Inhalable tranexamic acid for haemoptysis treatment

PurposeAn inhalable dry powder formulation of tranexamic acid (TA) was developed and tested in a novel high-dose Orbital® multi-breath inhaler. The formulation was specifically intended for the treatment of pulmonary haemorrhage and wound healing associated with haemoptysis.MethodsInhalable TA particles were prepared by spray drying and the powder characterised using laser diffraction, electron microscopy, thermal analysis, moisture sorption and X-ray powder diffraction. The aerosol performance was evaluated using cascade impaction and inline laser diffraction and interaction with epithelia cells and wound healing capacity investigated using Calu-3 air interface model.ResultsThe spray dried TA particles were crystalline and spherical with a D_0.5 of 3.35 μm. The powders were stable and had limited moisture sorption (0.307% w/w at 90% RH). The Orbital device delivered ca. 38 mg powder per ‘inhalation’ at 60 l · min⁻¹ across four sequential shots with an overall fine particle fraction (⩽6.4 μm) of 59.3 ± 3.5% based on the emitted mass of ca. 150 mg. The TA particles were well tolerated by Calu-3 bronchial epithelia cells across a wide range of doses (from 1 nM to 10 nM) and no increase in inflammatory mediators was observed after deposition of the particles (a decrease in IL-1β, IL-8 and INFγ was observed). Time lapse microscopy of a damaged confluent epithelia indicated that wound closure was significantly greater in TA treated cells compared to control.ConclusionA stable, high performance aerosol of TA has been developed in a multi-breath DPI device that can be used for the treatment of pulmonary lesions and haemoptysis.     

普鲁卡因与垂体后叶素用于老年肺结核咯血止血治疗的对比研究

目的对比和分析普鲁卡因与垂体后叶素两种方法治疗老年肺结核并中、大咯血的止血效果、禁忌证和不良反应。方法观察组：普鲁卡因300mg加入5％葡萄糖或生理盐水500ml中静脉滴注，15～20滴／min，每天2次，维持至咯血停止后72h；对照组：垂体后叶素10～20u加入5％葡萄糖500ml中静脉滴注，15～20滴／min，每天2次，维持至咯血停止后72h。结果普鲁卡因组止血效果显著高于脑垂体后叶素组（P〈0．05），而且脑垂体后叶素组禁忌证及不良反应显著高于普鲁卡因组（P〈0．005）。结论普鲁卡因比垂体后叶素更适宜于治疗老年肺结核中、大量咯血。     

支气管动脉畸形致大咯血的血管造影检查和栓塞治疗

目的：探讨支气管动脉造影及栓塞术对支气管动脉畸形致大咯血的诊治价值。材料和方法：对7例不明原因的大咯血患者急诊或择期支气管动脉数字减影血管造影（DSA）检查，对异常血管用聚乙烯泡沫醇（PVA）颗粒或明胶海绵颗粒加钢圈栓塞。结果：共发现9支畸形支气管动脉，表现为一侧或双侧支气管动脉扭曲、分支增多，粗细不均，远端有弥漫造影剂浓染者3例，伴有一处或多处支气管动脉－肺动脉瘘者4例。除1例明胶海绵及钢圈栓塞患者1周内复发外，PVA栓塞者平均随访27．5月未见复发。结论：支气管动脉造影可明确致大咯血的支气管动脉畸形，栓塞治疗可望获得良好的远期疗效。     

Treatment of complicated pulmonary aspergillomas with cavernostomy and muscle flap: interest of concomitant limited thoracoplasty

Objective: Lung resection for complex aspergilloma (CA) carries high morbidity and mortality and remains controversial in high-risk patients. Cavernostomy followed by muscle-flap plombage has been recommended for patients considered unfit for resection, but subsequent muscle-flap atrophy may be a main cause of failure. We reviewed the place of a limited thoracoplasty in association with that procedure. Methods: Five patients complaining of haemoptysis related to CA were denied lung resection because of bilateral lung destruction (n = 1), and required completion pneumonectomy (previous lobectomy for cancer followed by adjuvant radiation therapy, n = 4). We analysed the data concerning the alternative surgical procedures performed and their immediate and late results. Results: The surgery consisted in cavernostomy, removal of the fungus ball, cavity obliteration with the most directly available muscle flaps (rhomboid muscle n = 2, trapezius and rhomboid n = 2, serratus major and subscapular n = 1). A limited thoracoplasty ranging from 2 to 5 portions of rib (mean resected rib portions n = 3.4) was performed in addition to this procedure. The postoperative course was uneventful. All patients are still alive (mean follow-up 3 years; range: 1–6 years) and faring well without thoracoplasty-related aftereffect, complication related to muscle-flap disuse atrophy nor recurrence of the disease. Conclusion: Cavernostomy followed by muscle transposition has been reported to provide encouraging results. Combining a limited thoracoplasty during the same operation is a simple, safe and well-tolerated procedure regularly achieving good results, and thus deserving consideration.     

顽固性咯血支气管动脉造影及栓塞方法与疗效研究

目的对内科治疗不能有效止血的顽固性咯血患者,寻求效果肯定、快捷、安全的治疗方法。方法对56例顽固性咯血患者及时采用seldinger导管法行支气管动脉造影,并对出血病变血管予以明胶海绵（或）和Fe304微粒或小号不锈钢圈作选择性栓塞,术后随访观察近期和远期疗效。结果56例中立即止血49例（87.50%）,近期总有效率为100%。远期观察1.5～11年,平均随访39.7个月,单纯明胶海绵栓塞者复发2例,疗效持久巩固率为96.43%。结论支气管动脉造影并选择性病变血管栓塞疗法,对顽固性咯血疗效可靠,且快捷,安全,巩固 对明确病变血管形态异常者宜采用永久性材料或＂双重＂栓塞。     

Therapeutic embolization of a systemic arterialization of lung without sequestration

We report the case of a 51-year-old man with massive haemoptysis due to a systemic arterialization of lung without sequestration. Unlike bronchopulmonary sequestration there was a normal bronchial distribution and the involved lung parenchyma was normal. Therefore a therapeutic transarterial embolization of the aberrant systemic vessel from the distal thoracic aorta was performed. The embolization was successful and the patient did not suffer from further haemoptysis during the subsequent follow-up of ten months. A postembolization aortogram 6 months later demonstrated a complete occlusion of the embolized aberrant artery; in the lung perfusion scan there was only a small perfusion defect, but normal ventilation in the embolized basal part of the left lower lobe. Our case represents an alternative treatment to surgery for this rare anomaly. Received 11 February 1997; Revision received 12 May 1997; Accepted 10 June 1997     

Surgical management of pulmonary aspergilloma—12 years’ experience from a tertiary care centre in India

Introduction and purposePulmonary aspergilloma is the formation of saprophytic colonies of fungus in pre-existing pulmonary cavities. They may cause life-threatening haemoptysis. As medical treatment often fails, surgery is the mainstay of treatment in symptomatic patients. Earlier studies had reported high levels of mortality and morbidity with surgery while more recent studies have shown better results. Hence, being in a large tertiary care centre in India, we decided to analyse the details of our own experience in the surgical management of pulmonary aspergilloma.MethodsDetails of all adult patients treated surgically for pulmonary aspergilloma, between the years 2009 and 2020, maintained in a live database in our institute, were retrieved and analysed.ResultsThere were 102 patients in the study. The average age was 40 years. There was a male (M: F, 3:1) and right side preponderance. Pulmonary tuberculosis (TB) was the commonest cause for cavities in which aspergilloma developed as identified in 84 (82%) patients and diabetes mellitus, the commonest comorbidity present in 28 (27.5%) patients. Parenchyma-preserving lung resections (PPLRs) were feasible in 8 (44%) of the non-tubercular patients, but only in 14 (17%) of the TB patients. Post-operative complications (11.7%) were higher among the patients with TB. There were 2 (1.9%) post-operative mortalities.ConclusionThough surgery is technically complex in the presence of pulmonary aspergilloma, it is yielding better results with improvements in treatment strategies. Surgery for aspergilloma in patients with prior or current pulmonary TB has more morbidity and mortality when compared to the non-TB patients.