• Title/Summary/Keyword: Medical thoracoscopy

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Diagnostic Accuracy and Safety of Medical Thoracoscopy (내과적 흉강경 검사의 진단적 유용성과 안전성)

  • Yang, Jung Kyung;Lee, Jung-Ho;Kwon, Mi-Hye;Jeong, Ji Hyun;Lee, Go Eun;Cho, Hyun Min;Kim, Young Jin;Jung, Sung Mee;Choi, Eu Gene;Son, Ji Woong;Na, Moon Jun
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.3
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    • pp.261-267
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    • 2007
  • Background: The causes of the pleural effusion are remained unclear in a the substantial number of patients with exudative effusions determined by an examination of the fluid obtained via thoracentesis. Among the various tools for diagnosing exudative pleural effusions, thoracoscopy has a high diagnostic yield for cancer and tuberculosis. Medical thoracoscopy can also be carried out under local anesthesia with mild sedation. The aim of this study was to determine diagnostic accuracy and safety of medical thoracoscopy. Methods: Twenty-five patients with exudative pleural effusions of an unknown cause underwent medical thoracoscopy between October 2005 and September 2006 in Konyang University Hospital. The clinical data such as age, gender, preoperative pulmonary function, amounts of pleural effusion on lateral decubitus radiography were collected. The vital signs were recorded, and arterial blood gas analyses were performed five times during medical thoracoscopy in order to evaluate the cardiopulmonary status and acid-base changes. Results: The mean age of the patients was 56.8 years (range 22-79). The mean depth of the effusion on lateral decubitus radiography (LDR) was 27.49 mm. The medical thoracoscopic pleural biopsy was diagnostic in 24 patients (96.0%), with a diagnosis of tuberculosis pleurisy in 9 patients (36%), malignant effusions in 8 patients (32%), and parapneumonic effusions in 7 patients (28%). Medical thoracoscopy failed to confirm the cause of the pleural effusion in one patient, who was diagnosed with tuberculosis by a pericardial biopsy. There were no significant changes in blood pressure, heart rate, acid-base and no major complications in all cases during medical thoracoscopy (p>0.05). Conclusions: Medical thoracoscopy is a safe method for patients with unknown pleural effusions with a relatively high diagnostic accuracy.

Medical Imaging of Pyothorax in a Dog (개에서 농흉증의 영상의학적 접근)

  • Choi, Ho-Jung;Lee, Young-Won;Park, Ki-Tae;Wang, Ji-Hwan;Kim, Young-Ki;Yeon, Seong-Chan;Lee, Hyo-Jong;Lee, Hee-Chun
    • Journal of Veterinary Clinics
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    • v.27 no.1
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    • pp.107-112
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    • 2010
  • A 3-years-old female Pointer was evaluated for anorexia, dyspnea and exercise intolerance for 10 days. Auscultation revealed muffling of heart sound. There were leukocytosis, anemia, hypoalbuminaemia and hyperglobulinaemia on the blood profiles. Radiography showed severe pleural effusion. Thorax ultrasonographs described traped pleural effusion, pericardial effusion and collapsed right lung lobe(s). On CT images, thoracic neoplasia and lung torsion were ruled-out. Thoracocentesis with thoracoscopy and bacterial culture revealed pyothorax and pleuritis. The diagnosis of pyothorax in dogs and cats is based on clinical signs, radiography, thoracocentesis and cytology and culture of the exudate. In this case, various diagnostic medical imaging techniques (radiography, ultrasonography, CT and thoracoscopy) were used for diagnosis of pyothorax.

Left Upper Mediastinal Lymph Nodes Dissection during Minimally Invasive Esophagectomy (식도암 최소 침습 수술 시 좌측 종격동 림프절 절제술)

  • Lee, Kyo-Seon;Jeong, In-Seok;Ryu, Sang-Woo;Song, Sang-Yun;Na, Kook-Joo
    • Journal of Chest Surgery
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    • v.40 no.3 s.272
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    • pp.244-246
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    • 2007
  • Mediastinal lymph node dissection is a method that increases the long term survival of patients with an esophageal carcinoma. However, dissection of the left mediastinal lymph node is almost impossible, as it is not easy to see. Herein, a left mediastinal lymph node dissection, with thoracoscopy through a cervical incision wound during minimal invasive esophageal surgery, is reported.

Pericardial Window Operation in Oncology Patients: Analysis of Long-Term Survival and Prognostic Factors

  • Sung Min Kim;Jun Ho Lee;Su Ryeun Chung;Kiick Sung;Wook Sung Kim;Yang Hyun Cho
    • Journal of Chest Surgery
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    • v.57 no.2
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    • pp.169-177
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    • 2024
  • Background: Pericardial effusion (PE) is a serious condition in cancer patients, primarily arising from malignant dissemination. Pericardial window formation is a surgical intervention for refractory PE. However, the long-term outcomes and factors associated with postoperative survival remain unclear. Methods: We retrospectively analyzed data from 166 oncology patients who underwent pericardial window formation at Samsung Medical Center between 2011 and 2023. We analyzed survival and PE recurrence regarding surgical approach, cancer type, and cytopathological findings. To identify factors associated with survival, we utilized Cox proportional-hazards regression. Results: All patients had tumors documented in accordance with the American Joint Committee on Cancer staging manual, including lung (61.4%), breast (9.6%), gastrointestinal (9.0%), hematologic (3.6%), and other cancers (16.4%). Surgical approaches included mini-thoracotomy (67.5%) and thoracoscopy (32.5%). Postsurgical cytopathology confirmed malignancy in 94 cases (56.6%). Over a median follow-up duration of 50.0 months, 142 deaths and 16 PE recurrences occurred. The 1-year overall and PE recurrence-free survival rates were 31.4% and 28.6%, respectively. One-year survival rates were significantly higher for thoracoscopy recipients (43.7% vs. 25.6%, p=0.031) and patients with negative cytopathology results (45.1% vs. 20.6%, p<0.001). No significant survival difference was observed between lung cancer and other types (p=0.129). Multivariate analysis identified New York Heart Association class, cancer stage, and cytopathology as independent prognostic factors. Conclusion: This series is the largest to date concerning window formation among cancer patients with PE. Patients' long-term survival after surgery was generally unfavorable. However, cases with negative cytopathology or earlier tumor stage demonstrated comparatively high survival rates.

Benign Metastasizing Leiomyoma of Lung -A case report- (폐에 발생한 양성 전이성 근종-1례 보고-)

  • 박찬범;서종희;장윤희;문석환;조건현
    • Journal of Chest Surgery
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    • v.34 no.5
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    • pp.422-425
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    • 2001
  • We performed thoracoscopic resection for diagnosis in 41 year-old-female presenting with multiple pulmonary nodules in both lung fields, which was detected incidentally on routine chest x-ray and followed by additional exmaminations including chest CT scan and percutaneous needle aspiration biopsy under the presumptive diagnosis of metastatic cancer. During thoracoscopy, the result of the frozen section analysis of multiple masses revealed strong evidence of leiomyoma. In her past medical history, she had undergone myomectomy, and hysterectomy, 7 year ago and 10 year ago, respectively. Based on permanent, special staining of specimen, estrogen receptor assay and review of past specimen of uterine myoma the final diagnosis was benign metastasizing leiomyomata from uterine myoma, the report was very uncommon in Korean and English literatures. The patient has been followed up for 2 year without special therapy, such as hormonal therapy.

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Antireflux Surgery (위식도역류질환의 수술)

  • Na, Kook-Joo
    • Korean Journal of Bronchoesophagology
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    • v.16 no.2
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    • pp.105-108
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    • 2010
  • The prevalence of gastroesophageal reflux disease(GERD) has been increased recently in Korea. Most patients who have GERD are well treated by medication. But patients who have suboptimal disease control under medical therapy are needed further treatment. Nowadays minimally invasive surgery using laparoscopy and thoracoscopy has become popular in the operation of GERD although antireflux surgery is vary. Antireflux surgery is a well-documented, effective therapeutic alternative to control GERD.

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Incidentally Detected Pericardial Defect in a Patient with Pneumothorax as Confirmed on Video-Assisted Thoracoscopic Surgery (흉강경 수술로 확인한 우연히 발견된 기흉을 동반한 심막결손)

  • Hyunwoo Cho;Eun-Ju Kang;Moon Sung Kim;Sangseok Jeong;Ki-Nam Lee
    • Journal of the Korean Society of Radiology
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    • v.82 no.3
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    • pp.749-755
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    • 2021
  • Congenital defects of the pericardium, which are generally asymptomatic, are rare disorders characterized by complete or partial absence of the pericardium. Here, we report a rare case of a 19-year-old male who was incidentally diagnosed with congenital absence of the left pericardium during examination for symptoms of pneumothorax. Chest radiography and CT revealed a collapsed left lung without any evidence of trauma, no unusual findings of free air spaces along the right side of the ascending aorta, heart shifted toward the left side of the thorax, and a shallow chest. Subsequent thoracoscopy confirmed the absence of the left pericardium and displacement of the heart toward the left thoracic cavity. We further discuss the correlation between radiologic images and surgical findings of a congenital pericardial defect associated with spontaneous pneumothorax.

New Paradigm for Patients with Pulmonary Nodule Expecting Thoracoscopic Resection (흉강경수술이 예상되는 폐결절 환자에서의 새로운 방침)

  • 조민섭;심성보;왕영필;조건현;서종희;곽문섭;이선희;김학희;문석환
    • Journal of Chest Surgery
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    • v.36 no.10
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    • pp.748-753
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    • 2003
  • Background: The pulmonary nodules (PN), when indicated, need thoracoscopic resection, especially in cases of non-diagnostic or technically infeasible PCNA (percutaneous needle aspiration). In the difficult situations of small or deeply seated PN, several techniques facilitating thoracoscopy have been used for detecting them. Our new protocol for managing PN was developed and prospectively reviewed. Material and Method: In the procedure of PCNA, we firstly placed the tip of the needle in the center of, or just in contact with PN under CT guidance, and loaded one or two segments of platinum radiomarker inside the needle after removing the stylet. Then, we forced the radiomarker to move to the tip of the needle by pushing the stylet. Finally, if the tip of the needle was not within PN, it was reoriented to the their center to obtain the sample for PCNA. Result: Between May 1999 and May 2000, radiomarkers were successfully placed in 28 PN of 26 patients, with the exception of one. In 18 (85%) of 21 nodules needing throacoscopy, intraoperative fluoroscopy was used to detect them or guide stapling resection during thoracoscopy. Conclusion: The advantages of this technique are that there is that there is no need for further localization for thoracoscopy even in cases of unsuccessful PCNA, and it was more effective in respect to both cost and time. Therefore, this strategy for PN expecting thoracoscopy will be helpful to patients and medical staff alike.

Successful Diagnosis and Treatment of a Pancreaticopleural Fistula in a Patient Presenting with Unusual Empyema and Hemoptysis

  • Kim, Eunji;Ahn, Hyo Yeong;Kim, Yeong Dae;I, Hoseok;Cho, Jeong Su
    • Journal of Chest Surgery
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    • v.52 no.3
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    • pp.174-177
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    • 2019
  • Pancreaticopleural fistula (PPF) is a rare complication in patients with pancreatitis. Its symptoms are similar to those of empyema or pleural effusion; therefore, it is important to consider PPF in the differential diagnosis. Herein, we describe the diagnosis and treatment of PPF in a patient presenting with unusual empyema and delayed hemoptysis.