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pleural fibrinolysis

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https://www.readbyqxmd.com/read/27815709/stage-directed-therapy-of-pleural-empyema
#1
REVIEW
Martin Reichert, Matthias Hecker, Biruta Witte, Johannes Bodner, Winfried Padberg, Markus A Weigand, Andreas Hecker
PURPOSE: Intensivists and surgeons are often confronted with critically ill patients suffering from pleural empyema. Due to it' s multifactorial pathogenesis and etiology, medicals should be sensitized to recognize the different stages of the disease. Besides a whole bundle of different established classification systems, the progress of pleural effusions can be subdivided into the early exudative, the intermediate fibropurulent and the late organized phase according to the classification of the American Thoracic Society...
November 4, 2016: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/27343192/dose-dependency-of-outcomes-of-intrapleural-fibrinolytic-therapy-in-new-rabbit-empyema-models
#2
Andrey A Komissarov, Galina Florova, Ali O Azghani, Ann Buchanan, Jake Boren, Timothy Allen, Najib M Rahman, Kathleen Koenig, Mignote Chamiso, Sophia Karandashova, James Henry, Steven Idell
The incidence of empyema (EMP) is increasing worldwide; EMP generally occurs with pleural loculation and impaired drainage is often treated with intrapleural fibrinolytic therapy (IPFT) or surgery. A number of IPFT options are used clinically with empiric dosing and variable outcomes in adults. To evaluate mechanisms governing intrapleural fibrinolysis and disease outcomes, models of Pasteurella multocida and Streptococcus pneumoniae were generated in rabbits and the animals were treated with either human tissue (tPA) plasminogen activator or prourokinase (scuPA)...
August 1, 2016: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/27097620/an-approach-to-the-management-of-pleural-empyema-with-early-video-assisted-thoracoscopic-surgery-and-early-transition-to-oral-antibiotic-therapy
#3
Claudia M Espinosa, Mary E Fallat, Charles R Woods, Kathryn E Weakley, Gary S Marshall
Practice variation exists in the management of children with bacterial pneumonia complicated by empyema. The success of video-assisted thoracoscopic surgery (VATS) versus chest tube insertion for drainage and fibrinolysis may be dependent on the stage of disease. There is little published experience with early transition to oral (PO) antibiotics, and many children are treated with intravenous (IV) antibiotics at home. To describe a cohort of children with pneumonia and empyema in a primarily rural state managed with early VATS and transition to PO antibiotics...
April 2016: American Surgeon
https://www.readbyqxmd.com/read/26919911/clinical-characteristics-of-323-children-with-parapneumonic-pleural-effusion-and-pleural-empyema-due-to-community-acquired-pneumonia
#4
Katarzyna Krenke, Emilia Urbankowska, Tomasz Urbankowski, Joanna Lange, Marek Kulus
BACKGROUND: An increasing incidence of parapneumonic effusion and pleural empyema (PPE/PE) in children has been found in several studies published in the last decades. The aim of the study was to evaluate the incidence, etiology, clinical features, treatment strategies and outcomes of PPE/PE in children treated in a referral pulmonary center in central Poland. MATERIAL AND METHODS: We performed a retrospective analysis of clinical, radiological and laboratory data of all children aged between 1 month and 18 years with PPE/PE due to community acquired pneumonia (CAP) between January 2002 and December 2013...
May 2016: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/26835359/initial-treatment-of-septated-parapneumonic-empyema-with-drainage-plus-fibrinolytic-agents-is-equally-effective-as-video-assisted-thoracoscopic-surgery-and-is-suitable-as-first-line-therapy
#5
Chiyoe Shirota, Hiroo Uchida
It is thought that 0.6-2% of cases of pneumonia in children are complicated by parapneumonic empyema. The mainstay treatment options for empyema are pleural chest drainage plus fibrinolysis or video-assisted thoracoscopic surgery (VATS). Marhuenda et al. reported the results of a prospective, multicenter, clinical trial in which patients with parapneumonic empyema were randomized to either drainage plus urokinase or to VATS. That showed that the median postoperative stay, median hospital stay, and number of febrile days after treatment were not significantly different between the VATS group and the urokinase group...
January 2015: Translational pediatrics
https://www.readbyqxmd.com/read/26766669/-significance-of-thoracic-surgery-for-treatment-of-pleural-empyema-in-childhood-and-adolescence
#6
V Haas, R Bayerstorfer, O Kuhtin, T Bulgan, M Hohls, N Zap, I Vinogradova, E Nekrasova, S Shai, I Heesen, P Heister, C Andrée, T Niehues
BACKGROUND: There still is controversy about surgical treatment of pleural empyema in children. PATIENTS AND METHODS: Retrospective analysis of treatment strategy, focussing on indication for surgery and outcome of children treated in 2 centres for pleural complications due to primary pneumonia from January 1(st) 2008 to December 31(st) 2012. RESULTS were compared to studies published within the last 10 years. RESULTS: 1 451 children with pneumonia were treated during the 5 year period...
January 2016: Klinische Pädiatrie
https://www.readbyqxmd.com/read/26510382/predictors-of-prolonged-stay-in-patients-with-community-acquired-pneumonia-and-complicated-parapneumonic-effusion
#7
Junghyun Kim, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Hyo-Jeong Lim, Deog Kyeom Kim
BACKGROUND AND OBJECTIVE: Development of CPE in CAP is associated with prolonged hospital stay and it may increase the morbidity and mortality. We aimed to identify microbiological and clinical factors that predicate a prolonged hospital admission in patients treated with a tube thoracostomy to control CPE. METHODS: This retrospective cohort included patients with CPE requiring chest tube drainage in a tertiary referral Korean hospital from 1 January 2004 to 30 July 2012...
January 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/26428749/impact-of-fibrinolytics-on-the-outcome-of-empyema-in-south-african-children
#8
Marco Zampoli, Alexia Kappos, Charl Verwey, Rendani Mamathuba, Heather J Zar
BACKGROUND: Childhood pneumonia is common in all countries, and empyema is one of the commonest complications. The role of routine intrapleural fibrinolytics in the management of childhood empyema is not well established in low- and middle-income countries. METHODS: We did a prospective observational study of children sequentially hospitalised with empyema between December 2006 and December 2011 in South Africa (SA). Intrapleural tissue plasminogen activator (TPA), administered according to a standard protocol, was introduced in September 2009...
July 2015: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/26423784/intrapleural-fibrinolysis-with-urokinase-versus-alteplase-in-complicated-parapneumonic-pleural-effusions-and-empyemas-a-prospective-randomized-study
#9
RANDOMIZED CONTROLLED TRIAL
Carmen Alemán, José M Porcel, José Alegre, Eva Ruiz, Silvia Bielsa, Jordi Andreu, Maria Deu, Pilar Suñé, Mireia Martínez-Sogués, Iker López, Esther Pallisa, Joan Antoni Schoenenberger, J Bruno Montoro, Tomás Fernández de Sevilla
BACKGROUND: Pleurofibrinolysis has been reported to be potentially beneficial in the management of complicated parapneumonic effusions (CPPE) and empyemas in the adult population. METHODS: Prospective, controlled, randomized, and double-blind study, to evaluate intrapleural alteplase 10 mg (initially 20 mg was considered but bleeding events forced dose reduction) versus 100,000 UI urokinase every 24 h for a maximum of 6 days in patients with CPPE or empyemas. The primary aim was to evaluate the success rate of each fibrinolytic agent at 3 and 6 days...
December 2015: Lung
https://www.readbyqxmd.com/read/26382287/-less-may-be-best-pediatric-parapneumonic-effusion-and-empyema-management-lessons-from-a-uk-center
#10
Anna-May Long, Jonathan Smith-Williams, Sarah Mayell, Jon Couriel, Matthew O Jones, Paul D Losty
BACKGROUND: Children with empyema are managed at our center using a protocol-driven clinical care pathway. Chemical fibrinolysis is deployed as first-line management for significant pleural disease. We therefore examined clinical outcome(s) to benchmark standards of care while analyzing disease severity with introduction of the pneumococcal conjugate vaccine. METHODS: Medical case-records of children managed at a UK pediatric center were surveyed from Jan 2006 to Dec 2012...
April 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/26351760/-para-and-postpneumonic-pleural-empyema-current-treatment-strategies-in-children-and-adults
#11
REVIEW
M Ried, J Graml, C Großer, H-S Hofmann, Z Sziklavari
INTRODUCTION: Parapneumonic pleural effusions arise from pneumonia and may develop into pleural empyema (PE). PE is defined as collection of pus in the pleural space with secondary inflammation of the visceral and parietal pleura. This review article describes the current treatment strategies for para- and postpneumonic PE both in children and adults. MATERIAL AND METHODS: Selective literature research via Medline (key words: pleural empyema, pleural empyema in children, thoracic empyema) and presentation of our own clinical experience with therapy recommendations...
October 2015: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/26214713/safety-and-efficacy-of-fibrinolytic-therapy-in-restoring-function-of-an-obstructed-tunneled-pleural-catheter
#12
Candice L Wilshire, Brian E Louie, Ralph W Aye, Alexander S Farivar, Eric Vallières, Jed A Gorden
RATIONALE: Tunneled pleural catheters have been established to be safe and effective in the management of recurrent symptomatic pleural effusions. Obstruction of the tunneled pleural catheter is rare; however, when obstructed the catheter fails to achieve its primary goal of symptom palliation. The management of pleural catheter obstruction has not been studied. OBJECTIVES: We aimed to determine if the use of intracatheter fibrinolytic therapy is safe and effective in restoring catheter function...
September 2015: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/26163512/the-time-course-of-resolution-of-adhesions-during-fibrinolytic-therapy-in-tetracycline-induced-pleural-injury-in-rabbits
#13
Andrey A Komissarov, Galina Florova, Ali O Azghani, Ann Buchanan, William M Bradley, Chris Schaefer, Kathleen Koenig, Steven Idell
The time required for the effective clearance of pleural adhesions/organization after intrapleural fibrinolytic therapy (IPFT) is unknown. Chest ultrasonography and computed tomography (CT) were used to assess the efficacy of IPFT in a rabbit model of tetracycline-induced pleural injury, treated with single-chain (sc) urokinase plasminogen activators (scuPAs) or tissue PAs (sctPA). IPFT with sctPA (0.145 mg/kg; n = 10) and scuPA (0.5 mg/kg; n = 12) was monitored by serial ultrasonography alone (n = 12) or alongside CT scanning (n = 10)...
September 15, 2015: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/25964730/retrospective-analysis-of-large-dose-intrapleural-alteplase-for-complicated-pediatric-parapneumonic-effusion-and-empyema
#14
Jessica L Taylor, Meixia Liu, David S Hoff
OBJECTIVES: Medical treatment of complicated parapneumonic effusion or empyema in pediatric patients includes antibiotics and pleural space drainage. Intrapleural fibrinolysis may facilitate pleural drainage; however, there is a lack of consensus regarding the optimal dosing regimen. The primary purpose of this study was to evaluate the efficacy and safety of a large-dose intrapleural alteplase regimen in pediatric patients. Secondarily, this investigation sought to differentiate the clinical characteristics of responders and non-responders to intrapleural alteplase therapy...
March 2015: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/25847131/intrapleural-alteplase-decreases-parapneumonic-effusion-volume-in-children-more-than-saline-irrigation
#15
RANDOMIZED CONTROLLED TRIAL
Sheila J Hanson, Peter L Havens, Pippa M Simpson, Melodee L Nugent, Robert G Wells
OBJECTIVE: In this prospective, double-blind, randomized crossover trial, we determined the effect of intrapleural fibrinolysis with alteplase compared to that of normal saline irrigation on the thoracostomy tube output and pleural effusion volume in children with complicated parapneumonic effusion. METHODS: Twenty seven children, median age 3.5 years, referred to the interventional radiology service for thoracostomy tube drainage of a parapneumonic effusion were studied...
December 2015: Pediatric Pulmonology
https://www.readbyqxmd.com/read/25824668/antibiotic-utilization-based-on-primary-treatment-of-pediatric-empyema
#16
Katherine W Gonzalez, Brian G A Dalton, Angela L Myers, Jason G Newland, Shawn D St Peter
BACKGROUND: Chemical fibrinolysis has been shown to be as effective as surgical debridement for the treatment of pediatric empyema. However, no studies effectively evaluate antibiotic treatment. We evaluated antibiotic utilization among different treatments of pediatric empyema. METHODS: This is a retrospective review of 169 empyema patients who underwent chemical and/or mechanical fibrinolysis at a dedicated children's hospital from 2005-2013. Data points included duration of therapy, cultures, presence of necrosis or abscess, and adverse drug reactions...
June 15, 2015: Journal of Surgical Research
https://www.readbyqxmd.com/read/25742001/intrapleural-fibrinolysis-for-the-treatment-of-indwelling-pleural-catheter-related-symptomatic-loculations-a-multicenter-observational-study
#17
MULTICENTER STUDY
Rajesh Thomas, Francesco Piccolo, Daniel Miller, Paul R MacEachern, Alex C Chee, Taha Huseini, Lonny Yarmus, Rahul Bhatnagar, Hans J Lee, David Feller-Kopman, Nick A Maskell, Alain Tremblay, Y C Gary Lee
BACKGROUND: Indwelling pleural catheters (IPCs) are an effective option in the management of malignant pleural effusion. Up to 14% of patients with IPCs develop symptomatic pleural loculations causing ineffective fluid drainage and breathlessness. To our knowledge, this is the first study to describe intrapleural fibrinolytic therapy for IPC-related symptomatic loculations. METHODS: All patients who received intrapleural fibrinolytic therapy for symptomatic loculations between January 1, 2002, and June 30, 2014, in four established IPC centers were retrospectively included...
September 2015: Chest
https://www.readbyqxmd.com/read/25617977/-community-acquired-pneumonia-in-children-treatment-of-complicated-cases-and-risk-patients-consensus-statement-by-the-spanish-society-of-paediatric-infectious-diseases-seip-and-the-spanish-society-of-paediatric-chest-diseases-senp
#18
D Moreno-Pérez, A Andrés Martín, A Tagarro García, A Escribano Montaner, J Figuerola Mulet, J J García García, A Moreno-Galdó, C Rodrigo Gonzalo de Lliria, J Saavedra Lozano
The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence...
September 2015: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/25555911/proteolytic-regulation-of-epithelial-sodium-channels-by-urokinase-plasminogen-activator-cutting-edge-and-cleavage-sites
#19
Hong-Long Ji, Runzhen Zhao, Andrey A Komissarov, Yongchang Chang, Yongfeng Liu, Michael A Matthay
Plasminogen activator inhibitor 1 (PAI-1) level is extremely elevated in the edematous fluid of acutely injured lungs and pleurae. Elevated PAI-1 specifically inactivates pulmonary urokinase-type (uPA) and tissue-type plasminogen activators (tPA). We hypothesized that plasminogen activation and fibrinolysis may alter epithelial sodium channel (ENaC) activity, a key player in clearing edematous fluid. Two-chain urokinase (tcuPA) has been found to strongly stimulate heterologous human αβγ ENaC activity in a dose- and time-dependent manner...
February 27, 2015: Journal of Biological Chemistry
https://www.readbyqxmd.com/read/25548359/intrapleural-fibrinolysis-during-pediatric-extracorporeal-life-support
#20
Cordelie E Witt, Andrew L Mesher, Joshua L Hermsen, Thomas V Brogan, David Michael McMullan
Pediatric patients who require extracorporeal life support (ECLS) for refractory cardiorespiratory failure are at increased risk for intrapleural hemorrhage due to the effects of systemic anticoagulation and frequent occurrence of pneumothorax. Surgical evacuation is standard therapy for retained hemothorax to prevent secondary empyema, pulmonary compression, and development of fibrothorax. However, surgical interventions during ECLS are hazardous and place patients at increased risk for surgical site bleeding...
January 2015: World Journal for Pediatric & Congenital Heart Surgery
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