Unmasking The Risk of Vaping-Associated Pneumothorax in Rib Cartilage Rhinoplasty

Air Travel and Pneumothorax

What Constitutes Effective Management of Pneumothorax After CT-Guided Needle Biopsy of the Lung?

Asian rhinoplasty using a thin rib cartilage graft and ultrafine diced cartilage wrapped in fascia: A comparative study between septal cartilage graft and rib cartilage graft

Describe a modified technique to increase nostril cross-sectional area using rib and septal cartilage graft over alar nasal cartilages. A modified surgical technique was used to obtain, carve and insert cartilage grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad(®); 30 were taken before any procedure and 60 were taken after grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage). Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance) for the variable "area". There's statistical evidence that rib cartilage graft is more effective than septal cartilage graft. The mean area after the insertion of septal cartilage graft is smaller than the mean area under rib graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%). The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage graft over lateral crura rather than by septal graft.

There are several methods that may be used to confirm the status of rib cartilage, such as physical examinations or chest radiography, for subjects with microtia. However, these methods are limited because of clinicians' inability to gain accurate information about the rib cartilage. We performed 3-dimensional chest computed tomography to preoperatively evaluate the accuracy of rib cartilage imaging. A total of 37 patients preparing for auricular reconstruction using a rib cartilage graft underwent preoperative 3-dimensional rib cage computed tomography (3-D rib CT). The 3-D rib CT was performed in cases of secondary revisional reconstruction, those with a history of surgery using rib cartilage, in those with a history of trauma related to the rib cage, older patients with question of calcification of rib cartilage, or those with a suspected rib cartilage anomaly on physical examination. Preoperatively, the appropriateness of using the rib cartilage were evaluated. With the aid of the 3-D rib CT, successful autogenous auricular reconstruction was achieved in 36 patients. Framework fabrication in combination with a porous polyethylene implant and autogenous rib cartilage was performed in the remaining patient as planned preoperatively. By analyzing the 3-D rib CT image preoperatively, auricular reconstruction using a recycled rib cartilage graft with newly harvested rib cartilage was performed successfully in 13 of 14 secondary revisional cases. Based on preoperative CT images, modified surgical planning in terms of cartilage harvest and framework fabrication was needed in 8 of 11 patients who had a history of operation using rib cartilage and in 3 of 5 subjects with suspected rib cage anomalies on physical examination. Successful reconstruction was achieved using the modified surgical plan. A preoperative 3-D rib CT helps in surgical planning for autogenous auricular reconstruction for microtia, especially in patients with suspicious rib cartilage status.

Introduction: Spontaneous pneumothorax (SP) is commonly observed in tall, thin, young males, particularly affecting the apical regions of the lungs. While typically idiopathic, emerging evidence suggests that vaping may be a significant contributing factor. We present a case of recurrent spontaneous apical pneumothorax in a tall, thin Caucasian male, where vaping is likely the primary cause given the histopathological findings. Case presentation: A 25-year-old male with a history of bilateral apical pneumothoraxes and vaping use disorder presented with sudden left-sided chest pain and shortness of breath while cleaning his truck. Initial chest x-ray revealed a mild to moderate left apical pneumothorax. Given his history, cardiothoracic surgery was consulted, and he underwent video-assisted thoracoscopic surgery (VATS) with biopsy and chest tube placement. Post-procedure, his symptoms improved, and pathology showed chronic inflammation, fibrosis, and subpleural blebs. The chest tube remained in place for nearly a week until the pneumothorax resolved without recurrence. Follow-up imaging showed a stable, small residual pneumothorax, which remained unchanged over the next week. This case highlights the potential link between vaping and recurrent spontaneous pneumothorax in young patients. Discussion: This case highlights the potential role of vaping in the recurrence of spontaneous pneumothorax, particularly in tall, thin individuals, possibly due to increased inflammation and the development of subpleural blebs. Previous studies suggest a reduced incidence of pneumothorax after quitting vaping, and case series have shown that cessation may lower the risk of recurrence. This reinforces the importance of advising young, at-risk patients to quit vaping as a preventive measure against further pneumothorax episodes.

1. Katherine Cashen, DO* 2. Tara L. Petersen, MD† 1. *Department of Pediatrics, Children's Hospital of Michigan/Wayne State University School of Medicine, Detroit, MI 2. †Division of Critical Care, Department of Pediatrics, The Children’s Hospital of Wisconsin/The Medical College of Wisconsin, Milwaukee, WI * Abbreviations: BTS: : British Thoracic Society CHF: : congestive heart failure CT: : computed tomography VATS: : video-assisted thoracoscopic surgery 1. Clinicians should be aware of the causes and clinical presentation of pleural effusions and pneumothoraces. 2. Clinicians should understand the current role of diagnostic tests, imaging modalities, and timing of minimally invasive treatments. After completing this article, readers should be able to: 1. Describe the pathogenesis of pleural fluid accumulation. 2. Identify the most likely causes of pleural effusion and pneumothorax. 3. Understand the basic clinical presentation, diagnostic tests, and management of pleural effusions and pneumothoraces. 4. Differentiate between transudative and exudative pleural effusions. 5. Understand the natural history of spontaneous pneumothorax. The pleural space is created by the parietal and visceral pleura that line the chest wall and the lung surface, respectively. Normally, only a small amount (0.3 mL/kg) of hypotonic fluid is present within the pleural space due to homeostatic balances in physiologic fluid production and absorption. Various infectious and noninfectious processes can lead to pathologic filling of the pleural space with fluid (effusion) or air (pneumothorax). Such pathologic changes create a true space that can interfere with normal lung mechanics and, in severe cases, cardiac function. Although much less common in pediatric than adult populations, pleural effusions and pneumothoraces in both groups can lead to substantial complications, resulting in significant morbidity and mortality if unrecognized or untreated. Overall, the cause of pleural effusions and pneumothoraces differs in children compared to adults. In adults, congestive heart failure (CHF) and malignancy account for a substantial number of pleural effusions, but these are uncommon causes in children. Infectious pleural effusions in the setting of pneumonia (parapneumonic effusions) remain the most common cause of effusions in both children and adults. Unlike the adult population, children experience spontaneous …

The aim of this study was to evaluate the effect of coaxial guide needle gauge (18 vs. 19 gauge) on the risk of pneumothorax and chest tube placement after CT-guided lung biopsy. Imaging records of all patients who had undergone CT-guided lung biopsies at our institution from March 1, 2006 to December 9, 2010 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to assess the effect of various patient-, lesion-, and procedure-related variables on subsequent pneumothorax and chest tube placement rates. The study included 4262 biopsies (2304 with 18-gauge and 1958 with 19-gauge coaxial guide needles) in 3917 patients. The rates of pneumothorax and chest tube placement were 30.2 and 15%, respectively. Pneumothorax occurred in 35% of procedures performed with 18-gauge needles and in 24.5% of procedures performed with 19-gauge needles (p < 0.0001). Chest tube insertion occurred in 16.7% of procedures performed with 18-gauge needles and in 13.1% of procedures performed with 19-gauge needles (p = 0.0011). Multivariate logistic regression models demonstrated that the use of an 18-gauge needle was associated with a higher rate of pneumothorax (p < 0.0001) and chest tube placement (p = 0.0003). The following factors were also associated with higher rates of pneumothorax and chest tube placement: older age, emphysema, greater number of pleural surfaces crossed, and a longer biopsy needle path length. The use of a 19-gauge coaxial guide needle significantly decreases the risk of pneumothorax and chest tube placement compared with an 18-guage needle.

Unileaflet Mitral Valve in Patient With Marfanoid Habitus

The purpose of this paper is to evaluate whether meteorological variables influence rates of pneumothorax and chest tube placement after percutaneous transthoracic needle biopsy (PTNB) of pulmonary nodules. A retrospective review of 338 consecutive PTNBs of pulmonary nodules at a single institution was performed. All procedures implemented a coaxial approach, using a 19-gauge outer guide needle for access and a 20-gauge core biopsy gun with or without a small-gauge aspiration needle for tissue sampling. Correlation between age, sex, smoking history, lesion size, meteorological variables, and frequency of complications were evaluated. Fisher exact, trend and t tests were used to evaluate the relationship between each factor and rates of pneumothorax and chest tube placement. A p value of less than 0.05 was considered to indicate a statistically significant difference. Pneumothorax occurred in 115 of 338 patients (34%). Chest tube placement was required in 30 patients (8.9%). No significant relationship was found between pneumothorax rate and age (p = 0.172), sex (p = 0.909), smoking history (p = 0.819), or lesion location (p = 0.765). The presence or absence of special weather conditions did not correlate with the rate of pneumothorax (p = 0.241) or chest tube placement (p = 0.213). The mean atmospheric temperature (p = 0.619) and degree of humidity (p = 0.858) also did not correlate with differences in the rate of pneumothorax. Finally, mean atmospheric pressure on the day of the procedure demonstrated no correlation with the rate of pneumothorax (p = 0.277) or chest tube placement (p = 0.767). In conclusion, no correlation is demonstrated between the occurrence of pneumothorax after PTNB of pulmonary nodules and the studied meteorological variables.

Introduction Cigarette smoking is a well-established risk factor for adverse perinatal outcomes, including preterm birth (PTB), fetal growth restriction (FGR), neonatal intensive care unit admission, and low birth weight. Fortunately, public health initiatives in the United States have contributed to the significant decline in cigarette smoking among pregnant and postpartum patients. However, as the rates of cigarette smoking decline, there has been a recent rise of electronic cigarette (e-cigarette) use, or vaping. While many believe that vaping is a safer alternative, e-cigarette aerosols contain potentially toxic compounds, including nicotine and harmful flavorings, which may harm fetal development. Recent studies have established an association between vaping during pregnancy and increased risk of PTB and low birth weight. However, comparison of vaping to cigarette smoking remains limited. Objective This project aims to compare the effects of e-cigarette use and traditional cigarette smoking on perinatal outcomes, including FGR, PTB, hypertensive disorders of pregnancy, and miscarriage. Methods A nested cohort study was conducted using the TriNetX Research Network Database, which contains data from 92 healthcare organizations globally. Cohorts were identified using the International Classification of Diseases, Tenth Division, Clinical Modification (ICD-10-CM) coding with exposure defined as: 1) patients with a diagnosis of cigarette smoking within one year of pregnancy and 2) patients with a diagnosis of vaping use within one year of pregnancy. Patients with nicotine dependence from other products or dual cigarette and vape use were excluded. 1:1 propensity matching was performed based on age, race, ethnicity, BMI, pre-existing conditions (prediabetes, diabetes mellitus, hypertension), and history of PTB. Statistical analysis was performed within the TriNetX platform. Results Of the 331 298 patients identified with cigarette use and 924 with vaping use, 919 patients were matched for analysis. No significant differences were found between the groups for preterm labor (OR: 0.559, 95% CI: 0.281-1.11; p = 0.0923), FGR (OR: 0.727, 95% CI: 0.416-1.27; p = 0.2603), miscarriage (OR: 0.767, 95% CI: 0.334-1.758; p = 0.529), pre-existing hypertension with pre-eclampsia (OR: 0.663, 95% CI: 0.296-1.484; p = 0.3139), and eclampsia (OR: 1, 95% CI: 0.414-2.414; p = 1.0). However, patients who used e-cigarettes had higher incidence of gestational hypertension (OR: 0.497, 95% CI: 0.301-0.82; p = 0.0054) and pre-eclampsia (OR: 0.287, 95% CI: 0.157-0.525; p &amp;lt; 0.0001). After propensity score matching, the differences between the groups in terms of age, race, ethnicity, BMI, prediabetes, diabetes mellitus, hypertension, and history of PTB were no longer statistically significant. Conclusions This study suggests that e-cigarette use is associated with increased rates of gestational hypertension and pre-eclampsia as compared to cigarette use. Given the recent rise in e-cigarette use, these findings emphasize the need for counseling on its risks, as it may not be a safer alternative to cigarette smoking during pregnancy. Further research is required to explore the effects of vaping on perinatal health. Disclosure No.

Autologous cartilage has been extensively employed in nasal tip plasty procedures. Nevertheless, long-term resorption rates of autologous cartilage grafts, particularly on the nasal tip, remain uncertain to surgeons worldwide. Thus, the present study aims to assess the resorption rate of conchal cartilage and rib cartilage. A total of 27 patients who underwent nasal tip plasty using either ear cartilage graft as cap graft or rib cartilage used as septal extension graft and cap graft simultaneously between 2015 and 2024 were included in this study. These patients underwent 3D photogrammetry before the surgery (T0), immediately postoperatively (T1, average of 11.1 days), and one long-term follow-up (T2, average of 453 days). Both 2D metrics such as tip height and 3D metrics including nose volume, nasal tip volume were analyzed using computer software to evaluate the difference in long-term resorption rate. The conchal cartilage group (n = 17) showed a higher resorption rate in tip height (95.40% ± 0.953) compared to the rib cartilage group (17.50% ± 0.521, p = 0.026). Similarly, the conchal group (n = 10) exhibited a greater resorption rate in tip volume (57.12% ± 0.343) compared to the rib group (30.42% ± 0.274, p = 0.047), while resorption rate in other measurements did not show significant difference. Both cartilage grafts adequately provided support in the short term, while the septal extension graft and cap graft constructed with rib cartilage demonstrated superior long-term stability and a reduced rate of tip projection loss, which indicates lower resorption rate when compared to cap graft constructed with conchal cartilage. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

BackgroundThe risk of endobronchial ultrasound-guided transbronchial biopsy-related pneumothorax is a major concern and warrants further studies. The aim of our study was to estimate the risk of pneumothorax after this procedure and identify its risk factors.MethodsFrom 2007 to 2011, 399 patients who underwent endobronchial ultrasound-guided transbronchial biopsy for peripheral lung lesions were included in this study. The variables analyzed included patient factors, lesion factors and procedure factors. Multivariate logistic regression analysis was used to identify independent risk factors for pneumothorax.ResultsThe incidence of pneumothorax was 3.3% (13/399). Chest tube placement was required for 31% (4/13) of pneumothoraces. Independent risk factors for pneumothorax included pulmonary emphysema (OR, 55.09; 95% CI, 9.37–324.03; p<0.001) and probe position adjacent to the lesion (OR, 17.01; 95% CI, 2.85–101.64; p = 0.002). The number of biopsy specimens, age, sex, history of prior lung surgery and lesion size, location and character did not influence the risk of pneumothorax in our analyses.ConclusionsThe risk of pneumothorax after endobronchial ultrasound-guided transbronchial biopsy is low. To further reduce the risk of pneumothorax, every effort should be made to advance the endobronchial ultrasound probe into the bronchus where it is imaged within the target lesion before embarking on transbronchial biopsy.

The purpose of this study was to evaluate the epidemiology and perioperative complications of different reconstructive strategies to correct cleft nasal deformity, with particular attention paid to type and timing of cartilage grafting. Retrospective cohort study was conducted of cleft rhinoplasty performed between 2012 and 2017 in North America utilizing the American College of Surgeons National Surgical Quality Improvement Program- Pediatric hospital network. Medical/surgical complications, reoperations, and readmissions within 30 days postoperatively were analyzed with appropriate statistics. During the study interval, 3317 pediatric patients underwent cleft rhinoplasty, with 8.0% involving the use of cartilage grafts. Ear cartilage was significantly more commonly used for intermediate repair, whereas rib cartilage was more commonly used for late repair (P=0.006). Overall, rhinoplasties with ear cartilage grafts had shorter procedure durations than those without cartilage grafts (P=0.005), whereas those with rib cartilage grafts had increased procedure duration (P<0.001). The use of cartilage grafts was not associated with increased complications in either intermediate or late cleft rhinoplasty. Patients with bilateral clefts were more likely to undergo rhinoplasty with cartilage grafts overall (P=0.047) and with cartilage grafts for late reconstruction (P=0.039). Ear cartilage is most frequently utilized for intermediate repair, whereas rib cartilage is most frequently utilized for late repair during cleft rhinoplasty. Ear cartilage grafts are associated with significantly decreased procedure duration, whereas rib cartilage grafts are associated with significantly increased procedure duration. Not surprisingly, cleft rhinoplasty is relatively safe, with a 2% overall short-term complication rate.

A CASE OF E-CIGARETTE OR VAPING PRODUCT USE-ASSOCIATED LUNG INJURY IN AN INFREQUENT VAPE USER