• Tuberculosis and Respiratory Diseases
• /
• v.60 no.1
• /
• pp.72-75
• /
• 2006

Background : This report reviews our experience with persistent air leaks in the peumothorax that were not considered candidates for surgical treatment in order to evaluate the efficacy and risks of the OK-432 plus autoblood or OK-432 pleurodesis. Material & Methods : From March 2004 to July 2005, 8 consecutive patients who had an air leak in the pneumothorax over 5 days and had been treated with OK-432 plus autoblood or OK-432 pleurodesis. The patients were not considered candidates for surgical treatments because the chest CT findings revealed severe chronic lung disease with multiple bullae and/or bullous changes. A prolonged air leak with/without dead space was treated with either OK-432 plus autoblood or OK-432 pleurodesis. The efficacy and side effects of OK-432 pleurodesis were assessed by determining the duration of the air leak, the number of pleurodesis, the patients' symptoms, measurements of the white blood cell count and the c-reactive protein level. Results : All of eight patients were male and the mean age was $72.4{\pm}8.5$. The mean number of pleurodesis was $1.9{\pm}1.1$ and the mean duration of the air leak was $4.6{\pm}4.6days$ after pleurodesis. Side effects after pleurodesis were encountered in 7 patients, which included a chilling sensation in 7 cases, chest pain in 5 cases, headache in 3 cases, local heat sensation in 2 cases, and fever in 1 case. Leukocytosis was observed in 6 patients, and the mean of WBC count and CRP were $14500{\pm}2100$ and $21.9{\pm}11.4mg/dL$, respectively. Conclusion : Either OK-432 plus autoblood or OK-432 pleurodesis has acceptable side effects, and can be considered a treatment option for persistent air leaks in the pneumothorax that are not candidates for surgical treatment.

• Tuberculosis and Respiratory Diseases
• /
• v.41 no.5
• /
• pp.531-536
• /
• 1994

Background: The intrapleural instillation of tetracycline for pleural sclerosis had been most commonly used in patients with symptomatic malignant pleural effusion or recurrent pneumothorax for a long time. Unfortunately, at a time of expanding use of this agent, the production of injectable tetracycline hydrochloride used for pleurodesis was discontinued by its sole manufacturer in mid-1991 because the manufacturer was unable to meet US Food and Drug Administration purity standards. So we performed a preliminary study of doxycycline, as a alternative pleural sclerosant on rabbit pleura and compared its efficacy with that of tetracycline. Method: Eighteen New Zealand white rabbits weighing 2 to 3kg(mean 2.6kg) were devided into three groups. In each groups, one tetracycline(20 mg/ml/kg) and two doxycycline solutions(7 mg/ml/kg and 20 mg/ml/kg) instillated into the right pleural space through an 18-gauge angiocath with care to prevent pneumothorax. All rabbits were sacrificed after 28 days. Results: 1) In the group of tetracycline 20 mg/ml/kg(six rabbits), five rabbits showed partial pleural symphysis with several fibrous bands, and one rabbit died on 22th day. 2) In the group of doxycycline 7 mg/ml/kg(six rabbits), three rabbits showed partial pleural symphysis and the other three rabbits showed complete pleural symphysis without necrosis of underlying parenchymal lung tissue. 3) In the group of doxycycline 20 mg/ml/kg(six rabbits), two rabbits showed complete pleural symphysis without lung necrosis, another two rabbits showed complete pleural symphysis with lung necrosis, and the other two rabbits died on 4th and 13th day, respectively. Conclusion: We concluded that doxycycline is a highly effective sclerosing agent having stronger pleurodesis effect with that of tetracycline by dose base and its optimal dosage was considered as 7 mg/ml/kg with minimal complications.

• Journal of Chest Surgery
• /
• v.37 no.2
• /
• pp.166-172
• /
• 2004

When compare with blebectomy or bullaectomy simply and pleurodesis together in treatment of primary spontaneous pnevmthorax, the later has been realized as the method that can reduce the recurrent rate after surgical operation. Therefore, in this study, we compared the merits and demerits of the clinical result of chemical pleurodesis that use Talcum powder in pleurodesis and mechanical pleurodesis that use apical pleurectomy and analyzed the reappearance rate etc. Material and Method: The Pleurodesis through the apical pleurectomy and talc powder insufflation had been used as secondary procedure after blebectomy of spontaneous pneumothorax from January 1, 2000 to June 30, 2002. This study consisted of a retrospective review of 68 patients who were treated with apical pleurectomy, and 84 patients treated with talc powder insufflation. We compaired the apical pleurectomy and talc powder insufflation in terms of age, sex, cause of operation, number of used autosuture staple, tine duration of procedure after blebectomy, severity of pain and complication after operation, postoperative air leakage period, duration of chest tube insertion, hospitalization, and recurrence rate of pneumothorax. Result: Time required for secondary procedure was longer in apical pleurectomy than talc powder insufflation. Postoperative pain was more severe in talc powder insufflation than apical pleurectomy. Otherwise there was no significant difference between two methods. Conclusion: Although Talc powder insufflation is more convenient than apical pleurectomy, the difference is not large and, the severity of postoperative pain is worse in talc powder insufflation. Therefore apical pleurectomy can be recommended for the secondary surgical procedure after blebectomy of primary spontaneous pneumothorax can be recommended.

• Journal of Chest Surgery
• /
• v.43 no.4
• /
• pp.399-403
• /
• 2010

Background: Video-Assisted Thoracic Surgery can be performed with the lung collapsed. During the procedure, pleural adhesion may result in lung injury, bleeding, and thoracotomy conversion. Identifying the presence of pleural adhesion before surgery can make it easy to plan trocar introduction and perform the procedure. Material and Method: Between June 2009 and November 2009, we performed ultrasound in 24 patients to detect pleural adhesion before surgery and compared the results with the operative findings. We primarily examined the lateral chest, where the trocar would be inserted, and, occasionally, the anterior or posterior chest. Result: Patient diseases were: 6 hyperhidroses, 8 interstitial lung diseases, 5 lung cancers, 2 mediastinal tumors, 1 peripheral pulmonary embolism, 1 metastatic lung cancer, and 1 sarcoidosis. Of the 22 patients who did not have pleural adhesions on ultrasound, four revealed mild adhesions not related to the trocar insertion sites. However, ultrasound showed pleural adhesions in two patients, consistent with the operative findings. There was no air leak or thoracotomy conversion related with trocar insertion. Conclusion: Ultrasound requires only a few minutes to detect the presence of the pleural adhesion and was very useful in identifying the pleural adhesion before VATS.

• Journal of Chest Surgery
• /
• v.36 no.10
• /
• pp.721-727
• /
• 2003

Background: Parenteral tetracycline is no longer available for pleural sclerosing agent for pleurodesis in Korea due to the discontinuation of the production. The purposes of this study were to determine whether oral doxycycline (ODC) could be used as an effective sclerosing agent for pleurodesis, and to compare the effectiveness of ODC to other agents, such as homologous blood and talc. Material and Method: Twenty male rats were divided into four groups (A to D). Following agents were given to each group intrapleurally; 10 $m\ell$/kg of 0.9% saline to group A, 10 mg/kg of ODC to group B, 2 $m\ell$/kg of homologous blood to group e, and 70 mg/kg of talc slurry to group D. All animals were sacrificed 28 days after instillation. The pleural spaces were assessed grossly and microscopically and were graded from 0 to 3, and the thicknesses of the pleura were measured. Result: The gross score of group A was 0.0, group B was 1.4$\pm$0.9, group e was 1.0$\pm$0.7, and group D was 2.2$\pm$0.8. Significant adhesion were examined in group B and D grossly (p < 0.05). The pleural thickness of group A was 0.7$\pm$0.2 /10$^2$ mm, group B was 1.2$\pm$0.4 /10$^2$ mm, group C was 1.4$\pm$0.4 /10$^2$ mm, and group D was 3.5$\pm$0.9 /10$^2$ mm. Group D showed pleural thickening significantly (p < 0.05). The microscopic score of group A was 1.0, group B was 1.7$\pm$0.5, group e was $1.5\pm$0.4, and group D was 2.8$\pm$0.4. Group B and D showed significant inflammations and depositions of collagen (p < 0.05). Conclusion: ODC showed significant pleurodesis grossly and microscopically, and homologous blood did not show adhesion. Talc was a significant sclerosing agent for pleurodesis causing extensive inflammation and collagen depisotion.

• Journal of Yeungnam Medical Science
• /
• v.14 no.2
• /
• pp.285-292
• /
• 1997

• Journal of Chest Surgery
• /
• v.37 no.12
• /
• pp.978-982
• /
• 2004

Background: Malignant pleural effusion is a common clinical problem in neoplastic patients. With the diagnosis of a malignant pleural effusion, palliative therapy was done. One of the treatments was a chemical pleurodesis. Talc was the most commonly used a sclerosing agent, but the quality of patient's life was not improved. We was evaluated by other agents such as Viscum album for relief of malignant pleural effusion. Material and Method: From November 2001 to October 2003, 17 patients who underwent to chemical pleurodesis for the malignant pleural effusion. We compared the talc (group I: 10 patients) and Viscum album (group II: 7 patients). We analysed them retrospectively in term of various factors and results. Result: There were no significant differences between group I and group II in the sex ratio, mean age, origin of primary cancer and site, but, group I had higher successful rate (80% : 71 %) than group II. Group II had better length of chest tube stay after procedure, Karnofsky performance and recurrence than group I. The failed treatement group was related to the pleural fluid pH and interval of initial chemical pleurodesis after thoracostomy. Conculsion: Although the chemical pleurodesis with Viscum album was slightly lower than talc in the successful rate, there was an alternative method instead of the chemical pleurodesis with talc to improve the patient's quality of life in malignant pleural effusion.

• Journal of Veterinary Clinics
• /
• v.17 no.2
• /
• pp.368-375
• /
• 2000

개의 개흉술이나 개심술 후에 주요 합병증인 유착에 대한 sodium carboxymethyl- cellulose (SCMC)의 효과를 평가하기 위하여 1% SCMC총액을 흉막 및 심낭에 적용하였다. 10두의 개를 SCMC투여 군과 생리식염수 투여 군으로 각각 5두씩 배치하고, 개흉 후 4번째 메서 7번째 늑골의 늑연골 연접부 부위에 찰과상을 유도하였고 심낭 절개 후 심낭의 내측 및 닿는 심근에 각각 $2{\times}2cm$크기로 찰과상을 유발하였다. 찰과상 유발 후 생리식염수 투여 군은 멸균 생리식염수를 3.5m1/kg을, SCMC투여 군은 같은 용량의 1% SCMC를 흉강 및 심낭 내에 각각 도포 하였다. 수술 전후에 CBC와 혈장 plasminogen치를 측정하였다. 유착 정도 는 수술 30일 후에 0-4로 점수화하여 판정하였다 십장과 심낭의 평균 유착치는 SCMC투여 군이 2.4$\pm$0.8, 생리식염수 투여군이 $3.7{\pm}0.9$로 나타나 SCMC 투여군에서 유착 발생이 유의 성 있게 낮았다(p<0.01). 폐염과 흉막간의 평균 유착치는 SCMC 투여군이 1.7$\pm$0.2이었고, saline 투여군은 $3.5{\pm}0.8$로. SCHC투여 군에서 유착 발생이 유의성 있게 낮았다(p<0.01). Saline 투여군의 혈중 plasminogen 농도는 술 후 1일에 $28.2{\pm}5.677$로 감소하였고,술 후 7일에 $47{\pm}1.4%$.증가하였다(p<0.05). SCMC 투여군에서는 실험적 수술 1일 후 $27.1{\pm}10.3$로 감소하였고 7일 후에는 $30.3{\pm}21.6%$로 증가(p<0.01)하였으나 두 군간의 유의적인 차이는 없었다 이 상의 결과로 볼 때 개흉술 및 개심술시 1% SCMC를 투여하여 흉강 내의 유착을 방지함으로써 재수술이 필요한 경우에 수술의 어려움과 조직손상의 위험을 감소시킬 것으로 사료된다.로 사료된다.

• Tuberculosis and Respiratory Diseases
• /
• v.49 no.6
• /
• pp.724-732
• /
• 2000

Background : In patients with severe chronic lung diseases even a small pneumothorax can result in life-threatening respiratory distress. It is important to treat the attack by chest tube drainage until the lung expands. Pneumothorax with a persistent air leak that does not resolve under prolonged tube thoracostomy suction is usually treated by open operation to excise or oversew a bulla or cluster of blebs to stop the air leak. Pleurodesis by the instillation of chemical agents is used for the patient who has persistent air leak and is not good candidate for surgical treatment. When the primary trial of pleurodesis with common agent fails, it is uncertain which agent should be used f or stopping the air leak by pleurodesis. It is well known that inappropriate drainage of hemothorax results in severe pleural adhesion and thickening. Based on this idea, some reports described a successful treatment with autologous blood instillation for pneumothorax patients with or without residual pleural space. We tried pleurodesis with autologous bood for pneumothorax with persistent air leak and then we evaluated the efficacy and safety. Methods : Fifteen patients who had persistent air leak in the pneumothorax complicated from the severe chronic lung disease were enrolled. They were not good candidates for surgical treatment and doxycycline pleurodesis failed to stop up their air leaks. We used a mixture of autologous blood and 50% dextrose for pleurodesis. Effect and complications were assessed by clinical out∞me, chest radiography and pulmonary function tests. Results : The mean duration of air leak was 18.4${\pm}$6.16 days before ABP (autologous blood and dextrose pleurodesis) and $5.2{\pm}1.68$ days after ABP. The mean severity of pain was $2.3{\pm}0.70$ for DP(doxycycline pleurodesis) and $1.7{\pm}0.59$ for ABDP (p<0.05). There was no other complication except mild fever. Pleural adhesion grade was a mean of $0.6{\pm}0.63$. The mean dyspnea scale was $1.7{\pm}0.46$ before pneumothrax and $2.0{\pm}0.59$ after ABDP (p>0.05). The mean $FEV_1$ was $1.47{\pm}1.01$ before pneumothorax and $1.44{\pm}1.00$ after ABDP (p>0.05). Except in 1 patient, 14 patients had no recurrent pneumothorax. Conclusion : Autologous blood pleurodesis (ABP) was successful for treatment of persistent air leak in the pneumothorax. It was easy and inexpensive and involved less pain than doxycycline pleurodesis. It did not cause complications and severe pleural adhesion. We report that ABP can be considered as a useful treatment for persistent air leak in the pneumothorax complicated from the severe chronic lung disease.

• Tuberculosis and Respiratory Diseases
• /
• v.46 no.4
• /
• pp.481-488
• /
• 1999

Background: The routine application of the combined regimen of corticosteroid-antituberculosis therapy to the tuberculous pleurisy remains controversial. Steroid therapy to tuberculous pleurisy could be effective on the acceleration of absorption of pleural effusion and symptom improvement, but there has been debate about the effect of prednisolone on the prevention of pleural adhesion. So we studied the efficacy of combined regimen of prednisolone-antituberculosis therapy on the absorption of pleural effusion and prevention of pleural adhesion. Method: A prospective, randomized study was performed in 82 patients, 50 patients(non-steroid group) were treated with only antituberculosis regimen for 6 months and in 32 patients(steroid group) prednisolone(30mg/day) were administered in addition to antituberculosis regimen for one months and tapered for another month. The amount of pleural effusion was compared at the beginning of treatment, 2nd month, 6th month and final visit with chest X-ray findings which were graded from grade 0(complete absorption) to grade 6(near total haziness). Results: The amount of pleural effusion of steroid group at 2nd month, 6th month and final visit was lesser than that of non-steroid group(P<0.05). The incidence of the complete absorption of the pleural effusion was 3/32(9.4%) in steroid group, 1/50(2%) in non-steroid group at 2nd month after treatment; and 12/32(37.5%) in steroid group, 6/50(12%) in non-steroid group at 6th month after treatment(P<0.05). At final observation, the incidence of residual pleural thickening was 15/32(47%) in steroid group and 37/50(74%) in non-steroid group(P<0.05). No serious side effects were noted during the treatment with prednisolone. Conclusion: The administration of prednisolone in conjunction with antituberculosis chemotherapy improved the absorption of pleural effusion and decreased the residual pleural thickening.