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Respiratory
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
The use of chemical pleurodesis is advised in cases of difficult or recurrent pneumothoraces. From a surgical perspective, cases of persistent air leak or failure of lung expansion should be referred for thoracic input for open thoracotomy or video-assisted thoracic surgery.
Chylothorax
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Although pleurodesis can be performed as a stand-alone operation to treat a refractory chylothorax, the procedure is more commonly employed in combination with thoracic duct ligation, particularly if no focal leak is identified. Once access to the parietal pleura is obtained either by thoracotomy or thoracoscopy, the entire parietal pleura of the lower thorax adjacent to the thoracic duct is mechanically abraded with a surgical sponge, peanut, or cautery scratch pad. An alternative approach to pleurodesis is to instill a chemical agent such as bleomycin, doxycycline, or talc, all of which are known to facilitate significant pleural inflammation. Chemical pleurodesis is generally reserved for treatment in older children and in patients with congenital lymphangiomatosis. A chest tube should be left in place after pleurodesis.
Lung Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Specific symptoms can be improved with interventions including external-beam radiotherapy and endobronchial debulking or stenting, which can improve breathlessness associated with endobronchial obstruction. Pleural effusions can be relieved by drainage of fluid and pleurodesis to prevent re-accumulation. Immediate relief from symptoms of superior vena cava obstruction (SVCO) can be achieved by radiological stent insertion. Both denosumab and bisphosphonates improve pain and skeletal events resulting from bone metastases.
A rare cause of recurrent hemopneumothorax
Published in Acta Clinica Belgica, 2020
Mike Ralki, Alaaddin Yilmaz, Jacques Vanwing, Kristof Cuppens
On admission, chest tomography showed presence of a hydropneumothorax on the right side with multiple thin-walled cysts and surrounding ground glass attenuation in the right middle lobe (Figure 1(a)). Pleural fluid analysis showed a bloody eosinophilic exudate without microbial or cytological anomalies. Our patient was referred for video-assisted thoracoscopic surgery due to the absence of definite diagnosis and the presence of persistent air leak despite thoracic drainage. Peroperative inspection revealed diffuse subpleural hemorrhagic cysts in the right middle lobe and a complete lobe resection was performed. Pleurodesis was not performed since the rest of the lung and the pleural membranes were normal. Pathologic examination of the resection specimen revealed an angiosarcoma (Figure 2).
Making cold malignant pleural effusions hot: driving novel immunotherapies
Published in OncoImmunology, 2019
Pranav Murthy, Chigozirim N. Ekeke, Kira L. Russell, Samuel C. Butler, Yue Wang, James D. Luketich, Adam C. Soloff, Rajeev Dhupar, Michael T. Lotze
Management choice is guided by the patient’s prognosis, preference, functional status, rate of pleural effusion accumulation and resolution, failed therapeutic options, and the surgical team’s experience. To date, there are no established criteria for selecting from the available therapeutic options. The decision to undergo pleurodesis is often based upon an anticipated survival of longer than three to four months.16 Talc pleurodesis was previously the mainstay of treatment. The mechanism of action involves promoting local inflammation following installation of a sclerosing pleurodesis agent to promote pleural symphysis and prevent recurrent fluid collection.16 Despite the potential therapeutic benefits, pleurodesis failure remains a major drawback. A meta-analysis of 62 randomized trials involving over 3,000 patients compared and ranked agents based on pleurodesis efficacy.16 Talc poudrage was identified as the superior method when compared to bleomycin, mepacrine, or iodine installation. There was no evidence of survival benefit associated with any of the individual types of pleurodesis. Failure of lung expansion remains a contraindication for chemical pleurodesis and the introduction of the intrapleural catheter has served as an initial suitable remedy for lung entrapment.43
Surgical and non-surgical management of malignant pleural effusions
Published in Expert Review of Respiratory Medicine, 2018
Deirdre B. Fitzgerald, Coenraad F. N. Koegelenberg, Kazuhiro Yasufuku, Y. C. Gary Lee
The majority of reports on VATS in the literature describe a relatively standardized procedure in the management of MPEs [22–25]. Port-size is typically 10 mm and often a thoracoscope with a 5-mm working channel is used, aiming to reduce the number of access points (usually two to three). Fibrinous adhesions are removed while dense fibrous adhesions are divided. Pleural biopsies are taken as required (Figure 1). The lung is assessed for full expansion while being inflated with positive pressure and, if satisfactory, pleurodesis is performed. The most common method of pleurodesis is talc poudrage, with insufflation of 2–10 g of sterile, asbestos-free, graded talc. Alternative options for chemical pleurodesis include bleomycin, doxycycline, or alcohol [26,27]. Mechanical abrasion, involving ‘scarification’ of the visceral and parietal surfaces, is sometimes used; parietal pleurectomy is less commonly employed [28,29]. Decortication to free a non-expanding or ‘trapped’ lung is intermittently performed, though careful assessment for air leak is required in these cases [22,23,25,30].