Diseases of the pleura:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schriftenreihe: | Clinics in chest medicine
19,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII S., S. 229 - 422 Ill., graph. Darst. |
Internformat
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| 245 | 1 | 0 | |a Diseases of the pleura |c Veena B. Antony guest ed. |
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| 490 | 1 | |a Clinics in chest medicine |v 19,2 | |
| 650 | 2 | |a Maladies de la plèvre | |
| 650 | 7 | |a Pleura |2 gtt | |
| 650 | 2 | |a Plèvre - anatomie et histologie | |
| 650 | 7 | |a Ziekten |2 gtt | |
| 650 | 4 | |a Pleura |x Diseases | |
| 650 | 4 | |a Pleura |x anatomy & histology | |
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Datensatz im Suchindex
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| adam_text | DISEASES OF THE PLEURA
CONTENTS
Preface xiii
Anatomy of the Pleura 229
Nai San Wang
The pleura with an inner layer of mesothelial cells is like a sealed, wet,
and stretchable plastic bag that is inserted between the lung and the
thoracic cage. The apical bushy microvilli of mesothelial cells enmesh
slimy hyaluronic acid rich glycoproteins to decrease the friction between
the ever moving lung and the chest wall. The amount of fluid in the
pleural cavity is closely regulated by hydrostatic osmotic pressure relation¬
ship and cells are removed through stomas, like the drain, into the lym¬
phatic system. Reactive mesothelial cells constantly repair the incurred
damage and keep the pleural cavity open.
Mechanical Coupling and Liquid Exchanges in the Pleural Space 241
Emilio Agostoni and Luciano Zocchi
The pleural space provides the mechanical coupling between lung and
chest wall: two views about this coupling are reported and discussed.
Information on volume, composition, thickness, and pressure of the pleural
liquid under physiologic conditions in a few species is provided. The
Starling pressures of the parietal pleura filtering liquid into pleural space,
and those of the visceral pleura absorbing liquid from the space are
considered along with the permeability of the mesothelium. Information
on the lymphatic drainage through the parietal pleura and on the solute
coupled liquid absorption from the pleural space under physiologic condi¬
tions and with various kinds of hydrothorax are provided.
CT and MR in Pleural Disease 261
Theresa C. McLoud
A number of different imaging modalities can be used in the assessment
of pleural disease. Although ultrasound has been the more traditional
method, CT has found increasing utility for the assessment of the empy
ema and loculated pleural fluid collections prior to drainage and the
evaluation of benign and malignant pleural tumors. MRI has a limited but
j CLINICS IN CHEST MEDICINE VOLUME 19 • NUMBER 2 • JUNE 1998 ix
important role particularly in the evaluation of focal pleural tumors such
as lipomas and in determining the extent of malignant mesothelioma prior
to therapy.
Evaluating Diagnostic Tests in the Pleural Space: Differentiating
Transudates from Exudates as a Model 277
John E. Heffner
Physicians have a staggering variety of diagnostic tests available for direct¬
ing their diagnostic and therapeutic decisions. Technologic advances in
laboratory science have increased the sophistication of new tests and
accelerated their rate of adoption into clinical practice. Unfortunately,
studies that report the value of new diagnostic tests often fail to follow
accepted methodologic standards for unbiased test assessment or provide
clinicians with sufficient information for the intelligent evaluation of a
test s performance and applicability. The following review of pleural fluid
tests that discriminate between exudative and transudative effusions
serves to highlight important methodologic considerations in the assess¬
ment of diagnostic tests.
Diagnostic Thoracoscopy 295
Christian Boutin and Philippe Astoul
Thoracoscopy provides diagnosis of pleural diseases with a high degree
of accuracy. Moreover, this procedure allows a careful pleural staging of
the disease, in particular for pleural cancer, which is important for the
prognosis and therapeutic decision. This article focuses on the technique,
indications, and results of medical thoracoscopy.
Asbestos Induced Pleural Disease 311
Stephen L. Nishimura and V. Courtney Broaddus
Asbestos induced pleural disease has become the most common manifesta¬
tion of asbestos exposure. Asbestos has an unusual affinity for the pleural
space and leads to plaques, benign effusions, fibrosis, and malignant
mesothelioma. The explanation for its affinity for the pleura may lie in
part with new evidence showing that asbestos fibers can accumulate in
certain regions of the parietal pleura at higher concentrations than in the
lung. With the control of industrial exposures to asbestos, the incidence of
this disease should decrease, with the incidence of mesothelioma peaking
in the years 2000 to 2020. Nonetheless, the toxic features of asbestos
including shape, chemical composition, and surface characteristics should
be understood to avoid toxicity in fibers used to replace asbestos and to
know the risks of low level exposures from asbestos currently in our
environment.
Drug Induced Pleural Disease 331
Veena B. Antony
Drug induced pleural disease in the form of pleural fibrosis or pleural
effusions is a common but frequently overlooked toxic or allergic manifes¬
tation of usage of a particular class of drugs. A detailed history of drug
intake will often unveil the cause for the pleural pathology. Discontinua¬
tion of the drug with or without the addition of steroid therapy may
be helpful.
Pleural Disease in Patients with Acquired Immune Deficiency
Syndrome 341
James M. Beck
Given the multiple impairments in host defense that occur during HIV
infection, patients with AIDS are at risk for a variety of pleural infections
X CONTENTS
and neoplasms. Of infectious causes, bacterial parapneumonic effusions
and empyemas and tuberculous pleurisy occur more frequently than effu¬
sions caused by Pneumocystis carinii. In the setting of systemic Kaposi s
sarcoma, pleural involvement is common, although diagnosis is difficult
and therapeutic options are limited. Pleural effusions caused by non
Hodgkin s lymphoma often occur in the setting of pulmonary parenchy
mal disease. The recently described entity of primary effusion lymphoma
occurs in the absence of solid organ involvement. The development of a
spontaneous pneumothorax in an HIV infected individual should prompt
a search for P. carinii infection. Although these pneumothoraces often recur
and are difficult to manage, recent series suggest that surgical approaches
to bronchopleural fistulas are reasonable in selected patients.
Malignancy Metastatic to the Pleura 351
Steven A. Sahn
Malignancy is one of the most common causes of exudative effusions and
increases in incidence in the elderly. Lung cancer is the most common
cause of malignant effusion caused by contiguous spread and its propen¬
sity to invade the pulmonary vasculature and embolize to the visceral
pleura. Lung, breast, ovary, and gastric cancer and lymphomas account
for about 80% of all malignant effusions. Dyspnea and cough are the most
common symptoms at presentation. Thirty percent of patients have a low
pleural fluid pH ( 7.30) and glucose ( 60 mg/dL) at presentation, which
predicts a decreased survival, an increase yield on diagnostic studies, and
a poor response to chemical pleurodesis. Talc by poudrage or slurry is the
most successful pleurodesis agent. Pleural peritoneal shunt is an option
for patients with an intractable, symptomatic malignant effusion who
cannot undergo or who have failed pleurodesis.
Common Pleural Effusions in Children 363
Deborah C. Givan and Howard Eigen
The evaluation of pleural effusions in children differ from that of the adult
in cause, symptom presentation, character of the fluid, techniques for
diagnosis, treatment or management, and prognosis. These similarities and
differences are reviewed with emphasis on the treatment of empyema.
Management of Parapneumonic Effusions 373
Richard W. Light and R. Michael Rodriguez
When a patient with pneumonia and pleural effusion is first evaluated, a
therapeutic thoracentesis should be performed. If the fluid recurs after an
initial successful therapeutic thoracentesis, a repeat therapeutic thoracente¬
sis is indicated. If the fluid recurs after a second therapeutic thoracentesis,
tube thoracostomy should be performed. If the fluid cannot be evacuated
because of loculations, a chest tube should be placed and intrapleural
thrombolytics administered. Thoracoscopy with the breakdown of adhe¬
sions and debridement of the pleural space is indicated if tube thoracos¬
tomy plus thrombolytics is unsuccessful. Thoracotomy with decortication
should be performed if thoracoscopy is unsuccessful or if the patient has
a chronic empyema.
Therapeutic Thoracoscopy 383
Henri G. Colt
Thoracoscopy is increasingly used to treat pleuropulmonary diseases. Al¬
though anesthesia techniques are similar to those used for open thoracic
surgery procedures, much of the equipment, instrumentation, and tech¬
niques are specific to video endoscopic interventions. Many of the indica
CONTENTS xi
tions for therapeutic thoracoscopy are still controversial, depending on
institutional biases and physician preferences. In this article techniques,
complications, indications, and results of therapeutic thoracoscopy are
discussed.
Surgical Management of Empyema 395
Kushagra Katariya and Richard J. Thurer
The cause and presentation of empyema thoraces has changed little since
it was first described. The natural history of the disease can be divided
into different stages. Different therapeutic measures, medical and surgical,
are available for the treatment at various stages. The management of
empyema is discussed, emphasizing the surgical aspects.
Management of Undiagnosed Persistent Pleural Effusions 407
Tariq Ansari and Steven Idell
Difficult to diagnose pleural effusions are not uncommonly encountered
in clinical practice. We define these effusions as those that remain undiag¬
nosed after initial thoracentesis and repeat thoracentesis with pleural bi¬
opsy. Tuberculosis and malignancy are often found to be the underlying
causes when a diagnosis is ultimately made, but other causes, including
pulmonary embolism and intra abdominal conditions, need to be consid¬
ered as potential causes of the difficult to diagnose effusions. In selected
cases, presumptive treatment of tuberculosis is indicated whereas in oth¬
ers, a decision must be made either to obtain a definitive diagnosis by
invasive surgical procedures or to follow the patient with careful observa¬
tion and watchful waiting.
Index 419
Subscription Information Inside back cover
Xii CONTENTS
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| spelling | Diseases of the pleura Veena B. Antony guest ed. Philadelphia [u.a.] Saunders 1998 XII S., S. 229 - 422 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in chest medicine 19,2 Maladies de la plèvre Pleura gtt Plèvre - anatomie et histologie Ziekten gtt Pleura Diseases Pleura anatomy & histology Pleural Diseases Pleurakrankheit (DE-588)4221577-8 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Pleurakrankheit (DE-588)4221577-8 s DE-604 Antony, Veena B. Sonstige oth Clinics in chest medicine 19,2 (DE-604)BV000001084 19,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008139728&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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