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Ann Thorac Surg 1999;67:1829-1830
© 1999 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Division of Cardiothoracic Surgery, Department of Surgery, Section of General Thoracic Surgery, Emory University School of Medicine, 25 Prescott St, Suite 3420, Atlanta, GA 30308, USA

To the Editor

We appreciate the opportunity to reply to the comments by Drs Riquet, Hubsch and Chehab concerning our article [1]. As pointed out by Riquet and colleagues, their group in Paris, France have previously reported on pleural drainage for the treatment of the purulent chest effusions [2]. In that series, the majority of their patients appear to have had a parapneumonic effusion or empyema that were, by definition, simple in origin. Single chest tubes were utilized in 74.5% of the patients and multiple chest tubes in the remaining. Average length of stay was 21 days and the range was 2 to 72 days.

In our series, the majority of patients presented with multiloculated, complex effusions of various etilogies and in many, but not all of htese patients, fibrinolytics were tried. We agree with Riquet and colleagues that in early, simple parapneumonic effusions or empyemas that chest tube drainage treatment with fibrinolytics (urokinase being the fibrinolytic of choice) should be the first modality of treatment. However, in our series, we had an increased number of patients with multiloculated, complex parapneumonic empyemas in which case, early surgical intervention proved to be more therapeutic and cost-effective.

References

1. Thourani V.H., Brady K.M., Mansour K.A., Miller J.I., Jr, Lee R.B. Evaluation of treatment modalities for thoracic empyema: a cost-effective analysis. Ann Thorac Surg 1998;66:1121-1127.[Abstract/Free Full Text]
2. Debesse B., Bellamy J., Dumouchel A., et al. Drainage pleural et eradication du foyer pulmonaire. Traitement standard des pleuresies purulentes aigues a germes banals (113 cas). Rev Fr Mal Resp. 1983;11:245-246.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joseph I. Miller, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thourani, V. H. Articles by Miller, J. I. Search for Related Content PubMed Articles by Thourani, V. H. Articles by Miller, J. I., Jr Related Collections Related Article