الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 166 |  |  |
| | | from | 166 | | |
Abstract
Introduction: Malignant pleural effusion can’t be controlled by repeated thoracocentesis and surgical pleuroectomy may not be considered appropriate for terminally ill patients. Chemical pleurodesis has been suggested to achieve the best balance between efficacy and acceptability for terminally ill patient.
Aim of work: We evaluated the efficacy of two different agents (Povidoniodine and viscum) via two different procedures (small bore catheter and large bore tube after MT) to induce pleurodesis in a group of patients with documented malignant effusion.
Patients and methods: This study carried out at Chest Department Mansoura University Hospitals, in period from April 2008 to August 2011, comprised 100 patients with malignant pleural effusion, subdivided according to the material used and the procedure into 4 groups: group A using Viscum via MT (n=18), group B using povidine-iodine via MT (n=20), group C using Viscum via SBC (n=33) and group D using povidine-iodine via SBC (n=29).
Results: The end point of the study was the success rate after 4 weeks where patients were described as having either a complete response (no fluid reaccumulation after pleurodesis), a partial response (asymptomatic fluid reaccumulation that needs no further therapy), and failure of response (symptomatic fluid reaccumulation to the pre-pleurodesis level that needs further therapy). For the purpose of simplicity, the complete and partial responses were summed up as total response. The response rate ranged from (complete-total): 77.8-88.9%, 75-90%, 60.6-87.9%, and 69-89.7% in group A, B, C, and D respectively. The time to pleurodesis was significantly shorter in patients subjected to pleurodesis after MT and large bore chest tube (4.5 days) compared pleurodesis via SBC (6.5 days) regardless the agent used. This finding was consistent among previous studies comparing both techniques. Different agents had variable side effects such as chest pain (67.3%) and hypotension (16.3%) with povidone-iodine. Fever was an exclusive side effect of viscum (72.5%).
Conclusions: Both povidone-iodine and viscum pleurodesis have similar results regarding the success rate and time to pleurodesis. The success rate of these materials is also comparable to other commonly used materials such as talc. Although large bore chest tubes after medical thoracoscopy led to rapid pleurodesis with the advantage of distributing used agent on most available surface area of pleura under complete vision with cutting of adhesions, the success rates were similar to SBC. Moreover, SBC was better tolerated due to minimal complications. These support a growing role for SBC in pleurodesis.