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Annals of Translational Medicine Oct 2019To introduce a modified pleurodesis as an effective treatment for refractory chylothorax and to develop a novel insight for its mechanism.
BACKGROUND
To introduce a modified pleurodesis as an effective treatment for refractory chylothorax and to develop a novel insight for its mechanism.
METHODS
Patients who underwent thoracic surgery at West China Hospital or its affiliated hospitals between 2010 and 2015 and who subsequently experienced chylothorax that was not resolved by conventional treatment, received daily pleurodesis involving 100 mL 50% glucose and 20 mL 1% lidocaine. The chest tube was clamped after 7 days of pleurodesis, regardless of drainage amount. If no remarkable pulmonary atelectasis was detected within 2 days, the chest tube was removed. All patients were followed up with for at least 3 months after discharge from our hospital.
RESULTS
Among the 34 patients, 10 did not experience an increase in the pleural fluid after the chest tube was clamped. Minor effusion increase occurred in 21 patients, while encapsulated effusion occurred in 3. In 23 patients among the latter 24 patients, pleural fluid was gradually absorbed and disappeared spontaneously. One patient suffered chylothorax recurrence after discharge but successfully recovered after the second round of modified pleurodesis. Several patients suffered from electrolyte imbalance, weakness, and dyspnea; all were cured by plasma infusion and other symptomatic treatments.
CONCLUSIONS
Being safe and effective for patients with postoperative refractory chylothorax, our modified pleurodesis enhanced the process of chemical pleurodesis and could remove the chest tube right after the extensive adhesion formed instead requiring a wait for drainage decrease. This method can thus shorten the period of hospitalization and reduce fluid loss compared with traditional pleurodesis.
PubMed: 31807531
DOI: 10.21037/atm.2019.09.87 -
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 Medicine Nov 2006The search for an 'ideal' agent for pleurodesis continues. Iodopovidone is a topical antiseptic and has been shown to be safe and effective in many studies. The aim of... (Meta-Analysis)
Meta-Analysis Review
The search for an 'ideal' agent for pleurodesis continues. Iodopovidone is a topical antiseptic and has been shown to be safe and effective in many studies. The aim of this study was to evaluate the efficacy and safety of iodopovidone as an agent for chemical pleurodesis. We performed a systematic review of all the observational trials which have used iodopovidone for chemical pleurodesis. Six studies including 265 patients who had undergone chemical pleurodesis with iodopovidone were included for this analysis. Iodopovidone was used for variety of indications, which included pleural effusion (157 patients), and pneumothorax (108 patients). Pleurodesis was performed through tube thoracostomy in 144 patients and through thoracoscopy in 121 patients. The success rate of pleurodesis varied from 64.2% to 100%, and summary success rate of all the studies was 90.6% (95% confidence intervals [CI], 86.4-93.8). The success rate was independent for the procedure (tube thoracostomy [126/144; 87.5%, 95% CI 80.9-92.4] or thoracoscopy [114/121; 94.2%, 95% CI 88.4-97.6]) used for performing pleurodesis or for the indication (pleural effusion [139/157; 88.5%, 95% CI 82.5-93.1] or pneumothorax [101/108; 93.5%, 95% CI 87.1-97.4]). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in three patients in only one study. There were no deaths related to chemical pleurodesis with iodopovidone. Overall, this review supports the safety and efficacy of iodopovidone as an agent for chemical pleurodesis in cases of recurrent pleural effusions and pneumothoraces regardless of their etiology.
Topics: Anti-Infective Agents, Local; Chest Pain; Humans; Indoles; Pleural Diseases; Pleural Effusion; Pleurodesis; Pneumothorax; Treatment Outcome
PubMed: 16574389
DOI: 10.1016/j.rmed.2006.02.009 -
Current Opinion in Pulmonary Medicine Jul 2018Pleural effusions in patients with hematologic malignancy may represent malignant pleural effusion (MPE) or occur secondary to infection, treatment effects, and other... (Review)
Review
PURPOSE OF REVIEW
Pleural effusions in patients with hematologic malignancy may represent malignant pleural effusion (MPE) or occur secondary to infection, treatment effects, and other common causes. The impact of MPE on prognosis in this cohort remains unclear. Indwelling pleural catheters (IPCs) are routinely placed for palliation of recurrent symptomatic MPEs, but perceived concerns over infection and bleeding may limit their use in patients with hematologic malignancies. However, recent evidence suggests IPCs are both well tolerated and effective in this cohort. In this review, the evaluation of pleural effusions in hematologic malignancies and their management with an IPC are outlined.
RECENT FINDINGS
Two retrospective studies have been published regarding the use of IPCs in hematologic malignancies. Lymphomatous effusions are the most common cause of MPE in this cohort. The rates of complications and pleurodesis with IPC in hematologic malignancies are similar to those with solid organ tumors.
SUMMARY
Pleural effusions in patients with hematologic malignancies may be managed safely with an IPC. Sterile technique, barrier protection, standardized algorithms for placement and removal, and quality assurance initiatives are crucial to centers that place IPCs for all patients. The safety of IPC in hematologic malignancies warrants a paradigm shift in the management of pleural disease for this cohort.
Topics: Catheter-Related Infections; Catheters, Indwelling; Chest Tubes; Drainage; Hematologic Neoplasms; Humans; Palliative Care; Pleural Effusion, Malignant; Pleurodesis; Prognosis
PubMed: 29629920
DOI: 10.1097/MCP.0000000000000490 -
Respirology (Carlton, Vic.) Aug 2014The approach to management of malignant pleural effusions (MPE) has changed over the past few decades. The key goals of MPE management are to relieve patient symptoms... (Review)
Review
The approach to management of malignant pleural effusions (MPE) has changed over the past few decades. The key goals of MPE management are to relieve patient symptoms using the least invasive means and in the most cost-effective manner. There is now a realization that patient-reported outcome measures should be the primary goal of MPE treatment, and this now is the focus in most clinical trials. Efforts to minimize patient morbidity are complemented by development of less invasive treatments that have mostly replaced the more aggressive surgical approaches of the past. Therapeutic thoracentesis is simple, effective and generally safe, although its benefits may only be temporary. Pleurodesis is the conventional and for a long time the only definitive therapy available. However, the efficacy and safety of talc pleurodesis has been challenged. Indwelling pleural catheter (IPC) drainage is increasingly accepted worldwide and represents a new concept to improve symptoms without necessarily generating pleural symphysis. Recent studies support the effectiveness of IPC treatment and provide reassurance regarding its safety. An unprecedented number of clinical trials are now underway to improve various aspects of MPE care. However, choosing an optimal intervention for MPE in an individual patient remains a challenge due to our limited understanding of the underlying pathophysiology of breathlessness in MPE and a lack of predictors of survival and pleurodesis outcome. This review provides an overview of common pleural interventional procedures used for MPE management, controversies and limitations of current practice, and areas of research most needed to improve practice in future.
Topics: Catheters, Indwelling; Disease Management; Drainage; Humans; Outcome Assessment, Health Care; Pleural Effusion, Malignant; Pleurodesis; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 24947955
DOI: 10.1111/resp.12328 -
The Journal of Thoracic and... May 2013The objective of this study was to evaluate long-term survival and prognostic factors in patients with malignant pleural mesothelioma.
OBJECTIVE
The objective of this study was to evaluate long-term survival and prognostic factors in patients with malignant pleural mesothelioma.
METHODS
All consecutive patients referred for surgical diagnosis and/or pleurodesis for malignant pleural mesothelioma between 2000 and 2010 were studied. The following parameters were prospectively recorded: age, sex, tobacco consumption, asbestos exposure, type and duration of symptoms, American Society of Anesthesiologists (ASA) score, body mass index, preoperative C-reactive protein levels, white blood cells and platelet count, pachypleuritis on chest radiograph, type of diagnostic surgical procedure, histologic type, modality of pleurodesis, and chemotherapy. Survival was assessed on March 1, 2011.
RESULTS
A total of 170 patients were included. For the entire population, median survival was 12 months (95% confidence interval [CI], 10-15). Two-, 5-, and 7-year overall survival was 26% (95% CI, 19-35), 11% (95% CI, 6-21), and 5% (95% CI, 9-22), respectively. Asbestos exposure, age, ASA class III versus ASA classes I and II, nonepithelioid histology, C-reactive protein levels >3 mg/L, and white cell count >12,000/mm(3) influenced outcome in univariate analysis. Multivariate analysis showed that nonepithelioid histology (hazard ratio [HR], 2.76; 95% CI, 1.50-5.08); age (HR, 1.05; 95% CI, 1.01-1.08); C-reactive protein levels between 4 and 50 mg/L, and >51 (HR, 2.28; 95% CI, 1.18-4.42; and HR, 2.69; CI, 1.29-5.60, respectively); and leukocytosis >12,000/mm(3) (HR, 2.28; 95% CI, 1.22-4.25) were independent worse survival predictors.
CONCLUSIONS
Median survival in an unselected population of patients with malignant pleural mesothelioma treated nonsurgically is 12 months. Nonepithelioid histology, older age, abnormal C-reactive protein levels, and leukocytosis are independent predictors of worse survival.
Topics: Age Factors; Aged; Aged, 80 and over; Biomarkers; Biopsy; C-Reactive Protein; Female; Humans; Kaplan-Meier Estimate; Leukocytosis; Male; Mesothelioma; Middle Aged; Multivariate Analysis; Pleural Neoplasms; Pleurodesis; Predictive Value of Tests; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Thoracic Surgery, Video-Assisted; Time Factors; Treatment Outcome
PubMed: 23072703
DOI: 10.1016/j.jtcvs.2012.09.023 -
Toxicology Reports 2022Pleural effusion, the pathological condition in which an abnormal amount of pleural fluid is accumulated in the small space between the visceral and parietal pleurae of...
Pleural effusion, the pathological condition in which an abnormal amount of pleural fluid is accumulated in the small space between the visceral and parietal pleurae of the lungs, can be treated by pleurodesis, whereby the pleural space is obliterated. This effect can be achieved by chemical pleurodesis utilizing various reagents such as talc, an agent commonly employed in pleurodesis. Zeolites, microporous tectosilicates found in nature as minerals, can be used in a wide range of medical applications. Different zeolite compounds may exhibit variable efficacy and safety profiles, mainly depending on their particle size. In this study, we evaluated the efficacy and safety of zeolite pleurodesis. New Zealand rabbits were administered 400 mg/kg of either agent dissolved in 2 mL of isotonic saline solution by injection into their pleural cavity, and computed tomography images were obtained on postoperative day 26. Euthanization was conducted at the end of 28 days for histopathological evaluation. Furthermore, subacute toxicity and mutagenicity profiles of zeolite were analyzed. Our findings revealed that zeolite was able to induce an adequate inflammatory response to achieve successful pleurodesis. The adhesion profiles were in favor of zeolite when compared to talc pleurodesis. Moreover, none of the tested doses of zeolite induced subacute toxicity or mutagenesis. Collectively, our results suggested zeolite as an effective and safe pleurodesis agent.
PubMed: 36518378
DOI: 10.1016/j.toxrep.2022.09.003 -
Therapeutic Advances in Respiratory... 2019Pleurodesis is often used to prevent the re-accumulation of a malignant pleural effusion (MPE). Intrapleural urokinase (IPUK) therapy facilitates lung re-expansion for... (Comparative Study)
Comparative Study
BACKGROUND
Pleurodesis is often used to prevent the re-accumulation of a malignant pleural effusion (MPE). Intrapleural urokinase (IPUK) therapy facilitates lung re-expansion for patients with loculated MPE or a trapped lung that allows subsequent pleurodesis. MPE management has been traditionally regarded as a symptomatic treatment. We tried to evaluate their impact on patient survival.
METHODS
There were 314 consecutive patients with symptomatic MPE that underwent minocycline pleurodesis with ( n = 109) and without ( n = 205) the antecedent IPUK therapy between September 2005 and August 2015, who were recruited for the pleurodesis outcome and survival analysis.
RESULTS
The rate of successful pleurodesis was similar between the simple pleurodesis group and the IPUK therapy group followed by the pleurodesis group (69.0% versus 70.5%; p = 0.804). The patients who succeeded pleurodesis had a longer survival rate than those who failed in either the simple pleurodesis group (median, 414 versus 100 days; p < 0.001) or the IPUK therapy followed by pleurodesis group (259 versus 102 days; p < 0.001). The survival differences remained when the lung and breast cancer patients were studied separately.
CONCLUSION
Successful pleurodesis translated into a better survival rate that promotes performing pleurodesis on lung re-expansion. The apparent shorter survival of the patients with loculated MPE or trapped lung, and those that did not respond to the IPUK therapy, lowered the probability of the survival benefit through the simple physical barrier by the fibrin formation to prevent the tumor spreading. The successfully induced inflammatory response by minocycline is supposed to prohibit the tumor invasion and metastasis. Further studies are warranted to clarify the mechanism and provide opportunities to develop novel therapeutic strategies.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Female; Humans; Male; Middle Aged; Minocycline; Pleural Effusion, Malignant; Pleurodesis; Retrospective Studies; Survival Rate; Time Factors; Treatment Outcome; Urokinase-Type Plasminogen Activator; Young Adult
PubMed: 30945619
DOI: 10.1177/1753466619841231 -
Tuberculosis and Respiratory Diseases Jan 2021Pleurodesis fails in 10%-40% of patients with recurrent malignant pleural effusions malignant pleural effusion and dyspnea. This study aimed to assess the values of...
BACKGROUND
Pleurodesis fails in 10%-40% of patients with recurrent malignant pleural effusions malignant pleural effusion and dyspnea. This study aimed to assess the values of pleural elastance (PEL) after the aspiration of 500 mL of pleural fluid and their relation to the pleurodesis outcome, and to compare the pleurodesis outcome with the chemical characteristics of pleural fluid.
METHODS
A prospective study was conducted in Kasr El-Aini Hospital, Cairo University, during the period from March 2019 to January 2020. The study population consisted of 40 patients with malignant pleural effusion. The measurement of PEL after the aspiration of 500 mL of fluid was done with "PEL 0.5" (cm H2O/L), and the characteristics of the pleural fluid were chemically and cytologically analyzed. Pleurodesis was done and the patients were evaluated one month later. The PEL values were compared with pleurodesis outcomes.
RESULTS
After 4-week of follow-up, the success rate of pleurodesis was 65%. The PEL 0.5 was significantly higher in failed pleurodesis than it was in successful pleurodesis. A cutoff point of PEL 0.5 >14.5 cm H2O/L was associated with pleurodesis failure with a sensitivity and specificity of 93% and 100%, respectively. The patients with failed pleurodesis had significantly lower pH levels in fluid than those in the successful group (p<0.001).
CONCLUSION
PEL measurement was a significant predictor in differentiating between failed and successful pleurodesis. The increase in acidity of the malignant pleural fluid can be used as a predictor for pleurodesis failure in patients with malignant pleural effusion.
PubMed: 33161689
DOI: 10.4046/trd.2020.0081 -
Deutsches Arzteblatt International May 2013Pleural carcinosis is caused by tumors of the chest (e.g., lung and breast cancer) or elsewhere in the body (e.g., ovarian carcinoma) that metastasize to the visceral... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pleural carcinosis is caused by tumors of the chest (e.g., lung and breast cancer) or elsewhere in the body (e.g., ovarian carcinoma) that metastasize to the visceral and/or parietal pleura. Recurrent malignant pleural effusion due to pleural carcinosis is one of the most common findings in oncology. It affects about 56 000 patients per year in Germany alone.
METHODS
This review is based on pertinent literature retrieved by a selective search of the Medline database (key words: malignant pleural effusion, pleural carcinosis) and on the authors' clinical experience.
RESULTS
Although many retrospective studies have been published, there has been only one randomized controlled trial of treatment, in which permanent pleural catheters were compared with talcum pleurodesis. Patients with pleural carcinosis have a median survival of less than 12 months. Many are suffering from progression of their underlying disease, with generalized tumor involvement; thus, the symptomatic treatment of pain and dyspnea is often the main therapeutic issue. The underlying tumor, usually an adenocarcinoma, can be diagnosed either by histology or by cytology. The main complication is progressive respiratory failure. The treatment is palliative, rather than curative. The main approaches are drainage of the effusion (by thoracocentesis or with permanent pleural catheters) and pleurodesis (obliteration of the pleural space by causing the visceral and parietal pleura to adhere to each other).
CONCLUSION
Pleural carcinosis with symptomatic malignant pleural effusion is treated palliatively. The appropriate treatment in each case should be determined through discussion with the patient, with the goal of improving the patient's quality of life.
Topics: Comorbidity; Drainage; Evidence-Based Medicine; Humans; Palliative Care; Pleural Effusion, Malignant; Pleurodesis; Prevalence; Survival Analysis; Survival Rate; Treatment Outcome
PubMed: 23720697
DOI: 10.3238/arztebl.2013.0313