Cryotherapy in Semirigid Thoracoscopy for Debridement of Multiloculated Empyema

Respiration ◽  
2020 ◽  
Vol 99 (9) ◽  
pp. 784-788
Author(s):  
Qi Zhang ◽  
Xi Wang ◽  
Yan Hu ◽  
Fang-Fang Guo ◽  
Kun-Yao Yu ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Pleural Cavity ◽  
Surgical Intervention ◽  
Pleural Empyema ◽  
The Novel ◽  
Medical Thoracoscopy

Surgical intervention is occasionally required for the treatment of pleural empyema. Semirigid thoracoscopy is a safe and successful surgical approach utilized by interventional pulmonologists, conventionally utilizing flexible forceps and suction as the main tools, but they can sometimes be inefficient for more complicated cases. In debriding a case of multiloculated empyema with semirigid thoracoscopy, we report the novel use of cryotherapy in clearing adhesions from the pleural cavity. We found using the cryoprobe to be more efficient than using forceps and suggest further investigation into its use in medical thoracoscopy.

Pleuraempyem: Kryotherapie in der Thorakoskopie nutzen

2021 ◽  
pp. 1-2
Author(s):  
Franz Stanzel
Keyword(s):  
Surgical Approach ◽  
Pleural Cavity ◽  
Surgical Intervention ◽  
Pleural Empyema ◽  
The Novel ◽  
Medical Thoracoscopy

Surgical intervention is occasionally required for the treatment of pleural empyema. Semirigid thoracoscopy is a safe and successful surgical approach utilized by interventional pulmonologists, conventionally utilizing flexible forceps and suction as the main tools, but they can sometimes be inefficient for more complicated cases. In debriding a case of multiloculated empyema with semirigid thoracoscopy, we report the novel use of cryotherapy in clearing adhesions from the pleural cavity. We found using the cryoprobe to be more efficient than using forceps and suggest further investigation into its use in medical thoracoscopy.

scholarly journals Practical management of pleural empyema

2016 ◽  
Vol 73 (3) ◽  
Author(s):  
G.F. Tassi ◽  
G.P. Marchetti ◽  
V. Pinelli ◽  
S. Chiari
Keyword(s):  
Retrospective Studies ◽  
Pleural Cavity ◽  
Pleural Empyema ◽  
Pleural Space ◽  
Space Infection ◽  
Medical Thoracoscopy ◽  
Conditioning Treatment ◽  
Pleural Infection ◽  
Considerable Morbidity

Empyema is defined as pus in the thoracic cavity due to pleural space infection and has a multifactorial underlying cause, although the majority of cases are post-bacterial pneumonia. Despite treatment with antibiotics, patients with empyema have a considerable morbidity and mortality due at least in part to inappropriate management of the effusion. Timely diagnosis of pleural space infection and rapid initiation of effective pleural drainage represent fundamental principles for managing patients with empyema. Ultrasound is particularly useful to identify early fibrin membranes and septations in the pleural cavity conditioning treatment strategy. Empyema and large or loculated effusion with a pH<7.20 need to be drained. Thoracoscopy has largely been used in pleural effusion due to lung infection. Whereas the efficacy of video-assisted thoracic surgery (VATS) in empyema management has been evaluated in several retrospective studies showing favourable results, less is known about the role of medical thoracoscopy (MT) in pleural infection. MT, appears to be safe and successful in multiloculated empyema treatment. It is also lower in cost and in frail patients is better tolerated than VATS which requires tracheal intubation.

FEATURES OF PLEURAL CAVITY DRAINAGE IN PATIENTS WITH ACUTE NONSPECIFIC PLEURAL EMPYEMA

2020 ◽  
pp. 39-42
Author(s):  
D. V. Minukhin ◽  
O. I. Tsyvenko ◽  
A. Yu. Korolevska ◽  
L. G. Tarasenko ◽  
D. Yu. Melnyk ◽  
...  
Keyword(s):  
Chest Wall ◽  
Pleural Cavity ◽  
Pleural Empyema ◽  
Pleural Drainage ◽  
Main Method ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Minor Surgery ◽  
Surgical Manipulation

Most authors considered pleural cavity drainage to be the main method of treatment of acute pleural empyema using minor surgery. Despite the simplicity of drainage of the pleural cavity, the number of complications after this surgical manipulation, according to the reports of some authors, varies from 3 to 8 %. The complications of pleural drainage in the patients with acute nonspecific pleural empyema have been studied and the technique of pleural drainage "blindly" has been introduced, which allows drainage to be located along the chest wall. At the first stage of the four−stage study, the complications of pleural drainage in 38 patients with acute nonspecific pleural empyema were analyzed, at the second stage a device for drainage of the pleural cavity "blindly" was developed to place drainage in parallel to the chest wall, at the third stage patients were tested; on IV −− drainage of the pleural cavity of 34 patients was performed according to the proposed method. The reason for the development of drainage complications in the pleural cavity of patients with acute pleural empyema was the inadequate location of drainage in the pleural cavity, drainage of the pleural cavity was carried out in general hospitals without the use of thoracoscopic equipment. Curved thoracoport with trocar for a blind drainage of the pleural cavity "blindly" was developed and introduced into clinical practice. This technique eliminates the involuntary location of the drainage in the pleural cavity, installing it along the chest wall, and is safe. Complications associated with drainage of the pleural cavity according to the developed method using a curved thoracoport with a trocar, inadequate location of drainage, were not observed in patients. Key words: acute pleural empyema, pleural cavity drainage, curved trocar.

scholarly journals ROLE OF MEDICAL THORACOSCOPY IN THE DIAGNOSIS OF PLEURAL EMPYEMA

2016 ◽  
Vol 5 (37) ◽  
pp. 2189-2192
Author(s):  
Yugandhar Bhatt C ◽  
Methuku Narender ◽  
Kiran Kumar Kondapaka ◽  
Vavilala Satish Kumar Rao ◽  
Auzumeedi Sai Kumar ◽  
...  
Keyword(s):  
Pleural Empyema ◽  
Medical Thoracoscopy

scholarly journals Sphenochoanal Polyp - "The Forgotten Element?"

2021 ◽  
Vol 29 (2) ◽  
pp. 209-212
Author(s):  
Misbahul Haque ◽  
Subhrajit Das ◽  
Subrata Mukhopadhyay
Keyword(s):  
Case Report ◽  
Nasal Obstruction ◽  
Surgical Approach ◽  
Surgical Intervention ◽  
Complete Removal ◽  
Endoscopic Polypectomy ◽  
Complete Excision ◽  
Sphenochoanal Polyp

Introduction The occurrence of isolated spheno-choanal polyps are not very common and can be very well confused with antro-choanal polyps or adenoids in adolescents and children. Appropriate diagnosis and prompt surgical intervention are essential for its removal.   Case Report We report one such case of a 16 year old female who presented with complaints nasal obstruction and reduced hearing. Endoscopic polypectomy was done with complete removal of the polyp.   Discussion Sphenochoanal Polyp is often misdiagnosed and proper investigations are thus essential for its diagnosis. Surgical Approach is the mainstay form of treatment with complete excision of the polyp.

scholarly journals A rare case of pancreaticopleural fistula patient presented in surgery OPD

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 1329-1332
Author(s):  
Sajika Dighe ◽  
Raju Shinde ◽  
Sangita Shinde ◽  
Mohit Gupte
Keyword(s):  
Chronic Pancreatitis ◽  
Pleural Fluid ◽  
Pleural Cavity ◽  
Surgical Intervention ◽  
Fluid Collection ◽  
Clinical Suspicion ◽  
Treatment Modalities ◽  
Chest Drain ◽  
High Level

Pancreatico-pleural fistula is rare and infrequent complication of commonly occurring chronic pancreatitis leading to an extra-peritoneal abnormal connection between the pancreatic system and pleural cavity. Diagnosis needs high-level clinical suspicion to avoid delay in the diagnosis as the patient presents with respiratory distress rather than any abdominal symptom and produces large quantities of pleural fluid intractable of pleural tapping or chest drain. Diagnosis of the fistula is clicked by elevated pleural fluid amylase. Various imaging options are available with their unique importance like CECT, ERCP and MRCP. In a low resource, setup CECT becomes a useful modality to delineate the pancreatic parenchymal changes, pancreatic duct anatomy and fluid collection, thus aid in the diagnosis. Treatment modalities depending on structural anatomy of the duct and parenchymal destruction are either Medical, Conservative and Surgical. Here our patient presented with massive left sided pleural effusion resistant to surgical intervention secondary to chronic pancreatitis in a 28-year man later diagnosed as Pancreatico-pleural fistula on CECT. The patient underwent distal pancreatectomy with splenectomy with decortication of the lung with excision of PPF. The patient now is continuous follow-up for chronic pancreatitis and is symptom-free from last 2 years.

scholarly journals Gigantomastia and Macroprolactinemia Responding to Cabergoline Treatment: A Case Report and Minireview of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Fatma Dilek Dellal ◽  
Didem Ozdemir ◽  
Cevdet Aydin ◽  
Gulfem Kaya ◽  
Reyhan Ersoy ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Case Report ◽  
Medical Treatment ◽  
High Molecular Weight ◽  
Surgical Therapy ◽  
Surgical Approach ◽  
Breast Tissue ◽  
Surgical Intervention ◽  
Laboratory Examination ◽  
Inactive Molecule

Background. Macroprolactinemia is defined as predominance of high molecular weight prolactin forms in the circulation. Although macroprolactin is considered as a biologically inactive molecule, some authorities suggest treatment in symptomatic cases. Gigantomastia is defined as excess breast tissue and most cases in the literature were treated by surgical intervention.Case. A 44-year-old woman was admitted to our clinic with gigantomastia and galactorrhea. The patient had a demand for surgical therapy. In laboratory examination, she had hyperprolactinemia and macroprolactinemia. Pituitary imaging revealed 6 mm microadenoma in right side of the hypophysis. Since she was symptomatic, cabergolin treatment was started. Macroprolactin became negative, breast circumference decreased significantly, and galactorrhea resolved after treatment.Conclusion. Gigantomastia might be the presenting symptom in patients with macroprolactinemia. In these patients medical treatment with cabergoline may be used initially as an alternative to surgical approach.

Length of Nonoperative Treatment and Risk of Pleural Empyema in the Management of Pancreatitis-induced Pancreaticopleural Fistula

2013 ◽  
Vol 79 (6) ◽  
pp. 614-619 ◽  
Author(s):  
Michael Schweigert ◽  
Norbert Solymosi ◽  
Attila Dubecz ◽  
Dietmar Ofner ◽  
Hubert J. Stein
Keyword(s):  
Surgical Intervention ◽  
Nonoperative Management ◽  
Case Reports ◽  
English Literature ◽  
Fistulous Tract ◽  
Pleural Empyema ◽  
Nonoperative Treatment ◽  
Endoscopic Stenting ◽  
Septic Complications ◽  
Ascending Infection

Pancreaticopleural fistula is a very uncommon complication of pancreatitis resulting from pancreatic duct disruption with leakage of pancreatic secretions into the pleural cavity. Initial conservative treatment fails in a significant number of cases. Ascending infection through the fistulous tract results in pleural empyema. The aim of this study is to investigate the relation between lengths of nonoperative management and risk of pleural empyema. The retrospective study includes our own experience as well as all case reports identified by a systematic review of the English literature from 1954 to 2012. Inclusion criteria were acute or chronic pancreatitis, whereas tumorous fistulization or complications of pancreatic surgery were kept out. A total of 113 patients were identified. There were 86 men and 27 women. The mean age was 46.5 years and 78 patients had a history of alcoholism. The mortality rate was 1.8 per cent (two of 113). Non-operative management including interventional therapy and endoscopic stenting was successful in only 40 cases (36%), whereas 73 patients (64%) finally underwent surgery. The most common procedure was distal pancreatectomy (32 of 73). Pleural empyema occurred in 17 cases. Successful nonoperative management had a mean length of 5.5 weeks, whereas surgery was performed after an average of 10.9 weeks of failed conservative efforts. Initial nonoperative therapy was significantly longer in patients eventually sustaining empyema (17 weeks, P < 0.001) and all needed surgical intervention. Prolonged nonoperative treatment is associated with a noteworthy risk of septic complications such as pleural empyema. Further improvement seems achievable by reducing the time gap between fruitless conservative efforts and surgical intervention.

scholarly journals A surgical approach in the management of mucormycosis in a trauma patient

2016 ◽  
Vol 98 (8) ◽  
pp. e173-e177 ◽  
Author(s):  
BA Zahoor ◽  
JE Piercey ◽  
DR Wall ◽  
KD Tetsworth
Keyword(s):  
Trauma Patient ◽  
Surgical Approach ◽  
Surgical Intervention ◽  
Surgical Debridement ◽  
Direct Result ◽  
Immunocompromised Patients ◽  
Fatality Rate ◽  
Proactive Approach ◽  
Aggressive Surgical Approach ◽  
Anti Fungal

Mucormycosis as a consequence of trauma is a devastating complication; these infections are challenging to control, with a fatality rate approaching 96% in immunocompromised patients. We present a case where a proactive approach was successfully employed to treat mucormycosis following complex polytrauma. Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proved successful in this instance. In our opinion, mucormycosis in trauma mandates an aggressive surgical approach. This prevents ascending dissemination of mucormycosis and certainly reduces the risk of patient mortality as a direct result. Anti-fungal therapy should be used secondarily as an adjunct together with surgical debridement, or as an alternative when surgical intervention is not feasible.

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