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Pleura

June 11, 2015
The authors evaluated VATS vs pleural drainage for initial primary spontaneous pneumothorax in 122 pts, evaluating costs and QOL.  Costs for VATS were half of those for pleural drainage.  Quality adjusted life years were better for VATS.  The incremental cost-effectiveness ratio for VATS was 7,600 euros at 1 year and 10,000 euros at 5 years, well wit
May 19, 2015
The question in this review was whether patients who experience tension pneumothorax differ in presentation depending on whether they are breathing spontaneously or are on positive pressure ventilation.  Assisted ventilation was more often associated with hypoxia, hypotension, and cardiac arrest.  These adverse clinical signs frequently arose within
April 30, 2015
This prospective study evaluated QOL and lung function after extended pleurectomy/decortication (EPD) for mesothelioma in 36 patients.  Patients with performance status (PS) 0 experienced little or no improvement in QOL but did have a significant decrease in lung function (FVC, FEV1, TLC, DLCO).  Patients with PS 1-2 experienced improved QOL and no i
April 9, 2015
This article offers an overview of the evolution of thoracic drainage and development of the modern chest tube from ancient Greece to the present time.
January 14, 2015
A tool for assessing competency in chest tube insertion was developed and validated using mannequins and patients.  Scores varied according to participant experience, and interrater consistency in evaluations was high.  It is suggested that this assessment tool can be used to judge the development of competence in chest to insertion and to evaluate t
November 6, 2014
The authors performed a single center review to assess outcomes of thoracentesis for inpatients.  For 9,320 thoracenteses in 4,618 patients the incidence of adverse outcomes was quite low: pneumothorax 0.6%, reexpansion pulmonary edema 0.01%, and bleeding 0.2%.  Current guidelines may not be aligned with outcomes of expert clinical practice.
September 25, 2014
This randomized controlled trial compared VATS partial pleurectomy (VAT-PP) to talc pleurodesis in patients with malignant mesothelioma and a pleural effusion, evaluating overall survival.  VAT-PP was associated with significantly greater surgical complications, a higher rate of respiratory complications and prolonged air leak, and a significantly lo
September 16, 2014
This retrospective review of pts undergoing complete resection by extrapleural pneumonectomy 1998-2011 for malignant mesothelioma focused on stage predictors of survival.  Surgical mortality was 5%.  Overall survival at 5 years was 14%, and median survival was 18 mos.   Median survival for N1 or N2 disease was 17 and 13 mos, respectively.  Nodal stag
August 11, 2014
Data from 6 cohort studies were evaluated to assess the ongoing risk of mesothelioma more than 40 years after initial environmental exposure to asbestos.  Among over 22,000 of those exposed, 707 cases of pleural mesothelioma were diagnosed.  The rate and risk increased until 45 years after exposure, then the rate of increase tapered off somewhat.
August 7, 2014
The authors developed and validated a survival predictive score for patients with malignant pleural effusion using 3 large international cohorts of patients.  The LENT score is based on LDH level, ECOG performance status, neutrophil to lymphocyte ratio, and tumor type.  Low risk patients had a median survival of 319 days, moderate risk group survival

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