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Alavi M, Ali W, Sagar A, Shafiq M, Azhar M, Ali AS, Salahuddin M. Real-world effectiveness and safety of handheld ultrasound in pleural procedures. Monaldi Arch Chest Dis 2024. [PMID: 39361012 DOI: 10.4081/monaldi.2024.2992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/30/2024] [Indexed: 10/05/2024] Open
Abstract
The use of ultrasound for pleural procedures is associated with a decreased risk of complications. Handheld ultrasounds allow for easier evaluation of the pleural space. Limited data exists for the use of such devices for pleural procedures. The primary objective of our study was to assess the effectiveness and safety of handheld ultrasound for pleural procedures. We performed a prospective observational study, including all consecutive patients who underwent pleural procedures using the handheld ultrasound between September 2021 and November 2023. A total of 332 pleural procedures were attempted with handheld ultrasound, of which 329 pleural procedures (99.1%) were successfully performed. The median volume of fluid drained was 500 (interquartile range: 300-800). Thoracentesis was performed in 127 patients (38.5%), tube thoracostomy in 179 patients (54.4%), and medical thoracoscopy in 23 patients (7.0%). Exudative pleural effusions were found in 264 patients (80.0%), of which 152 (46.2%) were determined to be due to infectious etiologies. A total of 4 (1.2%) patients had a complication due to the procedure. 2 patients (0.6%) had a pneumothorax, while 2 patients (0.6%) developed a hemothorax. A total of 101 patients had either low platelets (<50×109/L) or use of anti-platelet or anti-coagulant drugs. 128 patients (38.8%) were on positive pressure support during the pleural procedure. Our study shows that handheld ultrasounds are effective and safe for pleural procedures, including cases with septated pleural effusions and patients on anti-platelet or anti-coagulant drugs.
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Affiliation(s)
- Musaib Alavi
- Department of Medicine, Aga Khan University, Karachi.
| | - Waris Ali
- Department of Medicine, Aga Khan University, Karachi.
| | - Alaeddin Sagar
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Madinah.
| | - Majid Shafiq
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | | | - Akbar S Ali
- Department of Medicine, Aga Khan University, Karachi.
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Zelachowski KA, Rishniw M, DeFrancesco TC. A survey of the use of ultrasound by small animal veterinary clinicians. Vet Radiol Ultrasound 2024; 65:429-436. [PMID: 38668650 DOI: 10.1111/vru.13377] [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] [Received: 12/11/2023] [Revised: 03/14/2024] [Accepted: 04/12/2024] [Indexed: 07/21/2024] Open
Abstract
This study aimed to determine the current use of ultrasound amongst small animal veterinarians. A total of 1216 small animal veterinary practitioners responded to an electronic survey that was administered through the Veterinary Information Network to all its members. Descriptive statistics were generated; limited inferential statistics were performed to examine specific relationships. Eighty-four percent of respondents had access to an ultrasound unit, and 86% of respondents reported using their unit multiple times per week. The most common uses were assistance with cystocentesis (93%) and abdominocentesis (71%), pregnancy diagnosis (69%), limited abdominal evaluation (63%), to aid in thoracocentesis (59%), and limited thoracic evaluation (52%). Eighty-nine percent of respondents received some formal training in ultrasound, most commonly from continuing education courses. Most respondents (52%) reported receiving ≤25 h of training. Additionally, 88% of respondents believed it was either extremely or very important for there to be ultrasound training for veterinary students prior to graduation. Based on this survey, most small animal practitioners commonly use ultrasound for limited examinations, being most confident in the sonographic evaluation and centesis of the bladder and for the detection and centesis of effusion in a body cavity. With most respondents having ≤25 h of training in ultrasound, typically obtained in postgraduate courses, an expansion in standardized basic ultrasound training within the veterinary curriculum may be warranted.
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Affiliation(s)
- Kendra A Zelachowski
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Mark Rishniw
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
- Veterinary Information Network, Davis, California, USA
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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3
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Tajarernmuang P, Valenti D, Gonzalez AV, Artho G, Tsatoumas M, Beaudoin S. Reduction of Chest Drain Overuse Through Implementation of a Pleural Drainage Order Set. Qual Manag Health Care 2024; 33:206-212. [PMID: 37651595 DOI: 10.1097/qmh.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Small chest drains are used in many centers as the default drainage strategy for various pleural effusions. This can lead to drain overuse, which may be harmful. This study aimed to reduce chest drain overuse. METHODS We studied consecutive pleural procedures performed in the radiology department before (August 1, 2015, to July 31, 2016) and after intervention (September 1, 2019, to January 31, 2020). Chest drains were deemed indicated or not based on criteria established by a local interdisciplinary work group. The intervention consisted of a pleural drainage order set embedded in electronic medical records. It included indications for chest drain insertion, prespecified drain sizes for each indication, fluid analyses, and postprocedure radiography orders. Overall chest drain use and proportion of nonindicated drains were the outcomes of interest. RESULTS We reviewed a total of 288 procedures (pre-intervention) and 155 procedures (post-intervention) (thoracentesis and drains). Order-set implementation led to a reduction in drain use (86.5% vs 54.8% of all procedures, P < .001) and reduction in drain insertions in the absence of an indication (from 45.4% to 29.4% of drains, P = .01). The need for repeat procedures did not increase after order-set implementation (22.0% pre vs 17.7% post, P = .40). Complication rates and length of hospital stay did not differ significantly after the intervention. More pleural infections were treated with drain sizes of 12Fr and greater (31 vs 70%, P < .001) after order-set deployment, and direct procedural costs were reduced by 27 CAN$ per procedure. CONCLUSION Implementation of a pleural drainage order-set reduced chest drain use, improved procedure selection according to clinical needs, and reduced direct procedural costs. In institutions where small chest drains are used as the default drainage strategy for pleural effusions, this order set can reduce chest drain overuse.
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Affiliation(s)
- Pattraporn Tajarernmuang
- Author Affiliations: Respiratory Division, Department of Medicine (Drs Tajarernmuang, Gonzalez, and Beaudoin) and Department of Radiology (Drs Valenti, Artho, and Tsatoumas), McGill University Health Centre, Montreal, Quebec, Canada; and Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (Dr Tajarernmuang)
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Scott S, Morrison B, Young K, Clark L, Li Y, Walter C, Rohr A, Alli A. Re-expansion Pulmonary Edema (REPE) Following Thoracentesis: Is Large-Volume Thoracentesis Associated with Increased Incidence of REPE? Cardiovasc Intervent Radiol 2024; 47:912-917. [PMID: 38858252 DOI: 10.1007/s00270-024-03773-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE To determine the safety and efficacy associated with drainage volumes greater than 1,500 mL in a single, unilateral thoracentesis without pleural manometry measurements. MATERIALS AND METHODS This retrospective, single-institution study included 872 patients (18 years and older) who underwent ultrasound-guided thoracentesis. Patient and procedures data were collected including demographics, number of and laterality of thoracenteses, volume and consistency of fluid removed, and whether clinical or radiologic evidence of re-expansion pulmonary edema (REPE) developed within 24 h of thoracentesis. Fisher's exact test was used to test the significance of the relationship between volume of fluid removed and evidence of REPE. RESULTS A total of 1376 thoracenteses were performed among the patients included in the study. The mean volume of fluid removed among all procedures was 901.1 mL (SD = 641.7 mL), with 194 (14.1%) procedures involving the removal of ≥ 1,500 mL of fluid. In total, six (0.7%) patients developed signs of REPE following thoracentesis, five of which were a first-time thoracentesis. No statistically significant difference in incidence of REPE was observed between those with ≥ 1,500 mL of fluid removed compared to those with < 1,500 mL of fluid removed (p-value = 0.599). CONCLUSIONS Large-volume thoracentesis may safely improve patients' symptoms while preventing the need for repeat procedures.
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Affiliation(s)
- Sandon Scott
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Brennan Morrison
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Kate Young
- Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Lauren Clark
- Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Yanming Li
- Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Carissa Walter
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Aaron Rohr
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Adam Alli
- Department of Interventional Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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Sarrigeorgiou I, Rouka E, Kotsiou OS, Perlepe G, Gerovasileiou ES, Gourgoulianis KI, Lymberi P, Zarogiannis SG. Natural antibodies targeting LPS in pleural effusions of various etiologies. Am J Physiol Lung Cell Mol Physiol 2024; 326:L727-L735. [PMID: 38591123 DOI: 10.1152/ajplung.00377.2023] [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] [Received: 11/28/2023] [Revised: 03/01/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
Respiratory infection, cancer, and heart failure can cause abnormal accumulation of fluid in the pleural cavity. The immune responses within the cavity are orchestrated by leucocytes that reside in the serosal-associated lymphoid tissue. Natural antibodies (NAbs) are abundant in the serum (S) having a major role in systemic and mucosal immunity; however, their occurrence in pleural fluid (PF) remains an open question. Our aim herein was to detect and measure the levels of NAbs (IgM, IgG, IgA) targeting lipopolysaccharides (LPS) in both the pleural fluid and the serum of 78 patients with pleural effusions (PEs) of various etiologies. The values of anti-LPS NAb activity were extracted through a normalization step regarding the total IgM, IgG, and IgA levels, all determined by in-house ELISA. In addition, the ratios of PF/S values were analyzed further with other critical biochemical parameters from pleural fluids. Anti-LPS NAbs of all Ig classes were detected in most of the samples, while a significant increase of anti-LPS activity was observed in infectious and noninfectious compared with malignant PEs. Multivariate linear regression confirmed a negative correlation of IgM and IgA anti-LPS PF/S ratio with malignancy. Moreover, anti-LPS NAbs PF/S measurements led to increased positive and negative predictive power in ROC curves generated for the discrimination between benign and malignant PEs. Our results highlight the role of anti-LPS NAbs in the pleural cavity and demonstrate the potential translational impact that should be further explored.NEW & NOTEWORTHY Here we describe the detection and quantification of natural antibodies (NAbs) in the human pleural cavity. We show for the first time that IgM, IgG, and IgA anti-LPS natural antibodies are detected and measured in pleural effusions of infectious, noninfectious, and malignant etiologies and provide clinical correlates to demonstrate the translational impact of our findings.
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Affiliation(s)
- Ioannis Sarrigeorgiou
- Laboratory of Immunology, Department of Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - Erasmia Rouka
- Department of Nursing, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ourania S Kotsiou
- Department of Nursing, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Garyfallia Perlepe
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efrosini S Gerovasileiou
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Peggy Lymberi
- Laboratory of Immunology, Department of Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - Sotirios G Zarogiannis
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Kameda Y, Osawa H, Sueishi Y, Ishikawa Y, Maehara T. A case of delayed bleeding of the chest wall after VATS treated with transcatheter arterial embolization. J Surg Case Rep 2024; 2024:rjae271. [PMID: 38742017 PMCID: PMC11090606 DOI: 10.1093/jscr/rjae271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
We report a case of delayed bleeding after video-assisted thoracic surgery (VATS) that was successfully treated with transcatheter arterial embolization. An 81-year-old woman underwent a pleural biopsy via VATS for pleural dissemination of lung cancer. The postoperative course was good, but 8 days later she was hospitalized for swelling in the right axilla and was admitted to our hospital with a diagnosis of delayed postoperative hemorrhage. Gauze compression was performed, and the patient was discharged without exacerbation of hematoma. However, 4 days later, she was hospitalized for rapidly worsening swelling and pain. Chest computed tomography at the time of rebleeding showed an increase in the hematoma and extravasation in the peripheral right lateral thoracic artery. The patient was immediately treated with emergency angiography, and coil embolization was performed. After this treatment, the patient has done well and there has been no subsequent recurrence of bleeding.
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Affiliation(s)
- Yohei Kameda
- Department of Thoracic Surgery, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuurahigashi, Kanazawa-ku, Yokohama 236-0037, Kanagawa, Japan
| | - Hiroyuki Osawa
- Department of Thoracic Surgery, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuurahigashi, Kanazawa-ku, Yokohama 236-0037, Kanagawa, Japan
| | - Yui Sueishi
- Department of General Thoracic Surgery, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan
| | - Yoshihiro Ishikawa
- Department of General Thoracic Surgery, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan
| | - Takamitsu Maehara
- Department of Thoracic Surgery, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuurahigashi, Kanazawa-ku, Yokohama 236-0037, Kanagawa, Japan
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7
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Teja B, Bosch NA, Diep C, Pereira TV, Mauricio P, Sklar MC, Sankar A, Wijeysundera HC, Saskin R, Walkey A, Wijeysundera DN, Wunsch H. Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis. JAMA Intern Med 2024; 184:474-482. [PMID: 38436976 DOI: 10.1001/jamainternmed.2023.8232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Importance Central venous catheters (CVCs) are commonly used but are associated with complications. Quantifying complication rates is essential for guiding CVC utilization decisions. Objective To summarize current rates of CVC-associated complications. Data Sources MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for observational studies and randomized clinical trials published between 2015 to 2023. Study Selection This study included English-language observational studies and randomized clinical trials of adult patients that reported complication rates of short-term centrally inserted CVCs and data for 1 or more outcomes of interest. Studies that evaluated long-term intravascular devices, focused on dialysis catheters not typically used for medication administration, or studied catheters placed by radiologists were excluded. Data Extraction and Synthesis Two reviewers independently extracted data and assessed risk of bias. Bayesian random-effects meta-analysis was applied to summarize event rates. Rates of placement complications (events/1000 catheters with 95% credible interval [CrI]) and use complications (events/1000 catheter-days with 95% CrI) were estimated. Main Outcomes and Measures Ten prespecified complications associated with CVC placement (placement failure, arterial puncture, arterial cannulation, pneumothorax, bleeding events requiring action, nerve injury, arteriovenous fistula, cardiac tamponade, arrhythmia, and delay of ≥1 hour in vasopressor administration) and 5 prespecified complications associated with CVC use (malfunction, infection, deep vein thrombosis [DVT], thrombophlebitis, and venous stenosis) were assessed. The composite of 4 serious complications (arterial cannulation, pneumothorax, infection, or DVT) after CVC exposure for 3 days was also assessed. Results Of 11 722 screened studies, 130 were included in the analyses. Seven of 15 prespecified complications were meta-analyzed. Placement failure occurred at 20.4 (95% CrI, 10.9-34.4) events per 1000 catheters placed. Other rates of CVC placement complications (per 1000 catheters) were arterial canulation (2.8; 95% CrI, 0.1-10), arterial puncture (16.2; 95% CrI, 11.5-22), and pneumothorax (4.4; 95% CrI, 2.7-6.5). Rates of CVC use complications (per 1000 catheter-days) were malfunction (5.5; 95% CrI, 0.6-38), infection (4.8; 95% CrI, 3.4-6.6), and DVT (2.7; 95% CrI, 1.0-6.2). It was estimated that 30.2 (95% CrI, 21.8-43.0) in 1000 patients with a CVC for 3 days would develop 1 or more serious complication (arterial cannulation, pneumothorax, infection, or DVT). Use of ultrasonography was associated with lower rates of arterial puncture (risk ratio [RR], 0.20; 95% CrI, 0.09-0.44; 13.5 events vs 68.8 events/1000 catheters) and pneumothorax (RR, 0.25; 95% CrI, 0.08-0.80; 2.4 events vs 9.9 events/1000 catheters). Conclusions and Relevance Approximately 3% of CVC placements were associated with major complications. Use of ultrasonography guidance may reduce specific risks including arterial puncture and pneumothorax.
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Affiliation(s)
- Bijan Teja
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nicholas A Bosch
- The Pulmonary Center, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiago V Pereira
- Clinical Trial Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paolo Mauricio
- The Pulmonary Center, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Michael C Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashwin Sankar
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Refik Saskin
- ICES Central, University of Toronto, Toronto, Ontario, Canada
| | - Allan Walkey
- Division of Health Systems Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- ICES Central, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Hannah Wunsch
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
- Sunnybrook Research Institute, Toronto, Ontario, Canada
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Seghers S, Le Compte M, Hendriks JMH, Van Schil P, Janssens A, Wener R, Komen N, Prenen H, Deben C. A systematic review of patient-derived tumor organoids generation from malignant effusions. Crit Rev Oncol Hematol 2024; 195:104285. [PMID: 38311013 DOI: 10.1016/j.critrevonc.2024.104285] [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] [Received: 12/07/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/06/2024] Open
Abstract
This review assesses the possibility of utilizing malignant effusions (MEs) for generating patient-derived tumor organoids (PDTOs). Obtained through minimally invasive procedures MEs broaden the spectrum of organoid sources beyond resection specimens and tissue biopsies. A systematic search yielded 11 articles, detailing the successful generation of 190 ME-PDTOs (122 pleural effusions, 54 malignant ascites). Success rates ranged from 33% to 100%, with an average of 84% and median of 92%. A broad and easily applicable array of techniques can be employed, encompassing diverse collection methods, variable centrifugation speeds, and the inclusion of approaches like RBC lysis buffer or centrifuged ME supernatants supplementation, enhancing the versatility and accessibility of the methodology. ME-PDTOs were found to recapitulate primary tumor characteristics and were primarily used for drug screening applications. Thus, MEs are a reliable source for developing PDTOs, emphasizing the need for further research to maximize their potential, validate usage, and refine culturing processes.
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Affiliation(s)
- Sofie Seghers
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium; Center for Oncological Research (CORE), University of Antwerp, Wilrijk, Belgium.
| | - Maxim Le Compte
- Center for Oncological Research (CORE), University of Antwerp, Wilrijk, Belgium
| | - Jeroen M H Hendriks
- Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium; Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium; Antwerp ReSURG Group, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Wilrijk, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium; Antwerp ReSURG Group, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Wilrijk, Belgium
| | - Annelies Janssens
- Department of Thoracic Oncology Antwerp University Hospital, Edegem, Belgium
| | - Reinier Wener
- Department of Thoracic Oncology Antwerp University Hospital, Edegem, Belgium; Department of Pulmonary Diseases, Antwerp University Hospital, Edegem, Belgium
| | - Niels Komen
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium; Antwerp ReSURG Group, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Wilrijk, Belgium
| | - Hans Prenen
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium; Center for Oncological Research (CORE), University of Antwerp, Wilrijk, Belgium; Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
| | - Christophe Deben
- Center for Oncological Research (CORE), University of Antwerp, Wilrijk, Belgium; Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
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Osman KT, Naritsin A, Amuchi B, Qamar AA. Liver transplantation for refractory hepatic hydrothorax is associated with a greater survival benefit compared to other complications of cirrhosis. Liver Transpl 2024; 30:142-150. [PMID: 37450656 DOI: 10.1097/lvt.0000000000000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
Hepatic hydrothorax (HH) is a significant complication of cirrhosis associated with increased mortality. Liver transplantation (LT) remains the best treatment modality. We aim to assess predictors of mortality and the survival benefit of LT in patients with HH. A prospectively maintained cohort of adult patients with cirrhosis, being evaluated for LT at our institution, was retrospectively reviewed from 2015 to 2020. The primary outcome was death or LT. Cox proportional hazard regression identified associations between covariates and death. We calculated the years saved due to LT by comparing patients who were on the waiting list with patients who received an LT. This was done by calculating the area under the Kaplan-Meier curve. Censoring occurred at the time of the last follow-up or death. Patients with refractory HH had the lowest median survival of only 0.26 years. Within the HH group, having a refractory HH group was significantly associated with an increased risk of mortality (HR 1.73; 95% CI 1.06-2.81; p -value 0.03). Refractory HH was also significantly associated with mortality when evaluated in the entire cohort and after adjusting for other covariates (HR 1.48, 95% CI 1.03-2.11; p -value 0.03). Patients with refractory HH had the highest 1-year survival benefit with LT (0.48 y), followed by patients with non-refractory HH (0.28 y), then patients with other complications of cirrhosis (0.19 y). In this large study evaluating the prognostic impact of HH on patients with cirrhosis, refractory HH was an independent predictor of mortality. LT provides an additional survival benefit to patients with HH compared with those without HH.
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Affiliation(s)
- Karim T Osman
- Division of Gastroenterology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Anastasia Naritsin
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Brenda Amuchi
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Amir A Qamar
- Division of Gastroenterology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Division of Transplant and Hepatobiliary Diseases, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
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10
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Glargaard S, Thomsen JH, Løgstrup BB, Schou M, Iversen KK, Tuxen C, Nielsen OW, Bang CA, Lindholm MG, Seven E, Barasa A, Stride N, Vraa S, Tofterup M, Rasmussen RV, Høfsten DE, Rossing K, Køber L, Gustafsson F, Thune JJ. Thoracentesis to alleviate pleural effusion in acute heart failure: study protocol for the multicentre, open-label, randomised controlled TAP-IT trial. BMJ Open 2024; 14:e078155. [PMID: 38245015 PMCID: PMC10806591 DOI: 10.1136/bmjopen-2023-078155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Pleural effusion is present in half of the patients hospitalised with acute heart failure. The condition is treated with diuretics and/or therapeutic thoracentesis for larger effusions. No evidence from randomised trials or guidelines supports thoracentesis to alleviate pleural effusion due to acute heart failure. The Thoracentesis to Alleviate cardiac Pleural effusion Interventional Trial (TAP-IT) will investigate if a strategy of referring patients with acute heart failure and pleural effusion to up-front thoracentesis by pleural pigtail catheter insertion in addition to pharmacological therapy compared with pharmacological therapy alone can increase the number of days the participants are alive and not hospitalised during the 90 days following randomisation. METHODS AND ANALYSIS TAP-IT is a pragmatic, multicentre, open-label, randomised controlled trial aiming to include 126 adult patients with left ventricular ejection fraction ≤45% and a non-negligible pleural effusion due to heart failure. Participants will be randomised 1:1, stratified according to site and anticoagulant treatment, and assigned to referral to up-front ultrasound-guided pleural pigtail catheter thoracentesis in addition to standard pharmacological therapy or to standard pharmacological therapy only. Thoracentesis is performed according to local guidelines and can be performed in participants in the pharmacological treatment arm if their condition deteriorates or if no significant improvement is observed within 5 days. The primary endpoint is how many days participants are alive and not hospitalised within 90 days from randomisation and will be analysed in the intention-to-treat population. Key secondary outcomes include 90-day mortality, complications, readmissions, and quality of life. ETHICS AND DISSEMINATION The study has been approved by the Capital Region of Denmark Scientific Ethical Committee (H-20060817) and Knowledge Center for Data Reviews (P-2021-149). All participants will sign an informed consent form. Enrolment began in August 2021. Regardless of the nature, results will be published in a peer-reviewed medical journal. TRIAL REGISTRATION NUMBER NCT05017753.
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Affiliation(s)
- Signe Glargaard
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Brian Bridal Løgstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Tuxen
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Olav W Nielsen
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Axel Bang
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | - Ekim Seven
- Department of Cardiology, Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, Denmark
| | - Anders Barasa
- Department of Cardiology, Copenhagen University Hospital-Glostrup, Glostrup, Denmark
| | - Nis Stride
- Department of Cardiology, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | - Søren Vraa
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Marlene Tofterup
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rasmus Vedby Rasmussen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Dan Eik Høfsten
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Mohammed A, Hochfeld U, Hong S, Hosseini DK, Kim K, Omidvari K. Thoracentesis techniques: A literature review. Medicine (Baltimore) 2024; 103:e36850. [PMID: 38181250 PMCID: PMC10766253 DOI: 10.1097/md.0000000000036850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
Thoracentesis is performed by 4 methods: gravity, manual aspiration, vacuum-bottle suction, and wall suction. This literature review investigates the safety of these techniques and determines if there is significant difference in complication rates. A comprehensive literature search revealed 6 articles studying thoracentesis techniques and their complication rates, reviewing 20,815 thoracenteses: 80 (0.4%) by gravity, 9431 (45.3%) by manual aspiration, 3498 (16.8%) by vacuum-bottle suction, 7580 (36.4%) by wall suction and 226 (1.1%) unspecified. Of the 6 studies, 2 were smaller with 100 and 140 patients respectively. Overall, there was a 4.4% complication rate including hemothoraces, pneumothoraces, re-expansion pulmonary edema (REPE), chest discomfort, bleeding at the site, pain, and vasovagal episodes. The pneumothorax and REPE rate was 2.5%. Sub-analyzed by each method, there was a 47.5% (38/80) complication rate in the gravity group, 1.2% (115/9431) in the manual aspiration group including 0.7% pneumothorax or REPE, 8% (285/3498) in the vacuum-bottle group including 3.7% pneumothorax or REPE, 4% (309/7580) in the wall suction group all of which were either pneumothorax or REPE, and 73% (166/226) in the unspecified group most of which were vasovagal episodes. Procedure duration was less in the suction groups versus gravity drainage. The 2 smaller studies indicated that in the vacuum groups, early procedure termination rate from respiratory failure was significantly higher than non-vacuum techniques. Significant complication rate from thoracentesis by any technique is low. Suction drainage was noted to have a lower procedure time. Symptom-limited thoracentesis is safe using vacuum or wall suction even with large volumes drained. Other factors such as procedure duration, quantity of fluid removed, number of needle passes, patients' BMI, and operator technique may have more of an impact on complication rate than drainage modality. All suction modalities of drainage seem to be safe. Operator technique, attention to symptom development, amount of fluid removed, and intrapleural pressure changes may be important in predicting complication development, and therefore, may be useful in choosing which technique to employ. Specific drainage modes and their complications need to be further studied.
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Affiliation(s)
- Asna Mohammed
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Uri Hochfeld
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sung Hong
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Davood K. Hosseini
- Department of Internal Medicine, Division of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Kevin Kim
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Karan Omidvari
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Hackensack University Medical Center, Hackensack, NJ, USA
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12
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Wen KZ, Brereton CJ, Douglas EM, Samuel SRN, Jones AC. Pleural procedures: an audit of practice and complications in a regional Australian teaching hospital. Intern Med J 2024; 54:172-177. [PMID: 37255366 DOI: 10.1111/imj.16147] [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] [Received: 03/31/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Pleural procedures are essential for the investigation and management of pleural disease and can be associated with significant morbidity and mortality. There is a lack of pleural procedure complication data in the Australian and New Zealand region. AIMS To review pleural procedure practices at Wollongong Hospital with an emphasis on the assessment of complications, use of thoracic ultrasound (TUS), pathology results and comparison of findings with international data. METHODS Retrospective analysis of medical records was performed on pleural procedures identified through respiratory specialist trainee logbooks at Wollongong Hospital from January 2018 to December 2021. Comparison of complication rates was made to the British Thoracic Society 2011 a national pleural audit. RESULTS One hundred and twenty-one pleural procedures were identified. There were 71 chest drains, 49 thoracocentesis and one indwelling pleural catheter (IPC) insertion. Ninety-seven per cent of procedures were performed for pleural effusions and 3% for pneumothorax. This audit demonstrated a complication rate (excluding pain) of 16.9% for chest drains and 4.1% for thoracocentesis. This gave an overall complication event rate of 10.8% (excluding pain) for pleural procedures. There was no major bleeding, organ puncture, pleural space infection or death. Bedside TUS was used in 99% of procedures. CONCLUSION Complication rates for pleural procedures performed by respiratory specialist trainees at Wollongong Hospital are comparable with international outcomes. This audit provides data for comparison on pleural procedure complication rates in Australia. Future studies are required to determine complication rates with IPCs.
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Affiliation(s)
- Kevin Z Wen
- Department of Respiratory and Sleep Medicine, Wollongong Hospital, Sydney, New South Wales, Australia
| | - Christopher J Brereton
- Department of Respiratory and Sleep Medicine, Wollongong Hospital, Sydney, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Sydney, New South Wales, Australia
| | - Eric M Douglas
- Department of Respiratory and Sleep Medicine, Wollongong Hospital, Sydney, New South Wales, Australia
| | - Sameh R N Samuel
- Department of Respiratory and Sleep Medicine, Wollongong Hospital, Sydney, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Sydney, New South Wales, Australia
| | - Andrew C Jones
- Department of Respiratory and Sleep Medicine, Wollongong Hospital, Sydney, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Sydney, New South Wales, Australia
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13
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Duong V, Tacey M, Shum E, Hannan L, See K, Muruganandan S. Early outcomes following the implementation of a specialised pleural disease service. Intern Med J 2023; 53:2270-2276. [PMID: 37070808 DOI: 10.1111/imj.16077] [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] [Received: 09/01/2022] [Accepted: 03/15/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Pleural effusion is a common cause of hospitalisation and a poor prognostic marker that is associated with morbidity and mortality. The evaluation and management of pleural effusion may be performed more effectively by a specialised pleural disease service (SPDS). AIMS To evaluate the impact of a SPDS established in 2017 at a 400-bed metropolitan hospital in Victoria, Australia. METHODS A retrospective observational study was undertaken comparing outcomes of individuals with pleural effusions. People with pleural effusion were identified using administrative data. Two 12-month time periods were compared, 2016 (Period 1, before SPDS) and 2018 (Period 2, after SPDS). RESULTS Period 1 had n = 76 and Period 2 had n = 96 individuals with pleural effusion receiving intervention. Age (69.8 ± 17.6 vs 71.8 ± 15.8), gender and Charlson Comorbidity Index (4.9 ± 2.8 vs 5.4 ± 3.0) were similar across both periods. Utilisation of point-of-care ultrasound for pleural procedures increased from Period 1 to 2, 57.3-85.7% (P < 0.001). There was a reduction in median days from admission to intervention (3.8-2.1 days, P = 0.048) and pleural-related re-intervention rate (32% vs 19%, P = 0.032). Pleural fluid testing was more consistent with recommendations (16.8% vs 43.2%, P < 0.001). Overall, there was no difference in the median length of stay (7.9 vs 6.4 days, P = 0.23), pleural-related readmissions (11% vs 16%, P = 0.69) or mortality (17.1% vs 15.6%, P = 0.79). Procedural complications were similar between the two periods. CONCLUSIONS The introduction of a SPDS was associated with increased point-of-care ultrasound utilisation for pleural procedures, shorter delays to intervention and improved standardisation of tests on pleural fluid.
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Affiliation(s)
- Victor Duong
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Mark Tacey
- Northern Health, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Evonne Shum
- Northern Health, Melbourne, Victoria, Australia
- Austin Health, Melbourne, Victoria, Australia
| | - Liam Hannan
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Katharine See
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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14
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Kamei J, Kuriyama A, Ohno T, Ohtsuru S. Thoracodorsal Artery Injury After Tube Thoracostomy: A Case Report. J Emerg Med 2023; 65:e303-e306. [PMID: 37690956 DOI: 10.1016/j.jemermed.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Tube thoracostomy is rarely associated with serious bleeding complications. Although intercostal artery injury is a well-known bleeding complication, other vascular injuries in the chest wall have only rarely been reported. CASE REPORT A 58-year-old man with alcoholic liver cirrhosis presented to the emergency department with dyspnea. He was diagnosed by chest computed tomography with spontaneous hemopneumothorax, for which he underwent tube thoracostomy. However, bleeding in the chest wall continued, which required chest tube removal and blood transfusion. Contrast-enhanced computed tomography and angiography revealed contrast extravasation from the thoracodorsal artery, which confirmed a diagnosis of thoracodorsal artery injury. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Because the thoracodorsal artery gives branches to the serratus anterior muscles that are located in the "triangle of safety," chest tube placement in this area is not always safe; it can still cause major bleeding complications from vessels such as the thoracodorsal artery. Hence, close monitoring for bleeding is needed after tube thoracostomy.
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Affiliation(s)
- Jun Kamei
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Kuriyama
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Ohno
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeru Ohtsuru
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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15
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Asciak R, Bedawi EO, Bhatnagar R, Clive AO, Hassan M, Lloyd H, Reddy R, Roberts H, Rahman NM. British Thoracic Society Clinical Statement on pleural procedures. Thorax 2023; 78:s43-s68. [PMID: 37433579 DOI: 10.1136/thorax-2022-219371] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Rachelle Asciak
- Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Eihab O Bedawi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Maged Hassan
- Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Heather Lloyd
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Raja Reddy
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Helen Roberts
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, UK
| | - Najib M Rahman
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
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16
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Fox AH, Nishino M, Osarogiagbon RU, Rivera MP, Rosenthal LS, Smith RA, Farjah F, Sholl LM, Silvestri GA, Johnson BE. Acquiring tissue for advanced lung cancer diagnosis and comprehensive biomarker testing: A National Lung Cancer Roundtable best-practice guide. CA Cancer J Clin 2023; 73:358-375. [PMID: 36859638 DOI: 10.3322/caac.21774] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 03/03/2023] Open
Abstract
Advances in biomarker-driven therapies for patients with nonsmall cell lung cancer (NSCLC) both provide opportunities to improve the treatment (and thus outcomes) for patients and pose new challenges for equitable care delivery. Over the last decade, the continuing development of new biomarker-driven therapies and evolving indications for their use have intensified the importance of interdisciplinary communication and coordination for patients with or suspected to have lung cancer. Multidisciplinary teams are challenged with completing comprehensive and timely biomarker testing and navigating the constantly evolving evidence base for a complex and time-sensitive disease. This guide provides context for the current state of comprehensive biomarker testing for NSCLC, reviews how biomarker testing integrates within the diagnostic continuum for patients, and illustrates best practices and common pitfalls that influence the success and timeliness of biomarker testing using a series of case scenarios.
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Affiliation(s)
- Adam H Fox
- Division of Pulmonary Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mizuki Nishino
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raymond U Osarogiagbon
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
| | - M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Lauren S Rosenthal
- Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia, USA
| | - Robert A Smith
- Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia, USA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gerard A Silvestri
- Division of Pulmonary Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bruce E Johnson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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17
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Sieber S, Garbe J, Böhm S, Eisenmann S. Pneumothorax detection with thoracic ultrasound as the method of choice in interventional pulmonology - A retrospective single-center analysis and experience. BMC Pulm Med 2023; 23:227. [PMID: 37365532 DOI: 10.1186/s12890-023-02511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Recent studies have shown that thoracic ultrasound (TUS) is not inferior to chest radiography (CR) in detecting pneumothorax (PTX). It is unclear if adopting TUS can reduce the number of CR in the daily clinical routine. This retrospective study investigates the utilization of post-interventional CR and TUS for PTX detection after the introduction of TUS as the method of choice in an interventional pulmonology unit. METHODS All interventions with CR or TUS for ruling out PTX performed in the Pneumology Department of the University Hospital Halle (Germany) 2014 to 2020 were included. The documented TUS and CR performed before (period A) and after the introduction of TUS as the method of choice (period B), as well as the number of diagnosed and missed PTX were recorded. RESULTS The study included 754 interventions (110 in period A and 644 in period B). The proportion of CR decreased from 98.2% (n = 108) to 25.8% (n = 166) (p < 0.001). During period B, a total of 29 (4.5%) PTX were diagnosed. Of these, 28 (96.6%) were detected on initial imaging (14 by CR, 14 by TUS ). One PTX (0.2%) was initially missed by TUS, none by CR. Confirmatory investigations were ordered more frequently after TUS (21 of 478, 4.4%) than after CR (3 of 166, 1.8%). CONCLUSION The use of TUS in interventional pulmonology can effectively reduce the number of CR and thus save resources. However, CR may still be favored in specific circumstances or if pre-existing conditions limit sonographic findings.
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Affiliation(s)
- Sonja Sieber
- Department of Internal Medicine, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany.
| | - Jakob Garbe
- Department of Internal Medicine, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Sebastian Böhm
- Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany
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Polyzogopoulou E, Velliou M, Verras C, Ventoulis I, Parissis J, Osterwalder J, Hoffmann B. Point-of-Care Ultrasound: A Multimodal Tool for the Management of Sepsis in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1180. [PMID: 37374384 DOI: 10.3390/medicina59061180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and mortality. Hence, early diagnosis and management of both conditions is of paramount importance. Point-of-care ultrasound (POCUS) is a cost-effective and safe imaging modality performed at the bedside, which has rapidly emerged as an excellent multimodal tool and has been gradually incorporated as an adjunct to physical examination in order to facilitate evaluation, diagnosis and management. In sepsis, POCUS can assist in the evaluation of undifferentiated sepsis, while, in cases of shock, it can contribute to the differential diagnosis of other types of shock, thus facilitating the decision-making process. Other potential benefits of POCUS include prompt identification and control of the source of infection, as well as close haemodynamic and treatment monitoring. The aim of this review is to determine and highlight the role of POCUS in the evaluation, diagnosis, treatment and monitoring of the septic patient. Future research should focus on developing and implementing a well-defined algorithmic approach for the POCUS-guided management of sepsis in the emergency department setting given its unequivocal utility as a multimodal tool for the overall evaluation and management of the septic patient.
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Affiliation(s)
- Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Christos Verras
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
- National Centre of Emergency Care (EKAB), 11527 Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | | | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd, WCC2, Boston, MA 02215, USA
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Radulescu PM, Nemeş AF, Calarasu C, Georgescu I, Radulescu D. Pleural Effusion as a Negative Prognostic Factor in Patients with Acute Pancreatitis and COVID-19. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:193-199. [PMID: 37786621 PMCID: PMC10541516 DOI: 10.12865/chsj.49.02.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/21/2023] [Indexed: 10/04/2023]
Abstract
We conducted a retrospective multicentre study to investigate the association between acute pancreatitis, COVID-19, and pleural effusion. The study involved a total of 433 patients. Among them, 405 patients did not have COVID-19 infection, while 28 patients had both acute pancreatitis and COVID-19. Out of the 28 patients with both conditions, 12 also had pleural effusion. Among the 405 patients with acute pancreatitis without COVID-19, 48 had pleural effusion. The results showed that the relative risk of death associated with pleural effusion was approximately 4 times higher in patients with COVID-19 and pleural effusion compared to those with pleural effusion without COVID-19.
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Affiliation(s)
| | - Alexandra Floriana Nemeş
- Department of Neonatology, Louis Ţurcanu Clinical Emergency Hospital for Children, Timişoara, Romania
| | - Cristina Calarasu
- Department of Pulmonology, University of Medicine and Pharmacy of Craiova, Romania
| | - Ion Georgescu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, Romania
| | - Dumitru Radulescu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, Romania
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20
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Maughan KS, Romain M, Brown DB. Use of Ethylene Vinyl Copolymer for Embolization Outside the Central Nervous System: A Case Review. Semin Intervent Radiol 2023; 40:221-230. [PMID: 37333750 PMCID: PMC10275679 DOI: 10.1055/s-0043-1768611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Affiliation(s)
- Kyle S. Maughan
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mike Romain
- Meharry Medical College, Nashville, Tennessee
| | - Daniel B. Brown
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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21
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Simulation-based Mastery Learning Improves Critical Care Skills of Advanced Practice Providers. ATS Sch 2023; 4:48-60. [PMID: 37089675 PMCID: PMC10117416 DOI: 10.34197/ats-scholar.2022-0065oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
Background Advanced practice providers (APPs) are essential members of intensive care unit (ICU) interprofessional teams and are expected to be competent in performing procedures. There are no published criteria for establishing when APPs can independently perform procedures. Simulation-based mastery learning (SBML) is an effective strategy for improving critical care skills but has not been applied to practicing ICU APPs. Objective The purpose of this study was to evaluate if an SBML curriculum could improve the critical care skills and procedural self-confidence of ICU APPs. Methods We performed a pretest-posttest study of central venous catheter (CVC) insertion, thoracentesis, and mechanical ventilation (MV) management skills among ICU APPs who participated in an SBML course at an academic hospital. For each skill, APPs underwent baseline skills assessments (pretests) on a simulator using previously published checklists, followed by didactic sessions and deliberate practice with individualized feedback. Within 2 weeks, participants were required to meet or exceed previously established minimum passing standards (MPS) on simulated skills assessments (posttests) using the same checklists. Further deliberate practice was provided for those unable to meet the MPS until they retested and met this standard. We compared pretest to posttest skills checklist scores and procedural confidence. Results All 12 eligible ICU APPs participated in internal jugular CVC, subclavian CVC, and MV training. Five APPs participated in thoracentesis training. At baseline, no APPs met the MPS on all skills. At training completion, all APPs achieved the mastery standard. Internal jugular CVC pretest performance improved from a mean of 67.2% (standard deviation [SD], 28.8%) items correct to 97.1% (SD, 3.8%) at posttest (P = 0.005). Subclavian CVC pretest performance improved from 29.2% (SD, 32.7%) items correct to 93.1% (SD 3.9%) at posttest (P < 0.001). Thoracentesis pretest skill improved from 63.9% (SD, 30.6%) items correct to 99.2% (SD, 1.7%) at posttest (P = 0.054). Pretest MV skills improved from 54.8% (SD, 19.7%) items correct to 92.3% (SD, 5.0%) at posttest (P < 0.001). APP procedural confidence improved for each skill from pre to posttest. Conclusion SBML is effective for training APPs to perform ICU skills. Relying on traditional educational methods does not reliably ensure that APPs are adequately prepared to perform skills such as CVC insertion, thoracentesis, and MV management.
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Hughes SM, Carmichael JJ. Malignant Pleural Effusions: Updates in Diagnosis and Management. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010115. [PMID: 36676064 PMCID: PMC9861375 DOI: 10.3390/life13010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
Malignant pleural effusions remain a significant clinical problem resulting in greater than 125,000 hospitalizations per year and leading to over 5 billion dollars in healthcare utilization costs. Not only are health care expenditures related to malignant pleural effusion significant, but malignant pleural effusions also often result in significant patient discomfort and distress, largely at the end of life. Advances in management over the past several years have provided patients with greater autonomy as they are able to provide self-aid at home either alone or with family assistance. Additionally, practice changes have allowed for fewer interventions allowing patients to spend more time out of the clinic or inpatient wards.
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Large Intrathoracic Desmoid Tumor and Re-Expansion Pulmonary Edema: Case Report and Review of the Literature. Medicina (B Aires) 2022; 58:medicina58121857. [PMID: 36557059 PMCID: PMC9785014 DOI: 10.3390/medicina58121857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Re-expansion pulmonary edema is a potentially life-threatening situation following thoracic surgery of a compromised lung. We report the case of a 24-year-old female scheduled for a resection of a large intrathoracic desmoid tumor that presented with re-expansion pulmonary edema at the conclusion of her surgery and discuss the clinical presentation, mechanism and predictors of this entity and review similar cases reported in the literature.
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Control of bleeding from intercostal artery laceration. Respir Med Case Rep 2022; 40:101783. [PMID: 36440304 PMCID: PMC9685333 DOI: 10.1016/j.rmcr.2022.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022] Open
Abstract
Laceration of an intercostal artery is a rare but potentially catastrophic complication of pleural procedures such as thoracentesis. Recognition of this problem often occurs late in the bleeding process, only after hemodynamic decompensation has occurred. Aggressive and emergent measures are usually undertaken such as angiographic embolization or thoracotomy. In our review of the literature, manual pressure over the pleural space is not described as an intervention in case reports or case series. We demonstrate the first video proof of the immediate success of direct pressure over an intercostal site as a simple, rapid, and effective method for definitively stopping intercostal arterial hemorrhage after a pleural procedure.
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Osman KT, Abdelfattah AM, Mahmood SK, Elkhabiry L, Gordon FD, Qamar AA. Refractory Hepatic Hydrothorax Is an Independent Predictor of Mortality When Compared to Refractory Ascites. Dig Dis Sci 2022; 67:4929-4938. [PMID: 35534742 DOI: 10.1007/s10620-022-07522-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 02/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatic hydrothorax (HHT) is an uncommon but significant complication of cirrhosis and portal hypertension, associated with a worse prognosis and mortality. Nearly 25% of patients with HHT will have refractory pleural effusion. It is unclear if refractory HHT has a different prognosis compared to refractory ascites. AIMS We aim to evaluate the prognostic significance of refractory HHT when compared to refractory ascites. METHODS Forty-seven patients who had refractory HHT in a tertiary care center were identified, and matched, retrospectively, one-to-one by age, gender and MELD-Na with 47 patients with refractory ascites. One-year mortality rate was compared between both groups. Cox proportional hazard regression was used to identify the association between different covariates and primary endpoint. RESULTS The 1-year mortality was 51.06% in the HHT group compared to 19.15% in the refractory ascites group. The median survival for patients with refractory hepatic hydrothorax was 4.87 months while the median survival for patients with refractory ascites exceeded 1 year. The presence of HHT was statistically significant in predicting the development of 1-year mortality [Hazard Ratio (HR) 4.45, 95% Confidence Interval (CI) 2.25-8.82; P value < 0.001]. Furthermore, refractory HHT remained associated with one-year mortality after adjusting for all other covariates. In a subgroup of patients with MELD-Na ≤ 20, HHT continued to be a significant predictor of one-year mortality (HR 3.30, 95% CI 1.47-7.40; P value 0.004). CONCLUSIONS Refractory HHT is a significant independent predictor of mortality and offers additional prognostic value.
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Affiliation(s)
- Karim T Osman
- Department of Internal Medicine, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA.
| | - Ahmed M Abdelfattah
- Department of Gastroenterology, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA
| | - Syed K Mahmood
- Department of Gastroenterology, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA
| | - Lina Elkhabiry
- Department of Internal Medicine, University of Alexandria, Alexandria, Egypt
| | - Fredric D Gordon
- Department of Transplant and Hepatobiliary Diseases, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - Amir A Qamar
- Department of Transplant and Hepatobiliary Diseases, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA.,Tufts University School of Medicine, Boston, MA, USA
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Nguyen ET, Bayanati H, Hurrell C, Aitken M, Cheung EM, Gupta A, Harris S, Sedlic T, Taylor JL, Gahide G, Dennie C. Canadian Association of Radiologists/Canadian Association of Interventional Radiologists/Canadian Society of Thoracic Radiology Guidelines on Thoracic Interventions. Can Assoc Radiol J 2022; 74:272-287. [PMID: 36154303 DOI: 10.1177/08465371221122807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thoracic interventions are frequently performed by radiologists, but guidelines on appropriateness criteria and technical considerations to ensure patient safety regarding such interventions is lacking. These guidelines, developed by the Canadian Association of Radiologists, Canadian Association of Interventional Radiologists and Canadian Society of Thoracic Radiology focus on the interventions commonly performed by thoracic radiologists. They provide evidence-based recommendations and expert consensus informed best practices for patient preparation; biopsies of the lung, mediastinum, pleura and chest wall; thoracentesis; pre-operative lung nodule localization; and potential complications and their management.
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Affiliation(s)
- Elsie T Nguyen
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Hamid Bayanati
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Matthew Aitken
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada,St. Michael's Hospital, University of Toronto, ON, Canada
| | - Edward M Cheung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Ashish Gupta
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Scott Harris
- Health Sciences Centre, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Tony Sedlic
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jana Lyn Taylor
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Gerald Gahide
- Service de radiologie interventionelle, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Fan L, Ma W, Ma J, Yang L, Wang Z, Xu K, Jia Y, Sun B, Sieren JC, Yang H, Yao F. The improved success rate and reduced complications of a novel localization device vs. hookwire for thoracoscopic resection of small pulmonary nodules: a single-center, open-label, randomized clinical trial. Transl Lung Cancer Res 2022; 11:1702-1712. [PMID: 36090631 PMCID: PMC9459612 DOI: 10.21037/tlcr-22-555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/11/2022] [Indexed: 01/28/2023]
Abstract
Background In our previous study, we developed a 4-hook claw-suture localization device for pulmonary nodule resection, which acheived satifisfactory results. Following this, we conducted this single-center, open-label, randomized clinical trial to compare the success rate and complication rate of this novel localization device and currently widely-used hookwire. Methods Patients with small pulmonary nodules (0.4-1 cm) who received preoperative localization and thoracoscopic resection at Shanghai Chest Hospital were randomly assigned (1:2 ratio, via computer-generated randomized numbers) to undergo localization using either a novel claw-suture system (claw group) or classical (hookwire group) localization device. The primary endpoint of this study was localization success rate, and the secondary endpoints included complications, localization-related time, and pain. Results A total of 411 patients were randomly assigned to the claw group (n=136) or the hookwire group (n=275) before thoracoscopic resection of small pulmonary nodules and analyzed. Compared with the hookwire group, the claw group had a significantly higher success rate (133/136, 97.8% vs. 254/275, 92.4%, P=0.027), less asymptomatic hemorrhage (16.9% vs. 37.5%, P=0.003) and pleural reaction (0% vs. 5.1%, P=0.017), as well as better pain alleviation 10 min after localization (measured using the difference between two visual analog scale scores, 0.84±0.98 vs. 0.35±0.79, P<0.001). In contrast, the hookwire group was associated with a shorter localization procedure duration than the claw group (7.2±2.9 vs. 14.4±6.6 min, P<0.001). In the multiple localization subgroup, the claw group compared to the hookwire group also achieved higher success (32/33, 97.0% vs. 70/86, 81.4%) and less pleural reaction (0% vs. 16.3%). Conclusions The new claw-suture localization device is superior to traditional hookwire, with a higher success rate, fewer complications, and better patient tolerance for preoperative localization of small pulmonary nodules. Trial Registration Chinese Clinical Trial Registry ChiCTR1900027346.
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Affiliation(s)
- Liwen Fan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenyan Ma
- Clinical Research Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Ma
- Department of Thoracic Surgery, Anhui Chest Hospital, Hefei, China
| | - Longtang Yang
- Department of Radiology, Funan County No. 3 People’s Hospital, Funan, China
| | - Zhexin Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ke Xu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yunxuan Jia
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Beibei Sun
- Institute for Thoracic Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jessica C. Sieren
- Department of Radiology and Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Malone K, Stevens CM, Merriman C, Harper D, Wadhwa R, D'agostino HR. A Sleeve-Sheath With a Coaxial Exchangeable Catheter for Palliative Evacuation of Recurrent Thoracic and Abdominal Effusions. Cureus 2022; 14:e25174. [PMID: 35747036 PMCID: PMC9209405 DOI: 10.7759/cureus.25174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Herein we describe an outer cannula sleeve-sheath with a coaxially inserted exchangeable drainage catheter (SCDC) for effective evacuation of recurrent symptomatic fluid collections in the thorax and abdomen on patients in lieu of, or failed, current evacuation catheters and methods. The design is an alternative to existing commercially available devices and adds distinct enhancements with the possibility of intrathoracic or intrabdominal trans outer sleeve-sheath diagnostic or therapeutic interventions. This device aims at requiring a single invasive procedure (thoracentesis and paracentesis) while offering catheter exchange and repositioning if malfunction or malposition occurs during the patient’s lifetime. The SCDC outer sheath in the subcutaneous tissues of the thorax or abdomen has built-in two antibacterial cuffs to prevent infection. At the same time, the exchangeable coaxially inserted drainage catheter is deployed over a guidewire within the thoracic or abdominal cavities. The drainage catheter has a fluid dynamic proven efficient design to facilitate drainage and can recanalize its lumen if occluded by fibrin or tissue.
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Mochida Y, Nishizawa R, Ochiai K, Inoue Y, Kaita Y, Yamaguchi Y. Delayed tension gastrothorax caused necrosis of stomach and re-expansion pulmonary edema: a case report. Surg Case Rep 2022; 8:100. [PMID: 35585466 PMCID: PMC9117577 DOI: 10.1186/s40792-022-01454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic tension gastrothorax is a rare and potentially fatal condition occurring in patients with congenital or acquired diaphragmatic defects. Traumatic tension gastrothorax leads to acute and severe respiratory distress. Delayed tension gastrothorax that develops late during injury can be more severe. Case presentation An 84-year-old woman was brought to our facility with cardiac arrest and returned to spontaneous circulation after 2 min of cardiopulmonary resuscitation. Computed tomography showed diaphragmatic injury and tension gastrothorax due to trauma because of a fall episode few days earlier. Emergency thoracotomy and laparotomy was performed, because nasogastric tube insertion failed. There was a partially necrotic stomach in the chest cavity. The stomach was retracted from the thoracic cavity into the abdominal cavity and placed in its proper position. There was a 5 cm tear of the diaphragm. The tear was sutured and closed and then the necrotic area of the stomach was resected. Although the surgery relieved the intrathoracic compression, it resulted in re-expansion pulmonary edema immediately after surgery and hypoxemia. The patient was unable to overcome the hypoxemic state and eventually died. Conclusions Delayed tension gastrothorax can lead not only to obstructive shock due to intrathoracic compression but also to more severe organ ischemia and re-expansion pulmonary edema due to insufflation.
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Affiliation(s)
- Yuki Mochida
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.
| | - Ryohei Nishizawa
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Koji Ochiai
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Yoshitaka Inoue
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Yasuhiko Kaita
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
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López-Baamonde M, Eulufi S, Ascaso M, Arguis MJ, Navarro-Ripoll R, Rovira I. Unilateral pulmonary edema associated factors after minimally invasive mitral valve surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:134-142. [PMID: 35305949 DOI: 10.1016/j.redare.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 03/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES In recent years, minimally invasive cardiac surgery (MICS) has been developed and applied to a greater number of pathologies, especially in mitral valve surgeries, as it obtains results comparable to those of conventional techniques while entailing lower surgical trauma and shorter recovery time. MICS requiring one-lung ventilation has been associated to the appearance of unilateral pulmonary edema (UPE), which is a potentially serious complication. The objective is determining the incidence of UPE after mitral MICS and its development associated factors. MATERIAL AND METHODS Observational descriptive and single-center study analyzing data from patients undergoing mitral valve MICS (right mini-thoracotomy) consecutively collected between the years 2015 and 2017. RESULTS A total of 93 patients were included and 26 presented UPE. The most common complications after mitral valve MICS were atrial fibrillation (38.7%), UPE (28%) and transient and/or definitive second- or third-degree auriculoventricular block (19.4%). The UPE group had longer ICU stay (3.3 ± 8.0 vs. 1.84 ± 2.23 days) and longer total hospitalization length-of-stay (15.5 ± 34.7 vs. 10.6 ± 7.5 days). The mortality in the UPE group was 3.9%. A significant association was found between the following collected variables and the development of postoperative UPE: preoperative baseline pulse oximetry, preoperative use of ACE inhibitors, postoperative atrial fibrillation and 24 first-hours cumulative chest tube drainage volume on the first 24 h. CONCLUSIONS The incidence of UPE is high and its appearance is associated with a longer ICU and total length of stay. More studies are required to understand its pathophysiology and apply measures to help decreasing its appearance.
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Affiliation(s)
- M López-Baamonde
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - S Eulufi
- Servicio de Anestesiología y Reanimación, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - M Ascaso
- Servicio de Cirugía Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M J Arguis
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain
| | - R Navarro-Ripoll
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain
| | - I Rovira
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain
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Kuvaja P, Keinänen N, Pakanen L. The incidence of iatrogenic deaths in the Finnish cause-of-death statistics; a retrospective study. J Forensic Leg Med 2022; 86:102302. [PMID: 34999300 DOI: 10.1016/j.jflm.2021.102302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE An adverse event in health care leading to death is a significant event when assessing patient safety. This study was designed in order to assess, how many iatrogenic deaths are registered in Finland annually, and what type of treatment they are mostly related to. METHODS Material was collected using cause of death-statistics that includes "manner of death"-classification in Finland in 2014-2015. RESULTS There were 350 cases that met the criteria of the study. In a majority of the cases (264, 75%), a medico-legal autopsy was performed. This represents only 1.4% of all medicolegal autopsies during the study period in Finland. The cases were most often related to medication (30%) or known high-risk procedures such as gastrointestinal surgery (23%) and cardiothoracic surgery (11%). Only 12% of the cases had no prior significant medical history. Patient characteristics were somewhat different among the surgical disciplines, probably reflecting treatment practices. CONCLUSION Deaths that are classified as iatrogenic are mostly related to known high-risk surgery or medication. Further studies are needed to assess the true incidence of malpractice among this material.
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Affiliation(s)
- Paula Kuvaja
- Forensic Medicine Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 310, FI-90101, Oulu, Finland.
| | - Noora Keinänen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 310, FI-90101, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 310, FI-90101, Oulu, Finland; Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
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Ruwanpathirana PS, Karunatillake R, Jayasinghe S. Positive pressure–assisted pleural aspiration: A case report of a novel procedure and a review of literature. SAGE Open Med Case Rep 2022; 10:2050313X221122450. [PMID: 36090532 PMCID: PMC9459455 DOI: 10.1177/2050313x221122450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 08/01/2022] [Indexed: 11/21/2022] Open
Abstract
Drainage of a pleural effusion is done either by inserting an intercostal tube or
by aspirating pleural fluid using a syringe. The latter is a time-consuming and
labour-intensive procedure. The serious complications of pleural aspiration are
the development of a pneumothorax and re-expansion pulmonary oedema. We describe
an observation made during a pleural aspiration in a patient who was on positive
pressure ventilation. We explain the physiological basis for the observation,
the safety of the procedure and its potential to reduce complications by
reviewing the literature. A 56-year-old Sri Lankan female patient with end-stage
kidney disease presented with fluid overload and bilateral pleural effusions.
She was found to have concurrent COVID pneumonia. The patient was on bilevel
positive airway pressure, non-invasive ventilation when pleural aspiration was
done. The pleural fluid drained completely without the need for aspiration, once
the cannula was inserted into the pleural space. One litre of fluid drained in
15 min without the patient developing symptoms or complications. Positive
pressure ventilation leads to a supra-atmospheric (positive) pressure in the
pleural cavity. This leads to a persistent positive pressure gradient throughout
the procedure, leading to complete drainage of pleural fluid. Pleural fluid
drainage in mechanically ventilated patients has been proven to be safe,
implying the safety of positive pressure ventilation in pleural fluid aspiration
and drainage. It further has the potential to reduce the incidence of
post-aspiration pneumothorax by reducing the pressure fluctuations at the
visceral pleura. Re-expansion pulmonary oedema is associated with a higher
negative pleural pressure during aspiration, and the use of positive pressure
ventilation can theoretically prevent re-expansion pulmonary oedema. Positive
pressure ventilation can reduce the re-accumulation of the effusion as well. We
suggest utilizing positive pressure ventilation to assist pleural aspiration in
suitable patients.
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Sundaralingam A, Bedawi EO, Harriss EK, Munnavar M, Rahman NM. The Frequency, Risk Factors and Management of Complications from Pleural Procedures. Chest 2021; 161:1407-1425. [PMID: 34896096 DOI: 10.1016/j.chest.2021.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022] Open
Abstract
Pleural disease is a common presentation and spans a heterogenous population across broad disease entities but a common feature is the requirement for interventional procedures. Despite the frequency of such procedures, there is little consensus on rates of complications and risk factors associated with such complications. Here follows a narrative review based on a structured search of the literature. Searches were limited to 2010 onwards, in recognition of the sea-change in procedural complications following the mainstream use of thoracic ultrasound (US). Procedures of interest were limited to thoracocentesis, intercostal drains (ICD), indwelling pleural catheters (IPC) and local anaesthetic thoracoscopy (LAT). 4308 studies were screened, to identify 48 studies for inclusion. Iatrogenic pneumothorax (PTX) remains the commonest complication following thoracocentesis: 3.3% (95% CI, 3.2-3.4), though PTX requiring intervention was rare: 0.3% (95% CI, 0.2-0.4) when the procedure was US guided. Drain blockage and displacement are the commonest complications following ICD insertion (6.3%, and 6.8%, respectively). IPC related infections can be a significant problem: 5.8% (95% CI, 5.1-6.7), however most cases can be managed without removal of the IPC. LAT has an overall mortality of 0.1% (95% CI, 0.03-0.3). Data on safety and complication rates in procedural interventions are limited by methodological problems and novel methods to study this topic bears consideration. Whilst complications remain rare events, once encountered, they have the potential to rapidly escalate. It is of paramount importance for operators to prepare and have in place plans for such events, to ensure high quality and above all, safe care.
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Affiliation(s)
- Anand Sundaralingam
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital.
| | - Eihab O Bedawi
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital
| | | | | | - Najib M Rahman
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital; University of Oxford, NIHR Oxford Biomedical Research Centre
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A Case of Multiple Posterior Intercostal Artery Common Trunks in Conjunction with Additional Arterial Variations. Case Rep Surg 2021; 2021:7430752. [PMID: 34840849 PMCID: PMC8616708 DOI: 10.1155/2021/7430752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Several thoracic vasculature variations were observed in an 81-year-old male cadaver during routine dissection. These included 5 common trunks of posterior intercostal arteries, a descending branch of the right vertebral artery, and atypical neurovascular relationships within intercostal spaces. On the right side, two common trunks of posterior intercostal arteries were observed supplying the 4th-7th intercostal spaces and 9th-11th intercostal spaces, respectively. There was also a small accessary branch supplying the 9th intercostal space. The first three posterior intercostal spaces on the right were supplied by a descending branch of the vertebral artery. On the left side, three common trunks of posterior intercostal arteries were encountered, supplying intercostal spaces 3-5, 6-7, and 11 plus the subcostal space. An atypical neurovascular relationship was observed in the right 6th intercostal space, as well as the left 2nd, 3rd, and 6th intercostal spaces. This is the first case report that presents 5 common trunks of posterior intercostal arteries, as well as common trunks in conjunction with other arterial variation in the posterior thoracic wall. These variations carry a high level of clinical significance and may be helpful in guiding decision-making related to surgical procedures related to the posterior thoracic cavity and spine.
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Park C, Lee J. Massive hemothorax due to intercostal arterial bleeding after percutaneous catheter removal in a multiple-trauma patient: A case report. World J Clin Cases 2021; 9:9942-9947. [PMID: 34877334 PMCID: PMC8610904 DOI: 10.12998/wjcc.v9.i32.9942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/30/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intercostal arterial bleeding is unusual complication of percutaneous chest procedures. However, intercostal arterial bleeding is likely to result in critical complications such as abnormalities in vital signs, hypovolemic shock, and death due to massive bleeding. Therefore, it is very important to establish the diagnosis of intercostal arterial bleeding and to initiate treatment.
CASE SUMMARY We report a case in which a 59-year-old woman who was hospitalized at intensive care unit with multiple trauma had a massive hemothorax after the removal of a percutaneous catheter. She sustained a refractory right pleural effusion due to biloma caused by a traumatic injury to the liver, despite persistent intraperitoneal drainage. As a result, atelectasis persisted in the dependent portion of the right lung. Therefore, we performed right percutaneous catheter drainage (8.5-F pigtail catheter) for pleural effusion drainage at the 7th intercostal space. After percutaneous catheter removal, portable chest radiography and vital signs of the patient assisted in establishing a diagnosis of intercostal arterial bleeding. Intercostal arterial bleeding was also confirmed using transarterial angiography; and embolization was performed. The patient’s condition progressively improved, and no further intervention was required.
CONCLUSION Massive hemothorax is a rare complication of percutaneous catheter removal. Clinicians should carefully examine and diagnose patients to improve prognosis. And interventional selective angiography may be a feasible and minimally invasive treatment for intercostal arterial bleeding control.
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Affiliation(s)
- Chanhee Park
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu 42601, South Korea
| | - Jeongwoo Lee
- Division of Trauma Surgery, Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu 42601, South Korea
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Smith TA, Gage D, Quencer KB. Narrative review of vascular iatrogenic trauma and endovascular treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1199. [PMID: 34430640 PMCID: PMC8350708 DOI: 10.21037/atm-20-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.
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Affiliation(s)
- Tyler Andrew Smith
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT, USA
| | - David Gage
- Department of Medicine, Intermountain Healthcare, Murray, UT, USA
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Abstract
The evolution of pleural disease imaging modalities through the years has helped the scientific community understand and treat various disease states. Ultrasound (US) has been an image modality that has reigned superior to those used in the past such as chest X-ray and computed tomographic scan in terms of cost effectiveness, portability, and reduction in unwarranted radiation exposure to patients. Here we provide a succinct review of US use in pleural disease including imaging techniques, identifying safe pleural space for access, and predicting pleural fluid volume and etiology along with specificities regarding trapped lung identification and pleural mass biopsy. We believe bedside chest US is an adjunct to the physical exam adding superior diagnostic abilities. Further research is warranted in more specific aspects of sonographic use such as in fibrinolytic therapy management, evaluation for trapped lung, and the utility of specific modes like the color flow Doppler.
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Safai Zadeh E, Weide J, Dietrich CF, Trenker C, Koczulla AR, Görg C. Diagnostic Accuracy of B-Mode- and Contrast-Enhanced Ultrasound in Differentiating Malignant from Benign Pleural Effusions. Diagnostics (Basel) 2021; 11:diagnostics11071293. [PMID: 34359376 PMCID: PMC8305637 DOI: 10.3390/diagnostics11071293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose: To evaluate the value of CEUS in differentiating malignant from benign pleural effusions (PEs). Methods: From 2008 to 2017, 83 patients with PEs of unknown cause were examined using B-mode thoracic ultrasound (B-TUS), CEUS, and cytological examination. The extent of enhancement of the pleural thickening, the presence of enhancement of septa or a solid mass within the PE, and the homogeneity of the enhancement in the associated lung consolidation, were examined. Subsequently, the diagnostic value of cytology, B-TUS, and CEUS in differentiating malignant from benign PEs was determined. Results: With CEUS, markedly enhanced pleural thickening and inhomogeneous enhanced lung consolidation were significantly more frequently associated with malignancy (p < 0.05). In the subgroup analysis, the use of CEUS increased the sensitivity from 69.2 to 92.3 in patients with initial negative cytology but clinical suspicion of malignant PE; it also increased the specificity from 63.0 to 90.0, the positive predictive value from 69.2 to 92.3, the negative predictive value from 63.0 to 90.0, and the diagnostic accuracy from 66.7 to 87.5, in the evaluation of PE malignancy. Conclusion: The use of clinically based B-TUS and CEUS as a complementary method to cytological evaluation may be beneficial for evaluating a PE of unknown cause. CEUS patterns of enhanced pleural thickening and inhomogeneous enhanced lung consolidation may suggest a malignant PE.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (J.W.)
| | - Johanna Weide
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (J.W.)
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland;
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany;
| | - Andreas Rembert Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, 83471 Schoenau am Koenigssee, Germany;
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), 35033 Marburg, Germany;
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (J.W.)
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research (DZL), 35033 Marburg, Germany;
- Correspondence: ; Tel.: +49-6421-58-61538; Fax: +49-6421-58-62825
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Panaro F, Al Taweel B, Leon P, Ghinolfi D, Testa G, Kalisvaart M, Muiesan P, Romagnoli R, Lesurtel M, Cassese G, Truant S, Addeo P, Sainz-Barrica M, Baccarani U, De Simone P, Belafia F, Herrero A, Navarro F. Morbidity and mortality of iatrogenic hemothorax occurring in a cohort of liver transplantation recipients: a multicenter observational study. Updates Surg 2021; 73:1727-1734. [PMID: 34216370 PMCID: PMC8254062 DOI: 10.1007/s13304-021-01098-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022]
Abstract
Hemothorax (HT) is a life-threatening condition, mainly iatrogenic and poorly explored in Liver Transplantation (LT) recipients. The aim of this study is to report and analyze for the first time incidence and outcomes of HT in LT recipients, as well as to suggest a management strategy. Data concerning 7130 consecutive adult liver and liver-kidney transplant recipients were retrospectively collected from ten Transplantation Centers' institutional databases, over a 10-year period. Clinical parameters, management strategies and survival data about post-operative HT were analyzed and reported. Thirty patients developed HT during hospitalization (0.42%). Thoracentesis was found to be the most common cause of HT (16 patients). A non-surgical management was performed in 17 patients, while 13 patients underwent surgery. 19 patients developed thoracic complications after HT treatment, with an overall mortality rate of 50%. The median length of stay in Intensive Care Units was 22 days (IQR25-75 5-66.5). Postoperative hemothorax is mainly due to iatrogenic causes in LT recipients. Despite rare, it represents a serious complication with a high mortality rate and a challenging medical and surgical management. Its occurrence should always be prevented.
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Affiliation(s)
- Fabrizio Panaro
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France. .,Division of HBP Surgery and Transplantation, Department of Surgery, St. Eloi Hospital, Montpellier University Hospital-School of Medicine, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
| | - Bader Al Taweel
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
| | - Piera Leon
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
| | - Davide Ghinolfi
- Division of Transplantation, Department of Surgery, Pisa University Hospital, Pisa, Italy
| | - Giuliano Testa
- Liver Transplantation Unit, Department of Surgery, Baylor University Hospital, Dallas, TX, USA
| | | | - Paolo Muiesan
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Renato Romagnoli
- Liver Transplantation Unit, Department of Surgery, Turin University Hospital, Turin, Italy
| | - Mickael Lesurtel
- Division of Liver Transplantation, Department of Surgery, Lyon University Hospital, Lyon, France
| | - Gianluca Cassese
- HPB Surgery Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Stephanie Truant
- Division of Transplantation, Department of Surgery, Lille University Hospital, Lille, France
| | - Pietro Addeo
- Department of Surgery, HPB Surgery and Liver Transplantation, Hôpital de Hautepierre, University Hospital, Strasbourg, France
| | - Mauricio Sainz-Barrica
- Division of Transplantation, Department of Surgery, Leuven University Hospital, Leuven, Belgium
| | - Umberto Baccarani
- Division of Transplantation, Department of Surgery, Udine University Hospital, Udine, Italy
| | - Paolo De Simone
- Division of Transplantation, Department of Surgery, Pisa University Hospital, Pisa, Italy
| | - Fouad Belafia
- Department of ICU, Montpellier University Hospital, 34070, Montpellier, France
| | - Astrid Herrero
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
| | - Francis Navarro
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
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Tajarernmuang P, Gonzalez AV, Valenti D, Beaudoin S. Overuse of small chest drains for pleural effusions: a retrospective practice review. Int J Health Care Qual Assur 2021; ahead-of-print. [PMID: 33909374 DOI: 10.1108/ijhcqa-11-2020-0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Small-bore drains (≤ 16 Fr) are used in many centers to manage all pleural effusions. The goal of this study was to determine the proportion of avoidable chest drains and associated complications when a strategy of routine chest drain insertion is in place. DESIGN/METHODOLOGY/APPROACH We retrospectively reviewed consecutive pleural procedures performed in the Radiology Department of the McGill University Health Centre over one year (August 2015-July 2016). Drain insertion was the default drainage strategy. An interdisciplinary workgroup established criteria for drain insertion, namely: pneumothorax, pleural infection (confirmed/highly suspected), massive effusion (more than 2/3 of hemithorax with severe dyspnea /hypoxemia), effusions in ventilated patients and hemothorax. Drains inserted without any of these criteria were deemed potentially avoidable. FINDINGS A total of 288 procedures performed in 205 patients were reviewed: 249 (86.5%) drain insertions and 39 (13.5%) thoracenteses. Out of 249 chest drains, 113 (45.4%) were placed in the absence of drain insertion criteria and were deemed potentially avoidable. Of those, 33.6% were inserted for malignant effusions (without subsequent pleurodesis) and 34.5% for transudative effusions (median drainage duration of 2 and 4 days, respectively). Major complications were seen in 21.5% of all procedures. Pneumothorax requiring intervention (2.1%), bleeding (0.7%) and organ puncture or drain misplacement (2%) only occurred with drain insertion. Narcotics were prescribed more frequently following drain insertion vs. thoracentesis (27.1% vs. 9.1%, p = 0.03). ORIGINALITY/VALUE Routine use of chest drains for pleural effusions leads to avoidable drain insertions in a large proportion of cases and causes unnecessary harms.
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Affiliation(s)
- Pattraporn Tajarernmuang
- Division of Pulmonary, Critical Care, and Allergy, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anne V Gonzalez
- Respiratory Division, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - David Valenti
- Radiology Department, McGill University Health Centre, Montreal, Canada
| | - Stéphane Beaudoin
- Respiratory Division, Department of Medicine, McGill University Health Centre, Montreal, Canada
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Halili H, Azizkhani R, Tavakoli Garmaseh S, Jafarpisheh MS, Heydari F, Masoumi B, Maghami Mehr A. Comparing the Effect of Lidocaine-Prilocaine Cream and Infiltrative Lidocaine on Overall Pain Perception During Thoracentesis and Abdominocentesis: A Randomized Clinical Trial. Anesth Pain Med 2020; 11:e106275. [PMID: 34249663 PMCID: PMC8256634 DOI: 10.5812/aapm.106275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/23/2020] [Accepted: 09/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background Acute pain management is a core ethical commitment to medical practice. However, there is evidence to suggest that sometimes infiltrative lidocaine (IL) is not used prior to thoracentesis and abdominocentesis due to the belief that two needles cause greater pain than one. However, topical anesthetics like lidocaine-prilocaine cream (LPC) are painless, easy to use, and have less systemic side effects. Therefore, LPC can be a suitable substitute for medical procedures. Objectives This study was designed to compare the analgesic effects of LPC with IL in thoracentesis and abdominocentesis. Methods Patients were divided into two study groups, including individuals seeing a physician for a thoracentesis (N = 36) and those seeing a physician for an abdominocentesis (N = 33). Patients were randomly assigned to the IL (N = 35) or LPC (N = 34) groups for diagnostic and/or therapeutic purposes. The IL group received 100 mg of 2% lidocaine 5 minutes prior to their procedure, whereas the LPC group received 2.5 g of lidocaine-prilocaine cream. The cream was spread over a 20 - 25 cm2 area and occluded with dressing plaster for 30 minutes prior to the procedure. In both study groups, the thoracentesis and abdominocentesis were ultrasound-guided. Results The findings suggest a non-significant difference between overall pain perception in LPC and IL groups generally, as well as specifically in abdominocentesis and thoracentesis groups. Furthermore, the result remained the same after controlling for confounding variables. The number of attempts to perform successful abdominocentesis was significantly higher in the LPC than IL (P-value = 0.003) group but was not significant in the thoracentesis group (P-value = 0.131). The level of patient satisfaction in the LPC and IL groups were not significantly different (P-value > 0.05). Conclusions Overall, LPC appears to be an appropriate alternative to IL in reducing pain during thoracentesis and abdominocentesis, but it seemed to increase unsuccessful medical procedure attempts.
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Affiliation(s)
- Hanieh Halili
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Azizkhani
- Emergency Medicine Department, Isfahan University of Medical Sciences, Isfahan, Iran
- Corresponding Author: Al Zahra Hospital, Soffeh Blvd, Postal Code: 8174675731, Isfahan, Iran. Tel: +98-31362020202,
| | | | | | - Farhad Heydari
- Emergency Medicine Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Masoumi
- Emergency Medicine Department, Isfahan University of Medical Sciences, Isfahan, Iran
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Grigoriadou GΙ, Esagian SM, Ryu HS, Nikas IP. Molecular Profiling of Malignant Pleural Effusions with Next Generation Sequencing (NGS): Evidence that Supports Its Role in Cancer Management. J Pers Med 2020; 10:jpm10040206. [PMID: 33139621 PMCID: PMC7712846 DOI: 10.3390/jpm10040206] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Malignant pleural effusions (MPEs) often develop in advanced cancer patients and confer significant morbidity and mortality. In this review, we evaluated whether molecular profiling of MPEs with next generation sequencing (NGS) could have a role in cancer management, focusing on lung cancer. We reviewed and compared the diagnostic performance of pleural fluid liquid biopsy with other types of samples. When applied in MPEs, NGS may have comparable performance with corresponding tissue biopsies, yield higher DNA amount, and detect more genetic aberrations than blood-derived liquid biopsies. NGS in MPEs may also be preferable to plasma liquid biopsy in advanced cancer patients with a MPE and a paucicellular or it could be difficult to obtain tissue/fine-needle aspiration biopsy. Of interest, post-centrifuge supernatant NGS may exhibit superior results compared to cell pellet, cell block or other materials. NGS in MPEs can also guide clinicians in tailoring established therapies and identifying therapy resistance. Evidence is still premature regarding the role of NGS in MPEs from patients with cancers other than lung. We concluded that MPE processing could provide useful prognostic and theranostic information, besides its diagnostic role.
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Affiliation(s)
- Georgia Ι. Grigoriadou
- 1st Department of Medical Oncology, Theageneio Anticancer Hospital, 54007 Thessaloniki, Greece;
| | - Stepan M. Esagian
- Department of Medicine, School of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul 03080, Korea;
| | - Ilias P. Nikas
- School of Medicine, European University of Cyprus, 2404 Nicosia, Cyprus
- Correspondence:
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Singh K, Balthazar P, Duszak R, Horný M, Hanna TN. Clinical Yield of Routine Chest Radiography after Ultrasound-Guided Thoracentesis. Acad Radiol 2020; 27:1379-1384. [PMID: 31831265 DOI: 10.1016/j.acra.2019.10.031] [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: 08/23/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the clinical yield of routine chest radiography in identifying pneumothorax warranting chest tube decompression in patients undergoing ultrasound-guided thoracentesis. MATERIALS AND METHODS All adult patients without pre-existing pneumothorax who underwent ultrasound-guided thoracentesis by a radiologist within a four-hospital large metropolitan academic health system over a 10-year period were identified. Demographic, clinical, and radiographic report information were obtained. Chest radiographic reports were assessed for the presence of pneumothorax and, if positive, manual image and chart review were performed. RESULTS Of 2541 consecutive ultrasound-guided thoracentesis procedures, 12 were excluded due to pre-existing pneumothorax, yielding 2529 cases. Mean patient age was 67.7 years; 54.5% were male. Overall, 89 procedures (3.5%) resulted in a postprocedural pneumothorax. Of those, only six (6.7%) had documented changes in patient symptoms. Chest tubes were placed in 15, representing 16.9% (15/89) of cases with postprocedural pneumothoraces and 0.59% (15/2,529) of all procedures. Of these 15, 5 (33.3%) had symptomatic pneumothoraces, most commonly shortness of breath. CONCLUSION Following ultrasound-guided thoracentesis, the incidence of pneumothorax requiring chest tube decompression is only 1 in 170. Of the 1 in 30 patients who develop a pneumothorax, only 1 in 6 require a chest tube. This information can inform procedural consent discussions as well as future guidelines about the necessity of routine postprocedural chest radiography.
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Affiliation(s)
- Kush Singh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, United States.
| | - Patricia Balthazar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, United States
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, United States
| | - Michal Horný
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, United States; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
| | - Tarek N Hanna
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, United States
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Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review. Case Rep Nephrol 2020; 2020:8832080. [PMID: 32934854 PMCID: PMC7479454 DOI: 10.1155/2020/8832080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022] Open
Abstract
Pleural effusions are frequently seen in patients on dialysis. A pleuroperitoneal leak or communication is a rare but important cause of pleural effusion in patients on peritoneal dialysis. This diagnosis can be made with a combination of biochemical tests and radiological modalities, in the absence of a gold standard diagnostic test. In addition to thoracocentesis, treatment often involves cessation of peritoneal dialysis and transition to hemodialysis. We describe a case of an 80-year-old man who presented with unilateral right-sided pleural effusion. He underwent therapeutic thoracocentesis and was subsequently diagnosed with a pleuroperitoneal leak through pleural fluid analysis. Peritoneal dialysis was ceased, and he transitioned temporarily to hemodialysis. He was subsequently treated with talc pleurodesis and successfully recommenced on peritoneal dialysis at six weeks after operation. In our report, we also review diagnostic imaging modalities, as well as advantages and disadvantages of each modality. A pleuroperitoneal leak is a rare but important complication of peritoneal dialysis and needs consideration in any patient on peritoneal dialysis presenting with unilateral pleural effusion.
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45
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Fang H, Xu L, Zhu F, Xia Z. Re-expansion pulmonary edema post-pneumothorax. BURNS & TRAUMA 2020; 8:tkaa032. [PMID: 32905050 PMCID: PMC7462719 DOI: 10.1093/burnst/tkaa032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/26/2020] [Accepted: 06/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
| | | | - Feng Zhu
- Correspondence. Feng Zhu, ; Zhaofan Xia,
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Desai NR, French KD, Kovitz KL. Basic and Advanced Pleural Procedures: Coding and Professional Fees Update for Pulmonologists. Chest 2020; 158:2517-2523. [PMID: 32882245 DOI: 10.1016/j.chest.2020.08.2070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 02/05/2023] Open
Abstract
There is an evolution of pleural procedures that involve broadened clinical indication and expanded scope that include advanced diagnostic, therapeutic, and palliative procedures. Finance and clinical professionals have been challenged to understand the indication and coding complexities that accompany these procedures. This article describes the utility of pleural procedures, the appropriate current procedural terminology coding, and necessary modifiers. Coding pearls that help close the knowledge gap between basic and advanced procedures aim to address coding confusion that is prevalent with pleural procedures and the risk of payment denials, potential underpayment, and documentation audits.
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Affiliation(s)
- Neeraj R Desai
- Chicago Chest Center, Elk Grove Village, IL; AMITA Health, Lisle, IL; Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL.
| | - Kim D French
- Chicago Chest Center, Elk Grove Village, IL; AMITA Health, Lisle, IL
| | - Kevin L Kovitz
- Chicago Chest Center, Elk Grove Village, IL; AMITA Health, Lisle, IL; Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL
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Sá Mendes G, De Araújo Gonçalves P, Madeira S, Oliveira P. Percutaneous closure of accidental left atrium puncture: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 33426441 PMCID: PMC7780441 DOI: 10.1093/ehjcr/ytaa194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/13/2020] [Accepted: 06/05/2020] [Indexed: 12/01/2022]
Abstract
Background Minimally invasive alternatives to surgical closure of cardiac perforations are a recognized need, especially in critically ill patients in whom predicted surgical mortality is prohibitive. To the best of our knowledge, this is the first reported case of an iatrogenic left atrium (LA) puncture closed with a plug-based vascular closure device (VCD). Case summary During a palliative right-sided thoracentesis on a 73-year-old woman, with end-stage heart failure due to rheumatic valvular heart disease, an accidental puncture and insertion of a central venous catheter into an aneurysmatic LA occurred. This complication was successfully managed percutaneously, under transthoracic echocardiographic guidance, after cardiac computed tomography planning, using a plug-based VCD. Discussion This case demonstrates the possible utility of plug-based devices for iatrogenic LA perforation closure, when surgical risk is deemed prohibitive.
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Affiliation(s)
- Gustavo Sá Mendes
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr Reinaldo dos Santos, Carnaxide 2790-134, Portugal
| | - Pedro De Araújo Gonçalves
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr Reinaldo dos Santos, Carnaxide 2790-134, Portugal
| | - Sérgio Madeira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr Reinaldo dos Santos, Carnaxide 2790-134, Portugal
| | - Paulo Oliveira
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr Reinaldo dos Santos, Carnaxide 2790-134, Portugal
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Congedo MT, Ferretti GM, Nachira D, Pennisi MA. Management of Pleural Effusions in the Emergency Department. Rev Recent Clin Trials 2020; 15:258-268. [PMID: 32579507 DOI: 10.2174/1574887115666200624194457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/02/2020] [Accepted: 04/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In symptomatic patients, admitted in emergency department for acute chest pain and dyspnea, who require an urgent treatment, a rapid diagnosis and prompt management of massive pleural effusion or hemothorax can be lifesaving. AIM The aim of this review was to summarize the current diagnostic and therapeutic approaches for the management of the main types of pleural effusions that physicians can have in an emergency department setting. METHODS Current literature about the topic was reviewed and critically reported, adding the experience of the authors in the management of pleural effusions in emergency settings. RESULTS The paper analyzed the main types of pleural effusions that physicians can have to treat. It illustrated the diagnostic steps by the principal radiological instruments, with a particular emphasis to the role of ultrasonography, in facilitating diagnosis and guiding invasive procedures. Then, the principal procedures, like thoracentesis and insertion of small and large bore chest drains, are indicated and illustrated according to the characteristics and the amount of the effusion and patient clinical conditions. CONCLUSION The emergency physician must have a systematic approach that allows rapid recognition, clinical cause identification and definitive management of potential urgent pleural effusions.
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Affiliation(s)
- Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Maria Ferretti
- Department of Thoracic Surgery, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Dania Nachira
- Department of Thoracic Surgery, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariano Alberto Pennisi
- Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
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Congenital Chylothorax: Common and Uncommon Findings in an Infant with Chylous Effusions. Neonatal Netw 2020; 38:357-364. [PMID: 31712400 DOI: 10.1891/0730-0832.38.6.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 11/25/2022]
Abstract
Congenital chylothorax is defined as an abnormal accumulation of lymphatic fluid in the pleural space. It is a rare condition in the neonate that causes significant respiratory, nutritional, and immunologic problems resulting in a high mortality rate. Presented here is a case of congenital bilateral chylothorax in a preterm infant. Fetal ultrasound at 33 weeks' gestation showed polyhydramnios, bilateral pleural effusions, ascites, and subcutaneous edema. Fetal pleuracentesis was done on the right side with 118 mL of fluid aspirated. This article addresses the management of this difficult disease process, complications, and implications for research of controversial therapies.
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Abstract
Malignant pleural effusion frequently complicates both solid and hematologic malignancies and is associated with high morbidity, mortality, and health care costs. Although no pleura-specific therapy is known to impact survival, both pleurodesis and indwelling pleural catheter (IPC) placement can significantly alleviate symptoms and improve quality of life. The optimal choice of therapy in terms of efficacy and particularly cost-effectiveness depends on patient preferences and individual characteristics, including lung expansion and life expectancy. Attempting chemical pleurodesis through an IPC in the outpatient setting appears to be a particularly promising approach in the absence of a nonexpandable lung.
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Affiliation(s)
- Majid Shafiq
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Suite 7-125, Baltimore, MD 21287, USA.
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