AIM To assess the evolution in management of children with parapneumonic effusion and empyema in a tertiary referral centre. METHOD We conducted a retrospective case note review of paediatric patients with parapneumonic effusion, pleural effusion and pleural empyema between December 2006 and December 2015. Digital database searches were performed to identify demographic data, referring hospit...

The intrapleural pressures on the contralateral side in pleurisy with effusion were within the normal range, the normal intrapleural pressures among Indians being ?14 to ?3 cm. of water during inspiration, ?10 to 0 cm. water during expiration, and the mean pressure ?12 to ?2 cm. water (Laha, 1946). Neither the amount nor the duration of effusion had any effect on the intrapleural pressures on t...

We describe the case of a patient with an empyema, how it forms and what the evidence behind the treatment options are with specific reference to intrapleural thrombolytic therapy.

Successful treatment of traumatic hemothoraces is imperative to reduce morbidity and mortality among patients. Treatment modalities range from more conservative to invasive measures, including antibiotic therapy, thoracostomy tube placement, video-assisted thoracoscopic surgery, or thoracotomy. Various studies have documented success in using fibrinolytics such as tissue plasminogen activator (...

The growing utilisation of indwelling pleural catheters (IPCs) has put forward a new era in the management of recurrent symptomatic pleural effusions. IPC use is safe compared to talc pleurodesis, though complications can occur. Pleural infection affects <5% of patients, and is usually responsive to antibiotic treatment without requiring catheter removal or surgery. Pleural loculations develop ...

Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy has recently been shown to improve outcomes in pleural infection in a randomized trial. Published literature, to date, consists of only ∼50 patients who had received tPA/DNase. Safety data of this regimen remain limited. Pleural contents often track along chest drains, but the effect of tPA/DNase on subcutaneo...

OBJECTIVES As the predominant approach to acute reperfusion for ST segment elevation myocardial infarction (STEMI) in many countries, fibrinolytic therapy provides a relative risk reduction for death of ∼16% across the range of baseline risk. For patients with low baseline mortality risk, fibrinolytic therapy may therefore provide little benefit, which may be offset by the risk of major bleedin...