tetracycline and Pleural-Diseases

We report the case of a 60 year female patient suffering from rheumatoid arthritis for the last 25 years, under TNF-blocker and leflunomide, affected by a recurrent pneumothorax with several subpleural nodules, basal bronchiectasis and apical bullous emphysema. The patient was administered several treatments: aspiration, talc pleurodesis, surgical pleurodesis, pleurodesis induced by tetracycline and autologous blood. To allow the pleural inflammatory reaction necessary to the success of the pleurodesis, we had to interrupt the treatment by TNF-blocker and leflunomide. We then witnessed a partial pleurodesis with persistence of a pneumothorax. The medical situation is improving with disappearance of dyspnea.

Topics: Anti-Bacterial Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Bronchiectasis; Dyspnea; Female; Humans; Immunosuppressive Agents; Isoxazoles; Leflunomide; Lung Diseases; Middle Aged; Pleural Diseases; Pleurodesis; Pneumothorax; Pulmonary Emphysema; Radiography, Thoracic; Recurrence; Tetracycline; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha

Endogenous active plasminogen activator inhibitor 1 (PAI-1) was targeted in vivo with monoclonal antibodies (mAbs) that redirect its reaction with proteinases to the substrate branch. mAbs were used as an adjunct to prourokinase (single-chain [sc] urokinase [uPA]) intrapleural fibrinolytic therapy (IPFT) of tetracycline-induced pleural injury in rabbits. Outcomes of scuPA IPFT (0.25 or 0.0625 mg/kg) with 0.5 mg/kg of mouse IgG or mAbs (MA-33H1F7 and MA-8H9D4) were assessed at 24 hours. Pleural fluid (PF) was collected at 0, 10, 20, and 40 minutes and 24 hours after IPFT and analyzed for plasminogen activating (PA), uPA, fibrinolytic activities, levels of total plasmin/plasminogen, α-macroglobulin (αM), mAbs/IgG antigens, free active uPA, and αM/uPA complexes. Anti-PAI-1 mAbs, but not mouse IgG, delivered with an eightfold reduction in the minimal effective dose of scuPA (from 0.5 to 0.0625 mg/kg), improved the outcome of IPFT (P < 0.05). mAbs and IgG were detectable in PFs at 24 hours. Compared with identical doses of scuPA alone or with IgG, treatment with scuPA and anti-PAI-1 mAbs generated higher PF uPA amidolytic and PA activities, faster formation of αM/uPA complexes, and slower uPA inactivation. However, PAI-1 targeting did not significantly affect intrapleural fibrinolytic activity or levels of total plasmin/plasminogen and αM antigens. Targeting PAI-1 did not induce bleeding, and rendered otherwise ineffective doses of scuPA able to improve outcomes in tetracycline-induced pleural injury. PAI-1-neutralizing mAbs improved IPFT by increasing the durability of intrapleural PA activity. These results suggest a novel, well-tolerated IPFT strategy that is tractable for clinical development.

Topics: Animals; Antibodies, Monoclonal, Murine-Derived; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Female; Fibrinolytic Agents; Plasminogen Activator Inhibitor 1; Pleural Diseases; Rabbits; Serine Proteinase Inhibitors; Tetracycline

Chemical pleurodesis using tetracycline is an accepted and commonly employed treatment of pneumothorax and pleural effusions. We describe a case of chemical burn of the pleura in a ventilated 41-year-old who came to thoracotomy after 3 days of continuous intrapleural infusion of tetracycline at another hospital. To our knowledge this has not been previously reported although other adverse effects of this procedure are documented. We suggest that damage to the pleura and underlying lung may occur if excessive amounts of tetracycline are used in attempted pleurodesis.

Topics: Adult; Anti-Bacterial Agents; Biopsy; Burns, Chemical; Drug Overdose; Humans; Male; Pleura; Pleural Diseases; Pleurodesis; Pneumothorax; Respiratory Care Units; Suction; Tetracycline; Thoracotomy

Pleural fibrin deposition that promotes loculation and fibrosis after pleural injury is initiated by tissue factor (TF). In this study, we sought to determine if tissue factor pathway inhibitor (TFPI), an inhibitor of the TF-factor VIIa complex, was likewise expressed in tetracycline (TCN)-induced pleural injury and, if so, whether TFPI was locally elaborated. Pleural fluid TFPI activity approximated that of plasma by 24 h and doubled by 3 days after intrapleural TCN. By contrast, pleural fluid coagulation factors VII and V remained below plasma concentrations at these intervals. Immunohistochemical studies demonstrated TF, TFPI and fibrin localized in pleural and subpleural tissues and within intrapleural adhesions. TFPI activity and mRNA were also elaborated by rabbit pleural mesothelial cells and lung fibroblasts. TFPI is locally expressed and pleural fluid TFPI exceeds plasma levels during TCN-induced pleural injury. Resident cells as well as extravasation likely contribute to intrapleural TFPI. TFPI expression temporally and anatomically approximates that of TF and may limit TF-induced fibrin deposition in evolving TCN-induced pleuritis.

Topics: Animals; Epithelium; Fibroblasts; Immunohistochemistry; Lipoproteins; Pleural Diseases; Rabbits; RNA, Messenger; Tetracycline

Topics: Bleomycin; Drainage; Fibrosis; Humans; Pleural Diseases; Pleural Effusion, Malignant; Sclerosing Solutions; Tetracycline; Tissue Adhesions

The results of treatment of 226 patients with unspecific spontaneous pneumothorax in 1980-1990 are discussed. Poor efficacy of punctures of the pleural cavity (32.4%) is noted. Pleural cavity drainage proved to be effective in 79.7% of cases, both in primary and in recurrent pneumothorax. Chemical pleurodesis with tetracycline and 4% sodium bicarbonate solution was conducted in patients with complicated forms of pneumothorax (bronchopleural fistulas, hydropneumothorax). The advantage of 4% sodium bicarbonate solution over the tetracycline solution was obvious. To prevent the development of encapsulated hydrothorax the authors improved the method of pleural cavity drainage. The described method of instrumental treatment of spontaneous pneumothorax allowed injurious surgical intervention and recurrent pneumothorax to be avoided in 100% of cases.

Topics: Adult; Animals; Bronchial Fistula; Combined Modality Therapy; Drainage; Female; Fistula; Humans; Hydropneumothorax; Male; Middle Aged; Pleural Diseases; Pneumothorax; Punctures; Rats; Recurrence; Sodium Bicarbonate; Tetracycline

Intrathoracic extramedullary hematopoiesis rarely involves the pleura and is usually asymptomatic. We report a 73-year-old woman with myelofibrosis who had pleural involvement with extramedullary hematopoietic tissue that produced a massive hemothorax. Before the diagnosis of extramedullary hematopoietic tissue was established, sclerosis with tetracycline was attempted, which accelerated pleural bleeding and required surgical evacuation. The bleeding was ultimately controlled by low-dose radiation therapy.

Topics: Aged; Combined Modality Therapy; Female; Hematopoiesis, Extramedullary; Hemothorax; Humans; Pleural Diseases; Pleural Effusion; Primary Myelofibrosis; Sclerotherapy; Tetracycline

Topics: AIDS-Related Opportunistic Infections; Bronchial Fistula; Chest Tubes; Doxycycline; Humans; Male; Pleura; Pleural Diseases; Pneumonia, Pneumocystis; Tetracycline

The epidemiology and etiology of spontaneous pneumothorax (SP) are shifting away from the predominance of subpleural bleb disease as emphasized by most reports since that of Kjaergaard (Sweden, 1932). We conducted a retrospective review of all patients admitted to a large urban hospital with the diagnosis of SP over the past 8 years. Of 120 patients, 32 had the acquired immunodeficiency syndrome (AIDS) (group 1, 26.6%), 43 patients had classic subpleural bleb disease or chronic obstructive pulmonary disease with blebs (group 2, 35.8%), and 45 patients had nonbleb disease exclusive of AIDS (group 3, 37.5%). These three groups were studied with respect to primary success rates with differing modalities of therapy. Bilateral SP occurred in 34% of group 1 patients, 2% of group 2 patients, and 11% of group 3 patients. The in-hospital mortality was 34% in group 1 compared with 2% in group 2 and 4% in group 3. Thirty-four percent of group 1 patients had recurrent SP compared with 16% of group 2 patients and 8% of group 3 patients. This report describes the changing etiology and epidemiology of SP in a large urban hospital from 1983 to 1991 and represents the largest single-institution report of AIDS-related pneumothorax. Standardized therapy was shown to have predictably favorable results in patients with bleb disease and nonbleb disease exclusive of AIDS. SP in patients with AIDS was associated with a high mortality rate and primary treatment failure; small-bore catheters and nondrainage therapies have a very limited role in these patients.

Topics: Acquired Immunodeficiency Syndrome; Catheterization; Chest Tubes; Humans; Lung Diseases; Lung Diseases, Obstructive; Oxygen Inhalation Therapy; Pleural Diseases; Pneumothorax; Punctures; Retrospective Studies; Suction; Tetracycline; Texas; Time Factors; Tissue Adhesions

Topics: Adult; Female; Hodgkin Disease; Humans; Insufflation; Pleural Diseases; Pleural Effusion, Malignant; Talc; Tetracycline; Thoracoscopy; Tissue Adhesions

Topics: Bronchial Fistula; Doxycycline; Embolization, Therapeutic; Fistula; Humans; Pleural Diseases; Tetracycline

Persistent bronchopleural fistulas (BPF) due to infection, trauma, or thoracic surgical procedures are often difficult to manage. We report a patient with fulminant Staphylococcus aureus pneumonia complicated by chronic BPF formation which prevented weaning from mechanical ventilation due to severe air leak. Fistula closure was obtained by instillation of tetracycline into the fistula via a fiberoptic bronchoscope using a balloon catheter and blood clot occlusion technique. This closed the BPF and allowed successful weaning from mechanical ventilation.

Topics: Adolescent; Bronchial Fistula; Bronchoscopy; Fistula; Humans; Instillation, Drug; Male; Pleural Diseases; Pneumonia, Staphylococcal; Sclerotherapy; Tetracycline

The aim of this study was to assess the value of peridural thoracic analgesia (ATP) to prevent pain observed during pleural symphysis with tetracycline (STP) for pneumothorax (PNO). 12 patients (age 27 +/- 6 years) having a spontaneous PNO benefited from 13 SPT (1 gm, tetracycline diluted in 60 cc of normal saline) under cover of an APT (at the D5-D6 level) with Fentanyl (0.1 mg) and Bupivacaine 0.5% adrenalin (1 mg/kg). The protocol was used on three successive days. Repeated determinations of blood bupivacaine levels were performed in 9 patients on the first day. No patient had an intolerable pain which required injection of parenteral morphine and/or an interruption of the protocol. For two patients (one of them having a right symphysis and then a left symphysis one month later) the treatment sessions to achieve a symphysis were totally painless. 10 patients experienced moderate pain, mainly on the first day, which was relieved by reinjection of peridural bupivacaine (25 mg) (n = 9) or by the parenteral injection of non morphine analgesia (n = 1). No patient had a respiratory depression, collapse or bradycardia. The blood bupivacaine levels were always significantly less than the toxic levels (1.6 mg). The results observed suggest that APT, (Fentanyl and Bupivacaine) is an effective method, non toxic and well tolerated for the prevention of intolerable pain which is seen in SPT for PNO.

Topics: Adult; Analgesia, Epidural; Blood Pressure; Bupivacaine; Female; Fentanyl; Humans; Injections; Male; Pleura; Pleural Diseases; Pneumothorax; Recurrence; Respiration; Tetracycline; Tissue Adhesions

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Pleural Diseases; Pneumothorax; Tetracycline; Tissue Adhesions

Topics: Adult; Female; Humans; Menstruation; Pleural Diseases; Pneumothorax; Recurrence; Tetracycline; Tissue Adhesions

Topics: Adult; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pleura; Pleural Diseases; Tetracycline; Tissue Adhesions

Topics: Ampicillin; Child, Preschool; Chloramphenicol; Colistin; Diagnosis, Differential; Drug Eruptions; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Electroencephalography; Erythromycin; Female; Fever; Humans; Hydrocortisone; Infections; Kanamycin; Kidney Diseases; Male; Middle Aged; Penicillins; Pericarditis; Pertussis Vaccine; Pleural Diseases; Recurrence; Salicylates; Tetracycline; Tonsillectomy

Topics: Actinomyces; Actinomycosis; Humans; Lung Diseases; Male; Middle Aged; Penicillins; Pleural Diseases; Tetracycline; Thoracic Diseases

Topics: Adult; Aged; Bronchial Diseases; Humans; Lung Diseases; Male; Middle Aged; Pleural Diseases; Respiratory Tract Diseases; Salts; Tetracycline

Topics: Adult; Ascorbic Acid; Chronic Disease; Escherichia coli Infections; Female; Humans; Infections; Lung Diseases; Male; Middle Aged; Osteomyelitis; Peritonitis; Pleural Diseases; Pneumonia; Staphylococcal Infections; Streptococcal Infections; Suppuration; Surgical Wound Infection; Tetracycline; Thiamine

Topics: Adolescent; Adult; Aged; Cardiac Surgical Procedures; Child; Empyema; Esophageal Diseases; Extracorporeal Circulation; Female; Humans; Hypothermia, Induced; Inflammation; Infusions, Parenteral; Injections, Intravenous; Injections, Spinal; Lung Diseases; Male; Middle Aged; Pleura; Pleural Diseases; Postoperative Care; Suppuration; Tetracycline; Troleandomycin

Topics: Adult; Anti-Bacterial Agents; Bacteroides; Bronchography; Empyema; Humans; Male; Middle Aged; Pleural Diseases; Tetracycline