Pleural Procedures Research Articles

Manual of Pleural Procedures

Manual of Pleural Procedures

Book Review: Manual of Pleural Procedures

Book Review: Manual of Pleural Procedures

Manual of Pleural Procedures

Manual of Pleural Procedures

Pleural mesothelioma.

The increasing incidence of malignant pleural mesothelioma (MPM), better knowledge of its pathogenesis with a strong implication of asbestos fibers, and some promising therapeutic results have led to a new interest in the management of patients with this disease. The diagnosis of MPM is easier because of new immunohistochemical markers that recognize the mesothelial cells with good specificity and sensitivity on pleural biopsy samples ideally obtained by thoracoscopy. Moreover, this endoscopic procedure allows the physician to make the diagnosis of MPM at an early stage, which is the key of the therapeutic management of this disease. If radiotherapy is necessary in preventing the malignant seeding after pleural procedures in patients, the lack of comparative studies did not show the superiority of a given treatment against another. A new international staging of the disease, however, allows physicians to discriminate several groups of patients for such comparative studies--in particular, for testing the efficacy of intrapleural therapy, e.g., cytokines--for early-stage MPM and multimodal management, i.e., extrapleural pneumonectomy, radiotherapy, and chemotherapy for more advanced diseases, has led to prolonged survival in carefully selected patients. To reach this target, all patients must be enrolled in protocols. The usual pessimism for the management of patients with malignant pleural mesothelioma is over.

Randomised controlled trial of intrapleural streptokinase in community acquired pleural infection.

BACKGROUND: Standard treatment for pleural infection includes catheter drainage and antibiotics. Tube drainage often fails if the fluid is loculated by fibrinous adhesions when surgical drainage is needed. Streptokinase may...

Open tube thoracoscopy: does it have a role in modern thoracic surgery?

To determine the role of open tube thoracoscopy in the diagnosis and management of thoracic diseases, a retrospective review of 48 patients was conducted. A mediastinoscope was used for open tube thoracoscopy. Eleven patients underwent diagnostic thoracoscopy, and 4 patients had thoracoscopy for cancer staging. All 11 diagnostic procedures yielded a diagnosis, and thoracic malignancies were staged accurately in all patients. Thirty-three patients underwent therapeutic thoracoscopy. Twelve therapeutic thoracoscopies were done for pneumothorax, 9 for loculated parapneumonic effusion or empyema, 4 for malignant effusions, 2 for traumatic hemothorax, 2 for wedge resection of peripheral lung cancers, and 4 for other indications. All but 1 therapeutic procedure were successful. Three patients experienced complications specific to thoracoscopy (empyema 1, prolonged air leak 1, chest tube site leakage 1). There were 5 deaths, but none were related to thoracoscopy. Open tube thoracoscopy is very effective for evacuation of loculated pleural fluid, pus, or blood, and it appears to have advantages over video thoracoscopy in these settings. Although open tube thoracoscopy is satisfactory for other simple pleural procedures and wedge resections of lung are possible, video thoracoscopic techniques are now preferred for these indications.

Experience with the Grillo pleural wrap procedure in 18 patients with perforation of the thoracic esophagus.

Perforation of the thoracic esophagus may be fatal unless diagnosed promptly and treated with an effective operation. The wide mortality range in different reports reflects the importance of these two factors. This range spans from as low as 11%, if operation is within 24 hours, to greater than 50% after two to three days. The high mortality with delayed treatment is principally due to inability to surgically close the perforation. Eighteen patients (aged from 31 to 78 years) were treated four hours to 14 days after thoracic esophageal perforation (less than 24 hours: 7 patients; 24 to 72 hours: 7 patients; greater than 72 hours: 4 patients). In 14 patients the perforation was sutured, after which the suture line was buttressed with a circumferential wrap of parietal pleura, originally described by Grillo. Underlying esophageal pathology was corrected and wide mediastinal drainage was instituted. All 14 patients recovered and were discharged from the hospital after a median stay of 20 days. Two patients had minor leaks at the suture line that soon closed. Four patients had perforations too extensive to close. Of these, one was resected, the Urschel procedure was used in two, and the Abbott T-tube drainage was used in one. Three of the four patients died. It was quite significant that the pleural wrap was equally effective with both early (6 patients) and delayed perforations (8 patients). These data indicate that the pleural wrap should be used routinely. Extensive perforations that cannot be closed should probably be treated by resection and drainage, followed by esophageal reconstruction at a later time.

Ventriculo-pleural shunting for adult hydrocephalus.

In order to evaluate the efficacy and safety of ventriculo-pleural shunting as an alternative to conventional atrial and peritoneal procedures, we have carried out a retrospective study of 88 pleural shunting procedures. There was a 7% complication rate related to the use of the pleural space as the shunt terminus. Complications at the pleural end included shunt obstruction (functional or structural), pleural effusion, pneumothorax, and other technical problems. There were no deaths associated with shunt dysfunction or other complications. Ventriculo-pleural shunting for hydrocephalus, when used with appropriate precautions and with careful patient selection is a viable alternative for the treatment of adult hydrocephalus. The complications that are unique to this procedure are pneumothorax and pleural effusion. They were encountered infrequently in this series. Ventriculo-pleural shunting may be indicated when other routes are not available.

Two methods for analyzing pleural smears for the presence of abnormalities

Two methods of designing a cell classifier as a first stage in a pleural sample classification procedure, where reliable a priori cell class labeling is not available, are presented. Cluster analysis is shown to be capable of taking into account structural information at the cell level, which may be lost in other methods.

Radiographic appearance of the chest after pleural space reduction procedures: construction of a pleural tent and phrenoplasty

Construction of a pleural tent and phrenoplasty are surgical procedures performed to reduce intrapleural dead space after partial lung resection. Both alter the radiographic appearance of the chest and may cause erroneous diagnosis including pneumothorax, subphrenic disease, subpulmonic effusion, diagphragmatic hernia, or diaphragmatic eventration. Radiologists should be aware of the potentially misleading appearance that these surgical procedures may present.

Diagenesis and the validity of the boron paleosalinity technique

<b>Percutaneous pleural procedures should not be considered aerosol generating. This study should inform future iterations of guidelines on the appropriate use of PPE when performing these procedures.</b>https://bit.ly/3xFF71d

Hazard of the Cope Biopsy Needle

To the Editor.— Use of the Cope biopsy needle has increased steadily since its introduction.1It is a valuable tool to obtain pleural, peritoneal, or other tissue quickly and more easily than through open surgical biopsy. Nonetheless, the instrument has its hazards and should be used cautiously. Pneumothorax and excessive bleeding are well-recognized complications of the pleural biopsy procedure. A further complication is noted. Report of a Case.— A 51-year-old man presented with a history of tuberculosis and pleurisy, for which he had received no medical therapy. Roentgenogram of the chest revealed a 2-cm mass in the upper lobe of the right lung with an associated pleural effusion. Pleural biopsy was attempted with the Cope needle. The instrument was inserted and positioned but would not retract into the cannula at the time of biopsy. The needle was cleared with the inner trocar and the biopsy procedure repeated without removing the