[Empyemectomy-treatment of pleural empyema]. / Empiemektomija esant uminei pleuros empiemai.

Empyema thoracis has been recognized as a disease entity since the time of Hippocrates and historically has been associated with high mortality. Over 30 years ago, the American Thoracic Society described three stages in the natural course of empyema, namely the exudative, fibrinopurulent, and organizing phases. Decortication and suction drainage usually result in lung re-expansion, otherwise pleurocutaneous window, intrathoracic transposition of skeletal muscle, or thoracoplasty remain life-saving but now uncommon options for treating a closed-space infection. During last 9 years (1993-2001) 50 patients underwent empyemectomy due to pleural empyema. Three patients died (6%). In 4 cases we had complications-hydropneumothorax. They received punction (3 patients) and 1 received tube toracostomy. In one case urgent retoracotomy was performed due to acute intrapleural bleeding. After successful empyemectomy 47 patients stay at hospital 14 days approximately.

[Odontogenic mediastinitis. Diagnostics and treatment]. / Odontogeninis mediastinitas. Diagnostika ir gydymas.

UNLABELLED: The aim of our work was to evaluate the diagnostic and treatment of patients with odontogenic mediastinitis. METHODS: The last 10 years (1991-2001) 13 males and 4 females, mean age 43 years, with odontogenic mediastinitis were submitted to surgical treatment. Primary odontogenic abscess occurred in all. Before admission to our clinic, 14 patients were treated at stomatological department. Diagnosis was made by clinical manifestation, roentgenographical features and confirmed by findings at mediastinum tissues during operation. RESULTS: All patients at the admission day underwent broad cervicotomies with transcervical mediastinal drainage. In 5 cases this management was associated with mediastinal drainage by transthoracic approach. For another 5 patients thoracotomies were performed late, the last 7 survived without thoracotomy. Six patient died, mortality rate was 35.2%. The reason of the high mortality rate-delay of transthoracic mediastinal drainage in 5 cases, when transcervical was inadequate. CONCLUSION: Ample cervicotomy, associated with transcervical and transthoracic mediastinal drainage can significantly reduce the mortality rate for odontogenic mediastinitis.