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Medicine Dec 2023Fungal pleural infections are infrequent and insidious, for which there are neither large clinical studies nor targeted guidelines to provide standardized treatment... (Review)
Review
Fungal pleural infections are infrequent and insidious, for which there are neither large clinical studies nor targeted guidelines to provide standardized treatment options. We reported 4 cases of fungal pleural infection and reviewed the cases of fungal pleural infections in previous studies to provide a basis for the diagnosis and treatment of fungal pleural infections. There were 2 females and 2 males with a mean age of 58.5 years in our data. The average time from onset to diagnosis was 30.25 days. Risk factors most frequently included pulmonary diseases (n = 4) and malignancy (n = 1). Two patients underwent pleural biopsy through a thoracoscope, and no pathogens were detected. Pleural fluid culture was positive in 2 out of 3 cases. The diagnoses were "possible" (n = 1), "probable" (n = 1), and "proven" (n = 2). All patients received systemic antifungal therapy, and 3 received combined thoracic drainage. The outcomes were cured (n = 1), improved (n = 2) and lost to follow-up (n = 1). We reviewed 12 cases of fungal pleural infection in previous studies. The diagnosis was confirmed via culture in 7 cases and via biopsy in 8 cases. The pathogen was Aspergillus in 7 cases. After a combination of systemic antifungal (n = 12) and local treatment (n = 11), 10 patients improved and 2 patients died. Diagnosis of fungal pleural infection should incorporate risk factors, clinical presentation and fungal evidence, with pleural fluid culture being an important and feasible mean of confirming the diagnosis; and treatment should be based on systemic antifungal therapy supplemented by topical therapy.
Topics: Male; Female; Humans; Middle Aged; Antifungal Agents; Mycoses; Pleura; Prognosis; Communicable Diseases; Pleural Diseases
PubMed: 38050212
DOI: 10.1097/MD.0000000000036411 -
Journal of Medical Virology Jan 2022Observational studies indicate that pleural effusion has an association with risk and the clinical prognosis of COVID-19 disease; however, the available literature on... (Meta-Analysis)
Meta-Analysis
Observational studies indicate that pleural effusion has an association with risk and the clinical prognosis of COVID-19 disease; however, the available literature on this area is inconsistent. The objective of this systematic review and meta-analysis is to evaluate the correlation between COVID-19 disease and pleural effusion. A rigorous literature search was conducted using multiple databases. All eligible observational studies were included from around the globe. The pooled prevalence and associated 95% confidence interval (CI) were calculated using the random effect model. Mantel-Haenszel odds ratios were produced to report overall effect size using random effect models for severity and mortality outcomes. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to appraise publication bias. Data from 23 studies including 6234 COVID-19 patients was obtained. The overall prevalence of pleural effusion in COVID-19 patients was 9.55% (95% CI, I = 92%). Our findings also indicated that the presence of pleural effusions associated with increased risk of severity of disease(OR = 5.08, 95% CI 3.14-8.22, I = 77.4%) and mortality due to illness(OR = 4.53, 95% CI 2.16-9.49, I = 66%) compared with patients without pleural effusion. Sensitivity analyses illustrated a similar effect size while decreasing the heterogeneity. No significant publication bias was evident in the meta-analysis. The presence of pleural effusion can assist as a prognostic factor to evaluate the risk of worse outcomes in COVID-19 patients hence, it is recommended that hospitalized COVID-19 patients with pleural effusion should be managed on an early basis.
Topics: COVID-19; Female; Humans; Male; Pleural Effusion; Prevalence; Prognosis; Severity of Illness Index
PubMed: 34449896
DOI: 10.1002/jmv.27301 -
Respiratory Medicine Dec 2018Although pleural manometry is a relatively simple medical procedure it is only occasionally used to follow pleural pressure (Ppl) changes during a therapeutic... (Review)
Review
Although pleural manometry is a relatively simple medical procedure it is only occasionally used to follow pleural pressure (Ppl) changes during a therapeutic thoracentesis and pneumothorax drainage. As some studies showed that pleural pressure monitoring might be associated with significant advantages, pleural manometry has been increasingly evaluated in the last decade. The major clinical applications of pleural pressure measurements include: the prevention of complications associated with large volume thoracentesis, diagnosis and differentiation between various types of an unexpandable lung and a possible prediction of the efficacy of chest tube drainage in patients with spontaneous pneumothorax. It is well known that the therapeutic thoracentesis might be complicated by cough, chest discomfort, and rarely, by a life threatening condition called reexpansion pulmonary edema (RPE). The serious adverse events of thoracentesis are related to pleural pressure drop rather than to the volume of removed pleural effusion. The use of pleural manometry during pleural fluid withdrawal enables the evaluation of the relationship between withdrawn pleural fluid volume, pleural pressure changes and procedure related complications. Pleural pressure measurement is also an important tool to study the different mechanism of pneumothorax complicating the thoracentesis. Pleural manometry is critical for measurement of pleural elastance, diagnosis of an unexpandable lung and differentiation between trapped lung and lung entrapment. This usually has significant clinical implications in terms of further management of patients with pleural effusion. The paper is a comprehensive review presenting different aspects of pleural pressure measurement in clinical practice.
Topics: Diagnosis, Differential; Elasticity; Humans; Manometry; Pleura; Pleural Diseases; Pleural Effusion; Pneumothorax; Pressure; Pulmonary Edema; Thoracentesis
PubMed: 29402510
DOI: 10.1016/j.rmed.2018.01.014 -
Radiology and Oncology Jan 2021The study investigated the influence of and polymorphisms, as well as the influence of interactions between polymorphism and interactions between polymorphisms and...
BACKGROUND
The study investigated the influence of and polymorphisms, as well as the influence of interactions between polymorphism and interactions between polymorphisms and asbestos exposure, on the risk of developing pleural plaques, asbestosis and malignant mesothelioma (MM).
SUBJECTS AND METHODS
The cross sectional study included 940 asbestos-exposed subjects, among them 390 subjects with pleural plaques, 147 subjects with asbestosis, 225 subjects with MM and 178 subjects with no asbestos-related disease. rs17883901, rs41303970, null, null, rs1695 and rs1138272 genotypes were determined using PCR based methods. In statistical analysis, logistic regression was used.
RESULTS
null genotype was associated with the decreased risk for pleural plaques (OR = 0.63; 95% CI = 0.40-0.98; p = 0.026) and asbestosis (OR = 0.51; 95% CI = 0.28-0.93; p = 0.028), but not for MM. A positive association was found between rs1695 AG + GG . AA genotypes for MM when compared to pleural plaques (OR = 1.39; 95% CI = 1.00-1.94; p = 0.049). The interactions between different polymorphisms showed no significant influence on the risk of investigated asbestos-related diseases. The interaction between null polymorphism and asbestos exposure decreased the MM risk (OR = 0.17; 95% CI = 0.03-0.85; p = 0.031).
CONCLUSIONS
Our findings suggest that null genotype may be associated with a decreased risk for pleural plaques and asbestosis, may modify the association between asbestos exposure and MM and may consequently act protectively on MM risk. This study also revealed a protective effect of the interaction between rs1695 polymorphism and asbestos exposure on MM risk.
Topics: Aged; Asbestos; Asbestosis; Cross-Sectional Studies; Female; Genotype; Glutamate-Cysteine Ligase; Glutathione; Glutathione S-Transferase pi; Glutathione Transferase; Humans; Male; Mesothelioma, Malignant; Middle Aged; Pleural Diseases; Polymorphism, Genetic; Regression Analysis; Smoking
PubMed: 33544514
DOI: 10.2478/raon-2021-0002 -
Thoracic Cancer Jan 2023Malignant pleural mesothelioma (MPM) is an invasive, aggressive pleural tumor with a predominantly local spread. The objective of this study was to assess thoracic...
BACKGROUND
Malignant pleural mesothelioma (MPM) is an invasive, aggressive pleural tumor with a predominantly local spread. The objective of this study was to assess thoracic ultrasound (TUS) as an imaging modality with high sensitivity for the identification of malignant pleural involvement and in order to guide pleural biopsies.
METHODS
In this retrospective single-center study between January 2018 and June 2022, 51 consecutive patients with impassable circumferential pleural thickening underwent TUS at the Thoracic Surgery Unit of the Vanvitelli University of Naples. Pleural biopsies were performed, and then large and multiple samples were sent to the pathological anatomy for histological examination.
RESULTS
In all patients who underwent ultrasound examination, we chose the optimal point of entry to perform pleural biopsies and selected the areas of greater thickening without pleural effusion. No patient had any complications. No drainage tubes were placed after the pleural biopsies and no pneumothorax was present during the following days of hospitalization. The patients were discharged on the second postoperative day.
CONCLUSION
With TUS the precise pleural thickening localization, local infiltration, mass extent, its nature (solid, cystic or complex) and ultrasound features can be easily defined. Furthermore, ultrasound is more economical than computed tomography and avoids the risks associated with radiation. Thoracic ultrasound is an important component of the diagnostic procedure in detecting a safe entry site for biopsies of MPMs.
Topics: Humans; Retrospective Studies; Pleura; Pleural Diseases; Pleural Neoplasms; Mesothelioma, Malignant
PubMed: 36415167
DOI: 10.1111/1759-7714.14735 -
The European Respiratory Journal May 2017
Topics: Humans; Pleural Effusion; Pleurisy; Tuberculosis, Pleural
PubMed: 28546275
DOI: 10.1183/13993003.00356-2017 -
The European Respiratory Journal May 2017
Topics: Humans; Pleural Effusion; Pleurisy; Tuberculosis, Pleural
PubMed: 28546270
DOI: 10.1183/13993003.02472-2016 -
The Clinical Respiratory Journal Jan 2021New flex-rigid pleuroscope enables observations with a maximum angle of curvature of 180 , allowing visualization of the area near the insertion site of the pleuroscope....
OBJECTIVE
New flex-rigid pleuroscope enables observations with a maximum angle of curvature of 180 , allowing visualization of the area near the insertion site of the pleuroscope. And, it improved the image quality and channel inner diameter. The aim of this study was to evaluate the clinical effectiveness and safety of a new flex-rigid pleuroscope.
METHODS
A retrospective analysis of patients who were examined with a new flex-rigid pleuroscope under local anesthesia at our institution was conducted. Pleuroscopy was performed in 33 patients with undiagnosed exudative pleural effusions from December 2016 to March 2019.
RESULTS
A total of 33 patients (10 women, 23 men); their median age 74 years (range 24-90) were investigated. Pleuroscopy showed that 18 had malignant pleural disease (54%), and 15 had benign pleural diseases (46%). The top three most frequent causes of pleural disease were pleural metastases of lung carcinoma (30.3%), pyothorax (15.1%), and malignant pleural mesothelioma (12.1%). In 32 cases (97%), observation at the introducer insertion site was possible. It was not possible in one case due to hard adhesions. The diagnostic rate was 100%, and the complication rate was 6.1%. There were no major complications, and minor complications included mild pain (one case) and minor bleeding (one case) that was stanched spontaneously.
CONCLUSIONS
The new flex-rigid pleuroscope is effective and safe for diagnosing pleural effusions. The improved bending angle is likely to minimize the blind area. The new pleuroscopy fiberscope may improve the diagnostic rate.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pleura; Pleural Effusion; Retrospective Studies; Thoracoscopes; Thoracoscopy; Young Adult
PubMed: 32949105
DOI: 10.1111/crj.13274 -
Arquivos Brasileiros de Cirurgia... 2017Pancreaticopleural fistula is a rare complication of chronic pancreatitis. (Review)
Review
INTRODUCTION
Pancreaticopleural fistula is a rare complication of chronic pancreatitis.
OBJECTIVE
To describe pancreaticopleural fistula due to chronic pancreatitis and perform an extensive review of literature on this topic.
METHODS
Comprehensive narrative review through online research on the databases Medline and Lilacs for articles published over the last 20 years. There were 22 case reports and four case series selected.
RESULTS
The main indication for surgical treatment is the failure of clinical and/or endoscopic treatments. Surgery is based on internal pancreatic drainage, especially by means of pancreaticojejunostomy, and/or pancreatic resections.
CONCLUSION
Pancreaticopleural fistula is a rare complication of chronic pancreatitis and the Frey procedure may be an appropriate therapeutic option in selected cases when clinical and endoscopic treatments are unsuccessful.
Topics: Humans; Pancreatic Fistula; Pancreatitis, Chronic; Pleural Diseases; Respiratory Tract Fistula
PubMed: 29019567
DOI: 10.1590/0102-6720201700030014 -
Chest Dec 2022Combination intrapleural fibrinolytic and enzyme therapy (IET) has been established as a therapeutic option in pleural infection. Despite demonstrated efficacy, studies... (Observational Study)
Observational Study
BACKGROUND
Combination intrapleural fibrinolytic and enzyme therapy (IET) has been established as a therapeutic option in pleural infection. Despite demonstrated efficacy, studies specifically designed and adequately powered to address complications are sparse. The safety profile, the effects of concurrent therapeutic anticoagulation, and the nature and extent of nonbleeding complications remain poorly defined.
RESEARCH QUESTION
What is the bleeding complication risk associated with IET use in pleural infection?
STUDY DESIGN AND METHODS
This was a multicenter, retrospective observational study conducted in 24 centers across the United States and the United Kingdom. Protocolized data collection for 1,851 patients treated with at least one dose of combination IET for pleural infection between January 2012 and May 2019 was undertaken. The primary outcome was the overall incidence of pleural bleeding defined using pre hoc criteria.
RESULTS
Overall, pleural bleeding occurred in 76 of 1,833 patients (4.1%; 95% CI, 3.0%-5.0%). Using a half-dose regimen (tissue plasminogen activator, 5 mg) did not change this risk significantly (6/172 [3.5%]; P = .68). Therapeutic anticoagulation alongside IET was associated with increased bleeding rates (19/197 [9.6%]) compared with temporarily withholding anticoagulation before administration of IET (3/118 [2.6%]; P = .017). As well as systemic anticoagulation, increasing RAPID score, elevated serum urea, and platelets of < 100 × 10/L were associated with a significant increase in bleeding risk. However, only RAPID score and use of systemic anticoagulation were independently predictive. Apart from pain, non-bleeding complications were rare.
INTERPRETATION
IET use in pleural infection confers a low overall bleeding risk. Increased rates of pleural bleeding are associated with concurrent use of anticoagulation but can be mitigated by withholding anticoagulation before IET. Concomitant administration of IET and therapeutic anticoagulation should be avoided. Parameters related to higher IET-related bleeding have been identified that may lead to altered risk thresholds for treatment.
Topics: Humans; Tissue Plasminogen Activator; Fibrinolytic Agents; Retrospective Studies; Pleural Effusion; Pleural Diseases; Hemorrhage; Enzyme Therapy; Communicable Diseases; Empyema, Pleural
PubMed: 35716828
DOI: 10.1016/j.chest.2022.06.008