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The Approach to the Patient with a Parapneumonic Effusion

Parapneumonic effusions are seen in up to 57% of patients with pneumonia. The majority of these effusions are noninfected and resolve with standard antibiotic treatment for the associated pneumonia. However, parapneumonic effusions in a minority of cases become infected and require prompt chest tube drainage and occasionally thoracic surgery.

Patients may present in a variety of ways from florid sepsis to weight loss and anorexia; such diversity mandates a high index of suspicion among physicians. The role of the combination of intrapleural deoxyribonuclease (DNase) and tissue plasminogen activator (t-PA) to aid fluid drainage shows promise but needs further assessment in large trials with surgery and mortality ...

The Utility of Thoracoscopy in the Diagnosis and Management of Pleural Disease

Recurrent and persistent pleural exudates are common in clinical practice, and in a large number of patients, thoracocentesis and blind pleural biopsy procedures do not provide a definitive diagnosis. In the Western world, the majority of these exudates are malignant.

Thoracoscopy today remains the gold standard technique in providing diagnosis and management in these cases. Other common indications include diagnosis and management of recurrent or refractory benign exudates or transudates, pleural based tumors and pleural thickening, selected cases of pleural empyema, and recurrent spontaneous primary and secondary pneumothorax. Major advantages of this technique are ease of application, high diagnostic accuracy...

Optimal Chest Drain Size: The Rise of the Small-Bore Pleural Catheter

The objective data supporting the use of large-bore tubes is scarce in most pleural diseases. Increasing evidence shows that small-bore catheters induce less pain and are of comparable efficacy to large-bore tubes, including in the management of pleural infection, malignant effusion, and pneumothoraces.

The onus now is on those who favor large tubes to produce clinical data to justify the more invasive approach.

Pleural Effusion in Pulmonary Embolism

An estimated 300,000 to 500,000 patients develop a pleural effusion secondary to pulmonary embolism each year in the United States. The pleural effusions due to pulmonary embolism are usually small. They occupy less than one third of the hemithorax in 90% and are frequently manifest only as blunting of the costophrenic angle. The pleural fluid with pulmonary embolism is almost always an exudate.

When pulmonary embolism is considered a diagnostic possibility, the clinical probability of pulmonary embolism should be assessed. If the probability is low, measurement of D-dimers is useful. If the D-dimer test is negative, the diagnosis is virtually excluded. If the D-dimer test is positive or if there is a high clini...

Profil étiologique et évolutif des bronchectasies chez la femme

Bien que considérées comme une maladie orpheline dans les pays développés, les dilatations des bronches (DDB) ou bronchectasies sont fréquentes en Tunisie comme dans tous les pays émergeants. Elles constituent une maladie à prédominance féminine et représentent un motif fréquent de consultation et d’hospitalisation en pneumologie.

Patientes et méthode: Pour dégager les particularités étiologiques et évolutives des bronchectasies chez la femme, nous avons mené une étude rétrospective portant sur 200 patientes.

Résultats: Notre population est composée de patientes d’âge moyen 55,60 ans. Le diagnostic de bronchectasies a été confirmé chez toutes les patientes. Sur le plan étiologique, les dilatations des bronches étaient post-tuberculeuses dans 56,5 % des...

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