Showing papers on "Hydrothorax published in 2012"

Congenital fetal and neonatal visceral chylous effusions: neonatal chylothorax and chylous ascites revisited. a multicenter retrospective study

Abstract: This retrospective study was carried out at eight Neonatal Intensive Care Units (NICU) Centers worldwide on 33 newborns presenting at birth with pleural, pericardial, or abdominal chylous effusions. Diagnosis of chylous effusion is based on findings of fluid with a milk-like appearance, a concentration of triglycerides in pleural effusion >1.1 mmol/l, and a total cell count >1,000 cells/ml with a predominance of >80% lymphocytes. Thirty-three newborns met the inclusion criteria and were studied. Six subjects who presented at birth with fetal effusion were treated by in-utero pleuro-amniotic shunt. Five of these patients are alive at follow-up. At birth, pleural drainage was performed in 29/33 patients and abdominal drainage was carried out in 3/33. Total parenteral nutrition (TPN) was given to 32/33 patients; 19/23 patients were fed a medium-chain triglycerides (MCT). No adverse effects were observed. Eight patients were treated with Octreotide at dosages ranging from 1 to 7 mcg/kg/hour for 8 to 35 days. All patients showed decreased chylous production. Two patients were treated by pleurodesis. Twenty-two babies are alive after at least 6 months follow-up, 9/33 are deceased, and 2 were lost to follow-up. Clinical conditions of survivors are basically good except for lung involvement [chronic lung disease (CLD) or lung lymphangiectasia] and lymphedema. All patients were using a MCT diet at follow-up with good control of chylous effusion. Visceral chylous effusions of the fetus and neonate are rare disorders, and there currently is only partial agreement on decision-making strategies. We suggest the need for an international prospective trial in an effort to establish the efficacy and effectiveness of diagnostic and therapeutic options described in this article.

Low pleural fluid-to-serum glucose gradient indicates pleuroperitoneal communication in peritoneal dialysis patients: presentation of two cases and a review of the literature

Abstract: Background Transudative pleural effusions due to pleuroperitoneal communication occur in 1.6-10% of patients receiving peritoneal dialysis (PD) and usually have overtly elevated glucose concentrations. Methods We report two cases of verified pleuroperitoneal communication with minimally elevated pleural fluid glucose levels. We reviewed the literature of all PD patients with pleuroperitoneal communication that reported pleural glucose levels to assess their clinical and laboratory features and pleural fluid-to-serum glucose gradients. Results We evaluated a total of 47 reported patients on PD with diagnosed pleuroperitoneal communication. Onset of the transudative pleural effusion after initiating PD was 100 mg/dL. All pleural fluid-to-serum glucose ratios were >1. Conclusions With a transudative pleural effusion in patients receiving PD, a pleural fluid-to-serum glucose ratio >1 is consistent with a pleuroperitoneal communication. In questionable cases, independent verification is necessary.

Experimental treatment of bilateral fetal chylothorax using in-utero pleurodesis

Abstract: Objective To assess the use and efficacy of in-utero pleurodesis for experimental treatment of bilateral fetal chylothorax. Methods This was a study of 78 fetuses with bilateral pleural effusion referred to three tertiary referral centers in Taiwan between 2005 and 2009. Fetuses were karyotyped following amniocentesis and the lymphocyte ratio in the pleural effusion was determined following thoracocentesis. Forty-nine (62.8%) fetuses had a normal karyotype and were recognized to have fetal chylothorax; of these, 45 underwent intrapleural injection of 0.1KE OK-432 per side per treatment. We evaluated clinical (hydrops vs. no hydrops) and genetic (mutations in the reported lymphedema-associated loci: VEGFR3, PTPN11, FOXC2, ITGA9) parameters, as well as treatment outcome. Long-term survival was defined as survival to 1 year of age. Results The overall long-term survival rate (LSR) was 35.6% (16/45); the LSR for non-hydropic fetuses was 66.7% (12/18) and for hydropic fetuses it was 14.8% (4/27). If we included only fetuses with onset of the condition in the second trimester, excluding those with onset in the third trimester, the LSR decreased to 29.4% (10/34). Notably, 29.6% (8/27) of hydropic fetuses had mutations in three of the four loci examined. Conclusions OK-432 pleurodesis appeared to be an experimental alternative to the gold-standard technique of thoracoamniotic shunting in non-hydropic fetal chylothorax. In hydropic fetuses, pleurodesis appeared less effective. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Percutaneous placement and management of the Denver shunt for portal hypertensive ascites.

Abstract: OBJECTIVE. Many patients with cirrhotic effusions in the peritoneal and pleural spaces lead a difficult existence. In addition to their decreased mobility and physical discomfort, they spend hours in the hospital or an outpatient facility undergoing peritoneal and pleural drainage. Liver transplantation is the ultimate solution for those with cirrhotic effusions refractory to medical management; however, most are on a long waiting list, forcing them to undergo a year or more of percutaneous centesis. Transjugular intrahepatic portosystemic shunts offer relief to those with cirrhotic ascites but at the cost of accelerated hepatic failure and hepatic encephalopathy. This article will review the development of the peritoneovenous and pleurovenous shunt, discuss reasons for its loss of favor, and suggest its current role in the armamentarium of the interventional radiologist. CONCLUSION. Peritoneovenous and pleurovenous shunt creation is a procedure that has the potential to significantly improve the quality ...

Prenatal management and thoracoamniotic shunting in primary fetal pleural effusions: a single centre experience.

Abstract: Objective Primary fetal pleural effusions are rare. If severe, thoracoamniotic shunting is needed. Our objective was to study the management and outcomes of pleural effusions in our unit. Methods Retrospective analysis of primary fetal hydrothorax between 1991 and 2010. Results Of 41 cases, 23 (56%) were hydropic, and 27 (66%) required shunting. Overall, 2 (4.8%) were diagnosed with a chromosomal condition and 4 (9.6%) with a congenital condition (3 Noonan syndrome, 1 mild structural cardiac defect). There were 5 terminations of pregnancy (TOP), 3 in utero deaths and 33 liveborn neonates (80%). Intact survival rate was 44% (12/27) among those shunted, 56% (23/41) among all cases and 70% (23/33) among all liveborn neonates. Most (87.5%) neonatal deaths occurred in newborns delivered before 34 weeks of gestation. The survival rate was higher in nonhydropic compared with hydropic fetuses (85% vs 47%). There were no procedure-related fetal losses. One in utero death was complicated by fatal maternal amniotic embolism. Conclusion Fetuses with pleural effusions should undergo expert prenatal workup. Hydropic fetuses and those with massive effusions are candidates for thoracoamniotic shunting. © 2012 John Wiley & Sons, Ltd.

Splenic artery embolization: A single center experience on the safety, efficacy, and clinical outcomes

Abstract: PURPOSE We aimed to assess the safety, efficacy, and clinical outcomes of splenic artery embolization (SAE). MATERIALS AND METHODS A total of 50 patients (male:female, 33:17; mean age, 49 years) who underwent 50 SAEs between 1998 and 2011 were retrospectively studied. The procedure indications included aneurysm or pseudoaneurysm (n=15), gastric variceal hemorrhage (n=15), preoperative reduction of surgical blood loss (n=9), or other (n=11). In total, 22 procedures were elective, and 28 procedures were urgent or emergent. The embolic agents included coils (n=50), gelatin sponges (n=15), and particles (n=4). The measured outcomes were the technical success of the procedure, efficacy, side effects, and the 30-day morbidity and mortality rates. RESULTS All embolizations were technically successful. The procedure efficacy was 90%; five patients (10%) had a recurrent hemorrhage requiring a secondary intervention. Side effects included hydrothorax (n=26, 52%), thrombocytosis (n=16, 32%), thrombocytopenia (n=13, 26%), and postembolization syndrome (n=11, 22%). Splenic infarcts occurred in 13 patients (26%). The overall and procedure-specific 30-day morbidity rates were 38% (19/50) and 14% (splenoportal thrombosis, 3/50; encapsulated bacterial infection, 1/50; splenic abscess, 1/50; femoral hematoma requiring surgery, 1/50; hydrothorax requiring drainage, 1/50). The overall and procedure-specific 30-day mortality rates were 8% (4/50) and 0%. The multivariate analysis showed that advanced patient age (P = 0.037), postprocedure thrombocytopenia (P = 0.008), postprocedure hydrothorax (P = 0.009), and the need for a secondary intervention (P = 0.004) predicted the 30-day morbidity, while renal insufficiency (P < 0.0001), preprocedure hemodynamic instability (P = 0.044), and preprocedure leukocytosis (P < 0.0001) were prognostic factors for the 30-day mortality. CONCLUSION SAE was performed with high technical success and efficacy, but the outcomes showed nontrivial morbidity rates. Elderly patients with thrombocytopenia and hydrothorax after SAE, and patients who require secondary interventions, should be monitored for complications.

Outcome of fetuses with congenital diaphragmatic hernia and associated intrafetal fluid effusions managed in the era of fetal surgery

Abstract: Objective Fetuses with congenital diaphragmatic hernia (CDH) and for whom additional ultrasound findings are abnormal typically are considered to have a dismal prognosis. Our aim was to assess the outcome of fetuses with CDH and associated intrafetal fluid effusions. Methods This was a retrospective bicentric cohort study on the perinatal management of fetuses with CDH and intrafetal fluid effusions. Results The incidence of effusions was 5.2% (n = 14) in 269 consecutive cases of left-sided CDH and 29.2% (n = 14) in 48 cases of right-sided CDH. Hydrothorax (n = 19 (68%)) and ascites (n = 16 (57%)) were the most common effusions. A combination of both was present in 11 (39%) fetuses. Of 20 ongoing pregnancies with CDH and fluid effusions, without other anomalies, five with moderate or mild pulmonary hypoplasia were managed without fetoscopic endoluminal tracheal occlusion (FETO). The 15 other cases underwent FETO because of severe pulmonary hypoplasia. Neonatal survival rate was similar in both groups (n = 2/5 and n = 6/15, respectively (P = 1.0)). Survival among those who underwent FETO was similar to previously published results concerning isolated cases undergoing FETO. Conclusions Our observations do not support the view that intrafetal effusions are an adverse prognostic factor in fetuses with CDH. In CDH fetuses with effusions and severe pulmonary hypoplasia treated with FETO, neonatal survival is similar to that in isolated cases undergoing the intervention. Whether pleural effusions should be addressed by thoracic drainage procedures remains unproven. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Late presentation of massive pleural effusion from intrathoracic migration of a ventriculoperitoneal shunt catheter: case report and review of the literature.

Abstract: We report an unusual case of ventriculoperitoneal (VP) shunt intrathoracic migration, associated with massive symptomatic hydrothorax. The VP shunt was inserted 10 years before presentation, after hemorrhagic hydrocephalus caused by prenatal intraventricular hemorrhage. The pleural fluid was drained via tube thoracostomy and the shunt was externalized, with full resolution of symptoms and signs. The patient was subsequently managed with shunt revision with drainage into the abdominal cavity. We review the 10 pediatric cases of cerebrospinal fluid hydrothorax reported in the literature and discuss the mechanism of shunt tip migration. Pleural effusion secondary to VP shunt insertion is a rare and potentially life-threatening occurrence, and it should be suspected in any patient with a VP shunt and respiratory distress.

Thoracoscopic surgical treatment for pleuroperitoneal communication

Abstract: Hydrothorax as a result of pleuroperitoneal communication (PPC) is an uncommon but a well-known complication of continuous ambulatory peritoneal dialysis (CAPD). In this paper, we present a 60-year old man with diabetic renal failure who underwent CAPD. Two weeks after starting CAPD, chest radiographs showed a right-sided hydrothorax. Radioscintigraphy was performed and PPC was diagnosed. Eight days after the diagnosis, thoracoscopic surgery was performed. The leakage points were closed by direct suturing with absorbable polyglycolic acid felt and fibrin glue. The patient resumed CAPD 2 weeks later, and there was no recurrence of the right hydrothorax. Video-assisted thoracic surgery with direct suturing represents a feasible method for treating PPC with confirmed fistulae.

CSF hydrothorax: neither migration of peritoneal catheter into the chest nor ascites. Case report and review of the literature.

Abstract: Introduction Complications of ventriculoperitoneal (V/P) shunt surgery are generally due to infection, or mechanical or dynamic dysfunction. Thoracic complications like cerebrospinal fluid (CSF) hydrothorax are rarely seen.

Recurrent pleural effusion without intrathoracic migration of ventriculoperitoneal shunt catheter: A case report

Abstract: Pleural effusion is a rare complication of ventriculoperitoneal (VP) shunting, usually due to the migration of the VP shunt catheter into the thorax. Herein we report a neurologically disadvantaged child with a lobar holoprosencephaly and hydrocephalus, initially treated with a VP shunt, who years later developed recurrent right-sided pleural effusion ultimately confirmed to be a cerebrospinal fluid (CSF) hydrothorax without intra-thoracic migration of the distal shunt catheter. Thoracentesis was compatible with a transudative effusion. Given the presence of a persistent pleural effusion, beta-2 transferrin concentrations were measured, which yielded a positive result. Plain radiographs and head computed tomography (CT) showed a normally positioned, functional VP shunt. A spine CT myelogram to look for a spinal dural-thoracic CSF fistula was negative. A radionuclide CSF shunt study demonstrated normal functioning VP shunt with radiotracer accumulation within the peritoneum, with subsequent tracer rapidly accumulating in the right hemithorax. Video-assisted thoracoscopic (VATS) exploration with drainage of the pleural effusion and pleurodesis was then performed. No diaphragmatic defect or shunt tubing within the thorax was found and the procedure failed to resolve the effusion. The patient's recurrent effusion was ultimately resolved with intracranial endoscopic choroid plexus coagulation to decrease CSF output.

Pneumothorax Ex-vacuo or “trapped lung” in the setting of hepatic hydrothorax

Abstract: Hepatic hydrothorax is a major pulmonary complication of liver disease occurring in up to 5-10% of patients with cirrhosis. We report four observations of the development of pneumothorax ex-vacuo or trapped lung in the setting of hepatic hydrothorax. The diagnosis of trapped lung was made based on the presence of a hydropneumothorax after evacuation of a longstanding hepatic hydrothorax with failure of the lung to re-expand after chest tube placement in three of the four cases. Two patients underwent surgical decortication with one subsequent death from post-operative bleeding. The other two patients remarkably had spontaneous improvement of their “trapped lung” without surgical intervention. While pneumothorax ex-vacuo is a known phenomenon in malignant effusions, to our knowledge, it has never been described in association with hepatic hydrothoraces. The pathophysiology of this phenomenon remains unclear but could be related to chronic inflammation with development of a fibrous layer along the visceral pleura.

Transjugular intrahepatic portosystemic shunt for hepatitis C virus‐related portal hypertension after liver transplantation

Abstract: Ghinolfi D, De Simone P, Catalano G, Petruccelli S, Coletti L, Carrai P, Marti J, Tincani G, Cicorelli A, Cioni R, Filipponi F. Transjugular intrahepatic portosystemic shunt for hepatitis C virus-related portal hypertension after liver transplantation. Abstract: This is a single center retrospective review of 19 consecutive liver transplant (LT) patients with hepatitis C virus (HCV)-related graft recurrent hepatitis who underwent transjugular intrahepatic portosystemic shunt (TIPS) at a median interval of 21 months (range: 5–50) from LT. Indications were refractory ascites in 11 patients (57.9%), hydrothorax in six (31.6%), and both in two (10.5%). TIPS was successful in 94.7% of cases (18/19) with only one procedure-related mortality (5.3%) owing to sepsis on day 35. At a median follow-up of 23 months (range: one month–nine yr), TIPS allowed for symptoms resolution in 16 patients (84.2%), with ascites resolving in all cases and hydrothorax persisting in 2. Post-TIPS patient survival at six months, one yr, and three yr was 84.2%, 73.7%, and 56.8%, respectively. We compared these results with a control group of 29 patients with HCV recurrence but without unresponsive ascites or hydrothorax. Patients in the control group had better survival than patients undergoing TIPS placement. However, survival of TIPS patients with a MELD score lower than or equal to 12 was similar to that of the control group. We conclude that TIPS may be used to treat complications secondary to HCV.

Sudden death associated with Meigs syndrome: an autopsy case report.

Abstract: The diagnostic criteria of Meigs syndrome are the presence of ascites and hydrothorax in association with a benign solid ovarian tumor and spontaneous resolution of ascites and pleural effusion on tumor resection. The case of a middle aged woman who died suddenly at home without significant history of illness is presented. Autopsy found a large left ovarian fibroma (which was confirmed histologically), ascites and bilateral pleural effusion with collapsed lungs. The commonest gynecologic causes of sudden death are ruptured ectopic pregnancy and induced abortions. Two case reports of death associated with Meigs syndrome were identified in the literature; both were diagnosed before the patients died. Literature search found no publication on "sudden death associated with Meigs syndrome". This is probably the first report of sudden death associated with Meigs syndrome. The terminal cause of death in this case was collapsed lungs (atelectasis). The autopsy investigation of ascites and or pleural effusion associated with an ovarian mass or lesion should always include consideration of Meigs syndrome.Sudden death associated with Meigs syndrome (undiagnosed in life) ina middle aged female is described, and selected literature on the condition reviewed.

Percutaneous radiofrequency ablation with artificial hydrothorax for liver cancer in the hepatic dome

Abstract: Objective To assess the value of application of percutaneous radiofrequency ablation （RFA） with artificial hydrothorax for liver cancer in the hepatic dome. Methods Thirty-two patients with 43 lesions of hepatic malignant tumors in the hepatic dome underwent ultrasound-guided percutaneous radiofrequency ablation （RFA） with artificial hydrothorax. Artificial hydrothorax was created by infusion of saline via an intrathoracically placed 14-G central venous catheter, which was ultrasound-guided percutaneously inserted before RFA, separating the right lung from the hepatic dome. The adverse reaction and therapeutic efficacy were also analyzed. Results In the 32 patients with 43 lesions in the hepatic dome （4 tumors in segment IV, 21 tumors in segment VII and 18 tumors in segment Ⅷ）, 18 lesions of 14 patients were not observed by ultrasound before the operation. Thirty-two patients received the ultrasound-guided placement of intrathoracical catheter, and （1606.3 ± 485.9）ml （1000-2500 ml） saline solution was infused successfully. After obtaining an image of the whole tumor, 31 patients received percutaneous RFA therapy on schedule, and 22 patients received percutaneous transdiaphragmatic RFA therapy. One patient with 2 lesions gave up the treatment, because one of his tumors was not detectable by ultrasound. Diaphragmatic muscle hemorrhage was seen in two patients, subcutaneous edema in two patients, and pneumothorax in one patient. All the complications were cured, and no serious complications or related death occurred. 1-month follow-up with contrast-enhanced CT/MRI images showed that 29 patients had complete ablation, and the effective rate of this technique was 93.5% （29/31）. Conclusions Artificial hydrothorax helps us not only to visualize the whole tumor in the hepatic dome, but also offers a transdiaphragmatic route for therapy. Ultrasound-guided percutaneous RFA with artificial hydrothorax is a feasible, safe, and effective technique for treating liver cancer in the hepatic dome and worthy of being promoted. Key words: Liver neoplasms ; Ultrosonography, interventional ; Catheter ablation; Artificical hydrothorax; Treatment outcome

Compensation by collateral circulation determines invasive therapeutic indications for patients with Budd-Chiari syndrome

Abstract: We read with interest the comprehensive review article by Rossle and Gerbes that details the management of ascites in patients with liver cirrhosis and concludes that the transjugular intrahepatic portosystemic shunt (TIPS) could manage refractory ascites more effectively than large-volume paracentesis.1 However, there is an important issue regarding the management of ascites, which is caused by Budd-Chiari syndrome (B-CS), that the authors failed to address. In patients with chronic course, the formation of intra and extrahepatic collaterals leads to improvement of liver function and may silence this disease and make it asymptomatic.2 Thus, collateral circulation …

Subarachnoid-pleural fistula in a child: the cause and treatment.

Abstract: Hydrothorax of the cerebrospinal fluid after a subarachnoid-pleural fistula is a rare condition. Subarachnoid-pleural fistula may appear after a trauma at the thoracolumbar vertebral column or iatrogenically after thoracotomy. A two years and four months old boy who was operated because of ganglioneuroblastoma was admitted to hospital due to respiratory distress. The chest roentgenogram obtained two months after thoracotomy, showed a pleural effusion at the left side and a chest tube was inserted. The craniospinal magnetic resonance imagining revealed subarachnoid-pleural fistula and lumbar external cerebrospinal fluid drainage was performed. The chest tube was removed by application of tetracycline between pleural layers. After the patient was discharged, respiratory distress reoccurred after 3 weeks and a chest tube was reinserted due to fluid at the left hemithorax. An external lumbar drainage was reapplied. The location of the fistula was determined by craniospinal magnetic resonance imagining and myelography. The fistula was surgically restored by a posterior approach and laminectomy. The cerebrospinal fluid drainage and chest tube was removed three days and seven days after the operation respectively. The patient was discharged at the 13 days after the operation. During periodical outpatient follow up the patient has no symptoms and is neurologically intact. Subarachnoid-pleural fistulas, usually do not regress spontaneously or respond to conservative methods. Invasive approaches including surgery may be needed to treat patients with subarachnoid-pleural fistulae.

Diaphragmatic repair of hepatic hydrothorax with VATS after abdominal insufflation with CO(2).

Abstract: Hepatic hydrothorax is defined as the presence of a significant pleural effusion that develops in a patient with cirrhosis of the liver who does not have an underlying cardiac or pulmonary disease. There have been few published case reports dealing with hepatic hydrothorax treated surgically. Recently, we treated a patient with refractory hepatic hydrothorax by directly suturing the diaphragmatic defect during VATS. During surgery, the diaphragmatic defect was identified by using abdominal insufflation with CO(2) . The defect was sutured and the diaphragm was covered by polyglycolic acid felt and fibrin glue. After surgery, the patient's pleural effusion improved, his postoperative course was uneventful and he did not require a drainage tube at discharge.

Human umbilical cord blood-derived mononuclear cell transplantation for umbilical hernia and hepatic hydrothorax in primary biliary cirrhosis

Abstract: Cell therapy was proposed as a potential treatment intervention for liver cirrhosis recently due to the fact that the therapeutic protocol for primary biliary cirrhosis (PBC)-associated refractory umbilical hernia and hepatic hydrothorax is not well defined currently. We report herein the case of a 58-year-old woman who received routine treatments for PBC, which developed into an incarcerated hernia and uncontrolled hydrothorax. This subject’s condition was significantly improved and maintained stable condition after receiving human umbilical cord blood-derived mononuclear cell (CBMC) transplantation. Consequently, this new strategy may be a potential treatment option for the refractory umbilical hernia and hydrothorax caused by PBC. However, sufficient data from large-scale controlled and double-blinded clinical trials are needed to further confirm the treatment efficacy and longterm safety before this cell transplantation can be used as a regular therapy for liver cirrhosis.

“Nutrothorax” complicating a misplaced nasogastric feeding tube in a severely ill patient

Abstract: Introduction of nasogastric feeding tubes is usually blindly performed and is generally considered a safe procedure. However, the rate of complications of a blind insertion technique varies from 0.3 to 15%, and is usually related to inadvertent insertion of nasogastric tubes into the trachea and distal airways. The main predisposing factors related to tube malpositioning and complications are altered mental status with decreased cough or gag reflex, a preexisting endotracheal tube and severe illness. Complications include severe aspiration pneumonia, hydrothorax, hemothorax, empyema and pneumothorax. The mortality related to misplacement of a nasogastric tube is around 0.1-0.3% of the procedures. This 61-year old female had a history of poor appetite, weight loss, dyspnea and fever. A chest axial computerized tomography showed enlarged mediastinal lymph nodes. Laboratory showed hypercalcemia with normal PTH and hypokalemia. As the patient remained anorectic, a nasogastric feeding tube was placed, through which the administration of enteral diet, by continuous infusion pump, was started. After 12 -en.jpg-en.jpghours the patient developed dyspnea, hypoxemia and hypotension. During orotracheal intubation, it was disclosed the presence of the nasogastric tube in the trachea as well as the infused diet within the respiratory tract. Autopsy revealed an unusual complication of a nasogastric tube misplacement, which led to a massive collection of enteral nutrition fluid into the pleural space - a "nutrothorax". Additionally, an underlying stage IV anaplastic large cell lymphoma with interstitial lung and bronchial mucosa involvement was diagnosed.

Deterioration of myocardial tissue Doppler indices in a case of fetal hydrothorax as a promising indication for clinical intervention before the development of nonimmune hydrops fetalis.

Abstract: The clinical course of fetal hydrothorax is highly variable between individuals, and its prenatal management varies from waiting and close observation to therapeutic intervention in utero or the termination of pregnancy. To date, the management of fetal hydrothorax has depended on the gestational age, rate of progression, and development of hydrops [1–3], partly because no appropriate indicator for clinical intervention is available before the onset of nonimmune hydrops fetalis (NIHF). Tissue Doppler imaging (TDI) has been shown to be useful in assessing the cardiac function of fetuses with a normal [4] as well as pathological condition such as hydrops fetalis [5, 6]. So far, few studies have investigated the longitudinal cardiac function in fetal hydrothorax by TDI until hydropic change, and it has yet to be clarified whether serial TDI can provide clinical information concerning the indication for clinical intervention. We serially evaluated the fetal cardiac function with TDI in a case of fetal hydrothorax. A 26-year-old primigravida woman was referred to our outpatient clinic for the evaluation of left unilateral fetal hydrothorax at 31 weeks and 6 days of gestation. An ultrasound scan digitally recorded at 25 weeks’ gestation did not show hydrothorax. Serological examination showed no evidence of intrauterine infection, rhesus isoimmunization, or other red cell antibodies. Normal fetal anatomy and growth were confirmed by serial ultrasound scans. No other maternal or fetal complications were noted before admission. On admission at 32 weeks and 2 days of gestation, the unilateral lesion had proceeded to become bilateral. Betamethasone was administered maternally to promote fetal lung maturity. We conservatively managed the patient and closely evaluated fetal well-being and cardiac function in the fetus using fetal heart rate monitoring, the biophysical profile, umbilical artery Doppler velocimetry, and conventional pulsed-Doppler and tissue Doppler echocardiography to determine the appropriate timing of pregnancy termination for postnatal care, because of the institutional treatment strategy for fetal hydrothorax, whereby therapeutic intervention in utero, thoracocentesis, or pleuro-amniotic shunt, should be considered before 32 weeks of gestation. During the first 3 days after admission, myocardial TDI parameters consistently increased with the gradual accumulation of pleural fluid and subcutaneous tissue thickening from 4 to 7 mm, although there were no apparent changes in conventional pulsed-Doppler parameters (Fig. 1), the biophysical profile, or fetal heart rate monitoring, and both ventricles were normal in size without mitral or tricuspid regurgitation. The myocardial TDI parameters observed at 32 weeks and 4 days of gestation were even higher than the 95th percentile of the gestational age-based reference ranges for myocardial TDI indices [7]. We considered that the deterioration of the TDI parameters suggested the presence of subclinical or clinical cardiac dysfunction that could proceed to the development of NIHF, and so we decided to terminate the pregnancy. At 32 weeks and 4 days of gestation, a male infant weighing 1,920 g was delivered by K. Sekii (&) T. Ogata S. Iwashima Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan e-mail: sekii@hama-med.ac.jp

Hydrothorax After Retraction of a Subclavian Central Venous Catheter

Abstract: Central venous catheters (CVCs) are frequently used in intensive care patients. However, their use is associated with mechanical and infectious complications. Most mechanical complications arise during insertion, rarely while the catheter is in situ or upon its removal.[1][1] The most frequent

Transjugular intrahepatic porto 全身的分流在老: 为门高血压的复杂并发症的减轻

Abstract: AIM:To present a dedicated series of transjugular intrahepatic porto-systemic shunts(TIPS) in the elderly since data is sparse on this population group.METHODS:A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010.Twentyfive patients were referred for TIPS.We deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver disease.Of the 23 patients suitable for TIPS,the indications for TIPS placement was portal hypertension complicated by refractory ascites alone(n = 9),hepatic hydrothorax alone(n = 2),refractory ascites and hydrothorax(n = 1),gastrointestinal bleeding alone(n = 8),gastrointestinal bleeding and ascites(n = 3).RESULTS:Of these 23 attempted TIPS procedure patients,21 patients had technically successful TIPS procedures.A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years(range 65-82 years).Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing TIPS.Sixteen of 21 patients who underwent successful TIPS(excluding 5 patients lost to follow-up) were followed for a mean of 14.7 mo.Ascites and/or hydrothorax was controlled following technically successful procedures in 12 of 13 patients.Bleeding was controlled following technically successful procedures in 10 out of 11 patients.CONCLUSION:We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients.

[Pleuroperitoneal communication detected at the beginning of continuous ambulatory peritoneal dialysis; report of a case].

Abstract: A 61-year-old female was diagnosed as having end-stage renal failure developed dyspnea soon after introduction of continuous ambulatory peritoneal dialysis (CAPD). Chest X-ray showed a right-side massive pleural effusion. Pleuro peritoneal communication was suspicious, because the hydrothorax significantly improved by the stop of CAPD. We performed video-assisted thoracic surgery. Using indigo carmine containing peritoneal dialysis fluid through a CAPD catheter, we found a fistula on the diaphragm from which blue dialysis solution flowed out like a fountain. The fistula of the diaphragm was directly closed with a surgical stapler and covered using cellulose oxidized (Surgicel) and fibrin glue. She could restart CAPD on postoperative days 7, and no recurrence of hydrothorax has been detected for 10 months after surgical treatment.

Hepatic hydrothorax after blunt chest trauma.

Abstract: We report a successful treatment result in a rare case of hepatitis C virus-related cirrhosis, who had sustained hydrothorax after blunt thoracoabdominal trauma. This was a female patient with liver cirrhosis, Child–Turcotte–Pugh class A, without ascites before injury. She sustained blunt thoracoabdominal trauma with a left clavicle fracture dislocation and right rib fractures. There was no hemopneumothorax at initial presentation. However, dyspnea and right pleural effusion developed gradually. We inserted a chest tube to relieve the patient's symptoms, and the daily drainage amount remained consistent. Hepatic hydrothorax was confirmed by the intraperitoneal injection of radioisotope 99mTc-sulfur colloid that demonstrated one-way transdiaphragmatic flow of fluid from the peritoneal cavity to pleural cavities. Finally, the hydrothorax was treated successfully by minocycline-induced pleural symphysis. To the best of our knowledge, this is the first case of hepatic hydrothorax developed after thoracoabdominal trauma.

Ovarian Mucinous Cystadenoma Presenting as Pseudo-Meigs Syndrome

Abstract: Meigs syndrome is defined as the co-existence of benign ovarian tumor with ascites and hydrothorax that resolves after resection of tumor. The ovarian tumor in Meigs syndrome is fibroma. On the contrary, Pseudo- Meigs syndrome is characterized by the co-existence of hydrothorax, ascites and ovarian tumor either benign or malignant other than ovarian fibroma. The case herein concerns a 70 year old postmenopausal woman presented with the complaints of progressive shortness of breath on exertion and progressive swelling of lower abdomen. Her clinical and radiological examination revealed a massive right sided pleural effusion, mild ascites and a large heterogeneous pelvic mass with solid and cystic components, suggestive of left ovarian tumor. The patient underwent an exploratory laparotomy with excision of tumor, right ovary and whole of the uterus. The tumor was diagnosed histologically as an ovarian mucinous ystadenoma. Postoperative resolution of hydrothorax and ascites confirmed the diagnosis of Pseudo-Meigs syndrome. DOI: http://dx.doi.org/10.3329/jom.v13i2.12760 J Medicine 2012; 13 : 216-218

Pseudo-Meigs syndrome in association with primitive peritoneal tumor

Abstract: We report the case of a 61-year old woman presented with a voluminous centro-pelvic mass (22 × 17 cm), hydrothorax and ascites. Serum CA-125 was high (11,000 UI/ml). An explorative laparotomy located the mass between the rectum and the posterior wall of the uterus. The histological examination showed a primitive peritoneal tumor with serous and endometrioid differentiations. There was a left ovarian metastasis and both peritoneal and pleural liquids revealed no sign of malignancy. After the incomplete surgery, the hydrothorax and ascites decreased considerably. This association of Pseudo-Meigs’ syndrome with primitive peritoneal tumor is uncommon. To our knowledge this is the first case described through a Medline search.