经内科胸腔镜多部位胸膜钳夹对恶性胸腔积液的诊治价值

目的 探讨经内科胸腔镜多部位胸膜钳夹对恶性胸腔积液的诊治价值.方法 对31例恶性胸腔积液患者实施胸腔镜检查,并经内科胸腔镜多部位胸膜钳夹,术后置胸腔闭式引流管,接闭式引流瓶,引流3d拔管,与常规抽胸水检查方法比较阳性率、诊断率,观察胸膜固定疗效及不良反应.结果 ①常规方法阳性率71.0%,诊断率35.5%,确诊率19.4%,而胸腔镜阳性率、诊断率、确诊率均为100%,两种方法比较差异有统计学意义(P＜0.01).② 31例恶性胸腔积液患者经治疗后完全缓解(CR)21例,部分缓解(PR)5例,稳定( SD)2例,无效(PD)4例,完全缓解率67.7%,总有效率83.9%,4例出现胸水复发,复发率19.0%,无持久性疼痛、大出血、心律失常和气胸等并发症发生.结论 经内科胸腔镜多部位胸膜钳夹不仅能准确诊断恶性胸膜疾病,还能有效治疗恶性胸腔积液,具有操作简单、安全性高、病人易接受、检查与治疗一次完成的优势,可作为恶性胸腔积液的初始治疗方法.     

红霉素联合顺铂治疗恶性胸腔积液21例临床观察

目的 :探讨恶性胸腔积液的治疗方法。方法 :经B超定位 ,行胸腔穿刺持续引流 ,待胸水放尽后 ,将DDP60～ 80mg注入胸腔 ;2天后 ,待胸水放尽后 ,用 5 %葡萄糖溶液 2 0ml将红霉素 1～ 1 5g溶解后注入胸腔 ;2 4小时后若积液量大于 2 0 0ml,应重复用红霉素注入胸腔 ,最多重复 3次。结果 :2 1例患者中显效 8例 ,有效 10例 ;随访 6个月 ,18例有效者未见胸腔积液复发。结论 :红霉素联合顺铂治疗恶性胸腔积液患者 ,疗效确切 ,是一种较好的治疗方法     

细管胸腔闭式引流并腔内注药治疗恶性胸水(附32例分析)

目的 探讨细管胸腔闭式引流术并腔内注药治疗恶性胸水的临床疗效。方法 对有临床确诊的恶性胸腔积液患，经B超胸水定位后，采用细套管针穿刺，细引流管引流，积液引流干净后胸腔内注入顺铂60mg，高聚生5000μ，每周2次。结果 32例恶性胸腔积液患显效16例，有效12例，无效4例，总有效率87．5％。结论 该方法所用药品价廉，患痛苦小，避免了粗管引流创伤大及引流管堵塞现象，显提高了临床疗效。     

胸腔闭式引流并腔内注射α-甘露聚糖肽治疗恶性胸腔积液的临床观察

目的:探索经中心静脉导管行胸腔闭式引流并腔内注射α-甘露聚糖肽治疗恶性胸腔积液的临床疗效.方法: 64例恶性胸腔积液患者随机分为α-甘露聚糖肽组33例和白介素-Ⅱ组31例,两组均接受中心静脉导管胸腔闭式引流,待胸腔积液尽量排净时分别向胸腔内注入α-甘露聚糖肽20mg和白介素-Ⅱ 60万U,观察两组用药后疗效(完全缓解、部分缓解、稳定、无效)和不良反应发生率,计算总有效率.结果:α-甘露聚糖肽组胸腔积液总有效率优于白介素-Ⅱ组(81.82% vs 58.06% ).不良反应发生率低.结论: 经中心静脉导管胸腔闭式引流并注入α-甘露聚糖肽治疗恶性胸腔积液,创伤小,简单有效,可减轻患者胸腔积液的症状、提高其生活质量.     

康莱特联合顺铂治疗恶性胸腔积液疗效观察

目的观察康莱特联合顺铂(PDD)治疗胸腔积液的近期疗效和毒副作用。方法48例恶性胸腔积液患者，先采用美国Arrow公司生产的一次性单腔中心静脉导管，进行胸腔穿刺置管和闭式引流胸水，再给予胸腔内注药，其中A组(n=25)康莱特加顺铂，B组(n=23)顺铂。康莱特每次注入100ml，顺铂每次注入50mg／m^2，每周注射1次，连续注射2周，一个月后观察两组的疗效及不良反应。结果康莱特加顺铂对恶性胸腔积液的有效率为80％，优于顺铂单用组。结论胸腔闭式引流后注入康莱特加顺铂，治疗恶性胸腔积液，疗效肯定，是控制恶性胸腔积液的有效方法。     

得力生和IL-2联合顺铂治疗恶性胸腔积液的疗效

目的:观察得力生和白细胞介素Ⅱ(IL-2)联合顺铂(PDD)治疗恶性胸腔积液的近期疗效和毒副反应。方法:58例恶性胸腔积液患者,先采用一次性单腔中心静脉导管,进行胸腔穿刺置管闭式引流胸水,再给予胸腔内注药,其中A组(n=32)白细胞介素Ⅱ加顺铂,B组(n=26)得力生加顺铂。白细胞介素Ⅱ每次注入200万U～300万U,得力生每次注入30ml～50ml,顺铂每次注入60mg～100mg,每周注射1次,连续注射3周,1个月观察两组的疗效及不良反应。结果:A组有效率81.3%(26/32),B组有效率76.9%(20/26),无显著性统计学差异(P>0.05)。结论:胸腔闭式引流后注入白细胞介素Ⅱ或得力生加顺铂,治疗恶性胸腔积液,疗效肯定,是控制恶性胸腔积液的有效方法。     

10-羟基喜树碱灌注治疗恶性胸腔积液近期疗效观察

目的观察10-羟基喜树碱(10-HCPT)胸腔灌注治疗恶性胸腔积液的疗效。方法对恶性胸腔积液的患者在行闭式引流,排尽胸水,然后经引流管灌注10-HCPT20mg用生理盐水40～60ml稀释,每周1次,2～3次为一疗程。结果10-HCTP灌注27例,有效率88.9%,疗效显著。结论10-HCTP灌注治疗恶性胸腔积液是一种安全、有效、经济的方法。     

红霉素联合顺铂治疗恶性胸腔积液21例临床观察

目的：探讨恶性胸腔积液的治疗方法。方法：经B超定位，行胸腔穿刺持续引流，待胸水放尽后，将DDP60～80mg注入胸腔；2天后，待胸水放尽后，用5％葡萄糖溶液20 ml将红霉素1～1.5g溶解后注入胸腔；24小时后若积液量大于200 ml，应重复用红霉素注入胸腔，最多重复3次。结果：21例患者中显效8例，有效10例；随访6个月，18例有效者未见胸腔积液复发。结论：红霉素联合顺铂治疗恶性胸腔积液患者，疗效确切，是一种较好的治疗方法。     

15例恶性胸水博莱霉素胸腔内灌注的疗效分析

应用中心静脉导管博莱霉素 (ｂｌｅｏｍｙｃｉｎＢＬＭ)胸腔内灌注治疗肺癌胸水 ,以局部治疗疗控制胸腔积液 ,取得较好的姑息效果。材料和方法一　研究对象　 15例患者均为病理学确诊为肺癌引起的恶性胸水 ,所有病例胸水中均找到癌细胞。大量胸水 11例 ,中等量胸水 4例。治疗前肿瘤放、化疗已停止 4周以上。二　治疗方法　在Ａ超定位下 ,胸腔内置入中心静脉导管 ,采用闭式引流胸腔积液 ,积液消失后 ,经导管向胸腔内注入ＢＬＭ 30ｍｇ加生理盐液 30ｍｌ,关闭引流管 ,嘱患者平卧并变换体位 ,使药液充分弥散整个胸膜腔。 2 4ｈ后开放引流管 ,引…     

10—羟基喜树碱灌注治疗恶性胸腔积液近期疗效观察

目的 观察10-羟基喜树碱（10-HCPT）胸腔灌注治疗恶性胸腔积液的疗效。方法 对恶性胸腔积液的患者在行闭式引流,排尽胸水,然后经引流管灌注10-HCPT20mg用生理盐水40-60ml稀释,每周1次,2-3次为一疗程。结果 10-HCTP灌注27例,有效率88.9%。疗效显著。结论 10-HCTP灌注治疗恶性胸腔积液是一种安全、有效、经济的方法。     

Hibernoma pleural

Hibernoma is a rare benign tumor arising in brown fat arising in young adults with similar incidence in both sexes. They are generally subcutaneous reaching in some instances a considerable size. The interscapular region, shoulders, head and neck are the main locations, but rare cases have been described in a wide variety of sites. Histologically three types of cells mixed in different proportions corresponding to the stages of maduration of the fatty cells. They are benign tumors with not recurrence after excision. We report a pleural hibernoma, a location not reported previously in the literature.     

Malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) used to be a rare disease, but is recently increasing in incidence. Most MPMs were thought to have a causal relationship with asbestos exposure. However, a DNA sequence similar to simian virus 40 has been detected in MPM tumor cells, which suggests a role of viral infection in its etiology. MPM predominantly afflicts men over 60 years old, with a male to female ratio of 3 to 1. MPM is a challenging disease in all aspects, including diagnosis, staging and treatment. Its diagnosis requires a panel of immunohistochemical stains. Multimodal treatment including surgery has shown significant benefit in highly selected patients. Most cytotoxic drugs administered as a single agent have been evaluated, but none have consistently demonstrated response rates greater than 20%. The combination of gemcitabine plus cisplatin has become a standard regimen, although there has been significant variability in response rates between studies. The novel antifolates pemetrexed and raltitrexed are promising agents and undergoing 3 phase III studies. One of these studies is the largest trial ever conducted in MPM patients, which randomized 456 patients into cisplatin with or without pemetrexed groups. The median survival time was 12.1 months in the cisplatin with pemetrexed arm and 9.3 months in the cisplatin alone arm (p = 0.02). Another of these studies is currently being conducted to compare cisplatin with or without raltitrexed. The third study is comparing pemetrexed alone to supportive care. The results of these trials are expected to define the role of chemotherapy for patients with MPM.     

Malignant pleural mesothelioma

Malignant pleural mesotheliomas are tumors originating in the serosal lining of the pleural cavities. Although these are relatively rare tumors, an increasing number of cases are anticipated over the next decade. Patients with these tumors, which are almost invariably fatal, usually have an interval of less than two years between the onset of symptoms and death. There is a well established link between mesothelioma and asbestos exposure. Treatment includes surgery, chemotherapy, and radiotherapy. This article explores the epidemiology and etiology of the disease, offers a summary of current treatment options, and discusses nursing strategies.     

Malignant pleural effusions

Opinion statement Malignant pleural effusions contribute to considerable morbidity in cancer patients and generally portend an overall poor prognosis. Treatment of malignant pleural effusions is palliative; therefore, quality of life issues, as well as the risks and benefits of the therapeutic options, become more critical. In my opinion, factors such as in patient versus outpatient management and associated procedural discomfort are important in the decision-making process, and the patient should participate in these subjective con-siderations. It is difficult to compare results and determine the true efficacy of different techniques and agents because endpoints and response criteria as well as the extent and method of follow-up vary. In addition, the etiology of the primary complaint, dyspnea, is frequently multifactorial. However, malignant effusions recur, and therefore repeated thoracentesis, especially if the fluid rapidly reaccumulates, is usually not a good long-term solution unless the patient’s overall prognosis and current condition prohibits a more invasive option. The standard option for recurrent effusions is insertion of a chest tube. If the lung re-expands, chemical pleurodesis is attempted to achieve adherence of the visceral to the parietal pleura. Sterilized talc is the best sclerosant; it has good efficacy and cost effectiveness and can be administered easily as a slurry at the bedside via a chest tube with minimal patient discomfort and without more aggressive and invasive procedures.     

Malignant pleural mesothelioma

Opinion statement Despite innumerable trials of surgery, radiotherapy, and countless chemotherapeutic drugs, it is unclear whether any intervention has had a significant impact on more than a few highly selected patients with malignant pleural mesothelioma. Because most patients die of respiratory failure from extensive disease progression in the thorax, treatment usually includes attempts at local control. Unfortunately, radiotherapy is associated with significant complications in pleural mesothelioma, and surgery is feasible in only a small percentage of patients. Although there have been several single-institution reports of combined-modality therapy with extrapleural pneumonectomy, postoperative radiation, and chemotherapy in which prolonged survival has been observed, most patients with malignant pleural mesothelioma have locally advanced disease, advanced age, or comorbid medical illnesses that preclude aggressive surgery. Therefore, the use of a systemic anticancer agent is the only treatment option for most patients with malignant pleural mesothelioma. Evaluation of effective chemotherapy regimens for this disease has been hampered by many factors. Because mesothelioma is an uncommon malignancy, most studies have enrolled small numbers of patients, and few trials have been randomized. The disease is heterogenous, yet until recently there was no single staging system that could reliably predict survival, nor is there a universally accepted set of prognostic criteria for selecting a uniform group of patients. Response assessment has been limited by the inherent difficulties of reproducibly measuring pleural-based disease. The real impact of systemic chemotherapy on the natural history of malignant mesothelioma is still uncertain because phase III trials comparing chemotherapy with best supportive care have not yet been completed. Although nearly every class of cytotoxic agent has been evaluated in mesothelioma, response rates of greater than 20% have not been consistently demonstrated for any drug. The most active drug classes are the antifolates, the anthracyclines, and the platinums. Doxorubicin has historically been considered the gold-standard chemotherapy, although its true response rate is likely only 15%. The most active commercially available drug for mesothelioma so far appears to be gemcitabine. Although gemcitabine has a limited role as a single agent, it is quite active in combination with a platinating agent. The impressive 48% response rate reported for the combination of gemcitabine with cisplatin in a single phase II study has made this regimen the new standard of care for off-protocol treatment of this disease, although this trial still requires validation. With the recent introduction of several new agents with definite activity in this disease, the therapeutic nihilism previously associated with malignant pleural mesothelioma is gradually being replaced by a cautious optimism. Early trials of angiogenesis inhibitors, gene therapy, and vaccines offer additional avenues for treatment. As we begin to incorporate these active new drugs with each other and in adjuvant and neoadjuvant treatment regimens, there is reason to believe that superior results for patients with malignant pleural mesothelioma can be achieved in the near future.     

Secretion of intelectin-1 from malignant pleural mesothelioma into pleural effusion

Background:

Malignant pleural mesothelioma (MPM) is a rare but fatal tumour. Although most MPM patients show pleural effusion at even the early stage, it is hard to diagnose as MPM at the early stage because a sensitive and reliable diagnostic marker for MPM has not been found in plasma or pleural effusion.

Methods:

In this study, we investigated whether intelectin-1 was specifically contained in MPM cells and the pleural effusion of MPM patient by immunohistochemistry, western blotting, and enzyme-linked immunosorbent assay.

Results:

Malignant pleural mesothelioma cell lines, but not lung adenocarcinoma cell lines, secreted intelectin-1. In immunohistochemistry, epithelioid-type MPMs, but neither pleura-invading lung adenocarcinomas nor reactive mesothelial cells near the lung adenocarcinomas, were stained with anti-intelectin antibodies. Pleural effusion of MPM patients contained a higher concentration of intelectin-1 than that of lung cancer patients.

Conclusion:

These results suggest that detection of intelectin-1 may be useful for a differential diagnosis of epithelioid-type MPM in immunohistochemistry and that a high concentration of intelectin-1 in pleural effusion can be used as a new marker for clinical diagnosis of MPM.