pleural symphysis

Spontaneous pneumothorax comprises app. 0.1-2 % of surgical diseases. There are four subtypes; primary, secondary, catamenial and neonatal. Aetiology of primary pneumothorax is not exactly known since there is no direct relation to any basic lung disease. Nevertheless, in most patients (80-85 %), it develops due to the rupture of an emphysematous bulla or a subpleural air bubble, i.e. blebs. On the other hand, secondary pneumothorax is a result or a complication of a verified localized or general lung disorder...

Videothoracoscopy is a minimally invasive techinique providing a direct view of the pleural cavity. It enables complete exploration of the cavity with biopsies of pathological zones. The indication, based on clinical or radiographic findings, is retained when less invasive methods have been unable to establish the diagnosis and a specific pleural disease (tumor or other) is suspected. Depending on the observations at videothoracoscopy and the suspected disease, deep biopsies to the subpleural fat can be made with a forceps if nodules have been identified...

Pleural effusions associated with malignancy--either malignant or paramalignant diseases--were found in ca. 20% of these patients. Large pleural effusions cause mainly dyspnoea but also cough and chest pain. The presence and degree of dyspnoea depend on the size of the effusion and the patient's underlying pulmonary function. In acute cases and large effusions immediate chest drainage is indicated in symptomatic patients, followed by the treatment of the underlying disease, e. g. chemotherapy. The most effective therapy for controlling reiterated malignant pleural effusions is the thoracoscopic talc poudrage (2...

PURPOSES: We investigated whether oral tetracyclines could produce an efficient and safe pleurodesis as does parenteral doxycycline, which is currently unavailable in many countries. METHODS: Parenteral doxycycline (10 mg/kg), oral tetracycline (35 mg/kg), or doxycycline (10 mg/kg) was injected intrapleurally through a right chest tube in rabbits. The oral forms were dissolved in saline solution and passed through a sterile membrane filter. When daily aspirated pleural fluid was < 5 mL/24 h, the chest tube was removed...

BACKGROUND: It has been suggested that talc and doxycycline might be acting through different pathways in creating pleurodesis. We hypothesized that combining doxycycline and talc in half the usual doses would be synergistic in inducing pleurodesis. METHODS: Thirty-two rabbits were equally allocated into four groups: group 1, half-dose combination (5 mg/kg of doxycycline and 200 mg/kg of talc slurry); group 2, quarter-dose combination (2.5 mg/kg of doxycycline and 100 mg/kg of talc slurry); group 3, half-dose doxycycline (5 mg/kg of doxycycline); and group 4, half-dose talc (100 mg/kg of talc slurry)...

STUDY OBJECTIVES: In patients with disseminated neoplastic disease, recurrent pleural effusion is frequently observed. The purpose of this study was to determine the long-term efficacy and safety of pleurodesis by thoracoscopic talc poudrage (TTP) in malignant pleural effusions (MPEs). METHODS: We report a consecutive series of 102 patients (45 women, 57 men; 20 to 83 years of age) who underwent medical thoracoscopy and TTP for recurrent MPE between 1999 and 2001...

STUDY OBJECTIVE: The aim of this study was to examined whether transforming growth factor (TGF)-beta(3) induces pleurodesis in rabbits and collagen production by human pleural mesothelial cells in vitro. DESIGN: A combined animal and in vitro study. METHODS: TGF-beta(3) was injected intrapleurally in rabbits at the following doses: 0.167 mug, 0.5 mug, 1.67 mug, and 5 mug (five rabbits per group). The rabbits were killed 14 days following injection, and pleurodesis was graded from 1 (none) to 8 (complete symphysis)...

OBJECTIVE: To provide further information addressing the etiology, optimal hormonal management and surgical management in catamenial pneumothorax (CP). METHODS: We retrospectively analyzed records of all female patients operated on for spontaneous pneumothorax at a university hospital between January 1993 and March 2002. RESULTS: In eight of 24 patients, pneumothoraces were timed with menses. In all, the right side was involved. Seven patients were on hormonal medications pre-operatively and six post-operatively...

Recurrent pleural malignant effusion is a common problem which can be treated by inducing symphysis of the pleural sheets. Many different drugs administered into the pleural space can be used to achieve this. The drugs cause an inflammatory response, which in turn is believed to cause the symphysis. Comparatively little has been published on the degree of pleural inflammation and the systemic response and whether this will affect the outcome. The aim of this study was to describe the systemic inflammatory reaction following instillation of a chemical agent into the pleura and to investigate whether this had any predictive value for the outcome (i...

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INTRODUCTION: Among the agents used to produce pleural symphysis talc is the most effective and least expensive. However, its use is controversial on account of the description of respiratory complications associated with subsequent systemic spread of the talc particles. This hypothesis rests on clinical and experimental observations of talc particles in the viscera. However, all talc preparations are not identical and this extra-pleural spread could be dependent on particle size. This experimental study was undertaken to determine whether there was systemic spread of a calibrated talc preparation used routinely in clinical practice following intra-pleural administration in rats...

Management of recurrent malignant pleural effusion, a common complication of malignancy, poses a challenge to clinicians. Although almost one century has elapsed since the introduction of the pleurodesis procedure, the ideal approach and best agent are still to be defined. Optimally, pleurodesis should be done at the bedside with a minimally invasive procedure, and suitable agents to achieve pleural symphysis should be inexpensive, available worldwide and free of adverse effects. To date, no substance completely fulfills these requirements...

OBJECTIVE: To evaluate the advantages of the ultrasonic scalpel compared to electrocoagulation in patients undergoing video-assisted thoracoscopic sympatholysis or sympathectomy for uncontrolled facial blushing. METHODS: Two hundred bilateral video-assisted thoracoscopic procedures to interrupt transmission in the thoracic sympathetic nerve were performed in 100 patients with incapacitating facial blushing. In 2 cases, the video-assisted approach was chosen because of pleural symphysis...

This study prospectively evaluated the usefulness of thoracoscopy for staging non-small cell lung cancer in 105 consecutive patients. A comparison was made of TNM stage grouping classification according to clinical disease, thoracoscopic data, and pathological findings. In 40 (38%) patients, thoracoscopy was unreliable for assessing extent of disease due to pleural symphysis. In 13 T1 clinical lesions, thoracoscopy was unreliable in 5, clinical and thoracoscopic staging concurred in 4, but 4 cases changed to T2...

By 2002, we had attempted video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy for 140 primary lung cancer cases. Four cases (2.9%) were converted to standard posterolateral thoracotomy for oncologic reasons and aortic injury, and 7 cases (5%) were converted to minithoracotomy with a 10 cm incision due to almost injuring the vascular system. Average blood loss in these cases was 379 ml, and there was no blood transfusion required. Seven of these 11 cases had true pleural symphysis in the thoracic cavity...

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