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.     

Surgical management of a voluminous abdominal paraganglioma and review of the literature

The Authors report a case of a voluminous abdominal paraganglioma and a review of the literature on the surgical management of paragangliomas. CASE REPORT: A 58 years old woman was admitted to our Institution with acute endocrine impairment and simultaneous intestinal necrosis resulting from the mass effect of the tumor on the mesenteric vessels. Clinical and biochemical preoperative work up posed the suspect of paraganglioma. Previous intensive care treatment, the patient, underwent surgical resection of the tumor and left hemicolectomy, with immediate remission of both endocrine and abdominal syndromes. Histological examination confirm the preoperative clinical hypothesis. Paragangliomas are rare tumors of the extra-adrenal chromaffin tissue. A paraganglioma may be discovered in the absence of any symptom. When symptomatic, the clinical findings are related to the hypersecretion of catecholamines or to the compression of several anatomical structures from a growing mass. Combined acute syndromes of hormonal impairment and contemporaneous mass effect, as in our case, are exceptional. The diagnosis of the secreting forms may be obtained on the basis of biochemical dosage of serum and urinary catecholamines and metanephrines. The assessment of malignancy for paragangliomas is not always feasible. Several imaging, cytological and histological parameters have been proposed as predictors of malignancy, but the only element widely accepted is the existence of distant metastasis. Surgery represents the treatment of choice for paragangliomas. Benign forms, catecholamine secreting forms and tumors compressing neighbouring anatomical structures can be treated surgically with success. In general, an accurate follow-up after complete resection must be considered.     

T2–T4 sympathectomy versus T3–T4 sympathicotomy for palmar and axillary hyperhidrosis

Objective  

To evaluate and compare the immediate and long-term outcomes of videothoracoscopic T2–T4 sympathectomy and T3–T4 sympathicotomy for the treatment of palmar and axillary hyperhidrosis.     

Associations between the neutrophil-to-lymphocyte and the platelet-to-lymphocyte ratios and the presence and severity of psoriasis: a systematic review and meta-analysis

Clinical and Experimental Medicine - The diagnosis of psoriasis, an immune-mediated disease that affects 2% of the population in Western countries, is largely based on history and clinical...     

Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis

Clinical and Experimental Medicine - Coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the...     

Serum hydroxybutyrate dehydrogenase and COVID-19 severity and mortality: a systematic review and meta-analysis with meta-regression

Clinical and Experimental Medicine - Alterations in cardiac and renal biomarkers have been reported in coronavirus disease 19 (COVID-19). We conducted a systematic review and meta-analysis to...