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1.
Vnitr Lek ; 66(7): 43-45, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380134

RESUMO

We present a case report of a 74-years old patient with a finding of bilateral pleural effusion due to a different fluid composition caused by gastric adenocarcinoma. The finding of a bilateral effusion, where the exudate fluid is of a different chemical composition, is a rare phenomenon. While the right-sided exudate had the characteristics of hydrothorax, the left-sided exudate had those of chylothorax. The initial suspicion of a lung tumor was not confirmed, and further examination surprisingly revealed gastric adenocarcinoma. The patient did not benefit from targeted oncological treatment for a long time and the chemotherapy was terminated after 3 cycles. The cause of right-sided hydrothorax is therefore attributed to hypalbuminemia and secondary pneumonia, left-sided chylothorax was a primo-manifestation of gastric adenocarcinoma. There is only a small number of similar case reports of patients with gastric tumor and chylothorax in the literature. While the recorded cases were mostly Asian ethnic patients, the course of their illness - including survival - was almost strikingly similar (and unfavorable).


Assuntos
Adenocarcinoma , Quilotórax , Hidrotórax , Derrame Pleural , Neoplasias Gástricas , Adenocarcinoma/complicações , Idoso , Quilotórax/etiologia , Humanos , Hidrotórax/diagnóstico por imagem , Hidrotórax/etiologia , Neoplasias Gástricas/complicações
2.
PLoS One ; 15(9): e0238602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881941

RESUMO

INTRODUCTION: Albeit uncommon, hydrothorax is an important complication of peritoneal dialysis (PD). Due to paucity of evidence for optimal treatment, this study aimed to evaluate the effectiveness and safety of computed tomographic (CT) peritoneography and surgical intervention involving video-assisted thoracic surgery (VATS) for hydrothorax in a retrospective cohort of patients who underwent PD in Japan. METHODS: Of the 982 patients who underwent PD from six centers in Japan between 2007 and 2019, 25 (2.5%) with diagnosed hydrothorax were enrolled in this study. PD withdrawal rates were compared between patients who underwent VATS for diaphragm repair (surgical group) and those who did not (non-surgical group) using the Kaplan-Meier method and log-rank test. RESULTS: The surgical and non-surgical groups comprised a total of 11 (44%) and 14 (56%) patients, respectively. Following hydrothorax diagnosis by thoracentesis and detection of penetrated sites on the diaphragm using CT peritoneography, VATS was performed at a median time of 31 days (interquartile range [IQR], 20-96 days). During follow-up (median, 26 months; IQR, 10-51 months), 9 (64.3%) and 2 (18.2%) patients in the non-surgical and surgical groups, respectively, withdrew from PD (P = 0.021). There were no surgery-related complications or hydrothorax relapse in the surgical group. CONCLUSIONS: This study demonstrated the effectiveness and safety of CT peritoneography and VATS for hydrothorax. This approach may be useful in hydrothorax cases to avoid early drop out of PD and continue PD in the long term. Further studies are warranted to confirm these results.


Assuntos
Hidrotórax/cirurgia , Falência Renal Crônica/complicações , Diálise Peritoneal/efeitos adversos , Cirurgia Torácica Vídeoassistida , Adulto , Idoso , Feminino , Humanos , Hidrotórax/etiologia , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Zhonghua Gan Zang Bing Za Zhi ; 28(5): 372-376, 2020 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-32536050

RESUMO

The rare complications of cirrhosis, such as chylous ascites, hepatic hydrothorax, spontaneous bacterial peritonitis, cirrhotic cardiomyopathy, portopulmonary hypertension, cirrhotic nervous system damage, etc., have not yet been fully understood and/or promptly and effectively diagnosed and treated by clinicians. Therefore, this article aims to introduce the above-mentioned rare complications, clinical features, treatment and prognosis of liver cirrhosis in an attempt to improve the clinicians' understanding and level of diagnosis and treatment.


Assuntos
Infecções Bacterianas , Hidrotórax , Cirrose Hepática , Peritonite , Ascite/etiologia , Infecções Bacterianas/etiologia , Humanos , Hidrotórax/etiologia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/terapia , Peritonite/etiologia , Prognóstico
5.
J Gastroenterol Hepatol ; 35(4): 641-647, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31441096

RESUMO

BACKGROUND AND AIM: Cirrhosis-related complications are associated with high inpatient mortality, cost, and length of stay. There is a lack of multi-centered studies on interventions for hepatic hydrothorax and its impact on patient outcomes. The aim of this study was to determine the effect of performing thoracentesis for hepatic hydrothorax on hospital length of stay, mortality, cost, and 30-day readmission. METHODS: A retrospective analysis of the Nationwide Inpatient Sample between 2002 and 2013 and Nationwide Readmission Database during 2013 was performed including patients with a primary diagnosis of hydrothorax or pleural effusion and a secondary diagnosis of cirrhosis based on International Classification of Disease 9 codes. Univariate and multivariate analyses were performed to determine the effect of thoracentesis on patient outcomes during their hospital stay. RESULTS: Of the 37 443 patients included from the Nationwide Inpatient Sample, 26 889 (72%) patients underwent thoracentesis. Thoracentesis was associated with a longer length of stay (4.56 days, 95% confidence interval [CI]: 2.40-6.72) and higher total cost ($9449, 95% CI: 3706-15 191). There was no significant difference in inpatient mortality between patients who underwent thoracentesis compared with those who did not. Of the 2371 patients included from the Nationwide Readmission Database, 870 (33%) were readmitted within 30 days. Thoracentesis was not a predictor of readmission; however, transjugular intrahepatic portosystemic shunt (odds ratio: 4.89, 95% CI: 1.17-20.39) and length of stay (odds ratio: 1.02, 95% CI: 1.001-1.05) on index admission were predictors of readmission. CONCLUSION: When considering treatment for hepatic hydrothorax, many factors should contribute to determining the best intervention. While performing thoracentesis may provide immediate relief to symptomatic patients, it should not be considered a long-term intervention given that it increases hospital cost, was associated with longer length of stays, and did not improve mortality.


Assuntos
Hidrotórax/mortalidade , Hidrotórax/cirurgia , Tempo de Internação , Readmissão do Paciente , Toracentese , Idoso , Humanos , Hidrotórax/economia , Hidrotórax/etiologia , Cirrose Hepática/complicações , Pessoa de Meia-Idade , Derivação Portossistêmica Transjugular Intra-Hepática , Estudos Retrospectivos , Toracentese/economia , Toracentese/mortalidade , Fatores de Tempo , Resultado do Tratamento
6.
BMJ Case Rep ; 12(11)2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31678925

RESUMO

Pleural effusion in liver cirrhotics is more commonly transudative. A transudative pleural effusion secondary to ascites in decompensated cirrhosis is also known as hepatic hydrothorax and is usually due to fluid seepage through congenital pores in the diaphragm. The patient, a known case of decompensated chronic liver disease, presented with a massive, left-sided, rapidly accumulating and transudative pleural effusion secondary to spontaneous diaphragmatic rupture. Clinically, he developed sudden onset shortness of breath and became hypotensive. This is a rare entity, and was confirmed on CT thorax revealing a focal segment defect ~1.6 cm over the left hemidiaphragm. Ascites treatment consisting of diuretics with salt restriction and repeated thoracentesis with albumin replacement improved his symptoms and lead to a complete resolution of the effusion.


Assuntos
Hidrotórax/etiologia , Cirrose Hepática Alcoólica/complicações , Ruptura Espontânea/complicações , Diafragma/diagnóstico por imagem , Humanos , Hidrotórax/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea/diagnóstico por imagem , Ultrassonografia
7.
Urology ; 134: 66-71, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31487511

RESUMO

OBJECTIVE: To analyze the outcomes of upper pole access during percutaneous nephrolithotomy (PCNL), an option pole often avoided due to the concern for pleural injury. METHODS: We retrospectively collected data on patients undergoing PCNL at our institution. Patients were divided into 3 groups according to access: supracostal upper calyx (group 1), subcostal upper calyx (group 2), and nonupper calyx (group 3). Preoperative imaging was reviewed to assess stone burden, Hounsfield units (HU), location, and Guy's Stone Score. Patients were considered stone-free if residual fragments were 3 mm or smaller on CT scan. RESULTS: We analyzed 329 PCNLs (left: 174; right: 155). Stones had a median size of 32 mm, 800 HU, and Guy's Stone Score of 2. Groups 1, 2, and 3 had 119, 108, and 102 patients, respectively. The 90-day complication rate was 20.4% (7.9% Clavien 3-4). Group 1 patients, with higher BMI and larger stones, had higher SFR than group 3 (89.9% vs 79.4%, P = .038), but with a significantly higher risk of complications (P = .001). Within group 1, left PCNL (7.0% vs 24.2%, P = .016) and BMI ≥30 (6.9% vs 25.0%, P = .013) carried a lower risk of chest tube insertion. There was no difference in complications between groups 2 and 3 (1.9% vs 2.9%). CONCLUSION: Upper pole access is safe and effective, particularly if done below the ribs. Supracostal access is an effective option to achieve higher stone-free rates in complex stones, while carrying a risk of significant hydrothorax, particularly on the right side and in nonobese patients.


Assuntos
Hidrotórax , Complicações Intraoperatórias , Cálculos Renais , Nefrolitotomia Percutânea , Pleura/lesões , Cuidados Pré-Operatórios/métodos , Adulto , Índice de Massa Corporal , Feminino , Humanos , Hidrotórax/etiologia , Hidrotórax/prevenção & controle , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Estados Unidos
9.
Emerg Med Clin North Am ; 37(3): 511-527, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262418

RESUMO

Patients with end-stage liver disease (ESLD) who require intensive care unit admission have high rates of mortality. This article reviews the pathophysiology and emergency department assessment and management of the most frequent conditions and complications encountered in critically ill ESLD patients including hepatic encephalopathy, gastrointestinal bleeding, sepsis and bacterial peritonitis, hepatorenal syndrome, severe coagulopathy, and hepatic hydrothorax.


Assuntos
Estado Terminal , Doença Hepática Terminal/complicações , Doença Hepática Terminal/terapia , Manuseio das Vias Aéreas/métodos , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/terapia , Medicina de Emergência , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/terapia , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/terapia , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiologia , Hidrotórax/terapia , Hiperamonemia/etiologia , Hiperamonemia/terapia , Unidades de Terapia Intensiva , Transplante de Fígado , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/terapia , Medição de Risco , Índice de Gravidade de Doença
10.
Rev Gastroenterol Peru ; 39(1): 64-69, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31042238

RESUMO

Hepatic hydrothorax is uncommon transudative pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. Ascites is also present in most of the patients and the pathophysiology include the passage of ascites fluid through small diaphragmatic defects. After diagnostic thoracentesis studies, the first line management is restricting sodium intake and diuretics combination including stepwise dose of spironolactone plus furosemide. Therapeutic thoracentesis is a simple and effective procedure to relief dyspnea. Hepatic hydrothorax is refractory in approximately 20-25% and treatments options include repeated thoracentesis, transjugular intrahepatic portosystemic shunts (TIPS) placement, chemical pleurodesis with repair diaphragmatic defects using video-assisted thoracoscopy surgery (VATS), and insertion of an indwelling pleural catheter. Chest tube insertion carries significant morbidity and mortality with questionable benefit. Hepatic transplantation remains the best treatment option with long term survival. We present three cases of hepatic hydrothorax with different therapeutic approach including first line management, failed chest tube insertion and TIPS placement.


Assuntos
Hidrotórax/terapia , Idoso , Ascite/terapia , Tubos Torácicos , Terapia Combinada , Tratamento Conservador , Diuréticos/uso terapêutico , Feminino , Hepatite C/complicações , Humanos , Hidrotórax/etiologia , Hidrotórax/cirurgia , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Transplante de Fígado , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Derrame Pleural/terapia , Pleurodese , Derivação Portossistêmica Transjugular Intra-Hepática , Toracentese
11.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936360

RESUMO

A 70-year-old woman with end-stage renal disease caused by a polycystic kidney disease developed massive right-sided pleural effusion 10 days after the initiation of peritoneal dialysis (PD). Although pleuroperitoneal communication (PPC) was suspected, computed tomographic peritoneography on usual breath holding did not show leakage. Therefore, we instructed her to strain with maximal breathing, which caused a jet of contrast material to stream from the peritoneal cavity into the right pleural cavity and allowed the identification of the exact site of the diaphragm defect. Following the thoracoscopic closure of the defect, she was discharged without recurrence of hydrothorax on PD. Hydrothorax due to PPC is a rare complication of PD. Notably, numerous previous modalities used to diagnose PPC lack sufficient sensitivity. Thus, an approach to spread the pressure gradient between the peritoneal cavity and the pleural cavity on imaging may improve this insufficient sensitivity.


Assuntos
Diafragma/cirurgia , Hidrotórax/etiologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Derrame Pleural/etiologia , Toracostomia/métodos , Idoso , Dispneia , Feminino , Humanos , Hidrotórax/diagnóstico por imagem , Hidrotórax/cirurgia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/cirurgia , Resultado do Tratamento
13.
BMJ Case Rep ; 12(3)2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30878955

RESUMO

Hepatic hydrothorax, a rare and debilitating complication of cirrhosis, carries high morbidity and mortality. First-line treatment consists of dietary sodium restriction and diuretic therapy. Some patients, mainly those who are refractory to medical management, will require invasive pleural drainage. The authors report the case of a 76-year-old man in a late cirrhotic stage of alcoholic chronic liver disease, presenting with recurrent right-sided hepatic hydrothorax, portal hypertension, hepatosplenomegaly and thrombocytopaenia. After recurrent admissions and complications, the potential for adjusting diuretic therapy was limited. After unsuccessful talc pleurodesis, an indwelling tunnelled pleural catheter was placed with effective symptomatic control. One month later, the patient was readmitted with empyema due to Acinetobacter radioresistens Despite optimised medical and surgical treatment, the patient died 4 weeks later.


Assuntos
Infecções por Acinetobacter/etiologia , Cateteres de Demora/efeitos adversos , Hidrotórax/terapia , Acinetobacter , Idoso , Humanos , Hidrotórax/diagnóstico por imagem , Hidrotórax/etiologia , Cirrose Hepática Alcoólica/complicações , Masculino , Radiografia
14.
Ann Vasc Surg ; 55: 309.e5-309.e8, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30217716

RESUMO

BACKGROUND: Pseudo-Meigs syndrome is an unusual condition involving pelvic tumors, excluding ovarian fibroma, and is associated with ascites and hydrothorax. Pseudo-Meigs syndrome originating from uterine leiomyoma is an even rarer condition. Intravenous leiomyomatosis originating from uterine tumors, which extend from the inferior vena cava to the right heart chambers, is also extremely rare. CASE REPORT: This report presents an extremely rare case of intravenous leiomyomatosis with intracardiac extension accompanied by Pseudo-Meigs syndrome caused by uterine leiomyoma. To the best of our knowledge, this is the first reported case of two different rare conditions originating simultaneously from one common pelvic benign tumor. We could only partially resect the tumor owing to its firm adherence to the vessel wall. It is crucial to remember that a pelvic neoplasm in a woman with various manifestations, such as hydrothorax, ascites, intravascular leiomyomatosis, intracardiac mass, and even elevated CA125 levels, does not always imply malignancy. All the accompanying symptoms can be resolved by simple surgical removal of the mass. CONCLUSIONS: Accurate preoperative assessment and detailed preparation for the surgery according to the nature of the tumor may yield successful results.


Assuntos
Ascite/etiologia , Átrios do Coração/patologia , Ventrículos do Coração/patologia , Hidrotórax/etiologia , Leiomioma/complicações , Síndrome de Meigs/etiologia , Derrame Pleural Maligno/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/patologia , Veia Cava Inferior/patologia , Ascite/diagnóstico por imagem , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Hidrotórax/diagnóstico por imagem , Leiomioma/patologia , Leiomioma/cirurgia , Síndrome de Meigs/diagnóstico por imagem , Síndrome de Meigs/patologia , Síndrome de Meigs/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Derrame Pleural Maligno/diagnóstico por imagem , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias Uterinas/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
15.
Thorac Cardiovasc Surg ; 67(2): 147-150, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-28582790

RESUMO

BACKGROUND: Pleuroperitoneal communication is a serious complication in patients receiving continuous ambulatory peritoneal dialysis. However, few single-institutional reports discuss the details of pleuroperitoneal communication in continuous ambulatory peritoneal dialysis patients regarding the intraoperative findings, postoperative course, and outcomes. METHODS: We retrospectively reviewed the records of consecutive pleuroperitoneal communication patients who were treated surgically from September 2008 to March 2016. RESULTS: All four patients had right-sided hydrothorax. The time from introduction of continuous ambulatory peritoneal dialysis to the diagnosis of hydrothorax ranged from 1 to 12 months (average: 5.5 months). Case 1 and case 4 had bleblike lesions near the center of the diaphragm; case 2 had a small hole located near the cardiophrenic angle, and case 3 had thinning of the diaphragm near the cardiophrenic angle. All lesions except for case 3 were directly closed with absorbable suture and reinforced by fibrin glue and a polyglycolic acid sheet. In case 3, the thinned diaphragm was reinforced using fibrin glue, a sealing sheet, and pericardial fat pad tissue. Continuous ambulatory peritoneal dialysis was reinitiated an average period of 11 days (range: 4-15 days) postoperatively. During postoperative follow-up, there was no recurrence of hydrothorax. Continuous ambulatory peritoneal dialysis was continued for an average of 16.7 months (range: 3-34 months) after surgical treatment. CONCLUSIONS: Surgical treatment for pleuroperitoneal communication is a safe and acceptable procedure and could greatly benefit continuous ambulatory peritoneal dialysis patients.


Assuntos
Hidrotórax/cirurgia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Doenças Peritoneais/cirurgia , Doenças Pleurais/cirurgia , Adolescente , Idoso , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/etiologia , Doenças Pleurais/diagnóstico , Doenças Pleurais/etiologia , Estudos Retrospectivos , Resultado do Tratamento
16.
Chest ; 155(3): 546-553, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30171863

RESUMO

BACKGROUND: The outcome of indwelling pleural catheter (IPC) use in hepatic hydrothorax (HH) is unclear. This study aimed to review the safety and feasibility of the IPC in patients with refractory HH. METHODS: A retrospective multicenter study of patients with HH from January 2010 to December 2016 was performed. Inclusion criteria were refractory HH treated with an IPC and an underlying diagnosis of cirrhosis. Records were reviewed for patient demographics, operative reports, and laboratory values. The Kaplan-Meier method was used to estimate catheter time to removal. The Cox proportional hazard model was used to evaluate for independent predictors of pleurodesis and death. RESULTS: Seventy-nine patients were identified from eight institutions. Indication for IPC placement was palliation in 58 patients (73%) and bridge to transplant in 21 patients (27%). The median in situ dwell time of all catheters was 156 days (range, 16-1,978 days). Eight patients (10%) were found to have pleural space infection, five of whom also had catheter-site cellulitis. Two patients (2.5%) died secondary to catheter-related sepsis. Catheter removal secondary to spontaneous pleurodesis was achieved in 22 patients (28%). Median time from catheter insertion to pleurodesis was 55 days (range, 10-370 days). Older age was an independent predictor of mortality on multivariate analysis (hazard ratio, 1.05; P = .01). CONCLUSIONS: We present, to our knowledge, the first multicenter study examining outcomes related to IPC use in HH. Ten percent infection risk and 2.5% mortality were identified. IPC placement may be a reasonable clinical option for patients with refractory HH, but it is associated with significant adverse events in this morbid population.


Assuntos
Cateteres de Demora , Hidrotórax , Pleurodese , Complicações Pós-Operatórias , Implantação de Prótese , Idoso , Feminino , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiologia , Hidrotórax/terapia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/terapia , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidados Paliativos/métodos , Pleurodese/efeitos adversos , Pleurodese/instrumentação , Pleurodese/métodos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/métodos , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Estudos Retrospectivos , Estados Unidos
17.
BMJ Case Rep ; 11(1)2018 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-30567279

RESUMO

Central venous catheters (CVCs) are very useful tools in clinical medicine. It is important not only for the administration of medications or fluids but also the measurement of haemodynamic variables, especially in intensive care patients. CVC placement is a relatively safe procedure but may occasionally be associated with complications, such as pneumothorax, haemothorax, cardiac tamponade, sepsis and thrombosis. We aim to report an extraordinary case of bilateral hydrothorax due to CVC placement.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Hidrotórax/diagnóstico , Veias Jugulares , Adulto , Diagnóstico Diferencial , Humanos , Hidrotórax/diagnóstico por imagem , Hidrotórax/etiologia , Doença Iatrogênica , Masculino , Procedimentos Neurocirúrgicos , Toracostomia , Tomografia Computadorizada por Raios X
19.
Semin Respir Crit Care Med ; 39(5): 546-555, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30485885

RESUMO

Acute respiratory failure has a high mortality in patients with end-stage liver disease (ESLD). These patients may develop acute respiratory failure for reasons specific to advanced liver disease, including hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. They may also develop respiratory complications due to conditions seen in the general intensive care unit population to which ESLD patients are at higher risk, including infection, volume overload, and the acute respiratory distress syndrome. Management of these patients is complicated and multifaceted, and a comprehensive understanding of the etiologies and treatment of acute respiratory failure is critical in this high-risk patient population. This article reviews current evidence surrounding the prevalence, management, and complications of the various etiologies of acute respiratory failure in ESLD patients.


Assuntos
Doença Hepática Terminal/complicações , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapia , Síndrome Hepatopulmonar/etiologia , Síndrome Hepatopulmonar/mortalidade , Humanos , Hidrotórax/etiologia , Hidrotórax/mortalidade , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/mortalidade , Unidades de Terapia Intensiva , Transplante de Fígado , Respiração Artificial
20.
Respiration ; 96(4): 330-337, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29991046

RESUMO

BACKGROUND: Repeat thoracentesis for symptom control is offered to patients with refractory hepatic hydrothorax (HH) but the risk profile for this management strategy remains unclear. OBJECTIVES: This study aimed to compare complication frequency and nature during repeat thoracentesis in patients with and without HH. METHODS: Complication rates in patients undergoing repeat thoracentesis for symptom relief was compared between patients with HH and a control group (non-HH group) at a single center from 2010 to 2015. Records were reviewed for demographics, laboratory values, number of thoracentesis, and associated complications with each procedure. RESULTS: 82 patients with HH (274 thoracenteses) and 100 control patients (188 thoracenteses) were included. A complication was noted in 17/462 (0.03%) procedures in the entire cohort. There was a higher overall complication rate with repeat thoracentesis in the HH group (8 vs. 0%, p = 0.016, 95% CI = 1.5-14.6). In the HH group, the cumulative risk of complications increased with sequential thoracenteses; a complication occurring in the preceding intervention was the strongest predictor for subsequent complication (OR = 17.1, p = 0.0013) and more than 1 previous complication was associated with a 15-fold increased risk of a subsequent complication (p < 0.001). In multivariate analysis within the HH group, the Model for End-Stage Liver Disease (MELD) score was an independent predictor of hemothorax (OR = 1.19, 95% CI = 1.03-1.36, p = 0.012). CONCLUSIONS: Repeat thoracentesis is an overall low-risk procedure, although a higher complication rate is observed in HH compared with non-HH patients. The presence of a previous complication significantly increases the risk of future complications in the HH population.


Assuntos
Hidrotórax/cirurgia , Hipertensão Portal/complicações , Complicações Pós-Operatórias/epidemiologia , Reoperação/efeitos adversos , Toracentese/efeitos adversos , Idoso , Feminino , Humanos , Hidrotórax/etiologia , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Virginia/epidemiologia
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