tetracycline and Hydrothorax

Hydrothorax due to pleuroperitoneal communication (PPC) can occur in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We report our experiences of the safety and efficacy of the treatment of four patients with a novel video-assisted thoracoscopy method.. Single-port video-assisted thoracoscopic surgery (VATS) was performed with a mini-thoracotomy of 5 cm in length. The PPC site was identified on the diaphragm and ligated using an endoscopic loop. The diaphragm was then covered using a polyglycolic acid (PGA) sheet, over which adhesive chemicals (OK432 and tetracycline) were sprayed.. We assessed the efficacy of our approach in four patients (one female and three males) aged 42-74 years (mean: 62.0 years). The hydrothoraxes were right sided in all the patients. The mean operation and postoperative drainage times were 92.5 min and 3.0 days, respectively. The hydrothoraxes did not recur in any patient during follow-up periods of 8-46 months.. Our suture- and staple-free technique is not only easy to perform but also appears to be safe and effective for the management of hydrothorax in patients receiving CAPD. Larger scale studies are now indicated.

Topics: Adult; Aged; Anti-Bacterial Agents; Drainage; Female; Humans; Hydrothorax; Ligation; Male; Middle Aged; Operative Time; Peritoneal Dialysis, Continuous Ambulatory; Picibanil; Polyglycolic Acid; Sutureless Surgical Procedures; Tetracycline; Thoracic Surgery, Video-Assisted; Thoracotomy; Treatment Outcome

Topics: Adolescent; Humans; Hydrothorax; Male; Peritoneal Dialysis; Pleurodesis; Sclerosing Solutions; Tetracycline

Topics: Aged; Blood; Female; Humans; Hydrothorax; Instillation, Drug; Peritoneal Dialysis, Continuous Ambulatory; Pleura; Recurrence; Tetracycline; Tissue Adhesions

The co-existence of pelvic tumor, hydrothorax and ascites has been known since the last century. The features of this disease were described by Meigs and Cass in 1937; in the same year Roads named it Meigs syndrome. According to the original description this syndrome only included, as pelvic involvement, an ovarian neoplasm; at present it is accepted that hydrothorax and the ascites can also be associated with a uterine tumor, like a fibroma. The existence of either an ovarian or a uterine neoplasm distinguishes the typical Meigs syndrome from a pseudo-Meigs syndrome. The most likely pathogenesis of Meigs syndrome ascribes the formation of the peritoneal and pleural effusion to the filtration of interstitial fluid in the peritoneum through the tumor capsule, and the diffusion to the pleural space, generally at the right side, through the diaphragm lymphatic vessels and the foramen of Bochdalek. Dockerty reported that at least 40% of ovarian tumors had a diameter of more than 6 cm when associated with hydrothorax and ascites. The entity of pleural and peritoneal effusion can be moderate or massive. The effusions generally derive from a transudative process, but they can occasionally contain blood cells. The connection between the pelvic tumor and the effusion is demonstrated by the regression of the latter when the neoplasm is excised. When the pelvic tumor has an ovarian location it derives from the connective tissue of the hilus, it appears during fertile age and has a slow growth, the clinical signs becoming evident in elder age.

Topics: Aged; Ascites; Drainage; Female; Humans; Hydrothorax; Meigs Syndrome; Ovarian Neoplasms; Tetracycline; Tomography, X-Ray Computed

Topics: Adult; Aged; Female; Humans; Hydrothorax; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Prospective Studies; Respiration, Artificial; Tetracycline

Eleven patients were treated with chest tube drainage and intrapleural instillation of tetracycline for malignant pleural effusion. In ten cases this procedure for 6-10 days achieved complete resolution of pleural fluid and produced pleurodesis. Only one patient needed longer treatment, but it was also successful. Fluid recurrence was not recognised during the follow-up period. This method is very effective and simple, so the authors recommend the tetracycline pleurodesis for the palliative management of malignant pleural effusions.

Topics: Breast Neoplasms; Drainage; Female; Hydrothorax; Palliative Care; Pleura; Pleural Effusion; Tetracycline

Recurrent hydrothorax complicating peritoneal dialysis has been considered a contraindication to continuing peritoneal dialysis. In the continuous ambulatory peritoneal dialysis (CAPD) population this problem has generally required a change of dialytic modality. Talc poudrage has been attempted to ameliorate the problem but has met with limited success. We report a successful case of intrapleural instillation of tetracycline to induce a pleural symphysis and prevent recurrence of peritoneal dialysis-related hydrothorax in a patient who refused any alternative mode of dialysis. We also review the literature, pathophysiology, epidemiology, diagnosis, and management of this compromising problem.

Topics: Female; Humans; Hydrothorax; Middle Aged; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Pleura; Sex Factors; Tetracycline

Hydrothorax occurs in 5.3 percent of ascitic patients. Our experience with 22 cases forms the basis of this report. Of the 22 cases, 21 were spontaneous and 1 was due to transdiaphragmatic incision. Eighteen occurred on the right side. Usually fluid enters the chest through tiny defects in the diaphragm. These defects are often covered by pleuroperitoneum, but the high abdominal pressure raises a bleb on the superior surface of the diaphragm. Rupture produces hydrothorax. The ascites is often relieved with the onset of the hydrothorax. Blockage of the thoracic duct has produced chylous ascites. The thoracoabdominal communication is immediately confirmed by a scan of the chest and abdomen after intraperitoneal injection of technetium-99 colloid. Fluid is tapped from the chest immediately before intraperitoneal injection. The rate at which the technetium-99 enters the chest is related to the size of the defect in the diaphragm. A significant transfer should occur within 12 hours. Immediate transfer occurs with large defects. The ruptured blister on the diaphragm forms a one-way valve. Intrathoracic injection does not migrate into the peritoneal cavity. The valvular characteristics of the leak force ascitic fluid into the thorax because the differential pressure between the abdominal and pleural cavities is intensified by inspiration. If tension hydrothorax has occurred, urgent thoracocentesis and paracentesis may be required. A chest tube should not be introduced. The main principle of surgery is to supply a low resistance pathway for the return of fluid to the venous system and to eliminate the diaphragmatic defect by obliteration of the pleural space. A LeVeen peritoneovenous shunt is performed after emptying the abdomen of its fluid load. After completion of the shunt operation, the chest is emptied of fluid, and a sclerosing agent (tetracycline or nitrogen mustard) is injected into the pleural cavity. Closure of the defect is verified by technetium-99 labeled scans which also confirm shunt patency. With this regime, the defect closed or was rendered insignificant in 18 of 22 patients. One patient had a post-transdiaphragmatic surgical defect which was too extensive to be closed by the aforementioned procedures. One patient remained well but did not have closure of the defect, one patient with a ruptured hiatal hernia did not have closure, and one patient who had previous placement of a chest tube could not be closed. Therefore, 18 of 22 patients were su

Topics: Ascites; Drainage; Humans; Hydrothorax; Intubation; Peritoneovenous Shunt; Pleura; Sclerosing Solutions; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tetracycline

Two patients with cirrhosis and ascites complicated by extensive unilateral pleural transudates refractory to therapy with dietary sodium restriction, diuretics, and repeated thoracentesis were successfully managed by tetracycline-induced pleural symphysis. The intrapleural instillation of this antibiotic prevented the recurrence of the effusion and substantially relieved the patients' symptoms with minimal undesirable side effects.

Topics: Female; Humans; Hydrothorax; Liver Cirrhosis; Male; Methods; Middle Aged; Pleura; Pleural Effusion; Recurrence; Tetracycline