Again children received fibrinolytics once daily for 3 days via chest tubes. No child required
lung resection. The mean duration of fibrinolytic instillation was 3.4 days Selleckchem Metformin (range 2 to 6), and the mean duration of chest tube drainage was 18.6 days (5–27). The average hospitalization time was 22.3 days (7–32). The amount of drainage via the thoracic tube after instillation of the fibrinolytic agent was 30–150 ml per day (mean 69 ml). No complications occurred during the treatment, and there was no evidence of hemorrhage. Surprisingly, even in the most neglected patients of our group, the follow-up CT scans done 3–4 months after discharge, were almost uneventful. The majority of spirometric parameters normalized within 6 months, and no child claimed dyspnoe due to physical strain. Parapneumonic effusions occur in as many as 50–70% of patients admitted with a complicated pneumonia ,  and . Most parapneumonic effusions treated with the appropriate antimicrobials of sufficient duration selleck monoclonal humanized antibody resolve without the development of complications. Usually in exudative stage, antibiotics and thoracentesis or tube thoracostomy result in cure ,  and . Complicated parapneumonic effusions in which a pleural peel is created and fibroblast proliferation result in parenchymal entrapment, require surgical intervention , ,  and . Intrapleural instillation
of a fibrinolytic agent to accelerate drainage of a loculated effusion was first reported in the 1950s . Urokinase was introduced in 1987 and became the most almost frequently
used agent for fibrinolysis because of concerns about the antigenicity of streptokinase ,  and . The fibrinolytic agent degrades a variety of proteins, including fibrin and fibrin blood clots. The fibrinolytic reaction is the result of streptokinase or urokinaze mediated enzymatic activation of the plasminogen-streptokinaze or -urokinaze complex to plasmin. Using fibrynolytics improved the care of the complicated empyema by improved management of loculations and amelioration of fibrous peel formation and fibrin deposition ,  and . We haven’t found in the literature descriptions of combined therapy for pleural empyemas with the use of VATS and fibrynolitics. There are reports with comparison of urokinaze and VATS for treatment of childhood empyema . Probably the lack of technique lead to partial expansion of the lung in our cases. After VATS our patient benefited from fibrinolytic therapy combined with early rehabilitation. All before admitting to our Clinic were ineffectively treated in general hospitals using conventional pleural drainages maintained for 1 day to 2 months (mean 12 days). Before the admission to our Clinic 8 of 11 our patients have had done radiologic examination – upright views of the chest.