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October 17, 1977

Topical Steroids for Uremic Pericardial Effusions

Author Affiliations

Organ Transplant Service Walter Reed Army Medical Center Washinaton. DC

JAMA. 1977;238(16):1721. doi:10.1001/jama.1977.03280170015006

To the Editor. —  Noting that uremic pericardial effusions frequently recur after pericardiocentesis, several authors now advocate immediate pericardiectomy for patients who have symptomatic effusions.1-3 Recent reports, however, suggest that intrapericardial steroids may greatly increase the efficacy of pericardiocentesis and make pericardiectomy unnecessary except when aspiration of the effusion is not possible.4-6Lindsay et al7 first described the successful use of intrapericardial methylprednisolone for a patient in whom oral prednisone had produced undesirable catabolic effects. Buselmeier et al4,5 have reported 24 patients who were cured of their effusions by the periodic intrapericardial instillation of triamcinolone hexacetonide, a less absorbable steroid, during 24 to 72 hours of catheter drainage. The amount instilled ranged from 200 to 950 mg. Using the same protocol, Fuller et al6 reported the successful management of five patients.In the following cases we found that aspiration of the pericardial effusion and a