Intrapericardial cisplatin combined with oral colchicine resulted in long term control of malignant pericardial effusion in the course of metastatic renal cancer.

Background Neoplastic pericardial effusion (NPE) represents a common cause of morbidity and mortality in patient with cancer. NPE presents frequently as cardiac tamponade, requiring urgent pericardiocentesis or pericardiotomy, with subsequent pericardial fluid drainage. Despite high effectiveness of such procedures, the recurrence of effusion is noted in 30- 60% of patients. Intrapericardial therapy with cisplatin was found to be effective in NPE due to lung and breast cancer. Its role in cardiac tamponade due to renal cancer is unknown. Case presentation We presented 82-year-old man with renal cancer who was admitted to the Intensive Care Unit because of threatening pericardial tamponade due to NPE . Urgent subxiphoid pericardiotomy was performed with subsequent evacuation of 1000ml of bloody fluid. On the inner surface of the pericardium several pink nodules were found. Histological examination revealed carcinoma clarocellulare. In view of the persistent high drainage of the pericardium, intrapericardial cisplatin therapy was performed. The first day after surgery colchicine 0.5 mg/day/po was also introduced. No side effects of this treatment were observed. The patient died 12- month later due to cancer progression and cachexia. No recurrence of pericardial effusion was observed. Conclusion This is the first case study demonstrating long-term efficacy and safety of intrapericardial cisplatin combined with oral colchicine in NPE due to metastatic renal cell carcinoma.

Intrapericardial fibrinolysis in purulent pericarditis-case report.

Purulent pericarditis (PP) continues to result in a very serious prognosis and high mortality. The most serious complication of pericarditis is constriction. Intrapericardial administration of fibrinolytic agents, although controversial, can prevent the development of constrictions. We present the case of a 63-year-old man with purulent inflammation of the right knee who was admitted to the intensive care unit (ICU) via emergency room orthopedic evaluation because of purulent pericarditis. Subxiphoid pericardiotomy was urgently performed, with 1200 ml of thick purulent fluid evacuated. As prevention for pericardial constriction, it was decided to administer fibrinolysis to the patient's pericardial cavity. Administration of streptokinase was complicated by the occurrence of a severe retrosternal pain and intrapericardial bleeding. Due to insufficiency of antibiotic therapy, 17 days after complicated fibrinolytic therapy with streptokinase, it was decided to administer 20 mg of r-tPA directly into the pericardium. In the following days, there remained a high drainage of purulent secretions. Fever up to 38 °C was still observed despite the use of antibiotics. Nine days after first administration of r-tPA, it was decided to apply the next dose. Daily drainage decreased from 50 to 20 ml in successive days. No fluid accumulation and symptoms and signs of constrictions were observed in clinical examinations as well as in echocardiography performed during 7 years follow-up after discharge.

Pulmonary artery stenosis due to embryonal carcinoma with primary mediastinal location.

A 29-year old man was admitted to the intensive care unit after losing consciousness. On physical examination, a loud systolic murmur over the heart was found. Echocardiography revealed narrowing of pulmonary artery with high pressure gradient. Computed tomography of the chest revealed the presence of large tumour localised in the upper anterior mediastinum. Due to the risk of total closure of the pulmonary artery, interventional mediastinotomy was performed and diagnosis of carcinoma embryonale was established. Subsequent chemotherapy (BEP regimen) has brought regression of tumour and significant improvement in haemodynamic parameters (relief of pressure gradient in pulmonary artery). During the second surgery, the resection of all accessible tumour mass together with marginal resection of the right upper lobe was performed. No signs of cardiac or great vessels infiltration was found. Histopathologic examination revealed the necrotic masses and neoplastic foci diagnosed as teratoma immaturum. In a four-month follow-up the patient's condition remained good. The patient is still under the care of both oncological and cardiological specialists. Thus far he has not required further chemotherapy. Holter ECG monitoring revealed no arrhythmia, but the patient is still treated with mexiletine. The patient is planning to return to work.

Recurrent hemoptysis: an emerging life-threatening complication in idiopathic pulmonary arterial hypertension.

Hemoptysis is a rarely reported complication of idiopathic pulmonary arterial hypertension (IPAH). We present the case of a 27-year-old woman with IPAH, who suffered from recurrent hemoptysis and who was treated with sitaxsentan and treprostinil and remained stable in World Health Organization functional class II. During several episodes of active hemoptysis, the patient underwent bronchial artery embolization (BAE), always with good immediate results. She developed severe respiratory insufficiency and died of electromechanical dissociation 2 days after another episode, despite effective bleeding control. Recurrent hemoptysis in patients with IPAH emerges as a potential indication for urgent placement on the lung transplant list, independent from the classic prognostic factors of functional class and indices of right-sided ventricular function. Repeated BAE should not be considered as a definitive treatment in patients with pulmonary arterial hypertension with recurrent bleeding, although it may help in bridging patients to lung transplant.