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A cervical approach to investigating pleural disease.

Ann Thorac Surg

July 2009

Department of Thoracic Surgery, Nottingham City Hospital, Nottingham, United Kingdom.

Article Synopsis
  • A new medical technique called mediastino-pleuroscopy lets doctors look inside the chest using special cameras, helping them examine and treat lung problems at the same time.
  • This method is done through a small cut in the neck and allows doctors to take samples, clean the area, and even treat issues like fluid build-up.
  • In a study with 15 patients, there were no deaths and most people went home just 2.4 days after the procedure, showing that it's a safe and easy way to help patients.
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A procedure for parasternal mediastinopleuroscopy (PMS) has been proposed for biopsy of pulmonary tissue and intrasternal lymph nodes. A surgical technique of intervention is described in the paper. PMS was performed in 81 patients with diffuse lesions of the lungs and the disease was morphologically verified.

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The authors suggest a clinical procedure of parasternal mediastinopleuroscopy which assures intercostal examination, instrumental palpation and biopsy of neoplasms of the anterior mediastinum without causing considerable trauma. The procedure makes it possible to assess operability and to determine optimal access for surgical removal of tumor. The procedure was used in clinic in 35 cases; in 23 of them, intervention was limited to biopsy, while 12 cases underwent radical surgery.

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With the advent of modern therapy, it has become essential to obtain a tissue diagnosis in all cases of pulmonary and mediastinal disease. Since it is often necessary to resort to thoracotomy as a final step in making such a diagnosis, we have sought a procedure that is simpler while capable of providing the same information. Through a standard cervical mediastinoscopy incision, the mediastinum is first explored; if the diagnosis is not obtained, the mediastinal pleura is digitally opened and lung or pleural biopsies are taken.

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