Occurrence Of Primary Spontaneous Pneumothorax Research Articles

Correlation of Primary Spontaneous Pneumothorax and Air Pollution in Adolescents.

BackgroundWe aimed to investigate the characteristics of primary spontaneous pneumothorax (PSP) in adolescents and to analyze the relationship between the occurrence of PSP and air pollutants.MethodsData pertaining to age, sex, body mass index, smoking status, initial pneumothorax volume, presence of bullae, treatment methods, and city of residence were retrospectively obtained from January 2010 to December 2014. We investigated the association between short-term exposure to air pollutants (SO2, NO2, O3, CO, and PM10) and the occurrence of PSP using a case-crossover design with conditional logistic regression.ResultsWe collected information from 598 patients who were admitted for PSP, with a mean follow-up duration of 62.9 months. The majority (91.1%) of the patients were male. In the case-crossover design, conditional logistic regression showed that no air pollutant was associated with the occurrence of pneumothorax. The results were consistent across all city subgroups (Anyang, Gunpo, Uiwang, and Gwacheon).ConclusionIn our study, the incidence rate of pneumothorax was 153.8 per 100,000 person-years in male adolescents and 16.7 per 100,000 person-years in female adolescents. The case-crossover design showed that PSP in adolescents is unlikely to be related to air pollution.

Fate of contralateral asymptomatic bullae in patients with primary spontaneous pneumothorax.

This retrospective cohort study aimed to analyse the impact of asymptomatic blebs/bullae on the occurrence of primary spontaneous pneumothorax (PSP) by monitoring the natural course of contralateral blebs/bullae in patients with ipsilateral pneumothorax. From January 2003 to December 2017, 1055 patients [age 19.6 ± 3.98 years (mean ± standard deviation), 953 men] experiencing the first episode of unilateral PSP were enrolled in this study, excluding patients aged 30 years or more. The presence, number and maximal size of the blebs/bullae were investigated in contralateral asymptomatic lungs based on high-resolution computed tomography. Multiple and single blebs/bullae were noted in contralateral lungs in 425 (40.3%) and 88 (8.3%) patients, respectively. The median follow-up period was 44.0 (interquartile range 71.5) months. The 1-, 3- and 5-year cumulative occurrence rates of PSP in contralateral lungs were 7.9%, 13.7% and 16.7%, respectively. On multivariable analysis, younger age [hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.12-1.27; P < 0.001) and multiple bullae (HR 4.42, 95% CI 3.06-6.38; P < 0.001) were independent risk factors for spontaneous pneumothorax in the contralateral lung. The 5-year cumulative occurrence rates of PSP were significantly higher in patients with multiple blebs/bullae than in those with no or a single bleb/bulla (28.2% vs 8.5%, respectively; P < 0.001). Asymptomatic blebs/bullae often lead to PSP. If the patient is eligible for surgery for pneumothorax, preemptive surgery for contralateral bullae could be considered, especially in patients with multiple blebs/bullae.

Primary spontaneous pneumothorax in children: factors predicting recurrence and contralateral occurrence.

The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes. We reviewed children aged < 18years admitted to our institution for PSP from 2008 to 2017, excluding those with malignancies. Basic demographic data were extracted. Clinical data collected include pneumothorax laterality, CT results, treatment protocols and recurrences. 63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4years (14.9-15.9), and body-mass index was 17.9kg/m2 (15.8-19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8months (11.6-35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685-608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1). This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.

Delayed-onset pneumothorax after posterior spinal fusion for idiopathic scoliosis: Report of two cases

Most complications related to posterior spinal fusion (PSF) are reported to be caused by direct injury of the pedicle screws or by an indirect mechanical load generated by the deformity correction during surgery. Primary spontaneous pneumothorax (PSP) is caused by the rupture of bulla/bleb, and is a very rare complication after scoliosis surgery. Herein, we present two cases of delayed-onset PSP after scoliosis surgery. In Case 1, an 18-year-old woman with adolescent idiopathic scoliosis (Lenke 1CN) underwent PSF at T2-L2. The correction rate was 80%. The patient was discharged at 2 weeks after the operation. On the 18th postoperative day, she suddenly felt dyspnea after back pain at home, and walked to an outpatient clinic. She was diagnosed with PSP of the left lung by whole spine X-ray. In Case 2, a 20-year-old woman with idiopathic scoliosis (Lenke 6CN) underwent PSF at T3-L4. The correction rate was 73.6% in the thoracic region and 67.5% in the lumbar region. The patient felt dyspnea at three months after the operation. She was diagnosed with PSP (tension pneumothorax) in the left lung by whole spine X-ray. Both cases underwent video-assisted bulla resection following several days of emergency thoracic drainage, after which the subjects became asymptomatic. PSP should be considered as a complication of PSF when patients show dyspnea following back pain at several weeks after the operation. The presence of bullae/blebs should be examined by perioperative computed tomography to predict the occurrence of PSP.

Efficacy and safety of pleurectomy and wedge resection versus simple pleurectomy in patients with primary spontaneous pneumothorax.

The treatment of primary spontaneous pneumothorax (PSP) remains controversial. Guidelines do not explicitly define surgical procedures. Different treatment modalities are observed in clinics of same profile. Treatment is controversial. The aim of the work was to compare the effectiveness of two methods-pleurectomy and pleurectomy combined with wedge resection in patients with PSP in terms of safety and efficiency. Non-randomized observational study based on clinical analysis of 73 patients, M:F ratio 3:1, aged 18 to 45 years, the average age was 29 years, operated between January 2008 and December 2014 due to the occurrence of PSP. Pleurectomy was supplemented by wedge resection in patients diagnosed intraoperatively with ELC (emphsema-like changes) ≥ III stage (classification of PSP by Vanderschueren). Efficacy was defined as follows: complete lung expansion, drainage (days), air leak, frequency of PAL (persistent air leak >5 days), recurrences and re-operations. Safety was defined as follows: heamothorax, major bleeding (loss of Hg >2 g/dL), infections, deaths. The research project was approved by the Bioethical Commission of the Silesian Medical University in Katowice (KNW/022/kb1/3/14). Mean follow-up was 22 months. Efficacy: recurrences occurred less frequently in group treated with pleurectomy without wedge resection. No results were found in other parameters. Safety: No results were found in all parameters. Efficacy and safety of pleurectomy vs. pleurectomy + wedge resection is comparable.

Does air pollution really impact the onset of spontaneous pneumothorax? A French case-crossover study

RationaleA link is established between air pollution and respiratory diseases. Very few studies evaluated this link with primary spontaneous pneumothorax (PSP). Contrasted results, low statistical power and methodological limits of these studies brought us to evaluate in a more thorough way this link. Objectives(1) to estimate the relation between PSP and air pollutants namely nitrogen dioxide (NO2), ozone (O3) and particulate matter with a diameter ≤ 10 μm (PM10); (2) to investigate a time lag effect between these pollutants and occurrence of PSP. MethodsThis study has a case-crossover design. Subjects aged ≥18 years admitted from 1st June 2009 to 31st May 2013, in 14 Emergency Departments centers on the French territory. Were excluded: patients with traumatic, secondary, recurrent or history of previous pneumothorax. NO2, O3 and PM10 data were collected hourly in monitoring stations. Three exposure assessments were retained: quantitative values, fast increase concentration of air pollutants and peak of pollution. These assessments were calculated for the entire exposure period and for each of the four days of all case and control periods. Results948 subjects included. Whatever the pollutant considered, no differences were observed between case and control periods, regardless of whether the quantitative values of air pollutants exposure (p > 0.09), fast increase concentration (p > 0.46) and peak of pollution (p > 0.20). ConclusionsWe failed to show a relation between PSP and short-term air pollution exposure to low levels of NO2 and PM10. An association between O3 exposure and PSP cannot be ruled out. An impact at higher exposure level, and/or a potentiating effect of different meteorological factors remain to be demonstrated.

Seorang Perempuan Perokok Tembakau dan Mariyuana dengan Pneumotoraks Spontan Primer Akibat Blep Multipel yang Pecah

Background: Primary spontaneous pneumothorax (PSP) can be caused by a ruptured blep emfisematus subpleural. People who smoke tobacco and marijuana simultaneously arise PSP will be more risky than just smoking tobacco. Pneumothorax in cannabis smokers may occur due to coughing at the time was holding their breath, when they were smoking marijuana. Case: We report the case of 33-year-old woman with recurrent shortness of breath as a result of primary spontaneous pneumothorax in the right hemithorax. The patient’s tobacco and marijuana smokers. Patients had undergone previous pleurodesis. Chest X-ray picture of the lines conveniently indicates lung collapse and air-fluid level in the right hemithorax. Thoracoscopic showed a large bronchopleural fistula. During thoracotomy found one bronkopeural fistula, three large blep, and more than 15 small blep. Then do the suturing of fistula and blep. Patients recover in a short time and in good condition during treatment. Conclusion: Tobacco and marijuana smoking is a risk factor that is synergistic to the occurrence of primary spontaneous pneumothorax. These patients consume both are irregular but have resulted in multiple blep that can rupture and cause a pneumothorax.

Influence of Environmental Factors on the Primary Spontaneous Pneumotorax

Pneumothorax is the presence of air between the two pleural effusions, making the pleural space from a virtual cavity to a real one. At present, we are facing a particular phenomenon: trying to establish with certainty the mechanisms underlying the occurrence of primary spontaneous pneumothorax and how to find and implement the best strategies for the application of treatment methods. Considering the classical conception that the incidence of spontaneous pneumothorax has a seasonal variability, we followed its distribution after the season, calendar month, by checking the statistical significance of the data obtained. Regardless of the dynamics factor involved and the likely mechanism of action, it seems to have an influence on the average duration of hospitalization and the length of time elapsed from intervention to discharge.

Seasonal and meteorological impacts on primary spontaneous pneumothorax.

Although several studies have suggested that primary spontaneous pneumothorax (PSP) might occur in clusters, only a few studies have found seasonal variations in PSP occurrence. Some meteorological parameters might be related to the occurrence of PSP occurrence, however, the effects of weather variations on the onset of PSP are still controversial. We examined seasonal differences in the occurrence of PSP and the meteorological risk factors for PSP. All PSP patients aged <40 years who were admitted to Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers from April 2007 through March 2013 were included in the study. The incidence rates of PSP were 16.7 and 2.1 per 100,000 person-years in men and women, respectively. The frequency of PSP days among months and seasons was significantly different with a peak in September and autumn. Daily changes in maximum wind speed had positive associations with PSP days [crude OR =1.11 (95% CI: 1.02-1.21) per 1 m/s, P=0.02; multivariable-adjusted OR =1.11 (95% CI: 1.00-1.23) per 1 m/s, P=0.05]. PSP tends to cluster seasonally. Increased wind speed may play a role in the development of PSP.

Air pollutants and atmospheric pressure increased risk of ED visit for spontaneous pneumothorax

ObjectiveTo investigate the impact of short-term exposure to air pollutants and meteorological variation on ED visits for primary spontaneous pneumothorax (PSP). Material and methodsWe retrospectively identified PSP cases that presented at the ED of our tertiary center between January 2015 and September 2016. We classified the days into three types: no PSP day (0 case/day), sporadic days (1–2 cases/day), and cluster days (PSP, ≥3 cases/day). Association between the daily incidence of PSP with air pollutants and meteorological data were determined using Poisson generalized-linear-model to calculate incidence rate ratio (IRRs) and the use of time-series (lag-1 [the cumulative air pollution level on the previous day of PSP], lag-2 [two days ago], and lag-3 [three days ago]). ResultsUsing multivariate logistic regression analysis, O3 (p = 0.010), NO2 (p = 0.047), particulate matters (PM)10 (p = 0.021), and PM2.5 (p = 0.008) were significant factors of PSP occurrence. When the concentration of O3, NO2, PM10, and PM2.5 were increased, PSP IRRs increased approximately 15, 16, 3, and 5-fold, respectively. With the time-series analyses, atmospheric pressure in lag-3 was significantly lower and in lag-2, was significantly higher in PSP days compared with no PSP days. Among air pollutant concentrations, O3 in lag-1 (p = 0.017) and lag-2 (p = 0.038), NO2 in lag-1 (p = 0.015) and lag-2 (p = 0.009), PM10 in lag-1 (p = 0.012), and PM2.5 in lag-1 (p = 0.021) and lag-2 (p = 0.032) were significantly different between no PSP and PSP days. ConclusionIncreased concentrations of air pollutants and abrupt change in atmospheric pressure were significantly associated with increased IRR of PSP.

Pulmonary Apical Opacities on Thin-Section Computed Tomography: Relationship to Primary Spontaneous Pneumothorax in Young Male Patients and Corresponding Histopathologic Findings.

The purpose of this study was to test the hypothesis that apical opacities on computed tomography (CT) are related to occurrence of primary spontaneous pneumothorax (PSP) in young male patients. We compared the frequency of apical opacities on thin-section CT between 70 male patients with PSP (PSP group) and 74 male patients without a history of PSP (non-PSP group). We also evaluated histopathologic findings of 39 specimens from 37 surgical cases in the PSP group. Apical opacities were significantly more frequent in the PSP group than in the non-PSP group (right side, P = 0.01; left side, P = 0.005). Histopathologically, subpleural band-like alveolar collapse was seen in 35 specimens (89.7%), which was always accompanied by fibroelastosis and fibroblastic foci. Apical opacities on CT were significantly associated with PSP in young male patients. These apical opacities histopathologically correspond to fibrotic pleural thickening with subpleural alveolar collapse.

Outcomes of Contralateral Bullae in Primary Spontaneous Pneumothorax.

BackgroundThe management of contralateral bullae incidentally found in radiological studies is controversial, largely due to the unpredictability of the natural course of incidentally found contralateral bullae. This study aimed to identify the factors associated with the contralateral occurrence of primary spontaneous pneumothorax (PSP), and to characterize the outcomes of contralateral bullae incidentally found in radiological studies.MethodsFrom January 2005 to December 2008, 285 patients were admitted to our institution for PSP, and the patients underwent follow-up until August 2012. The relationships between the following variables and contralateral pneumothorax occurrence were evaluated: age, sex, smoking history, body mass index, ipsilateral recurrence, ipsilateral bullae size, the number of ipsilateral bullae, contralateral bullae size, and the number of contralateral bullae.ResultsThe study group consisted of 233 males and 29 females. The mean age and mean body index of the patients were 23.85±9.50 years and 19.63±2.50 kg/m2. Contralateral PSP occurred in 26 patients. The five-year contralateral PSP occurrence- free survival rate was 64.3% in patients in whom contralateral bullae were found.ConclusionThe occurrence of contralateral PSP was associated with younger age, ipsilateral recurrence, and the presence of contralateral bullae. Contralateral PSP occurrence was more common in young patients and patients with recurrent PSP. Single-stage bilateral surgery should be considered if an operation is needed in young patients, patients with recurrent pneumothorax, and patients with contralateral bullae.

Recurrence of primary spontaneous pneumothorax in young adults and children.

Although better nutritional support has improved the growth rates in children, the occurrence of primary spontaneous pneumothorax has also been increasing in children. The current study attempts to investigate the occurrence and recurrence of primary spontaneous pneumothorax and the efficacy of surgery for primary spontaneous pneumothorax in young adults and children. A total of 840 patients were treated for pneumothorax at our hospital from January 2006 to December 2010. Exclusion criteria for this study were age >25 or secondary, traumatic or iatrogenic pneumothorax, and a total of 517 patients were included. Patients were classified into three groups according to age at the first episode of primary spontaneous pneumothorax: Group A: ≤16 years; Group B: 17-18 years and Group C: ≥19 years. The study group was composed of 470 male and 47 female patients. There were 234 right-sided, 279 left-sided and 4 bilateral primary spontaneous pneumothoraces. Wedge resection by video-assisted thoracic surgery was performed in 285 patients, while 232 were managed by observation or closed thoracostomy. In the wedge resection group, 51 patients experienced recurrence. The recurrence rates after wedge resection were 27.9% in Group A, 16.5% in Group B and 13.2% in Group C (P = 0.038). The recurrence rates after observation or closed thoracostomy were 45.7% in Group A, 51.9% in Group B and 47.7% in Group C (P = 0.764). In the present study, postoperative recurrence rates were higher than those in the literature. Intense and long-term follow-up was probably one reason for the relatively high recurrence rate. The recurrence rate after wedge resection in patients aged ≤16 years was higher than that in older patients. There was no difference between the recurrence rates after observation or closed thoracostomy, regardless of age. These results suggest that wedge resection might be delayed in children.

Rapid Increase in the Height and Width of the Upper Chest in Adolescents with Primary Spontaneous Pneumothorax

We determined the chest height in a cohort of patients with primary spontaneous pneumothorax (PSP) who had received chest radiographic examinations prior to the attack. The aim of this study was to determine when their chest height began to change and how this was related to the PSP. From June 2009 to February 2012, the chest posteroanterior radiographs of 156 patients with PSP (Group 1) were reviewed. Among another 3134 patients with PSP, we identified 52 patients who had a chest posteroanterior radiograph prior to the attack (Group 2). We also recruited 196 controls for comparison (Group 3). The chest height and chest width at different levels were measured and analyzed. Before 14 years of age, the chest height of patients in Group 2 was no different from that of patients in Group 3. By the age of 14 years, however, the chest height and upper chest width of patients with PSP was significantly higher than that of the normal controls. The difference from normal chest height did not increase at adulthood. The rapid increase in chest height and upper chest width is a unique finding in patients with PSP. It might be attributable to the occurrence of PSP. This finding may also help to identify patients who are at risk of PSP.

Invited Commentary

Current guidelines do not clearly recommend computed tomography (CT) after the first episode of primary spontaneous pneumothorax (PSP). However, a growing body of evidence suggests a compelling role of CT in predicting recurrence after the first episode. The article by Casali and colleagues [1Casali C. Stefani A. Ligabue G. et al.Role of blebs and bullae detected by high-resolution computed tomography and recurrent spontaneous pneumothorax.Ann Thorac Surg. 2013; 95: 249-256Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar] confirms these recent findings. The authors analyzed 176 patients admitted for a first episode of PSP and found that the presence of air-containing lesions in the lung was associated with a 68% risk of ipsilateral recurrence—data that in the authors' opinion would warrant surgical treatment right after the first episode. One of the most interesting aspects of their work is the external validation of a “dystrophy score,” a multifactorial scoring system based on high-resolution CT scan findings. They found that freedom from recurrence decreased from 93% to 22% in patients without air-containing lesions in comparison with patients with dystrophy scores greater than 5. Analyzing their Kaplan-Meier estimates, 50% of patients with even a single ipsilateral bleb identifiable at CT scan (low-grade score) experienced an ipsilateral recurrence. This proportion increased to 70% to 80% among those with intermediate or high-grade dystrophy scores. Of interest, most of the recurrences occurred within the first 12 months from the first PSP episode. If these results will be confirmed by future prospective studies, they will certainly warrant a more liberal use of a surgical procedure (reputedly the most effective form of preventative measure) after the first episode, particularly in those patients with the presence of blebs or bullae at CT scan. Future studies are needed to conciliate this observation with additional/alternative lung pathologic conditions, which have been associated with the occurrence of PSP (ie, pleural porosity). Finally, in light of the mounting evidence about the role of CT in predicting recurrence after the first episode of PSP, the current guidelines need probably to be updated. Role of Blebs and Bullae Detected by High-Resolution Computed Tomography and Recurrent Spontaneous PneumothoraxThe Annals of Thoracic SurgeryVol. 95Issue 1PreviewThe prevention of recurrence after a first episode of primary spontaneous pneumothorax (PSP) remains a debated issue. The likelihood of recurrence based on the presence of blebs and bullae detected on high-resolution computed tomography (HRCT) imaging is controversial. Full-Text PDF

Influence of Weather Conditions on the Onset of Primary Spontaneous Pneumothorax: Positive Association with Decreased Atmospheric Pressure

Primary spontaneous pneumothorax is believed to result from blebs, or from other abnormalities of the pleural surface. There is no consensus as to whether a change in weather conditions can precipitate spontaneous pneumothorax. The aim of the present study was to investigate the influence of weather conditions on the onset of primary spontaneous pneumothorax. The case histories of 1051 inpatients with primary spontaneous pneumothorax treated at Nissan Tamagawa Hospital between January 2006 and December 2011 were analyzed retrospectively. Data on weather conditions were collected daily throughout the 6-year period. The data were analyzed to determine differences in weather conditions between days on which primary spontaneous pneumothorax occurred and those on which it did not. Primary spontaneous pneumothorax occurred on 819 (37.3%) of 2191 study days. On days before and the day of primary spontaneous pneumothorax onset, the difference in mean atmospheric pressure was 0.6 hPa lower than on days in which no primary spontaneous pneumothorax occurred. This difference was statistically significant (P = 0.015). There was no statistical difference in mean, maximum, and minimum temperature, hours of sunshine, amount of precipitation, and mean and minimum humidity between days with and those without primary spontaneous pneumothorax. This largest study of the literature showed decreased atmospheric pressure might play an important role in the occurrence of primary spontaneous pneumothorax.

Climatic Conditions and the Onset of Primary Spontaneous Pneumothorax: An Investigation of the Influence of Solar Terms

Objective: To study the correlation between climatic changes and the development of primary spontaneous pneumothorax (PSP). Subjects and Methods: We retrospectively studied the relationship between 337 patients with conservatively treated PSP and meteorological conditions during a 3-year period in the urban area of Xi’an, China. The comparison was made depending on solar terms and on different aspects of atmospheric pressure, outdoor temperature, relative humidity, and wind speed. Results: Significant differences were found between PSP and non-PSP days depending on daily mean values of outdoor temperature and atmospheric pressure (p = 0.001 and p < 0.001, respectively). However, no obvious differences of meteorological factor variations between the ‘PSP day’ and the ‘pre-PSP day’ on days with and without PSP were found. The occurrence of PSP was associated with the solar terms Spring Equinox (p < 0.05) and End of Heat (p < 0.01). Conclusion: Among the factors examined in our study, daily mean outdoor temperature and atmospheric pressure showed a strong correlation with the occurrence of PSP. The solar terms Spring Equinox and End of Heat were found to be closely related with PSP development, which shed light on a new way for PSP incidence evaluation.

Clinical Analysis of Contralateral Bulla of Lung on HRCT in the Patients Having Video-Assisted Thoracoscopic Surgery for Unilateral Primary Spontaneous Pneumothorax

Background: It is controversial whether the presence of bullae on the contralateral lung on HRCT plays a role in occurrence of contralateral primary spontaneous pneumothorax. We analyzed the significance of bullae on the contralateral lung and the risk factors associated with contralateral occurrence of primary spontaneous pneumothorax. Material and Method: Three hundred ninety four patients who were undergone Video?Assisted Thoracoscopic Surgery for primary spontaneous pneumothorax between January 2004 and December 2009 were reviewed. The clinical features, HRCT and treatment of these patients were analyzed retrospectively. Result: Twenty eight of 394 patients had contralateral occurrence (7.10%). The average time was 13.06±9.79 months. A presence of contralateral bullae of lung on HRCT may not seem to be significant for occurrence of contralateral primary spontaneous pneumothorax (p=0.059). But bullae numbers were much more in contralateral pneumothorax patients (p=0.011). Younger than 20, being underweight (Body Mass Index＜18.5 ㎏/㎡) are independent risk factors for contralateral occurrence (odds ratio, 5.075 (1.679~5.339), 2.366 (1.048~5.339) respectively). Conclusion: The presence of bullae on the contralateral lung on HRCT was not significantly influenced the occurrence of contralateral primary spontaneous pneumothorax. However, age, body mass index, and the number of bullae were significant factors for the contralateral pneumothorax. We suggest that those high risk patients may require special attentions and general supportive care to prevent occurrence of contralateral primary spontaneous pneumothorax during the follow?up.

Tratamento cirúrgico do pneumotórax espontâneo primário no primeiro episódio

Objetivo: Avaliar os resultados do tratamento cirúrgico do PEP através da toracotomia axilar, ressecção de blebs e pleurodese abrasiva. Mediante os resultados e a comparação destes com as diversas opções de tratamento, discutir a abordagem cirúrgica como a primeira para os pacientes portadores de PEP, no primeiro episódio. Material e métodos: 35 toracotomias axilares com pleurodese abrasiva para tratamento do PEP foram realizadas no Serviço de Cirurgia Torácica da Universidade de Caxias do Sul entre janeiro de 1996 e março de 1999. Resultados: 23 pacientes foram tratados no primeiro episódio de PEP (65,7%) e 12 pacientes no segundo episódio. Os drenos pleurais permaneceram em média 2,7 ± 1,6 dias. O período médio de internação foi de 4,9 ± 2,4 dias. Morbidade de 8,5%, mortalidade zero. Não se evidenciou recidiva num período médio de 22 meses de acompanhamento. Conclusão: A indicação de toracotomia axilar com pleurodese abrasiva em pacientes portadores de pneumotórax espontâneo primário no primeiro ou segundo episódio mostrou baixos índices de morbidade, recidiva zero, além de curto período de permanência dos drenos pleurais e de hospitalização, comprovando sua eficácia terapêutica. A possibilidade de indicá-lo como primeiro método terapêutico para pacientes portadores de PEP deve ser considerada.

Can CT Scanning Be Used To Select Patients With Unilateral Primary Spontaneous Pneumothorax for Bilateral Surgery?

Despite advances in the surgical treatment of spontaneous pneumothorax, the timing of surgical intervention continues to be a subject of controversy. We test the hypothesis that CT scanning can help to predict the probability of the occurrence of primary spontaneous pneumothorax (PSP) by detecting lung bullae. Prospective, longitudinal cohort study. Between May 1994 to March 1995, 28 consecutive patients (23 men; age range, 18 to 47 years; mean, 29 years) with unilateral PSP who were to undergo video-assisted thoracic surgery (VATS) received preoperative CT of the thorax. CT scans were interpreted by one radiologist blinded to the clinical data for the presence of bullae in both lungs. All patients were followed-up in our outpatient clinic for an average of 59.0 months (range, 54 to 64 months). Eighty-eight percent of the blebs or bullae identified intraoperatively were demonstrated on preoperative CT scans. CT scans also showed the presence of lung blebs or bullae in the contralateral lung in 15 patients (53.6%). During the follow-up period, 4 of these 15 patients (26.7%) with contralateral blebs developed PSP in the untreated lung; none of the patients who did not have contralateral blebs (n = 13) developed PSP (p = 0.04 [chi(2) analysis]). The detection of lung bullae by CT scanning in the contralateral lung following unilateral PSP is associated with a higher rate of subsequent occurrence of pneumothorax in that lung. Thus, CT scanning can be used to predict the risk of occurrence of this condition, allowing preemptive surgical intervention in selected patients.