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At least 19 recordsLinked to original sources
PubMed2003

[From pneumonic infiltration to parapneumonic effusion--from effusion to pleural empyema: internal medicine aspects of parapneumonic effusion development and pleural empyema].

Infectious processes cause the majority part of all clinically relevant pleural effusions which frequently complicate the course of pneumonia. The assessment of an inflammatory effusion requires a careful history, physical examination, imaging techniques and clinical workup. The presence of polymorphonuclear leukocytes, high LDH-activity (> 200 U/L) and protein level (> 3 g/dL) in a pleural effusion indicates acute inflammation. An effusion is usually called empyema, when large numbers of neutrophils form thick, turbid exudates within preexisting body cavities. A thoracic empyema may occur as a result of primary or secondary pleural pathologies and in most cases involves infection with bacteria, frequently provided by progressing pneumonia. There are several therapeutic options for treatment of parapneumonic effusions and of thoracic empyemata, respectively. Optimal therapeutic management and antimicrobial medication to the infected pleural space depend in part on the stage of the empyema at presentation. Treatment can vary from a conservative medical approach in uncomplicated or small parapneumonic effusions to invasive surgical interventions in fibroprulent or organizational stages of empyema. Empyemata usually progress from a parapneumonic exudative stage (stage I), when the fluid is still sterile, with low leukocyte counts, low LDH, physiological pH, and normal glucose, to the fibropurulent [figures: see text] stage (stage II) with high leukocyte counts, high LDH activity, low pH, and low glucose, and finally to the organizational stage (stage III), in which fibroblasts convert fibrin strands into inelastic membranes. Pleural peels and pockets may compartmentalize the viscous empyematous fluid and can cause serious restrictive ventilatory impairment. Each patient must be individually evaluated to determine the nature of the exudate and the stage of the pleural space infection. Due to its high mortality rate (5%) a thoracic empyema requires prompt treatment. Diagnostic thoracentesis and withdrawal of liquid for the microbiological, cytological and biochemical analysis is urgently recommended in all cases to assess severity of the disease and the likelihood of a complicated or uncomplicated course, and to select the most appropriate treatment option.

Anti-Bacterial Agents↗
PubMed1977

Computed tomography (CT) in the diagnosis of intracranial abscesses. Brain abscess, subdural empyema, and epidural empyema.

Nine cases of brain abscess, five of subdural empyema, and one of epidural empyema with associated subdural empyema were identified using computed tomography (CT). Smal and multiple abscesses as well as unilateral, bilateral, and parafalcine empyemas were detected. These lesions were demonstrated rapidly and accurately, even in areas that are demonstrated poorly by other diagnostic techniques. No false-negative studies were found in cases of brain abscess or subdural empyema. However, since the appearance of brain abscesses of CT scans is similar to that of neoplastic and vascular lesions, false-positive reports of brain abscess were encountered.

Brain Abscess↗
PubMed1991

[Role of surgical treatment in thoracic empyema with bronchopleural and/or thoracic empyema].

Sixty-nine patients with thoracic empyema treated surgically were experienced from May, 1978 through December, 1990. Thirty-nine cases had bronchopleural and/or thoracic fistula. Thirty-two patients were associated with pulmonary tuberculosis, of whom fourteen had tuberculous empyema and eighteen were sequelae of pulmonary tuberculosis or tuberculous pleurisy. The remainder were postoperative, postpneumonic, and posttraumatic empyemas. Of fourteen patients who developed postoperative bronchopleural fistula, there were ten patients who had lobectomy or pneumonectomy for lung cancers. Omental pedicle flap method, in which empyema space was filled with the omentum and pedicled muscle flap, was performed on 19 patients with bronchopleural or thoracic fistula or both. Fifteen patients were cured successfully by single-stage procedure, though there was one operative death due to aspiration pneumonia, and two recurrences which were treated by muscle plombages. There was another patient who had multiple surgical procedures in the past resulting in partial recurrences, but the fistula of this patient subsequently closed without reoperation. Postoperative decrease of %VC, FEV1.0/PVC were minimal. Treatment of long standing bronchopleural fistula is a difficult problem, and our omental pedicle flap method is relatively simple and safe which can be most suitably applied to those patients in whom other procedures have failed and to those with poor pulmonary functions.

Adolescent↗
PubMed1990

Empyema after pneumonectomy--empyema window or thoracoplasty?

369 pneumonectomies carried out within the years 1981 to 1988 and their empyema complications form the basis for a retrospective analysis to assess the outcome of treating pneumonectomy cavity empyema by window healing. During the same period 31 empyema after 322 pneumonectomies to treat bronchial carcinoma are investigated in more detail as far as their therapeutic modalities are concerned. 20 patients received a thoracic window. 18 of 31 patients (58%) could be cured, and 9 of these were in the thoracic window group. The hospital mortality of empyema patients after pneumonectomy amounted to 42%. In an historical comparison no progress could be recognized in the treatment of this septic complication.

Bronchial Fistula↗
PubMed1992

[Asporogenic anaerobic thoracic empyema--an experimental model for anaerobic thoracic empyema in rabbits].

Sterile pleural effusion was induced by intrapleural administration of turpentine, and empyema was induced by direct intrapleural inoculation of bacteria in rabbits. Experimental models of anaerobic thoracic empyema were successfully made in this study, using Escherichia coli, Peptostreptococcus asaccharolyticus, Bacteroides fragilis, using the following methods; (1) a single bacterium inoculation of, a) E. coli, b) P. asaccharolyticus, c) B. fragilis, (2) simultaneous inoculations with an aerobe and an anaerobe, a) E. coli + P. asaccharolyticus, b) E. coli + B. fragilis. (3) an anaerobic inoculation 5 days after an aerobic inoculation, a) P. asaccharolyticus inoculation 5 days after E. coli inoculation, b) B. fragilis inoculation 5 days after E. coli inoculation. The developments of several parameters (sialic acid levels, glucose levels, oxidation-reduction potential levels, bacterial counts and WBC counts in the pleural fluid and so on) were measured in each group. There was little difference of the rate of incidence of empyema between each group. Empyema was highly induced even by a single anaerobe inoculation. The following tendencies were observed in development of parameters: (1) sialic acid levels and oxidation-reduction potential levels were decreased only in the conditions being associated by B. fragilis infections. (2) in mixed infections of E. coli and anaerobes, bacterial counts of E. coli increased in number in the late phases of the infections probably by the influences of anaerobes. The experiments of groups (2) and (3) were designed for demonstrations of biphasic infections between aerobes and anaerobes, but it turned out that quite unexpected results were seen in these models.

Animals↗
PubMed1990

[Asporogenic anaerobic empyema--clinical and bacteriological investigations of 31 patients with anaerobic empyema].

The author reviewed the records of 31 patients with asporogenic anaerobic empyema mostly seen in the wards of Internal Medicine, Juntendo University Hospital during the 27 years between 1961 and 1988, and obtained the following results. 1. There were 25 males and 8 females with an average age of 57.8 and 51.0 y/o (range, 25 to 79 y/o), respectively males more than forty years old occupied 74.2 percent of all cases. 28 patients (90%) had underlying conditions. 2. The cases of mixed infections with anaerobes and aerobes were only 22.6%. 3. The isolated bacteria were microaerophilic streptococcus, Bacteroides spp., Peptostreptococcus spp., Fusobacterium spp. etc. in this order. 4. There were no relationships between anaerobic infections with or without aerobes and putrid odor of pleural effusion. 5. Bacteroides spp. were isolated most in the group with putrid pleural effusion, however, they were not isolated in the group without putrid pleural effusion at all. This fact suggests that there is an intimate relationship between putrid odor and Bacteroides spp. 6. There was no deceased case which pleural effusion had been drained sufficiently with open or closed drainage. It suggests that sufficient drainage is the most important in therapeutic procedures of asporogenic anaerobic empyema.

Adult↗
PubMed1989

Interhemispheric empyema. An unusual form of subdural empyema.

A 16 year old male was admitted with a clinical picture suggesting an intracranial pyogenic infection. He also has focal convulsions and left abducens palsy. CT scan showed a subdural empyema with interhemispheric extension. Since the patient was improving clinically, neurosurgical intervention was deferred. Spontaneous interhemispheric empyema is an uncommon condition. In our case conservative management was curative in what is considered a neurosurgical emergency.

Adolescent↗