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Ann Thorac Surg 1996;62:223-224
© 1996 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 20% of the full text of this article appears below.

See also page 218.

DR RICARDO BEYRUTI (São Paulo, Brazil): I congratulate Dr Ali and associates for bringing attention to this subject. In Brazil we have to deal with a significant number of patients with empyema due to various causes including tuberculosis, and we have been using this same approach for several years, with similar good results.

At the São Paulo University Medical School Hospital, we recently simplified the pleurocutaneous window surgical technique. Using computed tomographic scans, the lowest part of the pleural cavity is spotted and under general anesthesia a 3- to 4-cm incision is made at that level, over the posterior axilary line. A 3-cm segment of the adjacent rib is resected and a specially developed silicone rubber stent is inserted. With this technique we were able to mantain a 2-cm opening as long as necessary. It is simpler and quicker, and it avoids all the tissue dissection and sutures commonly employed with the traditional technique.

From April 1995 to date we have used this stent in 13 patients ranging in age from 18 to 87 years, with empyemas due to several causes. We could follow up these patients for up to 290 days. Two of them had complete recovery of their pleural disease, and the stent could be removed 67 and 115 days postoperatively. The pleurocutaneous tract in both of them closed spontaneously about 1 week after the stent removal, leaving just a small skin scar. The remaining patients continue to improve, and their evolution is absolutely comparable with what we used to see with the classic thoracostomy technique.

. . . [Full Text of this Article]

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Open Drainage of Massive Tuberculous Empyema With Progressive Reexpansion of the Lung: An Old Concept Revisited

Sohaila Mohsin Ali, Abdul Aziz Siddiqui, and Joseph S. McLaughlin
Ann. Thorac. Surg. 1996 62: 218-223. [Abstract] [Full Text]