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Larisch C, Riedel J, Hofmann HS, Ried M. [Management of Malignant Pleural Effusion]. Zentralbl Chir 2024; 149:315-327. [PMID: 38838699 DOI: 10.1055/a-1990-5057] [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: 06/07/2024]
Abstract
Malignant pleural effusion is a common diagnosis in metastasized cancers. It is always of palliative character. Main symptoms are dyspnoea and reduced quality of life. Diagnosis is made by ultrasound-guided puncture of the pleural effusion (cytology) and often video-assisted thoracic surgery with biopsy of the pleural surface (histology). The goal of treatment is a fast, sustainable, minimally invasive, patient-centred therapy that increases quality of life. Besides systemic therapy and best supportive care the patient can be treated with local therapy including either pleurodesis (via drainage or VATS) or an indwelling-pleural catheter (IPC). Decision for one of these procedures is made upon performance index (ECOG), expandability of the lung, prognosis and the patient's wish. For the first technique, the lung must be expandable. The latter one (IPC) can be implanted both with expandable and trapped lung. Both are similarly effective in symptom control.
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Brookes JDL, Cochrane AD, Smith JA. Prolonged Non-Steroidal Anti-Inflammatory Drug Exposure After Pleurodesis Increases Pneumothorax Recurrence: A Retrospective Cohort Study. Heart Lung Circ 2024; 33:538-542. [PMID: 38458935 DOI: 10.1016/j.hlc.2023.12.018] [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: 04/20/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The use of non-steroidal anti-inflammatory drugs (NSAID) in patients undergoing pleurodesis remains controversial. Although many surgeons are comfortable prescribing NSAIDs post-operatively, some oppose this practice due to concerns of suppressing the inflammatory response and quality of pleurodesis. Only a small body of inconsistent publications exists with respect to guiding therapy in this common clinical scenario. METHODS A retrospective cohort study was undertaken assessing effect of NSAID exposure on pleurodesis outcomes. An institutional thoracic surgery database was reviewed yielding 147 patients who underwent pleurodesis for pneumothorax between 2010 and 2018. Medical records and imaging were reviewed for patient characteristics, NSAID exposure, recurrent pneumothorax and other adverse events. RESULTS There was no overall difference between rates of recurrence and procedural failure of pleurodesis (Relative Risk [RR] 1.67 [95% CI 0.74-3.77]). However, NSAID exposure of >48 hours was associated with increased risk of recurrent pneumothorax (RR 2.16 [95% CI 1.05-4.45]). There was no increased rate of other adverse events related to NSAID usage. CONCLUSIONS NSAID exposure does not increase failure rates or other adverse events following pleurodesis for pneumothorax. However, prolonged NSAID exposure post-pleurodesis may increase procedural failure rates. Further large volume randomised control trials are required.
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Affiliation(s)
- John D L Brookes
- Department of Cardiothoracic Surgery, Monash Health, Clayton, Vic, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia.
| | - Andrew D Cochrane
- Department of Cardiothoracic Surgery, Monash Health, Clayton, Vic, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia
| | - Julian A Smith
- Department of Cardiothoracic Surgery, Monash Health, Clayton, Vic, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia
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Yu PSY, Chan KW, Tsui CO, Chan S, Thung KH. Non-steroidal anti-inflammatory drugs reduce pleural adhesion in human: evidence from redo surgery. Sci Rep 2023; 13:14578. [PMID: 37666886 PMCID: PMC10477170 DOI: 10.1038/s41598-023-41680-7] [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: 02/08/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) reduced pleural adhesion in animal studies, but its effect on human had not been studied. A retrospective study was carried out for patients with solitary pulmonary nodules without a pre-operative tissue diagnosis positive for malignancy. The impact of the use of NSAIDs after stage one wedge resection was assessed by the degree of pleural adhesions encountered during second-stage, redo completion lobectomy. From April 2016 to March 2022, 50 consecutive patients meeting the inclusion criteria were included, and 44 patients were selected for analysis after exclusion (Treatment group with NSAID: N = 27; Control group without NSAID: N = 17). The preoperative characteristics and the final tumor pathologies were similar between the groups. The use of NSAID was significantly associated with lower risk of severe pleural adhesions and complete pleural symphysis (risk difference = -29%, p = 0.03). After controlling the effect of tumor size and chest drain duration, only the use of NSAID was statistically associated with the lowered risk of severe pleural adhesions and complete pleural symphysis. No statistically significant effects of NSAID on operative time (p = 0.86), blood loss (p = 0.72), and post-operative length of stay (p = 0.72) were demonstrated. In human, NSAIDs attenuated the formation of pleural adhesions after pleural disruptions. Physicians and surgeons should avoid the use of NSAIDs when pleural adhesion formation is the intended treatment outcome.
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Affiliation(s)
- Peter Sze-Yuen Yu
- Division of Cardiothoracic Surgery, Department of Surgery, Tuen Mun Hospital, Hong Kong, Hong Kong.
| | - Kin-Wai Chan
- Department of Statistics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chiu-On Tsui
- Division of Cardiothoracic Surgery, Department of Surgery, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Shun Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Kin-Hoi Thung
- Division of Cardiothoracic Surgery, Department of Surgery, Tuen Mun Hospital, Hong Kong, Hong Kong
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Peker E, Elpek GÖ. The Effect of Ellagic Acid on Intra-abdominal Adhesions Caused by Gallstones. Surg Laparosc Endosc Percutan Tech 2021; 32:166-171. [PMID: 34753896 DOI: 10.1097/sle.0000000000001019] [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: 03/09/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adhesion formation after peritoneal surgery is the main cause of postoperative bowel obstruction, infertility, and chronic pelvic pain. In this study, we evaluated the effect of oral ellagic acid on intra-abdominal adhesions caused by gallstones in rats. MATERIALS AND METHODS Forty-one Wistar-albino rats were used. Gallstones were dropped to the right lower quadrant of the abdomen to create adhesions. They were divided into 4 groups; sham-operated, intraperitoneal gallstone, oral ellagic acid (control), and intraperitoneal gallstone+oral ellagic acid. On the postoperative 10th day, relaparotomy was performed, adhesions were evaluated according to four different macroscopic adhesion score systems and adhesion-bearing tissues were examined histopathologically. Samples were graded for inflammation, vascularization, and fibrosis. RESULTS We found that oral administration of ellagic acid lowered all macroscopic adhesion scores. There were significant differences between groups of sham and gallstone; control and gallstone; control and gallstone+oral ellagic acid (P<0.05). CONCLUSION The ellagic acid administered orally at a dose of 100 mg/kg/d significantly inhibited intra-abdominal adhesion formation and no adverse effects were seen between treatments.
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Affiliation(s)
- Evren Peker
- Department of General Surgery, Marmara University Pendik Research and Education Hospital, Istanbul
| | - Gülsüm Ö Elpek
- Department of Pathology, Medical School, Akdeniz University, Antalya, Turkey
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Comparison of Ellagic Acid and NSAI Agents in the Treatment of Achilles Tendon Lacerations: An Experimental Study in Rabbits. Int Surg 2021. [DOI: 10.9738/intsurg-d-19-00007.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
Although Achilles tendon ruptures can have many causes, they are known to develop most commonly with trauma. Nonsteroidal anti-inflammatory drugs (NSAID) and low doses of corticosteroids are used in the medical treatment of tendon ruptures. Ellagic acid (EA), which also has an anti-inflammatory effect, has been reported to show its effect via cyclooxygenase 2 (COX2) inhibition as well. The effects of EA and diclofenac sodium on tendon healing were compared in this study.
Methods
We used a total of 18 male New Zealand rabbits in 3 groups with 6 in each. The study was performed under general anesthesia with a xylazine-ketamine combination. After a defect was created in the right Achilles tendon of all the rabbits, group I was administered diclofenac sodium and group II was administered EA for 1 week, whereas the control group (group III) was not administered anything. Postoperative follow-up was provided for all groups.
Results
Euthanasia was performed in all subjects at the end of the eighth week, and the tendons were compared in terms of macroscopic and histopathologic features and tensile resistance. Although there was no statistically significant difference in the tensile resistance Newton values of group I and group II, these values were higher than in the control group, and the NSAI group values were statistically significantly higher than in the control group.
Conclusions
We concluded that EA and NSAIs could be effective in the recovery of tendon integrity and tensile strength and increasing the movement capacity in pathology caused by tendon damage because of their anti-inflammatory features.
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Wan YY, Zhai CC, Lin XS, Yao ZH, Liu QH, Zhu L, Li DZ, Li XL, Wang N, Lin DJ. Safety and complications of medical thoracoscopy in the management of pleural diseases. BMC Pulm Med 2019; 19:125. [PMID: 31291926 PMCID: PMC6617601 DOI: 10.1186/s12890-019-0888-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical thoracoscopy is considered an overall safe procedure, whereas numbers of studies focus on complications of diagnostic thoracoscopy and talc poudrage pleurodesis. We conduct this study to evaluate the safety of medical thoracoscopy in the management of pleural diseases and to compare complications in different therapeutic thoracoscopic procedures. METHODS A retrospective study was performed in 1926 patients, 662 of whom underwent medical thoracoscopy for diagnosis and 1264 of whom for therapeutic interventions of pleural diseases. Data on complications were obtained from the patients, notes on computer system, laboratory and radiographic findings. Chi-square test was performed to compare categorical variables and Fisher's exact test was used for small samples. RESULTS The mean age was 51 ± 8.4 (range 21-86) years and 1117 (58%) were males. Diagnostic procedure was taken in 662 (34.4%) patients, whereas therapeutic procedure was taken in 1264 (65.6%) patients. Malignant histology was reported in 860 (44.6%) and 986 (51.2%) revealed benign pleural diseases. Eighty patients (4.2%) were not definitely diagnosed and they were considered as unidentified pleural effusion. One patient died during the creation of artificial pneumothorax, and the causes of death were supposed as air embolism or an inhibition of phrenic motoneurons and circulatory system. Complication of lung laceration was found in six patients (0.3%) and reexpansion pulmonary edema was observed in two patients (0.1%). Higher incidence of prolonged air leak was observed in bulla electrocoagulation group, in comparison with pleurodesis group. Moreover, pain and fever were the most frequently complications in pleurodesis group and cutaneous infection in entry site was the most frequently reported complication in pleural decortication of empyema group. CONCLUSIONS Medical thoracoscopy is generally a safe and effective method, not only in the diagnosis of undiagnosed pleural effusions, but also in the management of pleural diseases. Mastering medical thoracoscopy well, improving patient management after the procedure and attempts to reduce the occurrence of post-procedural complications are the targets that physicians are supposed to achieve in the future.
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Affiliation(s)
- Yun-Yan Wan
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
| | - Cong-Cong Zhai
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
| | - Xin-Shan Lin
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
| | - Zhou-Hong Yao
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
| | - Qing-Hua Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
| | - Ling Zhu
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
| | - De-Zhi Li
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
| | - Xi-Li Li
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
| | - Ning Wang
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
| | - Dian-Jie Lin
- Department of Respiratory Medicine, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province 250021 People’s Republic of China
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Non-steroid anti-inflammatory drugs reduce the efficacy of autologous blood pleurodesis. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:343-349. [PMID: 32082882 DOI: 10.5606/tgkdc.dergisi.2019.17544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/20/2019] [Indexed: 11/21/2022]
Abstract
Background This study aims to perform autologous blood pleurodesis in an animal model and investigate the effects of paracetamol and diclofenac on autologous blood pleurodesis. Methods We divided 42 female Wistar albino rats (aged three months; average weight 275±25 g) into three major groups of 14. Each major group was further divided into two subgroups of seven rats to be sacrificed at seven days for early changes and 21 days for late changes. We performed autologous blood pleurodesis in all rats at a dose of 3 mL/kg. Group C (control group) was administered saline, group P was administered paracetamol, and group D was administered diclofenac for the postoperative five consecutive days as a single dose intraperitoneally. We sacrificed the rats at the designated dates and removed the thoracic cages en bloc. Results According to macroscopical and microscopical evaluation of the specimens, paracetamol led to a similar degree of adhesions with saline, whereas diclofenac significantly reduced the intensity of the desired adhesions between the two pleural sheets (p=0.05). Conclusion Using anti-inflammatory analgesics following autologous blood pleurodesis may lead to unsuccessful outcome of the procedure.
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Watanabe T, Fukai I, Okuda K, Moriyama S, Haneda H, Kawano O, Yokota K, Shitara M, Tatematsu T, Sakane T, Oda R, Nakanishi R. Talc pleurodesis for secondary pneumothorax in elderly patients with persistent air leak. J Thorac Dis 2019; 11:171-176. [PMID: 30863586 DOI: 10.21037/jtd.2018.12.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We herein report the usefulness of two types of talc pleurodesis for secondary pneumothorax of elderly patients with persistent air leak who have severe pulmonary emphysema. Methods We assessed 17 elderly patients with persistent air leak who received talc pleurodesis for secondary pneumothorax from April 2013 to March 2017. Thoracoscopic talc poudrage (TTP) (n=11) was performed in patients whose general condition was thought to sufficiently stable to tolerate for general anesthesia. Talc slurry pleurodesis (TSP) (n=6) via a chest tube was performed in patients whose general condition was thought to be insufficiently stable to tolerate general anesthesia. Results The median drainage period after pleurodesis was 6 days in patients who received TTP and 12 days in patients who received TSP. Complications associated with talc pleurodesis included atrial fibrillation (n=1) in the thoracoscopic poudrage group, while the slurry pleurodesis group showed chest pain (n=2), asthmatic attack (n=1), and pneumonia (n=1). All patients who received thoracoscopic poudrage were able to leave the hospital after removal of the chest tube. Five of the six patients who received slurry pleurodesis were able to leave the hospital, but one of them died of acute exacerbation of interstitial pneumonia (IP) on the 45th day after pleurodesis. The success rate was 94% (16/17). There were no cases of recurrence during the observation period. Conclusions TTP was deemed likely to be safe and effective for patients able to tolerate general anesthesia. In patients with IP, especially those treated with steroids, the indication of talc pleurodesis should be cautiously considered.
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Affiliation(s)
- Takuya Watanabe
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ichiro Fukai
- Department of Thoracic Surgery, Suzuka General Hospital, Suzuka, Japan
| | - Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoru Moriyama
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Haneda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Osamu Kawano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keisuke Yokota
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masayuki Shitara
- Department of Thoracic Surgery, Suzuka General Hospital, Suzuka, Japan
| | - Tsutomu Tatematsu
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadashi Sakane
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Risa Oda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Dorman RM, Ventro G, Cairo SB, Vali K, Rothstein DH. The use of perioperative ketorolac in the surgical treatment of pediatric spontaneous pneumothorax. J Pediatr Surg 2018; 53:456-460. [PMID: 28728827 DOI: 10.1016/j.jpedsurg.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/25/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We sought to determine the effect of ketorolac on pediatric primary spontaneous pneumothorax recurrence after operation. METHODS The Pediatric Health Information System database was queried for patients ages 10-16years discharged in the years 2004-2014 with pneumothorax or pleural bleb and a related operative procedure. Deaths and secondary pneumothorax were excluded. Variables included demographics, chronic disease, intensive care unit admission, mechanical ventilation, and lung resection or plication. The primary variable was any ketorolac administration between post-operative day 0 and 5. Outcomes included reintervention within 1year, readmission, post-operative length of stay (LOS), and cost. Bivariate and multivariate logistic regression analyses were performed. RESULTS Of 1678 records that met inclusion criteria, 395 (23%) were subsequently excluded, leaving 1283 patients for analysis. Most patients had a lung resection recorded (78%) and the majority were administered ketorolac (57%); few required reintervention (20%) or readmission (18%). Mean postoperative LOS was 5.2±3.8days and mean cost was $17,649±$10,599. On bivariate analysis, ketorolac administration did not correlate with any measured outcome. On both bivariate and multivariate analysis, no variable was predictive of reintervention, and only lung resection correlated with readmission (adjusted odds ratio 0.63 [95% C.I. 0.45-0.90]). CONCLUSION Post-operative ketorolac administration was not associated with an increased likelihood of reintervention or readmission within 1year of operative treatment of primary spontaneous pneumothorax, suggesting that it may be used safely as part of a post-operative pain control regimen. Effects on postoperative length of stay and cost, however, were not demonstrated. LEVEL OF EVIDENCE AND TYPE OF STUDY Level III treatment study.
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Affiliation(s)
- R Michael Dorman
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo.
| | - George Ventro
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
| | - Sarah B Cairo
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
| | - Kaveh Vali
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
| | - David H Rothstein
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
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Leemans J, Dooms C, Ninane V, Yserbyt J. Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience. Respirology 2018; 23:613-617. [PMID: 29320805 DOI: 10.1111/resp.13252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Malignant pleurisy is associated with advanced oncological disease and dyspnoea is the most common presenting symptom. Pleurodesis is the preferred palliative and supportive treatment option, targeting symptom relief. The identification of clinical and endoscopic features that determine the success of talc pleurodesis in malignant pleurisy could guide clinical decision-making. METHODS All symptomatic patients with malignant pleurisy subjected to talc pleurodesis through medical thoracoscopy between January 2012 and December 2015 were included. Univariate and multivariate analyses were performed to identify factors associated with successful pleurodesis. RESULTS Of the 155 patients, 122 (78%) were classified as having a successful pleurodesis based on clinical and radiological criteria. Factors associated with unsuccessful pleurodesis (univariate analysis) were the presence of pleural adhesions (odds ratio (OR): 0.43 (95% CI: 0.19-0.96); P = 0.04), extensive spread of pleural lesions (OR: 0.17 (95% CI: 0.05-0.59); P = 0.001), the use of systemic corticosteroids (OR: 0.28 (95% CI: 0.10-0.83); P = 0.02) and a prolonged time period between the clinical diagnosis of the pleural effusion and the moment of pleurodesis (OR: 0.14 (95% CI: 0.06-0.32); P < 0.0001). The latter being associated with failure of pleurodesis in a multivariate analysis (OR: 0.08 (95% CI: 0.01-0.25); P < 0.0001). Chest ultrasound prior to pleurodesis showed a sensitivity of 91% and a specificity of 88% in predicting the success of pleurodesis. CONCLUSION The success rate of pleurodesis in malignant pleurisy could potentially be enhanced by correct patient selection and early referral for pleurodesis. Ultrasonic assessment of pleural adhesions and potential lung expansion prior to pleurodesis is useful in clinical decision-making.
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Affiliation(s)
- Joke Leemans
- Department of Respiratory Diseases, University Hospitals KU Leuven, Leuven, Belgium
| | - Christophe Dooms
- Department of Respiratory Diseases, University Hospitals KU Leuven, Leuven, Belgium
| | - Vincent Ninane
- Respiratory Division, St. Pierre University Hospital Brussels, Brussels, Belgium
| | - Jonas Yserbyt
- Department of Respiratory Diseases, University Hospitals KU Leuven, Leuven, Belgium
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The comparison of the effects of ellagic acid and diclofenac sodium on intra-abdominal adhesion: an in vivo study in the rat model. Int Surg 2016; 99:543-50. [PMID: 25216418 DOI: 10.9738/intsurg-d-14-00065.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Peritoneal adhesions are seen frequently after abdominal surgery and can cause serious complications. We aimed to evaluate the effects of the oral use of diclofenac sodium and ellagic acid on formation of postoperative adhesions in rats Studies have shown that agents with anti-inflammatory properties and antioxidant substances can prevent adhesion by decreasing oxidative stress. We compared and evaluated the effects of ellagic acid that has strong antioxidant and anti-inflammatory properties and the nonsteroidal anti-inflammatory diclofenac sodium on peritoneal adhesion development in our experimental study. Laparotomy was performed with a midline incision under general anesthesia and an adhesion model was created on the antimesenteric side of the cecum in Groups I, II, and III. Group I received 85 mg/kg ellagic acid and Group II, 50 mg/kg diclofenac sodium through the nasogastric catheter while Group III received no medication. Only laparotomy was performed in Group IV. The rats were sacrificed at the end of the 14th day. Following macroscopic scoring, tissue samples were removed and subjected to biochemical and histopathologic evaluation. The degree of adhesion and the malondialdehyde level were decreased (P < 0.05), and glutathione level increased (P < 0.05) in Group I compared to Group II and Group III. The effects of ellagic acid on the prevention of peritoneal adhesion were found to be stronger than diclofenac sodium. This can be explained by the fact that ellagic acid is a strong antioxidant and decreases oxidative stress with anti-inflammatory and anti-angiogenic effects.
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12
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Sihoe ADL, Yu PSY, Yeung JWL. Primary pneumothorax: Should surgery be offered after the first episode? World J Respirol 2015; 5:47-57. [DOI: 10.5320/wjr.v5.i1.47] [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: 09/28/2014] [Revised: 01/01/2015] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax (PSP). However, the conventional belief amongst most clinicians is that surgery should not be routinely offered to patients with an uncomplicated first episode of PSP. The view that surgery should be reserved for recurrent episodes of ipsilateral PSP is based on an apprehension regarding traumatic thoracic surgery combined with a perception that recurrences after a single episode of PSP are unlikely. Modern advances in minimally invasive thoracic surgery have now dramatically reduced the morbidity of PSP surgery. Such surgery is now safe, effective and causes minimal indisposition for patients. On the other hand, modern clinical data suggests that recurrence rate of PSP is perhaps much higher than previously assumed, with more than half of patients experiencing a second episode within several years of the first. With such new appreciations of the current situation, it is appropriate to now consider offering surgery to patients even after the first episode of PSP.
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Kouritas VK, Magkouta S, Zisis C, Psallidas I, Gourgoulianis KI, Kalomenidis I. Paracetamol and ibuprofen block hydrothorax absorption in mice†. Eur J Cardiothorac Surg 2014; 47:426-30; discussion 430. [DOI: 10.1093/ejcts/ezu211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Abstract
Malignant pleural effusions are a cause of significant symptoms and distress in patients with end-stage malignancies and portend a poor prognosis. Management is aimed at symptom relief, with minimally invasive interventions and minimal requirement for hospital length of stay. The management options include watchful waiting if no symptoms are present, repeat thoracentesis, medical or surgical thoracoscopic techniques to achieve pleurodesis, pleuroperitoneal shunts, placement of tunneled pleural catheters, or a combination of modalities. To determine the best modality for management, patients must be assessed individually with concern for symptoms, functional status, prognosis, and their social and financial situations.
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Affiliation(s)
- Justin M Thomas
- Division of Pulmonary and Critical Care, Department of Medicine, National Jewish Health, Denver, CO 80206, USA
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Peng C, Lv M, Tian J, Huang Y, Tian Y, Zhang Z. Herb–drug pharmacokinetic interaction of artificial calculus bovis with diclofenac sodium and chlorpheniramine maleate in rats. J Pharm Pharmacol 2013; 65:1064-72. [DOI: 10.1111/jphp.12069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 03/18/2013] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
To investigate the herb–drug pharmacokinetic interaction of artificial calculus bovis (ACB) with diclofenac sodium (DS) and chlorpheniramine maleate (CPM) in rats.
Methods
A sensitive high-performance liquid chromatography coupled with tandem mass spectrometry method was developed and validated for the simultaneous determination of DS and CPM in rat plasma. The proposed method was successfully applied to compare the herb–drug pharmacokinetic interaction of ACB with DS and CPM in rats following intragastric administration.
Key findings
The proposed method had good linearity and no endogenous material interfered with the analytes and internal standard peaks. The lower limit of quantification of DS and CPM was 1 and 0.1 ng/ml, respectively. There was no apparent pharmacokinetic interaction between DS and CPM. Co-administration of ACB with DS noticeably increased the area under the concentration–time curve (AUC0-∞) and peak plasma concentration (Cmax) of DS, while the parameters time of peak concentration (Tmax), clearance (ClZ/F) and apparent volume of distribution (VZ/F) of DS significantly decreased. Meanwhile, co-administration of ACB with CPM noticeably increased the Tmax, ClZ/F and VZ/F of CPM. A marked decline in AUC0-∞ and Cmax of CPM occurred in the presence of ACB.
Conclusions
This study indicated that co-administration of ACB with DS and CPM can result in an apparent herb–drug pharmacokinetic interaction in rats.
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Affiliation(s)
- Can Peng
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Nanjing, China
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Mengying Lv
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Nanjing, China
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Jixin Tian
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Nanjing, China
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Yin Huang
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Nanjing, China
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Yuan Tian
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Nanjing, China
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Zunjian Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Nanjing, China
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
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Opitz I, Arni S, Oberreiter B, Asmis LM, Vogt P, Rousson V, Weder W, Lardinois D. Perioperative diclofenac application during video-assisted thoracic surgery pleurodesis modulates early inflammatory and fibrinolytic processes in an experimental model. ACTA ACUST UNITED AC 2013; 50:14-23. [PMID: 23429206 DOI: 10.1159/000341670] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 07/07/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND/PURPOSE It has been substantiated that the quality of pleurodesis is reduced when non-steroidal anti-inflammatory drugs (NSAIDs) are used perioperatively. The effects of NSAID administration on the early inflammatory and fibrinolytic processes after mechanical pleurodesis were investigated in an established pig model. METHODS Left-sided mechanical pleural abrasion was performed on 24 pigs assigned to either an NSAID or a control group. Pleural fluid and blood samples were analysed over a 24-hour period. Histological evaluation of neutrophil influx at the site of pleural abrasion was performed. RESULTS The volume of pleural effusion was significantly decreased in the diclofenac group at 10 and 24 h, and the protein content was significantly lower. The diclofenac group at 24 h had a diminished total number of white blood cells and a reduced content of transforming growth factor-β. Moreover, the diclofenac group had a reduced percentage of neutrophils at 6 h. Significantly increased levels of D-dimers and tissue plasminogen activator were measured at 6 h and of interleukin-10 at 24 h. Neutrophils at the site of pleural abrasion were significantly reduced. CONCLUSIONS Systemic application of diclofenac led to a local enhancement of fibrinolysis and attenuation of pro-inflammatory and fibrotic processes necessary for adhesion formation in our model.
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Affiliation(s)
- Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
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Nonsteroidal antiinflammatory medications: efficient and safe treatment following video-assisted pleurodesis for spontaneous pneumothorax. World J Surg 2012; 35:2563-7. [PMID: 21882030 DOI: 10.1007/s00268-011-1207-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Recurrent spontaneous pneumothorax is widely treated by video-assisted thoracoscopic (VATS) bullectomy and pleurodesis. Treatment of postoperative pain with nonsteroidal antiinflammatory drugs (NSAIDs) is controversial as many surgeons believe that it reduces the efficacy of pleurodesis and increases the pneumothorax recurrence rate. METHODS In this retrospective study, we reviewed the hospital records for patients following VATS pleurodesis for recurrent spontaneous pneumothorax. The patients were divided into two groups: (1) NSAID group: patients were treated with NSAIDs for more than a week following surgery and (2) control group: patients did not receive NSAIDs. Data regarding short- and long-term outcomes were compared. RESULTS The study cohort included 105 patients: 48 in the NSAID group and 57 in the control group. During the early postoperative period the average daily requirement of narcotic analgesia and the incidence of narcotic-related side effects were lower in the NSAIDs group. No difference was found in the long-term recurrence rate: two of 48 (4%) in the NSAID group and three of 57 (5%) in the control group. There was one case of early recurrence in the NSAID group. Both groups had similar length of stay with no cases of mortality or major morbidity. CONCLUSIONS NSAIDs for postsurgical pleurodesis pain obviates the need for narcotics without increasing the pneumothorax recurrence rate. Prospective randomized controlled studies are needed to further investigate this issue.
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Kouritas VK, Zisis C, Bellenis I, Gourgoulianis KI, Molyvdas PA, Hatzoglou C. Nonsteroidal Anti-Inflammatory Drugs Alter the Human Mesothelial Pleural Permeability via Ion Cellular Transportation by Inhibiting Prostaglandin Synthesis. Respiration 2012; 84:62-8. [DOI: 10.1159/000336837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 01/23/2012] [Indexed: 11/19/2022] Open
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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.
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Affiliation(s)
- J Terrill Huggins
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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20
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Ragbetli C, Ilhan F, Aydinlioğlu A, Kara M, Ragbetli MC. A histological investigation concerning the effects of diclofenac sodium to the lung in 4- and 20-week-old rats treated prenatally. J Matern Fetal Neonatal Med 2010; 24:208-12. [PMID: 20222833 DOI: 10.3109/14767051003615426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to investigate the possible postnatal effects on the lung tissues of the rat offspring treated with diclofenac sodium (DS) during pregnancy. METHODS After mating, pregnant female rats were separated into the control (n = 10) and DS (n = 10) groups. DS (1 mg/kg) was injected intraperitoneally (i.p) to the drug-treated group for the period of gestational days 5-19. Physiological saline (1 ml, i.p.) was given to the control groups. After birth, pups were separated into DS treatment groups (n = 24) and control group (n = 24). The DS and control group animals were anaesthetised with i.p. injection of urethane and their lungs were removed to prepare for histopathological evaluation. RESULTS Histological examination of the lung tissues of the 4- and 20-week-old rats revealed no significant differences between males and females in both the control and DS treated rats. CONCLUSION Because of the use of DS in the pregnant women further studies are needed in this field.
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Affiliation(s)
- Cennet Ragbetli
- Department of Pharmacology/Toxicology, Dr Iki Nisan Cad, Konuklar Sit, 65100 Van, Turkey
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21
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Abstract
Chest pain from respiratory causes is a common complaint and may indicate the presence of a serious or even life-threatening pathologic condition. Most chest pains are the result of irritation or inflammation of the parietal pleura, as the visceral pleura is insensate, although pain may arise from direct malignant invasion or trauma to the chest wall. Rapid recognition with appropriate understanding of the anatomy and physiology of chest pain from respiratory causes is vital to ensure timely and appropriate therapy.
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Affiliation(s)
- Fraser J H Brims
- Respiratory Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK; Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
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Teixeira LR, Vargas FS, Acencio MMP, Antonangelo L, Novaes NP, Costa JD, Marchi E. Influence of parecoxib (cox-2 inhibitor) in experimental pleurodesis. Respir Med 2008; 103:595-600. [PMID: 19046861 DOI: 10.1016/j.rmed.2008.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 10/16/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The intrapleural instillation of a sclerosing agent produces an inflammatory process frequently followed by pain. The treatment can include the use of analgesics or anti-inflammatory drugs. Previously, it was demonstrated (experimental studies) that corticoids and nonsteroidal anti-inflammatory drugs (diclofenac) reduce the inflammation and fibrosis produced by talc but not by transforming growth factor-beta or silver nitrate. The objective of this study was to determine whether parecoxib (COX-2 inhibitor) affects pleurodesis induced by talc or silver nitrate. METHODS 140 rabbits received intrapleural injection (2mL) of 400mg/kg of talc or 0.5% silver nitrate. A subgroup of 70 animals received additional daily intramuscular parecoxib (1mg/kg). They were sacrificed at 4, 24, 48, 72h or 7, 14, or 28 days after the procedure. The pleural fluid was quantified; biochemical examinations (glucose, lactic dehydrogenase, and proteins) and immunologic dosages (interleukin-8, vascular endothelial growth factor, and transforming growth factor-beta(1)) were analyzed in pleural fluid and blood. Finally, macro- and microscopic pleura and lung studies were performed. RESULTS Evaluation after 28 days demonstrated that parecoxib reduced pleural and pulmonary inflammation but not pleural adhesions. The changes were observed precociously (congruent with 72h) and were more evident after silver nitrate injection. CONCLUSION Systemic parecoxib injection does not interfere with talc or silver nitrate pleurodesis. These results suggest that use of COX-2 inhibitors can be considered and depending of the results of other studies, recommended in human pleurodesis.
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Affiliation(s)
- Lisete R Teixeira
- Laboratory of Pleura (Pulmonary Division), Heart Institute (InCor) of the University of São Paulo Medical School, São Paulo, Brazil.
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Nadworny PL, Wang J, Tredget EE, Burrell RE. Anti-inflammatory activity of nanocrystalline silver in a porcine contact dermatitis model. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2008; 4:241-51. [DOI: 10.1016/j.nano.2008.04.006] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 04/09/2008] [Accepted: 04/13/2008] [Indexed: 10/22/2022]
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Abstract
Malignant pleural effusions (MPEs) complicate the clinical course of patients with a broad array of malignancies, which are most often due to lymphomas or carcinomas of the breast, lung, gastrointestinal tract or ovaries. Patients may present with a MPE as the initial manifestation of a cancer or develop an effusion during the advanced phases of a known malignancy. In either circumstance, the median survival after presentation with a MPE is 4 months. Effusions may result from direct pleural invasion (MPE) or indirect effects (paraneoplastic effusions), such as impairment of fluid efflux from the pleural space by lymphatic obstruction or pleural effects of cancer radiation or drug therapy. Because only 50% of patients with cancer who develop a pleural effusion during their clinical course have a MPE, careful evaluation of the effusion to establish its aetiology is required to direct therapy. Management is palliative with interventions directed towards decreasing the volume of intrapleural fluid and the severity of associated symptoms.
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Abstract
Malignant pleural effusions (MPEs) are an important complication for patients with intrathoracic and extrathoracic malignancies. Median survival after diagnosis of an MPE is 4 months. Patients can present with an MPE as a complication of far-advanced cancer or as the initial manifestation of an underlying malignancy. Common cancer types causing MPEs include lymphomas, mesotheliomas, and carcinomas of the breast, lung, gastrointestinal tract, and ovaries. However, almost all tumor types have been reported to cause MPEs. New imaging modalities assist the evaluation of patients with a suspected MPE; however, positive cytologic or tissue confirmation of malignant cells is necessary to establish a diagnosis. Even in the presence of known malignancy, up to 50% of pleural effusions are benign, underscoring the importance of a firm diagnosis to guide therapy. Rapidly evolving interventional and histopathologic techniques have improved the diagnostic yield of standard cytology and biopsy. Management of an MPE remains palliative; it is critical that the appropriate management approach is chosen on the basis of available expertise and the patient's clinical status. This review summarizes the pathogenesis, diagnosis, and management of MPE. Studies in the English language were identified by searching the MEDLINE database (1980-2007) using the search terms pleura, pleural, malignant, pleurodesis, and thoracoscopy.
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Affiliation(s)
- John E Heffner
- Department of Medicine, Providence Portland Medical Center, Oregon Health and Science University, 5040 NE Hoyt St, Ste 540, Portland, OR 97213, USA.
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Goyal RN, Oyama M, Umar AA, Tyagi A, Bachheti N. Determination of methylprednisolone acetate in biological fluids at gold nanoparticles modified ITO electrode. J Pharm Biomed Anal 2007; 44:1147-53. [PMID: 17629438 DOI: 10.1016/j.jpba.2007.05.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 05/10/2007] [Accepted: 05/29/2007] [Indexed: 11/28/2022]
Abstract
The electrochemical behavior of a corticosteroid methylprednisolone (MP), used for doping, has been studied at gold nanoparticles modified indium tin oxide (nanoAu/ITO) electrode. The nanoAu/ITO electrode exhibited an effective catalytic response towards its oxidation and lowered its oxidation potential by approximately 127 mV when compared with bare ITO electrode. Oxidation of MP has been carried out in phosphate containing electrolyte in the pH range 2.13-10.00 and a well-defined oxidation peak was noticed. Linear concentration curves are obtained over the concentration range 0.01-1.0 microM with a detection limit of 2.68 x 10(-7)M at nanoAu/ITO electrode. A diffusion coefficient of 2.36 x 10(-6)cm(2)/s is calculated for MP using chronoamperometry. The proposed method is effectively applied to detect the concentration of MP in pharmaceutical formulations and human blood plasma and urine samples. A comparison of MP concentration determined in blood plasma and urine by the proposed method and GC/MS indicated that the results are essentially similar. It is believed that the method will be useful in determining this drug in case of doping.
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Affiliation(s)
- Rajendra N Goyal
- Department of Chemistry, Indian Institute of Technology Roorkee, Roorkee 247667, India.
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Teixeira LR, Vargas FS, Acencio MMP, Bumlai RUM, Antonangelo L, Marchi E. Experimental pleurodesis induced by antibiotics (macrolides or quinolones). Clinics (Sao Paulo) 2006; 61:559-64. [PMID: 17187093 DOI: 10.1590/s1807-59322006000600012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Accepted: 10/23/2006] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Chemical pleurodesis is a therapeutic tool for the treatment of recurrent pleural effusions, mainly those of neoplastic etiology. In the past, tetracycline was the sclerosant agent of choice in clinical practice, but presently, there is no consensus about an ideal agent. The aim of this study was to evaluate the effectiveness of macrolides (azithromycin and clarithromycin) or quinolones (levofloxacin and gatifloxacin) in inducing experimental pleurodesis in rabbits. METHOD Forty New Zealand rabbits randomized into groups of 10 received (at a total volume of 2 mL for each animal) 1 of the 4 drugs by intrapleural injection. After 28 days, the animals were euthanized and the pleural cavity was evaluated macroscopically and microscopically. RESULTS The intensity of the macroscopic adhesions was mild in all groups. On microscopic analysis, minimal pleural fibrosis and inflammation were observed in all animals. CONCLUSION The macrolides (azithromycin or clarithromycin) and the quinolones (levofloxacin or gatifloxacin) when injected into the normal pleural space of rabbits are not effective in promoting pleurodesis. Additional research is required to identify sclerosing agents capable of inducing pleurodesis.
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Affiliation(s)
- Lisete R Teixeira
- Pleural Laboratory, Pulmonar Division, Heart Institute, São Paulo University Medical School, São Paulo, SP, Brazil.
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Liao H, Guo Y, Jun Na M, Lane KB, Light RW. The short-term administration of Ketoprofen does not decrease the effect of Pleurodesis induced by talc or Doxycycline in rabbits. Respir Med 2006; 101:963-8. [PMID: 17056242 DOI: 10.1016/j.rmed.2006.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 09/05/2006] [Accepted: 09/07/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether the concomitant administration of ketoprofen, a non-steroidal anti-inflammatory drug (NSAID) has any effect on the pleurodesis induced by talc or doxycycline in rabbits. METHODS Four groups of seven New Zealand rabbits were assigned to receive the following treatments: 400mg/kg of talc intrapleurally only (group 1), 400mg/kg of talc plus 1mg/kg of ketoprofen intramuscularly (group 2), 10mg/kg of doxycycline intrapleurally only (group 3) and 10mg/kg of doxycycline plus 1mg/kg of ketoprofen intramuscularly (group 4). Intramuscular administration of ketoprofen began 4h before the intrapleural administration of the sclerosing agents, followed by twice daily administrations for 1 week. Pleural fluid was collected 24, 48 and 72h after intrapleural injections. Pleurodesis was evaluated macroscopically and microscopically after 14 days. RESULTS The concomitant use of ketoprofen at 1mg/kg does not decrease the WBC, LDH, and protein in pleural fluid at 24h following intrapleural injection of talc or doxycycline. There were no significant differences in the macroscopic pleurodesis scores, the degree of microscopic pleural fibrosis, the thickness of the pleura or the percent of the pleura occupied with angiogenesis. CONCLUSIONS The study shows that the short-term systemic administration of NSAIDs does not affect the efficacy of pleurodesis induced by talc or doxycycline in rabbits.
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Affiliation(s)
- Huai Liao
- Department of Pulmonary Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
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