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Register a new userResults of Diagnostic Thoracoscopy in Pleural Effusions
نتائج تنظير الجنب في تشخيص انصبابات الجنب
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Damascus University ورقة بحثية
Publication date
2002
fields
Medicine
and research's language is
العربية
Authors
بسام درويش( باحث )
Created by
Shamra Editor
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أجرينا خلال ٤ سنوات (أيار ١٩٩٨ -أيار ٢٠٠٢) ١١٢ تنظيـراً جنبيـاً بقصـد تشخيص انصبابات الجنب الغامضـة- (التـي لـم يعـرف سـببها رغـم جميـع الاستقصاءات غير الباضعة بما فيها بزل و خزعة الجنب عبر الجلـد)- أي بمعـدل ٢٨ تنظيراً سنوياً. و أخذنا خزعات موجهة منهم جميعاً. أمكن متابعة خزعـات 98 مريضا.
Between May ١٩٩٨ and May ٢٠٠٢ we performed ١١٢ diagnostic thorososcopy for undiagnosed pleural effusions.The biopsy results for ٩٨ patients were investigate.
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Research summary
تناولت الدراسة التي أجراها الدكتور بسام درويش في مستشفى المواساة الجامعي بجامعة دمشق نتائج تنظير الجنب في تشخيص انصبابات الجنب غير المشخصة. تم إجراء الدراسة بين مايو 1998 ومايو 2002 وشملت 112 حالة. أظهرت النتائج أن تنظير الجنب هو تقنية ضرورية وآمنة لتشخيص انصبابات الجنب الغامضة التي لم يتمكن التشخيص التقليدي من تحديدها. تم اكتشاف أورام خبيثة في 58.2% من الحالات، وكانت الأورام الأكثر شيوعًا هي النقائل السرطانية (59.6%) والميزوتليوما (15.7%). كما تم تشخيص حالات التهاب الجنب النوعي في 29.6% من العينات. لم تحدث أي وفيات بين المرضى الذين خضعوا للتنظير، ولكن ظهرت بعض المضاعفات الطفيفة مثل الالتهابات غير النوعية بنسبة 8.1%. وأوصت الدراسة باستخدام التخدير العام أثناء إجراء التنظير وتجنب إجرائه في حالة وجود التصاقات أو سماكة جنبية.
Critical review
دراسة نقدية: تعتبر هذه الدراسة مهمة في مجال تشخيص انصبابات الجنب الغامضة، حيث أظهرت فعالية تنظير الجنب في الكشف عن الأمراض الخبيثة والتهابات الجنب النوعية. ومع ذلك، يمكن توجيه بعض النقد البناء للدراسة. أولاً، لم يتم توضيح تفاصيل حول توزيع الأعمار والجنس بين المرضى، مما قد يؤثر على تعميم النتائج. ثانياً، لم يتم مناقشة التكلفة الاقتصادية لتنظير الجنب مقارنة بالطرق التشخيصية الأخرى. وأخيراً، كان من الأفضل تضمين مجموعة مقارنة من المرضى الذين خضعوا لطرق تشخيصية تقليدية لتقييم فعالية تنظير الجنب بشكل أكثر شمولية.
Questions related to the research
-
ما هي الفترة الزمنية التي أجريت فيها الدراسة؟
أجريت الدراسة بين مايو 1998 ومايو 2002.
-
ما هي نسبة الأورام الخبيثة المكتشفة في العينات؟
تم اكتشاف أورام خبيثة في 58.2% من العينات.
-
ما هي الأورام الأكثر شيوعًا التي تم اكتشافها في الدراسة؟
الأورام الأكثر شيوعًا كانت النقائل السرطانية بنسبة 59.6% والميزوتليوما بنسبة 15.7%.
-
هل حدثت أي وفيات بين المرضى الذين خضعوا للتنظير؟
لم تحدث أي وفيات بين المرضى الذين خضعوا للتنظير.
References used
Boutin, C.and Astoul, P., Diagnostic Thoracoscopy, Clin. Chest Med
De Groot. M, and Walther. G., Thoracoscopy in Undiagnosed Pleural Effusions, S. Afr. Med. J
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The diagnosis of pleural diseases is one of the frequent clinical problems. Despite a
variety of diagnostic tests are available for evaluating pleural effusions, approximately 15–
20% of pleural effusions remains undiagnosed, In this cases ,a thora
coscopy plays an
important role, it permits the surgeon to visually view and evaluate the entire pleural space
,and to obtain enough accurate biopsies from suspected areas. This study aims to evaluate
the effectivenes of Video Assisted
Thoracoscopic surgery (VATS) in diagnosis of pleural effusions.
Between June 2012 and June 2015 we performed 38diagnostic thorososcopy for
undiagnosed pleural effusions. The histopathologic studies of pleural biopsies result were
as follows : )%60,5 ( malignancies,)%31,6 ( TB And )%7,9 ( nonspecific inflammatory
reaction.
The malignant diseases are: Mesothelioma )%60,9(, Metastases of adenocarcinoma
)%30,4(,Lymphoma )% 8,7(
4 Complications ,with no mortality.
Conclusion: Video Assisted Thoracoscopic Surgery is a safe and accurate diagnostic
procedure for pleural diseases but it also has a very useful role in therapy.(VATS) saves
time, effort and cost, more over it is preferred by the patient as he recovers and returns to
his normal activity rapidly.
Malignant Pleural Effusion is a common complication of advenced malignancies،
Particularly lung and breast cancer. Many patients experience considerable
dyspnea shortness of breath، dry cough and chest pain، wich decisively reduces
their capacity
for physical activity and their quality of life. Between 1995 – 1998.
39 cases with malignant pleural effusion were treated. Pleurectomy was
performed in 4 cases .The lung was trapped in 5 cases.Pleurodesis with talc slurry
for 25 cases، with Tetracyclin for 4 cases and with Bleomycin for one case were
performed. 73% - of these cases had positive results (decrease the dyspnea، no
effusion) during 1st month .and 66،6% had positive results too during 3 months.
So ،Pleurodesis is an effective and ، simple method of manegement of malignant
Pleural effusion It has also low cost and low complications.
The main aim of this study is to analyze all cases of pericardial effusions - except post
cardiac procedures - who were admitted to surgical department in Al-Assad and Tichreen
University Hospital in the period between 2007-2016.
(63) cases of Per
icardial effusions were analyzed, (38) male and (25) female, their ages
were ranging between (17-67) years.
The most important two causes of pericardial effusions were renal failure (50.7%) and
Malignancies (34.9%). lung cancer was the leading cause of Malignancies accounting
17.4% of whole cases and 50% of Malignancies.
Pericardial window via left mini thoracotomy was the preferred procedure in our study.
68.2% of the patients under went this procedure, recurrent rate was 4.6%, and the amount
of recurrent pericardial effusion was minimal and didn’t need any management.
Pericardiocentesis was performed in 39.6% of our patients, recurrent rate was very high
80%, therefore it was abondend as a method of treatment and its role was considered only
in hemodynamically unstable patients or as a first step of preparation for pericardial window.
Pericardial window via subxyhoid under local anesthesia was performed in 11.11%;
recurrent rate was high 28.6%.We consider this approach only in patients who are not fit to
undergo other approaches or when the expected survival is very limited.
Pericardial window via thoracoscopic approach was performed in 15.8% of our patients;
recurrent rate was 10% with encouraging results. During performance of pericardial
window via minithoracotomy or thoracoscopically we were able to perform in (19) patients
many other diagnostic and therapeutic procedures such as pleurectomy, Biopsies from the
lungs, mediastinal tumors, and mediastinal lymph nodes as well.
The histopathological examination of the resected pericardial window and concurrent
procedures played an important diagnostic role in 23.8% of idiopathic pericardial
effusions.
Pleural effusion is a common clinical condition. Congestive heart
failure (CHF) is the most frequent cause of pleural effusions, which typically
are transudates, but occasional patients with CHF are found to have
exudates in the absence of an appa
rent cause other than CHF, and the
presence of CHF does not always explain exudative effusions in those
patients. We aimed to determine the incidence, clinical significance of such
exudative effusions and to study the effects of diuretics on characteristics of
pleural fluid in patients with CHF accompanied with pleural effusion.
In Alassad Hospital we studied a population of 70 patients with pleural effusion for a period from August 2014 to Agust 2015 . The patients were 40men(57.1%) and 30 women(42.9) . According to the criteria used , 23(32.9%)patients were transudative ef
fusions , and 47(67.1%)had exudative effusions . In our study we measured the level of cholesterol in the pleural fluid to assess the role of this measure in differentiating between transudativ and exudative effusion and the different causes of the effusion . We found that : pleural fluid cholesterol levels were significantly lower in the transudative than in exudative effusions ( 10.702±21.8 mg/dL and 32.67±69.39 mg/L respectively ) , but Light's criteria is better than level of cholesterol in pleural effusion to differentiate between the two types of effusions . but the stsatistic result improved when we add cholesterol into lights criteria . In the exudative effusion with lymphocytic cholesterol level more than 72.5 mg/dL is a strong suggestion for tuberculosis effusion , whether the level lower suggestive of malignant for exudative effusions . So , levels of cholesterol in pleural effusion can narrow the differential diagnosis of pleural effusions and help for perfecting the results .
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