COMMENTARY

Surgery

Thoracic empyema

A Jaffé¹, G Cohen²

¹ Consultant and Honorary Senior Lecturer in Respiratory Research, Portex Respiratory Medicine Unit, Great Ormond Street Hospital for Children NHS Trust and Institute of Child Health, Great Ormond Street, London WC1N 3JH, UK
² Chief of Pediatric Cardiothoracic Surgery and Associate Professor of Surgery, Seattle Children’s Hospital, University of Washington School of Medicine, USA

Correspondence to:
Correspondence to:
Dr A Jaffé, Portex Respiratory Medicine Unit, Great Ormond Street Hospital for Children NHS Trust and Institute of Child Health, Great Ormond Street, London WC1N 3JH, UK;
a.jaffe@ich.ucl.ac.uk

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A role for primary video assisted thoracoscopic surgery?

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Keywords: decortication; empyema; urokinase; VATS

The first 150 words of the full text of this article appear below.

As long ago as 300 BC, Hippocrates commented that a person "with empyemata ... shall die on the fourteenth day, unless something favourable supervene".¹ After identifying the affected side he would recommend drainage with a tin tube. However, in the ensuing years, great debate surrounded the benefits of opening the chest. When Napoleon’s surgeon, Dupuytren, developed an empyema in 1835, he was heard to comment that "he would rather die at the hands of God than of surgeons". He lived 12 days. Over one and a half centuries later the role of the surgeon in the management of empyema remains controversial. This leading article will review the potential role for primary video assisted thoracoscopic surgery (VATS) in thoracic empyema in children.

The aim of empyema treatment is to return the lung to normal function. This is achieved by sterilising the pleural cavity with antibiotics, drainage of fluid, and expansion . . . [Full text of this article]

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This article has been cited by other articles:

• Jaffe, A, Calder, A D, Owens, C M, Stanojevic, S, Sonnappa, S (2008). Role of routine computed tomography in paediatric pleural empyema. Thorax 63: 897-902 [Abstract] [Full Text]  
• Sonnappa, S., Cohen, G., Owens, C. M., van Doorn, C., Cairns, J., Stanojevic, S., Elliott, M. J., Jaffe, A. (2006). Comparison of Urokinase and Video-assisted Thoracoscopic Surgery for Treatment of Childhood Empyema. Am. J. Respir. Crit. Care Med. 174: 221-227 [Abstract] [Full Text]  
• Balfour-Lynn, I M, Abrahamson, E, Cohen, G, Hartley, J, King, S, Parikh, D, Spencer, D, Thomson, A H, Urquhart, D, on behalf of the Paediatric Pleural Diseases Subco, (2005). BTS guidelines for the management of pleural infection in children. Thorax 60: i1-i21 [Full Text]