1
|
Chiruvella V, Ullah A, Elhelf I, Patel N, Karim NA. Would the Addition of Immunotherapy Impact the Prognosis of Patients With Malignant Pericardial Effusion? Front Oncol 2022; 12:871132. [PMID: 35600364 PMCID: PMC9120828 DOI: 10.3389/fonc.2022.871132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/11/2022] [Indexed: 12/12/2022] Open
Abstract
Pericardial effusion is a common finding in advanced-stage lung cancer. The presence of malignant cells or drainage of exudate effusion in the pericardial space may cause symptoms of dyspnea, pleuritic chest pain, and syncope. In addition to the difficulty physicians face in the detection and diagnosis of malignant pericardial effusion, treatment may be challenging considering the cancer prognosis and cardiovascular stability of the patient. Despite the availability of several treatment modalities for malignant pericardial effusion, including chemotherapy and surgery, patients with lung cancer historically present with poor prognoses. In addition to lung adenocarcinoma with malignant pericardial effusion, this case was complicated by COVID-19 and malignancy-associated obstructive pneumonia. We present a case of a 64-year-old woman with advanced non-small cell lung carcinoma (NSCLC) with malignant pericardial effusion who, despite testing positive for COVID-19 and having obstructive pneumonia, had favorable outcomes following systemic therapy with combined chemo-immunotherapy.
Collapse
|
2
|
Dhir AA, Sawant SP. Cardiac morbidity & mortality in patients with breast cancer: A review. Indian J Med Res 2021; 154:199-209. [PMID: 35295010 PMCID: PMC9131763 DOI: 10.4103/ijmr.ijmr_879_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cardiovascular disease (CVD) and breast cancer cause substantial morbidity and mortality in women and are major public health concerns. Breast cancer survivors are at a greater risk for CVD-related mortality compared to women without breast cancer. Breast cancer and cardiovascular diseases share a number of common risk factors. Breast cancer treatments like anthracycline based chemotherapy, novel targeted therapy and radiation therapy can cause cardiotoxicity. With improvements in breast cancer prevention and treatment, there is a significant improvement in survival and this shifts focus from disease control to long term effects of treatment and quality of life. Assessing CVD and minimizing complications from cancer therapy are important treatment goals.
Collapse
Affiliation(s)
- Aruna Alahari Dhir
- Department of Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sheela Prashant Sawant
- Department of Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India,For correspondence: Dr Sheela Prashant Sawant, Department of Medicine, Tata Memorial Hospital, Parel, Mumbai 400 012, Maharashtra, India e-mail:
| |
Collapse
|
3
|
Bisceglia I, Gabrielli D, Canale ML, Gallucci G, Parrini I, Turazza FM, Russo G, Maurea N, Quagliariello V, Lestuzzi C, Oliva S, Di Fusco SA, Lucà F, Tarantini L, Trambaiolo P, Gulizia MM, Colivicchi F. ANMCO POSITION PAPER: cardio-oncology in the COVID era (CO and CO). Eur Heart J Suppl 2021; 23:C128-C153. [PMID: 34456641 PMCID: PMC8388610 DOI: 10.1093/eurheartj/suab067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic and its impact on patients with cancer and cardiovascular disease have confirmed the particular vulnerability of these populations. Indeed, not only a higher risk of contracting the infection has been reported but also an increased occurrence of a more severe course and unfavourable outcome. Beyond the direct consequences of COVID-19 infection, the pandemic has an enormous impact on global health systems. Screening programmes and non-urgent tests have been postponed; clinical trials have suffered a setback. Similarly, in the area of cardiology care, a significant decline in STEMI accesses and an increase in cases of late presenting heart attacks with increased mortality and complication rates have been reported. Health care systems must therefore get ready to tackle the 'rebound effect' that will likely show a relative increase in the short- and medium-term incidence of diseases such as heart failure, myocardial infarction, arrhythmias, and cardio- and cerebrovascular complications. Scientific societies are taking action to provide general guidance and recommendations aimed at mitigating the unfavourable outcomes of this pandemic emergency. Cardio-oncology, as an emerging discipline, is more flexible in modulating care pathways and represents a beacon of innovation in the development of multi-specialty patient management. In the era of the COVID-19 pandemic, cardio-oncology has rapidly modified its clinical care pathways and implemented flexible monitoring protocols that include targeted use of cardiac imaging, increased use of biomarkers, and telemedicine systems. The goal of these strategic adjustments is to minimize the risk of infection for providers and patients while maintaining standards of care for the treatment of oncologic and cardiovascular diseases. The aim of this document is to evaluate the impact of the pandemic on the management of cardio-oncologic patients with the-state-of-the-art knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19) in order to optimize medical strategies during and after the pandemic.
Collapse
Affiliation(s)
- Irma Bisceglia
- Integrated Cardiology Services, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Domenico Gabrielli
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Maria Laura Canale
- Cardiology Department, Nuovo Ospedale Versilia Lido Di Camaiore, LU, Italy
| | | | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano Umberto I, Torino, Italy
| | | | - Giulia Russo
- Cardiovascular and Sports Medicine Department, ASUGI Trieste, Trieste, Italy
| | - Nicola Maurea
- Cardiology Department, Fondazione Pascale, Napoli, Italy
| | | | - Chiara Lestuzzi
- Cardiology Department, Centro di Riferimento Oncologico (CRO), Aviano, PN, Italy
| | - Stefano Oliva
- Cardio-Oncology Department, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Osp. Metropol-Bianchi Melacrino-Morelli, Reggio Calabria, Italy
| | - Luigi Tarantini
- Cardiology Department, Presidio Ospedaliero. Santa Maria Nuova—AUSL RE IRCCS, Reggio Emilia, Italy
| | | | - Michele Massimo Gulizia
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Firenze, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| |
Collapse
|
4
|
Keramida K, Farmakis D, López Fernández T, Lancellotti P. Focused echocardiography in cardio‐oncology. Echocardiography 2020; 37:1149-1158. [DOI: 10.1111/echo.14800] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/19/2020] [Accepted: 07/07/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Kalliopi Keramida
- Cardio‐Oncology Clinic Heart Failure Unit Department of Cardiology Attikon University Hospital National and Kapodistrian University of Athens Medical School Athens Greece
- University of Cyprus Medical School Nicosia Cyprus
| | | | | | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences Department of Cardiology and Radiology CHU Sart Tilman University of Liège Hospital Liège Belgium
- Gruppo Villa Maria Care and Research Lugo Italy
| |
Collapse
|
5
|
Abstract
Cardiogenic shock (CS) is increasingly recognized in patients with malignancies, while cancer is independently associated with worse prognosis in CS. A number of conditions may lead to CS in cancer, including acute coronary syndromes, cardiomyopathy, takotsubo syndrome, myocarditis, pulmonary embolism, tamponade, and cardiac herniation. In these conditions, CS may be related to cancer itself or to cancer therapy, including surgery, chemotherapy, or radiotherapy. Given the significantly improved overall survival of patients with malignancies, the early recognition and proper management of CS in cancer become increasingly important. In the present paper, we review the available evidence on CS in patients with malignancies and highlight issues related to its management.
Collapse
|
6
|
Casavecchia G, Lestuzzi C, Gravina M, Corrado G, Tusa M, Brunetti ND, Manuppelli V, Monte IP. Cardiac Tumors. J Cardiovasc Echogr 2020; 30:S45-S53. [PMID: 32566466 PMCID: PMC7293869 DOI: 10.4103/jcecho.jcecho_7_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/16/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy series. Primary tumors of the heart are far less common than metastatic tumors. CTs usually present with any possible clinical combination of heart failure, arrhythmias, or embolism. Echocardiography remains the first diagnostic approach when suspecting a CT which, on the other side, frequently appears unexpectedly during an echocardiographic examination. Yet, cardiac tomography and especially magnetic resonance imaging may offer several adjunctive opportunities in the diagnosis of CTs. Early and exact diagnosis is crucial for the following therapy and outcome of CTs.
Collapse
Affiliation(s)
| | - Chiara Lestuzzi
- Department of Cardiology, Aviano Hospital, Pordenone, Aviano, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | - Maurizio Tusa
- Department of Cardiology, Milano San Donato Hospital, Milano, Italy
| | | | | | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania, Italy
| |
Collapse
|
7
|
Ohuchi M, Inoue S, Ozaki Y, Namura Y, Ueda K. Single-trocar thoracoscopic pericardio-pleural fenestration under local anesthesia for malignant pleural effusion: a case report. Surg Case Rep 2019; 5:136. [PMID: 31456047 PMCID: PMC6712104 DOI: 10.1186/s40792-019-0694-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/19/2019] [Indexed: 12/02/2022] Open
Abstract
Background Pericardio-pleural fenestration by video-assisted thoracoscopic surgery is an efficient procedure for malignant pericardial effusion, but requires general anesthesia with single-lung ventilation. Case presentation A 43-year-old woman was referred with complaints of deteriorating dyspnea and orthopnea. Chest computed tomography revealed right massive pleural effusion and pericardial effusion. Echocardiography demonstrated collapse of both the right atrium and right ventricle due to cardiac tamponade. Semi-rigid thoracoscopic pleural biopsy and pericardio-pleural fenestration were successfully performed under local anesthesia via a single trocar, because surgical procedures under general anesthesia with single-lung ventilation might have been intolerable for the patient. Adequate biopsy specimens of pleura and pericardium and immediate relief of serious symptoms were obtained without perioperative complications. No recurrence of pleural or pericardial effusion was observed for 3 months postoperatively. Conclusion Thoracoscopic pericardio-pleural fenestration under local anesthesia via a single trocar is feasible as an alternative approach in critically ill patients, allowing effective pericardial drainage, evaluation of the pleural cavity, and accurate biopsies of the pericardium and parietal pleura simultaneously.
Collapse
Affiliation(s)
- Masatsugu Ohuchi
- Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan.
| | - Shuhei Inoue
- Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan
| | - Yoshitomo Ozaki
- Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan
| | - Yuki Namura
- Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan
| | - Keiko Ueda
- Department of Thoracic Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
| |
Collapse
|
8
|
Pabba K, Rojas-Hernandez CM. Concurrent presentation of a hemorrhagic pericardial effusion and venous thromboembolism in malignancy: a systematic review of case studies. J Thromb Thrombolysis 2019; 48:454-458. [PMID: 31134447 DOI: 10.1007/s11239-019-01884-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The concurrent presentation of symptomatic malignant pericardial hemorrhage and venous thromboembolism is a rare event that poses a clinical dilemma. Existing VTE guidelines do not indicate when, or if, anticoagulation therapy should be started after the treatment of the pericardial bleed. We performed a systematic review to compile the published clinical evidence on the occurrence of coexisting pericardial hemorrhage and VTE in cancer patients and to describe the clinical presentations and bleeding and thrombosis outcomes before and after anticoagulation therapy. We studied published case reports on patients with cancer who presented to the hospital with pericardial hemorrhage and VTE through April 11, 2019. We found seven published case reports. All patients had suffered from a pulmonary embolism and had pericardiocentesis during hospitalization. Five patients (71%) had lung cancer. Four patients (57%) were started on anticoagulation after pericardial drainage and survived the index event. Two patients (29%) were not started on anticoagulation after pericardiocentesis; only one of these patients survived the hospitalization. Pericardial bleeding risk in cancer may be inherent to malignancy, and it is unclear if anticoagulation use increases the risk of recurrent pericardial bleeding. The management of pericardial bleeding typically requires pericardiocentesis, and clinical registries, prospective collaboration projects, and case adjudication are needed to establish the safety of initiation of antithrombotic therapy in such patients.
Collapse
Affiliation(s)
- Krishna Pabba
- Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Cristhiam M Rojas-Hernandez
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Suite 1464, Houston, TX, 77030, USA.
| |
Collapse
|
9
|
Di Liso E, Menichetti A, Dieci MV, Ghiotto C, Banzato A, Bianchi A, Pintacuda G, Padovan M, Nappo F, Cumerlato E, Miglietta F, Mioranza E, Zago G, Corti L, Guarneri V, Conte P. Neoplastic Pericardial Effusion: A Monocentric Retrospective Study. J Palliat Med 2019; 22:691-695. [PMID: 30888908 DOI: 10.1089/jpm.2018.0491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Neoplastic pericardial effusion (NPE) is a life-threatening condition that can worsen clinical outcome in cancer patients. The optimal management of NPE has yet to be defined because randomized studies are lacking. Objective: We report a retrospective monoinstitutional experience describing characteristics, management and prognostic factors in NPE patients. Design: We reviewed clinical, pathological, and echocardiographic features, therapeutic strategies, and outcome in NPE patients referred to our institute from August 2011 to December 2017. Measurements: Twenty-nine patients with NPE from solid tumors have been identified: 21 lung, 5 breast, and 3 other cancer patients. Results: Median age was 62 years. Most of the patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2 (69%) and a symptomatic NPE (69%). In 52% of patients NPE was detected at first diagnosis of metastatic disease, and in 20% of patients pericardium was the only site of metastases. Most of the patients (62%) received systemic therapy, 28% received combined locoregional and systemic therapy, and 10% received locoregional therapy alone. Median overall survival (OS) from NPE diagnosis was 3.9 months. Patients with PS ≥2 had worse OS than patients with better PS <2 (hazard ratio [HR] 3.56, IC 95% 1.19-10.65, p 0.02). Older age, extrapericardial disease, and NPE at progression showed a trend of association with worse OS. Patients treated with locoregional therapy alone showed the shortest median OS (p 0.05). Conclusions: NPE is related to dismal prognosis. Poor PS significantly worsens survival and influences therapeutic approaches. Randomized studies are required to investigate prognostic factors and appropriate clinical management for patients with NPE.
Collapse
Affiliation(s)
- Elisabetta Di Liso
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Alice Menichetti
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Maria Vittoria Dieci
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Cristina Ghiotto
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Alberto Banzato
- 3 Cardiology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | | | - Marta Padovan
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Floriana Nappo
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Enrico Cumerlato
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Federica Miglietta
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Eleonora Mioranza
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Giulia Zago
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Luigi Corti
- 5 Radiotherapy Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Valentina Guarneri
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Pierfranco Conte
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| |
Collapse
|
10
|
Sinnaeve PR, Adriaenssens T. A contemporary look at pericardiocentesis. Trends Cardiovasc Med 2018; 29:375-383. [PMID: 30482483 DOI: 10.1016/j.tcm.2018.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022]
Abstract
Percutaneous drainage is the default strategy for evacuating a pericardial effusion. A pericardiocentesis can be necessary or required in a wide variety of clinical settings ranging from urgent tamponade to relieve in iatrogenic hemorrhagic effusions in the electrophysiology or catheterization room, to planned diagnostic procedures in patients with suspected or known malignancy or infections. With the help of several procedural improvements over the past decades, echocardiography and fluoroscopy-guided percutaneous pericardiocentesis has become the standard intervention for evacuating pericardial effusions, as well as an essential tool in the diagnostic work-up of an unexplained pericardial effusion. When performed by skilled physicians assisted by appropriate imaging it is a very safe procedure, and provided that an indwelling catheter is placed, it is also very effective with an acceptably low risk of recurrences. In this review, the indications and standard techniques for pericardiocentesis are discussed, as well as their consequences for patients with iatrogenic and malignant effusions.
Collapse
Affiliation(s)
- P R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Cardiovascular Sciences, University of Leuven, Belgium.
| | - T Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Cardiovascular Sciences, University of Leuven, Belgium
| |
Collapse
|
11
|
Venneri L, Zoppellaro G, Khattar RS. Cardio-oncology: the role of advanced echocardiography in cancer patients. Expert Rev Cardiovasc Ther 2018; 16:249-258. [PMID: 29457984 DOI: 10.1080/14779072.2018.1443394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cardio-oncology is a rapidly growing field aimed at improving the quality of care of cancer patients by preventing and monitoring cardiovascular complications resulting from cancer treatment. Cardiac imaging, and in particular, transthoracic echocardiography, plays an essential
role in the baseline assessment and serial follow-up of cardio-oncology patients. Areas covered: This review article discusses the role of cardiac imaging with a focus on advanced echocardiography for the detection and management of cancer therapy related cardiovascular complications, in particular, left ventricular dysfunction and heart failure. Expert commentary: While traditional imaging based assessment of left ventricular ejection fraction still has its place in cardiac monitoring, more advanced echocardiographic modalities, in particular, myocardial deformation imaging with speckle tracking strain analysis, show great potential for detecting early signs of cardiotoxicity. Larger studies are needed to determine both the clinical role of strain measurement in influencing initiation of cardioprotective agents and its prognostic value in long term outcome.
Collapse
Affiliation(s)
- Lucia Venneri
- a Department of Echocardiography , Royal Brompton Hospital , London , UK
| | - Giacomo Zoppellaro
- a Department of Echocardiography , Royal Brompton Hospital , London , UK
| | - Rajdeep S Khattar
- a Department of Echocardiography , Royal Brompton Hospital , London , UK
| |
Collapse
|
12
|
Gouriet F, Levy PY. Management of Pericardial Effusion. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
13
|
Cabrera César E, Fernández Aguirre MC, Hidalgo Sanjuan MV. Cardiac Metastases from A Lung Tumor. Arch Bronconeumol 2016; 53:80-81. [PMID: 27381972 DOI: 10.1016/j.arbres.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/13/2016] [Accepted: 06/01/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Eva Cabrera César
- Servicio de Neumología, Hospital Universitario Virgen de la Victoria, Málaga, España.
| | | | | |
Collapse
|
14
|
Numico G, Cristofano A, Occelli M, Sicuro M, Mozzicafreddo A, Fea E, Colantonio I, Merlano M, Piovano P, Silvestris N. Prolonged Drainage and Intrapericardial Bleomycin Administration for Cardiac Tamponade Secondary to Cancer-Related Pericardial Effusion. Medicine (Baltimore) 2016; 95:e3273. [PMID: 27082564 PMCID: PMC4839808 DOI: 10.1097/md.0000000000003273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Malignant pericardial effusion (MPE) is a serious complication of several cancers. The most commonly involved solid tumors are lung and breast cancer. MPE can give rise to the clinical picture of cardiac tamponade, a life threatening condition that needs immediate drainage. While simple pericardiocentesis allows resolution of the symptoms, MPE frequently relapses unless further procedures are performed. Prolonged drainage, talcage with antineoplastic agents, or surgical creation of a pleuro-pericardial window are the most commonly suggested ones. They all result in MPE resolution and high rates of long-term control. Patients suitable for further systemic treatments can have a good prognosis irrespective of the pericardial site of disease. We prospectively enrolled patients with cardiac tamponade treated with prolonged drainage associated with Bleomycin administration. Twenty-two consecutive patients with MPE and associated signs of hemodynamical compromise underwent prolonged drainage and subsequent Bleomycin administration. After injection of 100 mg lidocaine hydrochloride, 10 mg Bleomycin was injected into the pericardial space. The catheter was clumped for 48 h and then reopened. Removal was performed when the drainage volume was <25 mL daily. Twelve patients (54%) achieved complete response and 9 (41%) a partial response. Only 1 (5%) had a treatment failure and underwent a successful surgical procedure. Acute toxicity was of a low degree and occurred in 7 patients (32%). It consisted mainly in thoracic pain and supraventricular arrhythmia. The 1-year pericardial effusion progression-free survival rate was 74.0% (95% confidence interval [CI]: 51.0-97.3). At a median follow-up of 75 months, a pericardial progression was detected in 4 patients (18%). One- and two-year overall survival rates were 33.9% (95% CI: 13.6-54.2) and 14.5% (95% CI: 0.0-29.5), respectively, with lung cancer patients having a shorter survival than breast cancer patients. The worst prognosis, however, was shown in patients not suitable for systemic treatments, irrespective of the site of the primary tumor.Prolonged drainage and intrapericardial Bleomycin is a safe and effective treatment, which should be considered as first choice at least in patients suitable for active systemic treatment.
Collapse
Affiliation(s)
- Gianmauro Numico
- From the Medical Oncology, Azienda Ospedaliera SS Antonio e Biagio e C Arrigo, Alessandria (GN, PP); Medical Oncology and Hematology (AC, AM) and Cardiology (MS), Azienda USL della Valle d'Aosta, Aosta; Medical Oncology, Azienda Ospedaliera S. Croce e Carle, Cuneo (MO, EF, IC, MM); and Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari (NS), Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Niclauss L, Montemurro M, Prêtre R. Survival after surgical drainage of malignant pericardial effusion. World J Surg 2016; 39:1767-72. [PMID: 25708509 DOI: 10.1007/s00268-015-3025-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Management of malignant pericardial effusion (PE) is complex. Cardiac surgeons are not necessarily familiar with or are challenged by the many underlying etiologies. Analyzing risk factors for mortality may help to estimate the benefit of surgery in high-risk patients. METHODS Patients undergoing a surgical pericardiotomy for malignant PE, between 2001 and 2011, were included. The influence of tumor type, disease extension, intra-pericardial tumor infiltration on early mortality and long-term survival as well as freedom from symptoms after drainage, and the use of sclerosing agents on PE recurrence rates was analyzed. RESULTS PE drainage was performed on 46 patients 12 ± 30 months after tumor diagnosis. Malignant diseases were lung cancers (50 %), breast cancers (15 %), lymphoma and leukemia (13 %), cancers of the digestive tract (13 %), and others (9 %). 80 % of patients were symptomatic and symptom relief was achieved in 65 %. Nobody died during surgery. Recurrence rate was 4 %. Early in-hospital mortality was 22 %. After 1 year, 29 % of patients were alive. Eleven patients (24 %) had a complete tumor regression. Metastatic spread (p < 0.001), pericardial infiltration (p = 0.02), and intra-pericardial Bleomycin (p = 0.01) injection were associated with increased mortality. Hematological malignancies had a better prognosis for survival. CONCLUSION Surgical pericardiotomy is safe, associated with a low recurrence rate and symptom relief in the majority of dyspneic patients. Intra-pericardial Bleomycin may reduce recurrent effusion but does not ameliorate survival. Long-term survival rate was low with an increased mortality in cases of metastatic spreading, pericardial infiltration, and as the tumor of origin: breast cancers. Leukemic and lymphatic tumors have better prognosis.
Collapse
Affiliation(s)
- Lars Niclauss
- Department of Cardiac Surgery, University Hospital of Lausanne, 46, rue du Bugnon, 1011, Lausanne, Switzerland,
| | | | | |
Collapse
|
16
|
Early and long-term outcomes of pericardiotomy in the treatment of primary cardiac tamponade. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:191-4. [PMID: 26702272 PMCID: PMC4631908 DOI: 10.5114/kitp.2015.54451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 08/25/2015] [Accepted: 09/11/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cardiac tamponade is a life-threatening clinical entity that requires emergent treatment. A variety of therapeutic methods have been applied. The purpose of this retrospective analysis was to study the efficacy of emergent surgical pericardiotomy in both the relief of cardiac tamponade and in the prevention of recurrence of pericardial effusion. MATERIAL AND METHODS This study involved 90 consecutive patients (58 males and 32 females) with a mean age of 57.4 ± 14.1 years, who underwent emergent pericardiotomy in the years 2006 to 2011 due to symptomatic primary cardiac tamponade. At the end of the follow-up period all living subjects had control echocardiographic examination. Survival analysis was performed with the use of the Kaplan-Meier method. RESULTS The mean duration time of surgery was 14.2 ± 4.5 minutes. All patients survived surgery but one died during in-hospital stay. During the post-discharge follow-up period (median 49 months) 32 patients died for any reason. One-year and four-year probability of survival was 0.68 ± 0.05 and 0.64 ± 0.05, respectively. Malignancy diagnosis was associated with significant negative impact on survival. One-year and four-year probability of survival was 0.56 ± 0.06 and 0.53 ± 0.06 for cancer patients while it was 0.93 ± 0.05 and 0.89 ± 0.06 for the others, respectively. In two cases, only cancer patients, re-intervention due to effusion recurrence was necessary. CONCLUSIONS Pericardiotomy, although invasive, is a safe method to relieve cardiac tamponade. It is also very efficient in the prevention of recurrence of pericardial effusion, even in cancer patients.
Collapse
|
17
|
Angsutararux P, Luanpitpong S, Issaragrisil S. Chemotherapy-Induced Cardiotoxicity: Overview of the Roles of Oxidative Stress. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:795602. [PMID: 26491536 PMCID: PMC4602327 DOI: 10.1155/2015/795602] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/17/2015] [Indexed: 02/02/2023]
Abstract
Chemotherapy-induced cardiotoxicity is a serious complication that poses a serious threat to life and limits the clinical use of various chemotherapeutic agents, particularly the anthracyclines. Understanding molecular mechanisms of chemotherapy-induced cardiotoxicity is a key to effective preventive strategies and improved chemotherapy regimen. Although no reliable and effective preventive treatment has become available, numerous evidence demonstrates that chemotherapy-induced cardiotoxicity involves the generation of reactive oxygen species (ROS). This review provides an overview of the roles of oxidative stress in chemotherapy-induced cardiotoxicity using doxorubicin, which is one of the most effective chemotherapeutic agents against a wide range of cancers, as an example. Current understanding in the molecular mechanisms of ROS-mediated cardiotoxicity will be explored and discussed, with emphasis on cardiomyocyte apoptosis leading to cardiomyopathy. The review will conclude with perspectives on model development needed to facilitate further progress and understanding on chemotherapy-induced cardiotoxicity.
Collapse
Affiliation(s)
- Paweorn Angsutararux
- Siriraj Center of Excellence for Stem Cell Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sudjit Luanpitpong
- Siriraj Center of Excellence for Stem Cell Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Surapol Issaragrisil
- Siriraj Center of Excellence for Stem Cell Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| |
Collapse
|
18
|
Takayama T, Okura Y, Okada Y, Honma K, Nashimoto A, Sato N, Yokoyama A, Minamino T. Characteristics of neoplastic cardiac tamponade and prognosis after pericardiocentesis: a single-center study of 113 consecutive cancer patients. Int J Clin Oncol 2015; 20:872-7. [DOI: 10.1007/s10147-015-0794-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 01/23/2015] [Indexed: 12/31/2022]
|
19
|
Systemic chemotherapy in combination with pericardial window has better outcomes in malignant pericardial effusions. J Thorac Cardiovasc Surg 2014; 148:2288-93. [DOI: 10.1016/j.jtcvs.2014.04.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/20/2014] [Accepted: 04/11/2014] [Indexed: 01/30/2023]
|
20
|
Sun T, Zhang Y, Shen Y, Hu K, Zuo M. A case of advanced lung cancer with malignant pericardial effusion treated by intrapericardial Cinobufacini injection instillation. Biosci Trends 2014; 8:235-9. [PMID: 25048980 DOI: 10.5582/bst.2014.01073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Malignant pericardial effusion is one of the severe complications in advanced lung cancer patients, seriously affecting the patient's cardiopulmonary function and even life. Pericardial drainage and instillation of anti-neoplastic drugs in the pericardial cavity seems to offer the best chance of controlling pericardial effusion. We reported a case concerning treatment of a 63-year-old man in advanced lung cancer with a large amount of pericardial effusion. We utilized pericardium puncture and drainage combined with instillation of Cinobufacini injection in the pericardial cavity to treat pericardial effusion. After treatment with Cinobufacini injection for two weeks, the patient was followed up in one month to assess effectiveness, quality of life, and safety. We found that the cardiac tamponade symptoms such as difficult breathing, chest distress, and palpitations were significantly relieved. The patient's quality of life was effectively improved with KPS scores increased. We also found that the levels of tumor marker CA-125 in the pericardial effusion decreased (from 340.80 U/mL to 34.85 U/mL) and pericardium B ultrasound showed that the quantity of pericardial effusion reduced significantly (from 2.5 cm to 0.6 cm). Furthermore, there were little gastrointestinal adverse reactions and myelosuppression in the patient after instillation of the Cinobufacini injection. Taken together, this provides a new way for treating cancerous pericardial effusion, especially for patients who cannot tolerate instillation of chemotherapy drugs, and is worthwhile to carry out more standardized studies in the future.
Collapse
Affiliation(s)
- Tao Sun
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine
| | | | | | | | | |
Collapse
|
21
|
Amati M, Venco L, Roccabianca P, Santagostino SF, Bertazzolo W. Pericardial lymphoma in seven cats. J Feline Med Surg 2014; 16:507-12. [PMID: 24108202 PMCID: PMC11112177 DOI: 10.1177/1098612x13506199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
A presumed primary pericardial lymphoma was diagnosed in seven cats. Clinical findings at presentation included poor body condition, dehydration and dyspnoea. Thoracic diagnostic imaging was performed in six cases and revealed pleural effusion and a diffuse thickening of the pericardium. A cytological diagnosis of lymphoma was obtained in six cases; in four cases the diagnosis was confirmed at necropsy. Immunophenotyping was performed in six cases: three cases were classified as T-cell and three as B-cell lymphoma. Four cats did not receive any treatment. One cat received only prednisone and two cats received chemotherapy. Six cats lived 7-11 days, except for one cat that received a multi-drug chemotherapy protocol and was still alive at the time of writing (750 days after diagnosis). Primary pericardial lymphoma is a rare extranodal feline lymphoma that has never been described previously.
Collapse
Affiliation(s)
- Maria Amati
- Veterinary Hospital of the City of Pavia, Pavia, Italy
| | - Luigi Venco
- Veterinary Hospital of the City of Pavia, Pavia, Italy
| | - Paola Roccabianca
- Department of Veterinary Sciences and Public Health (DIVET), University of Milan, Milan, Italy
| | | | | |
Collapse
|
22
|
|
23
|
Petrofsky M. Management of Malignant Pericardial Effusion. J Adv Pract Oncol 2014; 5:281-9. [PMID: 26110072 PMCID: PMC4457183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
24
|
Block DR, Algeciras-Schimnich A. Body fluid analysis: Clinical utility and applicability of published studies to guide interpretation of today’s laboratory testing in serous fluids. Crit Rev Clin Lab Sci 2013; 50:107-24. [DOI: 10.3109/10408363.2013.844679] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
25
|
Buyukbayrak F, Aksoy E, Dedemoglu M, Kirali K, Alp HM. Pericardiectomy for treatment of neoplastic constrictive pericarditis. Asian Cardiovasc Thorac Ann 2013; 22:296-300. [DOI: 10.1177/0218492313484317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To share our results of a case series of 8 patients who underwent pericardiectomy for constrictive pericarditis that developed secondary to a known neoplastic disease. Patients and methods The underlying neoplasia was lung cancer in 5 (62.5%) patients, malignant pleural mesothelioma in 2 (25%), and Hodgkin lymphoma in 1 (12.5%). A diagnosis of constrictive pericarditis was made primarily by echocardiography, and right heart catheterization was performed in 6 (75%) patients. Total pericardiectomy was defined as wide excision of the anterior pericardium. Follow-up information was obtained by telephone interview and the civil registry database. Results Time from initial diagnosis of the neoplastic disease ranged from 1 to 15 years. Total pericardiectomy was performed in 6 (75%) patients. Histopathological examination revealed atypical cells in evacuated fluid and pericardial material in 6 patients. Nonspecific inflammation and fibrosis were observed in the other 2 cases. Hospital death occurred in 1 (12.5%) patient. Postoperative low cardiac output syndrome occurred in 7 (87.5%) patients. Follow-up ranged from 2.92 to 26.78 months. Mean survival was 14.82 ± 4.4 months. Conclusion Pericardial constriction may develop a long time after the initial presentation of certain neoplastic diseases, and the prognosis after pericardiectomy is poor.
Collapse
Affiliation(s)
| | - Eray Aksoy
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | | | - Kaan Kirali
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Hizir Mete Alp
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| |
Collapse
|
26
|
Lestuzzi C. Cardioncology, oncocardiology. Are we barking up the wrong tree? Int J Cardiol 2013; 167:307-9. [DOI: 10.1016/j.ijcard.2013.04.148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/06/2013] [Indexed: 12/11/2022]
|
27
|
Bloomfield GS, Barasa FA, Doll JA, Velazquez EJ. Heart failure in sub-Saharan Africa. Curr Cardiol Rev 2013; 9:157-73. [PMID: 23597299 PMCID: PMC3682399 DOI: 10.2174/1573403x11309020008] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/15/2012] [Accepted: 11/18/2012] [Indexed: 02/06/2023] Open
Abstract
The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure in sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa (e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic cardiomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale) and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs.
Collapse
|
28
|
Adão R, de Keulenaer G, Leite-Moreira A, Brás-Silva C. Cardiotoxicidade associada à terapêutica oncológica: mecanismos fisiopatológicos e estratégias de prevenção. Rev Port Cardiol 2013; 32:395-409. [DOI: 10.1016/j.repc.2012.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 11/01/2012] [Indexed: 10/26/2022] Open
|
29
|
Cardiotoxicity associated with cancer therapy: Pathophysiology and prevention. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2012.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
30
|
Abstract
Pericardial effusion is a common finding in clinical practice either as incidental finding or manifestation of a systemic or cardiac disease. The spectrum of pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade. The aetiology is varied (infectious, neoplastic, autoimmune, metabolic, and drug-related), being tuberculosis the leading cause of pericardial effusions in developing countries and all over the world, while concurrent HIV infection may have an important promoting role in this setting. Management is guided by the haemodynamic impact, size, presence of inflammation (i.e. pericarditis), associated medical conditions, and the aetiology whenever possible. Pericardiocentesis is mandatory for cardiac tamponade and when a bacterial or neoplastic aetiology is suspected. Pericardial biopsy is generally reserved for cases with recurrent cardiac tamponade or persistence without a defined aetiology, especially when a bacterial or neoplastic aetiology is suspected and cannot be assessed by other conventional and less invasive means. A true isolated effusion may not require a specific treatment if the patient is asymptomatic, but large ones are at risk of progression to cardiac tamponade (up to one third). Pericardiocentesis alone may be curative for large effusions, but recurrences are also common and pericardiectomy or less invasive options (i.e. pericardial window) should be considered with recurrent cardiac tamponade or symptomatic pericardial effusion (either circumferential or loculated). The aim of this paper was to summarize and critically evaluate current knowledge on the management of pericardial effusion.
Collapse
Affiliation(s)
- Massimo Imazio
- Department Cardiology, Maria Vittoria Hospital, Via Luigi Cibrario 72, Torino 10141, Italy.
| | | |
Collapse
|
31
|
Kim YJ, Hong YB, Cho CH, Seong YS, Bae I. Exploring protein kinase inhibitors: unveiling gemcitabine resistance in pancreatic cancer. Pancreas 2012; 41:815-6. [PMID: 22695089 PMCID: PMC3375494 DOI: 10.1097/mpa.0b013e31823f3fcb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Yeon Jeong Kim
- Department of Nanobiomedical Science and WCU Research Center of Nanobiomedical Science, Dankook University, Cheonan, Republic of Korea
| | - Young Bin Hong
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. Department of Nanobiomedical Science and WCU Research Center of Nanobiomedical Science, Dankook University, Cheonan, Republic of Korea
| | - Chi Heum Cho
- Department of Obstetrics and Gynecology, Keimyung University, School of Medicine, Daegu, Korea
| | - Yeon-Sun Seong
- Department of Nanobiomedical Science and WCU Research Center of Nanobiomedical Science, Dankook University, Cheonan, Republic of Korea
| | - Insoo Bae
- Correspondence: Tel, 1-202-687-5267; Fax, 1-202-687-2847;
| |
Collapse
|
32
|
Treatment with aspirin, NSAID, corticosteroids, and colchicine in acute and recurrent pericarditis. Heart Fail Rev 2012; 18:355-60. [DOI: 10.1007/s10741-012-9328-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
33
|
|
34
|
Casey DJ, Kim AY, Olszewski AJ. Progressive pericardial effusion during chemotherapy for advanced Hodgkin lymphoma. Am J Hematol 2012; 87:521-4. [PMID: 22120982 DOI: 10.1002/ajh.22239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 10/20/2011] [Accepted: 10/26/2011] [Indexed: 12/27/2022]
Affiliation(s)
- David J Casey
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | |
Collapse
|
35
|
Sparano DM, Ward RP. Pericarditis and Pericardial Effusion: Management Update. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:543-55. [DOI: 10.1007/s11936-011-0151-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
36
|
Gompelmann D, Eberhardt R, Herth FJF. Advanced malignant lung disease: what the specialist can offer. ACTA ACUST UNITED AC 2011; 82:111-23. [PMID: 21778793 DOI: 10.1159/000329703] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is not only the most commonly diagnosed cancer worldwide, but it is still the leading cause for cancer-related death. The 5-year survival for lung cancer in Europe and in the USA is totally 16%. Therefore, a palliative therapy regimen is required to control the disease and reduce symptoms with the objective of enhancing quality of life of lung cancer patients. In addition to chemotherapy that is still one of the most important pillars in the treatment of advanced lung cancer, further interventional strategies can be offered to improve a patient's quality of life. A locoregional tumour progression is frequently associated with malignant pleural effusion or pericardial effusion, central airway obstruction, tracheo-oesophageal fistula, severe haemoptysis or superior vena cava (SVC) syndrome threatening life and necessitating urgent palliation. Recurrent pleural effusion causing dyspnoea can be managed by pleurodesis, serial thoracocentesis or insertion of an indwelling catheter. Symptomatic malignant pericardial effusion often requires an urgent pericardiocentesis. Furthermore, surgical procedures, instillation of sclerosing agents or local chemotherapy should be considered in refractory pericardial effusion. The therapy regimen of central airway stenosis includes mechanical and thermic endoscopic procedures providing rapid relief of symptoms. To prevent recurrence of airway obstruction, the insertion of a stent or palliative brachytherapy provide re-establishment of the patency of obstructed airways. Haemoptysis can be managed by bronchoscopic interventions as well as by arterial embolization or palliative thoracic radiotherapy. The therapy of SVC syndrome is dependent of histology. In small-cell lung cancer, chemotherapy is recommended. In non-small-cell lung cancer, stent insertion and/or radiotherapy are the therapeutic pillars.
Collapse
Affiliation(s)
- Daniel Gompelmann
- Pneumology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany.
| | | | | |
Collapse
|
37
|
|
38
|
Sagristà-Sauleda J, Mercé AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol 2011; 3:135-43. [PMID: 21666814 PMCID: PMC3110902 DOI: 10.4330/wjc.v3.i5.135] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 04/28/2011] [Accepted: 05/05/2011] [Indexed: 02/06/2023] Open
Abstract
Pericardial effusion is a common finding in everyday clinical practice. The first challenge to the clinician is to try to establish an etiologic diagnosis. Sometimes, the pericardial effusion can be easily related to a known underlying disease, such as acute myocardial infarction, cardiac surgery, end-stage renal disease or widespread metastatic neoplasm. When no obvious cause is apparent, some clinical findings can be useful to establish a diagnosis of probability. The presence of acute inflammatory signs (chest pain, fever, pericardial friction rub) is predictive for acute idiopathic pericarditis irrespective of the size of the effusion or the presence or absence of tamponade. Severe effusion with absence of inflammatory signs and absence of tamponade is predictive for chronic idiopathic pericardial effusion, and tamponade without inflammatory signs for neoplastic pericardial effusion. Epidemiologic considerations are very important, as in developed countries acute idiopathic pericarditis and idiopathic pericardial effusion are the most common etiologies, but in some underdeveloped geographic areas tuberculous pericarditis is the leading cause of pericardial effusion. The second point is the evaluation of the hemodynamic compromise caused by pericardial fluid. Cardiac tamponade is not an "all or none" phenomenon, but a syndrome with a continuum of severity ranging from an asymptomatic elevation of intrapericardial pressure detectable only through hemodynamic methods to a clinical tamponade recognized by the presence of dyspnea, tachycardia, jugular venous distension, pulsus paradoxus and in the more severe cases arterial hypotension and shock. In the middle, echocardiographic tamponade is recognized by the presence of cardiac chamber collapses and characteristic alterations in respiratory variations of mitral and tricuspid flow. Medical treatment of pericardial effusion is mainly dictated by the presence of inflammatory signs and by the underlying disease if present. Pericardial drainage is mandatory when clinical tamponade is present. In the absence of clinical tamponade, examination of the pericardial fluid is indicated when there is a clinical suspicion of purulent pericarditis and in patients with underlying neoplasia. Patients with chronic massive idiopathic pericardial effusion should also be submitted to pericardial drainage because of the risk of developing unexpected tamponade. The selection of the pericardial drainage procedure depends on the etiology of the effusion. Simple pericardiocentesis is usually sufficient in patients with acute idiopathic or viral pericarditis. Purulent pericarditis should be drained surgically, usually through subxiphoid pericardiotomy. Neoplastic pericardial effusion constitutes a more difficult challenge because reaccumulation of pericardial fluid is a concern. The therapeutic possibilities include extended indwelling pericardial catheter, percutaneous pericardiostomy and intrapericardial instillation of antineoplastic and sclerosing agents. Massive chronic idiopathic pericardial effusions do not respond to medical treatment and tend to recur after pericardiocentesis, so wide anterior pericardiectomy is finally necessary in many cases.
Collapse
Affiliation(s)
- Jaume Sagristà-Sauleda
- Jaume Sagristà-Sauleda, Axel Sarrias Mercé, Jordi Soler-Soler, Cardiology Service, Àrea del cor, ACORVH, University Hospital Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | | | | |
Collapse
|