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1
Bok, Arnold Pierre Louis. "Subdural empyema : a clinical study." Master's thesis, University of Cape Town, 1987. http://hdl.handle.net/11427/25699.
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Subdural empyema is a relatively rare condition that carries a high mortality if not treated adequately. The experience at Groote Schuur Hospital over 8 years from 1979 to 1986 was reviewed. 47 cases of subdural empyema following on contiguous or distant infection, or where the source was not known, were included in this study. Subdural empyema following cranial operation, head trauma~, or meningitis was excluded. Computer Tomographic scanning facilitated early diagnosis and pinpointed subdural collections, and was used postoperatively, to locate residual subdural pus, which was then drained. The results indicate that an aggressive approach using modern radiological techniques to guide surgical procedures, vastly improves the outcome from subdural empyema. The mortality rate was only 8,5%, while 72,3% of our patients were cured and returned to pre-disease activity. The availability of Computer Tomographic scanning in the management of subdural empyema improves the outcome of patients treated with burrhole drainage and diminishes the need for craniotomy. Rare cases may even be managed with antibiotics only. It remains important to deal with the source of subdural empyema - paranasal in 31, otogenic in 10, osteitis in 2 and not known in 4 of the patients. Anaerobic organisms (28%), which are difficult to culture, and contribute to the high incidence of sterile cultures (32%), play an important role in subdural empyema. Chloramphenicol remains the most useful antibiotic. In the long term only 18,6% of patients had seizures and only 16,3% had focal neurological signs. Complications, especially brain abscess developed in 5 cases where pus was not drained adequately initially, and this contributed to a poorer outcome. Steroid administration did not seem to affect the management of subdural empyema. Repeated surgical drainage and administration of broad spectrum antibiotics remain the mainstays of the treatment of subdural empyema.
2
Heath, Claire Jane. "The pathogenesis of pleural empyema caused by Streptococcus pneumoniae." Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/384729/.
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3
Mischenko, Y. "Features of diagnosis and treatment of encysted pleural empyema." Thesis, Sumy State University, 2016. http://essuir.sumdu.edu.ua/handle/123456789/45879.
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The incidence of non-specific pathological processes of the lung and pleura increases every year. Encysted empyema is leading in terms of morbidity and mortality among all the diseases of the lungs and pleura. Just empyema remains one of the biggest problems in diagnosis for doctors of primary and secondary levels of medical care. Up to this point there is no single diagnostic algorithm for the disease. And as a result we don‘t have the single algorithm of treatment of encysted pleural empyema.
4
Thomas, Matthew F. "The increasing incidence of childhood empyema thoracis : epidemiology and clinical aspects." Thesis, University of Newcastle upon Tyne, 2013. http://hdl.handle.net/10443/2243.
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Historically, empyema thoracis has been a major cause of morbidity and mortality in children. It became the focus of considerable attention following its resurgence globally in the 1990’s. The factors driving this change remain uncertain. In addition, there remains significant controversy over the best method of management of the condition. This thesis aimed to define the epidemiology of paediatric empyema thoracis, to understand the factors contributing to the rise in the incidence of the disease. Secondary aims included investigation of the impact of the pneumococcal conjugate vaccine on paediatric empyema and evaluation of the effectiveness of different treatment methodologies in the condition. A progressive framework of multivariate time series models and wavelet analysis was used to investigate relationships between empyema and pneumonia, activity of Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes and Mycoplasma pneumoniae and time. The spatial epidemiology of the both conditions in North East England was defined and the impact of the introduction of routine pneumococcal vaccination investigated using an interrupted time series analysis. Multivariate survival models were used to investigate outcomes following different treatment methods. Hospitalisations due to empyema increased significantly in England between 1997 and 2006, underpinned by an increase in bacterial pneumonia. Isolations of S. pneumoniae and S. pyogenes were positive predictors of empyema nationally. No spatial variation in the risk of empyema was detected. Introduction of pneumococcal vaccination did not decrease empyema hospitalisations. Children who underwent primary surgical treatment for their empyema had a 40% reduction in hospital stay and a lower risk of readmission or of any complication. The increase in the incidence of paediatric empyema in England was driven predominantly by an increase in pneumococcal and streptococcal pneumonia. Primary surgery in empyema allowed earlier discharge, but further research is needed to establish which outcomes are most acceptable to patients and their families.
5
Міщенко, Юрій Олександрович, Юрий Александрович Мищенко, and Yurii Oleksandrovych Mishchenko. "Емпієма плеври - проблема сучасної торакальної хірургії." Thesis, Сумський державний університет, 2015. http://essuir.sumdu.edu.ua/handle/123456789/41974.
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Емпієма плеври являється найбільш грізним ускладненням запальних захворювань
легень, травм грудної клітки та оперативних втручань. Кожного року приріст неспецифічних
захворювань легень складає 5 %. Закономірно зростає кількість хворих на гостру та хронічну
емпієму плеври. За останнє десятиріччя відмічається повільний, але стійкий ріст
захворюваності на гостру пневмонію, яка у 4% випадків ускладнюється розвитком емпієми
плеври.
6
Freitas, Sergio Luiz Oliveira de. "Toracoscopia em crianças com derrame parapneumônico complicado na fase fibrinopurulenta." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2006. http://hdl.handle.net/10183/11504.
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Introdução: Apesar de a toracoscopia ser o procedimento preconizado em crianças com derrame pleural parapneumônico complicado (DPPC) na fase fibrinopurulenta, a grande maioria dos trabalhos citados na literatura é de relato de casos ou revisão de pequeno número de pacientes. Este estudo interinstitucional foi realizado para determinar a eficácia deste procedimento em número significativo de crianças com DPPC na fase fibrinopurulenta. Métodos: Estudo retrospectivo de 99 crianças (0,4 a 11 anos; idade média 2,6 anos) submetidas à toracoscopia para tratamento de DPPC na fase fibrinopurulenta, operadas em três hospitais diferentes e com mesmo algoritmo de tratamento, no período de novembro de 1995 a julho de 2005. Resultados: A toracoscopia foi eficaz em 87 crianças (87%); 12 (13%) necessitaram de outro procedimento cirúrgico - 6 novas toracoscopias e 6 toracotomia/pleurostomia. O tempo médio de drenagem após a toracoscopia foi de 3 dias naqueles em que a toracoscopia foi efetiva e de 10 dias nos reintervidos (P < 0,001). Todos resolveram a infecção pleural. As complicações da toracoscopia foram enfisema subcutâneo na inserção do trocater em duas crianças (2%), infecção da ferida operatória em outras duas (2%), sangramento pelo dreno torácico em 12 (12%) e fístula bronco pleural em 16 (16%). Nenhuma necessitou intervenção cirúrgica, Conclusões: A efetividade da toracoscopia em crianças com DPPC na fase fibrinopurulenta foi de 87%. O procedimento mostrou-se seguro, com baixa incidência de complicações graves, devendo ser considerada como primeira opção em crianças com DPPC na fase fibrinopurulenta.Introduction: Although Thorachoscopy being a procedure used to treat children with complicated parapneumonic pleural effusion (DPPC) in fibrinopurulent stage, most of the works presented in literature are case reports of only a few patients. The purpose of this work is to carry on a cross institutional study to determine the method’s effectiveness on a significant number of children with DPPC in its purulent stage. Methods: This is a retrospective case study of 99 children (ages 0,4 to 11; average age 2,6), from November 1009 to July 2005, submitted to thorachoscopy for the treatment of DPPC in fibrinopurulent stage, operated in three different hospitals and with the same treatment algorithm. Results: Thorachoscopy was effective for 87 children (87%). 12 (12%) needed to be submitted to another surgery – 6 to another thorachoscopy and 6 to thorachotomy/pleurostomy. The average draining time after thorachoscopy was 3 days for those whose thorachoscopy was effective and 10 days for those who were submitted to a new surgery (P< 0,001). In all cases, the pleural infection was successfully treated. Complications of the thorachoscopy were subcutaneous emphysema in the trocater insertion on two patients (2%), infection of the surgery incision on two other patients, bleeding through drain on 12 patients (12%) and bronchialpleural fistula on 16 patients (16%). None of them needed surgical treatment. Conclusion: The effectiveness of thorachoscopy on children with DPPC in fibrinopurulent stage was 87%. The procedure had low incidence of serious complications, and should be considered the first treatment option for children with DPPC in fibrinopurulent stage.
7
Rahman, Najib. "Clinical trials in pleural disease." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:930991f1-3424-4b96-984e-06df7f6e9204.
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The focus of this thesis is on practice changing clinical studies which impact upon the day to day treatment of patients with pleural infection, answering specific questions on several aspects of patient management. Specific areas of assessment in this thesis include: Assessment of the current evidence for optimal drain size choice in patients with pleural infection; Analysis and statistical modelling of a previous cohort of patients with pleural infection, in order to assess optimal drain size choice in pleural infection; The design, conduct and analysis of a 2 x 2 factorial multi-centre randomised, placebo controlled trial to assess the efficacy of two novel intrapleural agents (tPA and DNase) in aiding drainage in patients with pleural infection (The 2nd Multi-centre Intrapleural Sepsis Trial, referred to from here on as MIST2); Validation work informing the primary outcome measure of MIST2, assessing the relationship between chest radiograph imaging of infected pleural effusion and CT measured volume of pleural fluid using novel digital measurement strategies.
8
Дужий, Ігор Дмитрович, Игорь Дмитриевич Дужий, Ihor Dmytrovych Duzhyi, Юрій Олександрович Міщенко, Юрий Александрович Мищенко, Yurii Oleksandrovych Mishchenko, Галина Павлівна Олещенко, Галина Павловна Олещенко, Halyna Pavlivna Oleshchenko, and В. О. Олещенко. "Деякі особливості хірургічного лікування осумкованих емпієм плеври." Thesis, Національний інститут фтизіатрії і пульмонології імені Ф.Г. Яновского, 2019. https://essuir.sumdu.edu.ua/handle/123456789/81281.
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Запропонований метод оперативного лікування
емпієм плеври за їхньої схильності до осумкування і
ризиках щодо проведення плевректомії може бути
застосований у комбінації з антибактеріальною лімфо-
тропною терапією.
9
Pinotti, Karin Franco. "Utilidade da ultra-sonografia no manejo do derrame pleural parapneumônico em crianças /." Botucatu : [s.n.], 2005. http://hdl.handle.net/11449/86329.
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Orientador: Antônio José Maria CataneoResumo: A radiografia simples de tórax (RX) é um exame já consagrado, no derrame pleural parapneumônico (DPP), mas através dela não é possível determinar a viscosidade do líquido, presença de loculações ou encarceramento pulmonar, que podem ser avaliados pela ultrassonografia torácica (US). Avaliar prospectivamente a utilidade da US feita antes da drenagem em crianças internadas com DPP. Todas as crianças internadas com diagnóstico de DPP após RX deveriam passar pela US onde eram avaliadas: loculação pleural, ecogenicidade e quantidade de líquido estimada. Após punção era avaliado o aspecto, pH e bioquímicos do líquido pleural. Nos drenados era aferido o volume do líquido drenado para comparação com o volume estimado pela US. Os pacientes sem melhora clínica ou radiológica após drenagem eram encaminhados para procedimento cirúrgico maior. De agosto de 2001 a julho de 2003 foram avaliadas 52 crianças (31?, 21?) com idade de 5 meses a 13 anos, predominando a faixa etária menor que 2 anos. Destas, foi realizada US em 48, das quais 35 foram drenadas e 13 tratadas clinicamente. Dois dos drenados necessitaram de cirurgia maior. A US mostrou derrame livre em 38 e loculado em 10 casos. Dos livres foram drenados 25 (65,8%) e dos loculados 10 (100%). Quanto à ecogenicidade13 eram anecóicos, 18 espessos com septações e 17 espessos sem septações; foram drenados 6 anecóicos (46,15%), 15 espessos com septação (83,33%) e 14 espessos sem septação (82,35%). O volume de líquido estimado pela US variou de 20 a 860 ml. Quanto à ecogenicidade, o volume do líquido foi significativamente maior nos espessos com septação, e quanto à loculação foi significativamente maior nos loculados. Não houve diferença significante nos bioquímicos quando os grupos foram separados pela ecogenicidade, mas o pH e glicose pleurais foram significantemente menores e o DHL significativamente... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Utility of thoracic ultrasound in the management of parapneumonic effusions in children. Thoracic radiography, a well-known procedure in parapneumonic effusion (PPE), cannot evaluate fluid viscosity, the presence of loculations or "trapped lung", all of which can be established by thoracic ultrasound (US). Prospectively evaluate the utility of US before pleural drainage in children with PPE. All children hospitalized for PPE, identified by thoracic radiography, underwent US to assess pleural loculation, echogenicity, and amount of pleural fluid. After thoracocentesis, the extracted fluid was examined for gross appearance and was submitted to biochemical analysis. Among patients who underwent pleural drainage, the amount of fluid obtained from the procedure was compared to the amount estimated by US. Patients without clinical or radiological improvement underwent a more significant surgical procedure. From August 2001 to July 2003, 52 children (31 male, 21 female) were examined. These children ranged in age from 5 months to 13 years with the majority under the age of two. An US was performed on 48 of these children, 35 of whom received chest tube drainage and 13 of whom only received clinical treatment. Two pleural drainage patients, required a more significant surgical procedure. US identified 38 patients with free-flowing pleural fluid and 10 with loculated pleural fluid. Twenty five of the patients (65.8%) with free-flowing pleural fluid and 10 (100%) with loculation received chest tube drainage. Among patients with echogenicity, 13 were anechoic, 17 echoic without septations and 18 echoic with septations; 6 anaechoic (46.15%), 14 echoic without septations (82.35%) and 15 echoic with septations (83.33%) required chest tube drainage. The amount of fluid estimated by US varied from 20 to 860 ml. The volume of fluid was higher among patients that were echoic with... (Complete abstract click electronic access below)
Mestre
10
Литвинов, И. О., А. М. Пискарева, and Г. Н. Писаренко. "Эффективность использования видеоторакоскопических операций в лечении острой эмпиемы плевры." Thesis, Сумский государственный университет, 2015. http://essuir.sumdu.edu.ua/handle/123456789/42129.
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Эмпиема плевры (ЭП) встречается у 3-5% больных с гнойно-
воспалительными заболеваниями, требующими хирургического лечения. В сравнении с
видеоторакоскопическими операциями (ВТО) открытые оперативные вмешательства более
травматичны, с длительным послеоперационным периодом.
11
Pinotti, Karin Franco [UNESP]. "Utilidade da ultra-sonografia no manejo do derrame pleural parapneumônico em crianças." Universidade Estadual Paulista (UNESP), 2005. http://hdl.handle.net/11449/86329.
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A radiografia simples de tórax (RX) é um exame já consagrado, no derrame pleural parapneumônico (DPP), mas através dela não é possível determinar a viscosidade do líquido, presença de loculações ou encarceramento pulmonar, que podem ser avaliados pela ultrassonografia torácica (US). Avaliar prospectivamente a utilidade da US feita antes da drenagem em crianças internadas com DPP. Todas as crianças internadas com diagnóstico de DPP após RX deveriam passar pela US onde eram avaliadas: loculação pleural, ecogenicidade e quantidade de líquido estimada. Após punção era avaliado o aspecto, pH e bioquímicos do líquido pleural. Nos drenados era aferido o volume do líquido drenado para comparação com o volume estimado pela US. Os pacientes sem melhora clínica ou radiológica após drenagem eram encaminhados para procedimento cirúrgico maior. De agosto de 2001 a julho de 2003 foram avaliadas 52 crianças (31?, 21?) com idade de 5 meses a 13 anos, predominando a faixa etária menor que 2 anos. Destas, foi realizada US em 48, das quais 35 foram drenadas e 13 tratadas clinicamente. Dois dos drenados necessitaram de cirurgia maior. A US mostrou derrame livre em 38 e loculado em 10 casos. Dos livres foram drenados 25 (65,8%) e dos loculados 10 (100%). Quanto à ecogenicidade13 eram anecóicos, 18 espessos com septações e 17 espessos sem septações; foram drenados 6 anecóicos (46,15%), 15 espessos com septação (83,33%) e 14 espessos sem septação (82,35%). O volume de líquido estimado pela US variou de 20 a 860 ml. Quanto à ecogenicidade, o volume do líquido foi significativamente maior nos espessos com septação, e quanto à loculação foi significativamente maior nos loculados. Não houve diferença significante nos bioquímicos quando os grupos foram separados pela ecogenicidade, mas o pH e glicose pleurais foram significantemente menores e o DHL significativamente...
Utility of thoracic ultrasound in the management of parapneumonic effusions in children. Thoracic radiography, a well-known procedure in parapneumonic effusion (PPE), cannot evaluate fluid viscosity, the presence of loculations or trapped lung, all of which can be established by thoracic ultrasound (US). Prospectively evaluate the utility of US before pleural drainage in children with PPE. All children hospitalized for PPE, identified by thoracic radiography, underwent US to assess pleural loculation, echogenicity, and amount of pleural fluid. After thoracocentesis, the extracted fluid was examined for gross appearance and was submitted to biochemical analysis. Among patients who underwent pleural drainage, the amount of fluid obtained from the procedure was compared to the amount estimated by US. Patients without clinical or radiological improvement underwent a more significant surgical procedure. From August 2001 to July 2003, 52 children (31 male, 21 female) were examined. These children ranged in age from 5 months to 13 years with the majority under the age of two. An US was performed on 48 of these children, 35 of whom received chest tube drainage and 13 of whom only received clinical treatment. Two pleural drainage patients, required a more significant surgical procedure. US identified 38 patients with free-flowing pleural fluid and 10 with loculated pleural fluid. Twenty five of the patients (65.8%) with free-flowing pleural fluid and 10 (100%) with loculation received chest tube drainage. Among patients with echogenicity, 13 were anechoic, 17 echoic without septations and 18 echoic with septations; 6 anaechoic (46.15%), 14 echoic without septations (82.35%) and 15 echoic with septations (83.33%) required chest tube drainage. The amount of fluid estimated by US varied from 20 to 860 ml. The volume of fluid was higher among patients that were echoic with... (Complete abstract click electronic access below)
12
Vervloet, Leticia Alves 1960. "Pneumonia adquirida na comunidade e derrame pleural parapneumônico relacionados a Mycoplasma pneumoniae em crianças e adolescentes = Mycoplasma pneumoniae-related community-acquired pneumonia and parapneumonic pleural effusion in children and adolescents." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309984.
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Orientador: José Dirceu RibeiroTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivo: Determinar a prevalência e as características da pneumonia adquirida na comunidade (PAC) e derrames pleurais parapneumônicos (DPP) relacionados a Mycoplasma pneumoniae em um grupo de crianças e adolescentes. Métodos: Estudo observacional retrospectivo com 121 pacientes hospitalizados com PAC e DPP em um hospital de referência terciária, entre 2000 e 2008, divididos em seis grupos (G1 a G6) segundo o agente etiológico: M. pneumoniae com ou sem coinfecção, em 44 pacientes; outros agentes que não M. pneumoniae, em 77; M. pneumoniae sem coinfecção, em 34; Streptococcus pneumoniae, em 36; Staphylococcus aureus, em 34; e coinfecção M. pneumoniae/S. pneumoniae, em 9, respectivamente. Resultados: Na comparação entre os grupos, G1 apresentou frequências maiores em gênero feminino, tosse seca, uso prévio de beta-lactâmicos e maior tempo de evolução, assim como menor uso de assistência ventilatória e de drenagem torácica que G2, enquanto G3 teve maiores frequências em uso prévio de beta-lactâmicos e tosse seca, maior tempo de evolução e menor frequência de uso de drenos torácicos que G4 e G5, ao passo que G3 teve média de idade maior e menor frequência de náuseas/vômitos que G4, assim como menor uso de assistência ventilatória que G5. A coinfecção M. pneumoniae/S. pneumoniae aumentou a duração dos sintomas até a admissão. . Conclusões: Nesta amostra, a prevalência de PAC e DPP por M. pneumoniae foi de 12,75%, com evolução mais prolongada e quadro mais leves, que por outros microorganismos. Nossos dados sugerem a necessidade de uma maior diligência na investigação de M. pneumoniae em crianças e adolescentes com PAC e DPP em nosso meio
Abstract: Objective: To determine the prevalence and the characteristics of Mycoplasma pneumoniae-related community-acquired pneumonia (CAP) and parapneumonic pleural effusion (PPE) in children and adolescents. Methods: This was a retrospective observational study involving 121 patients with CAP/PPE hospitalized in a tertiary referral hospital between 2000 and 2008, divided into six groups according to the etiologic agent (G1 to G6, respectively): M. pneumoniae with or without co-infection, in 44 patients (group 1); etiologic agents other than M. pneumoniae, in 77 (group 2); M. pneumoniae without co-infection, in 34 (group 3); Streptococcus pneumoniae, in 34 (group 4); Staphylococcus aureus, in 34 (group 5); and M. pneumoniae/S. pneumoniae co-infection, in 9 (group 6). Results: In comparison with group 2, group 1 showed higher frequencies of females, dry cough, and previous use of beta-lactam antibiotics; longer disease evolution; and lower frequencies of use of mechanical ventilation and chest tube drainage. In comparison with groups 4 and 5, group 3 showed higher frequencies of previous use of beta-lactam antibiotics and dry cough; longer disease evolution; a lower frequency of use of chest tube drainage; a higher mean age and a lower frequency of nausea/vomiting (versus group 4 only); and a lower frequency of use of mechanical ventilation (versus group 5 only). M. pneumoniae/S. pneumoniae co-infection increased the duration of symptoms prior to admission. Conclusions: In this sample, the prevalence of M. pneumoniae-related CAP/PPE was 12.75%, with evolution longer and more prolonged course than other microorganisms. Our data suggest that M. pneumoniae-related CAP and PPE in children and adolescents should be more thoroughly investigated in Brazil
Doutorado
Pediatria
Doutor em Saude da Criança e do Adolescente
13
Peterson, Guilherme Eckert. "Dosagem de frações ativadas do sistema complemento em empiema induzido em ratos." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2016. http://hdl.handle.net/10183/150680.
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Introdução: Empiema pleural em geral decorre de complicação de pneumonias e, se não identificado e tratado precocemente, pode ocasionar aumento morbidade ou mesmo mortalidade. A identificação de marcadores no líquido pleural de efusões parapneumônicas que mostrem a presença ou a evolução precoce para empiema tem significância clínica. Neste cenário, dosagens das concentrações de frações ativadas do complemento no líquido pleural podem ajudar no diagnóstico precoce do empiema. Objetivos: Comparar as concentrações de frações ativadas do complemento (C3a, C5a e C5b9) em efusões pleurais induzidas em ratos por inoculação intrapleural de bactérias ou por irritante químico estéril (terebentina). Métodos: Trinta e nove ratos Wistar machos, peso médio de 414g (290 a 546g), realizaram anestesia geral com isofluorano inalatório por máscara, e toracocentese no 4º espaço intercostal com abocath conectado a oscilômetro de pressão para confirmar posição intrapleural. Os animais foram divididos em 3 grupos: SA (n=17) - inoculação de Staphylococcus aureus; SP (n=12) - inoculação de Streptococcus pneumoniae; C (n=10) – inoculação de terebintina (efusão pleural estéril, controle). Doze horas após a inoculação intrapleural foi coletado liquido pleural por toracocentese, sob controle ecográfico, e realizadas dosagens de C3a, C5a e C5b9 pelo método ELISA. Resultados: A dosagem de C3a foi de 1066,82 μg/ml (937,29 – 1196,35 μg/ml) no grupo SA, 1188,28 μg/ml (1095,65 – 1280,92 μg/ml) no SP, e de 679,13 μg/ml (601,29 – 756,98 μg/ml) no C (p<0,001). A dosagem de C5a foi de 55.727 ng/ml (41,22 – 70,23 ng/ml) no grupo SA, 520.107 ng/ml (278,92-761,3 ng/ml) no SP, e de 5.268 ng/ml (1,68 – 8,85 ng/ml) no C (p<0,001). A dosagem de C5b9 foi de 15,02 ng/ml (13,1 – 16,94 ng/ml) no SA, de 16,63 ng/ml (14,37 – 18,9 ng/ml) no SP, e de 14,05 ng/ml (9,8 – 18,29 ng/ml) no C (p=0,692). A avaliação das curvas ROC demonstrou área sob a curva de 0,987 (IC95% 0,953-1) para o C3a; 1 para C5a (1-1) e 0,757 (0,523-0,990). Conclusões: As frações ativadas dos complementos C3a e C5a foram significativamente maiores nos empiemas induzidos experimentalmente por inoculação intrapleural de Staphylococcus aureus e Streptococcus pneumoniae do que com aquelas observadas após inoculação intrapleural de terebentina. A dosagem elevada destas frações ativadas do complemento foi útil para o diagnóstico do empiema pleural induzido em ratos.Background Pleural empyema is a well-known complication of pneumonia. If treatment is delayed, empyema may increase morbidity and mortality in affected patients. Therefore, the identification of empyema biomarkers in parapneumonic pleural effusion is desirable. Previous research has suggested complement activation products as candidate empyema markers. Objective To compare the levels of complement activation products C3a, C5a, and C5b9 in pleural effusion induced by Staphylococcus aureus (SA), Streptococcus pneumoniae (SP), or turpentine (control). Method Thirty-nine male Wistar rats (mean weight 414g; 290-546g) were allocated as follows: 17 animals in the SA group, 12 in the SP group, and 10 in the control group. Bacteria or turpentine were injected into the pleural space. After 12h, intrapleural fluid was collected using ultrasound-guided thoracentesis. Levels of complement activation products were determined using ELISA kits. Results Two SA and 1 SP animals died before 12h. Mean levels were as follows: C3a: 1066.82 μg/mL (937.29-1196.35 μg/mL) in SA, 1188.28 μg/mL (1095.65-1280.92 μg/mL) in SP, and 679.13 μg/mL (601.29-756.98 μg/mL) in controls (p<0.001); C5a: 55.727 ng/mL (41.22-70.23 ng/mL) in SA, 520.107 ng/mL (278.92-761.3 ng/mL) in SP, and 5.268 ng/mL (1.68-8.85 ng/mL) in controls (p<0.001); C5b9: 15.02 ng/mL (13.1-16.94 ng/mL) in SA, 16.63 ng/mL (14.37-18.9 ng/mL) in SP, and 14.05 ng/mL (9.8-18.29 ng/mL) in controls (p=0.692). ROC analysis revealed an area under the curve of 0.987 (95%CI: 0.953-1) for C3a; 1 (1-1) for C5a; and 0.757 for C5b9 (0.523-0.990). Conclusions In the present rat model, complement activation fragments C3a and C5a accurately detected infected pleural effusion.
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Knebel, Rogério. "Toracoscopia vídeo-assistida para crianças com derrame parapneumônico complicado : quando indicar?" reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/129613.
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Objetivo: Avaliar a efetividade e o momento ideal da realização da toracoscopia vídeoassistida (TVA) para o tratamento de crianças com derrame pleural parapneumônico complicado (DPPC), bem como determinar se a drenagem torácica realizada como procedimento inicial pode influenciar os resultados da TVA. Métodos: Estudo retrospectivo de 79 crianças (idade média de 35 meses) submetidas à TVA, entre janeiro de 2000 e dezembro de 2011. Os pacientes foram tratados com o mesmo algoritmo de tratamento e os procedimentos cirúrgicos foram realizados ou supervisionados pelo mesmo cirurgião. As crianças foram divididas em dois grupos de acordo com o intervalo de quatro dias entre o diagnóstico do DPPC e a cirurgia. Resultados: Pacientes operados até o 4º dia após o diagnóstico do DPPC apresentaram menor tempo de internação (p=0,008), de uso de antibióticos (p=0,023) e de uso de dreno torácico (p=0,019), além de serem submetidos a menor número de procedimentos cirúrgicos (p<0,001). A drenagem pleural prévia retardou a realização da TVA em três dias, com consequente aumento no tempo de internação (p=0,050), no tempo de permanência do dreno torácico (p<0,001) e no tempo cirúrgico da TVA (p<0,001). TVA foi eficaz em 73 crianças (92,4%). Nem o intervalo entre o diagnóstico e a cirurgia, nem a drenagem pleural prévia, influenciaram a taxa de insucesso da TVA. Conclusões: TVA é um procedimento altamente efetivo em crianças com DPPC. TVA realizada até quatro dias após o diagnóstico do DPPC está associada à redução nos tempos de internação, de permanência do dreno torácico e do uso de antibióticos, além de diminuição no número de intervenções invasivas.thoracoscopic surgery (VATS) in the treatment of children with complicated parapneumonic pleural effusion (CPPE) and to determine whether the use of initial chest tube drainage (CTD) may influence VATS outcome. Methods: We retrospectively reviewed medical records of 79 children (mean age, 35 months) undergoing VATS from January 2000 to December 2011. The same treatment algorithm was used in the management of all patients, and all surgical procedures were performed or supervised by the same surgeon. The children were divided into two groups according to a 4-day interval between CPPE diagnosis and surgery. Results: Patients undergoing VATS within 4 days of CPPE diagnosis had a shorter hospital stay (p=0.008), fewer number of antibiotics administered (p=0.023), and decreased time with a chest tube (p=0.019), in addition to undergoing fewer number of surgical procedures (p<0.001). Initial CTD resulted in a delay of 3 days in performing VATS, leading to longer hospital stay (p=0.050), increased time with a chest tube (p<0.001), and longer VATS operating time (p<0.001). VATS was effective in 73 children (92.4%). The interval from diagnosis to surgery and initial CTD had no influence on VATS failure rate. Conclusions: VATS is a highly effective procedure for treating children with CPPE. VATS performed within 4 days of CPPE diagnosis is associated with shorter hospital stay, decreased time with a chest tube, fewer antibiotics administered, and fewer invasive interventions.
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Schneider, Airton. "Estudo comparativo de diferentes formas de protecao em modelo de fistula bronquica em ratos." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 1995. http://hdl.handle.net/10183/184848.
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Os autores apresentam os resultados obtidos no desenvolvimento de um modelo experimental de fístula brônquica e na comparação de diferentes formas de proteção no modelo de fístula brônquica desenvolvido. Para isso, foram utilizados ratos submetidos a pneumonectomia esquerda e o coto brônquico protegido com músculo intercostal ou gordura pericárdica pediculados. Os resultados demonstraram ser possível o desenvolvimento de um modelo de fístula brônquica em ratos com 65% de confiança e que não há diferença estatística (p>0,05) entre tecidos utilizados na proteção brônquica, desde que sejam pediculados.The authors present the resulte obtained after the development of an experimental model of bronchíal fistula and the comparison among different forms of post-pneumonectomy bronchial fistula protection. In order to achieve 'ha',were used rats that undergone left pneumonectomy whose bronchial stump was protected with either pedided muscle or pedicled fat. The results showed that it was possible to develop a bronchial fistula model with 65% of certainty and there was no slatistical difference (p>0,05) among the tissues used for bronchial protection, once they were pedicled.
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Wrightson, John M. "Pathogen identification in lower respiratory tract infection." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:30c757ec-99b7-492e-a12e-ff996581863a.
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Treatment of lower respiratory tract infection (pneumonia and pleural infection) relies on the use of empirical broad spectrum antibiotics, primarily because reliable pathogen identification occurs infrequently. Another consequence of poor rates of pathogen identification is that our understanding of the microbiology of these infections is incomplete. This thesis addresses some of these issues by combining the acquisition of high quality lower respiratory tract samples, free from nasooropharyngeal contamination, with novel molecular microbiological techniques in an attempt to increase rates of pathogen identification. Four main areas are examined: (i) The role of so-called ‘atypical pneumonia’ bacteria in causing pleural infection. These pathogens have been previously identified in the pleural space infrequently and routine culture usually fails to isolate such bacteria. High sensitivity nested polymerase chain reaction (PCR) is a culture-independent technique which is used to undertake a systematic evaluation for these pathogens in pleural infection samples. (ii) The role of Pneumocystis jirovecii in pleural infection, either as a co-infecting pathogen or in monomicrobial infection. This fungus causes severe pneumonia, particularly in the immunosuppressed, but is increasingly recognised as a co-pathogen in community-acquired pneumonia, and is frequently isolated in the upper and lower respiratory tract in health. A high sensitivity real-time PCR assay is used to examine for this fungus. (iii) Ultra-deep sequencing of the 16S rRNA gene is used to perform a comprehensive microbial survey in samples taken from the multi-centre MIST2 study of pleural infection. The techniques employed allow analysis of polymicrobial samples and give very high taxonomic resolution, whilst incorporating methods to control for potential contamination. Further, these techniques provide confirmation of the results from the ‘atypical’ bacteria nested PCR study. (iv) Bedside ultrasound-guided percutaneous transthoracic needle aspiration (TNA) of consolidated lung is undertaken in patients with pneumonia, as part of the PIPAP study. An evaluation is undertaken of the efficacy and acceptability of TNA. Aspirate samples acquired are also processed using ultra-deep sequencing of the 16S rRNA gene. Other samples obtained as part of the PIPAP study, such as ‘control’ lung aspirates and ‘control’ pleural fluid samples, are similarly processed to enable calculation of sensitivity and specificity of the sequencing methodology.
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Michel, Patrick. "Empyeme pleural a myocbacterium kansasii." Lyon 1, 1991. http://www.theses.fr/1991LYO1M100.
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Konradt, Guilherme. "Doenças inflamatórias bacterianas que afetam o sistema nervoso de ruminantes no Rio Grande do Sul." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2016. http://hdl.handle.net/10183/148563.
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Distúrbios do sistema nervoso central (SNC) em ruminantes abrangem um importante grupo de enfermidades responsáveis por grandes perdas econômicas em todo o mundo. As principais doenças neurológicas causadas por bactérias em ruminantes e que envolvem processos inflamatórios incluem listeriose, leptomeningites e meningoencefalites supurativas, abscessos cerebrais e medulares, empiema basilar e neurotuberculose. Esta dissertação teve por objetivo a caracterização epidemiológica, patológica, microbiológica e imuno-histoquímica das doenças inflamatórias de origem bacteriana que afetam o SNC de ruminantes no Rio Grande do Sul. Foi realizado um estudo retrospectivo no período compreendido entre janeiro de 1996 a dezembro de 2015, onde um total de 3.274 bovinos, 596 ovinos e 391 caprinos foram avaliados. Destes, 219 bovinos, 21 ovinos e sete caprinos foram diagnosticados com doenças inflamatórias no SNC. As doenças neurológicas inflamatórias de origem bacteriana totalizaram 60 casos divididos em 34 bovinos, 19 ovinos e sete caprinos, os quais foram subdivididas em: meningoencefalite por L. monocytogenes (oito ovinos, cinco caprinos e quatro bovinos), leptomeningite e meningoencefalite supurativa (14 bovinos, dois caprinos e um ovino), abscessos cerebrais (seis bovinos e dois ovinos) e medulares (sete ovinos), empiema basilar (quatro bovinos e um ovino) e neurotuberculose (seis bovinos). O exame imuno-histoquímica foi realizado em todos os casos diagnosticados com listeriose (anticorpo anti-L. monocytogenes), meningite e meningoencefalite supurativa (anticorpo anti-Escherichia coli) e neurotuberculose (anticorpo anti-Mycobacterium tuberculosis). A meningoencefalite por L. monocytogenes representou a principal enfermidade neurológica em ovinos e caprinos, seguido dos abscessos medulares em ovinos. Nos bovinos, a leptomeningite e meningoencefalite supurativa foi a doença neurológica mais prevalente para a espécie, frequentemente relacionada com a falha na transmissão da imunidade passiva. O empiema basilar, frequentemente diagnosticado em bezerros, está diretamente relacionado com o manejo do desmame interrompido através da utilização de tabuletas nasais. A neurotuberculose causada por Mycobacterium spp. é uma importante doença neurológica em bovinos jovens e deve ser considerada como diagnóstico diferencial de doenças neurológicas. Dos dados analisados neste período, as doenças neurológicas inflamatórias bacterianas representaram um total de 24,3% entre as doenças neurológicas inflamatórias diagnosticadas neste período e, com isso, conclui-se que representam importantes causas de mortalidade para os ruminantes domésticos.Central nervous system (CNS) diseases are worldwide economically important conditions in ruminants. The main neurological bacterial diseases which involve inflammation in ruminants are listeriosis, suppurative leptomeningitis and meningoencephalitis, brain and spinal cord abscesses, basilar empyema and neurotuberculosis. This study aim to describe the epidemiological, pathological, microbiological and immunohistochemical findings of the bacterial inflammatory diseases that affect the CNS of ruminants in Rio Grande do Sul state. A retrospective study was performed from January 1996 to December 2015, during which samples of 3.274 cattle, 596 sheep and 391 goats were evaluated. Of these, 219 cattle, 21 sheep and seven goats were diagnosed with inflammatory diseases affecting the CNS. The neurological inflammatory bacterial diseases accounted for 60 cases, which corresponded to 34 cases in cattle, 19 in sheep and seven in goats. These were further subdivided in: meningoencephalitis by L. monocytogenes (eigth sheep, five goats and four cattle), suppurative leptomeningitis and meningoencephalitis (14 cattle, two goats and one sheep), brain abscesses (six cattle and two sheep) and spinal cord (seven sheep), basilar empyema (four cattle and one sheep) and neurotuberculosis (six cattle). Immunohistochemical exam was performed in all cases diagnosed as listeriosis (antibody anti-L. monocytogenes), as suppurative leptomeningitis and meningoencephalitis (antibody anti-E. coli), and as neurotuberculosis (antibody anti-Mycobacterium tuberculosis). L. monocytogenes meningoencephalitis was the main neurological disease in sheep and goats, followed by spinal cord abscesses in sheep. In cattle, suppurative leptomeningitis and meningoencephalitis was the most frequent neurological disease, and its ocorrunce is related to the failure in passive immunity transmission. Basilar empyema is frequently diagnosed in calves and is directly related to early weaning handling through the use of nose-flaps. Neurotuberculosis caused by Mycobacterium spp. is an important neurological disease in young cattle and should be consired as a differential diagnosis of granulomatous meningoencephalitis. During the described period, neurological inflammatory bacterial diseases accounted for 24.3% of the neurological inflammatory diseases, and, thus, these are important causes of death in domestic ruminants.
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GIRAUD, BERNARD. "Empyeme cerebral et septicemie a eikenella corrodens." Aix-Marseille 2, 1994. http://www.theses.fr/1994AIX20109.
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MAINA, CLAUDE. "Les suppurations intracraniennes : etude de 64 cas : 1. abces isole (44 cas) - 2. empyeme sous et extra-dural (16 cas - 4 cas)." Aix-Marseille 2, 1988. http://www.theses.fr/1988AIX20494.
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LE, FOURN BRUNO. "Utilisation de l'epiploon dans le comblement des empyemes thoraciques chirurgicaux." Nantes, 1993. http://www.theses.fr/1993NANT203M.
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LEPRETRE, FLORIANE. "Les suppurations intracraniennes : a propos de 41 cas observes au c.h.r. d'angers entre janvier 1983 et avril 1992." Angers, 1994. http://www.theses.fr/1994ANGE1025.
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Orieux, Virginie. "Abcès et empyemes cérébraux : complications intracraniennes des sinusites." Montpellier 1, 1998. http://www.theses.fr/1998MON11150.
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Chanalet, Stéphane. "Les empyemes extra-cerebraux : aspects radio-cliniques a propos de 39 cas." Nice, 1989. http://www.theses.fr/1989NICE6014.
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Balu, Laurent Chevret Laurent. "Pleurésies purulentes communautaires de l'enfant et streptocoque A." Créteil : Université de Paris-Val-de-Marne, 2004. http://doxa.scd.univ-paris12.fr:80/theses/th0216517.pdf.
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Piazza, Giuseppina [Verfasser], Johannes G. [Gutachter] Liese, Christoph U. [Gutachter] Schoen, and Klaus [Gutachter] Brehm. "Evaluation der prästationären, stationären und poststationären antibiotischen Therapie bei Kindern und Jugendlichen mit parapneumonischen Pleuraergüssen/-empyemen in Deutschland (2010-2018) / Giuseppina Piazza ; Gutachter: Johannes G. Liese, Christoph U. Schoen, Klaus Brehm." Würzburg : Universität Würzburg, 2021. http://d-nb.info/1240614772/34.
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Kaye-Eddie, Grace Helga. "Retrospective comparison of empyema thoracis in HIV infected and non-infected patients with regards to aetiology and outcomes." Thesis, 2013. http://hdl.handle.net/10539/12488.
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Background
HIV is a risk factor for empyema. HIV-infected patients with empyema appear to have worse outcomes. This study assessed whether HIV infection affected aetiology or outcomes of patients with empyema.
Methods A retrospective study of patients with empyema admitted to CHBAH from January 2006 to December 2009 was conducted. HIV-infected and non-infected patients were evaluated for differences in aetiology and outcomes. Sub-analysis according to CD4 counts and antiretroviral use in HIV-infected patients was performed.
Results
0f 172 patients, 125 (73%) were HIV-infected. HIV infected patients with lower CD4 counts were more often diagnosed with clinical tuberculosis (p<0.05). Aetiology of empyema was frequently not determined in HIV non-infected patients (p<0.05). More patients on antiretrovirals underwent thoracic surgery (p<0.05) and had shorter hospital stays than those not on antiretrovirals (p<0.05).
Conclusions No differences in empyema aetiology among HIV-infected versus non-infected patients were found. Antiretroviral use was associated with improved outcomes.
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Chen, Hsiao Yun, and 陳筱筠. "Development of Biodegradable Antibiotic Beads for Empyema Treatment." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/65398097380441859456.
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碩士長庚大學
機械工程學系
98
Thoracic empyema continues to cause significant morbidity and mortality despite the improvement of antimicrobial therapy and the existence of multiple options for drainage of the infected pleural space. This current paper used vancomycin, penicillin and straptokanise combined with biodegradable polymers (50:50 poly(DL-lactide):co-glycolide) as antibiotic beads for a long-term drug release into the pleural space. To manufacture the biodegradable beads, polylactide-polyglycolide copolymers were mixed with the pharmaceuticals. The mixture was compressed and sintered at 65oC to form beads of different sizes. The beads were placed in 1 ml of phosphate buffered saline and incubated at 37.4 oC. An elution method combined with a bacterial inhibitory test was employed to characterize the release rate of the antibiotics over a 30-day period. The results suggested that the biodegradable beads released high concentrations of antibiotic (well above the minimum inhibitory concentration) and straptokanise in vitro for up to 28 days. This provides advantages as alternative choices of long-term pharmaceutical delivery for patients with empyema. Keywords: local antibiotic delivery, empyema, vancomycin, penicillin, straptokanise, polylactide-polyglycolide, release rate
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Schwenke, Katherine Linda. "Record review of patients with brain abscess and empyema." Thesis, 2010. http://hdl.handle.net/10539/7477.
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Thesis (M.Sc.(O.T.), Faculty of Health Sciences, University of the Witwatersrand, 2009Studies of patients presenting with brain abscess (BA) and Empyema are not routinely focused on occupational therapy (OT). There is a paucity of literature on deficits other than hemiplegia. Aims of this study were to determine the relationship between BA, Empyema, motor and other deficits and whether an OT intervention protocol is needed. Record review was used to establish clinical presentation trends. Hemiplegia was the most common motor deficit and the majority scored below the norm on the Beery- Buktenika Developmental Test of Visual Motor Integration (VMI). Patients with Brain Abscess generally had more significant deficits than those with Empyema for both motor and process deficits. Part B followed up a small sample (n=8) which indicated clinical improvement on the VMI test with the score on the supplemental test of motor coordination remaining a concern. Occupational Therapy is recommended to address these issues based on the Occupational Therapy Practice Framework-II.
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Huang, Hung-Che, and 黃弘哲. "Lung Abscess Predict the Surgical Outcome in Patients with Pleural Empyema." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/aqw6dq.
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碩士長榮大學
醫學研究所
97
Pleural empyema is one of the serious complications of pneumonia, which increases morbidity and mortality. The mortality of patients with pleural empyema is up to 20% and leads to a higher hospital cost and longer hospital stay. Lung abscess has previously been thought to be a rare condition of empyema and parapneumonic effusions. We compared the clinical presentations and surgical results of patients with pleural empyema with and without lung abscesses. From January 2004 to December 2006, 259 patients with pleural empyema were diagnosed and received operation in our department. We recorded the following data: age, gender, clinical findings, chronology of initial signs, diagnoses, bacteriological and biochemical studies of pleural fluid, and radiologic and intra-operative findings. The outcomes were compared to evaluate the correlationships exists between pleural empyema and lung abscess. All early and late deaths were attributed to progressive uncontrolled sepsis in patients with pleural empyema. The causes of pleural empyema included pneumonia or lung abscess (n = 239), lung cancer (n = 9), deep neck infection induced (n=1), post-traumatic empyema (n = 6) and post-operation complications (n = 4). 22 patients with lung abscess were diagnosed by the pre-operative image study or by the finding during operation. All these patients received video-assisted thoracic surgery, but two operations（0.77％）were converted to mini-thoracotomy due to thick peel. There are statistic significant difference between abscess group and non-abscess group in pre-operative leukocytosis（95.45％ and 63.29％, P< 0.05）, transferred into intensive care unit（63.64％ and 40.08％, P<0.05）, mortality during 30 days after operation（18.18％ and 2.95％, P<0.05）and overall mortality（22.73％ and 5.91％, P<0.05）. Patients with lung abscess and pleural empyema may need more operations（40％ and 1.7％， P>0.05）. The mortality is higher in pleural empyema patients with lung abscess, or without adequate drainage in time. Patients with lung abscess and pleural empyema may need more operation procedures and need careful clinical observation and care.
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Thobejane, Emmanuel Kgoro. "The outcome of intracranial subdural empyema at Steve Biko Academic Hospital : retrospective study." Diss., 2012. http://hdl.handle.net/2263/28415.
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Objectives: Intracranial subdural empyema (ICSDE) can be a devastating condition, with a sequelae ranging from epilepsy, focal deficits to death. Factors affecting the outcome in subdural empyema range from level of consciousness, the extend of subdural pus at the time of diagnosis and the type of surgical procedure performed. Previous studies have conflicting results of unfavourable prognostic factors associated with ICSDE. The outcome of this condition at Steve Biko Academic Hospital (SBAH) is reported, as well as factors influencing the outcome. Methods: A retrospective analysis of all the patients admitted at neurosurgery unit of SBAH during 2006 – 2010 period with confirmed subdural empyema on brain CT scan and at surgery. Data sheet was used to collect all clinical information from patients’ records. Glasgow Outcome Scale and Henk W. Mauser grading were used to report on the outcome. Results: A total of 34 patients (20 males and 14 females) with mean age of 16.1 years were admitted with a diagnosis of ICSDE. The common presenting features were headache (58.8%), fever and seizures (47.0% each). Over 61% of patients had hemiplegia at presentation. CT scan confirmed subdural collections with 70.6% over the convexity, 23.5% at the convexity and parafalx and only 5.9% had bilateral collections. Complicated paranasal sinusitis was the origin of infection in 82.3%, followed by meningitis with 8.8%. Burr hole washout was done in 52.9% of patients, while 38.2% had burr holes with drains in situ and 8.8% had craniotomy to evacuate the subdural pus. All the patients were given empiric triple antibiotic therapy. Streptococci species were the most cultured organisms in the 19 (56.0%) patients who had positive cultures, however 15 (44.0%) patients had negative cultures. Resistance to penicillin was noted in 5.0% of cases only. Sixty-five percent of patients had good outcome with no seizures nor neurological deficits. The overall mortality was 15.0% in this study, with none from patients who had craniotomy. Conclusion: Clinical presenting features and organisms cultured seems to be the same internationally, particularly those due to complicated sinusitis. Empiric triple antibiotic therapy of 3rd generation cephalosporin plus vancomycin plus metronidazole is still relevant at SBAH. Factors associated with favourable outcome were ages between 11 and 20 years, and craniotomy as the surgical procedure of choice.Dissertation (MMEd)--University of Pretoria, 2013.
Neurology
Unrestricted
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Pan, Chien-Te, and 盤建德. "Outcome of Empyema Patient Compare VATS and Open Method-A Nationwide Population-based Study." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/85937877948582977135.
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碩士國立陽明大學
醫務管理研究所
100
Background: The decortication has been used for a long period time to solve the problem of empyema. The VATS has been introduced since 90s’ and first introduced before 2000. Previous clinical data is obtained from single center. Lack compared to other hospital or other centers to reveal truly factor affected the choice of op method, the complication or the post-op death. Objective and Methology: from 2001 January to 2008 December, all patient who receive the operation of decortication for the reason of empyema, included from the database of NHI. We excluded the cancer or pre-teen patients, then we collect the data to run multiple logistic regression model to find out which factors is the key for choice of op method, the complication and even the post-op death. At final, we use the statistic skill to adjust the selection bias from the retrospective observational study. Results: The female patient has 1.75 times chance to receive VATSD (95%CI:1.0,1.3). If the doctor’s age has over 55 years old, only 0.5times to perform VATSD (95%CI;0.4,0.6). Privacy hospital has 1.8 times to perform VATSD (95%CI:1.2,1.5), the Eastern Taiwan has less chance to perform this operation with only 0.25times than Taipei city (95%CI;0.16,0.39). But the year of 2008 had 6.1 times (95%CI;4.8,7.7) than year of 2000 to perform VATSD. The factors which affect the complication, is patient’s age who over 65 years old has 3.87times than the 15 years old boy (95%CI;2.9,5.1). Female doctor is also has higher complication than male doctors, 2.57 times (95%CI;1.9,3.3). Medical center is the safer place for complication 0.43 times of odd ratio (95%CI;0.35,0.54). the OD has 1.63 times mortality than VATSD (95%CI:1.34,1.99). post-op death is also higher at the age group who is 65 year old or above, 8.87 times than young man (95%CI;2.17,36.17). if post-op complication is happened, 3.72 times mortality than others (95%CI;3.0,4.59). 7.33times higher rate of mortality if your CCI is equal or over 3 (95%CI:5.55,9.68). The propensity score is similar as the multiple logistic regression model. The post-op death rate is effected by the CCI, sex and SES of patient. The characteristics of hospital and doctor are less important to post-op death. The death rate is going down as the year. Conclusion: The choice of operation method is influenced a lots by Charlson comorbidity index、sex of patient. Also the doctor’s age and amount of operation per year is important. The number of operation of VATSD is increasing as the year significantly. The complication rate is going up year by year but the death date is decreasing as result of operation. Although the complication rate is no significant different, the higher death date is found in the group of OD. Therefore, we concluded the VATSD is safer for the patients of empyema.
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Chang, Wan-Ting, and 張菀庭. "Molecular Typing and Phenotypes Characterization of Methicillin-Resistant Staphylococcus aureus From Patients With Empyema Thoracis." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/91568985542732608941.
Full textAbstract:
碩士中山醫學大學
生化暨生物科技研究所
101
Background: Staphylococcus aureus (S.aureus) can cause many serious infections, such as bacteremia, skin and soft tissue infections, pneumonia, osteoarthritis, and sepsis ,with high mortality rate and complication rate. Methicillin-Resistant S. aureus( MRSA) was discovered in the 1960s, has 60-80% of S. aureus belonging to MRSA in Taiwan. Literature has reported on Community- associated (CA-MRSA) and Healthcare- associated MRSA (HA-MRSA) is significantly different between genotyping and phenotype, and MRSA has a few specific clones in particular endemic. The purpose of this study is to investigate the cause of empyema by MRSA strains of genotype and phenotype of specificity and differences.Methods: Based on clinical criteria collected 23 specimens from pleural effusion isolated with methicillin-resistant Staphylococcus aureus (MRSA) strains of the following organisms phenotype and molecular typing of identification. Phenotype for the strain identification, drug susceptibility testing, minimum inhibitory concentration(MIC) of vancomycin by agar dilution method, induced macrolide-lincosamide-streptogramin B resistance testing (MLSBi, D-test), Panton-Valentine Leukocidin toxin gene (pvl),determination of staphylococcal enterotoxin (SEs) virulence factor gene; molecular biology typing is performed Staphylococcal cassette chromosome mec (SCCmec), multilocus sequence typing (MLST), Staphylococcal protein A (spa), accessory gene regulator (agr), and direct repeat units (dru). Results: From 23 patients with empyema isolated MRSA, confirmed by laboratory analysis was identified as 19 non-duplicate of MRSA. Drug susceptibility test results of approximately 74% of the MRSA strains are multidrug-resistant strains;the range of minimum inhibitory concentration (MIC) to vancomycin using the agar dilution method were 2-3mg / L;19 MRSA strains of the macrolide-lincosamide-streptogramin B resistance testing (MLSBi) were negative; pvl positive rate of only 16%; 19 MRSA strains can be classified into nine kinds of enterotoxins (SEs) virulence factor complex. HA-MRSA accounted for 68% (molecular biology typing to SCCmecII and SCCmecIII); CA-MRSA accounted for 32% (molecular biology typing to SCCmecIV and SCCmecVT). 19 specimens from pleural empyema patient isolation of non-duplicate MRSA strains were having mecA gene, and total of five main genetic groups： SCCmecII-ST5-spat002-dru4, SCCmecIII-ST239-spat037-dru14or12or15, SCCmecIV-ST59-spat437-dru9, SCCmecIV-ST573-spat3523-dru9or8or10, SCCmecVT-ST59-spat437-dru11；pvl gene related with SCCmecIV, ST59 andspat437; multidrug resistance (more than or equal to 4 kinds antibiotics) related with SCCmecII, ST5, spat002, dru4; MRSA strain with high vancomycin MIC is related with SCCmecIII, ST239, spat037 and agr group I；there is no any related between MLSBi and phenotyping or genotyping；the 19 isolates identified into nine kinds of staphylococcal enterotoxins virulence factor gene complex, the major molecular typing of enterotoxins virulence factor genome is sea-selk-selq-SCCmecIII-agrI (5 strains of 26%). Conclusion: Diverse molecular types with relatively high rate of multidrug resistance and elevated MIC to vancomycin were found in 19 MRSA isolates from patient with empyema. More information including demographic and laboratory data of patients with MRSA empyema are needed to correlate these data with molecular and phenotyping results and to identify molecular and phenotypic indicators for outcomes of empyema patients.
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LIPPI, FRANCESCA. "Parapneumonic effusion in italian children: diagnosis and serotyping by real-time polymerase chain reaction." Doctoral thesis, 2014. http://hdl.handle.net/2158/853109.
Full textAbstract:
The aim of this study was to achieve diagnosis and serotyping of empyema cases using real-time polymerase chain reaction directly on pleural fluid in a large cohort of Italian children hospitalized with CAP complicated by empyema in pre- and post-pneumococcal conjugate vaccine (PCV13) era.
One hundred and thirty five children 0-16 years admitted with a diagnosis of parapneumonic effusion (PPE) to 24 Pediatric Hospitals all over Italy were included in the study.
Realtime PCR was performed in all 135 patients and was positive for at least one of the tested pathogens in 109/135 (80.7%) patients. Streptococcus pneumoniae was the most frequent and was found in 84/109 (77.1%) samples. In non-pneumococcal PPE pathogen more frequently found were Streptococcus pyogenes (8/135 cases) in younger (mean age 3.89 years) and Fusobacterium necrophorum or nucleatum (5/135 cases) in adolescents (mean age 11.49 years).
Between 2007 and 2010 (before the inclusion of Prevenar 13 in the Italian schedule) we found 81 cases of PPE. Streptococcus pneumoniae was found in 45/81 (55.6%). Betweeen 2011 and January 2014 we found where 55 cases of PPE. Streptococcus pneumoniae was the most frequent and was found in 39/55 (70.1%).
We have shown that in Italy there was not an increase in the incidence of other pathogens in PPE after the introduction of Prevenar13.
RT-PCR allowed serotyping in 81/84 (96.4%) patients with pneumococcal PPE. Actually, serotype distribution in PPE demonstrated a large preponderance of serotypes 1, 3 and 19A (non-PCV7 serotypes). Serotype 1 appeared significantly associated with complications and older age. Since the mean age for PPE is usually older than 3 years, at this point of time the direct effect of PCV13 vaccination in reducing PPE incidence is not yet evident . However in the 3 years since PCV13 has been introduced in Italy we did not found pneumococcal PPE in children aged <3,5 years. No cases in children aged <2 years, no cases in vaccinated children.
In 47 patients both cultures of pleural fluid and RT-PCR were performed at the same time. In the subgroup of 34 patients in which both tests were performed and etiologic diagnosis was obtained, the diagnosis was obtained by RT-PCR only in 30/34 (88.2%) patients, by both tests in 4/34 (11.8%) and by culture only in none. Realtime PCR appears 8.5 times more sensitive in individuating an etiologic agent in PPE and is significantly more sensitive than culture in achieving etiologic diagnosis of PPE.
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Makhambeni, Wilheminah Hendrika. "The underlying causes and management of intracranial subdural empyema in the neurosurgery department, Chris Hani Baragwanath Academic Hospital." Thesis, 2017. https://hdl.handle.net/10539/24903.
Full textAbstract:
Intracranial subdural empyema (SDE) is a potentially life-threatening condition. A retrospective
study of the Chris Hani Baragwanath Academic Hospital’s neurosurgery unit’s SDE patients
revealed a mean age of presentation of 15 years and male predominance (70%). In 61.7% SDE was
linked with sinusitis and in 83% with immunocompetence. There was a statistically significant
correlation between immunocompromise and death (40% mortality rate in the
immunocompromised subset). Among the patients’ culture positive specimen, 57.1% yielded a
Streptococcus spp., gram negative isolates were found in patients with immunocompromise or
previous head trauma/surgery, and 78.6% of the micro-organisms were sensitive to 3rd generation
cephalosporins. There was an 86.7% survival rate. A determinant of residual neurological deficit
could not be found among the parameters investigated.
Keywords: intracranial subdural empyema, complicated sinusitis, burrholesLG2018
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Chen, Hung-Jen, and 陳鴻仁. "Ultrasound in Peripheral Pulmonary Air-fluid Lesions: Color Doppler Imaging as an Aid in Differentiating Empyema and Abscess." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/17936274043326937861.
Full textAbstract:
碩士中國醫藥大學
臨床醫學研究所碩士班
98
Background: The aim of this study was to re-evaluate the clinical significance of sonographic appearances, in particular the application of color Doppler ultrasound (US) imaging, in discriminating peripheral air-fluid lung abscess from empyema. Methods: We retrospectively collected those patients who had had peripheral air-fluid lesions due to empyema or lung abscess, and undergone color Doppler US and gray-scale US examinations between January 2003 and October 2007. A total of 34 patients with confirmed lung abscess and 30 patients with empyema were identified. Four sonographic characteristics were observed and analyzed: 1. the wall characteristics of the lesions (wall width, luminal margin, outer margin and chest wall angle); 2. split pleura sign; 3. internal echogenicity (suspended microbubble sign, complex-septated effusions and passive atelectasis); 4. identification of color Doppler US vessel signals in peri-cavitary lesions (consolidation or atelectasis). Results: Among the sonographic characteristics, complex-septated effusions and passive atelectasis were specific for empyema, but the sensitivity was only 40% (12/30) and 47% (14/30), respectively. Identification of color Doppler US vessel signals in peri-cavitary consolidation was the most useful and specific for lung abscess. In our series, if we define the identification of color Doppler US vessel signals in peri-cavitary consolidation as a predictor for peripheral lung abscess, we can achieve sensitivity, specificity, positive predictive value and negative predictive value of 94%, 100%, 100% and 94%, respectively. Conclusions: Color Doppler US is powerful in differentiating the peripheral air-fluid abscess from empyema, with high specificity and without any risk.
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XU, ZHE-WEI, and 許哲維. "Using Survival Analysis to Explore the Influence of Empyema for COPD Patients: A Case Study of NHIRD in Taiwan." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/ctdcsx.
Full textAbstract:
碩士國立雲林科技大學
工業工程與管理系
105
The symptoms of chronic obstructive pulmonary disease (COPD) are always ignored. Patients with COPD often miss the best time for early treatment and their pulmonary function will fall gradually. When bacterial or virus infects lung, it will increase risk of pneumonia and empyema for patients with COPD. However, literature of epidemiologic studies do not explore that COPD influence on empyema. This research used survival analysis to explore the risk and incidence of empyema with different COPD patients’ characteristics by using a retrospective cohort study method. The data were from the National Health Insurance Research Database (NHIRD). We selected the patients who had been diagnosed COPD from 2003-2010. The overall incidence rate of Empyema was higher in the COPD group (15.76/〖10〗^4 person-years) than in the non-COPD group (4.10/〖10〗^4 person-years). The adjusted hazard rate (HR) of Empyema was 3.25. The incidence rate of Empyema is associated with different comorbidities. The highest incidence rate of Empyema was in the Cancer with COPD group. This research offered the objective and correct data to doctor for making decision. Doctors can understand risk and incidence rate of empyema in COPD patients by our result and they can give more correct medical treatment to COPD patients who have higher risk of empyema.
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Heuschen, [geb Korbmacher] Stella Christine. "Ergebnisse der Pleuraempyembehandlung in der Abteilung für Thorax-, Herz- und Thorakale Gefäßchirurgie des UK Würzburg - Eine retrospektive Analyse -." Doctoral thesis, 2018. https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-155837.
Full textAbstract:
Das Pleuraempyem ist eine Ansammlung infizierten Sekrets oder Eiters im Pleuraspalt mit konsekutiv entzündlich verschwielender Reaktion der parietalen und viszeralen Pleura. Trotz moderner Antibiotikatherapie stellt es eine ernste thorakale und mit einer hohen Morbidität und Letalität assoziierte Erkrankung dar. Die Pneumonie ist nach wie vor der häufigste ätiologisch relevante Faktor. Eine frühzeitige und ausführliche Diagnostik bei Patienten mit klinischem Verdacht auf ein Pleuraempyem ist eine notwendige Voraussetzung für eine effektive stadiengerechte Therapie. Ein Vergleich mit der zur Verfügung stehenden Literatur ergab eine weitgehende Übereinstimmung der prinzipiellen Therapieregime. Die größtmögliche Heilungschance besteht offensichtlich in der konsequenten, invasiven Diagnostik und einer sich daraus in entsprechenden Fällen ergebenden radikalen chirurgischen Therapie. Die vorliegende Evaluation der Behandlung des Pleuraempyems führt zu folgenden Schlussfolgerungen: 1.Jeder signifikante Pleuraerguss- insbesondere bei Vorliegen systemischer Infektionszeichen- sollte umgehend, ggf. unter CT-Führung, drainiert werden, wobei im selben Schritt Material zur mikrobiologischen Untersuchung asserviert werden sollte. 2.Eine zunächst kalkulierte Antibiose ist bei Vorliegen systemischer Infektionszeichen indiziert. Sie sollte nach der mikrobiologischen Untersuchung von (intraoperativ gewonnenem) Abstrichmaterial entsprechend angepasst werden. 3.Video-assistierte thorakale Chirurgie (VATS) ist auch beim schwerkranken Patienten (persistierendes Empyem nach Drainierung) ohne Zeitverzug durchzuführen. 4.Durch ein aggressives Operationsregime kann die vollständige Entleerung des Pleuraraumes erzwungen werden. Jedes Verbleiben infizierten Gewebes in der Pleurahöhle erhöht die Gefahr der Entwicklung eines septischen Schocks oder eines MultiorganversagensPleural empyema describes a purulent infection of the pleural space. Despite aggressive antibiotic therapy , it remains a serious illness with high both morbidity and lethality. It most often occurs secondary to parapneumonic effusions. Early and elaborated diagnostics in any case of suspected pleural empyema is an inevitable requirement for effective therpeutic choices. The comparison to therapy concepts described in the literature shows a general conformity in treatment. The greatest chance of recovery obviously consists in consequent and invasive diagnostics and radical surgical therapy. The evaluation of the therapy of pleural empyema at hand allows to state the following conclusions: 1. Any pleural effusion should be drained (possibly CT-guided)immediately and material for microbiological analysis should be collected. 2. Appropriate antibiotic treatment should be started promptly. 3. Video-assisted thoracoscopic surgery should be initiated without any delay (even in critically ill patients). 4. Through aggressive surgical treatment complete drain of the pleural space may be enforced. Any purulent fluid remaining increases the risk of septic shock or multiple organ failure
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Thöm, Sebastian [Verfasser]. "Die endosonographisch gesteuerte Drainage von Pankreaspseudozysten und -abszessen sowie intraperitonealen Empyemen / vorgelegt von Sebastian Thöm." 2009. http://d-nb.info/992721865/34.
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Piazza, Giuseppina. "Evaluation der prästationären, stationären und poststationären antibiotischen Therapie bei Kindern und Jugendlichen mit parapneumonischen Pleuraergüssen/-empyemen in Deutschland (2010-2018)." Doctoral thesis, 2021. https://doi.org/10.25972/OPUS-24335.
Full textAbstract:
Die Dissertation untersucht die vorstationäre, stationäre und poststationäre antibiotische Therapie bei 1724 Kindern und Jugendlichen mit parapneumonischen Pleuraergüssen/-empyemen in Deutschland. Der Untersuchungszeitraum war von Oktober 2010 bis Juni 2018. Untersucht wurden jeweils die Wirkstoffauswahl der häufigsten Mono- und Mehrfachtherapien, wie oft die Therapie im stationären Verlauf erweitert oder umgestellt wurden, sowie der klinische Verlauf der PatientenThe dissertation examines the pre-hospital, in-hospital and post-discharge antibiotic therapy in 1724 children and adolescents with parapneumonic pleural effusion and empyema in Germany. Patients were included between october 2010 and june 2018. The most common mono- and combination antibiotic therapies, the frequency of augmentation or change of therapy and the clinical outcomes were examined