Transforming growth factor beta1 (TGF-ß1) levels in a rat model of induced pleural empyema

Abstract Purpose: To evaluate the concentration of transforming growth factor beta 1 (TGFB1) levels in a rat pleural effusion obtained by inoculation of intrapleural bacteria or turpentine through thoracentesis. Methods: Thirty-Nine Wistar rats were divided into three groups: Staphylococcus aureus (SA, n = 17); Streptococcus pneumoniae (SP, n = 12); and turpentine (control, n = 10). Pleural fluid was collected through ultrasound-guided thoracentesis 12 h, 24 h, and 36 h after instillation of bacteria or turpentine. Levels of TGFB1 were measured in pleural fluid. Results: At 12 h, mean TGFB1concentrations were 5.3450 pg/mL in the SA group, 5.3449 pg/mL in the SP group, and 5.3450 pg/mL in controls. At 24 h, they were 4.6700 pg/mL in the SA group, 4.6700 pg/mL in the SP group, and 4.6700 pg/mL in controls. At 36 h, they were 4.6699 pg/mL in the SA group and in control. No difference was observed among the groups in mean TGFB1concentration (p = 0.12); however, a significant intragroup reduction in mean TGFB1 was observed between 12 and 24 h (p < 0.01). Conclusion: The transforming growth factor beta 1 concentrations were not useful as a diagnostic tool or an early marker of infected pleural effusion.

Tratamiento quirúrgico del empiema pleural / Surgical treatment of pleural empyema

Empyema in children occurs mainly in association with an underlying pneumonia. The causative microorganisms have changed with the introduction of vaccines; Streptococcus pneumoniae remains the predominant organism. Symptoms and physical examination can not differentiate between pneumonia with or without pleural effusion, when this one is of small amount. So the chest radiograph is essential. Failure to respond to 48 hours of pneumonia treatment should suggest pleural empiema. If the chest radiograph shows parapneumonic pleural effusion, ultrasound should be performed to confirm the presence of fluid in the pleural space and evaluate the first loculations and wall septations. If liquid is clear and sufficient, pleurocentesis for cytochemical and microbiological analysis must be made. If pleural effusion reproduces or has septations, a pleuropulmonary debridement with videothoracoscopy must be done to cure the child in less time and with less consequences.

El empiema en pediatría se produce principalmente en asociación con una neumonía subyacente. Los organismos causantes han cambiado con la introducción de vacunas, siendo el Streptococcus pneumoniae el microorganismo predominante. Tanto los síntomas como el examen físico no permiten diferenciar entre una neumonía con o sin derrame pleural, cuando éste es de poca cuantía, por lo que la radiografía de tórax es fundamental. La falta de respuesta a 48 horas de terapia de la neumonía debe hacer sospechar empiema. Si la radiografía muestra derrame debe realizarse una ecografía torácica para confirmar la presencia de líquido en el espacio pleural y evaluar las primeras loculaciones y tabiques. Si el líquido está libre y en cantidad suficiente debe realizar una pleurocentesis para análisis citoquímico y microbiológico. Si el derrame se reproduce o está tabicado se debe realizar una debridamiento pleuropulmonar videotoracoscópico que mejora al niño en menor tiempo y con menos secuelas.

Neumonía complicada en pediatría, su manejo: un reto / Treatment of empyema thoracis and necrotizing pnueumonia in children

Complicated pneumonia with pleural effusion or empyema is a condition that its incidence has been increasing in recent years. Its early diagnosis and timely management reduce costs and shorten hospital stays for patients. The optimized diagnostic aids treatments. In recent years the intervention and fibrinolytic substances as VATS surgery have opened a positive outlook in handling controversies exist yet at the time of application. This article reviews these aspects.

La neumonía complicada con derrame pleural o empiema es una patología que ha ido incrementando su incidencia en los últimos años. Su diagnóstico temprano y su manejo oportuno disminuyen los costos y acortan las estancias hospitalarias de los pacientes. Las ayudas diagnósticas optimizan los tratamientos. En los últimos años la intervención con sustancias fibrinolíticas y las intervenciones quirúrgicas como la videotoracoscopia han abierto un panorama positivo en el manejo sin embargo, existen controversias en el momento de su aplicación. Este artículo hace una revisión de estos aspectos.

Pleural and pericardial empyema in a patient with continuous ambulatory peritoneal dialysis peritonitis

No abstract available.

Massive Empyema Associated With Transient Hypogammaglobulinemia of Infancy and IgA Deficiency

Transient hypogammaglobulinemia of infancy (THI) is originally defined as a physiological maturation defect of immunoglobulin G (IgG) production that occurs at 3-6 months of age and lasts until 18 to 36 months of age. We report here on a 22-month-old child with THI and IgA deficiency, who had massive pneumococcal empyema. Her depressed IgG level returned to normal within 6 months, but IgA level was still low at 6 yr of age. Although THI is an age-dependent and self-limiting disorder, severe infection that includes an atypical presentation of an infection may occur in some patients and this requires evaluation with immunologic study.

Infección del líquido pleural y ascítico por Listeria monocytogenes: caso clínico / Pleural and ascitic fluid infection by Listeria monocytogenes: report of one case

Ascitic and pleural fluids infection by Listeria monocytogenes is uncommon. The association of spontaneous bacterial peritonitis and empyema caused by this microorganism has been seldom reported. A 61 year-old male with an alcoholic cirrhosis and an upper right ¡obectomy for a lung cáncer, consulted because of an exacerbation of dyspnea, abdominal pain and fever. Listeria monocytogenes was isolated from ascitic and pleural fluids and from blood cultures. He was successfully treated with ampicillin and a chest tube for drainage.

Características clínicas, diagnósticas y terapéuticas del empiema pleural en niños hospitalizados durante los años2000 - 2004 en el Hospital Nacional Cayetano Heredia / Clinical, diagnostic and therapeutic characteristics of pleural empyema in children hospitalized during years 2000-2004 at National Hospital Cayetano Heredia

Objetivo: Describir las características clínicas, diagnósticas y terapéuticas de los pacientes pediátricos con diagnóstico al alta de empiema pleural internados en el Hospital Nacional Cayetano Heredia desde enero 2000 hasta diciembre 2004. Material y Métodos: Se revisaron las historias clínicas, las variables investigadas fueron edad, sexo, estudio de líquido pleural, cultivos, tratamiento, complicaciones y tiempo de hospitalización. Se usó X2 de Pearson para el análisis estadístico. Resultados: Hubo 22 pacientes con diagnóstico de empiema la relación hombres/mujeres fue de 9/2; la mediana de edad fue 3 años (1 a 10 años), la mediana de días de hospitalización fue 11.5 días (3 a 28 días). En 8 pacientes (36.3 por ciento) hubo complicaciones: 7 bulas, 3 neumotórax, 1 fístula broncopleural y 1 absceso pulmonar. Se halló más tiempo de hospitalización asociado al tratamiento quirúrgico (p<0.05). Se identificó el germen en 12 casos (54.5 popr ciento) (hemocultivo: 2, cultivo líquido pleural:10, coaglutinación enlíquido pleural: 1); siendo Streptococcus pneumoniae el más frecuente (58.3 por ciento) seguido por Haemophilus influenzae (25 por ciento) y Staphylococcus aureus (16.6 por ceinto). En 1 paciente con tratamiento quirúrgico se encontró bacilo ácido alcohol resistente positivo en biopsia pleural. Conclusiones: El empiema es más común en pacientes varones menores de 5 años (77 por ciento), siendo el germen más comúnmente aislado Streptococcus pneumoniae seguido de Haemophilus influenzae y Staphylococcus aureus. Hubo coexistencia de empiema bacteriano y bacilo ácido alcohol resistente positivo en biopsia pleural en 1 paciente con tratamiento quirúrgico. El 31.8 por ciento de pacientes con tratamiento médico fracasó por lo que requirieron tratamiento quirúrgico. No hubo diferencias estadísticamente significativas al comparar el tratamiento médico (15 casos) versus tratamiento quirúrgico (7 casos) respecto a complicaciones.

Objective: To describe the clinical, diagnostic and therapeutic characteristics of pediatric patients with diagnosis of pleural empyema hospitalized at National Hospital Cayetano Heredia from january2000 to december 2004. Material and methods: Clinical histories were reviewed being the investigated variables age, sex, study of pleural liquid, cultures, treatment, complications and time of hospitalization. For the statistical analysis it was used x2 of Pearson. Results: There were 22 patients with diagnosis of empyema. The ratio male/female was of 9/2; the median of age was 3 years (1 to 10 years), the median of days of hospitalization was 11. 5 days (3 to 28 days). In 8 patients (36.3 per cent) there were complications (bullae: 7, pneumothorax: 3. bronchopleural fistula: 1. pulmonary abscess: 1). The time of hospitalization was longer associated to the surgical treatment (p<0.05). The germ was identified in 12 cases (54.5 per cent) (Blood culture: 2, pleural liquid Culture: 10. Agglutination in pleural liquid: 1) being Streptococcus pneumoniae, the most frequent (58.3 per cent) followed by Haemophilus influenzae (25 per cent) and Staphylococcus aureus (16.6 per cent). In 1 patient with surgical treatment acid alcohol resistant bacillus positive was isolated in pleural biopsy. Conclusions: Empyema is the most common in male patient younger than 5 years (77 per cent) being the germ more commonly isolated Streptococcus pneumoniae followed by Haemophilus influenzaeand Staphylococcus aureus. There was coexistence of empyema and acid alcohol resistant bacillus positive in pleural biopsy of one patient with surgical treatment. Medical treatment failured in 31.8 per cent of patients and requiered surgical treatment. There were no predictive factors at the entrance or in pleural liquid when comparing medical treatment (15 cases) versus surgical ...

Management of empyema thoraces in our setup

To find out the proper method of management of empyema thoraces to be adopted according to the stage of disease. Prospective study. This study was carried out at Children Hospital Complex, Multan in department of Paediatric Surgery from January 2003 to December 2005 for a period of three years. Fifty patients of post pneumonic empyema thoraces were managed from January 2003 to December 2005. All of them were included in the study. On basis of history, examination and investigations disease was staged as I, II and III. In addition to antibiotics according to culture and sensitivity, intercostals chest tube drainage was performed in all the patients of Stage-I and II. Out of fifty patients thirty four [68%] were male and sixteen [32%] female. Thirty nine [78%] were under 5 years and eleven [22%] of 6-12 years of age. Right side was involved in thirty two [64%] and left side in eighteen [36%]. Twenty nine [58%] were suffering from Stage-I, thirteen [26%] Stage-II and eight [16%] from Stage-Ill. Intercostals chest tube drainage was performed in Stage-I and II. All of the twenty nine [100%] of Stage-I and five out of thirteen [38%] of Stage-II recovered successfully. Thoracotomy was performed in all eight patients of Stage-III straight forward and eight out of thirteen of Stage-II who did not recovered after chest tube drainage. Fifteen out of these sixteen [94%] recovered, one [6%] developed sepsis and expired on 6[th] day after thoracotomy. Tube drainage is very much successful in Stage-I. Early thoracotomy is an excellent option to treat Stage-II and III. Pus drainage facilitative measures are helpful in evacuation of the pus and expansion of lungs

Empiema y efusión pleural en niños / Empyema and pleural efussion in children

Introducción: El empiema pleural (EP) es una complicación grave de la neumonía adquirida en la comunidad (NAC). Objetivos: Describir las características de los pacientes hospitalizados por EP en el Servicio de Pediatría del Hospital de la Universidad Católica durante el período 2000-2005. Se identificaron 86 hospitalizaciones por NAC con efusión pleural, practicándose en 59 (70 por ciento), al menos una toracocentesis. Se consideró EP a la presencia de pus, tinción de Gram con bacterias, cultivo positivo o pH < 7,10 en el líquido pleural, siendo las efusiones para-neumónicas los controles. Resultados: Se analizaron 24 EP y 25 controles [promedio 2,9 años (rango: 8 meses - 14,3 años)], 78 por ciento de edad inferior a 5 años con diferencia entre los grupos EP y controles [1,6 vs 3,3 años, respectivamente (p = 0,01)]. El promedio global (días) de síntomas previo al ingreso en los EP fue 7 (rango: 2-21), siendo los más frecuentes fiebre (100 por ciento) y tos (96 por ciento). Se identificó algún microorganismo en 15/24 EP, Streptococcus pneumoniae fue el más frecuente (n: 9). En 48 niños, el manejo inicial fue conservador, requiriéndose cuatro rescates quirúrgicos luego del cuarto día. El promedio (días) de hospitalización fue significativamente superior en el grupo EP vs controles [15 (rango: 5-38) vs 9 (rango: 3-16) (p < 0,01)]. Requirieron drenaje pleural 83 por ciento del grupo EP y 36 por ciento de los controles (p = 0,002). No hubo diferencia en el número de días de empleo de oxígeno [6 vs 4,5 (p = 0,36)] o drenaje pleural [3 vs 2,5 (p = 0,29)]. No se registraron fallecidos. Conclusión: El EP en niños fue una condición respiratoria aguda que se asoció a estadías hospitalarias prolongadas, especialmente en los de menor edad, no requiriéndose, en la mayoría, una intervención quirúrgica de rescate.

Introduction: Pleural empyema (PE) is a serious complication of community-acquired pneumonia (CAP). Objectives: To describe the clinical profile of hospitalized patients with PE in the pediatric ward of the Catholic University Hospital between 2000-2005. Patients y methods: Retrospectively, all pediatric admission due to CAP and pleural effusion (86 children) were identified. In 59 (70 percent) children > 1 thoracocentesis were performed. We considered PE as the presence in the pleural effusion of pus, and/or a positive gram strain and/ or positive culture, and/or a pH < 7.10. Children with effusions not meeting any criteria were used as controls. Results: Twenty four PE and 25 controls were identified, with a global mean age of 2.9 years (range: 8 months to 14.3 years); 78 percent were < 5 years, with a significant difference between PE and controls [1.6 vs 3.3 years (p = 0.01)]. The mean duration of symptoms in PE patients before admission was 7 days (range: 2-21), and the most frequent symptoms were fever (100 percent) and cough (96 percent). In 15/24 cases a microorganism was identified being Streptococcus pneumoniae (n = 9) the most common. In 48 patients management was conservative and in 4 surgical procedures were required. The mean duration of hospitalization was significantly higher in the PE group vs controls group: 15 (range: 5-38) vs 9 days (range 3-16) (p < 0.01). A chest tube was inserted in 83 percent of children with EP compared with 36 percent in the control group (p = 0.002). There were no difference in number of days of oxygen use [6 vs 4.5 (p = 0.36)] or number of chest tubes per child [3 vs 2.5 (p = 0.29)]. No deaths were reported. Conclusion: PE in children represented an acute respiratory event associated with more prolonged hospitalization especially at younger ages; the majority of cases did not require surgical intervention.

Tratamiento de empiema paraneumónico / Treatment of empyema paraneumónico

El empiema paraneumónico (EP) o pus en el espacio pleural es una complicación rara de la neumonía bacteriana en niños; sin embargo ésta se ha incrementado en Estados Unidos y Europa en los últimos años. Los autores mencionan que en su institución (Primary Children’s Medical Center, Salt Lake City) trataron 500 pacientes con empiema en la última década. En Utah incrementó de 1/100.000 niños el año1993 a 14/100.000 el 2003

Derrame pleural parapneumônico e empiema / Parapneumonic effusion and empyema

O derrame infeccioso, uma das causas mais freqüentes de derrame pleural obervados na pratica clinica, é um sinal de complicação do quadro pneumônico. O reconhecimento precoce do derrame parapneumônico é fundamental para determinar a melhor forma de tratamento, reduzindo o risco de morbidade e mortalidade. A evolução dos métodos diagnósticos e a experiência dos diversos estudos publicados na literatura permitiram estabelecer diretrizes baseadas em evidencias que orientam a conduta de abordagem terapêutica do derrame parapneumônico e empiema.

The infectious effusion, one of the most frequent causes of pleural effusions in the clinical practice, is a sign of complication of the pneumonic disease. The early recognition of the parapneumonic effusion is crucial to determine the best treatment form and reduce the risk of morbidity and mortality. The evolution in the diagnostic methods and the contribution of several studies published in the literature allowed to establish evidence-based guidelines that are used to guide the treatment of the parapneumonic pleural effusion and empyema.

Síndrome de Claude Bernard-Horner associada ao empiema pleural / Claude Bernard-Horner syndrome resulting from pleural empyema

A síndrome de Claude Bernard-Horner apresenta várias etiologias, ocorre por interrupção do estímulo nervoso em qualquer ponto do trajeto do nervo e pode ser intra ou extratorácica. É relatado um caso dessa síndrome causado por empiema pleural septado, localizado em região paravertebral, no terço superior do hemitórax direito. O paciente foi submetido à toracotomia para drenagem da cavidade pleural. A evolução foi satisfatória, com regressão do quadro infeccioso, expansão pulmonar e remissão da síndrome.

Empiema por actinomyces: el gran simulador / Empyema due to Actinomyces: a diagnostic challenge

El derrame pleural aislado, como única manifestación de la actinomicosis es una situación muy rara y un desafío diagnóstico para el clínico, no sólo por su infrecuencia sino por la dificultad técnica para cultivar al gérmen. La típica apariencia microscópica de este bacilo Gram-positivo ramificado en los cultivos suele ser la clave del dianóstico. Se informa un caso de derrame pleural masivo izquierdo por Actinomyces israelii, sin afectación del parénquima pulmonar, de difícil diagnóstico, que mejoró clínica y radiológicamente en forma completa con el drenaje quirúrgico y tratamiento antibiótico prolongado.

Role of decortication in cases of empyema thoracis in childhood - a case series

The aim was to analyze role of decortication in managing progressive empyema thoracis in children at our hospitals. The study included cases of empyema thoracis admitted at CH and ICH Lahore from May 1999 to November 2000. Total No. of patients included was fifty eight. There were 36 males and 22 females with a mean age of 4 years. Common presentation was fever, chest pain and cough. Mean duration of symptoms was 3 weeks Out of 58 patients 24 underwent decortication because fever and drainage of pus were not settling down. All the patients in decortication group were cured .34 patients responded well to medical treatment and tube thoracostomy commonest cause of empyema was pneumonia and tuberculosis. If the empyema is not setting down, early surgical intervention e.g. decortication should be instituted. Early referral of all empyema patients to thoracic units for definitive therapy is strongly recommended

Spontaneous bacterial empyema in cirrhotic patients: complements 3 and 4, opsonic power and C-reactive protein as pathogenic mechanisms and diagnostic tools

Hepatic hydrothorax occurs in approximately 5-12% of patients with cirrhosis and portal hypertension and may be complicated by spontaneous bacterial empyema [SBE]. Pathogenic mechanisms of SBE still need to be investigated. The present work assesses the role of complement components [C3, C4], opsonizing power and C-reactive protein in the pathogenesis of SBE in cirrhotic patients. Twenty five cirrhotic patients with hepatic hydrothorax were randomly selected and 10 patients with hydrothorax secondary to heart failure were included as controls in the study. Pleural fluid [PF] and serum samples were analyzed for: total protein [TP], albumin, lactic dehydrogenase [LDH], glucose, polymorph nuclear leukocytic count [PMNL], complement components [C3, C4], opsonic activity [on the basis of log-kill] and high sensitive C-reactive protein [CRP]. SBE was diagnosed when pleural fluid PMNL was > 250 cells/mm[3] with a positive culture or >500 cells/ mm[3] with a negative culture after exclusion of pulmonary infections. Thirteen patients [52%] [Group I] were diagnosed as SBE and 12 patients [48%] had no SBE [Group II]. There was no significant difference between patients and controls [GIII] as regards age, gender, serum proteins, serum C3, serum WBC and effusion CRP. Levels of serum albumin, total pleural effusion proteins, PT% and opsonic activity of groups I and II were significantly lower than in GIII with no significant difference between groups I and II. Levels of serum bilirubin and C4 of groups I and II were significantly higher than group III with no significant difference between groups I and II. Level of pleural effusion C3 in group I was significantly lower than in groups II and III and level of C3 in group II was significantly lower than in group III. Level of pleural effusion C4 in group I was significantly lower than group III, but there was no significant difference between groups I and II. In hepatic patients, 7 patients [28%] belonged to Child's class B and 18 [72%] to class C. Spontaneous bacterial empyema was detected in 56% of hepatic patients with Child's class C and in 43% of Child's class B. There was no significant difference between hepatic patients with and without SBE with regard to Child-Pugh's score. In patients with SBE, levels of C3 and C4 were significantly less in pleural fluid than in serum but there was no significant difference with regard to opsonic activity. Local complement defects [especially C3] and opsonic activity in cirrhotic patients predispose to SBE. Serum CRP increases, but effusion CRP level should be reassessed as a cheap diagnostic tool

pathological and clinical study of pyothorax [thoracic empyema] in two young Persian cats

Pyothorax [thoracic empyema] in two females 4 and 3.5-4-month-old cats are reported. The cats were referred to Small Animal Hospital, School of Veterinary Medicine, University of Tehran, Tehran, Iran, with the clinical signs and symptoms of acute fever, severe respiratory distress, anorexia and malaise. The clinical and radiological examinations pointed to an accumulation of fluid within the thoracic cavity. Because of the severity of the disease the animals died without obtaining any treatment. In post mortem examination, a bilateral pyothorax was diagnosed. Both Pasteurella multocida and Nocardia asteroides and Pasteurella multocida alone were isolated from case 2 and case 1, respectively