Intrapericardial Tetracycline for the Management of Cardiac Tamponade Secondary to Malignant Pericardial Effusion

Davis, Stephen; Sharma, Surendra Mohan; Blumberg, Edwin D.; Kim, Chung S.

doi:10.1056/nejm197811162992006

Cited by 70 publications

(18 citation statements)

References 7 publications

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“…The efficacy of Oxytetracycline is similar to that of tetracycline hydrochloride and is perhaps less toxic be cause of its lower solubility. The rate of side effects ob served by Davis as compared to ours was 40 vs. 27% for fever, 18 vs. 18% for cardiac arrythmia, and 100% for local pain after intracavitary instillation of the drug in the 6 preliminary patients [3] not commented on in the latter paper vs. 36% in our series. In our patients, local pain, fever and premature ventricular contractions were mild.…”

Section: Discussioncontrasting

confidence: 40%

“…Intrapericardial instillation of tetracycline hydrochloride is the treatment of choice to prevent the reaccumulation of fluid [1], Decrease or disappearance of pericardial effusion was obtained in 81-91% of the patients [2], Fever, local pain and cardiac arrythmia were the most frequent complica tions [2,3], Oxytetracycline is a less-soluble compound than hydrochloride [4], it is amphoteric and less crystal line, which encouraged us to use it expecting a lower toxic ity. …”

Section: Introductionmentioning

confidence: 99%

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Intracavitary Oxytetracycline in Malignant Pericardial Tamponade

Jj¹,

Vila²,

Palombo³

et al. 1992

Oncology

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We started a treatment trial for malignant pericardial tamponade with intracavitary oxytetracycline, 500–1,000 mg/day, administered via an indewelling pericardial cannula after extraction of as much pericardial fluid as possible. This procedure was repeated every 24 h for 6 consecutive days or until no more fluid could be drained. Eleven consecutive patients were entered in the study. The responses were obtained by clinical examination, chest roentgenogram and echocardiogram, prior to and after treatment. The primary cancer was located in the breast in 7 patients, in the stomach in 2 patients, and in the lung in 2 patients. In all cases, systemic chemotherapy or hormonal therapy was started after the pericardial tamponade was cured. The mean tetracycline dose per patient was 3,000 mg (range 1,500–6,000). All patients responded to the treatment with rapidly improving symptoms. Response persisted during a median of 9 months coinciding roughly with the median survival because all patients died because of progression of the neoplasm at sites other than the pericardium with no evidence of paricardial relapse. The main concomitant effects were mild local pain during tetracycline instillation in 4 patients, and transient fever (less than 39 °C) in 3. These data suggest that intracavitary oxytetracycline is perhaps less toxic and similar by successful as tetracycline hydrochloride in malignant pericardial tamponade.

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Section: Discussioncontrasting

confidence: 40%

Section: Introductionmentioning

confidence: 99%

Intracavitary Oxytetracycline in Malignant Pericardial Tamponade

Jj¹,

Vila²,

Palombo³

et al. 1992

Oncology

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“…Tetracycline was reported to be effective in controlling malignant pericardial effusion [10,11]. However, tetracy cline was also toxic with a high rate of side effects includ ing chest pain, fever, and arrhythmia, which precludes the usage in locally advanced-stage lung cancer.…”

Section: Discussionmentioning

confidence: 99%

A Simple Technique to Manage Malignant Pericardial Effusion with a Local Instillation of Bleomycin in Non-Small Cell Carcinoma of the Lung

et al. 1994

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To examine the efficacy of bleomycin on the local control of malignant pericardial effusion, we prospectively conducted a clinical trial consisting of continuous pericardial drainage and a local instillation of bleomycin. In the current study, we treated 7 patients, who suffered from malignant pericardial effusion with cardiac tamponade due to advanced-stage non-small cell carcinoma of the lung. The pericardial effusions were continuously drained through an echo-guided inserted catheter. After the effusions were drained as completely as possible, 5 mg of bleomycin were instilled locally via the catheter. In all patients but one, the draining catheter could be successfully removed. The duration of drainage ranged from 4 to 13 days (mean: 9.2 days). Five of the 7 patients achieved a complete remission of pericardial effusions, which was maintained until death or the last day of follow-up. Intrapericardial bleomycin treatment was thus found to be effective on malignant pericardial effusions without any adverse effects. However, a further study comparing the effect of pericardial instillation of bleomycin versus drainage alone would be needed for the determination of the usefulness of bleomycin.

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“…Davis [1] described the clinical effectiveness and lack of toxicity of intrapericardial tetracycline hydrochloride in six patients with malignant cardiac tamponade. Other authors have reported favorable results with this drug in larger groups of patients [2J.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Minocin on the Pericardium

Markiewicz

Ben-Arieh²,

Best³

et al. 1993

Oncology

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The purpose of this study was to evaluate in a dog model whether intrapericardial instillation oftetracycline is superior to the effect of drainage alone in causing pericardial adhesions and cavity obliteration. Twelve mongrel dogs were randomly divided into two experimental groups. All dogs received a pericardial drain through a sterile thoracotomy. Group A dogs (n = 6) received minocycline hydrochloride, 20 mg/kg, group B received normal saline. All dogs were sacrificed 1 month later. Echocardiograms performed 1 week postsurgery were normal in all dogs. Macroscopic evaluation disclosed that all group A dogs had over 25% cavity obliteration whereas group B dogs had no adhesions or had obliteration of less than 25% of the cavity area. Microscopic evaluation showed that group A dogs had severe pericardial fibrosis and thickening with slight focal lymphoplasmocytic infiltration. Myocardial damage was not seen. Our results support the clinical use of injecting tetracycline into the pericardium (in addition to drainage) to cause cavity obliteration in patients with persistent pericardial effusion.

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Intrapericardial Tetracycline for the Management of Cardiac Tamponade Secondary to Malignant Pericardial Effusion

Cited by 70 publications

References 7 publications

Intracavitary Oxytetracycline in Malignant Pericardial Tamponade

Intracavitary Oxytetracycline in Malignant Pericardial Tamponade

A Simple Technique to Manage Malignant Pericardial Effusion with a Local Instillation of Bleomycin in Non-Small Cell Carcinoma of the Lung

The Effect of Minocin on the Pericardium

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