• 제목/요약/키워드: pleurodesis

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Pleural Space Elastance and Its Relation to Success Rates of Pleurodesis in Malignant Pleural Effusion

  • Masoud, Hossam Hosny;El-Zorkany, Mahmoud Mohamed;Ahmed, Azza Anwar;Assal, Hebatallah Hany
    • Tuberculosis and Respiratory Diseases
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    • 제84권1호
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    • pp.67-73
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    • 2021
  • Background: Pleurodesis fails in 10%-40% of patients with recurrent malignant pleural effusions malignant pleural effusion and dyspnea. This study aimed to assess the values of pleural elastance (PEL) after the aspiration of 500 mL of pleural fluid and their relation to the pleurodesis outcome, and to compare the pleurodesis outcome with the chemical characteristics of pleural fluid. Methods: A prospective study was conducted in Kasr El-Aini Hospital, Cairo University, during the period from March 2019 to January 2020. The study population consisted of 40 patients with malignant pleural effusion. The measurement of PEL after the aspiration of 500 mL of fluid was done with "PEL 0.5" (cm H2O/L), and the characteristics of the pleural fluid were chemically and cytologically analyzed. Pleurodesis was done and the patients were evaluated one month later. The PEL values were compared with pleurodesis outcomes. Results: After 4-week of follow-up, the success rate of pleurodesis was 65%. The PEL 0.5 was significantly higher in failed pleurodesis than it was in successful pleurodesis. A cutoff point of PEL 0.5 >14.5 cm H2O/L was associated with pleurodesis failure with a sensitivity and specificity of 93% and 100%, respectively. The patients with failed pleurodesis had significantly lower pH levels in fluid than those in the successful group (p<0.001). Conclusion: PEL measurement was a significant predictor in differentiating between failed and successful pleurodesis. The increase in acidity of the malignant pleural fluid can be used as a predictor for pleurodesis failure in patients with malignant pleural effusion.

Early Pleurodesis for Postoperative Air Leak with Autologous Blood and 50% Glucose Solution

  • Jeong In Hong;Jun Hee Lee;Hyun Koo Kim
    • Journal of Chest Surgery
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    • 제56권1호
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    • pp.16-22
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    • 2023
  • Background: Postoperative air leaks after pulmonary resection prolong the duration of chest drainage and the length of hospital stay. One of the many treatment options is bedside pleurodesis using various agents. This study evaluated the feasibility of an early intervention to stop postoperative air leaks with either autologous blood or a 50% glucose solution. Methods: We retrospectively reviewed 323 patients who underwent bedside pleurodesis between January 2017 and March 2022. Sixty-four patients received autologous blood patch pleurodesis, and 36 were treated with a 50% glucose solution after pulmonary resection. The primary endpoints were the total postoperative tube indwelling time, post-pleurodesis tube indwelling time, and hospital stay. A propensity score-matched analysis was performed. Results: In the autologous blood patch pleurodesis and 50% glucose solution groups, the mean initiation timing of postoperative pleurodesis were 2.06±1.62 and 3.28±1.56 days, the mean duration of the tube indwelling time after surgery was 6.58±3.02 and 6.42±4.92 days, and the mean duration of the tube indwelling time after pleurodesis, it was 4.53±3.10 and 3.11±4.80 days, respectively. In addition, the total length of hospital stay was 9.11±5.42 and 7.83±4.75 days in the autologous blood patch pleurodesis and 50% glucose solution groups, respectively. Conclusion: Early postoperative air leak cessation with autologous blood patch pleurodesis or 50% glucose solution pleurodesis is a feasible procedure with acceptable outcomes that effectively shortens the hospital stay.

Which is the More Effective Option for Pleurodesis to Prevent the Recurrence of Malignant Pleural Effusion? Large-Particle Talc or Mistletoe Extract (ABNOVA Viscum Injection)

  • Changsung Han;Jonggeun Lee;Jeong Su Cho;Hyo Yeong Ahn
    • Journal of Chest Surgery
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    • 제56권5호
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    • pp.353-358
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    • 2023
  • Background: Malignant pleural effusion affects many patients with advanced cancer. When chemotherapy or radiotherapy fails to relieve malignant pleural effusion and related symptoms, drainage and pleurodesis can help. Although surgical talc pleurodesis is the most widely used method, Viscum album, which has been recently used in surgical or bedside procedures, has demonstrated significant results and is as effective as talc. This study aimed to determine the most effective agent and procedure. Methods: Between January 2015 and July 2022, chemical pleurodesis was performed in 137 patients with malignant pleural effusion, using a V. album surgical procedure in 48, a V. album bedside procedure in 55, and a talc surgical procedure in 34 patients. We reviewed patients' clinical responses and disease progression after chemical pleurodesis. Results: The success rate was not significantly different among the V. album surgical procedures (91.7%), V. album bedside procedures (83.6%), and talc surgical procedures (91.2%). However, the total drainage amount and tube insertion duration in both Viscum groups were more effective than those in the talc group. Furthermore, the bedside Viscum group showed significantly lower post-pleurodesis pain scores than the other 2 groups. Conclusion: According to our results, talc and V. album can be considered ideal agents for chemical pleurodesis. However, Viscum pleurodesis showed safer outcomes in terms of ensuring quality of life than talc. Additionally, the bedside Viscum group showed significantly lower pain scores than the other groups. Hence, patients for whom surgical procedures are inappropriate can undergo bedside Viscum pleurodesis without diminishing the therapeutic effect.

Chemical Pleurodesis Using Tetracycline for the Management of Postoperative Pneumothorax Recurrence

  • Jun Tae Yang;Sahri Kim;Hyoung Soo Kim;Hee Sung Lee;Yong Joon Ra;Hong Kyu Lee
    • Journal of Chest Surgery
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    • 제56권4호
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    • pp.240-243
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    • 2023
  • Background: Although there is no obvious recommendation for the management of pneumothorax recurrence after surgery, chemical pleurodesis with tetracycline has been applied as a significant treatment approach. The objective of this study was to evaluate the effectiveness of chemical pleurodesis with tetracycline for the management of postoperative recurrence of primary spontaneous pneumothorax (PSP). Methods: We retrospectively analyzed patients who underwent video-assisted thoracic surgery (VATS) as therapy for PSP at Hallym University Sacred Heart Hospital from January 2010 to December 2016. Patients who had ipsilateral recurrence after surgery were included in this study. Patients who underwent pleural drainage with chemical pleurodesis were compared with patients who only underwent pleural drainage. Results: In total, 932 patients who underwent VATS for PSP were analyzed, and ipsilateral recurrence after surgery occurred in 67 patients (7.1%). The treatment modalities for recurrence after surgery were observation (n=12), pleural drainage alone (n=16), pleural drainage with chemical pleurodesis (n=34), and repeated VATS (n=5). Eight of the 16 patients (50 %) treated with pleural drainage alone had recurrence again, while 15 of the 34 patients (44.1%) treated with pleural drainage and chemical pleurodesis experienced further recurrence. Chemical pleurodesis with tetracycline did not show a meaningful difference in the re-recurrence rate in comparison with pleural drainage alone (p=0.332). Conclusion: Chemical pleurodesis with tetracycline for the management of postoperative recurrence of PSP was not effective. Further research is required to identify alternative drugs that can significantly decrease the re-recurrence rate.

Chemical Pleurodesis Using Doxycycline and Viscum album Extract

  • Song, Kyung Sub;Keum, DongYoon;Kim, Jae Bum
    • Journal of Chest Surgery
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    • 제50권4호
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    • pp.281-286
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    • 2017
  • 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.

Talc 늑막유착술 이후 발생한 치명적 저산소증 2 예 (Two Cases of Fatal Hypoxemia after Talc Pleurodesis for Recurrent Malignant Pleural Effusion)

  • 박신애;이한희;김대준;심병용;송소향;김치홍;안명임;조덕곤;조규도;김훈교
    • Tuberculosis and Respiratory Diseases
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    • 제62권3호
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    • pp.217-222
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    • 2007
  • 저자들은 악성흉수 환자에서 가장 많은 치료법으로 선택되고 있는 talc 늑막유착술 이후에 급성 저산소증으로 사망한 환자 2예를 경험하였다. Talc 늑막유착술은 안전하고 효과적인 치료이지만, talc를 5 g 이상 사용하거나, 전신상태가 불량하거나, 반복적인 늑막유착술을 시행한 경우나, 양측에 흉수가 있거나, 늑막유착술 전 2주 이내에 항암요법이나 방사선치료를 한 경우나 폐실질에 전이성병변이 있을 때 예후가 불량하므로 talc 늑막유착술 환자를 선정할 때 주의하여야 하겠다.

Talc를 이용한 늑막유착술 후 발생한 급성 호흡곤란증후군 1례 (A Case of Acute Respiratory Distress Syndrome(ARDS) after Talc Pleurodesis)

  • 김기업;차건영;한상훈;윤여일;박성우;김도진;나문준;어수택;김용훈;박춘식
    • Tuberculosis and Respiratory Diseases
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    • 제51권3호
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    • pp.265-269
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    • 2001
  • 저자들은 악성 늑막삼출 환자에서 talc로 늑막유착술을 시행하여 급성 호흡곤란증후군을 보인 환자를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

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양측 특발성유미흉에 대한 OK 432주입 흉막유착술 (A Case of Idiopathic Bilateral Chylothorax Treated by Chemical Pleurodesis with OK 432)

  • 김맹호
    • Journal of Chest Surgery
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    • 제28권10호
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    • pp.951-953
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    • 1995
  • A male 17-year-old boy was tranferred from a private hospital for persistent bilateral pleural effusion.The effusion was confirmed as bilateral chylothorax by chest CT and lymphangiography. Persistent accumulation of the chylothorax was uncontrollable more 1000cc daily ever after pleuroperitoneal shunt operation and thoracoscopic thoracic duct ligation at Rt. side. Chemical pleurodesis with OK 432 into pleural cavity through thoracostomy tube was attempted as 1.5 KE-3 KE diluted in 50ml of normal saline for 3 consecutive days resulted dramatic reduction of the drainage amount. Chemical pleurodesis with OK 432 appeared to be very helpful for management idiopathic bilateral chylothorax.

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Acute Respiratory Distress Syndrome after Viscum album Pleurodesis for Primary Spontaneous Pneumothorax

  • Noh, Dongsub;Park, Joon Suk;Lee, Doo Yun
    • Journal of Chest Surgery
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    • 제50권1호
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    • pp.64-67
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    • 2017
  • A 52-year-old male patient who underwent multiple wedge resections experienced postoperative acute respiratory distress syndrome in both lungs after Viscum album pleurodesis. Despite initial rapid deterioration in clinical condition and rapid progression of bilateral lung infiltration, he exhibited a relatively smooth clinical recovery with marked response to glucocorticoid treatment. Our case report suggests that care must be taken to guard against the development of acute respiratory complications in the use of Viscum album for pleurodesis. However, in view of the clinically benign course, initial aggressive management of complications can prevent suffering and sequelae.

자가혈과 늑막유착제를 이용한 늑막유착술 -치험 2례 보고- (Pleurodesis with Autologous Blood Plus Sclerosing Agents)

  • 송종필;이종호;김병열;이정호;강경민
    • Journal of Chest Surgery
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    • 제32권1호
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    • pp.92-95
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    • 1999
  • 폐엽 절제술후 발생한 지속적인 공기 누출 환자에 있어서 현재 화학적 늑막유착술이 보편적으로 시행되고 있으며, 여기에 쓰이는 늑막유착제로는 talc, tetracyclin, doxycyclin, bleomycin, vibramycin, OK432 등이 있다. 그러나 재팽창이 불완전하여 사강이 남아있는 경우 화학적 늑막유착술 만으로는 그 효과를 기대하기 어려우며, 장기간 흉관을 가지고 있어야 함으로 농흉의 위험성도 증가한다. 따라서 폐절제술 혹은 늑막박피술후 발생한 지속적인 공기누출은 많은 흉부외과 의사의 고민이었다. 자가혈을 이용한 늑막유착술은 이러한 지속적 공기누출에 대한 해결법의 하나로 개발되었으며, 그 기전은 혈괴가 직접 기관지 늑막루를 폐쇄하면서 동시에 사강을 감소시킴으로서 늑막유착을 유발하는 것으로 생각된다. 본원에서는 폐수술후 지속적인 공기누출 2례에서 자가혈과 OK432 그리고 자가혈과 vibramycin을 각각 사용하여 좋은 결과를 얻었다.

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