title: [Pleural empyema: considerations about experience of the Thoracic Surgery Division in Monza and proposal of therapeutic protocol].
abstract: OBJECTIVE
  Optima l treatment of thoracic empyema depends on its phase of development. Thin, free-flowing exudative effusions can be adequately managed by thoracenthesis or simple closed tube thoracostomy and antibiotics. At the other end of the spectrum are well-organized chronic empyemas which are best treated with thoracothomy and decortication. In-between this two extremes are fibrino-purulent empyemas for which much controversies exist among pneumologists and thoracic surgeons over the most effective treatment. The authors present their experience about treatment of pleural empyema.
  
  
  METHODS
  This retrospective study reviews the Thoracic Surgery Department of Monza's S. Gerardo Hospital experience between 1982-2004 in the treatment of thoracic empyema and tries to formulate our own guidelines for the management of the fibrino-purulent forms.
  
  
  RESULTS
  In our experience we used a personal technique of thoracic drainage consisting in continuous wash-out of pleural cavity associated with intrapleural fibrinolytic if is it necessary. Since 1994 we have used the continuous positive alveolar pressure to mend lungs expansion and improve the
  
  
  RESULTS
  
  
  
  CONCLUSIONS
  Recent reports in the medical and surgical literature have suggested that empyemas can be managed effectively with less aggressive treatment than has been advocated in the past. In spite of the recent development of mini-invasive surgical techniques for the treatment of fibrino-purulent empyemas we believe that first approach should be always conservative. Intrapleural fibrinolytics seem to get improve the efficacy of closed tube thoracostomy.
authors.affiliation: Divisione di Chirurgia Toracica, Dipartimento di Chirurgia Cardiotoracica, A. O. San Gerardo, Monza. jlorenz@libero.it
authors.forename: J F
authors.initials: JF
authors.lastname: Sciuchetti
authors.forename: F
authors.initials: F
authors.lastname: Corti
authors.forename: D
authors.initials: D
authors.lastname: Ballabio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D016724:Empyema, Pleural / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies