Pleuroperitoneal shunt insertion for super-aged elderly patients with intractable pleural effusion

Both osteoporotic fractures and pleural effusions are frequently observed in medicine. However, rarely does one associate a hemorrhagic pleural effusion with a thoracic spinal fracture when the patient has not sustained massive trauma. In this paper, we discuss two cases where seemingly insignificant low-energy trauma precipitated massive haemothoraces in elderly patients with underlying osteoporosis, ultimately resulting in their immediate causes of death. This paper serves to remind health care professionals of the importance of using caution when moving elderly patients as well as to consider thoracic spinal fracture as a potential explanation for a hemorrhagic pleural effusion of undetermined etiology.

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Successful Treatment with S-1 and Oxaliplatin Combination Therapy in an Elderly Patient with Metastatic Colorectal Cancer Initially Presenting with Membranous Nephropathy

Case Reports in Oncology ◽

10.1159/000382119 ◽

2015 ◽

Vol 8 (1) ◽

pp. 212-216

Author(s):

Mototsugu Matsunaga ◽

Keisuke Miwa ◽

Yosuke Oka ◽

Tomoyuki Ushijima ◽

Kotaro Yuge ◽

...

Keyword(s):

Colorectal Cancer ◽

Pleural Effusion ◽

Elderly Patients ◽

Membranous Nephropathy ◽

Abdominal Ct ◽

Good Tolerability ◽

Systemic Complications ◽

Metastatic Lesions ◽

Number Of Patients ◽

Left Pleural Effusion

The incidence, morbidity, and mortality of colorectal cancer are increasing, largely owing to an increasingly aging population. Additionally, along with the increasing age of cancer patients, the number of patients with various comorbidities such as membranous nephropathy is also rising, and problems associated with the administration of chemotherapy to elderly patients with these conditions are becoming more common. Herein, we describe a case involving an 80-year-old woman who presented with general malaise, edematous limbs, and pleural effusion. An abdominal CT revealed multiple, relatively large, metastatic lesions in a wide area of the liver and left pleural effusion, and she was accordingly diagnosed with membranous nephropathy secondary to ascending colon cancer and multiple liver metastases. Despite her advanced age and the presence of membranous nephropathy, her general condition was favorable and chemotherapy was hence administered. Taking the toxicity profiles and the patient's preference into consideration, S-1 and oxaliplatin (SOX) therapy was selected, which showed a good tolerability. An abdominal CT after 8 cycles of SOX therapy revealed a marked reduction in the metastatic lesions in the liver and a decrease in the left pleural effusion, and the levels of tumor markers also decreased (partial response). At the latest follow-up, after the completion of 16 cycles, the condition of the patient remained stable, without any apparent signs of progressive disease. Based on this case, we conclude that, even for elderly patients with systemic complications or comorbid diseases, standard treatments should be considered after their general conditions, and therapeutic regimens have been sufficiently examined.

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Perinatal outcome following fetal chest shunt insertion for pleural effusion

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.7507 ◽

2009 ◽

Vol 36 (1) ◽

pp. 58-64 ◽

Cited By ~ 54

Author(s):

Y. Yinon ◽

S. Grisaru-Granovsky ◽

V. Chaddha ◽

R. Windrim ◽

P. G. R. Seaward ◽

...

Keyword(s):

Pleural Effusion ◽

Perinatal Outcome ◽

Shunt Insertion

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Malignant pleural effusion in elderly patients

Lung Cancer ◽

10.1016/s0169-5002(99)90814-0 ◽

1999 ◽

Vol 25 ◽

pp. S38

Author(s):

J. Zdravkovic

Keyword(s):

Pleural Effusion ◽

Elderly Patients ◽

Malignant Pleural Effusion

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PLEURODESIS WITH CARBOPLATIN IN ELDERLY PATIENTS WITH MALIGNANT PLEURAL EFFUSION AND LUNG ADENOCARCINOMA

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2006.00668_9.x ◽

2006 ◽

Vol 54 (4) ◽

pp. 722-723 ◽

Cited By ~ 2

Author(s):

Takahiko Sasaki ◽

Hiroyasu Yasuda ◽

Katsutoshi Nakayama ◽

Masanori Asada ◽

Shoji Okinaga ◽

...

Keyword(s):

Pleural Effusion ◽

Elderly Patients ◽

Lung Adenocarcinoma ◽

Malignant Pleural Effusion

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Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

10.21203/rs.3.rs-21428/v1 ◽

2020 ◽

Author(s):

Xiudi Han ◽

Xuedong Liu ◽

Liang Chen ◽

Yimin Wang ◽

Hui Li ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Pleural Effusion ◽

Elderly Patients ◽

Clinical Outcomes ◽

Logistic Regression Analysis ◽

Community Acquired Pneumonia ◽

Multivariable Logistic Regression Analysis ◽

Clinical Failure

Abstract Background: The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). Methods: 3,011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis. Results: The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH<7.3, PaO 2 /FiO 2 < 200 mmHg, sodium <130 mmol/L, healthcare-associated pneumonia, white blood cells >10000/mm 3 , pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors. Conclusions: Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP. Trial registration : A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb

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Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

BMC Infectious Diseases ◽

10.1186/s12879-020-05362-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiudi Han ◽

◽

Xuedong Liu ◽

Liang Chen ◽

Yimin Wang ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Pleural Effusion ◽

Elderly Patients ◽

Clinical Outcomes ◽

Logistic Regression Analysis ◽

Community Acquired Pneumonia ◽

Multivariable Logistic Regression Analysis ◽

Clinical Failure

Abstract Background The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). Methods 3011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis. Results The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH < 7.3, PaO2/FiO2 < 200 mmHg, sodium < 130 mmol/L, healthcare-associated pneumonia, white blood cells > 10,000/mm3, pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors. Conclusions Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP. Trial registration A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb

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Dyspnea, Massive Effusion and Lytic Rib Lesion as Initial Presentation of Multiple Myeloma in a Young Man

Canadian Respiratory Journal ◽

10.1155/2013/242045 ◽

2013 ◽

Vol 20 (4) ◽

pp. 253-255 ◽

Cited By ~ 2

Author(s):

Mohammed H AlShati ◽

Ramesh Kumar ◽

Shreeram Kannan

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Pleural Effusion ◽

Elderly Patients ◽

Plasma Cells ◽

Young Age ◽

Initial Presentation ◽

Chest Imaging ◽

Spontaneous Hemothorax ◽

Plain Chest

Multiple myeloma, a disorder commonly encountered in elderly patients, represents a malignant proliferation of plasma cells that primarily affects bone marrow. Pleural effusion as the presenting manifestation of the disease is uncommon. The authors report a case of multiple myeloma with unusual features presenting at a relatively young age with massive spontaneous hemothorax and multiple thoracic masses completely obscuring rib shadow on plain chest imaging. The patient demonstrated a good response to melphalan chemotherapy without recurrence of effusion or the need for additional chemical or surgical pleural interventions.

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Ventriculopleural shunts in a pediatric population: a review of 170 consecutive patients

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.3.peds2176 ◽

2021 ◽

Vol 28 (4) ◽

pp. 450-457

Author(s):

Eisha A. Christian ◽

Jeffrey J. Quezada ◽

Edward F. Melamed ◽

Carolyn Lai ◽

J. Gordon McComb

Keyword(s):

Pleural Effusion ◽

Los Angeles ◽

Pediatric Population ◽

Technical Difficulty ◽

Shunt Infection ◽

Pleural Space ◽

Complication Rates ◽

Shunt Valve ◽

Shunt Insertion ◽

Distal Catheter

OBJECTIVE The authors sought to determine the outcome of using the pleural space as the terminus for ventricular CSF-diverting shunts in a pediatric population. METHODS All ventriculopleural (VPl) shunt insertions or revisions done between 1978 and 2018 in patients at Children’s Hospital Los Angeles were identified. Data recorded for analysis were age, sex, weight, etiology of hydrocephalus, previous shunt history, reason for VPl shunt insertion or conversion from a ventriculoperitoneal (VP) or ventriculoatrial (VA) shunt, valve type, nature of malfunction, presence of shunt infection or pleural effusion, and conversion to a different distal site. RESULTS A total of 170 patients (mean age 14 ± 4 years) with a VPl shunt who were followed up for a mean of 57 ± 53 months were identified. The reasons for conversion to a VPl shunt for 167 patients were previous shunt infection in 57 (34%), multiple abdominal procedures in 44 (26%), inadequate absorption of CSF in 34 (20%), abdominal pseudocyst in 25 (15%), and obesity in 7 (4%). No VPl revisions were required in 97 (57%) patients. Of the 73 (43%) patients who did require revision, the most common reason was proximal obstruction in 32 (44%). The next most frequent complication was pleural effusion in 22 (30%) and included 3 patients with shunt infection. All 22 patients with a clinically significant pleural effusion required changing the distal end of the shunt from the pleural space. Pleural effusion was more likely to occur in VPl shunts without an antisiphon valve. Of the 29 children < 10 years old, 7 (24%) developed a pleural effusion requiring a revision of the distal catheter to outside the pleural space compared with 15 (11%) who were older (p = 0.049). There were 14 shunt infections with a rate of 4.2% per procedure and 8.2% per patient. CONCLUSIONS VPl shunts in children younger than 10 years of age have a significantly higher rate of symptomatic pleural effusion, requiring revision of the shunt’s terminus to a different location. VPl shunt complication rates are similar to those of VP shunts. The technical difficulty of inserting a VPl shunt is comparable to that of a VP shunt. In a patient older than 10 years, all else being equal, the authors recommend that the distal end of a shunt be placed into the pleural space rather than the right atrium if the peritoneal cavity is not suitable.

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Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

10.21203/rs.3.rs-21428/v2 ◽

2020 ◽

Author(s):

Xiudi Han ◽

Xuedong Liu ◽

Liang Chen ◽

Yimin Wang ◽

Hui Li ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Pleural Effusion ◽

Elderly Patients ◽

Clinical Outcomes ◽

Logistic Regression Analysis ◽

Community Acquired Pneumonia ◽

Multivariable Logistic Regression Analysis ◽

Clinical Failure

Abstract Background: The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP).Methods: 3,011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis.Results: The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH<7.3, PaO2/FiO2 < 200 mmHg, sodium <130 mmol/L, healthcare-associated pneumonia, white blood cells >10000/mm3, pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors.Conclusions: Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP.Trial registration: A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb

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