Tracking the outcomes of surgical treatment of Stage 2 and 3 empyema: introduction and consolidation of minimally invasive approach

Patella, Miriam; Minerva, Eleonora Maddalena; Porcellini, Iride; Cianfarani, Agnese; Tessitore, Adele; Cafarotti, Stefano

doi:10.1111/ans.17133

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…Surgical treatment has become a necessary treatment option for stage II/III TB empyema patients ( 5 ). Currently, thoracotomy and VATS are widely used for these disease conditions ( 18 ). As far as we know, there is a lack of NAATs based studies using pleural tissue specimens for the diagnosis of stage II/III TB empyema and we hope this study would cover this research gap.…”

Section: Discussionmentioning

confidence: 99%

Performance of TB-LAMP in the Diagnosis of Tuberculous Empyema Using Samples Obtained From Pleural Decortication

Liu¹,

Fan²,

Zhang³

et al. 2022

Front. Med.

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PurposeTo evaluate the performance of TB-LAMP in the diagnosis of TB empyema using pleural tissue specimens obtained during pleural decortication.MethodsUsing the clinical records and the different diagnostic test results of patients who underwent pleural decortication in a TB-designated hospital over 3.5 years, we calculated the sensitivity, specificity positive predictive, and negative predictive values of the pathology, MGIT 960 culture, and TB-LAMP obtained by using pleural tissue specimens against the etiologic diagnosis and composite clinical reference standard (CCRS) as the reference standards.ResultA total of 304 patients' records were extracted. All these patients had gone through pleural decortication. When the etiologic diagnosis was used as the reference, the sensitivity of TB-LAMP in identifying TB empyema was 77.8% (compared to 10.6% of MGIT 960 P < 0.05). The sensitivity of MGIT 960, pathology, and TB-LAMP was 8.2%, 77.7%, and 67.2% against CCRS as the reference; and the specificity of the three was 100.0, 100.0, and 96.2% against the same standard. A combination of pathology and TB-LAMP would increase the sensitivity and specificity to 84.7 and 96.0%. Using TB-LAMP to diagnose TB empyema using pleural tissue samples obtained from pleural decortication was faster with satisfactory performance.ConclusionTB-LAMP has great potential in faster and more accurate diagnosis of TB empyema. Our findings provide insights for optimizing diagnostic algorithms for TB empyema.

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Section: Discussionmentioning

confidence: 99%

Performance of TB-LAMP in the Diagnosis of Tuberculous Empyema Using Samples Obtained From Pleural Decortication

Liu¹,

Fan²,

Zhang³

et al. 2022

Front. Med.

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“…52 However, VATS requires a learning curve to achieve good results and, therefore, it should be performed in centers with experienced surgeons. 53 Conversion rates from VATS to open thoracotomy are variable among series, with an average of 25%. 54,55 Reasons for conversion are commonly the presence of an obliterated space by firm adhesions and failure to achieve total lung reexpansion.…”

Section: Surgerymentioning

confidence: 99%

Nonmalignant Pleural Effusions

Porcel

2022

Semin Respir Crit Care Med

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Although the potential causes of nonmalignant pleural effusions are many, the management of a few, including complicated pleural infections and refractory heart failure and hepatic hydrothoraces, can be challenging and requires the assistance of interventional pulmonologists. A pragmatic approach to complicated parapneumonic effusions or empyemas is the insertion of a small-bore chest tube (e.g., 14–16 Fr) through which fibrinolytics (e.g., urokinase and alteplase) and DNase are administered in combination. Therapeutic thoracenteses are usually reserved for small to moderate effusions that are expected to be completely aspirated at a single time, whereas video-assisted thoracic surgery should be considered after failure of intrapleural enzyme therapy. Refractory cardiac and liver-induced pleural effusions portend a poor prognosis. In cases of heart failure–related effusions, therapeutic thoracentesis is the first-line palliative therapy. However, if it is frequently needed, an indwelling pleural catheter (IPC) is recommended. In patients with hepatic hydrothorax, repeated therapeutic thoracenteses are commonly performed while a multidisciplinary decision on the most appropriate definitive management is taken. The percutaneous creation of a portosystemic shunt may be used as a bridge to liver transplantation or as a potential definitive therapy in nontransplant candidates. In general, an IPC should be avoided because of the high risk of complications, particularly infections, that may jeopardize candidacy for liver transplantation. Even so, in noncandidates for liver transplant or surgical correction of diaphragmatic defects, IPC is a therapeutic option as valid as serial thoracenteses.

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Tracking the outcomes of surgical treatment of Stage 2 and 3 empyema: introduction and consolidation of minimally invasive approach

Cited by 2 publications

References 29 publications

Performance of TB-LAMP in the Diagnosis of Tuberculous Empyema Using Samples Obtained From Pleural Decortication

Performance of TB-LAMP in the Diagnosis of Tuberculous Empyema Using Samples Obtained From Pleural Decortication

Nonmalignant Pleural Effusions

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