Chest
Clinical Investigations: The PleuraIntrapleural Fibrinolytics in Management of Empyema Thoracis
Section snippets
MATERIALS AND METHODS
All patients referred for decortication for ET between December 1992 and November 1994 were considered for FL. ET was defined as the presence of documented infection by Gram's stain or culture, the presence of grossly purulent pleural fluid, complicated parapneumonic effusion (two of the following: pH<7.20, lactate dehydrogenase [LDH]>400 IU/L, or glucose <40 mg/dL), or pleural effusion and clinical septicemia without other etiology. All patients had failed to respond to antibiotic therapy and
RESULTS
A total of 26 patients are described. Nineteen patients were treated with streptokinase, 7 with urokinase. Mean age was 41.8±17.1 years. Twelve percent (3/26) were female, and the remainder (23/26) were male.
The mean duration of ET symptoms prior to treatment was 2.9±2.6 weeks. The mean temperature maximum immediately prior to treatment was 38.4 ±1.2°C, the mean WBC count prior to initiating FL was 15.0±5.3×l03 cells/mm3.
Empyema fluid had a mean pH of 6.96±0.34, a mean glucose level of
DISCUSSION
ET is thought to proceed through several well-described stages during maturation. In the exudative stage, a parapneumonic effusion develops and becomes secondarily infected. As infection progresses, the initially serous fluid becomes thick and purulent with organisms, fibrin, and WBCs. Loculations develop: the fibropurulent stage. Additional time and inadequate treatment result in organization with fibroblasts and scar encasing the empyema, lung, and pleural space.
The therapy for ET is
ACKNOWLEDGMENT
Biostatistical support for this work was provided by Dr. Clifford Qualls, biostatistician for General Clinical Research Center, University of New Mexico.
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2007, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :One case study reported that 500,000 units of intrapleural streptokinase caused systemic hemorrhage with a mild–moderate disturbance of clotting indices [16]. Additionally, Temes et al. [28] reported in a case series a patient of significant local bleeding that required thoracotomy. Intravenous administration of streptokinase generates a systemic antibody response that can neutralize a later dose of streptokinase [29–35].