Cancer and Metastasis Reviews

, Volume 6, Issue 1, pp 23–40 | Cite as

Diagnosis and treatment of malignant pleural effusion

  • Frederick H. Hausheer
  • John W. Yarbro


Pleural effusion is a common and important complication of malignancy which may at times be difficult to diagnose or treat. Its well recognized association with numerous diseases plus the limitations of our usual diagnostic tests may occasionally cause difficulty. In the oncology patient there are a number of common medical problems associated with the development of pleural effusion which frequently coexist with the malignancy. Pleural effusion may be a presenting or late sign of cancer, and when recurrent can be a vexing symptomatic problem. Fortunately, an increasing number of effective diagnostic and therapeutic modalities are available which, when judiciously applied, facilitate our approach.


pleural effusion fransudate exudate mesothelioma cytogenetics pleuroscopy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hausheer FH, Yarbro JW: Diagnosis and treatment of malignant pleural effusion. Semin Oncol 12: 54, 1985Google Scholar
  2. 2.
    Agostoni E, Taglietti A, Setnikar I: Absorption force of the capillaries of the visceral pleura in determination of the intrapleural pressure. Am J Physiol 191: 277, 1957Google Scholar
  3. 3.
    Black LF: The pleural space and pleural fluid. Mayo Clin Proc 47: 493, 1972Google Scholar
  4. 4.
    Kinasewitz GT, Fishman AP: Influence of alterations in Starling forces on visceral pleural fluid movement. J Appl Physiol 51: 671, 1981Google Scholar
  5. 5.
    Stewart PB: The rate of formation and lymphatic removal of fluid in pleural effusions. J Clin Invest 42: 258, 1963Google Scholar
  6. 6.
    Light RW: Pleural effusions. Med Clin N Am 61: 1339, 1977Google Scholar
  7. 7.
    Dollinger MR: Management of recurrent malignant effusions. Ca 22: 139, 1972Google Scholar
  8. 8.
    Salyer WR, Eggleston JC, Erozan YS: Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura. Chest 67: 536, 1975Google Scholar
  9. 9.
    Leuallen EC, Carr DT: Pleural effusion—a statistical study of 436 patients. N Eng J Med 252: 79, 1955Google Scholar
  10. 10.
    Tinney WS, Olsen AM: The significance of fluid in the pleural space: a study of 274 cases. J Thorac Surg 14: 248, 1946Google Scholar
  11. 11.
    Storey DD, Dines DE, Coles DT: Pleural effusion: a diagnostic dilemma. JAMA 236: 2183, 1976Google Scholar
  12. 12.
    McKenna JM, Chandrasekhar AJ, Henkin RE: Diagnostic value of carcinoembryonic antigen in exudative pleural effusion. Chest 78: 587, 1980Google Scholar
  13. 13.
    Light RW, Erozan YS, Ball WC: Cells in pleural fluid: their value in the differential diagnosis. Arch Int Med 132: 854, 1973Google Scholar
  14. 14.
    Hirsch A, Ruffie P, Nebut M, Bignon J, Chretien J: Pleural effusion: laboratory tests in 300 cases. Thorax 34: 106, 1979Google Scholar
  15. 15.
    Chernow B, Sahn SA: Carcinomatous involvement of the pleura: an analysis of 96 patients. Am J Med 63: 695, 1977Google Scholar
  16. 16.
    Anderson CB, Philpott GW, Ferguson TB: The treatment of malignant pleural effusions. Cancer 33: 916, 1974Google Scholar
  17. 17.
    Johnston WW: The malignant pleural effusion: a review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer 56: 905, 1985Google Scholar
  18. 18.
    Martini N, Bains MS, BeattieJr EJ: Indications for pleurectomy in malignant effusion. Cancer 35: 734, 1975Google Scholar
  19. 19.
    Leff A, Hopewell PC, Costello J: Pleural effusions from malignancy. Ann Int Med 88: 532, 1978Google Scholar
  20. 20.
    Friedman MA, Slater E: Malignant pleural effusions. Canc Treat Rev 5: 49, 1978Google Scholar
  21. 21.
    Izbicki R, Weyhung BT, Baker L, Caoili EM, Vaitkevicius VK: Pleural effusion in cancer patients. Cancer 36: 1511, 1975Google Scholar
  22. 22.
    Hausheer FH, Yarbro JW: Malignant effusions as oncologic emergencies. 13th International Cancer Congress, Alan R Liss Inc. New York. Vol 132D: 347, 1983Google Scholar
  23. 23.
    Kaunitz J: Landmarks in simple pleural effusions. JAMA 113: 1312, 1939Google Scholar
  24. 24.
    Peterson JA: Recognition of infrapulmonary pleural effusion Radiol 74: 34, 1960Google Scholar
  25. 25.
    Rigler LG: Roentgen diagnosis of small pleural effusions: a new roentgenographic position. JAMA 96: 104, 1931Google Scholar
  26. 26.
    Rigler LG: Roentgenologic observations on the movement of pleural effusions. Am J Roentgen 25: 220, 1931Google Scholar
  27. 27.
    Woodring JH: Recognition of pleural effusion on supine radiographs: how much fluid is required. Am J Roentgen 142: 59, 1984Google Scholar
  28. 28.
    Williford ME, Hidalgo H, Putman CE, Korobkin M, Ram PC: Computed tomography of pleural disease. Am J Roentgen 140: 909, 1983Google Scholar
  29. 29.
    Kreel L: Computed tomography in mesothelioma. Semin Onc 8: 302, 1981Google Scholar
  30. 30.
    Mirvis S, Dutcher JP, Haney PJ, Whitley NO, Aisner J: CT of malignant pleural mesothelioma. Am J Roentgen 140: 665, 1983Google Scholar
  31. 31.
    Solomon A: The radiology of asbestos-related discases with special reference to diffuse mesothelioma. Semin Onc 8: 290, 1981Google Scholar
  32. 32.
    Antman KH: Clinical presentation and natural history of benign and malignant mesothelioma. Semin Onc 8: 313, 1981Google Scholar
  33. 33.
    Elmes PC, Simpson MJC: The clinical aspects of mesothelioma. Q J Med 45: 427, 1976Google Scholar
  34. 34.
    Herbert A, Gallagher P: Pleural biopsy in the diagnosis of malignant mesothelioma. Thorax 37: 816, 1982Google Scholar
  35. 35.
    Oels HC, Harrison EGJr., Carr DT, Bernatz PE: Diffuse malignant mesothelioma of the pleura: a review of 37 cases. Chest 60: 564, 1971Google Scholar
  36. 36.
    Prakash UBS, Reiman HM: Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc 60: 158, 1985Google Scholar
  37. 37.
    Health and Public Policy Committee, ACP: Diagnostic thoracentesis and pleural biopsy in pleural effusions. Ann Int Med 103: 799, 1985Google Scholar
  38. 38.
    Ratliff JL, Chavez CM, Jamchuck A, Foustner JE, Conn JH: Reexpansion pulmonary edema. Chest 64: 654, 1973Google Scholar
  39. 39.
    Trapnell DH, Thurston JGB: Unilateral pulmonary edema after pleural aspiration. Lancet 1: 1367, 1970Google Scholar
  40. 40.
    Waqaruddin M, Bernstein A: Reexpansion pulmonary oedema. Thorax 30: 54, 1975Google Scholar
  41. 41.
    Yamazaki S, Ogawa J, Shohzu A, Suzuki Y: Pulmonary blood flow to rapidly reexpanded lung in spontaneous pneumothorax. Chest 81: 118, 1982Google Scholar
  42. 42.
    Hausheer FH, Yarbro JW: Reexpansion pulmonary edema. Missouri Med 83: 33, 1986Google Scholar
  43. 43.
    Carr DT, Power MH: Clinical value of measurements of concentration of protein in pleural fluid. N Eng J Med 259: 926, 1958Google Scholar
  44. 44.
    Light RW, Macgregor MI, Luchsinger PC, Ball WC: Pleural effusions: the diagnostic separation of transudates and exudates. Ann Int Med 77: 507, 1972Google Scholar
  45. 45.
    Paddock FK: The diagnostic significance of serous fluids in disease. N Eng J Med 223: 1010, 1940Google Scholar
  46. 46.
    Weinberger SE, Weiss ST, Weiss JW, Johnson TS: Malignant transudative effusion: misleading results of pleural fluid analysis. Clin Notes Respir Dis 20: 13, 1981Google Scholar
  47. 47.
    Peterman TA, Speicher CE: Evaluating pleural effusions. JAMA 252: 1051, 1984Google Scholar
  48. 48.
    Winkelmann M, Pfitzer P: Blind pleural biopsy in combination with cytology of pleural effusions. ACTA Cytol 25: 373, 1981Google Scholar
  49. 49.
    Cardoza PL: A critical evaluation of 3000 cytologic analyses of pleural fluid, ascitic fluid, and pericardial fluid. ACTA Cytol 10: 455, 1966Google Scholar
  50. 50.
    Spriggs AI, Boddington MM: The cytology of effusions. Grune and Stratton: New York, NY, 12–40, 1968Google Scholar
  51. 51.
    Frist B, Kahan AV, Koss LG: Comparison of the diagnostic values biopsies of the pleura and cytologic evaluation of pleural fluids. Am J Clin Path 72: 48, 1979Google Scholar
  52. 52.
    Poe RH, Israel RH, Utell MJ, Hall WJ, Greenblatt DW, Kallay MC: Sensitivity, specificity, and predictive values of closed pleural biopsy. Arch Int Med 144: 325, 1984Google Scholar
  53. 53.
    Light RW, MacGregor MI, Ball WC, Luchsinger PC: Diagnostic significance of pleural fluid pH and pCO2. Chest 64: 591, 1973Google Scholar
  54. 54.
    Potts DE, Levin DC, Sahn SA: Pleural fluid pH in parapneumonic effusions. Chest 70: 328, 1976Google Scholar
  55. 55.
    Potts DE, Taryle DA, Sahn SA: The glucose-pH relationship in parapneumonic effusions. Arch Intern Med 138: 1378, 1978Google Scholar
  56. 56.
    Houston MC: Pleural effusion: diagnostic value of measurements of pO2, pCO2, and pH. South Med J 74: 585, 1981Google Scholar
  57. 57.
    Good JT, Taryle DA, Maulitz KM, Kaplan KL, Sahn SA: The diagnostic value of pleural fluid pH. Chest 78: 55, 1980Google Scholar
  58. 58.
    Good JT, Taryle DA, Sahn SA: The pathogenesis of low glucose, low pH malignant pleural effusions. Am Rev Resp Dis 131: 737, 1985Google Scholar
  59. 59.
    Halla JT, Schrohenloher RE, Volanolis JE: Immune complexes and other laboratory features of pleural effusions. Ann Int Med 92: 748, 1980Google Scholar
  60. 60.
    Sahn SA, Collins DD: Pleural fluid acidosis and diaphragmatic hernia. (letter) Ann Int Med 96: 380, 1982Google Scholar
  61. 61.
    Marshall JB: Pancreatic ascites and pleural effusions. Nebr Med J 67: 252, 1982Google Scholar
  62. 62.
    Salt WB, Schenker S: Amylase-its clinical significance: a review of the literature. Medicine 55: 269, 1976Google Scholar
  63. 63.
    Shapiro R, Dropkin R, Finkelstein J, Aledort D, Greenstein AJ. Ovarian carcinomatosis presenting with hyperamylasemia and pleural effusion. Am J Gastroenterol 76: 365, 1981Google Scholar
  64. 64.
    Sherr HP, Light RW, Merson MH, Wolf RO, Taylor LL, Hendrix TR: Origin of pleural fluid amylase in esophageal rupture. Ann Intern Med 76: 985, 1972Google Scholar
  65. 65.
    Satz N, Munch R, Kuhlman U, Pedio G, Gut P, Pei P, Ammann RW: High amylase content of neoplastic pleural and pericardial effusions probably secondary to amylase producing tumor cells: report of two cases. Klin Wochenschr 61: 91, 1983Google Scholar
  66. 66.
    Adelman M, Albelda SM, Gottlieb J, Haponik EF: Diagnostic utility of pleural fluid eosinophilia. Am J Med 77: 915, 1984Google Scholar
  67. 67.
    Vladutiu AO, Brason FW, Adler RH: Differential diagnosis of pleural effusions: clinical usefulness of cell marker quantitation. Chest 79: 297, 1981Google Scholar
  68. 68.
    Pierucci G, Lucivero G, Amoruso C, Bonomo L: Diagnostic value of carcinoembryonic antigen (CEA) assay in pleural effusions. Tumori 70: 421, 1984Google Scholar
  69. 69.
    Rittgers RA, Loewenstein MS, Feinerman AE, Kupchik HZ, Marcel BR, Koff RS, Zamcheck N: Carcinoembryonic antigen levels in benign and malignant pleural effusions. Ann Int Med 88: 631, 1978Google Scholar
  70. 70.
    Dewald G, Dines DE, Weiland LH, Gordon H: Usefulness of chromosome examination in the diagnosis of malignant pleural effusions. N Eng J Med 295: 1494, 1978Google Scholar
  71. 71.
    Carlevaro C, Rossi GA, Cerri E, Pelucco D: Cytogenetic study of pleural effusions. Tumori 64: 335, 1978Google Scholar
  72. 72.
    Falor WH, Ward RM, Brezler MR: Diagnosis of pleural effusions by chromosome analysis. Chest 81: 193, 1982Google Scholar
  73. 73.
    Fraisse J, Brizard CP, Emonot A, Fraisse H: Diagnosis of malignancy by cytogenetic means in effusions. Clin Genetics 14: 288, 1978Google Scholar
  74. 74.
    Bloomberg AE: Thoracoscopy in perspective. Surg Gyn Obstet 147: 433, 1978Google Scholar
  75. 75.
    Boutin C, Cargnino P, Viallat JR: Thoracoscopy in the early diagnosis of malignant pleural effusions. Endoscopy 12: 155, 1980Google Scholar
  76. 76.
    Lewis RJ, Kunderman PJ, Sisler GE, Mackenzie JW: Direct diagnostic thoracoscopy. Ann Thorac Surg 21: 536, 1976Google Scholar
  77. 77.
    Loddenkemper R, Mai J, Scheffler N, Brandt HJ: Diagnostic yield of blind needle biopsy and of thoracoscopy in pleural effusion- an intraindividual comparison. Endoscopy 10: 143, 1978Google Scholar
  78. 78.
    Oldenburg FA, Newhouse MT: Thoracoscopy. Chest 75: 45, 1979Google Scholar
  79. 79.
    Pepper JR: Thoracoscopy in the diagnosis of pleural effusions and tumors. Br J Dis Chest 72: 74, 1978Google Scholar
  80. 80.
    Weissburg D, Kaufman M, Zurkowski Z: Pleuroscopy in patients with pleural effusions and pleural masses. Ann Thorac Surg 29: 205, 1980Google Scholar
  81. 81.
    Weissburg D, Kaufman M: Diagnostic and therapeutic pleuroscopy: experience with 127 patients. Chest 78: 732, 1980Google Scholar
  82. 82.
    Ryan CJ, Rodgers RF, Unni KK, Hepper NG: The outcome of patients with pleural effusion of indeterminate cause at thoracotomy. Mayo Clin Proc 56: 145, 1981Google Scholar
  83. 83.
    Butchart EG, Asheroft T, Barnsley WC, Holden MP: The role of surgery in diffuse malignant mesothelioma of the pleura. Semin Oncol 8: 321, 1981Google Scholar
  84. 84.
    McCormack PM, Nagasaki F, Hilaris BS, Martini N: Surgical treatment of pleural mesothelioma. J Thorac Cardiovasc Surg 84: 834, 1982Google Scholar
  85. 85.
    Antman KH: Malignant mesothelioma. N Eng J Med 303: 200, 1980Google Scholar
  86. 86.
    Newhouse M: Epidemiology of asbestos-related tumors. Semin Onc 8: 250, 1981Google Scholar
  87. 87.
    Law MR, Hodson ME, Heard BE: Malignant mesothelioma of the pleura: relation between histological type and clinical behaviour. Thorax 37: 810, 1982Google Scholar
  88. 88.
    Legha SS, Muggia FM: Pleural mesothelioma: clinical features and therapeutic implications. Ann Int Med 87: 613, 1977Google Scholar
  89. 89.
    Selikoff IJ, Churg J, Hammond EC: Asbestos exposure and neoplasia. JAMA 188: 22, 1964Google Scholar
  90. 90.
    Roboz J, Greaves J, Silides D, Chahinian AP, Holland JF: Hyaluronic acid content of effusions as a diagnostic aid for malignant mesothelioma. Can Res 45: 1850, 1985Google Scholar
  91. 91.
    Rasmussen K, Farber V: Hyaluronic acid in 247 pleural fluids. Scand J Resp Dis 48: 366, 1967Google Scholar
  92. 92.
    Davis J: Ultrastructure of human mesotheliomas. J Natl Can Inst 52: 1715, 1974Google Scholar
  93. 93.
    Suzuki V, Churg J, Kannerstein M: Ultrastructure of human malignant diffuse mesothelioma. Am J Pathol 85: 241, 1976Google Scholar
  94. 94.
    Wang N, Huang S, Gold P: Absence of carcinoembryonic antigenlike material in mesothelioma: an immunohistochemical differentiation from other lung cancers. Cancer 44: 937, 1979Google Scholar
  95. 95.
    Wang NS: Electron microscopy in the diagnosis of pleural mesotheliomas. Cancer 31: 1046, 1973Google Scholar
  96. 96.
    Corson JM, Pinkus GS: Mesothelioma: profile of keratin proteins and carcinoembryonic antigen. Am J Pathol 108: 80, 1982Google Scholar
  97. 97.
    Perry MC, Yarbro JW: Toxicity of chemotherapy. Grune and Stratton: Orlando, FL. 1984Google Scholar
  98. 98.
    Estenne M, Yernault JC, Troyer AD: Mechanism of relief of dyspnea after thoracentesis in patients with large pleural effusions. Am J Med 74: 813, 1983Google Scholar
  99. 99.
    Fracchia AA, Knapper WH, Carey JT, Farrow JH: Intrapleural chemotherapy for effusions from metastatic breast carcinoma. Cancer 26: 626, 1970Google Scholar
  100. 100.
    Ostrowski MJ: An assessment of the long term results of controlling the reaccumulation of malignant effusions using intracavity bleomycin. Cancer 57: 721, 1986Google Scholar
  101. 101.
    Bitran JD, Brown C, Desser RK, Kozloff MF, Shapiro C, Billings AA: Intracavitary bleomycin for the control of malignant effusions. J Surg Oncol 16: 273, 1981Google Scholar
  102. 102.
    Cunningham TJ, Olson KD, Horton J, Wright A, Hussain M, Davies JNP, Harrington G: A clinical trial of intravenous and intracavitary bleomycin. Cancer 29: 1413, 1972Google Scholar
  103. 103.
    Gupta N, Opfell RW, Padova J, Margileth D, Souadjian J: Intrapleural bleomycin vs. tetracycline for control of malignant pleural effusions: a randomized study. ASCO Abstract C- 189: 366, 1980Google Scholar
  104. 104.
    Paladine W, Cunningham TJ, Sponzo R, Donovan M, Olson K, Horton J: Intracavitary bleomycin in the management of malignant effusions. Cancer 38: 1903, 1976Google Scholar
  105. 105.
    Trotter JM, Stuart JFB, McBeth JG, Calman KC: The management of malignant effusions with bleomycin. Brit J Cancer 40: 310, 1979Google Scholar
  106. 106.
    Lippman AJ, Cohen FB, Custodio MC: Clry bleomycin. ASCO Abstract 104: 247, 1975Google Scholar
  107. 107.
    Ostrowski MJ, Halsall GM: Intracavitary bleomycin in the management of malignant effusions. Canc Treat Rep 66: 1903, 1982Google Scholar
  108. 108.
    Bayly TC, Kisner DL, Sybert A, MacDonald JS, Tsou E, Schein PS: Tetracycline and quinacrine in the control of malignant pleural effusions. Cancer 41: 1188, 1978Google Scholar
  109. 109.
    Kefford RF, Woods RL, Fox RM, Tattersall MH: Intracavitary adriamycin, nitrogen mustard, and tetracycline in the control of malignant effusions: a randomized study. Med J Aust 2: 447, 1980Google Scholar
  110. 110.
    Narang RK, Mital OP, Kumar A: Intrapleural tetracycline in management of malignant pleural effusions. Indian J Chest Dis Allied Sci 22: 166, 1980Google Scholar
  111. 111.
    O'Neill W, Spurr C, Muss H, Righards F, White D, Cooper MR: A prospective study of chest tube drainage and tetracyline sclerosis vs. chest tube drainage alone in the treatment of malignant pleural effusion. ASCO Abst C- 120: 349, 1980Google Scholar
  112. 112.
    Rubinson RM, Bolooki H: Intrapleural tetracycline for control of malignant pleural effusion: a preliminary report. South Med J 65: 847, 1972Google Scholar
  113. 113.
    Sahn SA, Good JT, Potts DE: The pH of sclerosing agents. Chest 76: 198, 1979Google Scholar
  114. 114.
    Sarma PR, Moore MR: Approach to the management of pleural effusion in malignancy. South Med J 71: 133, 1978Google Scholar
  115. 115.
    Wallach HW: Intrapleural tetracycline for malignant pleural effusions. Chest 68: 510, 1975Google Scholar
  116. 116.
    Zaloznik AJ, Oswald SG, Langin M: Intrapleural tetracycline in malignant pleural effusion: a randomized study. Cancer 51: 752, 1983Google Scholar
  117. 117.
    Adler RH, Rappole BW: Recurrent malignant pleural effusions and tale powder aerosol treatment. Surgery 62: 1000, 1967Google Scholar
  118. 118.
    Adler RH, Sayek I: Treatment of malignant pleural effusion: a method using tube thoracostomy and tale. Ann Thorac Surg 22: 8, 1976Google Scholar
  119. 119.
    Camishion RC, Gibbon JH, Nealon TF: Tale poudrage in the treatment of pleural effusion due to cancer. Surg Clin N Am 42: 1521, 1962Google Scholar
  120. 120.
    Chambers JS: Palliative treatment of neoplastic pleural effusion with intercostal intubation and tale instillation. West J Surg Obstet Gyn 66: 26, 1958Google Scholar
  121. 121.
    Harley HR: Malignant pleural effusions and their treatment by intercostal tale pleurodesis. Br J Dis Chest 73: 173, 1979Google Scholar
  122. 122.
    Haupt GJ, Camishion RC, Templeton JY, Gibbon JH: Treatment of malignant pleural effusion by tale poudrage. JAMA 172: 918, 1960Google Scholar
  123. 123.
    Jones GR: Treatment of recurrent malignant pleural effusion by iodized tale pleurodesis. Thorax 24: 69, 1969Google Scholar
  124. 124.
    Pearson FG, Macgregor DC: Tale poudrage for malignant pleural effusion. J Thorac Cardiovasc Surg 51: 732, 1966Google Scholar
  125. 125.
    Prorok J, Nealon TF: Pleural symphysis by tale poudrage in the treatment of malignant pleural effusion. Bull Soc Int Chir 27: 630, 1968Google Scholar
  126. 126.
    Roche G, Delanoe Y, Moayer N: Tale poudrage of the pleura under pleuroscopy, results indications and technique. J France Med Chir Thor 17: 677, 1963Google Scholar
  127. 127.
    Shedbalker AR, Head JM, Head LR, Murphy DJ, Mason JH: Evaluation of tale pleural symphysis in management of malignant pleural effusion. J Thorac Cardiovasc Surg 61: 492, 1971Google Scholar
  128. 128.
    Breuneau R, Rubin P: The management of pleural effusions and chylothorax in lymphoma. Radiology 85: 1085, 1965Google Scholar
  129. 129.
    Strober SJ, Klotz E, Kuperman A, Ghossein NA: Malignant pleural disease—a radiotherapeutic approach to the problem. JAMA 226: 296, 1973Google Scholar
  130. 130.
    Wieck JK, Kiely JM, Harrison EG, Carr DT, Scanlon PW: Pleural effusion in lymphoma. Cancer 31: 848, 1973Google Scholar
  131. 131.
    Jensik R, Cagle JE, Milloy F, Perlia C, Taylor S, Kofman S, Beattie EJ: Pleurectomy in the treatment of pleural effusion due to metastatic malignancy. J Thorac Cardiovasc Surg 46: 322, 1963Google Scholar
  132. 132.
    Beattie EJ: The treatment of malignant pleural effusions by partial pleurectomy. Surg Clin N AM 43: 99, 1963Google Scholar

Copyright information

© Martinus Nijhoff Publishers 1987

Authors and Affiliations

  • Frederick H. Hausheer
    • 1
  • John W. Yarbro
    • 2
  1. 1.Division of Medical Oncologythe Johns Hopkins Oncology CenterBaltimore
  2. 2.Division of Hematology and Medical OncologyUniversity of Missouri School of MedicineColumbiaUSA

Personalised recommendations