***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Malignant pericardial effusion , although highly variable , is an uncommon complication of cancer . It is often associated with symptoms like dyspnea , chest pain , and cough , which may be severe and disabling . We analyzed the results of our current treatment policy to evaluate the effectiveness and tolerance of a new approach for this disorder . PATIENTS AND METHODS Patients with malignant pericardial effusions were treated with intracavitary thiotepa ( 15 mg on days 1 , 3 , and 5 ) through an indwelling pericardial cannula after extraction of as much pericardial fluid as possible on day 0 . Responses were assessed by clinical examination , computed tomographic ( CT ) scan , and echocardiography before treatment , 1 month after treatment , and every 2 months thereafter . Twenty-three patients with malignant symptomatic pericardial effusion were treated and all were assessable for effectiveness and tolerance of the procedure . RESULTS Nine patients with breast cancer , 11 with lung cancer , two with an unknown primary tumor , and one with metastatic melanoma were treated . In all but three patients , systemic medical treatment was started after completion of intracavitary therapy . Nineteen patients responded to treatment ( 83 % ; 95 % confidence interval , 61 % to 95 % ) with a rapid improvement of symptoms . The median time to pericardial effusion progression was 8.9 months ( range , 1 to 26 ) . No significant side effects were registered , except one patient who had transient grade III thrombocytopenia and leukopenia and one patient who had grade I leukopenia . CONCLUSION A short course of intracavitary treatment with thiotepa is highly effective and well tolerated in the treatment of malignant pericardial effusion OBJECTIVES This study describes the technique , clinical characteristics and results of the first 50 patients undergoing percutaneous balloon pericardiotomy as part of a multicenter registry . BACKGROUND Percutaneous balloon pericardiotomy involves the use of a percutaneous balloon dilating catheter to create a nonsurgical pericardial window . METHODS Patients eligible for percutaneous balloon pericardiotomy had either cardiac tamponade ( n = 36 ) or a moderate to large pericardial effusion ( n = 14 ) . In addition to clinical follow-up , serial echocardiograms and chest X-ray films were obtained . RESULTS The procedure was considered successful in 46 patients after a mean follow-up period of 3.6 + /- 3.3 months . Two patients required an early operation , one for bleeding from a pericardial vessel and one for persistent pericardial catheter drainage . Two patients required a late operation for recurrent tamponade . Minor complications of the procedure included fever in 6 of the first 37 patients ( studied before the prophylactic use of antibiotic agents ) , thoracentesis or chest tube placement in 8 and a small spontaneously resolving pneumothorax in 2 . Despite the short-term success of this procedure , the long-term prognosis of the 44 patients with malignant pericardial disease remained poor ( mean survival time 3.3 + /- 3.1 months ) . CONCLUSIONS Percutaneous balloon pericardiotomy is successful in helping to manage large pericardial effusions , particularly in patients with a malignant condition . It may become the preferred treatment to avoid a more invasive procedure for patients with pericardial effusion and a limited life expectancy We review ed 36 cases of symptomatic malignant pericardial effusion managed with pericardiocentesis at our institution from 1982 to 1989 . There were 13 men and 23 women , aged 49 + /- 12 years ( range , 33 - 76 years ) . The commonest underlying tumours were lung cancer ( 12 cases , 33 % ) and breast cancer ( 11 cases , 30 % ) .  Pericardiocentesis was successful as the initial management in 34 of 36 patients ( 94 % ) ; one patient died as a result of the procedure and another required subxiphoid incision and tube drainage of the effusion . When intrapericardial sclerotherapy was performed , only three of 28 patients required repeat pericardiocentesis , and when sclerotherapy was not performed initially , four of seven patients had recurrent symptomatic effusions . Median survival following pericardiocentesis in breast cancer patients was 10 months ( range , 0 - 36 months ) and in all other malignancies was four months ( range , 0 - 12 months ) . We conclude that pericardiocentesis with intrapericardial sclerotherapy provides good local control for symptomatic malignant pericardial effusion in the majority of patients . In spite of this , the median survival of such patients is poor , especially in patients with malignancies other than breast cancer , with few patients surviving more than a few months PURPOSE To compare the clinical efficacy and toxicity of doxycycline and bleomycin as sclerosing agents in the primary management of malignant pericardial effusion ( MPE ) . METHODS Twenty-seven consecutive adult patients referred to a tertiary-care institution for the management of cardiac tamponade and malignancy underwent pericardial drainage through a percutaneously placed pigtail catheter . They were then alternately assigned to undergo bleomycin or doxycycline pericardial sclerosis . RESULTS There were 13 men and 14 women , with a median age of 59 years . They mainly had lung ( 70 % ) and breast cancers ( 11 % ) , and all had clinical and echocardiographic evidence of cardiac tamponade . Although all patients had successfully placed catheters , six were inadvertently dislodged before sclerosis ; 11 underwent bleomycin sclerosis and 10 doxycycline sclerosis .  Twenty patients ( one early death ) were assessable . One patient in each group failed to respond to sclerosis with the initial agent , but both were sclerosed successfully with the other agent . Sclerosis was achieved with a median of two instillations for each agent and total median doses of bleomycin 20 mg and doxycycline 1,250 mg . Seventy percent of doxycycline patients developed significant retrosternal pain , compared with no bleomycin patients ( P = .04 ) . Doxycycline patients required a median of 3.5 more days of hospitalization ( 8.5 v 5 ) and 2 more days of pericardial catheterization ( 7 v 5 ) compared with bleomycin patients . Tamponade recurred in one bleomycin patient at 253 days , and in no doxycycline patient . CONCLUSION Although bleomycin and doxycycline are equally effective sclerosing agents , bleomycin is associated with significantly less morbidity and should be the first-line chemical sclerosing agent for malignant pericardial effusions 
    Output:
    
Although isolated pericardiocentesis can safely deliver immediate symptomatic relief , subsequent catheter drainage or sclerotherapy are required to minimize recurrence .
PBP has been shown to be highly effective and may be particularly useful in managing recurrent effusions .