Contralateral pneumothorax after lung cancer surgery: report of two cases

Due to recent increases in numbers of patients who underwent surgical treatments for lung cancer, numbers of complications of contralateral pneumothorax after lung surgery are suggested to increase. Moreover, recent spread of surgical indication to elderly people and patients with severely damaged pulmonary function may lead postoperative complication of contralateral pneumothorax more lethal. We herein describe 2 cases of contralateral pneumothorax following lung cancer surgery with a review of recent literatures. Case 1 underwent left lower lobectomy with combined partial resection of the chest wall for lung cancer. Five months later, he suffered from contralateral pneumothorax and respiratory failure. Immediate chest drainage followed by bullectomy and pleurodesis were performed. Case 2 was surgically treated for left lung cancer. Preoperative computed tomography incidentally demonstrated contralateral pneumothorax. Chest drainage was started immediately, followed by left lower lobectomy. Contralateral bullectomy and pleurodesis were performed 6 days after lobectomy. Both patients have been well without recurrence of pneumothorax or lung cancer.     

X线与CT诊断新生儿气胸临床研究

目的：研究诊断新生儿气胸时X线及CT检查方法的临床应用价值。方法：选择嘉兴市妇幼保健院2009年8月-2012年8月间120例出现气胸的新生儿患者,所有患儿均拍摄了胸部前后仰卧位X线片,116例患儿随后又进行多次胸片随访,其中20例患者还进行了胸部CT扫描。结果：进行X线检查得出41侧为少量气胸,22例需要外科引流术或者穿刺抽气;79例有多量气胸,其中71例需要进行外科处理。结论：新生儿气胸进行前后仰卧位X线胸片基本可以满足临床诊断的需要,但如果仅为一侧肺野透过度增强,膈面和心缘非常清晰锐利,则可诊断为多量气胸,对于该类患者,应用CT影像学检查可以增加诊断准确性。     

经腋下入路治疗气胸3O例

目的：探讨腋下入路治疗气胸的可行性。方法：选取本院气胸患者60例,腋下入路30例为治疗组,对照组为传统方法经锁骨中线方法30例,对比两组手术时间,术后肺复张情况,有无合并皮下气肿,疼痛评分,胸管有无脱出,合并血管、神经损伤情况。结果：两组均无脱管发生,皮下气肿发生率均较低,且均为少量皮下气肿,差异无统计学意义（P〉0．05）。治疗组较对照组疼痛减轻,手术时间缩短,治疗组29例安全出院,1例死亡;对照组全部安全出院。无血管损伤、上肢麻木,与对照组比较经腋下入路更易于术后护理。结论：经腋下人路行胸腔闭式引流安全、可靠,手术时间更为缩短,疼痛不加重,易于护理,值得推广。     

CT引导下经皮肺穿刺活检并发症的影响因素分析

目的探讨CT引导下经皮肺穿刺活检并发症的预防和处理,并分析其影响因素。方法分析南方医科大学珠江医院346例CT引导下经皮肺穿刺活检患者并发症种类、影响因素及其处理措施。结果除6例需行二次穿刺外,其余患者均一次穿刺成功。并发症主要为气胸（45例）及肺出血（31例）,气胸主要与病灶部位及穿刺针行径有关,肺出血主要与病灶部位及大小相关。少量气胸或出血无需特殊处理,大量气胸或出血较多时需及时行胸膜腔穿刺术,必要时留置胸膜腔闭式引流管。结论 CT引导下经皮肺穿刺是一种安全、有效的诊断方法,具有协助明确诊断及指导进一步治疗的价值。     

Spontaneous pneumothorax: review of 130 cases

Spontaneous pneumothorax is a frequent affliction. The primary type principally affects males in the third decade of life, while the secondary type affects elderly patients with lung disease. When reviewing the cases of pneumothorax registered by the Thoracic Surgery Unit of the Hospital of Navarra, we found an incidence similar to other countries in our geographic area, and a biphasic distribution of the disease with the incidence peaks in youth and old age that we have mentioned. The disease is more frequent in males, smokers, and during the winter months. An account is given of the physiological mechanisms responsible for the formation of bullas in puberty. The first step in treatment is pleural drainage, the aim of which is to achieve pulmonary re-expansion and the re-establishment of the integrity of the visceral pleura. Although there are controversies regarding the definitive treatment, we carry out surgical resection of the pulmonary bullas in cases of relapse or when the CAT indicates a high risk of relapse, or resection of the pulmonary vertex following a second episode in spite of the non-existence of lesions in the CAT. We do not carry out pleurodesis, except in elderly patients who are not susceptible to surgery. Our results are similar to those obtained by other groups with respect to relapses, low morbidity and nil mortality in primary spontaneous pneumothorax.     

Delayed pneumothorax after subclavian vein catheterization

One hundred fourteen patients having 121 subclavian venipunctures were studied retrospectively. Eight pneumothoraces occurred (6.6%) and were most frequent after the insertion of large catheters, or when the subclavian area was distorted by previous venipuncture or radiation. Delayed pneumothorax occurred in five patients. This unusual diagnosis was made radiographically 8 to 96 hr postoperatively in response to the appearance of new pulmonary symptoms. Delayed pneumothorax required treatment with tube thoracostomy more frequently than immediate pneumothorax. This study establishes the approximate incidence of delayed pneumothorax for the first time. The relative frequency of this complication may challenge the cost effectiveness of pneumothorax diagnosis by chest films done within 1 or 2 hr of subclavian venipuncture. An alternative diagnostic protocol is considered.     

Catamenial pneumothorax: a case report and review of the literature

A 39-year-old woman presented with the chief complaint of right-sided chest pressure and shortness of breath with dry cough for 3 days. These symptoms coincided with the onset of her menstrual cycle. Her physical examination was significant for decreased breath sounds at the right lung base. Her chest x-ray showed a moderate sized right pneumothorax extending from the apex to the lung base and a small amount of pleural fluid, findings that were verified by chest CT. The patient was seen by consultants from the pulmonary, obstetrics/gynecology, and thoracic surgery services, who agreed that the clinical diagnosis was catamenial pneumothorax, probably associated with thoracic endometriosis. The patient was discharged on levonorgestrel/ethinyl estradiol tablets, which she opted not to take. Three months later, she had similar symptoms that occurred again at the time of menstruation. Her chest x-ray now showed a 10% right-sided pneumothorax. Catamenial pneumothorax is a rare condition affecting women in their reproductive years. Women with this condition most commonly have right-sided pneumothorax. The proper diagnosis is based on being aware of the existence of this relatively rare condition and relating the symptoms of pneumothorax temporally to the menses.     

Secondary spontaneous pneumothorax in rapidly progressive forms of silicosis: characterization of pulmonary function measurements and clinical patterns

BACKGROUND: A secondary spontaneous pneumothorax is a complication of an underlying pulmonary disease. In recent years, there have been only a few scattered reports of patients with silicosis also having a pneumothorax. Silicosis, a form of disabling pulmonary fibrosis, is a well-known occupational disease resulting from high-level exposure to silica or silica-containing dusts. The objective of the present study was to elucidate any associations between the occurrence of a pneumothorax, and pulmonary function tests and clinical observations performed prior to the pneumothorax; these two factors may be predictors for a pneumothorax among workers exposed primarily to silica-containing respirable dust. METHODS: A diagnosis of silicosis was made on several factors: silica dust exposure, appropriate interval of time after exposure, clinical findings, pulmonary function tests and chest radiological findings. A checklist was designed for collecting data of occupational history, respiratory signs, and symptoms from onset of dust exposure to the occurrence of a pneumothorax. Spirometery was conducted in accordance to the recommendations of standard protocols and guidelines posited by the American Thoracic Society. Autopsies were performed in three cases where the patient had suffered a pneumothorax due to silicosis. Mann-Whitney U-tests and Fisher's exact tests were used to determine any associations between pneumothorax and predictor factors. RESULTS: An association between a progressive decrease in pulmonary function test values and a pneumothorax was observed. The occurrence of a pneumothorax was associated with complaints of pleuretic chest pain, resting dyspnea, respiratory distress, paroxysmal nocturnal dyspnea, orthopnea and crackle. CONCLUSION: A characteristic decline in pulmonary function test values and the severity of respiratory impairment may facilitate the occurrence of a pneumothorax in silicosis.     

锁骨下静脉穿刺管胸腔穿刺留置治疗自发性张力性气胸疗效及可行性分析

目的分析锁骨下静脉穿刺管胸腔穿刺留置治疗自发性张力性气胸的疗效和可行性。方法本组68例患者设为治疗组,采用胸腔切开置硅胶管持续闭式引流治疗为主的68例类似患者作为对照组,观察两组疗效和分析不足。结果两组治疗后症状缓解、患侧肺复张、拔管时间比较差异无统计学意义（P〉0．05）;两组出现的不良反应、并发症例数、总疗程比较差异有统计学意义（P〈0．05）。结论临床中治疗自发性张力性气胸,可把锁骨下静脉穿刺针行胸腔穿刺并留置穿刺管行胸腔持续闭式引流作为首选的治疗方法,值得在临床中推广应用。     

The treatment of severe falciparum malaria.

In severe falciparum malaria there is a pathophysiological cascade beginning with changes in the parasitized red blood cells which induce intermediate effects, in turn contributing to dysfunction of several organs. A low serum albumin is a common but often unrecognized finding which may contribute to oedema especially in the lung and brain. The only irreversible complication in falciparum malaria is the acute respiratory distress syndrome, manifested by cyanosis and rapid breathing, basically distinct from acute pulmonary oedema caused by therapeutic overhydration. The pathophysiology of falciparum malaria may be complex but the treatment is simple. Drugs, other than antimalarials, are rarely needed. Guidelines for cholorquine or quinine dosage in severe disease are proposed; each drug is given at a dose of 5 to 10 mg/kg in 10 ml/kg of fluid as an intravenous infusion in four hours at a frequency of dosing every 12 to 24 hours. When the disease has been brought under control the treatment should be changed from the intravenous to the oral route.     

可控制小儿导尿管负压引流联合吸氧治疗慢性阻塞性肺疾病并发气胸疗效

目的 探讨可控制小儿导尿管负压引流联合吸氧对治疗慢性阻塞性肺疾病(COPD)并发气胸的疗效.方法 将60例慢性阻塞性肺疾病自发性气胸患者随机分为负压引流组(A组)和闭式引流组(B组);分别用可控制小儿导尿管负压引流联合吸氧进行治疗,与利用传统的胸腔闭式引流术治疗进行对比观察,比较两组患儿的平均肺复张时间、总有效率、并发症发生率(感染、皮下气肿及肺水肿等)及复发率等指标.结果 肺的平均复张时间A组为(6.12±1.25)d,B组为(10.23±2.35)d,差异有统计学意义(P＜0.05);A组总有效率为96.67％,明显高于B组的70.00％(P＜0.05),并且A组的并发症发生率及复发率明显低于B组.结论 利用可控制小儿导尿管负压引流联合吸氧对治疗慢性阻塞性肺疾病合并气胸创伤小、有效率高、并发症发生率低,疗效好,值得临床推广使用.     

Delayed (tension) pneumothorax after placement of a central venous catheter]

Laborious attempts at introducing a central venous catheter for parenteral nutrition in two women, aged 36 and 62 years, were followed by shortness of breath after 32 and 10 hours, respectively. This symptom was due to a (tension) pneumothorax not visible on earlier roentgenograms. Thoracic drainage led to recovery. In all patients with a central venous catheter an undetected delayed pneumothorax can be present. Urgent chest X-ray examination should be performed in all patients with acute respiratory symptoms. Patients undergoing elective intubation with positive pressure breathing should be examined carefully, since they are at risk of developing a late (tension) pneumothorax.     

Reexpansion pulmonary edema a vacuo: a case report and literature review

Reexpansion pulmonary edema is a rare and potentially lethal complication with a 15 to 20% mortality. We report one case of pulmonary edema after evacuation of spontaneous right pneumothorax The pathophysiology of reexpansion pulmonary edema remains obscure; mechanical and inflammatory processes (production of Inerleukin 8--and Leukotrienne B4) seem incriminated. Duration and seventy of lung collapse and the rate of reexpansion appear to be the main causes justifying preventive measures. Curative treatment is based on oxygenation and lower aspiration pressure.     

Bilateral pneumothorax in a young woman after acupuncture

A 30-year-old woman presented at the emergency department with severe bilateral chest pain and shortness of breath. The complaints began after acupuncture treatment along the spine and paraspinal region of the thorax the previous day. Further examination revealed bilateral pneumothorax. Two days after insertion of chest drains, the patient was able to leave the hospital in a good condition. Bilateral pneumothorax after acupuncture of the thorax is a rare complication and its precise incidence is unknown. Acupuncturists as well as general practitioners and emergency room physicians should be aware that acupuncture of the thorax can lead to unilateral as well as bilateral pneumothorax.     

急性胸部创伤的X线诊断分析

目的观察分析急性胸部创伤患者的X线诊断的效果。方法把2018年3月-2019年3月我院收治的100例急性胸部创伤的患者作为研究对象,均采用X线、CT两种诊断方法,分析急性胸部创伤患者肋骨骨折、肺挫伤、血胸、气胸诊断的符合率。结果X线对肋骨骨折、肺挫伤、血胸、气胸诊断的符合率(94.44%、93.33%、93.33%、94.74%)比CT(83.33%、80.00%、73.33%、78.95%)高,其差异小无统计学意义(P> 0.05)。结论采用X线对急性胸部创伤患者的诊断效果更好,与CT诊断相比较,具有更显著的诊断效果。     

新生儿胎粪吸入综合征的临床X线分析(附81例报告)

目的:分析新生儿胎粪吸入综合征(简称MAS)的临床X线特征,进一步提高X线诊断水平。方法:回顾经X线平片和临床证实的8 l例胎粪吸入综合征并进行讨论。结果:X线征象因吸入量和胎粪羊水相对含量多少而异。其中65例X线表现程度相对较轻,表现为两肺纹理增强,轻度肺气肿征,部分可见小颗粒状影;16例较重显示两肺满布结节状和斑片状模糊影;5例并发气漏;合并肺内感染10例;合并ARDS 2例;死亡4例;2例放弃治疗。结论:胸部X线平片对MAS的诊断及其疗效评价具有重要价值。     

A patient with pulmonary edema following use of beta-sympathomimetics (tocolytic agents)

During her pregnancy (29 weeks) a 29-year-old woman complained of pain in the right upper quadrant of her abdomen. Gallbladder stones were demonstrated by ultrasonography. Because of recurrent pain attacks cholecystectomy was performed. Continuous intravenous tocolytic therapy, fenoterol bromide (Parusisten), was given during and following surgery. Two days after this first laparotomy she underwent a second laparotomy because of unexplained abdominal pain and blood loss. A subhepatic haematoma was found without a specific origin for the blood loss. Shortly after this second operation she developed clinical signs and abnormalities on the chest X-ray compatible with severe pulmonary oedema. She needed artificial ventilation for 15 days. There appears to be a pathophysiological relationship between the development of pulmonary oedema and tocolytic therapy. Probably, pulmonary oedema may develop during tocolytic therapy as a result of several factors such as increased hydrostatic pressure, decreased oncotic pressure and perhaps capillary leakage.     

Value of the 'non-diagnostic' lung scan--further classification as to the risk of pulmonary embolism not reliable

OBJECTIVE: To determine to what extent the 'non-diagnostic' lung scans made because of a clinical suspicion of pulmonary embolism enable further determination of the risk of pulmonary embolism. DESIGN: Retrospective. METHOD: All non-diagnostic lung perfusion ventilation scans made in the Academic Medical Centre of Amsterdam in 1997 of 114 patients in succession (55 males and 59 females aged 27-85 years) were subjected to blind and independent re-evaluation by three observers (an experienced nuclear medicine expert, an experienced and an inexperienced intern) who, using a lung segment chart, estimated the risk of embolism as < 25%, 25-50%, 50-75% and > 75%. They did this first without and then with the chest X-ray. The findings were grouped on the basis of accordance or non-accordance with the pulmonary angiogram. The interobserver agreement was calculated by means of kappa statistics. RESULTS: Of 58 patients the lung scan could be compared with a chest X-ray and a pulmonary angiogram. In 43 patients with a normal angiogram the observers in an average of 50% of the scans estimated the risk of pulmonary embolism as < 25%, as against 25-50% in 27%, 50-75% in 9% and > 75% in 5%. In 15 patients with a deviant pulmonary angiogram, these figures were 22%, 38%, 20%, and 12%, respectively. The interobserver kappa for evaluation without chest X-ray was < or = 0.16, as against < or = 0.41% with the chest X-ray. CONCLUSIONS: A reliable classification of the risk of pulmonary embolism was not possible on the basis of non-diagnostic lung scans, regardless of whether the patient did or did not have pulmonary embolism. The interobserver variability was less when the lung scan was evaluated together with the chest X-ray, but even so it was unacceptably high.     

彩超定位经皮肺穿对肺部肿瘤的诊断价值（附8例报告）

目的探讨彩超引导下经皮肺穿活检术对肺癌的诊断价值。方法8例肺部肿物与胸壁粘连且高度怀疑肺癌的患者,在彩超引导下经皮肺部肿瘤穿刺。结果8例肺部肿块在彩超引导下经皮肺穿活检明确组织学类型。仅有一例患者出现轻微气胸,未作处理。结论彩超定位经皮肺穿具有定位准确、安全有效、成功率高、并发症少经济便捷等特点,对肺癌的病理学诊断增加一种检诊方法。     

MSCT引导下行肺穿刺活检对肺部肿块的诊断有效性及安全性评价

目的：探讨MSCT引导下行肺穿刺活检对肺部肿块的有效性及安全性,为临床提供参考。方法：选取2013年4月-2014年4月本院住院的150例MSCT引导经肺穿刺活检患者,在手术之前进行常规CT胸部扫描后,进行MSCT引导下进行肺穿刺活检,观察其结果。结果：150例患者均穿刺成功。其中,经手术、病理检查后为恶性肿瘤的有104例,46例患者为良性病变。在恶性肿瘤及良性肿瘤患者中,敏感性或者特异性分别为92.3%、89.1%。病灶直径〈3 cm、3~5 cm、〉5 cm的敏感性分别为79.2%（19/24）、95.8%（46/48）、93.3%（28/30）,将3~5 cm与〈3 cm的敏感性对比分析后,差异有统计学意义（x^2=9.142,P〈0.05）;其他直径之间及距胸膜距离之间对比分析后,差异无统计学意义（P〉0.05）。在150例患者中,进行传统CT检查、MSCT检查出现并发症的患者有30例、10例,发生率分别为20.0%、6.7%,对比分析后,差异有统计学意义（x^2=10.382,P〈0.05）。所有气胸患者经过吸氧、卧床休息后,对胸片进行检查后,气胸能够完全吸收,咳血患者经过保守治疗后病情痊愈。结论：MSCT引导经肺穿刺活检手术是一种较为安全、准确的方式,对肺部肿块的诊断具有重要的临床意义,值得大力推广。