Imamura T, Tamura K, Takenaga M, Nagatomo Y, Ishikawa T, Nakagawa S
Department of Internal Medicine, Miyazaki Prefectural Hospital, Japan.
Cancer. 1991 Jul 15;68(2):259-63. doi: 10.1002/1097-0142(19910715)68:2<259::aid-cncr2820680207>3.0.co;2-v.
Ten patients with malignant pericardial effusion were treated with intrapericardial injection of OK-432 (penicillin-treated and heat-treated lyophilized powder of the substrain of Streptococcus pyogenes A3). After intrapericardial insertion of a catheter, a maximal volume of pericardial fluid was withdrawn with cytologic confirmation of malignancy. Five or 10 Klinische Einheit (KE) (KE is a unit used to express the strength of a preparation) of OK-432 diluted in 20 ml of saline was injected into the pericardial space in seven and three patients, respectively. It was repeated in case of reaccumulation. Seven patients were treated only once and the remaining three required a second treatment. Complete control of pericardial effusion was achieved in all patients for an average of 329 days (range, 54 to 790 days). Fever and chest pain were experienced in six and five patients, respectively, but were controlled with antipyretics. Two of three patients who received 10 KE of OK-432 experienced hypotension that was successfully controlled with vasopressor drugs with or without reaspiration of pericardial fluid. Rapid reactive reaccumulation of the pericardial fluid was thought to be a cause of hypotension. A follow-up computed tomography (CT) scan was performed in seven patients and a thickened pericardium was noticed in five; no patients had constrictive pericarditis. These results suggest that intrapericardial administration of 5 KE of OK-432 is an effective and safe treatment for malignant pericardial effusion.
10例恶性心包积液患者接受了心包腔内注射OK-432（青霉素处理并热处理的化脓性链球菌A3亚菌株冻干粉末）治疗。在心包腔内插入导管后，抽取最大量的心包积液并经细胞学证实为恶性。分别有7例和3例患者将5或10个临床单位（KE）（KE是用于表示制剂强度的单位）的OK-432用20 ml生理盐水稀释后注入心包腔。积液再积聚时重复注射。7例患者仅接受一次治疗，其余3例需要第二次治疗。所有患者的心包积液均得到完全控制，平均持续329天（范围为54至790天）。分别有6例和5例患者出现发热和胸痛，但均用退烧药控制。接受10 KE OK-432治疗的3例患者中有2例出现低血压，通过使用血管升压药，无论是否再次抽吸心包积液，均成功得到控制。心包积液的快速反应性再积聚被认为是低血压的一个原因。7例患者进行了随访计算机断层扫描（CT），其中5例发现心包增厚；无患者发生缩窄性心包炎。这些结果表明，心包腔内给予5 KE的OK-432是治疗恶性心包积液的一种有效且安全的方法。
