Intrapleural Tetracycline for the Prevention of Recurrent Spontaneous Pneumothorax

Light, Richard W.; OʼHara, Vincent S.; Möritz, Thomas; McElhinney, A. James; Butz, Ralph O.; Haakenson, Clair; Read, Raymond C.; Sassoon, Catherine S. H.; Eastridge, Charles E.; Berger, Rolando

doi:10.1001/jama.1990.03450170072025

Cited by 185 publications

(47 citation statements)

References 25 publications

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“…A survey of several studies (table 2) shows that the mean recurrence rate of primary spontaneous pneumothorax treated with bedrest, needle aspiration, or tube drainage was 30%, ranging 16-52% [43][44][45][46][47][48][49][50][51][52]. The majority of recurrences appeared within 6 months to 2 yrs [49,50], although other studies could not confirm this finding [45,47].…”

Section: Recurrencesmentioning

confidence: 99%

“…Needle aspiration, tube drainage and the use of a Heimlich flutter valve have proved to be safe procedures in the treatment of primary spontaneous pneumothorax, with minor side-effects [14,[44][45][46][47][48][49][50][51][52]. However the mean ipsilateral recurrence rate of 30% was rather high.…”

Section: Chemical Pleurodesismentioning

confidence: 99%

“…Chemical pleurodesis was shown to decrease the ipsilateral recurrence rate. In a prospective, multicentre, randomized clinical trial of 229 patients with spontaneous pneumothorax, tetracycline reduced the recurrence rate to 25%, compared to tube drainage with a recurrence rate of 41% [48]. In several other studies, tetracycline also resulted in effective pleurodesis, with average recurrence rates of 9-16% [8,63,64].…”

Section: Chemical Pleurodesismentioning

confidence: 99%

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Current aspects of spontaneous pneumothorax

Schramel¹,

Postmus²,

1997

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In spite of the fact that blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they seldom seem to be the actual cause of the pneumothorax. Inflammatory changes in the distal airways play an important role in the occurrence of the pneumothorax during transpulmonary pressure changes.The value of the routine use of additional expiratory chest radiographs in diagnosing pneumothoraces has been doubted in previous studies. In this review, the diagnostic yield from additional expiratory chest radiographs is analysed. The role of previous pneumothoraces at presentation and the presence of blebs and bullae are discussed in predicting future recurrences and choosing appropriate treatment for optimal cost-effectiveness. Recommendations are made regarding treatment of primary and secondary spontaneous pneumothorax. Eur Respir J 1997; 10: 1372-1379 Pneumothorax is defined as the presence of air in the pleural cavity [1]. As early as 1819, LAENNEC [2] described the symptoms and signs of a patient with a pneumothorax. Although most pneumothoraces were then caused by tuberculosis, he also found pneumothoraces during autopsies of patients with apparently healthy lungs; he named these "pneumothorax simple". Aetiology and pathogenesisToday, pneumothoraces are divided into spontaneous pneumothorax, occurring without a preceding event, and traumatic pneumothorax, due to direct or indirect trauma. Iatrogenic pneumothoraces, resulting from diagnostic or therapeutic medical procedures, are also categorized as traumatic pneumothoraces.Spontaneous pneumothoraces are divided into primary and secondary spontaneous pneumothoraces. Secondary spontaneous pneumothoraces are associated with underlying pulmonary pathology, usually chronic obstructive pulmonary disease (COPD). Acquired immune deficiency syndrome (AIDS) and Pneumocystis carinii infections appear to play an increasing role in the aetiology of secondary spontaneous pneumothoraces [3].No underlying pulmonary disease is present in patients with primary spontaneous pneumothorax. However, blebs and bullae seem to play a role in the pathogenesis, since they are frequently found during thoracoscopy, thoracotomy or sternotomy (table 1). Thoracoscopic studies have shown the presence of blebs and bullae in 48-79% of patients with unilateral primary spontaneous pneumo-thorax [4][5][6][7][8]. With the development of video-assisted techniques, the recognition of blebs and bullae during thoracoscopy has improved. In more than 76% of patients,

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Section: Recurrencesmentioning

confidence: 99%

Section: Chemical Pleurodesismentioning

confidence: 99%

Section: Chemical Pleurodesismentioning

confidence: 99%

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Current aspects of spontaneous pneumothorax

Schramel¹,

Postmus²,

1997

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“…In contrast with PSP, SSP is often serious and sometimes life-threatening because of the underlying lung disease; the recurrence rates are probably higher in SSP [10,11]. It is, therefore, recommended that all patients with SSP be treated with chest tube thoracotomy and be considered for pleurodesis [1].…”

mentioning

confidence: 99%

Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax

et al. 1997

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Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax. M. Noppen, M. Meysman, J. d'Haese, I. Monsieur, W. Verhaeghe, M. Schlesser, W. Vincken. ©ERS Journals Ltd 1997. ABSTRACT: Thoracoscopic talcage (TT) is a safe and effective prophylactic treatment for patients suffering from recurrent primary spontaneous pneumothorax (PSP). Empirically, TT is considered equally effective in the treatment of persistent secondary spontaneous pneumothorax (SSP), although this has not yet been proved.In this study, the efficacy and safety of TT was prospectively evaluated in 28 patients (17 males and 11 females, mean age 27±8 yrs), with 31 episodes of recurrent PSP, and in 20 patients (13 males and 7 females, mean age 43±21 yrs) with persistent SSP.TT proved to be equally effective in achieving pleurodesis in both groups: there were 6.5% recurrences in the PSP group and 8.7% in the SSP group during a mean follow-up period of 18 months (p>0.05). In the SSP group, there were significantly more prolonged postoperative air leaks (26 vs 0%; p=0.004) and a longer postoperative chest tube drainage time (35.5±18 vs 24.9±3.2 hrs; p=0.002) was necessary. All air leaks, however, ceased spontaneously during drainage. Duration of hospitalization was significantly longer in the SSP group (4.7±2 vs 3.2±0.5 days; p<0.0001). Postoperative pain (90 vs 43%; p<0.0001) and fever (65 vs 17%; p= 0.001) were more frequent in the PSP group than in the SSP group.There were no major peri-or postoperative complications in either group. We conclude that thoracoscopic talcage is as efficient and safe in achieving pleurodesis in persistent spontaneous pnuemothorax as in recurrent primary spontaneous pneumothorax. Eur Respir J 1997; 10: 412-416 Primary spontaneous pneumothorax (PSP) is defined as a pneumothorax occurring spontaneously in a person without (known) underlying lung disease; whereas, a secondary spontaneous pneumothorax (SSP) is defined as a spontaneous pneumothorax occurring in a patient with known underlying lung disease [1]. Although it is now widely recognized that the majority of PSP patients do have underlying abnormalities of their lungs (i.e. subpleural blebs or bullae, most often located at the apices of the lung) [2,3], their typical history and the absence of associated pulmonary disease allows the categorization of PSP as a distinct clinical entity [4,5].Numerous therapeutic options are available for the treatment of spontaneous pneumothorax, including: simple observation (with oxygen supplementation); simple manual aspiration; chest tube thoracostomy with or without instillation of various sclerozing agents; thoracoscopy with talc poudrage; pleural scarification; parietal pleurectomy; neodimium yytrium aluminium garnet (NdYAG) laser bleb ablation; bleb or bulla oversewing or stapling; and open thoracotomy with a variety of possible interventions [1]. The procedure of choice in any given patient with a spontaneous pneumothorax will depend upon: the extent and severi...

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“…The intrapleural administration of talc may be associated with the acute respiratory distress syndrome [1,2]. The tetracycline derivatives are not available throughout the world and their administration is sometimes associated with extreme pain [3]. Bleomycin has an excessive cost and overall appears to be less effective than talc [4].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Ethanolamine Oleate as a Pleural Sclerosing Agent in Rabbits

Teixeira

Vargas²,

Carmo³

et al. 1998

Respiration

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The ideal pleural sclerosing agent should be easily administered, without significant side effects, inexpensive, and widely available. None of the agents presently used meets all of these criteria. Ethanolamine oleate (ETH) is a sclerosing agent used in the sclerotherapy treatment of varicose veins of the legs and esophagus. The objective of the present study was to assess the efficacy of ETH as a pleural sclerosant in rabbits. An additional objective was to assess if better results were obtained when dextrose 50% (D50) as opposed to saline was used as the diluent. Each group of 10 rabbits received a total volume of 2 ml intrapleurally. The eight treatments were as follows: (1) 2 ml saline; (2) 2 ml D50; (3) 25 mg ETH plus 1.5 ml saline; (4) 25 mg ETH plus 1.5 ml D50; (5) 50 mg ETH plus 1.0 ml saline; (6) 50 mg ETH plus 1 ml D50; (7) 75 mg ETH plus 0.5 ml D50, and (8) 100 mg ETH. The rabbits were sacrificed 28 days after the injection. The intrapleural instillation of ETH resulted in evident pleurodesis, which was dose-dependent; 100 mg ETH induced significantly (p < 0.05) more adhesions than did any other treatment. The selection of the diluent had no effect on the pleurodesis. The microscopic examination of the right visceral pleura showed that the mean degree of fibrosis after 100 mg ETH was significantly (p < 0.05) greater than that after the other solutions. The mean degree of pleural inflammation, lung inflammation and lung fibrosis was minimal in all the groups. From this study we conclude that undiluted ETH produces pleurodesis in our experimental model. At the doses used, the pleurodesis was less than that produced after talc, tetracycline derivatives or silver nitrate in the same model.

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Intrapleural Tetracycline for the Prevention of Recurrent Spontaneous Pneumothorax

Cited by 185 publications

References 25 publications

Current aspects of spontaneous pneumothorax

Current aspects of spontaneous pneumothorax

Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax

Effectiveness of Ethanolamine Oleate as a Pleural Sclerosing Agent in Rabbits

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