Pleurodesis Research Articles (Page 1)

ABSTRACT Objectives Pleurodesis is an important management option to palliate breathlessness in patients with malignant pleural effusion (MPE). This systematic review aimed to examine available literature for studies investigating factors that predict pleurodesis outcome. Methods The healthcare databases advanced search (HDAS) Medline and Embase in addition to Cochrane Database of Systematic Reviews were searched on for publications reporting on pleurodesis for MPE in English language. All study types reporting previously unpublished data on predictors of pleurodesis success were included. Thirty-four studies involving 4626 patients were included in the systematic review. Results The most common pleurodesis agent used was talc which was used in 27 studies. Meta-analyses demonstrated that the strongest predictors of pleurodesis success were higher pleural fluid pH, smaller volume of effusion pre-pleurodesis and full lung re-expansion post effusion drainage. Shorter duration of tube drainage, higher pleural fluid glucose, lower LDH, and lower pleural tumor burden all seem to favor pleurodesis success, but with considerable statistical heterogeneity between studies. Available data do not suggest that chest tube size affects pleurodesis outcome. Conclusion Overall, available results are difficult to interpret due to evidence quality. Prospective studies are needed to further explore these factors. Protocol registration CRD42018115874 (Prospero database of systematic reviews)

Malignant pleural effusions often are managed by either talc pleurodesis or placing an indwelling pleural catheter. Both methods provide symptom

Objectives The aim of this study was to compare between small-caliber catheter rapid pleurodesis and conventional chest tube pleurodesis as regards efficacy and hospital stay in patients with malignant pleural effusion (MPE). Background Chemical pleurodesis can be palliative for recurrent, symptomatic pleural effusions in patients who are not candidate for a thoracic surgical procedure. We hypothesized that pleurodesis as effective as the standard method could be accomplished with a rapid method of pleurodesis. Patients and methods This prospective randomized controlled trial included 30 patients with MPE. Patients were divided into two groups: group A, which underwent rapid pleurodesis with a small-caliber tube (8–14 Fr), and group B, which underwent conventional pleurodesis. Talc was the sclerosing agent that was used. The small-caliber tube was inserted under local anesthesia with total evacuation of pleural fluid, maximum 1.5 l, followed by gradual evacuation. Rapid pleurodesis was performed only after obtaining radiological evidence of complete evacuation of the fluid and the tube was clamped for 1 h. The fluid was drained over 1 h and the catheter removed and the patient discharged. The chest tube was inserted under local anesthesia with total evacuation of pleural fluid, maximum 1.5 l, followed by gradual evacuation. Pleurodesis was performed only after obtaining radiological complete evacuation of the fluid, daily drainage of less than 300 l. The tube was clamped for 1 h. The fluid was drained over 6–12 h and the tube was removed and then the patient was discharged from hospital. Results Our study included 15 patients in group A who underwent rapid pleurodesis and 15 patients in group B who underwent conventional pleurodesis. There was a significant difference between the two groups as regards hospital stay and postoperative pain. Conclusion Small-caliber tube drainage and rapid pleurodesis were shown to be efficient and demonstrated a good safety profile in treating MPEs.

eComment. The ways to increase the effectivity of pleurodesis.

Management of malignant pleural effusion often includes chest tube placement and pleurodesis — two potentially painful procedures. In an international 2x2 factorial trial in 320 patients, investigators studied whether treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and use of smaller-bore chest tubes could spare patients discomfort without impeding the effectiveness of pleurodesis. …

Novel Method of Anchoring the Pleurodesis Talc-spraying Catheter to the Thoracoscopic Camera

Objective To study the therapeutic effect and safety of pleurodesis with medical thoracoscopy by powdery talc on treatment of malignant pleural effusion. Methods Retrospective analysis were done in 74 cases of malignant pleural effusion accepted simple powdery talc pleurodesis under medical thoracoscopy. Results The doses of powdery talc were from 1g to 5g,average 2.18g in the course of the treatment. After operation, 45(60.8%) cases which were complete remission(CR) were full pleural adhesion and complete lung recruitment, 14cases(18.9%), which were partial remission(PR),were less pleural adhesion and most lung recruitment, and 10cases(13.6%) were stable diseases(SD), while 5cases(6.7%), which were progressive diseases(PD), were without pleural reaction. The total effective rate, including CR,PR and SD, was 93.3%(69/74). The complications of simple powdery talcage under medical thoracoscopy were included in:95.9%(71/74) with chest pain,64.8%(48/74) with fever,28.4%(21/74) with shortness of breath,12.2%(9/74) with mediastinal and subcutaneous emphysema,5.4%(4/74)with nausea and vomiting,4.1%(3/74) with abdominal distension, while the complications of acute pulmonary edema, massive hemorrhage, pulmonary embolism and wound infection were not observed. Conclusion Treatment of malignant pleural effusion by simple powdery talcage under medical thoracoscopy has definite clinic therapeutic effect, which is safe, costeffective, less trauma and worthy of clinical application. Key words: Pleural effusion,malignant; Thoracoscopy; Pleurodesis; Talc

Lung cancer is the most common cancer worldwide in terms of both incidence and mortality. Prognosis is generally poor. Of all patients with lung cancer, approximately 15% survive for 5 years after diagnosis while 80% die within 1 year. Respiratory symptoms observed in patients with lung cancer (dyspnea, cough, haemoptysis) are determined by cancer’s histologic type, biological properties, and anatomic location. They may be caused either by the primary tumour itself or by locoregional metastases within the thorax. Respiratory symptoms can result from immediate mechanical effects of cancer spread, such as localized obstruction of large airways, postobstructive pneumonia, formation of fistulae between airways and other intrathoracic structures, pleural effusion, and paresis of diaphragm or vocal cords due to encroachment upon respective nerves. In such patients, noninvasive therapies may be insufficient to palliate respiratory symptoms. Invasive techniques are available to benefit this group of patients. Respiratory symptoms can be caused by chemotherapy, or complications of radiotherapy (airway stenosis and necrosis, fistula formation, haemoptysis). Moreover, comorbid conditions such as chronic obstructive lung disease (COPD), heart failure, pulmonary embolism, previous lung resection or malnutrition likewise contribute to respiratory symptoms. Dyspnea is the most frequently reported symptom in lung cancer patients: over of 65% patients have this symptom at some time during the course of their illness. In management of cancer-related dyspnea, opioids will remain the mainstay of therapy for the foreseeable future. Further studies will also be needed to identify the target populations who would benefit from oxygen, benzodiazepines, and the wide spectrum nonpharmacological interventions to relieve dyspnea. The design of these studies should respect the difference between cancer-related dyspnea and dyspnea from other causes. Suppression of cancer-related cough should also be addressed in future randomized studies. Current recommendations for palliative care in patients with advanced lung cancer, organized according to salient respiratory symptoms: Dyspnea: opioids; supplemental oxygen; other pharmacological interverventions; nonpharmacological interventions; dyspnea due to comorbidities and its treatment. Cough: opioids, non-opioid cough supressants, chemotherapy. Haemoptysis: pharmacologic treatment, bronchoscopic management, palliative thoracic radiotherapy. Malignant pleural effusion: thoracocentesis, chest tube dranaige, pleurodesis, and pleuroperitoneal shunting.

DOI: http://dx.doi.org/10.3329/jafmc.v8i2.16356 JAFMC Vol.8(2) 2012 pp.58-63

50％ブドウ糖液を使用した胸膜癒着術の有効性

Background Thoracoscopy with local anesthesia or medical thoracoscopy is an invasive method which is rather valuable not only for the approach of undiagnosed exudative pleural effusions but also for the treatment of symptomatic malignant effusions with the conduct of pleurodesis. This is a review of those patients who underwent medical thoracoscopy in the period May 2011 to September 2012 in the Pulmonary Department the Aristotle University of Thessaloniki.

To study the clinical characteristics and treatment method of pneumonoconiosis with spontaneous pneumothorax. The clinical data of 55 cases with spontaneous pneumothorax were analyzed. Among these 55 cases, there were 19 cases with left side pneumothorax, 25 cases with right side pneumothorax and 11 cases with bilateral pneumothorax. The lungs of 17 cases were compressed to less than 20%, the lungs of 29 cases were compressed to 20% ∼ 50% and the lungs of 9 cases were compressed to more than 50%, 17 cases were treated conservatively, 7 cases were treated by thoracentesis, and 32 cases were treated by closed thoracic drainage, including 10 cases intrapleural injected with thrombin and PAMBA. After the treatment, 41 cases were cured, 10 cases were improved, 3 cases were transferred to other hospital for plugging or pleurodesis and 1 case died of the respiratory failure. The clinical symptoms of cases with pneumonoconiosis and spontaneous pneumothorax are atypical. These cases easily recur. After treatment, the healing of these cases is better.

症例は81歳，女性，C型肝炎，肝硬変で治療中の2010年3月頃より，右胸水が出現し，外来にて定期的に穿刺吸引を行っていた．その後，胸水貯留の頻度が多くなり，呼吸困難がしばしば出現したため，当院紹介となった．入院後，胸腔ドレナージ，胸膜癒着療法を行ったが，胸水のコントロールが困難なため胸腔鏡下手術を施行した．鏡視下に横隔膜の小孔を探したが発見できなかったため，吸収性ポリグリコール酸フェルト（PGA felt）を横隔膜全体に被覆した．術後2週間で胸水の貯留は消失し，その後も胸水の貯留はみられなかった．横隔膜上の小孔を発見できない場合でも，横隔膜全体と肺底面が十分に癒着すれば，小孔は閉鎖されるものと思われた．難治性肝性胸水の治療には様々な報告がみられるが，鏡視下における癒着療法として考えると，簡便かつ有用な方法と思われた．

Background: Medical thoracoscopy is a procedure which enables pneumologist to inspect the pleural space, perform biopsy, pleurodesis, and facilitates optimal chest tube placement and drainage in patients with pleural effusion. We made a retrospective analysis of the procedures, performed at the University Hospital Golnik between January 2002 and December 2007. Patients and methods: We evaluated 129 thoracoscopies, performed in 125 patients in a 5-year period. All patients had pleural effusion or a pleural mass, which failed to be diagnosed by less invasive diagnostic methods. In the study group there were 90 (72.0 %) men and 35 (28.0 %) women. Their median age was 63 years (from 28 to 81 years). All procedures were performed under local anaesthesia with a videothoracoscope Olympus A5252A. Pleurodesis was performed by insufflation of 5g of talc. Results: 78 (62.4 %) of patients had malignant infiltration of the pleura and 47 (37.6 %) had a benign pleural disease. The diagnostic accuracy of thoracoscopy was 91.5 %. The sensitivity in the diagnostics of malignant pleural disease was 86.1 %, the negative predictive value was 82.0 %. Talc pleurodesis was performed in 14 patients with malignant pleural infiltration. Complications were detected in 33 (26.4 %) patients, most of them were not severe. Severe complications, such as empyema, bronchopleural fistula, prolonged duration of drainage, perforation of the diaphragm and trapped lung, occurred in 8 (6.4 %) patients. 30-day mortality rate after the procedure was 0 %. Conclusions: Thoracoscopy has a high diagnostic yield with an acceptably low rate of complications. Nevertheless, it is an invasive procedure, which requires careful indications, patient’s consent, best surgical technique and an accurate postoperative follow up.

Objective To study the treatment of postoperative pleural effusion in lung cancer.Methods Sixty-eight cases of lung cancer with postoperative pleural effusion were collected from January 2006 to June 2009 in Union hospital of Tongji Medical College.The treatment methods of pleural effusion included bronchoscopy,antibiotics adjustment,pleurodesis with talcum,DDP and 50% glucose through a transchest catheter,chest clearance and simultaneously bronchial stump embedment with pericardium or azygos vein.Results Sixty-six patients were cured,although 2 patients failed to remove pleural effusion.Conclusion Postoperative pleural effusion,a common complication induced by surgery in lung cancer,was able to be controlled by strongly treatment.

Malignant pleural effusion is caused by the pleural invasion of malignant tumors such as lung cancer, or by primary pleural tumors. It is a troublesome and debilitating complication of advanced malignancies. If malignant pleural effusion is not treated in time, the average life span of these patients is only several months. An effective treatment can improve the quality of life and prolong the average life spans. Key words: Neoplasms; Pleural effusion, malignant; Pleurodesis

OK432 chemical pleurodesis as a standard therapy of spontaneous pneumothorax

Technical Notes and Tips: Intrapleural Ropivacaine Local Anaesthetic Spray as an Adjunct in Patients Undergoing Surgical Pleurodesis

Background/Purpose. To investigate the clinical strategy, management, outcome and indications of early VATS intervention during the first episode of primary spontaneous pneumothorax (PSP) in children aged less than 18 years. Methods. Retrospective chart review of patients with a diagnosis of primary spontaneous pneumothorax from January 1, 2002 to July 31, 2007 in the Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital. Results. There were 11 episodes of PSP in 9 patients during the study period. The patients ranged in age from 12 to 17 years. The mean age was 15.5±2.6 years. All patients were boys. The mean height was 61.59 cm, the mean weight percentile was 35.64 and the mean BMI was 18.6. Pneumothorax occurred on the left side 63.6% of the time. The initial presenting symptoms were chest pain in 8 (73%) and dyspnea in 4 (35.64%) patients. All 9 patients underwent surgical procedures (VATS with blebectomy or abrasive pleurodesis) for the first episode. Blebs or bullae were found in specimens from all patients. No recurrence was noted on the same side after thoracoscopic therapy at the most recent follow-up (mean, 9.1 mo). Conclusion. VATS intervention for the first episode of PSP should be considered in pediatric patients who present with severe symptoms and signs, large (＞30%) pneumothorax, synchronous bilateral pneumothorax, progressively enlarging pneumothorax under conservative treatment, persistent air leakage (longer than 4 days) under tube thoracostomy drainage, subpleural blebs or bullae demonstrated on HRCT.

To summarize the experience of intercostal video-mediastinoscopy (VMS) in treatment for mediastinal masses, malignant pleural effusion and palmar hyperhidrosis. The clinical data of 701 patients received intercostal VMS from November 2001 to June 2007 were summarized retrospectively. Forty-eight patients with mediastinal masses and 46 patients with suspected malignant pleural effusion underwent intercostal VMS pleural biopsy (39 cases with talc pleurodesis) and 607 patients with palmar hyperhidrosis underwent bilateral intercostals VMS thoracic sympathectomy. No mortality and morbidity were reported in this group. Definitive pathologic diagnosis had been made through VMS mediastinal masses biopsy in mediastinal masses and pleural biopsy in pleura effusion. The efficiency of talc pleurodesis was 100% for 39 cases. The symptoms of sweating of hands in 607 patients with palmar hyperhidrosis disappeared completely, all patients' hands became dry with a 1.5 degrees C to 3.0 degrees C increase of the skin temperature immediately after operation. No recurrence occurred during the follow-up. VMS is a simple, convenient and alternative procedure for the treatment of mediastinal masses, malignant pleural effusion and palmar hyperhidrosis.