RICHARD S. STEIN, M.D.
STEIN RS. Malignant Pleural Effusion. Ann Intern Med. 1978;89:139. doi: 10.7326/0003-4819-89-1-139_2
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Published: Ann Intern Med. 1978;89(1):139.
To the editor: To the excellent review of malignant pleural effusion by Leff, Hopewell, and Costello (Ann Intern Med 88:532-537, 1978) I wish to add these practical clinical points.
1. Although nitrogen mustard is probably the most effective of the antineoplastic agents used to sclerose the pleura, the systemic toxicity of this therapy is unpredictable. Studies using the agent intrapleurally have not reported systematic evaluations of marrow toxicity, but all agree that some of the drug is absorbed. Although myelotoxicity is less with intrapleural therapy than with intravenous use, it is a potential complication (1, 2). In patients with neutropenia
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