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PubMed1990

Solute-coupled liquid absorption from the pleural space.

The occurrence of a solute-coupled absorption of liquid from the pleural space was studied by measuring in anesthetized rabbits the volume of liquid of the right pleural space 1 h after injecting into it 2 ml of Ringer solution or of Ringer with an inhibitor of a Na(+)-Cl- coupled transport or of the Na+/K+ pump. Volume collected after Ringer was 1.56 +/- 0.08 ml. Initial volume being 2.2 ml, net absorption rate was 0.64 ml/h. Volume collected after disulfonic stilbene (0.1 mM) or bumetanide (0.1 mM) was 2.01 +/- 0.06 and 2.01 +/- 0.05 ml, respectively; net absorption rate was reduced to 0.19 ml/h. This suggests the occurrence of Na(+)-Cl- coupled transports. Volume collected after ouabain (0.5 mM) was 2.08 +/- 0.08 ml; net absorption rate was reduced to 0.12 ml/h. This suggests the occurrence of the Na+/K+ pump. The marked reduction in the hydrothorax absorption produced by the inhibitors shows the occurrence of a solute-coupled liquid absorption from the pleural space. Liquid absorbed through the visceral pleura by the solute-coupled transport should be removed by the Starling forces of pulmonary capillaries. Solute-coupled absorption of liquid through the parietal pleura should oppose the filtration caused by the Starling forces.

4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfo↗
PubMed1991

Electrolyte transport across the pleura of rabbits.

The amounts of Na+ and Cl- in the right pleural space of anesthetized rabbits were determined 10 and 60 min after a 2 ml hydrothorax with the following solutions: Ringer, Ringer with an inhibitor of the Na(+)-Cl- coupled transport or of the Na+/K+ pump, Ringer with gluconate instead of Cl- or with methylglucamine instead of Na+. During the 10-60 min period: (a) with Ringer Na+ and Cl- decreased (P less than 0.01) along with an iso-osmotic liquid absorption, (b) with disulfonic-stilbene (0.1 mM), amiloride (0.7 mM), acetazolamide (0.1 mM), or ouabain (0.5 mM) Na+ did not change and Cl- decreased less (P less than 0.01) than with Ringer. With gluconate-Ringer or methylglucamine-Ringer the liquid flow reversed: in the former case Cl- and, to a smaller extent, Na+ increased (P less than 0.01); in the latter only Na+ increased (P less than 0.01). These findings suggest: (1) the occurrence of a Na+/H+ and Cl-/HCO3- double exchange on the serosal side and of a Na+/K+ pump on the interstitial side of the pleural mesothelium; (2) a slow efflux from the pleural space of gluconate or methylglucamine relative to the corresponding influx of Cl- or Na+, respectively; this drags liquid into the space by osmotic gradient.

Acetazolamide↗
PubMed1985

The role of metabolism in N-methylthiobenzamide-induced pneumotoxicity.

N-Methylthiobenzamide (NMTB) produces pulmonary edema, hydrothorax, and death in rodents. The objectives of the present studies were to establish a relationship between the lethality of NMTB and its pneumotoxicity and to explore the role of S-oxidation in these events. Pulmonary injury was assessed by measuring [14C]thymidine incorporation into pulmonary DNA. Administration of NMTB resulted in increased pulmonary [14C]thymidine incorporation in both rats and mice. These increases were blocked in both species by pretreatment of animals with sublethal doses of NMTB. However, the lethality of NMTB was not blocked in mice by prior administration of NMTB even though this procedure has been shown to protect rats. 1-Methyl-1-phenyl-3-benzoylthiourea (MPBTU) protected both rats and mice from lethal doses of NMTB and blocked NMTB-induced increases in pulmonary [14C]thymidine incorporation. N-Methylthiobenzamide S-oxide (NMTBSO), a metabolite of NMTB, produced lung injury which was similar to that produced by NMTB. NMTBSO was more potent than NMTB when administered iv, but not when given ip. The role of hepatic metabolism in NMTB pneumotoxicity was examined by administering NMTB to rats which had either undergone partial hepatectomy or been pretreated with N-octylimidazole. Neither of these procedures diminished the lethality of NMTB. These data suggest that NMTB lethality is mediated by pulmonary injury resulting from NMTB S-oxidation in the lung.

Amides↗
PubMed1988

The involvement of serotonin in the pneumotoxicity induced by N-methylthiobenzamide.

N-Methylthiobenzamide (NMTB) and alpha-naphthylthiourea (ANTU) are pneumotoxicants which cause pulmonary edema and hydrothorax. Recently a role was assigned to serotonin (5-hydroxytryptamine, 5-HT) in the pneumotoxic response to ANTU (D.E. Mais and T.R. Bosin, 1984, Toxicol. Appl. Pharmacol. 74, 185-194). We therefore investigated the participation of 5-HT in NMTB-induced pneumotoxicity. Pulmonary clearance of 5-HT was studied after NMTB or ANTU using the rat isolated perfused lung. Lung 5-HT uptake was not depressed 5 hr after ANTU or NMTB, but was depressed 12 hr after compound administration. At both time points lungs were edematous as judged by lung wet weight to body weight ratios. Pretreatment with reserpine, a drug known to deplete 5-HT, did not affect the NMTB-induced decrease in lung 5-HT uptake, but did diminish the increased lung wet weight to dry weight ratios seen after NMTB administration in rats and mice and the increased lung wet weight to body weight ratios in mice. NMTB induces a dose-dependant increase in the incorporation of [14C]thymidine into mouse pulmonary DNA. This increase was attenuated, but not abolished, by pretreatment with reserpine. Reserpine did not alter survival time after NMTB or ANTU and did not shift the 14-day LD50 of NMTB. These data suggest that 5-HT is not a primary mediator in the pneumotoxic response to these thiono-containing compounds.

Amides↗
PubMed1992

Transvaginal color Doppler sonography and CA-125 elevation in a patient with ovarian thecoma and ascites.

A postmenopausal patient presented with a pelvic mass and ascites. The CA-125 level was 329 U/ml, and transvaginal color Doppler sonography of the tumor vasculature suggested malignancy. At laparotomy, a luteinized thecoma and cytologically benign ascites were found. On rare occasions ovarian thecoma may be associated with ascites without hydrothorax. Preoperative evaluation of the patient with ascites and a pelvic mass may suggest malignancy, but histologic confirmation is necessary to exclude this rare association.

Aged↗
PubMed1992

Juvenile granulosa cell tumor in a 2-year-old infant: report of a case complicated with ascites and acute respiratory distress.

A two-year-old girl with a juvenile granulosa cell tumor (JGCT) and with acutely progressive hydrothorax and ascites is presented. She had precocious pseudopuberty and an elevated level of serum estradiol. Sudden onset of respiratory distress, due to a pleural effusion and severe abdominal distention, led to an emergency laparatomy. Unilateral salpingo-oophorectomy induced a rapidly favorable course. Histological examination showed no evidence of invasion or peritoneal metastasis. This is the first case of JGCT associated with an acute respiratory emergency as a main clinical feature.

Child, Preschool↗
PubMed1984

Lung perforation by nasogastric feeding tubes.

Endotracheal misdirection of narrow bore nasogastric feeding tubes resulted in perforation of the lung, pneumothorax and hydrothorax in two intensive care patients. Both were intubated with cuffed endotracheal low pressure tubes, one patient was on respirator therapy with neuromuscular relaxation. Feeding tubes were inserted by experienced personnel with the assistance of a steel stylet without difficulties. Aspiration of fluid was misinterpreted as proof of correct positioning, the liquid being however pleural effusion and not gastric juice. Similarly auscultation of gurgling sounds in the upper epigastrium was not a reliable sign of intragastric position. Insertion of nasoenteric feeding tubes may be complicated by perforation of the upper gastrointestinal tract and lung in poorly responsive patients with cuffed endotracheal devices during neuromuscular blockage. In these patients a laryngoscope and forceps should be used to ensure free passage of the tube into the oesophagus. Röntgenographic confirmation of correct positioning of the tube immediately after insertion is mandatory.

Journal Article↗
PubMed1989

Acute oral toxicity of dibenzothiophene for male CD-1 mice: LD50, lesions, and the effect of preinduction of mixed-function oxidases.

The acute oral toxicity of dibenzothiophene, a component of petroleum oils, was assessed in CD-1 mice. The estimated LD50 for a single oral dose in male mice was 470 mg/kg and was lowered to 335 mg/kg by prior induction of mixed-function oxidases. Abnormal behavior that ranged from a general sluggishness to full anesthesia developed within 2 hr of treatment and resolved within 24 hr in mice that survived. Gross lesions in mice that died included pulmonary congestion and edema, mild hydrothorax, intestinal hemorrhage, and mottled livers. The major histological lesions were severe centrilobular hepatic necrosis, necrosis of lymphocytes in thymic cortices, and degenerative changes in the walls of small arteries in the lung. All mortality occurred within 72 hr of treatment.

Animals↗
PubMed1989

Effect of reserpine on N-methylthiobenzamide-induced pulmonary edema: role of lung norepinephrine and hypothermia.

N-Methylthiobenzamide (NMTB) is a pneumotoxin which causes pulmonary edema and hydrothorax in rodents. Reserpine has been shown to attenuate the pneumotoxicity induced by NMTB. Some of that evidence suggests that the protection afforded by reserpine occurs independently of its capacity to reduce peripheral 5-hydroxytryptamine (5-HT). We therefore investigated 2 other pharmacologic properties of reserpine, namely: (1) its capacity to reduce lung norepinephrine (NE); and (2) its capacity to induce hypothermia, in order to more fully understand its mechanism of protection. Pretreatment of mice or rats with 6-hydroxydopamine at a dose which reduced lung NE by approximately 80% did not affect the pneumotoxic response to NMTB. Thus a decrease in lung NE probably does not account for reserpine's protective effect. An investigation of reserpine's effects on core temperature revealed that mice dosed with a combination of reserpine + NMTB presented with core temperatures lower than mice treated with either compound alone. Mice placed in a cold environment (2 degrees C) and dosed with NMTB presented with hypothermia and an attenuated toxic response to NMTB. Thus a reserpine-induced hypothermia could be allowing for a reduction of NMTB metabolism and consequent diminution of toxicity. These observations suggest that reserpine's capacity to protect animals against NMTB-induced pulmonary edema may in part be due to its capacity to induce hypothermia.

Amides↗
PubMed1992

Pressure overload-induced cardiac hypertrophy with and without dilation.

OBJECTIVES: The present study was designed to produce a small animal model showing compensated hypertrophy followed by congestive heart failure within a reasonable time period. BACKGROUND: Although there are various large animal experimental models of hypertrophy and heart failure, the occurrence of these two stages within a reasonable time period has not been shown very successfully in small animals. METHODS: A mildly constricting band was placed around the ascending aorta of very young guinea pigs (mean age 25 +/- 3 days) to impose a gradually increasing pressure overload. The animals were examined at different postoperative intervals up to 20 weeks. RESULTS: At 10 weeks, there was a 56% increase in ventricular weight/body weight ratio, a 33% increase in left ventricular wall thickness and a significant increase in left ventricular systolic pressure. The animals with 20 weeks of banding had developed various clinical symptoms of congestive heart failure including dyspnea, cyanotic appearance of the extremities, hydrothorax and ascites. Although at this stage there was 86% hypertrophy, the increase in wall thickness was only 20%, indicating cardiac dilation. Depressed left ventricular systolic pressure and increased left ventricular end-diastolic pressure and the increase in wet weight/dry weight ratio in the lungs and liver at 20 weeks also indicated the occurrence of heart failure. The collagen content in the heart of animals with banding for 10 and 20 weeks was 160% and 240%, respectively, of that in corresponding sham control animals. CONCLUSIONS: The data suggest that the heart was in a stage of compensated hypertrophy for up to 10 weeks, whereas heart failure was seen at 20 weeks. The two functional stages, compensatory hypertrophy followed by prolonged failure, make this model appropriate for studies on the transition of heart hypertrophy to congestive heart failure.

Animals↗
PubMed2006

The undiagnosed pleural effusion.

The most common causes for undiagnosed transudative effusions are congestive heart failure and hepatic hydrothorax. Pleural fluid N terminal pro-brain natriuretic peptide levels higher than 1500 pg/mL are virtually diagnostic of congestive heart failure. The most common causes for undiagnosed exudative pleural effusions are malignancy, pulmonary embolism, and tuberculosis. Clinical characteristics of patients with a malignant pleural effusion are symptoms for more than 1 month, absence of fever, blood-tinged pleural fluid, and CT findings suggestive of malignancy. Thoracoscopy is useful to establish the diagnosis of malignancy and tuberculosis.

Bronchoscopy↗
PubMedDate not supplied

Radiofrequency ablation for hypersplenism in patients with liver cirrhosis: a pilot study.

Radiofrequency ablation is a relatively new technique used for local ablation of unresectable tumors. We investigated the feasibility and efficacy of radiofrequency ablation for hypersplenism and its effect on liver function in patients with liver cirrhosis and portal hypertension. Nine consecutive patients with hypersplenism due to cirrhotic portal hypertension underwent radiofrequency ablation in enlarged spleens. The ablation was performed either intraoperatively or percutaneously. Patients are followed up for over 12 months. After treatment, between 20% and 43% of spleen volume was ablated, and spleen volume increased by 4%-10.2%. White blood cell count, platelet count, liver function, and hepatic artery blood flow showed significant improvement after 1-year follow-up. Splenic vein and portal vein blood flow were significantly reduced. Only minor complications including hydrothorax (three of nine patients) and mild abdominal pain (four of nine patients) were observed. No mortality or other morbidity occurred. Radiofrequency ablation is a safe, effective, and minimally invasive approach for the management of splenomegaly and hypersplenism in patients with liver cirrhosis and portal hypertension. Increased hepatic artery blood flow may be responsible for sustained improvement of liver condition. Radiofrequency ablation may be used as a bridging therapy for cirrhotic patients waiting for liver transplantation.

Adult↗
PubMed2006

Surgical treatment of hepatocellular carcinoma originating from caudate lobe--a report of 39 cases.

The study objective was to study the therapeutic effect of surgical treatment for hepatocellular carcinoma (HCC) originating from the caudate lobe. From 1995 to 2003, caudate lobe resection was carried out for 97 cases; among them 39 were for HCC, who were divided into two groups. Group A consisted of 19 cases undergoing isolated caudatectomy, and group B consisted of 20 cases undergoing caudatectomy combined with other liver resections. The factors that might influence postoperative recovery were compared between the two groups. A special instrument, Peng's Multifunctional Operative Dissector, was used for surgical dissection. All tumors were resected successfully. One patient died of postoperative renal failure. Hydrothorax occurred in three patients, ascites occurred in four patients, and bile leakage occurred in one patient. Thirty cases received long-term follow-up with survival rates at 1, 3, and 5 years of 53%, 50%, and 39%, respectively. Caudate lobectomy is an effective therapeutic method for HCC originating in the caudate lobe. Isolated caudatectomy should be performed as the first choice whenever possible. Anterior transhepatic approach is appropriate in some cases. Peng's Multifunctional Operative Dissector is a very useful instrument for surgical dissection.

Adult↗
PubMedDate not supplied

Cardiac tamponade complicating trimodal therapy for malignant mesothelioma.

Trimodal therapy, which includes extrapleural pneumonectomy as the cytoreductive procedure followed by combination chemoradiotherapy, is becoming the standard of care in the treatment of malignant mesothelioma. We report here a case of hypotension secondary to tension hydrothorax in which echocardiography and hemodynamic monitoring demonstrated evidence of tamponade physiology. Thoracentesis was lifesaving.

Antineoplastic Agents↗
PubMed2006

Spontaneous bilateral bacterial empyema in a patient with nephrotic syndrome.

Spontaneous bacterial empyema (SBEM), a rare infectious complication among liver cirrhosis patients, is characterized by infection in the presence of pleural effusion without evidence of pre-existing pneumonia. The prevalence of SBEM in cirrhotic patients with hydrothorax is about 13%. However, it has previously not been reported in medical literature in patients with nephrotic syndrome. The most common microorganism identified is Escherichia coli, followed by Streptococcus species, Enterococcus species, Klebsiella pneumoniae, and Pseudomonas stutzeri. We present a patient with a history of nephrotic syndrome caused by membranous nephropathy, who received steroids and cyclophosphamide. He developed bilateral SBEM due to Aeromonas hydrophila and E. coli, which were isolated from the left- and right-side pleural fluid, respectively. The detailed clinical course, treatment, and outcome are described.

Adult↗
PubMed2006

Venous arterialization in extralobar pulmonary sequestration associated with fetal hydrops.

BACKGROUND/PURPOSE: Fetal extralobar pulmonary sequestration (EPS) is sometimes complicated by massive pleural effusion (PE) leading to fetal hydrops. The underlying mechanisms as well as the origin of the fluid are not well understood. This study was performed to find a histological hallmark of an EPS with massive PE. We hypothesized that venous obstruction has a role to play in the mechanisms of fluid production by EPS. METHODS: We recently experienced 3 cases of fetal EPS complicated by fetal hydrothorax requiring thoracentesis and eventually thoracoamniotic shunt placement. Total protein content and cell count were measured in the aspirates, which were compared with chylothorax cases (n = 5) requiring fetal shunt placement. After birth, all 3 infants required mass resection for the control of PE. The venous wall thickness was measured on pathology slides stained with Elastica van Gieson staining. Thickness of the media and adventitia was measured in approximately 40 veins per case. They were corrected by external diameter and expressed as percentage of medial thickness and percentage of adventitial thickness. An EPS not associated with PE but with congenital diaphragmatic hernia served as a control. RESULTS: Total protein and the cell count of the EPS related PE were 0.6 +/- 0.3 mg/dL and 28 +/- 14/microL (mean +/- SD), which were significantly lower than those of PE in chylothorax (2.2 +/- 0.2 mg/dL and 1900 +/- 1100/microL). Percentages of adventitial thickness of EPS with PE were 9.8% +/- 3.8%, 10.4% +/- 3.6%, and 8.3% +/- 3.7%, which were significantly increased compared with the control of 3.1% +/- 1.3% (P < .01). Percentages of medial thickness of EPS with PE were 7.0% +/- 1.9%, 7.3% +/- 1.4%, and 6.6% +/- 2.3%, which were significantly increased compared with the control of 2.3% +/- 0.7% (P < .01). CONCLUSIONS: We conclude that PE associated with EPS is the transudate rather than the lymph. The thickened media and the adventitia found in EPS with PE support the hypothesis that partial obstruction of the venous system leads to an increased transudate production, which ultimately leads to fetal hydrops.

Bronchopulmonary Sequestration↗
PubMed2005

Comparative study of percutaneous access for staghorn calculi.

OBJECTIVES: To compare the success and complication rates of staghorn calculi treated through the upper pole calix, lower/middle calices, and multiple access. METHODS: Between January 1995 and December 2000, the records of 119 patients with staghorn calculi who underwent percutaneous nephrolithotomy were retrospectively reviewed. The mean stone burden was 6.9 cm. Of the 119 patients, 16 (13.4%) had upper pole access, 70 (58.8%) lower or middle calix access, and 33 (27.7%) multiple renal access. RESULTS: The stone-free rate was 80.0% for those in the lower/middle, 87.5% for those in the upper pole, and 84.8% for those in the multiple access group. Single access was performed in 72.3% and multiple access tracts in 27.7% of patients. The average operative time was 86.8 minutes in the upper pole, 139.1 minutes in the lower/middle pole, and 134.9 minutes in the multiple access groups. Extracorporeal shock wave lithotripsy was used in 4.2% of patients. The overall complication rate was 28.5% (25% in the upper pole, 21.4% in the lower/middle, and 45.4% in the multiple access group). Thoracic complications (pneumothorax and hydrothorax) occurred in 2 patients (1.7%), but only 1 patient had undergone supracostal access. Bleeding requiring blood transfusion was significantly greater in the multiple access group. The average hospital stay was 3.0 days for all patients. CONCLUSIONS: The success of percutaneous treatment of patients with staghorn calculi is highly related to optimal kidney access. The supracostal and multiple access approaches can be used, with a slight increase in the incidence of acceptable complications.

Humans↗
PubMed2004

Pseudo-Meigs' syndrome secondary to isolated colorectal metastasis to ovary: a case report and review of the literature.

INTRODUCTION: Pseudo-Meigs' syndrome is a syndrome that includes hydrothorax and/or ascites secondary to ovarian neoplasms other than benign primary tumors. Gastrointestinal malignancies, including colorectal or gastric adenocarcinoma, are rare etiologies for this syndrome. CASE REPORT: In this report, we present the case of a 49-year-old woman with metastatic colon cancer who acutely developed a massive pleural effusion and ascites coincident with a rapidly enlarging adnexal mass and a rising CA-125 level. DISCUSSION: Seven cases of pseudo-Meigs' syndrome secondary to gastrointestinal primaries have been reported to date. This case highlights the difficulty in discerning the diagnosis of pseudo-Meigs' syndrome from that of disseminated colorectal cancer or a new primary ovarian neoplasm and the importance in making the distinction to initiate appropriate therapy.

Colorectal Neoplasms↗