1、Thoracic Wall, Pleura Diseases,Beijing Lung Cancer Center,CUMS,EMPYEMA,Definition,An infected effusive process within the pleura space 希波克拉底是第一个采用引流术治疗Empyema的人,Cause,Infection 1, Bacteria infection2, TB infection3, Peculiar infection Others1, post-operation 2, Blood infection,Span of onset (For Tre
2、atment)Acute empyema Chronic empyema,Acute Empyema,Clinical Manifestation High Fever chest pain shortness of breath Cough,Physical Examination,Unilaterally decreased breath sounds decreased breath movement Mediastinal excursion,Laboratory Finding,WBC a shift to left X-ray opacification shadow, fluid
3、 level CT Scan: 超声检查,Treatment,Supportive improving immunity Antibiotic based on sensitive test Drainage: Key pointpenetration underwater-seal closed tube drainage ( Lowest position )surgery: VATS胸膜固定术,Chronic Empyema,Uncured acute empyema last for more than 3 month Later diagnosis No good result fr
4、om Acute empyema The second infection TB infection,Clinical Manifestation,Fever Malnutrition Systemically toxic Weakness Shortness of breath,Physical Examination,Unilaterally decreased breath sounds Chest wall collapsing Mediastinal excursion,X-ray and CT Finding,Thicken of pleura Narrowing of inter
5、-rib space Fluid level,Treatment,Nutrition support Antibiotic Drainage Surgerydebridement, thoracoplasty Key: to protect&restore lung function,Complications,Bronchopleural fistula Pericardial extension Mediastinal abscess Metastatic abscesses,Malignant Pleural Mesothelioma,Benign Mesothelioma,Locali
6、zed 分化良好乳头状间皮瘤 Well differentiated papillary mesothelioma腺瘤样瘤 Adenomatoid tumor多囊性间皮瘤 Multicystic mesothelioma Almost symptomless Surgery achieves good prognosis,Malignant Mesothelioma Relationship to Asbestos Exposure,A causative relationship between asbestos and malignant mesothelioma was not reco
7、gnized until 1960, when J Wagner observed an unusually high incidence of mesothelioma among asbestos miners in the North-West Cape Province of South Africa. Diffuse Malignant Mesothelioma (DMM) 职业暴露暴露强度 暴露频度 暴露时间 首次暴露时间 累计暴露,Malignant Mesothelioma,石棉职业暴露环境暴露 其他可能的病因非石棉纤维化学物（毛沸石 erionite）猿猴病毒 SV40: 是
8、一种DNA肿瘤病毒/1960辐射与其他因素：家族集聚性和个体易感性,发病率,美国 男性 1.6/10万 女性 0.4/10万中国 ?,Clinical Presentation,Symptoms observed in most patients 持续性Chest pain （40-70%） Shortness of breath （60-80%） Weight loss （30%） Other Symptoms Cough （10%） Hoarseness Fever Sweats,Clinical Presentation,Physical Examination Asymmetric c
9、hest excursion Unilaterally decreased breath sounds Laboratory FindingsLaboratory studies are generally not useful in disease diagnosis. However, leukocytosis, anemia, thrombocytosis, and elevated LDH are commonly observed and considered prognostic. 胸腔穿刺和胸膜穿刺活检有助于胸膜间皮瘤诊断（VATS） 开胸活检或电视纵隔镜活检术,Malignan
10、t Mesothelioma Diagnosis & Staging,X-ray & B-Ultrassound: Basic Chest CT Scan: Important MRI & ECT: Staging Prognosis PET Scan: N-stage, SUV-Prognosis,Met.,Malignant Mesothelioma,Butchart Staging System for Malignant Mesothelioma,Stage,Clinicopathological Description,I,Tumor confined to homolateral
11、pleura, lung, and pericardium,II,Tumor invading chest wall or involving mediastinal structures, eg, esophagus, heart, opposite pleura Lymph node involvement within the chest,III,Tumor penetrating diaphragm to involve peritoneum directly Lymph node involvement outside the chest,IV,Distant blood-born
12、metastases,Treatment,Sugery Chemotherapytaxol, taxotere,gemzar,alimta + CisplatinPemetrexed/Alimta, Radiotherapy,ALIMTA 治疗恶性胸膜间皮细胞瘤,CT scan 14/09/98 CT scan 01/04/99治疗前 8个周期后,Hughes et al. JCO 2002,研究未添加叶酸/维生素B12,ALIMTA单药治疗间皮细胞瘤的II期临床试验 (芝加哥大学),Shin et al. Proc Amer Soc Clin Oncol 2002, (abstr. 1175),Alimta Cisplatin可显著改善: 生存期 疾病进展时间 肿瘤缓解率 肺功能 生活质量 补充 FA和维生素B12 可以: 减少毒副反应(包括药物相关死亡) 提高各组的治疗疗效,恶性胸膜间皮细胞瘤- 结论 (1),
