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The authors report their experience of pleural talcage under thoracoscopy in 21 cases of lymphomatous pleurisy. This represents 9.6% of the total number of cancerous pleurisies treated with talc over four years. A successful result with talcage was achieved in 84% of cases. The success of failure of talcalge seems to depend on the macroscopic appearance (the existence of masses or nodules) as well as an abundance of pleural liquid, all constitute unfavourable factors. On the other hand the lymphoma (Hodgkins or non Hodgkins) does not seem to have any unfavourable effect.

From May 1983 to June 1985 the authors performed a thoracoscopy as a diagnostic and therapeutic objective in 83 patients with chronic recurrent pleurisy; amongst these patients, 69 had know intra or extra thoracic cancer and the other 14 presented with an isolated pleurisy. Eight other patients had pleural carcinomatosis proven by needle biopsy and had pleural talc introduced by thoracoscopy. The examination was performed under local anaesthesia with neuroleptanalgesia; a rigid 7 mm diameter thoracoscope was used; the biopsies were performed uniquely on the parietal pleura using tropical forceps. The outcome was uncomplicated with no deaths nor any serious complications due to the method. The sensitivity of the pleural biopsy was 91.5% or 76 positive biopsies out of 83. 73 biopsies were metastatic and 3 were tuberculous pleurisies. The macroscopic appearance was strongly suggestive of malignancy in 78 patients and appeared inflammatory in 13, of whom 9 cases were positive on biopsy. The authors performed a pleural talcage in every case; a lasting pleural adhesion was obtained in 66 patients but regrettably there were 14 failures, the effusion recurring after removal of the drain. The authors stress the reduced number of incidents of pleural effusion, which confirms the good tolerance of pleural endoscopy.

The authors report the results of their experience using tale pleurodesis under thoracoscopic control in the treatment of 218 cases of malignant pleural involvement. Although this technique is well tolerated it is necessary to note certain factors which prevent a successful pleurodesis (12% of cases). Thus, huge effusions greater than 12 litres, pleural involvement with large tumour masses, a very long history and patients aged more than 70 years were all factors contributing to a poor outcome. The success of pleural talc also depends on the nature of the primary cancer, for example in our series broncho-pulmonary cancers yielded better results than those effusions which were secondary to ovarian cancers.