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      TRATAMIENTO DEL DERRAME PLEURAL MALIGNO CON PLEURODESIS QUÍMICA Translated title: TREATMENT OF MALIGNANT PLEURAL EFFUSION WITH CHEMICAL PLEURODESIS

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          Abstract

          RESUMEN Introducción: Derrame pleural maligno (DPM) es aquel derrame pleural que ocurre en el contexto de una enfermedad neoplasia. La pleurodesis consiste en la unión permanente de ambas hojas de la pleura mediante estímulos naturales, químicos o quirúrgicos, siendo esta una posibilidad diagnóstica paliativa en los derrames pleurales recidivantes. Objetivo: Exponer la experiencia en el manejo del derrame pleural maligno a través de la pleurodesis química en la Primera Cátedra de Clínica Quirúrgica del Hospital de Clínicas. Resultados: Se evaluaron 688 pacientes con neoplasias de los cuales sólo 36 pacientes (5%) presentó derrame pleural maligno, siendo más frecuente en el sexo masculino y en la quinta década de la vida. Al evaluar la efectividad de la pleurodesis el mayor rendimiento de la pleurodesis química fue a través de la videocirugía en comparación a los otros procedimientos. Conclusión: La frecuencia de derrame pleural neoplásico arrojada por el estudio fue de 5%. Las causas principales de derrame pleural neoplásico fueron el cáncer de pulmón y el cáncer de mama. La eficacia fue del 100% para la videotoracoscopía y 85% por tubo pleural.

          Translated abstract

          SUMMARY Introduction: Malignant pleural effusion (DPM) is that pleural effusion occurs in the context of a disease neoplasia. Pleurodesis is permanent apposition of both leaves of the pleura by natural stimuli, chemical or surgical, this being a diagnostic possibility palliation in recurrent pleural effusions. Objective: Exhibit experience in managing malignant pleural effusion through chemical pleurodesis in the First Department of Clinical Surgical Hospital. Results: We evaluated 688 patients with malignancies of which only 36 patients (5%) had malignant pleural effusion, being more frequent in males and in the fifth decade of life. In assessing the effectiveness of the improved performance of pleurodesis chemical pleurodesis was through video surgery compared to other procedures. Conclusion: The frequency of malignant pleural effusion thrown by the study was 5%. The main causes of malignant pleural effusion were lung cancer and breast cancer. The efficacy was 100% for the VATS and 85% for pleural tube.

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          An Update in the Management of Malignant Pleural Effusion

           DK Muduly,  SVS Deo,  TS Subi (2011)
          Malignant pleural effusion (MPE) usually presents in the disseminated and advanced stage of malignancy. Dyspnea is the debilitating symptom which needs palliation in these patients. Various modalities are available in the management of MPE. Careful consideration of the patient's expected survival and quality of life is needed when deciding the optimum treatment modality in such patients. In this article, different modalities of the palliative management of MPE are discussed with an attempt to derive a treatment algorithm for the management of MPE.
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            Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: a review of 400 cases

            Background Malignant pleural effusion is a common sequelae in patients with certain malignancies. It represents a terminal condition with short median survival (in terms of months) and the goal is palliation. Aim of our study is to analyze morbidity, mortality and life expectancy following videothoracoscopic talc poudrage. Materials and methods From September 2004 to October 2009, 400 patients underwent video-assisted thoracic surgery (VATS) for malignant pleural effusion. The conditions of patients were assessed and graded before and after treatment concerning morbidity, mortality, success rate of pleurodesis and median survival. Results The median duration of follow up was 40 months (range 4-61 months). All patients demonstrated notable improvement in dyspnea. Intraoperative mortality was zero. The procedure was well tolerated and no significant adverse effects were observed. In hospital mortality was 2% and the pleurodesis success rate was 85%. A poor Karnofsky Performance Status and delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors for in-hospital mortality. The best survival was seen in breast cancer, followed by ovarian cancer, lymphoma and pleural mesothelioma. Conclusions Video-assisted thoracoscopic talc poudrage is an effective and safe procedure that yields a high rate of successful pleurodesis and achieves long-term control with marked dyspnea decrease.
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              What is the best treatment for malignant pleural effusions?

              A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether chemical pleurodesis is superior to catheter drainage or pleuroperitoneal shunts (PPS) in the management of patients with pleural effusions. Overall 161 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that chemical pleurodesis is superior to chronic catheter drainage and PPS in terms survival length and mortality rates but in patients with trapped lung syndrome chronic intrapleural catheter placement is indicated. Six studies reported patient outcomes after treatment with chemical pleurodesis. They report high success rates (89.4%) and low mortality rates (2%) without any need to convert to open thoracotomy. Mean hospital stay of 2.33 days, complication rates of 16.5% and mean survival length of 23.8 ± 16.3 months were observed. Five studies managed malignant pleural effusions (MPEs) using chronic indwelling catheters. They reported mean survival length of 126 days. Symptomatic relief was achieved in 94.2% of patients. There was a significant reduction in the Medical Research Council dyspnoea score (3.0-1.9, P < 0.001) and despite complication rates of 22%, comparable mortality rates (7.5%) were observed. Even in patients with trapped lung syndrome, mean survival length was 125 days with symptomatic improvement being achieved in 90.9% of patients. Three studies treated MPEs using PPSs. Mean hospital stay was 6.2 days (range 2-26) with a mean survival length of 11 months. Pleurodesis success rates varied from 57.1% to 95% with a complication rate of 14.8%. PPSs were shown to produce lower success rates (57.1% vs. 92.3%), shorter survival lengths (4.3 ± 1.9 vs. 6.7 ± 2.1 months) and higher complication rates (14.3% vs. 2.8%) than talc pleurodesis. Overall, chemical pleurodesis is the optimal treatment option for MPE with use of chronic intrapleural catheters reserved in cases where talc pleurodesis is not possible.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
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                Journal
                sopaci
                Cirugia paraguaya
                Cir. parag.
                Sociedad Paraguaya de Cirugía (Asunción, , Paraguay )
                2307-0420
                December 2012
                : 36
                : 2
                : 17-22
                Article
                S2307-04202012000200004

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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