povidone-iodine and Pleural-Effusion

Povidone iodine (PVI) pleurodesis is commonly used in adult. However, this procedure is still nonconsensual in newborns.. This article aimed to report a new case of refractory congenital chylothorax (CCT) managed with PVI pleurodesis with a review of previousreported cases.. a systematic review of similar cases published in PubMed. Clinical patterns, therapeutic modalities and outcome variables werereported.. In a full term neonate presenting refractory CCT, PVI pleurodesis was performed at day 16 of life by one intrapleural instillation of PVI4% with rapid success and no side effects. Renal function and thyroid tests stilled normal before and after instillation. The analysis of 18 casesreported in Medeline and our observation provided the following data: this procedure was successful without side effects in 11/19 cases. Severeside effects were reported in four patients with high risks before procedure.. PVI pleurodesis seems to be effective and inoffensive in the management of refractory CCT. It may be a good alternative tosurgery. Nevertheless, randomized studies on large neonatal population are required to precise: the risks and benefits of this procedure, thetiming and the modalities of its realization (duration of intervention, dilution and dosage of PVI) according to the patient`s field (gestational age,weight and associated morbidity).

Topics: Chylothorax; Female; Humans; Infant, Newborn; Pleural Effusion; Pleurodesis; Povidone-Iodine; Thoracentesis

Refractory chylothorax is a severe clinical issue, particularly in neonates. Conventional primary approach is based on diet with medium-chain fatty acids and/or total parenteral nutrition. In nonresponders, proposed second line treatments include chemical or surgical pleurodesis, thoracic duct ligation, pleuroperitoneal shunting and pleurectomy but none of these have been shown to be superior to other in terms of resolution rate and safety. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment.. Since 2013, povidone-iodine pleurodesis was attempted in all patients with persistent chylothorax who failed conservative treatment (no response to at least 10 days of total parenteral nutrition and maximum dosage of intravenous octreotide). Pleurodesis consisted in the injection of 2 ml/kg of a 4% povidone-iodine solution inside the pleural space, leaving the pleural tube clamped for the subsequent 4 hours.. Five patients were treated with chemical pleurodesis of persistent chylothorax. Four of 5 patients had their pleural effusion treated by one single povidone-iodine infusion. Median time for resolution was 4 days. A patient with massive superior vena cava thrombosis did not benefit from pleurodesis. None of the patients experienced long term side effects of the treatment.. Our data suggest that povidone-iodine pleurodesis may be considered a safe and effective option to treat refractory chylothorax in newborns.

Topics: Chylothorax; Female; Humans; Infant; Infant, Newborn; Injections; Male; Pleural Cavity; Pleural Effusion; Pleurodesis; Povidone-Iodine

Chemical pleurodesis is an accepted therapy for patients with recurrent pleural effusions and pneumothorax. Iodopovidone has been shown to be safe and effective for chemical pleurodesis in several studies. The aim of this systematic review was to update a previously reported meta-analysis on the efficacy and safety of iodopovidone pleurodesis.. Two databases MEDLINE and EMBASE were searched for a period (1952-2010), and studies that have reported success rates with iodopovidone pleurodesis were selected. The proportions with 95 per cent confidence interval (CI) were calculated to assess the outcomes in the individual studies and the results were pooled using a random effects model.. Thirteen eligible studies with 499 patients were included in the mata-analysis. The success rates varied from 70 to 100 per cent in different studies with the pooled success rate being 88.7 per cent (95% CI, 84.1 to 92.1). The success rate was not affected by the method (tube thoracostomy vs. thoracoscopy, 89.6 vs. 94.2%) or the indication of pleurodesis (pleural effusion vs. pneumothorax, 89.2 vs. 94.9%). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in six patients across the studies. There were no deaths associated with iodopovidone pleurodesis. Statistical heterogeneity and publication bias were found.. Iodopovidone may be considered a safe and effective agent for chemical pleurodesis in patients with pleural effusions and recurrent pneumothoraces.

Topics: Chest Pain; Humans; Pleural Effusion; Pleurodesis; Pneumothorax; Povidone-Iodine; Talc

To evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis through tube thoracostomy in patients with recurrent pleural effusions and pneumothorax.. This was a prospective study in which pleurodesis was performed with a solution of 20 mL 10% iodopovidone and 80 mL normal saline solution infused through a tube thoracostomy and left in the pleural cavity for 4 h.. A total of 64 patients (34 men) with a mean (+/-SD) age of 47.1 +/- 15.4 years were included. There were 37 cases of pleural effusion and 27 of pneumothorax. A complete response (neither reaccumulation of fluid nor recurrence of pneumothorax) was obtained in 32 (86.5%) patients with pleural effusion and 25 (92.6%) patients with pneumothorax. A second procedure (i.e. repeated pleurodesis) was attempted successfully in four patients in the pleural effusion group. All patients experienced chest pain to a varying degree as recorded on a Visual Analogue Scale (median 50.5, range 10-95). Seven patients developed fever and one immunocompromised patient developed empyema following the procedure. There were no recurrences at a median follow up of 5 months (range 3-15 months) in the pleural effusion group, and 13 months (range 6-24 months) in the pneumothorax group.. Iodopovidone can be used as an effective and safe agent for (chemical) pleurodesis (through tube thoracostomy), which is inexpensive and readily available.

Topics: Anti-Infective Agents, Local; Chest Tubes; Female; Humans; Male; Middle Aged; Pleural Effusion; Pleurodesis; Pneumothorax; Povidone-Iodine; Prospective Studies; Recurrence; Safety; Sclerosing Solutions; Thoracostomy

Chylothorax is a known complication of postcardiac surgery and the most common cause of pleural effusion in neonates. Conservative management is usually adopted, including Nil-per-Oral (NPO), treatment of underlying etiology of infection, and use of octreotide. Chylothorax resistant to medical therapy and drainage is often treated by chemical pleurodesis. Previously used pleurodesis agents have included talc, minocycline, OK-432, bleomycin, and povidone-iodine. 50% Dextrose (D50) has been reported to be useful for pleurodesis in adults. We successfully managed two cases of prematurely born infants with D50 as an alternative chemical sclerosant for chemical pleurodesis in a resistant chylothorax and discussed evidence of its use in the literature.

Topics: Adult; Chylothorax; Glucose; Humans; Infant; Infant, Newborn; Pleural Effusion; Pleurodesis; Povidone-Iodine

Chylothorax is a rare disease with a high mortality rate in pediatric patients like newborns and infants. As one of the minimally invasive treatments, chemical pleural pleurodesis has been gradually used in treating pediatric chylothorax patients in recent years. This study explored the feasibility, safety and effect of povidone-iodine chemical pleurodesis (CP) for spontaneous chylothorax in young pediatric patients.. From January 2009 to December 2019 the clinical data of 22 children treated for spontaneous chylothorax at Guangdong Second Provincial General Hospital were retrospectively analyzed. The data included the patients' medical history, clinical manifestations, pleural effusion examinations, treatment methods, and effects and complications. On the basis of conventional conservative treatment and closed thoracic drainage, all the children were treated by CP with povidone-iodine until the pleural effusion was absorbed and the thoracic tube was removed. After discharge from the hospital, each patient was followed up for 1-10 years.. Of the 22 children (16 males and 6 females), 3 cases were diagnosed with pleural effusion at prenatal examination, 5 cases had acute respiratory distress at birth, and 6 case had experienced pneumonia repeatedly since birth. All of the children had different degrees of cyanosis and dyspnea. Pleural effusion was diagnosed in all patients by chest X-ray and chest ultrasound after admission (12 cases on the left side, 5 cases on the right side, and 5 cases on both sides). The results of all chyle tests during pleural effusion examination were positive. The mean leukocyte count was (9,278.8±9,504.6)×106 /L, the lymphocyte ratio was (83.9±6.1)%, and the mean triglyceride content was (7.18±6.10) mmol/L. All patients were treated with thoracic drainage, diet control, nutritional support, and povidone-iodine CP, among 6 of them with pneumonia on admission received antibiotics. The mean length of stay (LOS) was (36.0±18.2) days. The patients received thoracic drainage for (23.0±15.6) days and pleurodesis (3.0±2.0) times. No serious side effects occurred after pleurodesis, although some patients experienced mild chest pain and low fever. All the patients successfully achieved a clinical cure.. Povidone-iodine CP is a safe, effective, and minimally invasive treatment, with high success rate and few complications in young pediatric patients with spontaneous chylothorax.

Topics: Child; Chylothorax; Female; Humans; Male; Pleural Effusion; Pleurodesis; Povidone-Iodine; Retrospective Studies

Urinothorax, an unusual and rare cause of pleural effusion, is usually secondary to urinary obstruction and abdominal trauma. We describe an uncommon case of left-sided urinothorax in a 35-year-old man with diabetes and hypothyroidism associated with an autoimmune disorder without obvious obstructive uropathy. Workup revealed pancytopenia, mild proteinuria, positive anti-nuclear and anti-dsDNA antibodies suggestive of probable systemic lupus erythematosus. Contrast-enhanced CT-chest and abdomen showed hepatosplenomegaly with bilateral renal abscesses and a fistulous connection between left superior calyx and left the pleural cavity. Patient was initially managed by intravenous antibiotics, intercostal tube drainage and ipsilateral double-J stent placement. The definitive management in the form of closure of nephropleural fistula was achieved with sclerotherapy using 0.1% povidone-iodine instillation, while oral steroids were started for the probable autoimmune disorder. To the best of our knowledge, this is the first case of spontaneous non-obstructive nephropleural fistula associated with an autoimmune disorder, managed by minimally invasive methods.

Topics: Adult; Anti-Bacterial Agents; Autoimmune Diseases; Diabetes Mellitus, Type 1; Drainage; Humans; Hypothyroidism; Male; Pleural Effusion; Povidone-Iodine; Rare Diseases; Respiratory Tract Fistula; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome; Urinary Fistula

Idiopathic congenital chylothorax refers to abnormal accumulation of lymphatic fluid within the pleural space due the disruption of the thoracic duct or its lymphatic tributaries. It is a relatively rare disease and a cause of neonatal respiratory distress with major nutritional and immunological consequences. Therefore, it is critical to decrease pleural effusion promptly. Conservative treatment is always started as soon as the diagnosis is made, and refractory cases require chemical pleurodesis or surgery. However, the choice and timing of therapeutic escalation is not clear in the neonatal period and long waiting periods may have adverse consequences for the baby. We report a case of congenital idiopathic chylothorax who did not respond to conservative treatment after 18 days in whom one intrapleural injection of 5 mL of 4% concentrated Betadine stopped the pleural effusion promptly, effectively, and definitively, with no side effects observed, thus challenging such delayed administration.

Topics: Anti-Infective Agents, Local; Chylothorax; Female; Humans; Infant, Newborn; Injections; Pleural Effusion; Povidone-Iodine

The aim of this case study is to present effectiveness of percutaneous drainage as a treatment option of ruptured lung and liver hydatid cysts. A 65-year-old male patient was admitted with complicated liver and lung hydatid cysts. A liver hydatid cyst had ruptured transdiaphragmatically, and a lung hydatid cyst had ruptured both into bronchi and pleural space. The patient could not undergo surgery because of decreased respiratory function. Both cysts were drained percutaneously using oral albendazole. Povidone-iodine was used to treat the liver cyst after closure of the diaphragmatic rupture. The drainage was considered successful, and the patient had no recurrence of signs and symptoms. Clinical, laboratory, and radiologic recovery was observed during 2.5 months of catheterization. The patient was asymptomatic after catheter drainage. No recurrence was detected during 86 months of follow-up. For inoperable patients with ruptured liver and lung hydatid cysts, percutaneous drainage with oral albendazole is an alternative treatment option to surgery. The percutaneous approach can be life-saving in such cases.

Topics: Aged; Albendazole; Anticestodal Agents; Bronchial Fistula; Combined Modality Therapy; Diaphragm; Drainage; Echinococcosis, Hepatic; Echinococcosis, Pulmonary; Humans; Male; Pleural Effusion; Povidone-Iodine; Rupture, Spontaneous; Sclerotherapy; Therapeutic Irrigation; Tomography, X-Ray Computed; Ultrasonography

Congenital chylothorax is a rare entity which is characterized by abnormal accumulation of chyle in pleural cavity. Chylothorax presenting as non-immune hydrops is even rarer. We report a case of congenital bilateral chylothorax presenting as non immune hydrops and managed successfully with chemical pleurodesis. A term male baby presented at birth with bilateral pleural effusions and subcutaneous edema. It was initially managed with ventilation and intercostals drainage (ICD). After the initiation of feeds, re-accumulation of pleural fluid led to the diagnosis of congenital chylothorax. Management with ICD and octreotide was unsuccessful but responded to chemical pleurodesis with 4% povidine iodine done on 3 separate occasions.

Topics: Anti-Infective Agents, Local; Chylothorax; Female; Humans; Infant, Newborn; Male; Pleural Effusion; Pleurodesis; Povidone-Iodine

Topics: Anti-Infective Agents, Local; Humans; Pleural Effusion; Pleurodesis; Povidone-Iodine; Talc

Chemical pleurodesis may be the best available treatment for recurrent and troublesome pleural effusions when the underlying cause cannot be corrected. A wide variety of pleural irritants have been used, but the search for the ideal agent for pleurodesis continues. The purpose of our study is to evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis in patients with recurrent pleural effusion.. Multicenter prospective study.. The pleurodesis solution consisted of a mixture of 20 mL 10% iodopovidone and 80 mL normal saline solution. It was infused and left in the pleural cavity for 2 h. In 12 patients, pleurodesis was performed through a tube thoracostomy, and in the remaining 40 patients it was carried out at the end of diagnostic thoracoscopy.. Fifty-two patients were included, with a mean (+/- SEM) age of 56.6 +/- 1.84 years. Eighty-five percent of the cases were related to a malignant neoplasm. A complete response, with no reaccumulation of fluid during follow-up, was obtained in 50 patients (96.1%). A second procedure was successful in the two remaining patients. Three patients (5.8%) experienced intense pleuritic pain and systemic hypotension after the instillation of the sclerosing agent. They recovered without incident. The mean length of follow-up was 13 +/- 1.46 months, with a median of 8.5 months. There were no 30-day postoperative deaths.. Iodopovidone is an effective, safe, readily available, and inexpensive alternative to achieve chemical pleurodesis in cases of recurrent, incapacitating effusions, regardless of etiology.

Topics: Anti-Infective Agents, Local; Chest Tubes; Follow-Up Studies; Humans; Pleural Effusion; Pleurodesis; Povidone-Iodine; Prospective Studies; Recurrence; Time Factors

A 50-year-old man with symptoms of bi-ventricular heart failure was transferred to our hospital with a diagnosis of extracardiac tumor. He had a 10 year history of untreated diabetes. Chest computed tomography (CT) revealed an extracardiac mass in the right atrio-ventricular groove. Cardiac catheterization revealed an elevated mean right atrial pressure of 18 mmHg, mean pulmonary wedge pressure of 16 mmHg, and the right ventricular pressure curve demonstrated typical dips and plateaus. At surgery, there was severe adhesion between the pericardium and epicardium, and the pericardium was severely thickened and contained turbid pus. In the left thoracic cavity, there was large amount of pleural effusion and pus. Therefore, the patient was diagnosed with purulent pericarditis caused by left empyema. The thickened pericardium at the anterior portion of the heart was resected, however resection of the remaining portion was abandoned because the adhesion was so tight. After surgery, the patient underwent irrigation of the heart and left thoracic cavity by 1% povidone iodine solution and 0.5 mg/ml of imipenem for 7 days. Bacteriologic culture of the pus from the pericardium revealed anaerobic gram negative bacteria. After 4 months of antibiotics infusion, his C reactive protein became negative and the patient was subsequently discharged from our hospital.

Topics: Anti-Infective Agents, Local; Cardiac Catheterization; Cardiac Output, Low; Diabetes Complications; Diagnosis, Differential; Empyema, Pleural; Gram-Negative Bacterial Infections; Humans; Imipenem; Male; Middle Aged; Pericarditis, Constrictive; Pleural Effusion; Povidone-Iodine; Suppuration; Thienamycins; Tissue Adhesions; Tomography, X-Ray Computed