Re: [MOL] Pleural effusion [01256] Medicine On Line

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Re: [MOL] Pleural effusion

Dear Darrell:
     My husband had a right lung pleural effusion as well as a large tumor 
and numerous metatastic nodules in both lungs which made him inoperable.  
Initially, they drained the fluid by thoracentesis at Sloan Kettering and by 
examining the cells in the fluid diagnosed it as adenocarcinoma (malignant 
large cell).  They were not sure if the lung was primary but they think it 
is. The fluid really can't be left because it will hamper breathing at the 
least. Also you can learn a lot about the type of cancer it is from draining 
it.  On the other hand, repeated thoracentesis is not good either because it 
can create a path where the needle goes in for metastasis.  So the pleural 
effusion needs to be removed permanently if possible. The jury is still out 
whether using bleomycin (a chemo agent) to dry out the pleural effusion is 
the best way or to use a talc poudrage procedure (which is what my husband 
had at Dana Farber). The talc MUST be absolutely sterile.   There is some 
statistical evidence that the latter is favored and has a higher success rate 
and doesn't interefere with trials and chemo agents that might want to be 
used later but I would consult with several good people where you are.  The 
talc poudrage is effective in 80% of cases.  Alas, my husband still has some 
fluid left. I have a 10 page medscape article discussing the methods in great 
detail and I can fax it to you if you have a fax #.  Otherwise you can do a 
mescape search for pleural effusion yourself.  Good luck.  Bess
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