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Janssen N, Franssen AJPM, Ramos González AA, Laven IEWG, Jansen YJL, Daemen JHT, Lozekoot PWJ, Hulsewé KWE, Vissers YLJ, de Loos ER. Uniportal versus multiportal video-assisted thoracoscopic surgery for spontaneous pneumothorax. J Cardiothorac Surg 2024; 19:387. [PMID: 38926766 PMCID: PMC11201089 DOI: 10.1186/s13019-024-02931-4] [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: 01/10/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Multiportal video-assisted thoracic surgery (mVATS) is the standard approach for the surgical treatment of spontaneous pneumothorax. However, uniportal VATS (uVATS) has emerged as an alternative aiming to minimize surgical morbidity. This study aims to strengthen the evidence on the safety and efficiency of uVATS compared to mVATS. METHODS From January 2004 to December 2020, records of patients who had undergone surgical treatment for primary or secondary spontaneous pneumothorax were evaluated for eligibility. Patients who had undergone pleurectomy combined with bullectomy or apical wedge resection via uVATS or mVATS were included. Surgical characteristics and postoperative data were compared between patients who had undergone surgery via uVATS or mVATS. Univariable and multivariable analyses were performed to determine whether the surgical approach was associated with any complication (primary outcome), major complications (i.e., Clavien-Dindo ≥ 3), recurrence, prolonged hospitalization or prolonged chest drainage duration (secondary outcomes). RESULTS A total of 212 patients were enrolled. Patients treated via uVATS (n = 71) and mVATS (n = 141) were significantly different in pneumothorax type (secondary spontaneous; uVATS: 54 [76%], mVATS: 79 [56%]; p = 0.004). No significant differences were observed in (major) complications and recurrence rates between both groups. Multivariable analyses revealed that the surgical approach was no significant predictor for the primary or secondary outcomes. CONCLUSIONS This study indicates that uVATS is non-inferior to mVATS in the surgical treatment of spontaneous pneumothorax regarding safety and efficiency, and thus the uVATS approach has the potential for further improvements in the perioperative surgical care for spontaneous pneumothorax.
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Affiliation(s)
- Nicky Janssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Aimée J P M Franssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Arlette A Ramos González
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Iris E W G Laven
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Yanina J L Jansen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Pieter W J Lozekoot
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands.
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Bisconti M, De Palma A, Pacifici R, Rotolo MC, Pichini S, Brascia D, Trabucco X, Pellegrini M, Carrozzi L, Pistelli F, Marulli G. Spontaneous Pneumothorax Secondary to Bullous Lung Emphysema Positive for Cannabinoids upon Toxicological Examination. J Clin Med 2023; 12:4956. [PMID: 37568358 PMCID: PMC10419578 DOI: 10.3390/jcm12154956] [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: 04/11/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Cannabis can be related to respiratory diseases, but the relationship between smoking marijuana and the development of a pneumothorax has scarcely been investigated. We aimed to analyze, in patients with a history of cannabis smoking abuse submitted to lung apicectomy for a primary spontaneous pneumothorax (PSP), the correlation between the presence of cannabinoids in the resected lung and the detection of bullous emphysema within the same tissue. Patients undergoing lung apicectomy for a PSP were prospectively enrolled, and the correlation between the presence of cannabinoids in the resected lung tissue and histological finding of bullous emphysema was investigated with Fisher's exact test. There were 21 male patients, with a median age of 27 years. The cannabinoids found by the toxicological examination in surgical specimens were mainly delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), and cannabidiol (CBD). In 14/21 patients, cannabinoids were detected in the resected lung tissue, and bullous emphysema was present in 13/14 of these (93%), while bullous emphysema was found in only 1/7 (14%) of the remaining patients who were negative for cannabinoids in the lung tissue, and the difference was found to be statistically significant (p < 0.0009). Our study demonstrated the presence of bullous emphysema in most cannabinoid-positive patients and its absence in most of those who were cannabinoid-negative, supporting the correlation between cannabinoids in the lung tissue and bullous emphysema with the development of a "secondary" spontaneous pneumothorax.
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Affiliation(s)
- Mario Bisconti
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.B.); (D.B.); (G.M.)
- Unit of Pneumology, Hospital “Vito Fazzi”, 73100 Lecce, Italy
| | - Angela De Palma
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.B.); (D.B.); (G.M.)
| | - Roberta Pacifici
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, 00161 Rome, Italy; (R.P.); (M.C.R.); (S.P.); (M.P.)
| | - Maria Concetta Rotolo
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, 00161 Rome, Italy; (R.P.); (M.C.R.); (S.P.); (M.P.)
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, 00161 Rome, Italy; (R.P.); (M.C.R.); (S.P.); (M.P.)
| | - Debora Brascia
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.B.); (D.B.); (G.M.)
| | - Xenia Trabucco
- Unit of Pathology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Manuela Pellegrini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, 00161 Rome, Italy; (R.P.); (M.C.R.); (S.P.); (M.P.)
| | - Laura Carrozzi
- Unit of Pneumology, University of Pisa, 56126 Pisa, Italy; (L.C.); (F.P.)
| | - Francesco Pistelli
- Unit of Pneumology, University of Pisa, 56126 Pisa, Italy; (L.C.); (F.P.)
| | - Giuseppe Marulli
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.B.); (D.B.); (G.M.)
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Mehrabi S, Shadmehr MB, Irajie C, Yavari Barhaghtalab MJ. Primary Spontaneous Pneumothorax: Open Thoracotomy vs. Video-assisted Thoracoscopic Surgery: A Single-center Retrospective Cohort Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:49-56. [PMID: 36688202 PMCID: PMC9843463 DOI: 10.30476/ijms.2022.91422.2260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/19/2021] [Accepted: 11/06/2021] [Indexed: 01/24/2023]
Abstract
Background Primary spontaneous pneumothorax (PSP) is a spontaneous pneumothorax without underlying lung disease. The main goals of this study were to compare the outcomes of video-assisted thoracoscopic surgery (VATS) and open thoracotomy in patients with PSP. Methods The current study is a retrospective cohort study of patients who were admitted to the emergency department or general surgery ward at Dr. Masih Daneshvari Hospital (Tehran, Iran) with the diagnosis of PSP and underwent surgery by open or VATS approach from 2006 to 2012. The groups were compared in terms of the length of operation, the length of hospitalization, recurrence, and postoperative complications. Data were analyzed using SPSS version 18.0, and Student's t test, analysis of variance (ANOVA), Chi square, and Fisher's exact test were employed. P values less than 0.05 were considered statistically significant. Results PSP was diagnosed in 90 patients who underwent surgery. Open thoracotomy and VATS procedures were performed in 65 (72.2%) and 25 (27.8%) patients, respectively. VATS was converted to open in seven cases (7.7%). Recurrent pneumothorax was the most common surgical indication for PSP. There was no significant difference between the two groups in terms of mean age, sex, smoking, side of the involved lung, previous pneumothorax history, mean length of hospitalization for recurrence, post-operation bleeding, and failure of lung expansion. However, the length of surgery (P=0.011) and air leakage (P=0.048) significantly differed between the two groups. Conclusion When compared to open thoracotomy, VATS could be the primary treatment option in the surgical treatment of PSP due to the shorter length of surgery and decreased complications such as air leakage.
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Affiliation(s)
- Saadat Mehrabi
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohammad Behgam Shadmehr
- Department of Thoracic Surgery, Tracheal Diseases Research Center, Massih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cambyz Irajie
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
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MIHALTAN F, NECHITA A, CONSTANTIN A. Cannabis - a Rewritten History and Its Pulmonary Consequences. MAEDICA 2022; 17:911-920. [PMID: 36818264 PMCID: PMC9923077 DOI: 10.26574/maedica.2022.17.4.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Cannabis presents itself as another challenge of the last decade. Better and better deciphered through in-depth studies, this drug remains a source of scientific debates. Legalized in some states, it competes with tobacco regarding the effects generating respiratory symptoms, chronic bronchitis, bronchial cancer, respiratory infections, etc. In this article we will review the pharmacology, epidemiology, clinical and prevention aspects and try to demonstrate which of these are the most effective means of prevention. This review proves once again that this drug has many hidden dangers.
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Affiliation(s)
- Florin MIHALTAN
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Andrada NECHITA
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Ancuta CONSTANTIN
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Pradère P, Ruppert AM, Peiffer G, Perriot J, Adler M, Underner M. [Inhaled marijuana and the lung, a toxic cocktail?]. Rev Mal Respir 2022; 39:708-718. [PMID: 36115751 DOI: 10.1016/j.rmr.2022.08.007] [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: 06/07/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022]
Abstract
Unlike the well-documented effects of tobacco smoke on the lung, the effects of cannabis smoke remain controversial, the main bias consisting in co-consumption of tobacco. That said, the composition of joint smoke is close to that of cigarettes, containing many compounds that are carcinogenic and/or alter the respiratory epithelium. Confirmed respiratory effects in chronic cannabis smokers include aggravated chronic bronchitis symptoms, a cumulative effect with tobacco on COPD and emphysema occurrence, an increased risk of bullous emphysema, and pneumothorax with heightened risk of recurrence after pleural symphysis. Recent prospective studies have shown a negative impact on lung function, with not only damage to the airways, but also DLCO alteration and an accelerated drop in FEV1. Finally, cannabis smoking is very common among young patients with lung cancer. Its consumption could lead to a different lung cancer profile, potentially more undifferentiated and less accessible to targeted therapy. Questioning about cannabis consumption must be systematic and targeted medical care should be offered.
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Affiliation(s)
- P Pradère
- Service de pneumologie, hôpital Marie Lannelongue, université Paris Saclay, groupe hospitalier Paris Saint Joseph, 92350 Le Plessis Robinson, France.
| | - A M Ruppert
- Sorbonne-université GRC04 Theranoscan, unité de tabacologie, service de pneumologie et oncologie thoracique, hôpital Tenon, APHP, Paris, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, Metz, France
| | - J Perriot
- Dispensaire Emile Roux, centre de tabacologie, Clermont-Ferrand, France
| | - M Adler
- Unité de tabacologie, hôpital Antoine Béclère, Clamart, France
| | - M Underner
- Unite de recherche clinique, centre hospitalier Henri Laborit, université de Poitiers, Poitiers, France
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Stead T, Lee J, Huang D, DeLosSantos J, Ganti L. Massive Spontaneous Pneumothorax. Cureus 2022; 14:e20992. [PMID: 35154967 PMCID: PMC8820470 DOI: 10.7759/cureus.20992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/05/2022] Open
Abstract
Spontaneous pneumothorax (SP) is an abnormal occurrence in which air enters the pleural space, increasing pressure that pushes on the lung, causing it to collapse in part or full. Diagnosis is made by physical exam and can be confirmed by chest X-ray (CXR), chest computed tomography (CT), ultrasonography, and other forms of imaging showing a collapsed lung. We present the case of a 35-year-old male cannabis user presenting with sharp sudden pains in the right chest, who presented almost 12 hours after symptom onset and was diagnosed with a 90% pneumothorax of the right lung. Symptoms, diagnosis, treatment, and risk factors are discussed.
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