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1.
Medicine (Baltimore) ; 99(15): e19656, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282716

RESUMO

To determine the influence of puncture site on aspiration in dealing with pneumothorax following CT-guided lung biopsy.Two hundred thirty-six pneumothorax patients after CT guided lung biopsies were retrospective analyzed from January 2013 to December 2018. Patients with minor asymptomatic pneumothorax were treated conservatively with monitoring of vital signs and follow-up CT to confirm stability. Ninety of the 236 pneumothorax patients, who underwent manual aspiration, were included in this analysis. In first manual aspiration, the needle from the lesion was retracted back into the pleural space after biopsy, and then aspiration treatment was performed. If the treatment is of unsatisfied result, a second attempt aspiration treatment, which puncture site away from initial biopsy one, was conducted. The efficacy of simple manual aspiration and the new method, changing puncture site for re-aspiration was observed.Immediate success was obtained in 62 out of the 90 patients in the first attempt. The effective rate and failure rate were 68.9% (62/90) and 31.1% (28/90), respectively. Twenty-eight patients in whom first attempt simple aspiration were unsuccessful underwent a second attempt aspiration, which puncture site away from initial biopsy one, was successful in 13 patients with 15 patients undergoing chest tube placement. The effective rate and failure rate were 46.4% (13/28) and 53.6% (15/28), respectively. Applying the modified procedure, total effective rate of aspiration elevated significantly from 68.9% (62/90) to 83.3% (75/90) (P < .05). No serious side effects were detected in the period of aspiration procedure.Manual aspiration with puncture site away from initial biopsy one is worth trying to deal with post-biopsy pneumothorax. This modified procedure improved the efficiency of treatment significantly, and reduced the rate of pneumothorax requiring chest tube placement.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Pulmão/patologia , Pneumotórax/etiologia , Punções/efeitos adversos , Idoso , Tubos Torácicos/estatística & dados numéricos , Feminino , Humanos , Biópsia Guiada por Imagem/instrumentação , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cavidade Pleural/patologia , Pneumotórax/terapia , Punções/métodos , Estudos Retrospectivos , Sucção/efeitos adversos , Sucção/métodos , Tomografia Computadorizada por Raios X/métodos , Falha de Tratamento
2.
Int J Nanomedicine ; 15: 943-952, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32103948

RESUMO

Background: Malignant pleural effusion (MPE) is the accumulation of fluid in the pleural cavity as a result of malignancies affecting the lung, pleura and mediastinal lymph nodes. Curcumin, a compound found in turmeric, has anti-cancer properties that could not only treat MPE accumulation but also reduce cancer burden. To our knowledge, direct administration of curcumin into the pleural cavity has never been reported, neither in animals nor in humans. Purpose: To explore the compartmental distribution, targeted pharmacokinetics and the safety profile of liposomal curcumin following intrapleural and intravenous administration. Methods: Liposomal curcumin (16 mg/kg) was administered into Fischer 344 rats by either intrapleural injection or intravenous infusion. The concentration of curcumin in plasma and tissues (lung, liver and diaphragm) were measured using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Blood and tissues were examined for pathological changes. Results: No pleural or lung pathologies were observed following intrapleural liposomal curcumin administration. Total curcumin concentration peaked 1.5 hrs after the administration of intrapleural liposomal curcumin and red blood cell morphology appeared normal. A red blood cells abnormality (echinocytosis) was observed immediately and at 1.5 hrs after intravenous infusion of liposomal curcumin. Conclusion: These results indicate that liposomal curcumin is safe when administered directly into the pleural cavity and may represent a viable alternative to intravenous infusion in patients with pleural-based tumors.


Assuntos
Curcumina/administração & dosagem , Curcumina/farmacocinética , Cavidade Pleural/efeitos dos fármacos , Administração Intravenosa , Animais , Cromatografia Líquida , Feminino , Lipossomos/administração & dosagem , Lipossomos/farmacocinética , Pulmão/efeitos dos fármacos , Masculino , Neoplasias Pleurais/patologia , Ratos Endogâmicos F344 , Espectrometria de Massas em Tandem , Distribuição Tecidual
3.
Medicine (Baltimore) ; 98(43): e17575, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651860

RESUMO

RATIONALE: Chylothorax remains a poorly understood phenomenon, and no optimal treatment or guidelines have been established. This is the first report of treating congenital chylothorax and lymphedema in a low-birth-weight infant by lymphovenous anastomosis (LVA). PATIENT CONCERNS: We report a case of successful LVA for persistent congenital chylothorax and lymphedema resistant to other conservative therapies. DIAGNOSIS: The diagnosis of chylothorax was confirmed by the predominance of lymphocytes in the pleural fluid draining from the chest tube. In addition, the infant developed oliguria and generalized lymphedema. INTERVENTIONS: LVA under local anesthesia combined with light sedation was performed at his medial thighs and left upper arm. OUTCOMES: Although his subcutaneous edema markedly improved, the decrease in chest tube drainage was gradual. No additional treatment was required. LESSONS: LVA is of considerable value as a surgical treatment option in the setting of persistent congenital chylothorax and lymphedema, because LVA is a less invasive procedure.


Assuntos
Quilotórax/congênito , Vasos Linfáticos/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Anastomose Cirúrgica/métodos , Quilotórax/cirurgia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Cavidade Pleural/cirurgia
4.
Medicine (Baltimore) ; 98(39): e17144, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574815

RESUMO

RATIONALE: Benign fibrous histiocytoma with pleural involvement in spinal region is a highly unusual disease with no standard curative managements yet. The objective of this study is to report an extremely rare case of a giant benign fibrous histiocytoma with pleural involvement in spinal region successfully operated by posterior spinal surgery. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS: A 23-year-old man presented with a 2-month history of continuous and progressive back pain. A giant, expanding lesion of the T7 vertebral and paraspinal region with pleural involvement was identified. DIAGNOSES: Computed tomography scan and magnetic resonance imaging of spine showed expanding lesion of the T7 vertebral and paraspinal region involving the right thoracic cavity, which presented as a solid tumor. Postoperative pathology confirmed the diagnosis of thoracic benign fibrous histiocytoma. INTERVENTIONS: The patient underwent thoracic spinal canal decompression, complete tumor resection, pleural defect repair, and T4 to T10 internal fixation procedure via a posterior approach. OUTCOMES: The patient's symptom improved significantly after the surgery, and the postoperative period was uneventful at the 2-year follow-up visit. There were no complications associated with the operation during the follow-up period. LESSONS: In summary, the tumor's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, thoracic surgery, neurosurgery, pathology, and medical oncology led to the successful diagnosis and management of this patient. Giant benign fibrous histiocytoma with pleural involvement in spinal region, although rare, should be part of the differential diagnosis when the patient presents with back pain and radiculopathy. We recommend the posterior or 1-stage anterior-posterior combined approach for complete resection of the giant thoracic benign fibrous histiocytoma when the tumor has caused severe symptoms or neurological deficits.


Assuntos
Descompressão Cirúrgica/métodos , Histiocitoma Fibroso Benigno/cirurgia , Neoplasias Pleurais/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Histiocitoma Fibroso Benigno/patologia , Humanos , Masculino , Cavidade Pleural/patologia , Cavidade Pleural/cirurgia , Neoplasias Pleurais/patologia , Neoplasias da Coluna Vertebral/patologia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia
5.
J Vet Med Sci ; 81(10): 1504-1508, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31413229

RESUMO

A slaughtered 2-year-old female sika deer (Cervus nippon yesoensis) had diffusely distributed multinodular lesions on the serosal surface of the peritoneal cavity and several nodules in the pleural cavity. Histologically, they were composed of proliferating spindle-shaped neoplastic cells, arranged in a fascicular fashion. The cells in the invasive foci transitioned from a sarcomatoid to an epithelioid appearance. Immunohistochemically, both the spindle-shaped and epithelioid cells were at least focally positive for pancytokeratin, vimentin, calretinin, α-SMA, and desmin. From these findings, the deer was diagnosed with peritoneal sarcomatoid mesothelioma with metastasis to the pleural cavity. To our knowledge, this is the first reported case of peritoneal mesothelioma in a cervid species and the first case of mesothelioma in a sika deer.


Assuntos
Neoplasias Abdominais/veterinária , Cervos , Mesotelioma/veterinária , Neoplasias Pleurais/veterinária , Neoplasias Abdominais/patologia , Animais , Feminino , Mesotelioma/patologia , Mesotelioma/secundário , Cavidade Peritoneal/patologia , Cavidade Pleural/patologia , Neoplasias Pleurais/patologia , Neoplasias Pleurais/secundário
8.
Pediatr Cardiol ; 40(8): 1609-1617, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31468062

RESUMO

Postoperative prolonged pleural effusion (PPE) remains a confounding problem after a Fontan operation. We aimed to describe the risk factors for PPE after a Fontan operation and to clarify the impact of prophylactic opening of the pleural cavity (POPC) for drainage tube insertion on PPE. We retrospectively reviewed the medical charts of 50 consecutive patients who underwent a Fontan operation at our institution. POPC for postoperative drainage was performed based on each surgeon's preference. Patients were divided into three groups for analysis: group A (n = 12), no opening; group B (n = 14), unilateral opening; and group C (n = 24), bilateral opening. At the time of surgery, the median age of our patient group was 26 months, with a median body weight of 10.5 kg. The volume of pleural effusion tended to be lower in group A than in groups B and C (p = 0.08). The median duration of drainage was significantly shorter (p = 0.03) in group A (3 days) than in group B (4 days) or C (5 days). Overall, 12 patients required chest tube drainage for ≥ 7 days. Multivariate analysis revealed POPC (p = 0.01) and postoperative water balance (p = 0.03) as independent predictors of PPE. POPC and postoperative water balance are risk factors for PPE after a Fontan operation. Therefore, avoiding POPC for postoperative drainage may reduce the risk of postoperative pleural effusion and morbidities associated with PPE after a Fontan operation.


Assuntos
Drenagem/efeitos adversos , Técnica de Fontan/efeitos adversos , Cavidade Pleural/cirurgia , Derrame Pleural/etiologia , Estudos de Casos e Controles , Tubos Torácicos/efeitos adversos , Pré-Escolar , Drenagem/métodos , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Khirurgiia (Mosk) ; (7): 15-23, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31355809

RESUMO

Drainage and endoscopic methods of sanitation of the pleural cavity do not always allow to achieve effective debridement of pathological contents. AIM: To development and introduction into clinical practice of hydrosurgical technologies for debridement of the pleural cavity. MATERIAL AND METHODS: From 423 children with acute community-acquired pneumonia 88 (20.80%) children destructive pneumonia were diagnosed. Of the 88 patients with destructive pneumonia, 28 patients did not have pleural complications and were excluded from the study. 60 patients were divided into 2 groups depending on the method of surgical treatment. In the first group (n=30), two additional subgroups were formed: IA group (main n=15) - they carried out drainage and washing the pleural cavity with saline; IB group (control n=15) - only drainage of the pleural cavity. The second group (n=30) were also divided into 2 subgroups; Group IIA (main n=15) children operated according to the method of video-assisted thoracoscopic sanitations of the pleural cavity developed by us using hydrosurgical technologies; Group IIB (control n=15) - children are operated on by the method of traditional video-assisted thoracoscopic sanitations of the pleural cavity. A prospective, non-randomized, single-center study was conducted to evaluate the effectiveness of various treatments. The treatment plan was determined on the basis of a combination of anamnesis, clinical and instrumental studies and laboratory parameters. RESULTS: All studied in the comparison groups were homogeneous by sex, weight and height. The results of applying the Kruskal-Wallis test revealed statistically significant differences between the groups for the periods of relief of the intoxication syndrome (p<0.001) and the periods of relief of the pain syndrome (p=0.012) in favor of the main group. Summarizing all analyzing the parameters in the comparison groups allowed us to prove the advantage of the proposed treatment methods over the treatment methods used in the control groups. CONCLUSION: Hydrosurgical methods of treatment demonstrate obvious clinical and economic efficacy, which leads to the rapid reexpantion of the affected lung.


Assuntos
Desbridamento/métodos , Empiema Pleural/cirurgia , Pleura/cirurgia , Cavidade Pleural/cirurgia , Pneumonia/complicações , Irrigação Terapêutica/métodos , Criança , Drenagem , Empiema Pleural/etiologia , Humanos , Estudos Prospectivos , Cirurgia Torácica Vídeoassistida , Toracoscopia
11.
Immunity ; 51(1): 119-130.e5, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31231034

RESUMO

Tissue-resident macrophages require specific milieus for the maintenance of defining gene-expression programs. Expression of the transcription factor GATA6 is required for the homeostasis, function and localization of peritoneal cavity-resident macrophages. Gata6 expression is maintained in a non-cell autonomous manner and is elicited by the vitamin A metabolite, retinoic acid. Here, we found that the GATA6 transcriptional program is a common feature of macrophages residing in all visceral body cavities. Retinoic acid-dependent and -independent hallmark genes of GATA6+ macrophages were induced by mesothelial and fibroblastic stromal cells that express the transcription factor Wilms' Tumor 1 (WT1), which drives the expression of two rate-limiting enzymes in retinol metabolism. Depletion of Wt1+ stromal cells reduced the frequency of GATA6+ macrophages in the peritoneal, pleural and pericardial cavities. Thus, Wt1+ mesothelial and fibroblastic stromal cells constitute essential niche components supporting the tissue-specifying transcriptional landscape and homeostasis of cavity-resident macrophages.


Assuntos
Fator de Transcrição GATA6/metabolismo , Macrófagos/fisiologia , Pericárdio/imunologia , Cavidade Peritoneal/fisiologia , Cavidade Pleural/imunologia , Proteínas Repressoras/metabolismo , Células Estromais/fisiologia , Animais , Diferenciação Celular , Células Cultivadas , Fator de Transcrição GATA6/genética , Homeostase , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteínas Repressoras/genética , Tretinoína/metabolismo
12.
Int J Nanomedicine ; 14: 3773-3784, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213801

RESUMO

Background: Intrapleural administration of compounds is a lung targeted, innovative therapeutic strategy for mesothelioma, which can be refined as a route for drug delivery that minimizes the potential for systemic toxicity. However, little is currently known about the retention of liposomal drugs at the site, after such topical administration. Purpose: To evaluate the retention of liposomes in lungs following intrapleural injection, and how this might be modulated by liposome properties and disease progression. Methods: DiR-incorporating liposomes with various lipid compositions and sizes were prepared, characterized (for size distribution and zeta potential) and injected intrapleurally in normal mice and mice with malignant pleural effusion (MPE). DiR retention in pleural cavity was followed by biofluorescence imaging. Results: Experimental results demonstrate that liposome size and PEG-coating, have a significant effect on residence time in the pleural cavity; negative surface charge does not. More than 20% liposomal-DiR is retained 24 d post-injection (in some cases), indicating the high potential towards localized diseases. Ex-vivo liposomal-DiR signal in tumors of MPE mice was similar to signal in liver, suggesting high tumor targeting potential of intrapleurally injected liposomes. Finally, no difference was noticed in liposomal-DiR retention between tumor-inoculated (MPE) and healthy mice, indicating the stability of liposomes in the presence of effusion (in MPE mice). Conclusion: The current study provides novel insights for using liposomes by intrapleural administration for the treatment of lung diseases.


Assuntos
Cavidade Pleural/metabolismo , Derrame Pleural Maligno/metabolismo , Animais , Linhagem Celular Tumoral , Colesterol/química , Feminino , Humanos , Injeções , Cinética , Lipossomos , Masculino , Camundongos Endogâmicos C57BL , Imagem Óptica , Fosfatidilgliceróis/química
13.
Sao Paulo Med J ; 137(1): 66-74, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31116274

RESUMO

BACKGROUND: The pleural drain insertion site after coronary artery bypass graft (CABG) surgery may alter lung function, especially respiratory muscle strength. The main objective of this study was to compare the effectiveness and safety of use of the left lateral intercostal region versus the subxiphoid position for pleural drainage during elective CABG surgery using extracorporeal circulation (ECC). DESIGN AND SETTING: Randomized trial conducted in a tertiary-level hospital in Porto Alegre, Brazil. METHODS: 48 patients were assigned to group 1 (pleural drain in the left lateral intercostal region) or group 2 (pleural drain in the subxiphoid position). Respiratory muscle strength was measured in terms of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24 and 72 hours after drain removal and before discharge from hospital. Painand dyspnea scales, presence of infections, pleural effusion and atelectasis, duration of drain use, drainage volumes and surgical reinterventions were also evaluated. RESULTS: After adjustments, there were no significant differences between the groups at the end of the study (before discharge), in predicted percentages either for MIP (delta group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP (delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). Therewere no differences between the groups in relation to other outcomes. CONCLUSION: There was no difference in maximal respiratory pressures in relation to the pleural drain insertion site among patients who underwent CABG surgery using ECC. TRIAL REGISTRATION: ReBEc V1111.1159.4447.


Assuntos
Ponte de Artéria Coronária/métodos , Drenagem/instrumentação , Drenagem/métodos , Cavidade Pleural/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Drenagem/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Circulação Extracorpórea/métodos , Feminino , Humanos , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Medição da Dor , Derrame Pleural/etiologia , Derrame Pleural/prevenção & controle , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(13): e15003, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921217

RESUMO

Pleural effusions are a common medical problem not only for pulmonologists but also for general physicians, often needing thoracentesis for a definite diagnosis. However, thoracentesis cannot always reveal malignant cells or microbiological evidence.In this context, we prospectively enrolled a total of 289 patients with pleural effusions due to diverse etiologies: parapneumonic effusion (PPE) (63), empyema (22), tuberculous pleural effusion (TBPE) (54), malignant pleural effusion (MPE) (140), or chronic renal failure (CRF)/congestive heart failure (CHF) (10). The MPE group consisted of lung cancer (adenocarcinoma, n = 90; squamous cell carcinoma, n = 5; small cell carcinoma, n = 4), malignant lymphoma (n = 17), malignant mesothelioma (n = 11), malignant melanoma (n = 3), and metastasis from other organs (n = 10).This study demonstrated that the pleural lactate dehydrogenase (LDH)to adenosine deaminase (ADA) ratios differed significantly between patients with CHF/CRF, MPE, TBPE, empyema, and PPE. We discovered a simple method to differentiate pleural diseases based on the pleural LDH to ADA ratio and carcinoembryonic antigen (CEA). A pleural LDH to ADA ratio greater than 15.5 and a pleural CEA level of less than 5 ng/mL is indicative of PPE or empyema rather than TBPE, MPE, or transudative pleural effusion (CRF, CHF).This method has a sensitivity of 62.0%, a specificity of 91.0%, and an area under the receiver operating characteristic curve of 0.765 (95% confidence interval [CI]: 0678-0.852, P < .001), odds ratio of 16.6 (95% CI: 7.28-37.8, P < .001), a positive likelihood ratio (LR) of 6.8, and a negative LR of 0.02.


Assuntos
Adenosina Desaminase/análise , Antígeno Carcinoembrionário/análise , Empiema Pleural/diagnóstico , L-Lactato Desidrogenase/análise , Derrame Pleural Maligno/diagnóstico , Área Sob a Curva , Diagnóstico Diferencial , Empiema Pleural/patologia , Humanos , Funções Verossimilhança , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Razão de Chances , Cavidade Pleural/metabolismo , Derrame Pleural Maligno/patologia , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
16.
Ultrasound Q ; 35(2): 164-168, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30724867

RESUMO

The aim of the study was to investigate the efficacy of shear-wave elastography (SWE) in the differentiation of transudative and exudative pleural effusions. This monocentric study comprised 60 cases (17 transudative, 43 exudative).Transthoracic SWE was performed in 60 cases for whom to use thoracentesis for the pleural fluid analysis was planned. The mean SWE values of each patient were recorded, and the correlation between the biochemical analysis results of pleural fluid after thoracentesis and SWE findings was evaluated. The effusion SWE values and biochemical analysis results were compared. Of the 60 patients who participated in this study, 32 (53.4) were male and 28 (46.6%) were female. The mean ± SD age was 59 ± 17.09 years (range = 21-89 years). Simultaneous serum biochemical analysis was performed for the patients with PE. The mean ± SD shear-wave velocity value of the transudative fluid was calculated 2.29 ± 0.41 (1.6-2.94), whereas the mean ± SD shear-wave velocity value of the exudative pleural fluid was calculated as 3.29 ± 0.63 (2.01-4.88) (P < 0.001). The receiver operating characteristic analysis showed that sensitivity and specificity were found as 91% and 76.5%, respectively, when the cutoff value was selected as 2.52 m/s in the differentiation of the transudative and exudative effusions.Shear-wave elastography may help in the differentiation of transudative and exudative of the pleural effusions.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Derrame Pleural/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Pleural/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
17.
Chest ; 155(4): 805-815, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30664856

RESUMO

BACKGROUND: Intrapleural lytic therapy has been established as an important modality of treatment for many pleural disorders, including hemothorax and empyema. Retained traumatic hemothorax is a common and understudied subset of pleural disease. The current standard of care for retained traumatic hemothorax is operative management. The use of lytic therapy for avoidance of operative intervention in the trauma population has not been well established. METHODS: Randomized controlled trials (RCTs) and non-RCTs reporting operative intervention following the use of intrapleural lytic treatment for retained traumatic hemothorax were identified in the literature. The primary outcome was avoidance of surgery following treatment with any lytic agent. Meta-analysis was performed to pool the results of those studies. Subgroup analysis by type of lytic therapy and analysis of length of stay were also performed. RESULTS: One RCT and nine non-RCTs including 162 patients were pooled in the analysis. Avoidance of surgery following treatment with any lytic agent was found to be 87% (95% CI, 81%-92%). Tissue plasminogen activator resulted in 83% operative avoidance (95% CI, 71%-94%), and other, non-tissue plasminogen activator lytic agents resulted in 87% operative avoidance (95% CI, 82%-93%). The average length of stay for patients undergoing lytic therapy was 14.88 days (95% CI, 12.88-16.88). CONCLUSIONS: Lytic therapy could reduce the need for operative intervention in trauma patients with retained traumatic hemothorax. RCTs are indicated to definitively evaluate the benefit of this approach.


Assuntos
Hemotórax/terapia , Traumatismos Torácicos/complicações , Cirurgia Torácica Vídeoassistida/métodos , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Fibrinolíticos/administração & dosagem , Hemotórax/etiologia , Humanos , Injeções , Cavidade Pleural , Resultado do Tratamento
18.
Lung Cancer ; 127: 25-33, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30642547

RESUMO

OBJECTIVES: A malignant pleural effusion (MPE) is a common complication in non-small cell lung cancer (NSCLC) with important staging and prognostic information. Patients with MPEs are often candidates for advanced therapies, however, the current gold standard, cytological analysis of pleural fluid samples, has limited sensitivity. We aimed to demonstrate the feasibility of non-invasive enumeration and immunophenotyping of EpCAM-positive cells in pleural fluid samples for the diagnosis of a MPE in NSCLC patients. MATERIALS AND METHODS: Pleural fluid specimens were prospectively collected from patients with NSCLC and the CellSearch® technology was utilized for the enumeration of pleural EpCAM-positive cells (PECs) and determination of PD-L1 expression on PECs from pleural fluid samples. The diagnostic performance of the enumeration of single PECs and PEC clusters was assessed using receiver operating characteristic (ROC) curves. The Kaplan-Meier method and Cox proportional hazards model was used to assess the impact of PECs and PEC clusters on overall survival (OS). RESULTS: 101 NSCLC patients were enrolled. The median number of PECs was significantly greater in the malignant (n = 84) versus non-malignant group (n = 17) (730 PECs/mL vs 1.0 PEC/mL, p < 0.001). The area under the ROC curve was 0.91. A cutoff value of 105 PECs/mL had a sensitivity and specificity of 73% and 100% for the diagnosis of a MPE, respectively. Among 69 patients with a pathology-confirmed MPE and tissue immunohistochemistry (IHC) results, 15 (22%) had greater than 50% PD-L1+ PECs. Overall concordance between tissue and PEC PD-L1 expression was 76%. Higher numbers of pleural effusion single PECs were associated with inferior overall survival (Cox adjusted HR 1.8, 95% CI: 1.02-3.05 p = 0.043). CONCLUSION: Non-invasive measurement of PECs in NSCLC patients, using an automated, clinically available approach, may improve the diagnostic accuracy of a MPE, allow for immunophenotyping of PECs, and provide prognostic information.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Molécula de Adesão da Célula Epitelial/metabolismo , Neoplasias Pulmonares/diagnóstico , Cavidade Pleural/parasitologia , Derrame Pleural Maligno/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno B7-H1/metabolismo , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Imunofenotipagem , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
19.
J Surg Res ; 233: 304-309, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502263

RESUMO

BACKGROUND: Congenital pleural effusion is a rare condition with an incidence of approximately one per 15,000 pregnancies. The development of secondary hydrops is a poor prognostic indicator and such cases can be managed with a thoracoamniotic shunt (TAS). Our objective is to describe postnatal outcomes in survivors after TAS placement for congenital pleural effusions. MATERIALS AND METHODS: A retrospective study of all cases with fetal pleural effusions treated between 2006 and 2016. Patients with dominant unilateral or bilateral pleural effusions complicated by secondary hydrops fetalis received TAS placement. The results are reported as median (range). RESULTS: A total of 29 patients with pleural effusion with secondary hydrops underwent TAS placement. The gestational age at the initial TAS placement was 27.6 (20.3-36.9) wk. Before delivery, hydrops resolved in 17 (58.6%) patients. The delivery gestational age was 35.7 (25.4-41.0) wk and the overall survival rate was 72.4%. Among the 21 survivors, 19 (90.5%) required admission to the neonatal intensive care unit for 15 (5-64) d. All 21 survivors had postnatal resolution of the pleural effusions. All 21 children were long-term survivors, with a median age of survivorship of 3 y 3 mo (9 mo-7 y 6 mo) at the time of last reported follow-up. CONCLUSIONS: Thoracoamniotic shunting in fetuses with a dominant pleural effusion(s) and secondary hydrops resulted in a 72% survival rate. Nearly all survivors required admission to the neonatal intensive care unit. However, a majority did not have significant long-term morbidity.


Assuntos
Âmnio/cirurgia , Terapias Fetais/métodos , Hidropisia Fetal/cirurgia , Cavidade Pleural/cirurgia , Derrame Pleural/cirurgia , Adolescente , Adulto , Cânula , Cateterismo/instrumentação , Cateterismo/métodos , Criança , Pré-Escolar , Feminino , Seguimentos , Idade Gestacional , Humanos , Hidropisia Fetal/etiologia , Hidropisia Fetal/mortalidade , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Idade Materna , Derrame Pleural/complicações , Derrame Pleural/mortalidade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Sobreviventes/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Ultrassonografia Pré-Natal , Adulto Jovem
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