Thoracoscopic Retrieval of Unusual Iatrogenic Foreign Bodies.

Background: Management of pyothorax and pneumothorax requires aspiration and/or intercostal drainage. Case characteristics: We present two cases which were complicated by instrument-related events resulting in breakage of needle or intercostal drainage tube resulting in pleural foreign body. Intervention/Outcome: The patients were stabilized and the foreign bodies retrieved using thoracoscopic approach. Message: Thoracoscopy provides a minimally invasive approach to deal with pleural foreign bodies.

Conservative treatment and surgical treatment of cervical cellulitis combineing mediastinal pleural abscess / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the diagnosis, treatment and curative effect of cervical cellulitis combineing mediastinal pleural abscess. Method:Clinical data of 37 patients with the cervical cellulitis and mediastinal pleural abscess were analyzed, all patients were confirmed using ultrasond, X-ray, CT, puncture and microbiology examination. The result will analysis the diagnosis, treatment and curative effect through the comparison of conservative treatment and surgical treatment. Result:Twenty-three cases of patients were underwent tracheotomy because of difficulty in breathing and successfully extubated after treatment. Nine cases of patients were given anti-infection treatment and recovered after conservative treatment. Twenty-one cases of neck multiple pus cavity were underwent cavity incision, full removal of necrotic tissue and pipe flushing; 7 cases of patients with neck and mediastinal abscess and within which 2 cases were with toxic shock were underwent adequate drainage of lavage and abscess incision through jugular joint path; the companion of pyothorax in 2 cases were underwent the chest closed drainage. All patients were giving sensitive antibiotic after drug sensitive test, anti-shock treatment and supportive treatment. All the patients were recovered and discharged. The average hospitalization days with conservative treatment of these patients were 15.7 days, and the average hospitalization days with surgical treatment of patients were 25.3 days. Conclusion:The condition of cervical cellulitis is complex, a few case can be cured with conservative treatment. The others progress rapidly when merging mediastinal pleural abscess can cause serious complications, surgical treatment is risky, fully abscess incision, lavage drainage and combine with sensitive antibiotics and supportive treatment are the keys to therapy.

Single pore video-assisted thoracoscopic surgery for patients with acute pyothorax / 局解手术学杂志

Objective To explore the curative effect of the single pore video-assisted thoracoscopic surgery and thoracic closed drainage for patients with acute pyothorax by comparing the advantage and disadvantage of two methods.Methods The clinical data of 65 patients with acute pyothorax in our hospital from January 2012 to June 2015 were retrospectively analyzed.Of which 30 patients underwent single pore video-assisted thoracoscopic surgery were as observation group,35 cases received thoracic closed drainage were as the control group.The cura-tive effect of two methods for acute pyothorax was compared by analyzing the result data of two groups.Results The postoperative chest tube indwelling time,length of hospital stay,postoperative antibiotics of observation group were significantly less than those of the control group,the difference was statistically significant(P<0.05).And the incidence of postoperative complications,the proportion of the chronic pyothorax and secondary tube rate of observation group were lower than those of the control group,the difference was statistically significant(P<0.05). Conclusion The single pore video-assisted thoracoscopic surgery is safe and effective for treatment of acute pyothorax, which is worth promoting.

Diffuse Large B-cell Lymphoma Arising from Chronic Tuberculous Empyema

Pyothorax-associated lymphoma is a relatively rare type of lymphoma that occurs in patients who have long histories of tuberculous pleuritis or induced pneumothorax. It is a type of non-Hodgkin's lymphoma of mainly the B-cell phenotype and is strongly associated with Epstein-Barr virus infection. A majority of these cases have been reported in Japan, although some cases have occurred in Western countries. Here, we describe a case of pyothorax-associated lymphoma in a patient with a 30-year history of chronic tuberculous empyema. The patient underwent decortication under the impression of chronic empyema with fistula. The histopathologic diagnosis was a diffuse large B-cell lymphoma associated chronic inflammation.

Efficacy Observation of Intrapleural Injection with Urokinase in the Treatment of Tuberculous Pyothorax / 中国药师

Objective:To observe the efficacy and safety of intrapleural injection with urokinase ( UK) in the treatment of tubercu-lous pyothorax. Methods:Totally 120 patients with tuberculous pyothorax were randomly divided into two groups. The vomicae in the control group were rinsed with 5% sodium bicarbonate, and those in the observation group were treated with UK. The total effective rate, symptom relief time, closure time of vomicae, pleural thickness changes and adverse reactions were observed in the two groups. Results:The total effective rate of the control group and the observation group respectively was 81. 7% and 98. 3%, which showed sta-tistically significant difference (P<0. 01). The symptom remission time and the pus cavity closure time of the observation group were shorter than those of the control group (P<0. 05). The pleural thickness of the observation group was thinner than that of the control group at the end of the treatment (P<0. 05). The incidence of adverse drug reactions in the observation group was significantly higher than that in the control group (P<0. 01). Conclusion:The curative effect of UK in the treatment of tuberculous pyothorax is better than that of sodium bicarbonate, however, it is necessary to pay attention to monitoring such adverse reactions as bleeding, low heat and the others.

Ipsilateral Reexpansion Pulmonary Edema Developed after Decortication: A Case Report / 대한구급학회지

Reexpansion pulmonary edema (RPE) is a rare but sometimes fatal complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis. We experienced a case of RPE that developed following decortication. A 46 year-old female had a decortication for pyothorax under one-lung anesthesia. There was no event during the operation and results of arterial blood gas analysis were within normal limits. After the operation, tracheal extubation was performed and 100% oxygen saturation on a pulse oximeter (SpO2) was maintained with 100% O2, (8 L/min) via mask ventilation with self-respiration. The patient, with 50% Venturi mask, was transported to the intensive care unit (ICU). On arrival at the ICU, a SpO2 of 80% was detected and arterial blood gas analysis revealed hypoxemia with acute hypercapnic respiratory acidosis. Fortunately, reexpansion pulmonary edema was detected early and intensive treatment was performed using mechanical ventilation with positive end-expiratory pressure. Tracheal extubation was performed after 1 day of mechanical ventilation. The reexpansion pulmonary edema was successfully treated and the patient recovered without any complications.

Results of Application of Video-Assisted Thoracoscopic Surgery for the Treatment of Empyema Thoracis / 결핵및호흡기질환

BACKGROUND: Since video-assisted thoracoscopic surgery (VATS) was introduced as a new treatment modality for empyema thoracis, numerous reports have suggested that VATS is a more effective treatment method than the traditional methods that mainly use antibiotics and drainage apparatus. However, no confirmative evidence of the superiority of VATS over the traditional method has been provided yet. METHODS: We attempted to evaluate the efficacy of VATS for the treatment of empyema thoracis by reviewing past medical records and simple chest films. First, we divided the patients into two groups based on the treatment method: group A of 15 patients who were treated with the traditional method between January 2001 and December 2003, and group B of 9 patients who were treated with VATS between December 2003 and August 2006. The final outcomes used in this study were the number of days of hospital stay, chest tube duration, leukocytosis duration, febrile duration, and intravenous antibiotics usage duration. In addition, radiological improvements were compared. RESULTS: The mean age(+/-standard deviation) of 11 men and 4 women in group A was 58.2+/-15.7 years, and of 9 men and 2 women in group B was 51.6+/-9.5 years. Group B had a significantly shorter hospital stay (16.6+/-7.4 vs. 33.7+/-22.6 days; p=0.014), shorter chest tube duration (10.5+/-5.7 vs. 19.5+/-14.4 days; p=0.039), shorter leukocytosis duration (6.7+/-6.5 vs. 18.8+/-13.2 days; p=0.008), shorter febrile duration (0.8+/-1.8 vs. 9.4+/-9.2 days; p=0.004), and shorter duration of intravenous antibiotics usage (14.9+/-6.4 vs. 25.4+/-13.9 days; p=0.018). However, radiological improvements did not show any statistical differences. CONCLUSION: Early application of VATS for empyema thoracis treatment reduced hospital stay, thoracostomy tube duration, leukocytosis duration, febrile duration, and antibiotics usage duration in comparison with the traditional methods. The early performing of VATS might be an effective treatment modality for empyema thoracis.

Two cases of Empyema(pyothorax) caused by Mycoplasma pneumoniae Pneumonia in Children / 소아알레르기및호흡기학회지

Mycoplasma pneumoniae is the only known human pathogen among the Mycoplasma species isolated from the human respiratory tract. This pathogen causes respiratory infections most commonly in school-aged children and young adults. It may causes a variety of pulmonary manifestations and a few complication. empyema(pyothorax) as a complication of mycoplasma infection in children has been rarely reported. We report these two cases of empyema(pyothorax) preceded by Mycoplasma pneumoniae pneumonia in 5-year-old boy and 6-year-old girl. They were successfully managed by administration of antibiotics as well as surgical drainage.

Imaging Diagnosis of Chronic Tuberculous Pyothorax Associated with Malignant Tumors:A Report of 3 Cases / 实用放射学杂志

Objective To study the clinical and imaging features of chronic tuberculous pyothorax associated with malignant tumors.Methods Imaging features of three cases of chronic tuberculous pyothorax associated with malignant tumors proved by pathology were analyzed with literatures reviewed.Results On chest radiograph and CT,thickening and calcification of the parietal and visceral pleura,soft tissue masses in the lung field adjacent to the empyema were showed.The soft tissue masses were connected with the wall of empyema,the density was homogeneous(one case) or heterogeneous(2 cases).At the location which masses connected with the empyema,the calcifications were removal,decreased or discontinuous.Conclusion The imaging features of chronic tuberculous pyothorax associated with malignant tumors are of some characteristics,especially the appearances of calcification,soft mass and haziness of fat plane are more valuable for diagnosis.