[Pleural amyloidosis: thoracoscopic diagnosis and physiopathological approach].

The authors report a case of pleural amyloidosis presenting as a generalised primary amyloidosis with immunological disturbance, in which the diagnosis was made at thoracoscopy. Bronchopulmonary disease during the course of generalised amyloidosis is frequent, but there are only thirteen cases of histologically proven pleural amyloidosis which have been reported in the literature. Using pleuroscopy the histology obtained enables a pathophysiological approach to this disease, taking account of the cells and enzymes found in the pleura, the inflammatory reactions suggests a local production at the pleura level and this would explain the exudative character of some effusions, although a transudate is most often described and is directly linked to congestive cardiac failure.

[Lipid pneumopathy and bronchopulmonary adenocarcinoma. Apropos of a case].

The authors report a case of a patient aged 83 who presented with a lipid pneumonia and a primary broncho-pulmonary adenocarcinoma of the left lower lobe. The diagnosis of the lipid pneumonia was confirmed following broncho-alveolar lavage and the autopsy confirms the neoplastic origin of the mass lesion at the left base. The authors report 16 similar cases in the literature between 1943 and 1989.

[Diagnosis and prognosis of malignant mesothelioma].

The early diagnosis of mesothelioma rests on very common clinical evidence, including pleuritis of recent onset, history of contact with asbestos, chest pain, often moderate loss of weight and slight changes in old pleural fluid cytology, 24% for Adams' needle biopsy and 93% for thoracoscopy, where the only negative results are obtained in patients with adhesive pleuritis. Prognosis depends on several factors, the most favourable ones being the histological type of the lesion (epithelial or mixed), the fact that it is limited to the parietal or diaphragmatic pleural and, on the patient's side and accessorily: female sex, lack of exposure to asbestos, age under 50, good general condition and absence of chest pain.

[Diagnosis of pleurisy].

Nowadays, the diagnosis of pleural effusion is greatly facilitated by thoracoscopy. Since most pleural effusions are due to neoplasias (notably in patients older than 40 years) and since the prognostic value of an early diagnosis is obvious in case of pleural carcinoma (notably mesothelioma), there is no justification in allowing the effusion to become chronic. If the diagnosis is confirmed by needle biopsy, thoracoscopy can rapidly be performed by skilled operators: in 95 p.

[The value of initial thoracoscopy in the treatment of pneumothorax].

Various methods have so far been used to treat pneumothorax, including rest, needle exsufflation and blind drainage. The results obtained are varied but the recurrence rate is high, averaging 50%. With thoracoscopy, not only can the pleura be explored and the cause of pneumothorax investigated, but specific treatment of the lesions can be carried out in some cases and symphysis can be obtained by pleural poudrage, thereby avoiding recurrences.

[Endobronchial tuberculosis simulating cancer].

Endobronchial tuberculosis may simulate a bronchial neoplasm. It is the data from a bronchial biopsy carried out along with the X-ray and endoscopy examination followed by the bacteriology of the expectorating sputum which enables a diagnosis to be made. This form of diagnosis is known but is rare.

[Treatment of mesothelioma with interferon gamma and interleukin 2].

Interferon gamma was first used in 10 patients with mesothelioma in doses of 20 x 10(6) IU administered intrapleurally twice a week for 2 months without success, then in 25 patients (12 in stage I, 11 in stage II or IV) in doses of 40 x 10(6) IU. Out of 20 assessable patients, 4 showed complete response (CR) confirmed at thoracoscopy or thoracotomy; 1 stage I patient and 1 stage II patients showed partial response (PR). Interleukin 2 was administered by continuous intrapleural infusion in increasing dosage.

The role of thoracoscopy in the evaluation and management of pleural effusions.

Diagnostic thoracoscopy is indicated in every patient where the usual investigations (including biochemistry, cytology, bacteriology, occasionally needle biopsy of the pleura) do not achieve a precise diagnosis. The percentage of so-called "idiopathic" effusions, amounting to approximately 20% in many published series, can be reduced to 4% after thoracoscopy. The sensibility of thoracoscopic biopsy reaches 93-97% of malignant or tuberculous pleural effusions.