Abstract Background More than one half of patients with cancer have a malignant pleural effusion (MPE) at some time during their life span. Recurrent malignant pleural effusions impair respiratory ...functions and worsen the quality of life. Once a patient develops MPE, only fluid drainage relieves pulmonary compression and dyspnea. Optimal treatment is however, still controversial. In patients not suitable for pleurodesis, or with recurrent MPE after pleurodesis, or with trapped lung, the outpatient intermittent drainage through a subcutaneous tunneled indwelling pleural catheter (IPC) is a possible choice. Methods In ten years, we treated 90 patients by outpatient insertion of IPC. Eligibility for IPC required previous thoracentesis with histological confirmation of malignancy and chest roentgenogram evidence of effusion. All patients treated were made aware of their malignancy and positive cytology in the pleural effusion. Results Mean survival was 197 days (range 23–296 days). Median time of draining interval was 7.0 days with maximum amount of effusion drained off being 1000 ml. Pleurodesis occurred in 37 (41.1%) patients with a mean time of pleurodesis of 51 days (range 34–78 days). No major complication was recorded. Conclusions The IPC is a useful device in the management of recurrent MPE. Treatment can be entirely accomplished at home and the complication rate is low.
OBJECTIVES
To investigate the usefulness of 18-fluorine fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET–CT) in the pretreatment evaluation of thymic epithelial ...neoplasms (TENs). We previously demonstrated that the ratio between standardized uptake value of the tumour and aortic arch (SUV T/M) correlates with World Health Organization (WHO) classification. We now focused our evaluation on thymomas only, excluding carcinomas. We also searched for the expression of a pathological biomarker, Ki-67, that gained both diagnostic and prognostic relevance for various solid tumours. Its correlation with SUV T/M and WHO classification was evaluated.
METHODS
We performed a retrospective dynamic cohort study of data from January 2006 to December 2012, on 23 consecutive patients with pathologically proven TEN, excluding thymic carcinomas, evaluated with PET–CT. For each patient, SUV T/M was calculated. The patients were then categorized, according to WHO classification, into two groups (low-risk: 3 A, 9 AB, 5 B1; high-risk: 5 B2, 1 B3) and Ki-67 labelling index (LI) was defined. We employed the Spearman rank non-linear correlation coefficient (ρ) to estimate the correlations between variables.
RESULTS
SUV T/M proved to be significantly higher for high-positive Ki-67 samples, indicating a strong correlation between SUV T/M and Ki-67 LI (ρ = 0.8). Furthermore, high Ki-67 LI samples correlate with the higher-risk WHO subgroup (ρ = 0.9).
CONCLUSIONS
FDG PET–CT can provide a useful tool in the preoperative work-up of TEN, reflecting its proliferation capacity, as described also by the Ki-67 expression. In particular, SUV T/M could provide a ‘metabolic biopsy’ to divide TEN into high-risk and low-risk neoplasms.
Objectives
The Electro-thermal bipolar tissue-sealing system (LigaSure®-Covidien) in lung resections is still undefined (although approved by FDA with limitations).
Methods
Prospective randomized ...study of 100 consecutive patients undergoing lobectomy. After muscle-sparing-thoracotomy and classification of lung fissures (Craig–Walker's), patients with fissure 2-4 were randomized to Stapler-Group or LS-Group. In LS-Group, only LS was used, instead of staplers, for fissure completion. Cost-benefit evaluation was performed using Pareto-optimal-analysis.
Results
There were no significant differences between groups (demographic and baseline characteristics). No patients were withdrawn from study; no adverse-effects were recorded. There was no mortality or major complications. There were no statistically significant differences between outcomes in LS-Group compared with Staplers-Group for operative-time, or morbidity. In LS Group, there was a non-significant increase of postoperative air-leaks in the first 24 hours postoperatively, and a statistically significant increase of drainage amount, without differences in hospital length of stay. LS Group had favourable multi-criteria analysis of cost/benefit ratio with good Pareto optimality.
Conclusions
LS is a safe device for lung resections and can be a valid alternative to staplers. LS allows for functional lung tissue preservation. LS is cost equivalent to Staplers. Nevertheless, larger series will be needed.
Disclosure
All authors have declared no conflicts of interest.
Acute facet capsular entrapment results in sudden onset of pain and reduced ability to perform active cervical motions. The Multifidus Isometric Technique (MIT) is a type of manual therapy ...intervention theorized to target the entrapped facet capsule and pull the entrapped synovial folds from the facet joint resulting in decreased pain and increased function.
To describe immediate MIT clinical outcomes for patients with acute neck pain.
Consecutive patients (n = 30; 70% female) with sudden onset of neck pain received MIT within 48 hours of symptom onset. Clinical outcome measures included: 1) 11-point Numeric Pain Rating Scale (NPRS); 2) cervical AROM, and 3) the Neck Disability Index (NDI). Paired-sample t-testing was used to assess for within and between-session changes in outcome measure scores.
Within-session NPRS improvements were observed during all cervical AROM movements (p < .01), with initial treatment associated with greater improvements on average (M = 2.4 ± 1.6 points) compared to the second treatment (M = 0.6 ± 0.9 points). Similarly, most within-session AROM measures improved during both sessions (p < .01) with greater average improvements observed following the initial treatment session and for cervical rotation to the symptomatic side (M = 26.5 ± 9.6 vs. 8.0 ± 9.7°). Between-session NDI scores improved (M = 15.3 ± 9.8, p < .01) with approximately 60% of patients achieving a minimally clinically important difference of 14 percentage points.
The MIT is a potentially beneficial intervention for patients with acute neck pain. Future studies consisting of longer follow-up time points and comparison treatment groups are needed to test MIT effectiveness.
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