Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare condition, mainly seen in patients with underlying lung disease. Up to now, there are 65 patients who have been published. Twelve consecutive patients who presented with SBSP as definitive diagnosis were recruited for this study. They represented 1 % of all patients with spontaneous pneumothorax. All patients had immediate bilateral chest tubes on admission. Five of the 12 patients (42%) had no underlying lung disease. In 7 patients, SBSP was secondary to pulmonary metastases, histiocytosis X, undefined interstitial pulmonary disease, tuberculosis, pneumonia and chronic obstructive pulmonary disease. None of the patients died during hospitalization. Eleven patients were treated with chemical pleurodesis, whereas thoracotomy and pleurectomy were necessary in 7 patients. Reexpansion of the lungs was achieved in all patients. Immediate bilateral chest tube insertion and pleurodesis are of major importance in the treatment of SBSP although a subset of patients needed surgical pleurectomy. Combination of these treatments provides successful and uneventful treatment of the disease.

This study demonstrated that TENS provided a better pain relief and comfort compared to PCA from the fourth postoperative day onwards, and this pain-reducing effect continued for at least two months postoperatively.

Gabapentin is safe and effective in the treatment of CPTP with minimal side effects and a high patient compliance. These results should be supported with multidisciplinary studies with larger sample sizes and longer follow-ups.

Expansion of the lung is necessary for successful pleurodesis therapy in patients with malignant pleural effusion (MPE). However, this is often impossible in multiloculated MPEs. The aim of this study was to investigate the effect of the fibrinolytic agent, streptokinase, on pleurodesis therapy used in the management of multiloculated MPE. Forty patients with multiloculated MPEs were randomly assigned to two groups: fibrinolytic and control. In the fibrinolytic group, 250,000 IU of streptokinase in 50 ml saline was applied into the pleural space at 24-36-48-60 h after opening a tube thoracostomy. In the control group, the same procedure was carried out using only 50 ml saline solution. Both groups were compared based on the following: (1) volume of pleural drainage at 24-48, 48-72, and 24-72 h, (2) chest computer tomography images before and after therapy, (3) dyspnea symptoms after therapy, and (4) recurrence rate. The mean drainage volumes for the fibrinolytic and control groups were 493 and 248 cc at 24-48 h, 446 and 198 cc at 48-72 h, and 939 and 446 cc at 24-72 h (P < 0.001). Comparison of the two groups by computer tomography revealed that 17 patients (85 %) in the fibrinolytic group had greater than 40 % improvement, whereas only 7 patients (35 %) in the control group had the same degree of improvement (P = 0.001). The dyspnea symptoms disappeared in 90 % of the patients in the fibrinolytic group and in 55 % of the patients in the control group (P = 0.03). Recurrence rate was 11 % in fibrinolytic group and 45 % in control group (P = 0.07). Streptokinase is a reliable treatment option in obtaining effective pleural drainage and increasing lung expansion in patients with multiloculated MPE.

Purpose. We compared the effi cacy and complications of video-assisted mediastinoscopy (VAM) and videoassisted mediastinal lymphadenectomy (VAMLA) for mediastinal staging of lung cancer. Methods. Between March 2006 and July 2008, a total of 157 patients with non-small-cell lung cancer (NSCLC) underwent VAM (n = 113, 72%) or VAMLA (n = 44, 28%). We studied them retrospectively. Data for the operating time, node stations sampled/dissected, number of biopsies, and the patients who were pN0 by mediastinoscopy and underwent thoracotomy were collected. The false-negative rate was calculated. Demographics and operative complications were analyzed.Results. The overall complication rate was 5.7% (n = 9). The most common complication was hoarseness (n = 8).Complications were seen signifi cantly more often after VAMLA than after VAM (11.3% vs. 2.6%, P = 0.04). There were no deaths. The mean number of removed lymph nodes (8.43 ± 1.08) and the station numbers (4.81 ± 0.44) per patient were higher with VAMLA than with VAM (7.65 ± 1.68, P = 0.008 and 4.38 ± 0.80, P = 0.001, respectively). The mean operating time was 44.8 ± 6.6 min for VAM and 82.0 ± 7.8 min for VAMLA. Patients diagnosed as pN2 numbered 9 in the VAMLA group and 27 in the VAM group. The patients diagnosed as pN0 with mediastinoscopy then underwent thoracotomy (VAM 77, VAMLA 32). When they were investigated for the presence of mediastinal lymph nodes, there were three (3.8%) false-negative results in the VAM group and fi ve (15.6%) in the VAMLA group. Sensitivity, accuracy, and negative predictive values for VAM and VAMLA were 0.90/0.97/0.96 and 0.64/0.87/0.84, respectively. Conclusion. VAMLA was found to be superior to VAM with regard to the number of stations and lymph nodes. Complications after VAMLA were common. The sensitivity and NPV of VAM for mediastinal staging are signifi cantly higher than those of VAMLA.