Chemical pleurodesis with Viscum album L. extract for secondary spontaneous pneumothorax in elderly patients

Abstract

Background: Secondary spontaneous pneumothorax is generally managed by surgery, if pneumothorax was not improved following chest tube insertion or in the event of persistent air leakage lasting more than 5 days. However, if surgery is not an option, chemical pleurodesis with sclerosants can be performed. Several sclerosants have been used in the chemical pleurodesis of secondary spontaneous pneumothorax, However, there is still controversy for what is the ideal sclerosant for Secondary spontaneous pneumothorax. The use of Viscum album L. for chemical pleurodesis in patients with secondary spontaneous pneumothorax aged >65 years has not been described to date, despite its extensive use. The authors tried to find out the effect of Viscum album L. for sclerosant for Secondary spontaneous pneumothorax in elder.Methods: This retrospective analysis examined 25 patients (aged >65 years) with secondary spontaneous pneumothorax with persistent air leakage who underwent chemical pleurodesis with Abnova Viscum-F ® (V. album L.). Results:The duration of chest tube drainage was 5.08 days after chemical pleurodesis. Adverse effects related to chemical pleurodesis with Abnova Viscum-F ® were fever (7/25), pain (4/25), leukocytosis (10/25), and dyspnea with desaturation (7/25); however all the patients recovered without sequela and were subsequently discharged.Conclusions: The present study demonstrated the successful use of chemical pleurodesis with V. album L. in the management of elderly patients with secondary spontaneous pneumothorax. Because of the high probability of dyspnea with desaturation in the elderly, caution must be exercised.

Alternative management of intractable chylous ascites following robot-assisted pancreaticoduodenectomy of <i>Viscum album</i> sclerotherapy: a case report

“…V. album , a European mistletoe, can act as sclerosant and it was previously proven effective to treat malignant pleural effusion and malignant ascites in many studies [ 10 ]. Viscum was also successfully used in chemical pleurodesis for secondary spontaneous pneumothorax in elderly patients [ 5 ]. V. album is known to be a considerably safe agent with mild adverse effects compared to other sclerotic agents, such as Picibanil (OK-432) which was used as a sclerosing agent in lymphatic malformation and in some cases of lymphoceles or intractable chylous leak after neck dissection [ 11 – 13 ].…”

“…V. album extract also acts as a sclerosant and it was proven to be effective in treating malignant pleural effusion in many studies [ 4 ]. It was also shown to be successful in the treatment of secondary spontaneous pneumothorax in elderly patients [ 5 ].…”

Simultaneous Viscum Pleurodesis and Bullectomy in Patients With Primary Spontaneous Pneumothorax

“…One of the most important issues in the treatment of PSP is preventing recurrence. Although surgery is the most effective treatment for PSP, the recurrence rate of pneumothorax remains 5-15% after thoracoscopic surgery [3][4][5][6]11,12 . In order to minimize recurrence rate of postoperative pneumothorax, chemical pleurodesis has been performed simultaneously with resection or sequentially.…”

Pleurodesis

“…Chambers [7]. Multiple substances or interventions on the pleura have been used to achieve pleurodesis, all with the purpose of generating fibrosis and adhesion between pleurae, starting with talc [8][9][10], iodized talc [7,11], silver nitrate [12], iodine [13], extending to the use of antimicrobials such as tetracycline [14,15], doxycycline [16][17][18][19][20], minocycline [18,21] tigecycline [22,23], quinacrine [24], mepacrine [25], cytotoxics such as bleomycin [18,19], mitomycin [26,27], mitoxantrone [28,29], platinum derivatives [30,31], bacterial agents such as Corynebacterium parvum [32], OK-432 (a derivative of Streptococcus) [26,33], Staphylococcus superantigens [26,34,35], lipoteichoic acid [36], reaching haematic patches [37][38][39], hypertonic glucose [40][41][42], mistletoe-derived substances such as Viscum album [43][44]…”