PubMed · 5662973
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1968-07-27. Malignant pleural effusion.. https://pubmed.ncbi.nlm.nih.gov/5662973/
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KEEP EXPLORING
OBJECTIVE: To evaluate the safety and efficacy of vacuum pleural drainage systems in selected patients. DESIGN: Prospective nonrandomized study. SETTING: Division of Upper Gastrointestinal Surgery at a tertiary care center. PATIENTS AND INTERVENTION: Between January 1, 1995, and December 31, 1995, 32 patients underwent a right-sided posterolateral thoracotomy for the resection of esophageal carcinoma. A vacuum drain was employed in 21 patients (group 1) and an under-water drain in 11 patients (group 2). The selection of patients for vacuum drainage was based on minimal pleural adhesions and technical ease of the operation. MAIN OUTCOME MEASURE: Data on drainage efficiency, total drainage output and duration of the drain being left in situ, and postoperative pulmonary complications were analyzed. RESULTS: The median total drainage outputs were 1280 mL and 1230 mL (P = .92, Mann-Whitney U test) in groups 1 and 2, respectively, and the median duration of chest drains being left in situ was 7 days and 6 days (P = .11, Mann-Whitney U test) in groups 1 and 2, respectively. Postoperative pulmonary complications occurred in 5 patients (24%) enrolled in group 1 and 5 patients (45%) enrolled in group 2 (P = .09, Fisher exact test). No hospital mortality was reported during the study. CONCLUSION: The vacuum drain has proved to be as safe and efficient as the traditional underwater drain, imposing less discomfort and allowing early mobilization. The vacuum drain is, therefore, recommended in selected patients undergoing thoracotomy for esophageal resection.
The function of irrigation suction drainage, as an additional method in the treatment of bone infection, is associated with hydrodynamic problems that can only be experimentally examined. The visualization of liquid movement in the experimental model was realized by adding a colored ink to the input drain of the drainage system. When only 2000 ml of liquid was used daily (80 drops/min), the ink penetrated the experimental cavity only through the most proximal holes in the input drain. It spread slowly and irregularly through the liquid in the experimental bottle, forming pocket deposits and leaving sediment. When 6000 ml of liquid was applied daily (240 drops/min), ink quickly penetrated the cavity through all holes in the drain, leading to turbulence and dispersing equally in the bottle. Decoloration of the model bottle was faster because the output drainage was more efficient. With an increased flow, i.e., with more liquid used in the drainage, a better result was achieved. This was manifested in a swift decoloration and rinsing of the cavity.
We report the case of 61-year-old woman with cryptogenic liver abscesses who had been profoundly ill with severe upper abdominal pain, impaired consciousness, prostration, continuous high fever secondary to sepsis, and thrombocytopenia (platelets, 1-5 x 10(4)/mm3) since admission. Ultrasonograms and computed tomograms revealed two separate multiloculated lesions in the right lobe of the liver, consistent with the liver abscesses. Immediately after diagnosis, percutaneous abscess drainage was performed under ultrasonographic guidance; however, only a small amount of pus was drained, prompting continuous irrigation of the abscess cavity. Four days later, transcatheter hepatic arterial infusion of antibiotics was attempted. However, the abscesses had enlarged and her general condition had worsened. On hospital day 8, she underwent right hepatectomy because the multiloculated lesions were refractory to drainage. The operation was successful in terms of hepatectomy, although she continued to suffer from sepsis, secondary right subphrenic abscess formation, and prolonged thrombocytopenia with associated coagulation disorders for two months. Examination of multiple cross sections of the resected specimen disclosed that the lesions consisted of aggregations of multiple small locules. There was no communication between the locules and there were true septations, rather than multiloculated lesions with pseudoseptations. The patient has been well for 2 years without recurrent abscess of the liver or any infectious disease.