tetracycline and Pericardial-Effusion

We reviewed 36 cases of symptomatic malignant pericardial effusion managed with pericardiocentesis at our institution from 1982 to 1989. There were 13 men and 23 women, aged 49 +/- 12 years (range, 33-76 years). The commonest underlying tumours were lung cancer (12 cases, 33%) and breast cancer (11 cases, 30%). Pericardiocentesis was successful as the initial management in 34 of 36 patients (94%); one patient died as a result of the procedure and another required subxiphoid incision and tube drainage of the effusion. When intrapericardial sclerotherapy was performed, only three of 28 patients required repeat pericardiocentesis, and when sclerotherapy was not performed initially, four of seven patients had recurrent symptomatic effusions. Median survival following pericardiocentesis in breast cancer patients was 10 months (range, 0-36 months) and in all other malignancies was four months (range, 0-12 months). We conclude that pericardiocentesis with intrapericardial sclerotherapy provides good local control for symptomatic malignant pericardial effusion in the majority of patients. In spite of this, the median survival of such patients is poor, especially in patients with malignancies other than breast cancer, with few patients surviving more than a few months.

Topics: Adult; Aged; Breast Neoplasms; Drainage; Echocardiography; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasms; Palliative Care; Pericardial Effusion; Pericardium; Prognosis; Punctures; Sclerotherapy; Survival Rate; Tetracycline

The purpose of this study was the evaluation of the effectiveness of intrapericardial administration of tetracycline, 5-fluorouracil and cisplatin in patients with recurrent malignant pericardial effusion. In 33 cases with malignant pericardial effusion 46 pericardiocenteses under two-dimensional echo-cardiography were performed. No complications were observed after this procedure. Pericardiocentesis was followed by catheterization of the pericardial space for a mean period of 15 days (range 1-64). In 4 cases bacterial pericarditis was observed during catheterization. The mean volume of the pericardial fluid was 2.41 (range 0.4-13 l). In cases with bloody pericardial fluid the PO2, PCO2 and pH of the fluid were estimated and the results compared with the values for venous blood obtained from the upper limbs. Highly statistically significant differences were documented. Twenty cases of malignant pericardial effusion were treated with direct pericardial administration of cisplatin, 3 with 5-fluorouracil and 2 with tetracycline. Good results (no fluid reaccumulation) were observed only after cisplatin therapy. We conclude that pericardiocentesis performed under two-dimensional echo cardiography, followed by pericardial catheterization and direct pericardial treatment with cisplatin are the methods of choice in cases with malignant pericardial effusion. In cases with bloody pericardial fluid PO2, PCO2 and pH analysis can be useful to differentiate the source of the bloody fluid (blood or bloody fluid).

Topics: Adult; Aged; Anti-Bacterial Agents; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carbon Dioxide; Catheterization; Cisplatin; Echocardiography; Female; Fluorouracil; Hemorrhage; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Neoplasms; Oxygen; Pericardial Effusion; Pericarditis; Punctures; Recurrence; Remission Induction; Tetracycline; Ultrasonography, Interventional

The management of malignant pericardial effusion remains controversial. We present our experience with 93 patients referred for drainage and sclerosing procedures between 1979 and 1994.. With continuous electrocardiographic monitoring, a Kifa catheter was inserted percutaneously into the pericardial sac and allowed to drain. A 100 mg dose of lidocaine hydrochloride was instilled intrapericardially, followed by 500 to 1000 mg tetracycline or doxycycline hydrochloride in 20 to 50 ml normal saline solution. The catheter was clamped for 1 to 2 hours and then reopened, and the procedure was repeated daily until the net drainage was less than 25 ml in 24 hours.. Subjects included 53 women and 40 men (median age 58 years). Eight patients could not undergo sclerosis because of technical failure. Eighty-five patients underwent sclerosis and required a median dose of 1500 mg of the sclerosing agent (range 500 to 700 mg), given in a median of three injections (range one to eight). Complications included pain (17 patients), atrial arrhythmias (eight patients), fever with temperature greater than 38.5 degrees C (seven patients), and infection (one patient). Two patients had cardiac arrest before sclerosis could be attempted. Sixty-eight patients (73%) had the effusion controlled for longer than 30 days, for an overall control rate of 81%. Seven other patients had control of the effusion but died of progressive malignant disease in less than 30 days. The overall median survival was 98 days (range 1 to 1724 days). Comparison of these results with outcomes reported for patients with malignant pericardial effusion who underwent surgical drainage indicates that drainage and sclerosis provide similar survivals but sclerosis carries lower morbidity, mortality, and recurrence rates.. Percutaneous drainage and sclerosis constitutes a safe and effective treatment for malignant pericardial effusion. Surgical management should be reserved for the small percentage of cases that cannot be controlled by this method.

Topics: Adult; Aged; Anesthetics, Local; Anti-Bacterial Agents; Arrhythmias, Cardiac; Bacterial Infections; Breast Neoplasms; Cardiac Tamponade; Catheterization; Doxycycline; Drainage; Electrocardiography, Ambulatory; Female; Fever; Follow-Up Studies; Heart Arrest; Humans; Lidocaine; Lung Neoplasms; Male; Middle Aged; Pain; Pericardial Effusion; Pericardium; Sclerosing Solutions; Survival Rate; Tetracycline; Treatment Outcome

Topics: Adult; Carcinoma, Non-Small-Cell Lung; Drainage; Electrocardiography; Humans; Lung Neoplasms; Male; Middle Aged; Pericardial Effusion; Pericardium; Tetracycline

Fifty-eight patients with malignant pericardial effusion were seen from 1979 to 1986. A Kifa catheter was inserted into the pericardial sac and allowed to drain for 12 to 24 hours during electrocardiographic monitoring. Lidocaine hydrochloride, 100 mg, was instilled intrapericardially, followed by tetracycline hydrochloride, 500 to 1,000 mg, in 20 ml of normal saline solution. The catheter was clamped for 1 to 2 hours and then reopened. This procedure was repeated daily until the net drainage was less than 25 ml/24 hours. There were 22 male and 36 female patients (median age 58 years). The primary malignancy included lung (27 patients), breast (16 patients), stomach (3 patients), adenocarcinoma of unknown primary (7 patients), mesothelioma (2 patients) and chronic granulocytic leukemia, ovary and lymphoma (1 patient each). Fifty-six patients received 1 to 5 tetracycline instillations. In 1 patient, the catheter could not be inserted and in another, clotting occurred within the catheter before injection of tetracycline. Complications included transient atrial arrhythmias (5 patients), pain after injection (9 patients) and temperature higher than 37.5 degrees C (5 patients). One patient had a cardiac arrest during pericardiocentesis. Forty-three patients (74%) had control of their effusions for longer than 30 days (median survival 168 days, range 30 to 1,149+), and 5 patients (9%) died before 30 days without effusion. Eight patients (14%) did not achieve control. One declined further therapy after 1 instillation, and 3 died within 6 days with progressive malignancy. One patient had persistent drainage after 3 instillations, and 3 had reaccumulation of fluid 2, 6 and 27 days after catheter removal.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Catheterization; Drainage; Electrocardiography; Female; Humans; Instillation, Drug; Male; Middle Aged; Neoplasms; Palliative Care; Pericardial Effusion; Pericardium; Sclerosing Solutions; Tetracycline

Topics: Breast Neoplasms; Cardiac Tamponade; Drainage; Emergencies; Female; Heart Neoplasms; Humans; Lung Neoplasms; Pericardial Effusion; Pericardium; Tetracycline

Twenty-two patients with malignant pericardial effusion were seen at the Toronto General Hospital between 1979 and 1984. Under ECG monitoring, an indwelling Kifa catheter was inserted into the pericardial sac and then connected to a Hemovac system and allowed to drain for 12 to 24 hours. Xylocaine hydrochloride, 100 mg, was first instilled intrapericardially, followed by tetracycline hydrochloride, 500 to 1,000 mg, dissolved in 20 mL normal saline. The catheter was clamped for one to two hours and then allowed to drain into the Hemovac. This procedure was repeated every 24 to 48 hours until the net drainage was less than 25 mL/24 hours. Nine men and 13 women were treated (median age, 55 years). The primary malignancy included lung in 15 patients, breast in two patients, and carcinoma of the stomach, ovary, pleural mesothelioma, chronic granulocytic leukemia, and adenocarcinoma of unknown primary in one patient each. Twenty patients received one to five instillations of tetracycline. In one patient the catheter could not be inserted into the pericardial sac, and in one patient the catheter clotted before tetracycline instillation. Minor complications included transient arrhythmia in two patients, postinjection pain in four patients, and self-limited temperature elevation greater than 38.5 degrees C in two patients. fifteen patients had good control of their malignant pericardial effusion for more than 30 days (median survival, 160 days; range, 38 to 275 days). Three patients died before 30 days without evidence of effusion, and no patient surviving longer than 30 days developed recurrent effusion or pericardial constriction. Intrapericardial tetracycline instillation is a safe and efficacious treatment for malignant pericardial effusion and should be considered the first treatment modality in this situation.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cardiac Catheterization; Drainage; Echocardiography; Electrocardiography; Female; Heart Neoplasms; Humans; Male; Middle Aged; Neoplasms; Pericardial Effusion; Pericardium; Prognosis; Sclerosis; Tetracycline

Thirty-three unselected patients with cardiac tamponade secondary to malignant pericardial effusion were treated by intrapericardial instillation of tetracycline hydrochloride. Complete control of the initial signs and symptoms of tamponade was obtained in 30 patients without concomitant chemotherapy or radiotherapy. The procedure did not result in clinically significant complications. Failure of the technique was related to premature removal of the catheter by the patient (one patient) or the inability to totally remove hemorrhagic, clot-filled pericardial fluid (two patients). Survival ranged between 28-704 days and extended survival was related to the performance status and/or chemoradiosensitivity of the primary cancer. No patient successfully treated subsequently developed recurrent cardiac tamponade or alternatively, constrictive pericarditis. Tetracycline pericardial instillation remains a safe, simple, and efficacious treatment of tamponade secondary to malignant disease.

Topics: Adult; Aged; Carcinoma, Bronchogenic; Cardiac Tamponade; Electrocardiography; Female; Heart Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Pericardial Effusion; Radiography; Sclerosing Solutions; Tetracycline

Topics: Aged; Breast Neoplasms; Cardiac Tamponade; Catheterization; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pericardial Effusion; Pericardium; Tetracycline

Topics: Acute Disease; Atrial Fibrillation; Cardiac Tamponade; Cortisone; Diagnosis, Differential; Electrocardiography; Humans; Male; Middle Aged; Pericardial Effusion; Pericarditis; Pleural Effusion; Rickettsia typhi; Tetracycline; Tuberculosis, Cardiovascular; Typhus, Endemic Flea-Borne