Evaluation of serial C-reactive protein measurements after surgical treatment of pleural empyema

OBJECTIVE: Serial C-reactive protein measurements have been used to diagnose and monitor the response to therapy in patients with pneumonia and other infectious diseases. Nonetheless, the role of C-reactive protein measurement after surgical treatment for pleural empyema is not well defined. The aim of this study is to describe the behavior of C-reactive protein levels after the surgical treatment of pleural empyema and to correlate this parameter with the patient's prognosis. METHODS: We retrospectively analyzed the records of patients with pleural empyema treated by either chest-tube drainage or surgery from January 2006 to December 2008. C-reactive protein levels were recorded preoperatively and 2 and 7 days postoperatively. The clinical outcome was binary: success or failure (mortality or the need for repeated pleural intervention). RESULTS: The study group comprised fifty-two patients. The median C-reactive protein values were as follows: 146 mg/L (pre-operative), 134 mg/L (post-operative day 2), and 116 mg/L (post-operative day 7). There was a trend toward a decrease in these values during the first week after surgery, but this difference was only statistically significant on day 7 after surgery. Over the first week after surgery, the C-reactive protein values decreased similarly in both groups (successful and failed treatment). No correlation between the preoperative C-reactive protein level and the clinical outcome was found. CONCLUSIONS: We observed that, in contrast to other medical conditions, C-reactive protein levels fall slowly during the first postoperative week in patients who have undergone surgical treatment for pleural empyema. No correlation between the perioperative C-reactive protein level and the clinical outcome was observed

Evaluation of serial C-reactive protein measurements after surgical treatment of pleural empyema

OBJECTIVE: Serial C-reactive protein measurements have been used to diagnose and monitor the response to therapy in patients with pneumonia and other infectious diseases. Nonetheless, the role of C-reactive protein measurement after surgical treatment for pleural empyema is not well defined. The aim of this study is to describe the behavior of C-reactive protein levels after the surgical treatment of pleural empyema and to correlate this parameter with the patient's prognosis. METHODS: We retrospectively analyzed the records of patients with pleural empyema treated by either chest-tube drainage or surgery from January 2006 to December 2008. C-reactive protein levels were recorded preoperatively and 2 and 7 days postoperatively. The clinical outcome was binary: success or failure (mortality or the need for repeated pleural intervention). RESULTS: The study group comprised fifty-two patients. The median C-reactive protein values were as follows: 146 mg/L (pre-operative), 134 mg/L (post-operative day 2), and 116 mg/L (post-operative day 7). There was a trend toward a decrease in these values during the first week after surgery, but this difference was only statistically significant on day 7 after surgery. Over the first week after surgery, the C-reactive protein values decreased similarly in both groups (successful and failed treatment). No correlation between the preoperative C-reactive protein level and the clinical outcome was found. CONCLUSIONS: We observed that, in contrast to other medical conditions, C-reactive protein levels fall slowly during the first postoperative week in patients who have undergone surgical treatment for pleural empyema. No correlation between the perioperative C-reactive protein level and the clinical outcome was observed

Malignant pleural effusion: individual management according to clinical presentation

Os pacientes com derrame pleural maligno (DPM) têm neoplasias em fase avançada com mau prognóstico e baixa resposta a tratamento sistêmico. Devido à curta expectativa devida e ao controle muitas vezes ineficaz pela quimioterapia, quando se apresentam muito sintomáticos alguma terapêutica paliativa efetiva é necessária para oferecer conforto e qualidade de vida a estes pacientes. Porém, visto a grande variedade de apresentações clínicas, a terapêutica ideal não deve ser generalizada para todos os pacientes com DPM, como é pode ser observado em muitos ensaios clínicos sobre o assunto. Esta deve ser individualizada considerando principalmente a performance status e as condições clínicas do paciente. Revisamos as várias opções terapêuticas descritas na literatura para o tratamento de pacientes com DPM, propondo uma abordagem individualizada destes pacientes, de acordo com a suas apresentações clínicas.Malignant pleural effusion (MPE) patients have advanced neoplasms with bad prognosis and low response of systemic therapy. When symptomatic, a palliative treatment is mandatory in order to offer comfort and quality of life to these patients. Several options are available, as ambulatory procedures and video assisted thoracic surgery. The clinical efficacy of these methods is a matter of debate and subject of many papers. Because of the high variety of clinical presentations, no single method should be considered as a gold standard procedure, rather the management should be individualized considering the performance status and clinical condition of the patient. We reviewed the options described in the literature for the treatment ofMPE and proposed an individualized management strategy for these patients according totheir clinical presentation