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The local instillation of quinacrine (mepacrine) hydrochloride is used widely in the United States of America for the treatment of neoplastic pleural effusions. To date, there has been no report of the use of this treatment in the United Kingdom. We have studied the effect of treatment in 12 consecutive patients presenting with a variety of types of malignant pleural effusion and report our experiences. In all of our patients the effusion was successfully controlled and sideeffects were not unduly troublesome. We conclude that quinacrine is at least as effective as other forms of treatment of neoplastic pleural effusion and merits more attention.Pleural effusion is a common complication of malignant disease. Treatment of the primary neoplasm is rarely effective against the effusion and current therapy rests between a conservative approach and attempted pleurodesis. Conservative methods include the intrapleural instillation of a variety of agents, including alkylating agents, radio-isotopes of gold or yttrium and talc. Pleurodesis involves the surgical stripping of the parietal pleura. This diversity of approach suggests in itself that results are less than satisfactory and following reports of successful trials in the United States we decided to use quinacrine (mepacrine) hydrochloride, hereafter referred to as quinacrine. Our experiences using this drug are reported below. PATIENTS AND METHODSTwelve consecutive patients with proven malignant pleural effusions were treated. In addition to pleuracentesis and local instillation of quinacrine, systemic therapy to control the primary lesion or for the relief of symptoms was given whenever indicated. Quinacrine was provided in ampoules containing 360 mg. to be dissolved in distilled water or pleural fluid.The effusion was first aspirated as completely as possible and this was followed by the instillation of 90 mg. quinacrine. A period of 24 to 72 hours was then allowed to elapse, during which time the toxic reactions were noted and allowed to settle before further therapy was given. Unless such reactions prevented continuation of treatment further aspiration was attempted and a repeat dose of quinacrine was given. Thereafter pleuracentesis was performed and quinacrine was instilled at regular intervals until the effusion was dry. The dose was governed by the severity of the initial systemic reaction. If this was insignificant then 180 mg. would be given and 360 mg. on subsequent occasions. A dose of 360 mg. was never exceeded on any one occasion and during a single course of treatment our patients rarely required a total dose greater than 500 mg. RESULTS

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It is possible to identify IBS more simply by self-report questionnaires.