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Chan JW, Ko FW, Ng CK, Yeung A, Yee WKS, So LKY, Lam B, Wong MML, Choo KL, Ho ASS, Tse PY, Fung SL, Lo CK, Yu WC. Management and prevention of spontaneous pneumothorax using pleurodesis in Hong Kong. Int J Tuberc Lung Dis 2011; 15:385-390. [PMID: 21333108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND The practice of pleurodesis for the management and prevention of spontaneous pneumothorax (SP) is uncertain. DESIGN A retrospective multicentre analysis of patients admitted to 12 hospitals in Hong Kong with SP in 2004 and who subsequently underwent pleurodesis for the same episode. RESULTS Pleurodesis was performed in 394 episodes. Initial medical chemical pleurodesis was performed for 258 (65.5%) patients ('initial medical group'), while 136 (34.5%) underwent initial surgical pleurodesis ('initial surgical group'). Secondary spontaneous pneumothorax (SSP; 237 episodes, 60.2%) was the most common indication for pleurodesis; it was also performed after a first episode of primary spontaneous pneumothorax (PSP) in 22 episodes (5.6%). Tetracycline derivatives (172 episodes, 66.7%) were the most popular sclerosing agents in the initial medical group. Those in the initial medical group were older and were more likely to be males, have SSP, chronic obstructive pulmonary disease and a history of past pleurodesis (P < 0.05) compared to the initial surgical group. Compared to the tetracycline group, more patients who initially received talc slurry had the procedure performed by surgeons, had larger (≥2 cm) pneumothorax or required suction during initial drainage (P < 0.05). CONCLUSIONS Despite the availability of international guidelines, there is considerable variation in pleurodesis for SP.
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Terra RM, Teixeira LR, Bibas BJ, Pego-Fernandes PM, Vargas FS, Jatene FB. Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status. Clinics (Sao Paulo) 2011; 66:211-6. [PMID: 21484035 PMCID: PMC3059870 DOI: 10.1590/s1807-59322011000200005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 09/24/2010] [Accepted: 11/01/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness and safety of pleurodesis carried out entirely on an outpatient basis in patients with recurrent malignant pleural effusions and Karnofsky Performance Status scores <70. METHODS This study was a prospective trial comprising patients with symptomatic recurrent malignant pleural effusion and Karnofsky Performance Status scores <70 but >30. All selected patients underwent pleural catheter placement (14 Fr) in an outpatient facility. When chest radiography revealed post-drainage lung expansion of >90%, pleurodesis (3 g of talc) was performed. Catheters were maintained until the daily output was ,100 mL/day. The patients were evaluated in the first month and every three months thereafter for fluid recurrence, the need for additional procedures, and complications. RESULTS During the study period (January 2005 to July 2007), 64 patients (24 men, 40 women), with an average age of 61.4 years, underwent elective chest tube drainage. Primary sites of the underlying malignancy were breast (27), lung (22), and others (15). Sixty-six pleural catheters were placed (bilaterally in 2 patients), and 52 talc pleurodesis procedures were performed. Fourteen patients had a trapped lung and were excluded from the trial. No complications were observed during catheter placement or pleurodesis. Post-pleurodesis complications included catheter obstruction (4 patients) and empyema (1). The average drainage time was 9.9 days. The recurrence rate observed in patients that were alive 30 days after pleurodesis was 13.9% (5/36 patients). Six patients required additional procedures after the pleurodesis. The average survival time was 101 days. CONCLUSION In this study, talc pleurodesis was safely performed in an outpatient setting with good efficacy and a reasonable complication rate, thereby avoiding hospital admission.
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Aihara K, Handa T, Nagai S, Tanizawa K, Watanabe K, Harada Y, Chihara Y, Hitomi T, Oga T, Tsuboi T, Chin K, Mishima M. Efficacy of blood-patch pleurodesis for secondary spontaneous pneumothorax in interstitial lung disease. Intern Med 2011; 50:1157-62. [PMID: 21628929 DOI: 10.2169/internalmedicine.50.4645] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We identified the prognostic relevance of pneumothorax in interstitial lung disease (ILD) patients and evaluated the efficacy and safety of autologous blood-patch pleurodesis. METHODS We retrospectively reviewed 59 occurrences of pneumothorax in 34 ILD patients identified over a 12-year period. RESULTS Air leakage ceased in 16 of 22 (72.7%) episodes after blood pleurodesis and in 11 of 14 (78.6%) episodes after chemical pleurodesis. Both the cure ratio and recurrence ratio in the cure episodes were comparable with those in the chemical pleurodesis group (p=0.99 and 0.99, respectively). In addition, there were no harmful events associated with blood pleurodesis. The median survival time after the first episode of pneumothorax was less than 9 months in patients with idiopathic interstitial pneumonia (IIP) and only around 3 years in the patients with other types of ILD, which have essentially favorable outcomes. Kaplan-Meier survival estimates were significantly worse in the patients with concomitant pneumomediastinum than in those without (p<0.05). A multivariate Cox regression analysis identified that the number of episodes of pneumothorax, IIP diagnosis and concomitant pneumomediastinum were independent predictors of death. CONCLUSION Autologous blood-patch pleurodesis is safe and worth considering as a first-line treatment for pneumothorax secondary to ILD. However, despite treatments, the prognosis after the onset of pneumothorax in ILD patients was found to be poor. In addition, concomitant pneumomediastinum may further worsen the prognosis.
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Abstract
Pleural malignancies, primary or metastatic, portend a grim prognosis. In addition to the serious oncologic implications of a pleural malignancy, these tumors can be highly symptomatic. A malignant pleural effusion can cause dyspnea, secondary to lung compression, or even tension physiology from a hydrothorax under pressure. The need to palliate these effusions is a seemingly straightforward clinical scenario, but with nuances that can result in disastrous complications for the patient if not attended to appropriately. Solid pleural malignancies can cause great pain from chest wall invasion or can cause a myriad of morbid symptoms because of the invasion of thoracic structures, such as the heart, lungs, or esophagus. This article reviews pleural malignancies, the purely palliative treatments, and the treatments that are performed with definitive (curative) intent.
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Makhija Z, Deshpande R, Marrinan MT. Effective and rapid technique to ensure uniform talc pleurodesis. Gen Thorac Cardiovasc Surg 2010; 58:595-7. [PMID: 21069502 DOI: 10.1007/s11748-009-0548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 09/28/2009] [Indexed: 10/18/2022]
Abstract
The use of talc for inducing chemical sclerosis in the pleural cavity dates back to 1935. Insufflation (also known as talc poudrage) and instillation have been the techniques used for administering talc. We describe a surgical technique to insufflate talc in the pleural cavity using an ingenious method at no additional cost that ensures effective, widespread talc dispersion and good results.
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Ng CK, Ko FW, Chan JW, Yeung A, Yee WKS, So LKY, Lam B, Wong MML, Choo KL, Ho ASS, Tse PY, Fung SL, Lo CK, Yu WC. Minocycline and talc slurry pleurodesis for patients with secondary spontaneous pneumothorax. Int J Tuberc Lung Dis 2010; 14:1342-1346. [PMID: 20843428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
SETTING Few studies have evaluated the sclerosing efficacy of minocycline, and none have specifically compared its sclerosing efficacy and safety profiles with talc slurry in secondary spontaneous pneumothorax (SSP). DESIGN A retrospective analysis was conducted in patients with SSP who underwent chemical pleurodesis from January to December 2004 with minocycline or talc slurry in 12 public hospitals of Hong Kong. RESULT There were 121 episodes of minocycline pleurodesis and 64 episodes of talc slurry pleurodesis. Immediate procedural failure were similar in the minocycline and talc slurry groups (21.5% vs. 28.1%, P = 0.31). Presence of interstitial lung disease, ≥ 2 previous episodes of pneumothorax, requiring mechanical ventilation during pleurodesis and persistent air leak before pleurodesis were independently associated with procedural failure. Pain was experienced in respectively 44.6% and 37.5% of the minocycline and the talc slurry groups. Pain was more common in patients receiving high doses of talc (≥ 5 g; P = 0.03). Respiratory distress was found in respectively 1.7% and 1.6% of the minocycline and talc slurry groups. CONCLUSION Minocycline and talc slurry had comparable sclerosing efficacy in SSP, with immediate success rates of >70%. Pain was the most common adverse effect and respiratory distress was uncommon. Both appeared to be effective and safe for chemical pleurodesis in SSP.
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Chambers A, Routledge T, Billè A, Scarci M. Is blood pleurodesis effective for determining the cessation of persistent air leak? Interact Cardiovasc Thorac Surg 2010; 11:468-72. [PMID: 20628018 DOI: 10.1510/icvts.2010.234559] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Daddi N, Vannucci J, Maggio C, Giontella A, Bravi I, Marziani F, Capozzi R, Ragusa M, Bufalari A, Puma F. Efficacy of tigecycline pleurodesis: a comparative experimental study. J Surg Res 2010; 169:e109-18. [PMID: 20934718 DOI: 10.1016/j.jss.2010.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/08/2010] [Accepted: 07/01/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND We investigated whether tigecycline (TIGE) is more effective than talc in inducing pleurodesis in rabbits. METHODS Fifty-six New Zealand rabbits were utilized in a two-phase study: Effects at 14 d (phase I) and at 28 d (phase II) were assessed. Saline solution (SAL n = 3), talc slurry (TALC 200 mg/kg, n = 5), and TIGE at different concentrations (mg/kg): TIGE0.5 (n = 5); TIGE1 (n = 5); TIGE3 (n = 5); TIGE25 (n = 5); TIGE50 (n = 5) were randomly injected, for each phase, through a right chest drainage. TIGE0.5 and TIGE1 were ineffective during phase I and were thus excluded from further investigation. At post mortem examination, pleurodesis was graded grossly and microscopically by three observers blinded to treatment groups. RESULTS Phase I: pleurodesis was more effective in TIGE25 and TIGE50 (P < 0.001); TALC was better than TIGE0.5 (P < 0.001), and TIGE1 (P = 0.49), macroscopically. Pleural thickness was significantly higher in TIGE25 compared with SAL, TALC, TIGE0.5, TIGE1, and TIGE3 (P < 0.01). No significant differences were evident between TALC and TIGE3, both macroscopically (P = 0.90) and microscopically (inflammation P = 0.99, fibrosis P = 0.96, pleural thickness P = 0.99). Phase II: better effectiveness of TIGE50 compared with all other groups (P < 0.001) except TIGE 25 (P = 0.29); results similar to phase I for TALC and TIGE3 (P = 0.99), macroscopically. Microscopically greater inflammation in TALC compared with TIGE3 (P < 0.05) and in TIGE50 to TIGE3 (P = 0.05). Significant complications occurred in all TIGE50 group. One of TIGE25 and one of TIGE50 died of respiratory distress and of right hemothorax+ascites, respectively. CONCLUSIONS Intrapleural TIGE3 mg/kg is as effective as talc in inducing pleurodesis in rabbits. The intrapleural TIGE toxicity threshold was reached at TIGE25 mg/kg concentration.
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Low L, Adams N. Managing iatrogenic subcutaneous emphysema on a background of COPD while treating persistent secondary pneumothorax. BMJ Case Rep 2010; 2010:bcr0920092283. [PMID: 22767691 PMCID: PMC3030005 DOI: 10.1136/bcr.09.2009.2283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is a case of a 77-year-old gentleman with severe smoking related chronic obstructive airways disease (COPD) who presented with a secondary pneumothorax. Attempts to treat a persistent air leak using (IC) drains of increasing size led to sudden worsening of iatrogenic subcutaneous emphysema. A CT scan performed confirmed the presence of a pneumomediastium and florid subcutaneous emphysema in the face and torso. Although the patient reported a change in voice with hoarseness there was no evidence of airway compromise. The patient was conservatively managed in the high-dependency unit. He was not considered fit enough to undergo general anaesthesia and surgery; therefore, a pleurodesis using sterile talc was undertaken. The IC drain was successfully removed, following resolution of the air leak, and the lung remained re-inflated. His subcutaneous emphysema gradually spontaneously resolved with no further complications.
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Lee YH, Suh KS, Hwang JM. Efficacy of posterior fixation suture augmented with talc or doxycycline. Graefes Arch Clin Exp Ophthalmol 2010; 248:1287-92. [PMID: 20407786 DOI: 10.1007/s00417-010-1374-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/10/2010] [Accepted: 03/18/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To compare the efficacy of posterior fixation using talc or doxycycline with the conventional posterior fixation suture. METHODS Thirty superior rectus muscles in 15 rabbits were divided into three groups. Each superior rectus muscle underwent one of three different procedures: conventional posterior fixation suture with non-absorbable suture (conventional group), posterior fixation with absorbable suture and application of talc (talc group), or posterior fixation suture with absorbable suture and application of doxycycline (doxycycline group). Eight weeks postoperatively, adhesion formation, tensile strength, and histologic findings were evaluated in a masked fashion. RESULTS Myoscleral adhesion formation was localized to the suture passage in the conventional and doxycycline groups. In the talc group, a wide and continuous myoscleral adhesion was formed between the two sutures. The average tensile strength of myoscleral union did not show significant difference between the talc group (353 +/- 70 gram weight) and conventional group (309 +/- 61 gram weight) (p = 0.234). In the the doxycycline group, it was significantly weaker than conventional group (p = 0.000). There were no abnormal histologic findings, except for fibrosis in the muscle and the sclera. CONCLUSIONS Modified posterior fixation suture technique using absorbable suture and talc has the potential to reinforce myoscleral union.
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Sen S, Sentürk E, Pabuşcu E, Cokpinar S, Yaman E. [Minimally invasive approach in the pleural fluids]. Tuberk Toraks 2010; 58:71-77. [PMID: 20517732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
The excess production or depleted absorbtion of pleural fluid is the major mechanism of pleural effusion formation. Primary lung pathologies or pathologies that originated from the other organs can be cause of pleural effusion. The search for suitable, practical and ideal treatment is continued at the present day. We have reviewed 94 patients with pleural effusion that have been treated by 10F catheter with local anesthesia in 2007-2008. The patient with dispenea, massive effusion or reoccurrent pleural effusion have been administrated pleural catheter through 7th or 8th intercostal interspace with local anesthesia. The mean age of patients (58 male, 36 female) was 57.2 (26-94). The most common etiologic causes were primary broncho carcinoma (34 cases 36.1%), cardiac failure (11 cases 11.1%) and empyema (eight cases 9.5%). Fifty three (56.3%) have been administrated pleurodesis because of treatment failure or reoccurrence. In 19 of these cases (20.2%), pleurodesis was successful. Pleurodesis agent was talc or tetracycline according to patients pain threshold. The treatment methods of pleural effusion include thoracentesis, thoracoscopy, tube thoracostomy and catheters with permanent tunnel. The simple and small-diameter catheters are administrated easily with minimal morbidity and no mortality. It's not only used in malign effusion but also used in benign effusion. Finally, simple catheter can be first treatment choice in short-term therapy and alternative choice in long-term therapy because of it's administrating facility, effectiveness in pleurodesis and cost-effectiveness.
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Habal P, Mand'ák J, Simek J, Stĕtina M, Jankovicová K, Kondĕlková K, Krejsek J. [Monitoring the effectiveness of surgical treatment of malignant pleural effusions]. KLINICKA ONKOLOGIE : CASOPIS CESKE A SLOVENSKE ONKOLOGICKE SPOLECNOSTI 2010; 23:99-103. [PMID: 20465088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUNDS Recurrent pleural effusion occured in 10% of cancer patients. Repeated thoracocentesis or drainage may be complicated by pneumothorax, haemothorax or pleural cavity infection. Thoracoscopic talc poudrage is one of the most effective pleurodesis technique in patients with malignant pleural effusions. The effectiveness of such pleurodesis is reaching the 70 to 90%. This surgical approach also allows to take a biopsy for histological verification of the process. An effort to predict the success rate of chemical pleurodesis on the basis of the body's general inflammatory reaction rate, which is determined by the dynamics of values of humoral and cellular inflammatory parameters in both serum and in pleural effusion. PATIENTS In the period 6/2008-12/2009 we applied biotalcum to 14 patients with malignant pleural effusions. The group of patients consisted of 10 male patients and 4 female patients of average age 71 years. Indication to include patients in the group was a second or further thoracic puncture, shortening of the interval between interventions, estimated time of survival > 3 months and the possibility of operation under selective pulmonary ventilation. METHOD We performed the collection of pleural effusion and blood serum at 12-hour intervals. The first collection was performed preoperatively before biotalcum application, and then during the time of losses from thoracic drainage bigger than 150 ml in 24 hours. The duration of thoracic drainage was 4 days +/- 1 day. The success of the treatment was observed by ultrasound scan before drainage removal; during the first three months always at intervals of 1 month and then after 3 and 6 months, depending on the progression of a disease. RESULTS No reccurence occured when the P-CRP (pleural) and S-CRP (serum) ratio exceeded 60% during the first 48 hours after pleurodesis. On the other hand, when the ratio fall bellow 30-35%, the effusion relapsed frequently. CONCLUSION The P-CRP/S-CRP ratio as a promising marker of talc pleurodesis effectiveness and monitoring both P-CRP and S-CRP levels is inexpensive and acceptable method for clinical practice. The pleural effusion caused by malignant mesothelioma appeares to be resistant to talc pleurodesis.
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Borges H, Schnyder JM, Frey JG, Tschopp JM. [Referring to an unusual case: pulmonary affection and rheumatoid arthritis]. REVUE MEDICALE SUISSE 2009; 5:2276-2280. [PMID: 19999316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report the case of a 60 year female patient suffering from rheumatoid arthritis for the last 25 years, under TNF-blocker and leflunomide, affected by a recurrent pneumothorax with several subpleural nodules, basal bronchiectasis and apical bullous emphysema. The patient was administered several treatments: aspiration, talc pleurodesis, surgical pleurodesis, pleurodesis induced by tetracycline and autologous blood. To allow the pleural inflammatory reaction necessary to the success of the pleurodesis, we had to interrupt the treatment by TNF-blocker and leflunomide. We then witnessed a partial pleurodesis with persistence of a pneumothorax. The medical situation is improving with disappearance of dyspnea.
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Zhu QQ, Sun GY. [The effect of intrapleural pingyangmycin administration on activity of fibrinolytic system and transforming growth factor-beta1 in malignant pleural effusion]. ZHONGHUA JIE HE HE HU XI ZA ZHI = ZHONGHUA JIEHE HE HUXI ZAZHI = CHINESE JOURNAL OF TUBERCULOSIS AND RESPIRATORY DISEASES 2009; 32:674-678. [PMID: 20079281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To observe the changes of the concentrations of plasminogen activator inhibitor-1(PAI-1), tissue-type plasminogen activator(t-PA), transforming growth factor-beta(1)(TGF-beta(1)) in peripheral blood and pleural effusion before and after intrapleural pingyangmycin administration, and therefore to investigate the mechanism by which pingyangmycin produces pleurodesis. METHODS Since February to September 2008, a total of 26 patients with malignant pleural effusion (MPE) underwent intrapleural pingyangmycin administration. The concentrations of PAI-1, t-PA, TGF-beta(1) and the number of leucocytes in peripheral blood and pleural effusion before and after treatment were detected. The pleurodesis efficacy according to WHO standard was evaluated 1 month later. Patients who showed complete disappearance of pleural effusion lasting more than 1 month and reduction of pleural effusion more than 50% were classified as the effective group, while the others were classified as the failure group. RESULTS One month after intrapleural pingyangmycin administration, the total response rate of MPE control was 57.7% (effective group = 15 cases). The number of leucocytes and neutrophils in peripheral blood were significantly higher after intrapleural pingyangmycin administration [the number of leucocytes: effective group (9.2 +/- 2.0) x 10(9)/L, failure group (9.4 +/- 3.8) x 10(9)/L; neutrophil count: effective group (7.9 +/- 2.1) x 10(9)/L, failure group (8.1 +/- 3.3) x 10(9)/L] than in those before[the number of leucocytes: effective group (6.6 +/- 1.4) x 10(9)/L, failure group (5.6 +/- 0.9) x 10(9)/L; neutrophil count: effective group (4.5 +/- 1.3) x 10(9)/L, failure group (4.2 +/- 1.0) x 10(9)/L. F = 30.80, 46.08 respectively, all P < 0.01]. However, the concentrations of PAI-1, t-PA and TGF-beta(1) in the peripheral blood showed no significant difference before and after treatment(P > 0.05). The concentrations of PAI-1 were significantly lower in the pleural effusion before treatment [effective group (1054 +/- 1039) microg/L, failure group (1027 +/- 955) microg/L] than after treatment [24 h after intrapleural pingyangmycin administration: effective group (2195 +/- 861) microg/L, failure group (1099 +/- 568) microg/L]; 72 h after treatment: effective group (1688 +/- 703) microg/L, failure group (1383 +/- 797) microg/L(F = 6.29, P = 0.01). The levels of t-PA were significantly higher in the pleural effusion before treatment [the effective group (42 +/- 33) microg/L, failure group (54 +/- 25) microg/L] than after treatment[24 h after intrapleural pingyangmycin administration: the effective group (49 +/- 49) microg/L, failure group (53 +/- 40) microg/L; 72 h after treatment: the effective group (17 +/- 20) microg/L, failure group (28 +/- 22) microg/L (F = 19.85, P < 0.01). The levels of TGF-beta(1) in the pleural effusion showed no significant difference before and after treatment (P > 0.05). The number of leucocytes in pleural effusion was significantly higher after intrapleural pingyangmycin administration [the effective group (4.7 +/- 4.7) x 10(9)/L, failure group (2.1 +/- 1.4) x 10(9)/L] than before [the effective group (2.3 +/- 1.9) x 10(9)/L, failure group (1.0 +/- 0.9) x 10(9)/L. F = 8.05, P < 0.01]. The number of leucocytes, neutrophils and the concentrations of PAI-1, t-PA, TGF-beta(1) in the peripheral blood showed no significant difference between the effective group and the failure group before and after treatment (P > 0.05). However, the concentrations of PAI-1 in pleural effusion after treatment were higher in the effective group than in the failure group (F = 8.51, P < 0.01). CONCLUSION Intrapleural pingyangmycin administration is a safe and effective treatment for MPE. The mechanism of pleurodesis is related to inhibiting the activity of plasminogen in the pleural cavity.
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Tschopp JM, Schnyder JM, Astoul P, Noppen M, Froudarakis M, Bolliger CT, Gasparini S, Tassi GF, Rodriguez-Panadero F, Loddenkemper R, Aelony Y, Janssen JP. Pleurodesis by talc poudrage under simple medical thoracoscopy: an international opinion. Thorax 2009; 64:273-274. [PMID: 19252034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Gossot D. Seeking for the ideal tale pleurodesis method. Gen Thorac Cardiovasc Surg 2009; 57:118. [PMID: 19297795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Ak G, Metintaş M, Yildirim H, Metintaş S, Dündar E, Erginel S, Alataş F. Pleurodesis in follow-up and treatment of malignant pleural mesothelioma patients. Tuberk Toraks 2009; 57:22-31. [PMID: 19533434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
We analyzed the necessity of pleurodesis in the follow-up of the patients with malignant pleural mesothelioma (MPM), and how much it contributes to the survival period by determining the indications, efficiency, and reliability of the pleurodesis application. 191 patients were assessed retrospectively and 69 (36%) of them were established with a pleurodesis indication. In 42 patients accepting pleurodesis, the pleurodesis success was evaluated. Factors affecting the success of pleurodesis and the effect of pleurodesis on survival were assessed. Pleurodesis was a success in 26 (62%) of the 42 patients. In the group in which the pleurodesis process was a success, it was observed that KPS and pleural fluid pH were higher (p= 0.030, p= 0.032, respectively). In case of KPS > or = 80, the sensitivity was: 76.9%, specificity: 50.0%, PPV: 71.4%, and NPV was established as 57.1%. In case of pleural fluid pH > 7.27, the sensitivity was: 92.9%, specificity: 50.0%, PPV: 76.5%, and NPV was observed as 80.0%. In the group in which pleurodesis was a success, the median survival was longer (Log-rank: 11.2; p= 0.0008). Independently from chemotherapy, the chance of living longer for patients whose pleurodesis was a success was 2.6 times higher. A severe complication concerning the process was not observed. Pleurodesis is performed less frequently than it is assumed on patients with MPM. In patients with KPS > or = 80, pleural fluid pH > 7.27, and with indication, pleurodesis must be administered. In feasible patients, a successful pleurodesis with talc increases the survival of patients with MPM, and it can be safely administered.
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Montcriol A, Prunet B, Bordes J, Raymond A, Meaudre E. [Autologous "blood patch" pleurodesis: a helpful procedure]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2009; 28:102-103. [PMID: 19038530 DOI: 10.1016/j.annfar.2008.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Sekiya M, Ishiwata T, Yoshimi K, Nagaoka T, Morio Y, Shiota S, Suzuki T, Seyama K, Takahashi K. Malignant pleurisy associated with primary lung cancer well controlled by pleurodesis using distilled water. Intern Med 2009; 48:1051-5. [PMID: 19525597 DOI: 10.2169/internalmedicine.48.1762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was an 84-year-old man patient diagnosed as malignant pleurisy associated with lung cancer. After drainage of the right pleural effusion, pleurodesis with distilled water was performed. Despite the enlargement of the primary lesion of the lung cancer during the follow-up period, the amount of pleural effusion did not increase for more than one year. No adverse effects associated with pleurodesis were noted. Pleurodesis with distilled water should be considered as one of the choices for treatment in the management of malignant pleurisy especially in elderly.
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Higashihara K, Kimbara Y, Suzuki Y, Kawate E, Takahashi H. Severe hyponatremia due to inappropriate secretion of antidiuretic hormone following pleurodesis. Intern Med 2009; 48:1069-71. [PMID: 19525601 DOI: 10.2169/internalmedicine.48.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 69-year-old man was diagnosed as having syndrome of inappropriate secretion of antidiuretic hormone (SIADH) (serum sodium: 113 mEq/L) 13 days after a right upper lobectomy due to squamous cell carcinoma of the lung (pT1N0M0, stage IA) whereas the preoperative serum sodium level was nearly normal. He had undergone pleurodesis by instillation of OK432 at 2 and 5 days after surgery for prolonged air leakage. Since other possible causes of SIADH, such as residue of lung cancer, pulmonary infections, brain disorders, or known causative drugs were ruled out, the SIADH in this patient was likely associated with pleurodesis by the use of OK-432. A review of similar cases reported suggests that it is important to be aware of the possibility of severe hyponatremia due to SIADH after chemical pleurodesis.
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Zhang W, Wang GF, Zhang H, Mu XD, Jin Z. [Medical thoracoscopic talc pleurodesis for malignant pleural effusion: an analysis of 27 cases]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2008; 40:600-602. [PMID: 19088831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of talc poudrage pleurodesis via semi-rigid medical thoracoscopy in the treatment of malignant pleural effusions, as well as the factors that may influence the outcomes. METHODS A series of 27 patients with malignant pleural effusion underwent medical thoracoscopic talc poudrage pleurodesis between July 2005 and September 2007 in Peking University First Hospital. RESULTS There were 16 male and 11 female patients in the series, the average age being 65.2 years. All the patients had documented malignant pleural effusions, including 16 cases of adenocarcinoma, 6 of malignant mesothelioma, 2 of squamous cell carcinoma, 1 of lymphoepithelioma-like carcinoma, 1 of small cell carcinoma and 1 of undifferentiated lung cancer. Thirty days after the procedures, complete successful pleurodesis was achieved in 22 cases, and partial successful in 4 cases. Pleurodesis was not successful in one case. Overall successful rate was 96.3% (26/27). The average duration of thoracic tubing was 6.85 days. Chest pain, fever and an increase in peripheral WBC after the procedure occurred in 19(70.4%, 19/27), 21(77.8%, 21/27), and 12(44.4%, 12/27) cases respectively. No respiratory failure occurred. CONCLUSION Medical thoracoscopic talc poudrage pleurodesis is a safe and effective method for the treatment of malignant pleural effusion.
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147
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Severgin VE, Shipulin PP, Martyniuk VA, Baĭdan VI, Baĭdan VV, Kiriliuk AA. [The role of videothoracoscopy in diagnosis and treatment of metastatic tumoral pleuritis]. KLINICHNA KHIRURHIIA 2008:61-63. [PMID: 19405406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The experience of diagnosis and treatment of 108 patients, suffering malignant metastatic exudative pleuritis, is presented. Different variants of pleuropulmonary biopsy, performed under local anesthesia and narcosis, are suggested. Special attention is dedicated to various methods of pleurodesis, performed as a variant of palliative treatment and prophylaxis of exudation. Comparative characteristics on efficacy of various methods of pleurodesis and the others are adduced. Simple methods, using chemopreparations, must be preferred while choosing the pleurodesis method. All the patients are alive.
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Severgin VE, Shipulin PP, Grubnik VV, Martyniuk VA, Baĭdan VV, Kiriliuk AA. [Application of videothoracoscopic pleurodesis in malignant exudative pleuritis]. KLINICHNA KHIRURHIIA 2008:34-36. [PMID: 19145841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Experience of the different etiology metastatic pleuritis treatment in 15 patients was summarized. The method of videothoracoscopic pleurodesis performance after wide biopsy of parietal pleura was depicted. Various methods of pleurodesis performance, using electrocoagulation, laser irradiation, chemical substances, are adduced. The technique of videothoracoscopic interventions performance and complications are depicted in detail. In 80% of patients the fair result, demonstrated by cessation of the exudates production, was achieved.
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Davies HE, Lee YCG, Davies RJO. Pleurodesis for malignant pleural effusion: talc, toxicity and where next? Thorax 2008; 63:572-4. [PMID: 18587029 DOI: 10.1136/thx.2007.092940] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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150
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Stevenson NJ, Simpson J. Respiratory problems on the acute take: pleural disease and acute dyspnoea. Clin Med (Lond) 2008; 8:288-91. [PMID: 18624037 PMCID: PMC4953832 DOI: 10.7861/clinmedicine.8-3-288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Respiratory disease contributes significantly to the workload of the acute medical take. This article, aimed at all physicians, reviews the evidence base for common respiratory conditions presenting as an acute emergency. There is particular emphasis on pleural disease and respiratory diagnoses likely to present with acute breathlessness.
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