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      Utilidad del cisplatino intrapericárdico en el tratamiento del derrame pericárdico maligno Translated title: Usefulness of Intrapericardial Cisplatin for the Management of Malignant Pericardial Effusion

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          Abstract

          Introducción El derrame pericárdico maligno recidiva en hasta el 62% de los pacientes luego de una pericardiocentesis. Debido a ello, se ha intentado completar el tratamiento con la instilación intrapericárdica de drogas luego del drenaje de la cavidad. El cisplatino ha demostrado que es útil y seguro para ese propósito. Objetivo Presentar la experiencia en nuestra institución del uso del cisplatino intrapericárdico en el tratamiento del derrame pericárdico maligno. Material y métodos Se incluyeron los pacientes ingresados en el Instituto Alexander Fleming entre enero de 2005 y mayo de 2009 con diagnóstico de taponamiento cardíaco o de derrame pericárdico grave tratados con drenaje percutáneo e instilación de cisplatino intrapericárdico (10 mg en 20 ml de solución fisiológica por 5 días). Se requirió: a) confirmación citológica de malignidad o b) hallazgo ecocardiográfico de lesiones compatibles con invasión neoplásica del saco pericárdico y c) poca expectativa de respuesta a un tratamiento sistémico. Resultados Se incluyeron 9 pacientes (6 hombres y 3 mujeres), edad media 60 años (51-69). El tumor primario fue pulmonar (n = 4), de mama (n = 1), de vejiga (n =1), de esófago (n = 1), de riñón (n = 1) y de próstata (n = 1). La citología fue positiva en 6 casos. El tiempo de permanencia del catéter fue de 7 días. Hubo efectos adversos en tres casos: dolor, fiebre y fibrilación auricular. Un solo paciente tuvo recidiva del derrame al mes. Ocho pacientes fallecieron [tiempo medio a la muerte: 50 días (7-83)] y uno vive. Conclusiones El cisplatino intrapericárdico resulta factible de realizar, se tolera bien y se observa un porcentaje bajo de recidivas, lo cual cumple con el objetivo del tratamiento.

          Translated abstract

          The recurrence rate of malignant pericardial effusion after pericardiocentesis is 62%. For this reason, intrapericardial instillation of therapeutic agents is performed after pericardial evacuation to improve the treatment. Cisplatin has proved to be a useful and safe agent. Objective To present our experience with intrapericardial instillation of cisplatin for the management of malignant pericardial disease. Material and Methods We included patients admitted to the Instituto Alexander Fleming between January 2005 and May 2009 with cardiac tamponade or severe pericardial effusion treated with pericardial drainage and instillation of cisplatin (10 mg in 20 ml of physiological solution for 5 days). Malignant pericardial effusion had to be confirmed by cytological examination or by echocardiographic evidence of malignant disease involving the pericardial space. Low treatment expectation was another requirement for inclusion. Results A total of 9 patients (6 men and 3 women) were included; mean age was 60 years (51-69). The primary tumors were lung cancer (n=4); breast cancer (n=1); bladder cancer (n=1); esophageal cancer (n=1), and prostate cancer (n=1). The cytological examination was positive in 6 cases. The catheter was removed after 7 days. Three patients presented adverse events: pain, fever and atrial fibrillation. One patient had a recurrence one month later. Eight patients died [mean time to death: 50 days (7-83)] and one is alive. Conclusion Intrapericardial instillation of cisplatin is a feasible and welltolerated procedure. The incidence of recurrences is low.

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          The usefulness of diagnostic tests on pericardial fluid.

          To determine the physical, chemical, and cellular characteristics of pericardial fluid in various disease states and to assess their diagnostic accuracies. A metropolitan university hospital. Consecutive case series. One hundred seventy-five hospital patients, aged 1 month to 87 years, who had undergone pericardiocentesis (n = 165) or control subjects who had undergone open heart surgery (n = 10) between 1984 and 1996. The appearance of pericardial fluid and results of chemistry tests, cell counts, cytologic studies, Gram's stain, and microbial cultures were obtained by chart review. The etiology of each pericardial fluid sample was determined using prospective diagnostic criteria. Exudates differed from transudates by higher leukocyte counts and ratios of fluid to serum lactate dehydrogenase levels. Fluid glucose levels were significantly less in exudates. Sensitivity for detecting exudates was high for specific gravity > 1.015 (90%), fluid total protein > 3.0 g/dL (97%), fluid to serum protein ratio > 0.5 (96%), fluid lactate dehydrogenase ratio > 0.6 (94%), and fluid to serum glucose ratio < 1.0 (85%). None of these indicators were specific. Fluid total protein and specific gravity were moderately correlated (r = 0.56). Fluid cytologic study had a sensitivity of 92% and specificity of 100% for malignant effusion. No other test was diagnostic for a specific etiology. Among infection-associated effusions, culture-positive fluid had more neutrophils, higher lactate dehydrogenase levels, and lower ratios of fluid to serum glucose than culture-negative (parainfective) fluid. Evaluation of pericardial fluid might be limited to cell count, glucose, protein, and lactate dehydrogenase determinations plus bacterial culture and cytology. While not used routinely, other tests that may be highly specific for particular diseases should be ordered only to confirm a high clinical suspicion.
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            Pericardial disease: what the general cardiologist needs to know.

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              Outcomes of Primary and Secondary Treatment of Pericardial Effusion in Patients With Malignancy

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rac
                Revista argentina de cardiología
                Rev. argent. cardiol.
                Sociedad Argentina de Cardiología (Ciudad Autónoma de Buenos Aires )
                1850-3748
                April 2010
                : 78
                : 2
                : 114-117
                Affiliations
                [1 ] Instituto Alexander Fleming Argentina
                [2 ] American College of Physicians Colombia
                [3 ] Instituto Alexander Fleming Argentina
                [4 ] Instituto Alexander Fleming Argentina
                [5 ] Academia Argentina de Cirugía Argentina
                [6 ] Instituto Alexander Fleming Argentina
                Article
                S1850-37482010000200005
                f6c0dd9b-7921-4e4e-89ac-ea3335244c92

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Argentina

                Self URI (journal page): http://www.scielo.org.ar/scielo.php?script=sci_serial&pid=1850-3748&lng=en
                Categories
                CARDIAC & CARDIOVASCULAR SYSTEMS

                Cardiovascular Medicine
                Cisplatin,Chemotherapy,Pericardium,Metastases,Cisplatino,Quimioterapia,Pericardio,Metástasis

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