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Background - Malignant pleural effusions are a frequent complication of advanced malignancy, and cause considerable morbidity from dyspnoea. The drainage and subsequent control of malignant effusions relieves symptoms and maintains quality of life, and is difficult in patients with multiloculated or septated effusions. We report the use of intrapleural streptokinase (IPSK) to aid pleural drainage in 10 consecutive patients with malignant multiloculated pleural effusions resistant to standard chest tube darinage. Methods - Ten patients with malignant multi-loculated pleural effusions were given twice daily doses of intrapleural streptokinase 250,000 i.u. when inadequate drainage was achieved by tube thoracostomy alone. Outcome was assessed by chest radiograph and dyspnoea control. Results - Radiographic improvement and control of dyspnoea was seen in all 10 patients. There was a reduction in the largest linear dimension of the collection in 9/10 patients (mean[SD] 6.5 [3.34]cm; C.I. 4.36-9.14, p<0.0001, paired t-test). Eight patients showed a >75% reduction in volume of pleural effusion with IPSK and 9/10 patients had ≤ 10% area of hemithorax occupied by residual pleural effusion after treatment. Conclusions - Intrapleural streptokinase controls dyspnoea by improving the drainage of malignant multiloculated pleural effusions in patients who fail to drain adequately with a standard chest tube. This technique improves dyspnoea and so maintains quality of life in patients with this otherwise difficult clinical problem.


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