Talc Pleurodesis Research Articles

Prise en charge diagnostique et thérapeutique du mésothéliome pleural en 2024

Pleural mesothelioma (PM) is a quite rare tumor, usually due to previous asbestos exposure. Its global prognosis is poor, without validated curative treatment to date. Diagnosis relies ideally on thoracoscopy with pleural biopsies, ± combined with (immediate) talc pleurodesis. Surgery with curative intent, included with multimodal treatment and restrained to highly selected patients, was recently rechallenged. As frontline treatment, standard pemetrexed/platinum-based chemotherapy was lightly improved by addition of bevacizumab. It is currently challenged by the immunotherapy combination of Nivolumab + Ipilimumab, and perhaps soon by combinations of chemotherapy + immunotherapy. No standard treatment is firmly validated beyond first line treatment, even if anti-PD-1/PD-L1 ± anti-CTLA-4 checkpoint inhibitors also exhibited some interesting results in this setting, in phase II and III clinical trials. Therefore, the search of new treatments, strategies and biomarkers is a crucial goal, and recruitment of patients in clinical trials strongly encouraged. Other immunotherapies alone or combined with standard treatments and/or targeted therapies, multimodal strategies are currently assessed. In France, the national network of expert centers for PM management, “NETMESO” (labelled by INCa), aims at proposing an optimal management to all patients systematically discussed in regional (± national) MTB dedicated to PM, and at stimulating clinical and translational research in collaboration with its partners including patients advocating associations.1877-1203/© 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.

EP.14A.16 Effect of Talc Pleurodesis on the Treatment of Diffuse Pleural Mesothelioma Patients Treated with Chemotherapy

EP.14A.16 Effect of Talc Pleurodesis on the Treatment of Diffuse Pleural Mesothelioma Patients Treated with Chemotherapy

Composite mesh a novel innovative bridge approach for refractory pancreatic effusion - sequelae of porous diaphragm syndrome: Case series

Introduction and importanceManaging refractory pancreatic effusion due to porous diaphragm syndrome (PDS) is a challenge. Various surgical interventions such as repairing the defect, sealing with fibrin glue, performing parietal pleurectomy, and talc pleurodesis have been reported however, the use of composite mesh placement in treating PDS has not been described in the literature. Case presentationAll three male patients with a low body mass index were diagnosed with pancreatic disease as described in cases 1–3 and associated pancreatic effusion. These patients required medical treatment as an initial approach and surgical intervention in the form of decortication, sterilization of the thoracic cavity with 20 % betadine and normal saline in the ratio 1:4, followed by warm normal saline washes and composite mesh placement for PDS followed by endoscopic retrograde cholangiopancreatography (ERCP) as a pancreatic intervention after 3 weeks. Only one patient underwent sphincterotomy, while the other two patients had no abnormality on ERCP. Post-operative follow-ups at 3, 6, and 12 months were uneventful with no recurrence. Clinical discussionThe mechanism for pancreatic effusion is explained by pancreatic duct disruption followed by enzyme leak leading to pancreatic-pleural communication mediated by PDS. Various studies have described their role in treating PDS, even thoracoscopic pleurodesis requiring prolong chest tube and repeated talc slurry for better outcome. However, to address this, we performed the above procedure as a bridge approach followed by a pancreatic intervention. ConclusionThoracic intervention with composite mesh can serve as a bridge procedure before future pancreatic intervention or surgery.

The role of day-case thoracoscopy at a district general hospital: A real world observational study

ObjectiveTo assess the feasibility and safety of talc pleurodesis performed as part of day-case medical thoracoscopy. MethodsA Richard Wolf® 5 mm mini thoracoscope through a 5.5 mm port was used with eligible cases having talc poudrage followed by insertion of indwelling pleural catheter (IPC). District nurses drain the IPC daily for the first 5 days. Once the drain output is <150 mL, the frequency is progressively reduced to once weekly. The drain is removed after two consecutive dry taps 1 week apart. ResultsOverall, 51 patients underwent day-case thoracoscopy. Median time to removal of IPC for our day-case protocol was 14 days. There were seven deaths within 70 days among 41 patients with malignant pleural effusion in the day-case cohort, compared to eight deaths in the 33 conventional thoracoscopy controls. Overall, the day-case cohort observed a statistically significant reduction in all-cause mortality at 180 days compared to the conventional cohort (log rank p = 0.024). The average cost per patient of the day-case and inpatient cohort was £1,328.0 ± 106.0 and £1,835.0 ± 295.0 (p = 0.961). ConclusionThis study suggests that thoracoscopy and talc poudrage can be performed safely as a day-case procedure. Further data are needed to ascertain long-term outcomes.

Fast pleurodesis combining talc poudrage and indwelling pleural catheter for the management of recurrent malignant pleural effusions

Background and objectivesMalignant pleural effusions (MPE) are a frequent and major turning point in neoplastic disease usually leading to poor life expectancy. Improve quality of life and relieve the dyspnea are the main objectives in this palliative care setting. This can be achieved by the placement of an indwelling catheter (IPC) or talc pleurodesis ideally performed by thoracoscopy route (talc poudrage). Beside to misidentify a trapped-lung, the latter requires a prolonged hospital stay and the IPC placement does not allow a high pleurodesis rate. To overcome these drawbacks, a combination of both technique could be proposed for the management of recurrent malignant pleural effusions. Safety and efficacy of this pragmatic approach are reported. MethodsConsecutive patients who have been managed for recurrent MPE by a combination of talc poudrage for pleural symphysis by thoracoscopy route ending with the insertion of IPC using the same thoracic point of entry. Demographic data, hospital length of stay (LOS), procedural-related complications, patients’ quality of life (QoL) and success of pleurodesis were collected. Patients were followed-up for 6 months. ResultsThe data of twenty-five consecutive patients undergoing the procedure were analyzed. Successful pleurodesis was obtained for 14/25 patients (66 %) at one month, 17/20 patients (85 %) at 3 months and 13/15 patients (86 %) at 6 months respectively. On average, the hospital LOS after the procedure was 3.24 days (IQR 1–4) with a median of 1 day. A prolonged hospitalization (>1 day) was never due to the procedure except for one patient (pneumothorax). No IPC related infection or procedure related deaths were noted. ConclusionAmong patients with recurrent MPE, the combination of talc poudrage symphysis by thoracoscopy route and IPC placement on the same time results in a shortened hospital LOS and higher rate of pleurodesis. Further randomized clinical trials are needed to confirm these results.

Small cell lung carcinoma presenting initially with recurrent pneumothoraces: a case report

BackgroundPneumothorax is a non-physiological collection of air in the pleural space. Pneumothoraces can be broadly divided into Primary, Secondary, and Traumatic. Cancer of the lung is a known cause of secondary pneumothorax in both primary and metastatic lesions, however, pneumothorax as the presentation of lung cancer is exceedingly rare. Non-small cell lung carcinoma (NSCLC) has been reported in the literature to present with a pneumothorax, particularly in adeno/squamous cell carcinomas. It is almost completely unheard of for small cell lung carcinoma (SCLC) to present with a pneumothorax.Case PresentationWe present the case of a 62-year-old male patient, presenting twice in two months with spontaneous pneumothorax. The initial management involved admission and chest drain insertion. The patient has a past medical history of COPD and a significant smoking history. On the second admission, he underwent a video-assisted thoracoscopic (VATS) bullectomy and talc pleurodesis. The pathology report of the resected specimen confirmed SCLC with extensive infiltration. No gross evidence of metastatic spread was present on CT. Due to the R1 resection and significant risk of recurrence, the management plan included four cycles of adjuvant chemotherapy with carboplatin and etoposide, and radiotherapy as a consideration upon completion.ConclusionsPneumothorax as the presentation of lung cancer imparts a very poor prognosis, however the reasons for this are largely unknown. Furthermore, the mechanisms underlying spontaneous pneumothorax in lung cancer are also not well understood.

Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist's point of view. Part 2.

In recent years, lung ultrasound (LUS) has developed rapidly, and it is gaining growing popularity in various scenarios. There are constant attempts to introduce it to new fields. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemics. In the first part of this review we discuss lines, signs and pheno-mena, profiles, some applications, and misconceptions. An aim of the second part of the review is mainly to discuss some advanced applications of LUS, including lung elastography, lung spectroscopy, colour and spectral Doppler, contrast-enhanced ultrasound of lung, speckled tracking of pleura, quantification of pulmonary oedema, predicting success of talc pleurodesis, asthma exacerbations, detecting chest wall invasion by tumours, lung biopsy, estimating pleural effusion volume, and predicting mechanical ventilatory weaning outcome. For this purpose, we reviewed literature concerning LUS.

Is povidone-iodine pleurodesis as effective, safe and well tolerated as talc pleurodesis for recurrent malignant pleural effusions?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'For patients with malignant pleural effusion is chemical pleurodesis with povidone-iodine as effective, safe and well tolerated as talc pleurodesis for prevention of recurrent malignant pleural effusions?'. A total of 124 papers were found during the search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. At present, medical-grade talc is the most commonly used agent for chemical pleurodesis due to its high success rate, extensive history of clinical use and well-known side-effect profile. However, studies using povidone-iodine seek to establish it as a readily available,low-cost alternative to talc that can be easily administered through an intercostal catheter at the bedside. The summation of available evidence suggests that povidone-iodine is a safe, well-tolerated and equally efficacious agent for pleurodesis in the setting of malignant pleural effusion, when compared to talc.

Thoracoscopy in a country with limited resources in sub-Saharan Africa: a first series of cases from Togo

Objectives: Video-assisted thoracoscopic surgery is experiencing significant growth nowadays. However, in Africa, it is slow to develop. The objectives of this study were to describe the indications and results of thoracoscopy in low and incomes country as Togo. Materials and Methods: A retrospective descriptive cross-sectional study was conducted on patients who underwent exploration and therapeutic procedures by video-assisted surgery from June 2019 to November 2020 and from January 2022 to September 2023 (39 months) in Lomé. Results: Sixteen patients underwent thoracoscopy during the study period. The mean age was 46.06 +/- 23 years. Patients over 45 years old represented 56.2%. The male-to-female ratio was 2.2. Six patients underwent preoperative pleural biopsies. Videothoracoscopy was diagnostic in 10 patients and therapeutic in 6 patients. It was performed under general anesthesia with or without selective intubation in the majority of cases (14/16). Two ports were used in the majority of cases (8/16). Biopsies were performed in 11 patients and intraoperative pleural talc pleurodesis in 4 patients. Pleural debridement was performed in 2 patients. Conversion to thoracotomy was done in 5 patients. The average drainage duration was 4 days. The average length of hospital stay was 5 days. Morbidity and mortality were marked by one case of bronchopleural fistula. Conclusion: Video-assisted thoracoscopic surgery is in its early stages in Togo. Preliminary results are encouraging for its development in Togo.

Chinese expert consensus on treatment of malignant pleural effusion (2023 Edition)

Malignant pleural effusion (MPE) is a pleural effusion that is caused by a malignant tumor originating in the pleura or by a metastatic malignant tumor from another site that has invaded the pleura. MPE is associated with poor prognosis. Members of the Pleural and Mediastinal Diseases Working Group (preparatory) of Chinese Thoracic Society and some external experts selected clinical issues related to the management of MPE and conducted rigorous evidence retrieval and evaluation. After several meetings and revisions of the manuscript, recommendations were made. This consensus applies to patients aged≥18 years old with MPE caused by various malignancies except for pleural mesothelioma. It included four chapters: pathogenesis of MPE, prognostic evaluation of MPE, local thoracic treatment, and systemic anticancer therapy for MPE.The main recommendations of this consensus are as follows:1. Prognosis evaluation of MPE was valuable in formulating treatment options. It is suggested to comprehensively evaluate the patient's prognosis by combining the patient's performance status, tumor type, and laboratory examination.2. It is recommended that in patients with symptomatic MPE, therapeutic thoracentesis could be used as the initial therapeutic option. Evaluate whether the lung is expandable after thoracentesis and drainage, and then develop a therapeutic regimen.3. In patients with MPE and known expandable or nonexpandable lung, an indwelling pleural catheter (IPC) is recommended as a first-line pleural management. Daily IPC drainages are recommended. In patients with MPE and expandable lung, talc pleurodesis by talc poudrage or talc slurry is recommended if the drug is accessible. Other pleurodesis agents include povidone iodine, bleomycin, and doxycycline.4. After drainage, it is suggested to consider the option of intrapleural use of recombinant human endostatin or bevacizumab alone or in combination with intrapleural chemotherapy. Intrapleural intervention including electrocautery, argon knife, cryotherapy, laser and radiofrequency ablation, is recommended for use in patients who have undergone rigorous evaluation in eligible hospitals. The use of intrapleural urokinase or streptokinase via pleural catheter is recommended for patients with symptomatic MPE and loculated effusion.5. For patients with good performance status and metastatic malignancies, systemic anti-cancer treatment is recommended as standard of care.

Short comparison of talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion.

Objective: To compare talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion. Study Design: Controlled Clinical Trial. Setting: Division of Pulmonology, Jinnah Hospital Lahore. Period: September, 2022 up until May, 2023. Material &amp; Methods: 100 individuals, both male and female, ranging in age from 20 to 80 years, diagnosed with malignant pleural effusion confirmed on biopsy were included by nonprobability consecutive sampling. Patients with active pleural infection, hemodynamic instability, systemic infection, serum hematocrit &lt; 25%, hemothorax, chylothorax, multiple etiologies of pleural effusion, prior chemical pleurodesis, sensitivity to study drugs, life expectancy &lt; 1 month, pregnancy and chest X-ray displaying trapped lung post chest tube drainage on the affected side were excluded. The patients were allocated into two groups at random using a lottery system. In group 1, patients received pleurodesis with talc poudrage and in group 2, patients received pleurodesis alongside tetracycline. Success was assessed after 4 weeks of pleurodesis. Results: In this study, mean age in talc group was 58.94±13.6 years and in tetracycline group it was 59.26±13.7 years.65% patients were male and 35% were females.Success was 94% in talc group and 76% in tetracycline group with p-value = 0.012. In terms of adverse effects, there is no statistically significant difference between the two groups. Conclusion: Talc pleurodesis has a higher success rate than the tetracycline pleurodesis. Talc pleurodesis also has less adverse effects than tetracycline pleurodesis.

Video Assisted Thoracoscopy Talc Pleurodesis in the Management of Metastatic Pleural Effusion

Introduction: Metastatic pleural effusion complicates many cancers and impairs patients' quality of life. In a palliative situation, the decision between thoracoscopy talc pleurodesis, tube chest, iterative punctures or abstention is difficult and often operator dependent. Materials and methods: We report a study of 87 patients with metastatic pleural effusion treated by video assisted thoracoscopy talc pleurodesis. Results: Breast cancer constitutes the primary site causing metastatic pleural effusion in approximately half of cases, followed by bronchopulmonary cancers and finally digestive cancers. The complete response rate in the short and medium term is very satisfactory. We did not report any complications apart from one case of empyema. Conclusion: video assisted thoracoscopy talc pleurodesis constitutes an interesting treatment for recurrence of metastatic pleural effusion.

The prognostic value of F18 Fluorothymidine positron emission tomography for assessing the response of malignant pleural mesothelioma to chemotherapy - A prospective cohort study.

Malignant pleural mesothelioma is difficult to prognosticate. F18-Fluorodeoxyglucose positron emission tomography (FDG PET) shows promise for response assessment but is confounded by talc pleurodesis. F18-Fluorothymidine (FLT) PET is an alternative tracer specific for proliferation. We compared the prognostic value of FDG and FLT PET and determined the influence of talc pleurodesis on these parameters. Overall, 29 prospectively recruited patients had FLT PET, FDG PET and CT-scans performed prior to and post one chemotherapy cycle; 10 had prior talc pleurodesis. Patients were followed for overall survival. CT response was assessed using mRECIST. Radiomic features were extracted using the MiM software platform. Changes in maximum SUV (SUVmax), mean SUV (SUVmean), FDG total lesion glycolysis (TLG), FLT total lesion proliferation (TLP) and metabolic tumour volume (MTV) after one chemotherapy cycle. Cox univariate analysis demonstrated FDG PET radiomics were confounded by talc pleurodesis, and that percentage change in FLT MTV was predictive of overall survival. Cox multivariate analysis showed a 10% increase in FLT tumour volume corresponded with 9.5% worsened odds for overall survival (P = 0.028, HR = 1.095, 95% CI [1.010, 1.187]). No other variables were significant on multivariate analysis. This is the first prospective study showing the statistical significance of FLT PET tumour volumes for measuring mesothelioma treatment response. FLT may be better than FDG for monitoring mesothelioma treatment response, which could help optimise mesothelioma treatment regimes.

Prise en charge diagnostique et thérapeutique du mésothéliome pleural en 2023: Management of pleural mesothelioma in 2023

Pleural mesothelioma (PM) is a rare tumor, usually due to previous asbestos occupational exposure. Its global prognosis is poor, without validated curative treatment to date. Diagnosis relies ideally on thoracoscopy with pleural biopsies, ± combined with talc pleurodesis. Surgery with curative intent, included with multimodal treatment, is restrained to highly selected patients. As frontline treatment, standard pemetrexed/ platinum-based chemotherapy was lightly improved by addition of bevacizumab. It is now challenged by the double-immunotherapy regiment combining Nivolumab + Ipilimumab, and perhaps soon by the combination standard chemotherapy + Pembrolizumab. No treatment is firmly validated beyond first line treatment, even if anti-PD-1/ PD-L1 ± anti-CTLA-4 antibodies also exhibited some promising results in this setting, in phase II and III trials. Thus, the search of new treatments, strategies and biomarkers is a crucial goal, and recruitment of patients in clinical trials strongly encouraged. Other immuno therapies alone or combined with standard treatments and/or targeted therapies, multimodal strategies are currently assessed. In France, the national network of expert centers for PM management, « NETMESO » (labelled by INCA), aims at proposing an optimal management to all patients systematically discussed in regional (± national) MTB dedicated to MPM, and at stimulating clinical and translational research in collaboration with its partners including patients advocating associations.1877-1203/© 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Comparison of Outcomes in Patients with Malignant Pleural Efusion et Causa Breast Cancer Metastase Thought of Pleurodesis with Talc Poudrage and Talc Slurry at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Breast cancer accounts for about 50-65% of malignant pleural effusions. Talc pleurodesis is one of the definitive procedures for pleural effusions in which the route of administration is divided into poudrage and slurry. This study aimed to compare the differences of outcomes in malignant pleural effusion patients et causa breast cancer metastase who receive pleurodesis therapy with talc poudrage and talc slurry.&#x0D; Methods: This study has a cross-sectional design, which was conducted at Dr. M. Djamil General Hospital in May – July 2023. This study used medical records of patients diagnosed with malignant pleural effusion due to metastases of breast cancer at Dr. M. Djamil General Hospital Padang from January 2019 – July 2023. The outcomes assessed included drain production in 24 hours, drain release time, and in-hospital mortality.&#x0D; Results: In this study, 12 respondents who have talc poudrage and talc slurry pleurodesis were included. In the talc poudrage group, the mean of 24-hour drain production was 259.17 ± 46.79 ml, the mean of drain release time was 4.08 ± 0.66 days, and there was one respondent who died during hospitality. In the talc slurry group, the mean of 24-hour drain production was found to be more (420.83 ± 78.21 ml), drain release time was found to be much longer (5.67 ± 0.98 days), and 3 respondents died in hospital. The bivariate analysis found a significant difference between the 24-hour drain production and drain release time of patients who underwent talc slurry and talc poudrage meanwhile there was no difference in hospital mortality.&#x0D; Conclusion: Talc poudrage has a better outcome than talc slurry regarding drain production and drain release time in patients with malignant pleural effusion due to metastases of breast cancer.

OA19 A complex case of bilateral pneumothoraces due to probable certolizumab driven rheumatoid lung nodules

OA19 A complex case of bilateral pneumothoraces due to probable certolizumab driven rheumatoid lung nodules

Uniportal Video-assisted Thoracoscopic Talc Pleurodesis in the Treatment of Malignant Pleural Effusions. Is Early Phase Talc Pleurodesis More Effective?

Objective: VATS talk pleurodesis is an effective method for palliatively treating malignant pleural effusion (MPE). This study aimed to compare early and late-phase talc pleurodesis procedures and to determine the factors affecting the success of the uniportal VATS talc pleurodesis procedure. &#x0D; Materials and Methods: The data of 58 patients who underwent uniportal VATS talc pleurodesis due to MPE were analysed retrospectively. The patients were divided into two groups as early-phase talc pleurodesis (n=23, 48.3%) and late-phase (n=25, 51.7%). Groups were compared using Pearson chi-square test and Mann-Whitney U tests.&#x0D; Results: Complications developed in 10 patients (17.2%). No significant difference was found between the early-phase talc pleurodesis and the late-phase pleurodesis regarding complication rate (p=0.905), durations of hospitalisation (p=0.821). It was observed that the early-phase talc pleurodesis procedure had higher success than the late-phase talc pleurodesis procedure (Odds ratio=1.425, 95%CI=0.307-6.624), although not statistically significant (p=0.06). It was determined that 86% of the patients who underwent early talc pleurodesis had no hospital readmission due to MPE within the first 3 months. &#x0D; Conclusion: Uniportal VATS talc pleurodesis is a safe and effective treatment method for malignant pleural effusion, with low complication and high success rates. Early-phase talc pleurodesis procedure significantly reduces recurrent hospitalisations.

862 Successful Surgical Management of Chylothorax Secondary to Gorham-Stout Disease

Abstract Introduction Gorham-Scout Disease (GSD) is a rare skeletal disorder of unknown aetiology characterised by progressive osteolysis and excessive lymphovascular proliferation. Chylothorax is a severe and life-threatening complication of GSD that confers a poor prognosis. Literature review reveals only one previous case of successful surgical management for chylothorax secondary to GSD. Case presentation A teenage asylum seeker presented with a large left pleural effusion on a background of chronic left flank collection secondary to lymphovascular malformation. Cytological analysis of the fluid drained from chest drain insertion confirmed a chylothorax. A posterior rib excision biopsy helped to confirm the diagnosis of GSD. She had VATS ligation of the thoracic duct and talc pleurodesis, however, due to recollection and ongoing symptomatic discomfort, she subsequently underwent left thoracotomy, decortication of lung and pleurectomy. These surgical interventions helped to stabilise the chylothorax with ongoing management for GSD related to radiotherapy and pain control via the administration of bisphosphonates. Conclusions GSD is a rare disease that can develop a number of severe complications including a chylothorax. Management via surgical and radiotherapeutic techniques can provide long term remission, however, other modalities may be needed in order to optimise analgesic requirements.

Which is the More Effective Option for Pleurodesis to Prevent the Recurrence of Malignant Pleural Effusion? Large-Particle Talc or Mistletoe Extract (ABNOVA Viscum Injection).

Malignant pleural effusion affects many patients with advanced cancer. When chemotherapy or radiotherapy fails to relieve malignant pleural effusion and related symptoms, drainage and pleurodesis can help. Although surgical talc pleurodesis is the most widely used method, Viscum album, which has been recently used in surgical or bedside procedures, has demonstrated significant results and is as effective as talc. This study aimed to determine the most effective agent and procedure. Between January 2015 and July 2022, chemical pleurodesis was performed in 137 patients with malignant pleural effusion, using a V. album surgical procedure in 48, a V. album bedside procedure in 55, and a talc surgical procedure in 34 patients. We reviewed patients' clinical responses and disease progression after chemical pleurodesis. The success rate was not significantly different among the V. album surgical procedures (91.7%), V. album bedside procedures (83.6%), and talc surgical procedures (91.2%). However, the total drainage amount and tube insertion duration in both Viscum groups were more effective than those in the talc group. Furthermore, the bedside Viscum group showed significantly lower post-pleurodesis pain scores than the other 2 groups. According to our results, talc and V. album can be considered ideal agents for chemical pleurodesis. However, Viscum pleurodesis showed safer outcomes in terms of ensuring quality of life than talc. Additionally, the bedside Viscum group showed significantly lower pain scores than the other groups. Hence, patients for whom surgical procedures are inappropriate can undergo bedside Viscum pleurodesis without diminishing the therapeutic effect.

Successful Combination Treatment with Bronchial Occlusion Followed by Talc Pleurodesis for Refractory Bilateral Pneumothorax in a Patient with Interstitial Lung Disease

Successful Combination Treatment with Bronchial Occlusion Followed by Talc Pleurodesis for Refractory Bilateral Pneumothorax in a Patient with Interstitial Lung Disease