Contemporary empyema necessitatis.

Empyema necessitatis is defined by the extension of an empyema through the parietal pleura, into surrounding tissue. Clinical manifestations are generally subacute, representing the indolent nature of the most commonly implicated pathogens (Mycobacterium tuberculosis and Actinomyces israelii). Treatment with antimicrobials and surgical debridement has drastically reduced mortality; however, with proper initial assessment and treatment of pulmonary infection, this rare complication can often be avoided.

Pulmonary hypertension: new perspectives.

The World Health Organization symposium offers a new treatment-oriented classification of pulmonary hypertension based on an improved understanding of its pathophysiology. Regardless of the etiology, severe or unrelieved pulmonary hypertension leads to right heart failure. Symptoms and signs of pulmonary hypertension are often subtle and nonspecific.