Onset Of Primary Spontaneous Pneumothorax Research Articles

Is the recurrence of primary spontaneous pneumothorax predictable?

Background: Recurrence of Primary Spontaneous Pneumothorax (PSP) constitutes a serious challenge for both physicians and patients.Methods: A retrospective study was conducted in 115 patients who had chest tubes at their first onset of PSP. Considering the development of recurrence, two groups were composed and comparatively examined in terms of age, body mass index, smoking status, side and size of initial pneumothorax, presence of bulla and duration of chest tube drainage at the first episode.Results: Among 115 patients with PSP, 24 cases developed recurrence. Male gender was prominently relevant to develop recurrent PSP (p=0.034) whereas remaining inspected parameters revealed no significant relationship with a relapse. Interval between first onset and recurrence of PSP was calculated as 9.2 months. Interestingly, most of the patients developed recurrence in low-temperature months.Conclusions: Recurrence of PSP is substantially unpredictable. Therefore, close follow-up of cases in the following year of their first episode and also informing the patients about probability of a relapse and measures to consider under this circumstance is of great importance.

Primary spontaneous pneumothorax in children and adolescents: a systematic review

Primary spontaneous pneumothorax (PSP) is common in young population. But despite its incidence, specific guidelines for pediatric patients are not available and an agreement on the optimal management of this pathology has not been reached yet. Current protocols for treatment of PSP are not up to date at genetic and pathologic advances, remaining those of 20th century. If the presence of blebs and bullae in the apex of the lung is still considered the principal determinant for PSP, the process underlying their formation is not completely clarified. Research on connective tissue pathology and on elastogenesis pathway allowed physicians to identify further predisposing factors for the onset of PSP, for that reason the belief that this disease occurs in “otherwise normal lungs” might be reviewed. For pediatric patients, a more accurate risk stratification of PSP and a specific tailored strategy are required. When inherited or acquired predisposing factors are present, children and adolescents have a higher likelihood to develop PSP than adults, and an early surgical treatment can be proposed. When surgery is needed, mini-invasive approaches are the option of choice. After the advent of videothoracoscopy, surgical techniques have been developed up to a single incision thoracoscopic surgery which allows better outcomes and can be more accepted by younger patients. The aim of this review is to summarize the last thirty years of literature on PSP in young patients, to focus the evidences which can improve the management of this disease.

Influence of meteorological factors on the onset of primary spontaneous pneumothorax.

Introduction Although links between meteorological conditions and primary spontaneous pneumothorax have been proposed, the reports are controversial. The aim of the study is to correlate between climatic changes and the development of this condition. Materials and methods A retrospective chart review included all patient presenting with primary spontaneous pneumothorax to King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia, from 1 January 2005 to 31 December 2016. Meteorological data were collected from King Abdulaziz airbase station using an online source for the same time interval. The data were analysed to determine differences in weather conditions between days on which primary spontaneous pneumothorax occurred and those in which it did not. Logistic regression model was used to obtain predicted risks for the onset of primary spontaneous pneumothorax with respect to weather conditions. Result Two hundred and eighty-nine patients were found to have primary spontaneous pneumothorax in the 281 days included in the study. Among the meteorological parameters, significant differences were found in average temperature and atmospheric pressure difference between day of admission and two days before the admission, between days with primary spontaneous pneumothorax and days without. There was no significant difference in the other meteorological factors between days with primary spontaneous pneumothorax and days without. Conclusion Two hundred and eighty-nine patients were found to have primary spontaneous pneumothorax in the 281 days included in the study. Among the meteorological parameters, significant differences were found in average temperature and atmospheric pressure difference between day of admission and two days before the admission, between days with primary spontaneous pneumothorax and days without. There was no significant difference in the other meteorological factors between days with primary spontaneous pneumothorax and days without.

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.

Relationship between onset of spontaneous pneumothorax and weather conditions.

Spontaneous pneumothorax (SP) results from the rupture of blebs or bullae. It has been suggested that changes in weather conditions may trigger the onset of SP. Our aim was to examine the association between the onset of primary SP with weather changes in the general population in Sapporo, Japan. From January 2008 through September 2013, 345 consecutive cases with a diagnosis of primary SP were reviewed. All cases of primary SP developed in the area within 40 km from the Sapporo District Meteorological Observatory. Climatic measurements were obtained from the Observatory, which included 1-h readings of weather conditions. Logistic regression model was used to obtain predicted risks for the onset of SP with respect to weather conditions. SP occurred significantly when the atmospheric pressure decreased by - 18 hPa or less during 96 h before the survey date (odds ratio = 1.379, P = 0.026), when the pressure increased by 15 hPa or more during 72 h before the survey date (odds ratio = 1.095, P = 0.007) and when maximum fluctuation in atmospheric pressure over 22 hPa was observed during 96 h before the survey date (odds ratio = 1.519, P = 0.001). Other weather conditions, including the presence of thunderstorms, were not significantly correlated with the onset of pneumothorax. Changes in atmospheric pressure influence the onset of SP. Future studies on the relationship between the onset of SP and weather conditions on days other than before the onset and with large number of patients may enable us to predict the onset of SP in various regions and weather conditions.

Do atmospheric conditions influence the first episode of primary spontaneous pneumothorax?

Several studies suggest that changes in airway pressure may influence the onset of primary spontaneous pneumothorax (PSP). The aim of this study was to investigate the influence of atmospheric changes on the onset of the first episode of PSP. We retrospectively analysed cases of pneumothorax admitted to our department between 1 January 2009 and 31 October 2013. Patients with recurrent pneumothorax, traumatic pneumothorax, older than 35 years or presenting history of underlying pulmonary disease were excluded. Meteorological data were collected from the Météo-France archives. Variation (Δ) of mean atmospheric pressure, and relative humidity, were calculated for each day between the day at which symptoms began (D-day), the day before first symptoms (D-1), 2 days before the first symptoms (D-2) and 3 days before the first symptoms (D-3). Six hundred and thirty-eight cases of pneumothorax were observed during the period of this study; 106 of them (16.6%) were a first episode of PSP. We did not observe any significant differences between days with or without PSP admission for any of the weather parameters that we tested. We could not find any thresholds in the variation of atmospheric pressure that could be used to determine the probability of PSP occurrence. Variation of atmospheric pressure, relative humidity, rainfall, wind speed and temperature were not significantly related to the onset of the first episode of PSP in healthy patients. These results suggest that the scientific community should focus on other possible aetiological factors than airway pressure modifications.

Analysis of spontaneous pneumothorax in the city of Cuneo: environmental correlations with meteorological and air pollutant variables.

Primary spontaneous pneumothorax (PSP) tends to cluster. Previous studies have found a correlation between PSP and atmospheric pressure variations or thunderstorms. We conducted this study to analyze the PSP correlations with meteorological variables and the concentrations of air pollutants in the city of Cuneo in Italy (IT). We evaluated prospectively 451 consecutive PSP patients treated between 2004 and 2010. For each day within the period analyzed, the meteorological parameters and pollutants data were recorded. Statistical analyses on PSP were done for distribution characteristics, spectral autocorrelation, and spectral analysis. Multivariate regression analyses were performed using artificial neural networks. Analysis of annual, seasonal, and monthly distributions showed no significant correlation between PSP and the time series. The spectral analysis showed that PSP events were not random. Correlations between meteorological and environmental variables confirmed that PSP was significantly more likely to occur on warm windy days with high atmospheric pressure and high mean nitrogen dioxide concentration. Meteorological parameters and atmospheric pollutants might explain the cluster onset of PSP.

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.

Retrospective Comparison of Needle Thoracoscopy and Conventional Thoracoscopic Surgery to Treat Primary Spontaneous Pneumothorax

To retrospectively compare needle video-thoracoscopic surgery (NVTS) with conventional video-thoracoscopic surgery (CVTS) for the treatment of primary spontaneous pneumothorax. The charts of 9 female and 66 male patients with onset of primary spontaneous pneumothorax between July 1999 and December 2005 were reviewed. Twenty-two patients in the NVTS group were treated with NVTS, using a needle-shaped thoracoscope and instruments (3-mm in diameter), and assisted by one 10-mm standard port, whereas 53 patients in the CVTS group were treated using conventional endoscopic devices with a 10-mm thoracoscope. All patients underwent endoscopic stapling to excise blebs if identified. Postoperative wound pain was scored using a numerical pain scale. Neither group experienced mortality or any major morbidity during mean follow-up of 80.5 months. In the NVTS and CVTS groups, intraoperative blood loss (11.4+/-14.8 and 17.4+/-18.1 mL respectively, P=0.174), and mean operative times (75.5+/-38.5 and 92.2+/-33.1 min, respectively, P=0.062) did not differ significantly. Mean durations of pleural drainage (0.6+/-1.0 and 2.6+/-2.3 d, respectively, P<0.01), and postoperative hospital stay (2.3+/-1.4 and 4.4+/-2.5 d, respectively, P<0.01) were less in the needle video-thorascopic surgery group. The degree of postoperative wound pain did not differ significantly between the 2 groups. There were 3 cases of persistent postoperative air leakage in both groups, which required further approaches to check for unrecognized blebs. There was no recurrence of pneumothorax in the NVTS group, and 3.6% recurrence rate in the CVTS group. Needle thoracoscopy seems to be a safe alternative to treat primary spontaneous pneumothorax.