The Respiratory System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
The fiberoptic bronchoscope is an instrument utilized for visual examination of the bronchi through the procedure of bronchoscopy and may be used to obtain bronchial brushings and biopsies. Mediastinoscopy is the examination of the mediastinum and its lymph nodes, particularly in suspected malignancy. Use of an endoscope to inspect the larynx is laryngoscopy. Thoracoscopy denotes examination of the pleural cavity. Fluoroscopy is a type of radiographic technique that allows visualization of the thoracic contents In a dynamic manner and provides a range of views.
Anterior Thoracoscopic Release/Fusion and Instrumentation for Spinal Deformities
Alexander R. Vaccaro, Christopher M. Bono in Minimally Invasive Spine Surgery, 2007
The worldwide experience with thoracoscopic anterior scoliosis systems has been increasing since Picetti first reported on its clinical use (18–22). Today, anterior thoracoscopic scoliosis correction remains a relatively new procedure with limited follow-up data. Comparative studies of anterior thoracoscopic and open posterior approaches to scoliosis correction have suggested similar degrees of deformity correction when curve patterns were matched (23–28). Complication rates, however, have been consistently greater for all inexperienced surgeons, as this approach remains technically demanding and requires thorough disc excision and grafting to obtain early solid union. Several functional advantages have been associated with the thoracoscopic approach, when compared with open procedures, suggesting that benefits may be realized once the surgeon becomes more experienced and is able to master the technique. For example, shoulder girdle strength and range of motion have been found to return to normal within three to six months following surgery, and a more rapid return to normal activity and less severe decrease in pulmonary function has been noted in patients compared with after open anterior instrumentation. Figure 12 demonstrates pre- and postoperative stand radiographs of a patient with the typical thoracic adolescent idiopathic scoliosis curve, corrected with a thoracoscopic instrumentation system.
Clinical Diagnosis of Pleural Disease
Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley in Diagnostic Pulmonary Pathology, 2008
A fourth option is to perform thoracoscopy. Thoracoscopy is an excellent means to establish the diagnosis of pleural malignancy or tuberculosis. Thoracoscopy establishes the diagnosis of pleural malignancy in approximately 90% of cases including mesothelioma. The diagnosis of tuberculous pleuritis can also be established in almost all patients with tuberculosis. However, only rarely are other diagnoses established. Thoracoscopy is recommended for the patient with an undiagnosed pleural effusion in whom the diagnosis of malignancy or tuberculosis is suspected, and in whom the pleural fluid cytology and a pleural fluid test for tuberculosis (ADA or interferon-γ) are negative or equivocal. In addition, thoracoscopy is recommended only if the effusion is not resolving. It should be noted that less than 10% of patients who present with a pleural effusion will meet these criteria and therefore need a thoracoscopy (19). When thoracoscopy is done for diagnostic purposes, it is important for the operator to be prepared to perform a procedure to create a pleurodesis at the time of the surgery. Our preferred method is pleural abrasion.
Application of Narrow-Band Imaging thoracoscopy in diagnosis of pleural diseases
Published in Postgraduate Medicine, 2020
Xinglu Zhang, Feng Wang, Zhaohui Tong
Patients of age over 18 years, who was presented with an undiagnosed exudative pleural effusion after at least one thoracocentesis, admitted to our hospital between September 2017 and September 2019 were eligible. Patients were excluded when they were presented with multiple pleural adhesions, transudative hydrothorax, severe respiratory failure, unresolved coagulation disorders, uncontrolled hypertension, anesthetic allergy, pregnancy, or any other contraindications. A total of 100 patients were screened for the study. The age of patients enrolled ranged from 21 to 85 years, including 54 male and 46 female. All patients received routine pleural effusion tests (such as cytology analysis, biochemical examination, microbiological examination), chest ultrasonography, chest CT scans, ECGs. This study was approved by the Institutional Review Board of Beijing Chaoyang Hospital. We have registered this study with its registration number ChiCTR2000029440. The approved number of ethic committee was 2018-KE-322. Patients were explained in detail regarding risks and alternatives before the thoracoscopy. All patients signed the consent information.
Diagnostic value of soluble biomarkers for parapneumonic pleural effusion
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Xi-Shan Cao, Wen-Qi Zheng, Zhi-De Hu
The currently available diagnostic tools for PPE include medical imaging, bacterial culture, thoracoscopy and biomarkers [9]. Chest X-ray, ultrasound and CT are common imaging methods for PPE identification, but all of them have disadvantages such as subjectivity, requirement for special training, high cost, and radiation hazard. Microbiological examination is the gold standard for the diagnosis of PPE, but its sensitivity and long turn-around time limit its clinical utility. The sensitivity of pleural fluid culture in patients with pleural infection is 50–70% [15,17,18]. The sensitivity of pleural fluid culture in UPPE was only 7% [15]. Thoracoscopy has a high diagnostic yield for PPE, but it is an invasive procedure and 45% of patients have pain, which makes them uncomfortable and requires additional analgesics [19]. In addition, thoracoscopy requires special training, which limits its application in areas with insufficient medical resources. Measurements of serum and pleural fluid biomarkers have the advantages of objective results and a short turn-around time; thus they may be a practical diagnostic tool [13]. Thoracocentesis, used to obtain pleural fluid for biomarker measurement, is an invasive procedure with complications such as iatrogenic pneumothorax [20], re-expansion pulmonary edema, and bleeding [21]; however, its level of invasiveness is lower than that for thoracoscopy or pleural biopsy. Here, we review the diagnostic and stratified values of various biomarkers in pleural fluid and circulation for PPE.
Efficacy of endoscopic ultrasound and endoscopic resection for esophageal schwannoma
Published in Scandinavian Journal of Gastroenterology, 2023
Jiao Jiao, Xiaofei Fan, Lili Luo, Wei Zhao, Zhongqing Zheng, Xin Chen, Tao Wang, Bangmao Wang, Wentian Liu
According to the consensus of Chinese experts on the endoscopic diagnosis and treatment of gastrointestinal submucosal tumors [33], ES that meets the following criteria is considered for resection: (1) lesions suspected of malignant potential by preoperative examination or confirmed by biopsy pathology; and (2) patients suspected of benign lesions by preoperative examination or confirmed by pathology, who cannot be followed up regularly, whose internal tumors increase in a short time during the follow-up period, or who have a strong desire for endoscopic treatment. Resection is not only used for diagnosis but also treatment. Common treatment methods are surgical or endoscopic resection. At present, surgical methods mainly include thoracotomy, thoracoscopy, or mediastinoscopy resection. Thoracotomy has been largely replaced by thoracoscopy or mediastinoscopy surgery because it causes great trauma and has a high medical expenditure. However, thoracotomy is suitable for ES with a lesion diameter greater than 7 cm [35]. In recent years, endoscopic treatment had little interference with anatomical structures due to the rapid development of digestive endoscopic resection and suture technology; as such, the postoperative pain score, wound infection, and reflux symptoms are lower than those in surgical resection [16].
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