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Omoregbee BI, Okugbo S. Pleurodesis with povidone iodine in patients with malignant pleural effusion in a tertiary center in Nigeria. Pan Afr Med J 2021; 38:169. [PMID: 33995776 PMCID: PMC8077678 DOI: 10.11604/pamj.2021.38.169.22405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 02/06/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION malignant pleural effusion occurs as a consequence of a primary or metastatic malignant process involving the pleura. The aim of pleurodesis is to prevent re-accumulation of the effusion and avoid the need for repeated hospitalization. Povidone iodine has been used in other climes for pleurodesis with good results. The aim of this study is to assess the efficacy and safety of povidone iodine in producing pleurodesis as compared to tetracycline. METHODS the study is a prospective experimental study. The patients are randomized into two groups A (tetracycline-control) and B (povidone iodine). All patients are assessed with chest X-ray after 1 week and 1 month. The responses were ascribed as complete, partial or failure. RESULTS thirty patients were recruited into this study, 15 patients in each group A (tetracycline) and B (povidone iodine). The mean age was 45.7±14.24 years. The commonest primary malignancy was Breast cancer (70%) followed by bronchogenic cancer (10%). Seventy three (73%) of the patients in this study had complete response and in 7% pleurodesis failed whilst 20% has partial response. In the povidone group the success rate was 93.4% and in the tetracycline group was 93.3% with a p-value of 0.716. There was no statistical difference in the responses based on the agents used. CONCLUSION malignant pleural effusion is a devastating condition as it heralds the end-of-life processes of a primary malignancy. Povidone iodine is a safe, cheap, effective, widely available and effective pleurodesing agent for use in patients with malignant pleural effusion.
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Affiliation(s)
- Benjamin Irene Omoregbee
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, United Kingdom
- Cardiothoracic Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Stanley Okugbo
- Cardiothoracic Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
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Muthu V, Dhooria S, Sehgal IS, Prasad KT, Aggarwal AN, Agarwal R. Iodopovidone pleurodesis for malignant pleural effusions: an updated systematic review and meta-analysis. Support Care Cancer 2021; 29:4733-4742. [PMID: 33515303 DOI: 10.1007/s00520-021-06004-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chemical pleurodesis is an important option for palliation in malignant pleural effusion (MPE). OBJECTIVES To evaluate the status of iodopovidone for pleurodesis in MPE. METHODS We performed a systematic review of PubMed and EMBASE databases to identify studies evaluating the role of iodopovidone for pleurodesis in MPE. We calculated the pooled success rate of iodopovidone pleurodesis from observational studies and the risk ratio (RR) of successful pleurodesis (compared to other agents) from randomized controlled trials (RCTs). We pooled the data using the random-effects model. We also assessed the safety of iodopovidone. RESULTS We included 26 studies (n = 1132, 15 observational, and 11 RCTs) in our review. The pooled success rate (95% confidence interval [CI]) from 15 observational studies (n = 648) was 90% (86-94). The efficacy rate of iodopovidone was similar with either tube thoracostomy or thoracoscopy. Eleven (n = 484) RCTs compared the efficacy of iodopovidone with other agents (especially bleomycin and talc). We found a similar success rate of iodopovidone compared to other agents with a pooled RR (95% CI) of 0.99 (0.91-1.08). The most frequent adverse event was chest pain. No hypo or hyperthyroidism, or visual disturbance was encountered in any study. There were no deaths attributed to iodopovidone use. CONCLUSIONS Iodopovidone is a safe and effective agent for pleurodesis in the management of MPE. Further confirmation is required since the available evidence is limited by the low quality and small sample size of the included studies.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
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Mishra DR, Bhatta N, Koirala P, Shah B, Bista B, Shah N. Success of Using Iodopovidone as a Sclerosing Agent for Chemical Pleurodesis in a Tertiary Care Center: A Descriptive Cross-Sectional Study. ACTA ACUST UNITED AC 2021; 59:69-73. [PMID: 34508441 PMCID: PMC7893386 DOI: 10.31729/jnma.6033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 11/17/2022]
Abstract
Introduction: Pleurodesis is a procedure to achieve symphysis between the two layers of pleura aimed at preventing the accumulation of either air or fluid in the pleural space. In Nepal, intrapleural instillation of the chemical sclerosing agent is more commonly done as a Thoracoscopy facility is not easily available. However, iodopovidone is rarely used for this purpose in Nepal. The study aims to find the prevalence of success using iodopovidone as the chemical sclerosing agent. Methods: The study included cases undergoing pleurodesis over a two-year period. The clinic-odemographic data, diagnosis, treatment effect and treatment response were analyzed. The treatment response was graded as Treatment Success (Complete Response or Partial Response) and Treatment Failure. Results: Pleurodesis was done in a total of 54 cases. Of those, 39 cases were Secondary Spontaneous Pneumothorax, 11 were Malignant Pleural Effusion, 3 were Primary Spontaneous Pneumothorax, and 1 was a case of Hepatic Hydrothorax. Among Secondary Spontaneous Pneumothorax, Pleurodesis was successful in 37 (95%) out of 39 cases, with 35 (90%) having a Complete Response and 2 (5%) having a Partial Response while 2 (5%) had Treatment failure. Among Malignant Pleural Effusion, treatment success was achieved in 6 (55%) out of 11, whereas 5 (45%) failed the treatment. The commonest complication was burning sensation, and the commonest pain scale was “distressing.” Conclusions: This study highlights the safety and the ease of use of iodopovidone as an agent for chemical pleurodesis. It confirms the high rate of success of pleurodesis in cases of pneumothorax as found in other studies. In contrast, the success rate is understandably lower in cases of Malignant Pleural effusion.
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Affiliation(s)
- Deebya Raj Mishra
- Department of Pulmonary, Critical Care and Sleep Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narendra Bhatta
- Department of Pulmonary, Critical Care and Sleep Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Puru Koirala
- Department of Internal Medicine, Birat Medical College, Nepal
| | - Bhupendra Shah
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bidesh Bista
- Department of Internal Medicine, Civil Hospital, Nepal
| | - Niharika Shah
- Department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Makkar A, Patni S, Joad AK, Lakhera KK. An observational study on safety and efficacy of povidone-iodine for pleurodesis in cancer patients. South Asian J Cancer 2020; 6:79-80. [PMID: 28702414 PMCID: PMC5506817 DOI: 10.4103/2278-330x.208849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Pleurodesis is a time-honored procedure for malignant effusion as one of the palliative procedures to treat recurrent effusions. Various agents have been used in the past such as tetracycline, talc, bleomycin, and povidone-iodine. This paper aims at evaluating safety and efficacy of povidone-iodine for the procedure. Materials and Methods: One hundred and four patients underwent of pleurodesis with povidone-iodine done at our center for malignant effusion between June 2008 and August 2015. The safety and efficacy of the procedure was analyzed. Results: One hundred and four patients of malignant effusion with mean age of 53 years and a mean follow-up of 7.8 months were evaluated. A total of 79% patients did not show any reaccumulation of fluid in their follow-up. There was no periprocedural mortality. Eight patients had severe pain; eleven patients had fever, while one patient had arrhythmia. Conclusion: Povidone-iodine is a simple, cheap, and effective method of pleurodesis with no major complication and a high success rate.
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Affiliation(s)
- Ayush Makkar
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Sanjeev Patni
- Department of Anaesthesia and Palliative Care, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Anjum Khan Joad
- Department of Anaesthesia and Palliative Care, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Kamal Kishor Lakhera
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
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Garzón JC, Edward Vinck E, Carolina Cárdenas D, Jaime Téllez L. Video-assisted thoracoscopic iodopovidone pleurodesis for malignant pleural effusions in moderate to high-risk Colombian patients. J Cardiovasc Thorac Res 2020; 12:328-333. [PMID: 33510883 PMCID: PMC7828754 DOI: 10.34172/jcvtr.2020.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs).
Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging.
Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively.
Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.
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Affiliation(s)
- Juan Carlos Garzón
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| | - Eric Edward Vinck
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| | - Diana Carolina Cárdenas
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| | - Luis Jaime Téllez
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
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Park JB, Lee SA, Lee WS, Kim YH, Hwang JJ. The management of chemical pleurodesis with viscum album in patients with persistent air leakage. J Thorac Dis 2018; 10:371-376. [PMID: 29600069 DOI: 10.21037/jtd.2017.12.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Persistent air leak (PAL) after major pulmonary resection or involved with secondary lung disease is prevalent and associated with significant morbidity. Chemical pleurodesis is a practical therapeutic tool to manage the patients with PAL. Among various sclerosing substances, viscum album (fraxini) is considered effective and safe. The aim of this study was to evaluate the efficacy and safety of viscum album pleurodesis in patients with intractable prolonged air leakage. Methods Between February 2013 and February 2015, 73 consecutive patients who underwent pleurodesis due to PAL were enrolled in this study. Pleurodesis was performed using 100 mg of viscum album (fraxini) at 1 time through the indwelling chest tube. Main studied outcomes were focused on success rate of pleurodesis assessed on chest radiography and cessation of the air leak after procedure. Results The study population was predominantly male (n=64, 87.7%). The overall success rate was 90.4%. One patient died of pneumonia not related to the viscum album pleurodesis. The mean length of stoppage to air leakage was 28.00±22.19 hours. The mean duration of chest tube drainage after pleurodesis was 2.78±1.35 days. The mean number of pleurodesis was 1.38±0.75. Thirty-six patients (49.3%) complained of chest pain requiring a prescription for pain control. There were no major relevant complications or mortalities. Conclusions Air leaks remain an important cause of morbidity. This viscum album pleurodesis could be considered as an option for the treatment of prolonged air leak patients, associated with acceptable side effects.
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Affiliation(s)
- Jae Bum Park
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Song Am Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Woo Surng Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Yo Han Kim
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Jae Joon Hwang
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Seoul, Korea
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Kahrom H, Aghajanzadeh M, Asgari MR, Kahrom M. Efficacy and Safety of Povidone-iodine Pleurodesis in Malignant Pleural Effusions. Indian J Palliat Care 2017; 23:53-56. [PMID: 28216863 PMCID: PMC5294438 DOI: 10.4103/0973-1075.197958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is determined by the detection of malignant cells in pleural fluid or pleural tissue. Neoplasm of lung, breast, ovary and lymphoma are the causes of more than 75% of MPE. Pleurodesis is a usual technique in the management of MPE to achieve a symphysis between two layers of the pleura, and various chemical agents have been used in an attempt to produce pleurodesis. With regard to complications and limitations of these sclerosing agents, efficacy and safety of povidone-iodine have been investigated in this study. MATERIALS AND METHODS Between June 2014 and June 2016, 63 consecutive patients were admitted to the Department of Thoracic Surgery because of symptomatic MPE. After insertion of a chest tube, pleurodesis with instillation of povidone-iodine was performed. Thyroid and renal function tests were checked, and success rate as well as recurrence of MPE was monitored in the next follow-up visits. RESULTS The complete response to this procedure was about 53.57%, and failure of treatment was 10.71% with efficacy of 82.2%. The most common complication was pain during instillation (26.9%). Changes in thyroid and renal function tests were not significant. CONCLUSION Povidone-iodine is a safe and effective agent with minor side effects in pleurodesis of patients with MPEs and can be used as an accessible and low-cost alternative than other sclerosing agents.
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Affiliation(s)
- Hadi Kahrom
- Department of General Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Mohammad Reza Asgari
- Department of General Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahdi Kahrom
- Department of Cardiovascular Surgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Pigtail Catheter: A Less Invasive Option for Pleural Drainage in Egyptian Patients with Recurrent Hepatic Hydrothorax. Gastroenterol Res Pract 2016; 2016:4013052. [PMID: 27340399 PMCID: PMC4909926 DOI: 10.1155/2016/4013052] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/18/2016] [Accepted: 05/15/2016] [Indexed: 12/13/2022] Open
Abstract
Background and Aims. Treatment of hepatic hydrothorax is a clinical challenge. Chest tube insertion for hepatic hydrothorax is associated with high complication rates. We assessed the use of pigtail catheter as a safe and practical method for treatment of recurrent hepatic hydrothorax as it had not been assessed before in a large series of patients. Methods. This study was conducted on 60 patients admitted to Tanta University Hospital, Egypt, suffering from recurrent hepatic hydrothorax. The site of pigtail catheter insertion was determined by ultrasound guidance under complete aseptic measures and proper local anesthesia. Insertion was done by pushing the trocar and catheter until reaching the pleural cavity and then the trocar was withdrawn gradually while inserting the catheter which was then connected to a collecting bag via a triple way valve. Results. The use of pigtail catheter was successful in pleural drainage in 48 (80%) patients with hepatic hydrothorax. Complications were few and included pain at the site of insertion in 12 (20%) patients, blockage of the catheter in only 2 (3.3%) patients, and rapid reaccumulation of fluid in 12 (20%) patients. Pleurodesis was performed on 38 patients with no recurrence of fluid within three months of observation. Conclusions. Pigtail catheter insertion is a practical method for treatment of recurrent hepatic hydrothorax with a low rate of complications. This trial is registered with ClinicalTrials.gov Identifier: NCT02119169.
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Gulcan E, Korkmaz M, Kıdır V, Sanal B, Vural AH. Treatment with Povidone-Iodine of Pleural Effusion Due to Diaphragmatic Defect in a Patient Undergoing Peritoneal Dialysis. Perit Dial Int 2016; 36:233. [PMID: 27006443 DOI: 10.3747/pdi.2015.00263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E Gulcan
- Department of Nephrology, Dumlupinar University Medical Faculty, Kutahya, Turkey
| | - M Korkmaz
- Department of Radiology, Dumlupinar University Medical Faculty, Kutahya, Turkey
| | - V Kıdır
- Department of Nephrology, Dumlupinar University Medical Faculty, Kutahya, Turkey
| | - B Sanal
- Department of Radiology, Dumlupinar University Medical Faculty, Kutahya, Turkey
| | - A H Vural
- Department of Cardiovascular Surgery, Dumlupinar University Medical Faculty, Kutahya, Turkey
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Moon Y, Kim KS, Park JK. Simple intrapleural hyperthermia at thoracoscopic exploration to treat malignant pleural effusion. J Cardiothorac Surg 2015; 10:136. [PMID: 26510956 PMCID: PMC4625971 DOI: 10.1186/s13019-015-0340-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/19/2015] [Indexed: 12/17/2022] Open
Abstract
Background Malignant pleural effusion (MPE) occurs at a terminal stage of cancer, and related symptoms may considerably reduce a patient’s respiratory function and quality of life. We assessed the benefit of simple intrapleural hyperthermia (SIH) during thoracoscopic exploration for MPE. Methods We conducted a retrospective review of 34 patients underwent thoracoscopic exploration and SIH procedures for MPE between April, 2009 and July, 2014 at our institution. One month after removal of the tube, therapeutic efficacy was evaluated, calculating response rates and recurrence rate. Results In this cohort (male, 11; female, 23; average age, 54.2 ± 12.7 years), the most frequent primary cancers were breast (n = 11, 32.4 %), lung (n = 10, 29.4 %), and ovarian (n = 6, 17.6 %). Therapeutic response (ie, presence of pleural effusion) was assessed 1 month after chest tube removal, with 19 (55.9 %) showing complete response (CR), 9 (26.5 %) showing partial response (PR), and non-response (NR) seen in 6 (17.6 %). The combined (CR + PR) response rate was 82.4 %. During follow-up, there were seven instances of recurrence, requiring repeat drainage. Three- and 7-month recurrence-free rates were 86.9 and 73.9 %, respectively. No postoperative respiratory complications or fever developed. Early death within 3 months from progression of primary cancer was identified as a risk factor in patients of NR status (HR = 18.36, p = 0.043). Conclusions If thoracoscopic exploration is indicated for MPE, SIH is a safe and effective management alternative in patients whose primary malignancy is not rapidly progressing.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic Medical Center School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu, 06591, Republic of Korea.
| | - Kyung Soo Kim
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic Medical Center School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu, 06591, Republic of Korea.
| | - Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic Medical Center School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu, 06591, Republic of Korea.
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Cho SJ, Kim SW, Chang JW. Acute pneumonitis consequent on pleurodesis with Viscum album extract: severe chest images but benign clinical course. Multidiscip Respir Med 2014; 9:61. [PMID: 25699179 PMCID: PMC4333894 DOI: 10.1186/2049-6958-9-61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/17/2014] [Indexed: 11/18/2022] Open
Abstract
Chemical pleurodesis is widely recommended in the treatment of pulmonary air leak of different etiologies as well as malignant pleural effusions and chylothorax. Conventional chemical pleurodesis using erythromycin, tetracycline, hydrophilic fumed silica, autologous blood and talc slurry has been standardized, and its complications, including high fever, intractable chest pain, and acute lung injury, seem to be frequent. Viscum album extract is a new chemical agent for pleurodesis, and only a few studies have reported outcomes of such chemical pleurodesis in the treatment of malignant pleural effusion. Moreover, the complications resulting from pleurodesis using Viscum album extract are very rare, and acute pneumonitis has not been reported. in this paper we report the first case of acute pneumonitis after pleurodesis using Viscum album extract in a 58-year-old man who had prolonged air leaks after a left upper lingularsegmentectomy for metastatic lung cancer. We performed repeated pleurodesis four times with 2 to 4 days intervals. While the patient had no symptoms of pneumonia, such as cough, sputum, chilling, and fatigue, a follow-up chest X-ray revealed increasing peribronchial consolidations and infiltrations in the left upper lobe. A chest tomography showed extensive parenchymal consolidations and ground-glass appearances in the left lungs, representing pneumonia with acute lung injury. The acute pneumonitis was spontaneously resolved with supportive care, and the patient was discharged ten days after the development of pneumonitis. We think that pleurodesis with Viscum album extract is effective, but repeated pleurodesis should be avoided for possible onset of acute pneumonitis.
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Affiliation(s)
- Suk Ju Cho
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Su Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Aran 13 gil 15, Jeju-si, Jeju Special Self-Governing Province 690-767 Korea
| | - Jee Won Chang
- Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Aran 13 gil 15, Jeju-si, Jeju Special Self-Governing Province 690-767 Korea
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Fiorelli A, Pentimalli F, D'Urso V, Di Marzo D, Forte IM, Giordano A, Di Domenico M, Accardo M, Di Serio U, Santini M. Antineoplastic activity of povidone-iodine on different mesothelioma cell lines: results of in vitro study. Eur J Cardiothorac Surg 2014; 45:993-1000. [PMID: 24394552 DOI: 10.1093/ejcts/ezt534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Povidone-iodine (PVP-I) or Betadine, owing to its antineoplastic activity, is also used as an adjuvant during intra-abdominal or intrathoracic surgery. However, the protocol of PVP-I administration has not been optimized to achieve the best antitumoural efficacy. We aimed to determine the optimal concentration of PVP-I, the time of incubation and the mechanism of cell death by analysing the effect of different doses and time of administration of PVP-I on the cell viability of different mesothelioma cell lines. METHODS Four different cell lines (MET 5A/normal mesothelium; H2052/sarcomatoid mesothelioma; ISTMES2/epithelial mesothelioma; MSTO/biphasic mesothelioma) were incubated with increasing concentrations of diluted PVP-I (0.0001; 0.001; 0.01; 0.1; 1%) for 5, 10, 30, 60 min and 24 h, respectively. Cell viability was determined using cell direct cytotoxicity assay and cell death was determined through flow cytometry assay analysis. The superoxide dismutase activity was assessed functionally through a specific inhibitor to evaluate the mechanism of cell death. RESULTS The antiproliferative effect of PVP-I varied largely among different cell lines in a dose- and time-dependent manner. At 0.1% concentration for 10 min of incubation, the percentage of viable cells was 0.5 ± 0.1; 0.8 ± 0.5 and 0% (P < 0.01) for MET5A, ISTMES2 and MSTO, respectively. Conversely, the same concentration did not significantly affect the H2052 cell line which was completely suppressed at a 1% concentration of PVP-I. Double staining of Annexin V and DNA showed that PVP-I induced cell death in all four cell lines via necrosis depending on PVP-I concentration. However, H2052 was found to be more resistant than MSTO, ISTMES2 and MET 5A cells lines. The activity of superoxide dismutase was significantly inhibited in all cell lines. CONCLUSIONS Our results confirmed the anti-neoplastic activity of PVP-I especially on ISTMES2 and MSTO cell lines. With respect to chemotherapy pleural irrigation, washing with PVP-I is cost-effective and easy. If confirmed by larger studies, our findings suggest that the intrapleural irrigation with PVP-I (0.1% concentration for 10 min) in patients with epithelial or biphasic mesothelioma undergoing cytoreductive surgery might be applied in thoracic surgery practice to prevent neoplastic cell growth.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | - Francesca Pentimalli
- INT-CROM, 'Pascale Foundation' National Cancer Institute - Cancer Research Center, Mercogliano, Italy
| | - Vittorio D'Urso
- INT-CROM, 'Pascale Foundation' National Cancer Institute - Cancer Research Center, Mercogliano, Italy
| | - Domenico Di Marzo
- INT-CROM, 'Pascale Foundation' National Cancer Institute - Cancer Research Center, Mercogliano, Italy
| | - Iris Maria Forte
- INT-CROM, 'Pascale Foundation' National Cancer Institute - Cancer Research Center, Mercogliano, Italy
| | - Antonio Giordano
- INT-CROM, 'Pascale Foundation' National Cancer Institute - Cancer Research Center, Mercogliano, Italy Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, PA, USA
| | | | - Marina Accardo
- Department of Morphopathology, Second University of Naples, Naples, Italy
| | - Umberto Di Serio
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
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