picibanil and Bronchial-Fistula

Treatment options for bronchial fistula (BF) after pneumonectomy are often limited and carry significant morbidity and mortality. The patient underwent right extrapleural pneumonectomy for malignant pleural mesothelioma had BF without macroscopic fistula found by bronchography. We treated this minor BF using bronchoscopy with the administration of OK-432, fibroblast growth factor basic, and fibrin glue sealant. Two weeks after this treatment, we confirmed the improvement of the fistula by bronchography. Bronchoscopic therapy for BF was useful for a small, early fistula without infection.

Topics: Bronchial Fistula; Bronchoscopy; Fibrin Tissue Adhesive; Fibroblast Growth Factors; Humans; Picibanil; Pleural Diseases; Pneumonectomy

We report a case of cerebral arterial air embolism that was followed by a brain computed tomographic scan and magnetic resonance imaging during the first week after onset. A 73-year-old man was admitted for treatment of pleural dissemination that was a recurrence after right lower bilectomy for advanced lung cancer. Thirty minutes after an anti-drug administration through the chest drainage tube, he lost consciousness shortly after coughing. A bubble in the inferior sagittal sinus was observed on the day of the stroke, which then disappeared within 24 hours. It seems that the anti-cancer agent evoked inflammation at the visceral pleura and the subject inhaled massive air flow into the systemic circulation.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Brain Edema; Brain Ischemia; Bronchial Fistula; Carcinoma, Squamous Cell; Cerebral Infarction; Chest Tubes; Cisplatin; Coma; Combined Modality Therapy; Cough; Disease Progression; Embolism, Air; Fatal Outcome; Fistula; Hemiplegia; Humans; Injections; Intracranial Embolism; Lung Neoplasms; Lymph Node Excision; Male; Picibanil; Pleura; Pleural Cavity; Pleural Effusion, Malignant; Pneumonectomy; Postoperative Complications; Pulmonary Veins

We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (Picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.

Topics: Bronchial Fistula; Bronchoalveolar Lavage; Embolization, Therapeutic; Empyema, Pleural; Female; Fistula; Humans; Middle Aged; Minocycline; Picibanil; Pleural Diseases; Postoperative Complications; Tomography, X-Ray Computed