Yellow nail syndrome: treatment with octreotide
Identifieur interne : 001B23 ( Istex/Corpus ); précédent : 001B22; suivant : 001B24Yellow nail syndrome: treatment with octreotide
Auteurs : Gunnar HillerdalSource :
- The Clinical Respiratory Journal [ 1752-6981 ] ; 2007-12.
Abstract
Introduction: The yellow nail syndrome (YNS) is the triad of ‘yellow’ nails, peripheral oedema and pleural effusions. For diagnosis, which is clinical, at least two of these findings are necessary. Also typical is a long‐standing chronic cough often caused by low‐grade bronchiectases. The pleural effusions often require pleurodesis. The pathogenesis is probably a dysfunction of the lymphatic system (1, 2). Octreotide regulates the release of growth hormone and thyrotropin, and also has effects on the gastro‐intestinal tract, where it inhibits glandular secretion, neurotransmission, smooth‐muscle contraction and absorption of nutrients. Adverse effects are nausea, abdominal cramps, diarrhoea, malabsorption of fat and flatulence (3). Because of the inhibition of absorption of fats and other nutrients, octreotide has been useful in chylothorax from many different causes (4). The pleural effusion in YNS is usually an exudate, but in rare cases a frank chylothorax. One such case with successful octreotide treatment has been described in the literature (5).
Url:
DOI: 10.1111/j.1752-699X.2007.00022.x
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ISTEX:3BAA4C3B2F2BA656FC8F3CB1847C5D93CD1973F3Le document en format XML
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For diagnosis, which is clinical, at least two of these findings are necessary. Also typical is a long‐standing chronic cough often caused by low‐grade bronchiectases. The pleural effusions often require pleurodesis. The pathogenesis is probably a dysfunction of the lymphatic system (1, 2). Octreotide regulates the release of growth hormone and thyrotropin, and also has effects on the gastro‐intestinal tract, where it inhibits glandular secretion, neurotransmission, smooth‐muscle contraction and absorption of nutrients. Adverse effects are nausea, abdominal cramps, diarrhoea, malabsorption of fat and flatulence (3). Because of the inhibition of absorption of fats and other nutrients, octreotide has been useful in chylothorax from many different causes (4). The pleural effusion in YNS is usually an exudate, but in rare cases a frank chylothorax. 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Karolinska University Hospital, SE 171 76 Stockholm, Sweden<address><country key="SE"></country></address></affiliation></author><idno type="istex">3BAA4C3B2F2BA656FC8F3CB1847C5D93CD1973F3</idno><idno type="DOI">10.1111/j.1752-699X.2007.00022.x</idno><idno type="unit">CRJ022</idno><idno type="toTypesetVersion">file:CRJ.CRJ022.pdf</idno></analytic><monogr><title level="j" type="main">The Clinical Respiratory Journal</title><title level="j" type="alt">CLINICAL RESPIRATORY JOURNAL</title><idno type="pISSN">1752-6981</idno><idno type="eISSN">1752-699X</idno><idno type="book-DOI">10.1111/(ISSN)1752-699X</idno><idno type="book-part-DOI">10.1111/crj.2007.1.issue-2</idno><idno type="product">CRJ</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">1</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="120">120</biblScope><biblScope unit="page" to="121">121</biblScope><biblScope unit="page-count">2</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2007-12"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><p><hi rend="bold">Introduction: </hi> The yellow nail syndrome (YNS) is the triad of ‘yellow’ nails, peripheral oedema and pleural effusions. For diagnosis, which is clinical, at least two of these findings are necessary. Also typical is a long‐standing chronic cough often caused by low‐grade bronchiectases. The pleural effusions often require pleurodesis. The pathogenesis is probably a dysfunction of the lymphatic system (<ref type="bibr" target="#b1 #b2">1, 2</ref>). Octreotide regulates the release of growth hormone and thyrotropin, and also has effects on the gastro‐intestinal tract, where it inhibits glandular secretion, neurotransmission, smooth‐muscle contraction and absorption of nutrients. Adverse effects are nausea, abdominal cramps, diarrhoea, malabsorption of fat and flatulence (<ref type="bibr" target="#b3">3</ref>). Because of the inhibition of absorption of fats and other nutrients, octreotide has been useful in chylothorax from many different causes (<ref type="bibr" target="#b4">4</ref>). The pleural effusion in YNS is usually an exudate, but in rare cases a frank chylothorax. One such case with successful octreotide treatment has been described in the literature (<ref type="bibr" target="#b5">5</ref>).</p><p><hi rend="bold">Objective: </hi> The aim of this report was to investigate the effect of octreotide treatment on a patient with YNS with pleural exudates not resulting from chylothorax.</p><p><hi rend="bold">Methods and results: </hi> A 62‐year‐old man with typical YNS presented with bilateral large pleural effusions (<ref type="figure" target="#f1">Fig. 1</ref>). He had suffered from repeated pneumonia for many years, and 10 years earlier mild bronchiectases were diagnosed and yellow nails were noted. From the right pleura, 1750‐mL clear yellowish fluid was removed and a few days later, 1300 mL was removed from the left side. During the next few weeks, repeated thoracocenteses on both sides were necessary for the palliation of his dyspnoea, and the total amount of removed fluid was more than 10 L. The pleural fluid showed a low cholesterol value, 1.2 mmol/L (serum, 3.5), a fairly high albumin level, 19.0 g/L [serum, 25 g/L (normal, 36–45)], and no triglycerides. Octreotide was administered, initially 0.5 mg subcutaneously twice daily to make sure that there were no side effects, then the long‐acting drug, 30 mg given every fourth week. There was a subjective improvement after the first week, and even though he still has pleural effusions bilaterally, he no longer needs palliative thoracocenteses and can live a normal life. His nails are better, as is the oedema. He is satisfied with his treatment and does not wish to have any pleurodesis. The observation time is now 6 months, and no adverse side effects have been seen so far.</p><figure xml:id="f1"><label>1</label><media mimeType="image" url="urn:x-wiley:17526981:media:CRJ022:CRJ_022_f1"></media><media mimeType="image/gif" url="" rendition="webOriginal"></media><media mimeType="image/gif" url="" rendition="webLoRes"></media><figDesc>
Yellow nail syndrome. Pitting oedema on the legs, bilateral massive pleural effusions and typical toenails.
</figDesc></figure><p><hi rend="bold">Conclusion: </hi> Octreotide can be tried in cases of YNS before more aggressive therapies are started. However, the best results are probably achieved in the rare cases where the effusion is a chylothorax. The other symptoms, such as yellow nails and oedema, also seemed to improve but evaluation is difficult because even normally, there are variations over time with these symptoms. Pleurodesis will probably be necessary in the future for our patient despite his octreotide treatment. Further studies are warranted in this rare disease.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">peripheral oedema</term><term xml:id="k2">pleural effusions</term><term xml:id="k3">treatment</term><term xml:id="k4">yellow nails</term></keywords><classCode scheme="tocHeading1">FORUM: SHORT COMMUNICATION</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/3BAA4C3B2F2BA656FC8F3CB1847C5D93CD1973F3/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1752-699X</doi><issn type="print">1752-6981</issn><issn type="electronic">1752-699X</issn><idGroup><id type="product" value="CRJ"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="CLINICAL RESPIRATORY JOURNAL">The Clinical Respiratory Journal</title></titleGroup></publicationMeta><publicationMeta level="part" position="12002"><doi origin="wiley">10.1111/crj.2007.1.issue-2</doi><numberingGroup><numbering type="journalVolume" number="1">1</numbering><numbering type="journalIssue" number="2">2</numbering></numberingGroup><coverDate startDate="2007-12">December 2007</coverDate></publicationMeta><publicationMeta level="unit" type="shortCommunication" position="10" status="forIssue"><doi origin="wiley">10.1111/j.1752-699X.2007.00022.x</doi><idGroup><id type="unit" value="CRJ022"></id></idGroup><countGroup><count type="pageTotal" number="2"></count></countGroup><titleGroup><title type="tocHeading1">FORUM: SHORT COMMUNICATION</title></titleGroup><eventGroup><event type="firstOnline" date="2007-08-15"></event><event type="publishedOnlineFinalForm" date="2007-08-15"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.5 mode:FullText source:HeaderRef result:HeaderRef" date="2010-04-08"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-16"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-11-04"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="120">120</numbering><numbering type="pageLast" number="121">121</numbering></numberingGroup><correspondenceTo>Gunnar Hillerdal, MD, PhD, Department of Lung Medicine and Allergy, Karolinska University Hospital, SE 171 76 Stockholm, Sweden.
Fax: +46 8 33 29 98
e‐mail: <email>gunnar.hillerdal@karolinska.se</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:CRJ.CRJ022.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Received: 08 March 2007Revision requested: 15 June 2007Accepted: 09 July 2007</unparsedEditorialHistory><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="0"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="5"></count><count type="wordTotal" number="681"></count><count type="linksPubMed" number="0"></count><count type="linksCrossRef" number="0"></count></countGroup><titleGroup><title type="main">Yellow nail syndrome: treatment with octreotide</title><title type="shortAuthors">Hillerdal</title><title type="short">Short communication</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#aff-1-1"><personName><givenNames>Gunnar</givenNames><familyName>Hillerdal</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="aff-1-1" countryCode="SE"><unparsedAffiliation>Department of Lung Medicine and Allergy
Karolinska University Hospital, SE 171 76 Stockholm, Sweden</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">peripheral oedema</keyword><keyword xml:id="k2">pleural effusions</keyword><keyword xml:id="k3">treatment</keyword><keyword xml:id="k4">yellow nails</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p><b>Introduction: </b> The yellow nail syndrome (YNS) is the triad of ‘yellow’ nails, peripheral oedema and pleural effusions. For diagnosis, which is clinical, at least two of these findings are necessary. Also typical is a long‐standing chronic cough often caused by low‐grade bronchiectases. The pleural effusions often require pleurodesis. The pathogenesis is probably a dysfunction of the lymphatic system (<link href="#b1 #b2">1, 2</link>). Octreotide regulates the release of growth hormone and thyrotropin, and also has effects on the gastro‐intestinal tract, where it inhibits glandular secretion, neurotransmission, smooth‐muscle contraction and absorption of nutrients. Adverse effects are nausea, abdominal cramps, diarrhoea, malabsorption of fat and flatulence (<link href="#b3">3</link>). Because of the inhibition of absorption of fats and other nutrients, octreotide has been useful in chylothorax from many different causes (<link href="#b4">4</link>). The pleural effusion in YNS is usually an exudate, but in rare cases a frank chylothorax. One such case with successful octreotide treatment has been described in the literature (<link href="#b5">5</link>).</p><p><b>Objective: </b> The aim of this report was to investigate the effect of octreotide treatment on a patient with YNS with pleural exudates not resulting from chylothorax.</p><p><b>Methods and results: </b> A 62‐year‐old man with typical YNS presented with bilateral large pleural effusions (<link href="#f1">Fig. 1</link>). He had suffered from repeated pneumonia for many years, and 10 years earlier mild bronchiectases were diagnosed and yellow nails were noted. From the right pleura, 1750‐mL clear yellowish fluid was removed and a few days later, 1300 mL was removed from the left side. During the next few weeks, repeated thoracocenteses on both sides were necessary for the palliation of his dyspnoea, and the total amount of removed fluid was more than 10 L. The pleural fluid showed a low cholesterol value, 1.2 mmol/L (serum, 3.5), a fairly high albumin level, 19.0 g/L [serum, 25 g/L (normal, 36–45)], and no triglycerides. Octreotide was administered, initially 0.5 mg subcutaneously twice daily to make sure that there were no side effects, then the long‐acting drug, 30 mg given every fourth week. There was a subjective improvement after the first week, and even though he still has pleural effusions bilaterally, he no longer needs palliative thoracocenteses and can live a normal life. His nails are better, as is the oedema. He is satisfied with his treatment and does not wish to have any pleurodesis. The observation time is now 6 months, and no adverse side effects have been seen so far.</p><figure xml:id="f1"><label>1</label><mediaResourceGroup><mediaResource alt="image" href="urn:x-wiley:17526981:media:CRJ022:CRJ_022_f1"></mediaResource><mediaResource alt="image" mimeType="image/gif" rendition="webOriginal" href=""></mediaResource><mediaResource alt="image" mimeType="image/gif" rendition="webLoRes" href=""></mediaResource></mediaResourceGroup><caption><p>Yellow nail syndrome. Pitting oedema on the legs, bilateral massive pleural effusions and typical toenails.</p></caption></figure><p><b>Conclusion: </b> Octreotide can be tried in cases of YNS before more aggressive therapies are started. However, the best results are probably achieved in the rare cases where the effusion is a chylothorax. The other symptoms, such as yellow nails and oedema, also seemed to improve but evaluation is difficult because even normally, there are variations over time with these symptoms. Pleurodesis will probably be necessary in the future for our patient despite his octreotide treatment. Further studies are warranted in this rare disease.</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="artCateg-note" numbered="no"><p>SHORT COMMUNICATION</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Yellow nail syndrome: treatment with octreotide</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Short communication</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Yellow nail syndrome: treatment with octreotide</title></titleInfo><name type="personal"><namePart type="given">Gunnar</namePart><namePart type="family">Hillerdal</namePart><affiliation>Department of Lung Medicine and AllergyKarolinska University Hospital, SE 171 76 Stockholm, Sweden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="brief-communication" displayLabel="shortCommunication"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2007-12</dateIssued><edition>Received: 08 March 2007Revision requested: 15 June 2007Accepted: 09 July 2007</edition><copyrightDate encoding="w3cdtf">2007</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="references">5</extent><extent unit="words">681</extent></physicalDescription><abstract>Introduction: The yellow nail syndrome (YNS) is the triad of ‘yellow’ nails, peripheral oedema and pleural effusions. For diagnosis, which is clinical, at least two of these findings are necessary. Also typical is a long‐standing chronic cough often caused by low‐grade bronchiectases. The pleural effusions often require pleurodesis. The pathogenesis is probably a dysfunction of the lymphatic system (1, 2). Octreotide regulates the release of growth hormone and thyrotropin, and also has effects on the gastro‐intestinal tract, where it inhibits glandular secretion, neurotransmission, smooth‐muscle contraction and absorption of nutrients. Adverse effects are nausea, abdominal cramps, diarrhoea, malabsorption of fat and flatulence (3). Because of the inhibition of absorption of fats and other nutrients, octreotide has been useful in chylothorax from many different causes (4). The pleural effusion in YNS is usually an exudate, but in rare cases a frank chylothorax. One such case with successful octreotide treatment has been described in the literature (5).</abstract><abstract>Objective: The aim of this report was to investigate the effect of octreotide treatment on a patient with YNS with pleural exudates not resulting from chylothorax.</abstract><abstract>Methods and results: A 62‐year‐old man with typical YNS presented with bilateral large pleural effusions (Fig. 1). He had suffered from repeated pneumonia for many years, and 10 years earlier mild bronchiectases were diagnosed and yellow nails were noted. From the right pleura, 1750‐mL clear yellowish fluid was removed and a few days later, 1300 mL was removed from the left side. During the next few weeks, repeated thoracocenteses on both sides were necessary for the palliation of his dyspnoea, and the total amount of removed fluid was more than 10 L. The pleural fluid showed a low cholesterol value, 1.2 mmol/L (serum, 3.5), a fairly high albumin level, 19.0 g/L [serum, 25 g/L (normal, 36–45)], and no triglycerides. Octreotide was administered, initially 0.5 mg subcutaneously twice daily to make sure that there were no side effects, then the long‐acting drug, 30 mg given every fourth week. There was a subjective improvement after the first week, and even though he still has pleural effusions bilaterally, he no longer needs palliative thoracocenteses and can live a normal life. His nails are better, as is the oedema. He is satisfied with his treatment and does not wish to have any pleurodesis. The observation time is now 6 months, and no adverse side effects have been seen so far.</abstract><abstract>Conclusion: Octreotide can be tried in cases of YNS before more aggressive therapies are started. However, the best results are probably achieved in the rare cases where the effusion is a chylothorax. The other symptoms, such as yellow nails and oedema, also seemed to improve but evaluation is difficult because even normally, there are variations over time with these symptoms. Pleurodesis will probably be necessary in the future for our patient despite his octreotide treatment. Further studies are warranted in this rare disease.</abstract><subject lang="en"><genre>keywords</genre><topic>peripheral oedema</topic><topic>pleural effusions</topic><topic>treatment</topic><topic>yellow nails</topic></subject><relatedItem type="host"><titleInfo><title>The Clinical Respiratory Journal</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1752-6981</identifier><identifier type="eISSN">1752-699X</identifier><identifier type="DOI">10.1111/(ISSN)1752-699X</identifier><identifier type="PublisherID">CRJ</identifier><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>1</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>120</start><end>121</end><total>2</total></extent></part></relatedItem><identifier type="istex">3BAA4C3B2F2BA656FC8F3CB1847C5D93CD1973F3</identifier><identifier type="DOI">10.1111/j.1752-699X.2007.00022.x</identifier><identifier type="ArticleID">CRJ022</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Ltd</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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