altri trattamenti come lo Shunt pleuroperito- neale con il posizionamento di un particolare tipo di catetere con valvola unidirezionale e un sistema di pompaggio del liquido pleurico e l’intervento chirurgico sono da considerare trattamenti rivolti a circostanze veramente particolari. Le casistiche relative a questi ap- procci sono molto piccole e le problematiche legate alla gestione e al rilevante numero di complicanze rendono tali approcci veramen- te aneddotici e problematici anche per l’in- vasività delle procedure stesse 5.
Figura 6. Paziente con esiti di precedente inter- vento chirurgico di Extrapleural pneumonectomy a sinistra con asportazione dell’emidiaframma sin. e di parte del pericardio per sospetto mesote- lioma rivelatosi poi, sul pezzo operatorio definiti- vo, non un mesotelioma ma un adenocarcinoma. Recidiva neoplastica con versamento pleurico CTM positivo a destra dopo un anno dall’inter- vento chirurgico e trattato con applicazione di piccolo catetere a permanenza (9 Fr.). Lo svuota- mento del versamento con rimozione del liquido dal drenaggio era guidato dalla sintomatologia. Il drenaggio è rimasto in sede, ottimamente fun- zionante, per sei mesi, fino alla morte del pazien- te avvenuta per cachessia neoplastica.
Bibliografia
1 Light rW. Pleural Diseases. 4th ed. philadel-
phia: Lippincott Willianms e Wilkins 2001.
2 rodriguez-panadero F, Borderas Naranjo F,
Lopez-mejias J. Pleural metastatic tumours
and effusions: frequency and pathogenic mechanisms in a post-mortem series. eur respir J 199;2:366-9.
3 Chernow B, Sahn aS. Carcinomatous
involvement of the pleura. am J med 1977;63:695-702.
4 molengraft van de FJJm, Vooijs Gp. Survival of patients with malignancy-associated effu- sions. acta Cytol 199;33:911-6.
5 antunes G, Neville e, duffy J, et al. on
behalf of the BtS pleural disease Group, a subgroup of the BtS Standards of Care Committee. BTS guidelines for the manage-
ment of malignant pleural effusions. thorax 2003;5:ii29.
6 american thoracic Society. Management of malignant pleural effusions. am J respir Crit Care med 2000;162;197-2001.
7 miserocchi G. Physiology and pathophysi- ology of pleural fluid turnover. eur respir J 1997;10:219-25.
Light rW, Hamm H. Malignant pleural effu- sion: would the real cause please stand up? eur respir J 1997;10:1701-2.
9 meyer pC. Metastatic carcinoma of the pleu- ra. thorax 1966;21:437-43.
10 Kraft a, Weindel K, Ochs a, et al. Vascular endothelial growth factor in the sera and ef- fusions of patients with malignant and non malignant disease. Cancer 1999;5:17-7.
11 Hott JW, Yu L, antony VB, et al. Role of vascular endothelial growth factor (VEGF) in the formation of malignant pleural effu- sions. am J respir Crit Care med 1999;159: a212.
12 Noceti p, Nosenzo m. Versamento pleurico maligno. in: Casalini aG, ed. Pneumologia
Interventistica. milano: Spriger-Verlag 2007.
13 Johnston WW. The malignant pleural effu- sion: a review of cytopathological diagnoses of 584 specimens from 472 consecutive pa- tients. Cancer 195;56:905-9.
14 Starr rL, Sherman me. The value of multiple preparations in the diagnosis of malignant pleural effusions. acta Cytol 1991;35:533-7.
15 martinez-moragon e, aparicio J, Sanchtis J,
et al. Malignant pleural effusion: prognostic
factors for survival and response to chemical pleurodesis in a series of 120 cases. respira- tion 199;65:10-13.
16 tassi G, marchetti Gp, Bosio G. Pleurodesi Toracoscopia. in: Casalini aG, ed. Pneu-
mologia Interventistica. milano: Spriger- Verlag 2007.
17 maher GG, Berger HW. Massive pleu- ral effusion: malignant and nonmalignant causes in 46 patients. am rev respir dis 1972;105:45-60.
1 Judson ma, Sahn Sa. Pulmonary physi- ologic abnormalities caused by pleural disease. Semin respir Crit Care med 1995;16:346-53.
19 Weick JK, Kiely Jm, Harrison eG, et al. Pleural effusion in lymphoma. Cancer 1973;31:4.
20 Livingston rV, mcCracken Jd, trauth CJ,
et al. Isolated pleural effusion in small cell
lung carcinoma: favorable prognosis. Chest 192;1:20.
21 mcCarty KS, Wortman J, moore JO,
et al. Malignant effusions in recurrent
breast cancer. Steroid hormone receptor analysis of effusion derived cells. Cancer 190;45:1609.
22 Bosio G. Toracentesi. in: Casalini aG,
ed. Pneumologia Interventistica. milano: Spriger-Verlag 2007.
23 Senel mG, Corwin rW, Gold LH, et al. Com- plications associated with thoracocentesis.
Chest 196;90:97-100.
24 Kamffer WJ, Jooste eV, Nel Jt, et al. Sur- gical glove powder and intraperitoneal ad- hesion formation. An appeal for the use of powder-free surgical gloves. S afr med J 1992;1:15-9.
25 Xie C, teixeira Lr, mcGovern Jp, et al. Sys- temic corticosteroids decrease the effective- ness of talc pleurodesis. am J respir Crit Care med 199;157:1441-4.
26 Shaw p, agarwal r. Pleurodesis for malig- nant pleural effusions. Cochrane database Syst rev 2004;1:Cd002916.
27 mori pa, Casalini aG. La toracoscopia med- ica terapeutica. Consensus Conference pro- tocolli Operativi in pneumologia interventis- tica, Bologna, 2-3 marzo 2006.
7 2 paschoalini mS, Vargas FS, marchi e, et al.
Prospective randomized trial of silver ni- trate vs talc slurry in pleurodesis for symp- tomatic malignant pleural effusions. Chest 2005;12:64-9.
29 Vargas F, marchi e. Pleurodesis for malig- nant pleural effusion. international pleural Newsletter. Volume 3, issue 1, January 2005.
30 antony VB, Nasreen N, mohammed Ka, et
al. Talc pleurodesis: basic fibroblast growth
factor mediates pleural fibrosis. Chest 2004;126:1522-.
31 patlakas G, Bouros d. Trapped Lung. inter-
national pleural Newsletter. Volume 3, issue 1, January 2005.
32 erS/atS Statement. Management of ma- lignant pleural effusions. eur respir J 2001;1:402-19.
33 Owen S, Gould d. Underwater seal chest drains: the patient’s experience. J Clin Nurs 1997;6:215-25.
34 Sahn S. Is talc indicated for pleurodesis? Pro: talc shold be used for pleurodesis. J Broncoh 2002;9:223-7.
35 Light rW. Is talc indicated for pleurodesis? Con: talc shold not be used for pleurodesis. Broncoh 2002;9:22-32.
36 Kennedy L, Sahn Sa. Talc pleurodesis for the treatment of pneumothorax and pleural effu- sion. Chest 1994;106:1215-22.
37 antunes G, Neville e. Management of ma- lignant pleural effusions. thorax 2000; 55:91.
3 tremblay a, michaud G. Single-center expe- rience with 250 tunnelled pleural catheter in- sertions for malignant pleural effusion. Chest 2006;129:362.
39 putnam JB, Light rW, rodriguez rm, et
al. A randomized comparison of indwelling
pleural catheter and doxycycline pleurodesis in the management of malignant pleural effu- sions. Cancer 1999;6:1992-9.