Red neural artificial para predecir factores de riesgo asociados a complicaciones postoperatorias secundarias al tratamiento del neumotórax / Artificial neural network to predict risk factors associated with postoperative complications secondary to pneumothorax treatment

Introducción. Debido a la ausencia de modelos predictivos estadísticamente significativos enfocados a las complicaciones postoperatorias en el manejo quirúrgico del neumotórax, desarrollamos un modelo, utilizando redes neurales, que identifica las variables independientes y su importancia para reducir la incidencia de complicaciones. Métodos. Se realizó un estudio retrospectivo en un centro asistencial, donde se incluyeron 106 pacientes que requirieron manejo quirúrgico de neumotórax. Todos fueron operados por el mismo cirujano. Se desarrolló una red neural artificial para manejo de datos con muestras limitadas; se optimizaron los datos y cada algoritmo fue evaluado de forma independiente y mediante validación cruzada, para obtener el menor error posible y la mayor precisión con el menor tiempo de respuesta. Resultados. Las variables de mayor importancia según su peso en el sistema de decisión de la red neural (área bajo la curva 0,991) fueron el abordaje por toracoscopia video asistida (OR 1,131), el uso de pleurodesis con talco (OR 0,994) y el uso de autosuturas (OR 0,792; p<0,05). Discusión. En nuestro estudio, los principales predictores independientes asociados a mayor riesgo de complicaciones fueron el neumotórax de etiología secundaria y el neumotórax recurrente. Adicionalmente, confirmamos que las variables asociadas a reducción de riesgo de complicaciones postoperatorias tuvieron significancia estadística. Conclusión. Identificamos la toracoscopia video asistida, el uso de autosuturas y la pleurodesis con talco como posibles variables asociadas a menor riesgo de complicaciones. Se plantea la posibilidad de desarrollar una herramienta que facilite y apoye la toma de decisiones, por lo cual es necesaria la validación externa en estudios prospectivos

Introduction. Due to the absence of statistically significant predictive models focused on postoperative complications in the surgical management of pneumothorax, we developed a model using neural networks that identify the independent variables and their importance in reducing the incidence of postoperative complications. Methods. A retrospective single-center study was carried out, where 106 patients who required surgical management of pneumothorax were included. All patients were operated by the same surgeon. An artificial neural network was developed to manage data with limited samples. The data is optimized and each algorithm is evaluated independently and through cross-validation to obtain the lowest possible error and the highest precision with the shortest response time. Results. The most important variables according to their weight in the decision system of the neural network (AUC 0.991) were the approach via video-assisted thoracoscopy (OR 1.131), use of pleurodesis with powder talcum (OR 0.994) and use of autosutures (OR 0.792, p<0.05). Discussion. In our study, the main independent predictors associated with a higher risk of complications are pneumothorax of secondary etiology and recurrent pneumothorax. Additionally, we confirm that the variables associated with a reduction in the risk of postoperative complications have statistical significance. Conclusion. We identify video-assisted thoracoscopy, use of autosuture and powder talcum pleurodesis as possible variables associated with a lower risk of complications and raise the possibility of developing a tool that facilitates and supports decision-making, for which external validation in prospective studies is necessary

Actualidad en el manejo clínico del derrame pleural maligno: revisión narrativa / Update on the clinical management of malignant pleural effusion: narrative review: A narrative review

Introducción: Cerca del 50 % de los derrames pleurales (DP) es neoplásico. El comportamiento clínico del DP neoplásico es altamente sintomático por el gran volumen y su recidiva temprana. Propósito de la revisión: El objetivo de la revisión es delinear el papel de los diferentes métodos diagnósticos y terapéuticos de DP maligno. Buscamos reportes actualizados en donde se incluye los resultados de mejor supervivencia para los distintos tratamientos actuales. Recientes hallazgos: Los criterios de Light es el método estándar para diferenciar un exudado maligno. La toracocentesis guiada por ultrasonido debe ser usada como método diagnóstico/terapéutico. En pacientes con DP maligno se recomienda el drenaje permanente con el posicionamiento de un tubo de tórax y un sello hidráulico con drenaje cerrado. La pleurodesia con instilación de talco está recomendada en pacientes con DP maligno en busca de disminuir el volumen, las recidivas del DP y el tiempo de hospitalización. Conclusiones: Para el correcto manejo del DP maligno, hay que tomar en cuenta varios aspectos, como identificar la presencia de células malignas mediante estudio citológico y descartar una infección. La ecografía pleural permite definir el volumen del DP y permite decidir drenaje en ese momento, con la posibilidad de inserción de catéter intrapleural, con el objetivo de evaluar la posibilidad de esclerosar las pleuras a través de pleurodesia. Sin embargo, para llegar a esta decisión hay que analizar cada uno de los detalles que podrían tener un papel de importancia para el buen manejo y resolución definitiva o por el contrario decidir el manejo a título paliativo, siempre analizando cada caso con el objetivo de proveer de mejoría de síntomas y mejorar la calidad de vida del paciente.

Introduction: Approximately 50% of pleural effusions (PE) are neoplastic. The clinical behavior of neoplastic PE is highly symptomatic due to its large volume and early recurrence. Purpose of review: This review aims to outline the role of the different diagnostic and therapeutic methods of malignant PE. We look for updated reports that include the best survival results for the other current treatments. Recent findings: Light's criteria are the standard to differentiate a malignant exudate. Ultrasound-guided thoracentesis should be used as a diagnostic/therapeutic method. In patients with malignant PE, permanent drainage is recommended with the placement of a chest tube and a hydraulic seal with closed drainage. Pleurodesis with the installation of talc is recommended in patients with malignant PE to reduce volume, PE recurrences, and hospitalization time. Conclusions: For the correct management of malignant PE, several aspects must be considered, such as identifying the presence of malignant cells by cytological study and ruling out infection. Pleural ultrasound allows for defining the volume of the PE. It will enable deciding on drainage at that time, with the possibility of inserting an intrapleural catheter, to evaluate the likelihood of sclerosing the pleurae through pleurodesis. However, to reach this decision, it is necessary to analyze each of the details that could play an essential role in good management and definitive resolution or, on the contrary, decide on palliative management, constantly investigating each case to provide symptom improvement. In addition, improving the patient's quality of life.

Neumonitis química grave secundaria a la inhalación de talco. A propósito de un caso pediátrico / Severe chemical pneumonitis secondary to talc inhalation. A pediatric case

El talco, un silicato de magnesio hidratado, formó parte durante décadas del cuidado tradicional de lactantes y niños pequeños. Si bien en los niños su inhalación aguda, que suele ser accidental durante el cambio de pañales, no es frecuente, es una condición potencialmente peligrosa, que puede provocar dificultad respiratoria grave e incluso cuadros mortales. Se describe el grave compromiso respiratorio por neumonitis química asociado con la inhalación accidental de talco en un lactante de 14 meses. El niño presentó un cuadro de dificultad respiratoria con requerimiento de asistencia respiratoria mecánica (ARM) durante una semana. En cuanto al tratamiento, no existe un estándar, se utilizaron antibióticos y corticoides sistémicos y aerosolterapia. No presentó complicaciones en otros órganos o sistemas. Su evolución fue favorable, se pudo externar al décimo día de internación y presentó posteriormente episodios aislados de hiperreactividad bronquial.

Talc is a hydrated magnesium silicate. It was part of traditional infant and young child care for decades. In children, its acute inhalation, generally accidental during diaper changes, although not frequent, is a potentially dangerous condition, and can cause severe respiratory distress and even death. We describe the case of a 14-month child who had an accidental inhalation of talc, chemical pneumonitis and severe respiratory compromise. The patient had acute respiratory distress syndrome requiring mechanical ventilation for one week. There is no standard treatment, we used systemic antibiotics and corticosteroids and aerosol therapy. He did not have complications in other organs or systems. He was hospitalized for ten days. In the follow up, he had isolated episodes of bronchial hyperresponsiveness.

Talco estéril versus yodopovidona en pleurodesis como tratamiento del derrame pleural maligno. Estudio prospectivo no aleatorizado / Sterile talc versus povidone-iodine in pleurodesis as a treatment for malignant pleural effusion. Non-randomized prospective study

Comparar el uso del talco estéril versus yodopovidona como agentes químicos en pleurodesis para el tratamiento del derrame pleural maligno.Materiales y Métodos: Estudio clínico, analítico, observacional, prospectivo, el cual incluyó 12 pacientes con diagnóstico clínico e histopatológico de derrame pleural maligno, a quienes se les practicó pleurodesis empleando talco estéril y yodopovidona.Resultados : Edad promedio fue de 46,25 ± 17,3 y la neoplasia primaria más común fue el cáncer de mama, representando el 50% de los casos estudiados. El grupo de pacientes tratados con yodopovidona tuvo 100% de efectividad en la fusión pleural posterior a la pleurodesis, y presentaron menos complicaciones durante el procedimiento y 24 horas posteriores al mismo con respecto al grupo tratado con talco estéril, el cual tuvo un 71,4% de efectividad y un 28,6% de falla al procedimiento; asimismo, estos últimos presentaron mayor porcentaje de complicaciones. Por otra parte, no se evidenció recidiva del derrame pleural en los 30 días de valoración posteriores al procedimiento. Estas diferencias no fueron estadísticamente significativas.Conclusiones : Ambos agentes esclerosantes fueron eficaces para lograr la fusión de las pleuras en pacientes con derrame pleural maligno, siendo el talco estéril el agente con mayor tendencia a producir complicaciones y fallo del procedimiento, en comparación a la yodopovidona(AU)

To compare the use of sterile talc versus povidone-iodine as chemical agents on pleurodesis for the treatment of malignant pleural effusion.Materials and Methods : A total of 12 patients with clinical and histopathologic diagnose of malignant pleural effusion were enrolled in a clinical, analytic, observational and prospective trial, to whom sterile talc and povidone-iodine pleurodesis was applied.Results : The mean age was 46,25 ± 17,3 and the most common primary neoplasm was breast cancer, which was present in 50% of the surveyed cases. The group of patients who received povidone-iodine had 100% of effectiveness on post-pleurodesis pleural fusion, and had fewer complications during the procedure and 24 hours afterwards vis-à-vis the group who received sterile talc powder, which had 74.4% of effectiveness and 28.6% of procedure failure; furthermore, the last mentioned had higher percentage of complications. Moreover, there was no evidence of recurrence of pleural effusion in the 30 days post-procedure assessment.Conclusions : Both sclerosant agents were efficient to accomplish pleural fusion in patients with malignant pleural effusion, with sterile talc being the agent with higher tendency to generate more complications and procedure failure compared to povidone-iodine(AU)

Knowledge of Diaper Dermatitis and Diaper Hygiene Practices among Mothers of Diaper-wearing Children

PURPOSE: The purpose of this study was to investigate the prevalence of diaper dermatitis (DD), knowledge of DD prevention and treatment, and diaper hygiene practices among mothers with diaper-wearing children. METHODS: The participants were 176 mothers who presented to an outpatient clinic at a children's hospital with diaper-wearing children. Data were collected using a structured self-administered questionnaire. RESULTS: The percent of correct answer for knowledge about DD was 59.7%. Almost half of the participants' children had experienced at least 1 episode of DD during the last 6 months. Inappropriate diaper hygiene practices, such as using talcum powder on DD and rubbing with a dry towel after cleansing, were reported. Moreover, only 37% of mothers used the recommended skin barrier to prevent DD. Although many children suffer from DD, levels of educational experience and perceived need for education on this topic were low. Almost 70% of mothers obtained DD-related information through internet sites. CONCLUSION: Educating parents about the etiology of DD and evidence-based diaper hygiene practices is an important aspect of effective DD prevention and treatment. Internet sites or smartphone apps may be effective methods for education on DD prevention and treatment considering parents' preferences for ways to obtain health information.

Pleurodese em derrame pleural neoplásico: revisão da literatura / Pleurodesis in neoplastic pleural effort: literature review

RESUMO INTRODUÇÃO: O derrame pleural neoplásico é caracterizado pelo acúmulo anormal de líquido com células malignas no espaço pleural. Pode ser assintomático porém, seu principal sintoma é a dispneia. As causas mais frequentes de neoplasias com derrame pleural maligno são: carcinoma broncogênico, neoplasia mamária, mesotelioma, linfoma de Hodgkin, leucemias, tumores de ovário e carcinomas do trato digestivo. OBJETIVO: Realizar uma revisão da literatura sobre os derrames pleurais neoplásicos e o uso da pleurodese como opção de tratamento. MÉTODO: Foi realizada revisão da literatura, retrospectiva, com os dados coletados entre os meses de maio a agosto de 2019, utilizando as palavras-chave "pleurodese", "derrame pleural neoplásico" e "talco" no portal de periódicos da CAPES e na Cochrane. Revisado 39 artigos dos quais foram incluídos 14 artigos publicados nos últimos 15 anos. DISCUSSÃO: Para os casos inéditos de derrame pleural maligno e sintomático, deve-se realizar toracocentese de alívio. A pleurodese está indicada em pacientes sintomáticos, com derrame de repetição e expansão pulmonar adequada. O talco é o agente esclerosante de escolha na realização da pleurodese, devido seu baixo custo, disponibilidade, fácil administração, poucas complicações e boa efetividade. Atualmente, o talco é aplicado por toracoscopia ou pelo dreno, neste caso, sob a forma do talco "slurry" (suspensão de talco). O talco slurry é a forma de escolha, quando comparado ao talco em pó, pois apresenta menos efeitos colaterais, com eficácia semelhante. CONCLUSÃO: A pleurodese em derrame neoplásicos se destina à remissão dos sintomas, com melhora da qualidade de vida. Não tem efeito no prognóstico do paciente e aumento de sua sobrevida. Palavras-Chave: Pleurodese. Talco. Derrame pleural maligno

Spontaneous Regression of Metastatic Renal Cell Carcinoma after Talc Pleurodesis

Spontaneous regression of metastatic renal cell carcinoma (mRCC) was reported over the last century. However, there are no reports on spontaneous regression of mRCC by talc pleurodesis. A 43-year-old man who underwent left nephrectomy by RCC visited emergency room with headache and hallucination. Tumor was metastasized to brain, lung, and pleura accompanied by malignant pleural effusion. Talc pleurodesis by video-assisted thoracoscopic surgery was performed to treat malignant pleural effusion. After 7 months without specific chemotherapy, pulmonary lesions of mRCC gradually regressed. We thought that this phenomenon appears as an immunologic response of talc pleurodesis. We herein present a rare case of spontaneous regression of mRCC following talc pleurodesis. To the best of our knowledge, this is the first case of spontaneous regression in mRCC following talc pleurodesis.

Developing Asbestos Job Exposure Matrix Using Occupation and Industry Specific Exposure Data (1984–2008) in Republic of Korea

BACKGROUND: The goal of this study is to develop a general population job-exposure matrix (GPJEM) on asbestos to estimate occupational asbestos exposure levels in the Republic of Korea. METHODS: Three Korean domestic quantitative exposure datasets collected from 1984 to 2008 were used to build the GPJEM. Exposure groups in collected data were reclassified based on the current Korean Standard Industrial Classification (9th edition) and the Korean Standard Classification of Occupations code (6th edition) that is in accordance to international standards. All of the exposure levels were expressed by weighted arithmetic mean (WAM) and minimum and maximum concentrations. RESULTS: Based on the established GPJEM, the 112 exposure groups could be reclassified into 86 industries and 74 occupations. In the 1980s, the highest exposure levels were estimated in “knitting and weaving machine operators” with a WAM concentration of 7.48 fibers/mL (f/mL); in the 1990s, “plastic products production machine operators” with 5.12 f/mL, and in the 2000s “detergents production machine operators” handling talc containing asbestos with 2.45 f/mL. Of the 112 exposure groups, 44 groups had higher WAM concentrations than the Korean occupational exposure limit of 0.1 f/mL. CONCLUSION: The newly constructed GPJEM which is generated from actual domestic quantitative exposure data could be useful in evaluating historical exposure levels to asbestos and could contribute to improved prediction of asbestos-related diseases among Koreans.

Evaluation of the mechanical properties of acetic-cure silicone with the addition of magnesium silicate / Avaliação das propriedades mecânicas de silicone de cura acética, com a adição de silicato de magnésio

Current study evaluates the mechanical properties (tensile and tear strength) of an acetic- cure silicone with the addition of 10 or 20% vol. magnesium silicate. Magnesium silicate was added to the silicone at concentrations of 10 (MS-10) and 20% (MS-20) volume, followed by the analysis of tensile strength, maximal elongation during tensile and tear strength. Results were compared to control group of silicone without additives (CG). Mean rates were determined and compared by analysis of variance and Tukey's test (p < 0.05). Control group had the greatest elongation when subjected to tensile strength (650%), whereas the MS-10 group statistically showed a better tensile strength (8.8 MPa) when compared to CG (7.5 MPa) and MS -20 (7.5 MPa) groups. Both magnesium silicate groups exhibited statistically similar tear strength, whereas MS-20 group demonstrated statistically greater tear strength. The addition of 10% magnesium silicate increased tensile strength, but tear strength and elongation were similar to control. The addition of 20% magnesium silicate did not affect tensile but increased tear strength.

O objetivo deste estudo foi avaliar as propriedades mecânicas (resistência à tração e ao rasgamento) de um silicone de cura acética com adição de 10 ou 20% em volume de silicato de magnésio. O silicato de magnésio foi adicionado ao silicone em concentrações de 10 (MS-10) e 20% (MS-20), em volume, avaliado por análise de resistência à tração, deformação máxima em tração e resistência ao rasgamento. Os resultados foram comparados com um grupo de controle sem aditivos de silicone (GC). Os valores médios foram determinados e comparados através de análise de variância e teste de Tukey (p < 0,05). O grupo de controle apresentou o maior alongamento quando submetido à tensão (650%). O grupo MS-10 exibiu estatisticamente melhor resistência à tração (8,8 MPa) em relação ao GC (7,5 MPa) e MS-20 (7,5 MPa) grupos. Ambos os grupos de silicato de magnésio exibiram médias de resistência ao rasgamento estatisticamente semelhantes, enquanto que o grupo de EM-20 demonstrou estatisticamente maior resistência ao rasgamento em comparação com o grupo de controle. A adição de 10% de silicato de magnésio em volume propiciou maiores valores de resistência ao rasgamento e resistência à tração. A adição de 20% de silicato de magnésio não afetou a resistência à tração, mas produziu aumento na resistência ao rasgamento.

Caracterización y resultados de la pleurodesis con talco en derrame pleural neoplásico / Characterization and result of talc pleurodesis for malignant pleural effusion

INTRODUCCIÓN: El derrame pleural neoplásico o maligno (DPN) es una complicación frecuente de las neoplasias metastásicas. La pleurodesis con talco es un tratamiento paliativo local efectivo, que tiene por objetivo mejorar la calidad de vida del paciente. OBJETIVOS: Describir características de pacientes con DPN y los resultados inmediatos y alejados del tratamiento quirúrgico con pleurodesis con talco. MATERIALES Y MÉTODO: Estudio descriptivo transversal, se describieron características clínicas, morbimortalidad, resultados inmediatos y alejados de pacientes con DPN tratados con pleurodesis con talco, desde enero del 2011 hasta noviembre del 2015, en Hospital Clínico de Concepción. Datos extraídos de protocolos quirúrgicos, fichas clínicas y registro de anatomía patológica, previa aprobación por el comité ético-científico. RESULTADOS: Total 70 pacientes; 47 (67,1%) mujeres, edad promedio 60,5±14,3 años (Rango 15- 85). Síntomas: disnea 67 (95,7%), dolor torácico 50 (71,4%); 43 (61,4%) correspondieron al lado derecho; 55 (78,6%) se clasificaron como derrames pleurales masivos. Tipo de cáncer: cáncer de mama 20 (28,6%), cáncer broncogénico 12 (17,1%). Procedimiento quirúrgico: videotoracoscopía 53 (75,7%), pleurotomía 14 (20,0%). Se realizó biopsia pleural en 52 (74,3%). Complicaciones post-operatorias en 7 (10,0%) pacientes. Presentaron reexpansión radiológica al alta 62 (88,6%) pacientes. Necesitaron nuevo procedimiento de evacuación pleural 6 (8,6%) pacientes. Supervivencia promedio 8,3 + 9,5 meses (Rango 1-46), con un 55,7% de sobrevida a los 3 meses de seguimiento. DISCUSIÓN: La pleurodesis con talco es un tratamiento paliativo efectivo del DPN, con adecuada reexpansión pulmonar al alta, baja morbimortalidad y baja necesidad de un nuevo procedimiento de evaluación pleural, similar a lo observado en la literatura

Effectiveness of medical thoracoscopy and thoracoscopic talc poudrage in patients with exudative pleural effusion

<p><b>INTRODUCTION</b>This study aimed to assess the effectiveness of medical thoracoscopy (MT) and thoracoscopic talc poudrage (TTP) in patients with exudative pleural effusion.</p><p><b>METHODS</b>We evaluated the diagnostic yields, complications and outcomes of MT and TTP in 41 consecutive patients with symptomatic pleural effusions who were planned to undergo both procedures from 1 December 2011 to 30 November 2012. Data was reviewed retrospectively and prospectively up to March 2013.</p><p><b>RESULTS</b>Among the 41 patients, 36 underwent MT with the intent of biopsy and talc pleurodesis, 2 underwent MT for pleurodesis only and 3 had failed MT. Aetiologies of pleural effusion included lung cancer (n = 14), tuberculosis (n = 9), breast cancer (n = 7), ovarian cancer (n = 2), malignant mesothelioma (n = 1), congestive cardiac failure (n = 1), peritoneal dialysis (n = 1) and hepatic hydrothorax (n = 1); pleural effusion was undiagnosed in five patients. The overall diagnostic yield of MT, and the yield in tubercular and malignant pleural effusions were 77.8%, 100.0% and 82.6%, respectively; it was inconclusive in 22.2%. Complications that occurred were self-limiting, with no procedure-related mortality. The 30-day mortality rate was 17.1%. A total of 15 patients underwent TTP. The 30-, 60- and 90-day success rates were 77.8%, 80.0% and 80.0%, respectively, with one patient having complications (i.e. empyema). The 30-day mortality was 40.0%.</p><p><b>CONCLUSION</b>MT is a safe procedure with high diagnostic yields in undiagnosed pleural effusions. TTP is an effective method to stop recurrence of pleural effusions.</p>

Malignant Pleural Mesothelioma Diagnosed by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration / 결핵및호흡기질환

A 61-year-old woman came to the hospital with dyspnea and pleural effusion on chest radiography. She underwent repeated thoracentesis, transbronchial lung biopsy, bronchoalveolar lavage, and thoracoscopic pleural biopsy with talc pleurodesis, but diagnosis of her was uncertain. Positron emission tomography showed multiple lymphadenopathies, so she underwent endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes. Here, we report a case of malignant pleural mesothelioma that was eventually diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. This is an unusual and first case in Korea.

Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis.

Background & objectives: Chemical pleurodesis is an accepted therapy for patients with recurrent pleural effusions and pneumothorax. Iodopovidone has been shown to be safe and effective for chemical pleurodesis in several studies. The aim of this systematic review was to update a previously reported meta-analysis on the efficacy and safety of iodopovidone pleurodesis. Methods: Two databases MEDLINE and EMBASE were searched for a period (1952-2010), and studies that have reported success rates with iodopovidone pleurodesis were selected. The proportions with 95 per cent confidence interval (CI) were calculated to assess the outcomes in the individual studies and the results were pooled using a random effects model. Results: Thirteen eligible studies with 499 patients were included in the mata-analysis. The success rates varied from 70 to 100 per cent in different studies with the pooled success rate being 88.7 per cent (95% CI, 84.1 to 92.1). The success rate was not affected by the method (tube thoracostomy vs. thoracoscopy, 89.6 vs. 94.2%) or the indication of pleurodesis (pleural effusion vs. pneumothorax, 89.2 vs. 94.9%). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in six patients across the studies. There were no deaths associated with iodopovidone pleurodesis. Statistical heterogeneity and publication bias were found. Interpretation & conclusions: Iodopovidone may be considered a safe and effective agent for chemical pleurodesis in patients with pleural effusions and recurrent pneumothoraces.

Fluid-filled Giant Bulla Treated with Percutaneous Drainage and Talc Sclerotherapy: A Modified Brompton Technique

A 75-year-old man who was diagnosed as having a fluid-filled giant bulla was treated with a modified Brompton technique due to his poor performance status. Percutaneous drainage, suction, and talc sclerotherapy through a Foley catheter can be good treatment options for patients with conditions that are too poor to allow surgical intervention, especially if there is adhesion between a giant bulla and parietal pleura. Talc can also be used safely when mixed with normal saline as a sclerosant.

Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status

OBJECTIVES: To evaluate the effectiveness and safety of pleurodesis carried out entirely on an outpatient basis in patients with recurrent malignant pleural effusions and Karnofsky Performance Status scores <70. METHODS: This study was a prospective trial comprising patients with symptomatic recurrent malignant pleural effusion and Karnofsky Performance Status scores <70 but >30. All selected patients underwent pleural catheter placement (14 Fr) in an outpatient facility. When chest radiography revealed post-drainage lung expansion of >90 percent, pleurodesis (3 g of talc) was performed. Catheters were maintained until the daily output was ,100 mL/day. The patients were evaluated in the first month and every three months thereafter for fluid recurrence, the need for additional procedures, and complications. RESULTS: During the study period (January 2005 to July 2007), 64 patients (24 men, 40 women), with an average age of 61.4 years, underwent elective chest tube drainage. Primary sites of the underlying malignancy were breast (27), lung (22), and others (15). Sixty-six pleural catheters were placed (bilaterally in 2 patients), and 52 talc pleurodesis procedures were performed. Fourteen patients had a trapped lung and were excluded from the trial. No complications were observed during catheter placement or pleurodesis. Post-pleurodesis complications included catheter obstruction (4 patients) and empyema (1). The average drainage time was 9.9 days. The recurrence rate observed in patients that were alive 30 days after pleurodesis was 13.9 percent (5/36 patients). Six patients required additional procedures after the pleurodesis. The average survival time was 101 days. CONCLUSION: In this study, talc pleurodesis was safely performed in an outpatient setting with good efficacy and a reasonable complication rate, thereby avoiding hospital admission.

Pleural Effusion in a Peritoneal Dialysis Patient / 전남의대학술지

A 34-year-old female presented with end-stage renal disease (ESRD) treated by peritoneal dialysis (CAPD) complained of a dry cough. Chest X-ray and chest computed tomography (CT) scan revealed massive right hydrothorax. Because the glucose concentration of pleural fluid was markedly high compared with that of serum, we performed isotope and contrast peritoneography. We used CT for localizing it. MRI was also trying to show transdiaphragmatic leakage in peritoneoflural fistula. Temporary discontinuation of CAPD, tetracycline instillation into the pleural space and surgical patch grafting of the diaphragmatic leak have all been described. A novel method may be video-assisted talc pleurodesis.

Diagnosis and Management of Malignant Pleural Effusion / 대한내과학회지

Malignant pleural effusions (MPEs) are an important clinical problem in patients with neoplastic disease. They can occur as the initial presentation of cancer, a delayed complication in patients with previously diagnosed malignancies, or the first manifestation of cancer recurrence after therapy. Common cancer types causing MPEs include lymphomas, mesotheliomas, and carcinomas of the breast, lung, and ovaries. However, almost all tumor types have been reported to cause MPEs. Regardless of the etiology, the median survival from clinical recognition is 4 months. New imaging modalities assist the evaluation of patients with a suspected MPE. However cytologic or tissue confirmation of malignant cells is necessary to establish a diagnosis. Management of an MPE remains palliative. Managements are directed toward removing pleural fluids and when appropriate, performing pleurodesis or initiating long-term drainage to prevent fluid reaccumulation. Talc pleurodesis is still the choice of treatment although concerns about its safety remain. Several factors such as performance status, expected survival, lung re-expansion following pleural fluid drainage and co-morbidities should be considered before the treatment.