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[PMID]:29466146
[Au] Autor:Feller-Kopman D; Light R
[Ad] Endereço:From the Division of Pulmonary, Critical Care, and Sleep Medicine, Johns Hopkins University, Baltimore (D.F.-K.); and the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville (R.L.).
[Ti] Título:Pleural Disease.
[So] Source:N Engl J Med;378(8):740-751, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Empiema Pleural/terapia
Pleura/fisiopatologia
Derrame Pleural Maligno/terapia
Derrame Pleural/fisiopatologia
Pneumotórax/terapia
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Empiema Pleural/diagnóstico
Empiema Pleural/fisiopatologia
Exsudatos e Transudatos/fisiologia
Seres Humanos
Pleura/anatomia & histologia
Derrame Pleural/diagnóstico
Derrame Pleural/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMra1403503


  2 / 2414 MEDLINE  
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[PMID]:29190798
[Au] Autor:Popowicz ND; Lansley SM; Cheah HM; Kay ID; Carson CF; Waterer GW; Paton JC; Brown JS; Lee YCG
[Ad] Endereço:Pharmacy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
[Ti] Título:Human pleural fluid is a potent growth medium for Streptococcus pneumoniae.
[So] Source:PLoS One;12(11):e0188833, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Empyema is defined by the presence of bacteria and/or pus in pleural effusions. However, the biology of bacteria within human pleural fluid has not been studied. Streptococcus pneumoniae is the most common cause of pediatric and frequent cause of adult empyema. We investigated whether S. pneumoniae can proliferate within human pleural fluid and if growth is affected by the cellular content of the fluid and/or characteristics of pneumococcal surface proteins. Invasive S. pneumoniae isolates (n = 24) and reference strain recovered from human blood or empyema were inoculated (1.5×106CFU/mL) into sterile human malignant pleural fluid samples (n = 11). All S. pneumoniae (n = 25) strains proliferated rapidly, increasing by a median of 3009 (IQR 1063-9846) from baseline at 24hrs in all pleural effusions tested. Proliferation was greater than in commercial pneumococcal culture media and concentrations were maintained for 48hrs without autolysis. A similar magnitude of proliferation was observed in pleural fluid before and after removal of its cellular content, p = 0.728. S. pneumoniae (D39 strain) wild-type, and derivatives (n = 12), each with mutation(s) in a different gene required for full virulence were inoculated into human pleural fluid (n = 8). S. pneumoniae with pneumococcal surface antigen A (ΔpsaA) mutation failed to grow (2207-fold lower than wild-type), p<0.001, however growth was restored with manganese supplementation. Growth of other common respiratory pathogens (n = 14) across pleural fluid samples (n = 7) was variable and inconsistent, with some strains failing to grow. We establish for the first time that pleural fluid is a potent growth medium for S. pneumoniae and proliferation is dependent on the PsaA surface protein and manganese.
[Mh] Termos MeSH primário: Empiema Pleural/microbiologia
Derrame Pleural/microbiologia
Streptococcus pneumoniae/crescimento & desenvolvimento
[Mh] Termos MeSH secundário: Seres Humanos
Streptococcus pneumoniae/patogenicidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188833


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[PMID]:28460424
[Au] Autor:Scott J; Singh A; Monnet E; Coleman KA; Runge JJ; Case JB; Mayhew PD
[Ad] Endereço:Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
[Ti] Título:Video-assisted thoracic surgery for the management of pyothorax in dogs: 14 cases.
[So] Source:Vet Surg;46(5):722-730, 2017 Jul.
[Is] ISSN:1532-950X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To report the perioperative findings and outcome of dogs undergoing video-assisted thoracic surgery (VATS) for the management of pyothorax. DESIGN: Multi-institutional, retrospective study. ANIMALS: Client-owned dogs (n = 14). METHODS: Medical records of dogs with pyothorax managed via VATS were reviewed for signalment, history, clinical signs, clinicopathological findings, diagnostic imaging results, surgical variables, bacterial culture and sensitivity results, post-operative management and outcome. VATS was performed after placing a paraxyphoid endoscopic portal and 2-3 intercostal instrument portals. VATS exploration was followed by one or more of the following: mediastinal debridement, tissue sampling, pleural lavage, and placement of a thoracostomy tube. RESULTS: Two dogs (14%) required conversion from VATS to an open thoracotomy to completely resect proliferative mediastinal tissue. These dogs had severe pleural effusion on preoperative thoracic radiographs and one had severely thickened contrast-enhancing mediastinum on preoperative computed tomography (CT). The cause of pyothorax was identified as a penetrating gastric foreign body (n = 2), migrating plant material (n = 2), and idiopathic (n = 10). The median follow-up time was 143 days (range, 14-2402 days). All dogs were discharged from the hospital and their clinical signs resolved. One patient had recurrence of a pyothorax requiring revision surgery 17 months postoperatively. CONCLUSION: VATS allows minimally invasive treatment of uncomplicated canine pyothorax. Preoperative thoracic CT may help identify candidates for VATS among dogs with pyothorax.
[Mh] Termos MeSH primário: Doenças do Cão/cirurgia
Empiema Pleural/veterinária
Cirurgia Torácica Vídeoassistida/veterinária
[Mh] Termos MeSH secundário: Animais
Cães
Empiema Pleural/cirurgia
Feminino
Masculino
Paracentese/veterinária
Derrame Pleural/cirurgia
Reoperação
Estudos Retrospectivos
Toracotomia/veterinária
Tomografia Computadorizada por Raios X
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1111/vsu.12661


  4 / 2414 MEDLINE  
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[PMID]:28953667
[Au] Autor:Lian R; Zhang G; Zhang G
[Ad] Endereço:aDepartment of Emergency Medicine bDepartmentof General Surgery, China-Japan Friendship Hospital, Beijing, China.
[Ti] Título:Empyema caused by a colopleural fistula: A case report.
[So] Source:Medicine (Baltimore);96(39):e8165, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATINALE: Empyema is a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. An empyema caused by colo-pleural fistula is a rare but potentially life-threatening condition. PATIENT CONCERNS: We describe a case of 42-year-old man was brought to our Emergency Department for chest pain with dyspnea and fever. DIAGNOSES: The final diagnoses are empyema caused by colo-pleural fistula and colon cancer. INTERVENTIONS: The patient underwent laparotomy surgery, during which a tumor was found in the splenic flexure of the descending colon. The tumor penetrated the colonic serosa and invaded the left side of the diaphragm. A left hemicolectomy was performed. OUTCOMES: After the operation, the patient recovered smoothly and was discharged on postoperative day 14. It's been over 3 years now, CT and colonoscopy assessments show no recurrence or metastasis. LESSONS: This case serves as a reminder to test for pathogens in patients with an unexplained empyema. If normal intestinal bacteria are detected, the empyema may be derived from intestinal disease. In addition, an abdominal examination should be performed in patients with an empyema of unknown origin.
[Mh] Termos MeSH primário: Colectomia
Colo Descendente
Neoplasias do Colo
Empiema Pleural
Fístula
Cavidade Pleural
[Mh] Termos MeSH secundário: Adulto
Colectomia/efeitos adversos
Colectomia/métodos
Colo Descendente/diagnóstico por imagem
Colo Descendente/patologia
Neoplasias do Colo/complicações
Neoplasias do Colo/patologia
Colonoscopia/métodos
Empiema Pleural/diagnóstico
Empiema Pleural/etiologia
Empiema Pleural/microbiologia
Empiema Pleural/terapia
Enterococcus faecium/isolamento & purificação
Escherichia coli/isolamento & purificação
Fístula/diagnóstico
Fístula/etiologia
Fístula/fisiopatologia
Fístula/cirurgia
Microbioma Gastrointestinal
Seres Humanos
Masculino
Invasividade Neoplásica
Estadiamento de Neoplasias
Cavidade Pleural/diagnóstico por imagem
Cavidade Pleural/patologia
Toracentese/métodos
Tomografia Computadorizada por Raios X/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008165


  5 / 2414 MEDLINE  
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[PMID]:28885331
[Au] Autor:Lai SW; Lin CL; Liao KF
[Ad] Endereço:aCollege of Medicine bDepartment of Family Medicine cManagement Office for Health Data, China Medical University Hospital, Taichung dCollege of Medicine, Tzu Chi University, Hualien eDepartment of Internal Medicine, Taichung Tzu Chi General Hospital fGraduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
[Ti] Título:Population-based cohort study investigating the correlation of diabetes mellitus with pleural empyema in adults in Taiwan.
[So] Source:Medicine (Baltimore);96(36):e7763, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We assessed the association between diabetes mellitus and the risk of pleural empyema in Taiwan.A population-based retrospective cohort study was conducted using the database of the Taiwan National Health Insurance Program. There were 28,802 subjects aged 20 to 84 years who were newly diagnosed with diabetes mellitus from 2000 to 2010 as the diabetes group and 114,916 randomly selected subjects without diabetes mellitus as the non-diabetes group. The diabetes group and the non-diabetes group were matched by sex, age, comorbidities, and the year of index date. The incidence of pleural empyema at the end of 2011 was estimated. A multivariable Cox proportional hazards regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) for pleural empyema associated with diabetes mellitus.The overall incidence of pleural empyema was 1.65-fold higher in the diabetes group than that in the non-diabetes group (1.58 vs 0.96 per 10,000 person-years, 95% CI 1.57-1.72). After adjusting for confounders, a multivariable Cox proportional hazards regression model revealed that the adjusted HR of pleural empyema was 1.71 in subjects with diabetes mellitus (95% CI 1.16-2.51), compared with those without diabetes mellitus. In further analysis, even in the absence of any comorbidity, the adjusted HR was 1.99 for subjects with diabetes mellitus alone (95% CI 1.18-3.38).Diabetic patients confer a 1.71-fold increased hazard of developing pleural empyema. Even in the absence of any comorbidity, the risk remains existent.
[Mh] Termos MeSH primário: Diabetes Mellitus/epidemiologia
Empiema Pleural/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Incidência
Masculino
Meia-Idade
Modelos de Riscos Proporcionais
Doença Pulmonar Obstrutiva Crônica/epidemiologia
Estudos Retrospectivos
Fatores de Risco
Fatores Sexuais
Taiwan/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007763


  6 / 2414 MEDLINE  
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[PMID]:28681368
[Au] Autor:Wakai S; Otsuka H; Aoki H; Yamagiwa T; Nakagawa Y; Inokuchi S
[Ad] Endereço:Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan. rocketronnie147@yahoo.co.jp.
[Ti] Título:A Case of Incarcerated and Perforated Stomach in Delayed Traumatic Diaphragmatic Hernia.
[So] Source:Tokai J Exp Clin Med;42(2):85-88, 2017 Jul 20.
[Is] ISSN:2185-2243
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:The patient was an emergency transported, 57-year-old man complaining of left thoraco-lateroabdominal pain, with a history of blunt chest trauma 3 months prior. Thoracoabdominal computed tomography (CT) resulted in a diagnosis of diaphragmatic hernia with incarceration and perforation of the stomach, and same-day emergency surgery was performed. The surgery was performed via an abdominal approach, and after manually repositioning the stomach incarceration, the perforated region was resected and the diaphragm sutured closed. Diaphragmatic hernia can be occasionally difficult to diagnose at the time of initial treatment, and may have been overlooked at the initial presentation, 3 months earlier in the present case. When examining a case of blunt force thoracoabdominal trauma, it is important to keep in mind the possibility of diaphragmatic injury. Additionally, during surgery for traumatic diaphragmatic hernia, in cases where manipulation of the abdominal organs is thought necessary, commencing the surgery with an abdominal approach is desirable.
[Mh] Termos MeSH primário: Hérnia Diafragmática Traumática/etiologia
Perfuração Intestinal/etiologia
Gastropatias/etiologia
Traumatismos Torácicos/complicações
Ferimentos não Penetrantes/complicações
[Mh] Termos MeSH secundário: Dor Abdominal/etiologia
Dor no Peito/etiologia
Emergências
Empiema Pleural/etiologia
Hérnia Diafragmática Traumática/diagnóstico por imagem
Hérnia Diafragmática Traumática/cirurgia
Seres Humanos
Perfuração Intestinal/diagnóstico por imagem
Perfuração Intestinal/cirurgia
Masculino
Meia-Idade
Gastropatias/diagnóstico por imagem
Gastropatias/cirurgia
Fatores de Tempo
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE


  7 / 2414 MEDLINE  
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[PMID]:28609232
[Au] Autor:Mathis G
[Ad] Endereço:1 Internistische Praxis, Rankweil, Österreich.
[Ti] Título:Solide Pleuraveränderungen im Ultraschall..
[So] Source:Praxis (Bern 1994);106(12):641-645, 2017 Jun.
[Is] ISSN:1661-8157
[Cp] País de publicação:Switzerland
[La] Idioma:ger
[Mh] Termos MeSH primário: Mesotelioma/diagnóstico por imagem
Derrame Pleural/diagnóstico por imagem
Neoplasias Pleurais/diagnóstico por imagem
Neoplasias Pleurais/secundário
Ultrassonografia/métodos
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Empiema Pleural/diagnóstico por imagem
Seres Humanos
Pleura/diagnóstico por imagem
Pleurisia/diagnóstico por imagem
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE
[do] DOI:10.1024/1661-8157/a002719


  8 / 2414 MEDLINE  
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[PMID]:28496088
[Au] Autor:Gabe A; Nagamine N
[Ad] Endereço:Department of Thoracic Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
[Ti] Título:[Lung Abscess with Acute Empyema Which Improved after Performing by Video Assissted Thoracic Surgery( Including Pneumonotomy and Lung Abscess Drainage);Report of a Case].
[So] Source:Kyobu Geka;70(5):389-391, 2017 May.
[Is] ISSN:0021-5252
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:We herein report the case of a patient demonstrating a lung abscess with acute empyema which improved after performing pnemumonotomy and lung abscess drainage. A 60-year-old male was referred to our hospital to receive treatment for a lung abscess with acute empyema. At surgery, the lung parenchyma was slightly torn with pus leakage. After drainage of lung abscess by enlarging the injured part, curettage in the thoracic cavity and decortication were performed. The postoperative course was uneventful. Direct drainage of an abscess into the thoracic cavity is thought to be a choice for the treatment of lung abscesses.
[Mh] Termos MeSH primário: Empiema Pleural/cirurgia
Abscesso Pulmonar/cirurgia
[Mh] Termos MeSH secundário: Doença Aguda
Drenagem
Empiema Pleural/complicações
Empiema Pleural/diagnóstico por imagem
Seres Humanos
Abscesso Pulmonar/complicações
Abscesso Pulmonar/diagnóstico por imagem
Masculino
Meia-Idade
Procedimentos Cirúrgicos Pulmonares
Cirurgia Torácica Vídeoassistida
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170513
[St] Status:MEDLINE


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[PMID]:28474458
[Au] Autor:Peterson GE; Silva SS; Amantéa SL; Miorelli P; Sanches P; Kulczynski J; Roesch E; Fraga JC
[Ad] Endereço:Hospital Fêmina, Porto Alegre, Rio Grande do Sul, Brazil.
[Ti] Título:Accuracy of complement activation product levels to detect infected pleural effusion in rats.
[So] Source:Pediatr Pulmonol;52(6):757-762, 2017 Jun.
[Is] ISSN:1099-0496
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo: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. Previous research has suggested complement activation products as candidate empyema markers. OBJECTIVE: To compare the levels of complement activation products C3a, C5a, and C5b9 in pleural effusion induced by Staphylococcus aureus (SA), Streptococcus pneumoniae (SP), or turpentine (control). METHODS: Thirty-nine male Wistar rats (mean weight 414 g; 290-546 g) were allocated as follows: 17 animals in the SA group, 12 in the SP group, and 10 in the control group. Bacteria or turpentine were injected into the pleural space. After 12 hr, intrapleural fluid was collected using ultrasound-guided thoracentesis. Levels of complement activation products were determined using ELISA kits. RESULTS: Two SA and one SP animals died before 12 hr. Mean levels were as follows: C3a: 1066.82 µg/ml (937.29-1196.35 µg/ml) in SA, 1188.28 µg/ml (1095.65-1280.92 µg/ml) in SP, and 679.13 µg/ml (601.29-756.98 µg/ml) in controls (P < 0.001); C5a: 55.727 ng/ml (41.22-70.23 ng/ml) in SA, 520.107 ng/ml (278.92-761.3 ng/ml) in SP, and 5.268 ng/ml (1.68-8.85 ng/ml) in controls (P < 0.001); C5b9: 15.02 ng/ml (13.1-16.94 ng/ml) in SA, 16.63 ng/ml (14.37-18.9 ng/ml) in SP, and 14.05 ng/ml (9.8-18.29 ng/ml) in controls (P = 0.692). ROC analysis revealed an area under the curve of 0.987 (95% CI: 0.953-1) for C3a; 1 (1-1) for C5a; and 0.757 for C5b9 (0.523-0.990). CONCLUSIONS: In the present rat model, complement activation fragments C3a and C5a accurately detected infected pleural effusion. Pediatr Pulmonol. 2017;52:757-762. © 2017 Wiley Periodicals, Inc.
[Mh] Termos MeSH primário: Ativação do Complemento
Empiema Pleural/imunologia
Derrame Pleural/imunologia
[Mh] Termos MeSH secundário: Animais
Complemento C3a/imunologia
Complemento C5a/imunologia
Complexo de Ataque à Membrana do Sistema Complemento/imunologia
Empiema Pleural/etiologia
Masculino
Derrame Pleural/etiologia
Infecções Pneumocócicas/complicações
Infecções Pneumocócicas/imunologia
Ratos Wistar
Infecções Estafilocócicas/complicações
Infecções Estafilocócicas/imunologia
Staphylococcus aureus
Streptococcus pneumoniae
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Complement Membrane Attack Complex); 80295-42-7 (Complement C3a); 80295-54-1 (Complement C5a)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170506
[St] Status:MEDLINE
[do] DOI:10.1002/ppul.23666


  10 / 2414 MEDLINE  
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[PMID]:28304084
[Au] Autor:Redden MD; Chin TY; van Driel ML
[Ad] Endereço:Ipswich Hospital, Ipswich, Queensland, Australia.
[Ti] Título:Surgical versus non-surgical management for pleural empyema.
[So] Source:Cochrane Database Syst Rev;3:CD010651, 2017 Mar 17.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo: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. There is currently a lack of consensus regarding optimal treatment. OBJECTIVES: To assess the effectiveness and safety of surgical versus non-surgical treatments for complicated parapneumonic effusion or pleural empyema. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015 to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015), Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS (1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for ongoing studies (December 2016). SELECTION CRITERIA: Randomised controlled trials that compared a surgical with a non-surgical method of management for all age groups with pleural empyema. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We included eight randomised controlled trials with a total of 391 participants. Six trials focused on children and two on adults. Trials compared tube thoracostomy drainage (non-surgical), with or without intrapleural fibrinolytics, to either VATS or thoracotomy (surgical) for the management of pleural empyema. Assessment of risk of bias for the included studies was generally unclear for selection and blinding but low for attrition and reporting bias. Data analyses compared thoracotomy versus tube thoracostomy and VATS versus tube thoracostomy. We pooled data for meta-analysis where appropriate. We performed a subgroup analysis for children along with a sensitivity analysis for studies that used fibrinolysis in non-surgical treatment arms.The comparison of open thoracotomy versus thoracostomy drainage included only one study in children, which reported no deaths in either treatment arm. However, the trial showed a statistically significant reduction in mean hospital stay of 5.90 days for those treated with primary thoracotomy. It also showed a statistically significant reduction in procedural complications for those treated with thoracotomy compared to thoracostomy drainage. We downgraded the quality of the evidence for length of hospital stay and procedural complications outcomes to moderate due to the small sample size.The comparison of VATS versus thoracostomy drainage included seven studies, which we pooled in a meta-analysis. There was no statistically significant difference in mortality or procedural complications between groups. This was true for both adults and children with or without fibrinolysis. However, mortality data were limited: one study reported one death in each treatment arm, and seven studies reported no deaths. There was a statistically significant reduction in mean length of hospital stay for those treated with VATS. The subgroup analysis showed the same result in adults, but there was insufficient evidence to estimate an effect for children. We could not perform a separate analysis for fibrinolysis for this outcome because all included studies used fibrinolysis in the non-surgical arms. We downgraded the quality of the evidence to low for mortality (due to wide confidence intervals and indirectness), and moderate for other outcomes in this comparison due to either high heterogeneity or wide confidence intervals. AUTHORS' CONCLUSIONS: Our findings suggest there is no statistically significant difference in mortality between primary surgical and non-surgical management of pleural empyema for all age groups. Video-assisted thoracoscopic surgery may reduce length of hospital stay compared to thoracostomy drainage alone.There was insufficient evidence to assess the impact of fibrinolytic therapy.A number of common outcomes were reported in the included studies that were not directly examined in our primary and secondary outcomes. These included duration of chest tube drainage, duration of fever, analgesia requirement, and total cost of treatment. Future studies focusing on patient-centred outcomes, such as patient functional scores, and other clinically relevant outcomes, such as radiographic improvement, treatment failure rates, and amount of fluid drainage, are needed to inform clinical decisions.
[Mh] Termos MeSH primário: Empiema Pleural/terapia
Cirurgia Torácica Vídeoassistida
Toracostomia
[Mh] Termos MeSH secundário: Adulto
Criança
Drenagem/efeitos adversos
Drenagem/métodos
Drenagem/mortalidade
Empiema Pleural/mortalidade
Empiema Pleural/cirurgia
Seres Humanos
Tempo de Internação
Ensaios Clínicos Controlados Aleatórios como Assunto
Viés de Seleção
Cirurgia Torácica Vídeoassistida/efeitos adversos
Cirurgia Torácica Vídeoassistida/mortalidade
Toracostomia/efeitos adversos
Toracostomia/mortalidade
Terapia Trombolítica
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170318
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD010651.pub2



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