tetracycline and Pleural-Effusion

Two cases of yellow nail syndrome (a triad of yellow dystrophic nails, chronic lymphedema and pleural effusion) are described which demonstrate long-term control of recurrent pleural effusions by tetracycline pleurodesis. Neither patient developed problems as a result of the procedure enabling us to conclude that tetracycline pleurodesis is effective in managing reaccumulating pleural fluid in yellow nail syndrome and may avoid loss of lung function due to pleural peel.

Topics: Aged; Chronic Disease; Female; Follow-Up Studies; Humans; Lymphedema; Male; Middle Aged; Nail Diseases; Pleural Effusion; Pleurodesis; Syndrome; Tetracycline

This paper briefly reviews the incidence of malignant pleural effusions (MPE) and the measures that have been used to treat this condition. The role of intracavitary bleomycin in controlling MPE, the doses used, and morbidity associated with its use are reviewed in depth with reference to multicenter studies that the author has coordinated as well as the published literature. The short- and long-term results reported when bleomycin was used alone or as compared with other agents are discussed. The author concludes that intracavitary bleomycin is an effective agent comparable to, if not more effective than, most agents used to prevent the recurrence of MPE after simple drainage procedures: it is safe and convenient to use; toxicity is low with minimal side effects and no myelosuppression. It can be safely administered to immunocomprised patients and those undergoing systemic chemotherapy.

Topics: Adolescent; Adult; Aged; Bleomycin; Drainage; Evaluation Studies as Topic; Female; Humans; Immunotherapy; Instillation, Drug; Male; Middle Aged; Palliative Care; Pleural Effusion; Pleural Neoplasms; Propionibacterium acnes; Tetracycline

Chronic or recurrent pleural effusions are a consequence of a variety of disease states and may produce significant pain or discomfort in a patient. Both surgical and pharmacological attempts to control pleural effusions have been tried, with moderate success. This article reviews the pathophysiology of pleural effusion and the role of intrapleural tetracycline in its management. Irritating chemicals, when instilled into the pleural space, are known to produce adhesion of the pleural membranes. Tetracycline has been shown in both animal and human studies to be effective in preventing the recurrence of a pleural effusion while producing only minor side effects, such as fever and pleuritic pain. Studies involving tetracycline in treating pleural effusions are reviewed, and guidelines for the preparation and administration of intrapleural tetracycline are presented. Because of its efficacy, low toxicity, ease of preparation, ready availability, and low cost, tetracycline deserves strong consideration as a first-line agent in the management of recurrent pleural effusions.

Topics: Animals; Humans; Pleural Effusion; Sclerosing Solutions; Tetracycline

Topics: Biopsy; Bleomycin; Carcinoembryonic Antigen; Chromosome Aberrations; Cytodiagnosis; Drainage; Endoscopy; Humans; Mesothelioma; Neoplasms; Nitrogen Mustard Compounds; Pleural Effusion; Pleural Neoplasms; Quinacrine; Talc; Tetracycline

Effective control of a recurrent malignant pleural effusion can greatly improve the quality of life of the cancer patient. At least a dozen different techniques have been advocated for controlling this common complication of malignant disease. The present review collects and examines the clinical results of all techniques designed to treat this problem. The pathophysiology and diagnostic evaluation of the effusion are also discussed. On the basis of comparisons involving effectiveness, morbidity, and convenience, we recommend intrapleurally administered tetracycline with thoracostomy drainage as the technique of choice. Instillation of a talc suspension with thoracostomy drainage is also a safe and effective technique and should be employed when tetracycline fails or is contraindicated.

Topics: Drainage; Humans; Intubation; Neoplasm Metastasis; Neoplasms; Nitrogen Mustard Compounds; Pleura; Pleural Effusion; Quinacrine; Radioisotopes; Talc; Tetracycline; Thorax

A study was undertaken to compare the efficacy of short term tube thoracostomy drainage with standard tube thoracostomy drainage before instillation of tetracycline for sclerotherapy of malignant pleural effusions.. The study consisted of a randomised clinical trial in a sequential sample of 25 patients with malignant pleural effusions documented cytopathologically. Fifteen patients were randomly assigned to group 1 (standard protocol) and 10 to group 2 (short term protocol). Patients in group 1 had tube thoracostomy suction drainage until radiological evidence of lung re-expansion was obtained and the amount of fluid drained was < 150 ml/day, before tetracycline (1.5 g) was instilled. The chest tube was removed when the amount of fluid drained after instillation was < 150 ml/day. Patients in group 2 also had suction drainage, but the tetracycline (1.5 g) was instilled when the chest radiograph showed the lung to be re-expanded and the effusion drained, which was usually within 24 hours. The chest tube was removed the next day.. The response to tetracycline sclerotherapy in the two groups was the same (80%) but the duration of chest tube drainage was significantly shorter for patients in group 2 (median two days) than for those in group 1 (median seven days).. The duration of chest tube drainage before sclerotherapy for malignant pleural effusions need not be influenced by the amount of fluid drained daily but by radiographic evidence of fluid evacuation and lung re-expansion. Shorter duration of drainage will reduce the length of hospital stay without sacrificing the efficacy of pleurodesis.

Topics: Adult; Aged; Aged, 80 and over; Chest Tubes; Drainage; Female; Follow-Up Studies; Humans; Male; Middle Aged; Palliative Care; Pleural Effusion; Prospective Studies; Sclerotherapy; Tetracycline; Time Factors; Treatment Outcome

Previously, we have shown rapid and complete dispersion of tetracycline hydrochloride in the pleural space following chest tube instillation. To assess the clinical relevance of this observation, we randomized patients with symptomatic pleural effusions to rotation (R) (n = 19) and nonrotation (NR) (n = 21) groups following administration of tetracycline hydrochloride, 20 mg/kg (n = 30); 300 mg of minocycline hydrochloride (n = 6); and 500 mg of doxycycline hydrochloride (n = 4) through a chest tube. Patients in the R group were maneuvered through six positions for the 2 h that the chest tube remained clamped. The NR patients remained supine for 2 h. Rotation and nonrotation groups were similar in demographics, source of pleural effusion, symptoms, and serum and pleural fluid analyses (all p = NS). A chest radiograph was scored based on pleural fluid recurrence throughout survival or up to 12 months. Survival, duration of chest tube instillation, and success of pleurodesis assessed by radiographic pleural fluid reaccumulation (73.7 vs 61.9 percent; R vs NR) were similar (p = NS). Rotational maneuvers appear to offer no benefit to the success of pleural symphysis after intrapleural instillation of tetracycline class agents.

Topics: Aged; Chest Tubes; Doxycycline; Female; Humans; Instillation, Drug; Male; Middle Aged; Minocycline; Pleura; Pleural Effusion; Posture; Recurrence; Tetracycline

In a prospective randomized study the effect of pleurodesis using fibrin-glue was compared with pleurodesis using tetracycline in the management of malignant pleural effusions. Intrapleural therapy with fibrin-glue was significantly more effective concerning long-term results as relapse of pleural effusion and improvement of lung function just as time of draining pleural effusion and pain during the application of fibrin glue/tetracycline. Thus, intracavitary therapy with fibrin glue may be recommended in the control of malignant pleural effusions.

Topics: Female; Fibrin Tissue Adhesive; Follow-Up Studies; Humans; Male; Neoplasms; Palliative Care; Pleura; Pleural Effusion; Tetracycline

The paper presents the results of a prospective comparative study of pleurodesis via fibrin adhesive or tetracycline. It appears that fibrin adhesive pleurodesis is more effective and less stress-intensive. However, final results must be awaited.

Topics: Aprotinin; Drug Combinations; Factor XIII; Fibrin Tissue Adhesive; Fibrinogen; Humans; Pleural Effusion; Pleural Neoplasms; Tetracycline; Thoracoscopy; Thrombin

Fifty patients with malignant pleural effusion were randomized to receive one or two doses of tetracycline sclerotherapy. We found that a single sclerotherapy treatment with tetracycline at a dose of 20 mg/kg was as effective as two sclerotherapy treatments and provided symptomatic relief in 46 of the 50 patients.

Topics: Humans; Instillation, Drug; Neoplasms; Pleural Effusion; Sclerosing Solutions; Tetracycline

Both bleomycin and tetracycline have been suggested as the sclerosing agent of choice in the management of malignant pleural effusions. To determine if one drug is superior to the other in this role, patients with malignant pleural effusions were randomly assigned to receive either bleomycin or tetracycline in the previously evacuated pleural space through a thoracostomy tube. Following instillation of the assigned agent, the tube was clamped for 8 hours and then reattached to suction. When the chest tube drainage had slowed to less than 40 ml in a 24-hour period or if 7 days had passed, the tube was removed. Pleural sclerosis was attempted 42 times in 34 patients. No statistically significant differences were found between the two treatment groups when prevention of effusion reaccumulation and time to removal of the chest tube (efficiency) were compared. Side effects including pleural pain and fever, occurred with both agents, but were manageable. Since one drug was not clearly superior to the other, and bleomycin is more costly, we suggest that tetracycline rather than bleomycin be used when pleural sclerosis is needed to manage malignant pleural effusions.

Topics: Bleomycin; Humans; Neoplasms; Pleural Effusion; Random Allocation; Sclerosing Solutions; Tetracycline

Forty-one patients with malignant pleural effusions secondary to breast cancer were randomly allocated to treatment with either intracavitary talc or intracavitary tetracycline. Of 33 evaluable patients, radiological control was achieved in 11/12 (92%) of the talc group compared with 10/21 (48%) of the tetracycline group (P = 0.022). Intracavitary talc provides effective palliation of metastatic pleural effusions secondary to breast cancer.

Topics: Breast Neoplasms; Clinical Trials as Topic; Humans; Middle Aged; Pleural Effusion; Postoperative Complications; Random Allocation; Talc; Tetracycline

Intrapleural instillation of tetracycline (TCN) has been shown to be effective in preventing the recurrence of malignant pleural effusions. Although the precise mechanism of action is unknown, it has been postulated that the pH of the TCN solution may be an important factor. Thirty patients with malignant pleural effusions were randomized in a double-blind trial to receive intrapleural administration of either 500 mg of tetracycline in solution (pH = 2.8) or a solution of similar pH and appearance. All patients had chest tube drainage of their effusion. There were 24/30 patients evaluable. There were 9/13 patients in the TCN group and 1/9 patients in the control group who had no reaccumulation of fluid (P less than 0.05). These results would suggest that the efficacy of TCN as a sclerosing agent is not related to its acidic pH and that intrapleural TCN is more effective than chest tube drainage alone for control of malignant effusions.

Topics: Antineoplastic Agents; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Humans; Hydrogen-Ion Concentration; Pleural Effusion; Prospective Studies; Random Allocation; Tetracycline

Eighteen patients with advanced metastatic malignancy who had 21 pleural effusions requiring sclerosis for control were randomly allocated to intrapleural therapy with tetracycline or quinacrine. Tetracycline produced partial or complete control of the effusion in ten of 12 trials for a median duration of 6 months (range 1.5 to 22 months). Partial or complete control was obtained in nine of ten trials with quinacrine, for a median duration of 3 months (range 1 to 13 months). All complete responders who died achieved control of their effusions until their terminal admissions despite clinical evidence of overt systemic tumor progression in the intervening period. Single-dose tetracycline therapy was accompanied by less fever (p less than 0.04) and less pleuritic pain (p = 0.09) than quinacrine. Tetracycline is effective, well tolerated, easily administered, and should be considered as the initial therapy for malignant pleural effusions requiring pleural sclerosis.

Topics: Clinical Trials as Topic; Female; Humans; Intubation; Neoplasms; Pleura; Pleural Effusion; Quinacrine; 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

We investigated whether oral tetracyclines could produce an efficient and safe pleurodesis as does parenteral doxycycline, which is currently unavailable in many countries.. Parenteral doxycycline (10 mg/kg), oral tetracycline (35 mg/kg), or doxycycline (10 mg/kg) was injected intrapleurally through a right chest tube in rabbits. The oral forms were dissolved in saline solution and passed through a sterile membrane filter. When daily aspirated pleural fluid was < 5 mL/24 h, the chest tube was removed. Fluid WBC, lactate dehydrogenase (LDH), and protein levels were measured 24 h after the injection. After the death of the animals on day 14, pleurodesis was graded from 1 (none) to 8 (> 50% symphysis) by two observers blinded to treatment groups.. The right pleurodesis score of the combined oral groups (median, 7.0; interquartile range [IQR], 4.0; n = 26) did not differ significantly (p = 0.349) from that of the parenteral group (median, 7.5; IQR, 6.0; n = 10). Oral tetracycline (capsule or tablet, n = 6 in each group) and doxycycline (capsule or tablet, n = 7 in each group) were as effective as parenteral doxycycline in producing pleurodesis: tetracycline capsule (median, 7.50; IQR, 6.00); tetracycline tablet (median, 6.50; IQR, 6.00); doxycycline capsule (median, 4.00; IQR, 1.00); doxycycline tablet (median, 8.00; IQR, 5.00), and parenteral doxycycline (median, 7.50; IQR, 6.00) [p = 0.235]. The left pleurodesis scores were 1.00 in all 36 rabbits. Fluid total volume, WBC, LDH, and protein levels were comparable between each oral and parenteral group, excluding WBCs in the tetracycline tablet group (p = 0.047). The complications were nonfatal (right hemothorax: tetracycline capsule [n = 3]/tetracycline tablet [n = 2], doxycycline tablet [n = 2], parenteral doxycycline [n = 2]; left hemothorax: tetracycline capsule [n = 1]; ascites: parenteral doxycycline [n = 1]). There was no growth on all filtrate cultures. Oral forms cost less than parenteral doxycycline (<1 US dollar vs 4.72 US dollars per rabbit). Filtering costs were 1.12 US dollars per rabbit.. Oral tetracycline or doxycycline is as effective and safe as parenteral doxycycline in producing pleurodesis in rabbits; thus, they may also be used in humans.

Topics: Administration, Oral; Animals; Anti-Bacterial Agents; Doxycycline; L-Lactate Dehydrogenase; Pleural Effusion; Pleurodesis; Rabbits; Tetracycline

Topics: Aged; Combined Modality Therapy; Diabetes Mellitus, Type 2; Disease Progression; Female; Finland; Follow-Up Studies; Humans; Hypertension; Nail Diseases; Pleural Effusion; Pleurodesis; Radiography, Thoracic; Risk Assessment; Severity of Illness Index; Tetracycline

Pleurodesis is used to treat pleural effusions, and a number of agents with varying degrees of efficacy and systemic toxicity have been trialed. This study was conducted to evaluate the efficacy and systemic toxicity of polidocanol in pleurodesis.. Thirty albino Wistar rats were divided into three groups of ten rats each. Group 1 (control) was given isotonic saline, group 2 was given 35 mg/kg tetracycline, and group 3 was given 2.5 mg 0.5% polidocanol, all intrapleurally in a total volume of 0.5 ml. The rats were killed on postoperative day 30 and the macroscopic pleural adhesions and microscopic evidence of inflammation were evaluated. Hepatic, renal, and pancreatic function tests were done and various tissues were microscopically examined to detect systemic toxicity. The mean values of macroscopic and microscopic scoring and biochemical parameters were compared among the three groups.. The polidocanol- and tetracycline-treated rats had significantly more adhesions than the control group rats, and polidocanol was more effective for pleurodesis than tetracycline (P = 0.027). Microscopic scoring was similar in the polidocanol- and tetracycline-treated rats, being significantly higher than that in the control rats. No significant difference was found in the biochemical parameters among the three groups. There were no signs of toxicity in any of the tissues studied microscopically.. Polidocanol was found to be a more effective sclerosing agent than tetracycline for pleurodesis. Systemic toxicity was not shown by the biochemical parameters and histopathologic findings.

Topics: Animals; Anti-Bacterial Agents; Male; Pleural Effusion; Pleurodesis; Polidocanol; Polyethylene Glycols; Rats; Rats, Wistar; Sclerosing Solutions; Tetracycline

Intrapleural loculation can increase morbidity in hemothoraces or parapneumonic effusions. Intrapleural fibrin precedes visceral-parietal pleural adhesions. We speculated that single-chain urokinase plasminogen activator alone or bound to its receptor could prevent these adhesions by their relative resistance to local inhibition by plasminogen activator inhibitors. We found that recombinant human single-chain urokinase-bound rabbit pleural mesothelial cells or lung fibroblasts with kinetics similar to that reported for human cells (kD of approximately 5 nM). The receptor-bound fibrinolysin maintained in vitro fibrinolytic activity in the presence of pleural fluids from rabbits with tetracycline-induced pleural injury over 24 hours. In rabbits given intrapleural single-chain urokinase 24 and 48 hours after intrapleural tetracycline (n = 10 animals), adhesions were prevented, whereas the receptor-complexed form (n = 12) attenuated adhesions versus vehicle/tetracycline-treated rabbits (n = 22, p

Topics: Animals; Anti-Bacterial Agents; Biomarkers; Body Fluids; Cell Count; Disease Models, Animal; Epithelium; Female; Fibrin; Fibroblasts; Pleura; Pleural Effusion; Pleurisy; Rabbits; Receptors, Cell Surface; Receptors, Urokinase Plasminogen Activator; Tetracycline; Tissue Adhesions; Urokinase-Type Plasminogen Activator

Pericardial and pleural effusions occur commonly after open cardiac procedures. However, the combination of tamponade and massive pleural effusion is not often observed. We present a case of such a patient who received an orthotopic heart transplant in a setting of previously diagnosed systemic sarcoidosis. Treatment ultimately required the creation of a pericardial window and chemical pleurodesis.

Topics: Anti-Bacterial Agents; Cardiac Tamponade; Female; Heart Transplantation; Humans; Middle Aged; Pericardial Window Techniques; Pleural Effusion; Pleurodesis; Recurrence; Tetracycline

Sclerosants such as tetracycline (TCN) have often been used in the control of malignant pleural effusions. Although the resultant inflammatory response is probably important in the ensuing pleural fibrosis, the signals responsible for the cellular influx into the pleural space following TCN instillation are not well understood. This study, therefore, sought to determine whether the chemokines interleukin-8 (IL-8), growth-related protein (Gro), and monocyte chemotactic protein-1 (MCP-1) were locally elaborated within the first 72 h following intrapleural TCN administration. TCN induced an exudative effusion with high lactate dehydrogenase activity. Although there was no significant change in the pleural fluid total leukocyte content, the median polymorphonuclear neutrophil concentration decreased from 1.067x10(6) to 2.03x10(5) cells x mL(-1) between 24 and 72 h, whereas the median macrophage concentration increased from 1.44x10(5) to 5.98x10(5) cells x mL(-1) over the same period. Furthermore, IL-8, Gro and MCP-1 concentrations decreased between 24 and 72 h. Immunocytochemistry indicated expression of IL-8 by pleural mesothelial cells 24 h, but not 72 h, following TCN administration. The data suggest that local elaboration of interleukin-8 and growth-related protein, in part of mesothelial origin, may influence neutrophil recruitment in tetracycline-induced pleuritis.

Topics: Analysis of Variance; Animals; Chemokine CCL2; Chemokines; Disease Models, Animal; Enzyme-Linked Immunosorbent Assay; Female; Immunohistochemistry; Interleukin-8; Leukocyte Count; Neutrophils; Nuclear Proteins; Pleural Effusion; Pleurisy; Rabbits; Statistics, Nonparametric; Tetracycline

Topics: Diagnosis, Differential; Female; Hemorrhage; Hemostasis, Surgical; Humans; Middle Aged; Pleural Effusion; Pleurisy; Pleurodesis; Protein Synthesis Inhibitors; Tetracycline; Thoracic Injuries; Thoracic Surgery, Video-Assisted

Tetracycline (TCN) has been considered the agent of choice for pleurodesis in patients with symptomatic malignant pleural effusions and recurrent pneumothoraces. However, the intravenous form of TCN used for pleurodesis is no longer available. Erythromycin, like TCN, often produces irritation when administered intravenously. In view of these irritant properties, we tested the effect of erythromycin as a pleural sclerosant in rabbits as compared with TCN. Normal saline was used as a control. Adult rabbits weighing 2.5 to 3.0 kg underwent sterile placement of a silastic pleural tube in the right pleural space. Erythromycin (n = 17) or TCN (n = 6), each in doses of 35 mg/kg in 2 ml saline, was administered via the tube. Control animals (n = 6) received 2 ml saline. The chest tubes were left in place for removal of pleural fluid and to maintain lung expansion. Animals were killed 8 d after receiving the various treatments, and their pleural surfaces were examined grossly and histologically. Numerous adhesions were present between the visceral and parietal pleurae in all animals receiving erythromycin and TCN, but not in those receiving saline. On light microscopy, pleurae treated with erythromycin or TCN were histologically identical, showing inflammation, edema, and fibroblast proliferation in the submesothelial tissues. The saline-treated animals had a normal pleura. Because erythromycin produced pleural inflammation and adhesions within 8 d of treatment, we propose that it may have a potential role as a pleural sclerosant.

Topics: Animals; Erythromycin; Lung; Pleura; Pleural Effusion; Pleurodesis; Rabbits; Sclerosing Solutions; Tetracycline

Tetracycline has been one of the most commonly used agents for producing a pleurodesis. However, it is no longer available due to more stringent requirements on the manufacturing process. The objective of this project was to determine whether Corynebacterium parvum is an effective sclerosant in an experimental model in rabbits. The following medications were instilled intrapleurally in anaesthetized male rabbits: tetracycline 35 mg.kg-1 or C. parvum 4 or 8 mg, all diluted with bacteriostatic saline solution. Twenty eight days after the instillation, the animals were sacrificed and the pleural spaces assessed macroscopically for evidence of pleurodesis and microscopically for evidence of fibrosis and inflammation. The intrapleural injection of C. parvum was ineffective in creating pleural fibrosis. The mean degree of pleurodesis in the 10 rabbits who received tetracycline was 3.5 +/- 0.7 (scale 0-4) whilst in the 10 rabbits that received 4 mg C. parvum it was 0.0 +/- 0.0, and in the 10 rabbits that received 8 mg C. parvum it was 0.5 +/- 0.8. Based on this study, we recommend that C. parvum should not be used as a pleural sclerosant in patients with normal pleura.

Topics: Animals; Male; Pleura; Pleural Effusion; Pleurodesis; Propionibacterium acnes; Rabbits; Tetracycline

We hypothesized that inhibition of matrix-degrading metalloproteinases (MMPs) accounts for a portion of the pleural fibrosis and adhesions of tetracycline pleurodesis. MMPs recently have been described in pleural fluid from patients with both exudative and transudative effusions. Since tetracyclines are recognized inhibitors of other metalloproteinases, we investigated their inhibitory capacity in pleural fluid. High concentrations of several different tetracyclines reduced MMP activity of pleural fluid by more than 75 percent. Lower concentrations (< or = 1 mg/ml) had only modest inhibitory effects. High concentration of of tetracyclines also inhibited cell synthesis of MMPs, in vitro, but other measures of vital cell function were also impaired. We conclude that tetracyclines are effective inhibitors of MMP activity in pleural fluid and may also reduce synthesis of MMPs via non specific cell injury. These data suggest a possible mechanism to account for tetracycline pleurodesis; ie, an inhibition of MMP activity in pleural fluid.

Topics: Collagenases; Doxycycline; Electrophoresis; Gelatinases; Humans; In Vitro Techniques; Metalloendopeptidases; Pleura; Pleural Effusion; Tetracycline; Tissue Adhesions; Tumor Cells, Cultured

The histopathologic findings were compared from 20 mg/kg intrapleural tetracycline hydrochloride (TCN) and three doses of intrapleural minocycline hydrochloride (5, 10, and 20 mg/kg) (MCN) in New Zealand white rabbits. Both TCN and MCN produced an early neutrophilic predominant pleural effusion that became mononuclear over 48 h. There was no difference in pleural fluid accumulation, number of adhesions, or histologically measured visceral and parietal pleural thickness between TCN and MCN (all p = ns). The TCN, 20 mg/kg, produced more visceral pleural plaque than MCN, 5 mg/kg (p < 0.05). Increasing MCN doses resulted in greater pleural fluid neutrophil accumulation. With higher dose MCN, greater mesothelial cell desquamation and fibroblast proliferation was evident compared to the 5 mg/kg dose. The MCN and TCN produce similar histopathologic condition in the rabbit pleura which suggests that MCN should cause a similar clinical response in humans.

Topics: Analysis of Variance; Animals; Minocycline; Pleura; Pleural Effusion; Pleurisy; Rabbits; Tetracycline; Time Factors; Tissue Adhesions

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: Adult; Humans; Instillation, Drug; Lupus Erythematosus, Systemic; Male; Pleura; Pleural Effusion; Recurrence; Tetracycline

Pleural effusion was induced in 12 dogs by ligation of the cranial vena cava. Pleurodesis was attempted by injecting a solution of tetracycline hydrochloride into the pleural space of 8 dogs (4 dogs, 25 mg/kg of body weight; 4 dogs, 50 mg/kg) via bilateral thoracostomy tubes. In both groups, tetracycline was diluted in 40 ml of normal saline solution and 10 ml of 1% lidocaine before injection. Half of the solution (25 ml) was instilled in each hemithorax. Four control dogs were treated in the same manner with a solution of normal saline and lidocaine. Daily pleural fluid production was measured after the attempted pleurodesis. Thirty days after administration of the solution, each dog was euthanatized and necropsied. Surface area of pleural adhesions was measured. Tissues from regions of pleural adhesions and areas of parietal and visceral pleura not involved in adhesions were analyzed histologically. Formation of pleural fluid stopped in all but 1 control dog within 48 hours after injection of solution. This dog effused throughout the study. The resolution of effusion was not significantly (P less than 0.05) different between the tetracycline-treated dogs and the control group. Although diffuse pleural adhesions were not induced in any of the dogs, significantly (P less than 0.0027) more surface area of lung was adhered in dogs treated with the higher dose of tetracycline.

Topics: Animals; Dog Diseases; Dogs; Ligation; Pleura; Pleural Effusion; Tetracycline; Vena Cava, Superior

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

This study describes our experience using a percutaneously placed small-bore catheter for drainage of malignant pleural effusions and subsequent instillation of a sclerosing agent to obliterate the pleural space. We treated 15 consecutive patients with known metastatic cancer and a symptomatic pleural effusion. Twelve patients survived for more than four weeks after the procedure; 11 of these 12 patients had a successful objective clinical response. The procedure was well tolerated, with little or no discomfort during catheter placement and the maintenance period. No serious complications were encountered. We conclude that the use of a small-bore percutaneously placed "pneumothorax" catheter in the management of malignant pleural effusions is an effective and more comfortable alternative to large-bore closed-tube thoracostomy.

Topics: Adult; Aged; Combined Modality Therapy; Drainage; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Palliative Care; Pleural Effusion; Pleural Neoplasms; Pneumothorax, Artificial; Radiography; Recurrence; Tetracycline

Malignant pleural effusion is a common complication of malignant disease requiring drainage and palliative sclerosing therapy in the vast majority of cases. Tetracycline in conjunction with thoracoscopic drainage is currently considered as the optimal sclerosing agent due to its high efficacy, good patient tolerance, simple and repeatable applicability and low cost of treatment. Traditional and more recent agents like fibrin-sealant may give similar results, but do not achieve a favourable all-round-properties. The relevant data from the literature are reviewed, our own results are presented. An explicit description of pleurodesis is given, also a brief discussion of possible mechanisms of action of sclerosing agents. Concepts are suggested for positioning pleurodesis in the general therapeutic approach to various tumours. The concept of pleurodesis can be similarly successful and safely applied on malignant pericardial effusion (pericardesis).

Topics: Drainage; Humans; Pleural Effusion; Pleural Neoplasms; Tetracycline; Thiotepa; Thoracoscopy

Topics: Evaluation Studies as Topic; Humans; Pleural Effusion; Talc; Tetracycline; Thoracoscopy

Successful use of nonnarcotic, thoracic epidural analgesia for the control of pain associated with pleural sclerosis was accomplished in three gynecologic oncology patients with severe respiratory compromise due to malignant pleural effusions. Excellent analgesia was obtained with no observed anesthetic complications.

Topics: Adult; Analgesia, Epidural; Bupivacaine; Catheters, Indwelling; Drug Combinations; Epinephrine; Female; Humans; Middle Aged; Pain; Pleural Effusion; Sclerosing Solutions; Tetracycline

Thoracostomy tube drainage with tetracycline (TCN) instillation is an effective technique for management of recurrent, symptomatic, malignant pleural effusions. Although patient rotation through various positions after instillation of TCN has been advocated empirically, it has not been shown scientifically to be necessary and is often uncomfortable for the patient and time-consuming for personnel. Five patients with symptomatic, malignant pleural effusions were studied during pleurodesis using radiolabelled TCN. Scintigraphic imaging was done immediately after TCN instillation prior to patient rotation. Patients were rotated through six positions and multiple images were obtained at 30 and 120 minutes. Tetracycline dispersed throughout the pleural space within seconds. Patient positioning had no effect on the intrapleural distribution of TCN in four of the five patients. In one patient with loculated hydropneumothorax and trapped lung, rotation minimally improved distribution of TCN to the apex. Rotation during pleurodesis does not appear to be necessary in patients with a relatively normal pleural space. However, patient rotation enhances distribution of TCN when the lung is separated substantially from the chest wall, as with trapped lung. Possibly, in this situation the properties of fluid mechanics and capillary action no longer apply.

Topics: Adult; Aged; Humans; Middle Aged; Pleura; Pleural Effusion; Posture; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Tetracycline; Thoracostomy; Tissue Distribution

Pleurodesis for effective control of malignant pleural effusion can be induced with various methods and agents. In 18 patients with histologically or cytologically proven malignant pleural effusion, 500 mg doxycycline hydrochloride diluted in 30 ml of saline was instilled into the emptied pleural space. Tube drainage was performed using suction or gravity. More than one doxycycline instillation was required in 13 cases. Serial chest radiography showed the response to be complete in 11 of the 18 patients and partial in four, while three did not respond. There was no difference between the results obtained with the two drainage systems. In all of the complete responders who died there was no sign of reaccumulated pleural effusion at terminal admission, despite clinical evidence of systemic tumor progression. Three patients--all with breast carcinoma--are alive after 5-27 months, two as complete responders and one as partial responder. The most common side effect was pleuritic pain, defined as significant if narcotic analgesics were required. A moderate febrile reaction appeared in four patients during the first 24 hours post-instillation. The study showed doxycycline to be an effective sclerosing agent for inducing pleurodesis, with acceptable adverse effects.

Topics: Aged; Aged, 80 and over; Animals; Breast Neoplasms; Doxycycline; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasms; Pleural Effusion; Rabbits; Tetracycline

Seven patients with symptomatic pleural effusions (six) and recurrent pneumothorax (one) underwent attempted pleurodesis using tetracycline. Lidocaine (150 mg), followed immediately by tetracycline (20 mg/kg), was instilled into the pleural space through a chest tube. Venous blood was obtained at 0, 15, 30, 60, and 120 minutes following instillation in order to determine concentrations of lidocaine and tetracycline. The mean peak serum concentration of lidocaine was 1.3 mu/ml +/- 0.4 microgram/ml (mean +/- SE) (range, 0.3 microgram/ml to 3.2 microgram/ml), and the mean time to peak serum concentration of lidocaine was 86 +/- 13 minutes. The mean peak serum concentration of tetracycline was 3.6 microgram/ml +/- 0.9 microgram/ml (range, 1.0 microgram/ml to 5.0 micrograms/ml), and the mean time to peak serum concentration of tetracycline was 96 +/- 16 minutes. Therapeutic serum concentrations of lidocaine were found in four of the seven patients and therapeutic serum levels of tetracycline in four of five patients. With systemic absorption of lidocaine and tetracycline following intrapleural instillation, patients are at risk for potential toxic effects. If lidocaine is used in a dosage of less than 3 mg/kg, toxic levels of the drug are unlikely to occur. Furthermore, use of tetracycline or lidocaine in pleurodesis is contraindicated in patients with known sensitivity to the drugs.

Topics: Female; Humans; Instillation, Drug; Lidocaine; Male; Pleura; Pleural Effusion; Pneumothorax; Recurrence; Tetracycline

A 26 year old woman had recurrent unilateral pleural effusions secondary to active systemic lupus erythematosus. The effusions were resistant to conventional treatment with steroids but did not recur after tetracycline pleurodesis.

Topics: Adult; Drug Resistance; Female; Humans; Lupus Erythematosus, Systemic; Pleural Effusion; Prednisolone; Recurrence; Tetracycline

Topics: Administration, Topical; Aged; Female; Humans; Male; Middle Aged; Neoplasms; Pleura; Pleural Effusion; Tetracycline

We retrospectively examined the use of tetracycline pleurodesis for the palliative treatment of malignant pleural effusions. Twenty-five patients (32 procedures) were identified for study. In contrast to higher success rates in prior reports, 13 procedures (40.6%) failed as repeated pleural drainage was required. Only five procedures (15.6%) achieved complete resolution of pleural fluid. In 14 procedures (43.8%) pleural effusions recurred but were not treated. In some of these cases the effusion may have been reduced sufficiently to relieve symptoms, while in others the high short-term mortality rate (29% in 30 days) and the development of loculated effusions (34%) may have led to the decision not to treat. Instillation of a larger dose of tetracycline (greater than or equal to 1 g) was associated with a better outcome. Although adequate pleural drainage and proper technique were used, other factors such as the presence of pleural masses, atelectasis, loculations, and patient performance status were not uniformly controlled. Greater attention to these factors and use of a larger dose of tetracycline (greater than or equal to 1 g) may increase the likelihood of a successful pleural symphysis.

Topics: Adult; Aged; Aged, 80 and over; Dose-Response Relationship, Drug; Drainage; Female; Humans; Male; Middle Aged; Neoplasms; Palliative Care; Pleural Effusion; Radiography; Retrospective Studies; Tetracycline

Because many patients with malignant pleural effusions could survive for months to years beyond its onset, definitive management must be safe and effective. Chemical pleurodesis with tetracycline has gained general acceptance as the therapy of choice, even though no large series confirming this viewpoint has appeared in the literature. We reviewed 108 procedures involving tube thoracostomy and tetracycline pleurodesis, and report a success rate of 94.4% without serious complications. Considering all patients, 49% were symptom-free at three months, and 13% were alive one year later. Several potentially important changes in technique have emerged since the initial description of this procedure. With adherence to meticulous technique, tetracycline pleurodesis provides rapid, effective, and safe palliation of malignant pleural effusions.

Topics: Adult; Aged; Aged, 80 and over; Drainage; Female; Humans; Male; Methods; Middle Aged; Neoplasms; Palliative Care; Pleura; Pleural Effusion; Retrospective Studies; Rotation; Tetracycline

We report our experience in the treatment of pleural effusion in 25 patients with metastatic breast cancer. Seventeen patients received initial systemic therapy and in 13 of them local intrapleural therapy was subsequently employed; the remaining 8 patients received local therapy only. Several modalities of local treatment were used: intrapleural chemotherapy with thiotepa and 5-fluorouracil; the production of pleural adhesion by the use of chest drainage alone or associated with instillation of sclerosing agents, such as nitrogen mustard or tetracycline. Of the 21 patients who were subjected to local therapy, 19 (90.5%) achieved an objective response (16 complete (76.2%) and 3 (14.34%) partial). Complete responses were observed exclusively in patients who had pleurodesis. Our data suggest that pleurodesis is the treatment of choice for neoplastic pleural effusion and that the use of tetracycline as a sclerosing agent is the most useful because of its availability, low cost and low morbidity.

Topics: Adult; Aged; Breast Neoplasms; Female; Humans; Middle Aged; Neoplasm Metastasis; Pleural Effusion; Sclerosing Solutions; Tetracycline

Topics: Animals; Bacterial Vaccines; Humans; Immunotherapy; Pleura; Pleural Effusion; Propionibacterium acnes; Sclerosing Solutions; Tetracycline

Topics: Aged; Drainage; Female; Humans; Pleural Effusion; Pleural Neoplasms; Tetracycline

Pleural effusions are common in cancer patients, developing either from the malignant condition or from unrelated causes, such as congestive heart failure, pulmonary infarction, or infection. Diagnosis of malignant pleural effusion rests on demonstration of the presence of malignant cells in the pleural fluid or pleural biopsy specimen. Treatment is usually aimed at relief of symptoms rather than at the underlying malignancy. Specific therapeutic measures include thoracentesis, chest tube drainage, pleurodesis with chemicals or biologic agents, radiation and systemic chemotherapy, surgical pleurodesis, and pleuroperitoneal shunt. These should be supplemented by ancillary measures to maintain fluid and nutritional balance and prevent complications.

Topics: Chyle; Drainage; Exudates and Transudates; Humans; Pleura; Pleural Effusion; Pleural Neoplasms; Tetracycline; Tissue Adhesions

Topics: Adult; Aged; Combined Modality Therapy; Drainage; Female; Humans; Male; Middle Aged; Neoplasms; Pleural Effusion; Tetracycline

Topics: Breast Neoplasms; Humans; Injections; Lung Neoplasms; Pleura; Pleural Effusion; Tetracycline

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Neoplasms; Pleura; Pleural Effusion; Pleurisy; Suction; Tetracycline; Thoracoscopy

The methods used to induce pleural symphisis in recidivant malignant pleural effusions are reviewed. The most suitable for an average hospital are the intrapleural introduction of talc and tetracycline clorhydrate, of which the procedures are described.

Topics: Drainage; Humans; Immunotherapy; Methods; Neoplasm Recurrence, Local; Pleura; Pleural Effusion; Pleural Neoplasms; Talc; Tetracycline

New Zealand white rabbits received intrapleural instillations of either tetracycline (7, 20, and 35 mg/kg), HCI (0.01N), quinacrine (10 mg/kg), nitrogen mustard (0.2 mg/kg), bleomycin (1.5 mg/kg), or NaOH (0.5%). All sclerosing agents produced a neutrophil-predominant, exudative pleural effusion within 12 h of instillation. By 48 h the pleural fluid was predominantly mononuclear. Despite the large pH range of the sclerosing agents (tetracycline, 2.0; NaOH, 13.0), the pleural fluid pH was always between 7.40 and 7.49 during the 144-h observation period. There was no difference in protein concentration, leukocyte count, or neutrophil differential with either the 3 different doses of tetracycline or the 5 other sclerosing agents. Autopsies at 30 days showed that only the 35 mg/kg dose of tetracycline produced pleural symphysis. We concluded that the common sclerosing agents produce a similar type of pleural effusion, but only tetracycline leads to pleural fibrosis; this effect appears to be dose-dependent. The pH of the sclerosing agent per se probably has little effect on the development of pleural symphysis.

Topics: Animals; Bleomycin; Mechlorethamine; Pleural Effusion; Quinacrine; Rabbits; Sclerosing Solutions; Sodium Hydroxide; Tetracycline

Topics: Aged; Female; Humans; Male; Middle Aged; Palliative Care; Pleural Effusion; Sodium Hydroxide; Tetracycline

Topics: Drainage; Humans; Neoplasms; Palliative Care; Pleural Effusion; Tetracycline

Ninety-seven patients with breast cancer developed pleural effusions between January, 1971 and December, 1976. A retrospective analysis of 170 treatment procedures showed that 75 involved thoracocentesis alone, 23 involved thoracocentesis plus therapy with an alkylating agent, 22 involved drainage via a chest tube plus instillation of an alkylating agent, and 50 involved drainage via a chest tube plus instillation of tetracycline. The results are presented as censored survival curves. When management by chest tube plus instillation of an alkylating agent or tetracycline was compared with management by thoracocentesis plus therapy with an alkylating agent, analysis at six months after treatment showed that 42 percent (30/72) of the procedures left patients free of effusion using the former method, compared with 22 percent (5/23) of the procedures using the latter method. This is not quite significant at the 5 percent level using a summary chi2 procedure. The reasons for preferring tetracycline as a sclerosing agent are discussed.

Topics: Alkylating Agents; Breast Neoplasms; Drainage; Humans; Pleural Effusion; Punctures; Retrospective Studies; Tetracycline

Topics: Female; Humans; Lidocaine; Middle Aged; Pleura; Pleural Effusion; Tetracycline

A pleural effusion is a frequent complication of malignant disease. Essential to the care of oncology patients is a fundamental knowledge of the pathophysiology and treatment of such effusions. This article discusses the current thoughts concerning the occurrence of malignant effusions, outlines the current available methods and agents employed for control, and presents a modification of the thoracostomy procedure that appears to be more effective than the standard procedure.

Topics: Bleomycin; Fluorouracil; Gold Radioisotopes; Humans; Mechlorethamine; Methods; Neoplasms; Phosphorus Radioisotopes; Pleura; Pleural Effusion; Quinacrine; Talc; Tetracycline; Thiotepa; Thoracic Surgery; Thorax

Topics: Humans; Injections; Lidocaine; Pleura; Pleural Effusion; Pleural Neoplasms; Tetracycline

The sera from 2453 patients suffering from pneumonia were investigated for antibodies against the agent causing "Legionnaires' disease". A complement-fixing antigen developed in this institute was used for the screening of these sera, and the positive results were confirmed with the IF-test developed by CDC Atlanta. Antibodies were found in 23 Swiss patients. The clinical details from one of these patients are presented.

Topics: Aged; Doxycycline; Erythromycin; Humans; Jaundice; Legionnaires' Disease; Male; Pleural Effusion; Switzerland; Tetracycline

Topics: Humans; Methods; Pleura; Pleural Effusion; 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

Salmonella empyema in an immunologically compromised patient with malignant pleural effusion is described. Antimicrobial treatment was ineffective when given parenterally. Intrapleural administration of antibiotics resulted in a rapid rise of the antibacterial activity of the pleural fluid, leading to rapid clinical improvement and eradication of the infections.

Topics: Adenocarcinoma; Empyema; Humans; Lung Neoplasms; Male; Microbial Sensitivity Tests; Middle Aged; Neoplasm Metastasis; Pleural Effusion; Salmonella; Salmonella Infections; Tetracycline; Thyroid Neoplasms

Topics: Breast Neoplasms; Drainage; Female; Humans; Lung Neoplasms; Pleural Effusion; Sodium Hydroxide; Tetracycline

A study was made of 111 strains of plasma-negative spathylococci isolated from the blood, pleural fluid, urine, and exudate of the abdominal cavity of 30 patients. The studies were carried out by 18 criteria. A variety of biological properties and signs characteristic of pathogenic staphylococci (hemolytic activity, anaerobic splitting of mannite, the presence of phosphatase, lysozyme, protease, alpha-toxin, fibrinolysin) were noted. A high resistance to tetracycline and penicillin was found in the strains isolated from the blood and the pleural cavity.

Topics: Animals; Ascitic Fluid; Bacteriophage Typing; Bacteriuria; Cross Infection; Erythrocytes; Fibrinolysin; Hemolysis; Humans; Mannitol; Muramidase; Penicillin Resistance; Penicillins; Phospholipases; Phosphoric Monoester Hydrolases; Pleural Effusion; Pyelonephritis; Rabbits; Sepsis; Staphylococcal Infections; Staphylococcus; Surgical Procedures, Operative; Tetracycline; Toxins, Biological

After drainage by closed-tube thoracostomy, tetracycline was instilled in seven patients with malignant pleural effusions. None of the patients had clinically significant recurrence of effusion, even though four patients worsened while receiving systemic chemotherapy and died.

Topics: Adult; Aged; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Pleura; Pleural Effusion; Tetracycline; Thoracic Neoplasms

The "tetracycline fluorescence test" is considered, as a consequence of the experiments made by various AA., specific for the diagnosis of tumourous cases. With a purpose to confirm its validity, in the broncopleuropulmonary cases, A. examines 30 spittings and 10 pleural fluids of suspicious cases, comparing the results got by means of this test with those of the routine cytohystological examinations. The results confirm 96% positivity with said test against the 60% postivity of the routine cytohystological ones.

Topics: Bronchial Neoplasms; Fluorescence; Lung Neoplasms; Pleural Effusion; Pleural Neoplasms; Sputum; Tetracycline

Two cases of pseudomembranous colitis are presented. The first patient had been treated with novobiocin-tetracycline and penicillin, and two weeks later developed severe fulminating diarrhea with ascites and bilateral pleural effusions which did not respond to intravenous ACTH. Subsequently she underwent subtotal colectomy and made a rapid and complete recovery. The second patient developed severe diarrhea two weeks after a 10-day course of clindamycin. She was treated with intravenous ACTH, oral Lactobacillus and a fecal enema and made a complete recovery.These cases reconfirm the importance of antibiotics as etiologic agents in this disease. They also stress the classic sigmoidoscopic and histologic findings that should facilitate prompt and rapid diagnosis.

Topics: Adolescent; Adrenocorticotropic Hormone; Anti-Bacterial Agents; Ascites; Biological Products; Clindamycin; Colon; Diarrhea; Enema; Enterocolitis, Pseudomembranous; Female; Humans; Lactobacillus; Middle Aged; Novobiocin; Penicillins; Pleural Effusion; Rectum; Tetracycline

Topics: Aged; Biopsy; Female; Humans; Kidney Glomerulus; Methods; Nephrotic Syndrome; Pleura; Pleural Effusion; Recurrence; Tetracycline

Topics: Acute Disease; Adult; Fever; Humans; Lung; Male; Mycoplasma Infections; Pain; Penicillin G; Pleural Effusion; Pleuropneumonia; Radiography; Tetracycline; Transients and Migrants

Topics: Adult; Aged; Ascitic Fluid; Bone Neoplasms; Breast Neoplasms; Cardiovascular Diseases; False Negative Reactions; False Positive Reactions; Female; Filtration; Gastrointestinal Neoplasms; Humans; Male; Membranes, Artificial; Methods; Middle Aged; Neoplasms; Ovarian Neoplasms; Pleural Effusion; Prostatic Neoplasms; Respiratory Tract Diseases; Respiratory Tract Neoplasms; Testicular Neoplasms; Tetracycline; Tuberculosis

Topics: Complement Fixation Tests; Diagnosis, Differential; Endocarditis, Subacute Bacterial; Humans; Infectious Mononucleosis; Influenza, Human; Lung; Mycoplasma Infections; Pleural Effusion; Psittacosis; Q Fever; Radiography; Sulfamethoxazole; 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

Topics: Adult; Aged; Breast Neoplasms; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Kidney Neoplasms; Lung Neoplasms; Male; Methods; Middle Aged; Neoplasm Metastasis; Pleural Effusion; Radiography, Thoracic; Tetracycline

Topics: Adolescent; Adult; Age Factors; Aged; Bronchi; Child; Chloramphenicol; Drainage; Empyema; Erythromycin; Female; Hospitalization; Humans; Lung Diseases; Male; Middle Aged; Missouri; Penicillins; Pleural Effusion; Sepsis; Sputum; Streptomycin; Tetracycline

Topics: Adult; Anemia, Hemolytic; Female; Humans; Mycoplasma Infections; Myocarditis; Pleural Effusion; Pneumonia; Tetracycline

Topics: Alpha-Globulins; Diagnosis, Differential; Female; Fluorescence; Humans; Lung Neoplasms; Male; Methods; Pleural Effusion; Pneumonia; Sputum; Tetracycline

Topics: Adult; Aged; Ascites; Cytodiagnosis; Female; Fluoresceins; Fluorescence; Humans; Male; Middle Aged; Pleural Effusion; Tetracycline

Topics: Alpha-Globulins; Fluorescence; Glucose; Humans; L-Lactate Dehydrogenase; Methods; Pleural Effusion; Pleural Neoplasms; Tetracycline

Topics: Fluorescence; Humans; Pleural Effusion; Tetracycline

Topics: Cytodiagnosis; Exudates and Transudates; Fluorescence; Gastric Juice; Humans; In Vitro Techniques; Intestinal Secretions; Microscopy, Fluorescence; Neoplasms; Pleural Effusion; Sputum; Tetracycline

Topics: Bronchial Neoplasms; Carcinoma, Bronchogenic; Cytodiagnosis; Humans; Lung Diseases; Lung Neoplasms; Microscopy, Fluorescence; Pleural Effusion; Tetracycline

Topics: Abscess; Anti-Bacterial Agents; Bacitracin; Bronchial Fistula; Chloramphenicol; Empyema; Erythromycin; Humans; Kanamycin; Novobiocin; Penicillins; Pleural Effusion; Pneumonia; Pneumonia, Staphylococcal; Pneumothorax; Sepsis; Staphylococcal Infections; Tetracycline; Vancomycin

Topics: Drug Hypersensitivity; Dyspnea; Eosinophilia; Fever; Humans; Lung Diseases; Nitrofurantoin; Pleural Effusion; Radiography, Thoracic; Tetracycline; Toxicology; Urinary Tract Infections

Topics: Achlorhydria; Ascites; Bile; Biomedical Research; Body Fluids; Duodenal Ulcer; Fluorescence; Gastric Lavage; Hernia, Diaphragmatic; Humans; Leiomyosarcoma; Lymphoma; Lymphoma, Non-Hodgkin; Neoplasms; Pancreatic Juice; Pleural Effusion; Polyps; Secretin; Stomach; Stomach Neoplasms; Stomach Ulcer; Tetracycline