Role of semirigid thoracoscopy in the diagnosis of exudative pleural effusion: Assiut University Hospital experience

The procedure of medical thoracoscopy provides a window into the pleural space to perform biopsy under direct visualization, particularly when thoracocentesis and closed pleural biopsy are inconclusive. The development of the semirigid thoracoscope, which is handled similarly to a bronchoscope, has made this procedure feasible and successful by most pulmonologists. It remains unknown whether certain pleural lesions, as visualized on thoracoscopy, has potential diagnostic value. We aimed to assess diagnostic value of the semirigid thoracoscope and correlate endoscopic finding with the histological diagnosis. From January 2010 to January 2012, 64 diagnostic medical thoracoscopies were performed to 64 patients with undiagnosed pleural effusion, in a tertiary care university hospital. All patients had thoracoscopy with visually directed biopsies and pleural lesion rating under local anaesthesia and mild sedation. Endoscopic findings were classified as: pleural thickening, nodules, adhesions and whitish lymphedema. The yield of the thoracoscopic biopsy in reaching final diagnosis was [98.4%]. Thoracoscopic diagnosis of malignancy in our study was [76.6%] whereas benign diagnosis was [23.4%]. Thoracoscopy was well tolerated under local anaesthesia and in most cases it was a one day procedure. Significant relations were found between endoscopic and pathology findings. Presence of nodules and lymphedema had a trend a positive relation with malignancy, p-value [0.002] and [0.009] respectively. Medical thoracoscopy is a simple relatively low-cost procedure. In the hands of experienced physicians it is generally safe, and highly effective at achieving a histological diagnosis. The presence of nodules and lymphedema, carries a high possibility of the effusion to be of a malignant etiology

Role of sleep endoscopy in obstructive sleep apnea syndrome

There are limited data about the role of sleep endoscopy in obstructive sleep apnea syndrome [OSAS]. The aim of this study was to evaluate the level, degree and shape of obstruction of the upper airway in patients with OSAS by sleep endoscopy and their relation to OSAS severity. Fifty consecutive patients with OSAS were prospectively enrolled in this cross sectional analytic study. All patients underwent history, a full night-attended polysomnogra-phy and sleep endoscopy. The degree of pharyngeal narrowing [grades I-IV] was evaluated at ret-ropalatal, retroglossal and hypopharyngeal levels. Shape of pharyngeal collapse was classified into circular, lateral or antero-posterior at retropalatal and retroglossal levels. Shape of the epiglottis was also observed. All patients showed multisegmental levels of obstruction. Moderate OSAS had a higher percentage of grade II obstruction but a lower percentage of grade I at hypopharyngeal level compared to mild OSAS [P < 0.05]. Also, in moderate OSAS, tongue base obstruction was 47.4% which was significantly higher comparing to mild OSAS [16.7%] [P < 0.05]. There was no significant difference between different grades of obstruction at all anatomical levels in polysomnograph-ic parameters. Omega shaped epiglottis was associated with the highest apnea hypopnea index, desaturation index, lowest average and minimum O[2] level. Sleep endoscopy is a useful tool for the assessment of level, degree and shape of the upper airway obstruction during sleep in OSAS and this could be helpful in preoperative evaluation. Presence of obstruction at hypopharyngeal level or tongue base obstruction is an indicator of OSAS severity