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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Es sabido que la septaci&#243;n&#44; el aumento de la viscosidad del l&#237;quido pleural y una inadecuada colocaci&#243;n de los tubos de drenaje tor&#225;cico constituyen la principal causa de fracasos en el drenaje de las colecciones pleurales&#46; Tambi&#233;n est&#225; recogido en la bibliograf&#237;a c&#243;mo se puede solventar este tipo de problemas guiando la colocaci&#243;n de los tubos con medios de imagen como la ultrasonograf&#237;a &#40;US&#41; y utilizando agentes f&#237;brinol&#237;ticos intrapleurales que impidan la septaci&#243;n y licuen la viscosidad del l&#237;quido pleural&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluamos nuestra experiencia&#44; el papel y efectividad de la administraci&#243;n de la urocinasa &#40;UC&#41; intracavitaria a trav&#233;s de un cat&#233;ter de peque&#241;o calibre &#40;CPC&#41;&#44; implantado bajo control ecogr&#225;fico&#44; en el conjunto del tratamiento que requieren los derrames pleurales &#40;DP&#41; loculados y&#47;o tabicados&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se drenaron 50 DP loculados y&#47;o tabicados mediante un CPC tipo <span class="elsevierStyleItalic">pig-tail</span> de entre 8&#44;2 y 10 F de calibre&#44; insertado bajo control ecogr&#225;fico&#46; Los criterios para iniciar el procedimiento fueron los siguientes&#58; DP de cualquier etiolog&#237;a en el que por ecograf&#237;a se comprob&#243; la presencia de tabiques o septos de fibrina y&#47;o loculaci&#243;n sin que existieran contraindicaciones para el uso de UC&#46; La dosis de UC administrada fue de 100&#46;000 U cada 2 h hasta la resoluci&#243;n del derrame&#46; Antes y despu&#233;s del tratamiento se midieron los niveles de d&#237;mero D con el fin de verificar la actividad fibrinol&#237;tica pleural&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En el 100&#37; de los pacientes se ubic&#243; el CPC en el lugar m&#225;s adecuado&#46; La cantidad media de UC administrada fue de 366&#46;000 U y el tiempo de permanencia del CPC fue de 4&#44;7 d&#237;as&#46; Inicialmente el drenaje fue completo en todos los DP&#46; Evaluamos nuevamente a los pacientes a los 30 d&#237;as encontrando en dos &#40;4&#37;&#41; una recidiva del DP&#44; en ocho &#40;16&#37;&#41; la resoluci&#243;n completa sin secuelas&#44; en 32 &#40;64&#37;&#41; casi completa&#44; quedando un peque&#241;o engrosamiento pleural&#44; y en ocho &#40;16&#37;&#41; una resoluci&#243;n parcial&#44; quedando un engrosamiento pleural mayor de 2<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La utilizaci&#243;n de CPC combinado con el uso de UC &#40;pleurofibrin&#243;lisis&#41; constituye un procedimiento poco invasivo&#44; eficaz&#44; bien tolerado por los pacientes&#44; que acorta el tiempo de drenaje&#44; evita secuelas posteriores y econ&#243;micamente no es muy caro para el tratamiento de los DP que presentan septos de fibrina y&#47;o est&#225;n ya loculados&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The main causes of pleural fluid drainage failure are known to be the formation of fibrin septa&#44; increased viscosity in pleural fluid and inappropriate placement of chest tubes&#46; Reports also tell us that such problems can be solved by using ultrasound as a guide for tube placement and by infusing intrapleural fibrinolitic agents to prevent the formation of septa and reduce the viscosity of pleural fluid&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To assess our experience&#44; the role and efficacy of administering intercavitary urokinase &#40;UK&#41; through a small caliber catheter &#40;SCC&#41; implanted with ultrasound guidance as part of the treatment for pleural effusions &#40;PE&#41; that are multiloculated and&#47;or loculated&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fifty multiloculated and&#47;or loculated PE were drained through a pig-tail type SCC between 8&#46;2 and 10 F caliber inserted with ultrasound guidance&#46; The criteria for prescribing the procedure were as follows&#58; PE of any etiology with ultrasound confirmation of fibrin septa and&#47;or multiloculation and absence of contraindication for UK administration&#46; UK was given at a dose of 100&#44;000 <span class="elsevierStyleSmallCaps">I</span>&#46;U&#46; every two hours until disappearance of PE&#46; Before and after treatment the levels of D-dimer were measured in order to monitor pleural fibrinolitic activity&#46;</p><p id="spar9045" class="elsevierStyleSimplePara elsevierViewall">The SCC was properly placed in all patients&#46; UK administration was 366&#44;000 <span class="elsevierStyleSmallCaps">I</span>&#46;U&#46; and time the SCC were in place was 4&#46;7 days&#46; All PEs were initially drained completly&#46; We examined the patients 30 days later&#44; finding that PE had recurred in 2 &#40;4&#37;&#41;&#44; resolution was complete and without sequelae in 8 &#40;16&#37;&#41;&#44; nearly complete but with slight pleural thickening in 32 &#40;64&#37;&#41; and partial with pleural opacities larger than 2<span class="elsevierStyleHsp" style=""></span>mm in 8 &#40;16&#37;&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Use of SCC and UK &#40;pleural fibrinolysis&#41; is a moderately invasive procedure that is effective and well tolerated and that shortens drainage time&#44; preven&#237;s sequelae and is relatively inexpensive for the treatment of PE with fibrin septation and&#47;or multiloculation&#46;</p></span>"
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Journal Information
Vol. 32. Issue 10.
Pages 510-515 (December 1996)
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Vol. 32. Issue 10.
Pages 510-515 (December 1996)
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Drenaje de derrames pleurales loculados y/o tabicados mediante catéter de pequeño calibre y urocinasa (pleurofibrinólisis)
Drainage of loculated and/or multiloculate pleural effusion using a small caliber catheter and urokinase (pleural-fíbrinolysis)
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M.A. de Gregorio1, E.R. Alfonso, J.A. Fernández, I. Ariño
Sección de Radiología Intervencionista. Hospital Universitario Lozano Blesa. Zaragoza
C. Ruiz*, A. Pérez-Trullén*, F. Rodríguez Panadero**
* Servicio de Neumología. Hospital Universitario Lozano Blesa. Zaragoza
** Servicio de Neumología. Hospital Universitario Virgen del Rocío. Sevilla
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Article information

Es sabido que la septación, el aumento de la viscosidad del líquido pleural y una inadecuada colocación de los tubos de drenaje torácico constituyen la principal causa de fracasos en el drenaje de las colecciones pleurales. También está recogido en la bibliografía cómo se puede solventar este tipo de problemas guiando la colocación de los tubos con medios de imagen como la ultrasonografía (US) y utilizando agentes fíbrinolíticos intrapleurales que impidan la septación y licuen la viscosidad del líquido pleural.

Evaluamos nuestra experiencia, el papel y efectividad de la administración de la urocinasa (UC) intracavitaria a través de un catéter de pequeño calibre (CPC), implantado bajo control ecográfico, en el conjunto del tratamiento que requieren los derrames pleurales (DP) loculados y/o tabicados.

Se drenaron 50 DP loculados y/o tabicados mediante un CPC tipo pig-tail de entre 8,2 y 10 F de calibre, insertado bajo control ecográfico. Los criterios para iniciar el procedimiento fueron los siguientes: DP de cualquier etiología en el que por ecografía se comprobó la presencia de tabiques o septos de fibrina y/o loculación sin que existieran contraindicaciones para el uso de UC. La dosis de UC administrada fue de 100.000 U cada 2 h hasta la resolución del derrame. Antes y después del tratamiento se midieron los niveles de dímero D con el fin de verificar la actividad fibrinolítica pleural.

En el 100% de los pacientes se ubicó el CPC en el lugar más adecuado. La cantidad media de UC administrada fue de 366.000 U y el tiempo de permanencia del CPC fue de 4,7 días. Inicialmente el drenaje fue completo en todos los DP. Evaluamos nuevamente a los pacientes a los 30 días encontrando en dos (4%) una recidiva del DP, en ocho (16%) la resolución completa sin secuelas, en 32 (64%) casi completa, quedando un pequeño engrosamiento pleural, y en ocho (16%) una resolución parcial, quedando un engrosamiento pleural mayor de 2mm.

La utilización de CPC combinado con el uso de UC (pleurofibrinólisis) constituye un procedimiento poco invasivo, eficaz, bien tolerado por los pacientes, que acorta el tiempo de drenaje, evita secuelas posteriores y económicamente no es muy caro para el tratamiento de los DP que presentan septos de fibrina y/o están ya loculados.

Palabras clave:
Urocinasa
Fibrinólisis intrapleural
Pleurofibrinólisis
Derrame pleural loculado
Drenaje percutáneo
Ultrasonografía
Empiema pleural

The main causes of pleural fluid drainage failure are known to be the formation of fibrin septa, increased viscosity in pleural fluid and inappropriate placement of chest tubes. Reports also tell us that such problems can be solved by using ultrasound as a guide for tube placement and by infusing intrapleural fibrinolitic agents to prevent the formation of septa and reduce the viscosity of pleural fluid.

To assess our experience, the role and efficacy of administering intercavitary urokinase (UK) through a small caliber catheter (SCC) implanted with ultrasound guidance as part of the treatment for pleural effusions (PE) that are multiloculated and/or loculated.

Fifty multiloculated and/or loculated PE were drained through a pig-tail type SCC between 8.2 and 10 F caliber inserted with ultrasound guidance. The criteria for prescribing the procedure were as follows: PE of any etiology with ultrasound confirmation of fibrin septa and/or multiloculation and absence of contraindication for UK administration. UK was given at a dose of 100,000 I.U. every two hours until disappearance of PE. Before and after treatment the levels of D-dimer were measured in order to monitor pleural fibrinolitic activity.

The SCC was properly placed in all patients. UK administration was 366,000 I.U. and time the SCC were in place was 4.7 days. All PEs were initially drained completly. We examined the patients 30 days later, finding that PE had recurred in 2 (4%), resolution was complete and without sequelae in 8 (16%), nearly complete but with slight pleural thickening in 32 (64%) and partial with pleural opacities larger than 2mm in 8 (16%).

Use of SCC and UK (pleural fibrinolysis) is a moderately invasive procedure that is effective and well tolerated and that shortens drainage time, prevenís sequelae and is relatively inexpensive for the treatment of PE with fibrin septation and/or multiloculation.

Key words:
Urokinase
Intrapleural fibrinolysis
Pleural fibrinolysis
Multiloculated pleural effusion
Percutaneous drainage
Ultrasonography
Pleural empyema
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Copyright © 1996. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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