الفهرس 
Acknowledgements
Lymphatic drainageOnly 14 pages are availabe for public view
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Abstract
This prospective non-blinded randomized clinical trial study had been designed to compare chemical pleurodesis using silver nitrate and the use of indwelling pleural catheter in the management of MPE in the Chest Department at Assiut university hospital during the period from April 2018 to October 2019. The study included 45 patients with MPE. They were 21 (46.6%) males and 24 (53.4%) females. The mean age of these participants was 59±11.3 years. Twenty-one patients underwent pleurodesis using silver nitrate solution (0.5 %) via chest tube (26 F or 28 F ) while 24 patients underwent modified indwelling pleural catheter insertion. All patients were subjected to the following: medical history taking, clinical examination, radiology (Plain chest x-ray and computed tomography of the chest if possible). Routine laboratory investigations like CBC and coagulation profile had been done. Pleural fluid cytology and/or pleural biopsy were done to confirm the diagnosis. The following results were observed: Successful pleurodesis was achieved in 61.9% of the SNP group and 69.6% of the modified IPC group being nearly equally effective in the achievement of pleurodesis in cases with malignant pleural effusion with a high success rate. Both methods of pleurodesis were safe and inexpensive. There was a statistically insignificant difference (P >0. 05) with the initial amount of pleural effusion so that it might be considered an insignificant predictor for successful pleurodesis. There was a statistically insignificant difference (P >0. 05) with the histopathological type of MPE having no association with the probability of failure. No complications occurred in 10 (47.6%) of the SNP group, and 7 (30.4%) of the IPC group. Minor complications had occurred in 11 (52.4%), and 16 (69.6%) patients of SNP and IPC groups respectively There was an insignificant change in oxygen saturation of patients recorded before or after the procedure except for one patient in the SNP group who developed hypoxemia which necessitated hospitalization and supportive treatment till improvement and discharge. Chest pain was the most frequent complication seen in the modified IPC group with 100% while loculated effusion was the most common complication in the SNP group in 23.8% of cases. Other complications included fever, pleural infections, pneumothorax, hypoxemia, catheter tract metastasis, blocked or slipped catheter and cellulitis. Patients with modified IPC were characterized by a short hospital stay and insertion of an IPC could be done in an outpatient setting as 66.7% of patients from the modified IPC group were discharged on the same day of the procedure. Patients with the SNP group recorded lower pain scores in comparison with the modified IPC group. There was no significant difference in the survival between both groups. In conclusion, silver nitrate and modified IPC pleurodesis were nearly equally effective, safe, and inexpensive methods in the achievement of pleurodesis in cases with malignant pleural effusion with high success rate and low tolerable complications. SNP had lower pain scores while modified IPC pleurodesis had a shorter hospital stay. Recommendations We recommend that: Further large sample size study and the use of the original IPC (Pleurx) instead of modified IPC which is expensive and unavailable in our country. Also, we recommend a further study in which we use modified IPC for chronic drainage followed by chemical pleurodesis through injection of a sclerosing agent such as SNS for the achievement of higher success rate of pleurodesis