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PubMed2000

The results of thoracoscopic surgery for primary spontaneous pneumothorax.

OBJECTIVE: To review our experience of video-assisted thoracoscopic surgery for the treatment of primary spontaneous pneumothorax. DESIGN: Longitudinal cohort study following up consecutive patients for 3 to 4.3 years. SETTING: Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. PATIENTS AND INTERVENTION: Seventy-two consecutive patients undergoing thoracoscopy for primary spontaneous pneumothorax from January 1994 to June 1996. RESULTS: The mean age of the patients was 25 years (range, 15 to 40 years), and 67 were men (93%). All patients were successfully treated using video-assisted thoracoscopic technique. Recurrent pneumothorax was the most frequent indication for surgery, occurring in 49 patients. The most common method of management was stapling of an identified bleb, which was done in 56 cases. Pleurodesis was achieved by gauze abrasion (n = 39) and apical pleurectomy (n = 33). Postoperative prolonged air leak occurred in five patients (6.9%). There were no deaths attributable to the procedure. The mean (+/-SD) postoperative hospital stay was 4 +/- 2 days. Mean follow-up is 42 months (range, 36 to 54 months) for all patients. Pneumothorax recurred in four patients (5.5%) in whom pleural abrasion was done. The recurrences occurred in the first year of follow-up, three required a reoperation, and one healed by rest without pleural drainage. CONCLUSIONS: Video-assisted thoracoscopic surgery is a safe procedure in the treatment of primary spontaneous pneumothorax. Apical pleurectomy is a more effective way of producing pleural symphysis. Long-term follow-up did not increase the rate of recurrence.

Adolescent↗
PubMed2002

Pneumothorax in the ICU: patient outcomes and prognostic factors.

STUDY OBJECTIVE: To identify the prognostic factors for pneumothorax in patients in the ICU. DESIGN: Retrospective cohort study. SETTING: ICU at a university-based teaching hospital. PATIENTS AND METHODS: Sixty patients developed pneumothoraces in the ICU during a period of 36 months. Medical records relating to patients' age, sex, underlying diseases, associated medical conditions, reasons for admission, acute physiology and chronic health evaluation (APACHE) II scores, procedures performed before the development of pneumothorax, occurrences of tension pneumothorax, duration of chest tube placement, chest tube removal, duration of ICU stay, and patient outcomes all were analyzed. A multivariate logistic regression model was applied with variables that were significantly associated with survival in the univariate analysis. The probabilities of chest tube removal were calculated using the Kaplan-Meier method. RESULTS: Thirty-five patients (58%) had procedure-related pneumothoraces. The procedure that most commonly caused pneumothoraces was thoracentesis (n = 19; 54%), followed by central vein/pulmonary artery catheterization (n = 14; 40%) and bronchoscopy/transbronchial lung biopsy (n = 8; 23%). A multivariate logistic regression analysis also showed that pneumothorax due to barotrauma (p = 0.001), tension pneumothorax (p = 0.0023), and concurrent septic shock (p = 0.0476) were significantly and independently associated with death. The log-rank test revealed that the success rate of chest tube removal was higher in patients with procedure-related pneumothoraces (p = 0.0055). CONCLUSIONS: Patients with procedure-related pneumothoraces had better outcomes. Patients with pneumothoraces occurring in the ICU due to barotrauma, or a complicating tension pneumothoraces, carry a higher risk of mortality.

APACHE↗
PubMed2003

Catamenial pneumothorax: a prospective study.

OBJECTIVES: To evaluate the incidence of catamenial pneumothorax (CP) among women who have been referred for the surgical treatment of spontaneous pneumothorax (SP) and to study its pathogenic mechanisms. DESIGN: A prospective study of women of reproductive age who have been referred to our center for the surgical treatment of SP. Patients with pneumothorax secondary to a known lung disease were excluded. SETTING: A university hospital. METHODS: At the preoperative evaluation, special attention was given to the investigation of a possible temporal relationship between pneumothorax and menses. Video-assisted thoracoscopy constituted the operative technique of choice. The lung was inspected to identify blebs or bullae and the origin of possible air leaks. Signs of thoracic endometriosis were also carefully searched for. The diaphragm was systematically inspected to search for holes and/or endometrial implants. When limited diaphragmatic abnormalities were found, a partial diaphragmatic resection was carried out using an endoscopic stapler. In case of lesions that were not accessible by a purely endoscopic approach, a utility minithoracotomy was used. RESULTS: In an 18-month period, 32 women with SP were referred for surgery. In eight cases, the catamenial character of the pneumothorax was recognized by clinical history. In all these patients, the following diaphragmatic abnormalities were found at surgery: holes (one patient); endometrial implants (three patients); and both (four patients). Visceral pleural endometriosis was found in one patient. During pathologic examination, diaphragmatic endometriosis was confirmed in seven of the eight cases. In one patient, it was associated with pulmonary and pleural endometriosis. In only one patient (with multiple diaphragmatic holes and a pulmonary nodular brown lesion), endometriosis could not be confirmed at histology, but signs of parenchymal focal hemorrhages were found. CONCLUSIONS: Our experience shows that (1) CP is more frequent than expected and (2) diaphragmatic abnormalities seem to play a fundamental role in its pathogenesis.

Adult↗
PubMed1985

Diving and chronic spontaneous pneumothorax.

Diving and pneumothorax cannot go together. An air bubble between the visceral and the parietal pleura will change its size according to Boyle's law, and pneumothorax might increase in size during the ascent from a dive. We would like to present the case of a professional diver, who was engaged in active diving for a period of five months during which time he made 80 to 85 dives with pneumothorax. As far as we know, this is the first such case published in the medical literature. We should also like to emphasize the protracted nature of the pneumothorax, which persisted for that time without changing size. This diver had no medical problems with diving, and the deeper he descended, the better he felt. No tension pneumothorax ever occurred and the diagnosis was made by chance.

Adult↗
PubMed1986

Spontaneous pneumothorax and mitral valve prolapse.

We searched for mitral valve prolapse in patients with spontaneous pneumothorax to test the hypothesis that both may be part of a common disorder of connective tissue. Echocardiographic mitral valve prolapse was found in 11 (50 percent) of 22 patients who had suffered spontaneous pneumothorax compared to four (10 percent) of 40 age-matched control subjects (p less than 0.01). The body mass index (BMI) (weight/height2) was lower (p less than 0.001) in the group with pneumothorax; in five patients who were the thinnest in the study (BMI less than 2 standard deviations lower than mean normal value), mitral valve prolapse was present in four. The finding of a strong association of spontaneous pneumothorax with mitral valve prolapse, especially in subjects with an abnormal body build, suggests that in many patients, spontaneous pneumothorax may be a manifestation of a systemic abnormality of connective tissue.

Adult↗
PubMed1990

Pneumothorax following transbronchial biopsy. Low diagnostic yield with routine chest roentgenograms.

A chest roentgenogram is commonly obtained after a transbronchial biopsy to exclude a pneumothorax. We hypothesized that these routine chest roentgenograms rarely demonstrate a pneumothorax in patients who have neither symptoms nor fluoroscopic findings of lung collapse. To test this hypothesis, we studied 305 consecutive patients undergoing bronchoscopy with fluoroscopically guided TBB. No patient without symptoms and fluoroscopic findings suggesting lung collapse had a pneumothorax demonstrated on the post-biopsy chest roentgenogram. At the University of Virginia, routine chest roentgenograms failed to demonstrate a single unsuspected pneumothorax among all patients undergoing TBB during a period of nearly six years. Given this low incidence of unsuspected pneumothorax, we conclude that routine chest roentgenograms have a low diagnostic yield and may not be necessary in all patients after fluoroscopically guided TBB.

Adolescent↗
PubMed1988

Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests.

Pulmonary function tests and chest radiographs of 160 patients who had had percutaneous needle biopsy of lung lesions were reviewed to determine the value of these examinations in estimating the risk of postbiopsy pneumothorax. Chest radiographs were evaluated subjectively for changes of obstructive and restrictive airway disease and for size and depth of lesion. Pulmonary function tests, consisting of simple spirometry (forced vital capacity, percentage of predicted forced vital capacity, forced expiratory volume in 1 sec, percentage of predicted forced expiratory volume in 1 sec, and [forced expiratory in 1 sec/forced vital capacity] X 100), and the pulmonologist's interpretation were evaluated. Pneumothorax developed in 46% (31/67) of patients who had obstructive airway disease according to the results of pulmonary function tests and in 42% (34/81) of those who had obstructive airway disease according to changes on chest radiographs, compared with 19% (10/53) and 25% (17/67) of those who had normal pulmonary function tests and chest radiographs, respectively. Pneumothorax developed in 46% (23/50) of patients who had findings of obstructive airway disease on both pulmonary function tests and on chest radiographs, compared with 7% (2/28) of patients who were classified as normal by both criteria. None of the patients who had normal pulmonary function tests required placement of a chest tube, whereas 19% (13/67) of those who had obstructive airway disease required chest tubes. Decreasing size of lesion and increasing depth of lesion were associated with a significant increase in the risk of pneumothorax. We conclude that the results of chest radiographs and pulmonary function tests are useful parameters for estimating the risk of postbiopsy pneumothorax.

Adult↗
PubMed1995

Quantification of pneumothorax size on chest radiographs using interpleural distances: regression analysis based on volume measurements from helical CT.

OBJECTIVE: The aim of this study was to define the relationship between interpleural distance measurements on an erect posteroanterior chest radiograph and pneumothorax size as measured by helical CT in a series of patients. SUBJECTS AND METHODS: Twenty pneumothoraces from 19 patients (10 males, nine females) were analyzed. Most pneumothoraces were on the right side (n = 16). The etiology was spontaneous in seven patients and iatrogenic in thirteen. All patients underwent an erect inspiratory posteroanterior radiograph and a helical CT scan of the thorax on the same visit to the radiology department. The interpleural distance was measured at three locations and the figures added together. Following helical CT of the thorax, the percentage pneumothorax size was calculated by drawing regions of interest around the relevant hemithorax and lung on 10-mm reconstructed slices. A scattergram of the sum of interpleural distances in centimeters versus percentage pneumothorax size was plotted. RESULTS: Analysis of results showed that percentage pneumothorax size could be calculated by the formula Y = 4.2 + [4.7 x (A + B + C)], r = .98, p < .0001. CONCLUSION: This study identified a formula for accurately calculating percentage pneumothorax size as determined by helical CT from an erect posteroanterior radiograph. Using this formula with the clinical status of the patient should more easily identify patients requiring active intervention.

Adolescent↗
PubMed1982

Increased content of neutrosoluble collagen and dialyzable hydroxyproline in panacinar emphysema and spontaneous pneumothorax.

Hydroxyproline transfer to an incubation medium was studied in ten emphysematous, nine relapsing pneumothorax, and eight control samples surgically removed from 2 females and 25 males, ranging in age from 17 to 69 years. Total hydroxyproline in the lung pieces, expressed as a fraction of DNA, was not modified. A large increase of dialyzable and nondialyzable hydroxyproline fraction was observed in the incubation medium of biopsies from emphysema dn pneumothorax groups. Although the pneumothorax group had average values between controls and emphysema, some pneumothorax patients exhibited very high content of soluble hydroxyproline, suggesting a common pattern between some relapsing pneumothorax and emphysema. These findings could not be due to extracellular degradation during the processing of the samples since the results were not affected by the presence of protease inhibitors. These observations suggest that individuals with emphysema and pneumothrax have abnormalities in lung collagen structure and/or biosynthesis resulting in increased degradation of this macromolecule.

Adolescent↗
PubMed2000

Management of persistent or recurrent pneumothorax with a two millimeter mini-videothoracoscope.

The aim of this study was to assess whether a 2 mm mini-videothoracoscope could be used as a conventional videothoracoscope in the management of pneumothorax. Thirty patients of ages from 15 to 35 years with recurrent or persistent pneumothorax were involved in this study. The subjects consisted of 27 males and three females. The indications for videothoracoscopic surgery were ipsilateral recurrent pneumothorax in 12 (40%), persistent air leakage in 15 (50%), visible bullae in 2 (6%), and 1 bilateral pneumothorax (3%). The mean operation time was 42.9+/-12.9 min. The average number of uses for Endo-GIA was 1.9+/-1.3 times and chest tube indwelling time was 3.8+/-2.7 days. The average amount of keptoprofen (100 mg/2 mL/ampule) used on the first postoperative day was 1.2+/-1.1 ampules. No parenteral opioids were given to the patients for pain control after the procedures. After a follow up of 8 to 20 months, there was only one recurrence among the patients. In conclusion, a 2 mm videothoracoscope, in selective cases, can be successfully used as conventional videothoracoscope to manage persistent or recurrent pneumothorax with cosmetically excellent results.

Adolescent↗
PubMed1999

Five cases of asymptomatic spontaneous pneumothorax.

Asymptomatic spontaneous pneumothorax (ASPT) is an uncommon condition. Between January 1, 1989 and December 31, 1997, 269 patients were admitted to our department with spontaneous pneumothorax. Of the 269 patients, 5 had no symptoms at the time of discovery. Their ages ranged from 15 to 61 years (mean, 37.8 years), and all of them were male. Of the 5 patients with no complaints, 2 had bilateral metachronous pneumothoraces and 3 had hemilateral pneumothorax. All of these ASPTs were revealed by chest roentgenographs taken during medical examinations or follow-up studies relating to other diseases. The mean value of body mass index (BMI) was 19.96 +/- 1.4 (range 18.7 - 22.1). Two of the 5 patients underwent bilateral partial lung resection. Histopathological examination of the resected specimens showed elastofibrosis, scar formation, and an interruption of the elastic fiber of the pleura. In these 5 cases, clinical courses were uneventful, and relapse of the pneumothorax did not occur. Clinical physicians should be aware of the possibility of asymptomatic pneumothorax, as well as the optimal radiographic techniques for revealing small pneumothoraces.

Adolescent↗
PubMed1999

[Video-assisted thoracic surgery in the treatment of spontaneous pneumothorax].

BACKGROUND: The aim of this study was to evaluate the surgical indications and the results of a series of 107 patients treated by video-assisted thoracic surgery for spontaneous pneumothorax with a minimum follow-up of 12 months. METHODS: From January 1991 to December 1997, 107 patients (86 male and 21 female patients) mean age 28 years (range 14-78), underwent VATS for treatment of spontaneous pneumothorax. RESULTS: Seventy-five patients had primary spontaneous pneumothorax (PSP) and thirty-two patients had secondary spontaneous pneumothorax (SSP). Bullous area was not seen in 26 patients with PSP. Ninety-nine patients were treated with wedge stapled resection of the bullous area or of the apex (when no bullous area was seen) and some form of pleurodesis, whereas 8 patients with PSP were treated only with pleurodesis. Among these 8 patients, two presented recurrence. Two patients with PSP and 8 patients with SSP were treated by apical pleurectomy: no one developed recurrence. The other 97 were treated with electrocoagulation of the parietal pleura. Conversion to a thoracotomy was necessary in 4 patients (12.5%) because of massive pleural adhesions. There were no postoperative deaths. A complication developed in 3 patients (4%) with PSP and in 5 patients (17.8%) with SSP, whose procedure was ended by VATS. The duration of systematic postoperative drainage was 3.8 +/- 0.9 (range 3-15 days) for the group of patients with PSP and 6 +/- 2.1 (range 4-23 days) for the group of patients with SSP. The duration of the hospital stay was 5.6 +/- 1.4 (range 4-15) and 8.4 +/- 2.3 (range 6-18) in patients with PSP and SSP respectively. Follow-up analysis revealed 2 (2.66%) ipsilateral recurrent pneumothorax in 75 patients treated for PSP. Among 26 patients with SSP, whose procedure was completed by VATS, 2 recurrences (7.7%) were observed. CONCLUSIONS: Surgical treatment by VATS is a valid alternative to open thoracotomy in patients with PSP and will be the treatment of choice because, with increased experience of surgeons, it will yield the same results as standard operative therapy but with the advantages of the minimally invasive operation. The usefulness of VATS in patients with SSP remains to be defined.

Adolescent↗
PubMed1999

Video-assisted thoracoscopic surgery for spontaneous pneumothorax--a 7-year learning experience.

OBJECTIVES: To determine the effect of increasing experience of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax (SP) on clinical efficacy and surgical practice. PATIENTS AND METHODS: A prospective study of 180 consecutive operations in 173 patients who underwent VATS for SP by a single surgeon during a 7 year period. RESULTS: 118 patients, mean age 32.1 years (range 13-63 years), were treated for primary spontaneous pneumothorax (PSP) while 55 patients, mean age 65.9 years (range 28-92 years), were treated for secondary spontaneous pneumothorax (SSP). All patients had VAT parietal pleurectomy combined in 162 (90%) patients with stapled bullectomy. At a current median experience of 2.0 years (range 0.4-6.8 years), 12 (6.6%) patients required reoperation for treatment failures within 12 months of surgery--9 patients within 30 days of VATS and 3 for late recurrent pneumothorax. Two patients (both with SSP) died within 30 days of surgery. When compared with PSP, VATS in SSP is characterized by an elderly, male predominance, a longer postoperative stay, a higher mortality rate and a lower rate of late recurrence. With increasing experience of the technique, there has been a significant decrease in treatment failures. In the treatment of PSP, both operating time and postoperative stay have decreased significantly with experience whilst the use of staple cartridges per patient has increased significantly with experience in both PSP and SSP. CONCLUSION: There is a demonstrable 'learning curve' effect on the clinical efficacy and surgical practice of video assisted thoracoscopic surgery for spontaneous pneumothorax.

Adolescent↗
PubMed2001

[Simultaneous bilateral pneumothorax complicating Pneumocystis carinii pneumonia in a homeless man with AIDS].

Although pneumothorax is a well-known complication of AIDS related Pneumocystis carinii pneumonia, simultaneous bilateral pneumothorax has not been reported in Japan. A 54-year-old homeless man was admitted with emaciation and dyspnea. Chest X-ray showed diffuse ground glass opacity. Computed tomography of the chest demonstrated ground glass opacity and cyst-like lesions in both upper lobes of the lung. The patient was HIV positive. Grocott's stain of a bronchial lavage specimen demonstrated Pneumocystis carinii microorganisms. Intravenous trimethoprim-sulfamethoxazol and steroid administration was started. Seven days later, the patient developed tension pneumothorax of the right lung. Immediately after the thoracostomy, contralateral pneumothorax developed. Another chest tube was inserted. Subsequently, the patient died from bilateral pneumothorax. The endemicity of HIV infections among the homeless population is already a significant problem in Western countries. We should be aware that HIV infection may become a problem among the Japanese homeless as well.

AIDS-Related Opportunistic Infections↗
PubMed2001

[Catamenial pneumothorax--case report].

The objective of the work was to present summarized information on a very rare catamenial pneumothorax. Catamenial pneumothorax is one of the forms of spontaneous pneumothorax. An integral part of the paper is a review of the literature. The authors present the case-record of a young woman with catamenial pneumothorax who suffered in the course of almost 11 months five episodes of spontaneous pneumothorax.

Adult↗
PubMed2001

Systemic lupus erythematosus complicated by recurrent spontaneous pneumothorax--a case report.

Despite frequent pleuro-pulmonary involvement, spontaneous pneumothorax is rare in patients with systemic lupus erythematosus (SLE). Here, we report a 17-year-old female patient with SLE, complicated by multiple organs involvement. She initially presented with interstitial pneumonitis and pulmonary hemorrhage, followed by spontaneous pneumothorax and CNS involvement. The patient was treated with immunosuppressive agents, including steroid and cyclophosphamide pulse therapies. Spontaneous pneumothorax happened to her once again at a different location during treatment. After aggressive therapy, the disease activity of SLE gradually diminished, and pneumothorax had not recurred during the further follow-up. Therefore, the pneumothorax may occur in SLE patients with high disease activity.

Adolescent↗
PubMed2002

Stapler blebectomy and pleural abrasion by video-assisted thoracoscopy for spontaneous pneumothorax.

BACKGROUND: This study aims to evaluate the efficacy of video-assisted thoracoscopic surgery (VATS) pleurodesis in the treatment of spontaneous pneumothorax with particular reference to the postoperative period and the rate of recurrence after pleural abrasion. METHODS: One hundred and thirty-three patients who underwent VATS management of primary spontaneous pneumothorax were retrospectively reviewed. They were 113 males and 20 females with median age of 26 (range 12-37). Among these patients, 114 underwent VATS for recurrent pneumothorax and 19 for persistent air-leakage at the first episode. During surgical procedure, in 78% of cases, parenchymal blebs were identified and resected by stapler resection. All patients were submitted to pleural abrasion. RESULTS: No intra- or postoperative deaths occurred. Postoperative complications were persistent air-leak for more than 7 days in 6 patients (4.3%) bleeding in 3 patients (2.2%). The median chest-tube duration and hospital stay were 2 (range 2-11) and 3 (range 3-12) days, respectively. Median follow-up period of 53 (range 6-96) months was complete for all patients. Five episodes of recurrent pneumothorax were encountered and 4 of them, because of major entity, required re-do VATS with stapler resection and pleural abrasion: their postoperative period and residual follow-up was uneventful. CONCLUSIONS: The goal in the surgical management of spontaneous pneumothorax, which often affects "apparently healthy" young patients, is to secure the less recurrence rate with no mortality and quite null morbidity and functional impairment. VATS stapler resection and pleural abrasion is a safe procedure allowing a good management of the disease with low complication rate, short chest-drain duration, hospital stay and recurrence rate quite similar to those referred for other procedures such as pleural poudrage or limited pleurectomy.

Adolescent↗
PubMed2002

Risk of renal and colonic neoplasms and spontaneous pneumothorax in the Birt-Hogg-Dubé syndrome.

The Birt-Hogg-Dubé syndrome, a genodermatosis characterized by benign tumors of the hair follicle, has been associated with renal and colonic neoplasms and spontaneous pneumothorax, but the risk of developing these disorders is unknown. We identified risk factors for renal tumors and spontaneous pneumothorax in 98 patients affected with the Birt-Hogg-Dubé syndrome, in 13 Birt-Hogg-Dubé haplotype carriers, and in 112 unaffected family members. Development of renal tumors was strongly associated with the Birt-Hogg-Dubé syndrome and age. The odds ratio for renal tumor in BHD-affected family members adjusted for age was 6.9 (95% confidence interval, 1.5-31.6) and approximately 9.0 for the other risk factors considered. Chromophobe renal carcinoma, an uncommon type of renal cancer, was the predominant type of renal cancer found. Spontaneous pneumothorax was also strongly associated with the Birt-Hogg-Dubé syndrome and age. The odds ratio for pneumothorax in BHD-affected individuals, adjusted for age, was 50.3 (95% confidence interval, 6.4-392), and about 32 times higher adjusting for the other risk variables. Colon cancer and colon polyps were not related to the Birt-Hogg-Dubé syndrome. The Birt-Hogg-Dubé syndrome confers an increased risk for the development of renal tumors and spontaneous pneumothorax. We found no increase in risk for the development of colon polyps or colon carcinomas.

Adult↗