oxytetracycline--anhydrous and Pericardial-Effusion

Here we report a rare case of bronchopericardial fistula following intrapericardial instillation of oxytetracycline. A 63-year-old female patient was admitted for management of malignant pericardial effusion secondary to right-sided bronchogenic carcinoma. Medical therapy and recurrent percutaneous catheter drainage failed in resolving the problem, so subxiphoid pericardiostomy and drainage tube insertion was performed. There was no decrease in the drainage so we decided to perform pericardial sclerosis by intrapericardial tetracycline instillation. After the second time oxytetracycline instillation, the patient developed respiratory arrest with hemodynamic instability. A huge amount of yellow frothy secretion aspirated through the endotracheal tube. The presence of tetracycline in the bronchial secretion was proved by microbiological methods. The hemodynamic status of the patient deteriorated rapidly and despite all resuscitation measures we lost the patient within a few hours.

Topics: Bronchial Fistula; Carcinoma, Bronchogenic; Drainage; Fatal Outcome; Female; Fistula; Heart Diseases; Humans; Middle Aged; Oxytetracycline; Pericardial Effusion; Pericardial Window Techniques; Pericardium; Sclerosing Solutions; Sclerotherapy; Treatment Failure; Treatment Outcome

We started a treatment trial for malignant pericardial tamponade with intracavitary oxytetracycline, 500-1,000 mg/day, administered via an indwelling pericardial cannula after extraction of as much pericardial fluid as possible. This procedure was repeated every 24 h for 6 consecutive days or until no more fluid could be drained. Eleven consecutive patients were entered in the study. The responses were obtained by clinical examination, chest roentgenogram and echocardiogram, prior to and after treatment. The primary cancer was located in the breast in 7 patients, in the stomach in 2 patients, and in the lung in 2 patients. In all cases, systemic chemotherapy or hormonal therapy was started after the pericardial tamponade was cured. The mean tetracycline dose per patient was 3,000 mg (range 1,500-6,000). All patients responded to the treatment with rapidly improving symptoms. Response persisted during a median of 9 months coinciding roughly with the median survival because all patients died because of progression of the neoplasm at sites other than the pericardium with no evidence of pericardial relapse. The main concomitant effects were mild local pain during tetracycline instillation in 4 patients, and transient fever (less than 39 degrees C) in 3. These data suggest that intracavitary oxytetracycline is perhaps less toxic and similar by successful as tetracycline hydrochloride in malignant pericardial tamponade.

Topics: Adult; Aged; Cardiac Tamponade; Female; Heart Neoplasms; Humans; Male; Middle Aged; Oxytetracycline; Pericardial Effusion; Pericardium