Treatment of Lung Edema (Pleural Effusions) with Pleur(x) Catheter

Management of malignant pleural effusions using the Pleur(x) catheter.

Ann Thorac Surg. 2008 Mar

Warren WH, Kalimi R, Khodadadian LM, Kim AW.
Department of Cardiovascular-Thoracic Surgery, Rush University Medical Center, Chicago, Illinois, USA. wwarren@rush.edu

BACKGROUND: A malignant pleural effusion can cause significant morbidity to terminal patients. Drainage and control of the fluid can provide great palliation. Improving the quality of life for these patients on an outpatient basis is a worthy goal.

METHODS: We have inserted 231 Pleur(x) (Cardinal Health Systems, McGaw Park, IL) catheters into 202 patients with symptomatic malignant pleural effusions with the goal of treating the fluid on an outpatient basis. The catheters were drained at home, using vacuum bottles, every other day after an initial week of draining daily. No sclerosing agents were instilled. The catheters were removed when drainage was less than 50 mL/day. Primary tumor sites, irradiation to the hemithorax, and incomplete re-expansion of the lung were studied for their ability to predict prolonged drainage (over 100 days).

RESULTS: In all cases, evacuation of the fluid with a Pleur(x) catheter palliated the patient's symptoms. Overall, 134 of 231 (58.0%) catheters were removed after the drainage tapered off. Reaccumulation of the pleural effusion occurred in 5 of 132 (3.8%) patients. The incidence of infection was 5 of 231 (2.2%) and was usually limited to cellulitis at the insertion site. The incidence of blockage was 11 of 231 (4.8%) and was most common in patients with an underlying cancer at sites other than breast and gynecologic primaries. Drainage for more than 100 days was seen most often in patients who had incomplete reexpansion of the underlying lung. Primary tumor site and irradiation did not have significant predictive value.

CONCLUSIONS: Insertion of Pleur(x) catheters is an effective way to treat patients with a malignant pleural effusion on an outpatient basis with a high degree of patient compliance and few complications. Overall, almost 60% of the catheters can be removed with a very low chance of reaccumulation, and without the need to instill a sclerosing agent. Even patients with a trapped lung can be palliated and released from hospital, although the likelihood of removing the catheter is small.

PMID: 18291195 [PubMed - in process]

Identification of clinical factors predicting Pleur(x)((R)) catheter removal in patients treated for malignant pleural effusion.

Eur J Cardiothorac Surg. 2008 Jan

Warren WH, Kim AW, Liptay MJ.
Department of Cardiovascular-Thoracic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.

Objective: The objective of the study was to review the clinical records of patients undergoing insertion of a Pleur(x)((R)) catheter in the management of malignant pleural effusions. In particular, clinical parameters were analyzed for their influence on catheter removeability.

Methods: Between January 1998 and July 2006, 263 patients underwent insertion of 295 Pleur(x)((R)) catheters for malignant pleural effusion(s). Patients were allocated to one of four groups based upon the site of the primary tumor: group 1 (breast), group 2 (lung), group 3 (gynecologic), and group 4 (all others). A history of prior chest irradiation, cytologic analysis (positive or negative for malignant cells), and incidence of trapped lung were also studied to determine if, in addition to the primary site, these influenced the incidence of pleurodesis.

Results: Overall, 58.6% of Pleur(x)((R)) catheters were removed prior to death. The incidence of spontaneous symphysis and catheter removal in groups 1 (69.6%) and 3 (72.5%) was significantly higher than in groups 2 and 4 (p<0.001).>

Conclusions: Pleur(x)((R)) catheters effectively relieve patients of dyspnea by evacuating the pleural space. Spontaneous pleural symphysis and catheter removal is more likely in patients with breast or gynecologic primary tumors, absence of chest wall irradiation, cytologic positivity, and complete re-expansion of the underlying lung.

PubMed

Surgical and other invasive approaches to recurrent pleural effusion with malignant etiology.

Support Care Cancer. 2008 Feb 8

Neragi-Miandoab S.
Department of Surgery, School of Medicine, Case Western Reserve University, 11100 Euclid Ave. LKS 7109, Cleveland, OH, USA, Sneragi@yahoo.com.

With an increasing number of cancer survivors, the annual incidence of malignant pleural effusions has been rising in recent decades worldwide. Many patients with various forms of cancer develop malignant pleural effusions at some point in their life. Patients most commonly present with progressive dyspnea. These effusions are refractory and are associated with impaired quality of life for these patients. The main goals of management are evacuation of the pleural fluid and prevention of its re-accumulation. The therapy plan should consider the general health of the patients, their performance status, the presence of trapped lung, and the primary malignancy. However, there is no universally established, standard approach. Surgical options include thoracentesis, chest tube drainage, thoracoscopy followed by chemical and mechanical pleurodesis, Pleur-X catheter drainage, and pleurectomy. Chemical pleurodesis is the most common modality of therapy for patients with recurrent pleural effusion. For example, Talc is the most successful pleurodesis agent with similar equal to that of poudrage or slurry. Pleur-X catheter can reduce hospital stay and adds value to the treatment of patients with trapped lung, who are not appropriate candidates for pleurodesis. Furthermore, a mechanical pleurodesis has been shown to be effective particularly in pleural effusions with lower pH. This article reviews the surgical and other invasive options as well as their technical aspects in the management of recurrent malignant pleural effusions.

SpringerLink

Neuroprotective effect of erythropoietin after experimental cold injury-induced vasogenic brain edema in rats.

Neuroprotective effect of erythropoietin after experimental cold injury-induced vasogenic brain edema in rats.

February 2008

Okutan O, Turkoglu OF, Gok HB, Beskonakli E.
Department of Neurosurgery, Ankara Ataturk Research and Education Hospital, Ankara, Turkey.

BACKGROUND: The aims of this study were to evaluate the efficiency of EPO in the treatment of cold injury-induced brain edema, apoptosis, and inflammation and to compare its effectiveness with DSP.

METHODS: One hundred fifteen adult male Sprague-Dawley rats weighing between 280 and 300 g were used for the study. Rats were divided into 5 groups. Controls received craniotomy only. The injury group underwent cold injury and had no medication. In the EPO group, a single dose of 1000 IU/kg body weight of EPO was administered. The DSP group received 0.2 mg/kg body weight of DSP. The vehicle group received a vehicle solution containing human serum albumin, which is the solvent for EPO. Brain edema was formed by cold injury using metal sterile rods with a diameter of 4 mm that were previously cooled at -80 degrees C. Twenty-four hours after the injury, animals were decapitated and brain tissues were investigated for brain edema, tissue MPO and caspase-3 levels, and ultrastructure.

RESULTS: A significant increase in brain water content was revealed in injury group of rats at 24 hours after cold injury. Injury significantly increased tissue MPO and caspase-3 levels and resulted in ultrastructural damage. Both EPO and DSP markedly decreased tissue MPO and caspase-3 levels and preserved ultrastructure of the injured brain cortex.

CONCLUSIONS: Erythropoietin and DSP were found to be neuroprotective in cold injury-induced brain edema model in rats via anti-apoptotic and anti-inflammatory actions.

PMID: 18291472 [PubMed - as supplied by publisher]

Comparison of obstructive sleep apnea patients with and without leg edema

Comparison of obstructive sleep apnea patients with and without leg edema.

Sleep Med. 2008 Feb 11

Iftikhar I, Ahmed M, Tarr S, Zyzanski SJ, Blankfield RP.
Department of Internal Medicine, Fairview Hospital, Cleveland Clinic System, Cleveland, OH, United States.

BACKGROUND: To determine the proportion of patients with obstructive sleep apnea (OSA) who have leg edema, and to identify differences between edematous and non-edematous OSA patients.

METHODS: Retrospective, cross-sectional study of 378 patients with OSA (apnea/hypopnea index [AHI] 15) who had neither heart failure nor chronic lung disease.

RESULTS: Thirty-five percent (133/378) of the subjects with OSA had bilateral leg edema. Eighty-one percent (108/133) of the edematous subjects had mild pitting that was 1+. Compared to the non-edematous OSA subjects, the edematous subjects were older (age=51+/-13 versus 45+/-13 years, p=0.001), more obese (body mass index=39+/-9 versus 33+/-8kg/m(2), p=0.001), had more severe OSA (AHI=46+/-71 versus 27+/-29, p=0.004), spent a greater proportion of sleep time with an oxygen saturation <90% p="0.001)," p="0.001)" p="0.001)." p="0.04).

CONCLUSIONS: Approximately one-third of OSA patients have edema. Edematous OSA patients are older, more obese, more likely to have diabetes mellitus and hypertension, and have more severe OSA than OSA patients who lack edema.

Elsevier

Short-term Safety and Efficacy of Intravitreal Triamcinolone Acetonide for Uveitic Macular Edema in Children.

Short-term Safety and Efficacy of Intravitreal Triamcinolone Acetonide for Uveitic Macular Edema in Children.
Arch Ophthalmol. 2008 Feb

Sallam A, Comer RM, Chang JH, Grigg JR, Andrews R, McCluskey PJ, Lightman S.
Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 2PD, England. s.lightman@ucl.ac.uk.

OBJECTIVES: To evaluate the short-term safety and efficacy of intravitreal (IV) triamcinolone acetonide (TA) for treating pediatric cystoid macular edema (CME) secondary to noninfectious uveitis.

METHODS: A retrospective noncomparative interventional case series. The medical records of 15 consecutive children (16 eyes) with uveitic CME treated with IVTA (2 or 4 mg) were reviewed. Data collected included details of uveitis, CME, visual acuity, intraocular pressure, and cataract development. The median follow-up time was 16 months (range, 9-36 months).

RESULTS: Resolution of CME was achieved in all of the treated eyes. The median time taken for CME to resolve was 3 weeks (range, 1-24 weeks). The mean improvement of visual acuity after IVTA was 0.6 logarithm of the minimum angle of resolution. Following initial response to IVTA, CME relapsed in 5 eyes (31%) after a median time of 7 months (range, 3-13 months). The most common adverse effect was increased intraocular pressure, with an increase of more than 15 mm Hg in 5 eyes (31%). Steroid-induced cataract was observed in 6 of 11 phakic eyes (55%).

CONCLUSIONS: We found that IVTA is efficacious in the treatment of uveitic CME in children and results in CME resolution and visual acuity improvement. As in adults, treatment in children may be associated with elevated intraocular pressure and cataract.

Journal of Ophthalmology

Bone marrow edema pattern in advanced hip osteoarthritis

Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology.

Skeletal Radiol. 2008 Feb 15
Taljanovic MS, Graham AR, Benjamin JB, Gmitro AF, Krupinski EA, Schwartz SA, Hunter TB, Resnick DL.

Department of Radiology, The University of Arizona HSC, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA, mihrat@radiology.arizona.edu.

OBJECTIVE: To correlate the amount of bone marrow edema (BME) calculated by magnetic resonance imaging(MRI) with clinical findings, histopathology, and radiographic findings, in patients with advanced hip osteoarthritis(OA).

MATERIALS AND METHODS: The study was approved by The Institutional Human Subject Protection Committee. Coronal MRI of hips was acquired in 19 patients who underwent hip replacement. A spin echo (SE) sequence with four echoes and separate fast spin echo (FSE) proton density (PD)-weighted SE sequences of fat (F) and water (W) were acquired with water and fat suppression, respectively. T2 and water:fat ratio calculations were made for the outlined regions of interest. The calculated MRI values were correlated with the clinical, radiographic, and histopathologic findings.

RESULTS: Analyses of variance were done on the MRI data for W/(W + F) and for T2 values (total and focal values) for the symptomatic and contralateral hips. The values were significantly higher in the study group. Statistically significant correlations were found between pain and total W/(W + F), pain and focal T2 values, and the number of microfractures and calculated BME for the focal W/(W + F) in the proximal femora. Statistically significant correlations were found between the radiographic findings and MRI values for total W/(W + F), focal W/(W + F) and focal T2 and among the radiographic findings, pain, and hip movement. On histopathology, only a small amount of BME was seen in eight proximal femora.

CONCLUSION: The amount of BME in the OA hip, as measured by MRI, correlates with the severity of pain, radiographic findings, and number of microfractures.

PMID: 18274742 [PubMed - as supplied by publisher]

Effects of medroxyprogesterone acetate on cerebral edema

Effects of medroxyprogesterone acetate on cerebral oedema and spatial learning performance after traumatic brain injury in rats.

Brain Inj. 2008 Feb

Wright DW, Hoffman SW, Virmani S, Stein DG.
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Background: Given after brain injury (TBI), progesterone reduces cerebral oedema and facilitates functional recovery. Progesterone analogues have been synthesized for use in many medical conditions and exhibit different chemical and biological properties.

Medroxyprogesterone acetate (MPA) is widely used in clinical practice, but oestrogen/MPA combinations may increase the risk of stroke and cardiovascular disease rather than preventing them. In some conditions, MPA can exhibit pharmacological actions that are different from those of natural progesterone.

Primary objective and hypothesis: Using laboratory rats, this study assessed the efficacy of MPA to determine whether this progestin and natural progesterone exert similar effects as a treatment after bilateral injury to the frontal cortex.

Main outcomes and results: MPA produced a dose-related reduction of cerebral oedema at 48 hours post-TBI but neither 4 nor 16 mg/kg doses of MPA enhanced behavioural recovery.

Conclusion: These findings help to clarify the divergent results from prior positive progesterone studies and the negative MPA clinical trials for hormone replacement therapy. The results can be taken to suggest that the control of cerebral oedema, while clearly desirable, is not the only contributor to progesterone-induced behavioural recovery.

Informa Healthcare