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Hospital. RA was diagnosed according to the 2010 American College of Rheumatology and European League Against Rheumatism classification criteria [3]. For all patients, the following were documented: detailed medical history, thorough clinical examination, plain chest radiograph, full laboratory investigations including rheumatoid titer, full spirometric study, and DL CO . The following patients were excluded from the study: patients with concurrent lung disease, patients with occupational history predisposing to lung disorder, patients who cannot undergo perform pulmonary function tests (PFTs) and DL CO , patients with clinical or laboratory evidence of other collagen vascular disease, smokers, patients with abnormal chest radiograph, and cardiac patients. All patients provided consent to participate and the study was approved by the institutional ethical committee. Lung functionForced expiratory volume in the first second (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC ratio, and forced expiratory flow over 25-75% part of FVC (FEF 25-75% ) were measured using the spirometry

Background Video-assisted thoracoscopic surgery (VATS) is effective for fibropurulent thoracic empyema and less invasive, and it may be important as a bridge between minimally invasive and conventional open thoracic surgical management. Aim The aim of this study was to determine the optimal treatment of parapneumonic effusion in the fibrinopurulent stage comparing blind thoracostomy versus VATS with regard to efficacy, duration of hospitalization and intercostal tube (ICT) insertion, and need for further surgery or not. Patients and methods This study was a prospective comparative randomized study conducted on 60 patients with confirmed parapneumonic effusion where they were classified into two groups. The blind thoracostomy group: 30 patients underwent blind thoracostomy and the VATS group: 30 patients underwent VATS. Results The incidence of clinical improvement was more in the VATS group when compared to the blind thoracostomy group. The hospital outcome in the VATS group was much better than in the blind group, where in the VATS group, the postoperative length of hospital stay was around 4.8 days and the time of ICT removal was after 5 days from insertion, whereas in the blind group, the length of hospital stay was around 9.7 days and the time of ICT removal was after about 6 days of insertion. The incidence of postoperative complications was higher in the blind group than in the VATS group. Conclusion VATS provides more accurate staging for parapneumonic effusion, an excellent surgical view for a complicated empyema cavity, thus making it possible to perform a sufficient evacuation of all empyema membranes.