Intrathoracic negative pressure therapy for pleural empyema using an open-pore drainage film.

BACKGROUND: We report our initial experience with intrathoracic negative pressure therapy (ITNPT) in the stage-adjusted treatment of pleural empyema (PE) based on a case series. MATERIALS AND METHODS: ITNPT represents a further development for intrathoracic use. After thoracic surgical open debridement, an intrathoracic negative pressure dressing was inserted. The drainage elements were a thin open-pore double-layer drainage film (OF) with open-pore polyurethane foams (PUF). Only the OF was placed in direct contact with the lung parenchyma. Negative pressure was generated using an electronic pump (continuous suction, -75 mm Hg). In revision thoracotomies, ITNPT was stopped or continued depending on local findings. RESULTS: In total, 31 patients with stage II and III pleural empyema underwent ITNPT, which was administered during the primary procedure (n = 17) or at revision (n = 14). Treatment duration was a mean of 10 days (2-18 days) with a mean change interval of 4 days (2-6 days). Intrathoracic negative pressure dressings were applied a mean of 3.5 (1-6) times. The empyema cavity continuously reduced in size and was cleansed by the suction. The OF has a minimum intrinsic volume with maximum absorption surface. Once negative pressure is established, there is no intrathoracic dead volume and the parenchyma can expand. The protective material properties of OF make ITNPT suitable for the treatment of pleural empyema. Targeted local intrathoracic drainage of the septic focus is a possible adjunct to surgery. The surgical dressings must be changed repeatedly. The method is suitable for the treatment of complex stage II and III pleural empyemas. CONCLUSION: The OF can be used as an intrathoracic drainage element for ITNPT in pleural empyema. This new application option expands the range of indications for negative pressure therapy.

[Femoral shaft fractures in the growth period--results following the end of the growing period]. / Oberschenkelschaftfrakturen im Wachstumsalter--Resultate nach Wachstumsabschluss.

Between 1960 and 1987 we treated 270 children for fractures of the femoral shaft. 195 could be followed up two times clinically and radiologically. The age at the time of accident is decreasing, might be a sign of battered-child syndrome. Boys were two times more afflicted than girls. Normally we use overhead extension or Weber-Bock-extension for 4-6 weeks and a pelvis leg cast for the same time afterwards. If the extension is not sufficient one reduction trial is allowed, the second one should give way the operation in the following complications: axial shift of more than 20 degrees, rotational aberration of more than 15 degrees and fragment deviation in more fragment fractures. The torsion was measured using Rippstein's method. 17 patients showed a difference between the angles of antetorsion of more than 10 degrees after being 18 years of age (only 2 of them were operated). Length growing was also measured and more confirmed in the only extended fractures. Both parameters showed better results, when both "detorsional thrusts" came after the accident. So the indication for an operative proceeding should be more liberal after the 7th and more often after the 12th year of age.