Pleurodesis with Iodized Talc for Malignant Effusions Using Pigtail Catheters

1998 ◽  
Vol 32 (7-8) ◽  
pp. 739-742 ◽  
Author(s):  
Robert L Thompson ◽  
Jonathan C Yau ◽  
Ronald F Donnelly ◽  
Debra J Gowan ◽  
Frederick RK Matzinger
Keyword(s):  
Pleural Effusion ◽  
Tertiary Care ◽  
Pleural Space ◽  
Pigtail Catheter ◽  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Malignant Pleural Effusions ◽  
Kaplan Meier ◽  
A Prospective Study ◽  
The Cost

OBJECTIVE: To assess the efficacy of using an iodized talc slurry as a sclerosing agent instilled into the pleural space via a 12-French pigtail catheter for controlling malignant pleural effusions. DESIGN: A prospective study in which patients were followed until their death. SETTING: A university-affiliated tertiary-care teaching hospital. PATIENTS: Medical oncology patients admitted with symptomatic malignant pleural effusions were considered for iodized talc pleurodesis. MAIN OUTCOME MEASURES: The control of pleural effusion. Treatment failure was defined as any reaccumulation of fluid in the pleural space. RESULTS: Fifteen patients were treated for a total of 17 instillations. The median follow-up on all patients until death was 6 months (range 1–20). The most frequent adverse effect in the study group was pleuritic chest pain (60%). The probability of control of effusion, as determined by the method of Kaplan–Meier, was 81% (SEM 9.7%). The cost of preparing 5 g of iodized talc was $4.32 (US). CONCLUSIONS: Iodized talc slurry instilled through a small-bore pigtail catheter is a safe, economical, and effective treatment for malignant pleural effusion.

scholarly journals Diagnostic Accuracy of Sonographic Septations in Tuberculous and Malignant Pleural Effusions

2020 ◽  
Vol 9 (2) ◽  
pp. 95-102
Author(s):  
Abdul Rasheed Qureshi ◽  
Muhammad Irfan ◽  
Zeeshan Ashraf
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Tertiary Care ◽  
Positive Likelihood Ratio ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Pleural Effusions ◽  
Malignant Pleural Effusions ◽  
Malignant Group

Background: Discrimination between tuberculous (TB) and malignant pleural effusions is a real practical challenge because both exist as exudative lymphocytic type. Transthoracic ultrasonography not only identifies and quantifies pleural effusion but also displays sonographic septations, which are frequently seen in TB pleural effusions and can help in differentiation between tuberculosis and malignancy successfully, without any invasive procedure. We designed this study to determine the diagnostic usefulness of these septations for tuberculous and malignant pleural effusions. Material and Methods: This prospective study was conducted in the OPD of Gulab Devi Chest Hospital Lahore, Pakistan, a 1500 bedded tertiary care hospital, from November 2016 to February 2018. Total of 339 consecutive cases, aged 14-83 years with radiological evidence of pleural effusion were included in the study. After detailed history, thorough physical examination, radiological, haematological and biochemical findings were recorded. Pleural fluid macroscopic, cytological, microbiologic and biochemical analysis results were also recorded. Ultrasonography was done, septated and non-septated pleural effusions identified and findings were noted. SPSS-16 was used for statistical evaluation. Fisher Exact test was utilized for comparison between TB and malignant cases with P-value < 0.05 taken as significant. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and positive likelihood ratio were calculated. Results: Out of total 339 cases, 49 (14.45%) were malignant and 290 (85.55%) were non-malignant. In the malignant group, only 03 cases (6.12%) showed sonographic septations. In the non-malignant group, 259/290 (89.31%) cases showed tuberculous etiology and 187/259 (72.20%) of these cases displayed sonographic septations. By considering septations as predictor of TB, statistical analysis revealed a sensitivity of 79.23%, specificity of 92.85%, PPV of 98.42%, NPV of 44.31% and diagnostic accuracy of 81.29%, respectively. Conclusions: Sonographic septations can be a valuable predictor of tuberculosis, in a population with high prevalence of the disease. We found it to be a useful feature in differentiating between a malignant and tuberculous etiology, in exudative lymphocytic pleural effusions. It can be used with confidence in patients who are unfit for interventional procedures.

scholarly journals Profile of children with pleural effusion in an urban tertiary care hospital

2017 ◽  
Vol 4 (5) ◽  
pp. 1857
Author(s):  
Maulik P. Saliya ◽  
Gurudutt S. Joshi
Keyword(s):  
Pleural Effusion ◽  
Clinical Symptoms ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Pleural Effusions ◽  
Number Of Patients ◽  
Laboratory Profile ◽  
Almost All ◽  
A Prospective Study

Background: Management of pleural effusions depends on their origin whether exudates or transudates, simple or complicated with septations and pneumonia. A complicated effusion requires longer treatment. This study was carried out to find out types of effusion and their etiology.Methods: A Prospective study of 34 patients was analyzed for clinical and laboratory profile, origin and type of fluid, etiology of pleural effusion in pediatric patients.Results: Majority of the patients were in 6-11 years age group. Fever and cough were most common clinical symptoms in all type of effusion. Parapneumonic effusion was most common type of effusion followed by tuberculosis and empyema. Almost all exudates satisfied Lights criteria.Conclusions: Pleural effusions are mostly exudative in origin in pediatric age and are associated with consolidation and septations especially in empyema. In tubercular Pleural effusion, Sputum for AFB was positive in more number of patients as compared to CBNAAT in this study. 

scholarly journals Management of Malignant Pleural Effusions with Indwelling Pleural Catheters or Talc Pleurodesis

2013 ◽  
Vol 20 (2) ◽  
pp. 106-110 ◽  
Author(s):  
Nadim Srour ◽  
Kayvan Amjadi ◽  
Alan John Forster ◽  
Shawn David Aaron
Keyword(s):  
Pleural Effusion ◽  
Group Performance ◽  
Performance Status ◽  
Management Strategies ◽  
Eastern Cooperative Oncology Group ◽  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Free Survival ◽  
Malignant Pleural Effusions ◽  
Pleural Catheter

BACKGROUND: Management of malignant pleural effusion typically involves insertion of an indwelling pleural catheter (IPC) or chemical pleurodesis with agents such as talc.OBJECTIVES: To compare these management strategies with regard to success of pleural effusion management.METHODS: A retrospective cohort study was designed comparing patients with malignant and paramalignant pleural effusions and Eastern Cooperative Oncology Group performance status <4 managed with IPC insertion or talc pleurodesis (TP) through tube thoracostomy during non-contemporary three-year periods at a single centre.RESULTS: The IPC and TP groups comprised 193 and 167 patients, respectively. The pleural effusion control rate at six months was higher in the IPC group (52.7% versus 34.4% in the TP group; P<0.01), but the rate of freedom from catheter at 90 days and pleural effusion at 180 days was not significantly different (IPC 25.8% versus TP 34.4% [P=0.17]). Median effusion-free survival from the date of catheter insertion was significantly longer in the IPC group (101 days versus 58 days in the TP group; log-rank P=0.025). Both procedures were safe.DISCUSSION: While the results suggest better pleural effusion control and longer effusion-free survival with IPC insertion compared with TP, the present study had several limitations. Other recent studies have not shown one strategy to be clearly superior to the other.CONCLUSION: Both IPC insertion and TP remain acceptable options for the management of malignant pleural effusions.

scholarly journals Matrix metalloproteinases production in malignant pleural effusions after talc pleurodesis

2003 ◽  
Vol 134 (1) ◽  
pp. 138-142 ◽  
Author(s):  
P. D’AGOSTINO ◽  
A. RAO CAMEMI ◽  
R. CARUSO ◽  
F. ARCOLEO ◽  
A. CASCIO ◽  
...  
Keyword(s):  
Matrix Metalloproteinases ◽  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Malignant Pleural Effusions

scholarly journals Pacemaker-Associated Post-cardiac Injury Syndrome Presenting with Tamponade and Recurrent Pleural Effusion

2020 ◽  
Vol 13 ◽  
pp. 117954762096555
Author(s):  
Young Ju Lee ◽  
Mahmood Mubasher ◽  
Abir Zainal ◽  
Tausif Syed ◽  
Mouhand F.H. Mohamed ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Cardiac Tamponade ◽  
Cardiac Injury ◽  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Immune Mediated ◽  
Pacemaker Insertion ◽  
Recurrent Pleural Effusion

Post-cardiac injury syndrome (PCIS) is presumed to be an immune-mediated process. It affects the pericardium and, to a lesser extent, the epicardium, myocardium, and pleura. It has been rarely reported following pacemaker insertion with an estimated incidence of 1% to 2%. We present the case of a 62-year-old female who developed PCIS 8 weeks following pacemaker insertion. She presented with impending cardiac tamponade requiring pericardiocentesis; recurrent pleural effusions subsequently complicated her condition. The pleural effusion recurred despite trials of steroids, eventually requiring talc pleurodesis. This case highlights the need to consider PCIS as a possible etiology of recurrent pleural effusion following pacemaker insertion.

The Cost of Managing Pleural Effusion Associated with Dasatinib in CML Patients Post Imatinib Failure.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4586-4586
Author(s):  
Jennifer Stephens ◽  
Kim Carpiuc ◽  
Marc Botteman ◽  
WeiWei Feng ◽  
Richard C. Woodman
Keyword(s):  
Pleural Effusion ◽  
Resource Utilization ◽  
Cancer Center ◽  
X Rays ◽  
Medical Resource ◽  
Office Visits ◽  
Pleural Effusions ◽  
Invasive Procedures ◽  
Pleural Catheter ◽  
The Cost

Abstract Background: Recent follow-up data from dasatinib at a large cancer center suggests that pleural effusion events occur in up to 35% of patients, emerging as late as 24 months into therapy, and require additional medical resource use beyond the typical routine care. This study aims to apply economic costs to the medical resource utilization involved with treating pleural effusions associated with dasatinib. Methods: The costs of managing pleural effusions were estimated by applying standard cost data to medical resource utilization reported for 48 patients with dasatinib-related pleural effusions at one large cancer center (Quintas-Cardama et al, ASH 2006). Relevant CPT codes and median fees for outpatient procedures and office visits were retrieved from the 2006 Ingenix National Fee Analyzer. Cost of inpatient management of pleural effusions with chest tubes or other procedures were obtained from the medical literature (Putnam et al, 2000). Clinical expert input was used to supplement the literature related to assumptions of frequency of office visits and chest X-rays. Based on the above, the following key assumptions were made: 100% of patients incurred two additional physician visits, two chest x-rays, and a course of diuretics; 30% received steroids; 24% had recurrent effusions; 19% required 3 thoracentesis outpatient procedures; 5% were managed as inpatients with chest tube; and 4% required Denver shunts as inpatients. All costs were inflated to 2006 US prices. Results: Fifty-eight percent of pleural effusions reported at the cancer center involved ≤25% of one lung volume and were managed medically including diuretics and steroids. Costs for this medically managed group were $619 per episode, including physician office visits, chest X-rays and medications. Forty-two percent of pleural effusions were more significant, involving 26% to >75% of one lung volume, with half of those patients requiring invasive procedures. The cost of invasive procedures for inpatient management of pleural effusions was $10,130 for a chest tube and $14,475 with a pleural catheter. The cost of invasive outpatient management of pleural effusions ranged from $680 for ultrasound thoracentesis to $4,387 for pleural catheter. The average projected cost of treating a pleural effusion adverse event (including all severity levels) ranged from $1,694 to $3,882, depending on whether outpatient thoracentesis occurred or placement of outpatient pleural catheter was utilized. Important cost drivers included management of recurrent effusions. Conclusion: This economic analysis based on actually observed treatment patterns suggests that the management of pleural effusions with dasatinib is costly and requires intensive resource utilization. Development of pleural effusions with dasatinib poses a significant challenge to physicians, as they cannot be predicted, the time of onset is variable, and management may require repeat invasive procedures and possible complications. This economic analysis is likely conservative in that it did not include the cost of platelet transfusions that may be needed to perform thoracentesis, or the potential complications of hypokalemia and QTcF prolongation with the use of diuretics. Effective tyrosine kinase inhibitors with lower rates of pleural effusions may represent a clinically and economically valuable alternative for imatinib-resistant or -intolerant CML patients.

Comparison of in-dwelling catheters and talc pleurodesis in the management of malignant pleural effusions.

2010 ◽  
Vol 28 (15_suppl) ◽  
pp. 9031-9031 ◽  
Author(s):  
T. L. Demmy ◽  
L. Gu ◽  
J. E. Burkhalter ◽  
E. M. Toloza ◽  
T. A. D'Amico ◽  
...  
Keyword(s):  
Pleural Effusions ◽  
Talc Pleurodesis ◽  
Malignant Pleural Effusions

scholarly journals Chest Tube Drainage Under Radiological Guidance for Pleural Effusion and Pneumothorax in a Tertiary Care University Teaching Hospital: Review of 51 Cases

2005 ◽  
Vol 12 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Luce Cantin ◽  
Carl Chartrand-Lefebvre ◽  
Luigi Lepanto ◽  
David Gianfelice ◽  
Antoine Rabbat ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Teaching Hospital ◽  
Chest Tube ◽  
Tertiary Care ◽  
Chest Tube Drainage ◽  
University Teaching ◽  
Tube Placement ◽  
Pigtail Catheter ◽  
First Line ◽  
Tube Drainage

BACKGROUND: Chest tube drainage under radiological guidance has been used with increasing frequency as a treatment option for pleural effusions and pneumothoraxes.OBJECTIVE: To evaluate the safety and usefulness of pleural drainage under radiological guidance for pleural effusion and pneumothorax in a tertiary care university teaching hospital.METHODS: A retrospective study of cases of chest tube placement under radiological guidance over a 12-month period in a university hospital.RESULTS: Fifty-one percutaneous pigtail catheter drainage cases were reviewed (30 patients). Forty-six (90%) chest tubes were inserted as a first-line treatment. The overall success rate of radiological drainage was 88%. Specific success rates were 92%, 85% and 91% for loculated pleural effusion, pneumothorax and empyema, respectively. The complications were few and minor.CONCLUSIONS: Pigtail catheter insertion under radiological guidance is a useful procedure for the treatment of sterile pleural effusion, empyema and pneumothorax. This technique can be used as a first-line procedure in the majority of cases.

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