Spontaneous Pneumothorax in Emphysema.

Dines, David E.

doi:10.7326/0003-4819-72-5-809_4

Cited by 28 publications

(30 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It often requires immediate treatment. It is accompanied by ipsilateral chest pain, hypoxaemia or hypotension, or even hypercapnia [28]. Pneumothorax should always be excluded in the case of decompensated COPD or cystic fibrosis [29].…”

mentioning

confidence: 99%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

Eur Respir J

192

141

View full text Add to dashboard Cite

Spontaneous pneumothorax remains a significant health problem. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment.Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of spontaneous pneumothorax, and that blebs and bullae are not always the cause of pneumothorax. In first episodes of primary spontaneous pneumothorax, observation and simple aspiration are established first-line therapies, as proven by randomised controlled trials. Aspiration should be better promoted in daily medical practice. In the case of recurrent or persistent pneumothorax, simple talc poudrage under thoracoscopy has been shown to be safe, cost-effective and no more painful than a conservative treatment using a chest tube. There are also new experimental data showing that talc poudrage, as used in Europe, does not lead to serious side-effects and is currently the best available pleural sclerosing agent.Alternatively, surgical techniques have considerably improved, and are now less invasive, especially due to the development of video-assisted thoracoscopic surgery. Studies suggest that video-assisted thoracoscopic surgery may be more cost-effective than chest tube drainage in spontaneous pneumothorax requiring chest tube drainage, although it is more expensive than simple thoracoscopy and requires general anaesthesia, double-lumen tube intubation and ventilation.Recommendations are made regarding the treatment of pneumothorax. In secondary or complicated primary pneumothorax, i.e. recurrent or persistent pneumothorax, some diffuse treatment of the visceral pleura should be offered, either by talc poudrage under thoracoscopy or by video-assisted thoracoscopic surgery. Moreover, all of these new techniques should be better standardised to permit comparison in randomised controlled studies.

show abstract

mentioning

confidence: 99%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

Eur Respir J

192

141

View full text Add to dashboard Cite

show abstract

“…It is known that patients with idiopathic SP have a likelihood of developing a recur rence of up to 50% when treated conserva tively [1]. The recurrence rate of sympto matic SP is probably similar to that of idio pathic SP [2,3]. With every subsequent recurrence, the incidence of complications such as the development of vascularized adhesions causing a hemopneumothorax by tearing, increases.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic Pleurodesis in the Management of Spontaneous Pneumothorax

Verschoof¹,

Velde²,

Greve³

et al. 1988

Respiration

View full text Add to dashboard Cite

To assess the contribution of thoracoscopy in the management of spontaneous pneumothorax (SP) 101 consecutive cases treated in our department were reviewed. The patients were divided into two groups: group 1 was treated conservatively; in group 2 thoracoscopy was performed and in case of an idiopathic SP, pleurodesis was carried out with iodinated talcum. Group 1 consisted of 51 patients of whom 28 were considered to have a symptomatic SP (1A) and 23 an idiopathic SP (1B). The recurrence rate was 46 and 26%, respectively. Group 2 consisted of 50 patients of whom 12 had a symptomatic SP (2A) and 38 an idiopathic SP (2B). In group 2A, thoracoscopy provided the indication for primary surgical intervention in 3 patients. Patients in group 2B were treated by chemical pleurodesis with iodinated talcum. In only 1 did a recurrence occur. Complications of thoracoscopy and/or pleurodesis were not observed. We conclude that thoracoscopy enables accurate assessment of the type of pneumothorax, and can play an important role in the management of SP. Chemical pleurodesis causes a significant reduction of the recurrence rate in the treatment of idiopathic SP.

show abstract

“…Das klinische Beschwerdebild hängt insbesondere auch von der pulmonalen Grunderkrankung ab. So tritt bei Patienten mit vorbestehendem Lungenemphysem vermehrt Dyspnoe auf [5]. Der Schmerz verstärkt sich meist bei tiefer Inspiration.…”

Section: Pneumothoraxunclassified