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1.
Thorac Cancer ; 13(15): 2158-2163, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35748347

RESUMO

BACKGROUND: The objective of this nationwide, registry-based study was to compare the two most frequently used procedures for the palliative treatment of a malignant pleural effusion (MPE) and to evaluate differentiated indications for these two procedures. METHODS: This was a retrospective observational study based on data of the "PLEURATUMOR" registry of the German Society for Thoracic Surgery. Patients who were documented in the period from January 2015 to November 2021 and had video-assisted thoracic surgery (VATS) talc pleurodesis or implantation of an indwelling pleural catheter (IPC) were included. RESULTS: A total of 543 patients were evaluated. The majority suffered from secondary pleural carcinomatosis (n = 402; 74%). VATS talc pleurodesis (n = 361; 66.5%) was performed about twice as often as IPC implantation (n = 182; 33.5%). The duration of surgery was significantly shorter in IPC-patients with 30 min compared to VATS talc pleurodesis (38 min; p = 0.000). Postoperative complication rate was 11.8% overall and slightly higher after VATS talc pleurodesis (n = 49; 13.6%) than after IPC implantation (n = 15; 8.2%). After VATS talc pleurodesis patients were hospitalized significantly longer compared to the IPC group (6 vs. 3.5 days; p = 0.000). There was no significant difference in postoperative wound infections between the groups (p = 0.10). The 30-day mortality was 7.9% (n = 41). CONCLUSION: The implantation of an IPC can significantly shorten the duration of surgery and the hospital stay. For this reason, the procedure should be matched with the patient's expectations preoperatively and the use of an IPC should be considered not only in the case of a trapped lung.


Assuntos
Derrame Pleural Maligno , Cateteres de Demora , Humanos , Cuidados Paliativos , Derrame Pleural Maligno/cirurgia , Pleurodese/métodos , Talco/uso terapêutico , Resultado do Tratamento
2.
Lima; IETSI; mar. 2021.
Não convencional em Espanhol | BRISA/RedTESA, BRISA/RedTESA | ID: biblio-1358461

RESUMO

INTRODUCCIÓN: El presente documento de evaluación de tecnología sanitaria (ETS) expone la evaluación de la eficacia y seguridad del drenaje pleural con set de drenaje torácico digital (SDTD) en pacientes adultos con derrame pleural maligno (DPM) o fístula pulmonar en comparación con el set de drenaje torácico convencional (SDTC). El derrame pleural maligno (DPM) y las fistulas broncopleurales (FBP) son condiciones amenazantes para la vida del paciente. El DPM es una condición que ocurre en su mayoría en pacientes en etapas avanzadas de cáncer y cuya expectativa de vida es muy baja. Por otro lado, las FBP son comunicaciones patológicas entre el árbol bronquial y espacio pulmonar, que aparecen como consecuencia de una cirugía de reseccion pulmonar, por lo general por causas oncológicas, y con menor frecuencia debido a quimioterapias y radioterapias. El DPM y las FBP pueden producir la invasión de colecciones líquidas y aire en el espacio pleural; causando desestabilización de su presión negativa1 y consecuentemente colapso pulmonar y disnea respiratoria. Ambas condiciones deben ser tratadas a tiempo para favorecer el restablecimiento del espacio pleural y reexpansión pulmonar. Uno de los tratamientos del DPM o las FBP es el drenaje pleural, que permite descomprimir el espacio pleural del exceso de líquido o aire, permitiendo una mejor respiración, así como menor compromiso de otros órganos vitales. En el contexto de EsSalud, los pacientes con diagnóstico de DPM o FBP son tratados con la tecnología set de drenaje torácico convencional (SDTC); sin embargo, los médicos especialistas del Hospital Nacional Edgardo Rebagliati Martins (HNERM) han solicitado la incorporación al Petitorio de EsSalud de la tecnología sanitaria set de drenaje torácico digital (SDTD). La justificación de la inclusión de esta tecnología según los especialistas es que el SDTC requiere de un sistema de succión de pared, que limitaría la movilidad del paciente. Además, la lectura de los indicadores de drenaje y fuga aérea con esta tecnología debe ser realizada cualitativamente por un profesional, pudiendo existir subjetividad de la evaluación, así como variabilidad interobservador. Por el contrario, señalan que el SDTD cuenta con un sistema de succión portátil, y además, permite un registro digital evolutivo de los indicadores de ausencia de drenaje y fuga aérea en estos pacientes, lo que podría traducirse en un mayor beneficio clínico para ellos, en términos de recuperación y tiempo de estancia hospitalaria. METODOLOGÍA: Se realizó una búsqueda sistemática de información con el objetivo de identificar la mejor evidencia disponible a la fecha (02 de marzo de 2020) sobre la eficacia y seguridad del drenaje pleural con SDTD, comparado con SDTC, en pacientes adultos con DPM o FBP. Se realizó una búsqueda bibliográfica avanzada en las bases de datos de PubMed, Cochrane Database of Systematic Reviews y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). La búsqueda sistemática fue suplementada con una búsqueda manual en la lista de referencias bibliográficas de la evidencia incluida en el presente dictamen. Además, se realizó una búsqueda de literatura gris en el motor de búsqueda Google, a fin de poder identificar GPC y ETS de relevancia que pudiesen haber sido omitidas por la estrategia de búsqueda o que no hayan sido publicadas en las bases de datos consideradas. Asimismo, se realizó una búsqueda dentro de bases de datos pertenecientes a grupos que realizan ETS y GPC, incluyendo, el National Institute for Health and Care Excellence (NICE), la Canadian Agency for Drugs and Technologies in Health (CADTH), la Haute Autorité de Santé (HAS), el Institut für Qualitát und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), además de la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA) y páginas web de sociedades especializadas en el manejo del DPM y las FBP. Por último, se realizó una búsqueda de estudios clínicos en ejecución o aún no publicados en las páginas web de ClinicalTrials.gov y del International Clinical Trial Registry Platform (ICTRP). RESULTADOS: A través de la búsqueda bibliográfica en las bases de datos, se identificaron 420 documentos. Luego de eliminar los documentos duplicados, 401 fueron elegibles para tamizaje por título y resumen. De ellos, 20 documentos fueron elegibles para evaluación a texto completo. Finalmente, dos documentos fueron elegidos para incluirse en el presente dictamen. Como producto de la búsqueda bibliográfica y selección sistemática de la evidencia, se han incluido dos GPC que emiten recomendaciones para el tratamiento de pacientes con DPM (Tabla 1). No se encontraron RS con o sin MA, ECA o estudios observacionales elegibles para evaluación. A continuación se reporta brevemente el cuerpo de evidencia de acuerdo con la pirámide de jerarquía de Haynes, siguiendo lo indicado en los criterios de elegibilidad. CONCLUSIONES: El presente dictamen preliminar tuvo por objetivo realizar una síntesis de la mejor evidencia disponible a la fecha (02 de marzo del 2021) sobre la eficacia y seguridad del drenaje pleural empleando SDTD en comparación con SDTC en pacientes con DPM o FBP con indicación de drenaje pleural. En el contexto de EsSalud, los pacientes con DPM o FBP son tratados con drenaje pleural empleando SDTC; sin embargo, los especialistas de la entidad han propuesto la incorporación de SDTD debido a que este superaría algunos potenciales inconvenientes de la tecnología de uso actual en EsSalud, como el riesgo de evaluación subjetiva de ausencia de drenaje y fuga aérea, y la necesidad de estar conectada a un sistema de succión de pared. Por ello, se realizó una evaluación de la eficacia y seguridad de SDTD, en comparación con SDTC, para el manejo de estos pacientes. Luego de la búsqueda sistemática de información (02 de marzo del 2021) se incluyeron dos GPC sobre el manejo de pacientes con DPM para su evaluación (National Institute for Health and Care Excellence 2019, Feller-Kopman et al. 2018). No se encontraron GPC sobre el manejo de pacientes con FBP. Tampoco se encontraron ECA, RS con o sin MA, o estudios obseservacionales que comparen a las tecnologías SDTD y SDTC en procedimientos de drenaje pleural en pacientes con DPM o FBP. Ninguna de las GPC evaluadas mencionó al SDTD o SDTC entre sus recomendaciones de drenaje pleural para el manejo paliativo de pacientes con DPM. Aunque una de las GPC recomienda la colocación de catéter permanente (tecnología que puede ser conectada a SDTD o SDTC) para realizar el drenaje pleural, no se mencionó a qué sistema de drenaje se debe conectarse el dispositivo para realizar el procedimiento (Feller-Kopman et al. 2018). Asimismo, ninguno de los estudios empleados como sustento para estas recomendaciones menciona que sistema de drenaje se utilizó para llevar a cabo el drenaje pleural. En consecuencia, existe incertidumbre sobre cuál es el sistema de drenaje de elección (SDTD o SDTC) para llevar a cabo estos procedimientos. Durante la búsqueda de la literatura se observaron estudios de bajo nivel metodológico (reportes de casos y resúmenes de congreso) que evaluaron el uso de la tecnología SDTD en pacientes con DPM o FBP. Esto se condice con lo mencionado por la literatura acerca de la escasa evidencia de alto nivel metodológico para el cuidado paliativo de pacientes, como es el caso de pacientes con DPM. En ese sentido, para realizar una evaluación objetiva de la eficacia y seguridad de la tecnología SDTD es necesario contar con ECA bien diseñados. Por otro lado, aunque existen estudios de alto nivel metodológico (i.e. ECA) que comparan a las tecnologías SDTD y SDTC, estos fueron realizados en pacientes con marcadas diferencias en la fisiopatología, pronóstico, necesidad de tratamiento y objetivo del drenaje pleural, en comparación con la población de pacientes con DPM o FBP. Por lo tanto, los resultados de estos estudios no pueden extrapolarse a los pacientes con DPM o FBP. De igual manera, es preciso señalar que, según el fabricante de la tecnología SDTD solicitada, la indicación de uso de la misma es para drenaje torácico y pleural de pacientes sometidos a cirugía torácica o cardiaca, la cual difiere de la población de interés para la PICO, y explicaría la ausencia de estudios de alto nivel metodológico en esta población. Por todo lo expuesto, debido a que a la fecha no existen argumentos técnicos que apoyen el uso de la tecnología SDTD en pacientes con DPM o FBP, y que además, la indicación de uso de la tecnología no incluye a esta población, sino a pacientes sometidos a cirugía torácica y cardiaca, el IETSI no aprueba el uso de SDTD en pacientes adultos con derrame pleural maligno o fístula pulmonar.


Assuntos
Humanos , Toracoscopia/métodos , Drenagem Postural/métodos , Derrame Pleural Maligno/cirurgia , Eficácia , Análise Custo-Benefício
3.
Cancer Cytopathol ; 129(6): 468-478, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33493383

RESUMO

BACKGROUND: Malignant mesothelioma (MM) is a therapy-resistant tumor, often causing an effusion. Drugs targeting the programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway have shown promising results, but assessment of PD-L1 expression to select patients for therapy has mainly been performed on histologic tissue samples. In a previous study, we showed that MM effusions are suitable for PD-L1 assessment with results comparable to those reported in histologic studies, but no studies have compared PD-L1 expression in histologic and cytologic samples. METHODS: PD-L1 expression was determined immunohistochemically (clone 28-8) in 61 paired samples of effusions and biopsies from patients with pleural MM, obtained at the time of diagnosis. Only cases with >100 tumor cells were included. Membranous staining in tumor cells was considered positive at ≥1%, >5%, >10%, and >50% cutoff levels. RESULTS: Of 61 histologic samples, PD-L1 expression was found in 28 and 7 samples at ≥1% and >50% cutoffs, respectively; the corresponding figures for cytology were 21 and 5, respectively. The overall percentage agreement between histology and cytology was 69% and 84%, with a kappa (κ) of 0.36 and 0.08 at ≥1% and >50% cutoffs, respectively. The concordance between cytology and histology tended to be higher for epithelioid MM versus nonepithelioid MM at a ≥1% cutoff. PD-L1 positivity in biopsies, but not in effusions, correlated with the histologic subtype at a ≥1% cutoff. CONCLUSIONS: A moderate concordance of PD-L1 expression between biopsies and effusions from pleural MM, especially for the epithelioid subtype, indicates biological differences between the 2 types of specimens. Cytology and histology may be complementary.


Assuntos
Antígeno B7-H1/metabolismo , Células Epitelioides/patologia , Mesotelioma/patologia , Derrame Pleural Maligno/patologia , Neoplasias Pleurais/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Citodiagnóstico/métodos , Células Epitelioides/metabolismo , Feminino , Seguimentos , Humanos , Masculino , Mesotelioma/metabolismo , Mesotelioma/cirurgia , Pessoa de Meia-Idade , Derrame Pleural Maligno/metabolismo , Derrame Pleural Maligno/cirurgia , Neoplasias Pleurais/metabolismo , Neoplasias Pleurais/cirurgia , Prognóstico
4.
Eur Rev Med Pharmacol Sci ; 24(22): 11716-11718, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33275240

RESUMO

OBJECTIVE: Malignant Pleural Effusion (MPE) carries significant morbidity and mortality. Indwelling pleural catheters (IPCs) are established in the management pathway. Large case reviews add to the evidence base regarding safety and efficacy. PATIENTS AND METHODS: 168 patients had an IPC inserted between January 2012 and December 2018 in a large pleural centre. Data on outcomes and complications were obtained from the patients' notes, laboratory and radiographic findings. A descriptive statistical methodology was applied. RESULTS: 168 IPCs were inserted in a predominantly male population. The overall complication rate is 13%. The incidence of any individual complication such as infection, metastatic seeding, drain displacement, and loculations are all less than previously described. CONCLUSIONS: This case review adds to the large body of evidence that IPCs are safe and have minimal complications. Specific factors enabling this are the use of pre-operative antibiotics, the use of theatre space, and the experience of the pleural interventional physicians.


Assuntos
Derrame Pleural Maligno/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
J Cancer Res Ther ; 16(4): 938-940, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32930147

RESUMO

We report the very rare case of recurrent unilateral pleural effusion in a 53-year-old male. Computed tomography (CT) scan and magnetic resonance imaging revealed a left-sided paravertebral mass at D3 level. Multiple biopsy and CT scan lead us to the diagnosis of "Angiomatous Malformation." The lesion was excised surgically which on final histopathological report termed hemangioma.


Assuntos
Hemangioma/patologia , Derrame Pleural Maligno/patologia , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/cirurgia , Prognóstico , Tomografia Computadorizada por Raios X/métodos
6.
Cancer Cytopathol ; 128(2): 126-132, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31821740

RESUMO

BACKGROUND: The separation of benign from malignant mesothelial proliferations on effusion cytology can be difficult. Loss of methylthioadenosine phosphorylase (MTAP) by immunohistochemistry is an established marker of malignancy in mesothelial proliferations, but to the authors' knowledge largely has been applied only to biopsies. The current study was conducted to determine the usefulness of MTAP immunohistochemistry in the diagnosis of malignant mesothelioma in effusion cytology specimens. METHODS: A total of 21 effusion cytology cases of malignant mesothelioma were stained for MTAP and BRCA-associated protein 1 (BAP1), with 15 reactive mesothelial cytology cases used as a control. Fourteen cases had a paired surgical specimen for comparison, and 7 cases were run for CDKN2A deletion by fluorescence in situ hybridization. RESULTS: Complete loss of MTAP cytoplasmic staining was noted in 7 of 21 effusion samples (33%), and no loss was observed in 11 effusion samples (52%); 11 of these cases had a matching surgical specimen and all 11 specimens demonstrated the same MTAP pattern. Partial loss was observed in 3 effusion specimens (80%, 40%, and 40% intact staining, respectively), but in all 3 the surgical specimen demonstrated 100% staining. None of the 15 reactive mesothelial cytology specimens demonstrated MTAP cytoplasmic loss. CDKN2A FISH demonstrated concordance in 5 of 7 cases (71%). MTAP immunohistochemistry had a sensitivity of 33% and a specificity of 100% for this differential diagnosis. CONCLUSIONS: MTAP staining demonstrated generally good concordance between the cytologic and surgical specimens and appears to be useful in the diagnosis of mesothelioma on effusion specimens. Complete loss of MTAP is a reliable marker of malignancy, but the significance of partial loss of MTAP staining is unclear.


Assuntos
Biomarcadores Tumorais/análise , Imuno-Histoquímica , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Derrame Pleural Maligno/diagnóstico , Purina-Núcleosídeo Fosforilase/análise , Proteínas Supressoras de Tumor/análise , Ubiquitina Tiolesterase/análise , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Biópsia , Inibidor p16 de Quinase Dependente de Ciclina/análise , Inibidor p16 de Quinase Dependente de Ciclina/genética , Deleção de Genes , Humanos , Hibridização in Situ Fluorescente , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Mesotelioma/genética , Mesotelioma/patologia , Mesotelioma/cirurgia , Mesotelioma Maligno , Cavidade Pleural/patologia , Derrame Pleural Maligno/genética , Derrame Pleural Maligno/patologia , Derrame Pleural Maligno/cirurgia , Purina-Núcleosídeo Fosforilase/metabolismo , Proteínas Supressoras de Tumor/metabolismo , Ubiquitina Tiolesterase/metabolismo
7.
Respirology ; 25(3): 298-304, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31433545

RESUMO

BACKGROUND AND OBJECTIVE: Non-expansile lung (NEL) frequently complicates management of malignant pleural effusion (MPE) and is an important factor in clinical practice and trials. NEL is frequently diagnosed on a single radiographic observation, but neither the inter-observer agreement of this approach nor the prognostic importance of NEL in MPE has been reported. METHODS: A multicentre retrospective cohort study was performed in two UK pleural centres. NEL was defined as <50% pleural re-apposition on post-drainage radiographs by primary and secondary assessors at each site. Inter-observer agreement was assessed by Cohen's kappa (κ). Kaplan-Meier methodology and multivariate Cox models were used to assess the prognostic impact of NEL versus no NEL and 'complete NEL' versus 'complete expansion', based on a single assessor's results from each site. RESULTS: NEL was identified by the primary assessor in 33 of 97 (34%) in Cohort 1 and 15 of 86 (17%) in Cohort 2. Inter-observer agreement between assessors was only fair-to-moderate (Cohort 1 κ: 0.38 (95% CI: 0.21-0.55), Cohort 2 κ: 0.51 (95% CI: 0.30-0.72)). In both cohorts, NEL was associated with shorter median overall survival (Cohort 1: 188 vs 371 days, Cohort 2: 192 vs 412 days). This prognostic association was independent in Cohort 1 (hazard ratio (HR): 2.19, 95% CI: 1.31-3.66) but not in Cohort 2 (HR: 1.42, 95% CI: 0.71-2.87). Survival was inferior in both cohorts in cases of complete NEL versus complete expansion. CONCLUSION: Radiographic NEL is common but inter-observer agreement is only fair-to-moderate. NEL is associated with adverse survival. These data do not support the use of single radiographic assessments to classify NEL.


Assuntos
Neoplasias Pulmonares/complicações , Pulmão/diagnóstico por imagem , Derrame Pleural Maligno/diagnóstico por imagem , Idoso , Drenagem , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Variações Dependentes do Observador , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/cirurgia , Prognóstico , Modelos de Riscos Proporcionais , Radiografia Torácica , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
8.
Thorac Cancer ; 11(2): 320-328, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31837116

RESUMO

BACKGROUND: The objective of our study was to analyze the prognostic value of the combination of serum ALP and pleural effusion LDH (AL score) for malignant pleural effusion (MPE) patients. METHODS: This study includes retrospective, descriptive and observational research from 1 June 2006 to 1 December 2017, which aimed to identify prognostic factors related to MPE patients. We analyzed the association of various clinical features, routinely tested markers from peripheral blood and MPE at diagnosis and overall survival (OS). All MPE patients were assigned to three groups according to their AL score. The impact of the AL score and other prognostic factors were evaluated with multivariable regression. RESULTS: According to their AL score, 193 patients were assigned to three groups with 25 in group 0 (sALP < 65 U/L and pLDH < 155 U/L), 121 in group 1 (sALP > 65 U/L or pLDH > 155 U/L) and 47 (sALP > 65 U/L and pLDH > 155 U/L) in group 2. For groups 0, 1 and 2, median survival times (MST) were 23, 15 and 7 months, respectively. Among the three groups, MST, serum albumin level, C reactive protein, erythrocyte sedimentation rate, the ratios of platelet-to-lymphocyte, neutrophil-to-lymphocyte showed significant differences. The counts of neutrophils, monocytes, platelets and AL score (0 vs. 1, P = 0.038, hazard ratio [HR]: 1.858, 95% confidence interval [CI]: [1.034, 3.339]; 0 vs. 2, P = 0.001, HR: 2.993, 95% CI: [1.556, 5.531]) were independent prognostic indicators for OS of MPE patients. CONCLUSION: AL score is a promising indicator which can be used to predict the prognosis of MPE patients. It can assist physicians in the selection of patients for appropriate palliative treatment. KEY POINTS: To our knowledge, this paper is the first study that combined two enzymes (sALP and pLDH) from serum and pleural effusion and studied the prognostic value for MPE patients. It has been proved to be a promising indicator to assist physicians select patients for appropriate palliative treatment.


Assuntos
Fosfatase Alcalina/sangue , Biomarcadores Tumorais/análise , L-Lactato Desidrogenase/análise , Derrame Pleural Maligno/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/enzimologia , Derrame Pleural Maligno/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
9.
Postgrad Med ; 132(1): 62-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31765233

RESUMO

Objectives: The aim of this research is by using sociological methods of scientific research for tracking the pain and satisfaction indicators to prove that decreasing the number of ports in the VATS (Video-assisted thoracic surgery) for Malignant Pleural Effusion reduces postoperative pain and improves patient's satisfaction.Methods: Our study included 117 VATS procedures performed in the period from 01 January 2013 to 31 September 2016. The sociological method used to measure the pain indicator was an interview. The severity of postoperative pain was determined and reported according to a ten-point pain visual analogue scale (VAS). The degree of satisfaction was determined and reported according to a six-point and ten-point grading systems on the basis of a research interview procedure.Results: In the single-port method, the verbal pain scale for all the days covered by the research study statistically showed significantly lower values (P Ë‚ 0.0001) in comparison with the conventional method (P Ë‚ 0.0001). With regard to the patient's satisfaction, determined on the basis of the six-point system, the results were as follows: conventional VATS approach - average 3.1 with a standard deviation of 1.1 and ranging from 0 to 5; single-port VATS approach - average 4.3 with a standard deviation of 1.0 and within the range from 0 to 6. Conventional VATS approach - 6.8 - neutral. Single-port VATS approach - 8.1 - prevailing satisfaction.Conclusions: Based on our study and the studies of other authors, it can be concluded that postoperative pain and satisfaction after VATS in patients with MPE (Malignant pleural effusion) are influenced by the number of ports and the one-port technique shows better results than the conventional three-port method.The research study was registered and approved by the Clinical Research and Ethics Committee at the 'Prof. Dr. Stoyan Kirkovich' AD University Multi-Profile Hospital for Active Treatment Hospital, Stara Zagora. According to Protocol No. 11, Ref. No. 12471/30.10.2015 approved are the methods used by the sociological research study which uses predefined indicators to track patients who have undergone conventional VATS and single-port VATS. Indicators: postoperative pain and satisfaction.


Assuntos
Dor Pós-Operatória/etiologia , Satisfação do Paciente , Derrame Pleural Maligno/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Medição da Dor
10.
Am J Case Rep ; 20: 1755-1759, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31772146

RESUMO

BACKGROUND The incidence of solitary fibrous tumor of the pleura (SFTP) is less than 5% of all pleural tumors. It is important to determine whether the tumor is benign or malignant in deciding on treatment and estimating prognosis, but this can sometimes be difficult. CASE REPORT A 59-year-old woman with no prior medical history presented with a 4-month history of right back pain and dyspnea. Contrast-enhanced computed tomography revealed a giant oval mass with inhomogeneous intensities, and bloody pleural effusion in the right thoracic cavity, proved to be solitary fibrous tumor of pleura (SFTP) under the complete thoracoscopic resection. The resected tumor seemed to have several malignant features, including large size of tumor, inhomogeneous intensities, and pleural effusion due to intratumor hemorrhage; however, Ki-67 (MIB-I) proliferation index was less than 1%, with no recurrence seen within 2 year after symptom onset. CONCLUSIONS We managed a case of SFTP presenting both malignant and benign features. In patients with SFTP, multi-disciplinary discussion among the clinician, radiologist, and pathologist was considered to be needed for estimating disease prognosis.


Assuntos
Derrame Pleural Maligno/cirurgia , Tumor Fibroso Solitário Pleural/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pleural Maligno/diagnóstico por imagem , Tumor Fibroso Solitário Pleural/diagnóstico por imagem , Toracoscopia , Tomógrafos Computadorizados
11.
Medicine (Baltimore) ; 98(41): e17555, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593139

RESUMO

RATIONALE: Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS). PATIENT CONCERNS: 52-year-old women with dyspnea, fever and a new loculated pleural effusion that was suspected to be the source of the fever but was not accessible through traditional thoracentesis. DIAGNOSIS: Malignant pleural effusion. INTERVENTIONS: Sampling and drainage of the loculated pleural fluid collection using EBUS scope introduced via the esophagus. OUTCOMES: Infection excluded. Resolution of fever and improved dyspnea after drainage of effusion. LESSONS: The convex curvilinear ultrasound bronchoscope allows unprecedented access to thoracic structures. The reach is not limited to mediastinal lymph nodes and parenchymal masses adjacent to the airways, and pleural space and pleural fluid are at times accessible, particularly when one considers the esophageal approach.


Assuntos
Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/cirurgia , Toracentese/métodos , Broncoscópios , Drenagem/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pleural Maligno/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Eur J Cardiothorac Surg ; 55(6): 1121-1129, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30726889

RESUMO

OBJECTIVES: Non-small-cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. However, several small-sample studies have demonstrated that they might benefit from surgery. We investigated the effects of primary tumour resection on survival in these patients. METHODS: Stage IV NSCLC patients with ipsilateral pleural dissemination were identified from the US National Cancer Institute Surveillance, Epidemiology and End Results database entries from 2010 to 2015. Survival analysis was performed before and after matching. Multivariable regression models were built to identify prognostic factors. RESULTS: Of the 5513 patients with ipsilateral pleural dissemination, 309 underwent primary tumour resection. In the entire cohort, surgery was associated with improved overall survival (OS) in both the unmatched and matched cohorts (both log rank, P < 0.001). In the surgery-recommended cohort, patients treated with surgery also had significantly longer OS before and after matching. Multivariable regression models showed that surgery was an independent favourable prognostic factor for OS [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.48-0.65; P < 0.001] and lung cancer-specific mortality (subhazard ratio 0.60, 95% CI 0.51-0.70; P < 0.001). Surgery was independently associated with improved survival in all subgroups except for those with pericardial effusion (P = 0.065) or N3 disease (P = 0.17). In the surgical cohort, patients who underwent lobe/bilobectomy had significantly better OS than those who underwent sublobar resection (log rank, P < 0.001). CONCLUSIONS: Inclusion of primary tumour resection in multimodal therapy of NSCLC was associated with improved survival in selected patients with ipsilateral pleural dissemination, except for those with pericardial effusion or N3 disease.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Estadiamento de Neoplasias , Derrame Pleural Maligno/cirurgia , Vigilância da População/métodos , Idoso , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Causas de Morte/tendências , China/epidemiologia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Masculino , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/mortalidade , Pneumonectomia/métodos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
15.
BMJ Open Respir Res ; 6(1): e000368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30687504

RESUMO

Introduction: One of the most debilitating symptoms of malignant pleural mesothelioma (MPM) is dyspnoea caused by pleural effusion. MPM can be complicated by the presence of tumour on the visceral pleura preventing the lung from re-expanding, known as trapped lung (TL). There is currently no consensus on the best way to manage TL. One approach is insertion of an indwelling pleural catheter (IPC) under local anaesthesia. Another is video-assisted thoracoscopic partial pleurectomy/decortication (VAT-PD). Performed under general anaesthesia, VAT-PD permits surgical removal of the rind of tumour from the visceral pleura thereby allowing the lung to fully re-expand. Methods and analysis: MesoTRAP is a feasibility study that includes a pilot multicentre, randomised controlled clinical trial comparing VAT-PD with IPC in patients with TL and pleural effusion due to MPM. The primary objective is to measure the SD of visual analogue scale scores for dyspnoea following randomisation and examine the patterns of change over time in each treatment group. Secondary objectives include documenting survival and adverse events, estimating the incidence and prevalence of TL in patients with MPM, examining completion of alternative forms of data capture for economic evaluation and determining the ability to randomise 38 patients in 18 months. Ethics and dissemination: This study was approved by the East of England-Cambridge Central Research Ethics Committee and the Health Research Authority (reference number 16/EE/0370). We aim to publish the outputs of this work in international peer-reviewed journals compliant with an Open Access policy. Trial registration: NCT03412357.


Assuntos
Neoplasias Pulmonares/cirurgia , Mesotelioma/cirurgia , Derrame Pleural Maligno/cirurgia , Neoplasias Pleurais/cirurgia , Pleurodese/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Cateteres de Demora , Ensaios Clínicos Fase III como Assunto , Inglaterra/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Masculino , Mesotelioma/complicações , Mesotelioma/mortalidade , Mesotelioma Maligno , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Projetos Piloto , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/mortalidade , Neoplasias Pleurais/complicações , Neoplasias Pleurais/mortalidade , Pleurodese/efeitos adversos , Pleurodese/instrumentação , Ensaios Clínicos Controlados Aleatórios como Assunto , Tamanho da Amostra , Análise de Sobrevida , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/instrumentação , Resultado do Tratamento
17.
Panminerva Med ; 61(3): 326-343, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30394712

RESUMO

Diseases of the pleura and pleural space are common and present a significant contribution to the workload of respiratory physicians, with most cases resulting from congestive heart failure, pneumonia, and cancer. Although the radiographic and ultrasonographic detection of pleural abnormalities may be obvious, the determination of a specific diagnosis can often represent a challenge. Invasive procedures such as pleural drainage, ultrasound/CT-guided pleural biopsy or medical thoracoscopy can be useful in determining specific diagnosis of pleural diseases. Management of primary and secondary spontaneous pneumothorax is mandatory in an interventional pulmonology training program, while the medical or surgical treatment of the recurrence is still a matter of discussion. Pleural drainage is a diagnostic and therapeutic procedure used in the treatment of pneumothorax and pleural effusions of different etiologies and even in palliation of symptomatic in malignant pleural effusion. Medical thoracoscopy (MT) is a minimally invasive procedure aimed at inspecting the pleural space. It could be a diagnostic procedure in pleural effusions (suspected malignant pleural effusion, infective pleural disease such as empyema or tuberculosis) or therapeutic procedure (chemical pleurodesis or opening of loculation in empyema). Diagnostic yield is 95% in patients with pleural malignancies and higher in pleural tuberculosis. In parapneumonic complex effusion, MT obviates the need for surgery in most cases. Thoracoscopy training should be considered being as important as bronchoscopy training for interventional pulmonology, although prior acquisition of ultrasonography and chest tube insertion skills is essential.


Assuntos
Competência Clínica , Pleura/diagnóstico por imagem , Pneumologia/educação , Toracoscopia/educação , Broncoscopia/efeitos adversos , Tubos Torácicos , Drenagem , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Derrame Pleural/cirurgia , Derrame Pleural Maligno/cirurgia , Pneumonia/complicações , Pneumotórax/cirurgia , Pneumologia/métodos , Reprodutibilidade dos Testes , Toracoscopia/métodos
18.
Ir Med J ; 111(9): 825, 2018 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-30556673

RESUMO

We present the case of a 44-year-old man diagnosed with metastatic sarcomatoid carcinoma of the prostate. The pathogenesis and optimal treatment of this rare and aggressive subtype of prostate cancer are not fully clear. The patient was managed using a multimodality approach of chemotherapy, hormonal blockade and radiation therapy, with palliative intent.


Assuntos
Carcinossarcoma/diagnóstico , Carcinossarcoma/terapia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapia , Adulto , Biópsia , Carcinossarcoma/patologia , Carcinossarcoma/secundário , Terapia Combinada , Docetaxel/administração & dosagem , Neoplasias Cardíacas/secundário , Ventrículos do Coração , Humanos , Imageamento por Ressonância Magnética , Masculino , Cuidados Paliativos , Derrame Pleural Maligno/cirurgia , Neoplasias da Próstata/patologia , Radioterapia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
20.
Support Care Cancer ; 26(8): 2499-2502, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29603030

RESUMO

INTRODUCTION: The optimal chest tube type and size for drainage and chemical pleurodesis of malignant pleural effusions remains controversial. This retrospective study was conducted to compare the efficacy of conventional versus pigtail chest tube in the treatment of malignant pleural effusions. METHODS: Patients submitted to chest tube drainage and slurry talc pleurodesis due to malignant pleural effusion in our pulmonology ward from 2012 to 2016 were eligible. According to the type of chest tube, they were divided into two groups: group I-conventional chest tube and group II-pigtail chest tube. Number of deaths, recurrence of malignant pleural effusion, and timelines associated with the procedures were reviewed and compared between groups. RESULTS: Out of the 61 included patients, 46 (75.4%) were included in group I and 15 (24.6%) in group II. Only one patient had pigtail chest tube obstruction, with posterior insertion of conventional chest tube. Death during hospital stay and up to 3 months, recurrence at 4 weeks, total duration of hospital stay, time from chest tube insertion to pleurodesis, and time from chest tube insertion to removal were not significantly different between the two groups (all p > 0.05). DISCUSSION: These findings suggest that pigtail chest tube can be an alternative on palliation, with no compromise in pleurodesis performance.


Assuntos
Tubos Torácicos/normas , Derrame Pleural Maligno/cirurgia , Derrame Pleural Maligno/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
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