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Objective To evaluate the positive rate, reliability and safety of thoracoscope pleural brushing for diagnosing malignant pleural effusion. Methods Seventy patients with unexplained pleural effusion were performed with medical thoracoscopy:(1) Observe the visceral and parietal pleura then use disposable cell brush to obtain specimens from suspect areas and take cytological examination. (2) Observe the parietal pleura then use biopsy forceps to forceps specimens from suspect areas and take histological examination. (3) Compare the positive rate of diagnosis, coincidence rate of pathological type and complication between two methods individual and combination in diagnosis. Results In 51 patients diagnosed as malignant pleural effusion, the diagnosis-positive rate of biopsy was 88.24%(45/51) and the diagnosis-positive rate of pleural brushing cytology was 90.20%(46/51). The diagnosis-positive rate of pleural brushing combined with biopsy was 96.08%(49/51), but there was no significant difference in diagnosis-positive rate between two methods individual and combination for malignant pleural effusion (P>0.05). In 51 patients, pathological type determination rate was 76.47%(39/51) evaluated by pleural brushing, 88.24% (45/51) by biopsy, and there was no significant difference in pathological type determination rate between two methods (P>0.05). Biopsy was performed for 168 times, more bleeding was found in 5 cases (2.98%), feeling pain in 134 cases (79.76%). Pleural brushing examination was performed for 198 times, no significant bleeding and pain were found. Conclusion Medical thoracoscopic pleural brushing under direct vision is a safe and reliable method, which can be use as an effective diagnostic method for malignant pleural effusion.
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Objective To observe the hemostatic efficacy and safety of argon plasma coagulation (APC) through bron?choscope after biopsy. Methods The APC was given to patients suffered from coronary heart disease combined hyperten?sion or paroxysmal auricular fibrillation and accepted bronchoscopy biopsy with much bleeding. The hemostatic effect and changes of heart rate, blood pressure and SPO2 were observed before and after treatment. Results Sixty-two patients were treated with endoscopic hemostasis by APC. The hemostasis was successful in 60 cases. The hemostasis was performed with APC successfully in 2 patients after intubation and mechanical ventilation because of the biopsy hemorrhage. Sixty-two cas?es included 42 cases of airway tumor (26 cases in lobe bronchus and 16 in segmental bronchus), 16 cases of broadening of the trachea ridge and mucosal rough, and 4 cases of granulation tissue of lobe bronchus. There were no significant differenc?es in mean arterial pressure and heart rate before and after treatment in 60 patients (P>0.05). The oxygen saturation was sig?nificantly lower after treatment than that before treatment (0.939±0.027 vs. 0.956±0.017, P<0.05). Conclusion Hemosta?sis treatment by APC through bronchoscope has the characteristics of rapid, thorough and safe, especially for patients com?bined with cardiovascular disease. It can avoid the occurrence of cardiovascular system complications caused by convention?al hemostatic treatment.
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Objective To study the predictive value of evaluation in oxygen partial pressure[p(O2)] and carbon dioxide partial pressure[p(CO2)] of pleural cavity to the closure of visceral pleura in primary spontaneous pneumothroax (PSP) pa-tients. Methods Seventy-six hospitalized pneumothroax patients were divided into two groups:closed pneumothroax group (n=40) and open pneumothroax group (n=36), according to the radiographic information.To collect the expiratory gas by the device which we designed and produced, to collect the gas in the pleural cavity by thoracentesis. To detect the p(O2)and p(CO2)respectively, and the blood gas analysis of radial artery was done at same time. Results There was significantly low-er value of p(O2)of the gas in the pleural cavity in patients of closed pneumothroax than that of open pneumothroax (P 0.05). There was significantly higher value of the expiratory gas/the pleural cavity gas p(O2) and a significantly lower value of p(CO2), in closed pneumothroax group than those of open pneumothroax group (P<0.05). Logistic regression analy-sis showed that values of the expiratory gas/the pleural cavity gas p(O2) and p(CO2) were the effective factors for the closure of visceral pleura. ROC curve showed that the areas under ROC curve (AUC) for the expiratory gas/the pleural cavity gas p(O2) and p(CO2) was 0.985 and 0.867, the sensitivities were 92.5% and 77.8%, the specificities were 100%and 85.0%and the reference values were 1.81 and 0.97. Conclusion To utilize the evaluation of gas partial pressure can predict whether the leakage of the visceral pleura is closed.
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Objective:To investigate the main clinical features of critically ill patients with influenza A (H1N1) influenza virus pneumonia, and the relationship between airway secretions and cardiopulmonary pathology change with continuous hypoxemia. Methods: The retrospective analysis was made in critically ill patients with H1N1 influenza virus pneumonia admitted to a respiratory intensive care unit(RICU). Twenty-four patients were all administrated antiviral drugs (oseltamivir 75/150 mg Bid). Twenty of them were subjected to application of hormonal therapy, and 6 of them with mechanical ventilation. Results: The average age of 24 patients was (48.25±19.73) years old. Fifteen of them were pregnant women, obesity and who suffered from chronic underlying diseases. The main symptoms of them were progressive shortness of breath, cough and myalgia. It was found by X-ray that 22 patients(91.67%) had multiple lung consolidation shadow. After admission, airway secretions were collected, and the protein concentration of which was 34.1-37.7 g/L in 5 cases. The concentration of l-lactate dehydrogenase(LDH) was 792-1 890 U/L. White blood cell count was (0.722-1.470)×10~9/L, included 0.21-0.44 neutrophils, 0.111-0.560 mononuclear cells, 0.027-0.110 eosinophils, 0.018-0.054 basophils. Pathological changes of these patients were hyaline membrane formation, alveolar cavity collapse, myocardial cell degeneration and focal myocardial necrosis. Intubation and mechanical ventilation were performed in 6 cases, 5 of them dead and the mortality rate was 20.83%. Conclusion: The lung pathological damages were increased LDH and protein in airway secretions, and increased count of inflammatory cells. Effect of mechanical ventilation was not satisfied in part of patients who had diffuse lung consolidation in X-ray, and the related complications leaded to exacerbation or death in part of them.