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Cheng HS, Wong C, Chiu PH, Tong CW, Miu PLF. Management of spontaneous pneumothorax: a mini-review on its latest evidence. J Thorac Dis 2024; 16:4756-4763. [PMID: 39144356 PMCID: PMC11320271 DOI: 10.21037/jtd-24-415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/14/2024] [Indexed: 08/16/2024]
Abstract
Spontaneous pneumothorax usually presents as a medical emergency and requires prompt attention and treatment. In patients with underlying lung diseases, it is often associated with prolonged hospitalization, persistent air leak and also a high rate of recurrence. It brings considerable clinical burden to patients and therefore advancement of spontaneous pneumothorax management is eagerly anticipated. In recent years, conservative approach with avoidance of invasive treatment has risen to be a main consideration for primary spontaneous pneumothorax (PSP) patients who are clinically stable with minimal symptoms. The body of evidence in secondary spontaneous pneumothorax (SSP) group is less robust compared with that in PSP group. Non-surgical treatment in SSP is becoming more common due to concerns about morbidity and mortality after surgical pleurodesis as patients are usually older with more underlying medical diseases. Until last year, there have been no updates on the international recommendation of pneumothorax management since the British Thoracic Society (BTS) guideline published in 2010. The latest 2023 BTS guideline on pleural diseases provides us a good opportunity to review the latest development and literature of the care for patients with spontaneous pneumothorax. This article will explore the goals of pneumothorax treatment including air evacuation, cessation of persistent air leak and prevention of recurrence.
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Affiliation(s)
- Hei-Shun Cheng
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Charles Wong
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Pui-Hing Chiu
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Chun-Wai Tong
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Pui-Ling Flora Miu
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
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Shah S, Mandal P, Chamlagain R, Yadav R, Pande Y, Sah SK, Sharma Paudel B, Gyawali M. Bronchopleural fistula and bilateral pneumothorax in a patient with COVID-19. Clin Case Rep 2021; 9:e05149. [PMID: 34853692 PMCID: PMC8614088 DOI: 10.1002/ccr3.5149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/08/2022] Open
Abstract
COVID-19 pneumonia causes several complications that include pneumothorax, hydropneumothorax, empyema, and rarely leads to bronchopleural fistula (BPF). BPF is a communication between the pleural space and the bronchial tree. We report a case of 24 years man with pneumothorax, hydropneumothorax, and BPF that appeared after COVID-19 infection.
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Affiliation(s)
- Sangam Shah
- Maharajgunj Medical CampusInstitute of MedicineTribhuvan UniversityMaharajgunjNepal
| | - Prince Mandal
- Maharajgunj Medical CampusInstitute of MedicineTribhuvan UniversityMaharajgunjNepal
| | | | - Rukesh Yadav
- Maharajgunj Medical CampusInstitute of MedicineTribhuvan UniversityMaharajgunjNepal
| | - Yubraj Pande
- Tribhuvan University Teaching HospitalMaharajgunjNepal
| | | | | | - Madan Gyawali
- Department of Internal MedicineInstitute of MedicineTribhuvan UniversityMaharajgunjNepal
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Nakano T, Kawada M, Minami K, Kaneda H. Successful endobronchial occlusion in empyema with broncho-pleural fistula secondary to COVID-19 pneumonia: a case report and literature review. Respirol Case Rep 2021; 9:e00785. [PMID: 34094570 PMCID: PMC8150524 DOI: 10.1002/rcr2.785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022] Open
Abstract
A few cases of empyema secondary to coronavirus disease 2019 (COVID-19) pneumonia have been reported. Here, we report our experience of a successful endobronchial occlusion using endobronchial Watanabe spigots (EWSs) for empyema with broncho-pleural fistula secondary to COVID-19 pneumonia. A 62-year-old man was diagnosed with COVID-19 and progressed to empyema with broncho-pleural fistula. Computed tomography (CT) imaging showed cyst formation and the right B5b was presumed to be a branch dependent on the cyst. The effusion and air in the pleural cavity were well drained, although the air leak persisted. Endobronchial occlusion was performed for right B5a and B5b using 7- and 5-mm EWSs (Novatech, France), respectively, and the air leak ceased. This is the first report of successful treatment of empyema with bronchial fistula with endobronchial occlusion. Air leak secondary to COVID-19 pneumonia with a limited number of air cysts may be a good indication for endobronchial occlusion.
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Affiliation(s)
- Takahito Nakano
- Division of Thoracic SurgeryKansai Medical University Medical CenterMoriguchishiJapan
| | - Masahiro Kawada
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakashiJapan
| | - Kensuke Minami
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakashiJapan
| | - Hiroyuki Kaneda
- Division of Thoracic SurgeryKansai Medical University Medical CenterMoriguchishiJapan
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Abstract
A pneumothorax is defined by the presence of free air between the pleura visceralis and the pleura partietalis. The lung separates from the chest wall, which then, depending on several parameters, leads to a slight or clinically threatening impairment of lung function. Non-specific signs such as thoracic pain or coughing are common and do not correlate with the extent of the pneumothorax. Almost without exception, the cause of this accumulation of air is a leakage in the lung's surface, which then results in air escaping into the pleural space. Depending on the cause of the "lung leakage", a distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP) that can be triggered without direct cause, and a secondary spontaneous pneumothorax (SSP) in case of an underlying known lung disease. Further between an iatrogenic pneumothorax in connection with a lung injury caused by medical measures, and a traumatic pneumothorax in the case of an accident-related lung tear. The relevant therapeutic goals are the elimination of the acute symptoms, the reliable achievement of re-expansion of the lungs, and, after appropriate information gathering about the probability and clinical significance of a pneumothorax recurrence and depending on the patient's wish, avoiding a recurrence by means of surgical measures. The therapy options range from a "wait-and-see" procedure, that merely monitors the findings, to a primary video-assisted thoracoscopic surgical therapy with detection and resection of the superficial lung lesion, as well as a measurement to obliterate the pleural cavity that prevents relapse. Regarding "follow-up care" or even behavioral recommendations after a pneumothorax, there are no recommendations that reduce the risk of recurrence.
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Bhoil R, Kumar R, Kaur J, Attri PK, Thakur R. Diagnosis of Traumatic Pneumothorax: A Comparison between Lung Ultrasound and Supine Chest Radiographs. Indian J Crit Care Med 2021; 25:176-180. [PMID: 33707896 PMCID: PMC7922442 DOI: 10.5005/jp-journals-10071-23729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/Objective Traumatic pneumothorax is an ominous condition necessitating urgent appropriate action. It is typically detected on chest X-rays; however, these may not be able to detect the presence of a subtle pneumothorax, especially in supine position. Lung ultrasound is emerging as a promising modality for detecting pneumothorax in trauma patients. The aim of our study was to compare ultrasound with supine chest radiography for the detection of pneumothorax in trauma patients. Materials and Methods This was a prospective, single-blinded study carried out on 212 adult thoracoabdominal trauma patients who underwent ultrasound FAST and supine (AP) chest radiography. During the FAST sonography, ultrasound thorax was done to rule out pneumothorax. Only those cases were considered (118) in which the presence or absence of pneumothorax could be confirmed on CT done subsequently or where pneumothorax was confirmed by air escape on chest tube placement, wherever indicated, and the results were compared with sonographic and chest X-ray findings. Observation/Results There were 48 true positives on CT/chest tube insertion. Among these, ultrasound was able to correctly detect pneumothorax in 43 patients, while supine chest X-rays correctly identified 33 cases. Sensitivity of ultrasound was 89.6 vs. 68.8% of supine chest radiography. Lung ultrasound also had a higher negative predictive value as compared to supine chest X-rays. Conclusions Lung ultrasound is more sensitive in detecting traumatic pneumothorax than supine chest X-rays, in addition to having numerous other inherent advantages over chest radiography. It should be incorporated in the emergency assessment of thoracic trauma patients to rule out pneumothorax. Clinical significance Lung sonography is more sensitive in detecting traumatic pneumothorax than supine chest X-rays. No added equipment is required, and the procedure can be carried out at the time of doing ultrasound FAST, thus saving precious time in trauma patients. How to cite this article Bhoil R, Kumar R, Kaur J, Attri PK, Thakur R. Diagnosis of Traumatic Pneumothorax: A Comparison between Lung Ultrasound and Supine Chest Radiographs. Indian J Crit Care Med 2021;25(2):176–180.
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Affiliation(s)
- Rohit Bhoil
- Department of Radiodiagnosis, SLBS Medical College, Mandi, Himachal Pradesh, India
| | - Ranesh Kumar
- Department of Surgery, SLBS Medical College, Mandi, Himachal Pradesh, India
| | - Jaswinder Kaur
- Department of Community Medicine, SLBS Medical College, Mandi, Himachal Pradesh, India
| | - Pardeep K Attri
- Department of Radiodiagnosis, SLBS Medical College, Mandi, Himachal Pradesh, India
| | - Rohini Thakur
- Department of Radiodiagnosis, SLBS Medical College, Mandi, Himachal Pradesh, India
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Tan J, Chen H, He J, Zhao L. Needle Aspiration Versus Closed Thoracostomy in the Treatment of Spontaneous Pneumothorax: A Meta-analysis. Lung 2020; 198:333-344. [PMID: 31927656 DOI: 10.1007/s00408-020-00322-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the effectiveness and safety between needle aspiration (NA) and closed thoracostomy (CT) method in adult spontaneous pneumothorax (SP) patients and to explore the most effective and safe protocol by using meta-analysis method. MATERIALS AND METHODS This study was based on Cochrane methodology for conducting meta-analysis. Only randomized controlled trials were eligible for this study. The participants were adults who had SP. The Review Manager Database was used to analyze selected studies. RESULTS Nine RCTs involving 665 patients were included. Although the initial success rate of CT was higher, the two groups were not statistically significant (RR 0.87 [95% CI 0.76-1.00]; p = 0.05). Compared the NA group, the use of CT method to treat SP significantly increased complications (RR 0.17 [95% CI 0.06-0.45]; p = 0.0003) and operation rate (RR 0.57 [95% CI 0.35-0.95]; p = 0.03). There was no significant difference in the 1-week success rate, admitted rate, 3-month recurrence rate, 1-year recurrence rate, and recurrence time between the two groups. Subgroup analysis of primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) patients showed that the initial success rate of the CT method was higher than NA group (RR 0.74 [95% CI 0.60-0.92]; p = 0.007). CONCLUSIONS For the treatment of SP, NA method could significantly decrease complication rate, operation rate, as well as hospital stay length, compared with the CT method. Subgroup analysis indicated that the use of CT method in SSP and PSP patients might increase the initial success rate.
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Affiliation(s)
- Jixiang Tan
- Department of Emergency & Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hong Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin He
- Department of Nephrology, Chonggang General Hospital, Chongqing, China
| | - Lin Zhao
- Department of Emergency & Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Kaneda H, Nakano T, Murakawa T. Measurement of intrapleural pressure in patients with spontaneous pneumothorax: a pilot study. BMC Pulm Med 2019; 19:267. [PMID: 31888739 PMCID: PMC6938002 DOI: 10.1186/s12890-019-1038-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/19/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The initial management of pneumothorax remains controversial, and we speculated that this might be because there is no method available for evaluation of air leak during initial management. We have developed a system for measurement of intrapleural pressure in pneumothorax to address air leak without the need for chest drainage. The aim of this clinical study was to confirm the ability of this measurement system and to determine the clinical impact of management of air leak.
Methods
Patients in whom need aspiration was indicated for spontaneous pneumothorax were enrolled in the study. The intrapleural pressure was measured during stable breathing and data recorded when patients were coughing were excluded.
Results
Eleven patients were enrolled in the study between December 2016 to July 2017. The patterns in change of intrapleural pressure varied widely depending on the state of the pneumothorax. The mean intrapleural pressure values on end-inspiration and end-expiration in patients with persistent air leak was significantly lower than those in patients without persistent air leak (p = 0.020). The number of negative mean pressure recordings in end-inspiration and end-expiration was significantly lower in patients with persistent air leak than in those without persistent air leak (p = 0.0060).
Conclusions
In this study, we demonstrated that intrapleural pressure could be successfully measured and visualized in patients with pneumothorax. Whether or not the pressure value is a predictor of persistent air leak needs to be confirmed in the future.
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Josiassen M, Kudibal MT, Gramkow C, Trojahn Kølle SF. Closure Of Thoracic Wall Defect Using Breast Implant Capsule Tissue As A Rotation Flap - A Case Report. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2018; 5:39-40. [PMID: 29868624 PMCID: PMC5974759 DOI: 10.1080/23320885.2018.1476150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/10/2018] [Indexed: 11/15/2022]
Abstract
A 70-year old woman underwent thoracic surgery resulting in rupture of a silicone implant. During re-implantation at a later time an iatrogenic thoracic wall defect was discovered. In order to complete re-implantation the defect was closed using a rotation flap constructed from capsular tissue from the previous silicone implant.
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Affiliation(s)
- Michael Josiassen
- Department of Plastic Surgery and Burn treatment, Rigshospitalet, Copenhagen, Denmark
| | - Madeline T Kudibal
- Department of Plastic Surgery and Burn treatment, Rigshospitalet, Copenhagen, Denmark
| | - Christina Gramkow
- Department of Plastic Surgery and Burn treatment, Rigshospitalet, Copenhagen, Denmark
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Wang C, Lyu M, Zhou J, Liu Y, Ji Y. Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better? J Thorac Dis 2017; 9:4027-4038. [PMID: 29268413 DOI: 10.21037/jtd.2017.08.140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Needle aspiration and chest tube drainages are two main treatments for primary spontaneous pneumothorax (PSP). However, the application of needle aspiration or chest tube drainages has not reached a consensus. The aim of this study is to compare the needle aspiration with chest tube drainages in patients suffering with PSP and therefore help offer suggestions for clinical practice. Methods We searched literatures from PubMed, OVID and Web of Science from their inception to June 30, 2017. Continuous and dichotomous outcomes were expressed by weight mean difference (WMD) and risk ratio (RR) respectively, and each with 95% confidence intervals (CIs). We used the fixed effect or random effect model to perform quantitative synthesis. Results A total of 6 RCTs recruiting 458 participants were included in our analysis. On the basis of the six studies, our results indicated that compared with chest tube drainage applying needle aspiration shortened the hospital stay (WMD: ‒1.67 days; 95% CI: ‒2.25 to 1.08; P<0.001) and decreased hospitalization rate (RR: 0.40; 95% CI: 0.22-0.75; P=0.004). However, there was no difference regarding immediate success rate (RR: 1.01; 95% CI: 0.70-1.46; P=0.96) and one-year recurrence rate (RR: 0.89; 95% CI: 0.58-1.38; P=0.61). Conclusions In the light of this present research, it is necessary to apply needle aspiration into treating PSP to reduce hospitalization rate and shorten hospital stay. However, the two treatments have no significant difference with respect to immediate success rate, one-year recurrence rate, one-week success rate, three-month recurrence rate or complication rate.
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Affiliation(s)
- Chengdi Wang
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mengyuan Lyu
- Department of Laboratory Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yang Liu
- Department of Vascular Surgery, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yulin Ji
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
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Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality. Can Respir J 2017; 2017:6014967. [PMID: 28386166 PMCID: PMC5366759 DOI: 10.1155/2017/6014967] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/05/2017] [Indexed: 11/17/2022] Open
Abstract
Background. Optimal treatment practices and factors associated with in-hospital mortality in spontaneous pneumothorax (SP) are not fully understood. We evaluated prevalence, clinical characteristics, and in-hospital mortality among Japanese patients with primary or secondary SP (PSP/SSP). Methods. We retrospectively reviewed and stratified 938 instances of pneumothorax in 751 consecutive patients diagnosed with SP into the PSP and SSP groups. Factors associated with in-hospital mortality in SSP were identified by multiple logistic regression analysis. Results. In the SSP group (n = 327; 34.9%), patient age, requirement for emergency transport, and length of stay were greater (all, p < 0.001), while the prevalence of smoking (p = 0.023) and number of surgical interventions (p < 0.001) were lower compared to those in the PSP group (n = 611; 65.1%). Among the 16 in-hospital deceased patients, 12 (75.0%) received emergency transportation and 10 (62.5%) exhibited performance status (PS) of 3-4. In the SSP group, emergency transportation was an independent factor for in-hospital mortality (odds ratio 16.37; 95% confidence interval, 4.85–55.20; p < 0.001). Conclusions. The prevalence and clinical characteristics of PSP and SSP differ considerably. Patients with SSP receiving emergency transportation should receive careful attention.
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Dżeljilji A, Rokicki W, Rokicki M, Karuś K. New aspects in the diagnosis and treatment of primary spontaneous pneumothorax. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2017; 14:27-31. [PMID: 28515745 PMCID: PMC5404124 DOI: 10.5114/kitp.2017.66926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 10/14/2016] [Indexed: 11/26/2022]
Abstract
This paper provides a recapitulation of the position of the British Thoracic Society and the American College of Chest Physicians based on a review of the literature concerning the current methods of diagnosing and treating primary spontaneous pneumothorax (PSP). The previously developed guidelines were re-evaluated in 2015 by a task force of the European Respiratory Society (ERS). They are intended to be used by surgeons as well as emergency and pulmonary ward physicians, and they apply largely to emergency procedures. In recent years, the effectiveness of minimally invasive methods (punctures, drainage) in combination with talc pleurodesis for the initial therapy of PSP has been recognized. The efficacy of thoracoscopy (VATS) for the treatment of this disease has been proven by the development of minimally invasive surgical techniques in thoracic surgery. This paper also discusses the efficacy of the surgical methods available.
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Affiliation(s)
- Agata Dżeljilji
- Department of Surgery, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Wojciech Rokicki
- Department of Thoracic Surgery in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Marek Rokicki
- Department of Thoracic Surgery in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Krzysztof Karuś
- Center of Pulmonology and Thoracic Surgery, Bystra Śląska, Poland
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12
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Is it possible to standardize the treatment of primary spontaneous pneumothorax? Part 1: etiology, symptoms, diagnostics, minimally invasive treatment. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 13:322-327. [PMID: 28096829 PMCID: PMC5233762 DOI: 10.5114/kitp.2016.64874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/16/2016] [Indexed: 11/25/2022]
Abstract
The authors of this report present the history of primary spontaneous pneumothorax (PSP) treatment, its etiology, clinical symptoms, and diagnostic methodology. Further, they discuss minimally invasive methods of treating PSP such as thoracentesis and chemical pleurodesis. They discuss the pros and cons of each method, emphasizing that, according to the international recommendations, they should be used as the first line of treatment for PSP.
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13
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Primavesi F, Jäger T, Meissnitzer T, Buchner S, Reich-Weinberger S, Öfner D, Hutter J, Aspalter M. First Episode of Spontaneous Pneumothorax: CT-based Scoring to Select Patients for Early Surgery. World J Surg 2016; 40:1112-20. [PMID: 26669786 DOI: 10.1007/s00268-015-3371-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although recurrence of primary spontaneous pneumothorax (PSP) is frequent, guidelines do not routinely recommend surgery after first presentation. A CT-based lung dystrophy severity score (DSS) has recently been proposed to predict recurrence following conservative therapy. This study compares the DSS in surgically and conservatively treated patients. METHODS This is a retrospective analysis of first episode PSP patients, comparing video-assisted thoracic surgery (VATS; group A) to conservative treatment with or without chest drainage (group B). CT scans were reviewed for blebs or bullae, and patients were assigned DSS values and stratified into risk groups (low and high-grade). Primary end point was ipsilateral or contralateral recurrence. RESULTS Fifty-six patients were included, 33 received VATS and 23 conservative treatment. In total, 37.5 % experienced recurrence, with a 5-year estimated recurrence rate of 40.7 % (group A: 13.3 %; group B: 73.9 %; p < 0.001). In group B, detection of any dystrophic lesions resulted in significantly higher 5-year recurrence rates (86.7 vs. 50.0 %; p = 0.03), there was no significant difference in group A (17.7 vs. 7.7 %; p = 0.50). Greater DSS values correlated with higher 5-year recurrence rates in group B (p = 0.02), but not in group A (p = 0.90). Comparing low- and high-grade patients in group B resulted in a significant 5-year recurrence rate of 53.8 versus 100 % (p = 0.023). CONCLUSIONS The DSS is useful to indicate VATS after the first episode. For routine application, assigning patients to low- and high-grade groups seems most practical. We recommend CT-evaluation for every PSP patient and early surgery for those with lesions exceeding one bleb. After VATS, the preoperative DSS is not beneficial in predicting recurrence.
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Affiliation(s)
- Florian Primavesi
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria.
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Thomas Meissnitzer
- Department of Radiology, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Selina Buchner
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Silvia Reich-Weinberger
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Dietmar Öfner
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria.,Department of Visceral-, Transplant- and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Jörg Hutter
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Manuela Aspalter
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
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Marchi E, de Carvalho MVH, Ventureli TR, Fruchi AJ, Lazaro A, do Carmo DC, Barreto TYAS, Dias BVB, Acencio MMP, Teixeira LR, Light RW. Abrasion Plus Local Fibrin Sealant Instillation Produces Pleurodesis Similar to Pleurectomy in Rabbits. Chest 2016; 150:673-9. [PMID: 27217265 DOI: 10.1016/j.chest.2016.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/09/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Pleurodesis performed either by pleurectomy or pleural abrasion is recommended in the approach to primary spontaneous pneumothorax to avoid recurrence. However, the efficacy of parietal pleural abrasion in producing pleurodesis is questioned. This study aims to determine the efficacy of apical abrasion alone, abrasion plus fibrin sealant application, and pleurectomy in producing pleurodesis in rabbits. METHODS Rabbits were subjected to video-assisted thoracic surgery alone (control) or to video-assisted thoracic surgery with apical gauze abrasion, abrasion plus fibrin sealant instillation, or apical pleurectomy. Blood samples were collected preoperatively and 48 h and 28 days postoperatively to measure total leukocytes (white blood cell count), neutrophil counts, and serum interleukin (IL)-8 levels. After 28 days the animals were sacrificed for macroscopic evaluation of the degree of apical pleurodesis and microscopic evaluation of local pleural fibrosis and collagen deposition. RESULTS White blood cell and neutrophil counts were similar in all groups, whereas the serum IL-8 level peaked at 48 h in all groups and decreased after 28 days, except in the pleurectomy group. After 28 days the abrasion plus fibrin sealant and pleurectomy groups had significantly more pleural adhesions, pleural fibrosis, and collagen deposition than the abrasion alone group, mainly due to thick mature fibers. CONCLUSIONS Abrasion with local fibrin sealant instillation is as effective as pleurectomy in producing pleurodesis in rabbits. Apical pleurectomy elicits a more persistent elevation of serum IL-8 levels than apical abrasion alone or abrasion plus fibrin adhesive instillation.
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Affiliation(s)
- Evaldo Marchi
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil.
| | | | - Tiago R Ventureli
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil
| | - Andre J Fruchi
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil
| | - Ariane Lazaro
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil
| | | | | | - Bruno V B Dias
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil
| | - Milena M P Acencio
- Pleura Laboratory, Pulmonary Division, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Lisete R Teixeira
- Pleura Laboratory, Pulmonary Division, InCor, University of São Paulo Medical School, São Paulo, Brazil
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Kaneda H, Murakawa T. Initial management of spontaneous pneumothorax. THE LANCET RESPIRATORY MEDICINE 2015; 3:e35-6. [PMID: 26545771 DOI: 10.1016/s2213-2600(15)00420-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 09/25/2015] [Accepted: 10/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroyuki Kaneda
- Department of Thoracic and Cardiovascular Surgery, Kansai Medical University 2-5-1 Shinmachi, Hirakatashi, Osaka, 573-1010 Japan.
| | - Tomohiro Murakawa
- Department of Thoracic and Cardiovascular Surgery, Kansai Medical University 2-5-1 Shinmachi, Hirakatashi, Osaka, 573-1010 Japan
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Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, Krasnik M, Maskell N, Van Schil P, Tonia T, Waller DA, Marquette CH, Cardillo G. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46:321-35. [PMID: 26113675 DOI: 10.1183/09031936.00219214] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.
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Affiliation(s)
- Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Dept of Internal Medicine RSV, Montana, Switzerland Task Force Chairs
| | - Oliver Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Emilio Canalis
- Dept of Surgery, University of Rovira I Virgili, Tarragona, Spain
| | | | - Julius Janssen
- Dept of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marc Krasnik
- Dept of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Nicholas Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Van Schil
- Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thomy Tonia
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - David A Waller
- Dept of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Charles-Hugo Marquette
- Hospital Pasteur CHU Nice and Institute for Research on Cancer and Ageing, University of Nice Sophia Antipolis, Nice, France
| | - Giuseppe Cardillo
- Dept of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy Task Force Chairs
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17
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How CH, Chen JS. Chemical pleurodesis for first presentation of primary spontaneous pneumothorax. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Divisi D, Di Leonardo G, Crisci R. Video-assisted thoracic surgery versus pleural drainage in the management of the first episode of primary spontaneous pneumothorax. Am J Surg 2015; 210:68-73. [PMID: 25769881 DOI: 10.1016/j.amjsurg.2014.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/10/2014] [Accepted: 10/06/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the study was to analyze the cost-effectiveness outcomes of video-assisted thoracic surgery (VATS) in the treatment of primary spontaneous pneumothorax (PSP), comparing the minimally invasive procedure with pleural drainage (PD). METHODS Between July 2006 and October 2012, we treated 122 patients with a first episode of PSP by VATS (61 patients) or pleural drainage (61 patients). We established the relationship between costs and quality-adjusted life (QAL) for both techniques. RESULTS The total cost per patient of minimally invasive procedure was more advantageous than that of chest tube (€2,422.96 vs €4,855.12). The QAL expectancy of VATS was longer than that of PD (57.00 vs 40.80 at 60 months). The QAL year of VATS (.32 at 1st year and .25 at 5th year) was better than that of PD. Incremental cost-effectiveness ratio of VATS versus PD was between €7,600.00 (1st year) and €10,045.00 (5th year), remaining well below the threshold of acceptability. CONCLUSION VATS as the first-line treatment for PSP allowed low morbidity, short hospitalization, and excellent quality of life.
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Affiliation(s)
- Duilio Divisi
- Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, Teramo, Italy.
| | - Gabriella Di Leonardo
- Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, Teramo, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, Teramo, Italy
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Huang Y, Huang H, Li Q, Browning RF, Parrish S, Turner JF, Zarogoulidis K, Kougioumtzi I, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N, Katsikogiannis N, Courcoutsakis N, Madesis A, Diplaris K, Karaiskos T, Zarogoulidis P. Approach of the treatment for pneumothorax. J Thorac Dis 2014; 6:S416-20. [PMID: 25337397 DOI: 10.3978/j.issn.2072-1439.2014.08.24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 08/13/2014] [Indexed: 11/14/2022]
Abstract
Pneumothorax can occur in several situations such as; chronic obstructive pulmonary disease (COPD) where emphysema is observed or due to a biopsy for malignancy suspicion. In any case it is a dangerous situation that requires immediate attention and treatment. Pneumothorax can be divided in primary and secondary. Staging of pneumothorax is also very important. In our current editorial we summarize etiology and treatment of pneumothorax from a panel of pulmonary physicians, oncologists and thoracic surgeons.
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Affiliation(s)
- Yong Huang
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haidong Huang
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Qiang Li
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert F Browning
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Scott Parrish
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Francis Turner
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dryllis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Courcoutsakis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Diplaris
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Parrish S, Browning RF, Turner JF, Zarogoulidis K, Kougioumtzi I, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N, Katsikogiannis N, Tsiouda T, Madesis A, Karaiskos T, Zarogoulidis P. The role for medical thoracoscopy in pneumothorax. J Thorac Dis 2014; 6:S383-91. [PMID: 25337393 DOI: 10.3978/j.issn.2072-1439.2014.08.06] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 08/06/2014] [Indexed: 02/02/2023]
Abstract
Pneumothorax is a life threatening situation that requires fast treatment. There are two major classifications: Primary and Secondary. Staging of pneumothorax is also very important for treatment. Treatment of pneumont can be performed either from thoracic surgeons, or pulmonary physicians. In our current work we provide up-to-date information regarding pneumothorax classification, staging and treatment from the point of view of expert pulmonary physicians.
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Affiliation(s)
- Scott Parrish
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert F Browning
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Francis Turner
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dryllis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Efficacy and long-term clinical outcome of bronchial occlusion with endobronchial Watanabe spigots for persistent air leaks. Respir Investig 2014; 53:30-6. [PMID: 25542601 DOI: 10.1016/j.resinv.2014.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/02/2014] [Accepted: 09/07/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND We reviewed our clinical experience and examined the efficacy and long-term outcome of bronchial occlusion with endobronchial Watanabe spigots (EWSs). METHODS We retrospectively reviewed the clinical charts of patients who had undergone endoscopic bronchial occlusion with EWSs between July 2002 and July 2004. The affected bronchi were identified by chest computed tomography, pleurography, and balloon occlusion test. RESULTS Of the 21 patients, 18 had underlying pulmonary complications, including chronic obstructive lung disease (n=14), cancer (n=4), pneumoconiosis (n=3), and pneumonia (n=1). Six (29%) achieved complete resolution and 12 (57%) experienced a reduction in air leaks after the first EWS insertion. Of the 12 patients with reduced air leaks, 10 subsequently underwent chemical pleurodesis and 5 (24%) achieved complete resolution after the procedure. A second EWS insertion procedure was performed for 8 patients: 2 achieved complete resolution and 5 achieved a further reduction in air leaks with complete resolution after chemical pleurodesis. Eighteen of the 21 patients were followed up at an outpatient clinic after discharge: 13 for more than 12 months and 4 for more than 84 months. During the follow-up period, most patients did not show any obvious pulmonary complications. CONCLUSIONS We showed that bronchial occlusion with EWSs was effective in stopping or reducing air leaks and that 86% of our patients finally achieved complete resolution, some when the occlusion was combined with chemical pleurodesis. The rate of complications was acceptable, even after long-term placement.
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Chew R, Gerhardy B, Simpson G. Conservative versus invasive treatment of primary spontaneous pneumothorax: a retrospective cohort study. Acute Med Surg 2014; 1:195-199. [PMID: 29930848 DOI: 10.1002/ams2.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/30/2014] [Indexed: 11/07/2022] Open
Abstract
Aim The best management of primary spontaneous pneumothorax is unclear. Conservative treatment has been proposed, but no studies comparing conservative with invasive management have been carried out where pneumothorax size has been numerically quantified. This study aimed to evaluate the feasibility of conservative management for primary spontaneous pneumothoraces of any size. Methods Retrospective cohort study of adult patients with primary spontaneous pneumothorax treated at an Australian tertiary hospital from 2006-2011, carried out by case-note and chest radiograph review. Patient demographics, smoking status, and outcome data were collected. Pneumothorax size was calculated using the Collins method, based on the sum of interpleural distances. Results One hundred and twenty-seven episodes from 116 patients were identified. Males (86) comprised 75% of patients, and the median age at presentation was 37 years. Eighty-two percent of cases (106) were ever-smokers. Of the episodes in which pre-treatment radiographs were available, 53 were treated conservatively and 58 invasively with tube thoracostomy, and all were clinically stable. When cases were stratified by pneumothorax size, age, sex, ethnicity, and smoking status had no effect on outcome. Compared to invasive treatment, conservative management resulted in no complications, an equal recurrence rate, and a significantly shorter length of stay. Conclusions Our results suggest that it may be feasible to adopt a conservative approach as the first-line treatment of primary spontaneous pneumothorax in clinically stable patients. However, given the limitations of this study, a large randomised controlled trial is required to conclusively prove this assertion.
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Affiliation(s)
- Rusheng Chew
- Department of Thoracic Medicine Cairns Base Hospital Cairns Australia.,James Cook University School of Medicine and Dentistry Cairns Australia
| | - Benjamin Gerhardy
- Department of Thoracic Medicine Cairns Base Hospital Cairns Australia.,Griffith University School of Medicine Gold Coast Queensland Australia
| | - Graham Simpson
- Department of Thoracic Medicine Cairns Base Hospital Cairns Australia
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