0
Communications to the Editor |

Intrapleural Administration of Diluted Fibrin Glue for Intractable Pneumothorax FREE TO VIEW

Neeraj Gupta, MD; Lokendra Dave, MBBS
Author and Funding Information

J.L.N. Medical College Ajmer, India

Correspondence to: Neeraj Gupta MD, Government Doctors Quarters, Type III/1, Near Ajmer Club, Opposite Fire Brigade, Ajmer—305 001 (Raj.) India; e-mail: guptang@yahoo.com



Chest. 2001;119(2):671-672. doi:10.1378/chest.119.2.671-a
Text Size: A A A
Published online

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.

  1. 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 procedure.

  2. 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?

  3. 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 pneumothoraces?

  4. 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 lung?

  5. 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; 143:561–564).

References

Kinoshita, T, Miyoshi, S, Katoh, M, et al (2000) Intrapleural administration of a large amount of diluted fibrin glue for intractable pneumothorax.Chest117,790-795. [CrossRef]
 

Figures

Tables

References

Kinoshita, T, Miyoshi, S, Katoh, M, et al (2000) Intrapleural administration of a large amount of diluted fibrin glue for intractable pneumothorax.Chest117,790-795. [CrossRef]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543