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Tunneled Pleural catheter

Rossella D'Amato, Luisa E Eiroa González, Ana Isabel Hernández Méndez
A 68-year-old man with alcoholic liver cirrhosis and portal hypertension was admitted due to ascites. Bilateral severe hepatic hydrothorax did not resolve despite sodium restriction, and diuretic treatment, requiring repeated thoracentesis for relief of dyspnoea. Curative options, as transjugular intrahepatic portosystemic shunt and liver transplantation were both contraindicated. An attempt of pleurodesis was ineffective. Bilateral insertion of tunnelled pleural catheter allowed symptom control and home discharge...
January 9, 2017: BMJ Case Reports
Seung Kwon Kim, Bryan G Belikoff, Carlos J Guevara, Seong Jin Park
We propose an algorithm for management after transjugular intrahepatic portosystemic shunt (TIPS) placement according to clinical manifestations. For patients with an initial good clinical response, surveillance Doppler ultrasound is recommended to detect stenosis or occlusion. A TIPS revision can be performed using basic or advanced techniques to treat stenosis or occlusion. In patients with an initial poor clinical response, a TIPS venogram with pressure measurements should be performed to assess shunt patency...
January 5, 2017: Digestive Diseases and Sciences
Momen M Wahidi, Chakravarthy Reddy, Lonny Yarmus, David Feller-Kopman, Ali Musani, R Wesley Shepherd, Hans Lee, Rabih Bechara, Carla Lamb, Scott Shofer, Kamran Mahmood, Gaetane Michaud, Jonathan Puchalski, Samaan Rafeq, Stephen M Cattaneo, John Mullon, Steven Leh, Martin Mayse, Samantha M Thomas, Bercedis Peterson, Richard W Light
RATIONALE: Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters (IPC) allow patients to drain pleural fluid at home and can lead to auto-pleurodesis. The optimal drainage frequency to achieve auto-pleurodesis and freedom from catheter has not been determined. OBJECTIVE: To determine whether an aggressive daily drainage strategy is superior to the current standard every other day drainage of pleural fluid in achieving auto-pleurodesis...
November 29, 2016: American Journal of Respiratory and Critical Care Medicine
Philip J Dempsey, Carole A Ridge, Stephen B Solomon
Image-guided lung intervention in the oncologic patient includes transthoracic needle biopsy, thermal ablation, fiducial placement, and tunneled pleural catheter placement and is made possible by technical advancements in computed tomography, fluoroscopy, and ultrasound technology, as well as the proliferation of available thermal ablation modalities such as radiofrequency, microwave, and cryoablation. With increasingly earlier cancer diagnoses being made and a greater patient demand for minimally invasive therapies, interventional oncology has many options to offer the patient with thoracic malignancies...
November 2016: Cancer Journal
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
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
Akash Verma, Chee Kiang Phua, Wen Yuan Sim, Reyes Elmer Algoso, Kuan Sen Tee, Sennen J W Lew, Albert Y H Lim, Soon Keng Goh, Dessmon Y H Tai, Ai Ching Kor, Benjamin Ho, John Abisheganaden
To study the performance of serum and pleural lactate dehydrogenase (LDH) level in predicting survival in patients with adenocarcinoma lung presenting with malignant pleural effusions (MPE) at initial diagnosis.Retrospective cohort study of the patient hospitalized for adenocarcinoma lung with MPE in year 2012.Univariate analyses showed lower pleural fluid LDH 667 (313-967) versus 971 (214-3800), P = 0.04, female gender 9 (100%) versus 27 (41.5%), P = 0.009, never smoking status 9 (100%) versus 36 (55.3%), P = 0...
June 2016: Medicine (Baltimore)
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
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
Zhouqiao Wu, Lixin Wang
No abstract text is available yet for this article.
August 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Jason Akulian, David Feller-Kopman
Pleural disease is frequently encountered by the chest physician. Pleural effusions arise as the sequelae of underlying disease processes including pressure/volume imbalances, infection and malignancy. In addition to pleural effusions, persistent air leaks after surgery and bronchopleural fistulae remain a challenge. Our understanding of pleural disease including its diagnosis and management, have made tremendous strides. The introduction of the molecular detection of organism specific infection, risk stratification and improvements in the non-surgical treatment of patients with pleural infection are all within reach and may be the standard of care in the very near future...
December 2015: Journal of Thoracic Disease
Adnan Majid, Fayez Kheir, Meghan Fashjian, Sumit Chatterji, Sebastian Fernandez-Bussy, Sebastian Ochoa, George Cheng, Erik Folch
RATIONALE: There is a paucity of evidence regarding the role of tunneled pleural catheters in pleural effusions caused by congestive heart failure that is refractory to medical management. OBJECTIVES: The aim of this study was to assess the feasibility of tunneled pleural catheter drainage for treatment of refractory pleural effusions associated with congestive heart failure, either when used alone or with concomitant talc pleurodesis performed during thoracoscopy...
February 2016: Annals of the American Thoracic Society
Mrinalini Krishnan, Pramil Cheriyath, Yijin Wert, Troy A Moritz
BACKGROUND: Tunneled pleural catheters (TPCs) are routinely used for outpatient drainage of malignant pleural effusions, although use in recurrent pleural effusions resulting from nonmalignant conditions requires further evaluation. We hypothesized that TPCs could decrease inpatient admission rates for exacerbations of nonmalignant pleural effusions. METHODS: A retrospective chart review was done of patients with TPCs inserted for recurrent nonmalignant pleural effusions...
December 2015: Annals of Thoracic Surgery
Candice L Wilshire, Brian E Louie, Ralph W Aye, Alexander S Farivar, Eric Vallières, Jed A Gorden
RATIONALE: Tunneled pleural catheters have been established to be safe and effective in the management of recurrent symptomatic pleural effusions. Obstruction of the tunneled pleural catheter is rare; however, when obstructed the catheter fails to achieve its primary goal of symptom palliation. The management of pleural catheter obstruction has not been studied. OBJECTIVES: We aimed to determine if the use of intracatheter fibrinolytic therapy is safe and effective in restoring catheter function...
September 2015: Annals of the American Thoracic Society
Ziad Boujaoude, Thaddeus Bartter, Mariam Abboud, Melvin Pratter, Wissam Abouzgheib
BACKGROUND: Malignant pleural effusion (MPE) is associated with poor prognosis and it often impinges upon quality of life; effective and efficient management is desirable. Combining pleuroscopic pleurodesis (PP) with a tunneled pleural catheter (TPC) could minimize hospitalization, effect rapid pleurodesis in most cases, and allow ongoing control of MPE for those not successfully pleurodesed. METHODS: Consecutive patients with pleural effusion associated with malignancy and with documented lung reexpansion after pleural fluid drainage were prospectively enrolled to undergo PP with TPC placement...
July 2015: Journal of Bronchology & Interventional Pulmonology
Majid Shafiq, Kevin D Frick, Hans Lee, Lonny Yarmus, David J Feller-Kopman
BACKGROUND: Malignant pleural effusion (MPE) is associated with a significant impact on health-related quality of life. Palliative interventions abound, with varying costs and degrees of invasiveness. We examined the relative cost-utility of 5 therapeutic alternatives for MPE among adults. METHODS: Original studies investigating the management of MPE were extensively researched, and the most robust and current data particularly those from the TIME2 trial were chosen to estimate event probabilities...
July 2015: Journal of Bronchology & Interventional Pulmonology
Abhishek Agarwal, Jagpal Klair, Setu Patolia, Nikhil K Meena
Plasma cell leucaemia (PCL) is a rare aggressive form of multiple myeloma. It occasionally involves the pleura, causing malignant pleural effusion (MPE). MPE presents a management dilemma for physicians, given the different treatment options available with varying efficacy and side effects. We report a case of a 64-year-old man with MPE due to PCL, successfully managed with intrapleural cisplatin and a tunnelled pleural catheter. We believe this to be the first report of management of PCL-associated MPE with intrapleural cisplatin...
2015: BMJ Case Reports
Christopher R Gilbert, Hans J Lee, Jason A Akulian, Margaret Hayes, Ricardo Ortiz, David Hashemi, Richard E Thompson, Sixto Arias, David J Feller-Kopman, Lonny B Yarmus
RATIONALE: The indwelling tunneled pleural catheter has altered the management of patients with dyspnea related to malignant pleural effusions. However, indwelling tunneled pleural catheter placement does not remain free from risk. The most commonly reported risk is infection. OBJECTIVES: The aim of this paper is to describe our continuous quality improvement program for infection rate recognition, the process changes implemented for improvement, and subsequent outcomes...
June 2015: Annals of the American Thoracic Society
Christopher R Gilbert, Hans J Lee, Joseph H Skalski, Fabien Maldonado, Momen Wahidi, Philip J Choi, Jamie Bessich, Daniel Sterman, A Christine Argento, Samira Shojaee, Jed A Gorden, Candice L Wilshire, David Feller-Kopman, Ricardo Ortiz, Bareng Aletta Sanny Nonyane, Lonny Yarmus
BACKGROUND: Malignant pleural effusion is a common complication of advanced malignancies. Indwelling tunneled pleural catheter (IPC) placement provides effective palliation but can be associated with complications, including infection. In particular, hematologic malignancy and the associated immunosuppressive treatment regimens may increase infectious complications. This study aimed to review outcomes in patients with hematologic malignancy undergoing IPC placement. METHODS: A retrospective multicenter study of IPCs placed in patients with hematologic malignancy from January 2009 to December 2013 was performed...
September 2015: Chest
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