A New Treatment for Unilateral Recurrent Hydrothorax during CAPD

1985 ◽  
Vol 5 (3) ◽  
pp. 180-181 ◽  
Author(s):  
Jannis Vlachojannis ◽  
Ivar Boettcher ◽  
Lothar Brandt ◽  
Wilhelm Schoeppe
Keyword(s):  
Peritoneal Dialysis ◽  
Triamcinolone Acetonide ◽  
Rare Complication ◽  
Pleural Space ◽  
Visceral Pleura ◽  
Pleural Effusions ◽  
Fibrin Adhesive ◽  
Fibrin Adhesion ◽  
Non Invasive ◽  
New Treatment

A 46-year-old woman undergoing CAPD developed a recurring right sided hydrothorax. Instillation of tetracycline HCI and triamcinolone acetonide did not correct the condition. However application of a fibrin adhesive (Tissucol) made it possible to achieve permanent adhesion of the pleural layers. This paper descrubes the method in detail. The development of pleural effusions in patients undergoing peritoneal dialysis, although a rare complication, can lead to the interruption of CAPD (2,3). As treatment, several workers have provoked the adhesion of parietal and visceral pleura by instillation tetracycline HCI or triamcinolone acetonide into the pleural space (6). As this report shows, these approaches failed in one patient and we achieved pennanent correction of this hydrothorax by employing a non-invasive, fibrin-adhesion technique.

scholarly journals Talcoma: A Diagnostic Challenge in Differential Diagnosis of Pleural Masses

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Iclal Ocak ◽  
Rohit Dewan
Keyword(s):  
Differential Diagnosis ◽  
Present Report ◽  
Rare Complication ◽  
Pleural Space ◽  
Pleural Effusions ◽  
Diagnostic Challenge ◽  
Talc Pleurodesis

Talcoma is a pleural mass which may develop as a rare complication following talc pleurodesis. Talc pleurodesis is performed to obliterate the pleural space to prevent recurrent pleural effusions or persistent pneumothoraces. The present report describes a case of a patient who developed enlarging pleural mass (talcoma) following talc pleurodesis.

Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

2020 ◽  
Vol 13 (4) ◽  
pp. 184-190
Author(s):  
Muhammad Irfan ◽  
Abdul Rasheed Qureshi ◽  
Zeeshan Ashraf ◽  
Muhammad Amjad Ramzan ◽  
Tehmina Naeem ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Diagnostic Efficacy ◽  
Chest Sonography ◽  
X Ray ◽  
Non Invasive ◽  
Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

scholarly journals Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

2021 ◽  
Author(s):  
Ayah Megahed ◽  
Rahul Hegde ◽  
Pranav Sharma ◽  
Rahmat Ali ◽  
Anas Bamashmos
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pleural Fluid ◽  
Rare Complication ◽  
Delayed Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pleural Effusions ◽  
Diagnostic Challenge ◽  
Abdominal Symptoms ◽  
Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

scholarly journals Chronic Pleural Effusions Secondary to Peritoneal Dialysis

CHEST Journal ◽  
2016 ◽  
Vol 150 (4) ◽  
pp. 587A
Author(s):  
Kunal Chawla ◽  
Amish Shah ◽  
Leena Pawar ◽  
Kristine Soltanpour ◽  
Samana Zaidi
Keyword(s):  
Peritoneal Dialysis ◽  
Pleural Effusions

Intra-Peritoneal Pseudocyst as a Rare Complication After Peritoneal Dialysis: The Use of a Staged Surgical Approach in Management

2021 ◽  
pp. 000313482110474
Author(s):  
Ahmad Kharsa ◽  
Kayla Colvill ◽  
Heather Stevenson ◽  
Jeffrey Fair ◽  
Rupak Kulkarni ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Approach ◽  
Rare Case ◽  
Diagnostic Laparoscopy ◽  
Rare Complication ◽  
Cyst Excision ◽  
Neoplastic Processes ◽  
Life Threatening ◽  
Pseudocyst Formation

Despite its numerous benefits, peritoneal dialysis (PD) can rarely result in dangerous and even life-threatening complications, including peritonitis, hernias, encapsulating peritoneal sclerosis (EPS), and rarely peritoneal pseudocysts. Herein, we present a rare case of a giant intra-peritoneal pseudocyst that presented four months following the discontinuation of a 5-year course of complicated PD. Despite the initially successful drainages, the patient’s symptoms continued to recur, and the imaging findings were concerning for underlying neoplastic processes. As such, a staged surgical approach was performed, starting with a diagnostic laparoscopy and was subsequently followed with cyst excision and marsupialization to the peritoneal cavity. While previous reports of such rare pseudocyst have been documented in the literature as a complication of PD, to our knowledge, this is the second case of pseudocyst formation to occur months after the discontinuation of PD therapy. This case emphasizes the importance of close follow-up in PD patients and showcases how a staged surgical approach can be utilized to accurately diagnose and manage such complicated cases.

Pleural Effusions: Diagnostic Considerations

1995 ◽  
Vol 16 (2) ◽  
pp. 79-79
Author(s):  
Jeffrey M. Ewig
Keyword(s):  
Chest Pain ◽  
Pleural Space ◽  
Pleural Effusions ◽  
Pleuritic Chest Pain ◽  
Radiographic Appearance ◽  
Air Bubble ◽  
Presenting Symptoms ◽  
Breath Sounds ◽  
Costophrenic Angle ◽  
Pleural Involvement

The presence of fluid in the pleural space can be seen in a variety of disorders. Presenting symptoms include dyspnea, pleuritic chest pain, and ipsilateral shoulder pain if pleural involvement occurs at the central portion of the diaphragm. Physical examination findings include chest asymmetry, diminished breath sounds, dullness to percussion, and decreased tactile fremitus. In an upright patient, the radiographic appearance of pleural fluid includes blunting of the costophrenic angle, straightening or a more lateral peak of the hemidiaphragm contour, simulation of an elevated hemidiaphragm, or a distance of greater than 2 cm between the gastric air bubble and the lung.

CAPD Catheter Exit-Site and Tunnel Infection with Fungal Etiology—Treatment and Catheter Reinsertion for an Extremely Rare Complication

2017 ◽  
Vol 37 (2) ◽  
pp. 237-239
Author(s):  
Manmeet Singh Jhawar ◽  
Jasmin Das ◽  
Pratish George ◽  
Anil Luther
Keyword(s):  
Candida Albicans ◽  
Peritoneal Dialysis ◽  
Case Report ◽  
Fungal Infection ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Rare Complication ◽  
Exit Site ◽  
Duration Of Therapy ◽  
Tunnel Infection ◽  
Few Data

Fungal infection is an extremely rare etiology of exit-site and tunnel infection in patients on continuous ambulatory peritoneal dialysis (CAPD). There are few data available regarding its management—especially choice of antifungals, duration of therapy, and removal of catheter. There are no guidelines pertaining to reinsertion of the CAPD catheter following fungal exit-site and tunnel infection. This case report highlights Candida albicans as a rare cause of exit-site and tunnel infection of the CAPD catheter. The catheter was removed and the patient received appropriate antifungal therapy followed by reinsertion of the CAPD catheter and re-initiation on CAPD.

scholarly journals Adaptive Magnetic Resonance-Guided Stereotactic Body Radiotherapy: The Next Step in the Treatment of Renal Cell Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Brian Keller ◽  
Anna M. E. Bruynzeel ◽  
Chad Tang ◽  
Anand Swaminath ◽  
Linda Kerkmeijer ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Oncologic Outcomes ◽  
Invasive Treatment ◽  
Non Invasive ◽  
Treatment Paradigm ◽  
Plan Adaptation ◽  
New Treatment ◽  
Tissue Sparing

Adaptive MR-guided radiotherapy (MRgRT) is a new treatment paradigm and its role as a non-invasive treatment option for renal cell carcinoma is evolving. The early clinical experience to date shows that real-time plan adaptation based on the daily MRI anatomy can lead to improved target coverage and normal tissue sparing. Continued technological innovations will further mitigate the challenges of organ motion and enable more advanced treatment adaptation, and potentially lead to enhanced oncologic outcomes and preservation of renal function. Future applications look promising to make a positive clinical impact and further the personalization of radiotherapy in the management of renal cell carcinoma.

Lung Ultrasound to Detect Pneumothorax or Mainstem Intubation

2021 ◽  
pp. 11-18
Author(s):  
J. Devin Roberts ◽  
Anna Clebone
Keyword(s):  
Pulmonary Edema ◽  
Chest Radiograph ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Parietal Pleura ◽  
Visceral Pleura ◽  
Pleural Effusions ◽  
Ultrasound Probe ◽  
Handheld Ultrasound

Chapter 2 covers the use of lung ultrasound to detect pneumothorax and mainstem intubation. In healthy patients, a layer of visceral pleura will slide on the parietal pleura with every breath. This can be readily imaged with a handheld ultrasound probe at the point of care, and this information can be used for diagnosis of pneumothorax or mainstem intubation. Lung ultrasound can also help the clinician to visualize pleural effusions or pulmonary edema. When trying to diagnose pneumothorax by imaging, lung ultrasound is more accurate for ruling pneumothorax in (level B evidence) or out (level A evidence) than supine anterior chest radiograph.

Sleep apnoea: treatment options and sleep/cardiovascular outcome

ESC CardioMed ◽  
2018 ◽  
pp. 1065-1069
Author(s):  
Holger Woehrle ◽  
Michael Arzt
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Invasive Ventilation ◽  
Adaptive Servo Ventilation ◽  
Central Sleep Apnoea ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
New Treatment

In addition to lifestyle interventions, treatments for obstructive sleep apnoea focus on maintaining upper airway patency. Continuous positive airway pressure (CPAP) is recommended as first-line therapy. Beneficial cardiovascular effects of CPAP include increased intrathoracic pressure, reduced left ventricular preload and afterload, and reduced transmural cardiac pressure gradients. CPAP also reduces nocturnal ischaemia and blood pressure, and decreases the risk of post-treatment atrial fibrillation recurrence. However, secondary prevention with CPAP did not significantly reduce the rate of major cardio- and cerebrovascular events in the SAVE study. Mandibular advancement devices, surgery, and upper airway stimulation are options for patients unwilling to use or tolerate CPAP. Central sleep apnoea and Cheyne–Stokes respiration are common in patients with heart disease, especially heart failure. Adaptive servo-ventilation is the most effective therapy for alleviating central sleep apnoea with Cheyne–Stokes respiration. However, it is now contraindicated in heart failure patients with an ejection fraction of 45% or lower and predominant central sleep apnoea because of an increased risk of cardiovascular death, based on SERVE-HF study results. However, adaptive servo-ventilation may still have a role in other settings, including heart failure with preserved ejection fraction. Phrenic nerve stimulation is a new treatment modality that has shown promising results in a feasibility study. Hypoventilation is another breathing disorder that needs effective management. Data in cardiovascular disease are lacking, but CPAP and non-invasive ventilation have been shown to be effective in patients with obesity hypoventilation syndrome. Furthermore, effective reduction of chronic hypercapnia during home non-invasive ventilation treatment in patients with chronic obstructive pulmonary disease has been shown to significantly improve survival.

Sign in / Sign up

Export Citation Format

Share Document