Refractory Pleural Effusion in Systemic Lupus Erythematosus Treated by Pleurectomy

Pleural effusion is a common pulmonary manifestation of systemic lupus erythematosus (SLE) and often occurs as bilateral exudative pleural effusion. The condition usually responds quickly to corticosteroid therapy. However, massive pleural effusion refractory to immunosuppressive drugs has rarely been reported; thus, the proper therapeutic modality is largely decided on a case-by-case basis. In this case, we describe successful treatment with surgical pleurectomy for massive refractory pleural effusion in a patient with SLE.

Pneumothorax and its etiology

Introduction: Air in the pleural space is defined as Pneumothorax. A case of pneumothorax is a medical emergency which can itself be serious and may endanger the life of the patient because of respiratory insufficiency. Aim of the study: To study the etiological factors of pneumothorax and hydropneumothorax, the inter-relation of spontaneous pneumothorax with different age groups, sexes and precipitating factors. Study the associated complications, degree of collapse of pulmonary parenchyma and outcome of the treatment. Materials and methods: Fifty cases of pneumothorax presenting to the department were admitted and investigated. Cases of pneumothorax with or without fluid, pus or blood in the pleural cavity; accidental and iatrogenic pneumothorax were also included. Pneumothorax is diagnosed by taking standard chest radiographs and computed tomograms (CT) of the chest wherever necessary. Results: A vast majority of the patients in this study were of poor socio economic background. Male to female ratio is 7:1. Of the 50 cases, 16 (32%) had pneumothorax only, 22 (44%) had pyopneumothorax and 10 (20%) had hydropneumothorax. Hemopneumothorax was found in 2 (4%) cases. Conclusion: Spontaneous pneumothorax is generally due to an underlying lung disease. It is important that pneumothorax is managed promptly and in an appropriate manner. Immediate management is largely determined by the extent of cardio-respiratory compromise, degree of symptoms and size of pneumothorax and may involve observation alone, needle aspiration or chest drain insertion.

The Effect of Thoracoscopic Pleurodesis in Primary Spontaneous Pneumothorax: Apical Parietal Pleurectomy versus Pleural Abrasion

BACKGROUND: The standard operative treatment of primary spontaneous pneumothorax (PSP) is thoracoscopic wedge resection, but necessity of pleurodesis still remains controversial. Nevertheless, pleural procedure after wedge resection such as pleurodesis has been performed in some patients who need an extremely low recurrence rate. MATERIALS AND METHODS: From January 2000 to July 2010, 207 patients who had undergone thoracoscopic wedge resection and pleurodesis were enrolled in this study. All patients were divided into two groups according to the methods of pleurodesis; apical parietal pleurectomy (group A) and pleural abrasion (group B). The recurrence after surgery had been checked by reviewing medical record through follow-up in ambulatory care clinic or calling to the patients, directly until January 2011. RESULTS: Of the 207 patients, the recurrence rate of group A and B was 9.1% and 12.8%, respectively and there was a significant difference (p=0.01, Cox's proportional hazard model). There was no significant difference in age, gender, smoking status, and body mass index between two groups. CONCLUSION: This study suggests that the risk of recurrence after surgery in PSP is significantly low in patients who underwent thoracoscopic wedge resection with parietal pleurectomy than pleural abrasion.

Retrospective Study of Thoracoscopic Apical Pleurectomy and Mechanical Pleural Abrasion for Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). MATERIAL AND METHOD: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). RESULT: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was 97+/-44 minutes in group A and 77+/-18 minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was 156+/-87 cc in group A and 147+/-87 cc in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was 31.7+/-25.3 months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. CONCLUSION: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.