fibrin and Pneumothorax

In recent years, a higher and higher percentage of patients with pleural effusions or pneumothorax are being treated with small-bore (10-14 F) chest tubes rather than large-bore (>20 F). However, there are very few randomized controlled studies comparing the efficacy and complication rates with the small- and large-bore catheters. Moreover, the randomized trials that are available have flaws in their design. The advantages of the small-bore catheters are that they are easier to insert and there is less pain with their insertion while they are in place. The placement of the small-bore catheters is probably more optimal when placement is done with ultrasound guidance. Small-bore chest tubes are recommended when pleurodesis is performed. The success of the small-bore indwelling tunnelled catheters that are left in place for weeks documents that the small-bore tubes do not commonly become obstructed with fibrin. Patients with complicated parapneumonic effusions are probably best managed with small-bore catheters even when the pleural fluid is purulent. Patients with haemothorax are best managed with large-bore catheters because of blood clots and the high volume of pleural fluid. Most patients with pneumothorax can be managed with aspiration or small-bore chest tubes. If these fail, a large-bore chest tube may be necessary. Patients on mechanical ventilation with barotrauma induced pneumothoraces are best managed with large-bore chest tubes.

Topics: Chest Pain; Chest Tubes; Chylothorax; Drainage; Empyema, Pleural; Fibrin; Hemothorax; Humans; Pleural Effusion; Pleurodesis; Pneumothorax; Randomized Controlled Trials as Topic; Respiration, Artificial; Treatment Outcome; Ultrasonography

The insertion and management of long-term venous catheters have long been the province of anaesthetists, intensive care physicians and surgeons. Radiologists are taking an increasing role in the insertion of central venous catheters (CVCs) because of their familiarity with the imaging equipment and their ability to manipulate catheters and guide-wires. The radiological management of the complications of CVCs has also expanded as a result. This article reviews the role of radiology in central venous access, covering the detection and management of their complications.

Topics: Aorta; Arteries; Catheterization, Central Venous; Fibrin; Foreign Bodies; Heart Injuries; Humans; Pneumothorax; Practice Guidelines as Topic; Pulmonary Artery; Radiology; Ultrasonography, Interventional; Venous Thrombosis

Topics: Diagnosis, Differential; Fibrin; Humans; Pleural Effusion; Pneumothorax; Tomography, X-Ray Computed

Topics: Blood; Chest Tubes; Fibrin; Glucose Solution, Hypertonic; Humans; Lung Diseases, Interstitial; Male; Middle Aged; Pleurodesis; Pneumothorax; Radiography

The immediate effects and long-term results are reported of thoracoscopic pleurodesis in 225 patients (158 men, 67 women) treated for persistent or recurrent spontaneous pneumothorax. The procedure was performed by combined local and neurolept analgesia with direct visual exploration of the pleural space through a rigid thoracoscope. The technique included electrocoagulation of small pleural blebs, followed by regional application of fibrin and insufflation of talc powder. The main indications were a first event which persisted more than 7 days despite chest-tube suction drainage in 27% (n = 61) or a recurrent event in 73% (n = 164). The procedure provided primary success in 96.4% of the patients. Only 8 patients (3.6%) required surgical intervention including parietal pleurectomy. Perioperative complications were pharmacologically induced respiratory failure (n = 5), generalized subcutaneous emphysema (n = 8), bleeding by cutting adhesions (n = 5) and Horner's syndrome (n = 2). However, no fatal complications occurred which could be ascribed to the procedure and all patients were discharged from the hospital after an average of 12.3 days except one who died of pulmonary embolism 5 days after thoracoscopy. Long-term follow-up over a mean period of 4.1 years revealed an ipsilateral recurrence rate of 10.2% (n = 24), 16% of the patients complained of sporadic pains at the site of insertion, 51% still had diffuse thoracic pains and 2.4% reported occasional attacks of dyspnea. Spirometric lung function tests showed normal values in 89%. The immediate and longterm results show thoracoscopic pleurodesis with fibrin and talcum to be a safe and effective method for treatment of patients with persistent or recurrent pneumothorax.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Fibrin; Humans; Male; Middle Aged; Pleura; Pneumothorax; Recurrence; Talc; Thoracoscopy; Tissue Adhesions

From 1975 to 1987, 44 of 230 patients with cystic fibrosis under our care underwent a total of 66 operations. There were no direct intra- or postoperative complications. If an optimal and aggressive adjuvant treatment is given postoperatively, there are no increased risks associated with surgical procedures in cystic fibrosis patients. Treatment of spontaneous pneumothorax remains a problem. An alternative treatment for pneumothorax using transcutaneous fibrin pleurodesis is presented.

Topics: Child; Child, Preschool; Cystic Fibrosis; Drainage; Fibrin; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Intraoperative Complications; Pneumothorax; Recurrence

Human fibrinogen cryoprecipitate has found wide application as a biologic tissue adhesive in thoracic and cardiovascular surgery. During 1979 and 1980 fibrin adhesive was applied in all surgical procedures involving persistent or recurrent pneumothorax and it was used prophylactically to cover large parenchymal defects following standard lung resections. The benefit of its application on pleura and lung tissue derives from added reinforcement of sutures and sealing of non-saturable defects. Twenty-one patients with recurrent spontaneous pneumothorax revealed a reduced average drainage period as compared to 15 non-glued cases with lesions of comparable size. Similarly, in 20 cases where tissue adhesive was applied to extensive pleural defects following segmental lung resection or lobectomy, suction drainage time was significantly less than in 11 cases of comparable, non-glued defects. Compared to 140 lung resections performed prior to the use of fibrin glue, these 20 cases were found to require the same average drainage time, although the extent of their lesions would otherwise have warranted longer periods of continued suction drainage.

Topics: Adult; Fibrin; Humans; Middle Aged; Pneumothorax; Recurrence; Thoracic Surgery; Tissue Adhesives

The treatment of choice in idiopathic spontaneous pneumothorax is continuous suction drainage by chest tube for 8--10 days. If this method is not successful, i.e., in patients with a persistent or recurrent pneumothorax, an attempt can be made to produce local pleural adhesions by means of a special fibrin glue, especially in patients with poor general condition. This fibrin glue pleurodesis was performed successfully in seven patients, four of them having a persistent, two a recurrent, and one an iatrogenic pneumothorax. Six of them are now, 3--10 months after therapy, without a recurrence and free of discomfort. One patient died 6 days after treatment from a cerebral stroke. Autopsy showed fibrinous adhesions in the area of the upper lobe. Good tissue compatibility was confirmed histologically.

Topics: Adult; Aged; Drainage; Evaluation Studies as Topic; Female; Fibrin; Humans; Male; Methods; Pleura; Pneumothorax; Recurrence; Tissue Adhesives

Topics: Embolism; Embolism, Air; Fibrin; Pneumothorax; Pneumothorax, Artificial; Tissue Adhesions

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

Topics: Fibrin; Humans; Pneumothorax

Topics: Blister; Fibrin; Humans; Hydropneumothorax; Pneumothorax

Topics: Blood; Fibrin; Humans; Pneumothorax; Pneumothorax, Artificial