PURPOSE: Our aim was to determine the impact of medical thoracoscopy (MT) on diagnostic work-up of patients with pleural effusions (PE) presenting to Respiratory Medicine by comparing number of investigations required to arrive at diagnosis, median time to diagnosis, length of hospital stay, need for other surgical interventions, and patient outcome before and after introduction of MT. MT began at our institution in 2004.

Objective: This study aimed to assess prospectively the accuracy, safety and outcome of flex‐rigid pleuroscopy in the diagnosis of patients with indeterminate pleural effusions.Methods: Included in the study were all patients with unilateral exudative pleural effusions of unknown aetiology who underwent diagnostic flex‐rigid pleuroscopy from July 2003 to June 2005, and were followed until December 2005. The procedure was conducted in the endoscopy suite under local anaesthesia and, where indicated, talc poudrage was carried out at the same time. Clinical data, length of hospitalization, chest tube drainage, outcome, diagnostic accuracy of pleuroscopy and procedure‐related adverse events were recorded prospectively.Results: Fifty‐one patients were recruited (20 male and 31 female). Median age was 53 years (range 45–67). Flex‐rigid pleuroscopy was 96% accurate and yielded a diagnosis in 49 out of 51 patients. It was safely carried out without need for surgical intervention, blood transfusion or endotracheal intubation. Culture‐negative fever was observed in eight patients (16%), and five patients (10%) required additional analgesia for postoperative pain. Duration of chest tube drainage and length of stay for patients who underwent diagnostic pleuroscopy were 1 and 2 days, respectively, while they were both 3 days when talc poudrage was carried out. Success rates with pleuroscopic talc pleurodesis for malignant pleural effusions were 94%, 92% and 89.5% at 3, 6 and 12 months, respectively, and the 30‐day mortality was 0%.Conclusion: Flex‐rigid pleuroscopy is a safe procedure with a high diagnostic accuracy and should be considered for the evaluation of indeterminate pleural effusion.

PURPOSE: Lung cancer is the leading cause of cancer deaths world wide, and adenocarcinoma is the most common cell type. Majority of patients with lung cancer present at advanced stage of disease with only 14% amenable to surgery for cure. Thus treatment is palliative, and for patients with malignant effusions due to pleural metastasis, pleurodesis with talc is one method to prevent recurrence. Although talc is widely used in clinical practice and is the preferred pleurodesis agent, exact mechanisms for its observed efficacy as well as whether it causes apoptosis of the cancer cells, have not been studied.

Esophageal stenting has emerged as a popular option in the palliation of malignant dysphagia and tracheoesophageal fistula in esophageal tumors. However, owing to the proximity of the airway, the subsequent airway sequelae should be considered. We describe five cases in our department that demonstrated airway complications subsequent to isolated esophageal stenting.