500.000 UI for empyema and 300.000 UI for exudative pleural effusions. Response was assessed by clinical outcome, pleural fluid drainage, chest radiography, pleural ultrasound. Results: Mean pleural fluid drainage after STK instillation was higher in all patients. Pleural fluid drainage was 640 \xb1 494 ml before STK instillation and 823 \xb1 755 ml after STK instillation for empyema; 765 \xb1 691 ml before STK instillation and 1,033 \xb1 757 ml after STK instillation for exudative pleural effusions. The success rate of clinical outcome was 100%. Only 2 patients required decortications. Fever occurred in 3 patients (8.8%) and allergy in 1 patient (3%). Conclusions: Intrapleural STK was safe and effective in the treatment of empyema and exudative pleural effusions. STK prevents pleural adhesions and reduces the risks for surgery.

Studying on value of thoracoscopy in the diagnosis and treatment of pneumothorax

Background: Thoracoscopy has used for lots of thoracic disorders. Pneumothorax may be ideally suited for thoracoscopic management. Objective: To study the value of thoracoscopy in the diagnosis and treatment of pneumothorax. Subjects and method: From September 2003 to October 2006, 30 patients with pneumothorax were treated by thoracoscopy at Department of Respiratory of Bach Mai Hospital. This was a longitudinal, retrospective and prospective study. Prospective study included 15 patients from September 2005 to October 2006. Retrospective study included 15 patients from September 2003 to August 2005. Results: In 30 patients, primary spontaneous pneumothorax accounted for 80%, secondary spontaneous pneumothorax 13.3%, catamenial pneumothorax 3.3% and iatrogenic pneumothorax 3.3%. Mean age of patients was 34\xb115 years (ranged from 17 to 77 years). 90% of cases were male. Bullea was found in 70% by thoracoscopy. Patients were in stage I 13.3%, stage II 20%, stage III 33.3%, and stage IV 33.3%. There were 3 procedures with ligation, 11 procedures with coagulator, 25 procedures with talc poudrage; mean dose of talc was 8.2\xb12.2 g. The success rates of procedures with talc poudrage were 80% and 100% after supplemental pleurodesis. Complications and side effects were subcutaneous emphysema 46.7%, empyema 3.3%, high fever 3.3% that we thought was nosocomial infections, bleeding in pleural cavity 3.3%, chest pain 96.7%, fever 63.3%, dyspnea 10%. After a mean follow up of 14.1\xb110.4 months, the recurrent rate was 3.3%. Conclusions: Medical thoracoscopy achieved a high success rate in the diagnosis and treatment of pneumothorax.