Thoracoscopic talc poudrage pleurodesis for chronic recurrent pleural effusions

Article Abstract:

Pleural effusion, or the collection of fluid in the thoracic cavity outside the lungs, can cause debilitating dyspnea (difficult breathing). Pleural effusions caused by diseases such as tuberculosis generally respond well to drug treatment and drainage of the thoracic cavity. However, there remains a group of patients suffering from pleural effusion that is refractory to the above treatments. This often results from cancerous invasion of the pleura (the membranes enclosing the lungs); patients afflicted with refractory pleural effusion can suffer severe dyspnea for many months or years. Thoracocentesis (removal of the fluid) provides only temporary relief, and various treatment strategies have been tried to effect pleurodesis (the production of adhesions between various segments of the pleura to stop fluid accumulation) with only limited success. To assess the effectiveness of thoracoscopic talc poudrage (instillation of talc into the thoracic cavity via a rigid tube inserted between the ribs), a study was carried out involving 47 consecutive patients with recurrent pleural effusion. Talc poudrage was carried out while the patients were under either local or general anesthesia. Chest X-rays were taken at 1, 3, and 12 months after surgery, and all patients were followed for 16 months (or until death). Of the 39 patients in whom follow-up evaluation could be performed, all patients reported relief from dyspnea; over 80 percent showed evidence of complete elimination of pleural effusions. Treatment was unsuccessful in three patients. No surgery-related illness or death occurred, although mild pain was reported by some patients. Patients with malignant disease lived an average of 12.4 months after the operation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Surgery, Lung diseases, Thoracoscopy

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Pleural effusions in hospitalized patients with AIDS

Article Abstract:

Pleural effusions occur quite frequently in AIDS patients with the most common cause being bacterial pneumonia. A pleural effusion is the presence of liquid in the membrane lining the chest cavity. The records of 222 patients diagnosed with AIDS and hospitalized between 1986 and 1992 were reviewed. Pleural effusions, which occurred in 27% of the patients, were most likely to be caused by an infectious organism. Bacterial pneumonia was the cause of the effusion in 31% of the patients, pneumocystis carinii pneumonia was present in 15% of the cases. Tuberculosis was also a cause of effusions in 8% of the patients. Noninfectious causes of effusions in AIDS patients included hypoalbuminemia and Kaposi sarcoma. Large pleural effusions are more likely to be caused by Kaposi sarcoma, tuberculosis and lymphoma.

Causes of, Complications and side effects, AIDS (Disease)

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Elastance of the pleural space: a predictor for the outcome of pleurodesis in patients with malignant pleural effusion

Article Abstract:

Elastance measurements taken while draining fluid buildup around the lungs appear to provide an effective benchmark to guide further chemical treatment decisions. Elastance measures recoil pressure in terms of pressure change per volume change. The success of a chemical adhesion therapy using bleomycin was evaluated among 64 patients with fluid buildup around the lungs resistant to treatment. Bleomycin therapy was not successful in any patients with elastance measurements higher than 19 millimeters mercury (mm Hg). Nearly all of the patients with an elastance less than 19 mm Hg were successfully treated with bleomycin.

Care and treatment, Lung volume measurements, Lung volume measurement

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