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1.
J Pediatr (Rio J) ; 100(1): 8-24, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37353207

RESUMO

OBJECTIVES: To compare LISA with INSURE technique for surfactant administration in preterm with gestational age (GA) < 36 weeks with RDS in respect to the incidence of pneumothorax, bronchopulmonary dysplasia (BPD), need for mechanical ventilation (MV), regional cerebral oxygen saturation (rSO2), peri­intraventricular hemorrhage (PIVH) and mortality. METHODS: A systematic search in PubMed, Embase, Lilacs, CINAHL, SciELO databases, Brazilian Registry of Randomized Clinical Trials (ReBEC), Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. RCTs evaluating the effects of the LISA technique versus INSURE in preterm infants with gestational age < 36 weeks and that had as outcomes evaluation of the rates of pneumothorax, BPD, need for MV, rSO2, PIVH, and mortality were included in the meta-analysis. Random effects and hazard ratio models were used to combine all study results. Inter-study heterogeneity was assessed using Cochrane Q statistics and Higgin's I2 statistics. RESULTS: Sixteen RCTs published between 2012 and 2020 met the inclusion criteria, a total of 1,944 preterms. Eleven studies showed a shorter duration of MV and CPAP in the LISA group than in INSURE group. Two studies evaluated rSO2 and suggested that LISA and INSURE transiently affect brain autoregulation during surfactant administration. INSURE group had a higher risk for MV in the first 72 h of life, pneumothorax, PIVH and mortality in comparison to the LISA group. CONCLUSION: This systematic review and meta-analyses provided evidence for the benefits of the LISA technique in the treatment of RDS, decreasing CPAP time, need for MV, BPD, pneumothorax, PIVH, and mortality when compared to INSURE.


Assuntos
Pneumotórax , Surfactantes Pulmonares , Síndrome do Desconforto Respiratório do Recém-Nascido , Lactente , Recém-Nascido , Humanos , Recém-Nascido Prematuro , Tensoativos/uso terapêutico , Extubação , Pneumotórax/tratamento farmacológico , Surfactantes Pulmonares/uso terapêutico , Intubação , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Hemorragia Cerebral
2.
BMC Pediatr ; 23(1): 608, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-38036980

RESUMO

BACKGROUND: The benefit of surfactant replacement therapy for respiratory distress syndrome (RDS) has been demonstrated. However, some surfactants are expensive and usually inaccessible. Consequently, the Iranian Survanta was produced, but its effect on complications and mortality of RDS is unknown. This study aimed to compare the therapeutic outcomes of Iranian surfactant (beraksurf) and BLES (bovine lipid extract surfactant) on RDS treatment among preterm neonates. METHODS: This triple blinded randomized controlled trial study was performed on 128 eligible neonates diagnosed with RDS in Afzalipour hospital in Kerman, Iran. Diagnosis of RDS, gestational age of 28-34 weeks and weight ≥ 1 kg were considered as inclusion criteria. Congenital anomalies such as congenital cyanotic heart diseases, digestive system anomalies and chromosome abnormalities were the exclusion criteria Neonates were randomly assigned into two equal groups: (1) those treated with BLES (n = 64) and (2) those treated with beraksurf (n = 64). Complications including patent ductus arteriosus (PDA), sepsis, intraventricular hemorrhage (IVH), pneumothorax, pulmonary hemorrhage, mortality, and also, the number of days required for invasive mechanical ventilation (using ventilator) and non-invasive continuous positive airway pressure (CPAP) were evaluated for all neonates. The risk ratio (RR) was calculated at 95% of confidence intervals (CI). RESULTS: Compared with BLES group, the RR estimate among neonates in beraksurf group was 0.89 (0.66-1.20) for PDA, 0.71 (0.23-2.13) for IVH, 0.44 (0.14-1.36) for sepsis, 0.35 (0.13-0.93) for pneumothorax, 0.33 (0.12-0.86) for pulmonary hemorrhage, and 0.55 (0.28-1.05) for mortality. CONCLUSIONS: Despite advances in the use of exogenous surfactants for the treatment of neonatal respiratory distress syndrome; There are still some controversial topics in this field. The results obtained in the present study showed that the two types of surfactant (BERAKSURF and BLES) have similar efficacy for the treatment and short-term outcomes in preterm infants with respiratory distress syndrome. Therefore, due to the cost-effectiveness of BRAKSURF compared to BLES, We recommend choosing BERAKSURF in terms of treatment.


Assuntos
Pneumopatias , Pneumotórax , Surfactantes Pulmonares , Síndrome do Desconforto Respiratório do Recém-Nascido , Sepse , Humanos , Recém-Nascido , Hemorragia Cerebral , Recém-Nascido Prematuro , Irã (Geográfico) , Pneumotórax/tratamento farmacológico , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Sepse/tratamento farmacológico , Tensoativos/uso terapêutico
3.
Surgeon ; 21(6): e378-e406, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37714802

RESUMO

BACKGROUND AND PURPOSE: Thoracic surgeons are now adopting a new method of using a mesh covering to reduce recurrence in surgical pleurodesis for pneumothorax. We aimed to review the literature and compare the outcomes of using mesh covering as an additional procedure during surgical pleurodesis. METHODS: A comprehensive search was performed from inception to October 2022 on PubMed, Embase, Cochrane and Scopus. Randomised controlled trials (RCTs) and observational cohort studies (OCSs) comparing the use of mesh coverage, and different materials were included. Data were extracted to compare recurrence and other outcomes using a random effect model. RESULTS: 23 studies consisting of 2 RCTs and 21 OCSs totalling 5092 patients were included. Patients with a mesh had a significantly lower recurrence (OR = 0.22, 95% CI 0.12-0.42, p < 0.0001) and a shorter duration of chest tube drainage (SMD = -0.74 days, 95% CI -0.28 to -1.20, p < 0.0001) but no significant difference in the length of operation. The use of polyglycolic acid (PGA) and vicryl mesh was associated with a significantly shorter duration of chest tube drainage [(PGA, SMD = 0.83 days, 95% CI 0.14-1.52, p < 0.0001), (vicryl, SMD = 1.06 days, 95% CI 0.71-2.82, p = 0.0005)]. They also had a shorter post-operative length of stay than oxidized regenerative cellulose (ORC) but this was not statistically significant. CONCLUSION: The use of a mesh material reduced the incidence of post-operative air leaks in the short term and the recurrence rate in the long term. Some mesh materials such as PGA and vicryl performed better than other materials.


Assuntos
Pneumotórax , Humanos , Pneumotórax/cirurgia , Pneumotórax/tratamento farmacológico , Telas Cirúrgicas , Poliglactina 910/uso terapêutico , Pleurodese/métodos , Drenagem , Recidiva , Cirurgia Torácica Vídeoassistida/métodos
4.
Pediatr Allergy Immunol Pulmonol ; 35(3): 120-123, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36121784

RESUMO

Background: Necrotizing pneumonia rarely occurs in children, but when it does it can be complicated by bronchopleural fistula, empyema, pneumothorax, sepsis, and acute respiratory distress syndrome (ARDS). Antimicrobial therapy is the cornerstone of its management; however, surgery is necessary in some cases. Ideally, surgical interventions are kept to a minimum, but this is not always possible if there is a mass effect from air and fluid in the pleural space, pulmonary necrosis leading to massive hemoptysis, uncontrolled sepsis, or difficulties with assisted ventilation. Case Presentation: Herein we present a patient with refractory pyopneumothorax and ARDS due to pneumococcal necrotizing pneumonia complicated by a bronchopleural fistula. The patient's clinical condition deteriorated despite antibiotics, surgical drainage, and assisted ventilation. Owing to pneumothorax with a high percentage of air leakage, bilateral diffuse collapse of the lungs, and insufficient oxygenation, surgical treatment was considered, but because of the patient's lack of tolerance for surgery due to hemodynamic reasons and the complications associated with surgery, medical treatment was determined to be more appropriate. Surfactant treatment was administered to the patient, resulting in significant clinical improvement. Conclusion: To the best of our knowledge, this is the first report of the use of surfactant to treat ARDS due to necrotizing pneumonia. Based on the presented case, we think surfactant can be considered as a salvage treatment for such patients.


Assuntos
Fístula Brônquica , Empiema Pleural , Doenças Pleurais , Pneumonia Necrosante , Pneumonia Pneumocócica , Pneumotórax , Síndrome do Desconforto Respiratório , Sepse , Antibacterianos/uso terapêutico , Fístula Brônquica/complicações , Fístula Brônquica/cirurgia , Criança , Empiema Pleural/complicações , Empiema Pleural/tratamento farmacológico , Humanos , Doenças Pleurais/complicações , Doenças Pleurais/tratamento farmacológico , Pneumonia Necrosante/complicações , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/tratamento farmacológico , Pneumotórax/complicações , Pneumotórax/tratamento farmacológico , Síndrome do Desconforto Respiratório/complicações , Síndrome do Desconforto Respiratório/tratamento farmacológico , Sepse/complicações , Sepse/tratamento farmacológico , Streptococcus pneumoniae , Tensoativos
5.
Orphanet J Rare Dis ; 16(1): 466, 2021 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732225

RESUMO

BACKGROUND: Patients with lymphangioleiomyomatosis (LAM) frequently experience pneumothorax. Although sirolimus is the standard therapy for LAM, its effect on pneumothorax is controversial. Recently, total pleural covering (TPC) and modified TPC (mTPC) were introduced as surgical treatment options for pneumothorax for patients with LAM. However, the effect of sirolimus on the recurrence of pneumothorax in patients who underwent the treatments is still uncertain. We hypothesized that some clinical factors including sirolimus treatment could predict postoperative recurrence of pneumothorax. In order to clarify this hypothesis, we retrospectively analyzed the clinical data from 18 consecutive patients with LAM who underwent 24 surgical pleural covering of entire lung (SPC) as 17 TPC and 7 mTPC against pneumothoraces from surgical database between January 2005 and January 2019, and we determined the predictors of postoperative recurrence. RESULTS: Of the 24 surgeries of SPC, 14 surgeries (58.3%) had a history of two or more ipsilateral pneumothoraces, and 11 surgeries (45.8%) had a history of ipsilateral pleural procedures before SPC. Sixteen surgeries (66.6%) in 12 patients received treatment of sirolimus after SPC (sirolimus group). With a median follow-up time of 69.0 months after SPC, four surgeries (16.6%) in three patients had a postoperative recurrence, and the 5-year recurrence-free survival (RFS) after SPC was 82.9%. In patients with postoperative recurrence, serum level of vascular endothelial growth factors D was significantly higher than that in those with non-recurrence (3260.5 vs. 892.7 pg/mL, p = 0.02), and the rate of sirolimus treatment in the recurrence group was significantly lower than that in the no-recurrence group (0 vs. 80%, p = 0.006). The log-rank test showed that the RFS of the sirolimus group (sirolimus use after SPC) was significantly better than that of the non-sirolimus group (p = 0.001), and no significant difference was observed for other factors. CONCLUSION: We first reported sirolimus might effectively suppress the recurrence of pneumothoraces in LAM patients who received SPC. Sirolimus induction after SPC (TPC or mTPC) might be a feasible option for frequent pneumothorax in LAM.


Assuntos
Neoplasias Pulmonares , Linfangioleiomiomatose , Pneumotórax , Humanos , Pulmão , Linfangioleiomiomatose/tratamento farmacológico , Linfangioleiomiomatose/cirurgia , Recidiva Local de Neoplasia/tratamento farmacológico , Pneumotórax/tratamento farmacológico , Pneumotórax/etiologia , Pneumotórax/cirurgia , Estudos Retrospectivos , Sirolimo/uso terapêutico
6.
Zhonghua Jie He He Hu Xi Za Zhi ; 44(7): 619-623, 2021 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-34256448

RESUMO

Objective: To explore the efficacy and safety of position selection in combination with intra-pleural thrombin injection in the treatment of persistent air leakage (PAL) after medical thoracoscopic treatment of bullous pulmonary-pleural diseases (e.g. spontaneous pneumothorax or giant emphysematous bulla). Methods: This was a prospective study conducted in Rizhao Hospital of Traditional Chinese Medicine from August 2018 to November 2020. Twenty patients(19 males,1 female) with a mean age of (62.3±8.1) years met the diagnostic criteria for PAL which was defined as the air leak persisted more than 3 days despite of the closed thoracic drainage after medical thoracoscopic treatment of bullous pulmonary-pleural diseases.They received the following treatment procedures (referred to as "position plus"):①Pleural cavity injection (50% glucose 20 ml+thrombin 5 000 U).②Changing the patient's position under continuous negative pressure suction to find the position causing the complete stop or significant reduction of air leakage, and keeping in the position for 24-48 hours.③If the PAL wasn't stopped 48 hours later, the procedures above would be repeated.The duration of air leakage after "position plus", times of pleural cavity injection, condition of lung re-expansion, recurrence of air leakage and complications during hospitalization were recorded. Descriptive statistics were used to summarize the results:¯x±s or M(P25, P75) for continuous variables; frequency and percentages for categoric variables. Results: A total of 20 patients were included. The average duration of air leakage after"position plus" was (1.32±0.97) days. The times of pleural cavity injection required were 1.0(1.0, 1.0).All the patients showed good lung re-expansion in review of imaging after PAL was stopped. One patient had recurrent air leakage during hospitalization. No serious complications occurred. Conclusion: The comprehensive "position plus" intervention method is effective, safe and easily operating for the treatment of PAL after medical thoracoscopic treatment of bullous pulmonary-pleural diseases.


Assuntos
Pneumotórax , Trombina , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleura/diagnóstico por imagem , Pleura/cirurgia , Pneumonectomia , Pneumotórax/diagnóstico por imagem , Pneumotórax/tratamento farmacológico , Pneumotórax/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Prospectivos
10.
Cardiovasc Intervent Radiol ; 42(6): 915-919, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30843091

RESUMO

PURPOSE: The purpose of this technical report is to describe the technique of intratumoral injection of hypertonic glucose combined with low-negative pressure drainage to treat refractory pneumothorax (RP) after microwave ablation (MWA) of lung tumors. MATERIALS AND METHODS: Between September 2016 and May 2018, four patients who developed RP after MWA of peripheral lung cancer were managed by a combined method, including intratumoral injection of hypertonic glucose and catheter drainage under low-negative pressure. Blood gas values were recorded and compared before the treatment and one-week posttreatment. All patients were followed up for at least one month to monitor the possible recurrence of pneumothorax by chest CT. RESULTS: All patients were successfully treated. One patient received the intratumoral injection of hypertonic glucose twice, while the remaining three patients received a single injection. The technical success rate was 100%. Dyspnea related to RP was significantly relieved in all patients, and PaO2 and SaO2 values were higher than those measured before treatment. No patient suffered a recurrence of pneumothorax during the follow-up. CONCLUSION: The combined method of intratumoral injection of hypertonic glucose and continuous catheter drainage under low-negative pressure might be an effective method to manage RP caused by MWA.


Assuntos
Técnicas de Ablação/efeitos adversos , Glucose/uso terapêutico , Neoplasias Pulmonares/cirurgia , Pneumotórax/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Glucose/administração & dosagem , Humanos , Injeções Intralesionais , Pulmão/diagnóstico por imagem , Masculino , Micro-Ondas , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Intern Med ; 58(8): 1137-1140, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30568135

RESUMO

A 64-year-old man who presented with repeated bouts of pneumothorax was admitted to our hospital because of gradually progressive dyspnea and repeated episodes of a fever. The physiological, radiological and pathological findings were consistent with pleuroparenchymal fibroelastosis (PPFE). In addition, the serum-specific precipitating antibody for Aspergillus was positive. After the administration of voriconazole, a marked improvement was observed in the imaging and physiological findings. Given this clinical course, we diagnosed the patient with PPFE secondary to aspergillosis. The present case suggests that a therapeutic approach based on the cause of secondary PPFE may improve the prognosis of PPFE.


Assuntos
Antifúngicos/uso terapêutico , Dispneia/tratamento farmacológico , Fibroelastose Endocárdica/tratamento farmacológico , Fibroelastose Endocárdica/microbiologia , Pneumotórax/tratamento farmacológico , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/tratamento farmacológico , Doença Crônica/tratamento farmacológico , Dispneia/etiologia , Fibroelastose Endocárdica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Aspergilose Pulmonar/fisiopatologia , Resultado do Tratamento
12.
Orphanet J Rare Dis ; 13(1): 168, 2018 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-30241551

RESUMO

Pneumothorax is one of the most common symptoms in patients with lymphangioleiomyomatosis (LAM). However, current management strategies for patients with LAM who present with recurrent pneumothorax remain inadequate. Here, we describe the successful prevention of recurrent pneumothorax by sirolimus treatment in five women with LAM. Before sirolimus treatment, all patients had received supplemental oxygen support, repeated chest tube drainage, or surgeries for management of the recurrent pneumothorax. Sirolimus treatment was initiated when the pneumothorax was completely resolved, and no patient developed pneumothorax during treatment. Moreover, they exhibited a significantly improved subjective quality of life, increased exercise capacity, and mild adverse effects such as mucositis, irregular menstruation, and delayed wound healing. On discontinuation of sirolimus or in the event that the plasma sirolimus level was markedly low, pneumothorax tended to relapse. The findings from these cases provide valuable insights that will aid in the improvement of treatment strategies for patients with LAM and recurrent pneumothorax.


Assuntos
Linfangioleiomiomatose/tratamento farmacológico , Pneumotórax/tratamento farmacológico , Sirolimo/uso terapêutico , Adulto , Feminino , Humanos , Linfangioleiomiomatose/sangue , Pneumotórax/sangue , Qualidade de Vida , Sirolimo/sangue , Adulto Jovem
13.
BMJ Case Rep ; 20182018 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-30061139

RESUMO

Coccidioides is a fungus endemic to Southwestern USA and Northern Mexico which can be asymptomatic or result in a well-defined clinical syndrome of community-acquired pneumonia. On rare occasion, coccidioidomycosis may have atypical presentations as in our patient, a 25-year-old man admitted with a 2-month history of progressive dyspnoea and cough. He was found to have a large right-sided pneumothorax with exudative pleural effusion which did not resolve following thoracentesis. Decortication was performed which revealed a dense rind of inflammatory tissue covering all lobes of his right lung. Histopathology demonstrated hyphae resembling Aspergillus, but culture and serology confirmed Coccidioides immitis Following several months of antifungal therapy, he achieved complete clinical recovery with near-complete resolution of radiographic findings.


Assuntos
Antifúngicos/uso terapêutico , Coccidioides/isolamento & purificação , Coccidioidomicose/diagnóstico , Tosse/microbiologia , Pneumopatias Fúngicas/diagnóstico , Pneumotórax/microbiologia , Adulto , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/fisiopatologia , Dispneia/microbiologia , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/fisiopatologia , Masculino , Pneumotórax/tratamento farmacológico , Pneumotórax/fisiopatologia , Resultado do Tratamento
14.
J Cardiothorac Surg ; 13(1): 7, 2018 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29334967

RESUMO

OBJECTIVES: To investigate the risk factors and treatment strategies for pneumothorax secondary to granulomatosis with polyangiitis (GPA). METHOD: Retrospective analysis of cases with pneumothorax secondary to GPA from our own practice and published on literature. RESULTS: A total of 25 patients, 18 males and 7 females, mean age 44 ± 15.7 years, were analyzed. Diagnosis included pneumothorax (11 cases), hydropneumothorax (n = 5), empyema (n = 8) and hemopneumothorax (n = 1). 88% (22/25) patients showed single/multiple pulmonary/ subpleural nodules with/without cavitation on chest imaging. Erythrocyte sedimentation rate and C-reactive protein were both elevated. Corticosteroids and immunosuppressive agents were used in 16 cases. Five cases received steroid pulse therapy, of which 4 patients survived. Pleural drainage was effective in some patients. Seven patients underwent surgical operations. In the 10 fatal cases, infection and respiratory failure were the most common cause. Lung biopsy/ autopsy showed lung/pleural necrotizing granulomatous vasculitis, breaking into the chest cavity, pleural fibrosis, bronchial pleural fistula, etc. The mean age in the death group was greater than the survival group (53 ± 12.9 years vs 40.1 ± 14.7 years, p = 0.05), the ineffective pleural drainage was also higher in the death group (5/5 vs 0/7, p = 0.01). CONCLUSIONS: Pneumothorax was seen in the active GPA, due to a variety of reasons, and gave rise to high fatality rate. Aggressive treatment of GPA can improve the prognosis. Older and lack of response for pleural drainage indicates poor prognosis.


Assuntos
Granulomatose com Poliangiite/mortalidade , Pneumotórax/mortalidade , Adolescente , Adulto , Idoso , China , Feminino , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/cirurgia , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pneumotórax/complicações , Pneumotórax/tratamento farmacológico , Pneumotórax/cirurgia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Respirology ; 23(1): 55-59, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28980363

RESUMO

BACKGROUND AND OBJECTIVE: Talc pleurodesis is commonly performed to manage refractory pleural effusion or pneumothorax. It is considered as a safe procedure as long as a limited amount of large particle size talc is used. However, acute respiratory distress syndrome (ARDS) is a rare but serious complication after talc pleurodesis. We sought to determine the risk factors for the development of ARDS after pleurodesis using a limited amount of large particle size talc. METHODS: We retrospectively reviewed patients who underwent pleurodesis with talc or OK-432 at the University of Tokyo Hospital. RESULTS: Twenty-seven and 35 patients underwent chemical pleurodesis using large particle size talc (4 g or less) or OK-432, respectively. Four of 27 (15%) patients developed ARDS after talc pleurodesis. Patients who developed ARDS were significantly older than those who did not (median 80 vs 66 years, P = 0.02) and had a higher prevalence of underlying interstitial abnormalities on chest computed tomography (CT; 2/4 vs 1/23, P < 0.05). No patient developed ARDS after pleurodesis with OK-432. This is the first case series of ARDS after pleurodesis using a limited amount of large particle size talc. CONCLUSION: Older age and underlying interstitial abnormalities on chest CT seem to be risk factors for developing ARDS after talc pleurodesis.


Assuntos
Doenças Pulmonares Intersticiais/complicações , Pleurodese/efeitos adversos , Síndrome do Desconforto Respiratório/etiologia , Talco/efeitos adversos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Picibanil/uso terapêutico , Derrame Pleural/complicações , Derrame Pleural/tratamento farmacológico , Pleurodese/métodos , Pneumotórax/complicações , Pneumotórax/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
16.
Interact Cardiovasc Thorac Surg ; 26(2): 319-322, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29049784

RESUMO

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether hormonal manipulation with gonadotrophin-releasing hormone analogues reduces the risk of recurrent catamenial pneumothorax after surgery, compared with surgery alone. Altogether 819 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, date, journal, country of publication, study type, level of evidence, patient group studied, relevant outcomes and results of these papers are tabulated. Of the 7 papers selected, 6 demonstrated a reduction in recurrence of catamenial pneumothorax with the use of gonadotrophin-releasing hormone analogues, whereas in the single paper where surgery alone was performed, no evidence of recurrence was demonstrated. We therefore conclude that, based on very small retrospective observational studies, gonadotrophin-releasing hormone analogues used as an adjunct to surgical intervention may reduce the risk of recurrent pneumothorax, when compared with either no hormonal therapy or oestrogen-progesterone therapy, but should be initiated and supervised by gynaecologists who will be familiar with the therapy and the potential side effects.


Assuntos
Hormônios/uso terapêutico , Pneumotórax/tratamento farmacológico , Prevenção Secundária/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adulto , Feminino , Humanos , Pneumotórax/etiologia , Recidiva , Estudos Retrospectivos
17.
Kyobu Geka ; 70(12): 980-984, 2017 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-29104195

RESUMO

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is the standard treatment for patients with spontaneous pneumothorax (SP). However, postoperative recurrence is not infrequent even with an absorbable covering sheet used to reinforce the visceral pleura. Recent reports suggest that intraoperative injection of a highly concentrated glucose solution into the thoracic cavity provides effective prophylaxis against postoperative SP recurrence. Since September 2015, we have been injecting 50 ml of 50 % glucose solution intraoperatively for pleural coating (GPC) around an absorbable sheet to prevent postoperative SP recurrence. METHODS: We evaluated 340 patients who underwent VATS between February 2011 and June 2017(88 patients:GPC group, 252:non-GPC group), and we retrospectively analyzed the efficacy of GPC in preventing postoperative SP recurrence. RESULTS: One year postoperative recurrence rates of GPC and non-GPC groups were 9.0 and 17.9%,respectively. The log-rank test revealed GPC as a significant factor in preventing postoperative recurrence (p=0.020). No severe adverse events occurred in either group. Minor postoperative complications, viz., high blood sugar, high volume of chest tube drainage occurred in the GPC group. CONCLUSION: Application of GPC is beneficial in reducing postoperative recurrence of SP.


Assuntos
Glucose/uso terapêutico , Pleura , Pneumotórax/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pneumotórax/etiologia , Recidiva , Estudos Retrospectivos , Fatores de Tempo
18.
Intern Med ; 56(23): 3243-3247, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29021472

RESUMO

Pneumothorax secondary to septic pulmonary embolism (SPE) is rare but life-threatening. We herein report a long-term hemodialysis patient with psoas abscess caused by methicillin-resistant Staphylococcus aureus, associated with other muscle and splenic abscesses and SPE. Intravenous vancomycin treatment and percutaneous drainage of the psoas abscess rapidly improved her condition. However, the SPE lesions continued to increase, and right-sided pneumothorax occurred 10 days after treatment. The pneumothorax resolved after two months and SPE and all abscesses after four months of treatment. Since late-onset pneumothorax caused by SPE can occur despite successful treatment of the primary infection, care should be taken with such patients.


Assuntos
Pneumotórax/tratamento farmacológico , Pneumotórax/etiologia , Abscesso do Psoas/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia , Diálise Renal/efeitos adversos , Vancomicina/uso terapêutico , Abscesso/microbiologia , Abscesso/fisiopatologia , Feminino , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Pessoa de Meia-Idade , Abscesso do Psoas/microbiologia , Insuficiência Renal/terapia , Resultado do Tratamento
19.
J Obstet Gynaecol Can ; 39(9): 764-768, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28647447

RESUMO

BACKGROUND: Catamenial pneumothorax is a rare but serious condition for women of reproductive age. We describe a trial of dienogest as hormonal therapy for catamenial pneumothorax and review the literature on hormonal suppressive therapy for this condition. CASE: A 39-year-old female, gravida 0 para 0, presented with recurrent pneumothoraces coinciding with her menses. After surgical therapy, she was started on leuprolide acetate injections for 6 months to reduce recurrence. To reduce long-term side effects of leuprolide acetate, the patient was started on dienogest 4 mg orally once daily instead of leuprolide acetate for hormonal suppression and experienced resolution of recurrent pneumothoraces. CONCLUSION: For women with recurrent catamenial pneumothorax, dienogest may be an effective hormonal treatment option and alternative to long-term GnRH agonist therapy for long-term suppression.


Assuntos
Antagonistas de Hormônios/uso terapêutico , Leuprolida/uso terapêutico , Nandrolona/análogos & derivados , Pneumotórax/tratamento farmacológico , Adulto , Feminino , Humanos , Nandrolona/uso terapêutico
20.
J Obstet Gynaecol Res ; 43(7): 1227-1231, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28503772

RESUMO

Thoracic endometriosis syndrome (TES) is a rare disorder presenting with catamenial pneumothorax, hemothorax, hemoptysis or pulmonary nodules. Bilateral involvement is uncommon, and only a very few cases have been reported in the literature. We report a case of bilateral catamenial hemothorax in a patient with recurrent thoracic endometriosis. Despite multiple surgical interventions, the patient continued to develop hemopneumothorax coinciding with menses. Remission was finally achieved with the addition of gonadotropin-releasing hormone agonist, highlighting the effectiveness of postoperative adjuvant hormone therapy and supporting a combined surgical and medical approach in the treatment of TES in patients who desire future fertility.


Assuntos
Endometriose/complicações , Hemotórax/etiologia , Ciclo Menstrual , Pneumotórax/etiologia , Adulto , Endometriose/tratamento farmacológico , Feminino , Hemotórax/tratamento farmacológico , Humanos , Pneumotórax/tratamento farmacológico , Recidiva
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