Clinical utility of thoracoscopy in elderly tuberculous pleurisy patients under local anesthesia

Fujimoto, Shota; Saito, Keisuke; Matsubayashi, Sachi; Sato, Akihito; Yamada, Masami; Yamanaka, Yoshiaki; Fujisaki, Ikumi; Odashima, Kyuto; Seki, Aya; Kazuyori, Taisuke; Seki, Yoshitaka; Takeda, Hiroshi; Ishikawa, Takeo; Sato, Syuji; Kuwano, Kazuyoshi

doi:10.1016/j.jiac.2020.08.008

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…With thoracoscopy, the positive rate of culture of M. tuberculosis is 55.6% (10/18). Therefore, thoracoscopy under local anesthesia has proven to be more effective for the diagnosis of pleural effusion [35]. Laparoscopy is the diagnostic tool of choice for abdominal tuberculosis and allows inspecting the peritoneum as well as obtaining biopsies for microbiological and histological examination [36].…”

Section: Radiological Findingsmentioning

confidence: 99%

Tuberculosis in the Elderly

Diamantis

Wazières

Gallien

2021

JCM

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The tuberculosis (TB) epidemic is most prevalent in the elderly, and there is a progressive increase in the notification rate with age. Most cases of TB in the elderly are linked to the reactivation of lesions that have remained dormant. The awakening of these lesions is attributable to changes in the immune system related to senescence. The mortality rate from tuberculosis remains higher in elderly patients. Symptoms of active TB are nonspecific and less pronounced in the elderly. Diagnostic difficulties in the elderly are common in many diseases but it is important to use all possible techniques to make a microbiological diagnosis. Recognising frailty to prevent loss of independence is a major challenge in dealing with the therapeutic aspects of elderly patients. Several studies report contrasting data about poorer tolerance of TB drugs in this population. Adherence to antituberculosis treatment is a fundamental issue for the outcome of treatment. Decreased completeness of treatment was shown in older people as well as a higher risk of treatment failure.

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Section: Radiological Findingsmentioning

confidence: 99%

Tuberculosis in the Elderly

Diamantis

Wazières

Gallien

2021

JCM

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“…Despite the many bene ts of thoracoscopy under local anaesthesia for tuberculous pleurisy [3], there is a paucity of data regarding the outcomes when it is used to treat infections such as pyothorax.…”

Section: Discussionmentioning

confidence: 99%

Single-centre experience on the safety and efficacy of thoracoscopy under local anaesthesia for the management of intrathoracic infections

Fujita,

Saito,

Ito

et al. 2024

Preprint

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Objectives: Thoracoscopy under local anaesthesia is widely performed to diagnose malignancies and infectious diseases. However, few reports have described the use of this procedure for diagnosing and treating intrathoracic infections. This study aimed to evaluate the safety and efficacy of thoracoscopy under local anaesthesia for the management of intrathoracic infections. Results: Data from patients who underwent thoracoscopy procedures performed by chest physicians under local anaesthesia at our hospital between January 2018 and December 2023 were retrospectively reviewed. We analysed their demographic factors, reasons for the examinations, diseases targeted, examination lengths, anaesthetic methods used, diagnostic and treatment success rates, as well as any adverse events. Thirty patients were included. Of these, 12 (40%) had thoracoscopies to diagnose infections, and 18 (60%) had them to treat pyothorax. In terms of diagnosing pleurisy, the causative microorganism of origin was identified via thoracoscopy in only three of 12 (25.0%) patients. For diagnosing pyothorax, the causative microorganism wasidentified in 7 of 18 (38.9%) patients. Methicillin-resistant Staphylococcus aureus was the most common causative microorganism identified. The treatment success rates were very high, ranging between 94.4–100%, whereas the identification rate of the causative microorganisms behind infections was low, ranging between 25.0–38.9%. The most frequent adverse events included perioperative hypoxaemia and pain. There were two (6.7%) serious adverse events of grade ≥ 3, but none resulted in death.

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“…Despite the many benefits of thoracoscopy under local anaesthesia for tuberculous pleurisy [ 3 ], there is a paucity of data regarding the outcomes when it is used to treat infections such as pyothorax.…”

Section: Discussionmentioning

confidence: 99%

“…Thoracoscopy has traditionally been performed under general anaesthesia; however, methods for performing the procedure under local anaesthesia have recently been established [ 1 , 2 ], and many medical institutions in Japan are now performing thoracoscopies under local anaesthesia [ 3 ]. Because thoracoscopies can be performed under local anaesthesia, they are often performed by chest physicians.…”

Section: Introductionmentioning

confidence: 99%

Single-centre observational study of the safety and efficacy of thoracoscopy under local anaesthesia for the management of thoracic infections

Fujita,

Saito,

Ito

et al. 2024

BMC Res Notes

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Objectives Thoracoscopy under local anaesthesia is widely performed to diagnose malignancies and infectious diseases. However, few reports have described the use of this procedure for diagnosing and treating intrathoracic infections. This study aimed to evaluate the safety and efficacy of thoracoscopy under local anaesthesia for the management of intrathoracic infections. Results Data from patients who underwent thoracoscopy procedures performed by chest physicians under local anaesthesia at our hospital between January 2018 and December 2023 were retrospectively reviewed. We analysed their demographic factors, reasons for the examinations, diseases targeted, examination lengths, anaesthetic methods used, diagnostic and treatment success rates, as well as any adverse events. Thirty patients were included. Of these, 12 (40%) had thoracoscopies to diagnose infections, and 18 (60%) had them to treat pyothorax. In terms of diagnosing pleurisy, the causative microorganism of origin was identified via thoracoscopy in only three of 12 (25.0%) patients. For diagnosing pyothorax, the causative microorganism was identified in 7 of 18 (38.9%) patients. Methicillin-resistant Staphylococcus aureus was the most common causative microorganism identified. The treatment success rates were very high, ranging between 94.4 and 100%, whereas the identification rate of the causative microorganisms behind infections was low, ranging between 25.0 and 38.9%. The most frequent adverse events included perioperative hypoxaemia and pain. There were two (6.7%) serious adverse events of grade ≥ 3, but none resulted in death. Conclusions The efficacy of managing intrathoracic infections through thoracoscopy under local anaesthesia is commendable. Nonetheless, the diagnostic accuracy of the procedure, regarding the precise identification of the causative microorganisms responsible for intrathoracic infections, persists at a notably low level, presenting a substantial clinical hurdle.

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Clinical utility of thoracoscopy in elderly tuberculous pleurisy patients under local anesthesia

Cited by 5 publications

References 20 publications

Tuberculosis in the Elderly

Tuberculosis in the Elderly

Single-centre experience on the safety and efficacy of thoracoscopy under local anaesthesia for the management of intrathoracic infections

Single-centre observational study of the safety and efficacy of thoracoscopy under local anaesthesia for the management of thoracic infections

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