3 research outputs found
Outpatient Management of Malignant Pleural Effusion Using a Tunneled Pleural Catheter: Preliminary Experience
Inpatient management of malignant pleural effusion
includes the placement of a conventional thoracostomy tube
for drainage and talc slurry pleurodesis and/or a surgical
approach consisting of video-assisted thoracoscopic talc
insufflation. Both techniques require prolonged hospital
stays of up to 1 week. Unfortunately, life expectancy in
patients with this disease does not usually exceed 6 months,
and so the primary aim of any palliative intervention
intended to improve quality of life should be to avoid
hospital admissions and to relieve pain as far as possible.
Of the few outpatient alternatives to hospital management
the most frequently used is repeated thoracentesis. We
describe the outpatient management of malignant pleural
effusion by placement of a tunneled pleural catheter in a
patient with stage IIIB lung adenocarcinoma. In our
opinion, the use of this catheter offers a viable alternative to
conventional therapy and is better tolerated
Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a Bronchus sign on CT imaging: results from a prospective study
Electromagnetic navigation bronchoscopy (ENB) has been developed as a
novel ancillary tool for the bronchoscopic diagnosis of pulmonary nodules.
Despite successful navigation in 90% of patients, ENB diagnostic yield does not
generally exceed 70%. We sought to determine whether the presence of a bronchus
sign on CT imaging conditions diagnostic yield of ENB and might account for the
discrepancy between successful navigation and diagnostic yield. METHODS: We
conducted a prospective, single-center study of ENB in 51 consecutive patients
with pulmonary nodules. ENB was chosen as the least invasive diagnostic technique
in patients with a high surgical risk, suspected metastatic disease, or
advanced-stage disease, or in those who demanded a preoperative diagnosis prior
to undergoing curative resection. We studied patient and technical variables that
might condition diagnostic yield, including size, cause, location, distance to
the pleural surface, and fluorodeoxyglucose uptake of a given nodule; the
presence of a bronchus sign on CT imaging; registration point divergence; and the
minimum distance from the tip of the locatable guide to the nodule measured
during the procedure. RESULTS: The diagnostic yield of ENB was 67% (34/51). The
sensitivity and specificity of ENB for malignancy in this study were 71% and
100%, respectively. ENB was diagnostic in 79% (30/38) patients with a bronchus
sign on CT imaging but only in 4/13 (31%) with no discernible bronchus sign.
Univariate analysis identified the bronchus sign (P = .005) and nodule size (P =
.04) as statistically significant variables conditioning yield, but on
multivariate analysis, only the bronchus sign remained significant (OR, 7.6; 95%
CI, 1.8-31.7). No procedure-related complications were observed. CONCLUSIONS: ENB
diagnostic yield is highly dependent on the presence of a bronchus sign on CT
imaging
Outpatient Management of Malignant Pleural Effusion Using a Tunneled Pleural Catheter: Preliminary Experience
Inpatient management of malignant pleural effusion
includes the placement of a conventional thoracostomy tube
for drainage and talc slurry pleurodesis and/or a surgical
approach consisting of video-assisted thoracoscopic talc
insufflation. Both techniques require prolonged hospital
stays of up to 1 week. Unfortunately, life expectancy in
patients with this disease does not usually exceed 6 months,
and so the primary aim of any palliative intervention
intended to improve quality of life should be to avoid
hospital admissions and to relieve pain as far as possible.
Of the few outpatient alternatives to hospital management
the most frequently used is repeated thoracentesis. We
describe the outpatient management of malignant pleural
effusion by placement of a tunneled pleural catheter in a
patient with stage IIIB lung adenocarcinoma. In our
opinion, the use of this catheter offers a viable alternative to
conventional therapy and is better tolerated