J.L.N. Medical College
Correspondence to: Neeraj Gupta MD, Government Doctors Quarters, Type III/1, Near Ajmer Club, Opposite Fire Brigade, Ajmer—305 001 (Raj.) India; e-mail: email@example.com
To the Editor:
I read with interest the observations (March 2000) of
Kinoshita et al,1 who used intrapleural diluted fibrin
glue for intractable pneumothoraces. This method would definitely add a
revolutionary step in management of large and severe spontaneous
pneumothoraces with persistent pleural airleaks. It may help avoid
major thoracic surgical procedures and subsequent postoperative
morbidity, at least in a group of patients who are not suitable
candidates for thoracotomy.
Although clinically very useful and an informative study, it raises
certain questions in mind that need further clarification.
Should the technique be called fibrin glue
pleurodesis? An adequate coverage of airleak by fibrin glue closes
the source of pneumothorax. Once the site of airleak is blocked with
fibrin glue, the lung will have a chance to expand. Does the glue
produce sufficient inflammation to cause pleural symphysis, so that it
can be called pleurodesis? Lack of inflammation might be
responsible for minimal pleural thickening associated with this
The relationship between failure of first and subsequent
infusions of fibrin glue and the extent of underlying lung disease is
not discussed by the authors. Did the presence of pulmonary fibrosis
prevent complete expansion of lung, even after adequate glue
application? Is there any contraindication to this procedure, where the
lung is not expected to expand because of severe underlying lung
disease, or when thick pleural rind has already been developed?
Is it possible to apply fibrin glue to bronchial stump at the
time of the pneumonectomy/lobectomy, so that risk of postoperative
airleaks may be lowered and reduce the incidence of such
I would also like to know the author’s experience with fibrin
glue in patients with pyopneumothorax or hydropneumothorax with
bronchopleural fistula because of bacterial or mycobacterial infections
in the underlying lung. Once the fluid is drained by chest tube, can it
be applied to pleural airleaks in the presence of infection in the
According to MEDLINE, references 27 and 29 are incorrectly
cited on the reference list. The article by O. Thetter (reference 27)
appears in Thoracic and Cardiovascular Surgeon (Thorac
Cardiovasc Surg), not Annals of Thoracic Surgery (Ann Thorac
Surg) (1981; 29:290–292). The name of the third author of reference 29
(Burhenna HG) was omitted from the reference citation (Am J Surg 1982;
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