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Barton E, Verduri A, Carter B, Hughes J, Hewitt J, Maskell NA. The association between frailty and survival in patients with pleural disease: a retrospective cohort study. BMC Pulm Med 2024; 24:180. [PMID: 38627673 PMCID: PMC11020337 DOI: 10.1186/s12890-024-02981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND There are currently no data on the relationship between frailty and mortality in pleural disease. Understanding the relationship between frailty and outcomes is increasingly important for clinicians to guide decisions regarding investigation and management. This study aims to explore the relationship between all-cause mortality and frailty status in patients with pleural disease. METHODS In this retrospective analysis of a prospectively collected observational cohort study, outpatients presenting to the pleural service at a tertiary centre in Bristol, UK with a radiologically confirmed, undiagnosed pleural effusion underwent comprehensive assessment and were assigned a final diagnosis at 12 months. The modified frailty index (mFI) was calculated and participants classified as frail (mFI ≥ 0.4) or not frail (mFI ≤ 0.2). RESULTS 676 participants were included from 3rd March 2008 to 29th December 2020. The median time to mortality was 490 days (IQR 161-1595). A positive association was found between 12-month mortality and frailty (aHR = 1.72, 95% CI 1.02-2.76, p = 0.025) and age ≥ 80 (aHR = 1.80, 95% CI 1.24-2.62, p = 0.002). Subgroup analyses found a stronger association between 12-month mortality and frailty in benign disease (aHR = 4.36, 95% CI 2.17-8.77, p < 0.0001) than in all pleural disease. Malignancy irrespective of frailty status was associated with an increase in all-cause mortality (aHR = 10.40, 95% CI 6.01-18.01, p < 0.0001). CONCLUSION This is the first study evaluating the relationship between frailty and outcomes in pleural disease. Our data demonstrates a strong association between frailty and 12-month mortality in this cohort. A malignant diagnosis is an independent predictor of 12-month mortality, irrespective of frailty status. Frailty was also strongly associated with 12-month mortality in patients with a benign underlying cause for their pleural disease. This has clinical relevance for pleural physicians; evaluating patients' frailty status and its impact on mortality can guide clinicians in assessing suitability for invasive investigation and management. TRIAL REGISTRATION This study is registered with the Health Research Authority (REC reference 08/H0102/11) and the NIHR Portfolio (Study ID 8960).
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Affiliation(s)
- Eleanor Barton
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
| | - A Verduri
- Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Policlinico Modena, Italy
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - J Hughes
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - J Hewitt
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - N A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Carneiro DC, Duarte D'Ambrosio P, Mariani AW, Fonini JS, Aguirre GKZ, Carneiro Leão JP, Schmidt Júnior AF, Bedawi EO, Rahman NM, Manuel Pêgo-Fernandes P. Evaluation of the RAPID score as a predictor of postoperative morbidity and mortality in patients undergoing pulmonary decortication for stage III pleural empyema. Clinics (Sao Paulo) 2024; 79:100356. [PMID: 38608555 PMCID: PMC11019092 DOI: 10.1016/j.clinsp.2024.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/22/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE This study aims to correlate the RAPID score with the 3-month survival and surgical results of patients undergoing lung decortication with stage III pleural empyema. METHODS This was a retrospective study with the population of patients with pleural empyema who underwent pulmonary decortication between January 2019 and June 2022. Data were collected from the institution's database, and patients were classified as low, medium, and high risk according to the RAPID score. The primary outcome was 3-month mortality. Secondary outcomes were the length of hospital stay, readmission rate, and the need for pleural re-intervention. RESULTS Of the 34 patients with pleural empyema, according to the RAPID score, patients were stratified into low risk (23.5 %), medium risk (47.1 %), and high risk (29.4 %). The high-risk group had a 3-month mortality of 40 %, while the moderate-risk group had a 6.25 % and the low-risk group had no deaths within 90 days, confirming a good correlation with the RAPID score (p < 0.05). Sensitivity and specificity for the primary outcome in the high-risk score were 80.0 % and 79.3 %, respectively. The secondary outcomes did not reach statistical significance. CONCLUSIONS In this retrospective series, the RAPID score had a good correlation with 3-month mortality in patients undergoing lung decortication. The morbidity indicators did not reach statistical significance. The present data justifies further studies to explore the capacity of the RAPID score to be used as a selection tool for treatment modality in patients with stage III pleural empyema.
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Affiliation(s)
- Danilo Caribé Carneiro
- Thoracic Surgery Resident, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Paula Duarte D'Ambrosio
- Thoracic Surgery Departament, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Alessandro Wasum Mariani
- Thoracic Surgery Departament, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Jaqueline Schaparini Fonini
- Thoracic Surgery Resident, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Gabriela Ketherine Zurita Aguirre
- Thoracic Surgery Resident, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - João Pedro Carneiro Leão
- Thoracic Surgery Resident, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Aurelino Fernandes Schmidt Júnior
- Thoracic Surgery Departament, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Eihab O Bedawi
- Department of Infection, Immunity and Cardiovascular Disease (IICD), University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland United Kingdom; Department of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland United Kingdom
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland United Kingdom; Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland United Kingdom
| | - Paulo Manuel Pêgo-Fernandes
- Thoracic Surgery Departament, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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3
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Salguero BD, Salman S, Agrawal A, Lo Cascio CM, Joy G, Chaddha U. Evaluating the safety of intraprocedural chest tube removal during medical thoracoscopy. Respir Med 2024; 224:107560. [PMID: 38331227 DOI: 10.1016/j.rmed.2024.107560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Medical Thoracoscopy (MT) is a diagnostic procedure during which after accessing the pleural space the patient's negative-pressure inspiratory efforts draw atmospheric air into the pleural cavity, which creates a space to work in. At the end of the procedure this air must be evacuated via a chest tube, which is typically removed in the post-anesthesia care unit (PACU). We hypothesized that its removal intra-operatively is safe and may lead to lesser post-operative pain in comparison to its removal in the PACU. METHODS A retrospective review was conducted of all the MT with intraprocedural chest tube removal done between 2019 to 2023 in adult patients in a single center in New York, NY by interventional pulmonology. RESULTS A total of 100 MT cases were identified in which the chest tube was removed intra-operatively. Seventy-seven percent of cases were performed as outpatient and all these patients were discharged on the same day. Post procedure ex-vacuo pneumothorax was present in 42% of cases. Sixty-five percent of cases had some post-procedure subcutaneous emphysema, none reported any complaint of this being painful, and no intervention was needed to relieve the air. Seventy-three percent required no additional analgesia in PACU. Of the 27% that required any form of analgesia, 59% required no additional analgesia beyond the first 24 h. CONCLUSIONS Intraprocedural CT removal for MT is safe and may decrease utilization of additional analgesia post procedure. Further prospective studies are necessary to validate these conclusions.
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Affiliation(s)
- Bertin D Salguero
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Sidra Salman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Morningside and West, New York, NY, USA
| | - Abhinav Agrawal
- Division of Pulmonary, Critical Care and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Christian M Lo Cascio
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Greta Joy
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Udit Chaddha
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Yang L, Wang K, Hou W, Liu D, Li W. Application of ultrasound-guided medical thoracoscopy in patients with small amounts or without pleural effusion. BMC Pulm Med 2024; 24:42. [PMID: 38243217 PMCID: PMC10797946 DOI: 10.1186/s12890-024-02855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Pleural disease is a common clinical condition, and some patients present with a small amount of pleural effusion or no pleural effusion. It is difficult to diagnose such patients in clinical practice. Medical thoracoscopy is the gold standard for the diagnosis of pleural effusion with unknown origin, and guidelines recommend that pneumothorax should be induced in such patients before medical thoracoscopy examination. However, the process of inducing pneumothorax is tedious and has many complications. Our study was conducted to clarify the value of thoracic ultrasound combined with medical thoracoscopy in patients with small amounts or without pleural effusion to simplify the process of medical thoracoscopy examination. METHODS In this retrospective study, we included patients who were assigned to complete medical thoracoscopy. Successful completion of medical thoracoscopy in patients was regarded as letting the endoscope get into the pleural cavity and completion of the biopsy. Finally, we analyzed the value of preoperative ultrasound in patients without or with small amounts of pleural effusion. RESULTS Seventy-two patients were finally included in the study. Among them, 68 patients who underwent ultrasound positioning of the access site successfully completed the examination and four patients failed the examination. Fifty-one cases showed no fluid sonolucent area at the access site, of which 48 cases had pleural sliding signs at the access site, and 47 patients successfully completed the examination; 3 cases without pleural sliding signs at the access site failed to complete thoracoscopy. In 21 cases, the fluid sonolucent area was selected as the access site, and all of them successfully completed thoracoscopy. CONCLUSION Medical thoracoscopy is one of the methods to confirm the diagnosis in patients with pleural disease with small amounts or without pleural effusion. The application of thoracic ultrasound before medical thoracoscopy can be used for the selection of the access site. It is possible to replace pneumothorax induction before medical thoracoscopy.
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Affiliation(s)
- Linhui Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaige Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wang Hou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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5
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Del Prado-Rico C, Hayes R, Mohamed N, Leonard R, Chapman K. Three cases of black pleural effusion. Respir Med Case Rep 2023; 44:101874. [PMID: 37260562 PMCID: PMC10227376 DOI: 10.1016/j.rmcr.2023.101874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023] Open
Abstract
Black pleural effusions (BPE) are rare, exudative pleural effusions that produce a black fluid on thoracentesis. While the name and definition of this pathology is undeniably simple, the etiologies, outcomes, and treatments for BPE are incredibly complex. Currently, BPE is not well-demonstrated in the literature. This case series reports three patients with different etiologies, past medical histories, presenting symptoms, treatments, and outcomes. BPE caused by pancreatic-pleural fistula and opportunistic infections are demonstrated in this case series. This report shows that early identification and treatment of the underlying cause of BPE is critical to the recovery of the patients.
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Affiliation(s)
- Christine Del Prado-Rico
- Division of Pulmonary, Critical Care, Sleep Medicine, Department of Medicine, West Virginia University, USA
| | - Ryan Hayes
- School of Medicine, West Virginia University, USA
| | - Nada Mohamed
- Division of Pulmonary, Critical Care, Sleep Medicine, Department of Medicine, West Virginia University, USA
| | - Rachel Leonard
- Division of Pulmonary, Critical Care, Sleep Medicine, Department of Medicine, West Virginia University, USA
| | - Kyle Chapman
- Division of Pulmonary, Critical Care, Sleep Medicine, Department of Medicine, West Virginia University, USA
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Fjaellegaard K, Petersen JK, Clementsen PF, Laursen CB, Bhatnagar R, Bodtger U. Additional Up-Front Thoracic Ultrasound in the Workup of Patients with Unilateral Pleural Effusion: A Prospective Observational Pilot Study. Respiration 2023:1-9. [PMID: 37062275 DOI: 10.1159/000529871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/20/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND In patients with pleural effusion, specific ultrasound characteristics are associated with pleural malignancy. OBJECTIVES This study aimed to evaluate the added value of an additional, up-front, systematic thoracic ultrasound (TUS) to standard imaging in patients with unilateral pleural effusion of unknown cause in a clinical setting. METHODS In a prospective observational pilot study, patients referred for workup and thoracentesis of a unilateral pleural effusion received up-front TUS following a set protocol in addition to available imaging and US guiding the thoracentesis or diagnostic puncture. The primary outcome was the proportion of cases where systematic TUS changed the planned diagnostic workup. Follow-up took place 26 weeks after inclusion. RESULTS From February to December 2020, 55 patients were included. Thirty-six (65%) patients had other chest imaging available before TUS. Twenty-one (38%) were diagnosed with malignant pleural effusion. Three patients (5%) had clinically relevant changes in the diagnostic workup after additional systematic TUS. CONCLUSIONS Additional up-front, systematic TUS had limited clinically relevant effect on the planned diagnostic workup in patients with unilateral pleural effusion in a setting where chest CT scans often are available at referral.
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Affiliation(s)
- Katrine Fjaellegaard
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde/Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Koefod Petersen
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde/Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rahul Bhatnagar
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde/Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Abdul Hamid MF, Hasbullah AHH, Mohamad Jailaini MF, Nik Abeed NN, Ng BH, Haron H, Md Ali NA, Ismail MI, Nik Ismail NA, Abdul Rahman MR, Ban AYL. Retrospective review comparing intrapleural fibrinolytic therapy (alteplase) and surgical intervention in complex pleural effusion. BMC Pulm Med 2022; 22:439. [PMID: 36419155 PMCID: PMC9685928 DOI: 10.1186/s12890-022-02239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Intrapleural fibrinolytic therapy (IPFT) is one of the treatment options for complex pleural effusion. In this study, the IPFT agent used was alteplase, a tissue plasminogen activator (t-PA). This study aims to determine the difference in the outcome of patients with complex pleural effusion between IPFT and surgery in terms of radiological improvement, inflammatory parameters, length of stay, and post-intervention complications.
Methods A retrospective review of patients with complex pleural effusion treated at Universiti Kebangsaan Malaysia Medical Center from January 2012 to August 2020 was performed. Patient demographics, chest imaging, drainage chart, inflammatory parameters, length of hospital stay, and post-intervention and outcome were analyzed. Results Fifty-eight patients were identified (surgical intervention, n = 18; 31% and IPFT, n = 40, 69%). The mean age was 51.7 ± 18.2 years. Indication for surgical intervention was pleural infection (n = 18; 100%), and MPE (n = 0). Indications for IPFT was pleural infection (n = 30; 75%) and MPE (n = 10; 25%). The dosages of t-PA were one to five doses of 2–50 mg. The baseline chest radiograph in the IPFT group was worse than in the surgical intervention group. (119.96 ± 56.05 vs. 78.19 ± 55.6; p = 0.029) At week 1, the radiological success rate for IPFT and surgical intervention were 27% and 20%, respectively, and at weeks 4–8, the success rate was 56% and 80% respectively. IPFT was associated with lesser complications; fever (17.5%), chest pain (10%), and non-life-threatening bleeding (5%). Conclusion IPFT was comparable to surgery in radiological outcome, inflammatory parameters, and length of stay with lesser reported complications.
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Affiliation(s)
- Mohamed Faisal Abdul Hamid
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Ahmad Hadyan Husainy Hasbullah
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Mas Fazlin Mohamad Jailaini
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Nik Nuratiqah Nik Abeed
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Boon Hau Ng
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Hairulfaizi Haron
- grid.240541.60000 0004 0627 933XCardiothoracic Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Nur Ayub Md Ali
- grid.240541.60000 0004 0627 933XCardiothoracic Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Muhammad Ishamuddin Ismail
- grid.240541.60000 0004 0627 933XCardiothoracic Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Nik Azuan Nik Ismail
- grid.240541.60000 0004 0627 933XDepartment of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Mohd Ramzisham Abdul Rahman
- grid.240541.60000 0004 0627 933XCardiothoracic Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Andrea Yu-Lin Ban
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
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8
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Yang H, Zhang Y, Wei D, Chen W, Zhang S, He L, Liao H, Tang Q, Liu J. Utility of high-frequency B-mode and contrast-enhanced ultrasound for the differential diagnosis of benign and malignant pleural diseases: a prospective study. J Thorac Dis 2022; 14:3695-3705. [PMID: 36389309 PMCID: PMC9641343 DOI: 10.21037/jtd-22-636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/23/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pleural disease is a prevalent condition. As precision therapy advances, noninvasive imaging modalities play even more important roles in the evaluation of pleural diseases. This study investigated the diagnostic capabilities of high-frequency B-mode ultrasound (US) and contrast-enhanced US (CEUS) in terms of differentiating between benign and malignant pleural diseases. METHODS Patients with unexplained thickened pleurae were prospectively analyzed via transthoracic US. High-frequency B-mode US was used to derive the pleural thickness, morphology, and echogenicity. We analyzed the high-frequency CEUS data including the enhancement mode and time intensity curve (TIC). The cause of pleural thickening was confirmed by pleural biopsy and follow-up after the biopsy. We analyzed the differences in various ultrasonic features between the malignant and benign groups. Moreover, we plotted receiver operator curves (ROCs) and obtained the area under the curves, sensitivities, and specificities of all significant continuous variables. Multivariate logistic regression was used to assess the combined usefulness of multiple US indicators in terms of predicting malignant pleurae. RESULTS Thirty malignant and twenty benign thickened pleurae were finally diagnosed via pleural biopsy and at least six months of follow-up. The pleural morphology and enhancement modes significantly differed between the two groups (all P<0.05). The thickness derived from B-mode US and CEUS were significantly thicker in the malignant group (both P<0.05). Arrival time (AT) and the time to peak (TTP) of TIC were significantly shorter in the malignant group, whereas peak intensity and the area under the TIC were significantly higher in the malignant group (all P<0.05). The area under the ROC for pleural thickness derived from B-mode US was 0.819; pleural thickness derived from CEUS was 0.848; AT was 0.804; TTP was 0.750; peak intensity was 0.745; the area under the TIC was 0.743; and the combined various B-mode and CEUS parameter was 0.975. CONCLUSIONS Pleural thickness, morphology, enhancement mode, and the TIC of high-frequency US aided the differentiation of benign from malignant pleural diseases. Combined analysis of US indicators further improved the diagnostic capability.
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Affiliation(s)
- Hongwei Yang
- Department of Ultrasound, First Affiliated Hospital of Jinan University, Guangzhou, China;,Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuxin Zhang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongjun Wei
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wuxi Chen
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyu Zhang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liantu He
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haixing Liao
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qing Tang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianhua Liu
- Department of Medical Ultrasound, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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9
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Abstract
This article details the pros, cons, challenges/pitfalls, and elements required for the successful conduct of multicenter randomized trials, with specific focus on trials related to pleural diseases. Several networks dedicated to the multicenter study of important pleural conditions have developed, yielding practice-changing studies in pleural disease. This review describes the importance of multicenter trials, major elements required for the conduct of such trials, and lessons learned from the ongoing development of the Interventional Pulmonary Outcomes Group, a consortium of interventional pulmonologists dedicated to advancing diagnostic and management strategies in pleural, pulmonary parenchymal, and airway disease by generating high-quality multicenter evidence.
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10
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Hu K, Chopra A, Kurman J, Huggins JT. Management of complex pleural disease in the critically ill patient. J Thorac Dis 2021; 13:5205-5222. [PMID: 34527360 PMCID: PMC8411157 DOI: 10.21037/jtd-2021-31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/21/2021] [Indexed: 11/08/2022]
Abstract
Disorders of the pleural space are quite common in the critically ill patient. They are generally associated with the underlying illness. It is sometimes difficult to assess for pleural space disorders in the ICU given the instability of some patients. Although the portable chest X-ray remains the primary modality of diagnosis for pleural disorders in the ICU. It can be nonspecific and may miss subtle findings. Ultrasound has become a useful tool to the bedside clinician to aid in diagnosis and management of pleural disease. The majority of pleural space disorders resolve as the patient’s illness improves. There remain a few pleural processes that need specific therapies. While uncomplicated parapneumonic effusions do not have their own treatments. Those that progress to become a complex infected pleural space can have its individual complexity in therapy. Chest tube drainage remains the cornerstone in therapy. The use of intrapleural fibrinolytics has decreased the need for surgical referral. A large hemothorax or pneumothorax in patients admitted to the ICU represent medical emergencies and require emergent action. In this review we focus on the management of commonly encountered complex pleural space disorders in critically ill patients such as complicated pleural space infections, hemothoraces and pneumothoraces.
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Affiliation(s)
- Kurt Hu
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Jonathan Kurman
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Terrill Huggins
- Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
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11
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Davies-Barrett AM, Owens LS, Eeckhout PA. Paleopathology of the Ychsma: Evidence of respiratory disease during the Late Intermediate Period (AD 1000-1476) at the Central Coastal site of Pachacamac, Peru. Int J Paleopathol 2021; 34:63-75. [PMID: 34153817 DOI: 10.1016/j.ijpp.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate evidence for maxillary sinusitis and pulmonary inflammation in archaeological skeletons dating to the Late Intermediate Period (AD 1000-1476) at the site of Pachacamac, Peru. MATERIALS Thirty-nine individuals (male, female, and unknown sex; 16+ years age-at-death) were analyzed for inflammatory periosteal reaction (IPR) on the visceral (inner) surfaces of the ribs, and 16 individuals were analyzed for evidence of maxillary sinusitis. METHODS All individuals were macroscopically examined for bony changes in the maxillary sinuses and new bone formation on the ribs according to pre-established criteria. RESULTS Some 33.3% (13/39) of individuals had IPR on the ribs and 93.8% (15/16) had bony changes in the maxillary sinuses. CONCLUSIONS Respiratory disease was likely prevalent in people buried at Pachacamac during the Late Intermediate Period. A number of factors may have increased the risk of developing respiratory disease, including exposure to poor air quality and increased crowding and social mixing, resulting from pilgrimage to this important ritual center. SIGNIFICANCE This paper represents one of the first systematic analyses of evidence for respiratory disease in Peruvian and South American human skeletal remains, demonstrating the suitability of the region for further study. LIMITATIONS A limited sample was available for analysis. Additionally, the site's skeletal preservation was excellent, meaning the sample available for assessment of maxillary sinusitis was smaller, being limited to individuals with post-mortem breakage. FURTHER RESEARCH The results of this study should stimulate further much needed systematic investigation of evidence for respiratory disease in other Peruvian and South American populations.
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Affiliation(s)
- Anna M Davies-Barrett
- School of History, Archaeology and Religion, Cardiff University, John Percival Building, Colum Drive, Cardiff, CF10 3EU, United Kingdom.
| | - Lawrence S Owens
- University of Winchester. Sparkford Road, Winchester, SO22 4NR, United Kingdom; University of South Africa, Preller Street, Muckleneuk, Pretoria, 0002, South Africa
| | - Peter A Eeckhout
- Faculté de Philosophie et Sciences Sociales CP133/01, Université libre de Bruxelles, Av. F. Roosevelt 50, 1050, Brussels, Belgium
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12
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Lui JK, Billatos E, Schembri F. Evaluation and management of pleural sepsis. Respir Med 2021; 187:106553. [PMID: 34340174 DOI: 10.1016/j.rmed.2021.106553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
Pleural sepsis stems from an infection within the pleural space typically from an underlying bacterial pneumonia leading to development of a parapneumonic effusion. This effusion is traditionally divided into uncomplicated, complicated, and empyema. Poor clinical outcomes and increased mortality can be associated with the development of parapneumonic effusions, reinforcing the importance of early recognition and diagnosis. Management necessitates a multimodal therapeutic strategy consisting of antimicrobials, catheter/tube thoracostomy, and at times, video-assisted thoracoscopic surgery.
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13
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Larose F, Quigley N, Lacasse Y, Martel S, Lang-Lazdunski L. Malignant pleural mesothelioma: Comparison of surgery-based trimodality therapy to medical therapy at two tertiary academic institutions. Lung Cancer 2021; 156:151-156. [PMID: 33962765 DOI: 10.1016/j.lungcan.2021.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Medical management based on palliative chemotherapy is currently the standard of care in malignant pleural mesothelioma (MPM). Median survival of 12-16 months has been reported with modern chemotherapy regimens with or without anti-angiogenic agents. Multimodality therapy incorporating cytoreductive surgery, systemic chemotherapy and radiotherapy has been offered for years to fit patients with early-stage disease, but its role remains debated. Our objective was to compare overall survival in patients offered multimodality therapy in a specialized clinic setting in London, UK to that of patients offered exclusively medical treatment at another academic institution in Quebec, Canada. MATERIALS AND METHODS We retrospectively compared the survival rates of 2 separate cohorts of patients treated consecutively: Cohort 1 (n = 106) received multimodality therapy including systemic chemotherapy, extended pleurectomy/decortication (P/D) and prophylactic radiotherapy in London (United Kingdom) between 2009 and 2016, while Cohort 2 (n = 98) received medical treatment at the Quebec Heart and Lung Institute (Canada) during the same period. RESULTS In Cohort 1, all patients but two completed trimodality therapy. In cohort 2, 51 % received palliative care only and 40 % received systemic chemotherapy. Median survival was 32 months vs 10 months in Cohort 1 and Cohort 2, respectively (hazard ratio with age, gender, pathology and TNM staging as covariates: 3.81; 95 % CI: 2.67-5.45; p < 0.0001). Similar results were obtained in sensitivity analyses, after excluding those who received best supportive care only and in a propensity score-matched analysis. CONCLUSION Aggressive therapy of MPM using cancer-directed surgery, systemic chemotherapy and prophylactic radiotherapy may provide a significant survival benefit in selected patients.
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Affiliation(s)
- Frédéric Larose
- Département multidisciplinaire de pneumologie et de chirurgie thoracique, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, Quebec, Canada.
| | - Nicholas Quigley
- Département multidisciplinaire de pneumologie et de chirurgie thoracique, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, Quebec, Canada.
| | - Yves Lacasse
- Département multidisciplinaire de pneumologie et de chirurgie thoracique, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, Quebec, Canada.
| | - Simon Martel
- Département multidisciplinaire de pneumologie et de chirurgie thoracique, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, Quebec, Canada.
| | - Loïc Lang-Lazdunski
- Département multidisciplinaire de pneumologie et de chirurgie thoracique, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, Quebec, Canada.
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14
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Reese SW, Cone E, Marchese M, Garcia B, Chou W, Ayub A, Kilbridge K, Weinhouse G, Trinh QD. Lessons from Pharmacovigilance: Pulmonary Immune-Related Adverse Events After Immune Checkpoint Inhibitor Therapy. Lung 2021; 199:199-211. [PMID: 33616727 DOI: 10.1007/s00408-021-00425-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/05/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To characterize pulmonary toxicities associated with the use of novel immune checkpoint inhibitors METHODS: Adverse event reports from immune checkpoint inhibitors targeting PD-1/L1 and CTLA-4 were captured from the W.H.O pharmacovigilance database (VigiBase) up until Dec. 31st 2019 and were analyzed to evaluate for measures of association between the use of immune checkpoint inhibitors and pulmonary toxicities. Disproportionality analysis using both frequentist and Bayesian approaches were used to detect signals between pulmonary immune-related adverse events and the use of these agents. RESULTS A total of 9202 adverse pulmonary immune checkpoint inhibitor-related events were captured up until 2019. Adverse pulmonary events were compromised of 1305 airway, 18 alveolar, 5491 interstitial, 898 pleural, 560 vascular and 939 non-specific pulmonary events. We found a common association between all immune checkpoint inhibitors studied and pneumonitis, interstitial lung disease, pulmonary embolism and respiratory failure. We also noted other associations between immune checkpoint inhibitors, however not as uniformly across agents. Most of these immune-related adverse drug reactions were noted to be severe and accounted for a significant source of mortality in the reported cases. CONCLUSION Immune checkpoint inhibitors are associated with a spectrum of inflammatory pulmonary toxicities. The breadth of pulmonary complications and prevalence may be underappreciated with the use of these agents.
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Affiliation(s)
- Stephen W Reese
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Harvard Medical School, Boston, MA, USA
| | - Eugene Cone
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Harvard Medical School, Boston, MA, USA
| | - Maya Marchese
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Harvard Medical School, Boston, MA, USA
| | - Brenda Garcia
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Wesley Chou
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Harvard Medical School, Boston, MA, USA
| | - Asha Ayub
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | | | - Gerald Weinhouse
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Pulmonology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Harvard Medical School, Boston, MA, USA. .,Division of Urological Surgery, Brigham and Women's Hospital, 45 Francis St., ASB II-3, Boston, MA, 02115, USA.
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15
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Koulelidis A, Anevlavis S, Nikitidis N, Pappas P, Ntolios P, Karkabounas A, Boti V, Steiropoulos P, Karpathiou G, Eleftheriadis S, Froudarakis ME. Local Anesthesia Thoracoscopy with versus without Midazolam: A Randomized Controlled Trial. Respiration 2020; 99:789-799. [PMID: 33207359 DOI: 10.1159/000509761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medical thoracoscopy is the gold standard for the diagnosis of pleural diseases. To date, no consensus exists regarding the choice of sedative and analgesic agents in patients undergoing local anesthetic thoracoscopy (LAT), and questions are raised as to whether sedatives may add to respiratory side effects. OBJECTIVE The aim of the study was to test the hypothesis that administration of midazolam associated with lidocaine versus lidocaine alone in patients with LAT adds to respiratory side effects. METHODS We randomly assigned 80 patients to a 1:1 study to 2 groups: local anesthesia by lidocaine (n = 40) versus lidocaine and midazolam (n = 40), with the primary end point being the mean lowest oxygen saturation. The secondary end points were cardiovascular parameters, complications, days of drainage, hospital stay, and patients' quality of life (QoL) as assessed by a visual analog scale (VAS). RESULTS The mean age of all patients was 66.6 ± 13.1 years. The study comprised 50 males (62.5%). No difference was observed in the demographics between the 2 groups. No significant difference was observed between the 2 groups in oxygen saturation (primary end point). A significant difference was observed in favor of the midazolam group regarding the QoL assessed by VAS. CONCLUSION Midazolam does not add to respiratory side effects when it is used with lidocaine for LAT, while patients' QoL is actually improved in this group. Therefore, in our department, we changed our startegy in favor of the association of lidocaine and midazolam.
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Affiliation(s)
- Andreas Koulelidis
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stavros Anevlavis
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Nikitidis
- Department of Anaesthesiology, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Periklis Pappas
- Pharmacology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Paschalis Ntolios
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Vasiliki Boti
- Chemistry, School of Sciences, University of Ioannina, Ioannina, Greece
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgia Karpathiou
- Department of Pathology, North Hospital, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France
| | - Savvas Eleftheriadis
- Department of Anaesthesiology, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marios E Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece,
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16
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Fjaellegaard K, Petersen JK, Stamp IM, Hoegholm A, Clementsen PF, Bodtger U. Pleural epithelioid hemangioendothelioma mimicking pleural empyema: A case report. Respir Med Case Rep 2020; 31:101194. [PMID: 32837903 PMCID: PMC7434324 DOI: 10.1016/j.rmcr.2020.101194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022] Open
Abstract
Malignant pleural effusion is an important and difficult differential diagnosis to pleural empyema. Epithelioid hemangioendothelioma is an uncommon vascular tumor, which typically occurs in liver, lung or bone. We present an extremely rare case of primary pleural epithelioid hemangioendothelioma mimicking pleural empyema. We conclude, that pleural epithelioid hemangioendothelioma should be kept in mind as a differential diagnosis in patients suspected of empyema.
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Affiliation(s)
- Katrine Fjaellegaard
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Koefod Petersen
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Inger Merete Stamp
- Department of Pathology, Zealand University Hospital Naestved, Naestved, Denmark
| | - Asbjorn Hoegholm
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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17
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Boerner T, Filippova OT, Chi AJ, Iasonos A, Zhou QC, Long Roche K, Zivanovic O, Park BJ, Huang J, Jones DR, Abu-Rustum NR, Gardner G, Sonoda Y, Chi DS. Video-assisted thoracic surgery in the primary management of advanced ovarian carcinoma with moderate to large pleural effusions: A Memorial Sloan Kettering Cancer Center Team Ovary Study. Gynecol Oncol 2020; 159:66-71. [PMID: 32792282 DOI: 10.1016/j.ygyno.2020.07.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We assessed the utility of video-assisted thoracic surgery (VATS) in defining extent of intrathoracic disease in advanced ovarian carcinoma with moderate-to-large pleural effusions. METHODS Beginning in 2001, VATS was performed on all patients with suspected advanced ovarian carcinoma and moderate-to-large pleural effusions, evaluating for macroscopic intrathoracic disease. The algorithm recommended primary debulking surgery (PDS) for ≤1 cm, neoadjuvant chemotherapy (NACT)/interval debulking surgery (IDS) for >1 cm intrathoracic disease. We reviewed records of patients undergoing VATS from 10/01-01/19. Differences between treatment groups were tested using standard statistical techniques. RESULTS One-hundred patients met eligibility criteria (median age, 60; median CA-125 level, 1158 U/mL; medium serum albumin, 3.8 g/dL). Macroscopic pleural disease was found in 70 (70%). After VATS, 50 (50%) underwent attempted PDS (PDS group), 50 (50%) received NACT (NACT/IDS group). Forty-seven (94%) underwent IDS. Median overall survival (OS) for the entire cohort (n = 100) was 44.5 months (95% CI: 37.8-51.7). The PDS group had significantly longer survival than the NACT/IDS group [45.8 (95% CI: 40.5-87.8) vs. 37.4 months (95% CI: 33.3-45.2); p = .016]. On multivariable analysis, macroscopic intrathoracic disease (HR 2.18, 95% CI: 1.14-4.18; p = .019) and age ≥ 65 (HR 1.98, 95% CI: 1.16-3.40; p = .013) were independently associated with elevated death risk. Patients with the best outcome had no macroscopic disease at VATS and underwent PDS (median OS, 87.8 months). CONCLUSIONS VATS is useful in therapeutic decision-making for PDS vs. NACT/IDS in advanced ovarian cancer with moderate-to-large pleural effusions.
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Affiliation(s)
- Thomas Boerner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Olga T Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrew J Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin C Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Bernard J Park
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - James Huang
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Ginger Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA.
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18
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Jiang C, Xie M, Cervellione K, Thurm C. Clinical efficacy and bleeding outcomes of tissue plasminogen activator and dornase alfa in pleural space infection with once daily concurrent administration: a retrospective cohort study. BMC Res Notes 2020; 13:368. [PMID: 32746902 PMCID: PMC7398294 DOI: 10.1186/s13104-020-05210-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/28/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The use of intrapleural tissue plasminogen activator (tPA) and dornase alfa (DNase) is common in the management of pleural space infection. We review our experience with the efficacy and safety of this therapy. We performed a single center, retrospective study of consecutive patients with complicated parapneumonic effusion or empyema who received tPA/DNase therapy. Treatment success was defined as radiographic and clinical improvement in pleural space infection that precluded the need for surgical intervention, and the absence of mortality related to pleural infection. Results Fifty-six patients received concurrent once daily tPA/DNase therapy (median 3 days) from July 2014 to July 2019. Fifty-two patients (92.9%) had treatment success. Median duration of chest tube therapy was 10 days and length of stay was 15 days. Significant pleural bleeding requiring transfusion therapy occurred in five patients (8.9%). Of these, three patients (5.4%) required operative intervention. Concurrent once daily administration of tPA/DNase in patients with pleural infection yielded comparable rates of treatment success as compared to twice daily concurrent or sequential administration. However, adverse events highlight potential safety concerns with using once daily concurrent administration of tPA/DNAse.
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Affiliation(s)
- Chuan Jiang
- Department of Medicine-Division of Pulmonary Medicine, Jamaica Hospital Medical Center, Jamaica, NY, 11418, USA.
| | - Meng Xie
- Department of Clinical Research, Jamaica Hospital Medical Center, Jamaica, NY, 11418, USA
| | - Kelly Cervellione
- Department of Clinical Research, Jamaica Hospital Medical Center, Jamaica, NY, 11418, USA
| | - Craig Thurm
- Department of Medicine-Division of Pulmonary Medicine, Jamaica Hospital Medical Center, Jamaica, NY, 11418, USA
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Abstract
BACKGROUND Pleural disease incidence is increasing and there has been a move towards outpatient management. Pleural clinics have been developed for patients to be assessed and have pleural procedures for diagnostic and symptomatic purposes. AIM The study aimed to assess the impact of nurse practitioner (NP) involvement in a pleural procedures clinic on clinic capacity, and staff and patient experience. METHODS A mixed-methods service evaluation was completed in a medium-sized general hospital. The number of patients seen in clinic over a 6-month period at the beginning of NP involvement was compared with the number of patients seen 1 year later. Semi-structured interviews of key staff stakeholders were conducted. FINDINGS Clinic capacity increased from 4.57 to 5.86 patients per list. NP involvement increased access, improved patient care, reduced work burden for other staff and improved educational opportunities. CONCLUSION The impact of NP involvement in the pleural clinic was seen as positive and increased clinic capacity. The same model of practice could be considered elsewhere.
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Affiliation(s)
- Eleanor Peter
- Medical Nurse Practitioner, Royal United Hospitals Foundation Trust, Bath
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20
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Shiroshita A, Matsui H, Yoshida K, Shiraishi A, Tanaka Y, Nakashima K, Aoshima M. Safety of the anterior approach versus the lateral approach for chest tube insertion by residents treating spontaneous pneumothorax: a propensity score weighted analysis. Gen Thorac Cardiovasc Surg 2020; 68:1425-1431. [PMID: 32519192 DOI: 10.1007/s11748-020-01403-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the risk of chest tube malposition, the most common complication during chest tube insertion, with the anterior or lateral approach for thoracostomy performed for patients with spontaneous pneumothorax by junior and senior residents. METHODS We retrospectively included patients aged ≥ 20 years who exhibited primary or secondary spontaneous pneumothorax without pleural adhesion and underwent chest tube drainage performed by junior or senior residents at tertiary care hospital. The study exposure involved insertion of the chest tube in the midclavicular line (anterior approach) or the anterior or midaxillary line (lateral approach). The primary outcome was the number of chest tube malpositions. Multiple imputation was used for missing data. The inverse probability of treatment weighting method was used to adjust for baseline confounders. RESULTS We identified 34 and 219 patients who underwent thoracostomy using the midclavicular and lateral approaches, respectively. The number of chest tube malpositions was 4 (11.8%) in the anterior approach and 34 (15.5%) in the lateral approach. The inverse probability of treatment weighting analysis revealed that the estimated odds ratio for chest tube malposition in the anterior approach group versus the lateral approach group was 0.61 (95% confidence interval, 0.17-2.11). The duration of chest tube drainage and the number of operations for persistent air leaks were not significantly different between the groups. CONCLUSIONS The current study revealed that the risk of chest tube malposition in thoracostomies with the midclavicular approach was not different from that with the lateral approach.
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Affiliation(s)
- Akihiro Shiroshita
- Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Hiroki Matsui
- Clinical Research Support Division, Kameda Institute for Health Science, Kameda College of Health Science, Kamogawa, Japan
| | - Kazuki Yoshida
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Atsushi Shiraishi
- Department of Emergency Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Yu Tanaka
- Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Kei Nakashima
- Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Masahiro Aoshima
- Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
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21
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Hassan M, Gadallah M, Mercer RM, Harriss E, Rahman NM. Predictors of outcome of pleurodesis in patients with malignant pleural effusion: a systematic review and meta-analysis. Expert Rev Respir Med 2020; 14:645-654. [PMID: 32213100 DOI: 10.1080/17476348.2020.1746647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: Pleurodesis is an important management option to palliate breathlessness in patients with malignant pleural effusion (MPE). This systematic review aimed to examine available literature for studies investigating factors that predict pleurodesis outcome.Methods: The healthcare databases advanced search (HDAS) Medline and Embase in addition to Cochrane Database of Systematic Reviews were searched on for publications reporting on pleurodesis for MPE in English language. All study types reporting previously unpublished data on predictors of pleurodesis success were included. Thirty-four studies involving 4626 patients were included in the systematic review.Results: The most common pleurodesis agent used was talc which was used in 27 studies. Meta-analyses demonstrated that the strongest predictors of pleurodesis success were higher pleural fluid pH, smaller volume of effusion pre-pleurodesis and full lung re-expansion post effusion drainage. Shorter duration of tube drainage, higher pleural fluid glucose, lower LDH, and lower pleural tumor burden all seem to favor pleurodesis success, but with considerable statistical heterogeneity between studies. Available data do not suggest that chest tube size affects pleurodesis outcome.Conclusion: Overall, available results are difficult to interpret due to evidence quality. Prospective studies are needed to further explore these factors.Protocol registration: CRD42018115874 (Prospero database of systematic reviews).
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Affiliation(s)
- Maged Hassan
- Chest Diseases Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Mohamed Gadallah
- Chest Diseases Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Rachel M Mercer
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Elinor Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
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22
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Okamoto S, Tsuboi H, Sato R, Terasaki M, Terasaki T, Toko H, Shimizu M, Honda F, Yagishita M, Ohyama A, Kurata I, Abe S, Takahashi H, Osada A, Hagiwara S, Kondo Y, Matsumoto I, Sumida T. IgG4-related pleural disease with aortitis and submandibular glands involvement successfully treated with corticosteroid: case-based review. Rheumatol Int 2020; 40:1725-1732. [PMID: 32206878 DOI: 10.1007/s00296-020-04555-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/13/2020] [Indexed: 12/25/2022]
Abstract
IgG4-related disease (IgG4-RD) is a fibro-inflammatory condition characterized by increased serum IgG4 level, infiltration of lymphocytes and IgG4-positive (IgG4+) plasma cells and fibrosis. It can occur in almost all organs, commonly affecting the pancreas, biliary tract, salivary and lacrimal glands and kidneys. However, reports of IgG4-RD accompanied by pathologically confirmed, IgG4-related pleural disease are scarce. Here, we present a case of a 64-year-old man with suspected malignant pleural mesothelioma based on imaging findings but finally diagnosed with IgG4-RD (including pleuritis, periaortitis and bilateral submandibular gland enlargement) based on a high serum IgG4 level and pleural histopathological findings such as lymphoplasmacytic infiltration including IgG4+ plasma cells and fibrosis. Systemic corticosteroid therapy was effective at reducing serum IgG4, improving bilateral submandibular gland enlargement, and regressing pleural thickening and periaortic soft tissue. We also discuss clinical characteristics and pleural pathological features of previously reported cases with IgG4-related pleural disease based on a comprehensive literature review. Our case of IgG4-RD with pleura, aorta and submandibular gland involvement, pathologically confirmed by pleural specimen might be unique and very rare.
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Affiliation(s)
- Shota Okamoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Ryota Sato
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Mayu Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toshihiko Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hirofumi Toko
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masaru Shimizu
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumika Honda
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Mizuki Yagishita
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Ayako Ohyama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Izumi Kurata
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Saori Abe
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroyuki Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Atsumu Osada
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinya Hagiwara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
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Abstract
Exposure to Libby Asbestiform Amphibole (LAA) is associated with asbestos-related diseases, including mesothelioma, pulmonary carcinoma, pleural fibrosis, and systemic autoimmune diseases. The pleural fibrosis can manifest as a rapidly progressing lamellar pleural thickening (LPT), which causes thoracic pain, dyspnea, and worsening pulmonary function tests (PFT). It is refractory to treatment and frequently fatal.Objective: Because of the immune dysfunction that has been described in the LAA-exposed population and the association of pleural manifestations with the presence of autoantibodies, this study tested whether specific immunological factors were associated with progressive LPT and whether they could be used as markers of progressive disease.Methods: Subjects were placed into three study groups defined as (1) progressive LPT, (2) stable LPT, (3) no LPT. Serum samples were tested for antinuclear autoantibodies, mesothelial cell autoantibodies, anti-plasminogen antibodies, IL1 beta, and IL17; which have all been shown to be elevated in mice and/or humans exposed to LAA.Results: Group 1 had significantly higher mean values for all of the autoantibodies, but not IL1 or IL-17, compared to the control Group 3. All three autoantibody tests had high specificity but low sensitivity, but ROC area-under-the-curve values for all three antibodies were over 0.7, statistically higher than a test with no value. When all LPT subjects were combined (Progressive plus Stable), no marker had predictive value for disease.Conclusion: The data support the hypothesis that progressive LPT is associated with immunological findings that may serve as an initial screen for progressive LPT.
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Affiliation(s)
- Jean C Pfau
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT, USA
| | - Tracy McNew
- Center for Asbestos Related Diseases, Libby, MT, USA
| | | | - Lindsay Swan
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT, USA
| | - Brad Black
- Center for Asbestos Related Diseases, Libby, MT, USA
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24
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Hakozaki T, Okuma Y, Hosomi Y, Hishima T. Radiographic Assessment of Objective Responses Using the ITMIG-Modified Criteria in Thymic Carcinoma. Oncology 2019; 97:264-269. [PMID: 31307031 DOI: 10.1159/000501104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pleural metastases are common among patients with thymic carcinoma. Accurate and consistent measurement of pleural lesions is often difficult because of their unique locations and growth patterns. To minimize intraobserver variability, the International Thymic Malignancies Interest Group (ITMIG) proposed modified criteria for measurement of tumor response for thymic epithelial tumors. METHODS We conducted a retrospective review of the medical records of advanced or recurrent thymic carcinoma patients treated with chemotherapy between 1980 and 2016 in our institution. The best objective responses were assessed using the Response Evaluation Criteria in Solid Tumor version 1.1 (RECIST 1.1) and the ITMIG-modified criteria. RESULTS A total of 26 patients were included in the present study. According to the RECIST criteria, 1 (3.8%) patient showed complete response (CR), and 13 (50.0%), 10 (38.5%), and 2 (7.7%) showed partial response (PR), stable disease (SD), and progressive disease (PD), respectively. All 26 patients had the same best overall response using the ITMIG criteria. The median time to progression (TTP) according to the RECIST criteria and the ITMIG-modified criteria was 5.5 months (95% confidence interval [CI] 3.8-8.6) and 7.0 months (95% CI 3.8-9.3), respectively (p = 0.993). CONCLUSION The ITMIG-modified criteria showed a high concordance rate with RECIST 1.1 criteria in response assessment of thymic carcinoma.
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Affiliation(s)
- Taiki Hakozaki
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan, .,Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan,
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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25
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Enríquez Rodríguez AI, García Clemente M, Ruiz Álvarez I, Hermida Valverde T, Herrero Huertas J, Arias Guillén M, Madrid Carbajal J, García Alfonso L, Ortiz Reyes AM, Moreda Bernardo A, Pérez Martínez L, Casan Clara P, López González FJ. Clinical Impact of a Pleural Unit in a Tertiary Level Hospital. Arch Bronconeumol 2019; 56:143-148. [PMID: 31253375 DOI: 10.1016/j.arbres.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Pleural disease involves a large number of admissions and long hospital stays. In order to improve this situation, a Pleural Unit (PU) was created in our hospital. Our aim was to analyze the clinical impact of this unit. MATERIAL AND METHODS In this prospective study, we included patients admitted to the PU of the Hospital Universitario Central de Asturias for primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP), complicated parapneumonic pleural effusion (CPPE), and malignant pleural effusion (MPE) between January 2015 and December 2018. We analyzed descriptive parameters, mean length of stay, readmissions at 1 month, need for surgery, and in the CPPE group, in-hospital mortality. The data were compared with those of patients admitted to the respiratory medicine department for the same diseases during the previous two years (2013-2014). We also describe all procedures performed in the PU, in both inpatients and outpatients. RESULTS A total of 741 patients were included, We observed a progressive decrease in total admissions for pleural diseases and mean length of stay (days) (with the exception of MPE), as follows: PSP: from 6.2 to 4.2 (P=.004); SSP: 13.2 to 8.6 (P=.005), MPE: 10.3 to 12.3 (P=.05); and CPPE: 18.3 to 11.3 (P=.001) There was a reduction in hospital readmissions at 1 month and in in-hospital mortality due to CPPE in the PU period (14.9% to 5.5%) (P=.021). CONCLUSIONS The creation of a PU could decrease the number of unnecessary admissions, and reduce mean lengths of stay and, in the case of CPPE, in-hospital mortality.
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Affiliation(s)
| | | | - Inés Ruiz Álvarez
- Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | | | - Miguel Arias Guillén
- Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | | | | | | | | | - Pére Casan Clara
- Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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26
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Herman DD, Thomson CC, Brosnhan S, Patel R, Trosini-Desert V, Bilaceroglu S, Poston JT, Liberman M, Shah PL, Ost DE, Chatterjee R, Michaud GC. Risk of bleeding in patients undergoing pulmonary procedures on antiplatelet or anticoagulants: A systematic review. Respir Med 2019; 153:76-84. [PMID: 31176274 DOI: 10.1016/j.rmed.2019.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/28/2019] [Indexed: 01/22/2023]
Abstract
As many as 25% of all patients undergoing invasive pulmonary procedures are receiving at least one antiplatelet or anticoagulant agent. For those undergoing elective procedures, the decision-making process is uncomplicated and the procedure may be postponed until the antiplatelet or anticoagulant agent may be safely held. However, many invasive pulmonary procedures are semi-elective or emergent in nature in which case a risk-benefit calculation and discussion occur between the provider and patient or surrogate decision-maker. Therefore, it is critical for providers to have an awareness of the risk of bleeding complications with different pulmonary procedures on various antiplatelet and anticoagulant agents. This systematic review summarizes the bleeding complications associated with different pulmonary procedures in patients on various antiplatelet or anticoagulant agents in the literature and reveals a paucity of high-quality evidence across a wide spectrum of pulmonary procedures and antiplatelet or anticoagulant agents. The results of this review can help inform providers of the bleeding risk in these patients to aid in the shared decision-making process and risk vs benefit discussion.
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Affiliation(s)
- D D Herman
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ohio State University, 201L Dorothy M. Davis Heart & Lung Research Institute, 473W. 12th Avenue, Columbus, OH, 43210, USA.
| | - C C Thomson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Auburn Hospital, 300 Mt Auburn St #419, Cambridge, MA, 02138, USA
| | - S Brosnhan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, NYU Lagone Health, 550 1st, Avenue New York, New York, 10016, USA
| | - R Patel
- Departments of Critical Care Medicine and Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, USA
| | - V Trosini-Desert
- Service de Pneumologie et Réanimation, Unité d'Endoscopie Bronchique, Groupe Hospitalier Pitié Salpétrière, 7 Avenue de la République, 94200, Ivry-sur-Seine, France
| | - S Bilaceroglu
- Department of Pulmonary Medicine, Izmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Health Sciences University, 35110, Yenisehir, Izmir, Turkey
| | - J T Poston
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - M Liberman
- Division of Thoracic Surgery, CHUM Endoscospic Tracheobronchial and Oesophageal Center, Department of Surgery, University of Montreal, 1560 rue Sherbrooke Est 8e CD - Pavillon Lachapelle, Bureau D, 8051, Montréal, Québec, H2L 4M1, Canada
| | - P L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom National Heart & Lung Institute, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - D E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 853, Houston, TX, 77030,, USA
| | - R Chatterjee
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, Texas, 78234, USA
| | - G C Michaud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, NYU Lagone Health, 530 1st Avenue, HCC, Suite 5D, New York, NY, 10016, USA
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27
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Abstract
Interventional pulmonology (IP) has evolved in recent decades, and recent advances have greatly expanded the services offered by IP physicians. IP is best defined as the use of advanced techniques for the evaluation and treatment of benign and malignant pulmonary disorders. The field has further advanced with the recent establishment of a board certification via the American Association of Bronchology and Interventional Pulmonology and the release in 2017 of accreditation standards for specialized fellowship training. This article provides a broad overview of the field to serve as a resource for primary care physicians.
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Affiliation(s)
- Christopher M Kniese
- Interventional Pulmonology, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado-Denver, University of Colorado Anschutz, 12700 East 19th Avenue, Research Complex 2, C272, Aurora, CO 80045, USA.
| | - Ali I Musani
- Interventional Pulmonology, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado-Denver, University of Colorado Anschutz, 12700 East 19th Avenue, Research Complex 2, C272, Aurora, CO 80045, USA
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28
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Asciak R, Hassan M, Mercer RM, Hallifax RJ, Wrightson JM, Psallidas I, Rahman NM. Prospective Analysis of the Predictive Value of Sonographic Pleural Fluid Echogenicity for the Diagnosis of Exudative Effusion. Respiration 2019; 97:451-456. [PMID: 30889605 DOI: 10.1159/000496153] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/10/2018] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Pleural effusion echogenicity on ultrasound has previously been suggested to allow identification of exudates. A case series suggested that homogenously echogenic effusions are always exudates. With modern imaging techniques and more advanced ultrasound technology, this may no longer be true. OBJECTIVES This study aims to prospectively assess the predictive value of echogenicity in the identification of exudates. METHOD Patients undergoing thoracic ultrasound before pleural fluid sampling were analysed prospectively (n = 140). Pleural fluid was classified as an exudate if both fluid total protein (TP) > 29 g/L and fluid lactate dehydrogenase (LDH) > 2/3 upper limit of normal serum LDH (which is 255 IU/L in females and 235 IU/L in males) were present. If only one of these criteria was met, the effusion was considered to have discordant biochemistry. RESULTS Fifty-five (39%) patients had non-echogenic and 85 (61%) had echogenic effusions. Six (7.1%) patients with echogenic effusions had transudates; the median fluid TP for this group was 18.5 g/L (IQR 9.75) and median LDH 63.0 IU/L (IQR 40.3). The specificity of echogenicity identifying exudates from transudates, excluding patients with discordant biochemistry, was 57.1%, positive predictive value (PPV) 90.3%, sensitivity 65.1%, and negative predictive value (NPV) 21.0%. The specificity of echogenicity identifying exudates (including discordant biochemistry) from transudates was 57.1%, PPV 92.9%, sensitivity 62.7%, and NPV 14.5%. CONCLUSIONS Echogenicity of a pleural effusion has a low specificity for identifying an underlying exudate, and the echogenic qualities of the fluid should not influence clinical decision-making.
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Affiliation(s)
- Rachelle Asciak
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom,
| | - Maged Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Rachel M Mercer
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Robert J Hallifax
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - John M Wrightson
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ioannis Psallidas
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Najib M Rahman
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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29
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Ganaie MB, Maqsood U, Lea S, Bankart MJ, Bikmalla S, Afridi MA, Khalil MA, Hussain I, Haris M. How should complete lung collapse secondary to primary spontaneous pneumothorax be managed? . Clin Med (Lond) 2019; 19:163-168. [PMID: 30872304 PMCID: PMC6454361 DOI: 10.7861/clinmedicine.19-2-163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Management of primary spontaneous pneumothorax (PSP) depends on the symptoms and size of lung collapse. The British Thoracic Society recommends needle aspiration (NA) for all PSP requiring intervention, followed by intercostal drain (ICD) if NA fails. We compared the role of NA versus ICD as the first step in PSP with 'complete lung collapse'.This was a retrospective observational study of 877 consecutive pneumothorax episodes at University Hospitals of North Midlands, Stoke on Trent, UK. Chest X-ray (CXR) at presentation was reviewed to identify PSP with complete lung collapse. The primary outcome measure was successful lung re-inflation after initial intervention.Two-hundred and sixty-six PSP patients were identified; 69 had complete lung collapse on CXR of which 35 had NA and 34 had ICD. The ICD group had a significantly better immediate success compared with the NA group (62% versus 11%, odds ratio (OR) = 12.5, p<0.0001; after adjustment for potential confounders, OR increased to 26.4, p=0.0001) although long-term outcomes were comparable.There should be clear consensus on definition and management of complete lung collapse. PSP with complete lung collapse could be managed as a separate subgroup where ICD placement is considered to be the first intervention.
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Affiliation(s)
| | - Usman Maqsood
- Sandwell and West Birmingham Hospitals, West Bromwich, UK
| | - Simon Lea
- Royal Stoke University Hospital, Stoke-on-Trent, UK
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30
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McComb BL, Ravenel JG, Steiner RM, Chung JH, Ackman JB, Carter B, Colletti PM, Crabtree TD, de Groot PM, Iannettoni MD, Jokerst C, Maldonado F, Kanne JP; Expert Panel on Thoracic Imaging:. ACR Appropriateness Criteria ® Chronic Dyspnea-Noncardiovascular Origin. J Am Coll Radiol 2018; 15:S291-301. [PMID: 30392598 DOI: 10.1016/j.jacr.2018.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Chronic dyspnea may result from a variety of disorders of cardiovascular, pulmonary, gastrointestinal, neuromuscular, systemic, and psychogenic etiology. This article discusses guidelines for the initial imaging of six variants for chronic dyspnea of noncardiovascular origin: (1) Chronic dyspnea of unclear etiology; (2) Chronic dyspnea with suspected chronic obstructive pulmonary disease; (3) Chronic dyspnea with suspected central airways disease; (4) Chronic dyspnea with suspected interstitial lung disease; (5) Chronic dyspnea with suspected disease of the pleura or chest wall; and (6) Chronic dyspnea with suspected diaphragm dysfunction. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Meyer CN, Armbruster K, Kemp M, Thomsen TR, Dessau RB. Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors. BMC Pulm Med 2018; 18:160. [PMID: 30314475 PMCID: PMC6186131 DOI: 10.1186/s12890-018-0726-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 09/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We explored the hypothesized importance of early knowledge of microbiological etiology in patients with pleural infection, including comorbidity and treatment factors in the outcome analyses. METHODS Data from the medical records of a large cohort of 437 consecutive patients in 9 hospitals in East-Denmark were included retrospectively. RESULTS Microbiology, co-morbidity, therapy and outcome are described in detail. Patient groups with microbiology negative and known bacterial etiology had a similar 30-day and 90-day mortality. There were no differences in initial antibiotic treatment regimens, antibiotic treatment duration, rate of intra-pleural fibrinolysis treatment, surgical referral rate, and ICU admittance rate. Patients with microbiology negative etiology were younger (60.8 vs 64.3 years) and fewer had predisposing risk factors (59% vs 71%), but pleural drainage was more often delayed (49% vs 36%). Mortality was similar in patients treated with either of the two nationally recommended initial antibiotic regimens. However, higher 90-day mortality (22.5% vs 9.7%), disease severity (31.5% vs 6.2%), and ICU admittance rate (21.3% vs 2.9%) was observed in a sub-group with initial broad-spectrum treatment compared to patients receiving the nationally recommended initial treatments, irrespective of knowledge of etiology. Several factors correlated independently to 90-day mortality, including age, predisposing risk factors, surgical referral (Odds-Ratios > 1), drainage delay and intra-pleural fibrinolysis (ORs < 1). CONCLUSIONS No difference was found between patients with microbiology negative and known bacterial etiology regarding outcome or treatment parameters. Treatment factors and predisposing factors independently relating to mortality were found in the cohort. Broad-spectrum antibiotics were initially used for treatment of patients with more severe illness and poorer outcome.
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Affiliation(s)
- Christian Niels Meyer
- Department of Internal Medicine, Zealand University Hospital Roskilde, Sygehusvej 10, 4000, Roskilde, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Karin Armbruster
- Department of Respiratory Medicine, Copenhagen University Hospital Gentofte, Gentofte, Denmark
| | - Michael Kemp
- Department of Clinical Microbiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Trine Rolighed Thomsen
- Danish Technological Institute, Life Science, Århus and Section of Biotechnology, Aalborg University, Aalborg, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
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Asciak R, Hallifax RJ, Mercer RM, Hassan M, Wigston C, Wrightson JM, Psallidas I, Rahman NM. The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions. Respiration 2018; 97:70-77. [PMID: 30227409 DOI: 10.1159/000491934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indwelling pleural catheters (IPC) offer an alternative to talc pleurodesis in recurrent effusion, especially in patients wishing to avoid hospitalization. Two randomized trials have demonstrated reduced time in hospital using IPCs versus talc pleurodesis in malignant pleural effusion (MPE). However, the impact of IPCs on hospital services and patients has not been well studied. OBJECTIVES To analyze long-term outcomes of IPCs and understand the hospital burden in terms of requirement for hospital visits and contacts with healthcare, while the IPC was in situ. METHODS IPC insertions in a tertiary pleural center were analyzed retrospectively. Reviews of patients with IPCs in situ considered "additional" to routine clinical follow-up were defined pre-hoc. RESULTS A total of 202 cases were analyzed: 89.6% MPE group (n = 181) and 10.4% non-MPE group (n = 21). There were a median 3.0 (interquartile range [IQR] 3) and 2.0 (IQR 2) ipsilateral pleural procedures prior to each IPC insertion in non-MPE and MPE groups, respectively (p = 0.26), and a mean 1.3 (SD 1.7) planned IPC-related outpatient follow-up visits per patient. There were 2 (9.5%) and 14 (7.7%) IPC-related infections in non-MPE and MPE groups, respectively. Four (19.0%) and 44 (24.3%) patients required additional IPC-related reviews in non-MPE and MPE groups, respectively (p = 0.6), and these occurred within 250 days post IPC insertion. CONCLUSIONS Although IPCs decrease initial length of hospital stay compared to talc pleurodesis via chest drain, IPCs are associated with significant hospital-visit burden, in addition to planned visits and regular home IPC drainages. IPC-using services need to be prepared for this additional work to run an IPC service effectively.
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How CH, Lin CW, Lin YC, Young TH, Chen KC, Chen JS. Evaluation of pleurodesis by poly-ε-caprolactone (PCL) gel in an animal model using New Zealand white rabbits. Asian J Surg 2018; 42:495-500. [PMID: 30104088 DOI: 10.1016/j.asjsur.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/PURPOSE Pleurodesis with biomaterial implant is an emerging treatment method for pleural diseases. However, the ideal biomaterial or the optimal form for the common diseases is still under investigation. In our previous study, Poly-ε-caprolactone (PCL) membrane produces significant pleurodesis in New Zealand White rabbit animal models. METHODS We investigate the Poly-ε-caprolactone (PCL) gel pleurodesis by animal models using New Zealand White rabbits, which were sacrificed for examination after one month. Thirty-Six New Zealand White rabbits were randomized into three groups equally to undergo procedures. Gross pleurodesis scoring was evaluated. Additionally, inflammation and fibrosis scoring were done under microscopic evaluation, as well as Western blot analysis. RESULTS Gross evaluation of pleurodesis score revealed that lower concentrated PCL gel (10%) produced moderate pleural adhesion, while higher concentrated PCL gel (25%) showed significantly higher pleurodesis scores. (P < 0.05) Control group with thoracostomy alone produced almost no pleurodesis (P < 0.05). Western blot showed fibronectin expression was more evident in the 25% PCL gel than 10% one. CONCLUSION PCL gel induced significant degree of pleurodesis in the rabbits. The 25% PCL gel produces more intensive adhesion than 10% one. Fibronectin plays an important role in the process of pleurodesis. Further study is required for the clinical application of the promising biomaterial with gel form.
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Affiliation(s)
- Cheng-Hung How
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, 100, Taiwan
| | - Chi-Wei Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Yong-Chong Lin
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, 100, Taiwan
| | - Tai-Horng Young
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, 100, Taiwan.
| | - Ke-Cheng Chen
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, 100, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan.
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
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Moser B, Fadel E, Fabre D, Keshavjee S, de Perrot M, Thomas P, Brioude G, Van Raemdonck D, Viskens S, Lang-Lazdunski L, Bille A, Weder W, Jungraithmayr W, Ruffini E, Guerrera F, Gómez de Antonio D, Liberman M, Novoa N, Scarci M, Janik S, Klepetko W. Surgical therapy of thymic tumours with pleural involvement: an ESTS Thymic Working Group Project. Eur J Cardiothorac Surg 2018; 52:346-355. [PMID: 28449028 PMCID: PMC5848821 DOI: 10.1093/ejcts/ezx090] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/26/2017] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES: Surgery for thymic epithelial tumours (TETs) with pleural involvement is infrequently performed. Thus, the value of surgical therapy for primary or recurrent TETs with pleural involvement is not sufficiently defined yet. METHODS: Twelve institutions contributed retrospective data on 152 patients undergoing surgery (1977–2014) on behalf of the ESTS Thymic Working group. Outcome measures included overall (OS), cause-specific (CSS) and disease-free (DFS) survival as well as freedom from recurrence (FFR). RESULTS: In 70.4% of cases, pleural involvement was present at the time of primary intervention, whereas 29.6% had surgery for recurrent disease involving the pleura. Pleural involvement resulted from thymomas (88.8%) and thymic carcinomas (11.2%). Forty extrapleural pneumonectomies (EPPs), 23 total pleurectomies (TPs), and 88 local pleurectomies (LPs) were performed (completeness of resection in 76.8%). OS for the entire patient population at 1, 3, 5 and 10 years was 96.4%, 91.0%, 87.2% and 62.7%, respectively. There was no statistically significant difference regarding FFR and OS for patients with local or advanced disease undergoing EPP, TP or LP. Thymic carcinomas in comparison with thymomas had a negative impact on OS [hazard ratio 6.506, P = 0.002], CSS and FFR. Incomplete resections predicted worse OS [hazard ratio 6.696, P = 0.003]. CONCLUSIONS: Complete resection remains the mainstay of treatment for TETs with pleural involvement. Study populations treated with EPP, TP and LP had similar survival that may be factual as observed, but in the presence of selection bias, we can further conclude from the results that EPP, TP and LP are equally effective procedures. Procedural choice depends upon the extent of tumour distribution. EPPs, TPs and LPs performed within a multimodality setting seem to be efficient procedures for local control of disease, as they yield excellent results regarding OS, DFS, CSS and FFR.
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Affiliation(s)
- Bernhard Moser
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris Sud University, Paris, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris Sud University, Paris, France
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Pascal Thomas
- Department of Thoracic Surgery, Aix-Marseille University, Marseille, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, Aix-Marseille University, Marseille, France
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sophie Viskens
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Loic Lang-Lazdunski
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | | | - Enrico Ruffini
- Department of Surgery, Section of Thoracic Surgery, University of Torino, Torino, Italy
| | - Francesco Guerrera
- Department of Surgery, Section of Thoracic Surgery, University of Torino, Torino, Italy
| | - David Gómez de Antonio
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montreal, QC, Canada
| | - Nuria Novoa
- Service of Thoracic Surgery, University Hospital, Salamanca, Spain
| | - Marco Scarci
- Department of Thoracic Surgery, University College London Hospital, London, UK
| | - Stefan Janik
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
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Pena E, Ojiaku M, Inacio JR, Gupta A, Macdonald DB, Shabana W, Seely JM, Rybicki FJ, Dennie C, Thornhill RE. Can CT and MR Shape and Textural Features Differentiate Benign Versus Malignant Pleural Lesions? Acad Radiol 2017; 24:1277-1287. [PMID: 28434856 DOI: 10.1016/j.acra.2017.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 01/13/2023]
Abstract
RATIONALE AND OBJECTIVES The study aimed to identify a radiomic approach based on CT and or magnetic resonance (MR) features (shape and texture) that may help differentiate benign versus malignant pleural lesions, and to assess if the radiomic model may improve confidence and accuracy of radiologists with different subspecialty backgrounds. MATERIALS AND METHODS Twenty-nine patients with pleural lesions studied on both contrast-enhanced CT and MR imaging were reviewed retrospectively. Three texture and three shape features were extracted. Combinations of features were used to generate logistic regression models using histopathology as outcome. Two thoracic and two abdominal radiologists evaluated their degree of confidence in malignancy. Diagnostic accuracy of radiologists was determined using contingency tables. Cohen's kappa coefficient was used to assess inter-reader agreement. Using optimal threshold criteria, sensitivity, specificity, and accuracy of each feature and combination of features were obtained and compared to the accuracy and confidence of radiologists. RESULTS The CT model that best discriminated malignant from benign lesions revealed an AUCCT = 0.92 ± 0.05 (P < 0.0001). The most discriminative MR model showed an AUCMR = 0.87 ± 0.09 (P < 0.0001). The CT model was compared to the diagnostic confidence of all radiologists and the model outperformed both abdominal radiologists (P < 0.002), whereas the top discriminative MR model outperformed one of the abdominal radiologists (P = 0.02). The most discriminative MR model was more accurate than one abdominal (P = 0.04) and one thoracic radiologist (P = 0.02). CONCLUSION Quantitative textural and shape analysis may help distinguish malignant from benign lesions. A radiomics-based approach may increase diagnostic confidence of abdominal radiologists on CT and MR and may potentially improve radiologists' accuracy in the assessment of pleural lesions characterized by MR.
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Affiliation(s)
- Elena Pena
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada.
| | - MacArinze Ojiaku
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Joao R Inacio
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ashish Gupta
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - D Blair Macdonald
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Wael Shabana
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean M Seely
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Frank J Rybicki
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Carole Dennie
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca E Thornhill
- Department of Medical Imaging, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y E49, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
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Vakil E, Sarkiss M, Ost D, Vial MR, Casal RF, Eapen GA, Grosu HB. Safety of Monitored Anesthesia Care Using Propofol-Based Sedation for Pleuroscopy. Respiration 2017; 95:1-7. [PMID: 28918427 DOI: 10.1159/000480153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/07/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The optimal approach to sedation for pleuroscopy remains undefined. Propofol is the favored sedative-hypnotic for many proceduralists but has a narrow therapeutic window and the risk for oversedation is high. Propofol-based sedation administered by anesthesiologists and the routine use of end-tidal capnography and bispectral index (BIS) monitoring may attenuate risks of complications. OBJECTIVES The purpose of our study was to evaluate the safety and efficacy of monitored anesthesia care for pleuroscopy. METHODS We conducted a retrospective cohort study of patients who underwent pleuroscopy. The primary outcome of interest was the incidence of anesthesia complications in patients undergoing pleuroscopy. Hypoxia was defined as oxygen saturation of less than 90% for 2 min and hypotension was defined as the need for vasopressors. RESULTS Of 199 enrolled patients, there were no significant complications attributed directly to anesthesia. Minor complications included hypoxia in 9 patients (4.5%), hypotension in 76 patients (38.2%), and insertion of a nasopharyngeal tube airway in 2 patients (1.0%). There was no significant difference in anesthesia-related complications between those with BIS monitoring and those without. Lower mean oxygen saturations (p = 0.028) and hypoxia (p = 0.021) were found in patients receiving the combination of propofol plus narcotics plus sedatives compared to those receiving propofol only, propofol plus narcotics or propofol plus sedatives. CONCLUSION Our study demonstrates that pleuroscopy using propofol with end-tidal capnography monitoring, with or without BIS monitoring, is safe and effective. The combination of propofol with narcotics and sedatives is associated with more hypoxia and lower mean oxygen saturation compared with propofol alone, propofol plus narcotics or propofol plus sedatives.
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Affiliation(s)
- Erik Vakil
- Department of Pulmonary Medicine, The University of Texas Health Science Center, Houston, TX, USA
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Kim DW, Na KJ, Yun JS, Song SY. Doege-potter syndrome: a report of a histologically benign but clinically malignant case. J Cardiothorac Surg 2017; 12:64. [PMID: 28784156 PMCID: PMC5547527 DOI: 10.1186/s13019-017-0630-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/02/2017] [Indexed: 11/28/2022] Open
Abstract
Background Solitary fibrous tumors of the pleura (SFTPs) are relatively rare tumors that originate from mesenchymal cells of submesothelial tissue of the pleura. Most patients with SFTPs are asymptomatic; however, pleuritic chest pain, cough, and dyspnea can develop. If hypoglycemia is associated with a solitary fibrous tumor, it is referred to as the Doege-Potter syndrome. Case presentation A 70-year-old man had visited our hospital with a chief complaint of dyspnea, and he was diagnosed as having a solitary fibrous tumor. A few years later, he developed hypoglycemia, and he underwent excision of the mass. Conclusion Occasionally, SFTPs induce several paraneoplastic events, such as hypertrophic osteoarthropathy. We described here a patient with an SFTP with Doege-Potter syndrome who was successfully treated with complete resection. Although lesions can be histologically benign, they can clinically present with malignant features.
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Affiliation(s)
- Do Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun, 519-763, Korea
| | - Kook Joo Na
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun, 519-763, Korea
| | - Ju Sik Yun
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun, 519-763, Korea
| | - Sang Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun, 519-763, Korea.
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Baek JH, Lee YU, Lee SS, Lee JH, Lee JC, Kim MS. Early Aggressive Surgical Treatment of Multiloculated Empyema. Korean J Thorac Cardiovasc Surg 2017; 50:202-206. [PMID: 28593157 PMCID: PMC5460968 DOI: 10.5090/kjtcs.2017.50.3.202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 11/21/2022]
Abstract
Background Empyema is the collection of purulent exudate within the pleural space. Overall, 36%–65% of patients with empyema cannot be treated by medical therapy alone and require surgery. Multiloculated empyema is particularly difficult to treat with percutaneous drainage. Therefore, we describe our experiences with early aggressive surgical treatment for rapid progressive multiloculated empyema. Methods From January 2001 to October 2015, we retrospectively reviewed 149 patients diagnosed with empyema who received surgery. The patients were divided into 2 groups according to whether they underwent emergency surgery or not. We then compared surgical outcomes between these groups. Results The patients in group A (emergency surgery, n=102) showed a more severe infectious state, but a lower complication rate and shorter length of hospital stay. The incidence of lung abscess was higher in group A, and abscesses were associated with diabetes and severe alcoholism. Conclusion Early aggressive surgical treatment resulted in good surgical outcomes for patients with rapid progressive multiloculated empyema. Furthermore, we suspect that the most likely causes of multiloculated empyema are lung abscesses found in patients with diabetes mellitus as well as severe alcoholism.
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Affiliation(s)
- Jong Hyun Baek
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine
| | - Young Uk Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine
| | - Seok Soo Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine
| | - Jang Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine
| | - Jung Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine
| | - Myeong Su Kim
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine
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Yoon J, Sivakumar P, O'Kane K, Ahmed L. A need to reconsider guidelines on management of primary spontaneous pneumothorax? Int J Emerg Med 2017; 10:9. [PMID: 28224348 PMCID: PMC5319942 DOI: 10.1186/s12245-017-0135-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background The key guidelines in the management of primary spontaneous pneumothorax (PSP) include the 2010 British Thoracic Society (BTS) Pleural Disease guideline and 2001 American College of Chest Physicians (ACCP) Consensus Statement. Current recommendations are dependent on radiographic measures which differ between these two guidelines. The aim of this study is to compare size classification of PSP cases, according to BTS and ACCP guidelines, and to evaluate guideline compliance. Findings We conducted a retrospective evaluation of all PSP episodes presenting to St Thomas’ Hospital, London, between February 2013 and December 2014. Data was recorded from review of chest X-rays and patient records. Eighty-seven episodes of PSP in 72 patients were identified (median age 25 years, IQR 22–32.25). Classification of “large” and “small” showed the greatest disparity in those managed conservatively (12/27, 44%) or with aspiration only (11/23, 48%). In this UK study, BTS guidelines were followed in 70% of episodes with adherence to ACCP guidelines in 32% of episodes. Conclusions There is a poor agreement in size classification between BTS and ACCP guidelines, resulting in conflicting recommendations for management of PSP. Robust clinical trial evidence is required to achieve international consensus on the management of PSP.
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Affiliation(s)
- Jiyoon Yoon
- Department of Respiratory Medicine, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Parthipan Sivakumar
- Department of Respiratory Medicine, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Kevin O'Kane
- Department of Emergency Medicine, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Liju Ahmed
- Department of Respiratory Medicine, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Abstract
Purpose of review The aim of this review is to provide the theoretical and practical
knowledge essential for non-radiologists to develop the skills necessary to apply
thoracic ultrasound as an extension of clinical assessment and
intervention. Recent findings Issues relating to training and competence are discussed and a
library of thoracic ultrasound videos is provided to illustrate artefacts,
pleural, parenchymal and pneumothorax pathology as well as important pitfalls to
consider. Novel and future diagnostic applications of thoracic ultrasound in the
setting of acute cardiorespiratory pathology including consolidation, acute
interstitial syndromes and pulmonary embolism are explored. Summary Thoracic ultrasound requires an understanding of imaging artefact
specific to lung and pleura and a working knowledge of machine knobology for image
optimisation and interpretation. Ultrasound is a valuable tool for the practicing
chest clinician providing diagnostic information for the assessment of pleural and
parenchymal disease and increased safety and cost effectiveness of thoracic
interventions. Electronic supplementary material The online version of this article (doi:10.1007/s13665-017-0164-1) contains supplementary material, which is available to authorized
users.
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Affiliation(s)
- Jonathan P Williamson
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, Australia.,Respiratory, Sleep and Environmental Health Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia
| | - Chris Grainge
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW Australia
| | - Ahilan Parameswaran
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Scott H Twaddell
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW Australia
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Ng L, Dabscheck E, Hew M. Diagnosis of complicated parapneumonic effusion by pleural pH measurement is jeopardized by inadequate physician knowledge and guideline-discordant laboratory practice. Respir Med 2016; 122:30-32. [PMID: 27993288 DOI: 10.1016/j.rmed.2016.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 10/30/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022]
Abstract
Pleural fluid pH is a crucial determinant of complicated parapneumonic effusion diagnosis and the need for drainage. It is best measured by blood gas analyzer. We examined whether physicians were aware of this, and whether their laboratories measured pleural pH according to their expectations. Only 53% of physicians understood the need for blood gas analyzer measurements, only 50% of laboratories used blood gas analyzers, and only 35% of physicians correctly identified the method performed in their laboratory. Diagnosis of complicated parapneumonic effusion is jeopardized by inadequate physician knowledge and guideline-discordant laboratory practice. We recommend cooperation between thoracic and biochemistry specialty societies to rectify this issue.
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Affiliation(s)
- Lauren Ng
- Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Prahran, VIC 3004, Australia.
| | - Eli Dabscheck
- Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Prahran, VIC 3004, Australia
| | - Mark Hew
- Respiratory Medicine, The Alfred Hospital and the School of Public Health & Preventive Medicine, Monash University, 55 Commercial Road, Prahran, VIC 3004, Australia
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Kelly C, Iqbal K, Iman-Gutierrez L, Evans P, Manchegowda K. Lung involvement in inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:870-888. [PMID: 27964793 DOI: 10.1016/j.berh.2016.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/05/2016] [Accepted: 10/13/2016] [Indexed: 02/08/2023]
Abstract
This chapter describes the involvement of the lung in systemic inflammatory joint disease (IJD) with a particular focus on rheumatoid arthritis, although the topics of pulmonary involvement in ankylosing spondylitis and psoriatic arthritis are also addressed. Interstitial lung disease is the most lethal pulmonary complication of IJD and the chapter describes recent advances in both our understanding of this complication and the therapeutic options that offer real hope for improved outcomes. Although less well recognised, airways disease is just as common and its association with IJD is described in some detail, with a section devoted to the recent surge in interest in bronchiectasis. Acute pulmonary infection is common in IJD and its management is reviewed in some detail. Although pleural disease is less common than it once was, its treatment is explored. We conclude by reviewing the relationship between the drug therapies employed in IJD and their effects on the lung.
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Affiliation(s)
- Clive Kelly
- Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK.
| | - Kundan Iqbal
- Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK
| | | | - Phil Evans
- Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK
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Hasegawa S, Okada M, Tanaka F, Yamanaka T, Soejima T, Kamikonya N, Tsujimura T, Fukuoka K, Yokoi K, Nakano T. Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial). Int J Clin Oncol 2016; 21:523-30. [PMID: 26577445 PMCID: PMC4901093 DOI: 10.1007/s10147-015-0925-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/02/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE We conducted a prospective multi-institutional study to determine the feasibility of trimodality therapy (TMT) comprising induction chemotherapy followed by extrapleural pneumonectomy (EPP) and radiation therapy in Japanese patients with malignant pleural mesothelioma (MPM). METHODS Major eligibility criteria were histologically confirmed diagnosis of MPM, including clinical subtypes T0-3, N0-2, M0 disease; no prior treatment for the disease; age 20-75 years; Eastern Cooperative Oncology Group performance status 0 or 1; predicted postoperative forced expiratory volume >1000 ml in 1 s; written informed consent. Treatment methods comprised induction chemotherapy using pemetrexed (500 mg/m(2)) plus cisplatin (60 mg/m(2)) for three cycles, followed by EPP and postoperative hemithoracic radiation therapy (54 Gy). Primary endpoints were macroscopic complete resection (MCR) rate for EPP and treatment-related mortality for TMT. RESULTS Forty-two eligible patients were enrolled: median age 64.5 (range 43-74) years; M:F = 39:3, clinical stage I:II:III = 14:13:15; histological type epithelioid were sarcomatoid; biphasic; others = 28:1:9:4. Of 42 patients, 30 completed EPP with MCR and 17 completed TMT. The trial met the primary endpoints, with an MCR rate of 71 % (30/42) and treatment-related mortality of 9.5 % (4/42). Overall median survival time and 2-year survival rate for 42 registered patients were 19.9 months and 42.9 %, respectively. Two-year relapse-free survival rate of 30 patients who completed EPP with MCR was 37.0 %. CONCLUSION This phase II study met the predefined primary endpoints, but its risk/benefit ratio was not satisfactory.
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Affiliation(s)
- Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Fumihiro Tanaka
- Department of Surgery, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Toshinori Soejima
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Norihiko Kamikonya
- Department of Radiation Oncology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Tohru Tsujimura
- Department of Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Kazuya Fukuoka
- Department of Medical Oncology, Sakai Hospital, Kinki University Faculty of Medicine, Osaka, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
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Porfyridis I, Georgiadis G, Michael M, Frangopoulos F, Vogazianos P, Papadopoulos A, Kara P, Charalampous C, Georgiou A. Rapid on-site evaluation with the Hemacolor rapid staining method of medical thoracoscopy biopsy specimens for the management of pleural disease. Respirology 2016; 21:1106-12. [PMID: 27080382 DOI: 10.1111/resp.12799] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Medical thoracoscopy (MT) is useful for the management of pleural disease. Rapid on-site evaluation (ROSE) of transbronchial needle aspirates proved to be useful during bronchoscopy. We aimed to evaluate the diagnostic performance of ROSE of MT biopsy specimens and thoracoscopists' impression of the macroscopic appearance and assess the intermodality agreement between ROSE and final histopathologic diagnosis. METHODS Sixty two patients with exudative pleural effusions further investigated with MT were enrolled. MT was performed under local anaesthesia and conscious sedation, using the rigid pleuroscope. ROSE with the Hemacolor rapid staining method of the biopsy specimens was performed. Thoracoscopists' impression of the macroscopic appearance was recorded. The final diagnosis was established following histopathological examination. RESULTS Thoracoscopic pleural biopsies were diagnosed in 61 patients (98.4%). Group A (n = 25) consisted of patients with malignancy and group B (n = 37) with benign disorders. Area under the curve of ROSE for the diagnosis of malignancy was 0.86 (95% CI: 0.76-0.96, P < 0.001), with a sensitivity of 79.17%, specificity of 94.59%, diagnostic accuracy of 88.5%, positive predictive value of 90.5% and negative predictive value of 87.5%. Intermodality agreement between ROSE and histopathology was good (κ ± SE = 0.615 ± 0.084, P < 0.001). Area under the curve of the thoracoscopists' impression of macroscopic appearance was 0.72 (95% CI: 0.58-0.85, P = 0.001), with a sensitivity of 100%, specificity of 44.7%, positive predictive value of 53.33% and negative predictive value of 100%. CONCLUSION Rapid on-site evaluation during MT was found to have high accuracy for predicting malignancy. ROSE can provide the thoracoscopist with an on-site preliminary diagnosis, especially in cases with inconclusive macroscopic appearance.
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Affiliation(s)
| | | | - Michalis Michael
- Cytopathology Department, Nicosia General Hospital, Nicosia, Cyprus
| | | | | | | | - Panayiota Kara
- Histopathology Department, Nicosia General Hospital, Nicosia, Cyprus
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Espósito DL, Bollela VR, Feitosa AL, da Fonseca BA. Expression Profiles of Cytokine mRNAs in the Pleural Fluid Reveal Differences Among Tuberculosis, Malignancies, and Pneumonia-Exudative Pleural Effusions. Lung 2015; 193:1001-7. [PMID: 26407584 DOI: 10.1007/s00408-015-9809-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Tuberculosis (TB) and malignant diseases are the most common causes of lymphocytic pleural effusion in adults. Serum and pleural fluid cytokine levels have been analyzed to help in the differential diagnosis, but with limited results. PURPOSE This study investigates transcription levels of selected cytokine genes in pleural effusion of patients under investigation for TB. METHODS This was a prospective study that included adult patients under investigation for pleural effusion in Brazil. The expression of 19 cytokine genes was analyzed by RT-qPCR. RESULTS The majority of cytokine-related genes expressed in pleural fluid of TB patients were similar in non-TB patients, except for RORA and RORC genes, which showed a statistically higher level in TB. All cytokines in the Th17 pattern were induced in TB patients' pleural fluid. Patients with malignant pleural effusion expressed higher levels of IFN-α1, IFN-β1, TNF-α, IL-4 and IL-6, and suppression of TGFβ-1. CONCLUSION There is still a lot to understand about the cytokine roles in the pro- and anti-inflammatory environment of exudative pleural effusions. The data presented here showed an increased expression of Th17 pattern cytokines genes in TB patients that could be used as markers to differentiate tuberculous pleuritis from other common causes of exudative pleural effusion.
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Chansakul T, Dellaripa PF, Doyle TJ, Madan R. Intra-thoracic rheumatoid arthritis: Imaging spectrum of typical findings and treatment related complications. Eur J Radiol 2015; 84:1981-91. [PMID: 26210094 DOI: 10.1016/j.ejrad.2015.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Non-cardiac thoracic manifestations of rheumatoid arthritis (RA) cause significant morbidity and mortality among RA patients. Essentially all anatomic compartments in the chest can be affected including the pleura, pulmonary parenchyma, airway, and vasculature. In addition, treatment-related complications and opportunistic infections are not uncommon. Accurate diagnosis of intra-thoracic disease in an RA patient can be difficult as the radiologic findings may be nonspecific and many of these conditions may coexist. This review article serves to highlight the multitude of RA-related intra-thoracic pathological processes, emphasize differential diagnosis, diagnostic conundrums and discuss how tailoring of CT imaging and image-guided biopsy plays a key role in the management of RA-related pulmonary disease.
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47
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Corcoran JP, Psallidas I, Wrightson JM, Hallifax RJ, Rahman NM. Pleural procedural complications: prevention and management. J Thorac Dis 2015; 7:1058-67. [PMID: 26150919 PMCID: PMC4466427 DOI: 10.3978/j.issn.2072-1439.2015.04.42] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/08/2015] [Indexed: 12/11/2022]
Abstract
Pleural disease is common with a rising case frequency. Many of these patients will be symptomatic and require diagnostic and/or therapeutic procedures. Patients with pleural disease present to a number of different medical specialties, and an equally broad range of clinicians are therefore required to have practical knowledge of these procedures. There is often underestimation of the morbidity and mortality associated with pleural interventions, even those regarded as being relatively straightforward, with potentially significant implications for processes relating to patient safety and informed consent. The advent of thoracic ultrasound (TUS) has had a major influence on patient safety and the number of physicians with the necessary skill set to perform pleural procedures. As the variety and complexity of pleural interventions increases, there is increasing recognition that early specialist input can reduce the risk of complications and number of procedures a patient requires. This review looks at the means by which complications of pleural procedures arise, along with how they can be managed or ideally prevented.
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Wang F, Tong Z, Wang Z, Wang X, Zhan X, Shi H. Application of medical thoracoscopy in diagnosis of sarcoidosis-related pleural effusion. Respirol Case Rep 2014; 2:99-101. [PMID: 25473581 PMCID: PMC4184738 DOI: 10.1002/rcr2.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/20/2014] [Accepted: 05/24/2014] [Indexed: 11/11/2022] Open
Abstract
Pleural effusion caused by sarcoidosis is unusual. Medical thoracoscopy could help clinicians detect associated pleural disease, yet studies on thoracoscopic observations in sarcoidosis pleural involvement are rare. In this article, we report the utility of medical thoracoscopy in diagnosing sarcoid-related pleural disease for three patients. Pleural nodularity was common with solitary and multiple nodules evident; biopsies confirmed the presence of diagnostic noncaseating granulomas.
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Affiliation(s)
- Feng Wang
- Feng Wang is now working at the Department of Respiratory Medicine, Fuxing Hospital, affiliated to Capital Medical University Beijing, China
| | - Zhaohui Tong
- Feng Wang is now working at the Department of Respiratory Medicine, Fuxing Hospital, affiliated to Capital Medical University Beijing, China
| | - Zhen Wang
- Feng Wang is now working at the Department of Respiratory Medicine, Fuxing Hospital, affiliated to Capital Medical University Beijing, China
| | - Xiaojuan Wang
- Feng Wang is now working at the Department of Respiratory Medicine, Fuxing Hospital, affiliated to Capital Medical University Beijing, China
| | - Xi Zhan
- Feng Wang is now working at the Department of Respiratory Medicine, Fuxing Hospital, affiliated to Capital Medical University Beijing, China
| | - Huanzhong Shi
- Feng Wang is now working at the Department of Respiratory Medicine, Fuxing Hospital, affiliated to Capital Medical University Beijing, China
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Lafontaine N, Joosten SA, Steinfort D, Irving L, Hew M. Differential implementation of special society pleural guidelines according to craft-group: impetus toward cross-specialty guidelines? Clin Med (Lond) 2014; 14:361-6. [PMID: 25099835 PMCID: PMC4952827 DOI: 10.7861/clinmedicine.14-4-361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We examined the effects of a programme to improve adherence to British Thoracic Society pleural procedure guidelines at our institution. Following a baseline audit, we performed an intervention to enhance adherence to these guidelines. We then performed a postintervention audit. At baseline, there were different levels of guideline adherence depending on the specialty of the clinician inserting chest tubes. Interventions to improve adherence were hampered by limited access to non-respiratory teams. Thus, improvements in response to intervention were also specialty specific. Overall, procedures performed by respiratory medicine had higher adherence rates compared with those performed by non-respiratory teams. We concluded that guidelines promoted at a local level by one specialty have limited traction on members of another specialty. For pleural procedures, which cross specialty boundaries, we propose that future guidelines be developed jointly by all relevant specialties. This could facilitate unified guideline implementation at the clinical coalface.
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Affiliation(s)
| | | | | | | | - Mark Hew
- Alfred Hospital, Melbourne, Australia
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50
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Inchingolo R, Smargiassi A, Mormile F, Marra R, De Carolis S, Lanzone A, Valente S, Corbo GM. Look at the lung: can chest ultrasonography be useful in pregnancy? Multidiscip Respir Med 2014; 9:32. [PMID: 24936303 PMCID: PMC4059469 DOI: 10.1186/2049-6958-9-32] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/20/2014] [Indexed: 01/28/2023] Open
Abstract
Background This study aimed to evaluate the clinical value of chest ultrasound (US) in the detection, diagnosis and follow-up of pathologic processes of both peripheral lung parenchyma and pleural space in pregnant women. Findings Pregnant women admitted to Obstetric Pathology Hospital Department for respiratory diseases were enrolled. Chest US examination was performed when there was a respiratory disease highly suggestive of pneumonia and/or pleural effusion and chest X-ray (CXR) should have been obtained. Three chest US patterns were identified: lung consolidation (LC), pleural effusion (PE) and focal sonographic interstitial syndromes (SIS). When chest US pathologic signs were reported, one or more subsequent chest US examinations were performed to follow-up the patient until their complete resolution. Sixteen inpatients underwent 54 chest US evaluations. We identified: 9 LCs, 6 PEs and 11 SISs. Total number of CXRs was 7 (10 females avoided X-rays exposure and one underwent 2 CXR evaluations on the advice of Gynecologist). Chest US follow-up, during and after therapy, showed complete resolution of echographic patterns previously described. Conclusions Chest US evaluation during pregnancy is a useful diagnostic tool to detect and monitor respiratory diseases, avoiding excessive X-rays exposure.
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Affiliation(s)
- Riccardo Inchingolo
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Andrea Smargiassi
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy.,Pulmonary Medicine Department, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Flaminio Mormile
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Roberta Marra
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Sara De Carolis
- Obstetric Pathology Department, University Hospital "A. Gemelli", Rome, Italy
| | - Antonio Lanzone
- Obstetric Pathology Department, University Hospital "A. Gemelli", Rome, Italy
| | - Salvatore Valente
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Giuseppe M Corbo
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
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