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      Bedside pleuroscopy in Taiwan : a great vision for critically-ill patients and intensivists

      research-article
      , MD MM PhD 1 , 2 , 3 , 4 , 5 ,
      BioMedicine
      China Medical University
      Bedside, Intensive Care Unit (ICU), Pleuroscopy, Taiwan

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          Abstract

          Bedside pleuroscopy can be used in daily practice by medical pulmonologists if a patient cannot tolerate either general anesthesia or being moved to an operating or endoscopy room due to their critical condition. It is a simple and safe technique that rarely has complications. The aim of this review is to summarize recent literatures about bedside pleuroscopy and share our experiences with using it in Taiwan.

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          Most cited references48

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          Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma.

          Malignant pleural mesothelioma (MPM) is a rare tumour but with increasing incidence and a poor prognosis. In 2008, the European Respiratory Society/European Society of Thoracic Surgeons Task Force brought together experts to propose practical and up-to-dated guidelines on the management of MPM. To obtain an earlier and reliable diagnosis of MPM, the experts recommend performing thoracoscopy, except in cases of pre-operative contraindication or pleural symphysis. The standard staining procedures are insufficient in approximately 10% of cases. Therefore, we propose using specific immunohistochemistry markers on pleural biopsies. In the absence of a uniform, robust and validated staging system, we advice use of the most recent TNM based classification, and propose a three step pre-treatment assessment. Patient's performance status and histological subtype are currently the only prognostic factors of clinical importance in the management of MPM. Other potential parameters should be recorded at baseline and reported in clinical trials. MPM exhibits a high resistance to chemotherapy and only a few patients are candidates for radical surgery. New therapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach should be included in a prospective trial at a specialised centre.
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            Diagnostic tools in tuberculous pleurisy: a direct comparative study.

            Thoracoscopy is the most accurate yet most expensive tool for establishing the diagnosis of tuberculous (TB) pleurisy. However, most high TB-incidence regions have limited financial resources, lack the infrastructure needed for routine thoracoscopy and require an alternative, cost-effective diagnostic approach for pleural effusions. Altogether, 51 patients with undiagnosed exudative pleural effusions were recruited for a prospective, direct comparison between bronchial wash, pleural fluid microbiology and biochemistry (adenosine deaminase (ADA) and cell count), closed needle biopsy, and medical thoracoscopy. The final diagnosis was TB in 42 patients (82%), malignancy in five (10%) and idiopathic in four patients (8%). Sensitivity of histology, culture and combined histology/culture was 66, 48 and 79%, respectively for closed needle biopsy and 100, 76 and 100%, respectively for thoracoscopy. Both were 100% specific. Pleural fluid ADA of > or = 50 U x L(-1) was 95% sensitive and 89% specific. Combined ADA, lymphocyte/neutrophil ratio > or = 0.75 plus closed needle biopsy reached 93% sensitivity and 100% specificity. A combination of pleural fluid adenosine deaminase, differential cell count and closed needle biopsy has a high diagnostic accuracy in undiagnosed exudative pleural effusions in areas with high incidences of tuberculosis and might substitute medical thoracoscopy at considerably lower expense in resource-poor countries.
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              Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Part 1: Diagnosis.

              F Rey, C Boutin (1993)
              To compare the diagnostic value of thoracoscopic biopsy, fluid cytology, and Abrams needle biopsy, the authors analyzed prospectively the records of 188 patients with malignant pleural mesothelioma examined between 1973 and 1990. Symptoms were pleural effusion in 173 patients, empyema in 1, spontaneous pneumothorax in 1, and radiologic tumor without effusion in 13. Thoracoscopy was performed using a rigid thoracoscope under local anesthesia with neuroleptanalgesia. A total of 10-20 biopsies were taken from the parietal, diaphragmatic, and visceral pleura. Each diagnosis was confirmed by the French panel of mesothelioma pathologists. To prevent parietal seeding, radiation therapy at a dose of 21 Gy was administered during a period of 3 days to all points of entry. Tolerance to thoracoscopy was good. The only complications were subcutaneous emphysema (1 patient), local pleural infection (4 patients), hemorrhage of less than 100 ml (3 patients), and temperature of 38-38.5 degrees C (26 patients). In 137 patients, the cavity was free, and complete endoscopic inspection was achieved. In 51 patients, inspection was limited by adhesions that were severed to obtain biopsy. Nonspecific inflammation was observed in 12 patients (6.5%), nodules in 92 (49%), thickening in 21 (11%), and mixed lesions in 63 (33.5%). Diagnosis was achieved by thoracoscopy in 98% of patients, by fluid cytology in 26%, and by needle biopsy in 21%. In most patients, thoracoscopy allows complete visualization of the pleural cavity and provides high-quality biopsy samples. The diagnostic accuracy of thoracoscopy is similar to open thoracotomy, but the procedure is far less invasive, usually requiring that the patient remain in the hospital only 1 day.
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                Author and article information

                Contributors
                ooihean@yahoo.com.tw
                Journal
                Biomedicine (Taipei)
                Biomedicine (Taipei)
                BioMedicine
                China Medical University (Taichung )
                2211-8020
                2211-8039
                12 August 2016
                12 August 2016
                September 2016
                : 6
                : 3
                : 13
                Affiliations
                [1 ]Department of Preventive Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, 427 Taichung, Taiwan
                [2 ]Division of Chest and Critical Care Medicine, Buddhist Tzu Chi General Hospital, Dalin Branch, 622 Chiayi, Taiwan
                [3 ]School of Medicine, Tzu Chi University, 970 Hualien, Taiwan
                [4 ]Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, No. 11, Buzih Lane, 406 Taichung, Taiwan
                [5 ]Department of Medical Research, China Medical University Hospital, China Medical University, 406 Taichung, Taiwan
                Article
                13
                10.7603/s40681-016-0013-5
                4980309
                27510964
                7863071a-8bec-4c8e-83d9-6d79ed368d29
                © China Medical University 2016
                History
                : 12 June 2016
                : 27 June 2016
                Categories
                Review Article
                Custom metadata
                © The Author(s) 2016

                bedside,intensive care unit (icu),pleuroscopy,taiwan
                bedside, intensive care unit (icu), pleuroscopy, taiwan

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