الفهرس | Only 14 pages are availabe for public view |
Abstract A pleural effusion is defined as a malignant pleural effusion by the presence of malignant cells in the pleural fluid and an increase in the volume of pleural fluid. A malignant pleural effusion is an ominous clinical indicator and represents advanced stage neoplasm. Malignant pleural effusions are most often characterized chemically as exudative pleural effusions. There are numerous mechanisms in which a malignancy can contribute to the formation of an MPE. The management of patients with MPE is cumbersome and can present important diagnostic and therapeutic challenges. Several palliative treatment options are available including therapeutic thoracentesis, tube thoracostomy, small caliber tube, chemical pleurodesis and video thoracoscopic pleurodesis Pleurodesis is performed to inflame the visceral and parietal pleura to fuse the pleurae together obliterating the potential pleural space. Traditional catheter drainage of MPE includes tube insertion, observation and pleurodesis if daily drainage is <200-400 ml. However, this approach may lead to very long hospitalization time with limited success of the procedure. Rapid pleurodesis can lead to fast palliation without the need for hospitalization in most patients. The technique aimed at full evacuation of pleural fluid and total radiological lung inflation then pleurodesis is carried out once this happens and the tube is removed and the patient is discharged. The study included in group A 3 males (20%) and 12 females (80%) and in group B there was 4 males (26.7%) and 11 females (73.3%) and ages ranged in both groups between 40 to 66 years old with no significant difference between both groups in age and sex . In comparison between the 2 groups there was significant difference regarding post-operative pain as in group A 40 % complaining no pain, 53.3 % show mild pain and only 6.7 % complaining moderate pain but in group B 53.3 % show moderate pain, 33.3 % show mild pain and only 13.3 % show no pain. In comparison between group A and B there was highly significant difference as median was 3 days in group A and it was 6 days in group B which means that in group A less hospital stay than group B. Regarding recurrence of the effusion observed with follow up of patients there was no significant difference between the two groups as recurrence occurs in 13.3 % in group A and in 20 % in group B. Conclusion: Small Caliber tube drainage and rapid pleurodesis was shown to be efficient pleurodesis and demonstrated a good safety profile in treating malignant pleural effusions. It can be considered as an alternative method for pleurodesis supported by some advantages regarding pain and the hospital stay. We should recognize that this is a palliative procedure aimed at improving the quality of life of patients who suffer end-stage cancer. |