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Indwelling pleural

Rebecca Krochmal, Chakravarthy Reddy, Lonny Yarmus, Neeraj R Desai, David Feller-Kopman, Hans J Lee
BACKGROUND: Malignant pleural effusions (MPEs) represent advanced stage disease with potentially significant patient discomfort due to dyspnea. Palliative management options include repetitive thoracenteses, placement of a tunneled pleural catheter (TPC), chemical pleurodesis, or some combination of these procedures. The rapid pleurodesis procedure combines thoracoscopic talc pleurodesis and insertion of a TPC at the same time with the goals of reducing both the length of hospitalization and the duration of catheter use...
September 2016: Journal of Thoracic Disease
Ramez R Hanna, Nicholas Kolanko, Carlos Torres
History A 70-year-old woman presented to a peripheral hospital with signs and symptoms of acute chronic obstructive pulmonary disease (COPD) exacerbation. The patient also reported acute on chronic onset of thoracolumbar back pain over a period of 24 hours. She denied any history of recent trauma or intravenous drug use. She did not have any long-term indwelling catheters. The patient's medical history was also complicated by stage 4 renal failure from long-standing type II diabetes, hypertension, iron deficiency anemia, aortic stenosis, and prior bariatric surgery...
October 2016: Radiology
Oliver J Bintcliffe, Gary Y C Lee, Najib M Rahman, Nick A Maskell
The evidence base concerning the management of benign pleural effusions has lagged behind that of malignant pleural effusions in which recent randomised trials are now informing current clinical practice and international guidelines.The causes of benign pleural effusions are broad, heterogenous and patients may benefit from individualised management targeted at both treating the underlying disease process and direct management of the fluid. Pleural effusions are very common in a number of non-malignant pathologies, such as decompensated heart failure, and following coronary artery bypass grafting...
September 2016: European Respiratory Review: An Official Journal of the European Respiratory Society
Kembu Nakamoto, Motohiro Takeshige, Toshiyuki Fujii, Hiroshi Hashiyada, Kazuya Yoshida, Sadahiro Kawamoto
BACKGROUND: The empyema space is refractory to elimination of bacterial colonization. Electrolyzed saline (ES) was used as intra-pleural irrigation for rapid disinfection of the empyema space. PATIENTS AND METHODS: Twenty consecutive patients with para-pneumonic empyema were reviewed in this study from 2007 to 2015. The empyema space was irrigated by miniaturized thoracoscopic surgery (mini VATS), and the efficacy and safety of the use of ES were evaluated. RESULTS: Sixteen patients were male and four were female, with a mean age of 66...
August 11, 2016: Surgical Infections
Aibek E Mirrakhimov, Taha Ayach, Adam Gray
No abstract text is available yet for this article.
August 2016: Annals of the American Thoracic Society
Alexander C Chen, Jeffrey S Crippin
No abstract text is available yet for this article.
August 2016: Annals of the American Thoracic Society
Susan Walker, Marijana Zubrinic, Christine Massey, Yaron Shargall, Eric Bédard, Gail Darling
BACKGROUND: In a patient population with a limited life expectancy, malignant pleural effusion can significantly impact quality of life (QoL). Different treatment options are available, each with its own effect on QoL. To date, satisfaction with treatment options has not been evaluated. PURPOSE: To evaluate QoL and satisfaction with treatment using patient-reported outcomes for four different treatment strategies. DESIGN: A prospective, cohort study that compared four treatment options: indwelling pleural catheter (IPC); video assisted thoracic surgery (VATS) and IPC; chest tube and talc slurry; and VATS talc poudrage...
July 2, 2016: International Journal of Palliative Nursing
Maree Azzopardi, Rajesh Thomas, Sanjeevan Muruganandan, David C L Lam, Luke A Garske, Benjamin C H Kwan, Muhammad Redzwan S Rashid Ali, Phan T Nguyen, Elaine Yap, Fiona C Horwood, Alexander J Ritchie, Michael Bint, Claire L Tobin, Ranjan Shrestha, Francesco Piccolo, Christian C De Chaneet, Jenette Creaney, Robert U Newton, Delia Hendrie, Kevin Murray, Catherine A Read, David Feller-Kopman, Nick A Maskell, Y C Gary Lee
INTRODUCTION: Malignant pleural effusions (MPEs) can complicate most cancers, causing dyspnoea and impairing quality of life (QoL). Indwelling pleural catheters (IPCs) are a novel management approach allowing ambulatory fluid drainage and are increasingly used as an alternative to pleurodesis. IPC drainage approaches vary greatly between centres. Some advocate aggressive (usually daily) removal of fluid to provide best symptom control and chance of spontaneous pleurodesis. Daily drainages however demand considerably more resources and may increase risks of complications...
2016: BMJ Open
Amelia O Clive, Hazel Taylor, Lee Dobson, Paula Wilson, Emma de Winton, Niki Panakis, Justin Pepperell, Timothy Howell, Samuel A Stewart, Erika Penz, Nikki Jordan, Anna J Morley, Natalie Zahan-Evans, Sarah Smith, Timothy J P Batchelor, Adrian Marchbank, Lesley Bishop, Alina A Ionescu, Mike Bayne, Samantha Cooper, Anthony Kerry, Peter Jenkins, Elizabeth Toy, Vallipuram Vigneswaran, James Gildersleve, Merina Ahmed, Fiona McDonald, Mick Button, Conrad Lewanski, Charles Comins, Muthukumar Dakshinamoorthy, Y C Gary Lee, Najib M Rahman, Nick A Maskell
BACKGROUND: The use of prophylactic radiotherapy to prevent procedure-tract metastases (PTMs) in malignant pleural mesothelioma remains controversial, and clinical practice varies worldwide. We aimed to compare prophylactic radiotherapy with deferred radiotherapy (given only when a PTM developed) in a suitably powered trial. METHODS: We did a multicentre, open-label, phase 3, randomised controlled trial in 22 UK hospitals of patients with histocytologically proven mesothelioma who had undergone large-bore pleural interventions in the 35 days prior to recruitment...
August 2016: Lancet Oncology
W M Wong, T Cc Tam, M Ky Wong, M Ms Lui, M Sm Ip, D Cl Lam
INTRODUCTION: Malignant pleural effusion can be recurrent despite active anti-cancer treatment. Significant malignant pleural effusion leads to debilitating dyspnoea and worsening quality of life in patients with advanced cancer. An indwelling pleural catheter offers a novel means to manage recurrent malignant pleural effusion and may remove the need for repeated thoracocentesis. Spontaneous pleurodesis is another unique advantage of indwelling pleural catheter placement but the factors associated with its occurrence are not clearly established...
August 2016: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Rahul Bhatnagar, John P Corcoran, Fabien Maldonado, David Feller-Kopman, Julius Janssen, Philippe Astoul, Najib M Rahman
The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy...
June 2016: European Respiratory Review: An Official Journal of the European Respiratory Society
Joseph H Skalski, Jasleen Pannu, Humberto C Sasieta, Eric S Edell, Fabien Maldonado
RATIONALE: The use of tunneled indwelling pleural catheters for management of refractory pleural effusions continues to increase. Pleural space infections are among the most common and serious complication of the procedure. The risk may be higher in patients receiving immunosuppressive medications. OBJECTIVES: The aim of this study was to assess the risk of infections complicating placement of a tunneled indwelling pleural catheter in patients who have received a solid organ transplant...
August 2016: Annals of the American Thoracic Society
Jason A Akulian, Lonny Yarmus
No abstract text is available yet for this article.
July 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
Amelia O Clive, Hayley E Jones, Rahul Bhatnagar, Nancy J Preston, Nick Maskell
BACKGROUND: Malignant pleural effusion (MPE) is a common problem for people with cancer as a result of malignant infiltration of the pleura. It is usually associated with considerable breathlessness. A number of treatment options are available to manage the uncontrolled accumulation of pleural fluid including administration of a pleurodesis agent (either via a chest tube or at thoracoscopy) or indwelling pleural catheter insertion. OBJECTIVES: To ascertain the optimal management strategy for adults with malignant pleural effusion in terms of pleurodesis success...
2016: Cochrane Database of Systematic Reviews
A Aujayeb, S Parker, S Bourke, J Miller, D Cooper
This paper reviews the organisation and outcomes of a pleural service, specifically geared towards the management of malignant pleural effusions, in a district general hospital in the north east of England. We summarise the evidence behind local anaesthetic thoracoscopy and indwelling pleural catheters. We then summarise the review of our service, including a discussion around complications.
March 2016: Journal of the Royal College of Physicians of Edinburgh
Macarena R Vial, David E Ost, Georgie A Eapen, Carlos A Jimenez, Rodolfo C Morice, Oisin O'Connell, Horiana B Grosu
BACKGROUND: Tissue plasminogen activator (tPA) has been successfully used to relieve obstruction of dysfunctional devices, including vascular catheters. Intrapleural tPA is used by some centers to restore flow of nondraining indwelling pleural catheters (IPCs) in symptomatic patients with malignant pleural effusions (MPEs). Because few studies have evaluated its safety and effectiveness, we conducted a retrospective cohort study of outcomes after tPA treatment during a 10-year period at our institution...
April 2016: Journal of Bronchology & Interventional Pulmonology
Macy M S Lui, Deirdre B Fitzgerald, Y C Gary Lee
PURPOSE OF REVIEW: Patients with malignant pleural effusions (MPEs) are heterogenous in their disease course, symptom severity, responses to cancer therapies, fluid recurrence rates, and thus need for definitive fluid control measures. To tailor the most appropriate treatment for individual patients, clinicians need to 'phenotype' the patients and predict their clinical course. This review highlights the recent efforts to develop better predictive tools and knowledge gaps for further research...
July 2016: Current Opinion in Pulmonary Medicine
Alexander Chen, Jennifer Massoni, Diana Jung, Jeffrey Crippin
RATIONALE: Hepatic hydrothorax is a complication of cirrhosis in which hydrostatic imbalances result in fluid accumulation within the pleural space. Although uncommon, this may cause significant morbidity, resulting in dyspnea requiring repeated pleural drainage procedures. Liver transplantation is curative, but it is rarely immediately available to qualified patients, presenting the clinical challenge of managing recurrent pleural effusions. Indwelling tunneled pleural catheters (ITPCs) have been used successfully to palliate dyspnea associated with recurrent malignant pleural effusions...
June 2016: Annals of the American Thoracic Society
Claire L Tobin, Rajesh Thomas, Siaw Ming Chai, Amanda Segal, Y C Gary Lee
BACKGROUND AND OBJECTIVE: Indwelling pleural catheters (IPC), used for management of malignant pleural effusions, are often left in situ for a long duration. This study reports for the first time the histological findings of IPCs removed from patients with underlying pleural malignancy. METHODS: Forty-one IPCs (in situ for median 126 days, interquartile range 43-226) that were removed over a 54-month period from a single centre were examined. RESULTS: Mesothelioma (n = 18) was the predominant underlying malignancy followed by breast, tubo-ovarian and lung carcinomas...
July 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
Charleen Chan Wah Hak, Parthipan Sivakumar, Liju Ahmed
BACKGROUND: Indwelling pleural catheters (IPC) are increasingly becoming a first-line treatment in the management of malignant pleural effusions. Ambulatory management using IPC are increasingly used in this patient group whilst they are receiving concurrent chemotherapy. There are currently no prospective trials examining IPC safety in chemotherapy. This study's objective is to determine if IPC insertion is safe in patients undergoing chemotherapy. METHODS: We conducted a retrospective analysis of all patients who underwent IPC insertion for malignant pleural effusion at our trust from September 2010 to December 2014...
2016: BMC Pulmonary Medicine
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