Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Chemical Pleurodesis Using Doxycycline and Viscum album Extract

  • Song, Kyung Sub (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Keum, DongYoon (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Jae Bum (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine)
  • Received : 2016.08.05
  • Accepted : 2017.04.03
  • Published : 2017.08.05
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Abstract

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 ($162.2{\pm}170.2mL$ vs. $97.0{\pm}77.2mL$, 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.

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References

  1. Salomaa ER, Pulkki K, Helenius H. Pleurodesis with doxycycline or Corynebacterium parvum in malignant pleural effusion. Acta Oncol 1995;34:117-21. https://doi.org/10.3109/02841869509093649
  2. Light RW, O'Hara VS, Moritz TE, et al. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax: results of a department of veterans affairs cooperative study. JAMA 1990;264:2224-30. https://doi.org/10.1001/jama.1990.03450170072025
  3. Eriksson K, Wikstrom L, Arestedt K, Fridlund B, Brostrom A. Numeric rating scale: patients' perceptions of its use in postoperative pain assessments. Appl Nurs Res 2014;27:41-6. https://doi.org/10.1016/j.apnr.2013.10.006
  4. Caglayan B, Torun E, Turan D, et al. Efficacy of iodopovidone pleurodesis and comparison of small-bore catheter versus large-bore chest tube. Ann Surg Oncol 2008;15:2594-9. https://doi.org/10.1245/s10434-008-0004-1
  5. Balassoulis G, Sichletidis L, Spyratos D, et al. Efficacy and safety of erythromycin as sclerosing agent in patients with recurrent malignant pleural effusion. Am J Clin Oncol 2008;31:384-9. https://doi.org/10.1097/COC.0b013e318165c061
  6. Yoshida K, Sugiura T, Takifuji N, et al. Randomized phase II trial of three intrapleural therapy regimens for the management of malignant pleural effusion in previously untreated non-small cell lung cancer: JCOG 9515. Lung Cancer 2007;58:362-8. https://doi.org/10.1016/j.lungcan.2007.07.009
  7. Rafiei R, Yazdani B, Ranjbar SM, et al. Long-term results of pleurodesis in malignant pleural effusions: Doxycycline vs Bleomycin. Adv Biomed Res 2014;3:149. https://doi.org/10.4103/2277-9175.137831
  8. Miller Q, Meschter C, Neumaster T, et al. Comparison of pleurodesis by erythromycin, talc, doxycycline, and diazepam in a rabbit model. J Surg Educ 2007;64:41-5. https://doi.org/10.1016/j.cursur.2006.07.006
  9. Kuzdzal J, Sladek K, Wasowski D, et al. Talc powder vs doxycycline in the control of malignant pleural effusion: a prospective, randomized trial. Med Sci Monit 2003;9:PI54-9.
  10. Bilaceroglu S, Guo Y, Hawthorne ML, et al. Oral forms of tetracycline and doxycycline are effective in producing pleurodesis. Chest 2005;128:3750-6. https://doi.org/10.1378/chest.128.5.3750
  11. Baumann MH. Treatment of spontaneous pneumothorax. Curr Opin Pulm Med 2000;6:275-80. https://doi.org/10.1097/00063198-200007000-00004
  12. Salzer G. The local treatment of malignant pleural exudations with Iscador (a drug obtained from Misteltoe): preliminary report (author's transl). Osterr Z Onkol 1977;4:13-4.
  13. Stumpf C, Bussing A. Stimulation of antitumour immunity by intrapleural instillation of a Viscum album L. extract. Anticancer Drugs 1997;8 Suppl 1:S23-6.
  14. Cho JS, Na KJ, Lee Y, et al. Chemical pleurodesis using mistletoe extraction (ABNOVAviscum Injection) for malignant pleural effusion. Ann Thorac Cardiovasc Surg 2016;22:20-6. https://doi.org/10.5761/atcs.oa.15-00230
  15. Gaafar R, Abdel Rahman AR, Aboulkasem F, El Bastawisy A. Mistletoe preparation (Viscum Fraxini-2) as palliative treatment for malignant pleural effusion: a feasibility study with comparison to bleomycin. Ecancermedicalscience 2014;8:424.
  16. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2004;(1):CD002916.
  17. Froudarakis ME, Klimathianaki M, Pougounias M. Systemic inflammatory reaction after thoracoscopic talc poudrage. Chest 2006;129:356-61. https://doi.org/10.1378/chest.129.2.356
  18. Farrar JT, Troxel AB, Stott C, Duncombe P, Jensen MP. Validity, reliability, and clinical importance of change in a 0-10 numeric rating scale measure of spasticity: a post hoc analysis of a randomized, double-blind, placebo-controlled trial. Clin Ther 2008;30:974-85. https://doi.org/10.1016/j.clinthera.2008.05.011
  19. Chen JS, Hsu HH, Kuo SW, et al. Effects of additional minocycline pleurodesis after thoracoscopic procedures for primary spontaneous pneumothorax. Chest 2004;125:50-5. https://doi.org/10.1378/chest.125.1.50
  20. Herrington JD, Gora-Harper ML, Salley RK. Chemical pleurodesis with doxycycline 1 g. Pharmacotherapy 1996;16:280-5.

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