Pulmonary resection in the prone position for suppurative lung disease in children.

Lung resection for suppurative inflammatory disease is hazardous in children whose small airway diameter precludes the use of standard methods of bronchial separation. A prospective evaluation of the prone position for thoracotomy in 17 children referred for operation with severe inflammatory disease was done. Bronchography showed whole lung bronchiectasis eight, destroyed lung in three, and lobar bronchiectasis five. Pulmonary resections performed with the child prone included left pneumonectomy (nine), right pneumonectomy (four), lingulectomy with lower lobectomy (two), and other lobectomy (two). No endobronchial or intrapleural spillage occurred. One child required reexploration for bleeding and one child developed a postoperative empyema that ultimately caused death. The remaining 16 children were discharged within 8 days of operation, and follow-up of 1 to 18 months records favorable progress.

Pulmonary aspergilloma--indications for surgical intervention. An analysis of 22 cases.

Surgical resection of aspergillomas has generally been associated with excess mortality and morbidity; 22 patients who had a resection of complicated mycetomas were studied retrospectively. Indications for surgery were serious haemoptysis (14), massive haemoptysis (6), and recurrent infection (2). Extrapleural pneumonectomy was required in 9 patients and extrapleural lobectomy in 12; thoracoplasty alone was done in 1 patient. There was 1 hospital death (4.5%); 4 patients developed postoperative empyemas (18%), 2 with associated bronchopleural fistulas. Two further patients (9%) had stable postresectional spaces. Surgery for complicated aspergilloma was associated with significant postoperative morbidity.

Taurolidine instillation as therapy for empyema thoracis. A prospective study of 50 patients.

Fifty patients with chronic empyema thoracis, without bronchopleural fistula, were treated by drainage and twice-daily instillations of 2% taurolidine (Taurolin; Continental Ethicals) for 14 days. No antibiotics were used. Forty-three patients completed the treatment and 7 were withdrawn from the trial, 3 because of evidence of bronchopleural fistula and 1 each because of pain during instillation, associated chest-wall cellulitis, an unexplained, acute epilepsy-like episode during instillation, and inadvertent administration of antibiotics. All 43 patients who completed the trial showed an excellent clinical response with control of the local and systemic toxic effects of sepsis. A rapid falling-off in the volume and purulence of pleural drainage fluid was noted. Twenty-four of the 43 patients (55,8%) were rendered bacteriologically sterile by the treatment. Instillation of 2% taurolidine was therefore an effective form of monotherapy in cases of chronic empyema thoracis without bronchopleural fistula.

Empyema thoracis--a prospective study on 73 patients.

A prospective study of empyema thoracis was conducted on 73 consecutive patients. The pathogenesis and bacteriological features of the condition and its clinical course and management are recorded and analysed. Pleural cultures revealed that the predominant pathogen was Staphylococcus aureus. Fifty of 65 patients had mixed isolates on pleural culture, with a 4:1 ratio of aerobes to anaerobes. Twenty per cent of the patients had anaerobic empyemas. The underlying lesion was parenchymal lung disease in 37 cases and an infected hemopneumothorax following penetrating injury in 26. The remaining 10 patients developed empyema after pulmonary resection. The empyema resolved completely in 81% of the patients.

The microflora of chronic pleural empyema. An analysis of 89 patients.

Bacteriological cultures from 89 patients with chronic pleural empyema were studied. Seventy-nine patients had positive and 10 negative culture results. Forty-eight patients had a single isolate--pyogenic cocci in 32 and Gram-negative enteric bacilli in 16--and multiple organisms were grown in 31 patients. Anaerobic organisms were recovered in 6,2%. Our negative culture rate of 11,2% may reflect failure to recover anaerobes, but could represent sterilization of the empyema by prior use of antibiotics. The results of antibiotic sensitivity tests and the pathogenicity of the organisms recovered suggest that the choice of antibiotic combinations for chronic pleural empyema requires careful consideration.