Thoracic Puncture Research Articles

Lung ultrasonography for the diagnosis of 11 patients with acute respiratory distress syndrome due to bird flu H7N9 infection

BackgroundA novel reassortant avian-origin influenza A (H7N9) virus was found to infect three Chinese residents, the first H7N9 infection in humans in Asia. Chest computed tomography (CT) for acute respiratory distress syndrome (ARDS) diagnosis is not only expensive but also exposes patients to radiation and might cause patients to be at risk of infection during transportation; in addition, chest radiography cannot be used to monitor the lung repeatedly in real time. Therefore, the routine use of bedside lung ultrasonography for critically ill patients with ARDS is especially valuable.ObjectivesThe aim of this study was to evaluate the application of ultrasound for lung examination in patients with ARDS.MethodsEleven patients infected with H7N9 avian influenza who developed ARDS were diagnosed by lung ultrasonography.ResultsSix patients who had severe ARDS showed a diffuse comet tail sign or a consolidation score ≥ 7 and a lung ultrasound score ≥ 20 points. A diffuse comet tail sign or a consolidation score ≤ 6 and a lung ultrasound score < 25 were observed in four patients. One patient showed a diffuse comet tail sign or consolidation area in four lung areas, with an ultrasound score of 14. Among all 11 patients studied, 6 patients had thoracic puncture and drainage of pleural effusion and 2 patients had pneumothorax puncture drainage.ConclusionsLung ultrasound could be useful for monitoring ARDS caused by the influenza virus A H7N9 strain in clinical applications.

Derrame pleural bilateral: ¿toracocentesis uni o bilateral? Estudio prospectivo

IntroductionIn the absence of firm recommendations, we analyzed whether unilateral thoracic puncture is sufficient for bilateral pleural effusion (PE), or if the procedure needs to be performed in both sides. Materials and methodsProspective study of patients seen consecutively for bilateral PE during a period of 3 years and 9 months. All patients underwent simultaneous bilateral thoracocentesis. The standard protocol variables collected in our hospital served as study parameters. Size of PE, presence of chest pain or fever, or accompanying lung abnormalities, different attenuation values on chest computed tomography, presence of loculated pleural fluid, and radiological resolution in a single side were also evaluated. ResultsA total of 36 patients (19 men; mean age 68.5±16.5 years) were included. The etiology of the effusion was different in each side in only 2 patients (5.6%). In 6/32 cases (18.8%), the biological analysis of the pleural fluid (in terms of transudate/exudate) from both sides did not correspond with the etiological diagnosis of the effusion. Correlation between biochemical parameters analyzed in the fluid from both sides (Pearson's correlation coefficient) ranged between 0.74 (LDH) and 0.998 (NT-proBNP). As different diagnoses in each side were found in only 2 patients, the circumstances in which bilateral diagnostic thoracocentesis would be necessary could not be determined. ConclusionsSimultaneous bilateral thoracocentesis does not appear to be recommendable. Larger series are needed to establish which factors might suggest the need for simultaneous puncture of both PE.

New biomarkers in the selection of patients for talcage of pleural cavity in the palliative therapy of malign pleural exudate.

Chemical pleurodesis using videothoracoscopically applied powdered talc under general anaesthesia and selective pulmonary ventilation is the most effective method of palliative therapy for malign pleural exudate. Talc produces an intense systemic inflammatory reaction with the development of aseptic pleurisy. The result is obliteration of the pleural cavity provided there is an intense inflammatory reaction in the pleural cavity and good contact of both pleural leaves. The course of the adherence of pleural leaves can be followed using skiascopy. In routine practice, the course of local inflammatory markers is difficult to evaluate. Selection of suitable patients who will respond to this procedure is another principal obstacle of this surgical method. To evaluate the course of local inflammatory changes in the pleural cavity following application of talc and to quantify their dynamics. Selection of specific biomarkers to predict the intensity of inflammation in the pleural exudate for targeted selection of patients suitable for talcage was the second aim of this study. 114 patients were retrospectively divided into Group A (N1 = 98) or patients without relapse and Group B (N2 = 16), patients with relapse of exudate formation. The need for repeated thoracic punctures or drainage over the course of a 12-month monitoring period was a criterion of treatment failure. Quantification of the effusion was performed by ultrasonic examination over a one year observational period at 3-monthly intervals. The concentration of soluble CD163 scavenger receptor and soluble Apo/Fas molecule was determined in exudate by ELISA. Soluble receptors in the 2 groups differed significantly. Group B showed higher sCD163 levels before talcage (P0 = 0.00024), faster dynamic decline in 2 h (P2 = 0.0092) and in 24 h (P24 = 0.0087). During monitoring, decrease in group B was statistically significant at 2 h (P2 = 0.056) and at 24 hrs (P24 = 0.0066). This pilot study showed that high values of sCD163 and sApo/Fas in the pleural exudate can predict treatment failure. Unsuitable candidates for this type of therapy couldbe selected in this way.

Perspective in predicting the effect of pleurodesis in the treatment of malignant pleural effusions.

Pleurodesis with talc has been used for many years. No objective criteria of inflammatory symptoms are known in order to use them to predict the effect of therapy and selection of patients. To objectify the course of local inflammatory changes in the pleural cavity, quantify their dynamics in a clinically used procedure, and to determine specific predictors of inflammation as perspective markers of selection of patients suitable for talcage. A total of 114 patients were retrospectively divided into Group A (n1 = 98) of patients without relapse and Group B (n2 = 16) of patients with relapse of exudate. The need for repeated thoracic punctures or drainages over the course of a 12-month monitoring period was the criterion of treatment failure. The groups were not different as for the baseline values of sTLR-2 (p₀ = 0.638). Group A showed a marked growth during the monitoring period in 2 hours following talcage (p₂= 0.002) and in 24 hours (p24 = 0.016). Group B showed higher sCD-163 levels (p0 < 0.001). The initial sTREM-1 values and those after two hours were similar in both groups (p0 = 0.146; p2 < 0.0641). In 24 hours, Group A had markedly higher values (p24 < 0.001). The sTLR-2, sCD-163 and sTREM-1 values can be prospectively determined. High sCD-163 values predict unsuitable selection of a candidate for talcage. The degree of inflammatory response can be evaluated using sTLR-2 or sTREM-1. Talcage using an inserted thoracic drain can be repeated at low levels. The cost of ELISA examination is approximately 18 euros (Tab. 1, Fig. 4, Ref. 20).

Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique.

Aims:In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a prospective study with all patients undergoing LC under spinal anesthesia in our department since 2007.Settings and Design:Prospective observational.Materials and Methods:From 2007 to 2011, 369 patients with symptoms of colelithiasis, laparoscopic cholecystectomy were operated under spinal anesthesia with pneumoperitoneum and low pressure CO2. We compared 15 mg of hyperbaric bupivacaine and lumbar puncture with 10 or 7.5 mg of hyperbaric bupivacaine thoracic puncture, all with 25 μg fentanyl until the sensory level reached T3. Intraoperative parameters, post-operative pain, complications, recovery, patient satisfaction, and cost were compared between both groups.Statistical Analysis Used:Means were compared by ANOVA or Kruskal-Wallis test, the percentages of the Chi-square test or Fisher's exact test when appropriate. Time of motor and sensory block in spinal anesthesia group was compared by paired t test or Mann-Whitney test. Differences were considered significant when P ≤ 0.05, and for comparisons of mean pain visual scale, we employed the Bonferroni correction applied to be considered significant only with P ≤ 0.0125Results:All procedures were completed under spinal anesthesia. The use of lidocaine 1% was successful in the prevention of shoulder pain in 329 (89%) patients. There were significant differences in time to reach T3, obtaining 15 mg > 10 mg = 7.5 mg. There is a positive correlation between the dose and the incidence of hypotension. The lowest doses gave a decrease of 52.2% in the incidence of hypotension. There was a positive correlation between the dose and duration of sensory and motor block. Sensory block was almost twice the motor block at all doses. With low doses, 60% of patients went from table to stretcher. Satisfaction occurred in 99% of patients.Conclusions:Laparoscopic cholecystectomy can be performed successfully under spinal anesthesia with low-pressure pneumoperitoneum of CO2. The use of thoracic puncture and low doses of hyperbaric bupivacaine provided better hemodynamic stability, less hypotension, and shorter duration of sensory and motor blockade than lumbar spinal anesthesia with conventional doses.

Enquête sur les pratiques françaises d’analgésie en chirurgie thoracique (réalisée avec le concours de l’ARCOTHOVA)

ObjectiveTo assess the current practice of analgesia after thoracotomy and thoracoscopy in France. Study designCross-sectional practice survey. MaterialAnaesthetist physicians, each referent for one of the French centres practicing thoracic surgery, during year 2012. MethodsElectronic questionnaire about the activity of the centre in thoracic surgery, and modalities and estimated frequencies of different analgesic techniques. Primary assessment was the estimated percentage of acts, after imputation from original data. ResultsEighty-four centres out of 103 (82 %) answered the questionnaire. Coupling locoregional to general anaesthesia involved 74 % of thoracotomies and 35 % of thoracoscopies. A practice (i.e. for more than 5 % of patients) of epidural analgesia was declared by 68 centres (81 %), and by 27 centres (32 %) for paravertebral block. The most current practices for epidural analgesia were: thoracic puncture, intraoperative initiation, ropivacaïne 0.2 % plus sufentanil, patient-controlled administration with infusion plus bolus, application more than 48hrs post surgery. The practice rates for technique of paravertebral block were: Eason & Wyatt 34 %, ultrasound-guided 24 %, internal 42 %. The most frequent systemic analgesia was patient-controlled intravenous morphine. Ketamine was used in 60 % of the cases. ConclusionsFrench practice of analgesia after thoracic surgery improved quality during the last decade, but more than one patient on four (compared to 8 % in UK) may have neither epidural nor paravertebral block, while such techniques are nowadays considered as standard.

Successful Laparoscopic-Assisted Hemostasis of Intrathoracic Massive Vericeal Rupture During Living Related Liver Transplantation: A Case Report

End-stage liver disease that requires transplantation is usually accompained by esophagogastric or another collateral vessel varices. Sometimes, the esophagogastric varices rupture intraoperatively during liver transplantation. However we have reported rare case of rupture of an intercostal varicose vein, which was controlled successfully by flexible laparoscopy. The patient was a 62-year-old man, who suffered decompensated liver cirrhosis with hepatocellular carcinoma. The Child-Pugh score was 11 and the Model for End-stage Liver Diseases score was 14. Preoperative gastrointestinal fiberscopy and colon fiberscopy examinations revealed esophagogastric and rectal varices. He underwent living related liver transplantation from his son on February 10, 2010. Just after the liver transplantation, the patient's blood pressure tended to decrease. Chest radiography demonstrated a massive right pleural effusion. We drained 3000 mL of blood by thoracic puncture. Therefore we reoperated him for the question an intrathoracic variceal hemorrhage. We confirmed variceal bleeding after removal of the massive hematoma by opening the diaphragm. However, we could neigher show directly the bleeding point in the anterior thorax nor stop it because of the constriction of the diaphragm. Therefore we used a flexible laparoscope to both confirm the bleeding point and to achieve hemostasis. We believe that theoperative compression of the intercostal varicose vein by a retractor induced the vascular rupture.

Ultrasound-guided and radiographic monitoring-assisted peripherally inserted central catheterization

Keywords Basilic vein Complications PerioperativeinsertionTo the Editor:Although the first approach to central venous catheter-ization (CVC) under general anesthesia would generally bethe right internal jugular vein, this procedure is dangerouswhen patients are receiving anti-coagulant therapy or havelow platelet counts. We also note that, in the trendelenburgposition, the left internal jugular vein cannot be dilated,and the approach via the left internal jugular vein is alsodangerous for thoracic duct puncture. Central cathetershave been peripherally inserted via the basilic vein sincethe 1970s [1]. The advantages of peripherally insertedcentral catheters (PICCs) are low complication rates, easyaccess, reduced overall nursing required for i.v. mainte-nance, and low cost [2]. Perioperative insertion of a PICCvia the basilic vein would therefore confer some advanta-ges, and ultrasound-guided and radiographic monitoring-assisted insertion adds more safety and provides optimalmanagement. We therefore performed a clinical trial ofperioperative PICC insertion under ultrasound guidanceand radiographic monitoring.Fourteen patients scheduled for surgical repair ofabdominal aortic aneurysms were prospectively enrolled.The basilic vein in the upper arm was visualized using a4-F Groshong catheter (Medicon, Osaka, Japan) and a6- to 13-MHz ultrasound probe (Vivid i ; GE HealthcareJapan, Tokyo, Japan). The position of the PICC tip wasalso confirmed by radiographic monitoring. Briefly, eitherthe right or left upper arm was rotated 90 and then a 14-Gcannula was inserted into the vein under real-time ultra-sound guidance with a jobbing motion. When blood back-flowed from the vein, the PICC was directly inserted intothe basilic vein. The PICC was then advanced or with-drawn under radiographic monitoring to reach the preferredsite location. Forceful aspiration was added to obtain bloodreturn after the removal of the guidewire in the PICC. Anadditional catheter was cut and a sterile dressing waspositioned over the external portion of the PICC.The mean age of the patients was 71 years (range55–82). The tip of the PICC was successfully positioned in11 (78.6 %) of the 14 patients but became dislodged in 3(21.4 %) patients. The PICC tip was not advanced to thesuperior vena cava. Serious complications, such as infec-tion, accidental puncture of an artery, or injury of mediannerve, did not occur during PICC insertion in any patient.We had perioperatively inserted a CVC under landmarkor ultrasound guidance; therefore, the question arose as towhat should be done when a CVC could not be inserted viathe right internal jugular vein. Goldfarb and Lebrec [3]described difficulties with cannulation from the left internaljugular vein. However, both long- and short-term PICCplacement in infants and children has proven safe andeffective [4], although the PICC tip can quite frequentlybecome dislodged. Thus, ultrasound guidance and radio-graphic monitoring are important. Fricke et al. [5] reportedthat PICC placement was more successful with thanwithout radiographic monitoring. The PICC tip becamedislodged in three of our patients in whom the right basilic

Clinical exploration on inserting double cavity central venous catheters in thoracic cavity of patients with pleural effusion combined with injecting medicine

Objective To observe the clinical effects of inserting double cavity central venous catheters in the thoracic cavity of patients with pleural effusion combined with injecting medicine.Methods 80 cases of medium or large amounts of pleural effusion were randomly divided into treated group(n=41) and control group(n=39).In the treated group,double cavity central venous catheterization was put into the thoracic cavity to drain the pleural effusion combined with injecting medicine (the mixture of isoniazid injection 0.3g,Danshen injection 10 ml and normal saline 10 ml).The control group was given the simple repeated thoracic cavity puncture pumping fluids without injecting medicine.The comparisons were made on the treatment effects,its complications and the medical expenses.Results There were significant differences between the two groups in the average time of pleural effusion absorption,the pleural thickness and the complications (pleura reaction rate,pneumothorax rate and pleural fluid pkg incidence rate).Conclusion Inserting double cavity central venous catheters in the thoracic cavity of patients with pleural effusion combined with injecting medicine has the advantage of easy and safe operation,reducing hospitalization time and cost,with better treatment effects.It can be a cure for patients with pleural effusion. Key words: Double cavity central venous catheters; Injecting medicine into the thoracic cavity; Pleural effusion

EUS Guided Transesophageal Thoracic Duct Puncture in a Swine Model, A Survival Study

EUS Guided Transesophageal Thoracic Duct Puncture in a Swine Model, A Survival Study

Outcomes of an Algorithmic Approach to Management of Pneumothorax Complicating Thermal Ablation of Pulmonary Neoplasms

Purpose To investigate the outcomes of an algorithm for treatment of pneumothorax in association with radiofrequency (RF) and microwave (MW) ablation of pulmonary neoplasms. Materials and Methods This retrospective study included data from 248 ablation sessions for lung tumors in 164 patients (92 men; mean age, 59.7 y ± 9.8): 200 RF ablations (80.6%) and 48 MW ablations (19.4%). Pneumothorax was classified as mild, moderate, or severe. Twelve patients developed mild pneumothorax and were observed for further complications, and 33 developed moderate or severe pneumothorax and were managed with percutaneous aspiration of the pneumothorax. The decision to abort or continue ablation was determined based on clinical response to percutaneous aspiration, clinical distress, and feasibility of applying the applicator within the lesion. Results Incidence of pneumothorax was 18.1% (45 of 248 sessions), with four (8.9%) occurrences during MW ablation and 41 (91.1%) during RF ablation. Pneumothoraces were mild in 12 sessions (26.7%), moderate in 27 (60%), and severe in six (13.3%). Complete evacuation of the pneumothorax was achieved in 25 of 33 sessions (75.8%). Intercostal tube drainage was indicated in eight sessions (24.2%), including six severe and two moderate pneumothoraces. Pneumothorax evolved immediately after thoracic puncture in 10 patients. Ablation therapy was aborted in two sessions in which severe pneumothorax occurred, and an intercostal chest tube was inserted. Conclusions Mild pneumothorax can be managed by close observation without interruption of ablation therapy. Manual evacuation was an effective strategy for management of moderate pneumothorax and allowed for adequate positioning of the electrode, but did not suffice for severe and progressive pneumothorax, which required placement of an intercostal chest tube.

Treatment of complicated parapenumonic pleural effusion by ultrasound-guided thoracic puncture to indwell pigtail catheter

Objective To study the value of ultrasound-guided thoracic puncture to indwell pigtail catheter for treating the complicated parapneumonic pleural effusion. Methods One hundred and sixteen patients,clinically diagnosed the complicated parapneumonic pleural effusion,were randomly divided into the treatment group(58 cases) and the control group(58 cases). In the treatment group, patients were treated by ultrasound-guided thoracic puncture to indwell pigtail catheter. In the control group, patients were treated by conventional closed thoracic drainage. At the same time, systemic supportive therapy and antibiotics were given to all patients of two groups. The time of defervescence,the time of pleural effusion absorbed,days in hospital,the thickness of the pleura after treatment, indices of pulmonary function and the visual analogue scales after indwelling catheter were observed. Results In the time of defervescence, the time of pleural effusion absorbed ,days in hospital, the thickness of the pleura after treatment, indices of pulmonary function and the visual analogue scales after indwelling catheter,the differences between two groups were significant (P ＜ 0. 05). Conclusions For complicated parapneumonic pleural effusion, the method by ultrasoundguided thoracic puncture to indwell pigtail catheter is obviously superior to the traditional method. Key words: Ultrasonography; Pleural effusion; Cateters,indwelling

Application of closed thoracic drainage with micro-catheter in treatment of tuberculous pleural effusion

Objective To observe the effect and safety of pleural effusion treated by closed thoracic drainage with micro-catheter. Methods A total of 64 cases with pleural effusion were randomly divided into conventional therapy group ( control group ) and closed thoracic drainage with micro-catheter group ( treatment group) , each group including( 32 cases ). Control group were treated with drainage of thoracic puncture interruptedly while treatment group treated by closed thoracic drainage with micro-catheter. Results Both two therapeutic methods could reduce pleural effusion, but obvious effective rate of treatment group was higher than that of control group( P ＜ 0.05 ). Meanwhile, the rate of pleural reaction and treatment cost in treatment group were lower than that in control group. Conclusion Closed thoracic drainage with micro-catheter was effective, lower treatment cost and lower complications. Moreover, it could reduce medical risk. Key words: Micro-catheter; Closed thoracic drainage; Pleural effusion; Clinical effect

The Incidence of Paresthesia and Neurologic Complications after Lower Spinal Thoracic Puncture with Cut Needle Compared to Pencil Point Needle. Study in 300 Patients

Background: Anesthesiologists are reluctant to considerer higher levels for spinal anesthesia largely due to direct threats to spinal cord. Paresthesias are relatively common during spinal needle insertion; however, the clinical significance of the paresthesia is unknown. The main objective of this prospective study was to evaluate the incidence of paresthesia and neurologic complications after lower thoracic spinal anesthesia with a cut needle compared to a pencil point needle. Methods: Low thoracic spinal puncture (T10-T11) was performed in 300 patients in elective surgery using different techniques in this single-blind prospective trial. Patients randomized to 2 groups: group 1, subarachnoid puncture using a cut needle without introducer and group 2, subarachnoid puncture using a pencil point needle with introducer. In both groups patients were in the lateral or sitting position. Results: Paresthesias occurred in 20/300 (6.6%) of patients. Seven patients experienced a paresthesia with cut needle compared with 13 patients with pencil point, without statistical difference. All paresthesias were transient. No neurologic complications were observed in all patients during this study. Conclusions: Our data suggest that all transient paresthesia are transitory. Lower thoracic puncture is safe. Traumatic injury to the spinal cord is a rare cause of neurologic deficits in the thoracic puncture.

CT classification of lacerating lung injury and its clinical significance

Objective To explore the CT classification of lacerating lung injury in blunt thoracic trauma and its clinical significance. Methods A total of 63 patients with lung lacerating injury were classified using CT features as simple type injury (complete visceral pleura, with no pneumothorax or he-mopneumothorax) and complex type injury (accompanied by visceral pleura rupture, pneumothorax or he-mopneumothorax). A retrospective analysis was done on CT manifestations and clinical data. Results Of 63 patients, 35 patients (56%) had simple type of lacerating lung injury with complete visceral pleu-ra, most of which were focal pulmonary pseudocyst lesions present in the edge of lungs and could be dis-persed quickly after conservative therapy without complications. Mean hospital stay was 16 days. Of pa-tients with complex type of lacerating lung injury, 28 patients (44.4%) were accompanied by visceral pleura rupture with larger extent of pulmonary injury, 20 (71%) by lung eontnsion, 15 (54%) by ate-lectasis or pulmonary atelectasis and three (11%) by local pulmonary infection. Thoracic puncture or closed drainage was performed in 19 patients (69%) and thoracotomy in one (4%), with mean hospital stay of 58 days. Conclusions According to CT manifestations on whether there exists visceral pleura rupture or not, the lacerating lung injury is classified as simple type injury and complex type injury. CT classification of lacerating lung injury may be helpful in selecting clinical treatment protocols and predic-ting early prognosis. Key words: Lung; Laceration; Tomography, X-ray computed; Injury classification

LPR: A CT and MR-Compatible Puncture Robot to Enhance Accuracy and Safety of Image-Guided Interventions

Image-guided percutaneous interventions are common procedures used for diagnosis or therapeutic purposes. The clinical demand for such interventions is growing since they are minimally invasive. To increase the quality of the operations and provide optimal accuracy and safety to patients, puncture robots may be very helpful. This paper presents a new robotic architecture designed to perform abdominal and thoracic punctures under computer tomography (CT) or MRI guidance. Innovations concerning the robotic architecture, materials, and energy sources are described. Segmentation and registration algorithms have been developed to localize the robot on images coming from CT or MRI devices, and a specific control loop is used to verify the movements and the positioning of the robot. The results of the initial experiments made under CT and MRI environments are presented.

Bilateral Pneumothorax after Unilateral Transthoracic Puncture

Pneumothorax is a common complication following transthoracic interventional procedures. Most often, this occurs unilaterally on the side of the intervention. Bilateral pneumothorax following unilateral puncture is rare, but may mandate emergent chest tube insertion. We describe two cases in which bilateral pneumothorax occurred after unilateral thoracic puncture. One patient had a history of esophageal resection, while the other had no history of thoracic surgery.

1118: Practical update—interventional ultrasound techniques

The use of ultrasound in guided intervention has expanded rapidly in recent years. A huge range of established and new ultrasound guided procedures can be found in the recent literature, including: ultrasound guided pleurodesis for malignant effusion, percutaneous nephrolithotomy, ultrasonography-guided liver resection, femoral pseudoaneurysm thrombosis, ultrasound-guided biopsy, endoscopic ultrasound-guided fine-needle aspiration, neurolysis of coeliac plexus with guided linear endoscopic ultrasonography, ultrasound guided thoracic puncture in the pleural space, pulmonary parenchyma and mediastinum, endoscopic ultrasound guided therapy of benign and malignant biliary obstruction, ultrasound-guided high-intensity focused ultrasound treatment in patients with advanced pancreatic cancer, ultrasound guided treatment of tendinitis of the shoulder, ultrasound guidance for central venous catheter insertion, percutaneous thermal ablation for recurrent carcinoma, foreign bony retrieval and intravascular ultrasonography for TIPS.

PLEURODESIS WITH CARBOPLATIN IN ELDERLY PATIENTS WITH MALIGNANT PLEURAL EFFUSION AND LUNG ADENOCARCINOMA

PLEURODESIS WITH CARBOPLATIN IN ELDERLY PATIENTS WITH MALIGNANT PLEURAL EFFUSION AND LUNG ADENOCARCINOMA

The Clinical Pathology of Thoracic Puncture Fluids. By S. Roodhouse Gloyne, M.D., D.P.H., Pathologist, City of London Hospital for Diseases of the Heart and Lungs, Victoria Park. Post 8vo. Pp. 83 + vii. Illustrated. 1930. London: John Bale Sons &amp; Danielsson. 10s. 6d. net

The Clinical Pathology of Thoracic Puncture Fluids. By S. Roodhouse Gloyne, M.D., D.P.H., Pathologist, City of London Hospital for Diseases of the Heart and Lungs, Victoria Park. Post 8vo. Pp. 83 + vii. Illustrated. 1930. London: John Bale Sons & Danielsson. 10s. 6d. net Get access The Clinical Pathology of Thoracic Puncture Fluids. By S Roodhouse Gloyne, M.D., D.P.H., Pathologist, City of London Hospital for Diseases of the Heart and Lungs, Victoria Park. Post 8vo. Pp. 83 + vii. Illustrated. 1930. London: John Bale Sons & Danielsson. 10s. 6d. net British Journal of Surgery, Volume 18, Issue 70, October 1930, Page 350, https://doi.org/10.1002/bjs.1800187038 Published: 06 December 2005