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Journal of Thoracic Disease Aug 2018Surgical procedures of pleural cavity are crucial to complete the diagnoses or planning treatment of pleural effusions with an unknown aetiology. Traditionally, the...
Surgical procedures of pleural cavity are crucial to complete the diagnoses or planning treatment of pleural effusions with an unknown aetiology. Traditionally, the transthoracic approach has been the most used procedure to study the pleural cavity. The subxiphoid video-thoracoscopy is becoming an alternative to the transthoracic approach. Subxiphoid video-thoracoscopy is a minimally invasive technique that allows us to study both pleural cavities with a single subxiphoid incision. In the supine decubitus, through a small subxiphoid incision, a rigid video-mediastinoscope is introduced. Once all the tissues are dissected, mediastinal pleura can be identified and incised. A 30° thoracoscopy is then inserted into the pleural cavity through the video-mediastinoscope to obtain samples of pleural fluid and biopsies of the parietal pleura and lung nodules if present. Subxiphoid approach has some advantages compared with the traditional transthoracic approach. On the one hand, contrary to traditional thoracoscopy, in subxiphoid video-thoracoscopy it is not necessary to do a transthoracic approach even for the insertion of a chest tube. Avoidance of intercostal ports probably decreases the risk of post-operative pain and the patients can be discharged 24 hours after surgery with no increase in surgical risk. On the other hand, we can explore both pleural cavities at the same time through a single incision, in case of bilateral pleural effusion. If malignancy is confirmed by frozen-section or by macroscopic evidence of intrapleural tumour infiltration or implants, a pleurodesis to avoid recurrence can be performed prior to tube insertion and closure.
PubMed: 30345100
DOI: 10.21037/jtd.2018.03.99 -
Nature Nanotechnology Feb 2022Malignant pleural effusion (MPE) is indicative of terminal malignancy with a uniformly fatal prognosis. Often, two distinct compartments of tumour microenvironment, the...
Malignant pleural effusion (MPE) is indicative of terminal malignancy with a uniformly fatal prognosis. Often, two distinct compartments of tumour microenvironment, the effusion and disseminated pleural tumours, co-exist in the pleural cavity, presenting a major challenge for therapeutic interventions and drug delivery. Clinical evidence suggests that MPE comprises abundant tumour-associated myeloid cells with the tumour-promoting phenotype, impairing antitumour immunity. Here we developed a liposomal nanoparticle loaded with cyclic dinucleotide (LNP-CDN) for targeted activation of stimulators of interferon genes signalling in macrophages and dendritic cells and showed that, on intrapleural administration, they induce drastic changes in the transcriptional landscape in MPE, mitigating the immune cold MPE in both effusion and pleural tumours. Moreover, combination immunotherapy with blockade of programmed death ligand 1 potently reduced MPE volume and inhibited tumour growth not only in the pleural cavity but also in the lung parenchyma, conferring significantly prolonged survival of MPE-bearing mice. Furthermore, the LNP-CDN-induced immunological effects were also observed with clinical MPE samples, suggesting the potential of intrapleural LNP-CDN for clinical MPE immunotherapy.
Topics: Adaptive Immunity; Animals; B7-H1 Antigen; Cell Line, Tumor; Cell Proliferation; Dendritic Cells; Drug Delivery Systems; Humans; Immune Checkpoint Inhibitors; Immunity, Innate; Immunotherapy; Interferons; Mice; Nanoparticles; Pleural Cavity; Pleural Effusion, Malignant; Tumor Microenvironment; Xenograft Model Antitumor Assays
PubMed: 34916656
DOI: 10.1038/s41565-021-01032-w -
European Journal of Case Reports in... 2018Although the current medical literature is limited, hydropneumothorax was described as far back as the 5th century BC. It is characterized by the presence of air and...
UNLABELLED
Although the current medical literature is limited, hydropneumothorax was described as far back as the 5th century BC. It is characterized by the presence of air and fluid in the pleural cavity and is an infrequent finding. Causes include trauma, iatrogenesis following thoracentesis, the presence of gas-forming organisms, tuberculosis and malignancy. Diagnosis is based on clinical and radiological features. We report a case of hydropneumothorax and present radiological images showing the distinctive features of this entity.
LEARNING POINTS
Hydropneumothorax is defined as the presence of air and fluid in the pleural cavity and is an infrequent finding.Clinical features may present as breathlessness and chest pains with decreased breath sounds, dullness in a straight line, shifting dullness, a succussion splash and a positive coin test on physical examination; supine radiography demonstrates a distinctive pleural line with increased density lateral in the pleural cavity.Hydropneumothorax is managed by chest tube insertion for intercostal drainage.
PubMed: 30755991
DOI: 10.12890/2018_000975 -
Immunity May 2023The recent revolution in tissue-resident macrophage biology has resulted largely from murine studies performed in C57BL/6 mice. Here, using both C57BL/6 and BALB/c mice,...
The recent revolution in tissue-resident macrophage biology has resulted largely from murine studies performed in C57BL/6 mice. Here, using both C57BL/6 and BALB/c mice, we analyze immune cells in the pleural cavity. Unlike C57BL/6 mice, naive tissue-resident large-cavity macrophages (LCMs) of BALB/c mice failed to fully implement the tissue-residency program. Following infection with a pleural-dwelling nematode, these pre-existing differences were accentuated with LCM expansion occurring in C57BL/6, but not in BALB/c mice. While infection drove monocyte recruitment in both strains, only in C57BL/6 mice were monocytes able to efficiently integrate into the resident pool. Monocyte-to-macrophage conversion required both T cells and interleukin-4 receptor alpha (IL-4Rα) signaling. The transition to tissue residency altered macrophage function, and GATA6 tissue-resident macrophages were required for host resistance to nematode infection. Therefore, during tissue nematode infection, T helper 2 (Th2) cells control the differentiation pathway of resident macrophages, which determines infection outcome.
Topics: Mice; Animals; Filarioidea; Filariasis; Th2 Cells; Monocytes; Pleural Cavity; Mice, Inbred C57BL; Macrophages; Nematode Infections; Cell Differentiation; Mice, Inbred BALB C
PubMed: 36948193
DOI: 10.1016/j.immuni.2023.02.016