Clinical management of the patient with pleural effusion

Ferrer, Jaume; Roldán, Javier de Gracia

doi:10.1016/s0720-048x(00)00166-2

Cited by 16 publications

(13 citation statements)

References 81 publications

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“…Classically transudates are limpid, clear yellow-colored fluids. It is also important to smell the pleural fluid because an unpleasant smell suggests infection by anaerobic bacteria [23]. …”

Section: Pleural Thoracentesismentioning

confidence: 99%

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Diagnostic Work-Up of Pleural Effusions

Froudarakis¹

2008

Respiration

116

112

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A wide range of diseases may be the cause of an accumulation of fluid in the pleural space. Pleural effusion is a major diagnostic problem, since the pleura is an inner cavity with no direct access. The aim of this review is to provide a practical approach to the investigation of the patient presenting with pleural effusion. This should help to accurately diagnose pleural effusion and keep time-consuming, but necessary, invasive investigations to the minimum.

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Section: Pleural Thoracentesismentioning

confidence: 99%

“…The levels of complement in pleural fluid are low in both rheumatoid and lupus pleural effusions [31]. Pleural effusion of rheumatoid arthritis and systemic lupus erythematosus commonly resolves after adequate treatment of the disease [16, 23]. …”

Section: Pleural Fluid Biochemical Analysismentioning

confidence: 99%

Diagnostic Work-Up of Pleural Effusions

Froudarakis¹

2008

Respiration

116

112

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“…Bei der Pleuratuberkulose sollte zusätz-lich eine möglichst vollständige Ergussdrainage mit nachfolgender intensiver physikalischer Therapie erfolgen,um das Auftreten einer Pleuraschwartenbildung zu minimieren [9].Das tuberkulöse Pleuraempyem bedarf einer längerfristigen Drainagetherapie. Bei einer Pleuraverdickung auf bis zu 2 cm können wiederholte Streptokinase-oder Varidase ® -Instillationen zur Verschmälerung der Schwarte versucht werden.…”

Section: Extrapulmonale Tuberkuloseunclassified

Tuberkulose?gegenw�rtige Therapieprinzipien

Greinert

Zabel

2003

Der Internist

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Chemotherapy for tuberculosis is indicated in case of disease as well as in latent tuberculosis infection. Standard medication for drug-susceptible tuberculosis consists of isoniazid and rifampicin for six months with additional pyrazinamide and ethambutol for the first two months. Prolonged treatment is necessary in cases of cavernous pulmonary tuberculosis with lack of negative cultures by two months of therapy, in tuberculosis of the central nervous system and in some cases of superficial lymph node disease. Especially in multiple-drug resistant tuberculosis prolonged treatment with three or more drugs, that have been proven to be effective by susceptability testing, is mandatory. Attention must be payed to reliable delivery of chemotherapy as well as to side effects of antituberculosis medications. The classical treatment for latent tuberculosis infection is isoniazid. Multidrug short-course therapy, which has been shown to be equally effective, enhances patients' compliance, but toxicity is increased.

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“…At the multiloculation and early stages of fibrinopurulent states when the peel was not formed yet, VATS decortication would be the common procedure [4] , [3] . Also, some surgeons reported favorable results for VATS decortication at stage III of empyema that the results were the same for open thoracotomy decortication.…”

Section: Introductionmentioning

confidence: 99%

Surgical and nonsurgical outcomes for treating a cohort of empyema thoracis patients: A monocenteric retrospective cohort study

Sokouti

Ghojazadeh

Sokouti

et al. 2017

Annals of Medicine &Amp; Surgery

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BackgroundThere are several studies reporting high success rates for surgical and nonsurgical treatments of empyema separately. The aim of current retrospective cohort study is to find the best treatment in low socio-economic areas.Material and methodsA total of 149 patients were treated in the referring hospital from January 2002 to December 2008. The current retrospective cohort study was carried out by nonsurgical (medically & thoracenthesis & chest tube drainage with or without fibrinolytic agents) and surgical (VATS &open thoracotomy decortication methods) procedures in single center performed in thoracic and respiratory medicine wards. The independent t-test on demographic data was the statistical test tool.ResultsThe complete cure and mortality rates for 130 patients were 27% (35 out of 130 patients) and 0.3% (1 out of 130 patients), respectively. Thirteen out of 149 patients that were estimated to be at stage II underwent VATS decortication. The results showed zero success rates for this procedure which was then converted to open thoracotomy decortication. And, 113 patients who underwent thoracotomy decortication had a cure rate of 96.4% (109 patients) and mortality rate of 1.8% (2 patients). Four (3.5%) patients needed thoracoplasty, 2 died and 2 (1.8%) needed open window thoracostomy resulted in empyema necessitans that remained uncured. Total hospitalization lengths for the patients treated by tube thoracostomy and thoracotomy decortication were (15.4 ± 2.1) and (6.2 ± 1.8) days (P < 0.001), respectively. The success rates between surgical and nonsurgical treatments were 98.2% and 27.1%. And, the difference between them was significant (P < 0.001).ConclusionBecause of the advanced stages of empyema in our patients, thoracotomy decortication procedure is often the first rank choice with success rates higher than nonsurgical techniques. However, nowadays, the success rates of nonsurgical and VATS management of empyema thoracis are mostly reported in the literature.

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Clinical management of the patient with pleural effusion

Cited by 16 publications

References 81 publications

Diagnostic Work-Up of Pleural Effusions

Diagnostic Work-Up of Pleural Effusions

Tuberkulose?gegenw�rtige Therapieprinzipien

Surgical and nonsurgical outcomes for treating a cohort of empyema thoracis patients: A monocenteric retrospective cohort study

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