Analysis of the effect of infection prevention nursing on drainage of malignant pleural effusion with indwelling central venous catheter.

BACKGROUND: The aim of this study was to explore the effect of infection prevention care on the drainage of malignant pleural effusion (MPE) by indwelling Central venous catheterization (CVC). METHODS: From January 2016 to January 2018, 128 patients at our hospital who needed indwelling CVC for drainage of MPE were randomly divided into an infection prevention group and a conventional group. The corresponding nursing plan was given to compare the 2 groups in several measures, including nursing effect and complications. RESULTS: After intervention, the total effective rate of the infection prevention group was 96.88%, while the total effective rate of the conventional group was 87.50%, which was a statistically significant difference (P<0.05). The disappearance time of pleural effusion, catheter indwelling time, and length of stay in the infection prevention group were significantly lower than those in the conventional group (P<0.05). The incidence of infection and the total incidence of all complications in the infection prevention group were significantly lower than those in the conventional group (P<0.05). The proportion of the number of cases with Karnofsky Performance Scale (KPS) ≤10 in the infection prevention group was significantly lower than that in the conventional group (P<0.05). CONCLUSIONS: As infection prevention care significantly improves clinical efficacy and reduces the occurrence of complications, it uses in clinic is warranted.

Video-assisted biopsy and talc pleurodesis for malignant pleural mesothelioma.

Malignant pleural mesothelioma is a disease of the pleural cavity that is strongly associated with asbestos exposure. In most cases it carries a poor prognosis. Patients often present with respiratory symptoms, caused by pleural effusion. Treatment, preferably in a multimodal setting, cannot provide cure, but can prolong survival and improve quality of life in selected cases.  Prior to eventual cytoreductive surgery, surgical intervention can provide histopathological proof of disease, and symptoms can be controlled with talc pleurodesis.  We present the case of a 67-year-old patient with malignant pleural mesothelioma who underwent video-assisted thoracoscopic biopsy and talc pleurodesis, and demonstrate our technique with a video tutorial showing how we performed the procedure.

Thoracic perfusion of matrine as an adjuvant treatment improves the control of the malignant pleural effusions.

BACKGROUND: Many studies have investigated the efficacy and safety of matrine in treating malignant pleural effusion by thoracic perfusion. This study is an analytic value of available evidence. METHODS: Twelve studies were analyzed in this study. Pooled odds ratios and hazard ratio with 95 % confidence intervals were calculated using the fixed effects model. RESULTS: Overall response rate of matrine combined with other medications in treating malignant pleural effusion (MPE) was significantly higher than those of other medications alone (p < 0.05). Time to pleural effusion relief and quality of life were improved after the treatment of matrine combined with other medications (p < 0.05). Moreover, matrine combined with other medications had a lower incidence of adverse reactions (p < 0.05). CONCLUSIONS: Matrine combined with other medications improves the control of the malignant pleural effusions and decreases the incidence of adverse reactions.

Delayed methotrexate excretion in infants and young children with primary central nervous system tumors and postoperative fluid collections.

PURPOSE: High-dose methotrexate (HD-MTX) has been used to treat children with central nervous system tumors. Accumulation of MTX within pleural, peritoneal, or cardiac effusions has led to delayed excretion and increased risk of systemic toxicity. This retrospective study analyzed the association of intracranial post-resection fluid collections with MTX plasma disposition in infants and young children with brain tumors. METHODS: Brain MRI findings were analyzed for postoperative intracranial fluid collections in 75 pediatric patients treated with HD-MTX and for whom serial MTX plasma concentrations (MTX) were collected. Delayed plasma excretion was defined as (MTX) ≥1 µM at 42 hours (h). Leucovorin was administered at 42 h and then every 6 h until (MTX) <0.1 µM. Population and individual MTX pharmacokinetic parameters were estimated by nonlinear mixed-effects modeling. RESULTS: Fifty-eight patients had intracranial fluid collections present. Population average (inter-individual variation) MTX clearance was 96.0 ml/min/m² (41.1 CV %) and increased with age. Of the patients with intracranial fluid collections, 24 had delayed excretion; only 2 of the 17 without fluid collections (P < 0.04) had delayed excretion. Eleven patients had grade 3 or 4 toxicities attributed to HD-MTX. No significant difference was observed in intracranial fluid collection, total leucovorin dosing, or hydration fluids between those with and without toxicity. CONCLUSIONS: Although an intracranial fluid collection is associated with delayed MTX excretion, HD-MTX can be safely administered with monitoring of infants and young children with intracranial fluid collections. Infants younger than 1 year may need additional monitoring to avoid toxicity.

Mammalian target of rapamycin (mTOR) inhibition does not prevent lung adenocarcinoma-induced malignant pleural effusion.

The impact of temsirolimus was investigated in a murine model of malignant pleural effusion (MPE) created with intrapleural injection of Lewis Lung Cancer (LLC) cells. Temsirolimus (1 or 20 mg/kg) did not affect the pleural fluid volume or the number of pleural tumour foci. In addition, temsirolimus did not affect vascular endothelial growth factor expression by LLC cells in vitro. In conclusion, temsirolimus did not curtail experimental lung-adenocarcinoma-induced MPE.

Recombinant human endostatin (endostar) decreased recurrent ascites, pleural fluid and ascitic VEGF in a case of advanced mesothelioma.

We report a case of 43-year-old male with advanced malignant mesothelioma (MM) with a large amount of fluid in the pleural and peritoneal cavity. The addition of endostar to the gemcitabine-cisplatin regimen gave a prompt and significant improvement of clinical symptoms and disappearance of ascites. The patient is still progression free after 27 months. Endostar, in combination with chemotherapy should be explored in the treatment of MM, especially its effect on pleural and ascitic fluid.

Managing pleural effusions.

Malignant pleural effusions result from advanced metastatic disease and can have a devastating effect on patients and their families. The insertion of a tunneled pleural catheter, such as a Tenckhoff catheter, is a treatment option for this patient population. Nurses play a significant role during the patient's journey with the disease process, providing the skills necessary to promote self-care and autonomy, resulting in improved quality of life. In this article, the authors discuss the nursing care of patients who have a Tenckhoff catheter.

Inhibition of Met/HGF receptor and angiogenesis by NK4 leads to suppression of tumor growth and migration in malignant pleural mesothelioma.

NK4 exhibits two distinct biological actions: antagonistic inhibition of hepatocyte growth factor (HGF) through binding to the Met/HGF receptor, and antiangiogenic action through binding to perlecan. Here, the anti-tumor effect of NK4 on malignant pleural mesothelioma was investigated. Of the 7 human malignant mesothelioma cell lines (ACC-Meso-1, ACC-Meso-4, EHMES-1, EHMES-10, H28, H2052 and JMN-1B), only EHMES-10 cells formed subcutaneous tumors when implanted into mice. For EHMES-10 cells, HGF facilitated invasion of the cells in collagen gel, whereas NK4 and neutralizing anti-HGF antibody suppressed the HGF-induced invasion. In addition, NK4 but not anti-HGF antibody suppressed proliferation of EHMES-10 cells in collagen, suggesting that the suppression by NK4 was independent of the HGF-Met pathway. In the subcutaneous tumor model, recombinant adenovirus-mediated intratumoral expression of NK4 inhibited tumor growth, while the invasive characteristic of tumor cells was not observed. Analysis of Met receptor tyrosine phosphorylation, proliferation, apoptosis and blood vessels in the tumor tissues indicated that the inhibitory effect of NK4 expression might be primarily caused by the inhibition of tumor angiogenesis. In all the 7 mesothelioma lines, HGF stimulated Met tyrosine phosphorylation, and this was associated with enhanced cell migration. HGF-dependent Met activation and migration were inhibited by NK4. Since malignant pleural mesothelioma represents an aggressive neoplasm characterized by extensive invasive growth, suppression of invasive growth has therapeutic value. Thus, the simultaneous inhibition of the HGF-Met pathway and angiogenesis by NK4 for treatment of malignant pleural mesothelioma is significant, particularly to attenuate migration and invasive growth.

Therapeutic effects of recombinant human endostatin adenovirus in a mouse model of malignant pleural effusion.

PURPOSE: Malignant pleural effusion (MPE) is a common clinical problem in patients with advanced cancer. Evidence suggests that tumor-mediated angiogenesis and enhanced vascular permeability in the pleural wall are due to high levels of vascular endothelial growth factor (VEGF), which plays an important role in the pathogenesis of MPE. The present study was designed to test whether the recombinant adenovirus-mediated delivery of human endostatin (Ad-hEndo), one of the potent inhibitors of angiogenesis, would inhibit the formation and progression of MPE. METHODS: We developed a novel mouse model of MPE by injecting Lewis lung carcinoma (LLC) cells directly into pleural cavity of C57BL/6 mice. To evaluate the therapeutic effects of endostatin in this MPE model, we injected the Ad-hEndo into the pleural cavity of MPE-bearing mice three times with the 3-day interval. RESULTS: We found that this treatment resulted in significant reduction in pleural effusion volume, the number of pleural tumor foci, microvessel density, and vascular permeability, while it significantly prolonged the survival time. In addition, VEGF level of MPE in the group administered with the Ad-hEndo was obviously decreased as compared with that in the two control groups administered with null-adenovirus (Ad-null) or normal saline. CONCLUSIONS: Our work provides a rationale for future studies toward evaluating the effectiveness of the adenovirus-based endostatin therapy for MPE.

[Clinical evaluation of lung cancer patients with only best supportive care].

Eighteen cases with only symptomatically treated lung cancer admitted to our hospital from May 2002 to October 2006 were retrospectively investigated clinically. The patients consisted of 10 males and 8 females, aged 50-9 8 years old (mean age 78.1 yo). Clinical stage distribution revealed a higher incidence in the advanced stages. The performance status according to the ECOG classification was predominantly grade 2-4. The average survival time was 5.9 4 months. The cell type was the major prognosticator followed by clinical stage and age. There was a tendency to die early in any case that had a poor whole-body state, such as weight reduction and a feeling of whole body fatigue. There was a tendency for the at home period to be short in cases that required control of pleural effusion, and the survival period was short.

A spray catheter technique for pleural anesthesia: a novel method for pain control before talc poudrage.

BACKGROUND: Chemical pleurodesis causes severe pain, prompting physicians to perform thoracoscopic talc poudrage under general or neuroleptanalgesia. We describe a novel method for pain control in five patients with pneumothoraces and severe chronic obstructive pulmonary disease. METHODS: Patients were premedicated with IM pethidine and IV midazolam. The pleural space was examined with the flex-rigid pleuroscope. Before talc poudrage, 250 mg lidocaine was administered via spray catheter, and pain scores measured immediately after the procedure and on postoperative days 1 and 2 were 3, 2, and 2, respectively. RESULTS: No complications were noted, and 30-day mortality was 0%. CONCLUSION: Lidocaine via spray catheter is effective for pain control before pleurodesis.

ZD6474, an inhibitor of vascular endothelial growth factor receptor tyrosine kinase, inhibits growth of experimental lung metastasis and production of malignant pleural effusions in a non-small cell lung cancer model.

ZD6474 is a novel, orally active inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2) tyrosine kinase, with some additional activity against epidermal growth factor receptor (EGFR) tyrosine kinase. The purpose of this study was to determine the potential of ZD6474 in the control of established experimental lung metastasis and pleural effusions produced by human non-small cell lung cancer (NSCLC) cells. PC14PE6 (adenocarcinoma) and H226 (squamous cell carcinoma) cells express high levels of EGFR and only PC14PE6 cells overexpress VEGF. Neither ZD6474 nor the EGFR tyrosine kinase inhibitor gefitinib inhibit proliferation of PC14PE6 or H226 cells in vitro. Both PC14PE6 and H226 cells inoculated intravenously into nude mice induced multiple lung nodules after 5-7 weeks. In addition, PC14PE6 cells produced bloody pleural effusions. Daily oral treatment with ZD6474 did not reduce the number of lung nodules produced by PC14PE6 or H226 cells, but did reduce the lung weight and the size of lung nodules. ZD6474 also inhibited the production of pleural effusions by PC14PE6 cells. Histological analyses of lung lesions revealed that ZD6474 treatment inhibited activation of VEGFR-2 and reduced tumor vascularization and tumor cell proliferation. Therapeutic effects of ZD6474 were considered likely to be due to inhibition of VEGFR-2 tyrosine kinase because gefitinib was inactive in this model. These results indicate that ZD6474, an inhibitor of VEGFR-2, may be useful in controlling the growth of established lung metastasis and pleural effusions by NSCLC.

Talc powder vs doxycycline in the control of malignant pleural effusion: a prospective, randomized trial.

BACKGROUND: Malignant pleural effusion is a common problem in advanced cancers, contributing to the poor quality of life in this group of patients. The aim of the study was to assess the efficiency of talc powder and doxycycline in pleurodesis in patients with malignant pleural effusion in comparable conditions. MATERIAL/METHODS: Of 52 patients screened, 33 entered the trial. They were randomized to the talc group (n=18) and the doxycycline group (n=15). Both groups were comparable with regard to age, sex and the most important variables influencing effectiveness of the procedure, i.e. primary malignancy and stage of metastatic involvement of the pleura. Efficiency of pleurodesis was prospectively assessed. RESULTS: The analysis of short-term effectiveness of pleurodesis in the first 33 patients has shown a highly significant difference in favor of talc powder (p=0.009); this difference was the reason for terminating the randomization. Further observation has revealed in the doxycycline group an increasing number of patients with fluid reaccumulation, as time went by; this was not observed in the talc group. A statistical analysis of the long-term effectiveness of both agents studied has shown a more significant difference in favor of the talc powder (p=0.00003). CONCLUSIONS: Talc powder is superior to doxycycline in achieving pleurodesis in patients with malignant pleural effusion, in both short- and long-term observations.

Targeting vascular endothelial growth factor blockade: ascites and pleural effusion formation.

PRIMARY PURPOSE: Formation of ascites and pleural effusion (PE) is a common problem for patients with advanced-stage cancer. These fluid accumulations cause severe symptoms such as abdominal distention, shortness of breath, cachexia, anorexia, and fatigue. Preclinical models have demonstrated that vascular endothelial growth factor (VEGF) plays a pivotal role in the accumulation of malignant PE or ascites. This study investigated whether blockade of VEGF activity would reduce biological activity of PE and ascites on endothelial cells of cancer patients. PATIENTS AND METHODS: The activity of VEGF in PE and ascites of 58 patients (39 with PE and 19 with ascites) was measured. An endothelial cell proliferation assay with human umbilical vein endothelial cells was used to determine the biological activity of ascites and PE. RESULTS: VEGF concentrations ranged from 67-6,245 pg/ml. A significantly higher concentration of VEGF was detected in the ascites and PE of patients with cancer (median, 1,290 pg/ml) than in patients with nonmalignant disease (median, 250 pg/ml; p = 0.02). Of the 58 PE and ascites samples, 41 were biologically active, based on a two- to fourfold stimulation of endothelial cell proliferation in 72 hours. VEGF concentrations were significantly higher in the biologically active samples compared with the 17 nonactive samples (2,056 pg/ml versus 771 pg/ml; p = 0.02). Coincubation of the samples with either a neutralizing polyclonal antibody against VEGF or SU5416, a small molecule inhibitor of the VEGF receptor Flk-1/KDR, inhibited endothelial cell proliferation by 66% and 100%, respectively. The inhibition caused by the antibody and that caused by SU5416 correlated significantly (r = 0.8, p<0.001). CONCLUSION: We conclude that malignant ascites and PE contain high levels of biologically active VEGF. This study strongly supports the hypothesis that blockade of VEGF, such as that afforded by SU5416, may benefit cancer patients with recurrent ascites or PE formation.

Treatment for malignant pleural effusion of human lung adenocarcinoma by inhibition of vascular endothelial growth factor receptor tyrosine kinase phosphorylation.

Malignant pleural effusion (PE) is associated with advanced human lung cancer. We found recently, using a nude mouse model, that vascular endothelial growth factor/vascular permeability factor (VEGF/VPF) is responsible for PE induced by non-small cell human lung carcinoma cells. The purpose of this study was to determine the therapeutic potential of a VEGF/VPF receptor tyrosine kinase phosphorylation inhibitor, PTK 787, against PE formed by human lung adenocarcinoma (PC14PE6) cells. PTK 787 did not affect the in vitro proliferation of PC14PE6 cells, whereas it specifically inhibited proliferation of human dermal microvascular endothelial cells stimulated by VEGF/VPF. A specific platelet-derived growth factor receptor tyrosine kinase inhibitor, CGP57148 (used as a control because PTK 787 also inhibits platelet-derived growth factor receptor tyrosine kinases), had no effect on proliferation of PC14PE6 or human dermal microvascular endothelial cells. i.v. injection of PC14PE6 cells into nude mice produced lung lesions and a large volume of PE containing a high level of VEGF/VPF. Oral treatment with CGP57148 had no effect on PE or lung metastasis. In contrast, oral treatment with PTK 787 significantly reduced the formation of PE but not the number of lung lesions. Furthermore, treatment with PTK 787 significantly suppressed vascular hyperpermeability of PE-bearing mice but did not affect the VEGF/VPF level in PE or expression of VEGF/VPF protein and mRNA in the lung tumors of PC14PE6 cells in vivo. These findings indicate that PTK 787 reduced PE formation mainly by inhibiting vascular permeability, suggesting that this VEGF/VPF receptor tyrosine kinase inhibitor could be useful for the control of malignant PE.

Derrame Pleunal Neoplásico / Malignant Pleural Effusion

Introdução: O derrame pleural neoplásico é uma causa significativa de morbidade e queda do estado geral de pacientes com câncer avançado. Objetivo: tratamento atual do derrame pleural neoplásico. Métodos: Revisão de literatura recente correlacionando com a experiência pessoal. Resultados: Todos os métodos terapêuticos incluem toracocentese para esvaziamento da cavidade torácica e colocação de substância para pleurodese química (tetraciclina, bleomicina, talco)...

Pleural effusion in breast cancer: a review of the Nottingham experience.

A retrospective analysis of 40 patients with pleural effusions caused by breast cancer is presented. Evidence is presented which suggests that malignant pleural effusion in breast cancer is caused by lymphatic rather than blood spread. 70% of effusions are ipsilateral to the primary carcinoma and 22.5% of patients with pleural effusions have positive internal mammary node biopsies (compared to 10.4% in controls). 47.5% of effusions had positive cytology but this does not correlate with either survival or recurrence. In operable tumours, pleural effusion is correlated with the size of the primary tumour but effusions were uncommon with large, locally advanced Stage III tumours at presentation, which could be attributable either to the short survival of such patients or to the effect of adjuvant radiotherapy reducing the chance of an ipsilateral effusion. Although these patients overall had a short life expectancy (median 11 months) there was a wide range. Chest drainage and instillation of 100 mg mepacrine in 30 ml of bupivacaine to give rise to pleurodesis offers useful palliation and minimizes recurrence (29 treatments with only two symptomatic recurrences), compared with aspiration alone (19 treatments with 12 symptomatic recurrences) or instillation with tetracycline (10 treatments with five symptomatic recurrences). Pleural effusion secondary to breast cancer is a locoregional manifestation. Pleurodesis with mepacrine offers good local control.

Intrapleural doxycycline control of malignant pleural effusions.

The intrapleural instillation of agents for pleural sclerosis has proved effective in preventing the reaccumulation of symptomatic malignant pleural effusions. Because manufacture of the most popular agent, tetracycline, was recently discontinued, a preliminary study was undertaken to evaluate an alternative agent, doxycycline, for treating symptomatic malignant pleural effusions. From November 1991 to September 1992, 21 patients with symptomatic malignant pleural effusions have undergone overnight chest tube drainage followed by intrapleural instillation of 10 mL 1% lidocaine and then doxycycline, 500 mg in 30 mL 0.9% saline solution. The chest tube was clamped 2 hours with patient repositioning every 15 minutes. Tubes were removed when drainage was less than 50 mL/8 h. Of surviving patients, a complete objective response at 1 month was obtained in 88% (15/17), who were free of a symptomatic or radiographic recurrence of the effusion. Complications included mild pain in 23% (5/21), moderate pain requiring analgesics in 19% (4/21), and mild fever in 5% (1/21). There were no treatment-related deaths. The mean time for chest tube removal was 1.7 +/- 0.7 days after the last treatment. Based on this preliminary study, we conclude that doxycycline is a highly effective agent for the palliative treatment of symptomatic malignant pleural effusions. Its safety profile and efficacy compare favorably with those of tetracycline and other agents used for pleural sclerosis.