Logistic regression analysis of clinical and computed tomography features of pulmonary abscesses and risk factors for pulmonary abscess-related empyema.

OBJECTIVES: This study was conducted to investigate the risk factors for pulmonary abscess-related empyema by investigating the clinical characteristics and chest computed tomography imaging features of patients with pulmonary abscesses. METHODS: We retrospectively analyzed the chest computed tomography findings and clinical features of 101 cases of pulmonary abscess, including 25 cases with empyema (the experimental group) and 76 cases with no empyema (the control group). The potential risk factors for pulmonary abscess-related empyema were compared between the groups by using univariate and multivariate logistic regression analyses. RESULTS: The incidence of pulmonary abscess-related empyema was 24.8% (25/101). Univariate analysis showed that male gender, diabetes, pleuritic symptoms, white blood cells >10×109/L, albumin level <25 g/L, and positive sputum cultures were potential clinical-related risk factors and that an abscess >5 cm in diameter and transpulmonary fissure abscesses were potential computed tomography imaging-related risk factors for pulmonary abscess-related empyema. Multivariate logistic regression analysis showed that transpulmonary fissure abscesses (odds ratio=9.102, p=0.003), diabetes (odds ratio=9.066, p=0.003), an abscess >5 cm in diameter (odds ratio=8.998, p=0.002), and pleuritic symptoms (odds ratio=5.395, p=0.015) were independent risk factors for pulmonary abscess-related empyema. CONCLUSIONS: Transpulmonary fissure abscesses, diabetes, giant pulmonary abscesses, and pleuritic symptoms increased the risk of empyema among patients with pulmonary abscesses.

Logistic regression analysis of clinical and computed tomography features of pulmonary abscesses and risk factors for pulmonary abscess-related empyema

OBJECTIVES: This study was conducted to investigate the risk factors for pulmonary abscess-related empyema by investigating the clinical characteristics and chest computed tomography imaging features of patients with pulmonary abscesses. METHODS: We retrospectively analyzed the chest computed tomography findings and clinical features of 101 cases of pulmonary abscess, including 25 cases with empyema (the experimental group) and 76 cases with no empyema (the control group). The potential risk factors for pulmonary abscess-related empyema were compared between the groups by using univariate and multivariate logistic regression analyses. RESULTS: The incidence of pulmonary abscess-related empyema was 24.8% (25/101). Univariate analysis showed that male gender, diabetes, pleuritic symptoms, white blood cells >10×109/L, albumin level <25 g/L, and positive sputum cultures were potential clinical-related risk factors and that an abscess >5 cm in diameter and transpulmonary fissure abscesses were potential computed tomography imaging-related risk factors for pulmonary abscess-related empyema. Multivariate logistic regression analysis showed that transpulmonary fissure abscesses (odds ratio=9.102, p=0.003), diabetes (odds ratio=9.066, p=0.003), an abscess >5 cm in diameter (odds ratio=8.998, p=0.002), and pleuritic symptoms (odds ratio=5.395, p=0.015) were independent risk factors for pulmonary abscess-related empyema. CONCLUSIONS: Transpulmonary fissure abscesses, diabetes, giant pulmonary abscesses, and pleuritic symptoms increased the risk of empyema among patients with pulmonary abscesses.

A successful salvage therapy with daptomycin and linezolid for right-sided infective endocarditis and septic pulmonary embolism caused by methicillin-resistant Staphylococcus aureus.

Although vancomycin administration is recommended for the treatment of infective endocarditis (IE) caused by methicillin-resistant Staphylococcus aureus (MRSA), it is unclear whether an alternative agent, daptomycin, can be used to treat IE with pulmonary complications. A 26-year-old female who had undergone surgical repair of a ventricular septal defect as an early teenager presented with fever, headache, and vomiting. She was admitted to our hospital and diagnosed with right-sided IE with septic pulmonary embolism caused by MRSA. Vancomycin, rifampicin, and gentamicin were administered; however, exacerbation of drug eruption due to the antimicrobial agents on the 11th day led us to switch from vancomycin and rifampicin to daptomycin. Furthermore, we included linezolid to treat lung abscesses that accompanied the septic pulmonary embolism. We confirmed negative blood cultures on the 18th day. On the same day, a patch closure for the ventricular septal defect and tricuspid valve replacement were performed. She was discharged on the 65th day with an uneventful postoperative course. This experience suggests that daptomycin and linezolid are effective salvage therapies for right-sided IE caused by MRSA and accompanied by pulmonary complications.

[Disorder of fibronectin-dependent opsonization of monocytes in children in purulent pulmonary diseases and in osteomyelitis].

The influence of fibronectin (FN) on phagocytic activity of monocytes in children in abscessing pneumonia and in an acute hematogenic osteomyelitis was studied. Hypofibronectinemia, which may be explained by enhanced FN consumption, occurring as a reactive fibrin creation in pathological focus, was observed during an acute phase of the disease. Hypofibronectinemia is associated with the monocytes phagocytic activity lowering. The FN preparations application (the recently freezed plasm, cryoprecipitate) is pathogenetically substantiated for hypofibronectinemia elimination. Local hypercoagulation, the local blood flow disorder promotes the local lowering of the FN level, the fibronectin-dependent mechanism inhibition by monocytes, mainly in organs and tissues, harboring significant quantity of macrophages.

[Some blood indices and the leukocytic index of intoxication in tuberculosis, pneumonias, abscesses, and cancer of the lung].

Examining the values of hemoglobin, red and white blood cells, differential count, and leukocytic index of intoxication (LII) in patients with tuberculosis, abscesses, pneumonias, and cancer of the lung indicated that in accordance with clinical and X-ray findings, LII and the count of lymphocytes reflected the degree of patients' health status to the greatest extent. These blood values were of the greatest prognostic value. In lung cancer, LII increased only when inflammatory and purulent complications occurred. Erythrocyte sedimentation rates had a greater tendency to increase in nonspecific processes, which may be occasionally of differential diagnostic value.

Cytokines and fibrinolytic enzymes in tuberculous and parapneumonic effusions.

Tuberculous (TB) pleurisy and parapneumonic effusion (PPE) are common causes of pleural fibrosis. The mechanisms underlying fibrin deposition may be different since involved inflammatory cells are distinct. In this study, we measured various cytokines and fibrinolytic enzymes and compared the differences between the two effusions. PPE was further divided into noncomplicated PPE and complicated PPE/empyema subgroups. Tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, IL-8, macrophage inflammatory protein (MIP)-1beta, monocyte chemoattractant protein (MCP)-1, plasminogen activator inhibitor type 1 (PAI-1) and tissue type plasminogen activator (tPA) were measured using enzyme-linked immunosorbent assays. Significantly higher values of PAI-1, PAI-1/tPA ratio, IL-1beta, IL-8 and MIP-1beta and significantly lower values of TNF-alpha, IL-6 and MCP-1 were observed in PPE/empyema than in TB effusions. Compared to noncomplicated PPE, complicated PPE/empyema had significantly higher levels of TNF-alpha, IL-1beta, IL-8 and MIP-1beta. TB pleurisy patients who had higher effusion levels of TNF-alpha, IL-1beta and IL-8 were predisposing to residual pleural thickening. The underlying mechanisms of fibrin formation and deposition between the two effusions studied (PPE/empyema and TB pleurisy) could not be fully explained by the results of the present study. More studies are needed to explore this further.

[Comparative data on the use of a cryosupernatant and fresh-frozen plasma in the therapy of a protracted infectious-septic syndrome of disseminated intravascular coagulation]. / Sravnitel'nye dannye ob ispol'zovanii kriosupernatanta i svezhezamorozhennoi plazmy v terapii zatiazhnogo infektsionno-septicheskogo sindroma disseminirovannogo vnutrisosudistogo svertyvaniia krovi.

AIM: To compare therapeutic effectiveness of cryosupernatant plasma fraction (CSP) and fresh-frozen plasma (FFP) in long-term infectious-septic DIC syndrome arising in acute abscess and gangrene of the lung. MATERIALS AND METHODS: 106 and 131 patients with infectious-septic DIC syndrome were treated with CSP and FFP, respectively. The results of the treatment were compared clinically and hemotopogically. RESULTS: Clinical response to both treatments was evident from positive changes in XIIa-dependent fibrinolysis, lowering of fibrinogen level and enhanced activity of antithrombin III. CSP treatment brought about a decrease in the number of thromboses, lethal cases, unfavorable outcomes. CONCLUSION: The cryosupernatant can be used instead of fresh-frozen plasma in combined treatment of long-standing infectious-septic DIC syndrome.

[Functional disorders of the blood neutrophils and their correction in patients with bronchiectasis and lung abscess]. / Narusheniia funktsional'nogo sostoianiia neitrofilotsitov krovi i ikh korrektsiia u bol'nykh bronkhoéktaticheskoi bolezn'iu i abstsessom legkikh.

Studies conducted in 25 patients with bronchiectatic disease, 40 with chronic lung abscess, revealed decrement of the blood neutrophil capacity for uptaking bacteria, and cytochemical changes in these. Expediency of inclusion into the combination therapy of those drugs intensifying the leucocyte energy metabolism and phagocytic activity (vitamins C, B1, B2, B6, B12, PP, glutamic acid, prodigiosane, polyglucine) was validated in the experiment.

Acute phase protein response, food intake, liveweight change and lesions following intrathoracic injection of yeast in sheep.

Acute phase protein concentrations in blood, food intake and liveweight changes were compared in 10 sheep given intrathoracic injections of yeast and 10 control sheep over a period of 61 days. The yeast injections caused acute pleuritis and limited necrotising lung lesions which progressed to fibrous pleural adhesions and walled-off abscesses. The responses of ceruloplasmin, fibrinogen and haptoglobin were closely correlated (r = 0.87 to 0.91) in the yeast-injected sheep with peaks on days 5 or 7 after treatment (4, 4.6 and over 130 times control, respectively). Albumin concentration fell to a nadir of 89 per cent of control on day 12 after treatment. Depression of food intake was temporally related to the 'positive' acute phase protein responses with a nadir on day 5 after treatment (30 per cent of control). Liveweight showed a pronounced fall to five days after treatment and thereafter remained depressed relative to the controls for most of the experimental period. The data suggest that the 'positive' acute phase proteins may be useful indicators of production losses due to inflammatory diseases in sheep.

[The extracorporeal correction of disorders in the blood aggregate state in patients with acute infectious destructions of the lungs and pleura]. / Ekstrakorporal'naia korrektsiia narushenii agregatnogo sostoianiia krovi u bol'nykh s ostrymi infektsionnymi destruktsiiami legkikh i plevry.

Positive hemorheological effect was found in using therapeutical plasmapheresis in combination with extracorporeal blood oxygenation. Indications and contraindications for therapeutical plasmapheresis are discussed in the paper.

[The role of the pulmonary parenchyma in regulating the functional properties of the thrombocytes in acute septic lung lesions]. / Rol' legochnoi parenkhimy v reguliatsii funktsional'nykh svoistv trombotsitov pri ostrykh septicheskikh porazheniiakh legkikh.

An examination of 110 patients with septic injuries of the lungs (acute pneumonia without purulent destruction, acute abscessing pneumonia, gangrene and lung abscess) has established that lung parenchyma plays an important role in the regulation of functional properties of thrombocytes. Growth of unfavourable thrombocytic lesions were shown to accompany an increase of sizes of purulent-destructive lesions of the lungs. The suppression of coagulolytic and barrier function of the lungs was found to be associated with the appearance of thrombotic complications.

[The immune and fibrinolytic potentials of patients with a postpneumonic lung abscess from the viewpoints of systemic-regional correlations]. / Immunnyi i fibrinoliticheskii potentsialy u bol'nykh s postpnevmonicheskim abstsessom legkogo s pozitsii sistemno-regionarnykh sootnoshenii.

The immune and fibrinolytic systems were studied in 55 patients with postpneumonic lung abscess; 17 of them were operated on. Revealed were reductions of the number and functional activity of the T-cell immunity and a systemic-regional fibroanalysis data (high fibrinolytic activity in the systemic circulation and bronchial lumen; high activity in the blood of the resected lung portion). High activator activity of the sputum and its absence in the pus of the abscess cavity evidence that the source of the plasminogen activator is the bronchial wall not the destructed pulmonary tissue.

[Diagnosis of the obstructed pulmonary abscesses]. / Diagnostika blokirovannykh abstsessov legkikh.

Only spot bronchography, and if its results are negative, transthoracal puncture permit a correct diagnosis of blocked or partially blocked pulmonary abscess in 2/3 of cases. This result is of importance for the choice of the treatment strategy in such patients. Use of thin or super-thin needles for puncture helped to do without serious complications and obtain reliable diagnostic information in 90% of cases.

[Therapeutic plasmapheresis in suppurative-septic surgery]. / Lechebnyi plazmaferez v gnoino-septicheskoi khirurgii.

The results of the clinico-laboratory analysis conducted in 69 patients with varying forms of acute purulent surgical infections have shown that the therapeutic plasmapheresis is attended by the improvement of the disease clinical picture, and attenuation of endotoxicosis by day 3 after the perfusion. Indications and contraindications for plasmapheresis in critical patients are considered, the causes of unsuccessful plasmapheresis procedures are analyzed, the ways for the improvement of this operation are outlined.

[Megakaryocytopoiesis in patients with acute infectious destruction of the lungs]. / Megakariotsitopoèz u bol'nykh ostrymi infektsionnymi destruktsiiami legkikh.

Partial megakaryocytograms were studied in patients with acute infectious destructions of the lungs. Acid phosphatase and glycogen megakaryocytic levels, overall number of megakaryocytes elucidated the role of the central link of the system megakaryocyte--platelet in the onset of thromboembolism and hemorrhagic complications arising in the above patients. Inefficiency of megakaryocytopoiesis in pulmonary and pleural acute pyo-destructions is under discussion.

[Value of studying chemiluminescence of blood plasma in the diagnosis of acute suppurative destructive pneumonia in children]. / Znachenie issledovaniia khemiliuminestsentsii plazmy krovi v diagnostike ostroi gnoinoi destruktivnoi pnevmonii u detei.

Biophysical studies of the patients' blood plasma have demonstrated that the infiltrative form of acute pneumonia is characterized by appreciable enhancement of fluorescence, the destructive form by its dramatic depression. This rapid method is fairly informative, safe for the patient; it allows the determination of the dynamics of inflammatory and destructive processes that occur in the lungs and the monitoring of the treatment efficacy.

[The dynamic interleukin-1 and -2 contents in different variants of the complicated course of acute pneumonia]. / Dinamika soderzhaniia interleikinov-1, -2 pri razlichnykh variantakh oslozhnennogo techeniia ostroi pnevmonii.

The content of interleukins-1 and -2 in the peripheral blood was studied in 60 patients with different variants of acute pneumonia. The initial period of acute pneumonia was distinguished by an increased level of interleukin-1 and reduction of interleukin-2 level. The most characteristic prognostic sign of complicated course of acute pneumonia in this period was the high level of reduction of interleukin-2. It is recommended to use the obtained results for clinical prediction of unfavourable course of acute pneumonia and instituting differentiated pathogenetic treatment.

[Disorders of erythrocyte deformability in patients with acute suppurative-septic diseases of the lung and pleura]. / Narushenie deformiruemosti éritrotsitov u bol'nykh ostrymi gnoino-septicheskimi zabolevaniiami legkikh i plevry.

In 163 patients with acute suppurations of lungs and pleura a substantial reduction of deformability of erythrocytes was established. The maximum increased rigidity of blood red cells was noted at the peak of the pyo-destructive process and postoperative period as well as in the complicated course of the postoperative period. The curative plasmapheresis, general hyperbaric oxygenation exert positive influence upon plastic properties of erythrocytes.