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Brill L, Li N, Carino G. Spontaneous Pneumothorax in a Healthy Young Woman: Discussion About Treatment Options. Cureus 2024; 16:e55633. [PMID: 38586686 PMCID: PMC10996433 DOI: 10.7759/cureus.55633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
A spontaneous pneumothorax, a potentially life-threatening condition, is a disease process in which air enters the space between the visceral and parietal pleural of the lung, thus increasing the pressures in that space. It can be diagnosed by both physical exam and radiographic testing. In this case, we present a 21-year-old, otherwise healthy woman who presented with sudden, sharp shoulder pain and chest tightness and was diagnosed with her first, spontaneous pneumothorax. We further discuss the diagnosis and treatment options for a first-time spontaneous pneumothorax.
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Affiliation(s)
- Leah Brill
- Biology, College of Arts and Sciences, University of Vermont, Burlington, USA
| | - Nina Li
- Pulmonary and Critical Care, Warren Alpert Medical School at Brown University, Providence, USA
| | - Gerardo Carino
- Pulmonary and Critical Care, Warren Alpert Medical School at Brown University, Providence, USA
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Solanki NN, Thill CA, Chaker M, Messina Alvarez AA, Manasrah N, Chaudhary AJ. Recurrent Spontaneous Pneumothorax Secondary to Marijuana and Tobacco Abuse. Cureus 2024; 16:e52391. [PMID: 38361711 PMCID: PMC10868913 DOI: 10.7759/cureus.52391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Primary spontaneous pneumothorax occurs in patients without apparent clinical lung disease, with a higher incidence in tall, thin males between the ages of 10 and 30. Tension pneumothorax is a life-threatening condition that can develop within minutes due to progressive air accumulation in the pleural space; mechanical pressure can lead to significant cardiorespiratory compromise. Tobacco association with a higher incidence of spontaneous pneumothorax has been well documented, but marijuana and spontaneous pneumothorax connection has not been well studied. However, it has been observed that patients who use marijuana and tobacco simultaneously have a higher incidence of spontaneous tension and larger pneumothoraces, as well as longer postoperative stay and higher recurrence than cigarette-only users. We present a case of a 26-year-old young male with a history only significant for excessive tobacco and marijuana smoking who developed multiple recurrent spontaneous pneumothorax and had to undergo right-sided video-assisted thoracoscopic surgery (VATS) with minimally invasive thoracotomy and had a prolonged hospital stay. With our case report, we hope to add to the evidence the effects of combined marijuana and tobacco smoking on bullous lung disease and pneumothorax while emphasizing the importance of conducting a detailed substance use history in patients with spontaneous pneumothorax.
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Affiliation(s)
- Naisargee N Solanki
- Internal Medicine, Detroit Medical Center/Wayne State University (DMC/WSU) Sinai Grace Hospital, Detroit, USA
| | - Charlotte A Thill
- Internal Medicine, School of Medicine, Wayne State University, Detroit, USA
| | - Mahmoud Chaker
- Internal Medicine, Detroit Medical Center/Wayne State University (DMC/WSU) Sinai Grace Hospital, Detroit, USA
| | - Angelo A Messina Alvarez
- Internal Medicine, Detroit Medical Center/Wayne State University (DMC/WSU) Sinai Grace Hospital, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center/Wayne State University (DMC/WSU) Sinai Grace Hospital, Detroit, USA
| | - Ahmed Jamal Chaudhary
- Internal Medicine, Detroit Medical Center/Wayne State University (DMC/WSU) Sinai Grace Hospital, Detroit, USA
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Furuta C, Yano M, Kitagawa Y, Katsuya R, Ozeki N, Fukui T. Prospective Observation Study for Primary Spontaneous Pneumothorax: Incidence of and Risk Factors for Postoperative Neogenesis of Bullae. Ann Thorac Cardiovasc Surg 2024; 30:23-00206. [PMID: 38599823 PMCID: PMC11082493 DOI: 10.5761/atcs.oa.23-00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/16/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE Details of the neogenesis of bullae (NOB), which causes recurrent primary spontaneous pneumothorax (PSP) following bullectomy, have not been reported and risk factors for NOB remain unclear. We aimed to clarify the details of NOB. METHODS We conducted a prospective study using three computed tomography (CT) examinations performed 6, 12, and 24 months after bullectomy to identify the incidence of and risk factors for NOB. We enrolled 50 patients who underwent bullectomy for PSP. RESULTS After excluding 11 patients who canceled the postoperative CT examination at 6 months after bullectomy, only 39 patients were analyzed. The incidence of NOB at 6, 12, and 24 months after bullectomy was 38.5%, 55.2%, and 71.2%, respectively. The rate of NOB in the operated lung was almost 2 times higher than that in the contralateral nonoperative lung. Male sex, multiple bullae on preoperative CT, long stapling line (≥7 cm), deep stapling depth (≥1.5 cm), and heavier resected sample (≥5 g) were suggested to be risk factors for NOB. CONCLUSIONS We recognized a high incidence of postoperative NOB in PSP patients. Bullectomy itself seems to promote NOB. Postoperative NOB occurs frequently, especially in patients who require a large-volume lung resection with a long staple line.
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Affiliation(s)
- Chihiro Furuta
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Motoki Yano
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yuka Kitagawa
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Ryotaro Katsuya
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Naoki Ozeki
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takayuki Fukui
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
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Kang N, Zheng H, Ge W, Hu J, Liu W, Zhang R. Uniportal thoracoscopic bullectomy with improved parietal pleurectomy for primary spontaneous pneumothorax. Clin Respir J 2023; 17:1341-1348. [PMID: 38043134 PMCID: PMC10730464 DOI: 10.1111/crj.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Parietal pleurectomy with bullectomy has been established as an effective method for preventing the recurrence of primary spontaneous pneumothorax (PSP). Our center introduced enhanced technical measures in uniportal thoracoscopic parietal pleurectomy with bullectomy for patients with PSP, aiming to document our initial experience and assess the procedure's effectiveness in preventing the recurrence of PSP. METHODS We analyzed the clinical data of 86 patients with PSP who underwent the improved uniportal thoracoscopic parietal pleurectomy with bullectomy between July 2019 and August 2022. During the procedure, the parietal pleura above the second intercostal space was stripped but not removed. Instead, it was retained in the thoracic cavity using a piece of pedunculated pleura. Subsequently, the stumps of the lung were covered by the preserved parietal pleura. RESULTS The results of the study showed that the mean operative time was 59.87 ± 16.93 min, and the postoperative drainage duration averaged 3.94 ± 2.17 days. The mean intraoperative blood loss was 24.33 ± 48.91 ml, and the mean postoperative drainage volume was 289.00 ± 170.03 ml. Prolonged air leakage for more than 5 days was observed in five patients (5.81%), but no other postoperative complications were recorded. During the follow-up, one patient (1.16%) experienced a recurrence of pneumothorax. CONCLUSIONS The perioperative results of bullectomy with the improved pleurectomy technique are deemed satisfactory. The various technical steps attempted at our center are found to be feasible and safe, and they may contribute to reducing the rates of recurrence in PSP.
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Affiliation(s)
- Ningning Kang
- Department of Thoracic SurgeryFirst Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Hao Zheng
- Department of Thoracic SurgeryFirst Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Wei Ge
- Department of Thoracic SurgeryFirst Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Jin‐Xiu Hu
- Department of Thoracic SurgeryFirst Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Wen Liu
- Department of Thoracic SurgeryFirst Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Ren‐Quan Zhang
- Department of Thoracic SurgeryFirst Affiliated Hospital of Anhui Medical UniversityHefeiChina
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Mensah DN, Livingston J, Maddukuri V. Cannabis-Associated Pneumothorax: A Case Report. Cureus 2023; 15:e50825. [PMID: 38249204 PMCID: PMC10797579 DOI: 10.7759/cureus.50825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
The use of cannabis for therapeutic and recreational purposes has been on the rise in recent years. This has increased the prevalence of cannabis use disorder across various demographic subgroups. A recent medical literature review describes a few cases demonstrating the association of spontaneous pneumothorax and bullous lung disease in cannabis users without concomitant tobacco use. We herein present a case report of a young male with chronic cannabis use who presented with right-sided spontaneous pneumothorax and bilateral apical blebs.
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Affiliation(s)
- Dennis N Mensah
- Internal Medicine, New York Medical College at St. Mary's General Hospital and St. Clare's Health, Denville, USA
| | - Jonathan Livingston
- Internal Medicine, New York Medical College at St. Mary's General Hospital and St. Clare's Health, Denville, USA
| | - Vasudha Maddukuri
- Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Internal Medicine, New York Medical College at St. Mary's General Hospital and St. Clare's Health, Denville, USA
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Lee J, Jeong JY, Suh JH, Park CB, Kim D, Park SS. Diverse clinical presentation of primary spontaneous pneumothorax in patients with pectus excavatum. Front Surg 2023; 10:1245049. [PMID: 37675251 PMCID: PMC10477697 DOI: 10.3389/fsurg.2023.1245049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Objective Patients with primary spontaneous pneumothorax (PSP) tend to be young, tall, and thin, as do those with pectus excavatum (PE). Notably, the Haller index, which measures the severity of PE, tends also to be higher in patients with PSP, further suggesting a potential predisposing factor for the development of PSP in individuals with PE. This study aimed to share clinical experiences with case series of concomitant PSP and PE and to emphasize the importance of evaluating these two conditions together. Methods In this single-center study, we conducted a retrospective records review to identify patients who were diagnosed and treated (including surgical or conservative treatment and follow-up observation) for the diagnosis of PE between July 2011 and February 2023. From these, we selected patients who were diagnosed with both PE and PSP and analyzed their clinical presentations. Results Among a total of 139 patients with PE, there were 8 (5.76%) who had concurrent diagnoses of PE and PSP and who underwent surgery for PSP, PE, or both. The average age of these 8 patients (male:female = 7:1) was 19.38 years. The 8 patients were grouped into four categories based on their clinical scenarios. Group A had 1 patient with PE diagnosed first, followed by the discovery of PSP during evaluation; Group B included 2 patients initially presenting with PSP and subsequently diagnosed with PE during evaluation; Group C consisted of 1 patient who had PSP before undergoing surgical PE correction; and Group D comprised 4 patients who developed PSP after PE correction. Conclusions The incidence of PSP in patients with PE was 5.76% (8 out of 139 patients), indicating the importance of vigilant monitoring for PSP prior to PE surgery, and vice versa. Furthermore, the authors recommend close observation for PSP independent of PE surgery, even in the absence of postoperative complications.
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Affiliation(s)
- June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hui Suh
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Beom Park
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dulee Kim
- Department of Anesthesiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Seog Park
- Department of Anesthesiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Alruwaili SK, Alquraishi AA, Binsaddik OK, Alanazi NS, Bin Marshed A, Albargawi AM, Mounla Ali R, Arishi H. The Descriptive Features of Primary Spontaneous Pneumothorax Patients in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Cureus 2023; 15:e40493. [PMID: 37461752 PMCID: PMC10349917 DOI: 10.7759/cureus.40493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
Background Primary spontaneous pneumothorax (PSP) is a fairly prevalent disorder in emergency medicine. PSP most frequently affects tall, thin male smokers and is most prevalent during adolescence. Published literature contains a wide range of Primary Spontaneous Pneumothorax (PSP) recurrence rates, but there is limited information on the variables affecting recurrence. Objective To identify the descriptive features of PSP in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods This retrospective cross-sectional study was conducted in Surgery King Abdulaziz Medical City, Riyadh, Saudi Arabia. Including all PSP patients from 2016-2021, excluding pediatric and geriatric patients. Participants were selected using a simple random sampling technique, and data were collected from hospital records. Data analysis was conducted by using SPSS. Results In this study, we included a total of 131 participants. Most were males (93.1%), and most were aged between 21-30 years. Our findings showed that most PSP events occurred in winter (28.6%). Followed by fall (25.7%), summer (25.0%), and spring (20.7%). Concerning the smoking status of our respondents, our results revealed that most of them were active smokers (72.5%). Left-PSP was the most commonly reported type of PSP (43.5 %), followed by right-PSP (38.9%), non-simultaneous bilateral PSP (14.5%), and bilateral simultaneous PSP (3.1%). Moreover, we found that the recurrence rate of PSP was 42%. Regarding the management of PSP, almost half of the respondents were managed initially by Chest tube. The most frequently used surgical option was VATS- Bullectomy with Abrasion Pleurodesis. Finally, the recurrence rate of PSP was 42% among the patients. The percentage of patients with one recurrence only was 65.5% among the patients with recurrent PSP, second recurrence at 29.1%. Third, Fourth, and Fifth had the same recurrence percentage of 1.8%, and these percentages came to be statistically significant. (P value < 0.001) Conclusion Our study concluded that PSP was more prevalent in tall, thin, young male smokers. Almost half of the respondents suffered from at least one recurrence attack of PSP. The majority of the patients with recurrences experienced one recurrence only, and the second recurrence was estimated to be almost one-third. There is no significant association between the occurrence and seasons of the attack at a time. Most of the participants were managed initially by a chest tube. The most frequently used surgical option was Video Assisted Thoracoscopic Surgery (VATS) with abrasion pleurodesis.
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Affiliation(s)
| | | | | | - Nawaf S Alanazi
- General Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdulaziz Bin Marshed
- General Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Ali M Albargawi
- Surgery, King Abdulaziz Medical City, Riyadh, SAU
- Surgery, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Marx T, Joly LM, Parmentier AL, Pretalli JB, Puyraveau M, Meurice JC, Schmidt J, Tiffet O, Ferretti G, Lauque D, Honnart D, Al Freijat F, Dubart AE, Grandpierre RG, Viallon A, Perdu D, Roy PM, El Cadi T, Bronet N, Duncan G, Cardot G, Lestavel P, Mauny F, Desmettre T. Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial. Am J Respir Crit Care Med 2023; 207:1475-1485. [PMID: 36693146 DOI: 10.1164/rccm.202110-2409oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
Rationale: Management of first episodes of primary spontaneous pneumothorax remains the subject of debate. Objectives: To determine whether first-line simple aspiration is noninferior to first-line chest tube drainage for lung expansion in patients with complete primary spontaneous pneumothorax. Methods: We conducted a prospective, open-label, randomized noninferiority trial. Adults aged 18-50 years with complete primary spontaneous pneumothorax (total separation of the lung from the chest wall), recruited at 31 French hospitals from 2009 to 2015, received simple aspiration (n = 200) or chest tube drainage (n = 202) as first-line treatment. The primary outcome was pulmonary expansion 24 hours after the procedure. Secondary outcomes were tolerance of treatment, occurrence of adverse events, and recurrence of pneumothorax within 1 year. Substantial discordance in the numerical inputs used for trial planning and the actual trial rates of the primary outcome resulted in a reevaluation of the trial analysis plan. Measurement and Main Results: Treatment failure occurred in 29% in the aspiration group and 18% in the chest tube drainage group (difference in failure rate, 0.113; 95% confidence interval [CI], 0.026-0.200). The aspiration group experienced less pain overall (mean difference, -1.4; 95% CI, -1.89, -0.91), less pain limiting breathing (frequency difference, -0.18; 95% CI, -0.27, -0.09), and less kinking of the device (frequency difference, -0.05; 95% CI, -0.09, -0.01). Recurrence of pneumothorax was 20% in this group versus 27% in the drainage group (frequency difference, -0.07; 95% CI, -0.16, +0.02). Conclusions: First-line management of complete primary spontaneous pneumothorax with simple aspiration had a higher failure rate than chest tube drainage but was better tolerated with fewer adverse events. Clinical trial registered with www.clinicaltrials.gov (NCT01008228).
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Affiliation(s)
| | - Luc-Marie Joly
- Service d'accueil des urgences, Centre hospitalier universitaire de Rouen, Rouen, France
| | | | - Jean-Baptiste Pretalli
- Centre Investigation Clinique INSERM 1431, Centre hospitalier universitaire de Besançon, Besançon, France
| | | | - Jean-Claude Meurice
- Service de pneumologie, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Jeannot Schmidt
- Service d'accueil des urgences, Centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Gilbert Ferretti
- Service de radiologie diagnostic et thérapeutique, Centre hospitalier universitaire de Grenoble, Grenoble, France
| | | | - Didier Honnart
- Service d'accueil des urgences, Centre hospitalier universitaire de Dijon, Dijon, France
| | - Faraj Al Freijat
- Service de pneumologie, Hôpital Nords Franche-Comté, Trévenans, France
| | - Alain Eric Dubart
- Service d'accueil des urgences, Centre hospitalier de Béthune, Béthune, France
| | - Romain Genre Grandpierre
- Service d'anesthésie et soins intensifs, Centre hospitalier universitaire de Nîmes, Nîmes, France
| | - Alain Viallon
- Service d'accueil des urgences, Centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Dominique Perdu
- Service de pneumologie, Centre hospitalier universitaire de Reims, Reims, France
| | - Pierre Marie Roy
- Service d'accueil des urgences, Centre hospitalier universitaire d'Angers, Angers, France
| | - Toufiq El Cadi
- Service d'accueil des urgences, Groupe hospitalier de la Haute-Saône, Vesoul, France
| | - Nathalie Bronet
- Service d'accueil des urgences, Centre hospitalier Saint-Philibert-GHICL, Lomme, France
| | - Grégory Duncan
- Service d'accueil des urgences, Centre hospitalier Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Gilles Cardot
- Service de chirurgie thoracique, Centre hospitalier Duchenne, Boulogne-sur-Mer, France; and
| | - Philippe Lestavel
- Service de soins intensifs, Polyclinique de Hénin-Beaumont, Hénin-Beaumont, France
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Huerta CT, Saberi RA, Gilna GP, Ramsey WA, Kodia K, Parreco J, Thorson CM, Sola JE, Perez EA. Primary Spontaneous Pneumothorax Outcomes in Children: A National Analysis. Innovations (Phila) 2023; 18:175-184. [PMID: 37042098 DOI: 10.1177/15569845231166929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE Considerable variation in primary spontaneous pneumothorax (PSP) management exists in the pediatric population. This study aims to compare nationwide outcomes of children with PSP. METHODS The Nationwide Readmissions Database (2016 to 2018) was used to identify patients 1 to 18 years old with PSP. Trauma, secondary pneumothoraces, and elective admissions were excluded. Demographics and complications were compared among patients undergoing initial nonoperative management (NOM; observation or percutaneous drainage) or operative resection using standard statistical tests. RESULTS A total of 3,890 patients were identified with PSP (median age, 16 [interquartile range 14 to 17] years). Most (78%) underwent NOM, of which 17% failed requiring operative resection. Of the intent-to-treat cohort, 28% failed NOM during index admission or required repeat percutaneous drainage or operative resection on readmission. Patients treated by NOM had higher 30-day and overall readmission rates compared with operative resection (all P < 0.001). Ipsilateral recurrent pneumothorax was higher in those receiving NOM (13% vs 3%, P < 0.001). Patients from the lowest median household income quartile more frequently received NOM compared with the highest income quartile (82% vs 76%) with more readmissions. CONCLUSIONS Patients with PSP who underwent initial NOM experienced higher readmission rates than those receiving operative resection. Furthermore, socioeconomic status was associated with the utilization of nonoperative versus operative management.
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Affiliation(s)
| | | | | | | | | | | | | | - Juan E Sola
- University of Miami Miller School of Medicine, FL, USA
| | - Eduardo A Perez
- University of Miami Miller School of Medicine, FL, USA
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, FL, USA
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Elkhouly AG, Karamustafaoglu YA, Galvez C, Rao M, Lerut P, Grimonprez A, Akar FA, Peer M, Bedetti B, Tosi D, Turna A, Elkahwagy M, Pompeo E. Nonintubated versus intubated thoracoscopic bullectomy for primary spontaneous pneumothorax: A multicenter propensity-matched analysis. Asian Cardiovasc Thorac Ann 2022; 30:1010-1016. [PMID: 36163699 DOI: 10.1177/02184923221129239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed at comparing in a multicenter propensity-matched analysis, results of nonintubated versus intubated video-assisted thoracic surgery (VATS) bullectomy/blebectomy for primary spontaneous pneumothorax (PSP). METHODS Eleven Institutions participated in the study. A total of 208 patients underwent VATS bullectomy by intubated (IVATS) (N = 138) or nonintubated (NIVATS) (N = 70) anesthesia during 60 months. After propensity matching, 70 pairs of patients were compared. Anesthesia in NIVATS included intercostal (N = 61), paravertebral (N = 5) or thoracic epidural (N = 4) block and sedation with (N = 24) or without (N = 46) laryngeal mask under spontaneous ventilation. In the IVATS group, all patients underwent double-lumen-intubation and mechanical ventilation. Primary outcomes were morbidity and recurrence rates. RESULTS There was no difference in age (26.7 ± 8 vs 27.4 ± 9 years), body mass index (19.7 ± 2.6 vs 20.6 ± 2.5), and American Society of Anesthesiology score (2 vs 2). Main results show no difference both in morbidity (11.4% vs 12.8%; p = 0.79) and recurrence free rates (92.3% vs 91.4%; p = 0.49) between NIVATS and IVATS, respectively, whereas a difference favoring the NIVATS group was found in anesthesia time (p < 0.0001) and operative time (p < 0.0001), drainage time (p = 0.001), and hospital stay (p < 0.0001). There was no conversion to thoracotomy and no hospital mortality. One patient in the NIVATS group needed reoperation due to chest wall bleeding. CONCLUSION Results of this multicenter propensity-matched study have shown no intergroup difference in morbidity and recurrence rates whereas shorter operation room time and hospital stay favored the NIVATS group, suggesting a potential increase in the role of NIVATS in surgical management of PSP. Further prospective studies are warranted.
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Affiliation(s)
| | | | | | - Madhuri Rao
- 14400University of Minnesota, Minneapolis, USA
| | | | | | - Firas Abu Akar
- Thoracic Surgery Unit, 58883Edith Wolfson Medical Center, Holon, Tel-Aviv, Israel
| | | | | | - Davide Tosi
- 9339Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy
| | - Akif Turna
- I.Ü. Cerrahpasa, 64298Istanbul University, Istanbul, Turkey
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Magnadottir T, Heitmann LA, Arnardottir TH, Kristjansson TT, Silverborn PM, Sigurdsson MI, Gudbjartsson T. [Short- and long-term outcomes following surgery for primary spontaneous pneumothorax in Iceland]. LAEKNABLADID 2022; 108:299-305. [PMID: 35611981 DOI: 10.17992/lbl.2022.06.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is a common disease where surgery is indicated for persistant air leak or recurrent pneumothorax. We studied the outcomes of PSP-surgery over a 28 year period in a whole nation. MATERIALS AND METHODS A retrospective study on 386 patients (median age 24 years, 78% males) that underwent 430 PSP surgeries at Landspitali University Hospital 1991-2018. Annual incidence of the procedure was calculated and previous medical history, indication and type of surgery, complications and length of hospital stay were registered. Patients in four 7 year periods were compared, recurrent pneumothoraces requiring reoperation (median follow-up 16 years) registered and predictors of reoperation identified with logistic regression. RESULTS Annually 14.5 PSP surgeries (median, range 9-27) were performed; the incidence decreasing by 2.9% per year on average. Every other patient smoked and 77% of surgeries were performed with video assisted thoracocopic surgery (VATS). The most common early complications (p<30 days from surgery) were persistent airleak (17%), pneumonia (2%) and empyema (0,5%). No patient died within 30 days from surgery. Reoperation for recurrent pneumothorax was performed on 27 patients; 24 following VATS (7%), median time from the primary surgery being 16 months. Logistic regression showed that younger patients were more likely to require reoperation for recurrent pneumothorax. CONCLUSIONS Surgical treament for PSP is safe and major early complications rare. The rate of recurrent pneumothorax requiring surgery was 6%, which is similar to other studies. For unknown reasons the incidence of PSP surgery declined, but future research has to answer if it is linked to decreased smoking in the Icelandic population.
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Benhaïm E, Roth B, Michel F, Merrot T, Dubus J. Management of primary spontaneous pneumothorax in teenagers: An 11-year study. Acta Paediatr 2022; 111:845-849. [PMID: 34923666 DOI: 10.1111/apa.16223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
AIM Management of teenagers with primary spontaneous pneumothorax (PSP) is not consensual. We report our experience over an 11-year period. METHODS For each patient under 20 years hospitalised with PSP from 2008 to 2018, demographic data, smoking habits, clinical presentation, hospitalisation unit, radiological management and its results, therapeutic management (observation, needle aspiration, chest tube drainage and surgery), complications, length of stay, given advice at discharge and recurrence were collected. RESULTS Seventy patients were included in different paediatric or adult surgery or pulmonology wards (82.9% boys; 16.8 ± 1.7 years; one severe presentation; 18/58 smokers). Chest CT-scan (n = 42/70, 60%) revealed blebs/bullae in 18/39 examinations (46.2%). Treatment consisted of observation (14/70, 20%), needle aspiration (2/70, 2.9%), chest tube (53/70, 75.7%) and video-assisted thoracoscopy surgery (27/70, 38.6%). Half patients with interventional procedure presented complications. A median of 10 chest X-rays was noted during a median stay of 8 days. Advice concerning sport practice, flying, smoking, etc., was variably delivered. PSP recurrence concerned 35/70 patients (50%) without identified predictive factors. CONCLUSION Compared to recent recommendations of a more conservative approach, chest CT-scan and interventional strategy are overused in our teenagers with PSP. Observation, more or less needle aspiration, should be clearly the first-line treatments.
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Affiliation(s)
- Eve Benhaïm
- Unité de Pneumologie Pédiatrique Centre Hospitalo‐Universitaire (CHU) Timone‐Enfants Marseille France
| | - Brimbelle Roth
- Département de Santé Publique Centre Hospitalo‐Universitaire (CHU) de la Conception Marseille France
| | - Fabrice Michel
- Unité d’Anesthésie‐Réanimation Pédiatrique Centre Hospitalo‐Universitaire (CHU) Timone‐Enfants Marseille France
| | - Thierry Merrot
- Département de Chirurgie Viscérale Pédiatrique Centre Hospitalo‐Universitaire (CHU) Timone‐Enfants Marseille France
| | - Jean‐Christophe Dubus
- Unité de Pneumologie Pédiatrique Centre Hospitalo‐Universitaire (CHU) Timone‐Enfants Marseille France
- Aix Marseille Université IRD AP‐HM MEPHI IHU‐Méditerranée Infection Marseille France
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Muhetaer M, Paerhati K, Sun Q, Li D, Zong L, Zhang H, Zhang L. Effects of Different Treatment Regimens on Primary Spontaneous Pneumothorax: A Systematic Review and Network Meta-Analysis. Ann Thorac Cardiovasc Surg 2022; 28:389-402. [PMID: 36002271 PMCID: PMC9763716 DOI: 10.5761/atcs.oa.22-00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The best treatment strategy for primary spontaneous pneumothorax is controversial and varies widely in practice. METHODS Literatures were searched from databases till 24 August 2021. A Bayesian network meta-analysis was conducted to compare the outcomes of various treatments with the following endpoints: recurrence rate, postoperative chest tube duration, postoperative air leakage duration, length of hospital stay, and complications rate. RESULTS In all, 7210 patients of 20 randomized controlled trials and 17 cohort studies were included. Surgery had a significantly lower recurrence rate compared to other treatments. Besides, bullectomy (BT) combined with chemical pleurodesis (CP), mechanical pleurodesis, or staple line coverage (SLC) can reduce the recurrence rate compared to BT alone, but none of them were statistically significant. In terms of reducing chest tube duration, BT with tubular Neoveil outperformed BT + pleural abrasion (mean difference [MD], 95% confidence interval [CI]: -2.5 [-4.63, -0.35]) and BT + apical pleurectomy (MD, 95% CI: -2.72 [-5.16, -0.27]). CONCLUSIONS Surgical methods were superior to manual aspiration (MA), chest tube drainage (CTD), and conservative treatment in terms of recurrence reduction. There was no significant difference between MA and CTD in reducing the recurrence rate. Among surgical methods, CP is more effective than mechanical pleurodesis and SLC among the additional procedures based on BT.
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Affiliation(s)
- Muredili Muhetaer
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China,The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Keriman Paerhati
- The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Qingchao Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Desheng Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Liang Zong
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Haiping Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Liwei Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China,Corresponding author: Liwei Zhang. Department of Thoracic Surgery, The First Affiliated Hospital, Xinjiang Medical University, Urümqi, 830011, China
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Spezzotto G, Boscarelli A, Giangreco M, Ceschiutti G, Codrich D, Scarpa MG, Iaquinto M, Olenik D, Guida E, Schleef J. Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study. Front Pediatr 2022; 10:945641. [PMID: 35832585 PMCID: PMC9271819 DOI: 10.3389/fped.2022.945641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The management of primary spontaneous pneumothorax (PSP) in pediatrics remains controversial. The aim of this study was to investigate the risk of recurrence after non-surgical treatment vs. surgery, the difference in the length of stay (LOS) between various treatment options, and the role of computed tomography (CT) in the management of PSP. MATERIALS AND METHODS We retrospectively reviewed patients admitted to our Pediatric Surgery Unit for an episode of PSP between June 2009 and July 2020. Medical records including clinical presentation at admission, diagnostics, treatments, complications, and LOS were collected. RESULTS Twenty-three patients (22 males and 1 female) were included in this study. Median age was 15.65 (range 9-18). Chest X-rays were performed in all patients and showed 5 small (22%) and 18 large (78%) PSP. Chest drain was used for large PSP (≥2 cm) if the patient was clinically unstable. Eleven patients (48%) were managed non-operatively with observation alone and a recurrence rate of 18%, chest drain was used in 11 patients with a recurrence rate of 36%, and surgery was deemed necessary as a first treatment choice in one case. Six patients (27%) had an episode of relapse after non-operative management or chest drain placement. Following surgery, a relapse occurred in 2 of the 6 patients. Chest drain insertion was associated with a longer LOS than observation alone (6.36 vs. 2.4 days), and surgery resulted in a longer LOS than other types of treatment (P = 0.001). CONCLUSION According to our experience, small PSP or clinically stable larger PSP can be treated conservatively with observation alone. Operative management should be taken into consideration in children with large symptomatic PSP, persistent air leak, and/or relapse after chest drain insertion.
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Affiliation(s)
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giulia Ceschiutti
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marianna Iaquinto
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Surgical Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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Fung S, Alexander A, Ashmawy H, Dizdar L, Safi S, Rehders A, Fluegen G, Knoefel WT. Socioeconomic Impact of Recurrent Primary Spontaneous Pneumothorax: Should Video-Assisted Thoracoscopic Surgery Be Considered at First Episode of Primary Spontaneous Pneumothorax? Healthcare (Basel) 2021; 9:healthcare9091236. [PMID: 34575010 PMCID: PMC8466303 DOI: 10.3390/healthcare9091236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Current guidelines recommend video-assisted thoracoscopic surgery (VATS) for recurrent primary spontaneous pneumothorax (PSP) and for cases with persistent air leak after chest tube treatment. The socioeconomic impact of recurrent PSP on the healthcare system is insufficiently reported. METHODS Ninety-six patients treated for PSP between 01/2010 and 01/2020 were included. Forty-eight patients underwent primary VATS, while the second group received chest tube (CT) treatment only. Length of hospital stay (LOS), duration of chest tube, prolonged air leak, postoperative complications, recurrences and treatment costs were analyzed. RESULTS Prolonged air leaks were evident in 12.5% and 22.9% patients of the VATS and CT group, respectively. Ten (20.8%) patients in the CT group underwent VATS for persistent air leakage. During follow-up, the VATS group recurred at 8.3% compared to 52.1% in the CT group. The total cost of treatment per patient, including treatment cost due to recurrence, was EUR 1.501 in the VATS group and EUR 2.233 in the CT group. CONCLUSIONS Primary treatment of PSP by CT is associated with an increased socioeconomic burden for patients and the healthcare system due to high recurrence rates. This burden may be reduced if VATS is considered at the first episode of PSP.
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Klin B, Gueta I, Bibi H, Baram S, Abu-Kishk I. Electrocardiographic changes in young patients with spontaneous pneumothorax: A retrospective study. Medicine (Baltimore) 2021; 100:e26793. [PMID: 34397732 PMCID: PMC8322562 DOI: 10.1097/md.0000000000026793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/11/2021] [Indexed: 01/04/2023] Open
Abstract
Primary spontaneous pneumothorax (PSP) commonly occurs in adolescents. PSP symptoms can mimic cardiac event. We aimed to examine electrocardiography (ECG) changes that accompanied PSP in relation to side and size of pneumothorax.A retrospectively reviewed 57 adolescents presented with PSP and underwent a cardiac evaluation.Overall, 49 patients (86%) were male, median age of 16 years. Of these, 1 patient had a known mitral valve prolapse. In 56 patients the initial episode of PSP was unilateral (16 left sided and 40 right sided), and 1 was bilateral. The main initial symptom was chest pain or dyspnea and chest pain 66.6% and 33.3% respectively. Small pneumothorax was right and left sided in 1and 8 patients respectively, medium right (n = 8) medium left (n = 22), large right (n = 7) and large left (n = 10). One additional patient had medium bilateral pneumothorax. ECG findings were abnormal in 12 patients (21%) and included ST elevation in 5 patients, inverted T wave in 2 patients, incomplete right bundle branch block in 2 patients, poor R wave progression, left axis deviation and low QRS voltage in 1 patient each. Only 2 patients had abnormal echocardiography findings, MPV (n = 1) and minimal mitral and tricuspid regurgitation (n = 1). Serum troponin-T levels were normal in all patients.ECG changes were found in 21% among pediatric patients with PSP. No correlation was observed between ECG changes and side/size of pneumothorax. It is important to rule out pneumothorax among children presented with chest pain, dyspnea and ECG changes.
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Affiliation(s)
- Baruch Klin
- Pediatric Division, Shamir Medical Center (Assaf Harofeh), Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itai Gueta
- The Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Bibi
- Pediatric Division, Shamir Medical Center (Assaf Harofeh), Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shaul Baram
- Pediatric Division, Shamir Medical Center (Assaf Harofeh), Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ibrahim Abu-Kishk
- Pediatric Division, Shamir Medical Center (Assaf Harofeh), Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Vayvada M, Tezel Y, Tezel Ç. Is it a myth to perform blind apical wedge resection in primary spontaneous pneumothorax surgery to improve recurrence rates? J Minim Access Surg 2021; 18:279-283. [PMID: 33885029 PMCID: PMC8973495 DOI: 10.4103/jmas.jmas_269_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Video-assisted thoracoscopy surgery (VATS) is the first method for the surgical treatment of primary spontaneous pneumothorax (PSP). Many surgeons traditionally performed bullectomy or wedge resection (WR) in addition to mechanical or chemical pleurodesis. Our study aimed to determine whether WR was necessary without seeing bleb or bullae during the surgery. Methods: Patients with no bleb or bullae detected during surgery were included in the study. Apical pleurectomy was performed in all cases. The patients were divided into two groups as WR and non-WR. The minimum follow-up period was 24 months. Medical records of patients were evaluated retrospectively. Patients who could not be followed up were excluded from the study. Results: A total of 104 surgical treatments of PSP were performed, WR was not performed in 70 cases (67.3%). The surgical time was statistically significantly longer in the WR group than in the non-WR group. There was no statistically significant difference between the two groups in terms of drainage amount, drain removal time, length of hospital stay and bleeding requiring thoracotomy. Prolonged air leak was more common in the non-WR group than in the WR group (7.1% vs. 2.9%; P = 0.661). There was no difference in the rate of recurrence in either group. Recurrence was 2.9% (1/34) in the WR group and 2.9% (2/70) in the non-WR group. Conclusion: In VATS of PSP, blind apical WR without bleb or bullae reduced prolonged air leakage but did not contribute to lowering the rate of pneumothorax recurrence.
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Affiliation(s)
- Mustafa Vayvada
- Department of Thoracic Surgery, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Yelda Tezel
- Department of Chest Diseases, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Çağatay Tezel
- Department of Thoracic Surgery, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Rathi V, Madan K, Mohan A, Hadda V, Mittal S. Ambulatory management of primary spontaneous pneumothorax: the jury is still out. Adv Respir Med 2021; 89:225-226. [PMID: 33559124 DOI: 10.5603/arm.a2020.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Vidushi Rathi
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, India.
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Cattoni M, Rotolo N, Mastromarino MG, Cardillo G, Nosotti M, Mendogni P, Rizzi A, Raveglia F, Siciliani A, Rendina EA, Cagini L, Matricardi A, Filosso PL, Passone E, Margaritora S, Vita ML, Bertoglio P, Viti A, Dominioni L, Imperatori A. Chronic chest pain and paresthesia after video-assisted thoracoscopy for primary pneumothorax. J Thorac Dis 2021; 13:613-620. [PMID: 33717534 PMCID: PMC7947510 DOI: 10.21037/jtd-20-2860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background This study aims to identify clinical and surgical risk factors for chronic chest pain and paresthesia after video thoracoscopic surgery for primary spontaneous pneumothorax. Methods We retrospectively collected the data of 1,178 consecutive patients <40-years-old undergoing video thoracoscopic surgery for primary spontaneous pneumothorax in 9 Italian centers in 2007–2017. Cases with <2-month follow-up were excluded, leaving 920 patients [80% male; median age: 21 (IQR, 18–27) years] for statistical analysis. The following risk factors for chronic chest pain and chronic paresthesia were assessed by univariable and multivariable Cox regression model: age, gender, cannabis smoking, video thoracoscopy ports number, pleurodesis technique (partial pleurectomy/pleural electrocauterization/pleural abrasion/talc poudrage), chest tube size (24/28 F), postoperative chest tube stay. Results Blebs/bullae resection with pleurodesis was performed in 732 (80%) cases; pleurodesis alone in 188 (20%). During a median follow-up of 68 (IQR: 42–95) months, chronic chest pain developed in 8% of patients, chronic chest paresthesia in 22%; 0.5% of patients regularly assumed painkillers. Chronic chest pain was independently associated with partial pleurectomy/pleura abrasion (P<0.001) and postoperative chest tube stay (P=0.019). Chronic chest paresthesia was independently associated with pleurodesis by partial pleurectomy (P<0.001), chest tube stay (P=0.035) and 28 F chest tube (P<0.001). Conclusions After video thoracoscopic surgery for primary spontaneous pneumothorax, the incidence of chronic chest pain and paresthesia was significantly lower when pleurodesis was performed by pleural electrocauterization or talc poudrage, and chest tube was removed early. A 24 F chest tube was associated with lower risk of chronic chest paresthesia.
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Affiliation(s)
- Maria Cattoni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Regional Hospital San Camillo-Forlanini, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Rizzi
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | - Federico Raveglia
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | | | | | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Alberto Matricardi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Erika Passone
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella,Verona, Italy
| | - Andrea Viti
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella,Verona, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Chiu CY, Chen JR, Yin SY, Wang CJ, Chen TP, Hsieh TY. Histopathologic Findings Associated With Matrix Metalloproteinases Proceeding to Recurrence of Primary Spontaneous Pneumothorax in Adolescents. Front Pediatr 2021; 9:788336. [PMID: 34926357 PMCID: PMC8671608 DOI: 10.3389/fped.2021.788336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Primary spontaneous pneumothorax is potentially life-threatening, and its recurrence is always a serious problem. Pathological examination provides molecular insights into the pathophysiology of primary spontaneous pneumothorax. Objectives: To investigate the association of histopathologic features of primary spontaneous pneumothorax with matrix metalloproteinase expression and their relevance to the recurrence. Methods: A total of 217 tissue section slides in 172 adolescent patients with primary spontaneous pneumothorax were retrospectively reviewed from January 2001 to June 2020. All histopathologic features were recorded and pathologic findings related to ipsilateral recurrence and second surgery were analyzed. Serum levels of matrix metalloproteinases were prospectively measured in 25 primary spontaneous pneumothorax patients receiving surgery and 18 healthy controls. Their relevance to the histopathologic features of primary spontaneous pneumothorax related to its recurrence was also examined. Results: The major presenting histopathologic findings of primary spontaneous pneumothorax were bleb/bulla (98%) followed by fibrosis (68%). Low prevalence of the pathologic findings of granulation tissue and macrophage accumulation were significantly associated with recurrent primary spontaneous pneumothorax, whereas fibrosis was significantly higher in patients receiving more than once surgery. Furthermore, the ratios of matrix metalloproteinase-2/tissue inhibitor of metalloproteinase-1 and matrix metalloproteinase-9/tissue inhibitor of metalloproteinase-1 were significantly higher in theses pathological findings as well as multinucleated giant cells and mesothelial cell hyperplasia in comparison with healthy controls. Conclusions: Low prevalence of macrophage accumulation and granulation tissue related to the overexpression of matrix metalloproteinase-2 and-9 activities may contribute to healing impairment and primary spontaneous pneumothorax recurrence.
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Affiliation(s)
- Chih-Yung Chiu
- Department of Pediatrics and Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jim-Ray Chen
- Department of Pathology and Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Ying Yin
- Department of Surgery and Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chia-Jung Wang
- Department of Pediatrics and Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Ping Chen
- Department of Surgery and Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Tsan-Yu Hsieh
- Department of Pathology and Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Wang P, Zhang L, Zheng H, Yan D, Fan H, Liang H, Zhang J, Li Y. Comparison of single-port vs. two-port VATS technique for primary spontaneous pneumothorax. MINIM INVASIV THER 2020; 31:462-467. [PMID: 32852262 DOI: 10.1080/13645706.2020.1806077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has been used for thoracic surgery for about two decades. As the trend in VATS is to use fewer ports to decrease postoperative complications, we compared the results of our experience with single-port and two-port VATS for primary spontaneous pneumothorax (PSP). MATERIAL AND METHODS This is a non-randomized retrospective study. From January 2017 to December 2018, 104 patients with PSP underwent VATS. Fifty-six patients received single-port VATS and 48 patients received two-port VATS. Operation time, blood loss, number of staplers used, drainage time, postoperative hospital stay, complications, chest wall paresthesia, visual analog scale (VAS) pain scores, and patient satisfaction scale scores were compared between the two groups. RESULTS There was no difference in age, gender, body mass index (BMI), smoking status, surgical indication, and involved side between the two groups. The procedures performed in the single-port group were similar to those performed in the two-port group. No significant difference was found in operation time, blood loss, number of staplers used, drainage time, and recurrence rate. The rate of chest wall paresthesia was lower in the single-port group than in the two-port group (28.6 vs. 52.1%, p = .014). The VAS scores in the single-port group were lower than those in the two-port group at 24 and 48 h (p = .032 and p = .004). CONCLUSIONS Compared with two-port VATS, single-port VATS for PSP showed more favorable results in terms of postoperative paresthesia and pain. The single-port procedure may be considered a good alternative to the standard thoracoscopic treatment of PSP. Abbreviations: VATS: Video-assisted thoracic surgery; PSP: primary spontaneous pneumothorax.
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Affiliation(s)
- Peijie Wang
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China.,Department of Cardiothoracic Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Liang Zhang
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China
| | - Hongjie Zheng
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China
| | - Dongqing Yan
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China
| | - Haiyang Fan
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China
| | - Hongsen Liang
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China
| | - Junhang Zhang
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China
| | - Yun Li
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China
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Akıncı SM, Soyer T, Yalçın Ş, Ekinci S, Karnak İ, Çiftçi AÖ, Tanyel FC. The results and outcome of primary spontaneous pneumothorax in adolescents. Int J Adolesc Med Health 2020; 33:127-131. [PMID: 32549138 DOI: 10.1515/ijamh-2018-0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/09/2018] [Indexed: 11/15/2022]
Abstract
AIM Primary spontaneous pneumothorax (PSP) is a rare pulmonary pathology that occurs in the absence of known lung disease. A retrospective study was performed to evaluate the results and outcome of PSP treatment in adolescents. METHODS The cases with PSP from January 2004 to December 2017 were evaluated for age, sex, family and smoking history, clinical and radiological findings and results of treatment. RESULTS Ten cases with PSP were included. The mean age of the patients was 15 years (10-17 years) and the male to female ratio was 9:1. Two of the patients (20%) had family history of PSP and four cases (40%) had smoking history. The initial complaints were chest pain (n=8), acute onset of cough (n=1) and breathing difficulty (n=1). Tube thoracostomy was performed in nine cases in which three of them were bilateral. Chest computed tomography (CT) demonstrated bullae (n=4; 40%) and subpleural blebs (n=2; 20%). Pleurodesis with talc was performed in four patients with pneumothorax for longer than a week in follow-up (n=4; 40%). Five cases had recurrent PSP within one year (n=5; 50%) and underwent pleurodesis with talc (n=4), autologous-blood (n=1) and bleomycin (n=1). Bleb excision was performed in two cases with persistent pneumothorax despite pleurodesis. CONCLUSION Tube thoracostomy and oxygen supplementation, are considered as initial and adequate treatment of PSP in most of the adolescents. Prolonged air leaks require pleurosdesis as the first line treatment and surgical excision of blebs should be reversed for the patients who are unresponsive to other treatment options.
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Affiliation(s)
- Servet Melike Akıncı
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Şule Yalçın
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - İbrahim Karnak
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Arbay Özden Çiftçi
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Feridun Cahit Tanyel
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Liu Y, Cheng J, Xu J, Yu J, Zhao L, Zhao K, Chen B. Correlation between Sternal Slope Angle and Primary Spontaneous Pneumothorax in Young Males, a Propensity Score Match Analysis. Clin Anat 2020; 33:605-609. [PMID: 31444881 DOI: 10.1002/ca.23461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/28/2019] [Accepted: 08/17/2019] [Indexed: 02/05/2023]
Abstract
It is generally accepted that primary spontaneous pneumothorax (PSP) is found mostly in tall, thin young males. However, the precise etiology of PSP is unclear. We compared some thoracic structural angles of PSPs and controls in young males to determine the predominant factor. CT data of 43 male PSPs (age 21.88 ± 5.30) and 30 controls (age 21.47 ± 5.47) were collected. The angle of thoracic vertebrae slope (∠α), sternal slope angle (∠β), and tracheal-sternal stem angle (∠γ) were measured in the sagittal position. Carina angle (∠δ) was measured in the coronal position. After a propensity score match (PSM) of age and smoking history, the angles were comparatively evaluated. There were significant differences in all four angles between two unmatched groups, while only in three (∠β, ∠γ, and ∠δ) after PSM was performed. The correlation between ∠β and PSP was most significant, and R2 was 0.456. The prediction accuracy of ∠β was 81.3%, OR was 1.386, 95% confidence interval was (1.095-1.754). The sternal slope angles in PSPs are greater than controls indicate the sternal slope angle is associates with the development of PSP and it could be a thoracic structural index to predict the risk of PSP occurrence. Clin. Anat. 33:605-609, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Yong Liu
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cheng
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahang Xu
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junjie Yu
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Zhao
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Zhao
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baojun Chen
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Liu YW, Chang PC, Chang SJ, Chiang HH, Li HP, Chou SH. Simultaneous bilateral thoracoscopic blebs excision reduces contralateral recurrence in patients undergoing operation for ipsilateral primary spontaneous pneumothorax. J Thorac Cardiovasc Surg 2020; 159:1120-1127.e3. [PMID: 31606164 DOI: 10.1016/j.jtcvs.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/23/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Contralateral recurrence in patients with primary spontaneous pneumothorax is approximately 15%. If positive for blebs, the recurrence rate increases to 26%. This study seeks to determine whether simultaneous contralateral video-assisted thoracic surgery blebs excision would effectively lower the contralateral incidence of pneumothorax in patients undergoing surgery for ipsilateral primary spontaneous pneumothorax. METHODS Between January 2009 and December 2015, 335 patients with primary spontaneous pneumothorax, surgically treated in a single institution, were retrospectively studied. The median follow-up was 75 (50-99) months. All patients received video-assisted thoracic surgery blebectomy/bullectomy with pleural abrasions. They were classified into 3 groups: (1) ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae included 142 patients with ipsilateral primary spontaneous pneumothorax without contralateral blebs/bullae only receiving ipsilateral video-assisted thoracic surgery; (2) ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae included 123 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving only ipsilateral video-assisted thoracic surgery; and (3) bilateral video-assisted thoracic surgery with contralateral blebs/bullae included 70 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving 1-stage bilateral video-assisted thoracic surgery. Demographic data, perioperative details, recurrence patterns, recurrence-free survivals, and risk factors were compared. RESULTS The percentage of contralateral recurrence for the ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae, ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae, and bilateral video-assisted thoracic surgery with contralateral blebs/bullae groups differed significantly (0.7%, 14.6%, and 2.9%, respectively; P = .002). Multivariate analysis using the Cox proportional hazard model revealed that age less than 18 years (hazard ratio, 2.71; 95% confidence interval, 1.14-6.44; P = .024) and ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae (hazard ratio, 22.13, 95% confidence interval, 2.96-165, P = .003) were predictors of contralateral recurrence, of which recurrence-free survival was notably different among groups as determined by Kaplan-Meier analysis (P < .0001). CONCLUSIONS Simultaneous contralateral blebectomy in patients with primary spontaneous pneumothorax receiving ipsilateral video-assisted thoracic surgery significantly lowered future contralateral recurrence.
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Affiliation(s)
- Yu-Wei Liu
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shun-Jen Chang
- Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Hung-Hsing Chiang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsien-Pin Li
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Surgery, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.
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25
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Abstract
OBJECTIVE This study aimed to promote an understanding of spontaneous pneumothorax by analysing the prevalence rate and medical service use by patients with spontaneous pneumothorax according to sociodemographic characteristics. DESIGN A 12-year nationwide study. SETTING Data obtained from the Korean National Health Insurance Service Sharing Service. PARTICIPANTS A total of 4658 participants who used medical services due to spontaneous pneumothorax between 2002 and 2013 in Korea. OUTCOME MEASURES For those diagnosed with spontaneous pneumothorax, use of medical services, hospitalisation data, sociodemographics, comorbidity, treatment administered and medication prescribed were recorded. RESULTS The annual prevalence of spontaneous pneumothorax ranged from 39 to 66 per 100 000 individuals, while the prevalence of hospitalisation due to spontaneous pneumothorax ranged from 18 to 36 per 100 000 individuals. The prevalence rate of spontaneous pneumothorax in Korea has increased since 2002. The male to female ratio was approximately 4-10:1, with a higher prevalence rate in men. By age, the 15-34 years old group, and particularly those aged 15-19 years old, showed the highest prevalence rate; the rate then declined before increasing again for those aged 65 years or older. In total, 47%-57% of patients with spontaneous pneumothorax underwent hospitalisation. The average number of rehospitalisations due to pneumothorax was 1.56 per person, and more than 70% of recurrences occurred within 1 year. Chronic obstructive pulmonary disease was the most common comorbidity. The average treatment period was 11 days as an outpatient and 14 days in-hospital. The average medical costs were $94.50 for outpatients and $2523 for hospital admissions. The most common treatment for spontaneous pneumothorax was oxygen inhalation and thoracostomy, and the most commonly prescribed medications were analgesics, antitussives and antibiotics. CONCLUSIONS We here detailed the epidemiology and treatments for spontaneous pneumothorax in Korea. This information can contribute to the understanding of spontaneous pneumothorax.
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Affiliation(s)
- Doori Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea (the Republic of)
| | - Boyoung Jung
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea (the Republic of)
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, Korea (the Republic of)
| | - Seol-Hee Chung
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, Korea (the Republic of)
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea (the Republic of)
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea (the Republic of)
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26
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Liu Y, Cheng J, Xu J, Yu J, Zhao L, Zhao K, Chen B. Correlation between Sternal Slope Angle and Primary Spontaneous Pneumothorax in Young Males, a Propensity Score Match Analysis. Clin Anat 2019. [PMID: 31444881 DOI: 10.1002/ca.23461.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is generally accepted that primary spontaneous pneumothorax (PSP) is found mostly in tall, thin young males. However, the precise etiology of PSP is unclear. We compared some thoracic structural angles of PSPs and controls in young males to determine the predominant factor. CT data of 43 male PSPs (age 21.88 ± 5.30) and 30 controls (age 21.47 ± 5.47) were collected. The angle of thoracic vertebrae slope (∠α), sternal slope angle (∠β), and tracheal-sternal stem angle (∠γ) were measured in the sagittal position. Carina angle (∠δ) was measured in the coronal position. After a propensity score match (PSM) of age and smoking history, the angles were comparatively evaluated. There were significant differences in all four angles between two unmatched groups, while only in three (∠β, ∠γ, and ∠δ) after PSM was performed. The correlation between ∠β and PSP was most significant, and R2 was 0.456. The prediction accuracy of ∠β was 81.3%, OR was 1.386, 95% confidence interval was (1.095-1.754). The sternal slope angles in PSPs are greater than controls indicate the sternal slope angle is associates with the development of PSP and it could be a thoracic structural index to predict the risk of PSP occurrence. Clin. Anat. 33:605-609, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Yong Liu
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cheng
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahang Xu
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junjie Yu
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Zhao
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Zhao
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baojun Chen
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Plojoux J, Froudarakis M, Janssens JP, Soccal PM, Tschopp JM. New insights and improved strategies for the management of primary spontaneous pneumothorax. Clin Respir J 2019; 13:195-201. [PMID: 30615303 DOI: 10.1111/crj.12990] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/14/2018] [Accepted: 12/24/2018] [Indexed: 12/22/2022]
Abstract
The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema-like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta-analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of 'at risk patients' is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost-effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.
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Affiliation(s)
- Jérôme Plojoux
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Jean-Paul Janssens
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Paola M Soccal
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Department of Internal Medicine, Montana, Switzerland
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Ganaie MB, Maqsood U, Lea S, Bankart MJ, Bikmalla S, Afridi MA, Khalil MA, Hussain I, Haris M. How should complete lung collapse secondary to primary spontaneous pneumothorax be managed? . Clin Med (Lond) 2019; 19:163-168. [PMID: 30872304 PMCID: PMC6454361 DOI: 10.7861/clinmedicine.19-2-163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Management of primary spontaneous pneumothorax (PSP) depends on the symptoms and size of lung collapse. The British Thoracic Society recommends needle aspiration (NA) for all PSP requiring intervention, followed by intercostal drain (ICD) if NA fails. We compared the role of NA versus ICD as the first step in PSP with 'complete lung collapse'.This was a retrospective observational study of 877 consecutive pneumothorax episodes at University Hospitals of North Midlands, Stoke on Trent, UK. Chest X-ray (CXR) at presentation was reviewed to identify PSP with complete lung collapse. The primary outcome measure was successful lung re-inflation after initial intervention.Two-hundred and sixty-six PSP patients were identified; 69 had complete lung collapse on CXR of which 35 had NA and 34 had ICD. The ICD group had a significantly better immediate success compared with the NA group (62% versus 11%, odds ratio (OR) = 12.5, p<0.0001; after adjustment for potential confounders, OR increased to 26.4, p=0.0001) although long-term outcomes were comparable.There should be clear consensus on definition and management of complete lung collapse. PSP with complete lung collapse could be managed as a separate subgroup where ICD placement is considered to be the first intervention.
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Affiliation(s)
| | - Usman Maqsood
- Sandwell and West Birmingham Hospitals, West Bromwich, UK
| | - Simon Lea
- Royal Stoke University Hospital, Stoke-on-Trent, UK
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Khan F, Vali Y, Naeem M, Reddy R. Safety and efficacy of ambulatory management of secondary spontaneous pneumothorax: a case series. BMJ Open Respir Res 2019; 6:e000373. [PMID: 30956801 PMCID: PMC6424293 DOI: 10.1136/bmjresp-2018-000373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/28/2019] [Accepted: 02/03/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction The optimal management of pneumothorax remains undefined. There is a growing consensus that patients with spontaneous pneumothorax can be considered for ambulatory management with the use of a one-way valve. Despite this, there is little data on the outcomes of outpatient management of secondary spontaneous pneumothorax (SSP). Methods At our institution, selected patients with primary and secondary spontaneous pneumothorax who meet the predefined local criteria are managed on an ambulatory pathway. We prospectively evaluated our practice over a 3-year period and explore outcomes of patients with SSP using primary spontaneous pneumothorax (PSP) as a comparator group. Results 163 consecutive patients presenting to our hospital between September 2014 and July 2017 were evaluated using a predefined protocol. 111 (49 SSP and 62 PSP) were deemed suitable for outpatient management. Resolution on day 5 was similar between the two groups (65% in the SSP vs 79% in the PSP group; p=0.108). The mean drainage time was 5.84 days in SSP compared with 5.69 days in PSP, representing a difference of 0.15 days (95% CI −2.47 to 2.16; p=0.897). Complications such as infection and drain blockage/falling-out were scarce, with comparable pain and satisfaction scores across both groups. There were no deaths during this period. An estimated £86 796 ($113 920) was saved over the study period, equating to £1118.80 ($1550) per patient. Discussion This study suggests that outpatient management of selected patients with SSP may be effective, safe and cost-saving.
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Affiliation(s)
- Fasih Khan
- Respiratory Medicine, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Yusuf Vali
- Respiratory Medicine, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Muhammad Naeem
- Respiratory Medicine, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Raja Reddy
- Respiratory Medicine, Kettering General Hospital NHS Foundation Trust, Kettering, UK
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Chiu CY, Chen TP, Chen JR, Wang CJ, Yin SY, Lai SH, Wong KS. Overexpression of matrix metalloproteinase-9 in adolescents with primary spontaneous pneumothorax for surgical intervention. J Thorac Cardiovasc Surg 2018; 156:2328-2336.e2. [PMID: 30033106 DOI: 10.1016/j.jtcvs.2018.05.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 05/06/2018] [Accepted: 05/09/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine gene expression profiles associated with bullae formation in patients with primary spontaneous pneumothorax and to identify candidate genes associated with surgical intervention. METHODS Twenty-four adolescents with primary spontaneous pneumothorax were enrolled prospectively. A global gene expression analysis of 9 paired lung biopsies (lesion and normal adjacent sites) was performed to identify differentially expressed genes associated with spontaneous pneumothorax. Pathway and network analysis was performed using the Database for Annotation, Visualization and Integrated Discovery web tool. Candidate genes and encoding proteins were assessed in blood samples and compared between patients with pneumothorax and healthy control patients. RESULTS A total of 1519 differentially expressed transcripts corresponding to known genes were identified comparing the lesion lung with paired adjacent normal lung. The altered genes were mainly associated with focal adhesion and extracellular matrix-receptor interaction pathways. Genes involved in proteolysis and peptidase activity were up-regulated predominantly, especially matrix metalloproteinase-1 and -9 genes. Compared with the recovery stage, blood levels of matrix metalloproteinase-9/tissue inhibitor of metalloproteinase-1 were increased at the acute stage in patients with pneumothorax and, when compared between patients treated operatively with those treated nonoperatively, were also significantly greater. In addition, ratios of their serum levels were significantly greater in patients with pneumothorax compared with healthy control patients. Furthermore, matrix metalloproteinase-9 was predominantly overexpressed in neutrophils, alveolar macrophages, and mesothelial cells of lung biopsies. CONCLUSIONS An imbalance of cell-extracellular matrix interactions appears to be associated with primary spontaneous pneumothorax. Matrix metalloproteinase-9 overexpression may particularly play a role in contributing to pleural porosity for surgical intervention.
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Affiliation(s)
- Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Ping Chen
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital at Keelung, Keelung City, Taiwan.
| | - Jim-Ray Chen
- Department of Pathology, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Jung Wang
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Ying Yin
- Department of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital at Keelung, Keelung City, Taiwan
| | - Shen-Hao Lai
- Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kin-Sun Wong
- Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Doğusoy I, Yıldırım M, Ustaalioğlu R, Demirbağ H. A comparison of axillary thoracotomy versus video-assisted thoracoscopic surgery in the surgical treatment of primary spontaneous pneumothorax. Turk Gogus Kalp Damar Cerrahisi Derg 2018; 26:132-7. [PMID: 32082722 DOI: 10.5606/tgkdc.dergisi.2018.15279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/05/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to compare the results of video-assisted thoracoscopic surgery and axillary thoracotomy in the surgical treatment of primary spontaneous pneumothorax. Methods Between January 2009 and December 2015, a total of 199 patients (178 males, 21 females; mean age 21.3±7.1 years; range 13 to 35 years) with primary spontaneous pneumothorax who were operated at Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Thoracic Surgery and Kadikoy and Kozyatagi Acibadem hospitals were retrospectively analyzed. Of these patients, 48 underwent axillary thoracotomy, wedge resection, apical pleurectomy, and tissue adhesives, while 151 were administered videoassisted thoracoscopic surgery, wedge resection, apical pleurectomy, and tissue adhesives. Both groups were compared in terms of age, gender, the amount of long-term analgesic use, duration of surgery, length of hospitalization, recurrence, complication, and mortality rates. Results The patients were followed for one year. No mortality was observed in any patient. There was no significant difference in the age and gender distributions of the patients, postoperative length of hospital stay, recurrence rates, and complication rates according to the type of operation. However, the duration of operation was longer in the videoassisted thoracoscopic surgery patients. Conclusion Video-assisted thoracoscopic surgery is associated with less pain and higher patient satisfaction and allows returning to daily activities in a shorter time period. Based on our study results, we suggest that video-assisted thoracoscopic surgery is more suitable, compared to axillary thoracotomy, owing to its advantages, such as being less invasive and providing a better angle of view.
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Rokicki W, Rokicki M, Wojtacha J, Filipowski M, Dżejlili A, Czyżewski D. Is it possible to standardize the treatment of primary spontaneous pneumothorax? Part 1: etiology, symptoms, diagnostics, minimally invasive treatment. Kardiochir Torakochirurgia Pol 2016; 13:322-7. [PMID: 28096829 DOI: 10.5114/kitp.2016.64874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Loung RPY, Cooney M, Fallon EM, Langer JC, Katzman DK. Pneumothorax in a young man with anorexia nervosa. Int J Eat Disord 2016; 49:895-8. [PMID: 27196534 DOI: 10.1002/eat.22558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 03/28/2016] [Accepted: 04/03/2016] [Indexed: 11/06/2022]
Abstract
Primary spontaneous pneumothorax (PSP) is defined as a pneumothorax that occurs in the absence of an external cause in an individual without underlying generalized lung disease. A number of factors are important and should be carefully considered in the pathogenesis of PSP. This is the first case report of a PSP in a severely malnourished adolescent male with anorexia nervosa (AN) who was involved in excessive physical activity. Clinicians caring for adolescents with AN and vigorous exercise need to be aware of the risk factors associated with the development of a PSP. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:895-898).
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Affiliation(s)
- Robert P Y Loung
- Department of Pediatrics, The Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.,The Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada
| | - Megan Cooney
- Department of Pediatrics, The Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.,The Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada
| | - Erica M Fallon
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada.,Department of General and Thoracic Surgery, Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada
| | - Jacob C Langer
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada.,Department of General and Thoracic Surgery, Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada
| | - Debra K Katzman
- Department of Pediatrics, The Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada. .,The Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada.
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Akkas Y, Peri NG, Kocer B, Kaplan T, Alhan A. A novel structural risk index for primary spontaneous pneumothorax: Ankara Numune Risk Index. Asian J Surg 2015; 40:249-253. [PMID: 26585811 DOI: 10.1016/j.asjsur.2015.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/11/2015] [Accepted: 09/16/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In this study, we aimed to reveal a novel risk index as a structural risk marker for primary spontanoeus pneumothorax using body mass index and chest height, structural risk factors for pneumothorax development. METHODS Records of 86 cases admitted between February 2014 and January 2015 with or without primary spontaneous pneumothorax were analysed retrospectively. The patients were allocated to two groups as Group I and Group II. The patients were evaluated with regard to age, gender, pneumothorax side, duration of hospital stay, treatment type, recurrence, chest height and transverse diameter on posteroanterior chest graphy and body mass index. Body mass index ratio per cm of chest height was calculated by dividing body mass index with chest height. We named this risk index ratio which is defined first as 'Ankara Numune Risk Index'. Diagnostic value of Ankara Numune Risk Index value for prediction of primary spontaneous pneumothorax development was analysed with Receiver Operating Characteristics curver. RESULTS Of 86 patients, 69 (80.2%) were male and 17 (19.8%) were female. Each group was composed of 43 (50%) patients. When Receiver Operating Characteristics curve analysis was done for optimal limit value 0.74 of Ankara Numune Risk Index determined for prediction of pneumothorax development risk, area under the curve was 0.925 (95% Cl, 0.872-0.977, p < 0.001). CONCLUSIONS Ankara Numune Risk Index is one of the structural risk factors for prediction of primary spontaneous pneumothorax development however it is insufficient for determining recurrence.
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Affiliation(s)
- Yucel Akkas
- Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, Turkey.
| | - Neslihan Gulay Peri
- Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Bulent Kocer
- Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Tevfik Kaplan
- Department of Thoracic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Aslihan Alhan
- Department of Statistics, Ufuk University Faculty of Arts and Science, Ankara, Turkey
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Mo A, Luo Y, Yang X, Mo S, Wu J, Wei Y. Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax. J Thorac Dis 2015; 7:704-10. [PMID: 25973237 PMCID: PMC4419305 DOI: 10.3978/j.issn.2072-1439.2015.04.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/09/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Like many other countries, including the United States, China faces the problem of rising health care costs, which have become a heavy burden on the state and individuals. Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Therefore, the development of video-assisted thoracic surgery with no disposable consumables will help to control medical cost escalation. METHODS Between October 2011 and September 2014, a series of 66 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad. RESULTS Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage, and postoperative stay between the two groups. The follow-up period varied from 1 to 35 months and six cases of recurrence were noted. CONCLUSIONS The technique that we described appears to offer better economic results than bullectomy with a stapler under three-port video-assisted thoracoscopic surgery for treating primary spontaneous. The clinical outcomes are similar.
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Affiliation(s)
- Ansheng Mo
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China
| | - Yuzhong Luo
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China
| | - Xiaoping Yang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China
| | - Shaoxiong Mo
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China
| | - Jun Wu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China
| | - Yitong Wei
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China
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Dhua A, Chaudhuri AD, Kundu S, Tapadar SR, Bhuniya S, Ghosh B, Mukherjee S, Bhattacharya S. Assessment of spontaneous pneumothorax in adults in a tertiary care hospital. Lung India 2015; 32:132-6. [PMID: 25814797 PMCID: PMC4372866 DOI: 10.4103/0970-2113.152622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Context: Pneumothorax continues to be a major cause of morbidity and mortality among respiratory patients, but there is a paucity of data regarding etiology, clinical profile, management, and outcome of spontaneous pneumothorax (SP), from this part of the world. Aims: To assess the patients of spontaneous pneumothorax in adults with special reference to the etiology, clinical presentation, management, and outcome of SP. Settings and Design: Prospective, observational study conducted in a tertiary care institution over a period of one year. Materials and Methods: All adult patients of SP attending the department of pulmonary medicine in a tertiary hospital were studied and detailed clinical, radiological, and management data were recorded and analyzed. Results: Sixty consecutive patients, who satisfied the inclusion criteria were included in the study. Among them 10 had primary spontaneous pneumothorax (PSP) and 50 had secondary spontaneous pneumothorax (SSP). The overall male to female ratio was 4:1. The mean age of the PSP patients was 26.3 ± 2.19 years, whereas, that of the SSP patients was 53.42 ± 2.07 years (P < 0.0001). Seventy percent of the patients were smokers. The most common clinical manifestation of PSP was chest pain (80%) in contrast to dyspnea in SSP (96%). The most common cause of SSP (42%) was found to be chronic obstructive pulmonary disease (COPD) followed by pulmonary tuberculosis (30%). The cases were managed with intercostal tube drainage (85%), simple aspiration (8.33%), and observation (6.67%). Full expansion of the lung was noted in 91.67% of the cases. Conclusion: Spontaneous pneumothorax was more common in men. SSP was far more common in this study, and the predominant underlying cause of SSP was COPD, which surpassed tuberculosis as the leading cause of SSP. This is in contrast to the results from previous studies done in our country. Intercostal tube drainage was the mainstay of treatment and the response was good.
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Affiliation(s)
- Aparup Dhua
- Department of Pulmonary Medicine, Midnapore Medical College, Midnapore, India
| | | | - Susmita Kundu
- Department of Pulmonary Medicine, RG Kar Medical College, Kolkata, India
| | - Sumit Roy Tapadar
- Department of Pulmonary Medicine, RG Kar Medical College, Kolkata, India
| | - Sourin Bhuniya
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bijan Ghosh
- Department of Medicine, Calcutta National Medical College, Kolkata, India
| | - Subhasis Mukherjee
- Department of Pulmonary Medicine, College of Medicine and Sagar Dutta Hospial, Kolkata, India
| | - Soumya Bhattacharya
- Department of Pulmonary Medicine, Bankura Sammilani Medical College and Hospial, Bankura, West Bengal, India
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Chang PY, Wong KS, Lai JY, Chen JC, Chin TW, Chen KC, Wang CJ, Chang CJ, Hsu WM, Wang NL. Rapid increase in the height and width of the upper chest in adolescents with primary spontaneous pneumothorax. Pediatr Neonatol 2015; 56:53-7. [PMID: 25219870 DOI: 10.1016/j.pedneo.2014.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 06/30/2014] [Accepted: 07/28/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND We determined the chest height in a cohort of patients with primary spontaneous pneumothorax (PSP) who had received chest radiographic examinations prior to the attack. The aim of this study was to determine when their chest height began to change and how this was related to the PSP. METHODS From June 2009 to February 2012, the chest posteroanterior radiographs of 156 patients with PSP (Group 1) were reviewed. Among another 3134 patients with PSP, we identified 52 patients who had a chest posteroanterior radiograph prior to the attack (Group 2). We also recruited 196 controls for comparison (Group 3). The chest height and chest width at different levels were measured and analyzed. RESULTS Before 14 years of age, the chest height of patients in Group 2 was no different from that of patients in Group 3. By the age of 14 years, however, the chest height and upper chest width of patients with PSP was significantly higher than that of the normal controls. The difference from normal chest height did not increase at adulthood. CONCLUSION The rapid increase in chest height and upper chest width is a unique finding in patients with PSP. It might be attributable to the occurrence of PSP. This finding may also help to identify patients who are at risk of PSP.
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Affiliation(s)
- Pei-Yeh Chang
- Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Kin-Sun Wong
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Jeng-Chang Chen
- Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Tai-Wai Chin
- Department of Pediatric Surgery, Veteran General Hospital, Taipei, Taiwan
| | - Ke-Chi Chen
- Division of Pediatric Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Chao-Jan Wang
- Department of Radiology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Chang Gung Memorial Hospital, Resources Center for Clinical Research, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Ming Hsu
- Division of Pediatric Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Nien-Lu Wang
- Department of Pediatric Surgery Mackay Memorial Hospital, Taipei, Taiwan
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Li Z, Chen L, Wang J, Qin J, Zhu Q, Zhang B, Chen Y. A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax. J Biomed Res 2014; 28:494-7. [PMID: 25469119 PMCID: PMC4250528 DOI: 10.7555/jbr.28.20130098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/21/2013] [Accepted: 04/04/2014] [Indexed: 11/03/2022] Open
Abstract
This study sought to report our 6-year experience with the LigaSure vessel sealing system (LVSS) in video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax. A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010. Intraoperatively, large lesions (bullae or blebs) with a diameter more than 2 cm were resected by staplers, and the residual lesions were treated by LVSS. LVSS was also used to ablate the apical area when no lesions were found. Conventional apical pleural abrasion was done in all cases. All patients were successfully treated using VATS with minimal perioperative bleeding. The mean operating time was 76 minutes (range, 43-160 minutes) for single-side procedures and 169 minutes (range, 135-195 minutes) for bilateral procedures, the mean number of applied staples was 1.93 per patient (range, 0-8 days), the duration of drainage was 3.8 days (range, 2-15 days), and the duration of hospital stay was 5.8 days (range, 3-16 days). Postoperative complications included persistent air leak (> 5 days) in 11 cases (6.1%) and residual pneumothorax in 6 (3.3%). None required reoperation. The mean duration of follow-up was 57 months (range, 24-105 months). Recurrence was seen in three cases (1.7%), and all underwent another operation thereafter. None of the lesions in the relapse cases received ablation with LVSS in the first operation. LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples. The method is safe, easy to use, and cost-effective and produces satisfactory results.
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Affiliation(s)
- Zhi Li
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Liang Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jun Wang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jianwei Qin
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Quan Zhu
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Bin Zhang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yijiang Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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ARDÒ N, LOIZZI D, DE PALMA A, LOIZZI M, CAPORALE D, DE BELLIS R, CIALDELLA F, TANGO S, SIMONE V, SOLLITTO F. Comparison of two surgical approaches for the treatment of primary spontaneous pneumothorax*. G Chir 2014; 35:122-125. [PMID: 24979102 PMCID: PMC4321513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The authors report a retrospective study on surgical treatment of primary spontaneous pneumothorax (PSP). Surgical approaches by Videoassisted axillary mini-thoracothomy (VAMT) and three-port VATS (t-VATS) are compared. Mean post-operative stay (MPS) and ipsilateral recurrence rate (IRR) are assessed. Secondary endpoints were about complications, early post-operative pain and long term neurologic symptoms. PATIENTS AND METHODS From January 2009 to December 2011 we consecutively observed 85 cases of PSP. Treatment was represented by surgery in 52 patients: the approach was by VAMT in 39 instances and t-VATS in 13. Median follow up was 30 months. RESULTS Patients submitted to surgery had a MPS of 6.62 ± 1.5 days for VAMT and 6.69 ± 3.4 days for t-VATS (p=0,94). The IRR was 0% in both surgical approaches, comparing to 7,2% for the group of patients treated by simple drainage. Complications were observed in VAMT group: 2 conversions to thoracothomy for technical difficulties (extensive pleural adherences) and one case of re-thoracothomy for hemothorax. Mean Visual Analogic Scale (VAS) score for early post-operative pain was: 2.10±0.71 for VAMT and 1.92±0.64 for t-VATS, p=0.42 at t-student test. Paresthesia complain rate was 33.3% (VAMT) vs 30.7% (t-VATS) for moderate symptoms (p=0.72 at chi square test). The remaining patients complained only slight symptoms or no symptoms at all. CONCLUSIONS Our experience suggested that both surgical approaches to PSP are safe and effective. No differences were found for early post-operative pain and long term paresthesia rate, between the two approaches. No recurrence occurred during follow up.
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Affiliation(s)
- N.P. ARDÒ
- Thoracic Surgery Unit, University of Foggia, Foggia, Italy
| | - D. LOIZZI
- Thoracic Surgery Unit, University of Foggia, Foggia, Italy
| | - A. DE PALMA
- Thoracic Surgery Unit, “A. Moro” University of Bari, Bari, Italy
| | - M. LOIZZI
- Thoracic Surgery Unit, “A. Moro” University of Bari, Bari, Italy
| | - D. CAPORALE
- Thoracic Surgery Unit, University of Foggia, Foggia, Italy
| | - R. DE BELLIS
- Thoracic Surgery Unit, “A. Moro” University of Bari, Bari, Italy
| | - F. CIALDELLA
- Thoracic Surgery Unit, “A. Moro” University of Bari, Bari, Italy
| | - S. TANGO
- Thoracic Surgery Unit, “A. Moro” University of Bari, Bari, Italy
| | - V. SIMONE
- Thoracic Surgery Unit, “A. Moro” University of Bari, Bari, Italy
| | - F. SOLLITTO
- Thoracic Surgery Unit, University of Foggia, Foggia, Italy
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Huang SC, Lin GM, Li YH, Lin CS, Kao HW, Han CL. Abnormal Changes of a 12-Lead Electrocardiogram in Male Patients with Left Primary Spontaneous Pneumothorax. Acta Cardiol Sin 2014; 30:157-164. [PMID: 27122783 PMCID: PMC4805022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 10/17/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND Typical electrocardiographic (ECG) changes associated with left primary spontaneous pneumothorax (PSP) have previously been well-described. However, there were no reports in the literature about the characteristic of ECG in estimating the severity of pneumothorax. METHODS From 2003 through 2008, 63 male patients who had left PSP were divided into two groups: 1) large PSP, Light index ≥ 20% (n = 43), and 2) small PSP, Light index < 20% (n = 20). The ECGs of 64 age-matched disease-free men were used as the normal control. Those medical records reviewed that provided data for this study included patient backgrounds, severity of PSP, and 12-lead ECG characteristics. RESULTS As compared to the normal controls, left PSP patients had lower body mass index, more rapid heart beat rate and lower voltages in V3R-V6R. In analyzing QRS voltages, the amplitudes of V2S and V3S were significantly different. As with both V2S < 12 mm and V3S < 9 mm, the sensitivity, specificity and positive predictive value to predict patients who had large left PSP area were estimated at 42% (18/43), 100% (20/20) and 100% (18/18), respectively. CONCLUSIONS Using the criteria of V2S < 12 mm, V3S < 9 mm and electrical alternans could predict pneumothorax size exceeding 20% in patients who already had left PSP. KEY WORDS 12-lead electrocardiogram; Male; Primary spontaneous pneumothorax.
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Affiliation(s)
- Shih-Chung Huang
- Department of Internal Medicine
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung
| | - Gen-Min Lin
- Department of Internal Medicine
- Department of Internal Medicine, Hualien Armed Forces General Hospital
| | - Yi-Hwei Li
- Department of Public Health, Tzu- Chi University, Hualien
| | | | - Hung-Wen Kao
- Department of Radiology, Tri- Service General Hospital, National Defense Medical Center, Taipei
| | - Chih-Lu Han
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
PURPOSE Few reports have documented psychopathological abnormalities in patients with primary spontaneous pneumothorax (PSP). We analyzed the results of a multiphasic personal inventory test to investigate the psychopathologic impact of PSP in young Korean males. MATERIALS AND METHODS The authors reviewed the results of a Korean military multiphasic personal inventory (KMPI) administered to military conscripts in South Korea. A total of 234 young males participated in this study. The normal volunteer group (n=175) comprised individuals who did not have any lung disease. The PSP group (n=59) included individuals with PSP. None of the examinees had any psychological problems. The KMPI results of both groups were compared. RESULTS There were more abnormal responses in the PSP group (17.0%) than the normal volunteer group (9.1%, p=0.002). The anxiety scale and depression scale scores of the neurosis category were greater for the PSP group than the normal group (p=0.039 and 0.014, respectively). The personality disorder and paranoia scale scores of the psychopathy category were greater for the PSP group than the normal group (p=0.007 and 0.018, respectively). CONCLUSION Young males with PSP may have greater tendencies to suffer from anxiety, depression, personality disorders, and paranoia compared to normal individuals. Clinicians should be advised to evaluate the psychopathological aspects of patients with PSP.
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Affiliation(s)
- Hyun Kyoung Lim
- Department of Anesthesiology and Pain Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Chang Hyun Oh
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
- Seoul Regional Military Manpower Administration, Seoul, Korea
| | - Seol Ho Choo
- Seoul Regional Military Manpower Administration, Seoul, Korea
| | - Tae Hyun Kim
- Seoul Regional Military Manpower Administration, Seoul, Korea
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