Surgical access rather than method of pleurodesis (pleurectomy or pleural abrasion) influences recurrence rates for pneumothorax surgery: systematic review and meta-analysis

Aim  

Surgery for recurrent spontaneous pneumothoraces is one of the most commonly performed procedures in thoracic surgery, but few studies have evaluated the efficacy of the surgical treatment options. We aimed to evaluate the influence of the type of pleurodesis on recurrence whilst adjusting for surgical access by systematic review and meta-regression of randomised and non-randomised trials.     

Comparative evaluation of VATS assisted combined mechanical and chemical pleurodesis with chemical pleurodesis—is it worthwhile?

Introduction

Malignant Pleural Effusion (MPE) is a common terminal clinical problem in patients with advance cancer. Treatment options for MPE include observation, thoracocentesis, or pleurodesis. In the current study, we compared the effectiveness and safety of combined mechanical and chemical pleurodesis by Video Assisted Thoracoscopic Surgery (VATS) with chemical pleurodesis via intercostals tube alone, using talc as pleurodesis agent in both.

Material and methods

In this prospective study, diagnosed patients of MPE having Eastern Cooperative Oncology Group (ECOG) performance score 3 or less 3, expected life expectancy of more than 3 months, and having lung re-expansion after drainage were selected for pleurodesis. Patients with ability to undergo general anesthesia were considered for VATS assisted combined mechanical & chemical pleurodesis (Group A). In the remaining chemical pleurodesis was performed at bedside (Group B).

Results

The duration of this study was 1 year. The total number of patients was 30. There were 15 patients each in both the groups. Pleurodesis was achieved in 4.47?±?0.92 days in group A and 6.33?±?0.90 days in group B. This difference was highly significant (p?<?0.0001). Post procedural complaints were more or less same in both the groups.

Conclusion

Combined mechanical and chemical pleurodesis (VATS assisted) appears to be superior to chemical pleurodesis, as it offers less morbidity, lesser hospital stay, and complete response in follow up. This modality may be used in patients of MPE for palliation, who are fit for general/ regional anesthesia.     

A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study

Background  

Currently, most thoracic surgeons perform surgical pleurodesis for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic surgery (VATS). However, the superiority of VATS over axillary minithoracotomy is not been established in prospective studies to date. A modified two-port VATS technique and axillary minithoracotomy were prospectively evaluated for possible differences in the short- and long-term outcome for patients.     

Spontaneous pneumothorax rates following video-assisted thoracoscopic talc pleurodesis with or without resection of macroscopic bullous disease

Background

Recurrent primary spontaneous pneumothorax (PSP) is routinely treated by video-assisted thoracoscopic (VATS) talc pleurodesis (with or without localized resection of macroscopic bullous disease). There is a paucity of published data regarding durability of the procedure and the rate of recurrent pneumothorax after such surgery, and this has significant implications from a prognostic and employment limitation perspective.

Methods

Patients who underwent a VATS talc pleurodesis (with or without localized resection of macroscopic bullous disease) for the treatment of their second or subsequent PSP or a PSP were followed for recurrent ipsilateral pneumothorax and new contralateral PSP. Follow up was by way of telephone interview and medical record verification out to 48 months.

Results

New contralateral pneumothorax occurred in 7 patients (11.1%) in the talc pleurodesis plus wedge resection group and 2 (1.8%) in the talc pleurodesis only group. There was one case of recurrent ipsilateral pneumothorax in a patient who had no inflammatory response to talc insufflation.

Conclusion

Video-assisted thoracoscopic (VATS) talc pleurodesis (and lung resection for macroscopic bullous disease) is a durable treatment for recurrent PSP. Patients with macroscopic disease have a significant risk of subsequent contralateral PSP.     

Nonsteroidal Antiinflammatory Medications: Efficient and Safe Treatment Following Video-Assisted Pleurodesis for Spontaneous Pneumothorax

Background  

Recurrent spontaneous pneumothorax is widely treated by video-assisted thoracoscopic (VATS) bullectomy and pleurodesis. Treatment of postoperative pain with nonsteroidal antiinflammatory drugs (NSAIDs) is controversial as many surgeons believe that it reduces the efficacy of pleurodesis and increases the pneumothorax recurrence rate.     

Novel approach to pleurodesis with 50 % glucose for air leakage after lung resection or pneumothorax

Purpose

Pleurodesis is performed in patients demonstrating air leakage after lung resection and in those with pneumothorax who must avoid surgery. However, there have so far been very few reports of pleurodesis with 50 % glucose. We herein examined the feasibility and effectiveness of this novel pleurodesis technique.

Methods

Thirty-five patients after lung resection and 11 pneumothorax patients without surgery were treated with pleurodesis using 50 % glucose. Approximately, 200 mL of 50 % glucose solution was injected into the pleural space and repeated until the air leakage stopped. Cases in which the air leakage did not stop after three injections were considered to be unsuccessful and subsequently treated with conventional pleurodesis using OK-432.

Results

Thirty-nine patients were successfully treated with 50 % glucose, although 7 patients required further treatment with OK-432. The unsuccessful group had some pulmonary comorbidities (P < 0.001), and the pleural effusion volume after pleurodesis was less than that in the successful group (P < 0.001). Although the air leakage did not stop in unsuccessful patients, the amount of air leakage markedly decreased. A temporary elevation of the blood sugar level was observed in 20 patients, but no other side effects had appeared.

Conclusions

Pleurodesis with 50 % glucose is an easy, safe, and effective treatment modality. It is therefore considered to be a useful alternative method for pleurodesis.

     

Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax- is it as effective as it is safe?

Objective  

The aim of the present study was to evaluate the efficacy of autologous blood pleurodesis in the management of persistent air leak in spontaneous pneumothorax.     

Changes in the pleural cavity by pleurodesis using talc or OK-432: An experimental study

Purpose  

To define the changes in the pleural cavity after pleurodesis induced by talc or OK-432.     

Single access videothoracoscopic biopsy and talc pleurodesis in patients with malignant pleural effusion

Aim-Background

Recurrent pleural effusion is frequently observed in clinical experience and malignancy is one of the most frequent causes. Although it is generally necessary to prevent the recurrence of effusion in patients with disseminated neoplastic disease, in others, a diagnosis is required. The aim of this study was to determine the efficacy and safety of biopsy and pleurodesis by a single access videothoracoscopic approach.

Methods

We report a consecutive series of 20 patients (12 men, 8 women, aged 39 to 83 years) who underwent single access videothoracoscopy with pleural biopsy and talc pleurodesis for recurrent pleural effusion. In all cases, indication for the procedure was a recurrent pleural effusion, suspicious for malignancy. Videothoracoscopy was performed under general anaesthesia. For pleurodesis, an average of 8g of sterile talc powder was used. A six-month follow-up was completed for all patients, and efficacy was judged by clinical examination and chest X-ray.

Results

Diagnosis was obtained in all cases. In five cases, the diagnosis was a pleural involvement by breast cancer metastasis, and in four cases, a primary lung cancer was detected. Eight were mesotheliomas and one a parapneumonic collection. In two cases, an unknown-malignancy recurrent pleural effusion was observed. No deaths, talc-induced ARDS or malignant invasion of the scar occurred, but only a postoperative empyema and two subcutaneous emphysemas treated successfully without further operation.

Conclusions

Single access videothoracoscopic pleural biopsy and talc pleurodesis is a safe and effective method for the diagnosis and treatment of malignant pleural effusions.     

Autologous blood pleurodesis for treatment of prolonged air leak in secondary spontaneous pneumothorax

Background  

Persistent air leak after secondary spontaneous pneumothorax is one of the most common problems encountered by thoracic surgeons. The aim of this study was to assess the value of autologous blood pleurodesis to seal prolonged air leaks.     

Study of the therapeutic effects of an advanced hippotherapy simulator in children with cerebral palsy: a randomised controlled trial

Background  

Although hippotherapy treatment has been demonstrated to have therapeutic effects on children with cerebral palsy, the samples used in research studies have been very small. In the case of hippotherapy simulators, there are no studies that either recommend or advise against their use in the treatment of children with cerebral palsy. The aim of this randomised clinical study is to analyse the therapeutic effects or the contraindications of the use of a commercial hippotherapy simulator on several important factors relating to children with cerebral palsy such as their motor development, balance control in the sitting posture, hip abduction range of motion and electromyographic activity of adductor musculature.     

Reliability of videotaped observational gait analysis in patients with orthopedic impairments

Background  

In clinical practice, visual gait observation is often used to determine gait disorders and to evaluate treatment. Several reliability studies on observational gait analysis have been described in the literature and generally showed moderate reliability. However, patients with orthopedic disorders have received little attention. The objective of this study is to determine the reliability levels of visual observation of gait in patients with orthopedic disorders.     

Treatment of primary spontaneous pneumothorax by videothoracoscopic talc pleurodesis under local anesthesia: a review of 133 procedures

Aim

To review our experience of treatment of primary spontaneous pneumothorax by videothoracoscopic talc pleurodesis.

Methods

From 2000 to 2008, 124 consecutive patients with primary spontaneous pneumothorax were operated; 105 were men (84.7%) and 19 were women (15.3%) with a mean age of 26.6 years (range 17–46 years).

Results

No mortality was recorded. Staging according to Vanderschueren’s classification was as follows: stage I, 61 patients (45.9%); stage II, 39 patients (29.3%); stage III, 31 patients (23.3%); stage IV, two patients (1.5%). The overall rate of complications was 9% (12/133), corresponding to prolonged air leak in 9(6.7%) patients and hemothorax in 3(2.2%) patients. Four patients (3%) had recurrence requiring reoperation. There were no episodes of acute respiratory failure, pneumonia or subcutaneous emphysema following talc pleurodesis.

Conclusions

Thoracoscopic pleural talc pleurodesis as a treatment for recurrent pneumothorax is easy, safe, and rapid, and causes minimal morbidity and mortality.     

Eficacia y morbimortalidad del tratamiento quirúrgico mediante videotoracoscopia y pleurodesis con talco del neumotórax espontáneo primario

Introduction

A primary spontaneous pneumothorax (PSP) is due to the presence of air in the pleural space and is of unknown cause or aetiology. The main characteristic of this condition is its high tendency to re-occur. This study has two objectives: 1) to determine the efficacy of lung resection surgery using a videothorascope and talc pleurodesis, 2) to analyse the complications originating from the use of talc.

Material and methods

A review was carried out on a series of 130 PSP cases treated using videothorascopy, with or without parenchymal resection, and pleurodesis with 3 g of asbestos-free talc (STERITAL^®). Epidemiological data were collected, including the diagnostic method, surgical indication, mortality, general morbidity, and the specific morbidity due to talc pleurodesis, the number of recurrences, and their treatment.

Results

The patients had a mean age of 26.4 years, 84.3% were male, and 69% smoked. The surgical indication of the PSP was recurrence in 74.4% of cases. There was morbidity in 7% (9) cases, with the most frequent complication being an air leak. No specific complication, such as empyema, pachypleuritis or adult respiratory distress syndrome (ARDS, on the use of talc was recorded. The mean follow-up was 10.1 months, during which there was recurrence in 4 (3%) cases.

Conclusions

PSP treatment by videothorascopic talc pleurodesis is highly effective, superior to other techniques use to produce pleurodesis, has a low general morbidity, no mortality, and no specific complications due to the talc.     

Intraoperative mechanical and chemical pleurodesis with 50 % glucose solution for secondary spontaneous pneumothorax in patients with pulmonary emphysema

Purpose

Secondary spontaneous pneumothorax is life-threatening for patients with pulmonary emphysema. To prevent recurrence, intraoperative pleurodesis is performed in addition to bullectomy. We report the therapeutic process and effectiveness of adding mechanical plus chemical pleurodesis, with a 50 % glucose solution, to bullectomy, for patients with pulmonary emphysema-related pneumothorax.

Methods

The subjects were 20 patients (19 men and 1 woman; mean age 68 years) with pulmonary emphysema-related pneumothorax. After bullectomy was completed, 500 mL of a 50 % glucose solution was injected into the pleural cavity, followed by mechanical pleurodesis performed via ablation of the parietal pleura.

Results

The volume of pleural effusion decreased on postoperative day (POD) 1, and the temperature decreased on POD 2. The blood sugar levels increased on the day of surgery but decreased on POD 1. The mean postoperative follow-up period was 521 days. One patient died of pneumonia on POD 24. All other patients survived without pneumothorax recurrence.

Conclusions

These results demonstrated the effectiveness of our treatment process for pulmonary emphysema-related pneumothorax. The fact that no patient experienced pneumothorax recurrence suggests that mechanical and chemical pleurodesis with 50 % glucose solution might be effective prophylaxis.     

Effectiveness of rhGH treatment on final height of renal-transplant recipients in childhood

Background  

Growth retardation is a considerable clinical problem in children with chronic kidney disease (CKD). Optimization of metabolic and nutritional parameters does not always lead to improved growth. Recombinant human growth hormone (rhGH) treatment has been used to improve height. Several studies in the literature have shown increased growth velocity, although data on the final height (FH) reached are scarce.     

Impact of acute kidney injury on metformin-associated lactic acidosis

Objectives  

Metformin has been shown to reduce diabetic complications in overweight patients, and is increasingly used to treat this condition. However, this agent is associated with a rare but serious risk of lactic acidosis.     

Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty?

Background  

Several reports have confirmed the ability of intraoperative periarticular injections to control pain after THA. However, these studies used differing combinations of analgesic agents and the contribution of each, including the local anesthetic agent, is uncertain. Understanding the independent effects of the various agents could assist in improved pain management after surgery.     

Arsenic exposure predicts bladder cancer survival in a US population

Purpose  

Chronic arsenic exposure at levels found in US drinking water has been associated with bladder cancer. While arsenic is a known carcinogen, recent studies suggest that it is useful as a therapeutic agent for leukemia. This study examined the relationship between arsenic exposure and bladder cancer mortality.