Medical thoracoscopy (MT) is a minimally invasive procedure that uses rigid or semi-rigid thoracoscopes to directly visualize the pleural surfaces. It has diagnostic and therapeutic applications. The document discusses the history, techniques, indications, and innovations of MT. It notes that MT has a high diagnostic yield for conditions like tuberculosis and malignancies. Local anesthesia with conscious sedation is commonly used. Complications can include infection, bleeding, and re-expansion pulmonary edema. Ongoing studies are exploring modifications to MT techniques and applications in complex parapneumonic effusions.
Dynamic Central Airway Obstruction: Tracheomalacia, Tracheobronchomalacia, An...Bassel Ericsoussi, MD
Dynamic Central Airway Obstruction: Tracheomalacia, Tracheobronchomalacia, And Excessive Dynamic Airway Collapse: Classification, Diagnosis, and Treatment
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
Lung Ultrasound in Critical Care and Resuscitation: Daniel LichtensteinSMACC Conference
Daniel Lichtenstein wants to make his past your future. Join him on a journey through the history of lung ultrasound in critical care and resuscitation.
The scene is over 20 years ago in the desert of Mauritania. It is a noisy environment full of trucks and planes and motorbikes whipping up sand in a frenzy. You are attending a chest trauma and suspect a pneumothorax. However, in this chaotic environment, chest auscultation with a stethoscope is futile. Daniel describes a visual approach with a portable ultrasound in what was possibly the first extra-hospital ultrasound use.
Daniel also has a passion for in-hospital point of care. This stems from a time he “borrowed” an ultrasound machine from the radiology department and reached a critical diagnosis. His journey with lung ultrasound in critical care and resuscitation was born.
The usefulness of point of care ultrasound in critical care is far reaching. It is used for subclavian catheter insertion, searching for abdominal blood, and assessing the optic nerve or inferior vena cava. It is even used for assessing the “forbidden” area – the lungs.
The use of ultrasound is now ubiquitous; however, this has not always been the case. During its rise to prominence there was a trench war going on and its proponents had to fight claims of ridiculousness!
Daniel will highlight the utility of lung ultrasound in critical care, highlighting how proper use of the technology provides a holistic care approach to your patients. He will discuss multiple protocols he has been a part of developing and use them as an example of the philosophy of ultrasound.
The ultrasound revolution is certainly happening, but the work that made it possible happened long ago!
The discovery of malignant cells in pleural fluid
and/or parietal pleura signifies disseminated or
advanced disease and a reduced life expectancy in
patients with cancer.Median survival following
diagnosis ranges from 3 to 12 months and is
dependent on the stage and type of the underlying
malignancy. The shortest survival time is observed
in malignant effusions secondary to lung cancer
and the longest in ovarian cancer, while malignant
effusions due to an unknown primary have an
intermediate survival time.Historically, studies
showed that median survival times in effusions due
to carcinoma of the breast are 5-6 months.
However, more recent studies have suggested
longer survival times of up to 15 months. A
comparison of survival times in breast cancer
effusions in published studies to 1994 calculated
a median survival of 11 months.9
Currently, lung cancer is the most common
metastatic tumour to the pleura in men and breast
cancer in women.Together, both malignancies
account for 50- 65% of all malignant effusions. Lymphomas, tumours of the genitourinary
tract and gastrointestinal tract account for
a further 25% Pleural effusions from an
unknown primary are responsible for 15% of all
malignant pleural effusions.Few studies have
estimated the proportion of pleural effusions due to
mesothelioma: studies from 1975, 1985 and 1987
identified mesothelioma in 1/271, 3/472 and 22/592
patients, respectively, but there are no more recent
data to update this in light of the increasing incidence
of mesothelioma.
It is a minimally invasive procedure that uses ultrasound with an EBUS bronchoscope (thin, long flexible tube with a camera on an end) to see the airway wall and the adjacent structures.
Dynamic Central Airway Obstruction: Tracheomalacia, Tracheobronchomalacia, An...Bassel Ericsoussi, MD
Dynamic Central Airway Obstruction: Tracheomalacia, Tracheobronchomalacia, And Excessive Dynamic Airway Collapse: Classification, Diagnosis, and Treatment
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
Lung Ultrasound in Critical Care and Resuscitation: Daniel LichtensteinSMACC Conference
Daniel Lichtenstein wants to make his past your future. Join him on a journey through the history of lung ultrasound in critical care and resuscitation.
The scene is over 20 years ago in the desert of Mauritania. It is a noisy environment full of trucks and planes and motorbikes whipping up sand in a frenzy. You are attending a chest trauma and suspect a pneumothorax. However, in this chaotic environment, chest auscultation with a stethoscope is futile. Daniel describes a visual approach with a portable ultrasound in what was possibly the first extra-hospital ultrasound use.
Daniel also has a passion for in-hospital point of care. This stems from a time he “borrowed” an ultrasound machine from the radiology department and reached a critical diagnosis. His journey with lung ultrasound in critical care and resuscitation was born.
The usefulness of point of care ultrasound in critical care is far reaching. It is used for subclavian catheter insertion, searching for abdominal blood, and assessing the optic nerve or inferior vena cava. It is even used for assessing the “forbidden” area – the lungs.
The use of ultrasound is now ubiquitous; however, this has not always been the case. During its rise to prominence there was a trench war going on and its proponents had to fight claims of ridiculousness!
Daniel will highlight the utility of lung ultrasound in critical care, highlighting how proper use of the technology provides a holistic care approach to your patients. He will discuss multiple protocols he has been a part of developing and use them as an example of the philosophy of ultrasound.
The ultrasound revolution is certainly happening, but the work that made it possible happened long ago!
The discovery of malignant cells in pleural fluid
and/or parietal pleura signifies disseminated or
advanced disease and a reduced life expectancy in
patients with cancer.Median survival following
diagnosis ranges from 3 to 12 months and is
dependent on the stage and type of the underlying
malignancy. The shortest survival time is observed
in malignant effusions secondary to lung cancer
and the longest in ovarian cancer, while malignant
effusions due to an unknown primary have an
intermediate survival time.Historically, studies
showed that median survival times in effusions due
to carcinoma of the breast are 5-6 months.
However, more recent studies have suggested
longer survival times of up to 15 months. A
comparison of survival times in breast cancer
effusions in published studies to 1994 calculated
a median survival of 11 months.9
Currently, lung cancer is the most common
metastatic tumour to the pleura in men and breast
cancer in women.Together, both malignancies
account for 50- 65% of all malignant effusions. Lymphomas, tumours of the genitourinary
tract and gastrointestinal tract account for
a further 25% Pleural effusions from an
unknown primary are responsible for 15% of all
malignant pleural effusions.Few studies have
estimated the proportion of pleural effusions due to
mesothelioma: studies from 1975, 1985 and 1987
identified mesothelioma in 1/271, 3/472 and 22/592
patients, respectively, but there are no more recent
data to update this in light of the increasing incidence
of mesothelioma.
It is a minimally invasive procedure that uses ultrasound with an EBUS bronchoscope (thin, long flexible tube with a camera on an end) to see the airway wall and the adjacent structures.
Thermal Ablation of Renal Tumors under Ultrasound Guidance and Conscious Seda...asclepiuspdfs
Purpose: Computed tomography (CT) guidance and general anesthesia have recently been recommended as the approach of choice for percutaneous ablation of small renal cell carcinoma (RCC), whereas ultrasound (US) guidance and conscious sedation have been tagged as inadequate. Aim of the study was to assess the safety and effectiveness of percutaneous thermal ablation of small RCC under ultrasound (US)-guidance and conscious sedation. Methods: The records of 74 patients with small RCC (≤5 cm), who underwent US-guided thermal ablation under conscious sedation were retrospectively reviewed. Conscious sedation was usually induced by means of intravenous bolus of midazolam 50–100 μg/kg plus continuous infusion of a 25 μg/mL solution of remifentanil at a rate of 0.05 μg/kg/min. Technical success, technical efficacy, local tumor progression (LTP), primary and secondary efficacy rates, complication rate, and 1-, 3-, and 5-year survival rates were analyzed.
Endobronchial Ultrasound - dr deepak talwar best pulmonologist in IndiaMetro Hospital
Dr. Deepak Talwar
Director & Chair, Pulmonary,
Sleep & Critical Care Medicine,
Metro Group of Hospitals, Noida http://www.metrohospitals.com/doctors/deepak-talwar
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Outline
– Introduction
– Medical vs surgical thoracoscopy
– Historical background and Indian scenario
– Pleural biopsy methods- pros and cons
– Types, indications, contraindications of MT
– Preparation, procedure and complications
– Innovations and future directions
– Conclusion
4. Medical
Thoracoscopy
MT also termed “local anesthetic thoracoscopy” and
“pleuroscopy,” is a minimally invasive single-port
endoscopic technique using rigid and semi-rigid
thoracoscopes that offers direct visualization of pleural
surfaces, as well as channels to perform diagnostic and
therapeutic procedures.
Murthy and Bessich. MT: its evolving role
J Thorac Dis 2017;9(Suppl 10):S1011- S1021
7. • 659 respondents
• 47.8% practiced in corporate/private hospitals
• 47.2% performed MT
• 61.1% used flex-rigid/semi-rigid thoracoscopes
• Undiagnosed pleural effusions and recurrent pleural effusions were the
most common indications
• Majority of the thoracoscopists (71.4%) used conscious sedation and a
combination of Midazolam and Fentanyl was the most preferred
combination
8. • Rigid thoracoscope was the most commonly used instrument.
• The common indications of procedure included undiagnosed pleural effusion,
talc pleurodesis, and adhesiolysis.
• Local anesthesia with conscious sedation was the preferred anesthetic
modality. Midazolam, along with fentanyl, was the most widely used sedation
combination. 2% lignocaine was the most commonly used concentration for
local infiltrative anesthesia.
• Nearly 2/3 of the respondents reported having encountered any complication
of thoracoscopy. Significant reported complications included empyema,
incision/port-site infection, re-expansion pulmonary edema, and
procedure-related mortality.
9. Training in MT
• The American College of Chest Physicians (ACCP)
recommends that
20 supervised procedures are performed before
operators are considered competent
AND
10 procedures should be performed each year to
maintain competency
Ernst A, Silvestri GA, Johnstone D, et al. Interventional pulmonary procedures: guidelines from
the American College of Chest Physicians. Chest 2003; 123: 1693–1717.
10. Levels of competence in
medical thoracoscopy
3 levels of medical thoracoscopic practice in European countries
• Level I
includes basic diagnostic and therapeutic techniques, manage large pleural effusions,
biopsy the parietal but not the visceral pleura; undertake therapeutic talc insufflation
• Level II
small/no pleural effusion (pneumothorax induction); visceral pleural biopsy; pinch lung
biopsy; lysis of adhesions
• Level III
This level covers all VATS techniques (eg, lung resection) and is currently the province of
the thoracic surgeon.
Thorax 2010;65(Suppl 2):ii54eii60. doi:10.1136/thx.2010.137018
11.
12. • Pleural fluid cytology for malignancy has a varying sensitivity, with a
maximum of only 60% and it may increase with subsequent tapping.
• Closed pleural biopsy using a Cope or Abrams needle has a sensitivity up to
80% in cases of tuberculous effusion and 40% to73% in cases of
Malignancies.
• Drawback of closed pleural biopsy is false negative results. The sample
obtained may not be representative of the tumor due to localized seeding
of the cells.
• In TB endemic areas, diagnostic yield in a pleuroscopic guided biopsy for TB
is very high (98%) although a closed pleural biopsy which has a diagnostic
yield of 80% should suffice. But in view of increasing incidence of drug
resistant TB, it's wise to obtain a pleuroscopy guided biopsy for better
culture of organism for drug sensitivity
• Semi-rigid thoracoscopy is simple, safe procedure with a very high
sensitivity of 93-95% in cases of malignancies
16. Rigid or Semi-rigid ?
• Small-scale trials of both approaches suggest they
have a comparable diagnostic yield, despite the
generally larger biopsy specimens obtained via rigid
thoracoscopy.
• RCT comparing the two techniques by Dhooria et al
suggests that when biopsies are obtained, there is
little difference in the procedural approach selected,
but rigid thoracoscopy remains superior in the
setting of difficult-to-biopsy lesions.
22. Semi-rigid thoracoscope
Angled range:
up 160/down 130.
operating part is the
same as the
flexible
bronchoscope
Insertion section outer
diameter of 7 mm and a
working channel 2.8-mm
diameter
23.
24. Mini-thoracoscopy
currently defined as endoscopy using small instruments with
a diameter from 2-5 mm
Indications:
• Endoscopy of a small loculated effusion
• Evaluation for drainage of a loculated empyema
• Complete endoscopic examination of pleural cavity
• Pre-standard thoracoscopic evaluation in complex cases
Thoracoscopy for Pulmonologists: A Didactic Approach
DOI 10.1007/978-3-642-38351-9
25. Forceps ( below ) and optic ( above )
during minithoracoscopy
29. Rodriguez-Panadero F, Janssen JP, Astoul P (2006) Thoracoscopy: general overview and
place in the diagnosis and management of pleural effusion. Eur Respir J 28:409–421
30. Thoracoscopy procedure steps
• Place the patient in lateral decubitus positions (healthy lung down)
• Identify entry site (preferably using ultrasound guidance)
• Sterile prep of patient and proceduralist
• Give systemic and local anesthesia
• Skin incision
• Blunt dissection down to the parietal pleura
• Entry into the pleural space with measurement of the chest wall thickness
• Insertion of the trocar (care taken regarding depth of insertion)
• Trocar removed, outer cannula left in place
• Thoracoscope inserted for inspection of entire chest cavity
• Performance of diagnostic and therapeutic procedure(s)
• Insertion of chest drain
• Chest wall closure (muscle, fascia and skin layers)
38. BLEB
An apical bleb (black
arrow) close to
subclavian artery
(white arrow) in a
case of primary
spontaneous
pneumothorax
39. Diagnostic utility of medical thoracoscopy in undiagnosed
exudative pleural effusions.
Marwah V, Bhattacharyya D, Ali MF, Rajput AK, Sengupta P, Bhati G. Med J DY Patil Vidyapeeth
2020;13:525-8.
40. Ranganatha R, Tousheed SZ, MuraliMohan BV, Zuhaib M, Manivannan D, Harish BR, et al.
Role of medical thoracoscopy in the treatment of complicated parapneumonic effusions. Lung
India 2021;38:149-53.
43. Chest X-ray showing pleural fluid drainage;
(a) before drainage (b) after drainage
44. Conclusion :Early adhesiolysis and drainage of fluid
using medical thoracoscopy should be considered in
patients with multiloculated complicated PPE after
careful radiological (ultrasonography and CT)
stratification, as a more cost-effective and safe method
of management. 10.4103/lungindia.lungindia_543_20
45. • Eight studies included
• The pooled treatment success rate of thoracoscopy was 85% when
used as first-line intervention or after failure of chest tube
• The pooled complication rate was 9.0%
Conclusions: Medical thoracoscopy is effective and safe when
prescribed for complicated parapneumonic effusions and
empyema. Bacteriological negativity of pleural effusion
specimens and administration of adjuvant intra-pleural
fibrinolysis after the procedure are associated with a higher
success rate.
46. Limitation of the semi-rigid
thoracoscopy
• smaller sample size and the more superficial
sampling of the pleura.
• Though the smaller size of samples obtained with
semi-rigid thoracoscope does not affect diagnostic
yield, a larger biopsy tissue sample will always be
beneficial for further subclassi- fication using IHC
and doing molecular testing if we are dealing with a
malignancy.
• Difficult to obtain a sample with a flexible forceps
biopsy when the pleura is thickened or fibrosed
47.
48. Modifications in semi-rigid thoracoscopy
• Cryobiopsy through semi-rigid pleuroscope
• Electrocautery guided pleural biopsy using the IT knife
• Autofluorescence video thoracoscopy
• Narrow band imaging (NBI)
• Protective sheath guided pleurodesis
• Pleural infiltration of Lidocaine using TBNA needle
49. Cryobiopsy through semi-rigid pleuroscope
Pleuroscopic view showing the
cryo probe passed through the
working channel of pleuroscope
and freezing an area of parietal
pleura
Comparison of the size of sample
taken via conventional flexible biopsy
forceps (smaller piece on top) and
cryoprobe (larger piece)
50. White light pleuroscopy and narrow-band imaging (NBI) showing
abnormal vascular pattern due to malignant mesothelioma
White light pleuroscopy with
irregular vascular pattern
NBI pleuroscopy with enhanced
vascular tortuosity due to
malignant mesothelioma
52. Ongoing studies in MT
• A RCT in India is exploring the use of a “mini-rigid” thoracoscope with a
5.5 mm diameter working channel, comparing diagnostic yield and
patient-centered outcomes against the semi-rigid thoracoscope
(NCT02851927).
• Another group hopes to improve the diagnostic yield of the semi-rigid
approach by performing cryobiopsy of parietal pleura with the
standard flexible cryoprobe, comparing yield to the standard forceps
biopsy (NCT02500277).
• REPEAT trial hopes to establish the comparability of MT and VATS
pleural biopsy, with respect to diagnostic yield and the need for
additional interventions in patients with suspected malignancy
(NCT02834455).
• Majid et al. are exploring the role of MT in the management of complex
parapneumonic effusions in a trial comparing the procedure against
current standard-of-care medical therapy with combined intrapleural
tPA and DNase (NCT02973139).
53. Conclusion
• Medical thoracoscopy is an overall safe procedure
with very low complication and mortality rate when
performed by trained pulmonologists.
• The application of MT in pleural diseases is
supported by studies showing high diagnostic yield
and effective therapeutic intervention.
• Medical thoracoscopy appears to be valuable in
patients who are not surgical candidates or are at an
increased risk of complications from more invasive
procedures such as VATS.
54. REFERENCES
• Expert consensus for diagnosis and treatment using medical
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http://dx.doi.org/10.21037/jtd-19-2276
• Evolution of semi-rigid thoracoscopy Indian journal of tuberculosis (
2022) 12 e19 https://doi.org/10.1016/j.ijtb.2021.03.002
• Deschuyteneer EP, De Keukeleire T. BMJ Open Resp Res 2022;9:e001161.
doi:10.1136/bmjresp-2021-001161
• Z. Huo et al. / International Journal of Infectious Diseases 81 (2019) 38–
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• Kay Choong See and Pyng Lee Advances in the diagnosis of pleural
disease in lung cancer Ther Adv Respir Dis (2011) 5(6) 409–418 DOI:
10.1177/1753465811408637
55. REFERENCES cont.
• Mondoni et al. BMC Pulm Med (2021) 21:127 Medical
thoracoscopy treatment for pleural infections: a systematic
review and meta-analysis
• Ranganatha R, Tousheed SZ, MuraliMohan BV, Zuhaib M,
Manivannan D, Harish BR, et al. Role of medical thoracoscopy
in the treatment of complicated parapneumonic effusions.
Lung India 2021;38:149-53.
• Madan K, Tiwari P, Thankgakunam B, Mittal S, Hadda V,
Mohan A, et al. A survey of medical thoracoscopy practices in
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• DOI: 10.3892/etm.2018.6742 Diagnostic value of medical
thoracoscopy for undiagnosed pleural effusions
Lack of informed consent Hypercapnia or severe respiratory distress myocardial
infarction (for which the procedure should be delayed by at
trapped lung
