Therapy of the empyema thoracis. Why not thoracostoma?

Empyema toracis can be defined as a purulent pleural effusion. From 1998 to 2003 we treated 106 patients (87 men and 19 women), aged between 23 and 82 years, affected by localized empyema toracis. All of them received initially a chest tube and 73 of them (60 men and 13 women), in combination with selected antibiotics, had an uneventful recovery. Twenty three patients (17 men and 5 women) underwent thoracotomy and pleural decortication, and 7 patients (6 men and 1 woman) underwent open drainage, that means a thoracostoma. All these 7 patients were affected by chronic empyema: 3 of them with residual post-pneumectomy empyema (1 for lung cancer and 2 for tubercular lung disease); 3 had destroyed lung and 1 was suffering for multiorgan deficiency (respiratory, cardiac and chronic renal insufficiency). The thoracostoma procedure was under general tube anaesthesia with tracheal intubation. The mean surgical time was 26 minutes. The mean postoperative hospital stay was 10 days. In this period of time no death has been recorded or any kind of complication. Before the dismission all of them were teached with their familiars how to take care of the remaining thoracostoma. After the dismission all the patients were followed as outpatients for a variable period, for 14 and 36 months. During this period there were neither complications nor recidives, and all the patients have accepted the "thoracostoma" as a new way of life. Therefore thoracostoma appears as an acceptable, useful and no dangerous solution for the treatment of the chronic thoracic empyema.

Paraesophageal hernia in childhood.

AIM OF THE STUDY: Paraesophageal hernia is a particularly rare condition in childhood. Sometimes it is possible to have an asymptomatic course and to be discovered incidentally. Anyway there are no more than 20 reported cases of which only two are well studied and documented to be real paraesophageal hernias. CASE REPORT: Patients were all over 4 years old except for our little patient which was 18 months old, the only infant reported with this condition. On the contrary it is the most common postoperative complication of Nissen fundoplication, which is the most commonly performed, surgical technique for the correction of gastroesophageal reflux in children. CONCLUSIONS: The Authors believe that the presentation of this case with all its special characteristics will improve knowledge about this rare entity and add information about its treatment and surgical correction that are use full for all doctors that care children.