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PubMed2004

Management of malignant pleural effusions.

Malignant pleural effusion is a common clinical problem. Evacuation of the pleural fluid and prevention of its reaccumulation are the main aims of management. Pleurodesis should be attempted early, although considerable practice variations exist in the way it is performed. There is a lack of consensus among respiratory physicians worldwide on the optimal method and agent for pleurodesis. Talc remains the most commonly used pleurodesing compound in most countries. While talc produces a higher success rate than other compounds, it generates more side-effects. The association between talc and ARDS continues to be debated. Ambulatory small-bore pleural catheter drainage followed by intrapleural instillation of a pleurodesing agent is increasingly accepted as an alternative to conventional in-patient pleurodesis. Development of novel methods to control pleural fluid formation should be made a high priority in future pleural research.

Humans↗
PubMed1998

Management of malignant pleural effusion.

Malignant pleural effusion is a frequent cause of morbidity in cancer patients. Pleural aspiration relieves dyspnoea usually only for a matter of days, and if the tumour type is not chemosensitive, some form of pleurodesis is commonly required. Tube thoracostomy is widely used to achieve pleural drainage prior to attempting pleurodesis by instillation of a variety of 'sclerosants'. Recently thoracoscopic instillation of talc has been advocated and some authors report high rates of fluid control. Randomised trials comparing this approach compared to tube thoracostomy and chemical pleurodesis are required.

Chest Tubes↗
PubMed2002

[Thoracoscopic video-assisted talcum pleurodesis (TTP)--effective treatment of malignant pleural effusion].

INTRODUCTION: Aim of the palliative therapeutic procedure should be a fast, efficient and pain free treatment of the malignant pleural effusions. PATIENTS AND METHOD: Since 1995 the results of malignant pleural effusions treatment were analyzed retrospectively in 46 patients who underwent 51 video-assisted TTP. The most frequent origin of malignant pleural effusion was breast cancer, followed by bronchial carcinoma. Precondition for video-assisted TTP was the verification of a malignant pleural effusion by cytology. RESULTS: Following TTP one patient suffered from pneumonia, two recurrent diseases occurred. Four patients died due to their severe primary malignancy. Average hospitalization was 8 days (3-55). CONCLUSION: Video-assisted TTP is the standard procedure in palliative treatment of malignant pleural effusion; the recurrence rate is low and the technique minimal invasive.

Adult↗
PubMed2000

Pericardial and pleural effusions in decompensated chronic heart failure.

BACKGROUND: In decompensated chronic heart failure, there is controversy regarding the incidence and amount of pericardial fluid. Moreover, the relation of pericardial effusion to pleural effusion has not yet been clarified. The current study examined the incidence and amount of pericardial effusion in patients with decompensated chronic heart failure as a function of the volume of pleural effusion. METHODS AND RESULTS: The study subjects were 60 consecutive patients with chronic heart failure requiring diuresis to improve the symptoms and signs of congestion. Pericardial effusion was semiquantified on the basis of M-mode echocardiographic findings and the volume of thoracic effusion drawn from computed tomographic images of the chest with Simpson's method. Causes of decompensated chronic heart failure in the 60 patients included cardiac valve disease (n = 26), arterial hypertension (n = 12), chronic ischemic heart disease (n = 9), and others (n = 13). As many as 52 (87%) of the 60 patients had pleural effusion; of these, 45 had bilateral effusion, 5 had right-sided effusion only, and 2 had left-sided effusion only. In contrast, only 12 (20%) patients had small (n = 9) or moderate (n = 3) pericardial effusion. There was no significant association between the amount of pleural effusion and the semiquantified pericardial effusion (chi-square 3.27, P =.775). CONCLUSIONS: In this series of patients with congestive heart failure, small pericardial effusion was sometimes observed, but moderate to large effusion was uncommon, and there was no significant association between a given amount of pleural effusion and the volume of pericardial effusion.

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↗
PubMed1993

Management of malignant pleural effusions.

Malignant pleural effusions (MPEs) are a common complication of advanced malignancies, particularly lung and breast cancer. They are caused by a variety of mechanisms including tumor obstruction of lymphatic flow, spread of malignant cells via the systemic circulation, and tumor invasion of the pulmonary arterioles. Therapy is determined by tumor histology, stage of malignancy, and a careful assessment of a patient's performance status and comorbid diseases. A number of approaches have been used to treat patients with MPE ranging from thoracentesis to pleurectomy. Tube thoracostomy drainage followed by application of a sclerosing agent is the most common strategy. Effective sclerosing agents include quinacrine, talc, bleomycin, tetracycline and Corynebacterium parvum. Results from a recent multicenter randomized trial suggest that bleomycin may be superior in terms of control of effusion at 30 days. Further randomized studies are ongoing to determine the optimal method of draining the pleural space and the most effective sclerosing agent. Thoracoscopy using video-assisted techniques is a promising new approach to MPEs both for diagnosis and treatment. The application of biological agents such as interleukin-2, the interferons, and novel chemotherapeutic agents are experimental approaches that are under investigation.

Bleomycin↗
PubMed1988

Pleural effusions and pancreatico-pleural fistulae associated with asymptomatic pancreatic disease.

Four patients are described in whom recurrent large pleural effusions developed secondary to asymptomatic pancreatic disease. The diagnosis was made by measuring the amylase content of the pleural fluid. Endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) were useful in demonstrating pancreatico-pleural fistulae. Two patients underwent laparotomy and distal pancreatectomy. One recovered spontaneously after ERCP appeared to relieve an obstruction of the pancreatic duct and the other recovered after a period of parenteral nutrition. We suggest that pleural fluid amylase content should be measured in any case of exudative pleural effusion of unknown aetiology.

Adult↗
PubMed2000

Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter.

BACKGROUND: Previous studies have shown that a chronic indwelling pleural catheter (PC) safely and effectively relieved dyspnea, maintained quality of life, and reduced hospitalization in patients with malignant pleural effusions. Outpatient management of malignant pleural effusion with a PC may reduce length of stay and early (7-day) charges compared with inpatient management with chest tube and sclerosis. METHODS: A retrospective review of consecutive PC patients (n = 100; 60 outpatient, 40 inpatient) were treated from July 1, 1994 to September 2, 1998 and compared with 68 consecutive inpatients treated with chest tube and sclerosis between January 1, 1994 and December 31, 1997. Hospital charges were obtained from date of insertion (day 0) through day 7. RESULTS: Demographics were similar in both groups. Pretreatment cytology was positive in 126 of 168 patients (75%), negative in 21 (12.5%), and unknown in 21 (12.5%). Primary histology included lung (n = 61, 36%), breast (n = 39, 23%), lymphoma (n = 12, 7%), or other (n = 56, 34%). Median survival was 3.4 months and did not differ significantly between treatment groups. Overall median length of stay was 7.0 days for inpatient chest tube and inpatient PC versus 0.0 days for outpatient Pleurx. No mortality occurred related to the PC. Eighty-one percent (81/100) of PC patients had no complications. One or more complications occurred in 19 patients (19%). Patients treated with outpatient PC (n = 60) had early (7-day) mean charges of $3,391 +/- $1,753 compared with inpatient PC (n = 40, $11,188 +/- $7,964) or inpatient chest tube (n = 68, $7,830 +/- $4,497, SD) (p < 0.001). CONCLUSIONS: Outpatient PC may be used effectively and safely to treat malignant pleural effusions. Hospitalization is not required in selected patients. Early (7-day) charges for malignant pleural effusion are reduced in outpatient PC patients compared with inpatient PC patients or chest tube plus sclerosis patients.

Aged↗
PubMed1976

Coagulation factors and fibrinogen in pleural effusions.

31 pleural effusions from 27 patients with varied diseases were studied for specific coagulation factors and fibrinogen. In all fluids, exudates had a higher content of factors and fibrinogen than transudates. When pleural fluid to plasma total protein ratios were compared to specific coagulation factors a positive correlation existed for all. This was not true for fibrinogen. There was a poor correlation between the molecular weights of the specific factors and fibrinogen and their appearance in the pleural fluid. The concentration of factor XII in 35% and factor XI in 11% of pleural fluid exceeded their respective plasma concentration.

Adult↗
PubMed1991

Pulmonary neoplasms simulating interlobar pleural effusions.

Loculated pleural effusions simulating neoplasms are a well known pitfall. The reverse is less well recognized. We describe three cases where tumours were initially diagnosed as loculated effusions. The differentiation of these two entities is discussed.

Diagnosis, Differential↗
PubMed1985

Chyliform (cholesterol) pleural effusion.

Chyliform pleural effusions are a little known occurrence only sparingly reported in the literature. At the lung department in Uppsala, Sweden, 11 cases have been seen the last few years. Typically, the exudate develops in a long-standing pleural thickening resulting from therapeutic pneumothorax many years earlier. The exudate contains a high level of cholesterol, probably breakdown products from blood cells. It is usually sterile, and only very rarely can one find tubercle bacilli growing from it. There is a tendency toward recurrence. If the patient benefits clinically from aspiration of the fluid, decortication is indicated.

Cholesterol↗
PubMed2003

Effect of iatrogenic haemorrhage on biochemical parameters in pleural effusions.

AIM: Pleural fluid (PF) samples may become haemorrhagic due to trauma during diagnostic procedures. We aimed to evaluate the effect of increasing blood concentrations in pleural fluids on biochemical parameters which are used to discriminate transudates and exudates. METHODS: Sixty-seven pleural fluid samples were separated into five test tubes. Patient's own blood was added in the test tubes in different concentrations as follows: No blood in the first tube, 2% in the 2nd, 5% in the 3rd, 10% in the 4th, 20% in the 5th tube. RESULTS: After addition of blood, statistically significant changes in all biochemical parameters in transudate groups were detected. The characteristics changed from transudate to exudate 12.9%, 14%, 11.4%, 27% and 14.3% according to Light's criteria, serum-PF albumin gradient, cholesterol level, PF/serum cholesterol and PF/serum bilirubin, respectively. Results indicating an exudate according to Light's criteria were evident only in the 5th tube group, however, when other biochemical parameters were used, classification of samples could be altered with lower concentrations of blood. CONCLUSION: Contamination of blood, especially in borderline transudative pleural effusions, may result in misclassification as an exudate. Light's criteria appear to be the least effected and therefore the most reliable parameters in bloody effusions.

Bilirubin↗
PubMed1978

Management of malignant pleural effusion.

A pleural effusion is a frequent complication of malignant disease. Essential to the care of oncology patients is a fundamental knowledge of the pathophysiology and treatment of such effusions. This article discusses the current thoughts concerning the occurrence of malignant effusions, outlines the current available methods and agents employed for control, and presents a modification of the thoracostomy procedure that appears to be more effective than the standard procedure.

Bleomycin↗
PubMed1997

Myelomatous pleural effusion.

Malignant pleural effusions due to multiple myeloma are rare. Effusion in such patients is usually due to congestive heart failure or another process. Malignant myeloma cells identified in cytologic examination of the pleural fluid or by pleural biopsy establish the diagnosis of a myelomatous effusion. This finding portends a poor prognosis and death usually within 4 months.

Aged↗
PubMed1989

[Comparison of the effectiveness and adverse effects of a Corynebacterium parvum vaccine made in Czechoslovakia with Coparvax, a British preparation made by Wellcome, in the treatment of malignant pleural effusions].

Malignant pleural effusion complicates various malignant diseases, most frequently lung and breast cancer. A group of 20 patients with this complication were treated with the Czechoslovak vaccine Corynebacterium parvum and the English preparation Coparvax, and their effects and side-effects were compared. Within 4 weeks following the application, 7 patients died. In 9 surviving patients, the exudate ceased to be replenished and in 4 persons, after intrapleural application of the preparation, it had to be evacuated one more time, but then its formation ceased. The therapeutical effect of both the Czechoslovak and English preparations was satisfactory. The side-effects of both preparations were comparable except for a significantly higher temperature elicited by the Czechoslovak vaccine. Both preparations Corynebacterium parvum are suitable for palliative treatment of malignant pleural exudates.

Bacterial Vaccines↗
PubMed1992

A phase I-II study of recombinant intrapleural alpha interferon in malignant pleural effusions.

Malignant pleural effusion is a common and significant source of morbidity for many patients with cancer. In an attempt to control this condition without using chest tube drainage, we administered recombinant interferon alpha-2b (INTRON, Schering-Plough, Kenilworth, NJ) intrapleurally via catheter after routine thoracentesis. Twenty-two installations of interferon were administered to 15 patients in incremental dosages of 3-50 x 10(6) U/m2. Of 20 evaluable treatments, six (30%) achieved effusion stabilization; there were no complete or partial responses. Only one of nine treatments at a dosage less than 20 x 10(6) units/m2 resulted in symptoms, while four of 11 treatments at the higher dosage were associated with transient fever, chills, and chest pain. Interferon demonstrated no major activity in this heavily treated patient population with advanced malignancy.

Adult↗
PubMed1992

[Pathophysiology, incidence and therapy of malignant pleural effusion].

Malignant pleural effusions are a common and significant problem in patients with advanced malignancies. Effective control of recurrent malignant effusion can greatly improve the quality of life. On the basis of comparison involving, efficacy, toxicity, and costs we recommend intrapleurally tetracycline with chest tube drainage as the technique of choice inducing a response rate of 70%. Instillation of fibrin glue into the thoracic cavity through a tube is also a safe and effective technique and should be employed when tetracycline fails. Mediastinal radiation constitutes the best local therapy secondary to lymphoma. Pleurectomy would be appropriate in a very small subset of patients whose performance status is exceptionally good and whose malignancy ist otherwise under good control.

Antineoplastic Agents↗