Background: Catheter drainage and antibiotics were the standard therapy for parapneumonic effusions and/or empyema. Streptokinase may aid tube drainage if it failed due to fibrinous adhesions. Objective: This study aimed to identify the benefits of streptokinase in treatment of empyema by evaluating its efficacy and safety. Patients and Methods: 30 patients with parapneumonic effusions and/or empyema treated at Al-Azhar University Hospitals between April 2020 and June 2022. The diagnosis was made using a frank pus aspiration from a pleura seen on a chest radiograph (X-ray, ultrasonography, or CT), and it was later confirmed by the results of a bacteriological examination of samples collected. Streptokinase was given 24 hours after insertion of intercostal tube by 250,000 IU diluted in 50-100 ml of ordinary saline and given every 12 hours. The success of the technique was evaluated based on the volume of pleural fluid removed, the treatment's impact on chest radiography, and the incidence of post-injection events. Results: A complete improvement was seen in 21 patients (70%), a moderate effective response in 7 patients (23.3%), and failure was shown in 2 patients (6.7%). Surgical decortication was scheduled in 3 patients who had little to no reaction. Only 6 patients experienced temporary chest discomfort and cough, whereas fever and bleeding were less common. Conclusion:With a lower rate of surgical referral in our study, the therapy of empyema with intrapleural instillation of streptokinase was a safe and effective procedure.
Background: Mitral regurgitation increases the volume of the left ventricle and the atrium. Reverse LA remodeling is caused after surgical mitral valve replacement. There have been few studies that look at LA function following MV replacement. LA strain may be used to power LA reservoirs, conduits, and pumps. TMR causes atrial re-modeling in the left ventricle. The use of 3DE enables for more precise and dependable estimation of LA emptying fractions (total, active, and passive). In terms of estimating LA quantities, 3DE is currently more accurate than 2DE. We wanted to look at these issues. Objectives: The current work aimed to evaluate early improvement in left atrial remodeling and function after mitral valve replacement in organic symptomatic mitral regurgitation assessed by three-dimensional echocardiography in Al-Hussein University Hospital. Methods: Prospective 3DE study that was performed on 60 patients with symptomatic chronic organic MR before and after surgery (valve replacement with prosthetic mechanical valve). Additionally, the maximum volume (Vol-max), lowest volume (Vol-min), and pre-contraction volume (Vol-preA) volumes of the LA were computed. Results: Mean age of patients was 48 ± 15 years. Mean BMI reached 26 ± 5 kg/m 2 . Mean systolic blood pressure reached 123 ± 16 mmHg and diastolic blood pressure reached 74 ± 8. Male to female ratio was 1:1 and 51.7% of participants had a previous history of hypertension. Regarding etiology of MR, rheumatic cause was in 33.3% of cases, mitral prolapse was the cause in most of the participants. Regarding 2DE variables of the patients, there was high significant difference between pre-and post-operative results in all variables except for LA total emptying fraction. There was no significant difference in pre and post-operative LA total emptying fraction results. Conclusion: After a successful surgery on the mitral valve, some patients who had an organic MR and intact LV function may have a reversal of LA remodeling and functional alterations. Before surgery, a rise in active atria emptying fraction (AAEF) is linked to an increase in LV relaxation capacity. Preoperative transmitral mean gradient variation and diastolic blood pressure are factors that influence short-term postoperative reverse remodeling of the left atrium in patients.
Background: It has been postulated that disruption of the mitral valve apparatus at the time of mitral valve replacement (MVR) is a risk factor for postoperative ventricular dysfunction. The aim of this study was to evaluate the effect of single versus bilateral chordo-papillary preservation on the left ventricular function in comparison to no preservation. Methods: This study was conducted from 2015 to 2018 on sixty patients who had MVR. The patients were classified into group I included 20 patients who underwent MVR with complete excision of the subvalvular chordae and tips of papillary muscles, group II: included 20 patients who underwent MVR with preservation of posterior chordo-papillary apparatus, and group III: included 20 patients who underwent MVR with preservation of both posterior and anterior chordo-papillary apparatus. Results: There were 20 males (33.3%), and the mean age was 48.76± 8.91 years. Patients in group III were significantly older (37.15 ±4.92, 39.8 ± 5.49, and 57.25 ± 6.93 years in groups I, II, and III, respectively; p< 0.001). The left ventricular end-diastolic (5.40 ±0.34, 4.96 ± 0.43, and 4.44 ± 0.55 mm in group I, II and III, respectively, p<0.001) and end-systolic diameter (4.33 ±0.48, 3.58 ±0.43 and 3.20 ±0.43 mm in group I, II and III; respectively, p<0.001) were significantly reduced in partial and complete preservation groups after 6 months. Left ventricular ejection fraction improved in the bilateral preservation and partial preservation groups after 6 months (45.32 ±9.78, 56.79 ±10.14, and 56.60 ±11.68 % in groups I, II and III respectively, p<0.001). Mechanical ventilation was significantly longer in group I (24.10 ± 6.6, 16.80 ± 5.97, and 15.80 ± 5.24 hours in groups I, II and III, respectively, p<0.001) and the duration of ICU stay was significantly longer in group I (78.65 ± 15.32, 65.40 ± 14.21, and 60.20 ± 12.58 hours in groups I, II and III, respectively, p<0.001). Conclusion: Preservation of the annulo-papillary continuity may preserve left ventricular geometry and performance. Total preservation of chordae could be superior to partial preservation with better left ventricular remodeling and improvement in the left ventricular functions.
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