-
Respirology (Carlton, Vic.) Mar 2020
Topics: Humans; Lung; Observer Variation; Pleural Effusion, Malignant; Pleurodesis; Prognosis; Talc
PubMed: 31625223
DOI: 10.1111/resp.13718 -
Monaldi Archives For Chest Disease =... Jun 2013Malignant pleural effusion and persistent and/or recurrent spontaneous pneumothorax are clinical entities requiring pleurodesis to avoid the accumulation of liquid and... (Review)
Review
Malignant pleural effusion and persistent and/or recurrent spontaneous pneumothorax are clinical entities requiring pleurodesis to avoid the accumulation of liquid and air, respectively. The objectives are to alleviate symptoms (dyspnea, pain and cough), decrease prolonged air leak, avoid recurrence and improve quality of life. Chemical pleurodesis utilizes chemical irritants. The most common of these is "talc" because of its efficiency and its success in lowering the rate of recurrence. Its main indication is in the palliative treatment of malignant pleural effusion. Other substances less frequently used because they are rarely used currently or under study are cytostatics, antibiotics, antiseptics and autologous blood. Surgical pleurodesis with mechanical abrasion by videothoracoscopy is indicated primarily in the treatment of spontaneous pneumothorax because it is highly efficient, easy to carry out, and has low morbidity when compared to pleurectomy. Using pleurodesis in benign effusion is highly controversial. Its principal indications are hepatic hydrothorax, chylothorax, and cardiac effusion that does not respond to medical treatment. Plasma determinations of systemic inflammatory markers and thoracic ultrasound studies can evaluate the efficacy of pleurodesis. We do not recommend the use of non-steroidal anti-inflammatory drugs in the postoperative period to avoid the possibility of interfering with hemostasis or the formation of adherences.
Topics: Humans; Pleural Effusion; Pleurodesis; Pneumothorax
PubMed: 24354096
DOI: 10.4081/monaldi.2013.96 -
Supportive Care in Cancer : Official... Nov 2020Many patients diagnosed with advanced cancer have malignant pleural effusion that does not respond to chemotherapy or radiation therapy. These patients often have...
PURPOSE
Many patients diagnosed with advanced cancer have malignant pleural effusion that does not respond to chemotherapy or radiation therapy. These patients often have respiratory symptoms, especially dyspnea. In order to relieve these symptoms, various procedures including chemical pleurodesis have been performed. Although talc is the most widely used and effective sclerosing agent, there it has various adverse effects. The objective of this study was to determine whether Viscum (ABNOVA Viscum® Fraxini Injection, manufactured by ABNOVA GmbH, Germany) could be used as an agent to replace talc in clinical practice.
METHODS
Data of 56 patients with malignant pleural effusion who received chemical pleurodesis after tube thoracostomy from January 2003 to December 2017 were retrospectively reviewed to analyze clinical course and response after pleurodesis with each agent.
RESULTS
After pleurodesis, changes in numeric rating scale (NRS) was 1.4 ± 1.6 in the talc group and 0.5 ± 1.5 in the Viscum group (p = 0.108). Changes in white blood cell counts after pleurodesis were 4154.8 ± 6710.7 in the talc group and 3487.3 ± 6067.7 in the Viscum group (p = 0.702). Changes in C-reactive protein (CRP) were 9.03 ± 6.86 in the talc group and 6.3 ± 7.5 in the Viscum group (p = 0.366). The success rate of pleurodesis was 93.3% in the talc group and 96% in the Viscum group (p = 0.225).
CONCLUSION
Viscum pleurodesis showed comparable treatment results with talc pleurodesis while its adverse effects such as chest pain and fever tended to be relatively weak.
Topics: Adult; Aged; Chest Tubes; Dyspnea; Female; Germany; Humans; Male; Middle Aged; Neoplasms; Plant Extracts; Pleural Effusion, Malignant; Pleurodesis; Retrospective Studies; Talc; Treatment Outcome; Viscum
PubMed: 32166382
DOI: 10.1007/s00520-020-05405-0 -
Respiratory Medicine May 2022Roughly 150,000 malignant pleural effusions (MPE) are diagnosed in the United States each year. The majority of cases are caused by lung and breast cancer, and since MPE... (Review)
Review
Roughly 150,000 malignant pleural effusions (MPE) are diagnosed in the United States each year. The majority of cases are caused by lung and breast cancer, and since MPE represents advanced disease, the prognosis is generally poor. In this article we review the pathophysiology, epidemiology, and prognosis of MPE. We then discuss the approach to diagnosis of MPE including the role of imaging, pleural fluid analysis, and medical thoracoscopy. Current management strategies for symptomatic MPE include repeated thoracentesis for patients with very limited life expectancy as well as more definitive procedures such as chemical pleurodesis, tunneled indwelling pleural catheters, and novel combined approaches. The choice of intervention is guided by the efficacy, local expertise, and risk, as well as patient factors and preferences.
Topics: Drainage; Humans; Pleural Effusion, Malignant; Pleurodesis; Thoracentesis; Thoracoscopy
PubMed: 35287006
DOI: 10.1016/j.rmed.2022.106802 -
Expert Review of Respiratory Medicine Jul 2018Lung cancer is the leading cause of cancer-related deaths in the United States. Nearly 85% of all lung cancers are diagnosed at a late stage, with an associated... (Review)
Review
Lung cancer is the leading cause of cancer-related deaths in the United States. Nearly 85% of all lung cancers are diagnosed at a late stage, with an associated five-year survival rate of 4%. Malignant central airway obstruction and malignant pleural effusions occur in upwards of 30% of these patients. Many of these patients are in need of palliative interventions for symptom control and to help improve their quality of life. Areas covered: This review covers the treatment modalities of malignant central airway obstruction and malignant pleural effusion. PubMed was used to search for the most up to date and clinically relevant articles that guide current treatment strategies. This review focuses on rigid bronchoscopy and the tools used for the relief of central airway obstruction, as well as intra-pleural catheter use and pleurodesis for the management of malignant pleural effusions. Expert commentary: There are multiple treatment modalities that may be used to help alleviate the symptoms of malignant central airway obstruction and pleural effusion. The modality used depends on the urgency of the situation, and specific patient's goals. An open dialog to understand the patient's end of life goals is an important factor when choosing the appropriate treatment strategy.
Topics: Airway Obstruction; Argon Plasma Coagulation; Bronchoscopy; Catheters, Indwelling; Cryosurgery; Dilatation; Dyspnea; Electrocoagulation; Humans; Laser Therapy; Lung Neoplasms; Palliative Care; Photochemotherapy; Pleural Effusion, Malignant; Pleurodesis; Radiotherapy; Stents; Thoracentesis
PubMed: 29883216
DOI: 10.1080/17476348.2018.1486709 -
Thoracic Surgery Clinics Feb 2017There is scant evidence on the management of chest tubes after surgery for pneumothorax. Most of the current knowledge is extrapolated from studies performed on subjects... (Review)
Review
There is scant evidence on the management of chest tubes after surgery for pneumothorax. Most of the current knowledge is extrapolated from studies performed on subjects with lung cancer. This article reviews the existing literature with particular focus on the effect of suction and no suction on the duration of air leak after lung resection and surgery for pneumothorax. Moreover, the role of regulated suction, which seems to provide some benefit in reducing pneumothorax recurrence after bullectomy and pleurodesis, is discussed. Finally, a personal view on the management of chest tubes after surgery for pneumothorax is provided.
Topics: Chest Tubes; Humans; Lung; Pleurodesis; Pneumothorax; Postoperative Care; Suction
PubMed: 27865323
DOI: 10.1016/j.thorsurg.2016.08.004 -
Experimental and Clinical... Nov 2015The Spanish congress of the European association of pulmonologists and thoracic surgeons, held in 2009, confirmed the international classification of spontaneous...
The Spanish congress of the European association of pulmonologists and thoracic surgeons, held in 2009, confirmed the international classification of spontaneous pneumothorax in which catamenial (menstrual) pneumothorax was identified. Different from usual pneumothorax, its reason is not because of bleb disease in the lungs, but rather, caused by menstrual cycle in women. The cause was partly studied and explained by several theories. By the first of them, congenital defects (holes, fenestrations) in the diaphragm allow air to get into pleural space because of increased permeability of the fallopian tubes during menstruation. The second hypothesis, the same mechanism is considered, but it has been supposed that a hole in the diaphragm can be caused by endometriosis. The third theory, endometriosis of a pulmonary parenchyma can create leak of air during menstruation. The fourth theory, significance is attached to production of F2 prostaglandin, which is a powerful broncho- and vasoconstriction agent, causing ruptures of alveoli in women in the period of the woman's menstrual cycle. Two groups of patients were identified: with a defect in the diaphragm and without. Existence of such defects is described in 50% of cases. Having a wide clinical experience in the field of thoracic surgery, we, for the first time in practice, diagnosed catamenial pneumothorax in patients with the recurrence course of the disease.
Topics: Adult; Female; Humans; Menstrual Cycle; Pleurodesis; Pneumothorax; Predictive Value of Tests; Radiography; Recurrence; Talc; Thoracotomy; Treatment Outcome; Video-Assisted Surgery
PubMed: 26640936
DOI: 10.6002/ect.tdtd2015.P77 -
Therapeutic Advances in Respiratory... 2018Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a... (Review)
Review
Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a high degree of variability in the management thereof. We aimed to provide practicing clinicians with an overview of the current evidence on the management of MPE, preferentially focusing on studies that report patient-related outcomes rather than pleurodesis alone, and to provide guidance on how to approach individual cases. A pleural intervention for MPE will perforce be palliative in nature. A therapeutic thoracentesis provides immediate relief for most. It can be repeated, especially in patients with a slow rate of recurrence and a short anticipated survival. Definitive interventions, individualized according the patient's wishes, performance status, prognosis and other considerations (including the ability of the lung to expand) should be offered to the remainder of patients. Chemical pleurodesis (achieved via intercostal drain or pleuroscopy) and indwelling pleural catheter (IPC) have equal impact on patient-based outcomes, although patients treated with IPC spend less time in hospital and have less need for repeat pleural drainage interventions. Talc slurry via IPC is an attractive recently validated option for patients who do not have a nonexpandable lung.
Topics: Drainage; Humans; Palliative Care; Pleural Effusion, Malignant; Pleurodesis; Recurrence; Retreatment; Risk Factors; Thoracentesis; Treatment Outcome
PubMed: 29952251
DOI: 10.1177/1753466618785098 -
Revista Portuguesa de Pneumologia 2004Pleurodesis is a way of inducting an inflammatory process in the pleural surface in order to create the closure of the pleural space. The exact mechanism isn't... (Review)
Review
Pleurodesis is a way of inducting an inflammatory process in the pleural surface in order to create the closure of the pleural space. The exact mechanism isn't completely understood and there is still a great deal of controversy concerning pleurodesis. Pleurodesis can be achieved by introduction of a sclerosant agent trough a chest tube into the pleural space, by medical thoracoscopy, by surgical thoracoscopy or by thoracotomy. The principal sclerosant agents are talc and tetracycline. The indications for pleurodesis are malignant recurrent pleural effusion, primary recurrent pneumothorax, secondary pneumothorax and benign pleural effusion resistant to medical treatment. There are, although, some contraindications to performing it. Serious complications of pleurodesis are rare and depend on the technique and agent used. The method of choice for pleurodesis is related to the experience and technical facilities available. The author presents a review about pleurodesis.
Topics: Humans; Pleural Effusion; Pleurodesis; Pneumothorax; Sclerosing Solutions
PubMed: 15492876
DOI: 10.1016/s0873-2159(15)30588-2 -
Respiratory Research Jan 2024Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality and elevated costs to... (Review)
Review
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality and elevated costs to healthcare systems. Over the last decades the understanding of pathophysiology mechanisms, diagnostic techniques and optimal treatment intervention in MPE have been greatly advanced by recent high-quality research, leading to an ever less invasive diagnostic approach and more personalized management. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. In the next future, because of a better understanding of underlying tumor biology together with more sensitive molecular diagnostic techniques, it is likely that combined diagnostic and therapeutic procedures allowing near total outpatient management of MPE will become popular. This article provides a review of the current advances, new discoveries and future directions in the pathophysiology, diagnosis and management of MPE.
Topics: Humans; Pleural Effusion, Malignant; Pleurodesis; Talc; Catheters, Indwelling; Drainage
PubMed: 38243259
DOI: 10.1186/s12931-024-02684-7