R. Michael Rodriguez

The superior vena cava syndrome: clinical characteristics and evolving etiology.

Abstract: Malignancy is the most common cause of the superior vena cava (SVC) syndrome. With the increasing use of intravascular devices, the incidence of the SVC syndrome arising from benign etiologies is increasing. We reviewed the etiology and outcome of 78 patients with SVC syndrome over 5 years. Malignancy was the etiology in 60% of the cases, and bronchogenic carcinoma was the most common malignancy. Small cell and non-small cell lung cancer accounted for 17 (22%) and 19 (24%) cases, respectively, but a higher percentage of patients with small-cell lung cancer developed the syndrome (6% vs 1%). Lymphoma and germ cell tumors were other significant malignant causes (8% and 3% of cases, respectively). An intravascular device was the most common etiology in benign cases (22 of 31 cases; 71%), with fibrosing mediastinitis the second most common benign etiology (6 cases). The most frequent signs and symptoms were face or neck swelling (82%), upper extremity swelling (68%), dyspnea (66%), cough (50%), and dilated chest vein collaterals (38%). Dyspnea at rest, cough, and chest pain were more frequent in the patients with malignancy. Procedures performed for diagnostic or treatment purposes did not increase morbidity or mortality. Abbreviations: SVC = superior vena cava.

MANAGEMENT OF PARAPNEUMONIC EFFUSIONS

The annual incidence of bacterial pneumonia in the United States is estimated at 4 million and approximately 20% of those cases require hospitalization. 32 The incidence of parapneumonic effusion in patients hospitalized with pneumonia is about 40%. 25 The morbidity and mortality rates in patients with pneumonia and pleural effusions are greater than in patients with pneumonia alone. In one recent study, 16 the relative risk of mortality in patients with community-acquired pneumonia was 7.0 times higher for patients with bilateral pleural effusions and 3.4 times higher for patients with unilateral-pleural effusion of moderate or greater size compared with other patients with community-acquired pneumonia. Delay in instituting proper therapy for effusions is responsible for much of the increased morbidity and mortality.

Factors related to recurrence of spontaneous pneumothorax.

Objectives:  The purpose of this retrospective study was to identify factors associated with recurrent spontaneous pneumothorax (SP) in southern China, and to compare the therapeutic effectiveness of different procedures.

Prevalence and characteristics of pleural effusions in superior vena cava syndrome

Objective and background:  The prevalence and characteristics of pleural effusions occurring in adults with the superior vena cava (SVC) syndrome are unknown. The purpose of the present study was to characterize these pleural effusions.

Pleural Fluid Levels of Vascular Cell Adhesion Molecule-1 Are Elevated in Eosinophilic Pleural Effusions

STUDY OBJECTIVES The mechanisms responsible for the accumulation of eosinophils in pleural fluid are not fully understood. The objective of the present study was to examine the relationship between pleural fluid eosinophilia and the levels of vascular cell adhesion molecule (VCAM)-1, eotaxin, RANTES (regulated upon activation, normal T-cell expressed and secreted), and interleukin (IL)-4 in pleural effusions. PATIENTS AND METHODS Thirty-one patients with eosinophilic pleural effusion (EPE) [eosinophil percentage > 10% of the pleural fluid nucleated cells] and 10 patients without EPE were evaluated. VCAM-1, eotaxin, RANTES, and IL-4 in all pleural fluids were measured using enzyme-linked immunosorbent assay kits. IL-5 levels of the same fluids were measured in a previous study. RESULTS VCAM-1, eotaxin, and RANTES but not IL-4 were detectable in the pleural fluids. The mean level of VCAM-1 in EPE (336 +/- 85 ng/mL) was significantly higher (p = 0.011) than that in the noneosinophilic effusions (260 +/- 34 ng/mL) [mean +/- SD]. VCAM-1 levels were significantly correlated with the eosinophil count and percentage in all pleural fluids (r = 0.43, p = 0.005, and r = 0.37, p = 0.019, respectively). Multiple linear regression analysis disclosed that both IL-5 (beta, 0.63; p < 0.001) and VCAM-1 (beta, 0.27, p = 0.025) are independent predictors of the number of eosinophils in all pleural fluids. RANTES and eotaxin did not differ significantly between EPEs and non-EPEs, and were not correlated with the number of pleural fluid eosinophils. CONCLUSION The levels of VCAM-1 are increased in EPE, suggesting that VCAM-1 is important in the pathogenesis of EPE. Neither eotaxin nor RANTES is associated with pleural fluid eosinophilia.

Prevalence of pleural effusions post orthotopic heart transplantation

Background and objective:  The prevalence and natural history of pleural effusions occurring after orthotopic heart transplantations (OHT) are essentially unknown. The objective of this study was to determine the prevalence, laterality, size and prognosis of pleural effusions occurring after OHT.