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PubMed1981

Catamenial pneumothorax in sisters.

Two sisters had documented pelvic endometriosis and catamenial pneumothoraxes. Both were typical of the 54 reported cases of catamenial pneumothorax in that pneumothoraxes were always on the right and occurred only at menses with onset in the fourth decade. One patient was asymptomatic during 11 months of menstrual suppression with hormones but subsequently required surgery where diaphragmatic perforations were found. The other patient was treated with isoxazole ethisterone with no pneumothoraxes while under suppression. These patients are unlike any of the previously reported cases of familial pneumothoraxes. We have not found a previous report of a familial catamenial pneumothorax.

Adult↗
PubMed1976

A prospective survey on chest malignancies following multiple fluroscopies during artificial pneumothorax therapy for pulmonary tuberculosis.

Patients with pulmonary tuberculosis treated in 4 sanatoria in Niigata prefecture during the period from 1941 to 1961 were followed up. Of 2,756 patients, 1,193 responded and sent us effective information. However, 1,224 did not come into contact because of changed and unknown adress, 326 did not respond, and 13 were omitted because of incomplete answers. Of 1,193 effective responders, 568 had been treated by artificial pneumothorax (the pneumothorax group), and 552 had been treated by the other measures than pneumothorax (the control group). There were 65 deaths in the pneumothorax, group, and 40 deaths in the control group. No deaths from chest malignancies were reported in the pneumothorax group, while 4 chest malignancies in the control. In this survey, no evidence of increased frequency of chest malignancies including leukemia following multiple fluoroscopies during artificial pneumothorax was detected.

Adult↗
PubMed1983

Physical constitution and smoking habits of patients with idiopathic spontaneous pneumothorax.

This is a report on a statistical study comparing the Kaup index and the level of tobacco consumption of patients with idiopathic spontaneous pneumothorax and those of healthy subjects. A statistically significant difference was found between the average Kaup index of the patients with idiopathic spontaneous pneumothorax and that of normal healthy individuals in Japan as published by the Ministry of Health and Welfare. A statistically significant difference was also found in the physical features between 2,433 males with idiopathic pneumothorax and 1,906 healthy males when compared by means of the Kaup index. Again, a statistically significant difference was noted in the level of tobacco consumption between the males with idiopathic pneumothorax and normal males when compared by means of the Brinkmann index. The Kaup index of idiopathic pneumothorax patients was lower than that of healthy subjects, while the level of tobacco consumption of the former was higher. Idiopathic spontaneous pneumothorax is related to thin and tall individuals and the level of tobacco consumption among such patients is higher than among healthy subjects.

Adolescent↗
PubMed2002

Surgical and nonsurgical management of and selected risk factors for spontaneous pneumothorax in dogs: 64 cases (1986-1999).

OBJECTIVE: To compare results of surgical versus nonsurgical treatment of spontaneous pneumothorax in dogs. DESIGN: Retrospective study. ANIMALS: 64 dogs with pneumothorax without any history of antecedent trauma. PROCEDURE: Information on signalment, thoracic radiographic findings, treatment, histologic findings, and outcome was obtained from the medical records. Signalment of affected dogs was compared with signalment of a control population of 260 dogs examined by the emergency service for reasons other than pneumothorax during the study period. RESULTS: Siberian Huskies were overrepresented in the case population, compared with the control population of dogs examined by the emergency service for other reasons. Twenty-eight dogs were treated without surgery (ie, thoracocentesis or tube thoracostomy with or without cage rest), and 36 were treated with surgery. Information regarding final outcome was available for 33 dogs treated with surgery (median follow-up time, 485 days) and 15 dogs treated without surgery (median follow-up time, 366 days). Dogs that underwent surgery had significantly lower recurrence (1/30) and mortality (4/33) rates, compared with dogs treated without surgery (6/12 and 8/15, respectively). A definitive diagnosis was obtained for 38 dogs, including 34 of 36 dogs undergoing surgery; 26 had bullous emphysema and 4 had neoplasia. Two dogs developed spontaneous pneumothorax secondary to migration of plant foreign bodies. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that recurrence and mortality rates for dogs with spontaneous pneumothorax managed surgically were significantly lower than rates for dogs managed by nonsurgical means alone. Early surgical intervention is recommended for definitive diagnosis and treatment of dogs with spontaneous pneumothorax.

Animals↗
PubMed2003

Spontaneous pneumothorax in two cats with small airway disease.

Two adult domestic shorthair cats were examined because of pneumothorax. Neither had a history of trauma, and spontaneous pneumothorax secondary to small airway disease was diagnosed. In both cats, treatment consisted of thoracocentesis for evacuation of air and administration of anti-inflammatory agents. One cat had multiple episodes of pneumothorax and eventually died; the other had only a single episode of pneumothorax. Small airway disease should be considered as a potential underlying cause in cats that develop spontaneous pneumothorax. Additionally, the potential for pneumothorax should be considered in cats with small airway disease, particularly when clinical signs suddenly become much worse.

Animals↗
PubMed1999

Air travel following traumatic pneumothorax: when is it safe?

The safety of air travel for patients sustaining a recent traumatic pneumothorax has long been a subject of debate. The Aerospace Medicine Association has suggested that patients should be able to fly 2 to 3 weeks after radiographic resolution of their pneumothorax. To validate these recommendations, a prospective study was performed. Twelve consecutive patients with recent traumatic pneumothorax expressing a desire to travel by commercial airline were evaluated. Ten patients waited at least 14 days after radiographic resolution of their pneumothorax before air travel (mean, 17.5+/-4.9 days), and all were asymptomatic in-flight. One of two patients who flew earlier than 14 days developed respiratory distress in-flight, with symptoms suggestive of a recurrent pneumothorax. We conclude that commercial air travel appears to be safe 14 days following radiographic resolution of a traumatic pneumothorax.

Adult↗
PubMed2000

Pleurectomy in primary pneumothorax: is extensive pleurectomy necessary?

BACKGROUND: The aim of the study was to evaluate the results of parietal pleurectomy in patients with primary spontaneous pneumothorax comparing extensive pleurectomy performed by thoracotomy versus more limited pleurectomy performed by VATS. METHODS: Records of the patients operated on for primary pneumothorax at Royal Brompton Hospital from January 1994 to April 1997 were retrospectively reviewed. A follow-up questionnaire was sent to patients asking about further pneumothorax and the presence of long-term chest problems on the operated side. A statistical uni- and multivariate analysis was performed searching predictors for postoperative complications, recurrence and chronic chest problems. RESULTS: Thirty-six patients underwent extensive pleurectomy through a limited postero-lateral thoracotomy (40%, group A), 54 patients had a limited pleurectomy (60%, group B), 50 by VATS and 4 by axillary thoracotomy. Overall, 11 patients had postoperative complications (12.2%). In group A, 4 patients (11.1%) had complications (2 reoperation, 2 air leak >7 days). In group B, 7 patients (12.9%) had complications (1 reoperation, air leak >7 days, 1 wound infection). Two patients experienced recurrent ipsilateral pneumothorax after surgery, both belonging to group B (overall recurrence rate 2.5%, group B 4.1%). Thirteen patients in both groups (respectively 41.9% in group A and 27% in group B) admitted chest problems on the operated side. From statistical analysis, "indication" resulted a predictor of complications (p=0.03) and "thoracotomy" a predictor of long-term chest problems (p=0.03). CONCLUSIONS: Many theoretical advantages of limited VATS pleurectomy have still to be confirmed and it is reasonable to use it in uncomplicated primary pneumothorax. The superb exposure obtained with thoracotomy and the superiority of extensive pleurectomy in terms of recurrence indicate this approach in case of complicated pneumothorax or when long-term security is of paramount importance.

Adolescent↗
PubMed2000

[Spontaneous pneumothorax--a 10-year material from the regional hospital in Tromsö].

BACKGROUND: Spontaneous pneumothorax is a common disorder in which treatment strategies are changing. MATERIAL AND METHODS: 220 patients treated at the University Hospital of Tromsø over a 10-year period from 1988 to 1997 were studied. There were 128 patients with primary spontaneous pneumothorax, 51 with secondary spontaneous pneumothorax, and 41 with traumatic pneumothorax. The patients with spontaneous pneumothorax were divided into two groups depending on whether drainage time was less than three days or more. 68 patients were treated with videoassisted thoracoscopic surgery (VATS) or thoracotomy. RESULTS: Recurrence rate for primary pneumothorax was 19%, for secondary 13% and for traumatic 3%. Recurrence rate for patients having drains for more than three days was lower than the rate for those having drains for a shorter period; 11% and 27% respectively (p < 0.025). Recurrence rates after videoassisted thoracoscopic surgery or thoracotomy were 11% and 4% respectively (p > 0.05). INTERPRETATION: Although the results are good, the study indicates room for improvement. Drainage time should perhaps be somewhat prolonged when the airleak stops early (< 3 days). VATS should be considered early when there is a persisting leak.

Adolescent↗
PubMed2002

Diagnosis and treatment of tension pneumothorax under anesthesia: a case report.

An 80-year old woman with a history of tracheal stenosis, tracheostomy, and 3 months of increasing respiratory distress underwent tracheal dilatation under general anesthesia with jet ventilation. Tracheal dilatation was successfully performed via suspension laryngoscopy and jet ventilation. During emergence the patient developed decreased oxygen saturation, hypotension, and respiratory distress, requiring intubation and ventilatory support. During tracheostomy, anterior chest subcutaneous emphysema led to a diagnosis of tension pneumothorax. Chest tube placement facilitated tracheostomy and improved ventilatory and circulatory parameters. This article discusses the diagnosis and treatment of a tension pneumothorax under general anesthesia. Jet ventilation, spontaneous rupture of blebs or bullae, surgical trauma, or barotrauma are the 4 most likely explanations for a tension pneumothorax in this patient. Jet ventilation can cause pneumothorax, pneumomediastinum, or subcutaneous emphysema. Chronic obstructive pulmonary disease may cause blebs or bullae, which might rupture when exposed to positive pressure ventilation. Tissue trauma during dilatation or tracheostomy may cause a pneumothorax when positive pressure ventilation is employed. Barotrauma from high peak inspiratory pressure, rigid bronchoscopy, dilatation procedure, or jet ventilation may cause a pneumothorax. Prompt diagnosis and treatment will markedly decrease associated morbidity and mortality.

Aged↗
PubMed2002

[Catamenial pneumothorax. Failure of videothorascopic treatment].

INTRODUCTION: Catamenial pneumothorax occurs in women during the menses. It is frequently associated with diaphragmatic fenestrations or episodes of pleural endometriosis. OBSERVATION: We report the case of a patients who had presented 25 episodes of right pneumothorax despite treatment with videothorascopy initiated after the 10th episode. These episodes coincided with menstruation. Diagnosis of catamenial pneumothorax was evoked and thoracic surgery was indicated. Exploration of the pleural fossa did not reveal symphysis but 7 diaphragmatic orifices, which were sutured before conducting mechanical pleurodesis. No relapse of pneumothorax was reported following surgery. COMMENTS: Around one hundred cases of catamenial pneumothorax have been reported in the literature. They represent 2.8 to 5.6% of spontaneous pneumothroax in women. Diagnosis is evoked on the occurrence of recurrent pneumothorax appearing 24 to 72 hours after the onset of menstruation. The pathogeny is uncertain and several mechanisms are frequently evoked. In the prevention of relapses, treatment consists in closing the diaphragmatic orifices with thoracotomy, resection of eventual bubbles, and pleural symphysis. Videothorascopy does not appear adapted to treatment.

Adult↗
PubMed2002

[Clinical review of pneumothorax cases complicated with active pulmonary tuberculosis].

Pneumothorax is an important and dangerous complication of pulmonary tuberculosis. Forty-six pneumothorax cases complicated with active pulmonary tuberculosis at National Chiba-Higashi Hospital were studied retrospectively. From Jan. 1987 to Dec. 1997, we experienced 3611 patients with pulmonary tuberculosis, and among them 46 patients (18-90 years old, 38 males and 8 females) had pneumothorax. On admission, 33 out of 46 cases (71.7%) were smear positive by sputum examination of mycobacteria and 41 out of 46 cases (89.1%) had cavitary lesions on chest X-ray. Eleven cases had mild pneumothorax, thirty-two had moderate, and three had severe. Pneumothorax was present on admission in 23 patients and developed during treatment for tuberculosis in the other 23 patients. Eleven patients were treated with bed rest alone, four were thoracentesis and aspiration, twenty-four were intrathoracic tube drainage and seven were operated. Thirty-one patients were recovered, but fifteen passed away, among them 13 due to respiratory failure. The Prognostic nutritional index (PNI; 10 x serum albumin concentration +0.005 x peripheral lymphocyte count) which was proposed by Onodera, serum albumin level and Body mass index were lower in the fatal group than in the survival group. We consider these indices are useful to evaluate the prognosis of active tuberculosis patients complicated with pneumothorax.

Adolescent↗
PubMed2002

Poland's syndrome with spontaneous pneumothorax: report of two cases.

Poland's syndrome is an uncommon congenital anomaly of the chest wall characterized by the absence of the pectoralis major muscle and other nearby musculoskeletal components. Many associated aberrations over the thoracic cage, intrathoracic organs, and upper limbs have been reported. However, spontaneous pneumothorax in these patients has not been reported. Here, we describe two patients with both Poland's anomaly and spontaneous pneumothorax. One patient was a 16-year-old boy with left chest wall hypoplasia and pneumothorax on the right side. The other was a 27-year-old man with right chest wall hypoplasia, hand brachydactyly, and pneumothorax. Pneumothorax in both patients was treated with bullectomy and mechanical pleurodesis with the aid of videothoracoscopy, and the postoperative courses were smooth. Blood supply disruption has been hypothesized as a pathogenic mechanism of both spontaneous pneumothorax and Poland's syndrome, suggesting an association between these two diseases.

Adolescent↗
PubMed2002

[Specific features of spontaneous pneumothorax in patients with pulmonary tuberculosis].

To study the impact of pulmonary tuberculosis on the natural development of spontaneous pneumothorax and on the outcomes of its treatment, data on 589 patients were retrospectively analyzed. Two hundred and eighty patients had primary spontaneous pneumothorax and 170 had secondary nontuberculosis pneumothorax. Tuberculous pneumothorax was in 139 patients, of them 71 had decay cavities. The authors defined the causes of pneumothorax, the severity of respiratory diseases, assessed admission X-ray data, evaluated the efficiency of the first 24 hours of treatment, complications and mortality rates in these groups of patients. The efficiency of treatment for spontaneous pneumothorax has been ascertained to be determined by the degree of lung decay, by the adequacy of pleural cavity drainage, and by the rationality of a tactic algorithm rather than by the type of an infectious agent (Mycobacterium tuberculosis, nonspecific microflora).

Adolescent↗
PubMedDate not supplied

Pneumothorax after diagnostic laparoscopy.

Here we want to call laparoscopist's attention to pneumothorax after diagnostic laparoscopy. Diagnostic laparoscopy has less complications, compared with laparoscopic surgery. In our experience, only one case (0.04%) developed pneumothorax during routine diagnostic laparoscopic procedure. This complication is presented in a 50-year-old female. She complained of dyspnea just after the decrease of intraabdominal pressure and deflation of intraperitoneal gas. The chest roentgenogram showed a right pneumothorax, and a right chest tube was inserted with immediate relief of tension. Pneumothorax during diagnostic laparoscopy is relatively rare but a major complication; Medline literature research showed six reported cases of pneumothorax after diagnostic laparoscopy from 1983 to 1998 including our case. The etiology was idiopathy in 5 and diaphragmatic injury in 1. Hypotension, elevation of inspiratory pressure, dyspnea, a decrease in systemic oxygen saturation, and loss of breath sounds suggest tension pneumothorax. The clinical condition of the patients improved rapidly because of the easy diffusion of the gas used in laparoscopy. Diagnostic laparoscopists should be aware of this complication and treat ventilatory problems.

Biopsy↗
PubMed2002

[Contralateral pneumothorax after pneumonectomy for bronchogenic carcinoma; report of a case].

A case of contralateral pneumothorax after pneumonectomy was reported. Intrathoracic drainage was performed and pneumothorax was healed. Recurrent pneumothorax was occurred in this patient and intrathoracic drainage was performed again and pneumothorax was healed. We suspected that bulla was the cause of pneumothorax and thought that contralateral pneumothorax after pneumonectomy must be carefully follow-up.

Aged↗
PubMedDate not supplied

Role of chest CT scan in determining etiology of primary spontaneous pneumothorax.

BACKGROUND: Spontaneous pneumothorax occurs subsequent to a disruption in the continuity of visceral pleura and escape of air into pleural space. It is usually difficult, sometimes impossible to detect evidence of pulmonary pathology by clinical or conventional radiographic methods. Computed tomography provides additional informations not obtainable with conventional diagnostic modalities. METHODS: To determine the role of CT scan in the aetiological diagnosis and subsequent management of patients with primary spontaneous pneumothorax, a perspective study was undertaken. RESULTS: A total of 40 patients with spontaneous pneumothorax with normal skiagram chest after management of pneumothorax, were included in the study. In 75% of these cases, CT revealed underlying lung pathology as a cause for primary spontaneous pneumothorax. CONCLUSION: Our study shows that CT scan is a useful imaging modality in determining the aetiology of primary spontaneous pneumothorax.

Adult↗
PubMed2003

[High efficacy of pleurodesis using OK-432 for controlling intractable pneumothorax associated with pulmonary lymphangioleiomyomatosis].

We evaluated the efficacy of pleurodesis using OK-432 (Picibanil) for the treatment of pneumothorax associated with pulmonary lymphangioleiomyomatosis (LAM). Seven episodes of pneumothorax in five patients with LAM were treated with pleurodesis using OK-432. First, all patients underwent tube thoracostomy drainage. After drainage, 5 or 10 KE of OK-432 was administered via the tube. If incomplete lung expansion or a continuous air leak occurred, an additional 5 KE of OK-432 was administered. Of the five patients, two developed pneumothorax for the first time and three had a history of previous pneumothorax. The mean total dose of OK-432 administered was 13.6 KE, and the mean period of tube drainage was 11 days. The only recurrence of ipsilateral pneumothorax after OK-432 pleurodesis was observed seven years and eight months later in association with chronic respiratory failure in one patient. This patient was successfully treated with repeated pleurodesis using OK-432 during mechanical ventilation, and no recurrence has developed in the eight years since then. The main side effects of the procedure with OK-432 were fever and chest pain, which were well controlled by non-steroidal anti-inflammatory drugs. The study concluded that pleurodesis with OK-432 was an effective and safe treatment for intractable and recurrent pneumothorax associated with LAM.

Adult↗
PubMed1992

Subcutaneous emphysema from an axillary wound that resulted in pneumomediastinum and bilateral pneumothorax in a horse.

A 5-year-old Thoroughbred gelding was examined because of a small axillary wound sustained 5 days earlier and had resulted in extensive subcutaneous emphysema. Three days after admission, the horse's respiratory rate had increased to 72 breaths/min, and the horse appeared anxious and distressed. Thoracic radiography revealed pneumomediastinum and severe bilateral pneumothorax. Tube thoracostomy was performed on both hemithoraxes. The drains were connected to one-way suction valves and suction devices to decompress the thorax. A nasopharyngeal catheter was inserted, and oxygen insufflation was started. Cross ties were placed on the horse to limit movement, and the wound was packed. The horse improved within 30 minutes after initiating treatment. The horse was released 15 days after the development of pneumothorax, at which time the pneumothorax had resolved, the wound was no longer open, and the subcutaneous emphysema had greatly decreased. Although subcutaneous emphysema is usually regarded as a temporary cosmetic disfigurement, it can lead to serious complications such as pneumothorax. This case demonstrates that subcutaneous emphysema can lead to a life-threatening pneumothorax if the pressure is great enough to migrate through the mediastinum and into the pleural cavity. Horses with subcutaneous emphysema should be kept in confinement and monitored for the development of pneumothorax.

Animals↗