Safety and complications of medical thoracoscopy in the management of pleural diseases.

BACKGROUND: Medical thoracoscopy is considered an overall safe procedure, whereas numbers of studies focus on complications of diagnostic thoracoscopy and talc poudrage pleurodesis. We conduct this study to evaluate the safety of medical thoracoscopy in the management of pleural diseases and to compare complications in different therapeutic thoracoscopic procedures. METHODS: A retrospective study was performed in 1926 patients, 662 of whom underwent medical thoracoscopy for diagnosis and 1264 of whom for therapeutic interventions of pleural diseases. Data on complications were obtained from the patients, notes on computer system, laboratory and radiographic findings. Chi-square test was performed to compare categorical variables and Fisher's exact test was used for small samples. RESULTS: The mean age was 51 ± 8.4 (range 21-86) years and 1117 (58%) were males. Diagnostic procedure was taken in 662 (34.4%) patients, whereas therapeutic procedure was taken in 1264 (65.6%) patients. Malignant histology was reported in 860 (44.6%) and 986 (51.2%) revealed benign pleural diseases. Eighty patients (4.2%) were not definitely diagnosed and they were considered as unidentified pleural effusion. One patient died during the creation of artificial pneumothorax, and the causes of death were supposed as air embolism or an inhibition of phrenic motoneurons and circulatory system. Complication of lung laceration was found in six patients (0.3%) and reexpansion pulmonary edema was observed in two patients (0.1%). Higher incidence of prolonged air leak was observed in bulla electrocoagulation group, in comparison with pleurodesis group. Moreover, pain and fever were the most frequently complications in pleurodesis group and cutaneous infection in entry site was the most frequently reported complication in pleural decortication of empyema group. CONCLUSIONS: Medical thoracoscopy is generally a safe and effective method, not only in the diagnosis of undiagnosed pleural effusions, but also in the management of pleural diseases. Mastering medical thoracoscopy well, improving patient management after the procedure and attempts to reduce the occurrence of post-procedural complications are the targets that physicians are supposed to achieve in the future.

Erythromycin poudrage versus erythromycin slurry in the treatment of refractory spontaneous pneumothorax.

BACKGROUND: Refractory (recurrent or persistent) spontaneous pneumothorax with high recurrence rates required treatment either by continuous chest drainage or interventional approaches. Pleurodesis by sclerosing agents has become a significant therapy in the treatment of refractory spontaneous pneumothorax (RSP) on account of its high efficiency and safety. However, the efficacy, safety and appropriate mode of administration of intrapleural erythromycin for pleurodesis have not yet been realized in the treatment of RSP. METHODS: The trial was performed to compare thoracoscopic erythromycin poudrage with erythromycin slurry via a chest tube for patients with documented RSP. Fifty-seven patients with RSP were enrolled in this study with 30 patients for erythromycin poudrage and 27 patients for erythromycin slurry. Response to pleurodesis, complications and recurrences were recorded. Continuous variables were compared with t-test. Chi-square test was performed to compare categorical variables and Fisher's exact test was used for small samples. RESULTS: Twenty-four patients in the erythromycin poudrage group (80%) and sixteen in the erythromycin slurry (ES) group (59.26%) had an immediately successful pleurodesis within 5 days (P=0.087). Patients in erythromycin poudrage had shorter duration of postprocedural chest tube drainage (6.23±3.04 days) than patients in ES (10.67±9.81 days) (P=0.032). During the follow-up, there was no significant statistical difference in recurrence rates between the two groups. Common adverse reactions included fever and chest pain with no significant difference between the two groups. CONCLUSIONS: Erythromycin is an effective and safe sclerosing agent for pleurodesis in management of RSP. Both methods are safe but erythromycin poudrage is more effective than ES.