Pleural disease:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2006
|
| Schriftenreihe: | Clinics in chest medicine
27,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV S., S. 157 - 393 Ill., graph. Darst. |
| ISBN: | 1416035907 |
Internformat
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| 245 | 1 | 0 | |a Pleural disease |c guest ed. Steven A. Sahn |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2006 | |
| 300 | |a XIV S., S. 157 - 393 |b Ill., graph. Darst. | ||
| 336 | |b txt |2 rdacontent | ||
| 337 | |b n |2 rdamedia | ||
| 338 | |b nc |2 rdacarrier | ||
| 490 | 1 | |a Clinics in chest medicine |v 27,2 | |
| 650 | 4 | |a Pleura |x Diseases | |
| 650 | 4 | |a Pleural Diseases |x diagnosis | |
| 650 | 4 | |a Pleural Diseases |x pathology | |
| 650 | 4 | |a Pleural Diseases |x therapy | |
| 700 | 1 | |a Sahn, Steven A. |e Sonstige |4 oth | |
| 830 | 0 | |a Clinics in chest medicine |v 27,2 |w (DE-604)BV000001084 |9 27,2 | |
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Datensatz im Suchindex
| _version_ | 1804135463457390592 |
|---|---|
| adam_text | CONTENTS
Dedication xi
Steven A. Sahn
Preface xiii
Steven A. Sahn
Pathology of the Pleura 157
John C. English and Kevin O. Leslie
The pleura and lung are intimately associated and share many pathologic conditions.
Nevertheless, they represent two separate organs of different embryonic derivation and
with different yet often symbiotic functions. In this article, the authors explore the patho¬
logic manifestations of the many conditions that primarily or secondarily affect the pleura.
Pleural Fibrosis 181
Michael A. Jantz and Veena B. Antony
Pleural fibrosis can result from a variety of inflammatory processes. The response of the
pleural mesothelial cell to injury and the ability to maintain its integrity are crucial in
determining whether normal healing or pleural fibrosis occurs. The pleural mesothelial
cell, various cytokines, and disordered fibrin turnover are involved in the pathogenesis of
pleural fibrosis. The roles of these mediators in producing pleural fibrosis are examined.
This article reviews the most common clinical conditions associated with the develop¬
ment of pleural fibrosis. Fibrothorax and trapped lung are two unique and uncommon
consequences of pleural fibrosis. The management of pleural fibrosis, including fibrotho¬
rax and trapped lung, is discussed.
Imaging of Pleural Disease 193
Nagmi R. Qureshi and Fergus V. Gleeson
Imaging plays an important role in the diagnosis and subsequent management of patients
with pleural disease. The presence of a pleural abnormality is usually suggested following
a routine chest x ray, with a number of imaging modalities available for further characteri¬
zation. This article describes the radiographic and cross sectional appearances of pleural
VOLUME 27 • NUMBER 2 • JUNE 2006 v
diseases, which are commonly encountered in everyday practice. The conditions covered
include benign and malignant pleural thickening, pleural effusions, empyema and pneu
mothoraces. The relative merits of CT, MRI and PET in the assessment of these conditions
and the role of image guided intervention are discussed.
Pleural Ultrasonography 215
Paul H. Mayo and Peter Doelken
Ultrasonography has achieved acceptance as a routine clinical tool for clinicians manag¬
ing pleural disease. This article provides an overview of the field of pleural ultrasonog¬
raphy with an emphasis on clinical applicability and procedure guidance.
Pleural Manometry 229
John T. Huggins and Peter Doelken
The goals of therapeutic thoracentesis are to remove the maximum amount of pleural
fluid to improve dyspnea and to facilitate the diagnostic evaluation of large pleural effu¬
sions. Pleural manometry may be useful for immediately detecting an unexpandable
lung, which may coexist when any pleural fluid accumulates. Pleural manometry may
improve patient safety when removing large amounts of pleural fluid. The basics of
pleural space mechanics are discussed as they apply to the normal pleural space and to
pleural effusion associated with expandable and unexpandable lung. This article also
discusses the instrumentation required to perform bedside manometry, how manometry
may decrease the risk of re expansion pulmonary edema when large amounts of fluid
are removed, and the diagnostic capabilities of manometry.
Discriminating Between Transudates and Exudates 241
John E. Heffner
The dichotomous classification of pleural fluid as a transudate or an exudate simplifies
diagnostic efforts in determining the cause of pleural effusions. Multiple pleural fluid
tests are available to discriminate between these two classes of effusions. Tests commonly
used in clinical practice depend on the detection in pleural fluid of large molecular
weight chemicals that enter the pleural space to greater degrees in conditions associated
with exudative compared with transudative effusions. Considerable misclassifications
can occur with all available testing strategies, so clinicians benefit from adopting a
nondichotomous, bayesian approach for interpreting test results.
The Approach to the Patient with a Parapneumonic Effusion 253
Najib M. Rahman, Stephen J. Chapman, and Robert J.O. Davies
Parapneumonic effusion is a common clinical problem, and those that go on to develop
pleural infection have high morbidity and mortality. The process of pleural infection
evolution involves changes in pleural physiology that are increasingly being elucidated
and understood. The microbiology of pleural infection has changed over recent years,
with clear differences emerging between hospital and community acquired infections.
Using biochemical surrogates of infection, chest drainage can be undertaken rationally
for those who do not respond to antibiotics alone. Recent data suggest that fibrinolytics
do not influence outcomes in pleural infection. The optimal type and timing of surgery
remain controversial.
vi CONTENTS
The Spectrum of Pleural Effusions After Coronary Artery Bypass
Grafting Surgery 267
Jay Heidecker and Steven A. Sahn
Pleural effusions are common after coronary artery bypass grafting (CABG) surgery and
can be categorized by time intervals: perioperative (within the first week), early (within
1 month), late (2 12 months), or persistent (after 6 months). The perioperative effusions
are usually attributable to diaphragm dysfunction or internal mammary artery harvest¬
ing and are typically self limited. Early effusions are usually attributable to postcardiac
injury syndrome and may require corticosteroid treatment. Although late effusions can
have multiple causes, persistent effusions are attributable to trapped lung and often
require decortication. Diagnostic thoracentesis should be performed for patients with
large symptomatic pleural effusions or fever after CABG surgery. The range of manage¬
ment includes observation, therapeutic thoracentesis, corticosteroids, or decortication
depending on the cause and course of the effusion.
Pleural Effusions of Extravascular Origin 285
Steven A. Sahn
Most pleural effusions are caused by hydrostatic and oncotic pressure imbalance, inflam¬
mation or infection, or abnormalities in lymphatic drainage. A select number of effusions
are caused by fluid of extravascular orgin. Some of these effusions result from complica¬
tions of treatment, whereas others are a ramification of the underlying disease. The inci¬
dence, pathogenesis, clinical presentation, chest radiographic manifestations, pleural
fluid analysis, diagnosis, and management are discussed.
The Undiagnosed Pleural Effusion 309
Richard W. Light
The most common causes for undiagnosed transudative effusions are congestive heart
failure and hepatic hydrothorax. Pleural fluid N terminal pro brain narriuretic peptide
levels higher than 1500 pg/mL are virtually diagnostic of congestive heart failure. The
most common causes for undiagnosed exudative pleural effusions are malignancy, pul¬
monary embolism, and tuberculosis. Clinical characteristics of patients with a malignant
pleural effusion are symptoms for more than 1 month, absence of fever, blood tinged
pleural fluid, and CT findings suggestive of malignancy. Thoracoscopy is useful to estab¬
lish the diagnosis of malignancy and tuberculosis.
Staphylococcal Superantigens of the Enterotoxin Gene Cluster {egc) for
Treatment of Stage IHb Non Small Cell Lung Cancer with Pleural Effusion 321
David S. Terman, Gregory Bohach, Francois Vandenesch, Jerome Etienne,
Gerard Lina, and Steven A. Sahn
There has been renewed interest in the superantigens as antitumor agents with the dis¬
covery of a group of bacterial superantigens known as the enterotoxin gene cluster (cgc
staphylococcal enterotoxins [SEs]). This article discusses the mechanisms by which egc
SEs induce tumor killing and pleurodesis. The application of SE homolog and nucleic
acid compositions as vaccines and for treatment of established tumors is reviewed.
Finally, the use of native SEs ex vivo—intratumorally and intravesicularly administered
superantigens against established tumors—is described and the interrelation between
superantigen therapy and chemoradiotherapy.
CONTENTS vii
Management of Malignant Pleural Mesothelioma 335
Sophie D. West and Y.C. Gary Lee
Malignant mesothelioma is increasing in incidence globally and has no known cure. Its
unique clinical feature of local infiltration along tissue planes makes it a difficult neo¬
plasm to manage. There have been few randomized controlled trials regarding treatment
options, although these have increased in recent years, and results are eagerly awaited.
This article summarizes important advances in the management of mesothelioma, espe¬
cially diagnostic and therapeutic aspects.
Pleural Disease in Lymphangioleiomyomatosis 355
Khalid F. Almoosa, Francis X. McCormack, and Steven A. Sahn
Pleural disease is a common complication of lymphangioleiomyomatosis (LAM). The
incidence and recurrence rates of secondary spontaneous pneumothorax in LAM are the
highest among chronic pulmonary disorders. Most patients have at least one pneumothorax
before LAM is diagnosed, and pneumothorax is often the sentinel event that leads to the
diagnosis. Although early, definitive treatment for recurrent pneumothorax by pleurodesis
is recommended, the failure rate for chemical and surgical approaches is high.
Chylothorax occurs owing to obstruction of lymphatics by proliferating smooth muscle
cells and often requires pleurodesis to control expanding and recurrent effusions. Because
of the rarity of the LAM, few data exist on whether the occurrence of pleural complications
in LAM accelerates functional decline or portends a worse prognosis.
Management of Spontaneous Pneumothorax 369
Michael H. Baumann
Management of patients with a spontaneous pneumothorax continues to challenge cli¬
nicians. Recent guidelines help provide care pathways for these patients and highlight
the many areas in need of additional study. Management options for spontaneous pneu
mothoraces should be selected based primarily upon a patient s clinical status.
Observation or pleural air drainage, in selected patients, plays a significant role in
patients with primary spontaneous pneumothorax. By contrast, pleural air drainage
plays the central role in patients with a secondary spontaneous pneumothorax.
Surgically directed recurrence prevention and air leak management are preferred for
both primary and secondary spontaneous pneumothorax patients.
Index 383
viii CONTENTS
|
| adam_txt |
CONTENTS
Dedication xi
Steven A. Sahn
Preface xiii
Steven A. Sahn
Pathology of the Pleura 157
John C. English and Kevin O. Leslie
The pleura and lung are intimately associated and share many pathologic conditions.
Nevertheless, they represent two separate organs of different embryonic derivation and
with different yet often symbiotic functions. In this article, the authors explore the patho¬
logic manifestations of the many conditions that primarily or secondarily affect the pleura.
Pleural Fibrosis 181
Michael A. Jantz and Veena B. Antony
Pleural fibrosis can result from a variety of inflammatory processes. The response of the
pleural mesothelial cell to injury and the ability to maintain its integrity are crucial in
determining whether normal healing or pleural fibrosis occurs. The pleural mesothelial
cell, various cytokines, and disordered fibrin turnover are involved in the pathogenesis of
pleural fibrosis. The roles of these mediators in producing pleural fibrosis are examined.
This article reviews the most common clinical conditions associated with the develop¬
ment of pleural fibrosis. Fibrothorax and trapped lung are two unique and uncommon
consequences of pleural fibrosis. The management of pleural fibrosis, including fibrotho¬
rax and trapped lung, is discussed.
Imaging of Pleural Disease 193
Nagmi R. Qureshi and Fergus V. Gleeson
Imaging plays an important role in the diagnosis and subsequent management of patients
with pleural disease. The presence of a pleural abnormality is usually suggested following
a routine chest x ray, with a number of imaging modalities available for further characteri¬
zation. This article describes the radiographic and cross sectional appearances of pleural
VOLUME 27 • NUMBER 2 • JUNE 2006 v
diseases, which are commonly encountered in everyday practice. The conditions covered
include benign and malignant pleural thickening, pleural effusions, empyema and pneu
mothoraces. The relative merits of CT, MRI and PET in the assessment of these conditions
and the role of image guided intervention are discussed.
Pleural Ultrasonography 215
Paul H. Mayo and Peter Doelken
Ultrasonography has achieved acceptance as a routine clinical tool for clinicians manag¬
ing pleural disease. This article provides an overview of the field of pleural ultrasonog¬
raphy with an emphasis on clinical applicability and procedure guidance.
Pleural Manometry 229
John T. Huggins and Peter Doelken
The goals of therapeutic thoracentesis are to remove the maximum amount of pleural
fluid to improve dyspnea and to facilitate the diagnostic evaluation of large pleural effu¬
sions. Pleural manometry may be useful for immediately detecting an unexpandable
lung, which may coexist when any pleural fluid accumulates. Pleural manometry may
improve patient safety when removing large amounts of pleural fluid. The basics of
pleural space mechanics are discussed as they apply to the normal pleural space and to
pleural effusion associated with expandable and unexpandable lung. This article also
discusses the instrumentation required to perform bedside manometry, how manometry
may decrease the risk of re expansion pulmonary edema when large amounts of fluid
are removed, and the diagnostic capabilities of manometry.
Discriminating Between Transudates and Exudates 241
John E. Heffner
The dichotomous classification of pleural fluid as a transudate or an exudate simplifies
diagnostic efforts in determining the cause of pleural effusions. Multiple pleural fluid
tests are available to discriminate between these two classes of effusions. Tests commonly
used in clinical practice depend on the detection in pleural fluid of large molecular
weight chemicals that enter the pleural space to greater degrees in conditions associated
with exudative compared with transudative effusions. Considerable misclassifications
can occur with all available testing strategies, so clinicians benefit from adopting a
nondichotomous, bayesian approach for interpreting test results.
The Approach to the Patient with a Parapneumonic Effusion 253
Najib M. Rahman, Stephen J. Chapman, and Robert J.O. Davies
Parapneumonic effusion is a common clinical problem, and those that go on to develop
pleural infection have high morbidity and mortality. The process of pleural infection
evolution involves changes in pleural physiology that are increasingly being elucidated
and understood. The microbiology of pleural infection has changed over recent years,
with clear differences emerging between hospital and community acquired infections.
Using biochemical surrogates of infection, chest drainage can be undertaken rationally
for those who do not respond to antibiotics alone. Recent data suggest that fibrinolytics
do not influence outcomes in pleural infection. The optimal type and timing of surgery
remain controversial.
vi CONTENTS
The Spectrum of Pleural Effusions After Coronary Artery Bypass
Grafting Surgery 267
Jay Heidecker and Steven A. Sahn
Pleural effusions are common after coronary artery bypass grafting (CABG) surgery and
can be categorized by time intervals: perioperative (within the first week), early (within
1 month), late (2 12 months), or persistent (after 6 months). The perioperative effusions
are usually attributable to diaphragm dysfunction or internal mammary artery harvest¬
ing and are typically self limited. Early effusions are usually attributable to postcardiac
injury syndrome and may require corticosteroid treatment. Although late effusions can
have multiple causes, persistent effusions are attributable to trapped lung and often
require decortication. Diagnostic thoracentesis should be performed for patients with
large symptomatic pleural effusions or fever after CABG surgery. The range of manage¬
ment includes observation, therapeutic thoracentesis, corticosteroids, or decortication
depending on the cause and course of the effusion.
Pleural Effusions of Extravascular Origin 285
Steven A. Sahn
Most pleural effusions are caused by hydrostatic and oncotic pressure imbalance, inflam¬
mation or infection, or abnormalities in lymphatic drainage. A select number of effusions
are caused by fluid of extravascular orgin. Some of these effusions result from complica¬
tions of treatment, whereas others are a ramification of the underlying disease. The inci¬
dence, pathogenesis, clinical presentation, chest radiographic manifestations, pleural
fluid analysis, diagnosis, and management are discussed.
The Undiagnosed Pleural Effusion 309
Richard W. Light
The most common causes for undiagnosed transudative effusions are congestive heart
failure and hepatic hydrothorax. Pleural fluid N terminal pro brain narriuretic peptide
levels higher than 1500 pg/mL are virtually diagnostic of congestive heart failure. The
most common causes for undiagnosed exudative pleural effusions are malignancy, pul¬
monary embolism, and tuberculosis. Clinical characteristics of patients with a malignant
pleural effusion are symptoms for more than 1 month, absence of fever, blood tinged
pleural fluid, and CT findings suggestive of malignancy. Thoracoscopy is useful to estab¬
lish the diagnosis of malignancy and tuberculosis.
Staphylococcal Superantigens of the Enterotoxin Gene Cluster {egc) for
Treatment of Stage IHb Non Small Cell Lung Cancer with Pleural Effusion 321
David S. Terman, Gregory Bohach, Francois Vandenesch, Jerome Etienne,
Gerard Lina, and Steven A. Sahn
There has been renewed interest in the superantigens as antitumor agents with the dis¬
covery of a group of bacterial superantigens known as the enterotoxin gene cluster (cgc
staphylococcal enterotoxins [SEs]). This article discusses the mechanisms by which egc
SEs induce tumor killing and pleurodesis. The application of SE homolog and nucleic
acid compositions as vaccines and for treatment of established tumors is reviewed.
Finally, the use of native SEs ex vivo—intratumorally and intravesicularly administered
superantigens against established tumors—is described and the interrelation between
superantigen therapy and chemoradiotherapy.
CONTENTS vii
Management of Malignant Pleural Mesothelioma 335
Sophie D. West and Y.C. Gary Lee
Malignant mesothelioma is increasing in incidence globally and has no known cure. Its
unique clinical feature of local infiltration along tissue planes makes it a difficult neo¬
plasm to manage. There have been few randomized controlled trials regarding treatment
options, although these have increased in recent years, and results are eagerly awaited.
This article summarizes important advances in the management of mesothelioma, espe¬
cially diagnostic and therapeutic aspects.
Pleural Disease in Lymphangioleiomyomatosis 355
Khalid F. Almoosa, Francis X. McCormack, and Steven A. Sahn
Pleural disease is a common complication of lymphangioleiomyomatosis (LAM). The
incidence and recurrence rates of secondary spontaneous pneumothorax in LAM are the
highest among chronic pulmonary disorders. Most patients have at least one pneumothorax
before LAM is diagnosed, and pneumothorax is often the sentinel event that leads to the
diagnosis. Although early, definitive treatment for recurrent pneumothorax by pleurodesis
is recommended, the failure rate for chemical and surgical approaches is high.
Chylothorax occurs owing to obstruction of lymphatics by proliferating smooth muscle
cells and often requires pleurodesis to control expanding and recurrent effusions. Because
of the rarity of the LAM, few data exist on whether the occurrence of pleural complications
in LAM accelerates functional decline or portends a worse prognosis.
Management of Spontaneous Pneumothorax 369
Michael H. Baumann
Management of patients with a spontaneous pneumothorax continues to challenge cli¬
nicians. Recent guidelines help provide care pathways for these patients and highlight
the many areas in need of additional study. Management options for spontaneous pneu
mothoraces should be selected based primarily upon a patient's clinical status.
Observation or pleural air drainage, in selected patients, plays a significant role in
patients with primary spontaneous pneumothorax. By contrast, pleural air drainage
plays the central role in patients with a secondary spontaneous pneumothorax.
Surgically directed recurrence prevention and air leak management are preferred for
both primary and secondary spontaneous pneumothorax patients.
Index 383
viii CONTENTS |
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| series2 | Clinics in chest medicine |
| spelling | Pleural disease guest ed. Steven A. Sahn Philadelphia [u.a.] Saunders 2006 XIV S., S. 157 - 393 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in chest medicine 27,2 Pleura Diseases Pleural Diseases diagnosis Pleural Diseases pathology Pleural Diseases therapy Sahn, Steven A. Sonstige oth Clinics in chest medicine 27,2 (DE-604)BV000001084 27,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014869645&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Pleural disease Clinics in chest medicine Pleura Diseases Pleural Diseases diagnosis Pleural Diseases pathology Pleural Diseases therapy |
| title | Pleural disease |
| title_auth | Pleural disease |
| title_exact_search | Pleural disease |
| title_exact_search_txtP | Pleural disease |
| title_full | Pleural disease guest ed. Steven A. Sahn |
| title_fullStr | Pleural disease guest ed. Steven A. Sahn |
| title_full_unstemmed | Pleural disease guest ed. Steven A. Sahn |
| title_short | Pleural disease |
| title_sort | pleural disease |
| topic | Pleura Diseases Pleural Diseases diagnosis Pleural Diseases pathology Pleural Diseases therapy |
| topic_facet | Pleura Diseases Pleural Diseases diagnosis Pleural Diseases pathology Pleural Diseases therapy |
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