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Clinical Investigations: TechniquesThoracoscopy and Talc Poudrage in the Management of Hepatic Hydrothorax
Section snippets
Materials and Methods
A retrospective study is presented of 18 consecutive patients with clinical, laboratory, and radiologic evidence of liver disease, portal hypertension, and persistent right-sided symptomatic HH who were admitted to the Hospital Israelita Albert Einstein and Hospital das Clínicas, from May 1985 through May 1999. They underwent 21 procedures to control the pleural effusions. All patients had undergone multiple medical management and thoracenteses before transfer to our hospitals.
The series
Results
Thoracoscopy and talc insufflation were well tolerated by the patients in the present series (Table 1). Aerosolized talc was effective in the treatment of HH in 10 of 21 procedures (47.6%). Four recurrences (19.1%) occurred and were retreated. However, only one remained without recurrence during the next 3 months. The follow-up period was at least 3 months in all the surviving patients. During the study period, 7 of 18 patients (38.9%) died of hemorrhage secondary to esophageal varices (n = 2)
Discussion
Since the article in 1958 by Morrow et al11 describing HH as a rapid accumulation of massive right pleural effusion, after a diagnosis of cirrhosis of the liver, various studies have been published. Although a wealth of literature on the treatment of symptomatic HH exists, the optimal or standard therapy remains unclear. Once the diagnosis of HH is established, medical therapy with salt restriction and diuretics is initiated. The term refractory HH is used when these measures are ineffective.
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Pleurodesis
2021, Encyclopedia of Respiratory Medicine, Second EditionPleural Effusion: Hepatic Hydrothorax
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2018, Annals of HepatologyCitation Excerpt :The pleural effusion did not recur in the six patients with defects that were closed, but the other two patients had recurrent effusion and died 1 and 2 months following the procedure, respectively.120 In another series reported by Milanez de Campos, et al.121 in which 21 thoracoscopies were performed in 18 patients with HH, the overall success rate was 48%. Of those five patients in whom a suture could be performed, three had a good response (60%), one died of postoperative pneumonia and liver failure, and the other had empyema and drained fluid for 1 month.
Diagnosis and Management of Pleural Transudates
2017, Archivos de BronconeumologiaIndwelling Pleural Catheters for Nonmalignant Effusions: Evidence-Based Answers to Clinical Concerns
2017, American Journal of the Medical Sciences