title: A case series: Egyptian experience in using chemical pleurodesis as an alternative management in refractory hepatic hydrothorax.
abstract: BACKGROUND
  Chemical pleurodesis is an effective treatment for malignant effusion and pneumothorax. Although this mode of therapy is less widely accepted in treatment of patients with hepatic hydrothorax, the need for palliative treatment in such patients encouraged us to do this work. The aim of study was analysing the outcome of chemical pleurodesis using bovoiodine, Vibramycin and talc slurry in treatment of hepatic hydrothorax.
  
  
  METHODS
  A case series randomized study including 23 patients with symptomatic right side hepatic hydrothorax not responding to medical treatment and repeated thoracocentesis was conducted. From March 2007 to March 2008, 19 men and 4 women with a mean age of 54.3 ±8.1 years (range 42-70 years) underwent medical thoracoscopies to achieve pleurodesis by application of 3 sclerosing agents.
  
  
  RESULTS
  Out of the 23 patients pleurodesis was repeated in 20 cases. Three cases did not attend their follow-up so their responses to pleurodesis are not known. The follow-up period of the study was 3 months. The procedure was effective in 15 of 20 patients (75%): 7/8 cases treated with bovoiodine (87.5%), and 4/6 cases with Vibramycin and talc slurry (66.7%) for each. There were 4 recurrences (20%) and a single case of mortality (5%) due to hepatic coma which can be attributed to the course of the disease. We detected minimal morbidity during the follow-up period of 3 months.
  
  
  CONCLUSIONS
  The procedure appears to be indicated for these fragile patients especially when medical therapy fails. Chemical pleurodesis deserves to be considered as an alterative therapy in such patients.
authors.affiliation: Chest Diseases Department, Cairo University, Cairo, Egypt.
authors.forename: Nariman
authors.initials: N
authors.lastname: Helmy
authors.forename: Yosri
authors.initials: Y
authors.lastname: Akl
authors.forename: Safy
authors.initials: S
authors.lastname: Kaddah
authors.forename: Hamed Abd El
authors.initials: HA
authors.lastname: Hafiz
authors.forename: Hisham El
authors.initials: HE
authors.lastname: Makhzangy