纤支镜代胸腔镜对疑难胸水病因的诊断价值

目的探讨纤支镜代胸腔镜在不明原因胸腔积液诊断中的价值。方法收集我院2006～2010年住院66例原因不明的胸腔积液患者行纤支镜代胸腔镜检查术,观察胸膜病变及直视下取病变组织行病理检查。结果 66例胸膜腔积液患者,确诊58例(88%),8例(12%)未能确诊病因,术中术后所有病例均无严重并发症。结论纤支镜代胸腔镜检查对胸腔积液病因诊断是一种患者耐受性好且安全、有效、诊断率高的检查方法,值得临床推广应用。     

电子支气管镜代内科胸腔镜检查在疑难性胸腔积液诊断中的应用

目的 探讨电子支气管镜代内科胸腔镜检查在疑难性胸腔积液诊断中的应用.方法 回顾性分析52例原因不明胸腔积液患者电子支气管镜代替胸腔镜检查诊断结果及并发症,观察在支气管镜下的胸膜改变,并对可疑组织行病理检查.结果 52例原因不明胸腔积液患者,通过电子支气管镜代内科胸腔镜检查明确诊断48例,未能确诊4例,确诊率为92.31％.结论 电子支气管镜代替胸腔镜检查对不明原因的胸腔积液的病因诊断是一种操作简单、诊断率高、并发症少的检查方法,其具有较高临床应用价值,值得进一步推广使用.     

纤支镜代胸腔镜诊断病因不明的胸腔积液

目的探讨纤维支气管镜代胸腔镜诊断原因不明的胸腔积液。方法利用国产纤支镜对3例胸腔积液患者局麻下行胸腔检查并取活检。结果肺腺癌胸膜转移1例，恶性胸膜间皮瘤1例，胸膜结核肉芽肿1例。结论以纤维支气管镜代替胸腔镜行胸腔镜检创伤小，费用低，简便易操作。对原因不明胸腔积液者查明病因提供了一种有效的诊断方法。便于在基层医院推广。     

纤支镜代胸腔镜诊断胸水病因47例分析

目的探讨纤支镜代胸腔镜诊断胸水病因诊断中的应用价值。方法收集在我科住院的胸腔积液患者47例,进行纤支镜代胸腔镜检查。结果结核24例,间皮瘤1例,肺腺癌13例,小细胞癌2例,乳腺转移瘤2例,1例无明确胸膜病变,1例胸膜腔粘连严重手术失败,3例慢性非特异炎症,无严重不良反应。结论纤支镜代胸腔镜安全可靠诊断率较高,值得推广。     

胸膜疾病纤维支气管镜胸腔诊治的应用价值

目的探讨纤支镜代胸腔镜诊治胸膜疾病的临床应用价值。方法对25例自发性气胸和22例胸腔积液患者在局麻下用纤支镜行开放式胸腔检查治疗术。结果胸腔积液患者的诊断率为95.4%(21/22),包括胸膜转移癌11例,胸膜间皮瘤1例,胸膜结核6例,脓胸3例,气胸患者中13例寻找到肺大疱或胸膜破口,而48%(12例)镜下未见明显异常。结论局麻下纤支镜代胸腔镜术安全、简便,可直视下观察胸腔病变并进行活检,有利明确积液病因,对脓胸和自发性气胸的诊治也有较大的意义。     

纤支镜代胸腔镜及疑难胸腔积液的诊断价值

胸膜疾病为呼吸内科常见病之一 ,其良恶性胸腔积液的鉴别诊断有时非常困难 ,我科自 1999年 10月至 2 0 0 1年 3月对2 0例疑难胸腔积液的患者施行了纤维支气管镜代胸腔镜检查术 ,报告如下 :1　对象与方法本组 2 0例 ,男 15例 ,女 5例 ,年龄 34～ 6 5岁 ,平均 5 0 .83岁。均为经影像学、纤支镜、痰细胞学、胸水检查、盲目胸膜活检等常规方法不能确诊者。术前常规检查及消毒 ,如出凝血时间、心电图、胸部 X光片及胸部 B超等 ,纤支镜用甲醛熏蒸灭菌 12小时和 2 %戊二醛浸泡灭菌 30分钟等。术前建立人工气胸 ,常规胸腔穿刺 ,酌情注入胸腔 5 0 0…     

纤支镜代替胸腔镜诊治的安全性、实用性研究

对25例胸腔积液和22例自发性气胸患者纤支镜代替硬质胸腔镜行胸腔内诊治,同时监测肺阻抗血流图、血气、生命体征等。结果:胸腔积液患者检查时平均肺动脉压(MPAP)、心率、呼吸频率明显高于术前及术后(P<0.05);所有患者术中及术后未见严重并发症;胸腔积液组中,22例获病理诊断,气胸组中11例成功进行镜下胸膜破裂口或胸膜下肿大疱修补治     

胸腔镜对胸腔积液的诊断

胸腔镜对胸腔积液的诊断薛立福，姚秀云，高鲁芳我院１９８７～１９９４年对常规方法未能确诊的１００例胸液患者行胸腔镜检查。病例为门诊及住院胸液患者，经胸部Ｘ线摄片、胸液实验室检查、胸腔Ｂ超、纤维支气管镜（纤支镜）检查、胸壁胸膜活检、胸部ＣＴ、磁共振均未获...     

胸膜疾病纤维支气管镜胸腔诊治的应用价值

目的　探讨纤支镜代胸腔镜诊治胸膜疾病的临床应用价值。方法 对25例自发性气胸和22例胸腔积液患者在局麻下用纤支镜行开放式胸腔检查治疗术。结果 胸腔积液患者的诊断率为95.4%(21/22),包括胸膜转移癌11例,胸膜间皮瘤1例,胸膜结核6例,脓胸3例,气胸患者中13例寻找到肺大疱或胸膜破口,而48%(12例)镜下未见明显异常。结论 局麻下纤支镜代胸腔镜术安全、简便,可直视下观察胸腔病变并进行活检,有利明确积液病因,对脓胸和自发性气胸的诊治也有较大的意义。     

纤维支气管镜对原因不明胸腔积液的诊断价值

目的探讨纤维支气管镜对原因不明胸腔积液的诊断价值。方法对经常规检查不能明确诊断的16例胸腔积液患者行纤支镜胸膜腔检查并进行临床分析。结果 16例均能明确诊断,其中恶性胸膜间皮瘤4例,胸膜转移癌9例,结核性胸腔积液3例,病因诊断率为100%。无严重并发症发生。结论纤支镜是安全、简便的检查方法 ,对胸腔积液病因诊断有较高的实用价值。     

CLINICAL USE OF THE NEWLY DEVELOPED ELECTRONIC RADIAL ULTRASOUND ENDOSCOPE

Background: Endoscopic ultrasonography (EUS) is widely accepted as a diagnostic tool for bilio‐pancreatic and gastrointestinal tract diseases. Recently, an ultrasound endoscope with an electronic radial scan transducer has been developed. To evaluate the clinical usefulness of this system, its image quality, advantages and disadvantages were evaluated. Materials and methods: Ultrasound endoscope with electronic radial scan transducer and its monitor unit were used. The direction of the imaging plane was similar to that of the mechanical radial models. Color Doppler function and tissue harmonic imaging were feasible by this system. To evaluate this endoscope, we investigated the image quality and distance resolution by in‐vitro study using thin papers, and 50 patients were examined by this system. Results: Comparison with the mechanical radial endoscope GF‐UM2000 revealed that the image quality was almost equivalent. However, the ultrasound penetration of the electronic radial scanner was better and more satisfactory with less echoic reduction. In addition, the blood‐flow signal could be obtained by using the color Doppler function. In contrast, the diameter of the new endoscope was bigger than the advanced mechanical radial models, the monitor unit was bigger than that of the mechanical radial system, and the operation of this unit was complicated. Conclusion: A prototype of the ultrasound endoscope with electronic radial scan showed satisfactory results regarding the image quality, ultrasound penetration, and clinical diagnosis. The blood flow could be investigated by using the color Doppler function, which is useful to diagnose lesions and detect involvement of the blood vessels in cancers.     

Electronic endoscopy: Its present and future

As its image sensor, the electronic endoscope incorporates the so-called charge-coupled device (CCD) at its tip. The device was developed by the high technology of microelectronics, and it has a quite new construction, different from fibre-optics. Two years after the electronic endoscope was produced first by Welch-Allyn from the USA, the first Japanese electronic endoscope model was developed in 1985, and now an upper gastrointestinal model, a duodenoscope model, and a colonoscope model are available commercially from four companies worldwide.     

NEWLY DEVELOPED ULTRASOUND ENDOSCOPE WITH AN ELECTRONIC RADIAL ARRAY TRANSDUCER

A prototype electronic radial scan ultrasound endoscope has been developed by Olympus (Tokyo, Japan) for endoscopic ultrasound (EUS) study. The ultrasound view‐angle of this model is 360° vertical to the scope. Though the diameter of the scanner and the shaft of the scope is bigger than those of the present mechanical radial scan model, clinical manipulation of the new scope is the same as that of the present model. Image quality of the ultrasound picture demonstrated by the electronic radial model was as clear as those provided by the mechanical radial scan model. Ultrasound penetration was better and satisfactory because of less echoic reduction compared to the mechanical radial model. The newly developed electronic radial model can be evaluated as an ultrasound endoscope for the next generation. The advantage of this system is to facilitate the clinical use of color Doppler function and tissue harmonic imaging, and this system can be operated by the same monitor unit as a convex model of ultrasound endoscope.     

Quantitative Evaluation of Mucosal Regeneration in Gastric Ulcers by Electronic Endoscopy —Comparison between Tractable and Intractable Ulcers—

Abstract: The electronic endoscope named TGS-50B (TOSHIBA) provides a fine resolvable image (Fig. 6) and flat white balance covering a wide range (Fig. 7). Using this electronic endoscope, the regenerative mucosal patterns in 15 cases with intractable and 30 cases with tractable gastric ulcers (Table 1) were observed at 2-week intervals until the healed stage or until 12 weeks after the start of H₂-blocker administration. To clarify the difference between intractable and tractable gastric ulcers, the electronic endoscopic images were fed into an image analyzer; SPICCA (AVIONICS). The regenerative mucosal pattern was converted into 20 binary digited particles by the image analyzer (Fig. 4, Color) and quantified by the oval specification (OSF) value (Fig. 5). The OSF value of the tractable ulcers significantly increased in the healing stage I (H₁) and healing stage 2 (H₂), in comparison with those of intractable ulcers (Fig. 8). Moreover, the OSF value of the tractable ulcer significantly increased at 4 weeks after the start of an H₂-blocker, comparing with that at 2 weeks. Consequently, the OSF values of the tractable ulcers were significantly high in comparison with those of the intractable ulcers, at 4, 6 and 8 weeks after the start of administration of H₂-blockers (Fig. 9). By histological study of the biopsy specimen, an increase in the OSF value suggested an extension of the regenerative mucosa by a well progressed annular contraction of the gastric wall. In conclusion, it is thought that intractability of gastric ulcers may be objectively predictable in its early healing stages by determination of the OSF value using the electronic endoscope and the image analyzer.     

Therapeutic role of direct peroral cholangioscopy using an ultra-slim upper endoscope

Introduction

Peroral cholangioscopy provides direct visualization of the bile duct and facilitates diagnostic procedures and therapeutic intervention. The currently available mother?Cbaby scope system is not widely used because of its disadvantages. Direct peroral cholangioscopy (POC) with a regular, ultra-slim, upper endoscope can provide a valuable and economic solution for evaluating bile duct lesions, although its therapeutic role in biliary tract disease is uncertain. We assessed the usefulness of direct POC with an ultra-slim endoscope for therapeutic application in patients with biliary diseases.

Methods

Several new techniques and accessories allow therapeutic intervention under direct POC using an ultra-slim upper endoscope with a larger, 2-mm working channel. Intracorporeal laser or electrohydraulic lithotripsy under direct POC is a main therapeutic intervention for patients with bile duct stones resistant to conventional endoscopic procedures. Tumor ablation therapy such as photodynamic therapy and argon plasma coagulation may be performed under direct POC. Direct POC can be applied to guide biliary interventions such as guidewire placement, stone removal, and migrated stent retrieval, using diverse accessories.

Conclusion

Direct POC with an ultra-slim upper endoscope allows therapeutic intervention for patients with biliary diseases. Enhancements of the endoscope and specialized accessories are expected to expand the therapeutic role of direct POC.     

Endoscopic diagnosis of small intestinal diseases

The technological development in endoscopy is directed toward improved accuracy of the diagnoses of novel diseases. The capsule endoscope and balloon-assisted endoscope are examples of such technological development. By these novel technologies, the small intestine can be examined in more detail. Therefore, an increasing number of novel diseases have been discovered, requiring the establishment of diagnosis and treatment strategies for these unknown diseases. In particular, obscure gastrointestinal bleeding, Crohn’s disease, and nonsteroidal anti-inflammatory drug-induced enteropathy are of great interest to endoscopists. The capsule endoscope is the best method for screening the small intestine; however, the development of supporting methods such as the patency capsule is eagerly desired.     

A novel biomarker in the diagnosis of parapneumonic effusion: neutrophil gelatinase-associated lipocalin

Background

The protein neutrophil gelatinase-associated lipocalin (NGAL) is a mediator synthesized and released by neutrophils. Its physiological function is as yet unclear. Levels in blood increase in several inflammatory diseases. High serum values indicate poor prognosis for several diseases. Pleural effusion may appear as the result of various pathologies. The most common cause is heart failure (HF). Other common causes include parapneumonic (PPE) and malignant (MPE) pleural effusions, and pulmonary embolism. Tubercular effusion (TE) is commonly encountered in Turkey and similar developing countries. The purpose of this study was to investigate the effectiveness of NGAL, a current inflammation marker, in discriminating between different etiological diseases that cause pleural effusion.

Methods

The study was performed at the Recep Tayyip Erdo?an University Faculty of Medicine Chest Diseases Clinic. One hundred patients were included in the study, 25 with parapneumonic effusion, 25 with heart failure-related effusion, 25 with tubercular effusion and 25 with cancer-related effusion. NGAL was measured in patients’ serum and pleural fluids.

Results

Serum NGAL levels in PPE (171?±?56 ng/ml) were significantly higher (p?<?0.001) than those in HF (86?±?31 ng/ml), CA (103?±?42 ng/ml) and TE (63?±?19 ng/ml). Pleural NGAL levels were also significantly higher in PPE compared to HF, MPE and TE (p?<?0.001). Serum NGAL levels exhibited a positive correlation with white blood cell (WBC), neutrophil, C-reactive protein (CRP), sedimentation, serum LDH, creatinine, pleural leukocyte and pleural neutrophil numbers. The most significant correlation was between NGAL level and WBC (p?<?0.001, r?=?0.579). Both serum and pleural NGAL levels are highly effective in differentiating patients with PPE from those without PPE (AUC: 0.910 and 0.790, respectively).

Conclusions

NGAL can be used in the diagnosis of diseases with an acute inflammatory course. Serum and pleural NGAL levels can differentiate PPE from other diseases causing pleural fluid with high sensitivity and specificity.

     

Experience with Percutaneous Electronic Choledochoscopy

Experience with percutaneous choledochoscopy using a prototype electronic choledochoscope (Pentax ECN-1530) is presented herein. This electronic endoscope is 5.3 mm in outside diameter at the tip and has a forceps channel 2.0 mm in diameter. The outside diameter is 0.4 mm larger, while the forceps channel diameter is 0.2 mm smaller, than that of the conventional fiberoptic choledochoscope (FCN-15X) produced by the same company. Although the new electronic choledochoscope could be inserted through a 16 Fr in size fistula, we considered an 18 Fr fistula to be preferable for insertion without resistance. Various types of accessory equipment for endoscopic treatment, such as an electrohydraulic Shockwave lithotriptor (EHL) and an Nd-YAG laser, could be used without difficulty. The electronic choledochoscope was useful for examining bile duct carcinoma invasion to the hepatic side and evaluating the efficacy of various multi-modal treatments, as it provided observation of the bile duct mucosa in great detail due to a very clear dynamic image. Moreover, endoscopic treatment was also greatly facilitated because it provided a clear view on a large, bright monitor screen for the surgeons. We therefore believe that this new electronic choledochoscope is very useful for the accurate diagnosis and treatment of biliary diseases.     

Pathology of the pleura: what the pulmonologists need to know

Primary and metastatic pleural neoplasms, and non-neoplastic pleural diseases, can have similar clinical, radiographic and gross features. However, treatments and prognoses of these diverse pleural conditions vary greatly. Accurate diagnosis of pleural disease is therefore extremely important, and histological interpretation of pleural biopsies is vital to rendering an accurate diagnosis. Smaller biopsies contribute to the difficulties in accurately characterizing pleural lesions, and immunostains are frequently employed in their assessment. Diffuse malignant mesothelioma, the most common primary pulmonary neoplasm, is rare; however, other less common primary pleural neoplasms, including solitary fibrous tumour, the most common benign primary pleural neoplasm, occur. These neoplasms are discussed. Also, non-neoplastic pleural diseases, including granulomatous pleuritis, eosinophilic pleuritis and fibrous and fibrinous pleuritis, among other diseases, are discussed.     

Predictive Models for Tuberculous Pleural Effusions in a High Tuberculosis Prevalence Region

Background  

Patients with pleural effusions who reside in geographic areas with a high prevalence of tuberculosis frequently have similar clinical manifestations of other diseases. The aim of our study was to develop a simple but accurate clinical score for differential diagnosis of tuberculosis pleural effusion (TPE) from non-TB pleural effusion (NTPE).