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Whether the outcome of primary spontaneous pneumothorax (PSP) when treated with needlescopic video-assisted thoracic surgery is positive is still under scrutiny. The present study was conducted to compare the needlescopic approach with the conventional approach. One-hundred and six patients with primary spontaneous pneumothorax who had undergone needlescopic video-assisted thoracic surgery (NVATS) between May 2006 and August 2008 were reviewed. Their age, gender, smoking status, BMI, side of attack, operative indications, operative time, intraoperative blood loss, postoperative length of stay, postoperative pain in visual analog scale (VAS), postoperative recurrence and follow-up period were recorded. These data were compared with those of 89 patients with PSP who had undergone conventional video-assisted thoracic surgery (CVATS) between June 2002 and April 2006. The operative time was shorter (NVATS: 82.36 ± 35.58 min, CVATS: 99.78 ± 35.74 min; p = 0.008) and intraoperative blood loss was less (NVATS: 16.67 ± 25.90 ml, CVATS: 24.36 ± 26.86 ml; p = 0.04) for the NVATS group. The postoperative pain in VAS was significantly less in NVATS. No major complication or mortality was found in either group. For treatment of primary spontaneous pneumothorax, NVATS is a safe and effective option. Further, it has the added benefit of less pain and improved cosmetics. [ABSTRACT FROM AUTHOR]

Primary spontaneous pneumothorax (PSP) is by definition not associated with any underlying lung disease. However, this does not mean that there is no underlying pathological process. It has become increasingly apparent over recent years that PSP is associated with diffuse and often bilateral abnormalities within the pleura and is not simply a disease caused by ruptured blebs/bullae. The pathological process includes emphysema-like changes, pleural porosity and inflammation. In this review, we summarise the recent advances in our understanding of the pathogenesis of PSP and discuss how this relates to management strategies for patients with PSP. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis most commonly characterized by symmetrical skeletal involvement and may present with pulmonary involvement leading to chronically progressive pulmonary symptoms. Characteristics on chest radiography include non-specific findings of diffuse interstitial and pleural thickening, micronodules, ground-glass opacities and parenchymal condensation as a result of infiltration by lipid-laden histiocytes. We present the case of a 50-year-old man with ECD presenting with acute pulmonary symptoms due to rupture of a large cystic lesion with resultant pneumothorax. He was brought by ambulance to our hospital, complaining of acute anterior chest pain and severe dyspnea. Chest radiography showed right-sided pneumothorax with a collapsed lung, a large, left-sided cystic lesion in the upper lung field and accentuated interstitial markings. Bullectomy and surgical biopsy were performed, demonstrating histologically histiocytic infiltrates that were strongly positive for CD68, but negative for S-100 protein and CD1a. Subsequent systemic examinations indicated widespread symmetrical skeletal involvement, leading to a definitive diagnosis of ECD. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Bispectral index (BIS) is a valuable tool for assessing the depth of sedation and guiding the administration of sedative drugs. We previously demonstrated the benefits of BIS-guided propofol sedation in patients undergoing flexible bronchoscopy. Objective: To examine the feasibility and safety profile of propofol sedation in patients undergoing medical thoracoscopy (MT). Methods: Patients undergoing MT for diagnostic evaluation or treatment of pleuropulmonary diseases were enrolled over a 2-year period. Nurses and chest physicians were trained by anesthetists to provide analgosedation, to detect and correct cardiopulmonary disturbances. The level of sedation was optimized individually by titrating the propofol infusion according to the BIS and clinical evaluation. Patients' clinical data, procedure time, medications and any adverse events were recorded. Results: Fifty-three patients (60% male) with a median age of 62 years (range 19-84 years) underwent MT. The operative procedure lasted a median time of 28 min (range 9-112 min). The median doses of anesthetic drugs were 145 mg of propofol (range 20-410 mg) and 84 μg of fentanyl (range 0-225 μg). Hemodynamic disturbances occurred in 39 patients (bradycardia n = 4, tachycardia n = 12, hypotension n = 34) and required drug administration in only 4 cases. Hypoxemic events (n = 4) resolved upon gentle patient stimulation (verbal command, chin lift, oral cannula). All patients could be discharged from the recovery unit within 105 min after the procedure. Conclusions: BIS-guided propofol sedation is a safe method that might replace midazolam sedation in MT and can be managed by well-trained nonanesthesiologist personnel. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective. To examine the role of CT scans and early surgical intervention in the management of pediatric patients with primary spontaneous pneumothorax (PSP). Methods . Retrospective cohort study. Results. The authors identified 46 cases with 70 episodes of pneumothorax. The recurrence rate among conservatively treated patients was 50% both after the first and the subsequent episode. Recurrence rate in cases with and without blebs on CT was comparable. Initial episodes were treated with supplemental oxygen (n = 18) and chest tube drainage (n = 18), and 10 patients underwent video-assisted thoracoscopic surgery (VATS). The recurrence rate was significantly lower following surgical intervention compared with other therapy, and morbidity was comparable with that in patients who needed chest tube drainage. Conclusions. Recurrence after the first episode of PSP in children is frequent and is difficult to predict by CT findings. VATS is safe and effective in preventing recurrences. Surgical intervention may be an attractive alternative in patients who require chest tube drainage for the first episode of PSP. [ABSTRACT FROM PUBLISHER]

Thoracoscopy is currently the gold standard for the diagnosis and treatment of pleural diseases. Its diagnostic yield is 95% in patients with malignant pleural disease, with approximately 90% successful pleurodesis for malignant pleural effusion and 95% for pneumothorax. At the same time, thoracoscopy constitutes an important tool in the research of pleural pathophysiology and molecular biology. The improvement of technology has provided important tools to thoracoscopy, such as autofluorescence, narrow band imaging, and infrared light, used in clinical and basic research in many disorders involving the pleura. For these reasons, training in thoracoscopy should be considered equally important as training in bronchoscopy for residents in respiratory medicine. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: CT -guided percutaneous transthoracic fine needle aspiration biopsy (TFNAB) has become a widely accepted and effective minimally invasive technique for the diagnosis of a variety of intrathoracic lesions that are not readily accessible with bronchoscopy. It is generally regarded as a safe procedure with limited morbidity and extremely rare mortality. It provides high diagnostic accuracy and has a relatively low complications rate. Objectives: The aims of our study were to report our experience with regard to the accuracy & pneumothorax rate of percutaneous CT-guided biopsy of solitary pulmonary nodules using automatic biopsy gun. Patients and methods: Between January 2006 and August 2009, 54 patients (46 men and 8 women) with solitary pulmonary nodule underwent CT guided transthoracic biopsy at Al-Kadhimyia teaching hospital, Baghdad, Iraq. All the lesions could not be diagnosed with fiberoptic bronchoscopy. CT-guided biopsy was performed with an 18-gauge automatic biopsy gun. Chest radiography was done 2-4hr later and 24hr after biopsy for observation of pneumothorax. The overall diagnostic accuracy, pneumothorax rate, and chest tube insertion rate were determined. Diagnostic accuracy and pneumothorax rate were statistically compared according to lesion size & lesion depth (p value of less than 0.05 was considered to be significant). Results: Forty one patients (76%) diagnosed as malignant (diagnostic accuracy of 87.8%). Thirteen patients (24%) were diagnosed as benign (diagnostic accuracy of 92.3%). The overall diagnostic accuracy was 89% (48 of 54). The diagnostic accuracy did not differ with respect to the lesions size and lesions depth from the chest wall. Accurate diagnosis was made in 25 of the 29 nodules <20 mm (86%) and in 23 of the 25 nodules ≥20 mm (92%). Similarly accurate diagnosis was made for 36 (90%) of the 40 nodules shallower than 60 mm and for 12 (85.7%) of the 14 nodules ≥60 mm. Pneumothorax occurred in 23 (42%) patients. Pneumothorax occurred more frequently in small sized lesions (16 out of 29 lesions measuring <20 mm) as compared to (7 out of 25 lesions ≥20 mm) (P <0.05). similarly pneumothorax occurred more frequently in deeper lesions (10 out of 14 lesions ≥60mm in depth) as compared to (13 out of 40 lesions <60 mm in depth) (P <0.05). Only 7 (13%) patients requiring thoracostomy tube placement. Conclusions: CT- guided biopsy using automatic biopsy gun allowing a specific diagnosis for benign & probably malignant lesions. Diagnostic accuracy was not affected by the size and depth of the lesions. Deeper & small sized lesions have associated with an increased rate of pneumothorax. [ABSTRACT FROM AUTHOR]

Objective: To discuss the aetiology and determine the optimal surgical treatment of catamenial pneumothorax. Methods: Between January 1980 and December 2007, 17 patients with catamenial pneumothorax were treated at our institution. Regarding the surgical approach, thoracotomy was performed until 1991, and thoracoscopic surgery was performed from 1992 onward. Results: Pneumothorax was on the right side in all but two patients. Surgery was performed on 15 of the 17 patients. The surgical procedure was a diaphragm resection plus a partial bleb resection in eight patients, a diaphragm resection in two patients, a diaphragm resection plus an absorbable polyglycolic acid sheet in four patients, and a partial bleb resection in one patient. Five patients demonstrated a postoperative recurrence (33.0%). However, no recurrence has been observed thus far in the four patients with an absorbable polyglycolic sheet placed on the diaphragmatic surface. Conclusion: Although the postoperative recurrence rate of patients undergoing surgical procedures remains high, there were some patients with no postoperative recurrence. Placement of an absorbable sheet on the diaphragmatic surface may therefore prevent recurrence of catamenial pneumothorax. [ABSTRACT FROM AUTHOR]

Background: Tension pneumothorax requires emergent decompression. Unfortunately, some needle thoracostomies (NTs) are unsuccessful because of insufficient catheter length. All previous studies have used thickness of the chest wall (based on cadaver studies, ultrasonography or computed tomography [CT]) to extrapolate probable catheter effectiveness. The objective of this clinical study was to identify the frequency of NT failure with various catheter lengths. Methods: We evaluated the records of all patients with severe blunt injury who had a prehospital NT before arrival at a level-1 trauma centre over a 48-month period. Patients were divided into 2 groups: helicopter (4.5-cm catheter sheath) and ground ambulance (3.2 cm) transport. Success of the NT was confirmed by the absence of a large pneumothorax on subsequent thoracic ultrasonography and CT. Results: Needle thoracostomy decompression was attempted in 1.5% (142/9689) of patients. Among patients with blunt injuries, the incidence was 1.4% (101/7073). Patients transported by helicopter (74%) received a 4.5-cm sheath. The remainder (26% ground transport) received a 3.2-cm catheter. A minority in each group (helicopter 15%, ground 28%) underwent immediate chest tube insertion (before thoracic ultrasound) because of ongoing hemodynamic instabilityi' Failure to decompress the pleural space by NT was observed via ultrasound and/or CT in 65% (17/26) of attempts with a 3.2-cin catheter, compared with only 4% (3/75) of attempts with a 4.5-cm catheter (p< 0.001). Conclusion: Tension pneumothorax decompression using a 3.2-cm catheter was unsuccessful in up to 65% of cases. When a larger 4.5-cm catheter was used, fewer procedures (4%) failed. Thoracic ultrasonography can be used to confirm NT placement. [ABSTRACT FROM AUTHOR]

Summary: Spontaneous pneumothorax is an extremely frequent pathology. Despite this, there is still no clear consensus on managing these patients. Therefore, we perform a systematic review and meta-analysis of the effectiveness of percutaneous aspiration compared with tube drainage for treating idiopathic spontaneous pneumothorax. Controlled, randomised clinical trials were selected, in which the effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission. Relevant articles were identified by searching electronic databases (e.g., Medline, EMBASE, CENTRAL, mRCT and Pascal), as well as the references of the papers found in this manner, with a cut-off date of April 2009. Quality was assessed by two independent evaluators, using the CASPe appraisal tool. Effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission. [Copyright &y& Elsevier]

BACKGROUND: Aim of the study was to assess the results of surgery for secondary spontaneous pneumothorax (SSP) in the elderly with COPD at Shanghai Pulmonary Disease Hospital. METHODS: From 1 January 1993 to 30 June 2007, the operation for SSP was performed in 107 elderly patients (??60y) with COPD. All patient data was reviewed retrospectively. RESULTS: Morbidity was 25.2?% and mortality was 4.7?%. The total effective rate of intrapleural injection of human fibrinogen for the treatment of postoperative persistent air leaks was 86.7?%. Multivariate analyses of postoperative air leaks suggest that patients undergoing pleurodesis (OR 0.189, 95?% CI 0.045-0.790, P?=?0.022) have a decreased risk of postoperative air leaks. Multivariate analyses of postoperative complications suggest that patients with higher PaCO 2(OR 0.890, 95?% CI 0.814-0.973, P?=?0.011) have an increased risk and patients undergoing pleurodesis (OR 4.319, 95?% CI 1.398-13.349, P?=?0.011) have a decreased risk. CONCLUSIONS: Surgical intervention is recommended in selected elderly COPD patients with SSP, with hypercapnia known as an operative contraindication. Additionally, surgery offers the advantage of intraoperative pleurodesis for the prevention of prolonged postoperative air leaks, while intrapleural injection of human fibrinogen is an effective procedure in the treatment of air leaks. [ABSTRACT FROM AUTHOR]

Abstract: Background: The term occult pneumothorax (OP) describes a pneumothorax that is not suspected on the basis of either clinical examination or initial chest radiography, but is subsequently detected on computed tomography (CT) scan. The optimal management of OP in the blunt trauma setting remains controversial. Some physicians favour placement of a thoracostomy tube for patients with OP, particularly those undergoing positive pressure ventilation (PPV), while others favour close observation without chest drainage. This study was conducted both to determine the incidence of OP and to describe its current treatment status in the blunt trauma population at a Canadian tertiary trauma centre. Of interest were the rates of tube thoracostomy vs. observation without chest drainage and their respective outcomes. Methods: A retrospective review was conducted of the Nova Scotia Trauma Registry. The data on all consecutive blunt trauma patients between October 1994 and March 2003 was reviewed. Outcome measures evaluated include length of stay, discharge status—dead vs. alive, intervention and time to intervention (tube thoracostomy and its relation to institution of PPV). Direct comparison was made between the OP with tube thoracostomy group and OP without tube thoracostomy group (observation or control group). They were compared in terms of their baseline characteristics and outcome measures. Results: In 1881 consecutive blunt trauma patients over a 102-month period there were 307 pneumothoraces of which 68 were occult. Thirty five patients with OP underwent tube thoracostomy, 33 did not. Twenty nine (82.8%) with tube thoracostomy received positive pressure ventilation (PPV), as did 16 (48.4%) in the observation group. Mean injury severity score (ISS) for tube thoracostomy and observation groups were similar (25.80 and 22.39, p =0.101) whereas length of stay (LOS) was different (17.4 and 10.0 days, p =0.026). Mortality was similar (11.4% and 9.1%). There were no tension pneumothoraces. Conclusion: The natural history of OP in blunt trauma patients at our institution appears to be one of uneventful resolution irrespective of ISS, need for PPV, or placement of tube thoracostomy. This study suggests an interesting hypothesis that observation of the blunt trauma patient with OP, without tube thoracostomy, may be safe and contribute to a shorter hospital stay. These are observations that would benefit from further study in a large, prospective randomised controlled trial. [Copyright &y& Elsevier]

The benefit of bullae ablation for the management of primary spontaneous pneumothorax (PSP) has been established. However, various modalities for bullae ablation have been reported from different centers. The present study aimed to assess whether endoloop ligation of bullae was as effective as staple bullectomy for preventing the recurrence of pneumothorax. Between January 1993 and December 2003, 226 patients (203 men and 23 women) with PSP were recorded and retrospectively reviewed. One hundred thirty (57.5%) patients were treated with endoloop ligation of bullae and the other 96 (42.5%) were treated with staple bullectomy. Mechanical abrasion was performed in all patients after bullae ablation. The recurrence rate of pneumothorax was 6.2% (8 patients) in the endoloop ligation group and 17.7% (17 patients) in the staple bullectomy group ( p = 0.006). The postoperative complication rate was 14.6 and 20.8% in the endoloop ligation and staple bullectomy groups, respectively ( p = 0.221). The long-term chest discomfort rate after endoloop ligation and staple bullectomy was 14.6 and 13.5%, respectively ( p = 0.819) Endoloop ligation of bullae is as effective as mechanical staple bullectomy for the management of bullae in primary spontaneous pneumothorax. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Residual air spaces on chest radiographs after pneumothorax surgery are not uncommon. We aimed to study their incidence and impact on surgical outcomes. Methods: Four hundred and twenty-seven patients [283 men and 144 women with a median age of 31 (14–96) years] underwent surgery for pneumothorax from 1995 to 2005 in a single unit. Video-assisted thoracoscopy was used in 225 cases (53%). Outcomes were: duration of intercostal drainage and hospital stay, recurrence, re-operation and referral to chronic pain clinic. Results: Median duration of intercostal drainage and hospital stay were 5 and 6 days, respectively. We found a recurrence rate of 6.6% (n =28), re-operation rate of 2.8% (n =12) and need for referral to pain clinic of 7% (n =30). In 129 patients (30%) a small residual apical space (RAS) was reported on chest radiograph prior to discharge. Hospital stay and duration of drainage were longer in these cases (p =0.002 and 0.02, respectively). On multivariate analysis RAS on chest radiograph was associated with increased risk of recurrence [hazard ratio 3.1 (1.4–6.8 95% CI)] (p =0.005); but no need for re-operation or referral to pain clinic. Re-operation was associated with VATS surgery (p =0.001) and when no abnormalities were identified at operation (p =0.04). Referral to pain clinic was more common after open surgery (p =0.01). Discussion: The risk of recurrence after pneumothorax surgery is low. But the presence of a residual apical space on chest radiography after surgery increases it significantly. Recurrence may be due to the failure to achieve early pleural symphysis. [Copyright &y& Elsevier]

Spontaneous pneumothorax is usually caused by the rupture of subpleural blebs/bullae in the underlying lung and is one of the most common elective applications of video-assisted thoracoscopic surgery (VATS). VATS has been used as an alternative to thoracotomy in the treatment of spontaneous pneumothorax. Recurrent pneumothorax and persistent air leakage are quite often indications for spontaneous pneumothorax, and bilateral spontaneous pneumothorax is also considered to be an indication for surgical intervention. The goals of surgical intervention are to eliminate intrapleural air collection and prevent recurrence. Diverse procedures have been reported in the surgical treatment for spontaneous pneumothorax. We review the literature regarding the VATS approach for spontaneous pneumothorax. [ABSTRACT FROM AUTHOR]

The article discusses a review comparing recurrence rates from video-assisted surgery of recurrent pneumothorax against open surgery through analysis of randomized studies. Results of video-assisted and open pneumothorax surgery were combined in a meta-analysis with fixed and random effects models applied. The analysis revealed that the relative risk of recurrence is four times greater when pleurodesis surgery is performed using video-assistance.

Study objectives: To evaluate the safety and efficacy of additional minocycline pleurodesis after thoracoscopic treatment of primary spontaneous pneumothorax. Design: Retrospective comparative study with a historical control. Setting: Thoracic surgical division of a university-affiliated tertiary medical center. Patients and methods: Between April 1994 and April 2001, 313 consecutive patients (minocycline group) with primary spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. The procedures included resection of the blebs and mechanical pleurodesis by scrubbing the parietal pleura. After operation, minocycline hydrochloride, 7 mg/kg, was instilled into the pleural space through a thoracostomy tube. The control group consisted of 51 consecutive patients who underwent the same thoracoscopic procedures alone for primary spontaneous pneumothorax between January 1992 and April 1994. Results: There was no significant difference between the two groups in terms of demographic data, operative findings, and operation time. Chest pain was a common complaint after minocycline pleurodesis, but the total doses of requested analgesics were comparable in both groups. The rate of prolonged air leaks was significantly lower in the minocycline group (7.0% vs 17.6%, p = 0.025). Patients treated with minocycline had shorter periods of postoperative chest drainage and hospitalization. The ipsilateral recurrence rate was also significantly lower in these patients (2.9% vs 9.8%, p = 0.033). Conclusions: Minocycline pleurodesis is a safe and convenient procedure that may improve the outcome and reduce the rate of recurrence after thoracoscopic treatment for primary spontaneous pneumothorax. A randomized control study may be needed to confirm the findings. Key words: minocycline; pleurodesis; primary spontaneous pneumothorax; thoracoscopy. [ABSTRACT FROM AUTHOR]

Objective: To review our experience with bilateral video-assisted thoracoscopic surgery (VATS) for the treatment of bilateral spontaneous pneumothorax (SP).Design: Retrospective study followed by a telephone interview for follow-up.Setting: Thoracic Surgery Department, Chest Diseases Hospital, Kuwait.Patients and Interventions: Fifteen patients undergoing bilateral VATS for bilateral SP from 1994 to 1999.Results: The mean age of the patients was 22.9 years (range, 17 to 34 years), and 14 were men. All patients were successfully treated using the bilateral video-assisted technique. Operative indications included simultaneous bilateral pneumothorax (n = 7) and contralateral recurrence of SP (n = 8). Twelve patients had primary SP. In the three remaining patients, simultaneous bilateral SP was secondary to sarcoidosis in two patients and histiocytosis X in one patient. Eleven patients had multiple blebs or bullae located in the upper lobes, and 4 patients had no blebs. All blebs or bullae were resected. All patients had gauze pleurodesis. The mean +/- SD operative time was 133.6 +/- 9.1 min. There were no perioperative complications and no deaths attributable to the procedure. Postoperative prolonged air leak occurred in three patients (20%). The mean drainage time was 3 days (range, 2 to 8 days). The mean postoperative hospital stay was 5 +/- 1.7 days. Mean follow-up was 3.3 years (range, 2 to 5 years) for all patients. Pneumothorax recurred in one patient with histiocytosis X after 1 month and required a reoperation on the right side.Conclusions: Bilateral VATS is a safe procedure in the treatment of simultaneous and nonsimultaneous bilateral SP. This avoids the need for subsequent operations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the short and long term results of video-assisted thoracoscopic surgery for complicated pneumothorax. Design: Retrospective study. Setting: General hospital, Linz, Austria. Subjects: 76 consecutive patients with complicated pneumothorax. Interventions: 57 patients with primary and 19 with secondary spontaneous pneumothorax underwent video-assisted thoracoscopic surgery. Depending on the findings at thoracoscopy, patients were allocated to have stapled bleb resection (n = 29), multiple bleb resection combined with apical pleurectomy (n = 40), or apical segmental resection combined with apical pleurectomy (no visible disease on the lung surface, n = 7). Main outcome measures: Efficacy, morbidity, mortality, and late recurrence rate. Results: No conversions to open thoracotomy were necessary and early lung reexpansion was achieved in all but one patient (99%). There was one postoperative death (1%) and morbidity was 7%, including one persistent air leak and one early recurrence, both of which required thoracotomy. All postoperative complications developed in patients with spontaneous pneumothorax secondary to diffuse bullous emphysema. At a median follow up of 34 months there were 4 ipsilateral pneumothorax recurrences (5%), two of which developed after bleb resection combined with pleurectomy and two after bleb resection alone. Conclusion: Video-assisted thoracoscopic surgery was safe and effective for the treatment of complicated spontaneous pneumothorax. It is our procedure of choice for complicated primary spontaneous pneumothorax and is a valuable alternative to open thoracotomy for patients with secondary spontaneous pneumothorax. [ABSTRACT FROM AUTHOR]

Describes a thorascopic technique performed for spontaneous pneumothorax which includes bleb stapling and pleurectomy. Placement of the first port in the fifth intercostal space, anterior axillary line; Placement of the second port in the axilla, third intercostal space; Placement of the third port in the midclavicular line, fourth intercostal space.

The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest walls, due to the "protective" layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed. Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest tube removals (20/67).When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP. [ABSTRACT FROM AUTHOR]

The initial treatment of primary spontaneous pneumothorax is not standardized throughout the world. Although aspiration is less painful and requires less hospitalization than chest tube drainage does, the latter is still frequently used as the initial treatment. After a recurrence or failure of aspiration, chest tube drainage, again, is often the procedure of choice although VATS or thoracoscopy and talc poudrage have been proven to be much more effective. For the surgical treatment of recurrent pneumothorax, the role of routine resection of blebs and nonruptured bullae still needs to be assessed. Pleurodesis (chemical or mechanical) should be the standard treatment in a surgical procedure. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Spontaneous pneumothorax is a rarely seen complication in metastatic pulmonary diseases. It could be the first symptom and might be seen in the post chemotherapy period. We here report a 20-year-old male with surgically treated- bilaterally spontaneous pneumothorax who had hypopharyngeal synovial sarcoma initially and had been treated with surgery and chemotherapy. We emphasised that spontaneous pneumothorax could be caused by pulmonary mature metastais of synovial sarcoma, as a result of air leakage. Surgical treatment such as metastasectomy and pulmonary paranchimal repair and intraoperatively chemical pleurodesis would be required [ABSTRACT FROM AUTHOR]

Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: Welding of lung tissue is a new radio-frequency surgical method that allows sealing pulmonary tissue without overheating and damaging the tissue. The objective of the research was to study the results of sealing the lung tissue in a non-resectional procedure for spontaneous pneumothorax comprising ablation of bullae via video-assisted thoracoscopic surgery (VATS). Methods: We present a series of 133 consecutive patients with primary spontaneous pneumothorax, who were operated on during the past 3 years. Among 133 patients, 123 were men and 10 were women, with an average age of 26 years (from 14 to 59 years). Indications for surgery were pneumothorax recurrence (59 patients), contralateral occurrence (13), bilateral pneumothorax (one) and haemopneumothorax (two). Prolonged air leakage for more than 2 days was observed in 58 patients. We used the tissue-welding technology and an original bipolar hand-piece for bullae electroablation and lung sealing. Conventional apical pleural abrasion was carried out in all cases. Chest tubes were removed 48h postoperatively by protocol. Results: Intra-operatively, emphysema-like changes and blebs under 1cm were seen in 29 patients (22%) and bullae of 1–2cm in 48 patients (36%); in 56 cases (42%) the size of bullae exceeded 2cm. In all cases, lung sealing was achieved by tissue welding alone, without using staplers, sutures, glues and sealants. The operating time depended on the presence of adhesions and the number of bullae, but did not exceed 65min. Postoperative air leakage for 1–6 days was observed in six patients. Neither mortality nor major morbidity was observed. There were seven recurrences (5.2%). Conclusions: The tissue-welding procedure is easy to perform through VATS and is efficient for ablation of bullae of any size. Leak-proof sealing is achieved, allowing us to repair the pulmonary–pleural fistula, thus being a non-resectional alternative to wedge resection. No conventional wound-closing devices are needed. [Copyright &y& Elsevier]

Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Features the successful treatment of a young adult male with recurrent spontaneous pneumothorax (SP) using thoracoscopic stapling of bullae and pleural abrasion. Causes and symptoms; Characteristics of the disease; Epidemiology and histology; Differential and definitive diagnosis; Pulmonary auscultatory abnormalities; Patterns of chest pathology.

Few cases of catamenial pneumothorax with complete or partial diaphragmatic hernias are reported in the literature. We present herein the case of a 38-year-old woman affected by recurrent right-sided spontaneous pneumothorax during menstrual periods. CT scan revealed normal lung parenchyma and multiple diaphragmatic nodes suspected for endometrial implants. The patient underwent right thoracoscopy and the presence of multiple diaphragmatic perforations of the tendinous part was observed as well as partial hepatic hernia. Through a video-assisted procedure, pleural biopsies and diaphragmatic plication containing the tendinous part with total pleural abrasion and talc pleurodesis were performed. No endometrial implants were found on histologic examination of pleural biopsies. The surgical procedure was uneventful and totally successful. On the basis of the clinical data and endoscopic view, we consider our case as catamenially recurring pneumothorax. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article examines whether minimal access video-assisted thoracic surgery is as effective as open surgery (thoracotomy) in preventing recurrence of spontaneous pneumothorax. The article presents the findings of Allanah Barker and her colleagues who researched the issue. It is suggested in the article that the video-assisted thoracic surgery is preferable to a policy of thoracotomy. The article reports that early and late pain is less common for those patients who participate in video-assisted thoracic surgery, and they return to full health and mobility faster than with open surgery.

Patients with spontaneous pneumothorax require immediate insertion of a chest drain to evacuate the intrathoracic air. During video-assisted bullectomy, we made use of an existing chest drain hole to insert a thoracoscope or an endoscopic linear stapler. Video-assisted bullectomy was performed through three ports-two 2-mm ports and the existing chest drain hole. Therefore, no new skin incisions were required for the insertion of the 2-mm ports. A chest drain was again inserted via the existing chest drain hole after bullectomy. This procedure was used on 8 of 10 patients with spontaneous pneumothorax. There were no postoperative complications or recurrences. Thoracoscopic bullectomy using needlescopic instruments is technically feasible, safe, and effective. Currently, the procedure is indicated only for simple cases and not for the lysis of adhesions. [ABSTRACT FROM AUTHOR]

Surgical treatment of spontaneous pneumothorax can be done through a thoracotomy or a videothoracoscopic approach. Although the videothoracoscopic technique is currently popular it is not obviously superior to a more traditional axillary thoracotomy approach. We compared our recent experience with both techniques to determine the optimal surgical treatment for spontaneous pneumothoraces. A retrospective review of 79 patients treated surgically (34 thoracotomy and 45 thoracoscopy) for spontaneous pneumothoraces was done. Patients were treated between 1991 and 1997. Patients older than 60 years of age and those with spontaneous pneumothoraces secondary to generalized pulmonary emphysema were excluded. There were no operative deaths. Recurrence rate [thoracotomy, two of 34; thoracoscopy, three of 45 (P < 0.89)], air leak exceeding 7 days [thoracotomy, three of 34; thoracoscopy, three of 45 (P < 0.73)], operating room times [thoracotomy, 54 +/- 26 minutes; thoracoscopy, 53 +/- 16 minutes (P < 0.59)], and postoperative length of stay [thoracotomy, 5.7 +/- 4.3 days; thoracoscopy, 4.7 +/- 4.4 days (P < 0.26)] were not significantly different for the two techniques. We conclude that axillary thoracotomy and videothoracoscopy are equally effective surgical treatments for spontaneous pneumothoraces. A large randomized trial would be needed to determine whether one approach is truly superior to the other. [ABSTRACT FROM AUTHOR]

Pleural dissection in pleurectomy under videothoracoscopy in patients with pneumothorax is easily and safely performed using argon gas. [ABSTRACT FROM AUTHOR]

Objective: To explore diaphragmatic lesions that are potentially associated with catamenial pneumothorax by using an advanced flexible laparoscope with wide optic angle. Design: Case report. Setting: University hospital. Patient(s): A 30-year-old woman who was scheduled for thoracoscopic surgery because of recurrent right-sided catamenial pneumothorax. Intervention(s): The peritoneal surface of the diaphragm was explored with an advanced flexible laparoscope that was equipped with a charge-coupled device on the tip, concurrently with thoracoscopic surgery. Main Outcome Measure(s): Lesions associated with endometriosis on the peritoneal surface of the posterior diaphragm abutting the posterior abdominal wall and liver. Result(s): When the flexible laparoscope was inserted via an umbilical trocar and the peritoneal surface of the right-sided diaphragm was explored, guided by illumination from the thoracoscope, scattered specific lattice lesions and fenestrations were identified in the central tendon of the posterior diaphragm, a region that cannot be visualized with the conventional rigid laparoscope. Conclusion(s): By using the flexible laparoscope, endometriotic lesions potentially related to catamenial pneumothorax were identified on the posterior diaphragm. [Copyright &y& Elsevier]

Evaluates the surgical treatment of pneumothorax in patients with acquired immunodeficiency syndrome (AIDS). Retrospective review of AIDS patients at the Hotel-Dieu de Montreal in Canada; Statistics on patients with pneumothoraces; Associated pathology; Initial and definitive treatments; Need for individualized treatment.