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Biomedical subjects

Richard W Light

Publications and source records attributed to Richard W Light.

61 records · Page 4Linked to original sources
PubMed2002

Pleural effusions after coronary artery bypass graft surgery.

After coronary artery bypass graft surgery, most patients will have a small, unilateral, left-sided pleural effusion, and approximately 10% of patients will have a larger effusion. These large effusions can be separated into (1) early effusions occurring within the first 30 days of surgery that are bloody exudates with a high percentage of eosinophils, and (2) late effusions occurring more than 30 days after surgery that are clear yellow lymphocytic exudates. The primary symptom of pleural effusion after coronary artery bypass graft surgery is dyspnea; chest pain and fever are uncommon. Most patients with large pleural effusions after coronary artery bypass graft surgery are treated successfully with one to three therapeutic thoracenteses.

Coronary Artery Bypass↗
PubMed2002

The effect of corticosteroids on pleurodesis induced by doxycycline in rabbits.

STUDY OBJECTIVE: To determine if the administration of systemic corticosteroids diminishes the effectiveness of the pleurodesis induced by the intrapleural injection of doxycycline. STUDY DESIGN: Thirty New Zealand white male rabbits were classified into three groups (n = 10 rabbits), all of which received doxycycline, 10 mg/kg intrapleurally, in a volume of 2 mL. Rabbits in the control group received only the intrapleural injection of doxycycline; the steroid-once group received triamcinolone, 0.8 mg/kg IM, 24 h before the intrapleural injection; and the steroid-weekly group received triamcinolone, 0.8 mg/kg IM, 24 h before the intrapleural injection and weekly over the next 3 weeks. All rabbits had a chest tube placed before the intrapleural administration of doxycycline and underwent pleural fluid aspiration twice daily. The rabbits were killed after 28 days, and the pleura and lungs were examined macroscopically and microscopically. RESULTS: The administration of corticosteroids resulted in both a significant decrease in the macroscopic adhesion score (p < 0.001) and a tendency toward a decreased microscopic fibrosis score (p = 0.056) after 28 days. Animals receiving weekly corticosteroid injections had lower scores than animals receiving only one injection. CONCLUSION: This study demonstrates that the administration of corticosteroids (triamcinolone, 0.8 mg/kg) 24 h before the intrapleural injection of doxycycline, 10 mg/kg, decreases the effectiveness of pleurodesis in rabbits. Weekly injections decreased the effectiveness even more. If these results can be extrapolated to humans, efforts should be made to minimize the administration of exogenous corticosteroids when pleurodesis is attempted.

Animals↗
PubMed2002

Pleural fluid levels of interleukin-5 and eosinophils are closely correlated.

BACKGROUND: The mechanisms responsible for the accumulation of eosinophils in pleural fluid are not fully understood. The purpose of this study was to evaluate the relationship between eosinophil accumulation and the levels of interleukin (IL)-5, IL-3, and granulocyte/macrophage colony-simulating factor (GM-CSF) in pleural effusions. METHODS: We evaluated 30 patients with eosinophilic pleural effusions (eosinophil count > 10% nucleated cells in pleural fluid) and 10 patients with noneosinophilic pleural effusions. The patients with eosinophilic pleural effusions included 22 patients with post-coronary artery bypass graft surgery pleural effusions and 8 patients with eosinophilic pleural effusions caused by other causes. IL-5, IL-3, and GM-CSF in all pleural fluids were measured using enzyme-linked immunosorbent assay kits. RESULTS: The mean level of IL-5 in eosinophilic pleural effusions (283.1 +/- 341.6 pg/mL) was significantly (p < 0.025) higher than that in the noneosinophilic effusions (28.2 +/- 19.0 pg/mL). The absolute eosinophil count and percentage correlated significantly with the level of IL-5 in all patients (r = 0.55, p < 0.001, and r = 0.54, p < 0.001, respectively). There was no significant correlation between IL-5 levels and RBC counts in all patients (r = 0.24, p > 0.05). GM-CSF and IL-3 levels were below the detectable range in all pleural fluids. CONCLUSION: There is a significant relationship between the levels of IL-5 in pleural fluid and the total number and percentage of eosinophils in the pleural fluid. IL-5 seems to be related to the eosinophil accumulation associated with blood or air in the pleural space and other eosinophilic pleural effusions.

Enzyme-Linked Immunosorbent Assay↗
PubMed2002

Iodopovidone pleurodesis for recurrent pleural effusions.

STUDY OBJECTIVE: Chemical pleurodesis may be the best available treatment for recurrent and troublesome pleural effusions when the underlying cause cannot be corrected. A wide variety of pleural irritants have been used, but the search for the ideal agent for pleurodesis continues. The purpose of our study is to evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis in patients with recurrent pleural effusion. DESIGN AND SETTING: Multicenter prospective study. INTERVENTION: The pleurodesis solution consisted of a mixture of 20 mL 10% iodopovidone and 80 mL normal saline solution. It was infused and left in the pleural cavity for 2 h. In 12 patients, pleurodesis was performed through a tube thoracostomy, and in the remaining 40 patients it was carried out at the end of diagnostic thoracoscopy. RESULTS: Fifty-two patients were included, with a mean (+/- SEM) age of 56.6 +/- 1.84 years. Eighty-five percent of the cases were related to a malignant neoplasm. A complete response, with no reaccumulation of fluid during follow-up, was obtained in 50 patients (96.1%). A second procedure was successful in the two remaining patients. Three patients (5.8%) experienced intense pleuritic pain and systemic hypotension after the instillation of the sclerosing agent. They recovered without incident. The mean length of follow-up was 13 +/- 1.46 months, with a median of 8.5 months. There were no 30-day postoperative deaths. CONCLUSIONS: Iodopovidone is an effective, safe, readily available, and inexpensive alternative to achieve chemical pleurodesis in cases of recurrent, incapacitating effusions, regardless of etiology.

Anti-Infective Agents, Local↗
PubMed2002

Influence of particle size on extrapleural talc dissemination after talc slurry pleurodesis.

BACKGROUND: Cases of acute respiratory failure reported after talc pleurodesis have raised concerns about its safety. It has been speculated that this pulmonary inflammatory syndrome is secondary to the extrapleural dissemination of the talc particles. STUDY OBJECTIVES: To test the hypothesis that particle size influences extrapleural talc deposition and pleural inflammation after talc slurry pleurodesis. DESIGN: Thirty rabbits underwent pleurodesis as follows: 10 rabbits received 200 mg/kg of the talc used for human pleurodesis, normal talc (NT); 10 rabbits received 200 mg/kg of talc with particles of larger size, large talc (LT); and 10 rabbits received saline solution. Samples from the ipsilateral lung, chest wall, diaphragm, mediastinal pleura, heart, liver, spleen, and right kidney were obtained at 24 h and 7 days and processed for optic and electron microscopy and energy-dispersive x-ray analysis. RESULTS: Visceral pleural thickening was greater with NT than with LT, but no differences were observed in the macroscopic score of adhesions. There was more talc in the lungs of the rabbits that received NT than in those that received LT. Talc particles were detected in mediastinum (100%) and pericardium (20%), irrespective of the talc used. Three animals, all receiving NT, had talc particles in the liver. CONCLUSIONS: Our study shows that while both talcs were equally effective in achieving pleurodesis, the intrapleural injection of NT elicits greater pulmonary and systemic talc particle deposition than LT. Moreover, pleural inflammation was greater with NT than with LT.

Animals↗
PubMedDate not supplied

Acute pleuropulmonary complications detected by computed tomography following myocardial revascularization.

INTRODUCTION: Pleuropulmonary changes are common following coronary artery bypass grafting surgery performed with a saphenous vein graft, with or without an internal mammary artery. The presence of atelectasis or pleural effusions reflects the thoracic trauma. PURPOSE: To define the postoperative incidence of changes in the lung and in the pleural space and to evaluate the influence of the trauma. METHODS: Thirty patients underwent elective coronary artery bypass grafting surgery (8 saphenous vein grafts and 22 saphenous vein grafts and internal mammary artery grafts with pleurotomy). Chest tubes in the left pleural space were used in all internal mammary artery patients. On the second (day 2) and seventh (day 7) postoperative day, patients underwent a computed tomography, and pleural effusions were rated as follows: grade 0 = no fluid to grade 4 = fluid in more than 75% of the hemithorax. Atelectasis was rated as follows: laminar = 1, segmental = 3, and lobar = 10 points. RESULTS: All patients had pleural effusion or atelectasis. Between day 2 and day 7, the number of patients with effusions or atelectasis on the right side decreased (P < 0.05). The incidence of effusions on day 2 in the saphenous vein graft group (87.5%) was higher (P < 0.05) than in the internal mammary artery group (52.3%). The incidence of atelectasis in the lower right lobe decreased (P < 0.05) from 86.7% (day 2) to 26.7% (day 7). The degree of atelectasis in both sides did not differ on day 2 (P = 0.42) but did on day 7 (P < 0.0001). There was a decrease in the atelectasis from day 2 to day 7 on the right side (P < 0.001), but not on the left (P = 0.21). On day 2 there was a relationship between atelectasis and effusion on the right (P = 0.04), but not on the left (P = 0.113). CONCLUSION: The present series demonstrates that there is a high incidence of both minimal pleural effusion and atelectasis after coronary artery bypass grafting surgery, which drops on the right side from day 2 to day 7 post surgery. Factors that contribute to the persistence of changes on the left side include the thoracic trauma and the presence of chest tubes and pericardial effusion.

Acute Disease↗