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Register a new userPleurodesis in Malignant Pleural Effusion
إيثاق الجنب في انصباب الجنب الخبيث
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بسام درويش( باحث )
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يعد انصباب الجنب الخبيث مضاعفة شائعة للخباثات المتقدمة خاصة من الرئة و الثـدي، و يعـاني كثير من المرضى من زلة و عسرة تنفسية و أعراض أخرى تعيق فعالياتهم الفيزيائيـة و أسـلوب حياتهم.بين عامي ١٩٩٥-١٩٩٨ درسنا ٣٩ حالة انصباب جنب خبيث. أُجرِي تقشير جنب لـدى ٤ حالات ، و فجر الصدر لتفريغ الانصباب بقصد الإيثاق لدى الـ ٣٥ حالة الباقية، فلم تنتشر الرئة في ٥ حالات ، أُجرِي ايثاق الجنب للحالات التي انتشرت فيها الرئة و ذلك بمعلق التالك لـدى ٢٥ حالة ، و بالتتراسيكلين لدى ٤ حالات، و بالبليوميسين لحالة واحدة . و قد تحسنت الزلة التنفسية و لم ينكس الانصباب لدى حوالي ٧٣% من الحالات التي أُجرِي لهـا ايثاق الجنب و ذلك خلال الشهر الأول، و كانت النتائج مقبولة (حوالي ٦,٦٦ %) في نهاية الشـهر الثالث أيضا. لذا يعد إيثاق الجنب في انصباب الجنب الخبيث بقصد التلطيف واسطة علاجيـة سـهلة و ناجحـة و قليلة النفقات و ضئيلة المضاعفات.
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.
References used
Angouras et al, Talc Slurry Pleurodess for Symptomatic Malignant Pleural Effusion, 1 St. International Congress of Thorax Surgery, July 1997, Greece, 343-346
Cohen, R.G. et al، Pleural Effusion، Surgery of the Chest Philadelphia Saunder Company, 1995, 533-537
Kaczprzak et al, Management of Malignant Pleural Effusion, 2 ND International Congress of Thorax Surgery. June 1998, Italy, 325-330
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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 .
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.
Between May ١٩٩٨ and May ٢٠٠٢ we performed ١١٢
diagnostic thorososcopy for undiagnosed pleural
effusions.The biopsy results for ٩٨ patients were
investigate.
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.
Although malignant fibrous histiocytoma are uncommon in the oral
cavity. We observed these neoplasms in jawbones in 7 cases (5 in the
maxilla and 2 in the mandible) affecting males aged 24 to 51 years.
Histologically the pleomorphic pattern is dom
inant, and all patterns are
characterized by active proliferative cells, and scattered histiocytes
which stained positively by CD74 and CD68
These lesions cause radiolucencies with poorly defined margins and no
radiographically distinct features.
Differential diagnosis must involve osteosarcoma, chondrosarcoma and
fibrosarcoma .
The treatmenm of choice is wide surgical excision.
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