Efficacy of early thoracoscopic debridement for syn-pneumonic pleural effusions in pediatric age group

Background: Pleural effusion can be treated by antibiotics alone but thoracoscopy assisted debridement has proved superior to antibiotics alone. There is need to study this aspect in more details related to the superiority of the treatment. The objective was to study efficacy of early thoracoscopic debridement for syn-pneumonic pleural effusions in pediatric age group.Methods: A hospital based follow up study was carried out among 40 children of 1-7years of age. They were divided into two groups. One group with 15 children received only antibiotics while the other group with 25 children received thoracoscopic debridement. The results were compared in terms of hospital stay and clinical outcome.Results: It was found that the hospital stay was significantly shorter in children who received thoracoscopic debridement compared to antibiotic group. The chest X-ray was normal in all cases who received thoracoscopic debridement compared to antibiotic group. Decortications were required in five children in antibiotic group compared to none who received thoracoscopic debridement. There was no morbidity and mortality in the children received thoracoscopic debridement. Clinical and symptomatic relief was much better in children received thoracoscopic debridement compared to antibiotic group where there was persistence of the symptoms.Conclusions: Thoracoscopy done in 3days of syn-pneumonic effusions give better out come in terms of hospital stay, morbidity, radiological resolution, compared to thoracocentesis done cases.

Role of air way stenting (Duman- silica stent) in benign stricture trachea management

Background: Tracheal strictures are known to recur after dilatation, so they need stenting to prevent recurrence. The objective was to study role of air way stenting (Duman- silica stent) in benign stricture trachea management.Methods: A hospital based prospective study was carried out among 15 cases (as these cases are very rare, author could study only 15 cases) presented with various clinical features suggestive of tracheal strictures. They were examined and managed by putting tracheal stent for up to eight months period. All cases were followed at regular intervals till 14months after the stent was placed. The outcome was studied.Results: The tracheal strictures have been found to be more in the age group of 25-30 years. The male to female ratio was 4:1 i.e. for everyone female case there were four male cases. Thus, the tracheal strictures have been more common among the males compared to the females. All of the patients presented with severe stridor, breathing difficulty, and poor exercise tolerance. Most common cause of tracheal stricture was prolonged mechanical ventilatory support >8 days due to organo phosphorus poisoning in past 3months and all of them were males. All cases had good outcome at the end of 14months of follow up. All cases had normal findings. No one developed foreign body reaction, nor did no one develop granuloma formation at the stent site. After stent removal flexible bronchoscopy repeated after 3rd month and 6th month.Conclusions: Tracheal stenting is very useful procedure in the management of air way strictures

Outcome of pediatric non resolving pneumonias with the aid of pediatric flexible bronchoscopy

Background: Studies are required to establish the utility and safety of use of the procedure of the flexible bronchoscopy under various circumstances and the various settings. Aim: To study outcome of pediatric non resolving pneumonias with the aid of pediatric flexible bronchoscopy Material and Methods: Present study was hospital based prospective study. We selected 100 cases in 1 year to 8 years age group, with radiological features persisting after 3 weeks of optimal antibiotics, their sputum for AFB, and gastric lavage for AFB was negative, sputum culture was sterile. We did pediatric flexible bronchoscopy (Olympus BF3C30, outer diameter of 3.2 mm), under short general anesthesia. All the procedures were uneventful, no reported morbidity or mortality after the procedure, Followed after the procedure till radiological shadows disappear. Results: The most common finding of the flexible bronchoscopy was normal airway anatomy – with thick mucopurulent secretions was found in 55% of the cases. In the normal airway anatomy – with thick mucopurulent secretions, 20 showed TB gene positive. In the normal airway anatomy with thick mucus plug obstructing total lumen of affected air way was sterile in all 18 cases. Foreign body impacted in bronchus in 12 cases. Mediastinal lymph node compressing main stem bronchus was identified in 6 cases. Conclusion: Paediatric flexible bronchoscopy is very useful investigation in non-resolving pneumonias.

Role of thoracoscopic pleural biopsy in low Adenosin DeAminase pleural effusions: A hospital based cross sectional study

Background: To obtain the good amount of specimen by biopsy for proper diagnosis, thoracoscopy is a very good tool. Using thoracoscopy the diagnostic accuracy can reach 100% whereas the diagnostic accuracy of the closed pleural biopsy is around 51-79%. Aim: To study role of thoracoscopic pleural biopsy in low Adenosin DeAminase pleural effusions. Material and Methods: A hospital based cross sectional study was carried out among 50 study subjects aged > 45 years. All were cases of pleural effusion. Thoracoscopic pleural biopsy was performed in all cases. The samples were sent for histopathology after biopsy. Results: Majority of the study subjects were found to be in the age group of 45-55 years i.e. 60%. Males outnumbered females as the pleural effusion may be more common in males above the age of 45 years than among the females. Tuberculosis was more in females (60%) than males (40%). But malignancy – adenocarcinoma spreading to pleura was more common in males (90.5%) than females (9.5%). Only one female was found to have Meigs syndrom (ovarian tumor with secondaries pleura). Mesothelioma was seen in three cases and all of them were males. Normal histopathology finding was seen in five cases and all of them were males. It has been documented that pleural effusion due to tuberculosis was more common in females in the present study. Kiran Grandhi, Jayasri Helen Gali, Kokiwar PR. Role of thoracoscopic pleural biopsy in low Adenosin DeAminase pleural effusions: A hospital based cross sectional study. IAIM, 2019; 6(1): 83-88. Page 84 Conclusion: Thoracoscopic pleural biopsy diagnostic yield is high. Low ADA level in pleural fluid does not rule out kochs, incidence more in females.