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Complicated parapneumonic effusion

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https://www.readbyqxmd.com/read/28079399/safety-and-efficacy-of-tissue-plasminogen-activator-tpa-and-deoxyribonuclease-dnase-for-complicated-pleural-effusions-secondary-to-abdominal-pathology
#1
Adnan Majid, Sebastian Ochoa, Sumit Chatterji, Sebastian Fernandez-Bussy, Fayez Kheir, Estefania Rivera, George Cheng, Erik Folch
RATIONALE: Exudative pleural effusions may arise secondary to inflammation of intra-abdominal structures. Pleural space loculations can complicate these effusions, preventing adequate chest tube drainage and leading to consideration of surgical intervention. Previous studies have demonstrated that intrapleural administration of tissue plasminogen activator (tPA) combined with human recombinant deoxyribonuclease (DNase) can improve fluid drainage and reduce surgery for patients with loculated parapneumonic effusions; however, the efficacy of this treatment has not been evaluated for complicated pleural effusions attributed to intraabdominal inflammation...
January 12, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28054135/-community-acquired-pneumonia
#2
S Poetter-Lang, C J Herold
CLINICAL ISSUE: The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. STANDARD RADIOLOGICAL METHODS: For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. METHODICAL INNOVATIONS: Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging...
January 4, 2017: Der Radiologe
https://www.readbyqxmd.com/read/27993288/diagnosis-of-complicated-parapneumonic-effusion-by-pleural-ph-measurement-is-jeopardized-by-inadequate-physician-knowledge-and-guideline-discordant-laboratory-practice
#3
Lauren Ng, Eli Dabscheck, Mark Hew
Pleural fluid pH is a crucial determinant of complicated parapneumonic effusion diagnosis and the need for drainage. It is best measured by blood gas analyzer. We examined whether physicians were aware of this, and whether their laboratories measured pleural pH according to their expectations. Only 53% of physicians understood the need for blood gas analyzer measurements, only 50% of laboratories used blood gas analyzers, and only 35% of physicians correctly identified the method performed in their laboratory...
January 2017: Respiratory Medicine
https://www.readbyqxmd.com/read/27984384/mixing-it-up-coadministration-of-tpa-dnase-in-complicated-parapneumonic-pleural-effusions-and-empyema
#4
Raju Bishwakarma, Shiwan Shah, Luba Frank, Wei Zhang, Gulshan Sharma, Shawn P E Nishi
BACKGROUND: A recent randomized controlled trial showed 12 serial doses of tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) is safe and effective in managing complicated parapneumonic pleural effusions and empyema (CPEE). However, this regimen is laborious, requiring trained personnel to open/close the chest tube 8 times daily for 3 days. We present our observational data using a simplified regimen of coadministered tPA/DNase. MATERIALS AND METHODS: This is a retrospective observational study of patients who received coadministered tPA/DNase for CPEE from January 2012 to April 2015 at the University of Texas Medical Branch...
January 2017: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/27883327/the-role-of-serum-coagulation-factors-in-the-differential-diagnosis-of-patients-with-pneumonia-and-parapneumonic-effusion
#5
Sanja Petrusevska Marinkovic, Irena Kondova Topuzovska, Zvonko Milenkovic, Biserka Kaeva
The aim of this study was to identify the participations of the serum coagulations and fibrinolysis factors that contribute to the differential diagnosis of the patients with community-acquired pneumonia (CAP) without effusion, uncomplicated parapneumonic effusion (UCPPE) and complicated parapneumonic effusion (CPPE). The coagulations system is fundamental for the maintenance of homeostasis, and contributes to the inflammatory process responsible for CAP and the parapneumonic effusion. The factors of coagulations and fibrinolysis participate in the cellular proliferation and migration as in the synthesis of the inflammatory mediators...
November 1, 2016: Prilozi (Makedonska Akademija Na Naukite i Umetnostite. Oddelenie za Medicinski Nauki)
https://www.readbyqxmd.com/read/27866276/manual-intrapleural-saline-flushing-plus-urokinase-a-potentially-useful-therapy-for-complicated-parapneumonic-effusions-and-empyemas
#6
José M Porcel, Horacio Valencia, Silvia Bielsa
PURPOSE: We sought to evaluate the safety profile and effectiveness of manual pleural saline flushing, in addition to urokinase, for managing complicated parapneumonic effusions and empyemas. METHODS: Retrospective comparative review of 23 consecutive patients with complicated parapneumonic effusions or empyemas who received saline flushing plus urokinase through small-bore chest catheters, and 39 who were only treated with fibrinolytics. Both groups had similar baseline characteristics and treatments were mostly protocol-driven...
November 19, 2016: Lung
https://www.readbyqxmd.com/read/27793503/comparing-posteroanterior-with-lateral-and-anteroposterior-chest-radiography-in-the-initial-detection-of-parapneumonic-effusions
#7
Bryan K Moffett, Tanmay S Panchabhai, Raul Nakamatsu, Forest W Arnold, Paula Peyrani, Timothy Wiemken, Juan Guardiola, Julio A Ramirez
BACKGROUND: It is unclear whether anteroposterior (AP) or posteroanterior with lateral (PA/Lat) chest radiographs are superior in the early detection of clinically relevant parapneumonic effusions (CR-PPEs). The objective of this study was to identify which technique is preferred for detection of PPEs using chest computed tomography (CCT) as a reference standard. METHODS: A secondary analysis of a pneumonia database was conducted to identify patients who received a CCT within 24 hours of presentation and also received AP or PA/Lat chest radiographs within 24 hours of CCT...
December 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27709281/stratifying-fibrinolytic-dosing-in-pediatric-parapneumonic-effusion-based-on-ultrasound-grade-correlation
#8
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...
January 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/27703568/clinical-laboratory-and-radiographic-features-of-patients-with-pneumonia-and-parapneumonic-effusions
#9
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
https://www.readbyqxmd.com/read/27635382/pasteurella-multocida-pleural-effusion-a-case-report-and-review-of-literature
#10
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
https://www.readbyqxmd.com/read/27625443/thoracoscopic-evaluation-of-129-cases-having-undiagnosed-exudative-pleural-effusions
#11
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
https://www.readbyqxmd.com/read/27401931/risk-factors-for-local-complications-in-children-with-community-acquired-pneumonia
#12
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
https://www.readbyqxmd.com/read/27401009/development-and-validation-of-the-comples-score-for-differentiating-between-tuberculous-effusions-with-low-pleural-ph-or-glucose-and-complicated-parapneumonic-effusions
#13
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
https://www.readbyqxmd.com/read/27301332/microbial-aetiology-of-paediatric-pneumonia-complicated-with-parapneumonic-effusion-in-the-era-of-pneumococcal-vaccination
#14
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
https://www.readbyqxmd.com/read/27296817/etiology-of-parapneumonic-effusion-and-pleural-empyema-in-children-the-role-of-conventional-and-molecular-microbiological-tests
#15
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
https://www.readbyqxmd.com/read/27282206/c-reactive-protein-in-pleural-fluid-does-it-help-predict-complicated-parapneumonic-effusions
#16
L Ferreiro, L Valdés
No abstract text is available yet for this article.
October 2016: Revista Clínica Española
https://www.readbyqxmd.com/read/27161381/factors-influencing-pleural-drainage-in-parapneumonic-effusions
#17
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
https://www.readbyqxmd.com/read/27103079/metabolomic-profiling-of-infectious-parapneumonic-effusions-reveals-biomarkers-for-guiding-management-of-children-with-streptococcus-pneumoniae-pneumonia
#18
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
https://www.readbyqxmd.com/read/27058716/ultrasound-guided-pleural-effusion-drainage-with-a-small-catheter-using-the-single-step-trocar-or-modified-seldinger-technique
#19
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
https://www.readbyqxmd.com/read/26897270/neutrophilic-loculated-tuberculous-pleural-effusion-incidence-characteristics-and-differentiation-from-complicated-parapneumonic-effusion
#20
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
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