A. Kornecki et Y. Sivan, TREATMENT OF LOCULATED PLEURAL EFFUSION WITH INTRAPLEURAL UROKINASE IN CHILDREN, Journal of pediatric surgery, 32(10), 1997, pp. 1473-1475
Background/Purpose: The use of fibrinolytic agents such as urokinase a
nd streptokinase has been reported in cases of empyema in adults. In p
ediatric patients the experience is, however, very limited. Methods: A
series of seven consecutive children who had loculated pleural effusi
on that did ndt respond to drainage and antibiotics is reported. Resul
ts: In all cases, the effusion was found to be multiloculated. Urokina
se (UK) instillation through the already existing chest tube was start
ed. A dose of 100,000 U of UK diluted in 100 mt of normal saline was i
nstilled through the chest tube, which was clamped for 12 hours and th
en was left open for another 12 hours. In six of seven children, the t
reatment was terminated after complete or almost complete resolution w
as attained. This was achieved within 5 treatment days (mean, 3.3). Th
ere was one failure which was attributed to relatively late initiation
of treatment. No complications were observed. Conclusions. The author
s conclude that intrapleural administration of UK is a safe and effici
ent method of treatment in cases of loculated pleural effusions in chi
ldren. UK instillation to the intrapleural space should be considered:
early before initiating surgical intervention. Starting intrapleural U
K treatment Should not be delayed. Copyright (C) 1997 by W.B. Saunders
Company.