Evaluation of management of postpneumonic empyema thoracis in children

Background Empyema is a well-known sequelae of pneumonia, which is increasingly being reported in children despite strict management. The appropriate management remains controversial. The aim of this study was to evaluate different management options of postpneumonic empyema in children.Materials and methods A total of 330 patients were reviewed between 2002 and 2012; their ages ranged from 1.25 to 15 years, with a median age of 4.3 years. The various management procedures included thoracentesis (n= 11), chest tube drainage (n= 229), chest tube drainage with intrapleural fibrinolytic therapy (n =117), video-assisted thoracoscopic surgery (VATS) (n =35), and thoracotomy because of a trapped lung noted on admissions and failed procedures (n =94).Results Variable success rates were noted as follows: tube thoracotomy (48.24%), fibrinolytic treatment (68.37%), and VATS (85.71%). Postoperative complications (11.14%) included wound infection (n = 10), atelectasis (n= 18), delayed expansion (n= 7), and need for reoperation (n= 2). Four patients died (1.21%), two of them  following thoracotomy, one patient after fibrinolysis, and one patient following VATS. Patients treated with thoracotomy recovered completely.Conclusion New therapeutic modalities had variable success rates in children with postpneumonic empyema. Thoracotomy is still needed as a last resort for cases unresponsive to chemical fibrinolysis and following failed thoracoscopy.Keywords: decortication, empyema, fibrinolysis, thoracotom

Risk factors affecting outcome and morbidity in the surgical management of bronchiectasis

ObjectiveBronchiectasis continues to be a major cause of morbidity and mortality in developing countries. The purpose of this study was to present the results of our 14 years of surgical experience to re-evaluate our indications for using surgical therapy and to analyze several factors that might affect the outcome and postoperative complications of this disease.MethodAge, sex, etiologic factors, symptoms, the duration of symptoms, radiologic and radionuclide examinations, preoperative evaluation, surgical procedures, postoperative morbidity and mortality, and the follow-up results from 143 patients operated on for bronchiectasis between January 1992 and January 2006, were reviewed retrospectively.ResultsOne hundred forty-three patients underwent 148 operations for bronchiectasis. The mean age was 23.4 years. Complete resection was achieved in 118 patients. The morbidity rate was 23.0% and the mortality rate was 1.3%. Postoperatively, 75.9% of the patients were free of symptoms, 15.7% were improved, and 8.2% showed no improvement or were worse. The logistic regression analysis showed that a history of tuberculosis and incomplete resection were independent predictors of the operative result. Moreover, the lack of a preoperative bronchoscopic examination, a forced expiratory volume in 1 second of less than 60% of the predicted value, a history of tuberculosis, and incomplete resection were independent predictors of postoperative complications.ConclusionsA history of tuberculosis and incomplete resection were risk factors both for postoperative complications and for a worse operative result. The lack of a preoperative bronchoscopic examination and a low forced expiratory volume in 1 second were risk factors for postoperative complications. Surgery for multiple segments on different lobes should be performed whenever possible

Primary Mediastinal Cysts: Clinical Evaluation and Surgical Results of 32 Cases

The purpose of this retrospective study was to analyze our experience with mediastinal cysts, emphasizing the clinical presentations and results of surgery