The Effects of Urokinase Instillation Therapy via Percutaneous Transthoracic Catheter in Loculated Tuberculous Pleural Effusion: A Randomized Prospective Study

Kwak, Seung Min; Park, Chan Sup; Cho, Jae Hwa; Ryu, Jeong Seon; Kim, Sei Kyu; Chang, Joon; Kim, Sung Kyu

doi:10.3349/ymj.2004.45.5.822

Cited by 29 publications

(25 citation statements)

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“…This more efficient drainage improved dyspnoea more rapidly, but did not shorten the duration of fever. These findings are in line with previous studies [5,10,11], and strongly suggest that anti-TB medication is the mainstay of treatment for the resolution of pleural inflammation in TB pleurisy, whereas early and effective pleural drainage, with or without streptokinase instillation, improves respiratory function but does not affect the intensity of the pleural inflammation.…”

Section: Discussionsupporting

confidence: 82%

“…The influence of therapeutic thoracentesis on the development of RPT has not been verified by previous studies [2][3][4][5]. However, two recent studies indicated that RPT occurred less frequently in patients with loculated TB pleurisy treated with intrapleural urokinase than in those with no drainage or those treated with simple drainage [10,11]. In the present study, 10 (45%) out of 22 patients in the saline group developed RPT.…”

Section: Discussioncontrasting

confidence: 40%

“…Recent studies have shown that patients with loculated TB pleurisy treated with intrapleural urokinase developed less RPT than those with no drainage or those treated with simple drainage [10,11]. These results imply that intrapleural administration of fibrinolytic agents with effective drainage of the pleural effusion may be promising in the treatment of loculated TB pleurisy.…”

mentioning

confidence: 64%

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Early effective drainage in the treatment of loculated tuberculous pleurisy

Chung¹,

Chen²,

Yeh³

et al. 2008

Eur Respir J

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The role of early effective drainage in loculated tuberculous (TB) pleurisy treatment remains unclear.Consecutive patients with TB pleurisy subjected to anti-TB treatment and pigtail drainage (n564) were divided into three groups: 1) patients with free-flowing effusions irrigated with saline (free-flowing group; n520); 2) patients with loculated effusions irrigated with streptokinase (streptokinase group; n522); and 3) patients with loculated effusions irrigated with saline (saline group; n522). Pleural irrigation was performed for 3 days consecutively and the effusion drained as completely as possible. Outcomes were assessed for 12 months by clinical symptoms, effusion removed, radiological scores for effusion amount, lung function and occurrence of residual pleural thickening.The total effusion volumes removed were significantly greater in the free-flowing (2.36¡1.62 L) and streptokinase groups (2.59¡1.77 L) than in the saline group (1.28¡1.21 L). Compared with the saline group, the free-flowing and streptokinase groups showed significant improvement in radiological scores and forced vital capacity at different time-points during follow-up, and a significantly lower occurrence of residual pleural thickening. All outcome variables were comparable between the streptokinase and free-flowing groups.In summary, early effective drainage and complete anti-tuberculosis treatment may hasten clearance of pleural effusion, reduce residual pleural thickening occurrence and accelerate pulmonary function recovery in patients with symptomatic loculated tuberculous pleurisy.

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Section: Discussionsupporting

confidence: 82%

Section: Discussioncontrasting

confidence: 40%

mentioning

confidence: 64%

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Early effective drainage in the treatment of loculated tuberculous pleurisy

Chung¹,

Chen²,

Yeh³

et al. 2008

Eur Respir J

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“…Thirteen were then retrieved for full text review. Five [21][22][23][24][25] were then excluded because the study population consisted of mainly tuberculous pleural effusions, and one 26 was excluded because it did not have a control arm (ie, placebo) ( Fig 1 ). Thus, seven studies 7,[9][10][11][27][28][29] were included in the fi nal analysis.…”

Section: Resultsmentioning

confidence: 99%

Intrapleural Fibrinolytic Therapy for Treatment of Adult Parapneumonic Effusions and Empyemas

Janda

Swiston

2012

Chest

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“…Kwak and associates randomized 43 patients with loculated pleural effusions to receive 100,000 IU urokinase daily, administered through a pigtail catheter, starting when the pleural fluid drainage was less than 100 mL/day and finishing when the amount of pleural fluid was less than 50 mL/ day, or only anti-TB therapy [78]. They concluded that the mean width of pleural thickening was 0.46 cm in the urokinase group and 1.86 cm in the control group [78].…”

Section: Treatment Chemotherapymentioning

confidence: 99%

Tuberculous Pleural Effusion

Cohen

Light

2015

Tur Toraks Der

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When a patient presents with new pleural effusion, the diagnosis of tuberculous (TB) pleuritis should be considered. The patient is at risk for developing pulmonary or extrapulmonary TB if the diagnosis is not made. Between 3% and 25% of patients with TB will have TB pleuritis. The incidence of TB pleuritis is higher in patients who are human immunodeficiency virus (HIV)-positive. Pleural fluid is an exudate that usually has a predominance of lymphocytes. The easiest way to diagnose TB pleuritis in a patient with lymphocytic pleural effusion is to demonstrate a pleural fluid adenosine deaminase level above 40 IU/L. The treatment for TB pleuritis is the same as that for pulmonary TB. Tuberculous empyema is a rare occurrence, and the treatment is difficult. KEY WORDS:Tuberculosis, pleural effusions, adenosine deaminase, gamma interferon, pleural biopsy, empyema INTRODUCTION Tuberculosis (TB) remains a major public health problem in developing countries. Most patients with TB have pulmonary TB; however, 25% of adults can present with extrapulmonary TB, which mainly involves the lymph nodes and pleura but can affect any organ system, including the central nervous system (CNS), cardiovascular system, and gastrointestinal (GI) tract [1]. The most common form of extrapulmonary TB is infection of the pleura. In a patient who presents with undiagnosed pleural effusion, the diagnosis of TB pleuritis should be considered. Pleural effusion, as an isolated manifestation of TB, may be selflimited and of little immediate concern, but untreated, it can lead to serious disease many years later. Pathogenesis and Pathologic FeaturesTuberculous pleural effusion may occur in the absence of radiologically apparent TB [2]. The effusion may result as a sequela to a primary infection from 6-12 weeks earlier, or it may represent the reactivation of TB [2]. In developed countries, TB pleural effusions present more often in older patients. The median age in one North American study was 56, suggesting reactivation of the disease [3]. However, a study from 2004 in San Francisco showed that pleural TB cases were 2 times more likely to be clustered (when assessed by genotyping of the mycobacterial organisms) than pulmonary TB and 3 times more likely to be clustered than nonrespiratory TB cases [4]. The observations made in the San Francisco study suggest that the majority of patients has a postprimary infection [4]. This was not confirmed in studies performed in both Houston [5] and Baltimore [6] or in a study in sub-Saharan Africa, in which the prevalence of pleural TB was 63.2% in patients with a primary TB infection [7].The pathogenesis of TB pleural effusion is thought to be related to the rupture of a subpleural caseous focus in the lung into the pleural space [8]. The basis for this was the observation that a caseous TB focus could be demonstrated in the lung, contiguous with the diseased pleural, in 12 to 15 patients with TB pleuritis [9]. The 3 other patients in this study had parenchymal disease but did not have caseous foci adjacent...

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The Effects of Urokinase Instillation Therapy via Percutaneous Transthoracic Catheter in Loculated Tuberculous Pleural Effusion: A Randomized Prospective Study

Cited by 29 publications

References 0 publications

Early effective drainage in the treatment of loculated tuberculous pleurisy

Early effective drainage in the treatment of loculated tuberculous pleurisy

Intrapleural Fibrinolytic Therapy for Treatment of Adult Parapneumonic Effusions and Empyemas

Tuberculous Pleural Effusion

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