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Background: Malignant pleural effusions (MPEs) are common, and a third of them have underlying trapped lung (TL). Management of MPE and TL is suspected to be heterogeneous. Understanding current practices in Australasia is important in guiding policies and future research. Aims: Electronic survey of Australia‐New Zealand respiratory physicians, thoracic surgeons and their respective trainees to determine practice of MPE and TL management. Results: Of the 132 respondents, 56% were respiratory physicians, 23% were surgeons and 20% were trainees. Many respondents defined TL as >25% or any level of incomplete lung expansion; 75% would use large‐volume thoracentesis to determine whether TL was present. For patients with TL, indwelling pleural catheters (IPCs) were the preferred treatment irrespective of prognosis. In those without TL, surgical pleurodesis was the most common choice if prognosis was >6 months, whereas IPC was the preferred option if survival was <3 months. Only 5% of respondents considered decortication having a definite role in TL, but 55% would consider it in select cases. Forty‐nine per cent of surgeons would not perform decortication when the lung does not fully expand intra‐operatively. Perceived advantages of IPCs were minimisation of hospital time, effusion re‐intervention and usefulness irrespective of TL status. Perceived disadvantages of IPCs were lack of suitable drainage care, potentially indefinite duration of catheter‐in‐situ and catheter complications. Conclusion: This survey highlights the lack of definition of TL and heterogeneity of MPE management in Australasia, especially for patients with expandable lungs. This survey also identified the main hurdles of IPC use that should be targeted. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study was designed to evaluate platelet-rich plasma (PRP) as a method of pleurodesis in a rabbit model. Pleurodesis with PRP was compared against the gold-standard use of talc. The secondary evaluation assessed the ideal time for achieving pleurodesis. Materials and Methods: 25 healthy New Zealand white rabbits were assigned to three groups, as follows: 12 animals in the first and second groups, as well as one animal with no intervention in the final group, which was used as a control. The talc pleurodesis group (baseline) underwent pleurodesis with sterile talc, which is the gold-standard sclerosing agent used for pleurodesis. The PRP group underwent pleurodesis using autologous PRP. The last group had one rabbit with no intervention. A total of 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 3 days (72 h) after the intervention, and 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 6 days (144 h) after the intervention. In both the talc and PRP group, FBC and CRP were measured before the intervention and in 3 or 6 days afterwards, respectively. The pleura and the lungs were evaluated histopathologically. Results: Macroscopically, there were no statistically significant differences between the two groups. In terms of microscopic findings, there were no statistically significant differences in inflammatory reactions provoked in the visceral and parietal pleura between the PRP and talc. In addition, with talc pleurodesis, a foreign-body reaction was observed in about 50% of the cases, which was not observed with PRP. In terms of inflammation between 3 and 6 days, there were no statistically significant differences with PRP, there was only a statistically significant difference between 3 and 6 days regarding the parietal pleura in the talc group. Conclusions: The instillation of autologous PRP in the pleural cavity shows promise in achieving pleurodesis. The efficacy of PRP as a pleurodesis agent should be examined further. [ABSTRACT FROM AUTHOR]

Introduction: Recurrent pleural effusion secondary to advanced malignant diseases can lead to poor quality of life, recurrent hospital stays and increased hospital costs, which has yet to be extensively explored. Aim: To compare the effectiveness of erythromycin and bleomycin in producing pleurodesis in rabbits and to determine the influence of different analgesic drugs namely tramadol sodium and parecoxib sodium intramuscular on experimental pleurodesis induced by erythromycin or bleomycin intrapleural on the aforementioned rabbits. Material and methods : This was an experimental animal pilot study involving 28 white New Zealand rabbits which were divided into 4 groups of 7 specimens. They received different agents as follow: group A (erythromycin and parecoxib sodium), B (erythromycin and tramadol sodium), C (bleomycin and parecoxib sodium), and D (bleomycin and tramadol sodium) at the right hemithorax. The control was marked at the contralateral left hemithorax. After 30 days the rabbits were euthanized to allow for evaluation of macroscopic and microscopic pleural and parenchymal adhesions by a blinded respective pathologist. Results and discussion: The degree of pleurodesis induced by the intrapleural injection of erythromycin indicated that it was superior to bleomycin as a sclerosing agent in the rabbit sample (P = 0.003). The concomitant use of analgesics revealed that tramadol sodium reduces the degree of pleurodesis to a greater extent than parecoxib sodium (P = 0.009). Conclusions : The use of intrapleural erythromycin as a potent agent of chemical pleurodesis that is insensitive to the concomitant analgesic effect of parecoxib sodium has important clinical implications in relation to the effectiveness of chemical pleurodesis as a procedure. [ABSTRACT FROM AUTHOR]

Pleurodesis, from the Greek pleura and desis (binding together), is intended to achieve a symphysis between parietal and visceral pleura, in order to prevent accumulation of either air (pneumothrax) or fluid (pleural effusion) in the pleural space. The search for the ideal agent for pleurodesis continues. The aim of this research was to assess the chronic gross and microscopic pleural findings, after intrapleural administration of iodpovidone as a sclerosing agent. 12 New Zealand White rabbits were used for the study. After instillation of 2 ml 10% iodpovidone into the right pleural cavity, the animals were sacrificed in groups of three on day 5, 7, 10, 14. Gross pathology and histology analysis were performed. It was established, that jodpovidone has caused pleural inflammation whit mononuclear cells infiltration and formation of new blood vessels on day 5. It was also established expressive proliferation of fibroblasts within visceral pleura and collagen production. The final result was fibrotic transformation of the visceral pleura, which was established on day 14. As a result of pleural fibrotic transformation, complete obliteration of the pleural space occurred, which means effective pleurodesis. The study had shown that intrapleural instillation of iodpovidone has caused effective pleurodesis until the period of 14 days. The safeness of iodpovidone as an agent for chemical pleurodesis has also been proven in the study. [ABSTRACT FROM AUTHOR]

Pleurodesis is intended to achieve a symphysis between parietal and visceral pleura in order to prevent accumulation of air or fluid. The aim of this research was to assess the acute gross and microscopic pleural findings, after intrapleural administration of iodpovidone as a sclerosing agent. 22 New Zealand White rabbits were used for the study. After instillation of 2 ml 10% iodpovidone into the right pleural cavity, the animals were sacrificed in groups of three on days I, 2, 3, 4. Gross pathology, pleural fluid analysis and histology analysis were performed. It was found that iodpovidone caused pleural effusion with characteristic exudates and appearance of first fibrinous strands on day 3. It was found also that there were mesothelial abnormalities and dilatation of subpleural vessels, in response to intrapleural instillation of iodpovidone. The inflammatory cell infiltrates changed from polymorphonuclear to mononuclear, with fibroblast appearance on day 3. The study has shown that iodpovidone, as a pleural scierosing agent, caused pleural inflammatory reaction. Mesothelial cell abnormalities and dilatation of subpleural vessels are triggers of the pleural inflammatory reaction. It showed that the 3- to 4-day period represents the time of acute pleural changes caused by intrapleural injection of iodpovidone. [ABSTRACT FROM AUTHOR]