new look at an old agent for pleurodesis

Background and objective: Malignant pleural effusion [MPE] is a common problem in patients with malignancies. Chemical pleurodesis is the most commonly used palliative option. Parenteral tetracycline [TET] and doxycycline [DOX] are cost-effective and safe in producing pleurodesis but mostly unavailable currently. We investigated whether oral doxycycline could produce an efficient and safe pleurodesis as does parenteral doxycycline, which is currently unavailable in many countries

Methods: A prospective study of 24 pleurodesis procedures in 22 patients with malignant pleural effusions were conducted over a 3-year period. All pleurodesis was performed with oral forms of doxycycline as the sclerosing agent, where about 1000 mg of doxycycline was taken and prepared from the oral preparation [vibramycin 100 mg/capsule] and mixed in 50 ml. Physiological saline was then administered via tube thoracostomy. We assessed the success or failure of pleurodesis in addition to the frequency of complications and survival. Post-pleurodesis postero-anterior [PA] radiographs were obtained after tube removal and 30 days following the procedure

Results: Twenty-two patients were included [6 women, 16 men], the mean age was [62.5 years]. Origins of MPE were: lung and pleura 8 [36.4%], breast 2 [9.1%], ovarian 2 [9.1%], digestive 3 [13.6%], lymphoma 3 [13.6%] and unknown 4 [18.2%]. No immediate perioperative complications were noted. Chest tube duration averaged 4.2 +/- 2.6 days. Immediate postoperative events included chest pain in 10 patients [45.5%], fever in 2 [9.1%] patients, pain and fever in 5 patients [22.7%]. Sixteen patients [72.7%] had successful pleurodesis and 6 patients [27.3%] had failed pleurodesis at 1 month

Conclusions: Pleurodesis with oral forms of doxycycline dissolved in sterile saline solution have a high success rate with a low incidence of complications and could be a good option as palliative therapy in patients with symptomatic malignant pleural effusions

Role of the quantiferon-TB gold in tube in ruling out tuberculosis in end stage renal disease patients receiving hemodialysis

It is difficult to diagnose tuberculosis [TB] in dialysis patients because of the high rate of extrapulmonary TB in these patients compared with the general population. Recently, a new diagnostic test called QuantiFERON[QFT] has been developed and shown promise as a diagnostic tool for active TB diseases and latent TB infection. The aim of the present study was to analyze the performance of QuantiFERON-TB Gold in tube [QFT-G] in end stage renal disease patients receiving hemodialysis. QuantiFERON Gold in tube [QFT-GIT] were prospectively performed in 50 end stage renal disease [ESRD] cases undergoing hemodialysis [HD], including 6 patients with active TB and evaluated the utility of this test in dialysis patients. Among 50 dialysis patients, positive QFT results occurred in 10 [20%], negative QFT results occurred in 25 [50%] and indeterminate QFT results occurred in 15 [30%]. All six active TB patients had positive QFT results, and none of the 25 patients with negative results had active TB. Among 7 patients with a history of active TB, 2 [28.5%] had positive results. Although the indeterminate rate was relatively high, no patient with an indeterminate result had active TB. Among 30 cases after excluding the patients with previous TB and indeterminate results, the sensitivity of the QFT is 100% [6 of 6] and the specificity is 91.6% [22 of 24 cases]. Our data suggest that the QFT test is a useful supplementary tool for the diagnosis of active TB even in dialysis patients. Negative and indeterminate results on this test may be used to exclude the presence of active TB