BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral n...BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication.To address safety concerns associated with TPVBs,we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication.The MTP block was performed at the T9 level under ultrasound guidance,with 20 mL of 0.5%ropivacaine injected.Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels.Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement,with none exceeding a mean 24 h numeric rating scale>3.CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.展开更多
Back ground: Pleural effusion is a common clinical problem with different causes. Objective: To demonstrate clinical features and outcome of pleural effusion. Methods: Prospective descriptive study was conducted invol...Back ground: Pleural effusion is a common clinical problem with different causes. Objective: To demonstrate clinical features and outcome of pleural effusion. Methods: Prospective descriptive study was conducted involving 110 patients with pleural effusion admitted to a resource limited hospital in Ethiopia. Results: Males and females were almost equally represented. Cough, fever and weight loss were prominent presenting symptoms accounting 90, 77.3 and 77.3 percent respectively. Right side effusion was the common presentation 50 (45.5%). Forty (37.4%) patients had HIV infection among 107 tested. Tuberculosis was the commonest cause 78 (70.9%) followed by parapneumonic effusion 36 (32.7%) and empyema 27 (24.5%). Malignant pleural effusion was detected only in one patient. Eighty one (73.6%) improved from their illness and 7 (6.4%) died. Lympocytic pleural effusion found to be associated with tuberculosis (OR = 3.942 (1.527 - 10.179), P = 0.005. There were no associations between HIV infection, anemia, elevated ESR and side of pleural effusion with tuberculosis. Conclusion: Tuberculosis was the leading cause of pleural effusion in our setup even though etiologic diagnosis was difficult. Strengthening the laboratory and pathology services in the area is strongly recommended.展开更多
A 77-year-old man on systemic chemotherapy against postoperative bilateral multiple lung metastases of malignant solitary fibrous tumor of the pleura suffered from pruritus and jaundice. Blood examination showed eleva...A 77-year-old man on systemic chemotherapy against postoperative bilateral multiple lung metastases of malignant solitary fibrous tumor of the pleura suffered from pruritus and jaundice. Blood examination showed elevated levels of hepatobiliary enzymes. Abdominal computed tomography showed a tumor with peripheral enhancement in the pancreatic head, accompanied with the dilatation of intra- and extra-hepatic bile ducts. He was diagnosed as having obstructive jaundice caused by a pancreatic head tumor. The pancreatic head tumor was presumably diagnosed as the metastasis of malignant solitary fibrous tumor of the pleura, because the findings on the pancreatic head tumor on abdominal CT were similar to those on the primary lung lesion of malignant solitary fibrous tumor of the pleura. The pancreatic tumor grew rapidly after the implantation of metallic stent in the inferior part of the common bile duct. The patient died of lymphangitis carcinomatosa of the lungs. Autopsy revealed a tumor that spread from the pancreatic head to the hepatic hilum. Microscopically, spindle-shaped cells exhibiting nuclear atypicality or division together with collagen deposition were observed. Immunohistochemically the pancreatic head tumor cells were negative for staining of α-smooth muscle actin （α-SMA） or CD117, but positive for vimentin, CD34 and CD99. These findings are consistent with those on malignant solitary fibrous tumor of the pleura. We report the first case of obstructive jaundice caused by a secondary pancreatic tumor from malignant solitary fibrous tumor of the pleura.展开更多
Malignant pleural mesothelioma is a rare primary tumor rising from the pleura and is associated with exposure to asbestos fibers. Mesothelioma is a locally aggressive disease that usually presents at an advanced stage...Malignant pleural mesothelioma is a rare primary tumor rising from the pleura and is associated with exposure to asbestos fibers. Mesothelioma is a locally aggressive disease that usually presents at an advanced stage and has a median overall survival of 1 year. Treatment options rarely result in cure of disease and range from trimodality treatment, including chemotherapy, radiation, and surgery, to supportive care. In patients with limited local disease and good functional status, trimodality treatment with extra-pleural pneumonectomy, chemotherapy, and radiation is frequently employed. Best supportive care should be instituted for patients with metastatic disease and poor functional status. Palliative therapy focuses on control of pleural effusions with drainage techniques and pain with radiation therapy. Novel therapies are showing promise, including photodynamic therapy, immunotherapy, and molecular targeted therapy.展开更多
Background: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms with unpredictable behavior. Lack of unifying criteria for benign or malignant SFTP has resulted in reports of SFTP exhibiting malignant beha...Background: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms with unpredictable behavior. Lack of unifying criteria for benign or malignant SFTP has resulted in reports of SFTP exhibiting malignant behavior years after complete surgical resection (despite benign initial diagnosis). Additionally, the role of trans-thoracic needle biopsy in initial management of SFTP is unclear. Understanding predictors of malignancy identifies patients at unacceptably high risk for non-surgical primary therapy, and for recurrence despite complete surgical resection. Objectives: The primary objectives were to identify clinicopathological predictors of malignancy & recurrence in SFTP. The secondary aim was to determine the role of trans-thoracic needle biopsy in the management decision algorithm of SFTP. Methods: Retrospective chart review was conducted (Jan. 1983-Dec. 2013) at the Ottawa Hospital for pathologically confirmed SFTP. Data were collected on biopsy-related, clinical, histopathological & immunohistochemistry (IHC) variables. Appropriate tests of statistical inference were conducted for all variables. Results: Pathologically confirmed SFTP was identified in 26 cases. Transthoracic needle biopsy was conducted in 22 (84.6%);with 16 (72.7%) biopsies diagnostic of SFTP with IHC;3 (13.6%) being malignant. Primary management was surveillance in 3 and complete surgical resection in 23. Surgical pathology reported 15 (65.2%) benign and 8 (34.8%) malignant cases. Local recurrence occurred in 3 and distant recurrence in 1. Initial pathology was benign in 3 (75%) with recurrence. Clinicopathologic variables analyzed did not predict recurrent disease. IHC features did not differ between malignant & benign pathology significantly. Predictors of malignant pathology included: infiltrative cellular pattern (p = 0.042), nuclear crowding (p = 0.006), tumour necrosis (p 4 mitoses/ 10 high power field (p Conclusion: Because numerous variables analyzed did not predict recurrent disease, long-term follow-up is warranted regardless of benign or malignant initial histology. Histologic not IHC features predicted malignant pathology. Trans-thoracic needle biopsy did identify malignant SFTP;however its main use should be to differentiate SFTP from other pleural neoplasms using IHC.展开更多
BACKGROUND Nocardiosis is an uncommon infection that usually occurs in immunocompromised patients,and the pulmonary system is the most common site.We report an uncommon case of nocardiosis with diffuse involvement of ...BACKGROUND Nocardiosis is an uncommon infection that usually occurs in immunocompromised patients,and the pulmonary system is the most common site.We report an uncommon case of nocardiosis with diffuse involvement of the pleura,which presented as multiple localized nodular or hillock lesions on computed tomography(CT)with local chest wall infiltration.CASE SUMMARY A 54-year-old woman was referred to our hospital due to cough and fever for 20 d.She had a history of nephrotic syndrome for 7 mo and was given prednisone(60 mg/d)6 mo previously.The hormone was then gradually reduced to the current dose of 25 mg/d.Chest CT showed many nodular or hillock lesions in the right pleura,mediastinum,and interlobar fissure areas.On the lower layer,one lesion infiltrated the chest wall.She was treated with piperacillin sodium and sulbactam sodium,but the therapeutic effect was not good.In this regard,ultrasound-guided local infiltration anesthesia was further conducted for perihepatic hydrops drainage to improve diagnostic accuracy.Puncture fluid culture isolated Nocardia species,confirming the diagnosis of nocardiosis.Subtype Nocardia farcinica was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.Antibiotic treatment was switched to trimethoprim/sulfamethoxazole and imipenem.After 8 d of treatment,the patient was discharged from the hospital with improved condition,and she has been recurrence-free for 2 years.CONCLUSION This report illustrates that nocardiosis should be suspected when clinicians encounter patients who are immunocompromised and have diffuse involvement of the pleura.展开更多
209550 The management of giant mediastinal lymph node hyperplasia:report of 20 cases/Ye Bo(叶波,Dept Thorac Surg,Cancer Hosp,Chin Acad Med Sci Peking Union Med Col,Beijing 100021)…∥Chin J Thorac Cardio-vasc Surg. -2...209550 The management of giant mediastinal lymph node hyperplasia:report of 20 cases/Ye Bo(叶波,Dept Thorac Surg,Cancer Hosp,Chin Acad Med Sci Peking Union Med Col,Beijing 100021)…∥Chin J Thorac Cardio-vasc Surg. -2009,25(4). -248展开更多
With continuing advanced research into pleural fluid turnover, the majority of scientists hold the view that pleural fluid is derived from the microvessels in parietal pleura and drained via parietal lymphatic vessels...With continuing advanced research into pleural fluid turnover, the majority of scientists hold the view that pleural fluid is derived from the microvessels in parietal pleura and drained via parietal lymphatic vessels which empty into systemic veins. The lymphatic vessels that contribute to the pulmonary lymphatic circulation originate in the subpleural connective tissue, not directly from the visceral mesothelium. Therefore, according to the current point of view, pleural effusion absorption through the visceral pleural is normally neclligible and visceral pleura,展开更多
To the Editor. We read with great interest the article by Gao and his colleagues proposing a new schema and hypothesis regarding pleural fluid turnover. In the proposed hypothesis, the visceral pleura possesses a mor...To the Editor. We read with great interest the article by Gao and his colleagues proposing a new schema and hypothesis regarding pleural fluid turnover. In the proposed hypothesis, the visceral pleura possesses a more active role in humans than what was believed. The authors support the notion that in humans the pulmonary lymphatic vessels originate directly from the mesothelium of the visceral pleura and that it has an effect on both infiltration and reabsorption of pleural fluid in human beings.展开更多
基金Supported by Self-funded Research Projects of Guangxi Zhuang Autonomous Region Health Commission of China,No.Z20210063。
文摘BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication.To address safety concerns associated with TPVBs,we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication.The MTP block was performed at the T9 level under ultrasound guidance,with 20 mL of 0.5%ropivacaine injected.Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels.Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement,with none exceeding a mean 24 h numeric rating scale>3.CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.
文摘Back ground: Pleural effusion is a common clinical problem with different causes. Objective: To demonstrate clinical features and outcome of pleural effusion. Methods: Prospective descriptive study was conducted involving 110 patients with pleural effusion admitted to a resource limited hospital in Ethiopia. Results: Males and females were almost equally represented. Cough, fever and weight loss were prominent presenting symptoms accounting 90, 77.3 and 77.3 percent respectively. Right side effusion was the common presentation 50 (45.5%). Forty (37.4%) patients had HIV infection among 107 tested. Tuberculosis was the commonest cause 78 (70.9%) followed by parapneumonic effusion 36 (32.7%) and empyema 27 (24.5%). Malignant pleural effusion was detected only in one patient. Eighty one (73.6%) improved from their illness and 7 (6.4%) died. Lympocytic pleural effusion found to be associated with tuberculosis (OR = 3.942 (1.527 - 10.179), P = 0.005. There were no associations between HIV infection, anemia, elevated ESR and side of pleural effusion with tuberculosis. Conclusion: Tuberculosis was the leading cause of pleural effusion in our setup even though etiologic diagnosis was difficult. Strengthening the laboratory and pathology services in the area is strongly recommended.
文摘A 77-year-old man on systemic chemotherapy against postoperative bilateral multiple lung metastases of malignant solitary fibrous tumor of the pleura suffered from pruritus and jaundice. Blood examination showed elevated levels of hepatobiliary enzymes. Abdominal computed tomography showed a tumor with peripheral enhancement in the pancreatic head, accompanied with the dilatation of intra- and extra-hepatic bile ducts. He was diagnosed as having obstructive jaundice caused by a pancreatic head tumor. The pancreatic head tumor was presumably diagnosed as the metastasis of malignant solitary fibrous tumor of the pleura, because the findings on the pancreatic head tumor on abdominal CT were similar to those on the primary lung lesion of malignant solitary fibrous tumor of the pleura. The pancreatic tumor grew rapidly after the implantation of metallic stent in the inferior part of the common bile duct. The patient died of lymphangitis carcinomatosa of the lungs. Autopsy revealed a tumor that spread from the pancreatic head to the hepatic hilum. Microscopically, spindle-shaped cells exhibiting nuclear atypicality or division together with collagen deposition were observed. Immunohistochemically the pancreatic head tumor cells were negative for staining of α-smooth muscle actin （α-SMA） or CD117, but positive for vimentin, CD34 and CD99. These findings are consistent with those on malignant solitary fibrous tumor of the pleura. We report the first case of obstructive jaundice caused by a secondary pancreatic tumor from malignant solitary fibrous tumor of the pleura.
文摘Malignant pleural mesothelioma is a rare primary tumor rising from the pleura and is associated with exposure to asbestos fibers. Mesothelioma is a locally aggressive disease that usually presents at an advanced stage and has a median overall survival of 1 year. Treatment options rarely result in cure of disease and range from trimodality treatment, including chemotherapy, radiation, and surgery, to supportive care. In patients with limited local disease and good functional status, trimodality treatment with extra-pleural pneumonectomy, chemotherapy, and radiation is frequently employed. Best supportive care should be instituted for patients with metastatic disease and poor functional status. Palliative therapy focuses on control of pleural effusions with drainage techniques and pain with radiation therapy. Novel therapies are showing promise, including photodynamic therapy, immunotherapy, and molecular targeted therapy.
文摘Background: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms with unpredictable behavior. Lack of unifying criteria for benign or malignant SFTP has resulted in reports of SFTP exhibiting malignant behavior years after complete surgical resection (despite benign initial diagnosis). Additionally, the role of trans-thoracic needle biopsy in initial management of SFTP is unclear. Understanding predictors of malignancy identifies patients at unacceptably high risk for non-surgical primary therapy, and for recurrence despite complete surgical resection. Objectives: The primary objectives were to identify clinicopathological predictors of malignancy & recurrence in SFTP. The secondary aim was to determine the role of trans-thoracic needle biopsy in the management decision algorithm of SFTP. Methods: Retrospective chart review was conducted (Jan. 1983-Dec. 2013) at the Ottawa Hospital for pathologically confirmed SFTP. Data were collected on biopsy-related, clinical, histopathological & immunohistochemistry (IHC) variables. Appropriate tests of statistical inference were conducted for all variables. Results: Pathologically confirmed SFTP was identified in 26 cases. Transthoracic needle biopsy was conducted in 22 (84.6%);with 16 (72.7%) biopsies diagnostic of SFTP with IHC;3 (13.6%) being malignant. Primary management was surveillance in 3 and complete surgical resection in 23. Surgical pathology reported 15 (65.2%) benign and 8 (34.8%) malignant cases. Local recurrence occurred in 3 and distant recurrence in 1. Initial pathology was benign in 3 (75%) with recurrence. Clinicopathologic variables analyzed did not predict recurrent disease. IHC features did not differ between malignant & benign pathology significantly. Predictors of malignant pathology included: infiltrative cellular pattern (p = 0.042), nuclear crowding (p = 0.006), tumour necrosis (p 4 mitoses/ 10 high power field (p Conclusion: Because numerous variables analyzed did not predict recurrent disease, long-term follow-up is warranted regardless of benign or malignant initial histology. Histologic not IHC features predicted malignant pathology. Trans-thoracic needle biopsy did identify malignant SFTP;however its main use should be to differentiate SFTP from other pleural neoplasms using IHC.
文摘BACKGROUND Nocardiosis is an uncommon infection that usually occurs in immunocompromised patients,and the pulmonary system is the most common site.We report an uncommon case of nocardiosis with diffuse involvement of the pleura,which presented as multiple localized nodular or hillock lesions on computed tomography(CT)with local chest wall infiltration.CASE SUMMARY A 54-year-old woman was referred to our hospital due to cough and fever for 20 d.She had a history of nephrotic syndrome for 7 mo and was given prednisone(60 mg/d)6 mo previously.The hormone was then gradually reduced to the current dose of 25 mg/d.Chest CT showed many nodular or hillock lesions in the right pleura,mediastinum,and interlobar fissure areas.On the lower layer,one lesion infiltrated the chest wall.She was treated with piperacillin sodium and sulbactam sodium,but the therapeutic effect was not good.In this regard,ultrasound-guided local infiltration anesthesia was further conducted for perihepatic hydrops drainage to improve diagnostic accuracy.Puncture fluid culture isolated Nocardia species,confirming the diagnosis of nocardiosis.Subtype Nocardia farcinica was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.Antibiotic treatment was switched to trimethoprim/sulfamethoxazole and imipenem.After 8 d of treatment,the patient was discharged from the hospital with improved condition,and she has been recurrence-free for 2 years.CONCLUSION This report illustrates that nocardiosis should be suspected when clinicians encounter patients who are immunocompromised and have diffuse involvement of the pleura.
文摘209550 The management of giant mediastinal lymph node hyperplasia:report of 20 cases/Ye Bo(叶波,Dept Thorac Surg,Cancer Hosp,Chin Acad Med Sci Peking Union Med Col,Beijing 100021)…∥Chin J Thorac Cardio-vasc Surg. -2009,25(4). -248
文摘With continuing advanced research into pleural fluid turnover, the majority of scientists hold the view that pleural fluid is derived from the microvessels in parietal pleura and drained via parietal lymphatic vessels which empty into systemic veins. The lymphatic vessels that contribute to the pulmonary lymphatic circulation originate in the subpleural connective tissue, not directly from the visceral mesothelium. Therefore, according to the current point of view, pleural effusion absorption through the visceral pleural is normally neclligible and visceral pleura,
文摘To the Editor. We read with great interest the article by Gao and his colleagues proposing a new schema and hypothesis regarding pleural fluid turnover. In the proposed hypothesis, the visceral pleura possesses a more active role in humans than what was believed. The authors support the notion that in humans the pulmonary lymphatic vessels originate directly from the mesothelium of the visceral pleura and that it has an effect on both infiltration and reabsorption of pleural fluid in human beings.
文摘目的探索免疫治疗在恶性胸膜间皮瘤(malignant pleural mesothelioma,MPM)中免疫疗效相关关键分子及其可能的机制。方法2018年7月至2020年7月,纳入GEO数据库中GSE117358的表达谱进行分析;首先,根据是否对免疫治疗是否有效分为两组:免疫治疗反应组和免疫治疗无反应组,同时分析两组之间差异有统计学意义基因;其次,分析两组差异有统计学意义基因在基因本体(gene ontology,GO)生物学行为及京都基因与基因组百科全书(Kyoto encyclopedia of genes and ge‐nomes,KEGG)富集信号通路等方面的差异;最后,对差异有统计学意义基因构建蛋白-蛋白互作网络,筛选在生物学行为中的重要模块及关键基因,并对关键基因在TCGA数据库中进行整合分析验证。结果在免疫治疗反应组(12个样本)及免疫治疗无反应组(12个样本)中共筛选出1025个差异基因,相对于免疫治疗无反应组,在免疫治疗反应组中有782个上调和243个下调基因。GO和KEGG分析显示,这些差异基因的功能主要集中在细胞因子受体通路、细胞黏附通路、T细胞受体通路及NFkappa B信号通路等;在蛋白-蛋白互作网络分析中,筛选出节点度最高的10个核心基因包括Tnf,Il6,Ptprc,Csf2,Cd86,Cxcl9,Sell,Cxcr3,Ccl2,Cd40。TCGA数据库整合分析显示,Tnf,Il6,Cd86,Cxcl9,Sell,Cxcr3,Cd40等疗效相关关键基因在肉瘤样胸膜间皮瘤中呈现相对高表达,且差异有统计学意义。结论核心基因Tnf,Il6,Ptprc,Csf2,Cd86,Cxcl9,Sell,Cxcr3,Ccl2,Cd40有望成为预测MPM的分子标志物及治疗的潜在靶点。
