Current opinion in pulmonary medicine
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The role of chemical pleurodesis in the treatment of primary spontaneous pneumothorax remains unclear. According to current practice guidelines, chemical pleurodesis is reserved for patients who are unable or unwilling to have surgery. Some recent studies showed that intrapleural minocycline pleurodesis could decrease the rate of pneumothorax recurrence, when used either as the initial treatment for simple pneumothorax after successful aspiration and drainage or as an adjuvant treatment for complicated or recurrent pneumothorax following thoracoscopic surgery. The purpose of this review is to discuss the current available evidence on intrapleural minocycline pleurodesis for the treatment of primary spontaneous pneumothorax. ⋯ Intrapleural minocycline pleurodesis can be considered an adjunct to standard treatment of primary spontaneous pneumothorax, after either simple aspiration and drainage or after thoracoscopic surgery.
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Bronchopleural fistula is a cause of increased morbidity and mortality. Patients who develop bronchopleural fistula after lung resection or spontaneous pneumothorax often have multiple co-morbidities making them poor candidates for repeated surgical intervention. Previous nonsurgical treatments for bronchopleural fistula have had limited success. Endobronchial valves, originally designed for bronchoscopic lung volume reduction, have been used under a humanitarian use exception for the treatment of bronchopleural fistula. Numerous case series and reports have been published; however, guidelines for the use of endobronchial valves specifically for bronchopleural fistula have yet to be developed. ⋯ The use of endobronchial valves for the treatment of bronchopleural fistula is well tolerated and effective. Controlled clinical trials are needed to further evaluate their efficacy and identify ideal patient populations for their use.
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Treatment of hepatic hydrothorax is challenging because of its rapid symptomatic recurrence. This review will focus on potential therapeutic approaches to hepatic hydrothorax. ⋯ No single treatment option for refractory hepatic hydrothorax is ideal. However, in patients with contraindications to or who are awaiting liver transplantation, TIPS seems the most beneficial therapy, whereas IPC promises to be an alternative second-line consideration.
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Thoracentesis is a commonly performed procedure throughout the world. Convention dictates that patients should have laboratory values such as international normalized ratio (INR) and platelets corrected or medications that affect bleeding withheld prior to performing this procedure. By transfusing blood products or withholding medications, patients are exposed to risks that are different than but equally if not more significant than the risk of hemothorax from thoracentesis. This review highlights recent studies that suggest the parameters of performing thoracentesis should be less stringent than traditionally thought. ⋯ Although large randomized studies do not exist, recent literature suggests that it is time to reevaluate the need to correct INR and platelet counts or to transfuse blood products or withhold medications prior to thoracentesis in patients felt to have a risk of possible bleeding.