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Spontaneous hemopneumothorax is a rare and potentially life-threatening disorder which complicates about 1-12% of patients presenting with spontaneous pneumothorax and has a remarkable predilection for male patients. It may present with signs of hypovolemic shock without apparent cause. While there are no specific guidelines for the management of patients diagnosed with such condition, wide debate in the literature relating to patient selection for surgery remains unresolved, and recently there seems to be a trend increasingly favorable towards early surgical intervention. Video-assisted thoracic surgery emerges as an excellent option for stable patients and has now been considered the gold standard treatment for spontaneous hemopneumothorax. We report the case of a 17-year-old male patient who presented to the emergency department with a history of sudden chest pain and dyspnea, with no previous evidence of trauma. On admission, the patient presented with hypotension, tachycardia, and cutaneous pallor. Chest X-ray showed hydropneumothorax on the left hemithorax; then, chest tube was placed with an initial drainage of 2000 ml of blood.

BACKGROUND: Major thoracic surgery is characterized by release of inflammatory markers.The objective of this study was to assess the preoperative and postoperative systemic inflammatory markers of patients undergoing lung cancer resection. METHODS: This is a prospective follow up study conducted with 48 patients submitted to lung cancer resection.All patients were assessed before and 1 month after surgery through measurement of fibrinogen and C-reative protein(CRP), pulmonary function tests, 6- minute Walk Test (6MWT), maximal inspiratory pressure (PImax) and maximal expiratory preasure (PEmax), anxiety and depression scale and karnofsky performance status scale. RESULTS: Both fibrinogen and CRP were higher 1 month after surgery, although only the change in CRP was statistically significant (p = 0.03). The following functional parameters: 6MWT, PImax, PEmax, FEV1(%) and FVC(%) decreased after surgery with p 0.001 for all the parameters. Anxiety and depression improved and Karnofsky decrease after surgery (p = 0.03, p = 0.01 and p = 0.02; respectively). Change in CRP score following lung resection correlated significantly with changes in fibrinogen (r = 0.40; p = 0.003), change in Karnofsky scale (r = �0.50; p< 0.001) and a borderline significant trend with the 6MWT (r = �0.28; p = 0.05). With the exception of video-assisted thoracoscopic surgery (VATS), who had a significantly lower fibrinogen level 1 month after surgery compared with thoracotomy (p = 0.01), no significant differences in fibrinogen or CRP were noted in other subgroups of patients considered at increased risk for higher levels of inflammation compared with lower risk counterparts. CONCLUSION: Lung cancer resection surgery was associated with increased level of CRP, 1 month after surgery, and correlated directly with change in fibrinogen and inversely with measurement of performance status. VATS provided lower level of fibrinogen after surgery.

Objective: to evaluate the properties of the ICFS (Identity-Consequence Fatigue Scale) in patients with lung cancer (LC) and to assess intensity of fatigue and associated factors in these patients. Methods: A cross-sectional study with LC patients in Brazil. ICFS data were obtained from chronic heart disease (CHD) and healthy individuals(HI) for comparison with LC patients. Portuguese language version of ICFS was administered to 50 LC patients by two independents interviewers. To test for reproducibility, questionnaire was re-administered to the same patients. The patients were submitted to spirometry, six-minute walk test, Epworth sleepiness scale (ESS), hospital anxiety and depression scale (HADS), quality of life (QF) SF-36. The inflammatory status was avaliated by C-reative protein (CRP) and fatigue by ICFS and fatigue severity scale (FSS). To validate the ICFS we assessed the correlations of its scores with these variables. Results: the sample comprised 50 patients in each group (LC, CHD and HI). For the LC group, the intrarater reliability of ICFS summary variables fatigue experiences and fatigue impacts using the intraclass correlation coefficient (ICC) ranged from 0.94 to 0.76 and ICC for inter-rater reliability ranged from 0.94 to 0.79 respectively. The ICFS presented an excellente internal consistency and Bland-Altman plots showed good test-retest concordance. The ICFS correlated significantly with FSS, HADS, SF-36, ESS and CRP. Mean ICFS scores from LC patients were significantly different from CHD and HI group scores. Conclusion: ICFS is a valid and reliable instrument for evaluating LC patients. Depression, QF and CRP levels were significantly associated with fatigue.