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PubMed1986

Intracavitary electrode catheter cardioversion of atrial tachyarrhythmias in the dog.

This study examined factors determining efficacy of intracavitary cardioversion of atrial tachyarrhythmias in closed chest, anesthetized dogs with talc pericarditis. Electrode catheters were positioned transvenously with the cathode in the right atrial appendage. In Group 1 dogs (n = 6), three anode sites (superior and inferior venae cavae ostia and mid-right atrium) were tested with graded energy shocks to determine the lowest effective cardioversion energy at each anode position. In Group 2 dogs (n = 9), multiple cardioversion attempts with energy levels of 0.01 to 5.0 J were used to evaluate reproducibility of energy thresholds. In Group 3 dogs (n = 6) without talc-induced pericarditis, atrial pathologic study was done after five intracavitary shocks (0.5 or 5.0 J). In Group 1, cardioversion was achieved with 0.75 J or less with no significant difference in minimal effective cardioversion energies among the three anode positions tested. In Group 2, 98 (26%) of 372 cardioversion attempts were successful. Intra-animal minimal effective cardioversion energies varied widely, and timing of shocks relative to atrial electrograms did not influence efficacy. Complications were infrequent and included delayed sinus rhythm recovery, transient atrioventricular block and ventricular fibrillation. Ventricular fibrillation occurred in 9 (2.4%) of 372 shocks, and was associated with higher delivered energies (6 of 9 with greater than or equal to 1.0 J) and with shocks delivered 116 to 180 ms after onset of the QRS complex. In Group 3, two dogs had no histologic damage, three dogs had multiple small foci of subendocardial necrosis and in one dog these foci coalesced to involve half the atrial wall thickness. Thus, low energy cardioversion of atrial tachyarrhythmias is feasible using intracavitary electrodes. Synchronization of energy delivery to the QRS complex is important to minimize risk of ventricular fibrillation.

Animals↗
PubMed2000

The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions.

OBJECTIVE: Over the last 15 years we have managed patients with malignant pleural effusion, using a single procedure with thoracoscopy and talc pleurodesis or shunt as appropriate. Talc pleurodesis remains our primary treatment option but in those patient shown to have the 'trapped lung syndrome', in whom pleurodesis would fail, we have been using a pleuroperitoneal shunt. METHODS: This retrospective review was undertaken to evaluate the mortality and morbidity of pleuroperitoneal shunts in the management of malignant pleural effusions and to assess their long-term results. Three hundred and sixty patients were treated for malignant effusions during the period 1983-1998, 160 (44.4%) of whom had a pleuroperitoneal shunt inserted. There were no intraoperative deaths and the hospital mortality was three patients (1.87%). Follow up was available for 88.1% of patients. The median survival of all malignant cases was 7.7 months (range 1-72 months). Mesothelioma patients survived somewhat longer with a median survival of 10.1 months. RESULTS: Shunt complication occurred in 21 patients (14.8%). Twelve patients developed shunt occlusion, requiring revision in five and replacement in seven. The shunt was removed in eight patients due to skin erosion in one patient and infection in seven patients. The distal limb of shunt was broken in one patient and the shunt was replaced. One patient developed malignant seeding along the chest wall at the site of shunt insertion but there were no incidences of peritoneal deposits. Effective palliation was achieved in 95% of patients. CONCLUSIONS: Pleuroperitoneal shunt insertion provides effective and safe palliation for malignant pleural effusion when associated with the 'trapped lung syndrome'. There are however complications which require revision or shunt removal. There is no evidence that peritoneal deposits result from pleuroperitoneal shunting.

Adult↗
PubMed2006

[Outpatient management of malignant pleural effusion using a tunneled pleural catheter: Preliminary experience].

Inpatient management of malignant pleural effusion includes the placement of a conventional thoracostomy tube for drainage and talc slurry pleurodesis and/or a surgical approach consisting of video-assisted thoracoscopic talc insufflation. Both techniques require prolonged hospital stays of up to 1 week. Unfortunately, life expectancy in patients with this disease does not usually exceed 6 months, and so the primary aim of any palliative intervention intended to improve quality of life should be to avoid hospital admissions and to relieve pain as far as possible. Of the few outpatient alternatives to hospital management the most frequently used is repeated thoracentesis. We describe the outpatient management of malignant pleural effusion by placement of a tunneled pleural catheter in a patient with stage IIIB lung adenocarcinoma. In our opinion, the use of this catheter offers a viable alternative to conventional therapy and is better tolerated.

Aged↗
PubMed1978

Isolation of animal viruses from farm livestock waste, soil and water.

Ten porcine enteroviruses, 2 porcine adenoviruses and 1 coronavirus were isolated directly from 32 samples of slurry collected from a pig fattening house. Concentration of the same samples by adsorption with the polyelectrolyte PE-60 yielded 24 porcine enteroviruses and 3 porcine adenoviruses. A porcine enterovirus was isolated, following PE-60 concentration, from 1 to 6 slurry samples from a sow farrowing house. No virus was isolated from 12 samples of slurry from dairy cows nor from 6 slurry samples from a calf-rearing unit. A porcine enterovirus was isolated from soil samples, after concentration with PE-60, collected 1, 2 and 8 days after pig slurry was spread on hay stubble. Two porcine enteroviruses were isolated by membrane filtration from 26 samples of surface run-off from land on which pig slurry was routinely spread, and 2 bovine enteroviruses were isolated from cattle feedlot run-off after adsorption to layers of talc and celite followed by hydroextraction. A porcine enterovirus was also isolated from 1 of 33 samples of surface water collected on farms on which pig slurry was routinely spread on the land, but no virus was isolated from 36 samples of ground water from the same farms. The surface water and ground water samples were concentrated by talc-celite adsorption and hydroextraction.

Adenoviridae↗
PubMed2005

[The management of spontaneous pneumothorax].

The optimum management of spontaneous pneumothorax (SPTX) includes medical and surgical approaches but remains somewhat controversial due to inconclusive data background both in the treatment of the acute episode and preventive strategies. Current consensus recommendations suggest, that small and asymptomatic pneumothoraces can be managed conservatively by observation. Large and symptomatic pneumothoraces will respond to simple aspiration or small size catheter (< 16 F) insertion in about (2)/ (3) of cases. Otherwise, and in secondary SPTX, particularly in the elderly patient, large size (> 20 F) chest drainage, optimally combined with thoracoscopy (pleuroscopy), is the treatment of choice allowing success rates up to 96 %. Preventive strategies are indicated after the first recurrence and when predisposing pleuropulmonary lesions as in secondary SPTX are evident. With efficacy as a primary endpoint, currently available data do not provide clear evidence-based preference criteria between medical thoracoscopic talc pleurodesis and surgical strategies (usually VATS-based partial pleurectomy +/- parenchymal resection). Therefore selection of the appropriate procedure remains influenced by expert opinion. However simple talc poudrage under medical thoracoscopy has been shown to be highly effective, safe and cheap at a cost level virtually not exceeding that of large size chest drainage.

Catheterization↗
PubMed1993

Thoracoscopy in the diagnosis and management of chronic pleural effusions.

Thoracoscopy was performed in 76 patients with chronic pleural effusions in which thoracocentesis and blind needle biopsy failed to reach a precise diagnosis. Analysis of thoracoscopic biopsies provided a definitive diagnosis in 53 of the 76 subjects. The diagnoses included 35 malignant diseases in which the macroscopic appearance was diagnostic in only 27 patients. Among these 76 patients, a talc dusting was performed in the management of recurrent effusion in 33 patients. No recurrence of pleural effusion was observed after 1 month in 87% and after 6 months in 76% of patients with recurrent pleural effusion. We confirm that thoracoscopy is a safe and useful technique for the diagnosis of pleural effusion which substantially decreases the necessity for diagnostic thoracotomy and that talc dusting is effective to achieve pleurodesis.

Adolescent↗
PubMed1978

Occult thyroid disease in an elderly hospitalized population.

Measurements of thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), and T3 talc uptake (T3TU) were performed on 425 hospitalized patients over 60 years of age. Unsuspected thyroid disease was found in 10 patients (2.4%); 9 were hypothyroid and 1 hyperthyroid. Another 11% of the population had abnormal T4 or TSH levels but were not proved to have thyroid disease. Repeat measurements in 10 of 40 patients with low serum T4 concentrations showed a return of the tests to normal. The low T4 levels occurred in patients who were seriously ill and were usually associated with low T3TU values. Low serum T3 concentrations were observed in 32 of the patients. Although we found TSH to be the most useful test in the diagnosis of hypothyroidism, it is a relatively expensive test and is not helpful in screening for hyperthyroidism. The present results suggest that the best single test for screening for occult thyroid disease is a serum T4 measurement. We recommend a T4 test on all hospitalized patients over age 60 years. Serum should be held in the laboratory for measurement of TSH concentration if the T4 result is below 6.5 micrograms/dl. A T3 resin or talc uptake and a serum T3 measurement should be performed to rule out hyperthyroidism if the serum T4 concentration is elevated. This regimen will identify virtually all cases of occult thyroid disease.

Age Factors↗
PubMed1990

Methylprednisolone acetate does not cause inflammatory changes in the epidural space.

Few studies have examined the possible adverse effects that epidural injection of depot corticosteroid preparations may have on meningeal membranes and nervous tissue. Thirty-six healthy adult white rabbits received 0.3 ml/kg epidural injections of either lactated Ringer's solution (negative control group), 1% lidocaine containing methylprednisolone acetate (study group), or normal saline containing talc (positive control group). Animals were killed either 4 or 10 days after injection and stained sections of the spinal cord and meningeal membranes were examined by light microscopy. In all animals that received either lactated Ringer's solution or lidocaine with methylprednisolone acetate, microscopic examination of specimens taken from the L5-L6 interspace revealed no white cell infiltrates and no fibroblastic activity. All animals that received epidural injections of normal saline containing talc had marked infiltration of tissue macrophages in the epidural space. There was no thickening of the meningeal membranes or nerve roots in any animal. The complete lack of inflammatory changes and meningeal thickening demonstrated in this pilot study helps to confirm the safety of methylprednisolone acetate when injected into the epidural space.

Animals↗
PubMed1998

Medical thoracoscopy.

Thoracoscopy has received increasing attention over the past decade as a result of the considerable advances that have been made in the development of endoscopic instruments. In contrast to the newly established video-assisted thoracoscopic surgery, the classic way to perform thoracoscopy is using only local anesthesia and sedation (medical thoracoscopy) making the procedure less invasive and expensive. The leading diagnostic indication for medical thoracoscopy today is an exudative pleural effusion of unknown origin offering a yield of more than 90% in malignancy or tuberculous pleurisy. In addition, talc poudrage during thoracoscopy is the most effective way to perform pleurodesis. For spontaneous pneumothorax, the second most important indication, medical thoracoscopy allows staging as well as therapeutic measures such as coagulation of blebs or talc poudrage. Other indications such as biopsy for diffuse lung disease or peripheral nodules are now reserved for video-assisted thoracoscopic surgery.

Diagnosis, Differential↗
PubMed2005

Management of malignant pleural effusions.

PURPOSE OF REVIEW: Although malignant pleural effusions are a common medical problem, research into their optimal management remains sparse. The aim of this review is to summarise recent developments in this area. RECENT FINDINGS: Talc remains the most efficacious pleurodesis agent. However, concerns remain about its side effect profile, with a number of cases of acute respiratory distress syndrome documented in the literature. A recent trial showed that using calibrated talc particles reduced the risk of morbidity from this procedure. Work on novel pleurodesis agents, such as transforming growth factor-beta, appears to induce pleurodesis in animal models without any unwanted side effects. This is a promising development and human trials are awaited. With regard to mesothelioma, recent chemotherapy trials with pemetrexed/cisplatin and raltitrexed/cisplatin are encouraging and appear, for the first time, to offer a small but real survival advantage. SUMMARY: In the authors' opinion, the major developments in the management of malignant effusions during the past year are the development of safer pleurodesis agents and the promise of better combination chemotherapy agents for the treatment of mesothelioma.

Catheters, Indwelling↗
PubMed1986

Mechanical properties of some pigmented and unpigmented aqueous-based film coating formulations applied to aspirin tablets.

The Brinell hardness and Young's modulus of pigmented and unpigmented films of hydroxypropyl methylcellulose alone, and in combination with either polyethylene glycol 400 (plasticizer) or polyvinyl alcohol, which were applied to aspirin tablets, have been measured. Generally hardness and modulus data showed similar trends. The hardness and modulus of hydroxypropyl methylcellulose fell in the presence of polyethylene glycol 400 as a result of its plasticizing action. On the other hand, the hardness and modulus of the film former rose slightly when polyvinyl alcohol was initially incorporated, probably due to the crystalline phase of the additive, and then decreased when the level of the additive was further raised. Hardness and modulus were higher in films pigmented with talc than in those containing titanium dioxide because of the plate-like shape of talc and its greater interaction with the polymer systems. Some correlation was found between the Young's moduli of the applied films and those of the corresponding free films, with the moduli of the latter two 2-5 times greater. Ageing at 37 degrees C and 75% r.h. was found to cause a decrease in the mechanical properties of the unplasticized film coating systems probably as a result of decreased molecular order and enhanced polymer chain mobility.

Aspirin↗
PubMed1996

Retention of asbestos fibres in lungs of workers with asbestosis, asbestosis and lung cancer, and mesothelioma in Asbestos township.

OBJECTIVE: To conduct a mineralogical study on the particles retained in the necropsied lungs of a homogenous group of asbestos miners and millers from Asbestos township (and a local reference population) and to consider the hypothesis that there is a difference in size between fibres retained in the lungs of patients with asbestosis with and without lung cancer. METHODS: Samples of lung tissue were obtained from 38 patients with asbestosis without lung cancer, 25 with asbestosis and lung cancer, and 12 with mesothelioma, from necropsied Quebec chrysotile miners and millers from Asbestos township. Fibre concentrations in the lungs of these patients were compared with those in tissue from necropsies carried out on a local reference population: men who had died of either accidental death or acute myocardial infarction between 1990 and 1992. 23 were born before 1940 and 26 after 1940. RESULTS: Geometric mean (GM) concentrations were higher in cases than in the controls for chrysotile fibres 5 to 10 microns long in patients with asbestosis with or without lung cancer; for tremolite fibres 5 to 10 microns long in all patients; for crocidolite, talc, or anthophyllite fibres 5 to 10 microns long in patients with mesothelioma; for chrysotile and tremolite fibres > or = 10 microns long in patients with asbestosis; and crocidolite, talc, or anthophyllite fibres > or = 10 microns long in patients with mesothelioma. However, median concentrations of each type of fibre in the lungs did not show any significant differences between the three disease groups. Average length to diameter ratios of the fibres were calculated to be larger in patients with asbestosis and lung cancer than in those without lung cancer for crocidolite fibres > or = 10 microns long, for chrysotile, amosite, and tremolite fibres 5 to 10 microns long, and for chrysotile and crocidolite fibres < 5 microns long. However, there was no statistical difference in the median length to diameter ratios for any type of fibres across the disease groups when they were calculated in each patient. Cumulative smoking index (pack-years) was higher in the group with asbestosis and lung cancer but was not statistically different from the two other disease groups. CONCLUSION: Lung cancers occurred in workers with asbestosis from Asbestos township who had an equal concentration of retained fibres but a tendency to a higher length to diameter ratio of amphiboles. These workers had a 29% higher average cumulative smoking index.

Adult↗
PubMed2001

Transforming growth factor beta2 induced pleurodesis is not inhibited by corticosteroids.

BACKGROUND: Talc and tetracyclines induce pleurodesis by directly injuring the pleura. The injury results in intense inflammation which subsequently leads to fibrosis. Corticosteroids can inhibit talc pleurodesis by reducing the inflammatory process. We hypothesised that transforming growth factor beta2 (TGFbeta2), a fibrogenic cytokine with immunomodulatory functions, could induce effective pleurodesis without generating significant pleural inflammation and therefore remain effective despite co-administration of corticosteroids. METHODS: Thirty rabbits were divided into two groups. Rabbits in the steroid group received weekly intramuscular injections of triamcinolone diacetate (0.8 mg/kg). Ten rabbits in each group were given 5.0 microg TGFbeta2 intrapleurally via a chest tube while the remaining five received 1.7 microg TGFbeta2. Pleurodesis was graded macroscopically after 14 days from 1 (none) to 8 (>50% symphysis). RESULTS: TGFbeta2 produced excellent pleurodesis at both 5.0 microg and 1.7 microg doses. The pleural effusions produced after the injection were low in all inflammatory markers. No significant differences were seen between the steroid group and controls in macroscopic pleurodesis scores (7.2 (1.3) v 7.1 (1.2)), levels of inflammatory markers in the pleural fluids (leucocyte 1107 (387)/mm(3) v 1376 (581)/mm(3); protein 3.1 (0.3) mg/dl v 2.9 (0.3) mg/dl, and LDH 478 (232) IU/l v 502 (123) IU/l), and the degree of microscopic pleural fibrosis and pleural inflammation. CONCLUSIONS: TGFbeta2 can induce effective pleurodesis and remains effective in the presence of high dose parenteral corticosteroids.

Animals↗
PubMed1996

Friction, not texture, dictates grip forces used during object manipulation.

1. Three men and seven women, 25-40 yr of age, were asked to use the thumb and index fingers to grasp, lift, and hold the armature of a linear motor generating a 2.0-N opposing force (simulating an object weighing approximately 200 g) for 2 s. The surface in contact with the fingers was composed of smooth or polyamide plastic etched with 1.0-mm high Braille beads separated at 2.0- or 3.0-mm intervals measured from apex to apex. The surfaces were left either untreated or coated with talc, water, or sucrose films designed to change the coefficient of friction with the skin. Talc reduced the coefficient of friction, whereas water and sucrose both increased the friction against the skin. In all, 12 surface conditions were used to evaluate the effects of texture and friction on the grip force during lifting and holding. 2. For all subjects the inverse coefficient of friction was associated with proportionately scaled increases in grip force, regardless of surface texture. The peak lifting force as well as the static force used to hold the object stationary were significantly correlated with the inverse of the coefficient of friction. When coatings were applied to dissimilar surface textures to produce similar coefficients of friction, the grip force profiles were nearly identical. When strong adhesives increased the friction of the smooth surface compared with textured surfaces, grip forces decreased as friction increased. That is, although the untreated smooth surface had less friction than either of the two textured surfaces, the addition of sucrose increased the smooth surface friction to a higher level than either of the similarly treated textured surfaces. As a result, the effect of surface friction could be dissociated from the effect of either surface texture or coating. Friction appears to be a more important factor in determining the grip force than either texture or surface films at least for the range of textures and coatings examined in this study.

Adhesiveness↗
PubMed1993

Effects of cigarette smoke on epithelial uptake of non-asbestos mineral particles in tracheal organ culture.

Cigarette smoke is believed to increase the pulmonary retention of many different types of mineral dusts, but the mechanisms of this process are unclear. We have previously shown, using a tracheal organ culture system, that exposure to cigarette smoke directly increases the uptake of asbestos fibers by tracheal epithelial cells, and that this process is mediated by active oxygen species. To determine whether the same effects are seen with other types of mineral dust, we exposed rat tracheal explants to cigarette smoke or air (control) and then to a variety of dusts generally considered "inert" or of low pathogenicity. Explants were maintained in organ culture to allow dust uptake, and segments fixed and prepared for light microscopy at various times up to 1 wk; particle uptake was determined morphometrically. We observed that cigarette smoke significantly increased the epithelial uptake of nonfibrous titanium dioxide and talc, and of fibrous silicon carbide, but not of fibrous or nonfibrous iron oxide, nonfibrous silicon carbide, or fibrous wollastonite. Scavengers of active oxygen species (catalase) or agents that prevent the formation of active oxygen species (deferoxamine) blocked the effects of smoke in enhancing titanium dioxide uptake but did not block the effects of smoke on talc uptake. These observations indicate that cigarette smoke may potentiate the effects of many types of dust, including relatively inert dusts, by directly increasing the numbers of particles entering the tracheobronchial epithelium and eventually reaching the interstitium. However, smoke does not directly enhance the uptake of every dust.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1975

The role of iron in the pathogenesis of porphyria cutanea tarda. II. Inhibition of uroporphyrinogen decarboxylase.

Porphria cutanea tarda is characterized biochemically by excessive hepatic synthesis and urinary excretion of uroporphyrin I and 7-carboxylporphyrins. This pattern of excretion suggest an impaired ability to decarboxylate uroporphyrinogen to the paired ability to decarboxylate uroporphyringen to the 4-carboxyl porphyrinogen, coproporphyrinogen, a reaction catalyzed by the enzyme uroporphyringen decarboxylase. Because clinical evidence has implicated iron in the pathogenesis of porphyria cutanea tarda, these experiments were designed to study the effect of iron on uroporphyrinogen decarboxylase in procine crude liver extracts. Mitochondria-free crude liver extracts were preincubated with ferrous ion and aliquots were assayed for uroporphyrinogen decarboxylase activity. Uroporphyrinogens I and III, the substrates for the decarboxylase assay, were prepared enzymatically from (3H)porphobilinogen. The products of the decarboxylase reaction were identified and quantitated by three methods: (a) extraction into 1.5 N HCl and spectrophotometric quantitation; (b) adsorption onto talc, esterification, paper chromatographic identification, and quantitation by liquid scintillation counting; and (c) adsorption onto talc, esterification, thin-layer chromatographic identification on silica gel, and quantitation by liquid scintillation counting. The thin-layer scinllation method proved most sensitive as it was the only method which accurately identified and quantitated the 7-carboxyl porphyrin reaction product. Uroporphyrinogens I and III were decarboxylated at the same rate by porcine hepatic uroporphyrinogen decarboxylase, and the addition of iron induced marked inhibition of the decarboxylase activity. Ortholpehanthroline blocked the inhibitory effect of iron. The inhibition of uroporphyrinogen decarboxylase by ferrous ion, coupled with its previously reported inhibitory effect on uroporphyrinogen III cosynthetase, provides a possible biochemical explanation for the pattern of urinary porphyrin excretion observed in patients with porphyria cutanea tarda and the clinical association with disordered iron metabolism.

Animals↗
PubMed1997

Pleural diseases related to metastatic malignancies.

Pleural effusions associated with malignancy (either malignant or paramalignant) pose diagnostic and therapeutic dilemmas for the clinician. This article reviews the common causes of malignant and paramalignant pleural effusions, pathogenesis, clinical presentation, chest radiography, pleural fluid characteristics, diagnosis, prognosis, and treatment. Talc, used either by poudrage or slurry, is the most effective agent used for pleurodesis. Talc, which needs to be sterilized, has no clinically important immediate, short-term or long-term adverse effects.

Humans↗
PubMed1998

Thoracoscopy--state of the art.

"Medical" thoracoscopy as compared with "surgical" thoracoscopy (which is more precisely known as video-assisted thoracic surgery (VATS)) has the advantage that it can be performed under local anaesthesia or conscious sedation, in an endoscopy suite, using nondisposible rigid instruments. Thus, it is considerably less invasive and less expensive. The main diagnostic and therapeutic indications for medical thoracoscopy are pleural effusions and pneumothorax. Due to its high diagnostic accuracy, approaching almost 100% in malignant and tuberculous pleural effusions, it should be used when pleural fluid analysis and needle biopsy are nondiagnostic. In addition, medical thoracoscopy provides staging for lung cancer and diffuse malignant mesothelioma. Talc poudrage, as the best conservative method for pleurodesis in 1998, can also be performed with medical thoracoscopy. It can also be effectively used in the early management of empyema. In spontaneous pneumothorax it allows staging, thereby facilitating treatment decisions, and in addition coagulation of eventual blebs and talc poudrage for efficient pleurodesis. Medical thoracoscopy is a safe procedure which is even easier to learn than flexible bronchoscopy. Due to its high diagnostic and therapeutic efficiency, it should be applied increasingly in the management of the above-mentioned pleuropulmonary diseases.

Empyema↗