Thoracic surgery and difficult intubation: another application of univent tube for one-lung ventilation.
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Biomedical subjects
J Galbis
Publications and source records attributed to J Galbis.
Videothoracoscopy in the diagnosis and treatment of malignant pleural mesothelioma with associated pleural effusions.
Between 1985 and 1994 46 of 662 patients examined by thoracoscopy for secondary malignant pleural effusion were diagnosed to have diffuse malignant pleural mesothelioma. Mean patient age was 59 years, with a male: female ratio of 5:1. The right hemithorax was more frequently involved than the left (55% versus 45%). Pleural fluid cytology revealed malignancy in 61.5% of cases. All patients were treated thoracoscopically by talc pleurodesis. Mean patients survival was 9.4 months. Survival after one, two, and 5 years was 37.5%, 12.5%, and 5%, respectively. The characteristics of mesothelioma and pleural effusion evident in thoracoscopy and their diagnostic relevance are discussed. We suggest talc instillation as the sole therapeutic maneuver in evolutioned cases, since the literature and our own experience indicate that survival is not significantly prolonged by more aggressive surgical approaches.
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[The so-called malignant pleural effusion: a new review of direct data obtained with diagnostic pleuroscopy].
We analyze a series of 896 thoracoscopies for pleural effusion, of which 78% (662/896) were due to pleural carcinomatosis, primary or metastatic. Pleural malignancy was observed mainly, in the right hemithorax (65%), arising from tumors within the diaphragm. The likelihood of finding pleural metastasis in lung cancer was 77%. When the pleural effusion is slight (less than 500 ml) the likelihood falls to 22%. We therefore advise thoracoscopy in the former and thoracotomy in the latter. Blood-stained effusion continues to have the worst prognosis (84% stemming from metastasis) and signifies an advanced stage of pleural metastasis. The pleura parietal is involved in 69% of pleural carcinomatosis cases, and in 80% when the lower hemithorax or the area around breast or lung tumors are involved. The cytology yield was 45.9%, though always depending on extent of metastasis. When metastasis was slight, the likelihood of positive cytology was less (19%) and when metastasis was generalized throughout the entire pleura the likelihood increased to 73%. We found no reason to think that the cells in most pleural liquids are able to nest and form tumoral niches. The origin of such cell nests was rather found to be in shedding from the metastases themselves, from lung tumors or from carcinomatous lymphangitis by lymphatic obstruction. The diagnostic yield of thoracoscopy once again proved to be superior to that of pleural biopsy.
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[Videothoracoscopy in staging of lung cancer].
We present a review of 108 cases of lung cancer in patients who, for a variety of reasons outlined in this report, underwent video assisted thoracoscopy prior to staging. Overall results of the procedure were positive in 94%. We report the usefulness of this tool for identifying adenopathic locations, for effecting biopsies of tumors that could not be typed by other means, for resecting peripheral nodules for screening purposes, and for making etiological diagnoses of accompanying pleural effusions. For diagnostic purposes, this procedure provides a better image than does conventional thoracoscopy, involves the participation of an endoscopy team and even calls for the presence of a pathologist. We consider video assisted thoracoscopy to be a highly effective tool for avoiding so-called pointless thoracotomies and for completing alternative treatments. Its cost effectiveness is indisputable, as are its low rates of morbidity and mortality.
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[Pulmonary leiomyosarcoma].
We present the case of a young patient with leiomysarcoma of the lung that was at first diagnosed as a hydatid cyst. Pathological tissue analysis was needed for firm diagnosis. This rare tumor, of which fewer than 100 cases have been reported worldwide in the literature, needs to be considered as a differential diagnosis when lung cancer is suspected, given that leiomysarcoma has a better prognosis. Treatment is mainly surgical.
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Thoracoscopic pericardial fenestration: diagnostic and therapeutic aspects.
The cause of cardiac tamponade is only established in 50% of cases. This problem is most commonly treated by pericardiocentesis alone, pericardiotomy being reserved for cases of recurrence and pericardiectomy for those patients presenting with constrictive pericarditis. A series of 16 patients treated with pericardial fenestration via a thoracoscope is presented. Pericardial and pleural biopsies were performed, together with cytological and biochemical analysis of the pericardial and pleural fluid where present. This procedure established the aetiology of effusion in all cases. In malignant pericardial effusion bleomycin was used for pericardial sclerosis. This resulted in fewer recurrences than in those patients where sclerosis was not attempted (12.5% v 60%).
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