Search Our Scientific Publications & Authors

J Emerg Med 2019 Jan 9. Epub 2019 Jan 9.

Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore.

Background: Point-of-care ultrasonography (POCUS) is increasingly used for both diagnostic and guided procedures. Increasingly, POCUS has been used for identification of pneumonia and to assist in the differentiation of pleural effusions, as well as to guide thoracentesis. As such, there is a need for training with ideally high-fidelity lung ultrasound phantoms to ensure ultrasound proficiency and procedural competency. Read More

Respiration 2019 Jan 9:1-10. Epub 2019 Jan 9.

Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.

Background: Data regarding community-acquired pneumonia (CAP) identified on chest computed tomography (CT) but not on chest radiography (CR) are limited.

Objectives: The present study aimed to investigate the clinical and radiological features of these patients.

Methods: We retrospectively compared the clinical characteristics, etiological agents, treatment outcomes, and CT findings between CAP patients with negative CR and positive CT findings (negative CR group) and those with positive CR as well as CT findings (control group). Read More

J Thorac Dis 2018 Nov;10(Suppl 31):S3696-S3703

Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Background: The efficacy of video-assisted thoracic surgery (VATS) in the treatment of pleural empyema has recently been proven. Till today, very few works evaluated the role of uniportal-VATS (U-VATS) approach in the treatment of pleural empyema even if it currently represents the most innovative and less invasive thoracoscopic approach. We report our experience with U-VATS in the treatment of pleural empyema. Read More

BMC Pulm Med 2018 Nov 23;18(1):176. Epub 2018 Nov 23.

Department of Internal Medicine, Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.

Background: We aimed to determine the presepsin concentration in pleural fluid from patients with pleural effusions of different aetiologies and to compare its diagnostic value with that of pleural fluid C-reactive protein (CRP) and procalcitonin (PCT).

Methods: We enrolled 132 patients with pleural effusion who underwent diagnostic evaluation, and we classified them into six categories: empyema, parapneumonic effusion, tuberculous effusion, malignant effusion, paramalignant effusion, and transudate effusion. Additionally, all pleural effusions were categorised as infectious or non-infectious effusions. Read More

J Pediatric Infect Dis Soc 2018 Nov 8. Epub 2018 Nov 8.

Université Paris Est, IMRB-GRC GEMINI, Créteil, France.

We describe here changes in the bacterial causes of pleural empyema before and after implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) program in France (2009-2017). For 220 (39.3%) of 560 children, a bacterial cause was found. Read More

Clin Microbiol Infect 2018 Nov 3. Epub 2018 Nov 3.

Department of Paediatrics, University Hospital of Würzburg, Würzburg, Germany.

Objectives: Parapneumonic pleural effusions/empyema (PPE/PE) are severe complications of community-acquired pneumonia. We investigated the bacterial aetiology and incidence of paediatric PPE/PE in Germany after the introduction of universal pneumococcal conjugate vaccine (PCV) immunization for infants.

Methods: Children <18 years of age hospitalized with pneumonia-associated PPE/PE necessitating pleural drainage or persisting >7 days were reported to the German Surveillance Unit for Rare Diseases in Childhood between October 2010 and June 2017. Read More

Panminerva Med 2018 Oct 31. Epub 2018 Oct 31.

Divisione di Pneumologia, Spedali Civili di Brescia, Brescia, Italy.

Diseases of the pleura and pleural space are common and present a significant contribution to the workload of respiratory physicians, accounting for an annual incidence of more than 1.5 million cases in the US with the majority of cases resulting from congestive heart failure, pneumonia, and cancer 1. Although the radiographic and ultrasonographic detection of pleural abnormalities may be obvious, the determination of a specific diagnosis can often represent a challenge. Read More

Indian J Pediatr 2018 Sep 4. Epub 2018 Sep 4.

Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.

Objective: To identify predictors of complicated parapneumonic effusion (CPE)/empyema in patients of community acquired pneumonia (CAP) by using clinical and simple laboratory variables like hemoglobin (Hb), serum C-reactive protein (CRP), serum albumin (SA) levels and total leukocyte counts (TLC).

Methods: This prospective case-control study was conducted after institutional ethical approval. Subjects between ages of 2-59 mo with World Health Organization (WHO) defined CAP with written, informed parental consent were included. Read More

Clin Lab 2018 Jul;64(7):1269-1277

Background: Parapneumonic effusions usually occur secondary to an infection and produce pus (empyema) that accumulates in the pleural space. We aimed to evaluate the prevalence of anerobes in patients with empyema and to assess their resistance patterns for seven antimicrobials.

Methods: Pleural fluid specimens from 236 patients were inoculated on Schaedler agar. Read More

Lung 2018 Oct 11;196(5):623-629. Epub 2018 Aug 11.

Baptist Hospital of Miami, Miami, FL, USA.

Purpose: Complicated parapneumonic effusions and empyema are a leading cause of morbidity in the United States with over 1 million admissions annually and a mortality rate that remains high in spite of recent advances in diagnosis and treatment. The identification of high risk patients is crucial for improved management and the provision of cost-effective care. The RAPID score is a scoring system comprised of the following variables: renal function, age, purulence, infection source, and dietary factors and has been shown to predict outcomes in patients with pleural space infections. Read More

Clin Respir J 2018 Aug;12(8):2309-2320

Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, United Kingdom.

Objectives: Pleural infection is a condition commonly encountered by the respiratory physician. This review aims to provide the reader with an update on the most recent data regarding the epidemiology, microbiology, and the management of pleural infection.

Data Source: Medline was searched for articles related to pleural infection using the terms "pleural infection," "empyema," and "parapneumonic. Read More

Ann Thorac Cardiovasc Surg 2018 10 2;24(5):263-264. Epub 2018 Jul 2.

Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan.

Pediatr Radiol 2018 09 27;48(10):1410-1416. Epub 2018 Jun 27.

Department of Paediatric Radiology, Children's Hospital for Wales, Heath Park, Cardiff, UK, CF14 4XW.

Background: Chest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. Although the additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion.

Objective: To evaluate the effectiveness and safety of real-time US-guided, radiologically placed chest drains at a tertiary university hospital. Read More

Ci Ji Yi Xue Za Zhi 2018 Apr-Jun;30(2):97-101

Department of Preventive Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.

Objectives: It is not always possible to move critically ill patients to the operating or endoscopy room for a pleuroscopy. Bedside pleuroscopy is indicated for these patients. The aim of this study was to investigate the safety and complications of bedside pleuroscopy in an Intensive Care Unit (ICU). Read More

Expert Rev Respir Med 2018 06 20;12(6):521-535. Epub 2018 May 20.

a Pneumology Service , Complejo Hospitalario Universitario de Santiago , Santiago de Compostela , SPAIN.

Introduction: The management of infected pleural effusion is complex. Therapeutic resolution requires determining the following: appropriate antibiotic regimen, the need for pleural drainage, the optimal drainage tube size, and the need for intrapleural therapy or surgery. Areas covered: An updating of the latest advances in the management of parapneumonic pleural effusion based on the best evidence available is provided. Read More

Clin Respir J 2018 May;12(5):1779-1786

Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.

Tuberculosis (TB) is the leading infectious cause of death worldwide, and the commonest cause of death in people living with HIV. Globally, pleural TB remains one of the most frequent causes of pleural exudates, particularly in TB-endemic areas and in the HIV positive population. Most TB pleural effusions are exudates with high adenosine deaminase (ADA), lymphocyte-rich, straw-coloured and free flowing, with a low yield on mycobacterial culture. Read More

Children (Basel) 2018 Mar 3;5(3). Epub 2018 Mar 3.

Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa, ON K1H 8L1, Canada.

Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015. Read More

Chest 2018 Sep 6;154(3):550-556. Epub 2018 Feb 6.

Department of Surgery, Intermountain Medical Center, Murray, UT.

Background: Combined intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) has been shown to reduce the need for surgical intervention for complicated pleural effusion/empyema (CPE/empyema). For patients in whom tPA/DNase is likely to fail, however, receipt of this therapy may simply delay the inevitable. The goal of this study was to identify risk factors for failure of combined intrapleural therapy. Read More

Ann Am Thorac Soc 2018 May;15(5):515-517

2 Oxford Pleural Unit and Oxford Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford, United Kingdom; and.

Lung 2018 04 20;196(2):249-254. Epub 2018 Jan 20.

Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.

Purpose: We studied the diagnostic value of cytokines, including vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and interleukin-8 (IL-8), and the ratio of lactate dehydrogenase (LDH) to adenosine deaminase (ADA) in pleural fluid.

Methods: Prospective analysis of 44 inpatients or outpatients with pleural fluid, from December 2016 to March 2017 was conducted.

Results: We enrolled patients with malignant pleural effusion (MPE, N = 15), empyema (N = 11), parapneumonic effusion (PPE, N = 7), chronic renal failure (CRF)/chronic heart failure (CHF) (N = 7), and tuberculous pleural effusion (TBPE, N = 4). Read More

Ann Thorac Cardiovasc Surg 2018 Feb 17;24(1):19-24. Epub 2018 Jan 17.

Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey.

Background: Development of multiloculation-septation is a challenging entity in empyema patients. In this study, it is aimed to investigate the success rates of videothoracoscopic deloculation (VATS-D) and intrapleural fibrinolytic (IPFib) application after tube thoracostomy.

Methods: The study retrospectively examined the patients diagnosed with empyema with multiloculation and septation between January 2005 and December 2014. Read More

Am Surg 2017 Dec;83(12):1458-1459

J Thorac Dis 2017 Nov;9(11):4690-4699

Department of Respiratory Medicine, Pudong New Area Zhoupu Hospital, Shanghai 201318, China.

Pleural cavity infection continuously seriously threatens human health with continuous medical progress. From the perspective of pathophysiology, it can be divided into three stages: exudative stage, fibrin exudation and pus formation stage, and organization stage. Due to the pathogenic bacteria difference of pleural cavity infection and pulmonary infection, it is very important for disease treatment to analyze the bacteria and biochemical characteristics of the infectious pleural effusion. Read More

Clin Respir J 2018 Apr 23;12(4):1361-1366. Epub 2017 Nov 23.

Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain.

Objectives: To summarize the evidence underlying the non-surgical management of patients with complicated parapneumonic effusions (CPPE) or empyemas.

Data Source: All articles published in PubMed according to their relevance with the subject were identified.

Results And Conclusions: There is a lack of powered randomized controlled studies comparing medical and surgical approaches to CPPE/empyemas in adults. Read More

Clin Pulm Med 2017 Jul;24(4):163-169

Department of Cellular and Molecular Biology and Texas Lung Injury institute, The University of Texas Health Science Center.

Complicated pleural effusions and empyema with loculation and failed drainage are common clinical problems. In adults, intrapleural fibrinolytic therapy is commonly used with variable results and therapy remains empiric. Despite the intrapleural use of various plasminogen activators; fibrinolysins, for about sixty years, there is no clear consensus about which agent is most effective. Read More

Respirology 2018 02 25;23(2):232-233. Epub 2017 Oct 25.

Pleural Medicine Unit, Arnau de Vilanova University Hospital, Lleida, Spain.

Respirology 2018 02 25;23(2):232. Epub 2017 Oct 25.

Department of Respiratory Medicine, University Hospital of Thessaly, Larissa, Greece.

Respirology 2018 02 24;23(2):160-167. Epub 2017 Oct 24.

Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

Unexpandable lung is a common complication of malignant pleural effusions and inflammatory pleural diseases, such as pleural infection (e.g. empyema and complicated parapneumonic effusion) and noninfectious fibrinous pleuritis. Read More

Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2017 Sep;38(2):99-105

.

Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need to use extensive surgery - decortications or thoracoplasty. Read More

J Thorac Dis 2017 Jul;9(7):2135-2141

Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

A complex para-pneumonic effusion is a descriptive term for exudative effusions, which complicate or are likely to complicate the anatomy of the pleural space after pneumonia. We performed an online search was performed using the resources PubMed and Google Scholar to provide an update on the management of such effusions based on review of published literature. Search terms including pleural effusion (PE), parapneumonic effusion, and empyema were used. Read More

J Pediatr (Rio J) 2018 Mar - Apr;94(2):140-145. Epub 2017 Aug 22.

Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.

Objectives: To evaluate the effectiveness of videothoracoscopic surgery in the treatment of complicated parapneumonic pleural effusion and to determine whether there is a difference in the videothoracoscopic surgery outcome before or after the chest tube drainage.

Methods: The medical records of 79 children (mean age 35 months) undergoing videothoracoscopic surgery from January 2000 to December 2011 were retrospectively reviewed. The same treatment algorithm was used in the management of all patients. Read More

J Pediatr Surg 2018 Apr 24;53(4):644-646. Epub 2017 Jul 24.

Department of Surgery, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS28BJ, UK.

Aim: To assess the evolution in management of children with parapneumonic effusion and empyema in a tertiary referral centre.

Method: We conducted a retrospective case note review of paediatric patients with parapneumonic effusion, pleural effusion and pleural empyema between December 2006 and December 2015. Digital database searches were performed to identify demographic data, referring hospital, radiological and microbiological investigations. Read More

J Infect Chemother 2017 Oct 24;23(10):661-667. Epub 2017 Jul 24.

Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan. Electronic address:

Objects: Changes in patients' background and life environment could contribute to increase healthcare-associated (HCA) empyema. There are no guidelines and statements for HCA empyema.

Methods: We retrospectively reviewed all patients with empyema who were admitted to the Aichi Medical University Hospital, Japan between 2008 and 2015. Read More

J Ultrasound Med 2017 Sep 19;36(9):1943-1954. Epub 2017 Jun 19.

Department of Radiology, King's College London, King's College Hospital, London, England.

Pediatric pneumonia can be complicated by necrotizing pneumonia or a parapneumonic effusion either in the form of an empyema or a clear effusion. Ultrasonography (US) and computed tomography represent well-established modalities for evaluation of complicated pediatric pneumonia. Contrast-enhanced ultrasound (CEUS) was recently introduced and is gaining increasing acceptance in pediatric imaging. Read More

Arab J Gastroenterol 2017 Jun 1;18(2):104-107. Epub 2017 Jun 1.

Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.

Background And Study Aims: Spontaneous bacterial empyema (SBEM) is an underestimated condition in patients with ascites and hepatic hydrothorax with a high mortality. This study aimed to find whether spontaneous bacterial peritonitis (SBP) is a prerequisite for SBEM.

Patients And Methods: 3000 HCV-related cirrhotic patients with ascites and hydrothorax were screened for the presence of SBP (ascitic fluid neutrophils >250/mm) and SBEM (positive pleural fluid culture and neutrophils >250/mm or negative pleural fluid culture and neutrophils >500/mm with no evidence of pneumonia/parapneumonic effusion on chest radiograph or CT). Read More

Cureus 2017 Apr 12;9(4):e1159. Epub 2017 Apr 12.

Internal Medicine, Creighton University Medical Center.

( is a pioneer oral bacteria that is recognized as an agent of bacterial endocarditis. However, an extensive review of the literature revealed no reported case of causing empyema. We present a case of a 65-year-old male who presented with respiratory distress. Read More

Pediatr Pulmonol 2017 06 5;52(6):757-762. Epub 2017 May 5.

Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas (HCPA) de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Pleural empyema is a well-known complication of pneumonia. If treatment is delayed, empyema may increase morbidity and mortality in affected patients. Therefore, the identification of empyema biomarkers in parapneumonic pleural effusion is desirable. Read More

BMC Pediatr 2017 04 27;17(1):114. Epub 2017 Apr 27.

Service des Maladies Infectieuses Pédiatriques, Hôpital d'Enfants Abderrahim Harouchi, CHU Ibn Rochd, Casablanca, Morocco.

Background: Simple parapneumonic effusion is a pleural effusion associated with lung infection (i.e., pneumonia). Read More

Respirology 2017 08 30;22(6):1199-1204. Epub 2017 Mar 30.

Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Lleida, Spain.

Background And Objective: Due to limited data, we aimed to develop and validate a computed tomography (CT)-based scoring system for identifying those parapneumonic effusions (PPEs) requiring drainage.

Methods: A retrospective review of all patients with PPE who underwent thoracentesis and a chest CT scan before any attempt to place a tube thoracostomy, if applicable, over an 8-year period was conducted. Eleven chest CT characteristics were compared between 90 patients with complicated PPEs (CPPEs), defined as those which eventually required chest drainage, and 60 with non-complicated effusions (derivation sample). Read More

Cochrane Database Syst Rev 2017 Mar 17;3:CD010651. Epub 2017 Mar 17.

Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia, 4029.

Background: Empyema refers to pus in the pleural space, commonly due to adjacent pneumonia, chest wall injury, or a complication of thoracic surgery. A range of therapeutic options are available for its management, ranging from percutaneous aspiration and intercostal drainage to video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage. Intrapleural fibrinolytics may also be administered following intercostal drain insertion to facilitate pleural drainage. Read More

Rev Col Bras Cir 2016 Dec;43(6):424-429

Health Sciences Institute, Federal University of Pará, Belém, Pará, Brazil.

Objective: to define the profile and analyze the postoperative evolution of children with parapneumonic pleural effusion (PPE), and to evaluate strategies used in the presence of diagnostic and therapeutic limitations, emphasizing the open thoracic drainage (OTD) .

Methods: we conducted a cross-sectional, prospective, analytical study in which we followed children admitted in an Amazon university hospital with surgically addressed PPE, from October 2010 to October 2011.

Results: we studied 46 patients, most children under three years of age (74%), with no gender predominance. Read More

Acta Med Port 2016 Nov 30;29(11):711-715. Epub 2016 Nov 30.

Serviço de Cirurgia Pediátrica. Departamento da Infância e Adolescência. Centro Materno-Infantil do Norte. Centro Hospitalar do Porto. Porto. Portugal.

Introduction: The treatment of complicated pleural parapneumonic effusions with intrapleural instillation of fibrinolytics, has shown similar results as surgical treatment. The present study aimed to evaluate the results of the use of intrapleural instillation of fibrinolytics in the treatment of complicated pleural parapneumonic effusions, in patients followed in our hospital.

Material And Methods: A retrospective review of all the patients (aged between one month and 18 years) diagnosed with complicated parapneumonic effusions, which had chest drain insertion with intrapleural instillation of fibrinolytic, between January 2005 and December 2013, was undertaken. Read More

Respir Med 2017 02 12;123:28-33. Epub 2016 Dec 12.

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece.

Objective: Nonsteroidal anti-inflammatory drug (NSAID) pre-hospitalization consumption might affect the course of pneumonia. We opted to assess the potential effects of pre-hospitalization use of NSAIDs in patients with pleuropulmonary infection in the context of the duration of hospitalization.

Methods: A prospective observational study of 57 consecutive patients with a diagnosis of pneumonia and parapneumonic pleural effusion was conducted. Read More

Ann Am Thorac Soc 2017 Mar;14(3):342-346

6 Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

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 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 intra-abdominal inflammation. Read More

J Thorac Dis 2016 Nov;8(11):3168-3174

Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.

Background: The selection of ideal candidates for surgical intervention among patients with parapneumonic pleural effusion remains challenging. In this retrospective study, we sought to identify the main predictors of surgical treatment and devise a simple scoring system to guide surgical decision-making.

Method: Between 2005 and 2014, we identified 276 patients with parapneumonic pleural effusion. Read More

Radiologe 2017 Jan;57(1):6-12

Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medizinische Universität Wien, Währinger Guertel 18-20, 1090, Wien, Österreich.

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. Read More

Lung 2017 04 22;195(2):201-208. Epub 2016 Dec 22.

Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France.

Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed or used as self-medication in cases of community-acquired pneumonia (CAP). Nevertheless, the consequences of such medication on the risk of pleuroparenchymal complications are not well known. The aim was to investigate whether exposure to NSAIDs prior to hospital admission among patients suffering from CAP is associated with the development of pleural complications or a lung abscess. Read More

J Bronchology Interv Pulmonol 2017 Jan;24(1):40-47

*Department of Internal Medicine, Division of Pulmonary, Critical Care & Sleep Medicine ‡Sealy Center on Aging †Department of Radiology, University of Texas Medical Branch, Galveston, TX.

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. Read More

Lung 2017 02 19;195(1):135-138. Epub 2016 Nov 19.

Pleural Medicine Unit, Department of Internal Medicine, Arnau de Villanova University Hospital, Institute for Biomedical Research Dr Pifarre Foundation, IRBLLEIDA, Avda Alcalde Rovira Roure 80, 25198, Lleida, Spain.

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. Read More