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  • Vpliv pH plevralnega izliva na uspešnost torakoskopske mehanske plevrodeze pri bolnicah s karcinomom dojke : doktorska disertacija
    Crnjac, Anton
    Malignant pleural effusion is a frequent and serious complication of the breast carcinoma which causes the patients respiratory problems because of the pressure to the lung, chronic cough and pain ... and therefore significantly reduces the quality of their remaining life. Numerous more or less aggressive palliative methods for the treatment of the effusion are used in current practice. The most frequent among them is chemical pleurodesis with talcum, which is insufficiently effective when the pH of the malignant pleural effusion is bellow 7.3, due to tumour infiltration or fibrosis of the pleura. In the prospective randomized study, we compared the efficiency of the treatment of the malignant pleural effusion of the breast carcinoma with thoracoscopic mechanical pleurodesis as a new palliative method and the chemical pleurodesis with talcum, taking into consideration different values of the pH of the pleural effusion. The purpose of our research was to discover whether the changed pH values of the malignant pleural effusion influence the efficiency of the treatment with thoracoscopic mechanical pleurodesis and to determine which is the lowest pH value still ensuring the efficiency of those two palliative methods. The basic research hypothesis was that at lower pH values thoracoscopic mechanical pleurodesis is a more successful palliative method of treating malignant pleural effusion than chemical pleurodesis with talcum. Eigthy-seven patients with the breast carcinoma and consequent malignant pleural effusion resistant to systemic therapy were divided into two groups. In the TMP (thoracoscopic mehanical pleurodesis) group, we performed thoracoscopic abrasion of parietal and visceral pleura to petechial hemorrhage utilising general anesthesia in 24 patients with pH value above 7.3 and 21 patients with pH value below 7.3. In the CPT (chemical pleurodesis with talcum) group, on the other hand, we injected 5 g of sterile talcum dissolved in 100 ml of physiological solution through the chest tube drain in local anesthesia in 22 patients with the pH value above 7.3 and 20 patients with the pH value below 7.3. Postoperative follow-up was performed to determine a possible recurrence of the malignant pleural effusion with periodical X-rays of the lungs or ultrasound scans of the pleural space, the duration of the chest tube drainage and hospitalisation, the appearance of complications, as well as the mortality six months after the procedure. The success of the thoracoscopic mechanical pleurodesis and chemical pleurodesis with talcum was identical (92 % and 91 %) in patients with pH values above 7.3. The differences occured in patients with pH values below 7.3 (81 % and 55 %) (p=0.07). The lowest pH value at which thoracoscopic mechanical pleurodesis and chemical pleurodesis was successful, was 7.06 and 7.25 respectively. The average time of the chest tube drainage in the TMP group was 3.8 days and of hospitalisation 5.5 days, whereas in the CPT group it was 5.5 and 7.5 days. The differences were statistically significant (p<0.05). In the TMP group we had 16 % of easily treatable complications and no case of perioperative mortality, in the CPT group we registered 26 % of complications and four patients died within the first 30 days following the operation. Six patients of the TMP and eight patients of the CPT group died within the first six months after the operation procedure. The differences between the two groups were statistically insignificant (p=0.466). The results of our research showed that thoracoscopic mechanical pleurodesis is a safe palliative method of treating recurrent malignant pleural effusions of the breast carcinoma with a low number of complications, short chest tube drainage and hospitalisation. It is effective than chemical pleurodesis at pH values of the malignant pleural effusion below 7.3. In pH values of the malignant pleural effusion above 7.3, the chemical pleurodesis with talcum, in spite of equal efficiency, is a more usefull palliative treatment method because of its simplicity. Thoracoscopic mechanical pleurodesis is undoubtedly justified in this group of patients particularly in treating cytologically and histologically non-confirmed malignant pleural effusions and suspected scarring in the pleural space.
    Vrsta gradiva - disertacija ; neleposlovje za odrasle
    Založništvo in izdelava - Ljubljana : [A. Crnjac], 2005
    Jezik - slovenski
    COBISS.SI-ID - 1827647

Knjižnica Signatura – lokacija, inventarna št. ... Status izvoda
Narodna in univerzitetna knjižnica, Ljubljana GS II 607074 glavno skladišče prosto - za čitalnico
MF, Centralna medicinska knjižnica, Ljubljana doktorske disertacije
CRNJAC Anton Vpliv
IN: 020050575 		prosto - na dom, čas izposoje: 1 mes.
MF, Centralna medicinska knjižnica, Ljubljana doktorske disertacije
CRNJAC Anton Vpliv
IN: 020050576 		prosto - na dom, čas izposoje: 1 mes.
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