title: Effectiveness of medical thoracoscopy and thoracoscopic talc poudrage in patients with exudative pleural effusion.
abstract: BACKGROUND
  This study aimed to assess the effectiveness of medical thoracoscopy (MT) and thoracoscopic talc poudrage (TTP) in patients with exudative pleural effusion.
  
  
  METHODS
  We evaluated the diagnostic yields, complications and outcomes of MT and TTP in 41 consecutive patients with symptomatic pleural effusions who were planned to undergo both procedures from 1 December 2011 to 30 November 2012. Data was reviewed retrospectively and prospectively up to March 2013.
  
  
  RESULTS
  Among the 41 patients, 36 underwent MT with the intent of biopsy and talc pleurodesis, 2 underwent MT for pleurodesis only and 3 had failed MT. Aetiologies of pleural effusion included lung cancer (n = 14), tuberculosis (n = 9), breast cancer (n = 7), ovarian cancer (n = 2), malignant mesothelioma (n = 1), congestive cardiac failure (n = 1), peritoneal dialysis (n = 1) and hepatic hydrothorax (n = 1); pleural effusion was undiagnosed in five patients. The overall diagnostic yield of MT, and the yield in tubercular and malignant pleural effusions were 77.8%, 100.0% and 82.6%, respectively; it was inconclusive in 22.2%. Complications that occurred were self-limiting, with no procedure-related mortality. The 30-day mortality rate was 17.1%. A total of 15 patients underwent TTP. The 30-, 60- and 90-day success rates were 77.8%, 80.0% and 80.0%, respectively, with one patient having complications (i.e. empyema). The 30-day mortality was 40.0%.
  
  
  CONCLUSIONS
  MT is a safe procedure with high diagnostic yields in undiagnosed pleural effusions. TTP is an effective method to stop recurrence of pleural effusions.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: Akash
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: Aza
authors.initials: A
authors.lastname: Taha
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: Sridhar
authors.initials: S
authors.lastname: Venkateswaran
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: Augustine
authors.initials: A
authors.lastname: Tee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis; D010996:Pleural Effusion / Q000175:diagnosis* / Q000628:therapy*; D016066:Pleural Effusion, Malignant / Q000175:diagnosis*; D018700:Pleurodesis / Q000379:methods*; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D013627:Talc / Q000008:administration & dosage*; D013906:Thoracoscopy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis
chemical_list: D013627:Talc
keywords: chest tube; medical thoracoscopy; pleural effusion; pleurodesis; pleuroscopy