minocycline and Pneumothorax

 Primary spontaneous pneumothorax (PSP) and its high recurrence rate pose a therapeutic challenge to both patients and their managing surgeons. Mechanical or chemical pleurodesis can be used to prevent recurrence, but the optimal treatment often remains a matter of debate. This meta-analysis aims to compare the outcomes between mechanical and chemical pleurodesis following bullectomy for PSP..  Studies published up to 2019 were searched from Medline, Embase, Google Scholar, and Cochrane databases. A meta-analysis of randomized controlled trials (RCTs) and observational cohort studies (OCSs) comparing outcomes between mechanical and chemical pleurodesis for PSP was performed..  Seven studies (one RCT and six OCSs) were included, comprising 1,032 cases of mechanical (799 abrasions, 202 pleurectomies, and 31 unspecified abrasions/pleurectomies/both), and 901 cases of chemical (643 talc, 69 minocycline, and 189 unspecified talc/kaolin) pleurodesis. The recurrence rate of pneumothorax after chemical pleurodesis (1.2%) was significantly lower than mechanical pleurodesis (4.0%) (pooled odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.59-5.67;.  Chemical pleurodesis is superior to mechanical pleurodesis following bullectomy for PSP in reducing hospital stay and recurrence rate. However, more RCTs with longer follow-up are necessary to demonstrate the benefit of chemical pleurodesis for PSP.

Topics: Female; Humans; Length of Stay; Male; Minocycline; Operative Time; Pleurodesis; Pneumonectomy; Pneumothorax; Postoperative Complications; Secondary Prevention; Talc

Spontaneous pneumothorax is a common pathology. International guidelines suggest pleurodesis for non-resolving air leak or recurrence prevention at second occurrence. This study comprehensively reviews the existing literature regarding chemical pleurodesis efficacy.. We systematically reviewed the literature to identify relevant randomised controlled trials (RCTs), case-control studies and case series. We described the findings of these studies and tabulated relative recurrence rates or ORs (in studies with control groups). Meta-analysis was not performed due to substantial clinical heterogeneity.. Of 560 abstracts identified by our search strategy, 50 were included in our systematic review following screening. Recurrence rates in patients with chest tube drainage only were between 26.1% and 50.1%. Thoracoscopic talc poudrage (four studies (n=249)) provided recurrence rates of between 2.5% and 10.2% with the only RCT suggesting an OR of 0.10 compared with drainage alone. In comparison, talc administration during video-assisted thoracic surgery (VATS) from eight studies (n=2324) recurrence was between 0.0% and 3.2%, but the RCT did not demonstrate a significant difference compared with bleb/bullectomy alone. Minocycline appears similarly effective post-VATS (recurrence rates 0.0-2.9%). Prolonged air leak and recurrence prevention using tetracycline via chest drain (n=726) is likely to provide recurrence rates between 13.0% and 33.3% and autologous blood patch pleurodesis (n=270) between 15.6% and 18.2%.. Chemical pleurodesis postsurgical treatment or via thoracoscopy appears to be most effective. Evidence for definitive success rates of each agent is limited by the small number of randomised trials or other comparative studies.

Topics: Anti-Bacterial Agents; Humans; Minocycline; Pleurodesis; Pneumothorax; Recurrence; Talc; Thoracoscopy; Treatment Outcome

Pleural abrasion has been widely used to control the recurrence of primary spontaneous pneumothorax (PSP). However, controversy still exists regarding the advantages and disadvantages of pleural abrasion compared with other interventions in preventing the recurrence of PSP.. The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to December 15, 2014 to identify randomized controlled trials (RCTs) that compared the effects of pleural abrasion with those of other interventions in the treatment of PSP. The study outcomes included the PSP recurrence rate and the occurrence rate of adverse effects.. Mechanical pleural abrasion and apical pleurectomy after thoracoscopic stapled bullectomy exhibited similarly persistent postoperative air leak occurrence rates (p = 0.978) and 1-year PSP recurrence rates (p = 0.821), whereas pleural abrasion led to reduced residual chest pain and discomfort (p = 0.001) and a smaller rate of hemothorax (p = 0.036) than did apical pleurectomy. However, the addition of minocycline pleurodesis to pleural abrasion did not reduce the pneumothorax recurrence rate compared with apical pleurectomy (3.8% for both procedures) but was associated with fewer complications. There was no statistical difference in the pneumothorax recurrence rate between mechanical pleural abrasion and chemical pleurodesis with minocycline on either an intention-to-treat basis (4 of 42 versus 0 of 42, p = 0.12; Fisher exact test) or after exclusions (2 of 40 versus 0 of 42, p = 0.24; Fisher exact test). Pleural abrasion plus minocycline pleurodesis also did not reduce the pneumothorax recurrence rate compared with pleural abrasion alone (p = 0.055). Moreover, pleural abrasion plus minocycline pleurodesis was associated with more intense acute chest pain. The postoperative overall recurrence rate in patients who underwent staple line coverage with absorbable cellulose mesh and fibrin glue was similar to that with mechanical abrasion after thoracoscopic bullectomy (13.8% vs. 14.2%, respectively; p = 0.555), but staple line coverage resulted in less postoperative residual pain than mechanical abrasion (0.4% vs.3.2%; p<0.0001). Pleural abrasion after thoracoscopic wedge resection did not decrease the recurrence of pneumothorax compared with wedge resection alone (p = 0.791), but the intraoperative bleeding and postoperative pleural drainage rates were higher when pleural abrasion was performed.. In addition to resulting in the same pneumothorax recurrence rate, thoracoscopic pleural abrasion with or without minocycline pleurodesis is safer than apical pleurectomy in the treatment of PSP. However, minocycline pleurodesis with or without pleural abrasion is not any more effective than pleural abrasion alone. Moreover, additional mechanical abrasion is not safer than additional staple line coverage with absorbable cellulose mesh and fibrin glue after thoracoscopic bullectomy because of increased postoperative pain. Additionally, pleural abrasion after thoracoscopic wedge resection should not be recommended for routine application due to the greater incidence of adverse effects than wedge resection alone. However, further large-scale, well-designed RCTs are needed to confirm the best procedure.

Topics: Humans; Minocycline; Pleura; Pleurodesis; Pneumothorax; Randomized Controlled Trials as Topic; Thoracoscopy; Treatment Outcome

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.. In a recently published prospective, randomized controlled trial, additional minocycline pleurodesis following simple aspiration and drainage was a well tolerated and more effective initial treatment for a first episode of primary spontaneous pneumothorax than simple aspiration and drainage alone. Other prospective, randomized controlled trials showed that additional minocycline pleurodesis after thoracoscopic treatment was a well tolerated and convenient procedure which can reduce the rate of ipsilateral recurrence 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.

Topics: Anti-Bacterial Agents; Chest Pain; Drainage; Humans; Minocycline; Narcotics; Pleurodesis; Pneumothorax; Randomized Controlled Trials as Topic; Recurrence; Thoracoscopy; Treatment Outcome

Pneumothorax is defined as the presence of air in the pleural cavity. Spontaneous pneumothorax, occurring without antecedent traumatic or iatrogenic cause, is sub-divided into primary and secondary. The severity of pneumothorax could be varied from asymptomatic to hemodynamically compromised. Optimal management of this benign disease has been a matter of debate. In addition to evacuating air from the pleural space by simple aspiration or chest tube drainage, the management of spontaneous pneumothorax also focused on ceasing air leakage and preventing recurrences by surgical intervention or chemical pleurodesis. Chemical pleurodesis is a procedure to achieve symphysis between the two layers of pleura by sclerosing agents. In the current practice guidelines, chemical pleurodesis is reserved for patients unable or unwilling to receive surgery. Recent researches have found that chemical pleurodesis is also safe and effective in preventing pneumothorax recurrence in patients with the first episode of spontaneous pneumothorax or after thoracoscopic surgery and treating persistent air leakage after thoracoscopic surgery. In this article we aimed at exploring the role of chemical pleurodesis for spontaneous pneumothorax, including ceasing air leakage and preventing recurrence. The indications, choice of sclerosants, safety, effects, and possible side effects or complications of chemical pleurodesis are also reviewed here.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotics, Antineoplastic; Antineoplastic Agents; Bleomycin; Humans; Minocycline; Picibanil; Pleurodesis; Pneumothorax; Povidone-Iodine; Secondary Prevention; Talc; Tetracycline

A case of bilateral pneumothorax in the patient with Marfan Syndrome was reported 13-year-old male was admitted to our hospital with diagnosis of left pneumothorax. He was tall and thin with long tapered extremities and echography revealed annulo-aortic-ectasia. A diagnosis of Marfan Syndrome was established by these characteristic of skeletal and cardiovascular findings. Air leakage continued inspite of the drainage of left chest cavity. Therefore, the resection of bullae was surgically undertaken. Post-operative course was uneventful and he discharged on 18th post-operative day. The pneumothorax of the right side occurred six months after first operation. After chest drainage, the surgical treatment was performed. However, he had recurrence of right pneumothorax six months after second operation. He was treated successfully with drainage tube and minocycline injection into the right pleural cavity. He should be carefully followed up, because the patient of Marfan Syndrome often dies due to cardiovascular abnormalities.

Topics: Adolescent; Anti-Bacterial Agents; Drainage; Humans; Male; Marfan Syndrome; Minocycline; Pneumonectomy; Pneumothorax; Recurrence; Reoperation

Simple aspiration and drainage is a standard initial treatment for primary spontaneous pneumothorax, but the rate of pneumothorax recurrence is substantial. We investigated whether additional minocycline pleurodesis after simple aspiration and drainage reduces the rate of recurrence.. In our open-label, parallel-group, prospective, randomised, controlled trial at two hospitals in Taiwan, patients were aged 15-40 years and had a first episode of primary spontaneous pneumothorax with a rim of air greater than 2 cm on chest radiographs, complete lung expansion without air leakage after pigtail catheter drainage, adequate haematological function, and normal renal and hepatic function. After simple aspiration and drainage via a pigtail catheter, patients were randomly assigned (1:1) to receive 300 mg of minocycline pleurodesis or no further treatment (control group). Randomisation was by computer-generated random numbers in sealed envelopes. Our primary endpoint was rate of pneumothorax recurrence at 1 year. This trial is registered with ClinicalTrials.gov (NCT00418392).. Between Dec 31, 2006, and June 30, 2012, 214 patients were randomly assigned-106 to the minocycline group and 108 to the control group (intention-to-treat population). Treatment was unsuccessful within 7 days of randomisation in 14 patients in the minocycline group and 20 patients in the control group. At 1 year, pneumothoraces had recurred in 31 of 106 (29·2%) patients in the minocycline group compared with 53 of 108 (49·1%) in the control group (p=0·003). We noted no procedure-related complications in either group.. Simple aspiration and drainage followed by minocycline pleurodesis is a safe and more effective treatment for primary spontaneous pneumothorax than is simple aspiration and drainage only. Minocycline pleurodesis should be an adjunct to standard treatment for primary spontaneous pneumothorax.. Department of Health and National Science Council, Taiwan.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Drainage; Female; Follow-Up Studies; Humans; Male; Minocycline; Pleurodesis; Pneumothorax; Prospective Studies; Secondary Prevention; Treatment Outcome; Young Adult

To compare the efficacy and safety between apical pleurectomy and pleural abrasion with minocycline in primary spontaneous pneumothorax (PSP) with high recurrence risk.. The optimal thoracoscopic pleurodesis procedure for PSP with high recurrence risk remains controversial.. Between January 2006 and May 2009, a total of 369 patients with spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. After stapled bullectomy, 160 patients with no identifiable bleb or multiple blebs (≥3) were randomly chosen to undergo apical pleurectomy (pleurectomy group, 80 patients) or pleural abrasion with minocycline (abrasion/minocycline group, 80 patients).. Patients in the pleurectomy group had a longer operation duration (mean, 81.4 minutes vs 55.8 minutes, P < 0.001), a greater amount of operation bleeding (mean, 29.4 mL vs 13.2 mL, P = 0.025), and a greater amount of postoperative chest drainage (mean, 287.4 mL vs 195.8 mL, P = 0.040). Patients in the abrasion/minocycline group had a higher intensity of chest pain and required more frequent meperidine injections. Hemothorax occurred in 3 pleurectomy patients (3.8%). The short-term results showed that the 2 groups had comparable durations of postoperative chest drainage, durations of postoperative hospital stay, and complication rates. After a mean follow-up of 26.1 months, recurrent ipsilateral pneumothorax occurred in 3 patients (3.8%) in the pleurectomy group and 3 patients (3.8%) in the abrasion/minocycline group. Postoperative long-term residual chest pain and pulmonary function were comparable in both groups.. : Pleural abrasion with minocycline pleurodesis is as effective as apical pleurectomy and either technique is appropriate for treating PSP patients with high recurrence risk. This trial was registered at http://www.clinicaltrials.gov (ID: NCT00270751).

Topics: Adult; Female; Humans; Male; Minocycline; Pleura; Pleurodesis; Pneumothorax; Prospective Studies; Recurrence; Risk Factors; Single-Blind Method; Thoracoscopy; Young Adult

Ipsilateral recurrence rates of spontaneous pneumothorax after video-assisted thoracoscopic surgery are higher than rates after open thoracotomy.. This study was conducted to determine whether additional minocycline pleurodesis would be effective in diminishing recurrence after video-assisted thoracoscopic surgery treatment of primary spontaneous pneumothorax.. Between June 2001 and February 2004, 202 patients with primary spontaneous pneumothorax were treated by conventional or needlescopic video-assisted thoracoscopic surgery. The procedures included resection of blebs and mechanical pleurodesis by scrubbing the parietal pleura. After the operation, patients were randomly assigned to additional minocycline pleurodesis (103 patients) or to observation (99 patients).. Patients in the minocycline group had higher intensity chest pain and required a higher accumulated dose of meperidine. Short-term results showed that the two groups had comparable chest drainage duration, postoperative hospital stay, and complication rates. Patients in the minocycline group demonstrated a trend of decreased rate of prolonged air leaks (1.9 vs. 6.1%, p = 0.100). After a mean follow-up of 29 mo (12-47 mo), recurrent ipsilateral pneumothorax was noted in two patients in the minocycline group and eight patients in the observation group (p = 0.044 by the Kaplan-Meier method and log-rank test). Postoperative long-term residual chest pain and pulmonary function were comparable in both groups.. Although associated with intense immediate chest pain, additional minocycline pleurodesis is a safe and convenient procedure that can reduce the rate of ipsilateral recurrence after thoracoscopic treatment for primary spontaneous pneumothorax.

Topics: Adult; Chest Pain; Female; Humans; Male; Minocycline; Pleurodesis; Pneumothorax; Recurrence; Thoracic Surgery, Video-Assisted

We describe an 11-year-old boy with nemaline myopathy who developed tension pneumothorax while undergoing noninvasive positive-pressure ventilation (NIPPV). The patient developed a persistent air leak after pleurodesis with minocycline hydrochloride and lowering of the NIPPV inspiratory pressure. He required additional respiratory support without the high airway pressures that may aggravate pneumothorax. We provided adequate respiratory support without increasing the positive airway pressure using biphasic cuirass ventilation (BCV), which moved the patient's chest wall by negative pressure. The air leak was resolved without any additional treatment. We should provide BCV for patients in whom surgery may have a risk of both extubation failure and postoperative complications before deciding on surgery.

Topics: Airway Extubation; Child; Humans; Male; Minocycline; Myopathies, Nemaline; Pneumothorax; Positive-Pressure Respiration; Postoperative Complications

Prolonged air leak is the most common complication after thoracoscopic operation for primary spontaneous pneumothorax (PSP), and the role of chemical pleurodesis in treating air leaks remains unclear. This study evaluated the safety and efficacy of chemical pleurodesis with a comparison between minocycline and OK-432.. Between 1994 and 2011, 1083 PSP patients were treated by thoracoscopic operation. After the operation, patients with persistent air leak for 3 days or more were managed by minocycline or OK-432 pleurodesis. The demographic and outcome data for these patients were collected by retrospective chart review.. Seventy-nine patients (7.3%) with prolonged air leak after thoracoscopy underwent minocycline pleurodesis (60 patients) or OK-432 pleurodesis (19 patients) as the primary treatment. The primary success rate was 63% (38/60) for minocycline pleurodesis and 95% (18/19) for OK-432 pleurodesis (p = 0.009). Postpleurodesis pain was common and comparable between the two groups. No major complications were noted after a total of 121 treatments. Patients undergoing primary OK-432 pleurodesis had shorter durations of postpleurodesis chest drainage (mean 8.5 vs. 2.3 days; p < 0.001) and postoperative hospital stay (mean 11.9 vs. 6.8 days; p < 0.001) than those undergoing primary minocycline pleurodesis. After a median follow-up of 16 months, recurrence was noted in one patient in the OK-432 group and none in the minocycline group. Long-term pulmonary function in the two groups was comparable.. Chemical pleurodesis using OK-432 or minocycline is safe and convenient for prolonged air leak after thoracoscopic treatment for PSP. Our experience suggested that OK-432 may be more effective than minocycline in reducing air leak.

Topics: Adult; Female; Humans; Male; Minocycline; Picibanil; Pleurodesis; Pneumothorax; Postoperative Complications; Retrospective Studies; Thoracic Surgery, Video-Assisted

Topics: Anti-Bacterial Agents; Case-Control Studies; Clinical Trials as Topic; Female; Humans; Male; Minocycline; Pleurodesis; Pneumothorax; Secondary Prevention; Taiwan; Treatment Outcome

Topics: Anti-Bacterial Agents; Female; Humans; Male; Minocycline; Pleurodesis; Pneumothorax

Topics: Anti-Bacterial Agents; Female; Humans; Male; Minocycline; Pleurodesis; Pneumothorax

Topics: Anti-Bacterial Agents; Female; Humans; Male; Minocycline; Pleurodesis; Pneumothorax

Topics: Anti-Bacterial Agents; Female; Humans; Male; Minocycline; Pleurodesis; Pneumothorax

The current study is designed to compare the effectiveness of brushing the pleura vs. instillation of minocycline for the management of primary spontaneous pneumothorax, and to assess the sensitivity of echography in defining areas of defects. Blebectomy and pleurodesis were carried out thoracoscopically on 84 patients. In group A (42 patients), abrasions were induced using a sponge on a long ring forceps. Group B (42 patients) received intrapleural instillation of minocycline. Echography was carried out two weeks after discharge and then repeated two weeks later. Follow-up ranged between 28 and 39 months. Two patients were excluded from group A for incomplete follow-up. In group A, five patients (12%) showed areas of free mobility of the lung on first echography. At the second examination, three (7% of the total) showed the same areas of mobility; one patient developed an attack of localized pneumothorax after 32 and another after 45 weeks. Each had three adjacent areas of free mobility. In group B, two patients each showed one area of free mobility on the first and second examinations but no recurrence during follow-up. The two groups had comparable chest drainage, postoperative hospital stay and complication rates. The patients in group B demonstrated a trend towards a decreased rate of prolonged air leaks (2% vs. 5%; P=0.100). Thus, pleurodesis by instillation of minocycline as a part of thoracoscopy is more effective than brushing the pleura. Thoracic echography is a highly sensitive method for assessing the effectiveness of pleurodesis.

Topics: Adolescent; Adult; Drainage; Egypt; Female; Humans; Irritants; Length of Stay; Male; Minocycline; Pleurodesis; Pneumothorax; Predictive Value of Tests; Proportional Hazards Models; Recurrence; Thoracic Surgery, Video-Assisted; Time Factors; Treatment Outcome; Ultrasonography; Yemen; Young Adult

Topics: Female; Humans; Irritants; Male; Minocycline; Pleurodesis; Pneumothorax; Thoracic Surgery, Video-Assisted; Ultrasonography

Few studies have evaluated the sclerosing efficacy of minocycline, and none have specifically compared its sclerosing efficacy and safety profiles with talc slurry in secondary spontaneous pneumothorax (SSP).. A retrospective analysis was conducted in patients with SSP who underwent chemical pleurodesis from January to December 2004 with minocycline or talc slurry in 12 public hospitals of Hong Kong.. There were 121 episodes of minocycline pleurodesis and 64 episodes of talc slurry pleurodesis. Immediate procedural failure were similar in the minocycline and talc slurry groups (21.5% vs. 28.1%, P = 0.31). Presence of interstitial lung disease, ≥ 2 previous episodes of pneumothorax, requiring mechanical ventilation during pleurodesis and persistent air leak before pleurodesis were independently associated with procedural failure. Pain was experienced in respectively 44.6% and 37.5% of the minocycline and the talc slurry groups. Pain was more common in patients receiving high doses of talc (≥ 5 g; P = 0.03). Respiratory distress was found in respectively 1.7% and 1.6% of the minocycline and talc slurry groups.. Minocycline and talc slurry had comparable sclerosing efficacy in SSP, with immediate success rates of >70%. Pain was the most common adverse effect and respiratory distress was uncommon. Both appeared to be effective and safe for chemical pleurodesis in SSP.

Topics: Aged; Chi-Square Distribution; China; Female; Hospitals, Public; Hospitals, University; Humans; Logistic Models; Male; Middle Aged; Minocycline; Odds Ratio; Pain; Pleurodesis; Pneumothorax; Respiration Disorders; Retrospective Studies; Risk Assessment; Risk Factors; Sclerosing Solutions; Secondary Prevention; Talc; Treatment Outcome

The ideal thoracoscopic pleurodesis method for preventing recurrence of spontaneous pneumothorax remains controversial. This study was conducted to compare the patterns, effects, and thoracic volume changes achieved using a variety of thoracoscopic procedures in rabbits.. Thirty-six New Zealand White rabbits were randomly assigned to undergo the following thoracoscopic procedures in the left hemithorax: (a) parietal pleural abrasion; (b) minocycline instillation; (c) combination of abrasion and minocycline; or (d) examination alone. The rabbits were euthanatized 30 days after the operation to determine pleurodesis score, area of greatest adhesion, thoracic volume change, and histopathological findings.. Grossly, pleural abrasion produced moderate localized apical pleural symphysis with no obvious thoracic volume change. Minocycline instillation induced moderate generalized pleurodesis with a significant decrease in thoracic volume. The combination of abrasion and minocycline instillation produced the greatest generalized pleurodesis as well as a significant decrease in thoracic volume. On microscopic examination, the combination procedure produced the greatest inflammation and fibrosis of the visceral and parietal pleura. Increased intensity of pleurodesis score as well as pleural inflammation and fibrosis is associated with decreased thoracic volume.. Thoracoscopic pleurodesis achieved using pleural abrasion and minocycline instillation induced different patterns of pleurodesis, and a combination of each method generated a synergy and produced a better pleurodesis. However, as the generalization and intensity of the pleurodesis were inversely associated with thoracic volume, the optimal method should be determined on an individual basis according to the clinical situation.

Topics: Animals; Fibrosis; Minocycline; Pleura; Pleurodesis; Pneumothorax; Rabbits; Thoracoscopy; Thorax

The optimal initial management of primary spontaneous pneumothorax (PSP) remains controversial. This study was to evaluate the safety and efficacy of intrapleural minocycline following aspiration for initial treatment of PSP.. Between January 2004 and November 2006, 64 patients with a first episode of PSP were successfully treated by simple aspiration using pigtail or intravenous needle catheter. From December 2005, 31 of the patients also received 300mg of minocycline hydrochloride post lung expansion, instilled through the catheter into the pleural space (minocycline group). The control group consisted of the first 33 patients of the series who had successfully undergone simple aspiration alone between January 2004 and December 2005.. There was no significant difference between the two groups in terms of demographic data. Patients in the minocycline group had higher doses of meperidine injection. The group hospitalization rates and mean hospital stays were comparable. After a mean follow-up of 13 months (range 3-26), recurrence was noted in 4 of the minocycline group and 11 of the control group (12.9% versus 33.3%, p=0.045). Subsequent thoracoscopic surgery for the recurrent patients revealed that minocycline induced scant loose adhesions which did not significantly affect operation procedures. The long-term pulmonary function and rates of residual pain for the two groups were comparable.. Although associated with immediate chest pain, intrapleural minocycline following simple aspiration is a simple, safe and convenient initial treatment for PSP that may reduce the rates of ipsilateral recurrence.

Topics: Adult; Anti-Bacterial Agents; Chest Pain; Chest Tubes; Female; Humans; Infusions, Intralesional; Male; Minocycline; Pleura; Pleurodesis; Pneumothorax; Retrospective Studies; Suction; Treatment Outcome

Topics: Anti-Bacterial Agents; Humans; Minocycline; Pleurodesis; Pneumothorax; Thoracic Surgery, Video-Assisted

To evaluate the safety and efficacy of additional minocycline pleurodesis after thoracoscopic treatment of primary spontaneous pneumothorax.. Retrospective comparative study with a historical control.. Thoracic surgical division of a university-affiliated tertiary medical center.. Between April 1994 and April 2001, 313 consecutive patients (minocycline group) with primary spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. The procedures included resection of the blebs and mechanical pleurodesis by scrubbing the parietal pleura. After operation, minocycline hydrochloride, 7 mg/kg, was instilled into the pleural space through a thoracostomy tube. The control group consisted of 51 consecutive patients who underwent the same thoracoscopic procedures alone for primary spontaneous pneumothorax between January 1992 and April 1994.. There was no significant difference between the two groups in terms of demographic data, operative findings, and operation time. Chest pain was a common complaint after minocycline pleurodesis, but the total doses of requested analgesics were comparable in both groups. The rate of prolonged air leaks was significantly lower in the minocycline group (7.0% vs 17.6%, p = 0.025). Patients treated with minocycline had shorter periods of postoperative chest drainage and hospitalization. The ipsilateral recurrence rate was also significantly lower in these patients (2.9% vs 9.8%, p = 0.033).. Minocycline pleurodesis is a safe and convenient procedure that may improve the outcome and reduce the rate of recurrence after thoracoscopic treatment for primary spontaneous pneumothorax. A randomized control study may be needed to confirm the findings.

Topics: Adolescent; Adult; Female; Humans; Irritants; Male; Middle Aged; Minocycline; Pleurodesis; Pneumothorax; Postoperative Care; Recurrence; Thoracic Surgery, Video-Assisted

To clarify the management and treatment for the refractory cases of secondary spontaneous pneumothorax (SSP), we analyzed the clinical features in SSP complicating three cases of advanced silicosis, and discussed the available treatment. All three cases were males of age ranging from 60 to 70 years, and had silicosis with massive progressive fibrosis (PMF), classified as type 4 (PR4) according to the ILO guidelines. There was no correlation between the onset of SSP and the smoking habit, or the duration of the occupational exposure to silica. In a total of ten episodes of SSP, a refractory episode occurred in each of the three patients. No surgical treatment was possible because of some complications. Therefore, we administered conservative treatments under mechanical ventilation. The conservative treatments used were tube drainage with suction in each episode and pleurodesis by the combination of minocycline and OK-432 in one case. Approximately one month was the average time required for the air leak cessation. A significant decline in arterial oxygen tension (PaO2) was observed after the treatment of one case, suggesting further respiratory deterioration. These results imply that the more aggressive treatments for refractory SSP should be limited because of the patient status and progression. More information might be required before performing these options safely and effectively.

Topics: Aged; Humans; Male; Middle Aged; Minocycline; Picibanil; Pneumothorax; Pulmonary Fibrosis; Radiography; Respiration, Artificial; Silicosis

Topics: Bleomycin; Costs and Cost Analysis; Doxycycline; Humans; Incidence; Minocycline; Pleurodesis; Pneumothorax; Recurrence; Talc; Tetracycline; Thoracoscopy; Thoracotomy

Minocycline pleurodesis with intrapleural pretreatment of lidocaine (150 mg) was performed on 19 patients. Minocycline was instilled into the pleural space for postoperative air leakage in 12 patients and control of malignant pleural effusion in 7 patients. Postoperative air leakage persisted longer than seven days was indicated instillation of minocycline (300 mg) with thoracostomy drainage. Satisfactory results were obtained in 11 of the 12 patients (92%) treated with this method. In 7 patients to control malignant pleural effusion, only one of these patients had recurrence of pleural effusion. Seventeen patients of all 19 subjects were free of pain following pleurodesis. None of these patients had a side effect of lidocaine. In conclusion of instillation, minocycline with thoracostomy drainage is a safe and an effective technique.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Drug Evaluation; Female; Humans; Instillation, Drug; Lung Neoplasms; Male; Middle Aged; Minocycline; Pleural Effusion; Pneumonectomy; Pneumothorax; Postoperative Complications; Tetracyclines; Thorax