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.

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.

Thesis (M.Sc.(O.T.), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Studies 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.

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.

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.

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.

Rupture of a coccidioidal pulmonary cavity with subsequent pyopneumothorax is a rare clinical event, even in areas endemic for coccidioidomycosis. Our encounter with a patient diagnosed with this condition in northeast Tennessee serves notice to clinicians that coccidioidomycosis is indeed a traveling fungal disease, and practitioners must be alert to common and uncommon manifestations of infection associated with this fungus. A literature review pertaining to coccidioidal pyopneumothorax revealed that patients usually present with a recent onset of chest pain. Serologic testing and pleural fluid culture are highly useful, and management includes surgical intervention with or without antifungal therapy.

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.

Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2022 / Introduction: Pleural empyema in children is associated with high morbidity and high mortality. Staphylococcus aureus has been shown to be the most common causative organism in developing countries. Study design: This study applied a retrospective quantitative descriptive study design. Study population: The population of the study is comprised of children (between 1 years and 13 years) admitted to Pietersburg Provincial Hospital with pleural empyema from January 2016 until December 2020. Objectives: The study aimed to determine the causative organisms of pleural empyema, the treatment outcomes, and the relationship between pleural empyema, TB, and HIV infection. Data collection: The National Health Laboratory Services database was used to identify patients who had pleural empyema. A self-generated data collection tool was used to obtain secondary data related to all patients who met the operational definition of pleural empyema during the defined time period. Results: Eleven participants met inclusion criteria. The mean age of participants was 42 months with 43.8 standard deviation and 64% were males and females were 36% . Of these participants, 40% cultured S. Aureus in the pleural fluid, 10% Streptococcus pneumoniae, 30% were sterile and 20% cultured other organisms such as Klebsiella pneumoniae and Haemophilus influenzae. Cloxacillin was the most prescribed antibiotic. Intercostal drainage was inserted in 91% of the participants of which 18% were successful, no further surgical intervention needed,73% had thoracotomy and VATS was offered to 91% of participants and it was followed by thoracotomy. Fibrinolytics were not offered to the participants in this study. The majority of patients, 55%, were discharged back to their peripheral hospitals and 27% of them died. PCV immunisation status of the children was not documented hence the relationship between pleural empyema and PCV immunisation could not be established. There was a positive correlation between age of patients with pleural empyema and ICU length of stay (r=89%; p=0,01) while another strong correlation was depicted between HIV status and hospital length of stay (r=88%, p=0,019). Results further show a positive association between outcome and surgery intervention offered (Chi=7,00; p=0,02). Conclusion: Our study showed that S. aureus is the leading cause of pleural empyema, with a predominance of thoracocentesis and thoracotomy offered as surgical interventions.

Made available in DSpace on 2014-06-11T19:22:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2005Bitstream added on 2014-06-13T20:48:33Z : No. of bitstreams: 1 pinotti_kf_me_botfm.pdf: 691624 bytes, checksum: 91a24e4114a1154568a2a8f616cecf0b (MD5) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / 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)