Special Issue "Malignant Pleural Mesothelioma and Malignant Pleural Effusion: Current Knowledge and Future Perspectives"

A special issue of Medical Sciences (ISSN 2076-3271). This special issue belongs to the section "Cancer and Cancer-Related Research".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 1069

Special Issue Editor

Respiratory Medicine Department, Northumbria Healthcare NHS Foundation Trust, Cramlington NE22 9EH, UK
Interests: pleural infection; malignant and benign pleural disease; mesothelioma

Special Issue Information

Dear Colleagues,

The last decade or so has seen an explosion of good evidence from randomised controlled trials in the field of pleural disease. Significant advances have been made in the areas concerning pneumothorax, pleural infection, malignant as well as benign pleural effusion, and the interventions related to those. Despite this, much is unknown such as the use of suction in pneumothorax, the upfront role of surgery in pleural infection in adults, the use of indwelling pleural catheters in benign effusions, or the role of day case thoracoscopy, to cite just a few. The same can be said for mesothelioma where, recently, there has been some significant advances with the role of targeted immunotherapies, but there are many unanswered questions with future trials looking at the role of artificial intelligence or intra pleural chemotherapy. Palliative care in either clinical entity has been relatively understudied too.

This Special Issue of Medical Sciences invites researchers to contribute with original research articles and reviews in all aspects of pleural disease and mesothelioma. Topics of interest include, but are not limited to: (1) updates in the pathophysiology of pleural disease and mesothelioma; (2) emerging diagnostic techniques in either field; (3) preclinical treatments and new treatments for either; (4) palliative care in either field.

Dr. Avinash Aujayeb
Guest Editor

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  • malignant pleural effusion
  • pleural infection
  • pleural mesothelioma
  • benign pleural effusion

Published Papers (1 paper)

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Day Case Local Anaesthetic Thoracoscopy: Experience from 2 District General Hospitals in the United Kingdom
Med. Sci. 2023, 11(1), 23; https://doi.org/10.3390/medsci11010023 - 15 Mar 2023
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Background: Local anaesthetic thoracoscopy (LAT) can be a vital procedure for diagnosis of unexplained pleural effusions. Traditionally, poudrage for pleurodesis and insertion of a large bore drain necessitated admission. There has been a shift towards performing LAT as a day case procedure with [...] Read more.
Background: Local anaesthetic thoracoscopy (LAT) can be a vital procedure for diagnosis of unexplained pleural effusions. Traditionally, poudrage for pleurodesis and insertion of a large bore drain necessitated admission. There has been a shift towards performing LAT as a day case procedure with indwelling pleural catheter (IPC) insertion. This was advocated during the COVID pandemic by the British Thoracic Society (BTS). To determine the feasibility of such pathways, continuous evaluations are required. Methods: All day case LAT procedures with IPC insertion, performed in theatre, were identified at two large district general hospitals (Northumbria HealthCare in the North East of England and Victoria Hospital, NHS Fife, in Scotland). Rapid pleurodesis with talc was not performed due to local staffing problems. All patients had their LAT in theatre under conscious sedation with a rigid scope. Demographics, clinical, radiological and histopathological characteristics and outcomes were collected. Results: 79 patients underwent day case LAT. The lung did not deflate, meaning biopsies were not enabled, in four of the patients. The mean age was 72 years (standard deviation 13). Fifty-five patients were male and twenty-four were female. The main diagnoses were lung cancers, mesotheliomas and fibrinous pleuritis with an overall diagnostic sensitivity of 93%. Other diagnoses were breast, tonsillar, unknown primary cancers and lymphomas. Seventy-three IPCs were simultaneously placed and, due to normal macroscopic appearances in two patients, two large bore drains were placed and removed within one hour of LAT termination. Sixty-six (88%) patients were discharged on the same day. Seven patients required admission: one for treatment of surgical emphysema, four because they lived alone, one for pain control and one for control of a cardiac arrythmia. Within 30 days, there were five IPC site infections with two resultant empyemas (9%), with no associated mortality. Two patients developed pneumonia requiring admission and one patient required admission for pain management. The median number of days for which the IPCs remained in situ was 78.5 days (IQR 95). The median length of stay (LoS) was 0 days (IQR 0). No patients required further interventions for pleural fluid management. Conclusions: Day case LAT with IPC insertion is feasible with this current set up, with a median stay of 0 days, and should be widely adopted. The health economics of preventing admission are considerable, as our previous analysis showed a median length of stay of 3.96 days, although we are not comparing matched cohorts. Full article
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