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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 The use of pleural manometry during pleural fluid withdrawal enables the evaluation of the relationship between withdrawn pleural fluid volume, pleural pressure changes and procedure related complications.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 -
American Journal of Industrial Medicine Mar 2022Vermiculite ore from Libby, Montana contains on average 24% of a mixture of toxic and carcinogenic amphibole asbestiform fibers. These comprise primarily winchite (84%),...
BACKGROUND
Vermiculite ore from Libby, Montana contains on average 24% of a mixture of toxic and carcinogenic amphibole asbestiform fibers. These comprise primarily winchite (84%), with smaller quantities of richterite (11%) and tremolite (6%), which are together referred to as Libby amphibole (LA).
METHODS
A total of 1883 individuals who were occupationally and/or environmentally exposed to LA and were diagnosed with asbestos-related pleuropulmonary disease (ARPPD) following participation in communitywide screening programs supported by the Agency for Toxic Substances and Disease Registry (ATSDR) and followed up at the Center for Asbestos Related Disease (CARD) between 2000 and 2010. There were 203 deaths of patients with sufficient records and radiographs. Best clinical and radiologic evidence was used to determine the cause of death, which was compared with death certificates.
RESULTS
Asbestos-related mortality was 55% (n = 112) in this series of 203 patients. Of the 203 deaths, 34 (17%) were from asbestos-related malignancy, 75 (37%) were from parenchymal asbestosis, often with pleural fibrosis, and 3 (1.5%) were from respiratory failure secondary to pleural thickening.
CONCLUSIONS
Asbestos is the leading cause of mortality following both occupational and nonoccupational exposure to LA in those with asbestos-related disease.
Topics: Asbestos; Asbestos, Amphibole; Asbestosis; Humans; Montana; Pleural Diseases
PubMed: 34961951
DOI: 10.1002/ajim.23320 -
Pulmonary Medicine 2018Clinical pathways are evidence based multidisciplinary team approaches to optimize patient care. Pleural diseases are common and accounted for 3.4 billion US $ in 2014... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVES
Clinical pathways are evidence based multidisciplinary team approaches to optimize patient care. Pleural diseases are common and accounted for 3.4 billion US $ in 2014 US inpatient aggregate charges (HCUPnet data). An institutional clinical pathway ("pleural pathway") was implemented in conjunction with a dedicated pleural service. Design, implementation, and outcomes of the pleural pathway (from August 1, 2014, to July 31, 2015) in comparison to a previous era (from August 1, 2013, to July 31, 2014) are described.
METHODS
Tuality Healthcare is a 215-bed community healthcare system in Hillsboro, OR, USA. With the objective of standardizing pleural disease care, locally adapted British Thoracic Society guidelines and a centralized pleural service were implemented in the era. System-wide consensus regarding institutional guidelines for care of pleural disease was achieved. Preimplementation activities included training, acquisition of ultrasound equipment, and system-wide education. An audit database was set up with the intent of prospective audits. An administrative database was used for harvesting outcomes data and comparing them with the era.
RESULTS
54 unique consults were performed. A total of 55 ultrasound examinations and 60 pleural procedures were performed. All-cause inpatient pleural admissions were lower in the "pathway" era ( = 9) compared to the "prior to pathway" era ( = 17). Gains in average case charges (21,737$ versus 18,818.2$/case) and average length of stay (3.65 versus 2.78 days/case) were seen in the "pathway" era.
CONCLUSION
A "pleural pathway" and a centralized pleural service are associated with reduction in case charges, inpatient admissions, and length of stay for pleural conditions.
Topics: Aged; Critical Pathways; Female; Humans; Length of Stay; Male; Middle Aged; Pleural Diseases; Retrospective Studies; Treatment Outcome
PubMed: 29805807
DOI: 10.1155/2018/2035248 -
Respirology (Carlton, Vic.) Feb 2021
Topics: Humans; Lasers; Pleura; Pleural Neoplasms; Thoracoscopy
PubMed: 33251664
DOI: 10.1111/resp.13982 -
PloS One 2022Pleural mesothelial cells are the predominant cell type in the pleural cavity, but their role in the pathogenesis of pleural diseases needs to be further elucidated. 3D...
Pleural mesothelial cells are the predominant cell type in the pleural cavity, but their role in the pathogenesis of pleural diseases needs to be further elucidated. 3D organotypic models are an encouraging approach for an in vivo understanding of molecular disease development. The aim of the present study was to develop a 3D organotypic model of the pleural mesothelium. Specimens of human pleura parietalis were obtained from patients undergoing surgery at the University Hospital Leipzig, Germany. 3D co-culture model of pleura was established from human pleural mesothelial cells and fibroblasts. The model was compared to human pleura tissue by phase-contrast and light microscopy, immunochemistry and -fluorescence as well as solute permeation test. Histological assessment of the 3D co-culture model displayed the presence of both cell types mimicking the morphology of the human pleura. Vimentin and Cytokeratin, PHD1 showed a similar expression pattern in pleural biopsies and 3D model. Expression of Ki-67 indicates the presence of proliferating cells. Tight junctional marker ZO-1 was found localized at contact zones between mesothelial cells. Each of these markers were expressed in both the 3D co-culture model and human biopsies. Permeability of 3D organotypic co-culture model of pleura was found to be higher for 70 kDa-Dextran and no significant difference was seen in the permeability for small dextran (4 kDa). In summary, the presented 3D organoid of pleura functions as a robust assay for pleural research serving as a precise reproduction of the in vivo morphology and microenvironment.
Topics: Humans; Pleura; Coculture Techniques; Dextrans; Pleural Diseases; Pleural Cavity
PubMed: 36454800
DOI: 10.1371/journal.pone.0276978 -
BioMed Research International 2017Although by definition rheumatoid arthritis (RA) is an articular disorder, it is a systemic disease, and 18-40% of patients experience extra-articular manifestations... (Review)
Review
Although by definition rheumatoid arthritis (RA) is an articular disorder, it is a systemic disease, and 18-40% of patients experience extra-articular manifestations (EAMs). The involvement of the respiratory system occurs in about 30-40% of RA patients, and in about 10-20% of them it represents the first manifestation of RA. A wide range of pulmonary manifestations are detectable in RA patients, including pulmonary parenchymal disease, pleural involvement, and airway and pulmonary inflammation. The clinical, radiological, and histological spectra of respiratory manifestations in RA reflect chronic immune activation, increased susceptibility to infection (often related to immunosuppressive medications), or direct drug. The type and severity of pulmonary involvement influence the prognosis, ranging from mild self-limiting conditions to severe life-threatening complications. Herein, we reviewed the various manifestations of respiratory involvement in RA, providing an overview on epidemiological, histological, clinical, and radiological data.
Topics: Arthritis, Rheumatoid; Humans; Lung Diseases; Pleural Diseases; Pneumonia; Respiratory System
PubMed: 29238722
DOI: 10.1155/2017/7915340 -
Respirology (Carlton, Vic.) Feb 2019
Topics: Bacteriology; Empyema, Pleural; Humans; Pleural Diseases; Western Australia
PubMed: 30536720
DOI: 10.1111/resp.13455 -
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 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 -
Proceedings of the American Thoracic... May 2010Nanotechnology holds the promise of revolutionizing our society, bringing numerous beneficial innovations to improve structural materials, electronics, energy, medical... (Review)
Review
Nanotechnology holds the promise of revolutionizing our society, bringing numerous beneficial innovations to improve structural materials, electronics, energy, medical imaging, and drug delivery, among other applications. However, nanomaterials present potential safety concerns, and there is accumulating evidence to suggest that nanoparticles may exert adverse effects on the lung and other organ systems. This article will overview the potential risks of engineered nanoparticles and nanotechnology on the respiratory system and highlight recent findings related to pulmonary and systemic effects of inhaled nanoparticles. Special emphasis will be given to carbon nanotubes and the possibility that these nanoparticles could represent an emerging risk for environmental and occupational lung disease, especially in individuals with pre-existing respiratory diseases such as asthma.
Topics: Asthma; Humans; Inhalation Exposure; Lung Diseases, Interstitial; Nanoparticles; Nanotechnology; Pleural Diseases
PubMed: 20427587
DOI: 10.1513/pats.200907-061RM