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Lehtomäki A, Ukkonen M, Toikkanen V, Laurikka J, Khan J. The incidence of pleural infections in Finland. Respir Med Res 2024; 86:101132. [PMID: 39121590 DOI: 10.1016/j.resmer.2024.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/11/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND The incidence of pleural infections appears to be increasing in Western countries for unclear reasons. The aim of the study was to describe the incidence and treatment patterns of pleural infections in Finland over three decades. METHODS Data regarding each treatment episode for pleural infections in the Finnish special medical care between January 1994 and December 2016 was obtained from a national database and compared to the demographics of Finnish residents obtained from the national census bureau. The annual incidence rates, type of treatment given, as well as the lengths of the hospitalization were analyzed. RESULTS A total of 28,463 episodes were reported, of which 55% were inpatient episodes. Of these, 76% concerned males, and the median age of patients was 60 (interquartile range 49-70) years. The overall incidence of pleural infections was 23.4 per 100.000 patient-years, with a male-to-female -ratio of 3.3:1. The annual incidence rates increased throughout the study period with an average annual percentage change of +11.4% (95% CI ±7.4%). The highest incidence rates (>200 per 100.000 patient-years) were observed in men aged 80 or more. Altogether 88% of patients were treated conservatively. The proportion of patients treated by mini-invasive surgery significantly increased during study period (0-5.9%, p < 0.001) and was associated with shorter hospitalization (median 6 [interquartile range 4-12] days) than open surgery (median 7 [4.5-13] days) (p < 0.001). CONCLUSION The incidence of pleural infections has increased significantly over the previous decades in Finland and appears to be higher than previously reported, particularly in elderly men.
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Affiliation(s)
- Antti Lehtomäki
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland.
| | - Mika Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Wellbeing Services County of Pirkanmaa, Finland
| | - Vesa Toikkanen
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jari Laurikka
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Care Technology, Tampere University, Tampere, Finland
| | - Jahangir Khan
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland
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2
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Porcel JM, Lee YCG. Advances in pleural diseases. Eur Respir J 2024; 63:2400593. [PMID: 38901889 DOI: 10.1183/13993003.00593-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/03/2024] [Indexed: 06/22/2024]
Affiliation(s)
- José M Porcel
- Pleural Medicine and Clinical Ultrasound Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Y C Gary Lee
- University of Western Australia; Institute for Respiratory Health and Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
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3
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Henschke P, Guglielmetti LC, Hillinger S, Monsch GM, Schneiter D, Opitz I, Lauk O. Risk factors influencing postoperative pleural empyema in patients with pleural mesothelioma: a retrospective single-centre analysis. Eur J Cardiothorac Surg 2024; 65:ezae137. [PMID: 38637940 PMCID: PMC11055398 DOI: 10.1093/ejcts/ezae137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/14/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES Postoperative empyema is a severe, potentially lethal complication also present, but poorly studied in patients undergoing surgery for pleural mesothelioma. We aimed to analyse which perioperative characteristics might be associated with an increased risk for postoperative empyema. METHODS From September 1999 to February 2023 a retrospective analysis of consecutive patients undergoing surgery for pleural mesothelioma at the University Hospital of Zurich was performed. Uni- and multivariable logistic regression was used to identify associated risk factors of postoperative empyema after surgery. RESULTS A total of 400 PM patients were included in the analysis, of which n = 50 patients developed empyema after surgery (12.5%). Baseline demographics were comparable between patients with (Eyes) and without empyema (Eno). 39% (n = 156) patients underwent extrapleural pneumonectomy (EPP), of whom 22% (n = 35) developed postoperative pleural empyema; 6% (n = 15) of the remaining 244 patients undergoing pleurectomy and decortication (n = 46), extended pleurectomy and decortication (n = 114), partial pleurectomy (n = 54) or explorative thoracotomy (n = 30) resulted in postoperative empyema. In multivariable logistic regression analysis, EPP (odds ratio 2.8, 95% confidence interval 1.5-5.4, P = 0.002) emerged as the only risk factor associated with postoperative empyema when controlled for smoking status. Median overall survival was significantly worse for Eyes (16 months, interquartile range 5-27 months) than for Eno (18 months, interquartile range 8-35 months). CONCLUSIONS Patients undergoing EPP had a significantly higher risk of developing postoperative pleural empyema compared to patients undergoing other surgery types. Survival of patients with empyema was significantly shorter.
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Affiliation(s)
- Peter Henschke
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Gian-Marco Monsch
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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4
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Bedawi EO, Ricciardi S, Hassan M, Gooseman MR, Asciak R, Castro-Añón O, Armbruster K, Bonifazi M, Poole S, Harris EK, Elia S, Krenke R, Mariani A, Maskell NA, Polverino E, Porcel JM, Yarmus L, Belcher EP, Opitz I, Rahman NM. ERS/ESTS statement on the management of pleural infection in adults. Eur Respir J 2023; 61:2201062. [PMID: 36229045 DOI: 10.1183/13993003.01062-2022] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
Pleural infection is a common condition encountered by respiratory physicians and thoracic surgeons alike. The European Respiratory Society (ERS) and European Society of Thoracic Surgeons (ESTS) established a multidisciplinary collaboration of clinicians with expertise in managing pleural infection with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified: 1) epidemiology of pleural infection, 2) optimal antibiotic strategy, 3) diagnostic parameters for chest tube drainage, 4) status of intrapleural therapies, 5) role of surgery and 6) current place of outcome prediction in management. The literature revealed that recently updated epidemiological data continue to show an overall upwards trend in incidence, but there is an urgent need for a more comprehensive characterisation of the burden of pleural infection in specific populations such as immunocompromised hosts. There is a sparsity of regular analyses and documentation of microbiological patterns at a local level to inform geographical variation, and ongoing research efforts are needed to improve antibiotic stewardship. The evidence remains in favour of a small-bore chest tube optimally placed under image guidance as an appropriate initial intervention for most cases of pleural infection. With a growing body of data suggesting delays to treatment are key contributors to poor outcomes, this suggests that earlier consideration of combination intrapleural enzyme therapy (IET) with concurrent surgical consultation should remain a priority. Since publication of the MIST-2 study, there has been considerable data supporting safety and efficacy of IET, but further studies are needed to optimise dosing using individualised biomarkers of treatment failure. Pending further prospective evaluation, the MIST-2 regimen remains the most evidence based. Several studies have externally validated the RAPID score, but it requires incorporating into prospective intervention studies prior to adopting into clinical practice.
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Affiliation(s)
- Eihab O Bedawi
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
- PhD Program Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Michael R Gooseman
- Department of Thoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull York Medical School, University of Hull, Hull, UK
| | - Rachelle Asciak
- Department of Respiratory Medicine, Queen Alexandra Hospital, Portsmouth, UK
- Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
| | - Olalla Castro-Añón
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Cervo y Monforte de Lemos, Lugo, Spain
- C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Karin Armbruster
- Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Sarah Poole
- Department of Pharmacy and Medicines Management, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elinor K Harris
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Policlinico Tor Vergata, Rome, Italy
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Alessandro Mariani
- Thoracic Surgery Department, Heart Institute (InCor) do Hospital das Clnicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Jose M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth P Belcher
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Chinese Academy of Medical Health Sciences, University of Oxford, Oxford, UK
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5
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Lau EPM, Sidhu C, Popowicz ND, Lee YCG. Pharmacokinetics of antibiotics for pleural infection. Expert Rev Respir Med 2022; 16:1057-1066. [DOI: 10.1080/17476348.2022.2147508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E P M Lau
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Calvinjit Sidhu
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Natalia D Popowicz
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Allied Health, Division of Pharmacy, University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Centre for Respiratory Health, School of Medicine, University of Western Australia, Perth, Australia
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6
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Considerations on Baseline Generation for Imaging AI Studies Illustrated on the CT-Based Prediction of Empyema and Outcome Assessment. J Imaging 2022; 8:jimaging8030050. [PMID: 35324605 PMCID: PMC8954780 DOI: 10.3390/jimaging8030050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022] Open
Abstract
For AI-based classification tasks in computed tomography (CT), a reference standard for evaluating the clinical diagnostic accuracy of individual classes is essential. To enable the implementation of an AI tool in clinical practice, the raw data should be drawn from clinical routine data using state-of-the-art scanners, evaluated in a blinded manner and verified with a reference test. Three hundred and thirty-five consecutive CTs, performed between 1 January 2016 and 1 January 2021 with reported pleural effusion and pathology reports from thoracocentesis or biopsy within 7 days of the CT were retrospectively included. Two radiologists (4 and 10 PGY) blindly assessed the chest CTs for pleural CT features. If needed, consensus was achieved using an experienced radiologist’s opinion (29 PGY). In addition, diagnoses were extracted from written radiological reports. We analyzed these findings for a possible correlation with the following patient outcomes: mortality and median hospital stay. For AI prediction, we used an approach consisting of nnU-Net segmentation, PyRadiomics features and a random forest model. Specificity and sensitivity for CT-based detection of empyema (n = 81 of n = 335 patients) were 90.94 (95%-CI: 86.55–94.05) and 72.84 (95%-CI: 61.63–81.85%) in all effusions, with moderate to almost perfect interrater agreement for all pleural findings associated with empyema (Cohen’s kappa = 0.41–0.82). Highest accuracies were found for pleural enhancement or thickening with 87.02% and 81.49%, respectively. For empyema prediction, AI achieved a specificity and sensitivity of 74.41% (95% CI: 68.50–79.57) and 77.78% (95% CI: 66.91–85.96), respectively. Empyema was associated with a longer hospital stay (median = 20 versus 14 days), and findings consistent with pleural carcinomatosis impacted mortality.
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7
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Zettinig D, D’Antonoli TA, Wilder-Smith A, Bremerich J, Roth JA, Sexauer R. Diagnostic Accuracy of Imaging Findings in Pleural Empyema: Systematic Review and Meta-Analysis. J Imaging 2021; 8:jimaging8010003. [PMID: 35049844 PMCID: PMC8778997 DOI: 10.3390/jimaging8010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/26/2022] Open
Abstract
Computed tomography (CT) diagnosis of empyema is challenging because current literature features multiple overlapping pleural findings. We aimed to identify informative findings for structured reporting. The screening according to inclusion criteria (P: Pleural empyema, I: CT C: culture/gram-stain/pathology/pus, O: Diagnostic accuracy measures), data extraction, and risk of bias assessment of studies published between 01-1980 and 10-2021 on Pubmed, Embase, and Web of Science (WOS) were performed independently by two reviewers. CT findings with pooled diagnostic odds ratios (DOR) with 95% confidence intervals, not including 1, were considered as informative. Summary estimates of diagnostic accuracy for CT findings were calculated by using a bivariate random-effects model and heterogeneity sources were evaluated. Ten studies with a total of 252 patients with and 846 without empyema were included. From 119 overlapping descriptors, five informative CT findings were identified: Pleural enhancement, thickening, loculation, fat thickening, and fat stranding with an AUC of 0.80 (hierarchical summary receiver operating characteristic, HSROC). Potential sources of heterogeneity were different thresholds, empyema prevalence, and study year.
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Affiliation(s)
- Desiree Zettinig
- Division of Research and Analytical Services, Department of Informatics, University Hospital Basel, 4031 Basel, Switzerland; (D.Z.); (T.A.D.); (A.W.-S.); (J.A.R.)
- Institute of Radiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Tugba Akinci D’Antonoli
- Division of Research and Analytical Services, Department of Informatics, University Hospital Basel, 4031 Basel, Switzerland; (D.Z.); (T.A.D.); (A.W.-S.); (J.A.R.)
- Department of Radiology, University Children’s Hospital Basel, 4056 Basel, Switzerland
| | - Adrian Wilder-Smith
- Division of Research and Analytical Services, Department of Informatics, University Hospital Basel, 4031 Basel, Switzerland; (D.Z.); (T.A.D.); (A.W.-S.); (J.A.R.)
| | - Jens Bremerich
- Department of Radiology and Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - Jan A. Roth
- Division of Research and Analytical Services, Department of Informatics, University Hospital Basel, 4031 Basel, Switzerland; (D.Z.); (T.A.D.); (A.W.-S.); (J.A.R.)
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, 4056 Basel, Switzerland
| | - Raphael Sexauer
- Division of Research and Analytical Services, Department of Informatics, University Hospital Basel, 4031 Basel, Switzerland; (D.Z.); (T.A.D.); (A.W.-S.); (J.A.R.)
- Department of Radiology and Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland;
- Correspondence: ; Tel.: +41-6132-86-584
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8
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Lehtomäki AI, Nevalainen RM, Toikkanen VJ, Pohja ES, Nieminen JJ, Laurikka JO, Khan JA. Pleural infection-an indicator of morbidity and increased burden on health care. Interact Cardiovasc Thorac Surg 2021; 31:513-518. [PMID: 32901260 DOI: 10.1093/icvts/ivaa147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/20/2020] [Accepted: 07/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Patients with pleural infections frequently have several comorbidities and inferior long-term survival. We hypothesized that these patients represent a vulnerable cohort with high rates of hospitalization and frequent use of healthcare services. This study aims to ascertain the need for and causes of treatment episodes after pleural infections during long-term follow-up. METHODS Patients treated for pleural infections at Tampere University Hospital between January 2000 and December 2008 (n = 191, 81% males, median age 58 years) were included and compared to a demographically matched population-based random sample of 1910 controls. Seventy percent of the pleural infections were caused by pneumonias and 80% of the patients underwent surgery. Information regarding later in-hospital periods and emergency room and out-patient clinic visits, as well as survival data, was obtained from national registries and compared between patients and controls. RESULTS Patients treated for pleural infections had significantly higher rates of hospitalizations (8.19 vs 2.19), in-hospital days (88.5 vs 26.6), emergency room admissions (3.18 vs 1.45), out-patient clinic visits (41.1 vs 11.8) and procedures performed (1.26 vs 0.55) per 100 patient-months when compared to controls during 5-year follow-up, in addition to having increased mortality (30% vs 11%), P-value <0.00001 each. Particularly, episodes due to respiratory and digestive diseases, malignancies and mental disorders were more frequent. The patients' comorbidities, such as alcoholism or chronic pulmonary disease, were associated with more frequent use of healthcare services. CONCLUSIONS Patients treated for pleural infections have high rates of hospitalizations, emergency room admissions and out-patient clinic visits during follow-up.
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Affiliation(s)
- Antti I Lehtomäki
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | | | - Vesa J Toikkanen
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Emilia S Pohja
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jaakko J Nieminen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari O Laurikka
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jahangir A Khan
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
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9
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Gu Q, Deng X, Li Z, Wang J, Hu C, Lei S, Cai X. The Intrapleural Bridge Connection is One of the Reasons for Unknown Localized Pleural Adhesion. Int J Gen Med 2021; 14:1429-1435. [PMID: 33907447 PMCID: PMC8068496 DOI: 10.2147/ijgm.s299606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Simple signs of local pleural adhesion are often found in people during a physical examination. In the present study, we aimed to clarify whether the merely localized pleural adhesion was just caused by previous pleural inflammation or physiological variation. Materials and Methods Chest X-ray image materials were collected to analyze the incidence of simple pleural adhesions. Moreover, the causes of these simple pleural adhesions were further analyzed using thoracoscopy under direct vision and biopsy data. Results In all 2218 chest X-ray images, 68 cases were found to have pleural lesions (3.07%), including 15 cases of localized pleural adhesion only. Subsequently, we analyzed the characteristics of 70 cases of pleural lesions using thoracoscopy. In two lung cancer patients with pleural metastasis, we found an unusual pleural junction. This connective strip was smooth and free of inflammation, resembling the normal pleura. Conclusion Some of these purely localized pleural adhesions might be attributed to previous inflammation. However, there was still at least a possibility that there must be a physiological pleural junction, which could be the cause of the purely localized pleural adhesion shown in the chest radiograph.
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Affiliation(s)
- Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Xinhao Deng
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Zhao Li
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Jing Wang
- Department of Pathology, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Shuhua Lei
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Xiaoling Cai
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
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10
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Ala-Seppälä HM, Ukkonen MT, Lehtomäki AI, Pohja ES, Nieminen JJ, Laurikka JO, Khan JA. High Occurrence of Thrombo-Embolic Complications During Long-Term Follow-up After Pleural Infections-A Single-Center Experience with 536 Consecutive Patients Over 17 Years. Lung 2020; 198:671-678. [PMID: 32607673 PMCID: PMC7374478 DOI: 10.1007/s00408-020-00374-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Pleural infections are associated with significant inflammation, long hospitalizations, frequent comorbidities, and are often treated operatively-all of which are consequential risk factors for thrombo-embolic complications. However, their occurrence following the treatment of pleural infection is still unknown. The aim of the study was to ascertain the early and long-term occurrence of thrombo-embolic events in patients treated for pleural infections. METHODS The study included all patients that were treated for pleural infections in Tampere University Hospital between January 2000 and December 2016. Data regarding later treatment episodes due to pulmonary embolisms and/or deep vein thromboses as well as survival data were requested from national registries. The rates were also compared to a demographically matched reference population adjusted for age, sex, and the location of residence. RESULTS The final study population comprised 536 patients and 5318 controls (median age 60, 78% men). The most common etiology for pleural infection was pneumonia (73%) and 85% underwent surgical treatment for pleural infection. The occurrence of thrombo-embolic complications in patients and controls was 3.8% vs 0.1% at three months, 5.0% vs 0.4% at one year, 8.8% vs 1.0% at three years, and 12.4% vs 1.8% at five years, respectively, p < 0.001 each. Female sex, advanced age, chronic lung disease, immunosuppression, video-assisted surgery, and non-pneumonic etiology were associated with a higher incidence of thrombo-embolism. CONCLUSIONS The occurrence of thrombo-embolic events-particularly pulmonary embolism but also deep vein thrombosis-was significant in patients treated for pleural infections, both initially and during long-term follow-up.
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Affiliation(s)
- Henna Maria Ala-Seppälä
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Ensitie 4, 33520, Tampere, Finland
| | - Mika Tapani Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
- Faculty of Medicine and Life Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Antti Ilmari Lehtomäki
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Ensitie 4, 33520, Tampere, Finland
| | - Emilia Susanna Pohja
- Faculty of Medicine and Life Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Jaakko Juhani Nieminen
- Faculty of Medicine and Life Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Jari Olavi Laurikka
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Ensitie 4, 33520, Tampere, Finland
- Faculty of Medicine and Life Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Jahangir Ari Khan
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Ensitie 4, 33520, Tampere, Finland.
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11
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Khan J, Ala-Seppälä H, Lehtomäki A, Toikkanen V, Pohja E, Laurikka J, Ukkonen M. The Occurrence of Lung Cancer and Non-Pulmonary Malignancies After Pleural Infections. Scand J Surg 2020; 110:99-104. [PMID: 31959068 DOI: 10.1177/1457496919900406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Patients who develop infections of the pleura have several risk factors for malignancies, particularly lung cancer, and the infections might even be caused by undiagnosed intra-thoracic neoplasms. The aim of the study was to compare the occurrence of lung cancer and other malignancies between patients treated for pleural infections and controls during long-term follow-up. MATERIALS AND METHODS All consecutive patients treated for pleural infections between January 2000 and June 2016 at the Tampere University Hospital were included. Ten matched controls and data regarding later cancer diagnoses were requested from national registries. The cancer types and rates, the diagnostic delays, as well as survival were compared between patients and controls. RESULTS The material comprised 506 patients and 5022 controls (78% was male and median age was 60 years in both groups) with a median follow-up time of 69 months. In total, 74% of pleural infections were related to pneumonia. The occurrence of lung cancer during follow-up was 3.0% in all patients, 2.2% in pneumonia-related cases, and 0.6% in controls, p < 0.001 when compared with controls. The overall rate of non-pulmonary malignancies did not differ. Lung cancer was diagnosed within 3 months in 73% of patients versus in 6.9% of controls, p < 0.001. The survival in patients with later lung cancers or other malignancies was inferior to that of controls with similar neoplasms. CONCLUSION The rate of lung cancer diagnoses was significantly increased in patients treated for pleural infections when compared with matched controls and the prognosis of patients with subsequent malignancies was impacted.
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Affiliation(s)
- J Khan
- Department of Cardio-Thoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland
| | - H Ala-Seppälä
- Department of Cardio-Thoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland
| | - A Lehtomäki
- Department of Cardio-Thoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland
| | - V Toikkanen
- Department of Cardio-Thoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland
| | - E Pohja
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - J Laurikka
- Department of Cardio-Thoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - M Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
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Farooq H, Mohammad T, Farooq A, Mohammad Q. Streptococcus gordonii Empyema: A Rare Presentation of Streptococcus gordonii Infection. Cureus 2019; 11:e4611. [PMID: 31312538 PMCID: PMC6615575 DOI: 10.7759/cureus.4611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Empyema is often caused by Streptococcus pneumoniae, Staphylococcus aureus, and a variety of gram-negative organisms as well as anaerobes. Streptococcus gordonii (S. gordonii) is among some of the initial colonizers of the periodontal environment that is recognized to cause bacterial endocarditis. However, there are only a few case reports of S. gordonii causing empyema in the literature. We report the case of a 75-year-old male who presented with coughing up blood-tinged sputum. Physical examination revealed decreased breath sounds in the right lung base. Chest X-ray demonstrated a lower, right-sided, loculated pleural effusion. He underwent ultrasound-guided chest tube placement. The pleural fluid culture grew S. gordonii. He was started on ampicillin/ sulbactam. The follow-up computed tomography (CT) scan showed no significant improvement. Given his inability to improve with antibiotics and chest tube drainage, he was referred to an advanced care center for decortication of lung tissue.
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Affiliation(s)
- Hafsa Farooq
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Tayyaba Mohammad
- Internal Medicine, Rutgers New Jersey Medical School, Jersey City, USA
| | - Amna Farooq
- Miscellaneous, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, PAK
| | - Qasim Mohammad
- Internal Medicine, Windsor University School of Medicine, Boonton, USA
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Lehtomäki A, Nevalainen R, Ukkonen M, Nieminen J, Laurikka J, Khan J. Trends in the Incidence, Etiology, Treatment, and Outcomes of Pleural Infections in Adults Over a Decade in a Finnish University Hospital. Scand J Surg 2019; 109:127-132. [PMID: 30791827 DOI: 10.1177/1457496919832146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS The aim of the study was to ascertain changes in the incidence, etiology, treatment, and outcomes of pleural infections over a decade in a Finnish University Hospital. MATERIALS AND METHODS All patients treated for pleural infections in Tampere University Hospital during 2000-2008 and 2012-2016 were included. The incidence rates and the epidemiologic data and medical history of patients, etiology of infection, and treatment trends and outcomes were compared between the cohorts. RESULTS The incidence of pleural infections increased from 4.4 during 2000-2008 to 9.9 during 2012-2016 per 100.000 patient-years, p < 0.001. The patients in the latter group were older, 63 versus 57 years, p = 0.001, and the prevalence of chronic lung disease, hypertension, heart failure, dyslipidemia, and immunosuppressive medication were higher. The causes of infection remained similar and pneumonia accounted for 70% of all cases. The identification rate of the microbe pathogens increased from 49% to 64%, p = 0.002, while the distribution of identified pathogens was unchanged. More patients in the latter cohort were treated operatively, 88.3% versus 80.9%, p = 0.005, and, in these, the proportion of thoracoscopic surgery was higher, 57.4% versus 8.0%, p < 0.001, and the delay to surgery shorter, 5 versus 7 days, p < 0.001. Radiologic outcomes were similar. The 30-day mortality rate was 3.1% during 2000-2008 and 5.1% during 2012-2016, p = 0.293. CONCLUSION The overall incidence of pleural infections has increased significantly while the causes of pleural infections and the distribution of pathogens remain unchanged. Contemporary patients are older with higher prevalence of comorbidities and more frequently undergo thoracoscopic surgery.
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Affiliation(s)
- A Lehtomäki
- Department of Cardio-Thoracic Surgery, Tampere University Heart Hospital, Tampere, Finland
| | - R Nevalainen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - M Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - J Nieminen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - J Laurikka
- Department of Cardio-Thoracic Surgery, Tampere University Heart Hospital, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - J Khan
- Department of Cardio-Thoracic Surgery, Tampere University Heart Hospital, Tampere, Finland
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