Volume Of Pleural Effusion Research Articles

Relationship Between the Pleural Effusion and Mean Platelet Volume After Coronary Artery Bypass Graft

Background: A higher mean platelet volume (MPV) can lead to an increase in platelet activation and thrombosis in coronary artery bypass graft (CABG) patients. Therefore, the goal of this study was to demonstrate the relationship between postoperative hemorrhagic pleural effusion (PE) and the MPV in the early postoperative period, after a CABG. Methods: This study was conducted between January 2012 and January 2013. The study population was composed of 85 non-PE patients and 71 PE patients based on the control chest X-rays obtained two weeks after the operation. The PE group was compared with the non-PE group statistically in terms of the clinical, laboratory, and postoperative parameters. Results: The number of males (P = 0.033) and MPV (P < 0.001) were significantly higher in the non-PE group. However, there was no significant difference between the groups in terms of the other clinical, laboratory, and postoperative parameters. The multivariate logistic regression analysis revealed that only a higher MPV was an independent predictor of a lower incidence of postoperative hemorrhagic PE (odds ratio = 0.375, 95% confidence interval = 0.248 - 0.567, P < 0.001). Conclusions: A higher preoperative MPV was independently associated with a lower hemorrhagic PE incidence in patients with CABG during the early postoperative period. As a simple and widely available blood test value, the MPV can help to predict the development of PE in CABG patients postoperatively.

Endoscopic ultrasound-guided transesophageal thoracentesis for minimal pleural effusion.

Pleural effusion is a common finding both in patients with benign and malignant diseases of pleura and lung with diagnostic thoracentesis establishing the diagnosis in the majority of cases. The diagnostic thoracentesis can be done either blindly or under the guidance of ultrasound or computed tomography. However, minimal pleural effusion is difficult to sample even under image guidance. Endoscopic ultrasound (EUS) is known to detect smaller volume of pleural effusion and, thus, can help in guiding thoracentesis. To analyze the safety and efficacy of EUS-guided diagnostic thoracentesis in patients with undiagnosed minimal pleural effusion retrospectively. Retrospective analysis of the data of patients with minimal pleural effusion, who underwent EUS-guided transesophageal diagnostic thoracentesis over last 2years, was performed. Thirteen patients (11 male; mean age 46.7 ± 16.2years) with undiagnosed minimal pleural effusion underwent successful EUS-guided transesophageal diagnostic thoracentesis using a 22-G needle. Seven (53%) patients had fever on presentation whereas two presented with cough and loss of appetite. Eight to 54mL fluid was aspirated with an attempt to completely empty the pleural cavity. There were no complications of the procedure. EUS-guided diagnostic thoracentesis is a safe and effective alternative for evaluating patients with minimal pleural effusion.

Concurrent Versus Sequential Intrapleural Instillation of Tissue Plasminogen Activator and Deoxyribonuclease for Pleural Infection.

Treatment of pleural infection with instillation of sequential intrapleural tissue plasminogen activator (tPA) and human recombinant deoxyribonuclease (DNase) twice daily for a total of 6 doses has been shown to decrease surgical referral and improve radiographic imaging. This labor-intensive regimen was empirically chosen. Thus, it remains unclear whether the 2 drugs can be administered immediately one after the other (concurrent administration) instead of instilling them separately with a 1-hour to 2-hour interval in between (sequential administration). The aim of this study was to compare the efficacy and safety of sequential versus concurrent tPA/DNase therapy in patients with pleural infection. This was a prospective observational study. Consecutive patients with pleural infection who received concurrent and sequential tPA/DNase were included. The initiation and number of doses of tPA/DNase therapy were based on the amount of pleural fluid drainage, clinical response and radiographic findings. A total of 38 patients with pleural infection received tPA/DNase treatment: 18 in the sequential group and 20 in the concurrent group. Treatment was successful in 77.7% in the sequential group and 75% in concurrent group (P=0.57). There was no statistically significant difference between the 2 treatment groups (sequential and concurrent) in median pleural fluid drainage (P=0.45), median volume of pleural effusion estimated on chest computed tomography scan (P=0.4) or median hemithorax occupied by effusion on chest radiography (P=0.83) following intrapleural therapy. One patient required a blood transfusion for gradual pleural blood loss in each treatment group. Pain needing escalation of analgesia affected 3 patients in each arm but none required cessation of therapy. A simpler regimen of concurrent administration of intrapleural tPA/DNase as compared with sequential intrapleural therapy is safe, effective, and represents a viable option for the management of pleural infection.

EVALUATION OF NEW ULTRASOUND METHODS FOR QUANTIFYING THE FLUID IN THE PLEURAL CAVITY

Purpose: to determine accuracy of applying the new quantitative assessment methodology for liquid in the pleural cavity.Materials and methods. The research encompassed 296 patients who underwent surgeries at Federal Center of Cardiovascular Surgery (Penza, Russia) with assisted blood circulation from 2015 to 2017. All the patients had ultrasonic examinations of the pleural cavities that identified the full volume of the liquid component in the pleural cavity, shaped elliptically, with further calculation of the volume with the disk test EDV (Dmax × Lmax × 3.42) – 6.44. The research data was processed with the demo software SPSS Statistics (Statistical Package for the Social Sciences). In order to compare the two methods of assessing the pleural effusionvolume resulting from the pleural puncture, we applied the Bland-Altman comparison method and Pearson correlation coefficient. A difference and a mean difference (M difference) were calculated for each pair of measurements; a standard difference deviation (SD difference) was specified with further verification of the assumption that M difference differed from 0. For this purpose, the sampling mean was compared with the speculative general mean, as tested with Student’s t – distribution.Results. While determining potential connection between the findings of liquidquantity ultrasonic measurement and the actual volume after pleural cavity puncture, the equation of linear regression found a strong linear connection between them with R2 equal to 0.85 p &lt; 0.001). Comparison of the liquid volume by the Bland-Altman method did not find difference in the liquid volume either: all the measurements are within 2SD difference of those parameters, which proves congruity of those methods. When the sampling mean was compared with the speculative general mean, as tested with Student’s t – distribution, no reliable differences (p = 0.52) were identified.Conclusion. Development of this methodology proves to be justified by the fact that there are often cases in the postsurgery cardiosurgical and thoracic practice when the pleural effusion volume should be measured quickly and rather accurately and assessed in dynamics.

Intentional Modulation of Portal Venous Pressure by Splenectomy Saves the Patient with Liver Failure and Portal Hypertension After Major Hepatectomy: Is Delayed Splenectomy an Acceptable Therapeutic Option for Secondary Portal Hypertension?

Patient: Female, 56Final Diagnosis: Secondary portal hypertensionSymptoms: Intractable ascitesMedication: —Clinical Procedure: SplenectomySpecialty: Gastroenterology and HepatologyObjective:Unusual clinical courseBackground:Major or aggressively-extended hepatectomy (MAEH) may cause secondary portal hypertension (PH), and postoperative liver failure (POLF) and is often fatal. Challenges to prevent secondary PH and subsequent POLF, such as shunt creation and splenic arterial ligation, have been reported. However, these procedures have been performed simultaneously only during the initial MAEH.Case Report:A 58-year-old female with chronic hepatitis C developed a solitary hepatic cellular carcinoma with portal tumor thrombosis. Blood examination and imaging revealed a decreased platelet count and splenomegaly. Her liver viability was preserved, and collaterals did not develop, and her tumor thrombosis forced us to perform a right hepatectomy from an oncological standpoint. The estimated volume of her liver remnant was 51.8%. A large volume of ascites and pleural effusion were observed on post-operative day (POD) 3, and ascetic infection occurred on POD 14. Hepatic encephalopathy was observed on POD 16. According to the post-operative development of collaterals due to secondary PH, submucosal bleeding in the stomach occurred on POD 37. Though it is unclear whether delayed portal venous pressure (PVP) modulation after MAEH is effective, a therapeutic strategy for recovery from POLF may involve PVP modulation to resolve intractable PH. We performed a splenectomy on POD 41 to reduce PVP. The initial PVP value was 32 mm Hg, and splenectomy decreased PVP to 23 mm Hg. Thereafter, she had a complete recovery from POLF.Conclusions:Our thought-provoking case is the first successfully-treated case of secondary PH and POLF after MAEH, achieved by delayed splenectomy for PVP modulation.

A novel approach for preventing recurrence of malign pleural effusion: early phase pleurodesis.

IntroductionThe effective control of malignant pleural effusion (MPE) is of paramount importance in the treatment of patients with disseminated cancer. In this study, we compared two different approaches (early pleurodesis versus late pleurodesis) to MPE.Material and methodsPatients (188 cases) whose primary tumor type was known and who were confirmed to have MPE, were included in the study and were separated into two groups. One group consisted of patients who were asymptomatic and who underwent early phase pleurodesis (group I, n = 79). The other group (group II, n = 109) was composed of patients who were symptomatic and whose pleurodesis was performed later. In all cases, pleural effusion was evaluated by means of direct radiography. Computed tomography was performed with the goal of confirming the parenchymal or mediastinal lesions accompanying the pleural fluid.ResultsThe rate of complete success in group I cases was observed to be higher, while the rate of recurrence was lower (p = 0.001 and p = 0.002, respectively) than group II. In multiple logistic regression analysis, co-morbidities and the group that patient belong were found to be significant in terms of pleurodesis success (p = 0.02 and p = 0.03). There was a significant difference in survival time between group I and group II, with group I exhibiting longer average survival time (log rank test p < 0.001).ConclusionsWe observed that the success rate was lower and the rate of recurrence higher in the late pleurodesis group, whose members already had greater volumes of pleural effusion.

Validation of equations for pleural effusion volume estimation by ultrasonography.

To validate the accuracy of previously published equations that estimate pleural effusion volume using ultrasonography. Only equations using simple measurements were tested. Three measurements were taken at the posterior axillary line for each case with effusion: lateral height of effusion (H), distance between collapsed lung and chest wall (C) and distance between lung and diaphragm (D). Cases whose effusion was aspirated to dryness were included and drained volume was recorded. Intra-class correlation coefficient (ICC) was used to determine the predictive accuracy of five equations against the actual volume of aspirated effusion. 46 cases with effusion were included. The most accurate equation in predicting effusion volume was (H+D)×70 (ICC 0.83). The simplest and yet accurate equation was H×100 (ICC 0.79). Pleural effusion height measured by ultrasonography gives a reasonable estimate of effusion volume. Incorporating distance between lung base and diaphragm into estimation improves accuracy from 79% with the first method to 83% with the latter.

Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer.

The risk factors and potential practice implications of radiation-induced pleural effusion (RIPE) are undefined. This study examined lung cancer patients treated with thoracic radiation therapy (TRT) having follow-up computed tomography (CT) or 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Increased volumes of pleural effusion after TRT without evidence of tumor progression was considered RIPE. Parameters of lung dose-volume histogram including percent volumes irradiated with 5-55 Gy (V5-V55) and mean lung dose (MLD) were analyzed by receiver operating characteristic analysis. Clinical and treatment-related risk factors were detected by univariate and multivariate analyses. 175 out of 806 patients receiving TRT with post-treatment imaging were included. 51 patients (24.9%) developed RIPE; 40 had symptomatic RIPE including chest pain (47.1%), cough (23.5%) and dyspnea (35.3%). Female (OR = 0.380, 95% CI: 0.156–0.926, p = 0.033) and Caucasian race (OR = 3.519, 95% CI: 1.327–9.336, p = 0.011) were significantly associated with lower risk of RIPE. Stage and concurrent chemotherapy had borderline significance (OR = 1.665, p = 0.069 and OR = 2.580, p = 0.080, respectively) for RIPE. Patients with RIPE had significantly higher whole lung V5-V40, V50 and MLD. V5 remained as a significant predictive factor for RIPE and symptomatic RIPE (p = 0.007 and 0.022) after adjusting for race, gender and histology. To include, the incidence of RIPE is notable. Whole lung V5 appeared to be the most significant independent risk factor for symptomatic RIPE.

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

Prolonged air leak and high-volume pleural drainage are the most common causes for delays in chest tube removal following lung resection. While digital pleural drainage systems have been successfully used in the management of post-operative air leak, their effect on pleural drainage and inflammation has not been studied before. We hypothesized that digital drainage systems (as compared to traditional analog continuous suction), using intermittent balanced suction, are associated with decreased pleural inflammation and postoperative drainage volumes, thus leading to earlier chest tube removal. One hundred and three [103] patients were enrolled and randomized to either analog (n=50) or digital (n=53) drainage systems following oncologic lung resection. Chest tubes were removed according to standardized, pre-defined protocol. Inflammatory mediators [interleukin-1B (IL-1B), 6, 8, tumour necrosis factor-alpha (TNF-α)] in pleural fluid and serum were measured and analysed. The primary outcome of interest was the difference in total volume of postoperative fluid drainage. Secondary outcome measures included duration of chest tube in-situ, prolonged air-leak incidence, length of hospital stay and the correlation between pleural effusion formation, degree of inflammation and type of drainage system used. There was no significant difference in total amount of fluid drained or length of hospital stay between the two groups. A trend for shorter chest tube duration was found with the digital system when compared to the analog (P=0.055). Comparison of inflammatory mediator levels revealed no significant differences between digital and analog drainage systems. The incidence of prolonged post-operative air leak was significantly higher when using the analog system (9 versus 2 patients; P=0.025). Lobectomy was associated with longer chest tube duration (P=0.001) and increased fluid drainage when compared to sub-lobar resection (P<0.001), regardless of drainage system. Use of post-lung resection digital drainage does not appear to decrease pleural fluid formation, but is associated with decreased prolonged air leaks. Total pleural effusion volumes did not differ with the type of drainage system used. These findings support previously established benefits of the digital system in decreasing prolonged air leaks, but the advantages do not appear to extend to decreased pleural fluid formation.

Ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome

To explore the value of ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome. Methods: A total of 34 patients with liver tumors located at diaphragmatic dome in Hunan Provincial Tumor Hospital were recruited from January 2014 to October 2015. The number of lesions ≤3 or lesion diameter ≤5 cm was in line with the microwave ablation indications. B ultrasound-guided microwave ablation for the liver tumors was undertaken after the artificial pleural effusion being established. 3-4 weeks later after the microwave ablation, all patients were imaged with enhance CT or MRI. The effect of ablation and the complications were evaluated. Results: There were 49 lesions in 34 patients, including 30 cases (88.2%) of complete ablation (CA), 3 cases (8.8%) of partial ablation (PA) and one case with new lesions after ablation (2.9%). Thirty-four patients had (1 580±230.7) mL of pleural effusion volume, while one case had bloody pleural effusion. One case had a diaphragmatic thermal injury, and one case had a biliary tumor infection. All of them showed remission after symptomatic treatment. Conclusion: Combination of ultrasound-guided microwave ablation with artificial pleural effusion is a safe and effective therapy for liver tumor adjacent to diaphragmatic dome.

Effect of Ultrasound-Guided Thoracocentesis on Clinical and Physiological Outcomes in Mechanically Ventilated Patients

Background: Pleural effusions are common in critically ill patients, causes are multifactorial. Mechanical ventilation and critical illness lead to disturbance of the normal physiological processes which regulate pleural fluid homeostasis. Ultrasound can detect small volume of pleural effusion up to 20 mL. Aim of the work: We investigated the influence of large pleural effusion drainage on oxygenation, hemodynamics, and respiratory mechanics in mechanically ventilated patients. Methodology: We performed a prospective observational study on 65 mechanically ventilated patients examining the effects of large pleural fluid drainage on oxygenation; PaO2/FiO2 and Respiratory mechanics; peak inspiratory pressures, plateau pressures, dynamic compliance and total PEEP. Hemodynamics and complications also recorded at baseline, 6 h and 24 h after drainage. Results: Among 65 patients, the mean volume of effusion drained was (1868 ± 640) ml at 24 h. Uncomplicated pneumothorax occurred in two patients. When compared baseline; 6 h and 24 h after drainage,PaO2/FiO2 ratio significantly improved (196.69 ± 34.27, 227.02 ± 35.81, 269.78 ± 48.39; p<0.001), with a decrease in peak inspiratory pressure (38.23 ± 5.71, 34.14 ± 4.70, 29.89 ± 4.58 cm H2O, p<0.001) and plateau pressures (21.06 ± 3.47, 18.77 ± 3.17, 15.49 ± 2.91 cm H2O, p<0.001) and a large increase in dynamic compliance (17.48 ± 4.12, 21.79 ± 4.47, 26.77 ± 4.94 ml/cm H2O, p<0.001). Hemodynamics were not changed by drainage apart from respiratory rate which decreased significantly (19.4 ± 5.5, 17.4 ± 5, 16.5 ± 6.8 breaths/min, P=0.019). Conclusions: Ultrasound pleural effusion drainage in mechanically ventilated patients is safe. It appears to ameliorate oxygenation and respiratory mechanics and reducing the respiratory rate without affecting hemodynamics.

Quantification and characterization of pleural fluid in healthy dogs with thoracostomy tubes.

OBJECTIVE To quantify and characterize pleural fluid collected from healthy dogs after placement of a thoracostomy tube (TT). ANIMALS 8 healthy Coonhound-cross dogs (mean ± SD weight, 27.2 ± 1.6 kg). PROCEDURES Thoracic CT of each dog was performed before placement of a TT and daily thereafter for 7 days. Thoracic fluid volume was calculated from CT images. Effusion was aspirated when detected; volume was recorded, and cytologic analysis and bacterial culture were performed. RESULTS Mean ± SD volume of pleural effusion detected by CT was 1.43 ± 0.59 mL/kg (range, 0.12 to 3.32 mL/kg). Mean volume collected via aspiration was 0.48 ± 0.84 mL/kg (range, 0 to 2.16 mL/kg). Cytologic analysis yielded results consistent with an exudate, characterized by septic suppurative inflammation in 6 dogs and mixed inflammation in 1 dog; there was insufficient volume for analysis in 1 dog. Sufficient volume was obtained for bacterial culture for 6 dogs, which yielded pure growths of Staphylococcus pseudintermedius (n = 3) and Streptococcus equi subspecies zooepidemicus (2) and mixed growth of both of these species (1). The TT was removed before day 7 in 4 dogs because of pyothorax (n = 3) and irreversible damage to the TT (1). CONCLUSIONS AND CLINICAL RELEVANCE Presence of a TT induced a minimal volume of pleural effusion in healthy dogs. Pyothorax developed in most dogs between 4 and 6 days after TT placement. On the basis of these findings, a TT should be removed by the fourth day after placement, unless complications are detected sooner.

Role of MCP-1 in pleural effusion development in a carrageenan-induced murine model of pleurisy.

Exudative pleural effusions affect over 1500 patients per million population each year. The pathobiology of pleural exudate formation remains unclear. Our recent study revealed monocyte chemotactic protein-1 (MCP-1) as a key driver of fibrinolytic-induced exudate effusion while another study found a role for MCP-1 in malignant effusion formation. In the present study, we further evaluated the role of MCP-1 in the development of pleural effusion in a mouse model of acute pleural inflammation. λ-Carrageenan (CAR) was injected into the pleural cavity of CD1 mice and pleural effusion volume measured up to 16 h post-injection. Pleural effusion and serum protein and MCP-1 concentrations were measured and differential cell counts performed in fluids. Mice were also treated with either intraperitoneal (i) anti-MCP-1 antibody or isotype control or (ii) an MCP-1 receptor (CCR2) antagonist or vehicle control 12 h prior to and at the time of CAR injection. Intrapleural CAR induced significant pleural fluid accumulation (300.0 ± 49.9 μL) in mice after 4 h. Pleural fluid MCP-1 concentrations were significantly higher than corresponding serum MCP-1 (144 603 ± 23 204 pg/mL vs 3703 ± 801 pg/mL, P < 0.0001). A significant decrease in pleural fluid formation was seen both with anti-MCP-1 antibody (median (interquartile range, IQR): 36 (0-168) μL vs controls 290 (70-436) μL; P = 0.02) or CCR2 antagonist (153 (30-222) μL vs controls 240 (151-331) μL, P = 0.0049). Blockade of MCP-1 activity significantly reduced inflammatory pleural effusion formation in a CAR model. Together with recent successes in MCP-1 blockade in other effusion formation models, our data strongly support clinical evaluation of MCP-1 antagonists as a novel approach to pleural fluid management.

Chloroquine inhibits tumor growth and angiogenesis in malignant pleural effusion.

Malignant pleural effusion (MPE) is associated with a poor prognosis in lung cancer. Currently, no effective cure exists for MPE. Chloroquine (CQ) has been demonstrated to induce vascular normalization and inhibit tumor growth. The aim of this study was to assess whether CQ affects MPE. The xenografts mice were divided into normal saline (NS), CQ, or bevacizumab (BE) group. Tumor growth and microvascular density (MVD) were monitored. We explored the effect of CQ on the proliferation, survival, and proangiogenic signaling of tumor cells in vitro. We further evaluated the effects of CQ on the viability, migration, and tube formation of human umbilical vein endothelial cells (HUVECs). A chicken chorioallantoic membrane (CAM) model was used to elucidate the effects of CQ on angiogenesis. Finally, an MPE mouse model were treated by CQ, BE, or NS. The volume of pleural effusion, tumor foci, and MVD was evaluated. CQ therapy group exhibited decreased tumor volume, tumor weight, and MVD in the mouse xenografts. CQ inhibited the proliferation of the tumor cells. However, the expression of vascular endothelial growth factor was not affected. Additionally, CQ inhibited the proliferation, migration, and tube formation of HUVECs and also restrained angiogenesis in the CAM. Western blot showed that CQ might suppress angiogenesis by downregulating p-Akt, Jagged1, and Ang2 in HUVECs. In MPE mice, the volume of the pleural effusion, the number of pleural tumor foci, and the MVD were significantly reduced in the CQ group. Our work demonstrated that CQ played the role of an efficient treatment for MPE.

Multiplane ultrasound approach to quantify pleural effusion in ICU elderly patients

Objective To evaluate the accuracy and clinical practice feasibility of a multiplane ultrasound approach to qualify pleural effusion volume (PEV) in elderly critically ill patients. Methods Prospective study performed on elderly critically ill patients with pleural effusion(PE), and thoracic drainage was performed after PE was assessed by point of care lung ultrasound. Ultrasound PEV was calculated by multiplying the paravertebral PE length by its area, measured at the middle of the distance between apical and caudal limits of the PE. Results A total of 60 patients with 76 PEs was included in this study, who were divided into ventilation group (n=48) and non-ventilation group (n=28). Time of ultrasound examination was 2-9 minutes, and there was no significant difference in both group, [(4.8±1.5)min vs (4.9±1.1)min, P>0.05]. There were no statistically difference between ultrasound PEV and volume of the drained PE in both group [ventilation group (634±209)ml vs (639±224)ml, P=0.921; non-ventilation group (650±168)ml vs (666±179)ml, P=0.722], respectively. Ultrasound PEV was closely correlated with drained PEV (r=0.874, P<0.001), and the correlation coefficients of two group were 0.861(P<0.001), and 0.908(P<0.001), respectively. The mean biases between ultrasound and actual volumes of PE were -11 ml when compared to drainage (-260 to + 227) ml. Conclusions The multiplane approach is a simple and fast procedure of lung ultrasound with higher accuracy to measure the volume of pleural effusions in elderly critically ill patients. Key words: Ultrasonography; Pleural effusion; Aged; Mechanical ventilation

Clinical implications of pleural effusion in patients with acute type B aortic dissection.

Pleural effusion may complicate acute Stanford type B aortic dissection (ABAD). To identify the relationships between the quantity and side of the pleural effusion, biomarkers and outcomes in patients with ABAD. We undertook a retrospective review of 105 patients with ABAD. Their demographics, the data on admission and during hospital stay, the volume of pleural effusion calculated from the area on computed tomography images and clinical outcomes were analysed. The median estimated peak volume (median 6.7 days after onset) was 129 ml (63-192, range 26-514 ml) on the left and 11 ml (6-43, range 2-300 ml) on the right. On univariate analysis, the volume of bilateral effusions was associated with anaemia, hypoalbuminaemia and inflammatory markers, whereas the volume of left-sided effusions was associated with older age, low diastolic blood pressure and maximum aortic diameter. Multivariate analysis revealed that hypoalbuminaemia was independently associated with bilateral effusion volume ( P<0.001), while maximum aortic diameter was associated with left-sided effusion volume ( P=0.019). A greater volume of bilateral plural effusion was associated with longer intensive care unit stay. Larger bilateral pleural effusions in patients with ABAD were associated with hypoalbuminaemia and potentially with anaemia and inflammation, and may increase the length of intensive care unit stay. Left-sided effusion volume appears to be influenced by the nature of the aortic dilatation. Multiple mechanisms may underpin the development of pleural effusion in ABAD, and are likely to influence clinical outcomes.

Adaptive servo-ventilation suppresses elevation of C-reactive protein and sympathetic activity in acute uncomplicated type B aortic dissection.

The aim of this prospective, randomized study was to investigate the effects of adaptive servo-ventilation (ASV), based on haemodynamic parameters, sympathetic status and respiratory conditions in patients with acute uncomplicated type B aortic dissection. We enrolled 28 patients with acute uncomplicated type B aortic dissection requiring antihypertensive therapies, who had been admitted within 24 h from onset. Study subjects were randomly assigned either to the ASV group (n = 14) or to the non-ASV group (n = 14). Antihypertensive therapy at an acute phase led to significant reduction in blood pressure in both groups. Heart rate significantly dropped in the ASV group. In the non-ASV group, noradrenaline (746 ± 343 to 912 ± 402 pg/ml, P = 0.033) and dopamine (30 ± 21 to 42 ± 28 pg/ml, P = 0.015) significantly increased at 1 h after admission. Low frequency/high frequency ratios significantly decreased in the ASV group (2.1 ± 1.6 to 1.7 ± 1.1, P = 0.045). During follow-up at the subacute period, pleural effusion significantly increased in the non-ASV group (649 ± 611 vs 190 ± 292%, P = 0.033). Peak C-reactive protein (CRP) had a significant positive correlation with pleural effusion volume (P = 0.039) and was significantly greater in the non-ASV group (15.5 ± 6.3 vs 8.5 ± 6.1 mg/dl, P= 0.009). In acute type B aortic dissection, ASV was considered to have suppressed the development of sympathetic nervous activity, pleural effusion and elevation of peak CRP.

Therapeutic effect of IGF-1R-targeting inhibitor (TAE226) on malignant pleural effusion in nude mice

To study the therapeutic effect of IGF-1R inhibitor TAE226 on malignant pleural effusion (MPE) in nude mice. Human lung carcinoma A549 cells were injected into the pleural cavity of nude mice to establish MPE model. The mice were randomly divided into model group and treatment group, and were orally administered with distilled water and TAE226 (20 mg/kg) in the same volume, respectively. The volume of pleural effusion and tumor weight of the two groups were observed. HE staining was used to reveal the histological changes and enzyme-linked immunosorbent assay (ELISA) was used to detect the IGF-1R protein expression. IGF-1R mRNA level in the tumor tissue was determined by RT-PCR. Microvessel density (MVD) and cell proliferation index (PI) were assessed by immunohistochemical analysis. The protein expression levels of IGF-1R, p-IGF-1R, PI3K and p-PI3K in the tumor tissue were determined by Western blotting. The volumes of pleural effusion were (241.4±89.7) μl and (121.7±78.8) μl in the model and treatment groups, respectively (P<0.05). The tumor weight of treatment group was (316.7±186.3) mg, significantly lower than that of the model group (671.4±281.4) mg (P<0.05). RT-PCR analysis showed that IGF-1R mRNA level was 0.914±0.029 in the treatment group, significantly lower than that of the model group (1.152±0.037, P<0.01). The ELISA data revealed that IGF-1R protein expression level of the model group was significantly higher than that of the treatment group [(41.0±4.7) μg/L vs. (24.0±3.1) μg/L, P<0.01]. Immunohistochemical analysis showed that there were significant differences between MVD and PI in the model and treatment groups [MVD, 34.75±3.49 vs. 22.25±3.63; PI, (75.25±7.15)% vs. (45.75±5.12)%; P<0.01 for both). Western blot data showed that IGF-1R and PI3K protein expression levels were not significantly different between the model and treatment groups (1.03±0.33 vs. 0.98±0.37 and 1.05±0.28 vs. 0.98±0.19), respectively (P>0.05), but p-IGF-1R and p-PI3K protein expression levels had significant differences between the two groups (1.08±0.10 vs. 0.51±0.08 and 1.12±0.09 vs. 0.86±0.09), respectively (P<0.01 for both). The IGF-1R inhibitor can effectively inhibit the formation of malignant pleural effusion. Its mechanism may be related to the suppression of tumor cell proliferation, invasion and angiogenesis through inhibition of PI3K signaling. TAE226 treatment may be a potential therapeutic regimen of treating malignant pleural effusion.

Effect of Thoracentesis in the Respiratory Mechanics and Gas Exchange Among Mechanically Ventilated Patients With Different Types and Volume of Pleural Effusion

Effect of Thoracentesis in the Respiratory Mechanics and Gas Exchange Among Mechanically Ventilated Patients With Different Types and Volume of Pleural Effusion

Novel approach to pleurodesis with 50% glucose for air leakage after lung resection or pneumothorax.

PurposePleurodesis is performed in patients demonstrating air leakage after lung resection and in those with pneumothorax who must avoid surgery. However, there have so far been very few reports of pleurodesis with 50 % glucose. We herein examined the feasibility and effectiveness of this novel pleurodesis technique.MethodsThirty-five patients after lung resection and 11 pneumothorax patients without surgery were treated with pleurodesis using 50 % glucose. Approximately, 200 mL of 50 % glucose solution was injected into the pleural space and repeated until the air leakage stopped. Cases in which the air leakage did not stop after three injections were considered to be unsuccessful and subsequently treated with conventional pleurodesis using OK-432.ResultsThirty-nine patients were successfully treated with 50 % glucose, although 7 patients required further treatment with OK-432. The unsuccessful group had some pulmonary comorbidities (P < 0.001), and the pleural effusion volume after pleurodesis was less than that in the successful group (P < 0.001). Although the air leakage did not stop in unsuccessful patients, the amount of air leakage markedly decreased. A temporary elevation of the blood sugar level was observed in 20 patients, but no other side effects had appeared.ConclusionsPleurodesis with 50 % glucose is an easy, safe, and effective treatment modality. It is therefore considered to be a useful alternative method for pleurodesis.