ABSTRACT
Empyema thoracis remains a common thoracic problem with challenging management strategies. We analysed retrospectively 107 consecutive patients treated for empyema thoracic over a 5-year period. The majority of patients (75%) were male with a mean age of 51 years. Common presenting symptoms were cough, dyspnoea, chest pain and pyrexia. The mean duration of pre-admission symptoms was 7.5 weeks. The causes of empyema were pneumonia, malignancy, iatrogenic injury and trauma. The most frequently isolated organism was Streptococcus milleri. In 71% of patients there was an underlying systemic disorder. Forty-nine patients (46%) underwent an unsuccessful therapeutic procedure prior to admission to the surgical units. In the units, 24 patients received closed intercostal chest tube drainage, 14 of whom required further intervention. Two patients were treated with repeated thoracocentesis. The majority of patients underwent a surgical procedure in the first instance: rib resection and drainage (5), decortication (22), and more extensive procedures (9) with only two patients requiring further surgery. The mean post-operative stay was 16 days and the hospital mortality was 13%. We recommend early referral of all empyema patients to thoracic units, where assessment and definitive procedures can be performed with high chances of success and moderate risk of morbidity and mortality.
Subject(s)
Empyema, Pleural/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Chest Pain/physiopathology , Cough/physiopathology , Drainage , Dyspnea/physiopathology , Empyema, Pleural/etiology , Empyema, Pleural/microbiology , Empyema, Pleural/physiopathology , England/epidemiology , Female , Fever/physiopathology , Follow-Up Studies , Hospital Mortality , Humans , Iatrogenic Disease , Length of Stay , Male , Middle Aged , Pneumonia/complications , Punctures , Retrospective Studies , Streptococcal Infections , Survival Rate , Thoracic Injuries/complications , Thoracic Neoplasms/complications , Time Factors , Treatment OutcomeABSTRACT
This case report describes the occurrence of a supraventricular arrhythmia in a patient with a large epiphrenic oesophageal diverticulum. The arrhythmia was precipitated by meals and was thought to result from pressure effects on the left atrium. Medical therapy did not control the arrhythmia. Excision of the diverticulum combined with oesophageal myotomy resulted in a dramatic relief of symptoms.
