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Neumotórax en pacientes con SIDA: Actualización sobre el tema Pneumothorax in patients with AIDS: Update on the theme  [cached]
Alfredo L Marín Pérez,Nancy Toledo Santana,Alymays Marín Hernández,Norky Alonso Domínguez
Revista M??dica Electr?3nica , 2010,
Abstract: La aparición de neumotórax como complicación de la neumonía por Pneumocistis carinii (PCP) en pacientes con SIDA, es muy frecuente desde los inicios de la pandemia en 1982, y comporta gran mortalidad. En este trabajo se reporta una serie de 25 pacientes con neumotórax como complicación de la Pneumocistis carinii en pacientes con SIDA, tratado por los autores durante cinco a os de trabajo discontinuos en el cono sur africano: tres en Sudáfrica y dos en Zimbabwe. Se reportan los datos demográficos y el estado de los mismos al llegar a la sala de cirugía y su evolución después de tratados quirúrgicamente. La toracotomía fue necesaria en ocho pacientes (32 %), diez pacientes necesitaron cuidados de terapia intensiva (40 %), y la mortalidad global fue del 32 %. Se revisa la información actualizada sobre el tema, destacando las pautas terapéuticas más aceptadas internacionalmente. Conflictos de interés: Los autores no declaran conflicto de interés con editores, patrocinadores ni otros autores. Pneumothorax as a Pneumocistis carinii pneumonia complication in patients with AIDS is very frequent since the pandemic beginnings in 1982, and it is accompanied by a high mortality. In this work we report a series of 25 patients with Pneumothorax as a Pneumocistis carinii pneumonia complication in patients with AIDS, treated by the authors during five years of discontinuous work in the Southern Africa cone: three years in South Africa and two years in Zimbabwe. We report demographic data, the status of the patients when they arrived to the Surgery Service and their evolution after surgery. Thoracotomy was needed in eight patients (32 %), ten patients needed intensive care (40 %), and the global mortality was 32 %. We review the updated information on the theme, emphasizing the most accepted therapeutic guidelines at the international level.
Spontaneous pneumothorax
Davari R,Rahim MB
Tehran University Medical Journal , 1996,
Abstract: A case with bilateral spontaneous pneumothorax was presented. Etiology, mechanism, and treatment were discussed on the review of literature. Spontaneous Pneumothorax is a clinical entity resulting from a sudden non traumatic rupture of the lung. Biach reported in 1880 that 78% of 916 patients with spontaneous pneumothorax had tuberculosis. Kjergaard emphasized 1932 the primary importance of subpleural bleb disease. Currently the clinical spectrum of spontaneous pneumothorax seems to have entered a third era with the recognition of the interstitial lung disease and AIDS as a significant etiology. Standard treatment is including: observation, thoracocentesis, tube thoracostomy. Chemical pleurodesis, bullectomy or wedge resection of lung with pleural abrasion and occasionally pleurectomy. Little information has been reported regarding the efficacy of such treatment in spontaneous pneumothorax secondary to non bleb disease
Spontaneous pneumothorax
Heinrich Matthys
Multidisciplinary Respiratory Medicine , 2011, DOI: 10.1186/2049-6958-6-1-6
Abstract: From the clinical and etiological standpoint the pneumothorax is classified as: primary spontaneous pneumothorax if occurring without obvious reason or apparent lung disease, secondary spontaneous pneumothorax if due to a well known underlying lung or systemic disease, or as traumatic pneumothorax if it is the result of iatrogenic or non-iatrogenic blunt and/or penetrating chest interventions and injuries.Primary spontaneous pneumothorax (PSP) is therefore defined as the presence of air in the pleural space without apparent underlying lung disease or trauma. The pathogenesis of PSP is not the same for all events. Most authors believe that the communication of air between the alveolar spaces and the pleura is due to a rupture of subpleural blebs or bullae [1].Although most children [2] and adults [3] present blebs or bullae, it is unclear how often this pathology is responsible for the leakage of air from the alveolar into the pleural space [4].During thoracoscopy or surgery often there are other lesions present, such as inflammatory elastofibrotic layers with increased porosity and areas of disrupted mesothelial cells at the visceral pleura, allowing air leakage into the pleural space [5,6].Bullectomy has a recurrence rate of up to 20% without pleurodesis, which may be explained by factors like peripheral airway inflammation due to noxious agents, e.g. tobacco smoke [7], or exposure to high levels of ozone as discussed by Abul et al. in this issue of Multidisciplinary Respiratory Medicine (pp. 16-19). Hereditary factors [8], anatomical abnormalities of the bronchial tree, ischemia at the apices of the lungs [9], low body mass index due to anorexia and other causes of food restriction [10], Marfan syndrome [11] as well as increased aluminium plasma concentrations [12] may also lead to abnormal connective tissue formations (fibrillopathies) predisposing for the occurrence of PSP [13].Secondary spontaneous pneumothorax (SSP) is defined as the presence of air in the ple
Silicosis with bilateral spontaneous pneumothorax  [cached]
Fotedar Sanjay,Chaudhary Dhruva,Singhla Vikas,Narang Rajat
Lung India , 2010,
Abstract: Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax.The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature.
Spontaneous pneumothorax: epidemiology, pathophysiology and cause  [cached]
M. Noppen
European Respiratory Review , 2010,
Abstract: Spontaneous pneumothorax represents a common clinical problem. An overview of relevant and updated information on epidemiology, pathophysiology and cause(s) of spontaneous (primary and secondary) pneumothorax is described.
Contralateral pneumothorax after pneumonectomy
Onur Ak?ay,?zgür Samanc?lar,Serpil Sevin?,Ozan Usluer
Respiratory Case Reports , 2013, DOI: 10.5505/respircase.2012.98608
Abstract: Contralateral pneumothorax after pneumonectomy is a rare critical condition with high morbidity and mortality rates. In this study, a case of contralateral pneumothorax in the post-operative period which occured soon after left pneumonectomy for non-small cell lung carcinoma is presented with the related literature.
Occult pneumothorax, revisited
Hesham R Omar, Hany Abdelmalak, Devanand Mangar, Rania Rashad, Engy Helal, Enrico M Camporesi
Journal of Trauma Management & Outcomes , 2010, DOI: 10.1186/1752-2897-4-12
Abstract: The entity of occult pneumothorax is more frequently recognized nowadays due to the the increasing diffusion of CT scan and thoracic ultrasonography in the evaluation of trauma patients. These diagnostic tools enabled us to detect small abnormalities not clinched by the traditional chest radiograph. The concept of occult pneumothorax has been thoroughly discussed amongst the literature [1-5]. In trauma patients, AP chest radiograph has been traditionally the initial diagnostic imaging study especially if a cervical-collar limits patient mobilization. With advent of the extended FAST examination (Focused Assessment with Sonography for Trauma), most centers now utilize eFAST before the initial screening chest Xray. This review describes the differences between AP chest radiograph and chest CT in early detection of a pneumothorax in a trauma patient.Occult pneumothorax is a pneumothorax that was not suspected clinically nor was evident on the plain radiograph but rather identified on computed tomography scan.Due to the increased utilization of CT chest and thoracic ultrasonography as the initial screening tests for thoracic and abdominal trauma, occult pneumothorax has been common. Most nonradiologists diagnose pneumothorax based on the visualization of a superior-lateral visceral pleural stripe on the upright chest radiograph. This is however not feasible in the supine chest radiograph unless there is a sizable pneumothorax. Unfortunately, because of clinical concerns in trauma patients regarding cervical spine immobilization, initial imaging in seriously injured patients typically consists of a supine AP chest X-ray that is insensitive for detecting pneumothorax. As illustrated in figure 1 after an initial AP chest radiograph failed to show evidence of pneumothorax, a CT chest performed immediately after the chest Xray revealed right-sided pneumothorax.The reported incidence of occult pneumothorax varies widely between 3.7% in injured children presenting to an emerge
Automated Quantification of Pneumothorax in CT  [PDF]
Synho Do,Kristen Salvaggio,Supriya Gupta,Mannudeep Kalra,Nabeel U. Ali,Homer Pien
Computational and Mathematical Methods in Medicine , 2012, DOI: 10.1155/2012/736320
Abstract: An automated, computer-aided diagnosis (CAD) algorithm for the quantification of pneumothoraces from Multidetector Computed Tomography (MDCT) images has been developed. Algorithm performance was evaluated through comparison to manual segmentation by expert radiologists. A combination of two-dimensional and three-dimensional processing techniques was incorporated to reduce required processing time by two-thirds (as compared to similar techniques). Volumetric measurements on relative pneumothorax size were obtained and the overall performance of the automated method shows an average error of just below 1%. 1. Introduction Pneumothorax is defined as the accumulation of air or gas in the space between the lung and the chest wall. It is a potentially life-threatening occurrence which frequently results from traumatic injuries. Although the exact percentage is in dispute, research indicates that pneumothoraces occur in approximately 20–50% of all chest injury cases [1–3]. Research has shown that in the absence of other significant injuries, or the need for intermittent positive-pressure ventilation, a majority of pneumothorax may be treated conservatively (observation, oxygen treatment, simple manual aspiration) without exposing the patient to the risks of intervention [4]. A primary factor in making the decision to conservatively treat a pneumothorax is the size of the air collection relative to the entire pleural region of the patient. Generally, pneumothorax occupying less than 20% of the hemithorax is said to be “small” and may be treated by observation alone [1, 5–8]. Multiple methods have been explored for estimating the size of pneumothorax utilizing chest radiography; however, these methods are merely estimation tools. Kircher and Swartzel [9] draws rectangles from reference points to demarcate the outlines of the hemithorax and lung and subtracts the respective areas to find percent pneumothorax. Another method proposed by Rhea et al. [10] predicts pneumothorax size by correlating average interpleural distance with radiographic thoracic gas volume measurements. Another study [11] proposed that the change in volume of the lung is equal to the cube of the change in its linear dimensions as visualized in radiographs. Determination of the size of a pneumothorax from two-dimensional radiographic images results in a large variance among users, and prescribed guidelines (such as interpleural distance) for measurement are prone to underestimating the true size of the pneumothorax [4, 7]. Further, patients who sustain trauma may have subtle pneumothorax that
SPONTANEOUS PNEUMOTHORAX SECONDARY TO COPD
MANABENDRA BISWAS
The Professional Medical Journal , 2007,
Abstract: Introduction: The high recurrence rate of spontaneous pneumothorax secondary to COPD highlightsthe need for the prevention of recurrence with cheap and cost effective method. Chemical pleurodesis with tetracyclinehydrochlorides may be a good option for the prevention of recurrence of pneumothorax and thereby enablessatisfactory patient outcome. Objectives: (i) To compare the recurrence rate of spontaneous pneumothorax treatedwith chemical pleurodesis with tetracycline hydrochloride and tube thoracostomy alone. (ii) To make a standard protocolfor management. Study design: A prospective randomized case control study. Setting: The dept. of thoracic surgeryof the National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh. Period: From January2003 to December 2003. Material & Methods: Sixty patients with spontaneous pneumothorax, secondary to COPD.After randomization, 30 patients were treated with tube thoracostomy followed by pleurodesis with tetracyclinehydrochloride and another 30 patients of control group were treated with tube thoracostomy alone. Results: Patientswere followed up upto 6 months and were looked for recurrence. Patients with spontaneous pneumothorax were of4 to 6 decades of life and most of them were th th male. Most patients presented with moderate size of pneumothoraxand required 91-110 hours for lung expansion after tube thoracostomy. Recurrence rate of spontaneous pneumothoraxsecondary to COPD in the tetracycline group was 3.3%, whereas in control group it was 30%. Intrapleural instillationof tetracycline hydrochloride significantly reduces the recurrence of spontaneous pneumothorax secondary to COPD.(P=0.015). Morbidity related to tetracycline was negligible. Moreover, tetracycline is cheap, easily available, non-toxic, well tolerated. Conclusion: It is concluded that recurrence rate of spontaneous pneumothorax secondary to COPDcan be reduced effectively by chemical pleurodesis with tetracycline hydrochloride without any significant morbidity related to tetracycline hydrochloride and it is also very cost effective.
Sarcoidosis Complicating with Bilateral Pneumothorax
Funda Co?kun,Ahmet Ursava?,Ezgi Demird??en ?etino?lu,Asl? G?rek Dilekta?l?
Respiratory Case Reports , 2013, DOI: 10.5505/respircase.2012.14633
Abstract: Cases of sarcoidosis rarely present with pneumothorax. Case is a 57-year-old woman. She has been having complaints of cough for the past four years. The patient received corticosteroid treatment for sarcoidosis for 16 months, and visited our clinic one month after she voluntarily terminated her treatment due to an increase in complaints of cough. In her physical examination, her right hemithorax responded less to general respiration during pulmonary examination. Her lung PA X-ray demonstrated a pneumothorax line in her left hemithorax. There was an increase in dyspnea and right sided chest pain during the clinical follow-up, a day after hospitalization. The PA X-ray demonstrated a pneumotorax in the right hemithorax. Bilateral tube thoracostomy was applied on the patient and mediastinoscopy was performed. Due to the rareness of concomitant bilateral pneumothorax and sarcoidosis, what kind of information was presented in the light of literature in our case.
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