Is thoracoscopically aided pleural debridement advantageous in children?

Thoracic empyema encompasses a spectrum of inflammatory manifestations ranging from thin parapneumonic pleural effusion to the formation of a thick, constricting rind. The aim of this study is to determine the applicability of thoracoscopically aided pleural debridement (TAPD) in children with complicated empyema and to assess its possible advantages. In the last 6 years, 26 children (ages 2 months-16 years; median, 7 years; mean, 7 years) were diagnosed with empyema (right, n = 15; left, n = 11). Their charts, radiographs, and follow-up courses were reviewed. All children had typical clinical and radiological findings of empyema; one also had necrotizing pneumonitis. Treatment modalities included antibiotics only (n = 3), antibiotics with tube thoracostomy (n = 11), open thoracotomy (n = 5), and TAPD (n = 7). Children treated with antibiotics alone had an average (avg) length of stay (LOS) of 31 days. Those managed with tube thoracostomy had an avg LOS of 13 days, and those who underwent thoracotomy had an avg LOS of 16 days. The seven children treated with TAPD had an avg LOS of 12 days, and their avg postoperative chest tube use was 6 days. Children with TAPD had considerable less pain and recovered faster. TAPD of empyema is promising for children whose lungs do not expand promptly after tube thoracostomy or who have a persistent loculated empyema.

Can Subdural Hematoma Result From Repeated Minor Head Injury?

In brief A 17-year-old male high school football player sustained two mild concussions in 7 days. Five weeks later, he ran 50 yd in a game and fell to his knees complaining of severe headache, nausea, facial pain, and difficulty breathing. An immediate on-field physical examination was normal, but the boy progressively became lethargic, stuporous, then comatose. CT scan revealed a right subdural hematoma, perhaps a long-term complication of the two mild concussions. Rules requiring neurocognitive testing after head injury and a physician's written clearance to return to play may be needed to prevent life-threatening injury or permanent neuropsychological sequelae in head-injured athletes.

Histoplasmosis in purebred mice: influence of genetic susceptibility and immune depression on treatment.

These experiments demonstrate that susceptibility to Histoplasma infection of the mouse is dramatically influenced by genetic and immunologic factors, and that these factors appear to exert little influence on response to therapy. They further demonstrate that such influence may vary in different visceral organs. The explanation for these observations remains to be elucidated.

Pulmonary varix.

Pulmonary varix is a rare disorder which is usually discovered by change during the third to sixth decade in an asymptomatic patient. The 37th example is reported with a review of the literature. The disorder is possibly congenital and may affect any lobe. Pulmonary angiography is the preferred procedure for diagnosis. If symptoms are present, they can usually attributed to associated cardiopulmonary disease. Two serious complications have been reported--systematic embolus from a clot in the varix (two cases suspected), and rupture leading to the death of the patient (four cases). A third hazard to the patient is an unnecessary diagnostic thoracotomy. Patients without symptoms should have periodic chest radiographs of those with haemoptysis or systemic embolism should be considered for resection of the varix.

Coronary artery bypass for acute myocardial infarction.

Coronary artery bypass has been done on 20 patients for acute mmyocardial infarction associated with shock, arrhythmia, and/or cardiac arrest. Twelve had had catheterization before the time of infarction. There were 3 hospital deaths, 2 late deaths, and 15 survivors. Survivors are angina-free and active 4 to 40 months postoperatively. Five patients have been recatheterized since operation, and in 4 all grafts are patent and functioning. Ventricular function was not improved in one patient, has remained the same in one, and improved in 3 patients. Although the time interval from infarction to revascularization is important, success is just as dependent on the patient's existing coronary collateral circulation. Lesions of the left main coronary artery were associated with the highest mortality. The rationale for operation in patients with acute myocardial infarction is to revascularize the marginal myocardium adjacent to the infarct and other underperfused areas when indicated. Chance for survival may thereby be increased by improvement of cardiac pumping or reversal of cardiac arrest or arrhythmia.