Presence Of Pleural Adhesions Research Articles

Diagnostic and Prognostic Implications of Pleural Adhesions in Malignant Effusions

We aimed to examine the frequency of pleural adhesions and to determine their relationship with pleural tumor burden, pleural fluid (PF) biochemistries, PF cytologic yield, and survival in patients with malignant pleural effusion (MPE). We performed retrospective analysis of 540 consecutive patients with MPE who underwent medical thoracoscopy. Pleural lesion rating and grade of pleural adhesions based on a thoracoscopic score model were recorded. Sixty percent of patients with MPE were found to have adhesions in the pleural space. The sensitivity of PF cytology was 71% if there were no pleural adhesions, and 20% if the maximum adhesion score was reached (p < 0.01). The extent of pleural adhesions correlated positively with the pleural tumor burden, and inversely with PF pH. The median survival of patients with minimal or no adhesions in the pleural space was 9 months as compared with patients with the highest grade of adhesions, whose median survival was 5 months (p < 0.01). MPE are often loculated. The higher the grade of pleural adhesions, the greater the tumor burden exists, and paradoxically the lower the PF cytologic yield. The presence of pleural adhesions in MPE implies a poor prognosis.

Preoperative Detection of Pleural Adhesions by Chest Ultrasonography

The presence of pleural adhesions may render video-assisted thoracoscopic surgery difficult or impossible. The aim of this study was to assess the value of chest ultrasonography in the detection of pleural adhesions prior to thoracotomy. Between October 2001 and September 2002, 42 consecutive patients undergoing thoracotomies (including video-assisted thoracic surgery) were evaluated with chest ultrasonography. These patients underwent a preoperative ultrasonic examination of the chest wall using a 7-MHz linear ultrasound probe at 7 points along the chest wall. We measured the movement of the visceral pleural slide. When restricted viscera sliding was defined as less than 1 cm of excursion at the upper thoracic wall during exaggerated respirations, ultrasonography demonstrated a sensitivity of 63.6%, a specificity of 79.4%, a negative predictive value of 87.7%, a positive predictive value of 50.0%, and an overall accuracy of 75.6%. When restricted viscera sliding was defined as less than 2 cm of excursion at the lower thoracic wall during exaggerated respirations, ultrasonography demonstrated a sensitivity of 81.5%, a specificity of 81.0%, a negative predictive value of 96.0%, a positive predictive value of 44.0%, and an overall accuracy of 81.0%. Chest ultrasonography is moderately accurate in detecting the presence and location of pleural adhesions. Use of preoperative chest sonographic findings to plan trocar placement and to determine the need for an open approach is valuable in helping prevent visceral injury and facilitating video-assisted thoracoscopic surgery.

Predictors of prolonged air leak after pulmonary lobectomy

Background The objective of this study was to identify the predictors of prolonged air leak (air leak longer than 7 days) in patients submitted to pulmonary lobectomy for lung cancer. Methods A retrospective analysis on 588 patients operated on of pulmonary lobectomy from January 1995 through June 2003 was performed. Univariate and logistic regression analyses were performed to generate a model predicting the risk of prolonged air leak. Bootstrap resampling technique was used to validate the regression model. Results A prolonged leak was exhibited by 15.6% of patients. Logistic regression analysis demonstrated that significant independent predictors of prolonged air leak were a reduced predicted postoperative forced expiratory volume in 1 second ( p < 0.0001), the presence of pleural adhesions ( p = 0.003), and upper resections ( p = 0.006). Bootstrap resampling analysis confirmed the reliability of these variables. A regression equation was generated for the prediction of the risk of prolonged air leak. Conclusions We report that a low predicted postoperative forced expiratory volume in 1 second, the presence of pleural adhesions, and the upper lobectomy or bilobectomy increased the risk of air leak persisting for more than 7 days. A model was generated to calculate this risk and assist the surgeon in taking extra measures to prevent such complication (ie, optimizing bronchodilator treatment, pleural tent, sealants, buttressed staple lines, water seal, and chest tube drainage).

RESULTS OF VIDEO ASSISTED THORACOSCOPIC PLEURODESIS IN MANAGEMENT OF PNEUMOTHORACES

The objective of the study is to find out the efficiency of video assisted thoracoscopic (VATS) pleurodesis and predisposing factors of postoperative complications. This is a retrospective study that those who had VATS pleurodesis from January 1994 to December 2000 were recruited. There were consecutive 306 VATS pleurodesis performed on 271 patients. These included 33 female and 238 male patients from 15 to 73 years old. 31 of them had bilateral procedures. 244 of them had primary spontaneous pneumothoraces and 27 of them had secondary pneumothoraces. Most of them had two or more episodes of pneumothoraces and persistent air leakage >14 days before operations. 15 patients had failed surgical or chemical pleurodesis before VATS. There was no operative death. Usually they were discharged within five days after operations. There were 21 persistent air leakage >5 days (6.8%), 1 bleeding required surgical haemostasis (0.3%) and 4 infectious complications (1.3%). Follow up duration was up to 72 months. There was 12 recurrence (3.9%) after discharge. Absence of blebs, presence of pleural adhesion, prolonged chest tube placement before VATS pleurodesis, and failed surgical or chemical pleurodesis before are the predisposing factors of complications.

Pleural tent after upper lobectomy: a prospective randomized study

Background. The aim of the present study was to assess the cost/efficacy of the pleural tent procedure after upper lobectomy. Methods. A prospective randomized analysis was performed on 50 patients submitted to upper lobectomy and divided into two groups: group 1 (25 patients) with pleural tent; group 2 (25 patients) without pleural tent. Results. The univariate comparison between the two groups did not show any significant difference in terms of age, gender, spirometry, smoking history, chronic obstructive pulmonary disease index, side of tumor, arterial oxygen tension, arterial carbon dioxide tension, size and location of tumor, presence of pleural adhesions, length of the stapled parenchyma, and operative time. Pleural tent significantly reduced the days of postoperative air leak (1.2 versus 5.8, p = 0.01), chest tubes (5.4 versus 10.4, p = 0.01), and hospital stay (6.9 versus 10.8, p = 0.01). Moreover, no difference was noted between the two groups in terms of pleural effusion in the first postoperative 48 hours, need of postoperative blood transfusion, and occurrence of other complications. Conclusions. Pleural tenting after upper lobectomy is a safe and effective procedure and its routine use is warranted.

Accuracy of CT for the Detection of Pleural Adhesions: Correlation With Video-Assisted Thoracoscopic Surgery

The presence of pleural adhesions may render video-assisted thoracoscopic surgery (VATS) difficult or impossible. The aim of this study was to assess the value of chest CT in the detection of pleural adhesions prior to VATS. Prospective study of the accuracy of chest CT in detecting pleural adhesions prior to VATS. Tertiary-referra; teaching hospital and Veterans Administration hospital. Between July 1994 and March 1995, 63 consecutive patients undergoing 64 VATS procedures were evaluated with chest CT prior to surgery. Preoperative scans were interpreted by consensus of two pulmonary radiologists prior to surgery. Suspected pleural adhesions and other findings related to the pleura were recorded on a form given to the surgeon prior to VATS. The surgeon confirmed or excluded each suspected adhesion during VATS, and documented any other lesions not identified preoperatively. Patient-by-patient and lesion-by-lesion analyses were performed. Pleural adhesions were correctly identified by CT in 28 of 39 cases (sensitivity, 71%) and excluded in 18 of 25 cases (specificity, 72%). On a lesion-by-lesion basis, 73 adhesions were identified during VATS, of which only 28 were identified prospectively at CT. There were 45 missed adhesions and 20 adhesions that were suggested falsely (sensitivity, 38%; specificity, 46%). Eighteen pleural spaces were correctly identified as being free of pleural adhesions. CT is moderately sensitive and specific for preoperative identification of pleural adhesions in patients undergoing VATS but its accuracy is poorer for individual lesions.