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Igai H, Sawabata N, Obuchi T, Matsutani N, Tsuboshima K, Okamoto S, Hayashi A. Current situation of management of spontaneous pneumothorax in Japan: A cross-sectional cohort study. Respir Investig 2024; 62:328-333. [PMID: 38401246 DOI: 10.1016/j.resinv.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/03/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Limited epidemiological information is available on spontaneous pneumothorax. To address this gap, the Japan Society for Pneumothorax and Cystic Lung Disease (JSPCLD) conducted a nationwide retrospective survey to investigate the current epidemiology of spontaneous pneumothorax in Japan. METHODS In this study, we conducted a retrospective cross-sectional cohort study to demonstrate the clinical features of spontaneous pneumothorax in one year from April 2019 to March 2020, compare patient characteristics and treatment outcomes between primary (PSP) and secondary spontaneous pneumothorax (SSP), and investigate the risk factors associated with in-hospital mortality among patients with SSP. RESULTS A total of 1784 patients from 28 institutions were enrolled in the study, with PSP observed in 956 cases (53.6%) and SSP in 817 cases (45.8%). The age distribution showed a biphasic peak caused by the different peaks between PSP and SSP. In-hospital mortality occurred in 42 cases (2.4%) among all patients, with 0 cases (0%) in PSP and 42 cases (5.1%) in SSP. Multivariable analyses revealed that interstitial pneumonia as an underlying disease (odds ratio: 2.4700, 95% confidence interval: 1.1100 to 5.4800, p = 0.0269), performance status≧3 (odds ratio: 7.3900, 95% confidence interval: 3.1900 to 17.2000, p < 0.0001), and lower value of serum albumin on admission (odds ratio: 0.4060, 95% confidence interval: 0.2140 to 0.7690, p = 0.0057) were significantly associated with in-hospital mortality among patients with SSP. CONCLUSIONS SSP patients with poor baseline conditions are at a higher risk for in-hospital mortality. It is crucial to provide close and meticulous management for SSP patients with compromised conditions.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura, Maebashi, Gunma, 371-0811, Japan.
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardio-Vascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8511, Japan
| | - Toshiro Obuchi
- Department of Thoracic Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Noriyuki Matsutani
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, 5-1-1 Futago, Takatsu, Kawasaki, Kanagawa, 213-8507, Japan
| | - Kenji Tsuboshima
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, 4-8-1 Seta, Setagaya, Tokyo, 158-0095, Japan
| | - Shouichi Okamoto
- Department of Respiratory Medicine, Saiseikai Ibaraki Hospital, 2-1-45 Mitsukeyama, Ibaraki, Osaka, 567-0035, Japan
| | - Akihiro Hayashi
- Department of General Thoracic Surgery, Shin Koga Hospital, 120 Tenjin, Kurume, Fukuoka, Japan
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Agossou M, Sanchez BG, Alauzen PH, Olivier M, Cécilia-Joseph E, Chevallier L, Jean-Laurent M, Aline-Fardin A, Dramé M, Venissac N. Thoracic Endometriosis Syndrome (TES) in Martinique, a French West Indies Island. J Clin Med 2023; 12:5578. [PMID: 37685644 PMCID: PMC10488738 DOI: 10.3390/jcm12175578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Endometriosis is a female disease that affects 5-10% of women of childbearing age, with predominantly pelvic manifestations. It is currently declared as a public health priority in France. Thoracic endometriosis syndrome (TES) is the most common extra-pelvic manifestation. OBJECTIVE The objective of this study was to describe the epidemiological and clinical characteristics, and outcomes of patients with TES in Martinique. PATIENTS AND METHODS We performed a descriptive, retrospective study including all patients managed at the University Hospital of Martinique for TES between 1 January 2004 and 31 December 2020. RESULTS During the study period, we identified 479 cases of pneumothorax, of which 212 were women (44%). Sixty-three patients (30% of all female pneumothorax) were catamenial pneumothorax (CP) including 49 pneumothoraxes alone (78% of catamenial pneumothorax) and 14 hemopneumothorax (22% of catamenial pneumothorax). There were 71 cases of TES, including 49 pneumothoraxes (69%), 14 hemopneumothoraxes (20%) and 8 hemothorax (11%). The annual incidence of TES was 1.1 cases/100,000 inhabitants. The prevalence of TES was 1.2/1000 women aged from 15 to 45 years and the annual incidence of TES for this group was 6.9/100,000. The annual incidence of CP was 1 case/100,000 inhabitants. The average age at diagnosis was 36 ± 6 years. Eight patients (11%) had no prior diagnosis of pelvic endometriosis (PE). The mean age at pelvic endometriosis diagnosis was 29 ± 6 years. The mean time from symptom onset to diagnosis was 24 ± 50 weeks, and 53 ± 123 days from diagnosis to surgery. Thirty-two patients (47%) had prior abdominopelvic surgery. Seventeen patients (24%) presented other extra-pelvic localizations. When it came to management, 69/71 patients (97%) underwent surgery. Diaphragmatic nodules or perforations were found in 68/69 patients (98.5%). Histological confirmation was obtained in 55/65 patients who underwent resection (84.6%). Forty-four patients (62%) experienced recurrence. The mean time from the initial treatment to recurrence was 20 ± 33 months. The recurrence rate was 16/19 (84.2%) in patients who received medical therapy only, 11/17 (64.7%) in patients treated by surgery alone, and 17/31 (51.8%) in patients treated with surgery and medical therapy (p = 0.03). CONCLUSIONS We observed a very high incidence of TES in Martinique. The factors associated with this high incidence in this specific geographical area remain to be elucidated. The frequency of recurrence was lower in patients who received both hormone therapy and surgery.
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Affiliation(s)
- Moustapha Agossou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Bruno-Gilbert Sanchez
- Department of Thoracic and Cardiovascular Surgery, CHU of Martinique, 97261 Fort-de-France, France
| | - Paul-Henri Alauzen
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Maud Olivier
- Department of Thoracic and Cardiovascular Surgery, CHU of Martinique, 97261 Fort-de-France, France
| | - Elsa Cécilia-Joseph
- Department of Medical Information, CHU of Martinique, 97261 Fort-de-France, France;
| | - Ludivine Chevallier
- Department of Gynecology and Obstetrics, CHU of Martinique, 97261 Fort-de-France, France
| | - Mehdi Jean-Laurent
- Department of Gynecology and Obstetrics, CHU of Martinique, 97261 Fort-de-France, France
| | - Aude Aline-Fardin
- Department of Pathology, CHU of Martinique, 97261 Fort-de-France, France
| | - Moustapha Dramé
- Department of Clinical Research and Innovation, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, CHRU of Lille, 59000 Lille, France;
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Suter A, Müller ME, Daccord C, Taffé P, Lazor R. Probability of sporadic lymphangioleiomyomatosis in women presenting with spontaneous pneumothorax. Orphanet J Rare Dis 2023; 18:180. [PMID: 37415209 DOI: 10.1186/s13023-023-02784-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Sporadic lymphangioleiomyomatosis (S-LAM) is a rare low-grade neoplasm of young women characterized by multiple pulmonary cysts leading to progressive dyspnea and recurrent spontaneous pneumothorax (SP). The diagnosis of S-LAM may be delayed by several years. To reduce this delay, chest computed tomography (CT) screening has been proposed to uncover cystic lung disease in women presenting with SP. However, the probability to discover S-LAM in this population has not been determined precisely. The aim of this study was to calculate the probability of finding S-LAM in women presenting with (a) SP, and (b) apparent primary SP (PSP) as first manifestation of S-LAM. METHODS Calculations were made by applying the Bayes theorem to published epidemiological data on S-LAM, SP and PSP. Each term of the Bayes equation was determined by meta-analysis, and included: (1) the prevalence of S-LAM in the general female population, (2) the incidence rate of SP and PSP in the general female population, and (3) the incidence rate of SP and apparent PSP in women with S-LAM. RESULTS The prevalence of S-LAM in the general female population was 3.03 per million (95% confidence interval 2.48, 3.62). The incidence rate of SP in the general female population was 9.54 (8.15, 11.17) per 100,000 person-years (p-y). The incidence rate of SP in women with S-LAM was 0.13 (0.08, 0.20). By combining these data in the Bayes theorem, the probability of finding S-LAM in women presenting with SP was 0.0036 (0.0025, 0.0051). For PSP, the incidence rate in the general female population was 2.70 (1.95, 3.74) per 100,000 p-y. The incidence rate of apparent PSP in women with S-LAM was 0.041 (0.030, 0.055). With the Bayes theorem, the probability of finding S-LAM in women presenting with apparent PSP as first disease manifestation was 0.0030 (0.0020, 0.0046). The number of CT scans to perform in women to find one case of S-LAM was 279 for SP and 331 for PSP. CONCLUSION The probability of discovering S-LAM at chest CT in women presenting with apparent PSP as first disease manifestation was low (0.3%). Recommending chest CT screening in this population should be reconsidered.
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Affiliation(s)
- Audrey Suter
- Medical School, University of Lausanne, Lausanne, Switzerland
| | - Marie-Eve Müller
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Cécile Daccord
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Taffé
- Division of Biostatistics, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Romain Lazor
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
- Service de Pneumologie, Centre Hospitalier Universitaire Vaudois, BU44.07.2137, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Automated Radiology Alert System for Pneumothorax Detection on Chest Radiographs Improves Efficiency and Diagnostic Performance. Diagnostics (Basel) 2021; 11:diagnostics11071182. [PMID: 34209844 PMCID: PMC8307391 DOI: 10.3390/diagnostics11071182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/21/2021] [Accepted: 06/26/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to set up an Automated Radiology Alert System (ARAS) for the detection of pneumothorax in chest radiographs by a deep learning model, and to compare its efficiency and diagnostic performance with the existing Manual Radiology Alert System (MRAS) at the tertiary medical center. This study retrospectively collected 1235 chest radiographs with pneumothorax labeling from 2013 to 2019, and 337 chest radiographs with negative findings in 2019 were separated into training and validation datasets for the deep learning model of ARAS. The efficiency before and after using the model was compared in terms of alert time and report time. During parallel running of the two systems from September to October 2020, chest radiographs prospectively acquired in the emergency department with age more than 6 years served as the testing dataset for comparison of diagnostic performance. The efficiency was improved after using the model, with mean alert time improving from 8.45 min to 0.69 min and the mean report time from 2.81 days to 1.59 days. The comparison of the diagnostic performance of both systems using 3739 chest radiographs acquired during parallel running showed that the ARAS was better than the MRAS as assessed in terms of sensitivity (recall), area under receiver operating characteristic curve, and F1 score (0.837 vs. 0.256, 0.914 vs. 0.628, and 0.754 vs. 0.407, respectively), but worse in terms of positive predictive value (PPV) (precision) (0.686 vs. 1.000). This study had successfully designed a deep learning model for pneumothorax detection on chest radiographs and set up an ARAS with improved efficiency and overall diagnostic performance.
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Mecha E, Makunja R, Maoga JB, Mwaura AN, Riaz MA, Omwandho COA, Meinhold-Heerlein I, Konrad L. The Importance of Stromal Endometriosis in Thoracic Endometriosis. Cells 2021; 10:180. [PMID: 33477657 PMCID: PMC7831500 DOI: 10.3390/cells10010180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Thoracic endometriosis (TE) is a rare type of endometriosis, where endometrial tissue is found in or around the lungs and is frequent among extra-pelvic endometriosis patients. Catamenial pneumothorax (CP) is the most common form of TE and is characterized by recurrent lung collapses around menstruation. In addition to histology, immunohistochemical evaluation of endometrial implants is used more frequently. In this review, we compared immunohistochemical (CPE) with histological (CPH) characterizations of TE/CP and reevaluated arguments in favor of the implantation theory of Sampson. A summary since the first immunohistochemical description in 1998 until 2019 is provided. The emphasis was on classification of endometrial implants into glands, stroma, and both together. The most remarkable finding is the very high percentage of stromal endometriosis of 52.7% (CPE) compared to 10.2% (CPH). Chest pain, dyspnea, right-sided preference, and diaphragmatic endometrial implants showed the highest percentages in both groups. No significant association was found between the recurrence rate and the various appearances of endometriosis. Sometimes in CPE (6.8%) and CPH (30.6%) no endometrial implants were identified underlining the importance of sensitive detection of endometriosis during and after surgery. We suggest that immunohistochemical evaluation should become mandatory and will improve diagnosis and classification of the disease.
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Affiliation(s)
- Ezekiel Mecha
- Department of Biochemistry, University of Nairobi, Nairobi 00100, Kenya; (E.M.); (R.M.); (C.O.A.O.)
| | - Roselydiah Makunja
- Department of Biochemistry, University of Nairobi, Nairobi 00100, Kenya; (E.M.); (R.M.); (C.O.A.O.)
| | - Jane B. Maoga
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Agnes N. Mwaura
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Muhammad A. Riaz
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Charles O. A. Omwandho
- Department of Biochemistry, University of Nairobi, Nairobi 00100, Kenya; (E.M.); (R.M.); (C.O.A.O.)
- Deputy Vice Chancellor, Kirinyaga University, Kerugoya 10300, Kenya
| | - Ivo Meinhold-Heerlein
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Lutz Konrad
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
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Porcel JM. Phenotyping primary spontaneous pneumothorax. Eur Respir J 2018; 52:52/3/1801455. [DOI: 10.1183/13993003.01455-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 11/05/2022]
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Fukuda S, Hirata T, Neriishi K, Nakazawa A, Takamura M, Izumi G, Harada M, Hirota Y, Koga K, Wada-Hiraike O, Fujii T, Osuga Y. Thoracic endometriosis syndrome: Comparison between catamenial pneumothorax or endometriosis-related pneumothorax and catamenial hemoptysis. Eur J Obstet Gynecol Reprod Biol 2018; 225:118-123. [DOI: 10.1016/j.ejogrb.2018.04.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022]
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