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PubMed1983

Central chemical regulation of breathing movements in fetal lambs.

In 12 chronically prepared fetal lambs between 126 and 136 days of gestation, 17 ventriculocisternal perfusions (123 microliter/min) were performed. The concentration of bicarbonate ([HCO3-]) in the mock cerebrospinal fluid (CSF) perfusate was altered to manipulate the [HCO3-] in the cerebral ventricles. These perfusions did not systematically alter fetal arterial PCO2, PO2, pH, heart rate or mean blood pressure. Fetal breathing movements (FBM) were noted as rhythmic negative intrathoracic pressures with reference to amniotic fluid pressure. The incidence of FBM was determined and expressed as the percent of the 3 h observation period during which breathing movements were present. Perfusions with mock CSF having an approximately normal [HCO3-], resulted in cisternal [HCO3-] of 23.9 +/- 0.8 (SEM) meq/L and an incidence of fetal breathing movements (FBM) of 22.1 +/- 10.0%. Perfusions with an elevated [HCO3-] in the mock CSF increased the cisternal [HCO3-] to 30.7 +/- 0.4 meq/L and lowered the incidence of FBM to 0.6 +/- 0.2%. Perfusions with a lowered [HCO3-] mock CSF decreased the cisternal [HCO3-] to 17.3 +/- 0.8 meq/L and increased the incidence of FBM to 45.7 +/- 6.8%. These perfusions did not alter the relative incidence of low voltage (LV) versus high voltage (HV) electrocortical (ECOG) state. In 4 animals, low [HCO3-] perfusions induced FBM in the normally apneic HV ECOG state. We conclude that in the near-term fetal lamb, central chemoreceptors can modulate the incidence of rhythmic respiratory efforts, that tonic afferent stimuli arising from these receptors are critical for the generation of spontaneous FBMs and that central acidosis is capable of evoking FBMs in the normally apneic HV ECOG state.

Animals↗

PubMed1992

Neural respiratory responses to cortically induced seizures in cats.

Seizure activity can lead to profound respiratory stimulation in spontaneously breathing animals with intact respiratory feedback mechanisms (Paydarfar et al., Am. J. Physiol. 260, R934, 1991). The present study was designed to test the hypothesis that peripheral respiratory feedback mechanisms are not important for the genesis of seizure-induced hyperpnea. Studies were performed in 16 anesthetized, vagotomized, glomectomized cats whose end-tidal PCO2 (PETCO2) was kept constant. Integrated phrenic nerve activity was used to represent respiration. Seizures were induced by injection of penicillin into the parietal cortex and electrocorticographic (ECoG) and biceps femoris nerve activities, arterial pressure, airway PCO2 and brain temperature were recorded continuously. Progressive seizure activity was associated with progressive increases of respiratory frequency and peak phrenic activity, despite constancy of PETCO2 and brain temperature. Patterns of entrainment were identified among ECoG spikes, biceps femoris nerve and phrenic nerve activities. Phrenic nerve activity became highly irregular during generalized ictal seizures and ceased to respond to changes of PETCO2. Acute intercollicular decerebration in all experiments resulted in normalization of respiratory rhythm even while ictal ECoG activity continued. We conclude that stimulation of breathing during seizures occurs in the absence of respiratory feedback mechanisms. The findings suggest that an important cause of the respiratory response is a feedforward mechanism, whereby activation of subcortical structures above medulla and pons results in stimulation of breathing.

Animals↗

PubMed1992

Epileptogenic effects of skin extracts from the Australian frog Pseudophryne coriacea after intracerebral microinfusion in rats.

The behavioural and electrocortical (ECoG) effects induced by a methanol extract of the skin of the Australian frog Pseudophryne coriacea, directly microinjected into several areas of the brain, were studied in freely moving rats. Administration of the P. coriacea extract (5, 10, 15 and 20 micrograms) into the dorsal hippocampus produced a dose-dependent and reversible behavioural stimulation and ECoG spikes lasting 20-140 min. Similar but less intense effects were elicited in rats receiving injections into the III cerebral ventricle, amygdala and caudate nucleus. In conclusion, the present experiments show that the skin extract of P. coriacea produces behavioural stimulation and ECoG spikes when injected into the rat brain, the most sensitive area being the hippocampus.

Amphibian Venoms↗

PubMed1976

Dose-related effects of metrazol on retention and EEG.

The effects of various dose levels of Metrazol on retention and electrocorticogram (ECoG) were investigated. Mice given a subconvulsive 30 mg/kg or a convulsive 50 mg/kg dose of Metrazol 15 min before reversal training in a discriminated escape learning task showed retention impairment of reversal training retention. Lower dose levels (5 or 10 mg/kg) had no effect. The 30 mg/kg dose produced asymmetrical dissociation. The convulsive dose (50 mg/kg), previously reported to result in symmetrical dissociation, produced ECoG changes that were still evident 15 min following the injection, i.e. at the time when training or testing usually took place. With lower doses (10 or 30 mg/kg), no apparent ECoG effects were observed at this interval. The implications of the findings were discussed with respect to the state-dependent hypothesis.

Animals↗

PubMed1986

Nicotine alters catecholamines and electrocortical activity in perfused mouse brain.

Nicotine differentially altered electrocortical (ECoG) activity and brain catecholamine metabolism in mice (C3H and C57BL) known to differ in behavioral response to nicotine. Nicotine appeared to produce a concentration dependent desynchronization to ECoG activity in isolated perfused mouse brain (IPMB) from C3H mice. Homovanillic acid (HVA) production was unchanged in C3H perfused brains while an apparent reduction in 3-methoxy-4-hydroxyphenethyleneglycol (MPHG) was observed. Brain content of norepinephrine and dopamine remained relatively constant in the various regions tested. In IPMB from C57BL mice, nicotine elicited an enhancement of ECoG amplitude which was accompanied by decreased HVA production rates. A downward trend in MHPG production was also observed. These effects were associated with increased levels of norepinephrine and dopamine in various brain regions.

Animals↗

PubMed1988

A behavioral and electrocorticographic comparison of diazepam and pentylenetetrazol in rat pups.

This experiment assessed the possibility suggested by previous research that benzodiazepines cause convulsions in infant rats. Seven-day-old Wistar rats were randomly assigned to receive either diazepam (DZP) (0, 0.5 or 2.5 mg/kg), the convulsogen pentylenetetrazol (PTZ) (50 mg/kg), or DZP followed 30 minutes later by PTZ. The amount of paddling and wall progression and head and body tremors was recorded for each group. Both DZP and PTZ elevated paddling and wall progression, but only PTZ elevated head and body tremor scores. DZP antagonized the PTZ-induced increases in head and body tremors. In a second experiment, seven-day-old pups were implanted with cortical electrodes. The following day, baseline electrocorticograms (ECoGs) were taken for each animal. Each pup subsequently received either DZP vehicle, 0.5 mg/kg DZP, 50 mg/kg PTZ, or 0.5 mg/kg DZP followed 30 minutes later by 50 mg/kg PTZ. Neither the vehicle nor the DZP injections altered ECoG activity. In contrast, PTZ-treated pups showed continuous, high-amplitude, spiking activity. Pretreatment with DZP eliminated these PTZ-induced alterations in ECoG activity. We conclude that in infant rats, the behavioral and electrophysiological effects of DZP and PTZ are distinct from one another. Furthermore, both the behavioral and the electrocorticographic effects of PTZ are blocked by DZP. It is unlikely that DZP causes seizures in neonatal rats.

Animals↗

PubMed1994

Regional brain blood flow in the ovine fetus during transition to the low-voltage electrocortical state.

Sequential changes in cerebral blood flow and regional distribution were studied in nine chronically catheterized fetal sheep during the transition to the low-voltage ECOG (REM) state to determine the time course for blood flow change within the brain and whether executive centres for REM state generation might thus be identified. Blood flows were measured during the first, second and third minutes after the transition to the low-voltage ECOG state and during the third minute of the subsequent high-voltage ECOG (NREM) state using the radioactive labelled microsphere technique. Blood flow to the brain was increased during the low-voltage REM state when compared to that of the high-voltage NREM state, with the increase evident when measured during the first minute after the state transition and with no sequential change thereafter. Regional blood flow increases during the low-voltage state were greatest to those areas variously associated with the generation of REM state activity, but were again remarkably stable through the first 3 minutes after the state transition. This rapid increase in blood flow within the brain and the regional hierarchy for such, supports the participation of multiple anatomical areas which are highly integrated and act in concert to give rise to what is known as the REM state.

Animals↗

PubMed1985

Behavioural and spectrum power effects of opioid peptides in chicks.

The effects of intracerebroventricular administration of beta-endorphin, dermorphin, D-ala2-methionine-enkephalinamide (DALA) and pentazocine, on behaviour, electrocortical activity and ECoG spectrum power in young chicks were studied. Beta-endorphin, dermorphin and DALA produced dose-dependent behavioural sedation and sleep accompanied by electrocortical high voltage slow wave activity and increase in total voltage power with a predominant increase in the lower bands of ECoG spectrum. Dermorphin was found significantly more potent than beta-endorphin and DALA since it was active at much lower doses. Behavioural and ECoG sleep evoked by opioid peptides were rapidly reversed by naloxone showing that these effects are mediated through an activation of specific opioid receptors. Doses of pentazocine equimolar with doses of dermorphin and beta-endorphin producing sleep did not affect behaviour and spectrum power whereas higher doses produced opposite effects, i.e., behavioural stimulation, pecking and increase in locomotor activity.

Animals↗

PubMed1994

Hippocampal damage produced in rats by alpha-dendrotoxin--a selective K+ channel blocker--involves non-NMDA receptor activation.

The epileptogenic and neurodegenerative effects induced by intra-hippocampal injection of a selective K+ channel inhibitor, alpha-dendrotoxin (DTx), were investigated in normal rats and those bearing a monolateral surgical lesion of the Schaffer collaterals that causes degeneration of their nerve terminals and also, isolates the CA3 area. In addition, these effects have also been studied in rats pretreated with NBQX, an AMPA receptor antagonist. Injection of DTx (35 pmol) into one dorsal hippocampus induced motor and electrocortical (ECoG) seizures in all the treated animals that were rapid in onset (within 2-3 min). The seizures were accompanied at 24 h by significant neuronal cell loss which occurred in the CA1, CA3 and CA4 pyramidal cell layers of the hippocampus, ipsilateral to the side of injection. This neuronal loss was paralleled by a significant decrease in the density of radioiodinated DTx labelled acceptors. Lesioning of the excitatory afferents to the CA1 pyramidal cells, gave a substantial reduction in the density of radioiodinated DTx labelled acceptors in the strata oriens and radiatum, revealing that a proportion of these K+ channels are present on the Schaffer collateral terminals. Under these conditions, motor and ECoG seizures persisted. As expected, the lesion prevented loss of the isolated CA3 pyramids, normally produced by the administration of DTx, leaving unaffected CA1 and CA4 pyramidal cell damage, consistent with an observed diminution of DTx binding sites in the latter areas. In unlesioned rats pre-treated with NBQX (30 mg/kg i.p.), subsequent injection of DTx evoked epileptogenic effects after a latency of 15 min and caused significant cell loss in the CA1 but not in the CA3 and CA4 pyramidal cell layers, ipsilateral to the side of toxin injection. A lower dose of NBQX (15 mg/kg i.p.) proved ineffective. In conclusion, these data together with our published results on NMDA antagonists indicate that motor and ECoG seizures and CA1 pyramidal cell loss elicited by intra-hippocampal injection of the K+ channel blocker, DTx, are independent from mechanisms involving glutamate-mediated excitotoxicity whereas CA3 and CA4 pyramidal cell loss may be the consequence of excessive activation of AMPA receptors.

Animals↗

PubMed1995

Electrographic studies of the effects of RP 60180, a novel kappa agonist, on the photosensitive baboon Papio papio.

1. The authors describe here the effects of intravenous administration of RP 60180, a novel kappa agonist, on conscious baboons of the species Papio papio, which spontaneously present photically induced epileptic responses. 2. Animals (n = 2) were chronically implanted with epidural recording electrodes and tested whilst seated in a primate chair. The electrocorticogram (ECoG) and electrocardiogram (ECG) were recorded during a control period of at least 30 minutes before the injection of RP 60180 (1 to 4.5 mg/kg i.v.) and immediately afterwards. 3. Qualitatively, up to the dose of 4.5 mg/kg i.v., RP 60180 did not modify ECoG background in term of paroxysmal activity in comparison with that observed during the control period. It did not cause any manifest focal or generalized seizure discharges, nor did it consistently enhance or reduce photically induced myoclonic responses. 4. From the dose of 1 mg/kg i.v., RP 60180 slowed ECG frequency. This effect, which lasted for about 30 minutes post-injection, was most often seen at the higher doses. 5. In another set of experiments, one baboon received the kappa agonist U-50488 (a benzacetamide derivative of spiradoline) at 1 and 3 mg/kg i.v. U-50488, at 3 and to a lesser degree at 1 mg/kg i.v., induced paroxysmal bursts of slow wave ECoG activity and a slowing of the ECG. These effects lasted about 1 hour post-drug administration. During this period, we observed spontaneous vocalization, as if the animal were complaining, as well as shaking.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗

PubMed1994

Intracerebral injection of human immunodeficiency virus type 1 coat glycoprotein GP120 does not produce neurodegeneration in rats.

The human immunodeficiency virus type 1 (HIV-1) coat glycoprotein, GP120 has been reported to cause death of several neuronal cell types maintained in vitro. In the present experiments the gross behavioural, electrocortical (ECoG) and neuropathological effects of GP120 were studied in rats chronically microinfused into one lateral cerebral ventricle (i.c.v.) via mini-osmotic pumps. Treatment with GP120 (100 ng/day) for 1, 7 and 14 consecutive days lacked postural, motor and ECoG effects nor did it produce any apparent brain damage. In addition, acute i.c.v. injection of a subconvulsive dose (500 ng) of N-methyl-D-aspartate (NMDA) did not produce motor and ECoG epileptogenic discharges in rats which received 1 h beforehand a dose of GP120 (900 ng) into the dorsal hippocampus ipsilateral to the injected ventricle; per se this dose of GP120 was ineffective. In conclusion, the present experiments demonstrate that acute or chronic microinfusion of GP120 into the rat cerebral ventricular system does not produce neurotoxic effects. In addition, they demonstrate that intrahippocampal GP120 does not sensitize rats to the excitotoxic effects of a subconvulsive dose of NMDA.

Animals↗

PubMed1991

Effects of pentobarbital on respiratory functional dynamics in chronically instrumented guinea pigs.

Respiratory effects of sodium pentobarbital (35 mg/kg; IP) were studied in guinea pigs chronically instrumented to permit concurrent recordings of bulbar respiratory-related units (RRUs), diaphragmatic electromyogram (DEMG), and electrocorticogram (ECoG). RRU activities were recorded from either the Bötzinger Complex (BOT; expiratory) or Nucleus para-Ambiguus (NpA; inspiratory). Pentobarbital-induced changes in respiratory-related activities were evaluated before, throughout the course of, and during recovery from, anesthesia. The most notable development following pentobarbital was a state of progressive bradypnea which was accompanied by a variety of complex changes in the amplitude and temporal attributes of RRU, DEMG and ECoG activities. As anesthetic effects progressed, the activity profiles of both BOT and NpA units underwent striking transformations from a behavioral and state-dependent wakefulness pattern to an activity profile characterized by i) a significantly augmented RRU cycle duration, burst duration and spike frequency; and, ii) an alteration to the pattern of within-burst spike frequency modulation. Along with changes in RRU activity, pentobarbital also produced a marked attenuation of the amplitudes of diaphragmatic activity as well as a discrete, time-dependent alteration in the amplitude and spectral characters of ECoG activities. Differences in BOT and NpA unit responses to alveolar CO2 loading (ramp; 2% and 5%) across wakefulness and anesthesia states were also considerable. In addition to a depressed responsiveness to CO2, the temporal attributes of BOT and NpA activity profiles also indicated an asymmetrical change under pentobarbital anesthesia. Taken together, these findings indicate that pentobarbital causes not only a fundamental alteration in bulbar rhythmogenic mechanisms, but also a differential influence on bulbar respiratory system components that are involved in the definition of the shape and the amplitude of central respiratory drive. In conclusion, this study offers, for the first time, direct evidence from physiologically and structurally intact preparations that the functional dynamics of respiratory system components are profoundly altered during pentobarbital anesthesia.

Animals↗

PubMed2005

Electric cortical stimulation suppresses epileptic and background activities in neocortical epilepsy and mesial temporal lobe epilepsy.

OBJECTIVE: To evaluate the suppressive effect of electric cortical stimulation upon the seizure onset zone and the non-epileptic cortex covered by subdural electrodes in patients with neocortical epilepsy and mesial temporal lobe epilepsy (MTLE). METHODS: Four patients with medically intractable focal epilepsy had implanted subdural electrodes for preoperative evaluation. Cortical functional mapping was performed by intermittently repeating bursts of electric stimulation, which consisted of 50 Hz alternating square pulse of 0.3 ms duration, 1-15 mA, within 5 s. The effect of this stimulation on the seizure onset zones and on the non-epileptic areas was evaluated by comparing spike frequency and electrocorticogram (ECoG) power spectra before and after stimulation. A similar comparison was performed in stimulation of 0.9 Hz of the seizure onset zones for 15 min. RESULTS: When the seizure onset zone was stimulated with high frequency, spike frequency decreased by 24.7%. Logarithmic ECoG power spectra recorded at stimulated electrode significantly decreased in 10-32 Hz band by high frequency stimulation of the seizure onset zone, and in 14-32 Hz band by high frequency stimulation of the non-epileptic area. Low frequency stimulation of the seizure onset zone produced 18.5% spike reduction and slight power decrease in 12-14 Hz. CONCLUSIONS: Both high and low frequency electric cortical stimulation of the seizure onset zone have a suppressive effect on epileptogenicity. Reduction of ECoG fast activities after electric cortical stimulation suggests the augmentation of inhibitory mechanisms in human cortex.

Adult↗

PubMed2006

Post-chemotherapy gross tumor volume is predictive of survival in patients with stage III non-small cell lung cancer treated with combined modality therapy.

PURPOSE: To evaluate the influence of clinical covariates, particularly pre-chemotherapy gross tumor volume (GTV), post-chemotherapy GTV, on overall survival in the treatment of stage III non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: We retrospectively analyzed 102 patients who were enrolled on three consecutive clinical trials, which employed the treatment paradigm of two cycles of induction chemotherapy followed by thoracic radiation therapy. The pre-chemotherapy GTV, post-chemotherapy GTV, change in GTV, histology, disease stage, performance status, age, race, treatment with concurrent chemoradiotherapy versus radiotherapy alone were evaluated to determine their impact on overall survival. The log10 of the GTV was used to normalize the data and thereby reduce the impact of exceptionally large values. RESULTS: Both the log10 of the post-chemotherapy GTV and Eastern Cooperative Oncology Group (ECOG) performance status covariates were highly prognostic for overall survival (p = 0.006 and p = 0.008, respectively). Disease stage (at diagnosis) was also significant (p = 0.048). The log10 pre-chemotherapy GTV covariate was borderline significant (p = 0.067). The strongest prognostic model was the two-covariate model, which contained the log10 post-chemotherapy GTV and ECOG performance status covariates, (model chi2 of 18.67, with p = 0.001 for each covariate). CONCLUSIONS: The log10 post-chemotherapy GTV has significant prognostic survival value when the strategy of induction chemotherapy is employed in the treatment on stage III NSCLC. ECOG performance status and stage were also significant prognostic factors for survival.

Adult↗

PubMed2006

Phase II study of irinotecan and docetaxel in patients with previously treated non-small cell lung cancer: an Alpe-Adria Thoracic Oncology Multidisciplinary group study (ATOM 007).

This study was designed to evaluate the activity and tolerability of irinotecan and docetaxel in patients with previously treated non-small cell lung cancer (NSCLC). Eligibility included recurrent or progressive NSCLC, previous chemotherapy, age > or = 18 years, ECOG PS < or = 2. Treatment consisted of irinotecan (160 mg/m2 i.v.), followed by docetaxel (65 mg/m2 i.v.) on day 1 of a 21-day cycle, for a maximum of 6 cycles. Forty patients were enrolled. Median age was 60 years and median ECOG PS was 1. All patients were evaluable for toxicity and 31 (78%) were evaluable for response. A total of 125 cycles was administered (median, 3; range, 1-6). Most common grade 3-4 toxicities were neutropenia (62%), neutropenic fever (22%), and diarrhea (32%). Response rate was 10%; a further 40% of patients achieved stable disease. All responses were observed in patients with ECOG PS < or = 1, age <70 years, and who had received only one prior chemotherapy regimen. Median time to progression was 2.8 months and median survival was 7.4 months. Because of significant toxicity and limited activity, further investigation of irinotecan plus docetaxel in second line NSCLC is not recommended.

Adult↗

PubMed2006

The prognostic value of positron emission tomography in non-small cell lung cancer: analysis of 266 cases.

UNLABELLED: Positron emission tomography (PET) is more accurate than computed tomography (CT) in the staging of non-small cell lung cancer (NSCLC). We analyzed the prognostic value of PET for survival in NSCLC patients. METHODS: Consecutive patients with proven NSCLC with PET for staging were selected. Staging by laboratory tests, bronchoscopy, chest X-ray, and CT was performed in all patients, leading to a clinical stage (c-TNM) prior to PET. A separate classification (pet-TNM) was obtained from PET images by observers blinded to clinical data. We performed univariate survival analysis with ECOG performance score, sex, weight loss, comorbidity, histology, c-TNM, and pet-TNM as variables. Cox regression analysis was performed with significant variables from the univariate analyses. RESULTS: Two hundred and sixty-six patients were included, 205 men and 61 women. c-TNM and pet-TNM were identical in 150 (56%) patients, 69 were upstaged, and 47 were downstaged by PET. At time of analysis, 198 (74%) patients had died. Univariate analysis showed significant survival differences for ECOG performance score (0 versus 1/2), weight loss (<10% versus >or=10%), pulmonary comorbidity, c-TNM, and pet-TNM (stage IA versus IB, IIA, IIB, IIIA, IIIB, IV). Cox regression analysis identified pet-TNM as the most significant (p < 0.001) prognostic factor, followed by ECOG performance score (p = 0.018). CONCLUSION: Tumor stage as determined by PET is the most significant prognostic factor for survival in patients with NSCLC.

Adult↗

PubMedDate not supplied

Electroencephalographic, behavioral, and c-fos responses to acute domoic acid exposure.

Domoic acid, a potent excitotoxic analogue of glutamate and kainate, may cause seizures, amnesia, and sometimes death in humans consuming contaminated shellfish. Continuous behavioral observations and recordings of the electrocorticogram (ECoG, via bipolar, epidural electrodes) were obtained from nonanesthetized rats for 2 h after intraperitoneal injection with either saline, 2.2, or 4.4 mg/kg of domoic acid. Rats were then sacrificed for c-fos immunohistochemistry. Fast Fourier transformation (FFT) of the ECoG data to obtain the voltage as a function of frequency indicated that the lower frequency bands (theta, 4.75-6.75 Hz and delta, 1.25-4.50 Hz) were the first to respond, with a significant elevation by 30 min after the high dose of domoic acid. The lower dose of domoic acid also caused a significant elevation of ECoG voltage, but not until later in the session. Sixty minutes after dosing, the behavioral biomarkers of "ear scratching" and "rearing, praying" (RP) seizures became significantly elevated in the high-dose rats. The low-dose rats showed no significant alterations in behavior at any time during the session. In postmortem brains obtained immediately after the sessions, c-fos was activated in the anterior olfactory nucleus by both the low and high doses of domoic acid. However, only the high dose increased c-fos immunoreactivity in the hippocampus, affecting both the granule and pyramidal neurons. These data indicate that electroencephalographic and c-fos responses can be obtained at a dose of domoic acid that fails to activate the behavioral response most commonly used as a bioassay for this marine toxin: ear scratching with the ipsilateral foot.

Analysis of Variance↗

PubMed2002

Early and late mortality after pleurodesis for malignant pleural effusion.

BACKGROUND: The purpose of this study is to analyze morbidity and mortality and to determine the relative contribution of each of these potential prognosis variables for predicting morbidity and mortality in patients after pleurodesis by thoracotomy or thoracoscopy. METHODS: Between March 1, 1996, and January 31, 2001, a total of 70 patients underwent pleurodesis for recurrent malignant pleural effusion. Thoracoscopy was performed in 54 patients (77%); pleurodesis was achieved by pleural abrasion (n = 15), pleurectomy (n = 5), and talc insufflation (n = 34). Thoracotomy was performed in 16 patients (23%) who also needed pleurectomy and decortication for a trapped lung. RESULTS: Postoperative complications occurred in 24 patients (34%). Factors adversely affecting morbidity with univariate analysis included: three or four metastatic sites (p = 0.003), and thoracotomy (p = 0.009). Factors adversely affecting morbidity with multivariate analysis included: thoracotomy (p = 0.0005) and number of metastatic sites (p = 0.007). Six patient deaths (8.6%) occurred during hospitalization. Factors adversely affecting in-hospital mortality with univariate analysis included: Eastern Cooperative Oncology Group Performance Status 2 to 3 (p = 0.001), lower preoperative serum hemoglobin (p = 0.001), lower preoperative serum albumin (p = 0.0001), and thoracotomy (p = 0.03). Factors adversely affecting in-hospital mortality with multivariate analysis included: preoperative serum albumin less than 60 g/L (p = 0.007) and ECOG Performance Status 2 to 3 (p = 0.008). Twelve patients (17%) died within 90 days after surgery. Factors adversely affecting 3-month mortality with univariate analysis included: ECOG Performance Status 2 to 3 (p = 0.001), lower preoperative serum hemoglobin (p = 0.03), higher preoperative white cells (p = 0.03), lower preoperative serum albumin (p = 0.03), and preoperative thoracentesis more than once per month (p = 0.03). Factors adversely affecting 3-month mortality with multivariate analysis included: ECOG Performance Status 2 to 3 (p = 0.01), preoperative thoracentesis more than once per month (p = 0.03), three or four metastatic sites (p = 0.02), and preoperative white blood cell count > or = 12,000/mm3 (p = 0.03). CONCLUSIONS: Thoracotomy is not indicated in patients with a malignant effusion because of poor survival, a high frequency of complications, and prolonged hospital stay. Pleurodesis thoracoscopy is indicated in patients with good performance status coupled with good nutrition.

Aged↗