1
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Walker S, Hallifax R, Ricciardi S, Fitzgerald D, Keijzers M, Lauk O, Petersen J, Bertolaccini L, Bodtger U, Clive A, Elia S, Froudarakis M, Janssen J, Lee YCG, Licht P, Massard G, Nagavci B, Neudecker J, Roessner E, Van Schil P, Waller D, Walles T, Cardillo G, Maskell N, Rahman N. Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax. Eur J Cardiothorac Surg 2024; 65:ezae189. [PMID: 38804185 DOI: 10.1093/ejcts/ezae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/09/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. METHODS This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading, Recommendation, Assessment, Development and Evaluation). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. RESULTS The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. CONCLUSIONS With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made. SHAREABLE ABSTRACT This update of an ERS Task Force statement from 2015 provides a concise comprehensive update of the literature base. 24 evidence-based recommendations were made for management of pneumothorax, balancing clinical priorities and patient views.https://bit.ly/3TKGp9e.
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Affiliation(s)
- Steven Walker
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- Junior Chair of the Task Force
| | - Robert Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Deirdre Fitzgerald
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Marlies Keijzers
- Department of Surgery, Maxima Medical Center, Veldhoven, Netherlands
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jesper Petersen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Luca Bertolaccini
- Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Amelia Clive
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Tor Vergata University Hospital, Rome, Italy
| | - Marios Froudarakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Medical School, University Jean Monnet, Saint Etienne, France
| | - Julius Janssen
- Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Gilbert Massard
- Department of Thoracic Surgery, University of Luxembourg, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Blin Nagavci
- Institute for Evidence in Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Jens Neudecker
- Competence Center for Thoracic Surgery, Charité - Universitätsmedizin, Berlin, Germany
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany
| | - Eric Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - David Waller
- Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Thorsten Walles
- Clinic for Cardiac and Thoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unicamillus-International University of Health Sciences, Rome, Italy
- Senior Chairs of the Task Force
| | - Nick Maskell
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
- Senior Chairs of the Task Force
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK
- Senior Chairs of the Task Force
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Walker S, Hallifax R, Ricciardi S, Fitzgerald D, Keijzers M, Lauk O, Petersen J, Bertolaccini L, Bodtger U, Clive A, Elia S, Froudarakis M, Janssen J, Lee YCG, Licht P, Massard G, Nagavci B, Neudecker J, Roessner E, Van Schil P, Waller D, Walles T, Cardillo G, Maskell N, Rahman N. Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax. Eur Respir J 2024; 63:2300797. [PMID: 38806203 DOI: 10.1183/13993003.00797-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/09/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. METHODS This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading of Recommendations, Assessment, Development and Evaluations). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. RESULTS The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. CONCLUSIONS With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made.
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Affiliation(s)
- Steven Walker
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- Junior Chair of the Task Force
| | - Robert Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Deirdre Fitzgerald
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Marlies Keijzers
- Department of Surgery, Maxima Medical Center, Veldhoven, The Netherlands
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jesper Petersen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Luca Bertolaccini
- Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Amelia Clive
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Tor Vergata University Hospital, Rome, Italy
| | - Marios Froudarakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Medical School, University Jean Monnet, Saint Etienne, France
| | - Julius Janssen
- Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Gilbert Massard
- Department of Thoracic Surgery, University of Luxembourg, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Blin Nagavci
- Institute for Evidence in Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Jens Neudecker
- Competence Center for Thoracic Surgery, Charité - Universitätsmedizin, Berlin, Germany
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany
| | - Eric Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - David Waller
- Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Thorsten Walles
- Clinic for Cardiac and Thoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unicamillus - International University of Health Sciences, Rome, Italy
- Senior Chairs of the Task Force
| | - Nick Maskell
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
- Senior Chairs of the Task Force
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK
- Senior Chairs of the Task Force
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Thammineedi SR, Patnaik SC, Nusrath S, Naik V, Rayani B, Ramalingam PR, Vashist Y, Shukla S. Evaluation of indocyanine green tracheobronchial fluorescence (ICG-TBF) via nebulization during minimally invasive esophagectomy. Dis Esophagus 2024; 37:doad059. [PMID: 37702438 DOI: 10.1093/dote/doad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023]
Abstract
Surgical manipulation of the tracheobronchial complex is a contributing factor in pulmonary morbidity of esophagectomy. Accurate dissection between membranous trachea and bronchi with esophagus is essential. This study tests the feasibility of delivering indocyanine green (ICG) in an aerosol form to achieve tracheobronchial fluorescence (ICG-TBF). Patients with esophageal and esophagogastric junction carcinoma (N = 37) undergoing minimally invasive esophagectomy (McKeown type) were included. ICG was aerosolized by nebulization in supine position before thoracoscopy. ICG-TBF was observed with real-time fluorescence-enabled camera. Intra- and postoperative complications related to ICG were the primary focus. ICG-TBF was identified in 94.6% (35/37) of patients with median time to fluorescence identification of 15 minutes (range 1-43). There were no airway injuries in the study. The ICU median stay was 2 (range 2-21) days. No intra- or postoperative complications attributable to ICG were observed. Grade 3 or 4 pulmonary complications were seen in total 8.1% patients. No 90-day postoperative mortality was seen. ICG delivered in aerosol form was found to be safe and effective in achieving ICG-TBF. It aided in accurate dissection of esophagus from the tracheobronchial complex. Further studies on effect of ICG-TBF in decreasing pulmonary complications of esophagectomy are needed.
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Affiliation(s)
| | - Sujit Chyau Patnaik
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Syed Nusrath
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Vibhavari Naik
- Department of Onco-Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Basanth Rayani
- Department of Onco-Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Pratap Reddy Ramalingam
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Yogesh Vashist
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Srijan Shukla
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
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Wang S, Li J, Qian M, Wang J, Tan Y, Ou H, Wang Z, Chen X, Tu Y, Xu K. Excessive aggregation of fine particles may play a crucial role in adolescent spontaneous pneumothorax pathogenesis. PeerJ 2023; 11:e16484. [PMID: 38047016 PMCID: PMC10693242 DOI: 10.7717/peerj.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background The pathogenesis of primary spontaneous pneumothorax (PSP) is unclear. Fine particles aggregated in the lung can be phagocytosed by alveolar macrophages (AMs) to induce an inflammatory reaction and damage local pulmonary tissue, which could be a mechanism of PSP. This project aimed to explore the pathological association between fine particulate matter and PSP. Methods Thirty pulmonary bullae tissues were obtained from surgery of PSP patients (B group). The adjacent normal tissues of the lungs were defined as the control S group. Another 30 normal lung tissues with nonpneumothorax disease (NPD) were applied as the control N group. Hematoxylin and eosin (H & E), Wright-Giemsa (W-G), Victoria blue, and immunohistochemical (IHC) staining experiments were performed to measure the levels of fine particulate matter, alveolar macrophages (AMs), pulmonary elastic fibers, monocyte chemoattractant protein-1 (MCP-1), and matrix metalloproteinase-9 (MMP-9) in the lung tissues. The serum levels of MCP-1 and MMP-9 were prospectively analyzed as well. Results Histopathological examinations revealed obvious deposition of fine particulate matter and inflammatory reactions (proliferation of AMs) in the B group, compared with those in the S group and the N group. These alterations were significantly associated with PSP. The numbers of AMs and pulmonary elastic fibers, the positive area of the H-score, as well as the concentrations of MCP-1 and MMP-9 in the lungs of the experimental group were obviously raised compared with the controls (P < 0.05). Conclusions Fine particulate matter aggregation, inflammation (macrophage hyperplasia), and overexpression of MCP-1 and MMP-9 may contribute to the pathogenesis of PSP. The overaccumulation of fine particulate matter may play a crucial part in the occurrence of adolescent and young adult PSP. Trial registration This project was enrolled on the Chinese Clinical Trial Registry: ChiCTR2100051460.
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Affiliation(s)
- Sibo Wang
- Department of Cardiothoracic Surgery, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
| | - Jun Li
- Department of Cardiothoracic Surgery, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
| | - Mengjiao Qian
- Department of Cardiothoracic Surgery, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
| | - Jing Wang
- Department of Cardiothoracic Surgery, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
| | - Yongxing Tan
- Department of Pathology, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
| | - Haibo Ou
- Department of Cardiothoracic Surgery, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
| | - Zhongyin Wang
- Department of Cardiothoracic Surgery, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
| | - Xiao Chen
- Department of Cardiothoracic Surgery, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
| | - Yunjiao Tu
- Department of Pathology, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
| | - Kai Xu
- Department of Clinical Laboratory, The Southern Yunnan Central Hospital of Yunnan/The First People’s Hospital of Honghe Prefecture, Gejiu, Yunnan, China
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Yi E, Park JE, Chung JH, Ahn CB, Chung E, Noh OK, Lee S. Trends in recurrence of primary spontaneous pneumothorax in young population after treatment for first episode based on a nationwide population data. Sci Rep 2023; 13:13478. [PMID: 37596298 PMCID: PMC10439191 DOI: 10.1038/s41598-023-39717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/29/2023] [Indexed: 08/20/2023] Open
Abstract
The aim of this study is to identifying post treatment recurrence rates in pneumothorax patients under 35 and without any comorbidities according to the treatment types, gender, and age categories based on nationwide population data. Clinical information of pneumothorax patients was extracted from the Korean National Health Insurance Service (NHIS) database between January 2002 and December 2020. Enrolled patients were categorized into two groups; (1) Group I, those who underwent conservative management including pain relief, oxygen therapy, and closed thoracostomy, and (2) Group II, surgical intervention. Recurrence rates were compared according to age, gender, and type of treatment. Surgical intervention was performed in 25.6% patients as first treatment. The overall recurrence rate was 20.3%. Male patients showed a higher 5-year recurrence rate than female (20.8% vs. 10.9%, p < 0.001). Those with conservative management showed lower 5-year recurrence rates than those with surgical treatment (7.9% vs. 23.7%, p < 0.001). The 5-year recurrence rates of patients aged 14≤, and < 20 was higher than other age groups (29.2% vs. 4.5 and 11.9%, p < 0.001). Surgical intervention, male gender and aged under 20 showed association with higher recurrence rates.
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Affiliation(s)
- Eunjue Yi
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, 73, Koryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jun Eun Park
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Ho Chung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, 73, Koryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Chi Bum Ahn
- Biomedical Engineering Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Eugene Chung
- Department of Linguistics, Korea University, Seoul, Republic of Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.
- Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Suwon, Republic of Korea.
| | - Sungho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, 73, Koryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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Duron G, Backer E, Feller-Kopman D. Evaluation and management of persistent air leak. Expert Rev Respir Med 2023; 17:865-872. [PMID: 37855445 DOI: 10.1080/17476348.2023.2272701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Persistent air leaks (PAL) represent a challenging clinical problem for which there is not a clear consensus to guide optimal management. PAL is associated with significant morbidity, mortality, and increased length of hospital stay. There are a variety of surgical and non-surgical management options available. AREAS COVERED This narrative review describes the current evidence for PAL management including surgical approach, autologous blood patch pleurodesis, chemical pleurodesis, endobronchial valves, and one-way valves. Additionally, emerging topics such as drainage-dependent air leak and intensive care unit management are described. EXPERT OPINION There has been considerable progress in understanding the pathophysiology of PAL and growing evidence to support the various non-surgical treatment modalities. Increased recognition of drainage-dependent persistent air leaks offers the opportunity to decrease the number of patients requiring additional invasive treatment. Randomized control trials are needed to guide optimal management.
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Affiliation(s)
- Garret Duron
- Department of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elliot Backer
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, 1 Medical Center Drive, Lebanon, NH, Lebanon
| | - David Feller-Kopman
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, 1 Medical Center Drive, Lebanon, NH, Lebanon
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7
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Barton EC, Maskell NA, Walker SP. Expert Review on Spontaneous Pneumothorax: Advances, Controversies, and New Directions. Semin Respir Crit Care Med 2023. [PMID: 37321247 DOI: 10.1055/s-0043-1769615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in pneumothorax research has begun to address controversies surrounding the topic and change the face of pneumothorax management. In this article, we review controversies concerning the etiology, pathogenesis, and classification of pneumothorax, and discuss recent advances in its management, including conservative and ambulatory management. We review the evidence base for the challenges of managing pneumothorax, including persistent air leak, and suggest new directions for future research that can help provide patient-centered, evidence-based management for this challenging cohort of patients.
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Affiliation(s)
- Eleanor C Barton
- Academic Respiratory Unit, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Nick A Maskell
- Academic Respiratory Unit, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Steven P Walker
- Academic Respiratory Unit, North Bristol National Health Service Trust, Bristol, United Kingdom
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Sharma S, Badami V, Rojas E, Sangani R, Chapman K, Avalon C, King A, Wen S. High incidence of barotrauma in patients admitted with COVID-19 to ICU and associated mortality in rural Appalachia: An observational study. PLoS One 2023; 18:e0282735. [PMID: 36893088 PMCID: PMC9997869 DOI: 10.1371/journal.pone.0282735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES To assess the incidence of barotrauma and its impact on mortality in COVID-19 patients admitted to ICU. DESIGN Single-center retrospective study of consecutive COVID-19 patients admitted to a rural tertiary-care ICU. The primary outcomes were incidence of barotrauma in COVID-19 patients and all-cause 30-day mortality. Secondary outcomes were the length of stay (LOS) in the hospital and ICU. Kaplan-Meier method and log-rank test were used in the survival data analysis. SETTING Medical ICU, West Virginia University Hospital (WVUH), USA. PATIENTS All adult patients were admitted to the ICU for acute hypoxic respiratory failure due to coronavirus disease 2019 between September 1, 2020, and December 31, 2020. Historical controls were ARDS patients admitted pre-COVID. INTERVENTION Not applicable. MEASUREMENTS AND MAIN RESULTS One hundred and sixty-five consecutive patients with COVID-19 were admitted to the ICU during the defined period, compared to 39 historical non-COVID controls. The overall incidence of barotrauma in COVID-19 patients was 37/165 (22.4%) compared to 4/39 (10.3%) in the control group. Patients with COVID-19 and barotrauma had a significantly worse survival (HR = 1.56, p = 0.047) compared to controls. In those requiring invasive mechanical ventilation, the COVID group also had significantly higher rates of barotrauma (OR 3.1, p = 0.03) and worse all-cause mortality (OR 2.21, p = 0.018). COVID-19 with barotrauma had significantly higher LOS in the ICU and the hospital. CONCLUSIONS Our data on critically ill COVID-19 patients admitted to the ICU shows a high incidence of barotrauma and mortality compared to the controls. Additionally, we report a high incidence of barotrauma even in non-ventilated ICU patients.
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Affiliation(s)
- Sunil Sharma
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
- * E-mail:
| | - Varun Badami
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
| | - Edward Rojas
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
| | - Rahul Sangani
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
| | - Kyle Chapman
- Division of Pulmonary Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV, United States of America
- West Virginia University Critical Care and Trauma Institute, Morgantown, WV, United States of America
| | - Carlo Avalon
- Department of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Austin King
- Department of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States of America
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Recuero Díaz JL, Milián Goicoechea H, Carmona Soto P, Gálvez Muñoz C, Bello Rodríguez I, Figueroa Almánzar S, Foschini Martínez G, Genovés Crespo M, Soro García J, García Fernández JL, Rodríguez Suárez P, Obeso Carrillo A. Manejo quirúrgico del neumotórax espontáneo primario. Encuesta nacional del Grupo Emergente de Cirugía Torácica de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). OPEN RESPIRATORY ARCHIVES 2023. [PMID: 37497256 PMCID: PMC10369589 DOI: 10.1016/j.opresp.2022.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction In February 2022, the Emerging Thoracic Surgery Group of the Spanish Society of Pneumology and Thoracic Surgery initiated a multicenter study on the surgical management of primary spontaneous pneumothorax (PSP). As a preliminary step, this survey was developed with the aim of finding out the current situation in our country to specify and direct this project. Method A descriptive study was carried out based on the results of this survey launched through the Google Docs® platform. The survey was sent to all active national thoracic surgeons, a total of 319. It consisted of 20 questions including demographic, surgical and follow-up data. Results We obtained 124 responses (39% of all specialists and doctors in training in the national territory). The most consistent indications were: homolateral recurrence for 124 (100%), lack of resolution of the episode for 120 (96.7%), risk professions for 104 (84%) and bilateral pneumothorax for 93 (75%). The approach of choice for 100% of respondents was videothoracoscopy. Of these, 96 contemplated pulmonary resection of obvious lesions (77%). Regarding the pleurodesis technique, pleural abrasion was the technique most used by 70 respondents (56.7%) while 49 (40%) performed chemical pleurodesis with talc either alone or in combination with mechanical pleurodesis. Conclusions While there is some consistency in some aspects of surgical management of PSP, this survey makes evident the variability in pleurodesis techniques applied among surgeons in our country.
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10
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Aetiology of Primary Spontaneous Pneumothorax. J Clin Med 2022; 11:jcm11030490. [PMID: 35159942 PMCID: PMC8836443 DOI: 10.3390/jcm11030490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 01/01/2023] Open
Abstract
Air in the pleural cavity is termed pneumothorax. When this occurs in the absence of trauma or medical intervention, it is called spontaneous pneumothorax. Primary spontaneous pneumothorax typically occurs in young patients without known lung disease. However, the idea that these patients have “normal” lungs is outdated. This article will review evidence of inflammation and respiratory bronchiolitis on surgical specimens, discuss the identification of emphysema-like change (i.e., blebs and bullae), the concept of pleural porosity and review recent data on the overexpression of matrix metalloproteinases in the lungs of patients who have had pneumothorax.
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11
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Muhetaer M, Paerhati K, Sun Q, Li D, Zong L, Zhang H, Zhang L. Effects of Different Treatment Regimens on Primary Spontaneous Pneumothorax: A Systematic Review and Network Meta-Analysis. Ann Thorac Cardiovasc Surg 2022; 28:389-402. [PMID: 36002271 PMCID: PMC9763716 DOI: 10.5761/atcs.oa.22-00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The best treatment strategy for primary spontaneous pneumothorax is controversial and varies widely in practice. METHODS Literatures were searched from databases till 24 August 2021. A Bayesian network meta-analysis was conducted to compare the outcomes of various treatments with the following endpoints: recurrence rate, postoperative chest tube duration, postoperative air leakage duration, length of hospital stay, and complications rate. RESULTS In all, 7210 patients of 20 randomized controlled trials and 17 cohort studies were included. Surgery had a significantly lower recurrence rate compared to other treatments. Besides, bullectomy (BT) combined with chemical pleurodesis (CP), mechanical pleurodesis, or staple line coverage (SLC) can reduce the recurrence rate compared to BT alone, but none of them were statistically significant. In terms of reducing chest tube duration, BT with tubular Neoveil outperformed BT + pleural abrasion (mean difference [MD], 95% confidence interval [CI]: -2.5 [-4.63, -0.35]) and BT + apical pleurectomy (MD, 95% CI: -2.72 [-5.16, -0.27]). CONCLUSIONS Surgical methods were superior to manual aspiration (MA), chest tube drainage (CTD), and conservative treatment in terms of recurrence reduction. There was no significant difference between MA and CTD in reducing the recurrence rate. Among surgical methods, CP is more effective than mechanical pleurodesis and SLC among the additional procedures based on BT.
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Affiliation(s)
- Muredili Muhetaer
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China,The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Keriman Paerhati
- The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Qingchao Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Desheng Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Liang Zong
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Haiping Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China
| | - Liwei Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urümqi, China,Corresponding author: Liwei Zhang. Department of Thoracic Surgery, The First Affiliated Hospital, Xinjiang Medical University, Urümqi, 830011, China
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12
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Azam A, Zahid A, Abdullah Q, Qayyum N, Abdelmoteleb M, Ganaie MB. Utility of thoracic computed tomography to predict need for early surgery and recurrence after first episode of primary spontaneous pneumothorax. Clin Med (Lond) 2021; 22:71-74. [PMID: 34893502 DOI: 10.7861/clinmed.2021-0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION CT imaging is not advocated by British Thoracic Society guidelines after first episode of primary spontaneous pneumothorax (PSP). There is emerging evidence that emphysema-like changes and CT-based dystrophy severity score (DSS) can predict need for early surgery and recurrence. OBJECTIVES We aimed to assess the role of DSS during first episodes of PSP in predicting the need for early surgery and recurrence. METHODS We conducted a retrospective analysis of consecutive PSP episodes (n=197) admitted to our institution from 1 January 2012 to 31 December 2017. DSS was calculated based on type, number and distribution of blebs and bullae. Patients were categorised as low-grade (0-3) or high-grade (4-6) DSS assessed by a thoracic radiologist. RESULTS Forty-five PSP patients had CT at first presentation. Eight patients had low-grade DSS; all were managed non-surgically and none had recurrence over 12 months. Thirty-seven patients had high-grade DSS. Of these, 25 (67.5%) were managed surgically, with three having contralateral recurrence over 12 months; 12 (32.5%) were managed non-surgically, and of these two patients had ipsilateral recurrence over 12 months. CONCLUSION DSS seems to predict the need for early surgery and recurrence and CT can be used to risk-stratify patients after a first episode of PSP.
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Affiliation(s)
- Asif Azam
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Ahsan Zahid
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Qaiser Abdullah
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Noman Qayyum
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Mostafa Abdelmoteleb
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Muhammad Badar Ganaie
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
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13
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Abstract
Pneumothorax is a common problem worldwide. Pneumothorax develops secondary to diverse aetiologies; in many cases, there may be no recognizable lung abnormality. The pathogenetic mechanism(s) causing spontaneous pneumothorax may be related to an interplay between lung-related abnormalities and environmental factors such as smoking. Tobacco smoking is a major risk factor for primary spontaneous pneumothorax; chronic obstructive pulmonary disease is most frequently associated with secondary spontaneous pneumothorax. This review article provides an overview of the historical perspective, epidemiology, classification, and aetiology of pneumothorax. It also aims to highlight current knowledge and understanding of underlying risks and pathophysiological mechanisms in pneumothorax development.
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Affiliation(s)
- Nai-Chien Huan
- Department of Pulmonology, Serdang Hospital, Kajang, Malaysia
| | - Calvin Sidhu
- Edith Cowan University, Perth, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
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14
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Marx T, Bernard N, Kepka S, Gérazime A, Mauny F, Desmettre T. Pneumothorax and the environment: A systematic review of the impact of air pollution and meteorology, and a meta-analysis on meteorology factors. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 283:117089. [PMID: 33892373 DOI: 10.1016/j.envpol.2021.117089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 05/22/2023]
Abstract
A relationship between the occurrence of spontaneous pneumothorax (SP) and meteorological factors has been observed but with contradictory results. The objectives of this systematic review was to synthesis the current body of evidence to the relationships between the occurrence of SP and environmental determinants such as meteorological factors and air pollutants. We conducted a systematic search of MEDLINE, Scopus, Cochrane Library and gray literature from inception up to 31st December 2020, to find published scientific research articles based on the following eligibility criteria: original studies and population-based articles describing the relationship between meteorological factors or air pollutants and the occurrence of SP. For the meta-analysis, studies involving a quantitative analysis of the exposure variable (atmospheric pressure, temperature, humidity and wind speed) and the impact of the occurrence of SP with comparable methodology were selected. General characteristics and methodological information for each study were assessed. The quality was evaluated according to the Newcastle-Ottawa Scale. Fourty four and 13 studies were respectively included in the qualitative and quantitative analyses. The variability of the study design with moderate quality and the different measurements of the exposure variables highlight the contrasting results. The results of the meta-analyses are in favor of a higher temperature observed in the day with SP than in the days without SP (maximum: MD 0.25 (-0.08, 0.58) p = 0.14; I2 = 26%, p = 0.21; mean: MD 0.22 (-0.15, 0.59) p = 0.24; I2 = 45%, p = 0.07). The small number of studies focused on air pollution did not allow us to conclude to determine the potential impact of exposure to air pollutants on the occurrence of SP. Meteorological conditions seem to be related to SP occurrence, especially increased temperature.
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Affiliation(s)
- Tania Marx
- Emergency Department, CHU Besançon, 3 Boulevard Alexandre Fleming, 25030, Besançon, France; Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; Université Bourgogne Franche-Comté, 32 Avenue de L'Observatoire, 25000, Besançon, France.
| | - Nadine Bernard
- Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; Laboratory TheMA, UMR 6049 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; Université Bourgogne Franche-Comté, 32 Avenue de L'Observatoire, 25000, Besançon, France
| | - Sabrina Kepka
- Emergency Department, CHU Strasbourg, 3 Rue Koeberlé, 67000, Strasbourg, France
| | - Aurelie Gérazime
- UMETh - Centre Investigation Clinique 1431, CHU Besançon, 2 Place Saint-Jacques, 25030, Besançon, France
| | - Frédéric Mauny
- Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; UMETh - Centre Investigation Clinique 1431, CHU Besançon, 2 Place Saint-Jacques, 25030, Besançon, France; Université Bourgogne Franche-Comté, 32 Avenue de L'Observatoire, 25000, Besançon, France
| | - Thibaut Desmettre
- Emergency Department, CHU Besançon, 3 Boulevard Alexandre Fleming, 25030, Besançon, France; Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; Université Bourgogne Franche-Comté, 32 Avenue de L'Observatoire, 25000, Besançon, France
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15
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Quan YH, Oh CH, Jung D, Lim JY, Choi BH, Rho J, Choi Y, Han KN, Kim BM, Kim C, Park JH, Kim HK. Evaluation of Intraoperative Near-Infrared Fluorescence Visualization of the Lung Tumor Margin With Indocyanine Green Inhalation. JAMA Surg 2021; 155:732-740. [PMID: 32579150 DOI: 10.1001/jamasurg.2020.1314] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Identification of the tumor margin during surgery is important for precise minimal resection of lung tumors. Intravenous injection of indocyanine green (ICG) has several limitations when used for intraoperative visualization of lung cancer. Objectives To describe a technique for intraoperative visualization of lung tumor margin using ICG inhalation and evaluate the clinical applicability of the technique in mouse and rabbit lung tumor models as well as lung specimens of patients with lung tumors. Design, Setting, and Participants In lung tumor models of both mice and rabbits, the distribution of inhaled ICG in the lung tumor margin was investigated in vivo and ex vivo using a near-infrared imaging system. Lung tumor margin detection via inhalation of ICG was evaluated by comparing the results obtained with those of the intravenous injection method (n = 32, each time point for 4 mice). Based on preclinical data, use of ICG inhalation to help detect the tumor margin in patients with lung cancer was also evaluated (n = 6). This diagnostic study was conducted from May 31, 2017, to March 30, 2019. Main Outcomes and Measures The use of tumor margin detection by inhaled ICG was evaluated by comparing the inhaled formulation with intravenous administration of ICG. Results From 10 minutes after inhalation of ICG to 24 hours, the distribution of ICG in the lungs was significantly higher than that in other organs (signal to noise ratio in the lungs: 39 486.4; interquartile range [IQR], 36 983.74-43 592.5). Ex vivo and histologic analysis showed that, in both lung tumor models, inhaled ICG was observed throughout the healthy lung tissue but was rarely found in tumor tissue. The difference in the fluorescent signal between healthy and tumor lung tissues was associated with the mechanical airway obstruction caused by the tumor and with alveolar macrophage uptake of the inhaled ICG in healthy tissues. Inhalation at a 20-fold lower dose of ICG had a 2-fold higher efficiency for tumor margin detection than did the intravenous injection (2.9; IQR, 2.7-3.2; P < .001). Conclusions and Relevance The results of this study suggest that lung-specific inhalation delivery of ICG is feasible and may be useful for the intraoperative visualization of lung tumor margin in clinical practice.
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Affiliation(s)
- Yu Hua Quan
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.,Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Chan Hee Oh
- Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Daeho Jung
- Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Ji-Young Lim
- Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Byeong Hyeon Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.,Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jiyun Rho
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.,Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Yeonho Choi
- Department of Bio-Convergence, Korea University, Seoul, Republic of Korea
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Beop-Min Kim
- Department of Bio-Convergence, Korea University, Seoul, Republic of Korea
| | - Chungyeul Kim
- Department of Pathology, Korea University Guro Hospital, College of Medicine, Republic of Korea University, Seoul, Republic of Korea
| | - Ji-Ho Park
- Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.,Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea
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16
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Jang HJ, Lee JH, Nam SH, Ro SK. Fate of contralateral asymptomatic bullae in patients with primary spontaneous pneumothorax. Eur J Cardiothorac Surg 2021; 58:365-370. [PMID: 32182337 DOI: 10.1093/ejcts/ezaa054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/20/2020] [Accepted: 01/29/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Hyo Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Hyuk Nam
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Sun Kyun Ro
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea
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17
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Zaman S, Seligman H, Lloyd FH, Patel KT, Chappell D, O'Hare D, Cole GD, Francis DP, Petraco R, Linton NW. Aerosolised fluorescein can quantify FFP mask faceseal leakage: a cost-effective adaptation to the existing point of care fit test. Clin Med (Lond) 2021; 21:e263-e268. [PMID: 34001582 DOI: 10.7861/clinmed.2020-0982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A qualitative fit test using bitter-tasting aerosols is the commonest way to determine filtering face-piece (FFP) mask leakage. This taste test is subjective and biased by placebo. We propose a cheap, quantitative modification of the taste test by measuring the amount of fluorescein stained filter paper behind the mask using image analysis. METHODS A bitter-tasting fluorescein solution was aerosolised during mask fit tests, with filter paper placed on masks' inner surfaces. Participants reported whether they could taste bitterness to determine taste test 'pass' or 'fail' results. Filter paper photographs were digitally analysed to quantify total fluorescence (TF). RESULTS Fifty-six healthcare professionals were fit tested; 32 (57%) 'passed' the taste test. TF between the taste test 'pass' and 'fail' groups was significantly different (p<0.001). A cut-off (TF = 5.0 × 106 units) was determined at precision (78%) and recall (84%), resulting in 5/56 participants (9%) reclassified from 'pass' to 'fail' by the fluorescein test. Seven out of 56 (12%) reclassified from 'fail' to 'pass'. CONCLUSION Fluorescein is detectable and sensitive at identifying FFP mask leaks. These low-cost adaptations can enhance exiting fit testing to determine 'pass' and 'fail' groups, protecting those who 'passed' the taste test but have high fluorescein leak, and reassuring those who 'failed' the taste test despite having little fluorescein leak.
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Affiliation(s)
| | | | | | - Keval T Patel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Darrel P Francis
- Imperial College London, London, UK and Imperial College Healthcare NHS Trust, London, UK
| | - Ricardo Petraco
- Imperial College London, London, UK and Imperial College Healthcare NHS Trust, London, UK
| | - Nick Wf Linton
- Imperial College London, London, UK and Imperial College Healthcare NHS Trust, London, UK
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18
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Louw EH, Shaw JA, Koegelenberg CFN. New insights into spontaneous pneumothorax: A review. Afr J Thorac Crit Care Med 2021; 27:10.7196/AJTCCM.2021.v27i1.054. [PMID: 34240041 PMCID: PMC8203058 DOI: 10.7196/ajtccm.2021.v27i1.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 11/15/2022] Open
Abstract
A spontaneous pneumothorax is a pneumothorax that does not arise from trauma or an iatrogenic cause. Although the traditional classification of either primary or secondary spontaneous pneumothorax based on the absence or presence of overt underlying lung disease is still widely used, it is now well recognised that primary spontaneous pneumothorax is associated with underlying pleuropulmonary disease. Current evidence indicates that computed tomography screening for underlying disease should be considered in patients who present with spontaneous pneumothorax. Recent evidence suggests that conservative management has similar recurrence rates, less complications and shorter hospital stay compared with invasive interventions, even in large primary spontaneous pneumothoraces of >50%. A more conservative approach which is based on clinical assessment rather than pneumothorax size can thus be followed during the acute management in selected stable patients. The purpose of this review is to revisit the aetiology of spontaneous pneumothorax, identify which patients should be investigated for secondary causes and to give an overview of the management strategies at initial presentation as well as secondary prevention.
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Affiliation(s)
- E H Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - J A Shaw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - C F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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19
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Iyoda A, Azuma Y, Sakai T, Koezuka S, Otsuka H, Sano A. A novel finding related to bulla and bleb formation in patients with primary spontaneous pneumothorax. BMC Pulm Med 2021; 21:20. [PMID: 33422030 PMCID: PMC7797130 DOI: 10.1186/s12890-021-01402-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/04/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Spontaneous pneumothorax is a common problem globally. Bullas and blebs have been implicated in this problem, but the etiology of their formation is unknown. We aim to show the relation between a novel clinical finding, the pulmonary delayed inflation (PDI) sign, and the etiology of bulla and bleb formation in young patients. METHODS We retrospectively analyzed data from 111 patients with pneumothorax and a control group of 27 patients. We evaluated the relation between the PDI sign and other clinical factors. RESULTS The PDI sign was observed in 78 patients. Of these, 75 exhibited the PDI sign in only the upper lobe. Regardless of smoking status, patients 34 years of age or younger had a significantly higher incidence of the PDI sign than, patients 55 years of age or older and control patients. The inflation time in patients 34 years of age or younger, regardless of smoking status, was significantly longer than in patients 55 years of age or older and patients in the control group. There was no significant association between inflation time and the presence of asthma. CONCLUSIONS The novel PDI sign is seen in patients 34 years of age or younger. Because this sign may indicate a peripheral bronchial abnormality and may be related to the formation of blebs and bullae in young patients with spontaneous pneumothorax, it is possible that it can be used to develop effective treatments for pneumothorax in young patients.
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Affiliation(s)
- Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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20
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Ali JM, Aresu G. Is it time to reconsider the need for bullectomy in the surgical management of primary spontaneous pneumothorax? J Thorac Dis 2020; 12:3921-3923. [PMID: 32944299 PMCID: PMC7475578 DOI: 10.21037/jtd.2020.04.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jason M Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Giuseppe Aresu
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK
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21
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Short term association between air pollution (PM 10, NO 2 and O 3) and secondary spontaneous pneumothorax. Sci Rep 2020; 10:11823. [PMID: 32678253 PMCID: PMC7366720 DOI: 10.1038/s41598-020-68831-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022] Open
Abstract
Secondary spontaneous pneumothorax (SSP) occurs in the context of underlying pulmonary disease. Our objectives were to estimate the relationship between SSP and short term air pollution exposure with nitrogen dioxide (NO2), ozone (O3) and particulate matter with a diameter ≤ 10 μm (PM10). Patients with SSP were included between June 1, 2009 and May 31, 2013, in 14 Emergency Departments in France. In this case–crossover design study, PM10, NO2, and O3 data were collected hourly from monitoring stations. Quantitative values, fast increase in air pollutant concentration, and air quality threshold exceedance were retained. These assessments were calculated for each of the 4 days prior to the event (Lag 1–Lag 4) for all case and control period, and for the entire exposure period. A total of 135 patients with SSP were included, with a mean age of 55.56 (SD 18.54) years. For short term exposure of PM10, NO2 and O3, no differences were observed between case and control periods in terms of quantitative values of air pollutant exposure (P > 0.68), fast increase in concentration (P > 0.12) or air quality threshold exceedance (P > 0.68). An association between O3 exposures cannot be ruled out, especially when considering the Lag 2 prior to the event and in warm seasons.
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22
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Nishimoto K, Fujisawa T, Yoshimura K, Enomoto Y, Yasui H, Hozumi H, Karayama M, Suzuki Y, Furuhashi K, Enomoto N, Nakamura Y, Inui N, Sumikawa H, Johkoh T, Suda T. Pneumothorax in connective tissue disease-associated interstitial lung disease. PLoS One 2020; 15:e0235624. [PMID: 32634173 PMCID: PMC7340294 DOI: 10.1371/journal.pone.0235624] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background Spontaneous pneumothorax is a complication that occurs in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD); however, few studies on the clinical implications of pneumothorax for patients with CTD-ILD have been performed. Objectives This study aimed to investigate the incidence and prognostic significance of pneumothorax and the risk factors for its onset in patients with CTD-ILD. Methods This study included 140 consecutive patients with CTD-ILD. Clinical characteristics, laboratory findings, pulmonary function test results, and chest high-resolution computed tomography (HRCT) images were retrospectively evaluated. Results A total of 18 patients (12.9%) developed pneumothorax during their clinical course. The cumulative incidence of pneumothorax from the time of CTD-ILD diagnosis was 6.5%, 8.7%, and 11.3% at 1, 3, and 5 years, respectively. The 10-year survival rate was significantly lower in patients with pneumothorax (29.6%) than that in those without pneumothorax (81.3%). The development of pneumothorax was significantly associated with poor prognosis (HR 22.0; p < 0.010). Furthermore, a lower body mass index, greater extent of reticular abnormalities on HRCT, and administration of methylprednisolone pulse therapy were significantly associated with the development of pneumothorax. Conclusion Pneumothorax is a serious complication in the clinical course of patients with CTD-ILD and the onset of pneumothorax predicts a poor outcome.
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Affiliation(s)
- Koji Nishimoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- * E-mail:
| | - Katsuhiro Yoshimura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasunori Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Thomas R, Rahman NM, Maskell NA, Lee YCG. Pleural effusions and pneumothorax: Beyond simple plumbing: Expert opinions on knowledge gaps and essential next steps. Respirology 2020; 25:963-971. [PMID: 32613624 DOI: 10.1111/resp.13881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/15/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022]
Abstract
Pleural diseases affect millions of people worldwide. Pleural infection, malignant pleural diseases and pneumothorax are common clinical challenges. A large number of recent clinical trials have provided an evidence-based platform to evaluate conventional and novel methods to drain pleural effusions/air which reduce morbidity and unnecessary interventions. These successes have generated significant enthusiasm and raised the profile of pleural medicine as a new subspecialty. The ultimate goal of pleural research is to prevent/stop development of pleural effusions/pneumothorax. Current research studies mainly focus on the technical aspects of pleural drainage. Significant knowledge gaps exist in many aspects such as understanding of the pathobiology of the underlying pleural diseases, pharmacokinetics of pleural drug delivery, etc. Answers to these important questions are needed to move the field forward. This article collates opinions of leading experts in the field in highlighting major knowledge gaps in common pleural diseases to provoke thinking beyond pleural drainage. Recognizing the key barriers will help prioritize future research in the quest to ultimately cure (rather than just drain) these pleural conditions.
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Affiliation(s)
- Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK.,North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Y C Gary Lee
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia.,Centre for Respiratory Health, School of Medicine, University of Western Australia, Perth, WA, Australia
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24
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Saad AB, Migaou A, Ammar M, Mhamed SC, Fahem N, Rouatbi N, Joobeur S. [Recurrence score to predict the risk of recurrence after first episode of primary spontaneous pneumothorax]. Pan Afr Med J 2020; 36:107. [PMID: 32821318 PMCID: PMC7406466 DOI: 10.11604/pamj.2020.36.107.23432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/26/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction the relationship between computed tomography (CT) scan findings and the risk of recurrence of primary spontaneous pneumothorax (PSP) is controversial. The purpose of this study is to determine the relationship between the Dystrophy Severity Score (DSS) and PSP recurrence after an initial episode. Methods we conducted a retrospective study including patients admitted to the hospital with PSP (first episode) between 2005-2017. The study population was divided into 2 groups, G1: PSP recurrence, G2: No recurrence. We undertook univariate analysis including various variables such as the DSS score followed by multivariate analysis. Results eighty-six patients were included in this study. Forty-eight percent of cases had PSP recurrence. Although the DSS score was significantly associated with PSP recurrence (p=0.008), multivariate analysis showed that the presence of bubbles on chest CT scan was the independent risk factor associated with PSP recurrence after a first episode (risk report: 3.26, p < 0.008). Conclusion the risk of PSP recurrence is significantly associated with the presence of bubbles on chest CT scan. Further studies are needed for better assessment of the DSS score.
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Affiliation(s)
- Ahmed Ben Saad
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er Juin, 5000 Monastir, Tunisie
| | - Asma Migaou
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er Juin, 5000 Monastir, Tunisie
| | - Maroua Ammar
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er Juin, 5000 Monastir, Tunisie
| | - Saousen Cheikh Mhamed
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er Juin, 5000 Monastir, Tunisie
| | - Nesrine Fahem
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er Juin, 5000 Monastir, Tunisie
| | - Naceur Rouatbi
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er Juin, 5000 Monastir, Tunisie
| | - Samah Joobeur
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er Juin, 5000 Monastir, Tunisie
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Nachira D, Meacci E, Congedo MT, Pogliani L, Chiappetta M, Vita ML, Margaritora S. Surgical treatment of primary spontaneous pneumothorax: what is better to do? J Thorac Dis 2020; 12:1274-1276. [PMID: 32395261 PMCID: PMC7212159 DOI: 10.21037/jtd.2020.03.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Pogliani
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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26
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Dżeljilji A, Karuś K, Kierach A, Kazanecka B, Rokicki W, Tomkowski W. Efficacy and safety of pleurectomy and wedge resection versus simple pleurectomy in patients with primary spontaneous pneumothorax. J Thorac Dis 2020; 11:5502-5508. [PMID: 32030269 DOI: 10.21037/jtd.2019.11.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background 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. Methods 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). Results 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. Conclusions Efficacy and safety of pleurectomy vs. pleurectomy + wedge resection is comparable.
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Affiliation(s)
- Agata Dżeljilji
- Department of Thoracic Surgery, National Institute of Tuberculosis and Lung Diseases (NITLD), Warsaw, Poland
| | - Krzysztof Karuś
- Department of Thoracic Surgery, National Institute of Tuberculosis and Lung Diseases (NITLD), Warsaw, Poland
| | | | - Barbara Kazanecka
- Cardio-Pulmonary Intensive Care Department, National Institute of Tuberculosis and Lung Diseases (NITLD), Warsaw, Poland
| | - Wojciech Rokicki
- Department of Thoracic Surgery, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Witold Tomkowski
- Cardio-Pulmonary Intensive Care Department, National Institute of Tuberculosis and Lung Diseases (NITLD), Warsaw, Poland
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Mendogni P, Vannucci J, Ghisalberti M, Anile M, Aramini B, Congedo MT, Nosotti M, Bertolaccini L, D’Ambrosio AE, De Vico A, Guerrera F, Imbriglio G, Pardolesi A, Schiavon M, Russo E. Epidemiology and management of primary spontaneous pneumothorax: a systematic review. Interact Cardiovasc Thorac Surg 2019; 30:337-345. [DOI: 10.1093/icvts/ivz290] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 02/02/2023] Open
Abstract
Abstract
Primary spontaneous pneumothorax (PSP) is one of the most common thoracic diseases affecting adolescents and young adults. Despite the high incidence of PSP and the availability of several international guidelines for its diagnosis and treatment, a significant behavioural heterogeneity can be found among those management recommendations. A working group of the Italian Society of Thoracic Surgery summarized the best evidence available on PSP management with the methodological tool of a systematic review assessing the quality of previously published guidelines with the Appraisal of Guidelines for Research and Evaluation (AGREE) II. Concerning PSP physiopathology, the literature seems to be equally divided between those who support the hypothesis of a direct correlation between changes in atmospheric pressure and temperature and the incidence of PSP, so it is not currently possible to confirm or reject this theory with reasonable certainty. Regarding the choice between conservative treatment and chest drainage in the first episode, there is no evidence on whether one option is superior to the other. Video-assisted thoracic surgery represents the most common and preferred surgical approach. A primary surgical approach to patients with their first PSP seems to guarantee a lower recurrence rate than that of a primary approach consisting of a chest drainage positioning; conversely, the percentage of futile surgical interventions that would entail this aggressive attitude must be carefully evaluated. Surgical pleurodesis is recommended and frequently performed to limit recurrences; talc poudrage offers efficient pleurodesis, but a considerable number of surgeons are concerned about administering this inert material to young patients.
Clinical trial registration number
International Prospective Register of Systematic Reviews (PROSPERO): CRD42018084247.
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Affiliation(s)
- Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jacopo Vannucci
- Department of Thoracic Surgery, Umberto I Hospital, University of Rome Sapienza, Rome, Italy
| | | | - Marco Anile
- Department of Thoracic Surgery, Umberto I Hospital, University of Rome Sapienza, Rome, Italy
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Maria Teresa Congedo
- Division of Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Andrea De Vico
- Thoracic Surgery Unit, ASST Spedali Civili Brescia, Brescia, Italy
| | | | | | - Alessandro Pardolesi
- Unit of Thoracic Surgery, Foundation IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Emanuele Russo
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT – UPMC, Palermo, Italy
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Marx T, Bernard N, Parmentier AL, Puyraveau M, Martin B, Gantelet M, Pretalli JB, Dalphin JC, Mauny F, Desmettre T. Does air pollution really impact the onset of spontaneous pneumothorax? A French case-crossover study. ENVIRONMENT INTERNATIONAL 2019; 127:317-323. [PMID: 30953814 DOI: 10.1016/j.envint.2019.01.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
RATIONALE A 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. METHODS This 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. RESULTS 948 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). CONCLUSIONS We 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.
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Affiliation(s)
- Tania Marx
- Emergency Department, CHU de Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France; Laboratory Chrono-environnement, UMR 6249 Centre National de la Recherche Scientifique, 16 route de Gray, 25000 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France.
| | - Nadine Bernard
- Laboratory Chrono-environnement, UMR 6249 Centre National de la Recherche Scientifique, 16 route de Gray, 25000 Besançon, France; Laboratory TheMA, UMR 6049 Centre National de la Recherche Scientifique, 16 route de Gray, 25000 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France
| | - Anne-Laure Parmentier
- Laboratory Chrono-environnement, UMR 6249 Centre National de la Recherche Scientifique, 16 route de Gray, 25000 Besançon, France; Clinical Methodology Center, CHU de Besançon, 2 place Saint-Jacques, 25030 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France
| | - Marc Puyraveau
- Laboratory Chrono-environnement, UMR 6249 Centre National de la Recherche Scientifique, 16 route de Gray, 25000 Besançon, France; Clinical Methodology Center, CHU de Besançon, 2 place Saint-Jacques, 25030 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France
| | - Berenger Martin
- Clinical Methodology Center, CHU de Besançon, 2 place Saint-Jacques, 25030 Besançon, France
| | - Madeleine Gantelet
- Clinical Methodology Center, CHU de Besançon, 2 place Saint-Jacques, 25030 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France
| | - Jean-Baptiste Pretalli
- Emergency Department, CHU de Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France
| | - Jean-Charles Dalphin
- Laboratory Chrono-environnement, UMR 6249 Centre National de la Recherche Scientifique, 16 route de Gray, 25000 Besançon, France; Pneumology Department, CHU de Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France
| | - Frédéric Mauny
- Laboratory Chrono-environnement, UMR 6249 Centre National de la Recherche Scientifique, 16 route de Gray, 25000 Besançon, France; Clinical Methodology Center, CHU de Besançon, 2 place Saint-Jacques, 25030 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France
| | - Thibaut Desmettre
- Emergency Department, CHU de Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France; Laboratory Chrono-environnement, UMR 6249 Centre National de la Recherche Scientifique, 16 route de Gray, 25000 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France
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Froudarakis ME. Thematic series: Novel insights in pleural diseases: Pleural disease: A continuously improved information. THE CLINICAL RESPIRATORY JOURNAL 2019; 13:269-271. [PMID: 30953578 DOI: 10.1111/crj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Marios E Froudarakis
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
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30
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Plojoux J, Froudarakis M, Janssens JP, Soccal PM, Tschopp JM. New insights and improved strategies for the management of primary spontaneous pneumothorax. CLINICAL RESPIRATORY JOURNAL 2019; 13:195-201. [PMID: 30615303 DOI: 10.1111/crj.12990] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/14/2018] [Accepted: 12/24/2018] [Indexed: 12/22/2022]
Abstract
The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema-like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta-analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of 'at risk patients' is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost-effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.
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Affiliation(s)
- Jérôme Plojoux
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Jean-Paul Janssens
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Paola M Soccal
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Department of Internal Medicine, Montana, Switzerland
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Elsayed HH. Is chest tube drainage losing ground in management of patients with spontaneous pneumothorax? J Thorac Dis 2017; 9:3518-3522. [PMID: 29268330 DOI: 10.21037/jtd.2017.08.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hany Hasan Elsayed
- Thoracic Surgery Department, Ain Shams University Hospital, Cairo, Egypt
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32
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If Background Lung Abnormalities Do Not Affect the Presentation of Spontaneous Pneumothorax, Is Lung Resection Always Justified? J Bronchology Interv Pulmonol 2017; 24:225-231. [DOI: 10.1097/lbr.0000000000000386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Tschopp JM, Marquette CH. Spontaneous pneumothorax: stop chest tube as first-line therapy. Eur Respir J 2017; 49:49/4/1700306. [DOI: 10.1183/13993003.00306-2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 11/05/2022]
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Is it possible to standardize the treatment of primary spontaneous pneumothorax? Part 2: surgical methods of treatment. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 13:328-333. [PMID: 28096830 PMCID: PMC5233763 DOI: 10.5114/kitp.2016.64875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/16/2016] [Indexed: 11/17/2022]
Abstract
The present report provides a detailed description of the surgical methods for primary spontaneous pneumothorax (PSP) treatment, from open surgery (thoracotomy) to minimally invasive procedures (video-assisted thoracoscopic surgery - VATS). It describes the methods of preventing pneumothorax recurrence, including partial or complete resection of the parietal pleura and chemical pleurodesis with VATS. The pros and cons of each method are presented. The paper also discusses new techniques for diagnosing pneumothorax, such as fluorescein-enhanced autofluorescence thoracoscopy (FEAT) and infrared thoracoscopy. Finally, the authors propose their own algorithm for the treatment of PSP.
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Anevlavis S, Froudarakis ME. Advances in pleuroscopy. CLINICAL RESPIRATORY JOURNAL 2017; 12:839-847. [DOI: 10.1111/crj.12597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/11/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Stavros Anevlavis
- Department of Respiratory Medicine, Medical School of Alexandroupolis; Democritus University of Thrace; Greece
| | - Marios E. Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis; Democritus University of Thrace; Greece
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Primavesi F, Jäger T, Meissnitzer T, Buchner S, Reich-Weinberger S, Öfner D, Hutter J, Aspalter M. First Episode of Spontaneous Pneumothorax: CT-based Scoring to Select Patients for Early Surgery. World J Surg 2016; 40:1112-20. [PMID: 26669786 DOI: 10.1007/s00268-015-3371-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although recurrence of primary spontaneous pneumothorax (PSP) is frequent, guidelines do not routinely recommend surgery after first presentation. A CT-based lung dystrophy severity score (DSS) has recently been proposed to predict recurrence following conservative therapy. This study compares the DSS in surgically and conservatively treated patients. METHODS This is a retrospective analysis of first episode PSP patients, comparing video-assisted thoracic surgery (VATS; group A) to conservative treatment with or without chest drainage (group B). CT scans were reviewed for blebs or bullae, and patients were assigned DSS values and stratified into risk groups (low and high-grade). Primary end point was ipsilateral or contralateral recurrence. RESULTS Fifty-six patients were included, 33 received VATS and 23 conservative treatment. In total, 37.5 % experienced recurrence, with a 5-year estimated recurrence rate of 40.7 % (group A: 13.3 %; group B: 73.9 %; p < 0.001). In group B, detection of any dystrophic lesions resulted in significantly higher 5-year recurrence rates (86.7 vs. 50.0 %; p = 0.03), there was no significant difference in group A (17.7 vs. 7.7 %; p = 0.50). Greater DSS values correlated with higher 5-year recurrence rates in group B (p = 0.02), but not in group A (p = 0.90). Comparing low- and high-grade patients in group B resulted in a significant 5-year recurrence rate of 53.8 versus 100 % (p = 0.023). CONCLUSIONS The DSS is useful to indicate VATS after the first episode. For routine application, assigning patients to low- and high-grade groups seems most practical. We recommend CT-evaluation for every PSP patient and early surgery for those with lesions exceeding one bleb. After VATS, the preoperative DSS is not beneficial in predicting recurrence.
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Affiliation(s)
- Florian Primavesi
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria.
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Thomas Meissnitzer
- Department of Radiology, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Selina Buchner
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Silvia Reich-Weinberger
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Dietmar Öfner
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria.,Department of Visceral-, Transplant- and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Jörg Hutter
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Manuela Aspalter
- Department of Surgery, Paracelsus Medical University, Müllner-Hauptstrasse 48, 5020, Salzburg, Austria
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Cardillo G, Bintcliffe OJ, Carleo F, Carbone L, Di Martino M, Kahan BC, Maskell NA. Primary spontaneous pneumothorax: a cohort study of VATS with talc poudrage. Thorax 2016; 71:847-53. [PMID: 27422793 DOI: 10.1136/thoraxjnl-2015-207976] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/05/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) is an increasingly common treatment for recurrent or persistent primary spontaneous pneumothorax (PSP). Surgery usually involves diffuse treatment of the pleura and possible targeted therapy to areas of bullous disease. The purpose of this large cohort study was to examine incidence of recurrence after VATS and identify predictors of outcome. METHODS Patients undergoing VATS for PSP at a single centre between 2000 and 2012 were prospectively enrolled. All patients underwent talc poudrage. Targeted surgical techniques were used based on presence of air leak and Vanderschueren's stage. Patients had clinical and radiological follow-up for at least 2 years (median 8.5 years). RESULTS 1415 patients with PSP underwent VATS with talc poudrage. The most frequent indications were recurrent pneumothorax (92.2%) and persistent air leak (6.5%). The complication rate was 2.0% of which 1.7% was prolonged air leak. There was no mortality. Median length of stay was 5 days. Recurrent pneumothorax occurred in 26 patients (1.9%). At the time of surgery, 592 patients smoked (43%) and they had a significantly higher incidence of recurrence (24/575, 4.2%) than non-smokers (2/805, 0.2%), p<0.001. The incidence of recurrence in those undergoing bullae suturing (3.8%, n=260) was significant higher than those undergoing poudrage alone (0.3%, p=0.036). CONCLUSION The marked difference in recurrence between smokers and non-smokers suggests this as an important predictor of outcome. This study demonstrates a low incidence of recurrence and complications for patients with PSP undergoing VATS with talc poudrage. Talc poudrage requires prospective comparison with pleurectomy and mechanical abrasion.
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Affiliation(s)
- Giuseppe Cardillo
- Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Oliver J Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Francesco Carleo
- Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Luigi Carbone
- Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Marco Di Martino
- Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Akulian J, Feller-Kopman D. The past, current and future of diagnosis and management of pleural disease. J Thorac Dis 2016; 7:S329-38. [PMID: 26807281 DOI: 10.3978/j.issn.2072-1439.2015.11.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Pleural disease is frequently encountered by the chest physician. Pleural effusions arise as the sequelae of underlying disease processes including pressure/volume imbalances, infection and malignancy. In addition to pleural effusions, persistent air leaks after surgery and bronchopleural fistulae remain a challenge. Our understanding of pleural disease including its diagnosis and management, have made tremendous strides. The introduction of the molecular detection of organism specific infection, risk stratification and improvements in the non-surgical treatment of patients with pleural infection are all within reach and may be the standard of care in the very near future. Malignant pleural effusion management continues to evolve with the introduction of tunneled pleural catheters and procedures combining that and chemical pleurodesis. These advances in the diagnostic and therapeutic evaluation of pleural disease as well as what seems to be an increasing multidisciplinary interest in the space foretell a bright future.
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Affiliation(s)
- Jason Akulian
- 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina in Chapel Hill, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, The Johns Hopkins University, USA
| | - David Feller-Kopman
- 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina in Chapel Hill, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, The Johns Hopkins University, USA
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Soccorso G, Anbarasan R, Singh M, Lindley RM, Marven SS, Parikh DH. Management of large primary spontaneous pneumothorax in children: radiological guidance, surgical intervention and proposed guideline. Pediatr Surg Int 2015; 31:1139-44. [PMID: 26306420 DOI: 10.1007/s00383-015-3787-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Primary spontaneous pneumothorax (PSP) is managed in accordance with the adult British Thoracic Society (BTS) guidelines due to lack of paediatric evidence and consensus. We aim to highlight the differences and provide a best practice surgical management strategy for PSP based on experience of two major paediatric surgical centres. METHODS Retrospective review of PSP management and outcomes from two UK Tertiary Paediatric hospitals between 2004 and 2015. RESULTS Fifty children with 55 PSP (5 bilateral) were referred to our Thoracic Surgical Services after initial management: 53% of the needle aspirations failed. Nine children (20%) were associated with visible bullae on the initial chest X-ray. Forty-nine children were assessed with computed tomography scan (CT). Apical emphysematous-like changes (ELC) were identified in 37 children (75%). Ten children had also bullae in the asymptomatic contralateral lungs (20%). In two children (4%), CT demonstrated other lung lesions: a tumour of the left main bronchus in one child; a multi-cystic lesion of the right middle lobe in keeping with a congenital lung malformation in another child. Contralateral asymptomatic ELC were detected in 20% of the children: of those 40% developed pneumothorax within 6 months. Best surgical management was thoracoscopic staple bullectomy and pleurectomy with 11% risk of recurrence. Histology confirmed ELC in 100% of the apical lung wedge resections even in those apexes apparently normal at the time of thoracoscopy. CONCLUSION Our experience suggests that adult BTS guidelines are not applicable to children with large PSP. Needle aspiration is ineffective. We advocate early referral to a Paediatric Thoracic Service. We suggest early chest CT scan to identify ELC, for counselling regarding contralateral asymptomatic ELC and to rule out secondary pathological conditions causing pneumothorax. In rare instance if bulla is visible on presenting chest X-ray, thoracoscopy could be offered as primary option.
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Affiliation(s)
- Giampiero Soccorso
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Ravindar Anbarasan
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Michael Singh
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Richard M Lindley
- Paediatric Surgical Unit, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Sean S Marven
- Paediatric Surgical Unit, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Dakshesh H Parikh
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
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Bintcliffe OJ, Hallifax RJ, Edey A, Feller-Kopman D, Lee YCG, Marquette CH, Tschopp JM, West D, Rahman NM, Maskell NA. Spontaneous pneumothorax: time to rethink management? THE LANCET. RESPIRATORY MEDICINE 2015; 3:578-88. [PMID: 26170077 DOI: 10.1016/s2213-2600(15)00220-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/14/2015] [Accepted: 05/19/2015] [Indexed: 11/16/2022]
Abstract
There are substantial differences in international guidelines for the management of pneumothorax and much geographical variation in clinical practice. These discrepancies have, in part, been driven by a paucity of high-quality evidence. Advances in diagnostic techniques have increasingly allowed the identification of lung abnormalities in patients previously labelled as having primary spontaneous pneumothorax, a group in whom recommended management differs from those with clinically apparent lung disease. Pathophysiological mechanisms underlying pneumothorax are now better understood and this may have implications for clinical management. Risk stratification of patients at baseline could help to identify subgroups at higher risk of recurrent pneumothorax who would benefit from early intervention to prevent recurrence. Further research into the roles of conservative management, Heimlich valves, digital air-leak monitoring, and pleurodesis at first presentation might lead to an increase in their use in the future.
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Affiliation(s)
- Oliver J Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rob J Hallifax
- Oxford Centre for Respiratory Medicine and Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Anthony Edey
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | | | - Y C Gary Lee
- Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | | | | | | | - Najib M Rahman
- Oxford Centre for Respiratory Medicine and Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
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Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, Krasnik M, Maskell N, Van Schil P, Tonia T, Waller DA, Marquette CH, Cardillo G. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46:321-35. [PMID: 26113675 DOI: 10.1183/09031936.00219214] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.
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Affiliation(s)
- Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Dept of Internal Medicine RSV, Montana, Switzerland Task Force Chairs
| | - Oliver Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Emilio Canalis
- Dept of Surgery, University of Rovira I Virgili, Tarragona, Spain
| | | | - Julius Janssen
- Dept of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marc Krasnik
- Dept of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Nicholas Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Van Schil
- Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thomy Tonia
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - David A Waller
- Dept of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Charles-Hugo Marquette
- Hospital Pasteur CHU Nice and Institute for Research on Cancer and Ageing, University of Nice Sophia Antipolis, Nice, France
| | - Giuseppe Cardillo
- Dept of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy Task Force Chairs
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Herrmann D, Klapdor B, Ewig S, Hecker E. Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: a 10-year experience. Eur J Cardiothorac Surg 2015; 49:854-9. [PMID: 26094014 DOI: 10.1093/ejcts/ezv206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/04/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES First-line conservative treatment of primary spontaneous pneumothorax (PSP) may be challenged by recurrence rates and complications associated with different treatment options. The aim of this study was to evaluate the use of a standardized surgical treatment as 'first-line' treatment. METHODS In a 10-year period, 185 patients with PSP were treated with a standardized video-assisted thoracic surgery (VATS) approach including wedge resection and parietal pleurectomy. Data were evaluated retrospectively. All patients with a first event of PSP were included in the study. In addition, follow-up was done by a questionnaire. RESULTS Mean follow-up period was 70.8 months (±33.5 months). Sub-pleural emphysematous changes were found in every histopathological specimen. In addition, 70.8% had fibrosis of visceral pleura. Recurrence occurred in 4 patients (2.2%). Ten-year freedom from recurrence was 96.2%. Procedure-related morbidity rate was 7.6%. Approximately 85.7% of patients were satisfied with the procedure and the cosmetic result. Three patients died during follow-up (1.6%). CONCLUSIONS Treatment of first episode of PSP by VATS is a safe procedure, with a very low rate of recurrence and a high patient satisfaction. This management of first episode of PSP is based on the underlying pathology. We recommend the use of VATS as the treatment of first choice for patients with PSP.
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Affiliation(s)
- Dominik Herrmann
- Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany
| | - Benjamin Klapdor
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, Evangelisches Krankenhaus, Herne, Germany
| | - Santiago Ewig
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, Evangelisches Krankenhaus, Herne, Germany
| | - Erich Hecker
- Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany
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Parrish S, Browning RF, Turner JF, Zarogoulidis K, Kougioumtzi I, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N, Katsikogiannis N, Tsiouda T, Madesis A, Karaiskos T, Zarogoulidis P. The role for medical thoracoscopy in pneumothorax. J Thorac Dis 2014; 6:S383-91. [PMID: 25337393 DOI: 10.3978/j.issn.2072-1439.2014.08.06] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 08/06/2014] [Indexed: 02/02/2023]
Abstract
Pneumothorax is a life threatening situation that requires fast treatment. There are two major classifications: Primary and Secondary. Staging of pneumothorax is also very important for treatment. Treatment of pneumont can be performed either from thoracic surgeons, or pulmonary physicians. In our current work we provide up-to-date information regarding pneumothorax classification, staging and treatment from the point of view of expert pulmonary physicians.
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Affiliation(s)
- Scott Parrish
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert F Browning
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Francis Turner
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dryllis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Walter Reed National Military Medical Center, Interventional Pulmonary Service, Bethesda, USA ; 2 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece ; 8 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Case JB, Mayhew PD, Singh A. Evaluation of Video-Assisted Thoracic Surgery for Treatment of Spontaneous Pneumothorax and Pulmonary Bullae in Dogs. Vet Surg 2014; 44 Suppl 1:31-8. [PMID: 25307452 DOI: 10.1111/j.1532-950x.2014.12288.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 07/01/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the operative findings and clinical outcome in dogs undergoing video-assisted thoracic surgery (VATS) for treatment of spontaneous pneumothorax and pulmonary bullae. STUDY DESIGN Multi-institutional retrospective case series. ANIMALS Dogs (n = 12) with spontaneous pneumothorax and/or pulmonary bullae. METHODS Medical records (2008-2013) were reviewed for signalment, clinical signs, diagnostic imaging, surgical and histopathologic findings, and outcome in 12 dogs that had VATS for treatment of spontaneous pneumothorax and pulmonary bullae. In particular, conversion to median sternotomy and surgical success were evaluated. RESULTS Twelve dogs had initial VATS for spontaneous pneumothorax and/or pulmonary bullae. Conversion to median sternotomy because of inability to identify a parenchymal lesion/leak was necessary in 7 (58%) dogs. VATS without conversion to median sternotomy was performed in 6 (50%) dogs. Successful surgical outcomes occurred in 5 (83%) dogs that had conversion to median sternotomy, and in 3 (50%) dogs that had VATS without conversion to median sternotomy. CONCLUSIONS Exploratory thoracoscopy was associated with a high rate of conversion to median sternotomy because of inability to identify leaking pulmonary lesions in dogs with spontaneous pneumothorax and pulmonary bullae. Failure to convert to a median sternotomy may be associated with recurrent or persistent pneumothorax.
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Affiliation(s)
- J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California
| | - Ameet Singh
- Ontario Veterinary College, University Guelph, Guelph, Ontario, Canada
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Janssen J. Autofluorescence thoracoscopy in pleural disease: does it have clinical relevance? Expert Rev Respir Med 2014; 8:523-5. [PMID: 24856077 DOI: 10.1586/17476348.2014.923310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thoracoscopy has proved to be a reliable tool to demonstrate or exclude pleural malignancy, with a diagnostic yield of at least 90%. (Auto)fluorescence thoracoscopy is a technique used in clinical practice for the early detection of malignant changes in the pleura in order to increase the detection rate of early malignant disease. The sensitivity of autofluorescence thoracoscopy for detecting malignant lesions on the pleural surface was, in our experience, 100% and the specificity was 75%. Autofluorescence thoracoscopy is still in the preclinical research stage and not yet ready for routine use in clinical practice. It will neither increase the (already very high) diagnostic yield of thoracoscopy nor change treatment in patients suffering from malignant pleural disease.
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Affiliation(s)
- Julius Janssen
- Department of Pulmonary Diseases A75, Canisius Wilhelmina Hospital, Post box 9015, 6500 GS Nijmegen, Netherlands
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Casha AR, Manché A, Gatt R, Wolak W, Dudek K, Gauci M, Schembri-Wismayer P, Camilleri-Podesta MT, Grima JN. Is there a biomechanical cause for spontaneous pneumothorax? Eur J Cardiothorac Surg 2014; 45:1011-6. [PMID: 24644314 DOI: 10.1093/ejcts/ezt659] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Primary spontaneous pneumothorax has long been explained as being without apparent cause. This paper deals with the effect of chest wall shape and explains how this may lead to the pathogenesis of primary spontaneous pneumothorax. METHODS Rib cage measurements were taken from chest radiographs in 12 male pneumothorax patients and 12 age-matched controls. Another group of 15 consecutive male thoracic computerised tomography (CT) were investigated using paramedian coronal and sagittal CT reconstructions to assess apical lung shape. A finite element analysis (FEA) model of a lung apex was constructed, including indentations for the first rib guided by CT scan data, to assess pleural stress. This model was tested using different anteroposterior diameter ratios, producing a range of thoracic indexes. RESULTS The pneumothorax patients had a taller chest (P = 0.03), wider transversely (P = 0.009) and flatter (P = 0.03) when compared with controls, resulting in a low thoracic index. Prominent rib indentations were found anteriorly and posteriorly on the lung surface, especially on the first rib on CT. FEA of the lung revealed significantly higher stress (×5-×10) in the apex than in the rest of the lung. This was accentuated (×4) in low thoracic index chests, resulting in 20-fold higher stress levels in their apex. CONCLUSIONS The FEA model demonstrates a 20-fold increase in pleural stress in the apex of chests with low thoracic index typical of spontaneous pneumothorax patients. Mild changes in thoracic index, as occurring in females or with aging, reduce pleural stress. Spontaneous pneumothorax occurring in young male adults may have a biomechanical cause.
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Affiliation(s)
- Aaron R Casha
- Department of Cardiac Services, Mater Dei Hospital, Msida, Malta Faculty of Medicine, Department of Anatomy, University of Malta, Msida, Malta
| | - Alexander Manché
- Department of Cardiac Services, Mater Dei Hospital, Msida, Malta
| | - Ruben Gatt
- Faculty of Science, Metamaterials Unit, University of Malta, Msida, Malta
| | - Wiktor Wolak
- Department of Physics and Astronomy, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Krzysztof Dudek
- Department of Physics and Astronomy, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Marilyn Gauci
- Faculty of Medicine, Department of Anatomy, University of Malta, Msida, Malta
| | | | | | - Joseph N Grima
- Faculty of Science, Metamaterials Unit, University of Malta, Msida, Malta
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Amiconi S, Hirl B. A combination of predispositions and exposures as responsible for acute eosinophilic pneumonia. Multidiscip Respir Med 2014; 9:7. [PMID: 24475879 PMCID: PMC3909902 DOI: 10.1186/2049-6958-9-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/15/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute eosinophilic pneumonia (AEP) is a rare febrile illness which is characterized by respiratory failure and often requires mechanical ventilation. The causes and sequence of events of this disease at a biochemical and histological level remain largely unknown. In this article we report the exceptional case, possibly unique, of a patient who developed AEP and three pneumothoraces within less than one month during her hospitalization. CASE PRESENTATION A 39-year-old German woman was admitted to our hospital for a laparoscopy-assisted vaginal hysterectomy under general anaesthesia. The surgical intervention was followed by peritonitis in the early postoperative course. Following anaesthesia induction with propofol/midazolam and during the prolonged therapy with several broad-spectrum antibiotics, she developed AEP and three spontaneous (one left-sided and two right-sided) pneumothoraces, the latter ones observed in quick succession. Symptoms, laboratory markers, and chest radiology significantly improved after a one-day treatment with methylprednisolone. CONCLUSIONS On the whole, these pathological occurrences, together with similar cases reported in literature, can support the conclusion of possible predisposing genetic factors at the lung tissue level of AEP patients, a view that might shed new light on the pathogenesis of this disease. To provide a coherent pattern that explains the reported evidence for AEP and pneumothoraces, independently from the causative stimulus, the supposed molecular mutations could be localized in the connective tissue rather than in the epithelial cells. In order to interpret clinical and laboratory evidence, as well as to support the main conclusions, the important part of scientific research here presented can also assist physicians in making more informed decisions for the treatment of patients with pulmonary infiltrates.
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Affiliation(s)
- Simona Amiconi
- Department of Anesthesia and Critical Care, Schwabing Hospital, Munich 80804, Germany
| | - Bertrand Hirl
- Department of Anesthesia and Critical Care, Schwabing Hospital, Munich 80804, Germany
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Akulian J, Feller-Kopman D, Lee H, Yarmus L. Advances in interventional pulmonology. Expert Rev Respir Med 2014; 8:191-208. [PMID: 24450415 DOI: 10.1586/17476348.2014.880053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Interventional pulmonology (IP) remains a rapidly expanding and evolving subspecialty focused on the diagnosis and treatment of complex diseases of the thorax. As the field continues to push the leading edge of medical technology, new procedures allow for novel minimally invasive approaches to old diseases including asthma, chronic obstructive pulmonary disease and metastatic or primary lung malignancy. In addition to technologic advances, IP has matured into a defined subspecialty, requiring formal training necessary to perform the advanced procedures. This need for advanced training has led to the need for standardization of training and the institution of a subspecialty board examination. In this review, we will discuss the dynamic field of IP as well as novel technologies being investigated or employed in the treatment of thoracic disease.
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Affiliation(s)
- Jason Akulian
- University of North Carolina, Pulmonary and Critical Care, Chapel Hill, CA, USA
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