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General Thoracic and Cardiovascular... Jun 2016Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for... (Review)
Review
Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient's characteristics, and the operative procedures that had been performed.
Topics: Chest Tubes; Device Removal; Drainage; Humans; Lung; Pleura; Pleural Cavity; Pneumonectomy; Suction; Thoracostomy
PubMed: 27048219
DOI: 10.1007/s11748-016-0646-z -
The American Journal of Emergency... Oct 2018Urinothorax was first described in 1968 by Corriere et al. as the presence of urine in the pleural cavity due to retroperitoneal leakage of accumulated urine. Herein, we...
Urinothorax was first described in 1968 by Corriere et al. as the presence of urine in the pleural cavity due to retroperitoneal leakage of accumulated urine. Herein, we present a female patient, who complained of dyspnea due to urinothorax. This is the first case of urinothorax that developed so tardive after radiotherapy and was diagnosed due to high clinical evidence despite the negative scintigraphy.
Topics: Abdominal Pain; Aged; Dyspnea; Female; Fistula; Humans; Hydrothorax; Peritoneal Diseases; Pleural Effusion; Treatment Outcome; Ureteral Diseases
PubMed: 29914713
DOI: 10.1016/j.ajem.2018.06.026 -
Journal of Equine Veterinary Science Sep 2019The objective of this study was to evaluate clinical and cardiovascular parameters and pleural and intra-abdominal pressures of horses after experimentally induced...
The objective of this study was to evaluate clinical and cardiovascular parameters and pleural and intra-abdominal pressures of horses after experimentally induced unilateral open pneumothorax. Prospective, experimental study-animals: seven healthy adult horses, 4 females and 3 males. Left hemithorax thoracotomy was carried out to create an open pneumothorax for 60 minutes. Pleural pressure (P) was directly obtained at the midpoint of the left eighth intercostal space before thoracotomy. Esophageal pressure (P), arterial blood gas analysis, left ventricular function, and ultrasonographic assessment of pneumothorax extent/resolution were performed at the baseline, and 5, 10, 15, 30, 45, and 60 minutes after thoracotomy, and on the first, second, third, fifth, and seventh days postoperatively. Intra-abdominal pressure was only recorded while the pneumothorax was present. There was moderate correlation (Spearman's rs = 0.404; R = 0.8; P < .00001; Bland-Altman bias = -2.59; s.d. = 2.11) between P and P. Esophageal pressure increased (P < .05) after open pneumothorax until the fifth day postoperatively. Partial pressure of oxygen in arterial blood reduced (P < .05) until the third day postoperatively when it returned to the baseline. No significant variations in PCO, pH in arterial blood, and in left ventricular function were appreciated. The extent of the pneumothorax was assessed by thoracic ultrasonography. Esophageal pressure, in association with blood gas analysis and thoracic ultrasonography, could be used to aid diagnosis of pneumothorax in horses. Horses tolerate open pneumothorax, with minimum cardiovascular impairment, even without aspiration of free air from within pleural space to restore thoracic wall integrity.
Topics: Animals; Blood Gas Analysis; Female; Horses; Male; Pleura; Pleural Cavity; Pneumothorax; Prospective Studies
PubMed: 31443841
DOI: 10.1016/j.jevs.2019.06.011 -
Journal of Thoracic Imaging Jul 2021This article reviews the anatomy, histology, and disease processes of pulmonary fissures, with emphasis on clinical implications of accessory and incomplete fissures. (Review)
Review
OBJECTIVE
This article reviews the anatomy, histology, and disease processes of pulmonary fissures, with emphasis on clinical implications of accessory and incomplete fissures.
CONCLUSION
Accessory and incomplete pulmonary fissures are often overlooked during routine imaging but can have profound clinical importance. Knowledge of fissure anatomy could improve diagnostic accuracy and inform prognosis for oncologists, interventional pulmonologists, and thoracic surgeons.
Topics: Humans; Lung; Pleural Cavity; Tomography, X-Ray Computed
PubMed: 33075007
DOI: 10.1097/RTI.0000000000000558 -
Reports of Practical Oncology and... 2017Malignant pleural mesothelioma (MPM) is a rare and aggressive disease that poses a treatment challenge in spite of recent technical developments. The aim of this...
BACKGROUND
Malignant pleural mesothelioma (MPM) is a rare and aggressive disease that poses a treatment challenge in spite of recent technical developments. The aim of this retrospective analysis is to assess the feasibility of administering intensity-modulated radiotherapy (IMRT) to the pleural cavity using helical tomotherapy in patients who had undergone pleurectomy/decortication (P/D) and also the resulting toxicity levels.
PATIENTS AND METHODS
Ten patients who had MPM and had undergone P/D were treated with pleural cavity irradiation that included a median dose of 52.2 Gy using helical tomotherapy. The median age of the patients was 53 years (31-74). In addition to clinical and diagnostic findings from regular follow-up examinations, we evaluated the dose distribution for other organs at risk to assess treatment in relation to toxicity, with special regard for the underlying intact lung.
RESULTS
The mean lung dose on the treatment site was 32.8 Gy (±6.8). The V was 71.7% (±17.2). No treatment-related toxicity that exceeded grade III according to common toxicity criteria (CTC) was observed. Median progression-free survival (PFS) was 13 months with a median overall survival (OAS) of 19 months.
CONCLUSION
The findings of this analysis provide data indicating that sparing the underlying lung in patients with MPM after P/D is not only feasible with helical tomotherapy, but that this treatment also causes reasonably few side effects.
PubMed: 28831280
DOI: 10.1016/j.rpor.2017.07.006 -
International Journal of Oncology Mar 2021Patients with a variety of malignancies can develop malignant pleural effusion (MPE). MPE can cause significant symptoms and result in a marked decrease in quality of... (Review)
Review
Patients with a variety of malignancies can develop malignant pleural effusion (MPE). MPE can cause significant symptoms and result in a marked decrease in quality of life and a poor prognosis. MPE is primarily considered as an immune and vascular manifestation of pleural metastases. In the present review, the existing evidence supporting the applicability of anti‑angiogenic therapy and immunotherapy for the treatment of MPE was summarized. Patients with MPE have benefited from anti‑angiogenic agents, including bevacizumab and endostar; however, no relevant prospective phase III trial has, thus far, specifically analyzed the benefit of anti‑angiogenic therapy in MPE. Immunotherapy for MPE may be sufficient to turn a dire clinical situation into a therapeutic advantage. Similar to anti‑angiogenic therapy, more clinical data on the efficiency and safety of immunotherapy for controlling MPE are urgently required. The combined use of anti‑angiogenic therapy and immunotherapy may be a promising strategy for MPE, which requires to be further understood.
Topics: Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Cancer Vaccines; Combined Modality Therapy; Dendritic Cells; Endostatins; Humans; Immune Checkpoint Inhibitors; Immunotherapy; Oncolytic Virotherapy; Pleural Cavity; Pleural Effusion, Malignant; Prognosis; Quality of Life; Recombinant Proteins; Tumor Escape
PubMed: 33650668
DOI: 10.3892/ijo.2021.5174 -
Kyobu Geka. the Japanese Journal of... Sep 2018In the management of chest drain after thoracic surgery, it is important to egest fluid and air which accumulate in the pleural cavity and to gain information such as... (Review)
Review
In the management of chest drain after thoracic surgery, it is important to egest fluid and air which accumulate in the pleural cavity and to gain information such as air leakage, bleeding or pus discharge. To achieve these purpose, continuous chest drainage system is necessary for thoracic surgery. In addition, we have to understand the particularity in the pleural cavity and the structure of continuous chest drainage system. Traditional drainage system is based on 3-bottle system. Recently, we can use new drainage system, such as Thopaz, which is called digital drainage system. There are several studies comparing digital drainage system with traditional drainage system, but the superiority of digital drainage system to traditional drainage system is not confirmed.
Topics: Chest Tubes; Drainage; Humans; Therapy, Computer-Assisted; Thoracic Surgical Procedures
PubMed: 30310043
DOI: No ID Found -
Journal of Thoracic Disease Mar 2020This study aimed to investigate the clinical efficacy of pleural flaps usage in laparoscopic-thoracoscopic esophagectomy for esophageal cancer.
BACKGROUND
This study aimed to investigate the clinical efficacy of pleural flaps usage in laparoscopic-thoracoscopic esophagectomy for esophageal cancer.
METHODS
Six hundred and nineteen patients received esophagectomy for esophageal cancer. All these 619 patients received laparoscopic-thoracoscopic esophagectomy. These 304 patients (study group) used pleural flaps and the other 315 patients (control group) had no pleural flaps. The observation indicators were postoperative complications, including cervical subcutaneous emphysema, fistula of cervical anastomosis, and anastomotic leakage into the pleural cavity.
RESULTS
In the study group, 5 patients had cervical subcutaneous emphysema after surgery (1.64%) compared to 38 patients in the control group (12.06%), which showed significant difference (P<0.05). Moreover, the study group displayed 1 case of anastomotic leakage into the pleural cavity (0.33%), compared with 8 patients in the control group (2.54%), which showed significant difference (P<0.05). Logistic regression indicated that the application of pleural flaps effectively reduced the incidence of postoperative complications.
CONCLUSIONS
Covering the upper mediastinum with pleural flaps effectively reduced the incidence of cervical subcutaneous emphysema and anastomotic leakage into the pleural cavity.
PubMed: 32274166
DOI: 10.21037/jtd.2019.12.65 -
The Indian Journal of Tuberculosis Jul 2021Residual pleural opacity (RPO) is a common radiographic sequela in patients with tubercular pleural effusion at the end of the treatment. This study was designed to find...
INTRODUCTION
Residual pleural opacity (RPO) is a common radiographic sequela in patients with tubercular pleural effusion at the end of the treatment. This study was designed to find out the risk factors associated with residual pleural opacity (RPO).
MATERIALS & METHODS
This was a prospective longitudinal study performed to analyse data of 56 patients (46 males & 10 females) who were diagnosed as tubercular pleural effusion and treated for the same between 1st Jan 2019 to 30th March 2020. Chest X-ray posteroanterior & Lateral view was done (performed) at 0 and 6 months of treatment to quantify the amount of pleural effusion and measured the residual pleural opacity at the end of the treatment. RPO included both non resolving pleural effusion as well as residual pleural thickening (RPT). All statistical analysis was done using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Multivariate logistic regression was performed to explore the association of risk factors and Residual pleural opacity. The statistical significance level was set at 0.05 (two-tailed).
RESULTS
The incidence of Residual pleural opacity (RPO) at the end of 6 months of antituberculosis treatment was 53.57% (30/56)). The study patients were divided into RPO and non- RPO group. Male gender had significantly higher incidence of RPO (93.3% vs 69.2% P = 0.01)). Patients with RPO group had significantly more cough and weight loss as compared to non RPO group (96.6% vs 65.3% P = 0.002 and 60% vs 23% P = 0.005). The proportion of patients who underwent therapeutic aspiration and gained weight of more than 5kg during treatment (19.5% vs 7.6% P = 0.02 & 46.6% vs 7.6% P = 0.001) was significantly higher in RPO group. A significantly lower protein, glucose and higher LDH level in pleural fluid was observed in the RPO group compared to non-RPO group (P = 0.006, P = 0.01, P = 0.001)). No significant difference was found in the pleural fluid ADA, lymphocyte, neutrophil levels between the two groups (p > 0.05). Logistic regression analysis showed that the male gender, low pleural fluid glucose, presence of cough and weight loss were associated with significantly increased risk of residual pleural opacity and thickening (p < 0.05).
CONCLUSION
Tubercular pleural effusion is associated with residual pleural opacity in more than half of the patients. Male gender and low glucose levels in pleural fluid was associated with increased risk of residual pleural opacity.
Topics: Adult; Antitubercular Agents; Duration of Therapy; Female; Glucose; Humans; Incidence; India; Longitudinal Studies; Male; Organ Size; Pleura; Pleural Cavity; Pleural Effusion; Radiography, Thoracic; Risk Factors; Sex Factors; Treatment Outcome; Tuberculosis, Pleural
PubMed: 34099203
DOI: 10.1016/j.ijtb.2020.12.012 -
American Journal of Respiratory and... May 2021The physiological basis of lung protection and the impact of positive end-expiratory pressure (PEEP) during pronation in acute respiratory distress syndrome are not...
The physiological basis of lung protection and the impact of positive end-expiratory pressure (PEEP) during pronation in acute respiratory distress syndrome are not fully elucidated. To compare pleural pressure (Ppl) gradient, ventilation distribution, and regional compliance between dependent and nondependent lungs, and investigate the effect of PEEP during supination and pronation. We used a two-hit model of lung injury (saline lavage and high-volume ventilation) in 14 mechanically ventilated pigs and studied supine and prone positions. Global and regional lung mechanics including Ppl and distribution of ventilation (electrical impedance tomography) were analyzed across PEEP steps from 20 to 3 cm HO. Two pigs underwent computed tomography scans: tidal recruitment and hyperinflation were calculated. Pronation improved oxygenation, increased Ppl, thus decreasing transpulmonary pressure for any PEEP, and reduced the dorsal-ventral pleural pressure gradient at PEEP < 10 cm HO. The distribution of ventilation was homogenized between dependent and nondependent while prone and was less dependent on the PEEP level than while supine. The highest regional compliance was achieved at different PEEP levels in dependent and nondependent regions in supine position (15 and 8 cm HO), but for similar values in prone position (13 and 12 cm HO). Tidal recruitment was more evenly distributed (dependent and nondependent), hyperinflation lower, and lungs cephalocaudally longer in the prone position. In this lung injury model, pronation reduces the vertical pleural pressure gradient and homogenizes regional ventilation and compliance between the dependent and nondependent regions. Homogenization is much less dependent on the PEEP level in prone than in supine positon.
Topics: Animals; Disease Models, Animal; Lung Compliance; Lung Injury; Patient Positioning; Pleural Cavity; Positive-Pressure Respiration; Prone Position; Respiratory Distress Syndrome; Respiratory Mechanics; Supine Position; Swine
PubMed: 33406012
DOI: 10.1164/rccm.202007-2957OC