Use of indwelling pleural catheters for the definitive treatment of malignant pleural effusion / Utilização de cateter pleural de longa permanência para o tratamento definitivo de derrame pleural neoplásico

ABSTRACT Objective: To evaluate the safety and feasibility of the use of indwelling pleural catheters (IPCs) in patients with malignant pleural effusion (MPE). Methods: We prospectively collected data from patients with MPE undergoing IPC placement between January of 2014 and July of 2015. All patients submitted to IPC placement had a life expectancy > 30 days, in accordance with the MPE treatment guidelines established by the British Thoracic Society. The data collected included gender, age, body mass index, primary cancer site, duration of IPC drainage, IPC-related complications, length of hospital stay, pleural effusion recurrence, and occurrence of spontaneous pleurodesis. Results: A total of 19 patients underwent IPC placement during the study period. Median overall survival after IPC insertion was 145 days. The median follow-up among the surviving patients was 125 days (range, 53-485 days), and the median time between catheter insertion and removal was 31 days (range, 2-126 days). There were IPC-related complications in 5 patients (26.2%), and spontaneous pleurodesis was achieved in 8 (42.0%). Among those 8 patients, the IPC was removed between days 30 and 126 in 4, and spontaneous pleurodesis occurred within the first 30 days in 4. Conclusions: The use of IPCs seems to be feasible and safe in patients with MPE.

RESUMO Objetivo: Avaliar a segurança e a viabilidade do uso de cateter pleural de longa permanência (CPLP) em pacientes com derrame pleural neoplásico (DPN). Métodos: Dados referentes a pacientes com DPN que receberam CPLP entre janeiro de 2014 e julho de 2015 foram colhidos prospectivamente. Todos os pacientes que receberam CPLP tinham expectativa de vida > 30 dias, em conformidade com as diretrizes de tratamento de DPN da Sociedade Torácica Britânica. Foram colhidos dados sobre sexo, idade, índice de massa corporal, local do câncer primário, tempo de drenagem com o CPLP, complicações relacionadas com o CPLP, tempo de internação hospitalar, recidiva do derrame pleural e ocorrência de pleurodese espontânea. Resultados: Dezenove pacientes receberam CPLP durante o período de estudo. A mediana de sobrevida global após a inserção do CPLP foi de 145 dias. A mediana de tempo de acompanhamento dos pacientes sobreviventes foi de 125 dias (variação: 53-485 dias), e a mediana de tempo decorrido entre a inserção e a remoção do cateter foi de 31 dias (variação: 2-126 dias). Houve complicações relacionadas com o CPLP em 5 pacientes (26,2%) e pleurodese espontânea em 8 (42,0%). Nesses 8 pacientes, o CPLP foi retirado entre os dias 30 e 126 em 4, e a pleurodese espontânea ocorreu nos primeiros 30 dias em 4. Conclusões: O uso de CPLP parece ser viável e seguro em pacientes com DPN.

Diagnóstico e tratamento dos derrames pleurais malignos / Diagnosis and treatment of malignant pleural effusions

Carcinomas brônquicos, com maior frequência os adenocarcinomas, linfomas e carcinoma de mama, constituem 75% das causas de derrame pleural maligno (DPM). Para utilização das diversas opções terapêuticas paliativas disponíveis deve ser considerada uma avaliação multidisciplinar do estado do paciente, em conjunto com a experiência do profissional médico assistente, a capacidade técnica da instituição onde o tratamento será realizado e o custo-benefício AU.

Lung cancer, more often adenocarcinomas, lymphomas and breast carcinoma, are 75.0% of the causes of malignant pleural effusion. Palliative therapeutic options should be considered a multidisciplinary assessment of the patient's condition, together with the experience of the physician assistant professional, technical capacity of the institution where the treatment will be carried out and cost-effective AU.

Fatores prognósticos para a sobrevida dos pacientes com derrame pleural maligno / Prognostic factors for survival in patients with malignant pleural effusion

Introdução: O tratamento paliativo dos pacientes com Derrame Pleural Maligno (DPM) deve ser individualizado uma vez que esses pacientes têm sobrevida reduzida. O objetivo deste estudo foi desenvolver um modelo capaz de identificar os fatores prognósticos relacionados à sobrevida dos pacientes com DPM. Métodos: É um estudo retrospectivo, descritivo, observacional para identificar fatores prognósticos relacionados ao DPM em pacientes com diagnóstico confirmado de câncer oriundos do banco de dados do Instituto Nacional do Câncer (INCA), vinculado ao Ministério da Saúde. A análise multivariada de Kaplan-Meier e o modelo de regressão de Cox foram utilizadas para determinar os fatores com potencial prognóstico relacionados à sobrevida desses pacientes. A sobrevida foi definida como o tempo do diagnóstico anátomo patológico até o óbito. Resultados: Cento e sessenta e cinco pacientes foram incluídos no estudo; 77 homens (47%), e 88 mulheres (53%). A mediana da idade foi de 60 anos (1,0 ­ 95,0), e todos os pacientes tinham DPM confirmados por exames cito e/ou histopatológicos. O carcinoma de pulmão, do tipo não pequenas células (36%), a neoplasia de mama (26%) e os linfomas (13%) foram os tumores mais frequentemente diagnosticados. A mediana da sobrevida global dos pacientes a partir do diagnóstico foi de 5 meses (1,0-96,0). A análise univariada de Kaplan-Meier demonstrou que a sobrevida dos pacientes estava significativamente relacionada com os seguintes fatores prognósticos: a escala de capacidade funcional (PS) da Eastern Cooperative Oncology Group (ECOG) (HR 10,0, IC 95%: 5,96 a 18,50, p < 0,0001), local do tumor primário (HR 1,99, IC 95%: 1,23 a 3,22, p < 0,01), citologia oncótica do líquido pleural positiva (HR 1,25, IC 95%: 0,88 a 1,78, p = 0,04), e exame histológico da pleura positivo (HR 1,33, IC 95%: 0,97 a 1,81, p = 0,04). Outros fatores prognósticos independentes avaliados não tiveram influência na sobrevida. A análise de regressão de Cox demonstrou que somente a escala da capacidade funcional (PS) da ECOG estava altamente relacionada com a sobrevida dos pacientes (HR 73,58, IC 95%: 23,44 a 230,95, p < 0,0001). Conclusões: a escala da capacidade funcional (PS) da ECOG foi um fator previsor independente de sobrevida para os pacientes com DPM no momento do diagnóstico inicial. Este fator prognóstico pode auxiliar os médicos na seleção dos pacientes para o tratamento paliativo apropriado da síndrome do DPM. AU

Background: The approach to palliative treatment of malignant pleural effusion (MPE) should be individualized because these patients generally have poor survival. This study aimed to develop a model to identify prognostic factors for survival time in patients with MPE. Methods: This is a retrospective, descriptive, observational study to identify prognostic factors related to MPE in patients with a confirmed diagnosis of cancer. Cox regression analysis was used to determine significant potential prognostic factors with respect to survival time. Survival time was defined as the time from pathological diagnosis to death. Results: One hundred and sixty-five patients were included; 77 were men (47%) and 88 were women (53%). The median age was 60 years (1.0 ­ 95.0), and all of the patients were pathologically proven to have MPE. Non-small-cell lung cancer (36.0%), breast carcinoma (26%), and lymphoma (13.0%) were the most frequently diagnosed tumors. The median overall survival of patients from the initial diagnosis was 5 months (range: 1.0­96.0 months). The Kaplan­Meier univariate analysis showed that survival was significantly related to the following prognostic factors: Eastern Cooperative Oncology Group - Performance Status (ECOG - PS) (HR 10.0; 95% CI: 5.96 to 18.50, p < 0.0001); primary cancer site (HR 1.99; 95% CI: 1.23 to 3.22, p < 0.01); positive pleural cytology (HR 1.25; 95% CI: 0.88 to 1.78, p = 0.04); and positive histology (HR 1.33; 95% CI: 0.97 to 1.81, p = 0.04). Other potential independent diagnostic factors that were examined did not affect survival. Cox regression analysis showed that only the ECOG PS was highly predictive of survival (HR 73.58; 95% CI: 23.44 to230.95, p < 0.0001). Conclusions: ECOG PS is an independent predictor of survival in patients with MPE at initial diagnosis. This prognostic factor can help physicians select patients for appropriate palliative treatment of this syndrome. AU

Aspectos diagnósticos y terapéuticos en el mesotelioma pleural maligno / Diagnostic and therapeutic aspects in malignant pleural mesothelioma

Para el diagnóstico de mesotelioma se requiere distinguir entre afectación mesotelial benigna y maligna, y entre mesotelioma maligno y carcinoma metastásico. Para ello son necesarias técnicas inmuno-histoquímicas realizadas sobre biopsias amplias. La toracoscopia es la técnica de elección, aunque la biopsia con aguja usando técnicas de imagen en tiempo real puede ser muy útil si hay marcado engrosamiento nodular. Es improbable que la cirugía radical (pleuroneumonectomía) sea realmente curativa, por lo que está ganando adeptos la reducción de masa tumoral mediante pleurectomía/decorticación, con asociación de quimioterapia y radioterapia a la cirugía (terapia multimodal). Cuando la resección no es factible se plantea quimioterapia, con pleurodesis o colocación de un catéter pleural tunelizado si se requiere el control del derrame pleural y se reserva la radioterapia para tratar la infiltración de la pared torácica. También es esencial un completo control del dolor (que adquiere particular protagonismo en esta neoplasia) en unidades especializadas.

Diagnosis of malignant pleural mesothelioma requires making the distinction between benign mesothelial hiperplasia and true mesothelioma, and between malignant mesothelioma and metastatic pleural adenocarcinoma. This involves immunohisto-chemical techniques applied on large biopsy specimens, and thoracoscopy is the best choice for obtaining them. Real-time image-guided needle biopsy can also be very helpful in presence of marked nodular pleural thickening. Radical surgery (ie, extrapleural pneumonectomy) is unlikely to cure completely the patient, and cyto-reduction surgery with preservation of the underlying lung (pleurectomy/decortication), with addition of chemo and radiation therapy (muiltimodal treatment) is gaining adepts in the last few years. When surgery is not feasible at all, early chemotherapy -with pleurodesis or placement of a indwelling pleural catheter (to control the effusion if necessary)- is advisable. Radiation therapy should be reserved to treat chest wall infiltration in those cases, and complete control of pain in specialized units is also essential in those patients.

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 and safety of iodopovidone in an experimental pleurodesis model

OBJECTIVES: Chemical pleurodesis is an important therapeutic tool to control recurrent malignant pleural effusion. Among the various sclerosing agents, iodopovidone is considered effective and safe. However, in a recent study, ocular changes were described after iodopovidone was used in recurrent pneumothorax. The aim of the study was to evaluate the efficacy and morbidity of iodopovidone pleurodesis in an experimental model. METHODS: New Zealand rabbits were submitted to intrapleural injection of iodopovidone at concentrations of 2%, 4% and 10%. Biochemical (lactic dehydrogenase, proteins, triiodothyronine, free thyroxine, urea and creatinine) and immunological (Interleukin-8 [IL-8], VEGF and TGFβ) parameters were measured in the pleural fluid and blood. After 1, 3, 7, 14 and 28 days, groups of animals were euthanized, and macro- (pleura) and microscopic (pleura and retina) analyses were performed. RESULTS: An early pleural inflammatory response with low systemic repercussion was observed without corresponding changes in thyroid or renal function. The higher concentrations (4% and 10%) correlated with greater initial exudation, and maximum pleural thickening was observed after 28 days. No changes were observed in the retinal pigment epithelium of the rabbits. CONCLUSION: Iodopovidone is considered to be an effective and safe sclerosing agent in this animal model. However, its efficacy, tolerance and safety in humans should be further evaluated. .

new look at an old agent for pleurodesis

Background and objective: Malignant pleural effusion [MPE] is a common problem in patients with malignancies. Chemical pleurodesis is the most commonly used palliative option. Parenteral tetracycline [TET] and doxycycline [DOX] are cost-effective and safe in producing pleurodesis but mostly unavailable currently. We investigated whether oral doxycycline could produce an efficient and safe pleurodesis as does parenteral doxycycline, which is currently unavailable in many countries

Methods: A prospective study of 24 pleurodesis procedures in 22 patients with malignant pleural effusions were conducted over a 3-year period. All pleurodesis was performed with oral forms of doxycycline as the sclerosing agent, where about 1000 mg of doxycycline was taken and prepared from the oral preparation [vibramycin 100 mg/capsule] and mixed in 50 ml. Physiological saline was then administered via tube thoracostomy. We assessed the success or failure of pleurodesis in addition to the frequency of complications and survival. Post-pleurodesis postero-anterior [PA] radiographs were obtained after tube removal and 30 days following the procedure

Results: Twenty-two patients were included [6 women, 16 men], the mean age was [62.5 years]. Origins of MPE were: lung and pleura 8 [36.4%], breast 2 [9.1%], ovarian 2 [9.1%], digestive 3 [13.6%], lymphoma 3 [13.6%] and unknown 4 [18.2%]. No immediate perioperative complications were noted. Chest tube duration averaged 4.2 +/- 2.6 days. Immediate postoperative events included chest pain in 10 patients [45.5%], fever in 2 [9.1%] patients, pain and fever in 5 patients [22.7%]. Sixteen patients [72.7%] had successful pleurodesis and 6 patients [27.3%] had failed pleurodesis at 1 month

Conclusions: Pleurodesis with oral forms of doxycycline dissolved in sterile saline solution have a high success rate with a low incidence of complications and could be a good option as palliative therapy in patients with symptomatic malignant pleural effusions

Povidone-iodine versus bleomycin pleurodesis for malignant effusion in bronchogenic cancer guided by thoracic echography

This study was designed to compare effectiveness of intra-pleural instillation of bleomycin with instillation of povidone-iodine for control of malignant pleural effusion among patients with non-small cell lung cancer, guided by results of thoracic echography. Fifty one patients had the possibility of full lung expansion. Drainage of the effusion was followed by instillation of bleomycin or povidone- iodine through the thoracostomy tube. Four weeks after discharge, thoracic echography was performed and repeated 4 weeks later. Follow-up ranged between 4-32 months [mean: 21 + 3.5 months]. We received 79 patients with malignant pleural effusion as stage IV non-small cell lung cancer during the last four years. Seventeen patients had centrally-located tumors with persistent lung atelectasis. lntra-pleural injection of streptokinase to breakdown intra-pleural fibrinous adhesions, was carried out in 9 cases; and was successful in 6 cases 66% [6/9]. Finally, 54 patients had an evidence of possible lung expansion but three died before pleurodesis. Thus, 51 patients received intrapleural instillation of bleomycin or povidone-iodine in a randomized prospective comparative study. Among bleomycin group [no.=26]. echography showed excellent pleurodesis [no.= 21], effective pleurodesis [no.= 2] with one or two areas of free mobility and one area of fluid component, weak pleurodesis [no.= 3] with three areas of free lung movement [lung sliding sign] and areas of fluid component. Among povidone-iodine group [no.=25] excellent pleurodesis [no.=20], effective [no.=2] and weak pleurodesis.[no.=3]. The six cases with weak pleurodesis in both groups were those who had streptokinase before pleurodesis. Complications and hospital stay were comparable for both groups. Chest x-ray proved recurrence of effusion in the six cases with weak pleurodesis after symptom-free intervals that varied between 4 and 6 weeks among these 6 patients. Both bleomycin and povidone-iodine produced comparable excellent and effective pleurodesis among patients with malignant pleural effusion. The cost is much lower with povidone-iodine.

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.

Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central / Pleurodesis for malignant pleural effusions: a survey of physicians in South and Central America

OBJETIVO: A pleurodese é uma alternativa eficaz no controle dos derrames pleurais malignos, mas existem controvérsias a respeito de sua indicação e técnica. O objetivo deste estudo foi avaliar como é realizada a pleurodese em países da América do Sul e Central. MÉTODOS: Profissionais que realizam pleurodese responderam um questionário sobre critérios de indicação para pleurodese, técnicas utilizadas e desfechos. RESULTADOS: Nossa amostra envolveu 147 profissionais no Brasil, 49 em outros países da América do Sul e 36 em países da América Central. Mais de 50 por cento dos participantes realizavam pleurodese somente se confirmada a malignidade no derrame pleural. Entretanto, escalas de dispneia e de status de performance eram raramente utilizadas para indicar o procedimento. Aproximadamente 75 por cento dos participantes no Brasil e na América Central preferiam realizar a pleurodese somente no caso de recidiva do derrame, e a expansão pulmonar deveria variar de 90 por cento a 100 por cento. O talco slurry foi o agente mais utilizado, instilado via drenos de calibre intermediário. A toracoscopia foi realizada em menos de 25 por cento dos casos. Febre e dor torácica foram os efeitos adversos mais comuns, e empiema ocorreu em < 14 por cento dos casos. A média de sobrevida após o procedimento variou entre 6 e 12 meses. CONCLUSÕES: Há variações consideráveis quanto aos critérios de indicação para pleurodese, técnicas utilizadas e desfechos entre os países. Talco slurry é o agente mais frequentemente utilizado, e a toracoscopia é a primeira escolha no Brasil. Os baixos índices de complicações e o tempo de sobrevida elevado indicam que a pleurodese é efetiva e causa poucos efeitos adversos.

OBJECTIVE: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. METHODS: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. RESULTS: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50 percent of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and performance status scales were rarely used as indications for the procedure. Nearly 75 percent of the respondents in Brazil and in Central America preferred to perform pleurodesis only for recurrent effusions and stated that lung expansion should be 90-100 percent. Talc slurry, instilled via medium-sized chest tubes, was the agent most often employed. Thoracoscopy was performed in less than 25 percent of cases. Fever and chest pain were the most common side effects, and empyema occurred in < 14 percent of cases. The mean survival time after the procedure was most often reported to be 6-12 months. CONCLUSIONS: There was considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil. Pleurodesis is an effective procedure that has few side effects, as evidenced by the low complication rates and high survival times.

Derrame pleural maligno: abordagem individualizada conforme apresentação clínica / Malignant pleural effusion: individual management according to clinical presentation

Os pacientes com derrame pleural maligno (DPM) têm neoplasias em fase avançada com mau prognóstico e baixa resposta a tratamento sistêmico. Devido à curta expectativa de vida e ao controle muitas vezes ineficaz pela quimioterapia, quando se apresentam muito sintomáticos alguma terapêutica paliativa efetiva é necessária para oferecer conforto e qualidadede vida a estes pacientes. Porém, visto a grande variedade de apresentações clínicas, a terapêutica ideal não deve ser generalizada para todos os pacientes com DPM, como é pode ser observado em muitos ensaios clínicos sobre o assunto. Esta deve ser individualizada considerando principalmente a performance status e as condições clínicas do paciente. Revisamos as várias opções terapêuticas descritas na literatura para o tratamento de pacientescom DPM, propondo uma abordagem individualizada destes pacientes, de acordo com a suas...

Malignant pleural effusion (MPE) patients have advanced neoplasms with bad prognosis and low response of systemic therapy. When symptomatic, a palliative treatment is mandatory in order to offer comfort and quality of life to these patients. Several options areavailable, as ambulatory procedures and video assisted thoracic surgery. The clinical efficacy of these methods is a matter of debate and subject of many papers. Because of the high varietyof clinical presentations, no single method should be considered as a gold standard procedure, rather the management should be individualized considering the performance status and clinical condition of the patient. We reviewed the options described in the literature for the treatment ofMPE and proposed an individualized management strategy for these patients according to their clinical presentation...

Resultados preliminares de la pleurodesis con talco para el tratamiento de los derrames pleurales de causa maligna / Preliminary results of the pleurodesis with talc for the treatment of the spills pleurales of wicked cause

Se realizó un corte preliminar de un estudio descriptivo y prospectivo que se lleva a cabo en el Instituto Nacional de Oncología y Radiobiología, con el objetivo de conocer la efectividad de la pleurodesis con talco para evitar las recidivas de los derrames pleurales de causa maligna, aplicado a través de una pleurotomía mínima baja o por videotoracoscopia. Además, para valorar la ocurrencia de efectos adversos y complicaciones. Catorce individuos fueron incluidos tras presentar derrames secundarios a: metástasis de cáncer de mama (7; 50 por ciento), de pulmón (2; 14 por ciento), de colon (1; 7 por ciento), esófago (1; 7 por ciento), de ovario (1; 7 por ciento) de cuello uterino (1; 7 por ciento) y un paciente con mesotelioma (7 por ciento). No hubo recidivas sintomáticas ni efusiones mayores de 500 mL, tampoco efectos adversos menos graves ni graves. Por esta razón valoramos que en estos pacientes fue efectivo y seguro el uso del talco para provocar pleurodesis en los derrames pleurales de causas malignas y que mejoró la calidad de vida de estos(AU)

He/she was carried out a preliminary cut of a descriptive and prospective study that is carried out in the National Institute of Oncología and Radiobiología, with the objective of knowing the effectiveness of the pleurodesis with talc to avoid the relapses of the spills pleurales of wicked cause, applied through a low minimum pleurotomía or for videotoracoscopia. Also, to value the occurrence of adverse effects and complications. Fourteen individuals were included after presenting secondary spills to: cancer metástasis of he/she suckles (7; 50 percent), of lung (2; 14 percent), of colon (1; 7 percent), esophagus (1; 7 percent), of ovary (1; 7 percent) of uterine neck (1; 7 percent) and a patient with mesotelioma (7 percent). there were not symptomatic relapses neither gushes bigger than 500 mL, neither less serious adverse effects neither burden. For this reason we value that in these patients it was effective and sure the use of the talc to cause pleurodesis in the spills pleurales of wicked causes and that it improved the quality of life of these(AU)

Derrame pleural neoplásico / Malignant pleural effusion

O derrame pleural neoplásico é uma complicação freqüente nos pacientes portadores de tumores avançados. A presença de células malignas no líquido pleural ou na biópsia da pleura é indicativa de disseminação da doença primária, com conseqüente redução da expectativa de vida. O diagnóstico e tratamento precoce do derrame pleural maligno são fundamentais para promover uma melhor qualidade de vida aos pacientes portadores de câncer avançado.

The malignant pleural effusion is a frequent complication in patients with of advanced tumors. The presence of malignant cells in the pleural fluid or in the pleural biopsy is indicative of dissemination of the primary disease, with consequent reduction of life expectancy. The early diagnosis and treatment of the malignant effusion is pivotal in promoting a better quality of life to patients with advanced cancer.

Pleurodese: técnica e indicações / Pleurodesis: technique and indications

O derrame pleural recidivante é uma situação clínica comum que compromete a qualidade de vida dos pacientes, em especial dos portadores de doença oncológica em estágio avançado. A abordagem terapêutica do espaço pleural é variada, incluindo procedimentos agressivos como a pleurectomia. A pleurodese é a técnica mais freqüentemente utilizada, podendo ser induzida tanto através da inserção de cateteres pleurais, como por procedimentos cirúrgicos amplos (toracotomia). São vários os agentes esclerosantes indicados, incluindo o talco, que é o mais utilizado, o nitrato de prata e recentemente as citocinas proliferativas. Este artigo resume as principais abordagens do derrame pleural recidivante e particularmente da pleurodese, suas indicações, vantagens e desvantagens para a aplicação na prática diária do pneumologista.

Recurrent pleural effusion, which is commonly seen in clinical practice, compromises patient quality of life, especially in patients with advanced malignant disease. The therapeutic approach to the pleural space involves a wide range of techniques, including aggressive procedures such as pleurectomy. Among such techniques, pleurodesis is the most frequently used. Pleurodesis can be induced through the insertion of pleural catheters, as well as through major surgical procedures (such as thoracotomy). There are various recommended sclerosing agents, including talc (which is the most widely used), silver nitrate and, recently, proliferative cytokines. This article summarizes the principal approaches to the treatment of recurrent pleural effusion, pleurodesis in particular, addressing the indications for, as well as the advantages and disadvantages of, their application in daily pulmonology practice.

Short term results after tetracycline pleurodesis in recurrent pneumothorax and malignant pleural effusion

Therapeutic Tetracycline pleurodesis was performed in twenty-nine patients, including Twelve men and seventeen women, the aim of this pro spective study was to determine the Cure or success rate of pleurodesis for recurrent pneumothorax and malignant pleural effusion with tetracycline. From 1995 to 1999, twenty-nine patients were enrolled; eighteen were with malignant pleural effusion and eleven with pneumothorax. Pleurodesis was induced by instillation of tetracycline through Pleural drain. Followup period was from six months to forty months, with mean of fifteen months. Follow up rates were ninety-four percents. Three patients required repeated pleurodesis

Derrame pleural neoplásico: diagnóstico e tratamento / Malignant pleural effusion: diagnosis and treatment

Aproximadamente 10 por cento de todos os pacientes com câncer apresentam derrame pleural durante a evoluçäo de sua doença. Dos pacientes com câncer disseminado, 50 por cento iräo apresentar derrame pleural. Em 65 por cento das vezes os derrames pleurais neoplásicos ocorrem em mulheres devido à maior incidência dos cânceres de mama e ginecológico. Considerando todos os derrames pleurais constituídos por exsudato, 24 a 50 por cento säo secundários a doenças malignas. A distinçäo entre o derrame pleural neoplásico e derrames pleurais de outras etiologias é de fundamental importância, devendo a conduta terapêutica ser a mais específica possível. Säo considerados os aspectos relevantes no diagnóstico, diagnóstico diferencial e tratamento dos derrames pleurais neoplásicos.

Videotoracoscopia y pleuroscopia: análisis del real alcance de cada método / Videothoracoscopy and pleuroscopy: real range of each method

Desde el 1/VI/1992 al 31/III/1994 se realizaron 62 abordajes toracoscópicos: 35 videotoracoscopias y 27 pleuroscopias. En las videotoracoscopias se utilizó anestesia general con intubación traqueal de doble luz, siendo las indicaciones más frecuentes el neumotórax espontáneo (12 casos), infiltrado pulmonar (6 casos), nódulo pulmonar (6 casos), derrame pleural (4 casos) y tumor de mediastino y derrame pericárdico (2 casos cada uno). En las pleuroscopias se utilizó anestesia local en 14 casos y general con intubación simple en las otras 13. Correspondieron a 24 derrames pleurales y 3 neumotórax. No hubo complicaciones ni fallecidos relacionados con el procedimiento de ambos grupos. La pleuroscopia sigue vigente como método de estudio del derrame pleural sin diagnóstico. Es un procedimiento simple, de bajo costo y puede realizarse con anestesia local. Tiene una precisión diagnóstica del 90 por ciento y posibilita un eventual tratamiento de pleurodesis. La videotoracoscopia puede reemplazar con seguridad a la toracotomía como abordaje de biopsias y resecciones menores pulmonares, derrame pericárdico, quistes y tumores benignos de mediastino, empiema temprano y hemotórax. Con ella se reduce la morbilidad, el dolor postoperatorio, la hospitalización, los costos y se acelera la recuperación del paciente