Pleural empyema is a disease which is not always recognized. Despite consecutive treatment and antibiotics its mortality rate is still high, especially in older patients with concomitant disease or in the case of delayed treatment. We report our experience with early video-assisted thoracoscopic surgery of pleural empyema in 13 patients, where chest tube drainage had failed. The clinical symptoms of empyema did not exceed 14 days, bacteriologic cultures were positive in 62%. In all patients the fever disappeared within 1 to 5 days (mean 3.5) post-operatively and they remained in hospital for an average of 11.5 days after video-assisted thoracoscopic surgery. Pulmonary function tests 6 months later revealed normal values without a substantial loss of lung volumes. No relapse of empyema occurred.
The value of computed tomography (CT) in predicting direct mediastinal infiltration of stage T4N0-1 lung carcinoma was evaluated prospectively in 11 patients with surgical and histological proof. Furthermore, its role in twelve non-operated patients was assessed retrospectively. The radiologic signs detected independently by two radiologists correlated in 90%. Mediastinal infiltration was verified in 7 of 11 patients (63%). Only in 3 out of the 12 patients treated non-surgically was CT the only criterium for inoperability. In all other patients additional findings, such as scintigraphy, radiologic or bioptic proof of distant metastases, supported inoperability. The limited specificity of CT (63%) demands aggressive staging procedures before any patient is excluded from surgery, the only potentially curative treatment.
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