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Proceedings of the Thoracic Society Thorax: first published as 10.1136/thx.33.4.530 on 1 August 1978. Downloaded from Thorax, 1978, 33, 530-543 Proceedings of The Thoracic Society A joint meeting of the Belgische Vereniging voor Pneumologie (Societe Belge de Pneumologie) and the Thoracic Society was held in Bruges on 20-21 April 1978. Summaries of the papers follow: Electron microscopy of the normal and damaged radiographs. It is important to distinguish the true pulmonary alveolus diagnostic value of this new method for thoracic BRYAN CORRIN The electron microscopy of the normal lesions. alveolus is described with emphasis on function, par- 1 Degenerative pulmonary diseases The computerised ticularly gas exchange, surfactant secretion, phago- tomogram is more spectacular than conventional cytosis, and the metabolic processing of circulating radiology in pulmonary fibrosis and emphysema. vasoactive substances. The ultrastructural features of 2 Infectious diseases In pneumonic consolidation or alveolar regeneration after cytotoxic injury are de- collapse, either lobar or segmental, one is able to scribed together with the contribution of electron visualise a nodular lesion amid a dense lesion. The microscopy to our understanding of the pathology of contribution of the scanner is interesting in cases of the adult respiratory distress syndrome. mixed lesions involving a pleural component with a parenchymal lesion. Electron microscopy of cancer of the lung 3 Neoplastic processes Small pulmonary tumours and BRIAN E. HEARD and ANN S. DEWAR The typing of lung an objective diagnosis in neoplastic lesions (adenocar-copyright. tumours pathologically is based currently on appear- cinoma, etc) are still difficult to establish. However, ances in paraffin sections observed by light microscopy, early pleural tumours are diagnosed much earlier, as and a widely used classification is that of the World are pleural effusions. Health Organisation (1967). However, electron micros- 4 Metastatic les7ons Metastatic deposits that cannot copy is bringing to light much new information on the be seen on conventional radiographs can be visualised structure of these tumours, which will have to be on computerised tomograms (the vast majority of thesehttp://thorax.bmj.com/ incorporated in future classifications. In this paper are subpleural). The true indication is the formal the authors describe some ultrastructural findings in exclusion of all neoplastic lesions when a surgical their own series of lung tumours and discuss the im- operation has to be done. pact of findings of this type on present concepts based on observations made over the years by light 5 Mediastinal pathology The differentiation of various microscopy. elements in the mediastinum is sometimes difficult except for large structures (eg, thymus, and medi- astinal lymphoma). Electron microscopy of muscular evaginations Computerised tomography is a very useful method DONALD HEATH When smooth muscle cells shorten on in the study of the lung parenchymal and pleural on September 28, 2021 by guest. Protected collapse or constriction, bulbous evaginations project pathology. However, in many cases, traditional radi- from their surface in the gaps between attachment ology also permits an excellent approach to a similar points on the plasma membrane for myofilaments. On problem. electron microscopy such evaginations have a clear cytoplasm devoid of organelles and myofilaments. In Computerised tomography in the pathology of the ultrastructural studies of pulmonary vascular path- pleura and thoracic walls ology the observer who does not recognise such evaginations for what they are may be perplexed. M. OSTEAUX and L. JEANMART In the thoracic field, Examples of this phenomenon induced by hypoxia where conventional radiology is efficient, it seems and pyrrolizidine alkaloids are shown in the pul- reasonable to limit computerised tomography (CT) to monary trunk and pulmonary veins respectively. specific information. The following theoretical advan- tages of CT can be recognised: -Suppression of the superpositions without tomo- Comparison of the diagnostic contribution of graphical shadow, this being due to the point-to- scanner and conventional radiology point mathematical reconstruction of the picture MICHEL COLLARD, M. F. SERVAIS, and ALAIN BRIQUET -Great sensitivity to small density variations In a double-blind study, physicians made a thoracic -Ability to measure the density and deduce the com- diagnosis from computerised tomograms (EMI CT position and eventually the nature of some com- 5005-exposure time: 18 s) and from good standard ponents, either normal or due to a lesion 530 Thorax: first published as 10.1136/thx.33.4.530 on 1 August 1978. Downloaded from Proceedings of The Thoracic Society 531 -Representation of the total extent of the structures -On the basis of 30 years' experience with different from the wall to the mediastinum, due to the methods of anaesthesia, both local and different flexible expression of the picture through the play types of general anaesthesia, it seems that local of the centre and the window anaesthesia is not always the most appropriate -New topographical approach to the thorax by means method. of axial sections, this often constituting a decisive -Even for fibroscopy, general anaesthesia with the jet factor in the topographical understanding of com- technique, which provides good relaxation of the plex lesions and giving a new view in 'black' areas patient, should be used for the examination of chil- for conventional radiology: periphery, 'corners'. dren, elderly patients, patients under stress, nervous The limitations of the method are: people, and all patients in whom endoscopy may -Rather poor definition in comparison with standard take a long time. radiology 2 Is fibreoptic bronchoscopy actually the best tech- -Long scanning times, impairing definition of mobile nique for endoscopic intervention? structures -Firstly, as with the rigid bronchoscope, considerable -Rather thick slices (involving densitometric problems practice is needed to obtain good results. when dealing with small structures). -Except for minor indications, because of a better The contribution of CT is then analysed in two general view of the bronchial tree, and a better fields where it seems considerable: pleural lesions, control of unexpected situations, such as bleeding, which are poorly demonstrated by conventional radi- bronchorrhoea, and hypersecretion, the first endo- ology, and parietal pathology, where CT proves to be scopic examination should be performed with a rigid the diagnostic method of choice. bronchoscope under general 'jet' anaesthesia. It Conventional radiology shows the pleura and its should then necessarily be completed by a guided lesions very poorly. The intrinsic pleural contrast is fibroscopy through the rigid tube. In a well-relaxed indeed very small and besides the peripheral situation patient the superiority of the fibrescope over the is unfavourable in ordinary radiology. Tiny effusions classical bronchoscope complete with a good set of can be demonstrated. Metastases can be observed optical instruments is real except for the basal seg- which are otherwise absolutely invisible. In particular, mental bronchi. in the follow-up of neoplastic diseases it may be ob- 3 Does fibreoptic bronchoscopy permit serial examina- copyright. served that the occurrence of pleural effusions without tion? condensation in standard radiology is due to small- -At first it should be remembered that the fibreoptic sized pleural metastases which so far had escaped. The bronchoscope is a very frail instrument. pulmonary tumours, primary as well as secondary, are -Secondly, attention has recently been drawn to the very often bound to the pleura by thin opaque tracts, danger of microbial or viral contamination by way http://thorax.bmj.com/ which could represent a lymphatic extension of the of fibroscopy. disease. -Thirdly, proper sterilisation of the fibrescope is a The sternopericardiac ligament with its bilateral long-lasting and complex procedure (+60 h). There- pleural reflection is particularly well delineated. In the fore, unless one has several fibreoptic bronchoscopes, case of unilateral subatelectasia, the mediastinum tips serial examination is to be avoided. entirely over around its posterior insertions. The in- -Finally, the authors wish to stress the need to clination of the sternopericardiac ligament proves to continue the current practice of classical bronchos- be an early sign of subatelectasia. CT proves to be the copy in order to produce a number of well-trained method of choice in the study of parietal extension of bronchoscopists able to handle the removal of intrapulmonary lesions or vice versa. The primary foreign bodies which should, in principle, not be on September 28, 2021 by guest. Protected tumour formations of the wall in areas inaccessible attempted with fibreoptic bronchoscopes. for clinical examination are perfectly shown, in the same way as adenopathies of lymphomatous or meta- static origin. Comparison between the positive biopsy rates in lung As an original contribution of the technique, the cancer achieved with the rigid bronchoscope and with neoplastic or inflammatory invasion of the muscles, the fibreoptic bronchoscope of the subcutaneous tissue, and of the cartilages is J. WEBB and s. W. CLARKE The advent of fibreoptic clearly represented. bronchoscopy (FOB) in a chest hospital where a large number of rigid bronchoscopies were being done enabled a direct comparison between the two tech-
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