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PubMed2005

Oral forms of tetracycline and doxycycline are effective in producing pleurodesis.

PURPOSES: We investigated whether oral tetracyclines could produce an efficient and safe pleurodesis as does parenteral doxycycline, which is currently unavailable in many countries. METHODS: Parenteral doxycycline (10 mg/kg), oral tetracycline (35 mg/kg), or doxycycline (10 mg/kg) was injected intrapleurally through a right chest tube in rabbits. The oral forms were dissolved in saline solution and passed through a sterile membrane filter. When daily aspirated pleural fluid was < 5 mL/24 h, the chest tube was removed. Fluid WBC, lactate dehydrogenase (LDH), and protein levels were measured 24 h after the injection. After the death of the animals on day 14, pleurodesis was graded from 1 (none) to 8 (> 50% symphysis) by two observers blinded to treatment groups. RESULTS: The right pleurodesis score of the combined oral groups (median, 7.0; interquartile range [IQR], 4.0; n = 26) did not differ significantly (p = 0.349) from that of the parenteral group (median, 7.5; IQR, 6.0; n = 10). Oral tetracycline (capsule or tablet, n = 6 in each group) and doxycycline (capsule or tablet, n = 7 in each group) were as effective as parenteral doxycycline in producing pleurodesis: tetracycline capsule (median, 7.50; IQR, 6.00); tetracycline tablet (median, 6.50; IQR, 6.00); doxycycline capsule (median, 4.00; IQR, 1.00); doxycycline tablet (median, 8.00; IQR, 5.00), and parenteral doxycycline (median, 7.50; IQR, 6.00) [p = 0.235]. The left pleurodesis scores were 1.00 in all 36 rabbits. Fluid total volume, WBC, LDH, and protein levels were comparable between each oral and parenteral group, excluding WBCs in the tetracycline tablet group (p = 0.047). The complications were nonfatal (right hemothorax: tetracycline capsule [n = 3]/tetracycline tablet [n = 2], doxycycline tablet [n = 2], parenteral doxycycline [n = 2]; left hemothorax: tetracycline capsule [n = 1]; ascites: parenteral doxycycline [n = 1]). There was no growth on all filtrate cultures. Oral forms cost less than parenteral doxycycline (<1 US dollar vs 4.72 US dollars per rabbit). Filtering costs were 1.12 US dollars per rabbit. CONCLUSION: Oral tetracycline or doxycycline is as effective and safe as parenteral doxycycline in producing pleurodesis in rabbits; thus, they may also be used in humans.

Administration, Oral↗
PubMedDate not supplied

[Major thoracic trauma--sternal trauma].

From 1999 to 2003, 101 patients (M/F = 83/18, mean age = 46 +/- 18 y) with thoracic trauma have been admitted to the Center for Thoracic Surgery in Varese. Over 50% of pts. with major thoracic trauma were treated by chest tube drainage; however, surgery was necessary just in 16/101 pts.; 29 pts. were admitted to ICU; deaths were 3/101. The Authors recorded 23/101 sternal fractures. Routine blood test, chest radiography and EKG were performed in all patients; in case of abnormal EKG, echocardiography was performed; in case of widened mediastinum, chest CT was mandatory. 13/23 pts. showed associated injuries, 12 pts. a non-aligned sternal fracture, 7 pts. mediastinal hematoma. Simple observation in hospital was indicated in 15/23 pts. with sternal fractures; chest tubes were positioned in 3 pts. (hemopneumothorax) and one patient was surgically treated because of painful sternal pseudoarthrosis (2 months after trauma). Admission in ICU was necessary in 3 pts. with non-aligned sternal fracture, mediastinal hematoma and associated injuries. No patient with sternal fracture died.

Female↗
PubMed2006

Evaluation of biocompatible cardiopulmonary bypass circuit use during pediatric open heart surgery.

The contact of blood with nonbiological surfaces during cardiopulmonary bypass (CPB) induces a whole body inflammatory response and increases postoperative morbidity directly related to bleeding complications and end organ dysfunction. Methods to reduce these effects have included modification of extracorporeal circuits through biocompatible coating of disposables and the application of various pharmacological agents. Biocompatible coated surfaces are designed to mimic physiologic surfaces. This study was designed to ascertain the effects of using coated circuits during pediatric CPB. After Institutional Review Board approval and parent/guardian consent, patients undergoing CPB, weighing less than 15 kg, with target CPB temperatures more than 28 degrees C, were enrolled into the Coated Circuit Group using an entirely biocompatible CPB circuit with poly(2-methoxyethylacrylate) (PMEA) and a biocompatible coated oxygenator (n = 16). Those patients were retrospectively matched to control patients having the same congenital repair with respect to patient size, surgeon, anesthesiologist, bypass time, cross-clamp time, bypass temperature, and noncoated bypass disposables; (n = 16). CPB data collected included on-bypass platelet count, hematocrit (HCT), and CPB blood product use. Postprotamine data collected in the operating room included blood product use, time from initial protamine administration to chest closure, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR). Postoperative intensive care unit (ICU) data included blood product use, HCT, chest tube output, platelet count, PT, aPTT, INR, blood gases, lactate, and ventilator settings at 1, 2, 4, 6, 12, and 24 hours. Other data collected included intubation time, length of time to chest tube removal, and length of ICU stay. Statistical significance (p < .05) was seen in units of platelets transfused postprotamine, ventilator peak inflation pressure (PIP) on admission to the ICU, postoperative day 0 packed red blood cells (PRBC) and fresh frozen plasma (FFP) transfused, and lactate at 1, 2, 4, 6, and 12 hours postoperative. Several parameters approached statistical significance, including PRBC transfused postprotamine, time from protamine administration to chest closure, postoperative day 0 platelets transfused, and ICU stay. The data suggest that PMEA biocompatible CPB circuits can be used safely during pediatric heart surgery, resulting in a decrease in postoperative blood product use, improved postoperative lung function, and a reduction in the time spent in the ICU.

Acrylates↗
PubMed2006

Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients.

BACKGROUND: The aim of this study was to analyze the results of pleurodesis for malignant pleural effusion performed by surgeons. PATIENTS AND METHODS: A series of 273 patients with malignant pleural effusion underwent thoracoscopy with the aim of performing a palliative pleurodesis. There were 94 males (34.4%) and 175 females (64.1%), ranging in age from 15 to 94 years (mean age: 60.6 years). The effusion was on the right side in 136 patients (49.8%), on the left side in 110 (40.3%), and bilateral in 27 (9.9%). Thoracoscopy was performed under general anaesthesia in all patients. Pleural biopsy was performed in two thirds of the patients (70.7%). Pleurodesis was produced by instillation of 5g of sterile asbestos-free talc; the chest tube was left in place a minimum of 3 days. It was removed when fluid drainage was less than 200 ml/24 h. Patients were usually discharged the day after chest tube removal. RESULTS: There was no intraoperative mortality. Two patients (0.7%) had intraoperative complications; 17 (6.2%) underwent a bilateral pleurodesis, and 10 (3.7%) had a pericardiopleural window. In 32 patients (11.7%) no pleurodesis was done, either because the lung did not properly re-expand (5.2%), or because of suspected infection, e.g., false membranes (1.9%), or because of multiple adhesions (4.6%). Finally, only 241 patients (88.3%) had a talc poudrage at the time of thoracoscopy. Duration of postoperative pleural drainage ranged between 1 and 11 days (mean: 3.64 days). The postoperative hospital stay ranged from 2 to 21 days (mean: 7.1 days). Pleural empyema occurred in 4 patients (1.5%) and was lethal in one patient. The mean follow-up period was 8.39 (7.2 months, and 172 patients had regular follow up. In this group, there were 24 recurrences (14%), 12 of which were treated by repeat pleurodesis. The results were very good in 133 patients (77.3%), acceptable in 35 patients (20.3%), and there was a failure in 4 patients (2.4%). CONCLUSIONS: Results of surgical thoracoscopy for malignant pleural effusion are good, with low morbidity. However, in debilitated patients, bedside talc slurry may be preferable.

Adolescent↗
PubMed2000

Transjugular intrahepatic portosystemic shunt for recurrent hepatic hydrothorax.

For many years, pleural effusions have been recognized as a complication of cirrhosis, occurring in approximately 5.5% of patients. Recent studies have confirmed that small defects in the diaphragm allow for passage of ascitic fluid into the pleural space. Successful management of these patients is challenging, as many of the treatment options can be associated with increased morbidity. The initial treatment should focus on eliminating and preventing the recurrence of ascites with diuretics and water and salt restriction. For those patients who do not respond medically, more invasive techniques have been used including serial thoracentesis, chest tube placement, chemical pleurodesis, and peritoneovenous shunts. We present a patient with recurrent pleural effusions secondary to hepatic cirrhosis who was unsuccessfully treated medically, and subsequently treated with thoracentesis, chest tube drainage and pleurodesis, with ultimate resolution after transjugular intrahepatic portosystemic shunt placement.

Humans↗
PubMed1997

[Complications of thoracoscopic surgery for spontaneous pneumothorax].

We reviewed the cases of 122 patients with primary spontaneous pneumothorax who underwent thoracoscopic surgery at our institution between 1992 and 1995. In 9 cases, thoracotomy became necessary because of severe adhesions (3 cases), large foci (3 cases), and unrecognized foci (3 cases). Complications occurred in 17 cases: collapse in 1 patient after removal of the thoracic drain, persistent air leakage (> 7 days) in 2 patients, and recurrent pneumothorax in 14 patients. There were no significant differences between the recurrent and non-recurrent cases in age, sex location of bullae, past history of pneumothorax, operating time, intraoperative blood loss, or duration of chest tube drainage after surgery. The interval between onset and consult was significantly longer in recurrent cases than in non-recurrent cases, and the number of patients who required chest tube drainage before surgery was significantly higher in recurrent cases. Reoperation was performed in 9 cases. Bullaes that were not detected during the first surgery were found in the 7 of these cases. The recurrent cases in our study were regarded as resulting from a lack of surgical skill that may improved with increasing surgical experience. The Brinkman index was significantly higher in recurrent cases. Smoking and air-leakage before surgery may be risk factors for recurrence following thoracoscopic surgery for spontaneous pneumothorax.

Adolescent↗
PubMed1999

[Irrigation drainage and fibrinolysis for treatment of parapneumonial pleural empyema].

UNLABELLED: We report on our experiences on 336 patients suffering from manifest pleural empyema within a period of 10 years (1985-1995). Considering the pathogenesis, particularly the results of 218 patients with "parapneumonic pleural empyema" were analysed retrospectively. Definite healing could be achieved by chest tube placement and pleural irrigation in 201 patients (= 92.2%). Other 11 patients finally needed surgical interventions (= 5%). Only 6 patients could not be cured: An indwelling tube was palliatively inserted once and 5 patients died in the course of the medical treatment (mortality = 2.3%). Within the first years the irrigation therapy was performed using a single chest tube (n = 38%) but since 1989 a double-lumen drainage was used (n = 158). Since 1987 in most cases (n = 182) intrapleural medicinal fibrinolysis was performed by instillation of streptokinase (Varidase N). If outward invasively pretreated patients (n = 30) are analysed separately, a statistical dependency can be found between the duration and the way of treatment. Without significant difference between the groups (Gr) the average duration of treatment using a single tube without fibrinolysis (Gr1) was 31.8 days, but 26.5 days using a single tube combined with fibrinolysis (Gr2). A clear shortening of the duration is detectable if patients were treated with a combination of double lumen drainage and fibrinolysis: If 2 tubes were used (Gr4) the treatment lasted 20.6 days, using one double-lumen tube (Gr5) it took 19.8 days. There is a proof of significance at comparison of Gr4 with Gr1 (p = 0.005). Gr5 with Gr1 (p < 0.001) and Gr5 with Gr2 (p = 0.014) respectively. A significant longer duration of treatment (40.6 days, p < 0.001) is found for the group of the pretreated patients, if compared with the corresponding groups Gr4 or Gr5. CONCLUSION: Parapneumonic empyemas most often can be cured by irrigation drainage. The mortality is comparatively low. The shortest duration of treatment is needed using the combination of a double-lumen tube with intrapleural instillation of a fibrinolytic agent (Varidase N). Invasively pretreated patients need significantly longer durations at same form of treatment.

Adolescent↗
PubMed1988

The role of early limited thoracotomy in the treatment of empyema.

On the basis of clinical experience with 80 patients at Denver General Hospital from 1979 through 1984, we devised a three-part classification of empyema. Class I empyema (n = 12) is pleural effusion with pH less than 7.2 and with no bacteria. Patients with this type of empyema were treated with short-duration chest tubes. Further treatment was required in two of 12. There were no deaths. Class II (n = 28) is classic uniloculate empyema. Patients with this category of empyema were treated with chest tubes, with two deaths. Class III (n = 40) is complicated empyema, with multiple loculations. Tube thoracostomy failed more often than not; decortication was required in 10 of 18 patients treated with prolonged tube drainage. Limited thoracotomy for drainage and placement of tubes was done in 22 patients. Five required extension of the thoracotomy and decortication. All 22 had resolution of the empyema with no additional procedures. Limited thoracotomy immediately or during the first week of treatment is recommended for all multiloculated or complex empyemas.

Empyema↗
PubMed2005

Quantitative computed tomography versus spirometry in predicting air leak duration after major lung resection for cancer.

BACKGROUND: Emphysema is a well-known risk factor for developing air leak or persistent air leak after pulmonary resection. Although quantitative computed tomography (CT) and spirometry are used to diagnose emphysema, it remains controversial whether these tests are predictive of the duration of postoperative air leak. METHODS: Sixty-two consecutive patients who were scheduled to undergo major lung resection for cancer were enrolled in this prospective study to define the best predictor of postoperative air leak duration. Preoperative factors analyzed included spirometric variables and area of emphysema (proportion of the low-attenuation area) that was quantified in a three-dimensional CT lung model. Chest tubes were removed the day after disappearance of the air leak, regardless of pleural drainage. Univariate and multivariate proportional hazards analyses were used to determine the influence of preoperative factors on chest tube time (air leak duration). RESULTS: By univariate analysis, site of resection (upper, lower), forced expiratory volume in 1 second, predicted postoperative forced expiratory volume in 1 second, and area of emphysema (< 1%, 1% to 10%, > 10%) were significant predictors of air leak duration. By multivariate analysis, site of resection and area of emphysema were the best independent determinants of air leak duration. The results were similar for patients with a smoking history (n = 40), but neither forced expiratory volume in 1 second nor predicted postoperative forced expiratory volume in 1 second were predictive of air leak duration. CONCLUSIONS: Quantitative CT is superior to spirometry in predicting air leak duration after major lung resection for cancer. Quantitative CT may aid in the identification of patients, particularly among those with a smoking history, requiring additional preventive procedures against air leak.

Aged↗
PubMed2004

Risk factors for persistent pleural effusions after the extracardiac Fontan procedure.

OBJECTIVE: Pleural effusions after the Fontan operation contribute significantly to morbidity and prolonged hospitalization. This study investigates the association between selected preoperative, operative, and postoperative variables and persistent pleural effusions after the extracardiac Fontan procedure. METHODS: We conducted a retrospective study of extracardiac Fontan procedures. The variables analyzed as potential risk factors included age and weight at the time of the operation, anatomic diagnosis, preoperative oxygen saturation, mean pulmonary artery pressure, ventricular end-diastolic pressure, presence of an accessory source of pulmonary blood flow, presence of significant aortopulmonary collateral vessels, presence of fenestration, cardiopulmonary bypass time, conduit size, postoperative pulmonary artery pressure, use of angiotensin-converting enzyme inhibitors, and presence of postoperative infection. The outcome measures evaluated were duration and volume of chest tube drainage after surgical intervention. RESULTS: From June 1997 to August 2002, 100 consecutive patients underwent the extracardiac Fontan procedure. The median age at operation was 3.1 years. The median duration of chest tube drainage was 10 days, and the median volume of drainage was 14.7 mL.kg(-1).d(-1). As determined by means of multivariate analysis, significant risk factors for pleural effusions lasting more than 2 weeks were lower preoperative oxygen saturation (P =.011) and the presence of postoperative infections (P =.003). Significant risk factors for pleural effusions draining at more than 20 mL.kg(-1).d(-1) were lower preoperative oxygen saturation (P =.005), smaller conduit size (P =.04), and longer duration of cardiopulmonary bypass (P =.004). CONCLUSIONS: Lower preoperative oxygen saturation, presence of postoperative infection, smaller conduit size, and longer duration of cardiopulmonary bypass were associated with persistent pleural effusions after the extracardiac Fontan procedure. Modifications of some of these risk factors might influence the duration and volume of pleural drainage after surgical intervention.

Adolescent↗
PubMed2003

Perioperative pneumoperitoneum after lobectomy -- bilobectomy operations for lung cancer: a prospective study.

BACKGROUND: The aim of this study is to identify the effectiveness of perioperative pneumoperitoneum to prevent air leak after the lobectomy-bilobectomy operations for lung cancer. METHODS: A prospective study was designed on consecutive 50 patients who had lobectomy-bilobectomy operations for lung cancer and whose remnant lung had failed to fill the half of the hemithoracic cavity under 30 cm H(2)O positive pressure ventilation during the operation with totally relaxed diaphragm. The patients were divided into two groups: group 1 (25 patients) with perioperative pneumoperitoneum, group 2 (25 patients) without perioperative pneumoperitoneum. RESULTS: The statistical analysis between the two groups did not show any significant difference in terms of age, preoperative FEV1, and the type of resection. Perioperative pneumoperitoneum significantly reduced the duration of postoperative air leak (2.2 +/- 1.15 days vs. 6.04 +/- 3.27 days p < 0.0001) and total chest tube drainage time (3.84 +/- 0.98 days vs. 7.88 +/- 3.16 days p < 0.001). CONCLUSION: Perioperative pneumoperitoneum after lobectomy-bilobectomy operations for lung cancer is an effective method to decrease air leak and chest tube drainage time.

Adult↗
PubMed1979

Pseudomonas sternotomy wound infection and sternal osteomyelitis. Complications after open heart surgery.

Pseudomonas aeruginosa sternotomy wound infections occurred in five patients who underwent open heart surgery. The initial isolate in each case was from a mediastinal chest tube routinely cultured on removal. Soft-tissue infection developed in two patients, and sternal osteomyelitis developed in three patients. Pseudomonas-typing studies showed a correlation between five isolates from chest-tube suction pumps used postoperatively and the wound isolates. Analysis of antibiograms of Pseudomonas wound isolates from the cardiac surgery ward from 1975 to 1977 showed eight of 15 with the same antibiogram as the sternotomy pathogens, compared with two of 13 isolates from other wards.

Cardiac Surgical Procedures↗
PubMed1994

[Outpatient drainage treatment for simple spontaneous pneumothorax].

Spontaneous pneumothorax has been managed on an outpatient basis by intercostal tube drainage and a portable flutter valve device (pneumothorax set). In a series of 111 selected patients, from 14 to 75 years of age, who had no complaints such as dyspnea, had neither tension-nor hemo-pneumothorax, and could promptly return to hospital in an emergency, intercostal tube insertion and continuous negative pressure drainage were instituted at the outpatient department. After approximately one hour of suction, if an air leak ceased and the lung was re-expanded, the patient was allowed to return home with a pneumothorax set connected to the chest tube. But, if an air leak persisted, they were admitted to hospital. The outpatients were followed every 2 or 3 days thereafter, and if their course was uneventful, the chest tube was removed a week later. If the onset of lung recollapse was seen at outpatient check up, hospitalization was required. Outpatient treatment was successful in 81 cases (72.9%) of the series. However, 14 patients were hospitalized because of persistent air leak at the outpatient room, and 5 were admitted because of wound pain, re-expansion edema or other reasons. During the ambulatory course, 11 were admitted to hospital with recollapse of the lung. Bacterial cultures of drain tips were positive in 22.6% of 75 examined cases, which was a higher percentage than that associated with inpatient drainage. Wound infection with St. aureus occurred in one case after removal of the drain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions.

OBJECTIVE: The purpose of this study was to document in a historical cohort the incidence and clinical observations of pneumothorax ex vacuo after therapeutic thoracentesis for malignant pleural effusions in patients with underlying parenchymal lung disease. MATERIALS AND METHODS: Forty pneumothoraces resulted from 512 therapeutic thoracentesis performed for malignant pleural effusions over a 3-year period. Twenty-nine patients with pneumothoraces underwent catheter placement in the pleural space for treatment. Of these, 12 pneumothoraces resolved and 17 remained unchanged. We reviewed the charts of these 17 patients to document the cause of malignant pleural effusion, presence of underlying malignant parenchymal disease, volume of fluid aspirated, and improvement in symptoms. Clinical outcome was then evaluated, including size of residual pneumothorax, duration of catheter drainage, and reaccumulation of effusion. RESULTS: No patients' lungs reexpanded despite insertion of large-bore (16- to 35-French) chest tubes. All had pneumothoraces that occupied at least 30% of the hemithorax; all were asymptomatic; all had underlying parenchymal disease and noncompliant lungs. Pleural effusion reaccumulated in all 17 after removal of the chest tube. CONCLUSION: A subgroup of patients with malignant lung parenchymal disease who undergo therapeutic thoracentesis will develop asymptomatic hydropneumothoraces due to poor lung compliance. These patients do not require further catheter drainage. Pleural effusion will reaccumulate in the residual space over a variable period of time.

Adult↗
PubMed1985

Computed tomography used to exclude pneumothorax in bullous lung disease.

We report two patients with bullous lung disease and suspected pneumothorax on plain chest radiographs. Chest tubes were inserted in both patients, but no clinical or radiological improvement occurred. Computed tomographic (CT) scans were then performed and showed bullous lesions without any pneumothorax. This permitted the removal of unnecessary chest tubes. In selected patients with severe bullous disease, CT may be useful, either on admission or later, when the diagnosis of pneumothorax by conventional radiographs is doubtful.

Adult↗
PubMed1988

Transthoracic needle aspiration biopsy: evaluation of the blood patch technique.

A study was undertaken to evaluate the effectiveness of the blood patch technique in the prevention of pneumothorax after transthoracic needle aspiration biopsy. A total of 140 needle biopsies were performed with a coaxial system. Two groups of patients were defined according to whether or not autologous blood was injected into the introducing needle as it was withdrawn after needle aspiration biopsy. Fifty-two biopsies were performed with the blood patch technique (group A), while 88 biopsies were performed without the blood patch technique (group B). The frequency of postbiopsy pneumothorax was 28.8% (15 of 52 patients) in group A and 34.1% (30 of 88 patients) in group B. Chest tube insertion was required in 7.7% (four of 52 patients) in group A and in 9.1% (eight of 88 patients) in group B. There was no statistically significant difference in pneumothorax rate and chest-tube insertion rate between the two groups (P greater than .05). In this series of 140 biopsies, the blood patch technique failed to affect the rate of pneumothorax after transthoracic needle aspiration biopsy.

Biopsy, Needle↗
PubMed1992

Sclerotherapy of malignant pleural effusion through sonographically placed small-bore catheters.

Pleural sclerosis after drainage with a small-bore catheter was performed in 21 patients with malignant pleural effusions. Intrapleural catheters 7- to 24-French in size were placed by using sonographic guidance. Tetracycline (18 patients) and bleomycin (four patients) were used as sclerosing agents (one patient had both). Clinical and radiologic follow-up was available on all patients until they died (range, 2 weeks to 25 months; mean, 3.6 months). Pleural sclerosis was successful in 15 (71%) of 21 patients. Two patients in whom pleurodesis failed had pleural sclerosis repeated, with one success and one failure. All of the failures were in patients in whom the amount of chest-tube drainage was more than 100 ml/day. Pleurodesis with tetracycline was painful in six patients; no pain was associated with use of bleomycin. Small pneumothoraces developed in four patients at the time of chest-tube placement, without consequence. A superimposed infection that developed in a patient having continuous drainage of pleural fluid was successfully treated with antibiotics. Pleural sclerotherapy can be performed through sonographically placed small-bore catheters with results comparable to those seen with large-bore, surgically placed catheters.

Adult↗
PubMed2006

Once-daily vs. twice-daily intrapleural urokinase treatment of complicated parapneumonic effusion in paediatric patients: A randomised, prospective study.

To evaluate the effective dose frequency (once daily vs. twice daily) of intrapleural urokinase treatment in children who required tube thoracostomy for drainage of a complicated parapneumonic effusion, we designed a randomised prospective study in a tertiary medical centre in Taiwan. From June 2002 to January 2005, 30 paediatric patients with complicated parapneumonic effusion who had received chest tube drainage were randomised 1 : 1 to the once-daily (urokinase 5000-6000 IU/kg/dose) or twice-daily (urokinase 2500-3000 IU/kg/dose) treatment. We compared clinical manifestations and outcomes in both groups. There were no differences in pleural effusion characteristics between the groups. Six patients had Streptococcus pneumoniae, one had Staphylococcus aureus, one had Group A Streptococcus, and 22 had unknown pathogens. There were no significant differences between the once- vs. twice-daily group in the amount of drained pleural fluid (564.9 +/- 422.1 ml vs. 560.5 +/- 198.6 ml, respectively), fever duration after chest tube insertion (4.3 +/- 3.2 days vs. 5.3 +/- 2.7 days), or total admission days (14.3 +/- 3.9 days vs. 14.6 +/- 3.0 days) (p > 0.05 for all). Only two patients (one in each group) required the surgery. Thus, we found that both once- and twice-daily administration of urokinase were similarly efficacious, and resulted in good clinical outcomes. Both obviated the need for surgery in most (93%) cases of pneumonia with complicated parapneumonic effusion in this series. A larger, multicentre study is necessary to verify our findings.

Adolescent↗