Clinicopathological Profile of Myelomatous Pleural Effusion: Single-center Real-world Experience and Review of Literature

Background

Multiple myeloma (MM) is a hematologic malignancy of plasma cell origin. MM primarily affects bone marrow, but extramedullary sites can also be involved. Myelomatous pleural effusion (MPE) is an atypical and rare complication of MM. We aimed to systematically study the incidence and clinicopathologic profile of patients with MPE in a real-world setting.

CML Case Studies: Impact of Comorbidities

Clinicians have the choice of five approved tyrosine kinase inhibitors (TKI) to select from for chronic phase CML patients. The best frontline drug for each patient and decisions about if and when to change to another TKI or to stop therapy need to be considered in the context of the comorbidities present. These issues are explored in three illustrative cases. The predominant toxicity issue for all of the TKIs except imatinib is vascular occlusive events, so a systematic approach to assessing

Discussion

The excellent long-term outcomes achieved in most CML patients has led to a revision of the goals of therapy.¹³ While preventing progression to blast crisis remains an important goal, avoiding organ toxicity may be equally important, since deaths from causes other than CML are much more common than CML-related deaths. Patients most at risk of organ toxicity are those patients with comorbidities, particularly those patients with comorbidities that increase their risk of vascular events.

References

• 1.Saußele S, Krauß MP, Hehlmann R, Lauseker M, Proetel U et al, Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML Study IV. Blood. 2015;126:42-49.
• 2.Hochhaus A, Saglio G, Hughes TP, Larson RA, Kim D-W et al. Long-term benefits and risks of frontline nilotinib vs imatinib for chronic myeloid leukemia in chronic phase: 5-year update of the randomized ENESTnd trial. Leukemia. 2016; 30:1044–1054.
• 3.Castagnetti F, Gugliotta G, Breccia M,

     

Prevalence and clinical significance of pleural effusion in patients with acute pulmonary embolism: a retrospective study

BackgroundPleural effusion is observed in a subset of patients with acute pulmonary embolism (APE) and may be linked to clinical outcome, but findings from previous studies have been inconsistent. This study aimed to investigate the prevalence and clinical significance of pleural effusion in Chinese patients with APE.MethodsClinical data from hospitalized patients with APE were retrospectively collected and the prevalence of pleural effusion was determined. The relationship between the presence of pleural effusion and clinical outcome of APE was analyzed by Cox proportional hazards regression and Kaplan-Meier survival analysis.ResultsThe study enrolled 635 patients with APE. The prevalence of pleural effusion was 57.01% (362/635). Patients with pleural effusion had significantly higher in-hospital mortality (9.9% vs. 4.8%, P<0.05) and longer length of hospital stay (LOS) (19.99 vs. 15.31 days, P<0.05) than whose without pleural effusion. However, pleural effusion was not an independent risk factor for in-hospital mortality in patients with APE by multivariate Cox proportional hazards regression analysis [hazard ratio (HR) =1.70, 95% confidence interval (CI): 0.73–3.92, P=0.216] and Kaplan–Meier survival analysis (P=0.174).ConclusionsPleural effusion is a frequent occurrence in patients with APE and therefore merits greater attention from clinicians; however, it is not an independent risk factor for in-hospital mortality.     

超声引导下竖脊肌平面阻滞在慢性脓胸患者术中及术后镇痛中的效果

目的观察超声引导下竖脊肌平面(erector spinae plane, ESP)阻滞对慢性脓胸患者术中及术后镇痛效果的影响。方法择期行胸腔镜下胸膜纤维板剥脱术的慢性脓胸患者60例,男35例,女25例,年龄30～70岁,ASAⅠ或Ⅱ级,随机分为两组:ESP阻滞复合全身麻醉组(E组)和单纯全身麻醉组(G组)。两组均行全身麻醉,E组全身麻醉前实施超声引导下ESP阻滞,术毕均采用患者自控静脉镇痛(patient controlled intravenous analgesia, PCIA)。记录E组超声下胸椎旁间隙显示情况,ESP阻滞20 min后在锁中线处感觉阻滞范围;记录两组术中瑞芬太尼用量、PACU停留时间、术后PCIA泵有效按压次数、术后1、4、12、24、48 h静息和活动时VAS评分。结果 E组有24例胸椎旁间隙显示不清,ESP阻滞20 min后感觉阻滞节段为4.9±1.0。E组术中瑞芬太尼用量和术后PCIA泵有效按压次数明显少于G组(P0.05),PACU停留时间明显短于G组(P0.05),术后1、4、12、24 h静息和活动时VAS评分明显低于G组(P0.05)。结论超声引导下ESP阻滞对慢性脓胸患者是一种安全的镇痛方法,能够提供有效的术中及术后镇痛。     

Volumetric Modulated Arc Therapy After Lung Sparing Surgery for Malignant Pleural Mesothelioma: A Single Institution Experience

IntroductionWe investigated the possible role of volumetric modulated arc therapy (VMAT) in the setting of adjuvant treatment of malignant pleural mesothelioma (MPM) after lung-sparing surgery with pleurectomy and decortication.Materials and MethodsPatients affected by MPM who had undergone pleurectomy and decortication and adjuvant radiotherapy with VMAT were included. The endpoints of the present analysis were local control, progression-free survival, and overall survival. Assessment of the variables affecting survival was performed using univariate and multivariate Cox proportional hazard models.ResultsA total of 49 patients were included in the present study. Of the 49 patients, 96% had been treated with a trimodality approach. Radiotherapy was delivered to a median dose of 44 Gy in 22 fractions (range, 22-59.4 Gy). The treatment was well tolerated, with just 2 grade 3 acute toxicities, 1 grade 5, and 2 grade 4 toxicities recorded during the follow-up period. The median follow-up period was 27.4 months. The local control rate at 12, 24, and 36 months was 75.2%, 67.4%, and 56.5%, respectively. The median progression-free survival was 14.9 months (95% confidence interval [CI], 7.5-25.2). The median overall survival was 21.5 months (95% CI, 15.3-37.1). On multivariate analysis, the administration of carboplatin- instead of cisplatin-based chemotherapy (hazard ratio, 2.97; 95% CI, 1.22-7.26; P = .017) and R2 resection (hazard ratio, 1.95; 95% CI, 1.27-2.99; P = .002) showed a negative correlation with overall survival. On univariate analysis, the percentage of the heart receiving >20 Gy and >30 was associated with the occurrence of late pneumonitis (P = .018 and P = .077).ConclusionVMAT is feasible in the setting of MPM after lung-sparing surgery. The toxicity rates were reduced with this technique compared with historical data of older techniques. Local and distant failure remain a major issue to be addressed in future trials.     

胸腔镜冷冻治疗纤维黏连为主型结核性胸腔积液的临床观察

目的探讨经胸腔镜微创冷冻治疗结核性胸腔积液形成纤维黏连及壁层胸膜结核结节的临床疗效。方法对38例结核性胸腔积液形成纤维黏连的患者通过内科胸腔镜微创检查并对纤维黏连带采用冷冻探针清除,并对壁层胸膜结核结节进行冻融治疗。结果患者胸腔内见大量纤维黏连形成,采用冷冻探针进行冻切后可清除胸腔内病变,壁层胸膜结核结节通过冻融治疗后迅速坏死。经治疗后患者症状改善,胸腔积液吸收明显。显效:12例(31.6%);有效24例(63.2%),无效2例(5.3%),总有效率94.7%。结论内科胸腔镜能及时发现胸腔纤维黏连,并可以在直视下对病变进行清除,冷冻治疗是内镜介入治疗胸膜病变的有效方法,且安全。