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PubMedDate not supplied

[Thorascopy under local anesthesia (author's transl)].

Thoracoscopy has proved to be a method of investigation which can give important diagnostic information in diseases of the pleura, the diaphragm, the mediastinum, the thoracic wall and in some peripheral pulmonary lesions. Th procedure can be accomplished safely under local anesthesia which has important advantages in the better recognition of certain abnormalities and avoids a general anesthesia in many patients in a poor cardiopulmonary conditions.

Anesthesia, Local↗
PubMed1981

[The metrology of mineral fibres in thoracoscopic lung and pleural biopsies. Preliminary results (author's transl)].

Metrology of mineral fibres by electron microscopy was carried out in thoracoscopy specimens ("normal" parietal pleura, pleural plaque, tumour, lung) obtained from different sites in 19 patients: 9 exposed to asbestos and 10 non-exposed controls. With regard to results concerning the parietal pleura, the differences in exposure of the patients (as revealed by history) were not reflected by metrological characteristics (nature and number of fibres, size, topographical distribution) and it was impossible to distinguish the exposed cases from the controls. The number of fibres ("non-measurable presence" being 130.10(3) fibres/g) did not differ significantly between the two "exposed" and "non-exposed" groups. By contrast, the number of fibres found in lung biopsies was in general very high in exposed patients (up to 379.10(3) fibres/g.) In 3 non-exposed patients, there was no asbestos in the lung. Broadly speaking, metrological data were similar to those previously obtained in other cases and using surgical or autopsy specimens. This reinforces the validity of the method of metrology in thoracoscopic specimens and confirms the complexity and difficulties of assessment of pleural involvement. The advantages of study of early pleural specimens obtained under thoracoscopic control in comparison with surgical or autopsy specimens remains to be determined in a larger number of cases. The safety of the method should be emphasized, no complications having been seen in this series.

Asbestos↗
PubMed1981

[Pleural talcage in patients with spontaneous pneumothorax (author's transl)].

The insufflation of iodinised (1%) sterile talc in patients with spontaneous pneumothorax is presented as a safe and valuable method of treatment. A recidive pneumothorax occurs in 6.6% of the patients. This form of treatment should only be used in the forms of pneumothorax without bullous degeneration, which should be treated surgically. Pleural talcage can be performed under local anesthesia, without harmful repercussion on the patient or on the VC, FEV1, and diffusion capacity. In our experience, thoracoscopy provides the inestimable and necessary information for choosing the best way of treatment in patients with a spontaneous pneumothorax.

Humans↗
PubMed1981

[Pulmonary biopsy under visual control (author's transl)].

Out of more than 3 000 diagnostic thoracoscopies carried out in the Chest Hospital Heckeshorn since 1950, a pneumothorax was induced in 43% because of pulmonary lesions and in 16% because of disease of the mediastinum or of the thoracic wall. The pathologic changes can be differentiated more exactly by the use of telescopes than by the naked eye. Biopsies can be taken from several different points under visual control. We did not observe major bleedings in our cases with biopsy specimens as large as raisins. The post thoracoscopic suction drainage should be performed through tubes with a caliber of 8 mm and with multiple side holes. A negative pressure of 100 mbar and a pumping flow of more than 3, 51/min has to be applied. The mean time for drainage was 3.4 days, long-lasting fistulas were not seen. A protective antibiotic therapy can be discussed after five days of intrapleural suction. 87% of the lung biopsies revealed a specific morphological diagnosis. In only 13% of the cases additional open biopsy was indicated. This gave new informations in about one half, in the remaining cases the thoracoscopic findings were confirmed. We used the rigid 8 mm-thoracoscope (Storz) with a cold-light source. Only one trocar and one cannula are necessary because observation, photography biopsy, puncture, suction and diathermy are possible through the one-channel thoracoscope. In our opinion, flexible fiberoptics have more disadvantages than advantages.

Adolescent↗
PubMed1981

Thoracoscopic biopsy under visual control.

Description of a method to obtain by thoracoscopy adequate material for different investigation - purposes, in behalf of the pathologist in the first place. The thoracoscopic lung-biopsy has become in our clinic a routine diagnostic procedure in almost all cases with diffuse alterations on the chest X-ray. It is also practised in some cases of pleural effusion of unclear genesis. The method competes with other procedures like needle biopsy, surgical biopsy, transbronchial biopsy and sometimes mediastinoscopy. Induction of an artificial pneumothorax is essential. The procedure is almost painless under local anaesthesia and very weel tolerated by the patient. No complications of any importance were observed. The results of 115 cases (over a period of 15 years) are presented and discussed. Because of the safety and the very high percentage of positive pathology (95%) we regard the method as a procedure of first choice.

Adolescent↗
PubMed1994

The history of cervicothoracic sympathectomy.

As early as in 1889 surgery on the cervical sympathetic nervous system was performed. During the following decades this operation was tried for a variety of diseases. In the early 1920s it was clarified that patients with hyperhidrosis, vasospastic conditions, and angina pectoris would benefit from stellectomy. It was, however, soon discovered that removal of the upper thoracic ganglia was required in order to obtain complete sympathetic denervation of the upper extremity. Several open surgical techniques for upper thoracic sympathectomy were described. During the 1940s a few pioneers started to excise sympathetic ganglia by thoracoscopy which had originally been described as a diagnostic tool by Jacobaeus in 1910. The endoscopic approach, amply documented by Kux in 1954, did not, however, gain widespread popularity until the 1980s. Like the general upsurge of interest in endoscopic surgery, thoracoscopic ablation of the upper thoracic sympathetic ganglia is now rapidly being adopted by surgeons.

Ganglia, Sympathetic↗
PubMed1994

Bilateral thoracoscopic lower sympathetic-splanchnicectomy for upper abdominal cancer pain.

Upper abdominal pain secondary to cancer may cause great disability to patients. Surgical sympathetic-splanchnicectomy, or coeliac plexus block, has been used to relieve intractable upper abdominal cancer pain from stomach, liver, gallbladder or pancreas for a long time. There are, however, intrinsic disadvantages when performing these procedures. Due to our long experience of therapeutic thoracoscopy, we recently performed bilateral thoracoscopic sympathetic-splanchnicectomy on 14 patients (eight male and six female) for relief of pain from primary or metastatic upper abdominal cancers. Most of them were satisfied with the immediate pain relief after the operation. In this new era of therapeutic endoscopy, endoscopic surgery will gradually take the place of open methods in treatment of many diseases. It can be anticipated that thoracoscopic lower sympathetic-splanchnicectomy is undoubtedly a good alternative method for management of intractable upper abdominal pain.

Abdominal Pain↗
PubMed1994

Thoracoscopically assisted esophagectomy with gastric pull-up for esophageal cancer.

Thoracoscopically assisted esophagectomy with gastric pull-up was done in a 56-year-old man with esophageal cancer. The thoracoscopic technique, including the use of intraoperative ultrasound, is discussed. The addition of thoracoscopy offers safer and more complete esophageal dissection than transhiatal blunt esophagectomy and is less invasive than conventional thoracotomy.

Adenocarcinoma↗
PubMed1995

Thoracoscopic staging of esophageal carcinoma.

Thoracoscopy is an excellent complement to mediastinoscopy in staging thoracic malignancies. The author describes the technique of thoracoscopic and laparoscopic lymph node staging for patients with esophageal carcinoma.

Biopsy↗
PubMed1995

[Thoracoscopic surgery, current indication and technique].

Thoracoscopy has become an important tool in the diagnosis and management of intrathoracic disease. The development of endoscopic suturing techniques and stapling devices for abdominal surgery dramatically expanded the potential of thoracoscopic surgery. Between 1993 and 1994, 43 patients underwent thoracoscopic surgery. Lung resection were performed on 23 patients for pulmonary nodules and on 9 patients for diagnosis of interstitial lung disease. Extirpation were performed on 2 patients for mediastinal tumor. A procedure done thoracoscopically is far less invasive and the postoperative pain and its consequences are drastically reduced. As endoscopic instrumentation develops, newer operations will become technically feasible. We think that indications for thoracoscopic surgery will expand in developing these techniques in the future, if thoracoscopic surgery is safer and more efficient.

Adult↗
PubMed1995

[A case report of traumatic diaphragmatic hernia treated by thoracoscopic surgery].

A 56-year-old man who had been accidentally hit on the right side of the chest about 20 days previously was admitted because of intractable cough. Chest X-ray and CT scan revealed a right-sided diaphragmatic hernia and slight pneumothorax. No other hemorrhagic or perforative complications were detected. On the third hospital day, the patient underwent therapeutic thoracoscopy. Herniated transverse colon and liver were repaired through the abdominal cavity and the lacerated diaphragm was sutured through four thoracoports with video system assistance. The postoperative course was uneventful, and the patient was discharged 28 days later.

Endoscopy↗
PubMedDate not supplied

Intrapulmonary lymph nodes in the differential diagnosis of solitary pulmonary nodules: case report and review of the literature.

A 49-year-old man was admitted for further investigation of a coin lesion with a diameter of 1 cm. He was a heavy smoker with no professional exposure. Since the percutaneous needle biopsy did not yield a definitive diagnosis, a thoracoscopy was performed. The solitary pulmonary nodule was found to be an intrapulmonary lymph node with anthracosilicotic pigment and a thoracoscopic wedge resection was performed. A review of the case reports in the period 1961-1993 shows that intrapulmonary lymph nodes could be more frequent than originally thought. All patients were smokers but professional exposure was not a constant finding. The differential diagnosis and management of the indeterminate solitary pulmonary nodule are discussed.

Diagnosis, Differential↗
PubMed1995

[A case of diffuse malignant mesothelioma diagnosed by thoracoscopic biopsy].

We report a case of diffuse malignant mesothelioma discovered by thoracoscopic examination undertaken while formulating a preoperative diagnosis. A 61-year-old male complained of coughing and sputum production, and was admitted because his chest roentgenogram indicated an abnormal shadow. Chest CT scanning demonstrated right pleural effusion and multiple nodules sited on the diaphragm. Because aspiration biopsy of such nodules was difficult, we performed a thoracoscopic examination. The thoracoscopic findings demonstrated bloody pleural effusion in the right thoracic cavity and multiple nodules on the diaphragm, parietal and pulmonary pleura. They were white and 0.5 to 2 cm in size. By excisional biopsy, these were diagnosed as epithelial-type diffuse malignant mesothelioma. We therefore performed panpleuropneumonectomy. Even though we completely resected the canal of thoracoscope and drainage tube, microscopic findings showed invasion of mesothelioma cells into this thoracoscopic canal. Although we suggest that, in preoperative diagnosis of pleural tumor, thoracoscopy is efficient to perform a pathological examination and confirm the extension of tumor, in the actual operation, we believe that the thoracoscopic canal should be resected.

Biopsy↗
PubMed1995

Thoracoscopic pericardiectomy.

A new technique for pericardial resection is described using thoracoscopy. With the advent of newer videolaparoscopic techniques allowing better visualization and the use of new endoscopic staplers, a whole spectrum of surgical procedures can now be performed through the thoracoscope.

Humans↗
PubMed1995

[An experimental model of pleural adenocarcinoma constructed by the implantation of intact human neoplastic tissue in the nude mouse. The prognostic value of a lesion of the visceral pleura].

In certain cases pleural adenocarcinoma can behave like a primary tumour of the pleura. If the origin of this type of tumour is not clearly established, the macroscopic aspect of the pleura explored by thoracoscopy enables a distinction to be made between isolated disease of the parietal pleura and mixed disease of both the parietal and visceral pleura. The object of this study was to evaluate the prognosis of tumour disease of the visceral pleura. Using a murine model (the nude mouse) of cancer of both visceral and parietal pleura induced by implanting histologically intact human carcinoma, we have compared the symptoms of survival of the two groups of mice as well as the local and regional dissemination and metastases of the implanted tumour. The growth of the tumour was suspected by the appearance of weight loss, signs of respiratory difficulty and/or cachexia. Autopsy examination allowed a measure of the size of tumour dissemination. A pleural cancer, histologically identical to the initial human tumour with invasion of the neighbouring structures as one sees in man, was obtained in all the implants. Nevertheless, contralateral mediastinal lymph node metastases were only found in mice with implants on the visceral pleura. The median survival was 27.9 days and 31 days respectively for implanted mice on the visceral pleura and on the parietal pleura. Mice with implants on the visceral pleural lost more weight than those implanted on the parietal pleura (p < 0.001). The results of this study show that the models of parietal pleura and visceral pleura each correspond to an early stage disease and to a stage of advanced disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1995

[Videothorascopic surgery--initial experience].

Practical experience with the miniinvasive laparoscopic technique in abdominal surgery logically led to extension of this method to thoracic surgery. Video-assisted thoracoscopic operations hold their place in the treatment of spontaneous pneumothorax, pleural syndrome, benign tumours of the thoracic wall etc. A curative solution of malignant diseases by this route is so far controversial and is reserved only for specially defined cases. Experience from the authors' department is based on nine-month use of a thoracoscopic apparatus. The authors operated a total of 21 patients thoracoscopically, incl. pneumothorax 6x, fluidothorax 10x and tumourous disease of the lungs or mediastinum 5x. The use of thoracoscopy is controversial in metastases of the lungs and in thymectomy. With regard to the authors are against thoracoscopic indications in the latter conditions contemporary technical possibilities.

Adult↗
PubMed1995

Surgical therapy of esophageal leiomyoma.

BACKGROUND: Surgical enucleation is the treatment of choice in selected patients with esophageal leiomyoma. The video-thoracoscopic approach can potentially cause less patient discomfort postoperatively and reduce the hospital stay and recovery period. STUDY DESIGN: A retrospective evaluation of 66 patients who underwent surgical therapy for esophageal leiomyoma over a 27-year period was done. The main symptoms were dysphagia in 35 (53 percent) patients, heartburn or regurgitation, or both, in 11 (17 percent) patients, and retrosternal pain in ten (15 percent) patients. Associated esophageal disorders were found in 19 patients (some patients had more than one disorder): hiatal hernia in 15 (23 percent), epiphrenic diverticulum in four (6 percent), and achalasia in three (5 percent). The operation consisted of leiomyoma enucleation in 63 patients, and esophageal resection in three. In six patients, the enucleation was successfully performed by video-thoracoscopy combined with intraoperative esophagoscopy. The muscle layer of the esophagus was approximated in the majority of the patients after tumor enucleation. RESULTS: There was no operative mortality. The incidence of intraoperative esophageal perforation was greater in patients who had previously undergone endoscopic biopsy (p < 0.01). In one patient, a pseudodiverticulum developed after thoracoscopic enucleation, requiring reoperation with approximation of the muscle layer for relief of dysphagia. The length of hospital stay was shorter in patients undergoing the video-assisted operation (p < 0.05). The median follow-up period was 53 months (range, 12 to 248 months). No recurrence of leiomyoma was observed. Overall, seven (11 percent) patients complained of heartburn or epigastric pain, or both, which was responsive to antisecretory drugs, but only three had such symptoms induced by the operation. In two patients the symptoms appeared after combined treatment of an epiphrenic diverticulum, and in one patient after simple leiomyoma enucleation. CONCLUSIONS: Enucleation of esophageal leiomyoma is a safe and effective operation. The video-thoracoscopic approach combined with intraoperative esophagoscopy allows performance of this procedure with the added advantage of shortening hospital stay. The muscle layer of the esophagus should be approximated to avoid decreasing the propulsive activity of the esophageal body. This may improve the long-term outcome of the operation by preserving the acid-clearing mechanism of the esophagus and reducing the incidence of postoperative reflux esophagitis.

Adult↗
PubMed1993

[Biological effects of pleural talc in neoplastic pleurisy].

A study was carried out on ten patients who had received talc by thoracoscopy for secondary neoplastic pleural involvement. The study was in two parts. First, a laboratory study on blood specimens was made including the full blood count, sedimentation rate and alpha-2 globulins. Secondly, the pleural liquid was examined over a 24 hour period, measuring the leucocyte count/ml and also the pleural sugar. The studies revealed the occurrence of an early rise (J0) in the level of polynuclear neutrophil (PNN) in the pleural liquid, with a 24 hour peak preceded by a leucocytosis and a moderate polymorphonuclear response without any change in the sedimentation rate. These changes provide evidence for the role of PNN in the genesis of pleural symphysis during talc therapy. There was also an early fall in pleural sugar, and this was in parallel with the diminution of the quantity of pleural fluid drained and would be linked to a rise in the local cellular metabolism and to a disturbance in the exchange across the thickened pleural membrane, as a result of fibrosis.

Alpha-Globulins↗