A study of loculated tuberculous pleural effusions treated with intrapleural urokinase.
OBJECTIVE
To assess the effect of intrapleural urokinase, vis-à-vis simple pleural drainage, on residual pleural thickening in a series of patients suffering from loculated tuberculous pleural effusion.


METHODS
Twenty-nine patients (21 males and 8 females) with loculated pleural effusion were studied. These patients were randomly allocated to one of two groups: one group received intrapleural urokinase (n=12) and the other was treated by simple drainage with suction (n=17). The urokinase (125,000 UI) was administered into the pleural cavity via an intrathoracic tube. This procedure was repeated every 12h until the quantity of pleural fluid obtained was less than 50 cm3, at which point the intrathoracic tube was removed.


RESULTS
In both groups, the biochemical analysis of the pleural fluid was an exudate and the fluid had a serous appearance. Pleural thickening when the drainage tube was removed was 8.09+/-3.36 mm for the group treated with urokinase, and 14.78+/-17.20mm (P>0.05) for the control group. Residual pleural thickening measured upon completion of medical treatment at 6 months was 1.45+/-0.89 mm for the group treated with urokinase and 7.47+/-10.95 mm for the control group (P<0.05). In the control group, only two patients presented over 10mm of residual pleural thickening. The mean quantity of fluid drained in the two groups was 1.487+/-711 ml for the patients with urokinase, and 795+/-519 ml for the control group (P<0.01).


CONCLUSIONS
Our study shows that patients with loculated tuberculous pleural effusion treated with urokinase suffered less from residual pleural thickening, as measured after six months, than those treated by simple drainage. It is therefore suggested that the administration of intrapleural urokinase is a safe and effective treatment for those patients who drain a larger quantity of pleural fluid.
Cases Viedma
Enrique
E
Neumology Department, La Fe University Hospital, Avenida Campanar, 21, 46009 Valencia, Spain. cases_enr@gva.es
Lorenzo Dus
María José
MJ
González-Molina
Andrés
A
Sanchis Aldás
José Luis
JL
D000293:Adolescent; D000328:Adult; D004322:Drainage / Q000379:methods; D005122:Exudates and Transudates / Q000737:chemistry; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods; D010994:Pleura / Q000473:pathology; D010996:Pleural Effusion / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014396:Tuberculosis, Pleural / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator