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The palliative treatment with intrapleural streptokinase in patients with multiloculated malignant pleural effusion: a double-blind, placebo-controlled, randomized study.

Med Oncol. 2015 May;32(6):612

Authors: Saydam O, Karapinar K, Gokce M, Kilic L, Metin M, Oz II, Tanriverdi O

Abstract
Expansion of the lung is necessary for successful pleurodesis therapy in patients with malignant pleural effusion (MPE). However, this is often impossible in multiloculated MPEs. The aim of this study was to investigate the effect of the fibrinolytic agent, streptokinase, on pleurodesis therapy used in the management of multiloculated MPE. Forty patients with multiloculated MPEs were randomly assigned to two groups: fibrinolytic and control. In the fibrinolytic group, 250,000 IU of streptokinase in 50 ml saline was applied into the pleural space at 24-36-48-60 h after opening a tube thoracostomy. In the control group, the same procedure was carried out using only 50 ml saline solution. Both groups were compared based on the following: (1) volume of pleural drainage at 24-48, 48-72, and 24-72 h, (2) chest computer tomography images before and after therapy, (3) dyspnea symptoms after therapy, and (4) recurrence rate. The mean drainage volumes for the fibrinolytic and control groups were 493 and 248 cc at 24-48 h, 446 and 198 cc at 48-72 h, and 939 and 446 cc at 24-72 h (P < 0.001). Comparison of the two groups by computer tomography revealed that 17 patients (85 %) in the fibrinolytic group had greater than 40 % improvement, whereas only 7 patients (35 %) in the control group had the same degree of improvement (P = 0.001). The dyspnea symptoms disappeared in 90 % of the patients in the fibrinolytic group and in 55 % of the patients in the control group (P = 0.03). Recurrence rate was 11 % in fibrinolytic group and 45 % in control group (P = 0.07). Streptokinase is a reliable treatment option in obtaining effective pleural drainage and increasing lung expansion in patients with multiloculated MPE.

PMID: 25958101 [PubMed - in process]

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Mast cells in airway diseases and interstitial lung disease.

Eur J Pharmacol. 2015 May 7;

Authors: Cruse G, Bradding P

Abstract
Mast cells are major effector cells of inflammation and there is strong evidence that mast cells play a significant role in asthma pathophysiology. There is also a growing body of evidence that mast cells contribute to other inflammatory and fibrotic lung diseases such as chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis. This review discusses the role that mast cells play in airway diseases and highlights how mast cell microlocalisation within specific lung compartments and their cellular interactions are likely to be critical for their effector function in disease.

PMID: 25959386 [PubMed - as supplied by publisher]

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Longitudinal assessment of lung function decline in the occupational setting.

Curr Opin Allergy Clin Immunol. 2015 Apr;15(2):145-9

Authors: Redlich CA, Tarlo SM

Abstract
PURPOSE OF REVIEW: Spirometry is performed in the work setting as part of medical surveillance of workers with potentially respiratory hazardous work exposures, to identify early disease and evaluate the effectiveness of preventive interventions. However, many clinicians are not familiar with workplace medical surveillance and how to evaluate longitudinal spirometry over time.
RECENT FINDINGS: A recent American Thoracic Society technical standards report addressed issues related to performing spirometry in the work setting, including the interpretation of longitudinal lung function. Important considerations in assessing longitudinal lung function are reviewed. Recent studies evaluating the impact of selected occupational exposures on longitudinal lung function are reviewed.
SUMMARY: Recent longitudinal studies of exposed workers have identified novel occupational respiratory diseases such as flavoring-related lung disease, and advanced our understanding of more familiar exposures such as mineral dusts. Clinicians will increasingly need to be able to evaluate longitudinal spirometry, including thresholds that trigger further evaluation.

PMID: 25961387 [PubMed - in process]

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Efficacy of pirfenidone for idiopathic pulmonary fibrosis: An Italian real life study.

Respir Med. 2015 Apr 25;

Authors: Harari S, Caminati A, Albera C, Vancheri C, Poletti V, Pesci A, Luppi F, Saltini C, Agostini C, Bargagli E, Sebastiani A, Sanduzzi A, Giunta V, Della Porta R, Bandelli GP, Puglisi S, Tomassetti S, Biffi A, Cerri S, Mari A, Cinetto F, Tirelli F, Farinelli G, Bocchino M, Specchia C, Confalonieri M

Abstract
BACKGROUND: In this retrospective Italian study, which involved all major national interstitial lung diseases centers, we evaluated the effect of pirfenidone on disease progression in patients with IPF.
METHODS: We retrospectively studied 128 patients diagnosed with mild, moderate or severe IPF, and the decline in lung function monitored during the one-year treatment with pirfenidone was compared with the decline measured during the one-year pre-treatment period.
RESULTS: At baseline (first pirfenidone prescription), the mean percentage forced vital capacity (FVC) was 75% (35-143%) of predicted, and the mean percentage diffuse lung capacity (DLCO) was 47% (17-120%) of predicted. Forty-eight patients (37.5%) had mild disease (GAP index stage I), 64 patients (50%) had moderate IPF (stage II), and 8 patients (6.3%) had severe disease (stage III). In the whole population, pirfenidone attenuated the decline in FVC (p = 0.065), but did not influence the decline in DLCO (p = 0.355) in comparison to the pre-treatment period. Stratification of patients into mild and severe disease groups based on %FVC level at baseline (>75% and ≤75%) revealed that attenuation of decline in FVC (p = 0.002) was more pronounced in second group of patients. Stratification of patients according to GAP index at baseline (stage I vs. II/III) also revealed that attenuation of decline in lung function was more pronounced in patients with more severe disease.
CONCLUSIONS: In this national experience, pirfenidone reduced the rate of annual FVC decline (p = 0.065). Since pirfenidone provided significant treatment benefit for patients with moderate-severe disease, our results suggest that the drug may also be effective in patients with more advanced disease.

PMID: 25962649 [PubMed - as supplied by publisher]