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pleural drainage systems

Duneesha de Fonseka, Nick A Maskell
PURPOSE OF REVIEW: Pleural infection is a common problem associated with significant morbidity and mortality. Systemic or pleural fluid markers for reliably identifying pleural infection are limited. Procalcitonin (PCT) is known to be elevated in bacterial infection and is currently used for diagnosis and decision-making regarding antibiotic duration in respiratory infections. This review investigates if there is a role for serum and pleural fluid PCT (pf-PCT) in diagnosis and management of pleural infection...
March 9, 2018: Current Opinion in Pulmonary Medicine
José M Porcel
PURPOSE OF REVIEW: To provide an overview of the contribution of thoracic ultrasound (TUS) and computed tomography (CT) in the identification of complicated parapneumonic effusions (CPPE), defined as those which need chest tube drainage for resolution. RECENT FINDINGS: A recent retrospective study found that visualization of complex (nonanechoic) effusions on TUS (likelihood ratio positive = 6.92) outperformed the recognition of loculated/septated effusions on CT (likelihood ratio = 2...
March 6, 2018: Current Opinion in Pulmonary Medicine
James A Stefater, Dean Eliott, Leo A Kim
Purpose: To describe a case of a patient with acute systemic lupus erythematous (SLE) causing choroidal effusions and to report a novel technique for evaluation of the choroidal fluid which sheds light on effusion pathogenesis. Observations: A 37 year-old woman was referred for decreased vision, eye pain and shortness of breath. The patient had bilateral angle closure glaucoma from choroidal effusions and bilateral pleural effusions. Work-up revealed new onset acute SLE...
April 2017: American Journal of Ophthalmology Case Reports
Francesco Guerrera, Pier Luigi Filosso, Cecilia Pompili, Stefania Olivetti, Matteo Roffinella, Andrea Imperatori, Alessandro Brunelli
Background: The presence of air leak following lung resection remains a frequent problem, which may prolong hospital stay and increase hospital costs. In the past, some studies documented the efficacy of soft and flexible chest tube in patients who underwent thoracic surgery. Nevertheless, safety in case of post-operative large air or liquid leak remains questionable. The objective of this study was to verify through a multicentre study the safety and the effectiveness of the coaxial chest tube in a consecutive series of selected patients who underwent anatomical pulmonary resection and with an active and large air leak...
2018: Journal of Visualized Surgery
Tomoo Inoue, Atsushi Shimomura, Takuji Sugimoto, Shiori Wakamiya, Ukou Chou, Akira Fujiwara, Fumihiro Uchikoshi, Tarou Watanabe, Natsuko Kitamura
This study reports the treatment and local control of advanced breast cancer with a giant ulcer. A 53-year-old woman presented with a large left breast tumor and an associated giant ulcer, with massive exudates, bleeding, and an offensive odor. Histopathological examination revealed an invasive ductal carcinoma(Luminal B type). Computed tomography(CT) showed multiple metastases to the lymph nodes, lungs, liver and bones. The patient received chemotherapy with a combina- tion of paclitaxel(PTX 90mg/m / 2)and bevacizumab(BEV 10 mg/kg)...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Judit Várkonyi, Gergely Szombath, Anna Vályi-Nagy, Judit Csomor, Krisztina Egedi, Ilona Kovalszky, Katalin Tölgyesi, László Szerafin, László Tóth, Györgyi Soós, Tamás Masszi
Authors report on a case of a male patient of systemic mastocytosis that was associated with extensive cutaneous lesions. Chronic diarrhoea worsening his quality of life was well managed by the administration of antihistamines. The pleural fluid recurrence soon after drainage has been controlled by the administration of alpha interferon. 40 years after the onset of the first skin signs progression has been manifested in the development of "B" (bone marrow infiltration rate >30%, dysmyelopoiesis, serum tryptase >20 μg/L, hepato- and splenomegaly) and "C" symptoms (liver function test abnormalities, cytopenia, malabsorption, osteoporosis)...
February 2018: Orvosi Hetilap
José M Porcel
Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains...
January 24, 2018: Tuberculosis and Respiratory Diseases
Andrey A Komissarov, Najib M Rahman, Yc Gary Lee, Galina Florova, Sreerama Shetty, Richard Idell, Mitsuo Ikebe, Kumuda Das, Torry A Tucker, Steven Idell
Recent studies have shed new light on the role of the fibrinolytic system in the pathogenesis of pleural organization, including mechanisms by which the system regulates mesenchymal transition of mesothelial cells and how that process affects outcomes of pleural injury. The key contribution of plasminogen activator inhibitor-1 to the outcomes of pleural injury is now better understood as is its role in the regulation of intrapleural fibrinolytic therapy. In addition, mechanisms by which fibrinolysins are processed after intrapleural administration have now been elucidated, informing new candidate diagnostics and therapeutics for pleural loculation and failed drainage...
January 18, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
Emanuele Asti, Andrea Sironi, Gianluca Bonitta, Daniele Bernardi, Luigi Bonavina
BACKGROUND: Intercostal pleural drainage is standard practice after transthoracic esophagectomy but has some drawbacks. We hypothesized that a transhiatal pleural drain introduced through the subxyphoid port site incision at laparoscopy can be as effective as the intercostal drainage and may enhance patient recovery. PATIENTS AND METHODS: A proof of concept study was designed to assess a new method of pleural drainage in patients undergoing hybrid Ivor Lewis esophagectomy (laparoscopy and right thoracotomy)...
December 13, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Heather Torbic, Hanine Inaty, Siva Raja, Humberto Choi
Instillation of intrapleural (IP) fibrinolytics has been used in patients with complicated parapneumonic pleural effusions to improve fluid drainage and decrease the need for surgical intervention. However, clinical trials have not included certain special populations such as pregnant females and there are currently no published case reports of this practice in this group. We describe the case of a 35-year-old female, G2P1 at 32 weeks of gestation, with a complicated pleural effusion due to influenza pneumonia with superimposed bacterial pneumonia...
September 2017: Journal of Thoracic Disease
Shugeng Gao, Zhongheng Zhang, Javier Aragón, Alessandro Brunelli, Stephen Cassivi, Ying Chai, Chang Chen, Chun Chen, Gang Chen, Haiquan Chen, Jin-Shing Chen, David Tom Cooke, John B Downs, Pierre-Emmanuel Falcoz, Wentao Fang, Pier Luigi Filosso, Xiangning Fu, Seth D Force, Martínez I Garutti, Diego Gonzalez-Rivas, Dominique Gossot, Henrik Jessen Hansen, Jianxing He, Jie He, Bo Laksáfoss Holbek, Jian Hu, Yunchao Huang, Mohsen Ibrahim, Andrea Imperatori, Mahmoud Ismail, Gening Jiang, Hongjing Jiang, Zhongmin Jiang, Hyun Koo Kim, Danqing Li, Gaofeng Li, Hui Li, Qiang Li, Xiaofei Li, Yin Li, Zhijun Li, Eric Lim, Chia-Chuan Liu, Deruo Liu, Lunxu Liu, Yongyi Liu, Kevin W Lobdell, Haitao Ma, Weimin Mao, Yousheng Mao, Juwei Mou, Calvin Sze Hang Ng, Nuria M Novoa, René H Petersen, Hiroyuki Oizumi, Kostas Papagiannopoulos, Cecilia Pompili, Guibin Qiao, Majed Refai, Gaetano Rocco, Erico Ruffini, Michele Salati, Agathe Seguin-Givelet, Alan Dart Loon Sihoe, Lijie Tan, Qunyou Tan, Tang Tong, Kosmas Tsakiridis, Federico Venuta, Giulia Veronesi, Nestor Villamizar, Haidong Wang, Qun Wang, Ruwen Wang, Shumin Wang, Gavin M Wright, Deyao Xie, Qi Xue, Tao Xue, Lin Xu, Shidong Xu, Songtao Xu, Tiansheng Yan, Fenglei Yu, Zhentao Yu, Chunfang Zhang, Lanjun Zhang, Tao Zhang, Xun Zhang, Xiaojing Zhao, Xuewei Zhao, Xiuyi Zhi, Qinghua Zhou
The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e...
September 2017: Journal of Thoracic Disease
Alain Tremblay, Christine T Kearney, Chris Hanks, Jennifer Hughes Hanks, David S White, Marcia E Pereira, Craig E Zook, Karen Sargis, Luke Zhang
Purpose/Aim of the study: This study assessed the safety and potential toxicity of a silver nitrate coated indwelling pleural catheter (SNCIPC) designed to create pleurodesis in a large animal model. MATERIALS AND METHODS: Sixteen animals underwent insertion of either a SNCIPC or an uncoated silicone catheter. Half of the animals were sacrificed at day 7 and the others at day 30. Animal weight and assessment of well-being, pleural fluid and blood collection were performed at regular intervals...
November 2017: Experimental Lung Research
Bharat Bajantri, Shaik Danial, Richard Duncalf, Misbahuddin Khaja
Mycoplasma pneumoniae has been associated with respiratory tract infections. Mycoplasma pneumoniae pneumonia-related pleural effusion is rarely reported. Extra-pulmonary abnormalities such as encephalitis, myocarditis, glomerulonephritis, and myringitis have been reported. However pulmonary manifestations in systemic lupus erythematosus include pneumonitis, pleurisy, interstitial lung disease, and thromboembolic disease. We present the case of a 26-year-old male who came for evaluation of fever, cough, and shortness of breath with right-sided chest pain...
2017: Respiratory Medicine Case Reports
Ryo Mori, Koji Yamazaki, Fumihiro Shoji, Hidenori Kouso, Chie Ushijima, Naoko Miura, Tomoyoshi Takenaka, Sadanori Takeo
BACKGROUND: The sensitivity of postoperative pleural air leakage (PAL) after pulmonary resection is evaluated by a simple subjective grading method in clinical practice. A new electronic digital chest drainage evaluation system (DCS) recently became clinically available. This study was designed to evaluate the clinical application of the DCS in monitoring the airflow volume and managing postoperative PAL. METHODS: We prospectively enrolled 25 patients who underwent pulmonary resection...
2017: PloS One
Arno Teblick, Hilde Jansens, Karolien Dams, Francis J Somville, Philippe G Jorens
Objective and Importance Boerhaave's syndrome is a sudden and rare form of oesophageal rupture and is often complicated by local or systemic infection of the mediastinum or pleural cavity. Several micro-organisms are documented as cause of pleural empyema in patients with Boerhaave's syndrome. Intervention (& Technique) We report on a previously healthy 74-year-old male who was admitted at a regional hospital with severe retrosternal and abdominal pain after an episode of vigorous vomiting the morning after ingestion of large quantity of beer...
November 5, 2017: Acta Clinica Belgica
Periklis Perikleous, David A Waller
Parenchymal cancers of lung, breast, gastrointestinal tract and ovaries as well as lymphomas and mesotheliomas are among the most common cancer types causing malignant effusions, though almost all tumour types have been reported to cause a malignant effusion. The prognosis heavily depends on patients' response to systemic therapy however, regardless of the causing pathology and histopathologic form, malignant pleural disease is normally associated with a poor prognosis. To date, there are not sufficient data to allow accurate predictions of survival that would facilitate decision making for managing patients with malignant pleural diseases...
2017: Journal of Visualized Surgery
Tao Yan, Guang Tong, Ben Zhang, Feng Yan, Xuan Zhou, Xianyue Wang, Hua Lu, Tao Ma, Xiaowu Wang, Hao Yu, Zhongchan Sun, Weida Zhang
OBJECTIVES: The effect of antegrade pulmonary blood flow (APBF) has never been studied in the bidirectional Glenn (BDG) procedure performed late. METHODS: Records of 112 consecutive patients who had a BDG procedure during a 10-year period were reviewed retrospectively. The patients were divided into 2 groups based on whether APBF occurred following the BDG procedure (APBF group, n = 81) or not (non-APBF group, n = 31). The median age at the BDG procedure was 6...
October 13, 2017: Interactive Cardiovascular and Thoracic Surgery
Mark R Katlic
BACKGROUND: General anesthesia and endotracheal intubation are a luxury rather than a necessity for many video-assisted thoracic surgery (VATS) operations. Twenty-three years ago, I began using local anesthesia and sedation for pleural disease and subsequently, for pericardial and lung disease. STUDY DESIGN: The records of all patients undergoing VATS using local anesthesia and sedation at hospitals of the Geisinger Health System (Danville and Wilkes-Barre, PA), from June 1, 2002 to June 30, 2011, and the Lifebridge Health System (Baltimore, MD) from July 1, 2011 to March 1, 2017, were retrospectively reviewed...
January 2018: Journal of the American College of Surgeons
Norikazu Kawai, Takeshi Kawaguchi, Shuko Suzuki, Motoaki Yasukawa, Takashi Tojo, Shigeki Taniguchi
OBJECTIVE: We evaluated the efficacy of low-voltage coagulation (LVC) with polyglycolic acid (PGA) sheets (Neoveil, GUNZE Ltd., Japan) and fibrin glue to control intraoperative alveolar air leaks after lung surgery. METHODS: We included 176 patients with non-small cell lung cancer who underwent thoracoscopic lobectomies. When alveolar air leak was confirmed after lung resection, we applied LVC system to the pleural defect followed by layers of PGA sheets and fibrin glue (n = 40)...
December 2017: General Thoracic and Cardiovascular Surgery
Ruchir Aeron, Sunny Goel, Apul Goel, Vikas Kumar
Urinothorax, an unusual and rare cause of pleural effusion, is usually secondary to urinary obstruction and abdominal trauma. We describe an uncommon case of left-sided urinothorax in a 35-year-old man with diabetes and hypothyroidism associated with an autoimmune disorder without obvious obstructive uropathy. Workup revealed pancytopenia, mild proteinuria, positive anti-nuclear and anti-dsDNA antibodies suggestive of probable systemic lupus erythematosus. Contrast-enhanced CT-chest and abdomen showed hepatosplenomegaly with bilateral renal abscesses and a fistulous connection between left superior calyx and left the pleural cavity...
September 25, 2017: BMJ Case Reports
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