tetracycline and Pleural-Effusion--Malignant

Topics: Humans; Mitoxantrone; Pleural Effusion, Malignant; Pleurodesis; Propionibacterium acnes; Quinacrine; Randomized Controlled Trials as Topic; Sclerosing Solutions; Talc; Tetracycline

Approximately half of all patients with metastatic cancer develop a malignant pleural effusion which is likely to lead to a significant reduction in quality of life secondary to symptoms such as dyspnoea and cough. The aim of pleurodesis in these patients is to prevent re-accumulation of the effusion and thereby of symptoms, and avoid the need for repeated hospitalization for thoracocentesis. Numerous clinical studies have been performed to try to determine the optimal pleurodesis strategy, and synthesis of the available evidence should facilitate this.. The aims of this review were to ascertain the optimal technique of pleurodesis in cases of malignant pleural effusion; to confirm the need for a sclerosant; and to clarify which, if any, of the sclerosants is the most effective.. The Cochrane Central Register of Controlled Trials was searched for studies on 'pleurodesis'. Studies for inclusion were also identified from MEDLINE (1980 to June 2002) and EMBASE (1980 to May 2002). No language restriction was applied.. RCTs of adults subjects undergoing pleurodesis for pleural effusion in the context of metastatic malignancy (or a malignant process leading to pleural effusion) were included.. Two reviewers independently selected studies for inclusion in the review, and extracted data using a standard data collection form. Primary outcome measures sought were effectiveness of pleurodesis as defined by freedom from recurrence of effusions, and mortality after pleurodesis. Secondary outcomes were adverse events due to pleurodesis. Dichotomous data were meta-analysed using a fixed effect model and expressed as relative risk. The number-needed-to-treat (NNT) was calculated for pleurodesis efficacy. In addition, for adverse events, the overall percentage of patients across studies exhibiting a particular adverse effect such as fever, pain, or gastrointestinal symptoms was calculated.. A total of 36 RCTs with 1499 subjects were eligible for meta-analysis. The use of sclerosants (mitozantrone, talc and tetracycline combined)compared with control (instillation of isotonic saline or equivalent pH isotonic saline or tube drainage alone) was associated with an increased efficacy of pleurodesis. The relative risk (RR) of non-recurrence of an effusion is 1.20 (95% CI 1.04 to 1.38) in favour of the use of sclerosants based on five studies with a total 228 subjects. Comparing different sclerosants, talc was found to be the most efficacious. The RR of effusion non-recurrence was 1.34 (95% CI 1.16 to 1.55) in favour of talc compared with bleomycin, tetracycline, mustine or tube drainage alone based on 10 studies comprising 308 subjects. This was not associated with increased mortality post pleurodesis. The RR of death was 1.19 (95% CI 0.08 to 1.77) for talc compared to bleomycin, tetracycline, mustine and tube drainage alone based on six studies of 186 subjects. Death was not reported in all studies and, when reported, was attributed to underlying disease, only one death being reported as procedure-related. In the comparison of thoracoscopic versus medical pleurodesis, thoracoscopic pleurodesis was found to be more effective. The RR of non-recurrence of effusion is 1.19 (95% CI 1.04 to 1.36) in favour of thoracoscopic pleurodesis compared with tube thoracostamy pleurodesis utilizing talc as sclerosant based on two studies with 112 subjects. Comparing thoracoscopic versus bedside instillation (with different sized chest tubes) of various sclerosants (tetracycline, bleomycin, talc or mustine) the RR of non-recurrence of effusion is 1.68 (95% CI 1.35 to 2.10) based on five studies with a total of 145 participants.Adverse events were not reported adequately to enable meta-analysis.. The available evidence supports the need for chemical sclerosants for successful pleurodesis, the use of talc as the sclerosant of choice, and thoracoscopic pleurodesis as the preferred technique for pleurodesis based on efficacy. There was no evidence for an increase in mortality following talc pleurodesis.

Topics: Humans; Mitoxantrone; Pleural Effusion, Malignant; Pleurodesis; Propionibacterium acnes; Quinacrine; Randomized Controlled Trials as Topic; Sclerosing Solutions; Talc; Tetracycline

Malignant pleural effusion (MPE) causes significant morbidity in cancer patients. Management is often challenging because of the recurrent nature of MPE and the inconsistent response rates of various treatments. In patients whose underlying malignancy is unresponsive to systemic chemotherapy or radiation, MPE is usually managed by tube thoracostomy with subsequent sclerotherapy. Selection of a sclerosing agent should be based on several factors, including efficacy, toxicity, cost, and convenience. Of the numerous agents available for managing MPE, doxycycline, bleomycin, and talc have emerged as the most promising. Even these agents have disadvantages, such as the high cost of bleomycin and the possible need for multiple dosing of doxycycline. Talc is clearly the most controversial of the three. Although its efficacy is well documented, its role remains unclear because of its unattractive side effect profile and inconvenient preparation and administration. Results of controlled comparative trials are needed to identify the optimal sclerosing agent.

Topics: Bleomycin; Clinical Trials, Phase I as Topic; Costs and Cost Analysis; Doxycycline; Humans; Intubation; Pleural Effusion, Malignant; Sclerotherapy; Talc; Tetracycline; Thoracostomy

Malignant pleural effusions (MPEs) are a common complication of advanced malignancies, particularly lung and breast cancer. They are caused by a variety of mechanisms including tumor obstruction of lymphatic flow, spread of malignant cells via the systemic circulation, and tumor invasion of the pulmonary arterioles. Therapy is determined by tumor histology, stage of malignancy, and a careful assessment of a patient's performance status and comorbid diseases. A number of approaches have been used to treat patients with MPE ranging from thoracentesis to pleurectomy. Tube thoracostomy drainage followed by application of a sclerosing agent is the most common strategy. Effective sclerosing agents include quinacrine, talc, bleomycin, tetracycline and Corynebacterium parvum. Results from a recent multicenter randomized trial suggest that bleomycin may be superior in terms of control of effusion at 30 days. Further randomized studies are ongoing to determine the optimal method of draining the pleural space and the most effective sclerosing agent. Thoracoscopy using video-assisted techniques is a promising new approach to MPEs both for diagnosis and treatment. The application of biological agents such as interleukin-2, the interferons, and novel chemotherapeutic agents are experimental approaches that are under investigation.

Topics: Bleomycin; Humans; Pleural Effusion, Malignant; Talc; Tetracycline; Thoracostomy

Pleural effusions remain a distressing and symptomatic problem in cancer patients. Once a malignant pleural effusion is diagnosed, appropriate therapy may provide symptomatic relief and improved quality of life. In this paper, we review previous data on chest tube drainage and pleurodesis in patients with malignant pleural effusions. A comparison is made of the various sclerosing agents. Specifically, recent data from a study comparing bleomycin and tetracycline as sclerosing agents are discussed. These data show a clear advantage with bleomycin at both 30-day and 90-day end points--30-day recurrence, 36% versus 67%; 90-day recurrence, 30% versus 53%.

Topics: Bleomycin; Humans; Pleural Effusion, Malignant; Sclerosing Solutions; Tetracycline

Malignancy is the leading cause of exudative pleural effusion in patients over 60. Several techniques for palliative treatment of malignant pleural effusions (MPE) are recommended; in particular, sclerosing agents have been instilled into the pleural cavity. In up to 30%, recurrence of MPE cannot be prevented. In recent years excellent results (recurrence rate less than 10%) have been reported using the technique of thoracoscopic talkage. After a review of the most frequent techniques of pleurodesis, a treatment strategy, mentioning the indications for the thoracoscopic procedure, is presented stressing the following guidelines: after complete thoracocentesis the patient's respiratory symptoms should decrease significantly and the compressed lung must be expanded clinically and radiologically after drainage. For patients fulfilling these conditions thoracoscopic pleurodesis is an effective initial treatment. It seems to be a safe procedure with minor side effects even for patients in a reduced general condition.

Topics: Antineoplastic Agents; Drainage; Fibrin Tissue Adhesive; Humans; Pleural Effusion, Malignant; Sclerotherapy; Talc; Tetracycline

Malignant pleural effusions are a common and significant problem in patients with advanced malignancies. Effective control of recurrent malignant effusion can greatly improve the quality of life. On the basis of comparison involving, efficacy, toxicity, and costs we recommend intrapleurally tetracycline with chest tube drainage as the technique of choice inducing a response rate of 70%. Instillation of fibrin glue into the thoracic cavity through a tube is also a safe and effective technique and should be employed when tetracycline fails. Mediastinal radiation constitutes the best local therapy secondary to lymphoma. Pleurectomy would be appropriate in a very small subset of patients whose performance status is exceptionally good and whose malignancy ist otherwise under good control.

Topics: Antineoplastic Agents; Blood Coagulation Factors; Combined Modality Therapy; Drainage; Humans; Pleural Effusion, Malignant; Tetracycline

malignant pleural effusion occurs as a consequence of a primary or metastatic malignant process involving the pleura. The aim of pleurodesis is to prevent re-accumulation of the effusion and avoid the need for repeated hospitalization. Povidone iodine has been used in other climes for pleurodesis with good results. The aim of this study is to assess the efficacy and safety of povidone iodine in producing pleurodesis as compared to tetracycline.. the study is a prospective experimental study. The patients are randomized into two groups A (tetracycline-control) and B (povidone iodine). All patients are assessed with chest X-ray after 1 week and 1 month. The responses were ascribed as complete, partial or failure.. thirty patients were recruited into this study, 15 patients in each group A (tetracycline) and B (povidone iodine). The mean age was 45.7±14.24 years. The commonest primary malignancy was Breast cancer (70%) followed by bronchogenic cancer (10%). Seventy three (73%) of the patients in this study had complete response and in 7% pleurodesis failed whilst 20% has partial response. In the povidone group the success rate was 93.4% and in the tetracycline group was 93.3% with a p-value of 0.716. There was no statistical difference in the responses based on the agents used.. malignant pleural effusion is a devastating condition as it heralds the end-of-life processes of a primary malignancy. Povidone iodine is a safe, cheap, effective, widely available and effective pleurodesing agent for use in patients with malignant pleural effusion.

Topics: Adult; Female; Humans; Male; Middle Aged; Nigeria; Pleural Effusion, Malignant; Pleurodesis; Povidone-Iodine; Prospective Studies; Tertiary Care Centers; Tetracycline; Treatment Outcome

Autologous blood pleurodesis (ABP) is used for the treatment of pneumothorax with a good efficacy. The aim of this study is to determine the efficacy and safety of ABP in the treatment of malignant pleural effusion (MPE).. A prospective study was conducted at Songklanagarind Hospital, Thailand. Symptomatic MPE patients were randomized to receive pleurodesis with either autologous blood or tetracycline. In the ABP group, 100 ml of autologous venous blood was instilled via chest tube followed by 50 ml of sterile normal saline (NSS). In the tetracycline group, 20 ml of 1% lidocaine diluted in 30 ml NSS was instilled followed by 1 g of tetracycline diluted in 100 ml of NSS. The chest tube was clamped for 2 hours, then reconnected to suction and removed. Pleurodesis effectiveness was evaluated according to Paladine's criteria and adverse events were recorded.. A total of 48 symptomatic MPE patients were recruited. Of these, 24 cases were randomized to receive ABP and 24 cases received tetracycline. There was no difference between the two groups in baseline characteristics. The overall success rate of pleurodesis was the same in both the autologous blood group and the tetracycline group (83.4% versus 87.5%, p = 0.36). In the ABP group, the pain score and fever were significantly lower (8.3% versus 29.1%, p = 0.003) and there was a small percentage of cases that needed analgesia (4.2% versus 75%, p < 0.001); no serious events occurred.. ABP was as effective as tetracycline in the treatment of MPE. ABP produced less pain and fever, and could shorten the hospital stay.

Topics: Aged; Autografts; Blood; Female; Fever; Humans; Length of Stay; Male; Middle Aged; Pain; Pleural Effusion, Malignant; Pleurodesis; Prospective Studies; Sclerosing Solutions; Tetracycline; Thailand; Time Factors; Treatment Outcome

The aim of this prospective, randomized study was to investigate the possibility of performing pleurodesis using a small percutaneous catheter (Cystofix catheter, CH10, 65 cm) inserted at bedside in patients with recurrent malignant pleural effusion and to compare this catheter with a conventional large bore chest tube (CH24) placed in connection with diagnostic thoracoscopy. After drainage pleurodesis was performed with tetracycline as sclerosing agent. Of 18 evaluable consecutive patients (mean age 67.8 years) nine were randomized for pleurodesis with the small and nine for the large catheter. In the former group, the majority (seven of nine) did not find insertion of the catheter more unpleasant than thoracentesis. In the latter group only a few (two of nine) found insertion comparable with thoracentesis (P < 0.05). All patients found the presence of the large catheter very or somewhat unpleasant (two and seven patients), whereas this was only the case for a few (no and two patients) treated with the small catheter (P < 0.05). In the former group three patients required new thoracentesis, whereas this was only the case for two patients in the latter group (P > 0.05). No complications were seen. We conclude that pleurodesis in patients with recurrent malignant pleural effusion can be performed with a small percutaneous catheter (Cystofix) with an effect similar to that obtained with a large-bore chest tube and with less discomfort for the patient.

Topics: Aged; Anti-Bacterial Agents; Catheterization; Female; Humans; Male; Patient Satisfaction; Pleural Effusion, Malignant; Pleurodesis; Prospective Studies; Recurrence; Sclerosing Solutions; Tetracycline

Malignant pleural effusions are commonly managed with tube thoracostomy drainage followed by chemical pleurodesis. Both tetracycline and bleomycin have been shown to be effective for intrapleural instillation, although neither agent has definitively proved advantages over the other. The aim of the present study was to compare these two agents in terms of response rate and toxicity profile. A prospective, randomized trial was carried out in a single centre. Between May 1993 and January 1996, 62 evaluable patients with proved malignant pleural effusion were allocated to receive either intrapleural tetracycline (1.5 g) or bleomycin (60 mg) after the same drainage procedure. Demographic, clinical and fluid parameter data were comparable in both groups. Response was evaluated at 1, 3 and 6 months after pleurodesis. Mean survival and time to relapse did not differ between the two groups. No statistically significant differences were found in terms of efficacy at each evaluation time. Overall, 16 (52%) and 20 (64%) patients had a recurrence of pleural effusion during follow-up in the tetracycline and bleomycin arms, respectively. Fever was most common in bleomycin-treated patients (p=0.024) while pain was most frequent in the tetracycline arm (nonsignificant). Since no study agent was superior to the other in this trial, we suggest that economic costs, drug availability and medical skill should be considered in the choice of a sclerosing agent.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotics, Antineoplastic; Bleomycin; Chi-Square Distribution; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pleural Effusion, Malignant; Pleurodesis; Prognosis; Prospective Studies; Tetracycline; Treatment Outcome

Treatment of patients with malignant pleural effusions is mostly palliative. Tetracycline and bleomycin are the two most commonly used agents for the treatment of pleurodesis. In this study, the authors used a combination of the two drugs for this particular purpose.. Sixty patients with massive malignant pleural effusions were divided in 3 equal groups in a simple randomized manner. Tetracycline (20 mg/kg [maximum of 2 g] in 50 mL of normal saline) was administered through a chest tube in Group 1. Group 2 received bleomycin (1 U/kg [maximum of 60 U] in 50 mL of normal saline). Group 3 received the above 2 preparations (tetracycline, 20 mg/kg [maximum of 2 g] in 40 mL of normal saline and bleomycin, 1 U/kg [maximum of 60 U] in 30 mL of normal saline) instilled one after the other, while the chest tube was clamped for 5 minutes in the interim. Follow-up examinations were performed at 7 days, 30 days, 60 days, 90 days, and 6 months.. There was no significant difference in the complete response rate of the 3 groups during the first 4 months. At the end of the study, Group 3 had a significantly higher complete response rate (70%) compared with Groups 1 and 2 (35% and 25%, respectively) (P = 0.02).. The response to use of a combination of bleomycin and tetracycline for the treatment of patients with pleurodesis is superior to that achieved by either of these agents used alone.

Topics: Adult; Aged; Antibiotics, Antineoplastic; Bleomycin; Female; Humans; Male; Middle Aged; Pleural Effusion, Malignant; Recurrence; Tetracycline

Pleural sclerosis after tube thoracostomy was performed in 40 patients with malignant pleural effusions. The patients were randomly allocated to intrapleural therapy with tetracycline or mechlorethamine. Follow up was obtained on each patient to determine if a symptomatic effusion recurred. The response was classified as a complete or partial response and failure. (Complete response: complete lack of reaccumulation of pleural fluid for at least 60 days. Partial response: small pleural effusion asymptomatic not requiring further treatment for at least 60 days. Failure: all other cases). Tetracycline produced complete or partial control of the effusion in 16 of 20 trials for a duration of 6.1 +/- 4.1 months (range 2-14 months). Mechlorethamine produced control of the effusion in 12 of 20 trials for a duration of 4.4 +/- 1 months (range 2-8 months). These findings indicate that intracavitary tetracycline is a more effective treatment than intracavitary mechlorethamine for the control of neoplastic pleural effusion.

Topics: Adult; Aged; Aged, 80 and over; Double-Blind Method; Female; Humans; Injections, Intralesional; Male; Mechlorethamine; Middle Aged; Pleural Effusion, Malignant; Prospective Studies; Sclerotherapy; Tetracycline

The standard palliation of malignant pleural effusions involves tube thoracostomy drainage with chemical pleurodesis. The insufflation of intrapleural talc under thoracoscopic guidance (n = 39) was evaluated against documented controls that consisted of patients (n = 85) who participated in a randomized study with tube thoracostomy drainage followed by either bleomycin or tetracycline sclerosis. Under local anesthesia, which was supplemented by intravenous sedation, patients in the talc group underwent complete pleural fluid evacuation. The talc was then insufflated evenly on the entire pleural surface under thoracoscopic guidance. Of the patients in the talc group who survived their disease process, 97% had a successful pleurodesis at 30 days and 95% at 90 days. In comparison, the bleomycin group demonstrated a success rate of 64% at 30 days and 70% at 90 days (p = 0.003 and p = 0.047 versus the talc group). The tetracycline group had successful pleurodesis in only 33% at 30 days and 47% at 90 days (p < 0.001 and p < 0.001 versus the talc group). There were only two patients in the talc group in whom pleurodesis was not successful, and both were subsequently found to have extraluminal compression of the right lower lobe bronchus, which prevented lung reexpansion. These data demonstrate that the insufflation of talc into the pleural cavity under thoracoscopic guidance is a safe and efficacious procedure in the control of malignant pleural effusions.

Topics: Adult; Aged; Aged, 80 and over; Bleomycin; Female; Follow-Up Studies; Humans; Insufflation; Male; Middle Aged; Pleural Effusion, Malignant; Prospective Studies; Talc; Tetracycline; Thoracoscopy; Thoracostomy; Time Factors

Malignant pleural effusion is a frequent complication of metastatic breast cancer leading to a significant degree of morbidity. Drainage of the effusion by thoracocentesis and pleurodesis with tetracycline as the sclerosing agent is an established means of symptomatic relief in these patients. To determine whether the efficacy of tetracycline pleurodesis is improved by surgical rather than medical drainage and instillation of sclerosant, 34 patients were prospectively randomised to a trial comparing the two treatment modalities, of whom 29 were evaluable for response. The total failure rate of primary pleurodesis was 13.4%, the rate of recurrence of effusion within the first month was 24%, and only 1 patient (3.4%) required repeat aspiration in that time period. There was no significant difference in the rate of recurrence or reaspiration of effusion between the two treatment groups. Although the overall survival time from treatment of effusion is significantly longer in the surgical treatment group than in the medical treatment group (P = 0.03), this is likely to be due to factors other than the method of treating the effusion. We conclude that surgical tetracycline pleurodesis has no advantage over medical tetracycline pleurodesis.

Topics: Adult; Aged; Breast Neoplasms; Drainage; Female; Humans; Middle Aged; Pleural Effusion, Malignant; Prognosis; Prospective Studies; Tetracycline; Time Factors

Pleural effusions remain a distressing and symptomatic problem in cancer patients. Once a malignant pleural effusion is diagnosed, appropriate therapy may provide symptomatic relief and improved quality of life. In this paper, we review previous data on chest tube drainage and pleurodesis in patients with malignant pleural effusions. A comparison is made of the various sclerosing agents. Specifically, recent data from a study comparing bleomycin and tetracycline as sclerosing agents are discussed. These data show a clear advantage with bleomycin at both 30-day and 90-day end points--30-day recurrence, 36% versus 67%; 90-day recurrence, 30% versus 53%.

Topics: Bleomycin; Humans; Pleural Effusion, Malignant; Sclerosing Solutions; Tetracycline

Malignancy is the most common cause of exudative pleural effusion in patients over the age of 60 years. Control of the effusion significantly reduces morbidity and improves quality of life. Tube thoracostomy with subsequent chemical pleurodesis is the treatment of choice for patients with tumors that are relatively insensitive to systemic chemotherapy. The agents most commonly used for chemical pleurodesis are tetracycline and bleomycin. A 13-center randomized trial compared tetracycline 1 g and bleomycin 60 U. Median time to recurrence or progression of the malignant effusion was 32 days for tetracycline and more than 46 days for bleomycin (P = .037). The recurrence rate within 30 days of instillation was 36% for bleomycin (10 of 28 patients) and 67% (18 of 27 patients) for tetracycline (P = .023). At 90 days, the recurrence rate was 30% (11 of 37) for bleomycin, and 53% (19 of 36) for tetracycline (P = .047). From this study, the authors concluded that intrapleural bleomycin appears superior to tetracycline for controlling malignant pleural effusions. Selected patients who fail tube thoracostomy and chemical pleurodesis should be considered for pleuroperitoneal shunting or pleurectomy.

Topics: Bleomycin; Humans; Pleural Effusion, Malignant; Tetracycline

Between December 1985 and August 1988, there were 115 patients at 13 centers who were entered on a randomized comparison of tetracycline and bleomycin for treatment of malignant pleural effusions. Fifteen patients were not treated, primarily due to rapid progression of systemic cancer. Fifteen patients entered on a high-dose regimen of bleomycin (120 units) were excluded from this analysis (following early closure of that arm), leaving 85 patients randomized to low-dose bleomycin (60 units; 44 patients) or tetracycline (1 g; 41 patients). Patients were required to have a cytologically positive pleural effusion, good performance status (0, 1, or 2), lung reexpansion following tube thoracostomy with drainage rates of 100 ml/24 or less, no prior intrapleural therapy, no prior systemic bleomycin therapy, no chest irradiation, and no recent (four weeks) change in systemic therapy. A total of 11 patients (five with bleomycin and six with tetracycline) were not evaluable due to technical problems with tube drainage (one), loss to follow-up (two), sudden death due to pulmonary embolus (one), and rapid progression of systemic disease (seven). There were no clinically significant differences in demographic factors, primary site, performance status, or presence of metastases other than pleural effusion. Overall survival did not differ between the two groups. Median time to recurrence or progression of the effusion was 32 days for tetracycline-treated patients and at least 46 days for bleomycin-treated patients (p = 0.037). The recurrence rate within 30 days of instillation was 36 percent (10/28) with bleomycin and 67 percent (18/27) with tetracycline (p = 0.023) (not all patients were restudied in the first 30 days). By 90 days the corresponding recurrence rates were 30 percent (11/37) for bleomycin and 53 percent (19/36) for tetracycline (p = 0.047). Toxicity was similar between groups.

Topics: Adult; Aged; Aged, 80 and over; Bleomycin; Chest Tubes; Combined Modality Therapy; Female; Humans; Instillation, Drug; Male; Middle Aged; Pleural Effusion, Malignant; Recurrence; Sclerotherapy; Tetracycline; Thoracostomy

A best evidence topic was written according to a structured protocol. The question addressed was whether silver nitrate (SN) is an effective means of pleurodesis. A total of 42 papers were identified using the reported search, of which 8 represented the best evidence to address the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Three studies assessed the efficacy of SN in inducing pleurodesis in patients with malignant pleural effusion (MPE). Using intrapleural injections of SN in concentrations of 0.5-1%, they reported success rates of 89-96% at 30 days. One of these studies compared SN with talc slurry and found equally effective pleurodesis at monthly intervals up to 4 months (P = 0.349-1). Another two studies retrospectively reviewed the efficacy of thoracosopic SN instillation (1 or 10%) in patients with primary spontaneous pneumothorax (PSP). Recurrence rates were 0-1.1% during long-term follow-up. One of these compared SN with simple drainage and reported a therapeutic gain of 45 ± 30% (95% CI) with SN, at the cost of increased analgesia consumption, chest drainage and hospital stay. Finally, three studies reported the results of the comparison of intrapleural injections of SN, talc or tetracycline in inducing pleurodesis in rabbits. SN was equally effective with tetracycline and superior to talc at producing pleurodesis, with lower concentrations of SN (0.1%) resulting in significantly attenuated systemic inflammatory response when compared with either higher SN concentrations (0.5%) or talc. Although not commonly used, available evidence suggests that SN is an effective agent in inducing pleurodesis in patients with either MPE or PSP. Compared with universally employed talc, it seems to result in at least similar short-term recurrence rates for MPE, with a demonstrably good side-effect profile; the longer-term efficacy is, as yet, undetermined. In cases of PSP, evidence suggests that thoracoscopic SN instillation is at least as effective as talc, with potentially fewer systemic side effects.

Topics: Animals; Humans; Pleural Effusion, Malignant; Pleurodesis; Rabbits; Sclerosing Solutions; Silver Nitrate; Talc; Tetracycline; Treatment Outcome

Topics: Animals; Biomedical Research; Bleomycin; Breast Neoplasms; Dose-Response Relationship, Drug; Female; Humans; Lung Neoplasms; Mesothelioma; Pleural Effusion, Malignant; Pleurodesis; Povidone-Iodine; Rabbits; Talc; Tetracycline

The excess production or depleted absorbtion of pleural fluid is the major mechanism of pleural effusion formation. Primary lung pathologies or pathologies that originated from the other organs can be cause of pleural effusion. The search for suitable, practical and ideal treatment is continued at the present day. We have reviewed 94 patients with pleural effusion that have been treated by 10F catheter with local anesthesia in 2007-2008. The patient with dispenea, massive effusion or reoccurrent pleural effusion have been administrated pleural catheter through 7th or 8th intercostal interspace with local anesthesia. The mean age of patients (58 male, 36 female) was 57.2 (26-94). The most common etiologic causes were primary broncho carcinoma (34 cases 36.1%), cardiac failure (11 cases 11.1%) and empyema (eight cases 9.5%). Fifty three (56.3%) have been administrated pleurodesis because of treatment failure or reoccurrence. In 19 of these cases (20.2%), pleurodesis was successful. Pleurodesis agent was talc or tetracycline according to patients pain threshold. The treatment methods of pleural effusion include thoracentesis, thoracoscopy, tube thoracostomy and catheters with permanent tunnel. The simple and small-diameter catheters are administrated easily with minimal morbidity and no mortality. It's not only used in malign effusion but also used in benign effusion. Finally, simple catheter can be first treatment choice in short-term therapy and alternative choice in long-term therapy because of it's administrating facility, effectiveness in pleurodesis and cost-effectiveness.

Topics: Adult; Aged; Aged, 80 and over; Catheters, Indwelling; Drainage; Female; Humans; Male; Middle Aged; Pleural Effusion; Pleural Effusion, Malignant; Pleurodesis; Talc; Tetracycline; Treatment Outcome

Malignant pleural effusion is a common complication of primary and metastatic pleural malignancies. It is usually managed by drainage and pleurodesis, but there is no consensus as to the best method of pleurodesis. We compared the effectiveness, side effects, and cost of different chemical pleurodesis agents used in patients with malignant pleural effusion.. Between January 1990 and December 2001, 108 patients with malignant pleural effusion underwent chemical pleurodesis in our department. Thoracoscopy was performed in 64 patients (59%), a minithoracotomy in 18 (17%), tube thoracostomy in 11 (10%), and a small-bore catheter was inserted in 15 (14%). Talc was used in 68 (63%) patients, tetracycline in 26 (24%), and bleomycin in 14 (13%). Talc was instilled by insufflation during surgery after drainage, whereas tetracycline and bleomycin were instilled via tube or catheter for pleural analgesia.. Talc resulted in significantly earlier tube and catheter removal, after an average 4.1 days versus 5.1 days after tetracyline, and 6.3 days after bleomycin (P = 0.026, P = 0.001, respectively). A significantly lower reaccumulation ratio in 90 days was achieved by the talc group, with nine (13.2%) patients, representing an 86.8% success rate, than in the tetracyline and bleomycin groups, with seven (26.7%) and five (35.7%) patients, respectively, representing 73.8% and 64.3% success rates (P = 0.04).. Talc resulted in the earliest expansion, minimal drainage, and the earliest tube and catheter removal.

Topics: Adult; Aged; Aged, 80 and over; Bleomycin; Female; Humans; Male; Middle Aged; Pleural Effusion, Malignant; Pleurodesis; Recurrence; Retrospective Studies; Sclerosing Solutions; Talc; Tetracycline; Thoracic Surgical Procedures; Treatment Outcome

Pleurodesis is important in the management of malignant pleural effusions, but no consensus exists on the optimal agent or methods of pleurodesis. How pleurodesis is practiced worldwide has not been studied.. To identify variations in the clinical practice of pleurodesis in major English-speaking countries, and to quantify the experience of pulmonologists on the effectiveness and adverse effects of different pleurodesis agents worldwide.. Eight hundred fifty-nine pulmonologists practicing in the United States, United Kingdom, Canada, Australia, and New Zealand participated in a Web-based survey.. The respondents collectively perform > 8,300 pleurodesis annually. Talc was the preferred agent by most respondents (slurry, 56%; poudrage, 12%), followed by tetracycline derivatives (26%), and bleomycin (7%). Differences were seen in pleurodesis practice patterns among practitioners among and within the surveyed countries. Physicians' overall satisfaction with the available pleurodesis agents was modest (5.0 out of 8), and the reported success rate averaged only 66%. Talc (both poudrage and slurry) was perceived as significantly more effective, but was associated with significantly more pain, nausea, and fever (p < 0.05). Respiratory failure occurred more commonly with talc poudrage than with other agents (p < 0.05), and had been observed by 70% and 54% of physicians who used talc poudrage and slurry, respectively.. Significant variations exist in how pleurodesis is performed worldwide. Pleurodesis agents currently available are perceived as suboptimal. Talc poudrage and slurry were perceived to be more effective, but were associated with more complications, including respiratory failure.

Topics: Adult; Anti-Bacterial Agents; Australia; Doxycycline; Female; Humans; Male; Middle Aged; New Zealand; Pleural Effusion, Malignant; Pleurodesis; Practice Patterns, Physicians'; Pulmonary Medicine; Talc; Tetracycline; United Kingdom; United States

To evaluate the efficacy of small-bore (12 French vanSonnenberg) catheters compared with standard large-bore chest tubes in the drainage and sclerotherapy of malignant pleural effusions.. Retrospective review.. An academic tertiary care hospital.. Adult patients with documented neoplasms and malignant pleural effusions, treated between 1986 and 1995.. All patients included in the study underwent drainage of malignant pleural effusions either by large-bore chest tube or by ultrasound-guided small-bore catheter. After drainage, pleurodesis was performed.. Outcome as defined by recurrence of effusion was determined by blinded examination of all postpleurodesis chest radiographs. We identified 58 cases of malignant pleural effusion in which small-bore catheters were used and 44 in which large-bore chest tubes were used. The majority of patients had breast (n = 56, 55%) or lung cancer (n = 29, 28%). The median age was 65 years. Fifty-nine patients were actively being treated with chemotherapy at the time of pleurodesis. The following sclerosing agents were used: talc, 27 (26%); tetracycline, 72 (70%); bleomycin, 2 (2%); and interferon, 1 (1%). Actuarial probabilities of recurrence at 6 weeks and 4 months were 45% and 53% for the small tubes vs 45% and 51% for the large tubes. Univariate and multivariate analyses failed to demonstrate that tube size had any influence on the rate of recurrence.. We were unable to detect any major differences in outcomes with the use of either size of chest tube. Our study suggests that small-bore catheters may be effective in the treatment of malignant pleural effusions and deserve further evaluation in prospectively designed trials.

Topics: Adult; Aged; Aged, 80 and over; Bleomycin; Breast Neoplasms; Chest Tubes; Drainage; Female; Humans; Interferon Type I; Lung Neoplasms; Male; Middle Aged; Pleural Effusion, Malignant; Pleurodesis; Probability; Recurrence; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Survival Rate; Talc; Tetracycline

Because of the rising importance of talcum pleurodesis in the therapeutic management of malignant and benign pleural effusions in Germany, pleural samples after talcum pleurodesis were compared to microscopic, immunohistochemical, and scanning electron microscopy findings after Tetracyclin and Novantron pleurodesis in 24 patients up to 18 months after intrapleural therapy. The histomorphological findings after talcum pleurodesis show an early phase of up to 4 weeks, characterized by the presence of talcum-containing granulation tissue with giant-cell foreign-body reaction, and a subsequent late phase with organization of the granulation tissue and connective tissue formation and obliteration of the pleura sheets. The resulting characteristic linear talcum zone in the pleural connective tissue is missing in cases with tumorous infiltration of the pleura. Continuous fibroblast activation, e.g., by macrophage or foreign-body giant-cell-released mediators, seems to be the decisive factor in the fibrosing process. No therapy-related tumor growth alterations could be demonstrated.

Topics: Follow-Up Studies; Foreign-Body Reaction; Humans; Microscopy, Electron, Scanning; Mitoxantrone; Pleura; Pleural Effusion, Malignant; Pleural Neoplasms; Pleurodesis; Talc; Tetracycline

The distribution of labelled tetracycline in the pleural space of patients with malignant effusions has been shown not to improve significantly after rotating the patient. As the number of patients was small, we investigated the distribution of an inert radio labelled colloid (99mTc) in the pleural space directly after administration and after 1 h of rotation. Nineteen examinations were performed in 18 patients with malignant pleural effusions. In two out of 19 examinations (11%) a considerable improvement in distribution was observed and some improvement was found in five out of 19 examinations (26%). The relation between distribution and the effect of tetracycline pleurodesis at 12 weeks and the identification of patients for whom pleurodesis would not be successful were also studied. The analysis of the distribution and outcome of pleurodesis was hampered by the fact that additional anti tumour treatments were given after pleurodesis.. The influence of rotation on the distribution of 99mTc-colloid in the pleural space is minimal and indicates that this could be omitted. A distribution pattern predictive of failure of pleurodesis could not be identified in this study.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Pleural Effusion, Malignant; Pleurodesis; Technetium; Tetracycline; Thorax; Time Factors; Tissue Distribution

Topics: Blood Transfusion, Autologous; Humans; Pleural Effusion, Malignant; Sclerotherapy; Tetracycline

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

Topics: Bleomycin; Drainage; Humans; Pleural Effusion, Malignant; Sclerotherapy; Talc; Tetracycline

Malignant pleural effusions (MPE) are a common complication in patients with advanced neoplasms. Even though no large series confirming this exist, tetracycline pleurodesis has become the therapy of choice. The aim of this retrospective study was to evaluate its efficacy, adverse effects and possible factors predicting the success of the method.. Between 1985 through 1991, 91 patients with cytologically or histologically confirmed MPE were treated with 1,000-1,500 mg tetracycline pleurodesis. There were 49 females and 42 males, with a mean age of 59 years. The most common malignancies were lung, breast and unknown primary carcinomas. 85% patients complained of dyspnea and the volume of the effusion was moderate in half the cases. 12 variables were analyzed in relation with the probability of response through chi 2 test; survival and recurrence times were calculated with Kaplan and Meier's method.. 73 patients were evaluable, with a 67% response rate (22 complete, 27 partial). Time to relapse was significantly higher for partial responses (mean 112 days) than for failures (mean 33 days). 37 patients presented mild complications (pain and fever). Karnofsky performance status (70% or greater), size of the effusion (small or moderate), chest radiograph (only effusion) and pleural LDH (600 U/l or less) attained favourable prognostic significance. Median survival was reached at 6 months.. Tetracycline pleurodesis is an effective and well-tolerated paliative treatment for MPE. Along with other known parameters (pleural pH and glucose levels), Karnofsky performance status, size of the effusion, chest radiograph and pleural LDH allow to predict its results and optimize its indications.

Topics: Adult; Aged; Aged, 80 and over; Drainage; Female; Humans; Instillation, Drug; Male; Middle Aged; Pleural Effusion, Malignant; Remission Induction; Retrospective Studies; Survival Analysis; Tetracycline

Twenty-eight patients with malignant pleural effusion observed in a two year period were treated with intrapleural instillation of different substances: Tetracycline, Corynebacterium parvum and Beta-Interferon. Different results were observed: complete responsiveness (no recurrence of pleural effusion within three months); partial responsiveness (recurrence of moderate pleural effusion within one month after drainage removal); insufficient responsiveness (recurrence of massive effusion within one month). Among patients treated with Tetracycline seven complete, five partial and one insufficient responses were observed. Instillation of Corynebacterium parvum allowed two complete, two partial and three insufficient responses. Finally, in the group treated with Beta-Interferon complete responsiveness was obtained in just one patient, partial responsiveness in three, while the treatment was insufficient in the last two. These results suggest pleural drainage is the best treatment in patients with malignant pleural effusion, however, the association of Tetracycline instillation allows better results.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Drainage; Female; Humans; Interferon-beta; Male; Middle Aged; Pleural Effusion, Malignant; Propionibacterium acnes; Tetracycline; Treatment Outcome

Topics: Chest Tubes; Humans; Pleura; Pleural Effusion, Malignant; Powders; Tetracycline

To evaluate the changes in cellular components and cytokine levels (tumor necrosis factor, interleukin-6 and IL-8) before and after intrapleural tetracycline (TC) injection, we evaluated 10 patients with malignant pleural effusion. Differential cell counts in the pleural fluid were obtained using cytocentrifuge preparations. Mononuclear cells from pleural fluid, collected before intrapleural injection of TC, on Day 4, and Days 10 to 14 after TC injection, were stimulated either with phytohemagglutinin (PHA) or PHA plus phorbol myristic acetate. The production of tumor necrosis factor (TNF) and IL-8 was measured. In addition, IL-6, IL-8, and TNF from serial collections of pleural fluid in these patients were measured by RIA or ELISA. The main inflammatory cells in pleural effusions before therapy were lymphocytes and mononuclear cells, but neutrophils predominated after TC injection. IL-6, IL-8, and TNF were markedly increased on Day 4 after TC intrapleural injection and then decreased to baseline levels on Day 14. The results suggest that TC intrapleural injection induces the release of cytokines (IL-6 and TNF), which are markers of an inflammatory response, and releases IL-8, which attracts neutrophils into the pleural space, which may be the mechanism of the sclerosing effect of TC.

Topics: Aged; Analysis of Variance; Female; Humans; Injections; Interleukin-6; Interleukin-8; Leukocytes, Mononuclear; Male; Middle Aged; Pleura; Pleural Effusion, Malignant; Tetracycline; Time Factors; Tumor Necrosis Factor-alpha

Pleural sclerosis after drainage with a small-bore catheter was performed in 21 patients with malignant pleural effusions. Intrapleural catheters 7- to 24-French in size were placed by using sonographic guidance. Tetracycline (18 patients) and bleomycin (four patients) were used as sclerosing agents (one patient had both). Clinical and radiologic follow-up was available on all patients until they died (range, 2 weeks to 25 months; mean, 3.6 months). Pleural sclerosis was successful in 15 (71%) of 21 patients. Two patients in whom pleurodesis failed had pleural sclerosis repeated, with one success and one failure. All of the failures were in patients in whom the amount of chest-tube drainage was more than 100 ml/day. Pleurodesis with tetracycline was painful in six patients; no pain was associated with use of bleomycin. Small pneumothoraces developed in four patients at the time of chest-tube placement, without consequence. A superimposed infection that developed in a patient having continuous drainage of pleural fluid was successfully treated with antibiotics. Pleural sclerotherapy can be performed through sonographically placed small-bore catheters with results comparable to those seen with large-bore, surgically placed catheters.

Topics: Adult; Aged; Aged, 80 and over; Bleomycin; Catheterization; Female; Humans; Male; Middle Aged; Pleura; Pleural Effusion, Malignant; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Tetracycline; Ultrasonics

Topics: Bleomycin; Doxycycline; Humans; Pleural Effusion, Malignant; Sclerosing Solutions; Sclerotherapy; Talc; Tetracycline

Intrapleural instillation of tetracycline hydrochloride (TCN) is an effective means of achieving pleural fibrosis. However, its mechanism of action remains unknown. To evaluate the hypothesis that TCN stimulates pleural mesothelial cells to release growth-factor-like activity for fibroblasts we performed the following experiments. Rat visceral pleural mesothelial cells were incubated with TCN at doses ranging from 0.01 microgram/ml to 100 mg/ml. The conditioned media (CM) were collected after incubation for 2 to 48 h. CM caused fibroblasts to increase incorporation of thymidine when compared with CM that was unexposed to TCN (p less than 0.05). This growth-factor-like activity continued to be produced by mesothelial cells for 48 h after removal of TCN from the medium. There was a dose-response relationship since increasing doses of TCN to as much as 1 mg/ml caused increasing production of growth-factor-like activity without mesothelial cell injury as measured by trypan blue exclusion. The growth factor activity was a competence-type activity. It coeluted with human PDGF at a molecular weight of 31,000. It was heat-stable (100 degrees C for 10 min) and sensitive to trypsin and papain but not to heat-inactivated trypsin. Addition of cycloheximide or actinomycin D inhibited its production. TCN did not have any direct effect on fibroblasts. Bleomycin CM did not contain growth-factor-like activity for fibroblasts. These data demonstrate that TCN stimulates mesothelial cells to release a growth-factor-like activity for fibroblasts. This phenomenon may play an important role in TCN-induced pleural fibrosis.

Topics: Animals; Bleomycin; Cells, Cultured; Culture Media, Conditioned; Fibroblast Growth Factors; Fibroblasts; In Vitro Techniques; Platelet-Derived Growth Factor; Pleura; Pleural Effusion, Malignant; Rats; Stimulation, Chemical; Tetracycline

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

Topics: Humans; Pleural Effusion, Malignant; Sclerosing Solutions; Tetracycline

Topics: Humans; Pleura; Pleural Effusion, Malignant; Pneumothorax; Tetracycline; Tissue Adhesions

Topics: Bleomycin; Humans; Pleural Effusion, Malignant; Tetracycline

Topics: Bleomycin; Humans; Neoplasm Recurrence, Local; Pleural Effusion, Malignant; Tetracycline

Malignant pleural effusions are often symptomatic and tend to recur after simple aspiration. Pleurodesis may prevent recurrence of the effusion; many agents and techniques have been described. A questionnaire was sent to 448 clinicians in the United Kingdom to determine how pleurodesis is performed in practice. There was a 56% overall response, with replies from 101 respiratory physicians, 88 general physicians, 29 thoracic surgeons, and 35 general surgeons. General surgeons saw few cases of malignant pleural effusion and rarely performed pleurodesis. A patient with recurrent malignant pleural effusion would usually be managed with pleurodesis by 76 (76%) respiratory physicians, 26 (30%) general physicians, and 23 (81%) thoracic surgeons; a further 29 (33%) general physicians would refer such patients to another specialist. Most medical pleurodesis were performed by junior staff, whereas consultant thoracic surgeons were more likely to be concerned with the procedure. All the thoracic surgeons used an intercostal tube drain, usually with suction. An intercostal tube drain was used routinely by only 54 (54%) of the respiratory physicians and 28 (32%) general physicians. Thoracic surgeons preferred talc for pleurodesis whereas physicians most commonly used tetracycline. The variety of methods in use supports the need for randomised, controlled studies to determine the most effective technique of pleurodesis.

Topics: Bleomycin; Drainage; Humans; Palliative Care; Pleural Effusion, Malignant; Recurrence; Suction; Talc; Tetracycline