This randomised study was designed to compare clinical outcomes for simple aspiration versus tube thoracostomy, in the treatment of the first primary spontaneous pneumothorax (PSP) attack. A randomised trial, comparing simple aspiration with tube thoracostomy, in 137 patients with a first episode of PSP was carried out.Immediate success was obtained in 40 out of the 65 patients (62%) randomly assigned to undergo simple aspiration and in 49 out of the 72 patients (68%) who had been randomly assigned to undergo tube thoracostomy. The 1-week success rates were: 58 (89%) patients in the intentionto-treat simple aspiration group and 63 (88%) patients in the tube thoracostomy group. In the aspiration group, there were more recurrences during the 3-month follow-up period (15 versus 8%), though the difference was not significant. Recurrence rates at 1 and 2 yrs were 16 (22%) and 20 (31%) for patients who had undergone simple aspiration, respectively, and 17 (24%) and 18 (25%) for patients who had undergone tube thoracostomies, respectively. Complications occurred in 5 (7%) patients who had undergone a tube thoracostomy and 1 (2%) patient who had undergone simple aspiration. Analgesia was required in 22 (34%) patients of the simple aspiration group versus 40 (56%) patients of the tube thoracostomy group.These findings suggest that simple aspiration could be an acceptable alternative to tube thoracostomy in the treatment of primary spontaneous pneumothorax.

Video-assisted thoracoscopic stapling of an identified bleb or apex of the upper lobe and apical pleurectomy represents the standard treatment for the majority of recurrent or persistent PSP. Most patients with surgically treated PSP have subpleural blebs or bullae or isolated emphysema. In type I cases, simple apical excision and apical pleurectomy are not sufficient and perhaps additional talc poudrage might be indicated.

Objective: To assess the incidence and to identify the possible associated risk factors for postoperative pulmonary complications after major lung resection. Subjects and Methods:One hundred and sixty-eight consecutive patients undergoing major lung resection for benign and malignant lung disease over a 3-year period were included in the study. Preoperative assessment clinical parameters, intraoperative and postoperative events were recorded. Pulmonary complications were noted according to a precise definition. The risk of complications associated with age, comorbidity, forced vital capacity (FVC), blood transfusion and extended operation was evaluated using logistic regression analysis. Results: The mean age of the patients was 47.1 years (range 16–80 years), 137 (77%) patients underwent lobectomy, 23 (14%) pneumonectomy, and 15 (9%) bilobectomy. Forty-six (27%) patients developed postoperative pulmonary complications and 2 (1.1%) died within 30 days following the operation. Age ≧65 years (OR 3.7, 95% CI: 1.5–8.6, p = 0.002), the presence of comorbid cardiopulmonary disease (OR 0.2, 95% CI: 0.1–0.5, p = 0.001), FVC <50% (OR 0.2, 95% CI: 0.1–0.8, p = 0.02), blood transfusion (OR 0.2, 95% CI: 0.1–0.4, p = 0.0001), and extended operation (OR 0.2, 95% CI: 0.07–0.6, p = 0.005) were the identified factors associated with the development of postoperative pulmonary complications, which necessitated an increased length of hospital stay. Conclusion: Postoperative pulmonary complications are more likely to develop in patients with age ≧65 years with comorbid cardiopulmonary disease, FVC <50%, blood transfusion, and extended operation.

Bronchial injuries are rare (1.0%-2.8% of all trauma cases) but potentially fatal, with 80% of patients dying before reaching a medical facility. They occur after penetrating or blunt chest trauma. Bronchial injuries require careful evaluation and meticulous operative repair. Adequate diagnosis is missed initially in up to 68% of cases, particularly in the presence of other organ injuries. An early correct diagnosis and prompt surgical management are mandatory to prevent mortality and morbidity.