Neoplastic pericardial disease in lung cancer: impact on outcomes of different treatment strategies. A multicenter study.

Background: Local (intrapericardial) chemotherapy has been reported to be useful for the treatment of neoplastic pericardial disease, but it has never been compared to systemic chemotherapy, a combination of the two and simple pericardial drainage or sclerosis.

Methods: We analyzed the clinical and echocardiographic data of 119 patients, suffering of neoplastic pericarditis due to lung cancer (97 with non-small-cell), comparing the outcomes of four different treatment strategies (extended catheter drainage/sclerosis, systemic chemotherapy, local chemotherapy, and combined - local plus systemic - chemotherapy) at the last available follow-up or at the change of therapy after a treatment failure. The outcomes (based on semiquantitative evaluation of pericardial disease) were classified as complete, partial, no response and progressing disease.

Operative evaluation of cardiac tamponade in a patient with multiple myeloma.

Multiple myeloma presents with various clinical manifestations depending on the mode and the extent of organ involvement. Pericardial involvement by myeloma and subsequent cardiac tamponade is extremely rare. We report on the case of a patient with multiple myeloma who presented with cardiac tamponade and was evaluated surgically with thoracotomy and minimal debulking pericardiectomy (fenestration).

Malignant cardiac tamponade in women with breast cancer treated by pericardiocentesis and intrapericardial administration of triethylenethiophosphoramide (thiotepa).

We treated 19 women with malignant cardiac tamponade due to advanced breast cancer with subxiphoid pericardiocentesis and local thiotepa instillation. The method has no serious side effects, prevents pericardial fluid reaccumulation, and, combined with systemic adjuvant therapy, prolongs survival.

Long QT interval syndrome with increased QT dispersion.

This case report describes the anaesthetic management of a patient with sporadic-type long QT interval syndrome (LQTS), and increased QT dispersion, who presented for removal of an ovarian cyst. Beta adrenergic blockade and adequate depth of anaesthesia for successful management is emphasized. The successful use of epidural administration of lignocaine and opioids in addition to general anaesthesia is described.