Therapy of the empyema thoracis. Why not thoracostoma?

Empyema toracis can be defined as a purulent pleural effusion. From 1998 to 2003 we treated 106 patients (87 men and 19 women), aged between 23 and 82 years, affected by localized empyema toracis. All of them received initially a chest tube and 73 of them (60 men and 13 women), in combination with selected antibiotics, had an uneventful recovery. Twenty three patients (17 men and 5 women) underwent thoracotomy and pleural decortication, and 7 patients (6 men and 1 woman) underwent open drainage, that means a thoracostoma. All these 7 patients were affected by chronic empyema: 3 of them with residual post-pneumectomy empyema (1 for lung cancer and 2 for tubercular lung disease); 3 had destroyed lung and 1 was suffering for multiorgan deficiency (respiratory, cardiac and chronic renal insufficiency). The thoracostoma procedure was under general tube anaesthesia with tracheal intubation. The mean surgical time was 26 minutes. The mean postoperative hospital stay was 10 days. In this period of time no death has been recorded or any kind of complication. Before the dismission all of them were teached with their familiars how to take care of the remaining thoracostoma. After the dismission all the patients were followed as outpatients for a variable period, for 14 and 36 months. During this period there were neither complications nor recidives, and all the patients have accepted the "thoracostoma" as a new way of life. Therefore thoracostoma appears as an acceptable, useful and no dangerous solution for the treatment of the chronic thoracic empyema.

Spontaneous pneumothorax. When and how to treat.

INTRODUCTION: Spontaneous pneumothorax, whether primary or secondary, may occur in patients with or without a history of pneumonic disease. AIM OF THE STUDY: From 1992 to 2002, we treated 275 patients, 230 male and 45 female, in the department of Thoracic Surgery of the General Hospital of Nikaia-Piraeus. In this study the Authors report the data concerning the frequency correlated with age, sex, causes, symptoms, as well as the ways of treatment, in order to compare them and their results with those recorded in Greek and international literature. CONCLUSIONS: It is made obvious by our material that only approximately 10% of patients suffering from spontaneous pneumothorax need surgery (thoracotomy), while the remaining patients can be managed with closed thoracic drainage or conservative treatment and monitoring.

Sternal fracture with or without associated injuries. Assessment of the difference in the diagnosis, management and complications. Eighteen years of experience.

AIM OF THE STUDY: To determine the incidence of sternal fracture as an isolated injury as well as those which presented with concomitant injuries, and compare them in order to manage them more effectively. The Greek and International Literature related to the subject was also reviewed. MATERIAL AND METHODS: From 1984 to 2002 the Authors treated 134 patients with sternal fracture in the Department of Thoracic Surgery of their hospital, 59 males and 45 females, age from 17 to 84 years. Ninety patients had isolated sternal fracture and 44 sustained in addition fractured ribs, flail chest, pneumo-haemothorax, pneumo-haemomediastinum, some of them experienced respiratory failure, vertebral fractures, myocardial infarction, heart contusion, pericarditis, head injuries, fractures of upper lower limbs and intraperitoneal bleeding. Twelve patients were admitted in ITU and 4 with multiple trauma were fatally injured. Aortic tears or ruptures didn't occur in any of our patients. Sternal fracture as an isolated injury has a better prognosis compared to those with associated injuries. CONCLUSIONS: The management of sternal fracture is usually conservative with a good outcome, provided early diagnosis and treatment of concomitant injuries is offered from a well-trained and experienced medical team.