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Article in Chinese | WPRIM | ID: wpr-878722


Objective To evaluate the efficacy and risks of autologous blood patch pleurodesis in patients with persistent air leak(PAL)after lung resection. Methods A total of 97 patients with PAL after lung resection in Beijing Shijitan Hospital from October 2014 to October 2019 were retrospectively reviewed,including 53 treated by autologous blood patch pleurodesis and 44 by the conventional way.The therapeutic effect,adverse reactions and complications were analyzed. Results All the patients with PAL were cured with autologous blood patch pleurodesis.Most air leaks(81.1%)ceased within 48 hours after treatment,and the left 18.9% patients got cured after a repeat.The mean tube retention time and the mean in-hospital stay were 8.4 days and 10.0 days in the autologous blood patch pleurodesis group and 13.5 days and 15.3 days in the conventional treatment group.A prolonged drainage time(P=0.00)and in-hospital stay(P=0.00)were observed in the conventional treatment group.No severe complications were observed except two patients developed slight fever and cutaneous emphysema. Conclusion In our experience,the autologous blood patch pleurodesis is an effective way with low risk of adverse reactions in the treatment of PAL.

Drainage , Humans , Length of Stay , Lung , Pleurodesis , Retrospective Studies
Rev. cuba. med ; 59(4): e1577, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144505


Introducción: El derrame pleural recidivante maligno se reproduce en breve tiempo y requiere el diagnóstico etiológico positivo de malignidad, la etiología más frecuente es el cáncer de pulmón. La pleurodesis química es el tratamiento de elección con la aplicación intrapleural de sustancias sinfisiantes. Objetivo: Describir la respuesta clínica y radiológica de los enfermos con derrame pleural recidivante maligno con el uso de bleomicina. Método: Estudio observacional comparativo en 30 pacientes con derrame pleural recidivante maligno divididos en dos grupos, en uno se aplicó la bleomicina intrapleural y al otro yodo povidona. Resultado: El 33,3 por ciento fueron del sexo masculino, 60 por ciento perteneció al grupo de edades de 60-69 años. El grupo tratado con bleomicina presentó una respuesta clínica favorable en los síntomas, p<0,005 después de la pleurodesis. En la evaluación de la respuesta radiológica, 66,6 por ciento pacientes tratados con la bleomicina tuvieron una resolución completa. Conclusiones: Se logró una buena respuesta clínica-radiológica con la pleurodesis química similar entre ambas modalidades de tratamiento. Se obtuvieron mejores resultados y menos reacciones adversas con la bleomicina intrapleural(AU)

Introduction: The malignant recurrent pleural effusion reproduces in short time and it requires a positive etiological diagnosis of malignancy, the most frequent etiology is lung cancer. Chemical pleurodesis is the treatment of choice with the intrapleural application of symphysiating substances. Objective: To describe the clinical and radiological response of patients with malignant recurrent pleural effusion with the use of bleomycin. Method: A comparative observational study in 30 patients with recurrent malignant pleural effusion was carried out. They were divided into two groups, one used intrapleural bleomycin and the other group used povidone iodine. Result: 33.3 percent were male, 60 percent belonged to the 60-69 age group. The group treated with bleomycin presented favorable clinical response in symptoms, p <0.005 after pleurodesis. At the evaluation of the radiological response, 66.6 percent patients treated with bleomycin had a complete resolution. Conclusions: Good clinical-radiological response was achieved with similar chemical pleurodesis between both treatment modalities. Better results and fewer adverse reactions were obtained with intrapleural bleomycin(AU)

Humans , Male , Female , Bleomycin/therapeutic use , Pleural Effusion, Malignant/drug therapy , Lung Neoplasms/etiology , Observational Study
Article | IMSEAR | ID: sea-205207


Objective: To determine the efficacy of doxycycline as pleuridising agent in cases of malignant pleural effusions (MPE). Subject and methods: This was a descriptive case series that was conducted at Medical and Pulmonology Department of Combined Military Hospital Lahore from January 2018 to August 2018. In this study, the cases of malignant pleural effusion assessed on history and proven by histopathology on any biopsy of either gender falling in range of 30 years or more were included. The pleural fluid was drained by appropriate size intercostal chest tube (ICT). These cases then underwent pleurodesis with Doxycycline. For pleurodesis 10 capsule of Doxycycline each carrying 100 mg in it were taken and mixed with 50 ml of normal saline. A repeat chest X-ray and USG chest was done to see for presence of fluid, complete absence of fluid was labelled as efficacious pleurodesis. Results: In this study, there were total 60 cases of malignant pleural effusion (MPE) included, out of which 35 (58.33%) were females and 25 (41.67%) females. The mean age of the subjects was 57.32 ± 7.28 years. There were 29 (48.33%) cases with CA breast, 22 (36.67%) with CA lung and 9 (15%) had the other miscellaneous malignancies. The efficacy of pleurodesis with Doxycycline was seen in 26 (43.33%) of cases. There was significant better efficacy (p=0.001) in cases that had pleural effusion less than 1 liter at presentation where it was seen in 14 (63.64%) of cases as compared to 12 (31.58%) cases that had effusion less than 1 liter. There was no significant difference in terms of duration of pleural effusion with p=0.21. Conclusion: Doxycycline is efficacious in almost half of the cases and it is significantly better in cases that had effusion less than 1 liter.

ACM arq. catarin. med ; 48(4): 26-34, out.-set. 2019.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1048202


Objetivo: verificar a eficácia e analisar possíveis alterações toxicológicas da indução de pleurodese com hipoclorito de sódio a 1% em modelos animais. Métodos: ensaio pré-clínico, randomizado com coelhos albinos (G1 e G2). Em G1 realizou-se pleurodese através da instilação 10ml de solução de hipoclorito de sódio a 1%. Em G2, 10ml de solução fisiológica a 0,9%. Traçaram-se perfis bioquímicos, de ambos os grupos, prés e pós-operatórios, para identificar alterações toxicológicas, comparados através do Teste Wilcoxon. Os animais foram eutanasiados, aleatoriamente, após 1, 7 ou 30 dias para autópsia, determinando a eficácia da pleurodese conforme a presença ou não de aderências na cavidade torácica. Os grupos foram comparados através do teste qui-quadrado (p<0,05). O projeto de pesquisa foi aprovado pelo comitê de ética em pesquisa em animais da Universidade Regional de Blumenau sob o protocolo 022/04. Resultados: foram incluídos 44 coelhos, 21 pertencentes ao G1 e 23 ao G2. 90,48% dos animais de G1 apresentaram aderências pleurais e apenas 10% de G2 (p <0,001). Quanto à análise da toxicidade, verificaram-se alterações significativas referentes às enzimas preditoras das funções cardíaca e hepática em ambos os grupos. Conclusões: a pleurodese com hipoclorito de sódio mostrou-se eficaz. As alterações bioquímicas em ambos os grupos devem-se, provavelmente, a um fator intrínseco do procedimento e não às substâncias. Não foram evidenciados prejuízos significativos decorrentes da solução proposta.

Aims: to verify the efficacy and possible toxicological alterations of the 1% sodium hypochlorite solution in the induction of pleurodesis in albino rabbits. Methods: randomized preclinical trial (G1 and G2) with rabbits. In the G1 the pleurodesis was done by the instilation of 10ml of a 1% sodium hypochlorite solution (SHS), and in the G2 by the instilation of 10ml of physiological solution (0,9%). Preoperatory and postopetary biochemical profiles were done in both groups in order to identify toxicological alterations. These profiles were compared by the Wilxcoxon Test. The animals were randomly euthanized after one, seven or thirty days for an autopsy. The efficiency of the pleurodesis was measured according to the presence or not of macroscopic adhesions in the thoracic cavity. Findings in both groups were compared by the chi-square test (p<0,05). The research project was approved by the ethical committee envolving animals research of the Regional University of Blumenau under the protocol 022/04. Results: 44 rabbits were included. 21 from G1 and 23 from G2. 90,48% of the G1 animals showed pleural adhesions while 10% of the G1 did. Concerning the toxicologycal analysis, signifficant alterations were found in the cardiac and hepatic enzymes in both groups. Conclusion: pleurodesis induced by the SHS was shown to be effective. G1 and G2 exhibited toxicologycal alterations probably due to an intrinsic factor of the procedure and not caused by the different solutions used. The animals responded well to the proposed agent, no systemic effects were evidenced.

Article | IMSEAR | ID: sea-209390


Background: Tetracycline, talc, and bleomycin have been proved to be effective in recurrent spontaneous pneumothorax andmalignant pleural effusion. Recent studies have shown the efficacy of 2% betadine in pleurodesis.Objective: The objective of this study was to find out the success rate of 2% betadine in pleurodesis in patients with recurrentspontaneous pneumothorax and malignant pleural effusions.Materials and Methods: The study was conducted in SVS Medical College, Mahabubnagar Dist., Telangana, during the periodof May 2016 - Feb 2019. Patients with malignant pleural effusion and recurrent spontaneous pneumothorax were taken intoconsideration. About 2% betadine with xylocaine was used in this study.Results: A total of 26 patients underwent pleurodesis. Eighteen patients had malignant pleural effusion and eight patients hadrecurrent spontaneous pneumothorax. Of 26 patients, 23 (88.5%) patients had successful pleurodesis. Among 23 patients whohad underwent successful pleurodesis, 16 had malignant pleural effusion and seven had recurrent spontaneous pneumothorax.Conclusion: In our observation, we have seen that pleurodesis with 2% betadine is very effective and inexpensive in pleurodesiswithout many complications

Article | IMSEAR | ID: sea-202393


Introduction: Pleural effusion is one of the most frequentlyencountered pathology in our hospital. Thoracocentesis,thoracostomy, pleurodesis is the most commonly usedtreatment options for recurrent and persistent pleural effusion.Sterile talc powder is most commonly used as an sclerosingagent. In our study we have used sodium tetradecyl sulfateas a newer sclerosing agent and we have compared thecomplication rate, clinical response and success rate inboth sodium tetradecyl sulfate and talc sclerosing agent forpleurodesis. Study aimed to compare the safety and efficacyof the sodium tetradecyl sulfate and talc as a pleurodesis agentin pleural effusion cases.Material and methods: Pleural effusion cases (both malignantand non-malignant cases) were randomly allocated into groupA or group B. Group A patients were treated with 60mg of3% sodium tetradecyl sulfate, Group B patients were treatedwith 2 grams of sterile talc powder. Clinical data regardinggeneral complications, the rate of success, reduction in ICDdrainage and lung expansion were noted for every patient whounderwent pleurodesis.Results: 25 patients were allocated in each group. Patientscharacteristics were balanced between the two groups withthe majority of pleural effusion malignant in etiology. There isa statistically significant difference between the use of sodiumtetradecyl sulfate and talc in clinical response, ICD drainageand lung re-expansion. Sodium tetradecyl sulfate patient hasbetter lung reexpansion and clinical response in comparison totalc powder. The general complication was observed to be lowwith sodium tetradecyl sulfate than talc pleurodesis.Conclusion: Sodium tetradecyl sulfate pleurodesis appearsto have better pleurodesis effect than talc pleurodesis in ourstudy

Rev. gastroenterol. Perú ; 39(1): 64-69, ene.-mar. 2019. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1014127


El hidrotórax hepático (HH) se define como un derrame pleural mayor de 500 ml en pacientes con cirrosis e hipertensión portal. Representa una complicación infrecuente por lo general asociada con ascitis y su origen se relaciona con el paso de líquido ascítico a través de pequeños defectos en el diafragma de predominio en el hemitórax derecho. Una vez establecido el diagnóstico por imágenes, la toracentesis diagnostica permite confirmar un trasudado. La terapia inicial está basada en la restricción de sodio y el uso combinado de diuréticos. El 20-25% de los pacientes desarrolla un HH refractario, el cual requiere intervenciones invasivas tales como la derivación percutánea portosistémica intrahepática (DPPI), la reparación de los defectos diafragmáticos por videotoracoscopia asistida asociada a pleurodésis química y el uso de un catéter pleural tunelizado. No se recomienda la inserción de un tubo de tórax por su elevada morbilidad y mortalidad. El tratamiento definitivo del HH es el trasplante hepático el cual alcanza una excelente sobrevida. Presentamos tres casos de hidrotórax hepático con diferentes enfoques terapéuticos que incluyeron el manejo conservador con dieta y diuréticos, la inserción fallida de un tubo de tórax con pleurodesis y una DPPI.

Hepatic hydrothorax is uncommon transudative pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. Ascites is also present in most of the patients and the pathophysiology include the passage of ascites fluid through small diaphragmatic defects. After diagnostic thoracentesis studies, the first line management is restricting sodium intake and diuretics combination including stepwise dose of spironolactone plus furosemide. Therapeutic thoracentesis is a simple and effective procedure to relief dyspnea. Hepatic hydrothorax is refractory in approximately 20-25% and treatments options include repeated thoracentesis, transjugular intrahepatic portosystemic shunts (TIPS) placement, chemical pleurodesis with repair diaphragmatic defects using video-assisted thoracoscopy surgery (VATS), and insertion of an indwelling pleural catheter. Chest tube insertion carries significant morbidity and mortality with questionable benefit. Hepatic transplantation remains the best treatment option with long term survival. We present three cases of hepatic hydrothorax with different therapeutic approach including first line management, failed chest tube insertion and TIPS placement.

Organ Transplantation ; (6): 192-2019.
Article in Chinese | WPRIM | ID: wpr-780514


Objective To explore the treatment strategies of pleuroparenchymal fibroelastosis (PPFE). Methods A 22-year-old male patient was complicated with PPFE after receiving chemotherapy in combination with stem cell transplantation for lymphoma. He underwent thoracoscopic left lung tongue wedge resection, bilateral pleurodesis followed by allogeneic left lung transplantation. Literature review was performed to analyze the etiology, pathogenesis, imaging features, pathological features and treatment of PPFE. Results The PPFE patient required the non-invasive ventilator for 24 h before lung transplantation. After lung transplantation, the shortness of breath and respiratory failure were cured and the quality of life was significantly improved. No eligible studies was found in the domestic database, and 26 literatures published in English were found in the international databases. Among them, 9 literatures (case reports) were finally included after screening. PPFE could be divided into the primary and secondary categories according to the etiology. The clinical manifestations of PPFE mainly included dry cough, dyspnea on exertion, chest pain, repeated pneumothorax and body weight loss. Chest CT scan demonstrated irregular thickening of the pleura in bilateral upper lungs. Pathological manifestations consisted of evident thickening of the visceral pleura, fibroelastosis and arrangement disorder in the pleura and the underlying pulmonary interstitium. PPFE could progress rapidly. Adrenocortical hormone and other immunosuppressive agents yielded low clinical efficacy and poor clinical prognosis. Lung transplantation was a necessary treatment for PPFE. Conclusions PPFE cannot be effectively treated by conservative therapy. It is recommended to deliver lung transplantation as early as possible.

Neonatal Medicine ; : 233-239, 2019.
Article in Korean | WPRIM | ID: wpr-786435


Chylothorax, the accumulation of chyle in the pleural space, is a rare condition, but can lead to serious complications in neonates. Conservative therapy for chylothorax includes enteral feeding with medium-chain triglyceride-enriched diet or parenteral nutrition and administration of octreotide. Surgical management is considered in cases where there is no response to conservative therapy; however, the standardized approach to refractory neonatal chylothorax is still controversial. Chemical pleurodesis can be used when medical therapies for chylothorax fail, to avoid more invasive surgical procedures. We report an extremely preterm infant born at 26 weeks of gestation with refractory chylothorax after patent ductus arteriosus ligation. The infant was successfully treated with pleurodesis using 4% povidone-iodine, without long-term side effects.

Chyle , Chylothorax , Diet , Ductus Arteriosus, Patent , Enteral Nutrition , Humans , Infant , Infant, Extremely Low Birth Weight , Infant, Extremely Premature , Infant, Newborn , Infant, Premature , Ligation , Octreotide , Parenteral Nutrition , Pleurodesis , Povidone-Iodine , Pregnancy
Rev. inf. cient ; 98(6): 794-801, 2019. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1049404


Se reportó un caso de paciente femenina, mestiza de 29 años de edad con antecedentes de hipotiroidismo y conización por neoplasia intraepitelial cervical grado II, que realizó tres neumotórax en un plazo de 2 años, estando en reposo y durante el segundo día del ciclo menstrual. Es ingresada en la sala de Neumología del Hospital General "Dr. Juan Bruno Zayas Alfonso", con el diagnóstico probable de neumotórax secundario a endometriosis pleural. Se le realizó videotoracoscopia y laparoscopia con toma de muestra para estudio histológico. Se estableció el diagnóstico definitivo de neumotórax catamenial, se le hizo pleurodesis química con talco, tratamiento hormonal y antiinflamatorios no esteroideos (AINES), con lo que presentó una evolución satisfactoria(AU)

A case of a 29-year-old female, mixed race patient with a history of hypothyroidism and conization due to cervical intraepithelial neoplasia grade II was reported, who performed three pneumothorax within 2 years, being at rest and during the second day of the menstrual cycle. She is admitted to the Pulmonology ward of the General Hospital Dr. Juan Bruno Zayas Alfonso, with the probable diagnosis of pneumothorax secondary to pleural endometriosis. He underwent videotoracoscopy and laparoscopy with sampling for histological study. The definitive diagnosis of catamenial pneumothorax was established, chemical pleurodesis was made with talc, hormonal treatment and nonsteroidal anti-inflammatory drugs (NSAIDs), which presented a satisfactory evolution(AU)

Foi relatado o caso de uma paciente do sexo feminino, 29 anos, de raça mista, com história de hipotireoidismo e conização por neoplasia intraepitelial cervical grau II, que realizou três pneumotórax em 2 anos, estando em repouso e durante o segundo dia do ciclo menstrual. Ela é internada na enfermaria de Pneumologia do Hospital Geral "Dr. Juan Bruno Zayas Alfonso", com provável diagnóstico de pneumotórax secundário à endometriose pleural. Foi submetido a videotoracoscopia e laparoscopia com amostragem para estudo histológico. Foi estabelecido o diagnóstico definitivo de pneumotórax catamenial, realizada pleurodese química com talco, tratamento hormonal e antiinflamatórios não esteróides (AINEs), que apresentaram evolução satisfatória(AU)

Humans , Female , Adult , Pneumothorax/diagnosis , Pneumothorax/therapy , Pneumothorax/diagnostic imaging
Article | IMSEAR | ID: sea-185198


Setting: Department of Respiratory Medicine, Geetanjali medical college and hospital, Udaipur Aim: The study the efficacy and safety of povidone iodine in chemical pleurodesis Methodology: A mixture of 20 ml of 10% povidone-iodine + 10 ml of 2% lignocaine + 70 ml of Normal saline was inserted through intercostal drainage tube. Results: Total of 68 patients were taken into the study. Out of all, forty nine patients (72%) achieved confirmed complete response to treatment while nine patients (13.2%) achieved partial response. Failure of treatment was seen in ten (14.7%) patients. The overall success rate was 85.2%. Conclusions: Pleurodesis with povidone iodine is a safe and effective method which can be used for chemical pleurodesis.

Military Medical Sciences ; (12): 64-67, 2018.
Article in Chinese | WPRIM | ID: wpr-694318


Objective To investigate the effect and feasibility of pleurodesis in the treatment of systemic lupus erythematosus(SLE)complicated with refractory pleural effusion.Methods The clinical data on four patients were diagnosed with SLE complicated with refractory pleural effusion and received pleurodesis was retrospectively analyzed.At the same time,using such terms as"lupus"and"pleural effusion",we searched English literature in Pubmed and in Wan-Fang Database of China.Results A total of 7 cases with relative complete data were found from the literature.Six patients were female,and one was male.Three cases had bilateral pleural effusion,two had left pleural effusion,and two had right pleural effusion.Then,these eleven patients were analyed together.Those patients who suffered significant dyspnea were related to chronic pleural effusion.They were all treated with a large dose of corticosteroid and immunosuppressive agents before pleurodesis,but none of the therapies was valid.They had undergone frequent multiple fluid aspirations.The total aspirated volume of one patient exceeded 80 L before pleurodesis.The patients with pleurodesis were well tolerated and had no complications after operation.There was no relapse in follow-up.After pleurodesis,the pleural effusion of all the patients was completely improved.Conclusion The clinical manifestations of refractory pleural effusion are relatively rare in patients with SLE.Drug therapy has poor effect,while traditionally used pleurodesis may be safer and preferred in such cases.It can effectively improve patients′prognosis and quality of life,but due to the small number of reported patients,the best type of intervention waits to be found.

Article in Korean | WPRIM | ID: wpr-718693


Spontaneous regression of metastatic renal cell carcinoma (mRCC) was reported over the last century. However, there are no reports on spontaneous regression of mRCC by talc pleurodesis. A 43-year-old man who underwent left nephrectomy by RCC visited emergency room with headache and hallucination. Tumor was metastasized to brain, lung, and pleura accompanied by malignant pleural effusion. Talc pleurodesis by video-assisted thoracoscopic surgery was performed to treat malignant pleural effusion. After 7 months without specific chemotherapy, pulmonary lesions of mRCC gradually regressed. We thought that this phenomenon appears as an immunologic response of talc pleurodesis. We herein present a rare case of spontaneous regression of mRCC following talc pleurodesis. To the best of our knowledge, this is the first case of spontaneous regression in mRCC following talc pleurodesis.

Adult , Brain , Carcinoma, Renal Cell , Drug Therapy , Emergency Service, Hospital , Hallucinations , Headache , Humans , Lung , Nephrectomy , Pleura , Pleural Effusion, Malignant , Pleurodesis , Talc , Thoracic Surgery, Video-Assisted
J. bras. pneumol ; 43(3): 190-194, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-893840


ABSTRACT Objective: To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). Methods: This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Results: Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: −225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Conclusions: Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE.

RESUMO Objetivo: Avaliar o papel do posicionamento intrapleural do cateter pleural na expansão pulmonar precoce e no sucesso da pleurodese em pacientes com derrame pleural maligno recorrente (DPMR). Métodos: Trata-se de um estudo retrospectivo aninhado em um estudo prospectivo de coorte maior com pacientes com DPMR recrutados em um hospital-escola universitário terciário entre junho de 2009 e setembro de 2014. Os pacientes foram submetidos a inserção de cateter pleural e, em seguida, pleurodese à beira do leito. A TC de tórax foi realizada duas vezes: imediatamente antes da pleurodese (TCi) e 30 dias após a pleurodese (TC30). Com base na TCi, a posição do cateter foi classificada em posterolateral, anterior, fissural e subpulmonar. Usamos o volume pleural na TCi para estimar a expansão pulmonar precoce e a diferença entre os volumes pleurais na TC30 e na TCi a fim de avaliar o sucesso radiológico da pleurodese. Considerou-se que a pleurodese teve êxito clínico quando não foi necessário realizar nenhum outro procedimento pleural. Resultados: Dos 131 pacientes elegíveis do estudo original, 85 foram incluídos neste estudo aninhado (64 mulheres; média de idade: 60,74 anos). A posição da ponta do cateter foi subpulmonar em 35 pacientes (41%), anterior em 23 (27%), posterolateral em 17 (20%) e fissural em 10 (12%). Não houve diferenças significativas entre os grupos quanto à expansão pulmonar precoce (mediana da cavidade pleural residual = 377 ml; intervalo interquartil: 171-722 ml; p = 0,645), sucesso radiológico da pleurodese (mediana do volume = 33 ml; intervalo interquartil: −225 a 257 ml; p = 0,923) e sucesso clínico da pleurodese (85,8%; p = 0,676). Conclusões: Nossos resultados sugerem que a posição da ponta do cateter pleural não influencia nem a expansão pulmonar precoce nem o sucesso da pleurodese à beira do leito em pacientes com DPMR.

Humans , Male , Female , Middle Aged , Aged , Catheters, Indwelling , Pleural Effusion, Malignant/surgery , Pleurodesis/methods , Thoracentesis/instrumentation , Thoracentesis/methods , Ultrasonography, Interventional/methods , Catheterization/methods , Lung/physiopathology , Pleural Cavity/surgery , Pleura/pathology , Pleura/physiopathology , Prospective Studies , Reproducibility of Results , Retrospective Studies , Statistics, Nonparametric , Tomography, X-Ray Computed , Treatment Outcome
Article in English | WPRIM | ID: wpr-39837


A 52-year-old male patient who underwent multiple wedge resections experienced postoperative acute respiratory distress syndrome in both lungs after Viscum album pleurodesis. Despite initial rapid deterioration in clinical condition and rapid progression of bilateral lung infiltration, he exhibited a relatively smooth clinical recovery with marked response to glucocorticoid treatment. Our case report suggests that care must be taken to guard against the development of acute respiratory complications in the use of Viscum album for pleurodesis. However, in view of the clinically benign course, initial aggressive management of complications can prevent suffering and sequelae.

Humans , Lung , Male , Middle Aged , Pleurodesis , Pneumothorax , Respiratory Distress Syndrome , Viscum album , Viscum
Article in Chinese | WPRIM | ID: wpr-750340


@#Objective    To analyze the outcome of fast track surgery after intercostal nerve block (INB) during thoracoscopic resection of lung bullae. Methods    We recuited 76 patients who accepted thoracoscopic resection of lung bullae from February 2013 to March 2015. They were randomly divided into two groups: an intercostal nerve block and intravenous patient-controlled analgesia (INB+IPCA) group, in which 38 patients (30 males, 8 females, with a mean age of 23.63±4.10 years) received INB intraoperatively and IPCA postoperatively, and a postoperative intravenous patient-controlled analgesia (IPCA) group, in which 38 patients (33 males, 5 females, with a mean age of 24.93±6.34 years) only received IPCA postoperatively. Their general clinical data and the postoperative pain visual analogue scale (VAS) were recorded. Analgesia-associated side effects, rate of the pulmonary infection were observed. Expenses associated with analgesia during hospital were calculated. Results    The score of VAS, the incidence of nausea and vomiting, fatigue and other side effects, pulmonary atelectasis and the infection rate in the INB+IPCA group were significantly lower than those in the IPCA group. Postoperative use of analgesic drugs was significantly less than that in the IPCA group. Medical expenses did not significantly increase. Conclusion    INB+IPCA is beneficial for fast track surgery after thoracoscopic resection of lung bullae.

Article in Chinese | WPRIM | ID: wpr-749849


@#Objective    To investigate the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and pleurodesis for spontaneous pneumothorax. Methods    A retrospective analysis of 157 patients with spontaneous pneumothorax undergoing VATS from January 2012 to March 2016 in our hospital was done. According to different treatments, patients were divided into two groups: a group A (65 patients receving pleurodesis, 52 males and 13 females with a mean age of 34.77 years ranging from 17 to 73 years) and a group B (92 patients without pleurodesis, 76 males and 16 females with a mean age of 34.66 years ranging from 16 to 72 years). In the group A 29 patients underwent closed thoracic drainage; while in the group B there were 39 patients. Results    The patients were followed up for 3 months to 4 years. The recurrence rate of the group A was lower than that of the group B, but the difference was not statistically significant. For patients receving closed thoracic drainage preoperatively, intraoperative drainage volume at postoperative 24 h in the group A was more than that of the group B, but postoperative hospital stay was less than that of the group B (P<0.05). For patients not receving closed thoracic drainage preoperatively, drainage volume at postoperative 24 h, total drainage volume, postoperative hospital stay in the group A were more than those of the group B (P<0.05). Conclusion    Pleurodesis can not reduce the recurrence rate of spontaneous pneumothorax. Preoperative closed thoracic drainage combined with intraoperative pleurodesis can effectively reduce postoperative hospitalization; therefore pleurodesis is recommended. If preoperative closed thoracic drainage is not adopted, surgery without pleurodesis can effectively reduce thoracic drainage at postoperative 24 h, total drainage volume and hospital stay and the perioperative results are better; therefore mechanical pleurodesis is not recommended.

Article in English | WPRIM | ID: wpr-217611


BACKGROUND: In chemical pleurodesis for managing pulmonary air leak, tetracycline derivatives are commonly used, and their effectiveness has been established in many studies. Recently, a Viscum album extract was used in chemical pleurodesis. We compared the effects of V. album with those of a tetracycline derivative (doxycycline) to demonstrate the therapeutic effectiveness of the V. album extract in chemical pleurodesis for managing pulmonary air leak. METHODS: Between October 2010 and October 2016, chemical pleurodesis was performed using doxycycline in 40 patients and the V. album extract in 37 patients. Thirty-three patients were in the postoperative state after pulmonary resection, and 44 patients suffered from spontaneous pneumothorax. RESULTS: No statistically significant difference in the success rate was observed between the 2 groups (V. album extract and doxycycline). In both groups, chest pain was the most common complication. More patients in the doxycycline group complained of severe chest pain (42.1% vs. 13.5%, p=0.006). In the V. album extract group, 24.3% of the patients required a chest tube to drain the pleural effusion after cessation of the air leak (doxycycline group: 5%, p=0.022). Further, the amount of pleural effusion drained on the day after the last chemical pleurodesis in the V. album extract group was greater than that in the doxycycline group (162.2±170.2 mL vs. 97.0±77.2 mL, p=0.032). All patients were discharged from the hospital without complications after pleural effusion drainage. CONCLUSION: Considering that treatment using the V. album extract was less painful, V. album might be a feasible option for chemical pleurodesis. However, pleural effusion should be monitored carefully when using V. album extract for treating patients suffering from air leak.

Chest Pain , Chest Tubes , Doxycycline , Drainage , Humans , Pleural Effusion , Pleurodesis , Pneumothorax , Tetracycline , Viscum album , Viscum
Tianjin Medical Journal ; (12): 381-384, 2017.
Article in Chinese | WPRIM | ID: wpr-514822


Objective To analyze rick factors for postoperative recurrence of spontaneous pneumothorax surgery. Methods The clinic characteristics of 1128 patients who received spontaneous pneumothorax surgery in Tianjin Chest Hospital were collected from January 2009 to March 2015. The relationship between clinic characteristics and the pulmonary bullae was analyzed. Logistic regression analysis was used to assess factors affecting the postoperative relapse of spontaneous pneumothorax. Results The pulmonary bullae were found in 877 patients of 1128 during the operation. The incidence of pulmonary bullae was significantly high in patients with age below 25 years compared with patients over 25 years (P 3 d) were independent risk factors of postoperative recurrence for spontaneous pneumothorax (P<0.05). Conclusion Pulmonary bullae, pleurodesis without pleura friction and delayed drainage duration are risk factors of postoperative recurrence for spontaneous pneumothorax, which should be paid more attention in clinic.

Rev. ANACEM (Impresa) ; 10(1): 10-14, 20160124. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1291213


Introducción: El neumotórax espontáneo secundario (NES) es la presencia de aire en la cavidad pleural con ausencia de traumatismo, asociado a alguna enfermedad pulmonar subyacente. La pleurodesis es considerada una alternativa al tratamiento de esta patología. La fuga aérea persistente o masiva es una complicación importante del NES, donde la utilización de pleurodesis con sangre autóloga constituye una opción conveniente en pacientes con alto riesgo quirúrgico. Objetivos: Se propuso describir las características de pacientes con NES tratados con pleurodesis con sangre autóloga en Hospital Regional de Concepción. Pacientes y método: Estudio descriptivo transversal, período enero 2012 - enero 2015. Se realizó una revisión de base de datos, protocolos quirúrgicos y fichas clínicas, seguimiento clínico a 36 meses, donde se describieron características clínicas, morbimortalidad, resultados inmediatos y tardíos. Resultados: Del total de pacientes (n=7), 5 (71,4 %) fueron hombres, con edad promedio de 60,7±8,2 años. La causa del NES fue mayoritariamente enfermedad pulmonar difusa en seis pacientes (85,7 %). Se realizaron siete pleurodesis con sangre autóloga sin necesidad de repetir el procedimiento. Se observó cierre de fístula en el 100 % de los pacientes. Al seguimiento no se observó necesidad de nuevos procedimientos. Discusión: La pleurodesis con sangre autóloga es un tratamiento efectivo y seguro en el manejo de la fuga aérea persistente o masiva, con adecuados resultados inmediatos y tardíos en casos seleccionados.

Introduction: Secondary spontaneous pneumothorax (NES) is pleural air occupation without trauma associated with the presence of some underlying lung disease. Pleurodesis is considered an alternative to the treatment of this disease. Persistent or massive air leak is a major complication of NES, where the use of pleurodesis with autologous blood is an accepted option in patients with high surgical risk and air leak. Objetive: Describe characteristics of patients with NES treated with pleurodesis with autologous blood in Hospital Regional of Concepción. Patients and methods: Cross-sectional descriptive study period January 2012- January 2015. It`s made a review of Database, surgical protocols and review medical records, 36 months' clinical follow-up. Description of clinical features, morbidity and mortality, immediate and remote results. Results: Of all patients (n=7), 5 (71.4 %) were males, mean age 60.7 ± 8.2 years. The cause of NES was predominantly diffuse lung disease in 6 (85.7%) patients. Seven pleurodesis with autologous blood were performed without repeating the procedure. Fistula closure was observed in 100% of patients. In follow the need for new procedures wasn't observed. Discussion: Pleurodesis with autologous blood is an effective and safe treatment in the management of persistent or massive air leak, with immediate and remote adequate results.