[Pleural empyema]. / Pleuraempyem.

Despite of extensive use of antibiotics for respiratory tract infections pleural empyema is still seen as a complication to pneumonia (7-10 cases/100.000 inhabitants pr. year). Pleural empyema as a complication to pulmonary surgery is reported in 2-3% of the patients even with use of antibiotic prophylaxis. Pleural empyema is most often a serious disease of long duration. The diagnosis is obtained with microbiological and histological examination of the pleural fluid. Mixed infection occurs in over half of the cases, most often including anaerobic bacteria, but most human pathogens have been reported as etiological agents. Treatment includes drainage of pus and administration of relevant antibiotics, systemically and pleurally. Drainage can be performed via thoracocentesis, by tubes, or by resection of a part of the rib. The optimal treatment strategy is so far unknown, since good prospective comparative clinical studies are lacking.

[The synonymous preparation Andion vs. the original preparation becotide in the treatment of steroid-dependent bronchial asthma. A comparative double-blind cross-over trial]. / Synonympraeparatet Andion versus originalpraeparatet Becotide til behandling af steroidafhaengig asthma bronchiale. En sammenlignende dobbeltblind overkrydsningsundersøgelse.

Two different beclomethasone dipropionate inhalation aerosols (Andion and Becotide) were compared in a double-blind, cross-over study in patients with stable, steroid-dependent asthma. Fifty-two patients were included in the study, and 44 completed the two 6-week periods of treatment. The difference in therapeutic efficacy on FEV1 between Andion and Becotide was -0.018 1, and likewise no differences in therapeutic efficacy on FVC and peak expiratory flow were found. There were no significant differences between the two treatment periods regarding peak expiratory flow rates, symptoms, frequency of adverse effects, and amount of salbutamol and beclomethasone dipropionate employed. In conclusion, no significant differences could be demonstrated between Andion and Becotide with regard to pulmonary function, symptoms, and frequency of adverse effects in the treatment of patients with steroid-dependent bronchial asthma.

Treatment of pleural empyema secondary to pneumonia: thoracocentesis regimen versus tube drainage.

BACKGROUND: Pleural empyema is a well known complication of pneumonia. Attitudes differ, however, about the best treatment of this condition and the place of drainage, early operation, and local antibiotics. METHODS: In a retrospective study 94 consecutive patients with verified empyema caused by pneumonia were admitted to the department of either pulmonary medicine or thoracic surgery. Treatment was either by a lavage regimen (daily thoracocentesis, saline rinse, systemic antibiotics, and in some patients instillation of local antibiotics) in the medical ward (51 patients) or by tube drainage and systemic antibiotics in the surgical unit (43 patients). RESULTS: The stay in hospital was significantly shorter in the medically treated patients than in the surgical group--2.3 v 5.0 weeks respectively. Furthermore, pleurocutaneous and bronchopleural fistulas developed more frequently in patients treated by tube drainage than in those treated with the thoracocentesis regimen alone (13 (30%) v 5 (10%) and 6 (14%) v 2 (4%) for each complication respectively). The overall mortality was 8.5% with no differences between treatments. CONCLUSIONS: Treatment with a lavage regimen plus local and systemic antibiotics seems to be associated with a lower frequency of complications and a shorter duration of hospital stay than tube drainage and systemic antibiotics. These results should be confirmed by a prospective, randomised study.

[Therapeutic pleurodesis in spontaneous pneumothorax, malignant pleural effusion, heart insufficiency and chylothorax]. / Pleurodesebehandling ved spontan pneumothorax, malign pleuraeffusion, hjerteinsufficiens og chylothorax.

Treatment with pleurodesis is employed in spontaneous pneumothorax, in pleural effusion due to neoplastic disease, intractable transudate and chylothorax. When this treatment is employed in spontaneous pneumothorax, randomized studies show a lower recurrence rate when drainage is supplemented by a sclerosing agent. Pleurodesis alone scarcely alters the recurrence rate in pneumothorax. Treatment with pleurodesis is well accepted in malignant pleural effusion. Several randomized studies show a response rate of 11% when thoracocentesis is employed alone whereas a response rate of 40% is obtained when pleural drainage is also employed. When a sclerosing agent is added to pleural drainage, the response rate rises to approximately 60% or more. No randomized studies of pleurodesis in congestive heart failure and chylothorax were found. Pleurodesis is not recommended in the treatment of congestive heart failure because of reports of development of contralateral pleural effusion after successful pleurodesis. In chylothorax, pleurodesis is the last resort.

[Tuberculosis in children in Copenhagen during 1975-1985]. / Børnetuberkulose i København i perioden 1975-1985.

During the years 1975-1985, 25 Danish children (less than 15 years) and 40 children of immigrants in the Municipalities of Copenhagen and Frederiksberg had tuberculosis for the first time. The children were assessed at the time of diagnosis and were retraced in 1987. The incidence of tuberculosis among foreign children was 10-40 times that among Danish children. Pronounced differences in the localizations of tuberculosis in Danes and foreigners were observed. Whereas the Danish children had exclusively pulmonary tuberculosis, 13 of the foreign children had either extrapulmonary tuberculosis or pulmonary and extrapulmonary tuberculosis simultaneously. Two of the foreign children had tuberculosis meningitis and one miliary tuberculosis. Significantly more patients with bacillary tuberculosis were present among foreigners than among Danes. No significant differences were found between the occurrence of symptoms, Mantoux-positive reactions, previous Calmette vaccination or known contact with a person with tuberculosis in Danes and foreigners. Treatment was followed as prescribed and all were cured from tuberculosis. One child with tuberculosis meningitis developed slight sequelae while the remainder of the children developed somatically normally.

Childhood tuberculosis in a developed country.

From 1975 to 1985, 25 Danish children (aged less than 15 yrs) and 40 children of immigrants were notified for tuberculosis in Copenhagen for the first time. A follow-up was undertaken in 1987. The annual rate of tuberculosis per 100,000 among the Danish children was 5 and among immigrant children 68-200 depending on the nationality. At the time of diagnosis, no significant differences were present between Danes and immigrants as regards age, sex, occurrence of symptoms or previous BCG immunization, whereas there were significantly more bacteriologically proven cases among the immigrants. All Danish children had respiratory tuberculosis only, whereas 13 immigrant children had extrapulmonary manifestations including one case of miliary and two cases of meningeal tuberculosis. At follow-up, all patients were cured for tuberculosis and had experienced a normal physical development.