Angiosarcoma with pulmonary metastasis presenting with spontaneous bilateral pneumothorax in an elderly man.

Cutaneous angiosarcoma is a rare and invasive endothelial-derived sarcoma that occurs most frequently in the scalp and facial skin of elderly men. It is frequently accompanied by thin-walled cavitary pulmonary metastasis, and is often obscure on chest radiograph. We report a case of angiosarcoma of the scalp with cystic metastasis to the lung in a 63-year-old man, presenting as recurrent bilateral spontaneous pneumothorax. Lung metastasis was missed at the first episode of pneumothorax because the lung-expanded chest radiograph showed no significant abnormality. Two months later, bilateral pneumothorax recurred, and high-resolution computed tomography revealed multiple cystic, cavitary and nodular lesions. Pulmonary metastasis was confirmed by video-assisted thoracoscopic surgery, and pleurodesis was performed. After the operation, the patient received chemotherapy; no recurrence of pneumothorax was found during 6 months of follow-up. Pneumothorax in the elderly should be differentiated from malignant metastatic lung tumors.     

Pneumothorax during menstruation: a case report

Endometriosis is a condition where endometrial glands lie outside the uterine cavity. The underlying pathophysiological mechanism remain unclear. Pelvic localizations are common but thoracic are possible. Catamenial pneumothorax is a clinical variant of spontaneous pneumothorax. The 39 years old women with catamenial pneumothorax is reported. Patient suffered from endometriosis. Diagnosis was established on clinical grounds. After laparoscopy the danazol treatment was started.     

Poland's syndrome with spontaneous pneumothorax: report of two cases.

Poland's syndrome is an uncommon congenital anomaly of the chest wall characterized by the absence of the pectoralis major muscle and other nearby musculoskeletal components. Many associated aberrations over the thoracic cage, intrathoracic organs, and upper limbs have been reported. However, spontaneous pneumothorax in these patients has not been reported. Here, we describe two patients with both Poland's anomaly and spontaneous pneumothorax. One patient was a 16-year-old boy with left chest wall hypoplasia and pneumothorax on the right side. The other was a 27-year-old man with right chest wall hypoplasia, hand brachydactyly, and pneumothorax. Pneumothorax in both patients was treated with bullectomy and mechanical pleurodesis with the aid of videothoracoscopy, and the postoperative courses were smooth. Blood supply disruption has been hypothesized as a pathogenic mechanism of both spontaneous pneumothorax and Poland's syndrome, suggesting an association between these two diseases.     

Neumotórax complicado en una gestante a término: tratamiento mediante cesárea y videotoracoscopia simultáneas

Spontaneous pneumothorax rarely occurs during pregnancy. The most common cause is almost always related to the presence of apical blebs or bullae. The most frequent symptoms are chest pain and dyspnea and chest radiography usually confirms the diagnosis. The treatment of choice is insertion of a chest drain and surgery should be considered in recurrent pneumothorax or persistent air leaks. The most controversial issues in spontaneous pneumothorax during pregnancy are the timing of surgery and delivery route. We describe the case of a pregnant patient in the third trimester with spontaneous pneumothorax and persistent air leaks who was successfully treated with combined elective cesarean section and videothoracoscopy in the same intervention. We believe that combined fetal extraction and videothoracoscopy in the same intervention could be a valid alternative for the definitive treatment of complicated spontaneous pneumothorax in full term pregnancies in order to avoid risks to the mother and fetus.     

A 'no-fault' cerebral palsy pension scheme would benefit all Australians

The Australian Federal Productivity Commission is proposing two new schemes to better support those with major disability. The main National Disability Insurance Scheme (NDIS) will provide long-term care and support for the disabled. A smaller scheme, the National Injury Insurance Scheme (NIIS), will provide 'no-fault 'support for those following an accident or 'medical injury'. It is proposed that cerebral palsy (CP) is part of the NIIS. While this brings quicker and more equitable benefits to CP families, the scheme labels CP as a 'medical accident' and infers preventability. Obstetricians will fund much of the system. Despite being labelled a 'no-fault' system, maternity staff can still be litigated for extensive 'head of damages', eg loss of earning capacity. An additional option is for federal/state legislation to introduce a true 'no-fault' lifetime pension specifically for all children on CP registers. This pension would be graded by degree of disability and dependent on waiving civil litigation. Savings in medico-legal costs and potentially a 7% reduction in caesarean delivery would cover the estimated annual cost of $50?000 per annum indexed life pension for severe CP cases and the total annual cost of AUD $93 million for Australia. This pension and the NDIS would help cover the needs of children with CP without recourse to prolonged litigation and without detriment to the maternity services of Australia, caused by defensive obstetrics and maternity hospital closure because of CP litigation.     

Pneumothorax complicating laparoscopic-assisted vaginal hysterectomy

Right pneumothorax occurred 2 days after laparoscopic-assisted vaginal hysterectomy. The mechanism was most likely CO2 diffusion from pneumoperitoneum through a diaphragmatic defect. It is essential to be aware of this rare complication because of its late onset after the surgical procedure.     

Establishing the diagnosis of cerebral palsy

Cerebral palsy (CP) is a diagnosis of considerable concern to obstetricians, but the diagnosis of CP can be challenging, and may need to be confirmed by an experienced practitioner, ideally a child neurologist or psychiatrist. It is important not to make the diagnosis too early in infancy, especially when the signs are not severe, as resolution of early neuromotor abnormalities does occur, particularly in premature infants. Exclusion of genetic/metabolic disorders presenting with CP-like findings is important. The degree of activity limitation should be characterized; labeling children as having CP on the basis of abnormal examination findings alone without evidence of activity limitation is not useful. Brain imaging can be helpful in pinpointing the location of the underlying brain abnormality and sometimes provides etiologically useful information.     

Gynecologic Evaluation of Catamenial Pneumothorax Associated with Endometriosis

Study ObjectiveTo assess the pathogenesis of catamenial pneumothorax associated with endometriosis from a gynecologic perspective.DesignRetrospective study (Canadian Task Force classification II–2).SettingUniversity hospital.PatientsEleven patients with clinically suspected catamenial pneumothorax due to frequently recurrent pneumothorax who underwent thoracoscopy between September 2003 and February 2007 at our hospital.InterventionVideo-assisted thoracoscopy.Measurements and Main ResultsEpisodes of pneumothorax, coexistence of intrapelvic endometriosis, classification of intrathoracic lesions according to the appearance of pelvic endometriosis using the revised American Society of Reproductive Medicine (re-ASRM) classification, and histopathologic findings in intrathoracic specimens were assessed. A total of 38 episodes of pneumothorax, all on the right side, were documented in 11 patients with catamenial pneumothorax. Median (range) patient age at the initial pneumothorax was 42 (29–47) years. The re-ASRM score in 6 patients in whom pelvic endometriosis was directly observed at laparoscopy and laparotomy was 56 (18–96). We postoperatively reviewed videotape recordings of video-assisted thoracoscopy, and observed superficial thoracic diaphragmatic lesions classified as red (n = 5), black (n = 8), and white (n = 9) with fenestration according to the re-ASRM classifications for pelvic endometriosis. Tissue associated with endometriosis was detected at histopathologic analysis of resected diaphragmatic lesions in 9 patients. No endometriosis was identified at histopathologic analysis of visceral pleural lesions in 7 patients who underwent lung resection.ConclusionsGynecologic evaluation of catamenial pneumothorax associated with endometriosis is crucial to clarify the unelucidated pathogenesis of the disease.     

Relationship between Catamenial Pneumothorax or Non-catamenial Pneumothorax and Endometriosis

Study Objective

To evaluate the clinical characteristics of women presenting with catamenial pneumothorax and compare them with those with noncatamenial pneumothorax.

Delayed pneumothorax after laparoscopic ovarian cystectomy

Background  We describe a case that developed a delayed pneumothorax after laparoscopic surgery. Case  A 40-year-old woman (BMI: 19.1) underwent a laparoscopic ovarian cystectomy. On the first postoperative day, she developed a pneumothorax. The subcutaneous CO₂ tracked up through the fascial planes, and ruptured into the pleural space, where delayed pneumothorax developed. Conclusion  Gynecologists should be aware of pneumothorax after laparoscopic surgery and should also keep in mind its possible delayed development.     

Spontaneous pneumothorax after steroid treatment in a patient with bronchiolitis obliterans organizing pneumonia.

Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon pulmonary disorder which is a clinicopathologic syndrome. The typical symptoms include cough, fever and dyspnea. Corticosteroid therapy is effective. Death from progressive disease is infrequent. We report a case of BOOP in a 41-year-old male non-smoker, proved by pathologic findings. After steroid therapy (prednisolone 30 mg daily) for 10 days, he developed spontaneous pneumothorax of bilateral lung fields. Responses to steroid and chest tube thoracostomy were excellent. BOOP may be complicated with spontaneous pneumothorax which may adversely affect prognosis. BOOP should be included in the differential diagnosis of patients presenting with secondary spontaneous pneumothorax.     

Spontaneous pneumothorax during pregnancy--a case report

Authors present a case of spontaneous pneumothorax, which developed twice during the pregnancy of a lady, who delivered at term by a Cesarian section. Spontaneous pneumothorax is an extremely rare complication in pregnancy. The etiology of this condition is variable and previous broncho-pulmonary pathology is often found. Spontaneous pneumothorax may occur in any time during the pregnancy period. Early detection and prompt diagnosis of this condition are important for the prevention of some severe complications. The diagnostic and therapeutic methods used in pregnancy do not differ essentially to those used in non-pregnant patients. Delivery in such women can be performed per viasnaturales, with effortless bearing period, as well as per a Cesarian section, according to the severity and current condition of this complication.     

Neumotórax espontáneo durante la gestación

Spontaneous acute pneumothorax during pregnancy is extremely rare. A diagnosis of pneumothorax should be excluded in any pregnant women experiencing chest pain and dyspnea and must be confirmed radiographically. Treatment is the same as in non-pregnant women. Prognosis is generally good for both the mother and the fetus. We describe two cases of spontaneous pneumothorax during pregnancy with favorable maternal and perinatal outcomes.     

The activity of cancer procoagulant in cases of uterine leiomyomas

PURPOSE: It is currently believed that cancer procoagulant (CP), an enzymatic protein, is a product of malignant neoplastic cells. The present study was designed to test whether it is also synthesized by benign neoplastic cells, namely uterine leiomyomas. MATERIALS AND METHODS: We determined the activity of CP in the blood serum of women with uterine leiomyomas (N = 24), normal women (N = 15), and genital cancer patients (N = 6) by the coagulative method according to Gordon and Benson. Also, the CP activity in 10% tissue homogenates of uterine leiomyomas, normal uterine muscle and tissues of cervical and endometrial carcinoma was determined by the chromogenic method according to Colucci et al. RESULTS: The mean CP activity in the sera of women with uterine leiomyomas was 181.1 seconds (s) +/- 19.9 s, in healthy women--293.2 s +/- 33.8 s, and in genital cancer patients--78.8 +/- 18.5 s (all differences: p < 0.001). Similarly, in homogenates of uterine leiomyomas the CP activity was 19.6 +/- 3.8 nmoles pNa/ml, in normal uterine muscle it was 13.2 +/- 2.2 nmoles pNa/ml, and in cancerous tissue--28.0 +/- 6.6 nmol pNa/ml (all values being significantly different from each other). There was a strong correlation (r = -0.8122; p < 0.001) between the CP activity in uterine leiomyomas and serum activity, suggesting that the source of the serum CP activity was from the leiomyoma. The coagulation time of 120 to 240 s by the Gordon and Benson method supported the diagnosis of uterine leiomyoma, and a value below 120 s--the suspicion of genital cancer. CONCLUSIONS: Uterine leiomyomas, representing benign genital neoplasia, synthesize CP and are the likely origin of CP activity in blood, as has been described for malignant tumors, but to a lesser degree. There may be a role for CP as a tumor marker of genital neoplasia.     

Pneumothorax in pregnancy

Since 1957, only 15 cases of isolated spontaneous pneumothorax in pregnancy have to our knowledge been reported in the English literature. The treatment of pneumothorax in pregnancy is more difficult than in non-pregnant patients. A case is reported and therapy discussed.     

Prognostic indicators of survival in infants with congenital diaphragmatic hernia.

PURPOSE: This study sought to identify the factors predictive of the short-term outcome in infants with congenital diaphragmatic hernia (CDH). METHODS: We retrospectively reviewed medical records from September 1985 to December 1998 for all infants born with CDH and managed at National Taiwan University Hospital (NTUH). Coexisting pathology and measures of respiratory function were analyzed to determine the prognostic factors. RESULTS: A total of 32 infants with CDH were managed at NTUH over the past 13 years. The investigated factors associated with poor prognosis in CDH included congenital heart disease, chromosomal abnormality, pneumothorax, and preoperative parameters including arterial partial carbon dioxide pressure greater than 40 mmHg, arterial partial oxygen pressure less than 100 mmHg, alveolo-arterial partial oxygen pressure greater than 610 mmHg, and oxygen index (OI) greater than 0.4. Multiple logistic regression analyses indicated that only an OI greater than 0.4 and pneumothorax were significant indicators of poor prognosis. When the incidence of pneumothorax was compared between patients who received ventilation using a conventional mechanical ventilator or high-frequency oscillatory ventilator (HFOV), a trend toward a lower incidence of pneumothorax in those using HFOV for initial stabilization was found (p = 0.08). CONCLUSIONS: An OI greater than 0.4 before surgery and pneumothorax are poor prognostic indicators in infants with CDH. A high OI is reflective of the severity of pulmonary dysfunction in infants. Pneumothorax further compromises the dysfunction of a hypoplastic lung in infants with CDH. The results of this study show the importance of avoiding iatrogenic pneumothorax during management of infants with CDH.     

Difficult management of recurrent catamenial pneumothorax.

Catamenial pneumothorax is an uncommon disease whose management is not consensual. We report the case of a patient who experienced several episodes of pneumothorax. She was initially treated by repair of diaphragmatic defects and hormonal treatment. During the therapeutic amenorrhea, no recurrence occurred. However, each cessation of medical therapy was followed by recurrence. Finally, talc pleurodesis and tubal ligature were performed without any recurrence in the subsequent 12 months. This report outlines the great difficulties that can be encountered in the management of patients with catamenial pneumothorax.     

儿童缩窄性心包炎39例临床分析

目的探讨儿童缩窄性心包炎(CP)临床特点及诊治方法。 方法对1980 01—2003 12在重庆医科大学附属儿童医院住院，并经手术确诊的39例CP患儿的临床资料进行回顾性分析。 结果主要症状为乏力36例(92.3%)、水肿35例(89.7%)、气促32例(82.0%)，主要体征为肝脏肿大35例(89.7%)、颈静脉怒张31例(79.5%)、心音低钝或遥远31例(79.5%)。X线检查阳性率61.5%(24/39)，超声心动图检查阳性率76.3%(29/38)。病因确诊为肺吸虫7例、结核5例、化脓性3例，24例病因不清。 结论CP临床表现及血流动力学变化与限制性心肌病类似，其鉴别诊断比较困难，目前超声心动图在CP的诊断中仍被认为是最有价值的检查方法。一旦确诊，早期行心包切除术。     

胸腔子宫内膜异位综合征的诊治进展

子宫内膜异位症是育龄期女性常见的慢性疾病,其中胸腔子宫内膜异位综合征是较为罕见的一种类型。该病是子宫内膜组织异位到胸腔,从而引发多种与月经相关的胸腔受累的临床表现,包括气胸、血胸、咯血、肺结节和胸痛等,其中月经性气胸是最常见的。胸腔子宫内膜异位综合征的发病机制尚未完全明确,目前有多种假说解释子宫内膜组织是如何异位到胸腔以及月经性气胸的发病机制,但尚无一种假说可以单独解释胸腔子宫内膜异位综合征所有的临床表现。检查方法主要有影像学检查、组织学检查及其他检查等,其中影像学检查包括胸部X线、CT和磁共振成像（MRI）。治疗方式主要有药物治疗和手术治疗。药物治疗是一线治疗,其中,促性腺激素释放激素激动剂是一线用药。而对于药物治疗后仍复发或难以忍受药物治疗带来的不良反应的患者,应考虑手术治疗以根治疾病,并在术后辅以药物治疗。     

Catamenial pneumothorax. Case report and review of the literature]

Catamenial pneumothorax is a clinical variant of spontaneous pneumothorax. Its etiology is attributed either, generally, to endometriosis involving the diaphragm, or to prostaglandin-induced bronchiolar constriction. Clinically, it coincides with the onset of menstruation and resolves during the subsequent days. Treatment is currently based upon progestational agents and antigonadotrophins.