Thoracic surgery clinics
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Thoracic surgery clinics · Feb 2013
ReviewPermanent indwelling catheters in the management of pleural effusions.
The treatment of chronic recurrent pleural effusions continues to evolve with the recent emergence of tunneled indwelling pleural catheters (IPCs). Talc pleurodesis has been the standard of care for treatment of recurrent pleural effusions, but IPCs have gained more favor in recent years. IPCs offer several advantages, including a less invasive procedure, short postprocedure hospital stay, and greater patient control in the management of symptoms. Further randomized controlled studies are needed to more clearly differentiate which patients are better served by an IPC rather than traditional pleurodesis as their initial intervention.
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Thoracic surgery clinics · Feb 2013
ReviewCauses and management of common benign pleural effusions.
Benign pleural effusions are twice as common as malignant effusions and have diverse causes and manifestations, which often makes them a diagnostic challenge. Differentiating effusions as a transudate or exudate is the first, and often helpful, step in directing investigations for diagnosis and management. ⋯ Commonly exudative effusions are caused by infections or may be secondary to pulmonary embolism, drugs, collagen vascular diseases, or may follow cardiac surgery. This article gives an overview of the causes and management of common benign pleural effusions.
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Thoracic surgery clinics · Feb 2013
ReviewDecision making and algorithm for the management of pleural effusions.
Pleural effusions can be catagorised in to transudative effusions or exudative effusions. Causes include cardiovascular disease, infection and neoplasm. ⋯ Thoracocentesis and laboratory testing of the pleural fluid is usually diagnostic and can direct further investigations or treatment. Management of the pleural effusion ultimately varies according to the diagnosis but can be either directed towards reversing the cause of the effusion or treating the symptoms that arise as a result of the effusion.
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Thoracic surgery clinics · Feb 2013
ReviewLarge-bore and small-bore chest tubes: types, function, and placement.
Chest tubes are placed in the pleural space, either surgically or percutaneously to evacuate abnormal fluid and air. Indications for chest tubes include therapeutic drainage of pleural conditions such as pneumothorax, hemothorax, empyema, chylothorax, and malignant effusions, as well as prophylaxis drainage of air, blood, and other fluids after chest surgery. This article characterizes the types of chest tubes, reviews the basic techniques for insertion, and describes the comparative effectiveness between large-bore and small-bore chest tubes.
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Thoracic surgery clinics · Feb 2013
ReviewAnatomy and pathophysiology of the pleura and pleural space.
Pleural effusions are most often secondary to an underlying condition and may be the first sign of the underlying pathologic condition. The balance between the hydrostatic and oncotic forces dictates pleural fluid homeostasis. ⋯ Its vessels are closer to the pleural space compared with its visceral counterpart; it contains lymphatic stomata, absent on visceral pleura, which are responsible for a bulk clearance of fluid. The diagnosis and successful treatment of pleural effusions requires a mixture of imaging techniques and pleural fluid analysis.