BACKGROUND Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare,severe,acute disease that is clinically associated with extremely high morbidity and mortality.Traditional cerebrospi...BACKGROUND Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare,severe,acute disease that is clinically associated with extremely high morbidity and mortality.Traditional cerebrospinal fluid(CSF)bacterial culture is time-consuming,with a low positive rate,which frequently results in severe irreversible consequences.The next-generation sequencing technique is an emerging pathogenic microorganism detection method that can obtain results in a short time with high accuracy,thus providing great assistance in the clinical diagnosis and treatment of this disease.CASE SUMMARY This paper reports a rare case of dental focal infection-induced ventricular and spinal canal empyema.During the course of treatment at a local hospital,the patient had negative results from repeated CSF bacterial cultures and was empirically given vancomycin treatment.After transfer to our hospital,the nextgeneration sequencing technique was adopted to determine that the pathogenic microorganisms were multiple anaerobic infectious bacteria derived from the oral cavity.The antibiotic therapeutic scheme was adjusted in a timely manner,and the ventricular and spinal canal inflammation was also controlled.However,the antibiotics that had been applied at the local hospital were not able to cover all pathogenic microorganisms,which resulted in irreversible injury to the brain stem,finally leading to patient death.CONCLUSION Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare,severe,acute disease with high morbidity and mortality.Any delay in diagnosis and treatment will result in irreversible consequences.The early application of the next-generation sequencing technique can obtain results in a short time and clarify a diagnosis.Appropriate antibiotic treatment combined with suitable surgical intervention is the key to managing this disease.展开更多
Objective:To explore the clinical features,diagnosis,etiology,treatment,and outcomes of COVID-19 related empyema.Methods:Using PRISMA statement,a systematic search of relevant case reports published between December 2...Objective:To explore the clinical features,diagnosis,etiology,treatment,and outcomes of COVID-19 related empyema.Methods:Using PRISMA statement,a systematic search of relevant case reports published between December 2019 and April 2023 was performed through seven databases.The collected data included demographics,clinical manifestations,diagnostic findings,treatment,and outcomes.Results:Thirty-six case reports were identified with 43 cases of empyema.The included cases had a median age of 55 years(range:12-78 years)and 79.1%(34/43)were males.The majority of cases presented during hospitalization for management of acute COVID-19 infection(29/43,67.4%)and Charlson comorbidity index<3(40/43,93.0%).Pseudomonas aeruginosa was the most commonly isolated microorganism from the pleural fluid(9/43,20.9%)and 16.3%of the cases(7/43)had polymicrobial infections.Chest drainage was performed in all cases while surgery was indicated in 24 cases(55.8%).The most common complication of COVID-19-related empyema was broncho-pleural fistula(2/43,4.7%).The mortality rate was 23.3%(10/43).Sepsis and/or multi-organ failure were the most commonly reported causes of death.On univariate analysis,no statistically significant risk factor for mortality was identified.Conclusions:COVID-19-associated empyema has a variety of predisposing factors,time of presentation,clinical features,and causative organisms.Invasive or minimally invasive surgical procedures are performed more frequently than isolated chest drainage.Empyema in COVID-19 patients worsens their prognosis and can lead to serious complications.展开更多
BACKGROUND Thoracic empyema and malignant pleural mesothelioma(MPM)are distinct medical conditions with similar symptoms,including cough,chest pain,and breathing difficulty.We present a rare MPM case mimicking thoraci...BACKGROUND Thoracic empyema and malignant pleural mesothelioma(MPM)are distinct medical conditions with similar symptoms,including cough,chest pain,and breathing difficulty.We present a rare MPM case mimicking thoracic empyema.Physicians must consider MPM risks for patients exposed to building material who exhibit lobulated pleural effusions,indicating thoracic empyema.CASE SUMMARY A 68-year-old retired male construction worker suffered from shortness of breath and chest tightness over 10 d,particularly during physical activity.A poor appetite and 4 kg weight loss over the past 3 wk were also reported.Chest images and laboratory data concluded a tentative impression of empyema thoracis(right).Video-assisted thoracic surgery with decortication and delobulation(right)was conducted.The pathological report yielded an MPM diagnosis.Refractory pleural bilateral effusions and respiratory failure developed postoperatively,and the patient died three weeks after the operation.CONCLUSION Thoracic empyema and MPM are distinct medical conditions that can present similar symptoms,and video-assisted thoracic surgery facilitates an accurate diagnosis.Empyema-mimicking presentations and postoperative refractory pleural effusion may indicate a poor MPM outcome.展开更多
Objectives:Thoracic empyema is characterized by the collection of infected fluid/pus in the pleural space. A multitude of etiologies and surgical approaches exist. The current study aims to assess outcomes in elderly ...Objectives:Thoracic empyema is characterized by the collection of infected fluid/pus in the pleural space. A multitude of etiologies and surgical approaches exist. The current study aims to assess outcomes in elderly and young patients undergoing surgery for thoracic empyema. Methods: A retrospective comparative analysis was undertaken comparing outcomes in elderly and young patients undergoing surgery with an established diagnosis of empyema. Two groups were generated for comparison 1) patients older than 65 and 2) patients younger than 65. Demographics, comorbidities, post-operative complications, surgical approach and mortalities were compared between groups. Results: 526 patients underwent surgery for empyema during the study period (1993-2016). Group A (65) comprised 108 patients. With respect to group A, the median age at surgery was 45.30 years. Median post-operative stay was 10.50 days (9.10 vs. 11.90 in VATS and open respectively). 30-day mortality in group A was 1.90% (3.30% vs. 0.47% in VATS and open respectively). Group B comprised 108 patients (median age 72.70 years). Median post-operative stay was 14.40 days (11.20 vs. 17.8, VATS vs. open, p = 0.001). Overall 30-day mortality was 8.30 % (7.5% vs. 9% in VATS and open respectively, p = 0.03). Conclusions: The associated mortality and in-patient stay was significantly greater in elderly cohorts when compared to younger. Minimal access approaches confer a number of advantages in elderly patients including shorter hospital stay and reduced mortality.展开更多
Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conven-tional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option ...Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conven-tional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. In this paper we will review its development history, the present status and the future perspectives.展开更多
Intra-thoracic defects continue to pose a challenge for the reconstructive surgeon.Stable soft tissue coverage and obliteration of dead space can be particularly challenging when complicated by infection or previous r...Intra-thoracic defects continue to pose a challenge for the reconstructive surgeon.Stable soft tissue coverage and obliteration of dead space can be particularly challenging when complicated by infection or previous radiation.These cases may require a less conventional method of reconstruction.We describe a case in which vacuumassisted closure followed by pedicled omental flap transposition was successfully used to reconstruct a complicated intra-thoracic wound following pneumonectomy,radiation therapy,and recurrent wound dehiscences secondary to chronic infection.展开更多
文摘BACKGROUND Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare,severe,acute disease that is clinically associated with extremely high morbidity and mortality.Traditional cerebrospinal fluid(CSF)bacterial culture is time-consuming,with a low positive rate,which frequently results in severe irreversible consequences.The next-generation sequencing technique is an emerging pathogenic microorganism detection method that can obtain results in a short time with high accuracy,thus providing great assistance in the clinical diagnosis and treatment of this disease.CASE SUMMARY This paper reports a rare case of dental focal infection-induced ventricular and spinal canal empyema.During the course of treatment at a local hospital,the patient had negative results from repeated CSF bacterial cultures and was empirically given vancomycin treatment.After transfer to our hospital,the nextgeneration sequencing technique was adopted to determine that the pathogenic microorganisms were multiple anaerobic infectious bacteria derived from the oral cavity.The antibiotic therapeutic scheme was adjusted in a timely manner,and the ventricular and spinal canal inflammation was also controlled.However,the antibiotics that had been applied at the local hospital were not able to cover all pathogenic microorganisms,which resulted in irreversible injury to the brain stem,finally leading to patient death.CONCLUSION Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare,severe,acute disease with high morbidity and mortality.Any delay in diagnosis and treatment will result in irreversible consequences.The early application of the next-generation sequencing technique can obtain results in a short time and clarify a diagnosis.Appropriate antibiotic treatment combined with suitable surgical intervention is the key to managing this disease.
文摘Objective:To explore the clinical features,diagnosis,etiology,treatment,and outcomes of COVID-19 related empyema.Methods:Using PRISMA statement,a systematic search of relevant case reports published between December 2019 and April 2023 was performed through seven databases.The collected data included demographics,clinical manifestations,diagnostic findings,treatment,and outcomes.Results:Thirty-six case reports were identified with 43 cases of empyema.The included cases had a median age of 55 years(range:12-78 years)and 79.1%(34/43)were males.The majority of cases presented during hospitalization for management of acute COVID-19 infection(29/43,67.4%)and Charlson comorbidity index<3(40/43,93.0%).Pseudomonas aeruginosa was the most commonly isolated microorganism from the pleural fluid(9/43,20.9%)and 16.3%of the cases(7/43)had polymicrobial infections.Chest drainage was performed in all cases while surgery was indicated in 24 cases(55.8%).The most common complication of COVID-19-related empyema was broncho-pleural fistula(2/43,4.7%).The mortality rate was 23.3%(10/43).Sepsis and/or multi-organ failure were the most commonly reported causes of death.On univariate analysis,no statistically significant risk factor for mortality was identified.Conclusions:COVID-19-associated empyema has a variety of predisposing factors,time of presentation,clinical features,and causative organisms.Invasive or minimally invasive surgical procedures are performed more frequently than isolated chest drainage.Empyema in COVID-19 patients worsens their prognosis and can lead to serious complications.
文摘BACKGROUND Thoracic empyema and malignant pleural mesothelioma(MPM)are distinct medical conditions with similar symptoms,including cough,chest pain,and breathing difficulty.We present a rare MPM case mimicking thoracic empyema.Physicians must consider MPM risks for patients exposed to building material who exhibit lobulated pleural effusions,indicating thoracic empyema.CASE SUMMARY A 68-year-old retired male construction worker suffered from shortness of breath and chest tightness over 10 d,particularly during physical activity.A poor appetite and 4 kg weight loss over the past 3 wk were also reported.Chest images and laboratory data concluded a tentative impression of empyema thoracis(right).Video-assisted thoracic surgery with decortication and delobulation(right)was conducted.The pathological report yielded an MPM diagnosis.Refractory pleural bilateral effusions and respiratory failure developed postoperatively,and the patient died three weeks after the operation.CONCLUSION Thoracic empyema and MPM are distinct medical conditions that can present similar symptoms,and video-assisted thoracic surgery facilitates an accurate diagnosis.Empyema-mimicking presentations and postoperative refractory pleural effusion may indicate a poor MPM outcome.
文摘Objectives:Thoracic empyema is characterized by the collection of infected fluid/pus in the pleural space. A multitude of etiologies and surgical approaches exist. The current study aims to assess outcomes in elderly and young patients undergoing surgery for thoracic empyema. Methods: A retrospective comparative analysis was undertaken comparing outcomes in elderly and young patients undergoing surgery with an established diagnosis of empyema. Two groups were generated for comparison 1) patients older than 65 and 2) patients younger than 65. Demographics, comorbidities, post-operative complications, surgical approach and mortalities were compared between groups. Results: 526 patients underwent surgery for empyema during the study period (1993-2016). Group A (65) comprised 108 patients. With respect to group A, the median age at surgery was 45.30 years. Median post-operative stay was 10.50 days (9.10 vs. 11.90 in VATS and open respectively). 30-day mortality in group A was 1.90% (3.30% vs. 0.47% in VATS and open respectively). Group B comprised 108 patients (median age 72.70 years). Median post-operative stay was 14.40 days (11.20 vs. 17.8, VATS vs. open, p = 0.001). Overall 30-day mortality was 8.30 % (7.5% vs. 9% in VATS and open respectively, p = 0.03). Conclusions: The associated mortality and in-patient stay was significantly greater in elderly cohorts when compared to younger. Minimal access approaches confer a number of advantages in elderly patients including shorter hospital stay and reduced mortality.
文摘Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conven-tional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. In this paper we will review its development history, the present status and the future perspectives.
文摘Intra-thoracic defects continue to pose a challenge for the reconstructive surgeon.Stable soft tissue coverage and obliteration of dead space can be particularly challenging when complicated by infection or previous radiation.These cases may require a less conventional method of reconstruction.We describe a case in which vacuumassisted closure followed by pedicled omental flap transposition was successfully used to reconstruct a complicated intra-thoracic wound following pneumonectomy,radiation therapy,and recurrent wound dehiscences secondary to chronic infection.
