Protocol of the Australasian Malignant Pleural Effusion (AMPLE) trial: a multicentre randomised study comparing indwelling pleural catheter versus talc pleurodesis

INTRODUCTION: Malignant pleural effusion can complicate most cancers. It causes breathlessness and requires hospitalisation for invasive pleural drainages. Malignant effusions often herald advanced cancers and limited prognosis. Minimising time spent in hospital is of high priority to patients and their families. Various treatment strategies exist for the management of malignant effusions, though there is no consensus governing the best choice. Talc pleurodesis is the conventional management but requires hospitalisation (and substantial healthcare resources), can cause significant side effects, and has a suboptimal success rate. Indwelling pleural catheters (IPCs) allow ambulatory fluid drainage without hospitalisation, and are increasingly employed for management of malignant effusions. Previous studies have only investigated the length of hospital care immediately related to IPC insertion. Whether IPC management reduces time spent in hospital in the patients' remaining lifespan is unknown. A strategy of malignant effusion management that reduces hospital admission days will allow patients to spend more time outside hospital, reduce costs and save healthcare resources. METHODS AND ANALYSIS: The Australasian Malignant Pleural Effusion (AMPLE) trial is a multicentred, randomised trial designed to compare IPC with talc pleurodesis for the management of malignant pleural effusion. This study will randomise 146 adults with malignant pleural effusions (1:1) to IPC management or talc slurry pleurodesis. The primary end point is the total number of days spent in hospital (for any admissions) from treatment procedure to death or end of study follow-up. Secondary end points include hospital days specific to pleural effusion management, adverse events, self-reported symptom and quality-of-life scores. ETHICS AND DISSEMINATION: The Sir Charles Gairdner Group Human Research Ethics Committee has approved the study as have the ethics boards of all the participating hospitals. The trial results will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBERS: Australia New Zealand Clinical Trials Registry-ACTRN12611000567921; National Institutes of Health-NCT02045121.published_or_final_versio

Technischer Gesangeskursus für die Volksschule

für Seminaristen und Lehrer bearb. von H. A. Rosenstenge

Stratigraphy of amethyst geode-bearing lavas and fault-block structures of the Entre Rios mining district, Paraná volcanic province, southern Brazil

The Entre Rios mining district produces a large volume of amethyst geodes in underground mines and is part of the world class deposits in the Paraná volcanic province of South America. Two producing basalt flows are numbered 4 and 5 in the lava stratigraphy. A total of seven basalt flows and one rhyodacite flow are present in the district. At the base of the stratigraphy, beginning at the Chapecó river bed, two basalt flows are Esmeralda, low-Ti type. The third flow in the sequence is a rhyodacite, Chapecó type, Guarapuava subtype. Above the rhyodacite flow, four basalt flows are Pitanga, high-Ti type including the two mineralized flows; only the topmost basalt in the stratigraphy is a Paranapanema, intermediate-Ti type. Each individual flow is uniquely identified from its geochemical and gamma-spectrometric properties. The study of several sections in the district allowed for the identification of a fault-block structure. Blocks are elongated NW and the block on the west side of the fault was downthrown. This important structural characterization of the mining district will have significant consequences in the search for new amethyst geode deposits and in the understanding of the evolution of the Paraná volcanic province

Pleural empyema caused by Klebsiella oxytoca: A case series

We report on 19 patients from Western Australia of pleural empyema with Klebsiella oxytoca, an organism never before reported in association with this condition. Median age was 65 years, 14/17 (83%) had been in hospital within 30 days prior to diagnosis, 12/18 (67%) had active cancer, 9/17 (53%) had been in intensive care and 7/17 (41%) had prior surgery. Nine patients died at the time of censure, five within 90 days of infection