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Dive into the research topics where Jean-Marie Tschopp is active.

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Featured researches published by Jean-Marie Tschopp.


The Lancet | 2007

Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study

Julius Janssen; Gareth Collier; Phillippe Astoul; Gian Franco Tassi; Marc Noppen; Francisco Rodríguez-Panadero; Robert Loddenkemper; Felix J.F. Herth; Stefano Gasparini; Charles Hugo Marquette; Birgit Becke; Marios Froudarakis; Peter Driesen; Chris T. Bolliger; Jean-Marie Tschopp

BACKGROUNDnTalc is the most effective chemical pleurodesis agent for patients with malignant pleural effusion. However, concerns have arisen about the safety of intrapleural application of talc, after reports of development of acute respiratory distress syndrome in 1-9% of treated patients. Our aim was to establish whether use of large-particle-size talc is safe in patients with malignant pleural effusion.nnnMETHODSnWe did a multicentre, open-label, prospective cohort study of 558 patients with malignant pleural effusion who underwent thoracoscopy and talc poudrage with 4 g of calibrated French large-particle talc in 13 European hospitals, and one in South Africa. The primary endpoint was the occurrence of acute respiratory distress syndrome after talc pleurodesis.nnnFINDINGSnNo patients developed acute respiratory distress syndrome (frequency 0%, one-sided 95% CI 0-0.54%). 11 (2%) patients died within 30 days. Additionally, seven patients had non-fatal post-thoracoscopy complications (1.2%), including one case of respiratory failure due to unexplained bilateral pneumothorax.nnnINTERPRETATIONnUse of large-particle talc for pleurodesis in malignant pleural effusion is safe, and not associated with the development of acute respiratory distress syndrome.


Archive | 2014

The Safety Profile of Medical Thoracoscopy: Expert Advices and Recommendations

Philippe Astoul; GianFranco Tassi; Jean-Marie Tschopp

Everybody agrees that medical thoracoscopy is a minimally invasive technique which is well tolerated and associated with very few complications—provided the operators are well trained. It has been performed by pulmonologists on continental Europe for more than 100 years. It was an ambulatory procedure during the terrible era of tuberculosis for obtaining lung collapse by cutting pleural adhesions. This was a mainstay of tuberculosis management before antibiotics were invented. This intervention was performed and often repeated on patient.


Archive | 2014

The Current Practice of Medical Thoracoscopy

Philippe Astoul; GianFranco Tassi; Jean-Marie Tschopp

What do we mean by the green zone? Here we describe the classical indications for thoracoscopy that every pulmonologist interested in this technique should be able to practice easily after proper training. On one hand thoracoscopy is a diagnostic tool improving the diagnostic yield of malignant diseases or nonmalignant pleural effusions such as tuberculosis in almost 100 % of the cases. On the other hand it is also an efficient therapeutic tool which allows control of pleural effusions responsible for breathlessness in patients with important such effusions and efficiently prevents further recurrence of pneumothorax by talc pleurodesis. As recently shown, talc if properly chosen and used is innocuous contrary to the talc used, for instance, in Brazil and North America. Talc pleurodesis under thoracoscopy is safe as recently shown in Europe by two large prospective studies in malignant pleural effusion and treatment of recurrence of spontaneous pneumothorax.


Archive | 2014

Advanced Application of Medical Thoracoscopy

Philippe Astoul; GianFranco Tassi; Jean-Marie Tschopp

This section, identified as a “grey zone,” marks the transition from the common indications of thoracoscopy in the management of pleural effusion and pneumothorax, which are accepted into practice, and as discussed in the preceding chapters, to more complex applications. They should be limited to centers with extensive thoracoscopic experience.


Archive | 2014

Management of Spontaneous Pneumothorax: Common Sense Should Prevail

Jean-Marie Tschopp; Philippe Astoul

The management of spontaneous pneumothorax (SP) has been debated over the last two decades and lacks from good scientific evidence (Schramel et al. 1997; Miller 2008). However most will agree that the choice of treatment offered to patients with SP should be cost-effective and based on robust scientific evidence. The primary principle should be primum non nocere, first do no harm, i.e., the basis of medicine over the centuries. In other words, our responsibility should be to offer a beneficial treatment with minimal side effects. In addition, most experts agree that there are two aims when treating SP: to evacuate air, if necessary, and to prevent recurrences.


Archive | 2014

Future Developments in Medical Thoracoscopy

Philippe Astoul; GianFranco Tassi; Jean-Marie Tschopp

Progress in medical thoracoscopy, as discussed in the following chapters, will be centered on instrument development, new diagnostic methods, and associated clinical research.


Archive | 2014

Introduction to the Pleura and Thoracoscopy Technique

Philippe Astoul; GianFranco Tassi; Jean-Marie Tschopp

One hundred years ago, Jacobeus published the first paper describing the technique of thoracoscopy. The procedure became well known and played an important role as a first treatment for tuberculosis before the advent of chemotherapy. It is important to look to the past to better understand the new developments of this technique. In the 1950s, medical thoracoscopy was neglected in Great Britain and the United States of America, simply because it was considered out of date. However in some chest centers of continental Europe, especially in Berlin (Germany) and Marseille (France), pulmonologists went on using this technique and developed tools allowing not only a better view of the thoracic cavity but combining also the videothoracoscopy with new tools such as ultrasounds of the pleura. In the same way, the technique of sedation and local anesthesia and the great improvements in the equipment available have made this technique simple, provided physicians desiring to perform thoracoscopy receive good training and have access to the experience developed over the years.


Archive | 2014

The Frontier of Medical Thoracoscopy

Philippe Astoul; GianFranco Tassi; Jean-Marie Tschopp

Advanced procedures in medical thoracoscopy are best described as nonroutine. They are interventions associated with greater complexity and lie somewhere between the medical procedure of thoracoscopy and the surgical procedure of VATS. The current advanced indications as described in the literature include sympathectomy and pericardial window. At the present time, thoracoscopic sympathectomy is minimally invasive and is an accepted intervention for patients with a variety of autonomous nervous system disturbances. Patients with essential hyperhidrosis as well as highly selected subjects with other defined disorders can be symptomatically improved with this procedure. They can be performed by interventional pulmonologists, but it must be noted that when performed as a “medical thoracoscopy” they should be categorized as an advanced technique—a “red zone” procedure. A pericardial window can be performed at thoracoscopy, as previously described in the literature. However, VATS should be considered as the gold standard, and the dedicated chapter in this book is to remind the reader of the historical aspects and limits of medical thoracoscopy. For these advanced procedures expert skills are mandatory from performing the basic procedures, simulated training, and hands-on training under the supervision of an experienced trainer.


Karger Kompass Pneumologie | 2013

Endobronchiale ultraschallgeführte transbronchiale Biopsie peripherer Lungenläsionen: Wie viele Proben sind notwendig?

Seamus Grundy; Andrew Bentley; Jean-Marie Tschopp; Francisco Rodriguez-Panadero; Ana Montes-Worboys; Rudolf Hatz; Maurizio Bernasconi; David Berger; Michael Tamm; Daiana Stolz; Thomas Weig; Michael Irlbeck; Claus Neurohr; Hauke Winter; Rene Schramm; Thomas Knösel; David Horst

Hintergrund: Obwohl bereits aufgezeigt wurde, dass eine durch endobronchialen Ultraschall (EBUS) geführte transbronchiale Biopsie (TBB) die diagnostische Ausbeute gegenüber herkömmlichen Bronchoskopietechniken erhöht, wurde der wichtige Aspekt der benötigten optimalen Anzahl an Biopsieproben bisher nicht gründlich untersucht. Studienziele: Untersuchung, ob die Anzahl der entnommenen Biopsieproben mit der diagnostischen Ausbeute einer EBUS-geführten TBB zusammenhing und - sofern dies der Fall ist - Bestimmung der optimalen Probenanzahl, die für eine maximale diagnostische Ausbeute bei peripheren Lungenläsionen erforderlich ist. Methoden: Die Krankenakten aus den Jahren 2008-2010 von Patienten, bei denen eine EBUS-geführte TBB zur Diagnose peripherer Lungenläsionen durchgeführt wurde, wurden retrospektiv ausgewertet. Ferner wurde der Zusammenhang zwischen klinischen und radiologischen Merkmalen (einschließlich der Anzahl der Biopsieproben) und der diagnostischen Ausbeute analysiert. Ergebnisse: Die Analyse umfasste insgesamt 384 Patienten. Die diagnostische Gesamtausbeute der EBUS-geführten TBB betrug 73%; der einzige Faktor, der die diagnostische Ausbeute beeinflusste, war die Position der Sonde. Bei Patienten, bei denen die EBUS-Sonde innerhalb der Läsion platziert wurde, ergab sich eine signifikant höhere Ausbeute (85%) als bei den Patienten, bei denen sich die Sonde in der Nähe bzw. außerhalb der Läsion befand (38%; p < 0,001). Bei der Bestimmung der Anzahl der Biopsieproben auf Grundlage ihrer Genauigkeit ergab sich kein signifikanter Faktor bei der Vorhersage der diagnostischen Ausbeute. Schlussfolgerungen: Die Position der Sonde ist ein unabhängiger Prädiktor der diagnostischen Ausbeute bei der EBUS-geführten TBB. In der alltäglichen Praxis sollte die optimale Anzahl an Biopsieproben von Fall zu Fall entschieden werden.


Karger Kompass Pneumologie | 2013

Sarkoidale Granulome in zytologischen Proben einer intrathorakalen Adenopathie

Seamus Grundy; Andrew Bentley; Jean-Marie Tschopp; Francisco Rodriguez-Panadero; Ana Montes-Worboys; Rudolf Hatz; Maurizio Bernasconi; David Berger; Michael Tamm; Daiana Stolz; Thomas Weig; Michael Irlbeck; Claus Neurohr; Hauke Winter; Rene Schramm; Thomas Knösel; David Horst

Hintergrund: Klinische Erfahrungen und Daten in der Fachliteratur deuten darauf hin, dass die Fähigkeit von Pathologen, Granulome in zytologischen Proben einer intrathorakalen Lymphadenopathie zu identifizieren, erheblich schwankt. Dies kann die Ausbeute einer transbronchialen Nadelaspiration (TBNA) negativ beeinflussen - sowohl beim konventionellen als auch beim ultraschallgeführten (EBUS-TBNA) Vorgehen. Studienziele: Beschreibung der Zytomorphologie sarkoidaler Granulome in zytologischen TBNA-Proben und Untersuchung der Verbindungen zwischen den zytologischen Eigenschaften von Granulomen und dem Röntgenstadium der Sarkoidose. Methoden: Zwei Pathologen, die in Bezug auf die klinisch-radiologischen Details verblindet waren, untersuchten unabhängig voneinander zytologische TBNA-Proben von 123 Sarkoidose- und 14 Tuberkulosepatienten (Kontrollpopulation). Ergebnisse: Die sarkoidalen Granulome waren klein [größter medianer (IQR) Durchmesser: 0,478 (0,318-0,701) mm] und gut ausgebildet, rund oder elliptisch und wiesen fast immer einen regelmäßigen Umriss auf. Bei Hintergrundelementen fehlten nekrotische Trümmer bzw. Exsudat. Die Dichte [mediane (IQR) Anzahl der Granulome pro Objektträger: 6,85 (3,66-11) vs. 5,25 (2,5-8), p = 0,073] und Größe [größter medianer (IQR) Durchmesser: 0,51 (0,319-0,733) vs. 0,398 (0,318-0,522), p = 0,071] war bei Sarkoidose in Stadium I tendenziell höher als in Stadium II. In der untersuchten Kohorte mit Tuberkulose trat häufig ein nekrotischer Hintergrund auf (79 vs. 0%, p < 0,0001). Schlussfolgerungen: Granulome können in zytologischem TBNA-Material zuverlässig identifiziert werden, sobald sich ihre charakteristische Zytomorphologie abzeichnet. Eine größere Granulomdichte bei Lymphadenopathie von Patienten mit Sarkoidose in Stadium I könnte teilweise die höhere Erfolgsquote erklären, die durch TBNA und EBUS-TBNA in diesem Krankheitsstadium konstant erzielt wird. In einem geeigneten klinischen Bereich deutet ein nekrotischer Hintergrund eher auf eine tuberkuläre als auf eine sarkoidale Ätiologie der Granulome hin.

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Andrew Bentley

Manchester Academic Health Science Centre

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Seamus Grundy

Manchester Academic Health Science Centre

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Ana Montes-Worboys

Spanish National Research Council

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Hauke Winter

Providence Portland Medical Center

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Daiana Stolz

University Hospital of Basel

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