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PubMed2002

[Usual interstitial pneumonia associated with psoriasis vulgaris].

The patient was a 56-year-old man who had received diagnoses of psoriasis vulgaris at the age of thirty-three and of nephrotic syndrome at forty-five, and had been treated with prednisolone. He consulted the outpatient clinic because of a cough, and interstitial pneumonia was diagnosed. He was admitted to our hospital because his symptoms and chest radiographic findings continued to worsen under treatment with antitussives. Chest radiography revealed a linear-reticular shadow in the lower lung fields. Chest computed tomography also revealed micro-cystic lesions, reticular shadows and traction bronchiectasis underneath the pleura at the back of both lower lobes. His serum titer of antinuclear antibody was increased, but he had no other symptoms or autoantibodies. Surgical lung biopsy under thoracoscopy revealed usual interstitial pneumonia (UIP). The association of interstitial pneumonia with psoriasis vulgaris is rare.

Biopsy↗
PubMed2002

[Surgical treatment of chronic nonspecific empyemas].

Approximately 4% to 20% of all acute empyema turn into chronic empyema despite the up-to-date complex treatment. The authors report their results of the surgical treatment of 38 patients with chronic nontuberculous empyema within a 5 years period. The age of the patients range from 18 to 72 years and they include 26 men and 12 women. Twenty eight were treated by thoracotomy and decortication, 7 underwent video-assisted thoracoscopy and decortication, and 3 thoracoplasty. In one of the patients a latissimus dorsi muscle flap was used.

Adolescent↗
PubMed2003

[Three cases of respiratory bronchiolitis-associated interstitial lung disease (RB-ILD): a study of HRCT-pathologic correlation].

Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is a clinicopathologic entity occurring rarely in smokers. We report three cases of RB-ILD diagnosed pathologically by surgical lung biopsy. Cough was observed in all cases, sputum in one case and dyspnea on exertion in another. Reduction of diffusing capacity was observed in all three cases. No abnormality was found in the chest radiographs of any case. However, in high-resolution computed tomography (HRCT), ground-glass opacities and centrilobular nodules were observed in all three cases, emphysema in one case, intralobular linear or reticular opacities in two cases, small subpleural cysts in two and emphysema in one. Histologic examination of lung biopsy specimens taken by thoracoscopy showed peribronchiolar fibrosis and centrilobular intraluminal accumulation of macrophages in all three cases, centrilobular emphysema, membranous bronchioles filled with mucus and macrophages, and focal microscopic honeycombing in subpleural lesions in one case each. RB-ILD should be included in the differential diagnosis of interstitial lung disease in smokers.

Bronchiolitis↗
PubMed2003

[Catamenial pneumothorax in a young patient diagnosed by thoracoscopic surgery; report of a case].

A 16-year-old woman presented with chest pain on 2 days before the onset of menstruation and was referred to our hospital because of a pneumothorax. She was diagnosed as spontaneous penumothorax and surgical treatment was performed. Thoracoscopy revealed the presence of multiple blueberry spots near central tendon of the diaphragm and little pleural effusion. No other abnormal lesions were found in the left pleural cavity and left lung. Thoracoscopic biopsy and coagulation of the lesions were successfully performed. Histological findings of biopsied specimen did not contradict as an endometoriosis and catamenial pneumothorax was diagnosed. CA 125 level of the pleural effusion had increased to 99.2 U/ml. Because she was young, she did not receive a systemic hormonal therapy.

Adolescent↗
PubMed2003

[Experiences with endoscopic thoracic sympathectomy].

PATIENTS AND METHOD: Thoracic sympathectomy using thoracoscopy was performed in 38 cases on 35 patients from January 01. 1996, till December 31. 2000. In 3 cases bilateral sympathectomy was carried out. The youngest patient was 18, the oldest was 76 years old, the average age was 42 years. The indications for surgery were Raynaud syndrome, causalgia, post-traumatic sympathetic dystrophy, thoracic outlet syndrome combined with vasospastic syndrome, Buerger syndrome, obliteration of digital arteries, embolism and hyperhidrosis. This method was chosen if conservative therapy was unsuccessful. Laparoscopic instruments are particularly suitable for minimal invasive interventions. RESULTS: Authors describe their operative technique whereby the postoperative pain and also the duration of hospitalisation can be reduced, and the cosmetic result can be improved. In two cases conversion was the only choice due to pleural adhesions. Pneumothorax occurred in two cases, haemothorax in one case and transient intercostal neuralgy was seen in 3 cases. In four cases sympathetic activity returned during the follow up. Ceasing the sympathetic innervation dilates the arterioles of the skin, and the temperature of the skin increases. During follow-up the complaints of the patients improved significantly, the progression became slower and clear improvement was found with instrumental investigations. CONCLUSION: This method can be recommended to every institute where the conditions for traditional laparoscopic surgery are given and staff is experienced in thoracotomy.

Adult↗
PubMed2003

[Thoracoscopic resection of localized fibrous tumor of the pleura; report of a case and review of the Japanese literature].

A 61-year-old female was admitted with abnormal shadow on chest X-ray. Chest computed tomography (CT) showed a clearly localized flat tumor at the peripheral region of the left lung. We suspected localized fibrous tumor of the pleura (LFTP) and performed video-assisted thoracic surgery (VATS). Under the thoracoscopy, the tumor was connected to the visceral pleura with a short pedicle and completely resected with safety margin. Pathological findings, including immunohistochemical examination, definitely revealed benign LFTP. VATS is a good indication for the diagnosis and treatment of LFTP. This case was reported together with some reviews of the literature.

Female↗
PubMed2003

[The optimal procedure for chylothorax after operation for thoracic esophageal cancer; reasonable approaches to the thoracic duct from the point of view of routes for esophageal replacement].

In general, chylothorax after esophagectomy with lymph node dissection under thoracotomy is a rare postoperative complication. We report a 71-year-old man who developed chylothorax following esophagectomy and 3-field lymph node dissection together with reconstruction using stomach through the posterior mediastinum, and discuss ideal approaches that are less invasive and make it possible to provide better exposure of the thoracic duct. In selecting the ideal approach, the most important thing is differences in routes for esophageal replacement. The anatomical relation between the location of a conduit adopted for reconstruction of the resected esophagus and the thoracic duct should be considered in each case. In the case of the retrosternal or antesternal route, a video-assisted thoracoscopic approach allows for easy detection of the thoracic duct while reducing surgical invasiveness, because there is no conduit in the posterior mediastinum. On the other hand, a conduit interrupts the visual field of thoracoscopy in the case of the posterior mediastinal or intrathoracic route. Drawing up of a conduit to gain a good operative field involves some risks in protection of the vascular pedicle. Therefore, a transabdominomediastinal approach is an optimal option. With this approach, we could easily find the thoracic duct and directly ligate it just cranial to the hiatus, resulting in a remarkable decrease in discharge through the thoracic drainage tube. In addition, we present an intelligible intraoperative photograph.

Aged↗
PubMed1992

[Conservative therapy of malignant pleural effusion].

The nonsurgical treatment of malignant pleural effusion is palliative in principle. This aim must be achieved with a minimum of side effects and risks to the patients. Before treatment, a clear histologic diagnosis must be made. Thoracoscopy offers a fast and safe result with a more than 90% reliability. Systemic cytotoxic treatment and local procedures are available. Using pleurodesis, talkum is clearly superior to tetracycline in achieving a very low recurrence rate. The median survival in 287 patients was 9 months.

Chemotherapy, Adjuvant↗
PubMed2003

[Cutaneous metastasis of pleural mesothelioma: two cases].

INTRODUCTION: Cutaneous manifestations of pleural mesothelioma are rare, polymorphic, and occur at various stages of the disease. CASE REPORTS: Case 1. A 60 year-old man, 6 months after the initial diagnosis of a pleural mesothelioma, developed a right latero-thoracic subcutaneous nodule. The lesion resulted from an inoculation of tumoral cells to the wall at the time of the initial thoracoscopy. No specific treatment was proposed. Case 2. A 62 year-old man, with a history of pleural mesothelioma developed an inflammatory layer of the left chest wall. The lesion, laid out like an hemi-belt, was centred by the thoracotomy scar and was associated with retraction phenomena of the thoracic wall. The lesion corresponded to a direct extension of the mesothelioma to the wall. At the same time, the pleural disease was progressing. The patient died a few weeks later. COMMENTS: Cutaneous manifestations usually occur when the diagnosis of primitive pleural cancer has been already established. Distant cutaneous metastases are exceptional and involve with predilection the cephalic extremity. The majority of cutaneous lesions are distributed near the tumoral site and represent either a direct extension of the tumor to the thoracic wall, or a malignant seeding by diffusion of the pleural fluid at the time of the diagnostic and therapeutic procedures.

Cicatrix↗
PubMed2003

Minimally invasive surgery for pediatric solid neoplasms.

The role of minimally invasive surgery (MIS) in children with solid neoplasms is slowly evolving. MIS appears to be an ideal way to obtain diagnostic information (i.e., tissue biopsy) in children with solid neoplasms, but its role as an ablative/curative technique is controversial. We examined the safety, reliability, and outcome of decisions made on the basis of MIS performed in children with solid neoplasms. A total of 28 children (19 boys and nine girls; age range, 14 months to 17 years) with solid neoplasms underwent 29 MIS procedures between July 1, 2000 and June 30, 2002. Complications, biopsy results, and outcomes were reviewed. Successful ablation via MIS was defined as clear microscopic margins on permanent pathology and no evidence of remnant disease on follow-up diagnostic radiological examination. There were 20 thoracoscopic and nine laparoscopic procedures. Laparoscopy included purely diagnostic without tissue biopsy or simply determination of resectability (two), incisional biopsy (two), and excisional biopsy (five; two adrenalectomy and three oophorectomy). Thoracoscopy included 15 lung biopsies and five biopsies of mediastinal masses. Diagnostic accuracy was 100 per cent in all cases. MIS as an ablative technique was successful in 10 of 10 cases. No children were found retrospectively to have been inadequately treated via MIS. We conclude that MIS can be used safely and successfully to diagnose children with suspicious solid neoplasms. Furthermore MIS may have a role as an ablative/curative technique in carefully selected circumstances.

Adolescent↗
PubMed1992

[Treatment of spontaneous pneumothorax under videosurgery, 32 cases (with videofilm presentation)].

From September, 1991, to June, 1992, 32 cases of pneumothorax were operated with thoracoscopy (video surgery). The indication was established for second recurrence in 6 cases, first recurrence in 14 cases, a persistent bulla or a lung failing to return to the wall after a first pneumothorax in 5 cases, and in the presence of a large pulmonary bulla on radiographs or CT scans during an initial episode in the last 7 cases. Thoracic CT was performed in 18 cases and demonstrated a system of bullae in 14 (13 in the apical segment and 1 in the segmentum apicale). The procedure included exeresis of the bullae on endo-GIA with apical and posterolateral parietal pleurectomy. In two cases, conversion into axillary thoracotomy was required because of extensive pleural adhesion in one case and of a technical problem in the other. The average duration of surgery was 72 mn. The thoracic drains were removed on the 2nd and 3rd postoperative days. Partial pleural detachment occurred in two cases, one on the 4th day and the other on the 5th day after surgery, with spontaneous return to the wall on the 8th day in both cases. The average stay in hospital was of 6 days. All patients were examined 15 days after discharge with a control radiograph, which was normal in all cases. No patient complained of parietal pain when no conversion into thoracotomy was made.

Adolescent↗
PubMed2003

[Inflammatory pseudotumor diagnosed by thoracoscopic resections; report of a case].

A 65-year-old woman was referred to our hospital because of cough and sputum. Chest CT scan revealed a coin lesion (about 1.5 cm diameter) with slight speculation at the right upper lobe. We suspected a lung cancer and performed video assisted thoracic surgery (VATS). Under the thoracoscopy, the tumor was completely extirpated with safety margin by the partial resection of the right upper lobe. Pathological findings definitely revealed inflammatory pseudotumor, fibrohistiocytic variant type. VATS is a good indication for the diagnosis and treatment of inflammatory pseudotumor. This case was reported together with some reviews of the literature.

Aged↗
PubMed2003

[Esophageal diverticula].

Esophageal diverticula are considered to be rare but this has not deterred interest in the condition, either historically or in the present era. Most parabronchial esophageal diverticula are traction diverticula, and resection is thought to be unnecessary. The majority of pharyngoesophageal diverticula and epiphrenic diverticula are pulsion diverticula. It is now well accepted that they correlate with underlying motor disturbance and that surgery is indicated. If there is motor disturbance is preoperative manometry, it is necessary to add myotomy. However, if there is no motor disturbance, the surgical management remains controversial. Recently, minimal access surgery with laparoscopy or thoracoscopy has been successful in the treatment of epiphrenic diverticulum.

Diverticulum, Esophageal↗
PubMed2003

[Technique for vascular management under thoracoscopic surgery].

Vascular injury is the most life-threatening complication under thoracoscopic surgery. To reduce the risk of vascular injury, knowledge of the anatomy of the pulmonary artery, variations in its branching, skillful techniques and careful maneuver are necessary. Pulmonary artery being adherent to bronchus is dangerous to dissect under thoracoscopy, so it is better to convert to open thoracotomy. A3 of the left upper lobe is occasionally injured during dissection. It is a safety technique for using vascular stapler under thoracoscopic surgery. Stapler leader can allow the passage of a stapler to encircle the vessel.

Female↗
PubMed2003

[Thoracoscopic segmentectomy of the left upper division in a patient with endobronchial hamartoma; report of a case].

A 71-year-old man was admitted to our hospital for treatment of an endobronchial tumor. Although he was asymptomatic and chest radiography showed no tumor shadow, bronchoscopic findings demonstrated an endobronchial tumor with a villous surface occluding the bronchus of the left upper division. Endobronchial resection was abandoned because we could not directly observe the cervix with a bronchoscope. In addition, because we could not diagnose the tumor histologically as benign by biopsy specimens, we elected to perform a segmentectomy of the left upper division. To reduce surgical stress, the operation was carried out using thoracoscopy. The tumor was finally diagnosed as endobronchial chondromatous hamartoma. The patient's postoperative course was uneventful. When endobronchial resection is not feasible, a less invasive surgical approach and method should be taken in patients with suspected endobronchial hamartoma.

Aged↗
PubMedDate not supplied

Thoracoscopic pericardial window creation and thoracic duct ligation in neonates.

OBJECTIVE: We describe 2 newborn infants with persistent pericardial effusion treated with thoracoscopic pericardial window and thoracic duct ligation. METHODS: Patient 1 was a premature female newborn who presented with severe cardiac anomalies, including dextrocardia. She was treated with pulmonary artery handing and pacemaker placement for complete cardiac block. Postoperatively, she developed pericarditis with persistent symptomatic pericardial effusion. She did not improve despite pericardial drain placement. She was treated with a thoracoscopic pericardial window. Patient 2 was a newborn male who presented with cardiac tamponade secondary to congenital chylopericardium. He did not respond to pericardial drain placement or medical management with fasting, total parenteral nutrition, and octreotide. He was treated with thoracoscopic pericardial window and thoracic duct ligation. RESULTS: Patient 1 improved rapidly. The pericardial effusion disappeared. The chest tube was removed 5 days following surgery. She died 6 weeks later of a cardiac arrhythmia secondary to pacemaker failure. The pericardial effusion had resolved. Patient 2 responded to the pericardial window and thoracic duct ligation. He was discharged 10 days following the procedure. CONCLUSIONS: Thoracoscopy provides an excellent approach to the pericardium. Pericardial windows and biopsy can be safely performed with this approach. The thoracic duct can be easily identified and ligated even in small babies. Recovery can be fast with minimal postoperative discomfort. Cosmetic results are excellent and length of hospitalization is minimized.

Fatal Outcome↗
PubMedDate not supplied

Extraperitoneal endometriosis with catamenial pneumothoraces: a review of the literature.

OBJECTIVE: To present a case of recurrent catamenial pneumothorax and diaphragmatic endometriosis that was managed thoracoscopically. A review of the literature is also presented. METHODS: A-28-year-old woman presented with bloody stools, chronic constipation, and chest pain. A review of systems was positive for monthly chest pain associated with her menses. A preoperative chest x-ray revealed a right pneumothorax. Colonoscopy revealed biopsy proven endometriosis of the sigmoid colon. A pelvic computed tomography scan revealed bilateral complex, cystic and solid adenexal lesions. RESULTS: A right thoracoscopy was performed. A lesion on the right hemidiaphragm was excised and confirmed to be endometriosis. A wedge section of lung tissue containing a bleb was resected and also contained endometriosis. Three months later, the patient underwent laparoscopic excision of her pelvic endometriosis, including a low anterior rectal resection. Five months later, she presented again with right-sided chest pain. A thoracoscopic right total pleurectomy was performed for recurrent pneumothorax. CONCLUSION: Pullmonary endometriosis may present as chest pain, shortness of breath, or hemoptysis associated with menstrual cycles. This case emphasizes the importance of a careful review of systems in patients with known endometriosis. Management now includes an endoscopic alternative and all of its known benefits.

Adult↗
PubMed2003

[Pleural biopsy in the diagnosis of pleurisy: potentialities and efficiency].

The results of pleural biopsy were analyzed in 293 patients with exudative pleurisy, among whom a group of free pleurisy included 88 cases, encapsulated pleurisy and pleural obliteration were observed in 156 and 11 patients, respectively. Thoracoscopy with visual pinching pleural biopsy was performed in 59 patients puncture pleural biopsy was made in 234 patients. There is evidence for that thoracoscopic pleural biopsy had a significant advantage in pleurisy in the phase of organization. An original procedure that has allowed indications for thoracoscopic pleural biopsy to be expanded by covering patients with pleurisy in the phase of organization is presented.

Biopsy↗