minocycline and Hydrothorax

Hepatic hydrothorax is defined as a pleural effusion that arises in patients with cirrhosis of the liver and no cardiopulmonary disease; it is believed to result from peritoneopleural communication through a defect in the diaphragm.. Nine patients underwent thoracoscopic pleurodesis. The diaphragmatic defect was detected and corrected in two cases. In all patients, an argon beam coagulator was applied to the diaphragm surface, which was then completely covered with bioabsorbable prostheses. We then spread 3 ml of fibrin glue on the covered diaphragm and sprinkled 5 KE of OK-432 and 100 mg of minocycline hydrochloride in the thoracic cavity.. All patients showed clinical improvement. The pleural effusion and breathlessness resolved immediately after pleurodesis. There were two recurrences after 1 and 4 months, respectively. One of these patients improved after repeat pleurodesis; the other was treated conservatively.. Our new technique of thoracoscopic pleurodesis is an effective and minimally invasive treatment for patients with refractory hepatic hydrothorax.

Topics: Aged; Diaphragm; Female; Fibrin Tissue Adhesive; Humans; Hydrothorax; Laser Coagulation; Liver Cirrhosis; Liver Cirrhosis, Biliary; Male; Middle Aged; Minimally Invasive Surgical Procedures; Minocycline; Palliative Care; Picibanil; Pleurodesis; Polyglycolic Acid; Recurrence; Reoperation; Surgical Mesh; Thoracoscopy

Management of refractory hepatic hydrothorax is a challenge to physicians in clinical practice. We reported two patients with hepatic hydrothorax, non-alcoholic cirrhosis and rapidly recurring pleural effusion. They failed to improve with diuretics and repeated thoracentesis. Refractory hepatic hydrothorax was successfully treated by minocycline-induced pleural symphysis. After pleurodesis, ventilatory function returned to normal in both patients. No recurrence of pleural effusion was noted. We suggest that minocycline pleurodesis is an alternative treatment for refractory hepatic hydrothorax because it is simple, safe and effective.

Topics: Aged; Anti-Bacterial Agents; Humans; Hydrothorax; Liver Cirrhosis; Lung; Male; Middle Aged; Minocycline; Pleurodesis