Ann Thorac Surg 2003;76:1853
© 2003 The Society of Thoracic Surgeons
Invited commentary
Lary A. Robinson, MD
Division of Cardiovascular and Thoracic Surgery, Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612-9497, USA
e-mail: robinson@moffitt.usf.edu
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Over two millennia have passed since the first clinical description of pleural empyema by Hippocrates who recommended open incision and drainage. It was not until 1918 that Evarts Graham and the World War I Empyema Commission changed routine therapy to closed intercostal drainage resulting in a dramatic fall in mortality from 75% to 15% in streptococcal empyemas. But despite prompt intercostal tube insertion, some empyemas have already progressed to the multiloculated fibrinopurulent stage that precludes adequate treatment by simple drainage alone. For these patients, open surgical or thoracoscopic decortication, with its attendant mortality and morbidity, has been traditionally advocated. However, it was in 1949 that Sol Sherry described the first clinical use of intrapleural streptokinase to facilitate drainage of infected hemothoraces without surgery. Initially, this approach . . . [Full Text of this Article]
Copyright © 2003 by The Society of Thoracic Surgeons.
