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PubMed1975

[Spontaneous pneumothorax as an urgent internal problem].

92 cases of pneumothorax of the clinic for lung diseases Lostau and 35 cases from 9 county hospitals of the district Magdeburg were analysed. In the two groups a vast correspondence of the following data was found: average age of the patients (40.0 or 46.2 years), duration of stay in the ward (25.3/23.5 days), as urgent cases 11 or 8 patients, respectively, were hospitalised. Only in 5% of all cases a treatment on the conditions of an intensive therapy unit was necessary. Apart from the clinical and radiological basal diagnostics a measurement of the interpleural pressure by means of the pneumothorax apparatus is demanded. These values form the basis for a differentiated therapy of the pneumothorax: conservative attitude with sedation of cough of the patient in minimal pneumothoraces; withdrawal by means of the pneumothorax apparatus in more severe lung collapse, appearances of tension, lacking tendency to re-expansion of the lung after 3 days' conservative-medicamentous therapy; rubber-tube drainage when the withdrawal by means of the pneumothorax apparatus was ineffective for three times; surgical therapy when a 7 to 10 days' rubber-tube drainage was without success.

Cough↗
PubMed2002

[Thoracoscopy in management of spontaneous pneumothorax].

OBJECTIVES: To estimate possibilities of video-assisted thoracoscopy in surgical treatment of spontaneous pneumothorax. PATIENTS AND METHODS: A retrospective analysis of 209 clinical cases of spontaneous pneumothorax, which underwent urgent thoracoscopy, is presented. RESULTS: Eighty eight patients underwent coagulation of small bullos, twenty six - parietal pleura electroscarification, 12 - mechanical pleurodesis. Four patients underwent thoracoscopic parietal pleurectomy and wedge resection. The postoperative drainage time for spontaneous pneumothorax was 3-4 days. Hospital stay - 7 days. CONCLUSIONS: Modern video-assisted thoracoscopy diagnostics and surgical treatment are inseparable parts of management of spontaneous pneumothorax. Video-assisted thoracoscopy is a safe, simple, less traumatic and effective diagnostic and treatment procedure of patients with spontaneous pneumothorax.

Data Interpretation, Statistical↗
PubMed2003

Patient positioning after fine needle lung biopsy-effect on pneumothorax rate.

PURPOSE: To evaluate the efficacy of precautionary positioning in preventing the development of pneumothorax and reducing the rate of chest tube placement after fluoroscopy-guided transthoracic needle biopsy (TTNB). MATERIAL AND METHODS: One hundred and seven patients who underwent TTNB were randomly assigned to one of two postbiopsy treatment groups: patients were placed with (precautionary positioning group) and without (non-precautionary positioning group) recumbent puncture site either down (n = 59 and 48, respectively) for at least 30 min. RESULTS: The overall pneumothorax rate was 8.4% (n = 9). Four of the 9 patients needed chest tube insertion. Pneumothorax rate was 8.33% (4/48) and 8.47% (5/59) in the precaution and non-precaution groups, respectively. Rate of chest tube insertion was 6.25% (n = 3) and 1.85% (n = 1) in the precaution and non-precaution groups, respectively. There was no statistically significant difference in the rate of pneumothorax and chest tube insertion between the two groups. CONCLUSION: Precautionary positioning after TTNB does not reduce the incidence of postbiopsy pneumothorax and rate of chest tube insertion.

Adolescent↗
PubMed1992

Familial spontaneous pneumothorax-report of seven cases in two families.

Spontaneous pneumothorax usually occurs sporadically in healthy young adults, who tend to be tall and thin. The usual cause is rupture of small subpleural bullae found in the apex of the upper lobe. Familial spontaneous pneumothorax is a rare condition. With a review of the English literature from 1921 to 1991, only 59 families with 135 cases have been reported. A genetic background has been suggested, but the actual mode of inheritance is still unknown. Relationships between the HLA haplotype A2B40, the alpha1-antitrypsin phenotype and the occurrence of spontaneous pneumothorax have been proposed, but are still controversial. We present 7 patients in 2 families with 13 episodes of spontaneous pneumothorax. Neither congenital defect, alpha1-antitrypsin deficiency nor the described A2B40 HLA haplotype could be found in our patients. We propose that there are no such factors existed in these patients. Further study is required to determine if any genetic marker is linked to familial spontaneous pneumothorax.

Adult↗
PubMed1992

The effect of an increased index of suspicion on the diagnosis of pneumothorax in the critically ill.

The impact of specialized training in critical care producing a heightened index of suspicion for the diagnosis of pneumothorax in intensive care unit (ICU) patients was prospectively examined. During a 12-month period, 28 ICU patients were found to have a pneumothorax. Nine of the 28 patients with pneumothorax (32%) were initially misdiagnosed by physicians who neither received specialized training in critical care nor routinely cared for critically ill patients. Six of these nine initially misdiagnosed pneumothoraces (67%) were correctly diagnosed by a physician with specialized training and experience in critical care medicine prior to any clinical deterioration in the condition of the patients. This study suggests that specialized training and experience in the management of critically ill patients can significantly improve upon the diagnosis of pneumothorax in these patients and limit the occurrence of tension pneumothorax in the same patient population.

Critical Care↗
PubMed2003

[A case of catamenial pneumothorax due to diaphragmatic endometriosis confirmed by video-assisted thoracoscopic surgery].

We describe a case of catamenial pneumothorax caused by diaphragmatic endometriosis and histologically confirmed thoracoscopically. The patient was a 33-year-old woman who had had recurrent right chest pain starting on the day preceding each menstruation since she was 26 years of age. In June 2001, at the age of 33, she felt right chest pain and developed dyspnea, and so came to our hospital. Chest radiography showed bilateral pneumothorax. Timely thoracoscopy revealed the characteristic appearances of catamenial pneumothorax such as a blueberry spot on the central tendon of the right diaphragm and a purplish-red locus in the right apex. Histopathological examination further confirmed the presence of endometrial tissue on the diaphragm as well as in the lesion of the right lung. Despite resection of the endometrial tissues from the right hemidiaphragm and the lung under thoracoscopy, right pneumothorax recurred after one month. Since then, the patient's condition has been well controlled by therapy with gonadotropin releasing hormone, with no recurrence of catamenial pneumothorax.

Adult↗
PubMed2004

[Pneumothorax].

Most of the patients with spontaneous pneumothorax are young male adults without significant pulmonary disease and the prognosis in these patients is usually very good. But in a few cases when tension pneumothorax develops, immediate diagnosis and chest tube drainage is required to avoid life-threatening emergency. Needless to say mechanical ventilation with tracheal intubation is contraindication even if the patient has severe respiratory distress or hypoxia. Re-expansion pulmonary edema is another severe complication. This occurs to a long-term (over 1 week) complete collapse lung when it is rapidly re-expanded with high negative pressure. To treat such patient it is necessary to decompress the lung slowly using lower negative pressure or water seal suction. When persistent bleeding of hemothorax is present, it is important to decide to perform open thoracotomy or video-assisted thoracoscopic surgery to avoid blood transfusion. The diagnosis of pneumothorax is simply done by chest X-ray film. When the pneumothorax is suspected, chest X-ray examination has to be done first. A scheduled operation to prevent recurrence of pneumothorax has to be performed under relative indication in consideration of both the medical factor and the social factor of the patient.

Adult↗
PubMedDate not supplied

Role of simple needle aspiration in the management of pneumothorax.

OBJECTIVES: To determine the role of simple needle aspiration in the management of pneumothorax. DESIGN: All patients presenting with a pneumothorax requiring intervention were included in this prospective study. Patients who were very sick or had tension pneumothorax were treated with direct intercostal chest tube drainage (ICTD) and others were subjected to simple aspiration. The procedure was deemed successful, if after aspiration the lung expanded completely or symptoms were relieved with residual pneumothorax of less than 15% of hemithorax. In case of failed aspiration ICTD was carried out. RESULTS: Fifty-seven patients with 59 pneumothoraces were included in the study. Of these, 24 were treated with direct ICTD; 35 (12 spontaneous, 11 secondary and 12 iatrogenic pneumothoraces) were subjected to simple aspiration. Ten (83.3%) of the primary, 1 (9.6%) of the secondary and 11 (91.7%) of the iatrogenic pneumothoraces responded to simple aspiration. There were no significant complications. The pain perceived and the duration of hospital stay was significantly lesser in the simple aspiration group. CONCLUSIONS: Simple aspiration should be the initial modality of treatment for primary spontaneous and iatrogenic pneumothoraces. For secondary spontaneous pneumothorax and in conditions where pleurodesis is indicated, ICTD remains the treatment of choice.

Adolescent↗
PubMedDate not supplied

Etiology, presentation and management outcome of pneumothorax.

BACKGROUND: This study was carried to determine etiology, presentation, complications and management outcomes of pneumothorax in patients presenting at two hospitals in NWFP province of Pakistan.. METHODS: Pneumothorax patients reporting at the chest unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, and Pulmonology unit of Ayub Teaching Hospital, Abbottabad from 1999 to 2002 were included in the study. Patients of all ages were included. They were admitted and followed up to the full recovery/late complications. RESULTS: A total of 146 pneumothorax patients reported during this period. Majority of the patients were diagnosed to have pneumothorax due to pulmonary tuberculosis making about 36.30% of the total cases. Second most common cause was primary spontaneous pneumotihorax (19.86%). Bacterial infections were also sizeable at 16.43%. Other causes included COPD, Asthma, latrogenic, Interstitial lung disease, tuberous sclerosis and bronchiectasis. CONCLUSION: It was concluded from this study that pulmonary tuberculosis is the commonest cause of pneumothorax in our setup.

Adolescent↗
PubMed2005

The increase of oxygen requirement as index to identify the infants at high risk of pneumothorax during nasal continuous positive airway pressure.

AIM: The aim of this study was to evaluate the inspiration fraction of oxygen (FiO2) trend as an indicator of timing to suspend nasal continuous positive airway pressure (N-CPAP) and shift the babies to mechanical ventilation, in order to reduce the incidence of pneumothorax, comparing a similar population admitted in our division during the previous year. METHODS: Seventy-five newborns (mean gestational age 33.5 weeks, mean birth weight 2,072 g) admitted during 2003 in our Neonatal Intensive Care Unit, treated with Infant Flow System Nasal-CPAP, were included. Patients with more than 40% increase of the starting FiO2 in the first 24 h of treatment, were intubated and shift on mechanical ventilation. Seventy-seven infants, admitted during the previous year, with similar characteristics (mean gestational age 33.7 weeks, mean birth weight 2,047 g) were considered as control. RESULTS: Fifty-six neonates improved, 19 worsened and required mechanical ventilation. One of these developed pneumothorax (1.3%). Of the 77 infants admitted during the previous year, 26 worsened and were mechanically ventilated, and 8 developed pneumothorax (10.3%). The difference of incidence of pneumothorax was significant (P =0.0337). CONCLUSIONS: An increase of FiO2 more than 40% of the initial value during the first 24 h of N-CPAP may be considered a useful marker to identify infants at high risk of pneumothorax.

Age Factors↗
PubMed2006

Pneumothorax influenced 3D lung deformations.

In this paper we propose a method to simulate morphological changes caused by both closed and tension pneumothorax. We consider a clinical parameter, the pneumothorax-index (i.e., the degree of lung collapse), as the input to the simulation. Specifically, such an index constitutes a key parameter to the computation of the changes in size and shape of the affected lung. Once the index is obtained, the increase in ventilation rate and the change in the pressure-volume relationship of the affected lung are then computed. For tension pneumothorax, the air continuously flows into the pleural cavity and thus every exhalation is followed by the changes seen for a closed pneumothorax, until the affected lung collapses. The subsequent closure of pulmonary veins and resulting hyper expansion of the apposing lung is also presented. Results show a real-time visualization of closed and tension pneumothorax using a high-resolution 3D model obtained from a normal human subject.

Algorithms↗
PubMedDate not supplied

Aetiology and clinical profile of spontaneous pneumothorax in adults.

BACKGROUND: Limited information is available on epidemiology of spontaneous pneumothorax (SP) from India. The present study was aimed at studying aetiology and clinical profile of patients with SP. METHODS: All patients admitted at a tertiary care hospital with the diagnosis of SP between January 2001 and March 2002 were prospectively studied. Detailed demographic and clinical data were recorded. Patients were divided into two groups-primary spontaneous pneumothorax (PSP), if no underlying aetiology for pneumothorax was found, and secondary spontaneous pneumothorax (SSP), when an underlying respiratory disorder could be identified. The clinical features were compared between the two groups. RESULTS: Sixty patients (12 with PSP and 48 with SSP) were included in the study. Annual incidence of SP was calculated as 99.9 per 100,000 hospital admissions. Annual incidence figures for PSP and SSP were 20.0 and 80.0 per 100,000 hospital admissions respectively. Age distribution showed a biphasic pattern and the overall male to female ratio was 5 : 1. The most common cause of SSP was found to be pulmonary tuberculosis (41.7%). CONCLUSIONS: Pneumothorax is more common among men. In India, SSP is far more common than PSP, and the predominant underlying cause is pulmonary tuberculosis.

Adolescent↗
PubMed2006

Recurrent pneumothorax in pregnancy: what should we do after placing an intercostal drain.

Recurrent pneumothorax is rare during pregnancy. We describe a Chinese woman, with a history of spontaneous pneumothorax managed with an intercostal drain, who developed a recurrent pneumothorax during her 32nd week of pregnancy. There is no consensus on management in this situation. We review the literature and discuss different management approaches. Thirty-six cases of antepartum pneumothorax have been reported in 31 case reports. An intercostal drain only (n=11) or surgeries (thoracotomy, n=9; or video-assisted thoracoscopy, n=2) were common treatment options with no surgical complications reported. Twenty-two (61%) patients progressed to a normal vaginal delivery, while the rest required forceps delivery (22%) or Caesarean section (14%). No single treatment option outweighed the others. There were no maternal or foetal complications reported in those who underwent antepartum surgical intervention. Surgical management of recurrent pneumothorax during pregnancy is well tolerated.

Adult↗
PubMed1991

[Surgical pleurodesis in spontaneous pneumothorax].

Over a five year period 41 operations for spontaneous pneumothorax were performed on 38 patients. In all cases a transaxillary thoracotomy was performed in the third, or in some cases the fourth, intercostal space. Bullae were resected and operative pleurodesis carried out by rubbing the parietal pleura with a dry sponge. The indications for operation were: 1) More than one episode of pneumothorax on the relevant side. 2) The first incidence of pneumothorax if the patient had pneumothorax on the contralateral side before. 3) Continuous leakage of air after a week of drainage. One patient had to be reoperated for recurrence of pneumothorax, and one was reoperated due to formation of a large postoperative haematoma. One patient developed paresis of the serratus anterior muscle due to lesion of the long thoracic nerve.

Adolescent↗
PubMed1991

[A case of pneumothorax which was operated with the axillary longitudinal small incision].

A pneumothorax usually occurs in young men. From the cosmetic point of view, the size of the skin incision should be considered to be minimal if surgery is applied for young pneumothorax patients. We reported a case of pneumothorax which was operated with a small longitudinal axillary skin incision, the size of which was 3.5 cm long. The patient was a 18-year-old high school student. He was admitted to our hospital with the diagnosis of spontaneous pneumothorax. His chest X-ray showed a moderate collapse of his left lung and bullae in his left apex. Tube drainage was performed and the collapsed lung re-expanded completely. Chest CT scan demonstrated that he had bullae in the apex of his left lung. No other lesions were found in the other part of both lungs. Surgery was indicated socially. Bullectomy was successfully performed with a small (3.5 cm) longitudinal axillary skin incision. We recommend this skin incision for young patients with pneumothorax if the chest CT scan confirms that the bullae or blebs are localized to the apex of superior segment of the lower lobe.

Adolescent↗
PubMedDate not supplied

Pneumothorax in the newborn with respiratory difficulties.

Pneumothorax develops when extraalveolar air ruptures into the pleural space with partial or complete collapse of the affected lung. Pneumothorax can occur at any time during the newborn period, but it usually appears as a complication of some other respiratory problem. The purpose of this study is to known the incidence of pneumothorax due to the respiratory difficulties. The materials were taken from 2368 neonates suffering from respiratory difficulties, out of 7445 neonates born in Cipto Mangunkusumo General Hospital in 1987 and 1988. All these babies were put on radiological examination. Among those 10 babies were diagnosed as pneumothorax. It occurred as a complication of severe asphyxia (due to over vigorous initial resuscitation), and its incidence was 0.09%, that of respiratory distress syndrome (2.13%), bronchopneumonia (6.25%) and aspiration pneumonia (2.8%). The overall incidence of pneumothorax in the newborn with respiratory difficulties was 0.42% and the mortality 20%.

Asphyxia↗
PubMed1990

Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a Department of Veterans Affairs cooperative study.

This prospective, multicenter, randomized, "unblinded," controlled clinical trial was designed to determine if the intrapleural instillation of 1500 mg of tetracycline hydrochloride would be effective in diminishing the ipsilateral rate of recurrence for spontaneous pneumothorax. During the 4-year enrollment period, 113 patients were assigned to the tetracycline group; 116 patients were assigned to the control group. During the 5-year study period, the recurrence rate in the tetracycline group (25%) was significantly less than that in the control group (41%). Use of tetracycline seemed to reduce the recurrence rates for patients with either primary or secondary spontaneous pneumothorax and for patients with either an initial or a recurrent pneumothorax. We conclude that the intrapleural administration of tetracycline in patients with spontaneous pneumothorax significantly reduces the rate of ipsilateral recurrence but is associated with intense chest pain. Intrapleural tetracycline therapy is indicated for patients with a spontaneous pneumothorax who are hospitalized and are treated with tube thoracostomy.

Adult↗
PubMed1990

Spontaneous pneumothorax in acute paraquat toxicity.

Spontaneous pneumothorax as a presenting feature of acute paraquat toxicity is as yet unreported. A review of the literature has shown that there has been one reported case of spontaneous pneumothorax occurring after paraquat toxicity. In this case, the pneumothorax occurred seven years after ingestion of paraquat (Nakaoka et al, 1987). The two cases of paraquat ingestion presented in this report are associated with spontaneous pneumothorax in the acute phase. A proposed mechanism for the development of the pneumothorax is discussed.

Adolescent↗