1
|
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.
Collapse
|
2
|
Matsuoka N, Yamaguchi M, Asai A, Kamiya K, Kinashi H, Katsuno T, Kobayashi T, Tamai H, Morinaga T, Obayashi T, Nakabayashi K, Koide S, Nakanishi M, Koyama K, Suzuki Y, Ishimoto T, Mizuno M, Ito Y. The effectiveness and safety of computed tomographic peritoneography and video-assisted thoracic surgery for hydrothorax in peritoneal dialysis patients: A retrospective cohort study in Japan. PLoS One 2020; 15:e0238602. [PMID: 32881941 PMCID: PMC7470296 DOI: 10.1371/journal.pone.0238602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Albeit uncommon, hydrothorax is an important complication of peritoneal dialysis (PD). Due to paucity of evidence for optimal treatment, this study aimed to evaluate the effectiveness and safety of computed tomographic (CT) peritoneography and surgical intervention involving video-assisted thoracic surgery (VATS) for hydrothorax in a retrospective cohort of patients who underwent PD in Japan. Methods Of the 982 patients who underwent PD from six centers in Japan between 2007 and 2019, 25 (2.5%) with diagnosed hydrothorax were enrolled in this study. PD withdrawal rates were compared between patients who underwent VATS for diaphragm repair (surgical group) and those who did not (non-surgical group) using the Kaplan-Meier method and log-rank test. Results The surgical and non-surgical groups comprised a total of 11 (44%) and 14 (56%) patients, respectively. Following hydrothorax diagnosis by thoracentesis and detection of penetrated sites on the diaphragm using CT peritoneography, VATS was performed at a median time of 31 days (interquartile range [IQR], 20–96 days). During follow-up (median, 26 months; IQR, 10–51 months), 9 (64.3%) and 2 (18.2%) patients in the non-surgical and surgical groups, respectively, withdrew from PD (P = 0.021). There were no surgery-related complications or hydrothorax relapse in the surgical group. Conclusions This study demonstrated the effectiveness and safety of CT peritoneography and VATS for hydrothorax. This approach may be useful in hydrothorax cases to avoid early drop out of PD and continue PD in the long term. Further studies are warranted to confirm these results.
Collapse
Affiliation(s)
- Naoya Matsuoka
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
- Department of Renal Transplant Surgery, Aichi Medical University, Nagakute, Japan
| | - Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Akimasa Asai
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Keisuke Kamiya
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University, Nagakute, Japan
| | - Hirofumi Tamai
- Department of Nephrology, Anjo-Kosei Hospital, Anjo, Japan
| | | | - Takaaki Obayashi
- Department of Nephrology, Narita Memorial Hospital, Toyohashi, Japan
| | | | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Michimasa Nakanishi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Katsushi Koyama
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuji Ishimoto
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Mizuno
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
- * E-mail:
| |
Collapse
|
3
|
Abstract
Various clinical trials have been published on the optimal clinical management of patients with pleural exudates, particularly those caused by malignant tumors, while little information is available on the diagnosis and treatment of pleural transudates. The etiology of pleural transudates is wide and heterogeneous, and they can be caused by rare diseases, sometimes constituting a diagnostic challenge. Analysis of the pleural fluid can be a useful procedure for establishing diagnosis. Treatment should target not only the underlying disease, but also management of the pleural effusion itself. In cases refractory to medical treatment, invasive procedures will be necessary, for example therapeutic thoracentesis, pleurodesis with talc, or insertion of an indwelling pleural catheter. Little evidence is currently available and no firm recommendations have been made to establish when to perform an invasive procedure, or to determine the safest, most efficient approach in each case. This article aims to describe the spectrum of diseases that cause pleural transudate, to review the diagnostic contribution of pleural fluid analysis, and to highlight the lack of evidence on the efficacy of invasive procedures in the management and control of pleural effusion in these patients.
Collapse
|
4
|
Bintcliffe OJ, Lee GYC, Rahman NM, Maskell NA. The management of benign non-infective pleural effusions. Eur Respir Rev 2017; 25:303-16. [PMID: 27581830 PMCID: PMC9487207 DOI: 10.1183/16000617.0026-2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/03/2016] [Indexed: 01/28/2023] Open
Abstract
The evidence base concerning the management of benign pleural effusions has lagged behind that of malignant pleural effusions in which recent randomised trials are now informing current clinical practice and international guidelines. The causes of benign pleural effusions are broad, heterogenous and patients may benefit from individualised management targeted at both treating the underlying disease process and direct management of the fluid. Pleural effusions are very common in a number of non-malignant pathologies, such as decompensated heart failure, and following coronary artery bypass grafting. Pleural fluid analysis forms an important basis of the diagnostic evaluation, and more specific assays and imaging modalities are helpful in specific subpopulations. Options for management beyond treatment of the underlying disorder, whenever possible, include therapeutically aspirating the fluid, talc pleurodesis and insertion of an indwelling pleural catheter. Randomised trials will inform clinicians in the future as to the risks and benefits of these options providing a guide as to how best to manage patient symptoms in this challenging clinical setting. Benign pleural effusion management is challenging and based on limited evidence. Treatment options are discussedhttp://ow.ly/10EOSN
Collapse
Affiliation(s)
- Oliver J Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Gary Y C Lee
- Centre for Asthma, Allergy & Respiratory Research, School of Medicine & Pharmacology, University of Western Australia, Perth, Australia
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine and Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
5
|
Chambers DM, Abaid B, Gauhar U. Indwelling Pleural Catheters for Nonmalignant Effusions: Evidence-Based Answers to Clinical Concerns. Am J Med Sci 2017; 354:230-235. [PMID: 28918827 DOI: 10.1016/j.amjms.2017.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/07/2017] [Accepted: 03/02/2017] [Indexed: 11/30/2022]
Abstract
Pleural effusions occur in 1.5 million patients yearly and are a common cause of dyspnea. For nonmalignant effusions, initial treatment is directed at the underlying cause, but when effusions become refractory to medical therapy, palliative options are limited. Tunneled pleural catheters (TPCs) are commonly used for palliation of malignant effusions, but many clinicians are reluctant to recommend these devices for palliation of nonmalignant effusions, citing concerns of infection, renal failure, electrolyte disturbances and protein-loss malnutrition. Based on the published experience to date, TPCs relieve dyspnea and can result in spontaneous pleurodesis in patients with nonmalignant effusions. The infection rate compares favorably to that for malignant effusions with possible increased risk in patients with hepatic hydrothorax and posttransplant patients. Renal failure, electrolyte disturbance and protein-loss malnutrition have not been observed. TPCs are a reasonable option in select patients to palliate nonmalignant effusions refractory to maximal medical therapy.
Collapse
Affiliation(s)
- David Maurice Chambers
- Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, Louisville, Kentucky.
| | - Bilal Abaid
- Department of Infectious Disease, University of Louisville, Louisville, Kentucky
| | - Umair Gauhar
- Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, Louisville, Kentucky
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Due to the increasing burden of pleural diseases worldwide, a personalized cost-effective management of these conditions is essential to optimize the healthcare sources. The current review is focused on latest evidence in diagnostic work-up and management of pleural diseases. RECENT FINDINGS Recent research highlights the increasing role of thoracic ultrasound in both diagnostic and therapeutic interventions and the potential suitability of cytological sampling from pleural effusions for molecular analysis, essential requirement for a satisfactory test in the era of personalized anticancer therapy. The thoracoscopic approach, by means of rigid or semirigid instruments, remains the gold standard, and attractive tools to increase diagnostic yield in semirigid pleuroscopy include insulated-tip diathermic knife and cryprobe. Talc pleurodesis and indwelling pleural catheters are the most effective interventions, and their combination, likely to result in additional benefits, is currently under investigation. SUMMARY Because of the huge variety of possible clinical settings, a proper management of pleural diseases should be tailored on a case-by-case basis and requires a multidisciplinary approach. Recent advances in technologies has conferred to interventional pulmonology an increasing relevant role in this context, leading to the development of a dedicated subspecialty, and training programs are urgently needed to standardize skills and care pathways.
Collapse
|
7
|
Reply: The Undefined Value of Pleural Interventions in Advanced Heart Failure and Recurrent Pleural Effusions. Ann Am Thorac Soc 2016; 13:448-9. [PMID: 26963360 DOI: 10.1513/annalsats.201512-852le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
8
|
Treatment options for patients with recurrent, symptomatic pleural effusions secondary to heart failure. Curr Opin Pulm Med 2015; 21:363-7. [PMID: 26016580 DOI: 10.1097/mcp.0000000000000176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Pleural effusions are a common finding in the nearly six million Americans diagnosed with heart failure. This review focuses on the historical, present and potential future trends in the management of such benign pleural effusions. RECENT FINDINGS The management of symptomatic pleural effusions, in general, and in heart failure, specifically, has evolved in the last two decades. With more options, the treatment is often individualized for patients. Newer forms of therapy are also less invasive, resulting in less procedural morbidity, recuperation and cost. SUMMARY The majority of patients with a pleural effusion resulting from heart failure will resolve their symptoms with medical therapy. Patients who experience symptoms from reaccumulation of their effusion have a selection of treatment options that can be individualized based on the patient's prognosis, functional status, need for future intervention and desires.
Collapse
|
9
|
|
10
|
Abstract
A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions. Laboratory testing helps to distinguish pleural fluid transudate from an exudate. The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process. Immunohistochemistry provides increased diagnostic accuracy. Transudative effusions are usually managed by treating the underlying medical disorder. However, a large, refractory pleural effusion, whether a transudate or exudate, must be drained to provide symptomatic relief. Management of exudative effusion depends on the underlying etiology of the effusion. Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence. Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease. Percutaneous closed pleural biopsy is easiest to perform, the least expensive, with minimal complications, and should be used routinely. Empyemas need to be treated with appropriate antibiotics and intercostal drainage. Surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of bronchopleural fistula.
Collapse
Affiliation(s)
- Vinaya S Karkhanis
- Department of Respiratory Medicine, TN Medical College and BYL Nair Hospital, Mumbai, India
| | - Jyotsna M Joshi
- Department of Respiratory Medicine, TN Medical College and BYL Nair Hospital, Mumbai, India
| |
Collapse
|
11
|
Abstract
Numerous intrapleural therapies have been adopted to treat a vast array of pleural diseases. The first intrapleural therapies proposed focused on the use of fibrinolytics and DNase to promote fluid drainage in empyema. Numerous case series and five randomized controlled trials have been published to determine the outcomes of fibrinolytics in empyema treatment. In the largest randomized trial, the use of streptokinase had no reduction in mortality, decortication rates or hospital days compared with placebo in the treatment of empyema. Criticism over study design and patient selection may have potentially affected the outcomes in this study. The development of dyspnoea is common in the setting of malignant pleural effusions. Pleural fluid evacuation followed by pleurodesis is often attempted. Numerous sclerosing agents have been studied, with talc emerging as the most effective agent. Small particle size of talc should be avoided because of increased systemic absorption potentiating toxicity, such as acute lung injury. Over the past several years, the use of chronic indwelling pleural catheters have emerged as the preferred modality in the treating a symptomatic malignant pleural effusion. For patients with malignant-related lung entrapment, pleurodesis often fails due to the presence of visceral pleural restriction; however, chronic indwelling pleural catheters are effective in palliation of dyspnoea. Finally, the use of staphylococcal superantigens has been proposed as a therapeutic model for the treatment of non-small lung cancer. Intrapleural instillation of staphylococcal superantigens increased median survival by 5 months in patients with non-small cell lung cancer with a malignant pleural effusion.
Collapse
Affiliation(s)
- J Terrill Huggins
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
| | | | | |
Collapse
|
12
|
Chalhoub M, Harris K, Castellano M, Maroun R, Bourjeily G. The use of the PleurX catheter in the management of non-malignant pleural effusions. Chron Respir Dis 2011; 8:185-91. [PMID: 21636653 DOI: 10.1177/1479972311407216] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of the PleurX catheter in the management of recurrent non-malignant pleural effusions. METHODS All subjects who underwent a PleurX catheter placement between 2003 and 2009 were evaluated. General demographic data, time to pleurodesis, complications, and a satisfaction questionnaire were collected. The subjects were divided into two groups. Group I included patients with non-malignant effusions and group II included patients with malignant effusions. RESULTS A total of 64 subjects were included in the final data analysis. A total of 23 subjects were included in group I and 41 subjects were included in group II. The diagnoses in group I included congestive heart failure (CHF; 13), hepatic hydrothorax (8), traumatic bloody (1), and idiopathic exudative (1). The diagnoses in group II included lung cancer (20), breast cancer (11), colon cancer (5), prostate cancer (2), B-cell lymphoma (2), and mesothelioma (1). The time to pleurodesis was 36 ± 12 days for group II compared to 110.8 ± 41 days for group I (p < 0.0001). The mean satisfaction score was similar in both groups (3.8 ± 0.4). Time to pleurodesis was significantly shorter in hepatic hydrothorax compared to CHF (73.6 ± 9 days vs. 113 ± 36 days, p = 0.006). There was one case of exit site infection in a patient with hepatic hydrothorax. Among subjects who were alive at 3 months after the catheter removal, none had recurrence of their pleural effusion. CONCLUSION The Denver catheter was effective in achieving pleurodesis in non-malignant pleural effusions. The complication rate was low and patient satisfaction was high.
Collapse
Affiliation(s)
- Michel Chalhoub
- Pulmonary and Critical Care, Staten Island University Hospital, NY, USA.
| | | | | | | | | |
Collapse
|
13
|
Abstract
OBJECTIVES To describe the clinical and laboratory features of rheumatoid pleural effusion (RPE) and the diagnostic and therapeutic approaches to this condition. METHODS The review is based on a MEDLINE (PubMed) search of the English literature from 1964 to 2005, using the keywords "rheumatoid arthritis" (RA), "pulmonary complication", "pleural effusion", and "empyema". RESULTS Pleural effusion is common in middle-aged men with RA and positive rheumatoid factor (RF). It has features of an exudate and a high RF titer. Underlying lung pathology is common. Generally RPE is small and resolves spontaneously but symptomatic RPE may require thoracocentesis. Rarely, RPE has features of a sterile empyematous exudate with high lipids and lactate dehydrogenase, and very low glucose and pH levels. This type of effusion eventually leads to fibrothorax and lung restriction. Superimposed infective empyema often complicates RPE. Oral, parenteral, and intrapleural corticosteroids, pleurodesis and decortication, have been used for the treatment of sterile RPE. Infected empyema is treated with drainage and antibiotics. CONCLUSIONS RPE may evolve into a sterile empyematous exudate with the development of fibrothorax. Symptomatic effusions or suspicion of other causes of exudate (infection, malignancy) require thoracocentesis. The "rheumatoid" nature of the pleural exudate in patients without arthritis mandates a pleural biopsy to exclude tuberculosis or malignancy. The optimal therapy of RPE has yet to be established. The role of cytokines in the course of RPE and the possible usefulness of cytokine blockade in the treatment of this RA complication require further evaluation.
Collapse
|
14
|
Melo R, Gonçalves JR. Pleurodese. REVISTA PORTUGUESA DE PNEUMOLOGIA 2004; 10:305-17. [PMID: 15492876 DOI: 10.1016/s0873-2159(15)30588-2] [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: 10/23/2022] Open
Abstract
Pleurodesis is a way of inducting an inflammatory process in the pleural surface in order to create the closure of the pleural space. The exact mechanism isn't completely understood and there is still a great deal of controversy concerning pleurodesis. Pleurodesis can be achieved by introduction of a sclerosant agent trough a chest tube into the pleural space, by medical thoracoscopy, by surgical thoracoscopy or by thoracotomy. The principal sclerosant agents are talc and tetracycline. The indications for pleurodesis are malignant recurrent pleural effusion, primary recurrent pneumothorax, secondary pneumothorax and benign pleural effusion resistant to medical treatment. There are, although, some contraindications to performing it. Serious complications of pleurodesis are rare and depend on the technique and agent used. The method of choice for pleurodesis is related to the experience and technical facilities available. The author presents a review about pleurodesis.
Collapse
Affiliation(s)
- Ricardo Melo
- Serviço de Pneumologia, Hospital Santa Maria, Avenida Prof. Egas Moniz, 1699 Lisboa Codex, Portugal.
| | | |
Collapse
|
15
|
Glazer M, Berkman N, Lafair JS, Kramer MR. Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion. Chest 2000; 117:1404-9. [PMID: 10807829 DOI: 10.1378/chest.117.5.1404] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Chemical pleurodesis is an effective treatment for malignant pleural effusion and pneumothorax. This mode of therapy is, however, less widely accepted in the treatment of patients with refractory benign or undiagnosed pleural effusion. STUDY OBJECTIVES To analyze the outcome of talc slurry pleurodesis in patients with nonmalignant pleural effusions. DESIGN Retrospective and partly prospective analysis of clinical outcome. SETTING Hadassah University Hospital, Jerusalem, Israel. PATIENTS AND PARTICIPANTS Between 1992 and 1997, we treated 16 patients with nonmalignant pleural effusion using talc slurry pleurodesis. The cause of effusion was congestive heart failure in 6 patients, liver cirrhosis in 4 patients, yellow nail syndrome in 1 patient, systemic lupus erythematosus in 1 patient, chylothorax in 1 patient, and undiagnosed in 3 patients. INTERVENTIONS Nine patients were hospitalized, and seven patients received treatment in a day-care setting. Follow-up ranged from 2 months to 3 years. RESULTS Complete success was observed in 12 cases (75%), partial success in 3 cases (19%), and pleurodesis was ineffectual in 1 case (6%). There were no significant complications after the procedure in any of our patients. A review of the English-language medical literature revealed an additional 110 reported cases of nonmalignant pleural effusion that were treated with chemical pleurodesis. Of these cases, talc was used in 65% with a success rate of nearly 100%. CONCLUSIONS Chemical pleurodesis, and specifically talc slurry, is an effective treatment for recurrent benign or undiagnosed pleural effusion. This procedure is safe and easily performed and, in selected cases, can be performed in an outpatient day-care setting.
Collapse
Affiliation(s)
- M Glazer
- Institute of Pulmonology, Hadassah University Hospital and Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | | | | | | |
Collapse
|
16
|
Cagirici U, Sahin B, Cakan A, Kayabas H, Buduneli T. Autologous blood patch pleurodesis in spontaneous pneumothorax with persistent air leak. SCAND CARDIOVASC J 1998; 32:75-8. [PMID: 9636962 DOI: 10.1080/14017439850140210] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In a prospective study series of 167 patients with tube thoracostomy for spontaneous pneumothorax in 1993-1996, 32 patients (age range 16-79 years, mean age 45.5 years) were treated with autologous blood-patch pleurodesis for persistent air leak. In 27 (84%) of cases the air leak ceased within 72 h after the pleurodesis. The duration of air leak was significantly shorter (p < 0.01) than in simple drainage. Empyema developed in three cases, and two patients with failed pleurodesis required open thoracotomy. Minor complications, mainly fever and pleural effusion, occurred in nine patients. Neither analgesia nor sedation was required during or after pleurodesis. There was no recurrence of pneumothorax during 12-48 months of observation, whereas simple drainage was followed by recurrence in 22 patients. Blood-patch pleurodesis is a simple, effective and painless method in pneumothorax, but carries an increased risk of intrathoracic infection.
Collapse
Affiliation(s)
- U Cagirici
- Department of Thoracic Surgery, Thoracic Surgery Teaching Hospital, Izmir, Turkey
| | | | | | | | | |
Collapse
|
17
|
Aasebø U, Norum J, Sager G, Slørdal L. Intrapleurally instilled mitoxantrone in metastatic pleural effusions: a phase II study. J Chemother 1997; 9:106-11. [PMID: 9176748 DOI: 10.1179/joc.1997.9.2.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thirty cases (breast cancer-20 cases, malignant lymphoma-4 cases, different malignancies-6 cases) of histologically/cytologically verified malignant pleural effusion (MPE) in 29 patients were treated with intrapleurally instilled mitoxantrone (30 mg). The therapy was well tolerated. At evaluation, 25 patients had died of progressive disease. The median survival was 3 months (range 0.3-21.3 months). There were 26 responders (12 complete responses (CR), 14 partial responses (PR)), whereas 4 patients relapsed and 3 of these had an early relapse (within 3 months). Patients achieving PR or CR had a low risk (15%) of treatment failure. Five patients were subjected to a pharmacokinetic evaluation. This demonstrated rapidly declining plasma and pleural exudate levels of mitoxantrone within the first 6 hours. At 24 hours after instillation, mitoxantrone was only detected in circulating mononuclear cells. This study shows that mitoxantrone is efficacious in the treatment of MPE, and may represent a cost-effective alternative.
Collapse
Affiliation(s)
- U Aasebø
- Department of Pulmonary Medicine, University Hospital of Tromsø, Norway
| | | | | | | |
Collapse
|
18
|
Mouroux J, Perrin C, Venissac N, Blaive B, Richelme H. Management of pleural effusion of cirrhotic origin. Chest 1996; 109:1093-6. [PMID: 8635335 DOI: 10.1378/chest.109.4.1093] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
STUDY OBJECTIVE To determine the indications and limitations of surgical videothoracoscopy for management of pleural effusion, an infrequent and often recurring complication of cirrhotic ascites whose pathogenesis involves direct passage of ascitic fluid into the pleural space through minute defects in the diaphragm. DESIGN/SETTING/PATIENTS/INTERVENTIONS: Eight cirrhotic patients with ascites and recurrent pleural effusion underwent surgical videothoracoscopy to localize and close any diaphragmatic defects and to achieve pleurodesis by application of talc. MEASUREMENTS AND RESULTS Diaphragmatic defects were localized and closed in six patients; postoperative mean volume and duration of drainage were, respectively, 0.408 +/- 0.157 mL and 7.6 +/- 1.75 days. None of these six patients developed recurrent pleural effusion (follow-up, 7 to 36 months). In the 2 patients in whom no defect was found, drainage had to be maintained for 15 days and 18 days (drainage volumes, 3 and 4 L). At hospital discharge, both patients had a stable recurrent effusion occupying the lower third of the cavity. CONCLUSIONS Utilization of videothoracoscopy appears particularly indicated for these fragile patients when medical therapy fails. The procedure's efficacy is immediate and durable once defects are identified and closed. If the technique proves unsuccessful, it does not hinder subsequent use of other methods.
Collapse
Affiliation(s)
- J Mouroux
- Service de Chirurgie Abdominale et Thoracique, Hopital Pasteur, Nice Cedex, France
| | | | | | | | | |
Collapse
|
19
|
Weissberg D, Refaely Y. Pleuroscopy: therapeutic applications. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1996; 30:1-10. [PMID: 8727851 DOI: 10.3109/14017439609107234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pleuroscopy is mostly regarded as a diagnostic procedure. Although therapeutic uses of pleuroscopy were popular when pulmonary tuberculosis was common, they are less well known today. This review of modern therapeutic pleuroscopy is based on both personal experience and previous reports. We have grouped the purposes of therapeutic pleuroscopy as 1) to provoke formation of pleural adhesions in the management of pleural effusion, recurrent pneumothorax, chylothorax or (in selected cases) empyema, 2) to divide adhesions in persistent pneumothorax, 3) to perform pleural toilet in the fibrinopurulent stage of empyema, 4) to retrieve foreign bodies, and 5) to achieve haemostasis and removal of clotted blood following operation or trauma. These applications of pleuroscopy should be studied and popularized so that the method can attain recognition as a revived therapeutic procedure.
Collapse
Affiliation(s)
- D Weissberg
- Department of Thoracic Surgery, Tel Aviv University Sackler School of Medicine, E. Wolfson Medical Center, Holon, Israel
| | | |
Collapse
|
20
|
Vargas FS, Milanez JR, Filomeno LT, Fernandez A, Jatene A, Light RW. Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions. Chest 1994; 106:1771-5. [PMID: 7988198 DOI: 10.1378/chest.106.6.1771] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Chemical pleurodesis has become the preferred treatment for definitive management of malignant pleural effusions. The treatment of patients with recurrent benign or undiagnosed pleural effusions, however, remains a difficult clinical problem. Tetracycline has been widely used as a sclerosing agent, but parenteral tetracycline is no longer available. Therefore, alternative sclerosing agents are needed. Talc was used for the first time in 1935, and subsequently there have been several reports documenting its effectiveness in the treatment of malignant pleural effusion and pneumothorax. The objective of this study is to present our experience with a low dose of aerosolized talc for controlling nonmalignant pleural effusions. Between May 1985 and October 1992, twenty-two patients underwent talc pleurodesis at the time of thoracoscopy for control of a nonmalignant effusion. The cause of the effusion was cirrhosis in six patients, systemic lupus erythematosus in two, chylothorax in five, and no diagnosis in nine patients. Follow-up has ranged from 18 days to 5 years. Only two patients (9 percent), one with cirrhosis and another with an undiagnosed pleural effusion, had a recurrence of the effusions. We conclude that the intrapleural administration of 2 g of aerosolized talc is an effective treatment for recurrent benign (including chylothorax) or undiagnosed pleural effusions.
Collapse
Affiliation(s)
- F S Vargas
- Instituto do Coração, University of Sao Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
21
|
|
22
|
|