title: The role of video-assisted thoracoscopic surgery in the treatment of parapneumonic empyema after the failure of fibrinolytics.
abstract: BACKGROUND
  Approximately 10% of patients treated with intrapleural instillation of fibrinolytics fail to respond and therefore need more invasive techniques, such as video-assisted thoracoscopic surgery (VATS).
  
  
  METHODS
  During the period 1994-99, we treated 20 consecutive patients with complicated parapneumonic effusion (CPE) and pleural empyema (PE) that did not resolve with urokinase instillation given through the chest tube in a dose of 100,000 IU diluted in 100 ml of normal saline/daily for 3-5 days. The patients' ages ranged from 21 to 68 years (median, 46); 14 were male and six female. All patients had pleural fluid pH <7.1, LACTATE DEHYDRAGENASE (LDH) >1000, glucose <40 mg/dl and were submitted to VATS.
  
  
  RESULTS
  Complete drainage was observed in 17 patients (85%), in the other three (15%), the procedure had to be converted to open thoracotomy due to a thickened visceral pleural peel. The mean operative time was 80.3 min (range, 55-140), and the mean duration of postoperative hospital stay was 7.5 days (range, 4-19).
  
  
  CONCLUSIONS
  We found that VATS is a safe, effective, and well-tolerated surgical procedure in CPE and PE patients who have failed to resolve with initial treatment with fibrinolytics.
authors.affiliation: Department of Pneumonology, University Hospital, Heraklion, 711 10 Crete, Greece. bouros@med.uoc.gr
authors.forename: D
authors.initials: D
authors.lastname: Bouros
authors.forename: K M
authors.initials: KM
authors.lastname: Antoniou
authors.forename: G
authors.initials: G
authors.lastname: Chalkiadakis
authors.forename: J
authors.initials: J
authors.lastname: Drositis
authors.forename: I
authors.initials: I
authors.lastname: Petrakis
authors.forename: N
authors.initials: N
authors.lastname: Siafakas
mesh_terms: D016724:Empyema, Pleural / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D017211:Treatment Failure; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator