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Liao KM, Chiu CC, Lu HY. The Risk of Secondary Spontaneous Pneumothorax in Patients with Chronic Obstructive Pulmonary Disease in Taiwan. Respir Med 2024:107672. [PMID: 38763446 DOI: 10.1016/j.rmed.2024.107672] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Secondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group. METHODS In this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls. RESULTS We enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60% were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3% of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities. CONCLUSION Our study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yun-Lin, Taiwan.
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Dwikat MF, Azar J, Rabayah R, Salameh R, Abdeljaleel F, Almadhoun W, Ayyad A, Ibraik F, Safarini O. Folliculin gene-negative Birt-Hogg-Dube syndrome: a case report. Ann Med Surg (Lond) 2024; 86:1055-1060. [PMID: 38333273 PMCID: PMC10849385 DOI: 10.1097/ms9.0000000000001496] [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] [Received: 09/06/2023] [Accepted: 11/01/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Birt-Hogg-Dube (BHD) is a rare genetic disorder that results from a mutation in the folliculin (FLCN) gene. Manifestations include pulmonary cysts, fibrofolliculomas, renal tumors, and pneumothoraces. Genetic testing can be used to confirm the diagnosis when suspected. BHD syndrome is diagnosed in patients with negative FLCN gene results using diagnostic criteria. Case presentation A male in his 20s presented with recurrent pneumothoraces. A physical examination revealed bumps on his face and upper body. A chest computed tomography scan revealed cystic lesions. Blood tests, ESR, and CRP levels were unremarkable. Punch skin biopsy revealed fibrofolliculomas. Genetic testing for the FLCN mutation returned negative. His history, physical exam, imaging, and histopathology suggested BHD syndrome despite having a negative family history and genetic analysis. Eventually, the patient was diagnosed with FLCN gene-negative BHD syndrome. Clinical discussion More than a hundred families have been identified to have BHD worldwide. There are a few cases in the literature describing patients phenotypically presenting with BHD despite having a negative genetic analysis. One study in Japan found 16 out of 157 individuals having a clinical presentation of BHD with no mutations. Also, decreased expression of the FLCN mRNA may lead to BHD. Conclusion BHD syndrome can present with a negative FLCN gene mutation; however, patients must meet the known diagnostic criteria such as criteria made by Menko et al., Gupta et al., and Schmidt et al. in order to have a diagnosis of BHD syndrome. Also, a qualitative decrease of FLCN with the absence of mutations may also lead to BHD.
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Affiliation(s)
| | - Jehad Azar
- Pulmonary and Critical Care Department, Cleveland Clinic Foundation: Cleveland Clinic, Ohio
| | - Rama Rabayah
- Internal Medicine Department, Ibn Sina Specialized Hospital, Jenin
| | - Ruba Salameh
- Internal Medicine Department, MedStar Union Memorial Hospital, Maryland, USA
| | | | | | - Alaa Ayyad
- Internal Medicine Department, Palestine Medical Complex, Ramallah, Palestine
| | - Farah Ibraik
- Department of Internships, Ministry of Health, Nablus
| | - Omar Safarini
- Department of Internships, Ministry of Health, Nablus
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Kitamura N, Takahashi T, Kawamukai J, Shinno H, Tsuchiya T. Thoracoscopic Direct Suture Closure for a Large Bulla With Severe Adhesion Under Local Anesthesia: A Case Report. Cureus 2024; 16:e54718. [PMID: 38523949 PMCID: PMC10960731 DOI: 10.7759/cureus.54718] [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: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Although the usefulness of thoracoscopic surgery under local anesthesia for pneumothorax has been reported, there are some cases of failure. Therefore, it is important to share the various techniques and potential challenges associated with procedures performed under local anesthesia. A 79-year-old male, under monitoring for a left chronic pneumothorax, was newly diagnosed with a right pneumothorax. Chest computed tomography taken after thoracic drainage showed a poorly expanded right lung with severe adhesions and multiple bullae in the right lung, in addition to identifying a left pneumothorax. Although significant air leakage persisted, general anesthesia was deemed unsuitable, necessitating thoracoscopic surgery under local anesthesia. A fistula of approximately 1 × 1 cm was identified on the bulla wall, which was closed with 4-0 Prolene®sutures (Johnson&Johnson, New Jersey, United States), each reinforced with pledgets and covered with a polyglycolic acid sheet and fibrin glue. The patient was discharged on postoperative day six and no recurrence of pneumothorax was noted after discharge. Direct suture closure of the bulla wall under local anesthesia can be an alternative technique for the treatment of pneumothorax caused by large bulla collapse in patients at high risk for general anesthesia.
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Affiliation(s)
- Naoya Kitamura
- Thoracic Surgery, Toyama University Hospital, Toyama, JPN
| | - Tomohiko Takahashi
- General Thoracic Surgery, Toyama Prefectural Central Hospital, Toyama, JPN
| | - Jun Kawamukai
- General Thoracic Surgery, Toyama Prefectural Central Hospital, Toyama, JPN
| | - Hideki Shinno
- General Thoracic Surgery, Toyama Prefectural Central Hospital, Toyama, JPN
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Tanaka K, Suzuki H, Inage T, Ito T, Sakairi Y, Yoshino I. Surgery for Secondary Spontaneous Pneumothorax with Chronic Lung Diseases. Ann Thorac Cardiovasc Surg 2024; 30:23-00061. [PMID: 37518007 PMCID: PMC10902674 DOI: 10.5761/atcs.oa.23-00061] [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: 04/10/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
PURPOSES Secondary spontaneous pneumothorax (SSP) is occasionally observed in elderly patients suffering from diffuse lung diseases. The purpose of this study was to analyze the outcomes of surgical treatment of SSP patients with chronic lung diseases. METHODS In total, 242 patients who underwent surgery for spontaneous pneumothorax at Chiba University Hospital from January 2006 to October 2016 were included in this study. The patients' records were reviewed retrospectively for data on their background, surgical treatment, morbidity, mortality, and recurrence. RESULTS Of the spontaneous pneumothorax cohort, primary spontaneous pneumothorax (PSP) accounted for 144 patients. Among the 98 patients with SSP, 57 cases were caused by chronic obstructive pulmonary disease (COPD) and 21 were caused by interstitial pneumonia (IP). The postoperative complication rate was 19.3% in the COPD group, 42.9% in the IP group, and 11.1% in the PSP group. The recurrence rate was 5.3% in the COPD group, 28.6% in the IP group, and 21.5% in the PSP group. CONCLUSIONS The morbidity and recurrence were comparable between PSP and SSP cases with COPD, whereas these values were unfavorable in SSP cases with IP compared with PSP ones. Surgical intervention should be carefully considered in SSP patients with IP.
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Affiliation(s)
- Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Takamasa Ito
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
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Bhattarai P, Karki M. Recurrent Spontaneous Pneumothorax in a Young Male With Duchenne Muscular Dystrophy Following COVID-19 Infection. Cureus 2024; 16:e52408. [PMID: 38371092 PMCID: PMC10869316 DOI: 10.7759/cureus.52408] [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: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Duchene muscular dystrophy (DMD) is a genetic disorder primarily affecting males. It is characterized by progressive muscle tissue degeneration. Patients with DMD are at an increased risk of respiratory infections, including coronavirus disease 20019 (COVID-19), due to weakened respiratory muscles. We present a case of a young male with DMD who experienced recurrent pneumothorax 10 months after recovering from a COVID-19 infection. The patient required prompt medical intervention, including a chest tube, multiple surgeries, and mechanical pleurodesis. This case highlights the importance of recognizing recurring pneumothorax as a potential complication of COVID-19, particularly in patients with underlying neuromuscular disorders, as it is a medical emergency requiring prompt treatment to prevent respiratory compromise.
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Affiliation(s)
- Pramod Bhattarai
- Pulmonary Medicine, Howard University Hospital, Washington, DC, USA
- Critical Care Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- Internal Medicine, Harlem Hospital Center, New York, USA
| | - Monika Karki
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
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Nava GW, Walker SP. Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances. J Clin Med 2022; 11:1173. [PMID: 35268264 DOI: 10.3390/jcm11051173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 02/05/2023] Open
Abstract
Secondary spontaneous pneumothorax (SSP) is a medical emergency where the lung collapses in the presence of underlying chronic lung disease. It is the commonest cause of spontaneous pneumothorax and results in significant breathlessness, higher morbidity, mortality, and longer hospital admissions than with patients with pneumothoraces and no underlying lung disease. This article explores the current guidance, controversies, and recent advances in the management of this condition.
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Bamefleh H, Al-Hussain GO. Secondary Spontaneous Pneumothorax Caused by Pulmonary Schistosomiasis. Cureus 2021; 13:e18709. [PMID: 34790464 PMCID: PMC8582618 DOI: 10.7759/cureus.18709] [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] [Accepted: 10/12/2021] [Indexed: 11/05/2022] Open
Abstract
Schistosomiasis is an endemic disease commonly found in areas of Africa and the Middle East. It is a prevalent parasitic infection in the southern region of Saudi Arabia and Yemen. The most common species found are Schistosoma mansoni and Schistosoma haematobium. Schistosomiasis can manifest in the urinary bladder, liver, and gastrointestinal system. The occurrence of the infection in the lungs is very rare and usually appears after years of initial infection. We report a case of a 23-year-old Yemeni male who presented to the emergency department complaining of sudden, right-sided chest pain with shortness of breath of one day. Examination and chest X-ray revealed the presence of pneumothorax, and a chest tube was inserted accordingly. As the pneumothorax did not resolve and a continuous air leak was present, the patient was taken to the operation theatre on suspicion of a fistula. The diagnostic procedure found the presence of bullae and patterns of inflammatory infection. A resected lung wedge revealed the presence of Schistosoma eggs, and schistosomiasis was diagnosed. In conclusion, spontaneous pneumothorax secondary to infection can present in young healthy males. Meanwhile, schistosomiasis infection must be kept in mind when dealing with patients coming from endemic areas even if they present with no recent visit to endemic areas.
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Affiliation(s)
- Hanaa Bamefleh
- Anatomic Pathology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Ghadah O Al-Hussain
- Pathology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
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Cortes‐Telles A, Ortíz‐Farias DL, Perez‐Hernandez F, Rodriguez‐Morejon D. Secondary spontaneous pneumothorax: a time to re-evaluate management. Respirol Case Rep 2021; 9:e00749. [PMID: 34262774 PMCID: PMC8267824 DOI: 10.1002/rcr2.749] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous pneumothorax (SP) is defined as the presence of air in the pleural cavity and remains a significant health problem. Secondary SP (SSP) is associated with underlying lung diseases, such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD), and is associated with poor outcomes. The current guidelines in the management of SSP have not been updated since the last decade; therefore, new protocols focused on the management of SSP should be evaluated. We present two cases of patients admitted with SSP who were treated conservatively due to haemodynamic stability. In both cases, the pneumothoraces resolved without further complications.
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Affiliation(s)
- Arturo Cortes‐Telles
- Respiratory and Thoracic DepartmentHospital Regional de Alta Especialidad de la Península de YucatanMéridaYucatán97130Mexico
| | - Diana Lizbeth Ortíz‐Farias
- Respiratory and Thoracic DepartmentHospital Regional de Alta Especialidad de la Península de YucatanMéridaYucatán97130Mexico
| | - Felipe Perez‐Hernandez
- Respiratory and Thoracic DepartmentHospital Regional de Alta Especialidad de la Península de YucatanMéridaYucatán97130Mexico
| | - Dulce Rodriguez‐Morejon
- Respiratory and Thoracic DepartmentHospital Regional de Alta Especialidad de la Península de YucatanMéridaYucatán97130Mexico
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Walker BL, Boster J, Syed AS, Huprikar N, Sjulin T. Secondary Spontaneous Pneumothorax Mimicking Lung Herniation. Cureus 2020; 12:e9141. [PMID: 32789079 PMCID: PMC7417185 DOI: 10.7759/cureus.9141] [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: 11/05/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at an increased risk for numerous pulmonary complications, including secondary spontaneous pneumothorax (SSP) and lung herniation. We describe the case of a 66-year-old female patient with severe COPD and previous lingula-sparing left upper lobectomy from adenocarcinoma who presented to the emergency department with a painful anterior chest wall mass that varied in size with respiration. This finding, in a patient with a prior history of an invasive thoracic procedure, is suggestive of lung herniation. Further investigation revealed an SSP mimicking the classic physical exam finding of a lung herniation. The patient was deemed a poor surgical candidate; therefore, talc pleurodesis was administered with resolution of the pneumothorax.
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Affiliation(s)
- Brandon L Walker
- Pulmonary and Critical Care, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
| | - Joshua Boster
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Azfar S Syed
- Internal Medicine, Madigan Army Medical Center, Joint Base Lewis-McCord, USA
| | - Nikhil Huprikar
- Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, USA
| | - Tyson Sjulin
- Pulmonary and Critical Care, Brooke Army Medical Center, Fort Sam Houston, USA
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Wang Y, Abougergi MS, Li S, Kazmierski D, Patel P, Sharma N, Ochieng P. Recurrence Prophylaxis in Secondary Spontaneous Pneumothorax: A Nationwide Readmission Database Analysis. Chest 2020; 158:2474-2484. [PMID: 32599067 DOI: 10.1016/j.chest.2020.06.032] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Secondary spontaneous pneumothorax (SSP) is defined as a pneumothorax presenting as a complication of underlying lung disease. Due to the high recurrence rate and the possibility of life-threatening complications, same-admission recurrence prophylaxis (SARP) following the first occurrence of SSP is recommended by many experts. The rate of SARP in SSP admissions has not been reported. RESEARCH QUESTION How often were SARP procedures performed in SSP admissions in the United States? How did outcomes differ between SSP admissions with SARP vs those without SARP? STUDY DESIGN AND METHODS This study used the Nationwide Readmission Database to analyze 71,451,419 inpatient admissions in the United States in 2016 and 2017. SSP admissions with patients aged ≥ 18 years were included, and admissions with documented traumatic or iatrogenic causes of pneumothorax were excluded. Outcomes were compared between SSP admissions with and without SARP. Multivariate logistic analysis was used to model binary-dependent variables. RESULTS There were 21,838 SSP admissions in 2016 and 2017 (30.56 per 100,000 admissions per year), among which 7,366 (33.73%) received SARP. SARP was associated with lower odds of in-hospital mortality (adjusted OR [aOR], 0.48; 95% CI, 0.34-0.70), 30-day mortality (aOR, 0.52; 95% CI, 0.35-0.77), 90-day mortality (aOR, 0.56; 95% CI, 0.40-0.79), and 1-year mortality (aOR, 0.28; 95% CI, 0.10-0.74). SARP was also associated with lower all-cause readmission at 30 days (aOR, 0.40; 95% CI, 0.40-0.49), 90 days (aOR, 0.47; 95% CI, 0.40-0.55), and 1 year (aOR, 0.46; 95% CI, 0.30-0.68), as well as lower rates of postdischarge pneumothorax recurrence in 30 days (aOR, 0.22; 95% CI, 0.11-0.44), 90 days (aOR, 0.26; 95% CI, 0.20-0.33), and 1 year (aOR, 0.22; 95% CI, 0.11-0.44). INTERPRETATION The rate of SARP in SSP admissions was 33.73% in the United States in 2016 and 2017. SARP was associated with lower mortality, all-cause readmission, and pneumothorax recurrence in SSP admissions.
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Affiliation(s)
- Yichen Wang
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA.
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Simpsonville, SC; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA
| | - Daniel Kazmierski
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA
| | - Palakkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY
| | - Nishant Sharma
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA
| | - Pius Ochieng
- Department of Pulmonology and Critical Care, Geisinger Medical Center, Danville, PA
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Abstract
Electronic cigarettes (referred here as E-cigarettes or vapes) are devices that contain heated nicotine/cannabinol vaporized aerosol solution for consumption. While long-term toxicities of E-cigarettes are unknown, the acute adverse events of vaping that have occurred are concerning. There have been variations of pneumonitis presentations so far, however, very few case reports have been shown to have a complication of a pneumothorax. We hereby present a case of a 35-year-old male who presented with spontaneous pneumothorax and pneumonitis due to vaping.
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Affiliation(s)
- Munish Sharma
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Humayun Anjum
- Pulmonary/Critical Care, Corpus Christi Medical Center, Corpus Christi, USA
| | | | - Mihir Buch
- Pulmonary/Critical Care, Corpus Christi Medical Center, Corpus Christi, USA
| | - Salim R Surani
- Internal Medicine, Texas A&M Health Science Center, Temple, USA
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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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Ogawa K, Takahashi Y, Murase K, Hanada S, Uruga H, Takaya H, Miyamoto A, Morokawa N, Kurosaki A, Kishi K. OK-432 pleurodesis for the treatment of pneumothorax in patients with interstitial pneumonia. Respir Investig 2018; 56:410-417. [PMID: 29903606 DOI: 10.1016/j.resinv.2018.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/13/2018] [Revised: 03/31/2018] [Accepted: 05/15/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pneumothorax occasionally develops in patients with interstitial pneumonia (IP) and is often intractable. As there exists no well-established treatment for pneumothorax with IP, we evaluated the efficacy and safety of pleurodesis with OK-432, a lyophilized preparation of Streptococcus pyogenes Su strain that has been inactivated by benzylpenicillin. METHODS We retrospectively evaluated the efficacy and safety of pleurodesis using OK-432 in 39 patients treated for IP-related pneumothorax between January 2006 and May 2017. Five to 10 Klinische Einheit (KE) of OK-432 was injected through the chest tube of each patient. Pleurodesis was considered successful if 1) the chest tube was removed without air leaks and 2) there was no recurrence of pneumothorax within 4 weeks after tube removal, and no additional treatment was required. RESULTS OK-432 pleurodesis was performed 46 times in 39 patients. The median number of OK-432 intrapleural injections received was 1 (range, 1-6), and median dose was 10 KE (range, 5-55 KE). The success rate was 63% (29/46) and recurrence rate was 17.4% (8/46). Grade 5 adverse events were observed in eight patients, including two patients who developed acute exacerbation of IP. Patients in whom the first OK-432 pleurodesis was successful had a significantly longer median survival time than patients in whom it was unsuccessful (322 days vs. 70 days, p = 0.036). CONCLUSIONS Our results show that OK-432 pleurodesis is an effective treatment for pneumothorax associated with IP; however, clinicians should be aware of the possibility of adverse events, especially in patients who are critically ill.
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Affiliation(s)
- Kazumasa Ogawa
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan.
| | - Yui Takahashi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan
| | - Kyoko Murase
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan
| | - Shigeo Hanada
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan
| | - Hironori Uruga
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan
| | - Hisashi Takaya
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan
| | - Atsushi Miyamoto
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan
| | - Nasa Morokawa
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan
| | - Atsuko Kurosaki
- Department of Diagnostic Radiology, Japan Anti-Tuberculosis Association, Fukujuji Hospital, Tokyo, Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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14
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Ueyama M, Asakura T, Morimoto K, Namkoong H, Matsuda S, Osawa T, Ishii M, Hasegawa N, Kurashima A, Goto H. Pneumothorax associated with nontuberculous mycobacteria: A retrospective study of 69 patients. Medicine (Baltimore) 2016; 95:e4246. [PMID: 27442650 PMCID: PMC5265767 DOI: 10.1097/md.0000000000004246] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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] [Indexed: 11/26/2022] Open
Abstract
The incidence of nontuberculous mycobacterial pulmonary disease (NTMPD) is increasing worldwide. Secondary spontaneous pneumothorax occurs as a complication of underlying lung disease and is associated with higher morbidity, mortality, and recurrence than primary spontaneous pneumothorax. We here investigated the clinical features and long-term outcomes of pneumothorax associated with NTMPD.We conducted a retrospective study on consecutive adult patients with pneumothorax associated with NTMPD at Fukujuji Hospital and Keio University Hospital from January 1992 to December 2013. We reviewed the medical records of 69 such patients to obtain clinical characteristics, radiological findings, and long-term outcomes, including pneumothorax recurrence and mortality.The median age of the patients was 68 years; 34 patients were women. The median body mass index was 16.8 kg/m. Underlying pulmonary diseases mainly included chronic obstructive pulmonary disease and pulmonary tuberculosis. On computed tomography, nodules and bronchiectasis were observed in 46 (98%) and 45 (96%) patients, respectively. Consolidation, pleural thickening, interlobular septal thickening, and cavities were most common, and observed in 40 (85%), 40 (85%), 37 (79%), and 36 (77%) patients, respectively. Regarding pneumothorax treatment outcomes, complete and incomplete lung expansion were observed in 49 patients (71%) and 15 patients (22%), respectively. The survival rate after pneumothorax was 48% at 5 years. By the end of the follow-up, 33 patients had died, and the median survival was 4.4 years with a median follow-up period of 1.7 years. The rate of absence of recurrence after the first pneumothorax was 59% at 3 years. By the end of the follow-up, 18 patients had experienced pneumothorax recurrence. Furthermore, 12/18 patients (66%) with recurrent pneumothorax died during the study period. Twenty-three patients (70%) died because of NTMPD progression. Low body mass index (BMI) was a negative prognostic factor for pneumothorax associated with NTMPD in multivariate analysis (HR 0.79, 95% CI 0.64-0.96; P = 0.018)Patients with pneumothorax associated with NTMPD have advanced disease, a high rate of pneumothorax recurrence, and poor prognosis, regardless of the pneumothorax treatment used. Further improvements in early diagnosis of NTMPD and appropriate management in both NTMPD and NTMPD-associated pneumothorax are needed.
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Affiliation(s)
- M Ueyama
- Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
- Correspondence: M Ueyama, Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3–1–24, Matsuyama, Kiyose, Tokyo, Japan (e-mail: )
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku
- Correspondence: M Ueyama, Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3–1–24, Matsuyama, Kiyose, Tokyo, Japan (e-mail: )
| | - Kozo Morimoto
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku
| | - Shuichi Matsuda
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
| | - Takeshi Osawa
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku
| | - Naoki Hasegawa
- Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Shinjuku, Tokoyo, Japan
| | - Atsuyuki Kurashima
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
| | - Hajime Goto
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
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15
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Sevinc S, Kaya SO, Akcam TI, Ceylan KC, Ozturk O, Susam S. Prolonged air leakage in secondary spontaneous pneumothorax: is proportion of emphysema important? Clin Respir J 2016; 11:833-838. [PMID: 26646622 DOI: 10.1111/crj.12424] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/30/2015] [Accepted: 11/29/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Prolonged air leakage is the most common complication that can cause severe problems in cases of secondary spontaneous pneumothorax (SSP). The purpose of this study was to explore whether Goddard Classification Score (GCS) can be a marker of prolonged air leakage, particularly during the post-operative period, for patients with emphysema. METHODS Fifty patients, who underwent tube thoracostomy for SSP, were retrospectively evaluated. For the evaluation of emphysematous on the preoperative computed tomography image, visual scoring system described by Goddard was used. The correlations between age, duration of hospitalization, duration of drainage, number of pneumothorax episodes, prolonged air leakage and GCS parameters, were evaluated. RESULTS When 50 patients were scored, based on GCS, the distribution was as follows: G1: four cases, G2: 16 cases, G3: 17 cases, and G4: 13 cases. The mean number of pneumothorax episodes was 1.3 ± 0.5, the mean duration of drainage was 15.7 ± 11.3 days, and the mean duration of hospitalization was 9.2 ± 5.1 days. Prolonged air leakage was seen in 26 (52.2%) cases. The rate of prolonged air leakage was significantly higher in higher GCS cases (P = 0.035). There was a positive correlation between age and GCS (P = 0.011). The number of pneumothorax episodes rose significantly with increasing GCS (P = 0.011). The duration of hospitalization increased with the growing number of pneumothorax episodes (P = 0.027). CONCLUSION Prolonged air leakage and the recurrence rate of SSP rise with increasing GCS. Taking this condition into consideration in the treatment algorithm can be helpful for clinicians in patient follow-up.
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Affiliation(s)
- Serpil Sevinc
- Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Seyda Ors Kaya
- Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Tevfik Ilker Akcam
- Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Kenan Can Ceylan
- Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Ozgur Ozturk
- Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Seher Susam
- Department of Radiology, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
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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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Ishida A, Kida H, Muraoka H, Nishine H, Mineshita M, Miyazawa T. Intractable pneumothorax managed by talc pleurodesis and bronchial occlusion with spigots. Respirol Case Rep 2014; 3:13-5. [PMID: 25802742 PMCID: PMC4364791 DOI: 10.1002/rcr2.88] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/23/2014] [Accepted: 11/09/2014] [Indexed: 12/01/2022] Open
Abstract
Three cases of inoperable secondary spontaneous pneumothorax were diagnosed in patients with chronic obstructive pulmonary disease. Two cases initially underwent bronchial occlusion with endobronchial Watanabe spigot (EWS), while one underwent talc poudrage with pleuroscopy. As air leaks were not stopped completely in all cases with the initial procedures, we performed additional interventional treatments: pleuroscopic talc poudrage in cases when bronchial occlusion was performed first; and bronchial occlusion with EWS for a case that initially underwent talc pleurodesis. The air leaks ceased in all cases without complication. We successfully removed chest tubes 2–10 days after secondary procedure, which was 10–23 days after the first procedure. The combination of talc pleurodesis and bronchial occlusion with EWS, when a single, initial interventional treatment fails, can be considered in cases of intractable, inoperable secondary pneumothorax.
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Affiliation(s)
- Atsuko Ishida
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of MedicineKawasaki, Japan
| | - Hirotaka Kida
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of MedicineKawasaki, Japan
| | - Hiromi Muraoka
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of MedicineKawasaki, Japan
| | - Hiroki Nishine
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of MedicineKawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of MedicineKawasaki, Japan
| | - Teruomi Miyazawa
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of MedicineKawasaki, Japan
- Correspondence, Teruomi Miyazawa, Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan. E-mail:
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