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At least 235 records · Page 13Linked to original sources
PubMed2002

Thoracoscopy in management of empyema thoracis in children.

The usual treatment for empyema in children varies from a simple thoracocentesis to thoracotomy and open decortication. We studied the role of thoracoscopy in the management of empyema thoracis in 10 immunocompetent children after failure of medical management. All children recovered well with an early removal of intercostal tube and reduced postoperative hospital stay and showed complete resolution of empyema on follow up. Thoracoscopy has come as a new ray of hope for the patients with empyema, with the advantages of complete evacuation, minimal pulmonary dysfunction, reduced pain and hospital stay.

Child, Preschool↗
PubMed1992

[Upper parietal pleurectomy with resection of bullae by thoracoscopy in spontaneous pneumothorax. New perspectives from preliminary results in 20 cases].

In view of the increasing development of laparoscopic surgery and hoping to minimize thoracotomy's risks, we had the idea to perform pleurectomy as a treatment of Spontaneous Pneumothorax (S.P.) through video thoracoscopy. The operation was performed under general endobronchial anesthesia, the patient placed in the posterolateral thoracotomy position. Three trocars inserted through the 5th, 7th and 9th intercostal space, allowed the introduction of non specific thoracoscopic instruments similar to those used in laparoscopic surgery. The apical pleurectomy was delimited by the 6th rib, the internal thoracic vessels, the costovertebral sulcus and the first rib. Blebs and small bullae are now transected with application of the "EndoGIA 30". Pleural cavity was drained by F28 ans F32 tubes through the lower orifices. This procedure was performed in 18 patients presenting 20.S.P.. Operative indications were: persistent air link (7 cases), recurrence (9 cases), bullae with bridle and or anterior thoracotomy for S.P. (4 cases). One bleeding of 200 ml from a wounded intercostal vessel ligated with a clip was the sole operative hitch. Operative duration decreased from two to one hour. Average drainage duration was 3.5 dys and hospital stay 4.5 days. There was no death nor immediate complications. Post-operative pain was judged in all cases less intensive than that experienced after pleurectomy with thoracotomy. This original procedure is the first described as entirely performed through thoracoscopy with non specific instruments and hence economic impact.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[The use of thoracoscopy in the diagnosis and treatment of chest diseases].

The procedure and results of thoracoscopy by using a fiberoptic bronchoscope and rigid cold-light thoracoscope in 76 cases with chest diseases of unknown causes were reported. The positive diagnostic rate was 89.5% (68/76). The histologic diagnosis following thoracoscopic biopsy in 65 patients was compared with the findings at follow-up, the results showed the sensitivity being 87.7%, specificity 100% and diagnostic accuracy 89.2%. 3 cases with persistent or recurrent spontaneous pneumothorax were cured by Nd-YAG laser transendoscopically. 5 patients with malignant pleural effusion were treated with intrapleural talcum powder under thoracoscopic control, 4 of them obtained complete pleurodesis. There were only minor complications: transient fever in 40 cases and local subcutaneous emphysema in 7. It was concluded that thoracoscopy is simple, safe, reliable and practical in the diagnosis and treatment of chest diseases. It should be popularized clinically.

Adolescent↗
PubMed1992

[Surgical treatment of pneumothorax by video-thoracoscopy].

Between May and December 1991, 12 patients with spontaneous pneumothorax were treated surgically, using video-thoracoscopy. With this technique bullous lesions could be excised in 10 cases and pleurodesis could be performed in all patients. Morbidity and mortality were nil. The cosmetic and functional advantages of video-thoracoscopy were obvious. Long-term results remain to be evaluated. This technique has shown that it is possible in all cases to create pleurodesis (pleural poudrage or pleurectomy) and to treat parenchymatous lesions (excision of bullous systems). This suggests that the long-term results will be the same as those obtained with conventional surgery.

Adolescent↗
PubMed2005

[Penetrating chest trauma in which thoracoscopy was helpful; report of a case].

A 32-year-old builder suffered from a chest trauma in a construction area. A ratchet penetrated his right chest wall posterolaterally, and he was transferred to our hospital. A chest X-ray and a computed tomography (CT) revealed that the tip of the instrument remained in the thoracic cavity and there were no other obvious damages including pneumothorax, hemothorax, and liver damage. We thought the simple removal of the instrument from his body was dangerous so he was transferred to the operating room and his chest was opened under general anesthesia. However, it was difficult to confirm the inside of penetrating point from the thoracotomy wound; therefore we used a thoracoscope. The thoracoscopy disclosed a penetration in the lung and a contusion on the diaphragm. The application of thoracoscopy in the operation of thoracic trauma is very promising in exploration of the thoracic cavity, especially in the area which is out of vision from the open thoracotomy.

Accidents, Occupational↗
PubMed2005

[Experience with thoracoscopy for rifle gunshot penetrating trauma of the chest; report of a case].

A 57-year-old man came to our hospital by ambulance for a chest injury by a rifle gunshot. He had a penetrating injury of the chest wall, hemopneumothorax and pulmonary laceration. He was managed with chest drainage, oxygen inhalation. His respiratory and cardiac status was stable. However, for the purpose to prevent the development of empyema or pneumonia, and to check the existence of damage of intrathoracic structures by the gunshot injury, thoracoscopy was performed next day. He discharged without postoperative complications 17 days after the injury. Open thoracotomy is reported to be required in only about 10-15% of patients with chest injuries. However, operative indication of the chest injuries may spread in the future with the spread of thoracoscopy and its low invasiveness.

Hemopneumothorax↗
PubMed2005

[A case of malignant lymphoma diagnosed by thoracoscopy with local anesthesia].

A 67-year-old woman was hospitalized with right pleural effusion on chest radiography. Chest CT showed a thickened parietal pleura and pleural effusion in the right thorax. Cytological examination of pleural effusion showed atypical plasma cells. We performed thoracoscopy with local anesthesia for diagnosis and observed an about 5 x 5 cm seized red soft tumor on the parietal pleura. Pathological and immunohistochemical examination of the pleural tumor revealed that it was marginal zone B-cell malignant lymphoma. In this case, we could not reach a diagnosis only by cytological examination of the pleural effusion. Thoracoscopy with local anesthesia was safe and useful for diagnosis of malignant lymphoma with pleural effusion. Most cases of primary pleural malignant lymphoma have a history of chronic pyothorax. This case is thought to be a very rare case of primary pleural malignant lymphoma with no history of pyothorax.

Aged↗
PubMed1991

[Influences of open thoracoscopy on human body: experience in 65 cases].

The influence of open thoracoscopy with fiber-bronchoscope on human body was studied in 65 patients with pleural disease. The items observed included blood pressure, Pulse rate, respiration rate, blood gas analysis and clinical manifestations. It was found that open thoracoscopy has little influence on human body and the patients tolerated it well. No severe complication was found and operative procedures might be avoided popularization of this technique is therefore suggested.

Adolescent↗
PubMedDate not supplied

[Thoracoscopy in the diagnosis of pleural mesothelioma].

The Authors assess the results of thoracoscopy in 21 cases of pleural mesothelioma observed over the period from 1982 to 1991. The procedure yielded a correct diagnosis in 18 cases (in 2 cases, CTM due to adenoma at cytology allowed histological definition of the tumour). In 3 cases, thoracoscopy failed to detect the tumour, which was confirmed at a later stage. This type of investigation is indicated for the diagnosis of all pleural diseases and, in particular, for diagnosing mesothelioma (reliability in our series: 85.7%).

Adenocarcinoma↗
PubMed1991

[Excision of bronchogenic cyst by video-thoracoscopy].

We report what is probably the first case of para-oesophageal bronchogenic cyst treated by video-thoracoscopy. The patient was a 26-years old woman who presented with dysphagia to solid foods. Preoperative investigations showed that the lesion was a cyst and that it was located in the superior and posterior mediastinum; they also enabled us to determine its relations with nearby structures, notably the oesophagus, and to make the diagnosis of para-oesophageal bronchogenic cyst. Treatment consisted of excision of the cyst by video-thoracoscopy. The postoperative period was uneventful, and the patient was discharged on the fourth day.

Adult↗
PubMed1990

[The role of thoracoscopy in pleural biopsy in cases with pleural effusion].

Between April 1985 and July 1989, 125 cases with pleural effusion were admitted to our department. The causes of pleural effusion were carcinomatous pleurisy in 47 cases, infection without tuberculosis in 34 cases, tuberculous pleurisy in 17 cases, cardiac insufficiency and hypoproteinemia in 11 cases, trauma and pneumothorax in nine cases, collagen disease in two cases and unknown origin in five cases. Carcinomatous pleurisy and tuberculous pleurisy, the differential diagnosis of which is very important, comprised 37% and 14% of all cases, respectively. These diseases can be definitively diagnosed by pleural biopsy, effusion cytology and/or effusion culture. In July 1987, we introduced thoracoscopy to improve the ratio of definitive diagnoses. The ratio for carcinomatous pleurisy in the previous term, when thoracoscopy was not being used, was 59%, while that in the latter term, when it was used, was 73%. The ratio for all cases with tuberculous pleurisy was 47%. Prior to June 1987, pleural biopsies in our department were performed with a Cope needle. Using that procedure, a low positive ratio of 50% was obtained. For thoracoscopic pleural biopsies, a high positive ratio of 84% was achieved (in carcinomatous pleurisy, 13 out of 15 cases; in tuberculous pleurisy, three out of four cases). This procedure was performed with minimal patient discomfort and no serious complications. Therefore, thoracoscopic pleural biopsy is recommended as a diagnostic procedure for cases with pleural effusion.

Adult↗
PubMed1990

[Application of thoracoscopy in the diagnosis of pleuro-pulmonary disease].

Thoracoscopic examination was performed in 20 cases of pleuro-pulmonary diseases of uncertain etiology, 16 patients (80%) obtained positive thoracoscopic biopsy results while 4 false negative. Needle pleural biopsy was carried out in 10 cases and four of them gave correct diagnosis. After thoracoscopy thoracotomy were performed in 7 cases and all lesions were resected. Thirteen cases with advanced tumor or benign pleural diseases were treated conservatively. It was concluded that thoracoscopy is as an important technique in diagnosis of pleuro-pulmonary diseases.

Adult↗
PubMed1989

[Value of talc administration using thoracoscopy in the symptomatic treatment of recurrent pleurisy. Apropos of 302 cases].

From the data of a retrospective study the authors assess the value of pleural symphysis by talc in the symptomatic treatment of recurrent pleural effusion. 300 patients, 254 of whom were suffering from pleural effusion secondary to cancer and 48 of whom had non-cancerous pleural effusion, were subjected to a thoracoscopy under local anaesthetic allowing the instillation of 5-10 mls of talc powder followed by aspiration drainage for 4-8 days. Out of 270 evaluable cases, an immediate positive result (defined as the absence of any recurrence of the pleural effusion at the drainage site) was obtained in 251 cases or 93% +/- 3% (being 92.1% +/- 3.5% of the cases of pleural cancer and 97.7 +/- 4.5% in cases of non-cancerous pleural effusion). At the end of 6 months there was no recurrence of the effusion in 80.6% of cases. There were 19 early failures (7% +/- 3%) and 25 late failures of whom 9 benefitted from a further attempt at a pleural symphysis (either a pleurectomy, or injection of talc in suspension, or new talc therapy by thoracoscopy). On the whole the complications were minor: pain, fever and rarely more serious: empyema in 6 cases and cancerous nodules down the drainage line in 10 cases. There had been 15 deaths (5.3% +/- 2.6%) during the period of drainage in some very weak and fragile patients. Pleural talcage leads to an improvement in dyspnoea in 82% +/- 7.4% of cases and the general condition was improved in 54% +/- 9.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[The importance of thoracoscopy in the differential diagnosis of pleurisy].

Thoracoscopy was performed in 50 patients with pleural exudates of unclear etiology. Indications for thoracoscopy were: unclear character of accumulation of exudate, ineffective treatment including pleural punctures in case of hydrothorax. Visual examination of the pleura and chest organs supplemented by cyto- and histological study of tissues taken from involved places of the pleura allowed to arrive at an exact diagnosis in 90% of cases.

Adolescent↗
PubMed1989

[Thoracoscopy in diffuse lung diseases].

Thoracoscopy was performed under local anesthesia in 419 patients suffering from a diffuse lung disease. In 85% of the cases diagnosis was clarified by thoracoscopy. All other cases were confirmed by means of an open lung biopsy. The best results were obtained in sarcoidosis of the stages II and III, the sensitivity being 0.98. Tumour-conditioned diffuse lung diseases were clarified in 88% of the cases; proof of an interstitial pulmonary fibrosis or interstitial pneumonia was established in 85% of the patients. Results regarding histiocytosis X were poor: thoracoscopic-bioptic proof was successful in only 42% of the patients. In 419 examinations we only detected a severe complication (air embolism). Drainage times were on the average between 4 and 5 days. On the whole, the method was characterised in the field of diagnosis of diffuse lung diseases by a high degree of sensitivity and satisfactory specificity. Both in respect of the invasiveness of the examination and its sensitivity it occupies an intermediate position between peripheral bronchoscopically obtained biopsy and surgical open lung biopsy, representing a valuable extension of the diagnostic instrumentarium if the indication is carefully considered.

Adult↗
PubMed1989

[Thoracoscopy in the immunosuppressed patient].

The article reports on diagnostic thoracoscopy in 65 patients suffering from pulmonary complications in immunosuppression. The high sensitivity of 98% and the relatively low rate of complications assign to thoracoscopy a place between transbronchial peripheral and surgical open lung biopsy.

Biopsy↗
PubMed1989

Prediction of the diagnostic utility of thoracoscopy in pleural effusion.

Malignancies are today becoming a more and more common cause of pleural effusions and thereby also a major indication for thoracoscopy. To facilitate the choice of the most suitable diagnostic procedure, a method of estimating the risk of malignancy is required. In order to present such a method, 334 patients with pleural effusions were examined. The predictive value for malignancy was determined for 7 variables, viz. the patient's sex, age, smoking habits, asbestos exposure, size of effusion, pleural fluid colour and eosinophils. The variables were evaluated both separately, combining two by two and by a logistic regression function. Malignant effusions were revealed in 47% of the patients. A bloody pleural fluid showed the strongest positive predictive value for malignancy, while greater than 30% eosinophils in the fluid had the strongest negative predictive value. The predictive value was further improved by combining pleural fluid colour and eosinophils. A logistic regression function using all 7 registered variables could discriminate correctly between malignant and non-malignant disease in 79% of all cases. Thus, patients at significant risk of having a malignant disease could be identified and referred for further examinations if needed. Thoracoscopy should be the method of choice for further examination of these patients as it reveals significant additional information beyond that achieved by cytology.

Aged↗
PubMed1989

[Indications for thoracoscopy in pleural empyema].

If the acute empyema of the pleura is not treated well in time via thoracic drainage and lavage, a cavitated empyema of the pleura may result. Such cavitated empyemas may be drained via surgical thoracoscopy using the mediastinoscope in intubation anaesthesia. Major surgery as represented by standard thoracoscopy is thus avoided. By intraoperative positive pressure breathing the fibrin deposits on the visceral pleural are torn, thus enabling maximum possible re-expansion of the lungs.

Adult↗