T Tr re ea at tm me en nt t o of f p pa at ti ie en nt ts s w wi it th h s sp po on nt ta an ne eo ou us s p pn ne eu um mo ot th ho or ra ax x d du ur ri in ng g v vi id de eo ot th ho or ra ac co os sc co op py y J.P. Janssen*, J. van Mourik**, M. Cuesta Valentin**, G. Sutedja*, K. Gigengack ✝ , P.E. Postmus* All patients with spontaneous pneumothorax underwent videothoracoscopy under general anaesthesia with double lumen tube intubation. If no abnormalities were found on the visceral pleura, talc pleurodesis was performed. Small lesions, blebs or bullae <2 cm, were coagulated prior to pleurodesis. In case of blebs or bullae >2 cm, thoracoscopic resection with an EndoGIA stapling device was performed, followed by scarification, i.e. electrocoagulation, of the parietal pleura.In 43 patients, 44 procedures were performed. In 15 cases (34%) no blebs or bullae were found. In 6 cases (14%) only blebs <2 cm were found. In 23 cases (52%) blebs and bullae >2 cm were found. In 21 out of 44 cases (48%), talc pleurodesis was performed, and in 23 cases (52%) bullectomy was performed. No major complication occurred. The average hospital stay was 5.7 days after talc pleurodesis and 6.0 days after bullectomy. There were 2 recurrences (5%) after a follow-up of at least 18 months.In conclusion, the use of videothoracoscopy in spontaneous pneumothorax makes it possible to continue a diagnostic procedure as a therapeutic session. The recurrence rate is low after both talc pleurodesis and bullectomy, whilst the hospital stay after the procedure is no longer than after chest tube drainage alone. Videothoracoscopic treatment may significantly reduce the need for thoracotomy in patients with spontaneous pneumothorax. Eur Respir J., 1994Respir J., , 7, 1281 Spontaneous pneumothorax (SP) is a disease with a worldwide incidence of 5-15 patients per 100,000 persons a year [1]. It occurs 4-6 times more often in men than in women, with a peak incidence in adolescents.There is no consensus on the treatment of SP. Treatment varies from "wait and see" policy to operative. The role of pleurodesis has not definitely been established [2]. If pleurodesis is not performed, the recurrence rate is between 20 and 60% [3,4].More consensus exists on the treatment of recurrent SP. Patients with relapse are usually treated with pleurectomy and, in cases of bullae, bullectomy. This bullectomy is performed with the assumption of a causal relationship between the pneumothorax and the detected bullae.The high recurrence rate of SP has prompted several investigators to perform traditional thoracoscopy in all cases of SP, to identify the cause [5][6][7]. In cases of blebs or bullae ("lesions") with a diameter less than 2 cm, chemical pleurodesis was performed using talc or tetracycline. In cases of lesions with a diameter of more than 2 cm, thoracotomy, bullectomy and pleurectomy were performed. Both pleurectomy and bullectomy and talc insufflation significantly reduce the recurrence rate of pneumothorax [2,4,5,7]. Recent development of endoscopic stapler de...

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neurological disorder of the peripheral nerves which can lead to gradually increasing motor and sensory loss. It can be a difficult entity to diagnose, particularly in elderly patients with a history of Diabetes Mellitus due to their overlapping neuropathic syndromes. Reported is a case of CIDP in an elderly female who manifested multiple sensory, motor, and autonomic complaints. A compilation of clinical features, neuroimaging, lumbar puncture, electromyography, nerve conduction studies, and nerve biopsy were used to reach the diagnosis. Highlighted is a clinical approach to identifying CIDP that can cause neuropathy in the setting of other potential confounding disorders namely Diabetes Mellitus.

No abstract

No abstract

Congenital pulmonary airway malformations (CPAMs) are rarely encountered in the adult population. Although they are typically diagnosed in the prenatal period, some may not cause symptoms and go unnoticed until adulthood. Patients with CPAM are at risk of developing pneumonia, hemorrhage, pneumothorax, and malignancy. There is a paucity of evidence regarding the management and prognostication of adults with CPAM. Patients often need to undergo surgical resection to prevent further episodes of infection, bleeding, or malignant transformation. Here, we present the case of an adult male with a CPAM who presented with frank hemoptysis. Computed tomography scan and bronchoscopy localized the lesion to the lingula. The patient underwent elective surgical resection of the lesion by video-assisted thoracoscopy and did not suffer any adverse outcomes. Surgical resection is generally recommended and appears to be a safe and effective approach to treating patients with symptomatic CPAMs. Inhaled tranexamic acid and bronchial artery embolization are valuable interventions in our armamentarium for managing hemoptysis but should not replace a definite surgical intervention due to the risk of recurrence.