fibrin and Pleural-Diseases

Recent studies have shed new light on the role of the fibrinolytic system in the pathogenesis of pleural organization, including the mechanisms by which the system regulates mesenchymal transition of mesothelial cells and how that process affects outcomes of pleural injury. The key contribution of plasminogen activator inhibitor-1 to the outcomes of pleural injury is now better understood as is its role in the regulation of intrapleural fibrinolytic therapy. In addition, the mechanisms by which fibrinolysins are processed after intrapleural administration have now been elucidated, informing new candidate diagnostics and therapeutics for pleural loculation and failed drainage. The emergence of new potential interventional targets offers the potential for the development of new and more effective therapeutic candidates.

Topics: Animals; Fibrin; Humans; Pleural Diseases

Pleural fibrosis can result from a variety of inflammatory processes. The response of the pleural mesothelial cell to injury and the ability to maintain its integrity are crucial in determining whether normal healing or pleural fibrosis occurs. The pleural mesothelial cell, various cytokines, and disordered fibrin turnover are involved in the pathogenesis of pleural fibrosis. The roles of these mediators in producing pleural fibrosis are examined. This article reviews the most common clinical conditions associated with the development of pleural fibrosis. Fibrothorax and trapped lung are two unique and uncommon consequences of pleural fibrosis. The management of pleural fibrosis, including fibrothorax and trapped lung, is discussed.

Topics: Asbestosis; Coronary Artery Bypass; Epithelial Cells; Fibrin; Fibroblast Growth Factor 2; Fibrosis; Hemothorax; Platelet-Derived Growth Factor; Pleura; Pleural Diseases; Pleurisy; Tuberculosis, Pleural

Our objective was to compare the efficacy of adjunctive intrapleural fibrinolytic agents (IPFA) (streptokinase, urokinase) on fibrinopurulent stage empyema and chronic stage empyema in children. IPFA were used in 78 pediatric patients with empyema (36 fibrinopurulent stage empyemas, 42 chronic stage empyemas) between December 1994 and September 2002. Pleural biopsy was done for staging in all cases. Streptokinase 250,000 units in 100 ml normal saline (62 patients) or 100,000 units urokinase in 100 ml normal saline (16 patients) was instilled daily into the patient's chest tube, and the tube was clamped for 4 h, followed by suction. This treatment was continued daily for 2-8 days until resolution was demonstrated by chest radiographs and/or computed chest tomography. Success of treatment was 97.2% (complete response 24/36, partial response 11/36) in the fibrinopurulent stage and 9.4% (complete response 2/42, partial response 2/42) in chronic empyema cases. In one patient with fibrinopurulent empyema, the treatment was stopped due to allergic reaction and pleural hemorrhage; this patient died 1 day later in a septic condition. Although an invasive method, the pleural biopsy technique may be an alternative way of more properly staging thoracic empyema in selected children in whom staging based on radiographic and biochemical findings is doubtful. Intrapleural fibrinolytic treatment is an effective and safe therapy of choice and may have significant benefit in most children with fibrinopurulent phase empyema, except for those with bronchopleural fistula. IPFA do not seem to be effective in children with chronic phase empyema.

Topics: Adolescent; Biopsy; Chest Tubes; Child; Child, Preschool; Chronic Disease; Drug Hypersensitivity; Empyema, Pleural; Female; Fibrin; Fibrinolytic Agents; Hemorrhage; Humans; Infant; Male; Pleural Diseases; Staphylococcal Infections; Streptokinase; Suction; Tomography, X-Ray Computed; Treatment Outcome; Urokinase-Type Plasminogen Activator

Topics: Accidents, Traffic; Adolescent; Adult; Aprotinin; Bronchial Fistula; Bronchoscopes; Bronchoscopy; Catheterization, Swan-Ganz; Drug Combinations; Factor XIII; Fibrin; Fibrin Tissue Adhesive; Fibrinogen; Humans; Lung Injury; Pleural Diseases; Thrombin; Tissue Adhesives; Wounds, Nonpenetrating

An intrapleural free floating golf ball size body was an incidental finding at autopsy. The pathogenesis and clinical significance of this lesion are discussed.

Topics: Fibrin; Foreign Bodies; Humans; Male; Middle Aged; Pleura; Pleural Diseases

A simple, effective and safe method is proposed to liquidate a persistent residual pleural cavity by a biological filling prepared ex tempore from a solution of fibrinogen with antibacterial drugs. The method was used in 24 patients after pleura empyema. The method of filling is described as well as the conditions for a successful use of the new means of liquidation of the residual pleural cavity and prevention of recurrent pleura empyemas.

Topics: Adolescent; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bronchial Fistula; Combined Modality Therapy; Empyema; Fibrin; Fistula; Humans; Lung Diseases; Male; Pleural Diseases; Postoperative Complications; Prostheses and Implants; Skin Diseases

Topics: Carcinoma, Bronchogenic; Diagnosis, Differential; Fibrin; Humans; Lung Neoplasms; Lymphoma; Mesothelioma; Neoplasm Metastasis; Pleural Diseases; Pleural Neoplasms; Radiography

Topics: Adult; Aged; Autoimmune Diseases; Biopsy, Needle; Bronchiectasis; Chronic Disease; Empyema; Female; Fibrin; Fibrinogen; Fluorescent Antibody Technique; Humans; Kidney; Kidney Diseases; Lung; Lung Diseases; Male; Microscopy, Electron; Middle Aged; Phagocytosis; Pleural Diseases; Pneumonia

Topics: Blood Coagulation; Empyema; Fibrin; Hemothorax; Humans; Mesothelioma; Pleura; Pleural Diseases; Pleural Neoplasms

Topics: Adult; Aged; Asbestosis; Calcinosis; Diagnosis, Differential; Female; Fibrin; Humans; Male; Mesothelioma; Middle Aged; Pleural Diseases; Pleural Neoplasms; Pneumothorax, Artificial; Radiography; Tissue Adhesions; Tuberculosis, Pulmonary

Topics: Disease; Fibrin; Humans; Peptide Hydrolases; Pleura; Pleural Diseases

Topics: Diagnosis, Differential; Disease; Fibrin; Humans; Pleura; Pleural Diseases; Pneumothorax; Thoracic Injuries

Topics: Disease; Fibrin; Heart Aneurysm; Humans; Pleura; Pleural Diseases