Pleural Effusion Clinical Trial
Official title:
Evaluating Different Modalities for Pleural Adhesiolysis at Assuit University Hospital
interventional randomized clinical trial will be done at Assuit University Hospital ( Chest Department and Caridothoracic surgery department ),and all patients presented with complex septate pleural effusion in whom the symptoms excepted to be relieved by pleural fluid drainage will be included in our study within the two next years.
The goal in the management of pleural effusion is to provide symptomatic relief by removing
fluid from the pleural space and to allow the treatment of the underlying disease. Despite
the improvement in the management options of pleural effusion; intrapleural adhesions remain
a significant problem in many patients with pleural disease. The presence of adhesions carry
a poor prognostic factor in patients with exudative pleural effusions that it may render the
drainage of pleural fluid difficulty inspite of tube being patent and correctly positioned.
Two options are currently available to deal with the problem of pleural adhesions, the first
is chemical and the second is mechanical adhesiolysis . Chemical adhesiolysis means lysis of
the adhesive bands medically by instillation intrapleural chemical agents e.g.
streptokinase, urokinase, tissue plasminogen activator, streptodornase, deoxyribonuclease
(human recombinant [hr]DNAase), single-chain urokinase plasminogen activator and the
uncommonly used MESNA (2-mercaptoethane sulfonate Na) . Mechanical adhesiolysis means
breaking up the adhesive bands and removing it by pulling and dissecting via medical
thoracoscope, minimally invasive video assisted thoracoscopy (VATS) or more invasive
thoracotomy.
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