ABSTRACT
Noncommunicating locules of fluid may develop in the setting of a thoracic empyema or a complicated parapneumonic effusion. When this occurs a single chest tube may not provide adequate drainage. In an effort to promote drainage and thereby obviate the need for further procedures, instillation of streptokinase into the involved pleural space has been advocated. This communication reviews the literature and reports our experience with intrapleural streptokinase. In our retrospective review of nine patients, instillation of streptokinase resulted in an obvious increase in chest tube drainage in six. Of the nine patients, four with improved drainage required no further procedures. Two patients with improved drainage and the three with no change in drainage required an additional chest tube, a decortication procedure, or were lost to follow-up. None of the four patients with an empyema were benefitted. Intrapleural instillation of streptokinase may be a useful adjunct in the treatment of a complicated parapneumonic effusion but appears less likely to be of benefit in the management of an empyema.
Subject(s)
Empyema/drug therapy , Pleural Effusion/drug therapy , Streptokinase/therapeutic use , Adult , Aged , Chest Tubes , Drainage , Empyema/surgery , Female , Humans , Instillation, Drug , Male , Middle Aged , Pleural Effusion/surgery , Retrospective Studies , Streptokinase/administration & dosageABSTRACT
Mycobacterium malmoense was isolated from pulmonary material from 4 patients. Two patients had repeatedly positive smears and cultures along with roentgenographic progression of pulmonary disease in the absence of another pathogen. These 2 patients therefore meet the criteria for diagnosis of pulmonary mycobacteriosis. Isolation of the organism may represent colonization in a third patient, and M. malmoense has been isolated from a fourth patient on 2 occasions. It is not yet definite, however, that the pulmonary process is due to mycobacterial disease. Although uncommon, pulmonary disease caused by this organism has been reported from Europe. Only 1 prior case of pulmonary disease caused by M. malmoense, however, has been reported in the United States.
Subject(s)
Mycobacterium Infections , Pneumonia/etiology , Adult , Aged , Diagnosis, Differential , Female , Humans , Middle Aged , Mycobacterium/isolation & purification , Mycobacterium Infections/diagnostic imaging , Pneumonia/diagnostic imaging , RadiographySubject(s)
Asbestos/adverse effects , Asbestosis/pathology , Lung Diseases/etiology , Pleural Diseases/etiology , Carcinoma, Bronchogenic/etiology , Humans , Lung Diseases/diagnostic imaging , Lung Neoplasms/etiology , Mesothelioma/etiology , Mesothelioma/pathology , Pleura/diagnostic imaging , Pleura/pathology , Pleural Diseases/diagnostic imaging , Pleural Diseases/pathology , Pleural Effusion/etiology , Pleural Neoplasms/etiology , Pulmonary Atelectasis/etiology , Pulmonary Atelectasis/pathology , Tomography, X-Ray ComputedABSTRACT
Filling the pericardial sac with ice and saline during open heart surgery protects the myocardium during periods of ischemic arrest. Bilateral diaphragmatic paralysis complicated intense local hypothermia in five patients undergoing coronary artery bypass surgery. All complained of severe orthopnea, exertional dyspnea, insomnia, and excessive daytime somnolence. All exhibited paradoxic inward movement of the abdominal wall with inspiration. The diagnosis of bilateral diaphragmatic paralysis was confirmed with upright and supine spirometry and, in one patient, with transdiaphragmatic pressure measurements. Although paralysis has resolved in four patients, all experienced months of disabling impairment. One patient required four months of mechanical ventilatory support prior to her recovery. Alternative methods of intraoperative myocardial preservation that avoid this complication should be developed.
