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Background: Management of an early empyema is an important problem in thoracic surgery. As an alternative to surgical treatment empyema is in patients who developed early empyema, intra-pleural fibrinolysis has been used with favorable results. This modality of treatment may reduce known morbidities secondary to surgical procedures and may result in significant medical cost savings. Our study aim is to test the efficacy and safety of tissue plasminogen activator and Streptokinase for management of early empyema. Methods: Our study included 48 patients presented with complicated parapneumonic effusion and early empyema. Patients were divided into two groups each contains 24 patients. First group treated with intra-pleural Alteplase (tissue plasminogen activator) and the second group treated with streptokinase, both were instilled via an intercostal chest tube. Clinical and radiologic (chest radiographs (CXR) and chest computed tomography (CT) data used for evaluation of efficacy of both protocols. Results: Tissue plasminogen activator give excellent results in early empyema, it showed success rate 100%, dramatic improvement in both chest tube drain and pleural thickness with no need for further surgical intervention, Streptokinase showed success rate 83.4% in comparison to TPA. Conclusion: Intrapleural tissue plasminogen activator is safe and more efficient than Streptokinase as a chemical modality in treating patients presented with complicated pleural effusion and early empyema.

Objective: Prosthesis-patient mismatch (PPM) of the aortic prosthesis is frequent trouble following aortic valve replacement (AVR). The residual high transprosthetic pressure gradient (PG) could interrupt left ventricular mass regression (LVMR). The purpose of this study was to assess the frequency of PPM as well as its impact on LVMR postoperatively. Methods: 106 patients were prospectively evaluated after AVR for aortic stenosis (AS) from Jan 2016 to Dec 2021. Patients were classified into three groups based on the effective orifice area index (EOAI) (cm 2 /m 2 ); Group A (≥0.85), B (0.8-0.84), and C (< 0.8). Follow-up of LVMR was performed postoperatively on all patients after six months. Results: We didn't record significant changes in basic data among studied groups away from the basal surface area, which was substantially higher in group C (Mean 2.4, P<0.001). The PPM incidence was observed in 30 survivors (28.3%); 12 survivors in group B and 18 survivors in group C. All groups showed a substantial reduction in posterior wall thickness (P<0.001). However, a significant decrease in peak and mean PG, LVM index, and diameter of the interventricular septum was only observed in groups A and B. Conclusions: PPM with EOAI below 0.85 cm 2 /m 2 leads to high residual transprosthetic PG and subsequent impairment in LVMR. Therefore, meticulous choosing of the valve size with the availability of alternative options could prevent PPM squeal.