-
Lung Cancer (Amsterdam, Netherlands) Aug 2018Intra-pleural bacteria are effective pleurodesis agents in malignant pleural effusions. However, their relationship with survival is unclear.
BACKGROUND
Intra-pleural bacteria are effective pleurodesis agents in malignant pleural effusions. However, their relationship with survival is unclear.
OBJECTIVES
We undertook a comprehensive, structured evaluation of survival outcomes in adults with malignant pleural effusions treated with intra-pleural bacterial products.
DATA SOURCES
Medline, Embase, Cochrane library, Clinical Trials Registers and Open Grey.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS
Randomised controlled trials and non-randomised comparative studies were included, if the population included adults with malignant pleural effusions. Interventions of interest were any intra-pleural bacterial product, compared with placebo, alternative intra-pleural drug, or no treatment. Survival outcomes were collected.
STUDY APPRAISAL AND SYNTHESIS METHODS
Two reviewers independently screened studies for eligibility, assessed papers for risk of bias and extracted data. Narrative synthesis was performed as high heterogeneity between studies precluded meta-analysis.
RESULTS
631 studies were identified, of which 14 were included. All were at high or unclear risk of bias in at least one domain. Six studies reported a survival benefit associated with intra-pleural bacterial products, whilst 8 reported no difference. Non-randomised studies and studies published prior to 2000 were more likely to report survival benefits.
LIMITATIONS
There was high heterogeneity between studies, which limited the generalisability of findings. Publication bias may have affected the review as five full-text papers were unobtainable, and survival outcomes were missing in a further five.
CONCLUSIONS
There is a lack of high quality evidence regarding the relationship between intra-pleural bacterial products and survival. Implications of key findings: Well-designed, prospective randomised trials are needed, to determine whether intra-pleural bacterial products can improve survival in pleural malignancy.
PROSPERO REGISTRATION NUMBER
CRD42017058067.
Topics: Adult; Antigens, Bacterial; Humans; Pleura; Pleural Effusion, Malignant; Pleurodesis; Publication Bias; Randomized Controlled Trials as Topic; Survival Analysis
PubMed: 30032840
DOI: 10.1016/j.lungcan.2018.06.002 -
Undersea & Hyperbaric Medicine :... 2018Patients with prior primary spontaneous pneumothorax (PSP) frequently seek clearance to dive. Despite wide consensus in precluding compressed-air diving in this...
INTRODUCTION
Patients with prior primary spontaneous pneumothorax (PSP) frequently seek clearance to dive. Despite wide consensus in precluding compressed-air diving in this population, there is a paucity of data to support this decision. We reviewed the literature reporting the risk of PSP recurrence.
METHODS
A literature search was performed in PubMed and Web of Science using predefined terms. Studies published in English reporting the recurrence rate after a first PSP were included.
RESULTS
Forty studies (n=3,904) were included. Risk of PSP recurrence ranged 0-67% (22 ± 15.5%; mean ± SD). Mean follow-up was 36 months, and 63 ± 39% of recurrences occurred during the first year of follow-up. Elevated height/weight ratio and emphysema-like changes (ELCs) are associated with PSP recurrence. ELCs are present in 59%-89% (vs. 0-15%) of patients with recurrence and can be detected effectively with high-resolution CT scan (sensitivity of 84-88%). Surgical pleurodesis reduces the risk of recurrence substantially (4.0 ± 4% vs. 22 ± 15.5%).
CONCLUSION2
Risk of PSP recurrence seems to decline over time and is associated to certain radiological and clinical risk factors. This could be incremented by the stresses of compressed-air diving. A basis for informed patient-physician discussions regarding future diving is provided in this review.
Topics: Body Height; Body Weight; Diving; Humans; Pleurodesis; Pneumothorax; Pulmonary Emphysema; Recurrence; Risk Factors; Secondary Prevention; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 29734572
DOI: No ID Found -
Respiratory Medicine Apr 2018Primary spontaneous pneumothorax (PSP) remains a significant global health problem. Despite general agreement, an official algorithm for the management of PSP still does... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Primary spontaneous pneumothorax (PSP) remains a significant global health problem. Despite general agreement, an official algorithm for the management of PSP still does not exist.
OBJECTIVES
Evaluating the efficacy of all available treatments in PSP.
METHODS
A systematic search of 12 electronic databases was performed to identify all randomized controlled trials (RCTs) of any treatments in PSP. The primary endpoint was recurrence incidence; secondary were an immediate success, complication and hospitalization days. All available outcomes were included in frequentist network meta-analysis.
RESULTS
4262 patients of 29 RCTs were included. In patients with first episode of PSP, video-assisted thoracoscopic surgery (VATS), tube drainage and aspiration had no significant difference regarding recurrence. Chemical pleurodesis significantly reduced the recurrent incidence of 46% compared with aspiration and 54% compared with tube drainage. VATS and aspiration significantly decreased hospitalization days compared with tube drainage. In patients with recurrent or persistent PSP, thoracotomy with mechanical pleurodesis has a higher rank than VATS with or without pleurodesis in preventing recurrence, with no significant difference. VATS alone significantly reduced complications compared with all others treatments, except thoracotomy with abrasion.
CONCLUSIONS
Aspiration and tube drainage have no significant difference in treating patients with first episode of PSP regarding recurrence. Aspiration reduced hospitalization days when compared with tube drainage. Thoracotomy with mechanical pleurodesis and VATS with or without pleurodesis are not significantly different in preventing recurrence in patients with recurrent or persistent PSP. VATS alone reduced complications compared with others treatments except for thoracotomy with abrasion.
Topics: Adult; Chest Tubes; Drainage; Female; Hospitalization; Humans; Incidence; Length of Stay; Male; Middle Aged; Network Meta-Analysis; Pleurodesis; Pneumothorax; Randomized Controlled Trials as Topic; Recurrence; Thoracic Surgery, Video-Assisted; Thoracotomy; Treatment Outcome; Young Adult
PubMed: 29605200
DOI: 10.1016/j.rmed.2018.03.009 -
Revista Clinica Espanola Mar 2018Myelomatous pleural effusion (MPE) is rare in multiple myeloma, and therefore its characteristics are not well defined.
BACKGROUND
Myelomatous pleural effusion (MPE) is rare in multiple myeloma, and therefore its characteristics are not well defined.
METHODS
A systematic review (4 online databases) was conducted of articles describing the clinical characteristics of patients with MPE, pleural effusion's biochemical characteristics and treatment efficacy. We analysed isolated cases and small retrospective series.
RESULTS
We included 98 articles with a total of 153 patients with MPE. The median age was 62years, and the ratio of males to females was 1.7:1. The most common symptoms were dyspnoea (98.8%), bone pain (100%) and chest pain (95.3%), and the most relevant abnormal laboratory test results were anaemia (90.1%) and renal failure (53.8%). MPE was predominantly unilateral (63.9%) and covered more than two-thirds of the hemithorax (54.5%). The pleural fluid (PF) had a haematologic/serohaematologic appearance (87%) and met the criteria for lymphocytic (78.6%) exudate (94.7%). The most cost-effective diagnostic procedures were pleural cytology (95.9%) and the observation of a monoclonal peak in the PF (94.7%). In a significant proportion of patients (54.7%), the MPE did not respond to treatment, and the best response was achieved when chemotherapy (with/without corticosteroids) was combined with therapeutic thoracentesis, chest drainage or pleurodesis.
CONCLUSIONS
MPE predominates in middle to older age men, is symptomatic and is usually unilateral. PF is an exudate with a haemorrhagic appearance, and the most cost-effective diagnostic procedure is pleural cytology. Treatment response is unfavourable in more than half of patients.
PubMed: 29197468
DOI: 10.1016/j.rce.2017.11.001 -
Inhalation Toxicology Mar 2017Due to some historical (and inaccurate) reports that asbestos might be present in some cosmetic talc products, questions are occasionally raised regarding the potential... (Review)
Review
OBJECTIVE
Due to some historical (and inaccurate) reports that asbestos might be present in some cosmetic talc products, questions are occasionally raised regarding the potential pleural mesothelioma risks associated with cosmetic talc products. Our objective was to determine the incidence of pleural mesothelioma of individuals exposed to cosmetic talc.
MATERIALS AND METHODS
We conducted a systematic review of the epidemiological literature for cosmetic talc miners and millers and found three occupational cohort studies that evaluated pleural mesothelioma incidence in workers in Italy, Norway, France, and Austria. We conducted a second literature review to evaluate the incidence and mortality of pleural mesothelioma among patients who received talc pleurodesis treatments before 1965 and found retrospective clinical studies including over 300 patients with follow-up ranging from 14 to 40 years.
RESULTS
There were no mesotheliomas reported in any of the cosmetic talc miner and miller cohorts. A pooled analysis of data from the cohort mortality studies indicated that four mesothelioma deaths would have been expected from the 90,022 person-years of observation, and this was associated with 84% and 67% statistical power to observe a 3-fold or 2.5-fold increase in pleural mesothelioma mortality, respectively. None of the patients who received talc pleurodesis treatments developed mesothelioma.
CONCLUSION
We conclude that there is no epidemiological evidence to support the hypothesis that exposure to cosmetic talc is associated with the development of pleural mesothelioma.
Topics: Cosmetics; Humans; Mesothelioma; Occupational Exposure; Pleural Neoplasms; Risk Factors; Talc
PubMed: 28651470
DOI: 10.1080/08958378.2017.1336187 -
The Journal of Surgical Research Apr 2017Numerous thoracoscopic techniques have been used in the management of primary spontaneous pneumothorax (PSP), including wedge resection, pleurectomy, pleural abrasion,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Numerous thoracoscopic techniques have been used in the management of primary spontaneous pneumothorax (PSP), including wedge resection, pleurectomy, pleural abrasion, chemical pleurodesis, and staple line covering. The purpose of this systematic review was to compare outcomes for the most commonly reported techniques.
MATERIALS AND METHODS
A systematic literature search looking at pneumothorax recurrence rate, length of stay, and chest tube duration after surgery was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed database.
RESULTS
Fifty-one unique studies comprised of 6907 patients published between January 1988 and June 2015 were identified. Heterogeneity among effect sizes was significant for all outcomes. The lowest recurrence rates were observed in the wedge resection + chemical pleurodesis (1.7%; 95% confidence interval [CI], 1.0%-2.7%) and the wedge resection + pleural abrasion + chemical pleurodesis (2.8%; 95% CI, 1.7%-4.7%) groups. The shortest chest tube duration and length of stay were observed in the wedge resection + staple line covering ± other group (2.1 d; 95% CI, 1.4-2.9 and 3.3 d; 95% CI, 2.6-4.0, respectively).
CONCLUSIONS
The variability in reported outcomes and the lack of published multicenter randomized controlled trials highlights a need for more robust investigations into the optimal surgical technique in the management of PSP. Based on the limited quality studies available, this systematic review favors wedge resection + chemical pleurodesis and wedge resection + pleural abrasion + chemical pleurodesis in terms of recurrence rate after surgery for PSP.
Topics: Humans; Pleurodesis; Pneumonectomy; Pneumothorax; Recurrence; Surgical Stapling; Thoracoscopy; Treatment Outcome
PubMed: 28457339
DOI: 10.1016/j.jss.2016.10.024 -
Chest Mar 2017The indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions, could be a valuable management option for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions, could be a valuable management option for recurrent benign pleural effusion (BPE), replacing chemical pleurodesis. The purpose of this study is to analyze the efficacy and safety of IPC use in the management of refractory nonmalignant effusions.
METHODS
We conducted a systematic review and meta-analysis on the published literature. Retrospective cohort studies, case series, and reports that used IPCs for the management of pleural effusion were included in the study.
RESULTS
Thirteen studies were included in the analysis, with a total of 325 patients. Congestive heart failure (49.8%) was the most common cause of BPE requiring IPC placement. The estimated average rate of spontaneous pleurodesis was 51.3% (95% CI, 37.1%-65.6%). The estimated average rate of all complications was 17.2% (95% CI, 9.8%-24.5%) for the entire group. The estimated average rate of major complications included the following: empyema, 2.3% (95% CI, 0.0%-4.7%); loculation, 2.0% (95% CI, 0.0%-4.7%); dislodgement, 1.3% (95% CI, 0.0%-3.7%); leakage, 1.3% (95% CI, 0.0%-3.5%); and pneumothorax, 1.2% (95% CI, 0.0%-4.1%). The estimated average rate of minor complications included the following: skin infection, 2.7% (95% CI, 0.6%-4.9%); blockage and drainage failure, 1.1% (95% CI, 0.0%-3.5%); subcutaneous emphysema, 1.1% (95% CI, 0.0%-4.0%); and other, 2.5% (95% CI, 0.0%-5.2%). One death was directly related to IPC use.
CONCLUSIONS
IPCs are an effective and viable option in the management of patients with refractory BPE. The quality of evidence to support IPC use for BPE remains low, and high-quality studies such as randomized controlled trials are needed.
Topics: Catheters, Indwelling; Drainage; Empyema, Pleural; Foreign-Body Migration; Humans; Pleural Effusion; Pneumothorax
PubMed: 27845052
DOI: 10.1016/j.chest.2016.10.052 -
Thorax Dec 2017Spontaneous pneumothorax is a common pathology. International guidelines suggest pleurodesis for non-resolving air leak or recurrence prevention at second occurrence.... (Review)
Review
OBJECTIVES
Spontaneous pneumothorax is a common pathology. International guidelines suggest pleurodesis for non-resolving air leak or recurrence prevention at second occurrence. This study comprehensively reviews the existing literature regarding chemical pleurodesis efficacy.
DESIGN
We systematically reviewed the literature to identify relevant randomised controlled trials (RCTs), case-control studies and case series. We described the findings of these studies and tabulated relative recurrence rates or ORs (in studies with control groups). Meta-analysis was not performed due to substantial clinical heterogeneity.
RESULTS
Of 560 abstracts identified by our search strategy, 50 were included in our systematic review following screening. Recurrence rates in patients with chest tube drainage only were between 26.1% and 50.1%. Thoracoscopic talc poudrage (four studies (n=249)) provided recurrence rates of between 2.5% and 10.2% with the only RCT suggesting an OR of 0.10 compared with drainage alone. In comparison, talc administration during video-assisted thoracic surgery (VATS) from eight studies (n=2324) recurrence was between 0.0% and 3.2%, but the RCT did not demonstrate a significant difference compared with bleb/bullectomy alone. Minocycline appears similarly effective post-VATS (recurrence rates 0.0-2.9%). Prolonged air leak and recurrence prevention using tetracycline via chest drain (n=726) is likely to provide recurrence rates between 13.0% and 33.3% and autologous blood patch pleurodesis (n=270) between 15.6% and 18.2%.
CONCLUSIONS
Chemical pleurodesis postsurgical treatment or via thoracoscopy appears to be most effective. Evidence for definitive success rates of each agent is limited by the small number of randomised trials or other comparative studies.
Topics: Anti-Bacterial Agents; Humans; Minocycline; Pleurodesis; Pneumothorax; Recurrence; Talc; Thoracoscopy; Treatment Outcome
PubMed: 27803156
DOI: 10.1136/thoraxjnl-2015-207967 -
Digestive Diseases and Sciences Nov 2016Hepatic hydrothorax (HH) is a serious complication of end-stage liver diseases, which is associated with poor survival. There is no consensus regarding the treatment of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hepatic hydrothorax (HH) is a serious complication of end-stage liver diseases, which is associated with poor survival. There is no consensus regarding the treatment of HH.
AIM
To evaluate the effectiveness and safety of pleurodesis for HH in a systematic review with meta-analysis.
METHODS
All relevant papers were searched on the EMBASE and PubMed databases. As for the data from the eligible case reports, the continuous data were expressed as the median (range) and the categorical data were expressed as the frequency (percentage). As for the data from the eligible case series, the rates of complete response and complications were pooled. The proportions with 95 % confidence intervals (CIs) were calculated by using random-effect model.
RESULTS
Twenty case reports including 26 patients and 13 case series including 180 patients were eligible. As for the case reports, the median age was 55 years (range 7-78) and 15 patients were male. The prevalence of ascites was 76 % (19/25). Seventeen (65.38 %) patients responded favorably to pleurodesis. As for the case series, the mean age was 51.5-63.0 years and 83 patients were male. The pooled prevalence of ascites was 90 % (95 % CI 81-97 %) in 7 studies including 71 patients. The complete response rate after pleurodesis was reported in all studies, and the pooled rate was 72 % (95 % CI 65-79 %). Complications related to pleurodesis were reported in 6 studies including 63 patients, and the pooled rate was 82 % (95 % CI 66-94 %).
CONCLUSION
Pleurodesis may be a promising treatment for HH, but carries a high rate of complications.
Topics: Humans; Hydrothorax; Liver Cirrhosis; Pleurodesis; Thoracic Surgery, Video-Assisted; Thoracoscopy
PubMed: 27456504
DOI: 10.1007/s10620-016-4260-9 -
Journal of Thoracic Disease Aug 2016Pseudochylothorax (PCT) (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion (PE) that is commonly associated with chronic inflammatory...
BACKGROUND
Pseudochylothorax (PCT) (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion (PE) that is commonly associated with chronic inflammatory disorders. Nevertheless, the characteristics of patients with PCT are poorly defined.
METHODS
A systematic review was performed across two electronic databases searching for studies reporting clinical findings, PE characteristics, and the most effective treatment of PCT. Case descriptions and retrospective studies were included.
RESULTS
The review consisted of 62 studies with a total of 104 patients. Median age was 58 years, the male/female ratio was 2.6/1, and in the 88.5% of cases the etiology was tuberculosis (TB) or rheumatoid arthritis (RA). PE was usually unilateral (88%) and occupied greater than one-third of the hemithorax (96.3%). There was no evidence of pleural thickening in 20.6% of patients, and 14 patients had a previous PE. The pleural fluid (PF) was an exudate, usually milky (94%) and with a predominance of lymphocytes (61.1%). The most sensitive tests to establish the diagnosis were the cholesterol/triglycerides ratio (CHOL/TG ratio) >1, and the presence of cholesterol crystals (97.4% and 89.7%, respectively). PF culture for TB was positive in the 34.1% of patients. Favorable outcomes with medical treatment, therapeutic thoracentesis, decortication/pleurectomy, pleurodesis, thoracic drainage and thoracoscopic drainage were achieved in 78.9%, 47.8%, 86.7%, 66.6%, 37.5% and 42.9%, respectively.
CONCLUSIONS
PCT is usually tuberculous or rheumatoid, unilateral and the PF is a milky exudate. The presence of cholesterol crystals and a CHOL/TG ratio >1 are the most sensitive test for the diagnosis. The lack of pleural thickening does not rule out PCT. Treatment should be sequential, treating the underlying causes, and assessing the need for interventional techniques.
PubMed: 27621864
DOI: 10.21037/jtd.2016.07.84