INTRODUCTION: Management of recurrent inflammatory pleural effusions can be difficult for both providers and patients.Current therapeutic strategies are limited to management of systemic disease and symptomatic treatment with repeat pleural drainage, tunneled pleural catheter, pleurodesis or other surgical options.There currently is no established role for intrapleural steroids in management of pleuritis.Systemic steroids may be effective, though they have well known toxicities.CASE SERIES PRESENTATION: We describe a case series of 6 patients who presented with recurrent inflammatory pleural effusions which were successfully treated with a single dose of intra-pleural triamcinolone therapy.Three patients had pleuroscopy confirming diagnosis of fibrinous pleuritis; whereas, the other three had clinical diagnosis of pleural effusion secondary to inflammatory process (i.e sjogren's pleuritis/serositis, post-cardiotomy syndrome, and post infectious inflammation).All pleural fluid cytology (n=6) and biopsies (n=3) were negative for malignancy.Success was determined by reduction in pleural drainage and ability to remove chest tube or tunneled pleural catheter.In our series, after administration of one dose of triamcinolone (400mg for 4 cases, 600mg for 1, and 200mg for 1) followed by chest tube clamping (up to 24 hours), we were able to effectively reduce pleural drainage and remove the tunneled pleural catheter in two patients and pigtail catheter in the other four.One patient, despite having recurrent pleural effusion while on long standing immunosuppression, finally had resolution with intrapleural triamcinolone.Two patients were also on concomitant colchicine therapy; however, reduction in pleural fluid output noticeably decreased after triamcinolone therapy.DISCUSSION: There are no established guidelines for the use of intrapleural corticosteroids in the management of pleural effusions and pleuritis.There are a few published case reports suggesting benefit of intra-pleural methylprednisone or dexamethasone in patients with recurrent effusions from inflammatory diseases such as rheumatoid or ankylosing spondylitis.Data for efficacy of intrapleural triamcinolone is limited to a few cases in patients with metastatic effusions from gynecological cancers.There are limited data that show promising results from use of intra-pericardial triamcinolone with concomitant colchicine for inflammatory pericarditis.Our case series is unique as it describes the successful use in six patients (decrease in pleural output and ability to remove chest tube) and highlights the potential therapeutic role of a single dose intrapleural triamcinolone for the management of recurrent inflammatory, nonmalignant, pleural effusions.

A man aged 60 years presented to his primary care physician because of a 5-kg unintentional weight loss over 3 months, hemoptysis, and exertional shortness of breath, but no fever. He had smoked 20 to 30 cigarettes a day since his 20s before quitting a year prior because of health concerns. A chest

9531 Background: After decades of efforts on reducing lung cancer incidence and mortality, we are now challenged by the lack of understanding of the health conditions and quality of life (QOL) among the survivors. Methods: We evaluated 2,005 consecutive primary lung cancer patients diagnosed 1999- 2006. Two validated patient-reported assessments, the Lung Cancer Symptom Scale and Linear Analogue Self-Assessment, were used to measure overall QOL, pain, fatigue, appetite, symptoms, physical-, emotional-, mental-, and spiritual well-being, social activity/support, and financial/legal concerns. Cross-sectional and longitudinal analyses were performed. Assessments were translated onto a 0–100 (worst to best) scale, and a normative range was defined as 80.0±10.0 established in healthy individuals. Four QOL groups were defined: norm (70.0–90.0), above-norm (>90), below-norm (60.0–70.0), and poor (<60). Adjusted QOL was calculated by multiple regression models with variables at baseline (age, sex, ethnicity, marital status, years of education, employment status, smoking history, body weight, histology and stage, and comorbidities) and at each time a QOL questionnaire was answered (performance status, surgery, chemotherapy, and radiotherapy, weight change, and current tobacco use). Results: A total of 5,289 QOL questionnaires were answered by 2,005 patients from 6-month to 7-year post diagnosis. The mean (SD) overall QOL was 73.0 (23.2), ranging 70.8–76.0 across the 7 years, with and without covariates. Frequent pain and physical well-being were consistently below norm, fatigue scored as poor for all years, and shortness of breath was below norm between 6 months and year-4 and declined to poor thereafter. Longitudinally following patients in the four groups based on their initial overall QOL score, survivors stayed in the same QOL group throughout years, except those who started in the poor group (mean score 41.2) improved gradually to a mean score of 64.7 at year-5 although still below norm. Conclusions: This study describes health-related QOL by prospectively following a large lung cancer cohort. Modifiable contributors to poor QOL need to be identified and interventions should be designed to improve patients’ QOL in conjunction with prolonged survival. Supported by NIH grants CA77118, CA80127, and CA84354. No significant financial relationships to disclose.

The challenge presented by a solitary pulmonary nodule has faced physicians and patients since the advent of the chest radiograph. Is the nodule malignant or benign? When should something be done about it and what should that be? The majority of solitary nodules are benign, but the detection of a nodule may be the first and only chance for cure in the patient with lung cancer. The expanding availability and use of computed tomography are leading to increased numbers and decreased size of nodules detected. Surgical resection remains the most sensitive and specific method of analysis but introduces morbidity and mortality that may be unnecessary and avoidable. Advances in radiographic techniques have improved the ability to noninvasively identify whether a nodule is likely malignant or benign. Application of these techniques may ease the decision making and reduce the incision making.