Chylothorax is an uncommon disease where fatty fluid accumulates within the chest cavity. Conservative manage- ment, including repeated thoracentesis or pleurodesis, seems to be suitable to most cases. Herein, we present a case of efficacious pleurodesis by intrapleural injection of Sapylin, a streptococcus preparation, for the treatment of chylothorax. A 52-year-old non-smoking female farmer was diagnosed as idiopathic chylothorax after we ruled out possible causes including chest trauma, lymphoma, lung cancer, filariasis, tuberculosis, and etc. Two-time intra-thoracic injection of 3 Klinische Einheit (KE) Sapylin achieved rapid and effective control of chylothorax with no severe side effects. Sapylin may facilitate pleurodesis by producing a strong inflammatory response.
XU Zhi-hao WANG Chun-fu ZHANG Yue-qin SHEN Hua-hao XU Feng
Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in th
Yang YanXu FengShi Li-yunDiao RanCheng Yu-shengChen Xi-yuanJing Ji-yongWang Xuan-dingShen Hua-hao
