Assuntos
Ascite/tratamento farmacológico , Compostos Benzidrílicos/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Glucosídeos/uso terapêutico , Hidrotórax/tratamento farmacológico , Cirrose Hepática Biliar/complicações , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Ascite/etiologia , Feminino , Humanos , Hidrotórax/etiologia , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Objective To measure the rate of the A2063G mutation in the Mycoplasma pneumoniae ( M. pneumoniae) 23S rRNA domain V in children with pneumonia and to determine the correlation between radiographic findings and the presence of the A2063G mutation. Methods Patients who were hospitalized with a confirmed diagnosis of M. pneumoniae pneumonia were enrolled in this study. M. pneumoniae strains were collected for genotype analysis. Chest radiography was performed on all children prior to and following macrolide treatment. Clinical and imaging data were obtained. Results Of 211 patients, 195 (92.42%) harboured M. pneumoniae with the A2063G mutation. No significant differences were identified in inflammation score, chest radiography inflammation absorption grade before and after macrolide treatment, or pulmonary complications (atelectasis, hydrothorax, or pleuritis) prior to macrolide treatment when children were stratified based on the presence or absence of the A2063G mutation. Conclusions A high proportion of children with pneumonia harboured strains of M. pneumoniae with the A2063G mutation in the 23S rRNA domain V. However, no obvious chest radiographic features of M. pneumoniae pneumonia were associated with the A2063G variant.
Assuntos
Hidrotórax/diagnóstico por imagem , Mutação , Mycoplasma pneumoniae/genética , Pleurisia/diagnóstico por imagem , Pneumonia por Mycoplasma/diagnóstico por imagem , Atelectasia Pulmonar/diagnóstico por imagem , RNA Ribossômico 23S/genética , Antibacterianos/farmacologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana/genética , Feminino , Humanos , Hidrotórax/tratamento farmacológico , Hidrotórax/etiologia , Hidrotórax/microbiologia , Macrolídeos/farmacologia , Masculino , Mycoplasma pneumoniae/efeitos dos fármacos , Mycoplasma pneumoniae/crescimento & desenvolvimento , Mycoplasma pneumoniae/isolamento & purificação , Pleurisia/tratamento farmacológico , Pleurisia/etiologia , Pleurisia/microbiologia , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/microbiologia , Atelectasia Pulmonar/tratamento farmacológico , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/microbiologia , RadiografiaRESUMO
BACKGROUND: Primary fetal hydrothorax (PFHT) is an uncommon condition with an estimated prevalence of 1 in 10,000/15,000 pregnancies. Therapeutic interventions include thoracocentesis, thoraco-amniotic shunting (TAS), and pleurodesis using OK-432. METHODS: A review of the literature was performed to identify all cases of PFHT treated with TAS and OK-432. All cases of PFHT referred to the Fetal Maternal Unit at Royal Prince Alfred Hospital between 2002 and 2012 were retrospectively reviewed. In the cohort of fetuses treated with OK-432, the main perinatal outcomes evaluated were termination of pregnancy, live birth, neonatal death, and fetal death in utero. Secondary outcomes included gestational age (GA) at diagnosis, GA at treatment, GA at resolution, birth weight, and GA at birth. The development of the children was screened using the Ages and Stages Questionnaires, Version 3 (ASQ-3, 2009). RESULTS: Primary hydrothorax was diagnosed in 31 fetuses, of which 14 had treatment with OK-432. One pregnancy terminated after treatment with OK-432. Survival was 85% (11/13): 100% in fetuses treated with OK-432 without hydrops, and 78% in those treated with hydrops. This compares well to the cases of TAS in the literature with an average survival of 63%: 85% in fetuses without hydrops and 55% with hydrops. The mean GA at birth was 36(+4) weeks and mean birth weight 3,007 g. Eight of the 9 children screened with ASQ-3 scored well within the normal range. CONCLUSION: OK-432 appears to be a valid treatment option in fetuses with PFHT, particularly in those diagnosed at early GAs.
Assuntos
Doenças Fetais/tratamento farmacológico , Hidrotórax/tratamento farmacológico , Picibanil/uso terapêutico , Feminino , Doenças Fetais/diagnóstico por imagem , Idade Gestacional , Humanos , Hidrotórax/diagnóstico por imagem , Masculino , Gravidez , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Pré-NatalRESUMO
Hepatic hydrothorax is defined as a pleural effusion in patients with liver cirrhosis in the absence of cardiopulmonary disease. The estimated prevalence among patients with liver cirrhosis is approximately 5-6%. The pathophysiology involves the passage of ascitic fluid from the peritoneal cavity to the pleural space through diaphragmatic defects. The diagnosis is made from clinical presentation and confirmed by diagnostic thoracentesis with pleural fluid analysis. The initial medical management is sodium restriction and diuretics, but liver transplantation provides the only definitive therapy. For patients who are not transplant candidates and those who await organ availability, other therapeutic modalities that are to be considered include transjugular intrahepatic portosystemic shunt placement, videoassisted thoracoscopic surgery repair, pleurodesis, and vasoconstrictors (eg, octreotide and terlipressin). The primary therapeutic goals are to reduce ascitic fluid production and improve symptoms to bridge the time for liver transplantation.
Assuntos
Doença Hepática Terminal/tratamento farmacológico , Doença Hepática Terminal/terapia , Hidrotórax/tratamento farmacológico , Hidrotórax/terapia , Doença Hepática Terminal/complicações , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/fisiopatologia , Doença Hepática Terminal/cirurgia , Humanos , Hidrotórax/complicações , Hidrotórax/diagnóstico , Hidrotórax/fisiopatologia , Hidrotórax/cirurgia , Transplante de Fígado , Pleurodese , Derivação Portossistêmica Transjugular Intra-HepáticaRESUMO
Hepatic hydrothorax is defined as a pleural effusion in patients with liver cirrhosis without primary cardiac, pulmonary or pleural disease. It is a rare but important cause of unilateral-pleural effusion. The prevalence of this complication is 5-10% of the total number of patients with advanced stages of cirrhosis. In most cases (85%), the effusion is right-sided; however, in 13% of cases it can be left-sided and bilateral in 2% of the cases. We present a case of left-sided hepatic hydrothorax in the absence of ascites in a patient with primary biliary cirrhosis. The diagnosis of cirrhosis was confirmed by the biopsy;the patient didn't have any history or any signs or symptoms of cirrhosis prior to her presentation. In the case described, the patient was treated with spirnolactone, furosemide and ursodeoxycholic acid. At follow-up after six months since the diagnosis, she was responding to treatment with no complications. This case emphasizes the importance of considering hepatic hydrothorax as an etiology of a transudative pleural effusion regardless of the presence or absence of ascites inpatients with occult cirrhosis.
Assuntos
Hidrotórax/etiologia , Cirrose Hepática Biliar/complicações , Derrame Pleural/etiologia , Biópsia , Quimioterapia Combinada , Feminino , Furosemida/uso terapêutico , Humanos , Hidrotórax/diagnóstico , Hidrotórax/tratamento farmacológico , Cirrose Hepática Biliar/diagnóstico , Cirrose Hepática Biliar/tratamento farmacológico , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural/tratamento farmacológico , Espironolactona/uso terapêutico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ácido Ursodesoxicólico/uso terapêuticoAssuntos
Dispneia/diagnóstico , Hepatomegalia , Hidrotórax/etiologia , Cirrose Hepática/complicações , Derrame Pleural/diagnóstico por imagem , Diuréticos/uso terapêutico , Dispneia/diagnóstico por imagem , Feminino , Humanos , Hidrotórax/diagnóstico , Hidrotórax/dietoterapia , Hidrotórax/tratamento farmacológico , Hipertensão Portal , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural/terapia , Radiografia , Sódio na DietaRESUMO
This study assessed the effect of corticosteroid treatment in the clearance of hydrothoraces in mice. Twenty-four C57BL/6 mice were divided into four groups and were injected intrapleurally with 500 microL sterilized PBS-BSA 1% to create isosmotic hydrothoraces. Two groups served as control and two groups were treated with dexamethasone. The control groups received intraperitoneally PBS, while the corticosteroid treatment groups received dexamethasone (1 mg/kg), both 5 min after the induction of hydrothorax. Control and treated animals were sacrificed 2 and 4 h after the induction of hydrothorax, and pleural fluid volume was measured. The pleural fluid volume 2 and 4 h after the induction of hydrothoraces was significantly lower in the dexamethasone-treated group compared to the untreated group. The rate of pleural fluid absorption 2 and 4 h after the induction of hydrothoraces was significantly higher in the dexamethasone-treated groups. The present study demonstrated that dexamethasone accelerates pleural fluid absorption in induced isosmotic hydrothoraces in mice. This newly reported property of dexamethasone may partly account for the clinical observation of faster resolution of pleural effusions when corticosteroids are administered in patients with pleural effusions of certain etiologies.
Assuntos
Corticosteroides/farmacologia , Dexametasona/farmacologia , Hidrotórax/tratamento farmacológico , Derrame Pleural/tratamento farmacológico , Corticosteroides/uso terapêutico , Animais , Dexametasona/uso terapêutico , Modelos Animais de Doenças , Camundongos , Camundongos Endogâmicos C57BLRESUMO
Hepatitis B virus (HBV) infection is known to be responsible for both hepatic and extrahepatic manifestations including dermatitis, polyarthralgias and arthritis, pulmonary disease, aplastic anemia, glomerulonephritis and vasculitis. The mechanism of these extrahepatic disorders is thought to be linked to immune complex disease, but their pathogenesis is poorly clarified. Immunosuppressive treatment could promote viral load and impair hepatic disease, also worsening the vasculitis by enhancing viral antigenemia. Lamivudine is a nucleoside analogue approved for treating chronic hepatitis B, that decreases the amount of viral antigens by suppressing HBV replication. Several reports have suggested lamivudine in the treatment of vasculitis associated with HBV infection, but, although significant inhibition of HBV is achieved in the short term, resistance develops in 15-32 percent annual risk rating. We report an elderly patient whose chronic hepatitis B decompensated cirrhosis with associated refractory hepatic hydrothorax and extensive leukocytoclastic vasculitis was successfully treated with ongoing long-term lamivudine monotherapy.
Assuntos
Antivirais/uso terapêutico , Hepatite B Crônica/tratamento farmacológico , Lamivudina/uso terapêutico , Cirrose Hepática/virologia , Vasculite Leucocitoclástica Cutânea/virologia , Idoso de 80 Anos ou mais , DNA Viral/sangue , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/genética , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/imunologia , Humanos , Hidrotórax/tratamento farmacológico , Hidrotórax/virologia , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/imunologia , Masculino , Resultado do Tratamento , Vasculite Leucocitoclástica Cutânea/tratamento farmacológico , Vasculite Leucocitoclástica Cutânea/imunologia , Carga Viral , Replicação Viral/efeitos dos fármacosAssuntos
Amiloidose/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Síndrome Nefrótica/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Adulto , Amiloidose/complicações , Amiloidose/patologia , Anticorpos Monoclonais Humanizados , Artrite Juvenil/complicações , Artrite Juvenil/patologia , Ascite/tratamento farmacológico , Ascite/patologia , Feminino , Humanos , Hidrotórax/tratamento farmacológico , Hidrotórax/patologia , Síndrome Nefrótica/etiologia , Síndrome Nefrótica/patologia , Resultado do TratamentoRESUMO
The salt-avid state that accounts for the clinical syndrome congestive heart failure (CHF) leads to an initial expansion of intra- and subsequent rise in extravascular volumes that can include the appearance of pleural effusion. Herein, we present a 54-year-old man with a dilated cardiomyopathy who was hospitalized because of his CHF, which included bilateral pleural effusions, right hydrothorax greater than left. The pathophysiology of pleural fluid formation in CHF, previously debated, has now reached consensus, albeit not frequently reviewed. This index case offers such an opportunity.
Assuntos
Insuficiência Cardíaca/complicações , Derrame Pleural/etiologia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Hidrotórax/diagnóstico por imagem , Hidrotórax/tratamento farmacológico , Hidrotórax/etiologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/tratamento farmacológico , Radiografia , Resultado do TratamentoRESUMO
OBJECTIVE: To present an atypical case of massive ascites and hydrothorax after leuprolide acetate administration in a down-regulated woman undergoing assisted reproduction. DESIGN: Case report. SETTING: Centre for Reproductive Medicine, Department of Obstetrics, Gynaecology, and Neonatology, University of Parma, Parma, Italy. PATIENT(S): A 41-year-old, nulliparous, white woman who developed massive ascites and hydrothorax after administration of 0.50 mg/day of subcutaneous leuprolide acetate, beginning at the midluteal phase. INTERVENTION(S): Down-regulation with the gonadotropin-releasing hormone analogue was discontinued, and therapy was started with furosemide 50 mg/day for 10 days. MAIN OUTCOME MEASURE(S): Successful medical reduction of ascites and hydrothorax. RESULT(S): Resolution of symptoms. CONCLUSION(S): A comprehensive MEDLINE search revealed this to be the first reported case of massive ascites and hydrothorax after leuprolide acetate administration (0.5 mg daily) in a down-regulated woman undergoing assisted reproduction. This case can be explained by an increase in capillary permeability, which resulted in a rapid fluid shift from the intravascular space into the third space. We believe that ascites in our patient resulted from an increase in estradiol in the ovaries, due to a direct action of the gonadotropin-releasing hormone analogue on the corresponding ovarian receptors in the first few days after the start of therapy.
Assuntos
Ascite/induzido quimicamente , Hidrotórax/induzido quimicamente , Leuprolida/efeitos adversos , Técnicas de Reprodução Assistida/efeitos adversos , Adulto , Ascite/tratamento farmacológico , Regulação para Baixo , Feminino , Furosemida/uso terapêutico , Humanos , Hidrotórax/tratamento farmacológico , Infertilidade Feminina/tratamento farmacológicoRESUMO
Hepatic hydrothorax is a complication of cirrhosis that is uncommon and difficult to treat. Diuretic therapy, thoracentesis, transjugular intrahepatic portosystemic shunt and liver transplantation are the main therapeutic options. Here, we report on a 47-year-old man with decompensated liver cirrhosis related to hepatitis B and D virus infections and who had complications of hepatic hydrothorax and hepatorenal syndrome. In this case, the hepatic hydrothorax, which was refractory to thoracic tube drainage and octreotide treatment, could be controlled with 5 days of terlipressin therapy associated with albumin. Terlipressin administration resulted in both improvement in renal function and successful resolution of hepatic hydrothorax. Splanchnic vasoconstrictor agents that reduce splanchnic blood flow, increase both central volume and effective renal blood flow. Thus they improve renal function. In our case, terlipressin, known to be beneficial in hepatorenal syndrome, was also effective in the treatment of hepatic hydrothorax probably by similar mechanisms. This is the first case in the literature.
Assuntos
Hidrotórax/tratamento farmacológico , Hidrotórax/etiologia , Cirrose Hepática/complicações , Lipressina/análogos & derivados , Vasoconstritores/uso terapêutico , Albuminas/uso terapêutico , Hepatite B/complicações , Hepatite D/complicações , Humanos , Lipressina/uso terapêutico , Masculino , Pessoa de Meia-Idade , TerlipressinaAssuntos
Diuréticos/uso terapêutico , Hidrotórax/dietoterapia , Hidrotórax/tratamento farmacológico , Cirrose Hepática/complicações , Cloreto de Sódio/administração & dosagem , Espironolactona/uso terapêutico , Idoso , Feminino , Humanos , Hidrotórax/etiologia , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoAssuntos
Ascite/etiologia , Hemodinâmica/efeitos dos fármacos , Hidrotórax/etiologia , Cirrose Hepática/tratamento farmacológico , Midodrina/uso terapêutico , Octreotida/uso terapêutico , Sódio/urina , Agonistas alfa-Adrenérgicos/uso terapêutico , Idoso , Ascite/tratamento farmacológico , Ascite/urina , Quimioterapia Combinada , Feminino , Fármacos Gastrointestinais/uso terapêutico , Hemodinâmica/fisiologia , Humanos , Hidrotórax/tratamento farmacológico , Hidrotórax/urina , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologiaRESUMO
OBJECTIVE: To investigate the therapeutic effects of Aiyishu Injection (AYSI) on cancerous hydrothorax, quality of life (QOF), and cellular immune function of patients. METHODS: Sixty late-stage cancer patients accompanied hydrothorax were randomly divided into the experimental group (EG) and the control group (CG), with thirty patients in each group. After thoracenteses being carried out in all patients for draining off hydropsy, to the patients in EG, AYSI was medicated, 50 ml by intrathoracic and another 50 ml by intravenous injection; while to the patients in CG chemotherapeutic agent or interleukin-2 (IL-2) was given. The same treatment, thoracentesis and medication, was repeated 3 days later. After 4 weeks, the volume of pleural effusion was measured with B-mode ultrasound to evaluate the therapeutic effects of AYSI. QOF, body weight and T-lymphocyte subsets were compared between the two groups before and after treatment. RESULTS: The clinical efficacy was significantly higher in EG than that in CG (P < 0.01). Besides, QOF was significantly improved (P < 0.05) and levels of CD3+ , CD4+ , CD4+ /CD8+ in peripheral blood increased in EG after treatment, which were significantly different to those in CG (P < 0.01, P < 0.05). CONCLUSION: AYSI has definite therapeutic effects on cancerous hydrothorax, it could improve QOF and cellular immune function in patients with cancer.
Assuntos
Besouros , Hidrotórax/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Materia Medica/uso terapêutico , Animais , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Besouros/química , Humanos , Hidrotórax/etiologia , Injeções , Neoplasias Pulmonares/complicações , Subpopulações de Linfócitos T/efeitos dos fármacos , Subpopulações de Linfócitos T/imunologiaRESUMO
We report the case of a patient that developed hepatic hydrothorax as the first complication of liver cirrhosis. Due to the lack of response to diuretics, pleurodesis and TIPS, treatment with octreotide was started with resolution of hydrothorax. To the best of our knowledge, this is the third reported case of refractory hepatic hydrothorax with complete and sustained response to octreotide.
Assuntos
Fármacos Gastrointestinais/uso terapêutico , Hidrotórax/tratamento farmacológico , Octreotida/uso terapêutico , Idoso , Drenagem/métodos , Feminino , Humanos , Recidiva , Resultado do TratamentoRESUMO
OBJECTIVES: Talc pleurodesis can be offered to patients with hepatic hydrothorax. The authors wanted to determine their patient's eligibility for talc pleurodesis by excluding a pleural-peritoneal shunt. MATERIALS AND METHODS: The authors measured the size of the talc particles and matched them with the radionuclide particle size. After injecting radiopharmaceutical into the pleura, the authors imaged the abdomen for possible migration. RESULTS: In their patient, there was no migration of radionuclide from the thorax into the abdomen. CONCLUSION: Injecting radionuclide into the thoracic cavity and then imaging for an extended period of time is one way to determine whether the patient has a pleural-peritoneal shunt.