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Ji J, Shi T, Yan L, Wang K, Jiang K, Jiang Y, Pan S, Yu Y, Li C. Development of a diagnostic algorithm to ascertain malignant pleural effusion utilizing clinical indicators and serum metal concentrations. Front Oncol 2024; 14:1431318. [PMID: 38939338 PMCID: PMC11208470 DOI: 10.3389/fonc.2024.1431318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/30/2024] [Indexed: 06/29/2024] Open
Abstract
Background Malignant pleural effusion (MPE) is prevalent among cancer patients, indicating pleural metastasis and predicting poor prognosis. However, accurately identifying MPE in clinical settings is challenging. The aim of this study was to establish an innovative nomogram-derived model based on clinical indicators and serum metal ion levels to identify MPE. Methods From July 2020 to May 2022, 428 patients diagnosed with pleural effusion (PE) were consecutively recruited. Comprehensive demographic details, clinical symptoms, imaging data, pathological information, and laboratory results, including serum metal ion levels, were systematically collected. The nomogram was created by incorporating the most significant predictors identified through LASSO and multivariate logistic regression analysis. The predictors were assigned weighted points based on their respective regression coefficients, allowing for the calculation of a total score that corresponds to the probability of MPE. Internal validation using bootstrapping techniques assessed the nomogram's performance, including calibration, discrimination, and clinical applicability. Results Seven key variables were identified using LASSO regression and multiple regression analysis, including dyspnea, fever, X-ray/CT compatible with malignancy, pleural carcinoembryonic antigen(pCEA), serum neuron-specific enolase(sNSE), serum carcinoembryonic antigen(sCEA), and pleural lactate dehydrogenase(pLDH). Internal validation underscored the superior performance of our model (AUC=0.940). Decision curve analysis (DCA) analysis demonstrated substantial net benefit across a probability threshold range > 1%. Additionally, serum calcium and copper levels were significantly higher, while serum zinc levels were significantly lower in MPE patients compared to benign pleural effusion (BPE) patients. Conclusion This study effectively developed a user-friendly and reliable MPE identification model incorporating seven markers, aiding in the classification of PE subtypes in clinical settings. Furthermore, our study highlights the clinical value of serum metal ions in distinguishing malignant pleural effusion from BPE. This significant advancement provides essential tools for physicians to accurately diagnose and treat patients with MPE.
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Affiliation(s)
- Jinling Ji
- Department of Medical laboratory, the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Ting Shi
- Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Lei Yan
- Department of Medical laboratory, the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Kai Wang
- Department of Rheumatology, the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Kun Jiang
- Department of Medical laboratory, the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Yuzhang Jiang
- Department of Medical laboratory, the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Shengnan Pan
- Department of Medical laboratory, the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Yabin Yu
- Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Chang Li
- Department of Medical laboratory, the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
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Monteiro AC, França de Santana T, Morais M, Santos C, Aurélio J, Santos I, Cruz S, Vázquez D, Ferreira Arroja S, Mariz J. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine. Cureus 2024; 16:e55573. [PMID: 38576627 PMCID: PMC10994179 DOI: 10.7759/cureus.55573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
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Affiliation(s)
| | | | - Mariana Morais
- Internal Medicine Department, Centro Hospitalar Lisboa Central - Hospital São José, Lisboa, PRT
| | - Catarina Santos
- Internal Medicine Department, Hospital Garcia de Orta, Almada, PRT
| | - João Aurélio
- Internal Medicine Department, Centro Hospitalar do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Santos
- Internal Medicine Department, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Sofia Cruz
- Internal Medicine Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | | | - José Mariz
- Emergency Department, Hospital de Braga, Braga, PRT
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, PRT
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Sumer E, Hamitoglu M, Cumbul A, Ercan S, Bac N, Aydin A. Determination of In Vivo efficacy and safety of zeolite as a new pleurodesis agent. Toxicol Rep 2022; 9:1754-1765. [DOI: 10.1016/j.toxrep.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
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Wei XS, Pei XB, Liu YL, Wu XZ, Shi HZ, Zhou Q. IL-17A-Producing γδT Cells Inhibit the Formation of Malignant Pleural Effusions. Am J Respir Cell Mol Biol 2020; 61:174-184. [PMID: 30608868 DOI: 10.1165/rcmb.2018-0201oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
γδT cells are an important source of IL-17A and play an anti- or protumor role depending on the surrounding microenvironment. The precise role of γδT cells in the development of malignant pleural effusions (MPE) remains unknown. Using flow cytometry, we analyzed the distribution and differentiation of γδT cells in wild-type (WT) and IL-10-∕- mice. We carefully elucidated the influence of γδT cells on the formation of MPE by depleting γδT cells from WT, IL-10-∕-, and IL-17a-∕- mice. The distribution of γδT17 cells in human MPE and peripheral blood was also determined. Our data showed that both γδT cells and IL-17A-producing γδT (γδT17) cells accumulated in murine MPE, and IL-10 deficiency enhanced their accumulation. γδT cells were the main source of IL-17A in MPE for both WT and IL-10-∕- mice. IL-10 inhibited the chemotactic response of γδT cells to MPE and the proliferation of these cells. IL-10 suppressed γδT cell secretion of IL-17A via RORγt. The ablation of γδT cells accelerated MPE accumulation in both WT and IL-10-∕- mice, but it did not influence MPE accumulation in IL-17a-∕- mice. Patients with higher frequencies of γδT17 cells had significantly longer survival times than patients with lower frequencies of γδT17 cells. Taken together, our data demonstrate that γδT17 cells play an inhibitory role in the progression of MPE, and the accumulation of γδT17 cells in MPE is suppressed by IL-10.
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Affiliation(s)
- Xiao-Shan Wei
- 1Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | | | - Ya-Lan Liu
- 2Center of Medical Research and.,3Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiu-Zhi Wu
- 2Center of Medical Research and.,3Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huan-Zhong Shi
- 2Center of Medical Research and.,3Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qiong Zhou
- 1Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
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Tian AP, Yin YK, Yu L, Yang BY, Li N, Li JY, Bian ZM, Hu SY, Weng CX, Feng L. Low-Frequency Sonophoresis of Chinese Medicine Formula Improves Efficacy of Malignant Pleural Effusion Treatment. Chin J Integr Med 2019; 26:263-269. [DOI: 10.1007/s11655-019-3167-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 10/26/2022]
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Murthy P, Ekeke CN, Russell KL, Butler SC, Wang Y, Luketich JD, Soloff AC, Dhupar R, Lotze MT. Making cold malignant pleural effusions hot: driving novel immunotherapies. Oncoimmunology 2019; 8:e1554969. [PMID: 30906651 PMCID: PMC6422374 DOI: 10.1080/2162402x.2018.1554969] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 12/26/2022] Open
Abstract
Malignant pleural effusions, arising from either primary mesotheliomas or secondary malignancies, heralds advanced disease and poor prognosis. Current treatments, including therapeutic thoracentesis and tube thoracostomy, are largely palliative. The immunosuppressive environment within the pleural cavity includes myeloid derived suppressor cells, T-regulatory cells, and dysfunctional T cells. The advent of effective immunotherapy with checkpoint inhibitors and adoptive cell therapies for lung cancer and other malignancies suggests a renewed examination of local and systemic therapies for this malady. Prior strategies reporting remarkable success, including instillation of the cytokine interleukin-2, perhaps coupled with checkpoint inhibitors, should be further evaluated in the modern era.
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Affiliation(s)
- Pranav Murthy
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chigozirim N. Ekeke
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kira L. Russell
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samuel C. Butler
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yue Wang
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - James D. Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam C. Soloff
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Michael T. Lotze
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
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Emami Ardestani M, Modaemzadeh M, Mohammadi AR. Comparative Analysis of Mean Pleural Fluid D-dimer Level in Malignant and Non-Malignant Pleural Effusion Patients. TANAFFOS 2019; 18:47-51. [PMID: 31423140 PMCID: PMC6690320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Malignant Pleural Effusion (MPE) is a condition that mostly presents with dyspnea. There are some ways to distinguish it from Non-Malignant Pleural Effusion (NMPE).The aim of this study was to compare serum and pleural D-dimer levels between MPE and NMPE patients. MATERIALS AND METHODS Patients diagnosed with Pleural Effusion (PE) were selected to participate in this study. They were allocated in 2 groups of MPE and NMPE according to the etiology. Serum and pleural fluid D-dimer level were measured and statistically analyzed between two groups. RESULTS 32 MPE patients and 32 NMPE patients participated in this study. The mean age was 61.3 ± 12 years and M/F ratio was 35/29. The mean pleural and serum D-dimer levels were 3472± 1312 ng/dl and 3259±1220 ng/dl in patients with MPE, and 3425 ± 32.5ng/dl and 2425 ± 1311ng/dl in patients with NMPE, respectively. The serum D-dimer levels were not statistically different between 2 groups; while the pleural D-dimer levels were higher in MPE group in comparison with NMP patients (P<0.05). CONCLUSION This study showed that pleural D-dimer levels were significantly different between two groups and therefore pleural D-dimer can be considered as a non-invasive tool for diagnosis of MPE.
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Affiliation(s)
- Mohammad Emami Ardestani
- Departments of Pulmonology, Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Modaemzadeh
- Internal Medicine Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Reza Mohammadi
- Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Mohammadi AR, Address: Isfahan University of Medical Sciences, Isfahan, Iran, Email address:
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Dos Santos EDC, Pontes Campos AE, do Carmo OF, Lunardi AC. Comparing high and low levels of continuous positive airway pressure on lung aeration in patients with pleural drainage: A feasibility study for a randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1753. [PMID: 30378221 DOI: 10.1002/pri.1753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/30/2018] [Accepted: 09/29/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We explored the feasibility of use of continuous positive airway pressure (CPAP) with 15- and 4-cmH2 O for a randomized controlled trial with patients with pleural drainage. METHODS Ten patients with traumatic pleural effusion drained within 24 hr, with controlled pain received randomly CPAP with 0-, 4-, and 15-cmH2 O. Computed tomography was used to assess the lung aeration. Patients reported the level of tolerability. Air leak was also observed as a parameter of safety. The levels of pressure were compared using the Friedman test followed by the Tukey test as post hoc. RESULTS The lung area under CPAP with 15 cmH2 O (median = 3,913 mm2 ; IQR = 3,416-4,390 mm2 ) was greater than 4 (median = 3,495 mm2 ; IQR = 3,075-3,954 mm2 ) and 0 cmH2 O (median = 3,382 mm2 ; IQR = 2,962-3,658 mm2 ; p < 0.001). There was no difference between lung areas under CPAP with 4 and 0 cmH2 O. All levels of pressure were well tolerated by patients. No air leak was observed during the assessments. CONCLUSION CPAP with 15 cmH2 O is able to expand lungs of patients with pleural drainage. CPAP with 4 cmH2 O seems not have therapeutic effect. In addition, CPAP with 15 cmH2 O is well tolerated and safe in this population.
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Affiliation(s)
- Elinaldo da Conceição Dos Santos
- Master and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.,Department of Biological and Health Sciences, Universidade Federal do Amapá, Macapá, Brazil
| | | | | | - Adriana Claudia Lunardi
- Master and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.,Department of Physical Therapy of School of Medicine, University of Sao Paulo, São Paulo, Brazil
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Hillerdal CO, Ötvös R, Szatmári T, Own SA, Hillerdal G, Dackland ÅL, Dobra K, Hjerpe A. Ex vivo evaluation of tumor cell specific drug responses in malignant pleural effusions. Oncotarget 2017; 8:82885-82896. [PMID: 29137310 PMCID: PMC5669936 DOI: 10.18632/oncotarget.20889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 08/25/2017] [Indexed: 12/11/2022] Open
Abstract
The effect of chemotherapy may be improved by combining the most effective drugs based on testing the sensitivity of the individual tumor ex vivo. Such estimations of tumor cells from effusions have so far not been implemented in the clinical routine as a basis for individualized choice of therapy. One obstacle for such analyses is the admixture of benign cells that might obscure the results. In this paper we test and compare two ways of performing the analysis specifically on tumor cells. First we enrich the tumor cells, using antibody labeled magnetic separation, and measure the effects of subsequent drug exposure with the metabolic activity assays WST-1 and alamar blue. The second way of estimating drug effects specifically on tumor cells employs multi parameter flow cytometry, measuring apoptosis with the propidium iodide / AnnexinV technique and, particularly for pemetrexed, possible effects on cell cycle progression in immunologically identified tumor cells. The two techniques produce similar results, indicating a possible use in personalized medicine. The possible predictive role of the analysis remains to be shown.
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Affiliation(s)
- Carl-Olof Hillerdal
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Rita Ötvös
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Tünde Szatmári
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Sulaf Abd Own
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Gunnar Hillerdal
- Gävle Hospital, Department of Lung Medicine, 803 24 Gävle, Sweden
| | - Åsa-Lena Dackland
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Katalin Dobra
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Anders Hjerpe
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
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El Megied El Hadidy AA, Kamel KM, Al Kareem Abo Zaid AA, Kamal E, El Shahat Hussien Fayiad H. Role of chest ultrasound in detecting successful pleurodesis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Amin Z, Iskandar SD, Sibli. Prognostic Factors of 30-day Survival of Patients with Malignant Pleural Effusion. Indian J Palliat Care 2017; 23:321-324. [PMID: 28827939 PMCID: PMC5545961 DOI: 10.4103/ijpc.ijpc_2_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Treatment of malignant pleural effusion (MPE) depends on the 1 month prognosis of patients. Until now, there is no study evaluate factors affecting 1 month survival. Aims: This study aims to determine the predictors of survival within 1 month. Methods: Prospective study of 102 patients with MPE. Biochemistry data of pleural fluid, characteristics of tumor, and massiveness of the effusion were analyzed to determine their effect on 30-day survival of the patients. Univariate analysis was performed using Chi-square. All prognostic factors that had P < 0.25 were included in multivariate analysis using Cox regression. Results: Median age of patients was 51 years, most of them were female (56%). Common primary sites of tumor were lung (31%), breast (19%), and lymphatic tissue (11%). In univariate analysis, factors that have P < 0.25 were low glucose concentration in pleural fluid (P = 0.01), high lactate dehydrogenase concentration in pleural fluid (P = 0.25), and high risk tumor (P = 0.24). In multivariate analysis, only low glucose concentration was significantly related to poor survival within 1 month (hazard ratio 2.85 [1.10–7.61], P = 0.03). Conclusions: Low level of glucose in pleural fluid is an important factor related to 30-day survival in patients with MPE. It can be used to determine prognosis-based treatment objectively.
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Affiliation(s)
- Zulkifli Amin
- Department of Respirology and Critical Illness, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Stephen Diah Iskandar
- Department of Respirology and Critical Illness, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Sibli
- Department of Respirology and Critical Illness, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
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Kahrom H, Aghajanzadeh M, Asgari MR, Kahrom M. Efficacy and Safety of Povidone-iodine Pleurodesis in Malignant Pleural Effusions. Indian J Palliat Care 2017; 23:53-56. [PMID: 28216863 PMCID: PMC5294438 DOI: 10.4103/0973-1075.197958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is determined by the detection of malignant cells in pleural fluid or pleural tissue. Neoplasm of lung, breast, ovary and lymphoma are the causes of more than 75% of MPE. Pleurodesis is a usual technique in the management of MPE to achieve a symphysis between two layers of the pleura, and various chemical agents have been used in an attempt to produce pleurodesis. With regard to complications and limitations of these sclerosing agents, efficacy and safety of povidone-iodine have been investigated in this study. MATERIALS AND METHODS Between June 2014 and June 2016, 63 consecutive patients were admitted to the Department of Thoracic Surgery because of symptomatic MPE. After insertion of a chest tube, pleurodesis with instillation of povidone-iodine was performed. Thyroid and renal function tests were checked, and success rate as well as recurrence of MPE was monitored in the next follow-up visits. RESULTS The complete response to this procedure was about 53.57%, and failure of treatment was 10.71% with efficacy of 82.2%. The most common complication was pain during instillation (26.9%). Changes in thyroid and renal function tests were not significant. CONCLUSION Povidone-iodine is a safe and effective agent with minor side effects in pleurodesis of patients with MPEs and can be used as an accessible and low-cost alternative than other sclerosing agents.
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Affiliation(s)
- Hadi Kahrom
- Department of General Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Mohammad Reza Asgari
- Department of General Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahdi Kahrom
- Department of Cardiovascular Surgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Taghizadeh N, Fortin M, Tremblay A. US Hospitalizations for Malignant Pleural Effusions: Data From the 2012 National Inpatient Sample. Chest 2016; 151:845-854. [PMID: 27876589 DOI: 10.1016/j.chest.2016.11.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/06/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) is a common complication of advanced malignancy, but little is known regarding its prevalence and overall burden on a population level. METHODS We conducted a retrospective analysis of MPE-associated hospitalizations using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, Agency for Healthcare Research and Quality (HCUP-NIS 2012). Cases were included if MPE was coded as a primary or secondary diagnosis or if an unspecified pleural effusion was coded in addition to a diagnosis of cancer with either of these being the primary diagnosis. RESULTS A weighted sample of 126,825 admissions (0.35%) for MPE was identified among the 36,484,846 weighted admissions included in the database in 2012. Of these admissions, 70,750 (55.8%) were for female patients. The median age at admission was 68.0 years (interquartile range [IQR]), 58.4-77.2 years). Lung (37.8%), breast (15.2%), hematologic (11.2%), GI tract (11.0%), and gynecologic (9.0%) cancers were the most common primary malignancies associated with MPE. The median length of stay was 5.5 days (IQR, 2.7-10.1 days), and the inpatient mortality rate was 11.6%. Median hospitalization total charges were $42,376 (IQR, $21,618-$84,679). In the multivariate analyses, female sex, large fringe county residential area, Medicare insurance, and elective type of admission were independently associated with a lower risk of inpatient mortality. CONCLUSIONS There is a considerable inpatient burden and high inpatient mortality associated with MPE in the United States, with potential demographic, geographic, and socioeconomic disparities.
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Affiliation(s)
- Niloofar Taghizadeh
- Division of Respiratory Medicine, University of Calgary and Alberta Thoracic Oncology Program, Calgary, AB, Canada
| | - Marc Fortin
- Division of Respiratory Medicine, University of Calgary and Alberta Thoracic Oncology Program, Calgary, AB, Canada
| | - Alain Tremblay
- Division of Respiratory Medicine, University of Calgary and Alberta Thoracic Oncology Program, Calgary, AB, Canada.
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Sivakumar P, Douiri A, West A, Rao D, Warwick G, Chen T, Ahmed L. OPTIMUM: a protocol for a multicentre randomised controlled trial comparing Out Patient Talc slurry via Indwelling pleural catheter for Malignant pleural effusion vs Usual inpatient Management. BMJ Open 2016; 6:e012795. [PMID: 27798020 PMCID: PMC5073842 DOI: 10.1136/bmjopen-2016-012795] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The development of malignant pleural effusion (MPE) results in disabling breathlessness, pain and reduced physical capability with treatment a palliative strategy. Ambulatory management of MPE has the potential to improve quality of life (QoL). The OPTIMUM trial is designed to determine whether full outpatient management of MPE with an indwelling pleural catheter (IPC) and pleurodesis improves QoL compared with traditional inpatient care with a chest drain and talc pleurodesis. OPTIMUM is currently open for any centres interested in collaborating in this study. METHODS AND ANALYSIS OPTIMUM is a multicentre non-blinded randomised controlled trial. Patients with a diagnosis of MPE will be identified and screened for eligibility. Consenting participants will be randomised 1:1 either to an outpatient ambulatory pathway using IPCs and talc pleurodesis or standard inpatient treatment with chest drain and talc pleurodesis as per British Thoracic Society guidelines. The primary outcome measure is global health-related QoL at 30 days measured using the EORTC QLQ-C30 questionnaire. Secondary outcome measures include breathlessness and pain measured using a 100 mm Visual Analogue Scale and health-related QoL at 60 and 90 days. A sample size of 142 patients is needed to demonstrate a clinically significant difference of 8 points in global health status at 30 days, for an 80% power and a 5% significance level. ETHICS AND DISSEMINATION The study has been approved by the NRES Committee South East Coast-Brighton and Sussex (reference 15/LO/1018). The trial results will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBERS UKCRN19615 and ISRCTN15503522; Pre-results.
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Affiliation(s)
- P Sivakumar
- St Thomas’ Hospital, London, UK
- King's College London, London, UK
| | - A Douiri
- King's College London, London, UK
| | - A West
- St Thomas’ Hospital, London, UK
| | - D Rao
- Princess Royal University Hospital, Orpington, UK
| | | | - T Chen
- King's College London, London, UK
| | - L Ahmed
- St Thomas’ Hospital, London, UK
- King's College London, London, UK
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Khalil M, Shoukri AM. Thoracoscopic tetracycline poudrage for pleurodesis in malignant pleural effusion. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.184358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Primary Malignant Neuroendocrine Tumour of Pleura: First Case Report. Case Rep Oncol Med 2016; 2016:5462380. [PMID: 27034865 PMCID: PMC4789394 DOI: 10.1155/2016/5462380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
Metastatic tumours of pleura are the most common malignant tumours causing malignant pleural effusion. Lungs are the most common primary sites. Primary pleural tumours are rarely seen and diffuse malignant mesothelioma is the most common malignant tumour of pleura. Primary malignant neuroendocrine tumour of pleura is not reported in the literature. Here, we report a rare case of primary malignant neuroendocrine tumour of pleura in a fifty-two-year-old, nonsmoker female who presented with right-sided pleural effusion and ipsilateral, dull aching chest pain. Clinical presentations of inflammatory lesions like tuberculous pleuritis and benign and malignant neoplasms of pleura are indistinguishable; hence, fluid cytology, pleural biopsy, and immunohistochemistry are necessary for exact tissue diagnosis of the tumours, which is mandatory for correct treatment and prognostic assessment.
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17
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Hak CCW, Sivakumar P, Ahmed L. Safety of indwelling pleural catheter use in patients undergoing chemotherapy: a five-year retrospective evaluation. BMC Pulm Med 2016; 16:41. [PMID: 26968653 PMCID: PMC4788821 DOI: 10.1186/s12890-016-0203-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/01/2016] [Indexed: 12/13/2022] Open
Abstract
Background Indwelling pleural catheters (IPC) are increasingly becoming a first-line treatment in the management of malignant pleural effusions. Ambulatory management using IPC are increasingly used in this patient group whilst they are receiving concurrent chemotherapy. There are currently no prospective trials examining IPC safety in chemotherapy. This study’s objective is to determine if IPC insertion is safe in patients undergoing chemotherapy. Methods We conducted a retrospective analysis of all patients who underwent IPC insertion for malignant pleural effusion at our trust from September 2010 to December 2014. Data was collected on IPC insertion and removal, tumour type, systemic chemotherapy, pleural infection and other complications. Results One hundred four patients were identified, 43 in chemotherapy group and 61 in non-chemotherapy group. The incidence of pleural infection in chemotherapy group vs non-chemotherapy group, 4 (9.3 %) vs 3 (4.9 %) respectively, was not statistically different (Fisher’s exact p = 0.311). There was no significant difference in six-month infection-free duration from the date of IPC insertion (log rank p = 0.394). Overall six-month mortality in chemotherapy group was significantly lower than in non-chemotherapy group (log rank p = 0.007). Conclusions This is the second largest retrospective case–control series that concludes systemic chemotherapy is safe in patients with IPC undergoing chemotherapy.
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Affiliation(s)
- Charleen Chan Wah Hak
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK. .,School of Medicine, King's College London, London, UK.
| | - Parthipan Sivakumar
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Medicine, King's College London, London, UK
| | - Liju Ahmed
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Medicine, King's College London, London, UK
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Tsai MF, Chang TH, Wu SG, Yang HY, Hsu YC, Yang PC, Shih JY. EGFR-L858R mutant enhances lung adenocarcinoma cell invasive ability and promotes malignant pleural effusion formation through activation of the CXCL12-CXCR4 pathway. Sci Rep 2015; 5:13574. [PMID: 26338423 PMCID: PMC4559673 DOI: 10.1038/srep13574] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/30/2015] [Indexed: 12/13/2022] Open
Abstract
Malignant pleural effusion (MPE) is a common clinical problem in non-small cell lung carcinoma (NSCLC) patients; however, the underlying mechanisms are still largely unknown. Recent studies indicate that the frequency of the L858R mutant form of the epidermal growth factor receptor (EGFR-L858R) is higher in lung adenocarcinoma with MPE than in surgically resected specimens, suggesting that lung adenocarcinoma cells harboring this mutation tend to invade the adjacent pleural cavity. The purpose of this study was to clarify the relationship between the EGFR-L858R mutation and cancer cell invasion ability and to investigate the molecular mechanisms involved in the formation of MPE. We found that expression of EGFR-L858R in lung cancer cells resulted in up-regulation of the CXCR4 in association with increased cancer cell invasive ability and MPE formation. Ectopic expression of EGFR-L858R in lung cancer cells acted through activation of ERK signaling pathways to induce the expression of CXCR4. We also indicated that Inhibition of CXCR4 with small interfering RNA, neutralizing antibody, or receptor antagonist significantly suppressed the EGFR-L858R–dependent cell invasion. These results suggest that targeting the production of CXCR4 and blocking the CXCL12-CXCR4 pathway might be effective strategies for treating NSCLCs harboring a specific type of EGFR mutation.
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Affiliation(s)
- Meng-Feng Tsai
- Department of Molecular Biotechnology, College of Biotechnology and Bioresources, Dayeh University, Changhua 51591, Taiwan
| | - Tzu-Hua Chang
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Shang-Gin Wu
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin 64041, Taiwan
| | - Hsiao-Yin Yang
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Yi-Chiung Hsu
- Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan
| | - Pan-Chyr Yang
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei 10002, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei 10002, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
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Tabatabaei SA, Hashemi SM, Kamali A. Silver nitrate versus tetracycline in pleurodesis for malignant pleural effusions; a prospective randomized trial. Adv Biomed Res 2015; 4:178. [PMID: 26605217 PMCID: PMC4617005 DOI: 10.4103/2277-9175.164007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/03/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In this study, we aimed to investigate the effectiveness of silver nitrate (SN) versus tetracycline in pleurodesis among patients with malignant pleural effusion (MPE). METHODS In this prospective randomized clinical trial, patients with unilateral MPE candidate for pleurodesis were enrolled. The patients randomly allocated in two groups for receiving 20 mL 0.5% SN or 2.5 g tetracycline diluted in 30 cc normal saline and 0.1% lidocaine, through the chest tube. Patients were followed-up immediately (during 24 h) and 1-month after the procedure for evaluating recurrence of the pleural effusion using chest radiograph. They were clinically evaluated for chest pain and/or dyspnea and fever using a questionnaire that completed by the surgeon. The results were compared with two groups. RESULTS During this trial, 50 patients with MPE candidate for pleurodesis were selected and randomized into two interventional groups (25 patients in each group). Immediate and late recurrence of pleural effusion after pleurodesis were similar in two groups (P > 0.05). All patients in tetracycline group had fever and chest pain, but in SN group fever and chest pain were reported in 3 (12%) and 12 (48%) of patients, respectively (P < 0.05). CONCLUSION SN is at least as effective as tetracycline for MPE treatment. In addition, its side effects were lower than tetracycline. Other advantages of SN are its low cost, availability, and safety. For more accurate results, it is recommended to design further trials with larger sample size and with lower doses of both SN and tetracycline.
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Affiliation(s)
| | | | - Ali Kamali
- Department of Thorax Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Cox SE, Katlic MR. Non-intubated video-assisted thoracic surgery as the modality of choice for treatment of recurrent pleural effusions. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:103. [PMID: 26046044 DOI: 10.3978/j.issn.2305-5839.2015.04.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/23/2015] [Indexed: 11/14/2022]
Abstract
This review will establish that the best mode of treatment for recurrent pleural effusions is non-intubated video-assisted thoracic surgery (VATS) with chemical talc pleurodesis. The nature of recurrent pleural effusions mandates that any definitive and effective treatment of this condition should ideally provide direct visualization of the effusion, complete initial drainage, a low risk outpatient procedure, a high patient satisfaction rate, a high rate of pleurodesis and a high diagnostic yield for tissue diagnosis. There are various methods available for treatment of this condition including thoracostomy tube placement with bedside chemical pleurodesis, thoracentesis, placement of an indwelling pleural catheter, pleurectomy and VATS drainage with talc pleurodesis. Of these treatment options VATS drainage with the use of local anesthetic and intravenous sedation is the method that offers most of the desired outcomes, thus making it the best treatment modality.
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Affiliation(s)
- Solange E Cox
- Sinai Hospital of Baltimore, Baltimore, MD 21215-5216, USA
| | - Mark R Katlic
- Sinai Hospital of Baltimore, Baltimore, MD 21215-5216, USA
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Dhamija E, Thulkar S, Bhatnagar S. Utility and potential of bedside ultrasound in palliative care. Indian J Palliat Care 2015; 21:132-6. [PMID: 26009664 PMCID: PMC4441172 DOI: 10.4103/0973-1075.156465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Bedside ultrasound is an important tool in modern palliative care practice. It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures. With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards. Major applications of bedside ultrasound include drainage of malignant pleural effusions and ascites, nerve blocks, venous access, evaluation of urinary obstruction, deep vein thrombosis and abscesses. Bedside ultrasound leads to better clinical decision-making as well as more accurate and faster invasive therapeutic procedures. It also enhances patient comfort and reduces cost burden. However, use of bedside ultrasound is still not widespread among palliative care givers, owing to initial cost, lack of basic training in ultrasound and apprehensions about its use. A team approach involving radiologists is important to develop integration of bedside ultrasound in palliative care.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, Dr. Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr. Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Anaesthesia and Palliative Care, Dr. Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Malignant pleural effusion: Relationship between thoracoscopic findings and type of malignancy. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Domvri K, Zarogoulidis P, Theodoropoulos F, Huang H, Zarogoulidis K. Establishment of a malignant pleural effusion mouse model: pathogenesis pathways. Transl Lung Cancer Res 2015; 1:163-6. [PMID: 25806177 DOI: 10.3978/j.issn.2218-6751.2012.08.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 08/24/2012] [Indexed: 01/09/2023]
Affiliation(s)
- Kalliopi Domvri
- Pulmonary Department - Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- Pulmonary Department - Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; ; Pulmonary Department - Interventional Unit, "Ruhrlandklinik", University of Essen, Essen, Germany
| | - Fotis Theodoropoulos
- Pulmonary Department - Interventional Unit, "Ruhrlandklinik", University of Essen, Essen, Germany
| | - Haidong Huang
- Department of Respiratory diseases, Changhai hospital, Yangpu District, Shanghai 200082, China
| | - Konstantinos Zarogoulidis
- Pulmonary Department - Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Pleurodesis induction in rats by Copaiba (Copaifera multijuga Hayne) oil. BIOMED RESEARCH INTERNATIONAL 2014; 2014:939738. [PMID: 24999484 PMCID: PMC4066724 DOI: 10.1155/2014/939738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/06/2014] [Indexed: 11/17/2022]
Abstract
This study aims to assess and compare copaiba oleoresin of Copaifera multijuga and 0.5% silver nitrate for the induction of pleurodesis in an experimental model. Ninety-six male Wistar rats were divided into three groups: control (0.9% saline solution), copaiba (copaiba oil), and silver nitrate (0.5% silver nitrate). The substances were injected into the right pleural cavity and the alterations were observed macroscopically and microscopically at 24, 48, 72, and 504 h. The value of macroscopic alterations grade and acute inflammatory reaction grade means was higher in the 24 h copaiba group in relation to silver nitrate. Fibrosis and neovascularization means in the visceral pleura were higher in 504 h copaiba group in relation to the silver nitrate group. The grade of the alveolar edema mean was higher in the silver nitrate group in relation to the copaiba group, in which this alteration was not observed. The presence of bronchopneumonia was higher in the 24 h silver nitrate group (n = 4) in relation to the copaiba group (n = 0). In conclusion, both groups promoted pleurodesis, with better results in copaiba group and the silver nitrate group presented greater aggression to the pulmonary parenchyma.
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Usefulness of pigtail catheter in pleurodesis of malignant pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Godazandeh G, Qasemi NH, Saghafi M, Mortazian M, Tayebi P. Pleurodesis with povidone-iodine, as an effective procedure in management of patients with malignant pleural effusion. J Thorac Dis 2013; 5:141-4. [PMID: 23585939 DOI: 10.3978/j.issn.2072-1439.2013.02.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 02/21/2013] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Overtime, malignant pleural effusion (MPE) arises in advanced-stages of malignancies and frequently heralds a poor prognosis. If the underlying malignancy is chemo sensitive, systemic chemotherapy may control pleural effusion. A common method for the management of the patients with refractory MPE is pleurodesis through the introduction of sclerosing agents such as talc, bleomycin administered/instilled into the pleural cavity. However, the present prospective study aimed to investigate the efficacy and safety of pleurodesis with povidone-iodine (Betadine) in patients with MPE admitted in Sari General Hospital during 2008-2011. METHODS Thirty-six patients who underwent pleurodesis by instilling povidone-iodine through a thoracostomy tube, as a bedside procedure were enrolled in the study. For evaluating the effect of povidone-iodine on thyroid gland, the authors measured the thyroid function tests before and after the pleurodesis at 1 week. RESULTS The response to this procedure was complete in 26 patients (72.2%) and partial in 7 patients (19.4%). Treatment failure was displayed in 3 patients (8.3%). The overall success rate was 91.6%. In post-procedure, the most common complaints of the patients were pain (35.9%) followed by dyspnea, burning and fever. Povidone-iodine does not affect on thyroid function tests. CONCLUSIONS Povidone-iodine is an effective, inexpensive, safe and feasible agent for chemical pleurodesis in management of MPE.
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Affiliation(s)
- Gholamali Godazandeh
- Department of Thoracic Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Kumar SP, Sisodia V. An Exploratory Analysis of Levels of Evidence for Articles Published in Indian Journal of Palliative Care in the years 2010-2011. Indian J Palliat Care 2013; 19:170-9. [PMID: 24347908 PMCID: PMC3853396 DOI: 10.4103/0973-1075.121535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Indian Journal of Palliative Care (IJPC) provides a comprehensive multidisciplinary evidence base for an evidence-informed clinical decision making. AIMS To analyze the levels of evidence of articles published in IJPC in the years 2010-2011. SETTINGS AND DESIGN Systematic review of palliative care journals. MATERIALS AND METHODS Systematic review of articles was done and was scored according to Center for Evidence-Based Medicine levels of evidence into any of the five grades. The articles were categorized based upon article type, number of authors, study approach, age focus, population focus, disease focus, goals of care, domains of care, models of care, and year of publication. STATISTICAL ANALYSIS USED All descriptive analysis was done using frequencies and percentiles, and association between all categorical variables was done using Chi-square test at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) version 16 for Windows (SPSS Inc, Chicago, IL). RESULTS There was a greater prevalence of low level evidence (level 4: n = 46, 51%; level 5: n = 35, 39%) among the 90 selected articles, and article type (original articles with higher level of evidence, P = 0.000), article approach (analytical studies with higher level of evidence, P = 0.000), domains of palliative care (practice-related studies with higher level of evidence, P = 0.000) and models of care (biological or psychosocial model with higher level of evidence, P = 0.044) had a significant association with the grade of levels of evidence. Association with other factors was not statistically significant (P < 0.05). CONCLUSIONS The levels of research evidence for palliative care provided by articles published in IJPC were predominantly level 4 and level 5, and there is scope for more high quality evidence to inform palliative care decisions in the developing countries.
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Affiliation(s)
- Senthil Paramasivam Kumar
- Srinivas College of Physiotherapy, Pandeshwar, Mangalore, India,Address for correspondence: Dr. Senthil P Kumar E-mail:
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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.
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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
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