Role of Eloesser flap and thoracoplasty in the third millennium

Deslauriers, Jean; Jacques, Louis F; Grégoire, Jocelyn

doi:10.1016/s1052-3359(02)00017-0

Cited by 32 publications

(21 citation statements)

References 28 publications

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“…Conversion to thoracotomy can be effective when VATS cannot adequately access the pleural space [44,[51][52][53] and is the optimal method for successful debridement and decortication. However, decortication is a major operation and can often not be performed in debilitated patients.…”

Section: Managementmentioning

confidence: 99%

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Diagnosis and Management of Parapneumonic Effusions and Empyema

2007

Clinical Infectious Diseases

164

138

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Approximately 1 million patients develop parapneumonic effusions (PPEs) annually in the United States. The outcome of these effusions is related to the interval between the onset of clinical symptoms and presentation to the physician, comorbidities, and timely management. Early antibiotic treatment usually prevents the development of a PPE and its progression to a complicated PPE and empyema. Pleural fluid analysis provides diagnostic information and guides therapy. If the PPE is small to moderate in size, free-flowing, and nonpurulent (pH, 17.30), it is highly likely that antibiotic treatment alone will be effective. Prolonged pneumonia symptoms before evaluation, pleural fluid with a pH !7.20, and loculated pleural fluid suggest the need for pleural space drainage. The presence of pus (empyema) aspirated from the pleural space always requires drainage. Fibrinolytics are most likely to be effective during the early fibrinolytic stage and may make surgical drainage unnecessary. If pleural space drainage is ineffective, video-assisted thoracic surgery should be performed without delay.Parapneumonic effusion (PPE; i.e., pleural fluid that results from pneumonia or lung abscess) is the most common cause of an exudative pleural effusion. PPE may be the consequence of either community-acquired or nosocomial pneumonia. Between 20% and 57% of the 1 million patients hospitalized yearly in the United States with pneumonia develop a PPE [1][2][3]. Although PPEs are relatively common, empyema (i.e., the accumulation of pus in the pleural space) is less common, occurring in 5%-10% of patients who experience PPE [4]. In a review of 14 studies of empyema that involved a total of 1383 patients, 70% of PPEs were secondary to pneumonia (figure 1) [4]. CLASSIFICATIONA practical, clinical classification of PPE is as follows: (1) an uncomplicated parapneumonic effusion (UPPE) resolves with antibiotic therapy alone, without pleural space sequelae; (2) a complicated parapneumonic effusion (CPPE) requires pleural space drainage to resolve pleural sepsis and prevent progression to an empyema; and (3) empyema, the end stage of a PPE, occurs. Empyema is defined by its appearance; it is an opaque, whitish-yellow, viscous fluid that is the result of serum coagulation proteins, cellular debris, and fibrin deposition. Empyemas develop primarily because of delayed presentation by the patient with advanced pneumonia and progressive pleural infection and, less often, from inappropriate clinical management. Early antibiotic treatment prevents progression of pneumonia and the development of a PPE. Early antibiotic treatment will prevent development of an UPPE and progression to empyema. Risk factors for empyema include age (empyemas occur most frequently among children and elderly persons), debilitation, male sex, pneumonia requiring hospitalization, and comorbid diseases, such as bronchiectasis, chronic obstructive pulmonary disease, rheumatoid arthritis, alcoholism, diabetes, and gastroesophageal reflux disease [5]. Bacterial pneumonia, pneumon...

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Section: Managementmentioning

confidence: 99%

“…The success rate of standard thoracotomy for CPPE and empyema is 87%-100%, with the mortality rate ranging from 0% to 9% [44,51,52]. Open drainage for empyema is an alternative to decortication in the debilitated patient who cannot undergo a standard thoracotomy [53].…”

Section: Managementmentioning

confidence: 99%

Diagnosis and Management of Parapneumonic Effusions and Empyema

2007

Clinical Infectious Diseases

164

138

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“…This method may be a sovereign for the treatment of empires following pneumonectomy caused by bronchopular and / or esophagus -complicated fistula after pneumonectomy (36).…”

Section: Toracoplastymentioning

confidence: 99%

“…In advanced stages of the disease, in patients in severe general condition, operative thoracostomy (fenestration of the pleural space) is the first, and often the only method of treating empyema (36,37).…”

Section: Open Thoracic Windowmentioning

confidence: 99%

Pleural Empyema Menagement: A Brief Review of Litterature

Arsenijević

Milisavljević

Mrvic

et al. 2018

Serbian Journal of Experimental and Clinical Research

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“…In fact, thoracoplasty procedures dominated chest surgery before the 1950's and played an essential role in the development of thoracic surgery as a distinct specialty. After 1950-60's, the interest for this procedure decreased due to the introduction of medical treatment (antibiotics and specific TB drugs) and development of other less mutilating and more effective surgical procedures (Deslauriers et al, 2002, Horrigan & Snow, 1990.…”

Section: Historical Backgroundmentioning

confidence: 99%