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Sidhu C, Wright G, Peddle-McIntyre CJ, Tan AL, Lee YCG. Management of malignant pleural effusion and trapped lung: a survey of respiratory physicians and thoracic surgeons in Australasia. Intern Med J 2024. [PMID: 38560767 DOI: 10.1111/imj.16366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Malignant pleural effusions (MPEs) are common, and a third of them have underlying trapped lung (TL). Management of MPE and TL is suspected to be heterogeneous. Understanding current practices in Australasia is important in guiding policies and future research. AIMS Electronic survey of Australia-New Zealand respiratory physicians, thoracic surgeons and their respective trainees to determine practice of MPE and TL management. RESULTS Of the 132 respondents, 56% were respiratory physicians, 23% were surgeons and 20% were trainees. Many respondents defined TL as >25% or any level of incomplete lung expansion; 75% would use large-volume thoracentesis to determine whether TL was present. For patients with TL, indwelling pleural catheters (IPCs) were the preferred treatment irrespective of prognosis. In those without TL, surgical pleurodesis was the most common choice if prognosis was >6 months, whereas IPC was the preferred option if survival was <3 months. Only 5% of respondents considered decortication having a definite role in TL, but 55% would consider it in select cases. Forty-nine per cent of surgeons would not perform decortication when the lung does not fully expand intra-operatively. Perceived advantages of IPCs were minimisation of hospital time, effusion re-intervention and usefulness irrespective of TL status. Perceived disadvantages of IPCs were lack of suitable drainage care, potentially indefinite duration of catheter-in-situ and catheter complications. CONCLUSION This survey highlights the lack of definition of TL and heterogeneity of MPE management in Australasia, especially for patients with expandable lungs. This survey also identified the main hurdles of IPC use that should be targeted.
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Affiliation(s)
- Calvin Sidhu
- School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Gavin Wright
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Carolyn J Peddle-McIntyre
- School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- Pleural Medicine Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Ai Ling Tan
- Pleural Medicine Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Yun Chor Gary Lee
- Pleural Medicine Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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Wu WJ, Ma GC, Chang TY, Lee MH, Lin WH, Chen M. Outcome and etiology of fetal pleural effusion, fetal ascites and hydrops fetalis after fetal intervention: retrospective observational cohort from a single institution. Ultrasound Obstet Gynecol 2024; 63:536-543. [PMID: 37767652 DOI: 10.1002/uog.27501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Non-immune hydrops fetalis (NIHF) is the pathological accumulation of fluids in fetal compartments, without maternal isoimmunization. Fetal interventions (e.g. shunting, fetal paracentesis, fetal thoracocentesis, fetal pleurodesis) are used to alleviate fluid accumulations, but the outcome is uncertain because the underlying causes of NIHF vary. We aimed to explore the etiology and long-term outcome of NIHF after fetal intervention. METHODS This was a retrospective review of fetuses with NIHF, defined by the presence of fetal ascites, pleural or pericardial effusion, skin edema or cystic hygroma, or a combination of these features, who underwent intervention at our institution during the period 2012-2021. Clinical surveillance, genetic analysis and viral infection screening were used to define the etiology. Chart reviews and telephone interviews were conducted to assess the long-term outcomes. RESULTS In total, 55 fetuses were enrolled and 46 cases had final follow-up data after delivery. Etiology was identified in 33 cases, including four for which the underlying causes were not identified initially using small-gene-panel tests but which were later diagnosed with monogenic disorders by whole-exome sequencing (WES). Twenty-three cases with follow-up survived, having a follow-up period of 2-11 years at the time of writing, of which 17 were healthy. All 11 cases initially presenting as congenital chylothorax survived with favorable outcome. CONCLUSIONS The etiologies of NIHF are heterogeneous, and the long-term (spanning 2-11 years) outcome of fetal intervention varies, according to the underlying etiology, with cases caused by congenital chylothorax having the best prognosis. Genome-wide tests, such as WES, may be helpful in determining the underlying condition in cases caused by a genetic disorder, and this may affect fetal therapy approaches in the future. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W-J Wu
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - G-C Ma
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - T-Y Chang
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan
- Department of Bioscience Technology, Chung Yuan Christian University, Taoyuan, Taiwan
| | - M-H Lee
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan
| | - W-H Lin
- Welgene Biotechnology Company, Nangang Business Park, Taipei, Taiwan
| | - M Chen
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Sciences, National Tsing Hua University, Hsinchu, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Jonny J, Violetta L. Bilateral Pleural Effusion in Continuous Ambulatory Peritoneal Dialysis Managed by Vats Pleurodesis. Eur J Case Rep Intern Med 2024; 11:004343. [PMID: 38584902 PMCID: PMC10997387 DOI: 10.12890/2024_004343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024] Open
Abstract
Pleuroperitoneal leak as a cause of pleural effusions in peritoneal dialysis is a rare but important complication to consider in continuous ambulatory peritoneal dialysis (CAPD) patients presenting with recurrent progressive dyspnoea. Generally, these effusions are unilateral and right-sided, resulting in shortness of breath and reduced ultrafiltration volume, which are initially managed by peritoneal rest. We describe a case of bilateral pleural effusions in a 57-year-old female on chronic CAPD who developed recurrent progressive dyspnoea but maintained adequate dialysis output. A chest radiograph revealed bilateral pleural effusions with high glucose content, and scintigraphy confirmed the existence of a definite pleuroperitoneal communication. She was managed by temporary substitution to haemodialysis, followed by suturing of the shunt and successful video-assisted thoracoscopic surgery (VATS) pleurodesis with an aldehyde-based surgical glue. Unexplained recurring dyspnoea in chronic CAPD should raise the suspicion of a possible pleuroperitoneal leak, even in patients without an apparent loss of ultrafiltration. Pleurodesis using an aldehyde-based adhesive was effective and tolerated well by our patient and may be considered in managing cases of recurrent pleural effusion. LEARNING POINTS Recurrent dyspnoea in a chronic peritoneal dialysis patient should raise the diagnosis of a possible pleuroperitoneal leak, even if no apparent loss of ultrafiltration was observed.Minimally invasive surgical pleurodesis using surgical adhesive can be considered in cases of refractory pleuroperitoneal leak.
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Affiliation(s)
- Jonny Jonny
- Division of Nephrology, Department of Internal Medicine, Gatot Soebroto Central Army Hospital, Jakarta, Indonesia
- Faculty of Medicine, Prima University, Medan, Indonesia
- Faculty of Medicine, Jakarta Veterans National Development University, Jakarta, Indonesia
- Faculty of Military Medicine, Indonesia Defense University, Bogor, Indonesia
| | - Laurencia Violetta
- Division of Nephrology, Department of Internal Medicine, Gatot Soebroto Central Army Hospital, Jakarta, Indonesia
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Ordóñez Lozano PA. [Catamenial pneumothorax with persistent air leak]. An Sist Sanit Navar 2024; 47:e1069. [PMID: 38451043 PMCID: PMC10938963 DOI: 10.23938/assn.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
Catamenial pneumothorax is a spontaneous recurrent pneumothorax that occurs in women of reproductive age and in temporal relationship with the menses. It usually occurs within 24 hours before or 72 hours after the start of the menstrual cycle; however, multiple variations have been described in terms of the temporal relationship. To date, it is considered a rare condition; this may be justified by the limited available knowledge on this disease leading to misdiagnosis. Often, making a diagnosis of catamenial pneumothorax is complicated; it mainly depends on the medical history; also, it may be a surgical or histopathological diagnosis. Management strategies for catamenial pneumothorax may include combinations of hormonal therapy, pleurodesis, lung parenchyma resection, and diaphragm resection/repair. The aim of reporting this atypical case of catamenial pneumothorax is to highlight the relevance of having the adequate knowledge on this entity so it does not go unnoticed despite its apparent low incidence.
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Akopyan K, Zafar R, Faruqi I. Secondary Spontaneous Pneumothorax in a Patient With Interstitial Lung Disease Undergoing Routine Outpatient Pulmonary Function Tests. Cureus 2024; 16:e55675. [PMID: 38586742 PMCID: PMC10996884 DOI: 10.7759/cureus.55675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
We present the case of a 64-year-old female with a past medical history significant for unclassified interstitial lung disease (ILD) from suspected hypersensitivity pneumonitis secondary to chronic mold exposure with steroid responsiveness and prior pneumothorax. The patient developed shortness of breath and pleuritic chest pain after undergoing routine outpatient pulmonary function tests (PFTs). She was immediately transferred to the emergency department and found to have a moderate left basilar pneumothorax. She underwent emergent surgical chest tube placement followed by doxycycline pleurodesis. Repeat chest imaging showed inadvertent retraction of the chest tube and extensive subcutaneous emphysema. The surgical chest tube was replaced by a pigtail catheter with an improvement of subcutaneous emphysema. This case demonstrates the development of a rare but serious complication of pneumothorax that could occur in patients who have ILD undergoing routine PFTs. Clinicians should be aware of this risk when patients who have ILD present for PFTs and counsel them to seek immediate medical attention if they develop signs of acute onset dyspnea after performing PFTs.
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Affiliation(s)
| | - Raaed Zafar
- Medicine, University of Texas at Dallas, Dallas, USA
| | - Ibrahim Faruqi
- Pulmonary and Critical Care Medicine, University of Florida, Gainesville, USA
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Schramm J, Eslauer E, Hammoudeh S, Stange S, Sziklavari Z. Comparison of outcomes of surgical and other invasive treatment modalities for malignant pleural effusion in patients with pleural carcinomatosis. J Thorac Dis 2024; 16:960-972. [PMID: 38505037 PMCID: PMC10944730 DOI: 10.21037/jtd-23-1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/24/2023] [Indexed: 03/21/2024]
Abstract
Background Treatment modalities for malignant pleural effusion (MPE) are diverse. The objectives were to analyze actual clinical data from patients with MPE and pleural carcinomatosis and to compare the outcomes of different treatment modalities with regard to effectiveness, survival, morbidity, and mortality as well as the duration of hospitalization. Methods Patients with pathologically proven pleural carcinomatosis or MPE from 2018 to 2020 were included in this retrospective-observational study with additional questionnaires. We identified four treatment modalities: (I) video-assisted thoracic surgery with pleurodesis (VATS, mechanical/chemical); (II) VATS with pleurodesis combined with indwelling pleural catheter (IPC) placement; (III) VATS (without pleurodesis) combined with IPC placement; and (IV) management with IPC placement alone. Results We enrolled 91 patients aged 38-90 years who were treated by either VATS-pleurodesis (N=22), VATS-IPC placement (N=21), a combination of VATS with pleurodesis and IPC placement (N=22), or IPC placement alone (N=26). The mean survival time was 138.3 days. No significant differences were detected among treatment groups regarding the outcome of pleurodesis failure, either initially or later. Patients in the VATS-pleurodesis with IPC group experienced significantly more complications than those in the other treatment modality groups [odds ratio (OR): 3.288, P=0.026]. However, no statistically significant differences were observed regarding the type of adverse event and survival. Hypoalbuminemia, systemic therapy, and successful pleurodesis (P=0.008; P=0.011; P=0.044, respectively) were significantly correlated with survival. In multiple linear regression, hypoalbuminemia persisted as an independent predictor of survival (P=0.031). The type of intervention showed significant differences regarding the duration of hospitalization (P=0.017). IPC placement alone shortened the mean total hospitalization time by 7.9, 5.9, and 7.0 days compared to VATS-pleurodesis (P≤0.001), VATS-IPC placement (P=0.004), and VATS-pleurodesis with IPC placement (P≤0.001), respectively. Conclusions The survival time was very short, and each treatment group had pros and cons. Therefore, decisions should be made on a case-by-case basis. The use of an IPC, even if the lung is not trapped, can significantly reduce the length of hospital stay. VATS is needed when histology is needed. The ideal method for treating recurrent MPE should be simple, effective, and inexpensive, with minimal disturbance to the patient.
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Affiliation(s)
- Joshua Schramm
- Department of General and Visceral Surgery, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Elina Eslauer
- Department of Anaesthesiology, University Medical Center Augsburg, Augsburg, Germany
| | - Sameer Hammoudeh
- Department of Thoracic Surgery, REGIOMED Klinikum Coburg, Coburg, Germany
| | - Sebastian Stange
- Department of Thoracic Surgery, REGIOMED Klinikum Coburg, Coburg, Germany
| | - Zsolt Sziklavari
- Department of Thoracic Surgery, REGIOMED Klinikum Coburg, Coburg, Germany
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May IJ, Nowak AK, Francis RJ, Ebert MA, Dhaliwal SS. The prognostic value of F18 Fluorothymidine positron emission tomography for assessing the response of malignant pleural mesothelioma to chemotherapy - A prospective cohort study. J Med Imaging Radiat Oncol 2024; 68:57-66. [PMID: 37898984 DOI: 10.1111/1754-9485.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 09/21/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Malignant pleural mesothelioma is difficult to prognosticate. F18-Fluorodeoxyglucose positron emission tomography (FDG PET) shows promise for response assessment but is confounded by talc pleurodesis. F18-Fluorothymidine (FLT) PET is an alternative tracer specific for proliferation. We compared the prognostic value of FDG and FLT PET and determined the influence of talc pleurodesis on these parameters. METHODS Overall, 29 prospectively recruited patients had FLT PET, FDG PET and CT-scans performed prior to and post one chemotherapy cycle; 10 had prior talc pleurodesis. Patients were followed for overall survival. CT response was assessed using mRECIST. Radiomic features were extracted using the MiM software platform. Changes in maximum SUV (SUVmax), mean SUV (SUVmean), FDG total lesion glycolysis (TLG), FLT total lesion proliferation (TLP) and metabolic tumour volume (MTV) after one chemotherapy cycle. RESULTS Cox univariate analysis demonstrated FDG PET radiomics were confounded by talc pleurodesis, and that percentage change in FLT MTV was predictive of overall survival. Cox multivariate analysis showed a 10% increase in FLT tumour volume corresponded with 9.5% worsened odds for overall survival (P = 0.028, HR = 1.095, 95% CI [1.010, 1.187]). No other variables were significant on multivariate analysis. CONCLUSION This is the first prospective study showing the statistical significance of FLT PET tumour volumes for measuring mesothelioma treatment response. FLT may be better than FDG for monitoring mesothelioma treatment response, which could help optimise mesothelioma treatment regimes.
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Affiliation(s)
- Isaac J May
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Anna K Nowak
- Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- National Centre for Asbestos Related Diseases (NCARD), Nedlands, Western Australia, Australia
| | - Roslyn J Francis
- Department Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Faculty of Medicine, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Martin A Ebert
- Radiation Oncology Cancer, Imaging & Clinical Services, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Department of Physics, School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Western Australia, Australia
| | - Satvinder S Dhaliwal
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, B305, Curtin University, Bentley, Western Australia, Australia
- Duke-NUS Medical School, National University of Singapore, Singapore City, Singapore
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang, Pulau Pinang, Malaysia
- Singapore University of Social Sciences, Singapore City, Singapore
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Watanabe T, Yamauchi Y, Takeyama R, Kohmaru S, Dejima H, Saito Y, Sakao Y. A Comparison of the Efficacies of OK-432 and Talc Slurry for Pleurodesis in Patients with Prolonged Air Leak after Pulmonary Resection. Ann Thorac Cardiovasc Surg 2024; 30:n/a. [PMID: 37648484 PMCID: PMC10902650 DOI: 10.5761/atcs.oa.23-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
PURPOSE A prolonged air leak (PAL) is one of the common postoperative complications of pulmonary resection. The aim of this study was to evaluate the efficacy and safety of pleurodesis with sterile talc or OK-432 for postoperative air leak. METHODS Patients with postoperative air leak who received chemical pleurodesis using sterile talc or OK-432 were retrospectively identified from medical records data. For pleurodesis with either agent, prior assessment and approval by the hospital safety department were carried out for each case, in addition to individual consent. RESULTS Between February 2016 and June 2022, 39 patients had PALs and underwent chemical pleurodesis. Among them, 24 patients received pleurodesis with talc (Talc group) and 15 with OK-432 (OK-432 group). The leak resolved after less than two pleurodesis treatments in 22 patients (91.7%) in the Talc group compared with 14 patients (93.3%) in the OK-432 group. Pleurodesis significantly increased white blood cell counts, C-reactive protein concentration, and body temperature in the OK-432 group compared with that in the Talc group (p <0.001, p = 0.003, and p <0.001, respectively). CONCLUSIONS Pleurodesis with talc may be an effective treatment option for postoperative air leak. Our findings suggest that talc was as effective as OK-432 and resulted in a milder systemic inflammatory response.
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Affiliation(s)
- Tomohiro Watanabe
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshikane Yamauchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryo Takeyama
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinya Kohmaru
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hitoshi Dejima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukinori Sakao
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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How CH, Chen PH, Chen YC, Lin YC, Chen KC, Chen JS, Young TH. Safety assessment of poly- ε-caprolactone in the treatment of primary spontaneous pneumothorax. Front Surg 2024; 11:1335144. [PMID: 38313410 PMCID: PMC10834695 DOI: 10.3389/fsurg.2024.1335144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Background/purpose Biomaterial-based implants are gaining traction as an option for pleurodesis treatment, yet the search for the best biomaterial or the most suitable shape to handle spontaneous pneumothorax continues. This forward-looking research assessed the use of a poly-ε-caprolactone membrane for its safety when applied as a sclerosant in pleurodesis procedures in human patients. Methods From July 2017 to February 2018, we conducted a Phase I trial in which 10 patients with primary spontaneous pneumothorax were treated using video-assisted thoracoscopic surgery with a poly-ε-caprolactone membrane. These procedures encompassed bleb resection and mechanical pleurodesis through parietal pleura scrubbing. After resection, a 150 × 150 mm poly-ε-caprolactone membrane was applied to the apex. The primary outcome measures were the adverse events and laboratory outcomes. Results After surgery, we observed no cardiopulmonary-related adverse events or indications of systemic inflammation. Furthermore, no episodes of hypothermia or hyperthermia occurred. Chest radiographs showed no evident pneumonitis or effusion associated with tissue reactions. The average follow-up duration was 31.7 ± 17.7 months, during which two patients exhibited recurrence. Conclusion This study is the first to show the biocompatibility of poly-ε-caprolactone in humans, suggesting its potential as a treatment option for patients with primary spontaneous pneumothorax. Despite the relatively small number of patients, we maintain confidence in the reliability and safety profile of the PCL membrane, bolstered by its previously established efficacy in applications involving other organs. Phase II and phase III clinical studies are needed to support these observations.
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Affiliation(s)
- Cheng-Hung How
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei City, Taiwan
- Department of Surgery, Division of Thoracic Surgery, Far Eastern Memorial Hospital, Taipei City, Taiwan
| | - Pei-Hsing Chen
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei City, Taiwan
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yu-Ching Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yong-Chong Lin
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei City, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Tai-Horng Young
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei City, Taiwan
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Persano G, Crocoli A, Martucci C, Pardi V, Di Paolo PL, Petreschi F, Cafiero G, Inserra A. Recurrent thoracic air leak syndrome in patients affected by pulmonary graft-versus-host disease: Surgical strategies and outcome. Pediatr Pulmonol 2023; 58:3206-3212. [PMID: 37641438 DOI: 10.1002/ppul.26645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/29/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND AIMS Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83%-3.08% patients after allogenic hematopoietic stem cell transplant. Such complication is defined as the occurrence of any form of air leak in the thorax, including spontaneous pneumomediastinum or pneumopericardium, subcutaneous emphysema, interstitial emphysema and pneumothorax and has a negative impact on post-transplant survival. The aim of the present study is to describe a single-center experience in the surgical management of recurrent TALS in adolescents and young adults and its outcome. METHODS We retrospectively reviewed the clinical notes of patients with previous allogenic hematopoietic stem cell transplant who underwent surgical procedures for recurrent TALS from January 2016 until March 2021. We analyzed clinical data, number of episodes of thoracic air leak, surgical procedures and relative outcome. RESULTS In the examined period, four patients, aged 16-25 years, underwent surgical procedures for TALS, including thoracostomy tube placement, thoracoscopic pleurodesis and thoracotomy. All the patients had been diagnosed with pGvHD before the onset of TALS, with a mean time lapse of 276 days (range 42-513). These patients experienced on average 4.5 air leak episodes (range 3-6). All the patients experienced at least two episodes before surgery. One patient underwent emergency tube thoracostomy only, three patients underwent thoracoscopic pleurodesis and two patients underwent thoracotomy. After surgery, patients were free from air leak symptoms for a mean time of 176 days (range 25-477). Pulmonary function progressively deteriorated, and all the patients eventually died because of respiratory failure after a mean time of 483 days (range 127-1045) after the first episode of air leak. CONCLUSIONS Surgery provides temporary relief to symptoms related to TALS but has limited effects on the underlying pathophysiologic process. The development of TALS in a sign of progressive pulmonary function worsening and is associated with high risk of respiratory failure and mortality.
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Affiliation(s)
- Giorgio Persano
- Surgical Oncology Unit-General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit-General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Cristina Martucci
- Surgical Oncology Unit-General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Valerio Pardi
- Surgical Oncology Unit-General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Pier Luigi Di Paolo
- Radiology Unit, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Francesca Petreschi
- Bronchopneumology Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Italy
| | - Giulia Cafiero
- Sport and Hypertension Medicine Unit, Department of Cardiac Surgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Inserra
- Surgical Oncology Unit-General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Auda AH, Lawandy M, Mirgoli OJ, Jurri M, Baker I, August E, Malik T, Bokhari F, Bangolo AI. Complicated Traumatic Pneumothorax Requiring VATS With Lobectomy and Pleurodesis Arising Following SARS-CoV-2 (COVID-19) Recovery. Cureus 2023; 15:e49238. [PMID: 38024030 PMCID: PMC10664736 DOI: 10.7759/cureus.49238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
A case is presented in which COVID-19 pneumonia led a young male patient to develop a pneumothorax requiring lobectomy and pleurodesis after the resolution of COVID-19 pneumonia. The literature review showed a few similar cases with clear evidence suggesting that prior COVID-19 infection may be considered a risk factor for pneumothorax. It is crucial for clinicians to take such risk factors into consideration for better clinical outcomes.
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Affiliation(s)
- Auda H Auda
- Family Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Marco Lawandy
- Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Omead J Mirgoli
- Family Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Mohammad Jurri
- Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Iyad Baker
- Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Elizabeth August
- Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Tayyab Malik
- Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Faryaal Bokhari
- Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Ayrton I Bangolo
- Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
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12
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Kennedy N, Petrakis N, Chan J, Jurisevic C. Spontaneous pneumothorax rates following video-assisted thoracoscopic talc pleurodesis with or without resection of macroscopic bullous disease. ANZ J Surg 2023; 93:2402-2405. [PMID: 37332259 DOI: 10.1111/ans.18552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/23/2023] [Accepted: 05/20/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Recurrent primary spontaneous pneumothorax (PSP) is routinely treated by video-assisted thoracoscopic (VATS) talc pleurodesis (with or without localized resection of macroscopic bullous disease). There is a paucity of published data regarding durability of the procedure and the rate of recurrent pneumothorax after such surgery, and this has significant implications from a prognostic and employment limitation perspective. METHODS Patients who underwent a VATS talc pleurodesis (with or without localized resection of macroscopic bullous disease) for the treatment of their second or subsequent PSP or a PSP were followed for recurrent ipsilateral pneumothorax and new contralateral PSP. Follow up was by way of telephone interview and medical record verification out to 48 months. RESULTS New contralateral pneumothorax occurred in 7 patients (11.1%) in the talc pleurodesis plus wedge resection group and 2 (1.8%) in the talc pleurodesis only group. There was one case of recurrent ipsilateral pneumothorax in a patient who had no inflammatory response to talc insufflation. CONCLUSION Video-assisted thoracoscopic (VATS) talc pleurodesis (and lung resection for macroscopic bullous disease) is a durable treatment for recurrent PSP. Patients with macroscopic disease have a significant risk of subsequent contralateral PSP.
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Affiliation(s)
- Nicholas Kennedy
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nicholas Petrakis
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Justin Chan
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Craig Jurisevic
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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13
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Trindade AJ, Lentz RJ, Gannon WD, Rickman OB, Shojaee S, Vandervest K, Schwartz G, Li GW, Kumar A, Garcha PS, Seeley EJ, Gesthalter YB, Mueller S, Egan JP, DeMaio AJ, Yarmus LB, Josan ES, Pannu JK, Wayne MT, DeCardenas JL, Bacchetta MD, Maldonado F. Safety and utility of indwelling pleural catheters in lung transplant recipients. Clin Transplant 2023; 37:e15056. [PMID: 37354125 DOI: 10.1111/ctr.15056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/21/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The safety and efficacy of indwelling pleural catheters (IPCs) in lung allograft recipients is under-reported. METHODS We performed a multicenter, retrospective analysis between 1/1/2010 and 6/1/2022 of consecutive IPCs placed in lung transplant recipients. Outcomes included incidence of infectious and non-infectious complications and rate of auto-pleurodesis. RESULTS Seventy-one IPCs placed in 61 lung transplant patients at eight centers were included. The most common indication for IPC placement was recurrent post-operative effusion. IPCs were placed at a median of 59 days (IQR 40-203) post-transplant and remained for 43 days (IQR 25-88). There was a total of eight (11%) complications. Infection occurred in five patients (7%); four had empyema and one had a catheter tract infection. IPCs did not cause death or critical illness in our cohort. Auto-pleurodesis leading to the removal of the IPC occurred in 63 (89%) instances. None of the patients in this cohort required subsequent surgical decortication. CONCLUSIONS The use of IPCs in lung transplant patients was associated with an infectious complication rate comparable to other populations previously studied. A high rate of auto-pleurodesis was observed. This work suggests that IPCs may be considered for the management of recurrent pleural effusions in lung allograft recipients.
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Affiliation(s)
- Anil J Trindade
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Lentz
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Whitney D Gannon
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Otis B Rickman
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samira Shojaee
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katherine Vandervest
- Centers for Advanced Lung Disease and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Gary Schwartz
- Centers for Advanced Lung Disease and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Gloria W Li
- Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Anupam Kumar
- Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Puneet S Garcha
- Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Eric J Seeley
- Pulmonary and Critical Care Medicine, University California San Francisco, San Francisco, California, USA
| | - Yaron B Gesthalter
- Pulmonary and Critical Care Medicine, University California San Francisco, San Francisco, California, USA
| | - Stephanie Mueller
- Pulmonary and Critical Care, Spectrum Health, Grand Rapids, Michigan, USA
| | - John P Egan
- Pulmonary and Critical Care, Spectrum Health, Grand Rapids, Michigan, USA
| | - Andrew J DeMaio
- Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Lonny B Yarmus
- Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Enambir S Josan
- Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jasleen K Pannu
- Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Max T Wayne
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jose L DeCardenas
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew D Bacchetta
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fabien Maldonado
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lazarus DR. Extending the indications for indwelling pleural catheters: a tube for all seasons. J Thorac Dis 2023; 15:3501-3504. [PMID: 37559635 PMCID: PMC10407513 DOI: 10.21037/jtd-23-765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/19/2023] [Indexed: 08/11/2023]
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15
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de Boer WS, Dinjens L, Stigt JA. The determination of pleurodesis using sonography after surgical pleurectomy for pneumothorax: a pilot study. J Thorac Dis 2023; 15:3974-3978. [PMID: 37559644 PMCID: PMC10407510 DOI: 10.21037/jtd-23-116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/26/2023] [Indexed: 08/11/2023]
Abstract
The aim of this study is to evaluate feasibility of monitoring the process of pleurodesis after surgical pleurectomy with thoracic ultrasound. Repetitive measurements with thoracic ultrasound after surgical pleurectomy could provide information on the extent and development speed of pleurodesis. We conducted a prospective single-center cohort study. Adult patients who required surgical pleurectomy after pneumothorax were eligible. Participants had daily thoracic ultrasound examination until discharge to determine lung sliding [present (0 point), questionable (1 point), or absent (2 points)], and pleural thickening [normal (0 point), questionable (1 point), or present (2 points)]. Thoracic ultrasound was performed in six regions, the sum of all scores was divided by the number of regions. Fourteen patients were enrolled. Thoracic ultrasound on day 1-4 was 0.25±0.26, 0.39±0.48, 0.84±0.49, 1.12±0.56 for mean lung sliding, and 1.0±0.56, 1.17±0.48, 1.44±0.44, 1.54±0.34 for mean pleural thickening. Lung sliding and pleural thickening increased significantly between day 1 and day 4 (P=0.002 and P=0.023, respectively). One (7%) and 3 (21%) patients reached the maximum achievable grade for lung sliding and pleural thickening, respectively. Thoracic ultrasound grades tended to be lower in three patients with recurrent pneumothorax, although this was not statistically significant. This study shows a significant increase in thoracic ultrasound grading for pleurodesis lung sliding and pleural thickening during the first postoperative days after surgical pleurectomy, probably attributable to progressing pleurodesis. Only a minority of patients reached complete pleurodesis before discharge despite complete surgical pleurodesis (SP). The results of this study may guide future research regarding optimal timing of chest tube removal.
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16
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Solanki KK, Shook M, Yorke J, Vanlandingham A. A Rare Case of Catamenial Pneumothorax and a Review of the Current Literature. Cureus 2023; 15:e42006. [PMID: 37593305 PMCID: PMC10427888 DOI: 10.7759/cureus.42006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
A 34-year-old female smoker, with a history of pelvic endometriosis, presented with initial symptoms of shortness of breath and a choking sensation. She was found to have a right pneumothorax on chest x-ray. Over the next eight months, she ultimately underwent three tube thoracostomies, two video-assisted thoracoscopic surgeries (VATS), wedge resection, and repeated pleurodesis due to pneumothorax recurrence. She was seen multiple times post-surgically with the focus of treatment being smoking cessation rather than contraceptive therapy, despite an early follow-up visit noting that the initial symptoms coincided with her menstruation. The purpose of this article is to bring attention to this rarely diagnosed condition. With added awareness and understanding of the underlying causes and available treatments, medical providers could likely spare many women from similar experiences and dramatically improve the quality of their lives.
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Affiliation(s)
- Krupa K Solanki
- Pulmonology and Critical Care, East Tennessee State University - Quillen College of Medicine, Johnson, USA
| | - Micah Shook
- Internal Medicine, Norton Community Hospital, Norton, USA
| | - Jojo Yorke
- Pulmonology and Critical Care, East Tennessee State University - Quillen College of Medicine, Johnson, USA
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17
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Reinoso J, Aftab G, Vijayan K, Mehta HJ. Indwelling pleural catheters for persistent pleural effusions secondary to post lung resection for malignancies. J Thorac Dis 2023; 15:2469-2474. [PMID: 37324077 PMCID: PMC10267933 DOI: 10.21037/jtd-22-1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/10/2023] [Indexed: 08/11/2023]
Abstract
Background Malignant and nonmalignant pleural effusions (NMPEs) such as those due to hepatic hydrothorax have been successfully treated with an indwelling pleural catheter (IPC) with a low complication rate. There is no literature on the utility or safety of this treatment modality for NMPE post lung resection. We aimed to assess the utility of IPC for recurrent symptomatic NMPE secondary to post lung resection in lung cancer patients over a period of 4 years. Methods Patients who underwent lobectomy or segmentectomy as part of the treatment plan for lung cancer between January 2019 and June 2022 were identified, these patients were screened for post-surgical pleural effusion. A total of 422 underwent lung resection, of which 12 had recurrent symptomatic pleural effusions requiring IPC placement and were selected for final analysis. The primary end points were improved symptomatology and successful pleurodesis. Results Mean time to IPC placement was 78.4 days post-surgery. The mean length of IPC catheter was 77.7 days standard deviation (SD) 23.8. All 12 patients achieved spontaneous pleurodesis (SP), there was no second pleural intervention or re-accumulation of fluid on follow up imaging in any of the subjects after IPC removal. Two patients (16.7%) had skin infection related to catheter placement that was managed with oral antibiotics, there were no cases of pleural infections that required catheter removal. Conclusions IPC is a safe and effective alternative in managing recurrent NMPE post lung cancer surgery with high rate of pleurodesis and acceptable complication rates.
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Affiliation(s)
- Jean Reinoso
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Ghulam Aftab
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Karthik Vijayan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Hiren J Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
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18
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Hon KLE, Hui CMP, Fung GPG, Leung KKY, Yung TC. Hypertonic glucose pleurodesis for preterm neonates with chylothorax. Pediatr Pulmonol 2023. [PMID: 37171118 DOI: 10.1002/ppul.26436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 05/13/2023]
Abstract
Chylothorax is a known complication of postcardiac surgery and the most common cause of pleural effusion in neonates. Conservative management is usually adopted, including Nil-per-Oral (NPO), treatment of underlying etiology of infection, and use of octreotide. Chylothorax resistant to medical therapy and drainage is often treated by chemical pleurodesis. Previously used pleurodesis agents have included talc, minocycline, OK-432, bleomycin, and povidone-iodine. 50% Dextrose (D50) has been reported to be useful for pleurodesis in adults. We successfully managed two cases of prematurely born infants with D50 as an alternative chemical sclerosant for chemical pleurodesis in a resistant chylothorax and discussed evidence of its use in the literature.
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Affiliation(s)
- Kam Lun Ellis Hon
- Department of Paediatrics, CUHKMC, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Chuk Man Peter Hui
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Genevieve P G Fung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Karen K Y Leung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Tak C Yung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
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19
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Owda F, Mallah S, Ayyad M, Albandak M, Yousef S, Hmeedan A, Odeh M, Reid AM, Sleibi W, Azar J. A Very Uncommon Case of Transudative Chylothorax: A Case Report and Literature Review. Cureus 2023; 15:e38320. [PMID: 37261168 PMCID: PMC10227672 DOI: 10.7759/cureus.38320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 06/02/2023] Open
Abstract
The presence of chyle in the pleural cavity is referred to as chylothorax. Exudative chylothorax is usually related to damage or obstruction of the lymphatic vasculature with subsequent leakage into the pleural space. In contrast, transudative chylothorax is related to increased hydrostatic pressure caused by elevated intra-abdominal pressure, which leads to the translocation of chylous fluid into the pleural space. Cirrhosis is the most common cause of transudative chylothorax, commonly presenting with ascites and portal hypertension. To the best of our knowledge, isolated transudative chylothorax as a consequence of cirrhosis is exceptionally rare and has been scarcely reported in the literature. We herein report a female patient in her fifties who presented to our hospital with isolated unilateral transudative hepatic chylothorax, with no clinical evidence of cirrhosis or any stigmata of portal hypertension at the time of presentation.
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Affiliation(s)
- Fahed Owda
- Internal Medicine, An-Najah National University, Nablus, PSE
| | - Shatha Mallah
- Internal Medicine, An-Najah National University, Nablus, PSE
| | | | | | - Shahed Yousef
- School of Medicine, Al-Quds University, Jerusalem, PSE
| | - Alaa Hmeedan
- Internal Medicine, An-Najah National University, Nablus, PSE
| | - Mahmoud Odeh
- Internal Medicine, An-Najah National University, Nablus, PSE
| | - Adam M Reid
- Research, University of California Los Angeles, California, USA
| | - Wadi Sleibi
- Internal Medicine, Al-Quds University, Jerusalem, PSE
| | - Jehad Azar
- Respiratory Institute, Cleveland Clinic, Cleveland, USA
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20
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Umar Z, Nassar M, Ashfaq S, Foster A, Sandhu JK, Ariyaratnam J, Lopez R, Trandafirescu T. The Efficacy and Safety of Autologous Blood Patch for Persistent Air Leaks: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e36466. [PMID: 37090364 PMCID: PMC10115736 DOI: 10.7759/cureus.36466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 04/25/2023] Open
Abstract
Persistent air leaks (PALs) are associated with prolonged hospital stays, contamination and sustained infection of the pleural space, and significant morbidity. A fistulous tract between the alveoli and the pleural space is referred to as an alveolar-pleural fistula (APF), whereas a fistulous tract between the bronchiole and the pleural space is referred to as a bronchopleural fistula (BPF). There is no consensus on the treatment, and multiple modalities exist for the management of persistent air leak (PAL). Autologous blood patch (ABP) is a relatively safe and inexpensive method that has been used for many years for the treatment of PALs. We conducted an electronic database search between 08/24/2022 and 08/27/2022 in PubMed, Embase, and Cochrane using keywords. The following keywords were used: "Blood patch" OR "Autologous blood patch" AND "pleurodesis." Our study included all original studies with the prime focus on the etiology of PALs, clinical characteristics, procedural details of ABP, and outcomes of the proposed treatment. The primary outcomes that were the focus of our study were the time to seal the air leak, the time to remove the chest tube after air leak cessation, and the time to discharge from the hospital. To determine the safety of ABP, we also evaluated the procedural outcomes. Our findings suggest a statistically significant decrease in the time to air leak cessation when compared to the control group (mean difference of -3.75 {95% CI: -5.65 to -1.85; P=0.001}) with considerable heterogeneity of I2=85% and P=0.001. However, the difference was not statistically significant when a lower dose of ABP (50 mL) was compared to a higher dose (100 mL) (mean difference of 1.48 {95% CI: -0.07 to 3.02; P=0.06}) and considerable heterogeneity of I2=80% and P=0.03. There was no statistically significant difference in the time to discharge when compared to the control group (mean difference of -2.12 {95% CI: -4.83 to 0.59; P=0.13}) and considerable heterogeneity (I2=95% and P<0.001). When compared to the control group, ABP did not provide any statistically significant difference in the risk ratio for infection (1.18 {95% CI: 0.52 to 2.65; P=0.70} and moderate heterogeneity {I2=33% and P=0.20}), pain (1.18 {95% CI: 0.52 to 2.65; P=0.70} and moderate heterogeneity {I2=33% and P=0.20}), and fever (0.54 {95% CI: 0.27 to 1.10; P=0.09} and no heterogeneity {I2=0% and P=0.50}). Our study concludes that using ABP caused a statistically significant decrease in the time to air leak cessation when compared to the control group. However, the procedure does not provide a statistically significant difference in the time to discharge from the hospital when compared to conservative treatment. Similarly, there was no statistically significant difference in the risk ratio for complications such as infection, pain, and fever when compared to conservative management. More studies need to be conducted to fully understand the efficacy and safety of ABP in the management of PALs.
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Affiliation(s)
- Zaryab Umar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Salman Ashfaq
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Allison Foster
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Jasmine K Sandhu
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | | | - Ricardo Lopez
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Theo Trandafirescu
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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21
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Cheng HS, Lo YT, Miu FPL, So LKY, Yam LYC. Prevalence, risk factors, and recurrence risk of persistent air leak in patients with secondary spontaneous pneumothorax. Eur Clin Respir J 2023; 10:2168345. [PMID: 36743827 PMCID: PMC9897746 DOI: 10.1080/20018525.2023.2168345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Persistent air leak (PAL) is common in secondary spontaneous pneumothorax (SSP), with risk factors only been determined for post-pulmonary resection PAL. Information about its risk factors and long-term outcome is, however, necessary to enable selection of treatment modalities for elderly SSP patients with comorbid conditions. Methods A retrospective observational study was performed on chest drain-treated SSP patients from 2009 to 2018. The risk factors, long-term recurrent pneumothorax, and mortality rates of those with and without PAL were evaluated. Results Of 180 non-surgical SSP patients, PAL prevalence for >2 days and >7 days were 81.1% and 43.3%, respectively. Bulla was associated with PAL >7 days (OR: 2.32; P: 0.027) and serum albumin negatively associated (OR: 0.94; P: 0.028). PAL resulted in longer hospitalization in the index episode (P: <0.01). PAL >7 days was associated with a higher pneumothorax recurrence rate in three months (HR: 2.65; P: 0.041), one year (HR: 2.50; P: 0.040) and two-year post-discharge (HR: 2.40; P: 0.029). Patients treated with medical pleurodesis were significantly older (P: <0.01), had higher Charlson Co-morbidity index scores (P: <0.01), and 77.8% of those who had PAL >7 days were considered unfit for surgery. Of these, pneumothorax had not recurred in 69.4% after two years (HR: 0.47; P: 0.044). Conclusion Bulla was positively associated with PAL over seven days in SSP patients while albumin was negatively associated. PAL over seven days increased future recurrent pneumothorax risks, while elderly SSP patients unfit for surgery had acceptable recurrence rates after medical pleurodesis.
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Affiliation(s)
- Hei-Shun Cheng
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China,CONTACT Hei-Shun Cheng Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, China
| | - Yi-Tat Lo
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Flora Pui-Ling Miu
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Loletta Kit-Ying So
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Loretta Yin-Chun Yam
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
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22
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Kashima A, Fukuda Y, Shimamura M, Ijichi M, Sagara H. Successful treatment of extensive-stage small cell lung cancer with concurrent pleural and pericardial effusions: Case report. Front Oncol 2022; 12:1040452. [PMID: 36620539 PMCID: PMC9816567 DOI: 10.3389/fonc.2022.1040452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
It is unclear whether pleural/pericardial drainage and pleurodesis/pericardiodesis should be performed before or after initiating chemotherapy in patients with chemotherapy-sensitive small-cell lung cancer. A 76-year-old woman presented to the emergency department with progressive dyspnea on exertion for a week. Chest computed tomography showed a mass shadow anterior to the left upper lobe, bilateral pleural effusions, and a circumferential pericardial effusion surrounding the heart. We diagnosed extensive-stage small-cell lung cancer based on the clinical course and pathological findings. We first performed pleurodesis and pericardial drainage and successfully initiated immune checkpoint inhibitor combined chemotherapy, with improved performance status. This case highlights the importance of aggressive drainage and pleurodesis/pericardiodesis, and suggests that drainage and pleurodesis/pericardiodesis should be considered before systemic chemotherapy in patients with concurrent pericardial or pleural effusions, even in patients with small-cell lung cancer that is sensitive to chemotherapy.
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23
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Tanaka S, Takayama Y, Kitou R, Asakawa R, Tobita S, Ike A, Kawada M, Yamamoto S, Ueno K. Bilateral refractory pneumothorax treated by pleurodesis and bronchial occlusion in a COVID-19 patient. Clin Case Rep 2022; 10:e6754. [PMID: 36567689 PMCID: PMC9771784 DOI: 10.1002/ccr3.6754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has become a worldwide outbreak, and it can cause various symptoms and complications. However, pneumothorax secondary to COVID-19 is relatively uncommon. We herein report a 60-year-old man with bilateral refractory pneumothorax with severe COVID-19. In patients with poor general health and who are difficult to undergo surgery for pneumothorax post-COVID-19, internal treatments such as chest drainage, bronchial occlusion, and pleurodesis are essential to relieving refractory pneumothorax. It also indicates that autologous blood patch pleurodesis is a useful method in terms of efficacy and side effects.
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Affiliation(s)
- Satoshi Tanaka
- Department of Respiratory MedicineOsaka General Medical CenterOsakaJapan
| | - Yoshihiro Takayama
- Department of Respiratory MedicineOsaka General Medical CenterOsakaJapan
| | - Riiko Kitou
- Department of Respiratory MedicineOsaka General Medical CenterOsakaJapan
| | - Ryo Asakawa
- Department of Respiratory MedicineOsaka General Medical CenterOsakaJapan
| | - Satoshi Tobita
- Department of Respiratory MedicineOsaka General Medical CenterOsakaJapan
| | - Akihiro Ike
- Department of Thoracic SurgeryOsaka General Medical CenterOsakaJapan
| | - Masahiro Kawada
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
| | - Suguru Yamamoto
- Department of Respiratory MedicineOsaka General Medical CenterOsakaJapan
| | - Kiyonobu Ueno
- Department of Respiratory MedicineOsaka General Medical CenterOsakaJapan
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24
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Kolokotroni SM, Lamprinos D, Goutas N, Kapetanakis EI, Kontzoglou K, Perrea D, Tomos P. Platelet-Rich Plasma for Pleurodesis: An Experimental Study in Rabbits. Medicina (B Aires) 2022; 58:medicina58121842. [PMID: 36557044 PMCID: PMC9785005 DOI: 10.3390/medicina58121842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives: This study was designed to evaluate platelet-rich plasma (PRP) as a method of pleurodesis in a rabbit model. Pleurodesis with PRP was compared against the gold-standard use of talc. The secondary evaluation assessed the ideal time for achieving pleurodesis. Materials and Methods: 25 healthy New Zealand white rabbits were assigned to three groups, as follows: 12 animals in the first and second groups, as well as one animal with no intervention in the final group, which was used as a control. The talc pleurodesis group (baseline) underwent pleurodesis with sterile talc, which is the gold-standard sclerosing agent used for pleurodesis. The PRP group underwent pleurodesis using autologous PRP. The last group had one rabbit with no intervention. A total of 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 3 days (72 h) after the intervention, and 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 6 days (144 h) after the intervention. In both the talc and PRP group, FBC and CRP were measured before the intervention and in 3 or 6 days afterwards, respectively. The pleura and the lungs were evaluated histopathologically. Results: Macroscopically, there were no statistically significant differences between the two groups. In terms of microscopic findings, there were no statistically significant differences in inflammatory reactions provoked in the visceral and parietal pleura between the PRP and talc. In addition, with talc pleurodesis, a foreign-body reaction was observed in about 50% of the cases, which was not observed with PRP. In terms of inflammation between 3 and 6 days, there were no statistically significant differences with PRP, there was only a statistically significant difference between 3 and 6 days regarding the parietal pleura in the talc group. Conclusions: The instillation of autologous PRP in the pleural cavity shows promise in achieving pleurodesis. The efficacy of PRP as a pleurodesis agent should be examined further.
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Affiliation(s)
- Styliani Maria Kolokotroni
- Department of Cardiothoracic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Laboratory of Experimental Surgery and Surgical Research “N. S. Christeas”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
| | | | - Nikolaos Goutas
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Emmanouil I. Kapetanakis
- Department of Thoracic Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Kontzoglou
- Laboratory of Experimental Surgery and Surgical Research “N. S. Christeas”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Despoina Perrea
- Laboratory of Experimental Surgery and Surgical Research “N. S. Christeas”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Periklis Tomos
- Department of Thoracic Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
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25
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Muacevic A, Adler JR, Rabah H, Kassem A, Abou Yassine A, Dahabra L, Villa Sanchez M, Kilkenny T. Spontaneous Pneumothorax: A Tale of Two Unique Cases. Cureus 2022; 14:e32544. [PMID: 36654566 PMCID: PMC9840199 DOI: 10.7759/cureus.32544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
We herein present two cases of spontaneous pneumothorax. The first one is occurring in an elderly female who has an extensive history of smoking and an underlying chronic obstructive lung disease, whereas the second case represents a congenital bleb in a male patient who has no other underlying pulmonary disorder. Both cases presented to our facility with a spontaneous pneumothorax following pulmonary bleb rupture. Both patients underwent thoracoscopic surgery with subsequent partial pleurectomy and pleurodesis.
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26
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Muacevic A, Adler JR, Haloui O, Musallam M, Thouil A, Kouismi H. Bilateral Pleural Effusion Revealing a Rare Breast Tumor: A Case Report. Cureus 2022; 14:e32312. [PMID: 36628009 PMCID: PMC9824749 DOI: 10.7759/cureus.32312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
The most common tumors causing pleural metastasis in women are gynecological cancers, with breast cancer at the top of the list. However, the revelation of the latter by pleural effusion is rare. We report the case of a 61-year-old woman, with a history of well-controlled asthma since the age of 20, who was initially consulted for dyspnea stage III of the Modified Medical Research Council score (mMRC). Chest X-ray showed moderate bilateral pleural effusion. The pleural biopsy concluded with a pleural metastasis of breast carcinoma.
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27
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Hashimoto M, Yuki M, Kitajima K, Fukuda A, Nakamichi T, Nakamura A, Kuroda A, Matsumoto S, Kondo N, Sato A, Yamakado K, Tsujimura T, Hasegawa S. Incidence and Risk Factors of Chest Wall Metastasis at Biopsy Sites in Patients with Malignant Pleural Mesothelioma. Cancers (Basel) 2022; 14. [PMID: 36139517 DOI: 10.3390/cancers14184356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/04/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Abstract
To investigate the incidence and risk factors of chest wall metastasis (CWM) at biopsy sites in patients with malignant pleural mesothelioma (MPM). This retrospective cohort study was conducted in 262 consecutive MPM patients who underwent multimodal treatment in which including neoadjuvant chemotherapy (NAC) and curative-intent surgery, from August 2009 to March 2021. CWM was evaluated radiologically (r-CWM) and pathologically (p-CWM). We also investigated the risk factors of p-CWM and the consistency between r-CWM and p-CWM. Of 262 patients, 25 patients were excluded from analysis due to missing data or impossibility of evaluation. Of the eligible 237 patients, pleural biopsy was performed via video-assisted thoracoscopic surgery in 197 (83.1%) and medical thoracoscopy in 40 (16.9%). Pleurodesis was performed after pleural biopsy in 74 patients (31.2%). All patients received NAC followed by curative-intent surgery. Radiological examination showed r-CWM in 43 patients (18.1%), while pathological examination showed p-CWM in 135 patients (57.0%). The incidence of p-CWM was significantly higher in the patients who received pleurodesis after pleural biopsy (77.0% vs. 47.9%, <0.001). Multivariate logistic regression analysis for p-CWM revealed that pleurodesis is an independent risk factor of p-CWM (adjusted hazard ratio, 3.46; 95% confidence interval, 1.84−6.52, <0.001). CWM at the biopsy site was pathologically proven in more than half of the patients (57.0%) who received NAC followed by curative-intent surgery, which was higher than the numbers diagnosed by radiological examinations (p-CWM: 57.0% vs. r-CWM: 18.1%). Pleurodesis after pleural biopsy is an independent risk factor of p-CWM.
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28
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Markowiak T, Ried M, Großer C, Hofmann HS, Hillejan L, Hecker E, Semik M, Lesser T, Kugler C, Seifert S, Scheubel R. Postoperative outcome after palliative treatment of malignant pleural effusion. Thorac Cancer 2022; 13:2158-2163. [PMID: 35748347 PMCID: PMC9346186 DOI: 10.1111/1759-7714.14534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The objective of this nationwide, registry-based study was to compare the two most frequently used procedures for the palliative treatment of a malignant pleural effusion (MPE) and to evaluate differentiated indications for these two procedures. METHODS This was a retrospective observational study based on data of the "PLEURATUMOR" registry of the German Society for Thoracic Surgery. Patients who were documented in the period from January 2015 to November 2021 and had video-assisted thoracic surgery (VATS) talc pleurodesis or implantation of an indwelling pleural catheter (IPC) were included. RESULTS A total of 543 patients were evaluated. The majority suffered from secondary pleural carcinomatosis (n = 402; 74%). VATS talc pleurodesis (n = 361; 66.5%) was performed about twice as often as IPC implantation (n = 182; 33.5%). The duration of surgery was significantly shorter in IPC-patients with 30 min compared to VATS talc pleurodesis (38 min; p = 0.000). Postoperative complication rate was 11.8% overall and slightly higher after VATS talc pleurodesis (n = 49; 13.6%) than after IPC implantation (n = 15; 8.2%). After VATS talc pleurodesis patients were hospitalized significantly longer compared to the IPC group (6 vs. 3.5 days; p = 0.000). There was no significant difference in postoperative wound infections between the groups (p = 0.10). The 30-day mortality was 7.9% (n = 41). CONCLUSION The implantation of an IPC can significantly shorten the duration of surgery and the hospital stay. For this reason, the procedure should be matched with the patient's expectations preoperatively and the use of an IPC should be considered not only in the case of a trapped lung.
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian Großer
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.,Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Ludger Hillejan
- Department of Thoracic Surgery, Niels-Stensen-Kliniken, Ostercappeln, Germany
| | - Erich Hecker
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Academic Hospital, University Duisburg-Essen, Herne, Germany
| | - Michael Semik
- Department of Thoracic Surgery, Ibbenbueren General Hospital, Ibbenbueren, Germany
| | - Thomas Lesser
- Department of Thoracic and Vascular Surgery, Lung Cancer Center DKG, SRH Wald-Klinikum Gera, Gera, Germany
| | | | - Sven Seifert
- Department of Thorax, Vascular and Endovascular Surgery, Chemnitz Hospital, Chemnitz, Germany
| | - Robert Scheubel
- Clinic of Thoracic Surgery, Waldburg-Zeil Clinic, Wangen im Allgäu, Germany
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29
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Takahashi Y, Kinoshita Y, Kobayashi T, Arai Y, Ohyama T, Yokota N, Saito K, Sugai Y, Takano S. The usefulness of OK-432 for the treatment of postoperative chylothorax in a low-birth-weight infant with trisomy 18. Clin Case Rep 2022; 10:e05844. [PMID: 35600015 PMCID: PMC9122797 DOI: 10.1002/ccr3.5844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/18/2022] [Indexed: 11/12/2022] Open
Abstract
Chylothorax is a rare but life-threatening condition in neonates. We herein report the successful use of OK-432 for a low-birth-weight infant with trisomy 18 who developed refractory chylothorax after thoracic surgery. Increasing the concentration of OK-432 seems useful in cases with a lot of pleural effusion.
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Affiliation(s)
- Yoshiaki Takahashi
- Department of Pediatric SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Yoshiaki Kinoshita
- Department of Pediatric SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Takashi Kobayashi
- Department of Pediatric SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Yuhki Arai
- Department of Pediatric SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Toshiyuki Ohyama
- Department of Pediatric SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Naoki Yokota
- Department of Pediatric SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Koichi Saito
- Department of Pediatric SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Yu Sugai
- Department of Pediatric SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Shoichi Takano
- Department of Pediatric SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
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30
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Jacobs B, Sheikh G, Youness HA, Keddissi JI, Abdo T. Diagnosis and Management of Malignant Pleural Effusion: A Decade in Review. Diagnostics (Basel) 2022; 12:diagnostics12041016. [PMID: 35454064 PMCID: PMC9030780 DOI: 10.3390/diagnostics12041016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality. Treatment is mainly palliative, with symptomatic management achieved via effusion drainage and pleurodesis. Pleurodesis may be hastened by administering a sclerosing agent through a thoracostomy tube, thoracoscopy, or an indwelling pleural catheter (IPC). Over the last decade, several randomized controlled studies shaped the current management of MPE in favor of an outpatient-based approach with a notable increase in IPC usage. Patient preferences remain essential in choosing optimal therapy, especially when the lung is expandable. In this article, we reviewed the last 10 to 15 years of MPE literature with a particular focus on the diagnosis and evolving management.
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Affiliation(s)
| | | | | | | | - Tony Abdo
- Correspondence: ; Tel.: +1-405-271-6173; Fax: +1-405-271-5892
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31
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Tsai CY, Huang HC, Xu ZD, Hsia JY, Chen CY. Spontaneous pneumothorax with pulmonary Langerhans cell histiocytosis (PLCH) in an adult heavy cigarette smoker-A case report. Respirol Case Rep 2022; 10:e0939. [PMID: 35355660 PMCID: PMC8958243 DOI: 10.1002/rcr2.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary Langerhans cell histiocytosis is a rare disease caused by the proliferation of CD1a‐positive histiocyte‐like cells infiltrating the lung's interstitial layer. Most cases affect young to middle‐aged persons, especially adult heavy cigarette smokers. A 49‐year‐old male heavy smoker (40 pack‐year), with non‐productive cough, dyspnoea and desaturation, presented with a right‐sided pneumothorax on chest x‐ray with total atelectasis. Chest computed tomography (CT) revealed bilateral multiple thick‐walled infiltrated cysts and multiple ground‐glass nodules throughout the entire lung. Surgery with minimal invasive thoracoscopic lung biopsy and pleurodesis was performed. Pathology showed histiocyte‐like cells aggregates in the pulmonary parenchyma. Immunohistochemical stain demonstrated CD1a(+), S100(+) and CD68(+). After 3 months of smoking cessation, clear improvement was evidenced with a chest CT showing bilateral multiple thin‐walled rounded cysts and multiple ground‐glass nodules that are smaller in size and decreased in numbers. Early minimal invasive thoracoscopic lung biopsy and pleurodesis can also be a choice if the development of secondary spontaneous pneumothorax occurs.
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Affiliation(s)
- Chiao-Yun Tsai
- Division of Thoracic Surgery, Department of Surgery Chung Shan Medical University Hospital Taichung Taiwan, Republic of China.,Institute of Medicine Chung Shan Medical University Taichung Taiwan, Republic of China
| | - Hsu-Chih Huang
- Division of Thoracic Surgery, Department of Surgery Chung Shan Medical University Hospital Taichung Taiwan, Republic of China.,Institute of Medicine Chung Shan Medical University Taichung Taiwan, Republic of China
| | - Zhen-Dong Xu
- Department of Pathology Chung Shan Medical University Hospital Taichung Taiwan, Republic of China.,School of Medicine Chung Shan Medical University Taichung Taiwan, Republic of China
| | - Jiun-Yi Hsia
- Division of Thoracic Surgery, Department of Surgery Chung Shan Medical University Hospital Taichung Taiwan, Republic of China.,School of Medicine Chung Shan Medical University Taichung Taiwan, Republic of China
| | - Chih-Yi Chen
- Division of Thoracic Surgery, Department of Surgery Chung Shan Medical University Hospital Taichung Taiwan, Republic of China.,Institute of Medicine Chung Shan Medical University Taichung Taiwan, Republic of China
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32
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Grosu HB, Kern R, Maldonado F, Casal R, Andersen CR, Li L, Eapen G, Ost D, Jimenez C, Frangopoulos F, Sabath B, Vakil E, Schwalk A, Marcoux M, Sagar AE, Nasim F, Lin J, Salahudin M, Arain HM, Noor L, Montanez D, Stewart J, Mullon J, Michael M, Porfyridis I. Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study. Respirology 2022; 27:350-356. [PMID: 35178828 DOI: 10.1111/resp.14232] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Pleuroscopy with pleural biopsy has a high sensitivity for malignant pleural effusion (MPE). Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired. However, proceeding directly to treatment at the time of pleuroscopy requires confidence in the on-site diagnosis. The study's primary objective was to create a predictive model to estimate the probability of MPE during pleuroscopy. METHODS A prospective observational multicentre cohort study of consecutive patients undergoing pleuroscopy was conducted. We used a logistic regression model to evaluate the probability of MPE with relation to visual assessment, rapid on-site evaluation (ROSE) of touch preparation and presence of pleural nodules/masses on computed tomography (CT). To assess the model's prediction accuracy, a bootstrapped training/testing approach was utilized to estimate the cross-validated area under the receiver operating characteristic curve. RESULTS Of the 201 patients included in the study, 103 had MPE. Logistic regression showed that higher level of malignancy on visual assessment is associated with higher odds of MPE (OR = 34.68, 95% CI = 9.17-131.14, p < 0.001). The logistic regression also showed that higher level of malignancy on ROSE of touch preparation is associated with higher odds of MPE (OR = 11.63, 95% CI = 3.85-35.16, p < 0.001). Presence of pleural nodules/masses on CT is associated with higher odds of MPE (OR = 6.61, 95% CI = 1.97-22.1, p = 0.002). A multivariable logistic regression model of final pathologic status with relation to visual assessment, ROSE of touch preparation and presence of pleural nodules/masses on CT had a cross-validated AUC of 0.94 (95% CI = 0.91-0.97). CONCLUSION A prediction model using visual assessment, ROSE of touch preparation and CT scan findings demonstrated excellent predictive accuracy for MPE. Further validation studies are needed to confirm our findings.
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Affiliation(s)
- Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan Kern
- Pulmonary Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary And Critical Care Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Roberto Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Georgie Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Bruce Sabath
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erik Vakil
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Audra Schwalk
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mathieu Marcoux
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ala Eddin Sagar
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Faria Nasim
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julie Lin
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Moiz Salahudin
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hasan Muhammad Arain
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laila Noor
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Montanez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Stewart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Mullon
- Pulmonary Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michalis Michael
- Cytopathology Department, Nicosia General Hospital, Nicosia, Cyprus
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33
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Takahashi Y, Kinoshita Y, Kobayashi T, Arai Y, Ohyama T, Yokota N, Saito K, Sugai Y, Takano S. Management of refractory chylothorax in the neonatal intensive care unit: A 22-year experience. Pediatr Int 2022; 64:e15043. [PMID: 34706149 DOI: 10.1111/ped.15043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/01/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim was to assess the therapeutic strategy of patients with chylothorax in a neonatal intensive care unit. METHODS Twenty-eight infants with chylothorax were included in this study. Their clinical characteristics and outcomes were reviewed retrospectively. RESULTS The male-to-female ratio was 1:1. The mean gestational age and birthweight were 35.1 ± 3.5 weeks and 2,692 ± 791 g, respectively. Eighteen patients were diagnosed with congenital chylothorax; chylothorax occurred postoperatively in 10 patients. Chromosomal anomalies were diagnosed in 8 patients. Six patients received surgical therapy, such as pleurodesis, thoracic duct ligation, or lymphaticovenous anastomosis. Two patients required surgery due to resistance to pleurodesis. In surgically managed patients, the daily maximum amount of pleural effusion (mL)/bodyweight (kg) ratio was significantly larger than in non-surgically managed patients: 229.0 ± 180.5 versus 59.7 ± 49.2 mL/kg. In the receiver operating characteristic analysis of the daily maximum amount of pleural effusion/bodyweight ratio, the area under the curve was 0.889 when the cut-off value was 101 mL/kg, and the sensitivity was 0.8333 and the specificity was 0.8095 (P = 0.0059). CONCLUSIONS Pleurodesis using OK432 could become a surgical first-line therapy for chylothorax even for neonates. It was important to initiate pleurodesis for refractory chylothorax at an earlier stage. A daily chylous effusion/bodyweight ratio of >101 mL/kg was a good predictor and seemed to be a useful parameter for prompt surgical intervention.
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Affiliation(s)
- Yoshiaki Takahashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Takashi Kobayashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Yuhki Arai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Toshiyuki Ohyama
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Naoki Yokota
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Koichi Saito
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Yu Sugai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Shoichi Takano
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
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Hajnikova Z, Michalek P, Votruba J, Zahorec R. Interventional management of recurrent malignant pleural effusion: state of the art in 2021. BRATISL MED J 2021; 123:50-54. [PMID: 34967658 DOI: 10.4149/bll_2022_008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This narrative review aims to describe and compare different interventional methods for the management of recurrent malignant pleural effusion and offers perspectives for the future era. BACKGROUND Dyspnea as a result of the recurrent malignant pleural effusion is one of the main factors decreasing the quality of life in patients with oncologic diseases. To date, there is no strict guideline for the management of malignant pleural effusions. RESULTS Several different techniques are available to prevent production of the effusion or to provide intermittent drainage, however, the principle of these methods remains palliative. The choice of treatment in any patient depends mainly on the preferences of the patient, speed of the fluid production, expandability of the lung, and predicted survival of the patients. The interventional methods of managing malignant pleural effusions are described in detail, including thoracocentesis, chemical pleurodesis, talc poudrage pleurodesis, slurry pleurodesis, thoracoscopic procedures, indwelling pleural catheters, implantable pleural ports, and pleuroperitoneal shunting. CONCLUSION Pleurodesis and fully implantable devices such as pleural ports may become the most useful techniques in the future, mainly because of better comfort for the patients and no need for repeated pleural punctures (Ref. 55).
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Tsuboshima K, Kurihara M, Seyama K. Current opinion and comparison of surgical procedures for the treatment of primary spontaneous pneumothorax. Expert Rev Respir Med 2021; 16:161-171. [PMID: 34821193 DOI: 10.1080/17476348.2022.2011218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Although three-port video-assisted thoracoscopic surgery (VATS) is the standard radical treatment for primary spontaneous pneumothorax (PSP), several issues need to be addressed as the postoperative recurrence rate remains relatively high. Although bullectomy is effective in preventing the postoperative recurrence of PSP, recurrent pneumothorax often occurs, requiring additional methods such as pleural covering with absorbable mesh sheets, surgical chemical pleurodesis, pleural abrasion, or pleurectomy. In addition, minimally invasive approaches that exceed three-port VATS are required according to the social demand. These approaches, such as uniportal VATS, reduced port surgery, and needlescopic surgery, have cosmetic merits, lower postoperative pain, and similar surgical results as three-port VATS. AREAS COVERED We focused on conventional and novel treatments for PSP in this article. EXPERT OPINION Effective methods that prevent postoperative recurrence and minimally invasive approaches will become popular in the near future.
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Affiliation(s)
- Kenji Tsuboshima
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Kuniaki Seyama
- The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan.,Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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36
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Kulandaisamy PC, Kulandaisamy S, Kramer D, Mcgrath C. Malignant Pleural Effusions-A Review of Current Guidelines and Practices. J Clin Med 2021; 10:5535. [PMID: 34884236 DOI: 10.3390/jcm10235535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Malignant pleural effusion (MPE) occurs in 15% of all cancer patients and usually portends poor prognosis while also serving to limit the patient's quality of life. Palliation of symptoms has been the goal for the management of these effusions while keeping the patient's hospital stay to a minimum. Traditionally, this has been achieved by chest tube drainage followed by the instillation of sclerosing agents, such as talc, in the pleural space. A recent increase in evidence for the effectiveness and convenience of indwelling pleural catheters has changed the management of MPE, which is reflected in the guidelines released by the American Thoracic Society as well their European Counterpart (ERS/BTS). In this article, we aim to review the current management practices and guidelines for MPE.
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Foo CT, Pulimood T, Knolle M, Marciniak SJ, Herre J. Ambulatory Thoracoscopic Pleurodesis Combined With Indwelling Pleural Catheter in Malignant Pleural Effusion. Front Surg 2021; 8:738719. [PMID: 34760917 PMCID: PMC8572984 DOI: 10.3389/fsurg.2021.738719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Malignant pleural effusion (MPE) often results in debilitating symptoms. Relief of dyspnoea and improvement in quality of life can be achieved with either talc pleurodesis or insertion of an indwelling tunneled pleural catheter (IPC). The former requires a lengthy hospital stay and the latter is associated with lower pleurodesis rates. In response to limited hospital bed capacity, we developed a pragmatic approach in managing MPE by combining thoracoscopic talc poudrage and insertion of IPC into a single day case procedure. We present data on the safety and efficacy of this approach. Methods: Patients who had undergone the abovementioned procedure between 2017 and 2020 were analyzed. Demographic data, hospital length of stay (LOS), histological diagnosis, rates of pleurodesis success and procedural related complications were collated. Patients were followed-up for 6 months. Results: Forty-five patients underwent the procedure. Mean age was 68.5 ± 10.4 years and 56% were male. Histological diagnosis was achieved in all cases. 86.7% of patients were discharged on the day of the procedure. Median LOS was 0 (IQR 0–0) days. Successful pleurodesis was attained in 77.8% at 6-month follow-up. No procedure related deaths or IPC related infections were recorded. Conclusion: Ambulatory thoracoscopic poudrage and IPC insertion is a safe and effective option in the management of MPE. All patients received a definitive pleural intervention with 77.8% pleurodesis success at 6-months and majority of them discharged on the same day. Future randomized trials are required to confirm these findings.
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Affiliation(s)
- Chuan T Foo
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Thomas Pulimood
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Martin Knolle
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Stefan J Marciniak
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom.,Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Jurgen Herre
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
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38
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Patterson KN, Lawrence AE, Beyene TJ, Aldrink JH, Michalsky M, Minneci PC. Recurrence Rates After Video-Assisted Thoracoscopic Surgery for Spontaneous Pneumothorax. J Laparoendosc Adv Surg Tech A 2021; 31:1424-1430. [PMID: 34748424 DOI: 10.1089/lap.2021.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) with pulmonary apical wedge resection is the mainstay procedure performed for spontaneous pneumothorax (sPTX). However, there is variability in adjunctive techniques, including pleurectomy or mechanical pleurodesis, used to prevent recurrences. The objectives of this study were to determine sPTX recurrence rates after initial VATS and to compare the efficacy of adjunct pleurectomy versus mechanical pleurodesis. Methods: Patients 11-21 years old who experienced sPTX and underwent initial VATS from December 2011 to December 2020 were identified at a single institution. Descriptive analyses and statistical tests were performed to identify factors associated with ipsilateral sPTX recurrence after surgery. Results: Fifty-six patients (48 males) underwent 58 VATS. The majority of patients were white (82.1%), male (85.7%), and nonsmokers (78.6%). Pleurectomy was performed in 27 (46.5%) cases, mechanical pleurodesis in 25 (43.1%), and pleurectomy with mechanical pleurodesis in 6 (10.3%). Overall, 15 patients (25.9%) experienced a postoperative recurrence, of which 8 (13.8%) required intervention. Recurrences occurred between 7 and 800 days after the index procedure. There was no significant difference in rates of overall recurrence between pleurectomy, mechanical pleurodesis, and pleurectomy with mechanical pleurodesis [7/27 (25.9%); 7/25 (28.0%); 1/6 (16.7%): P = .99] or recurrences requiring intervention between the three adjunctive techniques (5/27; 3/25; 0/6: P = .66). Conclusion: Over 25% of patients experience recurrence of sPTX after VATS. Recurrence rates were similar whether pleurectomy, mechanical pleurodesis, or pleurectomy with pleurodesis was performed. Further multi-institutional and prospective studies are needed to establish the optimal strategy to limit recurrence rates for pediatric patients with sPTX.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amy E Lawrence
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer H Aldrink
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marc Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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Gilday C, Odunayo A, Hespel AM. Spontaneous Pneumothorax: Management and Prognosis. Top Companion Anim Med 2021; 45:100582. [PMID: 34509664 DOI: 10.1016/j.tcam.2021.100582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/27/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
This review article will review treatment and prognosis of spontaneous pneumothorax in dogs and cats. The advantages of surgical and medical management in dogs and cats, as well as current treatment practices, including autologous blood pleurodesis and small-bore chest tubes, will be discussed.
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Affiliation(s)
- Cassandra Gilday
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA.
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - Adrien-Maxence Hespel
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
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40
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Karampinis I, Galata C, Arani A, Grilli M, Hetjens S, Shackcloth M, Buderi S, Stamenovic D, Roessner ED. Autologous blood pleurodesis for the treatment of postoperative air leaks. A systematic review and meta-analysis. Thorac Cancer 2021; 12:2648-2654. [PMID: 34477307 PMCID: PMC8520794 DOI: 10.1111/1759-7714.14138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 01/21/2023] Open
Abstract
Background Postoperative air leaks are a common complication after lung surgery. They are associated with prolonged hospital stay, increased postoperative pain and treatment costs. The treatment of prolonged air leaks remains controversial. Several treatments have been proposed including different types of sealants, chemical pleurodesis, or early surgical intervention. The aim of this review was to analyze the impact of autologous blood pleurodesis in a systematic way. Methods A systematic review of the literature was conducted until July 2020. Studies with more than five adult patients undergoing lung resections were included. Studies in patients receiving blood pleurodesis for pneumothorax were excluded. The search strategy included proper combinations of the MeSH terms “air leak”, “blood transfusion” and “lung surgery”. Results Ten studies with a total of 198 patients were included in the analysis. The pooled success rate for sealing the air leak within 48 h of the blood pleurodesis was 83.7% (95% CI: 75.7; 90.3). The pooled incidence of the post‐interventional empyema was 1.5%, with a pooled incidence of post‐interventional fever of 8.6%. Conclusions Current evidence supports the idea that autologous blood pleurodesis leads to a faster healing of postoperative air leaks than conservative treatment. The complication rate is very low. Formal recommendations on how to perform the procedure are not possible with the current evidence. A randomized controlled trial in the modern era is necessary to confirm the benefits.
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Affiliation(s)
- Ioannis Karampinis
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany.,Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Christian Galata
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alireza Arani
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Medical Faculty Mannheim, Institute of Medical Statistic and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Shackcloth
- Division of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Silviu Buderi
- Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric D Roessner
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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Abstract
Video-assisted thoracic surgery (VATS) is the treatment of choice for recurrence prevention in patients with spontaneous pneumothorax (SP). Although the optimal surgical technique is uncertain, bullous resection using staplers in combination with mechanical pleurodesis, chemical pleurodesis and/or staple line coverage is usually undertaken. Currently, patient satisfaction, postoperative pain and other perioperative parameters have significantly improved with advancements in thoracoscopic technology, which include uniportal, needlescopic and nonintubated VATS variants. Ipsilateral recurrences after VATS occur in less than 5% of patients, in which case a redo-VATS is a feasible therapeutical option. Randomized controlled trials are urgently needed to shed light on the best definitive management of SP.
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42
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Gilbert CR, Shojaee S, Maldonado F, Yarmus LB, Bedawi E, Feller-Kopman D, Rahman NM, Akulian JA, Gorden JA. Pleural Interventions in the Management of Hepatic Hydrothorax. Chest 2021; 161:276-283. [PMID: 34390708 DOI: 10.1016/j.chest.2021.08.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatic hydrothorax can be present in 5% to 15% of patients with underlying cirrhosis and portal hypertension, often reflecting advanced liver disease. Its impact can be variable, because patients may have small pleural effusions and minimal pulmonary symptoms or massive pleural effusions and respiratory failure. Management of hepatic hydrothorax can be difficult because these patients often have a number of comorbidities and potential for complications. Minimal high-quality data are available for guidance specifically related to hepatic hydrothorax, potentially resulting in pulmonary or critical care physician struggling for best management options. We therefore provide a Case-based presentation with management options based on currently available data and opinion. We discuss the role of pleural interventions, including thoracentesis, tube thoracostomy, indwelling tunneled pleural catheter, pleurodesis, and surgical interventions. In general, we recommend that management be conducted within a multidisciplinary team including pulmonology, hepatology, and transplant surgery. Patients with refractory hepatic hydrothorax that are not transplant candidates should be managed with palliative intent; we suggest indwelling tunneled pleural catheter placement unless otherwise contraindicated. For patients with unclear or incomplete hepatology treatment plans or those unable to undergo more definitive procedures, we recommend serial thoracentesis. In patients who are transplant candidates, we often consider serial thoracentesis as a standard treatment, while also evaluating the role indwelling tunneled pleural catheter placement may play within the course of disease and transplant evaluation.
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Affiliation(s)
- Christopher R Gilbert
- Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA.
| | - Samira Shojaee
- Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, MD
| | - Eihab Bedawi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, MD
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jason A Akulian
- Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jed A Gorden
- Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
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Campisi A, Dell'Amore A, Gabryel P, Ciarrocchi AP, Sielewicz M, Zhang Y, Gu Z, Faccioli E, Stella F, Rea F, Fang W, Piwkowski C. Autologous blood patch pleurodesis: a large retrospective multicenter cohort study. Ann Thorac Surg 2021; 114:273-279. [PMID: 34375648 DOI: 10.1016/j.athoracsur.2021.06.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prolonged air leaks (PAL) complicate 10-15% of lung resections, delaying chest tube removal and prolonging length of hospital stay (LOS). Non consensus exists for managing this common complication, despite favourable results for autologous blood patch pleurodesis (ABPP) in the literature. The aim of this study was to evaluate the effectiveness and safety of ABPP. METHODS We retrospectively reviewed medical records of 510 patients with PAL after lobectomy in four centers, between January 2010 and December 2019. They were divided into two groups: Group A composed of patients who received ABPP for PAL of more than 5 days and Group B in which no ABPP or other procedure was performed for PAL unless strictly necessary. Propensity score-matched (PSM) analysis was performed, and 109 patients were included in each group. Time to cessation of air leak and chest tube removal, LOS, reoperation and complications rate were examined. RESULTS After the PSM, ABPP significantly reduced the number of days before chest tube removal (8.12vs9.30,p=0.004), and LOS (10.0vs11.0,p=0.045) with less perioperative complications (6vs17,p=0.015). Furthermore ABPP was related to lower incidence of any additional invasive procedures (0vs9,p=0.002) and reoperation (0vs4,p=0.044). No patient in the ABPP group had long term complications related to pleurodesis. CONCLUSIONS ABPP is safe and effective in reducing LOS and leads to earlier chest tube removal without increasing complications.
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Affiliation(s)
- Alessio Campisi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China; Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy.
| | - Andrea Dell'Amore
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua (PD), Italy
| | - Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Angelo Paolo Ciarrocchi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Magdalena Sielewicz
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Yonghui Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China
| | - Eleonora Faccioli
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua (PD), Italy
| | - Franco Stella
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Federico Rea
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua (PD), Italy
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Poudel A, Adhikari A, Aryal BB, Poudel Y, Shrestha I. Recurrent Pneumothorax in an Adult Male With Bilateral COVID-19 Pneumonia. Cureus 2021; 13:e17025. [PMID: 34522506 PMCID: PMC8425393 DOI: 10.7759/cureus.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/05/2022] Open
Abstract
Pneumothorax is defined as the condition in which air is collected between the visceral and parietal pleura. Pneumothorax as a complication of coronavirus disease 2019 (COVID-19) infection has been reported in relatively few cases and recurrent pneumothorax is even rarer. We present a case of a 50-year-old critically ill patient who required mechanical ventilation for 55 days and developed recurrent bilateral pneumothorax. The patient initially presented with shortness of breath and cough. He was found to be COVID-19 positive on the polymerase chain reaction (PCR) test. Subsequently, his oxygen demand increased, and he ultimately needed mechanical ventilation. He developed four episodes of pneumothorax. The patient was managed in all four episodes with intercostal tube insertion. To prevent subsequent episodes, pleurodesis was performed after the fourth episode of pneumothorax.
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Affiliation(s)
- Ayusha Poudel
- Intensive Care Unit, Nepal Korea Friendship Municipality Hospital, Madhyapur Thimi, NPL
| | - Anurag Adhikari
- Intensive Care Unit, Nepal Korea Friendship Municipality Hospital, Madhyapur Thimi, NPL
| | - Barun B Aryal
- Emergency Medicine, BP Smriti Hospital, Kathmandu, NPL
| | - Yashasa Poudel
- Anesthesiology and Critical Care, B & B Hospital Pvt. Ltd., Kathmandu, NPL
| | - Ishu Shrestha
- Internal Medicine, Dhulikhel Hospital, Dhulikhel, NPL
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Gilday C, Odunayo A, Hespel AM. Spontaneous Pneumothorax: Pathophysiology, Clinical Presentation and Diagnosis. Top Companion Anim Med 2021; 45:100563. [PMID: 34303864 DOI: 10.1016/j.tcam.2021.100563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 11/21/2022]
Abstract
Spontaneous pneumothorax, which may have an acute or insidious onset in dogs and cats, results in respiratory difficulty and has the potential to be life threatening.1-3 Dogs commonly develop spontaneous pneumothorax due to bullae or blebs, while cats typically have underlying inflammatory disease, like feline allergic airway disease. Urgent therapeutic intervention is essential in animals with respiratory distress. The recommended therapeutic strategies are typically different in each of these species due to underlying etiology. The first part of this review article will focus on physiology, clinical presentation, and diagnosis of spontaneous pneumothorax in dogs and cats. Advances in diagnostics, especially the recent utility of point of care ultrasound, will be discussed. The second part of the series will provide an overview of therapeutic options and management of patients with spontaneous pneumothorax, as well as information on prognosis.
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Plaksin SA, Farshatova LI. [Causes of resistant pleural effusions and efficiency of chemical pleurodesis in these patients]. Khirurgiia (Mosk) 2021:24-30. [PMID: 34270190 DOI: 10.17116/hirurgia202107124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the causes of resistant pleural effusions and efficiency of chemical pleurodesis with Betadin, Iodopyrone and concentrated glucose solution in these patients. MATERIAL AND METHODS Resistant pleuritis with daily exudation over 300 ml lasting ≥6 days occurred in 206 (48%) out of 424 cases of pleural effusions. Twenty-seven patients underwent chemical pleurodesis with Betadine, 15 patients - mixture of Iodopyrone with concentrated glucose solution. Solutions were injected via pleural drainage. RESULTS In multivariate analysis, the risk factors of complicated pleuritis were air leakage, prolonged drainage period, age over 60 years, fluid output volume during thoracoscopy and higher Charlson index. Pleurodesis with a mixture of Betadine 10% 10 ml and glucose 40% 40 ml suppressed exudation in 92.6% of cases. Pleurodesis with a mixture of Iodopyron and glucose solution in the same quantities was effective in 93.4% of cases. If exudation continued, pleurodesis was repeated after 3 days. VAS score of pain syndrome following Iodopyrone injection was 3.0±1.8, in case of Betadine - 3.4±0.3. No significant hemodynamic changes were noted. In case of malignant pleural effusions and low functional parameters after fluid evacuation, favorable effect was obtained after pleurodesis with a mixture of povidone-iodine with glucose through the same catheter and subsequent removal of drainage tube. CONCLUSION Resistant pleural effusions with daily exudation over 300 ml for more than 6 days are characterized by advanced risk of infectious and inflammatory complications due to air leakage and duration of drainage. Pleurodesis with mixtures of Betadine or iodopyrone and 40% glucose solution is effective for resistant pleural effusions.
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Affiliation(s)
- S A Plaksin
- Vagner Perm State Medical University, Perm, Russia
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Zablockis R, Danila E, Gruslys V, Cincilevičiūtė G. Systemic Inflammatory Response to Different Sclerosing Agents as a Predictor of Pleurodesis Outcome. In Vivo 2021; 35:2391-2398. [PMID: 34182522 DOI: 10.21873/invivo.12516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The objectives of this study were to evaluate systemic inflammation using different sclerosing agents and to estimate the prediction of systemic inflammation for the efficacy of pleurodesis. PATIENTS AND METHODS Ninety-six patients with recurrent and symptomatic malignant pleural effusion were enrolled in this retrospective study. We used serum C-reactive protein (CRP) levels, serum leukocyte counts and neutrophil-to-lymphocyte ratios (NLRs) as parameters of systemic inflammatory reactions. Evaluations of these parameters were performed before and 24 h after pleurodesis. RESULTS Pleurodesis was successful in 81 (84.4%) patients. The non-graded talc induced the highest changes in serum CRP levels, total white blood cell and neutrophil counts compared to other agents, while mitoxantrone induced the lowest. Graded talc and bleomycin induced the same levels of changes in serum CRP levels and serum leukocyte counts. The change in serum NLR was the same for all agent groups. Logistic regression confirmed that a change in serum CRP levels [odds ratio (OR)=0.92, p=0.002] and previous chemotherapy (OR=3.31, p=0.012) were independent predictors of pleurodesis efficacy. CONCLUSION Pleurodesis agents induced a systemic inflammatory response at different levels. The change in serum CRP levels could be useful for predicting the success of pleurodesis.
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Affiliation(s)
- Rolandas Zablockis
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania; .,Centre of Pulmonology and Allergology, Santaros Klinikos, Vilnius University Hospital, Vilnius, Lithuania
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Pulmonology and Allergology, Santaros Klinikos, Vilnius University Hospital, Vilnius, Lithuania
| | - Vygantas Gruslys
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Pulmonology and Allergology, Santaros Klinikos, Vilnius University Hospital, Vilnius, Lithuania
| | - Giedrė Cincilevičiūtė
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Pulmonology and Allergology, Santaros Klinikos, Vilnius University Hospital, Vilnius, Lithuania
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Théron ML, Lahuerta-Smith T, Sarrau S, Ben-Moura B, Hidalgo A. Autologous blood patch pleurodesis treatment for persistent pneumothorax: A case series of five dogs (2016-2020). Open Vet J 2021; 11:289-294. [PMID: 34307086 PMCID: PMC8288745 DOI: 10.5455/ovj.2021.v11.i2.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/03/2022] Open
Abstract
Background Autologous blood patch pleurodesis (ABP) has been described as a treatment for persistent pneumothorax in the dogs and among humans. Although the treatment of persistent or recurring spontaneous pneumothorax is classically surgical, it cannot always be performed due to medical or financial constraints. This case series describes the clinical course, etiology, and outcome of five dogs with persistent pneumothorax treated with ABP. Case Description Five client-owned dogs with persistent pneumothorax are presented. Two dogs had pneumothorax due to congenital pulmonary bullae, one due to thoracic trauma, another due to lungworm infection, and a fifth with unknown cause in the context of a relapsing subcutaneous haemangiosarcoma. Around 5 ml/kg of non-coagulated blood was aseptically collected from the jugular vein and injected via a thoracotomy tube immediately into the pleural cavity of dogs with persistent pneumothorax. The procedure was successful in four out of five dogs after one procedure, therefore a success rate of 80%. A repeat of the pleurodesis was attempted in the fifth dog, 12 hours after the first injection due to the recollection of the pneumothorax. Still, the dog died during anesthesia in preparation for the procedure. No complications that could be directly linked to ABP occurred. Conclusion ABP is a simple, rapid, inexpensive, effective, and safe procedure that can be useful for treating persistent pneumothorax that does not respond to conservative treatment and where surgical exploration cannot be carried out. Pneumothorax secondary due to trauma and congenital pulmonary bullae seem to respond well to ABP.
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Molnar TF, Drozgyik A. Narrative review of theoretical considerations regarding HITHOC between past and future. Ann Transl Med 2021; 9:954. [PMID: 34350269 PMCID: PMC8263867 DOI: 10.21037/atm-20-5855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023]
Abstract
Hyppocrates constructed the medicines-surgery-energy triangle which includes all therapeutical modalities. Hyperthermic intraoperative chemotherapy (HITHOC) is a synergy-based single stage multimodality treatment encompassing the locoregional manifestation of the systemic malignant process. Pleural space, thermal effect, lavage/irrigation and chemotherapy represent the basic science ports of the network hub: HITHOC. The malignant transformation and process of the pleural surface (and underlying lung) challenges space management and tissue control. Thermotherapy without local chemotherapy is insufficient, similar to the normothermic local irrigation aligned with anticancer agents. The local administration of combined heat-transfer fluid and chemotherapy with or without subsequent surgical removal offers reasonable outcome in extensive primary pleural neoplasms (malignant mesothelioma), advanced (> Stage IIIA) NSCLC, functionally inoperable lung cancer and pleural carcinosis from extrathoracic malignancies. Measured by symptom-free survival and the quality of life, HITHOC in its present form, offers a modest yet fully substantiated solution. HITHOC in combination with the local application of targeted therapy and/or immunotherapy administered in the pleural space are currently under investigation. Additional development including new acting substances, their solvents and the means regarding surgical delivery and anesthesiology techniques are sign posts up ahead. Level 2 evidence are required in order to stepping up the recommendation levels, rewriting protocols and guidelines, in which HITHOC earns its revered position in the decision making process it deserves.
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Affiliation(s)
- Tamas F Molnar
- Department of Operational Medicine, Faculty of Medicine, University of Pécs, Pécs, Hungary.,Chair of Surgery, Faculty of Medicine, University of Pécs/Dept Surgery, Aladar Petz University Teaching Hospital, Győr, Hungary
| | - Andras Drozgyik
- Chair of Surgery, Faculty of Medicine, University of Pécs/Dept Surgery, Aladar Petz University Teaching Hospital, Győr, Hungary
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Li BZ, Zhang XG, Li WQ, Li ZT, Guo HQ, Jiang FS. [ Pleurodesis with an Autologous Blood Patch in the Treatment of Persistent Air Leak after Lung Resection]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2021; 43:211-215. [PMID: 33966700 DOI: 10.3881/j.issn.1000-503x.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To evaluate the efficacy and risks of autologous blood patch pleurodesis in patients with persistent air leak(PAL)after lung resection. Methods A total of 97 patients with PAL after lung resection in Beijing Shijitan Hospital from October 2014 to October 2019 were retrospectively reviewed,including 53 treated by autologous blood patch pleurodesis and 44 by the conventional way.The therapeutic effect,adverse reactions and complications were analyzed. Results All the patients with PAL were cured with autologous blood patch pleurodesis.Most air leaks(81.1%)ceased within 48 hours after treatment,and the left 18.9% patients got cured after a repeat.The mean tube retention time and the mean in-hospital stay were 8.4 days and 10.0 days in the autologous blood patch pleurodesis group and 13.5 days and 15.3 days in the conventional treatment group.A prolonged drainage time(P=0.00)and in-hospital stay(P=0.00)were observed in the conventional treatment group.No severe complications were observed except two patients developed slight fever and cutaneous emphysema. Conclusion In our experience,the autologous blood patch pleurodesis is an effective way with low risk of adverse reactions in the treatment of PAL.
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Affiliation(s)
- Bao Zhong Li
- Department of Thoracic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
| | - Xu Gang Zhang
- Department of Thoracic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
| | - Wei Qing Li
- Department of Thoracic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
| | - Zhi Tian Li
- Department of Thoracic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
| | - Hui Qin Guo
- Department of Thoracic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
| | - Fu Sheng Jiang
- Department of Thoracic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
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