• Journal of Chest Surgery
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• v.26 no.8
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• pp.613-619
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• 1993

As developing surgical techniques and postoperative cares, a pneumonectomy is a relatively popular surgical method in disease which is not treated completely with other type of pulmonary resection, but a postpneumonectomy complication is a life-threatening serious problem if it occurred. We performed one hundred twenty-five cases of pneumonectomy for treatment of various causes of pulmonary diseases in Kosin Medical College during about ten years, and we experienced 41 cases of postoperative complications in 29 patients, so we analyzed them. The most common complication is an empyema thoracis in 13 cases[10.4%], of which one case combined with bronchopleural fistula died on early postoperative day. Of them except one case, the early postoperative empyema thoracis[within 30 days] were 6 cases, and the late postoperative empyema thoracis[above 30 days] were 6 cases. The main etiologic pathogens were a staphylococcus in early postoperative empyema and a streptococcus in late postoperative empyema, but the most cases were mixed infections with pseudomonas, klebsiella, acinectobacter, and candida. The treatment of postoperative empyema thoracis were that 4 cases were treated with open drainage using chest tube, 7 cases with Clagett`s operation, and 1 case with thoracoplasty. The next common complication was a postoperative serious respiratory insufficiency in 7 cases. And the other complications were massive postoperative bleeding in 5 cases, of which 2 cases advanced to occurrence of postoperative empyema thoracis, and wound disruption in 4 cases, cardiac arrhythmia in 3 cases, contralateral pneumothorax and pneumonia in each of 2 cases, esophagopleural fistula in 1 case. The postoperative deaths were 9 cases[7.2%] of 125 cases, the causes of death were respiratory insufficiency in 6 cases, sepsis in 2 cases, and cardiac arrhythmia in 1 case.

• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.310-313
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• 2016

Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M.tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema.

• Journal of Chest Surgery
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• v.26 no.10
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• pp.769-774
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• 1993

Thoracic empyema is defined as purulent pleural effusion or effusion with positive bacteriology. Recently, the empyema has markedly decreased by developement of antibiotics, but empyemas following thoracotomy were occasionaly reported. During the period of January, 1985 to May,1991, 18 patients with postthoracotomy empyema have been treated in the Department of Thoracic and Cardiovascular Surgery of Chonbuk National University Hospital.There were 17 males and 1 female ranged from 18 years to 67 years of age. The underlying diseases of empyema were tuberculosis [50%], lung cancer [33.3%], esophageal cancer [11.1%],and aspergillosis with tuberculosis[5.6%]. In surgical procedures causing the empyema, there were lobectomy[38.9%], pneumonectomy[22.2%], decortication[16.7%], decortication & lobectomy[11.1%], and esophagectomy [11.1%]. Etiologic organisms in the pleural fluid were Pseudomonas [27.7%], S.aureus [16.7%], mixed infection [16.7%], K.pneumonia [5.6%], M.tuberculosis [5.6%], and no isolation [27.7%]. In 6 cases with BPF, completion pneumonectomy was performed in 1 case, and open thoracostomy in 5 cases. In 12 cases without BPF, closed thoracostomy was performed in 1 case, decortication in 2 cases, decortication & open thoracostomy in 2 cases, and open thoracostomy in 7 cases. In 6 cases with BPF, the fistulas were closed in 4 cases at follow up, the other 2 cases died from pulmonary insufficiency after completion pneumonectomy and open thoracostomy,respectively. In 12 cases without BPF, the empyema cavities were filled with expanded lungs and granulation tissues, except 1 case died from sepsis.

• Journal of Chest Surgery
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• v.24 no.9
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• pp.945-949
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• 1991

The treatment of acute and chronic empyema with bronchopleural fistula is remained as serious postoperative complication in thoracic surgery. Although several operative procedures for the treatment of postpneumonectomy empyema have been reported, the method of treating empyema, and in particular empyema associated with fistula, remains controversial. Recently some successful results have been reported by use of the omentum in the patients with thoracic empyema resulting from bronchial fistula. We have performed one-stage operations using the omentum and chest wall muscles in 2 patients, one was acute, and the other was chronic case. Their postoperative courses were uneventful

• Journal of Chest Surgery
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• v.24 no.6
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• pp.555-559
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• 1991

Post-pneumonectomy empyema thoracis is an uncommon, but very serious problem. Early diagnosis & adequate drainage followed by thoracoplasty and or myoplasty are very important principles for the management of the empyema thoracis & will enable patient to recover from the toxic effects. During the period of January, 1985 to December, 1990, 13 patients with post-pneumonectomy empyema thoracis were treated in the department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine. There were 10 males % 3 females ranging from 31 years to 79 years of age. The occurrence ratio of left to right side was 8: 5. The underlying pathologic lesions of empyema thoracis were pulmonary tuberculosis[7], lung ca. [2] pneumothorax[2], lung abscess[1] pneumonia[1]. We treatment procedure for post-pneumonectomy empyema thoracis were open window thoracostomy in 10 cases, Clagett procedures in 2 cases, one thoracoplasty, and two cases of Clagett procedures followed by open window thoracostomy in one cases.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.899-904
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• 1990

One hundred and nine Patients with thoracic empyema were treated at the Chosun university hospital from Jul. 1983 to Sep. 1989. Seventy-nine[72.5%] of the empyemas were adults and 30[27.5%] patients were under fifteen-year children. 29 patients[26.6%] were associated with pulmonary tuberculosis, 23[21.1%] occurred as pneumonia, and 13[11.9%] were unknown. The cardinal symptoms were dyspnea, chest pain, fever, coughing. When used as the initial mode of drainage, repeat thoracentesis was successful in only 46 of 93 cases[49. 5%]. Rib resection, however, provided cure or controlled in 7 cases[100%]. And decortication showed high cure rate in 19 of 24 cases[79.2%] Eventual control or cure of empyema was achieved in 90 patients[89.6%], whereas 7 patients[6.4%] died [3 from their empyema and 4 with empyema as an active problem at the time of death]. of all empyema-caused deaths occurred in patients who underwent chest tube drainage as the most invasive treatment modality. Chest tube drainage was often inadequate and more aggressive management was likely to result in fewer treatment failure and fewer total procedure. Early rib resection was recommended.

• Journal of Chest Surgery
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• v.50 no.3
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• pp.202-206
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• 2017

Background: Empyema is the collection of purulent exudate within the pleural space. Overall, 36%-65% of patients with empyema cannot be treated by medical therapy alone and require surgery. Multiloculated empyema is particularly difficult to treat with percutaneous drainage. Therefore, we describe our experiences with early aggressive surgical treatment for rapid progressive multiloculated empyema. Methods: From January 2001 to October 2015, we retrospectively reviewed 149 patients diagnosed with empyema who received surgery. The patients were divided into 2 groups according to whether they underwent emergency surgery or not. We then compared surgical outcomes between these groups. Results: The patients in group A (emergency surgery, n=102) showed a more severe infectious state, but a lower complication rate and shorter length of hospital stay. The incidence of lung abscess was higher in group A, and abscesses were associated with diabetes and severe alcoholism. Conclusion: Early aggressive surgical treatment resulted in good surgical outcomes for patients with rapid progressive multiloculated empyema. Furthermore, we suspect that the most likely causes of multiloculated empyema are lung abscesses found in patients with diabetes mellitus as well as severe alcoholism.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.285-291
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• 1980

Post pneumonectomy empyema either with bronchopleural fistula or without bronchopleural fistula is an infrequent postoperative complication, but very serious and critical problem. But it is of some interest that the development of a postoperative empyema following resection for carcinoma of the lung might have a favorable effect on the survival of patients in recent speculation of the literature. We have experienced 4 cases of postoperative empyema following pneumonectomy for carcinoma of the lung at department of chest surgery, Yon Sei University, medical college during 11 years from Jan. 1968 to June 1980. Histologically, 3 cases were demonstrated squamous cell carcinoma except one oat cell carcinoma. Onset of postoperative empyema occurred over a wide range of time, from as early as the 5th postoperative day to insidious onset 6 months after pneumonectomy. The most common organisms isolated from the empyema cavities were staphylococcus aureus, pseudomonas aeruginosa and gram negative bacilli. All cases had a large number of organisms and more infections but not single infection. 2 out of 4 cases are treated with open pleural window drainage and irrigation with antibiotic`s solution 2 or 3 times per week by this time and postoperative general course is not eventful. One is alive to 2 years 3 months, another is alive to 8 years 11 months until now. And 2 out of 4 patients is survived over 4 years 10 months. Analysis of postoperative empyema complicating pneumonectomy for bronchogenic carcinoma revealed an increase in 4 year 10 months survival [50%].

• Journal of Chest Surgery
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• v.8 no.1
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• pp.9-12
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• 1975

Four patients with postpneumonectomy empyema were treated successfully by modification of Clagett`procedure. Their primary diseases were chronic bronchiectasis, empyema with bronchopleural fisula, pulmonary tuberculosis, and pyohemothorax. The time interval between 1st and 2nd operation was 26.5 months in average. The pleural space was irrigated with various kinds of antiseptic solutions for 23.3 days in average and debrided, filled with antibiotic saline solution. After the procedure, patients had no recurrences of empyema and discharged from hospital after brief days. (averages: 15.5 days)

• Journal of Chest Surgery
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• v.11 no.1
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• pp.35-41
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• 1978

After the advent of the effective antimicrobial drugs, empyema of the pleural cavity came to be considered an infrequent disease. However, in recent years the problem of empyema is increasing, probably due to bacterial changes associated with the use and misuse of antimicrobials as well as alterations in the host associated with increased longevity and chronic disease. During the 10 years period from 1957, Sop. to 1977, Aug., we experienced 152 cases of empyema, of which 37 were scheduled on open thoracotomy drainge for chronic empyema. 1. The ratio of male to female was 3.6:1 with male predominance and 64% of total was above 40 years old in age distribution. 2. The cardinal symptoms were fever[70%], dyspnea[40.5%], and sputum[40.5%]. The leucocytosis were observed in 75.7% of all cases. The hemoglobin level showed subnormal in 21.6% of all cases. 3- The underlying pathology predisposing to empyema were postoperative empyema [35.1%] and tuberculosis[32.4%] in order. 4. The pathologic organisms by bacterial culture in 37 patients were Pseudomonas [24.3%], Staphylococccus [21.6%], Streptococcus [21.6%]., no growth [8. 1%] and the remainders. 5. The late results were as follow; a. Spontaneous closure was seen in 10 patients and all of them belongs to non-tuberculous group. Their mean duration was 14 months. b. Still opened are eight; 6 in tuberculous group, remainders in non-tuberculous group. c. Secondary closure was performed in 6 patients, of which 5 cases showed successful secondary closure but one failed. The mean duration from OTD to secondary closure was 46.3 days. d. Eleven patients were not followed. e. Two patients were expired; one was due to progressive cachexia and pulmonary insufficiency, the other due to gastrointestinal bleeding unrelated to empyema.