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At least 1,009 records · Page 56Linked to original sources
PubMed2003

[A case of benign asbestos pleural effusion suspected on thoracoscopic examination under local anesthesia].

We report the case of a 92-year-old man with a 13-year history of occupational asbestos exposure who presented with a complaint of dyspnea. In September 2001, bilateral pleural effusions were revealed on chest radiography, and continued to progress despite treatment for heart failure. Chest CT revealed calcification of the pleura but no abnormal findings in the lung fields. Both pleural effusions were exudative and lymphocytes were the predominant cells contained in them. Antituberculous chemotherapy had no effect on the exudates. In March 2002, thoracoscopy was performed under local anesthesia (medical thoracoscopy). Plaque was recognized on the parietal pleura; however, the serosal surfaces of the parietal and visceral pleura were smooth, and no evidence of malignancy, especially malignant mesothelioma, was noted. The patient's condition was diagnosed as benign asbestos pleural effusions. Prednisolone was administered, and these effusions gradually decreased. Cases of benign asbestos pleural effusion occurring simultaneously with massive bilateral effusions are rare. Thoracoscopy aided in the differential diagnosis of this case.

Aged↗
PubMed1992

Use of mini-invasive procedures in esophageal surgery.

The authors have applied the advantages of mini-invasive surgery to the treatment of esophageal diseases. The technical possibilities of esophageal dissection have been investigated in patients with cancer of the intrathoracic esophagus. The mini-invasive techniques have been applied in the clinical setting to perform the esophagectomy through a trans-hiatal approach or by means of thoracoscopy. Performing the esophagectomy through the trans-hiatal approach allows an accurate mediastinal dissection and lymphadenectomy of the paraesophageal nodes. Performing the esophagectomy by means of thoracoscopy requires division of the azygos vein. In our experience better to divide the esophagus high in the chest. At present, trans-hiatal esophagectomy with mini-invasive procedures seems to be the technique of choice. However, the approach based on thoracoscopy will gain popularity with the development of more sophisticated instruments. In selected cases, it could be advantageous to use both techniques.

Diverticulum, Esophageal↗
PubMed2003

[The evaluation of the complications and its management in 800 patients who underwent the thoracoscopic surgery].

Thoracoscopy has been applied to almost all thoracic surgery as shown (table 1). Besides an opportunity to follow and encounter a trouble during surgery using thoracoscopy, so that it is necessary to become skilled in the prediction and management of complication. Nowadays, there are two options on surgery using thoracoscopy, thoracoscopic surgery (TS) is performed only on in a port and on a mini-thoracotomy with a few ports (video-assisted thoracoscopic surgery: VATS). When changing into emergency or converting into open thoracotomy, a muscle sparing thoracotomy could be available. The symptoms which occurred in the thorax are fundamentally similar during both TS and VATS procedure. However, peculiar dangerous factor existed according to the difference in internal organs, procedures, and diseases. Critical complications during surgery were as follows, i.e., injury of pulmonary vessels and bronchus, tension pneumothorax of the opposite lung and tumor implantation of the chest wall. Basically, standard practice is the most important to avoid an accident and determine whether converting to open thoracotomy should be employed. In the present commentary, we would like to present our experiences and propose regarding management.

Bronchi↗
PubMed1992

[An experimental anatomopathological study of pleural talcosis].

The aim of this work was to study the anatomical and pathological reaction and the mechanism of the formation of the pleural symphysis during pleural talcosis. The experiment was performed on fifteen dogs of similar breed, divided into three groups of five subjects each. After thoracoscopy under general anaesthesia, 2 ml of intrapleural physiological saline were injected in group I (controls) and 2 or 4 ml of talc granules in group II and III. A drainage tube was positioned at the end of the examination. One dog in each group was sacrificed on the 1st, 2nd, 7th, 15th, and 30th days post-thoracoscopy. At autopsy a detailed macroscopic study was carried out and some biopsies were taken for histology. In the control group, the inflammatory reaction was very moderate and rapidly disappeared whereas in the groups treated with talc, the talc led to an exudate of several millimeters, the exudate of inflammatory reaction was acute and early (J1) and involved the pleural in particular on the costal surface and was more moderate on the visceral surface and only involved the lung to a thickness of 2 or 3 mm and a few peripheral alveolar spaces. The granulomatous reaction occurred later (from the 3rd day) and was accompanied by the formation of a symphysis by the deposition and coagulation of fibrin which continued from the 7th to the 15th day, and became solid on the 30th day post-thoracoscopy. There was no significant difference between the two groups treated with talc, implying that the reaction was linked to the talc and was independent of the dose used.

Animals↗
PubMedDate not supplied

[Thoracoscopic management of suspected thoraco-pulmonary malignant diseases in pediatric age].

Recent improvements and miniaturization of instruments have encouraged a wider use of thoracoscopy and laparoscopy as a modality for diagnostic and operative procedures in pediatric age. The utility of thoracoscopy in pediatric patients with suspected thoracopulmonary oncological diseases is shown by diagnostic accuracy and, if necessary, the possibility to perform at the meantime a mininvasive surgery. We report the experience of our Institution in 16 patients with suspected thoraco-pulmonary oncological diseases and treated for this reason with thoracoscopy. Thoracoscopic is indicated in cases of suspected oncological diseases in children both for diagnosis and treatment.

Adolescent↗
PubMed2005

[A case of malignant mesothelioma showing rapid progression during one month].

A 57-year-old man with massive right pleural effusion was admitted to our hospital. Thoracoscopy revealed, fine granulations and small nodules scattered on the parietal pleura. Biopsy specimens suggested malignant mesothelioma. We performed thoracoscopy again one month later under general anesthesia to make a definitive diagnosis. At that time, the parietal pleura was covered with a large tumor and malignant mesothelioma was diagnosed by biopsy. We could find early pleural lesions of malignant mesothelioma in thoracoscopy. While we managed to make a definitive diagnosis, the tumor progressed rapidly during one month. If malignant pleural mesothelioma is suspected, it is necessary to make all efforts, including surgical biopsy, to diagnose during the early stage of disease.

Biopsy↗
PubMedDate not supplied

[Thoracoscopic pleurodesis in malignant pleural effusions].

We performed retrospectively study on 136 thoracoscopies done in our clinic in the period January 2000 and December 2004. We reviewed 136 thoracoscopies, 71 patients were male and 65 were female (mean age 58.4 years). Straw colored effusions were present in 78 cases (57%) and hemorrhagic in 58 cases (43%). The surgical procedure consist in diagnostic of thoracoscopy with drainage of pleural effusion, multiply pleural biopsy, pleurodesis and continuous pleural drainage. In our study, the talc powder (5g) was successfully as sclerosing agent. The primary tumor was: lung-63 (46%), breast-26 (19%), mesothelioma-21 (15.5%), stomach-3, ovarian-3, prostate-3, colon-2, lymphoma-1, leukemia-2, plasmocytoma-1 and unknown primary tumor in 11 cases (8%). Adverse effects included-chest pain-35 cases (25%), fever-20 cases (15%), empyema-6 cases (4.5%), prolonged air leak-5 cases (4%), pulmonary infection-2 cases, acute respiratory failure-1 case, malignant invasion of scar-1 patient. For statistical analysis, the success of talc pleurodesis was defined as the absence of pleural fluid on the follow-up chest radiographs. Pleurodesis was successful in 125 cases (92%) of the patients after 1 month-follow-up. Thoracoscopic talc pleurodesis is a safe, economical and effective treatment for malignant pleural effusion.

Adult↗
PubMed1991

Thoracoscopic ablation of blebs using PDS-endoloop in recurrent spontaneous pneumothorax.

Thoracoscopy has specific advantages over traditional open thoracotomy, including shorter hospitalization, decreased recovery time, and an earlier return to the work force. Thoracoscopy and bleb ablation using sophisticated lasers has been successful in treating spontaneous pneumothorax. We have recently completed thoracoscopy bleb ablation with PDS Endoloop (Polyclioxanone, Ethicon, Inc., Somerville, NJ, U.S.A.) and pleurodesis in a patient with a recurrent spontaneous pneumothorax. The chest tube was removed and the patient discharged on the 3rd postoperative day. He returned to work on the 7th postoperative day. This new procedure can be used on selected patients with small blebs.

Adolescent↗
PubMed2005

[Diagnostic and treatment strategy for patients with the first episode of primary spontaneous pneumothorax].

A retrospective analysis of 198 patients (164 men and 28 women) with the first episode of primary spontaneous pneumothorax (PSP) was made. All the patients underwent diagnostic thoracoscopy (DT) under local anesthesia before insertion of a chest tube. For 115 patients the chest tube thoracoscopy was the only treatment procedure (group I) and 77 patients underwent video-assisted thoracoscopic (VATS) wedge (atypical) resection and pleurectomy (group II). The patients were followed-up from 13 through 77 months. In group I there were 19 recurrences (16.5%), and only two recurrences in group II. In patients of group II having no pathological changes there were no recurrences while in group I there were two (3.3%). The recurrence rate in patients with pathological changes (II, III and IV stages of Vanderschuren classification) was 3% after VATS and as high as 31.5% after the chest tube treatment. The diagnostic thoracoscopy should be performed in all patients with the first episode of PSP for the assessment of the lung and pleura condition. The presence of any pathological changes points to a high risk of recurrences and should be considered as an indication for antirelapse measures (VATS). Surgery is not necessary when no morphological alterations are revealed at DT.

Adult↗
PubMed2006

Thoracoscopic pleural biopsy for tuberculous pleurisy under local anesthesia.

OBJECTIVE: We directly examined the thoracic cavity by thoracoscopy under local anesthesia, performed pleural biopsy, and made a definitive pathological diagnosis in tuberculous pleurisy. SUBJECTS AND METHODS: We performed a retrospective study of 32 patients who had been bacteriologically and pathologically diagnosed with tuberculous pleurisy by thoracoscopy under local anesthesia in our hospital between January 1995 and November 2004. RESULTS: Bacteriological examination of pleural fluids obtained by thoracentesis before examination showed that one sample was polymerase chain reaction (PCR)-positive, and 5 samples were culture-positive. Bacteriological examination of pleural fluids obtained by thoracoscopy revealed that 2 samples were PCR-positive, and 5 samples culture-positive, including 2 preoperatively positive samples. The adenosine deaminase (ADA) levels ranged from 18.3 to 279.0 U/L, with a mean of 72.9 U/L, including 50 U/L or less in 5 patients and 35 U/L or less in 3 patients. Thirty patients (93.8%) were successfully diagnosed by pleural biopsy with pathological examination, and 21 (65.6%) of them by pathological examination alone. CONCLUSION: In patients with suspected tuberculous pleurisy, thoracoscopic pleural biopsy under local anesthesia should be actively performed, because the technique has a high diagnostic rate, and can be easily and safely performed.

Adenosine Deaminase↗
PubMed1990

[Diagnosis of pleurisy].

Nowadays, the diagnosis of pleural effusion is greatly facilitated by thoracoscopy. Since most pleural effusions are due to neoplasias (notably in patients older than 40 years) and since the prognostic value of an early diagnosis is obvious in case of pleural carcinoma (notably mesothelioma), there is no justification in allowing the effusion to become chronic. If the diagnosis is confirmed by needle biopsy, thoracoscopy can rapidly be performed by skilled operators: in 95 p. 100 of the cases it provides the diagnosis. Five per cent of pleural effusions remain of unknown origin. In such cases the patients must be closely followed up for 12 to 18 months to make sure that no cancer has been missed and another thoracoscopy must be performed at the slightest clinical change. Test treatments (antibuberculous drugs, corticosteroids) are now obsolete.

Biopsy, Needle↗
PubMed1990

[Experiences in the diagnostic and surgical video-endoscopy of the thoracic cavity].

Thoracoscopy is a well-established method for diagnostic evaluation of various manifestations of intrathoracic disease, with a high degree of sensitivity and specificity. While a rigid telescope is generally used, we have modified this technique by connecting a CCD-chip-camera to the thoracoscope to achieve direct visualization for observers. 52 patients were examined in this manner, 18 for diagnostic reasons and 35 for therapeutic purposes. The mean age of the patients was 55 years, ranging from 26 to 84 years. Potential risk factors associated with this modified endoscopic procedure were analyzed. Mortality was zero, but complications occurred in 5.6%. Surgical re-intervention was necessary in two cases for control of postoperative intrathoracic hemorrhage; in another case the introductory trocar caused superficial injury to the lung without further consequences. In these complications extensive scarring of the pleura was noted. It is only natural that the rate of complications is closely associated with a learning period during which the operative technique is improved. Following adequate mastery of the technique our goal is presently to treat spontaneous pneumothorax and malignant effusions by thoracoscopy. We strongly recommend treatment of malignant effusions and pneumothorax by thoracoscopy as a primary procedure and not secondarily when blind attempts at pleurodesis have failed and given rise to partially obstructive adhesions.

Adult↗
PubMed1990

[Pleuroscopy in the preoperative staging of bronchial cancer].

The use of pleuroscopy or thoracoscopy in preoperative staging and resectability assessment of lung cancer is uncommon. Diagnostic and exploratory thoracoscopy could be helpful in three circumstances: when malignant pleural effusion is suspected with a lung cancer, while all the initial investigations remain negative: (cytology, needle-biopsy); in cases with radiological images (using CTs-can or MRI) of small metastatic pleural masses without effusion: thoracoscopy is performed after creating a pneumothorax; when mediastinal or hilar extension of the tumor and lymph-nodes (especially in the left superior mediastinum) cannot be reached for biopsy by mediastinoscopy or parasternal mediastinotomy. The investigation is performed under general anesthesia using double-lumen selective intubation and lung exclusion. This procedure provides a better view of the pleural space and mediastinal and hilar areas; macroscopic involvement of vital structures, organs or vessels can be easily seen and large biopsy specimens safely taken, without any postoperative morbidity. Talc insufflation for pleurodesis is added in patients with massive pleural effusion. Failures of the method or false-negative biopsies are related to previous pleurodesis, pleural partition, or adhesions. The contribution of CT scan and MRI imaging is mandatory to determine indications and to select the best endoscopic approach.

Aged↗
PubMed1988

[Thoracoscopic diagnosis and therapy of spontaneous pneumothorax].

Thoracoscopy must be regarded as an obligatory procedure in the diagnosis and therapy of symptomatic spontaneous pneumothorax. In up to 81% of cases data obtained by thoracoscopy considerably influence therapy. Indication for surgery has to be weighed against endoscopic therapy (coagulation, laser and pleurodesis). Thoracoscopy should be performed at the first recurrence of an idiopathic spontaneous pneumothorax, unless the lung does not expand during suction drainage or recollapses after expansion.

Aprotinin↗
PubMed1989

[Treatment of recurrent pneumothorax applying fibrin adhesive under endoscopy].

Recurrent or chronic pneumothorax may be treated by thoracoscopy and the administration of substances to achieve a symphysis. Several substances have been tried and amongst these talc currently gives the best result. This study looked at the action of a fibrin adhesive (Tissucol) administered through a thoracoscope to achieve a pleural symphysis. 32 patients were treated, all suffering from recurrent pneumothoraces and a thoracoscopy was carried out under local anaesthetic using the standard technique, the Tissucol was spread over the apico-axillary region in a dose of 2 ml. After one year's follow up a success rate of 75% was noted. If category IV pneumothorax was excluded (bullous dystrophy) the percentage of favourable results was 35%. The painless nature of Tissucol applications was noted and this method thus gives satisfactory results in pneumothorax where there is no apparent bullous dystrophy and perhaps can be used as a therapeutic technique during a thoracoscopy where important bullous dystrophy is not noted as the cause of the pneumothorax.

Adolescent↗
PubMed1988

[Current therapeutic attitudes on pneumothorax in adults].

Recent advances in thoracoscopy and surgical procedures have led to modifications in therapeutic approaches to easily diagnosed pneumothorax. These procedures make it possible to adjust therapy to the severity and underlying causes of the disease which may vary from simple bullous dystrophy to neoplasia. For simple pneumothorax, a suitable treatment may be to put the patient under observation or exsufflation, but thoracoscopy has the advantage of visualizing the lesion and, in certain cases, enables it to be treated. Surgery is indicated when an extensive bullous system is seen at thoracoscopy or when this technique is unsuccessful. A considerable reduction in the risk of relapse of this usually benign condition should be expected.

Emergencies↗
PubMedDate not supplied

[New techniques in thoracic surgery. II].

The surgical approach to affections of the chest wall and pleura, still the predominant indications for thoracic surgery, has greatly changed since the advent of thoracoscopic procedures, and is emphasized in this second part of a two-part review, together with other indications for mediastinal tumours. Indicated after lung exeresis or emergency chest surgery, protective chest wall reconstruction with muscular flaps is no longer an exceptional operation. Inversely, thoracic surgery for infectious complications have become less frequent, unusually limited to well established procedures for tuberculosis surgery, treatment of bronchial fistula or mediastinal supperations. The chest cavity is well adapted to new techniques of thoracoscopy and video-assisted thoracic surgery both for diagnosis and treatment. Indications for pleuroscopy have taken on a completely new aspect since 1989. These techniques are used for pericardial fenestration, thoracic sympathectomy for dyshidrosis, vagotomy, splanchnicectomy, chylothorax, spinal affections, empyema and trauma surgery. These new techniques have also had an impact on treatment of spontaneous pneumothorax. For tumour surgery, thoracoscopy has made possible a more adapted strategy currently based on an initial needle biopsy, with limited thoracoscopic exeresis and ultimate treatment depending upon the pathology report. Immediate thoracoscopy without prior biopsy appears excessive. Video-assisted thoracosurgery is also used for most malignant mediastinal tumour which, due to advances in chemotherapy surgery have transformed the prognosis of a large number of mediastinal tumours.

Bronchial Fistula↗
PubMed1995

[Therapy of acute empyema thoracis using thoracoscopic instruments].

Adequate pleural drainage is imperative for the treatment of acute empyema thoracis. But chest tube drainage sometimes cannot operate effectively if blocked by intrathoracic loculations. We successfully treated two cases of acute empyema thoracis using thoracoscopy. These patients had both undergone closed intercostal drainage, but the drains had not worked effectually. We performed thoracoscopy under local anesthesia. Loculations were broken by the thoracoscopic instruments. After pleural irrigation, chest tubes were properly positioned under thoracoscopy. It seems likely that thoracoscopic procedures may be useful in shortening the length of hospitalization and in improving lung re-expansion of acute empyema thoracis patients.

Acute Disease↗