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Complicated parapneumonic effusion

Charles A James, Leah E Braswell, Amir H Pezeshkmehr, Paula K Roberson, James A Parks, Mary B Moore
BACKGROUND: Complicated pleural effusion prolongs the hospital course of pneumonia. Chest tube placement with instillation of fibrinolytic medication allows efficient drain output and decreases hospital stay. OBJECTIVE: To evaluate experience with lower fibrinolytic dose for parapneumonic effusions and to assess potential dose stratification based on a simple ultrasound grading system. MATERIALS AND METHODS: We retrospectively reviewed the medical record to identify children and young adults who received fibrinolytic therapy for parapneumonic effusion and had chest tube placement by an interventional radiology service at a single children's hospital...
October 5, 2016: Pediatric Radiology
Sanja Petrusevska-Marinkovic, Irena Kondova-Topuzovska, Zvonko Milenkovic, Goran Kondov, Ankica Anastasovska
BACKGROUND: Parapneumonic effusions complicating pneumonia are associated with increased morbidity and mortality. AIM: To determine the role of the clinical, laboratory and radiographic features to the differential diagnosis of patients with community- acquired pneumonia (CAP) without effusion, uncomplicated parapneumonic effusion (UCPPE) and complicated parapneumonic effusion (CPPE). MATERIAL AND METHODS: We analysed 148 patients with CAP without effusion, 50 with UCPPE and 44 with CPPE...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
Sidharth Navin Jogani, Ramesh Subedi, Amit Chopra, Marc A Judson
We describe a man who developed pleural effusion with Pasteurella multocida, and review the reported literature concerning this entity. We identified 21 such cases, including our own. Most patients with P. multocida pleural effusions are immunocompromised and/or have significant co-morbidities. These effusions are typically complicated parapneumonic effusions that are grossly purulent (87%) with a low pleural fluid pH (mean 6.8), high protein (mean 4.8 g/dl) and high LDH (mean 1911 U/L) and low glucose (28...
2016: Respiratory Medicine Case Reports
Chetan Basavaraj Patil, Ramakant Dixit, Rakesh Gupta, Neeraj Gupta, Varna Indushekar
BACKGROUND: Medical thoracoscopy is a minimally invasive procedure used in diagnostic and therapeutic applications for pleural diseases. In this study, we describe our experience in the outcome and analysis of thoracoscopy in undiagnosed pleural effusion presenting to our center. MATERIALS AND METHODS: This is a prospective study conducted over last 2 years. We performed thoracoscopy in 129 cases of undiagnosed exudative pleural effusions using rigid thoracoscope...
September 2016: Lung India: Official Organ of Indian Chest Society
Katarzyna Krenke, Marta Krawiec, Grażyna Kraj, Joanna Peradzynska, Agnieszka Krauze, Marek Kulus
AIM: The aim of this study was to evaluate the factors that could predict the development of local complications (parapneumonic effusion/pleural empyema, necrotizing pneumonia, and lung abscess) in children with community-acquired pneumonia (CAP). METHODS: Demographic, clinical, and laboratory data were prospectively collected and compared in children with noncomplicated and complicated CAP. RESULTS: Two-hundred and three patients aged from 2 months to 17 years were enrolled...
July 12, 2016: Clinical Respiratory Journal
Luis Corral-Gudino, Alberto García-Zamalloa, Cristina Prada-González, Silvia Bielsa, Duckens Alexis, Jorge Taboada-Gómez, Pilar R Dos-Santos-Gallego, María A Alonso-Fernández, Jose M Porcel
BACKGROUND: The frequency of "complicated" pleural effusions (CPE) (i.e., pleural fluid pH ≤ 7.2 and/or glucose ≤60 mg/dL) of tuberculous origin (CTPE) is not well reported. This study aims to quantify their prevalence, and develop a score to differentiate CTPE from complicated parapneumonic effusions (CPPE). METHODS: Retrospective analysis of databases from three Spanish hospitals which included patients with CTPE and CPPE. Forty percent of the study population served to generate a scoring system (COMPLES, COMplicated PLeural Effusion Score) that was further validated in the remaining 60 %...
October 2016: Lung
Are S Berg, Christopher S Inchley, Hans Olav Fjaerli, Truls M Leegaard, Britt Nakstad
No abstract text is available yet for this article.
September 2016: Infectious Diseases
Katarzyna Krenke, Ewa Sadowy, Edyta Podsiadły, Waleria Hryniewicz, Urszula Demkow, Marek Kulus
BACKGROUND: An increasing incidence of parapneumonic effusion and pleural empyema (PPE/PE) has been reported in recent studies. As only few data on etiology of PPE/PE in Central Europe have been reported, we undertook a study on the etiology of PPE/PE in children, using both standard culture and molecular techniques. METHODS: This prospective study was conducted between June 2011 and December 2013. Consecutive children with PPE/PE complicating community acquired pneumonia, who required diagnostic/therapeutic thoracentesis were included...
July 2016: Respiratory Medicine
L Ferreiro, L Valdés
No abstract text is available yet for this article.
June 6, 2016: Revista Clínica Española
J M Porcel, H Valencia, S Bielsa
OBJECTIVE: The identification of parapneumonic effusions (PPE) requiring pleural drainage is challenging. We aimed to determine the diagnostic accuracy of radiological and pleural fluid findings in discriminating between PPE that need drainage (complicated PPE (CPPE)) and those that could be resolved with antibiotics only (uncomplicated PPE (UPPE)). SUBJECTS AND METHODS: A retrospective review of 641 consecutive PPE, of which 393 were categorized as CPPE and 248 as UPPE...
May 6, 2016: Revista Clínica Española
Chih-Yung Chiu, Gigin Lin, Mei-Ling Cheng, Meng-Han Chiang, Ming-Han Tsai, Shen-Hao Lai, Kin-Sun Wong, Sen-Yung Hsieh
Metabolic markers in biofluids represent an attractive tool for guiding clinical management. The aim of this study was to identify metabolic mechanisms during the progress of pleural infection in children with Streptococcus pneumoniae pneumonia. Forty children diagnosed with pneumococcal pneumonia were enrolled and analysis of pleural fluid metabolites categorized by complicated parapneumonic effusions (CPE) and non-CPE was assessed by using (1)H-NMR spectroscopy. Multivariate statistical analysis including principal components analysis (PCA) and partial least-squares discriminant analysis (PLS-DA) were performed...
2016: Scientific Reports
Mohammad Abusedera, Ola Alkady
BACKGROUND: Studies have shown that small-catheter pleural effusion drainage is safe and has a lower complication rate. Our objective was to evaluate the outcomes and the safety of the single-step trocar or the modified Seldinger technique. METHODS: A total of 124 patients (83 men and 41 women), with mean age of 46±18 years and mean duration of drainage 5.3±2 days, were include in the study. The trocar technique was attempted in 201 (86.5%) cases, and the modified Seldinger technique was used in 38 (16...
April 2016: Journal of Bronchology & Interventional Pulmonology
Jaehee Lee, Jae Kwang Lim, So Yeon Lee, Seung Soo Yoo, Shin Yup Lee, Seung Ick Cha, Jae Yong Park, Chang Ho Kim
OBJECTIVES: Tuberculous pleural effusion (TPE) is generally characterized by lymphocytic exudative effusion, either free-flowing or loculated. However, patients can also have neutrophilic loculated TPE, although little data are available concerning the incidence and characteristics of this form of TPE. It is important to differentiate between neutrophilic loculated TPE and complicated parapneumonic effusion (PPE), which also shows neutrophilic loculated effusion but needs a different management approach...
February 2016: American Journal of the Medical Sciences
Hiren J Mehta, Abhishek Biswas, Andrea M Penley, Jessica Cope, Matthew Barnes, Michael A Jantz
BACKGROUND: Pleural infection remains a significant cause of morbidity, mortality, prolonged hospital stay, and increased healthcare costs, despite advances in therapy. Twice daily intrapleural tissue plasminogen activator (tPA)/deoxyribonuclease (DNase) initiated at the time of diagnosis has been shown to significantly improve radiological outcomes and decrease the need for surgery. OBJECTIVES: To analyze our experience with once daily tPA/DNase for intrapleural sepsis...
2016: Respiration; International Review of Thoracic Diseases
Simon V Vun, David G Lance
INTRODUCTION: Intrapleural fibrinolytic enzyme therapy is a potentially surgery-sparing treatment for poorly resolving parapneumonic effusion and empyema. It is safe in the majority of patients, however the most significant risk associated with this treatment is severe bleeding secondary to pleural hemorrhage. Contraindications for intrapleural enzyme therapy are not widely agreed upon and little is known about how to treat this difficult and potentially lethal hemorrhagic complication...
2015: Journal of Medical Case Reports
Gilberto Bueno Fischer
Parapneumonic pleural effusions (PPE) are a relatively common (5-40%) complication of paediatric pneumonia. However, in clinical practice the majority of the effusions are small and do not need any further investigation or specific treatment apart from antibiotic therapy. A small number require drainage or surgical intervention. Rarely, significant effusions are associated with non-bacterial pneumonia in the paediatric population. Pleural tuberculosis in our hospital is the second highest cause of pleural effusions related to the high incidence of TB in our city...
January 2016: Paediatric Respiratory Reviews
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
Jonathan Strutt, Anupam Kharbanda
Pediatric thoracostomy procedures are used in the emergency department to treat diseases of the pleural space. As children have unique thoracic anatomy and physiology, they may present with management challenges that the emergency clinician must consider. This issue reviews the use of chest tubes and pigtail catheters in pediatric patients, techniques and indications for placement, and possible complications. Diagnostic and treatment options for diseases of the pleural space, such as spontaneous pneumothorax, traumatic injury, and parapneumonic effusions/empyema, are examined...
November 2015: Pediatric Emergency Medicine Practice
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
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
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