Small-caliber Catheter Research Articles

Ultrasound guided percutaneous catheterization of the brachiocephalic vein by small caliber catheter: An alternative to epicutaneo-caval catheter in newborn and premature infants.

Umbilical Venous Catheter (UVC) and Epicutaneo-Caval Catheters (ECC) are reference catheters in the neonatal period. However, many factors such as the corpulence of neonates, poor venous capital, and anatomical variants can complicate ECC insertion or make it impossible. In newborns with failed ECC insertion, we developed an hybrid technique that combines the insertion of a long-lasting silicone or polyurethane small caliber catheter, usually used as a ECC in newborns, with the ease and speed of ultrasound guided puncture of the brachiocephalic vein (BCV). Three years retrospective single center experience of ultrasound guided BCV insertion of silicon or polyurethane small caliber central catheter in a tertiary neonatal intensive care in case of insertion fail of ECC. Twenty-one echo guided BCV-ECC insertions were performed in 20 newborns. Median age was 16 days (range: 0-110 days), median weight was 1700 g (range: 605-4960 g) at insertion. In most cases, insertion was on the left side (17/21). No failures were noted. Only one attempt was necessary in all cases. Insertion time, when noted, was always of <45 min. The median duration of use of these catheters was 11 days (range 3-35 days). No complication was noted during insertion or catheter use, including catheter-related infections and thrombosis. Echo guided percutaneous catheterization of the brachiocephalic vein with a long lasting silicone or polyurethane small caliber catheter is a safe alternative to the ECC if insertion has failed. However, it requires a mastery of ultrasound-guided insertion technique in term and premature neonates.

Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication

BackgroundMalignant obstruction and associated hydronephrosis is a common complication of advanced cervical cancer. Percutaneous nephrostomy (PCN) followed by antegrade stenting is often required to relieve obstruction as retrograde access fails in considerable proportion of such patients. Reno-pleural fistula is a rare complication of PCN which creates a patent connection between the renal collecting system and the thoracic cavity, and urine accumulation in the pleural space can cause pleural effusion (i.e., urinothorax). Upward or downward migration is a complication of indwelling ureteric stents. Further migration with extrusion outside of the urinary tract is uncommon. Herein we present an unprecedented case in adult of ureteric stent upward migration through a reno-pleural fistula into the thoracic cavity managed by thoracoscopy.Case presentationA 66-year-old female was diagnosed of advanced stage cervical cancer with suspicious bladder invasion. Given her bilateral hydronephrosis with impaired renal function, she underwent bilateral PCN and subsequent antegrade ureteric stenting. However, she presented with dyspnea, right back pain, and oliguria four days after bilateral PCN catheter removal. Computed tomography reported massive right pleural effusion and an intrathoracic ureteric stent within reno-pleural fistula. Thoracoscopy with thoracostomy was performed to remove the ureteric stent and urine in right pleural space. A week later, urinothorax had resolved and right PCN was performed again. She was discharged after regaining normal renal function with right PCN and a left ureteric stent in place.ConclusionsA reno-pleural fistula can serve as a route for ureteric stent migration and that continuous drainage of urine can cause urinothorax once the stent reaches the thoracic cavity. Anytime a supracostal approach is used for PCN, even when using small caliber catheters, clinicians should pay special attention given the risk of pleural injury and subsequent complications.

Controlled Catheter Movement Affects Dye Dispersal Volume in Agarose Gel Brain Phantoms.

The standard of care for treatment of glioblastoma results in a mean survival of only 12 to 15 months. Convection-enhanced delivery (CED) is an investigational therapy to treat glioblastoma that utilizes locoregional drug delivery via a small-caliber catheter placed into the brain parenchyma. Clinical trials have failed to reach their endpoints due to an inability of standard catheters to fully saturate the entire brain tumor and its margins. In this study, we examine the effects of controlled catheter movement on dye dispersal volume in agarose gel brain tissue phantoms. Four different catheter movement control protocols (stationary, continuous retraction, continuous insertion, and intermittent insertion) were applied for a single-port stepped catheter capable of intrainfusion movement. Infusions of indigo carmine dye into agarose gel brain tissue phantoms were conducted during the controlled catheter movement. The dispersal volume (Vd), forward dispersal volume (Vdf), infusion radius, backflow distance, and forward flow distance were quantified for each catheter movement protocol using optical images recorded throughout the experiment. Vd and Vdf for the retraction and intermittent insertion groups were significantly higher than the stationary group. The stationary group had a small but significantly larger infusion radius than either the retracting or the intermittent insertion groups. The stationary group had a greater backflow distance and lower forward flow distance than either the retraction or the intermittent insertion groups. Continuous retraction of catheters during CED treatments can result in larger Vd than traditional stationary catheters, which may be useful for improving the outcomes of CED treatment of glioblastoma. However, catheter design will be crucial in preventing backflow of infusate up the needle tract, which could significantly alter both the Vd and shape of the infusion.

Small-caliber tube drainage and rapid pleurodesis in malignant pleural effusion

Objectives The aim of this study was to compare between small-caliber catheter rapid pleurodesis and conventional chest tube pleurodesis as regards efficacy and hospital stay in patients with malignant pleural effusion (MPE). Background Chemical pleurodesis can be palliative for recurrent, symptomatic pleural effusions in patients who are not candidate for a thoracic surgical procedure. We hypothesized that pleurodesis as effective as the standard method could be accomplished with a rapid method of pleurodesis. Patients and methods This prospective randomized controlled trial included 30 patients with MPE. Patients were divided into two groups: group A, which underwent rapid pleurodesis with a small-caliber tube (8–14 Fr), and group B, which underwent conventional pleurodesis. Talc was the sclerosing agent that was used. The small-caliber tube was inserted under local anesthesia with total evacuation of pleural fluid, maximum 1.5 l, followed by gradual evacuation. Rapid pleurodesis was performed only after obtaining radiological evidence of complete evacuation of the fluid and the tube was clamped for 1 h. The fluid was drained over 1 h and the catheter removed and the patient discharged. The chest tube was inserted under local anesthesia with total evacuation of pleural fluid, maximum 1.5 l, followed by gradual evacuation. Pleurodesis was performed only after obtaining radiological complete evacuation of the fluid, daily drainage of less than 300 l. The tube was clamped for 1 h. The fluid was drained over 6–12 h and the tube was removed and then the patient was discharged from hospital. Results Our study included 15 patients in group A who underwent rapid pleurodesis and 15 patients in group B who underwent conventional pleurodesis. There was a significant difference between the two groups as regards hospital stay and postoperative pain. Conclusion Small-caliber tube drainage and rapid pleurodesis were shown to be efficient and demonstrated a good safety profile in treating MPEs.

Ergonomic Investigation of Interventional Radiology

Interventional radiology (IVR) refers to a variety of minimally invasive procedures using small-caliber catheters under fluoroscopic or ultrasound guidance for the treatment of vascular and digestive diseases. Common IVR applications include dilatation, occlusion, and selective cannulation of vessels and the digestive canal without open surgery. Indications for IVR are rapidly increasing. However, ergonomic problems of IVR for physicians have not been considered. Such ergonomic problems and countermeasures were investigated in this study. Ergonomic problems during hepatic arterial catheterization and placement of a stent in the digestive canal, two frequent IVR procedures, were investigated. Ergonomic problems of IVR, problems induced by X-ray protectors, inadequate working postures and asthenopia induced by the apparatus, impaired maneuverability and neuro-muscular fatigue forced by small caliber catheter for intra-vascular catheterization, lacks of intuitive usability and standardization the devices and instruction documents are revealed in this study. For the continued safe development of IVR, outstanding ergonomic and technological problems must be resolved. Potential solutions include the development of adequate holding and accessory devices for small-caliber devices, improved educational software, and head-mounted displays. Further analyses of the workflow and ergonomic medical device design with input from end users are also critical.

Cleaning the paracolic gutter: transcutaneous endoscopic necrosectomy through a fully covered metal esophageal stent

Transgastric endoscopic necrosectomy with nasocystic lavage is accepted as one of the standards of care for the management of walled-off necrosis secondary to acute pancreatitis. In severe cases, necrosis and inflammation can extend caudally toward the retroperitoneal spaces near the paracolic gutters. Those patients conventionally have undergone percutaneous drainage with a smallcaliber catheter or surgical debridement for management. We describe a case in which transcutaneous endoscopic necrosectomy using CO2 insufflation with cutaneocystic lavage through a fully covered metal esophageal stent was performed to treat such a collection. Similar concepts for endoscopic management of peripancreatic collections were applied in this scenario. The large retroperitoneal collection was initially accessed by interventional radiology with a percutaneous catheter. Subsequently, in the endoscopy suite, by using a sterile technique, wire access was obtained to the collec-

Assessment of right liver graft perfusion effectiveness between one and two-catheter infusion methods.

Backgrounds/AimsConventional graft perfusion method using one small-caliber catheter takes a relatively long time for right liver graft perfusion, thus some modification is needed. In this study, we intended to assess the effectiveness of right liver graft perfusion methods through comparison of different infusion catheters.MethodsThe study consisted of two parts including one bench experiment to obtain data of hydraulic infusion and one clinical trial of 40 cases on graft perfusion with one- versus two-catheter infusion methods. These two graft infusion methods were compared in terms of the perfusion time and washing-out efficiency.ResultsAt bench experiment, the infusion flow rate and infusion pressure were 3.3 ml/sec and 1.9 cmH20 in one blood transfusion catheter group, and 11.7 ml/sec and 3.1 cmH20 in single transurethral resection of prostate irrigation catheter group, and 6.6 ml/sec and 2.0 cmH20 in two blood transfusion catheters group, respectively. In clinical trial with 40 right liver grafts, two-catheter group had a shorter graft portal perfusion time for the first 2 L of histidine-tryptophan-ketoglutarate (HTK) solution than the conventional one-catheter group (375±25 seconds vs. 662±34 seconds; p=0.001) and a lower rate of incomplete blood washing-out after the initial 2 L portal perfusion (40% vs. 85%; p=0.03).ConclusionsThe two-catheter infusion method appears to be more effective than the conventional one-catheter infusion method for right liver graft perfusion at the back table. Large size of right liver grafts seems to be its good indication.

Bilateral pneumothorax after bevacizumab-containing chemotherapy in fibrosarcoma.

Bevacizumab-containing therapies can improve outcomes in patients with sarcoma. Bevacizumab had several notable adverse effects including bowel perforation but bilateral pneumothorax had never been reported in the available English literature. We reported a 23-year-old male with poorly differentiated fibrosarcoma who had spontaneous bilateral spontaneous pneumothorax (SP) after the third cycle of bevacizumab-containing chemotherapy. His bilateral pneumothorax resolved after closed drainage of pleural cavity with a small caliber catheter. The mechanism of pneumothorax developed after bevacizumab therapy was not clear. In patients who had chest discomfort after bevacizumab-containing therapy, pneumothorax should never be overlooked as one of the differential diagnoses.

Pneumothorax After Bevacizumab-containing Chemotherapy: A Case Report

Bevacizumab added to 5-fluorouracil-based chemotherapy can improve outcomes in patients with metastatic colorectal cancer. Bevacizumab had several notable adverse effects including bowel perforation but pneumothorax had never been reported in the available English literature. We reported a 45-year-old male with lung metastases from colorectal cancer who had spontaneous pneumothorax after the second cycle of bevacizumab-containing chemotherapy. His pneumothorax resolved after tube thoracostomy with a small caliber catheter. The mechanism of pneumothorax developed after bevacizumab therapy was not clear as bowel perforation but tumor necrosis with ruptured parietal pleura might be the cause. In patients who had chest discomfort after bevacizumab-containing therapy, pneumothorax should never be overlooked as one of the differential diagnoses.

Rectourethral Fistula Stenting: A Technique for Better Fistula Visualization and Efficient Repair

In this study, the authors present a technical tip for better and easier visualization of rectourethral fistula both during dissection and fistula closure. In this technique, a small-caliber ureteral catheter is used for catheterization of the fistulous tract under direct urethroscopic guidance. Five cases were treated using this technique. All cases had either brachytherapy as a monotherapy or combined brachytherapy and external beam radiotherapy. All cases had the fistula completely healed except for one failed case that had a 2-cm fistula.

Usefulness of Small Caliber Catheter Insertion for a Spontaneous Pneumothorax

Background: The large caliber catheter used in the treatment of pneumothorax causes great damage to the chest wall and organs. The purpose of this study was to prove that th e use of a smaller caliber catheter is effective in treating pneumothorax with decreasing admission period and that the recurrence rate of spontaneous pneumothorax is low. Methods: Patients who had been admitted for treatment of first time occurrence of pneumothorax between May, 2004 and December, 2008 were included in the study. The caliber of catheter used this study is 18 Guage (1.2 mm). The efficacy of treatment, admission period and recurrence rate of treating pneumothorax with small caliber catheter were compared to the control group using a tube thoracostomy for treatment. Results: The admission period for primary spontaneous pneumothorax was 10.8±3.6 days for the group (n=68) using tube thoracostomy compared to 4.5±1.3 days for the group (n=31) using the small caliber catheter (p＜0.05). There was no statistically significant difference in recurrence rate between the two groups. Conclusion: The use of a smaller caliber catheter for the treatment of pneumothorax reduces the admission period without a significant increase in recurrence rates.

Monitoring the Changes in Intraparenchymatous Venous Pressure to Ascertain Flap Viability

Disruption of venous outflow can lead to tissue necrosis. Thrombosis of a venous channel at the coaptation site in instances of free tissue transfer could cause death of the transplanted tissues. Although various techniques have been used to monitor the viability of transferred tissues, there has been no technique designed specifically to check the flow within and the patency of the venous channel. The authors have devised an approach with which to monitor the changes in venous pressure in a composite tissue transferred by means of microsurgical technique for bodily reconstruction. The status of the venous system in various composite tissue grafts was monitored at the time of surgery or for 3 days after the completion of surgery by placing a small-caliber catheter in the vein within the transferred tissue. A total of 52 patients participated in the study. The venous pressure noted in grafts with a patent venous channel remained constant within a range between 0 and 35 mmHg. Venous insufficiency was detected in three of the 52 cases, with unmistakable findings of an elevated venous pressure of over 50 mmHg. The technique of measuring the venous pressure by means of an indwelling venous catheter to monitor changes was found to accurately assess the patency of the venous channel and, by inference, the viability of the transferred tissue. No morbidity was associated with the technique.

Prise en charge du pneumothorax spontané du sujet jeune

Summary Introduction Idiopathic spontaneous pneumothorax is a frequent disorder with a poorly codified treatment. Methods We retrospectively studied 48 patients with an idiopathic pneumothorax hospitalized between 1993 and 1997, and we discuss the location and time of surgical treatment. We compare the outcome of patients treated by chest tube (24 F), and by small caliber catheter (8 F). Results One patient was treated by needle aspiration, five patients were just observed and three underwent surgery. Fifteen patients were treated by chest tube and 24 by small catheter. The duration of hospitalization of the 26 successfully drained patients was 3.1 ± 2 days. The recurrence rate of these patients was 31% after a 27 ± 17 month follow-up. The failure rate was 33% at 3.7 ± 2 days of hospitalization regardless of the drainage method, leading to surgical treatment. The hospital stay of surgically treated patients was 15.8 ± 5 days. None of the 20 patients treated by video-assisted thoracoscopic surgery re lapsed after a 26 ± 17 month period. Conclusion Taking into account a recurrence rate of 30% and a surgical success rate of 95%, we propose an early surgical treatment in case of drainage failure, performed on the third day. This attitude shortens the hospital stay of successfully drained patients to 3.1 ± 2 days. Moreover, small caliber catheter drainage seems to be as efficient as chest tubes to treat spontaneous pneumothorax.

Neumotorax espontáneo idiopático: tratamiento basado en la aspiración con catéter fino frente a drenaje torácico

Several options are available for treating patients with a first episode of primary spontaneous pneumothorax (ISP). The aim of this study was to compare the efficacy of two treatment alternatives: puncture-aspiration (PA) using a small caliber catheter, and pleural drainage through a chest tube (DCT). We compared a current series of 91 patients treated with PA with a retrospective series of 216 patients treated with DCT. PA was performed by emergency room physicians and DCT was performed by chest surgeons. Patients were followed for a period of 24 months. The immediate efficacy of PA was superior to DCT (86.7% versus 76%, p < 0.05). The proportion of recurrences after each treatment was similar (23% and 17%, respectively, NS). Duration of hospital stay was shorter for PA-treated patients (24 h) than for DCT-treated patients (138 h) (p < 0.05). The efficacy of the two procedures 24 months later was similar (63.7% and 62.9%, respectively, NS), and the cost of PA was three times less than that of DCT. PA is as effective a treatment procedure as DCT. PA is simple enough for emergency room physicians to perform correctly. Inconvenience to the patient, cost to the health care system, and time of hospital stay are all significantly less with PA.

Transcatheter intracavitary fibrinolysis of loculated pleural effusions: experience in 102 patients.

To assess the efficacy of intrapleural urokinase instillation through small-caliber catheters for the treatment of loculate and/or septate effusions. We inserted small-caliber catheters (8.2 Fr) in 102 patients with septate and/or loculate pleural effusions using ultrasonographic guidance. Urokinase (100,000 IU/2 hr, 3 times a day) was instilled through the catheter until the effusion resolved and D-dimer levels were <500 ng/ml. Patients were enrolled regardless of the etiology of the pleural effusion provided there were no contraindications for the use of urokinase. D-dimer levels were determined before and after treatment. Follow-up was performed by chest radiograph and sonography at 1 day, 7 days, and every 30 days thereafter for 6 months. Successful catheter placement was achieved in all cases. The mean time catheters stayed in place was 5.7 days and the mean dose of drug instilled was 690,000 IU. Pleural effusion drainage was complete at the first assessment in all patients. Failure of the treatment, with recurrent effusion at 30 days, occurred in six patients (5.8%). Complete resolution without sequelae was observed in 19 patients (19.6%). In 75 cases (73.5%) resolution was partial, with pleural thickening (>2 mm). Two patients died from unrelated causes within 30 days after catheter placement. Complications were seen in 13 patients (12.74%): hydropneumothorax, nine cases (8.82%); infection of the puncture point, three cases (2.94%); and adverse reaction, one case (0.98%). No further treatment was required. The use of intrapleural fibrinolytic agents delivered through small-caliber catheters for the treatment of loculate and/or septate pleural effusion is a simple, effective, minimally invasive and inexpensive procedure that can prevent sequelae and shorten drainage time.

Malignant pleural effusions: a description of an alternative method of external drainage with a fine-caliber catheter

We describe the results of treating symptomatic pleural effusion by implanting a Pleurocath-type small-caliber catheter connected to a three-way valve for external evacuation. The method was used in 6 patients with advanced neoplastic disease and dyspnea related to pleural effusion that could not be treated with the usual methods of pleurodesis. Dyspnea disappeared or was significantly relieved in 5 of the 6 patients, such that follow-up could be continued on an outpatient basis for 3. Catheters remained in position for periods of time ranging from 14 days to 10 months. Survival varied from 14 days to 14 months. The only important complication was one case of infection in the area of catheter insertion. We describe the extremely simple technique used and the results that have encouraged us to continue using the method in cases that meet the necessary conditions.

The Long-term Follow-up Study of Therapeutic Effects of 8 French Catheter for Spontaneous Pneumothorax

Background : Spontaneous pneumothoraces(SP) are divided into primary spontaneous pneumothoraces (PSP) which develop in healthy individuals without underlying pulmonary disorders and secondary spontaneous pneumothoraces(SSP) which occur in those who have underlying disorders such as tuberculosis or chronic obstructive lung diseases. Yet there is no established standard therapeutic approach to this disorder, i.e., from the spectrum of noninvasive treatment such as clinical observation with or without oxygen therapy, to aggressively invasive thoracoscopic bullectomy or open thoracotomy. Although chest tube thoracostomy has been most widely used, the patients should overcome pain in the initiation of tube insertion or during indwelling it potential infection and subcutaneous emphysema. Thus smaller-caliber tube has been challenged for the treatment of pneumothorax. Previously, we studied the therapeutic efficacy of 8 French catheter for spontaneous pneumothorax. But there has been few data for effectiveness of small-caliber catheterization in comparison with that of chest tube. In this study, we intended to observe the long-term effectiveness of 8 French catheter for the treatment of spontaneous pneumothoraces in comparison with that of chest tube thoracostomy. Method : From January, 1990 to January, 1996, sixty two patients with spontaneous pneumothoraces treated at Chung-Ang University Hospital were reviewed retrospectively. The patients were sub-divided into a group treated with 8 French catheter(n=23) and the other one with chest tube insertion(n=39). The clinical data were reviewed(age, sex, underlying pulmonary disorders, past history of pneumothorax, size of pneumothorax, follow-up period). And therapeutic effect of two groups was compared by treatment duration(duration of indwelling catheter or tube), treatment-associated complications and recurrence rate. Results : The follow-up period(median) of 8 French catheter group and chest tube group was 28 and 22 months, which had no statistical significance. Ther was no statistically significant difference of clinical characteristics between two groups with SP, PSP, SSP. The indwelling time of 8 French catheter group was days, which was significantly shorter than that of chest tube group in SP, days(p=0.047). In comparison of treatment-related complication in PSP, 8 French catheter group as 6.25% of complication showed lower tendency than the other group as 23.8% (p=0.041 ; one-tailed, p=0.053; two-tailed). The recurrence rate in each group of SP was 17.4%, 10.3%, which did not show any statistically significant difference. Conclusion : Treatment with 8 French catheter resulted in shorter indwelling time in sponteous pneumothorax, and lower incidence of treatment-related complication in primary spontaneous pneumothorax. And the recurrence rate in each of treatment group showed no statistically significant difference. So, we can recommend the 8 French small-caliber catheter for the initial therapy for spontaneous pneumothorax for the replacement of conventional chest tube thoracostomy. But further prospective study with more subjects of spontaneous pneumothorax will be needed for the evaluation of effectiveness of 8 French cateter.

Drenaje de derrames pleurales loculados y/o tabicados mediante catéter de pequeño calibre y urocinasa (pleurofibrinólisis)

The main causes of pleural fluid drainage failure are known to be the formation of fibrin septa, increased viscosity in pleural fluid and inappropriate placement of chest tubes. Reports also tell us that such problems can be solved by using ultrasound as a guide for tube placement and by infusing intrapleural fibrinolytic agents to prevent the formation of septa and reduce the viscosity of pleural fluid. To assess our experience, the role and efficacy of administering intercavitary urokinase (UK) through a small caliber catheter (SCC) implanted with ultrasound guidance as part of the treatment for pleural effusions (PE) that are multiloculated and/or loculated. Fifty multiloculated and/or loculated PE were drained through a pig-tail type SCC between 8.2 and 10 F caliber inserted with ultrasound guidance. The criteria for prescribing the procedure were as follows: PE of any etiology with ultrasound confirmation of fibrin septa and/or multiloculation and absence of contraindication off UK administration. UK was given at a dose of 100,000 i.u. every two hours until disappearance of PE. Before and after treatment the levels of D-dimer were measured in order to monitor pleural fibrinolytic activity. The SCC was properly placed in all patients. UK administration was 366,000 i.u. and time the SCC were in place was 4.7 days. All PEs were initially drained completely. We examined the patients 30 days later, finding that PE had recurred in 2 (4%), resolution was complete and without sequelae in 8 (16%), nearly complete but with slight pleural thickening in 32 (64%) and partial with pleural opacities larger than 2 mm in 8 (16%). Use of SCC and UK (pleural fibrinolysis) is a moderately invasive procedure that is effective and well tolerated and that shortens drainage time, prevents sequelae and is relatively inexpensive for the treatment of PE with fibrin septation and/or multiloculation.

The effect of 8 French catheter and chest tube on the treatment of spontaneous pneumothorax

Background : Spontaneous pneumothorax have been managed with a variety of methods. The technique most frequently used is chest tube drainage. Small caliber catheters were first used in the management of pneumothorax complicating the percutaneous needle aspiration lung biopsy, and the try to treat spontaneous pneumothorax also has been reported. However, the value of small caliber catheters in spontaneous pneumothorax has not been fully evaluated. So, we tried to elucidate the efficacy of 8 French catheter in the management of spontaneous pneumothorax. Method : From January, 1990, to April, 1994, 44 patients with spontaneous pneumothorax treated at Chung-Ang university hospital were reviewed. The patients were sub-divide into 8 French catheter insertion group (n=21) and chest tube insertion group (n=23). We compared the presence of underlying lung disease, the extent of the collapse, the duration of indwelling catheter and complication between two groups. Results : 1) The duration of indwelling showed no significant difference between 8 French catheter group and chest tube. But, complication after insertion as subcutaneous emphysema was developed in only chest tube group. (p

Primary spontaneous pneumothorax. A retrospective study of 495 cases

We conducted a retrospective study of patients treated in our department for primary spontaneous pneumothorax (PSP) between 1986 and 1993. The 495 patients were between 12 and 81 years old (mean 28.2 years). Four hundred fifteen (83.8%) were men and 80 (16.2%) were women. PSP was in the right lung in 262 cases (52.9%) and in the left lung in 215 (43.5%). Both sides were affected in 18 cases (3.6%). The initial treatment was pleural drainage; small caliber drains were used in 85 and no associated complications were observed. On 185 occasions (37.3%), patients required surgical repair as a result of air leaks, recurrence or acute hemorrhage. There were postsurgical complications in 15 cases (8.1%) but no recurrences or deaths after surgery. We observed no significant differences in the number of recurrences after use of conventional drains or small caliber drains. Nor were there differences in mean time of hospital stay or complications after conventional surgery or video assisted surgery, a technique that has only recently been introduced. We conclude that PSP responds well to treatment with pleural drains and that small caliber catheters offer a good alternative for treating first episodes. Surgery is indicated when there is recurrence or when air leaks are persistent. At present, video assisted thoracoscopic surgery has successfully replaced axillary thoracotomy for most patients.