OBJETIVO: A perda de heterozigosidade (LOH) é capaz de avaliar as alterações genéticas de lesões potencialmente malignas. Este ensaio avalia as regiões cromossômicas polimórficas que estão próximas ou na região dos oncogenes e genes supressores de tumor conhecidos. Os objetivos desta tese foram três principais: 1) Avaliar a frequência de perda de heterozigosidade de leucoplasias bucais com diferentes graus de severidade histopatológico em regiões cromossômicas próximas aos genes supressores de tumores. 2) Comparar e correlacionar o perfil de perda de heterozigosidade entre indivíduos da British Columbia (Canadá) e Rio Grande do Sul (Brasil). 3) Avaliar os danos ao DNA que podem ocorrer durante o processamento e armazenamento das amostras de tecido parafinado. MÉTODOS: Amostras de leucoplasia bucal (com e sem displasias), fixadas em formalina tamponada 10% e parafinadas, obtidas nos laboratório de patologia bucal do Canadá e do Brasil foram selecionadas e microdissectadas. Procedeu-se a extração de DNA, amplificação por PCR das seguintes regiões microssatélites: 4q (D4S243, FABP2), 9p21 (IFNA, D9S171, D9S1748, D9S1751), 17p11.2 (CHRNB1) e 17p13.1 (tp53 e D17S786). Após o produto do PCR foi separado e visualizado em gel de poliacrilamida por autoradiografia. RESULTADOS: Observou-se uma forte correlação entre o perfil de perda de heterozigosidade entre indivíduos com leucoplasia bucal de ambos os países, independentemente da etnicidade. Além disso, pode-se notar que amostras de tecidos parafinados submetidos a mais de 24 horas de fixação em formalina tamponada 10% não serão, em sua maioria, boas amostras para análises de DNA. CONCLUSÃO: As lesões potencialmente malignas, provavelmente não são influenciadas em sua etiopatogênia pelas diferenças étnicas. O modelo de risco genético validado por Zhang e colaboradores (2012) parece ser aplicável em nossa comunidade, sendo necessário a sua validação, respeitando procedimentos técnicos padronizados. Ainda, vale ressaltar, que é imprescindível que a comunidade científica passe a adotar metodologias que preservem o material genético das peças dos bancos de tecidos parafinados, que são de inestimável valor para a pesquisa biomédica. / OBJECTIVE: Loss of heterozygosity (LOH) can evaluate genetic alterations of pre-malignant lesions. This assay evaluates the chromosomal polymorphic regions that are present in tumor suppressor genes and oncogenes. The main objectives of this thesis were: 1) Evaluate the frequency of LOH of oral leukoplakias with different histopathological degrees at chromosomal regions of tumor suppressor genes. 2) Compare the profile of LOH between individuals from British Columbia (Canada) and Rio Grande do Sul (Brazil). 3) Evaluate the DNA damage that may occur with FFPE (formalin-fixed paraffin-embedded) tissues. METHODS: FFPE samples of oral leukoplakia (with and without dysplasia), obtained in Canadian and Brazilian oral pathology laboratories were selected and microdissected. DNA extraction and PCR amplification of the following microsatellite regions were conducted: 4q (D4S243, FABP2), 9p21 (IFNA, D9S171, D9S1748, D9S1751), 17p11.2 (CHRNB1) and 17p13.1 (tp53 and D17S786). PCR products were separated and visualized on polyacrylamide gel by autoradiography. RESULTS: A strong correlation between the LOH profile among individuals with oral leukoplakia from both countries was observed, regardless ethnicity. Furthermore, FFPE tissues subjected to more than 24 hours of fixation in 10% buffered formalin are not, generally, good samples for DNA analysis. CONCLUSION: Pre-malignant lesions etiopathogenesis may not be influenced by ethnicity. The genetic risk model validated by Zhang et al. (2012) seems to be applicable in our community, requiring its own validation, respecting standardized procedures. Still, it is important to emphasize that it is imperative that a scientific community adopts methodologies that preserve the genetic material FFPE tissues that are an invaluable resource for biomedical research.

The topic of this diploma thesis is ?The Nurse?s Contribution to the Management of Pain Treatment of Patients with a Malignant Disease?. The first objective is to ascertain whether nurses know the specifics of care of patients suffering from a cancer pain. The second objective is to ascertain whether nurses use an analogue score to assess the cancer pain. The third objective is to ascertain whether nurses document the pain intensity. The fourth objective is to ascertain whether nurses use non-pharmacological techniques to relieve cancer pains. The fifth objective is to ascertain whether nurses know the strategy of the WHO?s pain relief ladder. The research was conducted in the form of questioning while using the technique of anonymous structured questionnaires completed by the research set consisting of nurses in selected clinical wards with a high probability of occurrence of patients with an oncologic diagnosis. The total of 360 questionnaires was distributed, of which 198 completed questionnaires were returned. 105 questionnaires (53 %) came from the regional hospital in České Budějovice, 51 (26 %) from the St. Anne?s University Hospital in Brno and 42 (21 %) from the district hospital in Tábor. The research took place in March 2012. The results were assessed under the criteria preset by the author of the thesis. Hypothesis 1: Nurses are able to provide specific nursing care to patients suffering from a cancer pain, was confirmed. Hypothesis 2: Nurses assess the pain under the available analogue scores, was confirmed. Hypothesis 3: Nurses document the pain intensity, was disconfirmed. Hypothesis 4: Nurses use non-pharmacological techniques, especially physical ones, was confirmed. Hypothesis 5: Nurses know the strategy of the WHO?s pain relief ladder, was confirmed. In connection with the addressed issue, an educational leaflet about pain monitoring was drawn up for non-medical healthcare workers. This material describes the most frequently used methods of pain assessment and will serve as an overview of individual procedures including their specifics and application possibilities. The diploma thesis may serve for extending the knowledge of nurses in the field of pain treatment management.

OBJETIVO: A perda de heterozigosidade (LOH) é capaz de avaliar as alterações genéticas de lesões potencialmente malignas. Este ensaio avalia as regiões cromossômicas polimórficas que estão próximas ou na região dos oncogenes e genes supressores de tumor conhecidos. Os objetivos desta tese foram três principais: 1) Avaliar a frequência de perda de heterozigosidade de leucoplasias bucais com diferentes graus de severidade histopatológico em regiões cromossômicas próximas aos genes supressores de tumores. 2) Comparar e correlacionar o perfil de perda de heterozigosidade entre indivíduos da British Columbia (Canadá) e Rio Grande do Sul (Brasil). 3) Avaliar os danos ao DNA que podem ocorrer durante o processamento e armazenamento das amostras de tecido parafinado. MÉTODOS: Amostras de leucoplasia bucal (com e sem displasias), fixadas em formalina tamponada 10% e parafinadas, obtidas nos laboratório de patologia bucal do Canadá e do Brasil foram selecionadas e microdissectadas. Procedeu-se a extração de DNA, amplificação por PCR das seguintes regiões microssatélites: 4q (D4S243, FABP2), 9p21 (IFNA, D9S171, D9S1748, D9S1751), 17p11.2 (CHRNB1) e 17p13.1 (tp53 e D17S786). Após o produto do PCR foi separado e visualizado em gel de poliacrilamida por autoradiografia. RESULTADOS: Observou-se uma forte correlação entre o perfil de perda de heterozigosidade entre indivíduos com leucoplasia bucal de ambos os países, independentemente da etnicidade. Além disso, pode-se notar que amostras de tecidos parafinados submetidos a mais de 24 horas de fixação em formalina tamponada 10% não serão, em sua maioria, boas amostras para análises de DNA. CONCLUSÃO: As lesões potencialmente malignas, provavelmente não são influenciadas em sua etiopatogênia pelas diferenças étnicas. O modelo de risco genético validado por Zhang e colaboradores (2012) parece ser aplicável em nossa comunidade, sendo necessário a sua validação, respeitando procedimentos técnicos padronizados. Ainda, vale ressaltar, que é imprescindível que a comunidade científica passe a adotar metodologias que preservem o material genético das peças dos bancos de tecidos parafinados, que são de inestimável valor para a pesquisa biomédica. / OBJECTIVE: Loss of heterozygosity (LOH) can evaluate genetic alterations of pre-malignant lesions. This assay evaluates the chromosomal polymorphic regions that are present in tumor suppressor genes and oncogenes. The main objectives of this thesis were: 1) Evaluate the frequency of LOH of oral leukoplakias with different histopathological degrees at chromosomal regions of tumor suppressor genes. 2) Compare the profile of LOH between individuals from British Columbia (Canada) and Rio Grande do Sul (Brazil). 3) Evaluate the DNA damage that may occur with FFPE (formalin-fixed paraffin-embedded) tissues. METHODS: FFPE samples of oral leukoplakia (with and without dysplasia), obtained in Canadian and Brazilian oral pathology laboratories were selected and microdissected. DNA extraction and PCR amplification of the following microsatellite regions were conducted: 4q (D4S243, FABP2), 9p21 (IFNA, D9S171, D9S1748, D9S1751), 17p11.2 (CHRNB1) and 17p13.1 (tp53 and D17S786). PCR products were separated and visualized on polyacrylamide gel by autoradiography. RESULTS: A strong correlation between the LOH profile among individuals with oral leukoplakia from both countries was observed, regardless ethnicity. Furthermore, FFPE tissues subjected to more than 24 hours of fixation in 10% buffered formalin are not, generally, good samples for DNA analysis. CONCLUSION: Pre-malignant lesions etiopathogenesis may not be influenced by ethnicity. The genetic risk model validated by Zhang et al. (2012) seems to be applicable in our community, requiring its own validation, respecting standardized procedures. Still, it is important to emphasize that it is imperative that a scientific community adopts methodologies that preserve the genetic material FFPE tissues that are an invaluable resource for biomedical research.

In worldwide basis, the carcinoma of cervix is the second most frequent malignant tumour in women. There is up to 1200 new cases diagnosed in our country every year. Considering the sad fact that more than 400 women die in our country every year, the battle against the carcinoma of cervix became recently one of the priorities of the Ministry of Health of the Czech Republic. The nationwide screening focused on early detection of cervical cancer was launched in our country in 2008. The dissertation paper entitled ``Awareness of university students of the risk of cervical cancer and its prevention`` is mainly focused on monitoring of awareness of university students of the risk of cervical cancer disease and the possible ways of its prevention. The assessed group was made of university students, young women from South Bohemian and Prague universities. In the research part of the dissertation the author used a method of questioning with the technique of data collection using anonymous questionnaire. The research has revealed that the students have basic knowledge on the issue of cervical carcinoma, namely in the area of risk and prevention. It was also found that the awareness of the students of the South Region on this issue was much better than of the students in the Prague region. Despite the overall positive results, the research shows the need to inform the public especially about the hazards of smoking as a possible risk factor associated with cancer. It is also necessary to expand knowledge of women in already developed symptoms of the disease. There is currently only one known - bleeding after intercourse. In the area of prevention it is also desirable to highlight the availability of some special examinations for men, while appealing to the possibility of lifelong disability as a serious consequence of this disease. Research shows that it is still necessary to inform more and better the public about this issue. From the views of the respondents it is clear that in addition to ads aimed at promoting vaccination, the problems of the disease is poorly presented. This is confirmed by the fact that students do not know any organization focused on this problem. To a good awareness of women in this field, in terms of risks, prevention and possible vaccination, should contribute especially gynaecologists, together with the midwives, because as part of the preventive visits they have the opportunity to address the women and to specifically discuss the issues with them. It is unfortunately evident from the research that these doctors inform minimally about the possible ways of prevention. In my opinion, to respond to the observed facts and to refine and improve the information system for a maximum possible way it is in the interests of all women and girls, whether by improving the own work of gynaecologists, as well as improving awareness about this problem through the media or by using a variety of booklets and leaflets in offices of other physicians, that are currently seen only sporadically.

O carcinoma espinocelular (CEC) de cabeça e pescoço é uma neoplasia maligna de prognóstico desfavorável e baixa taxa de sobrevida. Entender os processos biológicos envolvidos na carcinogênese poderá ser de extrema importância para o desenvolvimento de novas tecnologias de tratamento e melhora do prognóstico em pacientes acometidos pela doença. A maior causa de insucessos clínicos em termos de terapia e prognóstico em pacientes com câncer é a invasão tecidual e o desenvolvimento de potencial metastático. A migração celular é indispensável para a progressão tumoral e as células apresentam motores moleculares desempenhados especialmente pela família da Miosina II não muscular (MNMII). Codificadas por diferentes genes, existem três isoformas conhecidas em células de mamíferos (MNMIIA, MNMIIB, MNMIIC). As MNMIIs estão envolvidas em funções celulares como migração, adesão e citocinese. Sendo o entendimento da migração, adesão celular e citocinese fatores chave na progressão tumoral, e que o a invasão tecidual e o desenvolvimento de potencial metastático são essenciais na definição do prognóstico dos pacientes, o objetivo deste estudo foi descrever o perfil e exposição à fatores de risco como álcool e fumo dos pacientes diagnosticados com CEC de cabeça e pescoço, graduação histológica, parâmetros clínicos tumorais (TNM), padrão de expressão das isoformas de MNMII (MNMIIA, MNMIIB, MNMIIC) no centro do tumor, zona de invasão e tecido epitelial não neoplásico adjacente ao tumor, relacionando a expressão e localização dessas proteínas com os dados descritos bem como evolução dos pacientes após 5 anos de acompanhamento. De acordo com os resultados sugere-se que a MNMIIB expressa no EA possa indicar o potencial de metástase regional do CEC e a MNMIIC presente na zona de invasão tumoral (ZI) seja um fator predictor de prognóstico ruim da doença. Sendo assim, é possível propor que a avaliação de imunorreatividade da MNMIIB no EA e MNMIIC na ZI seja utilizada na análise das peças operatórias, como complemento à análise morfológica de rotina. / Squamous cell carcinoma (SCC) of the head and neck is a malignant neoplasm of poor prognosis and low survival rate. Understand the biological processes involved in carcinogenesis can be extremely important for the development of new treatment technologies and improved prognosis in patients affected by the disease. The major cause of clinical failure in terms of therapy and prognosis in cancer patients is the development of tissue invasion and metastatic potential. Cell migration is essential for tumor progression and the cells have molecular motors especially formed from non-muscular myosin II family (NMMII). Encoded by different genes, there are three known isoforms in mammalian cells (NMMIIA, NMMIIB, NMMIIC). The NMMIIs are involved in cellular functions such as migration, adhesion, and cytokinesis. As the understanding of migration, cell adhesion and cytokinesis key factors in tumor progression, and that the tissue invasion and metastatic potential for development are essential in defining the prognosis of patients, the objective of this study was to describe the profile and exposure to risk factors such as alcohol and tobacco of patients diagnosed with head and neck SCC, histological grading, tumor clinical parameters (TNM), pattern of expression of isoforms NMMII (NMMIIA, NMMIIB, NMMIIC) in the center of the tumor (CT), tumor invasion zone area and not neoplastic adjacent to the tumor (AE), relating the expression and localization of these proteins with the data described and outcome of patients after 5 years of follow-up. According to the results it is suggested that the NMMIIB expressed in AE may indicate the potential regional metastasis of SCC and NMMIIC present in the tumor invasion zone (IZ) is a predictor factor of poor prognosis of the disease. Therefore, it is possible to propose that immunoreactivity assessment of NMMIIB in EA and NMMIIC in IZ could be used in the analysis of operative parts, as a complement to routine morphological analysis.

O carcinoma espinocelular (CEC) de cabeça e pescoço é uma neoplasia maligna de prognóstico desfavorável e baixa taxa de sobrevida. Entender os processos biológicos envolvidos na carcinogênese poderá ser de extrema importância para o desenvolvimento de novas tecnologias de tratamento e melhora do prognóstico em pacientes acometidos pela doença. A maior causa de insucessos clínicos em termos de terapia e prognóstico em pacientes com câncer é a invasão tecidual e o desenvolvimento de potencial metastático. A migração celular é indispensável para a progressão tumoral e as células apresentam motores moleculares desempenhados especialmente pela família da Miosina II não muscular (MNMII). Codificadas por diferentes genes, existem três isoformas conhecidas em células de mamíferos (MNMIIA, MNMIIB, MNMIIC). As MNMIIs estão envolvidas em funções celulares como migração, adesão e citocinese. Sendo o entendimento da migração, adesão celular e citocinese fatores chave na progressão tumoral, e que o a invasão tecidual e o desenvolvimento de potencial metastático são essenciais na definição do prognóstico dos pacientes, o objetivo deste estudo foi descrever o perfil e exposição à fatores de risco como álcool e fumo dos pacientes diagnosticados com CEC de cabeça e pescoço, graduação histológica, parâmetros clínicos tumorais (TNM), padrão de expressão das isoformas de MNMII (MNMIIA, MNMIIB, MNMIIC) no centro do tumor, zona de invasão e tecido epitelial não neoplásico adjacente ao tumor, relacionando a expressão e localização dessas proteínas com os dados descritos bem como evolução dos pacientes após 5 anos de acompanhamento. De acordo com os resultados sugere-se que a MNMIIB expressa no EA possa indicar o potencial de metástase regional do CEC e a MNMIIC presente na zona de invasão tumoral (ZI) seja um fator predictor de prognóstico ruim da doença. Sendo assim, é possível propor que a avaliação de imunorreatividade da MNMIIB no EA e MNMIIC na ZI seja utilizada na análise das peças operatórias, como complemento à análise morfológica de rotina. / Squamous cell carcinoma (SCC) of the head and neck is a malignant neoplasm of poor prognosis and low survival rate. Understand the biological processes involved in carcinogenesis can be extremely important for the development of new treatment technologies and improved prognosis in patients affected by the disease. The major cause of clinical failure in terms of therapy and prognosis in cancer patients is the development of tissue invasion and metastatic potential. Cell migration is essential for tumor progression and the cells have molecular motors especially formed from non-muscular myosin II family (NMMII). Encoded by different genes, there are three known isoforms in mammalian cells (NMMIIA, NMMIIB, NMMIIC). The NMMIIs are involved in cellular functions such as migration, adhesion, and cytokinesis. As the understanding of migration, cell adhesion and cytokinesis key factors in tumor progression, and that the tissue invasion and metastatic potential for development are essential in defining the prognosis of patients, the objective of this study was to describe the profile and exposure to risk factors such as alcohol and tobacco of patients diagnosed with head and neck SCC, histological grading, tumor clinical parameters (TNM), pattern of expression of isoforms NMMII (NMMIIA, NMMIIB, NMMIIC) in the center of the tumor (CT), tumor invasion zone area and not neoplastic adjacent to the tumor (AE), relating the expression and localization of these proteins with the data described and outcome of patients after 5 years of follow-up. According to the results it is suggested that the NMMIIB expressed in AE may indicate the potential regional metastasis of SCC and NMMIIC present in the tumor invasion zone (IZ) is a predictor factor of poor prognosis of the disease. Therefore, it is possible to propose that immunoreactivity assessment of NMMIIB in EA and NMMIIC in IZ could be used in the analysis of operative parts, as a complement to routine morphological analysis.

Astrocytoma, the tumor of astrocytic origin, accounts for about 60 % of the primary brain tumors. As per World Health Organization grading system, astrocytoma is classified as circumscribed astrocytoma (Grade I; pilocytic astrocytoma) and diffusely infiltrating astrocytoma. Grade I tumor is biologically benign and can be cured by surgical resection of the tumor. The diffusely infiltrating astrocytoma is further subclassified into grade II/diffuse astrocytoma (DA), grade III/anaplastic astrocytoma (AA) and grade IV/glioblastoma (GBM). Aggressiveness of the disease increases as the tumor progresses from lower grade to higher grade. In particular, GBMs are the most malignant and aggressive human cancers. For a newly diagnosed GBM patient, the current treatment option is surgical resection of the tumor followed by radiation and temozolomide therapy. Despite the treatment is multimodal (surgery+radiation+temozolomide) the median survival of GBM patients remain very low at 14.6 months. Although numerous markers with potential utility in prognosis and treatment of GBMs have been reported, they are yet to be translated into clinical utility. Our knowledge of understanding the complete biology of GBMs needs further comprehensive studies towards the identification of markers with potential utility to prognose/treat the GBM patients efficiently. Therefore, with an immense need to develop new biomarkers/therapeutic strategies in order to improve the diagnosis, prognosis and existing treatment of the GBM, the current work is designed to study the following aspects on glioma

Abstract Type XIII collagen is a type II oriented transmembrane protein with a short intracellular domain, a single transmembrane domain and a large, mostly collagenous extracellular domain. Tissue localization and cell culture studies have implicated that it is involved in cell adhesion. The spatio-temporal expression of type XIII collagen mRNA and protein during murine development is studied here. Type XIII collagen mRNAs were expressed at a constant rate during development, with an increase of expression towards birth. The strongest expression was detected in the central and peripheral nervous systems of the developing mouse fetus. Cultured primary neurons expressed this collagen, and recombinant type XIII collagen was found to enhance neurite outgrowth. Strong expression was also detected in the heart, with localization to cell-cell contacts and perinatal accentuation in the intercalated discs. Other sites of type XIII collagen expression included cartilage, bone, skeletal muscle, lung, intestine and skin. Clear developmental shifts in expression suggest a role in endochondral ossification of bone and the branching morphogenesis in the lung. To elucidate the function of type XIII collagen transgenic mice were generated by microinjection of a cDNA construct that directs the synthesis of truncated α1(XIII) chains with an in-frame deletion of the central collagenous COL2 domain. This construct was thought to disrupt the assembly of normal type XIII collagen trimers. Expression of shortened α1(XIII) chains by fibroblasts derived from mutant mice was demonstrated, and the lack of intracellular accumulation in immunohistochemical analysis of tissues suggested that the mutant molecules were expressed on the cell surface. Transgene expression led to developmental arrest and fetal mortality in offspring from heterozygous mating with two distinct phenotypes. The early phenotype fetuses were aborted by day 10.5 of development due to a failure in the fusion of the chorion and allantois membranes and subsequent disruption in placentation, while the late phenotype fetuses were aborted by day 13.5 of development due to cardiovascular and placental defects. Furthermore, it was shown that the heterozygous mice that were initially of normal appearance and bred normally had an increased susceptibility to develop T-cell lymphomas and angiosarcomas later in life. The results presented here increase the evidence that type XIII collagen is involved in cell adhesion, with several important tasks during development. A role of type XIII collagen in malignant transformation of certain mesenchymal cell populations is also implicated.

Hodková, Gabriela - Metabolic Effects Of Hyperthermic Isolated Limb Perfusion (HILP) in Malignant Melanoma Patients First Faculty of Medicine, Charles University in Prague, Praha 2, Kateřinská 32 Head of the work: Doc. MUDr. Michal Semrád, CSc. Supervisor - consultant: MUDr. Miroslav Špaček, Ph. D. The aim of the study is to assess the metabolic consequences of mechanical isolation and hyperthermic cytostatic perfusion in a limb affected by malignant process. The theoretical part refers to a topic of malignant melanoma, its clinical evaluation and treatment. Methods based on conservative and surgical treatment are described. The isolated hyperthermic cytostatic limb perfusion is a consecutive local treatment indicated in cases of recurrent malignant lesions following surgical resection, when next surgery is impossible. In the practical part, the laboratory samples and clinical data were recorded in patients who had undergone hyperthermic cytostatic limb perfusion in the 2nd Surgical Department of The General Teaching Hospital and First Faculty of Medicine, Charles University Prague. The affected limb was flushed with a warm oxygenated blood containing cytostatic drugs using an extracorporeal circuit apparatus. Selected arterial blood gas, metabolic and hematologic parameters were studied intra and...

BACKGROUND: Malignant and paramalignant pleural effusions are important complications of many malignancies. The two main management options debated in the literature are: 1) insertion of an indwelling pleural catheter (IPC) to achieve chronic drainage of the effusion, or 2) hospitalization with tube thoracostomy and subsequent chemical pleurodesis (CP) with talc or doxycycline to prevent fluid reaccumulation. We aimed to describe a large series of patients with malignant pleural effusions managed with an IPC, identify and validate factors identified in the literature as predictors of spontaneous pleurodesis in the IPC group and compare the group managed with IPC to patients managed with CP. METHODS: We designed a retrospective cohort study comparing patients with malignant and paramalignant pleural effusions managed either with CP between March 1, 2003 and February 28, 2006 or IPC insertion between May 1, 2006 and April 1, 2009. The CP group was identified through the prescription of talc or doxycycline and the IPC group from the IPC clinic database. Data were collected from paper and electronic records and from the Government of Ontario. RESULTS: We identified 193 consecutive patients with an ECOG performance status of less than 4 (ECOG less than 4 means that the patient is not completely disabled and confined to bed or chair) having undergone IPC insertion and 168 who were managed with CP. None of the variables we tested were significant predictors of spontaneous pleurodesis in the IPC group. Pleural effusion control rates at 6 months were higher in the IPC group than in the CP group (52.7% vs 34.0%, p<0.01) but the rate of freedom from pleural effusion at 180 days and catheter removal at 90 days was not significantly different (25.8% in the IPC group and 34.0% in the CP group p=0.14). Patients in the IPC group had a significantly longer median survival (148 days measured from the date of catheter insertion vs 133 days in the CP group, log-rank p<0.05). CONCLUSION: We found an intriguing possible survival benefit favouring management of malignant or paramalignant effusions with an IPC. Given possible biases due to the design of this study and uncertain explanatory mechanism, this needs to be confirmed in a randomized controlled trial. Quality of life, an important measure of success for these palliative procedures, should also be measured.