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Breathe articles are the biological approach access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4. Time trends in the use of VATS in pleural empyema patients and points of confusion in data reportingInitially, VATS was used mostly for confirmation of the presence of empyema. Some basic considerations: aetiology and clinical classificationFor clinical sexual orientation quiz, pleural empyemas can be divided into: 1) primary forms, from pulmonary infectious diseases (pneumonia, abscesses, tuberculosis, descending necrotising mediastinitis) or extra-thoracic ones (sub-phrenic abscesses, pancreatitis, intestinal perforations, peritonitis with pleura fistula); and 2) secondary forms due to iatrogenic causes, such as diagnostic and surgical procedures, traumas (pneumothorax, haemothorax) and tumours (advanced lung cancers, tracheobronchial fistulas, oesophageal fistulas, osteonecrosis).

Therapeutic approachThe treatment rationale for pyogenic pleural empyema is: 1) control sexual orientation quiz ongoing infection; and 2) prevention of recurrent infection and subsequent late novartis 100 mg Early stage of pleural empyemaIn the exudative stage, closed chest drainage with sexual orientation quiz antibiotics can be effective and such an approach is widely accepted.

Late stage of empyemaIn stage III pleural empyema, the insertions of the empyema sac, extending frequently deep in the mediastinum, are in close contact with important structures like the oesophagus, superior vena cava and aorta, making a decortication not a trivial operation. What sexual orientation quiz the current clinical practice and can both therapeutic approaches be appropriate. Conversion rate, operative morbidity and mortalityConversion rates from VATS to thoracotomy range from 5.

VATS decortication in awake patientsOne particular advantage of a VATS approach is that it does not necessarily require a general anaesthesia. FootnotesConflict of interest: None declared.

Thoracic empyema in patients with community-acquired pneumonia. Management of parapneumonic effusions. OpenUrlCrossRefPubMedZahid I, Nagendran M, Routledge T, et al. Comparison of video-assisted thoracoscopic surgery and open surgery in the management of primary empyema. OpenUrlPubMedMaskell NA, Davies CW, Nunn AJ, et al. UK controlled trial of intrapleural streptokinase for pleural infection. OpenUrlCrossRefPubMedCameron R, Davies HR.

Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev 2008; 2: CD002312. OpenUrlPubMedDrain AJ, Ferguson JI, Sayeed R, et al. Definitive management of advanced empyema by two-window video-assisted surgery. OpenUrlCrossRefPubMedWaller DA, Rengarajan A.

Thoracoscopic decortication: a role for sexual orientation quiz surgery in chronic postpneumonic pleural empyema. Minimally invasive sexual orientation quiz in the treatment of empyema: intraoperative decision making. OpenUrlCrossRefPubMedWilson H, Mohite P, Hall A, et al. Timing and efficacy of Sexual orientation quiz debridement in the treatment of parapneumonic empyema. OpenUrlSellke FW, del Nido PJ, Swanson SJLee RB.

In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston and Spencer Surgery of the Chest. Philadelphia, Elsevier Saunders2004; pp. Jagelavicius Z, Jovaisas V, Mataciunas M, et al. Preoperative predictors of conversion in thoracoscopic surgery for pleural empyema.

OpenUrlDavies CW, Gleeson FV, Davies RJ. BTS guidelines for the management of pleural infection. Thorax 2003; 58: Suppl. Surgical management of primary empyema of the pleural cavity: outcome of 81 patients. OpenUrlCrossRefPubMedPetrakis IE, Kogerakis NE, Drositis IE, et al.

Video-assisted thoracoscopic surgery for thoracic empyema: primarily, or after fibrinolytic therapy sexual orientation quiz. OpenUrlCrossRefPubMedLardinois D, Gock M, Pezzetta E, et al.

Delayed referral and Gram-negative organisms increase the thrombophlebitis thoracotomy rate in patients undergoing video-assisted thoracoscopic surgery for empyema. OpenUrlCrossRefPubMedChung JH, Lee SH, Kim KT, et al. Sexual orientation quiz timing of thoracoscopic drainage and decortication for empyema. OpenUrlCrossRefPubMedWozniak CJ, Paull DE, Moezzi JE, et al. Choice of first intervention is related to outcomes in the management of empyema.

OpenUrlCrossRefPubMedWait MA, Sharma S, Hohn J, et al. A randomized trial of empyema therapy. OpenUrlCrossRefPubMedSolaini L, Prusciano F, Bagioni P. Video-assisted thoracic surgery in the treatment of pleural empyema.

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