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Journal of Applied Physiology... Jan 2020Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and...
Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and intrathoracic pressures and their differences. The esophageal pressure (through esophageal balloon) and the intrathoracic/pleural pressure (through the chest tube on the surgery side) were measured after surgery in 28 patients immediately after lobectomy or wedge resection. Measurements were made in the nondependent lateral position (without or with ventilation of the operated lung) and in the supine position. In the lateral position with the nondependent lung, collapsed or ventilated, the differences between esophageal and pleural pressure amounted to 4.4 ± 1.6 and 5.1 ± 1.7 cmHO. In the supine position, the difference amounted to 7.3 ± 2.8 cmHO. In the supine position, the estimated compressive forces on the mediastinum were 10.5 ± 3.1 cmHO and on the iso-gravitational pleural plane 3.2 ± 1.8 cmHO. A simple model describing the roles of chest, lung, and pneumothorax volume matching on the pleural pressure genesis was developed; modeled pleural pressure = 1.0057 × measured pleural pressure + 0.6592 ( = 0.8). Whatever the position and the ventilator settings, the esophageal pressure changed in a 1:1 ratio with the changes in pleural pressure. Consequently, chest wall elastance (E) measured by intrathoracic (E = ΔPpl/tidal volume) or esophageal pressure (E = ΔPes/tidal volume) was identical in all the positions we tested. We conclude that esophageal and pleural pressures may be largely different depending on body position (gravitational forces) and lung-chest wall volume matching. Their changes, however, are identical. Esophageal and pleural pressure changes occur at a 1:1 ratio, fully justifying the use of esophageal pressure to compute the chest wall elastance and the changes in pleural pressure and in lung stress. The absolute value of esophageal and pleural pressures may be largely different, depending on the body position (gravitational forces) and the lung-chest wall volume matching. Therefore, the absolute value of esophageal pressure should not be used as a surrogate of pleural pressure.
Topics: Aged; Esophagus; Female; Humans; Lung; Lung Compliance; Lung Volume Measurements; Male; Pleural Cavity; Positive-Pressure Respiration; Posture; Pressure; Respiratory Mechanics
PubMed: 31774352
DOI: 10.1152/japplphysiol.00587.2019 -
International Journal of Nanomedicine 2020Malignant pleural effusion (MPE) is the accumulation of fluid in the pleural cavity as a result of malignancies affecting the lung, pleura and mediastinal lymph nodes....
BACKGROUND
Malignant pleural effusion (MPE) is the accumulation of fluid in the pleural cavity as a result of malignancies affecting the lung, pleura and mediastinal lymph nodes. Curcumin, a compound found in turmeric, has anti-cancer properties that could not only treat MPE accumulation but also reduce cancer burden. To our knowledge, direct administration of curcumin into the pleural cavity has never been reported, neither in animals nor in humans.
PURPOSE
To explore the compartmental distribution, targeted pharmacokinetics and the safety profile of liposomal curcumin following intrapleural and intravenous administration.
METHODS
Liposomal curcumin (16 mg/kg) was administered into Fischer 344 rats by either intrapleural injection or intravenous infusion. The concentration of curcumin in plasma and tissues (lung, liver and diaphragm) were measured using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Blood and tissues were examined for pathological changes.
RESULTS
No pleural or lung pathologies were observed following intrapleural liposomal curcumin administration. Total curcumin concentration peaked 1.5 hrs after the administration of intrapleural liposomal curcumin and red blood cell morphology appeared normal. A red blood cells abnormality (echinocytosis) was observed immediately and at 1.5 hrs after intravenous infusion of liposomal curcumin.
CONCLUSION
These results indicate that liposomal curcumin is safe when administered directly into the pleural cavity and may represent a viable alternative to intravenous infusion in patients with pleural-based tumors.
Topics: Administration, Intravenous; Animals; Chromatography, Liquid; Curcumin; Female; Liposomes; Lung; Male; Pleural Cavity; Pleural Neoplasms; Rats, Inbred F344; Tandem Mass Spectrometry; Tissue Distribution
PubMed: 32103948
DOI: 10.2147/IJN.S237536 -
The European Respiratory Journal Dec 2002Tight control of the volume and composition of the pleural liquid is necessary to ensure an efficient mechanical coupling between lung and chest wall. Liquid enters the... (Review)
Review
Tight control of the volume and composition of the pleural liquid is necessary to ensure an efficient mechanical coupling between lung and chest wall. Liquid enters the pleural space through the parietal pleura down a net filtering pressure gradient. Liquid removal is provided by an absorptive pressure gradient through the visceral pleura, by lymphatic drainage through the stomas of the parietal pleura, and by cellular mechanisms. Indeed, contrary to what was believed in the past, pleural mesothelial cells are metabolically active, and possess the cellular features for active transport of solutes, including vesicular transport of protein. Furthermore, the mesothelium was shown, on the basis of recent experimental evidence, both in vivo and in vitro, to be a less permeable barrier than previously believed, being provided with permeability characteristics similar to those of the microvascular endothelium. Direct assessment of the relative contribution of the different mechanisms of pleural fluid removal is difficult, due to the difficulty in measuring the relevant parameters in the appropriate areas, and to the fragility of the mesothelium. The role of the visceral pleura in pleural fluid removal under physiological conditions is supported by a number of findings and considerations. Further evidence indicates that direct lymphatic drainage through the stomas of the parietal pleura is crucial in removing particles and cells, and important in removing protein from the pleural space, but should not be the main effector of fluid removal. Its importance, however, increases markedly in the presence of increased intrapleural liquid loads. Removal of protein and liquid by transcytosis, although likely on the basis of morphological findings and suggested by recent indirect experimental evidence, still needs to be directly proven to occur in the pleura. When pleural liquid volume increases, an imbalance occurs in the forces involved in turnover, which favours fluid removal. In case of a primary abnormality of one ore more of the mechanisms of pleural liquid turnover, a pleural effusion ensues. The factors responsible for pleural effusion may be subdivided into three main categories: those changing transpleural pressure balance, those impairing lymphatic drainage, and those producing increases in mesothelial and capillary endothelial permeability. Except in the first case, pleural fluid protein concentration increases above normal: this feature underlies the classification of pleural effusions into transudative and exudative.
Topics: Humans; Hydrothorax; Lymphatic System; Pleural Cavity; Pleural Effusion
PubMed: 12503717
DOI: 10.1183/09031936.02.00062102 -
The Annals of Thoracic Surgery Nov 2007
Topics: Drainage; Humans; Paracentesis; Pleural Cavity; Pleural Effusion; Pulmonary Edema
PubMed: 17954080
DOI: 10.1016/j.athoracsur.2007.07.052 -
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 -
Cancer Science Jul 2014Multiwalled carbon nanotubes (MWCNT) have a fibrous structure similar to asbestos, raising concern that MWCNT exposure may lead to asbestos-like diseases. Previously we...
Multiwalled carbon nanotubes (MWCNT) have a fibrous structure similar to asbestos, raising concern that MWCNT exposure may lead to asbestos-like diseases. Previously we showed that MWCNT translocated from the lung alveoli into the pleural cavity and caused mesothelial proliferation and fibrosis in the visceral pleura. Multiwalled carbon nanotubes were not found in the parietal pleura, the initial site of development of asbestos-caused pleural diseases in humans, probably due to the short exposure period of the study. In the present study, we extended the exposure period to 24 weeks to determine whether the size and shape of MWCNT impact on deposition and lesion development in the pleura and lung. Two different MWCNTs were chosen for this study: a larger sized needle-like MWCNT (MWCNT-L; l = 8 μm, d = 150 nm), and a smaller sized MWCNT (MWCNT-S; l = 3 μm, d = 15 nm), which forms cotton candy-like aggregates. Both MWCNT-L and MWCNT-S suspensions were administered to the rat lung once every 2 weeks for 24 weeks by transtracheal intrapulmonary spraying. It was found that MWCNT-L, but not MWCNT-S, translocated into the pleural cavity, deposited in the parietal pleura, and induced fibrosis and patchy parietal mesothelial proliferation lesions. In addition, MWCNT-L induced stronger inflammatory reactions including increased inflammatory cell number and cytokine/chemokine levels in the pleural cavity lavage than MWCNT-S. In contrast, MWCNT-S induced stronger inflammation and higher 8-hydroxydeoxyguanosine level in the lung tissue than MWCNT-L. These results suggest that MWCNT-L has higher risk of causing asbestos-like pleural lesions relevant to mesothelioma development.
Topics: Animals; Cell Proliferation; Cytokines; Fibrosis; Inflammation; Lung; Male; Mesothelioma; Nanotubes, Carbon; Pleural Cavity; Rats; Rats, Inbred F344
PubMed: 24815191
DOI: 10.1111/cas.12437 -
BMC Pulmonary Medicine Nov 2010Several studies have been published in the literature on the diagnostic accuracy of NT-pro-BNP for pleural effusions from heart failure in the last decade. The purpose... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several studies have been published in the literature on the diagnostic accuracy of NT-pro-BNP for pleural effusions from heart failure in the last decade. The purpose of our study was to perform a systematic review and meta-analysis on the diagnostic accuracy of pleural fluid NT-pro-BNP for pleural effusions of cardiac origin.
METHODS
MEDLINE, EMBASE, PapersFirst, and the Cochrane collaboration and the Cochrane Register of controlled trials were searched. All searches were inclusive as of March 2010. Studies were only included if the absolute number of true-positive, false-negative, true-negative, and false-positive observations were available, and the "reference standards" were described clearly. Two investigators independently reviewed articles and extracted data. Quality was assessed with the Quality Assessment for Diagnostic Accuracy Studies (QUADAS). The bivariate model for diagnostic meta-analysis was used to obtain a pooled sensitivity and a pooled specificity.
RESULTS
Ten studies (total number of patients 1120) were included in the meta-analysis. The average pleural fluid NT-pro-BNP level in effusions of cardiac origin was 6140 pg/mL. The pooled sensitivity and specificity of all studies combined was 94% (95% CI: 90-97) and 94% (95% CI: 89-97) respectively. The pooled positive likelihood ratio was 15.2 (95% CI: 8.1-28.7) and the pooled negative likelihood ratio was 0.06 (95% CI: 0.03-0.11). The area under the ROC curve was 0.98 (95% CI: 0.96-0.99) and the diagnostic odds ratio was 246 (95% CI: 81-745).
CONCLUSIONS
Pleural fluid NT-pro-BNP is a very useful biomarker with high diagnostic accuracy for distinguishing pleural effusions of cardiac origin.
Topics: Biomarkers; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pleural Cavity; Pleural Effusion; Sensitivity and Specificity
PubMed: 21092122
DOI: 10.1186/1471-2466-10-58 -
BMJ (Clinical Research Ed.) May 2000
Review
Topics: Algorithms; Empyema; Humans; Pleural Diseases; Pleural Effusion; Pneumothorax
PubMed: 10807628
DOI: 10.1136/bmj.320.7245.1318 -
Facts, Views & Vision in ObGyn Dec 202210% of women of reproductive age are affected by endometriosis, and diaphragmatic endometriosis represents 1-1.5% of these cases. Diaphragmatic endometriotic lesions...
BACKGROUND
10% of women of reproductive age are affected by endometriosis, and diaphragmatic endometriosis represents 1-1.5% of these cases. Diaphragmatic endometriotic lesions often require surgical treatment.
OBJECTIVE
This video aims to demonstrate the appearance of diaphragmatic endometriosis and describe our experience with robot-assisted laparoscopic excision of full thickness diaphragmatic endometriosis.
MATERIALS AND METHODS
The patient was a 37-year-old female with the complaint of cyclical right shoulder pain (for 1 year). She previously had caesarean section scar and umbilical endometriosis excision procedures. The magnetic resonance imaging (MRI) of the abdomen highlighted three endometriotic nodules, one of which was described as full thickness on the right hemi-diaphragm. The patient underwent a robot-assisted laparoscopic endometriosis surgery as a joint procedure between the gynaecology and general surgery teams. The falciform ligament was completely divided to obtain full views of the endometriotic lesions on the diaphragm. Superficial diaphragmatic lesions were first excised. The larger deep nodule, which was described on the MRI, was then excised with the full thickness of diaphragm. Pleural cavity was entered intentionally to achieve complete excision of the nodule. Laparoscopic assessment of the right lower pleural cavity through this opening did not show any endometriotic lesions. After the excision, the diaphragm was repaired with a barbed suture. Negative pressure suction of the pleural cavity was performed at the end of this repair instead of using a chest tube.
RESULTS
The patient was discharged on the 3rd day with no complications encountered. Histopathological examination confirmed endometriosis. The patient was asymptomatic three months after surgery.
CONCLUSION
Robotic-assisted surgery is an easy and safe choice especially in such challenging dual compartment surgeries by providing a 3D view that abolishes sensory loss and increases depth perception, providing better manoeuvrability with tremor absence.
PubMed: 36724427
DOI: 10.52054/FVVO.14.4.048 -
American Journal of Respiratory and... Oct 2021
Topics: Humans; Lung; Pleural Cavity
PubMed: 34352193
DOI: 10.1164/rccm.202106-1526ED