Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Malignant pleural effusions are often symptomatic and tend to recur after simple aspiration. Pleurodesis may prevent recurrence of the effusion; many agents and techniques have been described. A questionnaire was sent to 448 clinicians in the United Kingdom to determine how pleurodesis is performed in practice. There was a 56% overall response, with replies from 101 respiratory physicians, 88 general physicians, 29 thoracic surgeons, and 35 general surgeons. General surgeons saw few cases of malignant pleural effusion and rarely performed pleurodesis. A patient with recurrent malignant pleural effusion would usually be managed with pleurodesis by 76 (76%) respiratory physicians, 26 (30%) general physicians, and 23 (81%) thoracic surgeons; a further 29 (33%) general physicians would refer such patients to another specialist. Most medical pleurodesis were performed by junior staff, whereas consultant thoracic surgeons were more likely to be concerned with the procedure. All the thoracic surgeons used an intercostal tube drain, usually with suction. An intercostal tube drain was used routinely by only 54 (54%) of the respiratory physicians and 28 (32%) general physicians. Thoracic surgeons preferred talc for pleurodesis whereas physicians most commonly used tetracycline. The variety of methods in use supports the need for randomised, controlled studies to determine the most effective technique of pleurodesis.
 ...
PMID:Management of recurrent malignant pleural effusion in the United Kingdom: survey of clinical practice. 169 95

Malignant pleural effusion (MPE) are associated with significant morbidity. Prompt clinical evaluation followed by aggressive treatment often results in successful palliation. Video-assisted Thoracic Surgery (VATS) today can be employed in the diagnosis and treatment of idiopatic and known MPE. Between January 1994 and December 1998 233 MPE patients were treated with pleurodesis. 206 of them underwent tube thoracostomy and drainage alone followed by chemical pleurodesis. In 27 out of the 233 cases VATS management was applied. These patients had undiagnosed pleural effusions or recurrent MPE following failed previous drainage and pleurodesis. The cause of the effusion was breast cancer in 11 patients, lung cancer in 9, urogenital cancer in 3, mesothelioma in 2 and other in 2. VATS intervention was thoracoscopic exploration with biopsy and directed chemical sclerosis in undiagnosed MPE (19/27) and lysis of pleural adhesions with partial decortication and pleurodesis in recurrent effusions (8/27). VATS managements were successful 26/27 after mean follow up of 6 months. Had not mortality postoperatively and severe morbidity. Chest tubes were removed 1.5 +/- 0.5 days postoperatively and hospital stay were averaged 4 +/- 1 days. We concluded that VATS is a safety and effective way of managing selected patients with pleural effusions.
 ...
PMID:Palliative treatment of malignant pleural effusions by video-assisted thoracoscopic surgery. 1059 13

The presence of malignant pleural effusion in patients with non-small cell bronchogenic cancer has a poor prognostic significance and is indicative of advanced disease (T4, IIIB). The present study will investigate the role of cytology and identify the various cellular components seen in thoracic washings, in the absence of an effusion, and will identify the potential pitfalls in diagnosing these specimens. The sensitivity, specificity, and positive and negative predictive values will be determined, as well as the associated predictive factors. From November 1996 to July 1997, 96 thoracic washings were performed on 44 patients with non-small cell carcinoma of the lung prior to and following resection. The specimens were processed routinely. To assess the false-negative or false-positive cases, all cases were rescreened and then correlated with the surgical pathology. Seven (15.9%) patients had positive findings detected on the pre- and/or postresection thoracic washings. One (2.3%) patient had a negative preresection, but cytologically atypical cells were found on the postresection. Thirty-six (81.8%) patients had negative pre- and postresection thoracic washings. There were no false-positive diagnoses in the study; however, two false-negative diagnoses were made. The finding of positive cytology in 7 of 44 (15.9%) patients appears significant. Thoracic washings may provide evidence of cancer beyond the pleura in patients without pleural effusion which may be indicative of advanced disease.
 ...
PMID:Pre- and postresection thoracic washings in non-small cell carcinoma of the lung: a cytological study of 44 patients without pleural effusion. 1078 40

More than half of neoplastic patients show in their clinical history the onset of pleural effusion. Malignant pleural effusion produces dyspnea, decreases respiratory function and quality of life in patients with advanced cancers. Optimal treatment is actually controversial. The aim of this study is to analyze the experience of malignant pleural effusion treatment of the Multidisciplinary Group of Thoracic Endoscopy. Patients are been subdivided in two group, depending on respiratory performance status and they are been submit to a Video-Assisted Thoracic Surgery (VATS) with talc pleurodesis and to positioning of a chronic indwelling pleural catheter. The treatment of malignant pleural effusion with the methods reported above allows, not only to achieve palliation of symptomatology, but also to achieve pleurodesis in patients with limited life-expectancy with good cost-beneficial ratio.
 ...
PMID:[The treatment of malignant pleural effusions: the experience of a multidisciplinary thoracic endoscopy group]. 1290 3

Video-assisted thoracoscopy under local anesthesia (VAT-LA) is a key investigation in the diagnosis and management of suspected malignant pleural effusion. Two problems encountered at VAT-LA are accessing the pleural space and fibrinous intrapleural septa. Thoracic sonography (TUS) is known to facilitate thoracocentesis after dry tap but has not been studied in detail before VAT-LA. We report a case of lateral decubitus pre-VAT TUS that helped locate the optimal access to the pleural space and demonstrated fibrinous intrapleural septation, thereby affecting the decision to avoid thoracoscopic pleurodesis.
 ...
PMID:The utility of thoracic ultrasound before local anesthetic video-assisted thoracoscopy in patients with suspected pleural malignancy. 1974 57

An 83-year-old male with left chest pain and dyspnea was referred to our hospital. A left upper lung tumor(f3. 6 cm in diameter)and pleural effusion in enhanced thoracic CT with suspicion of malignant pleural effusion were pointed out in June, 2009. There were no swelling lymph nodes and distant metastases by various imaging methods. The diagnosis of pleuritis carcinomatosa was obtained by Video-Assisted Thoracic Surgery(VATS). Intraoperative intrapleural hypotonic treatment was given at the same time. Cytology specimens revealed adenocarcinoma. We diagnosed Stage IV(cT2aN0M1a)adenocarcino- ma of the lung, and treated the patient with pemetrexed(PEM)/carboplatin(CBDCA)chemotherapy. He received 4 courses of chemotherapy. Thereafter, the pleural effusion improved, and the tumor lesion disappeared. There was no abnormal accumulation of fluorodeoxyglucose(FDG)in the positron emission tomography CT(PET-CT)scan, and he was doing well without any sign of recurrence twenty-two months after treatment. This was a rare case of adenocarcinoma of the lung with malignant pleural effusion treated effectively by PEM/CBDCA chemotherapy, a safe treatment for an elderly patient.
 ...
PMID:[A case of adenocarcinoma of the lung with malignant pleural effusion in elderly patient treated effectively by pemetrexed and carboplatin]. 2242 72

Urinary bladder carcinoma (UBC) is the ninth most common malignancy and the second most common urological malignancy after prostate cancer in men. Thoracic metastases occur in more than half of those with muscle-invasive disease, and these generally assume the form of multiple solid parenchymal lesions characteristic of hematogenous seeding of the lung. Unusual patterns of thoracic spread of UBC have also been described albeit sporadically in the form of case reports and series. The aim of our case series is to provide illustrations of several atypical patterns of thoracic involvement by UBC such as isolated mediastinal lymphadenopathy, cavitary lung metastases, malignant pleural effusion, endobronchial disease, and pulmonary tumor embolism. This review is meant to highlight the intersection of the fields of urological oncology and thoracic radiology in the care of patients with UBC.
 ...
PMID:Unusual Patterns of Thoracic Metastasis of Urinary Bladder Carcinoma. 2858 90

Malignant pleural effusion is a common complication of cancer and denotes a poor prognosis. It usually presents with dyspnea and a unilateral large pleural effusion. Thoracic computed tomography scans and ultrasound are helpful in distinguishing malignant from benign effusions. Pleural fluid cytology is diagnostic in about 60% of cases. In cytology-negative disease, pleural biopsies are helpful. Current management is palliative. Previously, first-line treatment for recurrent symptomatic malignant pleural effusion was chest drain insertion and talc pleurodesis, with indwelling pleural catheter insertion reserved for patients with trapped lung or failed talc pleurodesis. However, catheter insertion is an increasingly acceptable first-line treatment.
 ...
PMID:Malignant Pleural Effusion: From Diagnostics to Therapeutics. 2943 14