Use Of Artificial Pneumothorax Research Articles

Risk Factors for Hospitalization Duration Longer Than 24 Hours Following Percutaneous Radiofrequency Ablation of Liver Tumours.

Prior studies have described complications of radiofrequency ablation (RFA) of liver tumours. The aim of this study was to identify risk factors for hospitalization duration longer than 24 hours following RFA of liver tumours. This retrospective, single-centre study included patients with liver tumours undergoing RFA between October 2017 and July 2020. Medical records were reviewed to collect patient, tumours, and procedure characteristics for each RFA session. The association between potential risk factors and duration of hospitalization (less than or more than 24 hours) was analyzed using univariate and multivariate logistic regressions. Our study included 291 patients (mean age: 65.2 ± 11.2 [standard deviation]; 201 men) undergoing 324 RFA sessions. Sixty-eight sessions (21.0%) resulted in hospitalization of more than 24 hours. Multivariate analysis identified each additional needle insertion per session (OR 1.4; 95% CI [1.1-1.9]; P = .02), RFA performed in segment V (OR 2.8; 95% CI [1.4-5.7]; P = .004), and use of artificial pneumothorax (OR 14.5; 95% CI [1.4-146.0]; P = .02) as potential risk factors. A history of hepatic encephalopathy (OR 2.6; 95% CI [1.1-6.0]; P = .03) was only significant in univariate analysis. Post-hoc, subgroup analysis of patients with hepatocellular carcinoma (69.8%) did not identify other risk factors. Risk factors for a hospitalization duration longer than 24 hours include a higher number of needle insertions per session, radiofrequency ablation in segment V, and use of an artificial pneumothorax.

Invasive technologies in the complex treatment of tuberculosis in children and adolescents: from the past to the present (literature review)

Invasive technologies in the complex treatment of tuberculosis in children and adolescents have a long history, which began in the pre-antibiotic period. This is the way of their improvement from independent use of artificial pneumothorax and pneumoperitoneum to the use of these techniques in the complex treatment of respiratory tuberculosis during the development of chemotherapy for the disease. New technology uses valvular bronchial blocking. That procedure creates hypoventilation and atelectasis in the affected region of the lung with preservation of drainage function of the blocked bronchus and destruction cavity, which allow reducing indications for surgical treatment as a method with a high level of injury rate. The approaches to surgical intervention in children and adolescents with respiratory tuberculosis have also changed. It is also part of the comprehensive treatment of the disease. Minimally invasive accesses under the control of video-assisted thoracoscopy are used, which significantly reduced the risk of surgery and increased the immediate efficiency of surgical treatment. New technologies combined with all types of surgeries are being widely developed: electro- and argon plasma coagulation and pleurodesis, vaporization of the tuberculous lesion, and encapsulated pleura by high-energy CO2 laser, new materials (polypropylene implants) are used. Further development of invasive technologies with multiple and extensively drug-resistant Mycobacterium tuberculosis, to children and adolescents compensates for the lack of efficiency of conservative chemotherapy and is an urgent problem at the present stage of pediatric phthisiology.

Artificial pneumothorax suppresses postoperative inflammatory reaction in mediastinal tumor surgery.

The induction of artificial pneumothorax has many intraoperative advantages. However, few reports on the postoperative effects of artificial pneumothorax induction are available. In this study, we investigated the effect of artificial pneumothorax on postoperative clinical course in patients with mediastinal tumors. We retrospectively investigated the clinical courses of 89 patients who had undergone mediastinal tumor resection between January 2010 and December 2020. Sixty-five patients had undergone resection with artificial pneumothorax. The tumor location significantly varied across patients. The proportion of patients in whom artificial pneumothorax was induced was higher among those having anterior mediastinal tumors. The number of ports and the total skin incision length were significantly higher in patients without artificial pneumothorax. The C-reactive protein level elevation on postoperative day 2 and pleural effusion at 24h after surgery were significantly higher in patients without artificial pneumothorax. Furthermore, the albumin level reduction and hospital stay after surgery were significantly lower in patients with artificial pneumothorax. Multiple regression analysis showed that the use of artificial pneumothorax was an independent predictive factor of the C-reactive protein level elevation on postoperative day 2 and pleural effusion at 24h after surgery. In patients without artificial pneumothorax, the operation time positively correlated with the C-reactive protein level (r = 0.646, P < 0.001). Artificial pneumothorax suppressed the postoperative inflammatory response, pleural effusion, and albumin reduction, and shortened the hospital stay in patients undergoing mediastinal tumor surgery.

ЭФФЕКТИВНОСТЬ ИСКУССТВЕННОГО ПНЕВМОТОРАКСА У БОЛЬНЫХ КАВЕРНОЗНЫМ ТУБЕРКУЛЁЗОМ ЛЁГКИХ МОЛОДОГО ВОЗРАСТА С МНОЖЕСТВЕННОЙ И ШИРОКОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ ВОЗБУДИТЕЛЯ

The article presents the results of clinical studies of the effectiveness of artificial pneumothorax in the treatment of 124patients with cavernous pulmonary tuberculosis patients and extensively drug resistance. Clinical trials of the use of artificial pneumothorax in young patients with cavernous pulmonary tuberculosis MDR and XDR MBT have proved its high efficiency and that it can be recommended for widespread clinical use. The indications for the use of artificial pneumothorax is a cavernous pulmonary tuberculosis with the release of MDR and XDR MBT with unformed or formed thin-walled cavity not larger than 4 cm in diameter. Pleuropulmonary adhesions revealed at primary application of artificial pneumothorax are the direct indications fpr surgical burn of adhesions. With the diameter of cavities up to 2cm the artificial pneumothorax treatment is applied for 6months and with cavities of 2–4cm in diameter – for 12months. Contraindications to the use of artificial pneumothorax are cavities in the lungs more than 4cm in diam-eter, massive pleural commissures, with the impossibility of their surgical burnout; specific lesion bronchial tubes and severe comorbidities (mental illness, organic lesions of the central nervous system, chronic obstructive lung disease, chronic cardiovascular diseases in the stage of decompensation, congenital malformations of the heart and lungs, chest wall deformity). Treatment of patients with artificial pneumothorax cavernous pulmonary tuberculosis MDR and XDR pathogen can be recommended for use in stationary phase in TB facilities with thoracic surgery, where the implementation of operational burnout pleural commissures is possible.

Artificial Pneumothorax With Position Adjustment for Computed Tomography-Guided Percutaneous Core Biopsy of Mediastinum Lesions

This study was designed to assess the use of artificial pneumothorax with position adjustment to gain a pleural space approach in computed tomographic-guided core biopsy of mediastinal masses. Eleven patients with mediastinal lesions who were undergoing percutaneous core biopsies received an artificial pneumothorax with a 22-gauge lumbar puncture needle. Each patient's position was adjusted to place the lesion as high as possible in the thoracic cavity. Air was injected until the lung was displaced from the path of the biopsy needle. After completion of the biopsy, a comparable volume of air was aspirated. In all patients, satisfactory displacement of the lung from the biopsy site was achieved with the artificial pneuomothorax procedure enabling the target lesion to be reached. No postoperative air leaks requiring tube drainage were encountered. Artificial pneumothorax with position adjustment is a safe and effective method that provides access for computed tomographic-guided biopsy of mediastinal lesions without the risks of traversing aerated lung tissue and with a relatively low volume of injected air.

Invited Commentary

Invited Commentary

Artificial pneumothorax can be used to prevent lung toxicity in chest wall radiotherapy

We report two patients in whom an artificial pneumothorax was induced to reduce the risk of radiation pneumonitis and fibrosis after treatment for chest wall tumours. The procedure was well tolerated; the only complication observed was a single episode of syncope following overinflation. High doses of radiation were given to large chest wall fields with no clinical or radiological evidence of pneumonitis or fibrosis, either during or after treatment. The available literature on the use of artificial pneumothorax with radiation is reviewed, and the technique of induction is described.

Surgical Trends in Pulmonary Tuberculosis

Like others, we have practically abandoned the use of artificial pneumothorax, phrenemphraxis and primary thoracoplasty in the treatment of pulmonary tuberculosis. Most of the patients on our service who do not manifest adequate resolution of their disease under medical management, become candidates for pulmonary resection, unilateral or bilateral. Pulmonary resection is preferred to collapse therapy because: 1) It is considered to offer a more definitive and permanent means of control. 2) It is generally more conserving of respiratory function. 3) It avoids the late complications of artificial pneumothorax and extrapleural plombage. 4) It generally results in immediate sputum conversion. 5) Patients, usually, have a much shorter period of morbidity and can be rehabilitated earlier. 6) It permits a more rapid hospital turnover, reducing the bed shortage and permitting definitive treatment of a much larger number of patients during a specific period of time. 7) We believe that its wider use will materially reduce the number of readmissions due to reactivation and spread of disease. 8) Concomitantly there should be public health benefits if infectiousness is more readily and promptly controlled. 9) By reducing the length of therapy required for treating the individual patient the economic savings, to the patient and the State, should become of great magnitude. I admit that we may be using resection therapy too widely. We may learn that the antimicrobial medications now available, and new ones which will doubtless be discovered, can obviate the need for much of the surgery which we now perform. I have tried to review the trends which the surgical treatment of pulmonary tuberculosis has shown in our hands and certainly in those of many others. We must, however, continually re-evaluate our position. I have not attempted to offer statistics concerning the results of treatment, feeling that they would not have much value, as yet, from the standpoints of numbers and of time. In another 10 years we may look back on this heyday of resection as we do now on that of pneumothorax therapy. For while time is said to heal all wounds, it must also wound all those who would continue to heal by the convictions of yesterday.

Hexylresorcinol Solution in the Treatment of Tuberculous Empyema

Tuberculous empyema is a relatively common complication of artificial and spontaneous pneumothorax. Its increased incidence is directly related to the increased use of artificial pneumothorax in the treatment of pulmonary tuberculosis. Trauma to pleural adhesions encountered in about 80 per cent of pneumothorax cases is probably the important cause of the pleural effusions which subsequently become purulent. The beneficial effects of hexylresorcinol solution, 1:1000 in a small series of cases, furnishes the basis for this report. Treatment consisted of simple aspiration of the purulent exudate, irrigation with the solution, followed by instillation of from 20 to 200 cc. depending upon the size of the empyema cavity. Clinical results apparently indicate that this solution can be regarded as a valuable addition to those recommended for the local treatment of tuberculous empyema.

The Treatment of Acute Pulmonary Abscess

We have treated a total number of forty-five cases of acute pulmonary abscess with artificial pneumothorax since 1916. Of this number thirty-five, or 75 per cent, have recovered and four have died—a mortality of about 9 per cent. We feel the failure of other observers to obtain as good results has been due chiefly to the use of too large and too frequent doses of gas. Attempting to treat chronic abscesses of over two months' duration may also have contributed to less favorable results. We feel that the use of artificial pneumothorax has a definite place in the treatment of acute pulmonary abscess.

RESULTS OF COLLAPSE THERAPY IN CHILDREN WITH PULMONARY TUBERCULOSIS

The various methods of collapse therapy employed for adults with pulmonary tuberculosis have also been used for children. Some of the earliest reports of the use of artificial pneumothorax for tuberculous children appeared from 1911 to 1914 in Germany (Pielsticker and Vogt¹), in France (Rist²) and in Denmark.³In 1924 Eliasberg and Cahn⁴published their report of its use for 111 children varying in age from 4 months to 14 years. In subsequent years important contributions were made to the understanding of the immediate and ultimate results of pneumothorax therapy in children by Simon,⁵Klare,⁶Armand-Delille⁷and their co-workers. There was some delay in the application of bilateral pneumothorax to children. Among the earliest reports were those by Wiese⁸in 1926 and by Armand-Delille and Lestocquoy⁹in 1927. Both Wiese and Armand-Delille have employed collapse therapy for large numbers of children

Putrid lung abscess with massive hemoptysis

Although the use of artificial pneumothorax is contraindicated in the treatment of lung abscess it may be tried as a temporary measure in cases of massive hemoptysis. Cure of the abscess may not be expected by this means but thoracotomy and drainage should be performed at a later date, preferably in a one-stage operation.

ARTIFICIAL PNEUMOTHORAX IN THE TREATMENT OF LOBAR PNEUMONIA

Excerpt During the past year, a number of reports1, 2, 3have been published of effects secured in the therapy of lobar pneumonia by the use of artificial pneumothorax. We present here a report of 2...

Atelectasis as a Complication of Pulmonary Tuberculosis

ATELECTASIS as a complication of pulmonary tuberculosis has been recognized only during the past few years. It was first called to our attention in post-operative cases by the roentgenologists and surgeons. In these post-operative cases re-expansion or aeration of the atelectatic lung usually occurs promptly, especially if the patient is rolled backward and forward after the method described by Sante (1). In chronic pulmonary infections, especially tuberculosis, the tendency of atelectasis is to remain permanent, with the consequent formation of a fibrotic lung. Packard (2), in 1928, was one of the first to describe atelectasis in pulmonary tuberculosis, remarking on the mildness of the symptoms produced, its permanency, and the beneficial effect it had on the course of the disease. Hablitson (3) the same year described a case of massive collapse of the left lower lobe in which artificial pneumothorax was employed with improvement. Jacoboeus and Westermark (4) reported four cases in tuberculosis, and showed the value of artificial pneumothorax in the treatment of these cases. Hennell (5) described it as a factor in the production of fibroid phthisis. Korol (6) reports six cases occurring in tuberculosis. Glenn (7) described a number of cases and showed the value of artificial pneumothorax in the treatment. The writer (8) has reported eight cases and also undertaken to show the value of some form of artificial compression. As the complication is rarely fatal, a great deal cannot be definitely said as to what is the exact causative factor in the production of atelectasis in tuberculosis. Undoubtedly the chief causes of bronchial obstruction are aspiration of a caseous plug, hemorrhage with clot formation, plugging of a bronchus with thick tenacious sputum, pressure from an enlarged lymph node, and possibly contraction of a cicatrix. Lloyd (9) studied a number of cases by means of the bronchoscope, but was unable to find any obstruction in the larger bronchi, and believed that it was in the smaller bronchi beyond the vision of the bronchoscope. Glenn remarked that in all the cases that came under his observation, one or more cavities were present in the upper lobe of the involved side. This was also true in the cases seen by us. In our series the left side was involved more than the right. The pathology of this complication has been discussed rather extensively. As it does not prove fatal at the time, we must rely on roentgenographic studies and the use of artificial pneumothorax to demonstrate the nature of this condition in tuberculous cases. The pathology is essentially a bronchial or bronchiole obstruction, with absorption of the air and a consequent atelectasis or collapse of the air cells in that portion of the lung beyond the obstruction. As a result, the lung volume is reduced to a great extent, and a marked negative pressure produced, increasing the already negative pressure in the pleural cavity.

The Use of Artificial Pneumothorax in the Treatment of Pulmonary Tuberculosis

The Use of Artificial Pneumothorax in the Treatment of Pulmonary Tuberculosis

Newgrowths of the Lung, Primary and Secondary

PRIMARY tumors of the lung are being recognized with increasing frequency, both clinically and roentgenographically. One clinician2 states that he can recognize by means of physical examination, a tumor of the lung at a very early stage, even before it is recognizable on roentgen examination. This statement, however, requires further evidence from a series of proven cases. The use of artificial pneumothorax in the differential diagnosis of newgrowth of the lung is advocated by the same author, and should be more frequently utilized. “The writer2, 3 has recently aspirated fluid in the chest and replaced it with air in the usual way in which a pneumothorax for therapeutic purposes is induced. A tumor is then made much clearer on the roentgenographic plate than can be expected otherwise. Similarly a diagnostic pneumothorax is induced in cases without fluid with a view of bringing out the outlines of an intrathoracic neoplasm.” Another authority makes the following interesting statement4: “A decade ago, the diagnosis of tumor of the lung was regarded as a brilliant accomplishment and a clinical tour de force; to-day it may truthfully be said that by a proper combination of clinical and roentgen evidence, few pulmonary neoplasms need escape discovery.” The importance of recognition of very early metastatic lesions in the lung or mediastinum cannot be too strongly emphasized. I have known of error, due to the positive diagnosis of metastatic growth of the lung when no metastatic lesion was present, lead to the withholding of an operative procedure and institution of palliative measures. The error is usually due to attaching undue importance to the peribronchial and root shadows. On the other hand, true early metastatic lesions should always be looked for before any operation for malignant growth is undertaken. Ewing5 makes the following observations: “Bayle, in 1810, vaguely described pulmonary cancer, and Stokes, 1842, recognized several varieties of the disease. Rokitansky recognized several gross varieties of the pulmonary lesions, but the earliest microscopical studies were those of Langhans, Marchiafava, and Malassez, 1871–1876. “Primary malignant tumors of the lung form about 1 per cent of all cancers. Among 16,578 cancer autopsies from various Continental sources, 168 pulmonary cancers were recorded (compiled from Karrenstein and Adler). Kaufman places the proportion much higher—at 1.83 per cent. It is evident that increased attention has greatly augmented the list of observed cases. “Males are much more frequently affected than females, 71.9 per cent. Adler gives the following analysis of age incidence: “The right lung is more frequently affected than the left. According to histogenesis three groups of pulmonary carcinoma must be recognized, as arising from (a) bronchial epithelium (Fig. 1), (b) bronchial mucous glands, (c) alveolar epithelium.

ARTIFICIAL PNEUMOTHORAX IN THE TREATMENT OF BILATERAL CASES OF PULMONARY TUBERCULOSIS

The use of artificial pneumothorax in the treatment of tuberculosis has received much attention in the last few years. At present there are many institutions which do not make use of this valuable remedy in the treatment of pulmonary tuberculosis. This is apparently due in part to the belief of many physicians that it is not applicable to patients who have an infection in both lungs. Furthermore, as most of the patients who have pulmonary tuberculosis have a lesion in both lungs, this reason would seem plausible to a certain extent. If a patient is not doing well, however, and if both lungs are involved, the one more than the other, the physician must resort to radical measures. Some time previous to the writing of this article, a patient at the state sanatorium, in whom the disease was far advanced in both lungs, left us, after being told that we